72 results on '"Monaco F."'
Search Results
2. Amblyomma sparsum Neumann 1899 on migratory birds from Africa: First records in Italy.
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Menegon M, Mancuso E, Di Luca M, Casale F, Neves L, Smit A, Severini F, Castelli M, Di Giulio A, d'Alessio SG, Goffredo M, Monaco F, and Toma L
- Abstract
Migratory birds play an important role in transporting ixodid ticks and tick-borne pathogens between continents. During the Boreal spring, migratory birds reach Europe, mainly from sub-Saharan Africa or from northern African countries but not much is known about the diversity and ecology of the ticks they spread. From 2017 to 2022, in the framework of two consecutive projects focused on sampling migratory birds from Africa to Europe, a total of 27 immature Amblyomma ticks were collected from migratory birds, belonging to 8 species, captured on the Island of Ventotene, an important stop-over site in the Mediterranean Sea. In the absence of adult specimens, morphological identification was limited to assigning these ticks to the Amblyomma genus. In this study, sequencing and comparative analysis of three mitochondrial molecular markers (12S rDNA, 16S rDNA, COI) were performed to achieve taxonomic identification. Sequences obtained from Ventotene specimens matched at 100% identity with Amblyomma sparsum. In conclusion, this study documented that immature stages of this species belonging to the Amblyomma marmoreum complex reached the Pontine Islands for six consecutive years. The entry of alien tick species and their potentially transmitted pathogens deserves further study, also in light of the globally ongoing climate change., (Copyright © 2024 Istituto Superiore di sanità. Published by Elsevier GmbH.. All rights reserved.)
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- 2024
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3. Acute normovolemic hemodilution in cardiac surgery: Rationale and design of a multicenter randomized trial.
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Monaco F, Guarracino F, Vendramin I, Lei C, Zhang H, Lomivorotov V, Osinsky R, Efremov S, Gürcü ME, Mazzeffi M, Pasyuga V, Kotani Y, Biondi-Zoccai G, D'Ascenzo F, Romagnoli E, Nigro Neto C, Do Nascimento VTNDS, Ti LK, Lorsomradee S, Farag A, Bukamal N, Brizzi G, Lobreglio R, Belletti A, Arangino C, Paternoster G, Bonizzoni MA, Tucciariello MT, Kroeller D, Di Prima AL, Mantovani LF, Ajello V, Gerli C, Porta S, Ferrod F, Giardina G, Santonocito C, Ranucci M, Lembo R, Pisano A, Morselli F, Nakhnoukh C, Oriani A, Pieri M, Scandroglio AM, Kırali K, Likhvantsev V, Longhini F, Yavorovskiy A, Bellomo R, Landoni G, and Zangrillo A
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- Humans, Single-Blind Method, Erythrocyte Transfusion methods, Male, Blood Loss, Surgical prevention & control, Female, Hemodilution methods, Cardiac Surgical Procedures methods, Cardiopulmonary Bypass methods
- Abstract
Background: Minimizing the use of blood component can reduce known and unknown blood transfusion risks, preserve blood bank resources, and decrease healthcare costs. Red Blood Cell (RBC) transfusion is common after cardiac surgery and associated with adverse perioperative outcomes, including mortality. Acute normovolemic hemodilution (ANH) may reduce bleeding and the need for blood product transfusion after cardiac surgery. However, its blood-saving effect and impact on major outcomes remain uncertain., Methods: This is a single-blinded, multinational, pragmatic, randomized controlled trial with a 1:1 allocation ratio conducted in Tertiary and University hospitals. The study is designed to enroll patients scheduled for elective cardiac surgery with planned cardiopulmonary bypass (CPB). Patients are randomized to receive ANH before CPB or the best available treatment without ANH. We identified an ANH volume of at least 650 ml as the critical threshold for clinically relevant benefits. Larger ANH volumes, however, are allowed and tailored to the patient's characteristics and clinical conditions., Results: The primary outcome is the percentage of patients receiving RBCs transfusion from randomization until hospital discharge, which we hypothesize will be reduced from 35% to 28% with ANH. Secondary outcomes are all-cause 30-day mortality, acute kidney injury, bleeding complications, and ischemic complications., Conclusion: The trial is designed to determine whether ANH can safely reduce RBC transfusion after elective cardiac surgery with CPB., Study Registration: This trial was registered on ClinicalTrials.gov in April 2019 with the trial identification number NCT03913481., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Three authors specified the following financial interests even if not related to this paper: Dr Ranucci declares the following financial interests: CSL Behring, Haemonetics, LFB, Werfen, Grifols. Dr Guarracino declares the following financial interests: Abbott, AOP Orphan, Edwards, Masimo, Orion, Viatris Dr Mazzeffi declares the following financial interests: consulting fees from Octapharma, Hemosonics, NovoNordisk, (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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4. Donor-derived carbapenem-resistant gram-negative bacterial infections in solid organ transplant recipients: Active surveillance enhances recipient safety.
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Mularoni A, Cona A, Campanella M, Barbera F, Medaglia AA, Cervo A, Cuscino N, Di Mento G, Graziano E, El Jalbout JD, Alduino R, Tuzzolino F, Monaco F, Cascio A, Peghin M, Gruttadauria S, Bertani A, Conaldi PG, Mikulska M, and Grossi PA
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- Humans, Male, Prospective Studies, Female, Middle Aged, Adult, Risk Factors, Incidence, Follow-Up Studies, Prognosis, Aged, Gram-Negative Bacteria drug effects, Gram-Negative Bacteria isolation & purification, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents pharmacology, Postoperative Complications, Organ Transplantation adverse effects, Carbapenems pharmacology, Carbapenems therapeutic use, Tissue Donors, Transplant Recipients, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections epidemiology
- Abstract
Donor-derived infections (DDIs) caused by carbapenem-resistant gram-negative bacteria (CR-GNB) in solid organ transplant recipients are potentially life-threatening. In this prospective study, we evaluated the incidence, factors associated with transmission, and the outcome of recipients with unexpected CR-GNB DDIs after the implementation of our local active surveillance system (LASS). LASS provides for early detection of unexpected donor CR-GNB infections, prophylaxis of recipients at high risk, and early diagnosis and treatment of DDIs. Whole genome sequencing confirmed DDI. Among 791 recipients, 38 (4.8%) were at high risk of unexpected CR-GNB DDI: 25 for carbapenem-resistant Enterobacterales (CRE) and 13 for carbapenem-resistant Acinetobacter baumannii (CRAB). Transmission did not occur in 27 (71%) cases, whereas DDIs occurred in 9 of 25 of CRE and 2 of 13 of CRAB cases. Incidence of CR-GNB DDI was 1.4%. Recipients of organs with CR-GNB-positive preservation fluid and liver recipients from a donor with CRE infection were at the highest risk of DDI. There was no difference in length of hospital stay or survival in patients with and without CR-GNB DDI. Our LASS contains transmission and mitigates the negative impacts of CR-GNB DDI. Under well-defined conditions, organs from donors with CR-GNB may be considered after a thorough evaluation of the risk/benefit profile., Competing Interests: Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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5. Anaesthetic management of paediatric patients undergoing electrophysiology study and ablation for supraventricular tachycardia: A focused narrative review.
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Monaco F, D'Andria Ursoleo J, Lerose CC, Barucco G, Licheri M, Della Bella PE, Fioravanti F, and Gulletta S
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- Adult, Humans, Child, Electrophysiologic Techniques, Cardiac, Heart Rate, Electrophysiology, Tachycardia, Supraventricular surgery, Anesthetics, Catheter Ablation adverse effects
- Abstract
Every year, 80,000-100,000 ablation procedures take place in the United States and approximately 1% of these involve paediatric patients. As the paediatric population undergoing catheter ablation to treat dysrhythmia is constantly growing, involvement of anaesthesiologists in the cardiac electrophysiology laboratory is simultaneously increasing. Compared with the adult population, paediatric patients need deeper sedation or general anaesthesia (GA) to guarantee motionlessness and preserve comfort. As a result, the anaesthesiologist working in this setting should keep in mind heart physiopathology as well as possible interactions between anaesthetic drugs and arrhythmia. In fact, drug-induced suppression of accessory pathways (APs) conduction capacity is a major concern for completing a successful electrophysiology study (EPS). Nevertheless, the literature on this topic is scarce and the optimal type of anaesthesia in EPS and ablation procedures in children is still controversial. Thus, the main goal of the present review is to collect the literature published so far on the effects on cardiac conduction tissue of the drugs commonly employed for sedation/GA in the cath lab for EPS and ablation procedures to treat supraventricular tachycardia in patients aged <18 years., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)
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- 2024
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6. The first 100 years of the British Journal of Anaesthesia: a bibliometric analysis of the top-cited articles.
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D'Andria Ursoleo J, Losiggio R, and Monaco F
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- Humans, Bibliometrics, Journal Impact Factor, Anesthesia, Anesthesiology
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- 2024
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7. Argas ticks (Ixodida: Argasidae) on migratory birds from Africa: first record of a genotype close to Argas africolumbae in Italy.
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Menegon M, Casale F, Mancuso E, Di Luca M, Severini F, Monaco F, and Toma L
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- Animals, Italy epidemiology, Birds parasitology, South Africa epidemiology, Genotype, Larva genetics, Larva anatomy & histology, Ticks anatomy & histology, Argasidae, Argas
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In spring, migratory birds reach Europe, mainly from sub-Saharan Africa or from northern African countries. Avian species may be implicated in the spread of pathogens, either as reservoirs, hosts or carriers of infected ectoparasites. In 2021, on Ventotene Island (Latium region, Italy) within a project focused on the potential incoming pathogens via migratory birds from Africa, we found two larvae of Argas sp., on the redstart Phoenicurus phoenicurus, that shared morphological features with the African Argas (Argas) africolumbae. Comparison of the tested larval DNA sequences to the adult reference sequences showed the highest identity (> 92%) with homologous sequences of A. africolumbae collected in South Africa and in Spain. This study reports the first detection of Argas africolumbae-like specimens in Italy., (Copyright © 2023 The Author(s). Published by Elsevier GmbH.. All rights reserved.)
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- 2023
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8. Postoperative Quality of Life After Full-sternotomy and Ministernotomy Aortic Valve Replacement.
