Biomedical subjects

M Pepe

Publications and source records attributed to M Pepe.

At least 19 recordsLinked to original sources

PubMed2003

Management of syncope referred urgently to general hospitals with and without syncope units.

OBJECTIVE: We tested the hypothesis that management of patients with syncope admitted urgently to a general hospital may be influenced by the presence of an in-hospital structured syncope unit. BACKGROUND: The management of syncope is not standardized. Methods We compared six hospitals equipped with a syncope unit organized inside the department of cardiology with six matched hospitals without such facilities. The study enroled all consecutive patients referred to the emergency room from 5 November 2001 to 7 December 2001 who were affected by transient loss of consciousness as their principal symptom. RESULTS: There were 279 patients in the syncope unit hospitals and 274 in the control hospitals. In the study group, 30 (11%) patients were referred to the syncope unit for evaluation. In the study group, 12% fewer patients were hospitalized (43 vs 49%, not significant) and 8% fewer tests were performed (3.3+/-2.2 vs 3.6+/-2.2 per patient, not significant). In particular, the study group patients underwent fewer basic laboratory tests (75 vs 86%, P=0.002), fewer brain-imaging examinations (17 vs 24%, P=0.05), fewer echocardiograms (11 vs 16%, P=0.04), more carotid sinus massage (13 vs 8%, P=0.03) and more tilt testing (8 vs 1%, P=0.000). In the study group, there was a +56% rate of final diagnosis of neurally mediated syncope (56 vs 36%, P=0.000). CONCLUSION: Although only a minority of patients admitted as an emergency are referred to the syncope unit, overall management is substantially affected. It is speculated that the use of a standardized approach, such as that typically adopted in the syncope unit, is able to influence overall practice in the hospital.

Adult↗

PubMed2002

The impact of body-weight components on forced spirometry in healthy italians.

Many studies have investigated lung function in relation to age and height among Caucasians, however, most of these studies did not consider the individual components of body weight. The objective of the present study was to study the effect of body weight components [bone-free lean body mass (BF-LBM), bone mineral content (BMC), and fat mass (FM)] measured by dual x-ray absorptiometry (DXA) on the lung-function variables (FVC, FEV1, and PEF) and to derive prediction equations for these variables in healthy adult Italians. Dynamic spirometric tests and body composition analysis by DXA were performed on 58 nonsmoking males, mean age ( +/-SE) 26.72 +/- 1.98 years and BMI 25.51 +/- 0.64 kg/m2, and 60 nonsmoking females matched for age and BMI (29.61 +/- 1.65 years and 26.45 +/- 1.05 kg/m2, respectively). Bivariate linear regression analysis showed the variables age, height, BF-LBM, BMC, and the interaction term BF-LBM*Height, but not weight and FM, to correlate significantly with lung-function variables for males and for females separately. Multiple linear regression analysis showed that sex, age, height, and BF-LBM*Height were significantly associated with FVC, FEV1, and PEF. The prediction equations developed for FVC, FEV1, and PEF on the basis of the independent variables i.e. sex, age (y), height (m), and BF-LBM*Height (kg. m) had a significantly higher cumulative correlation coefficient and a lower SEE compared with those based on age and height only. The present report suggests that the BF-LBM, expressed independently from height, can be considered for predicting lung-function variables.

Adolescent↗

PubMed2002

Sexual inactivity results in reversible reduction of LH bioavailability.

