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Mancuso S, Mattana M, Giammancheri F, Russello F, Carlisi M, Santoro M, Siragusa S. Bone damage and health-related quality of life in Hodgkin lymphoma survivors: closing the gaps. Front Oncol 2024; 14:1201595. [PMID: 38406804 PMCID: PMC10884223 DOI: 10.3389/fonc.2024.1201595] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
In the recent decades, remarkable successes have been recorded in the treatment of Hodgkin's lymphoma to the point that today it represents one of the neoplasms with the highest rates of cure and with the highest life expectancy. Nonetheless, this raises the concern for the health of long- term survivors. Late side effects of treatments in synergy with other risk factors expose survivors to increased morbidity and impaired quality of life. In the complexity of the topics concerning these last aspects, an area of growing interest is that of bone damage that follows Hodgkin Lymphoma and its treatments. In this narrative review, we conducted our work through assessment of available evidence focusing on several aspects linking bone damage and quality of life with Hodgkin lymphoma and its treatments. At present, the problem of osteopenia and osteoporosis in Hodgkin lymphoma survivors is a theme for which awareness and knowledge need to be implemented.
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Affiliation(s)
- Salvatrice Mancuso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Division of Hematology, University of Palermo, Palermo, Italy
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Stuckey R, Ianotto JC, Santoro M, Czyż A, Encinas MMP, Gómez-Casares MT, Pereira MSN, de Nałęcz AK, Gołos A, Lewandowski K, Szukalski Ł, González-Martín JM, Sobas MA. Prediction of major bleeding events in 1381 patients with essential thrombocythemia. Int J Hematol 2023; 118:589-595. [PMID: 37660316 PMCID: PMC10615906 DOI: 10.1007/s12185-023-03650-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
The goal of therapy in essential thrombocythemia (ET) is reducing thrombotic risk. No algorithm to predict hemorrhage risk exists. The impact ofanti-platelet, cytoreductive and anticoagulation therapies on risk of major bleeding (MB) was evaluated. MB events were retrospectively analyzed in 1381 ET from 10 European centers. There were 0.286 MB events/person-year. Neither the International Thrombosis Prognostic Score for thrombosis in essential thrombocythemia (IPSET-t) nor the revised IPSET-t (r-IPSET-t) was predictive for hemorrhage-free survival at 10 years (p = 0.092 vs p = 0.1). Ageand leukocyte count were MB risk factors, while low hemoglobin was protective. For ET with extreme thrombocytosis (ExtT) and leukocytosis cytoreduction was not protective. MB were more frequent in ET with ExtT who received anticoagulation. Antiplatelet therapy was not, while anticoagulation was a risk factor for MB (HR 3.05, p = 0.016, CI 1.23-7.56), in particular vitamin K antagonists (22.6% of those treated had a MB event, HR 2.96, p = 0.004, CI 1.41-6.22). Survival at 10 years was associated with hemorrhage (OR 2.54, p < 0.001) but not thrombosis (HR 0.95, p = 0.829). Hemorrhage has a higher risk of mortality than thrombosis. Improved risk stratification for MB is necessary. The choice of anticoagulation, cytoreduction and antiplatelet therapies is an important area of research in ET.
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Affiliation(s)
- Ruth Stuckey
- Hematology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain
| | - Jean-Christophe Ianotto
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Marco Santoro
- Hematology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Anna Czyż
- Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland
| | - Manuel M Perez Encinas
- Hematology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Krzysztof Lewandowski
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Łukasz Szukalski
- Department of Haematology CM UMK in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | | | - Marta Anna Sobas
- Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland.
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Cavaco B, Madeira de Carvalho LM, Shimoda E, Santoro M, Werneck MR. Helminth Fauna of Juvenile Green Sea Turtles ( Chelonia mydas) from Rio de Janeiro State, Brazil. Helminthologia 2023; 60:196-200. [PMID: 37745228 PMCID: PMC10516470 DOI: 10.2478/helm-2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/20/2023] [Indexed: 09/26/2023] Open
Abstract
The helminth fauna of juvenile green sea turtles (Chelonia mydas Linnaeus, 1758) is still poorly known. Herein, we study the gastrointestinal helminths of 28 juvenile green sea turtles found stranded on the north coast of Rio de Janeiro state, Brazil. All turtles were infected showing a rich helminth fauna. In total, 14802 trematodes belonging to 30 species and 5 families including Micros-caphidiidae, Plagiorchiidae, Pronocephalidae, Hapalotrematidae, and Telorchiidae were recovered. An unidentified nematode specimens was also found. The mean intensity was 536 (95% CI = 362 - 853) (range: 1 - 2831), and the species richness was 7.86 (95% CI = 6.46 - 9.21) (range: 1 - 17). The coast of Rio de Janeiro state represents new locality records for Angiodictyum posterovitellatum, Microscaphidium aberrans, M. warui, Octangium hyphalum, O. sagitta, Enodiotrema reductum and Pleurogonius laterouterus. This study confirms that the green sea turtle harbors the richest helminth fauna among sea turtle species and provides useful information on the gastrointestinal helminths of a poorly known stage in the life cycle of this endangered chelonian.
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Affiliation(s)
- B. Cavaco
- CIISA – Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS)
| | - L. M. Madeira de Carvalho
- CIISA – Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS)
| | - E. Shimoda
- Universidade Cândido Mendes, Rua Anita Peçanha, 100, Parque São Caetano. 28030-335 Campos dos Goytacazes, RJ, Brazil
| | - M. Santoro
- Department of Integrative Marine Ecology, Stazione Zoologica Anton Dohrn, Villa Comunale 1, 80121Naples, Italy
| | - M. R. Werneck
- Instituto BW para Conservação e Medicina da Fauna Marinha. Araruama, RJ, 28970-000, Brazil
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Guarino M, La Bella S, Santoro M, Caposiena D, Di Lembo E, Chiarelli F, Iannetti G. The Leading Role of Brain and Abdominal Radiological Features in the Work-Up of Anti-NMDAR Encephalitis in Children: An Up-To-Date Review. Brain Sci 2023; 13:brainsci13040662. [PMID: 37190627 DOI: 10.3390/brainsci13040662] [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: 04/02/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis (NMDARe) is the most common cause of nonviral encephalitis, mostly affecting young women and adolescents with a strong female predominance (F/M ratio of around 4:1). NMDARe is characterized by the presence of cerebrospinal fluid (CSF) antibodies against NMDARs, even though its pathophysiological mechanisms have not totally been clarified. The clinical phenotype of NMDARe is composed of both severe neurological and neuropsychiatric symptoms, including generalized seizures with desaturations, behavioral abnormalities, and movement disorders. NMDARe is often a paraneoplastic illness, mainly due to the common presence of concomitant ovarian teratomas in young women. Abdominal ultrasonography (US) is a key imaging technique that should always be performed in suspected patients. The timely use of abdominal US and the peculiar radiological features observed in NMDARe may allow for a quick diagnosis and a good prognosis, with rapid improvement after the resection of the tumor and the correct drug therapy.
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Affiliation(s)
- Miriana Guarino
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Saverio La Bella
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Marco Santoro
- Department of Radiology, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Daniele Caposiena
- Department of Radiology, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Enza Di Lembo
- Department of Internist Ultrasound, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Giovanni Iannetti
- Department of Internist Ultrasound, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
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Morello F, Santoro M, Giachino F, Caciolli F, Capretti E, Castelli M, Pivetta E, Nazerian P, Lupia E. Pre-Test Probability Assessment and d-Dimer Based Evaluation in Patients with Previous Acute Aortic Syndrome. Medicina (B Aires) 2023; 59:medicina59030548. [PMID: 36984549 PMCID: PMC10057941 DOI: 10.3390/medicina59030548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
Background and Objectives. Acute aortic syndromes (AASs) are emergencies burdened by high morbidity and mortality. Guideline-recommended diagnostic workup is based on pre-test probability assessment (PPA) and d-dimer testing. However, the performance of PPA and d-dimer has never been studied in individuals with previous AAS (pAAS), which represent a challenging population. Materials and Methods. We analyzed a registry of patients with pAAS evaluated in two Emergency Departments (EDs) for suspected novel AAS (nAAS). Enrolment criteria were history of pAAS and the presence of truncal pain, syncope or perfusion deficit. All patients underwent advanced imaging. Clinical data were registered prospectively and PPA was performed by applying the aortic dissection detection (ADD) and an aorta simplified (AORTAs) score. Results. A total of 128 patients were enrolled, including 77 patients with previous Stanford type A aortic dissection and 45 patients with previous Stanford type B aortic dissection. The final diagnosis was nAAS in 40 (31%) patients. Clinical variables associated with nAAS were: aortic valve disease, thoracic aortic aneurysm, severe pain, sudden pain, ripping/tearing pain and hypotension/shock. ADD score ≥ 2 had a sensitivity of 65% and a specificity of 83% for nAAS; AORTAs score ≥ 2 had a sensitivity of 48% and a specificity of 88%. d-dimer (cutoff ≥ 500 ng/mL or age-adjusted cutoff) had a sensitivity of 97% and a specificity of 13%/14.7%, for diagnosis of nAAS. Patients that were candidates for guideline-compliant PPA/d-dimer integrated rule-out were: 5 (4.9%) with ADD ≤ 1/d-dimer and 8 (7.8%) with AORTAs ≤ 1/d-dimer < age-adjusted cutoff. None of them had a nAAS. Conclusions. Patients with pAAS evaluated in the ED for red-flag symptoms showed intermediate-to-high pre-test probability of nAAS. The ADD score had lower sensitivity and specificity than in unselected patients. d-dimer, alone and integrated with PPA, was highly sensitive for nAAS, but very unspecific. PPA/d-dimer integrated strategies are unlikely to significantly reduce the number of patients with pAAS undergoing advanced imaging.
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Affiliation(s)
- Fulvio Morello
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy
- Correspondence: ; Tel.: +39-011-6337009
| | - Marco Santoro
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
| | - Francesca Giachino
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
| | - Francesca Caciolli
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
| | - Elisa Capretti
- Dipartimento di Emergenza e Accettazione, A.O.U. Careggi, 50134 Firenze, Italy
| | - Matteo Castelli
- Dipartimento di Emergenza e Accettazione, A.O.U. Careggi, 50134 Firenze, Italy
| | - Emanuele Pivetta
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy
| | - Peiman Nazerian
- Dipartimento di Emergenza e Accettazione, A.O.U. Careggi, 50134 Firenze, Italy
| | - Enrico Lupia
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy
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Giamello JD, Martini G, Prato D, Santoro M, Arese Y, Melchio R, Bertolaccini L, Battle CE, Driscoll T, Sciolla A, Lauria G. A retrospective validation study of the STUMBL score for emergency department patients with blunt thoracic trauma. Injury 2023; 54:39-43. [PMID: 36028375 DOI: 10.1016/j.injury.2022.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Blunt thoracic trauma (BTT) is a leading cause of emergency department (ED) trauma-related attendance. Risk prediction tools are commonly to predict patients' outcomes and assign them to the most appropriate care setting. The STUMBL score is a prognostic model for BTT, derived and validated in the United Kingdom; items comprising the score are age, number of rib fractures, use of pre-injury anticoagulants, chronic lung disease and oxygen saturation levels. This study's aim was to validate the STUMBL score in an Italian ED. METHODS This single-centre retrospective validation study was conducted in the ED of Santa Croce and Carle hub hospital in Cuneo, north-western Italy. All patients with an ED attendance for isolated BTT from 2018 to 2021 were included. Exclusion criteria were an age of under eighteen and the presence of any immediately life-threatening lesion. The primary outcome was the development of trauma-related complications, defined by the occurrence of one or more of the following: in-hospital mortality, pulmonary complications (infection, pleural effusion, haemothorax, pneumothorax, pleural empyema), need for intensive care unit admission, hospital length of stay equal to or greater than seven days. The performance of the STUMBL score was analysed in terms of discrimination with the evaluation of the receiver operating characteristic curve and calibration with the Hosmer-Lemeshow test and with the calibration belt. RESULTS 745 patients were enroled (median age 64 [25th;75th percentile: 50;78], male/female ratio 1:4, median Charlson comorbidity index 2 [1;4], median STUMBL score 11 [6;17]). 65.2% of patients were discharged home after ED evaluation. 203 patients (27.2%) developed the primary outcome. The STUMBL score was significantly different in patients with complications compared to those without complications (9 [5;13] vs 21 [17;25], p < 0.001). The C index of the score for the primary outcome was 0.90 (95% CI 0.88-0.93), and the result of the Hosmer-Lemeshow test was 9.01 (p = 0.34). STUMBL score = 16 has a sensitivity of 0.80 (95% CI 0.75-0.85), specificity of 0.87 (95% CI 0.84-0.90), a positive predictive value of 0.70 (95% CI 0.64-0.76), and a negative predictive value of 0.92 (95% CI 0.90-0.94). CONCLUSION In this validation study, the STUMBL score demonstrated excellent discrimination and calibration in predicting the outcome of patients attending the ED with a BTT.
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Affiliation(s)
- Jacopo Davide Giamello
- School of Emergency Medicine, University of Turin; Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy.
| | - Gianpiero Martini
- Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Davide Prato
- Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Marco Santoro
- School of Emergency Medicine, University of Turin; Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Ylenia Arese
- School of Emergency Medicine, University of Turin; Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Remo Melchio
- Department of Internal Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Timothy Driscoll
- Swansea Trials Unit, Swansea University, Swansea, SA2 8PP, United Kingdom
| | - Andrea Sciolla
- Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Giuseppe Lauria
- Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
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Giamello JD, Martini G, Santoro M, Prato D, Arese Y, Battle CE, Driscoll T, Artana N, Barutta L, Sciolla A, Lauria G. 1404 Patients attending the emergency department for blunt thoracic trauma: a validation study of the STUMBL score. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-rcem2.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aims, Objectives and BackgroundBlunt thoracic trauma (BTT) is a leading cause of emergency department (ED) trauma-related attendance. The STUMBL score is a prognostic model for BTT, derived and validated in the United Kingdom; this study’s aim was to validate the STUMBL score in an Italian ED.Method and DesignThis single-centre retrospective validation study was conducted in the ED of Cuneo hospital, north-western Italy. All patients with an ED attendance for isolated BTT from 2018 to 2021 were included. Exclusion criteria were: age of under eighteen and the presence of any immediately life-threatening lesion. The primary outcome was the development of trauma-related complications, defined by the occurrence of one or more of the following: in-hospital mortality, pulmonary complications (infection, pleural effusion, haemothorax, pneumothorax, pleural empyema), need for intensive care unit admission, hospital length of stay equal to or greater than seven days. The performance of the STUMBL score was analysed in terms of discrimination with the evaluation of the receiver operating characteristiccurve and calibration with the Hosmer-Lemeshow test and with the calibration belt.Abstract 1404 Figure 1Results and Conclusion745 patients were enrolled (median age 64 [50;78], male/female ratio 1:4, median Charlson comorbidity index 2 [1;4], median STUMBL score 11 [6;17]). 65.2% of patients were discharged home after ED evaluation. 203 patients (27.2%) developed the primary outcome. The STUMBL score was significantly different in patients with complications compared to those without complications (9 [5;13] vs 21 [17;25], p<0.001). The C index of the score for the primary outcome was 0.9 (95% CI 0.88 – 0.93) (figure 1), and the result of the Hosmer-Lemeshow test was 9.01 (p=0.34). STUMBL score = 16 had a negative predictive value of 0.92. In conclusion, this validation study demonstrated that the STUMBL score had excellent discrimination and calibration in predicting the outcome of patients attending the ED with a BTT.