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Perrotti A, Francica A, Monaco F, Quintana E, Sponga S, El-Dean Z, Salizzoni S, Loizzo T, Salsano A, Di Cesare A, Benassi F, Castella M, Rinaldi M, Chocron S, Vendramin I, Faggian G, Santini F, Nicolini F, Milano AD, Ruggieri VG, and Onorati F
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- Humans, Sternotomy, Quality of Life, Treatment Outcome, Aortic Valve surgery, Heart Valve Prosthesis Implantation
- Abstract
Background: Few longitudinal data exist comparing quality of life (QoL) after full sternotomy (fs) aortic valve replacement (AVR) (fsAVR) with ministernotomy AVR (msAVR)., Methods: A total of 1844 consecutive patients undergoing AVR who were prospectively enrolled in a European multicenter registry were dichotomized according to surgical access. Nonparsimonious propensity score matching selected 187 pairs of patients who underwent fsAVR or msAVR with comparable baseline characteristics. Hospital outcome was compared in the 2 groups. QoL was assessed with the Short Form-36, further detailed in its Physical Component Summary (PCS) score and the Mental Component Summary (MCS) score. QoL was investigated at hospital admission, at discharge, and at 1 month, 6 months, and 1 year thereafter., Results: There were 1654 patients undergoing fsAVR and 190 undergoing msAVR in the entire population. The fsAVR group showed a worse preoperative risk profile, a longer intensive care unit length of stay (59.7 hours vs 38.8 hours; p = .002), and a higher rate of life-threatening or disabling bleeding (4.1% vs 0%; P = .011); the msAVR group had a higher rate of early reintervention for failed index intervention (2.1% vs 0.5%; P = .001). QoL investigations showed better PCS and MCS at 1 month after fsAVR, but no temporal trend differences (PCS group-time P = .202; MCS group-time P = .141). Propensity-matched pairs showed comparable baseline characteristics and hospital outcomes (P = not significant for all end points) and comparable improvements of PCS and MCS over time, but no between-group differences over time (PCS group time P = .834; MCS group time P = .737)., Conclusions: Patients with similar baseline profiles report comparable hospital outcomes and comparable improvements of physical and mental health, up to 1 year after surgery, with both fsAVR and msAVR. As for QoL, ministernotomy does not seem to offer any advantage compared with the traditional approach., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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9. Mitral Repair With Complete Rings or Posterior Bands in Barlow Disease: Long-term Results.
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Del Forno B, Carino D, Bisogno A, Rizzello A, Lapenna E, Ascione G, Gramegna F, Iaci G, Agricola E, Monaco F, Alfieri O, Castiglioni A, Maisano F, and De Bonis M
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- Humans, Treatment Outcome, Mitral Valve diagnostic imaging, Mitral Valve surgery, Retrospective Studies, Mitral Valve Insufficiency etiology, Mitral Valve Prolapse surgery, Mitral Valve Annuloplasty methods
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Background: Complete rings or posterior bands are both commonly used during mitral valve repair, but which one ensures the best long-term outcome in patients with Barlow disease is a topic of debate. This study evaluated whether the type of annuloplasty device affects the long-term durability of the repair., Methods: We selected 296 consecutive patients with severe mitral regurgitation due to Barlow disease who underwent edge-to-edge mitral repair at our institution between 2004 and 2013. For the edge-to-edge repair, a complete semirigid ring was used in 151 patients, whereas a posterior flexible band was used in 145 patients. The clinical and echocardiographic outcomes of both groups were compared at long-term follow-up., Results: At 14 years, the overall survival was 87.3% ± 2.79% in the ring group and 94.1% ± 2.30% in the band group (P = .056). The incidence of mitral valve reintervention was 4.9% ± 1.95% in the ring group and 5.5% ± 2.53% in the band group (P = .371) at 14 years. The incidence of recurrence of mitral regurgitation ≥3+ and ≥2+ was 8.3% ± 2.64% in the ring group and 8.7% ± 3.07% in the band group (P = .991) and 26.5% ± 4.23% in the ring group and 17.4% ± 3.26% in the band group (P = .697), respectively. Mitral regurgitation ≥1+ at discharge was the only independent predictor of reoperation and recurrence of mitral regurgitation ≥3+ in the long-term., Conclusions: In patients with Barlow disease undergoing edge-to-edge mitral valve repair, the type of annuloplasty device does not influence the long-term results. Achieving an optimal immediate result remains the key to maintain the stability of the repair at long-term., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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10. Association Between Type of Anaesthesia and Clinical Outcome in Patients Undergoing Endovascular Repair of Thoraco-Abdominal Aortic Aneurysms by Fenestrated and Branched Endografts.
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Monaco F, Barucco G, Licheri M, De Luca M, Labanca R, Rocchi M, Melissano G, Bertoglio L, Chiesa R, and Zangrillo A
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- Humans, Blood Vessel Prosthesis adverse effects, Retrospective Studies, Prosthesis Design, Postoperative Complications, Risk Factors, Treatment Outcome, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Abdominal complications, Endovascular Procedures methods, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic complications, Anesthesia, Blood Vessel Prosthesis Implantation adverse effects
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Objective: Although endovascular repair of thoraco-abdominal aortic aneurysm (TAAA) is the treatment of choice in the high risk population that is ineligible for an open surgical approach, little is known about the association between the type of anaesthesia and complications. This study compared the short term clinical outcomes of patients undergoing the visceral step of TAAA with fenestrated endograft aortic repair (FEVAR) and branched endograft aortic repair (BEVAR) under general anaesthesia (GA) with sedation with monitored care anaesthesia (MAC)., Methods: This single centre, retrospective, observational study recruited 124 consecutive patients undergoing elective F/BEVAR from 2014 - 2021. The primary endpoint was the short term complication rate according to the type of anaesthesia. Secondary endpoints included: need for inotropes or vasopressors for hypotension, time spent in the operating room, and admission to the intensive care unit. Propensity score matching was generated to account for the between group imbalance in the pre-operative covariables., Results: After propensity score matching, 42 patients under GA were matched with 42 under MAC. The two groups showed no difference in cardiac and non-cardiac complications. Among the secondary outcomes, a higher number of patients in the GA group required inotropes or vasopressors compared with MAC (33% vs. 9%; p = .031). Although GA and MAC showed the same 30 day technical success (81% vs. 83%; p = .078), non-significant lower rates of major adverse events (10% vs. 12%; p = .72), one year re-intervention (14% vs. 21%; p = .39), and one year target vessel instability (10% vs. 21%; p = .39) were observed in the GA group. Overall, the in hospital mortality rate was 4%, with no difference between GA and MAC (2% vs. 5%; p = 1.0)., Conclusion: The type of anaesthesia seemed to have no effect on procedure success, peri-operative morbidity, or mortality in patients undergoing F/BEVAR., (Copyright © 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
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- 2022
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11. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial. The PROTECTION trial.
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Landoni G, Brambillasca C, Baiardo Redaelli M, Bradić N, Ti LK, Povšić-Čevra Z, Nepomniashchikh VA, Zoccai GB, D'Ascenzo F, Romagnoli E, Scandroglio AM, Ballotta A, Rondello N, Franco A, Massaro C, Viscido C, Calabrò MG, Garofalo E, Canichella F, Monaco F, Severi L, Pisano A, Barucco G, Venditto M, Federici F, Licheri M, Paternoster G, Trompeo A, Belletti A, Mantovani LF, Perone R, Dalessandro G, Kroeller D, Haxhiademi D, Galbiati C, Tripodi VF, Giardina G, Lembo R, Nakhnoukh C, Guarracino F, Longhini F, Bove T, Zangrillo A, Bellomo R, and Fominskiy E
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- Adult, Amino Acids, Clinical Trials, Phase III as Topic, Crystalloid Solutions, Humans, Kidney, Multicenter Studies as Topic, Quality of Life, Randomized Controlled Trials as Topic, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology, Acute Kidney Injury prevention & control, Cardiac Surgical Procedures
- Abstract
Background: Postoperative acute kidney injury (AKI) is frequent in cardiac surgery patients. Its pathophysiology is complex and involves decreased renal perfusion. Preliminary clinical evidence in critically ill patients shows that amino acids infusion increases renal blood flow and may decrease the incidence and severity of AKI. We designed a study to evaluate the effectiveness of perioperative continuous infusion of amino acids in decreasing AKI., Methods: This is a phase III, multi-center, randomized, double-blind, placebo-controlled trial. Adults undergoing cardiac surgery with cardiopulmonary bypass (CPB) are included. Patients are randomly assigned to receive either continuous infusion of a balanced mixture of amino acids in a dose of 2 g/kg ideal body weight/day or placebo (balanced crystalloid solution) from the operating room up to start of renal replacement therapy (RRT), or ICU discharge, or 72 h after the first dose. The primary outcome is the incidence of AKI during hospital stay defined by KDIGO (Kidney Disease: Improving Global Outcomes). Secondary outcomes include the need for, and duration of, RRT, mechanical ventilation; ICU and hospital length of stay; all-cause mortality at ICU, hospital discharge, 30, 90, and 180 days after randomization; quality of life at 180 days. Data will be analyzed in 3500 patients on an intention-to-treat basis., Discussion: The trial is ongoing and currently recruiting. It will be one of the first randomized controlled studies to assess the relationship between amino acids use and kidney injury in cardiac surgery. If our hypothesis is confirmed, this practice could reduce morbidity in the studied population., Study Registration: This trial was registered on ClinicalTrials.gov with the trial identification NCT03709264 in October 2018., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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12. Immunogenicity and safety studies of an inactivated vaccine against Rift Valley fever.
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Ronchi GF, Testa L, Iorio M, Pinoni C, Bortone G, Dondona AC, Rossi E, Capista S, Mercante MT, Morelli D, Di Ventura M, and Monaco F
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- Adjuvants, Immunologic, Animals, Cattle, Mineral Oil, Mosquito Vectors, Sheep, Vaccines, Inactivated, Zoonoses prevention & control, Culicidae, Rift Valley Fever epidemiology, Rift Valley fever virus, Viral Vaccines adverse effects
- Abstract
Rift Valley fever (RVF) is an emerging transboundary, mosquito-borne, zoonotic viral disease caused by a single serotype of a virus belonging to the Phenuiviridae family (genus Phlebovirus). It is considered an important threat to both agriculture and public health in endemic areas, because the virus, transmitted by different mosquito genera, leads to abortions in susceptible animal hosts especially sheep, goat, cattle, and buffaloes, resulting in severe economic losses. Humans can also acquire the infection, and the major sources are represented by the direct contact with infected animal blood, aerosol, consumption of unpasteurized contaminated milk and the bite of infected mosquitoes. Actually, the EU territory does not seem to be exposed to an imminent risk of RVFV introduction, however, the recent outbreaks in a French overseas department and some cases detected in Turkey, Tunisia and Libya, raised the attention of the EU for a possible risk of introduction of infected vectors. Thus, there is an urgent need to develop new therapeutic and/or preventive drugs, such as vaccines. In our work, we studied the immunogenicity of an inactivated and adjuvanted vaccine produced using a Namibian field strain of RVF virus (RVFV). The vaccine object of this study was formulated with Montanide Pet Gel A, a polymer-based adjuvant that has been previously reported for its promising safety profile and for the capacity to elicit a strong immune response. The produced inactivated vaccine was tested on six sheep and the level of IgM and IgG after the immunization of animals was evaluated by a commercial competitive ELISA, in order to assess the immunogenicity profile of our vaccine and to evaluate its potential use, as an alternative to the attenuated vaccines commercially available, in case of Rift Valley fever epidemic disease on EU territory. Following the administration of the second dose, 35 days after the first one, all animals seroconverted., (Copyright © 2022 Elsevier B.V. All rights reserved.)
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- 2022
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13. Intraoperative neurophysiologic monitoring in thoracoabdominal aortic aneurysm surgery can provide real-time feedback for strategic decision making.