We have recently documented significantly reduced serum testosterone (T) levels in patients with erectile dysfunction (ED). To understand the mechanism of this hypotestosteronemia, which was independent of the etiology of ED, and its reversibility only in patients in whom a variety of nonhormonal therapies restored sexual activity, we measured serum luteinizing hormone (LH) in the same cohort of ED patients (n=83; 70% organic, 30% nonorganic). Both immunoreactive LH (I-LH) and bioactive LH (B-LH) were measured at entry and 3 months after therapy. Based on outcome (ie number of successful attempts of intercourse per month), patients were categorized as full responders (namely, at least eight attempts; n=51), partial responders (at least one attempt; n=20) and non-responders (n=16). Compared to 30 healthy men with no ED, baseline B-LH (mean+/-s.d.) in the 83 patients was decreased (13.6+/-5.5 vs 31.7+/-6.9 IU/L, P<0.001), in the face of a slightly increased, but in the normal range, I-LH (5.3+/-1.8 vs 3.4+/-0.9 IU/L, P<0.001); consequently, the B/I LH ratio was decreased (3.6+/-3.9 vs 9.7+/-3.3, P<0.001). Similar to our previous observation for serum T, the three outcome groups did not differ significantly for any of these three parameters at baseline. However, outcome groups differed after therapy. Bioactivity of LH increased markedly in full responders (pre-therapy=13.7+/-5.3, post-therapy=22.6+/-5.4, P<0.001), modestly in partial responders (14.8+/-6.9 vs 17.2+/-7.0, P<0.05) but remained unchanged in non-responders (11.2+/-2.2 vs 12.2+/-5.1). The corresponding changes went in the opposite direction for I-LH (5.2+/-1.7 vs 2.6+/-5.4, P<0.001; 5.4+/-2.2 vs 4.0+/-1.7, P<0.05; 5.6+/-1.2 vs 5.0+/-1.2, respectively), and in the same direction as B-LH for the B/I ratio (3.7+/-4.1 vs 11.8+/-7.8, P<0.001; 4.2+/-4.3 vs 5.8+/-4.2, P<0.05; 2.1+/-0.7 vs 2.6+/-1.3, respectively). We hypothesize that the hypotestosteronemia of ED patients is due to impaired bioactivity of LH. This reduced bioactivity is reversible, provided that resumption of sexual activity is achieved regardless of the therapeutic modality. Because biopotency of pituitary hormones is controlled by the hypothalamus, LH hypoactivity should be due to the hypothalamic functional damage associated to the psychological disturbances which unavoidably follow sexual inactivity.

Adult↗

PubMed2002

Body composition and pulmonary function in obese type 2 diabetic women.

Most patients with Type 2 diabetes mellitus (T2DM) are overweight and their fat-distribution pattern shows more truncal and less peripheral subcutaneous fat. Obesity also influences the respiratory system by mechanical effects on the diaphragm and chest wall depending on the distribution and size of excess adipose tissues. To determine if the impairment of pulmonary function in T2DM is associated with truncal fat distribution, we performed dynamic spirometric tests and body composition analysis, by dual X-ray absorptiometry, in 12 non-smoker mildly obese T2DM women and in an equal number of control normoglycaemic females, matched for age, body mass index and smoking habits. The forced vital capacity and forced expiratory volume in one second for T2DM women (2.67 +/- 0.30 and 2.15 +/- 0.20 1, respectively) were significantly (p < 0.05) lower than for control women (3.22 +/- 0.30 and 2.58 +/- 0.31 1, respectively). However, trunk fat mass and trunk lean body mass for T2DM women (16.68 +/- 2.31 and 20.87 +/- 1.91 kg, respectively) were comparable with those for controls (16.46 +/- 2.54 and 19.65 +/- 3.42 kg, respectively). Thus, we deduce that pulmonary function impairment in T2DM obese women is not associated with truncal fat mass deposition or with lean mass depletion.

Absorptiometry, Photon↗

PubMed2002

Evaluation of the innate immune response in pups during canine parvovirus type 1 infection.

In two pups (A and B) naturally infected with canine parvovirus type 1 (CPV1) phagocytic responses were evaluated over a period of two weeks (day 0 = T0; day 3 = T1; day 7 = T2; day 14 = T3). CPV1 infection led to a marked reduction of monocyte (MO) phagocytosis in both pups. Also MO killing was impaired and in pup B this function was totally absent. Polymorphonuclear (PMN) phagocytosis values of both pups fluctuated within normal ranges, as well as PMN killing of pup A. In pup B, killing exerted by PMN was absent at T0, then increased but again dropped below normal ranges at T3. The described alterations of phagocytic functions may be regarded as possible viral mechanisms of immune evasion.

Animals↗

PubMed2001

Relationship between apparent optical properties and photosynthetic pigments in the sub-alpine Lake Iseo.

