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F Prati

Publications and source records attributed to F Prati.

At least 19 recordsLinked to original sources

Energetic, structural, and antimicrobial analyses of beta-lactam side chain recognition by beta-lactamases.

BACKGROUND: Penicillins and cephalosporins are among the most widely used and successful antibiotics. The emergence of resistance to these beta-lactams, most often through bacterial expression of beta-lactamases, threatens public health. To understand how beta-lactamases recognize their substrates, it would be helpful to know their binding energies. Unfortunately, these have been difficult to measure because beta-lactams form covalent adducts with beta-lactamases. This has complicated functional analyses and inhibitor design. RESULTS: To investigate the contribution to interaction energy of the key amide (R1) side chain of beta-lactam antibiotics, eight acylglycineboronic acids that bear the side chains of characteristic penicillins and cephalosporins, as well as four other analogs, were synthesized. These transition-state analogs form reversible adducts with serine beta-lactamases. Therefore, binding energies can be calculated directly from K(i) values. The K(i) values measured span four orders of magnitude against the Group I beta-lactamase AmpC and three orders of magnitude against the Group II beta-lactamase TEM-1. The acylglycineboronic acids have K(i) values as low as 20 nM against AmpC and as low as 390 nM against TEM-1. The inhibitors showed little activity against serine proteases, such as chymotrypsin. R1 side chains characteristic of beta-lactam inhibitors did not have better affinity for AmpC than did side chains characteristic of beta-lactam substrates. Two of the inhibitors reversed the resistance of pathogenic bacteria to beta-lactams in cell culture. Structures of two inhibitors in their complexes with AmpC were determined by X-ray crystallography to 1.90 A and 1.75 A resolution; these structures suggest interactions that are important to the affinity of the inhibitors. CONCLUSIONS: Acylglycineboronic acids allow us to begin to dissect interaction energies between beta-lactam side chains and beta-lactamases. Surprisingly, there is little correlation between the affinity contributed by R1 side chains and their occurrence in beta-lactam inhibitors or beta-lactam substrates of serine beta-lactamases. Nevertheless, presented in acylglycineboronic acids, these side chains can lead to inhibitors with high affinities and specificities. The structures of their complexes with AmpC give a molecular context to their affinities and may guide the design of anti-resistance compounds in this series.

Anti-Bacterial Agents↗

Correlation between high frequency intravascular ultrasound and histomorphology in human coronary arteries.

OBJECTIVE: To test the efficacy of high frequency intravascular ultrasound (IVUS) transducers in identifying lipid/necrotic pools in atherosclerotic plaques. METHODS: 40 MHz transducers were used for in vitro IVUS assessment of 12 arterial segments (10 coronary and two carotid arteries, dissected from five different necropsy cases). IVUS acquisition was performed at 0.5 mm/s after ligature of the branching points to generate a closed system. Lipid/necrotic areas were defined by IVUS as large echolucent intraplaque areas surrounded by tissue with higher echodensity. To obtain histopathological sections corresponding to IVUS cross sections, vessels were divided into consecutive 3 mm long segments using the most distal recorded IVUS image as the starting reference. Samples were then fixed with 10% buffered formalin, processed for histopathological study, serially cut, and stained using the Movat pentacrome method. RESULTS: 122 sections were analysed. Lipid pools were observed by histology in 30 sections (25%). IVUS revealed the presence of lipid pools in 19 of these sections (16%; sensitivity 65%, specificity 95%). CONCLUSIONS: In vitro assessment of lipid/necrotic pools with high frequency transducers was achieved with good accuracy. This opens new perspectives for future IVUS characterisation of atherosclerotic plaques.

Aged↗

Intravascular ultrasound insights into plaque composition.

