Giuseppe Paolisso

Second University of Naples, Caserta, Campania, Italy

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Publications (425)1937.86 Total impact

  • Michelangela Barbieri · Virginia Boccardi · Giuseppe Paolisso
    Diet and Nutrition in Dementia and Cognitive Decline, 12/2015: pages 393-402; , ISBN: 9780124078246
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    ABSTRACT: We report a case of a 56-year-old man affected by frontal lobe seizures who has developed bradycardia followed by asystole. The patient had a positive family history for epilepsy. In fact, the mother, brothers, and one sister had epilepsy. Furthermore, the patient's two brothers suddenly died of unspecified heart disease at the ages of 26 and 53, respectively. The patient also experienced syncope once or twice a year. Three similar epileptic seizures, without the recurrence of asystole, were registered after pacemaker implantation.
    Epilepsy and Behavior Case Reports 12/2015; 4. DOI:10.1016/j.ebcr.2015.04.002
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    ABSTRACT: An internet survey was set up to assess the geriatric competence and perceived needs of 337 members of the Italian society of nephrology (SIN). The survey assessed how well aware nephrologists are of the typical geriatric conditions and needs of their elderly chronic kidney disease (CKD) patients. SIN associates were also questioned about their current use of comprehensive geriatric assessment, prescription of potentially nephrotoxic drugs, and screening for osteoporosis. The main finding is that CKD and dialysis are almost unanimously perceived as typically geriatric conditions, but knowledge and use of geriatric tools are scanty. While use of potentially inappropriate drugs is rare, almost half of the patients are not screened for osteoporosis. The significant clinical gaps observed could greatly impair the management of older CKD patients, and call for an urgent educational intervention.
    Journal of nephrology 09/2015; DOI:10.1007/s40620-015-0232-y · 1.45 Impact Factor
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    ABSTRACT: Background: Takotsubo syndrome is a stress cardiomyopathy, characterized by reversible left ventricle (LV) apical ballooning in the absence of significant angiographic coronary artery stenosis. The frequent association with emotional stress suggests in this disease an autonomic nervous system involvement. We could think that a therapeutic treatment targeting heart sympathetic dysfunction could be of crucial importance. Methods: From January 2010 to June 2012, 886 patients were consecutively evaluated at Cardarelli Hospital, Naples, Italy. Among these, 48 patients met takotsubo cardiomyopathy (TCM) criteria. Each patient was assessed with history and physical examination, 12-lead electrocardiogram, serum troponin, coronary arteriography, and left ventricular angiogram, perfusion myocardial scintigraphy with technetium 99m, with echocardiography and 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. At discharge, the surviving patients were randomly assigned to α-lipoic acid (ALA) treatment (600mg once daily) or placebo. Following discharge, after the initial TCM event, patients returned to our outpatient clinic at Internal Medicine of the Second University Naples for the follow-up evaluation quarterly until 12 months. Routine analysis, myocardial damage serum markers, oxidative stress serum markers, pro-inflammatory cytokines, and sympathetic tone activity were evaluated in all patients. Results: ALA administration improved MIBG defect size at 12 months compared to placebo. Conclusions: Adrenergic cardiac innervation dysfunction in TCM patients persists after previous experience of transient stress-induced cardiac dysfunction. ALA treatment improves the adrenergic cardiac innervation. This study evaluates whether sympatho-vagal alterations are TCM event-related.
    Journal of Cardiology 09/2015; DOI:10.1016/j.jjcc.2015.07.012 · 2.78 Impact Factor
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    DESCRIPTION: Heart failure (HF) and type 2 diabetesmellitus (T2DM) are two growing and related diseases in general population and particularly in elderly people. In selected patients affected by HF and severe dysfunction of left ventricle ejection fraction (LVEF), with left bundle brunch block, the cardiac resynchronization therapy with a defibrillator (CRT) is the treatment of choice to improve symptoms, NYHA class, and quality of life. CRT effects are related to alterations in genes and microRNAs (miRs) expression, which regulate cardiac processes involved in cardiac apoptosis, cardiac fibrosis, cardiac hypertrophy and angiogenesis, and membrane channel ionic currents. Different studies have shown a different prognosis in T2DMpatients and T2DMelderly patients treated by CRT-D.We reviewed the literature data on CRT-D effect on adult and elderly patients with T2DM as compared with nondiabetic patients.
