Lorenzo Tofani - Academia.edu (original) (raw)
Papers by Lorenzo Tofani
Journal of Vascular Access, Jul 26, 2019
Background:In a previous trial, in-line filtration significantly prevented postoperative phlebiti... more Background:In a previous trial, in-line filtration significantly prevented postoperative phlebitis associated with short peripheral venous cannulation. This study aims to describe the cost-effectiveness of in-line filtration in reducing phlebitis and examine patients’ perception of in-hospital vascular access management with and without in-line filtration.Methods:We analysed costs associated with in-line filtration: these data were prospectively recorded during the previous trial. Furthermore, we performed a follow-up for all the 268 patients enrolled in this trial. Among these, 213 patients responded and completed 6 months after hospital discharge questionnaires evaluating the perception of and satisfaction with the management of their vascular access.Results:In-line filtration group required 95.60€ more than the no-filtration group (a mean of € 0.71/patient). In terms of satisfaction with the perioperative management of their short peripheral venous cannulation, 110 (82%) and 103 (76.9%) patients, respectively, for in-line filtration and control group, completed this survey. Within in-line filtration group, 97.3% of patients were satisfied/strongly satisfied; if compared with previous experiences on short peripheral venous cannulation, 11% of them recognised in-line filtration as a relevant causative factor in determining their satisfaction. Among patients within the control group, 93.2% were satisfied/strongly satisfied, although up to 30% of them had experienced postoperative phlebitis. At the qualitative interview, they recognised no difference than previous experiences on short peripheral venous cannulation, and mentioned postoperative phlebitis as a common event that ‘normally occurs’ during a hospital stay.Conclusion:In-line filtration is cost-effective in preventing postoperative phlebitis, and it seems to contribute to increasing patient satisfaction and reducing short peripheral venous cannulation–related discomfort
Internal and Emergency Medicine, Jun 16, 2013
A prospective observational study was conducted to evaluate the impact of delirium on geriatric i... more A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). Enrolled patients were evaluated daily with CAM to detect incident delirium cases. Among the 560 included patients, 19 (3 %) had delirium on admission (prevalent) and 44 (8 %) developed delirium during hospitalization (incident). Prevalent delirium cases were excluded from the statistical analysis. Incident delirium was associated with increased length of hospital stay (p \ 0.01) and institutionalization (p \ 0.01, OR 3.026). Multivariate analysis found that cognitive impairment on admission (p \ 0.0002), diabetes (p \ 0.05, OR 1.936), chronic kidney failure (p \ 0.05, OR 2.078) and male gender (p \ 0.05, OR 2.178) was significantly associated with the development of delirium during hospitalization. Results show that delirium impact is relevant to older patients hospitalized in internal medicine wards. The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies.
Journal of Vascular Access, Mar 22, 2018
Background: During ultrasound-guided cannulation, venous filling is required for venipuncture. To... more Background: During ultrasound-guided cannulation, venous filling is required for venipuncture. Tourniquet with an elastic tube at the axilla is the most common method to induce venous stasis for cannulation of the deep veins of the arm. Although effective, this method might be associated with short-and long-term complications. Valsalva manoeuvre has been used to produce venous filling in other extrathoracic veins. The aim of this observational study is to demonstrate the effect of Valsalva manoeuvre in respect of the elastic tourniquet on venous distention during echography-guided cannulation of the deep veins of the arm. Method: Sixty-nine patients scheduled for cannulation of basilic or brachial vein were prospectively observed. Vein diameters were recorded at rest and after 10 s of Valsalva or tourniquet placement. Results: The mean difference between basilic vein diameters during tourniquet and Valsalva manoeuvre was 0.006 mm (95% confidence interval = −inf, 0.09) with a standard deviation of 0.5 mm (95% confidence interval = 0.5, 0.7; p > 0.01). The mean difference between brachial vein diameters during tourniquet and Valsalva manoeuvre was 0.04 mm (95% confidence interval = −0.23, 0.15) with a standard deviation of 0.8 mm (95% confidence interval = 0.7, 0.9; p > 0.01). Discussion: This increase in cross-sectional basilic and brachial vein diameters was not different to that obtained with the elastic tube tourniquet.
Journal of Chemotherapy, Mar 23, 2020
We describe caspofungin pharmacokinetics (PK) after the first and fourth doses in 20 critically i... more We describe caspofungin pharmacokinetics (PK) after the first and fourth doses in 20 critically ill septic patients. Monte Carlo simulation was used to analyze the probability of target attainment (PTA) (AUC/MIC > 865) for Candida spp. Caspofungin concentrations were analyzed by HPLC in plasma and urine. A great variability in PK parameters was observed after both doses. Patients were divided in two groups according to their AUC values (AUC 75 mg h/L cutoff). In the low-AUC group Cmax, Cmin and AUC were lower, while Vd and Cl were higher than in the high-AUC group (p < 0.05, both at day 1 and 4). The mean 24-h urinary recovery of the drug was 8 ± 6.3% (day1) and 9.8 ± 6.3 (day4). Monte Carlo simulation analysis (0.03-1 mg/L MIC-range) showed that PTA was guaranteed only for MICs 0.03 mg/L in the low-AUC group, and for MICs 0.06 mg/L in the high-AUC group. No group had a PTA ! 90% for 0.125 mg/L MIC (the epidemiological cutoff). Mortality was higher in low-AUC group (p < 0.01). In our 'real-world' population, no clinical data can predict which patient will have lower, suboptimal caspofungin exposure, therefore we suggest TDM to optimize caspofungin therapy and reduce the risk of selecting resistances (CEAVC,
Circulation: Genomic and Precision Medicine
BACKGROUND: The 2 sarcomere genes most commonly associated with hypertrophic cardiomyopathy (HCM)... more BACKGROUND: The 2 sarcomere genes most commonly associated with hypertrophic cardiomyopathy (HCM), MYBPC3 (myosin-binding protein C3) and MYH7 (β-myosin heavy chain), are indistinguishable at presentation, and genotype-phenotype correlations have been elusive. Based on molecular and pathophysiological differences, however, it is plausible to hypothesize a different behavior in myocardial performance, impacting lifetime changes in left ventricular (LV) function. METHODS: We reviewed the initial and final echocardiograms of 402 consecutive HCM patients with pathogenic or likely pathogenic MYBPC3 (n=251) or MYH7 (n=151) mutations, followed over 9±8 years. RESULTS: At presentation, MYBPC3 patients were less frequently obstructive (15% versus 26%; P =0.005) and had lower LV ejection fraction compared with MYH7 (66±8% versus 68±8%, respectively; P =0.03). Both HCM patients harboring MYBPC3 and MYH7 mutations exhibited a small but significant decline in LV systolic function during follow-u...