The aim of the present study was the evaluation of methods for estimating the content of bio-physical parameters in lake water on the basis of spectral reflectance measured above water surface, in particular the estimation of chlorophyll-a (chl-a) concentrations. Data sets considered refer to some sampling point located in the sub-alpine meso-eutrophic Lake Iseo, surveyed six times over the period March-July and once in November 1998, as these months were very important for the characterization of the springtime algal bloom, which affect the lake waters yearly. At each point station, limnological observations (chlorophyll, total suspended solids, Secchi disk depth) were conducted simultaneously with optical measurements. The latter consisted of water leaving radiance measured by means of a spectroradiometer above the water surface; moreover, a standard reflector radiance was also measured to obtain the water reflectance. Reflectance spectra were transformed according to two well-documented models and correlated to water quality parameters, to investigate their performances as retrieval algorithms under different conditions and referring to different analytical methods. Results outline the sensitivity of the models to chl-a concentrations, different phytoplankton composition, and the sampling depth.

Chlorophyll↗

PubMed2001

Detecting chlorophyll, Secchi disk depth and surface temperature in a sub-alpine lake using Landsat imagery.

Some bio-physical parameters, such as chlorophyll a concentration, Secchi disk depth and water surface temperature were mapped in the sub-alpine Lake Iseo (Italy) using Landsat Thematic Mapper (TM) data acquired on the 7 March 1997. In order to adequately investigate the water-leaving radiance, TM data were atmospherically corrected using a partially image-based method, and the atmospheric transmittance was measured in synchrony with the satellite passage. An empirical approach of relating atmospherically corrected TM spectral reflectance values to in situ measurements, collected during the satellite data acquisition, was used. The models developed were used to map the chlorophyll concentration and Secchi disk depth throughout the lake. Both models gave high determination coefficients (R2 = 0.99 for chlorophyll and R2 = 0.85 for the Secchi disk) and the spatial distribution of chlorophyll concentration and Secchi disk depth was mapped with contour intervals of 1 mg/m3 and 1 m, respectively. A scene-independent procedure was used to derive the surface temperature of the lake from the TM data with a root mean square error of 0.3 degrees C.

Atmosphere↗

PubMed2001

't Hooft loop in SU(2) Yang-Mills theory.

We study the behavior of the spatial and temporal 't Hooft loop at zero and finite temperature in the 4D SU(2) Yang-Mills theory, using a new numerical method. In the deconfined phase T > T(c), the spatial 't Hooft loop exhibits a dual string tension, which vanishes at T(c) with a 3D Ising-like critical exponent.

Journal Article↗

PubMed2001

Prevalence of chronic prostatitis in men with premature ejaculation.

OBJECTIVES: To investigate the prevalence of chronic prostatitis in men with premature ejaculation. The etiology of premature ejaculation is currently considered psychological in nature. However, the possibility that urologic, hormonal, or neurologic factors may contribute to this condition should be considered in its management. METHODS: We evaluated segmented urine specimens before and after prostatic massage and expressed prostatic secretion specimens from 46 patients with premature ejaculation and 30 controls by bacteriologic localization studies. The incidence of premature ejaculation in the subjects with chronic prostatitis was also evaluated. RESULTS: Prostatic inflammation was found in 56.5% and chronic bacterial prostatitis in 47.8% of the subjects with premature ejaculation, respectively. When compared with the controls, these novel findings were statistically significant (P <0.05). CONCLUSIONS: Considering the role of the prostate gland in the mechanism of ejaculation, we suggest a role for chronic prostate inflammation in the pathogenesis of some cases of premature ejaculation. Since chronic prostatitis has been found with a high frequency in men with premature ejaculation, we stress the importance of a careful examination of the prostate before any pharmacologic or psychosexual therapy for premature ejaculation.

Adult↗

PubMed2001

Immediate and long-term atrial sensing stability in single-lead VDD pacing depends on right atrial dimensions.

