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Article ; Online: Re: "Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients That Should Be Ramped up Immediately as Key to the Pandemic Crisis".

Meini, Simone

2020 Volume 190, Issue 7, Page(s) 1434–1435

MeSH term(s)	Ambulatory Care ; COVID-19 ; Humans ; Outpatients ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2020-12-15
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwaa274
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Article ; Online: Detection of a pituitary macroadenoma with transcranial ultrasonography: Principles and potential clinical applications.

Meini, Simone / Andreini, Roberto / Cozza, Sabino

Journal of clinical ultrasound : JCU

2022 Volume 50, Issue 3, Page(s) 411–414

Abstract: Transcranial color-coded duplex sonography (TCCS) allows to study intracranial vessels through the intact skull, but the visualization of normal and pathologic brain structures in adults is often suboptimal due to inadequate acoustic window. The full ... ...

Abstract	Transcranial color-coded duplex sonography (TCCS) allows to study intracranial vessels through the intact skull, but the visualization of normal and pathologic brain structures in adults is often suboptimal due to inadequate acoustic window. The full potential of TCCS for clinical practice remains unfulfilled. Here, we describe the ability of TCCS to detect a non-functioning pituitary macroadenoma in a 58-year-old man affected by headache. The macroadenoma was visualized as a roundish, well-defined mass, mildly hyperechogenic compared to the hypoechogenic mesencephalic brainstem but mainly hypoechogenic compared to the surrounding intracranial structures. Intracranial vessels represented useful landmarks. Using tissue harmonic imaging mode, the borders of the macroadenoma were visualized more clearly. Macroadenoma characteristics were confirmed by magnetic resonance imaging. Neurosonologists should be aware of the possibility to incidentally find, during routinary TCCS, pituitary macroadenomas or other brain tumors (as incidentalomas), worthy to be recognized and referred for further investigations.
MeSH term(s)	Adult ; Brain ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Ultrasonography ; Ultrasonography, Doppler, Color/methods ; Ultrasonography, Doppler, Transcranial/methods
Language	English
Publishing date	2022-02-15
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	189393-2
ISSN	1097-0096 ; 0091-2751
ISSN (online)	1097-0096
ISSN	0091-2751
DOI	10.1002/jcu.23156
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Article ; Online: Correction to: Mono vs. combo regimens with novel beta-lactam/beta-lactamase inhibitor combinations for the treatment of infections due to carbapenemase-producing Enterobacterales: insights from the literature.

Meini, Simone / Viaggi, Bruno / Tascini, Carlo

Infection

2021 Volume 49, Issue 3, Page(s) 423–425

Language	English
Publishing date	2021-03-16
Publishing country	Germany
Document type	Published Erratum
ZDB-ID	185104-4
ISSN	1439-0973 ; 0300-8126 ; 0173-2129
ISSN (online)	1439-0973
ISSN	0300-8126 ; 0173-2129
DOI	10.1007/s15010-021-01596-8
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Article ; Online: Mono vs. combo regimens with novel beta-lactam/beta-lactamase inhibitor combinations for the treatment of infections due to carbapenemase-producing Enterobacterales: insights from the literature.

Meini, Simone / Viaggi, Bruno / Tascini, Carlo

Infection

2021 Volume 49, Issue 3, Page(s) 411–421

Abstract: Ceftazidime-avibactam (CZA), meropenem-vaborbactam (MVB) and imipenem-relebactam (I-R) are combinations of old ß-lactams with novel non-ß-lactam ß-lactamase inhibitors (BLBLIs) able to inhibit some carbapenemases, such as the KPC-type, thus are becoming ... ...

