33 results on '"Gerra L"'
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2. Early relevant alerts from remote monitoring in heart failure patients with a cardiac implanted electronic device: what implications for long term outcome?
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Mei, D A, primary, Imberti, J F, additional, Sbarra, F, additional, Serafini, K, additional, Mantovani, M, additional, Leo, G, additional, Cherubini, B, additional, Gerra, L, additional, Vitolo, M, additional, Bonini, N, additional, Mauro, E, additional, Turco, V, additional, Casali, E, additional, and Boriani, G, additional
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- 2024
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3. Chelator‐Assisted Precipitation‐Based Separation of the Rare Earth Elements Neodymium and Dysprosium from Aqueous Solutions.
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Gao, Yangyang, Licup, Gerra L., Bigham, Nicholas P., Cantu, David C., and Wilson, Justin J.
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RARE earth metals , *STABILITY constants , *CHEMICAL properties , *DYSPROSIUM , *CLEAN energy , *BINDING energy - Abstract
The rare earth elements (REEs) are critical resources for many clean energy technologies, but are difficult to obtain in their elementally pure forms because of their nearly identical chemical properties. Here, an analogue of macropa, G‐macropa, was synthesized and employed for an aqueous precipitation‐based separation of Nd3+ and Dy3+. G‐macropa maintains the same thermodynamic preference for the large REEs as macropa, but shows smaller thermodynamic stability constants. Molecular dynamics studies demonstrate that the binding affinity differences of these chelators for Nd3+ and Dy3+ is a consequence of the presence or absence of an inner‐sphere water molecule, which alters the donor strength of the macrocyclic ethers. Leveraging the small REE affinity of G‐macropa, we demonstrate that within aqueous solutions of Nd3+, Dy3+, and G‐macropa, the addition of HCO3− selectively precipitates Dy2(CO3)3, leaving the Nd3+−G‐macropa complex in solution. With this method, remarkably high separation factors of 841 and 741 are achieved for 50 : 50 and 75 : 25 mixtures. Further studies involving Nd3+:Dy3+ ratios of 95 : 5 in authentic magnet waste also afford an efficient separation as well. Lastly, G‐macropa is recovered via crystallization with HCl and used for subsequent extractions, demonstrating its good recyclability. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Elucidating the Structure of the Eu‐EDTA Complex in Solution at Various Protonation States
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Licup, Gerra L., primary, Summers, Thomas J., additional, Sobrinho, Josiane A., additional, de Bettencourt‐Dias, Ana, additional, and Cantu, David C., additional
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- 2024
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5. Mutation Space of Spatially Conserved Amino Acid Sites in Proteins
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Caswell, Benjamin T., primary, Summers, Thomas J., additional, Licup, Gerra L., additional, and Cantu, David C., additional
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- 2023
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6. Low incidence rate of infections associated with cardiac implantable electronic device procedures in a large real-world patient cohort
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Imberti, J F, primary, Vitolo, M, additional, Mei, D A, additional, Bonini, N, additional, Fontanesi, R, additional, Muto, F, additional, Gerra, L, additional, Sbarra, F, additional, Turco, V, additional, Casali, E, additional, and Boriani, G, additional
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- 2023
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7. Functional Communication as a Means of Decreasing Self-Injurious Behavior: A Case Study.
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Gerra, L. L.
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This case study examines the effects of a systematic functional communication training program on the self-injurious behaviors of an 8-year-old girl who is blind and has severe disabilities. The girl was offered choices among preferred activities and learned to use a communication board. Self-injurious behaviors decreased. (Author/SW)
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- 1995
8. Development and application of portable, hand-held X-ray fluorescence spectrometers
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Gerra L. Bosco
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Materials science ,Spectrometer ,business.industry ,Hand held ,Analytical chemistry ,X-ray detector ,X-ray fluorescence ,X-ray tube ,Analytical Chemistry ,law.invention ,Optics ,law ,business ,Spectroscopy - Abstract
The James L. Waters Symposium 2012 had five invited speakers to describe the development and commercialization of portable, hand-held X-ray fluorescence (XRF) spectrometers. Lee Grodzins described the birth and the maturation of hand-held XRF (HHXRF) spectrometers. Andrew Ellis described how the stainless-steel industry in Finland led to the development of X-MET HHXRF analyzers. Charles Jensen reviewed the performance improvements in miniature X-ray sources made by his company, Moxtek. Alan Huber explained how his company, Amptek, led the development of detectors for HHXRF. Stanislaw Piorek detailed the evolution of analytical capabilities of field-portable, HHXRF analyzers.
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- 2013
9. Metal binding kinetics of bi-histidine sites used in [psi] analysis: evidence of high-energy protein folding intermediates
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Bosco, Gerra L., Baxa, Michael, and Sosnick, Tobin R.
