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Pellegrino R, Paganelli R, Di Iorio A, Bandinelli S, Mussi C, Sparvieri E, Volpato S, Tanaka T, Ferrucci L. Lack of Immune Resilience Negatively Affects Physical Resilience: Results From the InCHIANTI Follow-Up Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae076. [PMID: 38457361 PMCID: PMC11003532 DOI: 10.1093/gerona/glae076] [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: 09/22/2023] [Indexed: 03/10/2024] Open
Abstract
There is consistent evidence that immune response declines with aging, with wide interindividual variability and a still unclear relationship with the development of frailty. To address this question, we assessed the role of immune resilience (capacity to restore immune functions), operationalized as the neutrophil-to-lymphocytes ratio (NL-ratio) and monocytes-to-lymphocytes ratio (ML-ratio), in the pathway that from robust status shifts to pre-frailty and frailty, and finally to death. The InCHIANTI study enrolled representative samples from the registry lists of 2 towns in Tuscany, Italy. Baseline data were collected in 1998, with follow-up visits every 3 years. The 1 453 participants enrolled were assessed and followed for lifestyle, clinical condition, physical performance, clinical, and physiological measures. For the purpose of this analysis, we used only 1 022 subjects aged 65 or older at baseline. Participants in the 3 highest deciles of distribution for NL-ratio (>2.44) were more likely to experience a transition from robust to pre-frail, and to overt frailty status. Moreover, NL-ratio (tenth decile > 3.53) and ML-ratio (tenth decile > 2.02) were both predictors of mortality. These results were independent of chronological age, sex, comorbidities, and chronic low-grade inflammation assessed by high sensitivity C-reactive protein measurement. The 2 leucocytes-derived ratios, NL-ratio and ML-ratio, represent markers of immune resilience and predict changes in physical resilience and mortality. These biomarkers are inexpensive because they are based on data routinely collected in clinical practice and can be used to assess the risk of frailty progression and mortality. Clinical Trials Registration Number: NCT01331512.
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Affiliation(s)
- Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, Lugano–Pazzallo, Switzerland
- Santa Chiara Institute, Lecce, Italy
| | - Roberto Paganelli
- Department of Internal Medicine, Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Angelo Di Iorio
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio”, Chieti–Pescara, Italy
| | | | - Chiara Mussi
- Department of Biomedical, Metabolic, and Neural Sciences, Center for Gerontological Evaluation and Research, Modena e Reggio Emilia University, Modena, Italy
| | | | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Toshiko Tanaka
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
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Milic J, Renzetti S, Morini D, Motta F, Carli F, Menozzi M, Cuomo G, Mancini G, Simion M, Romani F, Spadoni A, Baldisserotto I, Barp N, Diazzi C, Mussi C, Mussini C, Rochira V, Calza S, Guaraldi G. Bone Mineral Density and Trabecular Bone Score Changes throughout Menopause in Women with HIV. Viruses 2023; 15:2375. [PMID: 38140615 PMCID: PMC10747369 DOI: 10.3390/v15122375] [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: 05/13/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE The objectives of this study were to describe the trajectories of bone mineral density (BMD) and trabecular bone score (TBS) changes throughout pre-menopause (reproductive phase and menopausal transition) and post-menopause (early and late menopause) in women with HIV (WWH) undergoing different antiretroviral therapies (ARTs) and explore the risk factors associated with those changes. METHODS This was an observational longitudinal retrospective study in WWH with a minimum of two DEXA evaluations comprising BMD and TBS measurements, both in the pre-menopausal and post-menopausal periods. Menopause was determined according to the STRAW+10 criteria, comprising four periods: the reproductive period, menopausal transition, and early- and late-menopausal periods. Mixed-effects models were fitted to estimate the trajectories of the two outcomes (BMD and TBS) over time. Annualized lumbar BMD and TBS absolute and percentage changes were calculated in each STRAW+10 time window. A backward elimination procedure was applied to obtain the final model, including the predictors that affected the trajectories of BMD or TBS over time. RESULTS A total of 202 WWH, all Caucasian, were included. In detail, 1954 BMD and 195 TBS data were analyzed. The median number of DEXA evaluations per woman was 10 (IQR: 7, 12). The median observation periods per patient were 12.0 years (IQR = 8.9-14.4) for BMD and 6.0 years (IQR: 4.3, 7.9) for TBS. The prevalence of osteopenia (63% vs. 76%; p < 0.001) and osteoporosis (16% vs. 36%; p < 0.001) increased significantly between the pre-menopausal and post-menopausal periods. Both BMD (1.03 (±0.14) vs. 0.92 (±0.12) g/cm2; p < 0.001) and TBS (1.41 (IQR: 1.35, 1.45) vs. 1.32 (IQR: 1.28, 1.39); p < 0.001) decreased significantly between the two periods. The trend in BMD decreased across the four STRAW+10 periods, with a slight attenuation only in the late-menopausal period when compared with the other intervals. The TBS slope did not significantly change throughout menopause. The delta mean values of TBS in WWH were lower between the menopausal transition and reproductive period compared with the difference between menopause and menopausal transition. CONCLUSIONS Both BMD and TBS significantly decreased over time. The slope of the change in BMD and TBS significantly decreased in the menopausal transition, suggesting that this period should be considered by clinicians as a key time during which to assess bone health and modifiable risk factors in WWH.
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Affiliation(s)
- Jovana Milic
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, 41121 Modena, Italy;
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
| | - Stefano Renzetti
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Denise Morini
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84121 Salerno, Italy;
| | - Federico Motta
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
| | - Federica Carli
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Gianluca Cuomo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Giuseppe Mancini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Mattia Simion
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Federico Romani
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Anna Spadoni
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Irene Baldisserotto
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Nicole Barp
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Chiara Diazzi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (C.D.); (V.R.)
| | - Chiara Mussi
- Department of Biomedical and Metabolic Sciences and Neuroscience, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (C.D.); (V.R.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, 41126 Modena, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, 41121 Modena, Italy;
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy; (F.M.); (C.M.)
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, 41121 Modena, Italy; (F.C.); (M.M.); (G.C.); (G.M.); (M.S.); (F.R.); (A.S.); (I.B.); (N.B.)
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Gandossi CM, Zambon A, Ferrara MC, Tassistro E, Castoldi G, Colombo F, Mussi C, Martini E, Sergi G, Coin A, Zatti G, Trevisan C, Volpato S, Ungar A, Bellelli G. Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study. Aging Clin Exp Res 2023; 35:2499-2506. [PMID: 37542601 PMCID: PMC10628048 DOI: 10.1007/s40520-023-02522-8] [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: 05/30/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND This study analyzes the effect of frailty and Post-Operative Delirium (POD) on the functional status at hospital discharge and at 4-month follow-up in patients with hip fracture (HF). METHODS Multicenter prospective observational study of older patients with HF admitted to 12 Italian Orthogeriatric centers (July 2019-August 2022). POD was assessed using the 4AT. A 26-item Frailty Index (FI) was created using data collected on admission. The outcome measures were Cumulated Ambulation Score (CAS) ≤ 2 at discharge and a telephone-administered CAS ≤ 2 after 4 months. Poisson regression models were used to assess the effect of frailty and POD on outcomes. RESULTS 984 patients (median age 84 years, IQR = 79-89) were recruited: 480 (48.7%) were frail at admission, 311 (31.6%) developed POD, and 158 (15.6%) had both frailty and POD. In a robust Poisson regression, frailty alone (Relative Risk, RR = 1.56, 95% Confidence Intervals, CI 1.19-2.04, p = 0.001) and its combination with POD (RR = 2.57, 95% CI 2.02-3.26, p < 0.001) were associated with poor functional status at discharge. At 4-month follow-up, the combination of frailty with POD (RR 3.65, 95% CI 1.85-7.2, p < 0.001) increased the risk of poor outcome more than frailty alone (RR 2.38, 95% CI 1.21-4.66, p < 0.001). CONCLUSIONS POD development exacerbates the negative effect that frailty exerts on functional outcomes in HF patients.
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Affiliation(s)
| | - Antonella Zambon
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
- Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Elena Tassistro
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Centre), School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Giuseppe Castoldi
- Orthopedic Unit, Carate Brianza Hospital, ASST Brianza, Vimercate, MB, Italy
| | - Francesca Colombo
- Orthopedic Unit, Carate Brianza Hospital, ASST Brianza, Vimercate, MB, Italy
| | - Chiara Mussi
- Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Emilio Martini
- Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Sergi
- Department of Medicine, Geriatrics Unit, University of Padua, Padua, Italy
| | - Alessandra Coin
- Department of Medicine, Geriatrics Unit, University of Padua, Padua, Italy
| | - Giovanni Zatti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Orthopedic Unit, IRCCS S. Gerardo Hospital, Monza, Italy
| | - Caterina Trevisan
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Orthogeriatric Unit, Arcispedale S. Anna, University Hospital of Ferrara, Ferrara, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Orthogeriatric Unit, Arcispedale S. Anna, University Hospital of Ferrara, Ferrara, Italy
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, University of Florence and AOU Careggi, Florence, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
- Orthogeriatric Unit, IRCCS San Gerardo Hospital, Monza, Italy.
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Bertolotti M, Franchi C, Lancellotti G, Mandelli S, Mussi C. Predicting hospital readmissions in older patients with heart failure with advanced bioinformatics tools: focus on the role of vulnerability and frailty. Intern Emerg Med 2022; 17:2403-2405. [PMID: 36149527 PMCID: PMC9652160 DOI: 10.1007/s11739-022-03099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Marco Bertolotti
- Division of Geriatrics, Department of Biomedical, Metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Ospedale Civile di Baggiovara, Università di Modena e Reggio Emilia, Via Giardini, 1355, 41026, Modena, MO, Italy.
| | - Carlotta Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giulia Lancellotti
- Division of Geriatrics, Department of Biomedical, Metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Ospedale Civile di Baggiovara, Università di Modena e Reggio Emilia, Via Giardini, 1355, 41026, Modena, MO, Italy
| | - Sara Mandelli
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Mussi
- Division of Geriatrics, Department of Biomedical, Metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Ospedale Civile di Baggiovara, Università di Modena e Reggio Emilia, Via Giardini, 1355, 41026, Modena, MO, Italy
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Trimarco V, Izzo R, Zanforlin A, Tursi F, Scarpelli F, Santus P, Pennisi A, Pelaia G, Mussi C, Mininni S, Messina N, Marazzi G, Maniscalco M, Mallardo M, Fazio G, Diana A, Capra Marzani M, Aloè T, Mone P, Trimarco B, Santulli G. Endothelial dysfunction in long-COVID: New insights from the nationwide multicenter LINCOLN Study. Pharmacol Res 2022; 185:106486. [PMID: 36206959 PMCID: PMC9531936 DOI: 10.1016/j.phrs.2022.106486] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Valentina Trimarco
- Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy,Corresponding author
| | | | | | | | | | | | - Girolamo Pelaia
- Department of Health Science, Magna Graecia University, Catanzaro, Italy
| | - Chiara Mussi
- Department of Biomedical and Metabolic Sciences and Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Mininni
- Associazione Scientifica Interdisciplinare Aggiornamento Medico (ASIAM), Florence, Italy
| | | | | | | | | | | | | | | | | | - Pasquale Mone
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - Bruno Trimarco
- Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University, Naples, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy,Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA,Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY, USA,Correspondence to: Departments of Medicine and Molecular Phaarmacology, Albert Einstein College of Medicine, New York, NY
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McDermott R, van Tilburg C, Lin J, Kummar S, Tan D, Albert C, Berlin J, Lassen U, Doz F, Geoerger B, Mascarenhas L, Federman N, Norenberg R, Dima L, Mussi C, De La Cuesta E, Laetsch T, Hong D, Drilon A. 463P Efficacy and safety of larotrectinib in a pooled analysis of patients (Pts) with tropomyosin receptor kinase (TRK) fusion cancer with an extended follow-up. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.592] [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: 11/01/2022] Open
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La Porta F, Lullini G, Caselli S, Valzania F, Mussi C, Tedeschi C, Pioli G, Bondavalli M, Bertolotti M, Banchelli F, D'Amico R, Vicini R, Puglisi S, Clerici PV, Chiari L. Efficacy of a multiple-component and multifactorial personalized fall prevention program in a mixed population of community-dwelling older adults with stroke, Parkinson's Disease, or frailty compared to usual care: The PRE.C.I.S.A. randomized controlled trial. Front Neurol 2022; 13:943918. [PMID: 36119666 PMCID: PMC9475118 DOI: 10.3389/fneur.2022.943918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fall risk in the elderly is a major public health issue due to the injury-related consequences and the risk of associated long-term disability. However, delivering preventive interventions in usual clinical practice still represents a challenge. Aim To evaluate the efficacy of a multiple-component combined with a multifactorial personalized intervention in reducing fall rates in a mixed population of community-dwelling elderly compared to usual care. Design Randomized Controlled Trial (NCT03592420, clinicalTrials.gov). Setting Outpatients in two Italian centers. Population 403 community-dwelling elderly at moderate-to-high fall risk, including subjects with Parkinson's Disease and stroke. Methods After the randomization, the described interventions were administered to the intervention group (n = 203). The control group (n = 200) received usual care and recommendations to minimize fall risk factors. In addition, each participant received a fall diary, followed by 12 monthly phone calls. The primary endpoint was the total number of falls in each group over 12 months, while the secondary endpoints were other fall-related indicators recorded at one year. In addition, participants' functioning was assessed at baseline (T1) and 3-month (T3). Results 690 falls were reported at 12 months, 48.8% in the intervention and 51.2% in the control group, with 1.66 (± 3.5) and 1.77 (± 3.2) mean falls per subject, respectively. Subjects with ≥ 1 fall and ≥2 falls were, respectively, 236 (58.6%) and 148 (36.7%). No statistically significant differences were observed between groups regarding the number of falls, the falling probability, and the time to the first fall. According to the subgroup analysis, no significant differences were reported. However, a statistically significant difference was found for the Mini-BESTest (p = 0.004) and the Fullerton Advanced Balance Scale (p = 0.006) for the intervention group, with a small effect size (Cohen's d 0.26 and 0.32, respectively), at T1 and T3 evaluations. Conclusions The intervention was ineffective in reducing the number of falls, the falling probability, and the time to the first fall at 12 months in a mixed population of community-dwelling elderly. A significant improvement for two balance indicators was recorded in the intervention group. Future studies are needed to explore different effects of the proposed interventions to reduce falls and consequences.
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Affiliation(s)
- Fabio La Porta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giada Lullini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- *Correspondence: Giada Lullini
| | - Serena Caselli
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Franco Valzania
- Azienda Ospedaliera Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Chiara Mussi
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Claudio Tedeschi
- Azienda Ospedaliera Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Giulio Pioli
- Azienda Ospedaliera Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | - Marco Bertolotti
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Federico Banchelli
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Unit of Statistical and Methodological Support for Clinical Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D'Amico
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Unit of Statistical and Methodological Support for Clinical Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Vicini
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Unit of Statistical and Methodological Support for Clinical Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Puglisi
- Rehabilitation Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, Bologna, Italy
- Health Sciences and Technologies Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
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Izzo R, Trimarco V, Mone P, Aloè T, Capra Marzani M, Diana A, Fazio G, Mallardo M, Maniscalco M, Marazzi G, Messina N, Mininni S, Mussi C, Pelaia G, Pennisi A, Santus P, Scarpelli F, Tursi F, Zanforlin A, Santulli G, Trimarco B. Combining L-Arginine with vitamin C improves long-COVID symptoms: The LINCOLN Survey. Pharmacol Res 2022; 183:106360. [PMID: 35868478 PMCID: PMC9295384 DOI: 10.1016/j.phrs.2022.106360] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Recent evidence suggests that oxidative stress and endothelial dysfunction play critical roles in the pathophysiology of COVID-19 and Long-COVID. We hypothesized that a supplementation combining L-Arginine (to improve endothelial function) and Vitamin C (to reduce oxidation) could have favorable effects on Long-COVID symptoms. METHODS We designed a survey (LINCOLN: L-Arginine and Vitamin C improves Long-COVID), assessing several symptoms that have been associated with Long-COVID to be administered nationwide to COVID-19 survivors; the survey also included effort perception, measured using the Borg scale. Patients receiving the survey were divided in two groups, with a 2:1 ratio: the first group included patients that received L-Arginine + Vitamin C, whereas the second group received a multivitamin combination (alternative treatment). RESULTS 1390 patients successfully completed the survey. Following a 30-day treatment in both groups, the survey revealed that patients in the L-Arginine + Vitamin C treatment arm had significantly lower scores compared to patients who had received the multivitamin combination. There were no other significant differences between the two groups. When examining effort perception, we observed a significantly lower value (p < 0.0001) in patients receiving L-Arginine + Vitamin C compared to the alternative-treatment arm. CONCLUSIONS Our survey indicates that the supplementation with L-Arginine + Vitamin C has beneficial effects in Long-COVID, in terms of attenuating its typical symptoms and improving effort perception.
