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Dall'Ara M, Guo Y, Poli D, Gilmer D, Ratti C. Analysis of the relative frequencies of the multipartite BNYVV genomic RNAs in different plants and tissues. J Gen Virol 2024; 105. [PMID: 38197877 DOI: 10.1099/jgv.0.001950] [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] [Indexed: 01/11/2024] Open
Abstract
Multipartite virus genomes are composed of two or more segments, each packaged into an independent viral particle. A potential advantage of multipartitism is the regulation of gene expression through changes in the segment copy number. Soil-borne beet necrotic yellow vein virus (BNYVV) is a typical example of multipartism, given its high number of genomic positive-sense RNAs (up to five). Here we analyse the relative frequencies of the four genomic RNAs of BNYVV type B during infection of different host plants (Chenopodium quinoa, Beta macrocarpa and Spinacia oleracea) and organs (leaves and roots). By successfully validating a two-step reverse-transcriptase digital droplet PCR protocol, we show that RNA1 and -2 genomic segments always replicate at low and comparable relative frequencies. In contrast, RNA3 and -4 accumulate with variable relative frequencies, resulting in distinct RNA1 : RNA2 : RNA3 : RNA4 ratios, depending on the infected host species and organ.
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Affiliation(s)
- M Dall'Ara
- DISTAL-Plant pathology, University of Bologna, Viale G. Fanin, 40, 40127 Bologna, Italy
| | - Y Guo
- DISTAL-Plant pathology, University of Bologna, Viale G. Fanin, 40, 40127 Bologna, Italy
| | - D Poli
- DISTAL-Plant pathology, University of Bologna, Viale G. Fanin, 40, 40127 Bologna, Italy
| | - D Gilmer
- Institut de biologie moléculaire des plantes, CNRS, Université de Strasbourg, France
| | - C Ratti
- DISTAL-Plant pathology, University of Bologna, Viale G. Fanin, 40, 40127 Bologna, Italy
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Canova S, Ceresoli G, Grosso F, Zucali P, Gelsomino F, Pasello G, Mencoboni M, Rulli E, Galli F, De Simone I, Carlucci L, De Angelis A, Belletti M, Bonomi M, D’Aveni A, Perrino M, Bono F, Cortinovis D, Canova S, Colonese F, Abbate M, Sala L, Sala E, Perez Gila M, Bono F, Pagni F, Ceresoli G, D’Aveni A, Bonomi M, Grosso F, De Angelis A, Ugo F, Belletti M, Zucali P, Perrino M, De Vincenzo F, Santoro A, Gelsomino F, Ardizzoni A, Pasello G, Frega S, Mencoboni M, Carlucci L, De Simone I, D’Incalci M, Galli F, Poli D, Rulli E, Torri V. Final results of DIADEM, a phase II study to investigate the efficacy and safety of durvalumab in advanced pretreated malignant pleural mesothelioma. ESMO Open 2022; 7:100644. [PMID: 36463732 PMCID: PMC9808442 DOI: 10.1016/j.esmoop.2022.100644] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a cancer with a high mortality rate and few therapeutic options. After platinum-pemetrexed combination, no further promising drug seems to be effective. Immune checkpoint inhibitors may have some activity in pretreated patients and no data are available in this population about durvalumab. MATERIALS AND METHODS DIADEM was a multicenter, open-label, single-arm, phase II trial aimed at evaluating the efficacy and safety of durvalumab. Patients with locally advanced/metastatic MPM who progressed after platinum-pemetrexed chemotherapy were enrolled to receive durvalumab (1500 mg, intravenously Q4W) for 12 months or until evidence of disease progression or unacceptable toxicity. The primary endpoint was the proportion of patients alive and free from progression at 16 weeks (PFS16wks) calculated from treatment initiation. Secondary endpoints were progression-free survival, overall survival, overall response rate, and safety. RESULTS Sixty-nine patients with a median age of 69 years (range 44-82 years) were enrolled; 62 patients (89.9%) had epithelioid histotype. As first-line treatment, all patients received platinum derivatives-pemetrexed combination (60.9% with carboplatin and 39.1% with cisplatin). As of March 2021, the median follow-up was 9.2 months (interquartile range 5.2-11.1 months). Six patients (8.7%) completed the 12-month treatment; 60 patients discontinued, of whom 42 for progressive disease, and 4 died. Seventeen patients (28.3%; 95% confidence interval 17.5% to 41.4%) were alive or free from progression at 16 weeks. Eleven patients (18.6%) had a grade 3 or 4 treatment-related adverse event (AE), and one (1.4%) had a grade ≥3 immune-related, treatment-related AE. There was one drug-related death. CONCLUSION Durvalumab alone in pretreated non-selected MPM did not reach a meaningful clinical activity, showing any new major safety issue signals.
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Affiliation(s)
- S. Canova
- ASST H S Gerardo, SC Medical Oncology, Monza
| | - G.L. Ceresoli
- Humanitas Gavazzeni, Bergamo,Department of Oncology, Saronno Hospital, ASST Valle Olona, Saronno (VA)
| | - F. Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - P.A. Zucali
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano,Department of Biomedical Sciences, Humanitas University, Rozzano
| | - F. Gelsomino
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - G. Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova,Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | | | - E. Rulli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - F. Galli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - I. De Simone
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - L. Carlucci
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - A. De Angelis
- Mesothelioma Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M. Belletti
- Mesothelioma Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M. Bonomi
- Humanitas Gavazzeni, Bergamo,Department of Oncology, ASST Cremona, Cremona, Italy
| | - A. D’Aveni
- Humanitas Gavazzeni, Bergamo,Department of Oncology, Saronno Hospital, ASST Valle Olona, Saronno (VA)
| | - M. Perrino
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano
| | - F. Bono
- ASST H S Gerardo, SC Medical Oncology, Monza
| | - D.L. Cortinovis
- ASST H S Gerardo, SC Medical Oncology, Monza,Correspondence to: Dr Diego Luigi Cortinovis, ASST-Monza San Gerardo Hospital, SC Medical Oncology, Monza, Via Pergolesi 33 20900 Monza, Italy. Tel: +39-0392339575; Fax: +39-0392332284
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De Pascali F, Squizzato A, Barcellona D, Bucciarelli P, Ciampa A, Grandone E, Malcangi G, Rescigno G, Toschi V, Testa S, Poli D. Management of anticoagulation in hemodialysis: Results from a survey of current clinical practice in the Italian anticoagulation clinics. Thromb Res 2022; 220:97-99. [DOI: 10.1016/j.thromres.2022.10.012] [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: 08/18/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
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Pinelli S, Alinovi R, Corradi M, Poli D, Cavallo D, Pelosi G, Ampollini L, Goldoni M, Mozzoni P. A comparison between the effects of over-expression of miRNA-16 and miRNA-34a on cell cycle progression of mesothelioma cell lines and on their cisplatin sensitivity. Cancer Treat Res Commun 2020; 26:100276. [PMID: 33338854 DOI: 10.1016/j.ctarc.2020.100276] [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] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 11/17/2022]
Abstract
The prognosis of patients affected by malignant pleural mesothelioma (MPM) is presently poor and no therapeutic strategies have improved their survival yet. Introduction of miRNA mimics to restore their reduced or absent functionality in cancer cells is considered an important opportunity and a combination of miR's might be even more effective. In the present study, miR-16 and miR-34a were transfected, singularly and in combination, in MPM cell lines H2052 and H28, and their effects on cell proliferation and sensitivity to cisplatin are reported. Interestingly, the overexpression of both miRs, alone or combined, slows down the cell cycle progression, modulates the p53 and HMGB1 expression and increases the sensitivity of cells to cisplatin, producing a marked impairment of cell proliferation and strengthening the apoptotic effect of the drug. However, the co-overexpression of the two miRs results more effective only in the regulation of the cell cycle, but does not enhance the sensitivity of MPM cells to cisplatin. Consequently, although the potential of miR-16 and miR-34a is confirmed, we must conclude that their combination does not improve the response of MPM to chemotherapy.
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Affiliation(s)
- S Pinelli
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126 Parma, Italy.
| | - R Alinovi
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126 Parma, Italy.
| | - M Corradi
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126 Parma, Italy; University Hospital of Parma, Parma, Italy.
| | - D Poli
- INAIL Research, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene Via Fontana Candida1, 00078 Monte Porzio Catone, Rome, Italy.
| | - D Cavallo
- INAIL Research, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene Via Fontana Candida1, 00078 Monte Porzio Catone, Rome, Italy.
| | - G Pelosi
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 17/A, 43124 Parma, Italy.
| | - L Ampollini
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126 Parma, Italy; University Hospital of Parma, Parma, Italy.
| | - M Goldoni
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126 Parma, Italy.
| | - P Mozzoni
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126 Parma, Italy.
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Cascinu S, Poli D, Zaniboni A, Lonardi S, Labianca R, Sobrero A, Rosati G, Di Bartolomeo M, Scartozzi M, Zagonel V, Pella N, Banzi M, Torri V. The prognostic impact of primary tumour location in patients with stage II and stage III colon cancer receiving adjuvant therapy. A GISCAD analysis from three large randomised trials. Eur J Cancer 2019; 111:1-7. [PMID: 30797014 DOI: 10.1016/j.ejca.2019.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 10/19/2018] [Revised: 01/16/2019] [Accepted: 01/20/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Because the role of the primary tumour location in the adjuvant setting has not been clearly established in colon cancer, we analysed the clinical outcome according to the primary tumour location from three Italian trials assessing adjuvant therapy in colon cancer. PATIENTS AND METHODS Overall survival (OS) and disease-free survival (DFS) were assessed globally and in each trial, according to right-sided, transverse and left-sided primary colon cancer. Analysis was planned to provide overall and stage-specific results. RESULTS Individual data of 5239 patients were included in this analysis. The right-sided tumours were 1540 (29%), tumours originating in the transverse were 815 (16%) and left-sided tumours were 2884 (55%). At the multivariate analysis, DFS findings from the comparison of the right-sided versus left-sided tumours (hazard ratio [HR] = 1.00; 95% confidence interval [CI] = 0.89-1.14) were not statistically associated with clinical outcomes in the overall population. On the contrary, OS findings, from the comparison of the right-sided versus left-sided tumours, were significantly associated with outcomes (HR = 1.20; 95% CI = 1.04-1.39). In stage II patients, there was no difference in terms of DFS and OS among the three different tumour locations, whereas in stage III patients, the left-sided tumours showed an improved prognosis in terms of OS (HR: 1.36 95% CI = 1.14-1.62, p < 0.001). CONCLUSION This is the largest analysis demonstrating a prognostic effect of the tumour location on patients with colon cancer receiving adjuvant chemotherapy. Nevertheless, the effect is limited to OS in stage III colon cancer. In stage II tumours, the primary location has a lesser impact. The transverse tumours should be prognostically considered in between the right-sided and left-sided tumours.