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Botta C, Gigliotta E, Paiva B, Anselmo R, Santoro M, Otero PR, Carlisi M, Conticello C, Romano A, Solimando AG, Cerchione C, Vià MD, Bolli N, Correale P, Di Raimondo F, Gentile M, San Miguel J, Siragusa S. Network meta-analysis of randomized trials in multiple myeloma: Efficacy and safety in frontline therapy for patients not eligible for transplant. Hematol Oncol 2022; 40:987-998. [PMID: 35794705 PMCID: PMC10084226 DOI: 10.1002/hon.3041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/26/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/13/2022]
Abstract
The treatment scenario for newly-diagnosed transplant-ineligible multiple myeloma patients (NEMM) is quickly evolving. Currently, combinations of proteasome inhibitors and/or immunomodulatory drugs +/- the monoclonal antibody Daratumumab are used for first-line treatment, even if head-to-head comparisons are lacking. To compare efficacy and safety of these regimens, we performed a network meta-analysis of 27 phase 2/3 randomized trials including a total of 12,935 patients and 23 different schedules. Four efficacy/outcome and one safety indicators were extracted and integrated to obtain (for each treatment) the surface under the cumulative ranking-curve (SUCRA), a metric used to build a ranking chart. With a mean SUCRA of 83.8 and 80.08 respectively, VMP + Daratumumab (DrVMP) and Rd + Daratumumab (DrRd) reached the top of the chart. However, SUCRA is designed to work for single outcomes. To overcome this limitation, we undertook a dimensionality reduction approach through a principal component analysis, that unbiasedly grouped the 23 regimens into three different subgroups. On the bases of our results, we demonstrated that first line treatment for NEMM should be based on DrRd (most active, but continuous treatment), DrVMP (quite "fixed-time" treatment), or, alternatively, VRD and that, surprisingly, melphalan as well as Rd doublets still deserve a role in this setting.
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Affiliation(s)
- Cirino Botta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Emilia Gigliotta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Bruno Paiva
- Clinica Universidad de Navarra, CCUN Centro de Investigacion Medica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - Rita Anselmo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Marco Santoro
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Paula Rodriguez Otero
- Clinica Universidad de Navarra, CCUN Centro de Investigacion Medica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - Melania Carlisi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Concetta Conticello
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | - Alessandra Romano
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | - Antonio Giovanni Solimando
- Guido Baccelli Unit of Internal Medicine, Department of Biomedical Sciences and Human Oncology (DIMO), School of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Claudio Cerchione
- Hematology Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Matteo Da Vià
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy.,Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Niccolò Bolli
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy.,Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pierpaolo Correale
- Medical Oncology Unit, Grand Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Francesco Di Raimondo
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | - Massimo Gentile
- Hematology Unit, Department of Hemato-Oncology, Annunziata Hospital, Cosenza, Italy
| | - Jesus San Miguel
- Clinica Universidad de Navarra, CCUN Centro de Investigacion Medica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - Sergio Siragusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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La Bella S, Coclite E, Chiavaroli V, Cicioni P, Santoro M, Chiarelli F, Di Valerio S. Spontaneously Healed Arterial Thrombosis at Birth. Circ Cardiovasc Imaging 2022; 15:e014510. [PMID: 36052675 DOI: 10.1161/circimaging.122.014510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Saverio La Bella
- University of Chieti and Pescara "Gabriele d'Annunzio", Department of Pediatrics, Italy (S.L.B., F.C.).,Pescara Public Hospital, Neonatal Intensive Care Unit, Italy (S.L.B., E.C., V.C., P.C., S.D.V.)
| | - Eleonora Coclite
- Pescara Public Hospital, Neonatal Intensive Care Unit, Italy (S.L.B., E.C., V.C., P.C., S.D.V.)
| | - Valentina Chiavaroli
- Pescara Public Hospital, Neonatal Intensive Care Unit, Italy (S.L.B., E.C., V.C., P.C., S.D.V.).,The University of Auckland, Liggins Institute, New Zealand (V.C.)
| | - Paola Cicioni
- Pescara Public Hospital, Neonatal Intensive Care Unit, Italy (S.L.B., E.C., V.C., P.C., S.D.V.)
| | - Marco Santoro
- Pescara Public Hospital, Department of Radiology, Italy (M.S.)
| | - Francesco Chiarelli
- University of Chieti and Pescara "Gabriele d'Annunzio", Department of Pediatrics, Italy (S.L.B., F.C.)
| | - Susanna Di Valerio
- Pescara Public Hospital, Neonatal Intensive Care Unit, Italy (S.L.B., E.C., V.C., P.C., S.D.V.)
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10
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Stuckey R, Ianotto JC, Santoro M, Czyż A, Perez Encinas MM, Gómez-Casares MT, Noya Pereira MS, de Nałęcz AK, Gołos A, Lewandowski K, Szukalski Ł, González-Martín JM, Wróbel T, Sobas MA. Validation of thrombotic risk factors in 1381 patients with essential thrombocythaemia: A multicentre retrospective real-life study. Br J Haematol 2022; 199:86-94. [PMID: 35906782 DOI: 10.1111/bjh.18387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/07/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Abstract
Thrombosis and haemorrhage are frequent in patients with essential thrombocythaemia (ET). The 2016 revised International Prognostic Score for Thrombosis in Essential Thrombocythaemia-thrombosis (r-IPSET-t) score stratifies patients into very-low- (VLR), low- (LR), intermediate- (IR) and high-risk (HR) groups. We validated the r-IPSET-t in the biggest population of patients with ET (n = 1381) to date and found it to be a better fit than the earlier IPSET-t score. With an average follow-up of 87.7 months, there were 0.578 thrombotic events/person-year and 0.286 bleeding events/person-year after diagnosis. The 10-year thrombosis-free survival was 88% and 99% for the r-IPSET-t LR and VLR groups (p < 0.001). Cytoreduction was a thrombotic risk factor in younger patients (aged <60 years, hazard ratio 9.49, p = 0.026; aged ≥60 years, hazard ratio 1.04, p = 0.93). In multivariable Cox regression analysis, anti-aggregation after diagnosis was protective for thrombosis (hazard ratio 0.31, p = 0.005) but a risk factor for major bleeding (hazard ratio 10.56, p = 0.021). Of the IPSET-t HR and LR groups, 132/780 and 249/301 were re-classified as LR and VLR respectively (p < 0.001). The European LeukemiaNET (ELN) does not recommend aspirin for VLR patients but in this real-life analysis 83.1% of VLR patients received it. Our results validate the r-IPSET-t score as more predictive for thrombosis than the ELN-recommended IPSET-t and raise concerns about unnecessary cytoreductive and anti-aggregative therapy.
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Affiliation(s)
- Ruth Stuckey
- Hematology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain
| | - Jean-Christophe Ianotto
- Service d'Hématologie Clinique, Institut de Cancéro-Hématologie, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - Marco Santoro
- Hematology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Anna Czyż
- Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Manuel M Perez Encinas
- Hematology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Aleksandra Gołos
- Department of Hematology, Institute of Hematology, Warsaw, Poland
| | - Krzysztof Lewandowski
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Łukasz Szukalski
- Department of Haematology CM UMK in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | | | - Tomasz Wróbel
- Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Anna Sobas
- Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
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11
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Di Lisi D, Madaudo C, Alagna G, Santoro M, Rossetto L, Siragusa S, Novo G. The new HFA/ICOS risk assessment tool to identify patients with chronic myeloid leukaemia at high risk of cardiotoxicity. ESC Heart Fail 2022; 9:1914-1919. [PMID: 35355425 PMCID: PMC9065844 DOI: 10.1002/ehf2.13897] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 10/11/2021] [Revised: 02/06/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Tyrosine kinase inhibitors (TKIs) used to treat chronic myeloid leukaemia (CML) can cause cardiovascular adverse events. So far, the Systematic Coronary Risk Evaluation (SCORE) charts of the European Society of Cardiology (ESC) have been used to identify cancer patients at increased cardiovascular risk. The primary aim of our study was to evaluate the usefulness of the new cardiovascular risk assessment model proposed by the Cardio-Oncology Study Group of the Heart Failure Association (HFA) of the ESC in collaboration with the International Cardio-Oncology Society (ICOS) to stratify the cardiovascular risk in CML patients, compared with SCORE risk charts. The secondary aim was to establish the incidence of adverse arterial events (AEs) in patients with CML treated with TKIs and the influence of preventive treatment with aspirin. METHODS AND RESULTS A retrospective single-centre observational study was carried out on 58 patients (32 men and 26 women; mean age ± SD: 59 ± 15 years) with CML treated with TKIs for a median period of 43 ± 31 months. Cardiological evaluation was performed and cardiovascular risk was estimated with SCORE risk charts and with the new risk assessment tool proposed by HFA/ICOS. AEs were recorded. According to SCORE charts and the new HFA/ICOS risk stratification tool, respectively, 46% (Group A1) and 60% (Group A2) of patients were at high-very high risk, and 54% (Group B1) and 40% (Group B2) at low-moderate risk. AEs were significantly more frequent in Group A1 than Group B1 (P value < 0.01) when considered overall; they were significantly more frequent in Group A2 than Group B2 either overall or considered individually. HFA/ICOS risk stratification tool was significantly more sensitive than SCORE (P < 0.01) in identifying patients at higher risk of cardiovascular toxicity. In addition, we did not find AEs in patients pretreated with aspirin. CONCLUSIONS The new HFA/ICOS risk stratification model allows a more tailored cardiovascular risk stratification in patients with CML and it is more sensitive than SCORE charts.
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Affiliation(s)
- Daniela Di Lisi
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Cristina Madaudo
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giulia Alagna
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Marco Santoro
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,Haematology Unit, University Hospital Paolo Giaccone, Palermo, Italy
| | - Ludovico Rossetto
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Sergio Siragusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,Haematology Unit, University Hospital Paolo Giaccone, Palermo, Italy
| | - Giuseppina Novo
- Cardiology Unit, University Hospital Paolo Giaccone, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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12
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Accurso V, Santoro M, Mancuso S, Vajana G, Tomasello R, Rotolo C, Camarda G, Mattana M, Siragusa S. Familial essential thrombocythemia: 6 cases from a mono‐institutional series. Clin Case Rep 2022; 10:e05525. [PMID: 35251652 PMCID: PMC8886651 DOI: 10.1002/ccr3.5525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
Rarely essential thrombocythemia (ET) is diagnosed in more than one person within a family. Familial myeloproliferative neoplasms are underdiagnosed. In this report, we describe 6 couples of familial ET, evaluating the heterogeneity of the mutational state and the clinical presentation. Familial essential thrombocythemia (ET) is very rare, also due to underdiagnosis. The collection of the cases could be useful to find out familial MPN diseases. Performing a complete blood count in relatives of patients with ET may lead to a suspicion of diagnosis of familial cases.
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Affiliation(s)
- Vincenzo Accurso
- Hematology Division University Hospital Policlinico "Paolo Giaccone" Palermo Italy
| | - Marco Santoro
- Hematology Unit Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) University of Palermo Palermo Italy
| | - Salvatrice Mancuso
- Hematology Unit Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) University of Palermo Palermo Italy
| | - Giorgia Vajana
- Hematology Division University Hospital Policlinico "Paolo Giaccone" Palermo Italy
| | - Riccardo Tomasello
- Hematology Division University Hospital Policlinico "Paolo Giaccone" Palermo Italy
| | - Cristina Rotolo
- Hematology Division University Hospital Policlinico "Paolo Giaccone" Palermo Italy
| | - Giulia Camarda
- Hematology Division University Hospital Policlinico "Paolo Giaccone" Palermo Italy
| | - Marta Mattana
- Hematology Division University Hospital Policlinico "Paolo Giaccone" Palermo Italy
| | - Sergio Siragusa
- Hematology Unit Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) University of Palermo Palermo Italy
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13
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Iezzi R, Posa A, Santoro M, Tanzilli A, Cerrito L, Ponziani FR, Pompili M, Grieco A, Rapaccini GL, Gasbarrini A, Manfredi R. Balloon-Occluded Radiofrequency Ablation as Bridge to TACE in the Treatment of Advanced HCC with Arterioportal Shunt. Curr Radiopharm 2022; 15:194-198. [PMID: 35209837 DOI: 10.2174/1874471015666220223102426] [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: 09/10/2021] [Revised: 12/30/2021] [Accepted: 01/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transarterial chemoembolization is the most widely used palliative treatment for unresectable hepatocellular carcinoma; however, arterioportal shunt represents a contraindication to this treatment. OBJECTIVE To assess the feasibility of balloon-occluded radiofrequency ablation in the transitory resolution of extensive arterioportal shunt in patients with advanced hepatocellular carcinoma as a bridge to safe and effective transarterial chemoembolization. METHODS 12 consecutive patients with advanced multinodular unilobar unresectable hepatocellular carcinoma with a target lesion larger than 5 cm (mean diameter 7.7 ± 1.4 cm), not suitable to transarterial chemoembolization due to extensive arterioportal shunt were recruited. Balloon-occluded radiofrequency ablation of the hepatic area surrounding the shunt during occlusion of the artery supplying the shunt was performed, followed by lobar conventional chemoembolization. Intra/periprocedural complications were evaluated. Technical success was defined by the result of radiofrequency ablation in terms of immediate disappearance, reduction or persistence of the shunt. Local efficacy of chemoembolization was evaluated at 1-month computed tomography according to m-RECIST criteria. RESULTS Technical success was achieved in all patients. No major complications were observed. 1-month follow-up showed a mean necrotic diameter of 6.3 cm (range: 3.8-8.7 cm), with an acceptable procedural result and persistence of the shunt. An overall response rate was obtained in all patients, with 25% complete response and 75% partial response. CONCLUSION Balloon-occluded radiofrequency ablation of arterioportal shunt in patients with advanced hepatocellular carcinoma can temporarily reduce shunting, allowing to perform a safe and therapeutically useful chemoembolization, with a satisfactory control of tumor growth.
