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Winchell G, de Greef R, Ouerdani A, Fauchet F, Wrishko RE, Mangin E, Bruno C, Waskin H. A population pharmacokinetic model for posaconazole intravenous solution and oral powder for suspension formulations in pediatric patients with neutropenia. Antimicrob Agents Chemother 2024; 68:e0119723. [PMID: 38376229 PMCID: PMC10994819 DOI: 10.1128/aac.01197-23] [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: 09/18/2023] [Accepted: 12/15/2023] [Indexed: 02/21/2024] Open
Abstract
The objective of this study was to support posaconazole dose regimens in pediatric patients aged ≥2 years, using a population pharmacokinetic (PK) approach with data from a phase 1b study (NCT02452034). A one-compartment model with first-order absorption was fit to pharmacokinetic data from 144 participants aged 2 to 17 years, who were administered posaconazole as intravenous (IV) and powder for oral suspension (PFS) formulations, or IV only, at dosing regimens of 3.5, 4.5, and 6 mg/kg. The influence of demographic and clinical factors on pharmacokinetic parameters was evaluated using a stepwise forward inclusion/backward exclusion procedure. The final model simulated posaconazole exposure in patients aged 2 to <7 and 7 to 17 years at dosing regimens of 4.5, 6, and 7.5 mg/kg. Plasma concentration data following IV and PFS administration were well-described by a one-compartment model with first-order absorption and estimated bioavailability, where clearance and volume were subject to allometric scaling by body weight. The 6-mg/kg dosing regimen achieved the pharmacokinetic target (90% of the pediatric population having an average steady-state plasma concentration of ≥500 and <2,000 ng/mL) for both age groups, regardless of whether patients received IV and PFS or IV only. In a virtual adolescent population (body weight >40 kg), the 300 mg/day posaconazole tablet was also predicted to achieve the pharmacokinetic target and remain within a safe range of exposure. These data informed a weight-based nomogram for PFS dosing to maximize the number of pediatric patients achieving the pharmacokinetic target across weight bands, while also maintaining a favorable benefit/risk profile.
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Mancini F, Di Nicuolo F, Teveroni E, Vergani E, Bianchetti G, Bruno C, Grande G, Iavarone F, Maulucci G, De Spirito M, Urbani A, Pontecorvi A, Milardi D. Combined evaluation of prolactin-induced peptide (PIP) and extracellular signal-regulated kinase (ERK) as new sperm biomarkers of FSH treatment efficacy in normogonadotropic idiopathic infertile men. J Endocrinol Invest 2024; 47:455-468. [PMID: 37480475 DOI: 10.1007/s40618-023-02161-w] [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: 05/14/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Nearly, 40% of the causes of male infertility remain idiopathic. The only suggested treatment in idiopathic oligo- and/or asthenozoospermia in normogonadotropic patients is the FSH. In the current clinical practice, efficacy is exclusively assessable through semen analysis after 3 months of treatment. No molecular markers of treatment efficacy are appliable in clinical practice. The aim of the present work is to evaluate the combination of extracellular signal regulated kinase (ERK) 1 and 2 and prolactin inducible peptide (PIP) as potential markers of idiopathic infertility and FSH treatment efficacy. METHODS Western blot and confocal microscopy were performed to analyze the modulation of PIP and ERK1/2 in idiopathic infertile patients (IIP) sperm cells. Taking advantage of mass spectrometry analysis, we identified these proteins unequivocally in sperm cells. RESULTS We demonstrated a significant decrease of both PIP protein and of ERK1/2 levels in spermatozoa obtained from IIP in comparison to healthy fertile patients (HFP). Conversely, we reported a significant increase of these markers comparing infertile patients before and after 3 months of FSH treatment. Importantly, this correlated with an increase in total number of sperm and sperm motility after FSH treatment. Finally, we identified of PIP and ERK2 proteins in sperm samples by proteomic analysis. CONCLUSIONS The combined evaluation of ERK1/2 and PIP proteins might represent a useful molecular marker to tailor FSH treatment in the management of male normogonadotropic idiopathic infertility.
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Affiliation(s)
- F Mancini
- International Scientific Institute Paul VI, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - F Di Nicuolo
- International Scientific Institute Paul VI, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E Teveroni
- International Scientific Institute Paul VI, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E Vergani
- Division of Endocrinology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Bianchetti
- Department of Neuroscience, Section of Biophysics, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Bruno
- Division of Endocrinology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Grande
- Unit of Andrology and Reproductive Medicine, University Hospital Padua, Padua, Italy
| | - F Iavarone
- Department of Laboratory and Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Maulucci
- Department of Neuroscience, Section of Biophysics, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M De Spirito
- Department of Neuroscience, Section of Biophysics, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Urbani
- Department of Laboratory and Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Pontecorvi
- International Scientific Institute Paul VI, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Division of Endocrinology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Milardi
- International Scientific Institute Paul VI, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Division of Endocrinology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Mancini A, Capobianco E, Bruno C, Vergani E, Nicolazzi M, Favuzzi AMR, Panocchia N, Meucci E, Mordente A, Silvestrini A. Non-thyroidal illness syndrome in chronic diseases: role of irisin as modulator of antioxidants. Eur Rev Med Pharmacol Sci 2023; 27:1582-1591. [PMID: 36876705 DOI: 10.26355/eurrev_202302_31401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Non-thyroidal-illness syndrome (NTIS) refers to condition found in chronic diseases that is an adaptive mechanism. However, oxidative stress is related to NTIS in a vicious circle, due to deiodinases alteration and negative effects of low T3 on antioxidant levels or activity. Muscle is one of the main targets of thyroid hormones and it can secrete a myokine named irisin, which is able to induce the browning of white adipose tissue, energy expenditure and protect against insulin resistance. Inconclusive data have been reported about irisin role in chronic diseases. Moreover, no correlation with antioxidants has been investigated. Therefore, we performed a case-control study with the primary endpoint to evaluate irisin levels in two models of NTIS, such as chronic heart failure (CHF) and chronic kidney disease (CKD) during haemodialytic treatment. The secondary endpoint was the correlation with total antioxidant capacity (TAC) to establish a possible role of irisin in the modulation of antioxidant systems. PATIENTS AND METHODS Three groups of subjects were enrolled. Group A included CHF patients (n=18; aged 70.22 ± 2.78 ys; BMI ± 27.75 ± 1.28 kg/m2); Group B included CKD patients (n=29; aged 67.03 ± 2.64; BMI 24.53 ± 1.01); finally, 11 normal subjects (Group C) have been enrolled as controls. Irisin has been evaluated by ELISA method and Total Antioxidant Capacity (TAC) by spectrophotometric method. RESULTS Irisin was significantly higher in Group B vs. A and C groups (Mean ± SEM: 20.18 ± 0.61 ng/ml vs. 2.77 ± 0.77 and 13.06 ± 0.56, respectively; p<0.05); a significant correlation between irisin and TAC was observed in group B. CONCLUSIONS These preliminary data suggest a possible role of irisin in the modulation of antioxidants in two chronic syndromes with low T3 (i.e., CHF and CKD) with differential pattern in these two models studied. Further insights are needed to confirm this pilot study, which could be the basis for a longitudinal investigation, to assess a prognostic role of irisin with possible therapeutic implications.
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Affiliation(s)
- A Mancini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
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Chibbaro S, Cornelius JF, Mallereau CH, Bruneau M, Zaed I, Visocchi M, Maduri R, Todeschi J, Bruno C, George B, Froelich S, Ganau M. Lateral Approach to the Cervical Spine to Manage Degenerative Cervical Myelopathy and Radiculopathy. Acta Neurochir Suppl 2023; 135:339-343. [PMID: 38153490 DOI: 10.1007/978-3-031-36084-8_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND The cervical lateral approach can enlarge the spinal canal and foramen to achieve an effective neural decompression without needing spine stabilization. For this review, the authors' main objective was to illustrate the rationale, advantages, disadvantages, complications, and pitfalls of this technique, highlighting also areas for future development. MATERIALS AND METHODS A Medline via PubMed database search was carried out by using both keywords, namely "cervical oblique corpectomy," "multilevel oblique corpectomy and foraminotomy," and "lateral vertebrectomy," and Medical Subject Headings (MeSH) terms from 1 January 1991, up to 31 December 2021. RESULTS The analyzed articles suggested that the use of such a technique has declined over time; only 29 clinical studies met all the inclusion criteria and were retained for data analysis, including 1200 patients undergoing such an approach for the management of degenerative cervical myelopathies (DCMs) or of radiculopathies. The main etiopathogeneses were cervical stenosis, degenerative disk disease, or a mix of them-78% of which had a favorable outcome; the most frequent complications were transient and permanent Horner syndrome in 13.6% and 9.2% of cases, respectively. Long-term stability was reported in 97% of patients. CONCLUSION Multilevel cervical oblique vertebrectomy and/or lateral foraminotomy allow wide neural structure decompression and optimal stability given that the physiological spinal motion is preserved.
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Affiliation(s)
- S Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - J F Cornelius
- Department of Neurosurgery, Duesseldorf University Hospital, Duesseldorf, Germany
| | - C H Mallereau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - M Bruneau
- Department of Neurosurgery, UZ Hospital Brussel, Jette, Belgium
| | - I Zaed
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - M Visocchi
- Department of Neurosurgery, Catholic University of Rome, Rome, Italy
| | - R Maduri
- Genolier Spine Care Center, Swiss Medical Network, Genolier, Switzerland
| | - J Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - C Bruno
- Department of Neurosurgery, Andria Bonomo Hospital, Andria, Italy
| | - B George
- Department of Neurosurgery, Lariboisiere University Hospital, Paris, France
| | - S Froelich
- Department of Neurosurgery, Lariboisiere University Hospital, Paris, France
| | - M Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
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Vergani E, Bruno C, Gavotti C, Oliva A, Currò D, Mancini A. Increased levels of plasma neudesin in adult growth hormone deficiency and their relationship with plasma liver-expressed antimicrobial peptide-2 levels: a cross-sectional study. J Endocrinol Invest 2022; 46:1187-1195. [PMID: 36495439 DOI: 10.1007/s40618-022-01974-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Adult growth hormone deficiency (aGHD) is characterized by an altered metabolic profile and increased cardiovascular risk. Neudesin is a newly discovered protein mainly secreted from adipose tissue and brain, under evaluation for its possible activity as a negative regulator of energy expenditure. Liver-expressed antimicrobial peptide (LEAP)-2 is a competitive antagonist of ghrelin on its receptor. An observational cross-sectional study was performed to test the hypothesis that plasma neudesin levels may be modified in aGHD. Given the role played in the energy balance, any possible relationships between neudesin, LEAP-2 and metabolic and anthropometric parameters were evaluated. SUBJECTS AND METHODS Thirty-eight patients were included: 18 aGHD patients (7 females and 11 males, aged 59.7 ± 2.6 years, BMI 30.2 ± 2.2 kg/m2); 20 healthy controls (12 females and 8 males, aged 47.1 ± 2.5 years, BMI 24.1 ± 0.9 kg/m2). All patients were evaluated for glucose, insulin, HOMA and QUICKI index, total/LDL/HDL cholesterol, triglycerides, uric acid, and IGF-1. Plasma neudesin, LEAP-2, and ghrelin were measured by ELISA. Fat mass was evaluated by DEXA. RESULTS Neudesin levels were significantly higher in aGHD versus controls. We confirmed the finding of significantly lower ghrelin levels and significantly higher LEAP-2/ghrelin ratio in aGHD patients and found a significant direct correlation between neudesin and LEAP-2 levels. A significant direct correlation between neudesin and fat mass percentage was found in the whole population. CONCLUSION These results suggest the onset of adaptive responses to an altered metabolic picture in aGHD. The changes in two distinct pathways that modulate food intake and the still limited knowledge about neudesin suggest future developments in this field.
