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1. Telemedicine for management of patients with amyotrophic lateral sclerosis through COVID-19 tail

Author

Bombaci, A, Abbadessa, G, Trojsi, F, Leocani, L, Bonavita, S, Lavorgna, L, Tedeschi, G, Mancardi, G, Padovani, A, Clerico, M, Brigo, F, Lanzillo, R, Russo, A, Giometto, B, Straccia, G, Iodice, R, Bucello, S, Annovazzi, P, Moccia, M, Prosperini, L, Stromillo, M, Repice, A, Miele, G, Lerario, A, De Martino, A, Iodice, F, Di Lorenzo, F, Cuffaro, L, Romoli, M, Silvestro, M, Artusi, C, Bombaci A., Abbadessa G., Trojsi F., Leocani L., Bonavita S., Lavorgna L., Tedeschi G., Mancardi G., Padovani A., Clerico M., Brigo F., Lanzillo R., Russo A., Giometto B., Straccia G., Iodice R., Bucello S., Annovazzi P., Moccia M., Prosperini L., Stromillo M. L., Repice A. M., Miele G., Lerario A., De Martino A., Iodice F., Di Lorenzo F., Cuffaro L., Romoli M., Silvestro M., Artusi C. A., Bombaci, A, Abbadessa, G, Trojsi, F, Leocani, L, Bonavita, S, Lavorgna, L, Tedeschi, G, Mancardi, G, Padovani, A, Clerico, M, Brigo, F, Lanzillo, R, Russo, A, Giometto, B, Straccia, G, Iodice, R, Bucello, S, Annovazzi, P, Moccia, M, Prosperini, L, Stromillo, M, Repice, A, Miele, G, Lerario, A, De Martino, A, Iodice, F, Di Lorenzo, F, Cuffaro, L, Romoli, M, Silvestro, M, Artusi, C, Bombaci A., Abbadessa G., Trojsi F., Leocani L., Bonavita S., Lavorgna L., Tedeschi G., Mancardi G., Padovani A., Clerico M., Brigo F., Lanzillo R., Russo A., Giometto B., Straccia G., Iodice R., Bucello S., Annovazzi P., Moccia M., Prosperini L., Stromillo M. L., Repice A. M., Miele G., Lerario A., De Martino A., Iodice F., Di Lorenzo F., Cuffaro L., Romoli M., Silvestro M., and Artusi C. A.

Abstract

Over the last months, due to coronavirus disease (COVID-19) pandemic, containment measures have led to important social restriction. Healthcare systems have faced a complete rearrangement of resources and spaces, with the creation of wards devoted to COVID-19 patients. In this context, patients affected by chronic neurological diseases, such as amyotrophic lateral sclerosis (ALS), are at risk to be lost at follow-up, leading to a higher risk of morbidity and mortality. Telemedicine may allow meet the needs of these patients. In this commentary, we briefly discuss the digital tools to remotely monitor and manage ALS patients. Focusing on detecting disease progression and preventing life-threatening conditions, we propose a toolset able to improve ALS management during this unprecedented situation.

Published
2021

2. Design of a study to investigate the mechanisms of obstructive sleep apnoea by means of drug-induced sleep endoscopy

Author

Bisogni, V, Maiolino, G, Ceolotto, G, Pengo, M, Marchese Ragona, R, Artusi, C, Brugnolo, L, Lerco, S, Borsetto, D, Gaudioso, P, Martini, A, Plebani, M, Rossi, G, Bisogni V., Maiolino G., Ceolotto G., Pengo M., Marchese Ragona R., Artusi C., Brugnolo L., Lerco S., Borsetto D., Gaudioso P., Martini A., Plebani M., Rossi G. P., Bisogni, V, Maiolino, G, Ceolotto, G, Pengo, M, Marchese Ragona, R, Artusi, C, Brugnolo, L, Lerco, S, Borsetto, D, Gaudioso, P, Martini, A, Plebani, M, Rossi, G, Bisogni V., Maiolino G., Ceolotto G., Pengo M., Marchese Ragona R., Artusi C., Brugnolo L., Lerco S., Borsetto D., Gaudioso P., Martini A., Plebani M., and Rossi G. P.

Abstract

Obstructive sleep apnoea (OSA) is an independent risk factor of hypertension and cardiovascular diseases. Recurrent episodes of upper airways collapse during sleep causing blood oxygen desaturation, hypercapnia, and micro-arousals, are known to activate the sympathetic nervous system (SNS). However, whether changes in the renin-angiotensin-aldosterone system and endothelial activation also occur remains contentious. Based on routine use of drug-induced sleep endoscopy (DISE) for the work-up of OSA patients in our centre, we designed a prospective study to investigate the haemodynamic and humoral changes occurring during the apnoeic episodes reproduced in vivo in the course of DISE. Specifically, plasma aldosterone concentration and renin activity, C-terminal fragment of proendothelin-1, as a marker of endothelial damage, and free plasma catecholamines, will be measured at fixed times during DISE. The activity of catechol-O-methyltransferase (COMT), a key catecholamine-inactivating enzyme that has been scantly investigated thus far owing to the lack of commercially available kits, will be also determined by a newly developed high performance liquid chromatography method, which is herein described. The aim of this study is to provide novel information on the haemodynamic, hormonal, and SNS changes, and also on COMT activity modification concomitantly occurring during apnoea, thus contributing substantively to the understanding of the pathophysiology of OSA.

Published
2019

3. Ventral tegmental area disconnection contributes two years early to correctly classify patients converted to alzheimer's disease: Implications for treatment

Author

Serra, L., D'Amelio, M., Esposito, S., Di Domenico, C., Koch, G., Marra, Camillo, Mercuri, N. B., Caltagirone, C., Artusi, C. A., Lopiano, L., Cercignani, M., Bozzali, M., Marra C. (ORCID:0000-0003-3994-4044), Serra, L., D'Amelio, M., Esposito, S., Di Domenico, C., Koch, G., Marra, Camillo, Mercuri, N. B., Caltagirone, C., Artusi, C. A., Lopiano, L., Cercignani, M., Bozzali, M., and Marra C. (ORCID:0000-0003-3994-4044)

Abstract

Background: Recent cross-sectional studies highlighted the loss of dopaminergic neurons in the ventral tegmental area (VTA) as an early pathophysiological event in Alzheimer's disease (AD). Objective: In this study, we longitudinally investigated by resting-state fMRI (rs-fMRI) a cohort of patients with mild cognitive impairment (MCI) due to AD to evaluate the impact of VTA disconnection in predicting the conversion to AD. Methods: A cohort of 35 patients with MCI due to AD were recruited and followed-up for 24 months. They underwent cognitive evaluation and rs-fMRI to assess VTA connectivity at baseline and at follow-up. Results: At 24-month follow-up, 16 out of 35 patients converted to AD. Although converters and non-converters to AD did not differ in demographic and behavioral characteristics at baseline, the first group showed a significant reduction of VTA-driven connectivity in the posterior cingulate and precentral cortex. This pattern of additional disconnection in MCI-Converters compared to non-converters remained substantially unchanged at 24-month follow-up. Conclusion: This study reinforces the hypothesis of an early contribution of dopaminergic dysfunction to AD evolution by targeting the default-mode network. These results have potential implications for AD staging and prognosis and support new opportunities for therapeutic interventions to slow down disease progression.

