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2. The Escape Project: Sensor Selection for the Development of a Portable System for Landfill Surface Emission Monitoring

Author

Veronica Villa, Dario Vernola, Stefano Robbiani, Beatrice J. Lotesoriere, Christian Ratti, Gabriele Viscardi, Manuel Roveri, Raffaele Dellacà, Yuri Ponzani, and Laura Capelli

Subjects
Chemical engineering, TP155-156, Computer engineering. Computer hardware, TK7885-7895
Abstract

The ESCAPE (Environmental Sites CH4 Assessment Platform Europe) has the aim to develop an innovative environmental monitoring system based on a cloud-based online platform, combining ground and space-based datasets with AI-based solutions and algorithms for spotting emissions from landfill sites. This paper presents the research activities related to the selection of the sensors for the implementation of a portable sensor system for monitoring gaseous emissions over the landfill surface. Specifically, 6 gas sensors (2 MOX, 3 digital MOX and 1 NDIR) were selected based on a technology scouting involving the study of scientific literature and technical documentation, and then tested towards different concentrations (i.e., 10, 100, 1,000 and 10,000 ppm) of CH4 and CO2. Test results show that the MOX sensors TGS2611, SGP40 and BME688 are sensitive to CH4 at concentrations down to 10 ppm, and have no (or low) cross-sensitivity to CO2, making them suitable for the considered application. The NDIR sensor, despite being sensitive only to CH4 concentrations >1000 ppm, could be nonetheless included in the sensors toolbox because of its selectivity.

Published
2024

4. Overcoming Therapeutic Inertia in Type 2 Diabetes: Exploring Machine Learning-Based Scenario Simulation for Improving Short-Term Glycemic Control

Author

Musacchio Nicoletta, Rita Zilich, Davide Masi, Fabio Baccetti, Besmir Nreu, Carlo Bruno Giorda, Giacomo Guaita, Lelio Morviducci, Marco Muselli, Alessandro Ozzello, Federico Pisani, Paola Ponzani, Antonio Rossi, Pierluigi Santin, Damiano Verda, Graziano Di Cianni, and Riccardo Candido

Subjects
machine learning, artificial intelligence, type 2 diabetes, therapeutic inertia, insulin, Computer engineering. Computer hardware, TK7885-7895
Abstract

Background: International guidelines for diabetes care emphasize the urgency of promptly achieving and sustaining adequate glycemic control to reduce the occurrence of micro/macrovascular complications in patients with type 2 diabetes mellitus (T2DM). However, data from the Italian Association of Medical Diabetologists (AMD) Annals reveal that only 47% of T2DM patients reach appropriate glycemic targets, with approximately 30% relying on insulin therapy, either solely or in combination. This artificial intelligence analysis seeks to assess the potential impact of timely insulin initiation in all eligible patients via a “what-if” scenario simulation, leveraging real-world data. Methods: This retrospective cohort study utilized the AMD Annals database, comprising 1,186,247 T2DM patients from 2005 to 2019. Employing the Logic Learning Machine (LLM), we simulated timely insulin use for all eligible patients, estimating its effect on glycemic control after 12 months within a cohort of 85,239 patients. Of these, 20,015 were employed for the machine learning phase and 65,224 for simulation. Results: Within the simulated scenario, the introduction of appropriate insulin therapy led to a noteworthy projected 17% increase in patients meeting the metabolic target after 12 months from therapy initiation within the cohort of 65,224 individuals. The LLM’s projection envisages 32,851 potential patients achieving the target (hemoglobin glycated < 7.5%) after 12 months, compared to 21,453 patients observed in real-world cases. The receiver operating characteristic (ROC) curve analysis for this model demonstrated modest performance, with an area under the curve (AUC) value of 70.4%. Conclusions: This study reaffirms the significance of combatting therapeutic inertia in managing T2DM patients. Early insulinization, when clinically appropriate, markedly enhances patients’ metabolic goals at the 12-month follow-up.

Published
2024
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5. Il riconoscimento della figura professionale del bibliotecario e la nuova edizione della UNI 11535

Author

Vittorio Ponzani, Paola Manoni, and Giovanna Mazzola Merola

Subjects
bibliotecari, riconoscimento professionale, norma UNI 11535, Bibliography. Library science. Information resources
Abstract

Si illustrano le caratteristiche dell’edizione 2023 della norma UNI 11535 sulla figura professionale del bibliotecario. Rientra infatti nel normale iter procedurale dell’Ente italiano di normazione UNI che ogni norma tecnica venga sottoposta periodicamente a revisione, conservando l’impianto e l’articolazione originale e modificando il testo in funzione dell’evoluzione della normativa italiana e internazionale. Conseguentemente le principali novità introdotte in questa edizione sono relative a: l’introduzione del concetto di autonomia e responsabilità, l’attribuzione della fascia di ottavo livello, lo stretto collegamento alle disposizioni definite dall’AIB in merito ai requisiti per accesso, mantenimento e rinnovo dell’attestazione dei propri associati. L’articolo ripercorre inoltre alcuni momenti del riconoscimento professionale con riferimento al contesto AIB e alla legge n. 4 del 2013, che evidenzia come le disposizioni in materia di professioni non organizzate hanno di fatto reso possibile una sinergia tra legislazione, normazione tecnica e ruolo delle associazioni.

Published
2024
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7. 透明机器学习预测决定2型糖尿病患者开始胰岛素治疗的关键驱动因素

Author

Nicoletta Musacchio, Rita Zilich, Paola Ponzani, Giacomo Guaita, Carlo Giorda, Rebeca Heidbreder, Pierluigi Santin, and Graziano Di Cianni

Subjects
2型糖尿病, 治疗惯性, 机器学习, 人工智能, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Abstract Aims The objective of this study is to establish a predictive model using transparent machine learning (ML) to identify any drivers that characterize therapeutic inertia. Methods Data in the form of both descriptive and dynamic variables collected from electronic records of 1.5 million patients seen at clinics within the Italian Association of Medical Diabetologists between 2005–2019 were analyzed using logic learning machine (LLM), a “clear box” ML technique. Data were subjected to a first stage of modeling to allow ML to automatically select the most relevant factors related to inertia, and then four further modeling steps individuated key variables that discriminated the presence or absence of inertia. Results The LLM model revealed a key role for average glycated hemoglobin (HbA1c) threshold values correlated with the presence or absence of insulin therapeutic inertia with an accuracy of 0.79. The model indicated that a patient's dynamic rather than static glycemic profile has a greater effect on therapeutic inertia. Specifically, the difference in HbA1c between two consecutive visits, what we call the HbA1c gap, plays a crucial role. Namely, insulin therapeutic inertia is correlated with an HbA1c gap of 11 mmol/mol (1.0%). Conclusions The results reveal, for the first time, the interrelationship between a patient's glycemic trend defined by sequential HbA1c measurements and timely or delayed initiation of insulin therapy. The results further demonstrate that LLM can provide insight in support of evidence‐based medicine using real world data.

Published
2023
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10. Measles vaccine uptake among Italian medical students compared to the pre-COVID-19 era

Author

Cristiana Ferrari, Giuseppina Somma, Ole Olesen, Ersilia Buonomo, Matteo Pasanisi Zingarello, Andrea Mazza, Stefano Rizza, Luca Di Giampaolo, Andrea Magrini, Francesca Ponzani, and Luca Coppeta

Subjects
measles, measles vaccine, outbreak, vaccination, healthcare workers, medical students, covid-19, sars-cov-2 pandemic, Immunologic diseases. Allergy, RC581-607, Therapeutics. Pharmacology, RM1-950
Abstract

The COVID-19 pandemic has severely affected health systems worldwide and raised the issue of vaccine hesitancy. In 2022, the World Health Organization reported an outbreak of measles infection among people over 20 years of age in the European Region. Previous studies found low rates of measles immunization among Italian healthcare workers (HCWs) and medical students. Vaccine hesitancy is a relevant cause of low immunization rate among HCWs and the general population. We aim to evaluate the measles vaccine uptake among medical students of a large teaching hospital, compared to the pre-pandemic period. This is a retrospective observational study, that evaluated the immune status and the vaccine acceptance rate for measles in medical students at the University of Tor Vergata, Rome, who underwent occupational health surveillance from 1 January to 1 December 2022. We also compared the data with the results of a pre-pandemic survey conducted in 2018. Vaccine uptake among unprotected medical students was 59.5%. The data showed no significant difference in vaccine uptake compared with the pre-COVID-19 period. Conversely, the rate of serologically immune subjects to measles increased from 89.66% in 2018 to 97.45% in 2022 as a result of the recent mandatory vaccination policy. Despite efforts to tackle vaccine hesitancy during the COVID-19 pandemic, measles vaccine uptake is still low among young adults starting their medical training, and their compliance with free workplace vaccination offers is suboptimal. Occupational health services should raise awareness among workers and work together to implement strategies to achieve comprehensive measles vaccination coverage among occupational health workers.

Published
2023
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15. Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review

Author

F. Andreozzi, R. Candido, S. Corrao, R. Fornengo, A. Giancaterini, P. Ponzani, M. C. Ponziani, F. Tuccinardi, and D. Mannino

Subjects
Clinical inertia, Diabetes care, Italian association of medical diabetologists, Therapeutic inertia, Type 2 diabetes mellitus, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Abstract Diabetes mellitus is a chronic disease characterized by high social, economic and health burden, mostly due to the high incidence and morbidity of diabetes complications. Numerous studies have shown that optimizing metabolic control may reduce the risk of micro and macrovascular complications related to the disease, and the algorithms suggest that an appropriate and timely step of care intensification should be proposed after 3 months from the failure to achieve metabolic goals. Nonetheless, many population studies show that glycemic control in diabetic patients is often inadequate. The phenomenon of clinical inertia in diabetology, defined as the failure to start a therapy or its intensification/de-intensification when appropriate, has been studied for almost 20 years, and it is not limited to diabetes care, but also affects other specialties. In the present manuscript, we have documented the issue of inertia in its complexity, assessing its dimensions, its epidemiological weight, and its burden over the effectiveness of care. Our main goal is the identification of the causes of clinical inertia in diabetology, and the quantification of its social and health-related consequences through the adoption of appropriate indicators, in an effort to advance possible solutions and proposals to fight and possibly overcome clinical inertia, thus improving health outcomes and quality of care.