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Affiliation(s)
- S Cascinu
- Modena Cancer Center, Università di Modena e Reggio Emilia, Italy.
| | - D Poli
- Laboratory of Methodology for Clinical Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - A Zaniboni
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - S Lonardi
- Medical Oncology 1, Istituto Oncologico Veneto (IOV)-IRCCS, Padova, Italy
| | - R Labianca
- Cancer Center, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - A Sobrero
- Medical Oncology Unit, IRCCS San Martino-IST, Genova, Italy
| | - G Rosati
- Medical Oncology Unit, Ospedale San Carlo, Potenza, Italy
| | - M Di Bartolomeo
- Medical Oncology Unit, Fondazione Istituto Nazionale Tumori-IRCCS, Milano, Italy
| | - M Scartozzi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - V Zagonel
- Medical Oncology 1, Istituto Oncologico Veneto (IOV)-IRCCS, Padova, Italy
| | - N Pella
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - M Banzi
- Medical Oncology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - V Torri
- Laboratory of Methodology for Clinical Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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Palareti G, Antonucci E, Ageno W, Mastroiacovo D, Poli D, Tosetto A. The American College of Chest Physician score to assess the risk of bleeding during anticoagulation in patients with venous thromboembolism: reply. J Thromb Haemost 2018; 16:2539-2540. [PMID: 30240521 DOI: 10.1111/jth.14300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G Palareti
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - E Antonucci
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - W Ageno
- Department of Internal Medicine, University of Insubria, Varese, Italy
| | - D Mastroiacovo
- Angiology Unit, SS Filippo and Nicola Hospital, Avezzano, L'Aquila, Italy
| | - D Poli
- Thrombosis Center, AOU Careggi, Firenze, Italy
| | - A Tosetto
- Hematology Department, S. Bortolo Hospital, Vicenza, Italy
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7
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Palareti G, Antonucci E, Mastroiacovo D, Ageno W, Pengo V, Poli D, Testa S, Tosetto A, Prandoni P. The American College of Chest Physician score to assess the risk of bleeding during anticoagulation in patients with venous thromboembolism. J Thromb Haemost 2018; 16:1994-2002. [PMID: 30059189 DOI: 10.1111/jth.14253] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 02/08/2018] [Indexed: 11/26/2022]
Abstract
Essentials The risk of bleeding influences the duration of anticoagulation (AC) after venous thromboembolism. We assessed the ACCP bleeding risk score in an inception-cohort of patients receiving AC. 53% were categorized at high-risk, but their bleeding rate was low during long-term AC. ACCP score had low predictive value for bleeding. SUMMARY Background The American College of Chest Physicians (ACCP) guideline proposes a score to decide on extended anticoagulation after an unprovoked venous thromboembolism (VTE). Methods We investigated the ACCP score to predict bleeding risk in an inception cohort of 2263 patients on long-term anticoagulation (1522 treated with vitamin K antagonists [VKAs] and the remaining with direct oral anticoagulants [DOACs]) belonging to the Italian START2 Register. Results More than half the patients were categorized as high risk; nevertheless, a higher proportion received anticoagulation for > 1 year compared with those in the low-risk category. For 3130 years (median 12 [interquartile range 6, 24] months), 48 bleeding outcomes occurred (1.53%/year) in the cohort (1.7%/year and 0.95%/year in high- and low-risk categories, respectively). The c-statistic of the ACCP score was 0.55 (0.48-0.63), 0.50 (0.42-0.58) and 0.56 (0.48-0.64) in low-, moderate- and high-risk categories, respectively. The bleeding incidence was higher during the first 90 days of treatment (3.0%/year) than afterwards (1.2%/year; relative risk (RR), 2.5 [1.3-4.7]), and similar among the three categories. The bleeding rate was not different during the initial 3 months of treatment in patients receiving VKAs or DOACs; it was, however, lower in the latter patients in the subsequent period (0.5%/year vs. 1.4%/year, respectively). Conclusion The bleeding rate during extended treatment was rather low in our patients. ACCP score had insufficiently predictive value for bleeding and cannot be used to guide decisions on extended treatment. New prediction tools for bleeding risk during anticoagulant treatments (including DOACs) are required.
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Affiliation(s)
- G Palareti
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - E Antonucci
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - D Mastroiacovo
- Angiology Unit, SS Filippo and Nicola Hospital, Avezzano, L'Aquila, Italy
| | - W Ageno
- Department of Internal Medicine, University of Insubria, Varese, Italy
| | - V Pengo
- Cardiology Clinic, Thrombosis Centre, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - D Poli
- Thrombosis Centre, AOU Careggi, Firenze, Italy
| | - S Testa
- Hemostasis and Thrombosis Center, Department of Laboratory Medicine, AO Istituti Ospitalieri, Cremona, Italy
| | - A Tosetto
- Hematology Department, S. Bortolo Hospital, Vicenza, Italy
| | - P Prandoni
- Department of Clinical Medicine, University of Padua, Padua, Italy
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Tedeschi S, Banti L, Graiani G, Poli D, Borghetti A, Perlini S, Cabassi A. ZINC-ALPHA 2 GLYCOPROTEIN FACILITATES CATECHOLAMINE-INDUCED LIPOLYSIS IN HUMAN ADIPOCYTES THROUGH A CATALASE-LIKE EFFECT. J Hypertens 2018. [DOI: 10.1097/01.hjh.0000539006.45662.11] [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: 11/25/2022]
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Testa S, Paoletti O, Legnani C, Dellanoce C, Antonucci E, Cosmi B, Pengo V, Poli D, Morandini R, Testa R, Tripodi A, Palareti G. Low drug levels and thrombotic complications in high-risk atrial fibrillation patients treated with direct oral anticoagulants. J Thromb Haemost 2018; 16:842-848. [PMID: 29532628 DOI: 10.1111/jth.14001] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Indexed: 11/30/2022]
Abstract
Essentials Direct oral anticoagulants (DOACs) do not require laboratory monitoring currently. DOAC specific measurements were performed at trough in patients with atrial fibrillation. Patients who developed thromboembolic events showed lower DOAC plasma levels. This study supports the concept of measuring DOAC levels at steady state. SUMMARY Background Direct oral anticoagulants (DOACs) are administered at fixed doses without the need for dose adjustment according to laboratory testing. High interindividual variability in drug blood levels has been shown with all DOACs. To evaluate a possible relationship between DOAC C-trough anticoagulant levels and thromboembolic events, 565 consecutive naive patients with atrial fibrillation (AF) were enrolled in this study performed within the START Laboratory Registry. Methods DOAC-specific measurements (diluted thrombin time or anti-activated factor II calibrated for dabigatran; anti-activated FX calibrated for rivaroxaban or apixaban) at C-trough were performed locally at steady state within 15-25 days after the start of treatment. For each DOAC, the interval of C-trough levels, from the limit of quantification to the highest value, was subdivided into four equal classes, and results were attributed to these classes; the median values of results were also calculated. Thromboembolic complications occurring during 1 year of follow-up were recorded. Results Thromboembolic events (1.8%) occurred in 10 patients who had baseline C-trough levels in the lowest class of drug levels. The incidence of thromboembolic events among patients with DOAC C-trough levels in the lowest level class was 2.4%, and that in the remaining groups was 0%. The patients with thrombotic complications also had a higher mean CHA2 DS2 -VASc score than that of the total patient population: 5.3 (95% confidence interval [CI] 4.3-6.3 versus 3.0 (95% CI 2.9-3.1). Conclusion In this study cohort, thrombotic complications occurred only in DOAC-treated AF patients who had very low C-trough levels, with a relatively high CHA2 DS2 -VASc score. Larger studies are warranted to confirm these preliminary observations.
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Affiliation(s)
- S Testa
- Hemostasis and Thrombosis Center, Ospedale di Cremona, Cremona, Italy
| | - O Paoletti
- Hemostasis and Thrombosis Center, Ospedale di Cremona, Cremona, Italy
| | - C Legnani
- Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy
| | - C Dellanoce
- Hemostasis and Thrombosis Center, Ospedale di Cremona, Cremona, Italy
| | - E Antonucci
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - B Cosmi
- Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy
| | - V Pengo
- Department of Cardiac, Thoracic and Vascular Sciences, Cardiology Clinic, Thrombosis Center, University of Padua, Padua, Italy
| | - D Poli
- Thrombosis Center, AOU Careggi, Firenze, Italy
| | - R Morandini
- Hemostasis and Thrombosis Center, Ospedale di Cremona, Cremona, Italy
| | - R Testa
- Clinical Laboratory and Molecular Diagnosis, INRCA-IRCCS National Institute, Ancona, Italy
| | - A Tripodi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS CàGranda Maggiore Hospital Foundation, Milano, Italy
| | - G Palareti
- Arianna Anticoagulazione Foundation, Bologna, Italy
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Rezoagli E, Martinelli I, Poli D, Scoditti U, Passamonti SM, Bucciarelli P, Ageno W, Dentali F. The effect of recanalization on long-term neurological outcome after cerebral venous thrombosis. J Thromb Haemost 2018; 16:718-724. [PMID: 29341411 DOI: 10.1111/jth.13954] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 09/28/2017] [Indexed: 12/01/2022]
Abstract
Essentials The role of cerebral venous thrombosis (CVT) recanalization on neurologic outcome is still debated. We studied a large cohort of 508 CVT patients with 419 patient years of radiological follow-up. Recanalization rate is high during the first months after CVT and neurologic outcome is favorable. High recanalization grade of CVT independently predicts good neurological outcome. SUMMARY Background Studies with limited sample size and with discordant results described the recanalization time-course of cerebral venous thrombosis (CVT). The neurological outcome after a first episode of CVT is good, but the role of recanalization on neurological dependence is still debated. Objectives The aim of the study is to assess the recanalization rate after cerebral venous thrombosis (CVT) and its prognostic role in long-term neurological outcome. Patients/Methods In a retrospective observational multicenter cohort study, patients with an acute first episode of CVT with at least one available imaging test during follow-up were enrolled. Patency status of the vessels was categorized as complete, partial or not recanalized. Neurological outcome was defined using the modified Rankin scale (mRS) as good (mRS = 0-1) or poor (mRS = 2-6). Results Five-hundred and eight patients (median [IQR] age, 39 [28.5-49] years; 26% male) were included. Complete or partial recanalization was not differently represented in patients undergoing scans at different periods of time (from 28-day to 3 month-period up to a 1-3 year-period). mRS at the time of follow-up imaging was available in 483 patients; 92.8% of them had a mRS of 0-1. CVT recanalization (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.59-4.13) was positively associated, whereas cancer (OR, 0.29; 95% CI, 0.09-0.88), and personal history of venous thromboembolism (VTE) (OR, 0.36; 95% CI, 0.14-0.92) were negatively associated as independent predictors of favorable (mRS = 0-1) outcome at follow-up. Conclusions Most patients with a first CVT had complete or partial recanalization at follow-up. Recanalization was independently associated with a favorable neurological outcome.