Biomedicines
Background: Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful.... more Background: Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful. However, early prediction of a long-term eGFR decline may be an even more important goal. Our aim was to identify and compare serum [creatinine, kineticGFR, cystatin C, neutrophil gelatinase–associated lipocalin (NGAL)] and urinary (NephroCheck, NGAL, proteinuria, albuminuria, acantocytes at urinary sediment) predictors of AKI that might efficiently predict long-term GFR decline after robotic Nephron-Spearing Surgery (rNSS). Methods: Monocentric prospective observational study. Patients scheduled for rNSS for suspected localized Renal Cell Carcinoma from May 2017 to October 2017 were enrolled. Samples were collected preoperatively and postoperatively (timepoints: 4 h, 10 h, 24 h, 48 h), while kidney function was re-assessed up to 24 months. Results: 38 patients were included; 16 (42%) developed clinical AKI. The eGFR decline at 24 months was more pronounced after postoperative AKI (−20....
Research Square (Research Square), Jan 26, 2023
BACKGROUND The severity of coagulation derangement correlates with poor prognosis in COVID-19 pat... more BACKGROUND The severity of coagulation derangement correlates with poor prognosis in COVID-19 patients. However, the clinical impact of coagulation alterations detected with rotational thromboelastometry (ROTEM) in intensive care unit (ICU) COVID-19 patients is not completely de ned. The study aimed to identify the correlation between ROTEM parameters and adverse ICU outcomes. The relationship between COVID-19 associated coagulopathy (CAC) and ROTEM alterations and possible risk factors for ICU mortality were also investigated. METHODS COVID-19 patients admitted to ICU between October 1, 2020 and May 31, 2021, were retrospectively enrolled. The sample was subsequently divided into subgroups (survivors vs. nonsurvivors, mechanical ventilation (MV) vs. non-invasive ventilation (NIV), venous thromboembolism (VTE) vs. NO-VTE, CAC vs. NO-CAC) among which ROTEM parameters and standard coagulation tests were compared. RESULTS One hundred ICU patients were enrolled. High D-dimer (DD) (5089 ± 1035 ng/ml) and brinogen levels (640 ± 112 mg/dl) and an increase in maximum clot rmness (MCF) were revealed. The nonsurvivors (n=50, 50%) had higher DD levels and lower platelet counts as well as lower clot lysis rates than survivors. EXTEM maximum lysis (ML) resulted lower in the MV subgroup than in NIV treated patients. Patients with thrombotic complications had higher DD levels than patients without VTE whereas ROTEM parameters were not different. Similarly no coagulation or ROTEM differences were identi ed in the subgroup of CAC patients (n=29, 29%). Reduced ML values in EXTEM and INTEM resulted as possible risk factors for ICU mortality. CONCLUSIONS In critically ill COVID-19 patients, hypo brinolysis and not hypercoagulability seems to be correlated with unfavourable ICU prognosis. Highlights Recently, in COVID-19 ICU patients, a severe prothrombotic pro le, persistent beyond intensive care unit (ICU) discharge, characterized by acceleration of clot formation time (CFT) and signi cant increase in maximum clot rmness (MCF) compared to severe non-SARS CoV-2 pneumonia patients has been detected. [7-8] Moreover, a higher incidence of brinolysis shutdown (maximum lysis (ML) in EXTEM < 3,5%) and VTE risk in COVID-19 patients than in non SARS-COV2 pneumonia patients has been observed [7-8-9]. Nevertheless, the clinical impact of ROTEM parameters at ICU admission in COVID-19 patients has yet to be fully clari ed. This study aimed to identify the correlation between ROTEM parameters at ICU admission and adverse outcomes in terms of mortality, respiratory failure requiring MV and thromboembolic complications. A correlation between CAC diagnosis and ROTEM prothrombotic alterations has also been explored. Furthermore, a survival analysis has investigated possible risk factors associated with ICU mortality, taking into account not only coagulation data but also ICU admission and hospitalization parameters. Methods
Journal of Reproductive Immunology, Feb 1, 2023
Indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO) metabolize tryptophan i... more Indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO) metabolize tryptophan in the kynurenine pathway. We evaluated these enzymes' mRNA expression in maternal and fetal sides of the placenta of uncomplicated, unlabored full-term pregnancies after elective cesarean section and compared it with that of placentas obtained from vaginal delivery. Tryptophan and kynurenine plasmatic levels after cesarean section were measured, to investigate their possible correlation with IDO1 and TDO mRNA (TDO2) expression. The results suggested that IDO1 and TDO2 expression was higher in the maternal side of the placenta and that labor significantly affects TDO2 expression and the plasma Kynurenine/Tryptophan ratio.
