المؤلفون: Ilaria Godi, Paolo Feltracco, Giulia Lorenzoni, Alessio Antonelli, Renato Salvador, Dario Gregori, Ivo Tiberio, Michele Valmasoni

المصدر: Kidney and Dialysis, Vol 4, Iss 2, Pp 93-104 (2024)

مصطلحات موضوعية: postoperative acute kidney injury, esophageal cancer surgery, outcome, Internal medicine, RC31-1245

الوصف: Background: Limited data exist on postoperative acute kidney injury (AKI) in patients who have undergone esophageal cancer surgery. The purpose of this study was to evaluate the incidence, risk factors, and consequences of postoperative acute kidney after esophagectomy. Methods: This was a retrospective cohort study. The study was conducted in a tertiary specialized cancer center in Italy. All patients undergoing elective esophageal cancer surgery between 2016 and 2021 were included in the study. AKI was defined according to Kidney Disease Improving Global Outcomes criteria (both serum creatinine and urine output), within 48 h after surgery. Preoperative and intraoperative data were registered. We also collected data concerning progression of AKI, need for renal replacement therapy, mortality, and medical (pulmonary, cardiovascular, septic) and surgical complications within 30 days from surgery, as well as length of hospital stay. Results: Incidence of postoperative AKI was 32%. The independent risk factors were body mass index and the use of an invasive surgical approach. Persistent AKI accounted for 15% of the cases and it was associated with increased risk of major cardiovascular events (odds ratio 4.14, 95% CI 1.05–15.8, p-value 0.036), pulmonary complications (OR 3.67, 95% CI 1.04–14.9, p-value 0.050), and increased length of hospital stay (AME 7.2, 0.5–13.9, p-value 0.035). Conclusions: Postoperative AKI is common after esophageal cancer surgery. BMI and a totally invasive surgical approach are independent risk factors. Persistent AKI lasting more than 48 h increased the risk for any cardiovascular or pulmonary complications, with prolonged length of hospital stay.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2673-8236/4/2/7Test; https://doaj.org/toc/2673-8236Test

الوصول الحر: https://doaj.org/article/fa2e60bc963942f2b7ec9a0a23f43c5dTest

المؤلفون: Cecilia Liberati, Daniele Donà, Linda Maestri, Maria Grazia Petris, Elisa Barbieri, Elisa Gallo, Jacopo Gallocchio, Marta Pierobon, Elisabetta Calore, Annachiara Zin, Giulia Brigadoi, Marcello Mariani, Alessio Mesini, Carolina Saffioti, Elisabetta Ugolotti, Dario Gregori, Carlo Giaquinto, Elio Castagnola, Alessandra Biffi

المصدر: Annals of Clinical Microbiology and Antimicrobials, Vol 23, Iss 1, Pp 1-9 (2024)

مصطلحات موضوعية: Febrile neutropenia, Empiric antibiotic treatment, Weighted-Incidence Syndromic Combination Antibiogram, Therapeutics. Pharmacology, RM1-950, Infectious and parasitic diseases, RC109-216, Microbiology, QR1-502

الوصف: Abstract Background Guidelines about febrile neutropenia in paediatric patients are not homogeneous; the best empiric treatment of this condition should be driven by local epidemiology. The Weighted-Incidence Syndromic Combination Antibiogram (WISCA) addresses the need for disease-specific local susceptibility evidence that could guide empiric antibiotic prescriptions based on outcome estimates of treatment regimens obtained as a weighted average of pathogen susceptibilities. This study developed a WISCA model to inform empirical antibiotic regimen selection for febrile neutropenia (FN) episodes in onco-haematological paediatric patients treated at two Italian paediatric tertiary centres. Methods We included blood cultures from patients with a bloodstream infection and neutropenia admitted to the Paediatric Haematology-Oncology wards in Padua and Genoa Hospitals from 2016 to 2021. WISCAs were developed by estimating the coverage of 20 antibiotics as monotherapy and of 21 combined regimens with a Bayesian probability distribution. Results We collected 350 blood cultures, including 196 g-negative and 154 g-positive bacteria. Considering the most used antibiotic combinations, such as piperacillin–tazobactam plus amikacin, the median coverage for the pool of bacteria collected in the study was 78%. When adding a glycopeptide, the median coverage increased to 89%, while the replacement of piperacillin–tazobactam with meropenem did not provide benefits. The developed WISCAs showed that no monotherapy offered an adequate coverage rate for the identified pathogens. Conclusions The application of WISCA offers the possibility of maximizing the clinical utility of microbiological surveillance data derived from large hospitals to inform the choice of the best empiric treatment while contributing to spare broad-spectrum antibiotics.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1476-0711Test

