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Boosting platelet inhibition in poor responder to aspirin and clopidogrel undergoing percutaneous coronary intervention: role of tirofiban
Gianluca Campo, Luca Fileti, Marco Valgimigli, et al
Journal of Blood Medicine , 2010, DOI: http://dx.doi.org/10.2147/JBM.S7236
Abstract: oosting platelet inhibition in poor responder to aspirin and clopidogrel undergoing percutaneous coronary intervention: role of tirofiban Review (3494) Total Article Views Authors: Gianluca Campo, Luca Fileti, Marco Valgimigli, et al Published Date May 2010 Volume 2010:1 Pages 61 - 69 DOI: http://dx.doi.org/10.2147/JBM.S7236 Gianluca Campo1, Luca Fileti1, Marco Valgimigli1, Jlenia Marchesini1, Antonella Scalone1, Roberto Ferrari1,2 1Cardiovascular Institute, Azienda Ospedaliera Universitaria S Anna, Ferrara, Italy; 2Cardiovascular Research Centre, Salvatore Maugeri Foundation, IRCCS Gussago (BS), Italy Abstract: Nowadays, aspirin (acetylsalicylic acid) and clopidogrel form the cornerstone in prevention of cardiovascular events and their clinical effectiveness has been well established. The thienopyridine clopidogrel is a prodrug that, after hepatic metabolization, strongly inhibits adenosine diphosphate-induced platelet aggregation. Aspirin is a non-steroidal anti-inflammatory drug that exerts its anti-platelet action through the irreversible acetylation of platelet cyclooxygenase (COX)-1, blocking thromboxane A2 production. However, despite dual-antiplatelet therapy, some patients still develop recurrent cardiovascular ischemic events. Many studies have clearly showed that a marked variability exists in the responsiveness to aspirin and clopidogrel, being the poor responder patients at higher risk of short (peri-procedural) and long-term ischemic complications. In particular, these patients showed a major recurrence of myocardial infarction and, after stent implantation, of stent thrombosis. The mechanisms of aspirin and clopidogrel poor response are numerous and not fully elucidated, and are likely multifactorial (eg, genetic polymorphisms, elevated baseline platelet reactivity, drug interaction). How to improve the short- and long-term outcome of these patients is currently unknown. Recently published and ongoing clinical trials are evaluating different strategies for the acute and chronic treatments (eg, reload of clopidogrel, double clopidogrel maintenance dose, switching to prasugrel). In this paper, we reviewed all available evidence on aspirin and clopidogrel resistance and focused our attention on tirofiban, a glycoprotein IIb/IIIa inhibitor that may be used to obtain a better platelet inhibition in poor responder patients during the acute phase and in particular during percutaneous coronary intervention.
Abciximab: a reappraisal of its use in coronary care
Marco Valgimigli,Gianluca Campo,Matteo Tebaldi,Roberto Carletti
Biologics: Targets and Therapy , 2008,
Abstract: Marco Valgimigli, Gianluca Campo, Matteo Tebaldi, Roberto Carletti, Chiara Arcozzi, Roberto Ferrari, Gianfranco PercocoCardiovascular Institute, Azienda Ospedaliera Universitaria S. Anna, Ferrara, Italy and Cardiovascular Research Centre, Salvatore Maugeri Foundation, IRCCS Gussago (BS), ItalyAbstract: Platelet reactivity plays a pivotal role in the pathogenesis of ischemic adverse events during and after acute coronary syndromes (ACS), and percutaneous coronary intervention (PCI). Glycoprotein (GP) IIb/IIIa inhibitors are the strongest antiplatelet agents currently available on the market and three different compounds, namely abciximab, tirofiban, and eptifibatide, have been approved for clinical use. Abciximab has been investigated in the clinical field far more extensively than the other GPIIb/IIIa inhibitors. Abciximab is an anti-integrin Fab fragment of a human – mouse chimeric monoclonal antibody with high affinity and a slow dissociation rate from the GP IIb/IIIa platelet receptor. Abciximab, given shortly before the coronary intervention, is superior to placebo in reducing the acute risk of ischemic complications (EPIC, EPISTENT, EPILOG trials); moreover, in the ISAR-REACT 2 study abciximab has been shown to reduce the risk of adverse events in patients with non ST-segment elevation ACS who are undergoing PCI even after optimal pre-treatment with 600 mg of clopidogrel. Finally, abciximab has been also used in abciximab-coated stent, with only bolus administration regimen and for direct intracoronary use with promising results that may extend and/or modify its current use in clinical practice in future.Keywords: abciximab, percutaneous coronary intervention, myocardial infarction
Coronary artery anomalies presenting with ST-segment elevation myocardial infarction