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Affiliation(s)
- E Rezoagli
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Anesthesia Center for Critical Care Research, Boston, USA
| | - I Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - D Poli
- Thrombosis Centre, Department of Heart and Vessels, University of Florence, Florence, Italy
| | - U Scoditti
- Thrombosis Centre, Department of Heart and Vessels, University of Florence, Florence, Italy
- Department of Neurology, University of Parma, Parma, Italy
| | - S M Passamonti
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - P Bucciarelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - W Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - F Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Cini M, Legnani C, Cosmi B, Testa S, Dellanoce C, Paoletti O, Marcucci R, Poli D, Paniccia R, Pengo V, Tripodi A, Palareti G. Comparison of five specific assays for determination of dabigatran plasma concentrations in patients enrolled in the START-Laboratory Register. Int J Lab Hematol 2018; 40:229-236. [DOI: 10.1111/ijlh.12772] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/15/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M. Cini
- Department of Angiology and Blood Coagulation; S. Orsola-Malpighi University Hospital; Bologna Italy
| | - C. Legnani
- Department of Angiology and Blood Coagulation; S. Orsola-Malpighi University Hospital; Bologna Italy
| | - B. Cosmi
- Department of Angiology and Blood Coagulation; S. Orsola-Malpighi University Hospital; Bologna Italy
| | - S. Testa
- Haemostasis and Thrombosis Center; Department of Laboratory Medicine; AO Istituti Ospitalieri; Cremona Italy
| | - C. Dellanoce
- Haemostasis and Thrombosis Center; Department of Laboratory Medicine; AO Istituti Ospitalieri; Cremona Italy
| | - O. Paoletti
- Haemostasis and Thrombosis Center; Department of Laboratory Medicine; AO Istituti Ospitalieri; Cremona Italy
| | - R. Marcucci
- Thrombosis Center; Department of Experimental and clinical Medicine; University of Florence; Florence Italy
| | - D. Poli
- Thrombosis Center; Department of Experimental and clinical Medicine; University of Florence; Florence Italy
| | - R. Paniccia
- Center for Bleeding Disorders; Careggi University Hospital; Florence Italy
| | - V. Pengo
- Department of Cardiothoracic and Vascular Sciences; University Hospital of Padua; Padua Italy
| | - A. Tripodi
- Department of Clinical Sciences and Community Health; Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Università degli Studi di Milano; Milan Italy
- IRCCS Maggiore Hospital Foundation; Milan Italy
| | - G. Palareti
- Cardiovascular Diseases; University of Bologna, Coordinator of the START-Register; Bologna Italy
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Fauchier L, Hylek E, Knight E, Lane D, Levi M, Marin F, Palareti G, Collet JP, Rubboli A, Poli D, Camm AJ, Lip G, Andreotti F, Huber K, Kirchhof P. Bleeding risk assessment and management in atrial fibrillation patients. Thromb Haemost 2017; 106:997-1011. [PMID: 22048796 DOI: 10.1160/th11-10-0690] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 10/27/2011] [Indexed: 12/13/2022]
Abstract
SummaryIn this executive summary of a Consensus Document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in atrial fibrillation (AF) patients. The main aim of the document was to summarise ‘best practice’ in dealing with bleeding risk in AF patients when approaching antithrombotic therapy, by addressing the epidemiology and size of the problem, and review established bleeding risk factors. We also summarise definitions of bleeding in the published literature. Patient values and preferences balancing the risk of bleeding against thromboembolism as well as the prognostic implications of bleeding are reviewed. We also provide an overview of published bleeding risk stratification and bleeding risk schema. Brief discussion of special situations (e.g. periablation, peri-devices such as implantable cardioverter defibrillators [ICD] or pacemakers, presentation with acute coronary syndromes and/or requiring percutanous coronary interventions/stents and bridging therapy) is made, as well as a discussion of the prevention of bleeds and managing bleeding complications. Finally, this document puts forwards consensus statements that may help to define evidence gaps and assist in everyday clinical practice.
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Tosetto A, Testa S, Martinelli I, Poli D, Cosmi B, Lodigiani C, Ageno W, De Stefano V, Falanga A, Nichele I, Paoletti O, Bucciarelli P, Antonucci E, Legnani C, Banfi E, Dentali F, Bartolomei F, Barcella L, Palareti G. External validation of the DASH prediction rule: a retrospective cohort study. J Thromb Haemost 2017; 15:1963-1970. [PMID: 28762665 DOI: 10.1111/jth.13781] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 05/22/2017] [Indexed: 11/27/2022]
Abstract
Essentials Predicting recurrences may guide therapy after unprovoked venous thromboembolism (VTE). We evaluated the DASH score in 827 patients with unprovoked VTE to verify prediction accuracy. A DASH score ≤ 1 had a cumulative recurrence risk at 1 year of 3.6%, as predicted by the model. The DASH score performed better in younger (< 65 years old) subjects. SUMMARY Background The DASH prediction model has been proposed as a guide to identify patients at low risk of recurrence of venous thromboembolism (VTE), but has never been validated in an independent cohort. Aims To validate the calibration and discrimination of the DASH prediction model, and to evaluate the DASH score in a predefined patient subgroup aged > 65 years. Methods Patients with a proximal unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) who received a full course of vitamin K antagonist or direct oral anticoagulant (> 3 months) and had D-dimer measured after treatment withdrawal were eligible. The DASH score was computed on the basis of the D-dimer level after therapy withdrawal and personal characteristics at the time of the event. Recurrent VTE events were symptomatic proximal or distal DVT/PE, and were analyzed with a time-dependent analysis. Observed 12-month and 24-month recurrence rates were compared with recurrence rates predicted by the DASH model. Results We analyzed a total of 827 patients, of whom 100 (12.1%) had an objectively documented recurrence. As compared with the original DASH cohort, there was a greater proportion of subjects with a 'low-risk' (≤ 1) DASH score (66.3% versus 51.6%, P < 0.001). The slope of the observed versus expected cumulative incidence at 2 years was 0.71 (95% confidence interval 0.51-1.45). The c-statistic was lower for subjects aged > 65 years (0.54) than for younger subjects (0.72). Conclusions These results confirm the validity of DASH prediction model, particularly in young subjects. The recurrence risk in elderly patients (> 65 years) was, however, > 5% even in those with the lowest DASH scores.
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Affiliation(s)
- A Tosetto
- Hematology Department, San Bortolo Hospital, Vicenza, Italy
| | - S Testa
- Hemostasis and Thrombosis Center, AO Istituti Ospitalieri di Cremona, Cremona, Italy
| | - I Martinelli
- Hemophilia and Thrombosis Center, Fondazione Angelo Bianchi Bonomi, IRCCS Ospedale Ca' Granda, Dipartimento di Medicina Interna, Università degli Studi di Milano, Milan, Italy
| | - D Poli
- Thrombosis Center, Dipartimento Oncologico AOU Careggi, Florence, Italy
| | - B Cosmi
- Department of Angiology and Blood Coagulation, S. Orsola Malpighi University Hospital, Bologna, Italy
| | - C Lodigiani
- Thrombosis and Hemorragic Diseases Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - W Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - V De Stefano
- Institute of Hematology, Catholic University, Rome, Italy
| | - A Falanga
- Thrombosis and Hemostasis Center, Department of Immunohematology and Transfusion Medicine, Bergamo, Italy
| | - I Nichele
- Hematology Department, San Bortolo Hospital, Vicenza, Italy
| | - O Paoletti
- Hemostasis and Thrombosis Center, AO Istituti Ospitalieri di Cremona, Cremona, Italy
| | - P Bucciarelli
- Hemophilia and Thrombosis Center, Fondazione Angelo Bianchi Bonomi, IRCCS Ospedale Ca' Granda, Dipartimento di Medicina Interna, Università degli Studi di Milano, Milan, Italy
| | - E Antonucci
- Fondazione Arianna Anticoagulazione, Bologna, Italy
| | - C Legnani
- Department of Angiology and Blood Coagulation, S. Orsola Malpighi University Hospital, Bologna, Italy
| | - E Banfi
- Thrombosis and Hemorragic Diseases Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - F Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - F Bartolomei
- Institute of Hematology, Catholic University, Rome, Italy
| | - L Barcella
- Thrombosis and Hemostasis Center, Department of Immunohematology and Transfusion Medicine, Bergamo, Italy
| | - G Palareti
- Fondazione Arianna Anticoagulazione, Bologna, Italy
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Gelsomino F, Torri V, Zaniboni A, Labianca R, Sobrero A, Poli D, Frontini L, Cascinu S. Sidedness influences prognosis in colon cancer patients receiving an adjuvant therapy. A GISCAD analysis from three randomized trials including 5234 patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.005] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Cascinu S, Poli D, Zaniboni A, Labianca R, Sobrero A, Torri V. Sidedness influences prognosis in stage III but not in stage II colon cancer patients receiving an adjuvant therapy: A GISCAD analysis from three randomized trials including 5234 patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.008] [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: 11/12/2022] Open
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Poli D, Palareti G, Pengo V, Antonucci E, Migliaccio L, Grifoni E, Maggini N, Moia M, Testa S, De Caterina R. 4110Thromboembolic and bleeding risk of patients with left-sided mechanical heart prostheses: the FCSA-START-Valvole Study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D. Poli
- Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - G. Palareti
- Fondazione Arianna Anticoagulazione, Bologna, Italy
| | - V. Pengo
- University Hospital of Padova, Padua, Italy
| | - E. Antonucci
- Fondazione Arianna Anticoagulazione, Bologna, Italy
| | | | - E. Grifoni
- University of Florence, Thrombosis Centre, Dpt of Medical and Surgical Critical Care, Florence, Italy
| | - N. Maggini
- Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - M. Moia
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S. Testa
- Hospital of Cremona, Haemostasis and Thrombosis Centre, Cremona, Italy
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Testa S, Legnani C, Tripodi A, Paoletti O, Pengo V, Abbate R, Bassi L, Carraro P, Cini M, Paniccia R, Poli D, Palareti G. Poor comparability of coagulation screening test with specific measurement in patients receiving direct oral anticoagulants: results from a multicenter/multiplatform study. J Thromb Haemost 2016; 14:2194-2201. [PMID: 27566988 DOI: 10.1111/jth.13486] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 01/25/2016] [Indexed: 11/30/2022]
Abstract
Essentials Prothrombin and partial thromboplastin time (PT/PTT) measure direct oral anticoagulants (DOACs). PT, PTT and specific tests for DOACs were performed on patients treated for atrial fibrillation. Normal PT/PTT don't exclude DOAC activity and their prolongation doesn't confirm DOAC action. The use of PT or PTT to evaluate DOAC activity could cause dangerous misinterpretations. SUMMARY Background Prothrombin time (PT) and activated partial thromboplastin time (APTT) have been proposed to measure the effect of oral anti-activated factor X (FXa) or anti-activated FII drugs, respectively. Aims To evaluate the relationships and responsiveness of PT and APTT versus direct oral anticoagulant (DOAC) concentrations measured with specific coagulation tests performed with different platforms in four Italian anticoagulation clinics. Methods Six hundred and thirty-five patients with atrial fibrillation participated in the study: 240 were receiving dabigatran, 264 were receiving rivaroxaban, and 131 were receiving apixaban. Blood was taken at trough and peak within the first month (15-25 days) of treatment. PT, APTT, diluted thrombin time (dTT) calibrated for dabigatran and anti-FXa calibrated for rivaroxaban or apixaban were determined. Results For dabigatran, the correlation between APTT and dTT ranged from r = 0.80 to r = 0.62. For rivaroxaban, the correlation between the anti-FXa assay and PT ranged from r = 0.91 to r = 0.73. For apixaban, the correlation between the anti-FXa assay and PT was lower than for the two other drugs (r = 0.81 to r = 0.54). Despite the above significant correlations, the responsiveness of PT or APTT was relatively poor. A discrepancy between global testing and DOAC plasma concentrations was shown in a considerable proportion of patients, depending on the platform and drug, with values ranging from 6% to 62%. Conclusions Overall, poor responsiveness of the screening tests to DOAC concentrations was observed. PT and APTT normal values cannot exclude DOAC anticoagulant activity, and PT or APTT prolongation is not always associated with DOAC anticoagulant effect as determined with specific tests.
