Publications by authors named "Gabriele Cevenini"

103 Publications

Burkitt lymphoma with granulomatous reaction: A M1/TH1-polarized microenvironment associates with controlled growth and spontaneous regression.

Histopathology 2021 May 5. Epub 2021 May 5.

Department of Medical Biotechnologies, University of Siena, Siena, Italy.

Aims: Burkitt lymphoma (BL) is an aggressive B-cell lymphoma, which in some instances, may show a granulomatous reaction associated with a favourable prognosis and occasional spontaneous regression. In the present study, we aimed to define the tumour microenvironment (TME) in four of such cases, two of which regressed spontaneously.

Methods And Results: All cases showed aggregates of tumour cells with the typical morphology, molecular cytogenetics and immunophenotype of BL surrounded by a florid epithelioid granulomatous reaction. All four cases were Epstein-Barr virus (EBV) positive with type I latency. The investigation of the tumour microenvironment (TME) showed similar features in all four cases. The analysis revealed a pro-inflammatory response triggered by Th1 lymphocytes and M1 polarized macrophages encircling the neoplastic cells with a peculiar topographic distribution.

Conclusions: Our data provide an in vivo picture of the role that specific immune cell subsets might play during the early phase of BL, which may be capable of maintaining the tumour in a self-limited state or inducing its regression. These novel results may provide insights to explore new potential therapeutic avenues in EBV-positive BL patients in the era of cellular immunotherapy.
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http://dx.doi.org/10.1111/his.14391DOI Listing
May 2021

An Emerging Innovative UV Disinfection Technology (Part II): Virucide Activity on SARS-CoV-2.

Int J Environ Res Public Health 2021 04 7;18(8). Epub 2021 Apr 7.

Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy.

The coronavirus SARS-CoV-2 pandemic has become a global health burden. Surface sanitation is one of the key points to reduce the risk of transmission both in healthcare and other public spaces. UVC light is already used in hospital and laboratory infection control, and some recent studies have shown its effectiveness on SARS-CoV-2. An innovative UV chip technology, described in Part I of this study, has recently appeared able to overcome the limits of old lamps and is proposed as a valid alternative to LEDs. This study was designed to test the virucidal activity on SARS-CoV-2 of a device based on the new UV chip technology. Via an initial concentration of virus suspension of 10 TCID/mL, the tests revealed a viral charge reduction of more than 99.9% after 3 min; the maximum detectable attenuation value of Log = 5.7 was measured at 10 min of UV exposure.
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http://dx.doi.org/10.3390/ijerph18083873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067697PMC
April 2021

A compartment modeling approach to reconstruct and analyze gender and age-grouped CoViD-19 Italian data for decision-making strategies.

J Biomed Inform 2021 06 24;118:103793. Epub 2021 Apr 24.

Department of Medical Biotechnologies, Bioengineering Lab, University of Siena, Siena, Italy; Department of Information Engineering and Mathematics, University of Siena, Siena, Italy.

Background: Available national public data are often too incomplete and noisy to be used directly to interpret the evolution of epidemics over time, which is essential for making timely and appropriate decisions. The use of compartment models can be a worthwhile and attractive approach to address this problem. The present study proposes a model compartmentalized by sex and age groups that allows for more complete information on the evolution of the CoViD-19 pandemic in Italy.

Material And Methods: Italian public data on CoViD-19 were pre-treated with a 7-day moving average filter to reduce noise. A time-varying susceptible-infected-recovered-deceased (SIRD) model distributed by age and sex groups was then proposed. Recovered and infected individuals distributed by groups were reconstructed through the SIRD model, which was also used to simulate and identify optimal scenarios of pandemic containment by vaccination. The simulation started from realistic initial conditions based on the SIRD model parameters, estimated from filtered and reconstructed Italian data, at different pandemic times and phases. The following three objective functions, accounting for total infections, total deaths, and total quality-adjusted life years (QALYs) lost, were minimized by optimizing the percentages of vaccinated individuals in five different age groups.

Results: The developed SIRD model clearly highlighted those pandemic phases in which younger people, who had more contacts and lower mortality, infected older people, characterized by a significantly higher mortality, especially in males. Optimizing vaccination strategies yielded different results depending on the cost function used. As expected, to reduce total deaths, the suggested strategy was to vaccinate the older age groups, whatever the baseline scenario. In contrast, for QALYs lost and total infections, the optimal vaccine solutions strongly depended on the initial pandemic conditions: during phases of high virus diffusion, the model suggested to vaccinate mainly younger groups with a higher contact rate.

Conclusion: Because of the poor quality and insufficient availability of stratified public pandemic data, ad hoc information filtering and reconstruction procedures proved essential. The time-varying SIRD model, stratified by age and sex groups, provided insights and additional information on the dynamics of CoViD-19 infection in Italy, also supporting decision making for containment strategies such as vaccination.
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http://dx.doi.org/10.1016/j.jbi.2021.103793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064908PMC
June 2021

Dermoscopy of early melanomas: variation according to the anatomic site.

Arch Dermatol Res 2021 Mar 26. Epub 2021 Mar 26.

Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.

To date, is yet to be elucidated whether the body location of cutaneous melanoma can significantly affect an early dermoscopic diagnosis and, consequently, if it can be regarded as a prognostic factor. To investigate the dermoscopic appearance of early melanomas (EMs) at different body sites; to test the ability of dermoscopists in recognizing specific dermoscopic features in EMs. A pool of 106 experienced dermoscopists evaluated the presence of 10 dermoscopic features assumed as suggestive of malignancy among 268 images of EMs with ambiguous appearance located at 16 body sites. According to 720 evaluations, EMs of the "upper extremities" showed a prevalence of early atypical lentiginous features. EMs of the "anterior trunk" exhibited the lower rate of recognition for all features. EMs of the "rear trunk" can be regarded as an intermediate area, showing high recognition rates of regression-related and chronic-traumatism-related features.
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http://dx.doi.org/10.1007/s00403-021-02226-xDOI Listing
March 2021

Pain Study in X-Linked Adrenoleukodystrophy in Males and Females.

Pain Ther 2021 Jun 20;10(1):505-523. Epub 2021 Feb 20.

Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.