Published
2020
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20. Examining the effects of stress and psychological distress on smoking abstinence in cancer patients

Author

Joanna M. Streck, Christina M. Luberto, Alona Muzikansky, Sarah Skurla, Colin J. Ponzani, Giselle K. Perez, Daniel L. Hall, Adam Gonzalez, Brittain Mahaffey, Nancy A. Rigotti, Jamie S. Ostroff, and Elyse R. Park

Subjects
Smoking cessation, Cancer patients, Stress, Distress, Anxiety, Smoking cessation intervention, Medicine
Abstract

Introduction: Cancer patients who smoke report more stress and psychological distress than patients who do not smoke. It is unclear how these emotional symptoms may modify smoking behavior in cancer patients. We examined the influence of a smoking cessation intervention for cancer patients on stress and distress, and the effects of these symptoms on smoking abstinence. Methods: Mixed-methods secondary analysis of data from the Smokefree Support Study, a two-site randomized controlled trial examining the efficacy of Intensive (IT; n = 153) vs. Standard Treatment (ST; n = 150) for smoking cessation in newly diagnosed cancer patients. Stress coping, perceived stress, distress, and anxiety were self-reported at baseline, 3, and 6 months. Abstinence was biochemically-confirmed at 6 months. A subset of patients (n = 72) completed qualitative exit-interviews. Results: Patients were on average, 58 years old, 56% female, and smoked a median of 10 cigarettes/day. There were no significant treatment group × time interactions or main effects of treatment group on stress or distress measures (p’s > 0.05), however there were significant main effects of time suggesting symptom improvements on each measure in both study groups (p’s

Published
2021
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25. Patient-Level Factors Associated with Oncology Provider-Delivered Brief Tobacco Treatment Among Recently Diagnosed Cancer Patients

Author

JM Neil, SN Price, ER Friedman, C Ponzani, JS Ostroff, A Muzikansky, and ER Park

Subjects
Public aspects of medicine, RA1-1270
Abstract

Background: A cancer diagnosis is seen as a “teachable moment” for patients to consider changing their behavioral risk factors, such as smoking. It also offers an opportunity for oncology providers to engage in a dialogue about how they can support patients changing their smoking behaviors. Brief, evidence-based tobacco cessation treatment delivered by oncology providers through the 5As (Ask, Advise, Assess, Assist Arrange) model is recommended, but provision to cancer patients remains suboptimal. Aim: Explore patient-level factors associated with 5As receipt among current smokers with a newly diagnosed cancer. Method: A total of 303 patients self-reported whether they received each of the 5As during their most recent oncology care visit. Multivariable regression analyses were conducted to identify patient-level factors associated with 5As receipt. Results: Oncology provider-delivered 5As rates ranged from 81.5% (Ask) to 30.7% (Arrange). 5As receipt was associated with: reporting lower illness-related stigma, diagnosis of a comorbid smoking-related disease, diagnosis of a smoking-related cancer, and diagnosis of a non-advanced cancer. Conclusion: Findings support previous literature in which smoking-related diagnoses were associated with greater receipt of 5As; however, disparities in the receipt of 5As existed for patients with more advanced cancer diagnoses and illness-related stigma. Inequities in the provision of quit assistance may further decrease treatment effectiveness and survival expectancy among certain patient populations. These findings are, therefore, important as they identify specific patient-level factors associated with lower 5As receipt among newly diagnosed cancer patients.

Published
2020
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26. Questioni di metodo: i comunicati AIB a supporto delle biblioteche e dei bibliotecari di fronte all’emergenza da Covid-19

Author

Vittorio Ponzani and Rosa Maiello

Subjects
covid-19, AIB, healthcare emergency, Bibliography. Library science. Information resources
Abstract

Il contributo rende conto dell’attività svolta dall’AIB e del metodo applicato in occasione dell’emergenza da Covid-19, per fornire informazioni e raccomandazioni a supporto delle biblioteche e del lavoro nel settore. Ci si concentra in particolar modo sugli aspetti della tutela della salute e dell’occupazione nel settore, le due emergenze – l’una contingente, ma che richiede l’adozione di soluzioni onerose anche a medio termine, l’altra strutturale – che pesano sulle prospettive del settore.

Published
2020
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27. Artificial Intelligence and Big Data in Diabetes Care: A Position Statement of the Italian Association of Medical Diabetologists

Author

Musacchio, Nicoletta, Giancaterini, Annalisa, Guaita, Giacomo, Ozzello, Alessandro, Pellegrini, Maria A, Ponzani, Paola, Russo, Giuseppina T, Zilich, Rita, and de Micheli, Alberto

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

Since the last decade, most of our daily activities have become digital. Digital health takes into account the ever-increasing synergy between advanced medical technologies, innovation, and digital communication. Thanks to machine learning, we are not limited anymore to a descriptive analysis of the data, as we can obtain greater value by identifying and predicting patterns resulting from inductive reasoning. Machine learning software programs that disclose the reasoning behind a prediction allow for “what-if” models by which it is possible to understand if and how, by changing certain factors, one may improve the outcomes, thereby identifying the optimal behavior. Currently, diabetes care is facing several challenges: the decreasing number of diabetologists, the increasing number of patients, the reduced time allowed for medical visits, the growing complexity of the disease both from the standpoints of clinical and patient care, the difficulty of achieving the relevant clinical targets, the growing burden of disease management for both the health care professional and the patient, and the health care accessibility and sustainability. In this context, new digital technologies and the use of artificial intelligence are certainly a great opportunity. Herein, we report the results of a careful analysis of the current literature and represent the vision of the Italian Association of Medical Diabetologists (AMD) on this controversial topic that, if well used, may be the key for a great scientific innovation. AMD believes that the use of artificial intelligence will enable the conversion of data (descriptive) into knowledge of the factors that “affect” the behavior and correlations (predictive), thereby identifying the key aspects that may establish an improvement of the expected results (prescriptive). Artificial intelligence can therefore become a tool of great technical support to help diabetologists become fully responsible of the individual patient, thereby assuring customized and precise medicine. This, in turn, will allow for comprehensive therapies to be built in accordance with the evidence criteria that should always be the ground for any therapeutic choice.

Published
2020
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29. Pleomorphic lobular carcinoma: is it more similar to a classic lobular cancer or to a high-grade ductal cancer?

Author

Costarelli L, Campagna D, Ascarelli A, Cavaliere F, Colavito MH, Ponzani T, Broglia L, La Pinta M, Manna E, and Fortunato L

Subjects
Breast cancer, lobular cancer, Pleomorphic, mastectomy, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Leopoldo Costarelli, Domenico Campagna, Alessandra Ascarelli, Francesco Cavaliere, Maria Helena Colavito, Tatiana Ponzani, Laura Broglia, Massimo La Pinta, Elena Manna, Lucio Fortunato Breast Unit, San Giovanni-Addolorata Hospital, Rome, Italy Background: Pleomorphic invasive lobular carcinoma (P-ILC) is an uncommon variety of invasive lobular carcinoma with aggressive clinical features. Little is described in the literature regarding this topic.Materials and methods: We reviewed our experiences from 2010 to 2015 and compared 40 patients with P-ILC, 126 patients with classic-ILC (C-ILC) and 574 cases of high-grade invasive ductal carcinoma (HG-IDC). We studied the histologic and immunohistochemical features, clinical presentation and surgical treatment.Results: P-ILC is diagnosed at the same age and tumor diameter as those of the other two histologic types. It is associated more frequently with multiple lymph node metastases and high proliferative index, and HER2/neu is amplified in 10% of cases. In spite of sharing some histologic characteristics with C-ILC (same growth pattern, loss of E-cadherin expression, same genetic pathway), its clinical and pathologic features define an autonomous entity. Its surgical treatment is similar to those of C-ILC and HG-IDC.Conclusion: This is the first review comparing these three pathologic entities. Our findings may be useful in understanding this variety of invasive lobular carcinoma, and further studies are certainly needed in this field. Keywords: breast cancer, lobular cancer, pleomorphic, mastectomy

Published
2017

32. Long-Term Effectiveness of Liraglutide for Treatment of Type 2 Diabetes in a Real-Life Setting: A 24-Month, Multicenter, Non-interventional, Retrospective Study

Author

Lapolla, Annunziata, Berra, Cesare, Boemi, Massimo, Bossi, Antonio Carlo, Candido, Riccardo, Di Cianni, Graziano, Frontoni, Simona, Genovese, Stefano, Ponzani, Paola, Provenzano, Vincenzo, Russo, Giuseppina T., Sciangula, Luigi, Simioni, Natalino, Bette, Cristiano, Nicolucci, Antonio, and On behalf of the NN2211-4118 Study Group

Published
2018
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35. L’alfabetizzazione sanitaria: biblioteche e bibliotecari per il benessere dei cittadini

Author

Vittorio Ponzani

Subjects
health literacy, information literacy, hospital libraries, Bibliography. Library science. Information resources
Abstract

L’alfabetizzazione sanitaria è la capacità di ottenere, elaborare e capire informazioni sanitarie, in modo tale da partecipare attivamente, insieme ai medici, al processo decisionale per quanto riguarda la propria salute. Le biblioteche e i bibliotecari svolgono un ruolo importante nella promozione della health literacy e nella realizzazione di strumenti informativi che permettano ai cittadini di accedere a informazioni certificate e di qualità, scritte in un linguaggio molto chiaro e facilmente comprensibile anche dai cittadini senza una adeguata alfabetizzazione sanitaria.