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Affiliation(s)
- E Vergani
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - C Bruno
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - C Gavotti
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - A Oliva
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - D Currò
- Dipartimento di Sicurezza e Bioetica, Sezione di Farmacologia, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - A Mancini
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
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Khankhel ZS, Dillon RJ, Thosar M, Bruno C, Puzniak L. Ceftolozane/tazobactam for the treatment of bacteremia: a systematic literature review (SLR). Ann Clin Microbiol Antimicrob 2022; 21:42. [PMID: 36192782 PMCID: PMC9531517 DOI: 10.1186/s12941-022-00528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Bloodstream infections (BSIs), or bacteremia, are responsible for considerable disease burden. Increasing rates of antibiotic resistance and delays in selection of appropriate treatment lead to increased morbidity, mortality, and costs. Due to limitations of current standard treatments, especially for bacteremia caused by resistant pathogens, a systematic literature review (SLR) was conducted to understand the utilization of ceftolozane/tazobactam (C/T) in bacteremia. Methods Electronic database searches of EMBASE®, MEDLINE®, CCTR and Northern Lights, as well as hand searches of conference proceedings from the last two annual meetings (i.e., 2018, 2019) of the European Congress of Clinical Microbiological and Infectious Diseases (ECCMID) and the Infectious Diseases Society of America’s annual meeting (IDWeek) were conducted. A total of 23 studies reporting on patients with bacteremia receiving C/T were included in the review. Results Most studies were observational (k = 20 studies), though few interventional studies were also identified (k = 3). Heterogeneity was ubiquitous with respect to source of bacteremia (i.e., primary or secondary), source of infection (for secondary bacteremia), pathogen type, antibiotic resistance, C/T dose, and outcome definitions. This heterogeneity, along with limited data, and small sample sizes (n = 1 to 31) made it difficult to draw any substantial conclusions, though overall results were favorable to C/T with respect to the outcomes of interest. Nineteen studies reported clinical cure or success (primary bacteremia: k = 6, reported range: 33.3% to 100%; secondary bacteremia: k = 8, 60% to 100%; mixed/unspecified bacteremia: k = 10, 50% to 91.7%). Eight studies reported microbiological cure or eradication rates (primary: k = 3, all reporting 100%; secondary: k = 4, 68% to 80%; mixed/unspecified: k = 5, 60% to 80%). Thirteen studies reported mortality (primary: k = 4, 0% to 14%; secondary: k = 7, 0% to 100%; or mixed/unspecified bacteremia: k = 7, 0% to 51.6%). One study each also reported composite clinical response, relapse, hospital re-admission, and hospital length of stay. Conclusions Although the available evidence and observed trends for C/T in bacteremia should be interpreted with caution, the direction of effect would support the utilization of C/T for these difficult to treat infections. Future research should supplement the existing evidence by considering the impact of key treatment effect modifiers without contributing to the observed heterogeneity. Supplementary Information The online version contains supplementary material available at 10.1186/s12941-022-00528-0.
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Affiliation(s)
| | | | | | - C Bruno
- Merck & Co., Inc, Kenilworth, NJ, USA
| | - L Puzniak
- Merck & Co., Inc, Kenilworth, NJ, USA
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Fauque P, Frappier J, Barberet J, Bruno C, Cavalieri M, Braquehais N, Chamoy B, Brualla A, Bergelson N, Hickman C. Use of CHLOE-EQ to select embryos for transfer at the Cleavage stage: a pilot study using paired sibling embryos with known implantation. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2022]
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Bruno C, Alarcan H, El Idrissi H, Darrouzain F. Contamination inter-échantillon de THC et ses métabolites : à propos d’un cas réel en pédiatrie néonatale. Toxicologie Analytique et Clinique 2022. [DOI: 10.1016/j.toxac.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Sun Y, Fan J, Chen G, Chen X, Du X, Wang Y, Wang H, Sun F, Johnson MG, Bensaci M, Huntington JA, Bruno C. 110. A Phase 3, Multicenter, Double-blind, Randomized Clinical Trial to Evaluate the Efficacy and Safety of Ceftolozane/Tazobactam Plus Metronidazole Versus Meropenem in Chinese Participants With Complicated Intra-abdominal Infections. Open Forum Infect Dis 2021. [PMCID: PMC8643727 DOI: 10.1093/ofid/ofab466.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In China, the prevalence of infections due to multidrug-resistant gram-negative bacteria is high and additional treatment options for complicated intra-abdominal infections (cIAI) are needed. This study compared the efficacy and safety of ceftolozane/tazobactam (C/T) + metronidazole (MTZ) versus meropenem (MEM) + placebo (pbo) for the treatment of cIAI in adult Chinese participants. Methods This was a phase 3, double-blind study conducted at 21 centers in China (NCT03830333). Participants aged 18-75 years with cIAI requiring surgical intervention within 24 hours of study drug administration were stratified by site of infection and randomized 1:1 to receive 1.5 g C/T (1 g ceftolozane and 0.5 g tazobactam) + 0.5 g MTZ administered intravenously (IV) every 8 hours (q8h) or 1 g MEM + pbo administered IV q8h for 4-14 days. The primary endpoint was clinical cure at test of cure (TOC) in the clinically evaluable (CE) population. Secondary endpoints included rates of clinical cure, per-participant microbiologic response, per-pathogen microbiologic response, and adverse events (AE). Non-inferiority for clinical cure at TOC in the CE population was confirmed if the lower bound of the 2-sided 95% CI for the between-treatment difference in the clinical cure rate was larger than −12.5%. Results A total of 134 participants were randomized to each treatment group. Demographics and baseline characteristics were generally well balanced between treatment groups (Table 1). The median (range) age in the ITT population was 50 (18-75) years and 61% were men. The most frequent sites of infection were the appendix (C/T + MTZ, 50.0%; MEM + pbo, 49.3%) and gallbladder (C/T + MTZ, 27.6%; MEM + pbo, 29.1%). Overall, the most frequently isolated pathogens were Escherichia coli (61.4%) and Klebsiella pneumoniae (17.3%); few anaerobes were isolated (Table 1). C/T + MTZ was non-inferior to MEM + pbo for clinical cure in the CE population (C/T + MTZ, 95.2%; MEM + pbo, 93.1%; difference, 2.1% [95% CI, −4.7% to 8.8%]). Results for key secondary endpoints were comparable between treatment groups (Table 2). Rates of AEs were generally similar between treatment groups (Table 3). ![]()
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Conclusion C/T + MTZ was non-inferior to MEM + pbo in the treatment of adult Chinese participants with cIAI and demonstrated a favorable safety profile. Disclosures Xiaofei Chen, n/a, MSD, China (Employee) Xiaoling Du, n/a, MSD, China (Employee) Ye Wang, n/a, MSD, China (Employee) Hui Wang, n/a, MSD, China (Employee) Fang Sun, n/a, MSD, China (Employee) Matthew G. Johnson, MD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee) Mekki Bensaci, PhD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee) Jennifer A. Huntington, PharmD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee) Christopher Bruno, MD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee)
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Affiliation(s)
- Yihong Sun
- Zhongshan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Jia Fan
- Zhongshan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Gang Chen
- The First Hospital of Kunming, Kunming, Yunnan, China
| | | | | | - Ye Wang
- MSD, China, Shanghai, Shanghai, China
| | - Hui Wang
- MSD, China, Shanghai, Shanghai, China
| | - Fang Sun
- MSD, China, Shanghai, Shanghai, China
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Jackson CCA, Newland J, Dementieva N, Lonchar J, Su FH, Huntington JA, Bensaci M, Popejoy MW, Johnson MG, De Anda CS, Rhee EG, Bruno C. 1154. Safety and Efficacy of Ceftolozane/Tazobactam Plus Metronidazole Versus Meropenem in Pediatric Participants With Complicated Intra-abdominal Infection: A Phase 2, Randomized Clinical Trial. Open Forum Infect Dis 2021. [PMCID: PMC8643866 DOI: 10.1093/ofid/ofab466.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Ceftolozane/tazobactam (C/T), a cephalosporin–β-lactamase inhibitor combination, is approved for treatment of complicated urinary tract infections, complicated intra-abdominal infections (cIAI), and nosocomial pneumonia in adults. Safety and efficacy of C/T in pediatric participants with cIAI was assessed. Methods This phase 2 study (NCT03217136) compared C/T + metronidazole (MTZ) with meropenem (MEM) for treatment of cIAI. Age- and weight-adjusted dosing is summarized in Table 1. The primary objective was to evaluate the safety and tolerability of C/T + MTZ compared with MEM. A key secondary endpoint was clinical cure at end of treatment (EOT) and test of cure (TOC). Table 1. Summary of Dosing and Pharmacokinetic Sampling Schedule by Age Cohort ![]()
Results A total of 94 participants were randomized 3:1; 91 were treated with C/T + MTZ (n=70) or MEM (n=21) comprising the modified intent-to-treat (MITT) population. The clinically evaluable population included 78 participants at EOT (C/T + MTZ, n=59; MEM, n=19) and 77 participants at TOC (C/T + MTZ, n=58; MEM, n=19). The most common diagnosis and pathogen in the MITT population were complicated appendicitis (C/T + MTZ, 91.4%; MEM, 100%) and Escherichia coli (C/T + MTZ, 67.1%; MEM, 61.9%). The mean (SD) intravenous therapy/overall treatment duration was 6.4 (2.8)/9.3 (3.6) days and 5.8 (1.8)/9.0 (3.2) days for C/T + MTZ and MEM, respectively. In total, ≥1 adverse events (AE) occurred in 80.0% and 61.9% of participants receiving C/T + MTZ and MEM, respectively (Table 2), of which 18.6% and 14.3% were considered drug related. Serious AE occurred in 11.4% (8/70) and 0% (0/21) of participants receiving C/T + MTZ and MEM, respectively; none were considered drug related. No drug-related study drug discontinuations occurred. In the MITT population, rates of clinical cure for C/T + MTZ and MEM at EOT were 80.0% and 95.2%, and at TOC were 80.0% and 100%, respectively (Figure 1); 6 of the 14 failures for C/T + MTZ were indeterminate responses scored as endpoint failures per protocol. In the clinically evaluable (CE) population, rates of clinical cure for C/T + MTZ and MEM were 89.8% and 100% at EOT, and 89.7% and 100% at TOC, respectively (Figure 1). ![]()
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Conclusion C/T + MTZ was well tolerated in pediatric participants with cIAI, and rates of clinical success were high with C/T treatment. C/T is a promising new treatment option for children with cIAI. Disclosures Carl-Christian A. Jackson, MD, Merck & Co. Inc. (Shareholder) Julia Lonchar, MSc, Merck Sharp & Dohme Corp. (Employee, Shareholder) Feng-Hsiu Su, MPH, MBA, Merck Sharp & Dohme Corp. (Employee, Shareholder) Jennifer A. Huntington, PharmD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee) Mekki Bensaci, PhD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee) Myra W. Popejoy, PharmD, Merck Sharp & Dohme Corp. (Employee) Matthew G. Johnson, MD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee) Carisa S. De Anda, PharmD, Merck Sharp & Dohme Corp. (Employee, Shareholder) Elizabeth G. Rhee, MD, Merck Sharp & Dohme Corp (Employee, Shareholder) Christopher Bruno, MD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee)