Introduction: X-linked adrenoleukodystrophy (ALD) is a metabolic disorder in which very long chain fatty acids (VLCFAs) are accumulated in the nervous system and adrenal cortex, impairing their functions. Three main variants are described in males: adrenomyeloneuropathy (AMN), a cerebral form (cALD or cAMN) and Addison's disease only (AD), while for females no classification is used. To evaluate pain and the functional state of afferent fibers, a series of tests was carried out in male and female patients.

Methods: Chronic pain occurrence and sensory phenotype profile were assessed in 30 patients (20 male: 10 AMN, 1 cAMN, 1 cALD, 8 AD; and 10 female). A set of instruments assessed the intensity, quality and extent of pain, while a battery of quantitative sensory testing (QST) procedures examined the functional status of Aβ and Aδ fibers. Principal component analysis and hierarchical clustering with sensory responses input were used to identify distinct clusters.

Results: Nearly half of the subjects reported pain, with a high prevalence in females and male AMN patients. No sex differences in pain dimensions were found. The sensory responses were heterogeneous, differing among the clinical variants and between genders. Male AMN/cAMN/cALD patients showed the worst impairment. Aβ and Aδ fibers were affected in males and females, but Aβ fibers appeared undamaged in females when tactile sensitivity was tested. Abnormal responses were localized in the lower body district, according to the dying-back pattern of the neuropathy. Cluster analysis showed discrete clusters for each function examined, with well-interpretable sensory and clinical phenotypes.

Conclusion: The study of pain and of the sensory profile appears to indicate a difference in the mechanisms underlying the AMN/cAMN/cALD and AD clinical forms and in the treatment of the respective generated pain types.
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http://dx.doi.org/10.1007/s40122-021-00245-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119579PMC
June 2021

Risk of QTc Interval Prolongation Associated With Circulating Anti-Ro/SSA Antibodies Among US Veterans: An Observational Cohort Study.

J Am Heart Assoc 2021 Feb 3;10(4):e018735. Epub 2021 Feb 3.

VA New York Harbor Healthcare SystemSUNY Downstate Medical Center New York NY.

Background Anti-Sjögren's syndrome-related antigen A-antibodies (anti-Ro/SSA-antibodies) are responsible for a novel form of acquired long-QT syndrome, owing to autoimmune-mediated inhibition of cardiac human ether-a-go-go-related gene-potassium channels. However, current evidence derives only from basic mechanistic studies and relatively small sample-size clinical investigations. Hence, the aim of our study is to estimate the risk of QTc prolongation associated with the presence of anti-Ro/SSA-antibodies in a large population of unselected subjects. Methods and Results This is a retrospective observational cohort study using the Veterans Affairs Informatics and Computing Infrastructure. Participants were veterans who were tested for anti-Ro/SSA status and had an ECG. Descriptive statistics and univariate and multivariate logistic regression analyses were performed to identify risk factors for heart rate-corrected QT interval (QTc) prolongation. The study population consisted of 7339 subjects (61.4±12.2 years), 612 of whom were anti-Ro/SSA-positive (8.3%). Subjects who were anti-Ro/SSA-positive showed an increased prevalence of QTc prolongation, in the presence of other concomitant risk factors (crude odds ratios [OR], 1.67 [1.26-2.21] for QTc >470/480 ms; 2.32 [1.54-3.49] for QTc >490 ms; 2.77 [1.66-4.60] for QTc >500 ms), independent of a connective tissue disease history. Adjustments for age, sex, electrolytes, cardiovascular risk factors/diseases, and medications gradually attenuated QTc prolongation estimates, particularly when QT-prolonging drugs were added to the model. Nevertheless, stepwise-fully adjusted OR for the higher cutoffs remained significantly increased in anti-Ro/SSA-positive subjects, particularly for QTc >500 ms (2.27 [1.34-3.87]). Conclusions Anti-Ro/SSA-antibody positivity was independently associated with an increased risk of marked QTc prolongation in a large cohort of US veterans. Our data suggest that within the general population individuals who are anti-Ro/SSA-positive may represent a subgroup of patients particularly predisposed to ventricular arrhythmias/sudden cardiac death.
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http://dx.doi.org/10.1161/JAHA.120.018735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955337PMC
February 2021

Heliox administration in anesthetized rabbits with spontaneous inspiratory flow limitation.

J Appl Physiol (1985) 2021 May 7;130(5):1496-1509. Epub 2021 Jan 7.

Department of Information Engineering and Mathematics, Università di Siena, Siena, Italy.

We investigated the effects of heliox administration (80% helium in O) on tidal inspiratory flow limitation (tIFL) occurring in supine anesthetized spontaneously breathing rabbits, regarded as an animal model of obstructive apnea-hypopnea syndrome. 22 rabbits were instrumented to record oro-nasal mask flow, airway opening, tracheal and esophageal pressures, and diaphragm and genioglossus electromyographic activities while breathing either room air or heliox, and, in 12 rabbits, also during the application of continuous positive airway pressure (CPAP; 6 cmHO). For the group, heliox increased peak inspiratory flow, ventilation (18 ± 11%), peak inspiratory tracheal and dynamic transpulmonary pressures, but in no animal eliminated tIFL, as instead CPAP did in all. Muscle activities were unaffected by heliox. In the presence of IFL the increase in flow with heliox (ΔV̇ifl) varied markedly among rabbits (2 to 49%), allowing the distinction between responders and non-responders. None of the baseline variables discriminated responders and non-responders. However, fitting the Rohrer equation ( =  + V̇) to the tracheal pressure-flow relationship over the first 0.1 s of inspiration while breathing air allowed such discrimination on the basis of larger in responders (0.005 ± 0.002 versus 0.002 ± 0.001 cmHO·s·ml; < 0.001), suggesting a corresponding difference in the relative contribution of laminar and turbulent flow. The differences in ΔV̇ifl between responders and non-responders were simulated by modeling the collapsible segment of the upper airways as a non-linear resistor and varying its pressure-volume curve, length, and diameter, thus showing the importance of mechanical and geometrical factors in determining the response to heliox in the presence of tIFL. In an obstructive sleep apnea rabbit model, heliox never abolishes tidal inspiratory flow limitation (IFL), but increases inspiratory flow and tidal volume, substantially in some and nearly nil in other animals. Positive response to heliox cannot be predicted on the basis of breathing pattern characteristics or upper airway resistance that preceded IFL onset, but is related to the mechanical and geometrical features of upper airway collapsible segment, as indicated by model simulation.
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http://dx.doi.org/10.1152/japplphysiol.00830.2020DOI Listing
May 2021

A new deep learning approach integrated with clinical data for the dermoscopic differentiation of early melanomas from atypical nevi.

