Domenico Martinelli - Academia.edu (original) (raw)

Papers by Domenico Martinelli

The Pediatric Infectious Disease Journal, 2012

A survey was proposed to Italian Prevention Department (PD) Directors to investigate the opinions... more A survey was proposed to Italian Prevention Department (PD) Directors to investigate the opinions on the value of the cocoon strategy and its introduction. Cocoon was considered the most efficacious strategy to protect newborns against pertussis by 76% of the interviewees. Prevention Departments should promote and coordinate locally the strategy for 75% of the respondents. Cocoon should be recommended by Regional Authority for 82% of the interviewees.

The European Journal of Contraception and Reproductive Health Care, 2012

Objective To assess opinions and attitudes towards the use of hormonal emergency contraception (H... more Objective To assess opinions and attitudes towards the use of hormonal emergency contraception (HEC) in a sample of young women in Puglia, Italy. Methods A self-administered standardised anonymous questionnaire was administered to female school-leavers who were attending a preparatory course at the University of Bari. Results Seven hundred and fi fty-four women, with an average age of 19.5 years, completed the questionnaire. Sixteen percent of respondents had used HEC and 3% had used it more than once. The reasons given for resorting to HEC were: rupture of the condom (57%), the lack of thought about the risk of an undesired pregnancy (25%), and the unavailability of contraceptives at the time of coitus (18%). Conclusions The opinions expressed by the interviewees in our survey do not suggest that the use of HEC would increase the risks linked to sexual behaviour. In Italy, over-thecounter availability of HEC should be implemented in parallel with the improvement of sex education programmes aimed at the young.

Human Vaccines & Immunotherapeutics, 2013

This study describes an outbreak of varicella, in a small town in the region of Puglia, Southern ... more This study describes an outbreak of varicella, in a small town in the region of Puglia, Southern Italy, in the period between February-March 2011. This outbreak presented the opportunity to assess varicella vaccine effectiveness and its determinants. The outbreak occurred in a small community in Puglia; parents of the children attending the schools of the community were contacted by telephone and information was gathered on current disease and varicella history. Varicella vaccination history was verified through the immunization registry of the Local Health Unit. Before the outbreak, immunization coverage was 86.6% of children attending preschool and 51.9% of children attending elementary school. In day care center where the outbreak was happened, the attack rate in vaccinated individuals was 32.1% and 80% in susceptible unvaccinated individuals. VE is therefore estimated as 59.9% (95% CI = 48.3-69.8). In the elementary school the VE can be calculated as 69.2% (95% CI = 50.5-88.1), since the attack rate in unvaccinated children was of 23.1% and in vaccinated of 7.1. The time between vaccination and the onset of the epidemic appears higher in children with a vaccine failure. The results of this study highlight the need for a reflection on the desirability of adopting a shorter schedule in Italy, with a minimum 1 mo interval between MMRV doses.

Respiratory Medicine, 2011

Objectives: Dyspnea perception in asthmatics differs between subjects. Poor perception is usually... more Objectives: Dyspnea perception in asthmatics differs between subjects. Poor perception is usually associated with increased risk of asthma attack/exacerbation. The advanced stage of the disease and the presence of eosinophilic airways inflammation have been recently recognized as being responsible for poor dyspnea perception. However, few studies are available on this topic. Design: The aim of this study was to analyse the influence of inflammatory pattern, age and affective status on dyspnea perception in asthmatic subjects. Subjects and interventions: Seventy-one consecutive asthmatic patients were recruited and underwent induced sputum, exhaled NO measurement and breath condensate collection. Perception of dyspnea was evaluated as a BORGeVAS/FEV 1 slope before and after the broncho-reversibility test and correlated with the stage of asthma, inflammatory markers, age and depression scale. Results: Dyspnea perception decreases with the worsening of asthma, with the advance of age and of depression status. Furthermore, airways inflammation plays a key role in the decline of dyspnea perception as proved by the negative correlation observed between inflammatory cells in sputum, exhaled pH and NO and BORGeVAS/FEV 1 slope. Conclusions: The results of our study suggested that airways inflammation, depression status, advance age and severity of asthma influence dyspnea perception and suggest a straight control to identify and better manage poor preceptor asthmatics. ª (G.E. Carpagnano). a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r m e d Respiratory Medicine (2011) 105, 195e203 0954-6111/$ -see front matter ª

Medical Oncology, 2014

The exhaled breath temperature (EBT) has been proven to be the expression of airways inflammation... more The exhaled breath temperature (EBT) has been proven to be the expression of airways inflammation as well as of the increased vascularity. Although both these conditions characterize lung cancer pathogenesis, this is the first study where the EBT has been analysed in patients affected by non-small-cell lung cancer. The aim of this study was to verify whether and how the lung cancer being examined influences the EBT for possible future clinical implications. Eighty-two consecutive subjects with a radiological suspicion of lung cancer were enrolled and underwent standard diagnostic and staging procedures for cancer. EBT was measured in all the subjects at the enrolment with the X-Halo device. Forty patients resulted as affected by lung cancer while 42 as false-positive (controls). We found a higher EBT in NSCLC patients compared to healthy subjects. The EBT was correlated with number of packs/year and associated with the stage of lung cancer. We identified a cut-off value for the EBT that is able to screen patients with lung cancer with a high sensitivity and specificity. Our results suggest that lung cancer causes an increase in the EBT, which, whether confirmed and validated, could become a new non-invasive clinical tool in the screening and monitoring of this disease.

