176 results on '"F. Bertoldo"'
Search Results
2. Vitamin D and disease severity in coronavirus disease 19 (COVID-19)
- Author
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G. Adami, A. Giollo, A. Fassio, C. Benini, E. Bertoldo, F. Bertoldo, G. Orsolini, L. Idolazzi, O. Viapiana, S. Giannini, G. Passeri, E. Tacconelli, C. Micheletto, D. Gatti, and M. Rossini
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COVID-19 ,vitamin D ,SARS-CoV-2. ,Medicine ,Internal medicine ,RC31-1245 - Abstract
The role of 25-OH-vitamin D in the assessment of coronavirus disease 19 (COVID-19) has not been investigated. We sought to investigate the prevalence of 25-OH-vitamin D deficiency among COVID-19 patients, and to determine the associations between 25-OH-vitamin D status and the severity of the disease. We have conducted a retrospective observational study of COVID-19 patients admitted to the University of Verona Hospital Trust. Demographic, clinical and biochemical parameters were collected at hospital admission, and serum 25-OH-vitamin D levels were measured. The following outcomes were assessed: arterial partial oxygen pressure (PaO2); C-reactive protein (CRP); length of hospitalization; requirement of oxygen therapy; non-invasive ventilation (NIV); mechanical ventilation; and death. Among 61 patients enrolled, 72.1% was 25-OH-vitamin D deficient (
- Published
- 2021
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3. Drug-induced osteonecrosis of the jaw: the state of the art
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A. Fassio, F. Bertoldo, L. Idolazzi, O. Viapiana, M. Rossini, and D. Gatti
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Osteonecrosis of the jaw ,bisphosponates ,osteoporosis. ,Medicine ,Internal medicine ,RC31-1245 - Abstract
Osteonecrosis of the jaw (ONJ) is a rare adverse event of antiresorptive drugs such as bisphosphonates (BP) and denosumab (DMAb). The diagnosis of ONJ is considered in cases where exposed bone in the maxillofacial region does not heal within 8 weeks in a patient previously treated with an antiresorptive agent. In patients with osteoporosis, ONJ is reported as a very rare adverse event while in oncologic patients with bone metastases or malignant hypercalcemia the incidence is significantly higher (up to the 1-10% of the patients). The pathophysiology of ONJ is still not completely understood but it is multi-factorial. ONJ is a condition associated with poor oral health, oral surgery, and use of antiresorptive agents. Prevention is of paramount importance especially in cancer patients, in whom the large majority of cases of ONJ (>90%) are reported, but it should also be considered in osteoporotic patients, especially during dental surgical procedure. Some simple prevention procedures are effective in reducing the risk of its appearance. When ONJ unfortunately occurs, the large majority of patients can be managed conservatively. In conclusion, ONJ is a rare condition associated with antiresorptive drugs. Both osteoporotic and oncologic patients should be well informed about its low absolute risk and regarding the fact that the benefits of antiresorptive therapy far outweigh this potential risk of ONJ.
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- 2017
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4. Guidelines for the diagnosis, prevention and management of osteoporosis
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M. Rossini, S. Adami, F. Bertoldo, D. Diacinti, D. Gatti, S. Giannini, A. Giusti, N. Malavolta, S. Minisola, G. Osella, M. Pedrazzoni, L. Sinigaglia, O. Viapiana, and G. C. Isaia
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Guidelines ,risk factors ,fractures ,dual-energy x-ray absorptiometry ,osteoporosis. ,Medicine ,Internal medicine ,RC31-1245 - Abstract
Osteoporosis poses a significant public health issue. National Societies have developed Guidelines for the diagnosis and treatment of this disorder with an effort of adapting specific tools for risk assessment on the peculiar characteristics of a given population. The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has recently revised the previously published Guidelines on the diagnosis, riskassessment, prevention and management of primary and secondary osteoporosis. The guidelines were first drafted by a working group and then approved by the board of SIOMMMS. Subsequently they received also the endorsement of other major Scientific Societies that deal with bone metabolic disease. These recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on leading experts’ experience and opinion, and on good clinical practice. The osteoporosis prevention should be based on the elimination of specific risk factors. The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk, and this is the case only when the risk of fracture is rather high as measured with variables susceptible to pharmacological effect. DeFRA (FRAX® derived fracture risk assessment) is recognized as a useful tool for easily estimate the long-term fracture risk. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management.
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- 2016
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5. Safety profile of drugs used in the treatment of osteoporosis: a systematical review of the literature
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M. Varenna, F. Bertoldo, M. Di Monaco, A. Giusti, G. Martini, M. Rossini, On behalf of SIOMMMS, and Endorsed by SIR
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Osteoporosi ,Trattamento ,Farmaci ,Eventi avversi ,Medicine ,Internal medicine ,RC31-1245 - Abstract
The range of osteoporosis treatments is increasingly large and, like any disease, the pharmacological management of patients should involve a risk/benefit evaluation to attain the greatest reduction in risk of fracture with the lowest incidence of adverse events. The aim of this review is to critically appraise the literature about the safety issues of the main pharmacological treatments of osteoporosis. This document is the result of a consensus of experts based on a systematic review of regulatory documents, randomized controlled trials, metaanalyses, pharmacovigilance surveys and case series related to possible adverse drug reactions to osteoporosis treatment with calcium and vitamin D supplements, bisphosphonates, strontium ranelate, selective estrogen receptor modulators, denosumab, and teriparatide. As expected, randomized controlled trials showed only the most common adverse events due to the samples size and the short observation time. Case series and observational studies are able to provide data about uncommon side effects, but in some cases a sure cause-effect relationship needs still to be confirmed. Consistently with methodological limitations, the newer drugs have a tolerance profile that has not been fully explored yet. Osteoporosis treatments showed an overall good tolerance profile with rare serious adverse events that, however, must be well known by the clinician who prescribes these drugs. The concern about possible adverse events should be weighed against the reduction of morbidity and mortality associated with a significant fracture risk reduction.
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- 2013
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6. Guidelines for the diagnosis, prevention and treatment of osteoporosis
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M. Rossini, G. Rini, R. Nuti, S. Minisola, S. Migliaccio, C. Mereu, L. Masi, C. Marcocci, E. Mannarino, G. Luisetto, G.C. Isaia, S. Gonnelli, S. Giannini, B. Frediani, E. Fiore, P. Filipponi, C. Cepollaro, M.L. Brandi, F. Bertoldo, S. Adami, M. Varenna, L. Ventura, and G. Bianchi
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Medicine ,Internal medicine ,RC31-1245 - Abstract
The guidelines for the osteoporosis management were first drafted by a working group and then critically evaluated by the board of SIOMMMS. The most relevant points are: Definition: Osteoporosis is defined as a quantitative and qualitative deterioration of bone tissue leading to increased risk of fracture. Postmenopausal and senile osteoporosis are defined as primitive. Diagnosis: The cornerstone for the diagnosis of osteoporosis is the measurement of bone mineral density (BMD) by DXA (dual-energy X-ray absortiometry) at the femoral neck with T-score values -2.5 is usually not justified. Pharmacological intervention: The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk. This is the case only when the risk of fracture is rather high. FRAX™ is recognized as a useful tool for easily estimate the long-term fracture risk. SIOMMMS with these guidelines is committed to validate and further develop this diagnostic tool.
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- 2011
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7. Evidences of safety and tolerability of the zoledronic acid 5 mg yearly in the post-menopausal osteoporosis: the HORIZON project
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F. Bertoldo, L. Dalle Carbonare, and V. Lo Cascio
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Medicine ,Internal medicine ,RC31-1245 - Abstract
Bisphosphonates are the most commonly prescribed medications for the treatment of osteoporosis. Despite evidence supporting the anti-fracture efficacy of aminobisphosphonates approximately 50% of patients do not follow their prescribed treatment regimen and/or discontinue treatment within the first year. Poor compliance is associated with negative outcomes, including increased fracture risk. Tolerability and safety are among the causes of poor compliance. Intravenous bisphosphonates avoids the gastrointestinal intolerance and the complex dosing instruction of the oral route ensuring full compliance which may provide improved efficacy. However, there are some concerns regarding potent intravenous bisphosphonates as zoledronic acid with respect to tolerability, mainly the acute phase response and to safety, mainly a theoretical risk of over suppression of bone turnover, renal toxicity and osteonecrosis of the jaw. In the HORIZON study, 152 patients on active treatment (82) or placebo (70) underwent to a bone biopsy after double tetracycline labeling. Bone biopsies (iliac crest) were obtained at the final visit at month 36, 1 year after the last infusion. The biopsies were analyzed by histomorphometry on bone sections and by micro-CT (μCT) analysis. 143 biopsies (76 zoledronic acid, 67 placebo) had at least one μCT parameter measured and 111 were available for quantitative histomorphometry (59 zoledronic acid, 52 placebo). Micro-CT analysis of bone structure revealed higher trabecular bone volume (BV/TV), decreased trabecular separation (Tb.Sp), and a strong trend towards improvement in connectivity density in biopsies obtained from patients treated with zoledronic acid, indicating preservation of trabecular bone structure with respect to placebo. Histomorphometric analysis obtained from patients treated with zoledronic acid exhibited reduction of bone turnover, as suggested by decreased activation frequency (Ac.F) by 63%, mineralizing surface (MS/BS), bone formation rate (BFR/BV). In addition, mineral appositional rate (MAR), reflecting the bone-forming capacity of osteoblastic teams at the bone multicellular unit (BMU) level, was significantly higher in patients on active treatment. No sign of excessive suppression of bone turnover or mineralization impairment was detected, confirming the safety of the treatment with intravenous zoledronic acid once a year. These interesting findings are discussed in the article, particularly in terms of new histomorphometric results and clinical findings supporting the tolerability and safety of zoledronic acid.
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- 2011
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8. Use of nonsteroidal anti-inflammatory drugs in patients with vertebral osteoporotic fractures
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M. Rossini, F. Bertoldo, R. Lovato, R. Bortolotti, D. Gatti, and S. Adami
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Medicine ,Internal medicine ,RC31-1245 - Abstract
Objective: The aim of the study was to assess the use of Non Steroidal Anti-Inflammatory Drugs (NSAIDs) in patients with a history of osteoporotic vertebral fractures. Methods: We investigated 119 patients with postmenopausal osteoporosis complicated by one or more non recent vertebral fractures. Results: More than 60% of the patients took at least one dose of NSAID weekly. The most prescribed NSAID was nimesulide, at a dose with an exclusively antalgic effect. Patients with wedge fracture and those with a documented vertebral fracture in the last 12 months were those taking NSAIDs more frequently. 77% of the patients that used NSAIDs had concomitant features of osteoarthritis, mainly at the spine or at the knee. The use of NSAIDs was negatively related to the use of specific therapy for osteoporosis, particularly for oral daily tablets. Conclusions: This study highlights the significant use of NSAIDs in patients with osteoporotic vertebral fractures and the overlap between osteoporosis, osteoarthritis and related treatments.
