Giuseppe Tarantini

Università degli Studi del Sannio, Benevento, Campania, Italy

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Publications (232)1117.82 Total impact

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    ABSTRACT: Clinical benefit of postconditioning in patients with ST-Elevation Myocardial Infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) is still controversial. We performed a meta-analysis of available randomized clinical trials (RCTs) to define the role of postconditioning in STEMI. Fourteen RCTs evaluating postconditioning in a total of 778 STEMI patients were identified in PubMed, EMBase and Cochrane databases from January 1998 to February 2014. Overall, postconditioning was found to be cardioprotective in term of infarct size reduction (weighted standardized mean differences [WSMD] -0.5837, 95%CI -0.9609 to -0.2066, p<0.05), but significant heterogeneity across the trials was detected (I2=84%). Univariate meta-regression analysis did not identify clinical or procedural variables associated with a more pronounced effect of postconditioning effects on infarct size with the exception of the use of cardiac magnetic resonance (CMR) to evaluate infarct size (p<0.01). Restricting the analysis to six RCTs including a total of 448 patients and evaluating the postconditioning effect on infarct size by means of CMR led to the disappearance of benefit of postconditioning on infarct size. In conclusion, the results of this meta-analysis of RCTs suggested that postconditioning reduces infarct size, as expressed by WSMD. However, if the analysis was limited to trials with a more accurate quantification of infarct size reduction, namely by CMR, the benefit was lost. More data are required before adoption of postconditioning in clinical practice.
    The American Journal of Cardiology 09/2014; 114(6). DOI:10.1016/j.amjcard.2014.06.026 · 3.28 Impact Factor
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    ABSTRACT: Objectives: This study sought to assess in vivo sex differences in the pathophysiology of ST-segment elevation myocardial infarction (STEMI) and vascular response to primary percutaneous coronary intervention (PCI). Background: There is no consensus on whether differences in the pathophysiology of STEMI and response to primary PCI between women and men reflect biological factors as opposed to differences in age. Methods: In this prospective, multicenter study, 140 age-matched men and women with STEMI undergoing primary PCI with everolimus-eluting stent were investigated with intravascular optical coherence tomography, histopathology-immunohistochemistry of thrombus aspirates, and serum biomarkers. Primary endpoints were the percentages of culprit plaque rupture at baseline and everolimus-eluting stent strut coverage at 9-month follow-up as determined by optical coherence tomography. Results: Men and women had similar rates of plaque rupture (50.0% vs. 48.4%; risk ratio [RR]: 1.03; 95% confidence interval [CI]: 0.73 to 1.47; p = 0.56). Nonruptured/eroded plaques comprised 25% of all cases (p = 0.86 in men vs. women). There were no sex differences in composition of aspirated thrombus and immune and inflammatory serum biomarkers. At 9 months, women had similar strut coverage (90.9% vs. 92.5%; difference in medians: RR: 0.2%; 95% CI: -0.4% to 1.3%; p = 0.89) and amount of in-stent neointimal obstruction (10.3% vs. 10.6%; p = 0.76) as men did. There were no sex differences in clinical outcome either at 30-day or 1-year follow-up. Conclusions: In patients presenting with STEMI undergoing primary PCI, no differences in culprit plaque morphology and factors associated with coronary thrombosis were observed between age-matched men and women. Women also showed similar vascular healing response to everolimus-eluting stents as men did. (Optical Coherence Tomography Assessment of Gender Diversity In Primary Angioplasty: The OCTAVIA Trial [OCTAVIA]; NCT01377207).