Molecular Cancer Therapeutics
Cholangiocarcinoma (CCA) is characterized by resistance to chemotherapy and a poor prognosis. The... more Cholangiocarcinoma (CCA) is characterized by resistance to chemotherapy and a poor prognosis. Therefore, treatments that can effectively suppress tumor growth are urgently needed. Aberrant activation of hedgehog (HH) signaling has been implicated in several cancers, including those of the hepatobiliary tract. However, the role of HH signaling in intrahepatic CCA (iCCA) has not been completely elucidated. In this study, we addressed the function of the main transducer Smoothened (SMO) and the transcription factors (TFs) GLI1 and GLI2 in iCCA. In addition, we evaluated the potential benefits of the combined inhibition of SMO and the DNA damage kinase WEE1. Transcriptomic analysis of 152 human iCCA samples showed increased expression of GLI1, GLI2, and Patched 1 (PTCH1) in tumor tissues compared with nontumor tissues. Genetic silencing of SMO, GLI1, and GLI2 inhibited the growth, survival, invasiveness, and self-renewal of iCCA cells. Pharmacologic inhibition of SMO reduced iCCA growth...
Pharmaceuticals
The role of Bronchoalveolar Lavage (BAL) in the evaluation of systemic sclerosis (SSc) interstiti... more The role of Bronchoalveolar Lavage (BAL) in the evaluation of systemic sclerosis (SSc) interstitial lung disease (ILD) is still controversial. The aim of this systematic literature review was to investigate the use of BAL in SSc-ILD, and to focus on the pros and cons of its real-life application. Methods: PubMed, Cochrane, and Embase were questioned from inception until 31 December 2021. Results: Eighteen papers were finally analyzed. A positive correlation was observed between lung function and BAL cytology; in particular, BAL neutrophilia/granulocytosis was related to lower diffusing capacity for carbon monoxide (DLCO) values and lower forced vital capacity (FVC). Moreover, a positive correlation between BAL cellularity and high-resolution computed tomography (HRCT) findings has been reported by several authors. Cytokines, chemokines, growth factors, coagulation factors, and eicosanoids have all been shown to be present, more often and in higher quantities in SSc-ILD patients than...
Transplant Infectious Disease
Annals of the Rheumatic Diseases, 2021
Background:In SSc, ILD is a major cause of morbidity and mortality. High resolution computed tomo... more Background:In SSc, ILD is a major cause of morbidity and mortality. High resolution computed tomography (HRCT) is the gold standard for the diagnosis. Predictors of ILD onset are eagerly awaited to improve SSc-ILD management. Pulmonary function test (PFTs) are routinely performed to measure lung function changes.Objectives:Our aim was to investigate the performance of DLCO (diffusing capacity of lung carbon monoxide) and FVC (forced vital capacity) in predicting the development of SSc-ILD.Methods:The longitudinal data of DLCO, FVC and ILD on HRCT of SSc patients from the EUSTAR database were evaluated at baseline (t0), after 12 (±4) (t1) and 24 (±4) (t2) months. Patients with negative HRCT for any sign of ILD both at t0 and t1 were included. Patients who presented or developed pulmonary hypertension during the study period were excluded. At baseline, demographic data, disease duration from Raynaud’s onset, disease subsets, autoantibodies and other laboratory and instrumental data we...
European Journal of Internal Medicine, 2022
BACKGROUND Gastrointestinal (GI) manifestations are frequent in systemic sclerosis (SSc) with an ... more BACKGROUND Gastrointestinal (GI) manifestations are frequent in systemic sclerosis (SSc) with an impact on quality of life and morbidity. Bowel vasculopathy is a key pathogenetic factor responsible for GI involvement. OBJECTIVES To compare abdominal ultrasound (US) and Color Doppler Ultrasonography (CDU) features of splanchnic vessels of SSc patients with healthy controls. METHODS The charts of SSc patients who underwent an abdominal US and CDU study were retrospectively analyzed. For Superior Mesenteric Artery (SMA) and Inferior Mesenteric Artery (IMA) caliber, Peak Systolic Velocity (PSV), Reverse Velocity (RV), End-Diastolic Velocity (EDV), Mean Velocity (mV), Blood-flow, Resistive Index (RI) and Pulsatility Index (PI) were recorded. RESULTS 28 SSc patients and 28 controls were enrolled. In SSc, caliber of SMA was significantly smaller than in controls (5.75 ± 0.62 mm vs. 6.45 ± 0.60 mm, p < 0.0001 - p adj =0.0002). The flow study of SMA and IMA showed a significant reduction of RV (SMA: 7.25 ± 6.37 cm/s vs. 18.52 ± 6.16 cm/s, p < 0.0001 - p adj <0.0001; IMA: 2.69 ± 6.10 cm/s vs. 17.06 ± 5.75 cm/s, p < 0.0001 - p adj <0.0001) and PI (SMA: 3.33 ± 0.75 vs. 4.53 ± 1.03, p < 0.0001 - p adj =0.0002; IMA: 3.54 ± 0.95 vs. 6.08 ± 1.53, p < 0.0001 - p adj <0.0001) in SSc patients than controls. CONCLUSION involvement of splanchnic vessels in SSc may be non-invasively investigated with abdominal US and CDU. Morphological and functional changes of Doppler parameters observed in SMA and IMA clearly demonstrate that these vessels are affected by SSc vasculopathy.