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Affiliation(s)
- Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Valentina Trimarco
- Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University, Naples, Italy
| | - Pasquale Mone
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | | | | | | | | | | | | | | | | | - Simone Mininni
- Associazione Scientifica Interdisciplinare Aggiornamento Medico (ASIAM), Florence, Italy
| | - Chiara Mussi
- Department of Biomedical and Metabolic Sciences and Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
| | - Girolamo Pelaia
- Department of Health Science, Magna Graecia University, Catanzaro, Italy
| | | | | | | | | | | | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy; Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA.
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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9
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Ungar A, Ceccofiglio A, Mussi C, Bo M, Rivasi G, Rafanelli M, Martone AM, Bellelli G, Nicosia F, Riccio D, Boccardi V, Tonon E, Curcio F, Landi F, Abete P, Mossello E. Truly unexplained falls after evaluation for syncope: A new diagnostic entity with severe prognosis. Eur J Intern Med 2022; 98:93-97. [PMID: 35172944 DOI: 10.1016/j.ejim.2022.02.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare one-year mortality risk associated with syncope and unexplained fall in older adults with dementia. METHODS 522 patients (aged >65 years) with dementia and history of transient loss of consciousness and/or unexplained falls were evaluated. The diagnosis of syncope was based on European Society of Cardiology guidelines. A "Syncopal Fall" was defined in patients with an initial clinical presentation of unexplained fall, but a final diagnosis of syncope after complete assessment. A "Truly Unexplained Fall" was defined in patients with an initial clinical presentation of unexplained fall, in whom a diagnosis of syncope had been excluded after the diagnostic work-up. One-year follow-up was assessed by phone interview. RESULTS Follow-up data were available for 501 participants (mean age 83 ± 6 years, 65% female). After a mean follow-up of 324 ± 93 days, death from any cause was reported in 188 participants (24%). Advanced age, male sex, cognitive and functional impairment were associated with a higher mortality rate. Patients with "Truly Unexplained Falls" had a higher mortality risk compared with syncope and "Syncopal Fall". A diagnosis of "Truly Unexplained Falls" remained an independent predictor of one-year all-cause mortality in multivariate model. CONCLUSIONS We propose the novel diagnostic category of "Truly Unexplained Fall", resulting from the application of syncope guidelines to subjects with unexplained falls. This condition in older adults with dementia is a predictor of one-year all-cause mortality. For this new high risk profile, we advice a comprehensive geriatric assessment focused on risk factors for fall, aimed at a possible improvement of prognosis.
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Affiliation(s)
- Andrea Ungar
- Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy.
| | - Alice Ceccofiglio
- Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy
| | - Chiara Mussi
- Centro di Valutazione e Ricerca Gerontologica, Chair of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Bo
- SCDU Geriatria e Malattie Metaboliche dell'Osso, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Giulia Rivasi
- Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy
| | - Martina Rafanelli
- Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giuseppe Bellelli
- Department of Health Sciences, University of Milano Bicocca and Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - Franco Nicosia
- Medicine and Geriatric Unit - Spedali Civili of Brescia, Brescia, Italy
| | - Daniela Riccio
- Geriatric Department, SS. Trinità Hospital, Cagliari, Italy
| | - Virginia Boccardi
- Department of Medicine, Institute of Gerontology and Geriatrics, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Francesco Curcio
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Enrico Mossello
- Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy
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10
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Manni B, Federzoni L, Zucchi P, Mussi C, Inzitari M, Carda CA, Fabbo A, Morandi A. Prevalence and management of delirium in community dwelling older people with dementia referred to a memory clinic. Aging Clin Exp Res 2021; 33:2243-2250. [PMID: 33211247 DOI: 10.1007/s40520-020-01753-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/24/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Our aim was to measure the prevalence of delirium, its clinical features, and outcomes in older patients referred to a memory clinic. METHODS A retrospective cohort study of 109 older outpatients with delirium referred to a memory clinic with a home care service. Delirium was diagnosed using the confusion assessment method and dementia with the DSM-5 criteria. We collected information on cognitive and functional status, mortality, institutionalization, and hospitalization during 6 months following the delirium episode. RESULTS Delirium prevalence was 3.6%, mostly of hyperactive type. Delirium worsened functional (ADL 2.95 ± 1.95 vs. 2.16 ± 1.84) and cognitive (MMSE 13.88 ± 8.96 vs.11.0 ± 9.49) status after 6 months compared to the baseline. The mortality rate was 29.4%, and 28.3% were admitted to a long-term facility after the episode of delirium. Of these patients, more than half were hospitalized during the follow-up. Of the 109 patients with delirium, 85 were managed at home and 24 were hospitalized. Patients who were hospitalized had more severe behavioral symptoms during the delirium episode. There was no difference in mortality and institutionalization according to the home or hospital management. CONCLUSIONS This retrospective cohort study adds novel information to the existing literature of an understudied setting and population. The study supports the need to further investigate the feasibility and efficacy of the hospital at home models for the prevention and management of delirium in a high-risk population.
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Affiliation(s)
- Barbara Manni
- Cognitive Disorders and Dementia Unit, Modena Health Authority and Services, Primary Care, Modena, Italy
| | - Lucia Federzoni
- Cognitive Disorders and Dementia Unit, Modena Health Authority and Services, Primary Care, Modena, Italy
| | - Patrizia Zucchi
- Cognitive Disorders and Dementia Unit, Modena Health Authority and Services, Primary Care, Modena, Italy
| | - Chiara Mussi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Inzitari
- REFiT Bcn Research Group, ParcSanitari Pere Virgili and Valld'Hebrón Institute of Research, Barcelona, Spain
| | - Cristina Arnal Carda
- REFiT Bcn Research Group, ParcSanitari Pere Virgili and Valld'Hebrón Institute of Research, Barcelona, Spain
| | - Andrea Fabbo
- Cognitive Disorders and Dementia Unit, Modena Health Authority and Services, Primary Care, Modena, Italy
| | - Alessandro Morandi
- REFiT Bcn Research Group, ParcSanitari Pere Virgili and Valld'Hebrón Institute of Research, Barcelona, Spain.
- Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital, Hospital Ancelle, Via Aselli 14, 26100, Cremona, Italy.
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11
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Franchi C, Lancellotti G, Bertolotti M, Di Salvatore S, Nobili A, Mannucci PM, Mussi C, Ardoino I. Use of Lipid-Lowering Drugs and Associated Outcomes According to Health State Profiles in Hospitalized Older Patients. Clin Interv Aging 2021; 16:1251-1264. [PMID: 34239298 PMCID: PMC8259728 DOI: 10.2147/cia.s305933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/09/2021] [Accepted: 05/10/2021] [Indexed: 12/21/2022] Open
Abstract
Objective To assess how lipid-lowering drugs (LLDs) are administered in the hospitalized patients aged 65 and older and their association with clinical outcomes according to their health-related profiles. Design This is a retrospective study based on data from REPOSI (REgistro POliterapie SIMI - Italian Society of Internal Medicine) register, an Italian network of internal medicine hospital wards. Setting and Participants A total of 4642 patients with a mean age of 79 years enrolled between 2010 and 2018. Methods Socio-demographic characteristics, functional abilities, cognitive skills, laboratory parameters and comorbidities were used to investigate the health state profiles by using multiple correspondence analysis and clustering. Logistic regression was used to assess whether LLD prescription was associated with patients' health state profiles and with short-term mortality. Results Four clusters of patients were identified according to their health state: two of them (Cluster III and IV) were the epitome of frailty conditions with poor short-term outcomes, whereas the others included healthier patients. The average prevalence of LLD use was 27.6%. The lowest prevalence was found among the healthier patients in Cluster I and among the oldest frail patients with severe functional and cognitive impairment in Cluster IV. The highest prevalence was among multimorbid patients in Cluster III (OR=4.50, 95% CI=3.76-5.38) characterized by a high cardiovascular risk. Being prescribed with LLDs was associated with a lower 3-month mortality, even after adjusting for cluster assignment (OR=0.59; 95% CI = 0.44-0.80). Conclusion The prevalence of LLD prescription was low and in overall agreement with guideline recommendations and with respect to patients' health state profiles.
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Affiliation(s)
- Carlotta Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giulia Lancellotti
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Marco Bertolotti
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Simona Di Salvatore
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Alessandro Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Mussi
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Ilaria Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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12
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De Vincentis A, Vespasiani-Gentilucci U, Costanzo L, Novella A, Cortesi L, Nobili A, Mannucci PM, Incalzi RA, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Mattioli I, Biolo G, Zanetti M, Bartelloni G, Vanoli M, Grignani G, Pulixi EA, Lupattelli G, Bianconi V, Alcidi R, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Beneduce V, Cacioppo F, Corrao S, Natoli G, Mularo S, Raspanti M, Zoli M, Matacena ML, Orio G, Magnolfi E, Serafini G, Simili A, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Fabio G, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Leoni S, Di Mauro AD, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Pontremoli R, Beccati V, Nobili G, Leoncini G, Anastasio L, Carbone M, Cipollone F, Guagnano MT, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Giorgi A, Gracin C, Zuccalà G, D'Aurizio G, Romanelli G, Marengoni A, Volpini A, Lucente D, Picardi A, Gentilucci UV, Bellelli G, Corsi M, Antonucci C, Sidoli C, Principato G, Arturi F, Succurro E, Tassone B, Giofrè F, Serra MG, Bleve MA, Brucato A, De Falco T, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Prandini T, Manfredini R, Fabbian F, Boari B, De Giorgi A, Tiseo R, Paolisso G, Rizzo MR, Catalano C, Borghi C, Strocchi E, Ianniello E, Soldati M, Schiavone S, Bragagni A, Sabbà C, Vella FS, Suppressa P, De Vincenzo GM, Comitangelo A, Amoruso E, Custodero C, Fenoglio L, Falcetta A, Fracanzani AL, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Colombo G, Agosti P, Monzani V, Savojardo V, Ceriani G, Salerno F, Pallini G, Montecucco F, Ottonello L, Caserza L, Vischi G, Liberato NL, Tognin T, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Pisciotta MS, Bellucci FB, Buffelli S, Montrucchio G, Peasso P, Favale E, Poletto C, Margaria C, Sanino M, Violi F, Perri L, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Diprizio RD, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Galassi M, Grassi Y, Greco A, Sciacqua A, Perticone M, Battaglia R, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Pipita ME, Castellino P, Zanoli L, Gennaro A, Gaudio A, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Vigorito C, Cittadini A, Moreo G, Prolo S, Pina G, Ballestrero A, Ferrando F, Gonella R, Cerminara D, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Sechi L, Catena C, Colussi G, Cavarape A, Da Porto A, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Grossi M, Del Giacco S, Firinu D, Costanzo G, Argiolas G, Montalto G, Licata A, Montalto FA, Corica F, Basile G, Catalano A, Bellone F, Principato C, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, Malfa LL, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Imperiale GN, Pirisi M, Fra GP, Sola D, Bellan M, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Napoli F, Aiello I, Landolfi R, Montalto M, Mirijello A, Purrello F, Di Pino A, del Primario NEC, Ghidoni S, Salvatore T, Monaco L, Ricozzi C, Pilotto A, Indiano I, Gandolfo F. The multifaceted spectrum of liver cirrhosis in older hospitalised patients: analysis of the REPOSI registry. Age Ageing 2021; 50:498-504. [PMID: 32926127 DOI: 10.1093/ageing/afaa150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/20/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. OBJECTIVES To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. METHODS A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. RESULTS LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. CONCLUSIONS LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features.