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Affiliation(s)
- S Testa
- Department of Laboratory Medicine, Hemostasis and Thrombosis Center, AO Istituti Ospitalieri, Cremona, Italy
| | - C Legnani
- Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy
| | - A Tripodi
- Department of Clinical Sciences and Community Health, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Università degli Studi di Milano, IRCCS Cà Granda Maggiore Hospital Foundation, Milan, Italy
| | - O Paoletti
- Department of Laboratory Medicine, Hemostasis and Thrombosis Center, AO Istituti Ospitalieri, Cremona, Italy
| | - V Pengo
- Department of Cardiothoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - R Abbate
- Thrombosis Center, Department of Heart and Vessels, University Hospital of Florence, Florence, Italy
| | - L Bassi
- Department of Laboratory Medicine, Hemostasis and Thrombosis Center, AO Istituti Ospitalieri, Cremona, Italy
| | - P Carraro
- Department of Laboratory Medicine, ULSS 16 and University-Hospital of Padova, Padova, Italy
| | - M Cini
- Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy
| | - R Paniccia
- Thrombosis Center, Department of Heart and Vessels, University Hospital of Florence, Florence, Italy
| | - D Poli
- Thrombosis Center, Department of Heart and Vessels, University Hospital of Florence, Florence, Italy
| | - G Palareti
- Cardiovascular Diseases, University of Bologna, Bologna, Italy
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18
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Cosmi B, Legnani C, Ghirarduzzi A, De Micheli V, Pengo V, Testa S, Poli D, Antonucci E, Prisco D, Tripodi A, Prandoni P, Palareti G. OC-15 - Risk factors for cancer development after idiopathic venous thromboembolism. Thromb Res 2016; 140 Suppl 1:S174. [DOI: 10.1016/s0049-3848(16)30132-3] [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: 10/22/2022]
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19
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Andreoli R, Spatari G, Pigini D, Poli D, Banda I, Goldoni M, Riccelli MG, Petyx M, Protano C, Vitali M, Barbaro M, Mutti A. Urinary biomarkers of exposure and of oxidative damage in children exposed to low airborne concentrations of benzene. Environ Res 2015; 142:264-272. [PMID: 26186134 DOI: 10.1016/j.envres.2015.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/23/2015] [Accepted: 07/07/2015] [Indexed: 06/04/2023]
Abstract
The aim of this work was to evaluate the oxidative damage to nucleic acids in children (5-11 years) associated with exposure to environmental pollutants and tobacco smoke (ETS). For each subject, urinary sampling was done twice (evening and next morning) to measure by tandem LC-MS-MS such oxidated products of nucleic acids as 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo), 8-oxo-7,8-dihydroguanosine (8-oxoGuo), and 8-oxo-7,8-dihydroguanine (8-oxoGua). Methyl tert-butyl ether (U-MTBE), benzene (U-Benz), and its metabolites (t,t-muconic and S-phenylmercapturic acids, t,t-MA and S-PMA, respectively) were determined as biomarkers of exposure to air pollution, and cotinine as a biomarker of exposure to ETS. Biomarkers of exposure (S-PMA and U-MTBE) and of DNA oxidation (8-oxodGuo) were dependent on the urbanization and industrialization levels and increased in the evening sample as compared to next morning (p<0.05). In both evening and next morning samples, 8-oxodGuo and 8-oxoGuo correlated with each other (r=0.596 and r=0.537, respectively, p<0.01) and with biomarkers of benzene exposure, particularly S-PMA (r=0.59 and r=0.45 for 8-oxodGuo and r=0.411 and r=0.383 for 8-oxoGuo, p<0.01). No such correlations were observed for U-MTBE and cotinine. Multiple linear regression analyses showed that 8-oxodGuo was positively associated with S-PMA at both sampling times (β=0.18 and β=0.14 for evening and next morning sampling, respectively; p<0.02) and weakly with U-MTBE (β=0.07, p=0.020) only in the evening urines. These results suggest that the selected biomarkers of exposure to benzene, particularly S-PMA, are good tracers of exposure to complex mixtures of oxidative pollutants and that the associated oxidative damage to nucleic acids is detectable even at very low levels of exposure.
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Affiliation(s)
- R Andreoli
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
| | - G Spatari
- Department of Environmental Science, Security, Territory, Food and Health, University of Messina, Messina, Italy
| | - D Pigini
- CERT, INAIL Research Center at the University of Parma, Parma, Italy
| | - D Poli
- CERT, INAIL Research Center at the University of Parma, Parma, Italy
| | - I Banda
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - M Goldoni
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - M G Riccelli
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - M Petyx
- INAIL, DMLEL, Monteporzio Catone, Rome, Italy
| | - C Protano
- Department of Public Health and Infectious Diseases, La Sapienza University, Rome, Italy
| | - M Vitali
- Department of Public Health and Infectious Diseases, La Sapienza University, Rome, Italy
| | - M Barbaro
- Department of Environmental Science, Security, Territory, Food and Health, University of Messina, Messina, Italy
| | - A Mutti
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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20
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Palareti G, Legnani C, Cosmi B, Antonucci E, Erba N, Poli D, Testa S, Tosetto A. Comparison between different D-Dimer cutoff values to assess the individual risk of recurrent venous thromboembolism: analysis of results obtained in the DULCIS study. Int J Lab Hematol 2015; 38:42-9. [PMID: 26362346 DOI: 10.1111/ijlh.12426] [Citation(s) in RCA: 254] [Impact Index Per Article: 28.2] [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: 05/17/2015] [Accepted: 08/10/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION D-dimer assay, generally evaluated according to cutoff points calibrated for VTE exclusion, is used to estimate the individual risk of recurrence after a first idiopathic event of venous thromboembolism (VTE). METHODS Commercial D-dimer assays, evaluated according to predetermined cutoff levels for each assay, specific for age (lower in subjects <70 years) and gender (lower in males), were used in the recent DULCIS study. The present analysis compared the results obtained in the DULCIS with those that might have been had using the following different cutoff criteria: traditional cutoff for VTE exclusion, higher levels in subjects aged ≥60 years, or age multiplied by 10. RESULTS In young subjects, the DULCIS low cutoff levels resulted in half the recurrent events that would have occurred using the other criteria. In elderly patients, the DULCIS results were similar to those calculated for the two age-adjusted criteria. The adoption of traditional VTE exclusion criteria would have led to positive results in the large majority of elderly subjects, without a significant reduction in the rate of recurrent event. CONCLUSION The results confirm the usefulness of the cutoff levels used in DULCIS.
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Affiliation(s)
- G Palareti
- Italian Association of Anticoagulated Patients, Bologna, Italy
| | - C Legnani
- Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy
| | - B Cosmi
- Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy
| | - E Antonucci
- Thrombosis Centre, Department Heart and Vessels, University Hospital of Florence, Florence, Italy
| | - N Erba
- Haemostasis and Thrombosis Centre, Hospital of Lecco, Lecco, Italy
| | - D Poli
- Thrombosis Centre, Department Heart and Vessels, University Hospital of Florence, Florence, Italy
| | - S Testa
- Haemostasis and Thrombosis Centre, Hospital of Cremona, Cremona, Italy
| | - A Tosetto
- Haematology and Thrombosis Centre, Hospital of Vicenza, Vicenza, Italy
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21
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Riva N, Ageno W, Poli D, Testa S, Rupoli S, Santoro R, Lerede T, Piana A, Carpenedo M, Nicolini A, Ferrini PM, Tosetto A. Safety of vitamin K antagonist treatment for splanchnic vein thrombosis: a multicenter cohort study. J Thromb Haemost 2015; 13:1019-27. [PMID: 25845412 DOI: 10.1111/jth.12930] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 09/02/2014] [Accepted: 03/16/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The treatment of splanchnic vein thrombosis (SVT) is challenging, due to the increased risk of bleeding and potentially life-threatening complications. Current recommendations are based on evidence from the treatment of venous thrombosis in usual sites, but small observational studies in SVT population suggest that the bleeding risk may offset the benefit of anticoagulant treatment in this setting. The aim of this study was to evaluate the safety of vitamin K antagonists (VKAs) in SVT patients. METHODS We retrospectively included SVT patients treated with VKAs followed by 37 Italian anticoagulation clinics, until June 2013. The primary outcome was the incidence of major bleeding (MB), according to the ISTH definition, during VKA treatment. Vascular events, including both arterial and venous thrombosis, and mortality were also documented. RESULTS Three hundred and seventy-five patients were included (median age 53 years; 54.7% males). During a median VKA treatment duration of 1.98 years, 15 MB events occurred, corresponding to an incidence rate of 1.24 (95% confidence interval [CI], 0.75-2.06) per 100 patient-years. Gastrointestinal bleeding represented 40% of all MB events. At multivariate analysis, the presence of esophageal varices emerged as independent predictor of MB (hazard ratio 5.4; 95% CI, 1.4-21.1). The incidence rate of vascular events on treatment was 1.37 (95% CI, 0.84-2.23) per 100 patient-years and the mortality rate was 0.83 (95% CI, 0.44-1.54) per 100 patient-years. CONCLUSIONS Selected SVT patients followed by anticoagulation clinics for the management of VKA treatment show a low rate of major bleeding and vascular events.
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Affiliation(s)
- N Riva
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - W Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - D Poli
- Department of Heart and Vessels, Thrombosis Centre, AOU-Careggi, Florence, Italy
| | - S Testa
- Haemostasis and Thrombosis Centre, AO Istituti Ospitalieri, Cremona, Italy
| | - S Rupoli
- Division of Hematology, Haemostasis and Thrombosis Center, AOU Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy
| | - R Santoro
- Hemostasis and Thrombosis Unit, Hemophilia Center, Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - T Lerede
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - A Piana
- Department of Internal Medicine, Ospedale S. Martino, Genoa, Italy
| | - M Carpenedo
- Department of Hematology and Transplant Unit, AO San Gerardo, Monza, Italy
| | - A Nicolini
- Department of Internal Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - P M Ferrini
- Dipartimento Emergenza-Urgenza e Area Medica e Specialistica, AOU Parma, Parma, Italy
| | - A Tosetto
- Department of Hematology, Hemostasis and Thrombosis Center, S. Bortolo Hospital, Vicenza, Italy
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Marcucci M, Iorio A, Douketis JD, Eichinger S, Tosetto A, Baglin T, Cushman M, Palareti G, Poli D, Tait RC, Kyrle PA. Risk of recurrence after a first unprovoked venous thromboembolism: external validation of the Vienna Prediction Model with pooled individual patient data. J Thromb Haemost 2015; 13:775-81. [PMID: 25660555 DOI: 10.1111/jth.12871] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 10/20/2014] [Accepted: 02/02/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND In order to stratify patients with a first unprovoked venous thromboembolism (VTE) according to their recurrence risk and to identify those who would actually benefit from indefinite anticoagulation, three prediction models have been developed so far; none of them has been yet externally validated. OBJECTIVE To externally validate the Vienna Prediction Model (VPM), a prediction guide for estimating the recurrence risk after a first unprovoked VTE developed through Cox modeling and including sex, D-dimer and index VTE site as predictors. PATIENTS/METHODS Nine hundred and four patients pooled from five prospective studies evaluating the prognostic value of D-dimer for VTE recurrence served as the validation cohort. The validity of the VPM in stratifying patients according to their relative recurrence risk (discrimination) and in predicting the absolute recurrence risk (calibration) was tested with survival analysis methods. RESULTS The ability of the VPM to distinguish patients' risk for recurrent VTE in the validation cohort was at least as good as in the original cohort, with a calibration slope of 1.17 (95% confidence interval 0.71-1.64; P = 0.456 for the hypothesis of a significant difference from 1), and a c-statistic of 0.626 (vs. 0.651 in the original derivation cohort). The VPM absolute predictions in terms of cumulative rates tended to underestimate the observed recurrence rates at 12 months. CONCLUSIONS By using a pooled individual patient database as a validation cohort, we confirmed the ability of the VPM to stratify patients with a first unprovoked VTE according to their risk of recurrence.