الوصول الحر: https://doaj.org/article/9229a3d28ea548289b9123e4632cfb2fTest

المؤلفون: Annalisa Boscolo, Tommaso Pettenuzzo, Francesco Zarantonello, Nicolò Sella, Elisa Pistollato, Alessandro De Cassai, Sabrina Congedi, Irene Paiusco, Giacomo Bertoldo, Silvia Crociani, Francesca Toma, Giulia Mormando, Giulia Lorenzoni, Dario Gregori, Paolo Navalesi

المصدر: BMC Pulmonary Medicine, Vol 24, Iss 1, Pp 1-11 (2024)

مصطلحات موضوعية: High-flow nasal cannula, High flow nasal oxygen, High flow nasal therapy, Asymmetrical cannula, DUET, Diseases of the respiratory system, RC705-779

الوصف: Abstract Background Standard high-flow nasal cannula (HFNC) is a respiratory support device widely used to manage post-extubation hypoxemic acute respiratory failure (hARF) due to greater comfort, oxygenation, alveolar recruitment, humidification, and reduction of dead space, as compared to conventional oxygen therapy. On the contrary, the effects of the new asymmetrical HFNC interface (Optiflow® Duet system (Fisher & Paykel, Healthcare, Auckland, New Zealand) is still under discussion. Our aim is investigating whether the use of asymmetrical HFNC interface presents any relevant difference, compared with the standard configuration, on lung aeration (as assessed by end-expiratory lung impedance (EELI) measured by electrical impedance tomography (EIT)), diaphragm ultrasound thickening fraction (TFdi) and excursion (DE), ventilatory efficiency (estimated by corrected minute ventilation (MV)), gas exchange, dyspnea, and comfort. Methods Pilot physiological crossover randomized controlled study enrolling 20 adults admitted to the Intensive Care unit, invasively ventilated for at least 24 h, and developing post-extubation hARF, i.e., PaO2/set FiO2

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2466Test

الوصول الحر: https://doaj.org/article/f824fef20d7a4a22a909b1879ab3dc10Test

المؤلفون: Sabrina Congedi, Annalisa Boscolo, Marco Nardelli, Martina Biscaro, Christian Legnaro, Nicolò Sella, Giulia Fichera, Tommaso Antonio Giacon, Paola Zanon, Davide Lovison, Mara Bassi, Bianca Maria Borrelli, Giulia Lorenzoni, Chiara Giraudo, Dario Gregori, Federico Rea, Paolo Navalesi

المصدر: Transplantology, Vol 4, Iss 4, Pp 218-229 (2023)

مصطلحات موضوعية: nutrition, lung transplant, muscular assessment, sarcopenia, Surgery, RD1-811

الوصف: Background: Scant data are available on nutritional status in bilateral lung transplant (BLT) candidates. Methods: All consecutive recipients admitted to the intensive care unit (ICU) of the University Hospital of Padua (February 2016–2020) after bilateral-lung transplant (BLT) were retrospectively screened. Data collected: (i) nutritional indices (body mass index (BMI), albumin level, prognostic nutritional index (PNI), mini nutritional assessment short-form (MNA-SF)); and (ii) muscular indices (creatinine height index (CHI)), skeletal muscle index (SMI), densitometry of paravertebral muscles on chest CT). Results: 108 BLT recipients were enrolled: 55% had a normal BMI, 83% had serum albumin levels > 35 g/L; high PNI and MNA-SF scores were recorded in most of patients. A total of 74% had a “normal or slightly reduced protein state“ according to the CHI score; 17% were identified as “sarcopenic” according to muscle densitometry (Hu < 30). Lower serum albumin was associated with longer invasive mechanical ventilation days (IMV) and ICU length of stay (p-value for non-linearity < 0.01). PNI and BMI were also associated with an increased ICU length of stay (p-value for non-linearity < 0.01). Conclusions: Most of the BLT recipients had normal nutritional and sarcopenia status. Pre-transplant albumin values correlated with the duration of IMV; serum albumin, PNI and BMI were associated with ICU stay. No nutritional or muscle parameters predicted re-intubation, 30-days rejection and overall length of hospital stay.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2673-3943/4/4/21Test; https://doaj.org/toc/2673-3943Test