J Dermatol Sci 2021 Feb 2;101(2):115-122. Epub 2020 Dec 2.

Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Italy; Bioengineering Unit, Department of Medical Biotechnology, University of Siena, Italy.

Background: Timely recognition of malignant melanoma (MM) is challenging for dermatologists worldwide and represents the main determinant for mortality. Dermoscopic examination is influenced by dermatologists' experience and fails to achieve adequate accuracy and reproducibility in discriminating atypical nevi (AN) from early melanomas (EM).

Objective: We aimed to develop a Deep Convolutional Neural Network (DCNN) model able to support dermatologists in the classification and management of atypical melanocytic skin lesions (aMSL).

Methods: A training set (630 images), a validation set (135) and a testing set (214) were derived from the idScore dataset of 979 challenging aMSL cases in which the dermoscopic image is integrated with clinical data (age, sex, body site and diameter) and associated with histological data. A DCNN_aMSL architecture was designed and then trained on both dermoscopic images of aMSL and the clinical/anamnestic data, resulting in the integrated "iDCNN_aMSL" model. Responses of 111 dermatologists with different experience levels on both aMSL classification (intuitive diagnosis) and management decisions (no/long follow-up; short follow-up; excision/preventive excision) were compared with the DCNNs models.

Results: In the lesion classification study, the iDCNN_aMSL achieved the best accuracy, reaching an AUC = 90.3 %, SE = 86.5 % and SP = 73.6 %, compared to DCNN_aMSL (SE = 89.2 %, SP = 65.7 %) and intuitive diagnosis of dermatologists (SE = 77.0 %; SP = 61.4 %).

Conclusions: The iDCNN_aMSL proved to be the best support tool for management decisions reducing the ratio of inappropriate excision. The proposed iDCNN_aMSL model can represent a valid support for dermatologists in discriminating AN from EM with high accuracy and for medical decision making by reducing their rates of inappropriate excisions.
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http://dx.doi.org/10.1016/j.jdermsci.2020.11.009DOI Listing
February 2021

Genitopelvic pain: retrospective evaluation of a multimodal treatment efficacy.

Minerva Ginecol 2020 Jun;72(3):123-131

Department of Medical Biotechnologies, University of Siena, Siena, Italy.

Background: Genitopelvic and sexual pain penetration disorder (GPPD) recognizes a multifaceted etiology. As with syndromes of chronic pain, it responds poorly to medications and its management is difficult. Clinicians consequently favor a multimodal comprehensive approach to tackle the different aspects of the disorder. To treat GPPD women, we chose a multimodal regimen including topical and systemic medications associated with physical interventions and behavioral couple therapy. Our aim was to evaluate the regimen efficacy and the influence that demographic, clinical, and pain characteristics may have on the outcome.

Methods: Sixty self -referred women requesting medical care for GPPD, who were free of debilitating illness, in stable heterosexual relationships and with healthy and sexually functional partners, were treated according with the multimodal regimen we tailored on the specific needs of these women. As said, it associated topical and systemic medications combined with physical exercises used in behavioral sex therapy, and behavioral couple therapy. Past sexual history, characteristics of pain, vestibular hyperreactivity, pelvic floor hypertonicity, general health, and couple harmony were evaluated and statistically analyzed to determine which characteristics were associated with therapy outcome.

Results: The statistical analysis of an association between demographic, reproductive, pain and medical conditions on one hand and therapy outcome on the other did not find any significance.

Conclusions: The lack of association between the investigated characteristics and treatment outcome is disappointing; on the other hand, the statistically significant impact of couple harmony (evaluated as partner presence and participation) on the treatment results may be the answer to our search for factors predicting outcome.
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http://dx.doi.org/10.23736/S0026-4784.20.04555-4DOI Listing
June 2020

A mobile device reducing airborne particulate can improve air quality.

AIMS Public Health 2020 2;7(3):469-477. Epub 2020 Jul 2.

Department of Medical Biotechnologies, University of Siena, via Aldo Moro 2, Siena, Italy.

Surgical site infections are the second major cause of hospital acquired infections, accounting for a large part of overall annual medical costs. Airborne particulate is known to be a potential carrier of pathogenic bacteria. We assessed a mobile air particle filter unit for improvement of air quality in an operating room (OR). A new mobile air decontamination and recirculation unit, equipped with a crystalline ultraviolet C (Illuvia® 500 UV) reactor and a HEPA filter, was tested in an OR. Airborne particulate was monitored in four consecutive phases: I) device OFF and OR at rest; II) device OFF and OR in operation; III) device ON and OR in operation; IV) device OFF and OR in operation. We used a particle counter to measure airborne particles of different sizes: ≥0.3, ≥0.5, ≥1, ≥3, ≥5, >10 µm. Activation of the device (phases III) produced a significant reduction (p < 0.05) in airborne particulate of all sizes. Switching the device OFF (phase IV) led to a statistically significant increase (p < 0.05) in the number of particles of most sizes: ≥0.3, ≥0.5, ≥1, ≥3 µm. The device significantly reduced airborne particulate in the OR, improving air quality and possibly lowering the probability of surgical site infections.
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http://dx.doi.org/10.3934/publichealth.2020038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505793PMC
July 2020

Long-Term Clinical Outcome in Familial and Sporadic Papillary Thyroid Carcinoma.

Eur Thyroid J 2020 Jul 28;9(4):213-220. Epub 2020 Apr 28.

Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.

Background: The definition and the behaviour of familial papillary thyroid cancer (FPTC) compared to the sporadic form (SPTC) are still debated. Some authors believe that only families with 3 or more affected members represent an actual example of familial diseases.

Objectives: The objective of the study was to analyse the clinicopathological features and the outcome of sporadic and familial PTC patients also according to the number of affected members.

Methods: Among 731 patients, we identified 101 (13.8%) with familial diseases, 79 with 2 affected members (FPTC-2) and 22 with 3 or more affected members (FPTC-3) followed for a mean period of 10 years.

