| 1. |
- Marchesi, Marcello, et al.
(författare)
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Modified protocol of the intraoral welding technique for immediate implant-supported rehabilitation of the edentulous maxilla
- 2015
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Ingår i: Implant Dentistry. - : Lippincott Williams & Wilkins. - 1056-6163 .- 1538-2982. ; 24:1, s. 110-116
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to report the outcomes of a treatment option of immediate loading with intraoral welding on only 4 implants for the restoration of patients with maxillary edentulism. MATERIALS AND METHODS: Seventeen consecutive patients were rehabilitated with 2 parallel and 2 tilted implants in the maxilla. Immediately after implant placement, angulated abutments were screwed on the implants to create better parallelism among the implants; thereafter, a titanium bar was intraorally welded to the welding pins to create a superstructure that rigidly splinted the implants. A fixed full-arch durable prosthesis was delivered on the same day of the surgery. The patients were followed for 26.5 months on average. RESULTS: During the follow-up time, 2 implants were lost giving an implant survival rate of 97%. Nonetheless, all the prostheses remained in function and the prosthetic success was 100%. CONCLUSIONS: The rehabilitation of the edentulous maxilla with an immediately loaded full-arch prosthesis, obtained through intraoral welding on only 4 implants, is a functionally and esthetically successful treatment.
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| 2. |
- Marchesi, Silvia, et al.
(författare)
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Abdominal Edema and Inflammation in a Ventilator-Induced Lung Injury Model : Comparison Between Spontaneous Breathing and Mechanical Ventilation
- 2016
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Ingår i: American Journal of Respiratory and Critical Care Medicine. - 1073-449X .- 1535-4970. ; 193
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- RATIONALE. The amount of abdominal edema and inflammation were investigated in a porcine model of ventilator-induced lung injury,VILI, and potential differences between spontaneously breathing and mechanically ventilated animals were studied.METHODS. Twelve piglets were submitted to a double hit lung injury. Five lung lavages with warm saline were followed by one hour ofinjurious ventilation: peak airway pressure 32 cmH2O, PEEP 0 and oxygen fraction (FIO2) 1. The animals were randomized into two groups:1. Mechanical ventilation (MV) group (tidal volume: 6 ml/kg, PEEP 15, respiratory rate around 40 and FIO2 0,5); 2. Spontaneous breathing(SB) group (CPAP mode with PEEP 15 and FIO2 0,5). Remifentanil infusion was provided in the SB group, to maintain analgesia while stillenabling spontaneous breathing.After six hours, the piglets were sacrificed and samples from intestine, liver and spleen were collected for histopathological analysis ofinflammation and measurement of wet-dry weight ratio to quantitate the degree of edema.RESULTS. No difference in hemodynamic parameters was observed between the groups.Tidal volume was slightly higher in the SB group (7,3 vs 6 ml/kg in the MV group). Respiratory rate was similar in both groups.Arterial oxygen pressure-fraction (P/F) ratio was higher in spontaneously breathing animals 5 hours after creation of VILI (Group 1: 455 ±27; Group 2: 506 ± 34; p < 0,05). The spontaneous breathing group returned to baseline values of P/F on an average of 3,3 hours (only oneanimal did not reach the baseline value). In the mechanical ventilation group only two animals reached the baseline value during theobservation period of 5 hours.Acute inflammation was present in all three studied abdominal organs and tended to be higher in intestine (Fig. 1) in the MV than SBgroup, but with no difference in liver or spleen. The wet-dry weight ratio showed no difference between the groups.CONCLUSION. The difference in P/F ratio may suggest that the animals on SB with high CPAP recovered faster than the MV group from thelung injury.The tendency to less intestinal inflammation in the SB than MV group may suggest reduced spread of inflammation from the lung and/orbetter intestinal immune response during SB.
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| 3. |
- Marchesi, Silvia, et al.
