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García-Prieto AM, Verdalles Ú, de José AP, Arroyo D, Aragoncillo I, Barbieri D, Camacho RE, Goicoechea M. Renin-angiotensin-aldosterone system blockers effect in chronic kidney disease progression in hypertensive elderly patients without proteinuria: PROERCAN trial. Hipertens Riesgo Vasc 2024; 41:95-103. [PMID: 38508877 DOI: 10.1016/j.hipert.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. MATERIALS AND METHODS Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3-4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years. Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. RESULTS 88 patients were included with a mean age of 77.9±6.1 years and a follow up period of 3 years: 40 were randomized to RAAS group and 48 to standard treatment. Ethiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown ethiology. In the RAAS group eGFR slope during follow up was -4.3±1.1ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6±0.4ml/min), p=0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. CONCLUSIONS In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression. The PROERCAN (PROgresión de Enfermedad Renal Crónica en ANcianos) trial (trial registration: NCT03195023).
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Affiliation(s)
- A M García-Prieto
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Ú Verdalles
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A P de José
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - D Arroyo
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Aragoncillo
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - D Barbieri
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R E Camacho
- Servicio de Nefrología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - M Goicoechea
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Zhang D, Sun H, Frattini F, Kim HY, Wu CW, Donatini G, Cestari A, Bertoli S, Barbieri D, Bussi M, Dionigi G. Use of Indocyanine Green Fluorescence During Total Thyroidectomy to Identify Parathyroid Glands and Prevent Hypoparathyroidism. Surg Technol Int 2023; 43:sti43/1741. [PMID: 38237113 DOI: 10.52198/23.sti.43.gs1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Total thyroidectomy is associated with a high rate of transient or permanent hypoparathyroidism. During surgery, indocyanine green (ICG) fluorescein angiography can be used to detect and preserve well-vascularized parathyroid glands. This technique has been introduced as an intraoperative support to prevent postoperative hypoparathyroidism. MATERIAL AND METHODS One-hundred consecutive patients who had undergone total thyroidectomy were included in this study. Autofluoroscopy was used on the first dominant side of thyroidectomy and to identify the contralateral parathyroid glands. An intravenous bolus of 5 mg ICG (VERDYE, Diagnostic Green GmbH, Aschheim-Dornacht, Germany) was administered once. ICG fluorescein angiography was used as a "bridge" at the end of the first dominant hemithyroidectomy and after exposure of the parathyroid glands on the second side. This allowed us to (i) determine the vascularization of the first two parathyroid glands and (ii) define the blood vessels and thus the line of dissection of the parathyroid glands of the second resection side. Finally, autofluoroscopy was then applied outside the surgical area on the surgical specimen to assess forgotten parathyroid glands, which should therefore be re-implanted. Autofluoroscopy and ICG fluorescein angiography were evaluated in real time using the same technology, i.e., FLUOBEAM® LX (EUROPE - Fluoptics Grenoble, France; USA - Fluoptics Imaging Inc., Cambridge, MA, USA). The study was approved by the local ethics committee. RESULTS Autofluorescence and ICG fluorescein angiography were performed without any problems in all cases. A total of 370 parathyroid glands were detected in this series. ICG changed the surgical strategy for the first-side parathyroid glands in 5% of cases, i.e,. they were not well-vascularized and were re-implanted. The rate of transient hypoparathyroidism was 19%. The percentage of parathyroids in the surgical specimen was 3.5% and all were re-implanted during the same surgery. There was no case of postoperative definitive hypoparathyroidism when at least one parathyroid gland with a high fluorescence intensity was preserved on the first side of resection. CONCLUSION Use of ICG fluorescein angiography may contribute to predicting and thus preventing postoperative definitive hypoparathyroidism after total thyroidectomy. The results of this case series confirm recent studies. Caution is advised when weakly perfused parathyroid glands are discovered.
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Affiliation(s)
- Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, Jilin Province, China
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, Jilin Province, China
| | - Francesco Frattini
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifco), Milan, Italy
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Che Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gianluca Donatini
- Department of Endocrine Surgery, CHU Poitiers, University of Poitiers, Poitiers, France
| | - Andrea Cestari
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifco), Milan, Italy
| | - Simona Bertoli
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifco), Milan, Italy
| | - Diego Barbieri
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianlorenzo Dionigi
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifco), Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Barbieri D, Goicoechea M, Verde E, García-Prieto A, Verdalles Ú, Pérez de José A, Delgado A, Sánchez-Niño MD, Ortiz A. Obesity, chronic kidney disease progression and the role of the adipokine C1q/TNF related protein-3. Nefrologia 2023; 43:328-334. [PMID: 36517365 DOI: 10.1016/j.nefroe.2022.02.009] [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: 11/08/2021] [Accepted: 02/07/2022] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION AND AIMS Obesity is a risk factor for incident chronic kidney disease (CKD). C1q/TNF related protein 3 (CTRP3) is an adipokine with multiple effects and may modulate the association between obesity and vascular diseases. The aim of the study is to explore potential links between obesity, CTRP3 levels and CKD progression. METHODS Patients with stage 3 and 4 CKD without previous cardiovascular events were enrolled and divided into groups according to body mass index (BMI) and sex. Demographic, clinical, analytical data and CTRP3 levels were collected at baseline. During follow-up, renal events (defined as dialysis initiation, serum creatinine doubling or a 50% decrease in estimated glomerular filtration rate were registered). RESULTS 81 patients were enrolled. 27 were obese and 54 non-obese. Baseline CTRP3 was similar between both groups (90.1±23.8 vs 84.5±6.2; p=0.28). Of the sum, 54 were men and 27 women, with higher CTRP3 in women (81.4±24.7 vs 106±24.7;p<0.01). During a mean follow-up of 68 months, 15 patients had a renal event. Patients in the higher CTRP3 tertile had less events but without statistical significance (p=0.07). Obese patients in the higher CTRP3 tertile significantly had less renal events (p=0.049). By multiple regression analysis CTRP3 levels could not predict renal events (HR 0.98; CI95% 0.96-1.06). CONCLUSIONS CTRP3 levels are higher in woman than men in patients with CKD, with similar levels between obese and non obese. Higher CTRP3 levels at baseline were associated with better renal outcomes in obese patients.
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Affiliation(s)
- Diego Barbieri
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Marian Goicoechea
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eduardo Verde
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana García-Prieto
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Úrsula Verdalles
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Pérez de José
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrés Delgado
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Alberto Ortiz
- Nephrology Department, ISS-Fundación Jimenez Díaz, Univerisdad Autonoma de Madrid, Madrid, Spain
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Barbieri D, Indelicato P, Vinciguerra A, Salerno E, Battista RA, Di Marco F, Giordano L, Luce FL, Bondi S, Trimarchi M, Bussi M. The impact of near-infrared autofluorescence on postoperative hypoparathyroidism during total thyroidectomy: a case-control study. Endocrine 2023; 79:392-399. [PMID: 36251116 DOI: 10.1007/s12020-022-03222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/02/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Near-infrared autofluorescence is a new technology in thyroid surgery to better localize and preserve parathyroid glands. The purpose of this study is to assess if the adoption of NIR-AF can improve in short-, medium-, and long-term post-operative calcium and PTH levels compared to conventional "naked eye" surgery in patients undergoing TT for benign or malignant conditions. METHODS 134 patients undergone total thyroidectomy between January 2020 and June 2022; 67 were treated with conventional thyroidectomy, the other 67 underwent surgery adopting an autofluorescence detecting device. RESULTS Significant differences were found between the two groups in percentage of patients with short-term hypocalcemia (p = 0.04) and short-term hypoparathyroidism (p = 0.011). Median short-term (p = 0.01) and medium-term (p = 0.03) PTH levels were significantly higher in autofluorescence group, while, short- (p = 0.001), medium- (p < 0.001) and long-term (p = 0.019) percentage variation of PTH levels from baseline were significantly higher in the standard-care group. Finally, the prescription of oral calcium (p < 0.01) after surgery were significantly lower in the autofluorescence group. CONCLUSION The adoption of near-infrared autofluorescence during total thyroidectomy is related to lower short-term hypocalcemia and hypoparathyroidism rates, decreased variation of post-operative PTH levels in short- and medium- and long-term, reducing the necessity of supplementation therapy with oral calcium compared to conventional surgery.