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- 2002
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9. Recent progress of the Computational 2D Materials Database (C2DB)
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M. N. Gjerding, A. Taghizadeh, A. Rasmussen, S. Ali, F. Bertoldo, T. Deilmann, N. R. Knøsgaard, M. Kruse, A. H. Larsen, S. Manti, T. G. Pedersen, U. Petralanda, T. Skovhus, M. K. Svendsen, J. J. Mortensen, T. Olsen and K. S. Thygesen
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- 2021
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10. Design of deep excavations in fine-grained soils accounting for changes in pore water pressures
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F Bertoldo, F Maltese, and L Callisto
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Excavations ,undrained conditions ,fine-grained soils ,Pore water pressure ,Soil water ,Soil science ,Geotechnical engineering ,Excavation ,Geology - Published
- 2014
11. Acute effects of deflazacort and prednisone on rates of mineralization and bone formation
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V. Lo Cascio, G. Poggi, S. Adami, J. A. Kanis, F. Bertoldo, M. N. C. Beneton, and Maria Elisabetta Zanolin
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Adult ,Male ,Acute effects ,acurte effects ,deflazacort ,bone formation ,histomorphometry ,medicine.medical_specialty ,Time Factors ,Endocrinology, Diabetes and Metabolism ,Mineralization (biology) ,Bone remodeling ,Calcification, Physiologic ,Endocrinology ,Osteogenesis ,Pregnenediones ,Prednisone ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Bone formation ,Prospective Studies ,Aged ,Osteoblasts ,business.industry ,Middle Aged ,Alkaline Phosphatase ,Deflazacort ,Apposition ,Female ,business ,Glucocorticoid ,medicine.drug - Abstract
The aims of this study were to determine (1) whether acute suppression of bone formation could be evaluated after the administration of corticosteroids in man by quantitative bone histomorphometry; and (2) whether there were significant differences between the effects of prednisone and its analog deflazacort. Thirteen patients who needed high-dose corticosteroid therapy were randomly allocated to two groups of treatment (prednisone or deflazacort). Quantitative bone histomorphometry, using the technique of triple labeling, and biochemical measurements of bone turnover were studied. There were no differences in biochemical indices of bone turnover between prednisone and deflazacort at the beginning and end of the 15 days of treatment course. During corticosteroid treatment, there were no significant changes in biochemical indices of bone turnover but a significant decline in total alkaline phosphatase (P
- Published
- 1995
12. Early diagnosis of acute mesenteric ischemia after cardiopulmonary bypass
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M, Garofalo, R, Borioni, P, Nardi, F, Turani, F, Bertoldo, S, Forlani, A, Pellegrino, and L, Chiariello
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Male ,Cardiopulmonary Bypass ,Time Factors ,L-Lactate Dehydrogenase ,Leukocytosis ,Alanine Transaminase ,Middle Aged ,Intestines ,Postoperative Complications ,Ischemia ,Risk Factors ,Case-Control Studies ,Acute Disease ,Humans ,Female ,Aspartate Aminotransferases ,Creatine Kinase ,Aged ,Retrospective Studies - Abstract
The aim of this study is to identify significant risk factors and eventual clinical markers associated with acute mesenteric ischemia (AMI) after cardiopulmonary bypass.The study was retrospectively performed on a group of 19 patients (group A) undergoing cardiac surgery between January 1991 and December 1999, who developed AMI within 30 days of their hospitalization. A control group of 48 patients (group B) was compared in order to define preoperative and operative risk factors for AMI.At the abdominal operation, a non-occlusive mesenteric ischemia was found in every case. In-hospital mortality was 84.2% (16/19). Compared to the control, there was a significant difference in aortic cross-clamp time (p0.001) and use of inotropic drugs (p0.01). Postoperatively, the studied group (group A) had a significantly higher mean value of the enzymatic serum levels at any time.A high index of suspicion for mesenteric ischemia after cardiopulmonary bypass should be considered in patients with conditions of hypoperfusion. The early laboratory signs of AMI might be searched during the first postoperative hours.
- Published
- 2002
13. [Isolated aortic valve replacement with CarboMedics mechanical prosthesis: 9-year clinical experience and mid-term results]
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A, Scafuri, P, Nardi, R, De Paulis, M M, Buratta, S, Forlani, F, Bertoldo, and L, Chiariello
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Adult ,Aged, 80 and over ,Male ,Time Factors ,Heart Valve Diseases ,Middle Aged ,Prosthesis Design ,Postoperative Complications ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Female ,Aged ,Follow-Up Studies - Abstract
Appraisal of the medium-term results of isolated aortic valve replacement with a CarboMedics mechanical prosthesis.We assessed the clinical data of 195 consecutive patients (mean age 59.7+/-10.9 years) operated on between January 1992 and June 2000. Valve disease consisted of aortic stenosis regurgitation in 94 patients (48.2%), isolated aortic failure in 57 (29.2%) and isolated stenosis in 44 (22.6%). One hundred and four patients were in NYHA functional class III and 25 in NYHA functional class IV Follow-up was by telephone interview to 100% of the patients (average follow-up 39+/-20 months).The operative mortality was 3.6% (5% in the period January 1992-December 1995, 1.3% in the period January 1996-June 2000). Sixteen deaths occurred in the long term. Thus, the actuarial survivals at 36 and 72 months were 92+/-7% and 82+/-16% respectively. In the group of survivors, 139 patients (81%) were in NYHA class 1,26 (15%) in NYHA class II, and 7 (4%) in NYHA class III. The freedom from embolic events was 96+/-3.7% and that from hemorrhagic events was 90+/-9.4%. All the events occurred during the first 36 months; none of the patients developed infections or periprosthetic leaks.At the medium term, the CarboMedics mechanical valve prosthesis appears to be reliable, with an actuarial survival, quality of life and incidence of morbidity comparable to those reported for other types of second-generation mechanical prostheses.
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- 2001
14. [Atrial septal aneurysm with cerebral ischemia: potential pathogenetic role of associated cerebral vascular malformation]
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P, Nardi, A, Scafuri, F, Bertoldo, F, el Fakhri, G M, De Matteis, S, Forlani, and L, Chiariello
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Adult ,Intracranial Arteriovenous Malformations ,Male ,Humans ,Heart Atria ,Heart Aneurysm ,Brain Ischemia - Abstract
Atrial septal aneurysm can be associated with other cardiovascular diseases such as atrial septal defect, patent ductus arteriosus, pulmonary hypertension and cerebrovascular events (transient ischemic attack or stroke). The introduction of transthoracic and more recently transesophageal echocardiography allowed for a more frequent observation of this pathology and also suggested that atrial septal aneurysm is a risk factor for cerebral ischemia. However, the pathophysiological pathway is still unclear. In January 1997 a 33-year-old man was admitted to our hospital because of atrial septal aneurysm and a previous cerebrovascular event. Magnetic resonance imaging revealed a cerebrovascular malformation and transesophageal echocardiography confirmed the presence of atrial septal aneurysm. We hypothesize that a common etiopathogenetic pathway may cause both the cardiac and cerebrovascular anomaly and that the latter may be responsible alone for cerebral ischemic events; thus in the presence of an atrial septal aneurysm associated with a cerebrovascular malformation, a conservative medical approach may be the treatment of choice.
- Published
- 2000
15. [The medical treatment of primary hyperparathyroidism]
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V, Lo Cascio, M, Rossini, and F, Bertoldo
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Parathyroid Hormone ,Hyperparathyroidism ,Hypercalcemia ,Fluid Therapy ,Humans - Abstract
The first-choice treatment of primary hyperparathyroidism is surgical removal of abnormal parathyroid gland(s) and the medical management is usually reserved only to control severe hypercalcemia. However, asymptomatic primary hyperparathyroidism with mild hypercalcemia and renal and bone status close to normal is now the more common picture of the disease and in this situation conservative management can be considered, because many of those patients may have a prolonged benign course. Management guidelines are therefore devised to minimize the risk for deterioration of renal, skeletal or gastrointestinal complications of hyperparathyroidism. General medical management includes recommendation to avoid dehydration, immobilization or excessive dietary calcium intake and therapy with thiazides; intravenous infusion with isotonic saline combined to furosemide or etacrinic acid are recommended to treat acute or threatening hypercalcemia. Many other drugs as phosphate, mithramycin, gallium nitrate and calcitonin have been reported to be useful in reversing hypercalcemia but their transient effects, toxicity and side effects limit their clinical use. The bisphosphonates, a new class of bone resorption inhibitors, have been shown to be particularly safe so they result especially effective on controlling acute hypercalcemia and on preventing "hungry bone" disease. However, their effect is not sustained because the serum calcium tends to return toward pretreatment levels despite continued therapy; therefore their consistent beneficial effect on long-term treatment seems unlike.
- Published
- 1993
16. Definition of a population-specific DXA reference standard in Italian women: the Densitometric Italian Normative Study (DINS).
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M. Pedrazzoni, G. Girasole, F. Bertoldo, G. Bianchi, C. Cepollaro, A. Del Puente, S. Giannini, S. Gonnelli, D. Maggio, C. Marcocci, S. Minisola, E. Palummeri, M. Rossini, L. Sartori, and L. Sinigaglia
- Subjects
OSTEOPOROSIS ,THERAPEUTIC use of x-rays ,DISEASES in women - Abstract
Osteoporosis is currently defined on the basis of the T-score by dual-energy X-ray absorptiometry (DXA). Despite its limitations, this definition is applied worldwide. However, the normal values provided by manufacturers may not be fully representative of specific local populations. So far, there are no normative data in the Italian population using Hologic densitometers. The Densitometric Italian Normative Study (DINS) is an ongoing multi-center study that aims to establish reference values for bone densitometry with dual-energy X-ray absorptiometry (DXA) in the male and female Italian population. In this paper we report the results of the lumbar vertebrae (L2?L4) and proximal femur in 1,622 women aged 20?79 years. Bone mineral density (BMD) was determined using dual-energy X-ray absorptiometry (DXA) on Hologic bone densitometers (Hologic, Waltham, Mass.). Most of the subjects were examined with a QDR 4500. The BMD of the lumbar vertebrae was virtually constant between 20 and 49 years (test for trend: P=0.66); the BMD values between 20?45 in premenopausal women (mean 1.036; SD 0.109 g/cm
2 ) were thus defined as the peak bone mass values, significantly lower compared to the Hologic reference curve (mean 1.079, SD 0.11 g/cm2 ). The mean BMD values of the femoral neck were virtually identical to those of the NHANES study in the first 3 decades; after the age of 50 the BMD values were slightly greater than those of the NHANES subject. The subject classification according to the WHO criteria was similar using the DINS and NHANES reference values for the femur; for the spine, the Hologic reference values classified a larger proportion of women as osteoporotic (21 vs. 16%) or osteopenic (42 vs. 38%) compared to DINS. [ABSTRACT FROM AUTHOR]- Published
- 2003
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17. 'A comparative analysis of different membranes in DNA transfer and hybridization procedures'
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GASPARINI, PAOLO, A. SAVOIA, P. BERTAZZON, F. BERTOLDO, C. MORANDI, P. F. PIGNATTI, Gasparini, Paolo, A., Savoia, P., Bertazzon, F., Bertoldo, C., Morandi, and P. F., Pignatti
- Published
- 1988
18. The use of dichloromethylene bisphosphonate and aminobutane bisphosphonate in hypercalcemia of malignancy
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S, Adami, G P, Bolzicco, A, Rizzo, G, Salvagno, F, Bertoldo, M, Rossini, R, Suppi, and V, Lo Cascio
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Adult ,Male ,Diphosphonates ,Administration, Oral ,Middle Aged ,Injections, Intramuscular ,Recurrence ,Neoplasms ,Hypercalcemia ,Humans ,Female ,Clodronic Acid ,Infusions, Intravenous ,Aged - Abstract
54 patients with malignant hypercalcemia were treated with either dichloromethylene bisphosphonate (Cl2MBP) or aminobutane bisphosphonate (AHButBP). Both compounds infused intravenously (i.v.) were rapidly effective in lowering serum calcium to normal range and a potency ratio between Cl2MBP and AHButBP could be roughly estimated as 1:100-250. 600 mg of Cl2MBP infused in one day over 9 h in nine patients were only slightly less effective (serum calcium from 12.3 +/- 1.7 to 10.1 +/- 1.1 SE, mg/dl) than 3300 mg infused in 11 consecutive days (13.4 +/- 1.9 to 9.3 +/- 1.2 SE, mg/dl). Thus the effectiveness of treatment with Cl2MBP was related better to the overall time of infusion than to the cumulative dose administered. This could not be demonstrated in a similar trial using AHButBP. 1600 mg Cl2MBP daily p.o. was unable to prevent the relapse of hypercalcemia in four patients after a treatment course with i.v. bisphosphonates. 100 mg of Cl2MBP intramuscularly maintained serum calcium within the normal range in two out of eight patients; however, weekly infusions of either Cl2MBP or AHButBP prevented the relapse of hypercalcemia in eight similarly treated patients for several weeks. Providing that adequate dosages are adopted, parenteral Cl2MBP and AHButBP may be a useful measure for controlling hypercalcemia in patients with carcinoma.
