Publications by authors named "Carlo Trevisan"

37 Publications

Comparison of the Therapeutic Effect of Treatment with Antibiotics or Nutraceuticals on Clinical Activity and the Fecal Microbiome of Dogs with Acute Diarrhea.

Animals (Basel) 2021 May 21;11(6). Epub 2021 May 21.

Faculty of Veterinary Medicine, University of Teramo, 64100 Guardiagrele, TE, Italy.

Dogs with acute diarrhea are often presented to clinical practice and, although this generally represents a self-limiting condition, antibiotics are still frequently used as treatment. The aim of this study was to evaluate the effects in dogs with acute non-hemorrhagic diarrhea of the administration of an antibiotic combination in comparison to a nutraceutical product. Thirty dogs were enrolled and randomly assigned to two groups: 15 dogs (group A) received a nutraceutical commercial product while 15 dogs (group B) received an antimicrobial combination of metronidazole and spiramycin. For each dog, the Canine Acute Diarrhea Severity Index, the fecal microbiota and the Dysbiosis Index were assessed. Both stool consistency and frequency decreased on day 2 in the dogs of group A compared to baseline, while in group B, these parameters significantly decreased at days 3 and 4. The global concern for rising antibiotic resistance associated with indiscriminate use of antimicrobials, in both humans and animals, suggests the necessity of avoiding empirical and injudicious use of these molecules in diarrheic dogs. These results suggest that the nutraceutical treatment had a similar clinical effect compared to the antibiotic formulation, representing a valid antibiotic-sparing therapeutic approach in canine acute diarrhea.
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http://dx.doi.org/10.3390/ani11061484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223982PMC
May 2021

Targeting the safe zones for cup position without fluoroscopic guidance in total hip arthroplasty: does the surgical approach affect the outcomes?

Eur J Orthop Surg Traumatol 2021 Oct 24;31(7):1471-1476. Epub 2021 Feb 24.

UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate - ASST, Bergamo Est, Italia Via Paderno, 21 - 24065, Seriate, BG, Italy.

Background: Proper acetabular cup positioning is crucial for achieving implant longevity and stability in total hip arthroplasty (THA). One of the elements that may affect the accuracy and precision of the positioning of the cup is the type of surgical approach used. This study compares the accuracy and the precision of conventional free-hand acetabular cup positioning relative to different "safe zones" in two groups of patients operated with THA using two different surgical approach.

Methods: Retrospective radiological comparative matched-pair controlled study of two groups of patients operated with primary THA: the first group was operated in supine decubitus with a mini-invasive direct anterior approach (DA group), the second group was operated in lateral decubitus with a conventional posterolateral approach (PL group). Cup inclination and anteversion were assessed using the digital planning software TraumaCad. Cup position in the two groups were compared in terms of accuracy and precision.

Results: Forty four patients were enrolled for each group. The DA group showed a less inclined and less anteverted cup compared to the PL group (respectively 38.5 ± 5.2 vs. 49.6 ± 5.6 and 16.2 ± 3.6 vs. 22.9 ± 6.4; p < 0.01). The DA group showed a significantly higher percentage of cups within the "safe zone" in 4 out of 6 reference zones and a significantly lower variance in anteversion (12.96 vs. 40.96, p < .01). There was no difference in the variance for inclination.

Conclusions: Our study found greater accuracy and precision in the positioning of the cup when surgery was performed through a direct anterior approach compared to the posterolateral approach due to the supine position of the patient which allows greater stability of the pelvis during surgery and makes it easier to target the desired angular references for cup positioning.
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http://dx.doi.org/10.1007/s00590-021-02909-1DOI Listing
October 2021

Fifteen years change in acute management of hip fracture patients: 1-year mortality calls for improvements.

Injury 2021 Aug 20;52(8):2367-2372. Epub 2021 Jan 20.

UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Italia, Via Paderno 21 - 24065 Seriate (BG), Italy.

Introduction: Over the past two decades, the average age of hip fractured patients has increased, patients are increasingly fragile and their management is more complex. Most of the literature suggest that care improvement lowered short-term mortality but there is no clear evidence whether mid- and long-term mortality rates are improving. The aim of this study was to evaluate the variations in comorbidities in hip fractured patients over 15 years, the changes in mortality and identify the predictive factors for mortality for identifying the patients at higher risk.

Materials And Methods: Hip fractured patients admitted in hospital in 2000-2001 (192 patients) and 2015-2016 (323 patients) were retrospectively reviewed. Demographic, clinical and management data from the two cohorts were compared. Thirty-day and 1-year mortality were calculated and compare between the two cohorts. A multivariate logistic regression model were performed to identify the most significant predictors of mortality.

Results: After fifteen years, mean age of hip fracture patients increased by 2.6 years with a 31% increase in comorbidity. The most prevalent comorbidities were hypertension, COPD, diabetes, arrhythmia, renal impairment and dementia. In the 2015-2016 cohort, the age-adjusted mortality at 30 days significantly declined compared to the 2000-2001 cohort (respectively 6.9% vs. 12.5%) but the age-adjusted mortality at 1-year was equivalent. Older age, reduced mobility, higher comorbidity, lateral fractures and male sex were significant risk factors for reduced survival time CONCLUSIONS: After 15 years, there was a significant improvement in 30-days mortality in hip fractured patients despite their increase in comorbidities but this advantage was not observed in 1-year mortality. This suggests the need to implement targeted and longer-term care support for males, older patients and those with greater comorbidities which are at higher risk.
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http://dx.doi.org/10.1016/j.injury.2021.01.025DOI Listing
August 2021

Correction to: Biomechanical reconstruction parameters obtained after direct anterior approach total hip arthroplasty do not compromise clinical outcome.

