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D’Amato A, Riemma G, Agrifoglio V, Chiantera V, Laganà AS, Mikuš M, Dellino M, Maglione A, Faioli R, Giannini A, Trojano G, Etrusco A. Reproductive Outcomes in Young Women with Early-Stage Cervical Cancer Greater than 2 cm Undergoing Fertility-Sparing Treatment: A Systematic Review. Medicina (Kaunas) 2024; 60:608. [PMID: 38674254 PMCID: PMC11051883 DOI: 10.3390/medicina60040608] [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] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Despite advancements in detection and treatment, cervical cancer remains a significant health concern, particularly among young women of reproductive age. Limited data exists in the literature regarding fertility-sparing treatment (FST) of cervical cancers with tumor sizes greater than 2 cm. The objective of this systematic review was to evaluate the reproductive outcomes of women diagnosed with cervical cancer greater than 2 cm who underwent FST. Materials and Methods: A comprehensive search of the literature was carried out on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), the Health Technology Assessment Database, and Web of Science. Only original studies (retrospective or prospective) that reported reproductive outcomes of patients with cervical cancer >2 cm were considered eligible for inclusion in this systematic review (CRD42024521964). Studies describing only the oncologic outcomes, involving FST for cervical cancers less than 2 cm in size, and case reports were excluded. Results: Seventeen papers that met the abovementioned inclusion criteria were included in the present systematic review. In total, 443 patients with a cervical cancer larger than 2 cm were included in this systematic review. Eighty pregnancies occurred, with 24 miscarriages and 54 live births. Conclusions: FST appears to be a viable option for women of childbearing age diagnosed with cervical cancer larger than 2 cm. However, careful consideration is advised in interpreting these encouraging results, as they are subject to limitations, such as variability in study designs and potential biases. In addition, reproductive outcomes should be further cross-referenced with oncologic outcomes to clarify the potential risk-benefit ratio. It is critical to conduct further research using standardized approaches and larger participant groups to strengthen the validity of the conclusions drawn.
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Affiliation(s)
- Antonio D’Amato
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.D.); (M.D.)
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Vittorio Agrifoglio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Gynecologic Oncology, National Cancer Institute—IRCCS—Fondazione “G. Pascale”, 81031 Naples, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10 000 Zagreb, Croatia;
| | - Miriam Dellino
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.D.); (M.D.)
| | - Annamaria Maglione
- Gynecology and Obstetrics Unit, IRCCS “Casa del Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (R.F.)
| | - Raffaele Faioli
- Gynecology and Obstetrics Unit, IRCCS “Casa del Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (R.F.)
| | - Andrea Giannini
- Unit of Gynecology, “Sant’Andrea” Hospital, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, “Madonna delle Grazie” Hospital, 75100 Matera, Italy;
| | - Andrea Etrusco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy
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Cocomazzi G, Del Pup L, Contu V, Maggio G, Parmegiani L, Ciampaglia W, De Ruvo D, Faioli R, Maglione A, Baldini GM, Baldini D, Pazienza V. Gynecological Cancers and Microbiota Dynamics: Insights into Pathogenesis and Therapy. Int J Mol Sci 2024; 25:2237. [PMID: 38396914 PMCID: PMC10889201 DOI: 10.3390/ijms25042237] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
In recent years, the relationship between the microbiota and various aspects of health has become a focal point of scientific investigation. Although the most studied microbiota concern the gastrointestinal tract, recently, the interest has also been extended to other body districts. Female genital tract dysbiosis and its possible impact on pathologies such as endometriosis, polycystic ovary syndrome (PCOS), pelvic inflammatory disease (PID), and gynecological cancers have been unveiled. The incursion of pathogenic microbes alters the ecological equilibrium of the vagina, triggering inflammation and compromising immune defense, potentially fostering an environment conducive to cancer development. The most common types of gynecological cancer include cervical, endometrial, and ovarian cancer, which occur in women of any age but especially in postmenopausal women. Several studies highlighted that a low presence of lactobacilli at the vaginal level, and consequently, in related areas (such as the endometrium and ovary), correlates with a higher risk of gynecological pathology and likely contributes to increased incidence and worse prognosis of gynecological cancers. The complex interplay between microbial communities and the development, progression, and treatment of gynecologic malignancies is a burgeoning field not yet fully understood. The intricate crosstalk between the gut microbiota and systemic inflammation introduces a new dimension to our understanding of gynecologic cancers. The objective of this review is to focus attention on the association between vaginal microbiota and gynecological malignancies and provide detailed knowledge for future diagnostic and therapeutic strategies.
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Affiliation(s)
- Giovanna Cocomazzi
- Division of Gastroenterology, Fondazione IRCCS-Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy;
| | - Lino Del Pup
- Gynecological Endocrinology and Fertility, University Sanitary Agency Friuli Central (ASUFC), Via Pozzuolo, 330, 33100 Udine, FVG, Italy;
| | - Viviana Contu
- Integrative Medicine Unit, Humanitas Gradenigo, Corso Regina Margherita 8/10, 10153 Torino, FC, Italy;
| | - Gabriele Maggio
- Pia Fondazione Cardinale Giovanni Panico, Via S. Pio X, 4, 73039 Tricase, LE, Italy;
| | - Lodovico Parmegiani
- Next Fertility GynePro, NextClinics International Via T. Cremona 8, 40137 Bologna, RE, Italy; (L.P.); (W.C.)
| | - Walter Ciampaglia
- Next Fertility GynePro, NextClinics International Via T. Cremona 8, 40137 Bologna, RE, Italy; (L.P.); (W.C.)