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Affiliation(s)
- Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - U.O.C. Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Alessandro Posa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - U.O.C. Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Marco Santoro
- Diagnostic imaging, Azienda USL di Pescara, Pescara, Italy
| | - Alessandro Tanzilli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - U.O.C. Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Lucia Cerrito
- Dipartimento di Scienze Mediche e Chirurgiche - U.O.C. Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Francesca Romana Ponziani
- Dipartimento di Scienze Mediche e Chirurgiche - U.O.C. Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Maurizio Pompili
- Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze Mediche e Chirurgiche - U.O.C. Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | | | | | | | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - U.O.C. Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
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14
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Mancuso S, Scaturro D, Santoro M, Di Gaetano G, Vitagliani F, Falco V, Siragusa S, Gonnelli S, Mauro GL. Bone damage after chemotherapy for lymphoma: a real-world experience. BMC Musculoskelet Disord 2021; 22:1024. [PMID: 34876084 PMCID: PMC8653589 DOI: 10.1186/s12891-021-04904-3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/11/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite recent improvements in survival due to advances in treatment, the quality of life of patients with lymphoma may be compromised by the long-term complications of chemotherapy and steroid therapy. Among these, a potentially relevant problem is bone loss and the development of fragility fractures. AIM To provide further evidence of clinical or subclinical skeletal complications in correlation with biological variables and markers of bone disease in patients with complete response to therapy. METHOD A cross-sectional observational study was conducted on subjects diagnosed with lymphoma with subsequent antineoplastic treatment, disease status after therapy defined as complete response disease for at least a year now. We performed: blood chemistry tests, imaging techniques and screening tools for the assessment of functional status and quality of life (SARC-F and mini-Osteoporosis Quality of Life). RESULTS Approximately 50% of patients had osteoporosis, with a prevalence of vertebral fractures of 65.5%. In most patients, we found hypovitaminosis D and high levels of parathyroid hormone (PTH). Furthermore, a statistically significant association was observed between high PTH levels and previous lymphoma treatment. Finally, the Mini-Osteoporosis Quality of life (mini-OQLQ) questionnaire demonstrated a loss of quality of life as a consequence of the change in bone status. CONCLUSIONS Patient treatment design for personalized chemotherapy would be desirable to reduce late effects on bone. Also, early prevention programs need to be applied before starting treatment. The most benefited subpopulations could be not only elderly but also young patients.
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Affiliation(s)
- S Mancuso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Hematology Unit, University of Palermo, Palermo, Italy
| | - Dalila Scaturro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via del vespro 129, 90127, Palermo, Italy.
| | - M Santoro
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Hematology Unit, University of Palermo, Palermo, Italy
| | | | | | - V Falco
- Department of Economics Business and Statistic, University of Palermo, Palermo, Italy
| | - S Siragusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Hematology Unit, University of Palermo, Palermo, Italy
| | - S Gonnelli
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Diseases and Lung Transplantation, Siena University Hospital, Siena, Italy
| | - G Letizia Mauro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
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15
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Sant'Antonio E, Borsani O, Camerini C, Botta C, Santoro M, Allegra A, Siragusa S. Philadelphia chromosome-negative myeloproliferative neoplasms in younger adults: A critical discussion of unmet medical needs, with a focus on pregnancy. Blood Rev 2021; 52:100903. [PMID: 34742614 DOI: 10.1016/j.blre.2021.100903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 11/02/2022]
Abstract
Myeloproliferative neoplasms (MPN) are traditionally regarded as a disease of older adults, though a not negligible fraction of cases occurs at a younger age, including women of childbearing potential. MPN in younger patients, indeed, offer several challenges for the clinical hematologist, that goes from difficulties in reaching a timely and accurate diagnosis to a peculiar thrombotic risk, with a relatively high incidence of thromboses in unusual sites (as the splanchnic veins or the cerebral ones). Moreover, the issue of pregnancy is recently gaining more attention as maternal age is rising and molecular screening are widely implemented, leading to a better recognition of these cases, both before and during pregnancy. In the present work we aim at discussing four clinical topic that we identified as areas of uncertainty or true unmet medical needs in the management of younger patients with MPN, with a particular focus on the topic of pregnancy. For each of these topics, we critically reviewed the available evidence that support treatment decisions, though acknowledging that recommendations in this field are mostly based on expert opinion or derived from guidelines of other clinical conditions that share with MPN a high vascular risk, as antiphospholipid syndrome. Taking into consideration both the lack of evidence-based data and the clinical heterogeneity of MPN, we support an individualized strategy of counseling and management for both young patients and for expectant mother with MPN.
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Affiliation(s)
| | - Oscar Borsani
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Chiara Camerini
- Division of Hematology, Azienda USL Toscana Nord Ovest, Ospedale San Luca, Lucca, Italy
| | - Cirino Botta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Marco Santoro
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Sergio Siragusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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16
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Alagna G, Di Lisi D, Santoro M, Accurso V, Madaudo C, Calcullo D, Siragusa SM, Galassi AR, Novo G. Usefulness of a new risk score in identifying patients with CML at increased risk of cardiovascular toxicities. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2868] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Anti-BCR-ABL tyrosine kinase inhibitors (TKIs) dramatically improved the prognosis of patients with Chronic Myeloid Leukemia (CML) however they have been associated with cardiovascular (CV) complications.
Purpose
The primary aim of our study was to compare the usefulness of two different tools to stratify the risk of developing cardiovascular adverse events in haematology patients treated with ponatinib or nilotinib.
Methods
A real-life retrospective observational study was carried out on 58 patients (32 M, 26 W; mean age ± SD: 59±15) affected by CML treated with TKIs for a median period of 43±31 months. Patients were divided in groups according to CV risk estimated with SCORE and the 2020 CV risk assessment proposed by the Cardio-Oncology Study Group of the ESC/ICOS. Cardiac evaluation and echocardiogram were performed in all patients. The recorded CV adverse events were: myocardial ischemia, peripheral vascular diseases, new-onset or progression of preexisting carotid atherosclerosis, arterial hypertension, arrhythmias.
Results
According to SCORE, 46% of patients were at high-very high risk (group A1) and 54% at low-moderate risk (group B1). Applying the ESC/ICOS risk stratification tools, 60% were at high-very high risk (group A2) and 40% at low-medium risk (group B2). 21 CV adverse events were observed. CV adverse events were significantly more frequent in group A1 than group B1 (p value = 0,0003) when considered overall, they were significantly more frequent in group A2 than group B2 either overall (p=0,0004) or considered individually (myocardial ischemia: p=0,01; peripheral arterial disease: p=0,03). See Table 1. Moreover, the ESC/ICOS risk stratification tools was significantly more sensitive than SCORE (p=0,0004) in identifying patients at higher risk of cardiovascular toxicity. See Table 2.
No patients treated with Ponatinib showed CV adverse events during follow up. It is worth of notice that all patients before starting treatment underwent cardio-oncological evaluation, risk factors correction and preventive treatment with aspirin. They also were treated with the lowest dose of TKI. None of the patients treated with nilotinib over 4 years and with multiple lines of therapy, experiencing adverse events, received aspirin in primary prevention.
Conclusions
Our study shows that the ESC/ICOS risk stratification tools is very sensitive and more performing than SCORE for risk stratification of cardiotoxicity in haematology patients treated with TKIs. It also suggests that baseline CV risk assessment, CV risk factors correction and preventive treatment with aspirin aid in reducing CV adverse events in patients treated with ponatinib.
Funding Acknowledgement
Type of funding sources: None. Table 1Table 2
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Affiliation(s)
- G Alagna
- University of Palermo, Palermo, Italy
| | - D Di Lisi
- University of Palermo, Palermo, Italy
| | - M Santoro
- University of Palermo, Palermo, Italy
| | - V Accurso
- University of Palermo, Palermo, Italy
| | - C Madaudo
- University of Palermo, Palermo, Italy
| | | | | | | | - G Novo
- University of Palermo, Palermo, Italy
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17
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Guglielmelli P, Palandri F, Selleri C, Cilloni D, Mendicino F, Mazza P, Pastore D, Palumbo GA, Santoro M, Pavone V, Impera S, Morelli M, Coco P, Valsecchi D, Passamonti F, Breccia M. Adherence to ruxolitinib, an oral JAK1/2 inhibitor, in patients with myelofibrosis: interim analysis from an Italian, prospective cohort study (ROMEI). Leuk Lymphoma 2021; 63:189-198. [PMID: 34521299 DOI: 10.1080/10428194.2021.1969388] [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] [Indexed: 10/20/2022]
Abstract
ROMEI, a prospective, observational study in patients with myelofibrosis receiving the oral JAK1/2 inhibitor ruxolitinib in real-world practice, assesses treatment adherence based on the 8-item Morisky Medication Adherence Scale (MMAS-8). Here, we present MMAS-8 results at week 24. Overall, 101 of 188 evaluable patients completed the questionnaire at every visit (full completers). Mean (±standard deviation) total MMAS-8 scores remained stable from week 4 to week 24 in the overall population (7.54 ± 0.77 and 7.67 ± 0.70, respectively) and full completers (7.53 ± 0.79 and 7.67 ± 0.73, respectively). Rates of low (MMAS-8 ˂6) or medium (MMAS-8 ≥ 6 to ˂8) adherence were 25-40% and 26-36%, respectively. Fifty-five full completers (54%) reported ≥1 change in adherence category (improvement and/or worsening), most of which were associated with unintentional behavior. The data suggest that one-third of patients receiving ruxolitinib may be undertreated due to non-adherence, potentially undermining disease control, and indicate a need for better interventions addressing noncompliance to oral therapies.
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Affiliation(s)
- Paola Guglielmelli
- CRIMM, Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Palandri
- Policlinico S.Orsola-Malpighi, Dipartimento di Oncologia e di Ematologia, Azienda Ospedaliero-Universitaria di Bologna, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico, Bologna, Italy
| | - Carmine Selleri
- UOC di Ematologia e Trapianti di Cellule Staminali Emopoietiche, Dipartimento di Medicina, Università di Salerno, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Patrizio Mazza
- C/O Ospedale Moscati, Department of Hematology-Oncology, Taranto, Italy
| | | | - Giuseppe A Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Unità Operativa di Ematologia con TMO AOU "Policlinico - San Marco", Università degli Studi di Catania, Catania, Italy
| | - Marco Santoro
- Dipartimento di Chirurgia, Stomatologia e Oncologia Sperimentale (DiChirOnS), Università degli Studi di Palermo, Palermo, Italy
| | | | | | - Mara Morelli
- Novartis Oncology, Novartis Farma SpA, Varese, Italy
| | - Paola Coco
- Novartis Oncology, Novartis Farma SpA, Varese, Italy
| | | | - Francesco Passamonti
- Università degli Studi dell'Insubria, Ospedale di Circolo - ASST Sette Laghi, Varese, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
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Loane M, Given JE, Tan J, Reid A, Akhmedzhanova D, Astolfi G, Barišić I, Bertille N, Bonet LB, Carbonell CC, Carollo OM, Coi A, Densem J, Draper E, Garne E, Gatt M, Glinianaia SV, Heino A, Hond ED, Jordan S, Khoshnood B, Kiuru-Kuhlefelt S, Klungsøyr K, Lelong N, Lutke LR, Neville AJ, Ostapchuk L, Puccini A, Rissmann A, Santoro M, Scanlon I, Thys G, Tucker D, Urhoj SK, de Walle HEK, Wellesley D, Zurriaga O, Morris JK. Linking a European cohort of children born with congenital anomalies to vital statistics and mortality records: A EUROlinkCAT study. PLoS One 2021; 16:e0256535. [PMID: 34449798 PMCID: PMC8396745 DOI: 10.1371/journal.pone.0256535] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
EUROCAT is a European network of population-based congenital anomaly (CA) registries. Twenty-one registries agreed to participate in the EUROlinkCAT study to determine if reliable information on the survival of children born with a major CA between 1995 and 2014 can be obtained through linkage to national vital statistics or mortality records. Live birth children with a CA could be linked using personal identifiers to either their national vital statistics (including birth records, death records, hospital records) or to mortality records only, depending on the data available within each region. In total, 18 of 21 registries with data on 192,862 children born with congenital anomalies participated in the study. One registry was unable to get ethical approval to participate and linkage was not possible for two registries due to local reasons. Eleven registries linked to vital statistics and seven registries linked to mortality records only; one of the latter only had identification numbers for 78% of cases, hence it was excluded from further analysis. For registries linking to vital statistics: six linked over 95% of their cases for all years and five were unable to link at least 85% of all live born CA children in the earlier years of the study. No estimate of linkage success could be calculated for registries linking to mortality records. Irrespective of linkage method, deaths that occurred during the first week of life were over three times less likely to be linked compared to deaths occurring after the first week of life. Linkage to vital statistics can provide accurate estimates of survival of children with CAs in some European countries. Bias arises when linkage is not successful, as early neonatal deaths were less likely to be linked. Linkage to mortality records only cannot be recommended, as linkage quality, and hence bias, cannot be assessed.