Eur J Orthop Surg Traumatol 2020 Dec;30(8):1471-1472

Orthopaedics and Traumatology, ASST Rhodense Ospedale Guido Salvini, Viale Forlanini, 95, 20024, Garbagnate Milanese (MI), Italy.

The original version of this article unfortunately contained a mistake. Figures 3 and 4 captions were interchanged.
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http://dx.doi.org/10.1007/s00590-020-02750-yDOI Listing
December 2020

Antero-inferior paralabral cyst of the shoulder: An atypical cause of rapidly evolving axillary and musculocutaneous nerve palsy.

J Clin Orthop Trauma 2020 Jul 4;11(Suppl 4):S681-S683. Epub 2019 Sep 4.

Ward of Orthopaedics and Traumatology of the Hospital ASST Bergamo Est, Via Paderno 21, 24068, Seriate, Bergamo, Italy.

Paralabral cysts of the shoulder are a rare cause of shoulder pain. Their association with neurological symptoms is uncommon. This case report presents an antero-inferior paralabral cyst in a painful atraumatic shoulder causing axillary and musculocutaneous nerve palsy. The patient in the present study showed a rapidly worsening active shoulder function with dull pain in the posterior shoulder and hypoesthesia over the deltoid. Magnetic resonance imaging revealed an antero-inferior paralabral cyst. Electromyography showed a profuse denervation of the deltoid, teres minor and biceps brachii muscles. The patient was diagnosed with a axillary and musculocutaneous nerve compression neuropathy caused by the cyst. Shoulder arthroscopy was performed with the goal of decompressing the cyst and explore the terminal branches of the brachial plexus. During surgery a partial labral tear was detected and anatomically repaired after cyst resection. Exploration of the terminal roots of the plexus brachialis showed the presence of dense fibrotic tissue that was released. Shoulder function recovered completely after surgery. Paralabral cysts are rare and surgical management consists of cyst removal and labral repair. In presence of neurological symptoms exploring the retrocoracoid plexus may be a useful option to check for fibrosis around the nerves that could limit or slow down nerve recovery.
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http://dx.doi.org/10.1016/j.jcot.2019.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394793PMC
July 2020

Biomechanical reconstruction parameters obtained after direct anterior approach total hip arthroplasty do not compromise clinical outcome.

Eur J Orthop Surg Traumatol 2020 Dec 1;30(8):1463-1470. Epub 2020 Jul 1.

Orthopaedics and Traumatology, ASST Rhodense Ospedale Guido Salvini, Viale Forlanini, 95, 20024, Garbagnate Milanese (MI), Italy.

Introduction: Accurate reconstruction of biomechanical parameters following total hip arthroplasty (THA) is crucial for good joint function. We investigated how reconstruction parameters achieved by minimally invasive anterior (MIS) THA may influence function and patient-related outcomes.

Methods: A consecutive series of 95 patients treated by MIS THA for primary osteoarthritis were retrospectively reviewed. Primary outcome measures were Harris Hip Score (HHS), hip disability and osteoarthritis outcome score (HOOS) and EQ-5D. Femoral offset (FO), abductor lever arm (ALA), centre of rotation (CoR), leg length discrepancy (LLD), cup version and stem alignment were measured pre- and post-operatively. Obtained reconstruction parameters compared to the contralateral hip were used as independent variables in a multivariate regression with each primary outcome measure as dependent variable.

Results: Mean age at surgery was 69 years. HHS rated 94.7% of patients as good/excellent and mean EQ-5D was 0.82. Post-operative HOOS subscales showed no statistical difference compared to the Italian benchmark population. Stem alignment averaged 0.2° valgus, mean cup inclination was 37.8° and mean anteversion was 12.8°. When compared to the contralateral side, CoR was post-operatively elevated by 2.6 mm and medialized by 2.4 mm averagely. An average FO reduction of -0.5 mm was observed while FO ratio increased by 1.9% averagely. ALA decreased by -3.3 mm while LLD was 2.3 mm averagely. Multivariate regression analysis revealed a significant contribution of ALA to HHS only.

Conclusions: Biomechanical parameters achieved by MIS THA are satisfactory with negligible impact on functional results and no impact on patient-related outcomes certifying the high quality achieved in THA.
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http://dx.doi.org/10.1007/s00590-020-02727-xDOI Listing
December 2020

Long-term results of the MA-38-mm metal-on-metal articulation.

J Orthop Traumatol 2018 Dec 7;19(1):21. Epub 2018 Dec 7.

UOC Ortopedia e Traumatologia, Ospedale Bolognini ASST Bergamo Est, Seriate, Italy.

Background: Large-diameter head metal-on-metal (MoM) bearings in total hip arthroplasty (THA) are associated with increased whole blood levels of chromium (Cr) and cobalt (Co), adverse reactions to metal debris (ARMD) and poor survival rates. The prevalence of high metals concentrations, ARMD and the risk of revision surgery may vary significantly among different prostheses and long-term studies are few. This single-center study reports the long-term results of the 38-mm MoM bearing system.

Materials And Methods: Between 2003 and 2009, 80 patients received primary cementless THA using the large head metal-on-metal articulating surface MA-38 cup (Biomet, Inc., Warsaw, IN, USA) at a single institution. Forty-five patients (53 hips) were retrospectively reviewed for a mean follow-up of 127 months.

