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Barbieri F, Bajetto A, Dellacasagrande I, Solari A, Würth R, Fernandez V, Rancati S, Ceresa D, Appolloni I, De Luca G, Dono M, Nozza P, Schiapparelli P, Gambaro M, Fiaschi P, Gaggero G, Costanzo N, Thellung S, Malatesta P, Pagano A, Zona G, De Pietri Tonelli D, Florio T. Stem-like signatures in human meningioma cells are under the control of CXCL11/CXCL12 chemokine activity. Neuro Oncol 2023; 25:1775-1787. [PMID: 37074930 PMCID: PMC10547527 DOI: 10.1093/neuonc/noad076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Meningiomas are mainly benign brain tumors, although about 20% of histologically benign cases are clinically aggressive and recur after resection. We hypothesize that meningioma brain invasiveness and recurrence may be related to the presence of cancer stem cells and their high responsiveness to the CXCL12-CXCR4/CXCR7 chemokine axis. The aim of this study was to isolate meningioma stem cells from human samples, characterize them for biological features related to malignant behavior, and to identify the role of CXCR4/CXCR7 in these processes. METHODS Meningioma stem cells were isolated from patient-derived primary cultures in stem cell-permissive conditions, and characterized for phenotype, self-renewal, proliferation and migration rates, vasculogenic mimicry (VM), and in vivo tumorigenesis, in comparison with differentiated meningioma cells and stem-like cells isolated from normal meninges. These cell populations were challenged with CXCL12 and CXCL11 and receptor antagonists to define the chemokine role in stem cell-related functions. RESULTS Stem-like cells isolated from meningioma cultures display higher proliferation and migration rates, and VM, as compared to meningioma non-stem cells or cells isolated from normal meninges and were the only tumorigenic population in vivo. In meningioma cells, these stem-like functions were under the control of the CXCR4/CXCR7 chemokine axis. CONCLUSIONS We report a role for CXCL11 and CXCL12 in the control of malignant features in stem-like cells isolated from human meningioma, providing a possible basis for the aggressive clinical behavior observed in subsets of these tumors. CXCR4/CXCR7 antagonists might represent a useful approach for meningioma at high risk of recurrence and malignant progression.
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Affiliation(s)
- Federica Barbieri
- Section of Pharmacology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Adriana Bajetto
- Section of Pharmacology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Irene Dellacasagrande
- Section of Pharmacology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Agnese Solari
- Section of Pharmacology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Roberto Würth
- Section of Pharmacology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Virginia Fernandez
- Neurobiology of miRNA, Istituto Italiano di Tecnologia (IIT), Genova, Italy
| | - Silvia Rancati
- Neurobiology of miRNA, Istituto Italiano di Tecnologia (IIT), Genova, Italy
| | - Davide Ceresa
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Irene Appolloni
- Department of Experimental Medicine, University of Genova, Genova, Italy
| | | | - Mariella Dono
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Nozza
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Monica Gambaro
- Medical Physics Department, E.O. Galliera Hospital, Genova, Italy
| | - Pietro Fiaschi
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | | | - Nicolò Costanzo
- Section of Pharmacology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Stefano Thellung
- Section of Pharmacology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Paolo Malatesta
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Experimental Medicine, University of Genova, Genova, Italy
| | - Aldo Pagano
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Experimental Medicine, University of Genova, Genova, Italy
| | - Gianluigi Zona
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | | | - Tullio Florio
- Section of Pharmacology, Department of Internal Medicine, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Leavitt VM, Kever AM, Weinstein SM, Shinohara RT, Schmidt H, Aoun SM, Solari A, Solomon AJ. Diagnosis concealment is prevalent in MS, and associated with diagnosis experience. Mult Scler Relat Disord 2022; 68:104373. [PMID: 36544320 DOI: 10.1016/j.msard.2022.104373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Receiving a diagnosis of multiple sclerosis (MS) can be stressful; later, patients may conceal their diagnosis. Here, we aimed to (1) assess prevalence of disclosure and concealment behaviors, and (2) explore whether diagnosis experience is associated with later concealment and if MS provider engagement on this topic modifies concealment. METHODS In a survey-based study, MS patients completed DISCO-MS assessing disclosure and concealment and responded to questions about diagnosis experience and practitioner attention to disclosure. Frequency analysis and Pearson's correlations were used in exploratory analyses. RESULTS 428 adults with MS participated. 49% (N = 201) conceal their diagnosis. Higher education [t(405) = 3.66, p < 0.001], younger age (r = -0.15, p = 0.002), and shorter disease duration (r = -0.18, p = 0.010) were associated with higher concealment. 39% (N = 159) anticipate negative consequences of disclosure. Individuals reporting positive diagnosis experience (26%, N = 102) were less likely to conceal later in disease course compared to those with negative experience (34%, N = 136) [t(233) = 2.483, p = 0.014]. Patients whose MS providers discussed disclosure (23%, N = 73) anticipated less negative consequences of disclosure [t(323) = 2.475, p = 0.014]. CONCLUSIONS Diagnosis concealment is common in MS. Favorable diagnosis experience and provider attention to the topic of disclosure throughout the MS disease course may influence diagnosis concealment.
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Affiliation(s)
- V M Leavitt
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, Box 16, New York, NY 10032, USA.
| | - A M Kever
- Department of Neurology, Columbia University Irving Medical Center, 630 W. 168th Street, Box 16, New York, NY 10032, USA
| | - S M Weinstein
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA, USA
| | - R T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA, USA
| | - H Schmidt
- Accelerated Cure Project, Waltham, MA, USA
| | - S M Aoun
- Perron Institute for Neurological and Translational Science, University of Western Australia, La Trobe University, Australia
| | - A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - A J Solomon
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, 1 South Prospect Street, Burlington, VT, USA
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Pita S, Lorite P, Cuadrado A, Panzera Y, De Oliveira J, Alevi KCC, Rosa JA, Freitas SPC, Gómez-Palacio A, Solari A, Monroy C, Dorn PL, Cabrera-Bravo M, Panzera F. High chromosomal mobility of rDNA clusters in holocentric chromosomes of Triatominae, vectors of Chagas disease (Hemiptera-Reduviidae). Med Vet Entomol 2022; 36:66-80. [PMID: 34730244 DOI: 10.1111/mve.12552] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/15/2021] [Accepted: 10/14/2021] [Indexed: 05/28/2023]
Abstract
The subfamily Triatominae (Hemiptera-Reduviidae) includes more than 150 blood-sucking species, potential vectors of the protozoan Trypanosoma cruzi, causative agent of Chagas disease. A distinctive cytogenetic characteristic of this group is the presence of extremely stable chromosome numbers. Unexpectedly, the analyses of the chromosomal location of ribosomal gene clusters and other repetitive sequences place Triatominae as a significantly diverse hemipteran subfamily. Here, we advance the understanding of Triatominae chromosomal evolution through the analysis of the 45S rDNA cluster chromosomal location in 92 Triatominae species. We found the 45S rDNA clusters in one to four loci per haploid genome with different chromosomal patterns: On one or two autosomes, on one, two or three sex chromosomes, on the X chromosome plus one to three autosomes. The movement of 45S rDNA clusters is discussed in an evolutionary context. Our results illustrate that rDNA mobility has been relatively common in the past and in recent evolutionary history of the group. The high frequency of rDNA patterns involving autosomes and sex chromosomes among closely related species could affect genetic recombination and the viability of hybrid populations, which suggests that the mobility of rDNA clusters could be a driver of species diversification.
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Affiliation(s)
- S Pita
- Sección Genética Evolutiva, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - P Lorite
- Department of Experimental Biology, Genetics, University of Jaén, Jaén, Spain
| | - A Cuadrado
- Department of Biomedicine and Biotechnology, University of Alcalá, Madrid, Spain
| | - Y Panzera
- Sección Genética Evolutiva, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - J De Oliveira
- Laboratório de Entomologia em Saúde Pública, Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - K C C Alevi
- Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), São Paulo, Brazil
| | - J A Rosa
- Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), São Paulo, Brazil
| | | | - A Gómez-Palacio
- Laboratorio de Investigación en Genética Evolutiva - LIGE, Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
| | - A Solari
- Programa de Biología Celular y Molecular, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - C Monroy
- Laboratorio de Entomología Aplicada y Parasitología, Escuela de Biología, Facultad de Farmacia, Universidad de San Carlos de Guatemala, Guatemala City, Guatemala
| | - P L Dorn
- Department of Biological Sciences, Loyola University New Orleans, New Orleans, Louisiana, U.S.A
| | - M Cabrera-Bravo
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - F Panzera
- Sección Genética Evolutiva, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
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Pace A, Solari A, De Panfilis L, Lissoni B, Pronello E, Rudà R, Silvani A, Salmaggi A, Merli R, De Paula U, Bertocchi E, Verza M, Veronese S. P14.72 Involving patients and caregivers in the production of guidelines for palliative care in primary brain tumours: identification of intervention priorities. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Involving patients and caregivers is an important component of clinical guideline development. The three main Italian scientific associations for neurology, neuro-oncology and palliative care (SIN-AINO-SICP) recently appointed a joint task force (TF) of clinicians and researchers to develop specific guidance on palliative care of people with primary brain tumours, following the GRADE approach. To identify clinical questions meaningful to the patients and caregivers, a qualitative approach was used.
MATERIAL AND METHODS
Based on the existing literature and on consensus, the TF identified nine intervention areas, whose relevance was apprised by patients (via personal semi-structured interviews) and bereaved caregivers (via focus groups, FGs) from five tertiary neuro-oncology centres. Participants were prompted to provide their personal disease-related experience, and were asked to elicit the areas that mostly impacted their own lives. Interviews and FGMs were audio-recorded, transcribed and analysed using thematic analysis.
RESULTS
Twenty interviews and five FGs (28 caregivers) were completed between late 2020 and early 2021. Preliminary findings show that all the pre-specified areas were defined as important by participants. Most discussed topics were communication, organization and service satisfaction, cognitive and psychological issues, and advance care planning (ACP). Caregivers focused their discussions on the need for patient psychological support, difficulties experienced with symptoms control (e.g. epileptic seizures, behavioural changes), communication and organizational issues.
CONCLUSION
Participation of Italian patients with brain tumours and family caregivers was high and information-rich. All of the nine guideline intervention areas were considered important, communication, care organization, symptom control and ACP being the most discussed.
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Affiliation(s)
- A Pace
- IRCCS Regina Elena Cancer Institute, Rome, Italy
| | - A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - L De Panfilis
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - B Lissoni
- Unit of Clinical Psychology, Niguarda Hospital, Milan, Italy
| | - E Pronello
- Department of Neuro-Oncology, City of Health and Science Hospital, Turin, Italy
| | - R Rudà
- Department of Neuro-Oncology, RomeCity of Health and Science University of Turin, Italy
| | - A Silvani
- Neuro-Oncologia Clinica, IRCC Istituto Neurologico Carlo Besta, Milan, Italy
| | - A Salmaggi
- Neurology and Stroke Unit, ASST, Lecco, Italy
| | - R Merli
- Neurosurgery Unit, ASST PGXXIII, Bergamo, Italy
| | - U De Paula
- Radiation Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - E Bertocchi
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Verza
- IRENE BT Patients Association, Rome, Italy
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Ferretti E, Carlomagno S, Pesce S, Muccio L, Obino V, Greppi M, Solari A, Setti C, Marcenaro E, Della Chiesa M, Sivori S. Role of the Main Non HLA-Specific Activating NK Receptors in Pancreatic, Colorectal and Gastric Tumors Surveillance. Cancers (Basel) 2020; 12:E3705. [PMID: 33321719 PMCID: PMC7763095 DOI: 10.3390/cancers12123705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022] Open
Abstract
Human NK cells can control tumor growth and metastatic spread thanks to their powerful cytolytic activity which relies on the expression of an array of activating receptors. Natural cytotoxicity receptors (NCRs) NKG2D and DNAM-1 are those non-HLA-specific activating NK receptors that are mainly involved in sensing tumor transformation by the recognition of different ligands, often stress-induced molecules, on the surface of cancer cells. Tumors display several mechanisms aimed at dampening/evading NK-mediated responses, a relevant fraction of which is based on the downregulation of the expression of activating receptors and/or their ligands. In this review, we summarize the role of the main non-HLA-specific activating NK receptors, NCRs, NKG2D and DNAM-1, in controlling tumor growth and metastatic spread in solid malignancies affecting the gastrointestinal tract with high incidence in the world population, i.e., pancreatic ductal adenocarcinoma (PDAC), colorectal cancer (CRC), and gastric cancer (GC), also describing the phenotypic and functional alterations induced on NK cells by their tumor microenvironment.