| | - Daniele De Ruvo
- Gynaecology, Obstetrics and Reproductive Medicine Affidea Promea, Via Menabrea 14, 10126 Torino, TO, Italy;
| | - Raffaele Faioli
- Gynecology and Obstetrics, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, FG, Italy; (R.F.); (A.M.)
| | - Annamaria Maglione
- Gynecology and Obstetrics, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, FG, Italy; (R.F.); (A.M.)
| | - Giorgio Maria Baldini
- IVF Center, Momò Fertilife, 76011 Bisceglie Via Cala dell’Arciprete, 76011 Bisceglie, BT, Italy; (G.M.B.); (D.B.)
| | - Domenico Baldini
- IVF Center, Momò Fertilife, 76011 Bisceglie Via Cala dell’Arciprete, 76011 Bisceglie, BT, Italy; (G.M.B.); (D.B.)
| | - Valerio Pazienza
- Division of Gastroenterology, Fondazione IRCCS-Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy;
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Cocomazzi G, De Stefani S, Del Pup L, Palini S, Buccheri M, Primiterra M, Sciannamè N, Faioli R, Maglione A, Baldini GM, Baldini D, Pazienza V. The Impact of the Female Genital Microbiota on the Outcome of Assisted Reproduction Treatments. Microorganisms 2023; 11:1443. [PMID: 37374945 DOI: 10.3390/microorganisms11061443] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 05/11/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
The vaginal microbiota plays a critical role in the health of the female genital tract, and its composition contributes to gynecological disorders and infertility. Lactobacilli are the dominant species in the female genital tract: their production of lactic acid, hydrogen peroxide, and bacteriocins prevents the invasion and growth of pathogenic microorganisms. Several factors such as hormonal changes, age of reproduction, sexual practices, menstrual cycle, pregnancy, and antimicrobial drugs use can cause imbalance and dysbiosis of the vaginal microbiota. This review aims to highlight the impact of the vaginal microbiota in Assisted Reproductive Technology techniques (ART) and it examines the factors that influence the vaginal microbiota, the consequences of dysbiosis, and potential interventions to restore a healthy female genital tract.
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Affiliation(s)
- Giovanna Cocomazzi
- Division of Gastroenterology, Fondazione IRCCS-Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | | | - Lino Del Pup
- Gynecological Endocrinology and Fertility, University Sanitary Agency Friuli Central (ASUFC), Via Pozzuolo, 330, 33100 Udine, Italy
| | - Simone Palini
- Ospedale "Cervesi" di Cattolica-AUSL Romagna Via Ludwig Van Beethoven, 1, 47841 Cattolica, Italy
| | - Matteo Buccheri
- Instituto Bernabeu Via Castellana, 88, 30030 Martellago, Italy
| | | | - Natale Sciannamè
- Gynecology and Obstetrics, IRCCS "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy
| | - Raffaele Faioli
- Gynecology and Obstetrics, IRCCS "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy
| | - Annamaria Maglione
- Gynecology and Obstetrics, IRCCS "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy
| | - Giorgio Maria Baldini
- IVF Center, Momò Fertilife, 76011 Bisceglie Via Cala dell'Arciprete, 76011 Bisceglie, Italy
| | - Domenico Baldini
- IVF Center, Momò Fertilife, 76011 Bisceglie Via Cala dell'Arciprete, 76011 Bisceglie, Italy
| | - Valerio Pazienza
- Division of Gastroenterology, Fondazione IRCCS-Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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Maiorano BA, Maiorano MFP, Ciardiello D, Maglione A, Orditura M, Lorusso D, Maiello E. Beyond Platinum, ICIs in Metastatic Cervical Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14235955. [PMID: 36497437 PMCID: PMC9737392 DOI: 10.3390/cancers14235955] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cervical cancer (CC) constitutes the fourth most common tumor among the female population. Therapeutic approaches to advanced CC are limited, with dismal results in terms of survival, mainly after progression to platinum-based regimens. Immune checkpoint inhibitors (ICIs) are remodeling the therapeutic scenario of many solid tumors. The role of ICIs in CC should be addressed. Therefore, we systematically reviewed the latest clinical trials employing ICIs in advanced CC to assess which ICIs have been employed and how ICIs might meet the need for new therapeutic options in terms of efficacy and safety. METHODS The review was conducted following the PRISMA guidelines. The following efficacy outcomes were specifically collected: overall response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS); for safety: type, number, and grade of adverse events (AEs). RESULTS A total of 17 studies were analyzed. Anti-PD1 (pembrolizumab, nivolumab, cemiplimab, balstilimab, and tislelizumab), anti-PD-L1 (atezolizumab), and anti-CTLA-4 (ipilimumab, zalifrelimab) agents were employed both as single agents or combinations. Overall ORR ranged from 0% to 65.9%. ORR ranged from 5.9% to 69.6% in PD-L1-positive patients and from 0% to 50% in PD-L1-negative patients. DCR was 30.6-94.1%. mPFS ranged from 2 to 10.4 months. mOS ranged from 8 months to not reached. PD-L1 status did not impact survival. A total of 33.9% to 100% of patients experienced AEs. CONCLUSION Immunotherapy represents an appealing strategy for patients with advanced CC, as 2 out of 3 patients seem to respond to ICIs. PD-L1 status might be an indicator of response without impacting survival.
