Publications by authors named "Annalisa De Silvestri"

166 Publications

Palliative treatment of endometrial cancer: what is the role of anastrozole in elderly women?

BMC Palliat Care 2021 Feb 5;20(1):28. Epub 2021 Feb 5.

Department of Obstetrics and Gynaecology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy.

Background: Type I endometrial cancer is the most common gynaecological tumour in developed countries and its incidence is increasing also because of population aging. The aim of this work is to test the feasibility and safety of anastrozole as palliative treatment of endometrial cancer in elderly women ineligible for standard surgical treatment.

Methods: Patients with histological diagnosis of type I endometrial cancer not suitable for surgical treatment were enrolled in this pilot study. Anastrozole was administered 1 mg daily orally after performing an accurate clinical and radiological staging. Validated questionnaire and self-reported outcomes were used to evaluate quality of life and compliance during the study period.

Results: Eight patients with a mean age of 85 (range 80-88 years) were enrolled. All patients had endometrial cancer confined to the uterus, and none progression of disease was observed during the study period. A partial response to the therapy was reported in seven patients, while one patient had stable disease. Tumour symptoms improvement such as pain, vaginal bleeding and vaginal discomfort was reported. The endometrial thickness after twelve months has showed a reduction of 9.25 ± 4.77 mm. The average follow-up time was 18.25 months. Four women died for non oncological reasons, none death related to endometrial cancer was reported. Evaluation of symptoms showed a significant reduction of appetite loss and insomnia, while a significant increase of global health status and fatigue was reported.

Conclusions: Our preliminary data suggested that the palliative use of anastrozole may be a suitable therapy for the proper management of early stages endometrial cancer in elderly women not suitable for surgical treatment with good compliance and tolerance.

Trial Registration: 2013000840. Date of registration: 21/09/2013. URL: trials.sanmatteo.loc .
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http://dx.doi.org/10.1186/s12904-021-00719-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863323PMC
February 2021

Oral melatonin as a new tool for neuroprotection in preterm newborns: study protocol for a randomized controlled trial.

Trials 2021 Jan 22;22(1):82. Epub 2021 Jan 22.

Child Neurology and Psychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy.

Background: Prevention of neurodevelopmental impairment due to preterm birth is a major health challenge. Despite advanced obstetric and neonatal care, to date there are few neuroprotective molecules available. Melatonin has been shown to have anti-oxidant/anti-inflammatory effects and to reduce brain damage, mainly after hypoxic ischemic encephalopathy. The planned study will be the first aiming to evaluate the capacity of melatonin to mitigate brain impairment due to premature birth.

Method: In our planned prospective, multicenter, double-blind, randomized vs placebo study, we will recruit, within 96 h of birth, 60 preterm newborns with a gestational age ≤ 29 weeks + 6 days; these infants will be randomly allocated to oral melatonin, 3 mg/kg/day, or placebo for 15 days. After the administration period, we will measure plasma levels of malondialdehyde, a lipid peroxidation product considered an early biological marker of melatonin treatment efficacy (primary outcome). At term-equivalent age, we will evaluate neurological status (through cerebral ultrasound, cerebral magnetic resonance imaging, vision and hearing evaluations, clinical neurological assessment, and screening for retinopathy of prematurity) as well as the incidence of bronchodysplasia and sepsis. We will also monitor neurodevelopmental outcome during the first 24 months of corrected age (using the modified Fagan Test of Infant Intelligence at 4-6 months and standardized neurological and developmental assessments at 24 months).

Discussion: Preterm birth survivors often present long-term neurodevelopmental sequelae, such as motor, learning, social-behavioral, and communication problems. We aim to assess the role of melatonin as a neuroprotectant during the first weeks of extrauterine life, when preterm infants are unable to produce it spontaneously. This approach is based on the supposition that its anti-oxidant mechanism could be useful in preventing neurodevelopmental impairment. Considering the short- and long-term morbidities related to preterm birth, and the financial and social costs of the care of preterm infants, both at birth and over time, we suggest that melatonin administration could lead to considerable saving of resources. This would be the first study addressing the role of melatonin in very low birth weight preterm newborns, and it could provide a basis for further studies on melatonin as a neuroprotection strategy in this vulnerable population.

Trial Registration: ClinicalTrials.gov NCT04235673 . Prospectively registered on 22 January 2020.
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http://dx.doi.org/10.1186/s13063-021-05034-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820522PMC
January 2021

Th17 and Treg Balance in Children With Obesity and Metabolically Altered Status.

Front Pediatr 2020 19;8:591012. Epub 2020 Nov 19.

Cell Factory, Pediatric Hematology Oncology Unit, Immunology and Transplantation Laboratory, Department of Maternal and Children's Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia, Italy.

Chronic low-grade inflammation and activation of the immune system are hallmark pathogenic mechanisms involved in metabolic dysfunction and are related to obesity. In particular, the involvement of regulatory and pro-inflammatory lymphocyte subpopulations has been reported in adults. We evaluated the Th17/Treg lymphocyte balance in obese and normal weight children, in relation with their metabolic status. We enrolled 50 pediatric patients. According to metabolic status, subjects were classified into: metabolically healthy (MH) and metabolically unhealthy (MU) groups. MU phenotype was defined as the presence of at least one of the following risk factors: blood pressure >90th percentile, glycemia>100 mg/dl, HDL cholesterol <40 mg/dl, triglycerides>100 mg/dl (<10 years) or >130 mg/dl (>10 years), impaired insulin sensitivity with HOMA-IR>97.5th percentile. Patient Treg and Th17 profiles were also evaluated. Based on the presence of metabolic and/or cardiovascular pathological parameters, we classified 15 MU (30%) and 35 MH (70%) children; all MU children were obese. Analyzing the correlations between lymphocyte subpopulations and metabolic data, we noted a correlation between Th17 percentage and systolic hypertension ( = 0.01, = -0.37); Treg/Th17 ratio and HOMA-IR ( = 0.02, = 0.32) and systolic hypertension ( = 0.05, = 0.30). Children with obesity have a high risk of developing metabolic and cardiovascular complications. The Th17/Treg lymphocyte balance appears to be involved in glycemic homeostasis and blood pressure control. Careful and early monitoring of the immune system would facilitate new early preventive strategies in pediatric metabolic diseases.
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http://dx.doi.org/10.3389/fped.2020.591012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710792PMC
November 2020

Esophageal Atresia: Nutritional Status and Energy Metabolism to Maximize Growth Outcome.

