COLLEGIO DI DIREZIONE - Azienda Ospedaliera di Parma

AZIENDA OSPEDALIERO-UNIVERSITARIA DI PARMA
PUBBLICAZIONI SU RIVISTE CENSITE
GENNAIO – MARZO 2012
A CURA DI : UNITÀ OPERATIVA RICERCA E INNOVAZIONE

1) Aldrovandi, A; Maffei, E; Seitun, S; Martini, C; Berti, E; Grilli, R; Messalli, G; Weustink, AC; Mollet,
NR; Nieman, K; Ardissino, D; de Feyter, PJ; Krestin, GP; Cademartiri, F (2012) Major Adverse Cardiac
Events and the Severity of Coronary Atherosclerosis Assessed by Computed Tomography Coronary
Angiography in an Outpatient Population With Suspected or Known Coronary Artery Disease JOURNAL
OF THORACIC IMAGING 27(1):23-28 IF=1.207 [Article]
Purpose: To investigate the predictive value of 64-slice computed tomography coronary angiography (CTCA) for
major adverse cardiac events (MACEs) in patients with suspected or known coronary artery disease (CAD). Materials
and Methods: Seven hundred and sixty-seven consecutive patients (496 men, age 62 +/- 11 y) with suspected or known
heart disease referred to an outpatient clinic underwent 64-slice CTCA. The patients were followed for the occurrence
of MACE (ie, cardiac death, nonfatal myocardial infarction, unstable angina). Results: Eleven thousand five hundred
and sixty-four coronary segments were assessed. Of these, 178 (1.5%) were not assessable because of insufficient
image quality. Overall, CTCA revealed the absence of CAD in 219 (28.5%) patients, nonobstructive CAD (coronary
plaque

4) Bianchi, B; Copelli, C; Ferrari, S; Ferri, A; Sesenna, E (2012) Successful salvage surgery after
treatment failures with cross graft and free muscle transplant in facial reanimation JOURNAL OF
CRANIO-MAXILLOFACIAL SURGERY 40(2):185-189 IF=1.54 [Article]
Background: The microneurovascular transfer of a free-muscle transplant is the procedure of choice for facial
animation, It is characterized by low morbidity in both adult and paediatric patients. In spite of the improvements in
microsurgical techniques, failures due to absent revascularization or reinnervation of the transplanted muscle or
infections causing flap necrosis are observed. We propose a second surgical procedure based on the gracilis muscle
transplant reinnervated by the masseteric nerve as a solution for these cases. Methods: We analyzed and report on two
patients treated in our department after the failure of a previous cross-facial nerve graft and free muscle transplant. They
were treated with a new facial reanimation using the contralateral gracilis muscle and the masseteric nerve as the donor
nerve. Results and discussion: We did not observe any postoperative complications, and all of the flaps survived.
Reinnervation and contraction of the muscle appeared 3-4 months postoperatively, with good functional and aesthetic
results. Conclusions: This technique is a one-step procedure characterized by reliable flap harvesting, low donor site
morbidity and good activity of the masseteric nerve. We consider it as a good option for treatment of facial animation
failures. (C) 2011 European Association for Cranio-Maxillo-Facial Surgery.
5) Bianchi, B; Ferri, A; Ferrari, S; Copelli, C; Boni, P; Ferri, T; Sesenna, E (2012) The free anterolateral
thigh musculocutaneous flap for head and neck reconstruction: One surgeon's experience in 92 cases
MICROSURGERY 32(2):87-95 IF=1.555 [Article]
Background: Applications of the free anterolateral thigh (ALT) musculocutaneous flap have been largely
underestimated compared with indications for fasciocutaneous or perforator flaps. In this article, the authors critically
review the experience of a single surgeon with the free ALT musculocutaneous flap for head and neck reconstruction,
focusing on its applications in different cephalic areas and on advantages and disadvantages of this technique. Patients
and methods: Ninety-two patients were treated using a free ALT musculocutaneous flap. Reconstructed areas included
tongue, oropharynx, mandible, maxilla, hypopharynx, cheek, and skull base. Results: Flap survival rate was 97.8%.
Donor site morbidity consisted in two cases of partial necrosis of the skin graft used its closure with a final donor site
complication rate of 2.2%. Overall results showed an 89% of patients returned to a normal or a soft diet. Speech was
good or intelligible in 88% and cosmesis resulted good or acceptable in 89% of cases. Conclusion: The free ALT
musculocutaneous flap offers unique advantages in head and neck reconstructions including adequate bulk when
needed, obliteration of dead space, support for the soft tissues of the face, low donor-site morbidity, and harvesting
without needing for perforators dissection, allowing for optimal patient outcome. Excessive bulky and thickness of
subcutaneous tissue, especially in occidental population, have to be considered as the main disadvantages of this
technique, finally the high incidence of hairy skin in thigh area in male patients and donor site scars associated with the
use of skin grafts have to be considered as supplementary minor drawbacks.
6) Bianchi, B; Ferri, A; Ferrari, S; Copelli, C; Ferri, T; Sesenna, E (2012) Functional and Aesthetic
Approach to Adult Unoperated Mobius Syndrome: Orthognathic Surgery followed by Bilateral Free Gracilis
Muscle Transfers PLASTIC AND RECONSTRUCTIVE SURGERY 129(1):161E-162E IF=2.635
[Letter]

7) Boni, C; Tiseo, M; Boni, L; Baldini, E; Recchia, F; Barone, C; Grossi, F; Germano, D; Matano, E;
Marini, G; Labianca, R; Di Costanzo, F; Bagnulo, A; Pennucci, C; Caroti, C; Mencoboni, M; Zanelli, F;
Prochilo, T; Cafferata, MA; Ardizzoni, A (2012) Triplets versus doublets, with or without cisplatin, in the
first-line treatment of stage IIIB-IV non-small cell lung cancer (NSCLC) patients: a multicenter randomised
factorial trial (FAST) BRITISH JOURNAL OF CANCER 106(4):658-665 IF=4.831 [Article]
BACKGROUND: The FAST is a 2 x 2 factorial trial addressing two questions: (1) the role of replacing cisplatin (P)
with a non-platinum agent, vinorelbine (N), and (2) the role of adding a third agent, ifosfamide (I), in a doublet based on
gemcitabine (G). METHODS: A total of 433 stage IIIB-IV non-small cell lung cancer (NSCLC) patients were
randomised to one of four arms: gemcitabine-cisplatin (GP), gemcitabine-vinorelbine, gemcitabine-ifosfamide-cisplatin
or gemcitabine-ifosfamide-vinorelbine. Two comparisons were performed: N- vs P-containing regimens and I-triplets
vs non-I doublets. RESULTS: For N- vs P-containing regimens, adjusted overall survival was 9.7 vs 11.3 months
(P=0.044), progression-free survival was 4.9 vs 6.4 months (P=0.020) and response rate was 24% vs 31% (P=0.124),
respectively. No statistically significant difference was observed between doublets and triplets. Grade 3-4
haematological toxicity was significantly more frequent in P-containing therapy; grade 3-4 leucopenia was significantly
more common in triplets. Concerning non-haematological toxicity, grade 3-4 nausea-vomiting was significantly
increased in P-containing regimens. CONCLUSIONS: This trial provides evidence of a slight survival superiority of
GP-containing regimens over platinum-free N- containing chemotherapy. This trial also confirms that the addition of a
third chemotherapy agent (I) to a standard G-based doublet does not improve treatment outcome.
8) Borrelli, O; de' Angelis, G (2012) Solitary Rectal Ulcer Syndrome: It's Time to Think About It
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION 54(2):167-168 IF=2.18
[Editorial Material]
9) Buti, S; Rovere, RK; Donini, M; Passalacqua, R; Pezzuolo, D; Buzio, C (2012) Changes in lymphocyte
count induced by repeated cycles with low-dose interleukin-2 and interferon-alpha in 146 patients with renal
cell carcinoma TUMORI 98(1):45-52 IF=1.014 [Article]
Aims and background. The exact mechanism by which recombinant interleulcine-2 and interferon-alpha modulate the
immunological response, inducing long-term responses in metastatic renal cell carcinoma, is still not clear. The aim of
the study was to analyze the modifications in peripheral blood lymphocytes during cycles of low-dose immunotherapy
as a marker of the biological response to the treatment in 146 patients with renal cell carcinoma (advanced and localized
disease). Methods and study design. Peripheral blood lymphocytes were evaluated before and after every cycle of
treatment. Results. We found a statistically significant overall difference between pre- and post-cycle values (mean
increase of 39%). The differences between pre- and post-cycle lymphocyte counts for each cycle were significant. Also,
the post-cycle lymphocyte count of each cycle remained higher than the baseline value. Furthermore, pre-cycle
lymphocyte counts of each cycle were still higher than the baseline value, with no difference between a pre-cycle
lymphocyte mean value and the other one (except that between the first and second cycle). From the end of each cycle,
but before starting the next one, the absolute value of lymphocytes fell on the average by 15-30%, concurring with the
fact that, even starting from pre-cycle values higher than baseline, the immune system remains sensitive to chronically