Retina, 2009

To examine the short-term fluctuation of diabetic macular edema (DME) after one intravitreal rani... more To examine the short-term fluctuation of diabetic macular edema (DME) after one intravitreal ranibizumab injection. Twenty consecutive patients with DME received an intravitreal injection of ranibizumab (0.05 mL/0.5 mg). Assessment of best-corrected visual acuity (BCVA), fundus biomicroscopy, MP-1 fundus-related perimetry using follow-up strategy (pattern macula 8 degrees 0 dB with threshold strategy 4-2), and optical coherence tomography central macular thickness (CMT),were performed at baseline and 1 hour, 24 hours, 14 days, 28 days, and 56 days after intravitreal injection of ranibizumab. A total of 18 eyes of 18 patients (9 male, 9 female; mean age, 62.28 +/- 8.08 years; range, 48-75 years) who completed the 56-day follow-up were included for analysis. Intravitreal ranibizumab was found to produce significant improvements in mean BCVA and MP-1 sensitivity, as well as reduction in mean CMT, after one injection. This anatomical and functional improvement, which compared with baseline was evident as soon as the 1-hour follow-up (mean CMT reduction: t= 1.7899, P = 0.045; mean MP-1 sensitivity improvement: t = -1.9891, P 0.0315), and lasted until the 56-day follow-up (mean BCVA improvement: t= 2.26, P < 0.05; mean CMT reduction: t = 3.61, P < 0.05; MP-1 sensitivity improvement: t = -5.21, P < 0.05). These short-term observations give insights into the physiopathology of DME treated with a intravitreal ranibizumab injection.

Human Vaccines & Immunotherapeutics, 2014

This study aims to evaluate the determinants of breakthrough infection after one dose of varicell... more This study aims to evaluate the determinants of breakthrough infection after one dose of varicella vaccine. We designed a retrospective case-control study. Breakthrough cases were children, aged 1-15, who presented varicella symptoms ≥ 42 days after the first dose of varicella vaccine (breakthrough). Controls were children, aged 1-15 years, who attended the same class (in a school or in a kindergarten) than the cases in the year of the breakthrough onset; they received a dose of varicella vaccine ≥ 42 days before the case rash onset and they did not develop varicella symptoms. We enrolled 45 cases and 135 controls. 40% of cases (n = 18; 95% CI = 25.4-54.6) presented at least one risk factor; this proportion was 39.2% (95% CI = 30.9-47.6) among the controls (chi-square = 0.0078; P = 0.93). Time between vaccination and virus exposure was longer among cases. Logistic regression showed that breakthrough disease was associated with duration of time from vaccination.

Human vaccines & immunotherapeutics, 2014

Pneumococcal disease epidemiology has changed after introduction of pneumococcal conjugate vaccin... more Pneumococcal disease epidemiology has changed after introduction of pneumococcal conjugate vaccines. sevenvalent vaccine (PcV7) has been effective in reducing invasive pneumococcal disease (IPD). In europe, PcV13 effectiveness was estimated at 78% (95% cI: -18-96%) for 2-priming doses. In Italy, PcV7 was introduced in 2006 in the childhood immunization schedule and replaced with PcV13 in 2010. In apulia, vaccination coverage has reached 95.1% (birth-cohort 2010). We estimated PcV program effectiveness and its impact on S.pneumoniae diseases.

Human vaccines & immunotherapeutics, 2015

Vaccination of healthcare workers (HCWs) reduces the risk of occupational infections, prevents no... more Vaccination of healthcare workers (HCWs) reduces the risk of occupational infections, prevents nosocomial transmission and maintains healthcare delivery during outbreaks. Despite the European directive and national legislation on workers' protection, immunization coverage among HCWs has often been very low. In light of Italian National Vaccination Plan 2012-2014 recommendations, the aim of this study was to assess levels of immunization and factors influencing adherence to vaccinations needed for HCWs in Puglia region, South Italy. The study was conducted using an interview-based standardized anonymous questionnaire administered to hospital employees in the period November 2009-March 2011. A total of 2198 health professionals responded in 51/69 Apulian hospitals (median age: 45 years; 65.2% nurses, 22.6% doctors and 12.2% other hospital personnel). Vaccination coverage was 24.8% for influenza, 70.1% for hepatitis B, 9.7% for MMR, 3.6% for varicella, and 15.5% for Td booster. Receiving counselling from occupational health physicians (OHPs) was associated with influenza (OR = 1.8; 95%CI = 1.5-2.2; P < 0.001), hepatitis B (OR = 4.9; 95%CI = 3.9-6.3; P < 0.001), varicella (OR = 43.7; 95%CI = 18.9-101.7; P < 0.001), MMR (OR = 8.8; 95%CI = 4.1-18.6; P < 0.001) and tetanus (OR = 50.5; 95%CI = 30.1-88.3; P < 0.001) vaccine uptake. OHPs should be trained with standard guidelines specific for healthcare settings and HCWs' risk groups to facilitate their crucial role in improving vaccine coverage among HCWs and increase awareness on the duty to protect both employees and patients.