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Affiliation(s)
- Diego Barbieri
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Pietro Indelicato
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Emilio Salerno
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Rosa Alessia Battista
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Di Marco
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leone Giordano
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Lira Luce
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Bondi
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS Candiolo Cancer Institute, Torino, Italy
| | - Matteo Trimarchi
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Barbieri D, Melegatti MN, Vinciguerra A, Indelicato P, Giordano L, Bondi S, Biafora M, Trimarchi M, Bussi M. The use of near-infrared autofluorescence during total laryngectomy with hemi- or total thyroidectomy. Eur Arch Otorhinolaryngol 2023; 280:365-371. [PMID: 35920893 DOI: 10.1007/s00405-022-07584-4] [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: 05/13/2022] [Accepted: 07/29/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this study is to describe the use of near-infrared autofluorescence (NIR-AF) to identify and preserve parathyroid glands (PGs) in a group of patients with advanced hypopharyngeal/laryngeal cancer undergone total (pharyngo)laryngectomy with hemi- or total thyroidectomy. METHODS At San Raffaele Hospital, Milan (Italy), from January 2021 to May 2021, 7 patients affected by cT4a laryngeal squamous cell carcinoma (SCC) underwent surgery using an autofluorescence detection system (Fluobeam-Fluoptics®). For proper surgical planning, the demolition phase envisaged extension of the intervention to 4 hemithyroidectomies and 3 total thyroidectomies associated, respectively, with homolateral or bilateral CCND. Serum calcium, ionized calcium, and parathyroid hormone (PTH) levels at post-operative day (POD) 1 and 2 and at 2 weeks after surgery were monitored. Finally, we compared the data obtained with a cohort of patients who underwent surgery without the adoption of NIR-AF. RESULTS With the use of NIR-AF, 18/20 PGs were identified, of which 7/18 were preserved exclusively thanks to the use of autoflorescence. The technique also made it possible to identify and isolate three PGs from the surgical specimen, which were subsequently transplanted only after intraoperative histological confirmation. On POD-1, 3/7 patients (42.8%) were hypocalcemic; on POD-2 and after 2 weeks only 1/7 patient (14.2%) was hypocalcemic. Comparing the two groups, we highlighted that the utilization of NIR-AF was related to a significant decrease of median serum (p = 0.026) and ionized calcium levels (p = 0.017) 2 weeks after surgery. Using this new technology, in no case did definitive histological examination reveal the presence of PGs in the surgical specimen, reaching an accuracy of 100%. CONCLUSIONS In our cohort of patients who underwent total (pharyngo)laryngectomy with hemi- or total thyroidectomy, the use of near-infrared autofluorescence improved medium term postoperative hypocalcemia rates. This new technology helps to achieve a better calcemic outcome compared to the standard naked eye approach, since it helps the surgeon to identify and preserve parathyroid glandular tissue with a lower incidence of post-operative hypocalcemia.
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Affiliation(s)
- Diego Barbieri
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michela Nicole Melegatti
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. .,Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina, 60, 20133, Milan, Italy.
| | | | - Pietro Indelicato
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Leone Giordano
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Bondi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Matteo Biafora
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Barbieri D, Goicoechea M, Verde E, García-Prieto A, Verdalles Ú, Pérez de José A, Delgado A, Sánchez-Niño MD, Ortiz A. Obesity, chronic kidney disease progression and the role of the adipokine C1q/TNF related protein-3. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Barbieri D, Triponez F, Indelicato P, Vinciguerra A, Trimarchi M, Bussi M. Total thyroidectomy with intraoperative neural monitoring and near-infrared fluorescence imaging. Langenbecks Arch Surg 2021; 406:2879-2885. [PMID: 34195868 DOI: 10.1007/s00423-021-02228-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe our personal experience during aclassic complete thyroidectomy adopting both intraoperative neural monitoringand near-infrared autofluorescence. METHODS In October 2021, 20 patients underwent totalthyroidectomy for benign and malignant conditions: 13 patients were affected bymultinodular goiter, 2 by Graves' disease, and 5 by indeterminate lesions (3Tir-3B and 2 Tir-3A). For each patient, intraoperative neural monitoring of therecurrent laryngeal nerve and near-infrared autofluorescence were used. RESULTS Overall, 76/80 (95.0%) parathyroid glands weredetected: 34/76 (44.7%) were identified by the surgeon during the dissection,while 42/76 (55.3%) were detected by the near-infrared camera before thesurgeon saw them with naked eye. Indocyanine green angiography was adopted inall the patients, and in 2 cases, parathyroid gland autotransplantation wasperformed since 2 parathyroid glands resulted devascularized after dissection.Operative time ranged from 113 to 201 min (mean 156 min). CONCLUSION Together with intraoperative neural monitoring,near-infrared autofluorescence is a reliable device in thyroid surgery. Furtherprospective studies are necessary to establish if the adoption ofautofluorescence may result in long-term benefit in terms of calcemia.
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Affiliation(s)
- Diego Barbieri
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Pietro Indelicato
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Vinciguerra
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Vinciguerra A, Rampi A, Giordano Resti A, Barbieri D, Bussi M, Trimarchi M. Melanoma of the lacrimal drainage system: A systematic review. Head Neck 2021; 43:2240-2252. [PMID: 33843111 DOI: 10.1002/hed.26705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/02/2021] [Accepted: 04/01/2021] [Indexed: 12/20/2022] Open
Abstract
Melanoma of the lacrimal drainage system (LDSM) is a rare and subtle condition that is frequently misdiagnosed. In the present work, we conducted a systematic review investigating the clinical features, management, and prognosis of LDSM. A structured search, according to PRISMA criteria, was performed in April 2020 and updated in February 2021 on Pubmed, EMBASE, Cochrane, and SCOPUS. The articles found underwent a double-reviewer selection and the main data were extracted. After complete screening, 30 articles reporting 38 cases were included. The time from the first symptom to medical contact ranged from 1 month to 4 years. Surgery was the treatment proposed to all patients, with a variable extension of resection. LDSM is a rare disease that is burdened by poor prognosis. Early diagnosis is crucial, even if difficult to achieve. Surgery and radiotherapy are standardized treatments, while targeted therapy and immunotherapy are attractive prospects.
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Affiliation(s)
- Alessandro Vinciguerra
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Rampi
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Giordano Resti
- Ophthalmologic Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Barbieri
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Department of Head and Neck, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Bondi S, Vinciguerra A, Lissoni A, Rizzo N, Barbieri D, Indelicato P, Abati S. Mucosal Melanoma of the Hard Palate: Surgical Treatment and Reconstruction. Int J Environ Res Public Health 2021; 18:3341. [PMID: 33804881 PMCID: PMC8036556 DOI: 10.3390/ijerph18073341] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/17/2021] [Accepted: 03/19/2021] [Indexed: 12/02/2022]
Abstract
Mucosal melanomas of the head and neck region are uncommon pathologies that can affect the oral cavity, and are characterized by a high rate of mortality. Considering the lack of knowledge regarding risk and prognostic factors, current best clinical practice is represented by a large surgical excision with disease-free margins, eventually associated with a reconstructive flap. Indeed, given the frequent necessity of postoperative radiotherapy and fast healing process, a reconstruction of the surgical gap is advisable. Even if several flaps have been most commonly used, the submental island flap represents a valid alternative thanks to local advantages and similar oncologic outcomes compared to free flaps.
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Affiliation(s)
- Stefano Bondi
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
| | - Alessandro Vinciguerra
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
| | - Alessandra Lissoni
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
- Department of Dentistry and Stomatology IRCCS San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy
| | - Nathalie Rizzo
- Pathology Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, 20100 Milano, Italy;
| | - Diego Barbieri
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
| | - Pietro Indelicato
- Otorhinolaryngology—Head & Neck Surgery Department, San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy; (A.V.); (D.B.); (P.I.)
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
| | - Silvio Abati
- School of Medicine, Vita-Salute San Raffaele University, 20100 Milano, Italy; (A.L.); (S.A.)
- Department of Dentistry and Stomatology IRCCS San Raffaele Hospital, University Vita-Salute, 20100 Milano, Italy
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10
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Barbieri D, Indelicato P, Vinciguerra A, Di Marco F, Formenti AM, Trimarchi M, Bussi M. Autofluorescence and Indocyanine Green in Thyroid Surgery: A Systematic Review and Meta-Analysis. Laryngoscope 2020; 131:1683-1692. [PMID: 33247620 DOI: 10.1002/lary.29297] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES/HYPOTHESIS To estimate the impact of optical techniques on prevention of post-operative hypocalcemia and hypoparathyroidism after total thyroidectomy. STUDY DESIGN Systematic review and meta-analysis. METHODS A literature search was conducted in Pubmed, EMBASE, SCOPUS, and Cochrane databases. The main inclusion criteria for eligible articles for meta-analysis were patients with benign or malignant thyroid pathologies who underwent total thyroidectomy, utilization of optical techniques to support PGs preservation, the availability of calcium and/or PTH levels. The primary outcome was to evaluate the variation of calcium and PTH levels when adopting optical technologies compared to standard naked-eye surgery. RESULTS In total, 13 papers with 1484 procedures were included. Pooled proportion for short- and medium-term hypocalcemia rates were 8% (95% CI, 5%:11%) and 1% (95% CI, 0%:4%) for optical techniques, while for naked-eye surgery were 15% (95% CI, 9%:23%) and 5% (95% CI, 2%:9%), respectively. CONCLUSIONS Optical technologies reduced short and medium term hypocalcemia compared to conventional surgery. LEVEL OF EVIDENCE NA Laryngoscope, 131:1683-1692, 2021.