Published
2021

4. The still under-investigated role of cognitive deficits in PML diagnosis

Author

Scarpazza, C, De Rossi, N, Moiola, L, Gerevini, S, Cosottini, M, Capra, R, Mattioli, F, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Bresciamorra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Clerico, M, Cordioli, C, D'Aleo, G, de Riz, M, Deotto, L, Durelli, L, Falcini, M, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Naldi, P, Pane, C, Perrone, P, Pizzorno, M, Pozzilli, C, Prosperini, L, Rezzonico, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza C., De Rossi N., Moiola L., Gerevini S., Cosottini M., Capra R., Mattioli F., Amato M. P., Artusi C. A., Bandini F., Barcella V., Bertolotto A., Bresciamorra V., Capobianco M., Cavaletti G., Cavalla P., Centonze D., Clerico M., Cordioli C., D'Aleo G., de Riz M., Deotto L., Durelli L., Falcini M., Ferrari E., Fusco M. L., Gasperini C., Ghezzi A., Grimaldi L., Guidotti M., Laroni A., Lugaresi A., Naldi P., Pane C., Perrone P., Pizzorno M., Pozzilli C., Prosperini L., Rezzonico M., Rovaris M., Salemi G., Salvetti M., Santuccio G., Scarpini E., Sessa E., Solaro C., Tabiadon G., Tortorella C., Trojano M., Valentino P., Scarpazza, C, De Rossi, N, Moiola, L, Gerevini, S, Cosottini, M, Capra, R, Mattioli, F, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Bresciamorra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Clerico, M, Cordioli, C, D'Aleo, G, de Riz, M, Deotto, L, Durelli, L, Falcini, M, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Naldi, P, Pane, C, Perrone, P, Pizzorno, M, Pozzilli, C, Prosperini, L, Rezzonico, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza C., De Rossi N., Moiola L., Gerevini S., Cosottini M., Capra R., Mattioli F., Amato M. P., Artusi C. A., Bandini F., Barcella V., Bertolotto A., Bresciamorra V., Capobianco M., Cavaletti G., Cavalla P., Centonze D., Clerico M., Cordioli C., D'Aleo G., de Riz M., Deotto L., Durelli L., Falcini M., Ferrari E., Fusco M. L., Gasperini C., Ghezzi A., Grimaldi L., Guidotti M., Laroni A., Lugaresi A., Naldi P., Pane C., Perrone P., Pizzorno M., Pozzilli C., Prosperini L., Rezzonico M., Rovaris M., Salemi G., Salvetti M., Santuccio G., Scarpini E., Sessa E., Solaro C., Tabiadon G., Tortorella C., Trojano M., and Valentino P.

Abstract

Background: Despite cognitive deficits frequently represent the first clinical manifestations of Progressive Multifocal Leukoencephalopathy (PML) in Natalizumab-treated MS patients, the importance of cognitive deficits in PML diagnosis is still under-investigated. The aim of the current study is to investigate the cognitive deficits at PML diagnosis in a group of Italian patients with PML. Methods: Thirty-four PML patients were included in the study. The demographic and clinical data, the lesion load and localization, and the longitudinal clinical course was compared between patients with (n = 13) and without (n = 15) cognitive deficit upon PML suspicion (the remaining six patients were asymptomatic). Clinical presentation of cognitive symptoms was described in detail. Result: After symptoms detection, the time to diagnosis resulted to be shorter for patients presenting with cognitive than for patients with non cognitive onset (p = 0.03). Within patients with cognitive onset, six patients were presenting with language and/or reading difficulties (46.15%); five patients with memory difficulties (38.4%); three patients with apraxia (23.1%); two patients with disorientation (15.3%); two patients with neglect (15.3%); one patients with object agnosia (7.7%), one patient with perseveration (7.7%) and one patient with dementia (7.7%). Frontal lesions were less frequent (p = 0.03), whereas temporal lesions were slightly more frequent (p = 0.06) in patients with cognitive deficits. The longitudinal PML course seemed to be more severe in cognitive than in non cognitive patients (F = 2.73, p = 0.03), but differences disappeared (F = 1.24, p = 0.29) when balancing for the incidence of immune reconstitution syndrome and for other treatments for PML (steroids, plasma exchange (PLEX) and other therapies (Mefloquine, Mirtazapine, Maraviroc). Conclusion: Cognitive deficits at PML onset manifest with symptoms which are absolutely rare in MS. Their appearance in MS patients should st

Published
2017

5. Early diagnosis of progressive multifocal leucoencephalopathy: Longitudinal lesion evolution

Author

Scarpazza, C, Signori, A, Prosperini, L, Sormani, M, Cosottini, M, Capra, R, Gerevini, S, Altieri, M, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Morra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Chiusole, M, Clerico, M, Cordioli, C, D'Aleo, G, De Luca, G, De Riz, M, De Rossi, N, Deotto, L, Durelli, L, Falcini, M, Ferrante, C, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Moiola, L, Naldi, P, Pane, C, Palmeri, B, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rottoli, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Stenta, G, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza, Cristina, Signori, Alessio, Prosperini, Luca, Sormani, Maria Pia, Cosottini, Mirco, Capra, Ruggero, Gerevini, Simonetta, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Chiusole, Maurizia, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, De Luca, Giovanna, De Riz, Milena, De Rossi, Nicola, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrante, Claudio, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Moiola, Lucia, Naldi, Paola, Pane, Chiara, Palmeri, Barbara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rottoli, Maria Rosa, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Stenta, Gianola, Tabiadon, Giulietta, Tortorella, Carla, Trojano, Maria, Valentino, Paola, Rottoli, Maira Rosa, Scarpazza, C, Signori, A, Prosperini, L, Sormani, M, Cosottini, M, Capra, R, Gerevini, S, Altieri, M, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Morra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Chiusole, M, Clerico, M, Cordioli, C, D'Aleo, G, De Luca, G, De Riz, M, De Rossi, N, Deotto, L, Durelli, L, Falcini, M, Ferrante, C, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Moiola, L, Naldi, P, Pane, C, Palmeri, B, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rottoli, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Stenta, G, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza, Cristina, Signori, Alessio, Prosperini, Luca, Sormani, Maria Pia, Cosottini, Mirco, Capra, Ruggero, Gerevini, Simonetta, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Chiusole, Maurizia, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, De Luca, Giovanna, De Riz, Milena, De Rossi, Nicola, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrante, Claudio, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Moiola, Lucia, Naldi, Paola, Pane, Chiara, Palmeri, Barbara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rottoli, Maria Rosa, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Stenta, Gianola, Tabiadon, Giulietta, Tortorella, Carla, Trojano, Maria, Valentino, Paola, and Rottoli, Maira Rosa

Abstract

Objective early diagnosis of natalizumab-related progressive multifocal leucoencephalopathy (NTZ-pML) in multiple sclerosis has been deemed a major priority by the regulatory agencies but has yet to become a reality. The current paper aims to: (1) investigate whether patients with NTZ-pML pass through a prolonged presymptomatic phase with MRI abnormalities, (2) estimate the longitudinal pML lesion volume increase during the presymptomatic phase and (3) estimate the presymptomatic phase length and its impact on therapy duration as a risk stratification parameter. Methods all Italian patients who developed NTZ-pML between 2009 and 2018 were included. The data of patients with available prediagnostic MRI were analysed (n=41). Detailed clinical and neuroradiological information was available for each participant. results (1) pML lesions were detectable in the presymptomatic phase in 32/41 (78%) patients; (ii) the lesion volume increased by 62.8 % for each month spent in the prediagnostic phase; (3) the prediagnostic phase length was 150.8±74.9 days; (4) pML MRI features were detectable before the 24th month of therapy in 31.7 % of patients in our cohort. Conclusions considering the latency of pML clinical manifestation, the presymptomatic phase length supports the usefulness of MRI surveillance every 3-4 months. early diagnosis could prompt a better outcome for patients due to the relationship between lesion volume and Jc virus infection. The insight from this study might also have an impact on risk stratification algorithms, as therapy duration as a parameter of stratification appears to need reassessment.

Published
2019

6. Subthalamic Deep Brain Stimulation

Author

Artusi, C. A., Zibetti, M., Romagnolo, A., Rizzone, M. G., Merola, A., and Lopiano, L.

Abstract

This is the peer reviewed version of the following article: [Artusi, C.A., Zibetti, M., Romagnolo, A., Rizzone, M.G., Merola, A., and Lopiano, L. (2017). Subthalamic deep brain stimulation and trunk posture in Parkinson's disease. Acta Neurologica Scandinavica 137, 481–487.], which has been published in final form at https://doi.org/10.1111/ane.12889. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions: https://authorservices.wiley.com/author-resources/Journal-Authors/licensing/self-archiving.html#3. Deposited by shareyourpaper.org and openaccessbutton.org. We've taken reasonable steps to ensure this content doesn't violate copyright. However, if you think it does you can request a takedown by emailing help@openaccessbutton.org.

