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1. Clinical profile of trazodone users in a multisetting older population: data from the Italian GeroCovid Observational study

Author

Coin, A, Noale, M, Gareri, P, Trevisan, C, Bellio, A, Fini, F, Abbatecola, A, Del Signore, S, Malara, A, Mossello, E, Fumagalli, S, Volpato, S, Monzani, F, Bellelli, G, Zia, G, Incalzi, R, Andrieri, D, Antognoli, R, Antonietti, M, Bagalà, V, Bandini, G, Bazzano, S, Bellotti, F, Benvenuti, E, Bergamin, M, Bertolotti, M, Biagini, C, Bianchetti, A, Bianchi, A, Bianchi, M, Bianchi, P, Biasin, F, Bignamini, S, Blandini, D, Boffelli, S, Bontempi, C, Bordignon, A, Bracchitta, L, Bugada, M, Cafariello, C, Caleri, V, Calsolaro, V, Calvani, D, Campagna, F, Capasso, A, Capurso, S, Carino, S, Carpagnano, E, Carrieri, B, Castaldo, V, Castelli, M, Castellino, M, Cavarape, A, Cazzulani, I, Celesti, C, Ceolin, C, Ceresini, M, Ceretti, A, Cherubini, A, Chizzoli, A, Ciarrocchi, E, Cicciomessere, P, Colombo, M, Corsi, A, Crispino, A, Cucunato, R, Custodero, C, D’Agostino, F, D’Errico, M, D’Amico, F, De Iorio, A, De Marchi, A, Dell’Armi, A, Delmonte, M, Desideri, G, Devita, M, Di Matteo, E, Espinosa, E, Esposito, L, Fazio, C, Ferro, C, Filippini, C, Fiore, L, Fiorillo, S, Fontana, C, Forte, L, Montorzi, R, Fumagalli, C, Gasbarri, P, Giordano, A, Giuliani, E, Granata, R, Coin A., Noale M., Gareri P., Trevisan C., Bellio A., Fini F., Abbatecola A. M., Del Signore S., Malara A., Mossello E., Fumagalli S., Volpato S., Monzani F., Bellelli G., Zia G., Incalzi R. A., Andrieri D., Antognoli R., Antonietti M. P., Bagalà V., Bandini G., Bazzano S., Bellotti F., Benvenuti E., Bergamin M., Bertolotti M., Biagini C. A., Bianchetti A., Bianchi A., Bianchi M., Bianchi P., Biasin F., Bignamini S., Blandini D., Boffelli S., Bontempi C., Bordignon A., Bracchitta L. M., Bugada M., Cafariello C., Caleri V., Calsolaro V., Calvani D., Campagna F. A., Capasso A., Capurso S., Carino S., Carpagnano E., Carrieri B., Castaldo V., Castelli M., Castellino M., Cavarape A., Cazzulani I., Celesti C., Ceolin C., Ceresini M. G., Ceretti A., Cherubini A., Chizzoli A., Ciarrocchi E., Cicciomessere P., Colombo M., Corsi A., Crispino A., Cucunato R., Custodero C., D’Agostino F., D’Errico M. M., D’Amico F., De Iorio A., De Marchi A., Dell’Armi A., Delmonte M., Desideri G., Devita M., Di Matteo E., Espinosa E., Esposito L., Fazio C., Ferro C., Filippini C., Fiore L., Fiorillo S., Fontana C., Forte L., Montorzi R. F., Fumagalli C., Gasbarri P. P., Giordano A., Giuliani E., Granata R., Coin, A, Noale, M, Gareri, P, Trevisan, C, Bellio, A, Fini, F, Abbatecola, A, Del Signore, S, Malara, A, Mossello, E, Fumagalli, S, Volpato, S, Monzani, F, Bellelli, G, Zia, G, Incalzi, R, Andrieri, D, Antognoli, R, Antonietti, M, Bagalà, V, Bandini, G, Bazzano, S, Bellotti, F, Benvenuti, E, Bergamin, M, Bertolotti, M, Biagini, C, Bianchetti, A, Bianchi, A, Bianchi, M, Bianchi, P, Biasin, F, Bignamini, S, Blandini, D, Boffelli, S, Bontempi, C, Bordignon, A, Bracchitta, L, Bugada, M, Cafariello, C, Caleri, V, Calsolaro, V, Calvani, D, Campagna, F, Capasso, A, Capurso, S, Carino, S, Carpagnano, E, Carrieri, B, Castaldo, V, Castelli, M, Castellino, M, Cavarape, A, Cazzulani, I, Celesti, C, Ceolin, C, Ceresini, M, Ceretti, A, Cherubini, A, Chizzoli, A, Ciarrocchi, E, Cicciomessere, P, Colombo, M, Corsi, A, Crispino, A, Cucunato, R, Custodero, C, D’Agostino, F, D’Errico, M, D’Amico, F, De Iorio, A, De Marchi, A, Dell’Armi, A, Delmonte, M, Desideri, G, Devita, M, Di Matteo, E, Espinosa, E, Esposito, L, Fazio, C, Ferro, C, Filippini, C, Fiore, L, Fiorillo, S, Fontana, C, Forte, L, Montorzi, R, Fumagalli, C, Gasbarri, P, Giordano, A, Giuliani, E, Granata, R, Coin A., Noale M., Gareri P., Trevisan C., Bellio A., Fini F., Abbatecola A. M., Del Signore S., Malara A., Mossello E., Fumagalli S., Volpato S., Monzani F., Bellelli G., Zia G., Incalzi R. A., Andrieri D., Antognoli R., Antonietti M. P., Bagalà V., Bandini G., Bazzano S., Bellotti F., Benvenuti E., Bergamin M., Bertolotti M., Biagini C. A., Bianchetti A., Bianchi A., Bianchi M., Bianchi P., Biasin F., Bignamini S., Blandini D., Boffelli S., Bontempi C., Bordignon A., Bracchitta L. M., Bugada M., Cafariello C., Caleri V., Calsolaro V., Calvani D., Campagna F. A., Capasso A., Capurso S., Carino S., Carpagnano E., Carrieri B., Castaldo V., Castelli M., Castellino M., Cavarape A., Cazzulani I., Celesti C., Ceolin C., Ceresini M. G., Ceretti A., Cherubini A., Chizzoli A., Ciarrocchi E., Cicciomessere P., Colombo M., Corsi A., Crispino A., Cucunato R., Custodero C., D’Agostino F., D’Errico M. M., D’Amico F., De Iorio A., De Marchi A., Dell’Armi A., Delmonte M., Desideri G., Devita M., Di Matteo E., Espinosa E., Esposito L., Fazio C., Ferro C., Filippini C., Fiore L., Fiorillo S., Fontana C., Forte L., Montorzi R. F., Fumagalli C., Gasbarri P. P., Giordano A., Giuliani E., and Granata R.