epeated stimulation by immunotherapy. We also found that non-metastatic patients had a higher number of peripheral
blood lymphocytes than metastatic patients, whereas the latter had a lower immune response to therapy. Conclusions.
The results support the idea that "maintenance" immunotherapy may not develop resistance over time in terms of
biological response and thus may have a role as chronic therapy in combination with other drugs such as target therapy.
We suppose that the immune system of patients with metastases is in a state of relative impairment, resulting in less
sensitivity to immunostimulating agents.
10) Cabassi, A; Rocco, R; Berretta, R; Regolisti, G; Bacchi-Modena, A (2012) Eplerenone Use in
Primary Aldosteronism During Pregnancy HYPERTENSION 59(2):E18-E19 IF=6.908 [Letter]
11) Capocasale, E; Iaria, M; Vistoli, F; Signori, S; Mazzoni, MP; Dalla Valle, R; De Lio, N; Perrone, V;
Amorese, G; Mosca, F; Boggi, U (2012) Incidence, Diagnosis, and Treatment of Chylous Leakage After
Laparoscopic Live Donor Nephrectomy TRANSPLANTATION 93(1):82-86 IF=3.676 [Article]
Background. Chylous leakage (CL) is a rare complication of laparoscopic live donor nephrectomy (LLDN). It may lead
to malnutrition and immunological deficits because of protein and lymphocyte depletion. Methods. Data from 208
consecutive LLDN performed at two institutions, between April 2000 and September 2010, were reviewed to identify
the anatomical basis behind CL along with its diagnostic and therapeutic options. Results. CL developed in eight donors
(3.8%), as determined by high-volume drainage (range 540-800 mL/24 hr) of triglyceride-rich fluid. All donors were
managed conservatively. Seven were put on total parenteral nutrition plus octreotide. One received low-fat diet,
medium-chain triglyceride supplementation, and octreotide. Chylous fistulas resolved in 5 to 16 days (mean time 12.3
days). Drains were removed before hospital discharge, and no donor was readmitted and/or needed outpatient care.
Conclusions. CL is a potentially insidious and perhaps misdiagnosed complication after LLDN. It occurs in nearly 4%
of LLDN and it seems to be uniquely associated to left-sided kidney recovery because of distinctive lymphatics
distribution around the periaortic area of dissection. Conservative therapy is effective in most donors and should be
initially attempted. Surgical ligatures or fibrin sealants may be indicated in case of refractory CL before the arising of
malnutrition and/or relevant immunodeficiency.
12) Carmi, C; Galvani, E; Vacondio, F; Rivara, S; Lodola, A; Russo, S; Aiello, S; Bordi, F; Costantino, G;
Cavazzoni, A; Alfieri, RR; Ardizzoni, A; Petronini, PG; Mor, M (2012) Irreversible Inhibition of Epidermal
Growth Factor Receptor Activity by 3-Aminopropanamides JOURNAL OF MEDICINAL CHEMISTRY
55(5):2251-2264 IF=5.207 [Article]
13) Coppola, A; Tagliaferri, A; Di Capua, M; Franchini, M (2012) Prophylaxis in Children with
Hemophilia: Evidence-Based Achievements, Old and New Challenges SEMINARS IN THROMBOSIS
AND HEMOSTASIS 38(1):79-94 IF=4.169 [Article]
Recurrent joint bleeding leading to progressive musculoskeletal damage (hemophilic arthropathy), in spite of ondemand
replacement with deficient factor concentrates, is the clinical hallmark of severe hemophilia A and B (i.e., the

congenital deficiencies of coagulation factors VIII and IX with circulating levels

from 27 patients with MR and persistent AF (group 1), 33 with MR in sinus rhythm (group 2), and 15 autopsy controls
(group 3) was used to measure myocyte diameter, percentage of myocytolytic myocytes, interstitial fibrosis, and
capillary density; RT-PCR and Western blotting were used to assess the mRNA and protein levels of SOD-1, SOD-2,
HO-1, calpain, MMP-2, MMP-9, TIMP-1, TIMP-2, and VEGF; immunofluorescence was used to locate these proteins.
Myocyte diameter was similar in groups 1 and 2, but larger than controls. Compared to group 2, group 1 had more
myocytolytic myocytes (20.8 +/- 5.6% vs 14.7 +/- 4.5%; P < 0.0001), increased interstitial fibrosis (10.4 +/- 5.1% vs 7.5
+/- 4.2%; P < 0.05), and decreased capillary density (923 +/- 107 No/mm(2) vs 1,040 +/- 100 No/mm(2); P < 0.0001).
All of the proteins were more expressed in groups 1 and 2 than in controls. The protein and mRNA levels of SOD-1,
SOD-2, MMP-2, and MMP-9 were higher in group 1 than in group 2. Conclusions: The LAPW of MR patients with or
without AF shows considerable SR. The former has more severe histopathological changes and higher levels of proteins
involved in SR, thereby reaching a threshold beyond which the sinus impulse cannot normally activate atrial
myocardium.
16) Costi, R; Le Bian, A; Cauchy, F; Diop, PS; Carloni, A; Catherine, L; Smadja, C (2012) Synchronous
pyogenic liver abscess and acute cholecystitis: how to recognize it and what to do (emergency
cholecystostomy followed by delayed laparoscopic cholecystectomy) SURGICAL ENDOSCOPY AND
OTHER INTERVENTIONAL TECHNIQUES 26(1):205-213 IF=3.436 [Article]
The treatment of synchronous pyogenic liver abscess (PLA) and acute cholecystitis (AC) may be challenging.
Moreover, because of the similarity of symptoms and the suboptimal accuracy of ultrasound (US), PLA(s) may be
undetected, unless a computer tomography (CT) scan is performed. The aims of this study were (1) to evaluate the
results of emergency cholecystostomy (CS) and late laparoscopic cholecystectomy (LC) in such a population and (2) to
identify the criteria for selecting patients with AC and a high risk of having synchronous PLA(s) for referral for a CT
scan. A retrospective analysis of the outcome of 12 patients with AC and PLA(s) treated by emergency CS followed by
delayed LC from January 1996 through May 2010 at a tertiary-care university hospital was performed. Clinical,
laboratory, and radiological data of patients with synchronous AC and PLA(s) are compared with those of 66 patients
with "simple" AC. The association of age > 55 years, temperature > 38A degrees C, WBC count > 12,000/ml, and
ASAT > 50 UI/l and/or ALAT > 75 UI/l allows for the selection of patients at high risk of PLA to undergo a CT scan
(sensitivity: 100%; specificity: 86%). All treated patients had a sudden improvement within 24 h following CS. PLA
was treated in 10/12 patients (83%). Hospital stay lasted 21.5 +/- A 3.5 days. Ten patients underwent elective LC 12 +/-
A 4 weeks after CS with no conversion and 30% perioperative morbidity. Operating time was 91 min. Hospital stay was
1.7 days [7 patients (70%) underwent surgery as an outpatient]. A simple algorithm is presented for the selection of
patients with AC to undergo a CT scan to identify synchronous PLA. Emergency CS followed by delayed LC is a
viable, first-line treatment option for synchronous PLA and AC.
17) Danese, E; Montagnana, M; Minicozzi, AM; Bonafini, S; Ruzzenente, O; Gelati, M; De Manzoni, G;
Lippi, G; Guidi, GC (2012) The role of resistin in colorectal cancer CLINICA CHIMICA ACTA 413(07-
ago):760-764 IF=2.388 [Article]

18) De Berti, G; Maggi, M; Conigliaro, R; Levrini, G; Salzano, S; Ghadir pour, R; Servadei, F (2012)
Administration of conscious sedation by a neuroradiology team during percutaneous vertebroplasty and
spinal biopsy procedures NEURORADIOLOGY 54(3):231-237 IF=2.87 [Article]
Percutaneous vertebroplasty, i.e. the consolidation of a vertebral body with polymethylmethacrylate, is a safe and
effective image-guided technique increasingly used as a treatment option for different pathologic conditions, mainly
vertebral body fractures secondary to osteoporosis, hemangiomas and metastasis. The procedure, although minimally
invasive, could be painful and is better tolerated if a conscious sedation regimen is added to local anesthesia. An
anesthesiologist usually performs the sedo/analgesia, but frequently, he is not available in our angiography unit, so we
have begun to perform the sedo/analgesia ourselves following an analogous situation that physicians of the Digestive
Endoscopic Unit of our institution experienced some years ago. Using the guidelines developed by Italian Society of
Digestive Endoscopy, Italian Society of Anesthesia, Analgesia, Reanimation and Intensive Therapy and National
Association of Endoscopy Operators and Technicians as a starting point, we then adapted their protocol to our
vertebroplasty requirements, after an adequate training period carried out by our anesthesiologist staff. The results have
been very satisfactory, greatly appreciated by patients for good pain control; we have never registered any adverse
effects nor have we had any particular problems in controlling sedation or monitoring procedures. In our experience, we
have observed that conscious sedation can be safely administered by neuroradiologists during spinal procedures,
provided that some basic rules are respected regarding patient selection and monitoring, personnel training and
angiography equipment.
19) Di Gennaro, C; Saccani-Jotti, G; Pinelli, S; Venturi, N; Palombi, F; Manfredi, G; Pellegrino, A;
Bicchieri, L; Sansoni, P; Montanari, A (2012) Endothelial Dysfunction and High Cardiovascular Risk
Profile in Severe Alcoholics Improve Only Partially Following a Medium-Term Alcohol Withdrawal
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH 36(2):242-250 IF=3.468 [Article]
Background: Little is known about brachial artery flow-mediated vasodilatation (FMD) in active and medium-term
withdrawing heavy alcoholics (HA). Methods: FMD and some parameters of cardiovascular (CV) risk were measured
in 29 HA (average alcohol intake 135, range 86 to 215 g per day) at baseline and after a 9 +/- 7 months withdrawal and
in 35 teetotalers. Results: HA showed baseline impaired maximal % FMD (8.5 +/- 5.4 SD vs. 14.9 +/- 7.4, < 0.001 vs.
teetotalers), higher systolic (SBP) and diastolic (DBP) blood pressure (+ 24 mm Hg, < 0.001; + 15 mm Hg, < 0.01), uric
acid (5.3 +/- 1.1 vs. 4.4 +/- 0.8 mg/dl, < 0.05), high-sensitivity C-reactive protein (hs-CRP; 2.7 +/- 2.0 vs. 1.0 +/- 0.9
mg/l, < 0.02), endothelin-1 (ET-1, 0.88 +/- 0.36 vs. 0.37 +/- 0.10 pg/ml,< 0.001), asymmetric dimethylarginine
(ADMA, 0.50 +/- 0.21 vs. 0.41 +/- 0.12 mu mol/l, p < 0.001), homeostasis model assessment of insulin resistance
(HOMA-IR) (2.3 +/- 1.1 vs. 1.2 +/- 0.4, < 0.001), and urinary 8-isoprostane (U8-iso-PGF2 alpha) (237.2 +/- 172.4 vs.
168.5 +/- 96.6 pg/mg creatinine, < 0.05). After withdrawal, SBP fell by 15 mm Hg, DBP by 11 mm Hg (p < 0.001), and
hs-CRP by 0.94 mg/l (p < 0.02), all remaining still higher than teetotalers (< 0.05, 0.01, 0.05 respectively). ET-1,
HOMA-IR, and U8-iso-PGF2 alpha were unchanged (p = NS vs. baseline, < 0.05 to 0.001 vs. teetotalers). Maximal %
FMD rose (to 10.6 +/- 6.2, p < 0.04), but it still remained impaired (< 0.04 vs. teetotalers). ADMA increased further to
0.64 +/- 0.15 mu mol/l (< 0.05 vs. baseline, < 0.02 vs. teetotalers). Conclusions: HA show marked endothelial
dysfunction (ED) and high BP, impaired insulin sensitivity, inflammation, increased oxidative stress, and elevated ET-1
and ADMA, which are unaffected or only partially reversed by a medium-term alcohol withdrawal. ED and related
abnormalities persist in detoxified alcoholics, thus contributing to a greater CV morbidity and mortality.