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Affiliation(s)
- M. Loane
- Faculty of Life and Health Sciences, Ulster University, Northern Ireland, United Kingdom
| | - J. E. Given
- Faculty of Life and Health Sciences, Ulster University, Northern Ireland, United Kingdom
| | - J. Tan
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - A. Reid
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - D. Akhmedzhanova
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - G. Astolfi
- Emilia Romagna Registry of Birth Defects, University Hospital of Ferrara, Ferrara, Italy
| | - I. Barišić
- Klinika za dječje bolesti, Zagreb, Croatia
| | - N. Bertille
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - L. B. Bonet
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - C. C. Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | | | - A. Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - J. Densem
- Biomedical Computing Limited, Battle, United Kingdom
| | - E. Draper
- East Midlands & South Yorkshire Congenital Anomaly Registry, University of Leicester, Leicester, United Kingdom
| | - E. Garne
- Hospital Lillebaelt, Region Syddanmark, Denmark
| | - M. Gatt
- Directorate for Health Information and Research, G’Mangia, Malta
| | - S. V. Glinianaia
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - A. Heino
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - E. Den Hond
- Provinciaal Instituut voor Hygiëne (PIH), Antwerpen, Belgium
| | - S. Jordan
- Swansea University, Wales, United Kingdom
| | - B. Khoshnood
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | | | - K. Klungsøyr
- Division of Mental and Physical Health, Department of Global Public Health and Primary Care, Norwegian Institute of Public Health, University of Bergen, Bergen, Norway
| | - N. Lelong
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - L. R. Lutke
- Department of Genetics, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - A. J. Neville
- Emilia Romagna Registry of Birth Defects, University Hospital of Ferrara, Ferrara, Italy
| | - L. Ostapchuk
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - A. Puccini
- Territorial Care Service, Emilia Romagna Health Authority, Bologna, Italy
| | - A. Rissmann
- Medical Faculty Otto-von-Guericke, Malformation Monitoring Centre Saxony-Anhalt, University Magdeburg, Magdeburg, Germany
| | - M. Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - I. Scanlon
- Swansea University, Wales, United Kingdom
| | - G. Thys
- Provinciaal Instituut voor Hygiëne (PIH), Antwerpen, Belgium
| | - D. Tucker
- Public Health Wales, Wales, United Kingdom
| | - S. K. Urhoj
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - H. E. K. de Walle
- Department of Genetics, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - D. Wellesley
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, United Kingdom
| | - O. Zurriaga
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - J. K. Morris
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
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Santoro M, Mancuso S, Accurso V, Di Lisi D, Novo G, Siragusa S. Cardiovascular Issues in Tyrosine Kinase Inhibitors Treatments for Chronic Myeloid Leukemia: A Review. Front Physiol 2021; 12:675811. [PMID: 34290617 PMCID: PMC8287514 DOI: 10.3389/fphys.2021.675811] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/04/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm driven by a fusion gene, encoding for the chimeric protein BCR-ABL, with constitutive tyrosine kinase activity. The use of tyrosine kinase inhibitors (TKIs) has drastically improved survival, but there are significant concerns about cardiovascular toxicity. Cardiovascular risk can be lowered with appropriate baseline evaluation, accurate choice of TKI therapy, improvement of modifiable cardiovascular risk factors through lifestyle modifications, and prescription of drugs for primary or secondary prevention. Which examinations are necessary, and when do they have to be scheduled? How often should a TKI-treated patient undergo which cardiology test or exam? Is there an accurate way to estimate the risk that each TKI may determine a cardiovascular adverse event in a CML patient? In a few words, how can we optimize the cardiovascular risk management in CML patients before and during TKI treatment? The aim of this review is to describe cardiac and vascular toxicity of TKIs used for CML treatment according to the most recent literature and to identify unmet clinical needs in cardiovascular risk management and complications in these patients. Regarding the TKI-induced cardiovascular toxicity, the full mechanism is still unclear, but it is accepted that different factors may play different roles: endothelial damage and atherosclerosis, metabolic impairment, hypertensive effect, glomerular impairment, and mast-cell disruption. Preventive strategies are aimed at minimizing cardiovascular risk when CML is diagnosed. Cardio-oncology units in specialized hematology centers may afford a personalized and multidisciplinary approach to the patient, optimizing the balance between treatment of the neoplasm and management of cardiovascular risk.
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Affiliation(s)
- Marco Santoro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Salvatrice Mancuso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy.,Hematology Unit, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Vincenzo Accurso
- Hematology Unit, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Daniela Di Lisi
- Department of Cardiology, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy.,Department of Cardiology, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | - Sergio Siragusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
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20
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Santoro M, Rotolo C, Accurso V, Morreale I, Mancuso S, Siragusa S. Isolated Nodal TBC Reactivation in a Patient with Post-Thrombocythemia Myelofibrosis Treated with Ruxolitinib: Case Report and Review of the Literature. Chemotherapy 2021; 66:87-91. [PMID: 33784668 DOI: 10.1159/000515430] [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: 11/25/2020] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Abstract
Ruxolitinib side effects include the most frequent hematological toxicity along with a more recently evidenced immunosuppressive activity, interfering both with the innate and adaptive immunity, and several cases of reactivation of latent infections by opportunistic agents in patients in treatment with ruxolitinib have been published in the last years. Several pathophysiological mechanisms may explain an association between ruxolitinib and opportunistic infections. From what we know, the only case of an isolated lymph node TBC reactivation in a ruxolitinib-treated myelofibrosis (MF) patient was reported by Patil et al. in 2016 [Int J Med Sci Public Health. 2017;6(3):1]. Other 10 cases describing TBC reactivations in MF patients assuming ruxolitinib and successfully treated with 4-drug anti-TBC therapy are available in the literature to date. The case we reported describes an isolated lymph nodal TBC reactivation in a patient with the diagnosis of post-essential thrombocythemia-MF during ruxolitinib treatment after a long course of interferon-a (IFN-α2b) assumed for the previous diagnosis of ET. The case we report teaches that lymphadenopathy with or without constitutional symptoms developing during ruxolitinib therapy should be considered as a possible manifestation of a TBC reactivation in patients with a previous positive TBC-exposure test. In these cases, Ziel-Nielsen testing on urine and sputum has to be performed to rule out infectiousness and eventually isolate the patient. Moreover, previous long-time exposition to IFN-α2b may be related with a higher risk for TBC reactivation in these subset of patients. We encourage reevaluation of the cohorts of patients treated with ruxolitinib in previous and current large prospective studies to study the possible correlation between previous exposition to IFN-α2b and TBC reactivation.
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Affiliation(s)
- Marco Santoro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Cristina Rotolo
- Hematology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vincenzo Accurso
- Hematology Unit, University Hospital "Paolo Giaccone,", Palermo, Italy
| | - Ilaria Morreale
- Clinical Pharmacology Unit, Department of Hospital General Services, University Hospital "Paolo Giaccone,", Palermo, Italy
| | - Salvatrice Mancuso
- Hematology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Sergio Siragusa
- Hematology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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21
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Santoro M, Nociti V, Lucchini M, Loiodice M, Centofanti F, Botta A, Losavio FA, De Fino C, Mirabella M. A pilot study of lncRNAs expression profile in serum of progressive multiple sclerosis patients. Eur Rev Med Pharmacol Sci 2021; 24:3267-3273. [PMID: 32271444 DOI: 10.26355/eurrev_202003_20694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Multiple Sclerosis (MS) is an inflammatory and neurodegenerative disease that affect both white and gray matter. The relapsing and the eventually progressive course of MS is heterogeneous; thus, a confident long-term prediction of individual prognosis is not possible yet. Recent studies have demonstrated the role of long non-coding RNA (lncRNAs) as potential biomarkers that could provide information to predict disease activity and progression. PATIENTS AND METHODS By qRT-PCR, we analysed the lncRNAs expression in the serum of 16 secondary progressive MS (SP-MS), 12 primary progressive (PP-MS) patients and 8 healthy controls. RESULTS We found that TUG1 was upregulated in SP-MS, while the comparison of PP-MS vs. controls showed a downregulation of non-protein coding RNA 188 (LRRC75A-AS1) and a significant upregulation of two lncRNAs: long intergenic non-protein coding RNA 293 (LINC00293) and RP11-29G8.3. Moreover, we performed an in-silico analysis using DIANA-LncBase v2 and HMDD v3.0 software, in order to predict the possible interaction of these four lncRNAs with miRNAs. We identified 21 miRNAs prediction targets possibly involved in MS. CONCLUSIONS Our data indicate a regulatory function of these lncRNAs in autoimmune and inflammatory processes related to MS suggesting their potential role in progressive MS pathogenesis.
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Affiliation(s)
- M Santoro
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
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22
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Raso S, Napolitano M, Arrigo G, Reale F, Lucchesi A, Silimbani P, Maggio A, Calvaruso G, Consoli U, Mannina D, Giordano G, Santoro M, Accurso V, Siragusa S. Antimicrobial prophylaxis in patients with immune thrombocytopenia treated with rituximab: a retrospective multicenter analysis. Ann Hematol 2021; 100:653-659. [PMID: 33495923 DOI: 10.1007/s00277-021-04438-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/19/2021] [Indexed: 11/28/2022]
Abstract
The primary aim of this study was to describe the use of primary anti-infective prophylaxis (AP) in common clinical practice in patients affected by immune thrombocytopenia (ITP) and treated with RTX. Population studied consisted of patients affected by ITP (age ≥ 18 years) who had received at least one dose of RTX from January 2008 to June 2018. Five Italian haematology centres participated in the current study. Data were retrospectively collected: demographic data (age, gender), concomitant comorbidities and previous therapies for ITP, characteristics of AP, the occurrence of infections and their management. The ITP cohort consisted of 67 patients sub-grouped into two categories according to the administration of AP: (1) treated with AP (N= 34; 51%) and (2) not treated with AP (N=33, 49%). AP consisted of combined trimethoprim/sulfamethoxazole (TMP/SMX) and acyclovir (AC) in half of patients. TPM/SMX as a single agent was adopted in 32% patients and one patient received only AC. Overall, infections were experienced in 15% of patients during follow-up with a similar proportion in the 2 groups (treated and not treated) of patients (14.7% vs 15%). Clinical course of infections was however, less severe in patients treated with AP, where all infections were grade 2 and did not require hospitalization. In neither group of patients was reported Pneumocystis pneumonia. In conclusion, despite the absence of clear evidence, our analysis shows that AP in patients with ITP receiving RTX is frequently adopted, even if in the absence of well-defined criteria. Prophylaxis administration is quite consistent within the same haematological Center; thus, it seems related to clinicians' experience.
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Affiliation(s)
- Simona Raso
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Mariasanta Napolitano
- Policlinico Paolo Giaccone, Unit of Haematology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Giulia Arrigo
- Policlinico Paolo Giaccone, Unit of Haematology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Francesco Reale
- Institute for Educational Technology, National Research Council of Italy, Palermo, Italy
| | - Alessandro Lucchesi
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Paolo Silimbani
- Oncology Pharmacy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Giuseppina Calvaruso
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Ugo Consoli
- Unit of Haematology, G.Garibaldi Hospital, Catania, Italy
| | - Donato Mannina
- Unit of Haematology, Azienda Ospedaliera Papardo, Messina, Italy
| | - Giulio Giordano
- Division of Internal Medicine, Hematology Service, Regional Hospital "A. Cardarelli", Campobasso, Italy
| | - Marco Santoro
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.,Policlinico Paolo Giaccone, Unit of Haematology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Vincenzo Accurso
- Policlinico Paolo Giaccone, Unit of Haematology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Sergio Siragusa
- Policlinico Paolo Giaccone, Unit of Haematology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
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23
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Morello F, Bima P, Pivetta E, Santoro M, Catini E, Casanova B, Leidel BA, de Matos Soeiro A, Nestelberger T, Mueller C, Grifoni S, Lupia E, Nazerian P. Development and Validation of a Simplified Probability Assessment Score Integrated With Age-Adjusted d-Dimer for Diagnosis of Acute Aortic Syndromes. J Am Heart Assoc 2021; 10:e018425. [PMID: 33474974 PMCID: PMC7955418 DOI: 10.1161/jaha.120.018425] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background When acute aortic syndromes (AASs) are suspected, pretest clinical probability assessment and d‐dimer (DD) testing are diagnostic options allowing standardized care. Guidelines suggest use of a 12‐item/3‐category score (aortic dissection detection) and a DD cutoff of 500 ng/mL. However, a simplified assessment tool and a more specific DD cutoff could be advantageous. Methods and Results In a prospective derivation cohort (n=1848), 6 items identified by logistic regression (thoracic aortic aneurysm, severe pain, sudden pain, pulse deficit, neurologic deficit, hypotension), composed a simplified score (AORTAs) assigning 2 points to hypotension and 1 to the other items. AORTAs≤1 and ≥2 defined low and high clinical probability, respectively. Age‐adjusted DD was calculated as years/age × 10 ng/mL (minimum 500). The AORTAs score and AORTAs≤1/age‐adjusted DD rule were validated in 2 patient cohorts: a high‐prevalence retrospective cohort (n=1035; 22% AASs) and a low‐prevalence prospective cohort (n=447; 11% AASs) subjected to 30‐day follow‐up. The AUC of the AORTAs score was 0.729 versus 0.697 of the aortic dissection detection score (P=0.005). AORTAs score assessment reclassified 16.6% to 25.1% of patients, with significant net reclassification improvement of 10.3% to 32.7% for AASs and −8.6 to −17% for alternative diagnoses. In both cohorts, AORTAs≥2 had superior sensitivity and slightly lower specificity than aortic dissection detection ≥2. In the prospective validation cohort, AORTAs≤1/age‐adjusted DD had a sensitivity of 100%, a specificity of 48.6%, and an efficiency of 43.3%. Conclusions AORTAs is a simplified score with increased sensitivity, improved AAS classification, and minor trade‐off in specificity, amenable to integration with age‐adjusted DD for diagnostic rule‐out.
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Affiliation(s)
- Fulvio Morello
- S.C.U. Medicina d'UrgenzaOspedale Molinette, A.O.U. Città della Salute e della Scienza Torino Italy.,Dipartimento di Scienze Mediche Università degli Studi di Torino Torino Italy
| | - Paolo Bima
- S.C.U. Medicina d'UrgenzaOspedale Molinette, A.O.U. Città della Salute e della Scienza Torino Italy
| | - Emanuele Pivetta
- S.C.U. Medicina d'UrgenzaOspedale Molinette, A.O.U. Città della Salute e della Scienza Torino Italy
| | - Marco Santoro
- S.C.U. Medicina d'UrgenzaOspedale Molinette, A.O.U. Città della Salute e della Scienza Torino Italy
| | - Elisabetta Catini
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Barbara Casanova
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Bernd A Leidel
- Department of Emergency Medicine Charité-Universitätsmedizin Berlin Berlin Germany
| | | | - Thomas Nestelberger
- Cardiovascular Research Institute University Hospital Basel Basel Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute University Hospital Basel Basel Switzerland
| | - Stefano Grifoni
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Enrico Lupia
- S.C.U. Medicina d'UrgenzaOspedale Molinette, A.O.U. Città della Salute e della Scienza Torino Italy.,Dipartimento di Scienze Mediche Università degli Studi di Torino Torino Italy
| | - Peiman Nazerian
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
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24
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Morello F, Santoro M, Fargion AT, Grifoni S, Nazerian P. Diagnosis and management of acute aortic syndromes in the emergency department. Intern Emerg Med 2021; 16:171-181. [PMID: 32358680 DOI: 10.1007/s11739-020-02354-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/25/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
Acute aortic syndromes (AASs) are deadly cardiovascular emergencies involving the thoracic aorta. AASs are relatively rare conditions, have unspecific signs and symptoms (including truncal pain, syncope, neurologic deficit and limb ischemia) and require contrast-enhanced tomography angiography (CTA) of the chest and abdomen for conclusive diagnosis and subsequent therapeutic planning. In the Emergency Department (ED), most patients with potential signs/symptoms of AASs are finally found affected by other alternative diagnoses. Hence, misdiagnosis and delayed diagnosis of AASs are major concerns. In critically ill patients, decision to perform CTA is usually straightforward, as exam benefits largely outweigh risks. In patients with ST-tract elevation on ECG, suspected primary ischemic stroke and in stable patients (representing the most prevalent ED scenarios), proper selection of patients necessitating CTA is cumbersome, due to concurrent risks of misdiagnosis and over-testing. Available studies support an algorithm integrating clinical probability assessment, bedside echocardiography and D-dimer (if the clinical probability is not high). Therapeutic management includes medical therapy for all patients including an opioid and anti-impulse drugs (a beta-blocker and a vasodilator), targeting a heart rate of 60 bpm and systolic blood pressure of 100-120 mmHg. Patients with AASs involving the ascending aorta are likely candidate for urgent surgery, and complicated type B AASs (severe aortic dilatation, impending or frank rupture, organ malperfusion, refractory pain, severe hypertension) necessitate evaluation for urgent endovascular treatment. For uncomplicated type B AASs, optimal medical therapy is the current standard of care.
