P Valentino

Universita' degli Studi "Magna Græcia" di Catanzaro, Catanzaro, Calabria, Italy

Are you P Valentino?

Claim your profile

Publications (98)402.49 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: We compared pre-amplification (PA) RT-PCR blood CD19 mRNA quantification with Flow Cytometry (FC), to personalize Rituximab re-treatment in Neuromyelitis Optica Spectrum Disorders (NMOSD) patients. 47 blood samples from 3NMOSD patients were studied. PA-RT-PCR quantified CD19 in all samples, and a positivity threshold was defined, whereas CD19 + B cells were under threshold in 31/47 samples by FC. In all samples where CD19 + B cells were above FC threshold, they resulted above the PA-RT-PCR threshold. CD19 mRNA was above threshold in 8 other samples, resulted negative by FC, and preceded the FC positivity in 7/8 samples by 1–3 months, showing major sensitivity.
    Journal of Neuroimmunology. 09/2014;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In this study, we used an automated segmentation of regions of interest and co-registration to diffusion tensor imaging (DTI) images to investigate whether microstructural abnormalities occur in gray structures of the frontal-subcortical circuits in patients with amyotrophic lateral sclerosis (ALS). Twenty-four patients with probable or definite sporadic ALS and 22 healthy controls were enrolled in the study. Thirteen out of 24 ALS patients and all of the control subjects underwent a detailed neuropsychological evaluation. DTI was performed to measure mean diffusivity (MD) and fractional anisotropy in the frontal cortex, caudate, putamen, globus pallidus, thalamus, amygdala and hippocampus. MD values of ALS patients were significantly higher in the frontal cortex (P = 0.023), caudate (P = 0.01), thalamus (P = 0.019), amygdala (P = 0.012) and hippocampus (P = 0.002) compared to controls. MD of these structures significantly correlated to a variable degree with neurological disability and neuropsychological dysfunctions. The increased MD values in several cortical and subcortical gray structures and their correlations with neuropsychological variables substantiate a multisystemic degeneration in ALS and suggest that dysfunctions of frontal-subcortical circuits could play a pivotal role in frontal impairment and behavioral symptoms in ALS patients.
    Neurological Sciences 01/2014; · 1.41 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Diffusion tensor imaging (DTI) is one of the most sensitive MRI tools for detecting subtle cerebral white matter abnormalities in amyotrophic lateral sclerosis (ALS). Nowadays a plethora of DTI tools have been proposed, but very few methods have been translated into clinical practice. New Method: The aim of this study is to validate the objective measurement of fiber tracts as provided by a new unbiased and automated tractography reconstruction tool named as TRActs Constrained by UnderLying Anatomy (TRACULA). The reliability of this tract-based approach was evaluated on a dataset of 14 patients with definite ALS compared with 14 age/sex-matched healthy controls. To further corroborate these measurements, we used a well-known voxelwise approach, called tract-based spatial statistics (TBSS), on the same dataset. TRACULA showed specific significant alterations of several DTI parameters in the corticospinal tract of the ALS group with respect to controls. Comparison with Existing Method: The same finding was detected using the well-known TBSS analysis. Similarly, both methods depicted also additional microstructural changes in the cingulum. DTI tractography metrics provided by TRACULA perfectly agree with those previously reported in several post-mortem and DTI studies, thus demonstrating the accuracy of this method in characterizing the microstructural changes occurring in ALS. With further validation (i.e. considering the heterogeneity of other clinical phenotypes), this method has the potential to become useful for clinical practice providing objective measurements that might aid radiologists in the interpretation of MR images and improve diagnostic accuracy of ALS.
    Journal of neuroscience methods 01/2014; · 2.30 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: β-Interferon therapy is known to be a potential trigger of suicidal behavior, but this effect has not been previously reported for other multiple sclerosis (MS) treatments, such as, natalizumab. Here we report the case history of a 32-year-old woman affected by relapsing-remitting MS, who attempted suicide during natalizumab treatment. This case suggests that a suicidal ideation might be a rare side effect of natalizumab. Nevertheless, this case represents the first evidence of the new adverse drug reaction related to natalizumab treatment. We should alert clinicians to be aware of the possibility of paradoxical activation of suicidality during its therapeutic use. The main purpose of the present article is to use this case to review the possible relationship between suicidal behavior and drugs.