Published
2017

11. Telemedicine for management of patients with amyotrophic lateral sclerosis through COVID-19 tail

Author

Bombaci, Alessandro, Abbadessa, Gianmarco, Trojsi, Francesca, Leocani, Letizia, Bonavita, Simona, Lavorgna, Luigi, Gioacchino Tedeschi, Giovanni Mancardi, Alessandro Padovani, Marinella Clerico, Francesco Brigo, Roberta Lanzillo, Antonio Russo, Bruno Giometto, Giulia Straccia, Rosa Iodice, Sebastiano Bucello, Pietro Annovazzi, Marcello Moccia, Luca Prosperini, Maria Laura Stromillo, Anna Maria Repice, Giuseppina Miele, Alberto Lerario, Antonio De Martino, Francesco Iodice, Francesco Di Lorenzo, Luca Cuffaro, Michele Romoli, Marcello Silvestro, Carlo Alberto Artusi, Bombaci, Alessandro, Abbadessa, Gianmarco, Trojsi, Francesca, Leocani, Letizia, Bonavita, Simona, Lavorgna, Luigi, Bombaci, A., Abbadessa, G., Trojsi, F., Leocani, L., Bonavita, S., Lavorgna, L., Tedeschi, G., Mancardi, G., Padovani, A., Clerico, M., Brigo, F., Lanzillo, R., Russo, A., Giometto, B., Straccia, G., Iodice, R., Bucello, S., Annovazzi, P., Moccia, M., Prosperini, L., Stromillo, M. L., Repice, A. M., Miele, G., Lerario, A., De Martino, A., Iodice, F., Di Lorenzo, F., Cuffaro, L., Romoli, M., Silvestro, M., Artusi, C. A., Bombaci, A, Abbadessa, G, Trojsi, F, Leocani, L, Bonavita, S, Lavorgna, L, Tedeschi, G, Mancardi, G, Padovani, A, Clerico, M, Brigo, F, Lanzillo, R, Russo, A, Giometto, B, Straccia, G, Iodice, R, Bucello, S, Annovazzi, P, Moccia, M, Prosperini, L, Stromillo, M, Repice, A, Miele, G, Lerario, A, De Martino, A, Iodice, F, Di Lorenzo, F, Cuffaro, L, Romoli, M, Silvestro, M, Artusi, C, Alessandro, Bombaci, Gianmarco, Abbadessa, Francesca, Trojsi, Letizia, Leocani, Simona, Bonavita, Luigi, Lavorgna, Tedeschi, Gioacchino, Mancardi, Giovanni, Padovani, Alessandro, Clerico, Marinella, Brigo, Francesco, Lanzillo, Roberta, Russo, Antonio, Giometto, Bruno, Straccia, Giulia, Iodice, Rosa, Bucello, Sebastiano, Annovazzi, Pietro, Moccia, Marcello, Prosperini, Luca, Laura Stromillo, Maria, Maria Repice, Anna, Miele, Giuseppina, Lerario, Alberto, De Martino, Antonio, Iodice, Francesco, Di Lorenzo, Francesco, Cuffaro, Luca, Romoli, Michele, Silvestro, Marcello, and Alberto Artusi, Carlo

Subjects
medicine.medical_specialty, Telemedicine, Neurology, Coronavirus disease 2019 (COVID-19), Clinical Neurology, Monitoring, Ambulatory, Context (language use), Disease, Review Article, Dermatology, Tele-health, Teleneurology, ALS patients, COVID-19, Remote monitoring, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Pandemic, medicine, Humans, 030212 general & internal medicine, Amyotrophic lateral sclerosis, Intensive care medicine, business.industry, Amyotrophic Lateral Sclerosis, General Medicine, medicine.disease, Psychiatry and Mental health, ALS patient, Neurology (clinical), Neurosurgery, business, 030217 neurology & neurosurgery
Abstract

Over the last months, due to coronavirus disease (COVID-19) pandemic, containment measures have led to important social restriction. Healthcare systems have faced a complete rearrangement of resources and spaces, with the creation of wards devoted to COVID-19 patients. In this context, patients affected by chronic neurological diseases, such as amyotrophic lateral sclerosis (ALS), are at risk to be lost at follow-up, leading to a higher risk of morbidity and mortality. Telemedicine may allow meet the needs of these patients. In this commentary, we briefly discuss the digital tools to remotely monitor and manage ALS patients. Focusing on detecting disease progression and preventing life-threatening conditions, we propose a toolset able to improve ALS management during this unprecedented situation.

Published
2020
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12. COVID-19 in systemic lupus erythematosus: Data from a survey on 417 patients

Author

Selene Nicolosi, Lorenzo Beretta, Carolina Artusi, Lorenza Maria Argolini, Giuseppe A. Ramirez, Maria Gerosa, Emanuel Della Torre, Chiara Bellocchi, Luca Moroni, Enrica Bozzolo, Roberto Caporali, Lorenzo Dagna, Ramirez, G. A., Gerosa, M., Beretta, L., Bellocchi, C., Argolini, L. M., Moroni, L., Della Torre, E., Artusi, C., Nicolosi, S., Caporali, R., Bozzolo, E. P., and Dagna, L.

Subjects
Male, Epidemiology, medicine.disease_cause, Autoimmunity, SLE, systemic lupus erythematosus, totCOVID-19, confirmed + presumptive COVID-19, COVID-19 Testing, 0302 clinical medicine, immune system diseases, Prednisone, Prevalence, Lupus Erythematosus, Systemic, 030212 general & internal medicine, skin and connective tissue diseases, Qualitative Research, education.field_of_study, Middle Aged, Web, NPSLE, neuropsychiatric SLE, Italy, Social Isolation, Antirheumatic Agents, pCOVID-19, presumptive COVID-19, Female, Viral disease, Symptom Assessment, medicine.symptom, Coronavirus Infections, cCOVID-19, COVID-19 confirmed by RT-PCR, noCOVID-19, patients without COVID-19, Hydroxychloroquine, medicine.drug, Adult, RT-PCR, reverse-transcriptase polymerase chain reaction, medicine.medical_specialty, Referral, Pneumonia, Viral, Population, Anosmia, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, Article, Betacoronavirus, 03 medical and health sciences, Systemic lupus erythematosus, Rheumatology, Internal medicine, medicine, Humans, education, Pandemics, 030203 arthritis & rheumatology, Clinical Laboratory Techniques, SARS-CoV-2, business.industry, COVID-19, HCQ, hydroxychloroquine, Coronavirus, Anesthesiology and Pain Medicine, Communicable Disease Control, Patient Compliance, COVID-19, coronavirus-related disease, business
Abstract

Highlights • Systemic lupus erythematosus (SLE) associates with infection susceptibility. • COVID-19 is a pandemic infectious disease with high morbidity and mortality. • The impact of COVID-19 in SLE is poorly characterised. • A web-based survey amongst patients with SLE suggest a moderate increase in morbidity due to COVID-19. • Hydroxychloroquine does not seem able to prevent COVID-19 in patients with SLE., Background Systemic lupus erythematosus (SLE) is a chronic disease characterised by autoimmunity and increased susceptibility to infections. COVID-19 is a systemic viral disease currently spreading as a pandemic. Little is known about the impact of COVID-19 in patients with SLE. Objective to acquire information on the impact of COVID-19 in SLE. Methods A 26-item anonymous questionnaire investigating demographics, SLE clinical features, COVID-19 diagnoses and changes in treatments and daily habits was administered to patients with SLE from three referral centres through www.surveymonkey.com over 10 days. Data from the survey were compared to those from published estimates about the general population. Results Four-hundred-seventeen patients responded to the survey. More than 60% of subjects complained of symptoms that are also associated to COVID-19. Fourteen COVID-19 diagnoses (five confirmed by polymerase chain reaction) were reported, in contrast to a 0.73% prevalence of confirmed cases in Lombardy. One hospitalisation was reported. Fever, anosmia, dry cough, a self-reported history of neuropsychiatric SLE and a recent contact with confirmed COVID-19 cases were more strongly associated with COVID-19, as were symptoms and lower compliance to behavioural preventive measures in patients’ contacts. No protective effect was seen in subjects on hydroxychloroquine. Conclusion COVID-19 morbidity might only moderately be increased in most patients with SLE, although limited information can be inferred on more severe cases. Hydroxychloroquine apparently seems not to confer protection to infection per se, although other beneficial roles cannot be excluded. Containment policies and behavioural preventive measures could have a major role in limiting the impact of COVID-19 in patients with SLE.

Published
2020
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13. Plasmatic Dimethylarginines in Dogs With Myxomatous Mitral Valve Disease

Author

Carlotta Valente, Carlo Guglielmini, Carlo Artusi, Barbara Contiero, Laura Brugnolo, Helen Poser, G. Romito, Marco Baron Toaldo, University of Zurich, Valente, Carlotta, Valente C., Guglielmini C., Baron Toaldo M., Romito G., Artusi C., Brugnolo L., Contiero B., and Poser H.