Abstract

Background and objectives: Depression is highly prevalent in older adults, especially in those with dementia. Trazodone, an antidepressant, has shown to be effective in older patients with moderate anxiolytic and hypnotic activity; and a common off-label use is rising for managing behavioral and psychological symptoms of dementia (BPSD). The aim of the study is to comparatively assess the clinical profiles of older patients treated with trazodone or other antidepressants. Methods: This cross-sectional study involved adults aged ≥ 60 years at risk of or affected with COVID-19 enrolled in the GeroCovid Observational study from acute wards, geriatric and dementia-specific outpatient clinics, as well as long-term care facilities (LTCF). Participants were grouped according to the use of trazodone, other antidepressants, or no antidepressant use. Results: Of the 3396 study participants (mean age 80.6 ± 9.1 years; 57.1% females), 10.8% used trazodone and 8.5% others antidepressants. Individuals treated with trazodone were older, more functionally dependent, and had a higher prevalence of dementia and BPSD than those using other antidepressants or no antidepressant use. Logistic regression analyses found that the presence of BPSD was associated with trazodone use (odds ratio (OR) 28.4, 95% confidence interval (CI) 18-44.7 for the outcome trazodone vs no antidepressants use, among participants without depression; OR 2.17, 95% CI 1.05-4.49 for the outcome trazodone vs no antidepressants use, among participants with depression). A cluster analysis of trazodone use identified three clusters: cluster 1 included mainly women, living at home with assistance, multimorbidity, dementia, BPSD, and depression; cluster 2 included mainly institutionalized women, with disabilities, depression, and dementia; cluster 3 included mostly men, often living at home unassisted, with better mobility performance, fewer chronic diseases, dementia, BPSD, and depression. Discussion: The use of trazodo