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    ABSTRACT: Understanding the dynamics of the complex interaction network of cytokines, defined as ''cytokinome'', can be useful to follow progression and evolution of hepatocellular carcinoma (HCC) from its early stages as well as to define therapeutic strategies. Recently we have evaluated the cytokinome profile in patients with type 2 diabetes (T2D) and/or chronic hepatitis C (CHC) infection and/or cirrhosis suggesting specific markers for the different stages of the diseases. Since T2D has been identified as one of the contributory cause of HCC, in this paper we examined the serum levels of cytokines, growth factors, chemokines, as well as of other cancer and diabetes biomarkers in a discovery cohort of patients with T2D, chronic hepatitis C (CHC) and/or CHC-related HCC comparing them with a healthy control group to define a profile of proteins able to characterize these patients, and to recognize the association between diabetes and HCC. The results have evidenced that the serum levels of some proteins are significantly and differently up-regulated in all the patients but they increased still more when HCC develops on the background of T2D. Our results were verified also using a separate validation cohort. Furthermore, significant correlations between clinical and laboratory data characterizing the various stages of this complex disease, have been found. In overall, our results highlighted that a large and simple omics approach, such as that of the cytokinome analysis, supplemented by common biochemical and clinical data, can give a complete picture able to improve the prognosis of the various stages of the disease progression. We have also demonstrated by means of interactomic analysis that our experimental results correlate positively with the general metabolic picture that is emerging in the literature for this complex multifactorial disease.
    PLoS ONE 08/2015; 10(7):e0134594. DOI:10.1371/journal.pone.0134594 · 3.23 Impact Factor
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    ABSTRACT: There is growing evidence that tight glycemic control may be more harmful than beneficial in older persons with Type 2 diabetes (T2DM). It remains controversial if tight glycemic control (lower glycated hemoglobin A1c (A1c)) is associated with functional impairments in older frail patients with T2DM. We explored associations between A1c and losses in Activities of Daily Living (ADLs) in diabetic nursing home (NH) patients and tested for differences according to anti-diabetic treatment: diet, anti-diabetic oral drug (AOD), insulin, combined insulin+AOD. We conducted a cross-sectional study on 1845 older NH patients with T2DM from 150 sites across Italy. Complete evaluations on ADLs, glycemic control, anti-diabetic treatments, comorbidities, and clinical data were recorded. ANOVA was applied to compare clinical characteristics across A1c tertiles. Multivariate regression models evaluated associations between A1c and ADL losses. Patients had a mean age [SD]=82 [8] years; BMI=25.5kg/m(2) [4.7]; Fasting Plasma Glucose (FPG)=7.4 [3.0] mmol/l; Post-prandial glucose (PPG)=10.3 [3.6] mmol/l; A1c=7.0% (54mmol/mol), ADL losses=3.7 [1.8]. Compared to higher A1c tertiles, patients in the lower tertile had greater ADL losses, were more likely to use AODs, while less likely to use insulin or insulin+AOD. After adjusting for multiple confounders, impairments in ADLs were associated with tighter A1c levels (B=-0.014; p=0.002). Regression models according to anti-diabetic treatment showed that tighter A1c levels continued as independent determinants of ADL losses in patients using AODs (B=-0.023; p=0.001), particularly in those using sulfonylureas (B=-0.043; p<0.001) or mitiglinides (B=-0.044; p=0.050). Tighter glycemic control was associated with ADL physical dependency losses, especially in those using sulfonylureas and mitiglinides. Copyright © 2015. Published by Elsevier Inc.