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Affiliation(s)
| | | | - Luisa Costanzo
- Unit of Geriatrics, University Campus Bio-Medico, Rome, Italy
| | - Alessio Novella
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Laura Cortesi
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Fabbo A, Neviani F, Petrella S, Beretta R, De Salvatore L, Mussi C. Cognitive impairment and dementia among older prisoners: A report from an Italian prison. Alzheimers Dement 2020. [DOI: 10.1002/alz.044010] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrea Fabbo
- Health Authority and Services of Modena (AUSL) Modena Italy
- Local Agency for Health of Modena (AUSL) Modena Italy
| | | | | | | | | | - Chiara Mussi
- University of Modena and Reggio Emilia Modena Italy
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14
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Morandi A, Zambon A, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bo M, Marengoni A, Bellelli G, Rispoli V, Malara A, Spadea F, Di Cello S, Ceravolo F, Fabiano F, Chiaradia G, Gabriele A, Lenino P, Andrea T, Settembrini V, Capomolla D, Citrino A, Scriva A, Bruno I, Secchi R, De Martino E, Muccinelli R, Lupi G, Paonessa P, Fabbri A, Passuti MT, Castellari S, Po A, Gaggioli G, Varesi M, Moneti P, Capurso S, Latini V, Ghidotti S, Riccardelli F, Macchi M, Rigo R, Claudio P, Angelo B, Flavio C, Benedetta B, Boffelli S, Cassinadri A, Franzoni S, Spazzini E, Andretto D, Tonini G, Andreani L, Coralli M, Balotta A, Cancelliere R, Ballardini G, Simoncelli M, Mancini A, Strazzacapa M, Fabio S, De Filippi F, Giudice C, Dentizzi C, Azzini M, Cazzadori M, Mastroeni V, Bertassello P, Claudia Benati HS, Nesta E, Tobaldini C, Guerini F, Elena T, Mombelloni P, Fontanini F, Gabriella L, Pizzorni C, Oliverio M, Del Grosso LL, Giavedoni C, Bidoli G, Mazzei B, Corsonello A, Fusco S, Vena S, De Vuono T, Maiuri G, Luca FF, Andrea A, Giovanni S, Rossella N, Castegnaro E, De Rosa S, Sechi RB, Benvenuti E, Del Lungo I, Giardini S, Giulietti C, Mauro DB, Eleonora B, Roberto F, Paolo B, DuranteMangoni E, Testoni M, Fabio DS, Loredana S, Valeria S, Fabiano M, Annabella DG, Salvatore DC, Martina P, Greco A, Grazia D, Daniele S, Gianluca R, Renzo G, Sergio M, Morena B, Vitali M, Marina P, Paolo DC, Irene F, Cristina S, Alessandra F, Orlandini F, La Regina M, Desirée A, Mirella F, Marco F, Mario B, Paola P, Giuliana B, Riccardo B, Michela T, Eleonora C, Padulo F, Cristina M, Dario R, Giancarla M, Guido R, Elena M, Prete C, Marileda N, Federica S, Igor B, Nicole B, Elena R, Paolillo C, Riccardi A, Claudia B, Barbara R, Francesca M, Silvia V, Chiara C, Ilaria DL, Oliver B, Mauro C, Eleonora M, Giuseppe P, Rosaria T, Maria C, Davide D, Stefania C, Marco C, Massimo P, Bertoletti E, Luca S, Martina DF, Paola V, Lia S, Sandro C, Valentina DS, Erminia B, Paola C, Romina R, Minisola S, D'Amico F, Luciano C, Pasquale A, Ilaria L, Francesca C, Guglielmo S, Marco E, Sara R, Paola A, Claudio A, Francesco R, Caronzolo F, Alessandro C, Simona M, Lara F, Paola R, Simonetta C, Antonella C, Generoso U, Fernando G, Giuliano C, Emanuela S, Grippa A, Mariolina S, Alessandro D, Chiara P, Giulia L, Alessandro G, Famularo S, Sandini M, Pinotti E, Gianotti L, Antonella B, Lombardo G, Giulia P, Sante G, Rossi A, Rubele S, Sant S, Marco V, Danila C, Fabio R, Bandirali MP, Nicoletta C, Pipicella T, Laura B, Paolo T, Luciano T, Leonello A, Margherita S, Stefania DN, Pierluigi DS, Laura R, Fabiana T, Giovanna C, Antonino S, Antonino A, Felice C, Giuseppe B, Danilo F, Giovanna DB, Francesco L, Salini S, Angela BM, De Filippi F, Giorgetta C, Francesco C, Giovanni G, Paola C, Gerardo B, Silvio R, Letizia S, Sabrina P, Davide B, Rosaria RM, Maria DA, Raffaele P, Valeria PG, Palmieri VO, Palasciano G, Belfiore A, Portincasa P, Carlo S, Vincenzo S, Alessia D, Valiani V, Carolina B, Tiziana C, Daniela L, Giuseppe M, Francesca C, Giordano C, Roberto S, Paola T, Ugo P, Federica R, Giacomo P, Castellano M, Anna G, Domenico C, Elisa C, Federica C, Antonietta CM, Luigi M, Fabio L, Salvatore B, Giuseppe M, Gelosa G, Viviana AT, Piras V, Giorgio B, Andrea C, Alessandra B, Coen D, Magliola R, Milanesio D, Muzzulini CL, Paolo F, Marinella T, Sofia CM, Marta B, March A, Siano P, Capo G, Napoletano R, Cecilia P, Mancini C, Del Buono C, De Bartolomeo G, Addolorata M, Carmen C, Roberto C, Nitti MT, Giovanni VA, Moschettini G, Franco M, Daniela R, D'Amico G, Mirella P, Endrizzi C, Trotta L, Ciarambino T, Orazio Z, Felici A, Emanuela T, Marta S, Thomas F, Giacomo T, Ignazio DF, Andrea B, Giuseppe O, Emanuela F, Serena A, Elena D, Pavan S, Anna C, Serena B, Erika N, Roberto S, Elena S, Manuela P, Francesca A, Angelo T, Piazzani F, Lunelli A, Dimori S, Margotta A, Soglia T, Postacchini D, Brunelli R, Santini S, Francavilla M, Macchiati I, Sorvillo F, Giuli C, Mecocci P, Longo A, Perticone F, Addesi D, Rosa PC, Bencardino G, Falbo T, Grillo N, Marco F, Mirella F, Fantò F, Isaia G, Pezzilli S, Bergamo D, Furno E, Rrodhe S, Lucarini S, Dijk B, Dall'Acqua F, Cappelletto F, Calvani D, Becheri D, Giuseppe M, Costanza M, Vito A, Francesca B, Magherini L, Novella M, Franca B, Lucia Gambardella PM, Valente C, Ilaria B, Alice F, Bo M, Porrino P, Ceci G, Giuliana B, Michela T, Eleonora C, Ettore E, Camellini C, Servello A, Grassi A, Rozzini R, Tironi S, Grassi MG, Troisi E, Carlo C, Simona Gabriella DS, Flaminia F, Federica R, Beatrice P, Sofia T, Gabutto A, Quazzo L, Rosatello A, Suraci D, Tagliabue B, Perrone C, Ferrara L, Castagna A, Tremolada ML, Giuseppe C, Stefano B, Davide O, Piano S, Serviddio G, Lo Buglio A, Gurrera T, Merlo V, Rovai C, Cotroneo AM, Carlucci R, Abbaldo A, Monzani F, Qasem AA, Bini G, Tafuto S, Galli G, Bruni AC, Mancuso G, Mancuso G, Calipari D, Giuseppe Massimiliano DL, Bernardini B, Corsini C, Michele C, Sara DF, Cagnin A, Fragiacomo F, Pompanin S, Piero A, Marco C, Zurlo A, Guerra G, Pala M, Menozzi L, Gatti CD, Magon S, Roberto M, Alfredo DG, Fabio F, Ruana T, Elisa M, Benedetta B, Christian M, Marco P, Massimo G, Di Francesco V, Faccioli S, Pellizzari L, Giorgia F, Barbagallo G, Lunardelli ML, Martini E, Ferrari E, Macchiarulo M, Corneli M, Bacci M, Battaglia G, Anastasio L, Lo Storto MS, Seresin C, Simonato M, Loreggian M, Cestonaro F, Durando M, Latella R, Mazzoleni M, Russo G, Ponte M, Valchera A, Salustri G, Petritola D, Costa A, Sinforiani E, Cotta MR, Piano S, Pizio RN, Cester A, Formilan M, Pietro B, Carbone P, Cazzaniga I, Appollonio I, Cereda D, Stabile A, Xhani R, Acampora R, Tremolizzo L, Federico P, Antonio C, Valerio P, Cesare B, Zhirajr M, Giovanni V, Maria A, Mariaelena S, Bottacchi E, Bucciantini E, Di Giovanni M, Franchi F, Lucchetti L, Mariani C, Grande G, Rapazzini P, Marco M, Romanelli G, Marengoni A, Franco N, Alessio M, Stefano B, Nicola L, Laura P, Nazario P, Carlo C, Chiara G, Soccorso P, Andrea S, Luca B, Francesca S, Roberto A, Marco F, Anna C, Francesco C, Anna C, Fugazza L, Guerrini C, De Paduanis G, Iallonardo L, Palumbo P, Zuliani G, Ortolani B, Capatti E, Soavi C, Bianchi L, Francesconi D, Miselli A, Gloria B, Tommaso R, Chiara P, Agata MM, Marco D, Luca M, Gianluca G, Suardi T, Mazzone A, Zaccarini C, Manuela R, Mirra G, Muti E, Bottura R, Gianpaolo M, Secreto P, Bisio E, Cecchettani M, Naldi T, Pallavicino A, Pugliese M, Iozzo RC, Grassi G, Michele B, Raffaella D, Fosca QT, Giorgio GC, Giovanni P, Ernesto C, Soccorso P, Mannironi A, Giorli E, Oberti S, Fierro B, Piccoli T, Giacalone F, Mandas A, Serchisu L, Costaggiu D, Pinna E, Orrù F, Mannai M, Cordioli Z, Pelizzari L, Turcato E, Arduini P, Cacace C, Chiloiro R, Cimino R, Ruberto C, Giovanni R, Pietro G, Laura G, Alberto C, Pietro G, Carmen R, Santo PD, Andriolli A, Burattin G, Rossi L, Andreolli Antonino CG, Giuseppe C, Tezza F, Maddalena P, Laura S, Crippa P, Aloisio P, Di Monda T, Malighetti A, Galbassini G, Salutis D, Ivaldi C, Russo AM, Bennati E, Pino E, Zavarise G, Pesci A, Suigo G, Faverio P, Andrea G, Sabrina P, Zanasi M, Moniello G, Rostagno C, Cartei A, Polidori G, Ungar A, Melis MR, Martellini E, Enrico M, Monica T, Antonella G, Giovanna L, Migliorini M, Caramelli F, Battiston B, Berardino M, Cavallo S, Alessandro M, Anna S, Lombardi B, D'Ippolito P, Furini A, Villani D, Clara R, Guarneri M, Paolucci S, Bassi A, Coiro P, De Angelis D, Morone G, Venturiero V, Palleschi L, Raganato P, Di Niro G, Rosa CA, Loredana B, Imoscopi A, Isaia G, Tibaldi V, Bottignole G G, Calvi E, Clementi C, Zanocchi M, Agosta L, Nortarelli A, Provenzano G, Mari D, Romano FY, Rosini F, Mansi M, Rossi S, Geriatria AR, Inzaghi L, Bonini G, Rossi P, Potena A, Lichii M, Candiani T, Grimaldi W, Bertani E, Alessandra P, Calogero P, Pinto D, Bernardi R, Nicolino F, Galetti C, Gianstefani A, Giulia C, Lorenzo M, Odetti P, Monacelli F, Prefumo M, Fiammetta M, Canepa M, Minaglia C, Paolisso G, Rizzo MR, Prestano R, Dalise AM, Barra D, Bosco LD, Asprinio V, Dallape L, Perina E, Incalzi RA, Bartoli IR, Pluderi A, Maina A, Pecoraro E, Sciarra M, Prudente A, Paola M, Francesca M, Manuel V, Luisella C, Maria PL, Tina S, Benini L, Levato F, Mhiuta V, Alius F, Davidoaia D, Giardini V, Garancini M, Bellamoli C, Terranova L, Bozzini C, Tosoni P, Provoli E, Cascone L, Dioli A, Ferrarin G, Gabutto A, Bucci A, Bua G, Fenu S, Bianchi G, Casella S, Romano V, Maurizio P, Mascherona I, Belotti G, Cavaliere S, Cuni E, Merciuc N, Oberti R, Veneziani S, Capoferri E, De Bernardi E, Colombo K, Bravi M, Nicoletta N, D'Arcangelo P, Montenegro N, Galli G, Montanari R, Lamanna P, Gasperini B, Isabella M, Stefania D, Gaia A, Filippo C, Palamà C, Di Emidio C, Scarpini E, Arighi A, Fumagalli G, Basilico P, De Amicis Margherita M, Marta M, Diletta M, D'Amico F, Granata A, Rostagno C, Ranalli C, Cammilli A, Cavallini MC, Tricca M, Natella D, Gabbani L, Tesi F, Martella L, Gurrera T, Imbrici R, Guerrini G, Scotuzzi AM, Sozzi F, Valenti L, Chiarello A, Monia M, Pilotto A, Prete C, Senesi B, Meta AC, Pendenza E, Monzani F, Pasqualetti G, Polini A, Tognini S, Ballino E, Cherubini A, Dell'Aquila G, Gasparrini PM, Marotti E, Migale M, Scrimieri A, Falsetti L, Salvi A, Toigo G, Ceschia G, Rosso A, Tongiorgi C, Scarpa C, Maurizio P, De Dominicis L, Pucci E, Renzi S, Cartechini E, Tomassini PF, Del Gobbo M, Ugenti F, Romeo P, Nardelli A, Lauretani F, Visioli S, Montanari I, Ermini F, Giordano A, Pigato G, Simeone E, Barbujani M, Giampieri M, Amoruso R, Piccinini M, Ferrari C, Gambetti C, Sfrappini M, Semeraro L, Striuli R, Mariani C, Pelliccioni G, Marinelli D, Fabi K, Rossi T, Pesallaccia M, Sabbatini D, Gobbi B, Cerqua R, Tagliani G, Schlauser E, Caser L, Caramello E, Sandigliano F, Rosso G, Ferrari A, Bendini C, Luisa DM, Casella M, Prampolini R, Scevola M, Vitale E, Roberto B, Carlo F, Sergio F, Alberto S, Daniela Z, Giulia B, Serena G, Michele B, Maugeri D, Sorace R, Anzaldi M, De Gesu R, Morrone G, Davolio F, Fabbo A, Palmieri M, Barbagallo G, Zoli M, Forti P, Pirazzoli L, Fabbri E, Terenzi L, Bergolari F, Wenter C, Ruffini I, Insam M, Abraham E, Kirchlechner C, Cucinotta D, Antonino L, Basile G, Grazia AM, Parise P, Boccali A, Amici S, Gambacorta M, Ferrari A, Lasagni A, Lovati R, Giovinazzo F, Kimak E, Zappa P, Medici F, Lo Castro M, Mauro F, De Luca A, Sancesario G, Martorana A, Scaricamazza B, Toniolo S, Di Lorenzo F, Liguori C, Lasco A, Basile G, Vita N, Giomi M, Dimori S, Forte F, Padovani A, Rozzini L, Ceraso A, Salvatore C, Padovani A, Cottino M, Vitali S, Marelli E, Tripi G, Miceli S, Urso G, Grioni G, Vezzadini G, Misaggi G, Forlani C, Avanzi S, Serena S, Claudia C, Marilena V, Alberto L, Diego G, Alessandro G, Iemolo F, Giordano A, Sanzaro E, D'Asta G, Proietto M, Carnemolla A, Razza G, Spadaro D, Bertolotti M, Mussi C, Neviani F, Roberto C, Valentina G, Linda M, Francesca V, Tarozzi A, Balestri F, Monica T, Mannarino G, Tesi F, Bigolari M, Natale A, Grassi S, Bottaro C, Stefanelli S, Bovone U, Tortorolo U, Quadri R, Leone G, Ponzetto M, Frasson P, Annoni G, Bellelli G, Bruni A, Confalonieri R, Corsi M, Moretti D, Teruzzi F, Umidi S, Mazzola P, Perego S, Persico I, Olivieri G, Bonfanti A, Hajnalka S, Galeazzi M, Massariello F, Anzuini A, Caffarra P, Barocco F, Spallazzi M, Paolo CG, Simonetta M, Andrea A, Chioatto P, Bortolamei S, Soattin L, Ruotolo G, Beneamino B, Pietro G, Giuseppe B, Carmen R, Castagna A, Bertazzoli M, Rota E, Adobati A, Scarpa A, Granziera S, Zuccher P, Fabbro AD, Zara D, Lo Nigro A, Franchetti L, Toniolo M, Marcuzzo C, Piano S, Rollone M, Guerriero F, Sgarlata C, Massè A, Berardino M, Cavallo S, Anna S, Zatti G, Piatti M, Graci J, Benati G, Boschi F, Biondi M, Fiumi N, Erika T, Locatelli SM, Mauri S, Beretta M, Margheritis L, Desideri G, Liberatore E, Carucci AC, Bonino P, Caput M, Antonietti MP, Polistena G, De la Pierre F, Mari M, Massignani P, Tombesi F, Selvaggio F, Verbo B, Bodoni P, Marchionni N, Mossello E, Cavallini MC, Sabatini T, Mussio E, Magni E, Bianchetti A, Crucitti A, Titoldini G, Cossu B, Fascendini S, Licini C, Tomasoni A, Calderazzo M, Daniela T, Valentina L, Ferrari A, Prampolini R, Melotti RM, Lilli A, Buda S, Adversi M, Noro G, Turco R, Ubezio MC, Mantovani AR, Viola MC, Serrati C, Pretta S, Infante M, Gentile S, Morandi A, D'Ambrosio V, Mazzanti P, Brambilla C, Sportelli S, Platto C, Faraci B, Quattrocchi D, Pernigotti LM, Pisu C, Sicuro F, Oliverio M, Del Grosso LL, Zagnoni P, Ghiglia S, Mosca M, Corazzin I, Deola M, Biagini CA, Bencini F, Cantini C, Tonon E, Pierinelli S, Onofrj M, Thomas A, Filomena B, Bonanni L, Gabriella C, Comi G, Magnani G, Santangelo R, Mazzeo S, Giuseppe M, Francesca C, Giordano C, Roberto S, Barbieri C, Giroldi L, Davolio F, Bandini F, Masina M, Malservisi S, Cicognani A, Ricca L, Ricca L, Piccininni M, Ferrari C, Gambetti C, Tassinari T, Brogi D, Sugo A, Alessandra F, Sonia M, Valerio V, Andrea UC, Enrico C, Vera RF, Assunta S, Gianmaria Z, Mauro P, Pietro B, Roberto M, Salvatore C, Barone A, Razzano M, Giuseppe I, Angela B, Francesco S, Valeria D, Federico G, Lucia P, Antonella V, Elisabetta DC, Cristina R, Nadia C, Maria S, Luciano A, Chiara C, Bini P, Pignata M, Enrico B, Maria V, Giovanni C, Giorgio C, Andrea T, Marco M, Anna C, Piera R, Alberto Z, Ceccon A, Magrin L, Marin S, Barbara S, Marco M, Laura G, Matteo M, Marco P, Caterina PM, Carla R, Federica G, Clara T, Melania C, Giampaolo B, Stefano G, Valeria G, Lucia M, Giovambattista D, Ester L, Cecilia CA, Maurizio T, Alessandra F, Vera RF, Nadia B, Grillo A, Arenare F, Tonino M, David K, Giorgio VP, Ubaldo B, Vincenzo S, Stefano M, Marino F, Busonera Flavio MT, Paolo A, Monica M, Francesco B. Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia. J Am Med Dir Assoc 2020; 21:486-492.e7. [DOI: 10.1016/j.jamda.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022]
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Casagranda I, Ungar A, Prevaldi C, Abete P, Biagioni S, Del Rosso A, Diamanti M, Fanciulli A, Fumagalli S, Furlan R, Lerza R, Locatelli C, Maggi R, Mussi C, Numeroso F, Rabajoli F, Testa S, Tomaino M, Brignole M. Anticoagulation therapy in older patients at risk for syncopal and not-syncopal fall and/or frailty. An AcEMC-GIMSI multidisciplinary consensus document. Emerg Care J 2020. [DOI: 10.4081/ecj.2020.8838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In aged patients, the most frequent indications for anticoagulation are atrial fibrillation (AF) and venous thromboembolism for stroke and systemic embolism prevention. Despite systemic anticoagulation recommended by current guidelines for patients over 65 years, in clinical practice up to 50 % of elderly patients do not receive maintenance anticoagulation therapy. This is particularly evident in frail subjects at risk of syncopal and not-syncopal fall, fearing intracranial bleeding following a fall. As the risk of bleeding associated with falls is still debated, the boards of the Academy of Emergency Medicine and Care (AcEMC) and the Italian Multidisciplinary Working Group on Syncope (GIMSI), in order to write a consensus document, submitted to a panel of experts eight statement which could represent as many controversial topics for anticoagulant prescription in patients over 75 years. The Delphi method was used to obtain consensus between 15 physicians from different medical specialties; some of them were expert in syncope management and worked in a Syncope Unit. All had experience in prescribing oral anticoagulation. A questionnaire was sent on the appropriateness of oral anticoagulation in eight clinical situations where the risk of fall is present (frailty, cognitive impairment, previous falls, absence of caregiver, chronic renal impairment, nonvalvular AF with HAS-BLED score ≥3 or CHA2DS2-VASc score ≥3). All experts completed the questionnaire within three rounds and the consensus was reached on many but not all statements, leaving room for debate on some clinical situations. The consensus document gives useful advice for elderly patients’ management, who need oral anticoagulant therapy but are at risk of syncopal or not-syncopal fall. Nonetheless, there are some unresolved issues where an individual decision should be taken by the physician in agreement with the patient.