    Journal of pharmacology & pharmacotherapeutics. 12/2013; 4(Suppl1):S90-S93.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this paper is to identify clinical or magnetic resonance imaging (MRI) predictors of long-term clinical progression in a large cohort of multiple sclerosis (MS) patients. A total of 241 relapsing-remitting (RR) MS patients were included in a nine-year follow-up (FU) study. The reference MRIs were acquired at baseline (BL) as part of a multicenter, cross-sectional, clinical-MRI study. Volumetric MRI metrics were measured by a fully automated, operator-independent, multi-parametric segmentation method. Clinical progression was evaluated as defined by: conversion from RR to secondary progressive (SP) disease course; progression of Expanded Disability Status Scale (EDSS); achievement and time to reach EDSS 4. We concluded that conversion from RR to SP (OR 0.79; CI 0.7-0.9), progression of EDSS (OR 0.85; CI 0.77-0.93), achievement of EDSS 4 (OR 0.8; CI 0.7-0.9), and time to reach EDSS 4 (HR 0.88; CI 0.82-0.94) were all predicted by BL gray matter (GM) volume and, except for progression of EDSS, by BL EDSS (respectively: (OR 2.88; CI 1.9-4.36), (OR 2.7; CI 1.7-4.2), (HR 3.86; CI 1.94-7.70)). BL GM volume and EDSS are the best long-term predictors of disease progression in RRMS patients with a relatively long and mild disease.
    Multiple Sclerosis 07/2013; · 4.47 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Episodic memory deficits are frequent symptoms in Multiple Sclerosis and have been associated with dysfunctions of the hippocampus, a key region for learning. However, it is unclear whether genetic factors that influence neural plasticity modulate episodic memory in MS. We thus studied how the Brain Derived Neurotrophic Factor Val(66)Met genotype, a common polymorphism influencing the hippocampal function in healthy controls, impacted on brain networks underlying episodic memory in patients with Multiple Sclerosis. Functional magnetic resonance imaging was used to assess how the Brain Derived Neurotrophic Factor Val(66)Met polymorphism modulated brain regional activity and functional connectivity in 26 cognitively unimpaired Multiple Sclerosis patients and 25 age- and education-matched healthy controls while performing an episodic memory task that included encoding and retrieving visual scenes. We found a highly significant group by genotype interaction in the left posterior hippocampus, bilateral parahippocampus, and left posterior cingulate cortex. In particular, Multiple Sclerosis patients homozygous for the Val(66) allele, relative to Met(66) carriers, showed greater brain responses during both encoding and retrieval while the opposite was true for healthy controls. Furthermore, a robust group by genotype by task interaction was detected for the functional connectivity between the left posterior hippocampus and the ipsilateral posterior cingulate cortex. Here, greater hippocampus-posterior cingulate cortex connectivity was observed in Multiple Sclerosis Met(66) carriers relative to Val(66) homozygous during retrieval (but not encoding) while, again, the reverse was true for healthy controls. The Val(66)Met polymorphism has opposite effects on hippocampal circuitry underlying episodic memory in Multiple Sclerosis patients and healthy controls. Enhancing the knowledge of how genetic factors influence cognitive functions may improve the clinical management of memory deficits in patients with Multiple Sclerosis.