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Affiliation(s)
- M Marcucci
- Geriatrics, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico & Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Corradi M, Poli D, Banda I, Bonini S, Mozzoni P, Pinelli S, Alinovi R, Andreoli R, Ampollini L, Casalini A, Carbognani P, Goldoni M, Mutti A. Exhaled breath analysis in suspected cases of non-small-cell lung cancer: a cross-sectional study. J Breath Res 2015; 9:027101. [PMID: 25634546 DOI: 10.1088/1752-7155/9/2/027101] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lung cancer is one of the most frequently diagnosed cancers worldwide and is still the leading cause of cancer-related deaths. There is a considerable interest in finding diagnostic methods in the disease's earliest stages. A complementary approach to imaging techniques could be provided by exhaled breath gas phase and exhaled breath condensate (EBC) analysis. The aim of this study was to quantify various biomarkers in the exhaled breath gas phase and EBC in suspected cases of non-small-cell lung cancer (NSCLC). The study involved 138 subjects with suspected lung cancer, 71 of whom had a subsequent diagnosis of NSCLC. The diagnostic power of a combination of hydrogen peroxide (H₂O₂)-EBC, and exhaled pentane, 2-methyl pentane, hexane, ethyl benzene, heptanal, trans-2-nonenal in distinguishing NSCLC and non-NSCLC subjects was poor-to-fair (area under the curve (AUC) = 0.68), similar to that of smoking history alone (expressed as pack-years, AUC = 0.70); a further improvement was observed when smoking history was combined with exhaled compounds (AUC = 0.80). The diagnostic power was increased in those patients with little or no past smoke exposure (AUC = 0.92) or where past smoke exposure was up to 30 pack-years (AUC = 0.85). Exhaled substances had a good accuracy in discriminating suspected cancerous cases only in those subjects with a modest smoking history (≤ 30 pack-years), but the inclusion of other exhaled biomarkers may increase the overall accuracy, regardless of tobacco smoke.
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Affiliation(s)
- M Corradi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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Bajetta E, Floriani I, Di Bartolomeo M, Labianca R, Falcone A, Di Costanzo F, Comella G, Amadori D, Pinto C, Carlomagno C, Nitti D, Daniele B, Mini E, Poli D, Santoro A, Mosconi S, Casaretti R, Boni C, Pinotti G, Bidoli P, Landi L, Rosati G, Ravaioli A, Cantore M, Di Fabio F, Aitini E, Marchet A. Randomized trial on adjuvant treatment with FOLFIRI followed by docetaxel and cisplatin versus 5-fluorouracil and folinic acid for radically resected gastric cancer. Ann Oncol 2014; 25:1373-1378. [PMID: 24728035 DOI: 10.1093/annonc/mdu146] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Some trial have demonstrated a benefit of adjuvant fluoropirimidine with or without platinum compounds compared with surgery alone. ITACA-S study was designed to evaluate whether a sequential treatment of FOLFIRI [irinotecan plus 5-fluorouracil/folinic acid (5-FU/LV)] followed by docetaxel plus cisplatin improves disease-free survival in comparison with 5-FU/LV in patients with radically resected gastric cancer. PATIENTS AND METHODS Patients with resectable adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to either FOLFIRI (irinotecan 180 mg/m(2) day 1, LV 100 mg/m(2) as 2 h infusion and 5-FU 400 mg/m(2) as bolus, days 1 and 2 followed by 600 mg/m(2)/day as 22 h continuous infusion, q14 for four cycles) followed by docetaxel 75 mg/m(2) day 1, cisplatin 75 mg/m(2) day 1, q21 for three cycles (sequential arm) or De Gramont regimen (5-FU/LV arm). RESULTS From February 2005 to August 2009, 1106 patients were enrolled, and 1100 included in the analysis: 562 in the sequential arm and 538 in the 5-FU/LV arm. With a median follow-up of 57.4 months, 581 patients recurred or died (297 sequential arm and 284 5-FU/LV arm), and 483 died (243 and 240, respectively). No statistically significant difference was detected for both disease-free [hazard ratio (HR) 1.00; 95% confidence interval (CI): 0.85-1.17; P = 0.974] and overall survival (OS) (HR 0.98; 95% CI: 0.82-1.18; P = 0.865). Five-year disease-free and OS rates were 44.6% and 44.6%, 51.0% and 50.6% in the sequential and 5-FU/LV arm, respectively. CONCLUSIONS A more intensive regimen failed to show any benefit in disease-free and OS versus monotherapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01640782.
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Affiliation(s)
- E Bajetta
- Istituto di Oncologia, Policlinico di Monza, Monza
| | - I Floriani
- Laboratory of Clinical Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milano.
| | - M Di Bartolomeo
- Struttura Complessa di Medicina Oncologica 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - R Labianca
- Unità di Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo
| | - A Falcone
- Dipartimento di Ricerca Traslazionale, Università di Pisa, Istituto Toscano Tumori, Pisa
| | - F Di Costanzo
- S.C. Oncologia Medica, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - G Comella
- Oncologia Medica A, Fondazione Pascale, Istituto Nazionale dei Tumori, Napoli
| | - D Amadori
- I.R.C.C.S. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola
| | - C Pinto
- U.O. di Oncologia Medica, Policlinico S.Orsola Malpighi, Bologna
| | - C Carlomagno
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli
| | - D Nitti
- Clinica Chiurgica 1, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, Padova
| | - B Daniele
- Dipartimento di Oncologia, A.O.G. Rummo, Benevento
| | - E Mini
- Dipartimento di Scienze Della Salute, Sezione di Farmacologia Clinica e Oncologia, Università degli Studi di Firenze, Firenze
| | - D Poli
- Laboratory of Clinical Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milano
| | - A Santoro
- U.O. Oncologia e Ematologia, Humanitas Cancer Center, Istituto Clinico Humanitas-I.R.C.C.S., Rozzano
| | - S Mosconi
- Unità di Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo
| | - R Casaretti
- S.C. di Oncologia Medica Addominale, dell'Istituto Tumori di Napoli, Napoli
| | - C Boni
- Oncologia, Arcispedale Santa Maria Nuova-I.R.C.C.S., Reggio Emilia, Reggio Emilia
| | - G Pinotti
- Divisione di Oncologia Medica, A.O. Ospedale di Circolo, Varese
| | - P Bidoli
- S.C. Oncologia Medica, A.O.S. Gerardo, Monza
| | - L Landi
- U.O. Oncologia Medica, Azienda USL6 di Livorno, Istituto Toscano Tumori, Livorno
| | - G Rosati
- Unità Oncologia Medica, Ospedale S. Carlo, Potenza
| | - A Ravaioli
- U.O. di Oncologia, Ospedale Infermi Rimini, Ospedale Cervesi, Azienda USL di Rimini, Rimini, Cattolica
| | - M Cantore
- Oncologia Medica, USL 1, Massa Carrara
| | - F Di Fabio
- U.O. di Oncologia Medica, Policlinico S.Orsola Malpighi, Bologna
| | - E Aitini
- Ospedale Carlo Poma, Mantova, Italy
| | - A Marchet
- Clinica Chiurgica 1, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, Padova
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Poli D, Antonucci E, Dentali F, Erba N, Testa S, Tiraferri E, Palareti G. Recurrence of ICH after resumption of anticoagulation with VK antagonists: CHIRONE Study. Neurology 2014; 82:1020-6. [DOI: 10.1212/wnl.0000000000000245] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Poli D, Antonucci E, Testa S, Cosmi B, Palareti G, Ageno W. The predictive ability of bleeding risk stratification models in very old patients on vitamin K antagonist treatment for venous thromboembolism: results of the prospective collaborative EPICA study: reply. J Thromb Haemost 2014; 12:423-4. [PMID: 24405549 DOI: 10.1111/jth.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D Poli
- Department of Heart and Vessels, Thrombosis Centre, AOU-Careggi, Florence, Italy
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27
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Poli D, Antonucci E, Testa S, Cosmi B, Palareti G, Ageno W. The predictive ability of bleeding risk stratification models in very old patients on vitamin K antagonist treatment for venous thromboembolism: results of the prospective collaborative EPICA study. J Thromb Haemost 2013; 11:1053-8. [PMID: 23578305 DOI: 10.1111/jth.12239] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [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: 07/24/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND The optimal duration of anticoagulant treatment after venous thromboembolism (VTE) should be evaluated in relation to bleeding risk. This assessment is particularly difficult with elderly patients, because of their increased risk of both recurrences and hemorrhages. Bleeding risk stratification models have been proposed, but their predictive ability in very elderly patients is unknown. We aimed to assess six bleeding stratification models in this setting, by using information available in our dataset. PATIENTS AND METHODS Patients aged ≥ 80 years receiving vitamin K antagonists (VKAs) for the secondary prevention of VTE were eligible for this prospective cohort study. All patients were followed at Italian anticoagulation clinics for monitoring of VKA treatment. Risk factors for bleeding were collected, and major bleeding events and mortality were documented during follow-up. The association of bleeding events with the available risk factors was tested by means of Cox regression analysis; the c-statistic was used to quantify the predictive validity of the classification schemes. RESULTS A total of 1078 patients (37.2% males; mean age, 84 years) were enrolled in the study, for a total observation period of 1981 patient-years. The rate of major bleeding was 2.4 per 100 patient-years (47 events; one was fatal). The mortality rate was 5.2 per 100 patient-years. None of the considered risk factors were significantly associated with bleeding events. The predictive validity of the risk stratification models was low, and the most accurate model was not specifically developed for VTE patients (HEMORR2 HAGES, c-statistic 0.60, 95% confidence interval 0.49-0.70). CONCLUSIONS Bleeding risk stratification models appear to have little accuracy in very elderly VTE patients.
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Affiliation(s)
- D Poli
- Department of Heart and Vessels, Thrombosis Center, AOU-Careggi, Florence.