Dokazatel'naya gastroenterologiya, 2017
ДОКАЗАТЕЛЬНАЯ ГАСТРОЭНТЕРОЛОГИЯ, 3 , 2017 The 1st serrated lesion to be described was the traditi... more ДОКАЗАТЕЛЬНАЯ ГАСТРОЭНТЕРОЛОГИЯ, 3 , 2017 The 1st serrated lesion to be described was the traditional serrated adenoma, defined by Longacre and Fenoglio Preiser in 1990 as «polyp with the architectural but not the cytologic features of Hyperplastic Polyp (HP)» [1]. Six years later Torlakovic and Snover defined the «serrated adenoma» as a distinct type of polyp that differed from the closely resembling hyperplastic polyp [2]; the term «sessile serrated adenoma» was so introduced. From that time many efforts have been made to characterize these lesions from an pathological, molecular and endoscopic point of view. Serrated colon polyps area group of heterogeneous lesions histologically characterized by glandular serration (ie, a saw-tooth folding of colonic crypt epithelium). The World Health Organization classified them as: Hyperplastic Polyps (HPs), Sessile Serrated Adenoma/Polyp (SSAs), Traditional Serrated Adenomas (TSAs), Mixed Polyps (MPs) and according to literature data they are the 36% of all colonic polyps [3]. While TSAs and MPs have always been diagnosed as adenomatous polyps and like them treated and surveilled, HPs and SSAs were once all diagnosed as HPs (diagnostic overlap), the differential diagnosisis difficult also for the pathologist but of significant importance since they have completely different anatomopathological, molecular, endoscopic features and as a consequence of that different malignant potential and follow-up. Exception made for HPs, the other serrated lesions have a malignant potential and follow a different pathway of carcinogenesis to the traditional «adenoma-carcinoma sequence». TSAs are more frequently KRAS mutated, but they can also be BRAF mutated [4, 5]; they follow the so called «alternative pathway» that leads to cancers that have similar features to the onesoriginating from the traditional adenomas: CIMP low and microsatellite stable [5—7]. SSAs are associated with BRAF mutations and follow the so called «serrated pathway» that leads to cancers that are CIMP high and microsatellite instable and are very similar to the ones seen in Lynch syndrome [6, 8—11]. The progression from a SSAto cancer is more rapid once that dysplasia arises [12]. A number of studies have reported that SSAs are associated with an increased risk of synchronous and metachronous neoplasia, including both advanced adenomas and cancer [13—18]. The aim of this study was to evaluate the misdiagnosis rate of SSAs as HPs during a 8 years period (2006— 2013) and the association between SPs and other colorectal lesions. We decided to focus on SSAs since they represent, in our opinion, the subtype of serrated lesion of most interest both for pathologists and endoscopists because of https://doi.org/10.17116/dokgastro20176326-29
Mediators of Inflammation, 2015
Pathological stage seems to be the major determinant of postoperative prognosis of solid tumors, ... more Pathological stage seems to be the major determinant of postoperative prognosis of solid tumors, but additional prognostic determinants need to be better investigated. The most important tumor marker for colorectal cancer (CRC) is the cell-surface antigen, Carcinoembryonic Antigen (CEA), and its assessment is considered a valuable index of circulating tumor cells (CTCs). In this paper, CEACAM3 evaluation was applied given its great specificity in the CRC. Whole blood from the basilic vein of 38 CRC patients was collected before and at various time intervals after the curative resection. Also, from 20 of them, we have obtained two additional intraoperative samples. CEACAM3 expression was evaluated in all the samples by RT-PCR. CEACAM3 duct values showed a decreasing trend from preoperative through early and later postoperative to 6th-month samples (p<0.001). The average values of CEACAM3 were related to the cancer size (T stage) (p=0.034) and WHO stage (p=0.035). A significant eff...
BMC Infectious Diseases, Oct 21, 2021
Journal of Reproductive Immunology
Indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO) are key enzymes for try... more Indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO) are key enzymes for tryptophan degradation, regulating immune tolerance during pregnancy. The intrauterine renin-angiotensin system is also involved in the progression of a healthy pregnancy. Angiotensin(1− 7) maintains the integrity of fetal membranes via counteracting the pro-inflammatory actions of Angiotensin II. No data are available on placental Angiotensin (1− 7) co-expression with TDO. We aimed to characterize TDO mRNA expression and its localization in different areas of the placenta of physiological pregnancies delivered at term; its co-expression with Angiotensin(1− 7) and its correlation with the plasma kynurenine/tryptophan (Kyn/Trp) ratio was investigated. This prospective observational study included a nonconsecutive series of 20 singleton uncomplicated pregnancies delivered vaginally. TDO mRNA was expressed in both maternal and fetal sides of the placentas and TDO protein also in the villi and it was co-expressed with IDO1 in almost half of the placental cells at these sites. The percentage of TDO + and IDO1 + cells appeared to be influenced by maternal pre-gestational smoking and newborn weight. A strong correlation was found between the percentage of TDO + and IDO1 + cells in the villi. TDO + cells also expressed Angiotensin(1− 7), with a higher percentage on the fetal side and in the villi compared to the maternal one. Kyn/ Trp plasma ratio was not correlated with IDO and TDO expression nor with the patient's characteristics. Collectively, our data indicate that TDO is detectable in placental tissue and is co-expressed with IDO and with Angiotensin(1− 7) + on the fetal side and in the villi.
Diagnostics
Background: Chest computed tomography (CT) is the gold standard for the evaluation of systemic sc... more Background: Chest computed tomography (CT) is the gold standard for the evaluation of systemic sclerosis-related interstitial lung disease (SSc-ILD). Lung ultrasound (LUS) is a radiation-free tool that identifies the B-lines as a main feature of ILD. We aimed to investigate the role of LUS in the evaluation of the extent of SSc-ILD. Methods: Adult SSc patients underwent pulmonary function tests (PFTs), LUS and CT. The CT images were qualitatively, semi-quantitatively (the Wells score on five levels and the categorical Goh et al. staging) and quantitatively (histogram-based densitometry) analysed for ILD. LUS quantified B-lines in 21 intercostal spaces on both the anterior and posterior chest wall. Results: Out of the 77 SSc patients eligible for the study, 35 presented with ILD on CT (21 limited, 14 extensive). Total B-lines significantly differentiated ILD vs. no ILD (median 24 vs. 8, p < 0.001). Posterior and total B-lines significantly differentiated limited from absent ILD, w...