    PLoS ONE 01/2013; 8(4):e61063. · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Multiple sclerosis (MS) is a demyelinating disease affecting the central nervous system, frequently associated with cognitive impairments. Damages of the cerebellum are very common features of patients with MS, although the impact of this clinical factor is generally neglected. Recent evidence from our group demonstrated that MS patients with cerebellar damages are characterized by selective cognitive dysfunctions related to attention and language abilities. Here, we aimed at investigating the presence of neuroanatomical abnormalities in relapsing-remitting MS patients with (RR-MSc) and without (RR-MSnc) cerebellar signs. Twelve RR-MSc patients, 14 demographically, clinically, and radiologically, matched RR-MSnc patients and 20 controls were investigated. All patients underwent neuropsychological assessment. After refilling of FLAIR lesions on the 3D T1-weighted images, VBM was performed using SPM8 and DARTEL. A correlation analysis was performed between VBM results and neuropsychological variables characterizing RR-MSc patients. Despite a similar clinical status, RR-MSc patients were characterized by more severe cognitive damages in attention and language domains with respect to RR-MSnc and controls. With respect to controls, RR-MSnc patients were characterized by a specific atrophy of the bilateral thalami that became more widespread (including motor cortex) in the RR-MSc group (FWE < 0.05). However, consistent with their well-defined neuropsychological deficits, RR-MSc group showed atrophies in the prefrontal and temporal cortical areas when directly compared with RR-MSnc group. Our results demonstrated that RR-MS patients having cerebellar signs were characterized by a distinct neuroanatomical profile, mainly involving cortical regions underpinning executive functions and verbal fluency.
    Journal of Neurology 12/2012; · 3.58 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT OBJECTIVE: Recent evidence suggests that intermediate-length polyglutamine (PolyQ) expansions in the ataxin-2 (ATXN-2) gene are a risk factor for amyotrophic lateral sclerosis (ALS). This work was undertaken with the aim to investigate the frequency of ataxin-1 (ATXN-1) and ATXN-2 PolyQ expansions in a cohort of patients with sporadic ALS (sALS) and patients with familial ALS (fALS) from southern Italy. METHODS: We assessed the PolyQ lengths of ATXN-1 and ATXN-2 in 405 patients with sALS, 13 patients with fALS, and 296 unrelated controls without history of neurodegenerative disorders. RESULTS: We found significantly higher intermediate PolyQ expansions ≥32 for ATXN-1 alleles and ≥28 for ATXN-2 alleles in the sALS cohort (ATXN-1: ALS, 7.07% vs controls, 2.38%; p = 0.0001; ATXN-2: ALS, 2.72% vs controls, 0.5%; p = 0.001). ATXN-1 CAT and ATXN-2 CAA interruptions were detected in patients with ALS only. Age at onset, site of onset, and sex were not significantly related to the ATXN-1 or ATXN-2 PolyQ repeat length expansions. CONCLUSIONS: Both ATXN-1 and ATXN-2 PolyQ intermediate expansions are independently associated with an increased risk for ALS.
    Neurology 11/2012; · 8.25 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: . Although a growing body of evidence has highlighted the role of cognitive rehabilitation (CR) in the management of cognitive dysfunctions in multiple sclerosis (MS), there is still no evidence for a validated therapeutic approach. OBJECTIVE: . We propose a new therapeutic strategy characterized by a computer-based intensive attention training program in MS patients with predominant attention deficits. We aim to investigate the effectiveness of our rehabilitation procedure, tailored for those with impaired abilities, using functional magnetic resonance imaging (fMRI). METHODS: . Using a double-blind randomized controlled study, we enrolled 12 MS patients, who underwent a CR program (experimental group), and 11 age-gender-matched MS patients, who underwent a placebo intervention (control group). fMRI was recorded during the execution of a cognitive task broadly used for assessing attention abilities in MS patients (paced visual serial addition test). RESULTS: . Significant effects were detected both at a phenotypic and at an intermediate phenotypic level. After CR, the experimental group, in comparison with the control group, showed a specific enhanced performance in attention abilities as assessed by the Stroop task with an effect size of 0.88, which was associated with increased activity in the posterior cerebellar lobule and in the superior parietal lobule. CONCLUSIONS: . Our study demonstrates that intensive CR tailored for those with impaired abilities affects neural plasticity and improves some aspects of cognitive deficits in MS patients. The reported neurophysiological and behavioral effects corroborate the benefits of our therapeutic approach, which might have a reliable application in the clinical management of cognitive deficits in MS.