Results: Two cups were revised. The cumulative implant survival rate was 98% at 10 years and 74% at 13 years. In the whole sample, the median Co and Cr concentrations were 4.8 µg/L (IQR 1.2-4.9 µg/L) and 2.5 µg/L (IQR 0.6-3.0 µg/L), respectively. The incidence of Co or Cr levels > 7 μg/L was 15.5% and the incidence of ARMD was 3.8%. Co and Cr levels showed no correlation with cup inclination, Harris Hip Score, or total Hip Disability and Osteoarthritis Outcome score.

Conclusions: Our results confirm that the problems of release of metal ions with the possible increase of metal circulating levels and of adverse reactions may also occur in the long term with this brand of MoM large head, and that a structured follow-up program is mandatory.

Levels Of Evidence: Level 4.
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http://dx.doi.org/10.1186/s10195-018-0514-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286272PMC
December 2018

The Cunéo and Picot fracture-dislocation of the ankle: A case report and review of the literature.

Foot (Edinb) 2018 Dec 18;37:11-15. Epub 2018 Jun 18.

ASST Bergamo Est, Ospedale "Bolognini", Seriate, Bergamo, Italy.

The Cunéo and Picot fracture-dislocation is an atypical trimalleolar fracture-dislocation of the ankle with unique anatomopathologic and radiographic features, which has not been reported in English literature. We report a case of a 42-year-old woman that was diagnosed with a trimalleolar fracture-dislocation and treated surgically with an open reduction and osteosynthesis of the lateral and medial malleolus. At one-month follow-up, X-rays showed secondary displacement of the medial malleolus requiring revision surgery. The patient complained of persisting pain, with X-rays showing no signs of apparent fracture displacement. A CT scan performed after hardware removal 10 months after trauma showed severe ankle arthritis and fracture malunion at the level of the syndesmosis. The patient was retrospectively diagnosed with a Cunéo and Picot fracture-dislocation. The treatment of trimalleolar fractures is discussed, especially regarding the correct indication of synthesis of the posterior malleolus. Cunéo and Picot fractures are usually inherently unstable even if the posterior malleolar fragment may be small and can easily be recognized from standard X-rays. Whenever this type of fracture is not correctly recognized and managed by osteosynthesis of only the medial and lateral malleolus, clinical outcomes and radiographic follow-ups tend to be unsatisfactory. Fixation of the posterior malleolus is indicated in the management of Cunéo and Picot fractures. Level of clinical evidence: 4.
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http://dx.doi.org/10.1016/j.foot.2018.06.003DOI Listing
December 2018

Year to year comparison of 2000-2015 in hip fracture management: same survival rate despite older and more fragile patients.

Aging Clin Exp Res 2019 Aug 1;31(8):1097-1103. Epub 2018 Oct 1.

Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.

Purpose: The aim of this study was to compare clinical data, comorbidities and survival rates at 30 days and 1 year in two groups with femoral fractures, the first including patients admitted in 2000, and the other including patients admitted in 2015. The hypothesis of the study is that patients admitted in 2015 have more comorbidities and will therefore have a lower survival rate at 30 days and 1 year from trauma.

Methods: Patients admitted to the hospital with proximal femoral fractures in 2000 (90 patients) and 2015 (167 patients) were retrospectively reviewed. The following data were collected: age, gender, source of admission, ASA score, comorbidities, time from admission to surgery and length of hospital stay. The Charlson Comorbidity Index (CCI) score, a measure of comorbidity, and the Nottingham Hip Fracture Score (NHFS), a predictor of 30-day and 1-year mortality after hip fracture, were both calculated.

Results: Patients in the 2015 group were older and more institutionalized before fracture (p < 0.05), with a significant increase in Alzheimer's disease, chronic obstructive pulmonary disease, congestive heart failure and renal impairment. The length of stay was significantly lower in 2015. The NHFS and CCI were significantly higher in 2000. Mortality at 30 days and 1 year did not differ significantly in 2000 when compared to 2015. The CCI had the best predictive ability for mortality in both groups at 30 days and 1 year.

Conclusions: The increase of comorbidities was not found to be correlated to increased mortality. This could be explained by enhanced patient management permitting earlier mobilization and weight bearing.
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http://dx.doi.org/10.1007/s40520-018-1047-1DOI Listing
August 2019

Broad phenotypic spectrum and genotype-phenotype correlations in GMPPB-related dystroglycanopathies: an Italian cross-sectional study.

Orphanet J Rare Dis 2018 09 26;13(1):170. Epub 2018 Sep 26.

Department of Developmental Neuroscience and Molecular Medicine Neuromuscular Unit and Child Neurology, IRCCS Fondazione Stella Maris, Via dei Giacinti 2, 56018, Pisa, Italy.

Background: Dystroglycanopathy (α-DG) is a relatively common, clinically and genetically heterogeneous category of congenital forms of muscular dystrophy (CMD) and limb-girdle muscular dystrophy (LGMD) associated with hypoglycosylated α-dystroglycan. To date, mutations in at least 19 genes have been associated with α-DG. One of them, GMPPB, encoding the guanosine-diphosphate-mannose (GDP-mannose) pyrophosphorylase B protein, has recently been associated with a wide clinical spectrum ranging from severe Walker-Warburg syndrome to pseudo-metabolic myopathy and even congenital myasthenic syndromes. We re-sequenced the full set of known disease genes in 73 Italian patients with evidence of either reduced or nearly absent α-dystroglycan to assess genotype-phenotype correlations in this cohort. We used innovative bioinformatic tools to calculate the effects of all described GMPPB mutations on protein function and attempted to correlate them with phenotypic expressions.