20) Favaloro, EJ; Funk, DM; Lippi, G (2012) Pre-analytical Variables in Coagulation Testing Associated
With Diagnostic Errors in Hemostasis LABMEDICINE 43(2):54-60 IF=0.267 [Article]
The use of modern laboratory instrumentation with high levels of test reliability and appropriate quality assurance
measures will lead to very few analytical errors within hemostasis testing. Nevertheless, incorrect or inappropriate test
results are still reported, often due to events outside the control of the laboratories performing the tests. This is due
primarily to pre-analytical events associated with sample collection and processing, as well as post-analytical events
related to the reporting and interpretation of test results. This review focuses on the pre-analytical phase, highlighting
contributory elements and providing suggestions on how problems can be minimized or prevented, thereby improving
the likelihood that reported test results actually represent the true clinical status of the patient rather than that of an
inappropriate sample. This review should be of value to both laboratory personnel and clinicians because an
appreciation of these issues will enable the optimal clinical management of patients.
21) Ferri, A; Ferri, T; Sesenna, E (2012) Bilateral Silent Sinus Syndrome: Case Report and Surgical
Solution JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY 70(1):E103-E106 IF=1.5 [Article]
abstract non disponibile
22) Franchini, M; Tagliaferri, A; Mengoli, C; Cruciani, M (2012) Cumulative inhibitor incidence in
previously untreated patients with severe hemophilia A treated with plasma-derived versus recombinant
factor VIII concentrates: A critical systematic review CRITICAL REVIEWS IN ONCOLOGY
HEMATOLOGY 81(1):82-93 IF=4.689 [Review]
Inhibitor development represents currently the most serious and challenging complication of clotting factor replacement
therapy. A number of studies have analyzed the impact of the type of factor VIII (FVIII) replacement therapy (plasmaderived
versus recombinant concentrates) on inhibitor development in hemophilia A patients with conflicting results. In
order to shed light on this controversial issue, we performed a systematic review and meta-analysis on the published
prospective studies evaluating the incidence rate of inhibitors in previously untreated patients (PUPs) with severe
hemophilia A. Data from a total of 800 patients enrolled in 25 prospective studies published between 1990 and 2007
were included in this review. The quality of the studies was evaluated using two different systems: the Newcastle-
Ottawa Scale (NOS) and STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). Overall,
the inhibitor incidence rate did not differ significantly between recipients of plasma-derived and recombinant FVIII
concentrates (weighted means: 21%; 95% CI, 14-30 versus 27%; 95% CI, 21-33). Similarly, high titer inhibitors did not
differ significantly between patients treated with plasma-derived (weighted means: 14%; 95% CI, 8-25) or recombinant
FVIII concentrates (weighted means: 16%; 95% CI, 13-20). Thus, the main conclusion of this systematic review
performed using selective criteria is that the type of FVIII product (i.e., plasma-derived versus recombinant FVIII
concentrates) does not seem to influence the inhibitor rate in PUPs with severe hemophilia A. (C) 2011 Elsevier Ireland
Ltd. All rights reserved.
23) Franzini, L; Ardigo, D; Valtuena, S; Pellegrini, N; Del Rio, D; Bianchi, MA; Scazzina, F; Piatti, PM;
Brighenti, F; Zavaroni, I (2012) Food selection based on high total antioxidant capacity improves

endothelial function in a low cardiovascular risk population NUTRITION METABOLISM AND
CARDIOVASCULAR DISEASES 22(1):50-57 IF=3.438 [Article]
Background and aims: Oxidative stress has been advocated as a major cause for cardiovascular disease (CVD), and low
plasma antioxidant concentrations are associated with endothelial dysfunction, the first step towards atherosclerosis.
However, although the antioxidant content in fruits and vegetables may explain at least in part their protective effect
against CVD, supplementation with antioxidant vitamins fails to improve endothelial function and reduce CVD risk.
The aim of this study was to investigate the impact of a diet rich in antioxidants on endothelial function measured by
flow-mediated dilatation (FMD) in volunteers at low cardiovascular risk. Methods and results: In a crossover trial, 24
subjects (13 women, mean age 61 +/- 3 years), received, in a randomised order, a 14-day high (HT) and a 14-day low
(LT) antioxidant diets, with a 2-week wash-out (WO) in between. Both diets were comparable in daily portions of fruits
and vegetables, and in alcohol, fibre and macronutrient intake, but differed in their total antioxidant capacity. Before
and after each diet, anthropometrics, blood pressure, fasting plasma glucose, lipid profile, hepatic enzymes, circulating
antioxidant concentrations, high sensitivity C-reactive protein (hs-CRP) and FMD were assessed. FMD increased
significantly during the HT diet compared to the LT (p < 0.000). FMD values were 2.3% higher after HT compared
with LT (p < 0.001) after adjustment for age, gender and diet order. a-tocopherol increased significantly (p < 0.05) and
hs-CRP and of gamma-glutamyltranspeptidase decreased significantly (p < 0.05 and p < 0.01, respectively) during the
HT diet, compared with the LT diet. Conclusions: A short-term HT diet improves endothelial function in volunteers at
low cardiovascular risk, which may further reduce their risk of CVD. (C) 2010 Elsevier B. V. All rights reserved.
24) Gaibazzi, N; Silva, L; Reverberi, C (2012) Safety and positive predictive value of high-dose
dipyridamole stress-echocardiography with or without contrast flash-replenishment perfusion imaging in
patients with suspected or known coronary artery disease INTERNATIONAL JOURNAL OF
CARDIOLOGY 154(3):382-383 IF=6.802 [Letter]
25) Giammanco, GM; Rotolo, V; Medici, MC; Tummolo, F; Bonura, F; Chezzi, C; Martella, V; De Grazia,
S (2012) Recombinant norovirus GII.g/GII.12 gastroenteritis in children INFECTION GENETICS AND
EVOLUTION 12(1):169-174 IF=3.086 [Article]
26) Guarnieri, B; Adorni, F; Musicco, M; Appollonio, I; Bonanni, E; Caffarra, P; Caltagirone, C; Cerroni,
G; Concari, L; Cosentino, FII; Ferrara, S; Fermi, S; Ferri, R; Gelosa, G; Lombardi, G; Mazzei, D; Mearelli,
S; Morrone, E; Murri, L; Nobili, FM; Passero, S; Perri, R; Rocchi, R; Sucapane, P; Tognoni, G; Zabberoni,
S; Sorbi, S (2012) Prevalence of Sleep Disturbances in Mild Cognitive Impairment and Dementing
Disorders: A Multicenter Italian Clinical Cross-Sectional Study on 431 Patients DEMENTIA AND
GERIATRIC COGNITIVE DISORDERS 33(1):50-58 IF=2.455 [Article]

27) Guidi, GC; Lippi, G (2012) Molar expression: Interconverting results of highly sensitive troponin I and
T while preserving clinical significance CLINICAL BIOCHEMISTRY 45(01-feb):183-183 IF=2.043
[Letter]
28) Hicks, GE; Shardell, M; Alley, DE; Miller, RR; Bandinelli, S; Guralnik, J; Lauretani, F; Simonsick,
EM; Ferrucci, L (2012) Absolute Strength and Loss of Strength as Predictors of Mobility Decline in Older
Adults: The InCHIANTI Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES
AND MEDICAL SCIENCES 67(1):66-73 IF=3.988 [Article]
29) Kwee, I; Rinaldi, A; Rancoita, P; Rossi, D; Capello, D; Forconi, F; Giuliani, N; Piva, R; Inghirami, G;
Gaidano, G; Zucca, E; Bertoni, F (2012) Integrated DNA copy number and methylation profiling of lymphoid
neoplasms using a single array BRITISH JOURNAL OF HAEMATOLOGY 156(3):354-357 IF=4.942
[Article]
30) Lauretani, F; Maggio, M; Silvestrini, C; Nardelli, A; Saccavini, M; Ceda, GP (2012) Parkinson's
disease (PD) in the elderly: An example of geriatric syndrome (GS)? ARCHIVES OF GERONTOLOGY
AND GERIATRICS 54(1):242-246 IF=1.438 [Article]
PD is an age-related neurodegenerative disorder that affects as many as 1-2% of persons aged 60 years and older. In the
latest decade, the approach to PD was dramatically changed. In fact, although for many years PD has been considered
only "a disease that affects walking", with a key role of the neurotransmitter dopamine, recently the neurological
approach has been substantially modified. The approach for this disease is not only a neurological issue. Given the
complexity of its clinical aspects, such as depression, anxiety, dementia, sleep disorder, pneumonia dysfagia-related and
malnutrition, a multidisciplinary evaluation and not just a neurological evaluation is needed. We suggest a n
multidisciplinary approach for this old actor, underlying a subtle link between neurophatological stages of the disease
(Braak's classification) and clinical aspects (Braak's stages 1 and 2 associated with the premotor phase; Braak's stages 3-
4 associated with the motor symptoms and Braak's stages 5-6 associated with cognitive impairment). In addition, we
emphasize the usefulness of geriatric evaluation for the identification of frail "in situ", frail, and disable status for
improving care and treatment in this multifaceted disease.
31) Leonida, A; Vescovi, P; Baldoni, M; Rossi, G; Lauritano, D (2012) Immediate Loading in Mandible
Full-Arch: Pilot Study in Patients With Osteoporosis in Bisphosphonate Therapy JOURNAL OF ORAL
IMPLANTOLOGY 38(1):85-94 IF=0 [Article] abstract non disponibile
32) Lippi, G (2012) Better Care for Patients With Diabetes: e-Medicine Is the Goal ARCHIVES OF
INTERNAL MEDICINE 172(4):373-373 IF=10.639 [Letter]