AIMS: Single-pass VDD is a physiological stimulation mode which requires a single-lead with a floating dipole to detect the atrial signal. We investigated the impact of right heart dimensions on immediate and long-term atrial sensing stability in VDD systems to draw guidelines for optimal atrial sensitivity programming. METHODS: Forty-one patients (23 males, mean age 73 +/- 11 years) with II or III degree AV block and normal sinus node function received a Thera VDD Medtronic 8948 pulse generator with Medtronic 5032 lead. Atrial sensing was evaluated at pre-discharge and during 12-months follow-up in the supine and upright positions, during normal and forced breathing. Atrial sensing variability, quantified by a D value (mV), which represents the difference between the maximum and the minimum atrial electrogram amplitude obtained during the various activities, was analyzed and related to right heart dimensions measured at echocardiography. RESULTS: Long-term appropriate atrial sensing was obtained in 40/41 patients. P wave mean amplitude at pre-discharge, during every specific activity, was predictive of 12-month values. No atrial oversensing was observed. According to the right atrial dimension (RAD), patients with RAD > 38 mm had a sensing variability significantly higher than those with RAD < or = 34 mm (D=1 + 1 Vs D=0.4+/-0.5; P<0.05). A linear relationship between D and RAD dimensions was observed (r=0.47; P<0.005). According to the distance from the roof of the right atrium to the right ventricular apex (RAVD), patients with RAVD < 93 mm had D=1.1 +/- 1, while patients with RAVD > 93 mm had D=0.5 +/- 0.4; P<0.05); a inverse correlation between RAVD and D was highlighted (r=-0.43; P<0.01). Using a cluster analysis, the combination of RAD and RAVD identified a subgroup (RAD > 30 mm and RAVD < 80 mm) at high risk of loss of AV synchrony with 67% sensitivity and 80% specificity. Nevertheless, apart from heart dimensions, no patient showed an atrial signal amplitude lower than 0.3 mV. CONCLUSIONS: According to our data, in VDD single-lead systems the amplitude of the atrial signal is stable over time in every physical activity. High RAD and low RAVD values may select patients with poor atrial sensing stability. Anyway, taking into account that no atrial oversensing was observed, atrial sensitivity setting at the highest value should be recommended.

Aged↗

PubMed2001

Defining a pulmonary exacerbation in cystic fibrosis.

OBJECTIVES: Despite the central importance of pulmonary exacerbations (PExs) as an outcome measure in cystic fibrosis clinical trials, no standardized definition of PEx exists. We conducted a prospective, multicenter study to establish a standardized PEx definition and score for use in clinical trials, based on clinical status rather than on treatment decisions. STUDY DESIGN: Subjects were 246 patients enrolled in the placebo arm of a randomized, controlled trial of tobramycin for inhalation. Physician-investigators completed PEx questionnaires on all subjects at scheduled intervals during the 6-month study, indicating new or worsening symptoms, physical examination findings, and impression of PEx status (presence or absence and severity). Logistic regression was used to assess the relative importance of each of the characteristics in predicting a PEx. RESULTS: We developed 2 PEx scores that use easily ascertained symptoms and chest examination findings; one also includes change in forced expiratory volume in 1 second over the preceding month. Both scores were sensitive and specific for predicting the presence of a PEx (sensitivity, 86%; specificity, 86%). The scores were validated in subjects in the intervention arm of the trial. CONCLUSION: We hope that the proposed PEx score might serve as a standardized outcome measure for future clinical trials in cystic fibrosis, allowing meaningful comparisons of study results.

Administration, Inhalation↗

PubMed2001

A syndrome characterized by psychiatric disorders, recurrent mucosal infections and natural immunity deficits: clinical approach.

The authors summarize their own previous work on the identification of a subset of patients characterized by psychiatric disorders, recurrency of mucosal infections and impaired natural immunity. The diagnostic approach to these patients based on the close collaboration between infectivologists, immunologists and psychiatrists is described with the aim to find out combined treatments for the amelioration of clinical manifestations.

Humans↗

PubMed2001

Immune responses to fungal infections and therapeutic implications.

Host responses to fungi result from a coordinate interplay between innate and adaptative immune system. Neutrophils and monocytes are involved in the non specific clearance of yeasts (e.g. Candida albicans and Cryptococcus neoformans), while T helper 1 type responses are protective via release of interferon gamma. By contrast, T helper 2 responses (IL-4 and IL 10 release) correlate with disease exacerbation and pathology. IL-12 production which enhances T helper 1 type responses seem to exert a beneficial role in the course of Candida infection. In particular, its production from neutrophilis may support memory T helper 1 cell responses of the fungus. With respect to anti-Candida vaccines several approaches are in progress, such as use of heat-killed Candida albicans in combination with adjuvants, purified peptides and proteins and immunogenic peptide-lipid conjugates. Furthermore, exogenous IL-12 may play an important role in inducing a T helper 1 anticandidal response, also replacing neutrophils in neutropenic patients. At the same time, granulocyte-colony stimulating factor has exhibited therapeutic efficacy in experimental and human models of fungal infection.