- Published
- 1987
19. Rapporti tra alterazioni del collagene e idrosadenite suppurativa: a proposito di due casi di sindrome di Loeys-Dietz.
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M., Vultaggio, L., Diluvio, F., Artosi, M. V., Cannizzaro, F., Bertoldo, G., Ruvolo, E., Campione, and L., Bianchi
- Abstract
La sindrome di Loeys-Dietz (sLD) è una malattia ereditaria caratterizzata da alterazioni del tessuto connettivo simili a quelle che si verificano nella sindrome di Ehlers-Danlos e nella sindrome di Marfan. Gli autori descrivono due nuovi casi di questa sindrome, segnalando tra i segni cutanei la presenza di idrosadenite suppurativa (IS) localizzata anche in sedi atipiche. Poiché una maggiore incidenza di IS è stata segnalata in altre malattie caratterizzate da alterazioni del collagene, come sindrome di Ehler-Danlos, sindrome di Marfan, spondiloartropatie autoimmuni, lichen sclerosus, strie diselastiche, gli autori discutono il significato di tali alterazioni nella patogenesi dell’IS. [ABSTRACT FROM AUTHOR]
- Published
- 2023
20. Use of the Valsalva graft and long-term follow-up
- Author
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Giuseppe Tarelli, Saverio Nardella, Roberto Di Bartolomeo, Davide Pacini, Raffaele Scaffa, Luigi Chiariello, Ruggero De Paulis, Luca Weltert, Fabrizio Settepani, Daniele Maselli, Fabio Bertoldo, Roberto Gallotti, R.B. GRIEPP, R. De Pauli, R. Scaffa, S. Nardella, D. Maselli, L. Weltert, F. Bertoldo, D. Pacini, F. Settepani, G. Tarelli, R. Gallotti, R. Di Bartolomeo, and L. Chiariello
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Male ,Marfan syndrome ,Aortic valve ,Time Factors ,Kaplan-Meier Estimate ,Severity of Illness Index ,Aortic aneurysm ,Bicuspid aortic valve ,Aortic valve replacement ,Risk Factors ,Ultrasonography ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Aortic dissection ,Polyethylene Terephthalates ,Middle Aged ,Aortic Aneurysm ,Cardiac surgery ,Survival Rate ,Treatment Outcome ,medicine.anatomical_structure ,Italy ,Aortic Valve ,Replantation ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Adult ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,Aortic Valve Insufficiency ,Prosthesis Design ,Risk Assessment ,Blood Vessel Prosthesis Implantation ,Young Adult ,Blood vessel prosthesis ,Internal medicine ,medicine ,Humans ,Aged ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Settore MED/23 - Chirurgia Cardiaca ,Sinus of Valsalva ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Logistic Models ,business - Abstract
Objective The Valsalva graft is a specifically designed Dacron graft that, on implantation and pressurization, generates pseudosinuses of Valsalva. We reviewed a multicenter experience of the reimplantation procedure with the Valsalva graft in patients with aneurysms involving the aortic root. Methods A total of 278 patients underwent valve-sparing aortic root replacement using the Valsalva graft at 4 different Italian cardiac surgery centers and were studied by clinical assessment and echocardiography. Of the 278 patients, 220 were men (79%), with a mean age of 56 ± 15 years. Of the patients, 42 (15%) had Marfan syndrome, 31 (11%) had a bicuspid aortic valve, 13 (5%) had acute aortic dissection, and 136 (49%) had grade 3 or 4+ aortic insufficiency. Concomitant cardiac procedures were performed in 78 patients (28%). Additional aortic leaflet repair was necessary in 25 patients (9%). The mean crossclamp time was 120 ± 27 minutes. Results There were 5 (1.8%) operative and 5 (1.8%) late deaths. The mean follow-up was 52 ± 28 months (range, 2–112 months) and was 100% complete. The cumulative actuarial survival was 95.2% (268 patients). A total of 32 patients (11%) had grade 3 to 4+ aortic insufficiency, and 17 of these required late aortic valve replacement (range, 3–78 months). At 10 years of follow-up, the freedom from aortic valve reoperation rate was 91%, and the rate of freedom from residual aortic insufficiency not needing reoperation was 88%. Conclusions The reimplantation type of valve-sparing procedure can be facilitated by the use of the Valsalva graft and can be performed with satisfactory perioperative and midterm results. How an optimal root reconstruction will affect the second decade of follow-up has yet to be determined.
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- 2010
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21. Correction: Letter to Editor regarding "Why are osteoporosis patients treated with antiresorptive therapies considered like oncology patients regarding their oral health care?"
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Campisi G, Mauceri R, Coppini M, Bedogni A, Bertoldo F, and Fusco V
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- 2024
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22. Italian position paper (SIPMO-SICMF) on medication-related osteonecrosis of the jaw (MRONJ).
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Bedogni A, Mauceri R, Fusco V, Bertoldo F, Bettini G, Di Fede O, Lo Casto A, Marchetti C, Panzarella V, Saia G, Vescovi P, and Campisi G
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- Humans, Italy, Risk Assessment, Risk Factors, Bisphosphonate-Associated Osteonecrosis of the Jaw etiology
- Abstract
Objective: This paper aims to describe the 2023 update position paper on MRONJ developed by the Italian Societies of Oral Pathology and Medicine (SIPMO) and of Maxillofacial Surgery (SICMF)., Methods: This is the second update following the 2013 and 2020 Italian position papers by the Expert panel, which is a representation of the two scientific societies (SIPMO and SICMF). The paper is based on an extensive analysis of the available literature from January 2003 to February 2020, and the subsequent review of literature conducted between March 2020 and December 2022 to include all new relevant published papers to confirm or modify the previous set of recommendations., Results: This position paper highlights the main issues of MRONJ on risk estimates, disease definition, diagnostic pathway, individual risk assessment, and the fundamental role of imaging in the diagnosis, classification, and management of MRONJ., Conclusion: The Expert Panel confirmed the MRONJ definition, the diagnostic work-up, the clinical-radiological staging system and the prophylactic drug holiday, as recognized by SIPMO-SICMF; while, it presented novel indications regarding the categories at risk of MRONJ, the prevention strategies, and the treatment strategies associated with the therapeutic drug holiday., (© 2024 The Authors. Oral Diseases published by Wiley Periodicals LLC.)
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- 2024
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23. Letter to Editor regarding "Why are osteoporosis patients treated with antiresorptive therapies considered like oncology patients regarding their oral health care?"
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Campisi G, Mauceri R, Coppini M, Bedogni A, Bertoldo F, and Fusco V
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- 2024
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24. miRNA-Driven Regulation of Endothelial-to-Mesenchymal Transition Differs among Thoracic Aortic Aneurysms.
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Terriaca S, Scioli MG, Bertoldo F, Pisano C, Nardi P, Balistreri CR, Magro D, Belmonte B, Savino L, Ferlosio A, and Orlandi A
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- Humans, Male, Female, Middle Aged, Endothelial Cells metabolism, Endothelial Cells pathology, Transcriptional Regulator ERG metabolism, Transcriptional Regulator ERG genetics, Bicuspid Aortic Valve Disease metabolism, Bicuspid Aortic Valve Disease pathology, Bicuspid Aortic Valve Disease genetics, Aged, Platelet Endothelial Cell Adhesion Molecule-1 metabolism, Adult, Gene Expression Regulation, Marfan Syndrome genetics, Marfan Syndrome pathology, Marfan Syndrome metabolism, MicroRNAs genetics, MicroRNAs metabolism, Aortic Aneurysm, Thoracic genetics, Aortic Aneurysm, Thoracic pathology, Aortic Aneurysm, Thoracic metabolism, Epithelial-Mesenchymal Transition genetics
- Abstract
Thoracic aortic aneurysms (TAAs) represent a serious health concern, as they are associated with early aortic dissection and rupture. TAA formation is triggered by genetic conditions, in particular Marfan syndrome (MFS) and bicuspid aortic valve (BAV). During the aneurysmatic process, aortic endothelial cells can undergo endothelial-to-mesenchymal transition (End-MT) with consequent phenotypic and functional alterations. We previously documented that MFS TAA is characterized by miR-632-driven End-MT exacerbation, whereas in BAV aortopathy, the occurrence of this process remains still controversial. We investigated the End-MT process and the underlined regulatory mechanisms in BAV, TAV and MFS TAA tissues. Gene expression and immunohistochemical analysis were performed in order to analyze some important miRNAs and genes characterizing End-MT. We documented that BAV endothelium maintains the expression of the endothelial homeostasis markers, such as ERG , CD31 and miR-126-5p, while it shows lower levels of miR-632 and mesenchymal markers compared with MFS. Interestingly, we also found higher levels of miR-632 in MFS patients' blood. Our findings definitively demonstrate that the End-MT process does not characterize BAV that, among the other TAAs, better maintains the endothelial features. In addition, our results suggest miR-632 as a promising diagnostic/prognostic factor in MFS aortopathy.
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- 2024
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25. Bone health and body composition in prostate cancer: Meet-URO and AIOM consensus about prevention and management strategies.