    Neurorehabilitation and neural repair 11/2012; · 4.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: An increased R2 recovery component of the blink reflex (R2-BRrc) has been commonly observed in Parkinson disease, cranio-cervical dystonia, and dystonic tremor, while the BRrc was reported normal in patients with essential tremor (ET). We studied BRrc in patients with ET associated with resting tremor (rET) in comparison with patients with ET. This was a cross-sectional study investigating R2-BRrc at interstimulus intervals (ISI) of 100, 150, 200, 300, 400, 500, and 750 msec in 14 patients with rET, 14 patients with ET, and 16 healthy controls. To compare individual patients, we calculated an R2 recovery index in each subject as the mean of R2 area ratio values at ISIs of 150, 200, 300, 400, and 500 msec. All patients and controls underwent DAT-SPECT. Patients with rET differed from those with ET for the presence of resting tremor associated in several cases (36%) with a subtle arm dystonia. DAT-SPECT was normal in all patients and controls. All patients with rET (with and without dystonia) had an increased R2-BRrc while all patients with ET had a normal BRrc comparable to that of control subjects. The R2 recovery index was abnormal in all patients with rET but in none of the patients with ET. Patients with rET showed increased R2-BRrc, suggesting that this form of tremor may be a dystonic tremor rather than a subtype of ET. BRrc helps to correctly diagnose DAT-negative patients with resting tremor also in the absence of overt dystonic posturing.
    Neurology 09/2012; 79(14):1490-5. · 8.25 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Consistent findings have shown that the cerebellum is critically implicated in a broad range of cognitive processes including executive functions. Of note, cerebellar symptoms and a number of cognitive deficits have been widely reported in patients with multiple sclerosis (MS). This study investigated for the first time the role of cerebellar symptoms in modulating the neural networks associated with a cognitive task broadly used in MS patients (Paced Visual Serial Addition Test (PVSAT)). Twelve relapsing-remitting (RR) MS patients with prevalent cerebellar signs and symptoms (RR-MSc), 15 RR-MS patients without cerebellar manifestation (RR-MSnc) and 16 matched-healthy controls were examined during functional magnetic resonance imaging (fMRI). We tested whether the RR-MSc patients displayed abnormal activations within "cognitive" cerebellar regions and other areas typically engaged in working memory and tightly connected with the cerebellum. Despite similar behavioral performances during fMRI, RR-MSc patients displayed, relatively to both RR-MSnc patients and controls, significantly greater responses in the left cerebellar Crus I/Lobule VI. RR-MSc patients also displayed reduced functional connectivity between the left cerebellar Crus I and the right superior parietal lobule (FWE<.05). These results demonstrated that the presence of the cerebellar signs drastically impacts on the neurofunctional networks underlying working memory in MS. The altered communication between the cerebellum and a cortical area implicated in short-term buffering and storage of relevant information, offer new insights into the pathophysiological mechanisms of cognition in MS.
    Experimental Neurology 08/2012; 237(2):418-26. · 4.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Glatiramer acetate (GA) in multiple sclerosis acts through the induction of GA-specific T-helper 2 cells. Nevertheless, the phenomenon is not universal in patients, explaining individual differences in clinical response. The objective of this article was to categorize GA-treated patients. An enhanced quantitative PCR assay was used for measuring ex-vivo GA-induced IFNγ and IL4 mRNA responses in mononuclear cells from 23 healthy donors, 27 untreated patients, 33 short-term (≤6 months) and 77 long-term (>6 months) GA-treated patients. Thresholds for IFNγ and IL4 transcriptional response were calculated by ROC analysis and long-term treated patients were compared in terms of prognostic stratification. Thresholds for IFNγ and IL4 transcriptional response were calculated at 5.36 and 1.41 relative expression (RE). Finally, 67% of long-term treated patients scored above both response thresholds. These patients had a higher proportion of relapse-free subjects (74% vs 40% when compare to patients who scored below both thresholds) and a significantly better relapse-free survival rate (p=0.006; CI 0.29-0.75). The negative predictive value to predict adverse clinical outcome was 79% (CI 0.63-0.90), meaning that by a positive response, there is a 79% chance that the patient will not experience a negative outcome at 3 years. Our enhanced quantitative PCR assay produced clinically significant results for GA-treated patients. As such, if patients have a positive response, it means they have less chance of a relapse, while patients with a negative response have a greater probability of a worse outcome.
