228 results on '"Plebani, Mario"'
Search Results
2. Can ultrasensitive thyroglobulin immunoassays avoid the need for ultrasound in thyroid cancer follow-up?
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Censi, Simona, De Rosa, Antonio, Galuppini, Francesca, Manso, Jacopo, Bertazza, Loris, Merante-Boschin, Isabella, Plebani, Mario, Faggian, Diego, Pennelli, Gianmaria, Barollo, Susi, Vianello, Federica, Iacobone, Maurizio, and Mian, Caterina
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Purpose:: Differentiated thyroid cancer (DTC) is the most common endocrine neoplasm, with a rising incidence and a long life expectancy. It has recently been suggested that patients with low- and intermediate-risk DTC with a good response to treatment at one year could be followed up using only highly sensitive immunoassays for thyroglobulin (Tg). The aim of this study was to examine the serum Tg levels in a series of DTC patients with histologically proven persistent or recurrent diseases. Methods:: The study involved 50 consecutive patients being routinely followed up at our center, whose clinical, histological, and biochemical data were retrospectively collected. Results:: The false-negative rate of ultrasensitive serum Tg assay was 14.3% (5/35) overall, and limited to anti-thyroglobulin autoantibodies (TgAb)-negative patients. Among them, only one patient had an excellent response to treatment at one-year follow-up and was diagnosed with a 4 mm recurrence, after more than seven years of periodic ultrasounds. The size of the neck lesion documented in the histological report was slightly larger in patients with detectable as opposed to negative Tg values (P< 0.05). Conclusions:: Serum highly sensitive Tg is undetectable in a proportion of patients with a proven persistent or recurrent DTC. The reasons behind this phenomenon are still unknown. However, in low/intermediate-risk patients cured at one-year follow-up, highly sensitive Tg without neck US seems an appropriate strategy for patients’ management.
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- 2022
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3. Fujirebio Lumipulse SARS-CoV-2 antigen immunoassay: pooled analysis of diagnostic accuracy
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Lippi, Giuseppe, Henry, Brandon M., Adeli, Khosrow, and Plebani, Mario
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We provide here a pooled analysis of accuracy of Fujirebio Lumipulse SARS-CoV-2 Antigen chemiluminescent immunoassay for diagnosing acute SARS-CoV-2 infections. An electronic search was conducted in Scopus and Medline with the keywords “Lumipulse” AND “antigen” AND “SARS-CoV-2” or “COVID-19”, up to January 21, 2022, for identifying clinical investigations (minimum sample size ≥100) where diagnostic accuracy of Lumipulse G SARS-CoV-2 Ag was tested against reference molecular techniques. All studies which allowed to construct a 2 × 2 table were included in a pooled analysis. A final number of 21 studies, totalling 17,648 nasopharyngeal and 8538 saliva specimens, were finally included. The pooled diagnostic sensitivity and specificity in nasopharyngeal swabs were 0.80 (95%CI, 0.78–0.81) and 0.98 (95%CI, 0.97–0.98), respectively, whilst the area under the curve and agreement were 0.980 (95%CI, 0.973–0.986) and 94.9%, respectively. In the twelve studies which used the fixed 1.34 pg/mL currently recommended manufacturer’s threshold, the diagnostic accuracy remained unvaried. In saliva samples, the pooled diagnostic sensitivity and specificity were 0.75 (95%CI, 0.71–0.75) and 1.00 (95%CI, 0.99–1.00), respectively, whilst the area under the curve and were 0.976 (95%CI, 0.969–0.984) and 98.4%, respectively. In the five studies which used the fixed 0.67 pg/mL currently recommended manufacturer’s threshold, the diagnostic accuracy remained unvaried. In conclusion, Lumipulse G SARS-CoV-2 Ag assay demonstrates good diagnostic sensitivity and specificity, thus representing a valuable complementary and integrative option to molecular testing for SARS-CoV-2 in the current pandemic.
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- 2021
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4. Rapid changes of miRNAs-20, -30, −410, −515, −134, and −183 and telomerase with psychological activity: A one year study on the relaxation response and epistemological considerations
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Dal Lin, Carlo, Marinova, Mariela, Brugnolo, Laura, Rubino, Giorgio, Plebani, Mario, Iliceto, Sabino, and Tona, Francesco
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Mental stress represents a pivotal factor in cardiovascular diseases. The mechanism by which stress produces its deleterious effects is still under study, but one of the most explored pathways is inflammation-aging and cell senescence. In this scenario, circulating microRNAs appear to be regulatory elements of the telomerase activity and alternative splicing within the nuclear factor kappa-light-chain-enhancer (NF-κB) network. Anti-stress techniques appeared to be able to slow down the inflammatory and aging processes. As we recently verified, the practice of the relaxation response (RR) counteracted psychological stress and determined favorable changes of the NF-κB, p53, and toll-like receptor-4 (TLR-4) gene expression and in neurotransmitters, hormones, cytokines, and inflammatory circulating microRNAs. We aimed to verify a possible change in the serum levels of six other micro-RNAs of cardiovascular interest, involved in cell senescence and in the NF-κB network (miRNAs −20, −30, −410, −515, −134, and −183), and tested the activity of telomerase in peripheral blood mononuclear cells (PBMCs).
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- 2021
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5. Between Web search engines and artificial intelligence: what side is shown in laboratory tests?
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Negrini, Davide, Padoan, Andrea, and Plebani, Mario
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- 2021
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6. The growing threat of hijacked journals
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Graber, Mark L. and Plebani, Mario
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- 2024
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7. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis.