Children (Basel) 2020 Nov 14;7(11). Epub 2020 Nov 14.

Pediatric Department, "V. Buzzi" Children's Hospital, 20157 Milano, Italy.

Background: Long-term negative sequelae of esophageal atresia (EA) may induce poor growth and impaired nutritional status in childhood. We describe the nutritional profile and energy metabolism of children with repaired EA to identify malnutrition risk factors and optimize growth management.

Methods: Twenty-one children (>4 years) were included, and anthropometric measurements, nutritional assessment, and energy metabolism were considered. The subjects were defined as undernourished if they met BMI < -2 standard deviation (SD). To grade undernutrition, we defined the prevalence of underweight, stunting, and wasting (cut-off level of <-2 SD). Medical records were reviewed for the type of EA and surgery and perinatal data.

Results: Malnutrition was detected in 28.6% of children. Underweight was detected in 23.8% of patients (all with undernutrition < 0.01). Wasting was noted in 28.6% of patients, of these 5 children were undernourished ( < 0.001) and stunting was noticed in only one patient with malnutrition ( = 0.5). Resting expenditure energy (REE) was lower in undernourished subjects compared to subjects with adequate nutritional status ( < 0.001). Malnutrition was associated to: type of EA ( = 0.003, particularly type A and C); intervention including deferred anastomosis due to long-gap repair ( = 0.04) with/or without jejunostomy ( = 0.02), gastric pull-up ( = 0.04), primary anastomosis ( = 0.04), pyloromyotomy in long-gap ( < 0.01); small for gestational age condition ( = 0.001).

Conclusions: undernutrition risk factors, beyond the type of malformation, surgery, and perinatal factors, must be early considered to personalize nutritional programming. Energy metabolism is important to monitor the nutritional requirements. The management of nutritional issues is surely a contributory factor able to counteract the poor growth of children with EA.
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http://dx.doi.org/10.3390/children7110228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696161PMC
November 2020

Adenoidectomy: Anatomical variables as predictive factors of intraoperative adenoid residues.

Int J Pediatr Otorhinolaryngol 2021 Jan 11;140:110493. Epub 2020 Nov 11.

Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Objectives: Adenoid hypertrophy is a common cause of upper airway obstruction in children. However, after adenoidectomy, nasal obstructive symptoms may persist or recur, requiring surgical revision. The aim of this study is to evaluate if individual patient features can influence the efficacy of the traditional technique.

Methods: A retrospective observational study was conducted by recruiting patients from candidates for adenoidectomy. All children underwent conventional transoral curettage adenoidectomy with endoscopic control at the end of procedure, and in presence of adenoid residues, a concomitant revision adenoidectomy was performed. For each patient, the following data were collected: age, sex, weight, height, length of the soft palate and surgical technique used.

Results: In 18% of patients (113/612), the most critical areas of the nasopharynx were not reached by standard surgery, making a complete adenoidectomy difficult. In this group, the average length of the soft palate was 3.1 cm, 5 mm more than the average of the sample, and 6 mm more than the average length of patients undergoing standard surgery alone (p < 0.001).

Conclusion: Our study confirms the hypothesis that a greater length of the soft palate conditions the results of the intervention. The length of the soft palate can be considered an intraoperative criterion to select the cases in which perform endoscopic control after the standard procedure.
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http://dx.doi.org/10.1016/j.ijporl.2020.110493DOI Listing
January 2021

Sézary Syndrome: a clinico-pathological study of 9 cases and review of the literature.

G Ital Dermatol Venereol 2020 Oct 21. Epub 2020 Oct 21.

Unit of Dermatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy -

Background: Sézary Syndrome (SS) is a rare and aggressive variant of cutaneous T-cell lymphoma characterized by erythroderma, generalized lymphadenopathy and atypical lymphocytes in peripheral blood. The aim of the study is to describe our experience with SS patients.

Methods: 9 SS patients were retrospectively identified within 288 patients with cutaneous Tcell lymphomas (CTCLs) followed from 1977 to 2017 in the Unit of Dermatology, IRCCS Policlinico San Matteo Foundation, Pavia.

Results: 9 SS patients were described: 5 males and 4 females, mean age at diagnosis 66.1 years (49-87 ys), overall survival (OS) after SS diagnosis was 2.6 years (31.5 ms). All the patients showed erythroderma, pruritus and lymphadenopathy. Palmo-plantar hyperkeratosis, nail lesions, alopecia and ectropion were also present. One patient was excluded for significative differences in management. Three lines treatment -extracorporeal photopheresis plus immunomodulator/s plus photo-photochemotherapy- was the most used first-line option for induction of remission, reached in 4 patients out of 8: 3 with Complete Remission (CR), 1 with Partial Remission (PR). Prognostic variables were investigated by univariate analysis: hypereosinophilia, highly elevated β2μglobulin >3500 μg/l, male sex and highly elevated LDH >450 U/l resulted with statistical power.

Conclusions: The improved comprehension of SS pathogenesis is progressively increasing the -still poor- survival: 38.5 months (3.2 years) considering only the 6 patients followed in the last five years, versus overall 31.5 months (2.6 years). The correct identification of SS patients remains determinant for the proper overall management. Among unfavorable prognostic markers, levels of β2μglobulin allow stratification of patients.
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http://dx.doi.org/10.23736/S0392-0488.19.06403-4DOI Listing
October 2020

Psoriatic patients undergoing long-term therapy with biologics: Impact of residual localization of psoriasis on quality of life in an Italian clinical setting.

Dermatol Ther 2020 11 3;33(6):e14337. Epub 2020 Oct 3.

Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.