Retina, 2010

The purpose of this study was to analyze the angiographic (confocal scanning laser ophthalmoscopy... more The purpose of this study was to analyze the angiographic (confocal scanning laser ophthalmoscopy technology) and corresponding (eye-tracked) spectral-domain optical coherence tomography (SD-OCT) features and to propose a classification for the progressive phases establishing retinal-choroidal anastomosis (RCA). We reviewed all consecutive eyes with RCA that underwent Heidelberg Retina Angiograph angiography and tracked Spectralis SD-OCT at the University Eye Clinic of Creteil between September 2007 and March 2009. Twenty-six eyes of 23 patients (8 men and 15 women, aged 70-88 years) showing RCA naïve to any treatment were included for analysis. In 6 of 7 eyes showing a discrete focal hyperfluorescence (focal staining), the corresponding (eye-tracked) SD-OCT scan showed a focal retinal pigment epithelium (RPE) erosion ("erosion sign") over a small, localized RPE elevation (which appeared filled with a hyperreflective material); in 7 of 8 eyes showing a typical "hot spot" in the late angiographic frames (focal leakage) and absence of a serosanguineous pigment epithelium detachment, the corresponding (eye-tracked) SD-OCT scan showed a focal RPE break leaving 2 free RPE flaps ("flap sign") at the level of a small, localized RPE elevation. In 10 of 11 eyes showing a typical hot spot in the late angiographic frames and presence of a serosanguineous pigment epithelium detachment, the corresponding (eye-tracked) SD-OCT scan showed, at the level of a large serosanguineous RPE detachment, a focal funnel-shaped RPE joining (kissing) an inverted focal funnel-shaped inner neuroepithelium ("kissing sign"). An early neovascularization (a discrete focal hyperfluorescence) arising from the choroid initially simply erodes the basement membrane/RPE (erosion sign; Phase 1) and later breaks the basement membrane/RPE (flap sign), infiltrating first into the outer retina forming an early RCA (Phase 2, a typical hot spot without a serosanguineous pigment epithelium detachment) and later into the inner retina (kissing sign) forming an established RCA (Phase 3, a typical hot spot with a serosanguineous pigment epithelium detachment).

Practical Management of Chronic Viral Hepatitis, 2013

Expert Review of Vaccines, 2010

Virology Journal, 2007

The genetic characterization of wild-type measles strains isolated during an epidemic cluster of ... more The genetic characterization of wild-type measles strains isolated during an epidemic cluster of measles occurred in Puglia (South Italy), between November 2006 and January 2007, was performed. Measles virus (MV) detection was carried out by a nested RT-PCR on 8 of 18 total cases. The viruses were analyzed using the standard genotyping protocols. The N gene sequences of the strains from outbreak were identical to each other, and sequence analysis revealed that the viruses belonged to genotype B3, subgroup B3.1, never identified before in Italy. An importation of measles B3.1 strains from Africa was hypothesized. Molecular surveillance will help to monitor the progress in measles elimination.

Vaccine, 2010

We describe an outbreak of varicella at a preschool center in Southern Italy, in the period Janua... more We describe an outbreak of varicella at a preschool center in Southern Italy, in the period January-May 2009, among children with a vaccination coverage of 53.9% for one dose.

Retina, 2011

The purpose of this study was to analyze the integrated infrared reflectance, fundus autofluoresc... more The purpose of this study was to analyze the integrated infrared reflectance, fundus autofluorescence, and fluorescein angiography (integrated confocal scanning laser ophthalmoscopy fundus imaging) features of reticular pseudodrusen and eye-tracked Spectralis high-resolution spectral domain optical coherence tomography (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany). Twenty-two consecutive patients with reticular pseudodrusen were prospectively enrolled and evaluated regarding confocal scanning laser ophthalmoscopy fundus imaging and eye-tracked SD-OCT findings. Integrated fundus imaging revealed a "target" aspect of most reticular pseudodrusen in the 42 included eyes (22 patients; 12 women, 10 men; mean age 81.38 ± 6.47 years). On fundus autofluorescence and infrared reflectance, the center of most reticular pseudodrusen appeared as an area of isoautofluorescence/reflectance surrounded by halos of reduced autofluorescence/reflectance. Similarly, on fluorescein angiography, the center of reticular pseudodrusen appeared as an area of decreased fluorescence surrounded by a faint halo of increased fluorescence. Spectral domain optical coherence tomography showed a well-defined round or triangular hyperreflective deposit localized between, externally, the retinal pigment epithelium layer, and, internally, the external limiting membrane or the outer plexiform layer. Moreover, SD-OCT showed the loss of both outer segment/retinal pigment epithelium interface and inner segment/outer segment interface over the hyperreflective lesions, as well as an abrupt interruption of both these interfaces at the border of the hyperreflective lesions. The peculiar confocal scanning laser ophthalmoscopy fundus imaging and tracked SD-OCT of reticular pseudodrusen suggest the presence of central lipofuscin-like retinal deposits localized above the retinal pigment epithelium. These findings give insights to other possible aspects of age-related retinal changes.