    Multiple Sclerosis 05/2012; 18(10):1484-92. · 4.47 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dystonic tremor (DT) is defined as a postural/kinetic tremor with irregular amplitude and variable frequency occurring in an extremity or body part affected by dystonia.(1).
    Neurology 04/2012; 78(17):1363-5. · 8.25 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Neuromyelitis optica (NMO) is a severely disabling autoimmune disorder of the central nervous system, which predominantly affects the optic nerves and spinal cord. In a majority of cases, NMO is associated with antibodies to aquaporin-4 (AQP4) (termed NMO-IgG). In this study, we evaluated a new multiparametric indirect immunofluorescence (IIF) assay for NMO serology. Sera from 20 patients with NMO, 41 patients with multiple sclerosis (MS), 30 healthy subjects, and a commercial anti-AQP4 IgG antibody were tested in a commercial composite immunofluorescence assay ("Neurology Mosaic 17"; Euroimmun, Germany), consisting of five different diagnostic substrates (HEK cells transfected with AQP4, non-transfected HEK cells, primate cerebellum, cerebrum, and optic nerve tissue sections). We identified AQP4 specific and non-specific fluorescence staining patterns and established positivity criteria. Based on these criteria, this kit yielded a high sensitivity (95%) and specificity (100%) for NMO and had a significant positive and negative likelihood ratio (LR+ = ∞, LR- = 0.05). Moreover, a 100% inter- and intra-laboratory reproducibility was found. The biochip mosaic assay tested in this study is a powerful tool for NMO serology, fast to perform, highly sensitive and specific for NMO, reproducible, and suitable for inter-laboratory standardization as required for multi-centre clinical trials.
    PLoS ONE 01/2012; 7(6):e38896. · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Fused in sarcoma (FUS) or translocation in liposarcoma (TLS), a DNA/RNA-binding protein, causes a dominant autosomal inherited form of amyotrophic lateral sclerosis (ALS), ALS 6. Its main role in neurodegeneration is highlighted by the presence of cytoplasmic accumulation of its mutant protein form in ALS patients. To further define the frequency and spectrum of FUS gene mutations, we have performed a molecular screening of a cohort of 327 Italian patients from Southern Italy with sporadic ALS (SALS). We identified 4 patients carrying 3 different missense mutations and several polymorphisms. Two different substitutions occurring in the same amino acidic position have been observed in 2 patients: R521G and R521C respectively; P525L mutation has been found in 2 additional cases. Most of the patients with FUS mutations showed early symptom onset and had short disease survival. We also detected 4 different polymorphic variants (3'-untranslated region [UTR] variant, c.*41G>A; c.523+3ins[GAGGTG]; c.335-15del[TTTT]; and rs13331793) in 9 patients from within our cohort. This study underlines the importance of population-based mutation screening of newly identified genes.
    Neurobiology of aging 11/2011; 33(4):837.e1-5. · 5.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We present a new application based on genetic algorithms (GAs) that evolves a Cellular Neural Network (CNN) capable of automatically determining the lesion load in multiple sclerosis (MS) patients from magnetic resonance imaging (MRI). In particular, it seeks to identify brain areas affected by lesions, whose presence is revealed by areas of higher intensity if compared to healthy tissue. The performance of the CNN algorithm has been quantitatively evaluated by comparing the CNN output with the expert's manual delineation of MS lesions. The CNN algorithm was run on a data set of 11 MS patients; for each one a single dataset of MRI images (matrix resolution of 256×256 pixels) was acquired. Our automated approach gives satisfactory results showing that after the learning process the CNN is capable of detecting MS lesions with different shapes and intensities (mean DICE coefficient=0.64). The system could provide a useful support tool for the evaluation of lesions in MS patients, although it needs to be evolved and developed in the future.