UNLABELLED: Previous studies correlating histomorphology with 20-30 MHz-derived intravascular ultrasound (IVUS) images showed that IVUS provides to some extent qualitative information on plaque composition. IVUS imaging proved to define calcifications with high sensitivity and specificity but was found to be less accurate in the assessment of soft components. Nevertheless previous studies on atherosclerotic plaque characterization were limited by use of low-frequency transducers that did not define accurately soft components. Our goal was to test the effectiveness of high frequency IVUS transducers in the identification of lipid/necrotic pools in atherosclerotic plaques. METHODS: Forty MHz transducers were used for in vitro IVUS assessment of 12 arterial segments (10 coronary arteries and 2 carotid arteries dissected from 5 different autopsy cases). IVUS acquisition was performed at a 0.5 mm/s speed after ligature of the branching points to generate a closed system. Lipid necrotic areas were defined by IVUS as large echolucent intraplaque areas surrounded by tissue with higher echodensity. To obtain histopathologic sections corresponding to IVUS cross sections, vessels were divided into consecutive 3 mm-long segments using the most distal recorded IVUS image as the starting reference. Then, samples were fixed with 10% buffered formalin, processed for histopathologic study, serially cut, and stained with the Movat penthacrome method. RESULTS: One hundred twenty-two sections were analyzed. Lipid pools were observed by histology in 30 cross sections (25%). IVUS revealed the presence of lipid pools in 19 of 122 cross sections with a sensitivity and specificity of 67% and 94%, respectively. CONCLUSIONS: High frequency transducers accurately identify lipid/necrotic pools and open new perspectives on future IVUS characterization of atherosclerotic plaques.

Arteriosclerosis↗

Intracoronary ultrasound measurements in women with myocardial infarction without significant coronary lesions.

METHODS: Morphologic characteristics of coronary arteries in eight women with myocardial infarction and angiographically normal or not significantly stenosed vessels were investigated with intracoronary ultrasound. The infarct-related vessel was assessed by three-dimensional volumetric analysis and compared with a control vessel from a noninfarcted area. RESULTS: Atherosclerosis was found in all infarct-related arteries. The plaques were predominantly soft, eccentric, poorly calcified, and with little lipid pools or none at all. Although the average area and thickness of plaques and cross-sectional narrowing of the infarct-related arteries were greater than those of control arteries, there were no pathognomonic characteristics of plaques in the infarct-related vessels. CONCLUSION: The possibility that atherosclerosis is the main etiologic factor for myocardial infarction can not be excluded even for women without an angiographically obvious coronary stenosis in the infarct-related vessels.

Aged↗

Screening of health care workers for hepatitis B virus and hepatitis C virus: criteria for fitness for work.

The aim of this study was to propose a protocol for assessment of markers of infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in exposed health care professionals and to define criteria for evaluation of fitness for the job of the infected personnel. The study comprised 800 persons involved in operative procedures, including 414 surgeons, 275 nurses, and 111 anaesthetists. A graduated protocol was created for monitoring markers of HBV and HCV infection. A well-defined combination of markers of antigen-antibody systems enabled identification of four groups of persons with HBV infection differing in fitness for work: 1) HBsAg-positive, HBeAg-positive, HBV DNA-positive; 2) HBsAg-positive, anti-HBe-positive, HBV DNA-positive; 3) HBsAg-positive, anti-HBe-positive, HBV DNA-negative; and 4) anti-HBs-positive, anti-HBc-positive, anti-HBe-positive group. For HCV infection, two groups with different job fitness were identified: 1) anti-HCV-positive, HCV RNA-negative and 2) anti-HCV-positive, HCV RNA-positive. Screening of hospital personnel at risk to HBV and HCV infection requires a well-defined protocol which may help to evaluate the fitness of the infected personnel for a specific job.

Hepatitis B↗

In-stent neointimal proliferation correlates with the amount of residual plaque burden outside the stent: an intravascular ultrasound study.