Results: We identified 13 additional cases from 12 families and defined seven novel mutations. Patients displayed variable phenotypes including less typical pictures, ranging from asymptomatic hyperCKemia, to arthrogryposis and congenital clubfoot at birth, and also showed neurodevelopmental comorbidities, such as seizures and ataxic gait, as well as autism-spectrum disorder, which is seldom described in clinical reports of dystroglycanopathies. We also demonstrated that few mutations recur in the Italian GMPPB-mutated population and that alterations of protein stability are the main effects of GMPPB missense variants.

Conclusion: This work adds to the data on genotype-phenotype correlations in α-DG and offers new bionformatic tools to provide the conceptual framework needed to understand the complexity of these disorders.
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http://dx.doi.org/10.1186/s13023-018-0863-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158856PMC
September 2018

An algorithm for predicting blood loss and transfusion risk after total hip arthroplasty.

Transfus Apher Sci 2018 Apr 27;57(2):272-276. Epub 2018 Mar 27.

Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, I-20122, Milan, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, I-20133, Milan, Italy. Electronic address:

Introduction: Patients receiving blood transfusions after total hip arthroplasty have increased morbidity and longer lengths of stay compared to non-transfused patients. The aim of this study is to create an algorithm in order to identify patients at risk for transfusion after total hip replacement and define a safe point in hemoglobin levels after which the need for blood, transfusion can be excluded.

Methods: This retrospective study analyzed hemoglobin (Hb) levels for 5 days in patients undergoing total hip replacement. An algorithm was implemented to identify the critical trends of Hb levels in the first two postoperative days, trying to identify the patients at high risk of transfusion. Specificity, sensibility and efficiency were calculated in relation to the capability of the algorithm to correctly identify transfused patients.

Results: The algorithm found a pre-operative Hb ≥ 13 g/dl as a cut off between patients at low-risk or high-risk for transfusion. When parameters were calculated considering the best efficiency with the least number of false negatives, the algorithm showed a specificity of 84% and a sensitivity of 70% with an efficiency of 80.6%. Hb values >10 g/dl in the first operative day for low-risk patients and Hb level > 11 g/dl the second post-operative day for high-risk patients led to exclusion of the need for transfusion.

Conclusions: The algorithm suggested critical Hb levels to predict transfusion. In association with clinical data, the suggested critical values of Hb may be useful to schedule lab tests and a safe early discharge.
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http://dx.doi.org/10.1016/j.transci.2018.03.006DOI Listing
April 2018

Angioleiomyoma in the posterior knee: A case report and literature review.

Knee 2017 Jun 10;24(3):675-679. Epub 2017 Apr 10.

ASST Bergamo Est, Ospedale "Bolognini", Seriate, Bergamo, Italy.

The authors present a case of angioleiomyoma situated in the posterior knee. A 47-year-old Caucasian woman presented in 2011 with recurrent stabbing pain on the lateral aspect of her right knee. She reported having pain for the last 6years. She had no history of trauma. In 2008 she was treated with a diagnostic arthroscopy and transposition of the tibial tuberosity, with no benefit to her symptoms. Electromyography of the lower limbs showed asymmetry of the amplitude of sensitive action potential of the superficial fibular nerve. Based on the clinical suspicion of entrapment of the common fibular nerve at its bifurcation, a surgical exploration was performed, but pain persisted. In 2014, ultrasonography localized at the trigger point showed a solid ovular formation of 1cm in diameter situated on the posterior aspect of the external femoral condyle in proximity to the joint capsule, which was confirmed by magnetic resonance imaging (MRI). Surgical excision of the 1-cm diameter tumor mass relieved the symptoms immediately and permanently. Histology evidenced the presence of a solid-type angioleiomyoma. The presence of an angioleiomyoma at the knee joint is very rare and few cases are reported in the literature. To the authors' knowledge this is the first time an angioleiomyoma in the posterior knee has been described. In case of unexplained and persistent pain in and around the knee, clinicians should be aware of the atypical locations of this tumor, considering that its surgical excision alone may relieve symptoms permanently.
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http://dx.doi.org/10.1016/j.knee.2017.03.008DOI Listing
June 2017

Estrogens enhance myoblast differentiation in facioscapulohumeral muscular dystrophy by antagonizing DUX4 activity.

J Clin Invest 2017 Apr 6;127(4):1531-1545. Epub 2017 Mar 6.

Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant neuromuscular disorder that is characterized by extreme variability in symptoms, with females being less severely affected than males and presenting a higher proportion of asymptomatic carriers. The sex-related factors involved in the disease are not known. Here, we have utilized myoblasts isolated from FSHD patients (FSHD myoblasts) to investigate the effect of estrogens on muscle properties. Our results demonstrated that estrogens counteract the differentiation impairment of FSHD myoblasts without affecting cell proliferation or survival. Estrogen effects are mediated by estrogen receptor β (ERβ), which reduces chromatin occupancy and transcriptional activity of double homeobox 4 (DUX4), a protein whose aberrant expression has been implicated in FSHD pathogenesis. During myoblast differentiation, we observed that the levels and activity of DUX4 increased progressively and were associated with its enhanced recruitment in the nucleus. ERβ interfered with this recruitment by relocalizing DUX4 in the cytoplasm. This work identifies estrogens as a potential disease modifier that underlie sex-related differences in FSHD by protecting against myoblast differentiation impairments in this disease.
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http://dx.doi.org/10.1172/JCI89401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373881PMC
April 2017

Risk factors in transient osteoporosis: a retrospective study on 23 cases.