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Affiliation(s)
| | | | - Natalia Dementieva
- Regional Children’s Hospital, Dnipropetrovsk, Dnipropetrovs’ka Oblast’, Ukraine
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Roilides E, Ashouri N, Bradley JS, Johnson MG, Lonchar J, Su FH, Huntington JA, Popejoy MW, Bensaci M, De Anda CS, Rhee EG, Bruno C. 1143. Safety and Efficacy of Ceftolozane/Tazobactam Versus Meropenem in Neonatal and Pediatric Participants With Complicated Urinary Tract Infection, Including Pyelonephritis: A Phase 2, Randomized, Clinical Trial. Open Forum Infect Dis 2021. [PMCID: PMC8643900 DOI: 10.1093/ofid/ofab466.1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Ceftolozane/tazobactam (C/T) is a cephalosporin–β-lactamase inhibitor combination approved to treat complicated urinary tract infections (cUTI), complicated intra-abdominal infections, and nosocomial pneumonia in adults. Safety and efficacy of C/T in neonatal and pediatric participants with cUTI was assessed. Methods This phase 2, randomized, double-blind study (NCT03230838) compared C/T with meropenem (MEM) for treatment of cUTI, including pyelonephritis in participants from birth to 18 years of age. Treatment duration was 7-14 days. After 3 days of intravenous therapy, optional oral step-down therapy was allowed. Participants were stratified and dosed by age group (Table 1). The primary objective was to evaluate the safety and tolerability of C/T compared with MEM, and key secondary end points included clinical response and per-participant microbiologic response at end of treatment (EOT) and test of cure (TOC). ![]()
Results Participants were randomized 3:1 and treated with C/T (n=100) or MEM (n=33). The microbiologic modified intent-to-treat population (mMITT) included 95 participants in the C/T (n=71) and MEM (n=24) arms; the most common reason for mMITT exclusion was lack of a qualifying baseline uropathogen (28.4%). Pyelonephritis was the most common baseline diagnosis (83.2%), and Escherichia coli was the most common qualifying baseline uropathogen (77.9%). Overall mean treatment duration was comparable in both arms (C/T, 10.2 days; MEM, 10.7); a total of 50 (70.4%) and 20 (83.3%) participants switched to optional oral step-down therapy in the C/T and MEM arms, respectively, both for a mean of approximately 6 days. The overall incidence of adverse events (AE; all and drug related), serious AE (SAE), and AE leading to discontinuation was comparable between C/T and MEM arms. There were no AE leading to death, drug-related SAE, or discontinuations due to drug-related AE or SAE (Table 2). For C/T and MEM, rates of clinical cure and microbiologic eradication at EOT and TOC were high (Figure). ![]()
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Conclusion In this study, C/T was well tolerated with a safety profile comparable to MEM and to the previously reported safety profile for C/T in adults with cUTI. C/T achieved high clinical cure and microbiologic eradication rates and is a potential new treatment option for children with cUTI. Disclosures Emmanuel Roilides, MD, PhD, FIDSA, FAAM, FESCMID, Merck Sharp & Dohme Corp. (Consultant, Grant/Research Support) Negar Ashouri, MD, Merck Sharp & Dohme Corp. (Grant/Research Support) Matthew G. Johnson, MD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee) Julia Lonchar, MSc, Merck Sharp & Dohme Corp. (Employee, Shareholder) Feng-Hsiu Su, MPH, MBA, Merck Sharp & Dohme Corp. (Employee, Shareholder) Jennifer A. Huntington, PharmD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee) Myra W. Popejoy, PharmD, Merck Sharp & Dohme Corp. (Employee) Mekki Bensaci, PhD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee) Carisa S. De Anda, PharmD, Merck Sharp & Dohme Corp. (Employee, Shareholder) Elizabeth G. Rhee, MD, Merck Sharp & Dohme Corp (Employee, Shareholder) Christopher Bruno, MD, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (Employee)
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Affiliation(s)
- Emmanuel Roilides
- Aristotle University and Hippokration General Hospital, Thessaloniki, Thessaloniki, Greece
| | | | - John S Bradley
- University of California San Diego, San Diego, California
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Panicucci C, Raffaghello L, Principi E, Baratto S, Pintus S, Antonini F, Zotto GD, Benzi A, Bruzzone S, Minetti C, Gazzerro E, Bruno C. LGMD. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chiriboga C, Bruno C, Duong T, Fischer D, Kirschner J, Mercuri E, Gerber M, Gorni K, Kletzl H, Carruthers I, Martin C, Warren F, Scoto M. SMA - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cardone N, Taglietti V, Kefi K, Periou P, Gitiaux C, Traverso M, Panicucci C, Baratto S, Authier J, Bruno C, Lafuste P, Fiorillo C, Relaix F, Malfatti E. DMD - BIOMARKERS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alonso-Pérez J, González-Quereda L, Bruno C, Panicucci C, Alavi A, Zanoteli E, Muelas N, Vilchez J, Dourado E, Kadem N, Umair M, Guglierir M, Marini-Bettolo C, Straub V, Diaz-Manera J. LGMD. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Panicucci C, Baratto S, Lizzia R, Tonin P, D'Amico A, Tasca G, Traverso M, Fiorillo C, Previtali S, Pegoraro E, Bruno C. LGMD. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.211] [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: 11/17/2022]
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Mancini A, Currò D, Cipolla C, Barini A, Bruno C, Vergani E, Di Segni C, Guidi F, Nicolotti N, Silvestrini A, Meucci E, Valentini P, Rossodivita AN. Evaluation of Kisspeptin levels in prepubertal obese and overweight children: sexual dimorphism and modulation of antioxidant levels. Eur Rev Med Pharmacol Sci 2021; 25:941-949. [PMID: 33577049 DOI: 10.26355/eurrev_202101_24663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Kisspeptin, neuropeptide involved in puberty beginning and regulation of pituitary-gonadal axis, has been shown to stimulate antioxidant defenses in murine models. Its levels are greater in females than males and also in obese prepubertal girls. Therefore, our aim was to evaluate sex-related differences in prepubertal obese patients and the relationships of Kisspeptin with metabolic/hormonal parameters. PATIENTS AND METHODS We studied Kisspeptin concentrations in 54 children (22 males and 32 females, Tanner stage 1), 5-12 ys, classified according to Cole's criteria into 17 overweight and 37 obese; 25 normal-weight children, aged 6-12 years, were studied as controls. We evaluated metabolic (glucose and insulin levels after oral glucose load, total- LDL- HDL-cholesterol, triglycerides, uric acid) and hormonal (fT3, fT4, TSH, IGF-1, leptin) parameters. Moreover, total antioxidant capacity (TAC) was evaluated by spectrophotometric method, using the system H202-metmyoglobin-ABTS. Kisspeptin levels were measured by RIA. RESULTS We did not find significant differences between obese and normal-weight children, but obese males presented significantly lower levels than females. Kisspeptin did not correlate with BMI, HOMA-IR, Insulin peak levels and TAC; a significant correlation was found between Kisspeptin and fT3 (r2=0.25; p=0.003) in the obese group; leptin levels, significantly greater in obese vs. overweight and control children, significantly correlated with TAC (r2=0.39; p=0.03). CONCLUSIONS These data suggest that both hormones could modulate antioxidants, Kisspeptin indirectly via influence on thyroid hormones, and Leptin by a direct effect. This mechanism seems to be sex-related, not attributable to peripheral steroid levels. Further studies can clarify the complex interrelationship between central and peripheral Kisspeptin secretion and oxidative stress in children obesity.
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Affiliation(s)
- A Mancini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
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Barberet J, Binquet C, Guilleman M, Doukani A, Choux C, Bruno C, Bourredjem A, Chapusot C, Bourc'his D, Duffourd Y, Fauque P. Do assisted reproductive technologies and in vitro embryo culture influence the epigenetic control of imprinted genes and transposable elements in children? Hum Reprod 2021; 36:479-492. [PMID: 33319250 DOI: 10.1093/humrep/deaa310] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 06/05/2020] [Revised: 09/10/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Do assisted reproductive technologies (ART) and in vitro embryo culture influence the epigenetic control of imprinted genes (IGs) and transposable elements (TEs) in children? SUMMARY ANSWER Significant differences in the DNA methylation of IGs or transposon families were reported between ART and naturally conceived children, but there was no difference between culture media. WHAT IS KNOWN ALREADY There is concern that ART may play a role in increasing the incidence of adverse health outcomes in children, probably through epigenetic mechanisms. It is crucial to assess epigenetic control, especially following non-optimal in vitro culture conditions and to compare epigenetic analyses from ART-conceived and naturally conceived children. STUDY DESIGN, SIZE, DURATION This follow-up study was based on an earlier randomized study comparing in vitro fertilization outcomes following the use of two distinct culture media. We compared the epigenetic profiles of children from the initial randomized study according to the mode of conception [i.e. ART singletons compared with those of a cohort of naturally conceived singleton children (CTL)], the type of embryo culture medium used [global medium (LifeGlobal) and single step medium (Irvine Scientific)] and the mode of in vitro fertilization (i.e. IVF versus ICSI). PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 57 buccal smears were collected from 7- to 8-year-old children. The DNA methylation profiles of four differentially methylated regions (DMRs) of IGs (H19/IGF2: IG-DMR, KCNQ1OT1: TSS-DMR, SNURF: TSS-DMR, and PEG3: TSS-DMR) and two TEs (AluYa5 and LINE-1) were first assessed by pyrosequencing. We further explored IGs and TEs' methylation changes through methylation array (Human MethylationEPIC BeadChip referred as EPIC array, Illumina). MAIN RESULTS AND THE ROLE OF CHANCE Changes in the IGs' DNA methylation levels were found in ART children compared to controls. DNA methylation levels of H19/IGF2 DMR were significantly lower in ART children than in CTL children [52% versus 58%, P = 0.003, false discovery rate (FDR) P = 0.018] while a significantly higher methylation rate was observed for the PEG3 DMR (51% versus 48%, P = 0.007, FDR P = 0.021). However, no differences were found between the culture media. After observing these targeted modifications, analyses were performed at wider scale. Again, no differences were detected according to the culture media, but imprinted-related DMRs overlapping promoter region near the genes major for the development (MEG3, BLCAP, and DLX5) were detected between the ART and CTL children. LIMITATIONS, REASONS FOR CAUTION The sample size could seem relatively small, but the high consistency of our results was ensured by the homogeneity of the cohort from the initial randomized study, the standardized laboratory techniques and the robust statistical analyses accounting for multiple testing. WIDER IMPLICATIONS OF THE FINDINGS Although this study did not report DNA methylation differences depending on the culture medium, it sheds light on epigenetic changes that could be observed in some children conceived by ART as compared to CTL children. The clinical relevance of such differences remains largely unknown, and it is still unclear whether such changes are due to some specific ART procedures and/or to parental infertility. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by funding from the Agence Nationale pour la Recherche ('CARE'-ANR JCJC 2017). The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER Not concerned.