Results: FPTC patients had more frequently bilateral tumour ( = 0.007). No difference was found between the 2 groups for the other evaluated variables. At the time of the first follow-up (1-2 years after initial therapy), FPTC patients had a higher rate of persistent disease. However, at the last follow-up, the clinical outcome was not different between sporadic and familial patients. When the comparison between SPTC and FPTC was performed, according to the number of affected members, a significant trend between the 3 groups was observed for tumour diameter ( = 0.002) and bilaterality ( = 0.003), while we did not observe a significant trend for both response to initial therapy ( = 0.15) and last clinical outcome ( = 0.22).

Conclusions: Our results suggest that, although the clinicopathological features of FPTC may be more aggressive, the long-term outcome is similar between FPTC and SPTC. A possible explanation is that PTC has a favourable prognosis, even when clinical presentation is more aggressive.
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http://dx.doi.org/10.1159/000506955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445652PMC
July 2020

A new clinical and dermoscopic monitoring of infantile hemangiomas treated with oral propranolol.

Dermatol Ther 2020 11 18;33(6):e14283. Epub 2020 Sep 18.

Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.

Oral propranolol (OP) demonstrated high efficacy and safety profile for treatment of critical infantile hemangiomas (IHs). Our aim was to assess the morphologic changes of IHs with standard and high-resolution video dermoscopy (HRVD) from baseline to 18 months either in presence or absence of OP therapy; to investigate if extended anamnestic perinatal data and clinical-dermoscopic characteristics of the IHs can correlate with therapeutic outcome. We enrolled 94 patients (112 IHs): 58 were treated with OP, 35 (42 IHs) for 6 months (group 1), and 23 (25 IHs) for 12-months (group 2); 36 (45 IHs) were followed-up. Clinical-dermoscopic examinations were performed every 3 months during therapy and follow-up. Among 67 treated IHs, superficial and deep IHs with homogenous clinical-dermoscopic aspect developed after the 2 weeks of life achieved the better outcome, stable at 9-month follow-up, independently form treatment duration. Under HRVD, glomerular vessels were prevalent at baseline; corckscrew, comma, and linear-irregular vessels were the prevalent pattern at 1, 3, and 6 months of therapy, respectively. At 12-month follow-up, adequate healing was achieved by 96% of IHs in group 2 and by 78% in group 1, showing dotted vessels. Persistent IHs displayed a reticulated aspect and linear irregular vessels, while arborizing vessels characterized relapsed IHs. A 12-month OP therapy can be considered for newborns presenting with nonhomogenous mixed IHs >3 cm on the perineal area/lower extremities. In conclusion, HRVD allows a real time monitoring of vascular changes in IHs treated with OP and can support physicians in identifying relapses before they become clinically evident.
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http://dx.doi.org/10.1111/dth.14283DOI Listing
November 2020

The Comparative Use of Multiple Electronic Devices in the Teledermoscopic Diagnosis of Early Melanoma.

Telemed J E Health 2021 05 14;27(5):495-502. Epub 2020 Aug 14.

Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy.

The use of mobile electronic devices as support to medical activity was largely implemented in the past decade. Our first aim was to evaluate the frequency of use of different electronic devices, that is, personal computer (PC), notebook, tablet, smartphone, in a pool of dermatologists recruited to perform multiple online testing session on difficult melanocytic skin lesions (MSLs) cases. The second aim was to evaluate the feasibility of each device in terms of teledermatologic diagnostic performance; the use of four different diagnostic methods, that is, intuitive diagnosis and three dermoscopic algorithms, was also investigated. A total of 111 dermatologists with 4 different levels of experience in dermoscopy, performed 4 tests (intuitive diagnosis and iDScore, ABCD rule, 7-point-checklist-based diagnosis) on 979 MSLs blinded cases. Each testing session was performed with a preferred device. The overall highest areas under the receiver operating characteristic (AUROC) (82%) was obtained by young generation dermoscopists 1-4 years experience) when using an integrated clinical dermoscopic algorithm (iDScore) on a notebook. The average dermatologist using the iDScore obtained AUROC 77.40% with large screen devices (PC and notebook) 77.6% with small screen (tablet, smartphone) and 78.2% by combining the two. Young generation of dermoscopists alternately use different devices, whereas elderly generation still prefer to use the PC. The diagnostic performances obtained with small/large screen were not statistically different from those obtained with fixed/mobile devices. Mobile devices were feasible tools to achieve adequate diagnostic accuracy in difficult MSLs, on a teledermatology setting, independently from participant skill level/age.
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http://dx.doi.org/10.1089/tmj.2020.0057DOI Listing
May 2021

Cardiac Arrest Risk During Acute Infections: Systemic Inflammation Directly Prolongs QTc Interval via Cytokine-Mediated Effects on Potassium Channel Expression.

Circ Arrhythm Electrophysiol 2020 08 13;13(8):e008627. Epub 2020 Jul 13.

Department of Medical Sciences, Surgery and Neurosciences (P.E.L., F.L.-P., F.F., F.V., M.N., S.B., B.G., N.M., A. D'Errico, P.L.C.), University Hospital of Siena, Italy.

Background: During acute infections, the risk of malignant ventricular arrhythmias is increased, partly because of a higher propensity to develop QTc prolongation. Although it is generally believed that QTc changes almost exclusively result from concomitant treatment with QT-prolonging antimicrobials, direct effects of inflammatory cytokines on ventricular repolarization are increasingly recognized. We hypothesized that systemic inflammation per se can significantly prolong QTc during acute infections, via cytokine-mediated changes in K channel expression.

Methods: We evaluated (1) the frequency of QTc prolongation and its association with inflammatory markers, in patients with different types of acute infections, during active disease and remission; (2) the prevalence of acute infections in a cohort of consecutive patients with Torsades de Pointes; (3) the relationship between K channel mRNA levels in ventricles and peripheral blood mononuclear cells and their changes in patients with acute infection over time.