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Affiliation(s)
- Brigida Anna Maiorano
- Oncology Unit, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Mauro Francesco Pio Maiorano
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy
- Correspondence:
| | - Davide Ciardiello
- Oncology Unit, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy
- Medical Oncology, Department of Precision Medicine, Luigi Vanvitelli University of Campania, 80131 Naples, Italy
| | - Annamaria Maglione
- Obstetrics and Gynecology Department, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy
| | - Michele Orditura
- Medical Oncology, Department of Precision Medicine, Luigi Vanvitelli University of Campania, 80131 Naples, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynaecologic Oncology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Evaristo Maiello
- Oncology Unit, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy
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Maiorano BA, Maiorano MFP, Cormio G, Maglione A, Lorusso D, Maiello E. How Immunotherapy Modified the Therapeutic Scenario of Endometrial Cancer: A Systematic Review. Front Oncol 2022; 12:844801. [PMID: 35494078 PMCID: PMC9047829 DOI: 10.3389/fonc.2022.844801] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 12/20/2022] Open
Abstract
Background Endometrial cancer (EC) represents the sixth most common female tumor. In the advanced setting, the prognosis is dismal with limited treatment options. Platinum-based chemotherapy represents the actual standard of care in first-line chemotherapy, but no standard second-line chemotherapy is approved, with less than 1/4 of patients responding to second-line chemotherapy. In the last 10 years, immune checkpoint inhibitors (ICIs) have changed the treatment landscape of many solid tumors. Methods The review was conducted according to the PRISMA guidelines. We searched EMBASE, MEDLINE, Cochrane Database, and conference abstracts from international societies, up to November 2021. Clinical trials employing ICIs in advanced EC, written in English, were included. Reviews, letters, and commentaries were excluded. The overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and safety (number and grade of treatment-related adverse events [TRAEs]) were evaluated. Results 15 studies, for a total of 1,627 patients, were included: 14 non-randomized phase I/II trials and 1 randomized phase III trial. Anti-PD1 (pembrolizumab, nivolumab, dostarlimab) and anti-PD-L1 agents (avelumab, atezolizumab, durvalumab) were administered as single agents; pembrolizumab and nivolumab were combined with the tyrosine-kinase inhibitors (TKI) lenvatinib and cabozantinib, respectively; and durvalumab was associated with anti-CTLA4 tremelimumab. 4 studies selected only MSI patients. Single agents determined an ORR from 26.7% to 58% among MSI patients, from 3% to 26.7% among MSS patients. DCR ranged from 53.5% to 88.9% in MSI, 31.4% to 35.2% in MSS patients. The combination of TKI and ICIs determined 32% to 63.6% of ORR in all-comers, 32%–36.2% in MSS patients. 54.2% to 76% of patients developed TRAEs. The combination of ICIs and TKI achieved a higher toxicity rate than single agents (≥G3 TRAEs 88.9%). Conclusion ICIs represent an effective option for pretreated advanced EC patients with a tolerable profile. Given the encouraging results in MSI patients, every woman diagnosed with EC should be investigated for MS status. In MSS women, the combination of ICIs and TKI is more effective than monotherapy, notwithstanding safety concerns. PD-L1 cannot predict ICI response, whereas other biomarkers such as MSI and tumor mutational burden seem more accurate. Ongoing randomized trials will further clarify the role of these therapeutic options. Systematic Review Registration PROSPERO, CRD42021293538.
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Affiliation(s)
- Brigida Anna Maiorano
- Oncology Department, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
- *Correspondence: Brigida Anna Maiorano,
| | - Mauro Francesco Pio Maiorano
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari, Italy
| | - Gennaro Cormio
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari, Italy
| | - Annamaria Maglione
- Obstetrics and Gynecology Department, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynaecologic Oncology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Evaristo Maiello
- Oncology Department, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
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Villani A, Fontana A, Barone S, de Stefani S, Primiterra M, Copetti M, Panebianco C, Parri C, Sciannamè N, Quitadamo PA, Tiezzi A, Santana L, Maglione A, D’Amato F, Perri F, Palini S, Pazienza V. Identifying Predictive Bacterial Markers from Cervical Swab Microbiota on Pregnancy Outcome in Woman Undergoing Assisted Reproductive Technologies. J Clin Med 2022; 11:jcm11030680. [PMID: 35160131 PMCID: PMC8836651 DOI: 10.3390/jcm11030680] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/04/2022] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 01/27/2023] Open
Abstract
Background and aims: Failure of the embryo to implant causes about three-fourths of lost pregnancies. Female genital tract microbiota has been associated to Assisted Reproductive Technologies (ART) outcomes. The objective of this study was to analyze the microbiota of human cervical swab and to correlate these findings with the ART outcomes. Materials and Methods: In this study, 88 cervical swabs were collected from women undergoing ART cycles, with various causes of infertility, at the beginning of the ART protocols. After microbial DNA extraction, V3–V4 variable regions of the 16S rRNA gene were amplified and sequenced on the Illumina MiSeq platform. PEnalized LOgistic Regression Analysis (PELORA) was performed to identify clusters of bacterial populations with differential abundances between patients with unfavorable and favorable pregnancy outcome groups, respectively. Results: We identified a core of microorganisms at lower taxonomic levels that were predictive of women’s pregnancy outcomes. Statistically significant differences were identified at species levels with Lactobacillus salivarius, Lactobacillus rhamnosus among others. Moreover the abundance of Lactobacillus crispatus and iners, respectively increased and decreased in favorable group as compared to unfavorable group, resulted within the core of microorganisms associated to positive ART outcome. Although the predominance of lactobacilli is generally considered to be advantageous for ART outcome, we found that also the presence of Bifidobacterium (together with the other lactobacilli) was more abundant in the favorable group. Discussion: Cervix is colonized by microorganisms which can play a role in ART outcomes as seen by an overall decrease in embryo attachment rates and pregnancy rates in both fertile and infertile women. If confirmed in a larger cohort, the abundance of these bacteria can be useful not only as a marker of unfavorable pregnancy outcome but also they may open the way to new interventional strategies based on genital tract microbiota manipulation in order to increase the pregnancy rates in woman undergoing assisted reproductive technologies.