Subjects
medicine.medical_specialty, 10253 Department of Small Animals, Arginine, Heart disease, Urinalysis, Veterinary medicine, 3400 General Veterinary, canine, heart failure, arginine, Gastroenterology, chemistry.chemical_compound, medicine.artery, Internal medicine, SF600-1100, SDMA, medicine, Original Research, Aorta, Creatinine, medicine.diagnostic_test, 630 Agriculture, General Veterinary, business.industry, dimethylarginines, medicine.disease, ADMA, dimethylarginine, Blood pressure, chemistry, Heart failure, ADMA, canine, heart failure, SDMA, arginine, dimethylarginines, 570 Life sciences, biology, Veterinary Science, Asymmetric dimethylarginine, business
Abstract

Plasmatic dimethylarginines, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are considered biomarkers of endothelial and renal dysfunction, respectively, in humans. We hypothesize that plasmatic concentration of dimethylarginines in dogs with myxomatous mitral valve disease (MMVD) is influenced by heart disease stage. Eighty-five client-owned dogs with MMVD, including 39, 19, and 27 dogs in ACVIM stages B1, B2, and C+D, respectively, and a control group of 11 clinically healthy dogs were enrolled. A prospective, multicentric, case-control study was performed. Each dog underwent a complete clinical examination, arterial blood pressure measurement, thoracic radiography, six-lead standard electrocardiogram, transthoracic echocardiography, CBC, biochemical profile, and urinalysis. Plasmatic concentration of dimethylarginines was determined through high-performance liquid chromatography coupled with tandem mass spectrometry. Median ADMA was significantly increased in dogs of group C+D (2.5 μmol/L [2.1–3.0]) compared to those of group B1 (1.8 μmol/L [1.6–2.3]; p < 0.001) and healthy dogs (1.9 μmol/L [1.7–2.3]; p = 0.02). Median SDMA was significantly increased in dogs of group C+D (0.7 μmol/L [0.5–0.9]) compared to those of groups B1 (0.4 μmol/L [0.3–0.5]; p < 0.001), B2 (0.4 μmol/L [0.3–0.6]; p < 0.01), and the control group (0.4 μmol/L [0.35–0.45]; p = 0.001). In the final multivariable analysis, ADMA and SDMA were significantly associated with left atrium to aorta ratio (p < 0.001), and creatinine (p < 0.001), respectively. Increased plasmatic concentrations of dimethylarginines suggest a possible role as biomarkers of disease severity in dogs with decompensated MMVD.

Published
2021

14. Digital work engagement among Italian neurologists

Author

Fabiana Colucci, Francesca Trojsi, Simona Bonavita, Letizia Leocani, Gioacchino Tedeschi, Maria Pia Sormani, Francesco Brigo, Marta Ponzano, Luigi Lavorgna, Marinella Clerico, Roberta Lanzillo, Gianmarco Abbadessa, Emanuele Spina, Luca Carmisciano, Maddalena Sparaco, Giovanni Cossu, Giuseppina Miele, Carla Tortorella, G. Servillo, Marco Bozzali, Carlo Alberto Artusi, Brigo, F., Ponzano, M., Sormani, M. P., Clerico, M., Abbadessa, G., Cossu, G., Trojsi, F., Colucci, F., Tortorella, C., Miele, G., Spina, E., Artusi, C. A., Carmisciano, L., Servillo, G., Bozzali, M., Sparaco, M., Leocani, L., Lanzillo, R., Tedeschi, G., Bonavita, S., Lavorgna, L., Brigo, Francesco, Ponzano, Marta, Sormani, Maria Pia, Clerico, Marinella, Abbadessa, Gianmarco, Cossu, Giovanni, Trojsi, Francesca, Colucci, Fabiana, Tortorella, Carla, Miele, Giuseppina, Spina, Emanuele, Artusi, Carlo Alberto, Carmisciano, Luca, Servillo, Giovanna, Bozzali, Marco, Sparaco, Maddalena, Leocani, Letizia, Lanzillo, Roberta, Tedeschi, Gioacchino, Bonavita, Simona, and Lavorgna, Luigi

Subjects
Digital work, The Role of Telemedicine in Chronic Disease, medicine.medical_specialty, Telemedicine, Medical education, Neurology, 020205 medical informatics, business.industry, Medicine (miscellaneous), 02 engineering and technology, RM1-950, Digital health, 03 medical and health sciences, 0302 clinical medicine, 0202 electrical engineering, electronic engineering, information engineering, medicine, Therapeutics. Pharmacology, business, 030217 neurology & neurosurgery, Original Research
Abstract

Background: Digital health, including telemedicine, is increasingly recommended for the management of chronic neurological disorders, and it has changed the roles of patients and clinicians. Methods: In this cross-sectional study we aimed to investigate the digital work engagement of Italian neurologists through a survey collected between September 2020 and January 2021. Questionnaires were anonymous and collected demographic characteristics, attitudes towards digital devices and social media, and details about the clinician–patient relationship. We used logistic-regression models to identify characteristics associated with the propensity to communicate with patients using social media. Results: Among the 553 neurologists who participated to the study, smartphones and computers were widely preferred compared with tablets; wearable devices were not common, although some neurologists desired them. A total of 48% of participants reported communicating with patients using social media but only a few were in favor of social friendship with patients; WhatsApp was the social media most popular for professional (86%) and personal (98%) purposes. Propensity to communicate with social media was significantly higher among those who were older ( p Conclusions: The preferred social media were those which were rapid and which safeguard privacy more effectively; neurologists made many efforts to disprove fake news circulating online, providing help to patients in various ways. This analysis can help direct future interventions for the management of chronic neurological disorders.

Published
2021

15. Does the degree of trunk bending predict patient disability, motor impairment, falls, and back pain in Parkinson's Disease?

Author

Christian Geroin, Carlo Alberto Artusi, Marialuisa Gandolfi, Elisabetta Zanolin, Roberto Ceravolo, Marianna Capecci, Elisa Andrenelli, Maria Gabriella Ceravolo, Laura Bonanni, Marco Onofrj, Roberta Telese, Giulia Bellavita, Mauro Catalan, Paolo Manganotti, Sonia Mazzucchi, Sara Giannoni, Laura Vacca, Fabrizio Stocchi, Miriam Casali, Cristian Falup-Pecurariu, Maurizio Zibetti, Alfonso Fasano, Leonardo Lopiano, Michele Tinazzi, Geroin, C., Artusi, C. A., Gandolfi, M., Zanolin, E., Ceravolo, R., Capecci, M., Andrenelli, E., Ceravolo, M. G., Bonanni, L., Onofrj, M., Telese, R., Bellavita, G., Catalan, M., Manganotti, P., Mazzucchi, S., Giannoni, S., Vacca, L., Stocchi, F., Casali, M., Falup-Pecurariu, C., Zibetti, M., Fasano, A., Lopiano, L., and Tinazzi, M.

Subjects
0301 basic medicine, medicine.medical_specialty, postural abnormalities, Parkinson's disease, Movement disorders, Activities of daily living, anterocolli, camptocormia, lcsh:RC346-429, 03 medical and health sciences, Camptocormia, 0302 clinical medicine, Physical medicine and rehabilitation, Back pain, Medicine, lcsh:Neurology. Diseases of the nervous system, Original Research, business.industry, Odds ratio, medicine.disease, Trunk, Confidence interval, Pisa syndrome, 030104 developmental biology, Neurology, Neurology (clinical), medicine.symptom, business, anterocollis, 030217 neurology & neurosurgery
Abstract

Background: Postural abnormalities in Parkinson's disease (PD) form a spectrum of functional trunk misalignment, ranging from a “typical” parkinsonian stooped posture to progressively greater degrees of spine deviation. Objective: To analyze the association between degree of postural abnormalities and disability and to determine cut-off values of trunk bending associated with limitations in activities of daily living (ADLs), motor impairment, falls, and back pain. Methods: The study population was 283 PD patients with ≥5° of forward trunk bending (FTB), lateral trunk bending (LTB) or forward neck bending (FNB). The degrees were calculated using a wall goniometer (WG) and software-based measurements (SBM). Logistic regression models were used to identify the degree of bending associated with moderate/severe limitation in ADLs (Movement Disorders Society Unified PD Rating Scale [MDS-UPDRS] part II ≥17), moderate/severe motor impairment (MDS-UPDRS part III ≥33), history of falls (≥1), and moderate/severe back pain intensity (numeric rating scale ≥4). The optimal cut-off was identified using receiver operating characteristic (ROC) curves. Results: We found significant associations between modified Hoehn & Yahr stage, disease duration, sex, and limitation in ADLs, motor impairment, back pain intensity, and history of falls. Degree of trunk bending was associated only with motor impairment in LTB (odds ratio [OR] 1.12; 95% confidence interval [CI], 1.03–1.22). ROC curves showed that patients with LTB of 10.5° (SBM, AUC 0.626) may have moderate/severe motor impairment. Conclusions: The severity of trunk misalignment does not fully explain limitation in ADLs, motor impairment, falls, and back pain. Multiple factors possibly related to an aggressive PD phenotype may account for disability in PD patients with FTB, LTB, and FNB.

