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  • 1
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    Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study
    Oxford University Press (OUP) ; 2023
    In:  British Journal of Surgery ( 2023-11-14)
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), ( 2023-11-14)
    Abstract: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy. Methods Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018–2021). Outcomes: 30-day mortality; Clavien-Dindo grade & gt;2 complications; removal of ≥ 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site. Results LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15–1.096, P = 0.003). The rate of ≥ 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56–0.85, P & lt; 0.001) and MEDIUM-volume (OR 0.72, 95% c.i. 0.62–0.83, P & lt; 0.001) centres was lower than in VERY HIGH-volume centres. Of the 4676 rectal cancer patients, the rate of ≥ 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41–0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56–0.77, P & lt; 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60–0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52–0.94, P = 0.019) volume centres (vs. VERY HIGH). Conclusion Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znad373
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2006309-X
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  • 2
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    Chronic coronary syndromes without standard modifiable cardiovascular risk factors and outcomes: the CLARIFY registry
    Oxford University Press (OUP) ; 2024
    In:  European Heart Journal ( 2024-05-20)
    Details
    In: European Heart Journal, Oxford University Press (OUP), ( 2024-05-20)
    Abstract: It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs—diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD). Methods CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE—CV death, non-fatal MI, or non-fatal stroke). Results Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08–7.19] vs. 7.68% [95% CI 7.30–8.08] , P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women. Conclusions SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors.
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehae299
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2024
    detail.hit.zdb_id: 2001908-7
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    #4562 OUTBREAK OF RALSTONIA SPP AND BURKHOLDERIA SPP CATHETER-RELATED BLOODSTREAM INFECTION IN A HAEMODIALYSIS UNIT
    Oxford University Press (OUP) ; 2023
    In:  Nephrology Dialysis Transplantation Vol. 38, No. Supplement_1 ( 2023-06-14)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. Supplement_1 ( 2023-06-14)
    Abstract: Ralstonia (RB) and Burkholderia (BB) species are environmental Gram-negative bacilli responsible for several nosocomial infections in immunocompromised or frail patients. RB and BB may contaminate medical devices because of their ability to survive in a biofilm and with low nutrient requests. Reports of infection outbreaks due to RB and BB are very few and only in sporadic cases, the source of contamination was identified. We describe here: i) how we managed an outbreak of bacteremia caused by RB and BB occurred in our dialysis unit, ii) what we have done to identify the source of infection and iii) the countermeasures we adopted to reduce the risk of new events. Method From 7 to 16 April 2021, 6 out of 39 (15.4%) hemodialyzed (HD) patients with a long-term indwelling central venous catheter (CVC) developed symptoms related to infection. Blood cultures revealed the presence of RB and BB. Thus, a prompt check of the blood cultures of all HD patients with CVC was performed. Blood samples were incubated in an automated microbial detection system (VIRTUO BIOMERIEUX) and subsequently, blood positive samples were inoculated in Chocolate and Columbia blood Agar plates. In addition, a microbiological analysis of disinfectants, drugs used in dialysis unit and samples collected from the reverse osmosis water unit (ROW) and from the ROW delivery line were performed. None of the samples obtained from the ROW and from the ROW delivery line resulted positive. Thus, a microbiological analysis of the biofilm attached on the loading pipes (LP) and on the loading plastic tubes (LPT) that connect the hemodialyzer consoles (HC) to the ROW delivery line were performed. Briefly, LTP