Published
2023

2. Clinical profile of trazodone users in a multisetting older population: data from the Italian GeroCovid Observational study

Author

Coin A., Noale M., Gareri P., Trevisan C., Bellio A., Fini F., Abbatecola A. M., Del Signore S., Malara A., Mossello E., Fumagalli S., Volpato S., Monzani F., Bellelli G., Zia G., Incalzi R. A., Andrieri D., Antognoli R., Antonietti M. P., Bagalà V., Bandini G., Bazzano S., Bellotti F., Benvenuti E., Bergamin M., Bertolotti M., Biagini C. A., Bianchetti A., Bianchi A., Bianchi M., Bianchi P., Biasin F., Bignamini S., Blandini D., Boffelli S., Bontempi C., Bordignon A., Bracchitta L. M., Bugada M., Cafariello C., Caleri V., Calsolaro V., Calvani D., Campagna F. A., Capasso A., Capurso S., Carino S., Carpagnano E., Carrieri B., Castaldo V., Castelli M., Castellino M., Cavarape A., Cazzulani I., Celesti C., Ceolin C., Ceresini M. G., Ceretti A., Cherubini A., Chizzoli A., Ciarrocchi E., Cicciomessere P., Colombo M., Corsi A., Crispino A., Cucunato R., Custodero C., D’Agostino F., D’Errico M. M., D’Amico F., De Iorio A., De Marchi A., Dell’Armi A., Delmonte M., Desideri G., Devita M., Di Matteo E., Espinosa E., Esposito L., Fazio C., Ferro C., Filippini C., Fiore L., Fiorillo S., Fontana C., Forte L., Montorzi R. F., Fumagalli C., Gasbarri P. P., Giordano A., Giuliani E., Granata R., Coin, A, Noale, M, Gareri, P, Trevisan, C, Bellio, A, Fini, F, Abbatecola, A, Del Signore, S, Malara, A, Mossello, E, Fumagalli, S, Volpato, S, Monzani, F, Bellelli, G, Zia, G, Incalzi, R, Andrieri, D, Antognoli, R, Antonietti, M, Bagalà, V, Bandini, G, Bazzano, S, Bellotti, F, Benvenuti, E, Bergamin, M, Bertolotti, M, Biagini, C, Bianchetti, A, Bianchi, A, Bianchi, M, Bianchi, P, Biasin, F, Bignamini, S, Blandini, D, Boffelli, S, Bontempi, C, Bordignon, A, Bracchitta, L, Bugada, M, Cafariello, C, Caleri, V, Calsolaro, V, Calvani, D, Campagna, F, Capasso, A, Capurso, S, Carino, S, Carpagnano, E, Carrieri, B, Castaldo, V, Castelli, M, Castellino, M, Cavarape, A, Cazzulani, I, Celesti, C, Ceolin, C, Ceresini, M, Ceretti, A, Cherubini, A, Chizzoli, A, Ciarrocchi, E, Cicciomessere, P, Colombo, M, Corsi, A, Crispino, A, Cucunato, R, Custodero, C, D’Agostino, F, D’Errico, M, D’Amico, F, De Iorio, A, De Marchi, A, Dell’Armi, A, Delmonte, M, Desideri, G, Devita, M, Di Matteo, E, Espinosa, E, Esposito, L, Fazio, C, Ferro, C, Filippini, C, Fiore, L, Fiorillo, S, Fontana, C, Forte, L, Montorzi, R, Fumagalli, C, Gasbarri, P, Giordano, A, Giuliani, E, and Granata, R