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Bianchi F, Cursi M, Caravati H, Butera C, Bosco L, Monaco F, Baccellieri D, Bertoglio L, Kahlberg A, Filippi M, Melissano G, Chiesa R, and Carro UD
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- Decision Making, Evoked Potentials, Motor physiology, Feedback, Humans, Retrospective Studies, Aortic Aneurysm, Thoracic complications, Aortic Aneurysm, Thoracic surgery, Intraoperative Neurophysiological Monitoring adverse effects, Spinal Cord Ischemia etiology, Spinal Cord Ischemia prevention & control
- Abstract
Objectives: Despite the introduction of several adjuncts to improve spinal perfusion, spinal cord ischemia (SCI) remains a devastating complication of thoracoabdominal aortic aneurysm (TAAA) repair. Our aim was to assess the effects on clinical outcome of interventions triggered by motor evoked potentials (MEP) alerts. Furthermore, we want to assess whether a multimodal intraoperative neurophysiologic monitoring (IONM) protocol is helpful for stratifying patients according to the risk of SCI at the end of the vascular phase of surgery., Methods: We prospectively studied one-hundred consecutive patients who underwent TAAA repair. We applied a multimodal IONM including MEP, somatosensory evoked potentials (SEP) and peripheral nerve monitoring techniques. Signal deteriorations were classified as reversible/irreversible according to whether they recovered or not at the end of monitoring (EOM), set at the end of the vascular phase of surgery. Significant MEP changes drove a series of corrective measures aimed to improve spinal perfusion., Results: The rate of immediate postoperative motor deficits consistent with SCI was significantly higher with irreversible MEP deteriorations compared to reversible ones. The interpretation of MEP findings at the EOM led to the development of risk categories for SCI, based on the association between MEP results and motor outcome., Conclusions: Our data seem to justify interventions made to reverse MEP deterioration in order to improve the clinical outcome. A multimodal IONM protocol could improve MEP interpretation at the end of the vascular phase of surgery, supporting the surgeon in their decision-making, before concluding vascular maneuvers., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest relevant to this article., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)
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- 2022
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14. Bibliometric Network Analysis on Rapid-Onset Opioids for Breakthrough Cancer Pain Treatment.
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Cascella M, Monaco F, Nocerino D, Chinè E, Carpenedo R, Picerno P, Migliaccio L, Armignacco A, Franceschini G, Coluccia S, Gennaro PD, Tracey MC, Forte CA, Tafuri M, Crispo A, Cutugno F, Vittori A, Natoli S, and Cuomo A
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- Analgesics, Opioid therapeutic use, Bibliometrics, Fentanyl, Humans, Breakthrough Pain drug therapy, Cancer Pain drug therapy, Neoplasms complications, Neoplasms drug therapy
- Abstract
Background and Objectives: Proper breakthrough cancer pain (BTcP) management is of pivotal importance. Although rapid-acting, oral and nasal transmucosal, fentanyl formulations (rapid-onset opioids, ROOs) are licensed for BTcP treatment, not all guidelines recommend their use. Presumably, some research gaps need to be bridged to produce solid evidence. We present a bibliometric network analysis on ROOs for BTcP treatment., Methods: Documents were retrieved from the Web of Science (WOS) online database. The string was "rapid onset opioids" or "transmucosal fentanyl" and "breakthrough cancer pain". Year of publication, journal metrics (impact factor and quartile), title, document type, topic, and clinical setting (in-patients, outpatients, and palliative care) were extracted. The software tool VOSviewer (version 1.6.17) was used to analyze the semantic network analyzes, bibliographic coupling, journals analysis, and research networks., Results: 502 articles were found in WOS. A declining trend in published articles from 2014 to 2021 was observed. Approximately 50% of documents regard top quartile (Q1) journals. Most articles focused on ROOs efficacy, but abuse and misuse issues are poorly addressed. With respect to article type, we calculated 132 clinical investigations. The semantic network analysis found interconnections between the terms "breakthrough cancer pain," "opioids," and "cancers." The top co-cited article was published in 2000 and addressed pain assessment. The largest number of partnerships regarded the United States, Italy, and England., Conclusion: In this research area, most articles are published in top-ranked journals. Nevertheless, paramount topics should be better addressed, and the implementation of research networks is needed., (Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2022
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15. Venoarterial Extracorporeal Membrane Oxygenation Support in Lung Cancer Resection.
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Novellis P, Monaco F, Landoni G, Rossetti F, Carretta A, Gregorc V, Zangrillo A, and Veronesi G
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- Hemodynamics, Humans, Stroke Volume, Extracorporeal Membrane Oxygenation, Heart Failure etiology, Lung Neoplasms etiology, Lung Neoplasms surgery
- Abstract
Cardiovascular comorbidities often prevent patients with otherwise resectable early-stage lung cancer from undergoing surgery due to prohibitive perioperative risk. Here we describe the intraoperative use of venoarterial (VA) extracorporeal membrane oxygenation in a stage cIIA lung cancer patient with arterial infiltration and severe postischemic dilated cardiomyopathy (ejection fraction, 0.23) undergoing left upper lobectomy with pulmonary artery angioplasty. Providing intraoperative cardiovascular and respiratory function support, venoarterial extracorporeal membrane oxygenation represents a suitable option for patients with heart failure, ensuring an adequate hemodynamic profile and reducing the risk of complications. Thus, these otherwise inoperable patients can be offered a potentially curative surgical resection of the malignancy., (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2022
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16. NGS-based miRNome identifies miR-449 cluster as marker of malignant transformation of sinonasal inverted papilloma.
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Re M, Tomasetti M, Monaco F, Amati M, Rubini C, Foschini MP, Sollini G, Gioacchini FM, Pasquini E, and Santarelli L
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- Biomarkers, Tumor genetics, Cell Transformation, Neoplastic genetics, High-Throughput Nucleotide Sequencing, Humans, MicroRNAs genetics, Papilloma, Inverted genetics, Paranasal Sinus Neoplasms genetics, Squamous Cell Carcinoma of Head and Neck genetics
- Abstract
Objective: identification of the miRNA expression profile in sinonasal inverted papilloma (SNIP) as a tool to evaluate the risk of transformation into sinonasal squamous cell carcinoma (SNSCC)., Materials and Methods: paired tumour tissues and adjacent normal tissues were obtained from SNIP and SNSCC patients who had undergone surgical resection and used for next-generation sequencing (NGS)-based miRNome analysis. SNIP tissues with concomitant dysplasia (SNIP-DISP) were used as malignant transition samples. By comparing the deregulated miRNAs in SNIP and SNSCC, an miRNA cluster was identified and its physio- and clinical-pathological value was predicted., Results: NGS identified 54 miRNAs significantly down- and upregulated in SNIP. Among them, the miR-449 cluster was upregulated in SNIP and could differentiate the benign tumour from normal tissue. Notably, the miR-449 cluster was found to be significantly underexpressed in SNSCC, and the cluster markedly changed in SNIP during the malignant transition into SNSCC. miRNA enrichment analysis and GO analysis revealed that miR-449 is involved in apoptotic and cell proliferation pathways., Conclusions: Our findings suggest that miR-449 may be involved in the molecular pathogenesis of SNIP and its malignant transformation into SNSCC. miR-449 might therefore be a useful tumour biomarker in patients with SNIP and may also have the potential to be used as a tool for detecting and monitoring the course of the possible malignant transformation., (Copyright © 2021. Published by Elsevier Ltd.)
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- 2021
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17. Simultaneous pneumothorax and pneumoperitoneum as a late consequence of traumatic injury of the diaphragm: Multimodality imaging approach with surgical correlation and treatment.
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Solazzo A, Barone M, Bonanno D, Sofia C, Bottari A, Ascenti V, Familiari D, Mazziotti S, Cicero G, and Monaco F
- Abstract
Simultaneous occurrence of pneumothorax and pneumoperitoneum is a rare event, usually related to traumas or surgical procedures involving the diaphragm. However, clinicians should be aware of the possible onset of these two clinical conditions even in patients without a recent clinical history that can clearly explain them. Cross-sectional imaging techniques are of great importance, providing crucial information about the patient's clinical status and guiding the following patient management. This work describes a unique case of a sudden occurrence of simultaneous pneumothorax and pneumoperitoneum in a previous asymptomatic man with a solely clinical history of minor trauma during childhood, evaluated through a multimodality imaging approach and treated with video-assisted thoracoscopy surgery., Competing Interests: The authors declare they have no conflict of interest., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)
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- 2021
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18. Dose/schedule-adjusted Rd-R vs continuous Rd for elderly, intermediate-fit patients with newly diagnosed multiple myeloma.
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Larocca A, Bonello F, Gaidano G, D'Agostino M, Offidani M, Cascavilla N, Capra A, Benevolo G, Tosi P, Galli M, Marasca R, Giuliani N, Bernardini A, Antonioli E, Rota-Scalabrini D, Cellini C, Pompa A, Monaco F, Patriarca F, Caravita di Toritto T, Corradini P, Tacchetti P, Boccadoro M, and Bringhen S
- Subjects
- Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols adverse effects, Dexamethasone administration & dosage, Dexamethasone adverse effects, Disease-Free Survival, Female, Follow-Up Studies, Humans, Lenalidomide administration & dosage, Lenalidomide adverse effects, Male, Survival Rate, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Multiple Myeloma diagnosis, Multiple Myeloma drug therapy, Multiple Myeloma mortality
- Abstract
Lenalidomide-dexamethasone (Rd) is standard treatment for elderly patients with multiple myeloma (MM). In this randomized phase 3 study, we investigated efficacy and feasibility of dose/schedule-adjusted Rd followed by maintenance at 10 mg per day without dexamethasone (Rd-R) vs continuous Rd in elderly, intermediate-fit newly diagnosed patients with MM. Primary end point was event-free survival (EFS), defined as progression/death from any cause, lenalidomide discontinuation, or hematologic grade 4 or nonhematologic grade 3 to 4 adverse event (AE). Of 199 evaluable patients, 101 received Rd-R and 98 continuous Rd. Median follow-up was 37 months. EFS was 10.4 vs 6.9 months (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.51-0.95; P = .02); median progression-free survival, 20.2 vs 18.3 months (HR, 0.78; 95% CI, 0.55-1.10; P = .16); and 3-year overall survival, 74% vs 63% (HR, 0.62; 95% CI, 0.37-1.03; P = .06) with Rd-R vs Rd, respectively. Rate of ≥1 nonhematologic grade ≥3 AE was 33% vs 43% (P = .14) in Rd-R vs Rd groups, with neutropenia (21% vs 18%), infections (10% vs 12%), and skin disorders (7% vs 3%) the most frequent; constitutional and central nervous system AEs mainly related to dexamethasone were more frequent with Rd. Lenalidomide was discontinued for AEs in 24% vs 30% and reduced in 45% vs 62% of patients receiving Rd-R vs Rd, respectively. In intermediate-fit patients, switching to reduced-dose lenalidomide maintenance without dexamethasone after 9 Rd cycles was feasible, with similar outcomes to standard continuous Rd. This trial was registered at www.clinicaltrials.gov as #NCT02215980., (© 2021 by The American Society of Hematology.)
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- 2021
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19. Single-center midterm results with the low-profile Zenith Alpha thoracic endovascular stent graft.