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Affiliation(s)
- Fulvio Morello
- S.C.U. Medicina d'Urgenza, Ospedale Molinette, A.O.U. Città della Salute e della Scienza, Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy
| | - Marco Santoro
- S.C.U. Medicina d'Urgenza, Ospedale Molinette, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | | | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla, 3, 50134, Firenze, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla, 3, 50134, Firenze, Italy.
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25
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Accurso V, Santoro M, Mancuso S, Napolitano M, Carlisi M, Mattana M, Russo C, Di Stefano A, Sirocchi D, Siragusa S. The Essential Thrombocythemia in 2020: What We Know and Where We Still Have to Dig Deep. Clin Med Insights Blood Disord 2020; 13:2634853520978210. [PMID: 33447121 PMCID: PMC7780200 DOI: 10.1177/2634853520978210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023]
Abstract
The Essential Thrombocythemia is a Chronic Philadelphia-negative Myeloproliferative Neoplasm characterized by a survival curve that is only slightly worse than that of age- and sex-adjusted healthy population. The criteria for diagnosis were reviewed in 2016 by WHO. The incidence varies from 0.2 to 2.5:100 000 people per year, with a prevalence of 38 to 57 cases per 100 000 people. The main characteristics of ET are the marked thrombocytosis and the high frequency of thrombosis. The spectrum of symptoms is quite wide, but fatigue results to be the most frequent. Thrombosis is frequently observed, often occurring before or at the time of diagnosis. The classification of thrombotic risk has undergone several revisions. Recently, the revised-IPSET-t has distinguished 4 risk classes, from very low risk to high risk. Driver mutations seem to influence thrombotic risk and prognosis, while the role of sub-driver mutations still remains uncertain. Antiplatelet therapy is recommended in all patients aged ⩾ 60 years and in those with a positive history of thrombosis or with cardiovascular risk factors, while cytoreductive therapy with hydroxyurea or interferon is reserved for high-risk patients.
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Affiliation(s)
- Vincenzo Accurso
- Hematology Division University Hospital Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Marco Santoro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Salvatrice Mancuso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Hematology Unit, University of Palermo, Palermo, Italy
| | - Mariasanta Napolitano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Hematology Unit, University of Palermo, Palermo, Italy
| | - Melania Carlisi
- Hematology Division University Hospital Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Marta Mattana
- Hematology Division University Hospital Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Chiara Russo
- Hematology Division University Hospital Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Alessandro Di Stefano
- Hematology Division University Hospital Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Davide Sirocchi
- Hematology Division University Hospital Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Sergio Siragusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Hematology Unit, University of Palermo, Palermo, Italy
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Serrao A, Breccia M, Napolitano M, Fiori L, Santoro M, Scalzulli E, Santopietro M, Santoro C, Raso S, Chistolini A. A multicenter real-life study on anticoagulant treatment with direct oral anticoagulants in patients with Ph-negative myeloproliferative neoplasms. Am J Hematol 2020; 95:E329-E332. [PMID: 32886820 DOI: 10.1002/ajh.25990] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Alessandra Serrao
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
| | - Mariasanta Napolitano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Haematology Unit, Reference Regional Centre for Thrombosis and Haemostasis University of Palermo Palermo Italy
| | - Luciano Fiori
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
| | - Marco Santoro
- Department of Surgical, Oncological and Oral Sciences (DICHIRONS) University of Palermo Palermo Italy
| | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
| | - Michelina Santopietro
- Hematology and Transplant Unit “Santa Maria Goretti” Hospital of Latina Latina Italy
| | - Cristina Santoro
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
| | - Simona Raso
- Department of Surgical, Oncological and Oral Sciences (DICHIRONS) University of Palermo Palermo Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
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Fazio E, Gökce B, De Giacomo A, Meneghetti M, Compagnini G, Tommasini M, Waag F, Lucotti A, Zanchi CG, Ossi PM, Dell’Aglio M, D’Urso L, Condorelli M, Scardaci V, Biscaglia F, Litti L, Gobbo M, Gallo G, Santoro M, Trusso S, Neri F. Nanoparticles Engineering by Pulsed Laser Ablation in Liquids: Concepts and Applications. Nanomaterials (Basel) 2020; 10:E2317. [PMID: 33238455 PMCID: PMC7700616 DOI: 10.3390/nano10112317] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
Laser synthesis emerges as a suitable technique to produce ligand-free nanoparticles, alloys and functionalized nanomaterials for catalysis, imaging, biomedicine, energy and environmental applications. In the last decade, laser ablation and nanoparticle generation in liquids has proven to be a unique and efficient technique to generate, excite, fragment and conjugate a large variety of nanostructures in a scalable and clean way. In this work, we give an overview on the fundamentals of pulsed laser synthesis of nanocolloids and new information about its scalability towards selected applications. Biomedicine, catalysis and sensing are the application areas mainly discussed in this review, highlighting advantages of laser-synthesized nanoparticles for these types of applications and, once partially resolved, the limitations to the technique for large-scale applications.
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Affiliation(s)
- Enza Fazio
- Department of Mathematical and Computational Sciences, Physics and Earth Physics, University of Messina, Viale F. Stagno D’Alcontres 31, I-98166 Messina, Italy; (G.G.); (F.N.)
| | - Bilal Gökce
- Department of Technical Chemistry I and Center for Nanointegration Duisburg-Essen, University of Duisburg-Essen, Universitätsstrasse 7, 45141 Essen, Germany; (B.G.); (F.W.)
| | - Alessandro De Giacomo
- Department of Chemistry, University of Bari, Via Orabona 4, 70126 Bari, Italy;
- CNR-NANOTEC, c/o Department of Chemistry, University of Bari, Via Orabona 4, 70126 Bari, Italy;
| | - Moreno Meneghetti
- Department of Chemical Sciences, University of Padova, Via Marzolo 1, 35131 Padova, Italy; (M.M.); (F.B.); (L.L.); (M.G.)
| | - Giuseppe Compagnini
- Department of Chemical Sciences, University of Catania, V.le A. Doria 6, 95125 Catania, Italy; (G.C.); (L.D.); (M.C.); (V.S.)
| | - Matteo Tommasini
- Department of Chemistry, Materials, Chemical Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, I-20133 Milano, Italy; (M.T.); (A.L.); (C.G.Z.)
| | - Friedrich Waag
- Department of Technical Chemistry I and Center for Nanointegration Duisburg-Essen, University of Duisburg-Essen, Universitätsstrasse 7, 45141 Essen, Germany; (B.G.); (F.W.)
| | - Andrea Lucotti
- Department of Chemistry, Materials, Chemical Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, I-20133 Milano, Italy; (M.T.); (A.L.); (C.G.Z.)
| | - Chiara Giuseppina Zanchi
- Department of Chemistry, Materials, Chemical Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, I-20133 Milano, Italy; (M.T.); (A.L.); (C.G.Z.)
| | - Paolo Maria Ossi
- Department of Energy & Center for NanoEngineered Materials and Surfaces—NEMAS, Politecnico di Milano, Piazza Leonardo da Vinci 32, I-20133 Milano, Italy;
| | - Marcella Dell’Aglio
- CNR-NANOTEC, c/o Department of Chemistry, University of Bari, Via Orabona 4, 70126 Bari, Italy;
| | - Luisa D’Urso
- Department of Chemical Sciences, University of Catania, V.le A. Doria 6, 95125 Catania, Italy; (G.C.); (L.D.); (M.C.); (V.S.)
| | - Marcello Condorelli
- Department of Chemical Sciences, University of Catania, V.le A. Doria 6, 95125 Catania, Italy; (G.C.); (L.D.); (M.C.); (V.S.)
| | - Vittorio Scardaci
- Department of Chemical Sciences, University of Catania, V.le A. Doria 6, 95125 Catania, Italy; (G.C.); (L.D.); (M.C.); (V.S.)
| | - Francesca Biscaglia
- Department of Chemical Sciences, University of Padova, Via Marzolo 1, 35131 Padova, Italy; (M.M.); (F.B.); (L.L.); (M.G.)
| | - Lucio Litti
- Department of Chemical Sciences, University of Padova, Via Marzolo 1, 35131 Padova, Italy; (M.M.); (F.B.); (L.L.); (M.G.)
| | - Marina Gobbo
- Department of Chemical Sciences, University of Padova, Via Marzolo 1, 35131 Padova, Italy; (M.M.); (F.B.); (L.L.); (M.G.)
| | - Giovanni Gallo
- Department of Mathematical and Computational Sciences, Physics and Earth Physics, University of Messina, Viale F. Stagno D’Alcontres 31, I-98166 Messina, Italy; (G.G.); (F.N.)
| | - Marco Santoro
- STMicroelectronics S.R.L., Stradale Primosole 37, 95121 Catania, Italy;
| | - Sebastiano Trusso
- CNR-IPCF Istituto per i Processi Chimico-Fisici, 98053 Messina, Italy;
| | - Fortunato Neri
- Department of Mathematical and Computational Sciences, Physics and Earth Physics, University of Messina, Viale F. Stagno D’Alcontres 31, I-98166 Messina, Italy; (G.G.); (F.N.)
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Dragani M, Rege Cambrin G, Berchialla P, Dogliotti I, Rosti G, Castagnetti F, Capodanno I, Martino B, Cerrano M, Ferrero D, Gambacorti-Passerini C, Crugnola M, Elena C, Breccia M, Iurlo A, Cattaneo D, Galimberti S, Gozzini A, Bocchia M, Lunghi F, Cedrone M, Sgherza N, Luciano L, Russo S, Santoro M, Giai V, Caocci G, Levato L, Abruzzese E, Sora F, Saglio G, Fava C. A Retrospective Analysis about Frequency of Monitoring in Italian Chronic Myeloid Leukemia Patients after Discontinuation. J Clin Med 2020; 9:jcm9113692. [PMID: 33213044 PMCID: PMC7698481 DOI: 10.3390/jcm9113692] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/26/2023] Open
Abstract
Successful discontinuation of tyrosine kinase inhibitors has been achieved in patients with chronic-phase chronic myeloid leukemia (CML). Careful molecular monitoring after discontinuation warrants safe and prompt resumption of therapy. We retrospectively evaluated how molecular monitoring has been conducted in Italy in a cohort of patients who discontinued tyrosine kinase inhibitor (TKI) treatment per clinical practice. The outcome of these patients has recently been reported-281 chronic-phase CML patients were included in this subanalysis. Median follow-up since discontinuation was 2 years. Overall, 2203 analyses were performed, 17.9% in the first three months and 38.4% in the first six months. Eighty-six patients lost major molecular response (MMR) in a mean time of 5.7 months-65 pts (75.6%) during the first six months. We evaluated the number of patients who would experience a delay in diagnosis of MMR loss if a three-month monitoring schedule was adopted. In the first 6 months, 19 pts (29.2%) would have a one-month delay, 26 (40%) a 2-month delay. Very few patients would experience a delay in the following months. A less intense frequency of monitoring, particularly after the first 6 months off treatment, would not have affected the success of treatment-free remission (TFR) nor put patients at risk of progression.
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Affiliation(s)
- Matteo Dragani
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
- Correspondence: ; Tel.: +39-011-902-6709
| | - Giovanna Rege Cambrin
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
| | - Irene Dogliotti
- Hematology Unit, Department of Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (I.D.); (M.C.); (D.F.)
| | - Gianantonio Rosti
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, 40138 Bologna, Italy; (G.R.); (F.C.)
| | - Fausto Castagnetti
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, 40138 Bologna, Italy; (G.R.); (F.C.)
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, 42123 Reggio Emilia, Italy;
| | - Bruno Martino
- Hematology Unit, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, 89124 Reggio Calabria, Italy;
| | - Marco Cerrano
- Hematology Unit, Department of Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (I.D.); (M.C.); (D.F.)
| | - Dario Ferrero
- Hematology Unit, Department of Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (I.D.); (M.C.); (D.F.)
| | | | - Monica Crugnola
- Division of Hematology, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy;
| | - Chiara Elena
- Department of Hematology Oncology, Foundation IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy;
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.I.); (D.C.)
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.I.); (D.C.)
| | - Sara Galimberti
- Hematology Department, University of Pisa, 56126 Pisa, Italy;
| | - Antonella Gozzini
- Hematology Division, Policlinico Careggi di Firenze, 50139 Firenze, Italy;
| | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute IRCCS, 20132 Milano, Italy;
| | - Michele Cedrone
- Hematology Division, Az. Ospedaliera San Giovanni Addolorata, 00184 Rome, Italy;
| | - Nicola Sgherza
- Division of Hematology, IRCCS Ospedale Casa Sollievo Sofferenza, 71043 San Giovanni Rotondo, Italy;
| | - Luigia Luciano
- Hematology Unit, “Federico II” Hospital, University of Naples, 80131 Napoli, Italy;
| | - Sabina Russo
- Department of Internal Medicine, AOU Policlinico di Messina, 98124 Messina, Italy;
| | - Marco Santoro
- Hematology Unit, University of Palermo, 90127 Palermo, Italy;
| | - Valentina Giai
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy;
| | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, 09121 Cagliari, Italy;
| | - Luciano Levato
- Department Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, 88100 Catanzaro, Italy;
| | - Elisabetta Abruzzese
- Hematology Unit, S. Eugenio Hospital, Tor Vergata University, 00144 Rome, Italy;
| | - Federica Sora
- Hematology Unit, Fondazione Policlinico Universitario Gemelli IRCCS, 00168 Rome, Italy;
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; (G.R.C.); (P.B.); (G.S.); (C.F.)