Journal of Vascular Access, Jul 26, 2019
Background:In a previous trial, in-line filtration significantly prevented postoperative phlebiti... more Background:In a previous trial, in-line filtration significantly prevented postoperative phlebitis associated with short peripheral venous cannulation. This study aims to describe the cost-effectiveness of in-line filtration in reducing phlebitis and examine patients’ perception of in-hospital vascular access management with and without in-line filtration.Methods:We analysed costs associated with in-line filtration: these data were prospectively recorded during the previous trial. Furthermore, we performed a follow-up for all the 268 patients enrolled in this trial. Among these, 213 patients responded and completed 6 months after hospital discharge questionnaires evaluating the perception of and satisfaction with the management of their vascular access.Results:In-line filtration group required 95.60€ more than the no-filtration group (a mean of € 0.71/patient). In terms of satisfaction with the perioperative management of their short peripheral venous cannulation, 110 (82%) and 103 (76.9%) patients, respectively, for in-line filtration and control group, completed this survey. Within in-line filtration group, 97.3% of patients were satisfied/strongly satisfied; if compared with previous experiences on short peripheral venous cannulation, 11% of them recognised in-line filtration as a relevant causative factor in determining their satisfaction. Among patients within the control group, 93.2% were satisfied/strongly satisfied, although up to 30% of them had experienced postoperative phlebitis. At the qualitative interview, they recognised no difference than previous experiences on short peripheral venous cannulation, and mentioned postoperative phlebitis as a common event that ‘normally occurs’ during a hospital stay.Conclusion:In-line filtration is cost-effective in preventing postoperative phlebitis, and it seems to contribute to increasing patient satisfaction and reducing short peripheral venous cannulation–related discomfort
Internal and Emergency Medicine, Jun 16, 2013
A prospective observational study was conducted to evaluate the impact of delirium on geriatric i... more A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). Enrolled patients were evaluated daily with CAM to detect incident delirium cases. Among the 560 included patients, 19 (3 %) had delirium on admission (prevalent) and 44 (8 %) developed delirium during hospitalization (incident). Prevalent delirium cases were excluded from the statistical analysis. Incident delirium was associated with increased length of hospital stay (p \ 0.01) and institutionalization (p \ 0.01, OR 3.026). Multivariate analysis found that cognitive impairment on admission (p \ 0.0002), diabetes (p \ 0.05, OR 1.936), chronic kidney failure (p \ 0.05, OR 2.078) and male gender (p \ 0.05, OR 2.178) was significantly associated with the development of delirium during hospitalization. Results show that delirium impact is relevant to older patients hospitalized in internal medicine wards. The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies.
Journal of Vascular Access, Mar 22, 2018
Background: During ultrasound-guided cannulation, venous filling is required for venipuncture. To... more Background: During ultrasound-guided cannulation, venous filling is required for venipuncture. Tourniquet with an elastic tube at the axilla is the most common method to induce venous stasis for cannulation of the deep veins of the arm. Although effective, this method might be associated with short-and long-term complications. Valsalva manoeuvre has been used to produce venous filling in other extrathoracic veins. The aim of this observational study is to demonstrate the effect of Valsalva manoeuvre in respect of the elastic tourniquet on venous distention during echography-guided cannulation of the deep veins of the arm. Method: Sixty-nine patients scheduled for cannulation of basilic or brachial vein were prospectively observed. Vein diameters were recorded at rest and after 10 s of Valsalva or tourniquet placement. Results: The mean difference between basilic vein diameters during tourniquet and Valsalva manoeuvre was 0.006 mm (95% confidence interval = −inf, 0.09) with a standard deviation of 0.5 mm (95% confidence interval = 0.5, 0.7; p > 0.01). The mean difference between brachial vein diameters during tourniquet and Valsalva manoeuvre was 0.04 mm (95% confidence interval = −0.23, 0.15) with a standard deviation of 0.8 mm (95% confidence interval = 0.7, 0.9; p > 0.01). Discussion: This increase in cross-sectional basilic and brachial vein diameters was not different to that obtained with the elastic tube tourniquet.
Journal of Chemotherapy, Mar 23, 2020
We describe caspofungin pharmacokinetics (PK) after the first and fourth doses in 20 critically i... more We describe caspofungin pharmacokinetics (PK) after the first and fourth doses in 20 critically ill septic patients. Monte Carlo simulation was used to analyze the probability of target attainment (PTA) (AUC/MIC > 865) for Candida spp. Caspofungin concentrations were analyzed by HPLC in plasma and urine. A great variability in PK parameters was observed after both doses. Patients were divided in two groups according to their AUC values (AUC 75 mg h/L cutoff). In the low-AUC group Cmax, Cmin and AUC were lower, while Vd and Cl were higher than in the high-AUC group (p < 0.05, both at day 1 and 4). The mean 24-h urinary recovery of the drug was 8 ± 6.3% (day1) and 9.8 ± 6.3 (day4). Monte Carlo simulation analysis (0.03-1 mg/L MIC-range) showed that PTA was guaranteed only for MICs 0.03 mg/L in the low-AUC group, and for MICs 0.06 mg/L in the high-AUC group. No group had a PTA ! 90% for 0.125 mg/L MIC (the epidemiological cutoff). Mortality was higher in low-AUC group (p < 0.01). In our 'real-world' population, no clinical data can predict which patient will have lower, suboptimal caspofungin exposure, therefore we suggest TDM to optimize caspofungin therapy and reduce the risk of selecting resistances (CEAVC,
Circulation: Genomic and Precision Medicine
BACKGROUND: The 2 sarcomere genes most commonly associated with hypertrophic cardiomyopathy (HCM)... more BACKGROUND: The 2 sarcomere genes most commonly associated with hypertrophic cardiomyopathy (HCM), MYBPC3 (myosin-binding protein C3) and MYH7 (β-myosin heavy chain), are indistinguishable at presentation, and genotype-phenotype correlations have been elusive. Based on molecular and pathophysiological differences, however, it is plausible to hypothesize a different behavior in myocardial performance, impacting lifetime changes in left ventricular (LV) function. METHODS: We reviewed the initial and final echocardiograms of 402 consecutive HCM patients with pathogenic or likely pathogenic MYBPC3 (n=251) or MYH7 (n=151) mutations, followed over 9±8 years. RESULTS: At presentation, MYBPC3 patients were less frequently obstructive (15% versus 26%; P =0.005) and had lower LV ejection fraction compared with MYH7 (66±8% versus 68±8%, respectively; P =0.03). Both HCM patients harboring MYBPC3 and MYH7 mutations exhibited a small but significant decline in LV systolic function during follow-u...