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Affiliation(s)
- Annacandida Villani
- Gastoenterology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza” Hospital, Viale Padre Pio 4, 71013 San Giovanni Rotondo, Italy; (A.V.); (C.P.); (F.P.)
| | - Andrea Fontana
- Unit of Biostatistic, Fondazione IRCCS “Casa Sollievo della Sofferenza” Hospital, Viale Padre Pio 4, 71013 San Giovanni Rotondo, Italy; (A.F.); (M.C.)
| | - Stefano Barone
- Unità Sanitaria Locale USL Toscana Nordovest, Assisted Reproductive Center Ospedale Versilia, 55041 Lido di Camaiore, Italy; (S.B.); (C.P.)
| | - Silvia de Stefani
- PMA Unit, Clinica Nuova Ricerca, Via Settembrini 17/h, 47923 Rimini, Italy; (S.d.S.); (M.P.); (A.T.); (L.S.)
| | - Mariangela Primiterra
- PMA Unit, Clinica Nuova Ricerca, Via Settembrini 17/h, 47923 Rimini, Italy; (S.d.S.); (M.P.); (A.T.); (L.S.)
| | - Massimiliano Copetti
- Unit of Biostatistic, Fondazione IRCCS “Casa Sollievo della Sofferenza” Hospital, Viale Padre Pio 4, 71013 San Giovanni Rotondo, Italy; (A.F.); (M.C.)
| | - Concetta Panebianco
- Gastoenterology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza” Hospital, Viale Padre Pio 4, 71013 San Giovanni Rotondo, Italy; (A.V.); (C.P.); (F.P.)
| | - Cristiana Parri
- Unità Sanitaria Locale USL Toscana Nordovest, Assisted Reproductive Center Ospedale Versilia, 55041 Lido di Camaiore, Italy; (S.B.); (C.P.)
| | - Natale Sciannamè
- Gynecology and Obstetrics Department, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (N.S.); (A.M.)
| | - Pasqua Anna Quitadamo
- Neonatology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Alessandra Tiezzi
- PMA Unit, Clinica Nuova Ricerca, Via Settembrini 17/h, 47923 Rimini, Italy; (S.d.S.); (M.P.); (A.T.); (L.S.)
| | - Liliana Santana
- PMA Unit, Clinica Nuova Ricerca, Via Settembrini 17/h, 47923 Rimini, Italy; (S.d.S.); (M.P.); (A.T.); (L.S.)
| | - Annamaria Maglione
- Gynecology and Obstetrics Department, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (N.S.); (A.M.)
| | - Federica D’Amato
- PMA Unit, Villa Margherita Hospital, Viale di Villa Massimo, 48, 00161 Roma, Italy;
| | - Francesco Perri
- Gastoenterology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza” Hospital, Viale Padre Pio 4, 71013 San Giovanni Rotondo, Italy; (A.V.); (C.P.); (F.P.)
| | - Simone Palini
- Pathophysiology of Reproduction Unit, Ospedale “Cervesi” di Cattolica—AUSL Romagna, Via Ludwig Van Beethoven, 1, 47841 Cattolica, Italy;
| | - Valerio Pazienza
- Gastoenterology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza” Hospital, Viale Padre Pio 4, 71013 San Giovanni Rotondo, Italy; (A.V.); (C.P.); (F.P.)
- Correspondence:
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7
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Mazzini L, Gelati M, Profico DC, Sorarù G, Ferrari D, Copetti M, Muzi G, Ricciolini C, Carletti S, Giorgi C, Spera C, Frondizi D, Masiero S, Stecco A, Cisari C, Bersano E, De Marchi F, Sarnelli MF, Querin G, Cantello R, Petruzzelli F, Maglione A, Zalfa C, Binda E, Visioli A, Trombetta D, Torres B, Bernardini L, Gaiani A, Massara M, Paolucci S, Boulis NM, Vescovi AL. Results from Phase I Clinical Trial with Intraspinal Injection of Neural Stem Cells in Amyotrophic Lateral Sclerosis: A Long-Term Outcome. Stem Cells Transl Med 2019; 8:887-897. [PMID: 31104357 PMCID: PMC6708070 DOI: 10.1002/sctm.18-0154] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 07/12/2018] [Accepted: 02/19/2019] [Indexed: 12/13/2022] Open
Abstract
The main objective of this phase I trial was to assess the feasibility and safety of microtransplanting human neural stem cell (hNSC) lines into the spinal cord of patients with amyotrophic lateral sclerosis (ALS). Eighteen patients with a definite diagnosis of ALS received microinjections of hNSCs into the gray matter tracts of the lumbar or cervical spinal cord. Patients were monitored before and after transplantation by clinical, psychological, neuroradiological, and neurophysiological assessment. For up to 60 months after surgery, none of the patients manifested severe adverse effects or increased disease progression because of the treatment. Eleven patients died, and two underwent tracheotomy as a result of the natural history of the disease. We detected a transitory decrease in progression of ALS Functional Rating Scale Revised, starting within the first month after surgery and up to 4 months after transplantation. Our results show that transplantation of hNSC is a safe procedure that causes no major deleterious effects over the short or long term. This study is the first example of medical transplantation of a highly standardized cell drug product, which can be reproducibly and stably expanded ex vivo, comprising hNSC that are not immortalized, and are derived from the forebrain of the same two donors throughout this entire study as well as across future trials. Our experimental design provides benefits in terms of enhancing both intra‐ and interstudy reproducibility and homogeneity. Given the potential therapeutic effects of the hNSCs, our observations support undertaking future phase II clinical studies in which increased cell dosages are studied in larger cohorts of patients. stem cells translational medicine2019;8:887&897
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Affiliation(s)
- Letizia Mazzini
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Maurizio Gelati