33) Lippi, G; Cervellin, G (2012) Degradation of Troponin I in Serum or Plasma: Mechanisms, and
Analytical and Clinical Implications SEMINARS IN THROMBOSIS AND HEMOSTASIS 38(2):222-229
IF=4.169 [Article]
A prolongedmyocardial ischemia, which results from a total deprivation of blood supply to an area of cardiacmuscle for
an appreciable period of time, is the leading mechanism responsible for acute myocardial infarction (AMI). The
irreversible injury of myocardiocytes and the subsequent release of a variety of intracellular components into blood is
the cornerstone of the diagnosis of AMI. Cardiac troponins are advocated as the biochemical gold standards among the
various biomarkers of plaque instability, plaque rupture, ischemia, reversible cellular injury, and early and late necrosis
(i.e., irreversible injury). The assessment of cardiac troponins in the diagnostic approach of patients with chest pain
presents, however, some specific challenges due to the complex mechanisms of release from the injured myocardium,
as well as to the enzymatic degradation by cardiac and extracardiac proteases (i.e., calpains, caspases, cathepsin L, and
gelatinase A) that might alter the immunoreactivity (and thus laboratory detection) of the molecules. These two aspects
will be discussed in this article, with specific focus on cardiac troponin I, as a variety of immunoassays based on
antibodies which recognize different epitopes on the molecule is available for the measurement of this important cardiac
biomarker.
34) Lippi, G; Cervellin, G; Aloe, R; Montagnana, M; Salvagno, GL; Guidi, GC (2012) Non-commutability
of results of highly sensitive troponin I and T immunoassays BIOCHEMIA MEDICA 22(1):127-129
IF=1.085 [Article]
Introduction: The measurement of cardiospecific troponins is pivotal in the diagnostic and prognostic approach of
patients with suspected acute myocardial infarction (AMI). However, no information is available on the commutability
of results between the novel highly-sensitive (HS) troponin T (TnT) and I (TnI) immunoassays. Materials and methods:
The study population consisted in 47 consecutive patients presenting at the emergency department (ED) of the
Academic Hospital of Parma with suspected AMI. TnI was measured with the novel prototype Beckman Coulter HS-
AccuTnI immunoassay on Access 2, whereas TnT was measured with the Roche HS-TnT immunoassay on Cobas.
Results: Eight out of the 47 patients (17%) were finally diagnosed as having an AMI. The overall correlation between
TnT and TnI for total patient group was acceptable (r = 0.944; P < 0.01). Nevertheless, when the analysis of data was
carried out in separate groups according to the final diagnosis of AMI, two different equation results were obtained, i.e.,
HS-TnT = HS-AccuTnI x 0.349 + 20 (r = 0.823; P

myocardial infarction in the emergency department ANNALS OF CLINICAL BIOCHEMISTRY 49():205-
206 IF=2.209 [Letter]
36) Lippi, G; Cervellin, G; Targher, G (2012) Random plasma glucose measurement may improve the
diagnostic specificity of highly sensitive troponin in the emergency department INTERNATIONAL
JOURNAL OF CARDIOLOGY 155(1):172-173 IF=6.802 [Letter]
37) Lippi, G; Favaloro, EJ (2012) Coagulopathies and Thrombosis: Usual and Unusual Causes and
Associations, Part VI Preface SEMINARS IN THROMBOSIS AND HEMOSTASIS 38(2):125-128
IF=4.169 [Editorial Material]
38) Lippi, G; Favaloro, EJ; Cervellin, G (2012) Hemostatic Properties of the Lymph: Relationships with
Occlusion and Thrombosis SEMINARS IN THROMBOSIS AND HEMOSTASIS 38(2):213-221
IF=4.169 [Article]
Lymphatic thrombosis is a rare occurrence, and although its frequency is likely underestimated, its burden remains
substantially lower than that of venous or arterial thrombosis. Current evidence suggests that despite measurable levels
of fibrinogen, von Willebrand factor and other coagulation factors in the lymph, fibrin generation is substantially
inhibited under physiological conditions, essentially making the lymph a hypocoagulable biological fluid. Although
factor VIIa-tissue factor-catalyzed activation of factor X is possible in the lymph, fibrin generation is largely
counteracted by the unavailability of cell surface anionic phospholipids such as those physiologically present on blood
platelets, combined with only low levels of coagulation factors, and the strong inhibitory activity of heparin,
antithrombin, and tissue factor pathway inhibitor. Enhanced fibrinolytic activity further contributes to reduce the
development and growth of lymph clots. Nevertheless, lymphatic thrombosis is occasionally detected, especially in the
thoracic duct, axillary, or inguinal lymphatics. Pathogenetic mechanisms are supported by the release of thromboplastin
substances from the injured lymphatic endothelium accompanied by chronic obstruction of lymph flow in the presence
of a hypercoagulable milieu, thereby mirroring the Virchow triad that otherwise characterizes venous thrombosis. In
theory, any source of lymphatic vessel occlusion, such as internal obliteration, external compression, or increased
lymphatic pressure, might predispose to localized lymphatic thrombosis. The leading pathologies that can trigger
thrombosis in the lymphatic vessels include cancer (due to external compression, neoplastic obliteration of the
lymphatic lumen by metastatic cells, or lymphatic dysfunction after lymph node dissection), infections (especially
lymphatic filariasis or sustained by Chlamydia trachomatis, Mycobacterium tuberculosis, Treponema pallidum, or
Streptococcus pyogenes), congestive heart failure, chronic edema and inflammation of the distal lower limb,
complications of central venous catheterization, coronary artery bypass grafting, thoracic outlet syndrome, and
amyloidosis.
39) Lippi, G; Favaloro, EJ; Simundic, AM (2012) Biomedical research platforms and their influence on
article submissions and journal rankings: An update. BIOCHEMIA MEDICA 22(1):7-14 IF=1.085
[Editorial Material]

40) Lippi, G; Fontana, R; Avanzini, P; Aloe, R; Ippolito, L; Sandei, F; Favaloro, EJ (2012) Influence of
mechanical trauma of blood and hemolysis on PFA-100 testing BLOOD COAGULATION &
FIBRINOLYSIS 23(1):82-86 IF=1.408 [Article]
Although the appropriate quality of samples is essential for platelet function testing, information is lacking on
interference from mechanical trauma of blood and hemolysis on PFA-100 analyzer. Citrated blood collected from nine
healthy volunteers was divided into three aliquots. The first aliquot ('A') was processed without further manipulation,
whereas the second and third were subjected to mechanical trauma by two ('aliquot B') or four passages ('aliquot C')
through a very fine needle (30 gauge) to produce hemolysis and cell trauma mimicking poor sample collection. Samples
were tested on PFA-100 and Advia 2120, and plasma then separated and tested for lactate dehydrogenase (LDH) and
hemolysis index. Negligible hemolysis was present in aliquot A (hemolysis index 0.2 +/- 0.1, cell-free hemoglobin 0-
0.5 g/l), whereas an increasing amount was present in aliquots B (hemolysis index of 13.1 +/- 1.8, cell-free hemoglobin
6.0-6.5 g/l) and C (hemolysis index 24.0 +/- 1.1, cell-free hemoglobin 11.5-12.0 g/l). Increases in LDH, and
concomitant reductions in platelet and red blood cell counts were observed in aliquots B and C. In hemolyzed aliquots
B, four out of nine samples yielded 'flow obstruction' with both PFA-100 agonist cartridges, whereas the closure times
were dramatically prolonged in the remaining five samples. In hemolyzed aliquots C, flow obstruction was recorded in
six of nine samples for collagen and ADP and all samples for collagen and epinephrine, whereas closure times of
collagen and ADP in the remaining three samples were dramatically prolonged. Mechanical trauma of blood causing
hemolysis makes PFA-100 testing unreliable. When flow obstructions are observed, the potential presence of hemolysis
should be investigated. Blood Coagul Fibrinolysis 23:82-86 (C) 2011 Wolters Kluwer Health vertical bar Lippincott
Williams & Wilkins.
41) Lippi, G; Ippolito, L; Russello, T; Ponzo, V; Salvagno, GL; Guidi, GC (2012) Analytical performance
of the new ACL AcuStar HemosIL D-Dimer BLOOD COAGULATION & FIBRINOLYSIS 23(2):164-167
IF=1.408 [Article]
Several lines of clinical evidence as well as guidelines and recommendations suggest that the overall diagnostic
performance of D-dimer testing outstrips that of any other biomarker in the diagnostic approach of patients with venous
thromboembolism or disseminated intravascular coagulation. Along with specific technical characteristics, the
analytical performance of each D-dimer immunoassay should, however, be assessed before implementation in clinical
practice. The aim of this study was to evaluate the analytical performance of HemosIL AcuStar D-Dimer immunoassay,
a novel chemiluminescent immunoassay specifically designed for the instrument Instrumentation Laboratory ACL
AcuStar. The within and between-run imprecision (n=20) was comprised between 3.6 and 5.8%. The linearity was
excellent up to 16 200 ng/ml (r=1.00; P

and accurate quantification of D-dimer in clinical laboratories. Blood Coagul Fibrinolysis 23:164-167 (C) 2012 Wolters
Kluwer Health vertical bar Lippincott Williams & Wilkins.
42) Lippi, G; Mercadanti, M; Aloe, R; Targher, G (2012) Erythrocyte mechanical fragility is increased in
patients with type 2 diabetes EUROPEAN JOURNAL OF INTERNAL MEDICINE 23(2):150-153
IF=1.657 [Article]
Background: Anemia is common among patients with type 2 diabetes. We determined whether type 2 diabetic patients
significantly differed in erythrocyte mechanical fragility as compared with nondiabetic subjects. Methods: We recruited
25 Caucasian patients with type 2 diabetes (14 men and 11 women; mean age 58 +/- 8 years) and 25 age-, race- and sexmatched
nondiabetic individuals. The fragility of erythrocytes was tested by inducing mechanical hemolysis by double
aspiration of K(2)EDTA blood through a 0.5 mL insulin syringe equipped with a very thin needle. The plasma was then
separated from the blood cells by centrifugation at 2000 xg for 15 min at room temperature. A Beckman Coulter DxC
800 was used to measure the hemolysis index by direct spectrophotometry. Results: Compared with matched
nondiabetic controls, type 2 diabetic patients had a significantly increased mechanical fragility of erythrocytes
(hemolysis index ratio 21 +/- 13 vs. 14 +/- 10, p=0.02). Univariable linear regression analysis revealed that there was a
strong positive association between percent hemolysis and fasting plasma glucose (r=0.669, p