were subjected to ultrasound sonication at 30-40 KHz (BactoSonic-Bandelin), to disrupt the bacterial biofilm. The material obtained from sonication was cultured. Bacteria was identified by an automated mass spectrometry (MALDI-TOF VITEK®MS, Biomerieux). Results Bacteremia due to RB and BB was confirmed in 7 out of 39 (17.9%) of the hemodialyzed patients with a long-term indwelling CVC. 1 out of 7 was asymptomatic. Baseline characteristics of the 6 symptomatic patients were: mean age 68±16 years; mean C-reactive protein 4.48±1.3 mg/dl; mean procalcitonin 13.27±11.07 ng/ml; mean body temperature 37.9±1.4°C. The antibiotic therapy was decided according to antibiogram and included meropenem and ciprofloxacin. CVC were removed in all infected patients between 6 to 11 days from the diagnosis. Concomitantly, a new one was placed. None of the HD patients with arterio-venous fistulae developed bacteremia. RB and BB were isolated in the biofilm of 11 out of 37 LPT. Thus, we modified the ROW delivery line in order to set up a scheduled chemical and physical disinfections of the ROW delivery line with the hemodialysis consoles connected avoiding the risk of new contamination of the LPT and loading pipes. Briefly, on alternate months the whole system that include ROW delivery line (PE-Xa Medical Device, Fresenius Medical Care), loading pipes, LPT and hemodialysis consoles are disinfected by hot water (90°C) produced by a water heater (AquaB plus HF, Fresenius Medical Care) and by chemical disinfectant, 5% peracetic acid according to the protocols made by the console fabricant. In addition, we added to the reverse osmosis system a filtration module of 0.01 μm (AquaUF, Fresenius Medical Care) prior to the ROW delivery line, Figure 1. Awaiting for the modification of the ROW delivery line, the patients with CVC were dialyzed using a portable water treatment unit. After more than 14 months from the modification of the whole system for production and delivery of ROW none of the hemodialyzed patients developed infection by RB and BB. Conclusion Our experience suggests that infection outbreak by unusual bacteria such as RB and BB could be successful treated using antibiotic therapy. Nevertheless, in dialysis unit the source of infection should be investigated in order to adopt the countermeasures necessary to reduce the risk of new infections.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfad063c_4562
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1465709-0
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  • 4
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    #4487 AN UNEXPECTED CASE OF 2,8-DIHYDROXYADENINE NEPHROPATHY AFTER KIDNEY TRANSPLANTATION RELATED TO NEW VARIANTS OF ADENINE PHOSPHORIBOSILTRANSFERASE GENE
    Oxford University Press (OUP) ; 2023
    In:  Nephrology Dialysis Transplantation Vol. 38, No. Supplement_1 ( 2023-06-14)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. Supplement_1 ( 2023-06-14)
    Abstract: Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive disorder of the purine metabolism which results in the conversion of adenine into 2,8 dihydroxyadenine (DHA) due to the activity of the xanthine oxidoreductase (XOR). Patients affected by APRT deficiency if not treated with inhibitors of XOR may develop 2,8-DHA nephropathy that might progress to end-stage kidney disease (ESKD) with the need of kidney transplant. The high rate of misdiagnosis of 2,8-DHA nephropathy in native kidneys could lead to the failure of kidney graft in transplanted patients affected by APRT deficiency. Method Here, we report the case of a female, 63-years old patient with ESKD of unknown cause on regular hemodialysis treatment from 2018 after a period of three years on peritoneal dialysis, who underwent kidney transplantation in our Center in 2022. Her medical history showed a metabolic syndrome. She did not experience episodes of renal colic whereas family history reported a brother affected by frequent renal colic of unknown cause. In March 2022, she underwent kidney transplantation from a deceased death brain donor. Induction therapy includes basiliximab, tacrolimus, mycophenolic acid and steroids. Due to the persistence of delay graft function, ten days after kidney transplantation an allograft biopsy has been performed. The histological examination revealed tubular damage surrounded by inflammation cells and intratubular crystals in the renal cortex. The crystals were reddish brown tinged in hematoxylin and eosin stain and were birefringent under polarized light Fig. 1 A, B, so they were strongly related to the hypothesis of DHA crystals. Consistently, the urinalysis showed yellow-brown crystals of DHA. Thus, a genetic analysis of APRT gene has been performed showing two novel heterozygous variants c.388_397p.