Residual psoriasis characterizes body sites resistant to biologic drugs. Some affected body sites exert disproportionate impact on patients' quality of life. The aim was to localize residual psoriasis in patients treated with biologics for at least 6 months, and to study the correlation between lesional localization and patients' quality of life. Current Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) were assessed. Quality of life was obtained by measuring Dermatology Life Quality Index (DLQI). An observational retrospective study was designed. Seventy-five psoriatic patients were included (59 males, 78.67%, mean age 52.45 ± 11.83 years). The overall median current PASI was 0 (Interquartile Range IQR 0-4). The overall median current NAPSI was 0 (IQR 0-0) and DLQI was 0 (IQR 0-1). The commonest sites of residual psoriasis were elbows (41.33%; 95% confidence interval [CI]: 2.502-38.9), followed by anterior lower legs (33.33%; 95% CI 2.097-23.8) and forearms (29.33%; 95% CI 1.019-10.1). Statistical significance between DLQI and forearm, dorsal hand and abdomen was observed. Sites traditionally regarded as difficult-to-treat were rarely affected by residual lesions and showed relatively limited impact on quality of life.
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http://dx.doi.org/10.1111/dth.14337DOI Listing
November 2020

Microbiota in -Associated Diarrhea: Comparison in Recurrent and Non-Recurrent Infections.

Biomedicines 2020 Sep 8;8(9). Epub 2020 Sep 8.

Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.

infection (CDI) is the leading cause of antibiotic-associated diarrhea, especially in hospitalized elderly patients, representing a global public health concern. Clinical presentations vary from mild diarrhea to severe pseudomembranous colitis that may progress to toxic megacolon or intestinal perforation. Antibiotic therapy is recognized as a risk factor and exacerbates dysbiosis of the intestinal microbiota, whose role in CDI is increasingly acknowledged. A clinically challenging complication is the development of recurrent disease (rCDI). In this study, using amplicon metagenomics, we compared the fecal microbiota of CDI and rCDI patients (sampled at initial and recurrent episode) and of non-infected controls. We also investigated whether CDI severity relates to specific microbiota compositions. rCDI patients showed a significantly decreased bacterial diversity as compared to controls ( < 0.01). The taxonomic composition presented significant shifts: both CDI and rCDI patients displayed significantly increased frequencies of , , , , and . and, within it, displayed opposite behaviors in CDI and rCDI, appearing discriminant between the two. Finally, the second episode of rCDI was characterized by significant shifts of unclassified , and . No peculiar taxa composition correlated with the severity of infection, likely reflecting the role of host-related factors in determining severity.
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http://dx.doi.org/10.3390/biomedicines8090335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554755PMC
September 2020

Phenotypic spectrum of short-chain enoyl-Coa hydratase-1 (ECHS1) deficiency.

Eur J Paediatr Neurol 2020 Sep 29;28:151-158. Epub 2020 Jul 29.

Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy. Electronic address:

Introduction: ECHS1 encodes for short-chain enoyl-CoA hydratase, a key component in b-oxidation. This enzyme is also involved in the isoleucine and valine catabolic pathways. The literature contains reports of scattered cases of ECHS1 mutation, which show a wide clinical spectrum of presentation. Despite that the clinical spectrum of the disease has not been defined so far due to the absence of previous systematic reviews and descriptions of large series of patients.

Methods: We performed a systematic literature review of so far reported ECHS1 mutated patients and we reported two additional cases. We pointed out clinical and neuroradiological features of all patients.

Results: 45 patients were included in the analysis. Based on clinical and neuroradiological feature we were able to distinguish four main phenotypes of ECHS1deficiency: a severe neonatal presentation with a rapid and fatal course and significant white matter abnormalities; a severe infantile variant with slower neurological deterioration, developmental delay, pyramidal and extrapyramidal signs, optic atrophy, feeding difficulties, and degeneration of the deep gray nuclei; a slowly progressive infantile form, qualitatively similar to the previous phenotype, but less severe with mainly basal ganglia involvement; and a final phenotype, present in only few cases, characterized by paroxysmal exercise-induced dystonic attacks, normal neurological examination between these episodes, and isolated pallidal degeneration on MRI.

Interpretation: ECHS1 mutations cause metabolic encephalopathy with a wide range of clinical presentations that can be grouped into four main phenotypes, each with a distinct profile in terms of severity on clinical presentation, disease course and MRI involvement.
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http://dx.doi.org/10.1016/j.ejpn.2020.07.007DOI Listing
September 2020

The Mont Blanc Study: The effect of altitude on intra ocular pressure and central corneal thickness.

PLoS One 2020 7;15(8):e0237343. Epub 2020 Aug 7.

University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

The aim of the Mont Blanc Study was to investigate the relationship between intraocular pressure (IOP), central corneal thickness (CCT), and altitude in healthy subjects. Thirty-three eyes of 33 healthy volunteers (mean age: 24.8 years, 17 females) had their IOP measured with Perkins and I-Care tonometers and their CCT using ultrasound pachymetry at three locations in Italy with different altitudes: Pavia, (PV), 77 meters above sea level (a.s.l); Courmayeur (CM), 1300 meters a.s.l; Pointe Helbronner (PH), 3466 meters a.s.l.). The measurements were performed at 9 am, 11 am, 1 pm and 3 pm (±30') in indoor settings (mean temperature of 19°C) in PV and PH. At 9 am, CCT and IOP were measured outdoor (mean temperature of -1.4°C) at PH. The mean values of the IOP curve decreased from PV to PH with the Perkins (p = 0.02) and I-Care tonometers (p = 0.001). Instead, CCT increased upon ascension from PV to PH (p = 0.01), and from CM to PH (p = 0.002). When exposed to sub-zero temperature, the IOP increased (p<0.001), while the CCT did not change (p = 0.30). The results suggest that IOP significantly decreased and CCT significantly increased upon ascension from the sea level to higher altitudes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237343PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413504PMC
October 2020

Emergency accesses in Dermatology Department during the Covid-19 pandemic in a referral third level center in the north of Italy.

Dermatol Ther 2020 Nov 2;33(6):e14027. Epub 2020 Sep 2.

Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, IRCCS Fondazione Policlinico San Matteo, Pavia, PhD Experimental Medicine, University of Pavia, Pavia, Italy.