accurately rule-out patients with non life-threatening conditions that can be considered for early and safe discharge or
further outpatient follow-up, rule-in patients with acute coronary syndrome and raise the degree of alert of the
emergency physicians on non-cardiac life-threatening emergencies. The introduction of novel biomarkers alongside the
well-established troponins might support this process and also provide prognostic information about acute short-term or
chronic long-term risk and severity. Among the various biomarkers, copeptin measurement holds appealing
perspectives. The utility of combining troponin with copeptin might be cost-effective due to the high negative predictive
value of the latter biomarker in the rule-out of an acute coronary syndrome. Moreover, in the presence of a remarkably
increased concentration (e.g., more than 10 times the upper limit of the reference range), to reveal the presence of acute
life-threatening conditions that may not necessarily be identified with the use of troponin alone. The aim of this article
is to review current evidence about the clinical significance of copeptin testing in the ED as well as its appropriate
placing within diagnostic protocols.
46) Lippi, G; Targher, G (2012) Optimal therapy for reduction of lipoprotein(a) JOURNAL OF CLINICAL
PHARMACY AND THERAPEUTICS 37(1):1-3 IF=1.649 [Editorial Material]
47) Lippi, G; Valentino, M; Cervellin, G (2012) Laboratory diagnosis of acute pancreatitis: in search of
the Holy Grail CRITICAL REVIEWS IN CLINICAL LABORATORY SCIENCES 49(1):18-31 IF=5.741
[Review]
Acute pancreatitis is an acute inflammatory condition of the pancreas, which might extend to local and distant
extrapancreatic tissues. The global incidence varies between 17.5 and 73.4 cases per 100,000 and the pathogenesis
recognizes alcohol exposure and biliary tract disease as the leading causes, ahead of post-endoscopic retrograde
cholangiopancreatography, drugs and abdominal trauma. The diagnosis of acute pancreatitis is substantially based on a
combination of clinical signs and symptoms, imaging techniques and laboratory investigations. Contrast-enhanced
computed tomography is the reference standard for the diagnosis, as well as for establishing disease severity. The
assessment of pancreatic enzymes, early released from necrotic tissue, is the cornerstone of laboratory diagnosis in this
clinical setting. Although there is no single test that shows optimal diagnostic accuracy, most current guidelines and
recommendations indicate that lipase should be preferred over total and pancreatic amylase. Although a definitive
diagnostic threshold cannot be identified, cut-offs comprised between >= 2 and >= 4 times the upper limit of the
reference interval are preferable. The combination of amylase and lipase has been discouraged as although it marginally
improves the diagnostic efficiency of either marker alone, it increases the cost of investigation. Some interesting
biomarkers have been also suggested (e. g., serum and urinary trypsinogen-1, -2 and -3, phospholipase A2, pancreatic
elastase, procalcitonin, trypsinogen activated protein, activation peptide of carboxypeptidase B, trypsin-2-alpha1
antitrypsin complex and circulating DNA), but none of them has found widespread application for a variety of reasons,
including the inferior diagnostic accuracy when compared with the traditional enzymes, the use of cumbersome
techniques, or their recent discovery. The promising results of recent proteomics studies showed that this innovative
technique might allow the identification of changes characterizing pancreatic tissue injury, thus highlighting new
potential biomarkers of acute pancreatitis.

48) Livadiotti, S; Milano, GM; Serra, A; Folgori, L; Jenkner, A; Castagnola, E; Cesaro, S; Rossi, MR;
Barone, A; Zanazzo, G; Nesi, F; Licciardello, M; De Santis, R; Ziino, O; Cellini, M; Porta, F; Caselli, D;
Pontrelli, G (2012) A survey on hematology-oncology pediatric AIEOP centers: prophylaxis, empirical
therapy and nursing prevention procedures of infectious complications HAEMATOLOGICA-THE
HEMATOLOGY JOURNAL 97(1):147-150 IF=6.532 [Article]
49) Maggio, M; Dall'Aglio, E; Lauretani, F; Cattabiani, C; Ceresini, G; Caffarra, P; Valenti, G; Volpi,
R; Vignali, A; Schiavi, G; Ceda, GP (2012) THE HORMONAL PATHWAY TO COGNITIVE IMPAIRMENT
IN OLDER MEN JOURNAL OF NUTRITION HEALTH & AGING 16(1):40-54 IF=2.484 [Article]
In older men there is a multiple hormonal dysregulation with a relative prevalence of catabolic hormones such as
thyroid hormones and cortisol and a decline in anabolic hormones such as dehydroepiandrosterone sulphate,
testosterone and insulin like growth factor 1 levels. Many studies suggest that this catabolic milieu is an important
predictor of frailty and mortality in older persons. There is a close relationship between frailty and cognitive impairment
with studies suggesting that development of frailty is consequence of cognitive impairment and others pointing out that
physical frailty is a determinant of cognitive decline. Decline in cognitive function, typically memory, is a major
symptom of dementia. The "preclinical phase" of cognitive impairment occurs many years before the onset of dementia.
The identification of relevant modifiable factors, including the hormonal dysregulation, may lead to therapeutic
strategies for preventing the cognitive dysfunction. There are several mechanisms by which anabolic hormones play a
role in neuroprotection and neuromodulation. These hormones facilitate recovery after brain injury and attenuate the
neuronal loss. In contrast, elevated thyroid hormones may increase oxidative stress and apoptosis, leading to neuronal
damage or death. In this mini review we will address the relationship between low levels of anabolic hormones, changes
in thyroid hormones and cognitive function in older men. Then, giving the contradictory data of the literature and the
multi-factorial origin of dementia, we will introduce the hypothesis of multiple hormonal derangement as a better
determinant of cognitive decline in older men.
50) Mannini, L; Menga, S; Tonelli, A; Zanotti, S; Bassi, MT; Magnani, C; Musio, A (2012) SMC1A Codon
496 Mutations Affect the Cellular Response to Genotoxic Treatments AMERICAN JOURNAL OF
MEDICAL GENETICS PART A 158A(1):224-228 IF=2.505 [Article]
51) Mascalchi, M; Diciotti, S; Sverzellati, N; Camiciottoli, G; Ciccotosto, C; Falaschi, F; Zompatori, M
(2012) Low agreement of visual rating for detailed quantification of pulmonary emphysema in whole-lung
CT ACTA RADIOLOGICA 53(1):53-60 IF=1.483 [Article]

52) Matucci, A; Vultaggio, A; Ridolo, E; Maggi, E; Canonica, GW; Rossi, O (2012) Asthma: developments
in targeted therapy EXPERT REVIEW OF CLINICAL IMMUNOLOGY 8(1):13-15 IF=0.593 [Editorial
Material]
53) Meschi, T; Nouvenne, A; Maggio, M; Lauretani, F; Borghi, L (2012) Bed-blockers: An 8 year
experience of clinical management EUROPEAN JOURNAL OF INTERNAL MEDICINE 23(2):E73-E74
IF=1.657 [Letter]
54) Montagnana, M; Favaloro, EJ; Lippi, G (2012) Coffee Intake and Cardiovascular Disease: Virtue Does
Not Take Center Stage SEMINARS IN THROMBOSIS AND HEMOSTASIS 38(2):164-177 IF=4.169
[Article]
Coffee is one of the most popular and heavily consumed beverages worldwide, despite the many different methods of
preparation and presentation. The results of several epidemiological studies are suggestive for the existence of a Ushaped
relationship between coffee consumption and both cardiovascular events and mortality, whereby a lower risk
seems associated with low (i.e., less than one cup per day) or high (i.e., more than or equal to four cups per day) coffee
intake, whereas a higher risk is reported for intermediate consumption (i.e., two to four cups per day). Most benefits are
evident in individuals with a rapid caffeine metabolizer genotype and a low baseline cardiovascular risk. Benefits have
also been differentially associated with consumption of decaffeinated coffee, filtered coffee, coffee consumption during
lunchtime or dinner, and when coffee is produced in the Italian style (i.e., by espresso or moka). The leading favorable
effects have been attributed to various compounds present in coffee. Thus, chlorogenic acids would be effective in
decreasing blood pressure, systemic inflammation, risk of type 2 diabetes, and platelet aggregation, whereas caffeine
intake has instead been associated with decreased body weight, as well as with increased flow-mediated dilatation and
fibrinolysis.
55) Montanini, L; Lasagna, L; Barili, V; Jonstrup, SP; Murgia, A; Pazzaglia, L; Conti, A; Novello, C;
Kjems, J; Perris, R; Benassi, MS (2012) MicroRNA cloning and sequencing in osteosarcoma cell lines:
differential role of miR-93 CELLULAR ONCOLOGY 35(1):29-41 IF=3.175 [Article]
56) Monti, LD; Lucotti, PCG; Setola, E; Rossodivita, A; Pala, MG; Galluccio, E; LaCanna, G; Castiglioni,
A; Cannoletta, M; Meloni, C; Zavaroni, I; Bosi, E; Alfieri, O; Piatti, PM (2012) Effects of chronic elevation
of atrial natriuretic peptide and free fatty acid levels in the induction of type 2 diabetes mellitus and insulin
resistance in patients with mitral valve disease NUTRITION METABOLISM AND CARDIOVASCULAR
DISEASES 22(1):58-65 IF=3.438 [Article]