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Cursano MC, Valsecchi AA, Pantano F, Di Maio M, Procopio G, Berruti A, Bertoldo F, Tucci M, De Giorgi U, and Santini D
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- Humans, Male, Androgen Antagonists therapeutic use, Delphi Technique, Prostatic Neoplasms complications, Body Composition, Consensus
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Background: Prostate cancer (PCa) treatments are associated with a detrimental impact on bone health (BH) and body composition. However, the evidence on these issues is limited and contradictory. This consensus, based on the Delphi method, provides further guidance on BH management in PCa., Materials and Methods: In May 2023, a survey made up of 37 questions and 74 statements was developed by a group of oncologists and endocrinologists with expertise in PCa and BH. In June 2023, 67 selected Italian experts, belonging to the Italian scientific societies Italian Association of Medical Oncology and Italian Network for Research in Urologic-Oncology (Meet-URO), were invited by e-mail to complete it, rating their strength of agreement with each statement on a 5-point scale. An agreement ≥75% defined the statement as accepted., Results: In non-metastatic hormone-sensitive PCa, the panel agreed that androgen deprivation therapy (ADT) alone implies sufficient fracture risk to warrant antifracture therapy with bone-targeting agents (BTAs) for cancer treatment-induced bone loss (CTIBL) prevention (79%). Therefore, no consensus was reached (48%) for the treatment with BTAs of patients receiving short-term ADT (<6 months). All patients receiving active treatment for metastatic hormone-sensitive PCa (75%), non-metastatic castration-resistant PCa (89%) and metastatic castration-resistant PCa (mCRPC) without bone metastases (84%) should be treated with BTAs at the doses and schedule for CTIBL prevention. All mCRPC patients with bone metastasis should be treated with BTAs to reduce skeletal-related events (94%). In all settings, the panel analyzed the type and timing of treatments and examinations to carry out for BH monitoring. The panel agreed on the higher risk of sarcopenic obesity of these patients and its correlation with bone fragility., Conclusions: This consensus highlights areas lacking major agreement, like non-metastatic hormone-sensitive prostate cancer patients undergoing short-term ADT. Evaluation of these issues in prospective clinical trials and identification of early biomarkers of bone loss are particularly urgent., Competing Interests: Disclosure DS reports fee from advisory boards by AstraZeneca, Lilly, Daiiki-Sanchio, Astellas, Janssenn, Recordati, Gilead, Pfizer, MSD, Novartis, BMS, Roche, EISAI and Ipsen. MDM reports honoraria from AstraZeneca, Boehringer Ingelheim, Janssen, Merck Sharp & Dohme (MSD), Novartis, Pfizer, Roche, GlaxoSmithKline, Amgen, Merck, Takeda for consultancy or participation to advisory boards; direct research funding from Tesaro/GlaxoSmithKline; institutional funding for work in clinical trials/contracted research from Beigene, Exelixis, MSD, Pfizer and Roche. UDG: consulting or advisory role for Amgen, Astellas Pharma, AstraZeneca, Bayer, Bristol Myers Squibb, DompéFarmaceutici, Eisai, Ipsen, Janssen, Merck KgaA, MSD, Novartis and Pfizer; research funding (institution) from AstraZeneca, Roche and Sanofi; and travel accommodations from AstraZeneca, Ipsen and Pfizer. All other authors have declared no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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26. Diagnosis and treatment of Paget's disease of bone: position paper from the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS).
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Rendina D, Falchetti A, Diacinti D, Bertoldo F, Merlotti D, Giannini S, Cianferotti L, Girasole G, Di Monaco M, Gonnelli S, Malavolta N, Minisola S, Vescini F, Rossini M, Frediani B, Chiodini I, Asciutti F, and Gennari L
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- Humans, Italy epidemiology, Bone Density Conservation Agents therapeutic use, Societies, Medical standards, Diphosphonates therapeutic use, Osteitis Deformans diagnosis, Osteitis Deformans therapy, Osteitis Deformans epidemiology, Osteitis Deformans drug therapy
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Introduction: Paget's disease of bone is a focal skeletal disorder causing bone deformities and impairing bone quality. Despite the prevalence of asymptomatic cases is increasing, the progression of the disease can lead to invalidating complications that compromise the quality of life. Doubts on clinical and therapeutic management aspects exist, although beneficial effects of antiresorptive drugs, particularly bisphosphonates are known. However, limited information is available from randomized controlled trials on the prevention of disease complications so that somewhat contrasting positions about treatment indications between expert panels from the main scientific societies of metabolic bone diseases exist. This task force, composed by expert representatives appointed by the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases and members of the Italian Association of Paget's disease of bone, felt the necessity for more specific and up to date indications for an early diagnosis and clinical management., Methods: Through selected key questions, we propose evidence-based recommendations for the diagnosis and treatment of the disease. In the lack of good evidence to support clear recommendations, available information from the literature together with expert opinion of the panel was used to provide suggestions for the clinical practice., Results and Conclusion: Description of the evidence quality and support of the strength of the statements was provided on each of the selected key questions. The diagnosis of PDB should be mainly based on symptoms and the typical biochemical and radiological features. While treatment is mandatory to all the symptomatic cases at diagnosis, less evidence is available on treatment indications in asymptomatic as well as in previously treated patients in the presence of biochemical recurrence. However, given the safety and long-term efficacy of potent intravenous bisphosphonates such as zoledronate, a suggestion to treat most if not all cases at the time of diagnosis was released., (© 2024. The Author(s).)
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- 2024
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27. Bone Mineral Density in Mountain, Road Cyclists and Untrained Controls: Exercise, Diet and Hormones.
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Zamboni F, Ferrari P, Cazzoletti L, Setti A, Bertoldo F, Dalle Carbonare LG, Danese E, Tardivo S, Crisafulli E, and Ferrari M
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- Humans, Male, Adult, Oxygen Consumption physiology, Energy Intake physiology, Exercise physiology, Absorptiometry, Photon, Calcium, Dietary administration & dosage, Diet, Testosterone blood, Hydrocortisone blood, Case-Control Studies, Young Adult, Bicycling physiology, Bone Density physiology, Lumbar Vertebrae physiology, Energy Metabolism physiology, Femur Neck physiology, Femur Neck diagnostic imaging
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Purpose : The aim of the study was to compare bone mineral density (BMD) in the lumbar spine (LS
BMD ) and the femoral neck (FBMD ) in male road cyclists (RC n = 39), mountain cyclists (MC n = 30) and controls (C n = 27) and to determine the factors associated with BMD in the same group of participants. Methods : BMD, fat mass (FM) and fat-free mass (FFM) were measured using DXA. Calcium intake (Cal), exercise energy expenditure (EEE) and energy availability (EA) were assessed using self-reported questionnaires. Samples for circulating hormones were also obtained. VO2max was estimated by a cycloergometric test. Results : After adjustment for body mass, in cyclists LSBMD (RC 0.98 ± 0.12; MC 0.98 ± 0.10 g/cm2 ) was significantly lower than in C (1.11 ± 0.10; p < .001), while FBMD resulted in no significant difference in cyclists compared to C ( p = 0.213). EA (kcal/FFM/day) was different in cyclists and in C ( p < .05). In C, EEE and EA were positively associated with LSBMD ( R = 0.561, R = 0.656, respectively, p < .01), whereas only EA was associated with FBMD ( R = 0.554, p < .05); a positive association between EA and FBMD was found in MC ( R = 0.464, p < .05). A negative relationship between VO2max and LSBMD in RC ( R = -0.418, p < .05) and a positive one between EEE and LSBMD in MC were found ( R = 0.605, p < .001). CaI, free testosterone and cortisol were unrelated to BMD. Conclusion : Both the RC and MC had lower LSBMD than C, whereas no difference was found between the two groups of cyclists. The factors associated with BMD are manifold, vary in relation to the measurement site and are likely different in RC, MC and C.- Published
- 2024
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28. Post-diagnosis serum 25-hydroxyvitamin D concentrations in women treated for breast cancer participating in a lifestyle trial in Italy.
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Fassio A, Porciello G, Carioli G, Palumbo E, Vitale S, Luongo A, Montagnese C, Prete M, Grimaldi M, Pica R, Rotondo E, Falzone L, Calabrese I, Minopoli A, Grilli B, Cuomo M, Fiorillo PC, Evangelista C, Cavalcanti E, De Laurentiis M, Cianniello D, Pacilio C, Pinto M, Thomas G, Rinaldo M, D'Aiuto M, Serraino D, Massarut S, Steffan A, Ferraù F, Rossello R, Messina F, Catalano F, Adami G, Bertoldo F, Libra M, Crispo A, Celentano E, La Vecchia C, Augustin LSA, and Gatti D
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- Female, Humans, Italy epidemiology, Life Style, Risk Factors, Breast Neoplasms epidemiology, Breast Neoplasms complications, Hypertriglyceridemia complications, Vitamin D analogs & derivatives, Vitamin D Deficiency epidemiology
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Objective: To report cross-sectionally serum levels of 25-hydroxyvitamin D [25(OH)D] in women living in Italy within 12 months from breast cancer (BC) diagnosis., Methods: Baseline data were obtained from 394 women diagnosed with primary BC, enrolled from 2016 to 2019 in a lifestyle trial conducted in Italy. Subjects' characteristics were compared between two 25(OH)D concentrations (hypovitaminosis D<20 and ≥20 ng/mL) with the Chi-squared test or Fisher's exact test for small-expected counts. Using multiple logistic regression-adjusted models, we estimated odds ratios (ORs) of hypovitaminosis D with 95% confidence intervals (CIs) in the total sample and in the unsupplemented subgroup., Results: Hypovitaminosis D was found in 39% of all subjects, 60% in unsupplemented subjects, and 10% in supplemented subjects. Increasing ORs of hypovitaminosis D were found with increasing body mass index, 25-30, >30, and ≥35 versus <25 kg/m2 (ORs: 2.50, 4.64, and 5.81, respectively, in the total cohort and ORs: 2.68, 5.38, and 7.08 in the unsupplemented); living in the most southern Italian region (OR 2.50, 95%CI 1.22-5.13); and with hypertriglyceridemia (OR 2.46; 95%CI 1.16-5.22), chemotherapy history (OR 1.86, 95%CI 1.03-3.38), and inversely with anti-estrogenic therapy (OR 0.43, 95%CI 0.24-0.75) in the total sample., Conclusions: Hypovitaminosis D in women recently diagnosed with BC and participating in a lifestyle trial in Italy was widespread and highest with obesity, hypertriglyceridemia, and chemotherapy use. Considering that hypovitaminosis D is a risk factor for lower efficacy of bone density treatments and possibly BC mortality, our results suggest the need to promptly address and treat vitamin D deficiency.
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- 2024
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29. The role of the female gender on mid-term outcome after coronary artery bypass grafting: a retrospective study.