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Affiliation(s)
- Diego Barbieri
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Indelicato
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Vinciguerra
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Di Marco
- Urological Research Institute (URI), Division of experimental oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Maria Formenti
- Department of Endocrinology, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Bussi
- Division of Head and Neck department, Otorhinolaryngology unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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11
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Vinciguerra A, Nonis A, Resti AG, Barbieri D, Bussi M, Trimarchi M. Influence of Surgical Techniques on Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 165:14-22. [DOI: 10.1177/0194599820972677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Endoscopic endonasal dacryocystorhinostomy (END-DCR) has increased as a valid alternative to the classic external approach to treat distal lacrimal obstruction. Different surgical varieties of the END-DCR approach have been proposed with no clear understanding of the best surgical technique. Data Source A comprehensive research was performed in PubMed, Embase, SCOPUS, and Cochrane databases with a final search on March 2020. Review Methods The aim of this search was to identify relevant END-DCR procedures performed with mechanical (Mecn-END-DCR) and powered (Pow-END-DCR) approaches to compare their functional success rate. In addition, the influence of mucosal flaps was evaluated. Articles were selected only if they were published later than 2000 and had at least 50 single-clinician surgical procedures performed. Excluded articles included acute infections, cancers, mixed cohort study, and revision cases. Results A total of 11,445 publications were identified and 2741 reviewed after screening; 15 articles were included after full-text review (0.6% of the initial articles reviewed). The mean success rate was 91.34% (95% CI, 87.1%-94.3%) for Pow-END-DCR and 89.5% (95% CI, 86.5%-91.9%) for Mecn-END-DCR with no significant difference between the surgical approaches ( P = .43). For mucosal flaps performed during END-DCR, the mean success rate was 89% (95% CI, 86%-91%) if mucosal flaps were used and 92% (95% CI, 88%-95%) if they were not used, with no statistical difference present ( P = .14). Conclusions Our analyses suggest that there are no differences in outcomes between mechanical and powered approaches in END-DCR and that mucosal flap preservation is not essential to achieve a superior END-DCR outcome.
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Affiliation(s)
- Alessandro Vinciguerra
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Alessandro Nonis
- CUSSB, University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milano, Italy
| | - Antonio Giordano Resti
- Division of Head and Neck department, Ophthalmologic Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Diego Barbieri
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Mario Bussi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
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12
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Goicoechea M, Sánchez Cámara LA, Macías N, Muñoz de Morales A, Rojas ÁG, Bascuñana A, Arroyo D, Vega A, Abad S, Verde E, García Prieto AM, Verdalles Ú, Barbieri D, Delgado AF, Carbayo J, Mijaylova A, Acosta A, Melero R, Tejedor A, Benitez PR, Pérez de José A, Rodriguez Ferrero ML, Anaya F, Rengel M, Barraca D, Luño J, Aragoncillo I. COVID-19: clinical course and outcomes of 36 hemodialysis patients in Spain. Kidney Int 2020; 98:27-34. [PMID: 32437770 PMCID: PMC7211728 DOI: 10.1016/j.kint.2020.04.031] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia emerged in Wuhan, China in December 2019. Unfortunately, there is a lack of evidence about the optimal management of novel coronavirus disease 2019 (COVID-19), and even less is available in patients on maintenance hemodialysis therapy than in the general population. In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of all maintenance hemodialysis patients hospitalized with COVID-19 from March 12th to April 10th, 2020 as confirmed by real-time polymerase chain reaction. Baseline features, clinical course, laboratory data, and different therapies were compared between survivors and nonsurvivors to identify risk factors associated with mortality. Among the 36 patients, 11 (30.5%) died, and 7 were able to be discharged within the observation period. Clinical and radiological evolution during the first week of admission were predictive of mortality. Among the 36 patients, 18 had worsening of their clinical status, as defined by severe hypoxia with oxygen therapy requirements greater than 4 L/min and radiological worsening. Significantly, 11 of those 18 patients (61.1%) died. None of the classical cardiovascular risk factors in the general population were associated with higher mortality. Compared to survivors, nonsurvivors had significantly longer dialysis vintage, increased lactate dehydrogenase (490 U/l ± 120 U/l vs. 281 U/l ± 151 U/l, P = 0.008) and C-reactive protein levels (18.3 mg/dl ± 13.7 mg/dl vs. 8.1 mg/dl ± 8.1 mg/dl, P = 0.021), and a lower lymphocyte count (0.38 ×103/µl ± 0.14 ×103/µl vs. 0.76 ×103/µl ± 0.48 ×103/µl, P = 0.04) 1 week after clinical onset. Thus, the mortality among hospitalized hemodialysis patients diagnosed with COVID-19 is high. Certain laboratory tests can be used to predict a worsening clinical course.
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Affiliation(s)
- Marian Goicoechea
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Red de Investigación Renal Instituto de Salud Carlos III (ISCIII) Red temática de investigación cooperativa en salud (RETIC) Red de Investigación Renal (REDINREN) RD016/009 (FEDER funds), Madrid, Spain.
| | | | - Nicolás Macías
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ángela González Rojas
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Arturo Bascuñana
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Arroyo
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Almudena Vega
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Soraya Abad
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eduardo Verde
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Úrsula Verdalles
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Diego Barbieri
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrés Felipe Delgado
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Carbayo
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Antonia Mijaylova
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Adriana Acosta
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rosa Melero
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Tejedor
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ana Pérez de José
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Fernando Anaya
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Rengel
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Daniel Barraca
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Luño
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Inés Aragoncillo
- Red de Investigación Renal Instituto de Salud Carlos III (ISCIII) Red temática de investigación cooperativa en salud (RETIC) Red de Investigación Renal (REDINREN) RD016/009 (FEDER funds), Madrid, Spain; Department of Nephrology, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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13
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García-Prieto AM, Verdalles Ú, de José AP, Verde E, Arroyo D, Aragoncillo I, Linares T, Barbieri D, Goicoechea M. The effect of renin-angiotensin-aldosterone system blockers on the progression of chronic kidney disease in hypertensive elderly patients without proteinuria: PROERCAN study. Rationale and design. Hipertens Riesgo Vasc 2020; 37:101-107. [PMID: 32156479 DOI: 10.1016/j.hipert.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Blood pressure (BP) control is fundamental to the care of patients with chronic kidney disease (CKD), and is relevant at all stages of CKD. Renin-angiotensin-aldosterone system (RAAS) blockers have shown to be effective, not only in BP control but also in reducing proteinuria and slowing CKD progression. However, there is a lack of evidence for recommending RAAS blockers in elderly patients with CKD without proteinuria. The primary outcome of the present study is to evaluate the impact of RAAS blockers on CKD progression in elderly patients without proteinuria. MATERIALS AND METHODS The PROERCAN trial (trial registration, NCT03195023) is a multicentre open-label, randomized controlled clinical trial with 110 participants over 65 years-old with hypertension and CKD stages 3-4 without proteinuria. Patients will be randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs, and will be followed up for three years. Primary outcome is the estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcomes include BP control, renal and cardiovascular events, and mortality. RESULTS AND CONCLUSIONS The design of this trial is presented here. The results will show if antihypertensive treatment with RAAS blockers has an impact on CKD progression in elderly patients without proteinuria. Any differences in BP control, cardiovascular events, and mortality with each antihypertensive treatment will be also clarified.
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Affiliation(s)
- A M García-Prieto
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain.
| | - Ú Verdalles
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - A P de José
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - E Verde
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - D Arroyo
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - I Aragoncillo
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - T Linares
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - D Barbieri
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - M Goicoechea
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain; Spanish Research Network (REDINREN), Madrid, Spain
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14
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Barbieri D, DELGADO ANDRÉSFELIPE, García-Prieto A, Vega A, Abad Esttebanez S, Muñoz de Morales A, Carbayo J, González-Rojas Á, Acosta Barrios A, Goicoechea M. P1180EVOLUTION OF SERUM B2MICROGLOBULIN LEVELS IN INCIDENT PERITONEAL DIALYSIS PATIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Retention of ß2microglobulin (ß2M), an uremic toxin in the middle molecular range, has been associated with cardiovascular morbidity and mortality in dialysis patients. Although ß2M levels are usually measured in hemodialysis patients, this practice is not common among peritoneal dialysis (PD) patients. The aim of this study is to evaluate the evolution of serum ß2M levels in incident PD patients.
Method
Prospective, observational study including incident PD patients in our hospital from January 2015 to October 2019. Patients with cardiorrenal syndrome or patients coming from hemodialysis were excluded. Serum ß2M levels were collected before starting PD and during follow up. Weekly KtV, residual renal function and cardiovascular events were also collected during follow up.