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Affiliation(s)
- J Barberet
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD) INSERM UMR1231, Dijon, France.,CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction-CECOS, Dijon, France
| | - C Binquet
- CHU Dijon Bourgogne, Centre d'Investigation Clinique, module Epidémiologie Clinique/essais cliniques (CIC-EC), Dijon, France.,INSERM, CIC1432, module épidémiologie clinique, Dijon, France
| | - M Guilleman
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD) INSERM UMR1231, Dijon, France.,CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction-CECOS, Dijon, France
| | - A Doukani
- Faculté de Médecine Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
| | - C Choux
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD) INSERM UMR1231, Dijon, France.,CHU Dijon Bourgogne, Service de Gynécologie-Obstétrique, Dijon, France
| | - C Bruno
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD) INSERM UMR1231, Dijon, France.,CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction-CECOS, Dijon, France
| | - A Bourredjem
- CHU Dijon Bourgogne, Centre d'Investigation Clinique, module Epidémiologie Clinique/essais cliniques (CIC-EC), Dijon, France.,INSERM, CIC1432, module épidémiologie clinique, Dijon, France
| | - C Chapusot
- CHU Dijon Bourgogne, Plateforme de génétique des Cancers de bourgogne, Dijon, France
| | - D Bourc'his
- Institut Curie, PSL University, CNRS, INSERM, Paris, France
| | - Y Duffourd
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD) INSERM UMR1231, Dijon, France
| | - P Fauque
- Université Bourgogne Franche-Comté-Equipe Génétique des Anomalies du Développement (GAD) INSERM UMR1231, Dijon, France.,CHU Dijon Bourgogne, Laboratoire de Biologie de la Reproduction-CECOS, Dijon, France
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Bruno C, Veyrat-Durebex C, Lumbu Lukuntonda CH, Andres CR, Moreau C, Bendavid C, Homedan C, Labarthe F, Tardieu M, Bigot A, Maillot F, Benz-de Bretagne I, Blasco H. Validation of plasma amino acid profile using UHPLC-mass spectrometer (QDa) as a screening method in a metabolic disorders reference centre: Performance and accreditation concerns. Clin Biochem 2021; 92:34-45. [PMID: 33736999 DOI: 10.1016/j.clinbiochem.2021.03.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 02/23/2021] [Accepted: 03/06/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Amino acid (AA) analysis in plasma is essential for diagnosis and monitoring of inborn errors of metabolism (IEM). The efficacy of patient management is governed by the rapidity of AA profile availability, along with the robustness of the method. French quality guidelines and progress made in analytical techniques have led biologists to develop AA profile exploration via mass spectrometry (MS). OBJECTIVES The aim of this study was to validate an analytical method with a single quadrupole mass spectrometer (MS) and to suggest reference values in regard to French quality and IEM society recommendations. DESIGN AND METHODS Plasma samples from patients were deproteinised and derivatised with AccqTag™ reagent. Analysis was performed by reverse-phase chromatography coupled to QDA detector. We evaluated accuracy, intra-days and inter-days precision and limit of quantification by the β-expectation tolerance interval method for 27 AA. Method comparison was performed with the standard method (ion exchange chromatography, IEC) on Jeol Aminotac® and to tandem MS. Reference values were established on AA concentrations of the cohort of patients who had no IEM. RESULTS Our method allowed the separations of almost all amino acids with a total run time of 12 min. Separation of isoleucine and alloisoleucine was incomplete (R = 0.55) but without impact on biological interpretation. Precision, accuracy and quantification were satisfactory (intra-days coefficient of variation (CV) was <5%, inter-days precision CV <10% and accuracy <15%). The limits of quantification were validated between 1 and 900 µmol/L. Results were comparable between the new method and IEC. CONCLUSION Ultimately, we validated a rapid method on plasma for quantifying 27 amino acids that can be used in routine practice, according to French quality laboratories and SFEIM (French Society of Inborn Error of Metabolism) recommendations. Furthermore, estimated reference values were similar to those found in published studies focusing on other methods. Despite a lower specificity compared to tandem MS, the simplicity and rapidity of our method are the main advantage of this technique and place it as a major tool in IEM diagnosis and management.
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Affiliation(s)
- C Bruno
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U1253, équipe "neurogénomique et physiopathologie neuronale", Université de Tours, Tours, France; Centre de référence des maladies héréditaires de métabolisme - filière G2M, France.
| | - C Veyrat-Durebex
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U1253, équipe "neurogénomique et physiopathologie neuronale", Université de Tours, Tours, France; Centre de référence des maladies héréditaires de métabolisme - filière G2M, France
| | - C H Lumbu Lukuntonda
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Centre de référence des maladies héréditaires de métabolisme - filière G2M, France
| | - C R Andres
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U1253, équipe "neurogénomique et physiopathologie neuronale", Université de Tours, Tours, France; Centre de référence des maladies héréditaires de métabolisme - filière G2M, France
| | - C Moreau
- Laboratoire de biochimie-toxicologie, Hôpital Pontchaillou CHU Rennes, France; Université de Rennes, Inserm, Inra, Institut NuMeCan, CHU Rennes, France
| | - C Bendavid
- Laboratoire de biochimie-toxicologie, Hôpital Pontchaillou CHU Rennes, France
| | - C Homedan
- Laboratoire de biochimie et génétique, Centre hospitalier universitaire, Angers, France
| | - F Labarthe
- Service de Médecine pédiatrique, CHRU de Tours, Tours, France; UMR INSERM U 1069 - Nutrition, Croissance et Cancer (N2C), Université de Tours, Tours, France; Centre de référence des maladies héréditaires de métabolisme - filière G2M, France
| | - M Tardieu
- Service de Médecine pédiatrique, CHRU de Tours, Tours, France; Centre de référence des maladies héréditaires de métabolisme - filière G2M, France
| | - A Bigot
- Service de Médecine Interne, CHRU de Tours, Tours, France; Centre de référence des maladies héréditaires de métabolisme - filière G2M, France
| | - F Maillot
- Unité INSERM U1253, équipe "neurogénomique et physiopathologie neuronale", Université de Tours, Tours, France; Service de Médecine Interne, CHRU de Tours, Tours, France; Centre de référence des maladies héréditaires de métabolisme - filière G2M, France
| | - I Benz-de Bretagne
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U1253, équipe "neurogénomique et physiopathologie neuronale", Université de Tours, Tours, France; Centre de référence des maladies héréditaires de métabolisme - filière G2M, France
| | - H Blasco
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U1253, équipe "neurogénomique et physiopathologie neuronale", Université de Tours, Tours, France; Centre de référence des maladies héréditaires de métabolisme - filière G2M, France
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Bruno C, Fiori GM, Locatello LG, Cannavicci A, Gallo O, Maggiore G. The role of Narrow Band Imaging (NBI) in the diagnosis of sinonasal diseases. Rhinology 2021; 59:40-48. [PMID: 32628224 DOI: 10.4193/rhin20.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Narrow band imaging (NBI) endoscopy is an optical method that helps to characterise tissue vasculature. Its appli- cation in sinonasal pathology remains scarce and a systematic study of its application to rhinology is lacking. The aim of this study is to analyse and describe the normal sinonasal mucosa under NBI light and to characterise the microvascular features of various sinonasal pathologies. We also want to suggest a classification of the patterns, peculiar to this district, and to evaluate whether they can be indicative of a specific physiological or pathological condition. METHODS Digital videos and images under white light and NBI of 103 patients (82 evaluated) with 29 sinonasal pathologies and 55 controls (33 evaluated). were independently analysed by three otolaryngologists and the final pattern was then arranged for each image, reaching an agreement between the individual evaluations. RESULTS Once the appearance of normal sinonasal (SN) mucosa was established (SN1), four patterns for the pathological mucosa were described and a working classification was proposed (SN2, SN3, SN4, SN5). We calculated specificity (80.6% vs 90.6%), sensi- tivity (20% vs 38.5%), PPV (46.1% vs 50%), NPV (54.7% vs 85.7%) and accuracy (53% vs 80.3%) of the ability of SN4 and SN5 pattern to discriminate between benign and malignant nasal neoformations. CONCLUSIONS This is the first study to propose a systematic NBI description and a classification of the vasculature of healthy and pathological mucosa in the sinonasal tract. Our preliminary results show that this technique can help in the workup of several rhinologic conditions and especially in distinguishing benign from malignant tumors.
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Affiliation(s)
- C Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - G M Fiori
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - L G Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - A Cannavicci
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - O Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - G Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
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Johnson MG, Bruno C, Castanheira M, Yu B, Huntington JA, Carmelitano P, Rhee EG, De Anda C, Motyl M. Evaluating the emergence of nonsusceptibility among Pseudomonas aeruginosa respiratory isolates from a phase-3 clinical trial for treatment of nosocomial pneumonia (ASPECT-NP). Int J Antimicrob Agents 2021; 57:106278. [PMID: 33434676 DOI: 10.1016/j.ijantimicag.2021.106278] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/22/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The emergence of nonsusceptibility to ceftolozane/tazobactam and meropenem was evaluated among Pseudomonas aeruginosa (P. aeruginosa) lower respiratory tract isolates obtained from participants in the ASPECT-NP clinical trial. METHODS ASPECT-NP was a phase-3, randomised, double-blind, multicentre trial that demonstrated noninferiority of 3 g ceftolozane/tazobactam q8h versus 1 g meropenem q8h for treatment of ventilated hospital-acquired/ventilator-associated bacterial pneumonia. Molecular resistance mechanisms among postbaseline nonsusceptible P. aeruginosa isolates and clinical outcomes associated with participants with emergence of nonsusceptibility were examined. Baseline susceptible and postbaseline nonsusceptible P. aeruginosa isolate pairs from the same participant underwent molecular typing. RESULTS Emergence of nonsusceptibility was not observed among the 59 participants with baseline susceptible P. aeruginosa isolates in the ceftolozane/tazobactam arm. Among 58 participants with baseline susceptible P. aeruginosa isolates in the meropenem arm, emergence of nonsusceptibility was observed in 13 (22.4%). Among participants who received ceftolozane/tazobactam and meropenem, 5.1% and 3.4% had a new infection with a nonsusceptible strain, respectively. None of the isolates with emergence of nonsusceptibility to meropenem developed co-resistance to ceftolozane/tazobactam. The molecular mechanisms associated with emergence of nonsusceptibility to meropenem were decreased expression or loss of OprD and overexpression of MexXY. CONCLUSIONS Among participants with emergence of nonsusceptibility to meropenem, clinical outcomes were similar to overall clinical outcomes in the ASPECT-NP meropenem arm. Ceftolozane/tazobactam was more stable to emergence of nonsusceptibility versus meropenem; emergence of nonsusceptibility was not observed in any participants with baseline susceptible P. aeruginosa who received ceftolozane/tazobactam in ASPECT-NP.
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Affiliation(s)
| | | | | | - Brian Yu
- Merck & Co., Inc., Kenilworth, NJ, USA
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22
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Favuzzi AMR, Venuti A, Bruno C, Nicolazzi MA, Fuorlo M, Dajko M, De Waure C, Landolfi R, Mancini A. Hormonal deficiencies in heart failure with preserved ejection fraction: prevalence and impact on diastolic dysfunction: a pilot study. Eur Rev Med Pharmacol Sci 2021; 24:352-361. [PMID: 31957849 DOI: 10.26355/eurrev_202001_19933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In heart failure with reduced ejection fraction, catabolic mechanisms have a strong negative impact on mortality and morbidity. The relationship between anabolic hormonal deficiency, thyroid function, and heart failure with preserved ejection fraction (HFpEF) has still been poorly investigated. Therefore, we aimed to define the multi-hormonal deficiency prevalence in HFpEF patients and the relationships between hormonal deficiency and echocardiographic indexes. PATIENTS AND METHODS Plasma levels of N-terminal pro-brain natriuretic peptide, fasting glucose, thyroid-stimulating hormone, free triiodothyronine (T3), free thyroxine, insulin-like growth factor-1, dehydroepiandrosterone-sulfate (DHEA-S), total testosterone (only in male subjects) in 40 patients with HFpEF were evaluated. An echocardiographic evaluation was performed. RESULTS One (2.5%) patient (2.5%) had no hormonal deficiencies; 8 (20%) patients had deficits of one hormone, 18 patients (45%) of two axes, 12 patients (30%) of three axes, and one patient (2.5%) of all four axes. Among them, 97.5% had DHEA-S deficiency, 67.5% IGF-1 deficiency, 37% testosterone deficiency, 22.5% a "Low T3 syndrome", and 20% subclinical hypothyroidism. Patients with IGF-1 deficit showed higher left atrial volume values, systolic pulmonary artery pressure (SPAP), tricuspid peak velocity (TPV), and lower tricuspid annular plane systolic excursion (TAPSE) and TAPSE/SPAP ratio values. Patients with testosterone deficiency had higher SPAP and TPV. Patients with low T3 syndrome had higher value of right ventricular mid cavity diameter. Hormonal dysfunction was independent from the presence of comorbidities and no difference between male and female subjects was noted. CONCLUSIONS Multi-hormonal deficiencies are associated with right ventricular dysfunction and diastolic dysfunction in patients with HFpEF.