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Henry, Brandon Michael, Aggarwal, Gaurav, Wong, Johnny, Benoit, Stefanie, Vikse, Jens, Plebani, Mario, and Lippi, Giuseppe
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Coronavirus disease 2019 (COVID-19) infection has now reached a pandemic state, affecting more than a million patients worldwide. Predictors of disease outcomes in these patients need to be urgently assessed to decrease morbidity and societal burden. Lactate dehydrogenase (LDH) has been associated with worse outcomes in patients with viral infections. In this pooled analysis of 9 published studies (n = 1532 COVID-19 patients), we evaluated the association between elevated LDH levels measured at earliest time point in hospitalization and disease outcomes in patients with COVID-19. Elevated LDH levels were associated with a ~6-fold increase in odds of developing severe disease and a ~16-fold increase in odds of mortality in patients with COVID-19. Larger studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]
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- 2020
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8. Serum uric acid levels and the risk of recurrent venous thromboembolism
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De Lucchi, Lara, Nardin, Chiara, Sponchiado, Alessandra, Raggi, Davide, Faggin, Elisabetta, Martini, Elena, Pagliara, Valeria, Callegari, Elena, Caberlotto, Livio, Plebani, Mario, Pauletto, Paolo, Cinetto, Francesco, Agostini, Carlo, Villalta, Sabina, and Rattazzi, Marcello
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- 2021
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9. Serum uric acid levels and the risk of recurrent venous thromboembolism
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De Lucchi, Lara, Nardin, Chiara, Sponchiado, Alessandra, Raggi, Davide, Faggin, Elisabetta, Martini, Elena, Pagliara, Valeria, Callegari, Elena, Caberlotto, Livio, Plebani, Mario, Pauletto, Paolo, Cinetto, Francesco, Agostini, Carlo, Villalta, Sabina, and Rattazzi, Marcello
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EssentialsIncrease in serum uric acid (SUA) levels has been widely associated with higher risk of cardiovascular disease.We investigated the link between SUA levels and the risk of venous thromboembolism (VTE) recurrence.Patients with SUA levels ≥ 4.38 mg/dL showed a three‐fold increase in the risk of VTE recurrence.Elevated SUA levels are associated with increased risk of recurrent VTE independently from traditional risk factors. Increase in serum uric acid (SUA) levels has been widely associated with higher risk of cardiovascular disease.We investigated the link between SUA levels and the risk of venous thromboembolism (VTE) recurrence.Patients with SUA levels ≥ 4.38 mg/dL showed a three‐fold increase in the risk of VTE recurrence.Elevated SUA levels are associated with increased risk of recurrent VTE independently from traditional risk factors. The link between serum uric acid (SUA) and the risk of cardiovascular disease is well established. However, the impact of SUA levels on the risk of venous thromboembolism (VTE) recurrence is unknown. To investigate the association between SUA and the risk of VTE recurrence. We performed a monocenter, prospective study on 280 patients with a previous episode of VTE that completed the oral anticoagulant period. SUA levels at enrollment were correlated with the risk of VTE recurrence (mean follow‐up 71.1 ± 29.2 months). Patients were stratified according to SUA tertiles distribution at baseline (tertiles cut‐off: I ≤ 4.37 mg/dL, II 4.38‐‐5.54 mg/dL, III ≥ 5.55 mg/dL). Fifty episodes of VTE recurrence occurred during the follow‐up and Kaplan‐Meier survival analysis showed that subjects in the lower tertile of SUA distribution had significantly lower risk of future VTE recurrence (P= .003). No differences were seen among patients belonging to the second and the third tertile of SUA distribution. A multivariate Cox regression analysis showed that higher tertiles of SUA distribution had about three‐fold increase in the risk of VTE recurrence as compared to subjects with SUA ≤ 4.37, independently from potential confounders (hazard ratio [HR] 3.04, 95% confidence interval [CI] 1.15‐‐8.05 P= .025). Moreover, we observed that the adjusted hazard of VTE recurrence increased by 30% for each additional unit of SUA (mg/dL; HR 1.30, 95% CI 1.01‐‐1.22, P= .040). Elevated SUA levels are associated with increased risk of future VTE recurrence independently from traditional risk factors.
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- 2021
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10. Evidence From Family Studies for Autoimmunity in Arrhythmogenic Right Ventricular Cardiomyopathy
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Caforio, Alida L.P., Re, Federica, Avella, Andrea, Marcolongo, Renzo, Baratta, Pasquale, Seguso, Mara, Gallo, Nicoletta, Plebani, Mario, Izquierdo-Bajo, Alvaro, Cheng, Chun-Yan, Syrris, Petros, Elliott, Perry M., d’Amati, Giulia, Thiene, Gaetano, Basso, Cristina, Gregori, Dario, Iliceto, Sabino, and Zachara, Elisabetta
- Abstract
Supplemental Digital Content is available in the text.
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- 2020
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11. Activation profiles of monocyte-macrophages and HDL function in healthy women in relation to menstrual cycle and in polycystic ovary syndrome patients
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Tedesco, Serena, Adorni, Maria Pia, Ronda, Nicoletta, Cappellari, Roberta, Mioni, Roberto, Barbot, Mattia, Pinelli, Silvia, Plebani, Mario, Bolego, Chiara, Scaroni, Carla, Bernini, Franco, Fadini, Gian Paolo, and Cignarella, Andrea
- Abstract
Purpose: Hormonal status and menopause affect human macrophage function and cardiometabolic risk. In polycystic ovary syndrome (PCOS) patients the cardiometabolic risk increases through mechanisms that are largely unknown. We tested the hypotheses that macrophage activation is influenced by menstrual cycle and that ovarian dysfunction in PCOS patients is associated with altered macrophage inflammatory responses and cholesterol efflux capacity of serum HDL. Methods: Blood samples were obtained in the follicular and luteal phases from cycling women (n?=?10) and on a single visit from PCOS patients with ovarian dysfunction (n?=?11). Monocyte-derived macrophage activation and monocyte subsets were characterized ex vivo using flow cytometry. The capacity of HDL to promote cell cholesterol efflux through the main efflux pathways, namely aqueous diffusion, ATP-binding cassette A1 and G1, was also evaluated. Results: Hormone and metabolic profiles differed as expected in relation to menstrual cycle and ovulatory dysfunction. Overall, macrophage responses to activating stimuli in PCOS patients were blunted compared with cycling women. Macrophages in the follicular phase were endowed with enhanced responsiveness to LPS/interferon-? compared with the luteal phase and PCOS. These changes were not related to baseline differences in monocytes. HDL cholesterol efflux capacity through multiple pathways was significantly impaired in PCOS patients compared to healthy women, at least in part independent from lower HDL-cholesterol levels. Conclusions: Regular menstrual cycles entailed fluctuations in macrophage activation. Such dynamic pattern was attenuated in PCOS. Along with impaired HDL function, this may contribute to the increased cardiometabolic risk associated with PCOS.
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- 2019
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12. Is vitamin D deficiency a risk factor for osteonecrosis of the jaw in patients with cancer? A matched case–control study.
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Bedogni, Alberto, Bettini, Giordana, Bedogni, Giorgio, Basso, Daniela, Gatti, Davide, Valisena, Silvia, Brunello, Antonella, Sorio, Marco, Berno, Tamara, Giannini, Sandro, Navaglia, Filippo, Plebani, Mario, Nocini, Pier Francesco, Blandamura, Stella, Saia, Giorgia, and Bertoldo, Francesco
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VITAMIN D deficiency ,OSTEOMALACIA ,CASE-control method ,CANCER patients ,DISEASE risk factors ,ALKALINE phosphatase - Abstract
A previous case–control histomorphometric study showed higher odds of osteomalacia in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). Vitamin D deficiency causes osteomalacia and may therefore be involved in the pathogenesis of BRONJ. The present case–control study aimed at testing such hypothesis. BRONJ+ and BRONJ− patients treated with bisphosphonates were matched by sex (same) and age (within 5 years). Serum 25-hydroxy-vitamin D (25-OH-D), parathyroid hormone, bone alkaline phosphatase, total procollagen type 1 amino-terminal propeptide, carboxy-terminal collagen crosslinks, Dickkopf WNT signaling pathway inhibitor 1 and sclerostin were measured. The main outcome was vitamin D deficiency defined as 25-OH-D < 50 nmol/l. A total of 51 BRONJ+ and 73 BRONJ− patients were studied. The frequency (95% CI) of vitamin D deficiency was 59% (45%–72%) in BRONJ+ and 62% (48%–75%) in BRONJ− patients. This amounts to a difference of −3% (−22%–16%, p = 0.77) for BRONJ+ patients. Serum 25-hydroxy-vitamin D and parathyroid hormone were similar in BRONJ+ and BRONJ− patients. Among the bone metabolism markers, only sclerostin differed between the two groups, being higher in BRONJ+ patients. The present matched case–control study suggests that vitamin D deficiency is not a risk factor for BRONJ. [ABSTRACT FROM AUTHOR]
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- 2019
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13. Prognostic value of cardiac troponin I assay in hospitalized elderly patients.