Results
We included 30 patients with a mean age of 57 +/- 17 years. 56.3% were male and 15.6% were diabetic. Mean follow up was 19.8 +/- 16.9 months. 18 patients were on continous ambulatory PD and 12 in automated PD. Mean serum ß2M levels before starting PD were 12.8 +/- 6.6 mg/l and they remained stable during follow up (12.9 +/- 5.2 mg/l, 15 +/- 4.2 mg/l, 14.3 +/- 6.9 mg/l, 10.2+/- 4.5 mg/l at month 6, 12, 24 and 36, respectively; p NS). No differences in serum ß2M levels were observed between continous ambulatory PD and automated PD. Serum ß2M levels were inversely and significantly correlated with weekly KtV (r= -0.943; p 0.009) and residual renal function (r= -0.829; p 0.042). One cardiovascular event was recorded during follow up.
Conclusion
Serum ß2M levels remain stable during follow up in our cohort of incident PD patients and is significantly and inversely correlated with weekly KtV and residual renal function. Serum ß2M levels monitoring could be helpful in these patients and would yield important information in this population.
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Affiliation(s)
| | | | | | - Almudena Vega
- Gregorio Marañón Hospital, Nephrology, Madrid, Spain
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15
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Garcia-Prieto A, Vega A, Abad Esttebanez S, Barbieri D, DELGADO ANDRÉSFELIPE, Goicoechea M. P1536EVOLUTION OF A COHORT OF PATIENTS UNDERGOING HOME ONLINE HEMODIAFILTRATION DURING A THREE YEAR FOLLOW UP PERIOD. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Online haemodiafiltration (OL- HDF) is the gold standard therapy in hemodialysis, as it has shown to reduce all-cause mortality in hemodialysis patients. Frequent hemodialysis has also shown to improve survival and quality of life. Home hemodialysis facilitates frequent therapy, and it is possible to perform OL-HDF at home, althought there is lack of evidence on its use. We report the evolution of a cohort of patients undergoing home OL-HDF during a 3 year follow up period.
Method
We designed a prospective, descriptive study to determine the evolution of prevalent and incident patients in home OL-HDF since 2016. Demographic and clinical variables were collected, including those related to hemodialysis technic and its potential complications.
Results
Three patients with a mean age of 47 years underwent home OL-HDF during follow up. All patients were males and caregiver was the couple in all cases. Two patients had an arteriovenous fistula (AVF) and one had a catheter. After a mean training period of 2.5 months at hospital, they started home OL- HDF with the assitance of a nephrologist, a nurse and a technician in the first session at home. We used the “5008-home”®FMC monitor and the AquaC®FMC for water treatment. Water cultures allways fulfilled the criteria for ultrapurity. Dialysis scheme was 2 hour sessions daily, 6 days a week.
During a mean follow up of 15 months, one patient received a kidney transplant. None needed hospitalization. One patient attended the emergency room once for fluid overload and needed ultrafiltration. The patient with catheter needed a catheter replacement due to hole infection. No vascular access problems were recorded in patients with AVF. Regarding dialysis efficacy, mean week KtV was over 2.1 in all cases and mean convective volumen achieved was 94 l/week.
Conclusion
In our experience, home OL-HDF is a safe and effective technic.
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Affiliation(s)
- Ana Garcia-Prieto
- HOSPITAL GENERAL UNIVERSITARIO GREGORIO MARAÑON, NEPHROLOGY, MADRID, Spain
| | - Almudena Vega
- HOSPITAL GENERAL UNIVERSITARIO GREGORIO MARAÑON, NEPHROLOGY, MADRID, Spain
| | | | - Diego Barbieri
- HOSPITAL GENERAL UNIVERSITARIO GREGORIO MARAÑON, NEPHROLOGY, MADRID, Spain
| | | | - Marian Goicoechea
- HOSPITAL GENERAL UNIVERSITARIO GREGORIO MARAÑON, NEPHROLOGY, MADRID, Spain
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16
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García-Prieto AM, Vega A, Abad S, Macías N, Aragoncillo I, Hurtado E, Delgado A, Torres E, Barbieri D, Luño J. Evaluation of the efficacy of a very high permeability dialyser and comparison with another high-flux dialyser in online haemodiafiltration. Clin Kidney J 2019; 13:114-115. [PMID: 32082561 PMCID: PMC7025349 DOI: 10.1093/ckj/sfz109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/16/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Almudena Vega
- Nephrology Department, Gregorio Marañón Hospital, Madrid, Spain
| | - Soraya Abad
- Nephrology Department, Gregorio Marañón Hospital, Madrid, Spain
| | - Nicolás Macías
- Nephrology Department, Gregorio Marañón Hospital, Madrid, Spain
| | | | - Esther Hurtado
- Nephrology Department, Gregorio Marañón Hospital, Madrid, Spain
| | - Andrés Delgado
- Nephrology Department, Gregorio Marañón Hospital, Madrid, Spain
| | - Esther Torres
- Nephrology Department, Gregorio Marañón Hospital, Madrid, Spain
| | - Diego Barbieri
- Nephrology Department, Gregorio Marañón Hospital, Madrid, Spain
| | - José Luño
- Nephrology Department, Gregorio Marañón Hospital, Madrid, Spain
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Carbayo J, Goicoechea M, Verde E, Verdalles U, Perez De Jose A, Muñoz De Morales A, Sanchez-Cámara L, Barbieri D, López-Lazareno N, Luño J. SP289ALDOSTERONE-RENIN RATIO DETERMINES POTASSIUM LEVELS IN PATIENTS WITH MODERATE CHRONIC KIDNEY DISEASE UNDER TREATMENT WITH RAAS BLOCKERS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - José Luño
- Gregorio Marañón Hospital, Madrid, Spain
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18
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Garcia-Prieto A, Vega A, Abad S, Macias N, Aragoncillo I, Hurtado E, Sanchez-Cámara L, Torres E, Barbieri D, Luño J. SP476EVALUATION OF THE EFFICACY OF A VERY HIGH PERMEABILITY DIALYZER AND COMPARISON WITH OTHER HIGH FLUX DIALYZER IN ONLINE HEMODIAFILTRATION. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - José Luño
- Gregorio Marañón Hospital, Madrid, Spain
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García-Prieto A, Torres E, Hernández A, Barbieri D, Vega A. Persistent pruritus as a rare and potentially serious manifestation of liver involvement in autosomal dominant polycystic kidney disease. Clin Kidney J 2019; 12:380-381. [PMID: 31198538 PMCID: PMC6543959 DOI: 10.1093/ckj/sfy057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Indexed: 11/27/2022] Open
Abstract
Polycystic liver disease (PCLD) is the most frequent extrarenal manifestation of autosomal dominant polycystic kidney disease (ADPKD), usually asymptomatic. We present a patient with ADPKD who developed cholestatic pruritus due to bile duct compression of multiple liver cysts. Because of severity of pruritus she received treatment with lanreotide to reduce liver volume and she was studied to be included in the liver transplant waiting list. She evolved favourably with medical treatment and she is now asymptomatic. In conclusion, persistent pruritus is a rare but potentially serious manifestation of PCLD, so it should be taken into account in patients with ADPKD.
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Affiliation(s)
- Ana García-Prieto
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Esther Torres
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrés Hernández
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Diego Barbieri
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Almudena Vega
- Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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20
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Barbieri D, Goicoechea M, Garcia-Prieto A, Verdalles U, Perez De Jose A, Verde E, Hurtado E, Delgado A, Sanchez-Cámara L, Luño J. SP313OBESITY AS A RISK FACTOR FOR CHRONIC KIDNEY DISEASE PROGRESSION AND INCIDENT CARDIOVASCULAR EVENTS IN PATIENTS WITH PREVALENT CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - José Luño
- Gregorio Marañón Hospital, Madrid, Spain
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de Morales AM, Goicoechea M, Verde E, Carbayo J, Barbieri D, Delgado A, Verdalles U, de Jose AP, Luño J. Pentoxifylline, progression of chronic kidney disease (CKD) and cardiovascular mortality: long-term follow-up of a randomized clinical trial. J Nephrol 2019; 32:581-587. [DOI: 10.1007/s40620-019-00607-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
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22
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Duan R, van Dijk LA, Barbieri D, de Groot F, Yuan H, de Bruijn JD. Accelerated bone formation by biphasic calcium phosphate with a novel sub-micron surface topography. Eur Cell Mater 2019; 37:60-73. [PMID: 30687909 DOI: 10.22203/ecm.v037a05] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Osteoinductive calcium phosphate (CaP) bone grafts have equivalent performance to autografts in repairing critical-size bone defects. The osteoinductive potential of CaP is linked to the size of the surface topographical features. In the present study, two novel biphasic calcium phosphate (BCP) bone grafts were synthesised with either sub-micron- (BCP<µm) or micron-scale (BCPµm) needle-shaped surface topography and compared to dimensionally similar tricalcium phosphate (TCP) with grain-shaped surface structures (TCP<µm and TCPµm). To clarify the possible function of the surface morphology (needle-like vs. grain-like) in initiating bone formation, the four CaP test materials were physicochemically characterised and implanted for 12 weeks in the dorsal muscle of beagles. The sub-micron needle-shaped topography of BCP<µm triggered earlier bone formation (3-6 weeks) as compared to the grain-shaped surface topography of TCP<µm, which formed bone at 6-9 weeks. After 12 weeks, the amount of induced bone formation in both materials was equivalent, based on histomorphometry. The micron-sized needle-shaped surface topography of BCPµm led to limited formation of new bone tissue, whereas its counterpart, TCPµm with grain-shaped surface topography, failed to trigger de novo bone formation. The relative strength of the parameters affecting CaP-driven bone induction was as follows: surface feature size > surface feature morphology > substrate chemistry. BCP materials with needle-shaped sub-micron surface topography gave rise to accelerated bone formation and slower rate of resorption than a comparable TCP. These characteristics may be translated to improve bone healing in orthotopic defects.