Biomedicines
Background: Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful.... more Background: Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful. However, early prediction of a long-term eGFR decline may be an even more important goal. Our aim was to identify and compare serum [creatinine, kineticGFR, cystatin C, neutrophil gelatinase–associated lipocalin (NGAL)] and urinary (NephroCheck, NGAL, proteinuria, albuminuria, acantocytes at urinary sediment) predictors of AKI that might efficiently predict long-term GFR decline after robotic Nephron-Spearing Surgery (rNSS). Methods: Monocentric prospective observational study. Patients scheduled for rNSS for suspected localized Renal Cell Carcinoma from May 2017 to October 2017 were enrolled. Samples were collected preoperatively and postoperatively (timepoints: 4 h, 10 h, 24 h, 48 h), while kidney function was re-assessed up to 24 months. Results: 38 patients were included; 16 (42%) developed clinical AKI. The eGFR decline at 24 months was more pronounced after postoperative AKI (−20....
Research Square (Research Square), Jan 26, 2023
BACKGROUND The severity of coagulation derangement correlates with poor prognosis in COVID-19 pat... more BACKGROUND The severity of coagulation derangement correlates with poor prognosis in COVID-19 patients. However, the clinical impact of coagulation alterations detected with rotational thromboelastometry (ROTEM) in intensive care unit (ICU) COVID-19 patients is not completely de ned. The study aimed to identify the correlation between ROTEM parameters and adverse ICU outcomes. The relationship between COVID-19 associated coagulopathy (CAC) and ROTEM alterations and possible risk factors for ICU mortality were also investigated. METHODS COVID-19 patients admitted to ICU between October 1, 2020 and May 31, 2021, were retrospectively enrolled. The sample was subsequently divided into subgroups (survivors vs. nonsurvivors, mechanical ventilation (MV) vs. non-invasive ventilation (NIV), venous thromboembolism (VTE) vs. NO-VTE, CAC vs. NO-CAC) among which ROTEM parameters and standard coagulation tests were compared. RESULTS One hundred ICU patients were enrolled. High D-dimer (DD) (5089 ± 1035 ng/ml) and brinogen levels (640 ± 112 mg/dl) and an increase in maximum clot rmness (MCF) were revealed. The nonsurvivors (n=50, 50%) had higher DD levels and lower platelet counts as well as lower clot lysis rates than survivors. EXTEM maximum lysis (ML) resulted lower in the MV subgroup than in NIV treated patients. Patients with thrombotic complications had higher DD levels than patients without VTE whereas ROTEM parameters were not different. Similarly no coagulation or ROTEM differences were identi ed in the subgroup of CAC patients (n=29, 29%). Reduced ML values in EXTEM and INTEM resulted as possible risk factors for ICU mortality. CONCLUSIONS In critically ill COVID-19 patients, hypo brinolysis and not hypercoagulability seems to be correlated with unfavourable ICU prognosis. Highlights Recently, in COVID-19 ICU patients, a severe prothrombotic pro le, persistent beyond intensive care unit (ICU) discharge, characterized by acceleration of clot formation time (CFT) and signi cant increase in maximum clot rmness (MCF) compared to severe non-SARS CoV-2 pneumonia patients has been detected. [7-8] Moreover, a higher incidence of brinolysis shutdown (maximum lysis (ML) in EXTEM < 3,5%) and VTE risk in COVID-19 patients than in non SARS-COV2 pneumonia patients has been observed [7-8-9]. Nevertheless, the clinical impact of ROTEM parameters at ICU admission in COVID-19 patients has yet to be fully clari ed. This study aimed to identify the correlation between ROTEM parameters at ICU admission and adverse outcomes in terms of mortality, respiratory failure requiring MV and thromboembolic complications. A correlation between CAC diagnosis and ROTEM prothrombotic alterations has also been explored. Furthermore, a survival analysis has investigated possible risk factors associated with ICU mortality, taking into account not only coagulation data but also ICU admission and hospitalization parameters. Methods
Journal of Reproductive Immunology, Feb 1, 2023
Indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO) metabolize tryptophan i... more Indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO) metabolize tryptophan in the kynurenine pathway. We evaluated these enzymes' mRNA expression in maternal and fetal sides of the placenta of uncomplicated, unlabored full-term pregnancies after elective cesarean section and compared it with that of placentas obtained from vaginal delivery. Tryptophan and kynurenine plasmatic levels after cesarean section were measured, to investigate their possible correlation with IDO1 and TDO mRNA (TDO2) expression. The results suggested that IDO1 and TDO2 expression was higher in the maternal side of the placenta and that labor significantly affects TDO2 expression and the plasma Kynurenine/Tryptophan ratio.
