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Panozzo G, Cicinelli MV, Dalla Mura G, Giannarelli D, Vadalà M, Bonfiglio V, Bellisario G, Bandello F. Enhancing Diabetic Macular Edema Treatment Outcomes: Exploring the ESASO Classification and Structural OCT Biomarkers. Ophthalmol Ther 2024:10.1007/s40123-024-00925-y. [PMID: 38530567 DOI: 10.1007/s40123-024-00925-y] [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: 01/25/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION This study assessed the European School of Advanced Studies in Ophthalmology (ESASO) classification's prognostic value for diabetic macular edema (DME) in predicting intravitreal therapy outcomes. METHODS In this retrospective, multicenter study, patients aged > 50 years with type 1 or 2 diabetes and DME received intravitreal antivascular endothelial growth factor (anti-VEGF) agents (ranibizumab, bevacizumab, and aflibercept) or steroids (dexamethasone). The primary outcome was visual acuity (VA) change post-treatment, termed as functional response, measured 4-6 weeks post-third anti-VEGF or 12-16 weeks post-steroid injection, stratified by initial DME stage. RESULTS Of the 560 eyes studied (62% male, mean age 66.7 years), 31% were classified as stage 1 (early), 50% stage 2 (advanced), 17% stage 3 (severe), and 2% stage 4 (atrophic). Visual acuity (VA; decimal) improved by 0.12-0.15 decimals in stages 1-2 but only 0.03 decimal in stage 3 (all p < 0.0001) and 0.01 in stage 4 (p = 0.38). Even in eyes with low baseline VA ≤ 0.3, improvements were significant only in stages 1 and 2 (0.12 and 0.17 decimals, respectively). Central subfield thickness (CST) improvement was greatest in stage 3 (-229 µm, 37.6%, p < 0.0001), but uncorrelated with VA gains, unlike stages 1 and 2 (respectively: -142 µm, 27.4%; - 5 µm, 12%; both p < 0.0001). Stage 4 showed no significant CST change. Baseline disorganization of retinal inner layers and focal damage of the ellipsoid zone/external limiting membrane did not influence VA improvement in stages 1 and 2. Treatment patterns varied, with 61% receiving anti-VEGF and 39% dexamethasone, influenced by DME stage, with no significant differences between therapeutic agents. CONCLUSION The ESASO classification, which views the retina as a neurovascular unit and integrates multiple biomarkers, surpasses single biomarkers in predicting visual outcomes. Significant functional improvement occurred only in stages 1 and 2, suggesting reversible damage, whereas stages 3 and 4 likely reflect irreversible damage.
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Affiliation(s)
- Giacomo Panozzo
- Ophthalmology Unit, Clinica San Francesco, Verona, Italy.
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland.
| | - Maria V Cicinelli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Dalla Mura
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| | - Diana Giannarelli
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Maria Vadalà
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Giovanni Bellisario
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Francesco Bandello
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
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Medici F, Ferioli M, Cammelli S, Forlani L, Laghi V, Ma J, Cilla S, Buwenge M, Macchia G, Deodato F, Vadalà M, Malizia C, Tagliaferri L, Perrone AM, De Iaco P, Strigari L, Bazzocchi A, Rizzo S, Arcelli A, Morganti AG. Sarcopenic Obesity in Cervical Carcinoma: A Strong and Independent Prognostic Factor beyond the Conventional Predictors (ESTHER Study-AFRAID Project). Cancers (Basel) 2024; 16:929. [PMID: 38473291 DOI: 10.3390/cancers16050929] [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: 01/14/2024] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Locally advanced cervical cancer represents a significant treatment challenge. Body composition parameters such as body mass index, sarcopenia, and sarcopenic obesity, defined by sarcopenia and BMI ≥ 30 kg/m2, have been identified as potential prognostic factors, yet their overall impact remains underexplored. This study assessed the relationship between these anthropometric parameters alongside clinical prognostic factors on the prognosis of 173 cervical cancer patients. Survival outcomes in terms of local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were analyzed using Kaplan regression methods-Meier and Cox. Older age, lower hemoglobin levels, higher FIGO (International Federation of Gynecology and Obstetrics) stages, and lower total radiation doses were significantly associated with worse outcomes. Univariate analysis showed a significant correlation between BMI and the outcomes examined, revealing that normal-weight patients show higher survival rates, which was not confirmed by the multivariate analysis. Sarcopenia was not correlated with any of the outcomes considered, while sarcopenic obesity was identified as an independent negative predictor of DFS (HR: 5.289, 95% CI: 1.298-21.546, p = 0.020) and OS (HR: 2.645, 95% CI: 1.275-5.488, p = 0.009). This study highlights the potential of sarcopenic obesity as an independent predictor of clinical outcomes. These results support their inclusion in prognostic assessments and treatment planning for patients with advanced cervical cancer.