Subjects
BPSD, Profile, Clinical characteristic, Depression, Trazodone, Dementia
Abstract

Background and objectives: Depression is highly prevalent in older adults, especially in those with dementia. Trazodone, an antidepressant, has shown to be effective in older patients with moderate anxiolytic and hypnotic activity; and a common off-label use is rising for managing behavioral and psychological symptoms of dementia (BPSD). The aim of the study is to comparatively assess the clinical profiles of older patients treated with trazodone or other antidepressants. Methods: This cross-sectional study involved adults aged ≥ 60 years at risk of or affected with COVID-19 enrolled in the GeroCovid Observational study from acute wards, geriatric and dementia-specific outpatient clinics, as well as long-term care facilities (LTCF). Participants were grouped according to the use of trazodone, other antidepressants, or no antidepressant use. Results: Of the 3396 study participants (mean age 80.6 ± 9.1 years; 57.1% females), 10.8% used trazodone and 8.5% others antidepressants. Individuals treated with trazodone were older, more functionally dependent, and had a higher prevalence of dementia and BPSD than those using other antidepressants or no antidepressant use. Logistic regression analyses found that the presence of BPSD was associated with trazodone use (odds ratio (OR) 28.4, 95% confidence interval (CI) 18-44.7 for the outcome trazodone vs no antidepressants use, among participants without depression; OR 2.17, 95% CI 1.05-4.49 for the outcome trazodone vs no antidepressants use, among participants with depression). A cluster analysis of trazodone use identified three clusters: cluster 1 included mainly women, living at home with assistance, multimorbidity, dementia, BPSD, and depression; cluster 2 included mainly institutionalized women, with disabilities, depression, and dementia; cluster 3 included mostly men, often living at home unassisted, with better mobility performance, fewer chronic diseases, dementia, BPSD, and depression. Discussion: The use of trazodone was highly prevalent in functionally dependent and comorbid older adults admitted to LTCF or living at home. Clinical conditions associated with its prescription included depression as well as BPSD.

Published
2023

3. The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage

Author

Mascia, L., Fedorko, L., terBrugge, K., Filippini, C., Pizzio, M., Ranieri, V. M., and Wallace, M. C.

Subjects
Subarachnoid hemorrhage -- Complications and side effects, Subarachnoid hemorrhage -- Research, Transcranial Doppler ultrasonography -- Usage, Blood circulation disorders -- Risk factors, Blood circulation disorders -- Diagnosis, Blood circulation disorders -- Research, Health care industry
Abstract

Byline: L. Mascia (1), L. Fedorko (2), K. terBrugge (3), C. Filippini (4), M. Pizzio (4), V. M. Ranieri (1), M. C. Wallace (5) Keywords: Subarachnoid hemorrhage; ROC analysis; Cerebral vasospasm; Transcranial Doppler; Angiography Abstract: Objectives To examine the accuracy of transcranial Doppler to detect cerebral vasospasm in a patient population with aneurysmal subarachnoid hemorrhage. Design Prospective blind comparison of transcranial Doppler with cerebral angiography. Diagnostic accuracy of transcranial Doppler was assessed using receiver operating characteristic (ROC) analysis and likelihood ratios. Sensitivity and specificity were calculated using directly measured middle cerebral artery diameter as reference standard. Setting Intensive Care Unit of a large university teaching hospital. Patients and participants Twenty-two patients with subarachnoid hemorrhage were included. Patients underwent angiography on admission and after 8 days to diagnose vasospasm and were defined as having clinical vasospasm, angiographic vasospasm, or no vasospasm. Measurements and results Sensitivity and specificity were 1.00 and 0.75 for angiographic vasospasm and both equal to 1.00 for clinical vasospasm diagnosis. A transcranial Doppler mean velocity threshold value of 100 cm/s for angiographic vasospasm and 160 cm/s for clinical vasospasm detection were chosen by ROC analysis. Conclusions A Transcranial Doppler mean velocity threshold of 160 cm/s, calculated by the ROC analysis, accurately detects clinical vasospasm. A daily transcranial Doppler examination performed by a trained operator should be routinely used to provide early identification of patients at high risk and to orient therapeutic decisions. Author Affiliation: (1) Dipartimento di Discipline Medico-Chirurgiche, Sezione di Anestesiologia e Rianimazione, Ospedale S. Giovanni Battista, Universita di Torino, Corso Dogliotti 14, 10126, Torino, Italy (2) Department of Anaesthesia, Toronto General Hospital, University of Toronto, Toronto, Canada (3) Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Canada (4) Dipartimento di Discipline Medico-Chirurgiche, Servizio Informatico, Ospedale S. Giovanni Battista, Universita di Torino, Torino, Italy (5) Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada Article History: Received Date: 18/09/2002 Accepted Date: 27/03/2003 Online Date: 28/05/2003 Article note: Dr L. Mascia was supported by the PhD program in Applied Physiology, University of Turin, Italy.