BACKGROUND: The aim of this study was to evaluate the relationship between residual plaque burden after coronary stent implantation and the development of late in-stent neointimal proliferation. METHODS AND RESULTS: Between January 1996 and May 1997, 50 patients underwent intravascular ultrasound (IVUS) interrogation at 6+/-1.2 months after coronary stent implantation in native coronary arteries. IVUS images were acquired with a motorized pullback, and cross-sectional measurements were performed within the stents at 1-mm intervals. The following measurements were obtained: (1) lumen area (LA), (2) stent area (SA), (3) area delimited by the external elastic membrane (EEMA), (4) percent neointimal area calculated as (SA-LA/SA)x100, and (5) percent residual plaque area calculated as (EEMA-SA)/EEMAx100. Volume measurements within the stented segments were calculated by applying Simpson's rule. In the pooled data analysis of 876 cross sections, linear regression showed a significant positive correlation between percent residual plaque area and percent neointimal area (r=0.50, y= 45.03+0.29x, P<0.01). There was significant incremental increase in mean percent neointimal area for stepwise increase in percent residual plaque area. Mean percent neointimal area was 16.3+/-10.3% for lesions with a percent residual plaque area of <50% and 27.7+/-11% for lesions with a percent residual plaque area of >/=50% (P<0.001). The volumetric analysis showed that the percent residual plaque volume was significantly greater in restenotic lesions compared with nonrestenotic lesions (58.7+/-4.3% versus 51.4+/-5.7%, respectively; P<0.01). CONCLUSIONS: Late in-stent neointimal proliferation has a direct correlation with the amount of residual plaque burden after coronary stent implantation, supporting the hypothesis that plaque removal before stent implantation may reduce restenosis.

Aged↗

From plaque biology to clinical setting.

Coronary atherosclerosis may cause acute and chronic ischemic syndromes; the former are caused by "acute plaque events," mostly thrombosis complicating vulnerable ruptured plaques, namely severe lesions with large core, thin cap, and weak shoulder infiltrated by activated inflammatory cells. Plaque rupture may also occur in nonischemic settings and is not obligatorily complicated by thrombosis. Furthermore, plaque rupture is not the only thrombus substrate in acute ischemic syndromes: Superficial erosion of fibrous plaques is found in 44% of acute thrombi in sudden coronary deaths and in 25% of those in acute myocardial infarctions. Coronary thrombosis appears to be triggered by superficial intimal inflammation in plaque ulceration and by neointimal hyperplasia in plaque erosion. "Endogenous" and, recently, exogenous factors, particularly infective intracellular organisms, have been proposed as major contributors to plaque inflammation, activation, and vulnerability. Possible exogenous triggers are DNA and RNA viruses and intracellular bacteria such as Chlamydia pneumoniae, which has been identified with microbiological, ultrastructural, immunohistochemical, and molecular tools in a consistent proportion of human plaque samples. Chlamydia increases local thrombogenicity and is associated with an atherogenic lipid profile. Systemic indexes of inflammation, such as PCR, SAA, and fibrinogen, are also increased in acute syndromes and common infectious diseases with high morbidity and minimal clinical impact are good candidates; Helicobacter pylori is a major one. Infectious agents could link local and systemic inflammation: White cells infected in its target tissue could circulate into the flow and be captured, on a specific local trigger, into vessel walls thus stimulating local inflammation.

Chlamydia Infections↗

Ocular hypertonia and crystalline lens opacities in healthcare workers exposed to ionising radiation.

Some activities performed by healthcare workers may still involve total or partial exposure to ionising radiation exceeding the limit values. In addition to the appearance of crystalline lens opacities which may lead to rays-cataract, recent studies have indicated possible induction of ocular hypertonia in occupationally exposed subjects. The aim of this study was to establish the actual prevalence of ocular hypertonia and crystalline lens opacities in a group of healthcare workers exposed to ionising radiation. The collected data failed to show significant risk of ocular hypertonia and suggested that crystalline lens opacity was not an important indicator of exposure. Notwithstanding, preventive and periodic (every 5 years) ophthalmologic control may prove helpful for medicolegal purposes. Namely, such control would record congenital crystalline lens opacities in many individuals and would thus rule out unjustified claims of occupational disease due to exposure to ionising radiation. Additionally, ophthalmologic control should focus on different and probably more important ocular risks for the radiologists such as the ocular fatigue resulting from a prolonged use of a video display terminal or other diagnostic screens or electrodiaphanoscopes.

Adult↗

Use of ultrasonography in monitoring work-related carpal tunnel syndrome: a case report.