Rejuvenation Research, 2012

Background: The exact diagnosis of malignant pleural effusions (PE) is difficult and often requir... more Background: The exact diagnosis of malignant pleural effusions (PE) is difficult and often requires combined procedures, because the cytological examination of pleural fluid does not detect tumoral cells in 40% of malignant effusion cases. The aim of this study was to analyze microsatellite alterations (MA) in malignant PE and to determine their diagnostic value as an additional test to cytological examination. The increase in cell-free DNA levels was also evaluated as a signal of probable malignancy. Methods: A total of 84 patients with PE were enrolled and underwent PE and whole blood and exhaled breath condensate analyses. Free DNA was measured by spectrophotometer analyses. DNA was extracted from all samples and analyzed for MA, using the microsatellite markers at chromosomes 3p, 12p, 5q, and 17p. Results: The microsatellite analysis of PE exhibited a higher percentage of alterations in malignant PE than in benign PE. In addition to this, cell-free DNA in PE was seen to be significantly more elevated in malignant than in benign PE. The sensitivity of the sole cytology increased considerably when patients showed at least one MA or DNA > 4 ng/lL in the PE. Conclusion: In conclusion, it was seen that the combination of the cytological examination with microsatellite analyses and cell-free DNA in pleural fluid could increase the sensitivity of the diagnosis in patients with PE who have a suspected malignancy, obviating the need for other invasive diagnostic procedures.

Rejuvenation Research, 2012

Matrix metalloproteinase-9 (MMP-9) has been recognized in several types of tumor development and ... more Matrix metalloproteinase-9 (MMP-9) has been recognized in several types of tumor development and progression, including lung cancer, for its role in the degradation and remodeling of lung tissue. Furthermore, increased MMP-9 has been commonly described in the serum and airways of non-small cell lung cancer (NSCLC) patients. The aim of this study was to investigate, for the first time, MMP-9 in the exhaled breath condensate (EBC) of NSCLC patients. We enrolled 40 NSCLC patients and 40 controls affected by transudative pleural effusion. MMP-9 concentrations were measured in the EBC, whole blood (WB), and pleural effusion (PE) of all the subjects under study using enzyme immunoassay (EIA) kits. MMP-9 levels were found to be significantly higher in EBC, WB, and PE of NSCLC patients compared with controls. A positive correlation was observed between MMP-9 in EBC, cigarettes smoked, and stage of cancer. Exhaled MMP-9 was elevated in NSCLC patients, especially during tumor progression, and could represent a suitable noninvasive marker in the diagnosis and monitoring of lung cancer.

Ophthalmic Research, 2011

To study the ability to appreciate qualitative features that indicate disease activity in patient... more To study the ability to appreciate qualitative features that indicate disease activity in patients with neovascular age-related macular degeneration (AMD) and to analyze the differences in automated retinal thickness measurement, using 1 time domain optical coherence tomography (TD-OCT) and 2 different spectral-domain OCT (SD-OCT) machines. Thirty-three consecutive naïve patients with neovascular AMD underwent Stratus TD-OCT, Cirrus SD-OCT and Spectralis SD-OCT, at baseline, 1 h, 1 day, 1 week and 1 month after intravitreal ranibizumab injection. As regards the ability to detect retinal cysts, subretinal fluid and pigment epithelium detachment, at each follow-up visit, there was a significant correlation among all 3 OCT devices (p < 0.05), even though Cirrus SD-OCT and Spectralis SD-OCT showed the highest level of intermachine agreement. At each follow-up visit, automated retinal thickness measurements showed a greater mean central macular thickness (CMT) for both Spectralis SD-OCT and Cirrus SD-OCT, compared with Stratus TD-OCT. However, the mean paired differences in CMT among the 3 OCT devices were not statistically significant (p > 0.05). Overall, Cirrus SD-CT showed fewer segmentation errors, compared with both Spectralis SD-OCT and Stratus TD-OCT. SD-OCT showed a greater ability to evaluate qualitative features indicating disease activity and fewer errors in automated segmentation. However, differences in CMT changes were similar between TD-OCT and SD-OCT systems during follow-up.

Neuropsychiatric Disease and Treatment, 2009

This study evaluates the correlation between failure to develop spontaneous imitation and languag... more This study evaluates the correlation between failure to develop spontaneous imitation and language skills in pervasive developmental disorders. Sixty-four children between the age of 3 and 8 years were assessed using the Autism Diagnostic Interview-Revised (ADI-R), the Childhood Autism Rating Scale (CARS), and the Autism Diagnostic Observation Schedule (ADOS), as well as direct observation of imitation. The sample was subdivided into a verbal and a nonverbal group. Analysis of mean scores on the CARS "imitation" items and of ADI-R "spontaneous imitation" and "pointing to express interest" revealed a statistically significant difference between verbal and nonverbal groups, with more severe impairment/higher scores in the nonverbal than the verbal group. These results suggest that nonverbal children have specifically impaired imitation and pointing skills.