(författare)
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Abdominal organ perfusion and inflammation in experimental sepsis : a magnetic resonance imaging study
- 2019
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Ingår i: American Journal of Physiology - Gastrointestinal and Liver Physiology. - : American Physiological Society. - 0193-1857 .- 1522-1547. ; 316:1, s. G187-G196
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Tidskriftsartikel (refereegranskat)abstract
- Diffusion-weighted magnetic resonance imaging (DW-MRI) uses water as contrast and enables the study of perfusion in many organs simultaneously in situ. We used DW-MRI in a sepsis model, comparing abdominal organs perfusion with global hemodynamic measurements and inflammation. Sixteen anesthetized piglets were randomized into 3 groups: HighMAP (mean arterial pressure, MAP > 65 mmHg), LowMAP (MAP between 50 and 60 mmHg) and Healthy Controls (HC). Sepsis was obtained with endotoxin and the desired MAP maintained with noradrenaline. After 6 hours DW-MRI was performed. Acute inflammation was assessed with IL-6 and TNFα in abdominal organs, ascites, and blood and by histology of intestine (duodenum). Perfusion of abdominal organs was reduced in the LowMAP group compared to the HighMAP group and HC. Liver perfusion was still reduced by 25% in the HighMAP group compared with HC. Intestinal perfusion did not differ significantly between the study groups. Cytokines concentration were generally higher in the LowMAP group but did not correlate with global hemodynamics. However, cytokines correlated with regional perfusion and, for liver and intestine, also with intra-abdominal pressure. Histopathology of intestine worsened with decreasing perfusion. In conclusion, although a low MAP (≤60 mmHg) indicated impeded abdominal perfusion in experimental sepsis, it did not predict inflammation, nor did other global measures of circulation. Decreased abdominal perfusion predicted partially inflammation but intestine, occupying most of the abdomen, and liver, were also affected by intra-abdominal pressure.
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| 4. |
- Marchesi, Silvia, MD, 1985-, et al.
(författare)
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Duodenum edema due to reduced lymphatic drainage leads to increased inflammation in a porcine endotoxemic model.
- 2022
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Ingår i: Intensive care medicine experimental. - : Springer Nature. - 2197-425X. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Interventions, such as mechanical ventilation with high positive end-expiratory pressure (PEEP), increase inflammation in abdominal organs. This effect could be due to reduced venous return and impaired splanchnic perfusion, or intestinal edema by reduced lymphatic drainage. However, it is not clear whether abdominal edema per se leads to increased intestinal inflammation when perfusion is normal. The aim of the presented study was to investigate if an impaired thoracic duct function can induce edema of the abdominal organs and if it is associated to increase inflammation when perfusion is maintained normal. In a porcine model, endotoxin was used to induce systemic inflammation. In the Edema group (n = 6) the abdominal portion of the thoracic duct was ligated, while in the Control group (7 animals) it was maintained intact. Half of the animals underwent a diffusion weighted-magnetic resonance imaging (DW-MRI) at the end of the 6-h observation period to determine the abdominal organ perfusion. Edema in abdominal organs was assessed using wet-dry weight and with MRI. Inflammation was assessed by measuring cytokine concentrations in abdominal organs and blood as well as histopathological analysis of the abdominal organs.RESULTS: Organ perfusion was similar in both groups, but the Edema group had more intestinal (duodenum) edema, ascites, higher intra-abdominal pressure (IAP) at the end of observation time, and higher cytokine concentration in the small intestine. Systemic cytokines (from blood samples) correlated with IAP.CONCLUSIONS: In this experimental endotoxemic porcine model, the thoracic duct's ligation enhanced edema formation in the duodenum, and it was associated with increased inflammation.
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| 5. |
- Marchesi, Silvia, MD, 1985-, et al.
(författare)
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Effect of mechanical ventilation versus spontaneous breathing on abdominal edema and inflammation in ARDS : an experimental porcine model
- 2020
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Ingår i: BMC Pulmonary Medicine. - : BioMed Central. - 1471-2466. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mechanical ventilation (MV), compared to spontaneous breathing (SB), has been found to increase abdominal edema and inflammation in experimental sepsis. Our hypothesis was that in primary acute respiratory distress syndrome (ARDS) MV would enhance inflammation and edema in the abdomen.METHODS: Thirteen piglets were randomized into two groups (SB and MV) after the induction of ARDS by lung lavage and 1 h of injurious ventilation. 1. SB: continuous positive airway pressure 15 cmH2O, fraction of inspired oxygen (FIO2) 0.5 and respiratory rate (RR) maintained at about 40 cycles min- 1 by titrating remifentanil infusion. 2. MV: volume control, tidal volume 6 ml kg- 1, positive end-expiratory pressure 15 cmH2O, RR 40 cycles min- 1, FIO2 0.5.MAIN OUTCOMES: abdominal edema, assessed by tissues histopathology and wet-dry weight; abdominal inflammation, assessed by cytokine concentration in tissues, blood and ascites, and tissue histopathology.RESULTS: The groups did not show significant differences in hemodynamic or respiratory parameters. Moreover, edema and inflammation in the abdominal organs were similar. However, blood IL6 increased in the MV group in all vascular beds (p < 0.001). In addition, TNFα ratio in blood increased through the lungs in MV group (+ 26% ± 3) but decreased in the SB group (- 17% ± 3).CONCLUSIONS: There were no differences between the MV and SB group for abdominal edema or inflammation. However, the systemic increase in IL6 and the TNFα increase through the lungs suggest that MV, in this model, was harmful to the lungs.
