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Pasello G, Fabricio ASC, Del Bianco P, Salizzato V, Favaretto A, Piccin L, Zustovich F, Fabozzi A, De Rossi C, Pigozzo J, De Nuzzo M, Cappelletto E, Bonanno L, Palleschi D, De Salvo GL, Guarneri V, Gion M, Chiarion-Sileni V. Sex-related differences in serum biomarker levels predict the activity and efficacy of immune checkpoint inhibitors in advanced melanoma and non-small cell lung cancer patients. J Transl Med 2024; 22:242. [PMID: 38443899 PMCID: PMC10916307 DOI: 10.1186/s12967-024-04920-6] [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: 11/30/2023] [Accepted: 01/20/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Immune Checkpoint Inhibitors (ICIs) lead to durable response and a significant increase in long-term survival in patients with advanced malignant melanoma (MM) and Non-Small Cell Lung Cancer (NSCLC). The identification of serum cytokines that can predict their activity and efficacy, and their sex interaction, could improve treatment personalization. METHODS In this prospective study, we enrolled immunotherapy-naïve patients affected by advanced MM and NSCLC treated with ICIs. The primary endpoint was to dissect the potential sex correlations between serum cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, GM-CSF, MCP-1, TNF-ɑ, IP-10, VEGF, sPD-L1) and the objective response rate (ORR). Secondly, we analyzed biomarker changes during treatment related to ORR, disease control rate (DCR), progression free survival (PFS) and overall survival (OS). Blood samples, collected at baseline and during treatment until disease progression (PD) or up to 2 years, were analyzed using Luminex xMAP or ELLA technologies. RESULTS Serum samples from 161 patients (98 males/63 females; 92 MM/69 NSCLC) were analyzed for treatment response. At baseline, IL-6 was significantly lower in females (F) versus males (M); lower levels of IL-4 in F and of IL-6 in both sexes significantly correlated with a better ORR, while higher IL-4 and TNF-ɑ values were predictive of a lower ORR in F versus M. One hundred and sixty-five patients were evaluable for survival analysis: at multiple Cox regression, an increased risk of PD was observed in F with higher baseline values of IL-4, sPD-L1 and IL-10, while higher IL-6 was a negative predictor in males. In males, higher levels of GM-CSF predict a longer survival, whereas higher IL-1β predicts a shorter survival. Regardless of sex, high baseline IL-8 values were associated with an increased risk of both PD and death, and high IL-6 levels only with shorter OS. CONCLUSIONS Serum IL-1β, IL-4, IL-6, IL-10, GM-CSF, TNF-ɑ, and sPD-L1 had a significant sex-related predictive impact on ORR, PFS and OS in melanoma and NSCLC patients treated with ICIs. These results will potentially pave the way for new ICI combinations, designed according to baseline and early changes of these cytokines and stratified by sex.
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Affiliation(s)
- Giulia Pasello
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy.
| | - Aline S C Fabricio
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Adolfo Favaretto
- Medical Oncology Unit, Ca' Foncello Hospital, AULSS 2, Treviso, Italy
| | - Luisa Piccin
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Alessio Fabozzi
- Medical Oncology 3, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Jacopo Pigozzo
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mattia De Nuzzo
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Elia Cappelletto
- Regional Center for Biomarkers, Department of Clinical Pathology, AULSS3 Serenissima, Venice, Italy
| | - Laura Bonanno
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Dario Palleschi
- Medical Oncology Unit, Ca' Foncello Hospital, AULSS 2, Treviso, Italy
| | - Gian Luca De Salvo
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valentina Guarneri
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Massimo Gion
- Regional Center for Biomarkers, Department of Clinical Pathology, AULSS3 Serenissima, Venice, Italy
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Miglietta F, Dieci MV, Giarratano T, Torri V, Giuliano M, Zustovich F, Mion M, Tondini CA, De Rossi C, Bria E, Franchi M, Merlini L, Giannatiempo R, Russo D, Fotia V, Poletti P, Caremoli ER, Arpino MG, De Salvo GL, Zambelli A, Guarneri V. Association of tumor-infiltrating lymphocytes with recurrence score in hormone receptor-positive/HER2-negative breast cancer: Analysis of four prospective studies. Eur J Cancer 2023; 195:113399. [PMID: 37950941 DOI: 10.1016/j.ejca.2023.113399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND The clinical value of tumor infiltrating lymphocytes (TILs) in hormone receptor-positive (HR+)/HER2- breast cancer (BC) may be unearthed by focusing on more biologically aggressive tumors. Here we deepen and describe the correlation between RS and TILs, proposing an immuno-genomic model for HR+ /HER2- BC. METHODS We enrolled T1-T3, N0-N1 BC patients with available RS® and TILs in the context of four multicenter, prospective studies. RS® and TILs were considered as continuous and categorical variables. RS® was categorized into: 0-10 (low risk), 11-25 (intermediate risk) and 26-100 (high risk); TILs were categorized into: low TILs (0-10%), intermediate TILs (11-59%) and high TILs (60-100%). RESULTS 811 patients were included. RS distribution was (n = 810): low risk 22.0%, intermediate risk 61.2%, high risk 16.8%. TIL distribution was (n = 455): low TILs 84.6%, intermediate TILs 13.6% and high TILs 1.8%. A significant, weak positive, linear correlation was found between continuous TILs and RS (Pearson coefficient=0.223, p < 0.001). When considering RS and TILs categories, tumors with intermediate/high TIL levels significantly enriched the high RS subgroup (p = 0.006). This was confirmed both within Luminal A and Luminal B cohorts. Among high-RS patients, 16.7% of Luminal A and 26.7% of Luminal B tumors had intermediate/high TILs. CONCLUSIONS We observed that RS® and TILs capture only slightly overlapping information on the biology of HR+ /HER2- tumor microenvironment. We demonstrated the feasibility of combining RS and TILs into a composite immuno-genomic model, which may serve the purpose of guiding and focalizing patient selection in the further development of immunotherapy strategies for Luminal-like disease.