During the lockdown period, most planned visits have been postponed and the number of accesses to emergency department (ED) has dramatically reduced. The aim of our study is to analyze the impact of the lockdown on the number, type, and severity of Dermatological ED diagnosis. We performed a retrospective review of all dermatological consultations in the ED of IRCSS San Matteo during the lockdown period in Italy (February 22-May 3 2020) and compared them with those from the same period in 2019. We noticed a sharply reduction in the number of dermatological consultations requested in the ED: from 164 patients in 2019 to 33 in 2020. Some diagnostic categories showed a significant difference with a higher incidence of vasculopathic lesions (0.6% vs 12.1%, P < .0001), urticarial rashes (8.5% vs 21.2%, P = .03), and scabies (3% vs 12.1%, P = .023). We observed an increase in the proportion of patients starting medications, before coming to the ED 26.2% in 2019 vs 66.7% in 2020 (P < .001). Furthermore, we noticed a significant increase in the average complexity of cases presenting to the ED in 2020, as proven by the increased need for biopsies and systemic therapy.
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http://dx.doi.org/10.1111/dth.14027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404501PMC
November 2020

Role of endobronchial ultrasound strain elastography in the identification of fibrotic lymph nodes in sarcoidosis: A pilot study.

Respirology 2020 Nov 12;25(11):1203-1206. Epub 2020 Jul 12.

Department of Pulmonology, Radboudumc, Nijmegen, The Netherlands.

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http://dx.doi.org/10.1111/resp.13900DOI Listing
November 2020

Timing, prevalence, and dynamics of thyroid disorders in children and adolescents affected with Down syndrome.

J Pediatr Endocrinol Metab 2020 Jul;33(7):885-891

Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.

Objectives Limited data on the evolution of thyroid disorders (TD) in Down syndrome (DS) are available. We characterized the timing, prevalence, and dynamics of TD in patients with DS during a long-term follow-up. Methods We retrospectively evaluated 91 children and adolescents with DS (12.5 ± 8.3; follow-up 7.5 ± 6.2). Children were monitored at birth, 6, and 12 months of age and twice a year thereafter. Thyroid status and autoimmunity were periodically investigated. Results TD were detected in 73.6% of patients, in particular congenital hypothyroidism (CH), autoimmune thyroid diseases (ATD) and subclinical hypothyroidism (SH) were recorded in 16.4, 31.8, and 25.3%, respectively. CH was diagnosed at newborn screening in 86.7% of cases and in the first 6 months of life in the remaining 13.3%; the condition was persistent in 61.5% of patients. In more than 30% of CH cases, glandular hypoplasia was also revealed. In the ATD group, 63.1% of patients with Hashimoto's disease (HD, 82.6%) were treated with levothyroxine and subjects with Graves' Disease (GD, 17.4%) started therapy with methimazole. DS with SH were treated in 42.1% of cases. A thyroid hypogenic echopattern, without autoantibody positivity was identified in 27.6% of SH patients. Conclusions The high prevalence and evolution of TD in SD requires frequent monitoring starting in the first months of life. CH can be misdiagnosed at screening. In DS subjects, there is a high prevalence of ATD and non-autoimmune diseases with early antibody-negative phases should not be excluded.
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http://dx.doi.org/10.1515/jpem-2020-0119DOI Listing
July 2020

The impact of covid-19 pandemic on urgent endoscopy in Italy: a nation-wide multicenter study.

Scand J Gastroenterol 2020 07 2;55(7):870-876. Epub 2020 Jul 2.

Gastrointestinal Unit, ASST Fatebenefratelli Sacco, Department of Biochemical and Clinical Sciences, University of Milan, Italy.

COVID-19 pandemic has seriously affected Italy. Radical changes occurred in the Italian NHS and thus in GI departments, as only urgent endoscopies were guaranteed. The study aimed to report how the demand for urgent endoscopy changed during the COVID-19 pandemic in Italy and to evaluate the appropriateness of urgent referrals in the Endoscopy Unit. Nation-wide, cross-sectional survey study in 54 Italian GI Units. Data were collected regarding urgent endoscopies (EGD, CS, ERCP) in two different time periods: March 2019 and March 2020. Thirty-five (64.8%) GI endoscopy Units responded to the survey. The entity of reduction of overall urgent EGDs and CSs performed in March 2020 versus March 2019 was statistically significant: 541 versus 974 (-80%),  < .001 for EGD and 171 versus 265 (-55%),  < .008, for CS, respectively. No statistically significant reduction of urgent ERCP performed in March 2020 versus March 2019 was found. The increase in overall diagnostic yield for urgent EGD in March 2020 versus March 2019 was 7.3% (CI [0.028-0.117],  = .001). No statistically significant difference in diagnostic yield for CS between 2019 and 2020 was found. The study showed a statistically significant reduction of urgent EGD and CS performed during the SARS-CoV-2 pandemic, in March 2020, compared to March 2019. The diagnostic yield of urgent EGD performed in March 2020 was significantly higher than that of March 2019. No statistically significant difference was found in terms of diagnostic yield of urgent CS between March 2020 and March 2019.
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http://dx.doi.org/10.1080/00365521.2020.1782466DOI Listing
July 2020

Lights and shadows of SARS-CoV-2 infection risk assessment in endoscopy.

Dig Liver Dis 2020 08 13;52(8):816-818. Epub 2020 Jun 13.

Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.dld.2020.06.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293506PMC
August 2020

Oral vitamin A supplementation for ROP prevention in VLBW preterm infants.

Ital J Pediatr 2020 Jun 3;46(1):77. Epub 2020 Jun 3.

Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Vitamin A administration may decrease any stage of retinopathy of prematurity (ROP) in preterm infants. To evaluate whether vitamin A oral supplementation could be preventive in ROP incidence and severity in VLBW infants, we compared results from 31 preterm infants, (< 1500 g or < 32 weeks) who, during a previous investigation, prospectively received 3000 UI/kg/die oral retinol palmitate drops, for 28 days, with 31 matching preterm newborns hospitalized in our NICU the same period, as control group. Although ROP incidence was similar, in the supplemented group, we had 9 cases of ROP grade 1, no ROP grade ≥ 2, in the un-supplemented group, 4 cases of ROP grade 1 and 6 ROP grade ≥ 2 (p = 0.018). The percentage of babies requiring treatment for ROP was 0 in treated and 16.6 in the un-treated group (p = 0.020). Moreover, Vitamin A administration showed a protective effect with an 88% risk reduction of developing severe ROP. Since vitamin A parenteral/IM administration presents some awareness, the results of this investigation may be important to plan further trials to confirm the usefulness of oral administration in mitigating the ROP severity of VLBW infants.ClinicalTrials.gov NCT02102711; may 03/06/2014.
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http://dx.doi.org/10.1186/s13052-020-00837-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268228PMC
June 2020

Plasma from donors recovered from the new Coronavirus 2019 as therapy for critical patients with COVID-19 (COVID-19 plasma study): a multicentre study protocol.

