VINCENZO VINICOLA - Academia.edu (original) (raw)

Papers by VINCENZO VINICOLA

Acta Neurochirurgica Supplementum, 2005

In severe brain injury patients few studies have examined the role of early clinical factors emer... more In severe brain injury patients few studies have examined the role of early clinical factors emerging before recovery of consciousness. Patients su¤ering from vegetative state and minimally conscious state in fact may need variable periods of time for recovery of the ability to follow commands. In a previous study we retrospectively examined a population of very severe traumatic brain injury patients with coma duration of at least 15 days (prolonged coma), and we found, as significant predictive factors for the final outcome, the time interval from brain injury to the recovery of the following clinical variables: optical fixation, spontaneous motor activity and first safe oral feeding. Psychomotor agitation and bulimia during coma recovery were also favourable prognostic factors for the final outcome. In a further study, also as for the neuropsychological recovery, the clinical variable with the best significant predictive value was the interval from head trauma to the recovery of safe oral feeding. In the present study the presence of psychomotor agitation diagnosed by means of LCF (score 4 ¼ confused-agitated) at the admission time in rehabilitation predicted a statistically significant better outcome at the discharge time in comparison with patients without agitation.

Brain Injury, 2007

To assess the incidence of late post-traumatic epilepsy (PTE) in patients with very severe trauma... more To assess the incidence of late post-traumatic epilepsy (PTE) in patients with very severe traumatic brain injury (TBI) who either received or did not receive anti-epileptic prophylactic treatment. Two populations were studied: 55 patients retrospectively and 82 subjects prospectively. Ten patients (18%) in the first population showed late PTE. Although the incidence was lower in patients who did not receive prophylactic treatment, the difference between the treated and the non-treated group was not statistically significant. Sixty-nine patients in the second group (84%) had prophylactic treatment. Twenty-seven patients (39%) suffered from late PTE during the 2-year follow-up period and 17 of them (63%) showed EEG epileptic abnormalities. No patient who did not receive preventive therapy suffered from late PTE during the observation period. Due to the negative cognitive effects of anti-epileptic drugs, the preliminary results are of considerable interest for the rehabilitation of patients with very severe TBI.

Brain Injury, 2004

To assess the outcome of severe traumatic brain injury at least 1 year after trauma, in relation ... more To assess the outcome of severe traumatic brain injury at least 1 year after trauma, in relation to some early clinical prognostic factors occurring during coma recovery. Retrospective study conducted at the post-coma unit of a rehabilitation hospital. A total of 43 patients were included. All of the patients sustained severe traumatic brain injury and prolonged coma, i.e. coma lasting at least 15 days. Outcome was assessed by means of Glasgow Coma Scale, Barthel Index and Mini Mental State 1 year after trauma, in relation to some early clinical prognostic factors occurring during coma recovery. At the 1 year follow-up, a statistically significant correlation was found with both the Glasgow Outcome Scale and the Barthel Index for the time interval from brain injury to recovery of the following clinical variables: optical fixation, ability to obey commands, spontaneous motor activity and first safe oral feeding. Psychomotor agitation and bulimia were also favourable prognostic factors for the final outcome. In the present study, first safe oral feeding during coma recovery represents the clinical feature that better predicts the final outcome of patients with severe traumatic brain injury and prolonged coma.