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Attanasio, Francesca, Carrer, Pamela, Zurlo, Anna, Rossi, Anna, Babuin, Luciano, Mion, Monica Maria, Zaninotto, Martina, Plebani, Mario, Iliceto, Sabino, Manzato, Enzo, and Giantin, Valter
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Background: Cardiac troponin I (cTnI) has been poorly studied in elderly inpatients.Aim: This study wanted to assess factors influencing the increase in cTnI and its prognostic value in hospitalized elderly patients.Methods: 354 elderly (mean age of 84.8 ± 6.9 years) patients consecutively admitted in the Geriatrics Division in Padua were tested for cTnI levels assay during the hospital stay. Number of subsequent patient deaths at 6 months and 2 years were registered.Results: Of the 354 patients, 27 (7.6%) died in hospital; their levels were not significantly higher or more frequently positive on cTnI than those of the remainder of the sample. 71 (20.01%) patients died within 6 months of being discharged, and in-hospital positive cTnI levels emerged as a mortality risk factor in this group [unadjusted HR 1.13 (1.04-1.23); p = 0.004]. At 2 years, a total of 174 patients (49.2%) had died, but in-hospital pathological cTnI levels were not a mortality risk factor in this group.Discussion: It should be noted that cTnI level was a risk factor for mortality at 6 months but no longer at 2 years after an elderly patient's hospitalization. This finding may relate to patients' limited physiological reserves or be driven by the fact that the elderly tend to receive fewer evidence-based treatments, and to be managed more conservatively than younger patients.Conclusions: In the multidimensional analysis of older patients, troponin I can be used to stratify patients and assess mortality risk at 6 months, but not at 2 years. [ABSTRACT FROM AUTHOR]
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- 2019
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14. Esami di laboratorio essenziali per l'inquadramento del paziente anziano multimorbido.
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Pelloso, Michela, Tosato, Francesca, and Plebani, Mario
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- 2018
15. Virucidal effects of mouthwashes or mouth rinses: a world of caution for molecular detection of SARS-CoV-2 in saliva
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Lippi, Giuseppe, Nocini, Riccardo, Henry, Brandon M., and Plebani, Mario
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- 2021
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16. miRNAs may change rapidly with thoughts: The Relaxation Response after myocardial infarction.
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Dal Lin, Carlo, Gola, Elisabetta, Brocca, Alessandra, Rubino, Giorgio, Marinova, Mariela, Brugnolo, Laura, Plebani, Mario, Iliceto, Sabino, and Tona, Francesco
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Introduction Mental stress is potentially a major cardiovascular risk factor. Meditation and listening to music may be able to compensate by eliciting the Relaxation Response (RR) with a beneficial prognostic impact after myocardial infarction (MI), reducing the progression of the arteriosclerotic process and improving coronary blood flow. We aimed to study a possible epigenetic mechanism of the RR speculating that circulating microRNAs levels could change during relaxation. Methods We enrolled 150 consecutive patients after MI. 50 were trained to meditate, 50 given music appreciation and 50 served as controls. In addition, in order to rule out that the disease state could interfere with the possible movement of microRNAs, we enrolled 50 healthy volunteers (25 were trained to meditate and 25 had music appreciation). After training, and after 60 days of RR practice, we studied the individual variation, before and after the relaxation session, of some important cardiovascular circulating microRNAs: the microRNA-1, −16, −24, −33, −92, −144, −146, −155. Results As the RR appeared to be triggered in the same way irrespective of whether this was by music or meditation data was combined. After the RR, a reduction in microRNA-16, −33, −92, −144, −146, −155 (p < 0.01) and an increase in the levels of microRNA-1 and −24 (p < 0.01) from baseline was observed both at the first observation and after 2 months. Conclusions The RR modulates some microRNAs levels suggesting that psychic activity may be an important epigenetic and pathophysiological factor in the arteriosclerotic process and in ischemic heart disease. In particular, the analyzed microRNAs levels seems to vary in relation to the state of stress or relaxation of the subjects. [ABSTRACT FROM AUTHOR]
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- 2018
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17. Combined use of the multidimensional prognostic index (MPI) and procalcitonin serum levels in predicting 1-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP): a prospective study.
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Pilotto, Alberto, Dini, Simone, Daragjati, Julia, Miolo, Manuela, Mion, Monica Maria, Fontana, Andrea, Storto, Mario Lo, Zaninotto, Martina, Cella, Alberto, Carraro, Paolo, Addante, Filomena, Copetti, Massimiliano, and Plebani, Mario
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Background: Several scores and biomarkers, i.e., procalcitonin (PCT), were proposed to stratify the mortality risk in community-acquired pneumonia (CAP).Aim: Evaluating prognostic accuracy of PCT and Multidimensional Prognostic Index (MPI) for 1-month mortality risk in older patients with CAP.Methods: At hospital admission and at discharge, patients were evaluated by a Comprehensive Geriatric Assessment to calculate MPI. Serum PCT was measured at admission and 1, 3, and 5 days after hospital admission.Results: 49 patients were enrolled. The overall 1-month mortality was 44.5 for 100-persons year. Mortality rates were higher with the increasing of MPI. In survived patients, MPI at discharge showed higher predictive accuracy than MPI at admission. Adding PCT levels to admission MPI prognostic accuracy for 1-month mortality significantly increased.Conclusion: In older patients with CAP, MPI significantly predicted 1 month mortality. PCT levels significantly improved the accuracy of MPI at admission in predicting 1-month mortality. [ABSTRACT FROM AUTHOR]
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- 2018
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18. Osteocalcin (bone GLA protein) levels, vascular calcifications, vertebral fractures and mortality in hemodialysis patients with diabetes mellitus
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Fusaro, Maria, Gallieni, Maurizio, Aghi, Andrea, Rizzo, Maria, Iervasi, Giorgio, Nickolas, Thomas, Fabris, Fabrizio, Mereu, Maria, Giannini, Sandro, Sella, Stefania, Giusti, Andrea, Pitino, Annalisa, D’Arrigo, Graziella, Rossini, Maurizio, Gatti, Davide, Ravera, Maura, Lullo, Luca, Bellasi, Antonio, Brunori, Giuliano, Piccoli, Antonio, Tripepi, Giovanni, and Plebani, Mario
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Diabetes mellitus is recognized as one of the major causes of end stage kidney disease. Bone Gla protein (BGP) is a vitamin K-dependent protein involved in bone mineralization and vascular calcifications (VC). Our goal was to characterize BGP and undercarboxylated BGP (ucBGP) in DM patients on HD, compared to HD patients without DM, and their association with vascular and bone disease. 387 HD patients from 18 dialysis centers in Italy. Associations of DM, levels of BGP, vitamin D and VC were evaluated. Time-to-event analysis for all-cause mortality was performed by the Kaplan–Meier. Patients with DM had lower levels of total BGP (139.00 vs. 202.50 mcg/L, p < 0.001), 25(OH)D (23.4 vs. 30.2 ng/ml, p < 0.001), and ucBGP (9.24 vs. 11.32 mcg/L, p = 0.022). In regression models, the geometric means of total BGP and ucBGP were 19% (p = 0.009) and 26% (p = 0.034) lower in diabetic patients. In univariate Cox regression analysis, DM patients had a higher risk of all-cause mortality (HR:1.83, 95% CI 1.13–2.96, p = 0.014). Adjustment for confounders confirmed the significant DM-mortality link. We included VC and warfarin into the Cox model, the DM-mortality link was no longer significant, suggesting a role of these risk factors as causal mediators leading to increased mortality in dialysis patients. HD patients have an increased mortality risk associated with DM. Furthermore, we found an association between DM and decreased BGP levels. Although our study does not support the notion that BGP levels act as mediator in the DM-mortality link, to our knowledge this is the first study in HD patients suggesting a potential protective role of BGP in the bone, endocrine and vascular pathway.