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Affiliation(s)
- A M R Favuzzi
- Division of Internal Medicine and Cardiovascular Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Dillon RJ, Khankhel ZS, De Anda C, Bruno C, Puzniak LA. 1596. Ceftolozane/tazobactam (Zerbaxa) for the Treatment of Pseudomonas aeruginosa (PSA) Bacteremia: A Systematic Literature Review (SLR). Open Forum Infect Dis 2020. [PMCID: PMC7778241 DOI: 10.1093/ofid/ofaa439.1776] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bacteremia is a significant cause of morbidity and mortality. Several studies have shown this burden to increase among patients with multidrug resistant (MDR) PSA, and in those treated with inappropriate empiric therapy. Ceftolozane/tazobactam (C/T) is a combination of a novel antipseudomonal cephalosporin and an established β-lactamase inhibitor approved for the treatment of complicated urinary tract infection, complicated intra-abdominal infection and hospital-acquired and ventilator-associated bacterial pneumonia. In the absence of specific bacteremia clinical trial data; the aim of this study is to describe all published evidence relating to C/T for the treatment of Gram negative bacteremia.
Methods
This SLR includes all published evidence from December 2015 to March 2020 searched via the OVID platform: EMBASE, MEDLINE, and MEDLINE In-Process. In addition, data published (2018-2019) from the European Society of Clinical Microbiology and Infectious Diseases and Infectious Disease Week Congresses were included. Eligible publications were on adult patients treated with C/T reporting any clinical outcome where data were reported specifically for the bacteremia population.
Results
The SLR identified 1,455 citations, of which 24 publications representing 23 unique studies met eligibility criteria. This included primary and secondary bacteremia. Ten studies included patients with primary bacteremia, only 7 of which reported results specific to primary bacteremia patients. Despite heterogeneity in study design, patient and treatment characteristics, and a lack of detailed reporting; the majority of studies focused on MDR/ extensively drug resistant (XDR) infections (range: 68.3%-100%). Clinical success/ cure ranged from 33%-100%, with 6/7 studies at >85%; 30-day mortality from 0%-67%, with 3/7 studies at 0% (Table 1).
Table 1. Clinical Outcomes reported among Primary Bacteremia population(s)
Conclusion
Although the number of C/T treated patients was small, favorable clinical outcomes were observed, even among highly resistant PSA infections. Heterogeneity was ubiquitous, with diverse and complex patient profiles identified. Further studies where outcomes are stratified by bacteremia status and by timing of C/T treatment are needed.
Disclosures
Ryan J. Dillon, MSc, Merck & Co., Inc., (Employee) Carisa De Anda, PharMD, Merck & Co Inc, (Employee) Christopher Bruno, MD, Merck & Co., Inc. (Employee) Laura A. Puzniak, PhD, Merck (Employee)
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24
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Sansone VA, Coratti G, Pera MC, Pane M, Messina S, Salmin F, Albamonte E, De Sanctis R, Sframeli M, Di Bella V, Morando S, d'Amico A, Frongia AL, Antonaci L, Pirola A, Pedemonte M, Bertini E, Bruno C, Mercuri E. Sometimes they come back: New and old spinal muscular atrophy adults in the era of nusinersen. Eur J Neurol 2020; 28:602-608. [PMID: 33012052 DOI: 10.1111/ene.14567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/24/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Following the commercial availability of nusinersen, there have been a number of new referrals of adults with spinal muscular atrophy (SMA) not regularly followed in tertiary-care centers or enrolled in any disease registry. METHODS We compared demographics and disease characteristics, including assessment of motor and respiratory function, in regularly followed patients and newcomers subdivided according to the SMA type. RESULTS The cohort included 166 adult patients (mean age: 37.09 years): one type I, 65 type II, 99 type III, and one type IV. Of these 166, there were 67 newcomers. There was no significant difference between newcomers and regularly followed patients in relation to age and disease duration. The Hammersmith Functional Motor Scale Expanded and Revised Upper Limb Module scores were higher in the regularly followed patients compared to newcomers in the whole cohort and in both SMA II and II. A difference was also found on ventilatory status (p = 0.013) and Cobb's angle >50° (p = 0.039) between the two subgroups. No difference was found in scoliosis surgery prevalence (p > 0.05). CONCLUSIONS Our results showed differences between the two subgroups, even if less marked in the type III patients. In the type II patients, there was a higher proportion of newcomers who were in the severe end of the spectrum. Of the newcomers, only approximately a third initiated treatment, as opposed to the 51% in the regularly followed patients. The identification of patients who were not part of the registries will help to redefine the overall prevalence of SMA and the occurrence of different phenotypes.
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Affiliation(s)
- V A Sansone
- The NEMO Center in Milan, Neurorehabilitation Unit, ASST Niguarda Hospital, University of Milan, Milan, Italy
| | - G Coratti
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M C Pera
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M Pane
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - S Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Nemo SUD Clinical Center, University Hospital 'G. Martino', Messina, Italy
| | - F Salmin
- The NEMO Center in Milan, Neurorehabilitation Unit, ASST Niguarda Hospital, University of Milan, Milan, Italy
| | - E Albamonte
- The NEMO Center in Milan, Neurorehabilitation Unit, ASST Niguarda Hospital, University of Milan, Milan, Italy
| | - R De Sanctis
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M Sframeli
- Nemo SUD Clinical Center, University Hospital 'G. Martino', Messina, Italy
| | - V Di Bella
- Nemo SUD Clinical Center, University Hospital 'G. Martino', Messina, Italy
| | - S Morando
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A d'Amico
- Department of Neurosciences, Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A L Frongia
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - L Antonaci
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A Pirola
- The NEMO Center in Milan, Neurorehabilitation Unit, ASST Niguarda Hospital, University of Milan, Milan, Italy
| | - M Pedemonte
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - E Bertini
- Department of Neurosciences, Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - C Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - E Mercuri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Chiriboga C, Bruno C, Duong T, Fischer D, Kirschner J, Mercuri E, Gerber M, Gorni K, Kletzl H, McIver T, Scalco R, Warren F, Scoto M. SMA – THERAPY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.272] [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: 11/26/2022]
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Barberet J, Bruno C, Valot E, Antunes-Nunes C, Jonval L, Chammas J, Choux C, Ginod P, Sagot P, Soudry-Faure A, Fauque P. Can novel early non-invasive biomarkers of embryo quality be identified with time-lapse imaging to predict live birth? Hum Reprod 2020; 34:1439-1449. [PMID: 31287145 PMCID: PMC6688874 DOI: 10.1093/humrep/dez085] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/24/2019] [Accepted: 05/07/2019] [Indexed: 01/31/2023] Open
Abstract
STUDY QUESTION Can time-lapse imaging systems make it possible to identify novel early non-invasive biomarkers to predict live birth? SUMMARY ANSWER From mostly high-grade embryos, out of 35 morphometric, morphologic and morphokinetic variables, only pronuclei (PN) position at time of PN juxtaposition and the absence of multinucleated blastomeres at the 2-cell stage (MNB2cell), were potentially associated with live birth. WHAT IS KNOWN ALREADY Previous studies indicate that some kinetic markers may be predictive of blastocyst development and embryonic implantation. Certain teams have suggested including some of them in decisional algorithms for embryo transfers. STUDY DESIGN, SIZE, DURATION Using a time-lapse incubator (EmbryoScope, Unisense FertiliTech), we retrospectively explored the associations between the morphometric, morphologic and morphokinetic parameters of oocytes, zygotes and embryos, and their associations with live birth. This study assessed 232 embryos from single embryo transfers after ICSI cycles performed between January 2014 and December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS The morphometric, morphologic and morphokinetic parameters (18, 4 and 13, respectively) of oocytes, zygotes and early embryos were studied retrospectively. The associations between these parameters were examined using a Spearman's correlation, Mann-Whitney or chi-squared test as appropriate. We examined whether these parameters were associated with outcomes in univariate and multivariate logistic regression analyses. MAIN RESULTS AND THE ROLE OF CHANCE Central PN juxtaposition was associated with a 2-fold increase in the odds of live birth (OR = 2.20; 95% CI, [1.26-3.89]; P = 0.006), while the presence of MNB2cell was associated with half the odds of live birth (OR = 0.51; 95% CI, [0.27-0.95]; P = 0.035). These two parameters were independent of embryo kinetics. The 33 remaining parameters had no significant association with the capacity of transferred embryos to develop to term. LIMITATIONS, REASONS FOR CAUTION Even though the population size was relatively small, our analyses were based on homogeneous cycles, i.e. young women whose transferred embryos were found to be high-grade according to conventional morphology evaluation. In addition, our conclusions were established from a specific, highly selected population, so other study populations, such as women in an older age bracket, may yield different results. Finally, because we assessed day 2/3 transfers, our findings cannot be generalized to embryos cultured up to the blastocyst stage. WIDER IMPLICATIONS OF THE FINDINGS It would be interesting to explore, prospectively, whether PN localisation is a relevant measure to predict embryo development when added into further algorithms and whether this parameter could be suitable for use in other IVF clinics. Further studies are needed, notably to explore the added value of timing evaluation in cohorts of embryos with low or intermediate morphology grade, as well as in other maternal populations (i.e. older women). STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. P. Sagot received funding from the following commercial companies: Merck Serono, Finox Biotech, Ferring, MSD France SAS, Teva Sante ́ SAS, Allergan France, Gedeon Richter France, Effik S.A., Karl Storz Endoscopie France, GE Medical Systems SCS, Laboratoires Genevrier, H.A.C. Pharma and Ipsen.All the authors confirm that none of this funding was used to support the research in this study. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the journal policies on sharing data and materials.
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Affiliation(s)
- J Barberet
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France.,INSERM UMR1231, Université de Bourgogne Franche comté, Dijon, France
| | - C Bruno
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France.,INSERM UMR1231, Université de Bourgogne Franche comté, Dijon, France
| | - E Valot
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | - C Antunes-Nunes
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | - L Jonval
- USMR, Dijon University Hospital, France
| | - J Chammas
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | - C Choux
- Service de Gynécologie-Obstétrique, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | - P Ginod
- Service de Gynécologie-Obstétrique, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | - P Sagot
- Service de Gynécologie-Obstétrique, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France
| | | | - P Fauque
- Laboratoire de Biologie de la Reproduction, Hôpital François Mitterrand, Université de Bourgogne, Dijon, France.,INSERM UMR1231, Université de Bourgogne Franche comté, Dijon, France
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Vergani E, Bruno C, Raimondo S, Macis G, Vecchio FM, Riccardi L, Ponziani FR, Pompili M, Mancini A. Recurrent hepatocellular carcinoma and non-classic adreno-genital syndrome. Eur Rev Med Pharmacol Sci 2020; 24:4172-4179. [PMID: 32373953 DOI: 10.26355/eurrev_202004_20997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) is one of the most common fatal cancer in the world and androgens are among the possible etiological factors. Congenital adrenal hyperplasia (CAH) is a group of inherited diseases caused by enzyme failure in the steroid biosynthesis of the adrenal cortex, resulting in an augmented 17-hydroxyprogesterone, androstenedione and testosterone production. While the occurrence of testicular adrenal rest tumors and adrenocortical tumors in congenital adrenal hyperplasia is well described in the literature, no data on HCC occurrence are available. CASE PRESENTATION A 35-years-old Italian man of Caucasian origin, affected by non-classic CAH due to partial 21-hydroxylase deficiency came to observation for revaluation of his adrenal picture. Besides common hormonal and biochemical analysis, an abdomen Magnetic Resonance Imaging was performed, resulting in an 18 mm large nodular lesion between liver segments VII and VIII. Radiological reports matched with an increased serum α-fetoprotein level. A surgical removal of the lesion was performed. After that, several recurrences of the lesion, which was consequently treated by radiofrequency ablation, occurred. Every recurrence was accompanied by an increase in testosterone and steroid hormone binding globulin serum levels. CONCLUSIONS Our report suggests the need for screening of liver lesions in males affected by this syndrome.