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Affiliation(s)
- Federica Medici
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Martina Ferioli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Silvia Cammelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Ludovica Forlani
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Viola Laghi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Johnny Ma
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy
| | - Maria Vadalà
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Anna Myriam Perrone
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), CH-6500 Lugano, Switzerland
| | - Alessandra Arcelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Palmieri B, Vadalà M, Al Bzour BM, Di Carmine M, Scarano A. A new easy technique to identify the correct artificial hair implantation site: A case series and preliminary results. J Cosmet Dermatol 2024; 23:614-621. [PMID: 37991104 DOI: 10.1111/jocd.16015] [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: 06/07/2023] [Revised: 08/01/2023] [Accepted: 09/19/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The implantation of artificial hair is a successful standardized procedure to restore bald areas or scarred alopecic surfaces of the scalp in both sexes. MATERIALS AND METHODS Sebometric measurements were taken, pre, 1, 3, and 6 months postimplant in two symmetric frontotemporal areas of the scalp of seven volunteers to be implanted with 50 units of artificial hair. The artificial hair used in this study are Biofibre 4.0 produced by Medicap srl, Italy. RESULTS The dermaroller assisted procedure was performed only on one side, and the plain random implant contralaterally for comparison. A marked downregulation of the sebum concentration was observed in the dermaroller treated area 1, 3, and 6 months later in respect to the control side. CONCLUSION The dermaroller assisted procedure is safe and effective in reducing the foreign body reaction by the sebaceous glands and the vascular axis injured by the implanting needle; a longer standing success of the implanted hair can thus be achieved reducing the burden of inflammatory reaction.
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Affiliation(s)
- Beniamino Palmieri
- Second Opinion Medical Network, Modena, Italy
- Medico Cura Te Stesso Onlus, Modena, Italy
| | - Maria Vadalà
- Second Opinion Medical Network, Modena, Italy
- Medico Cura Te Stesso Onlus, Modena, Italy
| | | | - Mariastella Di Carmine
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Chieti, Italy
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Chieti, Italy
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Medici F, Strolin S, Castellucci P, Cilla S, Laghi V, Galietta E, Vadalà M, Strigari L, Morganti AG, Cammelli S. Complete metabolic response after Partially Ablative Radiotherapy (PAR) for bulky retroperitoneal liposarcoma: A case report. Radiol Case Rep 2024; 19:305-309. [PMID: 38028304 PMCID: PMC10656220 DOI: 10.1016/j.radcr.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
In the management of symptomatic inoperable retroperitoneal sarcomas (RPS), palliative radiotherapy (RT) is a potential treatment option. However, the efficacy of low doses used in palliative RT is limited in these radioresistant tumors. Therefore, exploring dose escalation strategies targeting specific regions of the tumor may enhance the therapeutic effect of RT in relieving or preventing symptoms. In this case report, we present the case of an 87-year-old patient with rapidly growing undifferentiated liposarcoma in the retroperitoneum, where surgical and systemic therapies were ruled out due to age and comorbidities. RT was administered using volumetric modulated arc therapy, delivering 20 Gy in 4 fractions twice daily to the macroscopic tumor and 40 Gy in 4 fractions twice daily (simultaneous integrated boost) to the central part of the tumor (Gross Tumor Volume minus 2 cm). An 18F-FDG-PET-CT scan performed after RT demonstrated a complete metabolic response throughout the entire tumor mass. Although the patient eventually succumbed to metastatic spread to the bone, liver, and lung after 9 months, no local disease progression or pain/obstructive symptoms were observed. This case highlights the technical and clinical feasibility of delivering ablative doses of RT to the central region of the tumor and suggests the potential for achieving a complete metabolic response and durable tumor control.