Jlenia Marchesini,Gianluca Campo,Riccardo Righi,Giorgio Benea
Clinics and Practice , 2011, DOI: 10.4081/cp.2011.e107
Abstract: ST-segment elevation MI (STEMI) is a rare presentation in patients with coronary artery anomalies. In these patients, the identification of the culprit lesion and its treatment may be difficult, particularly in the emergency setting of primary percutaneous coronary intervention (PCI). From January 2008 to April 2011, 1015 STEMI patients received coronary artery angiography and primary PCI in our centre. Of these, 5 (0.4%) patients showed a coronary artery anomaly. In this paper we reported two rare cases: i) the first is a single coronary artery originating from right sinus of Valsalva; ii) the second is a separate origin of 3 coronary arteries originating from the right sinus of Valsalva. In conclusion, coronary artery anomalies presenting with STEMI are really uncommon, but often are a challenge. The integration between traditional coronary artery angiography and multidetector computerized tomography is crucial to optimize the interventional and medical management of these patients
In Vitro Characterization of Circulating Endothelial Progenitor Cells Isolated from Patients with Acute Coronary Syndrome
Diana Campioni, Giorgio Zauli, Stefania Gambetti, Gianluca Campo, Antonio Cuneo, Roberto Ferrari, Paola Secchiero
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0056377
Abstract: Background The current understanding of the functional characteristics of circulating endothelial progenitor cells (EPC) is limited, especially in patients affected by cardiovascular diseases. In this study, we have analyzed the in vitro clonogenic capacity of circulating EPC, also known as endothelial colony-forming cells (ECFC), in patients with acute coronary syndrome (ACS), in comparison to the colony forming unit-endothelial-like cells (CFU-EC) of hematopoietic/monocytic origin. Methodology/Principal Findings By culturing peripheral blood mononuclear cells (PBMC) of patients with ACS (n = 70), CFU-EC were frequently isolated (from 77% of ACS patients), while EPC/ECFC were obtained only in a small subset (13%) of PBMC samples, all harvested between 7–14 days after the acute cardiovascular event. Notably, ex-vivo generation of EPC/ECFC was correlated to a higher in vitro release of PDGF-AA by the corresponding ACS patient PBMC. By using specific endothelial culture media, EPC/ECFC displayed in vitro expansion capacity, allowing the phenotypic and functional characterization of the cells. Indeed, after expansion, EPC/ECFC exhibited a normal diploid chromosomal setting by FISH analysis and an immunophenotype characterized by: i) uniform positivity for the expression of CD105, CD31, CD146 and Factor VIII, i) variable expression of the CD34, CD106 and CD184 markers, and iii) negativity for CD45, CD90, CD117 and CD133. Of interest, in single-cell replanting assays EPC/ECFC exhibited clonogenic expansion capacity, forming secondary colonies characterized by variable proliferation capacities. Conclusion/Significance Our data indicate that a careful characterization of true EPC is needed in order to design future studies in the clinical autologous setting of patients with ACS.
Pro-inflammatory genetic profile and familiarity of acute myocardial infarction
Manuela Ianni, Sergio Callegari, Antonio Rizzo, Paolo Pastori, Paolo Moruzzi, Domenico Corradi, Elisa Porcellini, Gianluca Campo, Roberto Ferrari, Marco M Ferrario, Stefania Bitonte, Ilaria Carbone, Federico Licastro
Immunity & Ageing , 2012, DOI: 10.1186/1742-4933-9-14
Abstract: This study showed that a genetic signature consisting of the concomitant presence of the CC genotype of VEGF, the A allele of IL-10 and the A allele of IFN-γ was indeed present in the Offs population. In fact, the above genetic markers were more frequent in unaffected Offs (46.4%) and patients with sporadic AMI (31.8%) than in the CTR (17.3%) and the differences were highly statistically significant (Offs vs CTR: p?=?0.0001, OR?=?4.129; AMI vs CTR: p?=?0.0001, OR?=?2.224). During the 24-year follow-up, Offs with a positive familiarity in spite of a relatively young age showed an increased prevalence of diabetes, ischemic heart disease and stroke. These findings reinforce the notion that subjects with a familial history of AMI are at risk of an accelerated aging of cardiovascular system resulting in cardiovascular events.Our data suggest that selected genes with immune regulatory functions are part of the complex genetic background contributing to familiarity for cardiovascular diseases. This inflammatory genetic profile, along with classical cardiovascular risk factors, may be used for better defining individual risk of AMI in unaffected subjects.