    JACC Cardiovascular Interventions 08/2014; 7(9). DOI:10.1016/j.jcin.2014.05.011 · 7.35 Impact Factor
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    ABSTRACT: The impact of gender-related pathophysiologic features of severe aortic stenosis on transcatheter aortic valve implantation (TAVI) outcomes remains to be determined, as does the consistency of predictors of mortality between the genders. All consecutive patients who underwent TAVI at 6 institutions were enrolled in this study and stratified according to gender. Midterm all-cause mortality was the primary end point, with events at 30 days and at midterm as secondary end points. All events were adjudicated according to Valve Academic Research Consortium definitions. Eight hundred thirty-six patients were enrolled, 464 (55.5%) of whom were female. At midterm follow-up (median 365 days, interquartile range 100 to 516) women had similar rates of all-cause mortality compared with men (18.1% vs 22.6%, p = 0.11) and similar incidence of myocardial infarction and cerebrovascular accident. Gender did not affect mortality also on multivariate analysis. Among clinical and procedural features, glomerular filtration rate <30 ml/min/1.73 m(2) (hazard ratio [HR] 2.55, 95% confidence interval [CI] 1.36 to 4.79) and systolic pulmonary arterial pressure >50 mm Hg (HR 2.26, 95% CI 1.26 to 4.02) independently predicted mortality in women, while insulin-treated diabetes (HR 3.45, 95% CI 1.47 to 8.09), previous stroke (HR 3.42, 95% CI 1.43 to 8.18), and an ejection fraction <30% (HR 3.82, 95% CI 1.41 to 10.37) were related to mortality in men. Postprocedural aortic regurgitation was independently related to midterm mortality in the 2 groups (HR 11.19, 95% CI 3.3 to 37.9). In conclusion, women and men had the same life expectancy after TAVI, but different predictors of adverse events stratified by gender were demonstrated. These findings underline the importance of a gender-tailored clinical risk assessment in TAVI patients.
    The American Journal of Cardiology 07/2014; 114(8). DOI:10.1016/j.amjcard.2014.07.053 · 3.28 Impact Factor
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    ABSTRACT: Background: Cardiac perforation of the right ventricle (RV) is a rare but potentially life-threatening complication of both pacemaker (PM) and implantable cardioverter defibrillator (ICD) implant. Appropriate management is still uncertain. We assessed the incidence of subacute (24 hours-1 month) or delayed (>1 month) cardiac perforation by RV lead and the results of percutaneous lead extraction. Method: The study population included all patients diagnosed with subacute or delayed RV-lead perforation during the period 2007-2013. The incidence of perforation according to device type and fixation mechanism was calculated. The outcome of the percutaneous approach, consisting of lead extraction by simple traction, was assessed. Results: Cardiac perforation was diagnosed in 14 (eight females, mean age 71 [range 47-83] years) patients out of 3,815 who received an RV-lead implant (0.4%). The overall incidence of RV-lead perforation was similar between ICD (0.3%) and PM (0.4%) implants (P = 1.0) and between active (0.5%) and passive (0.3%) fixation leads (P = 0.3). All perforating leads were originally placed at the RV apex. Five patients were asymptomatic, but all presented altered lead electrical parameters. Surgical removal of the lead was performed in one patient while in the remaining the leads were successfully extracted by direct manual traction in the absence of any complications. In all patients, new active fixation leads were positioned in the RV septum and the follow-up (42 ± 27 months) was uneventful. Conclusions: RV perforation is a rare complication of both PM and ICD implants, regardless of the lead fixation mechanism. In most patients, percutaneous lead extraction is a safe and effective management approach.
    Pacing and Clinical Electrophysiology 07/2014; 37(12). DOI:10.1111/pace.12472 · 1.13 Impact Factor
  • Giuseppe Tarantini · Stefania Rizzo · Marco Mojoli · Cristina Basso
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    ABSTRACT: We report here the mechanical interference between mitral bioprostheses and devices currently adopted for percutaneous paravalvular leak closure as a possible cause for late dislodgement and embolization of successfully implanted and apparently stable closure devices.The images included in this study demonstrate that the topographical relationship of the target leak with the bioprosthetic valve posts may be a major obstacle for device stability after percutaneous paravalvular leak closure procedures.