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Affiliation(s)
| | | | | | | | | | - J D de Bruijn
- Bronkhorstlaan 10, building 48, 3723 MB Bilthoven, the
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23
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Barbieri D, Goicoechea M, Sánchez-Niño MD, Ortiz A, Verde E, Verdalles U, Pérez de José A, Delgado A, Hurtado E, Sánchez-Cámara L, Lopez-Lazareno N, García-Prieto A, Luño J. Obesity and chronic kidney disease progression-the role of a new adipocytokine: C1q/tumour necrosis factor-related protein-1. Clin Kidney J 2018; 12:420-426. [PMID: 31198543 PMCID: PMC6543966 DOI: 10.1093/ckj/sfy095] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 01/09/2023] Open
Abstract
Background Obesity is a risk factor for incident chronic kidney disease (CKD) in the general population. C1q/tumour necrosis factor-related protein 1 (CTRP1) is a new adipokine with multiple vascular and metabolic effects and may modulate the association between obesity and vascular diseases. The aim of the study is to explore potential links between obesity, CTRP1 levels and CKD progression. Methods Patients with Stages 3 and 4 CKD without previous cardiovascular events were enrolled and divided into two groups according to body mass index (BMI). Demographic, clinical and analytical data and CTRP1 levels were collected at baseline. During follow-up, renal events [defined as dialysis initiation, serum creatinine doubling or a 50% decrease in estimated glomerular filtration rate (Modification of Diet in Renal Disease)] were registered. Results A total of 71 patients with CKD were divided into two groups: 25 obese (BMI >30 kg/m2) and 46 non-obese. CTRP1 in plasma at baseline was higher in obese patients [median (interquartile range) 360 (148) versus 288 (188) ng/mL, P = 0.041]. No significant association was found between CTRP1 levels and CKD stage, presence of diabetes, aldosterone and renin levels, or blood pressure. Obese patients had higher systolic blood pressure (P = 0.018) and higher high-sensitivity C-reactive protein (P = 0.019) and uric acid (P = 0.003) levels, without significant differences in the percentage of diabetic patients or albuminuria. During a mean follow-up of 65 months, 14 patients had a renal event. Patients with CTRP1 in the lowest tertile had more renal events, both in the overall sample (log rank: 5.810, P = 0.016) and among obese patients (log rank: 5.405, P = 0.020). Higher CTRP1 levels were associated with slower renal progression (hazard ratio 0.992, 95% confidence interval 0.986–0.998; P = 0.001) in a model adjusted for obesity, aspirin, albuminuria and renal function. Conclusions CTRP1 levels are higher in obese than in non-obese patients with CKD. High CTRP1 levels may have a renal protective role since they were associated with slower kidney disease progression. Interventional studies are needed to explore this hypothesis.
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Affiliation(s)
- Diego Barbieri
- Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Marian Goicoechea
- Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Spanish Kidney Research Network (REDinREN), Madrid, Spain
| | - Maria Dolores Sánchez-Niño
- Spanish Kidney Research Network (REDinREN), Madrid, Spain.,Nephrology Department, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
| | - Alberto Ortiz
- Spanish Kidney Research Network (REDinREN), Madrid, Spain.,Nephrology Department, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
| | - Eduardo Verde
- Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Ursula Verdalles
- Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Ana Pérez de José
- Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Andrés Delgado
- Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Esther Hurtado
- Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Luis Sánchez-Cámara
- Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Nieves Lopez-Lazareno
- Biochemistry Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Ana García-Prieto
- Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - José Luño
- Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Spanish Kidney Research Network (REDinREN), Madrid, Spain
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García-Prieto A, Vega A, Linares T, Abad S, Macías N, Aragoncillo I, Torres E, Hernández A, Barbieri D, Luño J. Evaluation of the efficacy of a medium cut-off dialyser and comparison with other high-flux dialysers in conventional haemodialysis and online haemodiafiltration. Clin Kidney J 2018; 11:742-746. [PMID: 30288272 PMCID: PMC6165747 DOI: 10.1093/ckj/sfy004] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/19/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Online haemodiafiltration (OL-HDF) has been shown to reduce all-cause mortality versus conventional haemodialysis (HD); however, it is not always available. In these situations, a novel class of membranes with a higher pore size, medium cut-off (MCO) dialysers, could be promising. The aim of this study is to evaluate the efficacy of an MCO dialyser in the removal of small and medium-size molecules and compare it with standard high-flux (HF) dialysers in HD and OL-HDF. METHODS In this crossover study, 18 prevalent HD patients were studied in three single mid-week dialysis treatments during three consecutive weeks as follows: first week with OL-HDF with a standard HF dialyser, second week with conventional HD with a standard HF dialyser and third week with conventional HD with an MCO dialyser. Reduction ratios (RRs) of different-sized molecules and albumin losses were collected for the different dialysers. RESULTS MCO HD provided a greater reduction of middle and larger middle molecules compared with standard HF HD [rate reduction (RR) β2-microglobulin 74.7% versus 69.7%, P=0.01; RR myoglobin 62.5% versus 34.3%, P=0.001; RR prolactin 60% versus 32.8%, P=0.001; RR α1-glycoprotein 2.8% versus -0.1%, P=0.01]. We found no difference in the clearance of small and larger middle molecules comparing MCO HD with OL-HDF. Albumin losses were 0.03 g/session with MCO HD and 3.1 g/session with OL-HDF (P=0.001). CONCLUSION MCO HD is superior to standard HF HD in the removal of middle and larger middle molecules and it is not inferior to OL-HDF in the clearance of small and larger middle molecules. Thus it could be an alternative in patients in which it is not possible to perform OL-HDF.
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Affiliation(s)
- Ana García-Prieto
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Almudena Vega
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Tania Linares
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Soraya Abad
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nicolás Macías
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Inés Aragoncillo
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Esther Torres
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrés Hernández
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Diego Barbieri
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Luño
- Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Barbieri D, García-Prieto A, Torres E, Verde E, Goicoechea M, Luño J. Mixed cryoglobulinaemia vasculitis after sustained hepatitis C virological response with direct-acting antivirals. Clin Kidney J 2018; 12:362-364. [PMID: 31198535 PMCID: PMC6543977 DOI: 10.1093/ckj/sfy055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Indexed: 12/22/2022] Open
Abstract
Mixed cryoglobulinaemia (MCG) is one of the most severe extrahepatic hepatitis C virus (HCV)-associated complications, and could involve several organs, including the kidney. MCG prognosis relies on HCV response to antiviral treatment and has changed over the last years, especially after the introduction of new direct acting antivirals (DAA). MCG persistence despite sustained virological response (SVR) is uncommon and has a poorly known meaning and prognosis. We report a case of a patient with chronic HCV infection treated with DAA who developed MCG vasculitis despite the SVR.