Results: In patients with acute infections, regardless of concomitant QT-prolonging antimicrobial treatments, QTc was significantly prolonged but rapidly normalized in parallel to CRP (C-reactive protein) and cytokine level reduction. Consistently in the Torsades de Pointes cohort, concomitant acute infections were highly prevalent (30%), despite only a minority (25%) of these cases were treated with QT-prolonging antimicrobials. KCNJ2 K channel expression in peripheral blood mononuclear cell, which strongly correlated to that in ventricles, inversely associated to CRP and IL (interleukin)-1 changes in acute infection patients.

Conclusions: During acute infections, systemic inflammation rapidly induces cytokine-mediated ventricular electrical remodeling and significant QTc prolongation, regardless concomitant antimicrobial therapy. Although transient, these changes may significantly increase the risk of life-threatening ventricular arrhythmia in these patients. It is timely and warranted to transpose these findings to the current coronavirus disease 2019 (COVID-19) pandemic, in which both increased amounts of circulating cytokines and cardiac arrhythmias are demonstrated along with a frequent concomitant treatment with several QT-prolonging drugs. Graphic Abstract: A graphic abstract is available for this article.
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http://dx.doi.org/10.1161/CIRCEP.120.008627DOI Listing
August 2020

The Bayesian approach: may we learn a lesson from the ANDROMEDA-SHOCK trial?

Ann Transl Med 2020 Jun;8(12):804

Department of Medicine, Surgery and Neurosciences, Anesthesia and Intensive Care Unit, University Hospital of Siena, Siena, Italy.

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http://dx.doi.org/10.21037/atm.2020.02.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333104PMC
June 2020

Time changes of renal dimensions and variations of glomerular filtration rate in chronic kidney disease patients.

Arch Ital Urol Androl 2020 Apr 6;92(1):21-24. Epub 2020 Apr 6.

Hemodialysis Unit, S. Donato Hospital, Arezzo.

Background: The aim of this longitudinal prospective study was to search if even in the absence of total or partial nephrectomy the kidney size can increase as the kidney function improves.

Methods: We randomly enrolled 80 adult patients with various degrees of chronic renal failure but non-dialysis dependent neither totally or partially nephrectomized nor affected by any of the pathological conditions that can increase kidney size. The patients underwent a first examination comprehensive of a blood sample and renal ultrasonography and then were submitted to a therapeutic intervention aimed at removing all nephrotoxic agents to finally be subjected to a last similar medical examination.

Results: The statistical analysis displayed a strong positive correlation between the percentage variation of the renal diameters' average and the time changes of the GFR (r 0.731; p < 0.01) as well as the percentage variation of the GFR and the time changes variations of the right (r 0.487; p < 0.01) and left cortical kidney thickness (r 0.519; p < 0.01) and finally a strong negative correlation between the removal of nephrotoxic agents and the percentage variation of the renal diameters' average (r - 0.293; p < 0.01) and the time changes of the GFR (r - 0.429; p < 0.01).

Conclusions: In patients with chronic kidney disease, even in the absence of total or partial nephrectomy, under the stimulus of the removal of any nephrotoxic agents, there may be a limited increase in renal size according to a model that sees them vary according to the changes in GFR.
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http://dx.doi.org/10.4081/aiua.2020.1.21DOI Listing
April 2020

Correction to: IGHV mutational status of nodal marginal zone lymphoma by NGS reveals distinct pathogenic pathways with different prognostic implications.

Virchows Arch 2020 07;477(1):169

Department of Medical Biotechnologies, Anatomic Pathology Division, University of Siena, Via delle Scotte, 6, 53100, Siena, Italy.

This error was caused due to the author's oversight and this does not change the views or the results presented in the manuscript.
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http://dx.doi.org/10.1007/s00428-020-02794-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645535PMC
July 2020

IGHV mutational status of nodal marginal zone lymphoma by NGS reveals distinct pathogenic pathways with different prognostic implications.

Virchows Arch 2020 Jul 4;477(1):143-150. Epub 2019 Dec 4.

Department of Medical Biotechnologies, Anatomic Pathology Division, University of Siena, Via delle Scotte, 6, 53100, Siena, Italy.

The precise B cell of origin and molecular pathogenesis of nodal marginal zone lymphoma (NMZL) remain poorly defined. To date, due to the rarity of NMZL, the vast majority of already-published studies have been conducted on a limited number of samples and the technical approach to analyze the immunoglobulin genes was of amplifying rearranged variable region genes with the classical direct sequencing of the PCR products followed by cloning. Here, we studied the B cell Ig heavy-chain repertoires by next-generation sequencing (NGS) in 30 NMZL cases. Most of the cases were mutated (20/28; 71.5%) with homologies to the respective germ line genes ranging from 85 to 97, 83%, whereas 8/28 (28.5%) were unmutated. In addition, our results show that NMZL cases have a biased usage of specific immunoglobulin heavy-chain variable (IGHV) region genes. Moreover, we documented intraclonal diversity in all (100%) of the mutated cases and ongoing somatic hypermutations (SHM) have been confirmed by hundreds of reads. We analyzed the mutational pattern to detect and quantify antigen selection pressure and we found a positive selection in 4 cases, whereas in the remaining cases there was an unspecific stimulation. Finally, the disease-specific survival and the progression-free survival were significantly different between cases with mutated and unmutated IGHV genes, pointing out mutational status as a possible new biomarker in NMZL.
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http://dx.doi.org/10.1007/s00428-019-02712-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320062PMC
July 2020

Long-term therapy of multiple basal cell carcinomas: Clinicodermoscopic score for monitoring of intermittent vismodegib treatment.

Dermatol Ther 2019 11 17;32(6):e13097. Epub 2019 Oct 17.

Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.

Vismodegib treatment of multiple basal cell carcinomas (BCCs) is limited by adverse effects and high relapse rates: intermittent regimens are therefore preferred for long-term administration. The objective of this study was to investigate clinical and dermoscopic changes in BCCs during long-term intermittent treatment and to identify those most indicative of tumor persistence/clearing. Clinical and dermoscopic images (n = 380 each) of 38 BCCs were acquired at 10 observation times (t0-t9). Biopsies were performed at baseline (t0) and after 72 weeks of treatment (t9). All images were evaluated retrospectively by experts who assessed the presence/absence of 12 clinical and 14 dermoscopic features: clinical scores (CScs) and dermoscopic scores (DScs) were then calculated.
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http://dx.doi.org/10.1111/dth.13097DOI Listing
November 2019

Vitreomacular interface alterations following peripheral laser retinopexy: Interface changes after laser.