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Affiliation(s)
- Federica Medici
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Strolin
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Castellucci
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Viola Laghi
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Erika Galietta
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Vadalà
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Cammelli
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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5
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Medici F, Ferioli M, Forlani L, Laghi V, Ma J, Cilla S, Buwenge M, Macchia G, Deodato F, Vadalà M, Malizia C, Tagliaferri L, Perrone AM, De Iaco P, Strigari L, Arcelli A, Morganti AG. Decoding the Complexity of Systemic Inflammation Predictors in Locally Advanced Cervical Cancer, with Hemoglobin as the Hidden Key (the ESTHER Study). Cancers (Basel) 2023; 15:5056. [PMID: 37894423 PMCID: PMC10605166 DOI: 10.3390/cancers15205056] [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: 08/30/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Locally advanced cervical cancer (LACC) is treated with concurrent chemoradiation (CRT). Predictive models could improve the outcome through treatment personalization. Several factors influence prognosis in LACC, but the role of systemic inflammation indices (IIs) is unclear. This study aims to assess the correlation between IIs and prognosis in a large patient cohort considering several clinical data. We retrospectively analyzed pretreatment IIs (NLR, PLR, MLR, SII, LLR, COP-NLR, APRI, ALRI, SIRI, and ANRI) in 173 LACC patients. Patient, tumor, and treatment characteristics were also considered. Univariate and multivariate Cox's regressions were conducted to assess associations between IIs and clinical factors with local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Univariate analysis showed significant correlations between age, HB levels, tumor stage, FIGO stage, and CRT dose with survival outcomes. Specific pretreatment IIs (NLR, PLR, APRI, ANRI, and COP-NLR) demonstrated associations only with LC. The multivariate analysis confirmed Hb levels, CRT dose, and age as significant predictors of OS, while no II was correlated with any clinical outcome. The study findings contradict some prior research on IIs in LACC, emphasizing the need for comprehensive assessments of potential confounding variables.
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Affiliation(s)
- Federica Medici
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Martina Ferioli
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
| | - Ludovica Forlani
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Viola Laghi
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Johnny Ma
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy;
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy; (G.M.); (F.D.)
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy; (G.M.); (F.D.)
| | - Maria Vadalà
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.V.); (C.M.)
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.V.); (C.M.)
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy;
| | - Anna Myriam Perrone
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Alessandra Arcelli
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (L.F.); (V.L.); (J.M.); (M.B.); (A.M.P.); (P.D.I.); (A.A.); (A.G.M.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Fallico M, Macchi I, Maugeri A, Favara G, Barchitta M, Magnano San Lio R, Agodi A, Russo A, Longo A, Avitabile T, Castellino N, Reibaldi M, Pignatelli F, Vadalà M, Patanè C, Nebbioso M, Bonfiglio V. Anti-vascular endothelial growth factor monotherapy or combined with verteporfin photodynamic therapy for retinal angiomatous proliferation: a systematic review with meta-analysis. Front Pharmacol 2023; 14:1141077. [PMID: 37377929 PMCID: PMC10291099 DOI: 10.3389/fphar.2023.1141077] [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: 01/09/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose: To assess functional and anatomical outcomes of intravitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) monotherapy versus combined