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Affiliation(s)
- Federica Miglietta
- Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Italy
| | - Maria Vittoria Dieci
- Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Italy.
| | | | - Valter Torri
- Istituto Di Ricerche Farmacologiche Mario Negri - IRCCS, Milan, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | | | - Marta Mion
- UOC Oncologia, Camposampiero-Cittadella, AULSS6 Camposampiero, Italy
| | | | - Costanza De Rossi
- Medical Oncology Department, ULSS 3 Serenissima, Angel Hospital (Ospedale Dell'Angelo), Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Emilio Bria
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy; Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Rome, Italy
| | - Michela Franchi
- Oncology, FROM Fondazione per la Ricerca Ospedale Maggiore, Bergamo, Italy
| | - Laura Merlini
- UOC Oncologia Ospedali Riuniti Padova Sud, Padova, Italy
| | - Rosa Giannatiempo
- UOD di Anatomia Patologica, Ospedale Evangelico Betania, Napoli, Italy
| | - Daniela Russo
- Unit of Pathology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Vittoria Fotia
- Medical Oncology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Poletti
- Medical Oncology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Maria Grazia Arpino
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Gian Luca De Salvo
- Unità di ricerca clinica, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alberto Zambelli
- Medical Oncology Unit, Humanitas Cancer Center - IRCCS, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milano), Italy
| | - Valentina Guarneri
- Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Italy
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Gori S, Fabi A, Angiolini C, Turazza M, Salvini P, Ferretti G, Cretella E, Gianni L, Bighin C, Toss A, Zamagni C, Vici P, De Rossi C, Russo A, Bisagni G, Frassoldati A, Borgato L, Cariello A, Cappelletti C, Bordonaro R, Cinieri S, Modena A, Valerio M, Alvisi MF, De Simone I, Galli F, Rulli E, Santoni A, Nicolis F. Neoadjuvant Systemic Therapy in Early Breast Cancer: Results of a Prospective Observational Multicenter BRIDE Study. Cancers (Basel) 2023; 15:4852. [PMID: 37835546 PMCID: PMC10572070 DOI: 10.3390/cancers15194852] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
To evaluate the rate of early breast cancer (EBC) patients treated with neoadjuvant systemic therapy (NAT) in Italy, criteria of patient selection and types of therapies delivered, an analysis of 1276 patients with stage I-II-III was conducted out of 1633 patients enrolled in the multicenter prospective observational BRIDE study. A total of 177 patients (13.9%) were treated with NAT and 1099 (85.9%) with surgery; in multivariate analysis, menopausal status, cT, cN, grade, HER2-positive and Triple negative (TN) subgroups were significantly associated with the decision to administer NAT. The type of NAT delivered was influenced by EBC subtype. NAT was administered to 53.2% of HER2+/HR-negative, 27.9% of HER2+/HR+, 7.1% of HER2-negative/HR+ and 30.3% of TN EBC patients. The pCR rates were similar to the ones reported in the literature: 74.2% in HER2+/HR-negative, 52.3% in HER2+/HR+, 17.2% in HER2-negative/HR+ and 37.9% in TN. In clinical practice, patient and tumor characteristics influenced oncologists in the decision to administer NAT in EBC and in the choice of the type of systemic therapy, according to ESMO and AIOM Guidelines. Currently, it is recommended always to evaluate the use of NAT in EBC, mainly in HER2+ and TN patients, considering that pCR is associated with significantly better survival of the patient and that effective therapies are now available for residual disease.
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Affiliation(s)
- Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Alessandra Fabi
- Precision Medicine Unit in Senology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Catia Angiolini
- Breast Unit and Multidisciplinary Oncology Group, Department of Breast Oncology, AOU Careggi, 50134 Florence, Italy;
| | - Monica Turazza
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Piermario Salvini
- Oncology, Humanitas Gavazzeni, 24125 Bergamo, Italy;
- Oncological Medicine—Policlinico Ponte S Pietro di Istituti Ospedalieri Bergamaschi, 24036 Ponte San Pietro, Italy
| | - Gianluigi Ferretti
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | | | | | - Angela Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Claudio Zamagni
- Medical Oncology of Senology and Gynecology, IRCCS AOU Bologna, Policlinico Sant’Orsola, 40138 Bologna, Italy
| | - Patrizia Vici
- UOSD Sperimentazioni Fase IV, IRCCS Istituto Nazionale Tumori Regina Elena, 00144 Rome, Italy
| | - Costanza De Rossi
- Oncology—Ospedale dell’Angelo Azienda ULSS 3 Serenissima, 30174 Venice, Italy;
| | - Antonio Russo
- Medical Oncology, AOU Policlinico P. Giaccone, 90127 Palermo, Italy
| | - Giancarlo Bisagni
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, 22100 Reggio Emilia, Italy;
| | | | - Lucia Borgato
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, 36100 Vicenza, Italy
| | - Anna Cariello
- Medical Oncology, AUSL Ravenna, 48100 Ravenna, Italy;
| | | | | | - Saverio Cinieri
- Medical Oncology, Antonio Perrino Hospital, 72100 Brindisi, Italy
| | - Alessandra Modena
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Matteo Valerio
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Maria Francesca Alvisi
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Irene De Simone
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Francesca Galli
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Eliana Rulli
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Anna Santoni
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Fabrizio Nicolis
- Medical Direction, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