    Metabolism: clinical and experimental 07/2015; DOI:10.1016/j.metabol.2015.07.018 · 3.89 Impact Factor
  • Diabetes 05/2015; 64(5):e6. DOI:10.2337/db14-1676 · 8.10 Impact Factor
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    ABSTRACT: Severe hypoglycemia is associated with cognitive decline and dementia in older persons with type 2 diabetes. The role of antidiabetic treatments on severe hypoglycemia is unknown in dementia. The aims were to determine the prevalence of severe hypoglycemic events and investigate associations among severe hypoglycemic and specific antidiabetic treatments (classes of oral agents and types of insulin analogs) in a large sample of nursing home patients with diabetes according to dementia status. Cross-sectional observational study. A total of 150 nursing homes across Italy. A total of 2258 patients with type 2 diabetes (dementia = 1138, no dementia = 1120). Diagnosis of dementia before nursing home admission. Data were collected regarding functional status, glycemic control, antidiabetic treatments, comorbidities, and biochemical and clinical measurements. Logistic regression models with severe hypoglycemia as the dependent variable were used to test associations with antidiabetic agents. Patients had a mean age (SD) of 82 (8) years, body mass index (BMI) of 25.4 (4.8), fasting plasma glucose (FPG) of 7.5 (3.0) mmol/L, postprandial glucose (PPG) of 10.3 (3.6) mmol/L, HbA1c of 7.1% (54 mmol/L), and impairments in activities of daily living (ADLs) of 3.7 (2.1). Severe hypoglycemia was more prevalent in patients with dementia (18%) compared with patients without dementia (8%). Patients with dementia were older, showed greater ADL impairments, greater number of comorbidities, lower FPG, and higher PPG compared with those without dementia. Adjusted logistic regression models in patients with dementia showed that rapid- and long-acting insulin analogs were associated with reduced odds ratio (OR) (OR 0.333; 95% confidence interval [CI] 0.184-0.602; OR 0.248, 95% CI 0.070-0.882, respectively), whereas sulphonylureas and combined metformin + sulphonylurea were associated with increased ORs (OR 8.805, 95% CI 4.260-18.201; OR 6.639; 95% CI 3.273-14.710, respectively) of experiencing severe hypoglycemia. No correlations were found in patients without dementia. In older nursing home patients with type 2 diabetes, severe hypoglycemia was significantly higher in dementia. Our findings suggest that sulphonylureas should be used with caution, whereas rapid- and long-acting insulin analogs seem safer. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
    Journal of the American Medical Directors Association 02/2015; 16(4). DOI:10.1016/j.jamda.2014.12.014 · 4.94 Impact Factor
  • Virginia Boccardi · Giuseppe Paolisso
    Diet and Exercise in Cognitive Function and Neurological Diseases, 02/2015;
  • Virginia Boccardi · Giuseppe Paolisso
  • A M Abbatecola · G Paolisso · A.J. Sinclair
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    ABSTRACT: There is a rapidly growing number of persons reaching extreme age limits. Indeed, the fastest growth is found in those over the age of 80 years or octogenarians. Along with this continuous rise, there is a significant increase in type 2 diabetes in this population. Unfortunately, individuals living past 80 years of age are often accompanied by numerous comorbidities and geriatric conditions, all which render anti-diabetic treatment options challenging. Indeed the principles of managing type 2 diabetes is similar to younger patients. Special considerations in this delicate group are essential due to the increased prevalence of comorbidities and relative inability to tolerate adverse effects of medication and severe hypoglycemia. It is important to recall that octogenarians have shown to have a greater prevalence for cognitive impairment, physical disability, renal and hepatic dysfunction, and syndromes, such as frailty compared to younger elders. The frailty syndrome is considered one of the most important limitations when treating octogenarians with type 2 diabetes in polypharmacy. Due to the lack of evidence for specific targets of glucose and glycated hemoglobin (A1C) levels in the elderly, available treatment guidelines are based on data extrapolation from younger adults and expert opinion citing reliable evidence. Overall, the most important conclusion emerging from these groups is to accomplish a moderate glycemic control (A1C levels between 7 -8%) in complex elderly patients. However, the risk of hypoglycemia from some treatments may present the greatest significant barrier to optimal glycemic control for the very old. The present review discusses the highlights from the latest guidelines for treating older persons and underlines the need for specific considerations when treating the very old in order to maintain a balance between treating comorbidities and maintaining quality of life.
    Current Pharmaceutical Design 01/2015; 21(13). DOI:10.2174/1381612821666150130120747 · 3.45 Impact Factor
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    01/2015; 25(1). DOI:10.4103/2211-4122.158431
  • R. Marfella · G. Paolisso
    01/2015; DOI:10.1093/ehjcvp/pvv027
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    ABSTRACT: The purpose of this study was to investigate the impact of metabolic syndrome (MS) on outcome of catheter ablation (CA) for treatment of frequent premature ventricular contraction beats (PVCs) originating from right ventricular outflow tract (RVOT), left ventricular outflow tract (LVOT) or coronary cusps (CUSPs), in patients with normal ventricular systolic function and absence of cardiac structural disease. In this multicentre prospective study we evaluated 90 patients with frequent PVCs originating from RVOT (n = 68), LVOT (n = 19) or CUSPs (n = 3), treated with CA. According to baseline diagnosis they were divided in patients with MS (n = 24) or without MS (n = 66). The study endpoint was a composite of recurrence of acute or delayed outflow tract ventricular arrhythmia: acute spontaneous or inducible outflow tract ventricular arrhythmia recurrence or recurrence of outflow tract PVCs in holter monitoring at follow up. Patients with MS compared to patients without MS showed a higher acute post-procedural recurrence of outflow tract PVCs (n = 8, 66.6%, vs. n = 6, 9.0%, p = 0.005). At a mean follow up of 35 (17-43) months survival free of recurrence of outflow tract PVCs was lower in patients with baseline MS compared to patients without MS diagnosis (log-rank test, p < 0.001). In cox regression analysis, only MS was independently associated with study endpoint (HR = 9.655 , 95% CI 3.000-31.0.68 , p < 0.001). MS is associated with a higher recurrence rate of outflow tract PVCs after CA in patients without structural heart disease.