57) Mormile, R; Vittori, G; De Michele, M; Squarcia, U; Quaini, F (2012) Is a deceptive role of IGF-1 in
Sirt1-PARP1 interactions the primary step of postnatal regression of hypertrophic cardiomyopathy in infants
of diabetic mothers? INTERNATIONAL JOURNAL OF CARDIOLOGY 154(1):87-88 IF=6.802 [Letter]
58) Nuzzo, G; Giuliante, F; Ardito, F; Giovannini, I; Aldrighetti, L; Belli, G; Bresadola, F; Calise, F; Dalla
Valle, R; D'Amico, DF; Gennari, L; Giulini, SM; Guglielmi, A; Jovine, E; Pellicci, R; Pernthaler, H; Pinna,
AD; Puleo, S; Torzilli, G; Capussotti, L (2012) Improvement in Perioperative and Long-term Outcome After
Surgical Treatment of Hilar Cholangiocarcinoma Results of an Italian Multicenter Analysis of 440 Patients
ARCHIVES OF SURGERY 147(1):26-34 IF=4.5 [Article]
59) Parrino, L; Ferri, R; Bruni, O; Terzano, MG (2012) Cyclic alternating pattern (CAP): The marker of
sleep instability SLEEP MEDICINE REVIEWS 16(1):27-45 IF=6.338 [Review]
Cyclic alternating pattern CAP is the EEG marker of unstable sleep, a concept which is poorly appreciated among the
metrics of sleep physiology. Besides, duration, depth and continuity, sleep restorative properties depend on the capacity
of the brain to create periods of sustained stable sleep. This issue is not confined only to the EEG activities but
reverberates upon the ongoing autonomic activity and behavioral functions, which are mutually entrained in a
synchronized oscillation. CAP can be identified both in adult and children sleep and therefore represents a sensitive tool
for the investigation of sleep disorders across the lifespan. The present review illustrates the story of CAP in the last 25
years, the standardized scoring criteria, the basic physiological properties and how the dimension of sleep instability has
provided new insight into pathophysiolology and management of sleep disorders.
60) Pasquarella, C; Vitali, P; Saccani, E; Mariotti, F; Boccuni, C; Manotti, P; Ugolotti, M; Albertini, R
(2012) Microbial Air Monitoring as a Useful Tool When Commissioning Bone Marrow Transplant Units
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY 33(1):101-102 IF=3.751 [Letter]
61) Patrelli, TS; Franchi, L; Gizzo, S; Kiener, A; Berretta, R; Piantelli, G; Caruana, P; Nardelli, GB;
Modena, AB (2012) Rhabdomyoma of the vagina. Case report and short literature review ANNALES DE
PATHOLOGIE 32(1):53-57 IF=0.197 [Review]
The differential diagnosis of vaginal polypoid masses should take rhabdomyoma into consideration even it is an
extremely rare tumor. The present report describes a vaginal cystic mass located in the anterior wall of an
asymptomatic, 38-year-old, Caucasian, nulliparous woman. Local excision and subsequent pathological examination
were performed. The final diagnosis was vaginal rhabdomyoma. The literature is reviewed and differential diagnosis are
discussed.
62) Patrelli, TS; Gizzo, S; Cosmi, E; Carpano, MG; Di Gangi, S; Pedrazzi, G; Piantelli, G; Modena, AB
(2012) Maternal Hydration Therapy Improves the Quantity of Amniotic Fluid and the Pregnancy Outcome in
Third-Trimester Isolated Oligohydramnios A Controlled Randomized Institutional Trial JOURNAL OF
ULTRASOUND IN MEDICINE 31(2):239-244 IF=1.246 [Article]

Objectives-Amniotic fluid is important for the maintenance of fetal well-being; therefore, an amniotic fluid deficiency,
ie, oligohydramnios, can have multiple impacts on the prognosis of the pregnancy. In some cases, there are no evident
fetal or maternal causes, and the condition is called isolated oligohydramnios. The aim of our study was to validate
maternal intravenous and oral hydration therapy as a means for improvement of isolated oligohydramnios in the third
trimester of pregnancy. Methods-We conducted a prospective randomized controlled study on pregnancies complicated
by idiopathic oligohydramnios (group A, 66 women) with a control group of women with normal pregnancies without
oligohydramnios (group B, 71 women). Oligohydramnios was diagnosed using the amniotic fluid index (AFI;

A; Bartolomucci, A (2012) Characterization of a novel peripheral pro-lipolytic mechanism in mice: role of
VGF-derived peptide TLQP-21 BIOCHEMICAL JOURNAL 441():511-522 IF=5.016 [Article]
68) Prandoni, P; Noventa, F; Quintavalla, R; Bova, C; Cosmi, B; Siragusa, S; Bucherini, E; Astorri, F;
Cuppini, S; Dalla Valle, F; Lensing, AWA; Prins, MH; Villalta, S (2012) Thigh-length versus below-knee
compression elastic stockings for prevention of the postthrombotic syndrome in patients with proximal-
venous thrombosis: a randomized trial BLOOD 119(6):1561-1565 IF=10.558 [Article]
69) Querques, G; Avellis, FO; Querques, L; Massamba, N; Bandello, F; Souied, EH (2012) Three
dimensional spectral domain optical coherence tomography features of retinal-choroidal anastomosis
GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY 250(2):165-173
IF=2.158 [Article]
To correlate the three-dimensional (3D) spectral-domain optical coherence tomography (SD-OCT) features of retinalchoroidal
anastomosis (RCA) to conventional angiography. This is a retrospective chart review of consecutive patients
diagnosed with RCA who underwent 3D SD-OCT between July 2007 and June 2010. Main outcome measures were the
diagnostic capabilities of 3D SD-OCT, and the correlation between 3D findings and the features distinguished by
conventional angiography. Eighteen eyes of 18 patients [five males, 13 females, mean age 79.5 +/- 19.4 years (range,
70-93 years)] were included in the analysis. In eyes (n = 3) showing a focal staining on angiography, 3D OCT revealed
a slight convex prominence of the inner retinal surface in correspondence of a small dome-shaped retinal pigment
epithelium (RPE) elevation (which represented the early RCA). In eyes (n = 7) showing a "hot spot" without pigment
epithelium detachment (PED) on angiography, 3D OCT revealed a convex prominence of the inner retinal surface in
correspondence with a well-demarcated prominence of RPE with steep margins (which represented the RCA). In eyes
(n = 8) showing a "hot spot" with PED on angiography, 3D OCT revealed a convex prominence of the inner retinal
surface in correspondence with a convex RPE prominence with a peak at the top. 3D SD-OCT provides a map of the
retina and RPE, allowing a realistic visualization of the different pathological features in the disease development, and
may be able to provide clinically relevant information to complement angiography in the diagnosis of RCA.
70) Razzoli, M; Bo, E; Pascucci, T; Pavone, F; D'Amato, FR; Cero, C; Sanghez, V; Dadomo, H; Palanza, P;
Parmigiani, S; Ceresini, G; Puglisi-Allegra, S; Porta, M; Panzica, GC; Moles, A; Possenti, R; Bartolomucci,
A (2012) Implication of the VGF-derived peptide TLQP-21 in mouse acute and chronic stress responses
BEHAVIOURAL BRAIN RESEARCH 229(2):333-339 IF=3.393 [Article]
71) Sanchis-Gomar, F; Banfi, G; Lippi, G (2012) Plasticizer detection in urine samples after autologous
blood transfusion TRANSFUSION 52(3):680-680 IF=3.3 [Letter]

72) Sanchis-Gomar, F; Lippi, G (2012) TELMISARTAN AS METABOLIC MODULATOR: A NEW
PERSPECTIVE IN SPORTS DOPING? JOURNAL OF STRENGTH AND CONDITIONING RESEARCH
26(3):608-610 IF=1.848 [Article]
Sanchis-Gomar, F and Lippi, G. Telmisartan as metabolic modulator: A new perspective in sports doping? J Strength
Cond Res 26(3): 608-610, 2012-The World Antidoping Agency (WADA) has introduced some changes in the 2012
prohibited list. Among the leading innovations to the rules are that both 5-aminoimidazole-4-carboxamide-1-beta-Dribofuranoside
(peroxisome proliferator-activated receptor-delta[PPAR-delta]-5' adenosine monophosphate-activated
protein kinase [AMPK] agonist) and GW1516 (PPAR-delta-agonist) are no longer categorized as gene doping
substances in the new 2012 prohibited list but as metabolic modulators in the class "Hormone and metabolic
modulators.'' This may also be valid for the angotensin II receptor blocker telmisartan. It has recently been shown that
telmisartan might induce similar biochemical, biological, and metabolic changes (e. g., mitochondrial biogenesis and
changes in skeletal muscle fiber type) as those reported for the former call of substances. We suspect that metabolic
modulators abuse such as telmisartan might become a tangible threat in sports and should be thereby targeted as an
important antidoping issue. The 2012 WADA prohibited list does not provide telmisartan for a potential doping drug,
but arguments supporting the consideration to include them among "metabolic modulators'' are at hand.
73) Sanchis-Gomar, F; Lippi, G (2012) Front-of-Package Nutrition Labeling and Obesity Implications
AMERICAN JOURNAL OF PREVENTIVE MEDICINE 42(1):E1-E1 IF=4.11 [Letter]
74) Seidenari, S; Benati, E; Ponti, G; Borsari, S; Ferrari, C; Albertini, G; Altomare, G; Arcangeli, F; Aste, N;
Bernengo, MG; Bongiorno, MR; Borroni, G; Calvieri, S; Chimenti, S; Cusano, F; Fracchiolla, C; Gaddoni,
G; Girolomoni, G; Guarneri, B; Lanzoni, A; Lombardi, M; Lotti, T; Mariotti, A; Marsili, F; Micali, G;
Parodi, A; Peris, K; Peserico, A; Quaglino, P; Santini, M; Schiavon, S; Tonino, C; Trevisan, G; Tribuzi, P;
Valentini, P; Vena, GA; Virgili, A (2012) Italian Euromelanoma Day Screening Campaign (2005-2007) and
the planning of melanoma screening strategies EUROPEAN JOURNAL OF CANCER PREVENTION
21(1):89-95 IF=2.536 [Article]
75) Sesenna, E; Magri, AS; Magnani, C; Brevi, BC; Anghinoni, ML (2012) Mandibular distraction in
neonates: indications, technique, results ITALIAN JOURNAL OF PEDIATRICS 38():- IF=0 [Review]
Background: The Pierre Robin Sequence features were first described by Robin in 1923 and include micrognathia,
glossoptosis and respiratory distress with an incidence estimated as 1:8,500 to 1:20,000 newborns. Upper airway
obstruction and feeding difficulties are the main concerns related to the pathology. Mandibular distraction should be
considered a treatment option (when other treatments result inadequate). Patiants and methods: Ten patients between
the ages of 1 month and 2 years with severe micrognathia and airway obstruction were treated with Mandibular
Distraction Osteogenesis (MDO). All patients underwent fibroscopic examination of the upper airway and a

