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Fiorino C, Palumbo D, Mori M, Palazzo G, Pellegrini AE, Albarello L, Belardo A, Canevari C, Cossu A, Damascelli A, Elmore U, Mazza E, Pavarini M, Passoni P, Puccetti F, Slim N, Steidler S, Del Vecchio A, Di Muzio NG, Chiti A, Rosati R, De Cobelli F. Early regression index (ERI) on MR images as response predictor in esophageal cancer treated with neoadjuvant chemo-radiotherapy: Interim analysis of the prospective ESCAPE trial. Radiother Oncol 2024; 194:110160. [PMID: 38369025 DOI: 10.1016/j.radonc.2024.110160] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE The early regression index (ERI) predicts treatment response in rectal cancer patients. Aim of current study was to prospectively assess tumor response to neoadjuvant chemo-radiotherapy (nCRT) of locally advanced esophageal cancer using ERI, based on MRI. MATERIAL AND METHODS From January 2020 to May 2023, 30 patients with esophageal cancer were enrolled in a prospective study (ESCAPE). PET-MRI was performed: i) before nCRT (tpre); ii) at mid-radiotherapy, tmid; iii) after nCRT, 2-6 weeks before surgery (tpost); nCRT delivered 41.4 Gy/23fr with concurrent carboplatin and paclitaxel. For patients that skipped surgery, complete clinical response (cCR) was assessed if patients showed no local relapse after 18 months; patients with pathological complete response (pCR) or with cCR were considered as complete responders (pCR + cCR). GTV volumes were delineated by two observers (Vpre, Vmid, Vpost) on T2w MRI: ERI and other volume regression parameters at tmid and tpost were tested as predictors of pCR + cCR. RESULTS Complete data of 25 patients were available at the time of the analysis: 3/25 with complete response at imaging refused surgery and 2/3 were cCR; in total, 10/25 patients showed pCR + cCR (pCR = 8/22). Both ERImid and ERIpost classified pCR + cCR patients, with ERImid showing better performance (AUC:0.78, p = 0.014): A two-variable logistic model combining ERImid and Vpre improved performances (AUC:0.93, p < 0.0001). Inter-observer variability in contouring GTV did not affect the results. CONCLUSIONS Despite the limited numbers, interim analysis of ESCAPE study suggests ERI as a potential predictor of complete response after nCRT for esophageal cancer. Further validation on larger populations is warranted.
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Affiliation(s)
- C Fiorino
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy.
| | - D Palumbo
- Radiology, IRCCS San Raffaele Hospital, Milano, Italy
| | - M Mori
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy
| | - G Palazzo
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy
| | | | - L Albarello
- Pathology, IRCCS San Raffaele Hospital, Milano, Italy
| | - A Belardo
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy
| | - C Canevari
- Nuclear Medicine, IRCCS San Raffaele Hospital, Milano, Italy
| | - A Cossu
- Gastric Surgery, IRCCS San Raffaele Hospital, Milano, Italy
| | - A Damascelli
- Radiology, IRCCS San Raffaele Hospital, Milano, Italy
| | - U Elmore
- Gastric Surgery, IRCCS San Raffaele Hospital, Milano, Italy
| | - E Mazza
- Oncology, IRCCS San Raffaele Hospital, Milano, Italy
| | - M Pavarini
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy
| | - P Passoni
- Radiotherapy, IRCCS San Raffaele Hospital, Milano, Italy
| | - F Puccetti
- Gastric Surgery, IRCCS San Raffaele Hospital, Milano, Italy
| | - N Slim
- Radiotherapy, IRCCS San Raffaele Hospital, Milano, Italy
| | - S Steidler
- Radiology, IRCCS San Raffaele Hospital, Milano, Italy
| | - A Del Vecchio
- Medical Physics, IRCCS San Raffaele Hospital, Milano, Italy
| | - N G Di Muzio
- Radiotherapy, IRCCS San Raffaele Hospital, Milano, Italy; Vita-Salute University, Milano, Italy
| | - A Chiti
- Nuclear Medicine, IRCCS San Raffaele Hospital, Milano, Italy; Vita-Salute University, Milano, Italy
| | - R Rosati
- Gastric Surgery, IRCCS San Raffaele Hospital, Milano, Italy; Vita-Salute University, Milano, Italy
| | - F De Cobelli
- Radiology, IRCCS San Raffaele Hospital, Milano, Italy; Vita-Salute University, Milano, Italy
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Masson W, Barbagelata L, Corral P, Nogueira JP, Lavalle-Cobo A, Belardo A. Relationship Between Lipoprotein(a) Levels and Cardiovascular Outcomes in Postmenopausal Women: A Systematic Review. Curr Probl Cardiol 2023; 48:101589. [PMID: 36621517 DOI: 10.1016/j.cpcardiol.2023.101589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
Elevated lipoprotein(a) [Lp(a)] levels are independently associated with atherosclerotic cardiovascular disease, although this association is less explored in postmenopausal women. The main objective of this systematic review was to analyze the association between elevated Lp(a) levels and cardiovascular outcomes in posmenopausal women. Studies that evaluated this association were searched in the current literature. Ten studies including 157.690 women were considered eligible for this study. In total, 4 prospective cohorts, 3 cross-sectional studies, 2 nested case-control studies, and one post-hoc analysis from a randomized clinical trial were analyzed. The included studies showed different results regarding the association between Lp(a) levels and cardiovascular outcomes: a positive association (4 studies), no association (2 studies), or different results depending on the subgroups or outcomes evaluated (4 studies). The results were robust when evaluating coronary events. The reduction in coronary events attributed to a hormone replacement therapy-associated decrease in Lp(a) levels was controversial.