Animals↗

PubMed2000

Rotation of the clavicular portion of the pectoralis major for soft-tissue coverage of the clavicle. An anatomical study and case report.

BACKGROUND: The purposes of this study were to describe the anatomical features of a rotational flap consisting of the clavicular portion of the pectoralis major and to report the surgical technique and the outcome of use of this flap in a patient with poor soft-tissue coverage following multiple operations for a clavicular fracture complicated by nonunion and infection. METHODS: Ten shoulders from five cadavera were dissected to isolate the clavicular portion of the pectoralis major. The vascular pedicle, thoracoacromial artery, and axillary artery were identified, and the length of the vascular pedicle from the axillary artery to the muscle was measured. The angle of rotation of the flap about its intact clavicular origin was measured before and after division of the acromial branch of the thoracoacromial artery. The clavicular origin was then incised, and the overall length, width, and thickness of the muscle as well as the distance from each end of the muscle to the vascular pedicle were measured. RESULTS: The average length of the vascular pedicle from the axillary artery to the pectoralis muscle belly was 5.3 centimeters (range, 3.7 to 6.5 centimeters). The average maximum angle of rotation with the clavicular origin intact was 60 degrees (range, 55 to 67 degrees) before division of the acromial branch and 73 degrees (range, 65 to 82 degrees) after division. The average total length of the clavicular head was 20.2 centimeters (range, 18.0 to 23.0 centimeters). The average width of the clavicular head was 2.9 centimeters (range, 2.0 to 4.0 centimeters), and the average thickness was 0.5 centimeter (range, 0.2 to 0.7 centimeter). The vascular pedicle entered the muscle an average of 8.7 centimeters (range, 5.2 to 10.7 centimeters) lateral to the most medial extent of the muscle and an average of 11.5 centimeters (range, 9.5 to 14.0 centimeters) medial to the most lateral extent of the muscle. The rotational flap was successfully used clinically to provide soft-tissue coverage after bone-grafting and internal fixation of a clavicular nonunion that had been complicated by infection. CONCLUSIONS: The clavicular head of the pectoralis major may be used as a local rotational flap to cover soft-tissue deficiencies over the clavicle. It can be harvested with relative ease without damaging the sternocostal head.

Aged↗

PubMed2000

Evaluation of the natural immunity in pups inoculated with a modified-live canine parvovirus type 2b (CPV-2b) strain.

Three pups 2-4 months old were vaccinated subcutaneously with the modified live canine parvovirus, CPV-2b/29-97 strain. During an observation period of two weeks pups remained clinically health, exhibiting a vigorous post-vaccinal active serological response (haemoagglutinating inhibiting antibody titers for CPV-2 ranging from 1:2560 to 1:5120 at 21 days post inoculation). Phagocytosis and killing of Candida albicans exerted by polymorphonuclear cells and monocytes did not undergo significant modifications 3-6 days post vaccination up to 30 days. Antibacterial activity mediated by peripheral blood lymphocytes (Salmonella typhi was used as a target) was slightly, but not significantly decreased 3 days post vaccination. Conclusively, in pups the CPV type 2b vaccine seems to be safe as far as natural immune responses are concerned, while its immunogenicity is preserved.

Animals↗

PubMed1999

Nutritional effects of long-term gastrostomy feedings in children with cystic fibrosis.