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- 2019
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19. Decision Support and Patient Safety
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Plebani, Mario, Aita, Ada, Padoan, Andrea, and Sciacovelli, Laura
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In recent years, clinical decision support (CDS) systems have become recognized as increasingly important in assuring patient safety and supporting all phases of the clinical decision-making process. In Laboratory Medicine, CDS systems are usually used to drive test ordering and diagnostic prediction while combining IT components and staff skills. However, educational initiatives, user and provider feedback, and expert consultations should also be considered integral to CDS. The aim of this paper is to provide an overview of some important developments in CDS in supporting the clinical decision-making process and guaranteeing patient safety by reducing medical errors.
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- 2019
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20. Endocrine Disruption of Androgenic Activity by Perfluoroalkyl Substances: Clinical and Experimental Evidence.
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Di Nisio, Andrea, Sabovic, Iva, Valente, Umberto, Tescari, Simone, Rocca, Maria Santa, Guidolin, Diego, Dall'Acqua, Stefano, Acquasaliente, Laura, Pozzi, Nicola, Plebani, Mario, Garolla, Andrea, and Foresta, Carlo
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Considerable attention has been paid to perfluoroalkyl compounds (PFCs) because of their worldwide presence in humans, wildlife, and environment. A wide variety of toxicological effects is well supported in animals, including testicular toxicity and male infertility. For these reasons, the understanding of epidemiological associations and of the molecular mechanisms involved in the endocrine-disrupting properties of PFCs on human reproductive health is a major concern.
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- 2019
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21. Symptoms Predictive of Acute Myocardial Infarction in the Troponin Era: Analysis From the TRAPID-AMI Study
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McCord, James, Aurora, Lindsey, Lindahl, Bertil, Giannitsis, Evangelos, Calle-Muller, Carlos, Nowak, Richard, Body, Richard, Christ, Michael, deFilippi, Christopher R., Christenson, Robert H., Jacobsen, Gordon, Alquezar, Aitor, Panteghini, Mauro, Melki, Dina, Plebani, Mario, Verschuren, Franck, French, John, Bendig, Garnet, Weiser, Silvia, and Mueller, Christian
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The TRAPID-AMI (High Sensitivity Cardiac Troponin T assay for rapid Rule-out of Acute Myocardial Infarction) study evaluated a rapid “rule-out” acute myocardial infarction (AMI). We evaluated what symptoms were associated with AMI as part of a substudy of TRAPID-AMI. There were 1282 patients evaluated from 12 centers in Europe, the United States of America, and Australia from 2011 to 2013. Multiple symptom variables were prospectively obtained and evaluated for association with the final diagnosis of AMI. Multivariate logistic regression analysis was done, and odds ratios (OR) were calculated. There were 213/1282 (17%) AMIs. Four independent predictors for the diagnosis of AMI were identified: radiation to right arm or shoulder [OR = 3.0; confidence interval (CI): 1.8–5.0], chest pressure (OR = 2.5; CI: 1.3–4.6), worsened by physical activity (OR = 1.7; CI: 1.2–2.5), and radiation to left arm or shoulder (OR = 1.7; CI: 1.1–2.4). In the entire group, 131 (10%) had radiation to right arm or shoulder, 897 (70%) had chest pressure, 385 (30%) worsened with physical activity, and 448 (35%) had radiation to left arm or shoulder. Duration of symptoms was not predictive of AMI. There were no symptoms predictive of non-AMI. Relationship between AMI size and symptoms was also studied. For 213 AMI patients, cardiac troponins I values were divided into 4 quartiles. Symptoms including pulling chest pain, supramammillary right location, and right arm/shoulder radiation were significantly more likely to occur in patients with larger AMIs. In a large multicenter trial, only 4 symptoms were associated with the diagnosis of AMI, and no symptoms that were associated with a non-AMI diagnosis.
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- 2019
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22. Prognostic value of cardiac troponin I assay in hospitalized elderly patients
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Attanasio, Francesca, Carrer, Pamela, Zurlo, Anna, Rossi, Anna, Babuin, Luciano, Mion, Monica, Zaninotto, Martina, Plebani, Mario, Iliceto, Sabino, Manzato, Enzo, and Giantin, Valter
- Abstract
Cardiac troponin I (cTnI) has been poorly studied in elderly inpatients. This study wanted to assess factors influencing the increase in cTnI and its prognostic value in hospitalized elderly patients. 354 elderly (mean age of 84.8 ± 6.9 years) patients consecutively admitted in the Geriatrics Division in Padua were tested for cTnI levels assay during the hospital stay. Number of subsequent patient deaths at 6 months and 2 years were registered. Of the 354 patients, 27 (7.6%) died in hospital; their levels were not significantly higher or more frequently positive on cTnI than those of the remainder of the sample. 71 (20.01%) patients died within 6 months of being discharged, and in-hospital positive cTnI levels emerged as a mortality risk factor in this group [unadjusted HR 1.13 (1.04–1.23); p= 0.004]. At 2 years, a total of 174 patients (49.2%) had died, but in-hospital pathological cTnI levels were not a mortality risk factor in this group. It should be noted that cTnI level was a risk factor for mortality at 6 months but no longer at 2 years after an elderly patient’s hospitalization. This finding may relate to patients’ limited physiological reserves or be driven by the fact that the elderly tend to receive fewer evidence-based treatments, and to be managed more conservatively than younger patients. In the multidimensional analysis of older patients, troponin I can be used to stratify patients and assess mortality risk at 6 months, but not at 2 years.
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- 2019
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23. Ves-Matic CUBE 200: is modified Westergren method for erythrocyte sedimentation rate a valid alternative to the gold standard?
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Lapić, Ivana, Piva, Elisa, Spolaore, Federica, Musso, Giulia, Tosato, Francesca, Pelloso, Michela, and Plebani, Mario
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Ves-Matic CUBE 200 is an automated erythrocyte sedimentation rate (ESR) analyser based on the modified Westergren principle of measurement. In this study, we aimed to assess its analytical performance following the key points addressed by the International Council for Standardization in Haematology and the comparability with the gold standard Westergren method. Comparison of the two methods yielded a correlation coefficient of 0.852, no significant bias and a small constant difference between compared results. Intrarun coefficients of variation (CV) ranged from 2.2% to 22.2%, the higher being for lower ESR values, while inter-run CVs were 19.7% for the normal range and 3.0% for the abnormal range. This study proved the analytical validity of the Ves-Matic CUBE 200 and its high comparability with the Westergren method, showing obvious improvements in the technology applied for automated determination of ESR and a valuable step forward in standardisation of ESR methods.
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- 2019
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24. Metyrapone treatment in Cushing’s syndrome: a real-life study
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Ceccato, Filippo, Zilio, Marialuisa, Barbot, Mattia, Albiger, Nora, Antonelli, Giorgia, Plebani, Mario, Watutantrige-Fernando, Sara, Sabbadin, Chiara, Boscaro, Marco, and Scaroni, Carla
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Medical treatment is increasingly used in patients with Cushing’s syndrome (CS). Metyrapone (MET) is an inhibitor of 11β-hydroxylase: retrospective studies reported a decrease of cortisol secretion in 50% of cases. We evaluated the effectiveness of MET in an observational study, considering the normalization of urinary-free cortisol (UFC) and late-night salivary cortisol (LNSC) levels. We enrolled 31 patients with CS, treated with MET for at least 1 month (16 for primary treatment and 15 after surgical failure). A planned dose-titration regimen considering baseline UFC levels was adopted; MET dose was uptitrated until UFC normalization, surgery, or side effect occurrence. UFC and LNSC levels were routinely measured by liquid chromatography–tandem mass spectrometry. Patients were treated with a median dose of 1000 mg for 9 months. UFC and LNSC decreased quickly after the first month of treatment (−67 and −57% from baseline), with sustained UFC normalization up to 12 and 24 months (in 13 and 6 patients, respectively). UFC and LNSC normalized later (after 3–6 months) in patients with severe hypercortisolism (>5-fold baseline UFC). Regarding the last visit, 70 and 37% of patients normalized UFC and LNSC, respectively. Body weight reduction (−4 kg) was observed after UFC normalization. Severe side effects were not reported, half of the female patients complained of hirsutism, and blood pressure was not increased. MET therapy is a rapid-onset, long-term effective, and safe medical treatment in CS patients, achieving UFC normalization (in 70% of patients) more than cortisol rhythm recovery (in 37% of subjects).