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| 6. |
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| 7. |
- Marchesi, Silvia, MD, 1985-, et al.
(författare)
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Prone Positioning ventilation’s effect on abdominal organs: A clinical imaging study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Prone positioning is part of the management of acute respiratory distress syndrome (ARDS). During the pandemic of SARS-CoV-2, the use of prone positioning ventilation increased dramatically. However, the effect of the pronation on other organs than the lungs has not been widely studied. This study aimed to compare abdominal edema, perfusion and inflammation in supine and prone positioning in an endotoxemic porcine model.Methods: Sixteen piglets were randomized into two groups: a supine group (n = 8) and a Prone group (n = 8) Both groups received endotoxemic infusion and were observed for 6 hours. Hemodynamic, respiratory parameters were recorded and blood samples for blood gas analysis and cytokine (TNFa, IL6, IL1b) concentration measurement were performed at baseline and every hour. Three animals per group underwent magnetic resonance imaging (MRI) for imaging acquisition. Post-mortem samples of abdominal organs and lung tissue were collected for cytokine concentration measurements, histopathological analysis and wet-dry ratio.Results: The prone group had a faster CO2 washout and needed a lower positive end-expiratory pressure to maintain the desired oxygenation. Edema was higher in the duodenum (wet-dry ratio – median; range: supine group 1.47; 1.15-3.1 gr. Prone group 1.57; 1.2-2.9 gr. p value 0.04) and average perfusion was lower in kidneys (supine group: 0.13; prone group 0.03. p value 0.05) in the prone group. In addition, the histopathological samples of the kidneys showed a higher incidence and extent of glomerular thrombosis.Conclusions: The presented model showed that prone positioning was associated with a lower kidney perfusion and glomerular thrombosis.
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| 8. |
- Marchesi, Silvia, MD, 1985-
(författare)
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The effect of mechanical ventilation on abdominal organs : Analysing the role of PEEP and perfusion.
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The effect of mechanical ventilation on abdominal organs is not well understood and investigated yet. Previous studies, using an animal sepsis-like model, found an association between mechanical ventilation (MV) and abdominal edema and inflammation.The presented thesis was aimed to investigate the role of perfusion in edema formation and inflammation, and to study the abdomen during mechanical ventilation in an ARDS model to reduce the confounding effect of inflammation related to sepsis.Methods: In the first paper presented, inflammation and edema in the abdomen were investigated in an endotoxin model. The study subjects were divided into two groups with different mean arterial pressures (MAP), another small group of healthy controls were studied as well. MRI analyses were used to measure perfusion in the different abdominal organs. In the second paper presented, differences in abdominal edema and inflammation were assessed in two groups of subjects, one group underwent MV and one group had spontaneously breathing.Results: In the first study, MRI analyses confirm that the group with higher MAP had better perfusion than the low MAP group. In the liver, perfusion was lower in LowMAP group compared to HighMAP group, but the HighMAP group had lower perfusion than the healthy controls. However, in the other studied organs HighMAP group and healthy controls had similar perfusion.Edema did not differ between the groups. Inflammation was globally higher in LowMAP group and correlated with hemodynamics. TNFα in liver tissue and portal vein serum correlated with intra-abdominal pressure (IAP).In the second study, the cytokine concentration was higher in serum in the MV group. MV did not increase abdominal edema or inflammation, compared to spontaneous breathing. Discussion and conclusion: Abdominal edema and inflammation are multifactorial phenomena, and many elements have to be included in the analysis. Perfusion plays an important role in determining inflammation and IAP. MV per se was not found to be related to increased edema and inflammation. In a previous study, the role of different levels of PEEP and different respiratory rate between mechanically ventilated and spontaneously breathing animals were not analyzed, but could have contributed to the results. The efforts made in this study to maintain similar respiratory rate and PEEP in both groups, could have contributed to the presented results.It is important to underline that, even if MV was not related to inflammation in abdomen, it was related to an increase in systemic inflammation, most probably because of an enhanced lung production of inflammatory mediators.Further studies, focusing on the role of respiratory rate and PEEP on abdomen, as well as the analysis of the inter-relations among inflammation, perfusion and edema, are needed to increase the pathophysiological understanding of these phenomena.