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Nardi P, Pisano C, Bassano C, Bertoldo F, Buioni D, Labriola V, Salvati AC, Scognamiglio M, Altieri C, and Ruvolo G
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Background: Data on female gender differences on clinical prognosis after coronary artery bypass grafting (CABG) are still controversial. We evaluated retrospectively the impact of women patients in comparison with men undergoing CABG on mid-term outcome., Methods: Between December 2014 and March 2022, 1,044 consecutive patients (162 females, 15.5%, 882 males, 84.5%) underwent isolated CABG. The mean follow-up was 40±27 (median 38) months. Logistic and Cox model analysis regressions were used to assess the risk of female gender and other variables, Kaplan-Meier estimates to assess survival rates., Results: Women did not have a significant higher operative mortality than men (3.09% vs. 1.93%; P=0.37). There was no difference in the use of left internal mammary artery (97.5% vs . 94.9%; P=0.85). Independent predictors of early mortality were emergency CABG (P<0.0001), percutaneous coronary intervention (PCI) within 30 days (P=0.0026), and higher EuroSCORE II (P=0.0155). At 7.5 years, actuarial survival was 87%±3.6% for female gender vs. 88%±1.9% in male gender (P=0.41), freedom from cardiac death 97%±1.8% vs. 96.6%±1.0% (P=0.6), freedom from major adverse cardiac events (MACE) 87%±6.2% vs. 89.7%±2.5% (P=0.96). Independent predictor of all-causes death and cardiac death was the advanced age (74 years in dead patients vs. 67 years in survivors) (P<0.0001). Female gender was not a predictor of either operative mortality (P=0.34) or worse mid-term outcome (P=0.41)., Conclusions: Women undergoing CABG with the same surgical techniques currently adopted for men, do not appear to be associated with worse early prognosis. Freedom from late all-causes mortality, cardiac death and adverse cardiac events are comparable and equally satisfactory, highlighting the positive protective effect of CABG over time also in women., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-932/coif). The authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)
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- 2024
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30. miRNA Regulation of Cell Phenotype and Parietal Remodeling in Atherosclerotic and Non-Atherosclerotic Aortic Aneurysms: Differences and Similarities.
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Terriaca S, Ferlosio A, Scioli MG, Coppa F, Bertoldo F, Pisano C, Belmonte B, Balistreri CR, and Orlandi A
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- Humans, Aortic Valve pathology, Phenotype, Fibrosis, MicroRNAs metabolism, Aortic Aneurysm complications, Aortic Aneurysm, Thoracic genetics, Bicuspid Aortic Valve Disease, Marfan Syndrome genetics, Calcinosis pathology, Atherosclerosis metabolism
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Aortic aneurysms are a serious health concern as their rupture leads to high morbidity and mortality. Abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms (TAAs) exhibit differences and similarities in their pathophysiological and pathogenetic features. AAA is a multifactorial disease, mainly associated with atherosclerosis, characterized by a relevant inflammatory response and calcification. TAA is rarely associated with atherosclerosis and in some cases is associated with genetic mutations such as Marfan syndrome (MFS) and bicuspid aortic valve (BAV). MFS-related and non-genetic or sporadic TAA share aortic degeneration with endothelial-to-mesenchymal transition (End-Mt) and fibrosis, whereas in BAV TAA, aortic degeneration with calcification prevails. microRNA (miRNAs) contribute to the regulation of aneurysmatic aortic remodeling. miRNAs are a class of non-coding RNAs, which post-transcriptionally regulate gene expression. In this review, we report the involvement of deregulated miRNAs in the different aortic remodeling characterizing AAAs and TAAs. In AAA, miRNA deregulation appears to be involved in parietal inflammatory response, smooth muscle cell (SMC) apoptosis and aortic wall calcification. In sporadic and MFS-related TAA, miRNA deregulation promotes End-Mt, SMC myofibroblastic phenotypic switching and fibrosis with glycosaminoglycan accumulation. In BAV TAA, miRNA deregulation sustains aortic calcification. Those differences may support the development of more personalized therapeutic approaches.
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- 2024
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31. High-Throughput Search for Triplet Point Defects with Narrow Emission Lines in 2D Materials.
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Ali S, Nilsson FA, Manti S, Bertoldo F, Mortensen JJ, and Thygesen KS
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We employ a first-principles computational workflow to screen for optically accessible, high-spin point defects in wide band gap, two-dimensional (2D) crystals. Starting from an initial set of 5388 point defects, comprising both native and extrinsic, single and double defects in ten previously synthesized 2D host materials, we identify 596 defects with a triplet ground state. For these defects, we calculate the defect formation energy, hyperfine (HF) coupling, and zero-field splitting (ZFS) tensors. For 39 triplet transitions exhibiting particularly low Huang-Rhys factors, we calculate the full photoluminescence (PL) spectrum. Our approach reveals many spin defects with narrow PL line shapes and emission frequencies covering a broad spectral range. Most of the defects are hosted in hexagonal BN (hBN), which we ascribe to its high stiffness, but some are also found in MgI
2 , MoS2 , MgBr2 and CaI2 . As specific examples, we propose the defects vS MoS 0 and NiS MoS 0 in MoS2 as interesting candidates with potential applications to magnetic field sensors and quantum information technology.- Published
- 2023
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32. Saliency-Enhanced Content-Based Image Retrieval for Diagnosis Support in Dermatology Consultation: Reader Study.
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Gassner M, Barranco Garcia J, Tanadini-Lang S, Bertoldo F, Fröhlich F, Guckenberger M, Haueis S, Pelzer C, Reyes M, Schmithausen P, Simic D, Staeger R, Verardi F, Andratschke N, Adelmann A, and Braun RP
- Abstract
Background: Previous research studies have demonstrated that medical content image retrieval can play an important role by assisting dermatologists in skin lesion diagnosis. However, current state-of-the-art approaches have not been adopted in routine consultation, partly due to the lack of interpretability limiting trust by clinical users., Objective: This study developed a new image retrieval architecture for polarized or dermoscopic imaging guided by interpretable saliency maps. This approach provides better feature extraction, leading to better quantitative retrieval performance as well as providing interpretability for an eventual real-world implementation., Methods: Content-based image retrieval (CBIR) algorithms rely on the comparison of image features embedded by convolutional neural network (CNN) against a labeled data set. Saliency maps are computer vision-interpretable methods that highlight the most relevant regions for the prediction made by a neural network. By introducing a fine-tuning stage that includes saliency maps to guide feature extraction, the accuracy of image retrieval is optimized. We refer to this approach as saliency-enhanced CBIR (SE-CBIR). A reader study was designed at the University Hospital Zurich Dermatology Clinic to evaluate SE-CBIR's retrieval accuracy as well as the impact of the participant's confidence on the diagnosis., Results: SE-CBIR improved the retrieval accuracy by 7% (77% vs 84%) when doing single-lesion retrieval against traditional CBIR. The reader study showed an overall increase in classification accuracy of 22% (62% vs 84%) when the participant is provided with SE-CBIR retrieved images. In addition, the overall confidence in the lesion's diagnosis increased by 24%. Finally, the use of SE-CBIR as a support tool helped the participants reduce the number of nonmelanoma lesions previously diagnosed as melanoma (overdiagnosis) by 53%., Conclusions: SE-CBIR presents better retrieval accuracy compared to traditional CBIR CNN-based approaches. Furthermore, we have shown how these support tools can help dermatologists and residents improve diagnosis accuracy and confidence. Additionally, by introducing interpretable methods, we should expect increased acceptance and use of these tools in routine consultation., (©Mathias Gassner, Javier Barranco Garcia, Stephanie Tanadini-Lang, Fabio Bertoldo, Fabienne Fröhlich, Matthias Guckenberger, Silvia Haueis, Christin Pelzer, Mauricio Reyes, Patrick Schmithausen, Dario Simic, Ramon Staeger, Fabio Verardi, Nicolaus Andratschke, Andreas Adelmann, Ralph P Braun. Originally published in JMIR Dermatology (http://derma.jmir.org), 24.08.2023.)
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- 2023
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33. Reply to Wimalawansa, S.J. Comment on "Bertoldo et al. Definition, Assessment, and Management of Vitamin D Inadequacy: Suggestions, Recommendations, and Warnings from the Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS). Nutrients 2022, 14 , 4148".
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Bertoldo F, Cianferotti L, Di Monaco M, Falchetti A, Fassio A, Gatti D, Gennari L, Giannini S, Girasole G, Gonnelli S, Malavolta N, Minisola S, Pedrazzoni M, Rendina D, Rossini M, and Chiodini I
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- Humans, Vitamins, Italy, Minerals, Vitamin D, Osteoporosis
- Abstract
With regard to Dr. Wimalawansa's comment [...].
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- 2023
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34. Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis.
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Nardi P, Pisano C, Bassano C, Bertoldo F, Salvati AC, Buioni D, Trombetti D, Asta L, Scognamiglio M, Altieri C, and Ruvolo G
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- Humans, Male, Female, Aged, Middle Aged, Aged, 80 and over, Treatment Outcome, Aortic Valve surgery, Time Factors, Risk Factors, Retrospective Studies, Aorta, Aortic Aneurysm complications, Aortic Aneurysm surgery
- Abstract
Aim: To analyze early and mid-term outcomes of the Bentall operation. Methods: Two hundred and seventeen patients (mean age 65.6 ± 15.9 years, males/females 172/45) underwent Bentall operation in a 7-year period (January 2015−December 2021), on average, 30 Bentall operations occurred per year, using biological (n = 104) or mechanical (n = 113) valved conduits for the treatment of ascending aorta−aortic root aneurysms. Associate procedures were performed in 58 patients (26.7%); coronary artery bypass grafting (CABG) in 35 (16%). Mean follow-up was 55.2 ± 24 (median 60.2) months. Cox model analysis was used to assess risk factors, Kaplan−Meier and log-rank tests were used to assess different survival rates. Results: Operative mortality was 1.38%. At 7 years, survival, freedom from cardiac death, and event-free survival were 93% ± 2%, 99% ± 1%, and 81% ± 5%. NYHA class (p < 0.0001), trans-aortic valve mean (p < 0.0001) and maximum (p < 0.000) gradients, left ventricular hypertrophy (p < 0.05), and pulmonary arterial pressure (p = 0.002) significantly improved vs. preoperative values. Concomitant CABG during Bentall operation independently affected late outcomes (HR 1.9−2.3; p-values < 0.05). Late survival was affected by concomitant CABG (84% ± 8% vs. 95% ± 2%, p = 0.04), preoperative myocardial infarction (91% ± 9% vs. 97% ± 2%, p = 0.02), and biological vs. mechanical prostheses valved conduits (91% ± 9% vs. 95% ± 3%, p = 0.02). Event-free survival also was affected by concomitant CABG (62% ± 14% vs. 85% ± 5%, p = 0.005) and biological prostheses (78% ± 8% vs. 84% ± 6%, p = 0.06). Freedom from endocarditis−redo operation was 83% ± 9% for biological prostheses vs. 89% ± 6% for mechanical prostheses (p = 0.49). Conclusions: Low rates of operative mortality and late complications make Bentall operation the gold standard for the treatment of ascending aorta−aortic root aneurysms. Coronary ischemic disease affects late outcomes. Biological prostheses should be preferred for the elderly.
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- 2022
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35. Definition, Assessment, and Management of Vitamin D Inadequacy: Suggestions, Recommendations, and Warnings from the Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS).