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Affiliation(s)
- Elisa Ferretti
- Centro di Eccellenza per la Ricerca Biomedica, University of Genoa, 16132 Genoa, Italy;
| | - Simona Carlomagno
- Dipartimento di Medicina Sperimentale (DIMES), University of Genoa, 16132 Genoa, Italy; (S.C.); (S.P.); (L.M.); (V.O.); (M.G.); (A.S.); (C.S.)
| | - Silvia Pesce
- Dipartimento di Medicina Sperimentale (DIMES), University of Genoa, 16132 Genoa, Italy; (S.C.); (S.P.); (L.M.); (V.O.); (M.G.); (A.S.); (C.S.)
| | - Letizia Muccio
- Dipartimento di Medicina Sperimentale (DIMES), University of Genoa, 16132 Genoa, Italy; (S.C.); (S.P.); (L.M.); (V.O.); (M.G.); (A.S.); (C.S.)
| | - Valentina Obino
- Dipartimento di Medicina Sperimentale (DIMES), University of Genoa, 16132 Genoa, Italy; (S.C.); (S.P.); (L.M.); (V.O.); (M.G.); (A.S.); (C.S.)
| | - Marco Greppi
- Dipartimento di Medicina Sperimentale (DIMES), University of Genoa, 16132 Genoa, Italy; (S.C.); (S.P.); (L.M.); (V.O.); (M.G.); (A.S.); (C.S.)
| | - Agnese Solari
- Dipartimento di Medicina Sperimentale (DIMES), University of Genoa, 16132 Genoa, Italy; (S.C.); (S.P.); (L.M.); (V.O.); (M.G.); (A.S.); (C.S.)
| | - Chiara Setti
- Dipartimento di Medicina Sperimentale (DIMES), University of Genoa, 16132 Genoa, Italy; (S.C.); (S.P.); (L.M.); (V.O.); (M.G.); (A.S.); (C.S.)
| | - Emanuela Marcenaro
- Dipartimento di Medicina Sperimentale (DIMES) and Centro di Eccellenza per la Ricerca Biomedica, University of Genoa, 16132 Genoa, Italy;
| | - Mariella Della Chiesa
- Dipartimento di Medicina Sperimentale (DIMES) and Centro di Eccellenza per la Ricerca Biomedica, University of Genoa, 16132 Genoa, Italy;
| | - Simona Sivori
- Dipartimento di Medicina Sperimentale (DIMES) and Centro di Eccellenza per la Ricerca Biomedica, University of Genoa, 16132 Genoa, Italy;
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Vitale RM, Thellung S, Tinto F, Solari A, Gatti M, Nuzzo G, Ioannou E, Roussis V, Ciavatta ML, Manzo E, Florio T, Amodeo P. Identification of the hydantoin alkaloids parazoanthines as novel CXCR4 antagonists by computational and in vitro functional characterization. Bioorg Chem 2020; 105:104337. [PMID: 33113408 DOI: 10.1016/j.bioorg.2020.104337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/19/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022]
Abstract
CXCR4 chemokine receptor represents an attractive pharmacological target due to its key role in cancer metastasis and inflammatory diseases. Starting from our previously-developed pharmacophoric model, we applied a combined computational and experimental approach that led to the identification of the hydantoin alkaloids parazoanthines, isolated from the Mediterranean Sea anemone Parazoanthus axinellae, as novel CXCR4 antagonists. Parazoanthine analogues were then synthesized to evaluate the contribution of functional groups to the overall activity. Within the panel of synthesized natural and non-natural parazoanthines, parazoanthine-B was identified as the most potent CXCR4 antagonist with an IC50 value of 9.3 nM, even though all the investigated compounds were able to antagonize in vitro the down-stream effects of CXC12, albeit with variable potency and efficacy. The results of our study strongly support this class of small molecules as potent CXCR4 antagonists in tumoral pathologies characterized by an overexpression of this receptor. Furthermore, their structure-activity relationships allowed the optimization of our pharmacophoric model, useful for large-scale in silico screening.
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Affiliation(s)
- Rosa Maria Vitale
- Institute of Biomolecular Chemistry, National Research Council (ICB-CNR), Via Campi Flegrei 34, 80078, Pozzuoli, (NA), Italy
| | - Stefano Thellung
- Section of Pharmacology, Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Francesco Tinto
- Institute of Biomolecular Chemistry, National Research Council (ICB-CNR), Via Campi Flegrei 34, 80078, Pozzuoli, (NA), Italy
| | - Agnese Solari
- Section of Pharmacology, Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Monica Gatti
- Section of Pharmacology, Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Genoveffa Nuzzo
- Institute of Biomolecular Chemistry, National Research Council (ICB-CNR), Via Campi Flegrei 34, 80078, Pozzuoli, (NA), Italy
| | - Efstathia Ioannou
- Department of Pharmacognosy and Chemistry of Natural Products, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, Athens 15771, Greece
| | - Vassilios Roussis
- Department of Pharmacognosy and Chemistry of Natural Products, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistimiopolis Zografou, Athens 15771, Greece
| | - Maria Letizia Ciavatta
- Institute of Biomolecular Chemistry, National Research Council (ICB-CNR), Via Campi Flegrei 34, 80078, Pozzuoli, (NA), Italy
| | - Emiliano Manzo
- Institute of Biomolecular Chemistry, National Research Council (ICB-CNR), Via Campi Flegrei 34, 80078, Pozzuoli, (NA), Italy.
| | - Tullio Florio
- Section of Pharmacology, Department of Internal Medicine, University of Genova, 16132 Genova, Italy; IRCCS Policlinico San Martino, 16132 Genova, Italy.
| | - Pietro Amodeo
- Institute of Biomolecular Chemistry, National Research Council (ICB-CNR), Via Campi Flegrei 34, 80078, Pozzuoli, (NA), Italy.
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Solari A, Giordano A, Sastre-Garriga J, Köpke S, Rahn AC, Kleiter I, Aleksovska K, Battaglia MA, Bay J, Copetti M, Drulovic J, Kooij L, Mens J, Meza Murillo ER, Milanov I, Milo R, Pekmezovic T, Vosburgh J, Silber E, Veronese S, Patti F, Voltz R, Oliver D. EAN guideline on palliative care of people with severe, progressive multiple sclerosis. Eur J Neurol 2020; 27:1510-1529. [PMID: 32469447 DOI: 10.1111/ene.14248] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Patients with severe, progressive multiple sclerosis (MS) have complex physical and psychosocial needs, typically over several years. Few treatment options are available to prevent or delay further clinical worsening in this population. The objective was to develop an evidence-based clinical practice guideline for the palliative care of patients with severe, progressive MS. METHODS This guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Formulation of the clinical questions was performed in the Patients-Intervention-Comparator-Outcome format, involving patients, carers and healthcare professionals (HPs). No uniform definition of severe MS exists: in this guideline, constant bilateral support required to walk 20 m without resting (Expanded Disability Status Scale score > 6.0) or higher disability is referred to. When evidence was lacking for this population, recommendations were formulated using indirect evidence or good practice statements were devised. RESULTS Ten clinical questions were formulated. They encompassed general and specialist palliative care, advance care planning, discussing with HPs the patient's wish to hasten death, symptom management, multidisciplinary rehabilitation, interventions for caregivers and interventions for HPs. A total of 34 recommendations (33 weak, 1 strong) and seven good practice statements were devised. CONCLUSIONS The provision of home-based palliative care (either general or specialist) is recommended with weak strength for patients with severe, progressive MS. Further research on the integration of palliative care and MS care is needed. Areas that currently lack evidence of efficacy in this population include advance care planning, the management of symptoms such as fatigue and mood problems, and interventions for caregivers and HPs.
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Affiliation(s)
- A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - A Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - J Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Köpke
- Institute of Clinical Nursing Science, University of Cologne, Cologne, Germany.,Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A C Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - J Bay
- Multiple Sclerosis International Federation, People with MS Advisory Committee, Copenhagen, Denmark
| | - M Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - J Drulovic
- Clinic of Neurology, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - L Kooij
- Nieuw Unicum, Zandvoort, The Netherlands
| | - J Mens
- Nieuw Unicum, Zandvoort, The Netherlands
| | - E R Meza Murillo
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Milanov
- Medical University of Sofia, Sofia, Bulgaria
| | - R Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - T Pekmezovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - J Vosburgh
- Israel Multiple Sclerosis Society, Tel-Aviv, Israel
| | - E Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - S Veronese
- FARO Charitable Foundation, Turin, Italy
| | - F Patti
- Neurology Clinic, Multiple Sclerosis Centre, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - R Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - D Oliver
- The Tizard Centre, University of Kent, Canterbury, UK
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Comi G, Solari A, Leocani L, Centonze D, Otero‐Romero S, Amadeo R, Amato MP, Bertolotto A, Boffa L, Brichetto G, Comola M, Ghezzi A, Lus G, Marrosu MG, Molteni F, Patti F, Pozzilli C, Rovaris M, Saccà F, Sessa E, Solaro C, Trojano M, Trompetto C, Zaffaroni M. Italian consensus on treatment of spasticity in multiple sclerosis. Eur J Neurol 2019; 27:445-453. [DOI: 10.1111/ene.14110] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- G. Comi
- Institute of Experimental NeurologyUniversità Vita‐Salute, Ospedale S. Raffaele Milan Italy
| | - A. Solari
- Unit of NeuroepidemiologyFondazione IRCCS Istituto Neurologico C. Besta Milan Italy
| | - L. Leocani
- Institute of Experimental NeurologyUniversità Vita‐Salute, Ospedale S. Raffaele Milan Italy
| | - D. Centonze
- Unit of NeurologyIRCCS Neuromed Pozzilli Italy
- Laboratory of Synaptic ImmunopathologyDepartment of Systems MedicineTor Vergata University Rome Italy
| | - S. Otero‐Romero
- MS Centre of Catalonia (Cemcat), Dept. Neurology/NeuroimmunologyPreventive Medicine Dept.Vall d'Hebron University Hospital Barcelona Spain
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9
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Abstract
SummaryWhen multiple hypotheses are tested, interest is often in ensuring that the proportion of false discoveries is small with high confidence. In this paper, confidence upper bounds for the false discovery proportion are constructed, which are simultaneous over all rejection cut-offs. In particular, this allows the user to select a set of hypotheses post hoc such that the false discovery proportion lies below some constant with high confidence. Our method uses permutations to account for the dependence structure in the data. So far only Meinshausen (2006) has developed an exact, permutation-based and computationally feasible method for obtaining simultaneous false discovery proportion bounds. We propose an exact method which uniformly improves that procedure. Further, we provide a generalization of the method that lets the user select the shape of the simultaneous confidence bounds; this gives the user more freedom in determining the power properties of the method. Interestingly, several existing permutation methods, such as significance analysis of microarrays and the maxT method of Westfall & Young (1993), are obtained as special cases.
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Affiliation(s)
- J Hemerik
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Sognsvannsveien 9, Domus Medica, 0372 Oslo, Norway
| | - A Solari
- Department of Economics, Management and Statistics, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
| | - J J Goeman
- Biomedical Data Sciences, Leiden University Medical Center, Einthovenweg 20, 2333 ZC Leiden, The Netherlands
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10
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Cabe AM, Yañez F, Pinto R, López A, Ortiz S, Martin CMS, Botto-Mahan C, Solari A. Survivorship of wild caught Mepraia spinolai nymphs: The effect of seasonality and Trypanosoma cruzi infection after feeding and fasting in the laboratory. Infect Genet Evol 2019; 71:197-204. [PMID: 30953715 DOI: 10.1016/j.meegid.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022]
Abstract
Chagas disease is caused by Trypanosoma cruzi. Vector survival is an important variable affecting vectorial capacity to determine parasite transmission risk. The aims of this study are to evaluate vector survival under fasting/starvation conditions of wild-caught Mepraia spinolai after feeding and fasting, the pathogenicity of T. cruzi infection, the parasite burden and seasonal variation in parasite discrete typing units (DTU). The survivorship of M. spinolai nymphs after two continuous artificial feedings was evaluated, assessing their infection with microscopic observation of fecal samples and PCR. Later, insects were fasted/starved until death. We performed qPCR analyses of parasite load in the fecal samples and dead specimens. T. cruzi genotyping was performed using conventional PCR amplicons and hybridization tests. Infection rate was higher in M. spinolai nymphs in summer and spring than in fall. Parasite burden varied from 3 to 250,000 parasites/drop. Survival rate for starved nymph stage II was lower in insects collected in the spring compared to summer and fall. TcII was the most frequent DTU. Mainly metacyclic trypomastigotes were excreted. We conclude that M. spinolai infection rate in nymphs varies among seasons, suggesting higher transmission risk in warmer seasons. However, nymphs stage II collected in spring are more sensitive to starvation compared to other seasons. TcII in single or mixed infection does not seem relevant to determine vector pathogenicity. These results of vector survivorship after fasting/starvation are important to determine the competence of M. spinolai as a vector of T. cruzi, since they excrete metacyclic trypomastigotes and the parasitism with T. cruzi seems to be poorly pathogenic to the vector under a severe fasting/starvation condition.