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Affiliation(s)
- Diego Barbieri
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana García-Prieto
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Esther Torres
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eduardo Verde
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marian Goicoechea
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Luño
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Barbieri D, Sánchez-Niño MD, Goicoechea MA, Ortiz A, Verde E, Verdalles Ú, Perez de José A, Garcia-Prieto A, Torres E, Hernández Coronado A, Luño J. SP264C1Q TNF RELATED PROTEIN 1, OBESITY AND PROGRESSION OF CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Diego Barbieri
- Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Alberto Ortiz
- Nephrology, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Madrid, Spain
| | - Eduardo Verde
- Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Úrsula Verdalles
- Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Perez de José
- Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Garcia-Prieto
- Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Esther Torres
- Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jose Luño
- Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Garcia-Prieto A, Vega A, Linares T, Abad S, Macias N, Torres E, Hurtado E, Barbieri D, Luno J. SaO041EVALUATION OF THE EFFICACY OF A MEDIUM CUT OFF DIALYZER AND COMPARISON TO OTHER HIGH FLUX DIALYZERS IN CONVENTIONAL HEMODIALYSIS AND ONLINE HEMODIAFILTRATION. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sao041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Almudena Vega
- Nephrology, Gregorio Maranon Hospital, Madrid, Spain
| | - Tania Linares
- Nephrology, Gregorio Maranon Hospital, Madrid, Spain
| | - Soraya Abad
- Nephrology, Gregorio Maranon Hospital, Madrid, Spain
| | | | - Esther Torres
- Nephrology, Gregorio Maranon Hospital, Madrid, Spain
| | | | | | - Jose Luno
- Nephrology, Gregorio Maranon Hospital, Madrid, Spain
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Avilés-Reyes A, Freires IA, Kajfasz JK, Barbieri D, Miller JH, Lemos JA, Abranches J. Whole genome sequence and phenotypic characterization of a Cbm + serotype e strain of Streptococcus mutans. Mol Oral Microbiol 2018. [PMID: 29524318 DOI: 10.1111/omi.12222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report the whole genome sequence of the serotype e Cbm+ strain LAR01 of Streptococcus mutans, a dental pathogen frequently associated with extra-oral infections. The LAR01 genome is a single circular chromosome of 2.1 Mb with a GC content of 36.96%. The genome contains 15 phosphotransferase system gene clusters, seven cell wall-anchored (LPxTG) proteins, all genes required for the development of natural competence and genes coding for mutacins VI and K8. Interestingly, the cbm gene is genetically linked to a putative type VII secretion system that has been found in Mycobacteria and few other Gram-positive bacteria. When compared with the UA159 type strain, phenotypic characterization of LAR01 revealed increased biofilm formation in the presence of either glucose or sucrose but similar abilities to withstand acid and oxidative stresses. LAR01 was unable to inhibit the growth of Strpetococcus gordonii, which is consistent with the genomic data that indicate absence of mutacins that can kill mitis streptococci. On the other hand, LAR01 effectively inhibited growth of other S. mutans strains, suggesting that it may be specialized to outcompete strains from its own species. In vitro and in vivo studies using mutational and heterologous expression approaches revealed that Cbm is a virulence factor of S. mutans by mediating binding to extracellular matrix proteins and intracellular invasion. Collectively, the whole genome sequence analysis and phenotypic characterization of LAR01 provides new insights on the virulence properties of S. mutans and grants further opportunities to understand the genomic fluidity of this important human pathogen.
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Affiliation(s)
- A Avilés-Reyes
- Department of Oral Biology, University of Florida, College of Dentistry, Gainesville, FL, USA
| | - I A Freires
- Department of Oral Biology, University of Florida, College of Dentistry, Gainesville, FL, USA
| | - J K Kajfasz
- Department of Oral Biology, University of Florida, College of Dentistry, Gainesville, FL, USA
| | - D Barbieri
- Center for Oral Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - J H Miller
- Center for Oral Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - J A Lemos
- Department of Oral Biology, University of Florida, College of Dentistry, Gainesville, FL, USA
| | - J Abranches
- Department of Oral Biology, University of Florida, College of Dentistry, Gainesville, FL, USA
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Lombardi D, Paderno A, Giordano D, Barbieri D, Taboni S, Piazza C, Cappelli C, Bertagna F, Barbieri V, Piana S, Bellafiore S, Spriano G, Mercante G, Nicolai P. Therapeutic lateral neck dissection in well-differentiated thyroid cancer: Analysis on factors predicting distribution of positive nodes and prognosis. Head Neck 2017; 40:242-250. [PMID: 28963802 DOI: 10.1002/hed.24936] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 07/10/2017] [Accepted: 07/27/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Neck dissection is considered the treatment of choice in patients with lateral neck metastases from well-differentiated thyroid cancer. METHODS A multicenter, retrospective review of patients who underwent therapeutic lateral neck dissection for well-differentiated thyroid carcinoma was carried out. RESULTS The study included a total of 405 lateral neck dissections performed in 352 patients; 197 women (56%) and 155 men (44%). When considering ipsilateral neck metastases, levels IIa, IIb, III, IV, Va, Vb, and V (not otherwise specified) were involved in 42%, 6%, 73%, 67%, 11%, 31%, and 35% of cases, respectively. Five-year and 10-year overall survival (OS) were 93% and 81%, respectively. Age >55 years, pathologic T (pT)4 category, tumor diameter >4 cm, aggressive variants of well-differentiated thyroid carcinoma, endovascular invasion, and number of positive nodes >5 turned out to be the most important prognostic factors. CONCLUSION Neck dissection is a valid treatment option in the presence of neck metastasis from well-differentiated thyroid carcinoma. Levels IIa, III, IV, and Vb should always be removed.
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Affiliation(s)
- Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Giordano
- Otolaryngology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Diego Barbieri
- Department of Otorhinolaryngology - Head and Neck Surgery, University "San Raffaele", Milan, Italy
| | - Stefano Taboni
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Carlo Cappelli
- Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | | | - Verter Barbieri
- Otolaryngology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | | | - Giuseppe Spriano
- Department of Otorhinolaryngology - Head and Neck Surgery, Istituto Nazionale dei Tumori "Regina Elena", Rome, Italy
| | - Giuseppe Mercante
- Department of Otorhinolaryngology - Head and Neck Surgery, Istituto Nazionale dei Tumori "Regina Elena", Rome, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
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La Placa M, Venturoli S, Barbieri D, Nocera M, Patrizi A, Landini MP, Fanti PA, Dika E. Presence of cutaneous human papillomavirus DNA in squamous cell carcinoma of the scalp: a case series. J Eur Acad Dermatol Venereol 2017; 31:e369-e371. [PMID: 28191672 DOI: 10.1111/jdv.14168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M La Placa
- Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - S Venturoli
- Microbiology Unit, Department of Diagnostic Medicine and Prevention, University of Bologna, Bologna, Italy
| | - D Barbieri
- Microbiology Unit, Department of Diagnostic Medicine and Prevention, University of Bologna, Bologna, Italy
| | - M Nocera
- Microbiology Unit, Department of Diagnostic Medicine and Prevention, University of Bologna, Bologna, Italy
| | - A Patrizi
- Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M P Landini
- Microbiology Unit, Department of Diagnostic Medicine and Prevention, University of Bologna, Bologna, Italy
| | - P A Fanti
- Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - E Dika
- Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Bignardi M, Huscher A, Centurioni M, Colangione M, Barbieri D, Galelli M, Zaniboni A. EP-1270: SBRT for liver metastases from low grade neuroendocrine tumors. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32520-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Piazza C, Del Bon F, Paderno A, Grazioli P, Perotti P, Barbieri D, Majorana A, Bardellini E, Peretti G, Nicolai P. The diagnostic value of narrow band imaging in different oral and oropharyngeal subsites. Eur Arch Otorhinolaryngol 2016; 273:3347-53. [PMID: 26879990 DOI: 10.1007/s00405-016-3925-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 10/03/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Abstract
The diagnostic value of narrow band imaging (NBI) in the "optical biopsy" of leukoplakias (LP) and erythroplakias (EP) in different oral cavity (OC) and oropharyngeal (OP) subsites is still to be defined. We evaluated 128 unbiopsied and untreated OC/OP LP and EP by conventional oral examination (COE), white light (WL) endoscopy, and NBI and categorized them as "suspicious" or "innocuous". All lesions were treated by excisional biopsy. True positives were those considered as "suspicious" and with histopathology ranging from mild dysplasia to invasive carcinoma. Epithelia were classified as follows: type 1, keratinized thick stratified (gingiva, hard palate, dorsal tongue); type 2a, non-keratinized thin stratified (floor of mouth, vestibule, ventral tongue, soft palate, palatine tonsils, base of tongue); type 2b, non-keratinized, very thick stratified (retromolar trigon, lateral tongue, labial and buccal mucosa). Histopathology revealed 32 % benign lesions, 13 % mild to moderate dysplasias, 15 % severe dysplasias/carcinoma in situ, 16 % microinvasive, and 23 % invasive carcinomas. The false positive rates were 32 % at COE, 27 % at WL, and 15 % at NBI. The false negative rates were 49, 22, and 11 %, respectively. Diagnositic performance was higher for NBI compared to COE (p < 0.001) and to WL (p = 0.004). Comparison of the diagnostic value of NBI among different OC/OP subsites did not show statistically significant difference. NBI as an "optical biopsy" tool significantly reduces the rates of false positives and false negatives in diagnosis of OC/OP cancer compared with COE and WL. No statistically significant difference was noted in its diagnostic value among different OC/OP subsites.