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Histidine -- Chemical properties ,Histidine -- Thermal properties ,Hydrophobic effect -- Analysis ,Protein folding -- Analysis ,Ubiquitin -- Chemical properties ,Biological sciences ,Chemistry - Abstract
The article explains the kinetic and thermodynamic parameters of metal binding to the bi-histidine sites located in ubiquitin, which are often used for the [psi] analysis studied. The results demonstrate the significance of the high-energy protein folding intermediates as equilibrium between the denatured state and a series of high-energy species.
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- 2009
10. Imaging in the modern age
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Gerra L. Bosco
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Engineering ,business.industry ,Scanning confocal electron microscopy ,Nanotechnology ,business ,Ion microscopy ,Spectroscopy ,Analytical Chemistry - Abstract
This report of the 2011 James L. Waters Symposium at Pittcon 2011 highlights the powerful imaging technologies of electron microscopy (EM) and ion microscopy (IM). The four speakers each provided a window into a specific subset of the field: • David Bell described the history, development, application, and commercialization of transmission EM (TEM) and scanning TEM (STEM); • David Martin presented the challenges and methodologies of imaging ordered polymers and biomaterials with TEM; • Joseph Michael explained the history of the commercialization of scanning EM (SEM) and its modern applications; and, • David Joy, who submitted his talk in absentia , provided a history of EM and a summary of the advantages of IM versus EM.
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- 2011
11. The development of LC-MS – the marriage of the bird and the fish
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Gerra L. Bosco
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Environmental chemistry ,media_common.quotation_subject ,Art history ,%22">Fish ,Art ,Spectroscopy ,Analytical Chemistry ,media_common - Abstract
This is a report on the James L. Waters Symposium at PittCon 2010, which featured four speakers responsible for the development and the commercialization of liquid chromatography-mass spectrometry (LC-MS). • An early pioneer, William McFadden described the development of the moving belt system in the 1970s. • Marvin Vestal, CEO & CSO of Virgin Instruments, described how he and his team designed and perfected thermospray technology in the 1980s. • Jack Henion, Chairman and CSO of Advion BioSciences, Inc., discussed direct liquid introduction (DLI), atmospheric pressure ionization (API), the development of electrospray and new developments (e.g., bench-top LC-MS systems, nanospray, ion traps and microfluidics). • Tom Covey, a principal scientist at AB SCIEX, used the metaphor of the world histomap to document the history of LC-MS and compare his fellow speakers to famous historical figures.
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- 2010
12. James L. Waters Symposium 2009 on near-infrared spectroscopy
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Gerra L. Bosco
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Chemometrics ,Engineering ,business.industry ,Near-infrared spectroscopy ,Analytical chemistry ,business ,Spectroscopy ,Analytical Chemistry ,Remote sensing - Abstract
This is a report on the Pittcon 2009 Waters Symposium, which featured five speakers on the history and fast-growing applications of near-infrared spectroscopy (NIRS). Often called the “Father of NIRS”, Karl Norris described the development and the initial refinement of the first NIR instruments for use in whole-sample grain measurements. Peter Flinn provided an explanation of the science behind this technology and explained the need for and use of chemometrics in interpreting NIRS data. Franklin “Woody” Barton explained how the first official, standardized methods were developed and described the development of compact, dedicated NIR spectrometers for rapid, non-destructive, at-line and in-line analysis of material. Phil Williams detailed the introduction of NIRS to the world of commerce and the spread of NIR worldwide. Finally, Robert Lodder explained some out-of-the-box modern applications of NIRS in the fields of aging, artificial intelligence and astrobiology.
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- 2010
13. Metal Binding Kinetics of Bi-Histidine Sites Used in ψ Analysis: Evidence of High-Energy Protein Folding Intermediates
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Tobin R. Sosnick, Michael C. Baxa, and Gerra L. Bosco
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Models, Molecular ,Protein Denaturation ,Protein Folding ,Protein Conformation ,Metal ions in aqueous solution ,Biochemistry ,Article ,Metal ,Protein structure ,Histidine ,Binding site ,Staphylococcal Protein A ,Protein Stability ,Ubiquitin ,Chemistry ,Fluoresceins ,Binding constant ,Folding (chemistry) ,Kinetics ,Zinc ,A-site ,Crystallography ,visual_art ,visual_art.visual_art_medium ,Thermodynamics ,Protein folding - Abstract
The zinc-specific fluorophore, Zinpyr-1, is used in competition assays to determine the kinetic and thermodynamic parameters of Zn2+ binding to engineered bi-histidine sites located in ubiquitin and the B domain of protein A (BdpA). These binding sites are used in psi analysis studies to investigate structure formation in the folding transition state identified by the change in folding rate upon addition of metal ions. For ubiquitin, the on-rate binding constant and binding affinity for a site located along an alpha-helix are measured to be approximately 10(7) M-1 s-1 and 3 microM, respectively. For a site located across two beta-strands, the metal binding affinity was too weak to measure in the dye competition assays (Kd55 microM). The equilibrium-determined values for the Zn2+-induced stabilization of ubiquitin and BdpA match the values derived from changes in the global folding and unfolding rates. Therefore, metal ion binding is in fast equilibrium during the transit over the free energy barrier. Accordingly, the folding rate must be slower than the product of the fractional population of a high-energy intermediate with the metal site formed and the metal binding on-rate constant. The known folding rate of 20 s-1 at 1.5 M guanidinium chloride in 400 microM Zn2+ provides an upper bound for the stability of such intermediates (DeltaG(U-I)4 kcal/mol). These results support a view of the apparent two-state protein folding reaction surface as a fast pre-equilibrium between the denatured state and a series of high-energy species. The net folding rate is a product of the equilibrium constant of the highest-energy species and a transmission rate. For ubiquitin, we estimate the transmission rate to be approximately 10(4) s-1. Implications for the role of unfolded chain diffusion on folding rates and barrier heights are discussed.