The Pediatric Infectious Disease Journal, 2012

A survey was proposed to Italian Prevention Department (PD) Directors to investigate the opinions... more A survey was proposed to Italian Prevention Department (PD) Directors to investigate the opinions on the value of the cocoon strategy and its introduction. Cocoon was considered the most efficacious strategy to protect newborns against pertussis by 76% of the interviewees. Prevention Departments should promote and coordinate locally the strategy for 75% of the respondents. Cocoon should be recommended by Regional Authority for 82% of the interviewees.

The European Journal of Contraception and Reproductive Health Care, 2012

Objective To assess opinions and attitudes towards the use of hormonal emergency contraception (H... more Objective To assess opinions and attitudes towards the use of hormonal emergency contraception (HEC) in a sample of young women in Puglia, Italy. Methods A self-administered standardised anonymous questionnaire was administered to female school-leavers who were attending a preparatory course at the University of Bari. Results Seven hundred and fi fty-four women, with an average age of 19.5 years, completed the questionnaire. Sixteen percent of respondents had used HEC and 3% had used it more than once. The reasons given for resorting to HEC were: rupture of the condom (57%), the lack of thought about the risk of an undesired pregnancy (25%), and the unavailability of contraceptives at the time of coitus (18%). Conclusions The opinions expressed by the interviewees in our survey do not suggest that the use of HEC would increase the risks linked to sexual behaviour. In Italy, over-thecounter availability of HEC should be implemented in parallel with the improvement of sex education programmes aimed at the young.

Human Vaccines & Immunotherapeutics, 2013

This study describes an outbreak of varicella, in a small town in the region of Puglia, Southern ... more This study describes an outbreak of varicella, in a small town in the region of Puglia, Southern Italy, in the period between February-March 2011. This outbreak presented the opportunity to assess varicella vaccine effectiveness and its determinants. The outbreak occurred in a small community in Puglia; parents of the children attending the schools of the community were contacted by telephone and information was gathered on current disease and varicella history. Varicella vaccination history was verified through the immunization registry of the Local Health Unit. Before the outbreak, immunization coverage was 86.6% of children attending preschool and 51.9% of children attending elementary school. In day care center where the outbreak was happened, the attack rate in vaccinated individuals was 32.1% and 80% in susceptible unvaccinated individuals. VE is therefore estimated as 59.9% (95% CI = 48.3-69.8). In the elementary school the VE can be calculated as 69.2% (95% CI = 50.5-88.1), since the attack rate in unvaccinated children was of 23.1% and in vaccinated of 7.1. The time between vaccination and the onset of the epidemic appears higher in children with a vaccine failure. The results of this study highlight the need for a reflection on the desirability of adopting a shorter schedule in Italy, with a minimum 1 mo interval between MMRV doses.

Respiratory Medicine, 2011

Objectives: Dyspnea perception in asthmatics differs between subjects. Poor perception is usually... more Objectives: Dyspnea perception in asthmatics differs between subjects. Poor perception is usually associated with increased risk of asthma attack/exacerbation. The advanced stage of the disease and the presence of eosinophilic airways inflammation have been recently recognized as being responsible for poor dyspnea perception. However, few studies are available on this topic. Design: The aim of this study was to analyse the influence of inflammatory pattern, age and affective status on dyspnea perception in asthmatic subjects. Subjects and interventions: Seventy-one consecutive asthmatic patients were recruited and underwent induced sputum, exhaled NO measurement and breath condensate collection. Perception of dyspnea was evaluated as a BORGeVAS/FEV 1 slope before and after the broncho-reversibility test and correlated with the stage of asthma, inflammatory markers, age and depression scale. Results: Dyspnea perception decreases with the worsening of asthma, with the advance of age and of depression status. Furthermore, airways inflammation plays a key role in the decline of dyspnea perception as proved by the negative correlation observed between inflammatory cells in sputum, exhaled pH and NO and BORGeVAS/FEV 1 slope. Conclusions: The results of our study suggested that airways inflammation, depression status, advance age and severity of asthma influence dyspnea perception and suggest a straight control to identify and better manage poor preceptor asthmatics. ª (G.E. Carpagnano). a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r m e d Respiratory Medicine (2011) 105, 195e203 0954-6111/$ -see front matter ª

Medical Oncology, 2014

The exhaled breath temperature (EBT) has been proven to be the expression of airways inflammation... more The exhaled breath temperature (EBT) has been proven to be the expression of airways inflammation as well as of the increased vascularity. Although both these conditions characterize lung cancer pathogenesis, this is the first study where the EBT has been analysed in patients affected by non-small-cell lung cancer. The aim of this study was to verify whether and how the lung cancer being examined influences the EBT for possible future clinical implications. Eighty-two consecutive subjects with a radiological suspicion of lung cancer were enrolled and underwent standard diagnostic and staging procedures for cancer. EBT was measured in all the subjects at the enrolment with the X-Halo device. Forty patients resulted as affected by lung cancer while 42 as false-positive (controls). We found a higher EBT in NSCLC patients compared to healthy subjects. The EBT was correlated with number of packs/year and associated with the stage of lung cancer. We identified a cut-off value for the EBT that is able to screen patients with lung cancer with a high sensitivity and specificity. Our results suggest that lung cancer causes an increase in the EBT, which, whether confirmed and validated, could become a new non-invasive clinical tool in the screening and monitoring of this disease.