Abstract	Ceftazidime-avibactam (CZA), meropenem-vaborbactam (MVB) and imipenem-relebactam (I-R) are combinations of old ß-lactams with novel non-ß-lactam ß-lactamase inhibitors (BLBLIs) able to inhibit some carbapenemases, such as the KPC-type, thus are becoming the standard for difficult-to-treat carbapenemase-producing Enterobacterales (CPE); a practical question is whether these novel BLBLIs should be used as monotherapy or as part of a combination regimen with other antibiotics, and if so, with which ones, to reduce the emergence of resistant strains and to optimize their efficacy. In this short review, we assessed clinical outcomes in patients with CPE-infections treated with the novel BLBLIs as mono- or combo-regimens, and laboratory studies on the synergistic effects with other antimicrobials. Available evidence on combination therapy is scarce and mainly limited to retrospective studies involving 630 patients treated with CZA: aminoglycosides were used in 39.6% of 336 patients treated with combo-regimens, followed by polymyxin B/colistin (24.4%), tigecycline (24.1%), carbapenems (13.4%) and fosfomycin (5.4%). Aminoglycosides could be useful in case of bloodstream and severe urinary infections. Pneumonia is a risk factor for CZA-resistance emergence: fosfomycin, due to favorable lung pharmacokinetics/pharmacodynamics, could represent an interesting partner; fosfomycin could be added also for osteomyelitis. Tigecycline could be preferred for intrabdominal and skin-soft tissue infections. Due to nephrotoxicity and lack of in vitro synergy, the association CZA/colistin seems not optimal. MVB and I-R were mostly used as monotherapies. Currently, there is no definitive evidence whether combinations are more effective than monotherapies; further studies are warranted, and to date only personal opinions can be provided.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Bacterial Proteins ; Drug Combinations ; Enterobacteriaceae Infections/drug therapy ; Humans ; Lactams/therapeutic use ; Microbial Sensitivity Tests ; Retrospective Studies ; beta-Lactamase Inhibitors/therapeutic use ; beta-Lactamases
Chemical Substances	Anti-Bacterial Agents ; Bacterial Proteins ; Drug Combinations ; Lactams ; beta-Lactamase Inhibitors ; beta-Lactamases (EC 3.5.2.6) ; carbapenemase (EC 3.5.2.6)
Language	English
Publishing date	2021-02-03
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	185104-4
ISSN	1439-0973 ; 0300-8126 ; 0173-2129
ISSN (online)	1439-0973
ISSN	0300-8126 ; 0173-2129
DOI	10.1007/s15010-021-01577-x
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Article ; Online: Intussusceptive angiogenesis in Covid-19: hypothesis on the significance and focus on the possible role of FGF2.

Meini, Simone / Giani, Tommaso / Tascini, Carlo

Molecular biology reports

2020 Volume 47, Issue 10, Page(s) 8301–8304

Abstract: The interest on the role of angiogenesis in the pathogenesis and progression of human interstitial lung diseases is growing, with conventional sprouting (SA) and non-sprouting intussusceptive angiogenesis (IA) being differently represented in specific ... ...

Abstract	The interest on the role of angiogenesis in the pathogenesis and progression of human interstitial lung diseases is growing, with conventional sprouting (SA) and non-sprouting intussusceptive angiogenesis (IA) being differently represented in specific pulmonary injury patterns. The role of viruses as key regulators of angiogenesis is known for several years. A significantly enhanced amount of new vessel growth, through a mechanism of IA, has been reported in lungs of patients who died from Covid-19; among the angiogenesis-related genes, fibroblast growth factor 2 (FGF2) was found to be upregulated. These findings are intriguing. FGF2 plays a role in some viral infections: the upregulation is involved in the MERS-CoV-induced strong apoptotic response crucial for its highly lytic replication cycle in lung cells, whereas FGF2 is protective against the acute lung injury induced by H1N1 influenza virus, improving the lung wet-to-dry weight ratio. FGF2 plays a role also in regulating IA, acting on pericytes (crucial for the formation of intraluminal pillars), and endothelium, and FGF2-induced angiogenesis may be promoted by inflammation and hypoxia. IA is a faster and probably more efficient process than SA, able to modulate vascular remodeling through pruning of redundant or inefficient blood vessels. We can speculate that IA might have the function of restoring a functional vascular plexus consequently to extensive endothelialitis and alveolar capillary micro-thrombosis observed in Covid-19. Anti-Vascular endothelial growth factor (anti-VEGF) strategies are currently investigated for treatment of severe and critically ill Covid-19 patients, but also FGF2, and its expression and/or signaling, might represent a promising target.
MeSH term(s)	Antiviral Agents/pharmacology ; Antiviral Agents/therapeutic use ; COVID-19 ; Coronavirus Infections/drug therapy ; Coronavirus Infections/etiology ; Coronavirus Infections/pathology ; Drug Delivery Systems ; Fibroblast Growth Factor 2/antagonists & inhibitors ; Fibroblast Growth Factor 2/metabolism ; Humans ; Intussusception/virology ; Neovascularization, Pathologic/genetics ; Neovascularization, Pathologic/virology ; Pandemics ; Pneumonia, Viral/drug therapy ; Pneumonia, Viral/etiology ; Pneumonia, Viral/pathology
Chemical Substances	Antiviral Agents ; Fibroblast Growth Factor 2 (103107-01-3)
Keywords	covid19
Language	English
Publishing date	2020-09-12
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	186544-4
ISSN	1573-4978 ; 0301-4851
ISSN (online)	1573-4978
ISSN	0301-4851
DOI	10.1007/s11033-020-05831-7
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Article ; Online: A Severe Necrotizing Inflammatory Reaction of Leg Wounds Following Autologous Peripheral Blood Total Nucleated Cells Treatment in an Old Patient With Rheumatoid Arthritis and No-Option Chronic Limb-Threatening Ischemia: Is Cell Therapy Suitable for All Patients?