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Ceccofiglio A, Fumagalli S, Mussi C, Mossello E, Bo M, Martone AM, Bellelli G, Nicosia F, Riccio D, Langellotto A, Tava G, Boccardi V, Tonon E, Abete P, Ungar A. Atrial Fibrillation in Older Patients with Syncope and Dementia: Insights from the Syncope and Dementia Registry. J Am Med Dir Assoc 2020; 21:1238-1242. [PMID: 32179002 DOI: 10.1016/j.jamda.2020.01.110] [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: 09/18/2019] [Revised: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the clinical characteristics and the long-term outcome of atrial fibrillation (AF) patients with dementia and history of syncope or falls. DESIGN Observational: analysis of a prospective registry. SETTING AND PARTICIPANTS Between 2012 and 2016, the Syncope and Dementia Registry enrolled patients in 12 geriatric departments. Follow-up evaluation was at 12 months. MEASURES Clinical, functional, and cognitive assessment. RESULTS Of the 522 patients (women, 62.1%; Mini-Mental State Examination 17 ± 6), 26.4% have or presented an AF history. Patients with AF were older (85 ± 6 vs 83 ± 6 years, P = .012), with higher heart rate (78 ± 17 vs. 73 ± 14 bpm, P < .001), prescribed drugs (6.9 ± 2.9 vs 5.9 ± 2.7, P < .001), and an increased number (3.9 ± 2.0 vs 3.0 ± 1.8, P < .001) and severity of comorbidities. Oral anticoagulant therapy was underprescribed (39.9%). Cardiac syncope was more frequently diagnosed (18.8 vs 4.9%, P < .001). At multivariate analysis, AF patients were characterized by advanced age, a higher severity of comorbidities, a greater number of prescribed drugs, an increased heart rate, and a more frequent presence of cardiac symptoms. One-year mortality differed little between patients with and without AF (27.7 vs 22.1%, P = .229). In the arrhythmia group, multivariate predictors of prognosis were disability (number of lost BADLs; P = .020) and a higher heart rate (P = .006). CONCLUSIONS AND IMPLICATIONS AF and postural stability-related issues often co-exist in persons with dementia. This complex of conditions is associated with an intricate clinical picture, underprescription of oral anticoagulants, and high long-term mortality. Future studies are needed to evaluate the effects of therapy optimization in this population.
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Affiliation(s)
- Alice Ceccofiglio
- Department of Medicine and Geriatrics, Careggi Hospital and University of Florence, Florence, Italy
| | - Stefano Fumagalli
- Department of Medicine and Geriatrics, Careggi Hospital and University of Florence, Florence, Italy.
| | - Chiara Mussi
- Centro di Valutazione e Ricerca Gerontologica, Chair of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Mossello
- Department of Medicine and Geriatrics, Careggi Hospital and University of Florence, Florence, Italy
| | - Mario Bo
- SCDU Geriatria e Malattie Metaboliche dell'Osso, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Bellelli
- Department of Health Sciences, University of Milano Bicocca and Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - Franco Nicosia
- Medicine and Geriatric Unit, Spedali Civili of Brescia, Brescia, Italy
| | - Daniela Riccio
- Geriatric Department, SS. Trinità Hospital, Cagliari, Italy
| | | | - Gianni Tava
- Geriatric Unit, Santa Chiara Hospital, Trento, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Andrea Ungar
- Department of Medicine and Geriatrics, Careggi Hospital and University of Florence, Florence, Italy
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Ferrara MC, Andreano A, Tassistro E, Rapazzini P, Zurlo A, Volpato S, Mussi C, Corsi M, Lunardelli ML, Martini E, Castoldi G, De Filippi F, Pizzonia M, Monacelli F, Barone A, Pilotto A, March A, Ungar A, Capelli R, Galmarini V, Franzoni S, Terragnoli F, Bianchetti A, Cazzulani I, Gandossi C, Valsecchi MG, Bellelli G. Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients. Aging Clin Exp Res 2020; 32:1245-1253. [PMID: 32026420 DOI: 10.1007/s40520-020-01488-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers. METHODS The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed ≤ 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected. RESULTS The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80-90), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23-62). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators ("pre-surgical cognitive assessment", "bone protection prescription", "use of urinary catheter" and "start of physiotherapy"), moderate in two indicators ("surgery performed ≤ 48 h from fracture" and "discharge toward rehabilitation" and low in one ("absence of delirium on day following surgery"). Comparison with international studies suggests very different ways of providing care to HF Italian patients. CONCLUSIONS The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care.
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Carlotta F, Raffaella R, Ilaria A, Alessandro N, Mannuccio MP, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Caterina C, Biolo G, Zanetti M, Guadagni M, Zaccari M, Chiuch M, Zaccari M, Vanoli M, Grignani G, Pulixi EA, Bernardi M, Bassi SL, Santi L, Zaccherini G, Lupattelli G, Mannarino E, Bianconi V, Paciullo F, Alcidi R, Nuti R, Valenti R, Ruvio M, Cappelli S, Palazzuoli A, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Cocita F, Beneduce V, Plances L, Corrao S, Natoli G, Mularo S, Raspanti M, Cavallaro F, Zoli M, Lazzari I, Brunori M, Fabbri E, Magalotti D, Arnò R, Pasini FL, Capecchi PL, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Maira D, Di Stefano V, Fabio G, Seghezzi S, Mancarella M, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Conti F, Bonini G, Ottolini BB, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Murialdo G, Marra A, Cattaneo F, Pontremoli R, Beccati V, Nobili G, Secchi MB, Ghelfi D, Anastasio L, Sofia L, Carbone M, Cipollone F, Guagnano MT, Valeriani E, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Pes C, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Zuccalà G, D’Aurizio G, Romanelli G, Marengoni A, Zucchelli A, Manzoni F, Volpini A, Picardi A, Gentilucci UV, Gallo P, Dell’Unto C, Annoni G, Corsi M, Bellelli G, Zazzetta S, Mazzola P, Szabo H, Bonfanti A, Arturi F, Succurro E, Rubino M, Tassone B, Sesti G, Interna M, Serra MG, Bleve MA, Gasbarrone L, Sajeva MR, Brucato A, Ghidoni S, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Cosi E, Scarinzi P, Amabile A, Omenetto E, Prandini T, Manfredini R, Fabbian F, Boari B, Giorgi AD, Tiseo R, De Giorgio R, Paolisso G, Rizzo MR, Borghi C, Strocchi E, Ianniello E, Soldati M, Sabbà C, Vella FS, Suppressa P, Schilardi A, Loparco F, De Vincenzo GM, Comitangelo A, Amoruso E, Fenoglio L, Falcetta A, Bracco C, Fracanzani AL, Fargion S, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Ferrari B, Colombo G, Agosti P, Monzani V, Savojardo V, Folli C, Ceriani G, Salerno F, Pallini G, Dallegri F, Ottonello L, Liberale L, Caserza L, Salam K, Liberato NL, Tognin T, Bianchi GB, Giaquinto S, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Spazzini E, Ferrandina C, Montrucchio G, Petitti P, Peasso P, Favale E, Poletto C, Salmi R, Gaudenzi P, Violi F, Perri L, Landolfi R, Montalto M, Mirijello A, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Dondi G, Pellegrini E, Carulli L, Galassi M, Grassi Y, Perticone F, Perticone M, Battaglia R, FIlice M, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Gabrielli A, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Marigliano B, Pipita ME, Castellino P, Zanoli L, Pignataro S, Gennaro A, Blanco J, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Cittadini A, Vigorito C, Arcopinto M, Salzano A, Bobbio E, Marra AM, Sirico D, Moreo G, Gasparini F, Prolo S, Pina G, Ballestrero A, Ferrando F, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Scattolin G, Martinelli S, Turrin M, Sechi L, Catena C, Colussi G, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Del Giacco S, Firinu D, Losa F, Paoletti G, Costanzo G, Montalto G, Licata A, Malerba V, Montalto FA, Lasco A, Basile G, Catalano A, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, La Malfa L, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Lauretani F, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Pirisi M, Fra GP, Sola D, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Tedeschi A, Trotta L, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Cattaneo M, Napoli F. Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients. Eur J Intern Med 2019; 68:e7-e11. [PMID: 31405773 DOI: 10.1016/j.ejim.2019.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
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Guaraldi G, Francesco DD, Malagoli A, Zona S, Franconi I, Santoro A, Mussini C, Mussi C, Cesari M, Theou O, Rockwood K. Compression of frailty in adults living with HIV. BMC Geriatr 2019; 19:229. [PMID: 31438859 PMCID: PMC6706922 DOI: 10.1186/s12877-019-1247-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/19/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022] Open
Abstract
Background Contemporary HIV care may reduce frailty in older adults living with HIV (OALWH). Objective of the study was to estimate prevalence of frailty at the age of 50 and 75 years, and build a model to quantify the burden of frailty in the year 2030. Methods This study included OALWH attending Modena HIV Metabolic Clinic between 2009 and 2015. Patients are referred from more than 120 HIV clinics well distributed across Italy, therefore being country representative. Our model forecasts the new entries on yearly basis up to 2030. Changes in frailty over a one-year period using a 37-variable frailty index (FI) and death rates were modelled using a validated mathematical algorithm with parameters adjusted to best represent the changes observed at the clinic. In this study, we assessed the number of frailest individuals (defined with a FI > 0.4) at the age of 50 and at the age 75 by calendar year. Results In the period 2015–2030 we model that frailest OALWH at age 50 will decrease from 26 to 7%, and at the age of 75 years will increase from 43 to 52%. This implies a shift of the frailty prevalence at an older age. Conclusion We have presented projections of how the burden of frailty in older adults, living with HIV will change. We project fewer people aged 50+ with severe frailty, most of whom will be older than now. These results suggest a compression of age-related frailty. Electronic supplementary material The online version of this article (10.1186/s12877-019-1247-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy.
| | | | - Andrea Malagoli
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Stefano Zona
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Iacopo Franconi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Antonella Santoro
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Chiara Mussi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124, Modena, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Olga Theou
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Guaraldi G, Marcotullio S, Maserati R, Gargiulo M, Milic J, Franconi I, Chirianni A, Andreoni M, Galli M, Lazzarin A, D'Arminio Monforte A, Di Perri G, Perno CF, Puoti M, Vella S, Di Biagio A, Maia L, Mussi C, Cesari M, Antinori A. The Management of Geriatric and Frail HIV Patients. A 2017 Update from the Italian Guidelines for the Use of Antiretroviral Agents and the Diagnostic Clinical Management of HIV-1 Infected Persons. J Frailty Aging 2019; 8:10-16. [PMID: 30734825 DOI: 10.14283/jfa.2018.42] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This article deals with the attempt to join HIV and geriatric care management in the 2017 edition of the Italian guidelines for the use of antiretrovirals and the diagnostic-clinical management of HIV-1 infected persons. METHODS The outlined recommendations are based on evidence from randomized clinical trials and observational studies published in peer-reviewed journals and/or presented at international scientific conferences in recent years. The principles of starting antiretroviral therapy in elderly patients and the viro-immunological goals are the same as in the general HIV population. However, there are some specificities to consider, related to the host as well as the therapy itself. HIV care in elderly patients must shift from a combined AntiRetroviral Therapy specific approach to a more comprehensive management, and from a disease-based model (list of co-morbidities) to a multi-morbidity and frailty standpoint. The implementation of a geriatric approach, based on the Comprehensive Geriatric Assessment, is essential and consists of a broader evaluation of health status. This multidimensional and multidisciplinary evaluation is focused on the development of a tailored intervention plan. Polypharmacy is a frequent condition in the older population and an independent risk factor for negative health-related outcomes. This can be overcome with a multidisciplinary and cooperative approach involving HIV specialists, geriatricians and primary care physicians. CONCLUSION The inclusion of geriatric care becomes necessary due to the novel needs of an evolving patient population. It is important to underline that the HIV specialist will continue to lead multidimensional interventions and optimize quality of care for HIV-positive people.
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Affiliation(s)
- G Guaraldi
- Giovanni Guaraldi, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy. Tel: +39-0594225318; Fax: +39-0594333710; E-mail:
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Ceccofiglio A, Mussi C, Rafanelli M, Rivasi G, Bo M, Mossello E, Martone AM, Abete P, Ungar A. Increasing Prevalence of Orthostatic Hypotension as a Cause of Syncope With Advancing Age and Multimorbidity. J Am Med Dir Assoc 2019; 20:586-588. [PMID: 30926410 DOI: 10.1016/j.jamda.2019.01.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Alice Ceccofiglio
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Chiara Mussi
- Centro di Valutazione e Ricerca Gerontologica, Chair of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Martina Rafanelli
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Giulia Rivasi
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Enrico Mossello
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Andrea Ungar
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy.
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Bertolotti M, Lancellotti G, Mussi C. Management of high cholesterol levels in older people. Geriatr Gerontol Int 2019; 19:375-383. [PMID: 30900369 DOI: 10.1111/ggi.13647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/24/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 12/22/2022]
Abstract
The management of hypercholesterolemia in older adults still represents a challenge in clinical medicine. The pathophysiological alterations of cholesterol metabolism associated with aging are still incompletely understood, even if epidemiological evidence suggests that serum cholesterol levels increase with ongoing age, possibly with a plateau after the age of 80 years. Age is also one of the main determinants of cardiovascular disease, according to all cardiovascular risk estimate tools. Cholesterol-lowering treatment, therefore, would be expected to bring significant protection, even in these patients. Unfortunately, direct experimental evidence is extremely limited, particularly in the very old age strata of the population; a clinical benefit still seems to be present, but the risk for drug-related adverse events is clearly higher. At any rate, at the present time, definite guidelines for the correct management of hypercholesterolemia in older patients are not available. Therefore, the decision whether or not a pharmacological treatment should be set up, and the choice of the drug, need to be tailored to the individual patient, and requires accurate clinical judgment. The specific aspects of frailty and disability, along with the actual age of the patients, have to be considered together, with a comprehensive assessment approach. The present review summarizes the evidence regarding the modifications of cholesterol metabolism in older patients, the impact of lipid-lowering drugs on cardiovascular outcomes and focuses on the considerations that can help to define the most appropriate treatment strategy, in view of the individual functional profile. Geriatr Gerontol Int 2019; 19: 375-383.