adiographic imaging and/or computed tomography scans to detect malformations and to confirm that the obstruction
was caused by posterior tongue displacement. All patients were evaluated by a multidisciplinary team. Indications for
surgery included frequent apneic episodes with severe desaturation (70%). Gavage therapy was employed in all patients
since oral feeding was not possible. The two tracheotomy patients were 5 months and 2 years old respectively, and the
distraction procedure was performed to remove the tracheotomy tube. All patients were treated with bilateral
mandibular distraction: two cases with an external multivector distraction device, six cases with an internal nonresorbable
device and two cases with an internal resorbable device. In one case, the patient with Goldenhar's Syndrome,
the procedure was repeated. Results: The resolution of symptoms was obtained in all patients, and, when present,
tracheotomy was removed without complications. Of the two patients with pre-existing tracheotomies, in the younger
patient (5 months old) the tracheotomy was removed 7 days postoperatively. In the Goldenhar's syndrome case (2 years
old) a Montgomery device was necessary for 6 months due to the presence of tracheotomy-inducted tracheomalacia.
Patients were discharged when the endpoint was obtained: symptoms and signs of airway obstruction were resolved,
PAS and maxillomandibular relationship improved, and tracheotomy, when present, removed. During the follow-up, no
injury to the inferior alveolar nerve was noted and scarring was significant in only the two cases treated with external
devices. Conclusion: Mandibular Distraction Osteogenesis is a good solution in solving respiratory distress when other
procedures are failed in paediatric patients with severe micrognatia.
76) Shin, SH; Sivalingam, S; De Donato, G; Falcioni, M; Piazza, P; Sanna, M (2012) Vertebral Artery
Involvement by Tympanojugular Paragangliomas: Management and Outcomes with a Proposed Addition to
the Fisch Classification AUDIOLOGY AND NEURO-OTOLOGY 17(2):92-104 IF=2.228 [Article]
77) Siboni, SM; Zanon, E; Sottilotta, G; Consonni, D; Castaman, G; Mikovic, D; Biondo, F; Tagliaferri, A;
Iorio, A; Mannucci, PM; Peyvandi, F (2012) Central nervous system bleeding in patients with rare bleeding
disorders HAEMOPHILIA 18(1):34-38 IF=2.364 [Article]
78) Sverzellati, N; Cademartiri, F; Bravi, F; Martini, C; Gira, FA; Maffei, E; Marchiano, A; La Vecchia, C;
De Filippo, M; Kuhnigk, JM; Rossi, C; Pastorino, U (2012) Relationship and Prognostic Value of Modified
Coronary Artery Calcium Score, FEV1, and Emphysema in Lung Cancer Screening Population: The MILD
Trial RADIOLOGY 262(2):460-467 IF=6.066 [Article]
Purpose: To assess the relationship between a modified coronary artery calcium (mCAC) score and both forced
expiratory volume in 1 second (FEV1) and pulmonary emphysema and the associations of such factors with all-cause
mortality and cardiovascular events (CVEs) in a lung cancer computed tomographic (CT) screening trial. Materials and
Methods: In this institutional review board-approved study, both clinical and low-dose CT data were evaluated in a
cohort of heavy smokers consecutively recruited by the Multicentric Italian Lung Detection, or MILD, trial. Low-dose
CT images were analyzed by using software that allowed quantification of mCAC, mean lung attenuation (MLA), and
total extent of emphysema. The correlations between mCAC, percentage predicted FEV1, MLA, and emphysema extent

were tested by using the Pearson correlation coefficient. Adjusted multiple logistic regression models were applied to
assess the relationships between mCAC, FEV1, MLA, and emphysema extent and all-cause mortality and CVEs.
Results: The final study cohort consisted of 1159 smokers. There were no significant correlations between mCAC score
and FEV1 (r = -0.03, P = .4), MLA (r = -0.01, P = .7), or emphysema extent (r = 0.02, P = .6). An mCAC score greater
than 400 was the only factor that was independently associated with both all-cause mortality (odds ratio [OR]: 3.73;
95% confidence interval [CI]: 1.05, 13.32; P = .04) and CVEs (OR: 2.87; 95% CI: 1.13, 7.27; P = .03). Conclusion:
mCAC is a better predictor of CVE and all-cause mortality than FEV1 and emphysema extent and may contribute to the
identification of high-risk individuals in a lung cancer screening setting.
79) Tagliaferri, A; Di Perna, C; Riccardi, F; Pattacini, C; Rivolta, GF; Franchini, M (2012) The natural
history of mild haemophilia: a 30-year single centre experience HAEMOPHILIA 18(2):166-174 IF=2.364
[Article]
Although up to 50% of all haemophilic patients followed at haemophilia treatment centres (HTCs) are affected by a
mild factor VIII (FVIII) or factor IX (FIX) defect, published data regarding the natural history of these disorders are
scarce. To fill this lack of information, a retrospective single centre study was conducted. All cases with mild
haemophilia (75 A and 7 B) followed at the regional reference HTC of Parma were evaluated. The patients median age
at diagnosis was 11.5 years and their median age at first bleeding was 5.5 years; 95% of patients had a history of
haemorrhagic problems during their life. Twenty-three percent of patients were infected by HCV, and none by HIV.
Genetic analysis was performed in 80 patients (97% haemophilia A and 100% haemophilia B) and 21 different
mutations were characterized. Eleven percent of patients had never received treatment, whereas 67% were treated with
plasma-derived or recombinant FVIII/FIX concentrates (4% developed inhibitors). desmopressin (DDAVP) was used in
80% of the haemophilia A patients. The response to DDAVP was closely related to the patients genetic profile, as 60%
of non-responders had a mutation in the F8 promoter region. Patients with mild haemophilia may experience a variety
of medical problems, sometimes challenging for the physicians, during their lifetime. The HTCs play an important role
in the management of these patients, whose diagnosis is often delayed. The HTCs should improve patients knowledge
and consideration of their disease and encourage them to maintain regular contact with their haemophilia care provider.
80) Tagliaferri, A; Di Perna, C; Santoro, C; Schinco, P; Santoro, R; Rossetti, G; Coppola, A; Morfini, M;
Franchini, M (2012) Cancers in patients with hemophilia: a retrospective study from the Italian Association
of Hemophilia Centers JOURNAL OF THROMBOSIS AND HAEMOSTASIS 10(1):90-95 IF=5.439
[Article]
. Background: The increased life expectancy of the hemophilia population, primarily as a result of advances in factor
replacement therapy, has enabled hemophiliacs to reach an older age. Consequently, age-related diseases, such as
cardiovascular disorders and cancers, are being increasingly recognized in such patients. However, only few data are
available on such co-morbidities, their management and impact on the primary bleeding disorders. Objectives: With the
aim of investigating several still unclear issues regarding cancers in hemophilia patients, we conducted, on behalf the
Italian Association of Hemophilia Centers (AICE), a study on cancers among Italian hemophiliacs. Patients: Data
pertaining to 122 hemophiliacs with 127 cancers between 1980 and 2010 were retrospectively collected in 21 centers of
the AICE which chose to participate. Results: Sixty-nine percent of cancers were recorded during the decade 20012010.

Eighty-three percent of patients were infected with hepatitis C virus (HCV) and 22% of them were also co-infected with
human immunodeficiency virus (HIV). Forty-three percent of cancers were HCV-related, whereas 9% were HIVrelated.
Virus-related cancers were more frequent and non-virus-related cancers less frequent in patients with severe hemophilia
than in those with mild/moderate forms (P = 0.0004). The non-virus-related standardized mortality ratio (SMR) was 0.3.
Hemorrhagic complications occurred more frequently in patients undergoing chemotherapy (14%) or radiotherapy
(19%). Conclusions: The results of the present study confirm that cancers have become a new challenge for physicians
working in hemophilia centers and underline the need for prospective trials to better assess the epidemiology and to
optimize the management of hemophiliacs with cancer.
81) Targher, G; Pichiri, I; Lippi, G (2012) Vitamin D, Thrombosis, and Hemostasis: More than Skin Deep
SEMINARS IN THROMBOSIS AND HEMOSTASIS 38(1):114-123 IF=4.169 [Article]
Vitamin D-3 deficiency is a highly prevalent condition worldwide. Clinically, vitamin D-3 has a key role in calcium
homeostasis and bone mineralization and has recently been implicated in the pathogenesis and/or progression of several
acute and chronic illnesses, including cardiovascular disease (CVD). Accumulating evidence from observational,
prospective studies suggests that low levels of serum 25-hydroxyvitamin D-3 are independently associated with an
increased risk of CVD events and death. The molecular mechanisms of this association remain incompletely
understood. A variety of biologically plausible mechanisms may mediate a cardiovascular role for the active metabolite
of vitamin D-3. 1-alpha, 25-dihydroxyvitamin D-3 regulates the renin-angiotensin system, suppresses proliferation of
vascular cell smooth muscle, improves insulin resistance and endothelial cell-dependent vasodilation, inhibits
myocardial cell hypertrophy, exerts anticoagulant and antifibrotic activity, and modulates macrophage activity and
cytokine generation. Overall, the high prevalence of vitamin D-3 deficiency and the plausible biological mechanisms
linking this to CVD risk suggest that the treatment of vitamin D-3 deficiency to prevent CVD is a promising field to
explore. Large placebo-controlled randomized clinical trials are urgently needed to determine whether vitamin D
supplementation could have any potential benefit in reducing future CVD events and mortality risk.
82) Tedeschi, S; Pilotti, E; Parenti, E; Vicini, V; Coghi, P; Montanari, A; Regolisti, G; Fiaccadori, E;
Cabassi, A (2012) Serum adipokine zinc alpha 2-glycoprotein and lipolysis in cachectic and noncachectic
heart failure patients: relationship with neurohormonal and inflammatory biomarkers METABOLISM-
CLINICAL AND EXPERIMENTAL 61(1):37-42 IF=2.538 [Article]
Chronic heart failure is often complicated by the development of cachexia with the loss of fat mass. Zinc alpha 2glycoprotein
(ZAG) is a serum adipokine with lipolytic effects in cancer cachexia. We evaluated in patients with
advanced heart failure with (CxHF) or Without cachexia (nCxHF) the relationship of ZAG with circulating free fatty
acid (FFA), as an index of lipolysis, and with other neurohormonal and inflammatory biomarkers. Two groups, nCxHF
(n = 46) and CxHF (n = 18), the latter having a documented, involuntary, edema-free loss of body weight of at least
7.5% in the previous 6 months, underwent plasma determination of FFA, ZAG, norepinephrine (NE), tumor necrosis
factor-alpha, and natriuretic peptide levels (atrial natriuretic, B-type natriuretic peptide). The patients were compared
with age-matched healthy controls (CTR) (n = 21). Zinc alpha 2-glycoprotein, atrial natriuretic peptide, B-type
natriuretic peptide, and tumor necrosis factor-alpha circulating levels were similarly greater in CxHF and nCxHF than
in CTR. Free fatty acid and NE were higher in CxHF than in nCxHF. A positive correlation between FFA and NE was