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Fontanella C, Giorgi CA, Russo S, Angelini S, Nicolardi L, Giarratano T, Frezzini S, Pestrin M, Palleschi D, Bolzonello S, Parolin V, Haspinger ER, De Rossi C, Greco F, Gerratana L. Optimizing CDK4/6 inhibitors in advanced HR+/HER2- breast cancer: A personalized approach. Crit Rev Oncol Hematol 2022; 180:103848. [DOI: 10.1016/j.critrevonc.2022.103848] [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] [Received: 02/10/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
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Pasello G, Fabricio ASC, Del Bianco P, Favaretto A, Salizzato V, Piccin L, Zustovich F, De Rossi C, Pigozzo J, Fabozzi A, Benetti B, Tiozzo Fasiolo L, Bonanno L, Guarneri V, De Salvo GL, Palleschi D, Gion M, Chiarion-Sileni V. Circulating cytokines as predictors of response to immune checkpoint inhibitors (ICIs) in patients (pts) with melanoma (Mel) and non–small cell lung cancer (NSCLC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2549 Background: ICIs lead to durable response and a significant survival improvement in a limited number of advanced stage Mel and NSCLC pts. The identification of predictive circulating biomarkers could be a promising tool to optimize pts’ selection and outcome for ICIs treatment. Methods: This is a prospective real-world study enrolling advanced stage Mel and NSCLC pts referred to four Italian Centers and treated with ICIs. The primary endpoint is to verify the presence of an association between circulating cytokines (IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNFα, GM-CSF) and disease control rate (DCR), progression free survival (PFS) and overall survival (OS). Pts undergo a blood collection, before every cycle for 6 cycles (T1-T6) and at tumor assessment till disease progression (PD) or for 2 years. Biomarker levels were assessed by Luminex xMAP based technology using R&D High Sensitivity kits. Each marker was categorized according to high and low levels by maximizing its discriminative ability, and the association with the outcome was tested in univariate and multiple analyses. Results: We report preliminary results on the T1-T2 blood samples from the first 78 enrolled pts (32 females/46 males; 43 Mel/35 NSCLC; median age 69 years). Serum IL-6, IL-8 and IL-10 were significantly higher at T1 and T2 in pts with PD (Kruskal-Wallis test). The median relative increase (RI) of IL-8 was 32% and 2% in pts with PD and disease control (DC), respectively (p = 0.0001). At multiple logistic analysis, IL-6 and IL-8 at T2 and the RI of IL-8 were independent factors predicting the probability of DC, with an overall accuracy of 83.8%. High levels of IL-6 and IL-8 at T2 were significantly associated with a low probability of DC (OR = 0.13, 95%CI: 0.03-0.52 and OR = 0.09, 95%CI: 0.02-0.37, respectively), and the RI showed a significantly lower probability of DC (OR = 0.14, 95%CI: 0.02-0.58). With a median follow-up of 10.6 months (m), mPFS and mOS were 5.8 m, 95%CI: 2.3-7.4 and 8.3 m, 95%CI: 4.0-13.8 for NSCLC; 6.9 m, 95%CI: 2.8-15.9 and 12.6 m, 95%CI: 4.7-NE for Mel pts, respectively. In the multiple Cox model, elevated IL-6 and IL-8 at T1 (HR = 3.03, 95%CI: 1.55-6.37, HR = 2.86, 95%CI: 1.46-5.63), elevated IL-10 at T2 (HR = 2.86, 95%CI: 1.39-5.94), and a RI of IL-8 (HR = 4.22, 95%CI: 1.85-11.21) remained significantly associated with a worse PFS. Higher levels of IL-6 (HR = 3.85, 95%CI: 1.13-20.0) and IL-8 (HR = 4.29, 95%CI: 1.98-9.83) at T2 and a RI of IL-8 (HR = 3.06, 95%CI: 1.43-6.72) remained significantly associated with a worse OS. Conclusions: High serum levels of IL-8 and IL-6 at T2 of ICI, combined with an increase of IL-8 from baseline, are strong predictors of PD, PFS, OS, in pts with advanced Mel and NSCLC. The role of the other cytokines tested, their time fluctuations and associations with clinical prognostic factors, gender, and immuno-related adverse events will be presented at the meeting.
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Affiliation(s)
- Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | | | - Paola Del Bianco
- Clinical Trials and Biostatistics Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | | | - Luisa Piccin
- Melanoma Oncology Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S. Martino,, Belluno, Italy
| | - Costanza De Rossi
- Medical Oncology Department, ULSS 3, Serenissima, Mestre-Venezia Italy, Venice, Italy
| | - Jacopo Pigozzo
- Melanoma Oncology Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Alessio Fabozzi
- Medical Oncology 3, Istituto Oncologico Veneto IOV-IRCCS, Castelfranco Veneto, Italy
| | | | | | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, and Oncology 2, Veneto Insittute of Oncology IOV-IRCCS, Padua, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Dario Palleschi
- Oncology Unit, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Massimo Gion
- Regional Center for Biomarkers, SS Giovanni & Paolo Hospital, Venice, Italy
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Dieci MV, Guarneri V, Giarratano T, Mion M, Tortora G, De Rossi C, Gori S, Oliani C, Merlini L, Pasini F, Bonciarelli G, Griguolo G, Orvieto E, Michieletto S, Saibene T, Del Bianco P, De Salvo GL, Conte P. First Prospective Multicenter Italian Study on the Impact of the 21-Gene Recurrence Score in Adjuvant Clinical Decisions for Patients with ER Positive/HER2 Negative Breast Cancer. Oncologist 2017; 23:297-305. [PMID: 29133514 DOI: 10.1634/theoncologist.2017-0322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/02/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Breast DX Italy prospective study evaluated the impact of the 21-gene recurrence score (RS) result on adjuvant treatment decisions for patients with early breast cancer. MATERIALS AND METHODS Nine centers (two Hub and seven Spoke centers of the Veneto Oncology Network) participated. Consecutive patients with estrogen receptor positive, human