Published
2020

16. Design of a study to investigate the mechanisms of obstructive sleep apnoea by means of drug-induced sleep endoscopy

Author

Piergiorgio Gaudioso, Martino F. Pengo, Valeria Bisogni, Mario Plebani, Alessandro Martini, Gian Paolo Rossi, Laura Brugnolo, Silvia Lerco, Giulio Ceolotto, Daniele Borsetto, Carlo Artusi, Rosario Marchese Ragona, Giuseppe Maiolino, Bisogni, V, Maiolino, G, Ceolotto, G, Pengo, M, Marchese Ragona, R, Artusi, C, Brugnolo, L, Lerco, S, Borsetto, D, Gaudioso, P, Martini, A, Plebani, M, and Rossi, G

Subjects
Adult, Male, Sympathetic nervous system, medicine.medical_specialty, obstructive sleep apnoea, catechol-O-methyltransferase, Clinical Biochemistry, Hemodynamics, Pilot Projects, 030204 cardiovascular system & hematology, Catechol O-Methyltransferase, Plasma renin activity, Endothelial activation, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Catecholamines, Internal medicine, Renin–angiotensin system, Renin, medicine, Humans, 030212 general & internal medicine, Prospective Studies, drug-induced sleep endoscopy, endothelin-1, renin-angiotensin-aldosterone system, sympathetic nervous system, Protein Precursors, Aldosterone, Sleep Apnea, Obstructive, Catechol-O-methyl transferase, business.industry, Biochemistry (medical), Endoscopy, General Medicine, medicine.anatomical_structure, chemistry, Research Design, Cardiology, medicine.symptom, business, Sleep, Hypercapnia
Abstract

Background Obstructive sleep apnoea (OSA) is an independent risk factor of hypertension and cardiovascular diseases. Recurrent episodes of upper airways collapse during sleep causing blood oxygen desaturation, hypercapnia, and micro-arousals, are known to activate the sympathetic nervous system (SNS). However, whether changes in the renin-angiotensin-aldosterone system and endothelial activation also occur remains contentious. Methods Based on routine use of drug-induced sleep endoscopy (DISE) for the work-up of OSA patients in our centre, we designed a prospective study to investigate the haemodynamic and humoral changes occurring during the apnoeic episodes reproduced in vivo in the course of DISE. Specifically, plasma aldosterone concentration and renin activity, C-terminal fragment of proendothelin-1, as a marker of endothelial damage, and free plasma catecholamines, will be measured at fixed times during DISE. The activity of catechol-O-methyltransferase (COMT), a key catecholamine-inactivating enzyme that has been scantly investigated thus far owing to the lack of commercially available kits, will be also determined by a newly developed high performance liquid chromatography method, which is herein described. Results and conclusions The aim of this study is to provide novel information on the haemodynamic, hormonal, and SNS changes, and also on COMT activity modification concomitantly occurring during apnoea, thus contributing substantively to the understanding of the pathophysiology of OSA.

Published
2019

17. Validity of the wall goniometer as a screening tool to detect postural abnormalities in Parkinson's disease

Author

Christian Geroin, Marianna Capecci, Sara Giannoni, Leonardo Lopiano, Maria Gabriella Ceravolo, Michele Tinazzi, Carlo Alberto Artusi, Maurizio Zibetti, Elisabetta Zanolin, Alfonso Fasano, Claudio Bertolotti, Laura Bonanni, Roberto Ceravolo, Miriam Casali, Laura Vacca, Roberta Telese, Elisa Andrenelli, Sonia Mazzucchi, Paolo Manganotti, Ruggero Lanzafame, Marco Onofrj, Marialuisa Gandolfi, Fabrizio Stocchi, Paola Polverino, Tinazzi, M., Gandolfi, M., Artusi, C. A., Lanzafame, R., Zanolin, E., Ceravolo, R., Capecci, M., Andrenelli, E., Ceravolo, M. G., Bonanni, L., Onofrj, M., Telese, R., Bertolotti, Claudio, Polverino, Paola, Manganotti, P., Mazzucchi, S., Giannoni, S., Vacca, L., Stocchi, F., Casali, M., Zibetti, M., Lopiano, L., Fasano, A., and Geroin, C.

Subjects
Male, 0301 basic medicine, Movement disorders, Parkinson's disease, Intraclass correlation, Posture, Angle measurement, Parkinsonism, Spinal Curvatures, 03 medical and health sciences, Camptocormia, 0302 clinical medicine, Humans, Medicine, Bent spine syndrome, Movement disorder, Aged, Arthrometry, Articular, business.industry, Parkinson Disease, Gold standard (test), Middle Aged, medicine.disease, Trunk, 030104 developmental biology, Neurology, Goniometer, Female, Neurology (clinical), Geriatrics and Gerontology, medicine.symptom, business, Nuclear medicine, Software, 030217 neurology & neurosurgery
Abstract

Introduction Software-based measurements of postural abnormalities in Parkinson's disease (PD) are the gold standard but may be time-consuming and not always feasible in clinical practice. Wall goniometer (WG) is an easier, quicker, and inexpensive instrument for screening patients with postural abnormalities, but no studies have investigated its validity so far. The aim of this study was to investigate the validity of the WG to measure postural abnormalities. Methods A total of 283 consecutive PD outpatients with ≥5° forward trunk, lateral trunk or forward neck bending (FTB, LTB, FNB, respectively) were recruited from seven centers for movement disorders. Postural abnormalities were measured in lateral and posterior view using a freeware program (gold standard) and the WG. Both angles were expressed in degrees (°). Sensitivity and specificity for the diagnosis of camptocormia, Pisa syndrome, and anterocollis were assessed. Results WG showed good to excellent agreement (intraclass correlation coefficient from 0.80 to 0.98) compared to the gold standard. Bland-Altman plots showed a mean difference between the methods from −7.4° to 0.4° with limits of agreements from −17.7° to 9.5°. Sensitivity was 100% for the diagnosis of Pisa syndrome, 95.74% for anterocollis, 76.67% for upper camptocormia, and 63.64% for lower camptocormia. Specificity was 59.57% for Pisa syndrome, 71.43% for anterocollis, 89.80% for upper camptocormia, and 100% for lower camptocormia. Overall, the WG underestimated measurements, especially in lower camptocormia with an average of −8.7° (90% of cases). Conclusion WG is a valid tool for screening Pisa syndrome and anterocollis, but approximately 10° more should be added for camptocormia.