with verteporfin Photodynamic Therapy (PDT) for Retinal Angiomatous Proliferation (RAP). Methods: Studies reporting outcomes of intravitreal anti-VEGF monotherapy and/or in combination with verteporfin PDT in RAP eyes with a follow-up ≥ 12 months were searched. The primary outcome was the mean change in best corrected visual acuity (BCVA) at 12 months. Mean change in central macular thickness (CMT) and mean number of injections were considered as secondary outcomes. The mean difference (MD) between pre- and post-treatment values was calculated along with 95% Confidence Interval (95% CI). Meta-regressions were performed to assess the influence of anti-VEGF number of injections on BCVA and CMT outcomes. Results: Thirty-four studies were included. A mean gain of 5.16 letters (95% CI = 3.30-7.01) and 10.38 letters (95% CI = 8.02-12.75) was shown in the anti-VEGF group and combined group, respectively (anti-VEGF group vs. combined group, p < 0.01). A mean CMT reduction of 132.45 µm (95% CI = from -154.99 to -109.90) and 213.93 µm (95% CI = from -280.04 to -147.83) was shown in the anti-VEGF group and combined group, respectively (anti-VEGF group vs. combined group, p < 0.02). A mean of 4.9 injections (95% CI = 4.2-5.6) and 2.8 injections (95% CI = 1.3-4.4) were administered over a 12-month period in the anti-VEGF group and combined group, respectively. Meta-regression analyses showed no influence of injection number on visual and CMT outcomes. High heterogeneity was found across studies for both functional and anatomical outcomes. Conclusion: A combined approach with anti-VEGF and PDT could provide better functional and anatomical outcomes in RAP eyes compared with anti-VEGF monotherapy.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Iacopo Macchi
- Newcastle Eye Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Giuliana Favara
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Roberta Magnano San Lio
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | | | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
| | | | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Clara Patanè
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Marcella Nebbioso
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
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Mokthar G, Chaker C, Vadalà M, Giacomello M, Greco Lucchina A, Scarano A. Experience on biocompatible artificial hair implant. Eur Rev Med Pharmacol Sci 2023; 27:162-171. [PMID: 37129328 DOI: 10.26355/eurrev_202304_31336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE In Europe, a great number of investigations and studies followed up to develop safer techniques performed by physicians only. Successful dedicated medical protocols included the implant of single fibers with extractable root. The aim of our study was to evaluate the efficacy of biocompatible artificial hair implants in patients with androgenetic alopecia. PATIENTS AND METHODS 682 patients (488 males and 184 females) aged between 25 and 70 years old, with diagnosed AGA, requiring no invasive nor surgical hair restoration, with problems of baldness and refusing surgical options appealed to the Second Opinion Medical Consulting (Modena, Italy), and were included in the present protocol. Before the treatment, all patients underwent a test implant to rule out hypersensitivity by implanting 100 fibers on a selected skin spot. If no reaction was detected, five weeks later 500-1,200 fibers were further implanted per session at a minimum interval of 5 weeks until the required aesthetic result was achieved. RESULTS The average number of sessions for each patient was 5. The average number of implanted fibers was 2,100 (ranging from 800 to 12,000). The treated scalp area returned to normal appearance and tenderness in 3 days. CONCLUSIONS The socio-phycological benefit and the life quality improvement of our patients have been the focus of the study. On our side, the accurate selection, small hair units for each implant session, customized dermatological consultation and the use of highly biocompatible fibers have been the proper strategy to achieve the goal.
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Affiliation(s)
- G Mokthar
- "Medico Cura Te Stesso" Onlus, Modena, Italy.
