University of Florence

About: University of Florence is a education organization based out in Florence, Toscana, Italy. It is known for research contribution in the topics: Population & Carbonic anhydrase. The organization has 27292 authors who have published 79599 publications receiving 2341684 citations. The organization is also known as: Università degli studi di Firenze & Universita degli studi di Firenze.

Pheochromocytoma: recommendations for clinical practice from the First International Symposium

Abstract: Pheochromocytomas are rare, often hereditary, catecholamine producing tumors that can be difficult to diagnose and manage. This Review summarizes the recommendations for biochemical and genetic testing, localization and treatment, and is based on discussions at the First International Symposium on Pheochromocytoma, held in October 2005. The First International Symposium on Pheochromocytoma, held in October 2005, included discussions about developments concerning these rare catecholamine-producing tumors. Recommendations were made during the symposium for biochemical diagnosis, localization, genetics, and treatment. Measurement of plasma or urinary fractionated metanephrines, the most accurate screening approach, was recommended as the first-line test for diagnosis; reference intervals should favor sensitivity over specificity. Localization studies should only follow reasonable clinical evidence of a tumor. Preoperative pharmacologic blockade of circulatory responses to catecholamines is mandatory. Because approximately a quarter of tumors develop secondary to germ-line mutations in any one of five genes, mutation testing should be considered; however, it is not currently cost effective to test every gene in every patient. Consideration of tumor location, presence of multiple tumors, presence of metastases, and type of catecholamine produced is useful in deciding which genes to test. Inadequate methods to distinguish malignant from benign tumors and a lack of effective treatments for malignancy are important problems requiring further resolution.

Effect of Tocilizumab vs Standard Care on Clinical Worsening in Patients Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial.

Abstract: Importance The coronavirus disease 2019 (COVID-19) pandemic is threatening billions of people worldwide. Tocilizumab has shown promising results in retrospective studies in patients with COVID-19 pneumonia with a good safety profile. Objective To evaluate the effect of early tocilizumab administration vs standard therapy in preventing clinical worsening in patients hospitalized with COVID-19 pneumonia. Design, Setting, and Participants Prospective, open-label, randomized clinical trial that randomized patients hospitalized between March 31 and June 11, 2020, with COVID-19 pneumonia to receive tocilizumab or standard of care in 24 hospitals in Italy. Cases of COVID-19 were confirmed by polymerase chain reaction method with nasopharyngeal swab. Eligibility criteria included COVID-19 pneumonia documented by radiologic imaging, partial pressure of arterial oxygen to fraction of inspired oxygen (Pao2/Fio2) ratio between 200 and 300 mm Hg, and an inflammatory phenotype defined by fever and elevated C-reactive protein. Interventions Patients in the experimental arm received intravenous tocilizumab within 8 hours from randomization (8 mg/kg up to a maximum of 800 mg), followed by a second dose after 12 hours. Patients in the control arm received supportive care following the protocols of each clinical center until clinical worsening and then could receive tocilizumab as a rescue therapy. Main Outcome and Measures The primary composite outcome was defined as entry into the intensive care unit with invasive mechanical ventilation, death from all causes, or clinical aggravation documented by the finding of a Pao2/Fio2ratio less than 150 mm Hg, whichever came first. Results A total of 126 patients were randomized (60 to the tocilizumab group; 66 to the control group). The median (interquartile range) age was 60.0 (53.0-72.0) years, and the majority of patients were male (77 of 126, 61.1%). Three patients withdrew from the study, leaving 123 patients available for the intention-to-treat analyses. Seventeen patients of 60 (28.3%) in the tocilizumab arm and 17 of 63 (27.0%) in the standard care group showed clinical worsening within 14 days since randomization (rate ratio, 1.05; 95% CI, 0.59-1.86). Two patients in the experimental group and 1 in the control group died before 30 days from randomization, and 6 and 5 patients were intubated in the 2 groups, respectively. The trial was prematurely interrupted after an interim analysis for futility. Conclusions and Relevance In this randomized clinical trial of hospitalized adult patients with COVID-19 pneumonia and Pao2/Fio2ratio between 200 and 300 mm Hg who received tocilizumab, no benefit on disease progression was observed compared with standard care. Further blinded, placebo-controlled randomized clinical trials are needed to confirm the results and to evaluate possible applications of tocilizumab in different stages of the disease. Trial Registration ClinicalTrials.gov Identifier:NCT04346355; EudraCT Identifier:2020-001386-37

Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years.