    Journal of Cardiovascular Medicine 07/2014; Publish Ahead of Print. DOI:10.2459/JCM.0000000000000161 · 1.51 Impact Factor
  • Gianpiero D'Amico · Marco Mojoli · Paolo Buja · Giuseppe Tarantini
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    ABSTRACT: Transesophageal echocardiography (TEE) represents the gold standard technique to detect left atrial appendage (LAA) thrombosis. Several conditions may be erroneously interpreted as LAA thrombus at TEE, including artifacts mimicking thrombi. We report a case of a 78-year-old man with atrial fibrillation and contraindication to anticoagulation who was referred to our institution for percutaneous left appendage closure with a transcatheter trans-septal approach. Intraoperative transesophageal echocardiography revealed a thrombus-mimicking image, related to reverberations of left upper pulmonary vein ridge, located at twice the distance of the ridge from the transducer.
    Journal of Cardiovascular Medicine 07/2014; Publish Ahead of Print. DOI:10.2459/JCM.0000000000000081 · 1.51 Impact Factor
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    ABSTRACT: Transcatheter aortic valve replacement (TAVR) is an effective therapeutic option for patients with severe aortic stenosis at high risk for surgery. Identification of causes of death after TAVR may help improve patient selection and outcome. We enrolled 874 consecutive patients who underwent TAVR at 3 centers using all approved bioprostheses and different access routes. Clinical outcomes during follow-up were defined according to the Valve Academic Research Consortium 2 definitions. Causes of deaths were carefully investigated. Mean logistic European System for Cardiac Operative Risk Evaluation was 23.5% ± 15.3%; Society of Thoracic Surgery score, 9.0% ± 8.2%. The Corevalve (Medtronic, Minneapolis, MN) was used in 41.3%; the Edwards Sapien (Edwards Lifesciences Inc., Irvine, CA) in 57.3%. Vascular access was transfemoral in 75.7%. In-hospital mortality was 5.0%. Cumulative mortality rates at 1 to 3 years were 12.4%, 23.4%, and 31.5%, respectively. Landmark analysis showed a significantly higher incidence of cardiovascular (CV) death in the first 6 months of follow-up and a significantly higher incidence of non-CV death thereafter. At Cox regression analysis, the independent predictors of in-hospital mortality were acute kidney injury grades 2 to 3 (hazard ratio [HR] 3.41) life-threatening bleeding (HR 4.26), major bleeding (HR 4.61), and myocardial infarction (HR 3.89). The independent predictors of postdischarge mortality were chronic obstructive pulmonary disease (HR 1.48), left ventricular ejection fraction at discharge (HR 0.98), and glomerular filtration rate <30 mL/min per 1.73 m(2) (HR 1.64). Around a third of patients treated with TAVR in daily practice die within the first 3 years of follow-up. Early mortality is predominantly CV, whereas late mortality is mainly non-CV, and it is often due to preexisting comorbidity. Copyright © 2014 Elsevier Inc. All rights reserved.
    American Heart Journal 07/2014; 168(5). DOI:10.1016/j.ahj.2014.07.023 · 4.46 Impact Factor
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    Filippo Cademartiri · Teresa Arcadi · Giuseppe Tarantini · Erica Maffei
    Cardiology 06/2014; 128(4):301-303. DOI:10.1159/000362198 · 2.18 Impact Factor
  • Giuseppe Tarantini · Chiara Fraccaro · Francesco Bedogni
    Giornale italiano di cardiologia (2006) 05/2014; 15(5):269-75. DOI:10.1714/1563.17017
  • Giuseppe Tarantini · Marco Mojoli · Davide Capodanno
    Giornale italiano di cardiologia (2006) 04/2014; 15(4):199-204. DOI:10.1714/1497.16489
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    ABSTRACT: Identification of patients with non-ST elevation acute myocardial infarction (NSTEMI) at higher risk of in-hospital life-threatening ventricular arrhythmias (LT-VA) and death is crucial for determining appropriate levels of care/monitoring during hospitalisation. We assessed predictors of in-hospital LT-VA and all-cause mortality in a consecutive series of NSTEMI patients. We prospectively studied 1325 consecutive patients (69.7% males, median age 70 (61-79) years) presenting with NSTEMI and undergoing continuous electrocardiographic monitoring. The primary study end-point was the occurrence of spontaneous (unrelated to coronary interventions) in-hospital LT-VA, including sustained ventricular tachycardia and ventricular fibrillation; the secondary end-point was in-hospital mortality from all causes. Of 1325 patients, 21 (1.5%) experienced LT-VA and 62 (4.7%) died from either