Retina, 2009

To examine the short-term fluctuation of diabetic macular edema (DME) after one intravitreal rani... more To examine the short-term fluctuation of diabetic macular edema (DME) after one intravitreal ranibizumab injection. Twenty consecutive patients with DME received an intravitreal injection of ranibizumab (0.05 mL/0.5 mg). Assessment of best-corrected visual acuity (BCVA), fundus biomicroscopy, MP-1 fundus-related perimetry using follow-up strategy (pattern macula 8 degrees 0 dB with threshold strategy 4-2), and optical coherence tomography central macular thickness (CMT),were performed at baseline and 1 hour, 24 hours, 14 days, 28 days, and 56 days after intravitreal injection of ranibizumab. A total of 18 eyes of 18 patients (9 male, 9 female; mean age, 62.28 +/- 8.08 years; range, 48-75 years) who completed the 56-day follow-up were included for analysis. Intravitreal ranibizumab was found to produce significant improvements in mean BCVA and MP-1 sensitivity, as well as reduction in mean CMT, after one injection. This anatomical and functional improvement, which compared with baseline was evident as soon as the 1-hour follow-up (mean CMT reduction: t= 1.7899, P = 0.045; mean MP-1 sensitivity improvement: t = -1.9891, P 0.0315), and lasted until the 56-day follow-up (mean BCVA improvement: t= 2.26, P < 0.05; mean CMT reduction: t = 3.61, P < 0.05; MP-1 sensitivity improvement: t = -5.21, P < 0.05). These short-term observations give insights into the physiopathology of DME treated with a intravitreal ranibizumab injection.

Human Vaccines & Immunotherapeutics, 2014

This study aims to evaluate the determinants of breakthrough infection after one dose of varicell... more This study aims to evaluate the determinants of breakthrough infection after one dose of varicella vaccine. We designed a retrospective case-control study. Breakthrough cases were children, aged 1-15, who presented varicella symptoms ≥ 42 days after the first dose of varicella vaccine (breakthrough). Controls were children, aged 1-15 years, who attended the same class (in a school or in a kindergarten) than the cases in the year of the breakthrough onset; they received a dose of varicella vaccine ≥ 42 days before the case rash onset and they did not develop varicella symptoms. We enrolled 45 cases and 135 controls. 40% of cases (n = 18; 95% CI = 25.4-54.6) presented at least one risk factor; this proportion was 39.2% (95% CI = 30.9-47.6) among the controls (chi-square = 0.0078; P = 0.93). Time between vaccination and virus exposure was longer among cases. Logistic regression showed that breakthrough disease was associated with duration of time from vaccination.

Human vaccines & immunotherapeutics, 2014

Pneumococcal disease epidemiology has changed after introduction of pneumococcal conjugate vaccin... more Pneumococcal disease epidemiology has changed after introduction of pneumococcal conjugate vaccines. sevenvalent vaccine (PcV7) has been effective in reducing invasive pneumococcal disease (IPD). In europe, PcV13 effectiveness was estimated at 78% (95% cI: -18-96%) for 2-priming doses. In Italy, PcV7 was introduced in 2006 in the childhood immunization schedule and replaced with PcV13 in 2010. In apulia, vaccination coverage has reached 95.1% (birth-cohort 2010). We estimated PcV program effectiveness and its impact on S.pneumoniae diseases.

Human vaccines & immunotherapeutics, 2015

Vaccination of healthcare workers (HCWs) reduces the risk of occupational infections, prevents no... more Vaccination of healthcare workers (HCWs) reduces the risk of occupational infections, prevents nosocomial transmission and maintains healthcare delivery during outbreaks. Despite the European directive and national legislation on workers' protection, immunization coverage among HCWs has often been very low. In light of Italian National Vaccination Plan 2012-2014 recommendations, the aim of this study was to assess levels of immunization and factors influencing adherence to vaccinations needed for HCWs in Puglia region, South Italy. The study was conducted using an interview-based standardized anonymous questionnaire administered to hospital employees in the period November 2009-March 2011. A total of 2198 health professionals responded in 51/69 Apulian hospitals (median age: 45 years; 65.2% nurses, 22.6% doctors and 12.2% other hospital personnel). Vaccination coverage was 24.8% for influenza, 70.1% for hepatitis B, 9.7% for MMR, 3.6% for varicella, and 15.5% for Td booster. Receiving counselling from occupational health physicians (OHPs) was associated with influenza (OR = 1.8; 95%CI = 1.5-2.2; P < 0.001), hepatitis B (OR = 4.9; 95%CI = 3.9-6.3; P < 0.001), varicella (OR = 43.7; 95%CI = 18.9-101.7; P < 0.001), MMR (OR = 8.8; 95%CI = 4.1-18.6; P < 0.001) and tetanus (OR = 50.5; 95%CI = 30.1-88.3; P < 0.001) vaccine uptake. OHPs should be trained with standard guidelines specific for healthcare settings and HCWs' risk groups to facilitate their crucial role in improving vaccine coverage among HCWs and increase awareness on the duty to protect both employees and patients.

