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Maria Stella Graziani

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Martina Zaninotto

Associate Editors
Ferruccio Ceriotti
Davide Giavarina
Bruna Lo Sasso
Giampaolo Merlini
Martina Montagnana
Andrea Mosca
Paola Pezzati
Rossella Tomaiuolo
Matteo Vidali

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Francesco Busardò

International Advisory Board Khosrow Adeli Canada
Sergio Bernardini Italy
Marcello Ciaccio Italy
Eleftherios Diamandis Canada
Philippe Gillery France
Kjell Grankvist Sweden
Hans Jacobs The Netherlands
Eric Kilpatrick UK
Magdalena Krintus Poland
Giuseppe Lippi Italy
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Ana-Maria Simundic Croatia
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Giuseppe Agosta

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Chiara Riva
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ISSN print: 0393 – 0564
ISSN digital: 0392- 7091

BC: Articoli scritti da L. Zanolla

Glossario di epidemiologia
Glossary of epidemiology
<p>The COVID-19 pandemic faces the reader of scientific papers with a variety of epidemiologic terms, often not familiar to the reader. A further problem is due to the incomplete standardization of those terms, that can assume partly different meaning in different settings. These problems can hamper the correct comprehension and interpretation of the data presented. These considerations represented the spur to formulate a glossary of the more common epidemiological terms, mainly using the COVID-19 epidemics as example, but taking into account also other infectious diseases and chronic non-infectious diseases as well. To facilitate the reading of the vast majority of papers, which are written in English, the corresponding English terms are reported.</p>
Biochimica Clinica ; 45(2) 180-195
Documenti - Documents
Al “cuore” del quadro clinico di COVID-19
To the “heart” of the clinical picture of COVID-19
<p>Several studies document cardiac involvement in COVID-19 patients, as evidenced by cardiac biomarkers elevation. Hospitalized patients with cardiac involvement have a poorer prognosis, in terms of need for intensive care unit, or mortality. This paper provides a review of the wealth of literature on heart involvement in COVID 19. The majority of the available papers reports data from the Chinese experience and it is not clear at the moment whether the observations are related to really different populations of patients. The mechanism of the cardiac injury is likely multifactorial. There could be direct myocardial damage by the virus, but the few heart histologic specimens available do not evidence the presence of virus RNA in myocytes. The infection in the lungs may produce a cytokine storm which in turn could damage myocytes. Coagulation system is also affected by COVID-19: D-dimer is increased, while platelets are reduced in most studies, and both parameters relate directly with the risk of death. These alterations are probably the cause of the many cases of pulmonary embolism, venous thromboembolisms, and arterial embolism reported. Hypertension and previous cardiovascular diseases are also likely involved in the severity of the observed cardiac injury. Although all these mechanisms may play a role in cardiac involvement, the severe lung infection alone could justify cardiac damage, due to the simultaneous reduced supply and increased demand of myocardial oxygen. We still know very little about this new viral disease, but as knowledge is accumulating, the medical community will pinpoint the mechanism of cardiac involvement and find the optimal strategy to prevent its severe consequences.</p>
Biochimica Clinica ; 44(4) 019-020
Mortalità da COVID-19: una epidemia senza denominatore. Ma conosciamo il numeratore?
COVID-19 death rate: an epidemic without a denominator. But what do we know about the numerator?
L. Zanolla  | 
<p>Since many COVID-19 patients display few, if any, symptoms, assessing infection rate, hospitalization rate, and mortality rate is very challenging. Not only we do not know the denominator of these ratios, but in assessing the mortality rate, we also have problems to estimate the numerator. Between March and April 2020, Italy recorded 42633 excess deaths compared to the average of the five previous years. In the same period, 27 846 deaths were classified as due to COVID-19. Since the international definition of a COVID-19 case requires a microbiological confirmation of the presence of the virus, 34.7% of the excess deaths remain unexplained. Part of these may be COVID-19 deaths, left unconfirmed for the lack of a microbiological swab; but further deaths may be caused by delayed care of other diseases, due to the reluctance of many patients to visit the hospitals during the pandemic. The same apparent underestimation of COVID-19 deaths emerges for other European countries, with more evident differences in the United Kingdom and in the Netherlands. In other countries, the number of excess deaths is lower than the average of the previous years, probably due to a delay in recording deaths. In conclusion, we have uncertainty about the real number of victims of this pandemic; we will improve our knowledge when numbers will be no longer provisional, but there are areas where it is impossible to get the perfect assessment; however these figures are rather important to better face a possible further epidemic wave.</p>
Biochimica Clinica ; 44(4) 005-006
COVID-19 - Opinions
Un mondo senza significatività statistica?
A word without statistical significance?
L. Zanolla  | 
<p>A recently published comment (Nature, 2019), proposing to give up the use of the P value in scientific literature, spurred several contributions on the topic. The main target was the need to avoid the dichotomization of P, with p&lt;0.05 identifying the statistically significant results. A first proposal was to lower the threshold value to 0.005, labeling as &ldquo;suggestive&rdquo; results previously classified as significant but not meeting the new threshold. A more radical suggestion was to suppress the use of P, allowing its presence only in a descriptive sense. At the time of writing, only one journal took such a radical position, and this choice gave rise to problems in the interpretation of studies&rsquo; results. To avoid p-hacking and other inappropriate uses of P, the most sensible strategy would be to mandate the pre-publication of the study protocol, including the statistical analysis. The authors should then be required to adhere to their original published plan. This rule could be of great help for pragmatic trials, but does not apply to exploratory studies, which are more frequent in life sciences. It could also be imposed to report the P value only for sufficiently large sample sizes, reporting otherwise only descriptive statistics. Moreover, the term &ldquo;statistical significance&rdquo; could be replaced by &ldquo;statistical accuracy,&rdquo; in order to avoid the common confusion with &ldquo;clinical significance&rdquo;. This debate probably will not lead to the abandonment of P, but it may help to improve the quality of the statistical analysis of trials&rsquo; results.</p>