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Accurso V, Santoro M, Mancuso S, Siragusa S. Cardiovascular risk factor in MPN patients. J Thromb Thrombolysis 2020; 50:640-641. [DOI: 10.1007/s11239-020-02049-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Santoro M, Romano A, Mancuso S, Siragusa S, DI Raimondo F, Martinelli G, Cerchione C. Prevention of venous thromboembolic events occurring in myeloma patients treated with second-generation novel agents. Panminerva Med 2020; 63:1-6. [PMID: 32955183 DOI: 10.23736/s0031-0808.20.04133-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Thrombosis and neoplasms are strictly linked, and the diagnosis of a malignancy is a relevant risk factor for venous thromboembolism (VTE). In particular, between gammopathies, the VTE risk is known to be increased in both monoclonal gammopathy of uncertain significance and in multiple myeloma, with a 3- and 9-fold increase respectively, when compared to the general population. The risk appears to be further increased in patients treated with immunomodulating drugs, such as thalidomide, especially when in combination with dexamethasone or conventional cytotoxic chemotherapies, and lenalidomide. In 2008 the International Myeloma Working Group put out thrombosis prophylaxis recommendations for myeloma patients treated with IMiDs. Current recommendations for thromboprophylaxis suggest the use of low-dose acetylsalicylic acid in patients with low risk for thrombosis and therapeutic dose anticoagulation with LMWH or warfarin for high-risk patients. However, these recommendations have been frequently not followed in the clinical practice, due to various reasons that involve the patients' will, the level of evidence of the recommendations and some selection biases in the studies that were taken as basis for writing down the indications. The new direct oral anticoagulants have been preliminarily evaluated for the prophylaxis of thrombotic events in IMiDs-treated myelomas, being promising, even if more expensive. Currently, the most reliable tool for a correct thrombotic risk stratification appears to be the complete clinical and anamnestic evaluation of the myeloma patients added to a strong physician awareness of the evidences that the literature contains until now.
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Affiliation(s)
- Marco Santoro
- Department of Surgery, Stomatology and Experimental Oncology, University of Palermo, Palermo, Italy -
| | - Alessandra Romano
- Department of Surgery and Medical Surgical Specialty, University of Catania, Catania, Italy
| | - Salvatrice Mancuso
- Unit of Hematology, G. D'Alessandro Department of Health Promotion, Maternal-Child, Internal Medicine and Specialist Excellence, University of Palermo, Palermo, Italy
| | - Sergio Siragusa
- Unit of Hematology, G. D'Alessandro Department of Health Promotion, Maternal-Child, Internal Medicine and Specialist Excellence, University of Palermo, Palermo, Italy
| | - Francesco DI Raimondo
- Department of Surgery and Medical Surgical Specialty, University of Catania, Catania, Italy.,Unit of Hematology, A.O.U. Policlinico Rodolico-San Marco, Catania, Italy
| | - Giovanni Martinelli
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Claudio Cerchione
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
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Romano A, Santoro M, Conticello C, Siragusa S, DI Raimondo F, Martinelli G, Cerchione C. Post-transplant consolidation based on combination of lenalidomide and proteasome inhibitors in multiple myeloma. Panminerva Med 2020; 63:13-20. [PMID: 32955184 DOI: 10.23736/s0031-0808.20.04141-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple myeloma (MM) is a hematological malignancy due to uncontrolled proliferation of neoplastic plasma cells in the bone marrow, associated to chromosomal instability and cytogenetic abnormalities, which could have an impact on prognosis. Response to treatment and survival of newly diagnosed myeloma patients is heterogeneous, with median overall survival ranging from two to more than ten years, due to clinical and biological factors. To warrant long-term control of disease, several strategies have been proposed in the last years, including short-term high-dose of treatment, named as consolidation, before maintenance. This review will discuss the role of consolidation in the current myeloma treatment landscape, and further improvements required to optimize tailored front-line therapy.
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Affiliation(s)
- Alessandra Romano
- Department of Surgery and Medical Surgery, University of Catania, Catania, Italy
| | - Marco Santoro
- Department of Surgery, Stomatology and Experimental Oncology, University of Palermo, Palermo, Italy -
| | - Concetta Conticello
- Unit of Hematology, Rodolico San Marco University Polyclinic, Catania, Italy
| | - Sergio Siragusa
- Unit of Hematology, G. D'Alessandro Department of Health Promotion, Mother and Infant Care, Internal and Specialized Medicine, University of Palermo, Palermo, Italy
| | - Francesco DI Raimondo
- Department of Surgery and Medical Surgery, University of Catania, Catania, Italy.,Unit of Hematology, Rodolico San Marco University Polyclinic, Catania, Italy
| | - Giovanni Martinelli
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Claudio Cerchione
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
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Aquila S, De Amicis F, Santoro M, Panza S, De Rose D, Riccelli DA, Iannò B, Galasso O, Gasparini G. Conventional progesterone receptors (PR) B and PRA are expressed by human chondrocytes and can be involved in the pathogenesis of osteoarthritis. J BIOL REG HOMEOS AG 2020; 34:9-15. IORS Special Issue on Orthopedics. [PMID: 33738999] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To evaluate the expression, location and role of progesterone receptors (PRs) A and B in human chondrocytic cell lines, Western blotting, real time PCR analyses, transmission electron microscopy and immunogold assays were performed. By transfection and co-transfection assays, the influence of progesterone (OHPg) on estrogen receptor alpha (ERα) promoter activity was investigated. MTT and pAKT documented OHPg effects on chondrocytes survival. The PR-B and PR-A were both observed in human chondrocytes. The PR-B was evidenced both in the nucleus and in the cytosol of the cells. OHPg, through PR-B, induced ERα expression by acting at the ER promoter level affecting chondrocytes survival. We reported for the first time the expression of PRs in human chondrocytes. Interestingly, we described a novel mechanism via progesterone induction of ERα, which may explain, at least in part, the dramatic rise in OA prevalence among postmenopausal women.
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Affiliation(s)
- S Aquila
- Department of Pharmacy and Sciences of Health and Nutrition, University of Calabria, Rende, Italy
- Centro Sanitario, University of Calabria, Rende, Italy
| | - F De Amicis
- Department of Pharmacy and Sciences of Health and Nutrition, University of Calabria, Rende, Italy
| | - M Santoro
- Department of Pharmacy and Sciences of Health and Nutrition, University of Calabria, Rende, Italy
- Centro Sanitario, University of Calabria, Rende, Italy
| | - S Panza
- Department of Pharmacy and Sciences of Health and Nutrition, University of Calabria, Rende, Italy
| | - D De Rose
- Department of Pharmacy and Sciences of Health and Nutrition, University of Calabria, Rende, Italy
- Centro Sanitario, University of Calabria, Rende, Italy
| | - D A Riccelli
- Department of Orthopaedic Surgery, Magna Graecia University, Catanzaro, Italy
| | - B Iannò
- Department of Orthopaedic Surgery, Magna Graecia University, Catanzaro, Italy
| | - O Galasso
- Department of Orthopaedic Surgery, Magna Graecia University, Catanzaro, Italy
| | - G Gasparini
- Department of Orthopaedic Surgery, Magna Graecia University, Catanzaro, Italy
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Mancuso S, Santoro M, Accurso V, Agliastro G, Raso S, Di Piazza F, Perez A, Bono M, Russo A, Siragusa S. Cardiovascular Risk in Polycythemia Vera: Thrombotic Risk and Survival: Can Cytoreductive Therapy Be Useful in Patients with Low-Risk Polycythemia Vera with Cardiovascular Risk Factors? Oncol Res Treat 2020; 43:526-530. [PMID: 32772025 DOI: 10.1159/000509376] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 10/24/2019] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS Cardiovascular risk factors are not considered in the current scores for evaluation of the thrombotic risk in myeloproliferative neoplasms, and in polycythemia vera (PV) in particular. Cytoreduction is currently not indicated in low-risk patients with PV, despite the absence or presence of cardiovascular risk factors. Our purpose is to highlight how cardiovascular risk factors in patients with PV increase the thrombotic risk both in low- and high-risk patients. METHODS We collected and analyzed data from 165 consecutive patients with a diagnosis of PV followed at our institution and compared the frequency of thrombosis in subgroups of patients distinguished by the presence or absence of cardiovascular risk factors. The statistic tools used to obtain the results were the χ2 and the Kruskal-Wallis test for frequencies, and the Kaplan-Meyer method as well as the log-rank test for analysis of survival data. RESULTS The major result obtained is that the frequency of thrombotic events in our population is strictly linked with the cardiovascular risk, and it increases with the number of risk factors. Moreover, survival significantly worsens with the number of cardiovascular risk factors, despite the classical PV risk stratification. CONCLUSION It should be useful to design perspective studies to determine the real influence of cardiovascular risk factors on the thrombotic risk for patients with PV and on survival in order to evaluate the opportunity to develop new specific therapeutic recommendations.
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Affiliation(s)
- Salvatrice Mancuso
- Hematology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Marco Santoro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Vincenzo Accurso
- Division of Hematology, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy,
| | - Giuseppe Agliastro
- Division of Hematology, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | - Simona Raso
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Florinda Di Piazza
- Section of Medical Oncology, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Alessandro Perez
- Section of Medical Oncology, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Marco Bono
- Section of Medical Oncology, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Sergio Siragusa
- Hematology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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Pacifico L, Braff J, Buono F, Beall M, Neola B, Buch J, Sgroi G, Piantedosi D, Santoro M, Tyrrell P, Fioretti A, Breitschwerdt EB, Chandrashekar R, Veneziano V. Hepatozoon canis in hunting dogs from Southern Italy: distribution and risk factors. Parasitol Res 2020; 119:3023-3031. [PMID: 32725320 PMCID: PMC7431440 DOI: 10.1007/s00436-020-06820-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/21/2020] [Accepted: 07/16/2020] [Indexed: 01/25/2023]
Abstract
Hepatozoon canis is a hemoprotozoan organism that infects domestic and wild carnivores throughout much of Europe. The parasite is mainly transmitted through the ingestion of infected ticks containing mature oocysts. The aims of the present survey were to determine the prevalence of H. canis in hunting dogs living in Southern Italy and to assess potential infection risk factors. DNA extracted from whole blood samples, collected from 1433 apparently healthy dogs living in the Napoli, Avellino, and Salerno provinces of Campania region (Southern Italy), was tested by a quantitative real-time polymerase chain reaction (qPCR) assay to amplify H. canis. Furthermore, the investigated dog population was also screened by qPCR for the presence of Ehrlichia canis, a major tick-borne pathogen in Southern Italy, in order to assess possible co-infections. Two hundred dogs were H. canis PCR-positive, resulting in an overall prevalence of 14.0% (CI 12.2–15.9). Breed category (P < 0.0001), hair coat length (P = 0.015), and province of residence (P < 0.0001) represented significant risk factors for H. canis infection. The presence of H. canis DNA was also significantly associated with E. canis PCR positivity (P < 0.0001). Hunting dogs in Campania region (Southern Italy) are frequently exposed to H. canis, and the infection is potentially associated with close contact with wildlife. Further studies are needed to assess the pathogenic potential of H. canis, as well as the epidemiological relationships between hunting dogs and wild animal populations sharing the same habitats in Southern Italy.
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Affiliation(s)
- L Pacifico
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - J Braff
- IDEXX Laboratories, Inc., Westbrook, ME, 04092, USA
| | - F Buono
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - M Beall
- IDEXX Laboratories, Inc., Westbrook, ME, 04092, USA
| | - B Neola
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Italy
| | - J Buch
- IDEXX Laboratories, Inc., Westbrook, ME, 04092, USA
| | - G Sgroi
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli "Federico II", Naples, Italy.,Department of Veterinary Medicine, University of Bari Aldo Moro, Valenzano, Italy
| | - D Piantedosi
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - M Santoro
- Stazione Zoologica Anton Dohrn, Naples, Italy
| | - P Tyrrell
- IDEXX Laboratories, Inc., Westbrook, ME, 04092, USA
| | - A Fioretti
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - E B Breitschwerdt
- Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607, USA
| | | | - V Veneziano
- Department of Veterinary Medicine and Animal Productions, Università degli Studi di Napoli "Federico II", Naples, Italy.,Osservatorio Faunistico Venatorio - Regione Campania, Naples, Italy
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Kimicata M, Allbritton-King JD, Navarro J, Santoro M, Inoue T, Hibino N, Fisher JP. Assessment of decellularized pericardial extracellular matrix and poly(propylene fumarate) biohybrid for small-diameter vascular graft applications. Acta Biomater 2020; 110:68-81. [PMID: 32305447 PMCID: PMC7294167 DOI: 10.1016/j.actbio.2020.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 01/05/2023]
Abstract
Autologous grafts are the current gold standard of care for coronary artery bypass graft surgeries, but are limited by availability and plagued by high failure rates. Similarly, tissue engineering approaches to small diameter vascular grafts using naturally derived and synthetic materials fall short, largely due to inappropriate mechanical properties. Alternatively, decellularized extracellular matrix from tissue is biocompatible and has comparable strength to vessels, while poly(propylene fumarate) (PPF) has shown promising results for vascular grafts. This study investigates the integration of decellularized pericardial extracellular matrix (dECM) and PPF to create a biohybrid scaffold (dECM+PPF) suitable for use as a small diameter vascular graft. Our method to decellularize the ECM was efficient at removing DNA content and donor variability, while preserving protein composition. PPF was characterized and added to dECM, where it acted to preserve dECM against degradative effects of collagenase without disturbing the material's overall mechanics. A transport study showed that diffusion occurs across dECM+PPF without any effect from collagenase. The modulus of dECM+PPF matched that of human coronary arteries and saphenous veins. dECM+PPF demonstrated ample circumferential stress, burst pressure, and suture retention strength to survive in vivo. An in vivo study showed re-endothelialization and tissue growth. Overall, the dECM+PPF biohybrid presents a robust solution to overcome the limitations of the current methods of treatment for small diameter vascular grafts. STATEMENT OF SIGNIFICANCE: In creating a dECM+PPF biohybrid graft, we have observed phenomena that will have a lasting impact within the scientific community. First, we found that we can reduce donor variability through decellularization, a unique use of the decellularization process. Additionally, we coupled a natural material with a synthetic polymer to capitalize on the benefits of each: the cues provided to cells and the ability to easily tune material properties, respectively. This principle can be applied to other materials in a variety of applications. Finally, we created an off-the-shelf alternative to autologous grafts with a newly developed material that has yet to be utilized in any scaffolds. Furthermore, bovine pericardium has not been investigated as a small diameter vascular graft.
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Affiliation(s)
- Megan Kimicata
- Department of Materials Science and Engineering, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States; Center for Engineering Complex Tissues, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States
| | - Jules D Allbritton-King
- Center for Engineering Complex Tissues, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States; Fischell Department of Bioengineering, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States
| | - Javier Navarro
- Center for Engineering Complex Tissues, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States; Fischell Department of Bioengineering, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States
| | - Marco Santoro
- Center for Engineering Complex Tissues, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States; Fischell Department of Bioengineering, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States
| | - Takahiro Inoue
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287; Department of Surgery, Section of Cardiac Surgery, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, United States
| | - Narutoshi Hibino
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287; Department of Surgery, Section of Cardiac Surgery, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, United States
| | - John P Fisher
- Center for Engineering Complex Tissues, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States; Fischell Department of Bioengineering, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States.