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Bertoldo F, Cianferotti L, Di Monaco M, Falchetti A, Fassio A, Gatti D, Gennari L, Giannini S, Girasole G, Gonnelli S, Malavolta N, Minisola S, Pedrazzoni M, Rendina D, Rossini M, and Chiodini I
- Subjects
- Adult, Dietary Supplements adverse effects, Humans, Minerals therapeutic use, Vitamin D, Vitamins therapeutic use, Fractures, Bone drug therapy, Fractures, Bone prevention & control, Osteoporosis drug therapy, Osteoporosis etiology, Osteoporosis prevention & control, Vitamin D Deficiency
- Abstract
In the recent years, both the prescriptions of serum 25(OH)D levels assay, and vitamin D supplementation are constantly increasing, as well as the costs to be incurred relating to these specific aspects. As in many other countries, the risk of vitamin D deficiency is particularly high in Italy, as recently confirmed by cohort studies in the general population as well as in patients with metabolic bone disorder. Results confirmed the North-South gradient of vitamin D levels described among European countries, despite the wide use of supplements. Although vitamin D supplementation is also recommended by the Italian Medicine Agency for patients at risk for fragility fracture or for initiating osteoporotic medication, the therapeutic gap for osteoporosis in Italy is very high. There is a consistent proportion of osteoporotic patients not receiving specific therapy for osteoporosis following a fragility fracture, with a poor adherence to the recommendations provided by national guidelines and position paper documents. The failure or inadequate supplementation with vitamin D in patients on antiresorptive or anabolic treatment for osteoporosis is thought to further amplify the problem and exposes patients to a high risk of re-fracture and mortality. Therefore, it is important that attention to its possible clinical consequences must be given. Thus, in light of new evidence from the literature, the SIOMMMS board felt the need to revise and update, by a GRADE/PICO system approach, its previous original recommendations about the definition, prevention, and treatment of vitamin D deficiency in adults, released in 2011. Several key points have been here addressed, such as the definition of the vitamin D status: normality values and optimal values; who are the subjects considered at risk of hypovitaminosis D; opportunity or not of performing the biochemical assessment of serum 25(OH)D levels in general population and in subjects at risk of hypovitaminosis D; the need or not to evaluate baseline serum 25(OH)D in candidate subjects for pharmacological treatment for osteoporosis; how and whether to supplement vitamin D subjects with hypovitaminosis D or candidates for pharmacological treatment with bone active agents, and the general population; how and whether to supplement vitamin D in chronic kidney disease and/or chronic liver diseases or under treatment with drugs interfering with hepatic metabolism; and finally, if vitamin D may have toxic effects in the subject in need of supplementation.
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- 2022
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36. Effects of a 4400 km ultra-cycling non-competitive race and related training on body composition and circulating progenitors differentiation.
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Valenti MT, Braggio M, Minoia A, Dorelli G, Bertacco J, Bertoldo F, Cominacini M, De Simone T, Romanelli MG, Bhandary L, Mottes M, and Dalle Carbonare L
- Subjects
- Absorptiometry, Photon, Electric Impedance, Humans, Male, Body Composition, Lipids
- Abstract
Background: NorthCape4000 (NC4000) is the most participated ultra-endurance cycling race. Eight healthy male Caucasian amateur cyclists were evaluated: (a) before starting the preparation period; (b) in the week preceding NC4000 (after the training period); (c) after NC4000 race, with the aim to identify the effects of ultra-cycling on body composition, aerobic capacity and biochemical parameters as well as on the differentiation of progenitor cells., Methods: Bioelectrical impedance analysis (BIA) and dual energy x-ray absorptiometry (DEXA) assessed body composition; cardiopulmonary exercise test (CPET) evaluated aerobic capacity. Differentiation of circulating progenitor cells was evaluated by analyzing the modulation in the expression of relevant transcription factors. In addition, in vitro experiments were performed to investigate the effects of sera of NC4000 participants on adipogenesis and myogenesis. The effects of NC4000 sera on Sestrins and Sirtuin modulation and the promotion of brown adipogenesis in progenitor cells was investigated as well. Two-tailed Student's paired-test was used to perform statistical analyses., Results: We observed fat mass decrease after training as well as after NC4000 performance; we also recorded that vitamin D and lipid profiles were affected by ultra-cycling. In addition, our findings demonstrated that post-NC4000 participant's pooled sera exerted a positive effect in stimulating myogenesis and in inducing brown adipogenesis in progenitor cells., Conclusions: The training program and Ultra-cycling lead to beneficial effects on body composition and biochemical lipid parameters, as well as changes in differentiation of progenitor cells, with significant increases in brown adipogenesis and in MYOD levels., (© 2022. The Author(s).)
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- 2022
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37. The preventive care of medication-related osteonecrosis of the jaw (MRONJ): a position paper by Italian experts for dental hygienists.
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Mauceri R, Coniglio R, Abbinante A, Carcieri P, Tomassi D, Panzarella V, Di Fede O, Bertoldo F, Fusco V, Bedogni A, and Campisi G
- Subjects
- Dental Hygienists, Diphosphonates therapeutic use, Humans, Incidence, Bisphosphonate-Associated Osteonecrosis of the Jaw diagnosis, Bisphosphonate-Associated Osteonecrosis of the Jaw etiology, Bisphosphonate-Associated Osteonecrosis of the Jaw prevention & control, Bone Density Conservation Agents therapeutic use
- Abstract
Purpose: The prevention and early diagnosis of medication-related osteonecrosis of the jaw (MRONJ) is fundamental to reducing the incidence and progression of MRONJ. Many in the field believe that dental hygienists should play an integral role in primary and secondary MRONJ prevention. However, to date, very few publications in the literature have proposed standardised MRONJ protocols, which are dedicated to dental hygienists. The aim of this study was to provide guidance to the health care providers managing MRONJ., Methods: The expert opinion in this study was developed by dental hygienists from the main Italian technical-scientific associations (Italian Dental Hygienists Association, AIDI and National Union of Dental Hygienists, UNID) and authors of the latest Italian recommendations regarding MRONJ from the field of dentistry and maxillofacial surgery., Results: The oral care protocol outlined in this position paper is focused on the role of dental hygienist in patients at risk or affected by MRONJ, and it regards 3 main issues: primary prevention, secondary prevention and supporting the treatment of MRONJ. Each issue contains easy-to-apply indications and procedures, as described by the authors, regarding the role of the dental hygienist., Conclusion: Referring to the main issues under consideration (primary prevention, secondary prevention and the treatment of MRONJ), a clinical examination of periodontal tissue is critical in preventing MRONJ. It is the opinion of the authors of this study that the application of a periodontal screening score is fundamental in defining personalised strategies for patients at risk of MRONJ. By means of these basic procedures, a protocol for assisting the health care provider and the presentation of a practical approach for patients at risk or affected by MRONJ are described in this study., (© 2022. The Author(s).)
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- 2022
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38. Initial Surgical Strategy for the Treatment of Type A Acute Aortic Dissection: Does Proximal or Distal Extension of the Aortic Resection Influence the Outcomes?
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Bassano C, Pugliese M, Mve Mvondo C, Pisano C, Nardi P, Buioni D, Bertoldo F, Scognamiglio M, Salvati AC, Altieri C, and Ruvolo G
- Subjects
- Aorta surgery, Hospital Mortality, Humans, Retrospective Studies, Treatment Outcome, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation
- Abstract
(1) Background: We sought to analyze and compare the outcomes in terms of early and late mortality and freedom from a redo operation in patients undergoing surgical treatment for a type A acute aortic dissection in relation to the initial surgical treatment strategy, i.e., proximal or distal extension of the aortic segment resection, compared with isolated resection of the supracoronary ascending aorta. (2) Methods: This is a retrospective study in which we included 269 patients who underwent operations for a type A acute aortic dissection in the Department of Cardiac Surgery of Tor Vergata University from May 2006 to May 2016. The patients were grouped according to the extent of the performed surgical treatment: isolated replacement of the supracoronary ascending aorta (NE, no extension), replacement of the aortic root (PE, proximal extension), replacement of the aortic arch (DE, distal extension), and both (BE, bilateral extension). The analyzed variables were in-hospital mortality, postoperative complications (incidence of neurological damage, renal failure and need for prolonged intubation), late mortality and need for a redo operation. (3) Results: Unilateral cerebral perfusion was performed in 49.3% of the patients, and bilateral perfusion-in 50.6%. The overall in-hospital mortality was 31.97%. In the multivariate analysis, advanced age, cardiopulmonary bypass time and preoperative orotracheal intubation were independent predictors of in-hospital mortality. In the population of patients who survived the surgery, the probability of survival at 92 months was 70 ± 5%, the probability of freedom from a redo operation was 71.5 ± 5%, the probability of freedom from the combined end-point death and a redo operation was 50 ± 5%. The re-intervention rate in the general population was 16.9%. The overall probability of freedom from re-intervention was higher in patients undergoing aortic root replacement, although not reaching a level of statistical significance. Patients who underwent aortic arch treatment showed reduced survival. (4) Conclusions: In the treatment of type A acute aortic dissection, all the surgical strategies adopted were associated with satisfactory long-term survival. In the group of patients in which the aortic root had not been replaced, we observed reduced event-free survival.
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- 2022
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39. A facile strategy for the growth of high-quality tungsten disulfide crystals mediated by oxygen-deficient oxide precursors.
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Miakota DI, Unocic RR, Bertoldo F, Ghimire G, Engberg S, Geohegan D, Thygesen KS, and Canulescu S
- Abstract
Chemical vapor deposition (CVD) has been established as a versatile route for the large-scale synthesis of transition metal dichalcogenides, such as tungsten disulfide (WS
2 ). Yet, the precursor composition's role on the CVD process remains largely unknown and remains to be explored. Here, we employ Pulsed Laser Deposition (PLD) in a two-stage approach to tune the oxygen content in the tungsten oxide (WO3- x ) precursors and demonstrate the presence of oxygen vacancies in the oxide films leads to a more facile conversion from WO3- x to WS2 . Using a joint study based on ab initio density functional theory (DFT) calculations and experimental observations, we unravel that the oxygen vacancies in WO3- x can serve as niches through which sulfur atoms enter the lattice and facilitate an efficient conversion into WS2 crystals. By solely modulating the precursor stoichiometry, the photoluminescence emission of WS2 crystals can be significantly enhanced. Atomic resolution scanning transmission electron microscopy imaging (STEM) reveals that tungsten vacancies are the dominant intrinsic defects in mono- and bilayers WS2 . Moreover, bi- and multilayer WS2 crystals derived from oxides with a high V0 content exhibit dominant AA'/AB or AA(A…) stacking orientations. The atomic resolution images reveal local strain buildup in bilayer WS2 due to competing effects of complex grain boundaries. Our study provides means to tune the precursor composition to control the lateral growth of TMDs while revealing insights into the different pathways for forming grain boundaries in bilayer WS2 .- Published
- 2022
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40. Persistence and recurrence in tumor-induced osteomalacia: A systematic review of the literature and results from a national survey/case series.