Published
2018
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42. Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes 11 Medical and Health Sciences 1103 Clinical Sciences

Author

Mirijello, Antonio, Viazzi, Francesca, Fioretto, Paola, Giorda, C. B., Ceriello, Antonio, Russo, Giuspina T., Guida, Pietro, Pontremoli, Roberto, De Cosmo, S., Cimino, Antonino, Fava, Danila, Meloncelli, Illidio, Nicolucci, Antonio, Pellegrini, Fabio, Rossi, Maria Chiara, Turco, Salvatore, Vespasiani, Giacomo, Graziano, G., Lucisano, G., Memmo, R., Pellicciotta, E., Paciotti, V., Pupillo, M., Armentano, G., Giovannini, C., Armentano, V., Laudato, M., Acquati, S., Ciardullo, A. V., Laffi, G., Felace, G., Taboga, C., Tortul, C., Santantonio, G., Suraci, C., Ghisoni, G., Raffa, M., Genovese, S., Lovagnini-Scher, C. A., Rampini, P., Rocca, A., Ruggeri, P., Tortato, E., Cotti, L., Cristofaro, M. R., Tagliaferri, M., Comoglio, M., Fornengo, R., Gentile, F. M., Gigante, Antonio, Mastinu, F., Di Benedetto, A., Pata, P., Arcangeli, A., Orsini, P., Acler, P., De Blasi, G., Cicioni, G., Pocciati, S., Marangoni, A., Nogara, A., Lanero, M., Bertero, M. G., Damassino, R., Bergonzini, C., Schumtz, L., Seksich, L., Pipitone, A., Boaretto, M., Manfroi, I., Parmesan, L., Conte, B., Soccol, F., Pagano, A., Papini, E., Rinaldi, R., Petrucci, L., Graziano, F., Chianelli, M., Silvagni, S., Rosco, M., Ansaldi, E., Malvicino, F., Battezzati, M., Maresca, P., Palenzona, C., Boemi, M., Rabini, R. A., Brandoni, G., Lanari, L., Gatti, C., Testa, I., Cherubini, V., Doveri, G., Pecorelli, L., Ciccarelli, A., Gallardini, M. B., Courthoud, R., Sara Bredy, S., Ricciardi, G. P., Vitalone, G., Setti, D., Contrini, P., Corsi, A., Ghigliotti, V., Oddone, G., Ponzani, P., Valbonesi, G., Mazzini, V., Di Berardino, P., Colleluori, P., Montani, V., Trosini, V., Velussi, M., Alfidi, P., Verdecchia, B., Baliva, L., Di Pietro, A., Franchi, G., Luce, R. P., Pianta, A., Ferrari, M., Balzano, S., Beltranello, G., Dal Fabbro, S., Aricò, C. N., Cervo, L., Zanon, R., Rossa, S., Di Pace, M. C., Ciavarella, A., Giangiulio, S., Grimaldi, M., Mustacchio, A., Fattor, B., Monauni, T., Cristini, M., Orion, G., Crazzolara, D., Amor, F., Eisath, J. E., Lintner, S., Garavelli, S., Calari, T., Marini, P., Sandri, O., Scala, M., Stroppa, C., Trentin, A., Carlin, R., Carli, B., Sandonà, M., Zortea, C., Bonet, L., Pradel, L., Reato, S., Buschini, M., Bonfiglioli, D., Mones, D., Beldì, F., Morea, A., Bondesan, L., Perbellini, S., Valentini, U., Agosti, B., Corsini, R., Girelli, A., Zarra, E., Rocca, L., Bergmann, M., Pradi, I., Unterkircher, S., Piok, M., Pichler, M., Trinchera, A., Palamà, G., Palma, P., Carboni, L., Murtas, M. G., Mudadu, T., Turco, M. P., Floris, M., Delogu, A., Farris, L., Songini, M., Piras, G., Seguro, R., Floris, R., Corona, G., Lai, M., Piras, E., Contini, P. P., Cocco, S., Pilosu, R. M., Sannia, M. C., Spanu, F., Busciantella Ricci, N., Cartechini, M. G., Agostinelli, G., Fiorelli, C., Nuzzi, A., Ballauri, C., Lesina, A., Romeo, F., Giudici, G., Maciejewska, E. G., Deroma, A., Paduano, M., Rossi, L., Vagnini, C., Dolci, M., Mori, M., Baccetti, F., Gregori, G., Straface, E., Pozzuoli, G., Barone, M., Stasio, G. B., Tondini, S., Borgoni, F., Grosso, J., Scarsellato, C., Sciulli, A., De Marco, F., Confortin, L., Marin, N., Lamonica, M., Gialdino, S., Borzì, V., Gatta, C., Rapisard, R., Strano, S., Calabrò, M., Puccio, L., Zolli, M., Coracina, A., Starnone, V., Del Buono, A., Terracciano, A. M., Monda, M. V., Castro, F., Guaglianone, A., Maccari, V., Corsi, L., Versari, G., Falivene, M. R., Boletto, N., Corsi, S., Marafetti, L., Vitacolonna, E., Capani, F., Caputo, L., Di Nisio, L., Simonetti, F., Boscolo Bariga, A., Ballarin, G., De Boni, S., Di Benedetto, S., Chiambretti, A. M., Di Vito, L., Pascuzzo, M. D., Urli, P., Rumi, P., Balzarini, B., Galli, P., Castellan, M., Giannetti, A., Russotti, C., De Blasi, A., Perna, A., Campanelli, C., Ranchelli, A., Biccheri, D., Dadi, G., Massa, L., Baldi, G. P., Sciacca, F., Costanzo, E., Spada, M., Paolini, G., Ziller, P., Portolan, F., Pasolini, G., Ghilardi, G., Fiorina, P., Grata, M. L., Capretti, L., Speroni, G., Fugazza, L., Massafra, C., Lovagnini Scher, A., Cimicchi, M. C., Percudani, C., Risolo, T., Saccò, P., Gidoni Guarnieri, G. L., Piccolo, D., Bravin, C., De Noni, E., Scarpel, M., Marcon, M., Giacon, F., Panebianco, G., Tadiotto, F., Da Tos, V., D'Ambrosio, M., Pellizzola, D., Zampini, M. A., Frezzati, E., Mari, E., Raminelli, E., Gaiti, D., Bosi, E. A., Chierici, G., Pilla, S., Copelli, M., Zanichelli, P., Bertelli, L., Caretta, P., Vezzani, V., Bodecchi, S., Longobucco, A., Di Lembo, S., Spotti, E., Carrai, E., Degli Innocenti, A., Manini, L., Persico, R., Rossi, C., Magro, G., Marelli, G., Vilei, V., Andrioli, M., Bellato, L., Fedeli, M., Merlini, A., Pinelli, G., Marin, G., Contin, M. L., Gallo, A., Parlato, P., Pecchielan, W., Jacovacci, J., Placentino, G., Richini, D., Molinari, S., Strazzeri, R., Fabbri, T., Di Bartolo, P., Garrapa, G., D'Incau, F., Lagomanzini, P., Conte, P., Todesco, F., Foglini, P., Pantanetti, P., Bedetta, C., Maricotti, R., Tomasi, F., Monesi, M., Graziani, R., Beretta, F., Penna, L., Guberti, A., Dazzi, D., Forte, E., Gasbarrone, A., Marrocco, T., Moschetta, R., Tuccinardi, F., De Meo, F., Coppola, A., Pirolozzi, P., Placitelli, E., Vallefuoco, R., Catone, B., Ceschia, S., Urban, M., Fabbri, F., Torresani, M., Crovetto, R., Battistini, M., Carosia, P., Viviani, G. L., Durante, A., Pais, F., Lilliu, V., Quieto, C., D'Ugo, E., Squadrone, M., Amenduni, T., Iovannisci, M. M., Della Penna, L., Potente, F., Delle Donne, T., Massa, C., Ulisse, M. A., De Berardinis, F., Guarnieri, I., Pace, S., Splendiani, M., Di Giuseppe, R., Brunato, B., Assaloni, R., Muraro, R., Loro, R., Bucciol, S., Lavacca, C., Rossi, M., Sabbatini, G., Quadri, F., Sambuco, L., Santacroce, C., Paola Caretta, D., Marino, C., Micheletti, A., Petrelli, A., Corda, A., Pisano, L., Guaita, G., Deias, C., Trevisan, G., Coletti, I., Iannarelli, R., De Luca, A., Minnucci, A., Antenucci, D., Di Florio, C., Angelicola, G., Bosco, A., Fresco, R., Di Marco, G., Ugolotti, D., Cadossi, T., Di Caro, P., Mazzocchetti, M., Buzzetti, R., Leto, G., Gnessi, C., Cipolloni, L., Foffi, C., Moretti, C., Venditti, C., Meniconi, R., Bertoli, S., Cosimi, S., Di Cianni, G., Turco, A., Richini, A., Marconi, S., Sannino, C., Lemmi, P., Giuntoli, S., Manfrè, N., Giannini, F., Di Carlo, A., Casadidio, I., Melandri, P., Maolo, G., Polenta, B., Piccinini, N., Vincenti, C., Pastore, N., Mega, P., Magurano, E., Cananiello, A., Francescutto, C. A., Brussa Toi, E., Gaspardo, G., Angeli, L., Ronchese, L., Sciangula, L., Ciucci, A., Contartese, A., Banfi, E., Castelli, E., Tatti, P., Bloise, D., Di Mauro, P., Masselli, L., Lo Presti, A., Scarpitta, A. M., Gambina, F., Venezia, A., Morea, R., Lagonigro, G., Copeta, G., Iannucci, V., Milano, V., Trupo, M., Lochmann, A., Marchetto, P. E., Incelli, G., De Paola, G., Steiger, M. M., Gamper, M. A., Breitenberger, S., Holzner, M., Frischmann, J., Lambiase, C., Di Vece, T., D'Aniello, M., Fezza, M., Giordano, C., Leo, F., Saitta, G., Cucinotta, D., Di Vieste, G., Pintaudi, B., Mancuso, T., Musacchio, N., Giancaterini, A., Pessina, L., Salis, G., Schivalocchi, F., Testori, G., Cerutti, N., Morpugo, P. S., Cavaletto, M. L., Bonino, G., Morreale, F., Mariani, G., Ragonesi, P. D., Bollati, P., Colapinto, P., Falqui, L., Bortolato, L., Cosma, A., Pistolato, P., Centenaro, B., Ceccato, A., Campobasso, G., Zaurino, F., Mazzotta, G., Manti, R., Da