epidermal growth receptor negative, T1-T3, N0-N1 early breast cancer were prospectively registered; only those meeting protocol-defined clinicopathological "intermediate risk" criteria were eligible for the RS test. Pre-RS and post-RS physicians' treatment recommendations and treatment actually received were collected. RESULTS A total of n = 124 N0 and n = 126 N1 patients underwent the RS assay. The majority had Grade 2 tumors (71%); median age was 55 years, median tumor size was 16 mm, and median Ki67 expression was 20%. Patients enrolled at Hub centers presented higher-risk features. The distribution of RS results was <18 (60.8%), 18-30 (32.4%), and >30 (6.8%). The indication before RS was hormonal therapy (HT) alone in 52% of cases. An indication before RS of chemotherapy (CT)+HT was more frequent for patients with N1 versus N0 tumors (57% vs. 39%, p = .0035) and for patients enrolled at Hub versus Spoke centers (54% vs. 36%, p = .007).The overall rate of change in treatment decision was 16% (n = 40), mostly from CT+HT to HT (n = 30). According to nodal status, rate of change in treatment decision was 12% for the N0 cohort and 20% for the N1 cohort. The proportion of patients recommended to CT+HT was significantly reduced from before to after RS (48% to 40%, p < .0016), especially in the N1 cohort (57% to 45%, p = .0027) and at Hub centers (54% to 44%, p = .001). CONCLUSION Despite frequent indication of HT before RS, the use of the RS assay further contributed to sparing CT, especially for patients with N1 tumors and at Hub centers. IMPLICATIONS FOR PRACTICE This study shows that, although a high proportion of patients were recommended to receive endocrine treatment alone before knowing the recurrence score (RS) assay, the RS test further contributed in sparing chemotherapy for some of these patients, especially in case of the N1 stage or for patients enrolled at referral centers. These data highlight the need for further work in collaboration with health authorities and companies in order to define strategies for the implementation of the use of RS testing in clinical practice in the Italian setting.
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Affiliation(s)
- Maria Vittoria Dieci
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Tommaso Giarratano
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Marta Mion
- Medical Oncology, Ospedale Civile, Camposampiero, Italy
| | - Giampaolo Tortora
- Department of Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Costanza De Rossi
- Medical Oncology Department, Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Stefania Gori
- Oncology Unit, Ospedale Sacro Cuore-don Calabria, Negrar, Italy
| | - Cristina Oliani
- Oncology Unit, AULSS8 Berica Distretto Ovest, Vicenza, Italy
| | - Laura Merlini
- Department of Medical Oncology, Ospedale Civile S Bortolo, Vicenza, Italy
| | - Felice Pasini
- Department of Oncology, Ospedale Civile, Rovigo, Italy
| | | | - Gaia Griguolo
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Enrico Orvieto
- Department of Pathology, Azienda Ospedaliera di Padova, Padova, Italy
| | | | - Tania Saibene
- Breast Surgery Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Paola Del Bianco
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
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Girardi F, Paiusco P, Manente P, Bortolin M, Ruggeri MG, Biancon A, Vicario G, Scelzi E, Sgarbossa G, De Rossi C, Vultaggio G, Mazzola G. Simultaneous care in Italy’s Veneto Region Health District 8: Integrated assistance to provide better outcomes in end-of-life care. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e19595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19595 Background: The number of cancer patients requiring active treatment and palliation for symptoms relief is progressively increasing, due to the possibility to significantly prolong survival even in persons affected by metastatic disease. Italian Board of Health, within the National Oncological Plan 2010-2012, gave “simultaneous care” the recognition as the most qualified model to ensure the best result regarding life expectation, quality of life, adherence to therapies. Methods: In Italy’s veneto region health district 8 a unit dedicated to palliative care works in cooperation with oncology clinic, medical wards, general practitioner, social services; periodical meetings are scheduled to review all the requests; each patient is given a multidimensional evaluation, to assess the care needs. The Unit is able to provide a daily home-care, with total parenteral nutrition if needed, management of infusional devices, invasive procedures such as paracentesis, in order to minimize the number of intervening hospital admissions. We considered the percentage of patients who received a simultaneous care approach between 2008 and 2010, the number of patients who died at home or in a hospice, the average time-period of care, the number of elapsing hospital admissions. Results: In 2008 268 new patients received assistance by the Palliative Care Unit, 273 new patients in 2009 and 434 new patients in 2010; 82 (31,3%), 70 (25,6%) and 111 (25,6%) were affected by advanced cancer, respectively; in 2008 208 patients out of 262 (79,4%) died at home or in a hospice, in 2009 224 patients out of 273 (82,1%), in 2010 376 patients out of 434 (86,7%); in 2008 the average time-period of care was 93 days (calculated as the ratio between the total number of days of assistance to patients as a whole and the number of patients), 88 days in 2009; in 2008 the average number of intervening hospital admissions was 0,26 (calculated as the ratio between the number of admissions and the number of patients), 0,28 in 2009. Conclusions: Our data show that the earlier the patient affected by advanced cancer is evaluated by Palliative care Unit, the higher is the likelihood to develop an adequate home- or hospice-base care plan.