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Affiliation(s)
- Walter Masson
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Leandro Barbagelata
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Pablo Corral
- Facultad Medicina, Universidad FASTA, Mar del Plata, Buenos Aires, Argentina
| | - Juan P Nogueira
- Centro de Investigacion en Endocrinologia, Nutricion y Metabolismo (CIENM), Facultad de Ciencias de la Salud, Universidad Nacional de Formosa, Formosa, Argentina
| | | | - Alejandra Belardo
- Ginecology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Blümel JE, Arteaga E, Aedo S, Arriola-Montenegro J, López M, Martino M, Miranda C, Miranda O, Mostajo D, Ñañez M, Ojeda E, Pilnik S, Rojas J, Salinas C, Sosa L, Spritzer PM, Tserotas K, Vallejo MS, Belardo A, Fighera TM, Chedraui P. Metformin use is associated with a lower risk of osteoporosis in adult women independent of type 2 diabetes mellitus and obesity. REDLINC IX study. Gynecol Endocrinol 2020; 36:421-425. [PMID: 31994945 DOI: 10.1080/09513590.2020.1718092] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Metformin may decrease cell senescence, including bone; hence we aimed at evaluating the association between metformin use and osteoporosis. This was a cross-sectional study carried out in 1259 Latin American adult women aged 40 or more who were not on anti-osteoporotic drugs, were on metformin and had a bone densitometry performed. Of the whole sample, 40.3% reported being on metformin (at least 1 year), 30.2% had type 2 diabetes mellitus and 22.6% had osteoporosis. Median (interquartile range) body mass index (BMI) for the whole cohort was 27.7 (4.6) kg/m2 and 30.2% had type 2 diabetes mellitus. Current use of hormone therapy, calcium, and vitamin D corresponded respectively to 10.7%, 47.7%, and 43.1% of all surveyed women. A logistic regression model was used to analyze the association of osteoporosis with various covariates incorporated into the model such as age (OR: 1.07, 95% CI: 1.05-1.09), BMI (OR: 0.92, 95% CI: 0.89-0.96) and metformin use (OR: 0.44, 95% CI: 0.32-0.59). Metformin use, regardless of the presence of type 2 diabetes or obesity, was associated with a lower risk of osteoporosis in adult women. We propose that one explanation for this observation could be the effect of the drug over cellular senescence.
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Affiliation(s)
- Juan E Blümel
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - Eugenio Arteaga
- Departamento de Endocrinología and CETREN, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Sócrates Aedo
- Escuela de Medicina, Facultad de Medicina, Universidad Finis Terrae, Santiago de Chile, Chile
| | | | - Marcela López
- Departamento de Endocrinología, Hospital Militar, Santiago de Chile, Chile
| | - Mabel Martino
- Red Latinoamericana de Investigación en Climaterio, Rosario, Argentina
| | | | | | - Desireé Mostajo
- Red Latinoamericana de Investigación en Climaterio, Santa Cruz, Bolivia
| | - Mónica Ñañez
- Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Eliana Ojeda
- Departamento de Obstetricia y Ginecología, Universidad Andina del Cusco, Cusco, Perú
| | | | - José Rojas
- Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Lida Sosa
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | - Poli M Spritzer
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas, Porto Alegre, Brazil
| | - Konstantinos Tserotas
- Departamento de Gineco-Obstetricia, Complejo Hospitalario Dr. Arnulfo Arias Madrid de la Caja del Seguro Social de Panamá, Ciudad de Panamá, Panamá
| | - María S Vallejo
- Clínica Quilín, Universidad de Chile, Santiago de Chile, Chile
| | - Alejandra Belardo
- Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
| | - Tayane M Fighera
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas, Porto Alegre, Brazil
| | - Peter Chedraui
- Facultad de Ciencias Médicas, Instituto de Investigación e Innovación en Salud Integral, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
- Facultad de Ciencias de la Salud, Universidad Católica 'Nuestra Señora de la Asunción', Asunción, Paraguay
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Alfie J, Lugones L, Belardo A, Tutzer M, Galarza CR, Waisman GD, Cámera MI. Hemodynamic effects of transdermal estradiol alone and combined with norethisterone acetate. Maturitas 1997; 27:163-9. [PMID: 9255751 DOI: 10.1016/s0378-5122(97)00030-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 02/05/2023]
Abstract