Published
2003

4. A systematic review and individual participant data (IPD) meta-analysis of risk factors for anastomotic leak after rectal cancer surgery: the Syreal Study

Author

Arezzo, A., Migliore, M., Chiaro, P., Arolfo, S., Filippini, C., Di Cuonzo, D., Passera, R., Cirocchi, Roberto, Morino, M., Mistrangelo, M., Akiyoshi, T., Araujo, S. E. A., Baiocchi, G. L., Bergamaschi, R., Bertelsen, C. A., Biffi, R., Brachet Contul, R., Bujko, K., But hadzic, J., Cats, A., Cuesta, M. A., Desiderio, J., Eriksen, M. T., Evrard, S., Foo, D. C. C., Fukuoka, H., Harling, H., Hidaka, E., Jani, K., Jarry, J., Cheon Kim, J., Lange, M. M., Lakkis, Z., Law, W. L., Lim, S. B., Martz, J. E., Meershoek klein Kranenbarg, E., Motson, R., Valero Navarro, G., Palanivelu, C., Panis, Y., Parisi, A., Peeters, K. C., Penninckx, F., Sartori, C. A., Shmaissany, K., Sˇkrovina, M., Van De Velde, C. J. H., Van Der Noort, V., Veenhof, A. A., Velenik, V., Wibe, A., and You, K.

Published
2017

5. Instrumental evaluation of gait smoothness and history of falling in older persons: results from an exploratory case-control study.

Author

Zucchelli A, Lucente D, Filippini C, Marengoni A, and Lopomo NF

Subjects
Humans, Aged, Aged, 80 and over, Case-Control Studies, Movement, Gait, Walking
Abstract

Gait smoothness, perceived when a person walks continuously and uninterruptedly, is associated with an undisrupted gait pattern, good sensorimotor control, and a lower risk of falling. The spectral arc length (SPARC) is a quantitative metric proposed for the evaluation of movement smoothness from the signal obtained by wearable sensors. In this small exploratory case-control study, older persons with and without a history of injurious falls underwent a turn-test while wearing an accelerometer: gait smoothness was estimated by calculating SPARC during the straight and turning phases. Cases seemed to exhibit lower SPARC values during the turning phase, in comparison with control., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Published
2023
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6. Intraoperative thermal infrared imaging in neurosurgery: machine learning approaches for advanced segmentation of tumors.

Author

Cardone D, Trevisi G, Perpetuini D, Filippini C, Merla A, and Mangiola A

Subjects
Humans, Machine Learning, Neurosurgical Procedures, Diagnostic Imaging, Neurosurgery, Neoplasms
Abstract

Surgical resection is one of the most relevant practices in neurosurgery. Finding the correct surgical extent of the tumor is a key question and so far several techniques have been employed to assist the neurosurgeon in preserving the maximum amount of healthy tissue. Some of these methods are invasive for patients, not always allowing high precision in the detection of the tumor area. The aim of this study is to overcome these limitations, developing machine learning based models, relying on features obtained from a contactless and non-invasive technique, the thermal infrared (IR) imaging. The thermal IR videos of thirteen patients with heterogeneous tumors were recorded in the intraoperative context. Time (TD)- and frequency (FD)-domain features were extracted and fed different machine learning models. Models relying on FD features have proven to be the best solutions for the optimal detection of the tumor area (Average Accuracy = 90.45%; Average Sensitivity = 84.64%; Average Specificity = 93,74%). The obtained results highlight the possibility to accurately detect the tumor lesion boundary with a completely non-invasive, contactless, and portable technology, revealing thermal IR imaging as a very promising tool for the neurosurgeon., (© 2023. The Author(s).)