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Affiliation(s)
- Fabio Girardi
- Ospedale San Giacomo Apostolo - Medical Oncology, Castelfranco Veneto, Italy
| | - Paola Paiusco
- Ospedale San Giacomo Apostolo - Palliative Care Unit, Castelfranco Veneto, Italy
| | - Paolo Manente
- Ospedale San Giacomo Apostolo - Medical Oncology, Castelfranco Veneto, Italy
| | - Michela Bortolin
- Ospedale San Giacomo Apostolo - Medical Oncology, Castelfranco Veneto, Italy
| | | | | | - Giovanni Vicario
- Ospedale San Giacomo Apostolo - Medical Oncology, Castelfranco Veneto, Italy
| | - Elvira Scelzi
- Ospedale San Giacomo Apostolo - Medical Oncology, Castelfranco Veneto, Italy
| | - Gigliola Sgarbossa
- Ospedale San Giacomo Apostolo - Medical Oncology, Castelfranco Veneto, Italy
| | - Costanza De Rossi
- Ospedale San Giacomo Apostolo - Medical Oncology, Castelfranco Veneto, Italy
| | - Giuseppe Vultaggio
- Ospedale San Giacomo Apostolo - Medical Oncology, Castelfranco Veneto, Italy
| | - Giuseppe Mazzola
- Ospedale San Valentino - Palliative Care Unit, Montebelluna, Italy
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Danielli R, Ridolfi R, Chiarion-Sileni V, Queirolo P, Testori A, Plummer R, Boitano M, Calabrò L, De Rossi C, Giacomo AMD, Ferrucci PF, Ridolfi L, Altomonte M, Miracco C, Balestrazzi A, Maio M. Ipilimumab in pretreated patients with metastatic uveal melanoma: safety and clinical efficacy. Cancer Immunol Immunother 2012; 61:41-8. [PMID: 21833591 PMCID: PMC11028946 DOI: 10.1007/s00262-011-1089-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [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: 06/06/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Abstract
Current systemic treatments for metastatic uveal melanoma (UM) have not improved overall survival (OS). The fully human anti-cytotoxic T-lymphocyte antigen-4 (CTLA-4) monoclonal antibody, ipilimumab, improved OS of patients with advanced cutaneous melanoma in a phase 3 trial; however, UM patients were excluded. The aim of this subanalysis, performed by the ipilimumab-ocular melanoma expanded access program (I-OMEAP) study group, was to assess the activity and safety of ipilimumab in patients with UM in a setting similar to daily clinical practice. Patients participating in a multicenter expanded access program (EAP) received induction treatment with ipilimumab 10 mg/kg. Maintenance doses were administered in patients who experienced clinical benefit or at physicians' discretion. Tumor assessment was evaluated per modified World Health Organization criteria at baseline, Week 12, Week 24, and Week 36. Adverse events (AEs) and immune-related AEs (irAEs) were collected according to Common Terminology Criteria for Adverse Events version 3.0. Thirteen pretreated patients with metastatic UM were treated at 6 European institutions. All patients received at least one dose of ipilimumab. Overall, no objective responses were observed; however, two patients had stable disease (SD), with a third patient achieving SD after initial progressive disease. Median OS as of July 1, 2011, was 36 weeks (range 2-172+ weeks). No grade 3/4 AEs of non-immune origin were reported. Three patients (23%) experienced grade 3 irAEs (1 thrombocytopenia, 1 diarrhea, and 1 alanine/aspartate aminotransferase elevation) that resolved with steroid therapy. The results indicate UM is a potential indication for ipilimumab treatment that should be further investigated in clinical trials.
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Affiliation(s)
- Riccardo Danielli
- Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Ruggero Ridolfi
- Scientific Institute of Romagna for the Study and Treatment of Cancer (IRST), Meldola-Forlì, Italy
| | | | | | | | | | | | - Luana Calabrò
- Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | | | - Anna Maria Di Giacomo
- Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | | | - Laura Ridolfi
- Scientific Institute of Romagna for the Study and Treatment of Cancer (IRST), Meldola-Forlì, Italy
| | - Maresa Altomonte
- Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Clelia Miracco
- Pathology, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Angelo Balestrazzi
- Ophthalmology, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Michele Maio
- Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
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De Rossi C, Brunello A, Jirillo G, Jirillo A. When an interim analysis of randomized trial changes the practice in oncology: the lesson of adjuvant Trastuzumab and the HERA trial. Immunopharmacol Immunotoxicol 2009; 31:30-1. [DOI: 10.1080/08923970802340332] [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: 10/21/2022]
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10
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De Rossi C, Brunello A, Jirillo G, Jirillo A. When an interim analysis of randomized trial changes the practice in oncology: The lesson of adjuvant trastuzumab and the HERA trial. Immunopharmacol Immunotoxicol 2009; 31:1-4. [PMID: 19238693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
About 30% of the randomized clinical trials are stopped early because of appearance of clear clinical benefit. Though interim analyses protect patients in case of significant imbalance between two treatment arms, conclusions drawn from truncated studies can be premature and should be viewed with caution. We report the lesson learnt from the Herceptin adjuvant (HERA) trial.
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11
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Bisogno G, De Rossi C, Gamboa Y, Sotti G, Ferrari A, Dallorso S, Donfrancesco A, Cecchetto G, Calderone M, Gandola L, Rosolen A, Carli M. Improved survival for children with parameningeal rhabdomyosarcoma: results from the AIEOP soft tissue sarcoma committee. Pediatr Blood Cancer 2008; 50:1154-8. [PMID: 18300319 DOI: 10.1002/pbc.21527] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Parameningeal rhabdomyosarcoma (PM-RMS) is a rare, highly malignant pediatric tumor arising from locations adjacent to the meninges, from where it can spread intracranially. PROCEDURE We reviewed 109 children with non-metastatic PM-RMS enrolled in the Italian RMS79, RMS88 and RMS96 protocols over a 24-year period. All patients received intensive chemotherapy and standard or hyperfractionated and accelerated radiotherapy. Some had delayed surgery. RESULTS Five-year overall survival rose from 40% in the RMS79 to 72% in the RMS88 and RMS96 protocols (P = 0.01), where more intensive chemotherapy and hyperfractionated accelerated radiotherapy (HART) was used. Delayed surgery after initial treatment was statistically associated with a better prognosis. Unfavorable tumor characteristics for RMS arising in other sites, for example, histology, invasiveness or node involvement, did not predict outcome for PM-RMS. CONCLUSION Outcome in PM-RMS patients enrolled in three consecutive Italian protocols has progressively improved, as a result of intensive chemotherapy, delayed surgery and, possibly, HART, though improved imaging and radiotherapeutic tools may have had a role as well.