Bone, 2013

Introduction: Bone mineral density (BMD) result has a low predictive value on patients' risk for ... more Introduction: Bone mineral density (BMD) result has a low predictive value on patients' risk for future fractures. Thus, new approaches for examining patients at risk for developing osteoporosis would be desirable. Magnetic resonance (MR) investigations in cancellous bone have been shown to yield useful quantitative information on both trabecular-bone microstructure and bone marrow composition. This work was undertaken to address the hypothesis that the effective internal magnetic field gradient (IMFG), a new MR parameter, discriminates between healthy, osteopenic and osteoporotic postmenopausal women, classified on the basis of bone mineral density (BMD) criteria. The work builds on preliminary results indicating that IMFG, measured in trabecular-bone pores and quantified by spin-echo decay and water diffusion MR near the bone-bone marrow interface depends on both the bone marrow water rate of diffusion and the magnetic susceptibility difference (ΔX) between water and bone. Materials and methods: MR relaxometry, MR spectroscopy and diffusion-weighted MR imaging of the heel was performed in fifty-five women (mean age, 62.9 ± 6.6 years) at 3 T. Moreover, in order to study the reproducibility of IMFG measurement, five young women (mean age 31.0 ± 3.2 years; age range, 28-36 years) were scanned and rescanned. The study protocol was approved by the local Ethics Committee. Quantitative Computer Tomography (QCT) of the L1-L3 vertebral segments was performed to classify the postmenopausal women into three groups according to QCT BMD: healthy (n = 8); osteopenic (n = 25); and osteoporotic (n = 22). In all subjects, BMD T-scores, marrow fat content (Mfc), T2*, apparent diffusion coefficient (ADC) and IMFG (estimated from the additional spin-echo decay due to diffusion of water in local magnetic field gradients), were assessed in the whole calcaneus as well as in three calcaneal subregions: subtalar, tuber calcaneus, and cavum calcaneus. Between-group comparisons to assess group differences and Pearson correlation analysis were performed. Short and long-term coefficients of variation (CV S and CV L , respectively) were evaluated in young subjects. Results: Reproducibility of the IMFG measurement was satisfactory. No significant difference was found in the IMFG measurement performed in both calcaneus and subtalar calcaneal region between the two separate sessions comprised of five young women. Mfc did not significantly differ between groups. The IMFG in the subtalar region was significantly different between all three groups (P b 0.01), being greatest in healthy women, intermediate in those with osteopenia, and lowest in osteoporotic subjects. Conversely neither T2* nor ADC is able to discriminate healthy subjects from those with osteopenia and osteoporosis. Increased inter-trabecular space, as it typically occurs in patients with osteoporosis, modifies water diffusion, conferring higher ADC values, thereby lowering the IMFG. Conclusion: The IMFG measured in the calcaneal subtalar region shows a high ability in identifying healthy subjects. The new quantitative MR method based on measurement of the IMFG may provide a new means for assessing patients with osteoporosis.

Archives of Physical Medicine and Rehabilitation, 2005

Objectives: To evaluate the time course of motor recovery in a poststroke period ranging from 2 t... more Objectives: To evaluate the time course of motor recovery in a poststroke period ranging from 2 to 6 months and its correlation with both the severity of motor deficit and the muscle tone disturbances (flaccidity or spasticity) of the affected limbs. Design: Prospective cohort study. Setting: A comprehensive rehabilitation hospital. Participants: Forty consecutive stroke patients (21 men, 19 women) with first ischemic stroke who met the inclusion criteria. Interventions: Not applicable. Main Outcome Measure: Change in motor deficit as evaluated by the Adams Hemispheric Stroke Scale. Results: Stepwise regression analysis indicated that the most significant factors influencing motor recovery were the time elapsed since stroke and muscle tone. Conclusions: Rehabilitation of stroke patients is more effective in the first months after the event rather than later, considering the significant correlation observed between motor recovery and time elapsed since stroke. Flaccid patients appear to need 3 months or more before reaching the final plateau, because motor recovery occurs later and/or proceeds more slowly, whereas outcomes for spastic patients with spasticity appears to occur in the first months after stroke.