    BMC Cardiovascular Disorders 12/2014; 14(1):176. DOI:10.1186/1471-2261-14-176 · 1.88 Impact Factor
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    ABSTRACT: The role of sirtuin-6 (SIRT6) in atherosclerotic progression of diabetic patients is unknown. We evaluated SIRT6 expression and the effect of incretin-based therapies in carotid plaques of asymptomatic diabetic and non-diabetic patients. Plaques were obtained from 52 type 2 diabetic and 30 non-diabetic patients undergoing carotid endarterectomy. Twenty-two diabetic patients were treated with the drugs that work on the incretin system, glucagon-like-peptide-1 (GLP-1) receptor agonists and dipeptidyl-peptidase-4 (DPP-4)-inhibitors, for 26±8 months before endarterectomy. Compared to non-diabetic plaques, diabetic plaques had more inflammation and oxidative stress, along with a lesser SIRT6 expression and collagen content. Compared with no-GLP-1 therapies-treated plaques, GLP-1 therapies-treated plaques presented greater SIRT6 expression and collagen content, less inflammation and oxidative stress, indicating a more stable plaque phenotype. These results were supported by in vitro observations on endothelial progenitor cells (EPCs) and endothelial cells (EC). Indeed, both EPCs and EC treated with high-glucose (25mM) in the presence of GLP-1 (100 nM liraglutide) presented a greater SIRT6 and lower nuclear factor-kappa B (NF-ĸB) expression compared to cells treated only with high-glucose. These findings establish the involvement of SIRT6 in the inflammatory pathway(s) of diabetic atherosclerotic lesions and suggest its possible positive modulation by incretin, whose effect is associated with morphological and compositional characteristics of a potential stable plaque phenotype.
    Diabetes 10/2014; 64(4). DOI:10.2337/db14-1149 · 8.10 Impact Factor
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    ABSTRACT: AimsTo investigate the validity and reliability of the Audit of Diabetes-Dependent Quality of Life instrument in older Italians with diabetes and to test the association of diabetes-related quality of life with glycaemic control over time.MethodsA total of 558 outpatients with Type 2 diabetes from the Diabetic Unit of the Italian National Research Centre on Aging Hospital in Ancona were enrolled to complete questionnaires (Audit of Diabetes-Dependent Quality of Life-19 and the Short-Form-12), and to undergo clinical and biochemical testing at baseline and at 12 months of follow-up. The overall impact of diabetes using the average weighted impact score from the Audit of Diabetes-Dependent Quality of Life questionnaire was calculated. Participants were categorized according to this score as having either less or more negative diabetes-related quality of life.ResultsParticipants had a mean ± sd age of 67.7 ± 9.2 years and 51.8% were male. Factor analysis and Cronbach's coefficient of internal consistency (Cronbach's α=0.931) confirmed that the 19 domain-specific Audit of Diabetes-Dependent Quality of Life items could be combined into a single scale in this Italian population. The impact score correlated with the physical (r=0.275; P<0.001) and mental components (r=0.291; P<0.001) of the Short-Form-12 questionnaire. Significant differences were found according to diabetic complications in specific Audit of Diabetes-Dependent Quality of Life items and impact scores. Insulin use had a greater association with a more negative quality of life compared with other antidiabetic agents. A multivariate linear regression model with restricted linear spline application showed that the relationship between HbA1c and impact score was not linear and that the change in the impact score was associated with improved glycaemic control in those with a less negative diabetes-related quality of life at 12 months.Conclusions The Audit of Diabetes-Dependent Quality of Life-19 is a valid tool for measuring the impact of diabetes on quality of life in older Italians. Perception of diabetes-related quality of life is associated with glycaemic control over time.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 10/2014; 32(2). DOI:10.1111/dme.12605 · 3.12 Impact Factor