(Leu130ValfsTer4) and exon 3 deletion, expected pathogenic. The patient was treated with bolus of methylprednisolone (4mg/kg alternate to 50 mg) and a therapy with febuxostat 80 mg/die was started to reduce the amount of plasma DHA. In addition, based on our previous experience of recurrence DHA nephropathy after transplantation, we treated the patient with six consecutive hemodiafiltration (HDF) sessions without ultrafiltration, to promptly remove the serum DHA avoiding their precipitation in the graft while waiting for the lowering effect of febuxostat. At discharge the patient showed an increase of the urine output not associated with a complete recovery of kidney function (sCr 3.88 mg/dl, uric acid 1.6 mg/dl), so two other hemodialysis treatments were performed in the next two weeks. Results At present, almost one year after kidney transplant, the patient is doing well and the graft function is stable with a sCr of 1.6 mg/dl without significant presence of DHA crystals in the urine. Conclusion In conclusion, we find out an unexpected recurrence of 2,8-DHA nephropathy due to novel expected pathogenetic variants of APRT gene in patient without medical history of kidney stones successfully treated with steroid, febuxostat and hemodiafiltration.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfad063d_4487
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 5
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    Two Fatal Cases of Acute Liver Failure Due to HSV-1 Infection in COVID-19 Patients Following Immunomodulatory Therapies
    Oxford University Press (OUP) ; 2021
    In:  Clinical Infectious Diseases Vol. 73, No. 1 ( 2021-07-01), p. e252-e255
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 73, No. 1 ( 2021-07-01), p. e252-e255
    Abstract: We report two fatal cases of acute liver failure secondary to herpes simplex virus 1 infection in COVID-19 patients, following tocilizumab and corticosteroid therapy. Screening for and prompt recognition of herpes simplex virus 1 reactivation in these patients, undergoing immunomodulatory treatment, may have potentially relevant clinical consequences.
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciaa1246
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2002229-3
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  • 6
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    Shear wave splitting in the Alpine region
    Oxford University Press (OUP) ; 2021
    In:  Geophysical Journal International Vol. 227, No. 3 ( 2021-09-10), p. 1996-2015
    Details
    In: Geophysical Journal International, Oxford University Press (OUP), Vol. 227, No. 3 ( 2021-09-10), p. 1996-2015
    Abstract: To constrain seismic anisotropy under and around the Alps in Europe, we study SKS shear wave splitting from the region densely covered by the AlpArray seismic network. We apply a technique based on measuring the splitting intensity, constraining well both the fast orientation and the splitting delay. Four years of teleseismic earthquake data were processed, from 723 temporary and permanent broad-band stations of the AlpArray deployment including ocean-bottom seismometers, providing a spatial coverage that is unprecedented. The technique is applied automatically (without human intervention), and it thus provides a reproducible image of anisotropic structure in and around the Alpine region. As in earlier studies, we observe a coherent rotation of fast axes in the western part of the Alpine chain, and a region of homogeneous fast orientation in the Central Alps. The spatial variation of splitting delay times is particularly interesting though. On one hand, there is a clear positive correlation with Alpine topography, suggesting that part of the seismic anisotropy (deformation) is caused by the Alpine orogeny. On the other hand, anisotropic strength around the mountain chain shows a distinct contrast between the Western and Eastern Alps. This difference is best explained by the more active mantle flow around the Western Alps. The new observational constraints, especially the splitting delay, provide new information on Alpine geodynamics.