Vallini, Valerio / Venturini, Luigi / Carnesecchi, Paolo / Andreini, Roberto / Meini, Simone

The international journal of lower extremity wounds

2021 Volume 22, Issue 1, Page(s) 179–184

Abstract: Chronic limb-threatening ischemia (CLTI) represents an unfavorable evolution of peripheral artery disease, characterized by pain at rest, ulceration, and gangrene and also by an increased risk of cardiovascular events, amputations, and death. According ... ...

Abstract	Chronic limb-threatening ischemia (CLTI) represents an unfavorable evolution of peripheral artery disease, characterized by pain at rest, ulceration, and gangrene and also by an increased risk of cardiovascular events, amputations, and death. According to scientific literature, in almost one third of cases affected by CLTI, defined as no-option CLTI patients, revascularization strategies are not feasible. In the past decade, several studies investigated the role of therapeutic angiogenesis through cell autologous therapy, administered through intramuscular injections or multiple local intralesional and perilesional injections. In this article, we report the case of a necrotizing inflammatory reaction in a patient affected by CLTI and chronic leg wounds that occurred on the multiple injection sites after autologous peripheral blood-derived mononuclear cells (PB-TNCs) transplantation. Since the patient was affected by corticosteroid-induced skin atrophy and rheumatoid arthritis, we hypothesize that an increased skin fragility and a mechanism of immune-mediated pathergy could have been main factors leading to worsening of wounds. This case report strongly suggests the urgent need to better define the indications and contraindications of cell therapy, and further studies of adequate methodology are required to definitively assess the efficacy and safety of autologous cell therapy by local injections of PB-TNCs in patients with chronic inflammatory disorder, such as rheumatoid arthritis, especially in case of concomitant marked skin atrophy. Pending definitive evidence from literature, a strong caution is needed in patients affected by chronic systemic inflammatory diseases, since multiple injections, acting as mechanical stimulus and pathergy trigger, might exacerbate a severe and uncontrolled inflammatory response.
MeSH term(s)	Humans ; Leg/blood supply ; Chronic Limb-Threatening Ischemia ; Treatment Outcome ; Ischemia/etiology ; Ischemia/therapy ; Peripheral Arterial Disease ; Arthritis, Rheumatoid/therapy ; Arthritis, Rheumatoid/surgery ; Chronic Disease ; Limb Salvage/adverse effects ; Risk Factors ; Retrospective Studies
Language	English
Publishing date	2021-03-15
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2171119-7
ISSN	1552-6941 ; 1534-7346
ISSN (online)	1552-6941
ISSN	1534-7346
DOI	10.1177/1534734621997570
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Article: Intussusceptive angiogenesis in Covid-19: hypothesis on the significance and focus on the possible role of FGF2

Meini, Simone / Giani, Tommaso / Tascini, Carlo

Molecular biology reports. 2020 Oct., v. 47, no. 10

2020

Abstract	The interest on the role of angiogenesis in the pathogenesis and progression of human interstitial lung diseases is growing, with conventional sprouting (SA) and non-sprouting intussusceptive angiogenesis (IA) being differently represented in specific pulmonary injury patterns. The role of viruses as key regulators of angiogenesis is known for several years. A significantly enhanced amount of new vessel growth, through a mechanism of IA, has been reported in lungs of patients who died from Covid-19; among the angiogenesis-related genes, fibroblast growth factor 2 (FGF2) was found to be upregulated. These findings are intriguing. FGF2 plays a role in some viral infections: the upregulation is involved in the MERS-CoV-induced strong apoptotic response crucial for its highly lytic replication cycle in lung cells, whereas FGF2 is protective against the acute lung injury induced by H1N1 influenza virus, improving the lung wet-to-dry weight ratio. FGF2 plays a role also in regulating IA, acting on pericytes (crucial for the formation of intraluminal pillars), and endothelium, and FGF2-induced angiogenesis may be promoted by inflammation and hypoxia. IA is a faster and probably more efficient process than SA, able to modulate vascular remodeling through pruning of redundant or inefficient blood vessels. We can speculate that IA might have the function of restoring a functional vascular plexus consequently to extensive endothelialitis and alveolar capillary micro-thrombosis observed in Covid-19. Anti-Vascular endothelial growth factor (anti-VEGF) strategies are currently investigated for treatment of severe and critically ill Covid-19 patients, but also FGF2, and its expression and/or signaling, might represent a promising target.
Keywords	COVID-19 infection ; Orthomyxoviridae ; angiogenesis ; apoptosis ; blood ; endothelium ; fibroblast growth factor 2 ; humans ; hypoxia ; inflammation ; lungs ; molecular biology ; pathogenesis
Language	English
Dates of publication	2020-10
Size	p. 8301-8304.
Publishing place	Springer Netherlands
Document type	Article
Note	NAL-AP-2-clean
ZDB-ID	186544-4
ISSN	1573-4978 ; 0301-4851
ISSN (online)	1573-4978
ISSN	0301-4851
DOI	10.1007/s11033-020-05831-7
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Article ; Online: Clinical outcomes in elderly patients with infections caused by NDM-producing Klebsiella pneumoniae: results from a real-life retrospective single center study in an endemic area.