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Affiliation(s)
- A Mc Cabe
- Program of Cellular and Molecular Biology, ICBM, Faculty of Medicine, University of Chile, Chile
| | - F Yañez
- Program of Cellular and Molecular Biology, ICBM, Faculty of Medicine, University of Chile, Chile
| | - R Pinto
- Program of Cellular and Molecular Biology, ICBM, Faculty of Medicine, University of Chile, Chile
| | - A López
- Program of Cellular and Molecular Biology, ICBM, Faculty of Medicine, University of Chile, Chile
| | - S Ortiz
- Program of Cellular and Molecular Biology, ICBM, Faculty of Medicine, University of Chile, Chile.
| | - C Muñoz-San Martin
- Ecology Laboratory, Faculty of Veterinary Sciences and Livestock, University of Chile, Chile.
| | - C Botto-Mahan
- Department of Ecological Sciences, Faculty of Science, University of Chile, Chile.
| | - A Solari
- Program of Cellular and Molecular Biology, ICBM, Faculty of Medicine, University of Chile, Chile.
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11
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Wilkie DD, Solari A, Nicholas R. Initiating disease-modifying treatments in multiple sclerosis: Measuring the decision process using decisional conflict and decisional regret scales. Mult Scler J Exp Transl Clin 2019; 5:2055217319833006. [PMID: 30834139 PMCID: PMC6393834 DOI: 10.1177/2055217319833006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/08/2019] [Accepted: 01/27/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Initiating disease-modifying treatments (DMTs) in multiple sclerosis (MS) is a major decision for people with (pw)MS but little is known about how the decision is perceived by the individual. Objectives The aim of the study was to determine if decisional conflict (DC) and decisional regret reflect different stages of the decision-making process when initiating DMTs. Methods This was a cross-sectional study of three cohorts of pwMS (n = 254), a 'MS conference attendees', 'on treatment' and an 'offered treatment' cohort. Questionnaires assessing DC, decisional regret and control preference were performed. Results Forty-four per cent (113/254) of pwMS were dissatisfied with their treatment status and 53% (135/254) had DC. DC (p = 0.013) and decisional regret (p = 0.027) increase in treatment-naïve pwMS and also in those 'offered treatment' dissatisfied with their treatment status (p < 0.0001), whilst those 'on treatment' have low Decisional Regret Scale (DRS) score (p = 0.0005). DC and DRS were only correlated with treatment status in those on treatment and not in treatment-naïve patients. F (58/135) pwMS satisfied with treatment had DC. DC (n = 236, adjusted R 2 0.137, p = 0.000) and DRS (n = 235, adjusted R 2 0.232, p = 0.000) were increased by dissatisfaction with treatment, lower potency treatment, being from the 'MS conference attendees' cohort and reliance on the doctor's decision, with DC additionally associated with being employed. Conclusions DC and decisional regret vary in populations at different stages of initiating DMTs and are impacted by non-treatment issues.
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Affiliation(s)
- D D Wilkie
- Imperial College, Centre for Neuroscience, Imperial College Faculty of Medicine, London, UK; Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Rd, UK
| | - A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - R Nicholas
- Imperial College, Centre for Neuroscience, Imperial College Faculty of Medicine, London, UK; Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Rd, UK.,Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, London, United Kingdom
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12
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Schippling S, Langdon D, Solari A, Brochet B, Hupperts R, Piehl F, Lechner-Scott J, Montalban X, Keller B, Alexandri N. THUR 172 Phase iv study of cladribine tablets and quality of life: clarify-ms. J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-abn.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Authors Disclaimer: http://medpub-poster.merckgroup.com/ABN2018DISC_CLARIFY.pdfBackgroundRelapsing multiple sclerosis (RMS) negatively affects health-related quality of life (HRQoL).ObjectiveAn open-label, single-arm, exploratory Phase IV study in centres in Europe and Australia will assess HRQoL in RMS patients receiving CT 3.5 mg/kg (CT3.5).MethodsEligible patients will receive CT 3.5 (cumulative) over 2 years. HRQoL (Multiple Sclerosis Quality of Life-54 [MSQoL-54]) and other patient-reported outcomes (Fatigue Severity Scale; Hospital Anxiety and Depression Scale; Treatment Satisfaction Questionnaire for Medication v1.4) will be assessed at baseline, and at 6, 12, 24 months.Other outcomes include AEs, MRI measures (T1 Gd+ lesions, T2 lesions, brain atrophy), number of relapses, and disability/functioning measures (EDSS; 9-Hole Peg Test; Timed 25-Foot Walk and Brief International Cognitive Assessment for Multiple Sclerosis). The sample size estimation is based on the power to detect a mean difference of 5 points in MSQoL-54 composite score at 24 months vs baseline.ResultsThe study aims to recruit 356 adults with RMS by 2019. Final data are anticipated in 2022.ConclusionsThis study will explore the effects of CT on HRQoL outcomes, and describe the effects of CT on treatment satisfaction and disability/functioning.Disclosure statementThe trial is sponsored by Merck KGaA, Darmstadt, Germany.
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13
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Köpke S, Giordano A, Veronese S, Christin Rahn A, Kleiter I, Basedow-Rajwich B, Fornari A, Battaglia MA, Drulovic J, Kooij L, Koops J, Mens J, Meza Murillo ER, Milanov I, Milo R, Patti F, Pekmezovic T, Sastre-Garriga J, Vosburgh J, Voltz R, Bay J, Oliver DJ, Solari A. Patient and caregiver involvement in the formulation of guideline questions: findings from the European Academy of Neurology guideline on palliative care of people with severe multiple sclerosis. Eur J Neurol 2018; 26:41-50. [PMID: 30035845 DOI: 10.1111/ene.13760] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Patient and public involvement in clinical practice guideline development is recommended to increase guideline trustworthiness and relevance. The aim was to engage multiple sclerosis (MS) patients and caregivers in the definition of the key questions to be answered in the European Academy of Neurology guideline on palliative care of people with severe MS. METHODS A mixed methods approach was used: an international online survey launched by the national MS societies of eight countries, after pilot testing/debriefing on 20 MS patients and 18 caregivers, focus group meetings of Italian and German MS patients and caregivers. RESULTS Of 1199 participants, 951 (79%) completed the whole online survey and 934 from seven countries were analysed: 751 (80%) were MS patients (74% women, mean age 46.1) and 183 (20%) were caregivers (36% spouses/partners, 72% women, mean age 47.4). Participants agreed/strongly agreed on inclusion of the nine pre-specified topics (from 89% for 'advance care planning' to 98% for 'multidisciplinary rehabilitation'), and <5% replied 'I prefer not to answer' to any topic. There were 569 free comments: 182 (32%) on the pre-specified topics, 227 (40%) on additional topics (16 guideline-pertinent) and 160 (28%) on outcomes. Five focus group meetings (three of MS patients, two of caregivers, and overall 35 participants) corroborated the survey findings. In addition, they allowed an explanation of the guideline production process and the exploration of patient-important outcomes and of taxing issues. CONCLUSIONS Multiple sclerosis patient and caregiver involvement was resource and time intensive, but rewarding. It was the key for the formulation of the 10 guideline questions and for the identification of patient-important outcomes.
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Affiliation(s)
- S Köpke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - A Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - S Veronese
- FARO Charitable Foundation, Turin, Italy
| | - A Christin Rahn
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - I Kleiter
- Kempfenhausen Centre for Treatment of Multiple Sclerosis, Marianne-Strauß-Klinik, Berg, Germany
| | - B Basedow-Rajwich
- Kempfenhausen Centre for Treatment of Multiple Sclerosis, Marianne-Strauß-Klinik, Berg, Germany
| | - A Fornari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - J Drulovic
- Clinic of Neurology, CSS, Faculty of Medicine, University Hospital of Belgrade, Belgrade, Serbia
| | - L Kooij
- Nieuw Unicum, Zandvoort, The Netherlands
| | - J Koops
- Nieuw Unicum, Zandvoort, The Netherlands
| | - J Mens
- Nieuw Unicum, Zandvoort, The Netherlands
| | - E R Meza Murillo
- MS Centre of Catalonia (Cemcat), University Hospital Vall d'Hebron, Barcelona, Spain
| | - I Milanov
- Neurology Clinic, Medical University of Sofia, Sofia, Bulgaria
| | - R Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - F Patti
- Neurology Clinic, Multiple Sclerosis Centre, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - T Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - J Sastre-Garriga
- MS Centre of Catalonia (Cemcat), University Hospital Vall d'Hebron, Barcelona, Spain
| | - J Vosburgh
- Israel Multiple Sclerosis Society, Tel-Aviv, Israel
| | - R Voltz
- Department of Palliative Medicine, University Hospital Cologne, Cologne, Germany
| | - J Bay
- Multiple Sclerosis International Federation, People with MS Advisory Committee, Copenhagen, Denmark
| | - D J Oliver
- The Tizard Centre, University of Kent, Canterbury, UK
| | - A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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14
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Barbieri F, Würth R, Pattarozzi A, Verduci I, Mazzola C, Cattaneo MG, Tonelli M, Solari A, Bajetto A, Daga A, Vicentini LM, Mazzanti M, Florio T. Inhibition of Chloride Intracellular Channel 1 (CLIC1) as Biguanide Class-Effect to Impair Human Glioblastoma Stem Cell Viability. Front Pharmacol 2018; 9:899. [PMID: 30186163 PMCID: PMC6110922 DOI: 10.3389/fphar.2018.00899] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022] Open
Abstract
The antidiabetic biguanide metformin exerts antiproliferative effects in different solid tumors. However, during preclinical studies, metformin concentrations required to induce cell growth arrest were invariably within the mM range, thus difficult to translate in a clinical setting. Consequently, the search for more potent metformin derivatives is a current goal for new drug development. Although several cell-specific intracellular mechanisms contribute to the anti-tumor activity of metformin, the inhibition of the chloride intracellular channel 1 activity (CLIC1) at G1/S transition is a key events in metformin antiproliferative effect in glioblastoma stem cells (GSCs). Here we tested several known biguanide-related drugs for the ability to affect glioblastoma (but not normal) stem cell viability, and in particular: phenformin, a withdrawn antidiabetic drug; moroxydine, a former antiviral agent; and proguanil, an antimalarial compound, all of them possessing a linear biguanide structure as metformin; moreover, we evaluated cycloguanil, the active form of proguanil, characterized by a cyclized biguanide moiety. All these drugs caused a significant impairment of GSC proliferation, invasiveness, and self-renewal reaching IC50 values significantly lower than metformin, (range 0.054–0.53 mM vs. 9.4 mM of metformin). All biguanides inhibited CLIC1-mediated ion current, showing the same potency observed in the antiproliferative effects, with the exception of proguanil which was ineffective. These effects were specific for GSCs, since no (or little) cytotoxicity was observed in normal umbilical cord mesenchymal stem cells, whose viability was not affected by metformin and moroxydine, while cycloguanil and phenformin induced toxicity only at much higher concentrations than required to reduce GSC proliferation or invasiveness. Conversely, proguanil was highly cytotoxic also for normal mesenchymal stem cells. In conclusion, the inhibition of CLIC1 activity represents a biguanide class-effect to impair GSC viability, invasiveness, and self-renewal, although dissimilarities among different drugs were observed as far as potency, efficacy and selectivity as CLIC1 inhibitors. Being CLIC1 constitutively active in GSCs, this feature is relevant to grant the molecules with high specificity toward GSCs while sparing normal cells. These results could represent the basis for the development of novel biguanide-structured molecules, characterized by high antitumor efficacy and safe toxicological profile.