    Type of Medium: Online Resource
    ISSN: 0956-540X , 1365-246X
    URL: Article
    DOI: 10.1093/gji/ggab305
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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    detail.hit.zdb_id: 2006420-2
    detail.hit.zdb_id: 1002799-3
    SSG: 16,13
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  • 7
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    The AlpArray Research Seismicity-Catalogue
    Oxford University Press (OUP) ; 2022
    In:  Geophysical Journal International Vol. 231, No. 2 ( 2022-07-23), p. 921-943
    Details
    In: Geophysical Journal International, Oxford University Press (OUP), Vol. 231, No. 2 ( 2022-07-23), p. 921-943
    Abstract: We take advantage of the new large AlpArray Seismic Network (AASN) as part of the AlpArray research initiative (www.alparray.ethz.ch), to establish a consistent seismicity-catalogue for the greater Alpine region (GAR) for the time period 2016 January 1–2019 December 31. We use data from 1103 stations including the AASN backbone composed of 352 permanent and 276 (including 30 OBS) temporary broad-band stations (network code Z3). Although characterized by a moderate seismic hazard, the European Alps and surrounding regions have a higher seismic risk due to the higher concentration of values and people. For these reasons, the GAR seismicity is monitored and routinely reported in catalogues by a 11 national and 2 regional seismic observatories. The heterogeneity of these data set limits the possibility of extracting consistent information by simply merging to investigate the GAR's seismicity as a whole. The uniformly spaced and dense AASN provides, for the first time, a unique opportunity to calculate high-precision hypocentre locations and consistent magnitude estimation with uniformity and equal uncertainty across the GAR. We present a new, multistep, semi-automatic method to process ∼50 TB of seismic signals, combining three different software. We used the SeisComP3 for the initial earthquake detection, a newly developed Python library ADAPT for high-quality re-picking, and the well-established VELEST algorithm both for filtering and final location purposes. Moreover, we computed new local magnitudes based on the final high-precision hypocentre locations and re-evaluation of the amplitude observations. The final catalogue contains 3293 seismic events and is complete down to local magnitude 2.4 and regionally consistent with the magnitude 3+ of national catalogues for the same time period. Despite covering only 4 yr of seismicity, our catalogue evidences the main fault systems and orogens’ front in the region, that are documented as seismically active by the EPOS-EMSC manually revised regional bulletin for the same time period. Additionally, we jointly inverted for a new regional minimum 1-D P-wave velocity model for the GAR and station delays for both permanent station networks and temporary arrays. These results provide the base for a future re-evaluation of the past decades of seismicity, and for the future seismicity, eventually improving seismic-hazard studies in the region. Moreover, we provide a unique, consistent seismic data set fundamental to further investigate this complex and seismically active area. The catalogue, the minimum 1-D P-wave velocity model, and station delays associated are openly shared and distributed with a permanent DOI listed in the data availability section.
    Type of Medium: Online Resource
    ISSN: 0956-540X , 1365-246X
    URL: Article
    DOI: 10.1093/gji/ggac226
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 3042-9
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  • 8
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    Early and mid-term outcomes of 1904 patients undergoing transcatheter balloon-expandable valve implantation in Italy: results from the Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER)
    Oxford University Press (OUP) ; 2016
    In:  European Journal of Cardio-Thoracic Surgery Vol. 50, No. 6 ( 2016-12), p. 1139-1148
    Details
    In: European Journal of Cardio-Thoracic Surgery, Oxford University Press (OUP), Vol. 50, No. 6 ( 2016-12), p. 1139-1148
    Type of Medium: Online Resource
    ISSN: 1010-7940 , 1873-734X
    URL: Article
    DOI: 10.1093/ejcts/ezw218
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
    detail.hit.zdb_id: 1500330-9
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  • 9
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    651 Prevention of contrast induced nephropathy with urine alkalinization: the final results of the TEATE study
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal Supplements Vol. 23, No. Supplement_G ( 2021-12-08)
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 23, No. Supplement_G ( 2021-12-08)