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- 2018
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25. Diagnostic test accuracy: a valuable tool for promoting quality and patient safety
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Trenti, Tommaso and Plebani, Mario
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- 2018
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26. System-related and cognitive errors in laboratory medicine
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Plebani, Mario
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Current efforts focusing on better defining the prevalence of diagnostic errors, their causes and remediation strategies should address the role of laboratory testing and its contribution to high-quality care as well as a possible source of diagnostic errors. Data collected in the last few years highlight the vulnerability of extra-analytical phases of the testing cycle and the need for programs aiming to improve all steps of the process. Further studies have clarified the nature of laboratory-related errors, namely the evidence that both system-related and cognitive factors account for most errors in laboratory medicine. Technology developments are effective in decreasing the rates of system-related errors but organizational issues play a fundamental role in assuring a real improvement in quality and safety in laboratory processes. Educational interventions as well as technology-based interventions have been proposed to reduce the risk of cognitive errors. However, to reduce diagnostic errors and improve patient safety, clinical laboratories have to embark on a paradigmatic shift restoring the nature of laboratory services as an integral part of the diagnostic and therapy process.
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- 2018
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27. Cigarette Smoking is Associated with Decreased Bone Gla-protein (BGP) Levels in Hemodialysis Patients
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Fusaro, Maria, Gallieni, Maurizio, Aghi, Andrea, Iervasi, Giorgio, Rizzo, Maria A., Stucchi, Andrea, Noale, Marianna, Tripepi, Giovanni, Nickolas, Thomas, Veronese, Nicola, Fabris, Fabrizio, Giannini, Sandro, Calo, Lorenzo, Piccoli, Antonio, Mereu, Maria C., Cosmai, Laura, Ferraro, Alberto, Magonara, Fiorenza, Spinello, Michela, Sella, Stefania, and Plebani, Mario
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Background: Bone Gamma-carboxyglutamic acid (Gla)-protein (BGP or osteocalcin) is a vitamin K-dependent protein involved in the regulation of bone mineralization. Smoking is a risk factor for osteoporosis. Methods: We carried out a secondary analysis of the Vitamin K Italian (VIKI) study to investigate the association between cigarette smoking and BGP levels in patients with end stage renal disease. Data were collected in 370 haemodialysis patients, 37% (136) smokers (or ex-smokers) and 63% (234) nonsmokers. Vascular calcifications and vertebral fractures (quantitative morphometry) were identified on spine radiographs. Results: Smokers had significantly lower BGP levels (152 vs. 204 μg/L, p=0.003). Smokers had lower plasma phosphate levels (4.2 vs. 4.7 mg/dl, p<0.01). Lower BGP levels were associated with aortic calcification (p<0.001), iliac calcification (p=0.042) and vertebral fractures (p=0.023). In addition, the regression model showed that smoking is associated with a significant reduction of total BGP levels by about 18% (p=0.01). Conclusion: This is the first clinical study in a haemodialysis population, which identifies cigarette smoking as a potential factor that can lower BGP levels, a protective agent in bone and vascular health.
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- 2018
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28. Androstenedione and 17-α-Hydroxyprogesterone Are Better Indicators of Adrenal Vein Sampling Selectivity Than Cortisol.
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Ceolotto, Giulio, Maiolino, Giuseppe, Cesari, Maurizio, Rossitto, Giacomo, Bisogni, Valeria, Rossi, Gian Paolo, Antonelli, Giorgia, and Plebani, Mario
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For identification of potentially surgically curable primary aldosteronism, guidelines recommend use of adrenal vein sampling (AVS) that requires selective catheterization of both adrenal veins as verified by using the cortisol-derived selectivity index. Unfortunately, bilaterally selective studies are not obtained under unstimulated conditions in a proportion of the cases ranging between 15% and 50% depending on the cutoff used. We therefore investigated whether 17-α-hydroxyprogesterone and androstenedione, which showed a higher step-up between adrenal vein and inferior vena cava blood than cortisol, can ascertain selectivity when cortisol failed to do so. We prospectively recruited 32 hypertensive patients with confirmed primary aldosteronism, who underwent bilaterally simultaneous sampling without cosyntropin stimulation and with the same predefined AVS protocol. All were consecutively selected because of a cortisol-based selectivity index <2.00 in at least one of the paired adrenal vein blood samples collected as per protocol. Results showed that the values of the selectivity index based on 17-α-hydroxyprogesterone and androstenedione were higher (P<0.01) on average by 1.6- and 12-fold, respectively, than those based on cortisol. With use of these steroids, we rescued 43% and 73% of the AVS, respectively, from being judged nonselective. Thus, in challenging patients with primary aldosteronism submitted to AVS use of 17-α-hydroxyprogesterone, and even more so of androstenedione, for ascertaining selectivity allows demonstration of correct catheter placement in a proportion of AVS studies better than cortisol. Thus, replacing cortisol measurement with these steroids, and particularly androstenedione, can improve the diagnostic yield of AVS. [ABSTRACT FROM AUTHOR]
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- 2017
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29. Low vitamin K1 intake in haemodialysis patients.
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Fusaro, Maria, D'Alessandro, Claudia, Noale, Marianna, Tripepi, Giovanni, Plebani, Mario, Veronese, Nicola, Iervasi, Giorgio, Giannini, Sandro, Rossini, Maurizio, Tarroni, Giovanni, Lucatello, Sandro, Vianello, Alberto, Santinello, Irene, Bonfante, Luciana, Fabris, Fabrizio, Sella, Stefania, Piccoli, Antonio, Naso, Agostino, Ciurlino, Daniele, and Aghi, Andrea
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Summary Background & aims Vitamin K acts as a coenzyme in the γ-carboxylation of vitamin K-dependent proteins, including coagulation factors, osteocalcin, matrix Gla protein (MGP), and the growth arrest-specific 6 (GAS6) protein. Osteocalcin is a key factor for bone matrix formation. MGP is a local inhibitor of soft tissue calcification. GAS6 activity prevents the apoptosis of vascular smooth muscle cells. Few data on vitamin K intake in chronic kidney disease patients and no data in patients on a Mediterranean diet are available. In the present study, we evaluate the dietary intake of vitamin K1 in a cohort of patients undergoing haemodialysis. Methods In this multi-centre controlled observational study, data were collected from 91 patients aged >18 years on dialysis treatment for at least 12 months and from 85 age-matched control subjects with normal renal function. Participants completed a food journal of seven consecutive days for the estimation of dietary intakes of macro- and micro-nutrients (minerals and vitamins). Results Compared to controls, dialysis patients had a significant lower total energy intake, along with a lower dietary intake of proteins, fats, carbohydrates, fibres, and of all the examined minerals (Ca, P, Fe, Na, K, Zn, Cu, and Mg). With the exception of vitamin B12, vitamins intake followed a similar pattern, with a lower intake in vitamin A, B1, B2, C, D, E, folates, K1 and PP. These finding were confirmed also when normalized for total energy intake or for body weight. In respect to the adequate intakes recommended in the literature, the prevalence of a deficient vitamin K intake was very high (70–90%) and roughly double than in controls. Multivariate logistic model identified vitamin A and iron intake as predictors of vitamin K deficiency. Conclusions Haemodialysis patients had a significantly low intake in vitamin K1, which could contribute to increase the risk of bone fractures and vascular calcifications. Since the deficiency of vitamin K intake seems to be remarkable, dietary counselling to HD patients should also address the adequacy of vitamin K dietary intake and bioavailability. Whether diets with higher amounts of vitamin K1 or vitamin K supplementation can improve clinical outcomes in dialysis patients remains to be demonstrated. [ABSTRACT FROM AUTHOR]
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- 2017
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30. Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department.