Ros, R., Carlucci, S., Narduzzi, L., Bortolotto, D., D'Acunto, L., Stanic, L., Volpi, A., Cospite, A. M., Manicardi, V., Michelini, M., Finardi, L., Borghi, F., Manicardi, E., Lombardi, S., Tommasi, C., Iaccarino, M., Cozza, S., Binotto, M., Marini, F., Mecenero, I., Massignani, S., Stecco, P., Urbani, E., Massariol, W., Parolin, R., Gatti, A., Bonavita, M., Creso, E., Giannettino, R., Gobbo, M., Turco, S., Iovine, C., Riccardi, G., Iazzetta, N., Giannattasio, C., Egione, O., Galdieri, S., Velotti, A., Azzolina, A., Annicelli, G., Sorrentino, T., Gaeta, I., Zenari, L., Bertolini, L., Sorgato, C., Grippaldi, F., Stroppiana, M., Popolizio, R., Carbone, N., Grasso, S., Abate, S., Gaggero, G. C., Strazzabosco, M., Brun, E., Carlesi, G. P., Garrone, S., Cicalò, A. M., Clausi, C., Cau, R., Manconi, A., Carboni, A., Angius, M. F., Pinna, A. A., Caria, S., Filigheddu, G. D., Tonolo, G., Carta, I., Calebich, S., Burlotti, C., Saglietti, G., Schellino, A., Madau, G., Cossu, M., Mulas, F., Zoccheddu, S., Balsanelli, M., Fetonti, M., Rotolo, A., Sambo, P., Secchi, E., Angotzi, M. A., Loddoni, S., Brundu, I., Careddu, F., Becciu, A., Gabriella Piras, G., Novara, F., Cipro, F., Torchio, G., Palumbo, P., Bianchi, A., Colucci, G., La Motta, G., Tiengo, A., Avogaro, A., Bruttomesso, D., Crepaldi, C., Fadini, G., Guarnieri, G., Lavagnini, M. T., Maran, A., Vedovato, M., De Kreutzenberg, V., Fedele, D., Lapolla, A., Sartore, G., Bax, G., Cardone, C., Dalfrà, M. G., Masin, M., Toniato, R., Piarulli, Francesco, Mattina, G., Fulantelli, M. A., Gioia, D., Conti, M., Ridola, G., D'Agati, F., Grossi, G., Zavaroni, I., Dei Cas, A., Franzini, L., Usberti, E., Antonimi, M., Anelli, N., Poli, R., Ridolfi, V., Michela, M., Haddoub, S., Prampolini, G., Muoio, A., Filippi, D., Bucci, F., Tardio, S. M., Calderini, M. C., Magotti, M. G., Quarantelli, C., Vernazza, M. A., Carolfi, A., Saracca, R., Picchio, E., Del Sindaco, P., Spalluto, A., Maggiulli, L., Torreggiani, V., Rastelletti, S., Ugolini, C., Pucci, N., Magi, S., Muratori, S., La Penna, G., Consoli, A., Galeone, F., Magiar, A. V., Gherardini, V., Moretti, L., Bientinesi, M., Landi, L., Bernardi, A., Del Prato, S., Miccoli, R., Bianchi, C., Penno, G., Venditti, F., Anichini, R., De Bellis, A., Bruschi, T., Butelli, L., Gioffredi, M., Gori, R., Picciafuochi, R., Malagoli, R., Bernini, A., Gelisio, R., Zanon, M., Del Bianco, A., Bamiston, A., Signorato, M., Citro, G., Calabrese, M., Ianni, L., Lorenzetti, M., Marsocci, A., Guizzotti, S., Memoli, G., Cabasino, F., Farci, F., Atzori, A., Sanna, A., Ghiani, M., Siotto, I., Sedda, M., Manis, A., Loddo, C., Loddo, I., Seguro, P., Cuomo, A., Orlando, L., Olanda, G. B., Pucci, A., Massenzo, M., Sardu, C., Perrone, G., Corazziere, F., La Puzza, I., Tripodi, P. F., Riggio, S., Giampaolo, A., Mannino, D., Aleandri, A. R., Guidi, M. V., Battisti, B., Faraglia, M. R., Lilli, V., Leotta, S., Visalli, N., Gagliardi, A., Fontana, L., Altomare, M., Carletti, S., Abbruzzese, S., Chiaramonte, F., Giordano, R., Rossini, M., Migneco, G., Cappelloni, D., Urbani, A., Piergiovanni, F., Simonetta, A., Massimiani, F., Bulzomì, R., Giuliano, M., Pennafina, M. G., Di Perna, P., D'Accinni, M. P., Paolucci, D., D'Ubaldi, A., D'Angelo, M. T., Masaro, G., Pietrantoni, M., Fratini, M., La Rosa, R., Poggi, M., Piccirilli, F., Pisano, R., Saponara, C., Conforti, I., Penza, A., Scalpone, R., Lo Pinto, S., Iacovella, L., Caccamo, C., Sposito, S., Teodonio, C., Restuccia, M. G., Mirto, G., Girardello, R., Gennaro, R., De Moliner, L., Bettini, E., Mattuzzi, A., Speese, K., Frisinghelli, F., Locatelli, F., Nicoletti, M., Trojan, N., Centis, R., L Volsi, P., Levis, E., Zanette, G., Comba, G., Ballatore, L., Cattaneo, A., Aglialoro, A., Guido, R., Patrone, M., Zecchini, M., Clementi, L., Galetta, M., Marconi, V., Bordin, P., Perale, L., Vinci, C., Sira Zanon, M., Geretto, L., Toffolo, C., Furlan, M. G., Mazzanti, G., Vinci, M., Sica, V., Armeni, M., Derai, R., Ennas, O., Mamusa, S., Pisano, M. A., Carreras, L., Rauseo, A., Cervone, S., Leggieri, A., Pontonio, M., Sturaro, R., Quattrocchi, F., Molinaro, M., Trasatti, M., Ferretti, B., Labarile, G., Baule, G. M., Gentilini, A., Spanu, M. A., Fancellu, A., Bianco, P., Lione, L., Massazza, G., Bocchio, G., Bosco, E., Monachesi, M., Carta, G., Boschetti, M., Ceresola, E., Venier, E., Calcaterra, F., Cataldi, F., Miola, M., Manfrini, S., Lai, A., Locci, B., Putzu, D., Tanganelli, I., Leonini, M., Egger, K., Marchiotto, W., Vincis, L., Orlandini, V., Pilloni, C., Farci, R., Pelligra, I., Renier, G., Mameli, M., Pala, A., Devigus, E., Fumagalli, I., Lalli, C., Leandri, M., Agliani, M., De Pascalis, L., Malci, F., De Ciocchis, A., Diodati, M. B., Macerola, B., Davì, S., Caccavale, A., Brocato, L., Pognant Gros, M., Borla, S., Lattanzi, E., Piersanti, C., Piersanti, A., Spinelli, I., Tuzzoli, L., Tulini, V., Quaranta, G., Iorio, V., Tirabovi, M., De Terlizi, Candia, Massarelli, M. G., Venturi, S., Travaglini, A., Draghi, P., Pomante, P., Richiardi, L., Clerico, A., Bruno, A., Cavallo Perin, P., Ghigo, E., Porta, M., Scuntero, P., Arcari, R., Bertaina, S., Bo, S., Broglio, F., Bruno, G., Degiovanni, M., Fornengo, P., Grassi, G., Inglese, V., Maccario, M., Maghenzani, G., Marena, S., Martina, V., Passera, P., Ruiu, G., Tagliabue, M., Zanone, M., Monge, M., Boffano, G. M., Macrì, K., Maio, P., Ozzello, A., Pergolizzi, E., Gaia, D., Gennari, P., Micali, G., Rossetto, E., Dalmazzo, C., Oreglia, M., Stefani, T., Dossena, C., Paglia, P., Bosoni, S., Romanelli, T., Inchiostro, S., Dauriz, M., Bossi, C. A., Meregalli, G., Balini, A., Berzi, D., Filippini, B., Crotto, G., Paccagnella, A., Orrasch, M., Sambataro, M., Citro, T., Kiwanuka, E., Bagolin, E., Almoto, B., Macchia, A., Branca, M. T., Filesi, M., Candido, R., Caroli, E., Manca, E., Petrucco, A., Tommasi, E., Jagodnik, G., Baskar, B., Daris, N., Dal Col, P., Pellegrini, M. A., Tonutti, L., Venturini, G., Andreani, M., Turchi, F., Fedrighelli, F., Martinelli, G., Rongioletti, R., Candidi, M., Pais, M., Moro, E., Cervellino, F., Sinisi, R., Zampino, A., Mingardi, R., Lora, L., Reitano, R., Stocchiero, C., Simoncini, M., Mesturino, C. A., Zen, F., Di Pietro, S., Scoponi, C., Tilaro, L., Pelliccioni, S., Slongo, R., Vita, E., Garofalo, A., Vitale, F., Campanella, B., Mastrilli, V., Borrelli, T., D'Avino, A., Perbellini, A., Mirijello, A, Viazzi, F, Fioretto, P, Giorda, C, Ceriello, A, Russo, G, Guida, P, Pontremoli, R, De Cosmo, S, Cimino, A, Fava, D, Meloncelli, I, Nicolucci, A, Pellegrini, F, Rossi, M, Turco, S, Vespasiani, G, Graziano, G, Lucisano, G, Memmo, R, Pellicciotta, E, Paciotti, V, Pupillo, M, Armentano, G, Giovannini, C, Armentano, V, Laudato, M, Acquati, S, Ciardullo, A, Laffi, G, Felace, G, Taboga, C, Tortul, C, Santantonio, G, Suraci, C, Ghisoni, G, Raffa, M, Genovese, S, Lovagnini-Scher, C, Rampini, P, Rocca, A, Ruggeri, P, Tortato, E, Cotti, L, Cristofaro, M, Tagliaferri, M, Comoglio, M, Fornengo, R, Gentile, F, Gigante, A, Mastinu, F, Di Benedetto, A, Pata, P, Arcangeli, A, Orsini, P, Acler, P, De Blasi, G, Cicioni, G, Pocciati, S, Marangoni, A, Nogara, A, Lanero, M, Bertero, M, Damassino, R, Bergonzini, C, Schumtz, L, Seksich, L, Pipitone, A, Boaretto, M, Manfroi, I, Parmesan, L, Conte, B, Soccol, F, Pagano, A, Papini, E, Rinaldi, R, Petrucci, L, Graziano, F, Chianelli, M, Silvagni, S, Rosco, M, Ansaldi, E, Malvicino, F, Battezzati, M, Maresca, P, Palenzona, C, Boemi, M, Rabini, R, Brandoni, G, Lanari, L, Gatti, C, Testa, I, Cherubini, V, Doveri, G, Pecorelli, L, Ciccarelli, A, Gallardini, M, Courthoud, R, Sara Bredy, S, Ricciardi, G, Vitalone, G, Setti, D, Contrini, P, Corsi, A, Ghigliotti, V, Oddone, G, Ponzani, P, Valbonesi, G, Mazzini, V, Di