Eur J Ophthalmol 2020 Sep 20;30(5):941-947. Epub 2019 Sep 20.

Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.

Aim: To demonstrate the morphological outcomes of macular hole following prophylactic peripheral laser retinopexy (PPLR).

Methods: Our retrospective case-control analysis included 92 eyes, 55 in the laser group and 37 in the non-laser group. Fifty-five patients were subjected to prophylactic peripheral laser retinopexy in preparation for pars plana vitrectomy for macular hole, with and without vitreomacular adhesion (laser group). Before and after prophylactic peripheral laser retinopexy, we evaluated any changes in vitreomacular anatomy by optical coherence tomography. Optical coherence tomography changes were also analyzed in the visits preceding pars plana vitrectomy in 37 macular hole eyes not subjected to prophylactic peripheral laser retinopexy (non-laser group).

Results: In the laser group, 7 out of 55 eyes (12.7%) showed macular hole closure (6 out of 18 macular hole eyes with vitreomacular adhesion (33.3%) and 1 out of 37 eyes without vitreomacular adhesion (2.7%)), while no patients showed macular hole closure in the non-laser group (p < 0.05). The mean width of the seven closed macular hole was 191.4 µm (range: 59-282 µm). In all except one of the six macular hole eyes with vitreomacular adhesion, the macular hole closed without vitreomacular adhesion release. In our analysis of the patient subgroup with vitreomacular adhesion, we observed a release of vitreomacular adhesion in 3 out of 18 eyes (16.6%) in the laser group and in 1 out of 13 eyes (7.6%) in the non-laser group (p > 0.05).

Conclusion: These findings support a possible beneficial role for prophylactic peripheral laser retinopexy in selected individuals with macular hole.
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http://dx.doi.org/10.1177/1120672119876547DOI Listing
September 2020

Systemic Inflammation Rapidly Induces Reversible Atrial Electrical Remodeling: The Role of Interleukin-6-Mediated Changes in Connexin Expression.

J Am Heart Assoc 2019 08 19;8(16):e011006. Epub 2019 Aug 19.

Department of Medical Sciences, Surgery and Neurosciences University of Siena Italy.

Background Systemic inflammation is a strong predictor of atrial fibrillation. A key role for electrical remodeling is increasingly recognized, and experimental data suggest that inflammatory cytokines can directly affect connexins resulting in gap-junction dysfunction. We hypothesized that systemic inflammation, regardless of its origin, promotes atrial electric remodeling in vivo, as a result of cytokine-mediated changes in connexin expression. Methods and Results Fifty-four patients with different inflammatory diseases and elevated C-reactive protein were prospectively enrolled, and electrocardiographic P-wave dispersion indices, cytokine levels (interleukin-6, tumor necrosis factor-α, interleukin-1, interleukin-10), and connexin expression (connexin 40, connexin 43) were measured during active disease and after reducing C-reactive protein by >75%. Moreover, peripheral blood mononuclear cells and atrial tissue specimens from an additional sample of 12 patients undergoing cardiac surgery were evaluated for atrial and circulating mRNA levels of connexins. Finally, in vitro effects of interleukin-6 on connexin expression were studied in HL-1 mouse atrial myocytes. In patients with active inflammatory diseases, P-wave dispersion indices were increased but rapidly decreased within days when C-reactive protein normalizes and interleukin-6 levels decline. In inflammatory disease patients, both P-wave dispersion indices and interleukin-6 changes were inversely associated with circulating connexin levels, and a positive correlation between connexin expression in peripheral blood mononuclear cells and atrial tissue was demonstrated. Moreover, interleukin-6 significantly reduced connexin expression in HL-1 cells. Conclusions Our data suggest that regardless of specific etiology and organ localization, systemic inflammation, via interleukin-6 elevation, rapidly induces atrial electrical remodeling by down-regulating cardiac connexins. Although transient, these changes may significantly increase the risk for atrial fibrillation and related complications during active inflammatory processes.
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http://dx.doi.org/10.1161/JAHA.118.011006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759884PMC
August 2019

Association between air changes and airborne microbial contamination in operating rooms.

J Infect Public Health 2019 Nov - Dec;12(6):827-830. Epub 2019 May 30.

Department of Molecular and Developmental Medicine, University of Siena, Italy. Electronic address:

Background: Control of airborne microbial contamination is important in operating rooms (ORs). To keep airborne contamination low, guidelines should highlight the importance of air turnover. The aims of the study were: (1) to verify the association between air turnover and airborne contamination in ORs; and (2) to identify a statistical relationship between air turnover and airborne microbial contamination.

Methods: A cross sectional study was carried out from November 2014 to July 2017 in the teaching Hospital of Siena. Nineteen ORs (14 with turbulent and 5 with laminar flow ventilation) were surveyed a total of 59 times under operating conditions. Air samples were collected with an air sampler. Petri dishes, incubated at 36 °C for 48 h, were used to quantify colony forming units in the samples (CFU). The data was transformed to evaluate several statistically significant nonlinear associations between air turnover, quantified as air changes per hour (ACH) and CFU per cubic meter of air (p < 0.05).

Results: A log-linear regression model provided the best fit between ACH and CFU for laminar (p = 0.013; R = 0.3911) and turbulent flow systems (p = 0.002; R = 0.3443). The corresponding model was: ln(CFU) = (a - b*ACH), where the regression parameters were estimated at a = 4.02 and b = 0.037 for laminar flow and a = 5.24 and b = 0.067 for turbulent flow.

Conclusions: Italian guidelines indicate microbial load limits of 20 and 180 CFU/m for operating rooms with laminar and turbulent flow ventilation, respectively. The model allowed us to evaluate the minimum number of ACHs to keep CFU within these limits. Ad hoc measurements in other environments can be used to calibrate the relationship between ACH and CFU.
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http://dx.doi.org/10.1016/j.jiph.2019.05.010DOI Listing
March 2020

Low systolic blood pressure values, renal resistive index measurement and glomerular filtration rate in a non-dialysis dependent chronic kidney disease population.

Arch Ital Urol Androl 2019 Jan 17;90(4):288-292. Epub 2019 Jan 17.

Hemodialysis Unit, S. Donato Hospital, Arezzo.