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Affiliation(s)
- Federica Barbieri
- Sezione di Farmacologia, Dipartimento di Medicina Interna and Centro di Eccellenza per la Ricerca Biomedica, Università di Genova, Genova, Italy
| | - Roberto Würth
- Sezione di Farmacologia, Dipartimento di Medicina Interna and Centro di Eccellenza per la Ricerca Biomedica, Università di Genova, Genova, Italy
| | - Alessandra Pattarozzi
- Sezione di Farmacologia, Dipartimento di Medicina Interna and Centro di Eccellenza per la Ricerca Biomedica, Università di Genova, Genova, Italy
| | - Ivan Verduci
- Dipartimento di Bioscienze, Università degli Studi di Milano, Milan, Italy
| | - Chiara Mazzola
- Dipartimento di Bioscienze, Università degli Studi di Milano, Milan, Italy
| | - Maria G Cattaneo
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy
| | - Michele Tonelli
- Dipartimento di Farmacia, Università di Genova, Genova, Italy
| | - Agnese Solari
- Sezione di Farmacologia, Dipartimento di Medicina Interna and Centro di Eccellenza per la Ricerca Biomedica, Università di Genova, Genova, Italy
| | - Adriana Bajetto
- Sezione di Farmacologia, Dipartimento di Medicina Interna and Centro di Eccellenza per la Ricerca Biomedica, Università di Genova, Genova, Italy
| | - Antonio Daga
- IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia M Vicentini
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milan, Italy
| | - Michele Mazzanti
- Dipartimento di Bioscienze, Università degli Studi di Milano, Milan, Italy
| | - Tullio Florio
- Sezione di Farmacologia, Dipartimento di Medicina Interna and Centro di Eccellenza per la Ricerca Biomedica, Università di Genova, Genova, Italy.,IRCCS, Ospedale Policlinico San Martino, Genova, Italy
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15
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Gatti M, Solari A, Pattarozzi A, Campanella C, Thellung S, Maniscalco L, De Maria R, Würth R, Corsaro A, Bajetto A, Ratto A, Ferrari A, Daga A, Barbieri F, Florio T. In vitro and in vivo characterization of stem-like cells from canine osteosarcoma and assessment of drug sensitivity. Exp Cell Res 2018; 363:48-64. [PMID: 29305964 DOI: 10.1016/j.yexcr.2018.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 12/19/2022]
Abstract
Cancer stem cell (CSC) self-renewing and drug resistance cause treatment failure and tumor recurrence. Osteosarcoma is an aggressive bone tumor characterized by biological and molecular heterogeneity, possibly dependent on CSCs. CSC identification in osteosarcoma and their efficient targeting are still open questions. Spontaneous canine osteosarcoma shares clinical and biological features with the human tumors, representing a model for translational studies. We characterized three CSC-enriched canine osteosarcoma cultures. In serum-free conditions, these CSC cultures grow as anchorage-independent spheroids, show mesenchymal-like properties and in vivo tumorigenicity, recapitulating the heterogeneity of the original osteosarcoma. Osteosarcoma CSCs express stem-related factors (Sox2, Oct4, CD133) and chemokine receptors and ligands (CXCR4, CXCL12) involved in tumor proliferation and self-renewal. Standard drugs for osteosarcoma treatment (doxorubicin and cisplatin) affected CSC-enriched and parental primary cultures, showing different efficacy within tumors. Moreover, metformin, a type-2 diabetes drug, significantly inhibits osteosarcoma CSC viability, migration and self-renewal and, in co-treatment with doxorubicin and cisplatin, enhances drug cytotoxicity. Collectively, we demonstrate that canine osteosarcoma primary cultures contain CSCs exhibiting distinctive sensitivity to anticancer agents, as a reliable experimental model to assay drug efficacy. We also provide proof-of-principle of metformin efficacy, alone or in combination, as pharmacological strategy to target osteosarcoma CSCs.
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Affiliation(s)
- Monica Gatti
- Section of Pharmacology, Department of Internal Medicine, and Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 2, 16132 Genova, Italy
| | - Agnese Solari
- Section of Pharmacology, Department of Internal Medicine, and Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 2, 16132 Genova, Italy
| | - Alessandra Pattarozzi
- Section of Pharmacology, Department of Internal Medicine, and Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 2, 16132 Genova, Italy
| | - Chiara Campanella
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, National Reference Center of Veterinary and Comparative Oncology (CEROVEC), Piazza Borgo Pila 39, 16129 Genova, Italy
| | - Stefano Thellung
- Section of Pharmacology, Department of Internal Medicine, and Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 2, 16132 Genova, Italy
| | - Lorella Maniscalco
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco (Torino), Italy
| | - Raffaella De Maria
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco (Torino), Italy
| | - Roberto Würth
- Section of Pharmacology, Department of Internal Medicine, and Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 2, 16132 Genova, Italy
| | - Alessandro Corsaro
- Section of Pharmacology, Department of Internal Medicine, and Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 2, 16132 Genova, Italy
| | - Adriana Bajetto
- Section of Pharmacology, Department of Internal Medicine, and Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 2, 16132 Genova, Italy
| | - Alessandra Ratto
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, National Reference Center of Veterinary and Comparative Oncology (CEROVEC), Piazza Borgo Pila 39, 16129 Genova, Italy
| | - Angelo Ferrari
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, National Reference Center of Veterinary and Comparative Oncology (CEROVEC), Piazza Borgo Pila 39, 16129 Genova, Italy
| | - Antonio Daga
- IRCCS-AOU San Martino-IST, Largo Benzi 10, 16132 Genova, Italy
| | - Federica Barbieri
- Section of Pharmacology, Department of Internal Medicine, and Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 2, 16132 Genova, Italy.
| | - Tullio Florio
- Section of Pharmacology, Department of Internal Medicine, and Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 2, 16132 Genova, Italy.
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16
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Heesen C, Pöttgen J, Rahn AC, Liethmann K, Kasper J, Vahter L, Drulovic J, Van Nunen A, Wilkie D, Beckmann Y, Paul F, Köpke S, Giordano A, Solari A. What should a person with relapsing-remitting multiple sclerosis know? - Focus group and survey data of a risk knowledge questionnaire (RIKNO 2.0). Mult Scler Relat Disord 2017; 18:186-195. [PMID: 29141808 DOI: 10.1016/j.msard.2017.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk knowledge is relevant to make informed decisions in multiple sclerosis (MS). The risk knowledge questionnaire for relapsing-remitting MS (RIKNO 1.0) was developed and piloted in Germany. OBJECTIVE To produce a revised RIKNO 2.0 questionnaire using mixed methodology in a European setting. METHODS The questionnaire was translated in seven languages. MS patient and health professional (HP) expert feedback was obtained from Germany, Italy, Estonia, Serbia, and the UK. A German web-based survey of RIKNO 2.0 compared the tool with the MS Knowledge Questionnaire (MSKQ), each one used with two versions (with/without a "don't know" DN option). RESULTS While RIKNO 2.0 was considered difficult, it was rated as highly educational. One item was reframed, and two new items were added. The web-based German survey (n = 708 completers) showed that the DN version did not increase participation rate and did not produce significantly higher scores. Internal consistency (Cronbach alpha) without SN response was 0.73. RIKNO 2.0 scores showed normality distribution irrespective of the answering format. Item difficulty was high ranging from 0.07 to 0.79. Less than 50% of questions were answered correctly (mean 8.9) compared to 80.4% in the MSKQ (mean 20.1). Higher numeracy competency and education were significantly, albeit weakly, associated to higher scores for both RIKNO 2.0 and MSKQ. CONCLUSION Including "don't know" options in knowledge questionnaires does not increase percentage of correct replies. RIKNO 2.0 is a complex questionnaire to be used in an educational context and studies on patient information. The tool is now available in seven languages.
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Affiliation(s)
- C Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - J Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Neurologische Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - A C Rahn
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Unit of Health Sciences and Education, University of Hamburg, Papendamm 21, 20146 Hamburg, Germany.
| | - K Liethmann
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Unit of Health Sciences and Education, University of Hamburg, Papendamm 21, 20146 Hamburg, Germany.
| | - J Kasper
- Faculty of Health Sciences, Arctic University of Norway, 9073 Tromsø, Norway.
| | - L Vahter
- Department of Neurology, West-Tallinn Central Hospital, Paldiski mnt. 68, 10617 Tallinn, Estonia.
| | - J Drulovic
- Institute of Neurology, Clinical Center of Serbia, University of Belgrade, Dr. Subotića Starijeg 6, 11000 Beograd, Serbia.
| | - A Van Nunen
- National MS-Centrum, Melsbroek, Vereeckenstraat 44, 1820 Melsbroek, Belgium.
| | - D Wilkie
- Clinical Trials Unit, Department of Neurology, Imperial College, Room 10L18 (Lab Block, Charing Cross Campus, Hammersmith, London W6 8RF, UK.
| | - Y Beckmann
- Department of Neurology, Ataturk Training and Research Hospital, Faculty of Medicine, Konak Mahallesi, İnönü Cad. 269. Sok. No:102, 35150 Karabağlar, Izmir, Turkey.
| | - F Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - S Köpke
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany.
| | - A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Via Celoria 11, 20133 Milan, Italy.
| | - A Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Via Celoria 11, 20133 Milan, Italy.
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Ortiz S, Osorio G, Solari A. Minicircle classes heterogeneity within the TcIII and TcIV discrete typing units of Trypanosoma cruzi. Infect Genet Evol 2017; 51:104-107. [PMID: 28323069 DOI: 10.1016/j.meegid.2017.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 03/14/2017] [Accepted: 03/15/2017] [Indexed: 11/24/2022]
Abstract
The taxon Trypanosoma cruzi, causative agent of Chagas disease, is composed of several discrete typing units (DTUs) named TcI-TcVI, and Tcbat. The history of the taxon T. cruzi is known, even though several controversial aspects remain as the relationships between TcIII and TcIV. We analyzed cloned T. cruzi stocks pertaining to the seven DTUs by filter hybridization tests of PCR amplicons from minicircle variable regions and kinetoplast DNA probes. Minicircle DNA blots from the cloned stocks and filter hybridization with one TcI, one TcII, one TcV, one TcVI, three TcIII, one TcIV from North America and one TcIV kinetoplast DNA probes from South America revealed minicircle variable region cross-reaction in some T. cruzi DTUs probed. TcIII was heterogeneous in minicircle class composition, even though two TcIII probes revealed that a small fraction of minicircles cross-hybridized with the minicircles from the TcIII, TcV and TcVI DTUs. The minicircles of TcIV from North America cross-reacted only with TcIV from North America but not with TcIV stocks from Brazil and Bolivia. The results on minicircle cross-hybridizations are discussed in the context of RNA editing, mitochondrial function in T. cruzi DTUs.
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Affiliation(s)
- S Ortiz
- Programa de Biología Celular y Molecular, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - G Osorio
- Programa de Microbiología, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - A Solari
- Programa de Biología Celular y Molecular, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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18
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Mattarozzi K, Baldin E, Zenesini C, Solari A, Amato MP, Leone M, Mancardi G, Martinelli V, Savettieri G, Solaro C, Tola MR, D'Alessandro R. Effect of organizational features on patient satisfaction with care in Italian multiple sclerosis centres. Eur J Neurol 2017; 24:631-637. [DOI: 10.1111/ene.13263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- K. Mattarozzi
- Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - E. Baldin
- Epidemiology and Biostatistics Service; IRCCS; Institute of Neurological Sciences of Bologna; Bellaria Hospital; Bologna Italy
| | - C. Zenesini
- Epidemiology and Biostatistics Service; IRCCS; Institute of Neurological Sciences of Bologna; Bellaria Hospital; Bologna Italy
| | - A. Solari
- Neuroepidemiology Unit; Foundation IRCCS Neurological Institute C. Besta; Milan Italy
| | - M. P. Amato
- Department of Neurofarba; Section of Neurosciences; University of Florence; Florence Italy
| | - M. Leone
- SC Neurologia; Department of Medical Sciences; IRCCS ‘Casa Sollievo della Sofferenza’; San Giovanni Rotondo Italy
| | - G. Mancardi
- Department of Neurological Sciences and Vision; University of Genoa; Genoa Italy
| | - V. Martinelli
- Department of Neurology; MS Centre; San Raffaele Scientific Institute; Vit-Salute San Raffaele University; Milan Italy
| | - G. Savettieri
- Experimental Biomedicine and Clinical Neurosciences; University of Palermo; Palermo Italy
| | - C. Solaro
- Neurology Unit; ASL 3 Genovese; Genoa Italy
| | - M. R. Tola
- Neurology Unit; University of Ferrara; Ferrara Italy
| | - R. D'Alessandro
- Epidemiology and Biostatistics Service; IRCCS; Institute of Neurological Sciences of Bologna; Bellaria Hospital; Bologna Italy
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19
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Angeletti F, Fossati G, Pattarozzi A, Würth R, Solari A, Daga A, Masiello I, Barbieri F, Florio T, Comincini S. Inhibition of the Autophagy Pathway Synergistically Potentiates the Cytotoxic Activity of Givinostat (ITF2357) on Human Glioblastoma Cancer Stem Cells. Front Mol Neurosci 2016; 9:107. [PMID: 27833530 PMCID: PMC5081386 DOI: 10.3389/fnmol.2016.00107] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/07/2016] [Indexed: 12/13/2022] Open
Abstract
Increasing evidence highlighted the role of cancer stem cells (CSCs) in the development of tumor resistance to therapy, particularly in glioblastoma (GBM). Therefore, the development of new therapies, specifically directed against GBM CSCs, constitutes an important research avenue. Considering the extended range of cancer-related pathways modulated by histone acetylation/deacetylation processes, we studied the anti-proliferative and pro-apoptotic efficacy of givinostat (GVS), a pan-histone deacetylase inhibitor, on cell cultures enriched in CSCs, isolated from nine human GBMs. We report that GVS induced a significant reduction of viability and self-renewal ability in all GBM CSC cultures; conversely, GVS exposure did not cause a significant cytotoxic activity toward differentiated GBM cells and normal mesenchymal human stem cells. Analyzing the cellular and molecular mechanisms involved, we demonstrated that GVS affected CSC viability through the activation of programmed cell death pathways. In particular, a marked stimulation of macroautophagy was observed after GVS treatment. To understand the functional link between GVS treatment and autophagy activation, different genetic and pharmacological interfering strategies were used. We show that the up-regulation of the autophagy process, obtained by deprivation of growth factors, induced a reduction of CSC sensitivity to GVS, while the pharmacological inhibition of the autophagy pathway and the silencing of the key autophagy gene ATG7, increased the cell death rate induced by GVS. Altogether these findings suggest that autophagy represents a pro-survival mechanism activated by GBM CSCs to counteract the efficacy of the anti-proliferative activity of GVS. In conclusion, we demonstrate that GVS is a novel pharmacological tool able to target GBM CSC viability and its efficacy can be enhanced by autophagy inhibitory strategies.