Acta Neurochirurgica, 2004

Background. The aim of the study was to evaluate the possible significant role of some clinical f... more Background. The aim of the study was to evaluate the possible significant role of some clinical factors in predicting cognitive outcome in a group of severe traumatic brain injury (TBI) patients, with Glasgow Coma Scale (GCS) lower than 8 and duration of unconsciousness for at least 15 days (prolonged coma). Method. A consecutive sample of 25 survivors of severe TBI attending the Physical and Cognitive Rehabilitation program participated in this study. The neuropsychological test battery included: Word-list Learning, Prose recall, Rey Figure Delayed recall, Word fluency, Raven's Progressive Matrices' 47. The clinical variables evaluated in correlation with the neuropsychological outcome were the following: age, duration of unconsciousness, duration of post-traumatic amnesia, interval from head trauma to neuropsychological evaluation, interval from head trauma to recovery of oral feeding, and finally interval from head trauma to first verbal communication. Findings. The clinical variable with a significant predictive value on most neuropsychological scores was the interval from head trauma to the recovery of oral feeding. Conclusions. If this result is confirmed in larger samples, time interval of oral feeding recovery from head trauma should be considered as a possible predictor of neuropsychological outcome in TBI patients with prolonged coma.

$Research paper thumbnail of The Italian Observational Study on Severe Osteoporosis (ISSO): 24-month results on incidence of fractures and adherence to treatment$

Clinical and experimental rheumatology

To estimate the proportion of patients with very severe osteoporosis (those covered by the reimbu... more To estimate the proportion of patients with very severe osteoporosis (those covered by the reimbursement criteria of the Italian National Health Service) experiencing new vertebral and non-vertebral fragility fractures in the first 24 months of a new anti-osteoporosis treatment. Prospective observational study in men and post-menopausal women (aged > 21 years) initiating anti-osteoporosis treatment for very severe osteoporosis. Eligibility was based on teriparatide (TPD) reimbursement criteria in Italy: incident of vertebral or hip fracture during anti-resorptive treatment (minimum 1 year), or at least three prevalent severe vertebral fractures, or two prevalent severe vertebral fractures and a historical proximal hip fracture. Incidence of new clinical vertebral and non-vertebral fractures was documented by original x-rays and/or radiological reports, and a post-hoc analysis compared data from the TPD monotherapy population versus the total treated group. Overall, 767 patients (...

$Research paper thumbnail of Cost-effectiveness of percutaneous vertebroplasty in osteoporotic vertebral fractures$

European Spine Journal, 2008

A retrospective study was conducted in 179 consecutive patients (48 males, 131 females; mean age:... more A retrospective study was conducted in 179 consecutive patients (48 males, 131 females; mean age: 72.0 ± 8.59 years; range: 51-93) with single symptomatic acute amyelic osteoporotic vertebral fracture presenting between September 2004 and September 2005 to the Santa Lucia Foundation in Rome, Italy. Vertebral fractures usually become manifest due to pain which can be debilitating. Treatment depends on the presence or absence of spinal cord involvement. In the first case, surgical stabilization is mandatory. In the second case, treatment may be performed either by conservative medical therapy (CMT) or percutaneous vertebroplasty (PVT). The aim of this study was to evaluate the effectiveness, costs and cost-effectiveness of percutaneous vertebroplasty. After 2 weeks of analgesic therapy, 153 patients presented refractory pain and were offered treatment by PVT. A total of 58 patients accepted and underwent PVT (PVT group), while 95 refused and underwent conservative medical therapy (CMT group). Follow-up was performed by specialist consults, spine radiography and MRI and a self-assessment questionnaire evaluating pain using a Visual Analogue Scale (VAS) and function using an ambulation and an Activities of Daily Living (ADL) scale. A 12-month follow-up was obtained in 86 of 95 (90.5%) CMT group patients and 54 of 58 (93.1%) PVT group patients. Significant reduction of VAS and improvement of ambulation and ADL was observed in both groups at 1 week and 3 and 12 months (P \ 0.05; Wilcoxon signed rank test), however, these results were significantly superior in the PVT group at 1 week and 3 months (P \ 0.05; Mann-Whitney U test). Average cost per patient at 1 week and 3 and 12 months were respectively 755.49 ± 661.96, 3791.95 ± 3341.97 and 4299.55 ± 3211.53 € (CMT group) and 3311.35 ± 0.32, 3745.30 ± 3.59 and 4101.05 ± 755.41 € (PVT group). PVT resulted significantly more cost-effective than CMT with regards to the three scales at 1 week (P \ 0.05; Mann-Whitney U test). At 3 months PVT was more cost-effective than CMT with regards to the three scales, however, the difference was significant only with regards to ambulation. No significant differences in cost-effectiveness where found between the two groups at 12 months. PVT should be considered the treatment of first choice in symptomatic acute amyelic osteoporotic vertebral fractures with refractory pain after a short period of analgesic therapy.