Clin Rheumatol 2016 Oct 16;35(10):2517-22. Epub 2016 Mar 16.

UOC Ortopedia Ospedale Bolognini Seriate, ASST Bergamo Est, Seriate, BG, Italy.

The aim of this study is to verify the prevalence of risk factors for transient osteoporosis (TO) in a cohort of patients selected by strict diagnostic criteria. Retrospective observational cohort study on outpatients' data. Inclusion criteria were: (1) acute onset of pain at a lower limb joint exacerbated by weight bearing; (2) no history of trauma, tumors, rheumatic diseases, or infection; (3) presence bone marrow edema on MRI in a weight bearing joint without signs of intraarticular lesions; (4) no hyperesthesia and/or allodynia and/or sweeting changes. The following risk factors were search for in all patients: (1) previous episode of TO; (2) disorders of bone metabolism; (3) cigarette smoke; (4) sudden lower limb overuse; (5) presence of osteoporosis/osteopenia. Twenty-three patients (8 females, 15 males, mean age 48.4 years) fulfilled the inclusion criteria. An average of 1.96 risk factors for TO was present in the cohort. The most frequent risk factor was overuse (in 15 patients, 65.2 %) and the second risk factor was bone metabolism disorders (in 10 patients, 43.5 %). Seven patients (30.4 %) were heavy smokers (more than 20 cigarettes per day) and seven patients showed a previous episode of TO. Six patients (26.1 % of the overall cohort but 60 % of those investigated with DEXA) resulted osteoporotic or osteopenic. Our results suggest there are risk factors that must be investigated in these patients. The presence of these risk factors might support the thesis that their disorder is tied to a decoupling between microdamage accumulation and self-reparative ability of bone tissue. The identification of risk factors with a precise diagnostic pathway can accelerate the diagnostic process and reduce recurrences.
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http://dx.doi.org/10.1007/s10067-016-3228-7DOI Listing
October 2016

Aseptic osteonecrosis of the hip in the adult: current evidence on conservative treatment.

Clin Cases Miner Bone Metab 2015 Jan-Apr;12(Suppl 1):39-42. Epub 2016 Apr 7.

Orthopedics and Traumatology, AO Bolognini, Seriate (BG), Italy.

Treatment of Avascular Osteonecrosis (AVN) of the femoral head to prevent progression to an arthritic hip is a challenging subject. Many conservative treatment options have been proposed in the literature. Weight bearing restriction as a stand-alone therapy is insufficient in preventing disease progression but it may be useful when combined with pharmacological agents or surgery. Bisphosphonate treatment in AVN might be efficient in early stages of disease, however there are no clear recommendations on length of treatment and therapeutic dosage and, considered the limited evidence and potential side effects of treatment, it could be considered in a pre-collapse stage in selected cases. Current literature suggests that low molecular weight heparin could lower disease progression in idiopathic AVN with quality of evidence being very low. Also the evidence to support the use of statins or vasodilators in the treatment of osteonecrosis is very low and their use cannot be recommended. Extracorporeal shock wave therapy may improve pain and function in early stages of disease with a low evidence, but there doesn't seem to be a significant change in time to the occurrence of femoral head collapse. Only one study has been conducted with pulsed electromagnetic fields therefore no recommendation can be given on clinical use of PEF in AVN. Evidence on hyperbaric oxygen therapy in the treatment of AVN is very limited and the high cost of treatment and the limited availability of structures that can provide the service poses other concerns about its feasibility. Based on current evidence, conservative treatment may be considered in early stages of asymptomatic AVN instead of observation only.
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http://dx.doi.org/10.11138/ccmbm/2015.12.3s.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832407PMC
May 2016

Dominant muscular dystrophy with a novel SYNE1 gene mutation.

Muscle Nerve 2015 Jan 24;51(1):145-7. Epub 2014 Nov 24.

Department of Neurosciences, University of Padova, Padova, Italy.

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http://dx.doi.org/10.1002/mus.24357DOI Listing
January 2015

Undiagnosed myopathy before surgery and safe anaesthesia table.

Acta Myol 2013 Oct;32(2):100-5

O. S. Antonio, Padova, Italy.

Patients with muscle pathology are a challenge for anaesthesiologists because of possible life-threatening general anaesthesia complications. A review of the current medical literature on the issue clearly indicates that increasing awareness by anaesthesiologists in recent years has led to a reduction in the occurrence of adverse events in patients with diagnostically well-defined muscle disease. On the other hand, the current emerging aspect is that the great majority of complications concern subjects with clinically non-overt (silent to mildly symptomatic) and thus undiagnosed myopathy. With a view to improving prevention of possible critical anaesthesia complications in such patients, we present a "Safe Anaesthesia Table", listing both the anaesthetic drugs to be avoided and those considered harmless for myopathic patients, irrespective of age and type of pathology. In addition, a brief outline about the clinical aspects suggestive of a possible muscle pathology is also provided. Using "safe drugs" during routine surgical procedures in subjects with suspected undiagnosed myopathy will enable the anaesthesiologist to avoid delaying surgery, while protecting them from anaesthesia complications. By following this approach the presumed myopathy can be properly investigated after surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866898PMC
October 2013

Considerations on evolution and healing of vertebral fractures.