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Affiliation(s)
| | - Gianluca Fossati
- Preclinical Research Department Italfarmaco Research Center, Italfarmaco S.p.A Cinisello Balsamo, Italy
| | - Alessandra Pattarozzi
- Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genova Genova, Italy
| | - Roberto Würth
- Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genova Genova, Italy
| | - Agnese Solari
- Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genova Genova, Italy
| | - Antonio Daga
- Regenerative Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Genova, Italy
| | - Irene Masiello
- Department of Biology and Biotechnology, University of Pavia Pavia, Italy
| | - Federica Barbieri
- Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genova Genova, Italy
| | - Tullio Florio
- Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genova Genova, Italy
| | - Sergio Comincini
- Department of Biology and Biotechnology, University of Pavia Pavia, Italy
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20
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Ortiz S, Ceballos MJ, González CR, Reyes C, Gómez V, García A, Solari A. Trypanosoma cruzi diversity in infected dogs from areas of the north coast of Chile. Vet Parasitol Reg Stud Reports 2016; 5:42-47. [PMID: 31014537 DOI: 10.1016/j.vprsr.2016.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 01/10/2023]
Abstract
As part of a multi-site research program on the eco-epidemiology and control of Chagas disease in northern Chile, we sought to identify the Trypanosoma cruzi discrete typing units (DTUs) infecting rural and peridomestic dogs, using direct methods without grown of the parasite in the laboratory and thus to assess the use of this species as a sentinel of the disease in well-defined endemic areas of T. cruzi in Chile. Infected dogs (35) from three villages were included in the study. The studied villages were Caleta Río Seco and Caleta San Marcos, both in the Tarapacá Region, and La Serena in the Coquimbo Region. These villages were selected based on previous evidence of Mepraia infection reports of the Chilean Ministry of Health. Amplicons from nested-PCR positive samples were used as targets to determine the infective T. cruzi DTUs circulating in blood using PCR-DNA blotting and hybridization assays with five specific DNA probes (TcI, TcII, TcIII, TcV and TcVI). Results of hybridization with dog samples from Caleta Rio Seco showed single infections in 2 out of 16 and mixed infections in 14 out of 16. TcVI was the most frequent DTU found in this area. A highlight is that for the first time the presence of TcIII is reported in this area. Samples from Caleta San Marcos showed single infections in 5 out of 9 and mixed infections in 4 out of 9. TcVI was the most frequent DTU found in this area. Samples from La Serena showed single infections in 5 out of 10 and mixed infections in 2 out of 10; we were unable to genotype the other 3 samples. Our results indicate that infection by T. cruzi DTUs in dogs is not homogeneously distributed but rather specific to each region of our country, as demonstrated by the differences in the T. cruzi DTU distribution in some localities.
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Affiliation(s)
- S Ortiz
- Programa de Biología Celular y Molecular, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - M J Ceballos
- Escuela de Medicina Veterinaria, Facultad de Ciencias Agropecuarias, Universidad Pedro de Valdivia, La Serena, Chile
| | - C R González
- Instituto de Entomología, Facultad de Ciencias Básicas, Universidad, Metropolitana de Ciencias de la Educación, Santiago, Chile; Laboratorio de Entomología Médica, Sección Parasitología, Instituto de Salud, Pública de, Chile
| | - C Reyes
- Laboratorio de Entomología Médica, Sección Parasitología, Instituto de Salud, Pública de, Chile
| | - V Gómez
- Facultad de Medicina, Universidad Pedro de Valdivia, La Serena, Chile
| | - A García
- Facultad de Medicina, Universidad Pedro de Valdivia, La Serena, Chile
| | - A Solari
- Programa de Biología Celular y Molecular, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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Manganelli F, Pisciotta C, Reilly MM, Tozza S, Schenone A, Fabrizi GM, Cavallaro T, Vita G, Padua L, Gemignani F, Laurà M, Hughes RAC, Solari A, Pareyson D, Santoro L. Nerve conduction velocity in CMT1A: what else can we tell? Eur J Neurol 2016; 23:1566-71. [PMID: 27412484 DOI: 10.1111/ene.13079] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Charcot-Marie-Tooth disease (CMT) type 1A is characterized by uniformly reduced nerve conduction velocity (NCV) that is fully penetrant since the first years of life, remains fairly stable through the life and does not correlate with disability whereas compound muscular action potential (CMAP) amplitude does. The aim of the present study was to analyze the large amount of electrophysiological data collected in the ascorbic acid trial in Italy and the UK (CMT-TRIAAL/CMT-TRAUK) and to use these data to gain insights into the pathophysiology of NCV in CMT1A. METHODS Baseline electrophysiological data from 271 patients were analysed. Electrophysiological recordings were taken from the motor ulnar, median and peroneal nerves and the sensory ulnar nerve. Distal motor latency (DML), motor (MNCV) and sensory (SNCV) nerve conduction velocity, and amplitudes of CMAPs and sensory action potentials were assessed. Electrophysiological findings were correlated with age of patients at examination and the Charcot-Marie-Tooth Examination Score (CMTES). RESULTS NCV was markedly and uniformly reduced. CMAP amplitudes were overall reduced but more severely in lower limbs. DML decreased and MNCV and SNCV increased with age of the patients, whereas CMAP amplitudes worsened with age and also correlated with CMTES. CONCLUSIONS This is the largest sample of electrophysiological data obtained so far from CMT1A patients. Axonal degeneration as assessed by means of CMAP amplitude reflected clinical impairment and was consistent with a slowly progressive length-dependent neuropathy. All patients typically had markedly slowed NCV that did, however, slightly increase with age of the patients. The improvement of NCV might depend on myelin thickness remodelling that occurs during the adult life of CMT1A patients.
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Affiliation(s)
- F Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy.
| | - C Pisciotta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - M M Reilly
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - S Tozza
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - A Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal Infantile Sciences, University of Genoa, Genoa, Italy
| | - G M Fabrizi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - T Cavallaro
- Department of Neuroscience, AOUI, Verona, Italy
| | - G Vita
- Department of Clinical and Experimental Medicine, School of Neurosciences, University of Messina, Messina, Italy
| | - L Padua
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy.,Don Carlo Gnocchi Foundation, Milan, Italy
| | - F Gemignani
- Department of Neurosciences, University of Parma, Parma, Italy
| | - M Laurà
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - R A C Hughes
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - A Solari
- Carlo Besta Neurological Institute, IRCCS Foundation, Milan, Italy
| | - D Pareyson
- Carlo Besta Neurological Institute, IRCCS Foundation, Milan, Italy
| | - L Santoro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
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Jaureguizar AJ, Solari A, Cortés F, Milessi AC, Militelli MI, Camiolo MD, Luz Clara M, García M. Fish diversity in the Río de la Plata and adjacent waters: an overview of environmental influences on its spatial and temporal structure. J Fish Biol 2016; 89:569-600. [PMID: 27121796 DOI: 10.1111/jfb.12975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
The fish diversity and the main environmental factors affecting the spatial distribution of species, life history stages and community structure in the Río de la Plata (RdP) and adjacent waters are reviewed and analysed, with emphasis on the functional guild classification. The functional guild classification indicated that most species in the RdP were marine stragglers, zoobenthivores and oviparous species, although the biomass was dominated by estuarine species. Salinity had a stronger influence than temperature on the spatial pattern for all life stages, shallower and fresher waters are the preferred habitats of neonates and juveniles. During the breeding season (spring-summer), adults showed an intrusion into the inner part of RdP or to its adjacent nearshore waters from the offshore waters for spawning or mating, respectively. Variations in river discharge and wind patterns greatly affected the spatial extent of estuarine water, which ultimately influenced the domain of the main life-history stages (juveniles or adults) for both marine and estuarine fishes, as well as species and fish assemblage composition. The strong environmental gradient restricts some species and life-history stages to a particular section and defines three main fish assemblage areas. The composition of the fish assemblage is indicative of the recruitment of freshwater and marine species to the estuary in opposite ways, determined by the vertical stratification. Seasonal changes in the species composition were related to migration as a result of salinity and temperature variations and reproductive migrations to spawning and mating areas. This overview reveals that the RdP is under environmental variations that are likely to produce modifications to fish distribution and abundance that affect its fisheries. This context plus fish stock declines and changes in exploitation patterns could amplify the magnitude of the variations in the fisheries resources availability and affect the sustainability of fishing communities.
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Affiliation(s)
- A J Jaureguizar
- Comisión de Investigaciones Científicas de la Provincia de Buenos Aires (CIC), Calle 526 e/ 10-11, La Plata CP, 1900, Buenos Aires, República Argentina
- Instituto Nacional de Investigación y Desarrollo Pesquero (INIDEP), Mar del Plata CP, 7600, Buenos Aires, República Argentina
| | - A Solari
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia, 1917, Ciudad Autónoma de Buenos Aires, República Argentina
- Instituto de Biología Subtropical - Iguazú (CONICET/UNAM), Bertoni 85, Puerto Iguazú CP, 3370, Misiones, República Argentina
| | - F Cortés
- Instituto Nacional de Investigación y Desarrollo Pesquero (INIDEP), Mar del Plata CP, 7600, Buenos Aires, República Argentina
| | - A C Milessi
- Comisión de Investigaciones Científicas de la Provincia de Buenos Aires (CIC), Calle 526 e/ 10-11, La Plata CP, 1900, Buenos Aires, República Argentina
- Instituto Nacional de Investigación y Desarrollo Pesquero (INIDEP), Mar del Plata CP, 7600, Buenos Aires, República Argentina
| | - M I Militelli
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia, 1917, Ciudad Autónoma de Buenos Aires, República Argentina
- Instituto Nacional de Investigación y Desarrollo Pesquero (INIDEP), Mar del Plata CP, 7600, Buenos Aires, República Argentina
| | - M D Camiolo
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia, 1917, Ciudad Autónoma de Buenos Aires, República Argentina
- Instituto Nacional de Investigación y Desarrollo Pesquero (INIDEP), Mar del Plata CP, 7600, Buenos Aires, República Argentina
- Agencia Nacional de Promoción Científica y Tecnológica, Godoy Cruz 2370, C1425FQD, Ciudad Autónoma de Buenos Aires, República Argentina
| | - M Luz Clara
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia, 1917, Ciudad Autónoma de Buenos Aires, República Argentina
- Instituto Nacional de Investigación y Desarrollo Pesquero (INIDEP), Mar del Plata CP, 7600, Buenos Aires, República Argentina
| | - M García
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia, 1917, Ciudad Autónoma de Buenos Aires, República Argentina
- División Zoología Vertebrados, Facultad de Ciencias Naturales y Museo, Universidad Nacional de La Plata (UNLP), Paseo del Bosque s/n, La Plata CP, 1900, Buenos Aires, República Argentina
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23
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D'Amico D, Solari A, Usai S, Santoro P, Bernardoni P, Frediani F, De Marco R, Massetto N, Bussone G. Improvement in Quality of Life and Activity Limitations in Migraine Patients after Prophylaxis. A Prospective Longitudinal Multicentre Study. Cephalalgia 2016; 26:691-6. [PMID: 16686908 DOI: 10.1111/j.1468-2982.2005.01094.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Improved health-related quality of life (HRQOL) and reduced activity limitations are prime objectives of migraine therapy, but no data on the effect of preventive treatments on these outcomes are available. We monitored changes in HRQOL using the Short Form 36 (SF-36) and headache-related activity limitations using the Migraine Disability Assessment Score (MIDAS) in 141 consecutive migraine without aura patients on prophylaxis. A total of 102 patients completed the 3-month study. Mean (SD) number of headache days/month dropped from 8.0 (3.7) to 5.0 (2.3) ( P <0.001). Mean monthly consumption of acute drugs reduced from 7.4 (3.5) to 4.4 (3.1) ( P <0.001). MIDAS total score reduced (improved) significantly. All SF-36 scale scores increased (improved), most significantly. This first study to assess prospectively the impact of prophylaxis on HRQOL and daily activities in a large series indicates that migraine prophylaxis has the potential to reduce the global burden of migraine on individuals and society.
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Affiliation(s)
- D D'Amico
- C. Besta National Neurological Institute, Milan, Italy.