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- 2009
14. Development and application of portable, hand-held X-ray fluorescence spectrometers
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Bosco, Gerra L., primary
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- 2013
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15. Imaging in the modern age
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Bosco, Gerra L., primary
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- 2011
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16. The development of LC-MS – the marriage of the bird and the fish
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Bosco, Gerra L., primary
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- 2010
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17. James L. Waters Symposium 2009 on near-infrared spectroscopy
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Bosco, Gerra L., primary
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- 2010
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18. Metal Binding Kinetics of Bi-Histidine Sites Used in ψ Analysis: Evidence of High-Energy Protein Folding Intermediates
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Bosco, Gerra L., primary, Baxa, Michael, additional, and Sosnick, Tobin R., additional
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- 2009
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19. WASP Recruitment to the T Cell:APC Contact Site Occurs Independently of Cdc42 Activation
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Mary H.K McGavin, Gerra L. Bosco, Judy L. Cannon, Christine M. Labno, Katherine A. Siminovitch, Michael K. Rosen, Janis K. Burkhardt, and Abhinav Seth
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Proline ,T-Lymphocytes ,T cell ,Immunology ,Receptors, Antigen, T-Cell ,Antigen-Presenting Cells ,CDC42 ,macromolecular substances ,Models, Biological ,Jurkat cells ,Jurkat Cells ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Immunology and Allergy ,cdc42 GTP-Binding Protein ,Actin ,030304 developmental biology ,0303 health sciences ,ZAP-70 Protein-Tyrosine Kinase ,biology ,Kinase ,Wiskott–Aldrich syndrome protein ,Proteins ,Protein-Tyrosine Kinases ,Cell Compartmentation ,Protein Structure, Tertiary ,3. Good health ,Cell biology ,Intercellular Junctions ,medicine.anatomical_structure ,Infectious Diseases ,Lymphocyte Specific Protein Tyrosine Kinase p56(lck) ,biology.protein ,biological phenomena, cell phenomena, and immunity ,Signal transduction ,Wiskott-Aldrich Syndrome Protein ,Signal Transduction ,030215 immunology ,Binding domain - Abstract
Cdc42 and WASP are critical regulators of actin polymerization whose function during T cell signaling is poorly understood. Using a novel reagent that specifically detects Cdc42-GTP in fixed cells, we found that activated Cdc42 localizes to the T cell:APC contact site in an antigen-dependent manner. TCR signaling alone was sufficient to induce localization of Cdc42-GTP, and functional Lck and Zap-70 kinases were required. WASP also localized to the T cell:APC contact site in an antigen-dependent manner. Surprisingly, WASP localization was independent of the Cdc42 binding domain but required the proline-rich domain. Our results indicate that localized WASP activation requires the integration of multiple signals: WASP is recruited via interaction with SH3 domain-containing proteins and is activated by Cdc42-GTP concentrated at the same site.
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20. Acute kidney injury as a risk marker for hospital readmission: a single-center pilot study in the general population of the Parma area
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Giuseppe Regolisti, Gerra, L., Di Mario, F., Delsante, M., Piotti, G., Cantarelli, C., Morabito, S., Brambilla, M., Cantaluppi, V., Maggiore, U., and Fiaccadori, E.