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Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy.
| | - Francesca Del Bon
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy
| | - Paola Grazioli
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy
| | - Diego Barbieri
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy
| | - Alessandra Majorana
- Department of Oral Medicine, Dental Clinic, University of Brescia, Brescia, Italy
| | - Elena Bardellini
- Department of Oral Medicine, Dental Clinic, University of Brescia, Brescia, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy
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Laurita R, Barbieri D, Gherardi M, Colombo V, Lukes P. Chemical analysis of reactive species and antimicrobial activity of water treated by nanosecond pulsed DBD air plasma. Clinical Plasma Medicine 2015. [DOI: 10.1016/j.cpme.2015.10.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simoncelli E, Barbieri D, Laurita R, Liguori A, Stancampiano A, Viola L, Tonini R, Gherardi M, Colombo V. Preliminary investigation of the antibacterial efficacy of a handheld Plasma Gun source for endodontic procedures. Clinical Plasma Medicine 2015. [DOI: 10.1016/j.cpme.2015.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Piazza C, Barbieri D, Del Bon F, Grazioli P, Perotti P, Paderno A, Frittoli B, Mazza G, Penco S, Gaggero G, Nicolai P, Peretti G. Functional outcomes after different types of transoral supraglottic laryngectomy. Laryngoscope 2015; 126:1131-5. [DOI: 10.1002/lary.25562] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/20/2015] [Accepted: 07/15/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia
| | - Diego Barbieri
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia
| | - Francesca Del Bon
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia
| | - Paola Grazioli
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia
| | - Pietro Perotti
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia
| | | | | | - Sara Penco
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Giovanna Gaggero
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia
| | - Giorgio Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
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Piazza C, Del Bon F, Barbieri D, Grazioli P, Paderno A, Perotti P, Lombardi D, Peretti G, Nicolai P. Tracheal and Crico-Tracheal Resection and Anastomosis for Malignancies Involving the Thyroid Gland and the Airway. Ann Otol Rhinol Laryngol 2015; 125:97-104. [DOI: 10.1177/0003489415599000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objectives: To evaluate outcomes in different malignancies involving the thyroid and infiltrating the airway submitted to tracheal (TRA) or crico-tracheal resection and anastomosis (CTRA). Methods: Retrospective charts review of 27 patients affected by thyroid malignancies involving the airway treated by TRA/CTRA in a single academic institution. Kaplan-Meier curves were used to evaluate the overall (OS) and disease-specific (DSS) survivals and local (LC) and loco-regional control (LRC). Impact on survival of age, comorbidities, previous radiotherapy, types of TRA/CTRA, Shin’s stage (II, III, IV), grading (well vs poorly differentiated), and length of airway resected was calculated by the log-rank test. Results: Overall survival and DSS at 3 and 5 years were 82.3% and 71.6%, respectively. Local control and LRC in the entire group were 82.3% at 3 and 5 years. Crico-tracheal resection and anastomosis involving the cricoid arch and plate (type C) and tumor differentiation significantly affected OS and DSS (both P < .001). Type C CTRA and tumor differentiation significantly impacted on LC ( P = .002 and P = .009, respectively). Conclusions: Grading and extension of CTRA to the cricoid plate are the most important factors for oncologic outcomes in thyroid malignancies infiltrating the airway. Except for poorly differentiated tumors, TRA/CTRA allows adequate LC even in advanced stage lesions involving the crico-tracheal junction.
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Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Diego Barbieri
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Paola Grazioli
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
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Barski G, Youn JK, Barbieri D. Variability of leukemogenic potential of Rauscher virus in culture. Bibl Haematol 2015; 30:76-7. [PMID: 5691936 DOI: 10.1159/000391226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Dika E, Patrizi A, Venturoli S, Fanti PA, Barbieri D, Strammiello R, Melotti B, La Placa M. Human papillomavirus evaluation of vemurafenib-induced skin epithelial tumors: a case series. Br J Dermatol 2014; 172:540-2. [PMID: 25041062 DOI: 10.1111/bjd.13275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- E Dika
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
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Abstract
Accidental caustic ingestion occurs mainly in the 2- to 3-year-old age group. Up to 33% of patients develop long-term complications that principally involve the gastroesophageal tract, whereas their occurrence at the level of pharyngeal and laryngeal structures is less frequent. When present, strictures are the main disorders that can be observed. In this pathological situation, surgery is the treatment of choice, and several procedures have been described. We report the history of a 3-year-old boy affected by pharyngolaryngeal stenosis due to accidental caustic ingestion. After careful diagnosis, the child underwent surgery by transoral CO2laser. The patient had immediate improvement and restarted oral feeding 1 day after the surgical procedure. An analysis of diagnosis and treatment of this long-term complication is also presented.
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Affiliation(s)
- Marco Berlucchi
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
| | - Diego Barbieri
- Department of Otorhinolaryngology, University of Brescia, Brescia, Italy
| | | | - Stefania Stefini
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
| | - Giorgio Peretti
- Department of Otolaryngology, University of Genoa, Genoa, Italy
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Luo X, Barbieri D, Passanisi G, Yuan H, de Bruijn JD. Influence of fluoride in poly(d,l-lactide)/apatite composites on bone formation. J Biomed Mater Res B Appl Biomater 2014; 103:841-52. [DOI: 10.1002/jbm.b.33255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/27/2014] [Accepted: 07/15/2014] [Indexed: 01/25/2023]
Affiliation(s)
- X. Luo
- Xpand Biotechnology BV; Prof. Bronkhorstlaan 10, Bld 48 3723 MB Bilthoven The Netherlands
- MIRA Institute; University of Twente; Drienerlolaan 5 7522 NB Enschede The Netherlands
| | - D. Barbieri
- Xpand Biotechnology BV; Prof. Bronkhorstlaan 10, Bld 48 3723 MB Bilthoven The Netherlands
| | - G. Passanisi
- Xpand Biotechnology BV; Prof. Bronkhorstlaan 10, Bld 48 3723 MB Bilthoven The Netherlands
| | - H. Yuan
- Xpand Biotechnology BV; Prof. Bronkhorstlaan 10, Bld 48 3723 MB Bilthoven The Netherlands
- MIRA Institute; University of Twente; Drienerlolaan 5 7522 NB Enschede The Netherlands
- College of Physical Science and Technology; Sichuan University; Wangjiang Road 29 610064 Chengdu China
| | - J. D. de Bruijn
- Xpand Biotechnology BV; Prof. Bronkhorstlaan 10, Bld 48 3723 MB Bilthoven The Netherlands
- MIRA Institute; University of Twente; Drienerlolaan 5 7522 NB Enschede The Netherlands
- School of Engineering and Materials Science; Queen Mary University of London; Mile End Rd London E1 4NS UK
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Piazza C, Mangili S, Bon FD, Paderno A, Grazioli P, Barbieri D, Perotti P, Garofolo S, Nicolai P, Peretti G. Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: the Laryngoscore. Laryngoscope 2014; 124:2561-7. [PMID: 24964904 DOI: 10.1002/lary.24803] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/21/2014] [Accepted: 06/03/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify a clinical predictor score for difficult laryngeal exposure (DLE) during operative microlaryngoscopy. STUDY DESIGN Prospective cohort study in two academic institutions. METHODS We evaluated 319 patients before microlaryngoscopy for benign and malignant glottic diseases by a standardized preoperative assessment protocol (Laryngoscore) that included 11 parameters: interincisors gap (IIG), thyro-mental distance, upper jaw dental status, trismus, mandibular prognathism, macroglossia, micrognathia, degree of neck flexion-extension, history of previous open-neck and/or radiotherapy, Mallampati's modified score, and body mass index (BMI). Each parameter was assessed to obtain a total score. Patients were divided into five classes according to the anterior commissure (AC) visualization: class 0, complete AC visualization with large-bore laryngoscopes in the Boyce-Jackson position; class I, as class 0 with external laryngeal counterpressure; class II, as class I in the flexion-flexion position; class III, as class II using small-bore laryngoscopes; and class IV, impossible AC visualization. RESULTS Class 0-I-II (good/acceptable laryngeal exposure) presented a median score < 6. This value was chosen as cutoff for distinguishing favorable versus difficult/impossible laryngeal exposures. When the Laryngoscore was < 6, good laryngeal exposure was observed in 94% of patients, whereas when ≥ 6, DLE was encountered in 40%. When considering a Laryngoscore of ≥ 9, 67% of patients had a DLE. At univariate analysis, IIG, upper jaw dental status, macroglossia, micrognathia, degree of neck flexion-extension, and BMI statistically impacted on DLE (P < 0.05). CONCLUSIONS The Laryngoscore is a good predictor of DLE and assists in selecting the ideal candidates for operative microlaryngoscopy. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia
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Abstract
We propose a theoretical motivation to quantify actual physiological features, such as the shape index distributions measured by Jones and Palmer in cats and by Ringach in macaque monkeys. We will adopt the uncertainty principle associated to the task of detection of position and orientation as the main tool to provide quantitative bounds on the family of simple cells concretely implemented in primary visual cortex.Mathematics Subject Classification (2000)2010: 62P10, 43A32, 81R15.