Molecular Cancer Therapeutics
Cholangiocarcinoma (CCA) is characterized by resistance to chemotherapy and a poor prognosis. The... more Cholangiocarcinoma (CCA) is characterized by resistance to chemotherapy and a poor prognosis. Therefore, treatments that can effectively suppress tumor growth are urgently needed. Aberrant activation of hedgehog (HH) signaling has been implicated in several cancers, including those of the hepatobiliary tract. However, the role of HH signaling in intrahepatic CCA (iCCA) has not been completely elucidated. In this study, we addressed the function of the main transducer Smoothened (SMO) and the transcription factors (TFs) GLI1 and GLI2 in iCCA. In addition, we evaluated the potential benefits of the combined inhibition of SMO and the DNA damage kinase WEE1. Transcriptomic analysis of 152 human iCCA samples showed increased expression of GLI1, GLI2, and Patched 1 (PTCH1) in tumor tissues compared with nontumor tissues. Genetic silencing of SMO, GLI1, and GLI2 inhibited the growth, survival, invasiveness, and self-renewal of iCCA cells. Pharmacologic inhibition of SMO reduced iCCA growth...
Pharmaceuticals
The role of Bronchoalveolar Lavage (BAL) in the evaluation of systemic sclerosis (SSc) interstiti... more The role of Bronchoalveolar Lavage (BAL) in the evaluation of systemic sclerosis (SSc) interstitial lung disease (ILD) is still controversial. The aim of this systematic literature review was to investigate the use of BAL in SSc-ILD, and to focus on the pros and cons of its real-life application. Methods: PubMed, Cochrane, and Embase were questioned from inception until 31 December 2021. Results: Eighteen papers were finally analyzed. A positive correlation was observed between lung function and BAL cytology; in particular, BAL neutrophilia/granulocytosis was related to lower diffusing capacity for carbon monoxide (DLCO) values and lower forced vital capacity (FVC). Moreover, a positive correlation between BAL cellularity and high-resolution computed tomography (HRCT) findings has been reported by several authors. Cytokines, chemokines, growth factors, coagulation factors, and eicosanoids have all been shown to be present, more often and in higher quantities in SSc-ILD patients than...
Transplant Infectious Disease
Annals of the Rheumatic Diseases, 2021
Background:In SSc, ILD is a major cause of morbidity and mortality. High resolution computed tomo... more Background:In SSc, ILD is a major cause of morbidity and mortality. High resolution computed tomography (HRCT) is the gold standard for the diagnosis. Predictors of ILD onset are eagerly awaited to improve SSc-ILD management. Pulmonary function test (PFTs) are routinely performed to measure lung function changes.Objectives:Our aim was to investigate the performance of DLCO (diffusing capacity of lung carbon monoxide) and FVC (forced vital capacity) in predicting the development of SSc-ILD.Methods:The longitudinal data of DLCO, FVC and ILD on HRCT of SSc patients from the EUSTAR database were evaluated at baseline (t0), after 12 (±4) (t1) and 24 (±4) (t2) months. Patients with negative HRCT for any sign of ILD both at t0 and t1 were included. Patients who presented or developed pulmonary hypertension during the study period were excluded. At baseline, demographic data, disease duration from Raynaud’s onset, disease subsets, autoantibodies and other laboratory and instrumental data we...
European Journal of Internal Medicine, 2022
BACKGROUND Gastrointestinal (GI) manifestations are frequent in systemic sclerosis (SSc) with an ... more BACKGROUND Gastrointestinal (GI) manifestations are frequent in systemic sclerosis (SSc) with an impact on quality of life and morbidity. Bowel vasculopathy is a key pathogenetic factor responsible for GI involvement. OBJECTIVES To compare abdominal ultrasound (US) and Color Doppler Ultrasonography (CDU) features of splanchnic vessels of SSc patients with healthy controls. METHODS The charts of SSc patients who underwent an abdominal US and CDU study were retrospectively analyzed. For Superior Mesenteric Artery (SMA) and Inferior Mesenteric Artery (IMA) caliber, Peak Systolic Velocity (PSV), Reverse Velocity (RV), End-Diastolic Velocity (EDV), Mean Velocity (mV), Blood-flow, Resistive Index (RI) and Pulsatility Index (PI) were recorded. RESULTS 28 SSc patients and 28 controls were enrolled. In SSc, caliber of SMA was significantly smaller than in controls (5.75 ± 0.62 mm vs. 6.45 ± 0.60 mm, p < 0.0001 - p adj =0.0002). The flow study of SMA and IMA showed a significant reduction of RV (SMA: 7.25 ± 6.37 cm/s vs. 18.52 ± 6.16 cm/s, p < 0.0001 - p adj <0.0001; IMA: 2.69 ± 6.10 cm/s vs. 17.06 ± 5.75 cm/s, p < 0.0001 - p adj <0.0001) and PI (SMA: 3.33 ± 0.75 vs. 4.53 ± 1.03, p < 0.0001 - p adj =0.0002; IMA: 3.54 ± 0.95 vs. 6.08 ± 1.53, p < 0.0001 - p adj <0.0001) in SSc patients than controls. CONCLUSION involvement of splanchnic vessels in SSc may be non-invasively investigated with abdominal US and CDU. Morphological and functional changes of Doppler parameters observed in SMA and IMA clearly demonstrate that these vessels are affected by SSc vasculopathy.