Abstract: Objective To reassess, in a cohort of patients with early-onset multiple sclerosis, the long-term evolution of cognitive deficits, their relationship to the disease's clinical progression, and their effects on daily life. Design Ten years after our baseline assessment, we again compared the cognitive performance of patients and control subjects on a neuropsychological test battery. Clinical and demographic correlates of cognitive impairment and their effects on everyday functioning were determined by multiple linear regression analysis. Setting The research clinic of a university department of neurology. Participants Forty-five inpatients and outpatients with multiple sclerosis and 65 demographically matched healthy controls from the original sample. Main Outcome Measures Mean scores of both groups on the neuropsychological test battery in initial and 2 follow-up evaluations (about 4 and 10 years, respectively); number of cognitively impaired subjects, defined by the number of subtests failed; regression coefficients measuring the relationship between clinical variables and cognitive outcome and between mental decline and everyday functioning assessed by the Environmental and the Incapacity Status Scales. Results Previously detected cognitive defects in verbal memory, abstract reasoning, and linguistic processes were confirmed on the third testing, at which time deficits in attention/short-term spatial memory also emerged. Only 20 of 37 patients who were cognitively unimpaired on initial testing remained so by the end of the follow-up, when the proportion of subjects who were cognitively impaired reached 56%. Degree of physical disability, progressive disease course, and increasing age predicted the extent of cognitive decline. Disability level and degree of cognitive impairment were independent predictors of a patient's handicap in the workplace and in social settings. Conclusions In the course of a sufficiently long follow-up, cognitive dysfunction is likely to emerge and progress in a sizable proportion of patients. As multiple sclerosis advances, neurological and cognitive involvement tend to converge. Limitations in a patient's work and social activities are correlated with the extent of cognitive decline, independent of degree of physical disability.

Esca (Black Measles) and Brown Wood-Streaking: Two Old and Elusive Diseases of Grapevines

Abstract: “Esca” disease of grapevine has long been known wherever grapes are grown. The disease may be as old as vine cultivation itself. References to esca-like symptoms are found in several ancient Greek and Latin works. Greater descriptive accuracy is found in medieval works such as the Kitab al-Felahah by Ibn al-Awam, a Spanish Muslim who lived in Seville at the end of the twelfth century, and the Opus Ruralium Commodorum by Pietro de’ Crescenzi, born around 1233 in Bologna. Esca is a Latin word meaning food, aliment, or, figuratively, bait. The name indirectly refers to the fruiting bodies of certain wood-rotting fungi. For example, Fomes, which in Latin means “tinder,” is the name of a genus of basidiomycetes once used to make a dry, easily ignited material suitable to start fires when using flints. Wood decayed by these fungi, including rotted grapevine wood, burned slowly and was used to keep fires aglow without a flame. Esca is a complex disease that comprises an array of symptoms, some of which have locally given their own names to the disease. For example in California, the dark, tiny spotting of the grapes is called “black measles.” In many grapevine-growing areas of the world, the sudden wilting of esca-affected vines in summer has earned this form of the disease the name “apoplexy.” Research on the etiology of esca, which started at the end of the nineteenth century in France, can be divided into three periods. The first period began in 1898 with Ravaz (61) and ended in 1926 with Viala (79). The overall conclusion of this period was that two basidiomycetous fungi, Stereum hirsutum (Willd.) Pers. and Phellinus (Fomes) igniarius (L.:Fr.) Quél., were the causal agents, although this could not be shown by pathogenicity tests. However, in Italy in 1912, Petri (58) successfully reproduced some early internal esca symptoms with two undetermined species of Cephalosporium and one of Acremonium that had also been associated with the disease. The second period in esca research started in California in 1957 with Hewitt (35) and lasted until 1959, when Chiarappa (9) detected the relationship between internal wood decay and black measles. He also showed how a Cephalosporium sp. reproduced in vivo some of the symptoms observed in the wood of diseased vines, and how P. igniarius caused wood decay in vitro. The third period, initiated by Larignon and Dubos in 1987 (39) and still underway, is directed at understanding the role of the mitosporic (asexually reproducing) fungi that act alone or together with the basidiomycetes to cause esca and related diseases. In the 1990s, studies on esca and its etiology have intensified. This came after a dramatic upsurge in the disease, especially in Germany, Italy, and Greece, where the arsenites, traditionally used to keep esca under control, have been banned and were replaced by less effective fungicides. However, even in France, Portugal, and Spain, where restricted use of sodium arsenite is still permitted, esca is widespread in all vine-growing regions. This paper refers mostly to conditions in the Mediterranean area and focuses on the progress achieved in our understanding of esca over the last few years. Reference is also made to a decline of young grapevines caused by some of the same mitosporic fungi as those commonly associated with esca in adult vines. Finally, the relations between esca and related syndromes or diseases are also discussed.

Research criteria for subcortical vascular dementia in clinical trials.

Abstract: Vascular dementia (VaD) incorporate different vascular mechanisms and changes in the brain, and have different causes and clinical manifestations. Variation in defining the cognitive syndrome, in vascular etiologies, and allowable brain changes in current clinical definitions of VaD have resulted in variable estimates of prevalence, of groups of subjects, and of the types and distribution of putative causal brain lesions. Thus current criteria for VaD select an etiologically and clinically heterogeneous group. This definitional heterogeneity may have been a factor in “negative” clinical trials. An alternative for clinical drug trials is to focus on a more homogenous group, such as those with subcortical (ischemic) VaD. This designation incorporates two small vessel clinical entities “Binswanger’s disease” and “the lacunar state”. It comprises small vessel disease as the primary vascular etiology, lacunar infarct(s) and ischaemic white matter lesions as the primary type of brain lesions, and subcortical location as the primary location of lesions. The subcortical clinical syndrome is the primary clinical manifestation, a definition which still requires additional empirical data. We expect that subcortical VaD show a more predictable clinical picture, natural history, outcome, and treatment responses. We propose a modification of the NINDS-AIREN criteria as a new research criteria for subcortical VaD.