found in both CxHF (r = 0.73, P < .01) and nCxHF (r = 0.48, P < .01) but only in CxHF between ZAG and FFA (r =
0.54, P = .02) and between ZAG and NE (r = 0.70, P < .01). No correlations between natriuretic peptides and ZAG were
found. Serum ZAG levels are increased in advanced heart failure patients compared with CTR, without differences
between CxHF and nCxHF. Only in CxHF, ZAG levels are directly correlated to circulating levels of FFA and NE,
suggesting a close interaction of ZAG with sympathetic-mediated lipolysis.
83) Tibaldi, C; Giovannetti, E; Tiseo, M; Leon, LG; D'Incecco, A; Loosekoot, N; Bartolotti, M; Honeywell,
R; Cappuzzo, F; Ardizzoni, A; Peters, GJ (2012) Correlation of cytidine deaminase polymorphisms and
activity with clinical outcome in gemcitabine-/platinum-treated advanced non-small-cell lung cancer
patients ANNALS OF ONCOLOGY 23(3):670-677 IF=6.452 [Article]
84) Toma, L; Scarani, V; Heulfe, I; Brevi, BC (2012) Removal of Fractured Implants Using the
Apicoectomy Technique and Immediate Replacement With New Implants: Case Report JOURNAL OF
ORAL IMPLANTOLOGY 38(1):71-78 IF=0 [Article] abstract non disponibile
85) Tonini, MC; Giordano, L; Atzeni, L; Bogliun, G; Perri, G; Saracco, MG; Tombini, M; Torelli, P;
Turazzini, M; Vernieri, F; Aguggia, M; Bussone, G; Beghi, E (2012) Primary headache and epilepsy: A
multicenter cross-sectional study EPILEPSY & BEHAVIOR 23(3):342-347 IF=1.994 [Article]
86) Vaglio, A; Moosig, F; Zwerina, J (2012) Churg-Strauss syndrome: update on pathophysiology and
treatment CURRENT OPINION IN RHEUMATOLOGY 24(1):24-30 IF=4.497 [Review]
Purpose of review Churg-Strauss syndrome (CSS) has a clear clinical phenotype but its pathogenesis is not fully
elucidated. Recent studies have focused on its immunogenetic aspects and cytokine and chemokine-mediated
pathogenetic mechanisms, providing the rationale for the use of newer targeted therapies. This study will review recent
findings on the pathogenesis of CSS and its therapeutic approaches. Recent findings CSS is usually considered a Th2mediated
disease, but Th1 and Th17 responses might also play a role; the reported association between CSS and HLA-
DRB4 further underlines the pathogenetic relevance of CD4(+) T cells which, thanks to their ability to secrete cytokines
such as IL4, IL5, and IL13, promote allergic and eosinophilic reactions. Resident cells such as endothelial and epithelial
cells might also amplify the immune response by producing eosinophil-attracting chemokines such as eotaxin-3 and
CCL17. Conventional immunosuppressive therapies offer high chances of achieving sustained remission, but steroid
exposure remains high. Targeting IL5 with mepolizumab seems promising in sparing steroids, but relapses often follow
its withdrawal. B-cell depletion using rituximab has proved effective in refractory CSS cases. Summary Current
knowledge on CSS pathogenesis is evolving; the identification of key molecular mechanisms will pave the way for
newer, more specific treatments.

87) Vaglio, A; Strehl, JD; Manger, B; Maritati, F; Alberici, F; Beyer, C; Rech, J; Sinico, RA; Bonatti, F;
Battistelli, L; Distler, JHW; Schett, G; Zwerina, J (2012) IgG4 immune response in Churg-Strauss syndrome
ANNALS OF THE RHEUMATIC DISEASES 71(3):390-393 IF=9.082 [Article]
Objective T-helper type 2 responses are crucial in Churg-Strauss syndrome (CSS) and may enhance the production of
IgG4 antibodies. The authors assessed the IgG4 immune response in CSS patients. Methods The authors included 46
consecutive patients with CSS (24 with active and 22 with quiescent disease), 26 with granulomatosis with polyangiitis
(GPA, Wegener's), 25 with atopic asthma and 20 healthy controls and determined serum IgG, IgM, IgA, IgE and IgG
subclass levels. Tissue infiltration by IgG4 plasma cells was assessed in nine patients with CSS, 10 with GPA, 22 with
chronic sinusitis (11 with and 11 without eosinophilia). Results IgG4 levels were markedly higher in active CSS
patients than in controls (p

Objective: The purpose of this study was to compare surgical and nonsurgical approaches to the treatment of BRONJ
and the possible usefulness of Nd:YAG and Er: YAG lasers. Methods: One hundred and twenty-eight patients (33
males, 95 females; 52 with diagnosis of multiple myeloma, 53 with diagnosis of bone metastasis, and 23 with diagnosis
of osteoporosis) affected by BRONJ were evaluated at the Unit of Oral Pathology and Medicine and Laser-Assisted
Surgery of the University of Parma, Italy, between January 2004 and July 2009. Overall number of BRONJ sites was
151, and number of treated sites was 101. In order to assess the efficacy of different treatments, sites were subclassified
as follows: Group 1 (G1): 12 sites treated with medical therapy; Group 2 (G2): 27 sites treated with medical therapy
associated with low level laser therapy (LLLT); Group 3 (G3): 17 sites treated with a combination of medical and
surgical therapy; Group 4 (G4): 45 sites treated with a combination of medical therapy, surgical (including laserassisted)
therapy, and LLLT. Outcome of treatment was assessed using the staging system proposed by Ruggiero et al.
Transition from a higher stage to a lower one for at least 6 months was considered as clinical improvement and
suggestive of a successful treatment. Results: Clinical improvement was achieved in 3 out of 12 (25%) BRONJ sites in
G1. Sites if G2 with an improvement were 18 out of 27 (66%). Nine out 17 BRONJ sites (53%) in G3 had a transition
to a lower stage after treatment. For sites in G4, a clinical improvement was recorded in 40 out of 45 cases (89%).
Conclusions: In our experience, the percentage of success obtained with a combined approach based on medical
therapy, surgical (including laser-assisted) therapy, and LLLT (G4) is significantly higher than the percentage of
improvement obtained in G1, G2, and G3.
91) Vescovi, P; Merigo, E; Meleti, M; Manfredi, M; Guidotti, R; Nammour, S (2012) Bisphosphonatesrelated
osteonecrosis of the jaws: a concise review of the literature and a report of a single-centre
experience with 151 patients JOURNAL OF ORAL PATHOLOGY & MEDICINE 41(3):214-221
IF=2.075 [Article]
The osteonecrosis of the jaws (ONJ) is an adverse side effect of long-term bisphosphonate therapy (BPT) firstly
described in 2003. The aetiology of BRONJ remains unknown, and the pathogenesis seems multifactorial and related to
several local or general factors. Many expert panel developed preventive protocols to facilitate specialists involved in
the multidisciplinary management of BRONJ patients. In this paper, we present a concise review of the literature, and
we report the experience of the University of Parma with 151 patients that assumed BPT for both oncological (121
patients) and non-oncological (30 patients) diseases. One hundred and thirtynine BRONJ sites were treated with
different approaches (surgical and non-surgical, laser-assisted and non-laserassisted): in terms of clinical improvement,
a statistically significant difference was found between the group treated with the only medical therapy; in terms of
complete healing, the introduction in the treatment protocols of both laser-assisted approach and surgical approach
improves the therapeutical results.
92) Zampolini, M; Zaccaria, B; Tolli, V; Frustaci, A; Franceschini, M (2012) Rehabilitation of traumatic
brain injury in Italy: A multi-centred study BRAIN INJURY 26(1):27-35 IF=1.75 [Article]
Objectives: The aims of this study were to analyse TBI rehabilitation in Italy, identifying the main factors conditioning
motor and functional recovery and destination upon discharge of traumatic severe acquired brain injury (sABI) patients
who had undergone intensive rehabilitative treatment. Design: An observational prospective study of 863 consecutive
patients admitted to 52 Rehabilitation Centres from January 2001 to December 2003. Results: The main cause of trauma

was road accidents (79.8%), the mean length of stay was 87.31 +/- 77.26 days and 40.4% access to rehabilitation
facilities after a month. Pressure sore rates fell from 26.1% to 6.6% during the rehabilitation programme. After
discharge 615 patients returned home, whilst 212 were admitted to other health facilities. Discussion: This study
highlights some major criticisms of rehabilitation of TBI. The delay of admission and evitable complications such as
pressure sores are correlated to a worse outcome. While LOS causes a problem of cost-effectiveness, the rate of home
discharge is prevalent and very high compared with other studies.
93) Zanon, E; Iorio, A; Rocino, A; Artoni, A; Santoro, R; Tagliaferri, A; Coppola, A; Castaman, G;
Mannucci, PM (2012) Intracranial haemorrhage in the Italian population of haemophilia patients with and
without inhibitors HAEMOPHILIA 18(1):39-45 IF=2.364 [Article]
94) Zucali, PA; Simonelli, M; Michetti, G; Tiseo, M; Ceresoli, GL; Collova, E; Follador, A; Lo Dico, M;
Moretti, A; De Vincenzo, F; Lorenzi, E; Perrino, M; Giordano, L; Farina, G; Santoro, A; Garassino, M
(2012) Second-line chemotherapy in malignant pleural mesothelioma: Results of a retrospective multicenter
survey LUNG CANCER 75(3):360-367 IF=3.356 [Article]