arrhythmias (n=1) or other causes (n=61). Seven of the 20 patients who survived LT-VA subsequently died of heart failure. Independent predictors of in-hospital LT-VA were the Global Registry of Acute Coronary Events (GRACE) score >140 (odds ratio (OR)=7.5; 95% confidence interval (CI) 1.7-33.3; p=0.008) and left ventricular ejection fraction (LV-EF)<35% (OR=4.1; 95% CI 1.7-10.3; p=0.002). GRACE score >140 (OR=14.6; 95% CI 3.4-62) and LV-EF <35% (OR=4.4; 95% CI 1.9-10) also predicted in-hospital all-cause death. The cumulative probability of in-hospital LT-VA and death was respectively 9.2% and 23% in the 98 (7.4%) patients with GRACE score >140 and LV-EF<35%, while it was respectively 0.2% and 0% among the 627 (47.3%) with GRACE score ≤140 and LV-EF ≥35%. Simple risk stratification at admission based on GRACE score and echocardiographic LV-EF allows early identification of NSTEMI patients at higher risk of both in-hospital LT-VA and all-cause mortality.
    03/2014; 3(4). DOI:10.1177/2048872614528796
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    ABSTRACT: IntroductionDuration of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) hospitalization remains to be defined, both for patients treated medically and for those undergoing percutaneous transluminal coronary angioplasty (PTCA).Methods PubMed, Cochrane, and Google Scholar were systematically searched for studies including patients presenting with ACS, and treated either with DAPT longer than or shorter than 12 months. Multivariable-adjusted risk estimates for death and recurrent ACS with stopping DAPT after 12 months (odds ratios [OR] 95% confidence intervals [CI]) were pooled after logarithmic transformation according to random-effect models with inverse-variance weighting.ResultsFive studies with 49,586 patients were included. Median age was 66 (64–67) years, with 67% (65–75) males. Myocardial infarction (MI) represented the admission diagnosis for 88% (60–100) of the patients, and 66% (50–74) were treated with stenting. After a follow-up of 2.1 years (1.5–2.7), 40% (35–46) still on DAPT after 12 months and the rates of death or recurrent ACS were 16.6 (14.5–17.0). Risk of adverse events for patients stopping DAPT after 1 year was significantly increased (OR = 1.19 [1.07–1.32]) for those receiving stents, but not for patients managed medically (OR = 1.13 [0.95–1.35]). The increased risk did not vary according to age, gender, myocardial infarction as admission diagnosis, and kind of stent.Conclusions Interruption of DAPT over 12 months after ACS increases the risk of adverse events for patients treated with PTCA, but not for those managed conservatively, independently from baseline features and admission diagnosis. This hypothesis-generating finding should be tested in randomized controlled trials.
    Journal of Interventional Cardiology 03/2014; 27(3). DOI:10.1111/joic.12107 · 1.18 Impact Factor
  • JACC. Cardiovascular imaging 03/2014; 7(3):309-12. DOI:10.1016/j.jcmg.2013.10.016 · 7.19 Impact Factor
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    ABSTRACT: Bivalirudin significantly reduces 30-day major and minor bleeding compared with unfractionated heparin (UFH), while resulting in similar or lower rates of ischemic events in both patients with stable and unstable coronary disease undergoing percutaneous coronary intervention. We performed a meta-analysis of randomized trials to evaluate the impact of bivalirudin compared with UFH, with or without glycoprotein IIb/IIIa receptor inhibitors (GPI), on the rates of mortality, myocardial infarction (MI), and major bleeding. We searched electronic databases for randomized controlled trials with >100 patients comparing bivalirudin (±provisional GPI) with UFH with either routine or provisional GPI in patients undergoing percutaneous coronary intervention. The principal efficacy end points were mortality and MI within 30 day, whereas major bleeding was the principal safety end point. We assessed the benefit of bivalirudin for each efficacy end point relative to the baseline bleeding risk, using the control (UFH) major bleeding rate as proxy for that risk. A total of 12 randomized trials that enrolled 33,261 patients were included. Overall, there was no significant difference in mortality and MI between bivalirudin monotherapy and UFH (±GPI), whereas major bleeding was significantly lower with bivalirudin. Bivalirudin reduced major and minor bleeding across the entire bleeding risk spectrum. Bivalirudin significantly reduces major and minor bleeding regardless of the estimated baseline hemorrhagic risk.