Intern Emerg Med 2020 08 28;15(5):819-824. Epub 2020 May 28.

Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Since the end of 2019, a new coronavirus strain has been reported in the Chinese province of Wuhan, indicated as 2019-nCoV or SARS-CoV-2. In February 2020, the first case of transmission on Italian soil was reported. On March 09, 2020, at the time of protocol design, the Italian Ministry of Health reported 10,149 people who had contracted the virus; of these, 8514 were positive, of which 5038 were hospitalized with symptoms (59.2%) and 877 in intensive care (10.3%), while the remaining 2599 were in home isolation; 631 were deceased (6.2%) and 1004 healed (9.9%). To date there are no studies in the literature that demonstrate its feasibility and efficacy in the context of the worldwide SARS-CoV-2 epidemic. Based upon the little existing evidence, we planned to assess the efficacy of the infusion of hyperimmune plasma in COVID-19 patients in a one-arm proof-of-concept clinical trial. The primary objective of our study is to evaluate the efficacy of the administration of plasma taken from convalescent donors of COVID-19 to critically ill patients with COVID-19 in terms of their survival. Death from any cause will be considered. The main limit of this study is its one-arm proof-of-concept design with only 43 patients enrolled. However, in the absence of previous evidence, larger and/or randomized trials did not appear to be ethically acceptable. Moreover, the results from this study, if encouraging, will allow us to plan further informed large clinical trials. Trial registration: NCT04321421 March 23, 2020.
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http://dx.doi.org/10.1007/s11739-020-02384-2DOI Listing
August 2020

Interobserver agreement between pathologist, pulmonologist and molecular pathologist to estimate the tumour burden in rapid on-site evaluation smears from endosonography and guided bronchoscopy.

Cytopathology 2020 07;31(4):303-309

Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi & Ospedale Maggiore, Bologna, Italy.

Objective: A growing number of studies have suggested that non-pathologists can reliably assess the adequacy and malignancy in rapid on-site evaluation (ROSE) smears prepared during endoscopic sampling procedures. However, no study has verified whether they can also consistently estimate the tumour burden, which is critical for the molecular profiling of lung cancer. We aimed to assess the interobserver agreement (IOA) between a pathologist, a pulmonologist (previously trained in lung and lymph node cytopathology) and a molecular pathologist for the tumour burden in ROSE smears.

Methods: The ROSE smears of consecutive patients with suspected lung cancer undergoing endosonography or guided bronchoscopy were assessed independently by a pathologist, a pulmonologist and a molecular pathologist (gold standard). The IOA for the tumour burden, assessed through k-statistics, was the primary outcome.

Results: A total of 322 ROSE smears obtained from 162 patients were evaluated. The IOA between the molecular pathologist and pulmonologist was very good (moderate to substantial), although slightly inferior to the IOA between the molecular pathologist and pathologist in the whole slide set (k: 0.707, 95% confidence interval [CI]: 0.677-0.739 vs 0.793, 95% CI: 0.762-0.815), as well as in smears prepared from lymphadenopathy (k: 0.783, 95% CI: 0.760-0.855 vs 0.827, 95% CI: 0.728-0.892) or from pulmonary nodules/masses (k: 0.558, 95% CI: 0.416-0.686 vs 0.715, 95% CI: 0.621-0.767).

Conclusions: A professionally trained pulmonologist can reliably estimate the tumour burden in bronchoscopically derived ROSE smears, especially in the setting of lymphadenopathy. This can be particularly useful in institutions where a cytopathologist is not available regularly.
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http://dx.doi.org/10.1111/cyt.12867DOI Listing
July 2020

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing.

Front Pediatr 2020 8;8:203. Epub 2020 May 8.

Pediatric Unit, Department of Internal Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder (GB) pathologies. We evaluated clinical, ultrasonographic (US) data as well as histopathological findings in children affected with symptomatic cholecystic disease (SCD) who underwent LC, with the aim of defining surgical timing. We reviewed our cases who underwent elective LC (ELC) or urgent LC (ULC). Clinical, US, surgical and histological features were used to create different risk scores. We considered 26 children (17 ELC/9 ULC). US signs were not different in the two groups ( > 0.05). Operating times were longer in ELC than in ULC ( = 0.01). Histopathological evaluation revealed fibrosis and atrophy in both ELC and ULC. The clinical risk score was higher in ELC compared to ULC ( < 0.001). An increased operative risk score was noted in patients with systemic inflammatory signs (OR1.98), lithotherapy (OR1.4.3) and wall thickening ≥3 mm (OR2.6). An increased histopathological risk score was detected in children with symptom duration >7 days (OR3.61), concomitant hematological disease (OR1.23) and lithotherapy (OR3.61). Criteria adopted in adults cannot be adopted to detect the severity of GB damage in children. A dedicated clinical and US score is mandatory to define the most appropriate surgical timing.
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http://dx.doi.org/10.3389/fped.2020.00203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225274PMC
May 2020

Gender Differences at the Onset of Autoimmune Thyroid Diseases in Children and Adolescents.

Front Endocrinol (Lausanne) 2020 17;11:229. Epub 2020 Apr 17.

Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.

The incidence of autoimmune thyroid diseases (ATD) may vary with the beginning of reproductive function, although few reports differentiate the incidence before and during the onset of puberty, examining gender bias. We analyzed onset of ATD in a pediatric population to assess gender differences in onset age, disease subtype, pubertal status, autoimmune co-morbidity, family history and treatment, focusing on the interaction between gender and pubertal stage. We retrospectively recorded 382 children and adolescents with ATD. In each patient physical examination was considered. The presence of other associated autoimmune diseases (AAD) and familial predisposition was also recorded. Predominant prevalence was noted in females compared to males ( < 0.001), both in Hashimoto's diseases (HD or HT) and Graves' disease (GD) ( < 0.001). Mean age at diagnosis showed no significant difference between sexes ( > 0.05). A higher prevalence in pubertal subjects was noted compared to prepubertal ( < 0.001, particularly HT in early and GD in late pubertal stage), without sexes difference intra-(prepubertal vs. pubertal) and inter-puberty groups (prepubertal vs. early pubertal vs. late pubertal). Both in HT and in GD, the prevalence of autoimmune associated diseases (AAD) was higher in males compared to females ( = 0.04), with similar distribution according to the pubertal maturation. The familial predisposition was similarly distributed in both genders ( > 0.05) and into pubertal stages ( > 0.05). Females are more prone to develop ATD during puberty, earlier in HT than in GD. The effect of puberty is not different between genders, suggesting the role of additional factors other than hormones. The screening for detection of ATD is recommended in all patients with positive family history and other autoimmune diseases, mostly in males. Considerations of gender in pediatrics could be important to define pathogenic mechanisms of ATD and to help in early diagnosis and clinical management.
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http://dx.doi.org/10.3389/fendo.2020.00229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181383PMC
April 2020

Clinical phenotype and mortality in patients with idiopathic small bowel villous atrophy: a dual-centre international study.