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Affiliation(s)
- Gianni Bisogno
- Division of Hematology/Oncology, Department of Pediatrics, University Hospital of Padova, Padova, Italy.
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Grabois EW, Nosek MA, Rossi CD. Accessibility of primary care physicians' offices for people with disabilities. An analysis of compliance with the Americans With Disabilities Act. Arch Fam Med 1999; 8:44-51. [PMID: 9932071 DOI: 10.1001/archfami.8.1.44] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine if primary care physicians are in compliance with the Americans With Disabilities Act of 1990 (ADA) and to what extent offices of primary care physicians are usable for persons with disabilities. DESIGN Cross-sectional survey. SETTING Members listed in the Harris County (Texas) Medical Society roster. SUBJECTS Sixty-two general practitioners, family practitioners, internists, and obstetrician-gynecologists. MAIN OUTCOME MEASURE A 15-page questionnaire with 57 items and 136 variables. RESULTS Eleven (18%) of the primary care physicians in this study were unable to serve their patients with disabilities in the last year for reasons that could be interpreted as noncompliant with the ADA. Two physicians (3%) had offices that patients with disabilities could not enter because of physical barriers, and 1 physician (2%) had inaccessible equipment. Fourteen physicians (22%) were improperly referring patients with disabilities although they generally treat such patients. In measuring the level of compliance with regard to structural features that enhance the accessibility of the physicians' offices, only 8 (13%) had a low level of compliance. Thirty-nine (63%) of the physicians supplied auxiliary aids and services to their patients with disabilities. The most common aid was printed materials. CONCLUSIONS A substantial portion of primary care physicians' offices are not in compliance with the ADA, and some informational tools will be required to inform physicians about the nondiscriminatory requirements of the statute.
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Affiliation(s)
- E W Grabois
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Tex., USA.
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Abstract
OBJECTIVE To determine which nerve conduction parameters can predict the presence of acute denervation in carpal tunnel syndrome. SETTING The electrodiagnostic laboratories of a hospital and a county hospital district. DESIGN A retrospective review. PATIENTS A total of 1,590 consecutive cases from January 1992 to June 1996, diagnosed as having median neuropathy at the wrist. MAIN OUTCOME MEASURES Evidence of acute denervation on needle electromyography of the abductor pollicis brevis and its relationship to patient age, gender, and parameters obtained from nerve conduction studies, including median sensory latency and amplitude, and median motor latency and amplitude. RESULTS Logistic regression analysis identified gender, median motor latency, and median motor amplitude (all p < or = .008) as contributing to the prediction of denervation. Needle examination of the cases with a median motor amplitude <7 mV detected 95.3% (141/148) of all cases with denervation and could have spared 52% (708/1,362) of the population from a needle examination of the abductor pollicis brevis. CONCLUSION The median motor amplitude can predict the presence of acute denervation in the thenar muscles in median neuropathy at the wrist and possibly eliminate a painful needle examination of the median-innervated thenar muscles in over 50% of the cases.
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Affiliation(s)
- M J Vennix
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
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14
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Abstract
BACKGROUND Compared with predecessors, the modern-day patient who undergoes cardiac surgery is sicker, is older, has more diffuse disease, has poorer ventricular function, and is more likely to be a repeat surgery. Patients hospitalized after open heart surgery in the 1990s, therefore, may require increasingly comprehensive rehabilitation services before returning to the community; however, information documenting functional progress during, and outcome after, a hospital-based rehabilitation program is scarce. METHODS During a 14-month period, a consecutive sample of 44 patients who underwent cardiac surgery and were admitted to a rehabilitation unit in a tertiary acute hospital was studied. Thirty-one patients had coronary artery bypass graft, six had valvular surgery, and seven had both. Each patient's functional status on admission and discharge from the rehabilitation unit was assessed using the Functional Independence Measure. Other data studied included patient age and sex, premorbid medical problems, type of cardiac surgery, length of stay, and occurrence of medical complications in the acute and rehabilitation units. RESULTS The mean Functional Independence Measure scores at rehabilitation unit admission and discharge were 76.1 +/- 17.1 and 96.7 +/- 19.4, respectively, and this difference was significant (P < 0.0001). The most significant correlates (alpha = 0.05) of the discharge Functional Independence Measure were admission Functional Independence Measure (P < 0.00001) and length of stay in the acute care unit (P = 0.0072). Age and presence of medical complications were not significant. CONCLUSION Patients who undergo open heart surgery, many of whom have medical comorbidity, are able to demonstrate substantial functional improvement on an inpatient rehabilitation program before hospital discharge.
