Gestione delle riacutizzazioni di BPCO in Pronto Soccorso

La broncopneumopatia cronica ostruttiva (BPCO) è una delle principali cause di morbilità e mortalità nel mondo. La storia di tale condizione patologica prevede il verificarsi di fenomeni di riacutizzazione, che sono i principali responsabili del progressivo aggravamento del quadro clinico e degli accessi in Pronto Soccorso (PS), con successivo eventuale ricovero in ambito ospedaliero. Lo scopo del presente studio osservazionale retrospettivo è stato quello di valutare nella popolazione di pazienti che sperimentavano un episodio di riacutizzazione di BPCO, afferiti al PS di Pontedera nell’arco di un anno (2014), le caratteristiche demografiche e cliniche, tali da permettere di individuare dei fattori predittivi di gravità. Abbiamo infatti reclutato 179 pazienti affetti da BPCO riacutizzata, di cui 115 uomini e 64 donne, sovrapponibili per caratteristiche demografiche e cliniche. Successivamente tale popolazione è stata suddivisa in base all’esito dell’accesso in PS (dimissione a domicilio-45 vs ricovero-127), rivalutando la diversa rappresentazione delle caratteristiche demografiche e cliniche nei due nuovi gruppi. I pazienti ricoverati si sono differenziati per la maggiore età anagrafica, per la presenza di comorbidità quali lo scompenso cardiaco e di una politerapia domiciliare specialistica cronica; sono risultati inoltre maggiormente tachipnoici, tachicardici ed ipossici all’ingresso in PS e hanno presentato più frequentemente diagnosi associate di “insufficienza respiratoria” e “polmonite”. Infine la popolazione totale è stata suddivisa in base alla mortalità a sei mesi dall’accesso in PS (viventi-146 vs deceduti-33), rivalutando nuovamente la diversa rappresentazione delle caratteristiche demografiche e cliniche nei due nuovi gruppi. I pazienti deceduti si sono differenziati per la maggiore età anagrafica e per il maggior utilizzo di ossigenoterapia domiciliare; sono risultati inoltre essere maggiormente ipercapnici, ipotesi ed ipossici all’ingresso in PS. L’analisi di regressione logistica multipla, eseguita dapprima considerando il ricovero ospedaliero come variabile dipendente, ha mostrato l’associazione statisticamente significativa con le seguenti variabili indipendenti: insufficienza respiratoria (OR [CI 95%] = 23,97 [6,32-90,80], P < 0,002), polmonite (OR [CI 95%] = 7,53 [1,42-39,87], P = 0,01), frequenza cardiaca (OR [CI 95%] = 1,03 [1,01-1,06], P = 0,005) e tachipnea (OR [CI 95%] = 4,02 [1,51-10,71], P = 0,005). L’analisi di regressione logistica multipla, eseguita successivamente considerando la mortalità entro sei mesi dall’accesso in PS come variabile dipendente, ha mostrato l’associazione statisticamente significativa con le seguenti variabili indipendenti: ipercapnia (OR [CI 95%] = 3,28 [1,19-8,98], P = 0,02), età (OR [CI 95%] = 1,07 [1,01-1,14], P = 0,01) ed ossigenoterapia domiciliare (OR [CI 95%] = 3,15 [1,18-8,40], P = 0,02). In conclusione, la presenza di diagnosi associate quali “insufficienza respiratoria acuta” e “polmonite”, di tachipnea e di frequenza cardiaca aumentata ha mostrato incrementare significativamente il rischio di ospedalizzazione. Parimenti, la presenza di età anagrafica avanzata, ipercapnia all’ingresso in PS e ossigenoterapia domiciliare cronica, ha determinato un aumento significativo della mortalità entro sei mesi dall’accesso in PS per l’evento acuto

Imaging Modalities for the Diagnosis of Vascular Graft Infections:A Consensus Paper amongst Different Specialists

Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the patient. However, standardized diagnostic algorithms and a univocal consensus on the best strategy to reach a diagnosis still do not exist. This review aims to summarize different radiological and Nuclear Medicine (NM) modalities commonly adopted for the imaging of VGI. Moreover, we attempt to provide evidence-based answers to several practical questions raised by clinicians and surgeons when they approach imaging in order to plan the most appropriate radiological or NM examination for their patients

Imaging Modalities for the Diagnosis of Vascular Graft Infections: A Consensus Paper amongst Different Specialists

Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the patient. However, standardized diagnostic algorithms and a univocal consensus on the best strategy to reach a diagnosis still do not exist. This review aims to summarize different radiological and Nuclear Medicine (NM) modalities commonly adopted for the imaging of VGI. Moreover, we attempt to provide evidence-based answers to several practical questions raised by clinicians and surgeons when they approach imaging in order to plan the most appropriate radiological or NM examination for their patients

Designation of optimal reference strains representing the infant gut bifidobacterial species through a comprehensive multi-omics approach

The genomic era has resulted in the generation of a massive amount of genetic data concerning the genomic diversity of bacterial taxa. As a result, the microbiological community is increasingly looking for ways to define reference bacterial strains to perform experiments that are representative of the entire bacterial species. Despite this, there is currently no established approach allowing a reliable identification of reference strains based on a comprehensive genomic, ecological, and functional context. In the current study, we developed a comprehensive multi-omics approach that will allow the identification of the optimal reference strains using the Bifidobacterium genus as test case. Strain tracking analysis based on 1664 shotgun metagenomics datasets of healthy infant faecal samples were employed to identify bifidobacterial strains suitable for in silico and in vitro analyses. Subsequently, an ad hoc bioinformatic tool was developed to screen local strain collections for the most suitable species-representative strain alternative. The here presented approach was validated using in vitro trials followed by metagenomics and metatranscriptomics analyses. Altogether, these results demonstrated the validity of the proposed model for reference strain selection, thus allowing improved in silico and in vitro investigations both in terms of cross-laboratory reproducibility and relevance of research findings

Genetic strategies for sex-biased persistence of gut microbes across human life

Although compositional variation in the gut microbiome during human development has been extensively investigated, strain-resolved dynamic changes remain to be fully uncovered. In the current study, shotgun metagenomic sequencing data of 12,415 fecal microbiomes from healthy individuals are employed for strain-level tracking of gut microbiota members to elucidate its evolving biodiversity across the human life span. This detailed longitudinal meta-analysis reveals host sex-related persistence of strains belonging to common, maternally-inherited species, such as Bifidobacterium bifidum and Bifidobacterium longum subsp. longum. Comparative genome analyses, coupled with experiments including intimate interaction between microbes and human intestinal cells, show that specific bacterial glycosyl hydrolases related to host-glycan metabolism may contribute to more efficient colonization in females compared to males. These findings point to an intriguing ancient sex-specific host-microbe coevolution driving the selective persistence in women of key microbial taxa that may be vertically passed on to the next generation.We thank GenProbio Srl for the financial support of the Laboratory of Probiogenomics. Part of this research is conducted using the High- Performance Computing (HPC) facility of the University of Parma. This research has financially been supported by the Programme “FIL-Quota Incentivante” of University of Parma and co-sponsored by Fondazione Cariparma”. D.v.S. is a member of APC Microbiome Ireland funded by Science Foundation Ireland (SFI), through the Irish Government’s National Development Plan (Grant no. SFI/12/RC/2273-P1 and SFI/12/RC/ 2273-P2). G.T. has been supported by “Fondazione Cariparma” in the framework of the project entitled “Parma Microbiota”. LMV has been supported by by “Programma Operativo Nazionale 2014–2020 of the Italian Ministry of University and Research. The funding from Project AGL2017-83653R (Spanish “Ministerio de Ciencia, Innovación y Universidades (MCIU)”, “Agencia Estatal de Investigación (AEI)” and FEDER) is also acknowledged

The influence of body image on psychological symptomatology in breast cancer women undergoing intervention: a pre-post study

