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Ambulatory diastolic blood pressure:a marker of comorbidity in elderly fit hypertensive individuals?

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Journal of Geriatric Cardiology 2022年第4期19卷 254-264页

作者： Alfredo De Giorgi Rosaria Cappadona Caterina Savriè Benedetta Boari Ruana Tiseo Giulia Marta viglione Christian Molino Elisa Misurati Mauro Pasin Roberto Manfredini Fabio Fabbian clinica medica Unit Azienda Ospedaliero-Universitaria S.AnnaFerraraItaly Department of medical Sciences University of FerraraFerraraItaly

BACKGROUND Masked diastolic hypotension is a new blood pressure(BP)pattern detected by ambulatory blood pressure monitoring(ABPM)in elderly hypertensives.The aim of this study was to relate ABPM and comorbidity in a cohort of fit elderly subjects attending an outpatient hypertension clinic.METHODS Comorbidity was assessed by Charlson comorbidity index(CCI)and CHA_(2)DS_(2)vASc score.All subjects evaluated with ABPM were aged≥65 years.CCI and CHA_(2)DS_(2)vASc score were calculated.Diastolic hypotension was defined as mean am-bulatory diastolic BPve elderly patients aged 72.1±5.2 years,men were 93(53.4%).Mean CCI was 0.91±1.14 and mean CHA_(2)DS_(2)vASc score of 2.68±1.22.Subjects with night-time mean diastolic valuesvs.45.3%,P=0.048;odds ratio(OR)=1.914,95%CI:1.047−3.500].Logistic regression analysis showed that only CHA_(2)DS_(2)-vASc score was independently associated with night-time mean diastolic valuesvaluation appear associated in elderly fit subjects with masked ***-orbid women appear to have higher risk for low ambulatory BP.

关键词： hypertensive morbidity diastolic

Idiopathic hypereosinophilic syndrome presenting with severe vasculitis successfully treated with imatinib

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World Journal of clinical Cases 2016年第10期4卷 328-332页

作者： Paolo Fraticelli Alain Kafyeke Massimo Mattioli Giuseppe Pio Martino Marta Murri Armando Gabrielli clinica medica Department of Internal MedicineUniversità Politecnica delle Marche

Idiopathic hypereosinophilic syndrome(HES) is a rare disorder characterized by peripheral eosinophilia exceeding 1500/mm3, a chronic course, absence of secondary causes, and signs and symptoms of eosinophil-mediated tissue injury. One of the best-characterized forms of HES is the one associated with FIP1L1-PDGFRA gene rearrangement, which was recently demonstrated as responsive to treatment with the small molecule kinase inhibitor drug, imatinib mesylate. Here, we describe the case of a 51-year-old male, whose symptoms satisfied the clinical criteria for HES with cutaneous and cardiac involvement and who also presented with vasculitic brain lesions and retroperitoneal bleeding. Molecular testing, including fluorescence in situ hybridization, of bone marrow and peripheral blood showed no evidence of PDGFR rearrangements. The patient was initially treated with high-dose steroid therapy and then with hydroxyurea, but proved unresponsive to both. Upon subsequent initiation of imatinib mesilate, the patient showed a dramatic improvement in eosinophil count and progressed rapidly through clinical recovery. Long-term follow-up confirmed the efficacy of treatment with low-dose imatinib and with no need of supplemental steroid treatment, notwithstanding the absence of PDGFR rearrangement.

关键词： Idiopathic hypereosinophilic syndrome Eosinophilia Cerebral vasculitis PDGFR molecular rearrangement Imatinib mesilate

Normal serum alanine aminotransferase activity in uncomplicated obesity

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World Journal of Gastroenterology 2005年第38期11卷 6018-6021页

作者： Gianluca Iacobellis Antonio Moschetta Maria Cristina Ribaudo Alessandra Zappaterreno Concetta valeria Iannucci Frida Leonetti Endocrinology clinica medica "Augusto Murri"

AIM: To evaluate serum alanine aminotransferase (ALT)activity in a well-characterized group of uncomplicated obese subjects and its correlation with insulin resistance,plasma adiponectin, and leptin concentrations.METHODS: One hundred and five uncomplicatedobese subjects (87 women, 18 men, age 34.3±9.6 years,BMI 39.9±8.3 kg/m2)were studied. Serum ALT activity was evaluated. Insulin sensitivity was assessed by euglycemic hyperinsulinemic clamp (M index) and fasting insulin. Plasma leptin and adiponectin levels were also measured.RESULTS: Serum ALT concentration in the whole group of uncomplicated obese subjects was 17.73±6.33 U/L with none of the subjects presenting ALT levels greater than 43 U/L and only 9 (11%) women and 3 (19%) men showed ALT levels ＞19 and ＞30 U/L for women and men,respectively. No significant difference was detected in serum ALT levels between severe obese subjects (BMI ＞40 kg/m2) and those with BMI ＜40 kg/m2 (18.63±6.25 vs 17.26±6.02 U/L). ALT was significantly correlated with fasting insulin (r = 0.485, P = 0.02) and triglycerides (r= 0.358, P= 0.03).CONCLUSION: Serum ALT activity is practically normal in uncomplicated obese subjects, independently of their obesity degree. These findings suggest the role of obesityrelated comorbidities and not of BMI as main risk factors for elevated ALT levels in obese subjects.