Published
2023
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7. Single-Dose St. Thomas Versus Custodiol® Cardioplegia for Right Mini-thoracotomy Mitral Valve Surgery.

Author

Barbero C, Pocar M, Marchetto G, Cura Stura E, Calia C, Dalbesio B, Filippini C, Salizzoni S, Boffini M, Rinaldi M, and Ricci D

Subjects
Humans, Cardioplegic Solutions adverse effects, Potassium Chloride adverse effects, Heart Arrest, Induced adverse effects, Mitral Valve surgery, Thoracotomy
Abstract

Objective: Custodiol® and St. Thomas cardioplegia are widely employed in mini-thoracotomy mitral valve (MV) operations. One-dose of the former provides 3 h of myocardial protection. Conversely, St. Thomas solution is usually reinfused every 30 min and safety of single delivery is unknown. We aimed to compare single-shot St. Thomas versus Custodiol® cardioplegia., Methods: Primary endpoint of the prospective observational study was cardiac troponin T level at different post-operative time-points. Propensity-weighted treatment served to adjust for confounding factors., Results: Thirty-nine patients receiving St. Thomas were compared with 25 patients receiving Custodiol® cardioplegia; cross-clamping always exceeded 45 min. No differences were found in postoperative markers of myocardial injury. Ventricular fibrillation at the resumption of electric activity was more frequent following Custodiol® cardioplegia (P = .01)., Conclusion: Effective myocardial protection exceeding 1 h of ischemic arrest can be achieved with a single-dose St. Thomas cardioplegia in selected patients undergoing right mini-thoracotomy MV surgery., (© 2022. The Author(s).)

Published
2023
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8. Magnetic Resonance Imaging for Cerebral Micro-embolizations During Minimally Invasive Mitral Valve Surgery.

Author

Barbero C, Rinaldi M, Marchetto G, Valentini MC, Cura Stura E, Bosco G, Pocar M, Filippini C, Boffini M, and Ricci D

Subjects
Humans, Mitral Valve diagnostic imaging, Mitral Valve surgery, Minimally Invasive Surgical Procedures adverse effects, Minimally Invasive Surgical Procedures methods, Thoracotomy adverse effects, Thoracotomy methods, Magnetic Resonance Imaging, Treatment Outcome, Retrospective Studies, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures methods, Heart Valve Prosthesis Implantation adverse effects
Abstract

The role of aortic clamping techniques on the occurrence of neurological complications after right mini-thoracotomy mitral valve surgery is still debated. Brain injuries can occur also as silent cerebral micro-embolizations (SCM), which have been linked to significant deficits in physical and cognitive functions. Aims of this study are to evaluate the overall rate of SCM and to compare endoaortic clamp (EAC) with trans-thoracic clamp (TTC). Patients enrolled underwent a pre-operative, a post-operative, and a follow-up MRI. Forty-three patients were enrolled; EAC was adopted in 21 patients, TTC in 22 patients. Post-operative SCM were reported in 12 cases (27.9%). No differences between the 2 groups were highlighted (23.8% SCM in the EAC group versus 31.8% in the TTC). MRI analysis showed post-operative SCM in nearly 30% of selected patients after right mini-thoracotomy mitral valve surgery. Subgroup analysis on different types of aortic clamping showed comparable results. CLINICAL RELEVANCE: The rate of SCM reported in the present study on patients undergoing minimally invasive MVS and RAP is consistent with data in the literature on patients undergoing cardiac surgery through median sternotomy and antegrade arterial perfusion. Moreover, no differences were reported between EAC and TTC: both the aortic clamping techniques are safe, and the choice of the surgical setting to adopt can be really done according to the patient's characteristics., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Published
2022
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9. Neuroendocrine predictors of vasoplegia after cardiopulmonary bypass.