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24
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Solari A, Giordano A, Grasso MG, Confalonieri P, Patti F, Lugaresi A, Palmisano L, Amadeo R, Martino G, Ponzio M, Casale G, Borreani C, Causarano R, Veronese S, Zaratin P, Battaglia MA. Erratum to: 'Home-based palliative approach for people with severe multiple sclerosis and their carers: study protocol for a randomized controlled trial'. Trials 2016; 17:89. [PMID: 26883617 PMCID: PMC4756392 DOI: 10.1186/s13063-016-1228-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- A Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy.
| | - A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - M G Grasso
- Multiple Sclerosis Unit, Foundation IRCCS S. Lucia Rehabilitation Hospital, Rome, Italy
| | - P Confalonieri
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - F Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania; MS Center, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - A Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - L Palmisano
- Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - R Amadeo
- Associazione Italiana Sclerosi Multipla, Genoa, Italy
| | - G Martino
- Associazione Italiana Sclerosi Multipla, Genoa, Italy
| | - M Ponzio
- Fondazione Italiana Sclerosi Multipla, Genoa, Italy
| | - G Casale
- Antea Charitable Association, Rome, Italy
| | - C Borreani
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - R Causarano
- Unit of Palliative Care-Hospice, Niguarda Ca' Granda Hospital, Milan, Italy
| | - S Veronese
- FARO Charitable Foundation, Turin, Italy
| | - P Zaratin
- Fondazione Italiana Sclerosi Multipla, Genoa, Italy
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25
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Heesen C, Kasper J, Fischer K, Köpke S, Rahn A, Backhus I, Poettgen J, Vahter L, Drulovic J, Van Nunen A, Beckmann Y, Liethmann K, Giordano A, Fulcher G, Solari A. Risk Knowledge in Relapsing Multiple Sclerosis (RIKNO 1.0)--Development of an Outcome Instrument for Educational Interventions. PLoS One 2015; 10:e0138364. [PMID: 26430887 PMCID: PMC4591974 DOI: 10.1371/journal.pone.0138364] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/28/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adequate risk knowledge of patients is a prerequisite for shared decision making but few attempts have been made to develop assessment tools. Multiple Sclerosis (MS) is a chronic inflammatory disease of young adults with an increasing number of partially effective immunotherapies and therefore a paradigmatic disease to study patient involvement. OBJECTIVE/METHODS Based on an item bank of MS risk knowledge items and patient feedback including perceived relevance we developed a risk knowledge questionnaire for relapsing remitting (RR) MS (RIKNO 1.0) which was a primary outcome measure in a patient education trial (192 early RRMS patients). RESULTS Fourteen of the RIKNO 1.0 multiple-choice items were selected based on patient perceived relevance and item difficulty indices, and five on expert opinion. Mean item difficulty was 0.58, ranging from 0.14 to 0.79. Mean RIKNO 1.0 score increased after the educational intervention from 10.6 to 12.4 (p = 0.0003). Selected items were particularly difficult (e.g. those on absolute risk reductions of having a second relapse) and were answered correctly in only 30% of the patients, even after the intervention. CONCLUSION Despite its high difficulty, RIKNO 1.0 is a responsive instrument to assess risk knowledge in RRMS patients participating in educational interventions.
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Affiliation(s)
- C. Heesen
- Institute of Neuroimmunology and MS Research (INIMS), University Medical Center Eppendorf, Hamburg, Germany
- Dep. of Neurology, University Medical Center Eppendorf, Hamburg, Germany
- * E-mail:
| | - J. Kasper
- Institute of Neuroimmunology and MS Research (INIMS), University Medical Center Eppendorf, Hamburg, Germany
- Department of Health and Caring Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - K. Fischer
- Institute of Neuroimmunology and MS Research (INIMS), University Medical Center Eppendorf, Hamburg, Germany
| | - S. Köpke
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - A. Rahn
- Institute of Neuroimmunology and MS Research (INIMS), University Medical Center Eppendorf, Hamburg, Germany
- Unit of Health Sciences and Education, MIN Faculty, University of Hamburg, Hamburg, Germany
| | - I. Backhus
- Institute of Neuroimmunology and MS Research (INIMS), University Medical Center Eppendorf, Hamburg, Germany
| | - J. Poettgen
- Institute of Neuroimmunology and MS Research (INIMS), University Medical Center Eppendorf, Hamburg, Germany
| | - L. Vahter
- Department of Neurology, West-Tallinn Central Hospital, Tallinn, Estonia
| | - J. Drulovic
- Institute of Neurology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Y. Beckmann
- Department of Neurology, Ataturk Training and Research Hospital, Faculty of Medicine, Izmir, Turkey
| | - K. Liethmann
- Institute of Neuroimmunology and MS Research (INIMS), University Medical Center Eppendorf, Hamburg, Germany
| | - A. Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | | | - A. Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
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Solari A, Testa S, Bertolotto A, Confalonieri P, Patti F, Lugaresi A, Grasso M, Vickrey B, Toscano A, Giordano A, Rosato R. Development of a shortened version of the MSQOL-54 using factor analysis and item response theory. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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pietrolongo E, Lugaresi A, Florio C, Giordano A, Martinelli V, Patti F, Zaffaroni M, Borghesan S, Solari A. Role preferences in treatment decisions of MS patients in Italy. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Piscosquito G, Reilly MM, Schenone A, Fabrizi GM, Cavallaro T, Santoro L, Manganelli F, Vita G, Quattrone A, Padua L, Gemignani F, Visioli F, Laurà M, Calabrese D, Hughes RAC, Radice D, Solari A, Pareyson D. Responsiveness of clinical outcome measures in Charcot−Marie−Tooth disease. Eur J Neurol 2015; 22:1556-63. [DOI: 10.1111/ene.12783] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- G. Piscosquito
- C. Besta Neurological Institute; IRCCS Foundation; Milan Italy
| | - M. M. Reilly
- MRC Centre for Neuromuscular Diseases; Institute of Neurology; University College London; London UK
| | - A. Schenone
- Department of Neurology, Ophthalmology and Genetics; University of Genoa; Genoa Italy
| | - G. M. Fabrizi
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences; University of Verona; Verona Italy
| | - T. Cavallaro
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences; University of Verona; Verona Italy
| | - L. Santoro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; University Federico II of Naples; Naples Italy
| | - F. Manganelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; University Federico II of Naples; Naples Italy
| | - G. Vita
- Department of Neurosciences; University of Messina; Messina Italy
- Clinical Centre NEMO SUD; Fondazione Aurora Onlus; Messina Italy
| | - A. Quattrone
- Neurology Clinic; Neuroimaging Research Unit; National Research Council; Magna Graecia University; Catanzaro Italy
| | - L. Padua
- Department of Geriatrics; Neurosciences and Orthopaedics - Università Cattolica del Sacro Cuore; Rome; Don Carlo Gnocchi Foundation Milan Italy
| | - F. Gemignani
- Department of Neurosciences; University of Parma; Parma Italy
| | - F. Visioli
- Department of Pharmacological Sciences; University School of Pharmacy; Milan Italy
- Department of Molecular Medicine; University of Padua; Padua Italy
| | - M. Laurà
- MRC Centre for Neuromuscular Diseases; Institute of Neurology; University College London; London UK
| | - D. Calabrese
- C. Besta Neurological Institute; IRCCS Foundation; Milan Italy
| | - R. A. C. Hughes
- MRC Centre for Neuromuscular Diseases; Institute of Neurology; University College London; London UK
| | - D. Radice
- Department of Epidemiology and Biostatistics; European Institute of Oncology; Milan Italy
| | - A. Solari
- C. Besta Neurological Institute; IRCCS Foundation; Milan Italy
| | - D. Pareyson
- C. Besta Neurological Institute; IRCCS Foundation; Milan Italy
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Oda E, Solari A, Botto-Mahan C. Effects of mammal host diversity and density on the infection level of Trypanosoma cruzi in sylvatic kissing bugs. Med Vet Entomol 2014; 28:384-390. [PMID: 24844934 DOI: 10.1111/mve.12064] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/29/2014] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
Several reports have described host species diversity and identity as the most important factors influencing disease risk, producing either dilution or amplification of the pathogen in a host community. Triatomine vectors, mammals and the protozoan Trypanosoma cruzi (Trypanosomatida: Trypanosomatidae) Chagas are involved in the wild cycle of Chagas disease, in which infection of mammals occurs by contamination of mucous membranes or skin abrasions with insect-infected faeces. We examined the extent to which host diversity and identity determine the infection level observed in vector populations (i.e. disease risk in humans). We recorded infection in triatomine colonies and on the coexisting host mammalian species in semi-arid Chile. Host diversity, and total and infected host species densities are used as predictor variables for disease risk. Disease risk did not correlate with host diversity changes. However, the densities of each infected rodent species were positively associated with disease risk. We suggest that the infected host density surrounding the vector colonies is a relevant variable for disease risk and should be considered to understand disease dynamics. It is crucial to pay attention on the spatial scale of analysis, considering the pattern of vector dispersal, when the relationship between host diversity and disease risk is studied.
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Affiliation(s)
- E Oda
- Departamento de Ciencias Ecológicas, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
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Piscosquito G, Reilly MM, Schenone A, Fabrizi GM, Cavallaro T, Santoro L, Vita G, Quattrone A, Padua L, Gemignani F, Visioli F, Laurà M, Calabrese D, Hughes RAC, Radice D, Solari A, Pareyson D. Is overwork weakness relevant in Charcot-Marie-Tooth disease? J Neurol Neurosurg Psychiatry 2014; 85:1354-8. [PMID: 24659795 DOI: 10.1136/jnnp-2014-307598] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In overwork weakness (OW), muscles are increasingly weakened by exercise, work or daily activities. Although it is a well-established phenomenon in several neuromuscular disorders, it is debated whether it occurs in Charcot-Marie-Tooth disease (CMT). Dominant limb muscles undergo a heavier overload than non-dominant and therefore if OW occurs we would expect them to become weaker. Four previous studies, comparing dominant and non-dominant hand strength in CMT series employing manual testing or myometry, gave contradictory results. Moreover, none of them examined the behaviour of lower limb muscles. METHODS We tested the OW hypothesis in 271 CMT1A adult patients by comparing bilateral intrinsic hand and leg muscle strength with manual testing as well as manual dexterity. RESULTS We found no significant difference between sides for the strength of first dorsal interosseous, abductor pollicis brevis, anterior tibialis and triceps surae. Dominant side muscles did not become weaker than non-dominant with increasing age and disease severity (assessed with the CMT Neuropathy Score); in fact, the dominant triceps surae was slightly stronger than the non-dominant with increasing age and disease severity. DISCUSSION Our data does not support the OW hypothesis and the consequent harmful effect of exercise in patients with CMT1A. Physical activity should be encouraged, and rehabilitation remains the most effective treatment for CMT patients.
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Affiliation(s)
- G Piscosquito
- IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - M M Reilly
- MRC Centre for Neuromuscular diseases, UCL Institute of Neurology, London, UK
| | - A Schenone
- Department of Neurology, Ophthalmology and Genetics, University of Genoa, Genoa, Italy
| | - G M Fabrizi
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy
| | - T Cavallaro
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy
| | - L Santoro
- Federico II University Department of Neurological Sciences, Naples, Italy
| | - G Vita
- Department of Neurosciences, University of Messina, and Clinical Centre NEMO SUD, Fondazione Aurora Onlus, Messina, Italy
| | - A Quattrone
- Neurology Clinic, Magna Graecia University, and Neuroimaging Research Unit, National Research Council, Catanzaro, Italy
| | - L Padua
- Department of Neurosciences, Catholic University and Don Gnocchi Foundation, Rome, Italy
| | - F Gemignani
- Department of Neurosciences, University of Parma, Parma, Italy
| | - F Visioli
- Department of Pharmacological Sciences, University School of Pharmacy, Milan, Italy IMDEA-Food, Madrid, Spain
| | - M Laurà
- MRC Centre for Neuromuscular diseases, UCL Institute of Neurology, London, UK
| | - D Calabrese
- IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - R A C Hughes
- MRC Centre for Neuromuscular diseases, UCL Institute of Neurology, London, UK
| | - D Radice
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - A Solari
- IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - D Pareyson
- IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
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Garcia A, Ortiz S, Iribarren C, Bahamonde MI, Solari A. Congenital co-infection with different Trypanosoma cruzi lineages. Parasitol Int 2014; 63:138-139. [PMID: 24422218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Variability of mixed Trypanosoma cruzi congenital infection in Chile in twenty one congenital samples of Chagas disease is reported. Recognition of infecting strains was performed by minicircle hybridization tests. Seven newborns with double infection were found. Trypanosoma cruzi TcII and TcV lineages were the most frequent in single and mixed infections. With these results we pretend to understand the epidemiological significance of the T. cruzi lineages for which the placenta does not seem to represent an actual barrier in congenital infections.