الوصول الحر: https://doaj.org/article/25fa25c8fa8a431d98db22fd32a2b533Test

المؤلفون: Erica Cardamone, Francesca Iacoponi, Rita Di Benedetto, Giulia Lorenzoni, Annalisa Di Nucci, Federica Zobec, Dario Gregori, Marco Silano

المصدر: Frontiers in Nutrition, Vol 11 (2024)

مصطلحات موضوعية: Adherence to Mediterranean Diet, ARIANNA, MDSS, survey, dietary pattern, Nutrition. Foods and food supply, TX341-641

الوصف: IntroductionOver the last years, many Mediterranean countries, including Italy, have witnessed a shift away from the Mediterranean Diet, thus contributing to the high rates of overweight and obesity. The survey “Adherence to Mediterranean Diet in Italy (ARIANNA)” aimed to evaluate the Adherence to Mediterranean Diet (AMD) and its main determinants in the Italian population.Materials and methodsThis study started on March 2023 and was addressed to adults aged ≥17 years, born and resident in Italy, proficient in Italian. Data are collected electronically through a voluntary, anonymous and self-administered questionnaire on the project website. Univariate and then multivariate logistic regressions were performed to evaluate associations between AMD and demographic characteristics, socio-economic status, health status, and lifestyle.ResultsOn a total of 3,732 completed questionnaires, the 87.70% of the respondents was female and the 71.28% was 17–40 years old. The 83.82% of the respondents had medium AMD, 11.33% low and only 4.85% high. The multivariate analysis revealed that being male (p 40 years (p

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fnut.2024.1346455/fullTest; https://doaj.org/toc/2296-861XTest

الوصول الحر: https://doaj.org/article/e3542de233674b029ea21a28a17952c5Test

المؤلفون: Lauro Cortigiani, Nicola Gaibazzi, Quirino Ciampi, Fausto Rigo, Hugo Rodríguez‐Zanella, Karina Wierzbowska‐Drabik, Jaroslaw D. Kasprzak, Rosina Arbucci, Jorge Lowenstein, Angela Zagatina, Ylenia Bartolacelli, Dario Gregori, Scipione Carerj, Mauro Pepi, Patricia A. Pellikka, Eugenio Picano

المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 13, Iss 4 (2024)

مصطلحات موضوعية: coronary flow, diabetes, left anterior descending artery, vasodilatory stress, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background Resting coronary flow velocity (CFV) in the mid‐distal left anterior descending coronary artery can be easily assessed with transthoracic echocardiography. In this observational study, the authors sought to assess the relationship between resting CFV, CFV reserve (CFVR), and outcome in patients with chronic coronary syndromes. Methods and Results In a prospective multicenter study design, the authors retrospectively analyzed 7576 patients (age, 66±11 years; 4312 men) with chronic coronary syndromes and left ventricular ejection fraction ≥50% referred for dipyridamole stress echocardiography. Recruitment (years 2003–2021) involved 7 accredited laboratories, with interobserver variability 2.0. Conclusions High resting CFV is associated with worse survival in patients with chronic coronary syndromes and left ventricular ejection fraction ≥50%. The value is independent and additive to CFVR. The combination of high resting CFV and low CFVR is associated with the worst survival.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2047-9980Test

الوصول الحر: https://doaj.org/article/840282bd7d4a48b985d5a467d30aba59Test

المؤلفون: Edoardo Forin, Giulia Lorenzoni, Ricard Ferrer, Massimo De Cal, Monica Zanella, Nicola Marchionna, Dario Gregori, Francesco Forfori, Anna Lorenzin, Vinicio Danzi, Claudio Ronco, Silvia De Rosa

