Salta ai contenuti. | Salta alla navigazione

Strumenti personali

sito non più aggiornato
 

Sezioni

Tu sei qui: Home / Ricerca / 2011

Responsabile Giorgio Bellomo
Settore di ricerca Patologia Clinica
Personale docente Roberta Rolla  Mario Pirisi  Giuseppe De Luca
Personale non-docente Patrizia Pergolini  Matteo Vidali  Giuseppina Antonini               
Obiettivi della ricerca 1) Estimating the cost of redundancy in molecular diagnostics: the case of activated protein C resistance and factor V Leiden.
Risultati ottenuti 1) BACKGROUND: The activated protein C resistance--sensitivity ratio in the presence of Factor V deficient plasma (APC-SR/Factor V) exhibits a high sensitivity for factor V Leiden mutation and has been proposed as the diagnostic approach of choice, as an alternative to genetic tests, to evaluate activated protein C resistance. A survey, including 4969 requests, was performed on the activity of a typical Molecular Diagnostics Laboratory in order to estimate the costs due to reagents, instrumentation and personnel.

METHODS: The global costs of three hypothetical diagnostic approaches were compared: (A) exclusive molecular test for FV Leiden; (B) APC-SR alone; (C) APC-SR and the exclusive confirmation of positive results with molecular test.

RESULTS: The global cost for each patient with the three approaches investigated were respectively 42.20 euros (A), 1.09 euros (B), and 433 euros (C). The cost for finding a patient with factor V Leiden mutation was 549.00 euros for A, 14.18 euros for B, and 56.32 euros for C. It was calculated that a decrease of 97.42% and 89.74% can be obtained using the approaches B and C, respectively. The difference in cost between B and C can be justified by the avoidance of false positive cases (6%) and by the impossibility of distinguishing homozygous from heterozygous patients using APC-SR exclusively (B).

CONCLUSIONS: In the case of suspected phenotype APC resistance, we suggest a laboratory approach, which provides the combined and sequential use of ProCGlobal/FV analysis and a subsequent genetic test for positive patients.
 
Obiettivi della ricerca 2) Plasma fibrinogen levels and restenosis after primary percutaneous coronary intervention.
Risultati ottenuti 2) BACKGROUND: Plasma fibrinogen levels influence restenosis following elective percutaneous coronary intervention (PCI) for stable angina. It is unknown whether the same is true in the setting of primary PCI. The aim of the study was therefore to assess whether fibrinogen levels were associated to 6-month in-stent restenosis (ISR) in STEMI patients undergoing successful primary PCI.

METHODS: From January 2003 to October 2004, 267 patients were admitted to our Institution for STEMI and treated by primary PCI. Of these, 171 patients met the inclusion criteria and were enrolled in our study. Fibrinogen levels were assessed at admission, 12 h, 24 h, 48 h, 72 h following PCI and at discharge. Six-month angiographic follow-up was 100% complete.

RESULTS: Subjects with 6-month ISR showed higher fibrinogen levels than patients without ISR. Patients in the upper fibrinogen tertile showed a higher 6-month incidence of symptoms and/or inducible myocardial ischemia (27.1% vs. 7.1%, P = 0.006) and a larger late lumen loss (1.3 ± 0.8 vs. 1.0 ± 0.9 mm, P = 0.049). Logistic regression analysis demonstrated a significant and independent association between fibrinogen levels and ISR.

CONCLUSIONS: Our study suggests that increased plasma fibrinogen levels are related to ISR in STEMI patients undergoing primary PCI. Larger studies are warranted to assess the prognostic value of fibrinogen over harder end-points.
 
Obiettivi della ricerca 3) Unsuppressed parathyroid hormone in patients with autoimmune/inflammatory rheumatic diseases: implications for vitamin D supplementation.

Risultati ottenuti 3) OBJECTIVES: To verify if autoimmune/inflammatory rheumatic disease (ARD) patients were more refractory to PTH suppression by 25(OH) vitamin D (VITD).