Epicardial Fat Thickness as Cardiovascular Risk Factor and Therapeutic Target in Patients with Rheumatoid Arthritis Treated with Biological and Nonbiological Therapies
Marcos M. Lima-Martínez,Ediris Campo,Johanmary Salazar,Mariela Paoli,Irama Maldonado,Carlota Acosta,Marianela Rodney,Miguel Contreras,Julio O. Cabrera-Rego,Gianluca Iacobellis
Arthritis , 2014, DOI: 10.1155/2014/782850
Abstract: Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with high cardiovascular morbidity and mortality. Epicardial adipose tissue (EAT) thickness may act as a therapeutic target during treatments with drugs modulating the adipose tissue. We evaluate EAT thickness in RA patients treated with biological and nonbiological disease-modifying antirheumatic drugs (DMARDs). A cross-sectional study was conducted with a cohort of 34 female RA patients and 16 controls matched for age and body mass index (BMI). Plasma glucose, basal insulin, plasma lipids, and high-sensitivity C-reactive protein (hs-CRP) were assessed. EAT thickness and left ventricular mass (LVM) were measured by echocardiography. No significant differences in waist circumference (WC), blood pressure, fasting blood glucose, basal insulin, and lipid parameters were found between the groups. The control group showed lower concentrations () of hs-CRP and LVM () than those of the two RA groups. Patients treated with TNF-α inhibitors showed significantly lower EAT thickness than those treated with nonbiological DMARDs (8.56 ± 1.90?mm versus 9.71 ± 1.45?mm; ). Women with no RA revealed reduced EAT thickness (5.39 ± 1.52?mm) as compared to all RA patients (). Results suggest that RA patients have greater EAT thickness than controls regardless of BMI and WC. 1. Introduction Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with high cardiovascular morbidity and mortality [1]. Traditional risk factors along with inflammation and autoimmunity contribute to the development of coronary artery disease in RA patients [1]. Furthermore, a growing body of evidence has proved that these subjects present early alterations in some subclinical atherosclerosis markers [2, 3]. Tumor necrosis factor-alpha (TNF-α) is the key cytokine in RA inflammatory processes. Several clinical studies have proved that TNF-α inhibitors are effective in reducing the clinical signs of inflammation in RA patients whose treatment with nonbiological disease-modifying antirheumatic drugs (DMARDs) has been unsatisfactory [4, 5]. An additional benefit of the treatment with TNF-α inhibitors is the reduction in the risk of cardiovascular events [6]. Epicardial adipose tissue (EAT) thickness has recently emerged as new marker of cardiometabolic risk [7]. Clinically, the thickness of epicardial fat can be easily and accurately measured [8]. Epicardial fat thickness can serve as marker of visceral adiposity and visceral fat changes during treatments with drugs targeting the fat [9, 10]. A meta-analysis conducted
Dental Treatment with 30% Trichloroacetic Acid in a Patient with Moderate Hemophilia A  [PDF]
Evelyn Gonzalez Delgado, Gianluca Sottilotta
Open Journal of Blood Diseases (OJBD) , 2013, DOI: 10.4236/ojbd.2013.31003

We present the case of a 51-year-old moderate hemophiliac with gingival bleeding due to papillary inflammation and adherence in the molar area 47. After dental diagnosis a calculus was removed and 30% trichloroacetic acid was placed by a pressurized applicator for five seconds; the procedure was repeated until the bleeding stopped, then tranexamic acid was placed by a gauze. The patient chewed the gauze for 30 minutes and was discharged after repeating the same procedure for 30 minutes more. We observed how local treatment with trichloroacetic acid combined to tranexamic acid placed on the hemorrhagic site was able to stop the bleeding.

Book Review: Nicola Russo Filosofia ed ecologia. Idee sulla scienza e sulla prassi ecologiche Guida Editore, Napoli 2000
Gianluca Giannini
S&F_scienzaefilosofia.it , 2009,
IN-E-vocazioni della fine (o della cinemetafisica)
Gianluca Giannini
S&F_scienzaefilosofia.it , 2012,
Abstract: Is it somehow necessary for the human being to be? Is there something that reveals the need of the human being (and for the human being) to continue to be? Through the intersection between philosophy and cinema, and the age-old problem of “The End of the World”, this paper tries to develop an hypothesis involving the deconstruction of this question and, finally, of the inner reasons that support any answers based on traditional Metaphysics.
Jünger/Céline. Sulla Catastrofe
Gianluca Leggiero
S&F_scienzaefilosofia.it , 2012,
Abstract: In their works Jünger and Céline – a part from their meetings in Paris – have always dealt with the theme of the catastrophe, even in terms of apocalypse. This catastrophe has been considered both as an historical fact – in the experience of the First and Second World War – and a cultural phenomenon represented by nihilism – the philosophy through which the twentieth century showed its nature. For the French writer the catastrophe coincides with life itself, rather, it proves the unreasonableness of life, so that the apocalypse ultimately comes to represent a sort of universal catharsis. In Jünger, both the catastrophe and the apocalypse are means to a higher revelation, through which man can recover an original and poetic way of being in the world.
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