Objective: A longitudinal prospective case control study was organized to explore the relationships between glomerular filtration rate (GFR), renal resistive index (RRI) and blood pressure values in a non-dialysis dependent adult population affected by chronic kidney disease and exposed to low systolic blood pressure (SBP) values.

Material And Methods: The study sample (54 patients: 31 males and 23 females with an average age of 61.7 ± 19.2 years) was randomly selected from a population of adult non-dialysis dependent patients that scored a SBP < 100 mmHg at the medical examination. The patients were equally divided in two groups defined by the presence and absence of chronic kidney disease, (i.e. a GFR less or greater than 60 ml/min/1.73 m2, respectively). Patients were submitted to a full therapeutic and dietetic intervention to correct the hypotension until reaching a steady SBP > 100 mmHg.

Results: In the group with chronic renal disease, the comparison between the data recorded with SBP < 100 mmHg (t0) and those detected with SBP ≥ 100 mmHg (t1) showed a statistically significant decrease of serum creatinine as well as an increase of GFR (mean serum creatinine t0 - serum creatinine t1: 0.194 ± 0.35, p < 0.01; mean GFR t0 - GFR t1: -4.615 ± 8.8, p < 0.013). There was also a statistically significant reduction of the RRI (mean right kidney RRI t0 - mean right kidney RRI t1: + 0.082 ± 0.03, p < 0; mean left kidney RRI t0 - mean left kidney RRI t1: 0.076 ± 0.03, p < 0).

Conclusion: We concluded that, in CKD, when aorta is stiffed, a decrease of SBP can limit the renal perfusion that, in this condition, is mostly dependent by stroke volume, causing an increase of RRI and a decrease of GFR that we suppose as reversible with the restoration of SBP.
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http://dx.doi.org/10.4081/aiua.2018.4.288DOI Listing
January 2019

Impact of clinical and personal data in the dermoscopic differentiation between early melanoma and atypical nevi.

Dermatol Pract Concept 2018 Oct 31;8(4):324-327. Epub 2018 Oct 31.

Dermatology Division, Department of Medical, Surgical and NeuroSciences, University of Siena, Siena, Italy.

Background: Differential diagnosis of clinically atypical nevi (aN) and early melanomas (eMM) still represents a challenge even for experienced dermoscopists, as dermoscopy alone is not sufficient to adequately differentiate these equivocal melanocytic skin lesions (MSLs).

Objectives: The objectives of this study were to investigate what were the most relevant parameters for noninvasive differential diagnosis between eMM and aN among clinical, personal, and dermoscopic data and to evaluate their impact as risk factors for malignancy.

Methods: This was a retrospective study performed on 450 MSLs excised from 2014 to 2016 with a suspicion of malignancy. Dermoscopic standardized images of the 450 MSLs (300 aN and 150 eMM) were collected and evaluated. Patients' personal data (ie, age, gender, body site, maximum diameter) were also recorded. Dermoscopic evaluations were performed by 5 different experts in dermoscopy blinded to histopathological diagnosis. Fleiss' κ was calculated to measure concordance level between experts in the description of dermoscopic parameters for each MSL. The power of the studied variables in discriminating malignant from benign lesions was also investigated through F-statistics.

Results: The variables age and maximum diameter supplied the highest discriminant power ( = 253 and 227, respectively). Atypical network, blue white veil and white shiny streaks were the most significant dermoscopic patterns suggestive of malignancy ( = 110, 104 and 99.5, respectively). Shiny white streaks was the only dermoscopic parameter to obtain satisfactory concordance value. Gender was not a discriminant factor. The specific statistical weight of clinical and personal data (ie, "patient's age" and "lesion diameter") surpassed those of atypical dermoscopic features.

Conclusions: The objective clinical and personal data collected here could supply a fundamental contribution in the correct diagnosis of equivocal MSLs and should be included in diagnostic algorithms along with significant dermoscopic features (ie, atypical network, blue-white veil, and shiny white streaks).
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http://dx.doi.org/10.5826/dpc.0804a16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246054PMC
October 2018

Long-term evaluation of corneal sub-basal nerve recovery after photorefractive keratectomy and influence of pars plana vitrectomy.

J Cell Physiol 2019 05 11;234(5):7459-7466. Epub 2018 Nov 11.

Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania.

The corneal sub-basal nerve (SBN) plexus is destroyed during photorefractive keratectomy (PRK) and its recovery is still a matter of debate. In vivo confocal microscopy (IVCM) was used to evaluate SBN plexus in 23 patients at a distance of 10-25 years (mean 15.6 years) from myopic PRK. Because 8 out of the 23 PRK patients underwent pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment, IVCM was also performed on those patients 6 months after PPV. Thirteen patients matched for age and myopia served as controls (non-PRK). SBN plexus was markedly reduced after PRK compared with non-PRK eyes and showed a slow, continuous but incomplete recovery up to the end of our follow-up (range 10-25 years). PRK and non-PRK eyes showed a marked reduction in SBN density 6 months after PPV, thus demonstrating a detrimental effect exerted by PPV on SBN plexus.
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http://dx.doi.org/10.1002/jcp.27504DOI Listing
May 2019

Corneal Subbasal Nerve Density and Sensitivity After Pars Plana Vitrectomy Using Contact or Noncontact Wide-Angle Viewing Systems.

Cornea 2018 Sep;37(9):1130-1137

Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.

Purpose: To assess corneal subbasal nerve density (SBND) and corneal sensitivity (CS) after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) without intraoperative 360-degree laser treatment using contact or noncontact panoramic viewing systems.

Methods: This is a prospective study of 34 eyes affected by RRD, which underwent PPV using contact (18 eyes) and noncontact (16 eyes) panoramic viewing systems; 12 eyes which underwent scleral buckling, and 17 eyes which underwent cataract surgery. SBND and CS were assessed before surgery and 3 and 6 months postoperatively by in vivo confocal microscopy and Cochet-Bonnet esthesiometry.