Carpal tunnel syndrome (CTS) is a syndrome whose diagnosis is well established. One cause could be occupational factors, while others have no relation to work or the work environment. We present in this article a case report regarding a worker affected by CTS, which is of interest concerning the sensitivity of ultrasonography and electroneurography, applied as diagnostic methods, related in our protocol to the variations in occupational exposures. The case reports an agricultural worker, whose tasks required repetitive and high frequency movements of the hand-arm. Diagnosis of CTS used ultrasonography and electroneurography techniques. In our opinion, the clinical evolution of CTS encompasses three "work-related" phases (preclinical phase; phase of nerve compression; phase of irreversible damage). Ultrasonography provides greater information about the evolution of CTS, as well as other cumulative trauma disorders, and is able to discern tendinitis of flexors causing a compression on the median nerve in the carpal tunnel.

Carpal Tunnel Syndrome↗

Coexistence of vessel enlargement and paradoxical constriction in a diseased left anterior descending artery: an in vivo assessment using a new system for quantitative analysis of intracoronary ultrasound.

Previous studies based on conventional two-dimensional intravascular ultrasound revealed that coronary arteries can undergo either vessel enlargement and paradoxical constriction in response to plaque growth. We report a case in which the occurrence of vessel enlargement and paradoxical constriction was documented in the same coronary artery (left anterior descending). A multiple cross-section analysis was performed, using a novel 3-D system of reconstruction of IVUS images, which provides a large number of cross-sections within the reconstructed segments.

Cardiomegaly↗

Three-dimensional reconstruction techniques applied to intracoronary images.

In recent years, systems for the three-dimensional (3-D) reconstruction of intravascular ultrasound (IVUS) images have been developed. As a major advantage over conventional two-dimensional IVUS, 3-D IVUS offers longitudinal views of the reconstructed segments and provide more comprehensive insight into the spatial distribution of vascular structures. The present article is an overview of current 3-D reconstruction techniques. In particular, we discuss the sequence of basic steps required to obtain a 3-D reconstruction: IVUS image acquisition, digitization, segmentation and reconstruction. We also illustrate the different systems of 3-D reconstruction that are currently available. Some of them can be used on-line during surgical procedures, while others are more suited for off-line applications and are useful research tools.

Coronary Vessels↗

Extent and distribution of atherosclerotic plaque in relation to major coronary side-branches: an intravascular ultrasound study in vivo.

BACKGROUND: The non-uniform extent and distribution of atherosclerotic plaque at bifurcations have been described by necropsy studies and they are related to local blood-flow disturbances. Systematic evaluation of plaque extent and distribution upstream and downstream of major coronary side-branches has not yet been evaluated in vivo. METHODS: We used intravascular ultrasound imaging in 41 patients with atherosclerotic disease to study the region of 73 major coronary side-branches at 2 mm increments proximal and distal to the side-branch (657 images: 73 at origin of side-branch; 292 proximal; 292 distal). The maximum (MXT) and minimum (MINT) plaque thickness and the plaque burden percentage (% PB) were measured in all the segments. The angle of distribution of maximum plaque thickness with respect to the origin of the side-branch was determined in each cross-section and assigned to S1 when located on the semicircle in the direction of the origin of the side-branch and to S2 when located on the opposite wall. RESULTS: The mean value of maximum plaque thickness and the plaque burden percentage were similar at the origin and in the two adjacent segments proximal and distal to the side-branch (1.0 +/- 0.48 mm, 1.06 +/- 0.48 mm and 0.98 +/- 0.48 mm; 45 +/- 19%, 46 +/- 19% and 44 +/- 18%). In distal sites of analysis, the plaque was more frequently eccentric in comparison to proximal sites (presence of an arc of plaque-free wall: 79% versus 62% in very distal and in very proximal sites respectively; p < 0.05). The prevalence of maximum plaque in S2 was higher at the origin (84%) and in adjacent distal segments (86%) as compared with the adjacent proximal segments (60%; p < 0.0001). CONCLUSIONS: The distribution of plaque is influenced by the origin of a major coronary side-branch in patients with coronary atherosclerosis: in distal sites the location of maximum plaque is almost always eccentrically distributed on the wall opposite the take-off.

Adult↗

Incidence of compensatory enlargement and paradoxical shrinkage of coronary arteries in presence of atherosclerotic lesions: an intracoronary ultrasound study based on multiple cross-section analysis per artery.