METHODS: Data from 105 consecutive ARD patients (including RA, PMR, spondyloarthritis and other CTDs) attending a tertiary-level immuno-rheumatology clinic and 1542 subjects tested at our central laboratory from 2008 to 2010 (controls) were collected. After exclusion of patients with renal failure, primary hyperparathyroidism and hypercalcaemia (n = 522), plasma VITD, PTH, calcium and phosphate concentrations were compared between these two groups.

RESULTS: Plasma VITD concentrations were <25 nmol/l in 257 patients (severe deficit, 22.8%), ≥25 nmol/l but <75 nmol/l in 661 (mild deficit, 58.8%) and ≥ 75 nmol/l in 207 (normal, 18.4%). Despite similar median age, plasma VITD, calcium and phosphate values (P = 0.96, 0.30, 0.94, respectively), PTH was higher in ARD {73.0 [interquartile range (IQR) 54.2-93.7] pg/ml} than in controls [61.4 (46.9-80.3), P < 0.0002], also in all above-defined VITD categories (P < 0.05). Suppressed PTH was observed in 96.9% (95% CI 95.8%, 98.0%) of controls with VITD ≥ 75 nmol/l. However, PTH was increased more frequently in ARD vs controls. At multiple linear regression analysis, plasma VITD, age and the presence of an ARD (partial correlation coefficients -0.21, 0.15, 0.12, respectively, P < 0.0001) were independent predictors for increased PTH.

CONCLUSIONS: Patients with ARD had, on average, an increased PTH concentration for any plasma VITD range, suggesting an impaired vitamin D metabolism. Therefore, vitamin D supplementation to ARD patients may be targeted to reach PTH suppression and not simply to obtain VITD concentrations considered optimal in other categories of patients.

 
Collaborazioni in atto   
Comunicazioni a congressi •R. Rolla, M. Vidali, S. Meola, P. Pollarolo, M.R. Fanello, C. Nicolotti, L. Forti, G. Borra, F. D’Agostino, V. Rossi, O. Alabiso and G. Bellomo. Association between ultrarapid CYP2D6 polymorphisms and adverse drug reactions among women with breast cancer treated with tamoxifen. 2° Congress of the European Society of Predictive Medicine, 14-15 May Berlin 2011.

•R. Rolla, M. Vidali, S. Meola, P. Pollarolo, M.R. Fanello, C. Nicolotti, L. Forti, G. Borra, F. D’Agostino, V. Rossi, O. Alabiso and G. Bellomo. Association between ultrarapid CYP2D6 polymorphisms and adverse drug reactions among women with breast cancer treated with tamoxifen. IFCC-WorldLab 21st International Congress of Clinical Chemistry and Laboratory Medicine, 15-19 May Berlin 2011.

•Rolla R, Sulas MG, Bardone MB, Mairate E and Bellomo G. Hemolysis is a major cause of variability in insulin measurement during oral glucose tolerance test in children. IFCC-WorldLab 21st International Congress of Clinical Chemistry and Laboratory Medicine, 15-19 May Berlin 2011.

•R. Rolla, M. Vidali, S. Meola, P. Pollarolo, M.R. Fanello, C. Nicolotti, L. Forti, G. Borra, F. D’Agostino, V. Rossi, O. Alabiso and G. Bellomo. Association between ultrarapid CYP2D6 polymorphisms and adverse drug reactions among women with breast cancer treated with tamoxifen. Convegno AIOM, 13-14 maggio Stresa 2011.
 
Pubblicazioni
Estimating the cost of redundancy in molecular diagnostics: the case of activated protein C resistance and factor V Leiden.
Unsuppressed parathyroid hormone in patients with autoimmune/inflammatory rheumatic diseases: implications for vitamin D supplementation.
Plasma B-type natriuretic peptide in dialyzed patients: marker of cardiovascular disease or link to plasma refilling.
Low-molecular-weight-heparin and pregnancy, when the dose does it: a nephrologist's opinion: a rebuttal.