21. Clinical decisions for appropriate management of patients with atrial fibrillation.
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Boriani G, Bonini N, Imberti JF, Vitolo M, Gerra L, Mantovani M, Serafini K, Birtolo C, Tartaglia E, and Mei DA
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- Humans, Risk Assessment, Risk Factors, Thromboembolism prevention & control, Thromboembolism etiology, Treatment Outcome, Comorbidity, Administration, Oral, Atrial Fibrillation diagnosis, Atrial Fibrillation therapy, Atrial Fibrillation complications, Clinical Decision-Making, Anticoagulants therapeutic use, Hemorrhage chemically induced, Hemorrhage etiology, Stroke diagnosis, Stroke etiology, Stroke therapy
- Abstract
The management of patients with atrial fibrillation (AF) requires intricate clinical decision-making to optimize outcomes. In everyday clinical practice, physicians undergo difficult choices to better manage patients with AF. They need to balance thromboembolic and bleeding risk to focus on patients' symptoms and to manage a variety of multiple comorbidities. In this review, we aimed to explore the multifaceted dimensions of clinical decision-making in AF patients, encompassing the definition and diagnosis of clinical AF, stroke risk stratification, oral anticoagulant therapy selection, consideration of bleeding risk, and the ongoing debate between rhythm and rate control strategies. We will also focus on possible grey zones for the management of AF patients. In navigating this intricate landscape, clinicians must reconcile the dynamic interplay of patient-specific factors, evolving guidelines, and emerging therapies. The review underscores the need for personalized, evidence-based clinical decision-making to tailor interventions for optimal outcomes according to specific AF patient profiles.
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- 2024
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22. Cardiac resynchronization therapy (CRT) nonresponders in the contemporary era: A state-of-the-art review.
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Gerra L, Bonini N, Mei DA, Imberti JF, Vitolo M, Bucci T, Boriani G, and Lip GYH
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In the 2000s, cardiac resynchronization therapy (CRT) became a revolutionary treatment for heart failure with reduced left ventricular ejection fraction (HFrEF) and wide QRS. However, about one-third of CRT recipients do not show a favorable response. This review of the current literature aims to better define the concept of CRT response/nonresponse. The diagnosis of CRT nonresponder should be viewed as a continuum, and it cannot rely solely on a single parameter. Moreover, baseline features of some patients might predict an unfavorable response. A strong collaboration between heart failure specialists and electrophysiologists is key to overcoming this challenge with multiple strategies. In the contemporary era, new pacing modalities, such as His-bundle pacing and left bundle branch area pacing, represent a promising alternative to CRT. Observational studies have demonstrated their potential; however, several limitations should be addressed. Large randomized controlled trials are needed to prove their efficacy in HFrEF with electromechanical dyssynchrony., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
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- 2024
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23. Detection of subclinical atrial fibrillation with cardiac implanted electronic devices: What decision making on anticoagulation after the NOAH and ARTESiA trials?
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Boriani G, Gerra L, Mei DA, Bonini N, Vitolo M, Proietti M, and Imberti JF
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- Humans, Pacemaker, Artificial adverse effects, Clinical Decision-Making, Risk Assessment, Atrial Fibrillation drug therapy, Atrial Fibrillation complications, Anticoagulants therapeutic use, Anticoagulants administration & dosage, Defibrillators, Implantable, Stroke prevention & control, Stroke etiology, Randomized Controlled Trials as Topic
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Atrial fibrillation (AF) may be asymptomatic and the extensive monitoring capabilities of cardiac implantable electronic devices (CIEDs) revealed asymptomatic atrial tachi-arrhythmias of short duration (minutes-hours) occurring in patients with no prior history of AF and without AF detection at a conventional surface ECG. Both the terms "AHRE" (Atrial High-Rate Episodes) and subclinical AF were used in a series of prior studies, that evidenced the association with an increased risk of stroke. Two randomized controlled studies were planned in order to assess the risk-benefit profile of anticoagulation in patients with AHRE/subclinical AF: the NOAH and ARTESiA trials. The results of these two trials (6548 patients enrolled, overall) show that the risk of stroke/systemic embolism associated with AHRE/subclinical AF is in the range of 1-1.2 % per patient-year, but with an important proportion of severe/fatal strokes occurring in non-anticoagulated patients. The apparent discordance between ARTESiA and NOAH results may be approached by considering the related study-level meta-analysis, which highlights a consistent reduction of ischemic stroke with oral anticoagulants vs. aspirin/placebo (relative risk [RR] 0.68, 95 % CI 0.50-0.92). Oral anticoagulation was found to increase major bleeding (RR 1.62, 95 % CI 1.05-2.5), but no difference was found in fatal bleeding (RR 0.79, 95 % CI 0.37-1.69). Additionally, no difference was found in cardiovascular death or all-cause mortality. Taking into account these results, clinical decision-making for patients with AHRE/subclinical AF at risk of stroke, according to CHA
2 DS2 -VASc, can now be evidence-based, considering the benefits and related risks of oral anticoagulants, to be shared with appropriately informed patients., Competing Interests: Declaration of competing interest The authors report no conflict of interests related to the present article. G Boriani reported small speaker fees from Bayer, Boehringer Ingelheim, Boston, Daiichi Sankyo, Janssen, and Sanofi outside of the submitted work. G Boriani is the Principal Investigator of the ARISTOTELES project (Applying ARtificial Intelligence to define clinical trajectorieS for personalized predicTiOn and early deTEction of comorbidity and muLtimorbidity pattErnS) that received funding from the European Union within the Horizon 2020 Research and Innovation Program (Grant N. 101080189). M Proietti is the Italian national leader of the AFFIRMO project on multimorbidity in atrial fibrillation, that received funding from the European Union within the Horizon 2020 Research and Innovation Program (Grant N. 899871). The other authors did not report conflicts of interest to disclose outside of the submitted work., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)- Published
- 2024
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24. [Implications for clinical decision-making of the NOAH-AFNET 6 and ARTESiA studies: what risk-benefit ratio of anticoagulation in patients with subclinical atrial fibrillation?]
