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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]
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COLLEGIO DI DIREZIONE - Azienda Ospedaliera di Parma

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