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Melissano G, Rinaldi E, Mascia D, Carta N, Bilman V, Bertoglio L, Kahlberg A, De Luca M, Monaco F, and Chiesa R
- Subjects
- Aged, Aorta, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic mortality, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality, Databases, Factual, Diverticulum diagnostic imaging, Diverticulum mortality, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Humans, Italy, Male, Middle Aged, Postoperative Complications mortality, Postoperative Complications surgery, Prosthesis Design, Reoperation, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Diverticulum surgery, Endovascular Procedures instrumentation, Stents
- Abstract
Objective: The analysis of endovascular treatment of thoracic aortic diseases using new low-profile stent grafts in large series is crucial to understanding the durability of these devices. The present study reports the midterm outcomes of a single-center experience using the Zenith Alpha thoracic endovascular stent graft., Methods: The outcomes of 270 procedures performed on 262 patients (197 men; mean age, 70.5 ± 9.5 years) using the Zenith Alpha thoracic endovascular stent graft from November 2013 to December 2019 for different thoracic aortic diseases were analyzed. The primary endpoints were 30-day clinical success and midterm (5-year) clinical success. The secondary endpoints were the adverse event rate at 30 days and midterm and access- and device-related complications. The follow-up of surviving patients was performed using computed tomography angiography and office visits at 1, 6, and 12 months and annually thereafter. Kaplan-Meier analysis was performed for overall survival, and freedom from thoracic aortic endovascular repair-related mortality and related reinterventions., Results: The overall 30-day mortality was 5.2% (2.5% for elective and 30.8% for nonelective cases). Type I endoleaks were identified in six patients. The 30-day primary technical and clinical success rates were 97.8% and 92.6%, respectively. Femoral cutdown was used in 41.1% of cases and percutaneous access in 58.5%. The rate of femoral artery complications after the percutaneous approach was 5.1%, with the need for surgical conversion in 1.9%. The stroke rate was 4.1% (major stroke, 2.2%), and the spinal cord ischemia rate was 3.7% (permanent paraplegia, 0.7%). Of the 248 survivors, 239 complied with the follow-up protocol with adequate computed tomography angiograms available images. Overall follow-up survival was 94.0% at 1 year, 91.6% at 2 years, 88.9% at 3 years, and 88.5% at 5 years. The unplanned secondary endovascular procedure rate was 5.3%. No stent fractures or new-onset type I endoleaks due to stent graft migration were observed in the study cohort., Conclusions: The midterm outcomes of this new generation of low-profile devices were satisfactory. The reported low incidence of secondary procedures and the absence of migrations are promising for the long-term durability of these devices., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2021
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20. Trigger and Target for Fibrinogen Supplementation Using Thromboelastometry (ROTEM) in Patients Undergoing Open Thoraco-Abdominal Aortic Aneurysm Repair.
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Monaco F, Barucco G, Licheri M, Mattioli C, Ortalda A, Lombardi G, Pallanch O, De Luca M, Chiesa R, Melissano G, and Zangrillo A
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- Aged, Aortic Aneurysm, Thoracic blood, Blood Transfusion statistics & numerical data, Female, Fibrinogen administration & dosage, Follow-Up Studies, Humans, Intensive Care Units statistics & numerical data, Male, Middle Aged, Patient Admission statistics & numerical data, Postoperative Hemorrhage diagnosis, Postoperative Hemorrhage therapy, Predictive Value of Tests, Preoperative Period, Prospective Studies, ROC Curve, Reference Values, Reoperation statistics & numerical data, Reproducibility of Results, Retrospective Studies, Risk Assessment methods, Risk Assessment statistics & numerical data, Severity of Illness Index, Treatment Outcome, Vascular Surgical Procedures methods, Aortic Aneurysm, Thoracic surgery, Fibrinogen analysis, Postoperative Hemorrhage epidemiology, Thrombelastography statistics & numerical data, Vascular Surgical Procedures adverse effects
- Abstract
Objective: To determine the relationship between the value of fibrinogen assessed by the FIBTEM clot amplitude at 10 minutes (A10 FIBTEM) measured on admission to the intensive care unit (ICU) and the amount of drainage output at 24 hours, to investigate whether the A10 FIBTEM predicts severe bleeding (SB), and to define A10 FIBTEM thresholds to prevent (trigger) and treat (target) severe bleeding by fibrinogen supplementation., Methods: In a single centre, retrospective observational study, 166 patients underwent elective open thoraco-abdominal aortic aneurysm (TAAA) repair between March 2016 and January 2019. Exclusion criteria were emergency, congenital, or acquired coagulopathy, or administration of P
2 Y12 inhibitor antiplatelet agents in the five days before surgery. All patients were managed intra-operatively and post-operatively according to a rotational thromboelastometry driven transfusion protocol. The principal endpoint was a composite outcome, which included bleeding, large volume transfusion, and re-operation., Results: FIBTEM clot amplitude after 10 minutes measured on ICU admission and post-operative bleeding at 24 hours showed an inverse linear relationship (R2 = .03; p = .026). Performance of A10 FIBTEM in predicting SB evaluated by Receiving Operating Curve analysis showed an area under the curve of 0.63 (95% CI 0.56 - 0.70; p = .026) with a best cutoff of 9 mm. An A10 FIBTEM of 3 mm was the cutoff associated with a positive predictive value of 50%, while an A10 FIBTEM of 9 mm showed a negative predictive value of 92%. On multivariable analysis, an A10 FIBTEM ≤ 3 mm remained independently associated with SB., Conclusion: The present investigation shows for the first time in a population undergoing open TAAA repair that an A10 FIBTEM ≤ 3mm on ICU admission is associated with post-operative severe bleeding. Trigger and target values for fibrinogen supplementation, based on A10 FIBTEM, have been provided. The transferability and reliability of these cutoff values require further study., (Copyright © 2021 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)- Published
- 2021
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21. Nodular fasciitis of the anterior chest wall mimicking myxofibrosarcoma: A case report and literature review.
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Cattafi A, Galeano M, Pitrone P, Sofia C, Marino MA, Ascenti G, Lentini M, Ieni A, Cardia R, Costa AL, Familiari D, Barone M, Monaco F, and Colonna MR
- Abstract
Nodular fasciitis is a benign tumor of soft tissues originating from the proliferation of fibroblasts and myofibroblasts, generally developing between the subcutaneous tissue and the underlying muscular layer. Nodular fasciitis predominantly localizes in the upper extremities, trunk, head and neck. Biomolecular and immunohistochemical analyses result essential to demonstrate the benign origin of the process, also confirmed by very low recurrence rate after complete excision, which represents the gold standard for treatment. We report the case of a 36 years-old man who developed a nodular protuberance clinically evident in the upper-left side of the thorax. We further, highlight the main characteristics of this rare neoplasm trough a thorough review of the literature., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)
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- 2021
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22. Asymptomatic lymphangioleiomyomatosis: Large cyst mimicking a hydropneumothorax in a healthy patient.
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Benedetto C, Barbaro U, Anfuso C, Militi A, Morabito R, Ruvolo C, and Monaco F
- Abstract
Lymphangioleiomyomatosis (LAM) is a rare, idiopathic, cystic disease that affects lungs of young women at childbearing age. Usually, LAM clinical manifestations are pneumothorax, progressive dyspnea and chylous pleural effusions. In many cases, due to unusual and nonspecific symptoms, LAM is mis-recognized and patients, who are affected by such disease, receive delayed diagnosis. This case report focuses on a 45-year-old woman patient with asymptomatic lymphangioleiomyomatosis who presented a big cyst which makes it looks like hydropneumothorax condition. Although chest radiograph and following CT scan has given an incidental diagnosis of right hydropneumothorax, treatment with drainages and video-assisted thorascopic surgery, instead, has allowed us to formulate correct diagnosis of cysts in LAM., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)
- Published
- 2021
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23. Vascular Surgery During COVID-19 Emergency in Hub Hospitals of Lombardy: Experience on 305 Patients.
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Kahlberg A, Mascia D, Bellosta R, Attisani L, Pegorer M, Socrate AM, Ferraris M, Trabattoni P, Rinaldi E, Melloni A, Monaco F, Melissano G, and Chiesa R
- Subjects
- Aged, COVID-19 Testing methods, COVID-19 Testing statistics & numerical data, Emergencies epidemiology, Emergency Service, Hospital organization & administration, Emergency Service, Hospital statistics & numerical data, Female, Hospital Mortality, Humans, Italy epidemiology, Male, Outcome and Process Assessment, Health Care, Prognosis, Retrospective Studies, Risk Adjustment methods, Risk Factors, SARS-CoV-2 isolation & purification, COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 prevention & control, Infection Control methods, Infection Control organization & administration, Postoperative Complications epidemiology, Postoperative Complications therapy, Vascular Diseases diagnosis, Vascular Diseases mortality, Vascular Diseases surgery, Vascular Surgical Procedures adverse effects, Vascular Surgical Procedures methods
- Abstract
Objective: During the most aggressive phase of the COVID-19 outbreak in Italy, the Regional Authority of Lombardy identified a number of hospitals, named Hubs, chosen to serve the whole region for highly specialised cases, including vascular surgery. This study reports the experience of the four Hubs for Vascular Surgery in Lombardy and provides a comparison of in hospital mortality and major adverse events (MAEs) according to COVID-19 testing., Methods: Data from all patients who were referred to the Vascular Surgery Department of Hubs from 9 March to 28 April 2020 were collected prospectively and analysed. A positive COVID-19 polymerase chain reaction swab test, or symptoms (fever > 37.5 °C, upper respiratory tract symptoms, chest pain, and contact/travel history) associated with interstitial pneumonia on chest computed tomography scan were considered diagnostic of COVID-19 disease. Patient characteristics, operative variables, and in hospital outcomes were compared according to COVID-19 testing. A multivariable model was used to identify independent predictors of in hospital death and MAEs., Results: Among 305 included patients, 64 (21%) tested positive for COVID-19 (COVID group) and 241 (79%) did not (non-COVID group). COVID patients presented more frequently with acute limb ischaemia than non-COVID patients (64% vs. 23%; p < .001) and had a significantly higher in hospital mortality (25% vs. 6%; p < .001). Clinical success, MAEs, re-interventions, and pulmonary and renal complications were significantly worse in COVID patients. Independent risk factors for in hospital death were COVID (OR 4.1), medical treatment (OR 7.2), and emergency setting (OR 13.6). COVID (OR 3.4), obesity class V (OR 13.5), and emergency setting (OR 4.0) were independent risk factors for development of MAEs., Conclusion: During the COVID-19 pandemic in Lombardy, acute limb ischaemia was the most frequent vascular disease requiring surgical treatment. COVID-19 was associated with a fourfold increased risk of death and a threefold increased risk of major adverse events., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
- Published
- 2021
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24. First experience with a ROTEM-enhanced transfusion algorithm in patients undergoing aortic arch replacement with frozen elephant trunk technique. A theranostic approach to patient blood management.