OBJECTIVE: To analyze the long-term nutritional effects of supplemental gastrostomy feedings in undernourished patients with cystic fibrosis. DESIGN: Longitudinal, retrospective assessment of anthropometric measures before and for up to 4 years after gastrostomy. SUBJECTS/SETTING: All patients at a large cystic fibrosis care center who underwent gastrostomy between 1980 and 1993 when they were at least 1 year old and were followed up for a minimum of 1 year after gastrostomy. STATISTICAL ANALYSES PERFORMED: The Mann-Whitney U test was used to compare anthropometric values measured during 4 postgastrostomy time intervals with values measured during the year preceding gastrostomy. RESULTS: The 21 patients ranged in age from 1.1 to 20.8 years (median age = 7.4 years). They had mild to moderate malnutrition at the time of gastrostomy. Patients were followed up for a mean of 39 months after gastrostomy. Supplemental feedings were associated with significant improvements in weight and height percentiles for age, and in weight as a percentage of ideal weight. Improvement in weight occurred earlier than improvement in height. Among subjects followed up for at least 18 months after gastrostomy, median weight percentile for age increased from 2% for the year before gastrostomy to 12% for the period 6 to 18 months after gastrostomy (P < .001) and 19% for the period 30 to 48 months after gastrostomy (P = .002 compared with before gastrostomy). Other nutritional parameters followed similar, although less dramatic patterns. Gastrostomy feedings were well tolerated and associated with only minor complications. CONCLUSIONS: Long-term gastrostomy feedings appear to be a safe and effective means of improving nutrition in malnourished patients with cystic fibrosis. Clinical dietitians should function as care managers for patients with cystic fibrosis who are receiving supplemental gastrostomy feedings.

Adolescent↗

PubMed1999

Lack of sexual activity from erectile dysfunction is associated with a reversible reduction in serum testosterone.

The role of androgenic hormones in human sexuality, in the mechanism of erection and in the pathogenesis of impotence is under debate. While the use of testosterone is common in the clinical therapy of male erectile dysfunction, hypogonadism is a rare cause of impotence. We evaluated serum testosterone levels in men with erectile dysfunction resulting either from organic or non-organic causes before and after non-hormonal impotence therapy. Eighty-three consecutive cases of impotence (70% organic, 30% non-organic, vascular aetiology being the most frequent) were subjected to hormonal screening before and after various psychological, medical (prostaglandin E1, yohimbine) or mechanical therapies (vascular surgery, penile prostheses, vacuum devices). Thirty age-matched healthy men served as a control group. Compared to controls, patients with impotence resulting from both organic and non-organic causes showed reduced serum levels of both total testosterone (11.1 +/- 2.4 vs. 17.7 +/- 5.5 nmol/L) and free testosterone (56.2 +/- 22.9 vs. 79.4 +/- 27.0 pmol/L) (both p < 0.001). Irrespective of the different aetiologies and of the various impotence therapies, a dramatic increase in serum total and free testosterone levels (15.6 +/- 4.2 nmol/L and 73.8 +/- 22.5 pmol/L, respectively) was observed in patients who achieved normal sexual activity 3 months after commencing therapy (p < 0.001). On the contrary, serum testosterone levels did not change in patients in whom therapies were ineffective. Since the pre-therapy low testosterone levels were independent of the aetiology of impotence, we hypothesize that this hormonal pattern is related to the loss of sexual activity, as demonstrated by its normalization with the resumption of coital activity after different therapies. The corollary is that sexual activity may feed itself throughout the increase in testosterone levels.

Adolescent↗

PubMed1997

Gender gap in cystic fibrosis mortality.

The authors conducted the largest study to date of survival in cystic fibrosis. The study cohort consisted of all patients with cystic fibrosis seen at Cystic Fibrosis Foundation-accredited care centers in the United States between 1988 and 1992 (n = 21,047), or approximately 85% of all US patients diagnosed with cystic fibrosis. Cox proportional hazards regression analysis was used to compare the age-specific mortality rates of males and females and to identify risk factors serving as potential explanatory variables for the gender-related difference in survival. Among the subjects 1-20 years of age, females were 60% more likely to die than males (relative risk = 1.6, 95% confidence interval 1.4-1.8). Outside this age range, male and female survival rates were not significantly different. The median survival for females was 25.3 years and for males was 28.4 years. Nutritional status, pulmonary function, and airway microbiology at a given age were strong predictors of mortality at subsequent ages. Nonetheless, differences between the genders in these parameters, as well as pancreatic insufficiency, age at diagnosis, mode of presentation, and race, could not account for the poorer survival among females. Even after adjustment for all these potential risk factors, females in the age range 1-20 years remained at greater risk for death (relative risk = 1.6, 95% confidence interval 1.2-2.1). The authors concluded that in 1- to 20-year-old individuals with cystic fibrosis, survival in females was poorer than in males. This "gender gap" was not explained by a wide variety of potential risk factors.

Adolescent↗