Berardino, P, Colleluori, P, Montani, V, Trosini, V, Velussi, M, Alfidi, P, Verdecchia, B, Baliva, L, Di Pietro, A, Franchi, G, Luce, R, Pianta, A, Ferrari, M, Balzano, S, Beltranello, G, Dal Fabbro, S, Arico, C, Cervo, L, Zanon, R, Rossa, S, Di Pace, M, Ciavarella, A, Giangiulio, S, Grimaldi, M, Mustacchio, A, Fattor, B, Monauni, T, Cristini, M, Orion, G, Crazzolara, D, Amor, F, Eisath, J, Lintner, S, Garavelli, S, Calari, T, Marini, P, Sandri, O, Scala, M, Stroppa, C, Trentin, A, Carlin, R, Carli, B, Sandona, M, Zortea, C, Bonet, L, Pradel, L, Reato, S, Buschini, M, Bonfiglioli, D, Mones, D, Beldi, F, Morea, A, Bondesan, L, Perbellini, S, Valentini, U, Agosti, B, Corsini, R, Girelli, A, Zarra, E, Rocca, L, Bergmann, M, Pradi, I, Unterkircher, S, Piok, M, Pichler, M, Trinchera, A, Palama, G, Palma, P, Carboni, L, Murtas, M, Mudadu, T, Turco, M, Floris, M, Delogu, A, Farris, L, Songini, M, Piras, G, Seguro, R, Floris, R, Corona, G, Lai, M, Piras, E, Contini, P, Cocco, S, Pilosu, R, Sannia, M, Spanu, F, Busciantella Ricci, N, Cartechini, M, Agostinelli, G, Fiorelli, C, Nuzzi, A, Ballauri, C, Lesina, A, Romeo, F, Giudici, G, Maciejewska, E, Deroma, A, Paduano, M, Rossi, L, Vagnini, C, Dolci, M, Mori, M, Baccetti, F, Gregori, G, Straface, E, Pozzuoli, G, Barone, M, Stasio, G, Tondini, S, Borgoni, F, Grosso, J, Scarsellato, C, Sciulli, A, De Marco, F, Confortin, L, Marin, N, Lamonica, M, Gialdino, S, Borzi, V, Gatta, C, Rapisard, R, Strano, S, Calabro, M, Puccio, L, Zolli, M, Coracina, A, Starnone, V, Del Buono, A, Terracciano, A, Monda, M, Castro, F, Guaglianone, A, Maccari, V, Corsi, L, Versari, G, Falivene, M, Boletto, N, Corsi, S, Marafetti, L, Vitacolonna, E, Capani, F, Caputo, L, Di Nisio, L, Simonetti, F, Boscolo Bariga, A, Ballarin, G, De Boni, S, Di Benedetto, S, Chiambretti, A, Di Vito, L, Pascuzzo, M, Urli, P, Rumi, P, Balzarini, B, Galli, P, Castellan, M, Giannetti, A, Russotti, C, De Blasi, A, Perna, A, Campanelli, C, Ranchelli, A, Biccheri, D, Dadi, G, Massa, L, Baldi, G, Sciacca, F, Costanzo, E, Spada, M, Paolini, G, Ziller, P, Portolan, F, Pasolini, G, Ghilardi, G, Fiorina, P, Grata, M, Capretti, L, Speroni, G, Fugazza, L, Massafra, C, Lovagnini Scher, A, Cimicchi, M, Percudani, C, Risolo, T, Sacco, P, Gidoni Guarnieri, G, Piccolo, D, Bravin, C, De Noni, E, Scarpel, M, Marcon, M, Giacon, F, Panebianco, G, Tadiotto, F, Da Tos, V, D'Ambrosio, M, Pellizzola, D, Zampini, M, Frezzati, E, Mari, E, Raminelli, E, Gaiti, D, Bosi, E, Chierici, G, Pilla, S, Copelli, M, Zanichelli, P, Bertelli, L, Caretta, P, Vezzani, V, Bodecchi, S, Longobucco, A, Di Lembo, S, Spotti, E, Carrai, E, Degli Innocenti, A, Manini, L, Persico, R, Rossi, C, Magro, G, Marelli, G, Vilei, V, Andrioli, M, Bellato, L, Fedeli, M, Merlini, A, Pinelli, G, Marin, G, Contin, M, Gallo, A, Parlato, P, Pecchielan, W, Jacovacci, J, Placentino, G, Richini, D, Molinari, S, Strazzeri, R, Fabbri, T, Di Bartolo, P, Garrapa, G, D'Incau, F, Lagomanzini, P, Conte, P, Todesco, F, Foglini, P, Pantanetti, P, Bedetta, C, Maricotti, R, Tomasi, F, Monesi, M, Graziani, R, Beretta, F, Penna, L, Guberti, A, Dazzi, D, Forte, E, Gasbarrone, A, Marrocco, T, Moschetta, R, Tuccinardi, F, De Meo, F, Coppola, A, Pirolozzi, P, Placitelli, E, Vallefuoco, R, Catone, B, Ceschia, S, Urban, M, Fabbri, F, Torresani, M, Crovetto, R, Battistini, M, Carosia, P, Viviani, G, Durante, A, Pais, F, Lilliu, V, Quieto, C, D'Ugo, E, Squadrone, M, Amenduni, T, Iovannisci, M, Della Penna, L, Potente, F, Delle Donne, T, Massa, C, Ulisse, M, De Berardinis, S, Guarnieri, I, Pace, S, Splendiani, M, Di Giuseppe, R, Brunato, B, Assaloni, R, Muraro, R, Loro, R, Bucciol, S, Lavacca, C, Sabbatini, G, Quadri, F, Sambuco, L, Santacroce, C, Paola Caretta, D, Marino, C, Micheletti, A, Petrelli, A, Corda, A, Pisano, L, Guaita, G, Deias, C, Trevisan, G, Coletti, I, Iannarelli, R, De Luca, A, Minnucci, A, Antenucci, D, Di Florio, C, Angelicola, G, Bosco, A, Fresco, R, Di Marco, G, Ugolotti, D, Cadossi, T, Di Caro, P, Mazzocchetti, M, Buzzetti, R, Leto, G, Gnessi, C, Cipolloni, L, Foffi, C, Moretti, C, Venditti, C, Meniconi, R, Bertoli, S, Cosimi, S, Di Cianni, G, Turco, A, Richini, A, Marconi, S, Sannino, C, Lemmi, P, Giuntoli, S, Manfre, N, Giannini, F, Di Carlo, A, Casadidio, I, Melandri, P, Maolo, G, Polenta, B, Piccinini, N, Vincenti, C, Pastore, N, Mega, P, Magurano, E, Cananiello, A, Francescutto, C, Brussa Toi, E, Gaspardo, G, Angeli, L, Ronchese, L, Sciangula, L, Ciucci, A, Contartese, A, Banfi, E, Castelli, E, Tatti, P, Bloise, D, Di Mauro, P, Masselli, L, Lo Presti, A, Scarpitta, A, Gambina, F, Venezia, A, Morea, R, Lagonigro, G, Copeta, G, Iannucci, V, Milano, V, Trupo, M, Lochmann, A, Marchetto, P, Incelli, G, De Paola, G, Steiger, M, Gamper, M, Breitenberger, S, Holzner, M, Frischmann, J, Lambiase, C, Di Vece, T, D'Aniello, M, Fezza, M, Giordano, C, Leo, F, Saitta, G, Cucinotta, D, Di Vieste, G, Pintaudi, B, Mancuso, T, Musacchio, N, Giancaterini, A, Pessina, L, Salis, G, Schivalocchi, F, Testori, G, Cerutti, N, Morpugo, P, Cavaletto, M, Bonino, G, Morreale, F, Mariani, G, Ragonesi, P, Bollati, P, Colapinto, P, Falqui, L, Bortolato, L, Cosma, A, Pistolato, P, Centenaro, B, Ceccato, A, Campobasso, G, Zaurino, F, Mazzotta, G, Manti, R, Da Ros, R, Carlucci, S, Narduzzi, L, Bortolotto, D, D'Acunto, L, Stanic, L, Volpi, A, Cospite, A, Manicardi, V, Michelini, M, Finardi, L, Borghi, F, Manicardi, E, Lombardi, S, Tommasi, C, Iaccarino, M, Cozza, S, Binotto, M, Marini, F, Mecenero, I, Massignani, S, Stecco, P, Urbani, E, Massariol, W, Parolin, R, Gatti, A, Bonavita, M, Creso, E, Giannettino, R, Gobbo, M, Iovine, C, Riccardi, G, Iazzetta, N, Giannattasio, C, Egione, O, Galdieri, S, Velotti, A, Azzolina, A, Annicelli, G, Sorrentino, T, Gaeta, I, Zenari, L, Bertolini, L, Sorgato, C, Grippaldi, F, Stroppiana, M, Popolizio, R, Carbone, N, Grasso, S, Abate, S, Gaggero, G, Strazzabosco, M, Brun, E, Carlesi, G, Garrone, S, Cicalo, A, Clausi, C, Cau, R, Manconi, A, Carboni, A, Angius, M, Pinna, A, Caria, S, Filigheddu, G, Tonolo, G, Carta, I, Calebich, S, Burlotti, C, Saglietti, G, Schellino, A, Madau, G, Cossu, M, Mulas, F, Zoccheddu, S, Balsanelli, M, Fetonti, M, Rotolo, A, Sambo, P, Secchi, E, Angotzi, M, Loddoni, S, Brundu, I, Careddu, F, Becciu, A, Gabriella Piras, G, Novara, F, Cipro, F, Torchio, G, Palumbo, P, Bianchi, A, Colucci, G, La Motta, G, Tiengo, A, Avogaro, A, Bruttomesso, D, Crepaldi, C, Fadini, G, Guarnieri, G, Lavagnini, M, Maran, A, Vedovato, M, De Kreutzenberg, V, Fedele, D, Lapolla, A, Sartore, G, Bax, G, Cardone, C, Dalfra, M, Masin, M, Toniato, R, Piarulli, F, Mattina, G, Fulantelli, M, Gioia, D, Conti, M, Ridola, G, D'Agati, F, Grossi, G, Zavaroni, I, Dei Cas, A, Franzini, L, Usberti, E, Antonimi, M, Anelli, N, Poli, R, Ridolfi, V, Michela, M, Haddoub, S, Prampolini, G, Muoio, A, Filippi, D, Bucci, F, Tardio, S, Calderini, M, Magotti, M, Quarantelli, C, Vernazza, M, Carolfi, A, Saracca, R, Picchio, E, Del Sindaco, P, Spalluto, A, Maggiulli, L, Torreggiani, V, Rastelletti, S, Ugolini, C, Pucci, N, Magi, S, Muratori, S, La Penna, G, Consoli, A, Galeone, F, Magiar, A, Gherardini, V, Moretti, L, Bientinesi, M, Landi, L, Bernardi, A, Del Prato, S, Miccoli, R, Bianchi, C, Penno, G, Venditti, F, Anichini, R, De Bellis, A, Bruschi, T, Butelli, L, Gioffredi, M, Gori, R, Picciafuochi, R, Malagoli, R, Bernini, A, Gelisio, R, Zanon, M, Del Bianco, A, Bamiston, 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Subjects
Albuminuria, Diabetic kidney disease, GFR, Albuminuria, Diabetic kidney disease, GFR, Nephrology
Abstract

