Paola Mancinelli - Academia.edu (original) (raw)

Papers by Paola Mancinelli

Journal of Critical Care, Feb 1, 2018

In critically ill patient it is observed a severe oxidative stress, not only due to the acute pat... more In critically ill patient it is observed a severe oxidative stress, not only due to the acute pathology but also for some therapeutic treatments. The aim of the present study was to analyze the variations of non-enzymatic antioxidants in plasma during veno-venous ECMO-treatment in a homogeneous population of critical patients with ARDS. Materials and methods: We carried out a retrospective study enrolling all patients with ARDS by influence A H1N1 treated with veno-venous ECMO. In all patients included, we have recorded clinical and laboratory parameters considered indicators of oxidative stress during the first week of treatment. Results: With regard to non-enzymatic antioxidants evaluated, we observed that both albumin and uric acid decreased significantly, at all observation times, after ECMO-treatment [(25.88 ± 4.51, 18.05 ± 4.27, 16.32 ± 4.57, 19.07 ± 5.10, p b 0.05)(g/l), (5.46 ± 1.43, 2.30 ± 1.15, 2.90 ± 2.09, 2.07 ± 1.03, p b 0.05)(mg/dl), respectively]. At the same time the amount of insulin administered daily was increased with statistical significance (p = 0.03). Conclusions: The veno-venous ECMO-treatment causes a significant reduction of some of the major non-enzymatic antioxidants and a possible increase in insulin resistance in patients with ARDS by influence A H1N1.

Journal of Critical Care, Feb 1, 2014

The oxidative stress is recognized as a constant feature in critical illness. Nevertheless, the u... more The oxidative stress is recognized as a constant feature in critical illness. Nevertheless, the use of antioxidant therapy remains controversial. We tried to demonstrate that intravenous selenium supplementation could promote antioxidant status and help protect against infection and organ failure, improving outcome in critically ill patients. Materials and Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the exogenous supplementation of selenium versus standard therapy without any adjuvant in critically ill adults. Results: Nine RCTs met inclusion criteria. Selenium supplementation was associated with a reduction in 28day mortality of borderline statistical significance (risk ratio = 0.84, 95% confidence interval 0.71-0.99, P = .04). The analysis of pre-defined subgroups detected no significant effects regarding the supplementation with doses of selenium ≤ 500 μg/d, administration of a load dose with a bolus and duration of treatment. Only 2 studies analyzed 6-month mortality and could not show a difference. No effects could be demonstrated on hospital length of stay, pulmonary infections, or renal failure. Conclusions: The use of high-dose selenium might be associated with a beneficial effect on 28-day mortality in critically ill patients. Nevertheless, the use of selenium as adjuvant therapy needs further evaluations.

Anti-inflammatory & anti-allergy agents in medicinal chemistry, Mar 30, 2018

Background: Low circulating levels of adiponectin are associated with the occurrence of infection... more Background: Low circulating levels of adiponectin are associated with the occurrence of infection after surgery in patients with cancer. Data are lacking on whether surgical stress is associated with a reduction in circulating levels of adiponectin. Furthermore, the relationship between oxidative stress and postoperative complications has not been investigated. Objective: The aim of this study was to evaluate the pre-, intra-, and postoperative levels of adiponectin in patients who underwent major abdominal surgery for malignancy and their association with postoperative complications. Methods: An observational, prospective, single-center study was conducted in patients undergoing abdominal surgery for cancer. Circulating levels of adiponectin and of two biomarkers of oxidative stress were measured preoperatively, at the end of surgery, 24 and 48 hours after surgery. Patients were divided into two groups: complicated (CL+) and uncomplicated (CL), according to the Clavien-Dindo classification. Temporal patterns of adiponectin and markers of oxidative stress were followed at different time points. Results: Twelve patients were enrolled, seven with postoperative complications (CL+) and five without (CL). The preoperative median levels of adiponectin were statistically different between CL+ and CL groups (3.2 μg/ml vs 10.9 μg/ml; p=0.03). Levels of preoperative adiponectin were inversely related to the severity of postoperative complications (Rho= 0.68; p= 0.02). Pre-, intra-and postoperative levels of oxidative stress products were not statistically different between the two groups. Adiponectin levels decreased during surgery in both groups, while those of oxidative stress tended to increase. Conclusions: Preoperative adiponectin levels correlate with postoperative complications after cancer surgery.