Retina, 2010

The purpose of this study was to analyze the angiographic (confocal scanning laser ophthalmoscopy... more The purpose of this study was to analyze the angiographic (confocal scanning laser ophthalmoscopy technology) and corresponding (eye-tracked) spectral-domain optical coherence tomography (SD-OCT) features and to propose a classification for the progressive phases establishing retinal-choroidal anastomosis (RCA). We reviewed all consecutive eyes with RCA that underwent Heidelberg Retina Angiograph angiography and tracked Spectralis SD-OCT at the University Eye Clinic of Creteil between September 2007 and March 2009. Twenty-six eyes of 23 patients (8 men and 15 women, aged 70-88 years) showing RCA naïve to any treatment were included for analysis. In 6 of 7 eyes showing a discrete focal hyperfluorescence (focal staining), the corresponding (eye-tracked) SD-OCT scan showed a focal retinal pigment epithelium (RPE) erosion ("erosion sign") over a small, localized RPE elevation (which appeared filled with a hyperreflective material); in 7 of 8 eyes showing a typical "hot spot" in the late angiographic frames (focal leakage) and absence of a serosanguineous pigment epithelium detachment, the corresponding (eye-tracked) SD-OCT scan showed a focal RPE break leaving 2 free RPE flaps ("flap sign") at the level of a small, localized RPE elevation. In 10 of 11 eyes showing a typical hot spot in the late angiographic frames and presence of a serosanguineous pigment epithelium detachment, the corresponding (eye-tracked) SD-OCT scan showed, at the level of a large serosanguineous RPE detachment, a focal funnel-shaped RPE joining (kissing) an inverted focal funnel-shaped inner neuroepithelium ("kissing sign"). An early neovascularization (a discrete focal hyperfluorescence) arising from the choroid initially simply erodes the basement membrane/RPE (erosion sign; Phase 1) and later breaks the basement membrane/RPE (flap sign), infiltrating first into the outer retina forming an early RCA (Phase 2, a typical hot spot without a serosanguineous pigment epithelium detachment) and later into the inner retina (kissing sign) forming an established RCA (Phase 3, a typical hot spot with a serosanguineous pigment epithelium detachment).

Practical Management of Chronic Viral Hepatitis, 2013

Expert Review of Vaccines, 2010

Virology Journal, 2007

The genetic characterization of wild-type measles strains isolated during an epidemic cluster of ... more The genetic characterization of wild-type measles strains isolated during an epidemic cluster of measles occurred in Puglia (South Italy), between November 2006 and January 2007, was performed. Measles virus (MV) detection was carried out by a nested RT-PCR on 8 of 18 total cases. The viruses were analyzed using the standard genotyping protocols. The N gene sequences of the strains from outbreak were identical to each other, and sequence analysis revealed that the viruses belonged to genotype B3, subgroup B3.1, never identified before in Italy. An importation of measles B3.1 strains from Africa was hypothesized. Molecular surveillance will help to monitor the progress in measles elimination.

Vaccine, 2010

We describe an outbreak of varicella at a preschool center in Southern Italy, in the period Janua... more We describe an outbreak of varicella at a preschool center in Southern Italy, in the period January-May 2009, among children with a vaccination coverage of 53.9% for one dose.

Retina, 2011

The purpose of this study was to analyze the integrated infrared reflectance, fundus autofluoresc... more The purpose of this study was to analyze the integrated infrared reflectance, fundus autofluorescence, and fluorescein angiography (integrated confocal scanning laser ophthalmoscopy fundus imaging) features of reticular pseudodrusen and eye-tracked Spectralis high-resolution spectral domain optical coherence tomography (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany). Twenty-two consecutive patients with reticular pseudodrusen were prospectively enrolled and evaluated regarding confocal scanning laser ophthalmoscopy fundus imaging and eye-tracked SD-OCT findings. Integrated fundus imaging revealed a "target" aspect of most reticular pseudodrusen in the 42 included eyes (22 patients; 12 women, 10 men; mean age 81.38 ± 6.47 years). On fundus autofluorescence and infrared reflectance, the center of most reticular pseudodrusen appeared as an area of isoautofluorescence/reflectance surrounded by halos of reduced autofluorescence/reflectance. Similarly, on fluorescein angiography, the center of reticular pseudodrusen appeared as an area of decreased fluorescence surrounded by a faint halo of increased fluorescence. Spectral domain optical coherence tomography showed a well-defined round or triangular hyperreflective deposit localized between, externally, the retinal pigment epithelium layer, and, internally, the external limiting membrane or the outer plexiform layer. Moreover, SD-OCT showed the loss of both outer segment/retinal pigment epithelium interface and inner segment/outer segment interface over the hyperreflective lesions, as well as an abrupt interruption of both these interfaces at the border of the hyperreflective lesions. The peculiar confocal scanning laser ophthalmoscopy fundus imaging and tracked SD-OCT of reticular pseudodrusen suggest the presence of central lipofuscin-like retinal deposits localized above the retinal pigment epithelium. These findings give insights to other possible aspects of age-related retinal changes.