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Monaco F, Nardelli P, Denaro G, De Luca M, Franco A, Bertoglio L, Castiglioni A, and Zangrillo A
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- Algorithms, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Blood Transfusion, Humans, Precision Medicine, Retrospective Studies, Blood Vessel Prosthesis Implantation, Thrombelastography
- Abstract
Study Objective: To assess the effect of a rotational thromboelastometry (ROTEM)-enhanced transfusion algorithm with hemostatic agents on allogenic blood transfusion in patients undergoing frozen elephant trunk (FET) surgery., Design: Retrospective observational study conducted in a tertiary-care center., Setting: A tertiary care referral center for cardiac surgery., Patients: All patients undergoing elective FET were included in the study., Intervention: Until 2016, a protocol based on estimated blood losses and conventional coagulation tests was used. After, a ROTEM-enhanced transfusion protocol was adopted., Measurements: The transfusion rate of each blood component was observed and reported., Methods: Retrospective, observational study., Main Results: Out of 40 consecutive patients, 19 underwent FET surgery with a conventional transfusion approach and 21 with a ROTEM-enhanced transfusion strategy. Considering the overall transfusion rate, the administration of fresh frozen plasma and platelets was significantly lower in the ROTEM compared to conventional group (1000 [0-2500] vs 0 [0-875] ml, p = 0.015 and 1 [1, 2] vs 0 [0-1], p = 0.016, respectively). ROTEM algorithm allowed to decrease the number of patients who required plasma and platelets transfusion of 31%. Furthermore, a 40% reduction in overall allogenic blood products was observed. Number of red blood cells administered, percentage of patients transfused with red blood cells, blood losses, reoperation for bleeding and mortality did not significantly differ between the two groups. At the multiple linear regression analysis only ROTEM algorithm was associated with a significant decrease in the number of plasma and platelets units administered intraoperatively, at 24 h, at the ICU discharge and overall. ROTEM algorithm allowed to save 1435 ml of plasma, 0.91 unit of platelets and overall transfusion cost of the 21% per patient., Conclusions: A ROTEM-enhanced transfusion strategy halved intraoperative transfusion in the setting of FET. Further studies are needed to confirm the magnitude of our findings on clinically relevant endpoints., Competing Interests: Declaration of competing interest The authors declare they have no conflicts of interests., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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25. A Case of Covid-19 Patient with Acute Limb Ischemia and Heparin Resistance.
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Baccellieri D, Bilman V, Apruzzi L, Monaco F, D'Angelo A, Loschi D, Melissano G, and Chiesa R
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- Acute Disease, Aged, Anticoagulants pharmacology, Blood Coagulation drug effects, COVID-19, Coronavirus Infections diagnosis, Coronavirus Infections epidemiology, Humans, Ischemia blood, Ischemia etiology, Male, Pandemics, Pneumonia, Viral diagnosis, Pneumonia, Viral epidemiology, SARS-CoV-2, Tomography, X-Ray Computed, Betacoronavirus, Coronavirus Infections complications, Drug Resistance, Heparin pharmacology, Ischemia drug therapy, Lower Extremity blood supply, Pneumonia, Viral complications
- Abstract
Heparin resistance is an uncommon phenomenon defined as the need for high-dose unfractionated heparin (UFH) of more than 35,000 IU/day to achieve the target activated partial-thromboplastin time ratio or the failure to achieve the desired activated clotting time after a full UFH dose. This rare phenomenon is being more commonly observed in Covid-19 patients in a hypercoagulable state. We describe a Covid-19 patient confirmed by reverse-transcriptase polymerase chain reaction assay, with acute limb ischemia, who developed heparin resistance. The patient was managed by the departments of vascular surgery, anesthesia and intensive care, and the Coagulation Service and Thrombosis Research from San Raffaele Scientific Institute, Milan, Italy., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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26. Catastrophic descending necrotizing mediastinitis of the anterior and posterior compartments: A case report.
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Benedetto C, Tanzariello VN, Militi A, Fallica GE, Marco DD, Monaco F, and Ugo B
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Descending necrotizing mediastinitis (DNM) is a medical emergency with a high associated morbidity and mortality. DNM may arise secondary to primary odontogenic or neck infection in susceptible patients and it may spread contiguously via the "danger" space to the mediastinum. This case report is focused on complications following an odontogenic infection in a healthy 48-year-old male that led to a massive inflammation associated an extensive empyema. After chest and neck computed tomographic scan a diagnosis of cervical necrotizing fasciitis with DNM was made. A multidisciplinary approach with an urgent surgical intervention and the finding of the right antibiotic therapy resulted to be successful. After 2 weeks the patient was dismissed in better health condition., (© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)
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- 2020
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27. Mechanism of miR-222 and miR-126 regulation and its role in asbestos-induced malignancy.
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Gaetani S, Monaco F, Alessandrini F, Tagliabracci A, Sabbatini A, Bracci M, Valentino M, Neuzil J, Amati M, Santarelli L, and Tomasetti M
- Subjects
- Aged, Humans, Lung Neoplasms pathology, Male, Mesothelioma pathology, Mesothelioma, Malignant, Asbestos adverse effects, Carcinogens chemistry, Lung Neoplasms genetics, Mesothelioma genetics, MicroRNAs metabolism
- Abstract
MiR-222 and miR-126 are associated with asbestos exposure and the ensuing malignancy, but the mechanism(s) of their regulation remain unclear. We evaluated the mechanism by which asbestos regulates miR-222 and miR-126 expression in the context of cancer etiology. An 'in vitro' model of carcinogen-induced cell transformation was used based on exposing bronchial epithelium BEAS-2B cells to three different carcinogens including asbestos. Involvement of the EGFR pathway and the role of epigenetics have been investigated in carcinogen-transformed cells and in malignant mesothelioma, a neoplastic disease associated with asbestos exposure. Increased expression of miR-222 and miR-126 were found in asbestos-transformed cells, but not in cells exposed to arsenic and chrome. Asbestos-mediated activation of the EGFR pathway and macrophages-induced inflammation resulted in miR-222 upregulation, which was reversed by EGFR inhibition. Conversely, asbestos-induced miR-126 expression was affected neither by EGFR modulation nor inflammation. Rather than methylation of the miR-126 host gene EGFL7, epigenetic mechanism involving DNMT1- and PARP1-mediated chromatin remodeling was found to upregulate of miR-126 in asbestos-exposed cells, while miR-126 was downregulated in malignant cells. Analysis of MM tissue supported the role of PARP1 in miR-126 regulation. Therefore, activation of the EGFR pathway and the PARP1-mediated epigenetic regulation both play a role in asbestos-induced miRNA expression, associated with in asbestos-induced carcinogenesis and tumor progression., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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28. Detection of enzootic circulation of a new strain of West Nile virus lineage 1 in sentinel chickens in the north of Tunisia.
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Amdouni J, Monaco F, Portanti O, Sghaier S, Conte A, Hassine TB, Polci A, Valleriani F, Gennaro AD, Zoueri M, Savini G, and Hammami S
- Subjects
- Animals, Horses, Humans, Phylogeny, RNA, Viral genetics, Sentinel Surveillance, Tunisia epidemiology, West Nile Fever epidemiology, West Nile Fever virology, West Nile virus genetics, West Nile virus isolation & purification, Chickens virology, West Nile Fever veterinary, West Nile virus classification
- Abstract
Tunisia has experienced various West Nile disease outbreaks. Notwithstanding the serological and molecular confirmations in humans, horses and birds, the human surveillance system can still be improved. Three sentinel chicken flocks were placed in different Tunisian endemic regions and followed up from September 2016 to January 2017. A total of 422 sera from Sejnene (north of Tunisia), 392 from Moknine (east coast of Tunisia) and 386 from Tozeur (south of Tunisia) were tested for West Nile-specific antibodies and viral RNA. The WNV elisa positive rate in sentinel chickens in Sejnene was 10.7% (95% CI: 5.08-21.52). No positive samples were detected in Moknine. In Tozeur, the overall serological elisa positive rate during the study period was 9.8% (95% CI:4.35-21.03). West Nile virus nucleic acid was detected in two chickens in Sejnene.Phylogenetic analysis of one of the detected partial NS3 gene sequences showed that recent Tunisian WNV strain belong to WNV lineage 1 and is closely related to Italian strains detected in mosquitoes in 2016 and in a sparrow hawk in 2017. This report showed the circulation, first molecular detection and sequencing of WNV lineage 1 in chickens in the north of Tunisia and highlights the use of poultry as a surveillance tool to detect WNV transmission in a peri-domestic area., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier B.V. All rights reserved.)
- Published
- 2020
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29. Tranexamic acid in open aortic aneurysm surgery: a randomised clinical trial.
- Author
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Monaco F, Nardelli P, Pasin L, Barucco G, Mattioli C, Di Tomasso N, Dalessandro G, Giardina G, Landoni G, Chiesa R, and Zangrillo A
- Subjects
- Aged, Antifibrinolytic Agents adverse effects, Aortic Aneurysm mortality, Blood Loss, Surgical statistics & numerical data, Blood Transfusion statistics & numerical data, Cardiac Surgical Procedures mortality, Double-Blind Method, Erythrocyte Transfusion, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Thromboembolism epidemiology, Thromboembolism prevention & control, Tranexamic Acid adverse effects, Antifibrinolytic Agents therapeutic use, Aortic Aneurysm surgery, Blood Loss, Surgical prevention & control, Cardiac Surgical Procedures methods, Tranexamic Acid therapeutic use
- Abstract
Background: Bleeding and transfusions affect mortality in aortic surgery. Although tranexamic acid significantly reduced bleeding in multiple settings, its role in major vascular surgery was never studied. The aim of this study was to determine if tranexamic acid reduces blood loss in open abdominal aortic aneurysm (AAA) surgery., Methods: A total of 100 patients undergoing elective open AAA repair were randomised to receive tranexamic acid (a loading dose of 500 mg and a continuous infusion of 250 mg h
-1 ) or placebo. The primary outcome was intraoperative blood loss, and the secondary outcomes were the number of patients receiving red blood cells, occurrence of thromboembolic events, and mortality. Data were analysed using the intention-to-treat principle., Results: Fifty patients were randomised into each group. Median (inter-quartile range) intraoperative blood loss was 400 (300-1050) ml in the tranexamic acid group vs 500 (360-1000) ml in the placebo group (P=0.44). Transfusion rate was seven/50 (14%) in the tranexamic group vs 12/50 (24%) in the placebo group (P=0.20). No thrombosis was recorded. In a post hoc analysis, postoperative blood loss was reduced in the tranexamic group both at 4 h (60 [40-80] ml vs 100 [60-140] ml, P<0.001) and 24 h (180 [120-275] vs 275 [190-395] ml, P=0.003) after surgery. At 1 yr, three patients were dead, all in the placebo group (P=0.24) and all after 28 days., Conclusions: Tranexamic acid did not reduce intraoperative blood loss or blood transfusions in open AAA repair, although it may reduce postoperative blood loss without increasing adverse effects., Clinical Trial Registration: NCT02335359., (Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)- Published
- 2020
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30. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia.
- Author
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Pérez-Nadales E, Gutiérrez-Gutiérrez B, Natera AM, Abdala E, Reina Magalhães M, Mularoni A, Monaco F, Camera Pierrotti L, Pinheiro Freire M, Iyer RN, Mehta Steinke S, Grazia Calvi E, Tumbarello M, Falcone M, Fernández-Ruiz M, María Costa-Mateo J, Rana MM, Mara Varejão Strabelli T, Paul M, Carmen Fariñas M, Clemente WT, Roilides E, Muñoz P, Dewispelaere L, Loeches B, Lowman W, Tan BH, Escudero-Sánchez R, Bodro M, Antonio Grossi P, Soldani F, Gunseren F, Nestorova N, Pascual Á, Martínez-Martínez L, Aguado JM, Rodríguez-Baño J, and Torre-Cisneros J
- Abstract
Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance., (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)
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- 2019
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31. Assessing the role of migratory birds in the introduction of ticks and tick-borne pathogens from African countries: An Italian experience.