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Affiliation(s)
- K H Kong
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
Over a 4 year period, 119 acute spinal cord injury (SCI) patients were enrolled in this study. The 101 males and 18 females had a mean age of 35.9 years (range 16-87). Sixty-two patients were tetraplegic and 57 were paraplegic. All patients had a urine specimen taken for culture, colony count and sensitivity once weekly while they were receiving intermittent catheterization. Of these, 22 patients (18.5%), none of whom had underlying genito-urinary (GU) pathology, developed recolonization by an organism of the same species and genus previously cultured. All 22 reached sterile-urine between colonizations after being treated with antibiotics for at least 7 days. The 16 males and six females had a mean age of 35.1 years (range 17-79). Sixteen were tetraplegic and six were paraplegic. Plasmid analysis (PA) was used to determine whether these recolonizations were from the same or from a different strain. In those instances where the bacteria harbored no plasmids or where the results of plasmid analysis were otherwise inconclusive, bacteria were also compared using restriction fragment length polymorphism (RFLP) analysis. Recolonization was caused primarily by E. coli and K. pneumoniae. While there was no significant difference between the two organisms with respect to the number of days when sterile urine occurred to the time when recolonization was observed, there were significant differences seen in both organisms with regard to the time lapse from one colonization to the next: the average number of days to recolonization with an identical organism was 10.3 days, whereas with a different strain it was 15.9 days (P < 0.04). When a different organism was cultured between the recolonizations, the mean recolonization interval was 17.9 days. When no intervening organism occurred, the interval was 9.5 days (P < 0.005). Both intervals measured the days from the first sterile urine after the first colonization to the next colonization. These data indicate the proclivity for two common Gram negative normal bowel inhabitants to recolonize the neuropathic bladder of spinal cord injured patients even after adequate treatment. PA and RFLP provide a means of discriminating between relapses by the same organism versus recurrences by a different organism of the same species and genus. Those with the same identity tend to recur sooner than those of different identities and may be suspected when relapse occurs within two weeks of cessation of 7 day course of antibiotics. While an intervening organism may delay the relapse (or recurrence), it does not prevent it and identical organisms can reappear even after adequate therapeutic regimens. Since none of the patients in this study had GU pathology, recolonization by an identical strain (relapse) does not necessarily warrant an extensive investigation for disease within the GU tract.
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Affiliation(s)
- W H Donovan
- Institute for Rehabilitation and Research, University of Texas Medical School, Houston, USA
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16
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Garber SL, Rintala DH, Rossi CD, Hart KA, Fuhrer MJ. Reported pressure ulcer prevention and management techniques by persons with spinal cord injury. Arch Phys Med Rehabil 1996; 77:744-9. [PMID: 8702366 DOI: 10.1016/s0003-9993(96)90251-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [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: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors that resulted in severe pressure ulcers in a community-based sample of 23 persons with spinal cord injury (SCI). DESIGN A correlational design was used. SUBJECTS Twenty men and three women, 57% with tetraplegia and 43% with paraplegia, participated. Adult participants with an ulcer of 12 weeks' duration or less were recruited from the plastic surgery clinic of a regional SCI center. MEASURES A structured survey assessed demographic, SCI and ulcer characteristics; detection method; immediacy and appropriateness of action; time from detection to clinic visit; number of prior ulcers; and knowledge and practice of ulcer prevention techniques. Ulcer characteristics (ie, location, size, and stage) were assessed by examination and compared with participants' descriptions of their ulcers. RESULTS Severe ulcers and ulcers that progressed in severity after initial detection were less accurately described by participants. Individuals who waited longer to come to the clinic presented with more severe ulcers. Taking immediate or appropriate action when an ulcer was detected was related to reported performance of more preventive behaviors. Contrary to expectation, immediacy and appropriateness of action, and knowledge and practice of preventive behaviors were unrelated to severity, progression of severity, and time from detection to the clinic visit. The findings suggest that educational programs should emphasize more strongly immediate visits to a physician upon detection of an ulcer. Furthermore, such educational models should be assessed for their effectiveness in reducing ulcers and preventing progression in severity once persons with SCI return to the community.
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Affiliation(s)
- S L Garber
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
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17
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Abstract
The prevalence of self-reported alcohol and marijuana use, along with alcohol abuse as measured by the Short Michigan Alcoholism Screening Test, was assessed for a community-based sample (n = 123) of persons with spinal cord injury (SCI). Correlates of alcohol and marijuana use and alcohol abuse also were examined, including demographic variables, measures of impairment, disability, and handicap, SCI medical complications, and measures of subjective assessment such as health rating, health maintenance behaviors, depression, life satisfaction, perceived stress, pain, and social support. Prevalence of alcohol use (59%) and marijuana use (16%) in persons with SCI was less than that of comparison groups in the general population. However, prevalence of alcohol abuse (21%) exceeded that of general population studies. Participants who abused alcohol shared the following criteria: (1) perceived their overall health as worse than those who did not abuse alcohol; (2) were more depressed; and (3) experienced more stress in their lives than those who did not abuse alcohol. Participants who used marijuana were younger at the time of the study and were younger at injury. They were also more depressed and more stressed. The indications of alcohol abuse in one in five persons with SCI living in the community mandates that screening, treatment, and referrals be part of any rehabilitation treatment program.
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Affiliation(s)
- M E Young
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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Abstract
Concern over the development of tolerance in patients on continuous intrathecal baclofen therapy has arisen as this new form of treatment for spasticity has gained wider use. We have studied time-dose relationships in 18 spinal cord injured patients who have undergone intrathecal baclofen infusion pump implantation since February 1988 in our facility. Our data show that there was a significant increase in baclofen dosage needed to control spasticity during the first 12 months post implantation. After 12 months, however, no significant changes in dosage requirement was detected. In addition, there was no significant difference between completely and incompletely spinal cord injured patients with regard to both the initial dose and the tolerance trend.
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Affiliation(s)
- M N Akman
- Department of Physical Medicine and Rehabilitation, Inonu University Medical School, Malatya, Turkey
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Abstract
Hypotensive anesthesia has been advocated in spinal surgery for the purpose of diminishing operative blood loss. This study evaluated its effectiveness in 12 Jehovah's Witnesses undergoing Harrington instrumentation and fusion who refused transfusion. Previous series from this institute did not use deliberate hypotension because of routinely low blood loss. Compared with matched controls operated on under normotensive anesthesia, the Jehovah's Witness patients had lower absolute blood loss but also shorter operative time. Applied linear-regression analysis demonstrated that the diminished blood loss was associated with shorter operative time (P = 0.0002) rather than lower blood pressure. The majority of blood losses in spinal instrumentation with fusion occurs with decortication. This rapid bleeding occurs at venous pressures which are unaffected by arterial blood pressure manipulation. The authors conclude that spinal surgery is possible in Jehovah's Witnesses without transfusion and that operative technique is the single most important determinant of blood loss.