PubMed, May 1, 2016

Background: This study aims to assess the rate of gastric emptying in pregnant women in the third... more Background: This study aims to assess the rate of gastric emptying in pregnant women in the third trimester scheduled for elective caesarean section (CS), in view to highlight the aspiration risk. Methods: A prospective case-control study, with the approval of the Ethics Committee, was performed. At term pregnant women (group A) scheduled for CS and volunteer controls were recruited (group B). The ultrasonographic measurement of the antral area was performed, after a standardized meal, with a Convex probe. The antrum was displayed in the sagittal or parasagittal projections in the right upper quadrant, medial to the mid-clavicular line. The diameters of the antrum were measured and then the antral area was calculated. The measurements were conducted at 10 (T1), 90 (T2) and 240 (T3) minutes from the meal. Anthropometric data were collected for each patient. Results: In group B, antrum distention was observed already after 10 minutes from the meal, and then a gradual decrease in the antral area until 4 hours after the meal was registered. On the contrary, in group A (at term pregnant) there was an initial smaller increase of antral area, followed by a greater increase that lasts up to 90 minutes, and finally a delayed and smaller reduction. Conclusions: In pregnant women at term, the stomach does not seem to be able to expand immediately after the meal. The transit of food is completed later than in not pregnant women. The ultrasound of the stomach allows identifying delays gastric emptying and highlighting patients at risk of aspiration.

Anti-inflammatory & anti-allergy agents in medicinal chemistry, 2017

Low circulating levels of adiponectin are associated with the occurrence of infection after surge... more Low circulating levels of adiponectin are associated with the occurrence of infection after surgery in patients with cancer. Data are lacking on whether surgical stress is associated with a reduction in circulating levels of adiponectin. Furthermore, the relationship between oxidative stress and postoperative complications has not been investigated. The aim of this study was to evaluate the pre-, intra-, and postoperative levels of adiponectin in patients who underwent major abdominal surgery for malignancy and their association with postoperative complications. An observational, prospective, single-center study was conducted in patients undergoing abdominal surgery for cancer. Circulating levels of adiponectin and of two biomarkers of oxidative stress were measured preoperatively, at the end of surgery, 24 and 48 hours after surgery. Patients were divided into two groups: complicated (CL+) and uncomplicated (CL-), according to the Clavien-Dindo classification. Temporal patterns of ...

Journal of Critical Care, 2018

Minerva anestesiologica, Jan 10, 2015

This study aims to assess the rate of gastric emptying in pregnant women in the third trimester s... more This study aims to assess the rate of gastric emptying in pregnant women in the third trimester scheduled for elective caesarean section in view to highlight the aspiration risk. A prospective case-control study, with the approval from the Ethics Committee, was performed. At term pregnant women (Group A) scheduled for caesarean section and volunteer controls was recruited (Group B). The ultrasonographic measurement of the antral area was performed, after a standardized meal, with a Convex probe. The antrum was displayed in the sagittal or parasagittal projections in the right upper quadrant, medial to the mid-clavicular line. The diameters of the antrum were measured and then the antral area was calculated. The measurements were conducted at 10 (T1), 90 (T2) and 240 (T3) minutes from the meal. Anthropometric data were collected for each patient. In Group B, antrum distention was observed already after 10 minutes from the meal, and then a gradual decrease in the antral area until 4 h...

Journal of Critical Care, 2015

Critical Care, 2015

Endothelial cells line the inner portion of the heart, blood vessels, and lymphatic vessels; a ba... more Endothelial cells line the inner portion of the heart, blood vessels, and lymphatic vessels; a basal membrane of extracellular matrix lines the extraluminal side of endothelial cells. The apical side of endothelial cells is the site for the glycocalyx, which is a complex network of macromolecules, including cell-bound proteoglycans and sialoproteins. Sepsis-associated alterations of this structure may compromise endothelial permeability with associated interstitial fluid shift and generalized edema. Indeed, in sepsis, the glycocalyx acts as a target for inflammatory mediators and leukocytes, and its ubiquitous nature explains the damage of tissues that occurs distant from the original site of infection. Inflammatory-mediated injury to glycocalyx can be responsible for a number of specific clinical effects of sepsis, including acute kidney injury, respiratory failure, and hepatic dysfunction. Moreover, some markers of glycocalyx degradation, such as circulating levels of syndecan or selectins, may be used as markers of endothelial dysfunction and sepsis severity. Although a great deal of experimental evidence shows that alteration of glycocalyx is widely involved in endothelial damage caused by sepsis, therapeutic strategies aiming at preserving its integrity did not significantly improve the outcome of these patients.

Critical Care, 2007

A recent study by Forceville and colleagues evaluated the effect of high-dose selenium administra... more A recent study by Forceville and colleagues evaluated the effect of high-dose selenium administration as a treatment for septic shock. The study was negative and conflicts with existing clinical data regarding selenium administration in critically ill patients. Perhaps the key to understanding the differences between these discrepant observations lies in considering the dose and timing of selenium administration.