Aging Clin Exp Res 2013 Oct 18;25 Suppl 1:S75-6. Epub 2013 Sep 18.

Reparto di Ortopedia e Traumatologia, Ospedale "S.S. Capitanio e Gerosa", Via Martinoli, 9, 24060, Lovere (BG), Italy,

Only little is known when talking about the evolution of a vertebral fracture. From the few studies available in the literature, we can deduce that the risk a vertebral compression fracture has to worsen its deformity is consistent. It is important to try to make a prognosis on how the fracture is going to heal based on the type of fracture encountered. A chapter of its own is the occurrence of a vertebral fracture non-union that is difficult to diagnose and treat, but comes along with a poor prognosis.
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http://dx.doi.org/10.1007/s40520-013-0085-yDOI Listing
October 2013

Bisphosphonate treatment for osteolysis in total hip arthroplasty. A report of four cases.

Clin Cases Miner Bone Metab 2013 Jan;10(1):61-4

UOC of Orthopaedics and Traumatology, Hospital "SS. Capitanio e Gerosa - Lovere", AO Bolognini Seriate, Lovere (BG), Italy.

Aseptic loosening due to wear debris is the most frequent modality of failure in total hip arthroplasty. Bisphosphonates, a class of molecules which inhibit bone resorption showed an inhibitory effects on particles-induced osteolysis in vitro and in animal models. We report the clinical, radiographic and densitometric outcome of four postmenopausal women with total hip arthroplasty affected by peri-prosthetic osteolysis treated with neridronate due to their unwillingness to be operated. After neridronate treatment, there was general improvement in pain and function: VAS decrease 13 points (15%), the Harris Hip Score increase 9 points (15%). An average number of 3.3 x-ray per patients with an average follow-up of 23 months (range 12-34) were collected and evaluated. In all the patients except one, serial radiographs didn't show any progression of radioluciencies lines or periprosthetic osteolysis. Bone density was evaluated by Dual energy X-ray absorptiometry after an average follow-up of 21 months (range 6-46 mo): periprosthetic BMD around the whole stem and the cup increased respectively 2.4% and 7.1%. Treatment was well tolerated and no significant side effects were registered. This retrospective collection of a small group of patients suggest that bisphosphonates should be clinically useful in preventing periprosthetic wear debris mediated osteolysis and claim for dedicated clinical trials.
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http://dx.doi.org/10.11138/ccmbm/2013.10.1.061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710013PMC
January 2013

Large-scale population analysis challenges the current criteria for the molecular diagnosis of fascioscapulohumeral muscular dystrophy.

Am J Hum Genet 2012 Apr;90(4):628-35

Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy.

Facioscapulohumeral muscular dystrophy (FSHD) is a common hereditary myopathy causally linked to reduced numbers (≤8) of 3.3 kilobase D4Z4 tandem repeats at 4q35. However, because individuals carrying D4Z4-reduced alleles and no FSHD and patients with FSHD and no short allele have been observed, additional markers have been proposed to support an FSHD molecular diagnosis. In particular a reduction in the number of D4Z4 elements combined with the 4A(159/161/168)PAS haplotype (which provides the possibility of expressing DUX4) is currently used as the genetic signature uniquely associated with FSHD. Here, we analyzed these DNA elements in more than 800 Italian and Brazilian samples of normal individuals unrelated to any FSHD patients. We find that 3% of healthy subjects carry alleles with a reduced number (4-8) of D4Z4 repeats on chromosome 4q and that one-third of these alleles, 1.3%, occur in combination with the 4A161PAS haplotype. We also systematically characterized the 4q35 haplotype in 253 unrelated FSHD patients. We find that only 127 of them (50.1%) carry alleles with 1-8 D4Z4 repeats associated with 4A161PAS, whereas the remaining FSHD probands carry different haplotypes or alleles with a greater number of D4Z4 repeats. The present study shows that the current genetic signature of FSHD is a common polymorphism and that only half of FSHD probands carry this molecular signature. Our results suggest that the genetic basis of FSHD, which is remarkably heterogeneous, should be revisited, because this has important implications for genetic counseling and prenatal diagnosis of at-risk families.
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http://dx.doi.org/10.1016/j.ajhg.2012.02.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322229PMC
April 2012

Atypical onset in a series of 122 cases with FacioScapuloHumeral Muscular Dystrophy.

Clin Neurol Neurosurg 2012 Apr 12;114(3):230-4. Epub 2011 Nov 12.

Department of Neurosciences, University of Padua, Padua, Italy.

Introduction: FacioScapuloHumeral Muscular Dystrophy (FSHD), a disease linked to a heterozygous D4Z4 deletion on chromosome 4q35, typically starts with shoulder-girdle and facial muscle involvement. Atypical presentations have occasionally been reported, but their frequency has still not been defined.

Patients And Methods: We studied the occurrence rate of FSHD with atypical onset in 122 symptomatic subjects from 76 unrelated families with genetically confirmed FSHD. These 75 males and 47 females, with a mean age of 49 years (range: 11-85), had a mean EcoRI fragment of 25 kb (range: 11-38).

Results: Typical shoulder-girdle or facial weakness at onset was reported by 88 patients (72%). Unusual presentations included: foot drop in 16 (13%) and proximal lower limb weakness in eight patients (7%). Two cases at onset manifested quite atypical, apparently non-FSHD-related syndromes: a 42-year-old woman presented with infantile epilepsy and a 41-year-old man with myoglobinuria. In the latter patient, DNA analysis detected a 4q35 deletion associated to an heterozygous CAPN3 mutation.