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Pascucci I, Di Domenico M, Capobianco Dondona G, Di Gennaro A, Polci A, Capobianco Dondona A, Mancuso E, Cammà C, Savini G, Cecere JG, Spina F, and Monaco F
- Subjects
- Animals, Bacterial Infections epidemiology, Bacterial Infections microbiology, Bacterial Physiological Phenomena, Introduced Species, Italy, Virus Diseases epidemiology, Virus Diseases virology, Virus Physiological Phenomena, Animal Migration, Bacterial Infections veterinary, Birds microbiology, Birds physiology, Birds virology, Ixodidae physiology, Virus Diseases veterinary
- Abstract
The continuous flow of billions of birds between Africa and Europe creates an "ecological bridge" between physically remote areas. Migratory birds fly south from their breeding grounds during late summer/fall and fly back in spring. These movements regulate the spread of internal and external parasites, as well as pathogens of potential public health concern. The aim of the present study was to investigate the possible introduction of exotic tick species and tick-borne pathogens into Europe via migratory birds. At the bird observatory of Ventotene island (Italy), 443 feeding ticks were collected from 249 birds captured and ringed during their northbound migration in spring 2013. Each tick was identified by morphological and molecular methods and then tested for bacterial and viral pathogens: Borrelia burgdorferi s.l., Rickettsia spp., Ehrlichia ruminantium and Coxiella burnetii, Crimean Congo haemorrhagic fever virus (CCHFV) and Flavivirus. Morphological and molecular identification confirmed Hyalomma rufipes as the most abundant species among the collected arthropods (366/443; 82.6%) followed by Hyalomma marginatum (10/433; 2.3%). Rickettsia aeschlimannii was identified in 158 ticks, while one engorged Amblyomma variegatum nymph was infected with Rickettsia africae. The other bacteria were not detected in any specimen. Among viruses, RNA belonging to West Nile virus and other Flavivirus were detected whereas all ticks were negative for CCHFV RNA. These results confirm how migratory birds play a role in carrying Rickettsia-infected ticks, as well as viruses of zoonotic importance, from Africa into Europe. To what extent tick species are capable of establishing a permanent population once introduced in naïve areas, is far from defined and deserve further investigation., (Copyright © 2019 Elsevier GmbH. All rights reserved.)
- Published
- 2019
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32. Lenalidomide Combination Therapy in Relapsed/Refractory Diffuse Large B Cell Lymphoma: The Italian Real-Life Experience.
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Marangon M, Stefoni V, Castellino A, Visco C, Tani M, Cox MC, Marasca R, Tecchio C, Devizzi L, Monaco F, Romano A, Rusconi C, Rigacci L, Castellino C, Gaudio F, Argnani L, and Zinzani PL
- Subjects
- Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols adverse effects, Female, Follow-Up Studies, Humans, Italy, Lymphoma, Large B-Cell, Diffuse diagnosis, Lymphoma, Large B-Cell, Diffuse mortality, Male, Middle Aged, Neoplasm Staging, Prognosis, Thalidomide administration & dosage, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Lymphoma, Large B-Cell, Diffuse drug therapy
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- 2019
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33. Editor's Choice - A Rotational Thromboelastometry Driven Transfusion Strategy Reduces Allogenic Blood Transfusion During Open Thoraco-abdominal Aortic Aneurysm Repair: A Propensity Score Matched Study.
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Monaco F, Barucco G, Nardelli P, Licheri M, Notte C, De Luca M, Mattioli C, Melissano G, Chiesa R, and Zangrillo A
- Subjects
- Clinical Protocols, Cost-Benefit Analysis, Female, Humans, Italy, Male, Middle Aged, Patient Selection, Propensity Score, Treatment Outcome, Vascular Surgical Procedures methods, Aortic Aneurysm, Thoracic surgery, Blood Loss, Surgical, Erythrocyte Transfusion economics, Erythrocyte Transfusion methods, Erythrocyte Transfusion statistics & numerical data, Intraoperative Complications therapy, Plasma, Thrombelastography methods, Vascular Surgical Procedures adverse effects
- Abstract
Objective: Open repair of thoraco-abdominal aortic aneurysm (TAAA) is a challenging procedure, associated with high rates of peri-operative bleeding and blood product transfusions. A large intra-operative volume transfusion has been associated with higher in hospital mortality and prolonged mechanical ventilation. A propensity score matched study was carried out to assess whether the introduction of a rotational thromboelastometry (ROTEM) based transfusion strategy reduces allogenic blood transfusion and affects morbidity in patients undergoing open TAAA repair., Methods: All patients undergoing open TAAA repair at the San Raffaele Scientific Institute between 2009 and 2017 were included. Until 2016, a protocol based on estimated blood loss and conventional coagulation tests was used. After March 2016 a ROTEM guided transfusion protocol was developed and adopted. To account for selection bias, propensity score matching was performed., Results: Five hundred and forty-seven consecutive patients were included. After propensity score matching, 77 patients in the ROTEM algorithm group were successfully matched with 77 patients in the standard algorithm group. Patients managed with ROTEM received fewer red blood cells units (3.5 [range 0-11] vs. 4 [range 0-17]; p = .026) and a lower volume of fresh frozen plasma (286 ± 496 vs. 2,050 ± 1,120; p < .001). In addition, fewer patients received fresh frozen plasma (35% vs. 97%; p < .001). Patients in the ROTEM group showed a significant decrease in the occurrence of pulmonary complications (44% vs. 83%; p = .01). Cost analysis showed a relevant reduction of per-patient expense after the introduction of ROTEM (€834 ± €577 vs. €1,285 ± €851; p < .001) CONCLUSION: A ROTEM guided transfusion strategy significantly limited the quantity of transfused blood products during open TAAA repair, improving clinical outcomes while reducing costs, allowing for better resource distribution in a setting where blood loss is relevant., (Copyright © 2019 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
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- 2019
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34. Epidural Analgesia in Open Thoraco-abdominal Aortic Aneurysm Repair.
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Monaco F, Pieri M, Barucco G, Karpatri V, Redaelli MB, De Luca M, Mattioli C, Bove T, Melissano G, Chiesa R, Landoni G, and Zangrillo A
- Subjects
- Aged, Analgesia, Epidural adverse effects, Analgesia, Epidural mortality, Aortic Aneurysm, Thoracic diagnosis, Aortic Aneurysm, Thoracic mortality, Blood Vessel Prosthesis Implantation mortality, Databases, Factual, Female, Hospital Mortality, Humans, Male, Middle Aged, Pain Measurement, Pain, Postoperative diagnosis, Pain, Postoperative etiology, Pain, Postoperative mortality, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Analgesia, Epidural methods, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Pain, Postoperative prevention & control
- Abstract
Objective: Epidural analgesia improves pain control and outcomes of abdominal aortic aneurysm procedures, while the effect of thoracic epidural analgesia on thoraco-abdominal aortic aneurysm (TAAA) repair is unknown. The aim of the study was to evaluate thoracic epidural analgesia effects in patients undergoing open TAAA repair in terms of pain control and clinically relevant outcomes., Methods: This was a retrospective study of a prospectively collected database. Patients undergoing open TAAA repair between January 2009 and December 2016., Results: Four hundred and fifty-nine consecutive patients were included. Thoracic epidural analgesia was used in 409 (89%) of cases. On multivariable analysis, patients who received thoracic epidural analgesia experienced reduced post-operative pain (odds ratio [OR] 0.003, 95% confidence interval [CI] 0.0007-0.009; p < .001), a lower rate of acute kidney injury (AKI; OR 0.39, 95% CI 0.21-0.71 [p = .002]), atrial fibrillation (OR 0.47, 95% CI 0.23-0.95; p = .04), acute myocardial infarction (AMI; OR 0.189, 95% CI 0.05-0.64; p = .008), and paraplegia (OR 0.31, 95% CI 0.157-0.615; p = .001) compared with the conventional analgesia (CA) group. After propensity score matching, 43 patients in the CA group were compared with 43 in thoracic epidural analgesia group. On case match analysis thoracic epidural analgesia showed a significant reduction in post-operative pain (p < .001) and no differences in the incidence of AKI, atrial fibrillation, AMI, and paraplegia. In the thoracic epidural analgesia group there were no epidural haematomas., Conclusion: Thoracic epidural analgesia was effective in reducing post-operative pain with no effect on major post-operative complications. The use of thoracic epidural analgesia, if not contraindicated, might be considered in clinical practice, even in patients undergoing open TAAA repair. Whether a better post-operative management enhances patient's recovery in this setting remains to be tested., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
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- 2019
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35. Anesthetic management of carcinoid heart disease after cardiac surgery. A possible use of veno-arterial extracorporeal membrane oxygenation support.
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Di Tomasso N, Carcò F, Arangino C, De Luca M, Bove T, Zangrillo A, and Monaco F
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- Carcinoid Heart Disease complications, Cardiac Surgical Procedures methods, Female, Femoral Artery surgery, Femoral Vein surgery, Humans, Male, Middle Aged, Postoperative Complications etiology, Treatment Outcome, Ventricular Dysfunction, Right etiology, Carcinoid Heart Disease surgery, Cardiac Surgical Procedures adverse effects, Extracorporeal Membrane Oxygenation methods, Postoperative Complications therapy, Ventricular Dysfunction, Right therapy
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- 2018
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36. Satisfactory short-term outcomes of the STABILISE technique for type B aortic dissection.
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Melissano G, Bertoglio L, Rinaldi E, Mascia D, Kahlberg A, Loschi D, De Luca M, Monaco F, and Chiesa R
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- Acute Disease, Aged, Aortic Dissection diagnostic imaging, Aortic Dissection physiopathology, Angioplasty, Balloon adverse effects, Angioplasty, Balloon instrumentation, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm physiopathology, Aortography methods, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Computed Tomography Angiography, Echocardiography, Transesophageal, Humans, Male, Middle Aged, Retrospective Studies, Stents, Time Factors, Treatment Outcome, Aortic Dissection surgery, Angioplasty, Balloon methods, Aortic Aneurysm surgery, Blood Vessel Prosthesis Implantation methods
- Abstract
Objective: The aim of this study was to evaluate the perioperative and short-term results in a cohort of patients treated during the last year at our institution with the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair (STABILISE) technique for acute complicated aortic dissection., Methods: Between June 2016 and June 2017, 10 patients (all male; mean age, 62.6 ± 7.4 years) received treatment for acute complicated aortic dissection with the STABILISE technique. After a standard provisional extension to induce complete attachment procedure using the commercially available endovascular dissection system (Cook Medical, Bloomington, Ind), the distal stent graft area and the bare stent area were ballooned to completely exclude the thoracic false lumen (FL) and to obtain a single-channeled abdominal aorta. Computed tomography was routinely performed within the first postoperative week before discharge and then at 3 months, at 6 months, and yearly thereafter. The technical and clinical success rates were analyzed., Results: The 30-day technical and clinical success rates were 100%, with complete thrombosis of the thoracic FL and no type I endoleak. Malperfusion was resolved in all cases. No aortic ruptures were recorded, and no open conversion was required. One case of delayed spinal cord ischemia fully resolved within the discharge period. Predischarge computed tomography showed complete thrombosis of the thoracic FL in all cases. In two cases, some degree of patency of the abdominal FL was observed. At short-term follow-up, the overall aortic diameters remained stable with no further dilation., Conclusions: The STABILISE technique was safe and feasible in this cohort of patients, with complete thrombosis of the thoracic FL and creation of a single-channeled aorta in most cases. Further studies are needed to ascertain the long-term behavior of the treated aorta., (Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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37. Predictors of Advanced Conduction Disturbances Requiring a Late (≥48 H) Permanent Pacemaker Following Transcatheter Aortic Valve Replacement.