BACKGROUND: The aim of the study was to evaluate with intravascular ultrasound (IVUS) the incidence of compensatory enlargement and paradoxical shrinkage in 50 de novo coronary lesions, using two different approaches: 1) a single cross-section analysis and 2) a multiple cross-section analysis per artery. A 3-D IVUS system based on contour detection of lumen and plaque was applied (image acquisition speed: 0.5 mm/s, digitization rate: 5 images/s). In each cross section, we determined: 1) the lumen area (LA), 2) the external elastic membrane area (EEMA), 3) the plaque+media complex (p+m), 4) the relative EEMA = cross section EEMA/reference EEMA, 5) the relative p+m area = cross-section p+m area/reference p+m area, 6) the lumen area stenosis: 1-(cross-section LA/reference LA). In the single cross-section analysis, compensatory vessel enlargement was defined as narrowest EEMA > reference EEMA, and paradoxical vessel constriction as narrowest EEMA < reference EEMA. In the multiple cross-section analysis, compensatory vessel enlargement was defined as the presence of a significant positive correlation between relative EEMA and relative p+m area and paradoxical vessel constriction as a significant negative correlation between relative EEMA and lumen area stenosis. RESULTS: In the single cross-section analysis, compensatory vessel enlargement and paradoxical constriction occurred in 58 and 42% of cases respectively. The multiple cross-section per artery analysis showed compensatory vessel enlargement in 80% of cases and paradoxical constriction in 36% of cases and revealed the combination of compensatory enlargement with paradoxical constriction in 22% of the analyzed segments. CONCLUSIONS: Compensatory enlargement of coronary arteries was underestimated by the single cross-section analysis and was observed in 80% of cases when a multiple cross-section per artery analysis was applied. Paradoxical shrinkage was less common and often occurred in combination with compensatory enlargement within the same analyzed segment.

Adult↗

[The clinical, angiographic and procedural predictors of thrombosis and restenosis in Micro stent II (AVE) coronary stents].

The aim of the study was to assess the incidence and the predictors of thrombosis and restenosis in Micro stent II AVE. In a sample of 197 stents successfully implanted in 181 consecutive patients, the incidence of thrombosis was 4.1%. The multivariate analysis showed the minimum lumen diameter post-stenting to be the only independent predictor of overall thrombosis. In fact, we found that the risk of thrombosis increases as the minimal lumen diameter decreases. Angiographic follow-up was available in 74% of the stents at 6.8 +/- 4.1 months and stent restenosis occurred in 26.2% of cases. Independent predictors of restenosis (multivariate linear discriminant analysis) were: 1) nominal stent diameter (the risk of restenosis decreases as the stent diameter increases); 2) the ratio between the diameter of the balloon carrying the stent measured at the maximum pressure/nominal stent diameter (the risk increases as the ratio decreases); 3) stented vessel (the risk increases in the following order: right coronary < circumflex < left anterior descending); 4) the American Heart Association classification of lesion morphology (the risk increases in the order A < B < C); 5) a lower risk was found in the absence of diabetes mellitus.

Aged↗

On-line three-dimensional intracoronary ultrasound for guidance of catheter based interventions.

Intracoronary ultrasound (ICUS) provides valuable information on the distribution and composition of atherosclerotic plaque. For this reason its use for guidance of interventional procedures has been advocated. Recently, on-line systems of three-dimensional reconstruction have been introduced and offer great potential for guidance of interventional procedures since valuable details on longitudinal architecture of the plaque under treatment are obtained. In this article we review the current clinical application of three-dimensional (3-D) ICUS and report our experience with the use of an on-line 3-D ICUS system for guidance of interventional procedures. In our experience 3-D reconstruction of ICUS proved to be a feasible method facilitating device selection and guidance of catheter based interventions.

Catheter Ablation↗

Is quantitative angiography sufficient to guide stent implantation? A comparison with three-dimensional reconstruction of intracoronary ultrasound images.