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, Italy.,Fondazione IRCCS Casa Sollievo della Sofferenza, Advanced Therapies Production Unit, San Giovanni Rotondo, Foggia, Italy
| | - Daniela Celeste Profico
- Fondazione IRCCS Casa Sollievo della Sofferenza, Advanced Therapies Production Unit, San Giovanni Rotondo, Foggia, Italy
| | - Gianni Sorarù
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Daniela Ferrari
- Biotechnology and Bioscience Department Bicocca University, Milan, Italy
| | - Massimiliano Copetti
- Fondazione IRCCS Casa Sollievo della Sofferenza, Biostatistic Unit, San Giovanni Rotondo, Foggia, Italy
| | - Gianmarco Muzi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, Italy
| | - Claudia Ricciolini
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, Italy
| | - Sandro Carletti
- Department of Neurosurgery and Neuroscience, "Santa Maria" Hospital, Terni, Italy
| | - Cesare Giorgi
- Department of Neurosurgery and Neuroscience, "Santa Maria" Hospital, Terni, Italy
| | - Cristina Spera
- Department of Neurosurgery and Neuroscience, "Santa Maria" Hospital, Terni, Italy
| | - Domenico Frondizi
- Department of Neurosurgery and Neuroscience, "Santa Maria" Hospital, Terni, Italy
| | - Stefano Masiero
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Alessandro Stecco
- Department of Diagnostic and Interventional Radiology, "Eastern Piedmont" University, "Maggiore della Carità" Hospital, Novara
| | - Carlo Cisari
- Department of Physical Therapy, "Eastern Piedmont" University, "Maggiore della Carità" Hospital, Novara
| | - Enrica Bersano
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Fabiola De Marchi
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Maria Francesca Sarnelli
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Giorgia Querin
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Roberto Cantello
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Francesco Petruzzelli
- Fondazione IRCCS Casa Sollievo della Sofferenza, Obstetrics and Gynaecology Department, San Giovanni Rotondo, Foggia, Italy
| | - Annamaria Maglione
- Fondazione IRCCS Casa Sollievo della Sofferenza, Obstetrics and Gynaecology Department, San Giovanni Rotondo, Foggia, Italy
| | - Cristina Zalfa
- Biotechnology and Bioscience Department Bicocca University, Milan, Italy
| | - Elena Binda
- Fondazione IRCCS Casa Sollievo della Sofferenza, Cancer Stem Cells Unit, San Giovanni Rotondo, Foggia, Italy
| | | | - Domenico Trombetta
- Fondazione IRCCS Casa Sollievo della Sofferenza, Department of Oncology, San Giovanni Rotondo, Foggia, Italy
| | - Barbara Torres
- Fondazione IRCCS Casa Sollievo della Sofferenza, Cytogenetics Unit, San Giovanni Rotondo, Foggia, Italy
| | - Laura Bernardini
- Fondazione IRCCS Casa Sollievo della Sofferenza, Cytogenetics Unit, San Giovanni Rotondo, Foggia, Italy
| | | | - Maurilio Massara
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | - Silvia Paolucci
- Eastern Piedmont University, "Maggiore della Carità" Hospital, Dipartimento di Neurologia, Novara
| | | | - Angelo L Vescovi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, Italy.,Fondazione IRCCS Casa Sollievo della Sofferenza, Advanced Therapies Production Unit, San Giovanni Rotondo, Foggia, Italy.,Biotechnology and Bioscience Department Bicocca University, Milan, Italy
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8
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Maglione A, Borghini G, Aricò P, Borgia F, Graziani I, Colosimo A, Kong W, Vecchiato G, Babiloni F. Evaluation of the workload and drowsiness during car driving by using high resolution EEG activity and neurophysiologic indices. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:6238-41. [PMID: 25571422 DOI: 10.1109/embc.2014.6945054] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sleep deprivation and/or a high workload situation can adversely affect driving performance, decreasing a driver's capacity to respond effectively in dangerous situations. In this context, to provide useful feedback and alert signals in real time to the drivers physiological and brain activities have been increasingly investigated in literature. In this study, we analyze the increase of cerebral workload and the insurgence of drowsiness during car driving in a simulated environment by using high resolution electroencephalographic techniques (EEG) as well as neurophysiologic variables such as heart rate (HR) and eye blinks rate (EBR). The simulated drive tasks were modulated with five levels of increasing difficulty. A workload index was then generated by using the EEG signals and the related HR and EBR signals. Results suggest that the derived workload index is sensitive to the mental efforts of the driver during the different drive tasks performed. Such workload index was based on the estimation the variation of EEG power spectra in the theta band over prefrontal cortical areas and the variation of the EEG power spectra over the parietal cortical areas in alpha band. In addition, results suggested as HR increases during the execution of the difficult driving tasks while instead it decreases at the insurgence of the drowsiness. Finally, the results obtained showed as the EBR variable increases of its values when the insurgence of drowsiness in the driver occurs. The proposed workload index could be then used in a near future to assess on-line the mental state of the driver during a drive task.