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage ≥3 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage ≥3 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage ≥3 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 ± 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage ≥3 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage ≥3 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening.

Published
2018

45. Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Author

Mirijello, Antonio, Viazzi, Francesca, Fioretto, Paola, Giorda, Carlo, Ceriello, Antonio, Russo, Giuspina T., Guida, Pietro, Pontremoli, Roberto, De Cosmo, Salvatore, Cimino, Antonino, Fava, Danila, Giorda, Carlo Bruno, Meloncelli, Illidio, Nicolucci, Antonio, Pellegrini, Fabio, Rossi, Maria Chiara, Turco, Salvatore, Vespasiani, Giacomo, Pellegrini, F., Graziano, G., Lucisano, G., Memmo, R., Pellicciotta, E., Paciotti, V., Pupillo, M., Armentano, G., Giovannini, C., Armentano, V., Laudato, M., Turco, S., Acquati, S., Ciardullo, A. V., Laffi, G., Felace, G., Taboga, C., Tortul, C., Santantonio, G., Suraci, C., Ghisoni, G., Raffa, M., Genovese, S., Lovagnini-Scher, C. A., Rampini, P., Rocca, A., Ruggeri, P., Tortato, E., Cotti, L., Cristofaro, M. R., Tagliaferri, M., Comoglio, M., Fornengo, R., De Cosmo, S., Gentile, F. M., Gigante, A., Mastinu, F., Di Benedetto, A., Pata, P., Arcangeli, A., Orsini, P., Acler, P., De Blasi, G., Cicioni, G., Pocciati, S., Marangoni, A., Nogara, A., Lanero, M., Bertero, M. G., Damassino, R., Bergonzini, C., Schumtz, L., Seksich, L., Pipitone, A., Boaretto, M., Manfroi, I., Parmesan, L., Conte, B., Soccol, F., Pagano, A., Papini, E., Rinaldi, R., Petrucci, L., Graziano, F., Chianelli, M., Silvagni, S., Rosco, M., Ansaldi, E., Malvicino, F., Battezzati, M., Maresca, P., Palenzona, C., Boemi, M., Rabini, R. A., Brandoni, G., Lanari, L., Gatti, C., Testa, I., Cherubini, V., Doveri, G., Pecorelli, L., Ciccarelli, A., Gallardini, M. B., Courthoud, R., Sara Bredy, S., Ricciardi, G. P., Vitalone, G., Setti, D., Contrini, P., Corsi, A., Ghigliotti, V., Oddone, G., Ponzani, P., Valbonesi, G., Mazzini, V., Di Berardino, P., Colleluori, P., Montani, V., Trosini, V., Velussi, M., Alfidi, P., Verdecchia, B., Baliva, L., Di Pietro, A., Franchi, G., Luce, R. 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V., Gherardini, V., Moretti, L., Bientinesi, M., Landi, L., Bernardi, A., Del Prato, S., Miccoli, R., Bianchi, C., Penno, G., Venditti, F., Anichini, R., De Bellis, A., Bruschi, T., Butelli, L., Gioffredi, M., Gori, R., Picciafuochi, R., Malagoli, R., Bernini, A., Gelisio, R., Zanon, M., Del Bianco, A., Bamiston, A., Signorato, M., Citro, G., Calabrese, M., Ianni, L., Lorenzetti, M., Marsocci, A., Guizzotti, S., Memoli, G., Cabasino, F., Farci, F., Atzori, A., Sanna, A., Ghiani, M., Siotto, I., Sedda, M., Manis, A., Loddo, C., Loddo, I., Seguro, P., Cuomo, A., Orlando, L., Olanda, G. B., Pucci, A., Massenzo, M., Sardu, C., Perrone, G., Corazziere, F., La Puzza, I., Tripodi, P. F., Riggio, S., Giampaolo, A., Mannino, D., Aleandri, A. R., Guidi, M. V., Battisti, B., Faraglia, M. R., Lilli, V., Leotta, S., Visalli, N., Gagliardi, A., Fontana, L., Altomare, M., Carletti, S., Abbruzzese, S., Chiaramonte, F., Giordano, R., Rossini, M., Migneco, G., Cappelloni, D., Urbani, A., Piergiovanni, F., Fava, D., Simonetta, A., Massimiani, F., Bulzomì, R., Giuliano, M., Pennafina, M. G., Di Perna, P., D'Accinni, M. P., Paolucci, D., D'Ubaldi, A., D'Angelo, M. T., Masaro, G., Pietrantoni, M., Fratini, M., La Rosa, R., Poggi, M., Piccirilli, F., Pisano, R., Saponara, C., Conforti, I., Penza, A., Scalpone, R., Lo Pinto, S., Iacovella, L., Caccamo, C., Sposito, S., Teodonio, C., Restuccia, M. G., Mirto, G., Girardello, R., Gennaro, R., De Moliner, L., Bettini, E., Mattuzzi, A., Speese, K., Frisinghelli, F., Locatelli, F., Nicoletti, M., Trojan, N., Centis, R., L Volsi, P., Levis, E., Zanette, G., Comba, G., Ballatore, L., Cattaneo, A., Aglialoro, A., Guido, R., Patrone, M., Zecchini, M., Vespasiani, G., Meloncelli, I., Clementi, L., Galetta, M., Marconi, V., Bordin, P., Perale, L., Vinci, C., Sira Zanon, M., Geretto, L., Toffolo, C., Furlan, M. G., Mazzanti, G., Vinci, M., Sica, V., Armeni, M., Derai, R., Ennas, O., Mamusa, S., Pisano, M. A., Carreras, L., Rauseo, A., Cervone, S., Leggieri, A., Pontonio, M., Sturaro, R., Quattrocchi, F., Molinaro, M., Trasatti, M., Ferretti, B., Labarile, G., Baule, G. M., Gentilini, A., Spanu, M. A., Fancellu, A., Bianco, P., Lione, L., Massazza, G., Bocchio, G., Bosco, E., Monachesi, M., Carta, G., Boschetti, M., Ceresola, E., Venier, E., Calcaterra, F., Cataldi, F., Miola, M., Manfrini, S., Lai, A., Locci, B., Putzu, D., Tanganelli, I., Leonini, M., Egger, K., Marchiotto, W., Vincis, L., Orlandini, V., Pilloni, C., Farci, R., Pelligra, I., Renier, G., Mameli, M., Pala, A., Devigus, E., Fumagalli, I., Lalli, C., Leandri, M., Agliani, M., De Pascalis, L., Malci, F., De Ciocchis, A., Diodati, M. B., Macerola, B., Davì, S., Caccavale, A., Brocato, L., Pognant Gros, M., Borla, S., Lattanzi, E., Piersanti, C., Piersanti, A., Spinelli, I., Tuzzoli, L., Tulini, V., Quaranta, G., Iorio, V., Tirabovi, M., De Terlizi, Candia, Massarelli, M. G., Venturi, S., Travaglini, A., Draghi, P., Pomante, P., Richiardi, L., Clerico, A., Bruno, A., Cavallo Perin, P., Ghigo, E., Porta, M., Scuntero, P., Arcari, R., Bertaina, S., Bo, S., Broglio, F., Bruno, G., Degiovanni, M., Fornengo, P., Grassi, G., Inglese, V., Maccario, M., Maghenzani, G., Marena, S., Martina, V., Passera, P., Ruiu, G., Tagliabue, M., Zanone, M., Monge, M., Boffano, G. M., Macrì, K., Maio, P., Ozzello, A., Pergolizzi, E., Gaia, D., Gennari, P., Micali, G., Rossetto, E., Dalmazzo, C., Oreglia, M., Stefani, T., Dossena, C., Paglia, P., Bosoni, S., Romanelli, T., Inchiostro, S., Dauriz, M., Bossi, C. A., Meregalli, G., Balini, A., Berzi, D., Filippini, B., Crotto, G., Paccagnella, A., Orrasch, M., Sambataro, M., Citro, T., Kiwanuka, E., Bagolin, E., Almoto, B., Macchia, A., Branca, M. T., Filesi, M., Candido, R., Caroli, E., Manca, E., Petrucco, A., Tommasi, E., Jagodnik, G., Baskar, B., Daris, N., Dal Col, P., Pellegrini, M. A., Tonutti, L., Venturini, G., Andreani, M., Turchi, F., Fedrighelli, F., Martinelli, G., Rongioletti, R., Candidi, M., Pais, M., Moro, E., Cervellino, F., Sinisi, R., Zampino, A., Mingardi, R., Lora, L., Reitano, R., Stocchiero, C., Simoncini, M., Mesturino, C. A., Zen, F., Di Pietro, S., Scoponi, C., Tilaro, L., Pelliccioni, S., Slongo, R., Vita, E., Garofalo, A., Vitale, F., Campanella, B., Mastrilli, V., Borrelli, T., D'Avino, A., Perbellini, A., Mirijello, Antonio, Viazzi, Francesca, Fioretto, Paola, Giorda, Carlo, Ceriello, Antonio, Russo, Giuspina T, Guida, Pietro, Pontremoli, Roberto, and De Cosmo, Salvatore, Giordano, Carla

Subjects
Adult, Male, Nephrology, medicine.medical_specialty, endocrine system diseases, Renal function, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, lcsh:RC870-923, Kidney, urologic and male genital diseases, GFR, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Diabetes mellitus, medicine, Humans, Albuminuria, Diabetic kidney disease, Type 1 diabetes, urogenital system, business.industry, Incidence (epidemiology), Middle Aged, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, female genital diseases and pregnancy complications, Albuminuria, Diabetic kidney disease, GFR, Nephrology, Diabetes Mellitus, Type 1, medicine.anatomical_structure, Italy, Disease Progression, Female, medicine.symptom, business, Research Article, Follow-Up Studies, Glomerular Filtration Rate, Kidney disease
Abstract

Background Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage ≥3 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage ≥3 CKD in a large cohort of patients affected by T1DM. Methods A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage ≥3 CKD (eGFR 30% from baseline was evaluated. Results The mean estimated GFR was 98 ± 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions Albuminuria and eGFR reduction represent independent risk factors for incident stage ≥3 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening. Electronic supplementary material The online version of this article (10.1186/s12882-018-1136-6) contains supplementary material, which is available to authorized users.