Published
2019

18. The still under-investigated role of cognitive deficits in PML diagnosis

Author

Scarpazza, Cristina, De Rossi, Nicola, Moiola, Lucia, Gerevini, Simonetta, Cosottini, Mirco, Capra, Ruggero, Mattioli, Flavia, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Bresciamorra, Vincenzo, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, de Riz, Marilena, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Naldi, Paola, Pane, Chiara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Prosperini, Luca, Rezzonico, Monica, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Tabiadon, Giulia, Tortorella, Carla, Trojano, Maria, Valentino, Paola, Scarpazza C, De Rossi N, Gerevini S, Cosottini M, Capra R, Mattioli F, Amato MP, Artusi CA, Bandini F, Barcella V, Bertolotto A, Bresciamorra V, Capobianco M, Cavaletti G, Cavalla P, Centonze D, Clerico M, Cordioli C, D’Aleo G, de Riz M, Deotto L, Durelli L, Falcini M, Ferrari E, Fusco ML, Gasperini C, Ghezzi A, Grimaldi L, Guidotti M, Laroni A, Lugaresi A, Naldi P, Pane C, Perrone P, Pizzorno M, Pozzilli C, Prosperini L, Rezzonico M, Rovaris M, Salemi G, Salvetti M, Santuccio G, Scarpini E, Sessa E, Solaro C, Tabiadon G, Tortorella C, Trojano M, Valentino P., Scarpazza, C, De Rossi, N, Moiola, L, Gerevini, S, Cosottini, M, Capra, R, Mattioli, F, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Bresciamorra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Clerico, M, Cordioli, C, D'Aleo, G, de Riz, M, Deotto, L, Durelli, L, Falcini, M, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Naldi, P, Pane, C, Perrone, P, Pizzorno, M, Pozzilli, C, Prosperini, L, Rezzonico, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Tabiadon, G, Tortorella, C, Trojano, M, and Valentino, P

Subjects
0301 basic medicine, cognition, medicine.medical_specialty, Pediatrics, italian database, natalizumab, neuropsychological impairment, progressive multifocal leukoencephalopathy, neurology (clinical), neurology, immunology, immunology and allergy, Neurology, Settore MED/17 - Malattie Infettive, Asymptomatic, Apraxia, 03 medical and health sciences, 0302 clinical medicine, medicine, Dementia, Psychiatry, Cognitive deficit, Progressive multifocal leukoencephalopathy, Neuropsychology, Cognition, Progressive multifocal leukoencephalopathy Natalizumab Cognition Neuropsychological impairment Italian database, medicine.disease, 030104 developmental biology, Italian database, Natalizumab, Neuropsychological impairment, Cognition, Italian database, Natalizumab, Neuropsychological impairment, Progressive multifocal leukoencephalopathy, Immunology and Allergy, Immunology, Neurology (clinical), Settore MED/26 - Neurologia, medicine.symptom, Psychology, 030217 neurology & neurosurgery
Abstract

Background: Despite cognitive deficits frequently represent the first clinical manifestations of Progressive Multifocal Leukoencephalopathy (PML) in Natalizumab-treated MS patients, the importance of cognitive deficits in PML diagnosis is still under-investigated. The aim of the current study is to investigate the cognitive deficits at PML diagnosis in a group of Italian patients with PML. Methods: Thirty-four PML patients were included in the study. The demographic and clinical data, the lesion load and localization, and the longitudinal clinical course was compared between patients with (n = 13) and without (n = 15) cognitive deficit upon PML suspicion (the remaining six patients were asymptomatic). Clinical presentation of cognitive symptoms was described in detail. Result: After symptoms detection, the time to diagnosis resulted to be shorter for patients presenting with cognitive than for patients with non cognitive onset (p = 0.03). Within patients with cognitive onset, six patients were presenting with language and/or reading difficulties (46.15%); five patients with memory difficulties (38.4%); three patients with apraxia (23.1%); two patients with disorientation (15.3%); two patients with neglect (15.3%); one patients with object agnosia (7.7%), one patient with perseveration (7.7%) and one patient with dementia (7.7%). Frontal lesions were less frequent (p = 0.03), whereas temporal lesions were slightly more frequent (p = 0.06) in patients with cognitive deficits. The longitudinal PML course seemed to be more severe in cognitive than in non cognitive patients (F = 2.73, p = 0.03), but differences disappeared (F = 1.24, p = 0.29) when balancing for the incidence of immune reconstitution syndrome and for other treatments for PML (steroids, plasma exchange (PLEX) and other therapies (Mefloquine, Mirtazapine, Maraviroc). Conclusion: Cognitive deficits at PML onset manifest with symptoms which are absolutely rare in MS. Their appearance in MS patients should strongly suggest PML. Clinicians should be sensitive to the importance of formal neuropsychological evaluation, with particular focus on executive function, which are not easily detected without a formal assessment.

Published
2017

19. Treatment of axial postural abnormalities in parkinsonism disorders: A systematic review of pharmacological, rehabilitative and surgical interventions.

Author

Gandolfi M, Geroin C, Imbalzano G, Camozzi S, Menaspà Z, Tinazzi M, and Alberto Artusi C

Abstract

Axial postural abnormalities (PA) are frequent, highly disabling, and drug-refractory motor complications affecting patients with Parkinson's disease (PD) or atypical parkinsonism. Over the past few years, advances have been reached across diagnosis, assessment, and pathophysiological mechanisms of PA. Nonetheless, their management remains a challenge, and these disturbances are generally overlooked by healthcare professionals, potentially resulting in their worsening and impact on patients' disabilities. From shared consensus-based assessment and diagnostic criteria, PA calls for interdisciplinary management based on the complexity and multifactorial pathogenesis. In this context, we conducted a systematic literature review to analyze the available pharmacological and non-pharmacological treatment options for PA in PD according to the new expert-based classification of axial PA in Parkinsonism. Different multidisciplinary approaches, including dopaminergic therapy adjustment, physiotherapy, botulinum toxin injection, and deep brain stimulation, can improve PA depending on its type and severity. An early, interdisciplinary approach is recommended in PD patients to manage PA., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

Published
2024
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20. Plasmatic Dimethylarginines in Dogs With Myxomatous Mitral Valve Disease.

Author

Valente C, Guglielmini C, Baron Toaldo M, Romito G, Artusi C, Brugnolo L, Contiero B, and Poser H

Abstract

Plasmatic dimethylarginines, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are considered biomarkers of endothelial and renal dysfunction, respectively, in humans. We hypothesize that plasmatic concentration of dimethylarginines in dogs with myxomatous mitral valve disease (MMVD) is influenced by heart disease stage. Eighty-five client-owned dogs with MMVD, including 39, 19, and 27 dogs in ACVIM stages B1, B2, and C+D, respectively, and a control group of 11 clinically healthy dogs were enrolled. A prospective, multicentric, case-control study was performed. Each dog underwent a complete clinical examination, arterial blood pressure measurement, thoracic radiography, six-lead standard electrocardiogram, transthoracic echocardiography, CBC, biochemical profile, and urinalysis. Plasmatic concentration of dimethylarginines was determined through high-performance liquid chromatography coupled with tandem mass spectrometry. Median ADMA was significantly increased in dogs of group C+D (2.5 μmol/L [2.1-3.0]) compared to those of group B1 (1.8 μmol/L [1.6-2.3]; p < 0.001) and healthy dogs (1.9 μmol/L [1.7-2.3]; p = 0.02). Median SDMA was significantly increased in dogs of group C+D (0.7 μmol/L [0.5-0.9]) compared to those of groups B1 (0.4 μmol/L [0.3-0.5]; p < 0.001), B2 (0.4 μmol/L [0.3-0.6]; p < 0.01), and the control group (0.4 μmol/L [0.35-0.45]; p = 0.001). In the final multivariable analysis, ADMA and SDMA were significantly associated with left atrium to aorta ratio ( p < 0.001), and creatinine ( p < 0.001), respectively. Increased plasmatic concentrations of dimethylarginines suggest a possible role as biomarkers of disease severity in dogs with decompensated MMVD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Valente, Guglielmini, Baron Toaldo, Romito, Artusi, Brugnolo, Contiero and Poser.)

Published
2021
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21. Early Joint Replacement in Juvenile Idiopathic Arthritis: Trend Over Time and Factors Influencing Implant Survival.

Author

Marino A, Pontikaki I, Truzzi M, Menon A, Artusi C, Di Marco M, Randelli PS, Cimaz R, and Viganò R

Subjects
Adolescent, Adult, Age Factors, Arthritis, Juvenile diagnosis, Arthritis, Juvenile physiopathology, Arthroplasty, Replacement, Ankle adverse effects, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Knee adverse effects, Female, Humans, Italy, Joints diagnostic imaging, Joints physiopathology, Male, Middle Aged, Prosthesis Failure, Retrospective Studies, Risk Assessment, Risk Factors, Tertiary Care Centers, Time Factors, Treatment Outcome, Young Adult, Arthritis, Juvenile surgery, Arthroplasty, Replacement, Ankle instrumentation, Arthroplasty, Replacement, Hip instrumentation, Arthroplasty, Replacement, Knee instrumentation, Hip Prosthesis, Joints surgery, Knee Prosthesis
Abstract

Objective: To describe early prosthesis implantations in a cohort of patients with juvenile idiopathic arthritis (JIA) followed in a tertiary referral hospital and to analyze possible factors influencing implant survival., Methods: This was a retrospective cohort study. Charts of all patients with JIA who underwent total joint replacement at Gaetano Pini Hospital, Milan, Italy from January 1992 to June 2019 were retrieved, and relevant data were analyzed., Results: Eighty-five patients met the inclusion criteria for this study, with a median follow-up period of 17.2 years. The median age at first prosthesis was 22.7 years. The total number of replaced joints was 198 over a period of 27 years. The hip was the most frequently replaced joint, accounting for almost two-thirds of the total number of implants; the other one-third refers mostly to knee implants. Polyarticular JIA and systemic JIA were the most represented JIA categories in the study cohort. A significant upward trend of the age at arthroplasty and of disease duration before arthroplasty over decades was found. The rates of implant survival at 5, 10, and 15 years were comparable (from 84% to 89%); 50% of implants lasted ≥20 years., Conclusion: We reported retrospective data on early joint replacement in a cohort of patients with JIA. We observed a progressive and significant upward trend of both age at arthroplasty and disease duration before the first arthroplasty over time. The JIA category, year of implant, and presence of complications significantly affected implant survivorship., (© 2020, American College of Rheumatology.)