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Mangieri A, Lanzillo G, Bertoldi L, Jabbour RJ, Regazzoli D, Ancona MB, Tanaka A, Mitomo S, Garducci S, Montalto C, Pagnesi M, Giannini F, Giglio M, Montorfano M, Chieffo A, Rodès-Cabau J, Monaco F, Paglino G, Della Bella P, Colombo A, and Latib A
- Subjects
- Action Potentials, Aged, Aged, 80 and over, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac epidemiology, Arrhythmias, Cardiac physiopathology, Databases, Factual, Electrocardiography, Female, Heart Rate, Humans, Italy epidemiology, Male, Prevalence, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Arrhythmias, Cardiac therapy, Cardiac Pacing, Artificial, Heart Conduction System physiopathology, Pacemaker, Artificial, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Objectives: This study sought to determine predictors of advanced conduction disturbances requiring late (≥48 h) permanent pacemaker replacement (PPM) after transcatheter aortic valve replacement (TAVR)., Methods: Data of consecutive patients were identified by retrospective review of a TAVR database of a single center in Milan, Italy, between October 2007 and July 2015. We defined delta PR (ΔPR) and delta QRS (ΔQRS) interval as the difference between the last PR and QRS length available 48 h after TAVR and the baseline PR and QRS length., Results: Overall population included 740 patients. We excluded 78 patients who already had a PPM and 51 patients who received a PPM <48 h after TAVR. The final analysis included 611 patients. Fifty-four patients (8.8%) developed an advanced conduction disturbance requiring PPM ≥48 h following TAVR. Patients who required a late PPM implant had a wider QRS width (113 ± 25 ms vs. 105 ± 23 ms; p = 0.009) and a higher prevalence of baseline right bundle branch block (12.9% vs. 5.3%; p = 0.026) and were more likely to have a self-expandable valve implanted (51.8% vs. 31.9%; p = 0.003). The ΔPR was 40 ± 51 ms (p = 0.0001) and the ΔQRS was 22 ± 61 ms (p = 0.001). Multivariable analysis revealed that baseline right bundle branch block (odds ratio: 3.56; 95% confidence interval: 1.07 to 11.77; p = 0.037) and ΔPR (odds ratio for each 10-ms increase: 1.31; 95% confidence interval: 1.18 to 1.45; p = 0.0001) are independent predictors of delayed advanced conduction disturbances., Conclusions: This analysis showed that baseline right bundle branch block and the amount of increase of PR length after TAVR are independent predictors of late (≥48 h) advanced conduction disturbances requiring PPM replacement after TAVR in this cohort. A simple ECG analysis could help in detecting potentially lethal advanced conduction disturbances that could occur more than 48 h after TAVR., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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38. Percutaneous Direct Annuloplasty With Edge-to-Edge Technique for Mitral Regurgitation: Replicating a Complete Surgical Mitral Repair in a One-Step Procedure.
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Mangieri A, Colombo A, Demir OM, Agricola E, Ancona F, Regazzoli D, Ancona MB, Mitomo S, Lanzillo G, Del Sole PA, Monaco F, Pagnesi M, Montorfano M, and Latib A
- Subjects
- Aged, Echocardiography, Three-Dimensional, Echocardiography, Transesophageal, Fluoroscopy, Humans, Male, Mitral Valve diagnostic imaging, Mitral Valve Insufficiency diagnosis, Cardiac Catheterization methods, Mitral Valve surgery, Mitral Valve Annuloplasty methods, Mitral Valve Insufficiency surgery, Surgery, Computer-Assisted methods
- Abstract
Surgical treatment of functional mitral regurgitation (MR) is usually based on the correction of both annular dilation and leaflet disease to minimize the risk of recurrence of MR at follow-up. This combined approach may also represent an interesting strategy during transcatheter mitral valve repair systems. We report a successful case of combined Cardioband (Edwards Lifesciences, Irvine, California) and MitraClip (Abbott, Santa Clara, California) implantation for the treatment of functional MR, with good acute and medium-term clinical and echocardiographic outcomes., (Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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39. Hypertrophic Left Ventricle With Small Cavity and Severe Aortic Angulation: A Dangerous Association in Case of Transcatheter Aortic Valve Replacement.
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Ancona MB, Hachinohe D, Giannini F, Del Sole PA, Regazzoli D, Mangieri A, Romano V, Latib A, Ancona F, Monaco F, Castiglioni A, Esposito A, Montorfano M, and Colombo A
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- 2018
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40. Severe Mitral Stenosis and Persistent Left Appendage Thrombosis: When an Old Percutaneous Solution Meets New Percutaneous Strategies.
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Mangieri A, Montorfano M, Stella S, Regazzoli D, Ancona MB, Jabbour RJ, Mitomo S, Seresini G, Monaco F, Lanzillo G, Pagnesi M, Colombo A, and Latib A
- Subjects
- Atrial Appendage diagnostic imaging, Echocardiography, Doppler, Color, Echocardiography, Three-Dimensional, Embolic Protection Devices, Female, Hemodynamics, Humans, Medication Adherence, Middle Aged, Mitral Valve Stenosis diagnostic imaging, Mitral Valve Stenosis physiopathology, Recovery of Function, Rheumatic Heart Disease diagnostic imaging, Rheumatic Heart Disease physiopathology, Severity of Illness Index, Thrombosis diagnostic imaging, Thrombosis physiopathology, Treatment Outcome, Anticoagulants administration & dosage, Atrial Appendage drug effects, Balloon Valvuloplasty instrumentation, Cardiac Catheterization instrumentation, Mitral Valve Stenosis therapy, Rheumatic Heart Disease therapy, Thrombosis drug therapy
- Published
- 2018
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41. Transfemoral Implantation of a Balloon-Expandable Transcatheter Valve in a Rigid Mitral Annuloplasty Ring Optimized by Post-Dilatation.
- Author
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Regazzoli D, Stella S, De Pinto S, Montorfano M, Ancona MB, Mangieri A, Buzzatti N, Giannini F, Agricola E, Monaco F, Alfieri O, Colombo A, and Latib A
- Subjects
- Aged, Cardiac Catheterization methods, Echocardiography, Doppler, Color, Echocardiography, Transesophageal, Heart Valve Prosthesis Implantation methods, Humans, Male, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve Annuloplasty methods, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency physiopathology, Prosthesis Design, Tomography, X-Ray Computed, Treatment Outcome, Balloon Valvuloplasty, Cardiac Catheterization instrumentation, Catheterization, Peripheral, Femoral Artery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Mitral Valve surgery, Mitral Valve Annuloplasty instrumentation, Mitral Valve Insufficiency surgery
- Published
- 2017
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42. MortalitY in caRdIAc surgery (MYRIAD): A randomizeD controlled trial of volatile anesthetics. Rationale and design.
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Landoni G, Lomivorotov V, Pisano A, Nigro Neto C, Benedetto U, Biondi Zoccai G, Gemma M, Frassoni S, Agrò FE, Baiocchi M, Barbosa Gomes Galas FR, Bautin A, Bradic N, Carollo C, Crescenzi G, Elnakera AM, El-Tahan MR, Fominskiy E, Farag AG, Gazivoda G, Gianni S, Grigoryev E, Guarracino F, Hanafi S, Huang W, Kunst G, Kunstyr J, Lei C, Lembo R, Li ZJ, Likhvantsev V, Lozovskiy A, Ma J, Monaco F, Navalesi P, Nazar B, Pasyuga V, Porteri E, Royse C, Ruggeri L, Riha H, Santos Silva F, Severi L, Shmyrev V, Uvaliev N, Wang CB, Wang CY, Winterton D, Yong CY, Yu J, Bellomo R, and Zangrillo A
- Subjects
- Adult, Coronary Artery Disease mortality, Female, Humans, Male, Outcome and Process Assessment, Health Care, Survival Analysis, Volatilization, Anesthesia, Cardiac Procedures adverse effects, Anesthesia, Cardiac Procedures methods, Anesthetics, Inhalation administration & dosage, Anesthetics, Inhalation chemistry, Coronary Artery Bypass adverse effects, Coronary Artery Bypass methods, Coronary Artery Bypass mortality, Coronary Artery Disease surgery, Postoperative Complications etiology, Postoperative Complications prevention & control
- Abstract
Objective: There is initial evidence that the use of volatile anesthetics can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft (CABG) surgery. Nevertheless, small randomized controlled trials have failed to demonstrate a survival advantage. Thus, whether volatile anesthetics improve the postoperative outcome of cardiac surgical patients remains uncertain. An adequately powered randomized controlled trial appears desirable., Design: Single blinded, international, multicenter randomized controlled trial with 1:1 allocation ratio., Setting: Tertiary and University hospitals., Interventions: Patients (n=10,600) undergoing coronary artery bypass graft will be randomized to receive either volatile anesthetic as part of the anesthetic plan, or total intravenous anesthesia., Measurements and Main Results: The primary end point of the study will be one-year mortality (any cause). Secondary endpoints will be 30-day mortality; 30-day death or non-fatal myocardial infarction (composite endpoint); cardiac mortality at 30day and at one year; incidence of hospital re-admission during the one year follow-up period and duration of intensive care unit, and hospital stay. The sample size is based on the hypothesis that volatile anesthetics will reduce 1-year unadjusted mortality from 3% to 2%, using a two-sided alpha error of 0.05, and a power of 0.9., Conclusions: The trial will determine whether the simple intervention of adding a volatile anesthetic, an intervention that can be implemented by all anesthesiologists, can improve one-year survival in patients undergoing coronary artery bypass graft surgery., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2017
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43. Percutaneous Bicuspidization of the Tricuspid Valve.
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Latib A, Ancona MB, Agricola E, Giannini F, Mangieri A, Regazzoli D, Monaco F, Alfieri O, Hahn R, and Colombo A
- Subjects
- Aged, Compassionate Use Trials, Echocardiography, Doppler, Color, Echocardiography, Three-Dimensional, Echocardiography, Transesophageal, Female, Humans, Recovery of Function, Severity of Illness Index, Treatment Outcome, Tricuspid Valve diagnostic imaging, Tricuspid Valve physiopathology, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency physiopathology, Cardiac Valve Annuloplasty methods, Tricuspid Valve surgery, Tricuspid Valve Insufficiency surgery
- Published
- 2017
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44. Predicting the Need for Intra-operative Large Volume Blood Transfusions During Thoraco-abdominal Aortic Aneurysm Repair.