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McCord, James, Cabrera, Rafael, Lindahl, Bertil, Giannitsis, Evangelos, Evans, Kaleigh, Nowak, Richard, Frisoli, Tiberio, Body, Richard, Christ, Michael, deFilippi, Christopher R., Christenson, Robert H., Jacobsen, Gordon, Alquezar, Aitor, Panteghini, Mauro, Melki, Dina, Plebani, Mario, Verschuren, Franck, French, John, Bendig, Garnet, and Weiser, Silvia
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Background: The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial.Methods and Results: Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs (P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs (P=0.03).Conclusions: Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department. [ABSTRACT FROM AUTHOR]- Published
- 2017
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31. The novel coronavirus (2019-nCoV) outbreak: think the unthinkable and be prepared to face the challenge
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Lippi, Giuseppe and Plebani, Mario
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- 2020
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32. Use of copeptin for rapid rule-out of acute myocardial infarction
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Mueller, Christian, Möckel, Martin, Giannitsis, Evangelos, Huber, Kurt, Mair, Johannes, Plebani, Mario, Thygesen, Kristian, Jaffe, Allan S, and Lindahl, Bertil
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Copeptin is currently understood as a quantitative marker of endogenous stress. It rises rapidly in multiple acute disorders including acute myocardial infarction. As a single variable, it has only modest diagnostic accuracy for acute myocardial infarction. However, the use of copeptin within a dual-marker strategy together with conventional cardiac troponin increases the diagnostic accuracy and particularly the negative predictive value of cardiac troponin alone for acute myocardial infarction. The rapid rule-out of acute myocardial infarction is the only application in acute cardiac care mature enough to merit consideration for routine clinical care. However, the dual-marker approach seems to provide only very small incremental value when used in combination with sensitive or high-sensitivity cardiac troponin assays. This review aims to update and educate regarding the potential and the procedural details, as well as the caveats and challenges of using copeptin in clinical practice.
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- 2018
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33. What to do when you question cardiac troponin values
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Mair, Johannes, Lindahl, Bertil, Müller, Christian, Giannitsis, Evangelos, Huber, Kurt, Möckel, Martin, Plebani, Mario, Thygesen, Kristian, and Jaffe, Allan S
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High-sensitivity cardiac troponin assays enable cardiac troponin measurement with a high degree of analytical sensitivity and a low level of analytical imprecision at the low measuring range. One of the most important advantages of these new assays is that they allow novel, more rapid approaches for ruling in or ruling out acute myocardial infarctions. The increase in the early diagnostic sensitivity of high-sensitivity cardiac troponin assays comes at the cost of a reduced acute myocardial infarction specificity of the biomarker, because more patients with other causes of acute or chronic myocardial injury without overt myocardial ischaemia are detected than with previous cardiac troponin assays. Increased troponin concentrations that do not fit with the clinical presentation are seen in the daily routine, mainly as a result of a variety of pathologies, and if tested in the same sample, even discrepancies between high-sensitivity cardiac troponin I and troponin T test results may sometimes be found as well. In addition, analytically false-positive test results occasionally may occur since no assay is perfect. In this review, we summarise the biochemical, pathophysiological and analytical background of the work-up for such a clinical setting.
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- 2018
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34. How is cardiac troponin released from injured myocardium?
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Mair, Johannes, Lindahl, Bertil, Hammarsten, Ola, Müller, Christian, Giannitsis, Evangelos, Huber, Kurt, Möckel, Martin, Plebani, Mario, Thygesen, Kristian, and Jaffe, Allan S
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Cardiac troponin I and cardiac troponin T are nowadays the criterion biomarkers for the laboratory diagnosis of acute myocardial infarction due to their very high sensitivities and specificities for myocardial injury. However, still many aspects of their degradation, tissue release and elimination from the human circulation are incompletely understood. Myocardial injury may be caused by a variety of different mechanisms, for example, myocardial ischaemia, inflammatory and immunological processes, trauma, drugs and toxins, and myocardial necrosis is preceded by a substantial reversible prelethal phase. Recent experimental data in a pig model of myocardial ischaemia demonstrated cardiac troponin release into the circulation from apoptotic cardiomyocytes as an alternative explanation for clinical situations with increased cardiac troponin without any other evidence for myocardial necrosis. However, the comparably lower sensitivities of all currently available imaging modalities, including cardiac magnetic resonance imaging for the detection of particularly non-focal myocardial necrosis in patients, has to be considered for cardiac troponin test result interpretation in clinical settings without any other evidence for myocardial necrosis apart from increased cardiac troponin concentrations as well.
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- 2018
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35. Improved salivary cortisol rhythm with dual-release hydrocortisone
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Ceccato, Filippo, Selmin, Elisa, Sabbadin, Chiara, Dalla Costa, Miriam, Antonelli, Giorgia, Plebani, Mario, Barbot, Mattia, Betterle, Corrado, Boscaro, Marco, and Scaroni, Carla
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The purpose of replacement therapy in adrenal insufficiency (AI) is mimicking endogenous cortisol levels as closely as possible: dual release hydrocortisone (DR-HC) has been introduced to replicate the circadian cortisol rhythm. Multiple daily saliva collections could be used to assess the cortisol rhythm during real life: our aim was to study the salivary cortisol profile in AI.We prospectively evaluated, in an observational study, 18 adult outpatients with AI (11 primary and 7 secondary AI), switched from conventional treatment (conv-HC, 25 mg/day) to the same dose of DR-HC. We collected six samples of saliva in a day, measuring cortisol (F) and cortisone (E) with LC-MS/MS. Forty-three matched healthy subjects served as controls.F levels were similar in the morning (and higher than controls) in patients treated with conv-HC or DR-HC; otherwise F levels and exposure were lower in the afternoon and evening in patients with DR-HC, achieving a cortisol profile closer to healthy controls. Daily cortisol exposure, measured with area under the curve, was lower with DR-HC. Morning F and E presented sensitivity and specificity >90% to diagnose AI (respectively threshold of 3 and 9.45 nmol/L). Total cholesterol and HbA1c levels reduced with DR-HC.Salivary cortisol daily curve could be used as a new tool to assess the cortisol profiles in patients treated with conv-HC and DR-HC. A lower daily cortisol exposure was achieved with DR-HC (despite the same HC dose), especially in the afternoon-evening.