Results: Compared with baseline values, at 6 months, SBND and CS decreased in both contact PPV (SBND preoperative value: 19.1 ± 3.7 mm/mm; SBND postoperative value: 3.5 ± 1.3 mm/mm; CS preoperative value: 5.1 ± 0.5 cm; CS postoperative value: 1.5 ± 0.4 cm) and in noncontact PPV groups (SBND preoperative value: 19.5 ± 3.8 mm/mm; SBND postoperative value: 8.7 ± 2.3 mm/mm; CS preoperative value: 5.3 ± 0.5 cm; CS postoperative value: 2.5 ± 0.7 cm) (P < 0.001 for all comparisons). SBND reduction was greater in the contact PPV group than in the noncontact PPV group (P < 0.001). By contrast, the scleral buckling and cataract surgery group values were unchanged (P > 0.1 for all comparisons). In multivariate analysis, no significant effect was found for cataract surgery associated with PPV, pseudophakia, surgical time, intraocular pressure, or for laser in horizontal sectors for PPV groups. SBND was highly correlated with CS (r = 0.93).

Conclusions: A contact viewing system reduces SBND after PPV more than a noncontact system does.
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http://dx.doi.org/10.1097/ICO.0000000000001656DOI Listing
September 2018

Proton Pump Inhibitors and Serum Magnesium Levels in Patients With Torsades de Pointes.

Front Pharmacol 2018 20;9:363. Epub 2018 Apr 20.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.

Torsades de pointes (TdP) is a life-threatening ventricular tachycardia occurring in long QT-syndrome patients. It usually develops when multiple QT-prolonging factors are concomitantly present, more frequently drugs and electrolyte imbalances. Since proton-pump inhibitors (PPIs)-associated hypomagnesemia is an increasingly recognized adverse event, PPIs were recently included in the list of drugs with conditional risk of TdP, despite only few cases of TdP in PPI users have been reported so far. Aim of the present study is to evaluate whether PPI-induced hypomagnesemia actually has a significant clinical impact on the risk of TdP in the general population. Forty-eight unselected patients who experienced TdP were consecutively enrolled (2008-2017). Shortly after the first TdP episode, in those patients who did not receive magnesium sulfate and/or potassium or calcium replacement therapy, serum electrolytes were measured and their relationship with PPI usage analyzed. Many patients (28/48, 58%) were under current PPI treatment when TdP occurred. Among TdP patients in whom serum electrolyte determinations were obtained before replacement therapy (27/48), those taking PPIs had significantly lower serum magnesium levels than those who did not. Hypomagnesemia occurred in ~40% of patients receiving PPIs (6/14), in all cases after an extended treatment (>2 weeks). In patients taking PPIs the mean QT-prolonging risk factor number was significantly higher than in those who did not, a difference which was mainly driven by lower magnesium levels. In unselected TdP patients, PPI-induced hypomagnesemia was common and significantly contributed to their cumulative arrhythmic risk. By providing clinical support to current recommendations, our data confirm that more awareness is needed when a PPI is prescribed, specifically as regards the risk of life-threatening arrhythmias.
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http://dx.doi.org/10.3389/fphar.2018.00363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922007PMC
April 2018

Is balneotherapy effective for fibromyalgia? Results from a 6-month double-blind randomized clinical trial.

Clin Rheumatol 2018 Aug 5;37(8):2203-2212. Epub 2018 May 5.

Rheumatology Unit, S. Chiara Hospital, Trento, Italy.

The aim of this study was to assess the efficacy and tolerability of balneotherapy (BT) in patients with primary fibromyalgia syndrome (FS). In a prospective, randomized, controlled, double-blind trial with a 6-month follow-up, 100 FS patients were randomized to receive a cycle of BT with highly mineralized sulfate water (BT group) or with tap water (control group). Clinical assessments were performed at screening visit, at basal time, and after treatment (2 weeks, 3 and 6 months). The primary outcome measures were the change of global pain on the Visual Analogue Scale (VAS) and Fibromyalgia Impact Questionnaire total score (FIQ-Total) from baseline to 15 days. Secondary outcomes included Widespread Pain Index, Symptom Severity Scale Score, Short Form Health Survey, State-Trait Anxiety Inventory (STAI), and Center for Epidemiologic Studies Depression Scale. We performed an intent-to-treat analysis. The Kolmogorov-Smirnov test was applied to verify the normality distribution of all quantitative variables and the Student's t test to compare sample data. In the BT group, we observed a significant improvement of VAS and FIQ-Total at the end of the treatment that persisted until 6 months, while no significant differences were found in the control group. The differences between groups were significant for primary parameters at each time point. Similar results were obtained for the other secondary outcomes except for the STAI outcome. Adverse events were reported by 10 patients in the BT group and by 22 patients in the control group. Our results support the short- and long-term therapeutic efficacy of BT in FS.

Trial Registration: NCT02548065.
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http://dx.doi.org/10.1007/s10067-018-4117-zDOI Listing
August 2018

A new technique of ultrasound guided percutaneous renal biopsy by perforated probe and perpendicular needle trajectory.

Arch Ital Urol Androl 2018 Mar 31;90(1):29-33. Epub 2018 Mar 31.

Hemodialysis Unit, S. Donato Hospital, Arezzo.

The percutaneous biopsy of native kidneys according to the classical methodology is performed under real time ultrasound guidance with the needle introduction along a trajectory of about 30°, aimed to the lower pole of the kidney. Recently, a variant of the classical technique has been introduced by which a perforated ultrasound probe is used to guide the needle along a perpendicular trajectory to the terminal section of the lower kidney pole where the front and back margins of the cortical kidney tissue join each other without renal sinus interposition so to offer to the needle a 3-4 cm thick cortical tissue front which allows to obtain a cortical tissue sample suitable for histological examination even with a single needle pass, while at the same time limiting the possibility of damaging the smaller kidney calices of the lower group whose lesion causes hematuria. In this paper, we present a large survey (50 patients) to compare to data from the literature obtained by using similar needle gauge and with a similar follow-up period after biopsy. The result of this comparison confirms the efficacy of this variant of the classical technique because in front of a statistically lower number of needle passes, it allowed to obtain 100% of samples suitable for histological analysis, in absence of major complications and with a statistically lower post-biopsy hemoglobin drop in comparison to that observed in a group of 44 patients biopsied with a greater number of needle passes, in the only study of the literature which is directly comparable to our study in relation to needle gauge and duration of monitoring.
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http://dx.doi.org/10.4081/aiua.2018.1.29DOI Listing
March 2018