- Author
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Pieri M, Nardelli P, De Luca M, Landoni G, Frassoni S, Melissano G, Zangrillo A, Chiesa R, and Monaco F
- Subjects
- Aged, Aortic Aneurysm, Thoracic mortality, Chi-Square Distribution, Databases, Factual, Female, Hematocrit, Humans, Italy, Length of Stay, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Postoperative Complications etiology, Predictive Value of Tests, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Aortic Aneurysm, Thoracic surgery, Blood Loss, Surgical prevention & control, Erythrocyte Transfusion adverse effects, Erythrocyte Transfusion mortality, Vascular Surgical Procedures adverse effects, Vascular Surgical Procedures mortality
- Abstract
Objective: Thoraco-abdominal aortic aneurysm (TAAA) repair is a complex procedure performed in patients at high cardiovascular risk. High volume intra-operative bleeding is often recorded, and the amount of intra-operative blood product transfusion is associated with relevant morbidity and mortality. The aim of the study was to identify pre-operative predictors of intra-operative large volume blood transfusions (LVBT) to stratify patients pre-operatively., Methods: This was a retrospective analysis of prospectively collected data of all patients who underwent open TAAA surgery at San Raffaele Scientific Institute from January 2009 to December 2015. Intra-operative red blood cell (RBC) transfusions were administered to maintain a hematocrit of at least 30%. A LVBT was defined as a transfusion of at least four RBC units, corresponding to 1000 mL., Results: The study population included 428 patients: 260 (61%) received fewer than 4 RBC units, and 168 (39%) were transfused with at least 4 RBC units. In patients who underwent LVBT, higher mortality was observed after surgery (p=.003), longer intensive care unit admission (p=.004), and longer mechanical ventilation compared with less transfused patients (p=.0002). The patients who received fewer units were administered a higher dose of heparin during the surgical operation compared with patients of the LVBT group: 3400±1100 vs. 2900±1300 IU (international units) (p=.0004). Pre-operative chronic renal failure (OR 1.8), the pre-operative haemoglobin value (OR 0.8), and the need for urgent or emergent surgery (OR 3.15) were independent predictors of LVBT on multivariate analysis., Conclusions: The identification of patients at risk of intra-operative LVBT during TAAA surgery is critical as these patients experience a worse outcome. Nevertheless, only few independent predictors are available for clinical practice., (Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2017
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45. Usutu virus infections in humans: a retrospective analysis in the municipality of Modena, Italy.
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Grottola A, Marcacci M, Tagliazucchi S, Gennari W, Di Gennaro A, Orsini M, Monaco F, Marchegiano P, Marini V, Meacci M, Rumpianesi F, Lorusso A, Pecorari M, and Savini G
- Subjects
- Adult, Aged, Animals, Antibodies, Viral blood, Birds virology, Culex virology, Female, Flavivirus Infections blood, Flavivirus Infections cerebrospinal fluid, Flavivirus Infections epidemiology, Humans, Italy, Male, Middle Aged, Mosquito Vectors virology, Phylogeny, RNA, Viral blood, Retrospective Studies, Serologic Tests, Viral Proteins genetics, Viral Proteins metabolism, Flavivirus isolation & purification, Flavivirus Infections virology
- Abstract
Objective: To monitor the spread and to evaluate the role for public health of Usutu virus (USUV) in an endemic area of Italy., Methods: The survey was retrospectively conducted by detecting USUV RNA and USUV antibodies in cerebrospinal fluid and serum samples collected between 2008 and 2011 from 915 patients with or without neurologic impairments in the area of the municipality of Modena, Italy. Organs of birds and pools of mosquitoes were also tested for USUV RNA. Positive samples were partially sequenced and used for phylogenetic analysis., Results: The presence of USUV RNA (1.1%; 95% confidence interval (CI) 0.6-2.0) was significantly (p <0.05) higher than that of West Nile virus (0%; 95% CI 0-0.33). USUV antibody level was 6.57% (95% CI 4.87-8.82), and it was significantly higher (p <0.05) compared to that of West Nile virus (p 2.96, 95% CI 1.89-4.62). Partial genome sequencing of USUV strains detected in humans, birds and mosquitoes revealed high nucleotide sequence identity within them and with the USUV strains isolated in Central Europe., Conclusions: USUV infection in humans is not a sporadic event in the studied area, and USUV neuroinvasiveness has been confirmed., (Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2017
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46. Impact of post-procedural hyperglycemia on acute kidney injury after transcatheter aortic valve implantation.
- Author
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Giannini F, Latib A, Jabbour RJ, Ruparelia N, Aurelio A, Ancona MB, Figini F, Mangieri A, Regazzoli D, Tanaka A, Montalto C, Azzalini L, Monaco F, Agricola E, Chieffo A, Montorfano M, Alfieri O, and Colombo A
- Subjects
- Acute Kidney Injury blood, Acute Kidney Injury diagnosis, Aged, Aged, 80 and over, Aortic Valve Stenosis diagnosis, Female, Follow-Up Studies, Humans, Hyperglycemia blood, Hyperglycemia diagnosis, Male, Postoperative Complications blood, Postoperative Complications diagnosis, Prospective Studies, Retrospective Studies, Transcatheter Aortic Valve Replacement trends, Treatment Outcome, Acute Kidney Injury epidemiology, Aortic Valve Stenosis epidemiology, Aortic Valve Stenosis surgery, Hyperglycemia epidemiology, Postoperative Complications epidemiology, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Background: Post-operative hyperglycemia, in individuals with and without diabetes, has been identified as a predictor of acute kidney injury (AKI) in patients following cardiac surgery. Whether or not this is also true for patients undergoing transcatheter aortic valve implantation (TAVI) is unknown., Objectives: To evaluate whether post-procedural glucose levels are associated with AKI after TAVI., Methods and Results: A total of 422 consecutive patients undergoing transfemoral TAVI were included in the analysis. For each patient, plasma glucose levels were assessed at hospital admission, 4h after the procedure and daily during hospitalization. Post-procedural hyperglycemia was defined as 2 consecutive blood glucose readings ≥150mg/dL in the 72-hour period following TAVI. AKI was defined according to the VARC consensus report regarding standardized endpoint definitions. Overall, 137 (32.5%) patients developed post-procedural hyperglycemia and 138 (33%) patients developed AKI. Hyperglycemia was associated with a 2-fold higher incidence of AKI than in patients without hyperglycemia (48% vs. 25%, p<0.001). In-hospital mortality was higher in patients with hyperglycemia than in those without hyperglycemia (9.6% vs. 1.8%, p<0.001). In-hospital mortality rate was also higher in patients who developed AKI (12.7% vs. 2.7%, p<0.001). Patients with acute hyperglycemia that developed AKI had the highest in-hospital and long-term mortality rate (15% and 38%). Post-procedural hyperglycemia was an independent predictor of AKI., Conclusions: Post-procedural hyperglycemia is associated with a higher incidence of AKI and mortality after TAVI. Randomized controlled trials are needed to determine whether meticulous post-procedural glycemic control following TAVI impacts upon clinical outcomes., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
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47. Percutaneous Direct Annuloplasty With Cardioband to Treat Recurrent Mitral Regurgitation After MitraClip Implantation.
- Author
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Latib A, Ancona MB, Ferri L, Montorfano M, Mangieri A, Regazzoli D, Giannini F, Monaco F, Giglio M, De Servi S, Alfieri O, Colombo A, and Agricola E
- Subjects
- Aged, Cardiac Catheterization, Heart Valve Prosthesis Implantation, Humans, Male, Mitral Valve, Treatment Outcome, Mitral Valve Annuloplasty, Mitral Valve Insufficiency therapy
- Published
- 2016
- Full Text
- View/download PDF
48. Transcatheter aortic valve implantation in intermediate- and low-risk populations: An inevitable progression?
- Author
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Jabbour RJ, Pagnesi M, Kawamoto H, Tanaka A, Regazzoli D, Mangieri A, Ancona M, Monaco F, Agricola E, Spagnolo P, Castiglioni A, De Angelis G, Chieffo A, Montorfano M, Colombo A, and Latib A
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis mortality, Female, Follow-Up Studies, Humans, Male, Retrospective Studies, Risk Factors, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality, Aortic Valve Stenosis surgery, Disease Progression, Population Surveillance, Transcatheter Aortic Valve Replacement trends
- Published
- 2016
- Full Text
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49. Liberal transfusion strategy improves survival in perioperative but not in critically ill patients. A meta-analysis of randomised trials.
- Author
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Fominskiy E, Putzu A, Monaco F, Scandroglio AM, Karaskov A, Galas FR, Hajjar LA, Zangrillo A, and Landoni G
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- Critical Care statistics & numerical data, Humans, Perioperative Care statistics & numerical data, Survival Analysis, Treatment Outcome, Blood Transfusion statistics & numerical data, Critical Care methods, Critical Illness mortality, Perioperative Care methods, Perioperative Care mortality, Randomized Controlled Trials as Topic
- Abstract
Background: Guidelines support the use of a restrictive strategy in blood transfusion management in a variety of clinical settings. However, recent randomized controlled trials (RCTs) performed in the perioperative setting suggest a beneficial effect on survival of a liberal strategy. We aimed to assess the effect of liberal and restrictive blood transfusion strategies on mortality in perioperative and critically ill adult patients through a meta-analysis of RCTs., Methods: We searched PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, Transfusion Evidence Library, and Google Scholar up to 27 March 2015, for RCTs performed in perioperative or critically ill adult patients, receiving a restrictive or liberal transfusion strategy, and reporting all-cause mortality. We used a fixed or random-effects model to calculate the odds ratio (OR) and 95% confidence interval (CI) for pooled data. We assessed heterogeneity using Cochrane's Q and I(2) tests. The primary outcome was all-cause mortality within 90-day follow-up., Results: Patients in the perioperative period receiving a liberal transfusion strategy had lower all-cause mortality when compared with patients allocated to receive a restrictive transfusion strategy (OR 0.81; 95% CI 0.66‒1.00; P=0.05; I(2)=25%; Number needed to treat=97) with 7552 patients randomized in 17 trials. There was no difference in mortality among critically ill patients receiving a liberal transfusion strategy when compared with the restrictive transfusion strategy (OR 1.10; 95% CI 0.99‒1.23; P=0.07; I(2)=34%) with 3469 patients randomized in 10 trials., Conclusion: According to randomized published evidence, perioperative adult patients have an improved survival when receiving a liberal blood transfusion strategy., (© The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2015
- Full Text
- View/download PDF
50. Hepatic and renal effects of cardiopulmonary bypass.
- Author
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Di Tomasso N, Monaco F, and Landoni G
- Subjects
- Acute Kidney Injury metabolism, Acute Kidney Injury prevention & control, Animals, Biomarkers metabolism, Humans, Liver Diseases metabolism, Liver Diseases prevention & control, Postoperative Complications metabolism, Postoperative Complications prevention & control, Risk Factors, Acute Kidney Injury etiology, Cardiopulmonary Bypass adverse effects, Liver Diseases etiology, Postoperative Complications etiology
- Abstract
Although associated with low morbidity and mortality, cardiopulmonary bypass remains a "non-physiologic" device that carries a set of complications. Hepatic and renal impairment are associated with a poor outcome. The knowledge of pathophysiology, risk factors and therapeutic interventions can help the anaesthesiologist in preventing these complications in daily practice. The present narrative review provides an update of the literature on the effects of cardiopulmonary bypass on hepatic and renal functions, focussing on markers of hepatic and renal injuries, perioperative strategies in preserving organ function and replacement therapies., (Copyright © 2015 Elsevier Ltd. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
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