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- 2018
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36. Calcium-sensing receptor polymorphisms increase the risk of osteoporosis in ageing males
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Di Nisio, Andrea, Rocca, Maria, Ghezzi, Marco, Ponce, Maurizio, Taglianetti, Stefano, Plebani, Mario, Ferlin, Alberto, and Foresta, Carlo
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- 2018
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37. Clinical laboratory: bigger is not always better
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Plebani, Mario
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Laboratory services around the world are undergoing substantial consolidation and changes through mechanisms ranging from mergers, acquisitions and outsourcing, primarily based on expectations to improve efficiency, increasing volumes and reducing the cost per test. However, the relationship between volume and costs is not linear and numerous variables influence the end cost per test. In particular, the relationship between volumes and costs does not span the entire platter of clinical laboratories: high costs are associated with low volumes up to a threshold of 1 million test per year. Over this threshold, there is no linear association between volumes and costs, as laboratory organization rather than test volume more significantly affects the final costs. Currently, data on laboratory errors and associated diagnostic errors and risk for patient harm emphasize the need for a paradigmatic shift: from a focus on volumes and efficiency to a patient-centered vision restoring the nature of laboratory services as an integral part of the diagnostic and therapy process. Process and outcome quality indicators are effective tools to measure and improve laboratory services, by stimulating a competition based on intra- and extra-analytical performance specifications, intermediate outcomes and customer satisfaction. Rather than competing with economic value, clinical laboratories should adopt a strategy based on a set of harmonized quality indicators and performance specifications, active laboratory stewardship, and improved patient safety.
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- 2018
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38. Daily salivary cortisol and cortisone rhythm in patients with adrenal incidentaloma
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Ceccato, Filippo, Barbot, Mattia, Albiger, Nora, Antonelli, Giorgia, Zilio, Marialuisa, Todeschini, Marco, Regazzo, Daniela, Plebani, Mario, Lacognata, Carmelo, Iacobone, Maurizio, Mantero, Franco, Boscaro, Marco, and Scaroni, Carla
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Impaired cortisol rhythm is a characteristic feature of Cushing’s Syndrome, nevertheless late night salivary cortisol (LNSC) is not suitable to detect subclinical hypercortisolism in patients with adrenal incidentaloma (AI). We studied daily salivary cortisol (F) and cortisone (E) rhythm in patients with AI. Six saliva samples were collected from awakening to night in 106 patients with AI and 40 controls. F and E were measured with LC-MS/MS and daily F exposure was calculated with the area under the curve (AUC). Patients with serum cortisol after dexamethasone suppression test (DST) > 50 nmol/L showed higher morning F (15.5 ± 14.5 vs. 8.6 ± 5.5 nmol/L, p= 0.001), suppressed corticotropin levels (76 vs. 35%, p< 0.001) and increased daily F exposure (3795 ± 1716 vs. 2898 ± 1478, p= 0.012), especially in the morning (2035 ± 1267 vs. 1365 ± 777, p= 0.003), otherwise LNSC levels were similar. Salivary E and AUC levels were higher in patients with DST > 50 nmol/L. AUC was not correlated with urinary cortisol levels or adenoma size. F and E levels were similar among patients with unilateral or bilateral adenoma, or considering the presence of hypertension, dyslipidemia, diabetes, or cardiovascular events. Daily cortisol exposure, evaluated with AUC from multiple saliva collections, is increased in AI patients with serum cortisol > 50 nmol/L after DST, especially in the morning, leading to reduced corticotropin levels. Cortisol rhythm is preserved in patients with AI, remarking that LNSC is not a screening test for subclinical hypercortisolism.
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- 2018
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39. Combined use of the multidimensional prognostic index (MPI) and procalcitonin serum levels in predicting 1-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP): a prospective study
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Pilotto, Alberto, Dini, Simone, Daragjati, Julia, Miolo, Manuela, Mion, Monica, Fontana, Andrea, Storto, Mario, Zaninotto, Martina, Cella, Alberto, Carraro, Paolo, Addante, Filomena, Copetti, Massimiliano, and Plebani, Mario
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Several scores and biomarkers, i.e., procalcitonin (PCT), were proposed to stratify the mortality risk in community-acquired pneumonia (CAP). Evaluating prognostic accuracy of PCT and Multidimensional Prognostic Index (MPI) for 1-month mortality risk in older patients with CAP. At hospital admission and at discharge, patients were evaluated by a Comprehensive Geriatric Assessment to calculate MPI. Serum PCT was measured at admission and 1, 3, and 5 days after hospital admission. 49 patients were enrolled. The overall 1-month mortality was 44.5 for 100-persons year. Mortality rates were higher with the increasing of MPI. In survived patients, MPI at discharge showed higher predictive accuracy than MPI at admission. Adding PCT levels to admission MPI prognostic accuracy for 1-month mortality significantly increased. In older patients with CAP, MPI significantly predicted 1 month mortality. PCT levels significantly improved the accuracy of MPI at admission in predicting 1-month mortality.
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- 2018
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40. Thoughts modulate the expression of inflammatory genes and may improve the coronary blood flow in patients after a myocardial infarction
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Dal Lin, Carlo, Marinova, Mariela, Rubino, Giorgio, Gola, Elisabetta, Brocca, Alessandra, Pantano, Giorgia, Brugnolo, Laura, Sarais, Cristiano, Cucchini, Umberto, Volpe, Biancarosa, Cavalli, Chiara, Bellio, Maura, Fiorello, Emilia, Scali, Sofia, Plebani, Mario, Iliceto, Sabino, and Tona, Francesco
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Mental stress is one of the main risk factors for cardiovascular disease. Meditation and music listening are two techniques that are able to counteract it through the activation of specific brain areas, eliciting the so-called Relaxing Response (RR). Epidemiological evidence reveals that the RR practice has a beneficial prognostic impact on patients after myocardial infarction. We aimed to study the possible molecular mechanisms of RR underlying these findings.
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- 2018
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41. High sensitivity cardiac troponin T in patients not having an acute coronary syndrome: results from the TRAPID-AMI study
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Nowak, Richard, Mueller, Christian, Giannitsis, Evangelos, Christ, Michael, Ordonez-Llanos, Jordi, DeFilippi, Christopher, McCord, James, Body, Richard, Panteghini, Mauro, Jernberg, Tomas, Plebani, Mario, Verschuren, Franck, French, John K., Christenson, Robert, Jacobsen, Gordon, Dinkel, Carina, and Lindahl, Bertil
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AbstractPurpose:To describe the baseline, 1 hr and delta high sensitivity cardiac troponin (hs-cTnT) values in patients with suspected acute myocardial infarction (AMI) but without a final acute coronary syndrome (ACS) diagnosis.Materials and methods:hs-cTnTassay for RAPIDrule out of acute myocardial infarction (TRAPID-AMI) was a prospective diagnostic trial that enrolled emergency department (ED) patients with suspected AMI. Final patient diagnoses were adjudicated by a clinical events committee and subjects placed in different clinical groups: AMI, unstable angina, non-ACS cardiac, non-cardiac and unknown origin. The baseline, 1 hr and delta hs-cTnT values were analysed in the 902 non-ACS patients.Results:Amongst the 1282 studied the patient groups were 213 (17%) AMI, 167 (13%) unstable angina, 113 (9%) non-ACS cardiac, 288 (22%) non-cardiac and 501 (39%) unknown origin. The hs-cTnT values in the non-cardiac and unknown origin groups were combined. The median hs-cTnT values (ng/L) were higher (p < 0.001) in the non-ACS cardiac compared to the non-cardiac/unknown origin group at baseline (11.8, <5) and 1 hr (12.3, <5). Their negative predictive values were 0.955 (baseline) and 0.954 (1 hr) for predicting non-ACS cardiac versus non-cardiac/unknown origin diagnoses.Conclusions:Hs-cTnT may help predict whether non-ACS ED patients have a final non-ACS cardiac or non-cardiac/unknown origin diagnoses.
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- 2017
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42. Clinical Laboratory Medicine: An Alliance for the Optimal Management of Acute Kidney Injury with the Use of Biomarkers
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Plebani, Mario, Ronco, Claudio, and Forni, Lui G
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- 2017
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43. Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T.