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Boriani G, Mantovani M, Birtolo C, Righelli I, and Gerra L
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- Humans, Clinical Decision-Making, Anticoagulants adverse effects, Atrial Fibrillation complications, Atrial Fibrillation drug therapy
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- 2024
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25. Asymptomatic vs. symptomatic atrial fibrillation: Clinical outcomes in heart failure patients.
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Boriani G, Bonini N, Vitolo M, Mei DA, Imberti JF, Gerra L, Romiti GF, Corica B, Proietti M, Diemberger I, Dan GA, Potpara T, and Lip GY
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- Humans, Stroke Volume, Ventricular Function, Left, Risk Factors, Atrial Fibrillation complications, Atrial Fibrillation epidemiology, Heart Failure complications
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Background: The outcome implications of asymptomatic vs. symptomatic atrial fibrillation (AF) in specific groups of patients according to clinical heart failure (HF) and left ventricular ejection fraction (LVEF) need to be clarified., Methods: In a prospective observational study, patients were categorized according to overt HF with LVEF≤40 %, or with LVEF>40 %, or without overt HF with LVEF40 %≤ or > 40 %, as well as according to the presence of asymptomatic or symptomatic AF., Results: A total of 8096 patients, divided into 8 groups according to HF and LVEF, were included with similar proportions of asymptomatic AF (ranging from 43 to 48 %). After a median follow-up of 730 [699 -748] days, the composite outcome (all-cause death and MACE) was significantly worse for patients with asymptomatic AF associated with HF and reduced LVEF vs. symptomatic AF patients of the same group (p = 0.004). On adjusted Cox regression analysis, asymptomatic AF patients with HF and reduced LVEF were independently associated with a higher risk for the composite outcome (aHR 1.32, 95 % CI 1.04-1.69) and all-cause death (aHR 1.33, 95 % CI 1.02-1.73) compared to symptomatic AF patients with HF and reduced LVEF. Kaplan-Meier curves showed that HF-LVEF≤40 % asymptomatic patients had the highest cumulative incidence of all-cause death and MACE (p < 0.001 for both)., Conclusions: In a large European cohort of AF patients, the risk of the composite outcome at 2 years was not different between asymptomatic and symptomatic AF in the whole cohort but adverse implications for poor outcomes were found for asymptomatic AF in HF with LVEF≤40 %., Competing Interests: Declaration of Competing Interest The authors reported no conflict of interests related to the present article. GB reported small speaker fees from Bayer, Boehringer Ingelheim, Boston, Daiichi Sankyo, Janssen, and Sanofi. GFR reported consultancy for Boehringer Ingelheim and an educational grant from Anthos, outside the submitted work. (no fees are directly received personally). MP is national leader of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 899871; TP reported to be consultant for Bayer and Pfizer (no fees). GAD reported small speaker fees from Boehringer-Ingelheim, Pfizer, Bayer, Sanofi; GYHL reported to be consultant and speaker for Bayer/Janssen, BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo (no fees are directly received personally). All the disclosures occurred outside the submitted work. Other authors have no disclosures to declare, (Copyright © 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
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- 2024
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26. Oral anticoagulants in patients with atrial fibrillation and end-stage renal disease: Walking the tightrope between thromboembolic and bleeding risk.
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Vitolo M, Gerra L, and Boriani G
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- Humans, Anticoagulants adverse effects, Administration, Oral, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Thromboembolism prevention & control, Kidney Failure, Chronic complications, Kidney Failure, Chronic drug therapy, Stroke drug therapy
- Abstract
Competing Interests: Declaration of Competing Interest GB: small speaker fee from Bayer, Boston, Boehringer Ingelheim, Daiichi Sankyo, Janssen and Sanofi. All the disclosures occurred outside the submitted work. Other authors have no disclosures to declare
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- 2024
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27. Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications.