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9
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Mazzini L, Gelati M, Profico DC, Sgaravizzi G, Projetti Pensi M, Muzi G, Ricciolini C, Rota Nodari L, Carletti S, Giorgi C, Spera C, Domenico F, Bersano E, Petruzzelli F, Cisari C, Maglione A, Sarnelli MF, Stecco A, Querin G, Masiero S, Cantello R, Ferrari D, Zalfa C, Binda E, Visioli A, Trombetta D, Novelli A, Torres B, Bernardini L, Carriero A, Prandi P, Servo S, Cerino A, Cima V, Gaiani A, Nasuelli N, Massara M, Glass J, Sorarù G, Boulis NM, Vescovi AL. Human neural stem cell transplantation in ALS: initial results from a phase I trial. J Transl Med 2015; 13:17. [PMID: 25889343 PMCID: PMC4359401 DOI: 10.1186/s12967-014-0371-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/23/2014] [Indexed: 01/01/2023] Open
Abstract
Background We report the initial results from a phase I clinical trial for ALS. We transplanted GMP-grade, fetal human neural stem cells from natural in utero death (hNSCs) into the anterior horns of the spinal cord to test for the safety of both cells and neurosurgical procedures in these patients. The trial was approved by the Istituto Superiore di Sanità and the competent Ethics Committees and was monitored by an external Safety Board. Methods Six non-ambulatory patients were treated. Three of them received 3 unilateral hNSCs microinjections into the lumbar cord tract, while the remaining ones received bilateral (n = 3 + 3) microinjections. None manifested severe adverse events related to the treatment, even though nearly 5 times more cells were injected in the patients receiving bilateral implants and a much milder immune-suppression regimen was used as compared to previous trials. Results No increase of disease progression due to the treatment was observed for up to18 months after surgery. Rather, two patients showed a transitory improvement of the subscore ambulation on the ALS-FRS-R scale (from 1 to 2). A third patient showed improvement of the MRC score for tibialis anterior, which persisted for as long as 7 months. The latter and two additional patients refused PEG and invasive ventilation and died 8 months after surgery due to the progression of respiratory failure. The autopsies confirmed that this was related to the evolution of the disease. Conclusions We describe a safe cell therapy approach that will allow for the treatment of larger pools of patients for later-phase ALS clinical trials, while warranting good reproducibility. These can now be carried out under more standardized conditions, based on a more homogenous repertoire of clinical grade hNSCs. The use of brain tissue from natural miscarriages eliminates the ethical concerns that may arise from the use of fetal material. Trial registration EudraCT:2009-014484-39.
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Affiliation(s)
- Letizia Mazzini
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Maurizio Gelati
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Daniela Celeste Profico
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Giada Sgaravizzi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Massimo Projetti Pensi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Gianmarco Muzi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Claudia Ricciolini
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Laura Rota Nodari
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. .,Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Sandro Carletti
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Cesare Giorgi
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Cristina Spera
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Frondizi Domenico
- Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Enrica Bersano
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Francesco Petruzzelli
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Carlo Cisari
- Department of Physical Therapy, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Annamaria Maglione
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Maria Francesca Sarnelli
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Alessandro Stecco
- Department of Diagnostic and Interventional Radiology, "Eastern Piedmont" University, "Maggiore della Carità" Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Giorgia Querin
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Stefano Masiero
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Roberto Cantello
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Daniela Ferrari
- Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Cristina Zalfa
- Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Elena Binda
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. .,Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Alberto Visioli
- Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy.
| | - Domenico Trombetta
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Antonio Novelli
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Barbara Torres
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Laura Bernardini
- IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
| | - Alessandro Carriero
- Department of Diagnostic and Interventional Radiology, "Eastern Piedmont" University, "Maggiore della Carità" Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Paolo Prandi
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Serena Servo
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Annalisa Cerino
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Valentina Cima
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Alessandra Gaiani
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Nicola Nasuelli
- Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Maurilio Massara
- Department of Physical Therapy, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy.
| | - Jonathan Glass
- Department of Neurology Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA.
| | - Gianni Sorarù
- Department of Neuroscience, University of Padova, Via Giustiniani, 2 - 35100, Padova, Italy.
| | - Nicholas M Boulis
- Department of Neurosurgery Emory University, 201 Dowman Dr, Atlanta, GA, 30322, USA.
| | - Angelo L Vescovi
- Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. .,IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. .,Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy. .,Fondazione Cellule Staminali di Terni, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
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Toppi J, De Vico Fallani F, Petti M, Vecchiato G, Maglione A, Cincotti F, Salinari S, Mattia D, Babiloni F, Astolfi L. A new statistical approach for the extraction of adjacency matrix from effective connectivity networks. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:2932-2935. [PMID: 24110341 DOI: 10.1109/embc.2013.6610154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Graph theory is a powerful mathematical tool recently introduced in neuroscience field for quantitatively describing the main properties of investigated connectivity networks. Despite the technical advancements provided in the last few years, further investigations are needed for overcoming actual limitations in the field. In fact, the absence of a common procedure currently applied for the extraction of the adjacency matrix from a connectivity pattern has been leading to low consistency and reliability of ghaph indexes among the investigated population. In this paper we proposed a new approach for adjacency matrix extraction based on a statistical threshold as valid alternative to empirical approaches, extensively used in Neuroscience field (i.e. fixing the edge density). In particular we performed a simulation study for investigating the effects of the two different extraction approaches on the topological properties of the investigated networks. In particular, the comparison was performed on two different datasets, one composed by uncorrelated random signals (null-model) and the other one by signals acquired on a mannequin head used as a phantom (EEG null-model). The results highlighted the importance to use a statistical threshold for the adjacency matrix extraction in order to describe the real existing topological properties of the investigated networks. The use of an empirical threshold led to an erroneous definition of small-world properties for the considered connectivity patterns.
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Borghini G, Vecchiato G, Toppi J, Astolfi L, Maglione A, Isabella R, Caltagirone C, Kong W, Wei D, Zhou Z, Polidori L, Vitiello S, Babiloni F. Assessment of mental fatigue during car driving by using high resolution EEG activity and neurophysiologic indices. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2012:6442-6445. [PMID: 23367404 DOI: 10.1109/embc.2012.6347469] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Driving tasks are vulnerable to the effects of sleep deprivation and mental fatigue, diminishing driver's ability to respond effectively to unusual or emergent situations. Physiological and brain activity analysis could help to understand how to provide useful feedback and alert signals to the drivers for avoiding car accidents. In this study we analyze the insurgence of mental fatigue or drowsiness during car driving in a simulated environment by using high resolution EEG techniques as well as neurophysiologic variables such as heart rate (HR) and eye blinks rate (EBR). Results suggest that it is possible to introduce a EEG-based cerebral workload index that it is sensitive to the mental efforts of the driver during drive tasks of different levels of difficulty. Workload index was based on the estimation of increase of EEG power spectra in the theta band over prefrontal areas and the simultaneous decrease of EEG power spectra over parietal areas in alpha band during difficult drive conditions. Such index could be used in a future to assess on-line the mental state of the driver during the drive task.