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Affiliation(s)
- E Vergani
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
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Zwintscher N, Tugulan C, Jacks D, Akhtar F, Bruno C, Bates M, Desai S, Parrino P, Bansal A. Programmatic Specialization and Pathway Development Improves Outcomes in Mechanical Circulatory Support. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Prete M, Favoino E, Giacomelli R, Afeltra A, Cantatore FP, Bruno C, Corrado A, Emmi L, Emmi G, Grembiale RD, Navarini L, Marcoccia A, Liakouli V, Riccardi A, Valentini G, Perosa F. Evaluation of the influence of social, demographic, environmental, work-related factors and/or lifestyle habits on Raynaud's phenomenon: a case-control study. Clin Exp Med 2020; 20:31-37. [PMID: 31679095 DOI: 10.1007/s10238-019-00589-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
Raynaud's phenomenon (RP) is a clinical disorder characterized by recurrent, reversible episodes of digital vasospasm. RP can be classified as primary (pRP) or secondary, depending on whether it occurs as a benign condition (not disease-associated) or is associated with other diseases, mainly of the connective tissues. In both cases, it can be triggered by environmental factors, as indicated by the increased incidence of pRP episodes following exposure to cold, vibration injury or chemicals. The purpose of this prospective case-control study was to assess, in an Italian cohort of 132 pRP patients, the association of the phenomenon with demographic, lifestyle habits, environmental and work-related factors. Compared to healthy controls, pRP was found to be inversely associated with the use of contact lenses (OR = 0.4; p = 0.004) and of chlorous-based disinfectants (OR = 0.3; p < 0.001) and directly associated with the presence of prosthesis implants (OR = 5.3; p = 0.001) and the use of hydrogen peroxide-based compounds (OR = 2.6; p = 0.002), suggesting that the latter should be avoided in RP affected patients. Multivariate and multivariable analysis confirmed the associations. Further investigations are needed to understand the mechanism(s) underlying these findings.
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Affiliation(s)
- M Prete
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Science and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, I-70124, Bari, Italy
| | - E Favoino
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Science and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, I-70124, Bari, Italy
| | - R Giacomelli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Afeltra
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico, University of Roma, Roma, Italy
| | - F P Cantatore
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia, Italy
| | - C Bruno
- Rheumatology Research Unit, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - A Corrado
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia, Italy
| | - L Emmi
- Department of Neurosciences, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - G Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - R D Grembiale
- Rheumatology Research Unit, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - L Navarini
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico, University of Roma, Roma, Italy
| | - A Marcoccia
- UOSD of Ischemic Microangiopathy and Sclerodermic Ulcers, Sandro Pertini Hospital, Roma, Italy
| | - V Liakouli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Riccardi
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - G Valentini
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - F Perosa
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Science and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, I-70124, Bari, Italy.
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Kumar D, Vachharajani AJ, Wertheimer F, Vergales B, Glass K, Dannaway D, Winter L, Delaney H, Ganster A, Arnold J, Urban A, Johnston L, Bruno C, Gray MM, Sawyer T. Boot camps in neonatal-perinatal medicine fellowship programs: A national survey. J Neonatal Perinatal Med 2020; 12:231-237. [PMID: 30829620 DOI: 10.3233/npm-18117] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Simulation is widely used in graduate medical education. A prior survey showed that 80% of Neonatal-Perinatal Medicine (NPM) fellowship programs in the U.S. use simulation. There are multiple ways to provide simulation-based education. One such method is through intensive simulation-based education sessions held at the beginning of a training program, common called 'boot camps'. The aim of this study was to describe the use of simulation-based boot camps in NPM fellowship programs. METHODS Survey study of Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowships in the U.S. RESULTS Fifty-nine of 98 programs (60%) responded. Thirty six (61%) participated in 1st year fellow boot camps, which focused on procedural skills and newborn resuscitation. Nearly half of programs participated in regional boot camps. Most boot camps were one or two days long. Eleven programs (19%) held 2nd or 3rd year fellow boot camps, which focused on advanced resuscitation and communication. Barriers included lack of faculty protected time (57%), funding (39%), and lack of faculty experience (31%). CONCLUSIONS A majority of ACGME accredited NPM fellowships participate in 1st year fellows' boot camps. Many participate in regional boot camps. A few programs have 2nd or 3rd year fellow boot camps. Lack of time, funding, and faculty experience were common barriers.
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Affiliation(s)
- D Kumar
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | - A J Vachharajani
- Department of Pediatrics, Division of Newborn Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
| | - F Wertheimer
- Department of Pediatrics, Division of Neonatology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - B Vergales
- Department of Pediatrics, Division of Neonatology, University of Virginia Health System, Charlottesville, VA, USA
| | - K Glass
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - D Dannaway
- Department of Pediatrics, Section of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - L Winter
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - H Delaney
- Department of Pediatrics, Division of Neonatology, Brooke Army Medical Center, San Antonio, TX, USA
| | - A Ganster
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - J Arnold
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - A Urban
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - C Bruno
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - M M Gray
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital. Seattle, WA, USA
| | - T Sawyer
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital. Seattle, WA, USA
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Mancini A, Vergani E, Bruno C, Olivieri G, Di Segni C, Silvestrini A, Venuti A, Favuzzi A, Meucci E. Oxidative stress as a possible mechanism underlying multi-hormonal deficiency in chronic heart failure. Eur Rev Med Pharmacol Sci 2019; 22:3936-3961. [PMID: 29949170 DOI: 10.26355/eurrev_201806_15279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Chronic Heart Failure (CHF) is associated with multi-hormonal derangement depicting a prevalence of catabolic vs. anabolic axes. Moreover, thyroid adaption is characterized by the reduced conversion of thyroxine to the active hormone triiodothyronine. On the other hand, hormones modulate synthesis and utilization of antioxidant systems. Therefore, hormonal failure can cause unbalance between reactive radical species and the defenses, resulting in oxidative stress (OS). OS is well described in CHF, but the relationship with the hormonal picture is not entirely known. In the present review, we firstly analyze the mechanisms of ROS production in the heart, discussing animal and human studies, and focusing on new discovered protective mechanisms such as sirtuins and fibroblast growth factor 21 (FGF21). The second section is dedicated to the role of main anabolic axes influencing antioxidant systems. Finally, we present some data supporting the hypothesis that OS could be the link between hormonal derangement and clinical outcome of CHF.
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Affiliation(s)
- A Mancini
- Operative Unit of Endocrinology, A. Gemelli Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.
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Winchell GA, de Greef R, Wrishko RE, Mangin E, Waskin H, Bruno C. 1558. A Population Pharmacokinetic Model for Posaconazole Intravenous Solution and Oral Powder for Suspension Formulations in Pediatric Patients With Neutropenia. Open Forum Infect Dis 2019. [PMCID: PMC6808851 DOI: 10.1093/ofid/ofz360.1422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Posaconazole is approved in adults for prophylaxis and treatment of invasive fungal disease. Two formulations that offer weight-based dosing—intravenous (IV) and oral powder for suspension (PFS)—are being evaluated in children. A population pharmacokinetic (popPK) approach was used to characterize and predict the PK exposure of posaconazole PFS and IV formulations in children to identify dosages associated with achieving a target PK of 1200 ng/mL as the mean Cavg and individual Cavg ≥500 ng/mL and <2500 ng/mL in ~90% of patients.
Methods
A popPK model was developed through nonlinear mixed-effects modeling using data obtained from a trial in children with neutropenia (ClinicalTrials.gov, NCT02452034; Merck protocol, MK-5592-097). Three dose cohorts (3.5, 4.5, and 6 mg/kg/day [≤300 mg/day]) were studied in two age groups (2–<7 years and 7–17 years). Posaconazole IV was administered twice on day 1 then once daily through at least day 10, followed by PFS once daily through day 28 at clinician discretion. A compartmental model, including both formulations, was fit to the data. Model selection was based on the Log-Likelihood Criterion, goodness-of-fit plots, and scientific plausibility. Significance of the covariates was assessed in a stepwise forward inclusion/backward procedure. An additional assessment characterized the impact of different food covariates on bioavailability.
Results
An open one-compartmental PK model with first-order absorption and estimated bioavailability, as well as allometrically scaled effects of body weight on clearance and volume, adequately described the PK of posaconazole IV and PFS formulations. Model predictions are shown in the Table. Effects of the different food covariates were not statistically significant. Simulations indicated that for the 6-mg/kg/d dose, model-predicted Cavg generally met PK targets. Model-predicted Cavg was ≥500 ng/mL in >90% of subjects in all cohorts. The 1200-ng/mL target geometric mean Cavg was achieved for all but the 2–<7 years cohort receiving the PFS formulation.