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Malavasi VL, Muto F, Ceresoli PACM, Menozzi M, Righelli I, Gerra L, Vitolo M, Imberti JF, Mei DA, Bonini N, Gargiulo M, and Boriani G
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- Humans, Prevalence, Hospital Mortality, Incidence, Atrial Fibrillation diagnosis, Atrial Fibrillation epidemiology, Atrial Fibrillation etiology, Endovascular Procedures adverse effects, Stroke epidemiology, Stroke etiology
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Aims: To know the prevalence of atrial fibrillation (AF), as well as the incidence of postoperative AF (POAF) in vascular surgery for arterial diseases and its outcome implications., Methods: We performed a systematic review and meta-analysis following the PRISMA statement., Results: After the selection process, we analyzed 44 records (30 for the prevalence of AF history and 14 for the incidence of POAF).The prevalence of history of AF was 11.5% [95% confidence interval (CI) 1-13.3] with high heterogeneity (I2 = 100%). Prevalence was higher in the case of endovascular procedures. History of AF was associated with a worse outcome in terms of in-hospital death [odds ratio (OR) 3.29; 95% CI 2.66-4.06; P < 0.0001; I2 94%] or stroke (OR 1.61; 95% CI 1.39-1.86; P < 0.0001; I2 91%).The pooled incidence of POAF was 3.6% (95% CI 2-6.4) with high heterogeneity (I2 = 100%). POAF risk was associated with older age (mean difference 4.67 years, 95% CI 2.38-6.96; P = 0.00007). The risk of POAF was lower in patients treated with endovascular procedures as compared with an open surgical procedure (OR 0.35; 95% CI 0.13-0.91; P = 0.03; I2 = 61%)., Conclusions: In the setting of vascular surgery for arterial diseases a history of AF is found overall in 11.5% of patients, more frequently in the case of endovascular procedures, and is associated with worse outcomes in terms of short-term mortality and stroke.The incidence of POAF is overall 3.6%, and is lower in patients treated with an endovascular procedure as compared with open surgery procedures. The need for oral anticoagulants for preventing AF-related stroke should be evaluated with randomized clinical trials., (Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.)
- Published
- 2023
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28. Quantification of Myocardial Contraction Fraction with Three-Dimensional Automated, Machine-Learning-Based Left-Heart-Chamber Metrics: Diagnostic Utility in Hypertrophic Phenotypes and Normal Ejection Fraction.
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Barbieri A, Imberti JF, Bartolomei M, Bonini N, Laus V, Torlai Triglia L, Chiusolo S, Stuani M, Mari C, Muto F, Righelli I, Gerra L, Malaguti M, Mei DA, Vitolo M, and Boriani G
- Abstract
Aims: The differentiation of left ventricular (LV) hypertrophic phenotypes is challenging in patients with normal ejection fraction (EF). The myocardial contraction fraction (MCF) is a simple dimensionless index useful for specifically identifying cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) when calculated by cardiac magnetic resonance. The purpose of this study was to evaluate the value of MCF measured by three-dimensional automated, machine-learning-based LV chamber metrics (dynamic heart model [DHM]) for the discrimination of different forms of hypertrophic phenotypes. Methods and Results: We analyzed the DHM LV metrics of patients with CA ( n = 10), hypertrophic cardiomyopathy (HCM, n = 36), isolated hypertension (IH, n = 87), and 54 healthy controls. MCF was calculated by dividing LV stroke volume by LV myocardial volume. Compared with controls (median 61.95%, interquartile range 55.43-67.79%), mean values for MCF were significantly reduced in HCM-48.55% (43.46-54.86% p < 0.001)-and CA-40.92% (36.68-46.84% p < 0.002)-but not in IH-59.35% (53.22-64.93% p < 0.7). MCF showed a weak correlation with EF in the overall cohort (R
2 = 0.136) and the four study subgroups (healthy adults, R2 = 0.039 IH, R2 = 0.089; HCM, R2 = 0.225; CA, R2 = 0.102). ROC analyses showed that MCF could differentiate between healthy adults and HCM (sensitivity 75.9%, specificity 77.8%, AUC 0.814) and between healthy adults and CA (sensitivity 87.0%, specificity 100%, AUC 0.959). The best cut-off values were 55.3% and 52.8%. Conclusions: The easily derived quantification of MCF by DHM can refine our echocardiographic discrimination capacity in patients with hypertrophic phenotype and normal EF. It should be added to the diagnostic workup of these patients.- Published
- 2023
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29. Low Occurrence of Infections and Death in a Real-World Cohort of Patients with Cardiac Implantable Electronic Devices.