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Cianferotti L, Delli Poggi C, Bertoldo F, Caffarelli C, Crotti C, Gatti D, Giannini S, Gonnelli S, Mazzantini M, Ombretta V, Sella S, Setti A, Varenna M, Zucchi F, and Brandi ML
- Subjects
- Cross-Sectional Studies, Fibroblast Growth Factors metabolism, Humans, Retrospective Studies, Hypophosphatemia drug therapy, Osteomalacia complications, Paraneoplastic Syndromes etiology
- Abstract
Purpose: Tumor induced osteomalacia (TIO) is a rare disease of mineral metabolism, whose clinical picture is dominated by hypophosphatemia usually due to an excess of circulating FGF23 produced by small mesenchymal tumors. Data on the real prevalence of the disease are lacking, with the knowledge of the disease mainly relying on case reports and small case series. No estimate is available on the prevalence of uncured TIO., Methods: National multi-center, cross-sectional and retrospective study on persistent or recurrent cases of TIO followed in referral centers for bone diseases; systematic review of the published persistent and recurrent cases of TIO. Data from patients consecutively evaluated in referral Italian centers for bone diseases were collected; a PubMed search on persistent, recurrent and unoperable cases of TIO was carried out., Results: Sixteen patients (mean age at diagnosis 52.5 ± 10.6 years) with persistent (n = 6, 37,5%), recurrent (n = 7, 43.7%) or not operable (n = 3, 18.8%) TIO were described. Delay in diagnosis (2.5 ± 1.3 years) was demonstrated. All patients experienced fragility fractures or pseudofractures and disabling bone and muscle pain. BMD was significantly reduced (mean T-score -2.7 ± 1.7 and -2.7 ± 0.9 at lumbar spine and femoral neck, respectively). Fourteen patients were maintained under therapy with phosphate salts and calcitriol, while in 2 patients therapy with burosumab, an anti-FGF23 antibody, was commenced., Conclusion: A significant number of patients with TIO remain either undiagnosed for tumor localization or tumor recur or persist after surgery. These patients with active disease represent possible candidates for burosumab treatment., (© 2022. The Author(s).)
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- 2022
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41. The Potential Impact of Inducing a Restriction in Reimbursement Criteria on Vitamin D Supplementation in Osteoporotic Patients with or without Fractures.
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Esposti LD, Perrone V, Sella S, Arcidiacono G, Bertoldo F, Giustina A, Minisola S, Napoli N, Passeri G, Rossini M, and Giannini S
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- Dietary Supplements, Humans, Retrospective Studies, Vitamin D therapeutic use, Vitamins therapeutic use, Bone Density Conservation Agents therapeutic use, Osteoporosis etiology, Osteoporotic Fractures epidemiology, Osteoporotic Fractures prevention & control, Spinal Fractures complications
- Abstract
In October 2019, the Italian Drug Agency (AIFA) restricted reimbursement criteria for vitamin D (VD) use outside the osteoporosis setting (Note 96). However, whether this restriction could also have involved patients at risk for or with osteoporotic fractures has not yet been investigated. We retrospectively analyzed databases from five Italian Local Health Units. Patients aged ≥50 years with either at least one prescription for osteoporosis treatment or with fragility fractures and evidence of osteoporosis from 2011 to 2020 were included. The proportion of subjects with an interruption in VD treatment before and after the introduction of the new reimbursement criteria and predictors of this interruption were analyzed. A total of 94,505 patients (aged 69.4 years) were included. Following the introduction of Note 96, a 2-fold (OR 1.98, 95% CI: 1.92-2.04) increased risk of VD discontinuation was observed. These findings were independent of seasonal variation, osteoporosis treatment patterns, as well as other confounding variables. However, a higher rate of interruption was observed in patients without vertebral/femur fracture (37.8%) vs. those with fracture (32.9%). Rheumatoid arthritis, dyslipidemia and previous fracture were associated with a lower risk of VD interruption, while stroke increased the risk of VD interruption. Our results highlight that a possible misinterpretation of newly introduced criteria for reimbursement restrictions in VD outside of osteoporosis have resulted in an inadequate level of VD supplementation in patients with osteoporosis. This undertreatment could reduce the effect of osteoporosis therapies leading to increased risk of negative outcome.
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- 2022
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42. Long-Term Follow-Up of Device-Assisted Clampless Off-Pump Coronary Artery Bypass Grafting Compared with Conventional On-Pump Technique.
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Bassano C, Nardi P, Buioni D, Asta L, Pisano C, Bertoldo F, Altieri C, and Ruvolo G
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- Follow-Up Studies, Hospital Mortality, Humans, Retrospective Studies, Stroke Volume, Treatment Outcome, Coronary Artery Bypass, Ventricular Function, Left
- Abstract
Study Objective: To evaluate the long-term outcomes of clampless off-pump coronary artery bypass grafting (C-OPCAB) compared with conventional on-pump double clamping coronary artery bypass grafting (C-CABG)., Methods: From October 2006 to December 2011, 366 patients underwent isolated coronary artery bypass grafting. After propensity score matching of preoperative variables, 143 pairs were selected who received C-OPCAB with the use of device-assisted PAS-Port proximal venous graft anastomoses or C-CABG, performed by the same surgeon experienced in both techniques. Data of the two groups of patients were retrospectively analyzed up to 14 years of follow-up., Results: As compared with C-OPCAB, in the C-CABG patients, the performed number of grafts per patient was higher (2.9 ± 0.5 vs. 2.6 ± 0.6, p -value 0.0001). At 14 years, overall survival, including in-hospital death, was 64 ± 4.7% for the C-OPCAB vs. 55 ± 5.5% for the C-CABG, freedom from overall MACCEs 51 ± 6.2% vs. 41 ± 7.7%, and from late cardiac death 94 ± 2.4% vs. 96 ± 2.2% ( p -value not significant, for all comparisons). No significant statistical differences were observed in the actual rates of adverse events during follow-up. Independent predictors of survival were advanced age at operation ( p -value 0.001) and a lower mean value of preoperative left ventricular ejection fraction ( p -value 0.015)., Conclusions: Our single-center study analysis suggests that clampless OPCAB using device-assisted proximal anastomoses proved to be not inferior to double-clamping CABG in the long-term follow-up, provided that involved surgeons are familiar with both techniques. These conclusions are supported by a large and long-term follow-up period, eliminating potential bias, i.e., by means of the propensity score matching and analyzing single-surgeon experience.
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- 2021
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43. Management of Osteoporosis in Men: A Narrative Review.
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Vescini F, Chiodini I, Falchetti A, Palermo A, Salcuni AS, Bonadonna S, De Geronimo V, Cesareo R, Giovanelli L, Brigo M, Bertoldo F, Scillitani A, and Gennari L
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- Hormone Replacement Therapy, Humans, Male, Osteoporosis diagnosis, Osteoporosis physiopathology, Osteoporosis therapy, Testosterone, Disease Management, Osteoporosis prevention & control, Osteoporotic Fractures prevention & control
- Abstract
Male osteoporosis is a still largely underdiagnosed pathological condition. As a consequence, bone fragility in men remains undertreated mainly due to the low screening frequency and to controversies in the bone mineral density (BMD) testing standards. Up to the 40% of overall osteoporotic fractures affect men, in spite of the fact that women have a significant higher prevalence of osteoporosis. In addition, in males, hip fractures are associated with increased morbidity and mortality as compared to women. Importantly, male fractures occur about 10 years later in life than women, and, therefore, due to the advanced age, men may have more comorbidities and, consequently, their mortality is about twice the rate in women. Gender differences, which begin during puberty, lead to wider bones in males as compared with females. In men, follicle-stimulating hormones, testosterone, estrogens, and sex hormone-binding levels, together with genetic factors, interact in determining the peak of bone mass, BMD maintenance, and lifetime decrease. As compared with women, men are more frequently affected by secondary osteoporosis. Therefore, in all osteoporotic men, a complete clinical history should be collected and a careful physical examination should be done, in order to find clues of a possible underlying diseases and, ultimately, to guide laboratory testing. Currently, the pharmacological therapy of male osteoporosis includes aminobisphosphonates, denosumab, and teriparatide. Hypogonadal patients may be treated with testosterone replacement therapy. Given that the fractures related to mortality are higher in men than in women, treating male subjects with osteoporosis is of the utmost importance in clinical practice, as it may impact on mortality even more than in women.
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- 2021
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44. Romosozumab Followed by Antiresorptive Treatment Increases the Probability of Achieving Bone Mineral Density Treatment Goals.
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Cosman F, Libanati C, Deignan C, Yu Z, Wang Z, Ferrari S, Beck Jensen JE, Peris P, Bertoldo F, Lespessailles E, Hesse E, and Cummings SR
- Abstract
Increases in bone mineral density (BMD) with osteoporosis treatment are associated with reduced fracture risk. Increasing BMD is therefore a goal of osteoporosis therapy. Here, we compare the probability of achieving a T -score of > -2.5 over 3 years at the total hip (TH) or lumbar spine (LS) in women with osteoporosis, ≥55 years of age, after the following treatment sequences: 1 year romosozumab followed by 2 years denosumab (FRAME and FRAME extension trials), 1 year romosozumab followed by 2 years alendronate, or alendronate-only for 3 years (ARCH trial). Probabilities of attaining the BMD target within 1 year of treatment were also determined. At both skeletal sites, in women with a baseline T score ≥ -2.7, there was >50% probability of achieving the BMD target with any 3-year regimen. The probability of achieving the target BMD in those with a baseline TH T score equal to -3.0 was 61% with romosozumab/denosumab, 38% with romosozumab/alendronate, and 9% with alendronate. In those with a baseline LS T score equal to -3.0, the probability of achieving a T -score > -2.5 was 93% with romosozumab/denosumab, 81% with romosozumab/alendronate, and 55% with alendronate. With 1 year of treatment, in patients with a baseline TH T -score equal to -2.7, the probability of reaching the target T score with romosozumab was 71% to 78% and 38% with alendronate. For patients with an initial LS T -score equal to -3.0, the probability of achieving the target T -score over 1 year was 85% to 86% with romosozumab and 25% for alendronate. Our findings suggest baseline BMD and the probability of achieving BMD T -score goals are factors to consider when selecting initial treatment for patients with osteoporosis. As baseline T -score falls below -2.7 (TH) and -3.0 (LS), alendronate has <50% likelihood of achieving a BMD goal above osteoporosis range, whereas these probabilities remain relatively high for regimens beginning with romosozumab. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research., (© 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.)
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- 2021
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45. The impact of dual antiplatelet therapy administration on the risk of bleeding complications during coronary artery bypass surgery.