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Solari A, Grzeda M, Giordano A, Mattarozzi K, D'Alessandro R, Simone A, Tesio L. Use of Rasch analysis to refine a patient-reported questionnaire on satisfaction with communication of the multiple sclerosis diagnosis. Mult Scler 2014; 20:1224-33. [PMID: 24436456 DOI: 10.1177/1352458513518261] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 12/01/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Comunicazione medico-paziente nella Sclerosi Multipla - Revised (COSM-R) is a patient self-assessed questionnaire probing the moment of multiple sclerosis (MS) diagnosis disclosure (section 1, five items) and following period (section 2, 15 items). OBJECTIVES This study examined COSM-R dimensionality and measurement properties through Rasch analysis (partial-credit model) and proposed a revised questionnaire. METHODS Cross-sectional COSM-R data were obtained from 1068 people with MS (PwMS, 1065 questionnaires) participating in four studies (102 centres). Mean age was 40 years (range 17-73); 70% were women; 53% were from Northern, 25% from Central, and 21% from Southern Italy. RESULTS Unidimensionality was not confirmed for COSM-R section 1, but was for section 2 after removal of three items. The revised instrument (COSM-S, Shortened) consisted of the original five-item checklist (section 1), modified by removing the table grouping of three items, and 12 of the original 15 section 2 items, which could now be summed and transformed into an interval scale. Scores were higher for items assessing emotional satisfaction than for those assessing informational satisfaction. CONCLUSIONS The proposed COSM-S is a composite measure of satisfaction with MS diagnosis communication with improved metric properties over the original COSM-R, and whose section 2 satisfies Rasch model expectations.
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Affiliation(s)
- A Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Italy
| | - M Grzeda
- Department of Sociology, Faculty of Social Sciences, Warsaw University of Life Sciences, Poland Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Italy
| | - A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Italy
| | - K Mattarozzi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - R D'Alessandro
- Neuroepidemiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
| | - A Simone
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Italy
| | - L Tesio
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Italy Department of Biomedical Sciences for Health, University of Milan, Italy
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Giordano A, Lugaresi A, Confalonieri P, Granella F, Radice D, Trojano M, Martinelli V, Solari A, Giordano A, Martinelli V, Lugaresi A, Pucci E, Granella F, Trojano M, Solari A, Martinelli V, Pucci E, Messmer Uccelli M, Lugaresi A, Giordano A, Granella F, Solari A, Giordano A, Ferrari G, Martini F, Solari A, Radice D, D’Annunzio G, Lugaresi A, Farina D, Travaglini D, Pietrolongo E, Onofrj M, Torri Clerici V, Bonanno S, Brambilla L, Confalonieri P, Martinelli V, Radaelli M, Messina J, Comi G, Tortorella C, Luciannatelli E, Trojano M, Senesi C, Tsantes E, Granella F, Conti MZ, Rottoli MR, Bellantonio P, Fischetti M, Fantozzi R, Pala A, Traccis S, Di Battista G, Bianchi M, Benedetti MD, Gaetani L, Di Filippo M, Carolei A, Totaro R, Lanzillo R, Brescia Morra V, Coppola R, Cottone S, Chiavazza C, Cavalla P, Leonardi C, Aguglia U, Ziuliani C, Valla P, Sasanelli F, Valentino P, Quattrone A, Martino PG, Russo M, Vita G, Immovilli P. Implementation of the ‘Sapere Migliora’ information aid for newly diagnosed people with multiple sclerosis in routine clinical practice: a late-phase controlled trial. Mult Scler 2014; 20:1234-43. [DOI: 10.1177/1352458513519180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/11/2013] [Indexed: 11/16/2022]
Abstract
Background: The SIMS-Trial showed that the ‘Sapere Migliora’ information aid (IA) for newly diagnosed people with multiple sclerosis (PwMS) effectively improved patient knowledge and satisfaction with care. Objectives: The objectives of this paper are to assess the effectiveness of the IA in clinical practice and to compare the whole IA with the take-home booklet/website component alone. Methods: After updating the IA and replacing the CD with a website, a prospective, open-label non-randomised controlled trial compared the whole IA (group A, five SIMS-Trial centres) to take-home (group B, 16 centres). One month after the intervention, participants completed the MS Knowledge Questionnaire (MSKQ), care satisfaction questionnaire (COSM-R) (primary study outcomes), Hospital and Anxiety Depression Scale, and ad hoc questionnaire appraising the IA. Results: We enrolled 159 newly diagnosed PwMS (May 2012–March 2013). Drop-outs were four of 77 (5%, group A) and 11/82 (13%, group B). Primary endpoint (highest tertile both for MSKQ and COSM-R section 2 scores) was achieved by 38/77 (49%) group A and 33/82 (40%) group B ( p = 0.25). Attainment of secondary outcomes was also similar between groups. Conclusions: This study shows that the entire IA is not superior to the booklet/website alone, and that both are comparable in efficacy to the intervention arm of the SIMS-Trial. Trial registration number: ISRCTN78940214.
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Affiliation(s)
- A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Italy
| | - A Lugaresi
- Department of Neuroscience and Imaging, University G. d’Annunzio of Chieti-Pescara, Italy
| | - P Confalonieri
- Department of Neuroimmunology, Foundation IRCCS Neurological Institute C. Besta, Italy
| | - F Granella
- Department of Neurosciences, Neurology Unit, University of Parma, Italy
| | - D Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Italy
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | - V Martinelli
- Department of Neurology, Scientific Institute Hospital San Raffaele, Italy
| | - A Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Italy
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Apt W, Arribada A, Zulantay I, Solari A, Sánchez G, Mundaca K, Coronado X, Rodríguez J, Gil LC, Osuna A. Itraconazole or allopurinol in the treatment of chronic American trypanosomiasis: the results of clinical and parasitological examinations 11 years post-treatment. Annals of Tropical Medicine & Parasitology 2013; 99:733-41. [PMID: 16297286 DOI: 10.1179/136485905x75403] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Eleven years after they had been given itraconazole or allopurinol for the treatment of chronic American trypanosomiasis, 109 adult patients were checked for electrocardiographic abnormalities and evidence of Trypanosoma cruzi infection. The parasitological investigations included xenodiagnosis, in which the faeces of Triatoma infestans that had fed on the patients were checked under the microscope for flagellates. In addition, a PCR-based assay and a hybridization assay were used to test blood samples from the patients, and faeces from the Tri. infestans that had fed on the patients, for Try. cruzi DNA. For the data analysis, the patients were divided into four groups known as normal/normal, abnormal/normal, normal/abnormal and abnormal/abnormal, according to whether the patients had been found to have normal or abnormal electrocardiograms (ECG) shortly before the first treatment and to have normal or abnormal ECG when checked at the 11-year follow-up. The 51 normal/normal and 24 normal/abnormal patients were assumed to have been in the 'indeterminate' phase of the disease when they were treated, whereas the 16 abnormal/normal and 18 abnormal/abnormal patients all had evidence of chagasic cardiopathy at that time. When checked 11 years post-treatment, 40 (78.4%), 17 (70.8%), 14 (87.5%) and 17 (94.4%) of these patients, respectively, were each found positive for Try. cruzi in at least one of the parasitological tests. The hybridization assay, whether applied to human blood or bug faeces, appeared a significantly more sensitive test than the PCR-based assays or microscopically assessed xenodiagnosis (P<0.05). Only the 21 patients who appeared to be negative for Try. cruzi could be considered parasitologically cured (although all still appeared to have anti-Try. cruzi antibodies in their blood). Only 13 of these parasitologically cured patients (seven of those treated with itraconazole and six of those given allopurinol) had normal ECG at the 11-year follow-up. In Chile at least, itraconazole, which caused fewer adverse effects than the allopurinol while being no less effective at preventing cardiopathy, appears to be the drug of choice to treat chronic American trypanosomiasis in adults.
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Affiliation(s)
- W Apt
- Laboratorio de Parasitología Básico-Clínico, Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, P.O. Box 427, Santiago 3, Chile.
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Heesen C, Köpke S, Solari A, Geiger F, Kasper J. Patient autonomy in multiple sclerosis--possible goals and assessment strategies. J Neurol Sci 2013; 331:2-9. [PMID: 23711752 DOI: 10.1016/j.jns.2013.02.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 02/20/2013] [Indexed: 11/24/2022]
Abstract
Patient autonomy has been increasingly acknowledged as prerequisite for successful medical decision making in Western countries. In medical decisions with a need to involve a health professional, patient autonomy becomes apparent in the extent of patients' participation in the communication as described in the concept of shared decision making. Patient autonomy can be derived from different perspectives or goals and the focus of evaluation approaches may vary accordingly. Multiple sclerosis (MS) is a paradigmatic disease to study patient autonomy mainly because MS patients are highly disease competent and due to ambiguous evidence on many aspects of disease-related medical decision making. This review gives an overview on measurement issues in studying decision making in MS, categorized according to prerequisites, process measures and outcomes of patient autonomy. As relevant prerequisites role preferences, risk attribution, risk tolerance, and risk knowledge are discussed. Regarding processes, we distinguish intra-psychic and interpersonal aspects. Intra-psychic processes are elucidated using the theory of planned behavior, which guided development of a 30-item scale to capture decisions about immunotherapy. Moreover, a theory of uncertainty management has been created resulting in the development of a corresponding measurement concept. Interpersonal processes evolving between physician and patient can be thoroughly analyzed from different perspectives by use of the newly developed comprehensive MAPPIN'SDM inventory. Concerning outcomes, besides health related outcomes, we discuss match of preferred roles during the decision encounters (preference match), decisional conflict as well as an application of the multidimensional measure of informed choice to decisions of MS patients. These approaches provide an overview on patient-inherent and interpersonal factors and processes modulating medical decision making and health behavior in MS and beyond.
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Affiliation(s)
- C Heesen
- Institute of Neuroimmunology and Clinical MS Research, University Medical Center Hamburg, Hamburg, Germany.
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Campos R, Botto-Mahan C, Coronado X, Catala S, Solari A. Phylogenetic Relationships of the Spinolai Complex and Other Triatomini Based on Mitochondrial DNA Sequences (Hemiptera: Reduviidae). Vector Borne Zoonotic Dis 2013. [DOI: 10.1089/vbz.2011.0954] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R. Campos
- Programa de Biología Celular y Molecular, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - C. Botto-Mahan
- Departamento de Ciencias Ecológicas, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - X. Coronado
- Programa de Biología Celular y Molecular, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - S.S. Catala
- Centro Regional de Investigaciones Científicas y Transferencia Tecnológica de La Rioja, Anillaco, La Rioja, Argentina
| | - A. Solari
- Programa de Biología Celular y Molecular, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Abstract
Charcot-Marie-Tooth 1A disease (CMT1A) is a disease for which no drug treatments are available. In 2004, it was reported that ascorbic acid reduced the severity of neuropathy in transgenic mice overexpressing PMP22, an animal model of human CMT1A, compared with untreated mice. Based on those results, clinical trials were undertaken at different centers worldwide and four of them have been completed, but none of them resulted in significant improvements. Based on the pharmacokinetics of ascorbic acid, we propose that the randomized clinical trial carried out thus far confirmed the tight control of ascorbic acid's absorption and proved its tolerability at one and two years. The pharmacokinetic considerations discussed in this article might largely explain the disappointing results of the recent CMT1A trials.
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Affiliation(s)
- F. Visioli
- Laboratory of Functional Foods, IMDEA-Food, CEI UAM + CSIC, Calle Faraday 7, 28049 Madrid, Spain
| | - M.M. Reilly
- MRC Centre for Neuromuscular Diseases, Department of Molecular Neurosciences, UCL Institute of Neurology, London, UK
| | - M. Rimoldi
- Unit of Clinic of Central and Peripheral Degenerative Neuropathies, Department of Clinical Neurosciences, IRCCS Foundation, “C. Besta” Neurological Institute, Milan, Italy
| | - A. Solari
- Unit of Clinic of Central and Peripheral Degenerative Neuropathies, Department of Clinical Neurosciences, IRCCS Foundation, “C. Besta” Neurological Institute, Milan, Italy
| | - D. Pareyson
- Unit of Clinic of Central and Peripheral Degenerative Neuropathies, Department of Clinical Neurosciences, IRCCS Foundation, “C. Besta” Neurological Institute, Milan, Italy
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Giordano A, Ferrari G, Radice D, Randi G, Bisanti L, Solari A. Self-assessed health status changes in a community cohort of people with multiple sclerosis: 11 years of follow-up. Eur J Neurol 2012; 20:681-8. [DOI: 10.1111/ene.12028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 10/04/2012] [Indexed: 11/28/2022]
Affiliation(s)
- A. Giordano
- Unit of Neuroepidemiology; Foundation IRCCS Neurological Institute C. Besta; Milan Italy
| | - G. Ferrari
- Unit of Neuroepidemiology; Foundation IRCCS Neurological Institute C. Besta; Milan Italy
| | - D. Radice
- Division of Epidemiology and Biostatistics; European Institute of Oncology; Milan Italy
| | - G. Randi
- Unit of Epidemiology; Local Health Authority; Milan Italy
| | - L. Bisanti
- Unit of Epidemiology; Local Health Authority; Milan Italy
| | - A. Solari
- Unit of Neuroepidemiology; Foundation IRCCS Neurological Institute C. Besta; Milan Italy
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Giordano A, Ferrari G, Radice D, Randi G, Bisanti L, Solari A. Health-related quality of life and depressive symptoms in significant others of people with multiple sclerosis: a community study. Eur J Neurol 2012; 19:847-54. [PMID: 22233289 DOI: 10.1111/j.1468-1331.2011.03638.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Uncertain prognosis and modest treatment efficacy make multiple sclerosis (MS) a particularly difficult disease to adjust to for both patients and their significant others (SOs). Few studies have assessed health-related quality of life (HRQOL) and depressive symptoms in SOs of people with MS in the community. We assessed, and identified predictors of, HRQOL and depression in SOs of adults with MS. METHODS POSMOS (postal survey of self-assessed health in MS adults and SOs) is a longitudinal survey on a random sample of 251 people with MS in the Milan area. In 2010, SOs and contemporaneous controls completed the SF-36 and Chicago Multiscale Depression Inventory (CMDI). RESULTS Overall, 142 SOs (mean age 53.1 years; 50% women, 65% partners) and 120 controls (similar to SOs for sex and education, but older) participated. By multivariable modeling of the SO plus control population, SF-36 vitality was lower in SOs (proportional odds ratio 0.45; 95% confidence interval 0.28-0.70), women (0.41; 0.27-0.64), and older subjects (0.98; 0.97-0.99). SF-36 mental health was also lower in SOs (0.62; 0.40-0.96) and women (0.43; 0.28-0.67). Regarding MS characteristics associated with HRQOL and depression in SOs, severe disability [Expanded Disability Status Scale (EDSS > 6.5)] had no effect, whilst depressive symptoms (pathologic CMDI) negatively influenced most SF-36 and all CMDI scores in SOs. CONCLUSIONS SOs had significantly lower vitality and psychological well-being than controls, identifying a burden in being the companion of a person with MS. This burden was unrelated to physical compromise but associated with depressive symptoms in MS.