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Pengo V, Crippa L, Falanga A, Finazzi G, Marongiu F, Moia M, Palareti G, Poli D, Testa S, Tiraferri E, Tosetto A, Tripodi A, Siragusa S, Manotti C. Phase III studies on novel oral anticoagulants for stroke prevention in atrial fibrillation: a look beyond the excellent results. J Thromb Haemost 2012; 10:1979-87. [PMID: 22827490 DOI: 10.1111/j.1538-7836.2012.04866.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [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: 11/30/2022]
Abstract
In this overview we address the three phase III studies that compared new oral anticoagulants (dabigatran, rivaroxaban and apixaban) with warfarin in the setting of stroke prevention in atrial fibrillation. Strengths and weaknesses of the studies were examined in detail through indirect comparison. We analyze and comment the inclusion and exclusion criteria, the characteristics of randomized patients, the primary efficacy and safety end points and side effects. All new oral anticoagulants resulted in being non-inferior to vitamin K antagonists in reducing stroke or systemic embolism in patients with atrial fibrillation. Dabigatran 150 mg and apixaban were superior to vitamin K antagonists. Importantly, new oral anticoagulants significantly reduced hemorrhagic stroke in all three studies. Major differences among new oral anticoagulants include the way they are eliminated and side effects. Both dabigatran and apixaban were tested in low- to moderate-risk patients (mean CHADS2 [Congestive heart failure, Hypertension, Age, Diabetes, Stroke] score = 2.1-2.2) whereas rivaroxaban was tested in high-risk patients (mean CHADS2 score = 3.48) and at variance with dabigatran and apixaban was administered once daily. Apixaban significantly reduced mortality from any cause. The choice of a new oral anticoagulant should take into account these and other differences between the new drugs.
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Affiliation(s)
- V Pengo
- Department of Clinical Cardiology, Thrombosis Centre, University of Padua, Padua, Italy.
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Denas G, Padayattil Jose S, Gresele P, Erba N, Testa S, De Micheli V, Quintavalla R, Poli D, Bracco A, Fierro T, Iliceto S, Pengo V. Major bleeding in patients undergoing PCI and triple or dual antithrombotic therapy: a parallel-cohort study. J Thromb Thrombolysis 2012; 35:178-84. [DOI: 10.1007/s11239-012-0790-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Dentali F, Poli D, Scoditti U, Di Minno MND, De Stefano V, Stefano VD, Siragusa S, Kostal M, Palareti G, Sartori MT, Grandone E, Vedovati MC, Ageno W, Falanga A, Lerede T, Bianchi M, Testa S, Witt D, McCool K, Bucherini E, Grifoni E, Coalizzo D, Benedetti R, Marietta M, Sessa M, Guaschino C, di Minno G, Tufano A, Barbar S, Malato A, Pini M, Castellini P, Barco S, Barone M, Paciaroni M, Alberti A, Agnelli G, Giorgi Pierfranceschi M, Dulicek P, Silingardi M, Federica L, Ghirarduzzi A, Tiraferri E, di Lazzaro V, Rossi E, Ciminello A, Pasca S, Barillari G, Rezoagli E, Galli M, Squizzato A, Tosetto A. Long-term outcomes of patients with cerebral vein thrombosis: a multicenter study. J Thromb Haemost 2012; 10:1297-302. [PMID: 22578023 DOI: 10.1111/j.1538-7836.2012.04774.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [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: 12/01/2022]
Abstract
BACKGROUND Little information is available on the long-term clinical outcome of cerebral vein thrombosis (CVT). OBJECTIVES AND METHODS In an international, retrospective cohort study, we assessed the long-term rates of mortality, residual disability and recurrent venous thromboembolism (VTE) in a cohort of patients with a first CVT episode. RESULTS Seven hundred and six patients (73.7% females) with CVT were included. Patients were followed for a total of 3171 patient-years. Median follow-up was 40 months (range 6, 297 months). At the end of follow-up, 20 patients had died (2.8%). The outcome was generally good: 89.1% of patients had a complete recovery (modified Rankin Score [mRS] 0-1) and 3.8% had a partial recovery and were independent (mRS 2). Eighty-four per cent of patients were treated with oral anticoagulants and the mean treatment duration was 12 months. CVT recurred in 31 patients (4.4%), and 46 patients (6.5%) had a VTE in a different site, for an overall incidence of recurrence of 23.6 events per 1000 patient-years (95% confidence Interval [CI] 17.8, 28.7) and of 35.1 events/1000 patient-years (95% CI, 27.7, 44.4) after anticoagulant therapy withdrawal. A previous VTE was the only significant predictor of recurrence at multivariate analysis (hazard ratio [HR] 2.70; 95% CI 1.25, 5.83). CONCLUSIONS The long-term risk of mortality and recurrent VTE appears to be low in patients who survived the acute phase of CVT. A previous VTE history independently predicts recurrent events.
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Affiliation(s)
- F Dentali
- Department of Clinical Medicine, University of Insubria, Varese, Italy.
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31
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Tosetto A, Iorio A, Marcucci M, Baglin T, Cushman M, Eichinger S, Palareti G, Poli D, Tait RC, Douketis J. Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH). J Thromb Haemost 2012; 10:1019-25. [PMID: 22489957 DOI: 10.1111/j.1538-7836.2012.04735.x] [Citation(s) in RCA: 280] [Impact Index Per Article: 23.3] [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: 08/31/2023]
Abstract
BACKGROUND In patients with unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is anchored on estimating the risk of disease recurrence. OBJECTIVES We aimed to develop a score that could predict the recurrence risk following a first episode of unprovoked VTE, pooling individual patient data from seven prospective studies. METHODS One thousand eight hundred and eighteen cases with unprovoked VTE treated for at least 3 months with a vitamin K antagonist were available for analysis. Optimism-corrected Cox regression coefficients were used to develop a recurrence score that was subsequently internally validated by bootstrap analysis. RESULTS Abnormal D-dimer after stopping anticoagulation, age <50 years, male sex and VTE not associated with hormonal therapy (in women) were the main predictors of recurrence and were used to derive a prognostic recurrence score (DASH, D-dimer, Age, Sex, Hormonal therapy) showing a satisfactory predictive capability (ROC area =0.71). The annualized recurrence risk was 3.1% (95% confidence interval [CI], 2.3-3.9) for a score ≤ 1, 6.4% (95% CI, 4.8-7.9) for a score=2 and 12.3% (95% CI, 9.9-14.7) for a score ≥ 3. By considering at low recurrence risk those patients with a score ≤ 1, life-long anticoagulation might be avoided in about half of patients with unprovoked VTE. CONCLUSIONS The DASH prediction rule appears to predict recurrence risk in patients with a first unprovoked VTE and may be useful to decide whether anticoagulant therapy should be continued indefinitely or stopped after an initial treatment period of at least 3 months.
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Affiliation(s)
- A Tosetto
- Department of Hematology, S. Bortolo Hospital, Vicenza, Italy.
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Pengo V, Crippa L, Falanga A, Finazzi G, Marongiu F, Palareti G, Poli D, Testa S, Tiraferri E, Tosetto A, Tripodi A, Manotti C. Questions and answers on the use of dabigatran and perspectives on the use of other new oral anticoagulants in patients with atrial fibrillation. A consensus document of the Italian Federation of Thrombosis Centers (FCSA). Thromb Haemost 2011; 106:868-76. [PMID: 21946939 DOI: 10.1160/th11-05-0358] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 08/19/2011] [Indexed: 12/21/2022]
Abstract
Dabigatran and other new oral anticoagulants (OAC) represent a step forward in stroke prevention in patients with atrial fibrillation (AF). They indeed have been shown to be an alternative to vitamin K antagonists (VKAs) without the burden of laboratory control. However, these new drugs compete with an effective and well-established therapy, thus bringing about a series of questions and doubts. In this report members of the board of the Italian Federation of Thrombosis Centers (FCSA) answer some questions every clinician might be confronted with.
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Affiliation(s)
- V Pengo
- Clinical Cardiology, Thrombosis Center, Padova, Italy.
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33
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Corradi M, Poli D, Tillo R, Goldoni M, Acampa O, Mozzoni P, Sabbadini F, Pinelli S, Carbognani P, Internullo E, Casalini A, Gervasi G, Filetti A, Mutti A. [Early molecular diagnosis of lung cancer: a method to rule out the disease]. G Ital Med Lav Ergon 2011; 33:92-95. [PMID: 23393810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aim of this study was the determination of new markers for the diagnosis of lung cancer. 61 patients with non-small cell lung cancer (NSCLC) and 42 controls were enrolled. In the NSCLC patients the following markers were increased: H2O2 in exhaled breath condensate, pentane, hexane, nonenal, trans-2-heptanal, trans-2-nonenal in exhaled breath, while pentanal was decreased. Using multivariate statistical models, a sensitivity of 73.8% and a specificity of 76.8% were calculated. This study shows that with this non-invasive test followed by a most powerful test on positives (e.g. PET) it is possible to decrease the number of false positives.
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Affiliation(s)
- M Corradi
- Laboratorio di Tossicologia Industriale, Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, Università di Parma, Via Gramsci 14, 43126 Parma, Italy.
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De Palma G, Poli D, Manini P, Andreoli R, Mozzoni P, Apostoli P, Mutti A. [Environmental and biological monitoring of exposure to monoaromatic hydrocarbons and to methyl tert-butyl ether in a group of petrol station workers]. G Ital Med Lav Ergon 2011; 33:49-52. [PMID: 23393799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of the study was to evaluate biomarkers of exposure to gasoline in petrol station workers by a combined approach of environmental and biological monitoring. The personal exposure to benzene, toluene, ethylbenzene and xylene (BTEX) and the urinary levels of BTEX, methyl tert-butyl ether (U-MTBE), trans,trans-muconic (t,t-MA) and S-phenylmercapturic acids (S-PMA) and cotinine were determined by mass spectrometry coupled chromatographic techniques. U-MTBE levels were strictly influenced by occupational exposure to gasoline, whereas both U-B and S-PMA levels depended from smoking habits and occupational exposure.
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Affiliation(s)
- G De Palma
- Dipartimento di Medicina Sperimentale ed Applicata, Sezione di Medicina del Lavoro ed Igiene Industriale, Università di Brescia, Piazzale Spedali Civili 1, 25123 Brescia.
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35
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Baglin T, Douketis J, Tosetto A, Marcucci M, Cushman M, Kyrle P, Palareti G, Poli D, Tait RC, Iorio A. Does the clinical presentation and extent of venous thrombosis predict likelihood and type of recurrence? A patient-level meta-analysis. J Thromb Haemost 2010; 8:2436-42. [PMID: 20723032 DOI: 10.1111/j.1538-7836.2010.04022.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [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: 11/29/2022]
Abstract
AIM To determine if the mode of presentation of venous thromboembolism (VTE), as deep vein thrombosis (DVT) or pulmonary embolism (PE), predicts the likelihood and type of recurrence. METHODS We carried out a patient-level meta-analysis of seven prospective studies in patients with a first VTE who were followed after anticoagulation was stopped. We used Kaplan-Meier analysis to determine the cumulative incidence of recurrent VTE according to mode of presentation, and multivariable Cox regression to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for mode of and extent of DVT as potential risk factors for recurrence. RESULTS The 5-year cumulative rate of recurrent VTE in 2554 patients was 22.6%. In 869 (36.1%) patients with PE, the 5-year rate of any recurrence (DVT or PE) was 22.0%, and recurrence as PE was 10.6%. In 1365 patients with proximal DVT, the 5-year recurrence rate was 26.4%, and recurrence with PE was 3.6%. The risk of recurrence as PE was 3.1-fold greater in patients presenting with symptomatic PE than in patients with proximal DVT (HR, 3.1; 95% CI, 1.9-5.1). Patients with proximal DVT had a 4.8-fold higher cumulative recurrence rate than those with distal DVT (HR, 4.8; 95% CI, 2.1-11.0). CONCLUSION Whilst DVT and PE are manifestations of the same disease, the phenotypic expression is predetermined. Patients presenting with PE are three times more likely to suffer recurrence as PE than patients presenting with DVT. Patients presenting with calf DVT are at low risk of recurrence and at low risk of recurrence as PE.