Eur J Gastroenterol Hepatol 2020 08;32(8):938-949

Istituti Clinici Scientifici Maugeri, IRCCS, Gastroenterology Unit of Pavia Institute, University of Pavia, Pavia, Italy.

Objective: Causes of small-bowel villous atrophy (VA) include coeliac disease (CD), its complications and other rare non-coeliac enteropathies. However, forms of VA of unknown aetiology may also exist. We defined them as idiopathic VA (IVA). To retrospectively classify the largest cohort of IVA patients and compare their natural history with CD.

Methods: Notes of 76 IVA patients attending two tertiary centres between January 2000 and March 2019 were retrospectively reviewed. CD, its complications and all the known causes of VA were excluded in all of them. Persistence of VA during follow-up and lymphoproliferative features were used to retrospectively classify IVA, as follows. Group 1: IVA with spontaneous histological recovery (50 patients). Group 2: persistent IVA without lymphoproliferative features (14 patients). Group 3: persistent IVA with lymphoproliferative features (12 patients). Survival was compared between IVA groups and 1114 coeliac patients. HLA was compared between IVA patients, coeliac patients and appropriate controls.

Results: Five-year survival was 96% in IVA group 1, 100% in IVA group 2, 27% in IVA group 3 and 97% in CD. On a multivariate analysis hypoalbuminemia (P = 0.002) and age at diagnosis (P = 0.04) predicted mortality in IVA. Group 2 showed association with HLA DQB1*0301 and DQB1*06.

Conclusion: IVA consists of three groups of enteropathies with distinct clinical phenotypes and prognoses. Mortality in IVA is higher than in CD and mainly due to lymphoproliferative conditions necessitating more aggressive therapies.
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http://dx.doi.org/10.1097/MEG.0000000000001726DOI Listing
August 2020

Carrier frequency of HLA-DQB1*02 allele in patients affected with celiac disease: A systematic review assessing the potential rationale of a targeted allelic genotyping as a first-line screening.

World J Gastroenterol 2020 Mar;26(12):1365-1381

Scientific Direction, Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy.

Background: Celiac Disease (CD) is an immune-mediated disorder, in which the HLA immunogenetic background (DQ2 and DQ8 heterodimers) and environmental trigger (gluten) are well established. Indeed, both factors are necessary - but not sufficient - to develop CD. However, it is very likely that CD is underdiagnosed in both developing and developed countries, due to several aspects, including the fact that a lot of patients present mild and/or atypical symptoms, without the presence of any recognized risk factors. Therefore, the possibility and feasibility of widened screening strategies to identify CD patients are debated.

Aim: To provide further evidence of the main epidemiological importance of HLA-DQB1*02 allele in the population of CD patients.

Methods: We performed a systematic search in PubMed, EMBASE, Cochrane, Web of Science and Scopus databases, in order to produce a systematic review assessing the carrier frequency of HLA-DQB1*02 allele in the celiac population. Following the PRISMA guidelines, we retrieved all the original articles describing CD patients' HLA-DQB1 genotype in such a way that could allow to assess the HLA-DQB1*02 carrier frequency among CD patients, along with the evidence of the appropriate diagnostic work-up to achieve a correct and final diagnosis of CD.

Results: The final output of this systematic search in the medical literature consisted of 38 studies providing the appropriate HLA-DQB1 genotype information of the respective CD population. According to this systematic review, including a pool of 4945 HLA-DQ genotyped CD patients, the HLA-DQB1*02 carrier frequency was 94.94%, meaning that only 5.06% of CD patients were completely lacking this allelic variant. Interestingly, if we consider only the studies whereby the prevalence of CD patients affected with type 1 diabetes mellitus was supposed or clearly established to be very low, the frequency of non-HLA-DQB1*02 carriers among CD patients dropped to 3.65%.

Conclusion: Such a high carrier frequency of the HLA-DQB1*02 allelic variant (which is > 95%-96% in CD patients without risk factors, like type 1 diabetes mellitus comorbidity) might be exploited to consider a cost-effective and widened screening approach. If a sustainable strategy could be implemented through a low-cost targeted genetic test to detect the individual presence of HLA-DQB1*02 allele, an appropriate algorithm for serological screening in individuals resulting to be genetically predisposed to CD, might be considered.
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http://dx.doi.org/10.3748/wjg.v26.i12.1365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7109277PMC
March 2020

Baseline Amino Acid Substitutions in the NS5A ISDR and PKR Binding Domain of Hepatitis C and Different Fibrosis Levels and Levels of Development of Hepatocellular Carcinoma in Patients Treated with DAAs.

Viruses 2020 02 25;12(3). Epub 2020 Feb 25.

Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.

Variations in the interferon sensitivity-determining region (ISDR) within the NS5A region were related to the development of hepatocellular carcinoma (HCC) in patients infected with hepatitis C virus (HCV). The aim of the study was to investigate a relationship between ISDR/PKR substitutions and their association with liver fibrosis or HCC development. A total of 316 patients infected with HCV and treated with DAAs were evaluated. HCV RNA was quantified and sequenced before treatment. The liver fibrosis stage was assessed by transient elastography and equalized to METAVIR scores. Multivariate analysis showed that ≥3 substitutions in ISDR and ≥6 in PKR-bd were significantly associated with advanced fibrosis. Advanced fibrosis was observed in patients with higher substitutions in ISDR and PKR-bd. A higher correlation between advanced fibrosis and a high frequency of ≥3 substitutions in ISDR and ≥6 in PKR-bd was observed in patients infected with genotype 2c. In addition, in a higher proportion of HCC patients, advanced fibrosis (40.4% vs. 88.2%; < 0.001) and ≥6 substitutions in PKR-bd (15.4% vs. 41.2%; = 0.01) was observed. In conclusion, a higher number of substitutions in ISDR and PKR-bd were associated with advanced liver fibrosis, suggesting a use of like predictors for progression in the liver damage. A significantly higher number of PKR-bd substitutions was observed in HCC patients; in particular, in patients infected with HCV genotype 2c.
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http://dx.doi.org/10.3390/v12030255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150791PMC
February 2020

Epidemiology of Nonesophageal Eosinophilic Gastrointestinal Diseases in Symptomatic Patients: A Systematic Review and Meta-Analysis.