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Affiliation(s)
- G Borghini
- IRCCS Fondazione Santa Lucia, via Ardeatina 306, Rome, Italy
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12
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Ress C, Adami A, Lorenzelli L, Collini C, Tindiani A, Maglione A, Soncini G. Development and characterization of a multiparametric microsensor for yeast cell growth monitoring. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.proche.2009.07.264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maglione A, Di Giorgio G. [Successful outcome of pregnancy and vaginal delivery in a heart transplant recipient]. Minerva Ginecol 2003; 55:537-9. [PMID: 14676744] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The case is reported of a patient subjected 4 years before conception to a heart transplant for biventricular hypertrophic myocardiopathy. The woman undertook and successfully concluded a pregnancy without complication and at the 37th week delivered spontaneously and vaginally. Four years after the birth both the woman and the newborn had suffered no after-effects. The choice and possibility for a transplant patient to face up to pregnancy and childbirth depend essentially, from a medical point of view, on her general state of health and on the presence or otherwise of other associated pathologies, in addition to the will of the patient to tackle the risks attached to her transplanted condition. It is therefore fundamental, in all cases, for such patients to undergo clear and detailed preconceptional counseling.
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Affiliation(s)
- A Maglione
- Divisione di Ginecologia ed Ostetricia, Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo, Foggia, Italy
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Abstract
Only five pregnant women with multiple myeloma have been reported in literature. We present the case of one woman with multiple myeloma diagnosed in early pregnancy, who decided to postpone therapy until after delivery. A cesarean section was performed at the 34th week due to the progression of the disease and a normal healthy baby was delivered.
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Affiliation(s)
- Annamaria Maglione
- Department of Obstetrics and Gynecology, Hospital Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo, 71013 Foggia, Italy.
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15
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D'Arena G, Musto P, Cascavilla N, Minervini MM, Di Giorgio G, Maglione A, Carotenuto M. Inability of activated cord blood T lymphocytes to perform Th1-like and Th2-like responses: implications for transplantation. J Hematother Stem Cell Res 1999; 8:381-5. [PMID: 10634175 DOI: 10.1089/152581699320135] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cytokines secreted by alloreactive donor T cells play a crucial role in the pathogenesis of both acute and chronic GvHD, a complication of allogeneic hematopoietic transplants that occurs at a lower incidence and severity when human umbilical cord blood (HUCB) is used. Our five-dimensional flow cytometric study performed on 20 HUCB and 20 peripheral blood (PB) samples from healthy adults was focused on the Th1/Th2 cytokine profile of activated HUCB T cells. Lymphocytes of all samples were stimulated by specific mitogens, and cytokine secretion was blocked at the cytoplasmic level. CD4+ and CD8+ cells were then analyzed for surface expression of the very early human activation antigen CD69 and for IFN-gamma and IL-4 intracellular production as expression of Th1-like and Th2-like T cell cytokine response, respectively. HUCB T lymphocytes were shown to be unable to perform both a Th1-like and Th2-like response, as compared with normal PB T cells. However, all lymphocytes from both sources were normally activated, as indicated by regular expression of the CD69 molecule. These data suggest that the low response of HUCB T lymphocytes to mitogens may be responsible for the decreased incidence of acute and chronic GvHD and provide possible explanations for the clinical results in HUCB transplantation.
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Affiliation(s)
- G D'Arena
- Division of Hematology, IRCSS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
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Abstract
BACKGROUND After penetrating keratoplasty, many patients have high ametropia, which is difficult to correct with contact lenses. We used excimer laser in situ keratomileusis (LASIK) on four eyes of four consecutive patients that had previous penetrating keratoplasty in an attempt to correct myopia and astigmatism. METHODS We used an automated microkeratome to make a lamellar flap and a Chiron Technolas 193-nm argon fluoride excimer laser. The laser was programmed for the desired myopic and astigmatic correction and a multizone ablation was applied to the central stroma. The corneal flap was placed back into position without sutures. RESULTS After surgery, all corneas remained clear with no dislocation of the flap, and the edge of the flap was difficult to visualize after a few days. The average preoperative spherical equivalent was -10.75 diopters (D) (range -5.00 to -14.25 D) which decreased to an average -2.37 D (range -0.75 to -5.00 D) at a mean follow-up of 7 months (range 6 to 10.5 mos). The average preoperative astigmatism was -2.87 D (range -1.00 to -5.00 D) which changed to an average of -3.50 D. Uncorrected visual acuity was improved and spectacle-corrected visual acuity was preserved without changes. CONCLUSION LASIK can effectively reduce myopia after penetrating keratoplasty.