Conclusion: FSHD presentation with foot drop or lower limb proximal weakness appeared to be more frequent than expected. This type of weakness at onset has to be considered premature, but still representative of disease-related muscle involvement. Quite atypical onset appears very rare and calls for further investigation on non-FSHD-related etiology.
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http://dx.doi.org/10.1016/j.clineuro.2011.10.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314982PMC
April 2012

Secondary prevention of fractures and compliance to treatment in osteoporosis.

Authors:
Carlo Trevisan

Aging Clin Exp Res 2011 Apr;23(2 Suppl):22-4

UO Ortopedia e Traumatologia, AO Bolognini - Seriate (BG), and Ospedale SS Capitanio e Gerosa, Lovere (BG), Italy.

Osteoporosis is a mechanical incompetence of bone which finally leads to fracture. The occurrence of a fracture for a minor trauma is the definitive evidence of bone fragility and an indication of an higher probability for other fractures. Fracture at any site is a strong risk factor for a subsequent fracture, therefore any patient with a prevalent fracture is an ideal candidate for treatment due to the high risk for recurrence and to a favourable cost-benefit ratio. Most of the available pharmacological agents approved for osteoporosis treatment are effective in reducing fracture risk in this class of patients. Unfortunately, poor compliance is very common in patients treated for osteoporosis and this leads to reduced benefits and ineffectual costs. Dose regimen simplification is neither the only nor the most important solution to improve compliance, and a multifaceted strategy targeting cognitive, behavioural and emotional factors should be employed.
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April 2011

Spinal cord herniation: a missing piece in the pathogenesis of amyotrophic lateral sclerosis and multiple sclerosis?

Neurodegener Dis 2011 23;8(5):381-5. Epub 2011 Feb 23.

Neuroradiologic Unit, University Hospital of Padua, Padua, Italy.

Background: Idiopathic spinal cord herniation (SCH) is a rare and often misdiagnosed condition characterized by displacement of the spinal cord through an anterior defect of the dural sac. This condition determines continuous focal trauma of the spinal cord, causing slowly progressive myelopathy. The peculiar MR scan findings, particularly sagittal T(2)-weighted images, allow its recognition.

Objective: Herein, we report 3 cases of SCH and suggest a possible association with trauma-related neurodegenerative or chronic inflammatory diseases.

Methods: We reviewed the clinical files of all patients admitted to our hospital with a history and signs of progressive myelopathy (paraparesis and/or lower extremity hypoesthesia) who were diagnosed with SCH by MRI.

Results: We found 3 female patients (37, 69 and 68 years of age) with a diagnosis of SCH. Two of them presented with concomitant, relatively rare disabling neurological diseases, namely amyotrophic lateral sclerosis and multiple sclerosis. The third patient underwent surgery and gradually recovered over 6 months.

Conclusions: Persistent central nervous system trauma due to idiopathic SCH might provide an unexpected hint about the pathogenesis of amyotrophic lateral sclerosis and multiple sclerosis.
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http://dx.doi.org/10.1159/000323798DOI Listing
May 2012

Comparative transcriptional and biochemical studies in muscle of myotonic dystrophies (DM1 and DM2).

Neurol Sci 2009 Jun 27;30(3):185-92. Epub 2009 Mar 27.

Department of Biomedical Sciences, University of Padova, viale G. Colombo 3, Padua, Italy.

Myotonic dystrophy type 1 (DM1) and myotonic dystrophy type 2 (proximal muscular myopaty/DM2) are caused by similar dynamic mutations at two distinct genetic loci. The two diseases also lead to similar phenotypes but different clinical severity. Dysregulation of alternative splicing has been suggested as the common pathogenic mechanism. Here, we investigate the molecular differences between DM1 and DM2 using reverse transcriptase-polymerase chain reaction of troponin T (TnT) and the insulin receptor (IR), as well as immunoblotting of TnT in muscle biopsies from DM1 and DM2 patients. We found that: (a) slow TnT was encoded by two different transcripts in significantly different ratios in DM1 and DM2 muscles; (b) DM2 muscles exhibited a higher degree of alternative splicing dysregulation for fast TnT transcripts when compared to DM1 muscles; (c) the distribution of TnT proteins was significantly skewed towards higher molecular weight species in both diseases; (d) the RNA for the insulin-independent IR-A isoform was significantly increased and appeared related to the fibre-type composition in the majority of the cases examined. On the whole, these data should give a better insight on pathogenesis of DM1 and DM2.
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http://dx.doi.org/10.1007/s10072-009-0048-4DOI Listing
June 2009

New proposals for the definition of severe osteoporosis.

Authors:
Carlo Trevisan

Aging Clin Exp Res 2007 Aug;19(4 Suppl):3-6

Clinica Ortopedica, Università degli Studi di Milano Bicocca, Ospedale San Gerardo, 20052 Monza, Italy.