Published
2021
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22. β2 glycoprotein I participates in phagocytosis of apoptotic neurons and in vascular injury in experimental brain stroke.

Author

Grossi C, Artusi C, Meroni P, Borghi MO, Neglia L, Lonati PA, Oggioni M, Tedesco F, De Simoni MG, and Fumagalli S

Subjects
Animals, Brain metabolism, Brain pathology, Brain Ischemia etiology, Complement System Proteins metabolism, Disease Models, Animal, Endothelial Cells cytology, Endothelial Cells metabolism, Humans, Interleukin-6 metabolism, Liver metabolism, Liver pathology, Macrophages cytology, Macrophages immunology, Macrophages metabolism, Male, Mannose-Binding Lectin metabolism, Mice, Mice, Inbred C57BL, Microscopy, Confocal, Neurons cytology, Phagocytosis, Protein Binding, Vascular System Injuries complications, beta 2-Glycoprotein I blood, Brain Ischemia pathology, Neurons metabolism, Vascular System Injuries pathology, beta 2-Glycoprotein I metabolism
Abstract

Beta-2 Glycoprotein I (β2-GPI) is the main target of anti-phospholipid antibodies (aPL) in the autoimmune anti-phospholipid syndrome, characterized by increased risk of stroke. We here investigated the antibody independent role of β2-GPI after ischemia/reperfusion, modeled in vivo by transient middle cerebral artery occlusion (tMCAo) in male C57Bl/6J mice; in vitro by subjecting immortalized human brain microvascular endothelial cells (ihBMEC) to 16 h hypoxia and 4 h re-oxygenation. ApoH (coding for β2-GPI) was upregulated selectively in the liver at 48 h after tMCAo. At the same time β2-GPI circulating levels increased. β2-GPI was detectable in brain parenchyma and endothelium at all time points after tMCAo. Parenchymal β2-GPI recognized apoptotic neurons (positive for annexin V, C3 and TUNEL) cleared by CD68+ brain macrophages. Hypoxic ihBMEC showed increased release of IL-6, over-expression of thrombomodulin and IL-1α after re-oxygenation with β2-GPI alone. β2-GPI interacted with mannose-binding lectin in mouse plasma and ihBMEC medium, potentially involved in formation of thrombi. We show for the first time that brain ischemia triggers the hepatic production of β2-GPI. β2-GPI is present in the ischemic endothelium, enhancing vascular inflammation, and extravasates binding stressed neurons before their clearance by phagocytosis. Thus β2-GPI may be a new mediator of brain injury following ischemic stroke.

Published
2021
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23. Integrative Analysis Reveals a Molecular Stratification of Systemic Autoimmune Diseases.

Author

Barturen G, Babaei S, Català-Moll F, Martínez-Bueno M, Makowska Z, Martorell-Marugán J, Carmona-Sáez P, Toro-Domínguez D, Carnero-Montoro E, Teruel M, Kerick M, Acosta-Herrera M, Le Lann L, Jamin C, Rodríguez-Ubreva J, García-Gómez A, Kageyama J, Buttgereit A, Hayat S, Mueller J, Lesche R, Hernandez-Fuentes M, Juarez M, Rowley T, White I, Marañón C, Gomes Anjos T, Varela N, Aguilar-Quesada R, Garrancho FJ, López-Berrio A, Rodriguez Maresca M, Navarro-Linares H, Almeida I, Azevedo N, Brandão M, Campar A, Faria R, Farinha F, Marinho A, Neves E, Tavares A, Vasconcelos C, Trombetta E, Montanelli G, Vigone B, Alvarez-Errico D, Li T, Thiagaran D, Blanco Alonso R, Corrales Martínez A, Genre F, López Mejías R, Gonzalez-Gay MA, Remuzgo S, Ubilla Garcia B, Cervera R, Espinosa G, Rodríguez-Pintó I, De Langhe E, Cremer J, Lories R, Belz D, Hunzelmann N, Baerlecken N, Kniesch K, Witte T, Lehner M, Stummvoll G, Zauner M, Aguirre-Zamorano MA, Barbarroja N, Castro-Villegas MC, Collantes-Estevez E, de Ramon E, Díaz Quintero I, Escudero-Contreras A, Fernández Roldán MC, Jiménez Gómez Y, Jiménez Moleón I, Lopez-Pedrera R, Ortega-Castro R, Ortego N, Raya E, Artusi C, Gerosa M, Meroni PL, Schioppo T, De Groof A, Ducreux J, Lauwerys B, Maudoux AL, Cornec D, Devauchelle-Pensec V, Jousse-Joulin S, Jouve PE, Rouvière B, Saraux A, Simon Q, Alvarez M, Chizzolini C, Dufour A, Wynar D, Balog A, Bocskai M, Deák M, Dulic S, Kádár G, Kovács L, Cheng Q, Gerl V, Hiepe F, Khodadadi L, Thiel S, de Rinaldis E, Rao S, Benschop RJ, Chamberlain C, Dow ER, Ioannou Y, Laigle L, Marovac J, Wojcik J, Renaudineau Y, Borghi MO, Frostegård J, Martín J, Beretta L, Ballestar E, McDonald F, Pers JO, and Alarcón-Riquelme ME

Subjects
Adult, Aged, Antiphospholipid Syndrome genetics, Antiphospholipid Syndrome immunology, Arthritis, Rheumatoid genetics, Arthritis, Rheumatoid immunology, Autoimmune Diseases immunology, Case-Control Studies, Cluster Analysis, Cross-Sectional Studies, Epigenomics, Female, Humans, Inflammation immunology, Interferons immunology, Lupus Erythematosus, Systemic genetics, Lupus Erythematosus, Systemic immunology, Male, Middle Aged, Mixed Connective Tissue Disease genetics, Mixed Connective Tissue Disease immunology, Scleroderma, Systemic genetics, Scleroderma, Systemic immunology, Sjogren's Syndrome genetics, Sjogren's Syndrome immunology, Undifferentiated Connective Tissue Diseases genetics, Undifferentiated Connective Tissue Diseases immunology, Autoimmune Diseases classification, Autoimmune Diseases genetics, Epigenome, Gene Expression Profiling
Abstract

Objective: Clinical heterogeneity, a hallmark of systemic autoimmune diseases, impedes early diagnosis and effective treatment, issues that may be addressed if patients could be classified into groups defined by molecular pattern. This study was undertaken to identify molecular clusters for reclassifying systemic autoimmune diseases independently of clinical diagnosis., Methods: Unsupervised clustering of integrated whole blood transcriptome and methylome cross-sectional data on 955 patients with 7 systemic autoimmune diseases and 267 healthy controls was undertaken. In addition, an inception cohort was prospectively followed up for 6 or 14 months to validate the results and analyze whether or not cluster assignment changed over time., Results: Four clusters were identified and validated. Three were pathologic, representing "inflammatory," "lymphoid," and "interferon" patterns. Each included all diagnoses and was defined by genetic, clinical, serologic, and cellular features. A fourth cluster with no specific molecular pattern was associated with low disease activity and included healthy controls. A longitudinal and independent inception cohort showed a relapse-remission pattern, where patients remained in their pathologic cluster, moving only to the healthy one, thus showing that the molecular clusters remained stable over time and that single pathogenic molecular signatures characterized each individual patient., Conclusion: Patients with systemic autoimmune diseases can be jointly stratified into 3 stable disease clusters with specific molecular patterns differentiating different molecular disease mechanisms. These results have important implications for future clinical trials and the study of nonresponse to therapy, marking a paradigm shift in our view of systemic autoimmune diseases., (© 2020, American College of Rheumatology.)

