663 research outputs found
“Seminari Clinici di Psichiatria” (Astrazeneca) - Università di Genova, Genova, 24 novembre 2010, co-relatori Prof. F. Gabrielli, L. Ferrannini, K. Fontoulakis, G. Perugi.
No full textEvento sponsorizzat
“Disturbo Bipolare e Depressione Resistente” (Astrazeneca). Genova, 17 dicembre 2009, co-relatori, Prof. G. Perugi, F. Gabrielli, L. Ferrannini, G. Masi, G. Maina, V. Villari, M. Vaggi.
No full textDepressione resistente e correlati con disturbo bipolar
Prediction of declining renal function and albuminuria in patients with type 2 diabetes by metabolomics
No full textCONTEXT:
Renal disease in type 2 diabetes mellitus (T2DM) is associated with excess morbidity/mortality. Although estimated glomerular filtration rate (eGFR) and albuminuria are routine for assessing renal impairment, novel biomarkers could improve risk stratification and prediction.
OBJECTIVE:
To identify specific biomarkers of progression of renal dysfunction.
DESIGN:
Prospective observational.
SETTING:
Academic diabetes clinics.
PATIENTS:
A total of 286 T2DM patients (age, 62 ± 8 y; glycosylated hemoglobin, 7.2 ± 0.9%; eGFR, 85 ± 20 mL · min(-1) · 1.73 m(2)).
INTERVENTIONS:
None.
MAIN OUTCOME MEASURES:
Progression of eGFR and albuminuria.
RESULTS:
We performed screening metabolomics in serum and urine samples by gas chromatography/mass spectroscopy (MS) and ultra-high performance liquid chromatography/MS/MS. Biomarker identification was performed by random forest using an eGFR cutoff of < 60 mL · min(-1) · 1.73 m(2) or an albumin/creatinine ratio (ACR) cutoff ≥ 30 mg/g as response variables. At follow-up, eGFR had declined by 16 [9] (median [interquartile ratio]) mL · min(-1) · 1.73 m(2), and ACR had increased by 41 [135] mg/g in patients in the respective top quartile of changes from baseline. Clinical parameters (gender, age, fasting glucose, and baseline eGFR) predicted outcome, with receiver operator characteristics curve (ROC) = 0.671. The five serum metabolites best correlated with either eGFR < 60 or ACR ≥ 30 at baseline were tested for their ability to improve clinical prediction. The sum of C-glycosyl tryptophan, pseudouridine, and N-acetylthreonine (MetIndex) raised the ROC to 0.739 (P < .0001). eGFR decline was predicted by the top MetIndex quartile (odds ratio = 5.48 [95% confidence interval, 2.23-14.47]). MetIndex also predicted an ACR increase with an odds ratio of 2.82 [1.20-7.03] and a ROC of 0.750. Top urine metabolites did not add significant predictivity.
CONCLUSIONS:
A limited number of circulating intermediates of amino acid and nucleotide pathways carry clinically significant predictivity for deterioration of renal function in well-controlled T2DM
Cardiac abnormalities in systemic lupus erythematosus and their correlation with antiphospholipid antibodies.
No full textCongresso Intern Firenze 6-12 giugn
A model of glucose kinetics and their control by insulin. Compartmental and noncompartmental approaches.
No full textCompartmental and noncompartmentalmodels are used to quantify, from multiple steady-state tracer experiments, glucosekinetics and the effect of insulin upon them. Some aspects of experiment design are discussed. A physiological three-compartment model of glucosekinetics is proposed which provides a new quantitative picture of insulincontrol of glucose metabolism. Noncompartmental modeling is shown to have structural errors which prevent physiological insight. Compartmentalmodels make a better use of the informational content of kinetic data, even if more demanding both in terms of modeling and computational effort and in terms of physiological thinking
Dysglycaemia and cardiovascular disease. Aspects on screening, management, and prognosis
No full textBackground: Dysglycaemia, in this thesis defined as impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), is a major risk factor for cardiovascular disease (CVD). International guidelines recommend screening for dysglycaemia and target-driven lifestyle and pharmacological management in people with high cardiovascular (CV) risk or established CVD for both men and women. New glucose-lowering drugs with proven CV benefit are now available. Aims: The overall aim of this doctoral thesis was to investigate the screening and management of patients with CVD or at high CV risk including gender differences and implementation of new cardioprotective glucose-lowering drugs by studying: - the prevalence of dysglycaemia according to different screening tools in patients without known diabetes (Study I) and by gender (Study II); - the value of new screening methods for dysglycaemia in these patients (Study III and IV); - the management of such patients as regards lifestyle habits, use of cardioprotective drugs, and treatment target attainment (Study I) including possible gender disparities (Study II); - gender differences in prognosis (Study II); - whether cardioprotection of the glucagon-like peptide-1 receptor agonist dulaglutide is dependent on metformin (Study V). Methods: Studies I, II, III and IV were based on the population from the EUROASPIRE V cross-sectional survey; Study II included