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Imberti JF, Mei DA, Fontanesi R, Gerra L, Bonini N, Vitolo M, Turco V, Casali E, and Boriani G
- Abstract
Background: The incidence of infections and death in patients implanted with cardiac implantable electronic devices (CIEDs) is not fully known yet., Aim: To describe the incidence of CIED-related infection and death, and their potential predictors in a contemporary cohort of CIED patients., Methods: All consecutive patients implanted with a CIED at our institution were prospectively enrolled. Follow-up visits were performed 2 weeks after CIED implantation for all patients, and then every 6 months for implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) patients and every 12 months for pacemaker (PM) patients. The adjudication of CIED-related infections was performed by two independent investigators and potential disagreement was resolved by a senior investigator., Results: Between September 2016 and August 2020, a total of 838 patients were enrolled (34.6% female; median age 77 (69.6-83.6); median PADIT score 2 (2-4)). PMs were implanted in 569 (68%) patients and ICD/CRT in 269 (32%) patients. All patients had pre-implant antibiotic prophylaxis and 5.5% had an antibiotic-eluting envelope. Follow-up data were available for 832 (99.2%) patients. After a median follow-up of 42.3 (30.2-56.4) months, five (0.6%) patients had a CIED-related infection and 212 (25.5%) patients died. Using multivariate Cox regression analysis, end-stage chronic kidney disease (CKD) requiring dialysis and therapy with corticosteroids was independently associated with a higher risk of infection (hazard ratio (HR): 14.20; 95% confidence interval (CI) 1.48-136.62 and HR: 14.71; 95% CI 1.53-141.53, respectively). Age (HR: 1.07; 95% CI 1.05-1.09), end-stage CKD requiring dialysis (HR: 6.13; 95% CI 3.38-11.13) and history of atrial fibrillation (HR: 1.47; 95% CI 1.12-1.94) were independently associated with all-cause death., Conclusions: In a contemporary cohort of CIED patients, mortality was substantially high and associated with clinical factors depicting a population at risk. On the other hand, the incidence of CIED-related infections was low.
- Published
- 2023
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30. Single-lead VDD pacing: a literature review on short-term and long-term performance.
- Author
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Mei DA, Imberti JF, Vitolo M, Bonini N, Gerra L, Romiti GF, Proietti M, Lip GYH, and Boriani G
- Subjects
- Humans, Heart Atria, Cardiac Pacing, Artificial, Pacemaker, Artificial
- Abstract
Introduction: VDD pacing system was introduced more than 30 years ago. Its use is considered by the 2021 European Society of Cardiology guidelines on cardiac pacing as a potential alternative to dual chambers system for patients with atrioventricular block and normal sinus node function., Areas Covered: In this article, we performed a narrative review of current literature in order to identify the strengths and weaknesses of this pacing system. VDD system allows the maintenance of AV synchronous pacing and its hemodynamic advantages. Some disadvantages may be related to the non-negligible incidence of atrial undersensing and the possible subsequent need for upgrade to DDD system. On the other hand, shorter implantation time and lower complications rate may be advantages., Expert Opinion: In the modern pacing era, VDD pacing system struggles to find its own space. However, it may still be considered as a valuable alternative to a dual-chamber pacemaker for selected patients, in specific clinical scenarios.
- Published
- 2023
- Full Text
- View/download PDF
31. Atrial High-Rate Episodes Detected by Cardiac Implantable Electronic Devices: Dynamic Changes in Episodes and Predictors of Incident Atrial Fibrillation.
- Author
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Imberti JF, Bonini N, Tosetti A, Mei DA, Gerra L, Malavasi VL, Mazza A, Lip GYH, and Boriani G
- Abstract
Background: Atrial high rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) may be associated with a risk of progression towards long-lasting episodes (≥24 h) and clinical atrial fibrillation (AF)., Methods: Consecutive CIED patients presenting AHRE (with confirmation of an arrhythmia lasting 5 min-23 h 59 min, atrial rate ≥175/min, with no AF at 12-lead ECG and no prior clinical AF) were retrospectively enrolled. The aims of this study were to describe patients' characteristics and the incidence of adverse events, and second, to identify potential predictors of the composite outcome of clinical AF and/or AHRE episodes lasting ≥24 h., Results: 104/107 (97.2%) patients (median age 79.7 (74.0-84.2), 33.7% female) had available follow-up data. Over a median follow-up of 24.3 (10.6-40.3) months, 31/104 (29.8%) patients experienced the composite outcome of clinical AF or AHRE episodes lasting ≥24 h. Baseline CHA
2 DS2 -VASc score and the longest AHRE episode at enrollment lasting 12 h-23 h 59 min were independently associated with the composite outcome (Hazard ratio (HR); 95% CI: 1.40; 1.07-1.83 and HR: 8.15; 95% CI 2.32-28.65, respectively). Baseline CHA2 DS2 -VASc score and the longest AHRE episode at enrollment lasting 12 h-23 h 59 min were the only independent predictors of incident clinical AF (HR: 1.45; 95% CI 1.06-2.00 and HR: 4.25; 95% CI 1.05-17.20, respectively)., Conclusions: In patients with AHRE, the incidence of clinical AF or AHRE episodes lasting ≥24 h is high in a two-year follow-up. Baseline patients' characteristics (CHA2 DS2 -VASc score) and AHRE duration may help to intensify monitoring and decision-making, being independently associated with clinical AF at follow-up.- Published
- 2022
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32. Case Report: Irreversible Watery Diarrhea, Severe Metabolic Acidosis, Hypokalemia and Achloridria Syndrome Related to Vasoactive Intestinal Peptide Secreting Malignant Pheochromocytoma.