A 24 weeks, randomized, two-period, placebo controlled study was conducted to compare the effects of continuous transdermal 17 beta-estradiol replacement therapy (0.05 mg/day once a week) with placebo on systemic hemodynamics and blood pressure in postmenopausal women. Twenty-nine postmenopausal women (47-62 years) free of hormone replacement therapy were randomized in two groups; group 1 received estradiol patches for the first 12 weeks and placebo patches for the second, and group 2 received the same treatments in the reverse order. The effect of combined estradiol plus oral norethisterone acetate (NETA) 1 mg was also evaluated in the subset of women with intact uteri (n = 24). Crossover analysis showed that stroke volume and cardiac output were significantly higher (P < 0.05) and blood pressure was significantly lower (P < 0.05) with estradiol, irrespective of the order in which the treatments were administered. Although correlations between plasma estradiol levels during active treatment and hemodynamic changes were not significant, hemodynamic changes were significantly greater above 63 pg/ml than below this level (P < 0.05). Oral norethisterone acetate administration either during transdermal placebo or estradiol arms tended to modify systemic hemodynamics in the same direction than estradiol but the changes did not attained statistical significance. In summary compared with placebo, transdermal 17 beta-estradiol, replacement to postmenopausal women, increased cardiac output and decreased blood pressure. Although the average magnitude of changes was small, the results suggest that plasma estradiol levels could be a source of individual variability in the hemodynamic response. Oral NETA administration tended to enhance rather than reverse the estradiol-induced changes.
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Affiliation(s)
- J Alfie
- Unidad de Hipertension Arterial, Hospital Italiano, Buenos Aires, Argentina.
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Lugones L, Alflet J, Belardo A, Tutzer M, Galarza CR, Waisman G, Cámera MI. F212 Systemic hemodynamic changes during unopposed and combined hormone replacement therapy (HRT). Maturitas 1996. [DOI: 10.1016/s0378-5122(97)81176-0] [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: 11/16/2022]
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De Palma GD, Sivero L, Di Matteo E, Belardo A, Angrisani L, Catanzano C. [The current status of the perendoscopic treatment of biliary lithiasis]. MINERVA GASTROENTERO 1996; 42:1-5. [PMID: 8652735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The role of therapeutic biliary endoscopy, for management of bile duct stones, continues to be defined. Actually the endoscopic management should be considered the procedure of choice for treatment of retained or recurrent stones of the main bile duct, gallstone pancreatitis an acute cholangitis. It's role in the era of laparoscopic cholecystectomy is evolving. Actually new techniques and accessories continue to be developed for treatment of bile duct stones. The problem of the difficult bile duct stones has essentially been solved by the development of a variety of lithotripsy techniques. This work focuses on new developments in the therapeutic biliary endoscopy for treatment of main bile duct stones.
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Affiliation(s)
- G D De Palma
- Facoltà di Medicina e Chirurgia, Università degli Studi Federico II, Napoli
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De Palma GD, Di Matteo E, Monaco A, Abbruzzese P, Belardo A, Catanzano C. [Results of endoscopic Nd-Yag laser treatment of inoperable colorectal carcinoma]. MINERVA CHIR 1996; 51:87-91. [PMID: 8684659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Between November 1986 and December 1993, 94 patients underwent endoscopic laser therapy for inoperable colo-rectal cancers. According to the main clinical symptoms, tumors were divided into obstructing and bleeding; A Nd-YAG non contact laser was used at power setting of 70 to 100 watt. In 28 cases laser therapy was carried out after electrorection of the tumor and in 22 cases after dilation; in 41 cases it was associated with radiation therapy. In 90% of bleeding tumors and in 70% of obstructing tumors we achieved a good result in the short term. In 50% of bleeding tumors and in 65% of obstructing tumors the symptoms recurred after an interval of 8.2 and 6.1 weeks. The main survival period was 11.2 months for bleeding tumors and 7.4 months for obstructing tumors. Two patients with a small rectal cancer are free to neoplasia at 19 and 26 months after laser therapy.
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Affiliation(s)
- G D De Palma
- Cattedra di Chirurgia dell'Apparato Digerente, Università degli Studi di Napoli Federico II, Napoli
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