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Affiliation(s)
- Marco Bertolotti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
| | - Giulia Lancellotti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
| | - Chiara Mussi
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
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Curcio F, Testa G, Ceccofiglio A, Martone AM, Riccio D, Nicosia F, Noro G, Bellelli G, Bo M, Mussi C, Landi F, Ungar A, Abete P. Memantine Induces Reflex Syncope in Elderly Patients With Dementia: Results From the Syncope and Dementia Study (SYD-Study). J Am Med Dir Assoc 2019; 21:130-132. [PMID: 30872082 DOI: 10.1016/j.jamda.2019.01.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Francesco Curcio
- Department of Translational Medical Sciences, University of Naples, Federico II, Italy; Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Gianluca Testa
- Department of Translational Medical Sciences, University of Naples, Federico II, Italy; Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Alice Ceccofiglio
- Syncope Unit, Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniela Riccio
- Geriatric Department, SS. Trinità Hospital, Cagliari, Italy
| | - Franco Nicosia
- Medicine and Geriatric Unit, Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Noro
- Geriatric Unit, Santa Chiara Hospital, Trento, Italy
| | - Giuseppe Bellelli
- Department of Health Sciences, University of Milano Bicocca, Acute Geriatric Unit, San Gerardo Hospital, Monza; Milan Center for Neuroscience (Neuro-Mi), Milan, Italy
| | - Mario Bo
- SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Chiara Mussi
- Centro di Valutazione e Ricerca Gerontologica, Chair of Geriatrics, University of Modena and Reggio Emilia, Emilia-Romagna, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Ungar
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy; Syncope Unit, Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples, Federico II, Italy
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Bo M, Ceccofiglio A, Mussi C, Bellelli G, Nicosia F, Riccio D, Martone AM, Langellotto A, Tonon E, Tava G, Boccardi V, Abete P, Tibaldi M, Aurucci ML, Fonte G, Falcone Y, Ungar A. Prevalence, predictors and clinical implications of prolonged corrected QT in elderly patients with dementia and suspected syncope. Eur J Intern Med 2019; 61:34-39. [PMID: 30482635 DOI: 10.1016/j.ejim.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 05/11/2018] [Revised: 09/19/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Long QT and use of QT-prolonging drugs are common among older patients receiving polytherapies, but real-world evidence on their impact in clinical practice is controversial. We investigated prevalence, variables associated and clinical implications of prolonged corrected QT (QTc) among patients from the Syncope and Dementia study. METHODS Observational, prospective, multicenter study. Patients≥65 years with dementia and fall suspected for syncope in the previous three months were enrolled. Several clinical variables and the complete list of medications were recorded for each patient. A 12‑lead ECG was obtained and corrected QT was calculated by the Bazett's formula. One-year followup for death and recurrent syncope was performed. RESULTS Prolonged QTc was observed in 25% of the 432 enrolled patients (mean age 83.3), and was significantly associated with male gender (OR 2.09; 95% CI 1.34-3.26) and diuretics use (OR 1.85; 95% CI 1.18-2.90). At one-year 23.3% of patients died and 30.4% reported at least one recurrent event. Variables associated with one-year mortality were: age, male gender, atrial fibrillation (AF), use of calcium channel blockers and prolonged QTc (OR 1.80; 95% CI 1.01-3.20). Among patients with prolonged QTc a significant interaction for mortality was found with AF. Recurrent events were associated with the use of antiplatelets, cholinesterase. inhibitors and antipsychotics, but not with prolonged QTc. CONCLUSIONS We documented a high prevalence of prolonged QTc, that was associated with male gender and diuretics but not with psychoactive medications. Patients with prolonged QTc had higher one-year mortality, that was four-fold increased in those with concomitant AF.
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Affiliation(s)
- Mario Bo
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy
| | - Alice Ceccofiglio
- Syncope Unit, Department of Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Chiara Mussi
- O.U. of Geriatrics, Department of Biomedical Sciences, Metabolics and Neurosciences, University of Modena and Reggio Emilia, Italy
| | - Giuseppe Bellelli
- Department of Health Sciences, University of Milano Bicocca and Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - Franco Nicosia
- Medicine and Geriatric Unit - Spedali Civili of Brescia, Brescia, Italy
| | - Daniela Riccio
- Geriatric Department, SS, Trinità Hospital, Cagliari, Italy
| | - Anna M Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Gianni Tava
- Geriatric Unit, Santa Chiara Hospital, Trento, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Michela Tibaldi
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy
| | - Maria L Aurucci
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy.
| | - Gianfranco Fonte
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy
| | - Yolanda Falcone
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy
| | - Andrea Ungar
- Syncope Unit, Department of Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
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Testa G, Ceccofiglio A, Mussi C, Bellelli G, Nicosia F, Bo M, Riccio D, Curcio F, Martone AM, Noro G, Landi F, Ungar A, Abete P. Hypotensive Drugs and Syncope Due to Orthostatic Hypotension in Older Adults with Dementia (Syncope and Dementia Study). J Am Geriatr Soc 2018; 66:1532-1537. [DOI: 10.1111/jgs.15421] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/28/2018] [Accepted: 04/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Gianluca Testa
- Department of Translational Medical Sciences; University of Naples, Federico II; Naples Italy
| | - Alice Ceccofiglio
- Syncope Unit, Geriatric Cardiology and Medicine; University of Florence; Florence Italy
- Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Chiara Mussi
- Centro di Valutazione e Ricerca Gerontologica; University of Modena and Reggio Emilia; Modena Italy
| | - Giuseppe Bellelli
- Department of Health Sciences; University of Milano Bicocca; Milan Italy
- Acute Geriatric Unit; San Gerardo Hospital; Monza Italy
- Milan Center for Neuroscience; Milan Italy
| | - Franco Nicosia
- Medicine and Geriatric Unit; Spedali Civili of Brescia; Brescia Italy
| | - Mario Bo
- SCDU Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette-Torino; Turin Italy
| | - Daniela Riccio
- Geriatric Department; SS. Trinità Hospital; Cagliari Italy
| | - Francesco Curcio
- Department of Translational Medical Sciences; University of Naples, Federico II; Naples Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics; Catholic University of the Sacred Heart; Rome ITaly
| | | | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics; Catholic University of the Sacred Heart; Rome ITaly
| | - Andrea Ungar
- Syncope Unit, Geriatric Cardiology and Medicine; University of Florence; Florence Italy
- Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences; University of Naples, Federico II; Naples Italy
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Proietti M, Antoniazzi S, Monzani V, Santalucia P, Franchi C, Fenoglio LM, Melchio R, Fabris F, Sartori MT, Manfredini R, De Giorgi A, Fabbian F, Biolo G, Zanetti M, Altamura N, Sabbà C, Suppressa P, Bandiera F, Usai C, Murialdo G, Fezza F, Marra A, Castelli F, Cattaneo F, Beccati V, di Minno G, Tufano A, Contaldi P, Lupattelli G, Bianconi V, Cappellini D, Hu C, Minonzio F, Fargion S, Burdick L, Francione P, Peyvandi F, Rossio R, Colombo G, Monzani V, Ceriani G, Lucchi T, Brignolo B, Manfellotto D, Caridi I, Corazza GR, Miceli E, Padula D, Fraternale G, Guasti L, Squizzato A, Maresca A, Liberato NL, Tognin T, Rozzini R, Bellucci FB, Muscaritoli M, Molfino A, Petrillo E, Dore M, Mete F, Gino M, Franceschi F, Gabrielli M, Perticone F, Perticone M, Bertolotti M, Mussi C, Borghi C, Strocchi E, Durazzo M, Fornengo P, Dallegri F, Ottonello LC, Salam K, Caserza L, Barbagallo M, Di Bella G, Annoni G, Bruni AA, Odetti P, Nencioni A, Monacelli F, Napolitano A, Brucato A, Valenti A, Castellino P, Zanoli L, Mazzeo M. Use of oral anticoagulant drugs in older patients with atrial fibrillation in internal medicine wards. Eur J Intern Med 2018; 52:e12-e14. [PMID: 29657108 DOI: 10.1016/j.ejim.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Marco Proietti
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stefania Antoniazzi
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli - Sacco University Hospital, University of Milan, Milan, Italy
| | - Valter Monzani
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Santalucia
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; IRCCS Centro Neurolesi Bonino Pulejo - Ospedale Piemonte, Messina, Italy
| | - Carlotta Franchi
- Unit of Pharmacoepidemiological Research in Older People, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Luigi M Fenoglio
- Azienda Ospedaliera Santa Croce e Carle di Cuneo - Medicina Interna, Italy
| | - Remo Melchio
- Azienda Ospedaliera Santa Croce e Carle di Cuneo - Medicina Interna, Italy
| | - Fabrizio Fabris
- Azienda Ospedaliera Universitaria di Padova - Clinica Medica I, Italy
| | | | - Roberto Manfredini
- Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale S. Anna - Clinica Medica, Italy
| | - Alfredo De Giorgi
- Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale S. Anna - Clinica Medica, Italy
| | - Fabio Fabbian
- Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale S. Anna - Clinica Medica, Italy
| | - Gianni Biolo
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara - Clinica Medica, Italy
| | - Michela Zanetti
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara - Clinica Medica, Italy
| | - Nicola Altamura
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara - Clinica Medica, Italy
| | - Carlo Sabbà
- Azienda Ospedaliero-Universitaria Policlinico di Bari - Medicina Interna, Italy
| | - Patrizia Suppressa
- Azienda Ospedaliero-Universitaria Policlinico di Bari - Medicina Interna, Italy
| | | | - Carlo Usai
- Azienda Ospedaliero-Universitaria di Sassari - Medicina Interna, Italy
| | - Giovanni Murialdo
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Francesca Fezza
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Alessio Marra
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Francesca Castelli
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Federico Cattaneo
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Valentina Beccati
- Ospedale Policlinico San Martino, Genova - Clinica di Medicina Interna 2, Italy
| | - Giovanni di Minno
- Azienda Ospedaliera Universitaria Federico II di Napoli - Medicina Interna, Italy
| | - Antonella Tufano
- Azienda Ospedaliera Universitaria Federico II di Napoli - Medicina Interna, Italy
| | - Paola Contaldi
- Azienda Ospedaliera Universitaria Federico II di Napoli - Medicina Interna, Italy
| | - Graziana Lupattelli
- Ospedale "Santa Maria della Misericordia", S. Andrea delle Fratte di Perugia - Medicina Interna, Italy
| | - Vanessa Bianconi
- Ospedale "Santa Maria della Misericordia", S. Andrea delle Fratte di Perugia - Medicina Interna, Italy
| | - Domenica Cappellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna, Italy
| | - Cinzia Hu
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna, Italy
| | - Francesca Minonzio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna, Italy
| | - Silvia Fargion
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Indirizzo Metabolico, Italy
| | - Larry Burdick
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Indirizzo Metabolico, Italy
| | - Paolo Francione
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Indirizzo Metabolico, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Ematologia non tumorale e Coagulopatie, Italy
| | - Raffaella Rossio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Ematologia non tumorale e Coagulopatie, Italy
| | - Giulia Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Ematologia non tumorale e Coagulopatie, Italy
| | - Valter Monzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Alta Intensità Di Cura, Italy
| | - Giuliana Ceriani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Medicina Interna ad Alta Intensità Di Cura, Italy.
| | - Tiziano Lucchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Geriatria, Italy
| | - Barbara Brignolo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Geriatria, Italy
| | - Dario Manfellotto
- Ospedale San Giovanni Calibita Fatebenefratelli di Roma - Medicina Interna, Italy
| | - Irene Caridi
- Ospedale San Giovanni Calibita Fatebenefratelli di Roma - Medicina Interna, Italy
| | | | - Emanuela Miceli
- IRCCS Fondazione Policlinico San Matteo di Pavia - Clinica Medica I, Italy
| | - Donatella Padula
- IRCCS Fondazione Policlinico San Matteo di Pavia - Clinica Medica I, Italy
| | - Giacomo Fraternale
- IRCCS Fondazione Policlinico San Matteo di Pavia - Clinica Medica I, Italy
| | - Luigina Guasti
- Ospedale di Circolo e Fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette-Laghi, Varese, Università degli Studi dell'Insubria Varese - Medicina Interna 1, Italy
| | - Alessandro Squizzato
- Ospedale di Circolo e Fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette-Laghi, Varese, Università degli Studi dell'Insubria Varese - Medicina Interna 1, Italy
| | - Andrea Maresca
- Ospedale di Circolo e Fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette-Laghi, Varese, Università degli Studi dell'Insubria Varese - Medicina Interna 1, Italy
| | - Nicola Lucio Liberato
- Azienda Socio-Sanitaria Territoriale di Pavia Ospedale Civile "C. Mira" di Casorate Primo - Medicina Interna, Italy
| | - Tiziana Tognin
- Azienda Socio-Sanitaria Territoriale di Pavia Ospedale Civile "C. Mira" di Casorate Primo - Medicina Interna, Italy
| | - Renzo Rozzini
- Fondazione Poliambulanza Istituto Ospedaliero di Brescia - Geriatria, Italy
| | | | - Maurizio Muscaritoli
- Dipartimento di Medicina Clinica, Sapienza Università di Roma, Policlinico Umberto I di Roma - Medicina Interna e Nutrizione Clinica, Italy
| | - Alessio Molfino
- Dipartimento di Medicina Clinica, Sapienza Università di Roma, Policlinico Umberto I di Roma - Medicina Interna e Nutrizione Clinica, Italy
| | - Enrico Petrillo
- Dipartimento di Medicina Clinica, Sapienza Università di Roma, Policlinico Umberto I di Roma - Medicina Interna e Nutrizione Clinica, Italy
| | - Maurizio Dore
- Ospedale degli Infermi Di Rivoli - Medicina Generale, Italy
| | - Francesca Mete
- Ospedale degli Infermi Di Rivoli - Medicina Generale, Italy
| | - Miriam Gino
- Ospedale degli Infermi Di Rivoli - Medicina Generale, Italy
| | - Francesco Franceschi
- Fondazione Policlinico Universitario "Agostino Gemelli" di Roma - Medicina D'Urgenza e Pronto Soccorso, Italy
| | - Maurizio Gabrielli
- Fondazione Policlinico Universitario "Agostino Gemelli" di Roma - Medicina D'Urgenza e Pronto Soccorso, Italy
| | - Francesco Perticone
- Azienda Ospedaliero Universitaria "Mater Domini" di Catanzaro - Geriatria, Italy
| | - Maria Perticone
- Azienda Ospedaliero Universitaria "Mater Domini" di Catanzaro - Geriatria, Italy
| | - Marco Bertolotti
- Nuovo Ospedale Civile S. Agostino Estense di Modena - Geriatria e Post-Acuzie Geriatria, Italy
| | - Chiara Mussi
- Nuovo Ospedale Civile S. Agostino Estense di Modena - Geriatria e Post-Acuzie Geriatria, Italy
| | - Claudio Borghi
- Azienda Ospedaliero Universitaria - Policlinico S.Orsola-Malpighi di Bologna - Medicina Interna, Italy
| | - Enrico Strocchi
- Azienda Ospedaliero Universitaria - Policlinico S.Orsola-Malpighi di Bologna - Medicina Interna, Italy
| | - Marilena Durazzo
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino - Presidio Molinette, Medicina Interna 3, Italy
| | - Paolo Fornengo
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino - Presidio Molinette, Medicina Interna 3, Italy
| | - Franco Dallegri
- Ospedale Policlinico San Martino, Genova - Medicina Interna, Italy
| | | | - Kassem Salam
- Ospedale Policlinico San Martino, Genova - Medicina Interna, Italy
| | - Lara Caserza
- Ospedale Policlinico San Martino, Genova - Medicina Interna, Italy
| | - Mario Barbagallo
- Azienda Ospedaliera Universitaria Policlinico P. Giaccone di Palermo - Geriatria, Italy
| | - Giovanna Di Bella
- Azienda Ospedaliera Universitaria Policlinico P. Giaccone di Palermo - Geriatria, Italy
| | - Giorgio Annoni
- Ospedale S.Gerardo di Monza, Azienda Socio-Sanitaria Territoriale di Monza, Clinica Geriatrica Università degli Studi di Milano-Bicocca - Clinica Geriatrica, Italy
| | - Adriana Antonella Bruni
- Ospedale S.Gerardo di Monza, Azienda Socio-Sanitaria Territoriale di Monza, Clinica Geriatrica Università degli Studi di Milano-Bicocca - Clinica Geriatrica, Italy
| | - Patrizio Odetti
- Ospedale Policlinico San Martino, Genova - Clinica Geriatrica, Italy
| | - Alessio Nencioni
- Ospedale Policlinico San Martino, Genova - Clinica Geriatrica, Italy
| | | | | | - Antonio Brucato
- Ospedale Papa Giovanni XXIII di Bergamo - Medicina Interna, Italy
| | - Anna Valenti
- Ospedale Papa Giovanni XXIII di Bergamo - Medicina Interna, Italy
| | - Pietro Castellino
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" di Catania - Medicina Interna, Italy
| | - Luca Zanoli
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" di Catania - Medicina Interna, Italy
| | - Marco Mazzeo
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" di Catania - Medicina Interna, Italy
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Guaraldi G, Malagoli A, Calcagno A, Mussi C, Celesia BM, Carli F, Piconi S, De Socio GV, Cattelan AM, Orofino G, Riva A, Focà E, Nozza S, Di Perri G. The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 - 74 years and more than 75 years. BMC Geriatr 2018; 18:99. [PMID: 29678160 PMCID: PMC5910563 DOI: 10.1186/s12877-018-0789-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/12/2018] [Indexed: 02/06/2023] Open
Abstract
Background Geriatric Patients Living with HIV/AIDS (GEPPO) is a new prospective observational multicentre cohort consisting of all the HIV-positive geriatric patients being treated at 10 clinics in Italy, and HIV-negative controls attending a single geriatric clinic. The aim of this analysis of the GEPPO cohort was to compare prevalence and risk factors of individual non-communicable diseases (NCD), multi-morbidity (MM) and polypharmacy (PP) amongst HIV positive and HIV negative controls at enrolment into the GEPPO cohort. Methods This cross-sectional study was conducted between June 2015 and May 2016. The duration of HIV infection was subdivided into three intervals: < 10, 10–20 and > 20 years. The NCD diagnoses were based on guidelines defined criteria, including cardiovascular disease, hypertension, type 2 diabetes, chronic kidney disease, dyslipidaemia, chronic obstructive pulmonary disease. MM was classified as the presence of two or more co-morbidities. The medications prescribed for the treatment of comorbidities were collected in both HIV positive and HIV negative group from patient files and were categorized using the Anatomical Therapeutic Chemical (ATC) classification. PP was defined as the presence of five or more drug components other than anti-retroviral agents. Results The study involved a total of 1573 patient: 1258 HIV positive and 315 HIV negative). The prevalence of individual comorbidities was similar in the two groups with the exception of dyslipidaemia, which was more frequent in the HIV-positive patients (p < 0.01). When the HIV-positive group was stratified based on the duration of HIV infection, most of the co-morbidities were significantly more frequent than in control patients, except for hypertension and cardiovascular disease, while COPD was more prevalent in the control group. MM and PP were both more prevalent in the HIV-positive group, respectively 64% and 37%. Conclusions MM and PP burden in geriatric HIV positive patients are related to longer duration of HIV-infection rather than older age per se.