Intracoronary ultrasound (ICUS) frequently reveals stent underexpansion despite a satisfactory angiographic result by visual assessment. Whether on-line quantitative coronary angiography (QCA) alone can guide optimal stent deployment is still unknown. The aim of the study was to assess the usefulness of quantitative coronary angiography in the evaluation of optimal stent expansion, confirmed with a new on-line system of 3-D reconstruction of ICUS. The results obtained with 3-D ICUS were compared with the measurements achieved with QCA analyses in 49 patients (70 stents: 31 Palmaz-Schatz, 22 Wallstent, 7 Cordis, 6 Micro-stent, 2 Gianturco-Roubin, 2 Multi-Link). Following delivery of the stent, high pressure intrastent balloon inflation (14.2 +/- 3.3 atmospheres) was performed in all 70 stents. Optimal stent implantation by QCA was defined as minimal lumen diameter post-stenting > or = 90% of the reference diameter preintervention. Percent diameter stenosis (% DS) post-stenting was defined as minimal lumen diameter divided by the reference diameter post-stenting. The on-line 3-D ICUS reconstructions and measurements were performed processing the images on-line in the catheterization laboratory with an automated contour detection algorithm based on acoustic quantification. ICUS criteria for optimal stent expansion were defined as: 1) complete apposition of stent struts to vessel wall; 2) minimal stent lumen cross-sectional area > or = 80% of the average lumen area of the proximal and distal reference segments; 3) symmetry index (minimum divided by maximum lumen diameter) > 0.7. Ninety-seven percent of the deployed stents met the QCA criteria. Whilst 3-D ICUS documented complete stent apposition to the vessel wall in all cases and a symmetric expansion in 65 of 70 lesions (93%), the stent minimal lumen area was > or = 80% only in 30 out of 70 stents (43%). The diagnostic sensitivity and specificity at 10% residual diameter stenosis provided by QCA for optimal stent expansion compared to 3-D ICUS criteria were 86 and 45%, respectively. In conclusion 3-D ICUS criteria of adequate stent expansion were achieved only in 43% of patients despite the application of aggressive strategies of stent deployment leading to optimal results with quantitative angiography. Ten percent residual diameter stenosis provided by QCA may be an acceptable alternative for optimal stent deployment in clinical practice. The clinical benefit of an ICUS guided approach of stent deployment and of a lower cost strategy using on-line QCA guidance should be compared in large prospective randomized studies.

Angiocardiography↗

Usefulness of three-dimensional reconstruction for interpretation and quantitative analysis of intracoronary ultrasound during stent deployment.

We examined 49 coronary stents in 33 patients after angiographically guided optimization of the deployment by intracoronary ultrasound, and compared the findings of a conventional 2-dimensional analysis approach with the results obtained from an automatic lumen recognition provided by a 3-dimensional reconstruction system. The automatic lumen analysis demonstrated that only 15 stents (31%) fulfilled defined ultrasound criteria of adequate stent deployment, and that 5 of these cases were missed by the conventional approach, which systematically overestimated the dimensions of the minimal stent lumen.

Angioplasty, Balloon, Coronary↗

Usefulness of on-line three-dimensional reconstruction of intracoronary ultrasound for guidance of stent deployment.

The additional information provided by automated on-line 3-dimensional (3-D) reconstruction of intracoronary ultrasound (ICUS) was assessed in 42 patients (62 stents) who underwent stent deployment after achieving an optimal quantitative angiographic result. In 10 of 42 patients, 3-D ICUS was also performed before stenting. ICUS images of stents and adjacent reference segments were acquired by using a motorized pullback at a constant speed (1 mm/s) and immediately processed in the catheterization laboratory. Optimal stent expansion was detected by 3-D ICUS in case of complete apposition of stent struts to the vessel wall. Furthermore, an attempt was made to maximize the intrastent lumen area to match lumen area of the reference segment and to cover with stents all the segments with residual significant lesions (plaque burden >50%). Three-dimensional automated reconstruction of ICUS was successful in 8 of 10 patients (80%) before, and in 36 of 42 patients (86%) after stent deployment. In all 8 patients who underwent successful 3-D ICUS assessment before stent implantation, the selection of stent length was facilitated by accurately measuring the lesion length. After stenting, 3-D ICUS modified the management strategy in 21 of 36 patients (58%), triggering additional high-pressure dilatations in 13 patients (36%) and additional stent deployment in 8 (22%). In conclusion, on-line 3-D ICUS facilitates stent selection and strongly modifies the revascularization strategy by accurately detecting stent underexpansion and presence of uncovered lesions.

Aged↗