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| 9. |
- Marchesi, Silvia, MD, 1985-
(författare)
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The effect of mechanical ventilation on the abdominal organs
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During mechanical ventilation (MV), the interplay between abdomen and thorax has been studied unilaterally focusing on the effect that an increased abdominal pressure would have on the thorax. Only a small cluster of studies offered a different perspective showing a lower inflammation and a better lymphatic clearance of edema in abdominal organs when spontaneous breathing was applied compared to MV. Apart from these insights, a deeper understanding of the effect of different MV features on the abdominal organs remains uninvestigated.The aims of the thesis were: to investigate how changes in perfusion and edema influence inflammation and affect each other, and to examine how the management of ARDS could affect abdominal organs by comparing MV with spontaneous breathing and prone with supine position. All the studies were conducted using a porcine model. In three studies, a septic-like status was generated with an infusion of endotoxin; while in one study, a VILI model was used to simulate ARDS.In the first two studies, perfusion and lymphatic drainage were modified in different groups of animals and the impact of the changes on the abdominal organs was assessed. In the other two studies the effect of different ventilation settings on the abdominal organs was investigated: in Paper III, spontaneous breathing(CPAP) was compared with MV (maintaining positive end expiratory pressure – PEEP – and respiratory rate similar in both groups), and, in Paper IV, MV in prone position was compared with MV in supine position. The main findings were that low perfusion increased inflammation in the abdominal organs, but the hemodynamic parameters could not affect intestinal perfusion or edema. Similarly, increased edema was not associated with a decreased perfusion, but it enhanced inflammation in duodenum. MV increased systemic inflammation compared to CPAP, but did not increased inflammation or edema in the abdominal organs. Prone position reduced renal perfusion and was associated to extensive renal micro-thrombosis. In conclusion, both perfusion and edema influence inflammation in the abdomen, even if they seem not to affect one another. Besides, spontaneous breathing develops less systemic inflammation compared to MV, but it was not associated to a lower edema or inflammation in the abdomen; on the other side, prone positioning resulted in a possibly dangerous decrease of renal perfusion.
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| 10. |
- Marchesi, Silvia, MD, 1985-, et al.
(författare)
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The Use of Diffusion Weighted Imaging and Intravoxel Incoherent Motion to Assess Edema and Perfusion in Abdominal Organs during Endotoxemia
- 2023
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Ingår i: MAGNETOCHEMISTRY. - : MDPI. - 2312-7481. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- Diffusion weighted magnetic resonance imaging (DW-MRI) technique probing the microscopic movement of water molecules in tissue, allows for the quantification of water diffusivity and the contribution of perfusion to the total amount of water. In the last decades, its use in organs other than the brain has increased and it has successfully been applied to abdominal organs; otherwise the use of DWI for the assessment of perfusion (by measuring perfusion fraction and edema (by measuring the apparent diffusion coefficient-ADC) of entire organs is not a clinical standard. The aim of this paper is to assess whether DWI, specifically IVIM, can accurately assess edema (the amount of water contained in a tissue) and perfusion in abdominal organs (liver, spleen, intestine and kidneys) in an endotoxemic porcine model. Endotoxemia was induced in 20 piglets and they were divided into three groups: HM group (HighMAP, mean arterial pressure was maintained >65 mmHg by noradrenaline infusion), LM group (LowMAP, MAP was maintained between 50 and 60 mmHg) and LTD (the thoracic duct was ligated to increase abdominal edema). In addition, a fourth group of healthy controls (four animals) underwent MRI. Edema was also assessed by wet-dry weight in liver, spleen and intestine; and perfusion was assessed by hemodynamics, lactate concentration and SvO(2). ADC was found to be higher in the intestine of the LTD group compared with the other groups, in accordance with wet-dry weight. In addition, ADC in kidneys was found to be correlated to glomerular filtration rate. f was correlated with hemodynamics in kidneys and liver. The presented data show that there is a potential for clinical use of the technique in septic patients.
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