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Affiliation(s)
- T Baglin
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK.
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Cosmi B, Legnani C, Tosetto A, Pengo V, Ghirarduzzi A, Testa S, Prisco D, Poli D, Tripodi A, Palareti G. Sex, age and normal post-anticoagulation D-dimer as risk factors for recurrence after idiopathic venous thromboembolism in the Prolong study extension. J Thromb Haemost 2010; 8:1933-42. [PMID: 20553388 DOI: 10.1111/j.1538-7836.2010.03955.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The PROLONG randomized study showed that patients with an abnormal D-dimer after anticoagulation suspension for a first unprovoked episode of venous thromboembolism (VTE) benefited from anticoagulation resumption. Patients with normal D-dimer after anticoagulation suspension had a low recurrence rate (4.4% patient-years) but their anticoagulation optimal duration remained uncertain. OBJECTIVES To assess whether sex and age, in combination with normal D-dimer, are risk factors for VTE recurrence in patients enrolled in the PROLONG study extended follow-up. METHODS D-dimer was measured at 1 month after anticoagulation suspension. Patients with a normal D-dimer did not resume anticoagulants, whereas patients with an abnormal D-dimer were randomized either to resume or not anticoagulants. Primary outcome was recurrent VTE. RESULTS After excluding patients resuming anticoagulants for abnormal D-dimer, recurrences were higher in males than females [7.4% patient-years - 47/639 vs. 4.3% patient-years - 27/626; hazard ratio (HR) = 1.7; P = 0.027] and in patients aged 65 or older than in younger patients (8.4% patient-years - 50/598 vs. 3.6% patient-years - 24/667; HR = 2.1; P = 0.003). In patients with normal D-dimer and younger than 65, recurrences were higher in males than in females (5.1% vs. 0.4% patient-years; adjusted HR = 10.6; P = 0.023) and both females and males aged 65 years or older had more recurrences (6.6% and 8.1% patient-years, respectively, adjusted HR: 16.0; P = .008 and 16.0; P = 0.008, respectively) than females younger than 65. CONCLUSIONS In patients with idiopathic VTE and a normal D-dimer at 1 month after anticoagulation suspension, females younger than 65 had a very low risk of recurrence.
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Affiliation(s)
- B Cosmi
- Department of Angiology & Blood Coagulation Marino Golinelli, S.Orsola-Malpighi University Hospital, Bologna, Italy.
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Cosmi B, Legnani C, Tosetto A, Pengo V, Ghirarduzzi A, Alatri A, Testa S, Prisco D, Poli D, Tripodi A. PO-33 D-dimer testing to determine duration of anticoagulation and risk of occult cancer after a first episode of idiopathic venous thromboembolism: the extended follow-up of the PROLONG study. Thromb Res 2010. [DOI: 10.1016/s0049-3848(10)70083-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Poli D, Solarino B, Di Vella G, Tattoli L, Strisciullo G, Goldoni M, Mutti A, Gagliano-Candela R. Occupational asphyxiation by unknown compound(s): Environmental and toxicological approach. Forensic Sci Int 2010; 197:e19-26. [DOI: 10.1016/j.forsciint.2009.12.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 12/15/2009] [Accepted: 12/18/2009] [Indexed: 11/28/2022]
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Cosmi B, Legnani C, Iorio A, Pengo V, Ghirarduzzi A, Testa S, Poli D, Tripodi A, Palareti G. Residual Venous Obstruction, alone and in Combination with D-Dimer, as a Risk Factor for Recurrence after Anticoagulation Withdrawal following a First Idiopathic Deep Vein Thrombosis in the Prolong Study. Eur J Vasc Endovasc Surg 2010; 39:356-65. [DOI: 10.1016/j.ejvs.2009.11.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 11/01/2009] [Indexed: 10/19/2022]
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Porcu L, Poli D, Torri V, Rulli E, Di Tullio MC, Cinquini M, Bajetta E, Labianca R, Di Costanzo F, Nitti D, Floriani I. Impact of recent legislative bills regarding clinical research on Italian ethics committee activity. J Med Ethics 2008; 34:747-750. [PMID: 18827108 DOI: 10.1136/jme.2007.022178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIMS AND BACKGROUND The present work assessed the impact of two decrees on ethics committees in Italy, aimed at bringing the national laws on the conduct of clinical trials into line with the rest of the EC, and regulating and facilitating not-for-profit research. MATERIAL AND METHODS Prospectively collected data from an Italian multicentre study were examined with respect to the ethics review process. Administrative and time elements of the review process were audited. Main outcome measures were time between the application submission and the ethics committee definitive opinion, type and number of application submission forms, number of ethics committees that refused fee exemption, and time between the ethics committee approval and the administrative authorisation. RESULTS A total of 134 local research ethics committees (LRECs) were approached. Application submission procedures and application forms varied greatly; paper submission was mandatory. The median time from submission to approval was 72 days. Only two LRECs refused the fee exemption. The median time from LREC approval to administrative agreement was 50 days and only 9.6% of local authorities came to a verbal agreement with the sponsor. CONCLUSIONS Italian LRECs are still not sufficiently efficient in complying with the Directive 2001/20/EC requirement (60 days). Better coordination of LRECs work is needed although the optimal level of coordination between them is still not known. In the meantime, national guidelines are needed concerning the application of Directive 2001/20/EC. The behaviour of Italian LRECs towards not-for-profit research was excellent although only the fee exemption was requested.
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Affiliation(s)
- L Porcu
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
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Corradi M, Poli D, Goldoni M. [Molecular diagnosis of lung cancer]. G Ital Med Lav Ergon 2008; 30:115-116. [PMID: 19288801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Individuals who have been exposed to lung carcinogenics are concerned by their greater risk of developing lung cancer, thus consult physicians with the expectation of undergoing screening tests. Controversy remains as to which screening procedures should be assessed. Previous studies of sputum cytology and chest X-rays showed no benefits in lung cancer mortality reduction. Screening of high risk individuals through computerized tomography scan appeared promising, but this radiological technique suffers from low specificity. Currently, the differential diagnosis is mainly based on additional imaging techniques, particularly positron emission tomography, which is expensive, and also shows limitations in terms of sensitivity and specificity. Therefore, purely morphological criteria seem to be insufficient to distinguish lung cancer at early stages from benign nodules with sufficient confidence, and false positives undergoing surgical resection seem to occur frequently. A molecular approach to the diagnosis of lung cancer through the analysis of biomarkers obtained by non invasive means could greatly improve the specificity of imaging procedures. Extremely sensitive mass spectrometric techniques are available to detect molecular alterations in accessible media, which characterise lung cancer at early stages, thereby reducing the rate of false positives, expected to be very out without a sound application of confirmatory diagnostic tests.
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Affiliation(s)
- M Corradi
- Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, Università di Parma, Parma, Italy
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Dedola E, Albertin A, Poli D, La Colla L, Gandolfi A, Martani C, Torri G. Effect of nitrous oxide on desflurane MACBAR at two target-controlled concentrations of remifentanil. Minerva Anestesiol 2008; 74:165-172. [PMID: 18414359] [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: 05/26/2023]
Abstract
BACKGROUND The aim of this prospective, randomized, double-blind study was to determine the effect of nitrous oxide on the desflurane requirement for blunting sympathetic response following surgical incision (MACBAR) when desflurane was combined with two different target-controlled concentrations of remifentanil (1 and 3 ng/mL). METHODS A total of 103 patients, aged 20-50 years, ASA physical status I, scheduled to undergo general anesthesia for elective abdominal surgery, were randomly allocated to receive anesthesia with desflurane alone (Group A, n = 53), or with the addition of 60% nitrous oxide (Group N, n = 50). Patients of both groups were further assigned to receive a target-controlled plasma concentration of 1 ng/mL (Group A1, n = 27; Group N1, n = 26) or 3 ng/mL remifentanil (Group A3, n = 26, Group N3, n = 24). Sympathetic responses to surgical incision were determined after a 20 min period of constant end-tidal desflurane and target-controlled remifentanil concentrations. Predetermined end-tidal desflurane concentrations and the MACBAR for each group were determined using an up-and-down sequential allocation technique. RESULTS A total of 98 patients completed the study. The MACBAR of desflurane was 5.2% (95% confidence interval [CI95: 4.9-5.5%]) in Group A1 and 2.7% (CI95: 2.6-2.8%) in Group N1 (P<0.001), while in Groups A3 and N3 the MACBAR of desflurane was 2.2% (CI95:2-2.4%) and 2% (CI95:1.9-2.2%), respectively (P<0.01). When considering a minimum anesthetic concentration (MAC) value with a contribution of 60% nitrous oxide (0.55 MAC) in this population, the combined MACBAR values (expressed as multiples of the MAC) were 1.9 MAC for group A1, 1 MAC for group N1, 0.8 MAC for group A3, and 0.7 MAC for group N3. CONCLUSION The addition of 60% nitrous oxide reduces the MACBAR of desflurane by 52% when using a remifentanil concentration of 1 ng/mL, and reduces the MACBAR by 10% when using a remifentanil concentration of 3 ng/mL.
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Affiliation(s)
- E Dedola
- Department of Anesthesiology, IRCCS H. San Raffaele, Vita-Salute University of Milan, Milan, Italy
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Poli D, Antonucci E, Ciuti G, Abbate R, Prisco D. Combination of D-dimer, F1+2 and residual vein obstruction as predictors of VTE recurrence in patients with first VTE episode after OAT withdrawal. J Thromb Haemost 2008; 6:708-10. [PMID: 18194414 DOI: 10.1111/j.1538-7836.2008.02900.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baudo F, de Cataldo F, Mostarda G, Ghirarduzzi A, Molinatti M, Pengo V, Poli D, Tosetto A, Tiraferri E, Morra E. Management of patients on long-term oral anticoagulant therapy undergoing elective surgery: survey of the clinical practice in the Italian anticoagulation clinics. Intern Emerg Med 2007; 2:280-4. [PMID: 18046517 DOI: 10.1007/s11739-007-0078-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 07/20/2007] [Indexed: 10/22/2022]
Abstract
In the perioperative management of patients on long-term oral anticoagulant (OAC) therapy the problem is balancing the thromboembolic (TER) and the haemorrhagic risk (HR) in the perioperative period. The Federazione Centri per la diagnosi della trombosi e la Sorveglianza delle terapie Antitrombotiche (FCSA) activated an online registry from November 2001 to August 2003 in order to collect information on the management of these patients in Italy. Four hundred and eleven patients, undergoing elective major (18%) and minor surgery (82%), from 7 centres, were registered. Three hundred and ninety-nine out of 411 patients received LMWH either once a day (310 patients) or twice a day (89 patients) during OAC therapy discontinuation. Two thromboembolic (0.48%) and 16 bleeding events (7 major; 1.7%) were reported. Notwithstanding the lower doses of heparin (54.3 U/kg o.d. and 64.4 U/kg b.i.d.), the thromboembolic complications are in line with those reported in the literature. The data of this study suggest that the intervention with LMWH may be relevant only in the high-risk patients as already proposed by others.