Rejuvenation Research, 2012

Background: The exact diagnosis of malignant pleural effusions (PE) is difficult and often requir... more Background: The exact diagnosis of malignant pleural effusions (PE) is difficult and often requires combined procedures, because the cytological examination of pleural fluid does not detect tumoral cells in 40% of malignant effusion cases. The aim of this study was to analyze microsatellite alterations (MA) in malignant PE and to determine their diagnostic value as an additional test to cytological examination. The increase in cell-free DNA levels was also evaluated as a signal of probable malignancy. Methods: A total of 84 patients with PE were enrolled and underwent PE and whole blood and exhaled breath condensate analyses. Free DNA was measured by spectrophotometer analyses. DNA was extracted from all samples and analyzed for MA, using the microsatellite markers at chromosomes 3p, 12p, 5q, and 17p. Results: The microsatellite analysis of PE exhibited a higher percentage of alterations in malignant PE than in benign PE. In addition to this, cell-free DNA in PE was seen to be significantly more elevated in malignant than in benign PE. The sensitivity of the sole cytology increased considerably when patients showed at least one MA or DNA > 4 ng/lL in the PE. Conclusion: In conclusion, it was seen that the combination of the cytological examination with microsatellite analyses and cell-free DNA in pleural fluid could increase the sensitivity of the diagnosis in patients with PE who have a suspected malignancy, obviating the need for other invasive diagnostic procedures.

Rejuvenation Research, 2012

Matrix metalloproteinase-9 (MMP-9) has been recognized in several types of tumor development and ... more Matrix metalloproteinase-9 (MMP-9) has been recognized in several types of tumor development and progression, including lung cancer, for its role in the degradation and remodeling of lung tissue. Furthermore, increased MMP-9 has been commonly described in the serum and airways of non-small cell lung cancer (NSCLC) patients. The aim of this study was to investigate, for the first time, MMP-9 in the exhaled breath condensate (EBC) of NSCLC patients. We enrolled 40 NSCLC patients and 40 controls affected by transudative pleural effusion. MMP-9 concentrations were measured in the EBC, whole blood (WB), and pleural effusion (PE) of all the subjects under study using enzyme immunoassay (EIA) kits. MMP-9 levels were found to be significantly higher in EBC, WB, and PE of NSCLC patients compared with controls. A positive correlation was observed between MMP-9 in EBC, cigarettes smoked, and stage of cancer. Exhaled MMP-9 was elevated in NSCLC patients, especially during tumor progression, and could represent a suitable noninvasive marker in the diagnosis and monitoring of lung cancer.

Ophthalmic Research, 2011

To study the ability to appreciate qualitative features that indicate disease activity in patient... more To study the ability to appreciate qualitative features that indicate disease activity in patients with neovascular age-related macular degeneration (AMD) and to analyze the differences in automated retinal thickness measurement, using 1 time domain optical coherence tomography (TD-OCT) and 2 different spectral-domain OCT (SD-OCT) machines. Thirty-three consecutive naïve patients with neovascular AMD underwent Stratus TD-OCT, Cirrus SD-OCT and Spectralis SD-OCT, at baseline, 1 h, 1 day, 1 week and 1 month after intravitreal ranibizumab injection. As regards the ability to detect retinal cysts, subretinal fluid and pigment epithelium detachment, at each follow-up visit, there was a significant correlation among all 3 OCT devices (p < 0.05), even though Cirrus SD-OCT and Spectralis SD-OCT showed the highest level of intermachine agreement. At each follow-up visit, automated retinal thickness measurements showed a greater mean central macular thickness (CMT) for both Spectralis SD-OCT and Cirrus SD-OCT, compared with Stratus TD-OCT. However, the mean paired differences in CMT among the 3 OCT devices were not statistically significant (p > 0.05). Overall, Cirrus SD-CT showed fewer segmentation errors, compared with both Spectralis SD-OCT and Stratus TD-OCT. SD-OCT showed a greater ability to evaluate qualitative features indicating disease activity and fewer errors in automated segmentation. However, differences in CMT changes were similar between TD-OCT and SD-OCT systems during follow-up.

Neuropsychiatric Disease and Treatment, 2009

This study evaluates the correlation between failure to develop spontaneous imitation and languag... more This study evaluates the correlation between failure to develop spontaneous imitation and language skills in pervasive developmental disorders. Sixty-four children between the age of 3 and 8 years were assessed using the Autism Diagnostic Interview-Revised (ADI-R), the Childhood Autism Rating Scale (CARS), and the Autism Diagnostic Observation Schedule (ADOS), as well as direct observation of imitation. The sample was subdivided into a verbal and a nonverbal group. Analysis of mean scores on the CARS "imitation" items and of ADI-R "spontaneous imitation" and "pointing to express interest" revealed a statistically significant difference between verbal and nonverbal groups, with more severe impairment/higher scores in the nonverbal than the verbal group. These results suggest that nonverbal children have specifically impaired imitation and pointing skills.