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Affiliation(s)
- G Guaraldi
- Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - A Malagoli
- Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - C Mussi
- Centre of Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy
| | - B M Celesia
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, ARNAS Garibaldi, Catania, Italy
| | - F Carli
- Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - S Piconi
- First Division of Infectious Diseases Unit, University of Milan, Ospedale L. Sacco, Milan, Italy
| | - G V De Socio
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy
| | - A M Cattelan
- Unit of Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - G Orofino
- Unit of Infectious Diseases, Division A, Ospedale Amedeo di Savoia, ASLTO2, Turin, Italy
| | - A Riva
- Third Division of Infectious Diseases, University of Milan, Ospedale L. Sacco, Milan, Italy
| | - E Focà
- Unit of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - S Nozza
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
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28
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Mossello E, Ceccofiglio A, Rafanelli M, Riccardi A, Mussi C, Bellelli G, Nicosia F, Bo M, Riccio D, Martone AM, Langellotto A, Tonon E, Noro G, Abete P, Ungar A. Differential diagnosis of unexplained falls in dementia: Results of "Syncope & Dementia" registry. Eur J Intern Med 2018; 50:41-46. [PMID: 29398249 DOI: 10.1016/j.ejim.2017.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/29/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Enrico Mossello
- Syncope Unit, Department of Medicine and Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Alice Ceccofiglio
- Syncope Unit, Department of Medicine and Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Martina Rafanelli
- Syncope Unit, Department of Medicine and Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Angela Riccardi
- Syncope Unit, Department of Medicine and Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Chiara Mussi
- Centro di Valutazione e Ricerca Gerontologica, Chair of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Bellelli
- Department of Health Sciences, University of Milano Bicocca and Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - Franco Nicosia
- Medicine and Geriatric Unit - Spedali Civili of Brescia, Brescia, Italy
| | - Mario Bo
- SCDU Geriatria e Malattie Metaboliche dell'Osso, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniela Riccio
- Geriatric Department, SS. Trinità Hospital, Cagliari, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Gabriele Noro
- Geriatric Unit, Santa Chiara Hospital, Trento, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Andrea Ungar
- Syncope Unit, Department of Medicine and Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy.
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Andreoni M, Mussi C, Bellagamba R, Di Campli F, Montinaro V, Babiloni C. Biomarkers of monitoring and functional reserve of physiological systems over time in HIV: expert opinions for effective secondary prevention. New Microbiol 2018; 41:1-25. [PMID: 28994444] [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] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 06/07/2023]
Abstract
HIV-positive individuals are more vulnerable to poor health than HIV-negative individuals. This vulnerability is characterized by a higher risk of several common, age-related health problems, even after adjustment for established risk factors. This expert opinion report aims at identifying the optimal biomarkers for monitoring the structural integrity and function of physiological systems at risk across aging in HIV-seropositive subjects. These biomarkers, readily available locally and relatively cost-effective for clinicians in primary and secondary care, should allow early detection of the first preclinical structural and functional changes in renal, brain, cardiovascular, and skeleton systems or apparatus in HIV subjects across aging. A particular interest of this report is the definition of the concept of biomarker of the "organ functional reserve". This definition emphasizes the fact that some biomarkers for monitoring the molecular, structural and functional integrity of a given organ reflect a level of impairment that is basically irremediable despite effective pharmacological or nonpharmacological intervention.
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Affiliation(s)
- Massimo Andreoni
- Department of Medicine of Systems, Infectious Diseases, University of Rome "Tor Vergata", Rome, Italy
| | - Chiara Mussi
- Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena, and Reggio Emilia University, Modena, Italy
| | - Rita Bellagamba
- Clinical Department, National Institute for the Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
| | - Francesco Di Campli
- Infectious Diseases, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
| | - Vincenzo Montinaro
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology, University of Rome "La Sapienza", Rome, Italy
- IRCCS S. Raffaele Pisana, Rome, Italy
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Lancellotti G, Rontauroli C, Turrini E, Bertolotti M, Mussi C. Case of an old man with aortic dissection type A and enlarging meningioma. Aging Clin Exp Res 2017; 29:1071-1072. [PMID: 27914025 DOI: 10.1007/s40520-016-0690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/17/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Giulia Lancellotti
- Division of Geriatrics, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Tignale del Garda 9/2, 41125, Modena, Italy.
| | - Caterina Rontauroli
- Division of Geriatrics, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Tignale del Garda 9/2, 41125, Modena, Italy
| | | | - Marco Bertolotti
- Division of Geriatrics, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Tignale del Garda 9/2, 41125, Modena, Italy
| | - Chiara Mussi
- Division of Geriatrics, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Tignale del Garda 9/2, 41125, Modena, Italy
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Dondi G, Lancellotti G, Bertolotti M, Mussi C. The relationship between age and fat infiltration in liver and muscle. J Hepatol 2017; 67:881-883. [PMID: 28601674 DOI: 10.1016/j.jhep.2017.04.028] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 12/04/2022]
Affiliation(s)
- Giulia Dondi
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena and Reggio Emilia, Modena, Italy; Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giulia Lancellotti
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena and Reggio Emilia, Modena, Italy; Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Marco Bertolotti
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena and Reggio Emilia, Modena, Italy; Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
| | - Chiara Mussi
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena and Reggio Emilia, Modena, Italy; Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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Bertolotti M, Franchi C, Rocchi MBL, Miceli A, Libbra MV, Nobili A, Lancellotti G, Carulli L, Mussi C. Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Società Italiana di Medicina Interna) Study. Drugs Aging 2017; 34:311-319. [PMID: 28299634 DOI: 10.1007/s40266-017-0448-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. AIM The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. METHODS We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. RESULTS 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. CONCLUSIONS In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients' clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen.
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Affiliation(s)
- Marco Bertolotti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy. .,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy.
| | - Carlotta Franchi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Marco B L Rocchi
- Department of Biomolecular Sciences, University of Urbino, Urbino, Italy
| | - Andrea Miceli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy
| | - M Vittoria Libbra
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy
| | - Alessandro Nobili
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Giulia Lancellotti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy
| | - Lucia Carulli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy
| | - Chiara Mussi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy
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Turrini F, Scarlini S, Giovanardi P, Messora R, Roli L, Chester J, Mussi C, Bertolotti M, Trenti T, Bondi M. Effects of Cholecalciferol Supplementation in Patients with stable heart failure and LOw vITamin D levels (ECSPLOIT-D): a double-blind, randomized, placebo-controlled pilot study. Minerva Cardioangiol 2017; 65:553-562. [PMID: 28565886 DOI: 10.23736/s0026-4725.17.04340-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effects of vitamin D (VD) on the interaction among functional, echocardiographic and hormonal parameters in patients with heart failure (HF) and VD deficiency. METHODS In a randomized, double blind trial, 35 patients with HF and VD<20 ng/mL, received either 300,000 U of oral cholecalciferol followed by 50,000 U/month for 6 months, or placebo treatment. RESULTS Changes in the 6 Minute Walking Test (6MWT) assessed at 3 and 6 months in treatment group was the primary end point. Secondary endpoints were echocardiographic and hormonal changes. The same targets were compared in treated and placebo groups as secondary endpoints. In the treatment group the 6MWT improved at 3 (from 210±104 mt to 225±94 mt; P=0.033) but not at 6 months (from 210±104 mt to 217±94 mt; P=0.288) while PTH dropped at 3 (from 76.8±50.5 to 50.2±20.3 pg/mL; P=0.025), but not at 6 months. 6MWT improvement was negatively related to baseline VD levels. Variation in 6MWT did not significantly differ among groups at 3 (13.6±23.3 vs. 3.6±17.3; P 0.175) and 6 months (12.1±31.4 vs. 0.2±23.2; P 0.225). Left atrial size increased in the placebo group (from 50.8±20.7 to 61.7±36.0 mL/m2; P=0.010). Other hormonal parameters remained unchanged. CONCLUSIONS In summary, the treatment of VD deficiency in patients with HF improved 6MWT after 3 months along with a decrease in PTH levels. However when compared with the placebo arm, treatment of VD deficiency did not influence the final outcomes.
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Affiliation(s)
- Fabrizio Turrini
- Cardiovascular Medicine, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy -
| | - Stefania Scarlini
- Cardiovascular Medicine, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy
| | - Paolo Giovanardi
- Cardiovascular Medicine, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy
| | - Roberto Messora
- Cardiovascular Medicine, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy
| | - Laura Roli
- Department of Laboratory Medicine, Clinical Pathology-Toxicology, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy
| | - Johanna Chester
- Department of Laboratory Medicine, Clinical Pathology-Toxicology, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy
| | - Chiara Mussi
- Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy
| | - Marco Bertolotti
- Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy
| | - Tommaso Trenti
- Department of Laboratory Medicine, Clinical Pathology-Toxicology, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy
| | - Marco Bondi
- Cardiovascular Medicine, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy
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Ungar A, Ceccofiglio A, Pescini F, Mussi C, Tava G, Rafanelli M, Langellotto A, Marchionni N, van Dijk JG, Galizia G, Bonaduce D, Abete P. Syncope and Epilepsy coexist in 'possible' and 'drug-resistant' epilepsy (Overlap between Epilepsy and Syncope Study - OESYS). BMC Neurol 2017; 17:45. [PMID: 28241809 PMCID: PMC5330016 DOI: 10.1186/s12883-017-0822-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 08/10/2016] [Accepted: 02/16/2017] [Indexed: 01/23/2023] Open
Abstract
Background Differential diagnosis between syncope and epilepsy in patients with transient loss of consciousness of uncertain etiology is still unclear. Thus, the aim of the present work is to evaluate the prevalence of syncope in patients with “possible” or “drug-resistant” epilepsy. Methods The Overlap between Epilepsy and SYncope Study (OESYS) is a multicenter prospective observational study designed to estimate the prevalence of syncope in patients followed in Epilepsy Centers for “possible” or “drug-resistant” epilepsy and assessed according the European Society of Cardiology (ESC) guidelines of syncope diagnosis. Results One hundred seven patients were evaluated; 63 (58.9%) had possible and 44 (41.1%) drug-resistant epilepsy. A final diagnosis of isolated syncope was in 45 patients (42.1%), all with possible epilepsy (45/63, 71.4%). Isolated epilepsy was found in 21 patients (19.6%) and it was more frequent in the drug-resistant than in the possible epilepsy group (34.1% vs. 9.5%, p = 0.002). More importantly, syncope and epilepsy coexisted in 37.4% of all patients but the coexistence was more frequent among patients with drug-resistant than possible epilepsy (65.9% vs. 17.5%, p < 0.001). Conclusions Isolated syncope was diagnosed in ≈ 70% of patients with possible epilepsy. Syncope and epilepsy coexisted in ≈ 20% of patients with possible and in ≈ 60% of patients with drug-resistant epilepsy. These findings highlight the need of ESC guidelines of syncope approach in patients with possible and drug-resistant epilepsy.
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Affiliation(s)
- Andrea Ungar
- Department of Clinical and Experimental Medicine, Syncope Unit, Geriatric Cardiology and Medicine, University of Florence, Florence, Italy
| | - Alice Ceccofiglio
- Department of Clinical and Experimental Medicine, Syncope Unit, Geriatric Cardiology and Medicine, University of Florence, Florence, Italy
| | - Francesca Pescini
- Department of Neurological and Psychiatric Sciences, Epilepsy Center, University of Florence, Florence, Italy
| | - Chiara Mussi
- Geriatric and Gerontology Institute, University of Modena, Modena, Italy
| | - Gianni Tava
- Geriatric Unit, Santa Chiara Hospital, Trento, Italy
| | - Martina Rafanelli
- Department of Clinical and Experimental Medicine, Syncope Unit, Geriatric Cardiology and Medicine, University of Florence, Florence, Italy
| | | | - Niccolò Marchionni
- Department of Clinical and Experimental Medicine, Syncope Unit, Geriatric Cardiology and Medicine, University of Florence, Florence, Italy
| | - J Gert van Dijk
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gianlugi Galizia
- Istituti Clinici Scientifici Maugeri- Syncope unit - UOC Cure sub-acute, Milan, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini, 80131, Naples, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini, 80131, Naples, Italy.
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Guaraldi G, Menozzi M, Zona S, Calcagno A, Silva AR, Santoro A, Malagoli A, Dolci G, Mussi C, Mussini C, Cesari M, Khoo SH. Impact of polypharmacy on antiretroviral prescription in people living with HIV. J Antimicrob Chemother 2016; 72:511-514. [PMID: 27834193 DOI: 10.1093/jac/dkw437] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To evaluate the relationship between polypharmacy and ART, delivered as conventional multi-tablet three-drug regimens, single-tablet regimens or less-drug regimens (simplified mono or dual regimens). METHODS We conducted a cross-sectional analysis of electronic data from the prospective Modena HIV Metabolic Clinic Cohort Study. We included the last clinical observation for each patient from January 2006 to December 2015. Polypharmacy was defined as the use of five or more medications (excluding ART). Multi-morbidity was classified as the presence of two or more non-infectious comorbidities. Factors associated with different ART regimens were analysed using multivariable multinomial logistic regression analyses with multi-tablet three-drug regimens as the reference. RESULTS A total of 2944 patients (33.7% females) were included in the analysis. Multinomial logistic regression analysis identified polypharmacy to be negatively associated with single-tablet regimens [relative risk reduction (RRR) = 0.48, 95% CI = 0.28-0.81] independently from frailty (RRR = 0.68, 95% CI = 0.59-0.78), after correction for age, gender, HIV infection duration, current and nadir CD4 and calendar year. This association was not found comparing multi-tablet three-drug regimens and less-drug regimens. CONCLUSIONS Single-tablet regimens are less likely to be prescribed in patients with polypharmacy. Single-tablet regimens are perceived to be less flexible in patients with multi-morbidity and at higher risk of drug-drug interaction.