Published
2018

46. Left ventricular dysfunction and outcome at two-year follow-up in patients with type 2 diabetes: The DYDA study

Author

Cioffi G, Faggiano P, Lucci D, Maggioni AP, Manicardi V, Travaglini A, Girfoglio D, Masson S, Giorda CB, Velussi M, Di Lenarda A, Verdecchia P, Comaschi M. DYDA Investigators Collaborators Comaschi M, Giorda C, Tarantini L, de Simone G, Mureddu G, Comaschi M, Latini R, Vago T, Angeli F, Mazzotta G, Repaci S, Botta I, Casalnuovo G, Chinali M, Boemi M, Mocchegiani R, Corsi A, Ponzani P, Camerini A, Pinamonti B, Grosu A, Sforza A, Rambaldi R, Zarra E, Murtas MG, Montaldo C, Motta RM, Leonardi G, Marchese T, Brero ML, Magro G, Tanga M, Rotella CM, Lenuzza M, Baggiore CM, Leopardi A, Minneci C, Sulla A, De Micheli A, Papagna D, Maggi D, Spallarossa P, Aglialoro A, Magaja O, Sabbatini G, Cesareo F, Corda A, Pitzalis L, Masselli L, Midi P, Pontiroli AE, Mauri C, Carletti F, Piatti P, Agricola E, Donà G, Frigato N, Finardi L, Catellani E, Piazza A, Cozzolino D, Madau G, Scanu M, Reboldi G, Biagioli P, Arcangeli A, Marsocci A, Badia T, Dabizzi L, Trojani C, Amati S, Genovese S, Bragato RM, Vespasiani G, Galetta M, Floris F, Mastroianno S, Russo A, De Cosmo S, Sturaro R, Ubaldi S, Miselli V, Gambarati GP, Curci V, Mattioli R, Mezzetti P, Bovelli D, Limone P, Mabritto B, Fonda M, Manca E, Pinamonti B., GENTILE, Sandro, Cioffi, G, Faggiano, P, Lucci, D, Maggioni, Ap, Manicardi, V, Travaglini, A, Girfoglio, D, Masson, S, Giorda, Cb, Velussi, M, Di Lenarda, A, Verdecchia, P, Comaschi M., DYDA Investigators Collaborators Comaschi M, Giorda, C, Tarantini, L, de Simone, G, Mureddu, G, Comaschi, M, Latini, R, Vago, T, Angeli, F, Mazzotta, G, Repaci, S, Botta, I, Casalnuovo, G, Chinali, M, Boemi, M, Mocchegiani, R, Corsi, A, Ponzani, P, Camerini, A, Pinamonti, B, Grosu, A, Sforza, A, Rambaldi, R, Zarra, E, Murtas, Mg, Montaldo, C, Motta, Rm, Leonardi, G, Marchese, T, Brero, Ml, Magro, G, Tanga, M, Rotella, Cm, Lenuzza, M, Baggiore, Cm, Leopardi, A, Minneci, C, Sulla, A, De Micheli, A, Papagna, D, Maggi, D, Spallarossa, P, Aglialoro, A, Magaja, O, Sabbatini, G, Cesareo, F, Corda, A, Pitzalis, L, Masselli, L, Midi, P, Pontiroli, Ae, Mauri, C, Carletti, F, Piatti, P, Agricola, E, Donà, G, Frigato, N, Finardi, L, Catellani, E, Piazza, A, Gentile, Sandro, Cozzolino, D, Madau, G, Scanu, M, Reboldi, G, Biagioli, P, Arcangeli, A, Marsocci, A, Badia, T, Dabizzi, L, Trojani, C, Amati, S, Genovese, S, Bragato, Rm, Vespasiani, G, Galetta, M, Floris, F, Mastroianno, S, Russo, A, De Cosmo, S, Sturaro, R, Ubaldi, S, Miselli, V, Gambarati, Gp, Curci, V, Mattioli, R, Mezzetti, P, Bovelli, D, Limone, P, Mabritto, B, Fonda, M, Manca, E, and Pinamonti, B.

Abstract

Left ventricular dysfunction (LVD) in type 2 diabetes mellitus (DM) (DYDA) study is a prospective investigation enrolling 960 with DM without overt cardiac disease. At baseline, a high prevalence of LVD was detected by analysing midwall shortening. We report here the incidence of clinical events in DYDA patients after 2-year follow-up and the frequency of LVD detected at baseline and 2-year evaluation. METHODS: Systolic LVD was defined as midwall shortening ≤15%, diastolic LVD as any condition different from "normal diastolic function" identified as E/A ratio on Doppler mitral flow between 0.75 and 1.5 and deceleration time of E wave >140 ms. Major outcome was a composite of major events, including all-causes death and hospital admissions. RESULTS: During the study period, any systolic/diastolic LVD was found in 616 of 699 patients (88.1%) in whom LVD function could be measured at baseline or at 2 years. Older age and high HbA1c predicted the occurrence of LVD. During the follow-up 15 patients died (1.6%), 3 for cardiovascular causes, 139 were hospitalized (14.5%, 43 of them for cardiovascular causes, 20 for a new cancer). CONCLUSIONS: During a 2-year follow-up any LVD is detectable in a large majority of patients with DM without overt cardiac disease. Older age and higher HbA1c predict LVD. All-cause death or hospitalization occurred in 15% of patients, cardiovascular cause was uncommon. Independent predictors of events were older age, pathologic lipid profile, high HbA1c, claudicatio and repaglinide therapy. Echo-assessed LVD at baseline was not prognosticator of events. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Published
2013

47. Analysis of midwall shortening reveals high prevalence of left ventricular myocardial dysfunction in patients with diabetes mellitus: the DYDA study

Author

Cioffi G, Giorda CB, Chinali M, Di Lenarda A, Faggiano P, Lucci D, Maggioni AP, Masson S, Mureddu GF, Tarantini L, Velussi M, Comaschi M, DYDA I.n.v.e.s.t.i.g.a.t.o.r.s. Collaborators Comaschi M, Giorda C, de Simone G, Mureddu G, Verdecchia P, Latini R, Vago T, Angeli F, Mazzotta G, Repaci S, Botta I, Casalnuovo G, Girfoglio D, Boemi M, Mocchegiani R, Corsi A, Ponzani P, Camerini A, Pinamonti B, Grosu A, Sforza A, Rambaldi R, Zarra E, Murtas MG, Montaldo C, Motta RM, Leonardi G, Marchese T, Brero ML, Magro G, Tanga M, Rotella CM, Lenuzza M, Baggiore CM, Leopardi A, Minneci C, Sulla A, De Micheli A, Papagna D, Maggi D, Spallarossa P, Aglialoro A, Magaja O, Sabbatini G, Cesareo F, Corda A, Pitzalis L, Masselli L, Midi P, Pontiroli AE, Mauri C, Carletti F, Piatti P, Agricola E, Donà G, Frigato N, Manicardi V, Finardi L, Catellani E, Piazza A, Cozzolino D, Madau G, Scanu M, Reboldi G, Biagioli P, Arcangeli A, Marsocci A, Badia T, Dabizzi L, Trojani C, Amati S, Genovese S, Bragato RM, Vespasiani G, Galetta M, Floris F, Mastroianno S, Russo A, De Cosmo S, Sturaro R, Ubaldi S, Miselli V, Gambarati GP, Curci V, Mattioli R, Travaglini A, Mezzetti P, Bovelli D, Limone P, Mabritto B, Fonda M, Manca E, Pinamonti B., GENTILE, Sandro, Cioffi, G, Giorda, Cb, Chinali, M, Di Lenarda, A, Faggiano, P, Lucci, D, Maggioni, Ap, Masson, S, Mureddu, Gf, Tarantini, L, Velussi, M, Comaschi, M, Collaborators Comaschi M, DYDA I. n. v. e. s. t. i. g. a. t. o. r. s., Giorda, C, de Simone, G, Mureddu, G, Verdecchia, P, Latini, R, Vago, T, Angeli, F, Mazzotta, G, Repaci, S, Botta, I, Casalnuovo, G, Girfoglio, D, Boemi, M, Mocchegiani, R, Corsi, A, Ponzani, P, Camerini, A, Pinamonti, B, Grosu, A, Sforza, A, Rambaldi, R, Zarra, E, Murtas, Mg, Montaldo, C, Motta, Rm, Leonardi, G, Marchese, T, Brero, Ml, Magro, G, Tanga, M, Rotella, Cm, Lenuzza, M, Baggiore, Cm, Leopardi, A, Minneci, C, Sulla, A, De Micheli, A, Papagna, D, Maggi, D, Spallarossa, P, Aglialoro, A, Magaja, O, Sabbatini, G, Cesareo, F, Corda, A, Pitzalis, L, Masselli, L, Midi, P, Pontiroli, Ae, Mauri, C, Carletti, F, Piatti, P, Agricola, E, Donà, G, Frigato, N, Manicardi, V, Finardi, L, Catellani, E, Piazza, A, Gentile, Sandro, Cozzolino, D, Madau, G, Scanu, M, Reboldi, G, Biagioli, P, Arcangeli, A, Marsocci, A, Badia, T, Dabizzi, L, Trojani, C, Amati, S, Genovese, S, Bragato, Rm, Vespasiani, G, Galetta, M, Floris, F, Mastroianno, S, Russo, A, De Cosmo, S, Sturaro, R, Ubaldi, S, Miselli, V, Gambarati, Gp, Curci, V, Mattioli, R, Travaglini, A, Mezzetti, P, Bovelli, D, Limone, P, Mabritto, B, Fonda, M, Manca, E, and Pinamonti, B.

Abstract

Individuals with diabetes mellitus (DM) have a higher risk to develop heart failure. Clinical guidelines emphasize the importance of early diagnosis of left ventricular dysfunction (LVD) and preventive interventions in these patients. In this study we assessed the prevalence of LVD, systolic or diastolic, in DM patients without known cardiac disease recruited in the 'left ventricular DYsfunction in DiAbetes (DYDA)' study. DESIGN AND METHODS: We performed clinical, ECG, laboratory, and echocardiographic exams in 960 patients (61 ± 8 years, 59% hypertensive) recruited in the DYDA study from 37 Italian diabetes referral centres. ECG and echo exams were read in central facilities. Systolic LVD was defined as ejection fraction ≤ 50% or midwall shortening (MFS) ≤ 15%. Diastolic LVD was identified when transmitral E/A was out of the range of 0.75-1.5 or deceleration time of mitral E wave ≤ 140 msec. RESULTS: Echocardiographic data were obtained in 751 patients (78.2%). Isolated systolic LVD was detected in 22.0% of patients, isolated diastolic LVD in 21.5%, and combined systolic and diastolic LVD in 12.7%. All patients with systolic LVD had MFS ≤ 15%, while only 9% had an ejection fraction ≤ 50%. Higher LV mass, relative wall thickness, prevalence of concentric geometry, and LV hypertrophy characterized the patients with LVD. CONCLUSIONS: LVD is present in more than half of DM patients without clinically detectable cardiac disease and is associated with LV hypertrophy and concentric LV geometry. One-third of patients exhibits systolic LVD detectable at the midwall level.