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Affiliation(s)
- J W Brodsky
- University of Texas Health Science Center, Dallas
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20
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Donovan WH, Carter RE, Rossi CD, Wilkerson MA. Clonidine effect on spasticity: a clinical trial. Arch Phys Med Rehabil 1988; 69:193-4. [PMID: 3348719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Clonidine was used as an adjunct to baclofen in 55 patients with spasticity due to spinal cord injury. Dosage was held at the minimum effect amount for those who responded. No effect was seen in 24 patients (44%), although 31 (56%) benefitted from the drug. Patients were grouped as quadriplegics or paraplegics, having complete or incomplete lesions. Of all quadriplegics, seven of 11 complete (64%) and 17 of 25 incomplete patients (68%) responded; among the paraplegics, six of 15 complete (40%) and one of four incomplete patients (25%) improved. Side effects were limited to postural hypotension necessitating reduction in dosage in three patients that were successfully treated; in the unsuccessfully treated group, one patient had insomnia, one had dizziness, and one had drowsiness.
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Affiliation(s)
- W H Donovan
- Institute for Rehabilitation and Research, Houston, TX 77030
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21
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Alfred WG, Fuhrer MJ, Rossi CD. Vocational development following severe spinal cord injury: a longitudinal study. Arch Phys Med Rehabil 1987; 68:854-7. [PMID: 3426385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Vocational development of individual with spinal cord injury was studied from shortly after injury to two years after discharge from inpatient rehabilitation. Objectives included examining differences in the course of vocational development by level of functional independence, and predicting vocational outcomes two years after injury. Thirty-three spinal cord injury patients (17 quadriplegics, 16 paraplegics) were followed during the study. The Goldberg Scale of Vocational Development was used to measure changes in vocational development over time. The Barthel Index was used to measure level of functional independence. Results revealed that vocational development was markedly depressed during initial inpatient rehabilitation and for six months after injury. Gradual improvement occurred after six months, but two years after discharge the level of vocational development remained lower than that before injury. Changes in vocational development over time did not differ significantly by level of functional independence. Best predictors of successful vocational outcomes were educational attainment, educational plans made before injury, and origin of interests in work.
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Affiliation(s)
- W G Alfred
- Department of Rehabilitation, Baylor College of Medicine, Houston, TX 77030
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22
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Fuhrer MJ, Carter RE, Donovan WH, Rossi CD, Wilkerson MA. Postdischarge outcomes for ventilator-dependent quadriplegics. Arch Phys Med Rehabil 1987; 68:353-6. [PMID: 3592948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Based on data contributed to the National Spinal Cord Injury Data Base between the years 1975 and 1981, outcomes were assessed for 34 patients who had been injured approximately a year earlier and who were ventilator dependent when discharged from inpatient rehabilitation. Their outcomes were compared with those of 196 patients who required mechanical respiration some time during acute care or rehabilitation, but who were free of such assistance at discharge. Statistically significant differences were obtained between the groups in levels of spinal cord injury, duration of acute care hospitalization, duration of total hospitalization, extent of self-care capability, hours/week of hired attendant care, and hours of actual physical assistance/day. The groups did not differ significantly in terms of duration of inpatient rehabilitation, duration of rehospitalization, and vocational or prevocational status at follow-up.
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Halstead LS, Wiechers DO, Rossi CD. Results of a survey of 201 polio survivors. South Med J 1985; 78:1281-7. [PMID: 4071133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We present the results of a survey on the late effects of poliomyelitis in 201 persons. The most common new problems were fatigue, weakness in previously affected and unaffected muscles, muscle pain, and joint pain. The median time from poliomyelitis to onset of new problems ranged from 30 to 40 years. Factors at onset of polio most strongly associated with development of these late effects of polio were (1) hospitalization (P less than 0.00001), (2) age greater than 10 years (P less than 0.00001), (3) ventilator use (P less than 0.0029), and (4) paralytic involvement of all four limbs (P less than 0.0240). The differential diagnosis of these new problems, implications for treatment, and areas for future research are discussed.
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Abstract
Presented are the results of a questionnaire survey on new health problems in 539 polio survivors. The most common new problems were fatigue, weakness in previously affected and unaffected muscles, muscle pain, and joint pain. The median time from polio to the onset of these problems ranged from 30 to 40 years. Factors at onset of polio most strongly associated with developing these new health problems were: being hospitalized, being over 10 years old, being on a ventilator, and having paralytic involvement of all four limbs. The differential diagnoses of these new problems, implications for treatment and areas for future research are discussed.
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Dickson JH, Dericks GH, Rossi CD. Results in operated idiopathic scoliosis patients previously treated in the Milwaukee brace. Tex Med 1981; 77:45-7. [PMID: 7268645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Fuhrer MJ, Cardus D, Rossi CD. Judgments of the potential benefits of rehabilitation research. Arch Phys Med Rehabil 1979; 60:239-46. [PMID: 110286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A critical step in a project to develop a benefit-cost approach to evaluating proposed rehabilitation research has been to specify the potential benefits of such research in a reasonably systematic and comprehensive manner. The purposes of this study were: (1) to assess the contemporary relevance of 46 benefit factors yielded by a 1973 survey: (2) to acquire judgmental data to reduce these factors to fewer and more generic 2nd-order factors: (3) to compare 7 different rehabilitation role groups in terms of how the potential benefits of rehabilitation research are valued. "Hierarchical clustering" analyses of similarity judgments by 96 participants yielded 18 2nd-order benefit factors. A number of reliable differences were identified among the role groups regarding the value placed upon specific potential benefits of rehabilitation research.
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