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Affiliation(s)
- A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
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Díaz M, Solari A, González C. Differential expression of Trypanosoma cruzi I associated with clinical forms of Chagas disease: Overexpression of oxidative stress proteins in acute patient isolate. J Proteomics 2011; 74:1673-82. [DOI: 10.1016/j.jprot.2011.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 04/30/2011] [Accepted: 05/03/2011] [Indexed: 12/20/2022]
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González C, Ortiz S, Solari A. Colombian Trypanosoma cruzi major genotypes circulating in patients: Minicircle homologies by cross-hybridization analysis. Int J Parasitol 2010; 40:1685-92. [DOI: 10.1016/j.ijpara.2010.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 07/14/2010] [Accepted: 07/14/2010] [Indexed: 11/26/2022]
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Solari A, Martinelli V, Trojano M, Lugaresi A, Granella F, Giordano A, Messmer Uccelli M, D'Alessandro R, Pucci E, Confalonieri P, Borreani C. An information aid for newly diagnosed multiple sclerosis patients improves disease knowledge and satisfaction with care. Mult Scler 2010; 16:1393-405. [DOI: 10.1177/1352458510380417] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Patients report information deficits in the period surrounding diagnosis of multiple sclerosis (MS). We assessed the effectiveness of an add-on information aid for newly diagnosed MS patients. Methods: We randomly assigned 120 newly diagnosed MS patients from five Italian centres to diagnosis disclosure (current practice at the centre) or current practice plus information aid (ISRCTN81072971). The information aid consisted of a personal interview with a physician using a navigable compact disc and a take-home booklet. The primary composite endpoint was score in the highest tertile of MS knowledge and satisfaction with care questionnaires. Other endpoints were safety; treatment adherence; extra contacts/consultations; switching of care centre; and changes in Hospital Anxiety and Depression Scale and Control Preference Scale scores. Results: At 1 month, 30/60 intervention and 8/60 control patients achieved the primary endpoint (odds ratio [OR] 6.5, 95% CI 2.6—16.0; p < 0.001; number needed to treat [NNT] 3). Figures at 6 months were 26/60 intervention and 11/60 control patients (OR 3.4, 95% CI 1.5—7.8; p = 0.04; NNT 4). There were no adverse events. No significant treatment effects were seen on secondary outcomes. Conclusion: The information aid was safe and significantly associated with attainment of the primary outcome at 1 and 6 months.
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Affiliation(s)
- A. Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy,
| | - V Martinelli
- Department of Neurology, Scientific Institute Hospital San Raffaele, Milan, Italy
| | - M Trojano
- Departments of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - A Lugaresi
- Department of Neuroscience and Imaging, University G. D'Annunzio, Chieti, Italy
| | - F Granella
- Department of Neurosciences, Neurology Unit, University of Parma, Parma, Italy
| | - A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - M Messmer Uccelli
- Department of Health Services and Research, Italian MS Society, Genoa, Italy
| | - R D'Alessandro
- Department of Clinical Neurology, University of Bologna, Bologna, Italy
| | - E Pucci
- Neurology Department, Macerata Hospital, Macerata, Italy
| | - P Confalonieri
- Department of Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - C Borreani
- Psychology Unit, National Cancer Institute Foundation, Milan, Italy
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Solari A, Mattarozzi K, Vignatelli L, Giordano A, Russo PM, Messmer Uccelli M, D'Alessandro R. Development and validation of a patient self-assessed questionnaire on satisfaction with communication of the multiple sclerosis diagnosis. Mult Scler 2010; 16:1237-47. [DOI: 10.1177/1352458510376178] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: We describe the development and clinical validation of a patient self-administered tool assessing the quality of multiple sclerosis diagnosis disclosure. Method: A multiple sclerosis expert panel generated questionnaire items from the Doctor’s Interpersonal Skills Questionnaire, literature review, and interviews with neurology inpatients. The resulting 19-item Comunicazione medico-paziente nella Sclerosi Multipla (COSM) was pilot tested/debriefed on seven patients with multiple sclerosis and administered to 80 patients newly diagnosed with multiple sclerosis. The resulting revised 20-item version (COSM-R) was debriefed on five patients with multiple sclerosis, field tested/debriefed on multiple sclerosis patients, and field tested on 105 patients newly diagnosed with multiple sclerosis participating in a clinical trial on an information aid. The hypothesized monofactorial structure of COSM-R section 2 was tested on the latter two groups. Results: The questionnaire was well accepted. Scaling assumptions were satisfactory in terms of score distributions, item—total correlations and internal consistency. Factor analysis confirmed section 2’s monofactorial structure, which was also test—retest reliable (intraclass correlation coefficient [ICC] 0.73; 95% CI 0.54—0.85). Section 1 had only fair test—retest reliability (ICC 0.45; 95% CI 0.12—0.69), and three items had 8—21% missed responses. Conclusions: COSM-R is a brief, easy-to-interpret MS-specific questionnaire for use as a health care indicator.
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Affiliation(s)
- A. Solari
- Neuroepidemiology Unit, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy,
| | - K. Mattarozzi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - L. Vignatelli
- Local Health Unit, Neurology Outpatient Clinic, Bologna, Italy
| | - A. Giordano
- Neuroepidemiology Unit, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - PM Russo
- Department of Psychology, University of Bologna, Bologna, Italy
| | - M. Messmer Uccelli
- Department of Health Sciences and Research, Italian Multiple Sclerosis Society, Genoa, Italy
| | - R. D'Alessandro
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
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Giordano A, Uccelli MM, Pucci E, Martinelli V, Borreani C, Lugaresi A, Trojano M, Granella F, Confalonieri P, Radice D, Solari A. The Multiple Sclerosis Knowledge Questionnaire: a self-administered instrument for recently diagnosed patients. Mult Scler 2009; 16:100-11. [PMID: 19995834 DOI: 10.1177/1352458509352865] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are few studies on patient knowledge in multiple sclerosis (MS), and only two published questionnaires. The objective of this article was to develop and validate the MS Knowledge Questionnaire (MSKQ), a self-assessed instrument for newly diagnosed MS patients. Thirty multiple-choice statements, conceived to test MS knowledge, were produced by a multidisciplinary panel and pre-tested on three MS patients, resulting in an intermediate 26-item version. This was tested on 54 MS patients for internal consistency, content and construct validity (validation sample I). The final (25-item) MSKQ was a primary outcome measure in the SIMS-Trial on an information aid to newly diagnosed MS patients. Postal responses of SIMS-Trial participants to the MSKQ a month after intervention (validation sample II) were analysed. Median MSKQ scores in validation samples I and II were, respectively, 18 (range 9-23) and 17 (range 3-24). Acceptability, internal consistency (Kuder-Richardson-20 formula 0.76) and content validity were good. Educational attainment and receiving the information aid were the main independent predictors of MS knowledge. Other predictors were female sex (positive association) and disease duration (negative association). In conclusion, the MSKQ has good clinimetric properties and is sensitive to an educational intervention. We propose the MSKQ as a brief instrument for clinical practice and research.
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Affiliation(s)
- A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C Besta, Milan, Italy
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Giordano A, Pucci E, Naldi P, Mendozzi L, Milanese C, Tronci F, Leone M, Mascoli N, La Mantia L, Giuliani G, Solari A. Responsiveness of patient reported outcome measures in multiple sclerosis relapses: the REMS study. J Neurol Neurosurg Psychiatry 2009; 80:1023-8. [PMID: 19443471 DOI: 10.1136/jnnp.2008.171181] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the responsiveness of the three most used patient reported multiple sclerosis (MS) specific questionnaires: the Functional Assessment of MS (FAMS), the MS Impact Scale (MSIS-29) and the 54 item MS Quality of Life (MSQOL-54). DESIGN Prospective multicentre longitudinal study on 104 MS patients treated with intravenous steroids for clinical exacerbation. METHODS Patient reported data, Expanded Disability Status Scale (EDSS) score and clinical information were collected at admission and 8 weeks later. "Internal" (distribution based) responsiveness was assessed by standardised response means (SRM). "External" (anchor based) responsiveness was assessed by receiver operating characteristic (ROC) curves in relation to corresponding changes in a pre-specified reference measure (anchor). The pre-specified anchor was patients' self-reported recovery assessed on a 5 point Likert scale. RESULTS SRM was 0.39 for FAMS, 0.58 for MSIS-29 physical scale, 0.45 for MSIS-29 psychological scale, 0.71 for MSQOL-54 physical health composite and 0.57 for MSQOL-54 mental health composite. Seventy-three patients (70%) reported they had improved; physicians agreed substantially with patient assessments (kappa statistic 0.70, 95% CI 0.54 to 0.85). Areas under ROC curves differed significantly from 0.50 only for the MSIS-29 and MSQOL-54 scales where areas ranged from 0.65 (95% CI 0.53 to 0.76) for the MSIS-29 psychological scale to 0.70 (95% CI 0.58 to 0.81) for the MSQOL-54 mental health composite. Areas under ROC curves assessed using a physician based anchor were similar to the patient based areas. CONCLUSIONS The responsiveness of the MS specific instruments was less than ideal. The MSIS-29 and MSQOL-54 were significantly more responsive, using both distribution based and anchor based approaches, than FAMS, and should be preferred in longitudinal studies.
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Affiliation(s)
- A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C Besta, Via Celoria,11, 20133 Milan, Italy
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Affiliation(s)
- B Klingenberg
- Department of Mathematics and Statistics, Williams College, Williamstown, Massachusetts 01267, USA.
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Zulantay I, Apt W, Gil LC, Rocha C, Mundaca K, Solari A, Sánchez G, Rodriguez C, Martínez G, De Pablos LM, Sandoval L, Rodríguez J, Vilchez S, Osuna A. The PCR-based detection of Trypanosoma cruzi in the faeces of Triatoma infestans fed on patients with chronic American trypanosomiasis gives higher sensitivity and a quicker result than routine xenodiagnosis. Ann Trop Med Parasitol 2008; 101:673-9. [PMID: 18028728 DOI: 10.1179/136485907x241415] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In the xenodiagnosis (XD) of American trypanosomiasis (Chagas disease), Trypanosoma cruzi in the triatomine bugs fed on the patient can now be detected using PCR (XD-PCR) as well as by microscopy (XD-M). In a study to compare XD-PCR with XD-M, triatomine bugs were fed on 50 cases of chronic American trypanosomiasis, of whom only 25 were ever found positive by XD-M. Overall, the bugs fed on 34 of the patients (all 25 cases found positive by XD-M and nine of the other patients) were found PCR-positive, giving a 330-bp fragment corresponding to part of the hyper variable region of the kinetoplast DNA of T. cruzi. Of the 25 patients who were ever found positive by XD-M, 20 gave bugs that were smear-positive on day 90 and a similar number (24; P=0.125) gave bugs that were PCR-positive at this time. On day 30, however, the bugs fed on only 11 of these 25 patients were found positive by microscopy, whereas 23 of these patients were found positive by XD-PCR (P=0.0016). Thus, not only was XD-PCR more sensitive than XD-M but it was also quicker, revealing more cases within 30 days than detected using XD-M over a period of 90 days.
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Affiliation(s)
- I Zulantay
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, Casilla 427, Santiago 3, Chile
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