Conclusion
This popPK-based analysis demonstrated that the 6-mg/kg/d dose of IV or PFS posaconazole formulation (≤300 mg/days) is appropriate for children (2–17 years) and that PFS can be administered without regard to food.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
| | - Rik de Greef
- Certara Netherlands B.V., Oss, Netherlands, Kenilworth, New Jersey
| | | | | | - Hetty Waskin
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey
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Huntington JA, Yu B, Li L, Jensen E, Bruno C, Rhee EG. 2227. Outcomes in Patients with Renal Impairment from a Phase 3 Clinical Trial for Ceftolozane–Tazobactam (C/T) Treatment of Nosocomial Pneumonia (ASPECT-NP). Open Forum Infect Dis 2019. [PMCID: PMC6810491 DOI: 10.1093/ofid/ofz360.1905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background ASPECT-NP, a phase 3, randomized, double-blind study, evaluated C/T (at double the approved dose for other indications) vs. meropenem (MEM) in adults with ventilated nosocomial pneumonia. We compared safety and efficacy outcomes from this trial among patients with and without renal impairment (RI). Methods Patients were stratified by age and diagnosis and were randomized 1:1 to intravenous (IV) C/T 3 g every 8 h or IV MEM 1 g every 8 h. Study drug was administered for 8–14 days; doses were adjusted for moderate and severe RI. Eligible patients were mechanically ventilated; those on renal replacement therapy or with creatinine clearance (CrCL) < 15 mL/minute were excluded. Key efficacy endpoints included clinical cure rates at the test of cure (TOC) visit in the intent-to-treat (ITT) and clinically evaluable (CE) populations and Day 28 all-cause mortality (ACM) in the ITT population. In this analysis, patients were stratified based on renal function for outcome comparisons: normal renal function (CrCL ≥ 80 mL/minute); mild RI (CrCL > 50 to < 80 mL/minute); moderate RI (CrCL ≥ 30 to ≤ 50 mL/minute); and severe RI (CrCL ≥ 15 to < 30 mL/minute). Results A total of 726 patients were enrolled (C/T, N = 362; MEM, N = 364). Clinical cure rates at the TOC visit (CE and ITT populations) were robust across CrCL subgroups in both treatment arms and were similar based on 95% confidence intervals for treatment differences that included 0 (table). Day 28 ACM rates for patients with moderate and severe RI were numerically higher than those with mild RI in the MEM treatment arm. Rates of treatment-emergent adverse events (TEAEs) were similar in both treatment arms and across CrCL subgroups, with rates generally increasing with increasing RI severity. Rates of treatment-related TEAEs were low across treatment arms and CrCL subgroups with no treatment-related deaths reported. Conclusion Similar clinical cure and Day 28 ACM rates at the TOC visit were found across treatment groups for all CrCL subgroups, consistent with the overall primary and key secondary efficacy results for the ASPECT-NP study. Both drugs were well-tolerated. The results of this analysis indicate that the use of dose-adjusted C/T is appropriate in patients with nosocomial pneumonia and moderate or severe RI. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Brian Yu
- Merck & Co., Inc., Kenilworth, New Jersey
| | - Linping Li
- Merck & Co., Inc., Kenilworth, New Jersey
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Castanheira M, Johnson MG, Yu B, Huntington JA, Carmelitano P, Bruno C, Rhee EG, Motyl M. 624. Molecular Characterization of Baseline Enterobacteriaceae and Pseudomonas aeruginosa from a Phase 3 Nosocomial Pneumonia (ASPECT-NP) Clinical Trial. Open Forum Infect Dis 2019. [PMCID: PMC6811271 DOI: 10.1093/ofid/ofz360.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background ASPECT-NP, a phase 3, randomized, double-blind, multicenter trial, evaluated ceftolozane/tazobactam (C/T) 3 g q8h vs. meropenem 1 g q8h for 8–14 days in adults for treatment of ventilated nosocomial pneumonia. Baseline Gram-negative (GN) isolates from patients were tested for mechanisms of resistance. Methods Lower respiratory tract (LRT) isolates were sent to a central laboratory for organism identification and susceptibility. Of 664 total Enterobacteriaceae (ENT) and Pseudomonas aeruginosa (PsA) isolates, 351 (53%) were nonsusceptible to broad-spectrum cephalosporins and/or carbapenems and underwent whole-genome sequencing, quantitative RT–PCR, and western blot analysis. ENT isolates were tested for the presence of acquired β-lactamase genes and AmpC levels (selected species). PsA isolates were tested for acquired β-lactamase genes, AmpC (PDC) levels, efflux pump expression, and OprD loss. Results Of 262 ENT isolates, 114 (44%) were susceptible to C/T (MIC ≤2 µg/mL). An extended-spectrum β-lactamase (ESBL) gene was carried by 89 (78%) of the C/T-susceptible isolates. Of 148 C/T-nonsusceptible (C/T-NS) isolates, 87 (59%) were carbapenemase negative, and the majority 135 (91%) also carried an ESBL gene. The most common ESBL was blaCTX-M15 with blaOXA-1 and blaOXA-30. Klebsiella pneumoniae often displayed higher C/T MICs compared with other species carrying the same resistance genes. Among all C/T-NS isolates, 61 (41%) were carbapenemase positive, most commonly K. pneumoniae carrying blaOXA-48, blaNDM-1, and blaNDM-5. Of 89 PsA isolates, 58 (65%) were susceptible to C/T (MIC ≤4 µg/mL), despite elevated AmpC expression, efflux pumps, or loss of OprD; only 5 isolates had an acquired β-lactamase. Of the 31 C/T-NS PsA isolates, only 12 (39%) were carbapenemase positive and carried blaVIM or blaGES; isolates carrying blaGES had lower C/T MICs (8–32 µg/mL) compared with blaVIM (MIC > 128 µg/mL). PDC alleles were similar in isolates with high and low C/T MICs. Conclusion In baseline GN LRT isolates from ASPECT-NP, the most common ESBL detected in ENT was blaCTX-M15; carbapenemases were uncommon. There was no correlation of ESBL phenotype to C/T susceptibility among ENT, nor of PDC allele to C/T susceptibility among PsA. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Brian Yu
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | | | | | - Mary Motyl
- Merck & Co., Inc., Kenilworth, New Jersey
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Wunderink RG, Bruno C, Martin-Loeches I, Kollef M, Timsit JF, Yu B, Huntington JA, Li L, Jensen E, Wolf D, Butterton JR, Rhee EG. 2226. Impact of Prior and Concomitant Antibacterial Therapy on Outcomes in the ASPECT-NP Randomized, Controlled Trial of Ceftolozane/Tazobactam (C/T) vs. Meropenem (MEM) in Patients with Ventilated Nosocomial Pneumonia (NP). Open Forum Infect Dis 2019. [PMCID: PMC6810350 DOI: 10.1093/ofid/ofz360.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background NP is a frequent healthcare-acquired infection associated with high mortality; rising resistance rates among causative Gram-negative pathogens require new treatment options. In the randomized, controlled, double-blind, phase 3 ASPECT-NP trial, C/T (at double the initially approved dose) was noninferior to MEM for ventilated NP in both primary and key secondary endpoints. Here we evaluate the impact of prior and concomitant Gram-negative antibacterial therapy on outcomes in that trial. Methods Mechanically ventilated patients with ventilator-associated or hospital-acquired pneumonia were randomized 1:1 to 3 g C/T or 1 g MEM, both by 1-h IV infusion every 8 hours for 8–14 days. Patients could receive ≤24 hours of active antibacterial therapy within ≤72 hours prior to first dose; longer durations were permitted in case of prior treatment failure (i.e., signs and/or symptoms of the current episode of ventilated NP persisted/worsened despite ≥48 hours of treatment). At sites with MEM-resistant Pseudomonas aeruginosa rates ≥15%, patients could optionally receive up to 72 h of adjunctive empiric aminoglycoside (amikacin was recommended) until study drug susceptibility was confirmed. Primary and key secondary endpoints, respectively, were 28-d all-cause mortality and clinical response at test of cure (TOC; 7–14 days after the end of therapy) in the intent to treat (ITT) population (all randomized patients). Results In the C/T arm, 285/362 (79%) ITT patients received prior systemic Gram-negative therapy and 103/362 (28%) received adjunctive aminoglycoside, compared with 288/364 (79%) and 112/364 (31%) patients, respectively, in the MEM arm. In the microbiologic ITT population, causative pathogens in patients failing prior therapy at the time of enrollment (C/T 15%, MEM 11%) were mainly Klebsiella spp (33%), P. aeruginosa (17%), Escherichia coli (14%), and Acinetobacter baumannii (8%). Mortality and cure rates were comparable between C/T and MEM regardless of receipt of prior systemic or adjunctive Gram-negative therapy (table). Conclusion Prior and adjunctive Gram-negative antibacterial therapy did not affect the relative efficacy of C/T (at the 3-g dose) vs. MEM in these high-risk patients with Gram-negative ventilated NP. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Richard G Wunderink
- Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | | | | | - Marin Kollef
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Brian Yu
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - Linping Li
- Merck & Co., Inc., Kenilworth, New Jersey
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Maggi L, Verardo M, Rubegni A, Bruno C, Lupica A, Berardinelli A, Ripolone M, Vattemi G, Ruggiero L, D'Amico A, Rodolico C, Sciacco M, Nigro V, Santorelli F, Tonin P, Fiorillo C, Mora M. P.110Clinical, morphological and genetic data in Italian patients with fiber-type-disproportion. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bello L, D'Angelo G, Bruno C, Berardinelli A, Comi G, D'Amico A, Astrea G, Politano L, Baranello G, Sansone V, Previtali S, Vita G, Mongini T, Pini A, Mercuri E, Calore C, Vianello A, Hoffman E, McDonald C, Pegoraro E. P.267Modifiers of respiratory and cardiac function in the Italian Duchenne muscular dystrophy network and CINRG Duchenne natural history study. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Panicucci C, Di Iorgi N, Brigati G, Notarnicola S, Fiorillo C, Pedemonte M, Minetti C, Maghnie M, Bruno C. P.266Bone mass acquisition and determinants of bone mineral density and fragility fractures in DMD patients. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.380] [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: 11/17/2022]
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Bruno C, Paintaud G, Darrouzain F. Sampling and storage conditions for cannabinoid analysis: Plastic vs. glass. Toxicologie Analytique et Clinique 2019. [DOI: 10.1016/j.toxac.2019.03.106] [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: 11/28/2022]
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Zona A, Fazzo L, Minelli G, De Santis M, Bruno C, Conti S, Comba P. Peritoneal mesothelioma mortality in Italy: Spatial analysis and search for asbestos exposure sources. Cancer Epidemiol 2019; 60:162-167. [PMID: 31030080 DOI: 10.1016/j.canep.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 03/08/2019] [Accepted: 04/02/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study is part of a national plan of epidemiological surveillance of malignant mesothelioma (MM) mortality in Italy. The paper shows the results of malignant peritoneal mesothelioma (MPeM) mortality study in Italian Regions and municipalities. METHODS National Bureau of Statistics data for MPeM municipal mortality (ICD-10, Code C45.1) were analyzed in the time-window 2003-2014: mortality standardized rates (reference Italian population, census 2011), temporal trends of the annual national rates, Standardized Mortality Ratios and a municipal clustering analysis were performed. RESULTS 747 deaths for MPeM were recorded (0.10/100,000): 464 in men (0.14/100,000) and in 283 women (0.07/100,000). No significant MPeM mortality temporal trend was found. Seventeen municipalities showed excesses of mortality for MPeM in at least one gender and/or overall population. Four clusters in male population, and one in women were identified. CONCLUSIONS The study identifies some areas where remediation activities and/or health care actions may be warranted.
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Affiliation(s)
- A Zona
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - L Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - G Minelli
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - M De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - C Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - S Conti
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - P Comba
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
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Tolomeo D, Rubegni A, Severino M, Pochiero F, Bruno C, Cassandrini D, Madeo A, Doccini S, Pedemonte M, Rossi A, D'Amore F, Donati M, Di Rocco M, Santorelli F, Nesti C. Clinical and neuroimaging features of the m.10197G>A mtDNA mutation: New case reports and expansion of the phenotype variability. J Neurol Sci 2019; 399:69-75. [DOI: 10.1016/j.jns.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 12/20/2022]
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Padovan A, Oprandi G, Padulo J, Bruno C, Isoardi M, Gulotta F, Kuvačić G, De Giorgio A. A novel integrative approach to improve the quality of life by reducing pain and kinesiophobia in patients undergoing TKA: the IARA Model. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2018.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A.M. Padovan
- eCampus University, Faculty of Psychology, Novedrate (CO), Italy
- Kiara Association, Torino, Italy
| | | | - J. Padulo
- eCampus University, Faculty of Psychology, Novedrate (CO), Italy
- University of Split, Faculty of Kinesiology, Split, Croatia
- University of Split, Sport Performance Laboratory, Split, Croatia
| | | | | | | | - G. Kuvačić
- University of Split, Faculty of Kinesiology, Split, Croatia
- University of Split, Sport Performance Laboratory, Split, Croatia
| | - A. De Giorgio
- eCampus University, Faculty of Psychology, Novedrate (CO), Italy
- University of Split, Faculty of Kinesiology, Split, Croatia
- University of Split, Sport Performance Laboratory, Split, Croatia
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D'Amico A, Fattori F, Fiorillo C, Verardo M, Catteruccia M, Bellacchio E, Moggio M, Bruno C, Bertini E. CONGENITAL MYOPATHIES: NEMALINE AND TITINOPATHIES. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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DiIorgi N, Medone E, Brigati G, Notarnicola S, Panicucci C, Fiorillo C, Pedemonte M, Minetti C, Maghnie M, Bruno C. SMA CLINICAL DATA, OUTCOME MEASURES AND REGISTRIES. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.111] [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: 11/24/2022]
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Sansone VA, Pane M, Messina S, Bruno C, D'Amico A, Albamonte E, Catteruccia M, Sframeli M, Pedemonte M, Vita G, Bertini E, Mercuri E. A 5-center experience with intrathecal administration of nusinersen in SMA1 in Italy letter to the editor of european journal of pediatric neurology regarding the manuscript "single-center experience with intrathecal administration of nusinersen in children with spinal muscular atrophy type 1" written by pechmann and colleagues". Eur J Paediatr Neurol 2018; 22:729-731. [PMID: 29673809 DOI: 10.1016/j.ejpn.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/08/2018] [Accepted: 02/12/2018] [Indexed: 11/17/2022]
Affiliation(s)
- V A Sansone
- Neurorehabilitation Unit, University of Milan, The NEMO (NEuroMuscular Omniservice) Clinical Center, Milan, Italy.