المصدر: Scientific Reports, Vol 13, Iss 1, Pp 1-14 (2023)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract Although the precise clinical indication for initiation of PMX-HA is widely debated in the literature, a proper patient selection and timing of treatment delivery might play a critical role in the clinical course of a specific subphenotype of septic shock (endotoxic shock). In light of this view, since 2019, we have introduced in our clinical practice a diagnostic-therapeutic flowchart to select patients that can benefit the most from the treatment proposed. In addition, we reported in this study our experience of PMX-HA in a cohort of critically ill patients admitted to our intensive care unit (ICU). We analyzed a single centre, retrospective, observational web-based database (extracted from the EUPHAS2 registry) of critically ill patients admitted to the ICU between January 2016 and May 2021 who were affected by endotoxic shock. Patients were divided according to the diagnostic-therapeutic flowchart in two groups: Pre-Flowchart (Pre-F) and Post-Flowchart (Post-F). From January 2016 to May 2021, 61 patients were treated with PMX-HA out of 531 patients diagnosed with septic shock and of these, fifty patients (82%) developed AKI during their ICU stay. The most common source of infection was secondary peritonitis (36%), followed by community-acquired pneumonia (29%). Fifty-five (90%) out of 61 patients received a second PMX-HA treatment, with a statistically significant difference between the two groups (78% of the Pre-F vs. 100% of the Post-F group, p = 0.005). In both groups, between T0 and T120, the Endotoxin Activity Assay (EAA) decreased, while the SOFA score, mean arterial pressure (MAP), and Vasoactive Inotropic Score (VIS) improved with no statistically significant difference. Furthermore, when performing a propensity score matching analysis to compare mortality between the two groups, statistically significant lower ICU and 90-day mortalities were observed in the Post-F group [p = 0.016]. Although in this experienced centre data registry, PMX-HA was associated with organ function recovery, hemodynamic improvement, and current EAA level reduction in critically ill patients with endotoxic shock. Following propensity score-matched analysis, ICU mortality and 90-day mortalities were lower in the diagnostic-therapeutic flowchart group when considering two temporal groups based on strict patient selection criteria and timing to achieve PMX. Further Randomised Control Trials focused on centre selection, adequate training and a flowchart of action when assessing extracorporeal blood purification use should be performed.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/9b98787166df4968ad89f00ed5060c7fTest

المؤلفون: Samir Giuseppe Sukkar, Giulia Lorenzoni, Alice Carraro, Francesca Angioletti, Dario Gregori

المصدر: Journal of Clinical Medicine, Vol 13, Iss 11, p 3160 (2024)

مصطلحات موضوعية: malnutrition, dysphagia, modified texture food, Medicine

الوصف: Background: Institutionalized individuals with dysphagia are particularly at risk for malnutrition. This study investigated two texture-modified models for patients with dysphagia, as follows: (i) traditional homemade pureed food (PF) and (ii) homogenized meals obtained from dehydrated and rehydrated instantaneous preparations (IPs). Methods: A retrospective pilot study was performed. It included patients affected by medium-severity dysphagia admitted to the nursing home “Sacra Famiglia” Institute of Cocquio Trevisago, Varese. The patients were aged 41–81 years old and all had complex disabilities. They underwent anthropometric and biochemical parameter assessments at baseline, as well as at two months and four months follow-up. Results: The study involved 30 patients, 15 received the IP meal. The comparison between the baseline and the follow-up did not show significant anthropometric and biochemical parameter differences. Conversely, the IP group reported significantly higher levels of consumption and satisfaction, evaluated using a modified Chernoff scale based on three levels of smiles, than the PF group. Conclusions: The present findings provide promising indications to improve the diet of patients affected by dysphagia, since meal satisfaction is a relevant factor that has been shown to be associated with better patient mood, motivation to eat, and adherence to prescribed diet.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2077-0383/13/11/3160Test; https://doaj.org/toc/2077-0383Test

الوصول الحر: https://doaj.org/article/ced5c482ea4948e0ae0429418719e968Test

المؤلفون: Maria Vittoria Chiaruttini, Giulia Lorenzoni, Gaya Spolverato, Dario Gregori

المصدر: Journal of Clinical Medicine, Vol 13, Iss 11, p 3272 (2024)