Dokazatel'naya gastroenterologiya, 2017
ДОКАЗАТЕЛЬНАЯ ГАСТРОЭНТЕРОЛОГИЯ, 3 , 2017 The 1st serrated lesion to be described was the traditi... more ДОКАЗАТЕЛЬНАЯ ГАСТРОЭНТЕРОЛОГИЯ, 3 , 2017 The 1st serrated lesion to be described was the traditional serrated adenoma, defined by Longacre and Fenoglio Preiser in 1990 as «polyp with the architectural but not the cytologic features of Hyperplastic Polyp (HP)» [1]. Six years later Torlakovic and Snover defined the «serrated adenoma» as a distinct type of polyp that differed from the closely resembling hyperplastic polyp [2]; the term «sessile serrated adenoma» was so introduced. From that time many efforts have been made to characterize these lesions from an pathological, molecular and endoscopic point of view. Serrated colon polyps area group of heterogeneous lesions histologically characterized by glandular serration (ie, a saw-tooth folding of colonic crypt epithelium). The World Health Organization classified them as: Hyperplastic Polyps (HPs), Sessile Serrated Adenoma/Polyp (SSAs), Traditional Serrated Adenomas (TSAs), Mixed Polyps (MPs) and according to literature data they are the 36% of all colonic polyps [3]. While TSAs and MPs have always been diagnosed as adenomatous polyps and like them treated and surveilled, HPs and SSAs were once all diagnosed as HPs (diagnostic overlap), the differential diagnosisis difficult also for the pathologist but of significant importance since they have completely different anatomopathological, molecular, endoscopic features and as a consequence of that different malignant potential and follow-up. Exception made for HPs, the other serrated lesions have a malignant potential and follow a different pathway of carcinogenesis to the traditional «adenoma-carcinoma sequence». TSAs are more frequently KRAS mutated, but they can also be BRAF mutated [4, 5]; they follow the so called «alternative pathway» that leads to cancers that have similar features to the onesoriginating from the traditional adenomas: CIMP low and microsatellite stable [5—7]. SSAs are associated with BRAF mutations and follow the so called «serrated pathway» that leads to cancers that are CIMP high and microsatellite instable and are very similar to the ones seen in Lynch syndrome [6, 8—11]. The progression from a SSAto cancer is more rapid once that dysplasia arises [12]. A number of studies have reported that SSAs are associated with an increased risk of synchronous and metachronous neoplasia, including both advanced adenomas and cancer [13—18]. The aim of this study was to evaluate the misdiagnosis rate of SSAs as HPs during a 8 years period (2006— 2013) and the association between SPs and other colorectal lesions. We decided to focus on SSAs since they represent, in our opinion, the subtype of serrated lesion of most interest both for pathologists and endoscopists because of https://doi.org/10.17116/dokgastro20176326-29
Mediators of Inflammation, 2015
Pathological stage seems to be the major determinant of postoperative prognosis of solid tumors, ... more Pathological stage seems to be the major determinant of postoperative prognosis of solid tumors, but additional prognostic determinants need to be better investigated. The most important tumor marker for colorectal cancer (CRC) is the cell-surface antigen, Carcinoembryonic Antigen (CEA), and its assessment is considered a valuable index of circulating tumor cells (CTCs). In this paper, CEACAM3 evaluation was applied given its great specificity in the CRC. Whole blood from the basilic vein of 38 CRC patients was collected before and at various time intervals after the curative resection. Also, from 20 of them, we have obtained two additional intraoperative samples. CEACAM3 expression was evaluated in all the samples by RT-PCR. CEACAM3 duct values showed a decreasing trend from preoperative through early and later postoperative to 6th-month samples (p<0.001). The average values of CEACAM3 were related to the cancer size (T stage) (p=0.034) and WHO stage (p=0.035). A significant eff...
BMC Infectious Diseases, Oct 21, 2021
Journal of Reproductive Immunology
Indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO) are key enzymes for try... more Indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase (TDO) are key enzymes for tryptophan degradation, regulating immune tolerance during pregnancy. The intrauterine renin-angiotensin system is also involved in the progression of a healthy pregnancy. Angiotensin(1− 7) maintains the integrity of fetal membranes via counteracting the pro-inflammatory actions of Angiotensin II. No data are available on placental Angiotensin (1− 7) co-expression with TDO. We aimed to characterize TDO mRNA expression and its localization in different areas of the placenta of physiological pregnancies delivered at term; its co-expression with Angiotensin(1− 7) and its correlation with the plasma kynurenine/tryptophan (Kyn/Trp) ratio was investigated. This prospective observational study included a nonconsecutive series of 20 singleton uncomplicated pregnancies delivered vaginally. TDO mRNA was expressed in both maternal and fetal sides of the placentas and TDO protein also in the villi and it was co-expressed with IDO1 in almost half of the placental cells at these sites. The percentage of TDO + and IDO1 + cells appeared to be influenced by maternal pre-gestational smoking and newborn weight. A strong correlation was found between the percentage of TDO + and IDO1 + cells in the villi. TDO + cells also expressed Angiotensin(1− 7), with a higher percentage on the fetal side and in the villi compared to the maternal one. Kyn/ Trp plasma ratio was not correlated with IDO and TDO expression nor with the patient's characteristics. Collectively, our data indicate that TDO is detectable in placental tissue and is co-expressed with IDO and with Angiotensin(1− 7) + on the fetal side and in the villi.
Diagnostics
Background: Chest computed tomography (CT) is the gold standard for the evaluation of systemic sc... more Background: Chest computed tomography (CT) is the gold standard for the evaluation of systemic sclerosis-related interstitial lung disease (SSc-ILD). Lung ultrasound (LUS) is a radiation-free tool that identifies the B-lines as a main feature of ILD. We aimed to investigate the role of LUS in the evaluation of the extent of SSc-ILD. Methods: Adult SSc patients underwent pulmonary function tests (PFTs), LUS and CT. The CT images were qualitatively, semi-quantitatively (the Wells score on five levels and the categorical Goh et al. staging) and quantitatively (histogram-based densitometry) analysed for ILD. LUS quantified B-lines in 21 intercostal spaces on both the anterior and posterior chest wall. Results: Out of the 77 SSc patients eligible for the study, 35 presented with ILD on CT (21 limited, 14 extensive). Total B-lines significantly differentiated ILD vs. no ILD (median 24 vs. 8, p < 0.001). Posterior and total B-lines significantly differentiated limited from absent ILD, w...