Published
2012

48. Inappropriately high left ventricular mass in patients with type 2 diabetes mellitus and no overt cardiac disease. The DYDA study

Author

Cioffi G, Faggiano P, Lucci D, Di Lenarda A, Mureddu GF, Tarantini L, Verdecchia P, Comaschi M, Giorda CB, Velussi M, Chinali M, Latini R, Masson S, De Simone G, DYDAInvestigators Collaborators Comaschi M, Giorda C, de Simone G, Mureddu G, Maggioni AP, Vago T, Angeli F, Mazzotta G, Repaci S, Botta I, Casalnuovo G, Girfoglio D, Boemi M, Mocchegiani R, Corsi A, Ponzani P, Camerini A, Pinamonti B, Grosu A, Sforza A, Rambaldi R, Zarra E, Murtas MG, Montaldo C, Motta RM, Leonardi G, Marchese T, Brero ML, Magro G, Tanga M, Rotella CM, Lenuzza M, Baggiore CM, Leopardi A, Minneci C, Sulla A, De Micheli A, Papagna D, Maggi D, Spallarossa P, Aglialoro A, Magaja O, Sabbatini G, Cesareo F, Corda A, Pitzalis L, Masselli L, Midi P, PontiroliAE, Mauri C, Carletti F, Piatti P, Agricola E, Donà G, Frigato N, Manicardi V, Finardi L, Catellani E, Piazza A, Cozzolino D, Madau G, Scanu M, Reboldi G, Biagioli P, Arcangeli A, Marsocci A, Badia T, Dabizzi L, Trojani C, Amati S, Genovese S, Bragato RM, Vespasiani G, Galetta M, Floris F, Mastroianno S, Russo A, De Cosmo S, Sturaro R, Ubaldi S, Miselli V, Gambarati GP, Curci V, Mattioli R, Travaglini A, Mezzetti P, Bovelli D, Limone P, Mabritto B, Fonda M, Manca E, Pinamonti B., GENTILE, Sandro, Cioffi, G, Faggiano, P, Lucci, D, Di Lenarda, A, Mureddu, Gf, Tarantini, L, Verdecchia, P, Comaschi, M, Giorda, Cb, Velussi, M, Chinali, M, Latini, R, Masson, S, De Simone, G, DYDAInvestigators Collaborators Comaschi, M, Giorda, C, de Simone, G, Mureddu, G, Maggioni, Ap, Vago, T, Angeli, F, Mazzotta, G, Repaci, S, Botta, I, Casalnuovo, G, Girfoglio, D, Boemi, M, Mocchegiani, R, Corsi, A, Ponzani, P, Camerini, A, Pinamonti, B, Grosu, A, Sforza, A, Rambaldi, R, Zarra, E, Murtas, Mg, Montaldo, C, Motta, Rm, Leonardi, G, Marchese, T, Brero, Ml, Magro, G, Tanga, M, Rotella, Cm, Lenuzza, M, Baggiore, Cm, Leopardi, A, Minneci, C, Sulla, A, De Micheli, A, Papagna, D, Maggi, D, Spallarossa, P, Aglialoro, A, Magaja, O, Sabbatini, G, Cesareo, F, Corda, A, Pitzalis, L, Masselli, L, Midi, P, Pontiroliae, Mauri, C, Carletti, F, Piatti, P, Agricola, E, Donà, G, Frigato, N, Manicardi, V, Finardi, L, Catellani, E, Piazza, A, Gentile, Sandro, Cozzolino, D, Madau, G, Scanu, M, Reboldi, G, Biagioli, P, Arcangeli, A, Marsocci, A, Badia, T, Dabizzi, L, Trojani, C, Amati, S, Genovese, S, Bragato, Rm, Vespasiani, G, Galetta, M, Floris, F, Mastroianno, S, Russo, A, De Cosmo, S, Sturaro, R, Ubaldi, S, Miselli, V, Gambarati, Gp, Curci, V, Mattioli, R, Travaglini, A, Mezzetti, P, Bovelli, D, Limone, P, Mabritto, B, Fonda, M, Manca, E, and Pinamonti, B.

Abstract

An inappropriately high left ventricular mass (iLVM) may be detected in patients with diabetes mellitus. Several hemodynamic and nonhemodynamic factors stimulating LVM growth may actively operate in these patients. In this study, we assessed prevalence and factors associated with iLVM in patients with diabetes mellitus. METHODS: We analyzed baseline data from 708 patients (61 ± 7 years, 57% treated for hypertension) with type 2 diabetes mellitus without evidence of cardiac disease enrolled in the left ventricular dysfunction in diabetes study. iLVM was diagnosed by Doppler echocardiography as LVM more than 28% of the expected LVM predicted from height, sex and stroke work. RESULTS: iLVM was detected in 166 patients (23%), irrespective of concomitant hypertension. Patients with iLVM were more frequently women, had higher BMI and prevalence of metabolic syndrome, higher serum triglyceride levels and were treated more frequently with metformin and diuretics. In a multivariate model, female sex [odds ratio (OR) 1.502 (95% confidence interval (CI) 1.010-2.231), P = 0.04], higher serum triglyceride levels [OR 1.007 (95% CI 1.003-1.012), P

Published
2011

49. Predictors of early-stage left ventricular dysfunction in type 2 diabetes: results of DYDA study

Author

Giorda CB, Cioffi G, de Simone G, Di Lenarda A, Faggiano P, Latini R, Lucci D, Maggioni AP, Tarantini L, Velussi M, Verdecchia P, Comaschi M, DYDA I.n.v.e.s.t.i.g.a.t.o.r.s. Collaborators Comaschi M, Giorda C, Mureddu G, Masson S, Vago T, Angeli F, Mazzotta G, Repaci S, Botta I, Casalnuovo G, Chinali M, Girfoglio D, Boemi M, Mocchegiani R, Corsi A, Ponzani P, Camerini A, Pinamonti B, Grosu A, Sforza A, Rambaldi R, Zarra E, Murtas MG, Montaldo C, Motta RM, Leonardi G, Marchese T, Brero LM, Magro G, Tanga M, Bardini G, Lenuzza M, Baggiore CM, Leopardi A, Minneci C, Sulla A, De Micheli A, Papagna D, Maggi D, Spallarossa P, Aglialoro A, Magaja O, Sabbatini G, Cesareo F, Corda A, Pitzalis L, Masselli L, Midi P, Pontiroli AE, Mauri C, Carletti F, Piatti P, Agricola E, Dona G, Zanocco A, Manicardi V, Michelini M, Pattoneri P, Catellani E, Cozzolino D, Madau G, Scanu M, Reboldi G, Biagioli P, Arcangeli A, Marsocci A, Badia T, Dabizzi L, Trojani C, Amati S, Genovese S, Genovese L, Vespasiani G, Galetta M, Floris F, Mastroianno S, Russo A, Sturaro R, Ubaldi S, Miselli V, Gambarati GP, Curci V, Mattioli R, Travaglini A, Mezzetti P, Bovelli D, Limone P, Pizzuti A, Fonda M, Manca E, Pinamonti B., GENTILE, Sandro, Giorda, Cb, Cioffi, G, de Simone, G, Di Lenarda, A, Faggiano, P, Latini, R, Lucci, D, Maggioni, Ap, Tarantini, L, Velussi, M, Verdecchia, P, Comaschi, M, Collaborators Comaschi M, DYDA I. n. v. e. s. t. i. g. a. t. o. r. s., Giorda, C, Mureddu, G, Masson, S, Vago, T, Angeli, F, Mazzotta, G, Repaci, S, Botta, I, Casalnuovo, G, Chinali, M, Girfoglio, D, Boemi, M, Mocchegiani, R, Corsi, A, Ponzani, P, Camerini, A, Pinamonti, B, Grosu, A, Sforza, A, Rambaldi, R, Zarra, E, Murtas, Mg, Montaldo, C, Motta, Rm, Leonardi, G, Marchese, T, Brero, Lm, Magro, G, Tanga, M, Bardini, G, Lenuzza, M, Baggiore, Cm, Leopardi, A, Minneci, C, Sulla, A, De Micheli, A, Papagna, D, Maggi, D, Spallarossa, P, Aglialoro, A, Magaja, O, Sabbatini, G, Cesareo, F, Corda, A, Pitzalis, L, Masselli, L, Midi, P, Pontiroli, Ae, Mauri, C, Carletti, F, Piatti, P, Agricola, E, Dona, G, Zanocco, A, Manicardi, V, Michelini, M, Pattoneri, P, Catellani, E, Gentile, Sandro, Cozzolino, D, Madau, G, Scanu, M, Reboldi, G, Biagioli, P, Arcangeli, A, Marsocci, A, Badia, T, Dabizzi, L, Trojani, C, Amati, S, Genovese, S, Genovese, L, Vespasiani, G, Galetta, M, Floris, F, Mastroianno, S, Russo, A, Sturaro, R, Ubaldi, S, Miselli, V, Gambarati, Gp, Curci, V, Mattioli, R, Travaglini, A, Mezzetti, P, Bovelli, D, Limone, P, Pizzuti, A, Fonda, M, Manca, E, and Pinamonti, B.

Abstract

Better knowledge of prevalence and early-stage determinants of subclinical left ventricular dysfunction (LVD) in type 2 diabetes would be useful to design prevention strategies. The objective of the LVD in Diabetes (DYDA) study was to assess these points in patients without established cardiac disease. METHOD: Baseline clinical, ECG, laboratory and echocardiographic data from 751 patients (61 ± 7 years, 59% hypertensive) recruited by 37 Italian diabetes clinics were analysed. Clinical history, life habits, laboratory data (NT-proBNP, HsCRP, HbA1c, serum glucose, lipids and creatinine, liver enzymes, microalbuminuria, glomerular filtrate) and data on microvascular complications and drug therapy were collected. RESULTS: LVD was present in 59.9% of patients. Age (OR 1.05, 95% CI [1.02-1.07]), HbA1c (OR 1.27, 95% CI [1.09-1.49]), triglycerides (OR 1.003, 95% CI [1.001-1.006]), treatment with metformin (OR 1.62, 95% CI [1.09-2.40]) and doxazosine (OR 2.48, 95% CI [1.10-5.55]) were independent predictors of LVD. Glitazones were associated with reduced risk of diastolic dysfunction (OR 0.44, 95% CI [0.22-0.87]) whereas waist circumference and metformin were adversely associated with systolic dysfunction (OR 1.02, 95% CI [1.01-1.04] and 1.57, 95% CI [1.01-2.43], respectively). CONCLUSION: In asymptomatic and fairly controlled diabetic patients, age, worse HbA1c, traits of insulin resistance, such as visceral adiposity and triglycerides or treatment with metformin, and use of doxazosin indicate greater risk of LVD. Glitazones, at this stage, seem to be associated with better diastolic performance.

Published
2011

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