Author

Pasero D, Berton AM, Motta G, Raffaldi R, Fornaro G, Costamagna A, Toscano A, Filippini C, Mengozzi G, Prencipe N, Zavattaro M, Settanni F, Ghigo E, Brazzi L, and Benso AS

Subjects
Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Postoperative Complications blood, Postoperative Complications etiology, Prognosis, Prospective Studies, Vasoplegia blood, Vasoplegia etiology, Biomarkers blood, Cardiac Surgical Procedures adverse effects, Cardiopulmonary Bypass adverse effects, Glycopeptides blood, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Postoperative Complications diagnosis, Vasoplegia diagnosis
Abstract

Purpose: Vasoplegia often complicates on-pump cardiac surgery. Systemic inflammatory response induced by extracorporeal circulation represents the major determinant, but adrenal insufficiency and postoperative vasopressin deficiency may have a role. Pathophysiological meaning of perioperative changes in endocrine markers of hydro-electrolyte balance has not still fully elucidated. Objectives of the present research study were to estimate the incidence of vasoplegia in a homogeneous cohort of not severe cardiopathic patients, to define the role of presurgical adrenal insufficiency, to evaluate copeptin and NT-proBNP trends in the perioperative., Methods: We conducted a prospective cohort study in the cardiac intensive care unit of a tertiary referral center. We evaluated 350 consecutive patients scheduled for cardiac surgery; 55 subjects completed the study. Both standard and low-dose corticotropin stimulation tests were performed in the preoperative; copeptin and NT-proBNP were evaluated in the preoperative (T0), on day 1 (T1) and day 7 (T2) after surgery., Results: Nine subjects (16.3%) developed vasoplegic syndrome with longer bypass and clamping time (p < 0.001). Reduced response to low-dose ACTH test was not associated to vasoplegia. Preoperative copeptin > 16.9 pmol/L accurately predicted the syndrome (AUC 0.86, 95% CI 0.73-0.94; OR 1.17, 95% CI 1.04-1.32). An evident correlation was observed at 7 days postoperative between NT-proBNP and copeptin (r 0.88, 95% CI 0.8-0.93; p < 0.001)., Conclusion: Preoperative impaired response to low-dose ACTH stimulation test is not a risk factor for post-cardiotomic vasoplegia; conversely, higher preoperative copeptin predicts the complication. On-pump cardiac surgery could be an interesting model of rapid heart failure progression.

Published
2021
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11. A prospective randomized trial comparing corifollitropin-α late-start (day 4) versus standard administration (day 2) in expected poor, normal, and high responders undergoing controlled ovarian stimulation for IVF.

Author

Revelli A, Gennarelli G, Sestero M, Canosa S, Carosso A, Salvagno F, Pittatore G, Filippini C, and Benedetto C

Subjects
Adolescent, Adult, Birth Rate, Female, Fertilization in Vitro trends, Gonadotropins metabolism, Humans, Live Birth epidemiology, Oocyte Retrieval methods, Ovarian Hyperstimulation Syndrome pathology, Ovulation Induction methods, Pregnancy, Prospective Studies, Young Adult, Follicle Stimulating Hormone administration & dosage, Follicle Stimulating Hormone, Human administration & dosage, Gonadotropin-Releasing Hormone administration & dosage, Ovarian Hyperstimulation Syndrome drug therapy
Abstract