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Affiliation(s)
- Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Marianna Menozzi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Zona
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Ana R Silva
- Department Infectious Diseases, Hospital Beatriz Ângelo, Loures, Portugal
| | - Antonella Santoro
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Malagoli
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Dolci
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Mussi
- Geriatrics Division, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Saye H Khoo
- Institute of Translational Medicine, University of Liverpool & Royal Liverpool University Hospital, Liverpool, UK
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Toni G, Belvederi Murri M, Piepoli M, Zanetidou S, Cabassi A, Squatrito S, Bagnoli L, Piras A, Mussi C, Senaldi R, Menchetti M, Zocchi D, Ermini G, Ceresini G, Tripi F, Rucci P, Alexopoulos GS, Amore M. Physical Exercise for Late-Life Depression: Effects on Heart Rate Variability. Am J Geriatr Psychiatry 2016; 24:989-997. [PMID: 27660194 DOI: 10.1016/j.jagp.2016.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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] [Received: 02/07/2016] [Revised: 06/30/2016] [Accepted: 08/03/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Late-life major depression is associated with increased cardiovascular risk and impaired autonomic control of the heart, as evident from reduced heart rate variability (HRV). Moreover, antidepressant drug therapy also might be associated with further reductions of HRV. In the SEEDS study, we investigated whether sertraline associated with physical exercise protocols led to improvements of HRV, compared with antidepressant drug therapy alone. DESIGN Single-blind randomized controlled trial. SETTING Psychiatric consultation-liaison program for primary care. PARTICIPANTS Patients aged 65-85 years with major depression, recruited from primary care. INTERVENTIONS Sertraline plus structured, tailored group physical exercise (S + EX) versus sertraline alone (S) for 24 weeks. MEASUREMENTS HRV indices (RR, percentage of NN intervals greater than 50 msec [pNN50], square root of the mean squared differences of successive NN intervals [RMSSD], standard deviation of heart rate [SDHR], standard deviation of the NN interval [SDNN], high-frequency band [HF], low-frequency band [LF], and their ratio [LF/HF]) were measured at baseline, week 12, and week 24. Psychiatric and medical assessments. RESULTS Participants displayed significant improvements of most HRV indices over time, irrespective of the group assignment (pNN50, RMSSD, SDHR, SDNN, HF, LF, and LF/HF). Moreover, patients in the S + EX group displayed greater increases of different HRV indices(RR, pNN50, RMSSD, SDHR, SDNN, HF, and LF) compared with those in the S group. CONCLUSIONS The combination of structured physical exercise and sertraline might exert positive effects on the autonomic control of the heart among older patients with major depression.
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Affiliation(s)
- Giulio Toni
- Cardiology Unit, Ramazzini Hospital, Carpi, Italy
| | - Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics, and Infant-Maternal Science, University of Genoa, Genoa, Italy; Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK.
| | - Massimo Piepoli
- Heart Failure Unit, Cardiac Department, G. da Saliceto Polichirurgico Hospital, Piacenza, Italy
| | - Stamatula Zanetidou
- Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy
| | - Aderville Cabassi
- Cardiorenal Research Unit, Department of Clinical and Experimental Medicine, Parma University School of Medicine, Parma, Italy
| | - Salvatore Squatrito
- Department of Biomedical and Neuromotor Sciences, Section of Human and General Physiology, University of Bologna, Italy
| | - Luigi Bagnoli
- Primary Care Physicians in Private Practice, Bologna, Italy
| | - Alessandro Piras
- Department of Biomedical and Neuromotor Sciences, Section of Human and General Physiology, University of Bologna, Italy
| | - Chiara Mussi
- Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena, and Reggio Emilia University, Modena, Italy
| | | | - Marco Menchetti
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Donato Zocchi
- Primary Care Physicians in Private Practice, Bologna, Italy
| | | | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Endocrinology of Aging Unit, University of Parma, Italy
| | | | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Section of Human and General Physiology, University of Bologna, Italy
| | | | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics, and Infant-Maternal Science, University of Genoa, Genoa, Italy
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Cananzi FCM, Mussi C, Bordoni MG, Marrari A, De Sanctis R, Colombo P, Quagliuolo V. Role of surgery in the multimodal treatment of primary and recurrent leiomyosarcoma of the inferior vena cava. J Surg Oncol 2016; 114:44-49. [DOI: 10.1002/jso.24244] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
| | - Chiara Mussi
- Surgical Oncology Unit; Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Maria Grazia Bordoni
- Vascular Surgery Unit; Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Andrea Marrari
- Department of Oncology and Hematology; Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Rita De Sanctis
- Department of Oncology and Hematology; Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Piergiuseppe Colombo
- Department of Pathology; Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Vittorio Quagliuolo
- Surgical Oncology Unit; Humanitas Clinical and Research Center; Rozzano Milan Italy
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Ungar A, Mussi C, Ceccofiglio A, Bellelli G, Nicosia F, Bo M, Riccio D, Martone AM, Guadagno L, Noro G, Ghidoni G, Rafanelli M, Marchionni N, Abete P. Etiology of Syncope and Unexplained Falls in Elderly Adults with Dementia: Syncope and Dementia (SYD) Study. J Am Geriatr Soc 2016; 64:1567-73. [DOI: 10.1111/jgs.14225] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andrea Ungar
- Syncope Unit; Geriatric Cardiology and Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Chiara Mussi
- Centro di Valutazione e Ricerca Gerontologica; University of Modena and Reggio Emilia; Modena Italy
| | - Alice Ceccofiglio
- Syncope Unit; Geriatric Cardiology and Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Giuseppe Bellelli
- Department of Health Sciences; University of Milano Bicocca; Milan Italy
- Acute Geriatric Unit; San Gerardo Hospital; Monza Italy
- Milan Center for Neuroscience; Milan Italy
| | - Franco Nicosia
- Medicine and Geriatric Unit; Spedali Civili; Brescia Italy
| | - Mario Bo
- Struttura Complessa a Direzione Universitaria; Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Daniela Riccio
- Geriatric Department; SS. Trinità Hospital; Cagliari Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics; Catholic University of the Sacred Heart; Rome Italy
| | - Livia Guadagno
- Department of Translational Medical Sciences; University of Naples Federico II; Naples Italy
| | | | - Giulia Ghidoni
- Centro di Valutazione e Ricerca Gerontologica; University of Modena and Reggio Emilia; Modena Italy
| | - Martina Rafanelli
- Syncope Unit; Geriatric Cardiology and Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Niccolò Marchionni
- Syncope Unit; Geriatric Cardiology and Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences; University of Naples Federico II; Naples Italy
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Ungar A, Rivasi G, Rafanelli M, Toffanello G, Mussi C, Ceccofiglio A, McDonagh R, Drumm B, Marchionni N, Alboni P, Kenny RA. Safety and tolerability of Tilt Testing and Carotid Sinus Massage in the octogenarians. Age Ageing 2016; 45:242-8. [PMID: 26833302 DOI: 10.1093/ageing/afw004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 07/16/2015] [Accepted: 11/12/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE to evaluate the safety and tolerability of Tilt Testing (TT) and Carotid Sinus Massage (CSM) in octogenarians with unexplained syncope. METHODS patients consecutively referred for transient loss of consciousness to the 'Syncope Units' of three hospitals were enrolled. TT and CSM were performed according to the European Society of Cardiology guidelines on syncope. Complications were evaluated in each group. An early interruption of TT was defined as 'intolerance' and considered as a non-diagnostic response. RESULTS one thousand four hundred and one patients were enrolled (mean age 72 ± 16 years, male 40.8%). Six hundred and ninety-four patients (49.5%) were 80 years old or older (mean age 83 ± 3 years) and 707 (50.5%) were younger (mean age 60 ± 17 years). Complications after TT occurred in 4.5% of older patients and in 2.1% of the younger ones (P = 0.01). All complications were 'minor/moderate', as prolonged hypotension, observed in ∼3% of patients ≥80 years. Major complications such as sustained ventricular tachycardia, ventricular fibrillation, asystole requiring cardiac massage, transient ischaemic attack, stroke and death were not observed in any patient. The presence of orthostatic hypotension and the mean number of syncopal episodes were predictors of TT complications. Intolerance was reported in 2.4% of older patients and 1% of the younger ones (P = 0.08), mainly due to orthostatic intolerance. No complications occurred after CSM. CONCLUSIONS TT and CSM appear to be safe and well tolerated in octogenarians, who should not be excluded by age from the diagnostic work-up of syncope.
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Affiliation(s)
- Andrea Ungar
- Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy
| | - Giulia Rivasi
- Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy
| | - Martina Rafanelli
- Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy
| | - Giulia Toffanello
- Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy
| | - Chiara Mussi
- Geriatric and Gerontology Institute, University of Modena and Reggio Emilia, Modena, Italy
| | - Alice Ceccofiglio
- Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy
| | - Ruth McDonagh
- Department of Neurology, Trinity College, Dublin, Ireland
| | - Breffni Drumm
- School of Medicine and Institute of Neuroscience, Trinity College, St James's Hospital, Dublin, Ireland
| | - Niccolò Marchionni
- Geriatric Cardiology and Medicine, University of Florence and Careggi Hospital, Florence, Italy
| | - Paolo Alboni
- Section of Cardiology and Syncope Unit, Ospedale Privato Quisisana, Ferrara, Italy
| | - Rose Anne Kenny
- School of Medicine and Institute of Neuroscience, Trinity College, St James's Hospital, Dublin, Ireland
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De Sanctis R, Marrari A, Marchetti S, Mussi C, Balzarini L, Lutman FR, Daolio P, Bastoni S, Bertuzzi AF, Quagliuolo V, Santoro A. Efficacy of trabectedin in advanced soft tissue sarcoma: beyond lipo- and leiomyosarcoma. Drug Des Devel Ther 2015; 9:5785-91. [PMID: 26604682 PMCID: PMC4629957 DOI: 10.2147/dddt.s92395] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective Trabectedin is effective in leiomyosarcoma and liposarcoma, especially the myxoid variant, related to the presence of the FUS-CHOP transcript. We evaluated the efficacy of trabectedin in specific subgroups of patients with soft tissue sarcomas (STS). Methods Seventy-two patients with advanced anthracycline-pretreated STS, who received trabectedin at a dose of 1.5 mg/m2 every 3 weeks by continuous 24-hour infusion, were retrospectively analyzed. Best response rate according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria and severe adverse events (AEs) according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE v4.02) were evaluated. Secondary endpoints included progression-free survival and overall survival (OS). Results Median age was 48 (range, 20–75) years, with a median Eastern Cooperative Oncology Group performance status of 0. The median number of previous chemotherapy regimens was 1 (range, 0–5). Median number of trabectedin cycles was 3 (range, 1–17). About 69/72 patients (95.8%) were evaluable for response: 9 patients (13%) achieved partial response and 26 (37.7%) stable disease. According to histotype, clinical benefit (partial response + stable disease) was reported in synovial sarcoma (n=5), retroperitoneal liposarcoma (n=10), myxoid liposarcoma (n=5), leiomyosarcoma (n=8), high-grade undifferentiated pleomorphic sarcoma (n=5), Ewing/peripheral primitive neuroectodermal tumor (n=1), and malignant peripheral nerve sheath tumor (n=1). Any grade AEs were noncumulative, reversible, and manageable. G3/G4 AEs included anemia (n=1, 1.4%), neutropenia (n=7, 9.6%), liver toxicity (n=6, 8.3%), and fatigue (n=2, 2.8%). With a median follow-up time of 11 (range, 2–23) months, median progression-free survival and OS of the entire cohort were 2.97 months and 16.5 months, respectively. Conclusion Our experience confirms trabectedin as an effective therapeutic option for metastatic lipo- and leiomyosarcoma and suggests promise in synovial sarcomas and high-grade undifferentiated pleomorphic sarcoma.
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Affiliation(s)
- Rita De Sanctis
- Department of Medical Oncology and Haematology, Humanitas Cancer Center, IRCCS, Rozzano, Italy
| | - Andrea Marrari
- Department of Medical Oncology and Haematology, Humanitas Cancer Center, IRCCS, Rozzano, Italy
| | - Silvia Marchetti
- Department of Medical Oncology and Haematology, Humanitas Cancer Center, IRCCS, Rozzano, Italy
| | - Chiara Mussi
- Department of Surgical Oncology, Humanitas Cancer Center, IRCCS, Rozzano, Italy
| | - Luca Balzarini
- Department of Radiology, Humanitas Cancer Center, IRCCS, Rozzano, Italy
| | | | - Primo Daolio
- Department of Surgical Oncology, Orthopaedic Institute "G. Pini", Milan, Italy
| | - Stefano Bastoni
- Department of Surgical Oncology, Orthopaedic Institute "G. Pini", Milan, Italy
| | - Alexia Francesca Bertuzzi
- Department of Medical Oncology and Haematology, Humanitas Cancer Center, IRCCS, Rozzano, Italy ; Department of Medical Oncology, Adelaide and Meath Hospital, Incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Vittorio Quagliuolo
- Department of Surgical Oncology, Humanitas Cancer Center, IRCCS, Rozzano, Italy
| | - Armando Santoro
- Department of Medical Oncology and Haematology, Humanitas Cancer Center, IRCCS, Rozzano, Italy
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Bagnoli PF, Cananzi FCM, Brocchi A, Ardito A, Strada D, Cozzaglio L, Mussi C, Brusa S, Carlino C, Borrelli B, Alemanno F, Quagliuolo V. Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability. Eur J Surg Oncol 2014; 41:386-91. [PMID: 25554680 DOI: 10.1016/j.ejso.2014.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 09/05/2014] [Revised: 11/21/2014] [Accepted: 12/09/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Malignancies of the peritoneum remain a challenge in any hospital that accepts to manage them, due not only to difficulties associated with the complexity of the procedures involved but also the costs, which - in Italy and other countries that use a diagnosis-related group (DRG) system - are not adequately reimbursed. MATERIAL AND METHODS We analyzed data relative to 24 patients operated on between September 2010 and May 2013 with special regard to operating room expenditure, ICU stay, duration of hospitalization, and DRG reimbursement. The total costs per patient included clinical, operating room, procedure, pathology, imaging, ward care, allied healthcare, pharmaceutical, and ICU costs. RESULTS Postoperative hospital stay, drugs and materials, and operating room occupancy were the main factors affecting the expenditure for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. We had a median hospitalization of 14 days, median ICU stay of 2.4 days, and median operating room occupancy of 585 min. The median expenditure for each case was € 21,744; the median reimbursement by the national health system € 8,375. CONCLUSIONS In a DRG reimbursement system, the economic effort in the management of patients undergoing peritonectomy procedures may not be counterbalanced by adequate reimbursement. Joint efforts between medical and administration parties are mandatory to develop appropriate treatment protocols and keep down the costs.
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Affiliation(s)
- Pietro F Bagnoli
- Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
| | - F C M Cananzi
- Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - A Brocchi
- Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - A Ardito
- Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - D Strada
- Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - L Cozzaglio
- Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - C Mussi
- Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - S Brusa
- Department of Anesthesiology and Intensive Care Unit, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - C Carlino
- Department of Anesthesiology and Intensive Care Unit, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - B Borrelli
- Management Control Unit, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - F Alemanno
- Management Control Unit, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - V Quagliuolo
- Department of Cancer Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
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Bertolotti M, Lonardo A, Mussi C, Baldelli E, Pellegrini E, Ballestri S, Romagnoli D, Loria P. Nonalcoholic fatty liver disease and aging: Epidemiology to management. World J Gastroenterol 2014; 20:14185-14204. [PMID: 25339806 PMCID: PMC4202348 DOI: 10.3748/wjg.v20.i39.14185] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/17/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic (nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifestations and complications (cardiovascular disease, extrahepatic neoplasms) than in younger age groups. Therefore, proper identification and management of this condition is a major task for clinical geriatricians and geriatric hepatologists. In this paper, the epidemiology and pathophysiology of this condition are reviewed, and a full discussion of the link between NAFLD and the aspects that are peculiar to elderly individuals is provided; these aspects include frailty, multimorbidity, polypharmacy and dementia. The proper treatment strategy will have to consider the peculiarities of geriatric patients, so a multidisciplinary approach is mandatory. Non-pharmacological treatment (diet and physical exercise) has to be tailored individually considering the physical limitations of most elderly people and the need for an adequate caloric supply. Similarly, the choice of drug treatment must carefully balance the benefits and risks in terms of adverse events and pharmacological interactions in the common context of both multiple health conditions and polypharmacy. In conclusion, further epidemiological and pathophysiological insight is warranted. More accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach for individual elderly patients.