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Affiliation(s)
- F Baudo
- Thrombosis and Hemostasis Unit, Niguarda Hospital, Milan, Italy.
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Landoni G, Bove T, Crivellari M, Poli D, Fochi O, Marchetti C, Romano A, Marino G, Zangrillo A. Acute renal failure after isolated CABG surgery: six years of experience. Minerva Anestesiol 2007; 73:559-565. [PMID: 17952028] [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: 05/25/2023]
Abstract
BACKGROUND A prospective observational study was carried out in a Cardiosurgical Intensive Care Unit (ICU) in order to evaluate the incidence of Acute Renal Failure (ARF) after coronary artery bypass graft surgery and identify its predictors. The effects of ARF on outcome were also investigated. METHODS The study enrolled 3,013 consecutive patients undergoing coronary artery bypass graft surgery. Baseline variables including age, sex, preoperative renal failure, left-ventricular dysfunction, emergency surgery, neurological adverse events, patient history of chronic obstructive pulmonary disease and diabetes mellitus were collected. Intraoperative variables were: type of surgery (on- or off-pump), intra-aortic balloon pump placement, and cardiopulmonary bypass duration. The measured postoperative variables were: low cardiac output syndrome, hemorrhage, transfusion of blood products, and surgical revision. RESULTS Preoperative renal dysfunction (creatinine >1.4 mg/dL), blood transfusion, low-output syndrome, emergency surgery, low ejection fraction and age were independently associated with ARF. The median (interquartile range) ICU stay was 5.5 (range 4-11.5) days in patients who did and 1 (range 1-2) day in those who did not develop ARF (P<0.001). The median (interquartile range) hospital length of stay was 10 (range 8-21) days in patients who did and 5 (range 4-7) days in those who did not develop ARF (P<0.001). CONCLUSION Preoperative renal dysfunction, blood transfusion, low-output syndrome, emergency surgery, low ejection fraction and age were independently associated with ARF. Length of ICU and hospital stay were reduced in patients not developing ARF.
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Affiliation(s)
- G Landoni
- Department of Cardiothoracic Anesthesia and Intensive Care, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
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Goldoni M, Caglieri A, Poli D, Vettori MV, Ceccatelli S, Mutti A. Methylmercury at low doses modulates the toxicity of PCB153 on PC12 neuronal cell line in asynchronous combination experiments. Food Chem Toxicol 2007; 46:808-11. [PMID: 17980472 DOI: 10.1016/j.fct.2007.09.104] [Citation(s) in RCA: 8] [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] [Received: 02/26/2007] [Revised: 06/18/2007] [Accepted: 09/14/2007] [Indexed: 10/22/2022]
Abstract
Me-Hg and PCB153 are known neurotoxic contaminants which tend to accumulate in food, particularly in fish. Aim of this study was to perform asynchronous and combined exposure to Me-Hg and PCB153 in a neuronal rat cell line (PC12) to better characterise the antagonism observed at some combination concentrations. PC12 cells were treated with three concentrations of Me-Hg (0.1-0.5-1.0 microM) and PCB153 at one concentration (175 microM) in single and combined asynchronous exposures, using viability (MTT assay) as end-point. At all concentrations used, a statistically significant antagonistic effect was observed when Me-Hg preceded PCB153 exposure, while effect was additive when PCB153 preceded Me-Hg exposure. The antagonism is particularly evident at low concentrations of Me-Hg (0.1 microM). In conclusion, combined asynchronous exposure showed that whereas Me-Hg can modulate PCB153 toxicity, the opposite seems not to be true. Therefore, the use of asynchronous exposure could be a promising approach to study the mechanisms of toxicity of binary mixtures.
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Affiliation(s)
- M Goldoni
- Laboratory of Industrial Toxicology, Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy.
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La Colla L, La Colla G, Albertin A, Poli D, Baruffaldi Preis FW, Mangano A. The use of propofol and remifentanil for the anaesthetic management of a super-obese patient. Anaesthesia 2007; 62:842-5. [PMID: 17635437 DOI: 10.1111/j.1365-2044.2007.05102.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 10/23/2022]
Abstract
Morbid obesity is defined as body mass index (BMI) > 35 kg.m(-2), and super-obesity as BMI > 55 kg.m(-2). We report the case of a 290-kg super-obese patient scheduled for open bariatric surgery. A propofol-remifentanil TCI (target controlled infusion) was chosen as the anaesthetic technique both for sedation during awake fibreoptic nasotracheal intubation and for maintenance of anaesthesia during surgery. Servin's weight correction formula was used for propofol. Arterial blood samples were taken at fixed time points to assess the predictive performance of the TCI system. A significant difference between measured and predicted plasma propofol concentrations was found. After performing a computer simulation, we found that predictive performance would have improved significantly if we had used an unadjusted pharmacokinetic set. However, in conclusion (despite the differences between measured and predicted plasma propofol concentrations), the use of a propofol-remifentanil TCI technique both for sedation during awake fibreoptic intubation and for Bispectral Index-guided propofol-remifentanil anaesthesia resulted in a rapid and effective induction, and operative stability and a rapid emergence, allowing rapid extubation in the operating room and an uneventful recovery.
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Affiliation(s)
- L La Colla
- Department of Anaesthesiology - IRCCS San Raffaele (Italy), Vita-Salute University of Milan, Milan, Italy.
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La Colla G, La Colla L, Turi S, Poli D, Albertin A, Pasculli N, Bergonzi PC, Gonfalini M, Ruggieri F. Effect of morbid obesity on kinetic of desflurane: wash-in wash-out curves and recovery times. Minerva Anestesiol 2007; 73:275-9. [PMID: 17529920] [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: 05/15/2023]
Abstract
AIM The aim of this paper was to compare wash-in and wash-out curves of desflurane in morbidly obese and nonobese patients. METHODS Fourteen patients (7 obese and 7 nonobese) were studied. In the nonobese patients, anaesthesia was started by administering 2 mg/kg propofol bolus and a target controlled effect site concentration of remifentanil set at 2.5 ng/mL. Obese patients were intubated using a flexible fiberoptic bronchoscopic technique facilitated by a target controlled effect site concentration of remifentanil set at 2.5 ng/mL. After endotracheal intubation, general anaesthesia was started by administering a 1.5 mg/kg propofol bolus dose. Ten minutes after induction of anaesthesia, 4% desflurane was administered for 30 min. Desflurane kinetics was determined by collecting end-tidal samples from first breaths at 1, 5, 10, 15, 20, 25 and 30 min. At last skin suture, the end-tidal concentration of desflurane was recorded from 5 consecutive breaths before their discontinuation, then the end-tidal samples of the inhalational agent were collected at 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5 and 5 min after terminating its administration. The period of time from discontinuation of desflurane to opening eyes, squeezing the observer's hand, extubation, stating the patients' name and providing date of birth was also recorded. RESULTS The FA/FI ratio was higher in the nonobese group from the 10th to the 15th min. Wash-out curves of desflurane and recovery times were similar. CONCLUSION Our results show that desflurane provides similar kinetic and recovery profiles in obese and nonobese patients.
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Affiliation(s)
- G La Colla
- Department of Anaesthesia, University of Modena and Reggio Emilia, Modena, Italy.
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Landoni G, Pappalardo F, Crescenzi G, Aletti G, Marchetti C, Poli D, Franco A, Rosica C, Zangrillo A. The outcome of patients requiring emergency conversion from off-pump to on-pump coronary artery bypass grafting. Eur J Anaesthesiol 2007; 24:317-22. [PMID: 17054807 DOI: 10.1017/s0265021506001578] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients undergoing off-pump coronary artery bypass grafting (CABG) may need emergent institution of cardiopulmonary bypass (CPB) for circulatory collapse during the operation. Our aim was to evaluate outcome in such patients and identify preoperative and intraoperative risk factors. METHODS This is an observational study in a University Hospital setting. In the period June 2001-July 2003, data from 988 consecutive patients undergoing CABG in our institution were prospectively collected. No interventions were made. Prolonged hospital stay (>7 days), hospital mortality, temporal trends and risk factors for conversion from off-pump to on-pump surgery were studied. RESULTS Fifty-four patients with emergency operations and six with associated carotid artery surgery were excluded. Of the remaining 928 patients, 450 (48.5%) were planned for off-pump surgery. Thirty-seven (8.2%) of them required conversion to CPB on an emergency basis. These patients had higher mortality (5.4%) than the off-pump group (1.5%) and the CPB group (0.4%), P = 0.02. The incidence of prolonged hospital stay was also higher (conversion group = 27%, off-pump group = 12.3%, CPB group = 17.6%; P = 0.02). We did not identify any perioperative characteristics significantly associated with the risk of requiring conversion. The conversion rate was uniformly distributed over the study period. CONCLUSIONS Patients who are emergently converted to CPB during attempted off-pump procedures are at higher risk of death and prolonged hospital stay; this population should be included in comparative studies as "intention to treat" in the off-pump group.
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Affiliation(s)
- G Landoni
- Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Milan, Italy.
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Abstract
BACKGROUND Serum creatine kinase and myoglobin elevation has been described involving muscle manipulation after surgery and also after bariatric, urologic and gynaecologic procedures. It encompasses a wide range of severity, reflecting in the worst cases true rhabdomyolysis. We occasionally noted creatine kinase elevations after intracranial neurosurgery, an occurrence that has not yet been described. To assess whether the issue of postoperative muscle enzyme elevation is relevant to neurosurgery, we prospectively measured serum creatine kinase and myoglobin in a series of neurosurgical patients submitted to craniotomy. MATERIALS AND METHODS We studied 30 patients aged 22-69 yr submitted to craniotomy. Blood samples were taken prior to the procedure, at the end of anaesthesia and on the first, second and third postoperative days. Blood was checked for creatine kinase, myoglobin, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine and serum electrolytes. We recorded the patient's age, sex, height, weight and body mass index. Throughout surgery, we recorded the highest and the lowest body temperature and sampled the mean arterial pressure at 5 min intervals. We performed backwards stepwise logistic regression analysis to identify the elements that best correlate with the development of cell muscle damage. RESULTS On the first postoperative day creatine kinase peaked from baseline (305 (107-1306) UI L(-1) vs. 59 (42-94) UI L(-1); P < 0.001) while myoglobin rose significantly from baseline to the end of surgery (70 (42-147) ng mL(-1) vs. 36 (3044) ng mL(-1); P = 0.002). Logistic regression showed that length of surgery was the only factor clearly influencing peak creatine kinase (P < 0.001; R2 0.7) and myoglobin (P = 0.011; R2 0.41) concentration. CONCLUSIONS Creatine kinase and myoglobin elevation may occur after intracranial neurosurgery. In our series, length of surgery was a risk factor.
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Affiliation(s)
- D Poli
- Neurosurgical Anesthesia and Intensive Care Unit, Università Vita e Salute, S. Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
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