| | - M Pane
- The NEMO Clinical Center and Dept of Child Neurology, University Gemelli Hospital, Rome, Italy
| | - S Messina
- The NEMO Clinical Center and Dept of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - C Bruno
- Center of Myology, Istituto Giannina Gaslini, Genoa, Italy
| | - A D'Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, Rome, Italy
| | - E Albamonte
- Neurorehabilitation Unit, University of Milan, The NEMO (NEuroMuscular Omniservice) Clinical Center, Milan, Italy
| | - M Catteruccia
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, Rome, Italy
| | - M Sframeli
- The NEMO Clinical Center and Dept of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M Pedemonte
- Center of Myology, Istituto Giannina Gaslini, Genoa, Italy
| | - G Vita
- The NEMO Clinical Center and Dept of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - E Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, Rome, Italy
| | - E Mercuri
- The NEMO Clinical Center and Dept of Child Neurology, University Gemelli Hospital, Rome, Italy
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Ascoli V, Scalzo CC, Facciolo F, Martelli M, Manente L, Comba P, Bruno C, Nardi F. Malignant Mesothelioma in Rome, Italy 1980-1995. A Retrospective Study of 79 Patients. Tumori 2018; 82:526-32. [PMID: 9061058 DOI: 10.1177/030089169608200603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim and background To evaluate the characteristics of a case-series of 79 malignant mesothelioma patients collected from the main teaching hospital of Rome, Italy, and other local clinics of Latium Region and to assess the role of asbestos exposure, since previous studies on the occurrence of the disease in this area were lacking. Methods The study included cytohistologically diagnosed malignant mesothelioma (71 pleural, 7 peritoneal, and 1 testicular tunica vaginalis) detected or referred for consultation during the period 1980-1995. Information regarding occupational and/or nonoccupational exposures was derived from clinical records and interviews, when available. Results Patients were resident in Rome and other towns of Latium; a few were from other parts of central and southern Italy. Exposure to asbestos was assessed for 45.5% of patients, another 45.5% had unknown exposure, and for the remaining 9% such information was lacking. Occupational exposure occurred in 53% of men for whom information was available and nonoccupational exposure occurred in 20% of women. The study identified two clusters of cases from an asbestos-cement plant and a facility where asbestos was ubiquitous. Furthermore, most exposed subjects reported occupations in the construction industry, which is particularly active in the Latium Region; others were railroad workers, naval mechanics and navy personnel, bakers, explosive workers and car mechanics. A few patients reported indoor exposure to asbestos at home and/or in the workplace. Conclusions The study confirmed that mesothelioma risk is present in several job titles of the construction industry, and it is no longer confined to workers employed in the manufacture or application of asbestos products. The occurrence of malignant mesothelioma in patients with unexpected occupational and nonoccupational exposures indicates the need for further investigation on previously underestimated exposures.
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Affiliation(s)
- V Ascoli
- Dipartimento di Medicina Sperimentale e Patologia, Università La Sapienza, Rome, Italy
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Fattori F, Fiorillo C, Rodolico C, Tasca G, Verardo M, Bellacchio E, Pizzi S, Ciolfi A, Fagiolari G, Lupica A, Broda P, Pedemonte M, Moggio M, Bruno C, Tartaglia M, Bertini E, D'Amico A. Expanding the histopathological spectrum of CFL2
-related myopathies. Clin Genet 2018; 93:1234-1239. [DOI: 10.1111/cge.13240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 11/29/2022]
Affiliation(s)
- F. Fattori
- Unit of Neuromuscular and Neurodegenerative Disorders, Genetics and Rare Diseases Research Division; Bambino Gesù Children's Hospital; Rome Italy
| | - C. Fiorillo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics; Maternal and Child Health, University of Genoa; Genoa Italy
| | - C. Rodolico
- Department of Clinical and Experimental Medicine; University of Messina; Messina Italy
| | - G. Tasca
- Istituto di Neurologia; Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli"; Rome Italy
| | - M. Verardo
- Unit of Neuromuscular and Neurodegenerative Disorders, Genetics and Rare Diseases Research Division; Bambino Gesù Children's Hospital; Rome Italy
| | - E. Bellacchio
- Molecular Genetics and Functional Genomics, Genetics and Rare Diseases Research Division; Bambino Gesù Children's Hospital; Rome Italy
| | - S. Pizzi
- Molecular Genetics and Functional Genomics, Genetics and Rare Diseases Research Division; Bambino Gesù Children's Hospital; Rome Italy
| | - A. Ciolfi
- Molecular Genetics and Functional Genomics, Genetics and Rare Diseases Research Division; Bambino Gesù Children's Hospital; Rome Italy
| | - G. Fagiolari
- Neuromuscular and Rare Disease Unit, Department of Neuroscience, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico; University of Milan; Milan Italy
| | - A. Lupica
- Department of Clinical and Experimental Medicine; University of Messina; Messina Italy
| | - P. Broda
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics; Maternal and Child Health, University of Genoa; Genoa Italy
| | - M. Pedemonte
- Center of Myology and Neurodegenerative Disease; Istituto Giannina Gaslini; Genova Italy
| | - M. Moggio
- Neuromuscular and Rare Disease Unit, Department of Neuroscience, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico; University of Milan; Milan Italy
| | - C. Bruno
- Center of Myology and Neurodegenerative Disease; Istituto Giannina Gaslini; Genova Italy
| | - M. Tartaglia
- Molecular Genetics and Functional Genomics, Genetics and Rare Diseases Research Division; Bambino Gesù Children's Hospital; Rome Italy
| | - E. Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Genetics and Rare Diseases Research Division; Bambino Gesù Children's Hospital; Rome Italy
- Molecular Genetics and Functional Genomics, Genetics and Rare Diseases Research Division; Bambino Gesù Children's Hospital; Rome Italy
| | - A. D'Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Genetics and Rare Diseases Research Division; Bambino Gesù Children's Hospital; Rome Italy
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48
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Papa R, Fiorillo C, Malattia C, Minoia F, Caorsi R, Assereto S, Iacomino M, Savarese M, Nigro V, Bruno C, Minetti C, Picco P. Inflammatory myopathy in a patient with collagen VI mutations. Scand J Rheumatol Suppl 2018; 47:166-167. [DOI: 10.1080/03009742.2016.1274423] [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: 11/01/2022]
Affiliation(s)
- R Papa
- Pediatric Rheumatology Unit, Giannina Gaslini Institute, Genoa, Italy
| | - C Fiorillo
- Pediatric Neurology and Muscle Disease Unit, Giannina Gaslini Institute, Genoa, Italy
| | - C Malattia
- Pediatric Rheumatology Unit, Giannina Gaslini Institute, Genoa, Italy
| | - F Minoia
- Pediatric Rheumatology Unit, Giannina Gaslini Institute, Genoa, Italy
| | - R Caorsi
- Pediatric Rheumatology Unit, Giannina Gaslini Institute, Genoa, Italy
| | - S Assereto
- Pediatric Neurology and Muscle Disease Unit, Giannina Gaslini Institute, Genoa, Italy
| | - M Iacomino
- Pediatric Neurology and Muscle Disease Unit, Giannina Gaslini Institute, Genoa, Italy
| | - M Savarese
- Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy
| | - V Nigro
- Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy
| | - C Bruno
- Center of Myology and Neurodegenerative Disorders, Giannina Gaslini Institute, Genoa, Italy
| | - C Minetti
- Pediatric Neurology and Muscle Disease Unit, Giannina Gaslini Institute, Genoa, Italy
| | - P Picco
- Pediatric Rheumatology Unit, Giannina Gaslini Institute, Genoa, Italy
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49
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Choux C, Binquet C, Carmignac V, Bruno C, Chapusot C, Barberet J, Lamotte M, Sagot P, Bourc’his D, Fauque P. The epigenetic control of transposable elements and imprinted genes in newborns is affected by the mode of conception: ART versus spontaneous conception without underlying infertility. Hum Reprod 2017; 33:331-340. [DOI: 10.1093/humrep/dex366] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/22/2017] [Indexed: 12/12/2022] Open
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50
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Paparo L, Aitoro R, Nocerino R, Fierro C, Bruno C, Canani RB. Direct effects of fermented cow's milk product with Lactobacillus paracasei CBA L74 on human enterocytes. Benef Microbes 2017; 9:165-172. [PMID: 29065709 DOI: 10.3920/bm2017.0038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cow's milk fermented with Lactobacillus paracasei CBA L74 (FM-CBAL74) exerts a preventive effect against infectious diseases in children. We evaluated if this effect is at least in part related to a direct modulation of non-immune and immune defence mechanisms in human enterocytes. Human enterocytes (Caco-2) were stimulated for 48 h with FM-CBAL74 at different concentrations. Cell growth was assessed by colorimetric assay; cell differentiation (assessed by lactase expression), tight junction proteins (zonula occludens1 and occludin), mucin 2, and toll-like receptor (TRL) pathways were analysed by real-time PCR; innate immunity peptide synthesis, beta-defensin-2 (HBD-2) and cathelicidin (LL-37) were evaluated by ELISA. Mucus layer thickness was analysed by histochemistry. FMCBA L74 stimulated cell growth and differentiation, tight junction proteins and mucin 2 expression, and mucus layer thickness in a dose-dependent fashion. A significant stimulation of HBD-2 and LL-37 synthesis, associated with a modulation of TLR pathway, was also observed. FM-CBAL74 regulates non-immune and immune defence mechanisms through a direct interaction with the enterocytes. These effects could be involved in the preventive action against infectious diseases demonstrated by this fermented product in children.
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Affiliation(s)
- L Paparo
- 1 Department of Translational Medical Science, University of Naples 'Federico II', via S. Pansini 5, 80131 Naples, Italy
| | - R Aitoro
- 1 Department of Translational Medical Science, University of Naples 'Federico II', via S. Pansini 5, 80131 Naples, Italy
| | - R Nocerino
- 1 Department of Translational Medical Science, University of Naples 'Federico II', via S. Pansini 5, 80131 Naples, Italy
| | - C Fierro
- 1 Department of Translational Medical Science, University of Naples 'Federico II', via S. Pansini 5, 80131 Naples, Italy
| | - C Bruno
- 1 Department of Translational Medical Science, University of Naples 'Federico II', via S. Pansini 5, 80131 Naples, Italy
| | - R Berni Canani
- 1 Department of Translational Medical Science, University of Naples 'Federico II', via S. Pansini 5, 80131 Naples, Italy.,2 European Laboratory for the Investigation of Food-Induced Diseases, University of Naples 'Federico II', via S. Pansini 5, 80131 Naples, Italy.,3 CEINGE Advanced Biotechnologies, University of Naples 'Federico II', via S. Pansini 5, 80131 Naples, Italy
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