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Raso S, Napolitano M, Mansueto F, Mercurio P, Cocorullo G, Santoro M, Accurso V, Mancuso S, Siragusa S. Coexistence of Von Willebrand disease and gastrointestinal stromal tumor (G.I.S.T): Case report of a rare and challenge association. Transfus Apher Sci 2020; 59:102805. [PMID: 32444278 DOI: 10.1016/j.transci.2020.102805] [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: 12/09/2019] [Revised: 04/08/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Abstract
Von Willebrand disease (VWD) is the most common inherited bleeding disorder and is caused by a quantitative (type 1 and 3) or qualitative (type 2) defect of Von Willebrand factor (VWF). Bleeding from the gastrointestinal (GI) tract is not uncommon in VWD and is usually associated with angiodysplasia. We report herein on the management of a patient affected by VWD2B with severe GI bleeding secondary to gastrointestinal stromal tumor (GIST) complicated by deep vein thrombosis (DVT). The current case demonstrated that the hemostatic balance, in RBDs under specific circumstances, can range from a tendency toward a hemorrhagic to normal or prothrombotic state. In these patients, a close collaboration between hematologists and surgeons can guarantee appropriate management in high-risk clinical scenarios.
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Affiliation(s)
- Simona Raso
- University of Palermo, Unit of Haematology, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S), Palermo, Italy.
| | - Mariasanta Napolitano
- University of Palermo, Reference Regional Center for Thrombosis and Hemostasis, Unit of Haematology PROMISE Department, Palermo, Italy
| | - Francesca Mansueto
- University of Palermo, Reference Regional Center for Thrombosis and Hemostasis, Unit of Haematology PROMISE Department, Palermo, Italy
| | - Paola Mercurio
- University of Palermo, Department of General Emergency and Transplant Surgery, Unit of General and Emergency Surgery, Palermo, Italy
| | - Gianfranco Cocorullo
- University of Palermo, Department of General Emergency and Transplant Surgery, Unit of General and Emergency Surgery, Palermo, Italy
| | - Marco Santoro
- University of Palermo, Unit of Haematology, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S), Palermo, Italy
| | - Vincenzo Accurso
- University of Palermo, Reference Regional Center for Thrombosis and Hemostasis, Unit of Haematology PROMISE Department, Palermo, Italy
| | - Salvatrice Mancuso
- University of Palermo, Reference Regional Center for Thrombosis and Hemostasis, Unit of Haematology PROMISE Department, Palermo, Italy
| | - Sergio Siragusa
- University of Palermo, Reference Regional Center for Thrombosis and Hemostasis, Unit of Haematology PROMISE Department, Palermo, Italy
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Soto-Navarro C, Ravilious C, Arnell A, de Lamo X, Harfoot M, Hill SLL, Wearn OR, Santoro M, Bouvet A, Mermoz S, Le Toan T, Xia J, Liu S, Yuan W, Spawn SA, Gibbs HK, Ferrier S, Harwood T, Alkemade R, Schipper AM, Schmidt-Traub G, Strassburg B, Miles L, Burgess ND, Kapos V. Mapping co-benefits for carbon storage and biodiversity to inform conservation policy and action. Philos Trans R Soc Lond B Biol Sci 2020; 375:20190128. [PMID: 31983334 PMCID: PMC7017768 DOI: 10.1098/rstb.2019.0128] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
Integrated high-resolution maps of carbon stocks and biodiversity that identify areas of potential co-benefits for climate change mitigation and biodiversity conservation can help facilitate the implementation of global climate and biodiversity commitments at local levels. However, the multi-dimensional nature of biodiversity presents a major challenge for understanding, mapping and communicating where and how biodiversity benefits coincide with climate benefits. A new integrated approach to biodiversity is therefore needed. Here, we (a) present a new high-resolution map of global above- and below-ground carbon stored in biomass and soil, (b) quantify biodiversity values using two complementary indices (BIp and BIr) representing proactive and reactive approaches to conservation, and (c) examine patterns of carbon-biodiversity overlap by identifying 'hotspots' (20% highest values for both aspects). Our indices integrate local diversity and ecosystem intactness, as well as regional ecosystem intactness across the broader area supporting a similar natural assemblage of species to the location of interest. The western Amazon Basin, Central Africa and Southeast Asia capture the last strongholds of highest local biodiversity and ecosystem intactness worldwide, while the last refuges for unique biological communities whose habitats have been greatly reduced are mostly found in the tropical Andes and central Sundaland. There is 38 and 5% overlap in carbon and biodiversity hotspots, for proactive and reactive conservation, respectively. Alarmingly, only around 12 and 21% of these proactive and reactive hotspot areas, respectively, are formally protected. This highlights that a coupled approach is urgently needed to help achieve both climate and biodiversity global targets. This would involve (1) restoring and conserving unprotected, degraded ecosystems, particularly in the Neotropics and Indomalaya, and (2) retaining the remaining strongholds of intactness. This article is part of the theme issue 'Climate change and ecosystems: threats, opportunities and solutions'.
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Affiliation(s)
- C. Soto-Navarro
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), 219 Huntingdon Road, Cambridge CB3 0DL, UK
- Luc Hoffmann Institute, Rue Mauverney 28, 1196 Gland, Switzerland
| | - C. Ravilious
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), 219 Huntingdon Road, Cambridge CB3 0DL, UK
| | - A. Arnell
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), 219 Huntingdon Road, Cambridge CB3 0DL, UK
| | - X. de Lamo
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), 219 Huntingdon Road, Cambridge CB3 0DL, UK
| | - M. Harfoot
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), 219 Huntingdon Road, Cambridge CB3 0DL, UK
| | - S. L. L. Hill
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), 219 Huntingdon Road, Cambridge CB3 0DL, UK
- Natural History Museum, Cromwell Road, London SW7 5BD, UK
| | - O. R. Wearn
- Institute of Zoology, Zoological Society of London, Regent's Park, London NW1 4RY, UK
| | - M. Santoro
- Gamma Remote Sensing, Worbstrasse 225, 3073 Gümligen, Switzerland
| | - A. Bouvet
- CESBIO, Edouard Belin, 31401 Toulouse, France
| | - S. Mermoz
- GlobEO, Avenue Saint-Exupery, 31400 Toulouse, France
| | - T. Le Toan
- CESBIO, Edouard Belin, 31401 Toulouse, France
| | - J. Xia
- Tianjin Key Laboratory of Water Resources and Environment, Tianjin Normal University, Tianjin 300387, People's Republic of China
| | - S. Liu
- National Engineering Laboratory for Applied Technology of Forestry and Ecology in Southern China, College of Biological Science and Technology, Central South University of Forest and Technology, Changsha 410004, People's Republic of China
| | - W. Yuan
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, Beijing 100875, People's Republic of China
- State Key Laboratory of Cryospheric Sciences, Cold and Arid Regions Environmental and Engineering Research Institute, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - S. A. Spawn
- Department of Geography, University of Wisconsin-Madison, Madison, WI, USA
- Centre for Sustainability and the Global Environment, University of Wisconsin-Madison, Madison, WI, USA
| | - H. K. Gibbs
- Department of Geography, University of Wisconsin-Madison, Madison, WI, USA
- Centre for Sustainability and the Global Environment, University of Wisconsin-Madison, Madison, WI, USA
| | - S. Ferrier
- CSIRO, GPO BOX 1700, Canberra, Australian Capital Territory, Australia
| | - T. Harwood
- CSIRO, GPO BOX 1700, Canberra, Australian Capital Territory, Australia
| | - R. Alkemade
- PBL Netherlands Environmental Assessment Agency, PO Box 30314, 2500 GH The Hague, The Netherlands
| | - A. M. Schipper
- PBL Netherlands Environmental Assessment Agency, PO Box 30314, 2500 GH The Hague, The Netherlands
- Department of Environmental Science, Radboud University, PO Box 9010, 6500 GL Nijmegen, The Netherlands
| | - G. Schmidt-Traub
- UN Sustainable Development Solutions Network, 75009 Paris, France
| | - B. Strassburg
- International Institute for Sustainability (IIS), CEP: 22460-320, Rio de Janeiro, Brazil
| | - L. Miles
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), 219 Huntingdon Road, Cambridge CB3 0DL, UK
| | - N. D. Burgess
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), 219 Huntingdon Road, Cambridge CB3 0DL, UK
- Centre for Macroecology, Evolution and Climate, The Natural History Museum, University of Copenhagen, Copenhagen, Denmark
| | - V. Kapos
- UN Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), 219 Huntingdon Road, Cambridge CB3 0DL, UK
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Santoro M, Awosika TO, Snodderly KL, Hurley-Novatny AC, Lerman MJ, Fisher JP. Retracted: Endothelial/Mesenchymal Stem Cell Crosstalk Within Bioprinted Cocultures. Tissue Eng Part A 2020; 26:339-349. [DOI: 10.1089/ten.tea.2019.0175] [Citation(s) in RCA: 6] [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] [Indexed: 01/09/2023] Open
Affiliation(s)
- Marco Santoro
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
| | - Tolulope O. Awosika
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
| | - Kirstie L. Snodderly
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
| | - Amelia C. Hurley-Novatny
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
| | - Max J. Lerman
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
- Department of Materials Science and Engineering, University of Maryland, College Park, Maryland
| | - John P. Fisher
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
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Morello F, Bartalucci A, Bironzo M, Santoro M, Pivetta E, Ianniello A, Rumbolo F, Mengozzi G, Lupia E. Prospective diagnostic accuracy study of plasma soluble ST2 for diagnosis of acute aortic syndromes. Sci Rep 2020; 10:3103. [PMID: 32080259 PMCID: PMC7033105 DOI: 10.1038/s41598-020-59884-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/28/2020] [Indexed: 01/16/2023] Open
Abstract
Acute aortic syndromes (AASs) are difficult to diagnose emergencies. Plasma soluble ST2 (sST2), a prognostic biomarker for heart failure, has been proposed as a diagnostic biomarker of AASs outperforming D-dimer, the current diagnostic standard. We performed a prospective diagnostic accuracy study of sST2 for AASs in the Emergency Department (ED). In 2017–2018, patients were enrolled if they had ≥1 red-flag symptoms (chest/abdominal/back pain, syncope, perfusion deficit) and a clinical suspicion of AAS. sST2 was detected with the Presage® assay. Adjudication was based on computed tomography angiography (CTA) or on diagnostic outcome inclusive of 30-day follow-up. 297 patients were enrolled, including 88 with AASs. The median age was 67 years. In 162 patients with CTA, the median sST2 level was 41.7 ng/mL (IQR 29.4–103.2) in AASs and 34.6 ng/mL (IQR 21.4–51.5) in alternative diagnoses (P = 0.005). In ROC analysis, the AUC of sST2 was 0.63, as compared to 0.82 of D-dimer (P < 0.001). Sensitivity and specificity values of sST2 associated with different cutoffs were: 95.5% and 10.8% (≥12 ng/mL), 84.1% and 29.7% (≥23.7 ng/mL), 35.2% and 85.1% (≥66.5 ng/mL). Results were similar in the full cohort. In conclusion, in patients from a European ED, plasma sST2 provided modest accuracy for diagnosis of AASs.
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Affiliation(s)
- Fulvio Morello
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy. .,Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy.
| | - Alice Bartalucci
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Marco Bironzo
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Marco Santoro
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Emanuele Pivetta
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Alice Ianniello
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Francesca Rumbolo
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Giulio Mengozzi
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Enrico Lupia
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy.,Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy
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40
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Grosfeld EC, Smith BT, Santoro M, Lodoso-Torrecilla I, Jansen JA, Ulrich DJ, Melchiorri AJ, Scott DW, Mikos AG, van den Beucken JJJP. Fast dissolving glucose porogens for early calcium phosphate cement degradation and bone regeneration. ACTA ACUST UNITED AC 2020; 15:025002. [PMID: 31810074 DOI: 10.1088/1748-605x/ab5f9c] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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]
Abstract
Here, we demonstrate the in vivo efficacy of glucose microparticles (GMPs) to serve as porogens within calcium phosphate cements (CPCs) to obtain a fast-degrading bone substitute material. Composites were fabricated incorporating 20 wt% GMPs at two different GMP size ranges (100-150 μm (GMP-S) and 150-300 μm (GMP-L)), while CPC containing 20 wt% poly(lactic-co-glycolic acid) microparticles (PLGA) and plain CPC served as controls. After 2 and 8 weeks implantation in a rat femoral condyle defect model, specimens were retrieved and analyzed for material degradation and bone formation. Histologically, no adverse tissue response to any of the CPC-formulations was observed. All CPC-porogen formulations showed faster degradation compared to plain CPC control, but only GMP-containing formulations showed higher amounts of new bone formation compared to plain CPC controls. After 8 weeks, only CPC-porogen formulations with GMP-S or PLGA porogens showed higher degradation compared to plain CPC controls. Overall, the inclusion of GMPs into CPCs resulted in a macroporous structure that initially accelerated the generation of new bone. These findings highlight the efficacy of a novel approach that leverages simple porogen properties to generate porous CPCs with distinct degradation and bone regeneration profiles.
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Affiliation(s)
- Eline-Claire Grosfeld
- Radboudumc, Dentistry-Biomaterials, Philips van Leijdenlaan 25, 6525EX Nijmegen, The Netherlands
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Lerman MJ, Smith BT, Gerald AG, Santoro M, Fookes JA, Mikos AG, Fisher JP. Aminated 3D Printed Polystyrene Maintains Stem Cell Proliferation and Osteogenic Differentiation. Tissue Eng Part C Methods 2020; 26:118-131. [PMID: 31971874 PMCID: PMC7041340 DOI: 10.1089/ten.tec.2019.0217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/18/2019] [Indexed: 12/14/2022] Open
Abstract
As 3D printing becomes more common and the technique is used to build culture platforms, it is imperative to develop surface treatments for specific responses. The advantages of aminating and oxidizing polystyrene (PS) for human mesenchymal stem cell (hMSC) proliferation and osteogenic differentiation are investigated. We find that ammonia (NH3) plasma incorporates amines while oxygen plasma adds carbonyl and carboxylate groups. Across 2D, 3D, and 3D dynamic culture, we find that the NH3- treated surfaces encouraged cell proliferation. Our results show that the NH3-treated scaffold was the only treatment allowing dynamic proliferation of hMSCs with little evidence of osteogenic differentiation. With osteogenic media, particularly in 3D culture, we find the NH3 treatment encouraged greater and earlier expression of RUNX2 and ALP. The NH3-treated PS scaffolds support hMSC proliferation without spontaneous osteogenic differentiation in static and dynamic culture. This work provides an opportunity for further investigations into shear profiling and coculture within the developed culture system toward developing a bone marrow niche model.