IntroductionBody image concerns related to breast cancer surgery may challenge patients’ quality of life and their treatment outcomes, thus representing a key aspect to be assessed in the psycho-oncological settings. The present longitudinal study is aimed to (1) investigate the association between preoperative body image and postoperative psychological symptoms in breast cancer patients; (2) explore the impact of pre−/post-surgery variation in body image on psychological symptomatology.MethodsN = 72 women undergoing breast cancer surgery were preoperatively screened (T1) using the Body Uneasiness Test (BUT) and were assessed postoperatively (T2) using the Symptom Checklist-90 Revised (SCL-90-R) and re-administered the BUT. Spearman’s correlation was used to investigate the relationship between age, preoperative body image and postoperative psychological symptoms, and variation in body image. To predict post-surgical psychological symptomatology, two separated multiple regression models were used to evaluate preoperative body image and its variation after surgery controlling for covariates (i.e., education; intervention type). P significance was set as 0.05 for all analyses and adjusted for multiple comparisons.ResultsAt T1, anxiety in relation to body image scores emerged as the most frequently experienced psychological symptomatology after surgery (all adjusted p &lt; 0.05). Significant correlations were observed between all SCL-90-R scores at T2 and avoidance behaviors and depersonalization scores at T1. The associations were most significantly strong for somatization, depression, anxiety, and hostility (all adjusted p &lt; 0.05). However, change in body image between pre- and post-intervention was not associated with psychological symptomatology at T2 (all adjusted p &gt; 0.05). Pre-surgery body avoidance was significantly associated with post-intervention psychological symptoms (SOMβ = 0.453, p = 0.0001; DEPβ = 0.507, p = 0.0001; AXβ = 0.459, p = 0.0001; HOSβ = 0.410, p=. 0001). However, increased weight phobia between pre- and post-surgery was statistically associated with increased somatization, anxiety, depression and hostility at T2 (βSOM = 0.439, p = 0.0001; βDEP = 0.454, p = 0.0001; βANX = 0.471, p = 0.0001).DiscussionOverall, pre−/post-intervention body concerns were significantly associated with primary psychological symptoms in breast cancer patients undergoing surgery. Higher levels of body avoidance and weight phobia were significantly associated with the primary psychological dimensions assessed. As body concerns might act as quality-of-life predictors, their evaluation is crucial in fostering patients’ well-being and treatment adherence

Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE)

The objective of these Guidelines was to revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. The methodology applied in this update was the GRADE-SIGN version methodology, following the instructions of the AGREE quality of reporting checklist as well. The first methodological step was the formulation of clinical questions structured according to the PICO (Population, Intervention, Comparison, Outcome) model according to which the Recommendations were issued. Then, systematic reviews of the Literature were carried out for each PICO question or for homogeneous groups of questions, followed by the selection of the articles and the assessment of the methodological quality for each of them using qualitative checklists. Finally, a Considered Judgment form was filled in for each clinical question, in which the features of the evidence as a whole are assessed to establish the transition from the level of evidence to the direction and strength of the recommendations. These guidelines outline the correct management of patients with abdominal aortic aneurysm in terms of screening and surveillance. Medical management and indication for surgery are discussed, as well as preoperative assessment regarding patients' background and surgical risk evaluation. Once the indication for surgery has been established, the options for traditional open and endovascular surgery are described and compared, focusing specifically on patients with ruptured abdominal aortic aneurysms as well. Finally, indications for early and late postoperative follow-up are explained. The most recent evidence in the Literature has been able to confirm and possibly modify the previous recommendations updating them, likewise to propose new recommendations on prospectively relevant topics

Gene expression profiling in whole blood of patients with coronary artery disease