At present, severe osteoporosis is considered bone mineral density below a t-score of -2,5 existing together with a prevalent fragility fracture. This is a rough categorization of a wide range of clinical conditions. In osteoporotic patients, two different severities may be considered: prognostic severity, i.e., the risk of the occurrence of other fragility fractures and clinical severity, i.e. the degree of pain and disability experienced by the patient. While the former is currently under investigation in several studies, the latter has not been clearly defined in the current literature. Nevertheless, assessment of disease severity is useful for at least 3 purposes: identification of high-risk patients who deserve immediate attention and intervention; motivation of patients to follow prescribed therapies; and modulation of care intensity. The introduction of pharmacological treatments with varying degrees of efficacy and costs, reimbursement of which by the national health system is managed by regulatory agencies, calls for a consensus of the scientific community for a comprehensive classification of osteoporotic severity.
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August 2007

Pulp thumb defect reconstruction using a twin neurovascular island flaps: a case report.

Arch Orthop Trauma Surg 2008 Feb 27;128(2):195-8. Epub 2007 Nov 27.

Clinica Ortopedica, Università degli Studi di Milano Bicocca, Azienda Osp.S.Gerardo, Via Donizetti, 106-20052 Monza, MI, Italy.

In this report, we present the functional and cosmetic results of a case with complete loss of the thumb pulp for which the Chen and Noordhoof techniques has been chosen for reconstruction. A 33-year-old man, artisan, had his right thumb caught in a machine during the work, resulting in a degloving injury in the entire pulp of the distal phalanx of the thumb with all other digits of the right hand intact. The patient was a young man, in good health and non-smoker. He was involved in a heavy manual work for which an appropriate soft coverage of the distal thumb was desirable. A reconstruction of the thumb pulp with a twin neurovascular island flaps as described by Chen and Noordhoff was planned and performed the day after his admission to the hospital. The patient turned up to work at 10 weeks after surgery. After 2 years, we obtained a good aesthetic result, a sensitivity in the thumb and at the donor site comparable to the other hand and a complete recovery of normal function of the hand. In focal pulp loss of the thumb, the twin neurovascular island flaps suggested by Chen and Noordhoff could be an easy and efficient method to reconstruct soft tissue coverage and sensibility when microsurgical setting and abilities are not available.
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http://dx.doi.org/10.1007/s00402-007-0511-8DOI Listing
February 2008

Facioscapulohumeral muscular dystrophy: a multicenter study on hearing function.

Audiol Neurootol 2008 22;13(1):1-6. Epub 2007 Aug 22.

Department of Neurological and Psychiatric Sciences, University of Padua, Padua, Italy.

Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant progressive myopathy, characteristically associated with a 4q35 deletion. In the unusual infantile-onset form of this degenerative disease, sensorineural hearing loss is a frequent clinical manifestation, whereas in patients with typical late-onset FSHD, investigations regarding hearing impairment yielded controversial results. We describe the findings of a multicenter investigation on possible auditory impairment in a series of 73 FSHD patients with a genetically confirmed diagnosis. Among them, 49 cases with no risk factors for deafness, aside from the disease, were identified by a clinical questionnaire and otoscopic examination (mean age 37.8 years, 31 males and 18 females). These subjects were evaluated by pure-tone audiometry. None were aware of hearing loss, while 4 had raised unilateral or bilateral pure-tone audiometric thresholds at 4000 and 8000 Hz, when evaluated by standardized tables. However, the mean raw pure-tone audiometric threshold values for these 49 cases were not significantly different from those of 55 controls (mean age 37.1 years, 32 males and 23 females). Moreover, by statistical analysis, age of onset, degree of muscular weakness and 4q35 EcoRI fragment size made no significant difference to auditory thresholds in our FSHD patients. Overall, the results of our multicenter study suggest that hearing loss in typical FSHD is not more prevalent than in the normal population.
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http://dx.doi.org/10.1159/000107431DOI Listing
January 2008

Diagnosis and management of Wilson's disease: results of a single center experience.

J Clin Gastroenterol 2006 Nov-Dec;40(10):936-41

Department of Surgical and Gastroenterological Sciences, Section of Gastroenterology, University of Padova, Italy.

Aims: To report on the diagnostic features, management, and clinical outcome after different treatments of Wilson's disease patients followed over a mean period of 15 years.

Patients: Thirty-five patients with Wilson's disease referred to the University of Padova's Department of Gastroenterology for diagnosis or treatment were observed for a mean 15 years. The diagnosis was based on clinical symptoms, laboratory tests (ceruloplasmin, urinary, and hepatic copper concentrations), and uptake of the radiostable isotope Cu into the plasma protein pool. Hepatic Cu content was measured by regular follow-up biopsies. Neurologic outcome after therapy was assessed using a newly developed scoring system.

Results: Twenty-three (65.7%) patients presented with liver disease; 12 (34.3%) had mixed neurologic and hepatic involvement. All patients had been initially treated with either penicillamine (23) or zinc sulfate (12). The neurologic symptoms became worse or remained stationary in 75% of those treated with penicillamine, whereas zinc treatment improved these symptoms in 90% of treated cases. Both treatments were effective in improving the hepatic symptoms. No differences in hepatic Cu content emerged between follow-up biopsies in either treatment group. Six patients (26%) had to abandon the penicillamine treatment due to side effects. In all, 4 patients underwent liver transplantation, which was successful in 3, with a mean survival after transplantation of 4.6 years; the fourth, who had a severe neurologic impairment, died of central pontine myelinolysis.

Conclusions: Penicillamine and zinc can effectively treat Wilson's disease, though the side effects of penicillamine may be severe enough to prompt its suspension. Liver transplantation remains the treatment of choice for end-stage liver disease.
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http://dx.doi.org/10.1097/01.mcg.0000225670.91722.59DOI Listing
February 2007
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