Published
2021
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24. Identification of a Shared Microbiomic and Metabolomic Profile in Systemic Autoimmune Diseases.

Author

Bellocchi C, Fernández-Ochoa Á, Montanelli G, Vigone B, Santaniello A, Quirantes-Piné R, Borrás-Linares I, Gerosa M, Artusi C, Gualtierotti R, Segura-Carrettero A, Alarcón-Riquelme ME, and Beretta L

Abstract

Dysbiosis has been described in systemic autoimmune diseases (SADs), including systemic lupus erythematosus (SLE), Sjögren's syndrome (SjS), and primary anti-phosholipid syndrome (PAPS), however the biological implications of these associations are often elusive. Stool and plasma samples from 114 subjects, including in SLE ( n = 27), SjS ( n = 23), PAPs ( n = 11) and undifferentiated connective tissue (UCTD, n = 26) patients, and geographically-matched healthy controls (HCs, n = 27), were collected for microbiome (16s rRNA gene sequencing) and metabolome (high-performance liquid chromatography coupled to mass spectrometry) analysis to identify shared characteristics across diseases. Out of 130 identified microbial genera, a subset of 29 bacteria was able to differentiate study groups (area under receiver operating characteristics (AUROC) = 0.730 ± 0.025). A fair classification was obtained with a subset of 41 metabolic peaks out of 254 (AUROC = 0.748 ± 0.021). In both models, HCs were well separated from SADs, while UCTD largely overlapped with the other diseases. In all of the SADs pro-tolerogenic bacteria were reduced, while pathobiont genera were increased. Metabolic alterations included two clusters comprised of: (a) members of the acylcarnitine family, positively correlating with a Prevotella-enriched cluster and negatively correlating with a butyrate-producing bacteria-enriched cluster; and (b) phospholipids, negatively correlating with butyrate-producing bacteria. These findings demonstrate a strong interaction between intestinal microbiota and metabolic function in patients with SADs., Competing Interests: The authors declare no conflict of interest.

Published
2019
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25. Serum chemerin in systemic sclerosis: a novel marker of early diffuse disease?

Author

Chighizola CB, Raschi E, Privitera D, Luppino AF, Artusi C, Schioppo T, Mastaglio C, Ingegnoli F, Borghi MO, and Meroni PL

Subjects
Adult, Aged, Biomarkers blood, Female, Humans, Male, Middle Aged, Chemokines blood, Intercellular Signaling Peptides and Proteins blood, Scleroderma, Systemic blood
Published
2017

26. A Case of Atypical Urticaria.

Author

Marinova M, Nabergoj M, Artusi C, Zaninotto MM, and Plebani M

Subjects
Diagnosis, Differential, Female, Glycosylation, Humans, Middle Aged, Still's Disease, Adult-Onset blood, Still's Disease, Adult-Onset drug therapy, Treatment Outcome, Urticaria blood, Urticaria drug therapy, Ferritins blood, Still's Disease, Adult-Onset diagnosis, Urticaria diagnosis
Published
2016
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27. Asymmetric dimethylarginine, race, and mortality in hemodialysis patients.

Author

Drew DA, Tighiouart H, Scott T, Kantor A, Fan L, Artusi C, Plebani M, Weiner DE, and Sarnak MJ

Subjects
Aged, Aged, 80 and over, Arginine blood, Biomarkers blood, Boston epidemiology, Cause of Death, Female, Humans, Kidney Failure, Chronic blood, Kidney Failure, Chronic ethnology, Kidney Failure, Chronic mortality, Linear Models, Male, Middle Aged, Multivariate Analysis, Prognosis, Proportional Hazards Models, Renal Dialysis adverse effects, Risk Factors, Time Factors, Black or African American, Arginine analogs & derivatives, Kidney Failure, Chronic therapy, Renal Dialysis mortality
Abstract

Background and Objectives: Levels of asymmetric dimethylarginine, an inhibitor of nitric oxide synthase, are elevated in kidney disease and associated with mortality in white European hemodialysis populations. Nitric oxide production and degradation are partially genetically determined and differ by racial background. No studies have measured asymmetric dimethylarginine in African Americans on dialysis and assessed whether differences exist in its association with mortality by race., Design, Setting, Participants, & Measurements: Asymmetric dimethylarginine was measured in 259 patients on maintenance hemodialysis assembled from 2004 to 2012 in Boston area outpatient centers. Cox proportional hazards models were used to determine the association between asymmetric dimethylarginine and all-cause mortality, and an interaction with race was tested., Results: Mean (SD) age was 63 (17) years, 46% were women, and 22% were African American. Mean asymmetric dimethylarginine in non-African Americans was 0.79 µmol/L (0.16) versus 0.70 µmol/L (0.11) in African Americans (P<0.001); 130 patients died over a median follow-up of 2.3 years. African Americans had lower mortality risk than non-African Americans (hazard ratio, 0.27; 95% confidence interval, 0.15 to 0.50) that was robust to adjustment for age, comorbidity, and asymmetric dimethylarginine (hazard ratio, 0.35; 95% confidence interval, 0.17 to 0.69). An interaction was noted between race and asymmetric dimethylarginine (P=0.03), such that asymmetric dimethylarginine was associated with higher mortality in non-African Americans (adjusted hazard ratio, 1.29; 95% confidence interval, 1.06 to 1.57 per 1 SD higher asymmetric dimethylarginine) but not in African Americans (adjusted hazard ratio, 0.57; 95% confidence interval, 0.28 to 1.18). Additional adjustment for fibroblast growth factor 23 partially attenuated the association for non-African Americans (adjusted hazard ratio, 1.22; 95% confidence interval, 0.98 to 1.50)., Conclusions: African Americans have lower asymmetric dimethylarginine levels and lower hazard for mortality compared with non-African Americans. Levels of asymmetric dimethylarginine did not explain lower hazard for mortality in non-African American patients. High asymmetric dimethylarginine was a risk factor for mortality exclusively in non-African Americans. Mechanisms explaining these relationships need to be evaluated., (Copyright © 2014 by the American Society of Nephrology.)

Published
2014
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28. Roles of insulin, age, and asymmetric dimethylarginine on nitric oxide synthesis in vivo.

Author

Tessari P, Cecchet D, Artusi C, Vettore M, Millioni R, Plebani M, Puricelli L, and Vedovato M

Subjects
Adult, Age Factors, Aged, Arginine metabolism, Blood Glucose metabolism, Blood Pressure physiology, Humans, Hypercholesterolemia metabolism, Hypertension metabolism, Male, Middle Aged, Arginine analogs & derivatives, Diabetes Mellitus, Type 2 metabolism, Insulin metabolism, Insulin Resistance physiology, Nitric Oxide biosynthesis
Abstract

We tested the effects of insulin on production of nitrous oxide (NO)-related substances (nitrites and nitrates [NOx]) after (15)N-arginine intravenous infusion and on asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) concentrations in conditions reportedly associated with altered NO availability, i.e., aging, hypertension, hypercholesterolemia, and type 2 diabetes mellitus (T2DM). A total of 26 male subjects (age 23-71 years, BMI 23-33 kg/m(2)), some of whom were affected by mixed pathologic features, were enrolled. NOx fractional synthesis rate (FSR) was lower in elderly (P < 0.015) and T2DM subjects (P < 0.03) than in matched control subjects. Hyperinsulinemia generally increased both NOx FSR and absolute synthesis rate (ASR) and reduced NOx, ADMA, and SDMA concentrations. Insulin sensitivity was impaired only in T2DM. With use of simple linear regression analysis across all subjects, age was inversely correlated with both NOx FSR (R(2) = 0.23, P < 0.015) and ASR (R(2) = 0.21, P < 0.02). NOx FSR inversely correlated with both ADMA and SDMA. With use of multiple regression analysis and various models, NOx FSR remained inversely associated with age and ADMA, whereas ASR was inversely associated with age and diabetes. No association with insulin sensitivity was found. We conclude that whole-body NOx production is decreased in aging and T2DM. Age, ADMA concentration, and T2DM, but not insulin resistance, appear as negative regulators of whole-body NOx production.

Published
2013
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