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Affiliation(s)
- D Barbieri
- CAMS, EHESS/CNRS, 190-198, Avenue de France, 75244, Paris, France
| | - G Citti
- Dipartimento di Matematica, Università di Bologna, Piazza di Porta San Donato 5, 40126, Bologna, Italy
| | - A Sarti
- CAMS, EHESS/CNRS, 190-198, Avenue de France, 75244, Paris, France
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Piazza C, Del Bon F, Grazioli P, Mangili S, Barbieri D, Nicolai P, Peretti G. Organ preservation surgery for low- and intermediate-grade laryngeal chondrosarcomas: Analysis of 16 cases. Laryngoscope 2013; 124:907-12. [DOI: 10.1002/lary.24416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/21/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Paola Grazioli
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Stefano Mangili
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Diego Barbieri
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Genoa; Genoa Italy
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Monti D, Cossarizza A, Salvioli S, Barbieri D, Macchioni S, Guido M, Baggio G, Franceschi C. Apoptosis and immunosenescence. Aging Clin Exp Res 2013. [DOI: 10.1007/bf03324364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Peretti G, Piazza C, Del Bon F, Mora R, Grazioli P, Barbieri D, Mangili S, Nicolai P. Function preservation using transoral laser surgery for T2-T3 glottic cancer: oncologic, vocal, and swallowing outcomes. Eur Arch Otorhinolaryngol 2013; 270:2275-81. [PMID: 23568037 DOI: 10.1007/s00405-013-2461-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/20/2013] [Indexed: 10/27/2022]
Abstract
Aim of this study was to retrospectively analyze oncologic and functional results of a cohort of T2 and selected T3 glottic tumors treated by transoral laser surgery (TLS). Eighty-nine patients affected by T2 and T3 glottic tumors were treated by TLS from 2005 to 2010 at an academic institution by Type V cordectomies using an "en bloc" or, more frequently, a "piece-meal" technique depending on a number of variables. Kaplan-Meier curves were used to evaluate 5-year overall, disease-specific survivals, local control with laser, and organ preservation rates. Univariate analysis of the impact of different variables was performed. At least 1 year after surgery, we examined: subjective voice evaluation by voice handicap index (VHI), perceptive analysis by GRBAS scale, objective measurements with multidimensional voice program (MDVP), swallowing assessment with the M.D. Anderson Dysphagia Inventory (MDADI), videonasal endoscopic evaluation of swallowing (VEES), and videofluoroscopy (VFS). Fifty-nine patients were pT2 and 30 pT3. The 5-year overall, disease-specific survivals, local control with laser, and organ preservation rates were 92.4, 98.7, 68.5, and 82.1 %, respectively. VHI mean score was 20 (mild dysphonia). Mild and moderate dysphonias were detected by GRBAS in 82 and 18% of patients, respectively. Mean values of Jitter, Shimmer, and noise-to-harmonic ratio by MDVP resulted 7.87%, 24.8%, and 0.37, respectively. Mean value of MDADI was 95.75. Only 2% of patients at VEES and 4% at VFS showed tracheal aspiration. Our results highlight that T2 and selected T3 glottic tumors treated by TLS have favorable oncologic and functional outcomes.
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Affiliation(s)
- Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
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Bolzoni Villaret A, Barbieri D, Peretti G, Schreiber A, Fisogni S, Lonardi S, Facchetti F, Nicolai P. Angiogenesis and lymphangiogenesis in early-stage laryngeal carcinoma: Prognostic implications. Head Neck 2012; 35:1132-7. [PMID: 22907864 DOI: 10.1002/hed.23097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Many studies have recently emphasized the role of tumor angiogenesis and lymphangiogenesis in regional and distant spread of disease. Although early laryngeal cancer has a favorable oncologic outcome after conservative surgery or radiation therapy, we observed few cases with poor prognosis in terms of locoregional relapse, organ preservation, and survival. The aim of our study was to evaluate the immunohistochemical expression of CD31 and podoplanin to define angiogenic and lymphangiogenic patterns and their possible prognostic implications in previously untreated T1-T2 glottic squamous cell carcinoma. METHODS Four hundred twenty-eight patients with previously untreated early-stage laryngeal cancer underwent a laser surgical resection in the period between January 1994 and December 2007. Twenty-seven cases with poor outcome were identified and compared with a selected sample of 28 patients. All specimens were negative for the presence of high-risk human papillomavirus genotypes. Patients were followed up until death or for at least 24 months after treatment. Three-micrometer sections were obtained from formalin-fixed and paraffin-embedded tumoral tissues, and an immunohistochemical evaluation was performed. Monoclonal antibodies against CD31 and podoplanin were used for the detection of blood and lymphatic vessels, respectively. A morphometric measurement was used for the analysis of angiogenesis whereas lymphangiogenesis was studied with a semiquantitative technique. The data were analyzed by use of chi-square and Mann-Whitney tests as appropriate. RESULTS An increased tumor angiogenesis correlated with local relapse (p = .01), locoregional relapse (p = .01), and death of disease (p = .03). The presence of lymphatic vessels in peritumoral fields had an impact on local (p = .004) and locoregional recurrence (p = .01). CONCLUSIONS Evaluation of angiogenesis and lymphangiogenesis in early-stage laryngeal cancer could be useful to identify patients at higher risk of recurrence and consequently to modulate treatment planning and follow-up strategy.
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Bignardi M, Barbieri D, Smussi I, Galelli M. PO-0777 SBRT FOR LIVER TUMORS WITH BIOLOGICAL-BASED VMAT PLANNED BY MONACO TREATMENT PLANNING SYSTEM. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71110-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Oliveira A, Nogueira H, Diniz A, Barbieri D. Psychosocial indicators among aircraft maintenance workers with and without neck and shoulder musculoskeletal symptoms. Work 2012; 41 Suppl 1:5699-701. [DOI: 10.3233/wor-2012-1047-5699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Oliveira
- Graduate Program in Physical Therapy, Universidade Federal de São Carlos UFSCar, São Paulo,Brazil
- Undergraduate Program in Physical Therapy, Universidade Federal de São Carlos UFSCar, São Paulo, Brazil
| | - H Nogueira
- Graduate Program in Physical Therapy, Universidade Federal de São Carlos UFSCar, São Paulo,Brazil
| | - A Diniz
- Undergraduate Program in Physical Therapy, Universidade Federal de São Carlos UFSCar, São Paulo, Brazil
| | - D Barbieri
- Graduate Program in Physical Therapy, Universidade Federal de São Carlos UFSCar, São Paulo,Brazil
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Tonoli S, Magrini SM, Costa L, Paiar F, Simontacchi G, Scotti V, Pasinetti N, Barca R, Barbieri D, De Stefani A, Cellai E, Buglione M, Biti G. A benchmark study on 883 nasopharyngeal cancer patients treated in two Italian centres from 1977 to 2000. Part I: Evolving technical choices and survival. Radiol Med 2011; 117:690-714. [PMID: 22095424 DOI: 10.1007/s11547-011-0755-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 05/06/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The authors sought to define treatment results according to the different accrual periods and clinical-therapeutic features in a large series of nasopharyngeal cancer (NPC) patients treated in two Italian centres over more than two decades. MATERIALS AND METHODS A total of 883 patients consecutively treated with radiotherapy between 1977 and 2000 at the Florence (FLO) and Brescia (IRA) Radiation Oncology centres were studied. Five-year overall (OS) and disease-specific (DSS) actuarial survival rates in the different pathological, clinical and therapeutic subgroups were calculated, along with the actuarial local-regional control (LRC) probability. RESULTS At univariate analysis, survival and local control rates were significantly better in the more recent accrual periods and in the more favourable disease presentations; treatment-related parameters mainly affect LRC. At multivariate analysis, patient- and disease-related factors had a more evident prognostic effect than did therapeutic factors, although dose to the nasopharynx and treatment technique had a marginally significant impact on DSS and OS. CONCLUSIONS Results of this benchmark study may be useful for understanding the development of new radio-therapy techniques for NPC, such as three-dimensional conformal radiotherapy (3D-CRT) and particularly intensity-modulated radiotherapy (IMRT).
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Affiliation(s)
- S Tonoli
- Istituto del Radio O. Alberti, Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Abstract
To render polymeric materials osteoinductive, nano-sized calcium phosphate apatite particles (CaP) were introduced into a low molecular weight poly(D,L-lactide). Homogenous composites were made with 10%, 20% and 40% by weight of apatite content while pure polylactide was used as control. Thereafter porous samples (pore size 300-400 microm, 60% porosity) were fabricated and sterilized. In vitro studies showed that calcium ions were released from the composites depending on the apatite content, while surface mineral deposition was observed only on the 40% CaP composites in simulated body fluid (SBF) within 14 days. After 12 weeks of intramuscular implantation in dogs, only the 40% CaP composite implant retained its shape and showed ectopic bone formation within the pores. In conclusion, adding a content of 40% apatite into poly(D,L-lactide) could lead to an osteoinductive material. Future studies will focus on understanding this phenomenon of material-directed osteoinduction in order to develop a promising bone graft substitute.
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Affiliation(s)
- D Barbieri
- Xpand Biotechnology BV, 3723 MB Bilthoven, the Netherlands.
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