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Affiliation(s)
- Max J. Lerman
- Department of Materials Science and Engineering, University of Maryland, College Park, Maryland
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
| | - Brandon T. Smith
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
- Department of Bioengineering, MS-142 BioScience Research Collaborative, Rice University, Houston, Texas
| | - Anushka G. Gerald
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Marco Santoro
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - James A. Fookes
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Antonios G. Mikos
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
- Department of Bioengineering, MS-142 BioScience Research Collaborative, Rice University, Houston, Texas
| | - John P. Fisher
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
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42
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Van Belleghem S, Torres L, Santoro M, Mahadik B, Wolfand A, Kofinas P, Fisher JP. Hybrid 3D Printing of Synthetic and Cell-Laden Bioinks for Shape Retaining Soft Tissue Grafts. Adv Funct Mater 2020; 30:1907145. [PMID: 33041744 PMCID: PMC7546434 DOI: 10.1002/adfm.201907145] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Indexed: 05/24/2023]
Abstract
Despite recent advances in clinical procedures, the repair of soft tissue remains a reconstructive challenge. Current technologies such as synthetic implants and dermal flap autografting result in inefficient shape retention and unpredictable aesthetic outcomes. 3D printing, however, can be leveraged to produce superior soft tissue grafts that allow enhanced host integration and volume retention. Here, a novel dual bioink 3D printing strategy is presented that utilizes synthetic and natural materials to create stable, biomimetic soft tissue constructs. A double network ink composed of covalently crosslinked poly(ethylene) glycol and ionically crosslinked alginate acts as a physical support network that promotes cell growth and enables long-tersm graft shape retention. This is coupled with a cell-laden, biodegradable gelatin methacrylate bioink in a hybrid printing technique, and the composite scaffolds are evaluated in their mechanical properties, shape retention, and cytotoxicity. Additionally, a new shape analysis technique utilizing CloudCompare software is developed that expands the available toolbox for assessing scaffold aesthetic properties. With this dynamic 3D bioprinting strategy, complex geometries with robust internal structures can be easily modulated by varying the print ratio of non-degradable to sacrificial strands. The versatility of this hybrid printing fabrication platform can inspire the design of future multi-material regenerative implants.
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Affiliation(s)
- Sarah Van Belleghem
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, 20742, USA
| | - Leopoldo Torres
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, 20742, USA
| | - Marco Santoro
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, 20742, USA
| | - Bhushan Mahadik
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, 20742, USA
| | - Arley Wolfand
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, 20742, USA
| | - Peter Kofinas
- Chemical and Biomolecular Engineering Department, University of Maryland, 20742, USA
| | - John P. Fisher
- Fischell Department of Bioengineering, Center for Engineering Complex Tissues, University of Maryland, 20742, USA
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Santoro M, Accurso V, Mancuso S, Contrino AD, Sardo M, Novo G, Di Piazza F, Perez A, Russo A, Siragusa S. Management of Ponatinib in Patients with Chronic Myeloid Leukemia with Cardiovascular Risk Factors. Chemotherapy 2019; 64:205-209. [PMID: 31825920 DOI: 10.1159/000504664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022]
Abstract
Cardiovascular (CV) adverse events are considered common complications of ponatinib treatment. Recently, it has been demonstrated that ponatinib dose reductions in definite settings can obtain optimal responses and lower ponatinib-related CV events. In this study, we describe the management of 5 patients with chronic myeloid leukemia treated with ponatinib, from second to fourth line of tyrosine kinase inhibitor therapy, carrying high pre-ponatinib CV risk, who obtained optimal molecular response and developed no CV adverse event during follow-up. Among these 5 patients, 2 had diagnosis of ischemic heart disease and underwent percutaneous angioplasty, 2 had type 2 diabetes and arterial hypertension, and 1 had only arterial hypertension. Median follow-up for ponatinib therapy is 1,039 days (34.6 months). Median dosage administered is 30 mg a day. SCORE charts were used to estimate risk of CV death in 10 years and Charlson Comorbidity Index was applied to estimate age-adjusted risk of death related to comorbidities. Strict cardiologic follow-up (complete evaluation every 3 to 6 months) and maximum effort in the control of CV modifiable risk factors are strongly recommended in the management of ponatinib treatment in patients at high risk for CV events and may allow the use of ponatinib in patients belonging to CV risk category.
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Affiliation(s)
- Marco Santoro
- Department of Surgical, Oncological, and Stomatological Disciplines, University of Palermo, Palermo, Italy,
| | - Vincenzo Accurso
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | - Salvatrice Mancuso
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | | | - Mariano Sardo
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | - Giuseppina Novo
- Department of Cardiology, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | - Florinda Di Piazza
- Department of Surgical, Oncological, and Stomatological Disciplines, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Alessandro Perez
- Department of Surgical, Oncological, and Stomatological Disciplines, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Antonio Russo
- Department of Surgical, Oncological, and Stomatological Disciplines, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Sergio Siragusa
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
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44
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Accurso V, Santoro M, Raso S, Contrino AD, Casimiro P, Piazza FD, Perez A, Russo A, Siragusa S. Splenomegaly impacts prognosis in essential thrombocythemia and polycythemia vera: A single center study. Hematol Rep 2019; 11:8281. [PMID: 31871612 PMCID: PMC6902304 DOI: 10.4081/hr.2019.8281] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Splenomegaly is one of the major clinical manifestations of primary myelofibrosis and is common also in other chronic Philadelphia-negative myeloproliferative neoplasms, causing symptoms and signs and affecting quality of life of patients diagnosed with these diseases. We aimed to study the impact that such alteration has on thrombotic risk and on the survival of patients with essential thrombocythemia and patients with Polycythemia Vera (PV). We studied the relationship between splenomegaly (and its grade), thrombosis and survival in 238 patients with et and 165 patients with PV followed at our center between January 1997 and May 2019.
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Affiliation(s)
- Vincenzo Accurso
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo
| | - Marco Santoro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Italy
| | - Simona Raso
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Italy
| | | | - Paolo Casimiro
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo
| | - Florinda Di Piazza
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Italy
| | - Alessandro Perez
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Italy
| | - Sergio Siragusa
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo
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Navarro J, Swayambunathan J, Janes ME, Santoro M, Mikos AG, Fisher JP. Dual-chambered membrane bioreactor for coculture of stratified cell populations. Biotechnol Bioeng 2019; 116:3253-3268. [PMID: 31502660 DOI: 10.1002/bit.27164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 12/13/2022]
Abstract
We have developed a dual-chambered bioreactor (DCB) that incorporates a membrane to study stratified 3D cell populations for skin tissue engineering. The DCB provides adjacent flow lines within a common chamber; the inclusion of the membrane regulates flow layering or mixing, which can be exploited to produce layers or gradients of cell populations in the scaffolds. Computational modeling and experimental assays were used to study the transport phenomena within the bioreactor. Molecular transport across the membrane was defined by a balance of convection and diffusion; the symmetry of the system was proven by its bulk convection stability, while the movement of molecules from one flow line to the other is governed by coupled convection-diffusion. This balance allowed the perfusion of two different fluids, with the membrane defining the mixing degree between the two. The bioreactor sustained two adjacent cell populations for 28 days, and was used to induce indirect adipogenic differentiation of mesenchymal stem cells due to molecular cross-talk between the populations. We successfully developed a platform that can study the dermis-hypodermis complex to address limitations in skin tissue engineering. Furthermore, the DCB can be used for other multilayered tissues or the study of communication pathways between cell populations.
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Affiliation(s)
- Javier Navarro
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland.,Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
| | - Jay Swayambunathan
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland.,Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
| | - Morgan Elizabeth Janes
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland.,Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
| | - Marco Santoro
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland.,Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
| | - Antonios G Mikos
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland.,Department of Bioengineering, Rice University, Houston, Texas
| | - John P Fisher
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland.,Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland
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Santoro M, Accurso V, Mancuso S, Carlisi M, Raso S, Tarantino G, Di Piazza F, Perez A, Russo A, Siragusa S. Comparison between thrombotic risk scores in essential thrombocythemia and survival implications. Hematol Oncol 2019; 37:434-437. [PMID: 31465530 DOI: 10.1002/hon.2670] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 03/31/2019] [Revised: 06/05/2019] [Accepted: 08/24/2019] [Indexed: 11/07/2022]
Abstract
The conventional thrombotic risk stratification in essential thrombocythemia (ET) distinguishes patients in two risk groups based on previous thrombosis and age (< or >60). The IPSET-thrombosis takes into account four risk factors: age greater than 60 years and the presence of CV risk factors, thrombosis history and JAK2 V617F presence. The revised IPSET-thrombosis uses three adverse variables to delineate four risk categories: age greater than 60, thrombosis history, and JAK2 V617F presence. We compared different risk models in the estimation of thrombotic risk in 191 patients with ET and the role of specific driver mutations affecting overall survival, according to thrombotic risk. We also evaluated the mutational status of patients showing history of thrombosis or cardiovascular events versus patients who did not. Finally, we verified whether the thrombotic risk had a significant impact on survival in our ET patients. The data analysis has been performed through the conventional statistics and overall survival estimated by using the Kaplan-Meyer method. Interestingly, either using the traditional system for thrombotic risk or the IPSET-t prognostic score or the current stratification for the thrombotic risk, high-risk patients are always highly represented. This evidence is of note, being the high-risk category indicated for cytoreduction, affecting quality of life, despite the good overall prognosis of patients with ET diagnosis in general. The analysis of overall survival in our patients, according to different models for thrombotic risk, highlighted the poor prognosis of high-risk patients compared with those with a lower thrombotic risk, in particular when using traditional stratification and current stratification. In conclusion, the occurrence of thrombotic or cardiovascular events represents one of the most severe complications at diagnosis or during follow-up of ET despite current recommendations, having a significant impact on morbidity and survival.
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Affiliation(s)
- M Santoro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - V Accurso
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | - S Mancuso
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | - M Carlisi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - S Raso
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - G Tarantino
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - F Di Piazza
- Department of Surgical, Oncological and Stomatological Disciplines, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - A Perez
- Department of Surgical, Oncological and Stomatological Disciplines, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - A Russo
- Department of Surgical, Oncological and Stomatological Disciplines, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - S Siragusa
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
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Dragani M, Rege-Cambrin G, Ferrero D, Abruzzese E, Pregno P, Elena C, Cedrone M, Santoro M, Andreani G, Saglio G, Fava C. Beyond the comfort zone of deep molecular response: discontinuation in major molecular response chronic myeloid leukemia. Leuk Lymphoma 2019; 60:3330-3332. [PMID: 31161827 DOI: 10.1080/10428194.2019.1622103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Matteo Dragani
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Giovanna Rege-Cambrin
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Turin, Turin, Italy
| | | | - Patrizia Pregno
- Department of Hematology, A.O.U Città della Salute e della Scienza di Torino, Turin, Italy
| | - Chiara Elena
- Hematology Unit, University of Pavia, Pavia, Italy
| | - Michele Cedrone
- UOC of Hematology, San Giovanni - Addolorata Hospital, Rome, Italy
| | - Marco Santoro
- Hematology Unit, University of Palermo, Palermo, Italy
| | - Giacomo Andreani
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
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48
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Accurso V, Santoro M, Siragusa S. Age at diagnosis is an important prognostic factor in Philadelphia-negative Myeloproliferative Neoplasms. Eur J Haematol 2019; 103:140-141. [PMID: 31121064 DOI: 10.1111/ejh.13266] [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] [Received: 04/14/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Vincenzo Accurso
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | - Marco Santoro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Sergio Siragusa
- Hematology Division, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
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49
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Tommasini M, Zanchi C, Lucotti A, Bombelli A, Villa NS, Casazza M, Ciusani E, de Grazia U, Santoro M, Fazio E, Neri F, Trusso S, Ossi PM. Laser-Synthesized SERS Substrates as Sensors toward Therapeutic Drug Monitoring. Nanomaterials (Basel) 2019; 9:nano9050677. [PMID: 31052433 PMCID: PMC6566808 DOI: 10.3390/nano9050677] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 01/10/2023]
Abstract
The synthesis by pulsed laser ablation and the characterization of both the surface nanostructure and the optical properties of noble metal nanoparticle-based substrates used in Surface Enhanced Raman Spectroscopy are discussed with reference to application in the detection of anti-epileptic drugs. Results on two representative drugs, namely Carbamazepine and Perampanel, are critically addressed.
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Affiliation(s)
- Matteo Tommasini
- Dipartimento di Chimica, Materiali e Ingegneria Chimica "G. Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy.
| | - Chiara Zanchi
- Dipartimento di Chimica, Materiali e Ingegneria Chimica "G. Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy.
- Dipartimento di Energia, Politecnico di Milano, Via Ponzio 34/3, 20133 Milano, Italy.
| | - Andrea Lucotti
- Dipartimento di Chimica, Materiali e Ingegneria Chimica "G. Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy.
| | - Alessandro Bombelli
- Dipartimento di Energia, Politecnico di Milano, Via Ponzio 34/3, 20133 Milano, Italy.
| | - Nicolò S Villa
- Dipartimento di Chimica, Materiali e Ingegneria Chimica "G. Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy.
| | - Marina Casazza
- Division of Neurophysiopathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milano, Italy.
| | - Emilio Ciusani
- Laboratorio di Patologia Clinica e Genetica Medica, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milano, Italy.
| | - Ugo de Grazia
- Laboratorio di Patologia Clinica e Genetica Medica, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milano, Italy.
| | - Marco Santoro
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università di Messina, Viale Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy.
| | - Enza Fazio
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università di Messina, Viale Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy.
| | - Fortunato Neri
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università di Messina, Viale Ferdinando Stagno d'Alcontres 31, 98166 Messina, Italy.
| | - Sebastiano Trusso
- CNR-IPCF, Istituto per i Processi Chimico-Fisici del CNR, V.le F. S. D'Alcontres 37, 98158 Messina, Italy.
| | - Paolo M Ossi
- Dipartimento di Energia, Politecnico di Milano, Via Ponzio 34/3, 20133 Milano, Italy.
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Accurso V, Santoro M, Mancuso S, Napolitano M, Di Piazza F, Russo A, Siragusa SM. Efficacy of ruxolitinib retreatment in a patient with high-risk myelofibrosis using the international prognostic scoring system. Drugs Context 2019; 8:212569. [PMID: 30853998 PMCID: PMC6400146 DOI: 10.7573/dic.212569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/29/2022] Open
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