Fig.2: Histograms of calcaneal (A) and femoral (B) Mfc% in the different bone density groups, to ... more Fig.2: Histograms of calcaneal (A) and femoral (B) Mfc% in the different bone density groups, to show differences between groups (healthy, H, osteopenic, OPE, osteoporotic, OPO). * Statistically significant differences in marrow fat content (Mfc%) between H and OPE subjects. ° Statistically significant differences in Mfc% between H and OPO subjects. # Statistically significant differences in Mfc% between OPE and OPO subjects. Lipidic profile of bone marrow in peripheral skeleton sites assessed by 1H-MRSpectroscopy: looking for instrumental biomarkers of osteoporosis. Giulia Di Pietro, Vincenzo Vinicola, Guglielmo Manenti, Mauro Rebuzzi, Gisela Hagberg, Salvatore Masala, Giovanni Simonetti, Marco Bozzali, and Silvia Capuani IIT@Sapienza, Physics Department, Rome, Rome, Italy, 2 “Sapienza” University of Rome, Physics Department, Rome, Rome, Italy, Rehabilitation Hospital IRCCS Santa Lucia Foundation, Rome, Italy, Department of Diagnostic Imaging and Interventional Radiology, Universit...

Introduction Bone Mineral Density (BMD) accounts only for about 60% of the global risk of bone fr... more Introduction Bone Mineral Density (BMD) accounts only for about 60% of the global risk of bone fracture. This lack of sensitivity is due to the partial information that BMD provides on spongy bone characteristics, assessing exclusively its mineral component quantification. Other components, such as bone marrow, collagen, and proteins, are present in spongy bone tissue, and may contribute in determining its resistance to fracture. MR studies have showed that Magnetic Resonance approaches, based on T2* measurements, might be a useful tool for the evaluation of osteoporosis. The aim of this study was to measure bone marrow relaxation times T2 and T2* from human osteoporotic calcanei at 3.0T and to correlate these measurements with bone marrow fat-water fraction extracted from proton spectra. This is because it is well-known that an increase in trabecular bone spacing induced by osteoporosis reduces the spatial field inhomogeneity and thus prolongs T2*. However, the individual variabili...

Evaluation of bone quality in calcanei of young and postmenopausal women through ADC measurement ... more Evaluation of bone quality in calcanei of young and postmenopausal women through ADC measurement Silvia Capuani, Rebuzzi Mauro, Vincenzo Vinicola, Umberto Sabatini, and Marco Bozzali Physics Department, CNR IPCF Roma "Sapienza " University, Rome, Rome, Italy, Physics Department, Physics Department Sapienza University, Rome, Italy, Rehabilitation Hospital, IRCCS Santa Lucia Foundation, Rome, Italy, Radiology Department, IRCCS Santa Lucia Foundation, Rome, Italy, Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy

Minerva Endocrinologica

BACKGROUND Several formulations of vitamin D and alendronate are available for the treatment of o... more BACKGROUND Several formulations of vitamin D and alendronate are available for the treatment of osteoporosis. The objective of this study was to examine efficacy and safety of calcifediol (25(OH)D) compared to cholecalciferol (vitamin D3) and also the relationship between different formulations of alendronate and adverse reactions. METHODS We observed a population of women diagnosed with postmenopausal osteoporosis or osteopenia treated with alendronate 70 mg weekly associated to vitamin D3 or 25(OH)D at monthly total dose of 625 µg. Data collected both at baseline (T0) and at follow-up after at least 12 months of therapy (T1) were: demographic characteristics, BMI, full medical history, lumbar T-score, femur T-score, calcium, osteocalcin, alkaline phosphatase, PTH and vitamin D blood level. RESULTS A total of 362 patients were enrolled in the study. Alendronate 70 mg + calcifediol (A+25(OH)D) group consisted of 202 patients while 160 patients were treated with alendronate 70 mg + cholecalciferol (A+D3). In the A+25(OH)D group, we observed a significant increase in lumbar T-score value (0.26±0.35 vs. 0.13±0.3) and serum vitamin D (20.64±20.71 vs. 6.07±7.61 ng/mL) levels compared to the A+D3 group (P<0.05). The lowest incidence of gastrointestinal adverse reactions was observed among patients taking alendronate 70 mg in drinkable solution form (P<0.05). CONCLUSIONS Alendronate 70 mg with calcifediol gives a better outcome in the treatment of osteoporosis according to lumbar T-score and vitamin D serum level observed at one-year follow-up compared to alendronate 70 mg with cholecalciferol. Both vitamin D formulations did not show to cause hypercalcemia in this study. Alendronate 70 mg in drinkable solution form is also associated with lowest incidence of gastrointestinal adverse reactions.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2018

Patients with severe acquired brain injury (SABI) may evolve towards different outcomes. The prim... more Patients with severe acquired brain injury (SABI) may evolve towards different outcomes. The primary aim was to evaluate the clinical evolution of a large population of patients with SABI admitted to post-acute rehabilitation from 2001 to 2016, diagnosed with severe brain injury (GCS ≤ 8) in the acute phase and a coma duration of at least 24 h. The possible changes between the admission time to a post-acute rehabilitation hospital and the discharge time were measured by means of Glasgow Outcome Scale (GOS), Level of Cognitive Functioning (LCF), and Disability Rating Scale (DRS). We also correlated the improvement rate with some sociodemographic and clinical features of the individuals with SABI enrolled. Data of 890 patients were analyzed (54% TBI, length of stay = 162 ± 186 days, GCS = 7.46 ± 1.28); time interval from the SABI (OR = 0.246, CI 95% = 0.181 - 0.333), scores at admission of LCF (OR = 2.243, CI 95% = 1.492 - 3.73), GOS (OR = 0.138, CI 95% = 0.071 - 0.266), DRS (OR = 0.4...

Annali Dell Istituto Superiore Di Sanita, Feb 1, 2001

Active improvised music therapy may offer an adjuvant from of treatment in the early rehabilitati... more Active improvised music therapy may offer an adjuvant from of treatment in the early rehabilitation of severe brain-injured patients. Active music therapy consists of musical improvisation between patient and therapist by singing or by playing different musical instruments, according to the vital functions, the neurological conditions and the motor abilities of the patients. We studied 34 severe brain-injured patients with a mean coma duration of 52 days +/- 37.21 and a mean interval from coma onset to the beginning of rehabilitation of 154 days on average. Our preliminary results show a significant improvement of the collaboration of the severe brain-injured patients and a reduction of undesired behaviours such as inertia (reduced psychomotor initiative) or psychomotor agitation.

Medical Science Monitor International Medical Journal of Experimental and Clinical Research, Mar 1, 2009

Survivors of severe traumatic brain injury (TBI) may show transient or persistent extrapyramidal ... more Survivors of severe traumatic brain injury (TBI) may show transient or persistent extrapyramidal symptoms such as rigidity, akinesia and parkinsonian posture, associated with hypomimia, not estinguishable glabellar tap reflex, seborrhea and hypersalivation. The Blink Reflex (BR), an electrically-induced reflex, is abnormal in Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (PD) and in some parkinsonisms. The aim of the study was to investigate BR habituation and its recovery cycle in survivors of severe TBI suffering from parkinsonian syndrome and the possible correlation with neuroimaging findings. Twenty-three patients (18 males, 5 females; mean age 23.7 years, range 13-35), who sustained a severe TBI, (Glasgow Coma Scale or GCS, lower than 8 in the first 48 hours), and followed by coma for a duration equal or longer than 15 days, were studied during the post-acute or chronic phase. Enrollement criteria include the presence of at least 3 extrapyramidal symptoms. BR was elicited by electrical stimulation of the supraorbital nerve and responses were recorded with surface electrodes from the orbicularis oculi muscle ipsilateral to the stimulation. A repeated series of 10 electrical stimuli was applied at the frequencies of stimulation of 0.3, 0.5, 0.7, 1.0, 1.5, 2.0 and 3.0 Hz, respectively. Values between 0.5 and 1 Hz were considered as normal, according to the international literature, Cerebral Magnetic Resonance (C-MRI), with fast sequences was performed within 3 months after brain injury. Ten healthy subjects, age and sex matched, served as controls and underwent the same procedure. Nineteen of the twenty-three patients (82.6%) showed a significantly reduced BR habituation in comparison with controls. This findings highly correlated with C-MRI diagnosis of Diffuse Axonal Injury (DAI). A normal BR habituation was found in only 4 out of 23 patients (17%). In these subjects, C-MRI revealed focal lesions rather than DAI. BR changes correlate with parkinsonian signs and neuroimaging findings. BR may have a role as a diagnostic tool in post-traumatic parkinsonism and as a prognostic tool to evaluate the effect of therapeutic options.