    Journal of neuroscience methods 09/2011; 203(1):193-9. · 2.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A 35-year-old young man displayed Leber's optic neuropathy (LHON) due to T14484C and multiple sclerosis (MS) phenotype that was dominated by symptoms and signs of spinal cord impairment. Magnetic resonance imaging (MRI) revealed demyelinating lesions extending from D6 to D11 in the spinal cord with gadolinium enhancement, while only three linear demyelinating lesions were seen on brain MRI. In the literature, a major involvement of the spinal cord was already reported in three of four male patients with the 14484 LHON mutation who developed MS, but the reasons of this peculiar association remain unknown, and further research in this area is needed.
    Multiple Sclerosis 06/2011; 17(6):763-6. · 4.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: As with other autoimmune diseases, susceptibility to multiple sclerosis (MS) is believed to result from the complex interaction of a number of genes, each with modest effect. Several genome-wide screens have implicated the nitric oxide synthase 2A gene (NOS2A), which encodes the inducible form of nitric oxide synthase, as being potentially associated with MS. To determine whether genetic variants within this gene may constitute a risk factor for causing MS, we investigated 13 single nucleotide polymorphisms in the NOS2A gene, in a case-control group of 214 Italian patients with MS and 121 controls. All these single nucleotide polymorphisms (SNPs) were analyzed using the SNPlex™ Genotyping System (Applied Biosystems). Data were analyzed using Genemapper 4.0 and Haploview 4.1. No significant association between cases and controls (P>0.05) was observed for the alleles of the SNPs. Defining the haplotype blocks also failed to detect any associated haplotypes. Our results suggest that polymorphic variation within the NOS2A gene does not influence the susceptibility to MS in patients of Italian origin.
    Journal of the neurological sciences 03/2011; 304(1-2):75-7. · 2.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Data on the outcome predictors of surgical result of carpal tunnel syndrome (CTS) is sparse and often conflicting. The purpose of this prospective comparative study was to evaluate the neurophysiologic findings and histological characteristics of the flexor tenosynovium in patients with CTS, assessing possible associations between these findings and preoperative patient status or surgical outcome. We evaluated 30 consecutive patients with a diagnosis of idiopathic CTS who were referred for surgery. Demographic data, subjective and objective data, and responses on an expanded assessment set, were collected before and 6 months after surgery. All patients underwent diagnostic neurophysiological testing prior to surgery, and histological analysis of tenosynovium specimens that were removed during surgery. Ten fresh-frozen cadavers served as controls. There was significant improvement in most of the disease specific (Boston questionnaire and Hi-Ob scale) and health generic (SF-36 questionnaire) evaluation tools used in the study at the 6-month follow-up. Vascular changes were noted in the tenosynovium of the flexor tendon of patients with CTS when compared with controls. Greater synovial vascularization was negative predictor of the SF-36's physical summary score before surgery. Bilateral presentation of symptoms and low nerve conduction velocity were negative predictors of the quality of life of patients after surgery for CTS. These findings have to be considered when discussing with patients as for the expected and desired outcomes of CTS surgery. The increased vascularization of flexor tenosynovium is associated with patients' functional status.
    Journal of Orthopaedic Research 03/2011; 29(8):1298-304. · 2.88 Impact Factor
  • Journal of Neurology 01/2011; 258(7):1349-50. · 3.58 Impact Factor

Publication Stats

1k Citations
402.49 Total Impact Points

Institutions

  • 1997–2014
    • Universita' degli Studi "Magna Græcia" di Catanzaro
      • Department of Medical and Surgical Sciences
      Catanzaro, Calabria, Italy
  • 2008–2012
    • Azienda Ospedaliero Universitaria San Luigi Gonzaga
      Orbassano, Piedmont, Italy
  • 2006–2010
    • National Research Council
      • Institute of Neurological Sciences ISN
      Roma, Latium, Italy
  • 2004
    • Università di Pisa
      Pisa, Tuscany, Italy
  • 2002–2004
    • Università degli Studi di Palermo
      Palermo, Sicily, Italy
  • 2001
    • Institute of Neurology
      Moskva, Moscow, Russia
  • 1999
    • Mediterranean University of Reggio Calabria
      Reggio di Calabria, Calabria, Italy