Objective: To assess whether corifollitropin-α (CFα) late-start administration (day 4) and standard administration (day 2) can obtain similar oocyte yield and live birth rate., Study Design: A randomized controlled trial., Setting: University Hospital IVF Unit., Patients: One hundred thirteen women undergoing IVF., Interventions: Patients distributed in three subgroups (expected poor, normal, or high responders to FSH) were randomized into two treatment arms: (a) CFα late-start: CFα on day 4 + GnRH antagonist from day 8 + (when needed) recFSH from day 11; (b) CFα standard start: CFα on day 2 + GnRH antagonist from day 6 + (when needed) recFSH from day 9. IVF or ICSI was performed as indicated., Results: Considering the whole study group, the late-start regimen obtained comparable oocyte yield (8.9 ± 5.6 vs. 8.8 ± 6.2; p = n.s.), cPR/started cycle (25% vs. 31.6%, p = n.s.), and cumulative live birth rate (LBR)/ovum pickup (OPU) (29.2% vs. 37.7%, p = n.s.) than the standard regimen. The outcome of the two regimens was comparable in the two subgroups of high and normal responders. Differently, in poor responders, oocyte yield was similar, but LBR/OPU was significantly lower with late-start CFα administration that caused 40% cancellation rate due to monofollicular response. ROC curves showed that the threshold AMH levels associated with cycle cancellation were 0.6 ng/ml for late-start regimen and 0.2 ng/ml for standard regimen., Conclusion: CFα may be administered on either day 2 or day 4 to patients with expected high or normal response to FSH without compromising oocyte yield and/or live birth rate. Differently, late-start administration is not advisable for expected poor responders with AMH ≤ 0.6 ng/ml., Trial Registration: NCT03816670.

Published
2020
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12. Patient-centered communication, patient satisfaction, and retention in care in assisted reproductive technology visits.

Author

Borghi L, Leone D, Poli S, Becattini C, Chelo E, Costa M, De Lauretis L, Ferraretti AP, Filippini C, Giuffrida G, Livi C, Luehwink A, Palermo R, Revelli A, Tomasi G, Tomei F, and Vegni E

Subjects
Adolescent, Adult, Female, Humans, Italy epidemiology, Male, Middle Aged, Physician-Patient Relations, Reproductive Techniques, Assisted trends, Surveys and Questionnaires, Patient Satisfaction, Patient-Centered Care, Reproductive Techniques, Assisted psychology, Retention in Care
Abstract

Purpose: To explore the association between patient-centered communication, patients' satisfaction, and retention in care in assisted reproductive technology (ART) visits., Methods: ART visits at eight Italian clinics were videotaped and coded using the Roter Interaction Analysis System, which includes a Patient-Centered Index (PCI), a summary "patient-centered communication" ratio. After the visit, patients completed a satisfaction questionnaire (SATQ). After 3 months, patients were asked about their retention in care. Spearman correlations and Mann-Whitney tests were used to test associations between the study variables; the open-ended item of SATQ was analyzed through content analysis., Results: Eighty-five visits were videotaped (involving 28 gynecologists and 160 patients). PCI score (μ = 0.51 ± 0.28) revealed a more disease-oriented communication during the visit. Patients reported high levels of satisfaction with the visit and identified in the information provision or in the doctor's humanity or kindness the main reasons of satisfaction. At the follow-up, the majority of the couples declared to have followed the clinicians' recommendations and to have remained related to the ART center. No associations were found among the study variables, except for a lower male satisfaction among couples who declared to have changed ART clinic., Conclusions: Contrary to what was expected, the style of physician-patient communication was not found to be associated with patient satisfaction and retention in care. However, patients were highly satisfied and engaged. The actual meaning of a communication that is "patient-centered" in the ART context might be wider, including the couples' need for information, as suggested by qualitative findings.

Published
2019
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13. The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015".

Author

Bo M, Porrino P, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bianchetti A, Musicco M, Ferrari A, Ferrara N, Filippini C, Trabucchi M, Morandi A, and Bellelli G

Subjects
Aged, Aged, 80 and over, Female, Humans, Logistic Models, Male, Catheters, Indwelling adverse effects, Delirium etiology, Nursing Homes, Urinary Catheterization adverse effects
Abstract

Backround: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium., Aim: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients., Methods: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment)., Results: Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia., Discussion: We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents., Conclusion: Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence.

Published
2019
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