    Abstract: Contrast-induced acute kidney injury (CI-AKI) after coronary angiography and percutaneous interventions (PCI) impacts on hospitalization duration and mortality. Pre-procedural hydration is the sole strategy currently recommended for preventing CI-AKI. The role of sodium bicarbonate (SB) although attractive, since urine alkalinization suppresses the production of reactive oxygen species, is still controversial, and the optimal dosing to attain adequate urine alkalinization is still undefined. The PrevenTion of contrast-inducEd nephropathy with urine alkalinization (TEATE) study was a prospective 3-centre 3-arm single-blind randomized controlled trial testing the hypothesis that adequate urine alkalinization is associated with CI-AKI prevention. Secondary endpoints were the efficacy of SB vs. saline in achieving adequate urine alkalinization and reducing the incidence of CI-AKI compared with saline. Methods and results Patients candidate to coronary angiography and/or PCI with moderate-to-severe chronic kidney disease [eGFR of 15–60 ml/min/1.73 m2, by the Modification of Diet in Renal Disease Study equation (MDRD)] were randomly assigned to saline hydration (control), oral SB or i.v. SB. The study protocol was registered (ClinicalTrials.gov NCT02980003). We evaluated urinary pH at the time of hospitalization, immediately before coronary angiography and 24–48 h after angiography. According to urine pH immediately before the procedure, patients were divided in two groups above or below a pH cut-off of 6. We enrolled a total of 241 patients: 81 were randomly assigned to the control group, 82 to i.v. SB and 78 to oral SB. Patients achieving a urinary pH  & gt; 6 before angiography had a lower incidence of CI-AKI (46%) than patients with urinary pH ≤ 6 (54%) [OR = 0.48 (95% CI: 0.25–0.9), P = 0.023]. The number of patients with urine pH  & gt; 6 was higher in both the i.v. (71%) and the oral SB (65%) groups compared to the hydration-only group (44%, P = 0.004). We found however no difference in the incidence of CI-AKI in the three treatment arms (20% in hydration alone, 21% in oral SB group and 22% in i.v. SB group) (P = 0.94). Subgroup analyses according to basal urine pH and eGFR ranges failed to identify statistically significant differences in the development of CI-AKI according to treatment allocation. Conclusions Urinary pH before the administration of contrast medium is an inverse correlate of CI-AKI incidence, and SB is superior to hydration alone in achieving urinary alkalinization. Since, however, SB did not reduce the incidence of CI-AKI, we conclude that urinary pH is a marker and not a mediator of CI-AKI.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartj/suab134.033
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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    Radial versus femoral access in patients with acute coronary syndromes with or without ST-segment elevation
    Oxford University Press (OUP) ; 2017
    In:  European Heart Journal Vol. 38, No. 14 ( 2017-04-07), p. 1069-1080
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 38, No. 14 ( 2017-04-07), p. 1069-1080
    Abstract: To assess whether radial compared with femoral access is associated with consistent outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods and results In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) programme patients were randomized to radial or femoral access, stratified by STEMI (2001 radial, 2009 femoral) and NSTE-ACS (2196 radial, 2198 femoral). The 30-day co-primary outcomes were major adverse cardiovascular events (MACE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACE or major bleeding In the overall study population, radial access reduced the NACE but not MACE endpoint at the prespecified 0.025 alpha. MACE occurred in 121 (6.1%) STEMI patients with radial access vs. 126 (6.3%) patients with femoral access [rate ratio (RR) = 0.96, 95% CI = 0.75–1.24; P = 0.76] and in 248 (11.3%) NSTE-ACS patients with radial access vs. 303 (13.9%) with femoral access (RR = 0.80, 95% CI = 0.67–0.96; P = 0.016) (Pint = 0.25). NACE occurred in 142 (7.2%) STEMI patients with radial access and in 165 (8.3%) patients with femoral access (RR = 0.86, 95% CI = 0.68–1.08; P = 0.18) and in 268 (12.2%) NSTE-ACS patients with radial access compared with 321 (14.7%) with femoral access (RR = 0.82, 95% CI = 0.69–0.97; P = 0.023) (Pint = 0.76). All-cause mortality and access site-actionable bleeding favoured radial access irrespective of ACS type (Pint = 0.11 and Pint = 0.36, respectively). Conclusion Radial as compared with femoral access provided consistent benefit across the whole spectrum of patients with ACS, without evidence that type of presenting syndrome affected the results of the random access allocation.
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehx048
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
    detail.hit.zdb_id: 2001908-7
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