J Allergy Clin Immunol Pract 2020 06 28;8(6):1994-2003.e2. Epub 2020 Feb 28.

Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.

Background: Primary eosinophilic gastrointestinal diseases (EGIDs) are increasingly described disorders that include eosinophilic esophagitis (EoE), eosinophilic gastritis, gastroenteritis, and colitis. The exact epidemiology of nonesophageal EGIDs (non-EoE EGIDs) is still unclear.

Objective: To evaluate the epidemiology of non-EoE EGIDs in adults and children referred to outpatient clinics for gastrointestinal symptoms.

Methods: We conducted a systematic review and meta-analysis using a protocol registered and published with the international prospective register of systematic reviews (PROSPERO CRD42018111437). We searched PubMed, EMBASE, Web of Science, Scopus, and CINAHL for cohort or cross-sectional studies published since 1990, evaluating the incidence and prevalence of non-EoE EGIDs. We assessed study quality and risk of bias using items derived from the Strengthening the Reporting of Observational Studies in Epidemiology statement.

Results: A total of 576 articles were identified. Ten studies with 13,377 participants were included in the analysis, with the results showing high heterogeneity. No significant publication bias was found. The overall prevalence of non-EoE EGIDs in patients with gastrointestinal symptoms was 1.9% (95% confidence interval: 0.575-3.894; I = 92.72%; P < .001). Because none of the examined studies were prospectively designed, incidence rates could not be determined.

Conclusions: More prospective, large-scale, multicenter studies are needed to evaluate reported data and to further investigate the epidemiology of non-EoE EGIDs and their possible risk factors and comorbidities.
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http://dx.doi.org/10.1016/j.jaip.2020.01.060DOI Listing
June 2020

A proposal for a semiquantitative scoring system for lymphedema using Non-contrast Magnetic Resonance Lymphography (NMRL): Reproducibility among readers and correlation with clinical grading.

Magn Reson Imaging 2020 05 10;68:158-166. Epub 2020 Feb 10.

Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy.

Purpose: To assess the ability and reproducibility of Non-contrast Magnetic Resonance Lymphography (NMRL) in detecting and quantify lymphedema, using a semiquantitative scoring system.

Methods And Material: This is a monocentric retrospective study of 134 consecutive patients with a clinical diagnosis of limb lymphedema who performed a Non-contrast Magnetic Resonance Lymphography (NMRL) at our Institution between November 2014 and February 2017. Lymphedema was classified based both on clinical and radiologic evaluation. An NMRL total score was obtained for each limb's segment and compared to the clinical grade, used as reference standard. NMRL intra-observer, inter-observer variability and intraclass correlation were calculated. NMRL sensitivity, specificity, and accuracy in identifying lymphedema were provided. Based on score distribution an NMRL four-stage system was developed.

Results: NMRL showed 92% sensitivity, 77% specificity and 82% accuracy in identifying lymphedema. An almost perfect agreement was obtained by expert operators, while substantial agreement was obtained by non-expert operators. Substantial agreement resulted also for the inter-observer variability (Cohen's Kappa K = 0.73, CI 95% [0.69-0.78]). The intra-class correlation showed an almost perfect relationship both by expert and non-expert operators. Excellent correlation between clinical grade and NMRL score and between clinical grade and NMRL stage were found for each segment.

Conclusions: NMRL is a confident and reproducible exam with high sensitivity, good specificity and high accuracy in lymphedema detection; the semiquantitative NMRL score resulted a reliable and reproducible tool able to quantify lymphedema severity.
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http://dx.doi.org/10.1016/j.mri.2020.02.004DOI Listing
May 2020

Radiation-induced circulating miRNA expression in blood of head and neck cancer patients.

Radiat Environ Biophys 2020 05 10;59(2):237-244. Epub 2020 Feb 10.

Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, Via Ferrata 9, Pavia, Italy.

In recent years, scientists have found evidence confirming the aberrant expression of miRNAs in cancer patients compared to healthy individuals. The growing interest in the identification of non-invasive and specific diagnostic and prognostic molecular markers has identified microRNAs as potential candidates in cancer diagnosis, prognosis and treatment response. In the present study, we have analyzed the expression profile of circulating miR-21, -191 and -421 in peripheral blood of head and neck cancer patients (HNC) to investigate a possible modulation of mRNA levels by radiation and to identify the role of mRNA as biomarkers of cancer prognosis. Results showed a modulation of the microRNA expression at different time points after radiotherapy, suggesting that treatment may influence the release of circulating miRNAs depending also on the time interval elapsed since radiotherapy. The expression levels of miR-21, -191 and -421 were higher in blood of patients treated with radiotherapy alone after 6 months from the end of therapy and high levels of them seemed to correlate with the remission of the disease. The trends shown in this study confirmed that miRNAs could be useful prognosis markers and could provide preliminary data for further evaluation in predicting patients' response to radiotherapy by developing miRNA-based treatments to improve the sensitivity of cancer cells to radiotherapy.
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http://dx.doi.org/10.1007/s00411-020-00832-3DOI Listing
May 2020

Gender-based differences in the clustering of metabolic syndrome factors in children and adolescents.

J Pediatr Endocrinol Metab 2020 Feb;33(2):279-288

Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy.