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    ABSTRACT: Background and Aims This study aimed to investigate the relationship between asymptomatic episodes of atrial fibrillation (AF) and abnormalities of the autonomic nervous system in type 2 diabetic patients who did not have evidence of atrial fibrillation at baseline. Methods and Results In a multicentric cross-sectional controlled study, 1992 patients with type 2 diabetes were screened. All underwent ambulatory ECG recording for 48-hour at 3, 6, 9, and 12 months. Heart rate variability (HRV) was used as indicator of autonomic activity. 176 diabetics with silent atrial fibrillation episodes (SAFE group) and 288 without silent atrial fibrillation (non-SAFE group) were enrolled. These selected diabetics were matched on clinical and anthropometric data to 120 control subjects without diabetes of the control group. HRV analysis evidenced that LF/HF ratio was significantly higher in the SAFE group than in the non-SAFE group (P < 0.05) in the whole period of HM analysis. AF absolute burdens were positively correlated with LF/HF ratio (r = 0.31, P < 0.001). Multiple regression analysis showed that LF/HF ratio was an independent determinant of AF episodes. Conclusions This study originally showed a strong relationship between autonomic dysfunction and silent atrial fibrillation in type 2 diabetes.
    Journal of Diabetes and its Complications 09/2014; 29(1). DOI:10.1016/j.jdiacomp.2014.09.002 · 3.01 Impact Factor
  • European geriatric medicine 09/2014; 5:S194. DOI:10.1016/S1878-7649(14)70520-0 · 0.73 Impact Factor
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    ABSTRACT: Pseudomonas aeruginosa (PA) is a gram-negative bacillus capable of producing infections, which usually occur in hospital environment. Cutaneous manifestations represent a wide spectrum of pathologic entities, ranging from minor skin lesions to necrotizing skin infection and to potentially life-threatening PA septicemia. The pathogenesis of PA infections must be understood in the context of its role as an opportunistic pathogen. In particular, it rarely causes disease in healthy patients because of its low virulence. This species primarily cause disease in patients with local anatomical changes or in the immunocompromised host. In fact, it is rarely able to start an infection in healthy subjects, unless there is a local or general impairment of defense mechanisms. We described an otherwise healthy 75-year-old woman who developed a necrotizing PA skin infection after a routinely mosquito bite skin lesion.
    The American journal of emergency medicine 09/2014; 32(9). DOI:10.1016/j.ajem.2014.02.028 · 1.27 Impact Factor

Publication Stats

15k Citations
1,937.86 Total Impact Points


  • 1983–2015
    • Second University of Naples
      • • Faculty of Medicine and Surgery
      • • Dipartimento di Psicologia
      • • Dipartimento di Biochimica, Biofisica e Patologia Generale
      Caserta, Campania, Italy
  • 1983–2014
    • Naples Eastern University
      Napoli, Campania, Italy
  • 1986–2013
    • University of Naples Federico II
      • Department of Molecular Medicine and Medical Biotechnology
      Napoli, Campania, Italy
  • 2006
    • University of Ferrara
      • Department of Clinical and Experimental Medicine
      Ferrare, Emilia-Romagna, Italy
  • 2005
    • University of Milan
      Milano, Lombardy, Italy
  • 2004
    • National Institute on Aging
      Baltimore, Maryland, United States
    • University of Bologna
      • Department of Experimental, Diagnostic and Specialty Medicine DIMES
      Bolonia, Emilia-Romagna, Italy
  • 2003
    • Università degli Studi di Palermo
      • Department of internal medicine and medical specialties (DIMIS)
      Palermo, Sicily, Italy
  • 1995–1996
    • National Institutes of Health
      • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
      Maryland, United States
    • Interactive Institute
      Tukholma, Stockholm, Sweden
    • Albert Einstein College of Medicine
      New York, New York, United States
  • 1994
    • University of Liège
      • Diabetes, Nutrition and Metabolic Disorders Unit
      Liège, WAL, Belgium
  • 1990
    • Università degli Studi di Napoli L'Orientale
      Napoli, Campania, Italy
  • 1989
    • Centre Hospitalier Universitaire de Liège
      Luik, Walloon Region, Belgium
  • 1985
    • Catholic University of Louvain
      • School of Medicine
      Walloon Region, Belgium