data from EUROASPIRE IV and V. Both surveys included patients with established coronary artery disease recruited across Europe at least six months prior to the investigation. Data on clinical history, life-style advice and pharmacological treatment was based on validated questionnaires and standardised blood tests at a study visit. Study V is based on patients with T2DM at high CV risk from the randomised controlled trial REWIND. Results: Prevalence and screening for dysglycaemia: In Study I, 29% of the study population had dysglycaemia detected by screening, with 70% of them being identified by a two-hour postload glucose value (2hPG) during an oral glucose tolerance test (OGTT). Study II found that more women than men had IGT and more men had T2DM. Study III validated a diagnostic algorithm for T2DM based on the assessment of a one-hour postload glucose value (1hPG) during the OGTT, shortening the time needed for glycaemic classification in 79% of them. In Study IV, the diagnostic performance of different insulin resistance indexes was unsatisfactory compared with the yield of an OGTT. Management: Study I showed that multifactorial management after the coronary event was unsatisfactory, with poor adherence to recommended treatment targets for blood pressure, lipids and glycaemic control and a high prevalence of obesity, persistent smoking and limited physical activity. Study II highlighted how this management was particularly inadequate in women, possibly contributing to a worse prognosis compared with men in those with known T2DM. Study V found that CV protection with dulaglutide seems to be present irrespective of metformin treatment at baseline. Conclusions: There is a compelling need for implementation of screening for dysglycaemia in patients with CAD, and the OGTT should be the preferred method because it identifies more patients with dysglycaemia, which otherwise would be missed. Time might be mature to introduce an algorithm based on the 1hPG value to identify T2DM. Its prognostic implications should however be further investigated. Multifactorial management of these patients is in demand of a substantial improvement, especially in women, where deficient care may be associated with worse prognosis. The use of new glucose-lowering agents with cardiovascular efficacy should be prioritised regardless of background glucose-lowering therapy.List of scientific papersI. Ferrannini G, de Bacquer D, De Backer G, Kotseva K, Mellbin L, Wood D, Rydén L. On behalf of the EUROASPIRE V collaborators. Screening for glucose perturbations and risk factor management in dysglycaemic patients with coronary artery disease - a persistent challenge in need of substantial improvement. A report from EUROASPIRE V. Diabetes Care. 2020 Apr; 43(4):726-733. https://doi.org/10.2337/dc19-2165 II. Ferrannini G, De Bacquer D, Vynckier P, De Backer G, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Tuomilehto J, Wood D, Rydén L; EUROASPIRE IV & V Investigators. Gender differences in screening for glucose perturbations, cardiovascular risk factor management and prognosis in patients with dysglycaemia and coronary artery disease: results from the ESC‑EORP EUROASPIRE surveys. Cardiovascular Diabetology. 2021 Feb; 20(1):38. https://doi.org/10.1186/s12933-021-01233-6 III. Ferrannini G, De Bacquer D, Gyberg V, De Backer G, Kotseva K, Mellbin LG, Risebrink R, Tuomilehto J, Wood D, Rydén L. Saving time by replacing the standardised two-hour oral glucose tolerance test with a one-hour test. Validation of a new screening algorithm in patients with coronary artery disease from the ESC-EORP EUROASPIRE V registry. Diabetes Research and Clinical Practice. 2022 Jan; 183:109156. https://doi.org/10.1016/j.diabres.2021.109156 IV. Ferrannini G, De Bacquer D, Erlund I, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Schnell O, Tuomilehto J, Vihervaara T, Wood D, Rydén L. Measures of insulin resistance as a screening tool for dysglycaemia in patients with coronary artery disease. A report from EUROASPIRE V. Diabetes Care. 2022; 45: 2111-2117. https://doi.org/10.2337/dc22-0272 V. Ferrannini G, Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Dyal L, Lakshmanan M, Mellbin L, Probstfield J, Riddle MC, Shaw JE, Avezum A, Basile JN, Cushman WC, Jansky P, Keltai M, Lanas F, Leiter LA, Lopez-Jaramillo P, Pais P, Pīrāgs V, Pogosova N, Raubenheimer PJ, Sheu WH-H, Rydén L. Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin. A subgroup analysis of the REWIND Trial. European Heart Journal. 2021; 42: 2565-2573. https://doi.org/10.1093/eurheartj/ehaa777 </p
Spontaneous bilateral kidney rupture during autologous stem cell transplantation in a patient affected by amyloidosis
No full textKidney spontaneous rupture is not a recognized complication neither for amyloidosis nor of autologous stem cell transplantation (ASCT). A 46-year-old white woman, affected by nephrotic syndrome, was diagnosed as AL amyloidosis by renal biopsy. We report the singular case of a bilateral spontaneous kidney rupture during ASCT for AL with renal rescue. © 2010 The Author. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved
- …