Background We depicted gender-differences in metabolic syndrome (MS) clustering before and after puberty in pediatrics, in order to develop gender specific preventive strategies for childhood obesity. Methods We considered 1079 children and adolescents (529 females and 550 males; mean age 11.5 ± 2.8 year). According to body mass index (BMI) percentiles the subjects were classified as normal weight BMI <75th, overweight BMI 75-95th and with obesity BMI >95th. MS was diagnosed when three of the following criteria for age and sex percentiles were met: BMI >95th, triglycerides (TGs) level >95th, high-density lipoprotein-cholesterol (HDL-c) level <5th, blood pressure (blood pressure) >95th percentile, fasting blood glucose (FBG) >100 mg/dL and/or homeostatic model assessment- insulin resistance (HOMA-IR) >97.5th percentile. Results The prevalence of dismetabolic factors was similar in both genders, except for pathological BP, which was higher in males (p = 0.02). MS was detected only in patients with obesity, with a higher prevalence in pubertal than late/post-pubertal subjects (p < 0.001), without any significant difference between gender. In pre-puberty, the most common MS combination was obesity (HBMI) + hypertension (HBP) + hyperglycemia/insulin resistance (HGLY/IR) followed by HBMI + low HDL-levels (LHDL) + HGLY/IR versus HBMI + HBP + HGLY/IR followed by HBMI + HBP + LHDL, respectively, in females and males. In the early and late/post-pubertal periods, the most prevalent combination remained similar to pre-puberty, additionally in both sexes other combinations, such as HBMI + HTG + HBP + HGLY/IR, HBMI +  HBP + LHDL + HGLY/IR, HBMI + HTG + LHDL + HGLY/IR and HBMI + HTG + LHDL + HBP + HGLY/IR were also detected, differently distributed in males and females. Conclusions We confirm that MS is an important consequence related to obesity, particularly in the post-puberty stage. Some gender-based differences should be considered early in order to identify specific preventive and treatment strategies.
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http://dx.doi.org/10.1515/jpem-2019-0134DOI Listing
February 2020

Percutaneous Coronary Intervention Techniques for Bifurcation Disease: Network Meta-analysis Reveals Superiority of Double-Kissing Crush.

Can J Cardiol 2020 06 9;36(6):906-914. Epub 2019 Sep 9.

Service of Clinical Epidemiology and Biostatistic, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy.

Background: Provisional T-stenting (PS) is generally recommended to treat patients with coronary bifurcation disease (CBD) percutaneously, but PS may not fit all complex bifurcation anatomies. Therefore, several types of up-front 2-stent techniques have been described. We aimed to identify the best percutaneous coronary intervention (PCI) technique to manage patients with CBD.

Methods: We systematically reviewed randomized controlled trials (RCTs) including patients undergoing CBD PCI which included several types of PCI techniques-PS, double-kissing (DK) crush, T-stenting and protrusion, culotte, dedicated bifurcation stents, crushing, and T-stenting-and we compared device-oriented clinical events (DOCEs), a composite of cardiac death, target-vessel myocardial infarction, stent thrombosis, and target-lesion or target-vessel revascularization, in a network meta-analysis. We included 26 RCTs, leading to a pooled population of 10,339 patient-years and a total of 1229 DOCEs.

Results: The DK-crush technique was associated with the lowest DOCE rate, with a relative risk of 0.62 (95% CI 0.42-0.92) compared with the PS technique. DK-crush had the highest probability (model likelihood 90.2%, area under the cumulative ranking curve 98.0%) of being the best technique among those explored to reduce DOCEs in patients receiving CBD PCI.

Conclusions: When a 2-stent strategy is considered in a patient with CBD, the DK-crush technique reduces DOCEs compared with other bifurcation techniques based on all available RCTs.
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http://dx.doi.org/10.1016/j.cjca.2019.09.002DOI Listing
June 2020

Can High-Flow Oxygen Overstep Low-Flow Oxygen Therapy in Weaning From Noninvasive Ventilation in Patients With Acute Respiratory Failure Due to Chronic Obstructive Pulmonary Disease Exacerbation?

Crit Care Med 2020 01;48(1):e76

Emergency Department, Dipartimento Chirurgico e Grandi Traumi, M. Bufalini Hospital, Cesena, Italy Intensive Care Unit, Dipartimento Chirurgico e Grandi Traumi, M. Bufalini Hospital, Cesena, Italy Servizio di Epidemiologia Clinica e Biometria, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy Emergency Department, Dipartimento Chirurgico e Grandi Traumi, M. Bufalini Hospital, Cesena, Italy Emergency Department, ASST Fatebenefratelli-Sacco, P.O. Luigi Sacco, Milan, Italy Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy.

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http://dx.doi.org/10.1097/CCM.0000000000004040DOI Listing
January 2020

Pediatric anesthesia practice in Italy: a multicenter national prospective observational study derived from the APRICOT Trial.

Minerva Anestesiol 2020 Mar 9;86(3):295-303. Epub 2019 Dec 9.

Department of Anesthesia, Giannina Gaslini Institute, Genoa, Italy.

Background: Pediatric anesthesia nowadays requires specific knowledge and expertise. The Anesthesia PRactice In Children Observational Trial (APRICOT) was a European multicenter study designed for the identification of perioperative severe critical events and management. We aimed at analyzing the Italian database in an attempt to determine the practice of anesthesia and the incidence of severe critical events in Italy.

Methods: Secondary analyses of the database consisted in extracting the raw data from the 25 Italian centers that participated to APRICOT. Descriptive statistics and comparison with the reference data were made for all the variables collected.

Results: The study analyzed 2087 children. The Italian cohort represents 6.7% of the overall study population. Most of the children were ASA 1-2 (90.6%) and underwent a surgical procedure (62.8%). In more than 84% of the cases, anesthesia management was performed by an expert with main or frequent activity in pediatric anesthesia with on an average 15 years of experience. The overall incidence of severe critical events was 3% (95% CI: 2.2-3.8). The most frequently reported severe critical incidents were of respiratory (2%; CI: 1.4-2.6) and cardiovascular origin (0.7%; CI. 0.3-1), while drug error, anaphylaxis and bronchial aspiration were very rare. There were no reports of perioperative cardiac arrest or patients with neurological damage.

Conclusions: This secondary analysis demonstrates that the incidence of severe critical incidence was lower in Italy in comparison to that reported for Europe. This low rate of critical events may be related to the high expertise and experience of the anesthesiologists in charge of the children in the Italian centres that participated to APRICOT.
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http://dx.doi.org/10.23736/S0375-9393.19.14126-0DOI Listing
March 2020