مصطلحات موضوعية: chronic diseases, cancer, etiology and risk factors of diseases, win statistics, propensity score, observational studies, Medicine

الوصف: Background: Quality-of-life metrics are increasingly important for oncological patients alongside traditional endpoints like mortality and disease progression. Statistical tools such as Win Ratio, Win Odds, and Net Benefit prioritize clinically significant outcomes using composite endpoints. In randomized trials, Win Statistics provide fair comparisons between treatment and control groups. However, their use in observational studies is complicated by confounding variables. Propensity score (PS) matching mitigates confounding variables but may reduce the sample size, affecting the power of win statistics analyses. Alternatively, PS matching can stratify samples, preserving the sample size. This study aims to assess the long-term impact of these methods on decision making, particularly in colorectal cancer patients. Methods: A motivating example involves a cohort of patients from the ReSARCh observational study (2016–2021) with locally advanced adenocarcinoma of the rectum, situated up to 12 cm from the anal verge. These patients underwent either a watch-and-wait approach (WW) or trans-anal local excision (LE). Win statistics compared the effects of WW and LE on a composite outcome (overall survival, recurrence, presence of ostomy, and rectum excision). For matched win statistics, we used robust inference techniques proposed by Matsouaka et al. (2022), and for stratified win statistics, we applied the method proposed by Dong et al. (2018). A simulation study assessed the coverage probability of matched and stratified win statistics in balanced and unbalanced groups, calculating how often the confidence intervals included the true values of WR, NB, and WO across 1000 simulations. Results: The results suggest a better efficacy of the LE approach when considering efficacy outcomes alone (WR: 0.47 (0.01 to 1.14); NB: −0.16 (−0.34 to 0.02); and WO: 0.73 (0.5 to 1.05)). However, when QoL outcomes are included in the analyses, the estimates are closer to 1 (WR: 0.87 (0.06 to 2.06); WO: 0.93 (0.61 to 1.4)) and to 0 (NB: −0.04 (−0.25 to 0.17)), indicating a negative impact of the treatment effect of LE regarding the presence of ostomy and the excision of the rectum. Moreover, based on the simulation study, our findings underscore the superior performance of matched compared to stratified win statistics in terms of coverage probability (matched WR: 97% vs. stratified WR: 33.3% in a high-imbalance setting; matched WR: 98% vs. stratified WR: 34.4% in a medium-imbalance setting; and matched WR: 99.2% vs. stratified WR: 37.4% in a low-imbalance setting). Conclusions: In conclusion, our study sheds light on the interpretation of the results of win statistics in terms of statistical significance, providing insights into the application of pairwise comparison in observational settings, promoting its use to improve outcomes for cancer patients.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2077-0383/13/11/3272Test; https://doaj.org/toc/2077-0383Test

الوصول الحر: https://doaj.org/article/2c31c6846ad44644ab4860ce62d3438eTest

المؤلفون: Mattia Corianò, Corrado Lanera, Laura De Michieli, Martina Perazzolo Marra, Sabino Iliceto, Dario Gregori, Francesco Tona

المصدر: PLoS ONE, Vol 19, Iss 2, p e0297793 (2024)

مصطلحات موضوعية: Medicine, Science

الوصف: Prediction of major arrhythmic events (MAEs) in dilated cardiomyopathy represents an unmet clinical goal. Computational models and artificial intelligence (AI) are new technological tools that could offer a significant improvement in our ability to predict MAEs. In this proof-of-concept study, we propose a deep learning (DL)-based model, which we termed Deep ARrhythmic Prevention in dilated cardiomyopathy (DARP-D), built using multidimensional cardiac magnetic resonance data (cine videos and hypervideos and LGE images and hyperimages) and clinical covariates, aimed at predicting and tracking an individual patient's risk curve of MAEs (including sudden cardiac death, cardiac arrest due to ventricular fibrillation, sustained ventricular tachycardia lasting ≥30 s or causing haemodynamic collapse in

وصف الملف: electronic resource

العلاقة: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0297793&type=printableTest; https://doaj.org/toc/1932-6203Test

الوصول الحر: https://doaj.org/article/f1c7f3bb298148d3896e129a943c5c34Test