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Pioli G, Barone A, Mussi C, Tafaro L, Bellelli G, Falaschi P, Trabucchi M, Paolisso G. The management of hip fracture in the older population. Joint position statement by Gruppo Italiano Ortogeriatria (GIOG). Aging Clin Exp Res 2014; 26:547-53. [PMID: 24566982 DOI: 10.1007/s40520-014-0198-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
Abstract
This document is a Joint Position Statement by Gruppo Italiano di OrtoGeriatria (GIOG) supported by Società Italiana di Gerontologia e Geriatria (SIGG), and Associazione Italiana Psicogeriatria (AIP) on management of hip fracture older patients. Orthogeriatric care is at present the best model of care to improve results in older patients after hip fracture. The implementation of orthogeriatric model of care, based on the collaboration between orthopaedic surgeons and geriatricians, must take into account the local availability of resources and facilities and should be integrated into the local context. At the same time the programme must be based on the best available evidences and planned following accepted quality standards that ensure the efficacy of the intervention. The position paper focused on eight quality standards for the management of hip fracture older patients in orthogeriatric model of care. The GIOG promotes the development of a clinic database with the aim of obtaining a qualitative improvement in the management of hip fracture.
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Bellera CA, Penel N, Ouali M, Bonvalot S, Casali PG, Nielsen OS, Delannes M, Litière S, Bonnetain F, Dabakuyo TS, Benjamin RS, Blay JY, Bui BN, Collin F, Delaney TF, Duffaud F, Filleron T, Fiore M, Gelderblom H, George S, Grimer R, Grosclaude P, Gronchi A, Haas R, Hohenberger P, Issels R, Italiano A, Jooste V, Krarup-Hansen A, Le Péchoux C, Mussi C, Oberlin O, Patel S, Piperno-Neumann S, Raut C, Ray-Coquard I, Rutkowski P, Schuetze S, Sleijfer S, Stoeckle E, Van Glabbeke M, Woll P, Gourgou-Bourgade S, Mathoulin-Pélissier S. Guidelines for time-to-event end point definitions in sarcomas and gastrointestinal stromal tumors (GIST) trials: results of the DATECAN initiative (Definition for the Assessment of Time-to-event Endpoints in CANcer trials)†. Ann Oncol 2014; 26:865-872. [PMID: 25070543 DOI: 10.1093/annonc/mdu360] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 01/30/2014] [Accepted: 07/23/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The use of potential surrogate end points for overall survival, such as disease-free survival (DFS) or time-to-treatment failure (TTF) is increasingly common in randomized controlled trials (RCTs) in cancer. However, the definition of time-to-event (TTE) end points is rarely precise and lacks uniformity across trials. End point definition can impact trial results by affecting estimation of treatment effect and statistical power. The DATECAN initiative (Definition for the Assessment of Time-to-event End points in CANcer trials) aims to provide recommendations for definitions of TTE end points. We report guidelines for RCT in sarcomas and gastrointestinal stromal tumors (GIST). METHODS We first carried out a literature review to identify TTE end points (primary or secondary) reported in publications of RCT. An international multidisciplinary panel of experts proposed recommendations for the definitions of these end points. Recommendations were developed through a validated consensus method formalizing the degree of agreement among experts. RESULTS Recommended guidelines for the definition of TTE end points commonly used in RCT for sarcomas and GIST are provided for adjuvant and metastatic settings, including DFS, TTF, time to progression and others. CONCLUSION Use of standardized definitions should facilitate comparison of trials' results, and improve the quality of trial design and reporting. These guidelines could be of particular interest to research scientists involved in the design, conduct, reporting or assessment of RCT such as investigators, statisticians, reviewers, editors or regulatory authorities.
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Affiliation(s)
- C A Bellera
- Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Centre, Bordeaux; Clinical Epidemiology Unit, INSERM CIC 14.01 (Clinical Epidemiology), Bordeaux.
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Comprehensive Cancer Centre, Lille, France
| | - M Ouali
- Department of Biostatistics, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Biostatistics Unit, Institut Claudius Regaud, Comprehensive Cancer Centre, Toulouse
| | - S Bonvalot
- Department of Surgery, Institut Gustave Roussy, Comprehensive Cancer Centre, Villejuif, France
| | - P G Casali
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - O S Nielsen
- Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - M Delannes
- Department of Radiotherapy, Institut Claudius Régaud, Comprehensive Cancer Center, Toulouse
| | - S Litière
- Department of Biostatistics, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - F Bonnetain
- Methodological and Quality of Life Unit in Oncology (EA3181), CHU Besançon, Besançon
| | - T S Dabakuyo
- Biostatistics and Quality of Life Unit (EA4184), Centre Georges-François Leclerc, Comprehensive Cancer Centre, Dijon, France
| | - R S Benjamin
- Division of Cancer Medicine and Sarcoma Center, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - J-Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Comprehensive Cancer Centre, Lyon; Claude Bernard Lyon I University, Lyon; Medical Oncology Unit, Edouard Herriot Hospital, Lyon
| | - B N Bui
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
| | - F Collin
- Department of Biology and Pathology, Centre Georges-François Leclerc, Comprehensive Cancer Centre, Dijon, France
| | - T F Delaney
- Department of Radiation Oncology and Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, USA
| | - F Duffaud
- Department of Medical Oncology, La Timone Hospital University, Marseille, France
| | - T Filleron
- Biostatistics Unit, Institut Claudius Regaud, Comprehensive Cancer Centre, Toulouse
| | - M Fiore
- Department of Surgery and Sarcoma Unit, Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - H Gelderblom
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - S George
- Department of Medical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - R Grimer
- Royal Orthopaedic Hospital NHS Trust, Birmingham, UK
| | - P Grosclaude
- Cancer Registry of Tarn, Institut Claudius Regaud, Comprehensive Cancer Centre, Toulouse, France
| | - A Gronchi
- Department of Surgery and Sarcoma Unit, Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Haas
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - P Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, Mannheim
| | - R Issels
- Sarcoma Center, Ludwig-Maximilian University Munich, Munich; Department of Internal Medicine, Klinikum Grosshadern Medical Center, University of Munich, Munich, Germany
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
| | - V Jooste
- Burgundy Digestive Cancer Registry, INSERM U866, University of Burgundy, Dijon, France
| | - A Krarup-Hansen
- Department of Oncology, Herlev Hospital-University Copenhagen, Herlev, Denmark
| | - C Le Péchoux
- Department of Radiotherapy, Institut Gustave Roussy, Comprehensive Cancer Centre, Villejuif, France
| | - C Mussi
- Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - O Oberlin
- Department of Surgery and Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Comprehensive Cancer Centre, Villejuif
| | - S Patel
- Division of Cancer Medicine and Sarcoma Center, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - S Piperno-Neumann
- Department of Medical Oncology, Institut Curie, Comprehensive Cancer Centre, Paris, France
| | - C Raut
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Comprehensive Cancer Centre, Lyon
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - S Schuetze
- Department of Medical Oncology, University of Michigan, Ann Arbor, USA
| | - S Sleijfer
- Department of Medical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - E Stoeckle
- Department of Surgical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
| | - M Van Glabbeke
- Department of Biostatistics, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - P Woll
- Department of Oncology, Sheffield Cancer Research Centre, Weston Park Hospital, Sheffield, UK
| | - S Gourgou-Bourgade
- Montpellier Cancer Institute, Comprehensive Cancer Centre, Montpellier, France
| | - S Mathoulin-Pélissier
- Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Centre, Bordeaux; Clinical Epidemiology Unit, INSERM CIC 14.01 (Clinical Epidemiology), Bordeaux
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Bertolotti M, Mussi C, Pellegrini E, Magni A, Del Puppo M, Ognibene S, Carulli L, Anzivino C, Baldelli E, Loria P, Carulli N. Age-associated alterations in cholesterol homeostasis: evidence from a cross-sectional study in a Northern Italy population. Clin Interv Aging 2014; 9:425-32. [PMID: 24669190 PMCID: PMC3962317 DOI: 10.2147/cia.s57714] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The modifications of cholesterol metabolism associated with aging are ill-defined. The objective of this study was to define age-associated alterations of the different metabolic pathways controlling cholesterol homeostasis by analyzing circulating sterols. Methods We analyzed serum samples collected from 201 adult (75 male, 126 female) subjects within the epidemiological MICOL study (Multicentrica Italiana Colelitiasi). The age range was 38–79 years; 103 had evidence of gallstones. The concentrations of the different sterols, recognized as markers of the main pathways of cholesterol homeostasis, were analyzed by gas chromatography-mass spectrometry, including lathosterol (synthesis), campesterol and sitosterol (absorption), and 7α-hydroxy-4-cholesten-3-one (degradation to bile acids). Results A significant direct correlation was detected between age and cholesterol levels (r =0.34, P<0.01). The lathosterol/cholesterol ratio was lower in older age quartiles (P<0.05 by analysis of variance), with an inverse correlation between the lathosterol/cholesterol ratio and age (r=−0.32, P<0.01). Such correlation was particularly evident in females. The campesterol/cholesterol and sitosterol/cholesterol ratios were inversely correlated with aging in control, but not in gallstone patients. The levels of 7α-hydroxy-4-cholesten-3-one were not correlated with age. Conclusion These data show a reduction of cholesterol synthesis with aging which is associated with increased circulating cholesterol levels. The finding might be related to a reduced metabolic need for cholesterol in advancing age, leading to a downregulation of the main mechanisms of cholesterol intake in the liver. A different age-related behavior was observed in gallstone-free versus gallstone patients regarding cholesterol absorption. The possible implications in terms of the pharmacological management of hypercholesterolemia in the elderly remain to be defined.
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Affiliation(s)
- Marco Bertolotti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Mussi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Pellegrini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Magni
- Department of Health Sciences, University of Milano Bicocca, Monza, Italy
| | - Marina Del Puppo
- Department of Health Sciences, University of Milano Bicocca, Monza, Italy
| | - Silvia Ognibene
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucia Carulli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Anzivino
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrica Baldelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Loria
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Carulli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Gronchi A, Colombo C, Le Péchoux C, Dei Tos AP, Le Cesne A, Marrari A, Penel N, Grignani G, Blay JY, Casali PG, Stoeckle E, Gherlinzoni F, Meeus P, Mussi C, Gouin F, Duffaud F, Fiore M, Bonvalot S. Sporadic desmoid-type fibromatosis: a stepwise approach to a non-metastasising neoplasm--a position paper from the Italian and the French Sarcoma Group. Ann Oncol 2014; 25:578-583. [PMID: 24325833 PMCID: PMC4433504 DOI: 10.1093/annonc/mdt485] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [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: 08/28/2013] [Revised: 09/18/2013] [Accepted: 09/19/2013] [Indexed: 12/24/2022] Open
Abstract
Desmoid-type fibromatosis (DF) is a rare locally aggressive monoclonal proliferation of myofibroblasts lacking metastatic capacity. It may be observed in nearly every part of the body. Considering the variable clinical presentations, anatomic locations, and biologic behaviors, an individualized treatment approach is required. The pathogenesis of DF is not completely understood even if a high prevalence (∼85%) of CTNNB1 mutations discovered in sporadic DF underlies the importance of the Wnt/β-catenin pathway. No established and evidence-based approach for the treatment of this neoplasm is available as of today. Considering the unpredictable behavior and the heterogeneity of this disease, we propose a treatment algorithm approved by the French and the Italian Sarcoma Group, based on a front-line wait and see approach and subsequent therapy in the case of progression. A careful counseling at a referral center is mandatory and should be offered to all patients affected by sporadic DF from the time of their diagnosis.
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Affiliation(s)
- A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - C Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C Le Péchoux
- Department of Radiation Oncology, Institute Gustave Roussy, Villejuif, France
| | - A P Dei Tos
- Department of Pathology, Treviso General Hospital, Treviso, Italy
| | - A Le Cesne
- Department of Cancer Medicine, Institute Gustave Roussy, Villejuif, France
| | - A Marrari
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - N Penel
- Department of General Oncology, Centre Oscar Lambret, Lille, France
| | - G Grignani
- Department of Cancer Medicine, Institute for Cancer Research and Treatment at Candiolo, Torino, Italy
| | - J Y Blay
- Department of Cancer Medicine, Centre Leon Berard, Lyon
| | - P G Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Stoeckle
- Department of Surgery, Institut Bergonié, Regional Cancer Centre, Bordeaux, France
| | - F Gherlinzoni
- Department of Orthopedics, Gorizia General Hospital, Gorizia, Italy
| | - P Meeus
- Department of Surgery, Centre Leon Berard, Lyon, France
| | - C Mussi
- Department of Surgery, Humanitas Cancer Center, Rozzano, Italy
| | - F Gouin
- Department of Orthopedics, Centre Hospitalier Universitaire, Nantes
| | - F Duffaud
- Department of Medical Oncology, Marseille and Aix-Marseille University, Marseille
| | - M Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Bonvalot
- Department of Surgery, Institute Gustave Roussy, Villejuif, France
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Ungar A, Rafanelli M, Cellai T, Ceccofiglio A, Del Rosso A, Mussi C, Marchionni N. Poor diagnostic performance of tilt testing in hypertensive patients with unexplained syncope. J Hum Hypertens 2013; 28:259-62. [PMID: 24132139 DOI: 10.1038/jhh.2013.95] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 08/29/2013] [Accepted: 08/30/2013] [Indexed: 11/09/2022]
Abstract
Syncope is a common condition. Tilt testing with sublingual nitroglycerin (TT-TNT) provides a test with good specificity and positivity rate in young and old patients. Its use in hypertensive patients with unexplained syncope has not been validated. The aims of this study were to evaluate the positivity rate, specificity and tolerability of TT-TNT in hypertensive patients with unexplained syncope. Five hundred and ten subjects (mean age 55 years) were enrolled, 388 patients with unexplained syncope (73 hypertensive and 315 normotensive) and 122 controls (59 hypertensive and 63 normotensive). All subjects underwent TT-TNT. The responses were classified as positive, negative or exaggerated (aspecific). In hypertensive patients, the usual hypotensive therapy was taken on the day of the test. In hypertensive controls, the positive responses were higher than in normotensives (19% vs 6%, P<0.001). The overall specificity was 81% in hypertensives and 94% in normotensives. The positivity rate was significantly lower in hypertensives (55% vs 72%, P<0.03). There was no significant difference between young patients and patients >65 years. TT was well tolerated, and no serious side effects occurred. TT potentiated with TNT has a lower positivity rate and specificity in hypertensive than in normotensive patients with syncope.
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Affiliation(s)
- A Ungar
- 1] Syncope Unit, Cardiology and Geriatric Medicine, University of Florence, Florence, Italy [2] Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - M Rafanelli
- 1] Syncope Unit, Cardiology and Geriatric Medicine, University of Florence, Florence, Italy [2] Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - T Cellai
- 1] Syncope Unit, Cardiology and Geriatric Medicine, University of Florence, Florence, Italy [2] Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - A Ceccofiglio
- 1] Syncope Unit, Cardiology and Geriatric Medicine, University of Florence, Florence, Italy [2] Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - A Del Rosso
- Division of Cardiology, Ospedale San Giuseppe, Empoli, Italy
| | - C Mussi
- Geriatric and Gerontology Institute, University of Modena, Modena, Italy
| | - N Marchionni
- 1] Syncope Unit, Cardiology and Geriatric Medicine, University of Florence, Florence, Italy [2] Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Mussi C, Venturelli F, Finelli M, Neviani F, Martini E, Scotto R, Vedele C, Patti C, Lancellotti G, Bertolotti M, Neri M. Hypertensive disease in the elderly: Predictors of clinical evolution in a follow-up study. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.667] [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: 11/30/2022]
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Scarlini S, Turrini F, Giovanardi P, Messora R, Roli L, Mussi C, Bertolotti M, Trenti T, Loria P, Bondi M. Effects of cholecalciferol supplementation in patients with low vitamin D levels and chronic heart failure - a randomized double blind controlled trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3328] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mussi C. Postoperative delirium: diagnostic evaluation and treatment. Ital J Med 2013. [DOI: 10.4081/itjm.2007.4.9] [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: 11/23/2022] Open
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