Mura, Maddalena / Longo, Benedetta / Andreini, Roberto / Sbrana, Francesco / Ripoli, Andrea / Andreoli, Elisabetta / Sani, Spartaco / Tumbarello, Mario / Meini, Simone

Internal and emergency medicine

2023 Volume 18, Issue 8, Page(s) 2261–2269

Abstract: Real-life outcomes data for elderly patients with infections caused by Klebsiella pneumoniae producing New Delhi metallo-beta-lactamase (NDM-Kp) are lacking. We conducted a retrospective cohort study enrolling 33 consecutive adult patients (mean age 77.4 ...

Abstract	Real-life outcomes data for elderly patients with infections caused by Klebsiella pneumoniae producing New Delhi metallo-beta-lactamase (NDM-Kp) are lacking. We conducted a retrospective cohort study enrolling 33 consecutive adult patients (mean age 77.4 years; 48.5% males; mean Charlson Comorbidity Index-CCI 5.9) hospitalized for NDM-Kp infections during a 24-month period in an Italian highly endemic area. 78.8% were admitted to Internal Medicine ward. 45.4% of patients had bloodstream infections (BSI), 39.4% urinary tract infections (UTI) without BSI, 9.1% respiratory tract infections and 6.1% intra-abdominal infections. 93.9% had rectal colonization.Adequate definitive antibiotic therapy (mainly represented by aztreonam plus ceftazidime/avibactam) was provided to 36.4% of cases. Mean age and CCI of patients adequately treated were significantly lower than those inadequately treated (71.2 vs 80.9 years, p = 0.041, and 4.6 vs 6.7, p = 0.040, respectively). Patients adequately treated had a mean hospitalization length significantly higher (28 vs 15 days, p = 0.016). The overall 30-day survival rate of patients adequately and inadequately treated was 83.3% and 57.1%, respectively: this difference was not statistically significant. Mean age and CCI of 22 patients who survived at 30 days were lower than those of 11 patients who died (73.7 vs 84.8 years, p = 0.003, and 5.3 vs 7.2, p = 0.049, respectively). Twelve survivors received an inadequate therapy: 8/12 had UTI. Six of nine patients inadequately treated who died within 30 days, died before microbiological diagnosis. Our study provides real-life data on outcomes of elderly and multimorbid patients hospitalized for infections caused by NDM-Kp. Further studies with larger sample size are warranted.
MeSH term(s)	Adult ; Male ; Humans ; Aged ; Female ; Retrospective Studies ; Klebsiella pneumoniae ; Klebsiella Infections/drug therapy ; Klebsiella Infections/epidemiology ; Klebsiella Infections/microbiology ; Anti-Bacterial Agents/therapeutic use ; Aztreonam ; Urinary Tract Infections/drug therapy ; Microbial Sensitivity Tests
Chemical Substances	Anti-Bacterial Agents ; Aztreonam (G2B4VE5GH8)
Language	English
Publishing date	2023-09-12
Publishing country	Italy
Document type	Journal Article ; Comment
ZDB-ID	2454173-4
ISSN	1970-9366 ; 1828-0447
ISSN (online)	1970-9366
ISSN	1828-0447
DOI	10.1007/s11739-023-03416-3
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Article ; Online: Reinfection of SARS-CoV-2 - analysis of 23 cases from the literature.