- Author
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Negro A, Verzicco I, Tedeschi S, Campanini N, Zanelli M, Negri E, Farnetti E, Nicoli D, Palladini B, Santi R, Cunzi D, Calvi A, Coghi P, Gerra L, Volpi R, Graiani G, and Cabassi A
- Subjects
- Acidosis complications, Adrenal Gland Neoplasms complications, Adrenal Gland Neoplasms diagnosis, Adrenalectomy, Aged, Chromaffin Cells cytology, Diarrhea complications, Humans, Hypokalemia complications, Male, Peptides, Cyclic therapeutic use, Peripheral Nervous System Neoplasms, Radionuclide Imaging, Receptors, Somatostatin therapeutic use, Somatostatin analogs & derivatives, Somatostatin therapeutic use, Syndrome, Tomography, X-Ray Computed, Weight Loss, Acidosis diagnosis, Diarrhea diagnosis, Hypokalemia diagnosis, Pheochromocytoma physiopathology, Vasoactive Intestinal Peptide chemistry
- Abstract
Background: Pheochromocytoma (PHEO) clinical manifestations generally mirror excessive catecholamines secretion; rarely the clinical picture may reflect secretion of other hormones. Watery diarrhea, hypokalemia and achlorhydria (WDHA) is a rare syndrome related to excessive secretion of vasoactive intestinal peptide (VIP)., Clinical Case: A 73-year-old hypotensive man affected by adrenal PHEO presented with weight loss and watery diarrhea associated with hypokalemia, hyperchloremic metabolic acidosis (anion gap 15 mmol/l) and a negative urinary anion gap. Abdominal computed tomography scan showed a right adrenal PHEO, 8.1 cm in maximum diameter, with tracer uptake on
68 GaDOTA-octreotate positron emission tomography. Metastasis in lumbar region and lung were present. Both chromogranin A and VIP levels were high (more than10 times the normal value) with slightly elevated urine normetanephrine and metanephrine excretion. Right adrenalectomy was performed and a somatostatin analogue therapy with lanreotide started. Immunostaining showed chromogranin A and VIP co-expression, with weak somatostatin-receptor-2A positivity. In two months, patient clinical conditions deteriorated with severe WDHA and multiple liver and lung metastasis. Metabolic acidosis and hypokalemia worsened, leading to hemodynamic shock and exitus., Conclusions: A rare case of WDHA syndrome caused by malignant VIP-secreting PHEO was diagnosed. High levels of circulating VIP were responsible of the rapidly evolving clinical picture with massive dehydration and weight loss along with severe hyperchloremic metabolic acidosis and hypokalemia due to the profuse untreatable diarrhea. The rescue treatment with lanreotide was unsuccessful because of the paucity of somatostatin-receptor-2A on VIP-secreting PHEO chromaffin cells., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Negro, Verzicco, Tedeschi, Campanini, Zanelli, Negri, Farnetti, Nicoli, Palladini, Santi, Cunzi, Calvi, Coghi, Gerra, Volpi, Graiani and Cabassi.)- Published
- 2021
- Full Text
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33. [Acute kidney injury as a risk marker for hospital readmission: a single-center pilot study in the general population of the Parma area].
- Author
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Regolisti G, Gerra L, Di Mario F, Delsante M, Piotti G, Cantarelli C, Piotti G, Morabito S, Brambilla M, Cantaluppi V, Maggiore U, and Fiaccadori E
- Subjects
- Acute Kidney Injury therapy, Adult, Age Distribution, Aged, Aged, 80 and over, Hospital Mortality, Humans, Incidence, Italy, Middle Aged, Pilot Projects, Renal Replacement Therapy, Retrospective Studies, Risk, Treatment Outcome, Young Adult, Acute Kidney Injury epidemiology, Patient Readmission statistics & numerical data
- Abstract
Acute Kidney Injury (AKI) is an important issue for the healthcare system, as it is associated with high mortality and increased risk of readmission, with consequent elevated healthcare resource utilization. We investigated the incidence of AKI based on the examination of the discharge cards of all patients admitted between January 1 2011 and December 31 2015 at the Parma University Hospital, as well as the frequency and type of 30-day hospital readmission in the patients discharged with a first AKI diagnosis (index admission). The mean pooled 5-year incidence of AKI was 2.4%. The mean frequency of 30-day readmission for any disease in patients discharged with a first AKI diagnosis in the selected time interval was 23.1%/year. The main four disease categories, as assessed by the Diagnosis Related Group (DRG) classification, responsible for patient 30-day readmission were a new AKI episode, heart failure, respiratory failure requiring or not requiring mechanical ventilation, and sepsis. The mean lenght of hospital stay of patients discharged with AKI as a principal or secondary diagnosis was 14.4 and 21.8 days, respectively. Based on the evaluation of administrative data from all hospital admissions at the Parma University Hospital in the 2011-2015 5-year period, we conclude that AKI represents a serious challenge for the healthcare system, with high short-term morbidity and increased resource utilization due to frequent hospital readmissions., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)
- Published
- 2018
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