Owing to the dynamic nature of the transcriptome, gene expression profiling is a promising tool for discovery of disease-related genes and biological pathways. In the present study, we examined gene expression in whole blood of 12 patients with CAD (coronary artery disease) and 12 healthy control subjects. Furthermore, ten patients with CAD underwent whole-blood gene expression analysis before and after the completion of a cardiac rehabilitation programme following surgical coronary revascularization. mRNA and miRNA (microRNA) were isolated for expression profiling. Gene expression analysis identified 365 differentially expressed genes in patients with CAD compared with healthy controls (175 up- and 190 down-regulated in CAD), and 645 in CAD rehabilitation patients (196 up- and 449 down-regulated post-rehabilitation). Biological pathway analysis identified a number of canonical pathways, including oxidative phosphorylation and mitochondrial function, as being significantly and consistently modulated across the groups. Analysis of miRNA expression revealed a number of differentially expressed miRNAs, including hsa-miR-140-3p (control compared with CAD, P=0.017), hsa-miR-182 (control compared with CAD, P=0.093), hsa-miR-92a and hsa-miR-92b (post- compared with pre-exercise, P<0.01). Global analysis of predicted miRNA targets found significantly reduced expression of genes with target regions compared with those without: hsa-miR-140-3p (P=0.002), hsa-miR-182 (P=0.001), hsa-miR-92a and hsa-miR-92b (P=2.2×10−16). In conclusion, using whole blood as a ‘surrogate tissue’ in patients with CAD, we have identified differentially expressed miRNAs, differentially regulated genes and modulated pathways which warrant further investigation in the setting of cardiovascular function. This approach may represent a novel non-invasive strategy to unravel potentially modifiable pathways and possible therapeutic targets in cardiovascular disease

Impaired renal function impacts negatively on vascular stiffness in patients with coronary artery disease.

BACKGROUND: Chronic kidney disease (CKD) and coronary artery disease (CAD) are independently associated with increased vascular stiffness. We examined whether renal function contributes to vascular stiffness independently of CAD status. METHODS: We studied 160 patients with CAD and 169 subjects without CAD. The 4-variable MDRD formula was used to estimate glomerular filtration rate (eGFR); impaired renal function was defined as eGFR <60 mL/min. Carotid-femoral pulse wave velocity (PWV) was measured with the SphygmoCor® device. Circulating biomarkers were assessed in plasma using xMAP® multiplexing technology. RESULTS: Patients with CAD and impaired renal function had greater PWV compared to those with CAD and normal renal function (10.2 [9.1;11.2] vs 7.3 [6.9;7.7] m/s; P < 0.001). In all patients, PWV was a function of eGFR (β = -0.293; P < 0.001) even after adjustment for age, sex, systolic blood pressure, body mass index and presence or absence of CAD. Patients with CAD and impaired renal function had higher levels of adhesion and inflammatory molecules including E-selectin and osteopontin (all P < 0.05) compared to those with CAD alone, but had similar levels of markers of oxidative stress. CONCLUSIONS: Renal function is a determinant of vascular stiffness even in patients with severe atherosclerotic disease. This was paralleled by differences in markers of cell adhesion and inflammation. Increased vascular stiffness may therefore be linked to inflammatory remodeling of the vasculature in people with impaired renal function, irrespective of concomitant atherosclerotic disease

HER2-based recombinant immunogen to target DCs through FcγRs for cancer immunotherapy

Dendritic cell (DC)-based immunotherapy is an attractive approach to induce long lasting antitumor effector cells aiming to control cancer progression. DC targeting is a critical step in the design of DC vaccines in order to optimize delivery and processing of the antigen, and several receptors have been characterized for this purpose. In this study, we employed the FcγRs to target DCs both in vitro and in vivo. We designed a recombinant molecule (HER2-Fc) composed of the immunogenic sequence of the human tumor-associated antigen HER2 (aa 364–391) and the Fc domain of a human IgG1. In a mouse model, HER2-Fc cDNA vaccination activated significant T cell-mediated immune responses towards HER2 peptide epitopes as detected by IFN-γ ELIspot and induced longer tumor latency as compared to Ctrl-Fc-vaccinated control mice. Human in vitro studies indicated that the recombinant HER2-Fc immunogen efficiently targeted human DCs through the FcγRs resulting in protein cross-processing and in the activation of autologous HER2-specific CD8+ T cells from breast cancer patients