关键词：血清丙胺酸转氨酶酶活性单纯性肥胖

Pulmonary embolism and internal jugular vein thrombosis as evocative clues of Lemierre's syndrome:A case report and review of the literature

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World Journal of clinical Cases 2017年第3期5卷 112-118页

作者： Alfredo De Giorgi Fabio Fabbian Christian Molino Elisa Misurati Ruana Tiseo Claudia Parisi Benedetta Boari Roberto Manfredini Department of medical Sciences Clinica Medica UnitSchool of MedicineUniversity of FerraraUniversity Hospital of Ferrara

Lemierre’s syndrome(LS)is an uncommon condition with oropharyngeal infections,internal jugular vein thrombosis,and systemic metastatic septic embolization as the main features.Fusobacterium species,a group of strictly anaerobic Gram negative rod shaped bacteria,are advocated to be the main pathogen involved.We report a case of LS complicated by pulmonary embolism and pulmonary septic emboli that mimicked a neoplastic lung condition.A Medline search revealed 173 case reports of LS associated with internal jugular vein thrombosis that documented the type of microorganism.Data confirmed high prevalence in young males with Gram negative infections(83.2%).Pulmonary embolism was reported in 8.7% of cases mainly described in subjects with Gram positive infections(OR=9.786;95%CI:2.577-37.168,P=0.001),independently of age and gender.Only four fatal cases were reported.LS is an uncommon condition that could be complicated by pulmonary embolism,especially in subjects with Gram positive infections.

关键词： Lemierre’s syndrome Pulmonary embolism Fusobacterium species Internal jugular vein thrombosis Systemic septic embolization

Impaired coagulation,liver dysfunction and COvID-19:Discovering an intriguing relationship

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World Journal of Gastroenterology 2022年第11期28卷 1102-1112页

作者： Damiano D'Ardes Andrea Boccatonda Giulio Cocco Stefano Fabiani Ilaria Rossi Marco Bucci Maria Teresa Guagnano Cosima Schiavone Francesco Cipollone “clinica medica”Institute Department of Medicine and Aging Sciences“G.D’Annunzio”University of Chieti-PescaraChieti 66100Italy Unit of Ultrasound “G.D’Annunzio”University of Chieti-PescaraChieti 66100Italy

Coronavirus disease 2019(COvID-19)is,at present,one of the most relevant global health problems.In the literature hepatic alterations have been described in COvID-19 patients,and they are mainly represented by worsening of underlying chronic liver disease leading to hepatic decompensation and liver failure with higher mortality.Several potential mechanisms used by severe acute respiratory syndrome coronavirus 2(SARS-Co v-2)to cause liver damage have been hypothesized.COvID-19 primary liver injury is less common than secondary liver injury.Most of the available data demonstrate how liver damage in SARSCo v-2 infection is likely due to systemic inflammation,and it is less likely mediated by a cytopathic effect directed on liver cells.Moreover,liver alterations could be caused by hypoxic injury and drugs(antibiotics and non-steroidal antiinflammatory drugs,remdesivir,tocilizumab,tofacitinib and dexamethasone).SARS-Co v-2 infection can induce multiple vascular district atherothrombosis by affecting simultaneously cerebral,coronary and peripheral vascular beds.Data in the literature highlight how the virus triggers an exaggerated immune response,which added to the cytopathic effect of the virus can induce endothelial damage and a prothrombotic dysregulation of hemostasis.This leads to a higher incidence of symptomatic and confirmed venous thrombosis and of pulmonary embolisms,especially in central,lobar or segmental pulmonary arteries,in COvID-19.There are currently fewer data for arterial thrombosis,while myocardial injury was identified in 7%-17%of patients hospitalized with SARS-Co v-2 infection and 22%-31%in the intensive care unit setting.Available data also revealed a higher occurrence of stroke and more serious forms of peripheral arterial disease in COvID-19 patients.Hemostasis dysregulation is observed during the COvID-19 course.Lower platelet count,mildly increased prothrombin time and increased Ddimer are typical laboratory features of patients with severe SARS-Co v-2 infection,described as“COvID-19 associa

关键词： COvID-19 SARS-Cov-2 Liver Coagulation

Treatment of a patient with congenital analbuminemia with atorvastatin and albumin infusion

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World Journal of clinical Cases 2013年第1期1卷 44-48页

作者： Maria Del Ben Francesco Angelico Lorenzo Loffredo Francesco violi clinica medica I Sapienza University 00161 Rome Italy