    American heart journal 03/2014; 167(3):401-412.e6. DOI:10.1016/j.ahj.2013.11.013 · 4.46 Impact Factor
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    ABSTRACT: Large thrombus burden (LTB) lesions in the context of primary percutaneous coronary intervention (p-PCI) have been related to unsuccessful angiographic reperfusion and unfavorable clinical outcomes. However, the hazard of LTB treatment on myocardial damage has not been evaluated. We investigated the impact of LTB on myocardial damage using contrast-enhanced cardiac magnetic resonance (CE-CMR) in the setting of p-PCI. In 327 patients, who underwent p-PCI without thrombus aspiration within 12 hours from symptom onset, we prospectively assessed the impact of LTB on infarct size and microvascular damage using CE-CMR. LTB was defined by the presence of Thrombolysis In Myocardial Infarction thrombus score ≥3 in patent infarct-related artery (IRA); or by "cut-off" occlusion pattern and/or large reference vessel diameter (≥3.5 mm) in occluded IRA. One hundred ninety-seven patients (60.2%) showed LTB and 130 (39.8%) did not. Distal embolization occurred in 18.8% patients with versus 6.9% without LTB (p = 0.003). At CE-CMR, patients with LTB had larger infarct size index (27.5 ± 11.1 vs 22.1 ± 17.5, p = 0.009) and more often transmural necrosis (70.5% vs 55.4%, p = 0.008) compared with patients without LTB. Excluding patients with distal embolization, patients with LTB still had larger necrosis. At multivariate analysis, occluded (IRA) at baseline, anterior infarction, and presence of LTB predicted transmural necrosis. In conclusion, LTB in the setting of p-PCI is related to larger myocardial damage as detected by CE-CMR, regardless of angiographic detectable distal embolization.
    The American journal of cardiology 02/2014; 113(9). DOI:10.1016/j.amjcard.2014.01.423 · 3.28 Impact Factor
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    Article: Correction.
    Circulation 02/2014; 129(5):e327. DOI:10.1161/CIR.0000000000000014 · 14.43 Impact Factor
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    ABSTRACT: Aim: Aim of the present study was to assess stent- and patient-related outcomes of the first- vs. second-generation drug-eluting stents (DES) in diabetics, according to the insulin requirement status. Methods: Data were obtained from a prospective, single-center registry of 816 consecutive patients with diabetes mellitus (23% insulin-requiring) who underwent percutaneous coronary intervention (PCI) between April 2003 and May 2012 with first- (N.=534) or second-generation DES (N.=282) at our Institution, with at least 12 months of follow-up. We assessed the occurrence of stent-related outcome, including cardiac death, target vessel-related myocardial infarction and target lesion revascularization, versus patient-related outcome, including any cause death, any myocardial infarction and any coronary revascularization. Results: Patients treated with second-generation DES were older and had more complex lesions than patients treated with first-generation DES. Both among patients treated with first-generation DES and those treated with second generation DES, patient-related events were almost double than stent-related events. No interactions were observed between the DES generation type and insulin requirement status. Conclusion: In this observational study, first- and second-generation DES were equally safe and efficacious in diabetic patients undergoing PCI, regardless of insulin requirements. The greater number of patient-related than stent-related events in patients with complex clinical and lesion characteristics emphasizes that the optimization of secondary prevention is at least as important as the selection of which new generation DES to implant in a specific lesion.