Roberts, Anna Teresa / Piani, Fiorella / Longo, Benedetta / Andreini, Roberto / Meini, Simone

Infectious diseases (London, England)

2021 Volume 53, Issue 7, Page(s) 479–485

Abstract: Introduction: The duration of immunity after infection from SARS-CoV-2 conferring protection from subsequent COVID-19 episodes is not yet fully understood. We reviewed the literature for cases of documented reinfection.: Materials and methods: A ... ...

Abstract	Introduction: The duration of immunity after infection from SARS-CoV-2 conferring protection from subsequent COVID-19 episodes is not yet fully understood. We reviewed the literature for cases of documented reinfection. Materials and methods: A comprehensive computerized search in PubMed, through 15 December 2020, using the following terms in combination: Results: We identified 23 cases globally, for which viral genome analysis was performed in 10 cases and serology in 19 cases. The mean interval between the two episodes was 15 weeks. Mean age of cases was 44.5 years, and 10 (43.5%) were women. In 17/23 cases, no comorbidity was observed. In 10 cases, the first episode was more severe than the ensuing episode, whereas in seven cases the ensuing episode was more severe. In four cases, there was no difference in severity and in two cases both episodes were asymptomatic. Conclusions: From this sample of 23 cases, a clear pattern of the second episode being less or more severe did not emerge. A better understanding of immunity to SARS-CoV-2, necessary to assess the probability of a second infection and the durability of protection conferred by vaccination, is warranted.
MeSH term(s)	Adult ; COVID-19 ; Comorbidity ; Female ; Humans ; Male ; Recurrence ; Reinfection ; SARS-CoV-2
Language	English
Publishing date	2021-04-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2839775-7
ISSN	2374-4243 ; 2374-4235
ISSN (online)	2374-4243
ISSN	2374-4235
DOI	10.1080/23744235.2021.1905174
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Article ; Online: Validity of "Sepsis-3" criteria in identifying patients with community-onset sepsis in Internal Medicine wards; a prospective, multicenter study.

Fortini, Alberto / Faraone, Antonio / Meini, Simone / Bettucchi, Michael / Longo, Benedetta / Valoriani, Beatrice / Forni, Silvia

European journal of internal medicine

2021 Volume 85, Page(s) 92–97

Abstract: Background: Few data are available on the validity of "Sepsis-3" criteria in identifying patients with sepsis in internal medicine wards (IMWs). Real-life data about this topic and on the prevalence of sepsis in IMWs could be useful for improving ... ...

Abstract	Background: Few data are available on the validity of "Sepsis-3" criteria in identifying patients with sepsis in internal medicine wards (IMWs). Real-life data about this topic and on the prevalence of sepsis in IMWs could be useful for improving hospital organization. Objectives: To assess the validity of "Sepsis-3" criteria in identifying patients with community-onset sepsis in IMWs. Secondary objectives: to evaluate the prevalence of these patients in IMWs and to compare "Sepsis-3" and "Sepsis-1" criteria. Methods: Multicenter, prospective, observational, cohort study, carried out in 22 IMWs of Tuscany (Italy). All patients admitted to each of the study centers over a period of 21-31 days were evaluated within 48 hours; those with clinical signs of infection were enrolled. The main outcome was in-hospital mortality. Results: 2,839 patients were evaluated and 938 (33%) met the inclusion criteria. Patients with sepsis diagnosed according to "Sepsis-3" were 522, representing 55.6% of patients with infection and 18.4% of all patients hospitalized; they were older than those without sepsis (79.4±12.5 vs 74.6±15.2 years, p<0.001). In-hospital mortality was significantly higher in patients with sepsis compared to others (13.8% vs 4.6%; p<0.001). "Sepsis-3" criteria showed greater predictive validity for in-hospital mortality than "Sepsis-1" criteria (AUROC=0.71; 95%CI, 0.66-0.77 vs 0.60; 95%CI 0.54-0.66; p=0.0038). Conclusions: "Sepsis-3" criteria are able to identify patients with community-onset sepsis in IMWs, whose prevalence and in-hospital mortality are remarkably high. Medical departments should adapt their organization to the needs for care of these complex patients.
MeSH term(s)	Cohort Studies ; Hospital Mortality ; Hospitals ; Humans ; Italy/epidemiology ; Prospective Studies ; Retrospective Studies ; Sepsis/diagnosis ; Sepsis/epidemiology
Language	English
Publishing date	2021-01-12
Publishing country	Netherlands
Document type	Journal Article ; Multicenter Study
ZDB-ID	1038679-8
ISSN	1879-0828 ; 0953-6205
ISSN (online)	1879-0828
ISSN	0953-6205
DOI	10.1016/j.ejim.2020.12.025
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