Congenital analbuminemia is a rare autosomic recessive inherited disorder characterized by low plasma albumin and hypercholesterolemia, which may increase cardiovascular risk. Patients are essentially asymptomatic, apart from ease of fatigue, minimal ankle oedema and hypotension. There is no accepted strategy for safely treating both hypercholesterolemia and analbuminemia in order to eventually decrease the atherosclerotic risk. We report a case of congenital analbuminemia(1.0 g/dL) in a 38-year-old male with hypercholesterolemia(range: 406-475 mg/dL) and severe arterial dysfunction [no brachial artery flow-mediated dilation(FMD)]. Long-term, cholesterol-lowering treatment with atorvastatin was associated with the appearance of peripheral edema. Twomonths of infusion with albumin improved FMD(7%) and reduced serum cholesterol(273 mg/dL), supporting the hypothesis of a compensatory role of hypercholesterolemia. Statin treatment, together with periodical albumin infusions, may contribute to the safe reduction of cardiovascular risk.

关键词： Analbuminemia Hypercholesterolemia Atorvastatin Albumin infusion Endothelial dysfunction

Stem cells for end stage liver disease: How far have we got?

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World Journal of Gastroenterology 2008年第29期14卷 4593-4599页

作者： Stefania Lorenzini Stefano Gitto Elena Grandini Pietro Andreone Mauro Bernardi Dipartimento di Medicina clinica. Unità Operativa di Semeiotica medica. University of Bologna Italy

End stage liver disease (ESLD) is a health problem worldwide. Liver transplantation is currently the only effective therapy, but its many drawbacks include a shortage of donors, operative damage, risk of rejection and in some cases recidivism of the pre-transplant disease. These factors account for the recent growing interest in regenerative medicine. Experiments have sought to identify an optimal source of stem cells, sufficient to generate large amounts of hepatocytes to be used in bioartificial livers or injected in vivo to repair the diseased organ. This update aims to give non-stem cell specialists an overview of the results obtained to date in this fascinating field of biomedical research.

关键词：干细胞肝脏疾病再生药物治疗方法

Twenty years of misdiagnosis of schizophrenia in a patient with Dandy-Walker variant syndrome

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General Psychiatry 2019年第1期32卷 46-48页

作者： Joao Gama Marques Hospital Julio de Matos Centro Hospitalar Psiquiatrico de LisboaClinica Universitaria de Psiquiatriae Psicologia MedicaFaculdade de Medicina Universidade de LisboaLisboa Portugal

SUMMARY various case reports of patients with Dandy-Walker variant syndrome mimicking schizophrenia have been published in the last 20 years, suggest!ng that this neurodevelopment disorder should be part of the differential diagnosis for every patient with a first episode of psychosis. In this report, it is presented that a patient who was diagnosed and treated as a paranoid schizophrenic for 20 years and had four bone fractures secondary to ataxic gait impairment, before performing a neuroimaging examination that revealed Dandy-Walker variant syndrome.

关键词： Twenty years misdiagnosis schizophrenia

Dynamic carbon 13 breath tests for the study of liver function and gastric emptying

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Gastroenterology Report 2015年第1期3卷 12-21页

作者： Leonilde Bonfrate Ignazio Grattagliano Giuseppe Palasciano Piero Portincasa Department of Biomedical Sciences and Human Oncology Clinica Medica‘A.Murri’University of Bari Medical SchoolBariItaly Italian College of General Practitioners Florence and BariItaly

In gastroenterological practice,breath tests(BTs)are diagnostic tools used for indirect,non-invasive assessment of several pathophysiological metabolic processes,by monitoring the appearance in breath of a metabolite of a specific substrate.Labelled substrates originally employed radioactive carbon 14(^(14)C)and,more recently,the stable carbon 13 isotope(^(13)C)has been introduced to label specific substrates.The ingested^(13)C-substrate is metabolized,and exhaled^(13)CO_(2)is measured by mass spectrometry or infrared spectroscopy.Some^(13)C-BTs evaluate specific(microsomal,cytosolic,and mitochondrial)hepatic metabolic pathways and can be employed in liver diseases(i.***.simple liver steatosis,non-alcoholic steato-hepatitis,liver fibrosis,cirrhosis,hepatocellular carcinoma,drug and alcohol effects).Another field of clinical application for^(13)C-BTs is the assessment of gastric emptying kinetics in response to liquids(^(13)C-acetate)or solids(^(13)C-octanoic acid in egg yolk or in a pre-packed muffin or the^(13)C-Spirulina platensis given with a meal or a biscuit).Studies have shown that^(13)C-BTs,used for gastric emptying studies,yield results that are comparable to scintigraphy and can be useful in detecting either delayed-(gastroparesis)or accelerated gastric emptying or changes of gastric kinetics due to pharmacological effects.Thus,^(13)C-BTs represent an indirect,cost-effective and easy method of evaluating dynamic liver function and gastric kinetics in health and disease,and several other potential applications are being studied.

关键词： breath tests stable isotope hepatic metabolism gastric motility scintigraphy