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Nardi P, Pisano C, Turturici M, Bertoldo F, Maggio VR, Bassano C, Buioni D, Scafuri A, Altieri C, and Ruvolo G
- Abstract
Introduction: Dual antiplatelet therapy reduces the risk of cardiovascular death, myocardial infarction and recurrence of adverse ischemic events in patients affected by acute coronary syndromes, but in patients urgently needing coronary artery surgery it can increase the risk of severe perioperative bleeding complications., Aim: We evaluated the impact of dual antiplatelet therapy (DAPT) based on acetylsalicylic acid plus clopidogrel or ticagrelor in patients undergoing coronary artery bypass grafting (CABG)., Material and Methods: Three hundred and thirty-three patients underwent coronary artery bypass grafting with DAPT discontinuation > 72 hours or 3-4 days (group A, n = 159), 48-72 hours or 2-3 days (group B, n = 126), < 24 hours or 0-1 day (group C, n = 24) prior to CABG., Results: Operative mortality was 1.87% (group A), 0.79% (group B), absent (group C). The incidence of mediastinal re-exploration was 1.25% or 2 patients (group A), 1.59% or 2 patients (group B), 8.33% or 4 patients (group C) ( p = 0.01). Group C showed postoperatively a greater incidence of a blood loss greater than 500 ml at 6 hours and a blood loss from chest tube drainages significantly higher at 6 and 24 hours ( p < 0.01). Multivariate analysis showed that ongoing ticagrelor intake in group C (HR = 42.4; p = 0.02) and group C (HR = 6.9; p = 0.04) were the only independent predictors of surgical re-exploration. In group C, surgical re-exploration was 2.56% or 1/39 patients taking clopidogrel, 33.3% or 3/9 patients taking ticagrelor ( p = 0.002)., Conclusions: Dual antiplatelet therapy ongoing until 1 day or 24 hours before CABG showed a significantly increased risk of bleeding complications in comparison with its discontinuation at 2-3 and > 3-4 days before, respectively. Major blood loss and surgical re-exploration were not associated with increased risk of operative all-cause or bleeding-related mortality. As expected, taking ticagrelor compared with clopidogrel in the short interval confers a higher risk of bleeding complications., Competing Interests: The authors report no conflict of interest., (Copyright: © 2021 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)
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- 2021
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46. Management of bone fragility in type 2 diabetes: Perspective from an interdisciplinary expert panel.
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Chiodini I, Gaudio A, Palermo A, Napoli N, Vescini F, Falchetti A, Merlotti D, Eller-Vainicher C, Carnevale V, Scillitani A, Pugliese G, Rendina D, Salcuni A, Bertoldo F, Gonnelli S, Nuti R, Toscano V, Triggiani V, Cenci S, and Gennari L
- Subjects
- Bone Density Conservation Agents adverse effects, Consensus, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 diagnosis, Diabetes Mellitus, Type 2 mortality, Evidence-Based Medicine, Fractures, Bone diagnosis, Fractures, Bone etiology, Fractures, Bone mortality, Humans, Hypoglycemic Agents adverse effects, Osteoporosis diagnosis, Osteoporosis etiology, Osteoporosis mortality, Protective Factors, Risk Assessment, Risk Factors, Treatment Outcome, Bone Density Conservation Agents therapeutic use, Diabetes Mellitus, Type 2 drug therapy, Fractures, Bone prevention & control, Hypoglycemic Agents therapeutic use, Osteoporosis drug therapy
- Abstract
Aim: Bone fragility is increasingly recognized as a relevant complication of type 2 diabetes (T2D) and diabetic patients with fragility fractures have higher mortality rates than non diabetic individuals or diabetic patients without fractures. However, current diagnostic approaches for fracture risk stratification, such as bone mineral density measurement or the use of risk assessment algorithms, largely underestimate fracture risk in T2D patients. A multidisciplinary expert panel was established in order to in order to formulate clinical consensus recommendations on bone health assessment and management of fracture risk in patients with T2D., Data Synthesis: The following key questions were addressed: a) which are the risk factors for bone fragility in T2D?, b) which diagnostic procedures can be currently used to stratify fracture risk in T2D patients?, c) which are the effects of antidiabetic treatments on bone?, and d) how to prevent and treat bone fragility in T2D patients? Based on the available data members of this panel suggest that the stratification of fracture risk in patients with diabetes should firstly rely on the presence of a previous fragility fracture and on the individual risk profile, with the inclusion of T2D-specific risk factors (namely T2D duration above 10 yrs, presence of chronic T2D complications, use of insulin or thiazolidinediones and persistent HbA1c levels above 8% for at least 1 year). Two independent diagnostic approaches were then suggested in the presence or the absence of a prevalent fragility fracture, respectively., Conclusions: Clinical trials in T2D patients at risk for fragility fractures are needed to determine the efficacy and safety of available antiresorptive and anabolic agents in this specific setting., (Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)
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- 2021
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47. A pragmatic window of opportunity to minimise the risk of MRONJ development in individuals with osteoporosis on Denosumab therapy: a hypothesis.
- Author
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Campisi G, Mauceri R, Bertoldo F, Fusco V, and Bedogni A
- Subjects
- Denosumab adverse effects, Diphosphonates, Humans, Bisphosphonate-Associated Osteonecrosis of the Jaw epidemiology, Bisphosphonate-Associated Osteonecrosis of the Jaw etiology, Bisphosphonate-Associated Osteonecrosis of the Jaw prevention & control, Bone Density Conservation Agents adverse effects, Osteoporosis chemically induced, Osteoporosis drug therapy, Osteoporosis epidemiology
- Abstract
Denosumab is associated with the development of medication-related osteonecrosis of the jaw (MRONJ), an uncommon but severe oral side effect with a higher prevalence in metastatic cancer patients than in patients with metabolic bone fragility. Although several oral triggers can initiate MRONJ, invasive oral treatments and tooth extraction still remain the most common precipitating event. In general, tooth extraction and oral surgery should be avoided in patients at increased risk of MRONJ, while extraction of non-restorable teeth should be performed based on specific risk reduction protocols to eliminate dental/periodontal infections, still protecting from MRONJ onset. Based on the different pharmacological activity of denosumab and nitrogen-containing bisphosphonates, it is likely that the MRONJ risk profile of patients with osteoporosis could somewhat vary. We hypothesize the chance to maximize the pharmacokinetic of denosumab 60 mg (Prolia®) and identify a time interval in which invasive oral treatments can ideally take place without restrictions in patients with metabolic bone fragility, We propose that dental surgery (e.g. tooth extraction) may be safely performed without additional intra or peri-operative procedures in osteoporosis patients using denosumab provided that careful case selection, adequate communication among specialists, planning of a delayed dosing window (1-month deferral) and rigorous postoperative follow-up are granted., (© 2021. The Author(s).)
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- 2021
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48. Surgical "elephant trunk" arch replacement with a branched arch prosthesis: two alternative operative techniques.
- Author
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Bassano C, Buioni D, Scafuri A, Nardi P, Pisano C, Bertoldo F, and Ruvolo G
- Abstract
Introduction: Elephant trunk repair of the aortic arch cannot be performed with a branched prosthesis., Aim: We conceived two different modifications of the original technique to perform an arch replacement with a branched graft, while arranging an adequate landing zone for a subsequent thoracic endovascular aortic repair, without the need of dedicated material., Material and Methods: Eight consecutive patients underwent arch replacement with one of our techniques. Five were emergency patients with acute aortic dissection, and 3 suffered chronic expansive disease. The "modified elephant trunk" includes a separate anastomosis of an endo-luminal prosthetic segment in the descending aorta. Subsequently, the branched arch prosthesis is anastomosed to the distal aortic stump with the attached trunk. In the "prophylactic debranching", a tail is left on the distal end of the arch prosthesis, so that the branches for the supra-aortic vessels will remain displaced proximally, allowing a "zone 1" available for landing., Results: Three patients experienced transient cerebral deficits (1 transient ischemic attack and post-operative delirium in 2 cases), 1 required re-operation for bleeding and 2 needed prolonged intubation. One died of multi-organ failure., Conclusions: Both techniques proved to be easily reproducible, and allow an adequate landing zone for a subsequent endovascular procedure, while retaining the advantages of using a tetra-furcated prosthesis. They are a viable alternative when a hybrid prosthesis cannot be implanted., Competing Interests: The authors report no conflict of interest., (Copyright: © 2021 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)
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- 2021
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49. Marfan syndrome in children: correlation between musculoskeletal features and cardiac Z-score.
- Author
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De Maio F, Pisano C, Caterini A, Bertoldo F, Ruvolo G, and Farsetti P
- Subjects
- Adult, Child, Humans, Physical Examination, Funnel Chest diagnostic imaging, Heart Defects, Congenital, Marfan Syndrome diagnosis, Marfan Syndrome diagnostic imaging
- Abstract
We investigated the correlation between the musculoskeletal features and the cardiovascular anomalies in pediatric patients affected by Marfan syndrome, in order to identify possible orthopedic deformities that could be a warning sign for severe aortic dilatation. Moreover, we analyzed the role of the orthopedic aspects in the early diagnosis of the disease in a pediatric population. Seventy-two patients from 3 to 14 years of age, underwent interdisciplinary evaluation that included an orthopedic and cardiological examination. At the orthopedic examination, we analyzed the musculoskeletal features included in the systemic score of the revised Ghent criteria. Cardiological evaluation included a transthoracic echocardiography with definition of the cardiac Z-score, which is an index that evaluates aortic diameter. A statistical analysis was performed. We identified a statistically significant correlation between the presence of pectus excavatum and cardiac Z-score ≥3 (P = 0.022). Clinically, this data means that pectus excavatum is frequently observed in patients with larger aortic root diameter. On the contrary, no statistically significant correlation was found between the other investigated musculoskeletal features and a pathological Z-score. In the pediatric population, the diagnosis of Marfan syndrome remains difficult because many clinical manifestations are age-dependent and the Ghent criteria, usually used for adults, are not reliable in children. Our results show that the presence of pectus excavatum could help in the early identification of patients at greater risk of developing possibly fatal aortic disease. However, it is always indicated to screen all patients with Marfan syndrome for cardiac abnormalities, even in absence of pectus excavatum., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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50. The effects of DeBakey type acute aortic dissection and preoperative peripheral and cardiac malperfusion on the outcomes after surgical repair.
- Author
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Nardi P, Bassano C, Pisano C, Altieri C, Ferrante MS, Greci M, Buioni D, Bertoldo F, Farinaccio A, and Ruvolo G
- Abstract
Introduction: Emergent surgical repair of DeBakey type I and II acute aortic dissection represents the standard of care to prevent lethal complications., Aim: Evaluation of the effect of extension of aortic dissection (AAD) according to DeBakey classification, type I and II AAD, and the relationship with preoperative peripheral and myocardial malperfusion on early outcome and the mid-term follow-up period., Material and Methods: A total of 135 patients who underwent AAD surgery between January 2015 and October 2019 were analysed., Results: In total 103 patients were affected by DeBakey type I AAD and 32 by DeBakey type II; 56 patients preoperatively showed peripheral, cardiac malperfusion, or both. Intra-operative mortality was 11%. Postoperative peripheral, cardiac malperfusion, and intraoperative and postoperative mortality were lower for type II AAD. The protective factor for intra- and postoperative 60-day mortality was type II AAD (RR = 0.03, p = 0.001); independent predictors were hypertension, and preoperative cardiac and renal-visceral malperfusion. At 5 years the overall survival was 74 ±6.9%. Independent predictors of reduced survival were major extension of type I AAD (RR = 5.37, p < 0.05) and preoperative cardiac malperfusion (RR = 5.78, p < 0.05). Five-year freedom from cardiac death, redo surgical operation, and new vascular procedures on the thoracic and abdominal aorta was 92 ±5.7%, 99 ±1.2%, and 81 ±7.2%, respectively. Extension of DeBakey type I AAD into the thoracic-abdominal aorta segment was also a predictor of the need for new vascular procedures (RR = 1.66, p = 0.05)., Conclusions: A more favourable anatomy of DeBakey type II AAD is associated with better early and late outcomes after aortic repair. This is due to a lower incidence of peripheral and cardiac malperfusion., Competing Interests: The authors report no conflict of interest., (Copyright: © 2021 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)
- Published
- 2021
- Full Text
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