    02/2014; 62(1):9-18.
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    01/2014; 2014(1):100. DOI:10.5339/gcsp.2014.17
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    ABSTRACT: Current risk stratification for sudden cardiac death (SCD) in non-ischemic dilated cardiomyopathy (NIDC) relies on left ventricular (LV) dysfunction, a poor marker of ventricular electrical instability. Contrast-enhanced cardiac magnetic resonance (CE-CMR) has the ability to accurately identify and quantify ventricular myocardial fibrosis (late gadolinium enhancement, LGE). To evaluate the role of presence and amount of myocardial fibrosis for arrhythmogenic risk prediction in NIDC. 137 consecutive patients with angiographically proven NIDC. All patients were followed-up for a combined arrhythmic end point including sustained ventricular tachycardia (VT), appropriate ICD intervention, ventricular fibrillation (VF) and SCD. LV-LGE was identified in 76 patients (55.5%). During a median follow-up of 3 years, the combined arrhythmic end point occurred in 22 patients (16.1%): 8 (5.8%) sustained VT, 9 (6.6%) appropriate ICD intervention, either against VF (n=5) or VT (n=4), 3 (2.2%) aborted SCD, and 2 (1.5%) died suddenly. Kaplan-Meier analysis revealed a significant correlation between the LV-LGE presence (not the amount and distribution) and malignant arrhythmic events (p<0.001). On univariate Cox regression analysis, LV-LGE (HR 4.17; 95%CI 1.56-11.2;p=0.005) and left bundle branch block (HR 2.43; 95%CI 1.01-5.41;p=0.048) were associated with arrhythmias. On multivariable analysis, the presence of LGE remained the only independent predictor of arrhythmias (HR= 3.8; 95%CI:1.3-10.4;p=0.01). LV-LGE is a powerful and independent predictor of malignant arrhythmic prognosis, while its amount and distribution do not provide additional prognostic value. CE-CMR may contribute to identify candidates for ICD therapy not fulfilling the current criteria based on LVEF.
    Heart rhythm: the official journal of the Heart Rhythm Society 01/2014; 11(5). DOI:10.1016/j.hrthm.2014.01.014 · 5.08 Impact Factor
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    ABSTRACT: Antiplatelet therapy is the cornerstone of the pharmacologic management of patients with acute coronary syndrome (ACS). Over the last years, several studies have evaluated old and new oral or intravenous antiplatelet agents in ACS patients. In particular, research was focused on assessing superiority of two novel platelet ADP P2Y12 receptor antagonists (i.e., prasugrel and ticagrelor) over clopidogrel. Several large randomized controlled trials have been undertaken in this setting and a wide variety of prespecified and post-hoc analyses are available that evaluated the potential benefits of novel antiplatelet therapies in different subsets of patients with ACS. The aim of this document is to review recent data on the use of current antiplatelet agents for in-hospital treatment of ACS patients. For each drug or class of drugs, strong evidence and/or areas of uncertainty that warrant further research are highlighted by examining 10 subgroups of patients with ACS.
    Giornale italiano di cardiologia (2006) 12/2013; 14(12):839-866. DOI:10.1714/1371.15242

Publication Stats

2k Citations
1,117.82 Total Impact Points


  • 2015
    • Università degli Studi del Sannio
      • Department of Biological Sciences
      Benevento, Campania, Italy
  • 2004–2015
    • University of Padova
      • Department of Cardiac, Thoracic and Vascular Sciences
      Padua, Veneto, Italy
  • 2012–2014
    • It-Robotics
      Vicenza, Veneto, Italy
    • University of Catania
      Catania, Sicily, Italy
  • 2004–2014
    • University-Hospital of Padova
      Padua, Veneto, Italy
  • 2011
    • University Hospital of Parma
      Parma, Emilia-Romagna, Italy
  • 2010
    • Jacksonville University
      Jacksonville, Florida, United States
  • 2009
    • Università degli studi di Parma
      Parma, Emilia-Romagna, Italy