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Mueller, Christian, Giannitsis, Evangelos, Christ, Michael, Ordóñez-Llanos, Jorge, deFilippi, Christopher, McCord, James, Body, Richard, Panteghini, Mauro, Jernberg, Tomas, Plebani, Mario, Verschuren, Franck, French, John, Christenson, Robert, Weiser, Silvia, Bendig, Garnet, Dipl Stat, Peter Dilba, Lindahl, Bertil, Twerenbold, Raphael, Katus, Hugo A., and Popp, Steffen
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Study Objective: We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction.Methods: We enrolled patients presenting with suspected acute myocardial infarction and recent (<6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT below 12 ng/L and Δ1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or Δ1 hour at least 5 ng/L to rule in; remaining patients to the "observational zone") was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT.Results: Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone.Conclusion: The hs-cTnT 0-hour/1-hour algorithm performs well for early rule-out and rule-in of acute myocardial infarction. [ABSTRACT FROM AUTHOR]- Published
- 2016
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44. Impaired Release of Vitamin D in Dysfunctional Adipose Tissue: New Cues on Vitamin D Supplementation in Obesity
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Di Nisio, Andrea, De Toni, Luca, Sabovic, Iva, Rocca, Maria Santa, De Filippis, Vincenzo, Opocher, Giuseppe, Azzena, Bruno, Vettor, Roberto, Plebani, Mario, and Foresta, Carlo
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Trafficking of vitamin D was analyzed in insulin-resistant fat cells and adipose tissue from obese subjects. Adrenaline-induced lipolytic release is altered in dysfunctional adipose tissue.
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- 2017
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45. Will sacubitril-valsartan diminish the clinical utility of B-type natriuretic peptide testing in acute cardiac care?
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Mair, Johannes, Lindahl, Bertil, Giannitsis, Evangelos, Huber, Kurt, Thygesen, Kristian, Plebani, Mario, Möckel, Martin, Müller, Christian, and Jaffe, Allan S
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Since the approval of sacubitril-valsartan for the treatment of chronic heart failure with reduced ejection fraction, a commonly raised suspicion is that a wider clinical use of this new drug may diminish the clinical utility of B-type natriuretic peptide testing as sacubitril may interfere with B-type natriuretic peptide clearance. In this education paper we critically assess this hypothesis based on the pathophysiology of the natriuretic peptide system and the limited published data on the effects of neprilysin inhibition on natriuretic peptide plasma concentrations in humans. As the main clinical application of B-type natriuretic peptide testing in acute cardiac care is and will be the rapid rule-out of suspected acute heart failure there is no significant impairment to be expected for B-type natriuretic peptide testing in the acute setting. However, monitoring of chronic heart failure patients on sacubitril-valsartan treatment with B-type natriuretic peptide testing may be impaired. In contrast to N-terminal-proBNP, the current concept that the lower the B-type natriuretic peptide result in chronic heart failure patients, the better the prognosis during treatment monitoring, may no longer be true.
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- 2017
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46. Rapid rule out of acute myocardial infarction: novel biomarker-based strategies
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Mueller, Christian, Giannitsis, Evangelos, Möckel, Martin, Huber, Kurt, Mair, Johannes, Plebani, Mario, Thygesen, Kristian, Jaffe, Allan S, and Lindahl, Bertil
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- 2017
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47. Editor’s Choice-Rule-in of acute myocardial infarction: Focus on troponin
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Möckel, Martin, Giannitsis, Evangelos, Mueller, Christian, Huber, Kurt, Jaffe, Allan S, Mair, Johannes, Plebani, Mario, Thygesen, Kristian, and Lindahl, Bertil
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- 2017
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48. Quality Indicators for the Total Testing Process
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Plebani, Mario, Sciacovelli, Laura, and Aita, Ada
- Abstract
ISO 15189:2012 requires the use of quality indicators (QIs) to monitor and evaluate all steps of the total testing process, but several difficulties dissuade laboratories from effective and continuous use of QIs in routine practice. An International Federation of Clinical Chemistry and Laboratory Medicine working group addressed this problem and implemented a project to develop a model of QIs to be used in clinical laboratories worldwide to monitor and evaluate all steps of the total testing process, and decrease error rates and improve patient services in laboratory testing. All laboratories are invited, at no cost, to enroll in the project and contribute to harmonized management at the international level.
- Published
- 2017
- Full Text
- View/download PDF
49. How to use D-dimer in acute cardiovascular care
- Author
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Giannitsis, Evangelos, Mair, Johannes, Christersson, Christina, Siegbahn, Agneta, Huber, Kurt, Jaffe, Allan S, Peacock, W Frank, Plebani, Mario, Thygesen, Kristian, Möckel, Martin, Mueller, Christian, and Lindahl, Bertil
- Abstract
D-dimer testing is important to aid in the exclusion of venous thromboembolic events (VTEs), including deep venous thrombosis and pulmonary embolism, and it may be used to evaluate suspected aortic dissection. D-dimer is produced upon activation of the coagulation system with the generation and subsequent degradation of cross-linked fibrin by plasmin. Many different assays for D-dimer testing are currently used in routine care. However, these tests are neither standardized nor harmonized. Consequently, only clinically validated assays and assay specific decision limits should be used for routine testing. For the exclusion of pulmonary embolism/deep vein thrombosis, age-adjusted cut-offs are recommend. Clinicians must be aware of the validated use of their hospital’s D-dimer assay to avoid inappropriate use of this biomarker in routine care.
- Published
- 2017
- Full Text
- View/download PDF
50. Osteocalcin and Sex Hormone Binding Globulin Compete on a Specific Binding Site of GPRC6A
- Author
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De Toni, Luca, Guidolin, Diego, De Filippis, Vincenzo, Tescari, Simone, Strapazzon, Giacomo, Santa Rocca, Maria, Ferlin, Alberto, Plebani, Mario, and Foresta, Carlo
- Abstract
The undercarboxylated form of osteocalcin (ucOC) regulates male fertility and energy metabolism, acting through the G protein-coupled receptor (GPRC)6A, thus forming a new pancreas-bone-testis axis. Recently, GPRC6A has also been suggested to mediate the nongenomic responses of free testosterone (T). However, these data did not consider the physiological scenario, where circulating T is mainly bound to sex hormone-binding globulin (SHBG) and only a small percentage circulates freely in the blood. Here, by the use of computational modelling, we document the existence of similar structural moieties between ucOC and SHBG that are predicted to bind to GPRC6A at docking analysis. This hypothesis of competition was assessed by binding experiments on human embryonic kidney-293 cells transfected with human GPRC6Agene. Unliganded SHBG specifically bound the membrane of human embryonic kidney-293 cells transfected with GPRC6Aand was displaced by ucOC when coincubated at 100-fold molar excess. Furthermore, specific downstream Erk1/2 phosphorylation after stimulation of GPRC6A with ucOC was significantly blunted by 100-fold molar excess of unliganded SHBG. Intriguingly previous incubation with unliganded SHBG, followed by incubation with T, induced Erk1/2 phosphorylation in a dose-dependent manner. Neither binding nor stimulating activities were shown for SHBG saturated with T. Experiments on mutation constructs of GPRC6A strengthened the hypothesis of a common binding site of ucOC and SHBG. Given the role of GPRC6A on energy metabolism, these data agree with epidemiological association between SHBG levels and insulin sensitivity, suggest GPRC6A as a likely SHBG receptor, and add bases for the possible regulation of androgen activity in a nonsteroidal manner.
- Published
- 2016
- Full Text
- View/download PDF
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