Biochimica Clinica ; 44(4) 380-385
Opinioni - Opinions
Linee guida per la valutazione del rischio cardiovascolare: siamo a rischio di confusione?
Guidelines for cardiovascular risk assessment: do we risk an overcrowding?
<p>Cardiovascular diseases are highly prevalent in Western countries. Among modifiable risk factors for cardiovascular events, dyslipidaemias have a predominant role, being conveniently controlled either by a healthy lifestyle or by drugs, when necessary. A number of guidelines have been issued to guide both clinicians and laboratorians to assess the cardiovascular risk and to provide the best patient management. Guidelines accumulated and evolved with time, incorporating new available evidence; however, differences among them could generate disorientation among health professionals. The recent recommendations by the American College of Cardiologists and the American Heart Association are a breaking point in the guideline history, mainly because of the suggestion of abandoning the therapeutic LDL cholesterol targets. In this paper, we illustrate available guidelines, emphasizing the different approaches to risk prediction. The possible adoption of the recent American guideline will pose problems to both clinicians and clinical laboratories. The number of subjects to be treated would markedly increase and the lack of therapeutic targets could hamper the possibility to share with patients the targets to fulfil, jeopardising their compliance. For laboratories, the major issue would be the difficulty to report lipid results according to targets adjusted to risk levels. In an opposite direction, a recent national consensus document suggests adopting in reporting lipid results the desirable lipid levels as established by European recommendations.</p>
Biochimica Clinica ; 41(1) 085-095
Opinioni - Opinions
Come interpretare correttamente il valore di P?
Understanding the P value
<p>A number of recent contributions about the P value in statistics gave the spur to&nbsp;consider different aspects of its use in scientific papers. There is indeed a need of correct information on how and&nbsp;when to apply the P value to evaluate results of a scientific experiment and how to appropriately interpret the&nbsp;numerical value as well, considering that the P statistic is rather frequently reported in the medical literature. In this&nbsp;paper we first described the origin of the P value and its correct significance, using examples where the statistical&nbsp;significance of the P value does not necessarily mean a clinical significance. Then, we defined which kind of&nbsp;assumptions cannot be drawn from the a P value. The most common misuse is when a non-statistically significant P&nbsp;value is used to establish that two laboratory techniques are equivalent. Finally, some alternatives are given, the most&nbsp;common being the use of the confidence intervals. In spite of the interpretation mistakes commonly observed in&nbsp;scientific articles, the P value remains a useful statistic tool to be utilized and interpreted with better consciousness.</p>
Biochimica Clinica ; 40(1) 40-44
Opinioni - Opinions
Glossario per il lettore di un articolo scientifico. Parte III: la meta-analisi
Glossary for the reader of a scientific paper. Part III: the meta-analysis
<p>This document represents the third part&nbsp;of the project related to a glossary for statistics. The meta-analysis is the technique used to integrate the results from&nbsp;a number of different studies in only one quantitative evaluation to obtain conclusions that are stronger than those&nbsp;obtained from single studies. The meta-analysis is actually useful when the available studies are inadequately&nbsp;powerful because performed in a limited number of patients or when the results from single studies are discordant.&nbsp;The document includes statistical terms of more common use. To facilitate the reading of the vast majority of articles,&nbsp;which are written in English, corresponding English terms are also reported.</p>
Biochimica Clinica ; 38(6) 630-638
Documenti - Documents
Glossario per il lettore di un articolo scientifico. Parte II: la statistica inferenziale
Glossary for the reader of a scientific paper. Part II: inferential statistics
<p>This document represents the second&nbsp;part of the project related to a glossary for statistics. The inferential statistics is the part of the statistic used to&nbsp;formulate statements about the characteristics of a population from a sample of it, selected randomly. The document&nbsp;includes statistical terms of more common use. To facilitate the reading of the vast majority of articles, which are&nbsp;written in English, corresponding English terms are also reported.</p>
Biochimica Clinica ; 38(4) 314-325
Documenti - Documents
Glossario per il lettore di un articolo scientifico. Parte I: la statistica descrittiva
Glossary for the reader of a scientific paper. Part I: descriptive statistics
<p>Glossary for the reader of a scientific paper. Part I: descriptive statistics. The medical literature uses statistics<br />to describe results of observational studies, clinical trials and experimental studies and to test the underlying scientific&nbsp;hypothesis. The statistic language could, however, not be familiar to any reader; this can hamper the correct&nbsp;comprehension of the paper and the appropriate interpretation of results. These considerations represented the spur&nbsp;to formulate a glossary of the more common statistical terms. To facilitate the reading of the vast majority of articles,&nbsp;which are written in English, corresponding English terms are also reported. The present document represents the&nbsp;first part of the project, related to descriptive statistics.</p>
Biochimica Clinica ; 38(2) 129-135
Documenti - Documents