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Affiliation(s)
- E Arenas
- Ophthalmology Service, Fundación Santafé de Bogotá, Bogotá, Colombia
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Paparella P, Zullo MA, Astorri AL, Bondì M, Maglione A, Oliva C, Mancuso Bondì S. [Treatment in the event of antibiotic prophylaxis failure in gynecologic surgery. A retrospective study of 20 cases]. Minerva Ginecol 1994; 46:499-503. [PMID: 7984331] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A retrospective study was performed of the type of treatment used in 20 patients undergoing gynecological surgery in whom antibiotic prophylaxis with Mezlocillin (2 g i.v.) had failed. Patients were subdivided into three groups: A) Initial therapy with Mezlocillin (8 patients, 2 g/die i.m.) or Cefotetan (2 patients, 2 g/die i.m.) and subsequent addition of Gentamicin (8 patients, 240 mg/die i.m.) or Tobramycin (2 patients, 200 mg/die i.m.) and subsequently Metronidazole (7 patients, 1.5 g/die per os). B) Therapy with Imipenem/Cilastatin (6 patients, 1.5 g/die i.m.). C) Therapy with Imipenem/Cilastatin (4 patients, 1.5 g/die i.m.) after a variety of antibiotics: Cotrimoxazole (Trimethoprim 160 mg/die and sulphamethoxazole 800 mg/die per os), Pefloxacin (800 mg/die per os), Cefotetan (2 g/die i.m.) and Mezlocillin (2 g/die i.m.). Time taken to lower temperature was shorter in Group B (3.5 days) compared to Group A (6.8 days) and Group C (10 days). Postoperative hospital stay was also shorter in Group B (9 days) compared to Group C (16.5 days) and Group A (11.1 days). The immediate administration of an antibiotic active against Gram+ and Gram- germs, aerobes and anaerobes is therefore useful in the event of failure of antibiotic prophylaxis, rather than the use in succession of associations of antibiotics with a limited spectrum.
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Affiliation(s)
- P Paparella
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma
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Piccolboni D, de Vincentiis L, Guerriero G, Belli A, Romano L, Zofra S, Maglione A, de Vincentiis E. Nutritional and hormonal effects of biosynthetic human growth hormone in surgical patients on total parenteral nutrition. Nutrition 1991; 7:177-84. [PMID: 1802206] [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: 12/28/2022]
Abstract
The anabolic effects of biosynthetic human growth hormone (BHGH) were tested on 30 patients, aged 37-68 yr, divided into four groups: group 1 received surgery plus total parenteral nutrition (TPN) plus BHGH, group 2 received just surgery and TPN, Group 3 received TPN and BHGH, and group 4 received just TPN. TPN was given as an all-in-one formula (glucose 4.7 g.kg.-1day-1, amino acids 1.2 g.kg-1.day-1, lipids 0.7 g.kg-1.day-1, electrolytes and trace elements. BHGH (0.25 IU.kg-1.day-1) or placebo were administered subcutaneously at 0800 for 10 days. Nitrogen and phosphorous balance, as well as the common plasma nutritional markers (transferrin, albumin, prealbumin), triglycerides, apolipoprotein B, insulin, and cortisol were evaluated daily. Urinary creatinine loss was evaluated on days 3, 7, and 10. Cumulative nitrogen balance was better in group 1 (-16.1 +/- 3.2 g N2) than in group 2 (-33.7 +/- 4.6 g N2) (P less than 0.01), whereas the difference was nonsignificant in groups 3 and 4. Phosphorous balance and creatinine excretion paralleled nitrogen balance. Plasma markers were not significantly improved in group 1 compared with group 2; however, they were significantly better in group 3 than in group 4. Lipids were better metabolized in the BHGH-treated groups. Insulin was increased in both groups 1 and 3, whereas cortisol did not rise after surgical stress, probably because of BHGH administration. A positive effect of BHGH on nutritional status and hormonal background is suggested by these data.
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Affiliation(s)
- D Piccolboni
- Department of General Surgery, Monaldi Hospital, Naples, Italy
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Moisseiev J, Jerdan JA, Dyer K, Maglione A, Glaser BM. Retinal pigment epithelium cells can influence endothelial cell plasminogen activators. Invest Ophthalmol Vis Sci 1990; 31:1070-8. [PMID: 2354910] [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: 12/31/2022] Open
Abstract
Endothelial cells from both human retinal microvessels (HME) and fetal bovine aortic endothelium (FBAE) were grown in aggregate cultures alone, or with either retinal pigment epithelium (RPE) cells or fibroblasts. The levels of plasminogen activator (PA) and plasminogen activator inhibitor (PAI) in the conditioned media of the various aggregate types were measured. High PA levels were detected in the conditioned medium of pure endothelial cell aggregates (equal to 140% and 124% of urokinase control for HME and FBAE, respectively), and high PAI levels were associated with pure RPE aggregates (inhibiting 93% of the urokinase control). The conditioned medium of pure fibroblast aggregates had very low levels of either PA or PAI. When RPE cells were aggregated with FBAE or HME cells into mixed (heterogenous) aggregates, the PA measured in the conditioned medium was equal to 22% and 30% of the urokinase control, respectively. The PA level in the conditioned medium of mixed fibroblast-FBAE cell aggregates was higher, 104% of the control, and the difference was statistically significant (P less than 0.001). Co-incubation of pure RPE aggregates with pure FBAE aggregates or with pure HME aggregates resulted in PA activity in the conditioned medium that was equal to 110% and 96% of the control, respectively. The PA level found when pure FBAE cell aggregates were co-incubated with pure fibroblast aggregates was higher, 134% of the control, and the difference was statistically significant (P less than 0.001). Our results indicate that RPE cells can reduce endothelial cell PA, probably through both direct contact between the cells and PAI production. Fibroblasts did not have this influence on endothelial cell PA.
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Affiliation(s)
- J Moisseiev
- Center for Vitreoretinal Research, Wilmer Ophthalmological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Romano L, Zofra S, Imperato G, Adorno V, Maglione A. [Interference of digoxin-like immunoreactive substance in the analysis of digoxin in pulmonary pathology: preliminary results]. Arch Monaldi 1985; 40:157-64. [PMID: 3842060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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