Academic Radiology, 2016

To characterize the lipidic profile of bone marrow in the calcaneus and femoral neck of healthy, ... more To characterize the lipidic profile of bone marrow in the calcaneus and femoral neck of healthy, osteopenic, and osteoporotic women, by using magnetic resonance spectroscopy (MRS) at 3T. The final goal was to identify specific metabolites with the potential ability to discriminate between healthy, osteopenic, and osteoporotic subjects. Sixty-two and thirty three postmenopausal women recruited to investigate calcaneus and femoral neck, respectively, underwent a bone mineral density (BMD) measurement to be classified as healthy subjects (n = 22), osteopenic (n = 45), or osteoporotic (n = 28) patients. MRS spectra were used to quantify and compare bone marrow fat resonances between the three BMD groups. Between-group differences were tested using a Welch analysis of variance. Multiple comparisons were made with the Games-Howell correction. Relationships between pairs of variables were assessed with linear correlation analysis. Reproducibility analysis was performed for all the lipid resonances in both sites. The reproducibility was satisfactory. In femoral neck, methylene (L13), glycerol (L41, L43), and total lipid resonances were significantly lower in healthy as compared to osteoporotic subjects. On the other hand, in calcaneus, L13/glycerol significantly discriminated between osteopenic and osteoporotic subjects whereas L13/(unsaturated lipid) discriminated between healthy and osteopenic group. However, the reproducibility of both unsaturated lipid and glycerol resonances were less optimal. MRS of bone marrow lipid profiles from peripheral skeletal sites may be a promising tool for screening of large population to identify individuals with or at risk for developing osteoporosis. Moreover, it provides information about the metabolic changes occurring in bone marrow with the development of osteoporosis, which are skeletal site dependent.

Acta Neurochir, 2004

Summary Background. The aim of the study was to evaluate the possible significant role of some cl... more Summary Background. The aim of the study was to evaluate the possible significant role of some clinical factors in predicting cognitive outcome in a group of severe traumatic brain injury (TBI) patients, with Glasgow Coma Scale (GCS) lower than 8 and duration of unconsciousness for at least 15 days (prolonged coma). Method. A consecutive sample of 25 survivors of severe TBI attending the Physical and Cognitive Rehabilitation program participated in this study. The neuropsychological test battery included: Word-list Learning, Prose recall, Rey Figure Delayed recall, Word fluency, Raven’s Progressive Matrices’ 47. The clinical variables evaluated in correlation with the neuropsychological outcome were the following: age, duration of unconsciousness, duration of post-traumatic amnesia, interval from head trauma to neuropsychological evaluation, interval from head trauma to recovery of oral feeding, and finally interval from head trauma to first verbal communication. Findings. The clinical variable with a significant predictive value on most neuropsychological scores was the interval from head trauma to the recovery of oral feeding. Conclusions. If this result is confirmed in larger samples, time interval of oral feeding recovery from head trauma should be considered as a possible predictor of neuropsychological outcome in TBI patients with prolonged coma.