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Palmieri B, Vadalà M. The role of Carcinine treatment on glico-lipidic imbalance of patients with altered blood glucose pattern. Clin Ter 2023; 174:195-202. [PMID: 36920139 DOI: 10.7417/ct.2023.2519] [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] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Objective Several studies support the active role of Carcinine, an L-carnosine metabolite, in insulin resistance and dyslipidaemia, to modulate the insulinemic/glycaemic profile and fat metabolism. Materials and methods 100 (50 women and 50 men) volunteers, aged between 40 and 85 years with a body mass index (BMI) between 25 and 34,9 kg/m2, spontaneously addressed to our "Second Opinion Medical Consulting Network" (Modena, Italy) between 2019 and 2020, were included in this anecdotal, observational, retrospective trial. The aim of the study was to find an adequate possibly natural treatment for unbalanced insulin resistance pattern notwithstanding ongoing administration of statins, and hypoglycaemic chemical agents in healthy overweight/obese subjected. All the patients were divided in two groups: 1) the first group included 50 patients that were admi-nistered with a specific galenic nutraceutical product containing 20 mg of carcinine, and 2) the second group included 50 patients, which were administered with lithothamnion calcareum alga (190 mg) and three-time day for two months. The waist circumference, glycaemia, homeostasis model asses-sment (HOMA-IR), glycated haemoglobin, total cholesterol values were detected at time 0, and time 1 (after treatment). At the same time, the pre versus post treatment, Advanced Glycation End products (AGEs), that play an important role in the development of diabetic va-scular complications, were instrumentally measured at time 1 and 2. Results After 60 mg/day of Carcinina treatment, glycaemia (p=0,001), glycated haemoglobin (p<0,001), total cholesterol (p<0,003), serum insulin (p<0.05) were significantly reduced, respect to placebo period. Abdominal circumference (p<0.2), HOMA index (p<0.03) progressively were reduced as well. No cardiovascular risk and untoward effects were observed at the prescribed dosages. The AGE reader test showed a statistically meaningful reduced risk due to reduced amount. Conclusions Carcinine, at the daily dose of 60 mg/day, was able to modify, safely, the AGEs that induced cardiovascular risk, the waist circumference, and some glycolipid-metabolic parameters in over-weight/obese patients with altered blood glucose pattern, improving significantly the impending metabolic syndrome.
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Affiliation(s)
- B Palmieri
- Second Opinion Medical Network, Modena, Italy.,Medico Cura Te Stesso Onlus, Modena, Italy
| | - M Vadalà
- Medico Cura Te Stesso Onlus, Modena, Italy.,Second Opinion Medical Network, Modena, Italy
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Palmieri B, Vadalà M. Oral THC: CBD cannabis extract in main symptoms of Alzheimer disease: agitation and weight loss. Clin Ter 2023; 174:53-60. [PMID: 36655645 DOI: 10.7417/ct.2023.5009] [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] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Objectives Ten million new cases of dementia are recorded annually worldwide, with agitation and idiopathic weight loss being the most common symptoms. Several pharmacological therapies have emerged in recent years, but the clinical use of cannabis extracts in older patients with AD is constantly growing. This retrospective, analytical, observational, spontaneous trial aimed to enhance the clinical action of THC: CBD cannabis extract administration in AD patients with severe symptoms such as agitation, weight loss, cognitive impairment, and sleep disturbance. Methods Thirty patients (9 men and 21 women) diagnosed with mild, moderate, or severe AD, aged 65-90 years, appealing to our Second Opinion Medical Consultation (Modena, Italy), were enrolled and required to use oil-diluted cannabis extract, Bedrocan® (22% THC, 0.5% CBD, Olive Oil 50 ml), twice a day for 12 weeks. The efficacy of cannabinoid therapy was evaluated at baseline and 12 weeks after therapy, employing three self-administered questionnaires completed by the parents of the enrolled patients: NPI-Q, CMAI, and MMSE. Key findings The NPI-Q demonstrated a reduction (p<0.0001) in agitation, apathy, irritability, sleep disturbances, and eating disturbances, consequently improving caregiver distress. Levels of physically and verbally aggressive behaviours, measured using the CMAI questionnaire, were lower (p<0.0001) in all patients. The MMSSE questionnaire confirmed a significant decrease (p<0.0001) in cognitive impairment in 45% of the patients. Conclusion Our anecdotical, spontaneous, and observational study demonstrated the efficacy and safety of oil-diluted cannabis extract in patients with AD. The limitations of our study are: 1) small patient cohort, 2) absence of control group, 3) self-administered questionnaires that are the most practical but not objective instruments to assess the neurologic functions of AD patients.
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Affiliation(s)
- B Palmieri
- Second Opinion Medical Network, Modena (MO), Italy
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
| | - M Vadalà
- Second Opinion Medical Network, Modena (MO), Italy
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Palmieri B, Vadalà M. Oral THC: CBD cannabis extract in main symptoms of Alzheimer disease: agitation and weight loss. Clin Ter 2023; 174:53-60. [PMID: 36655645 DOI: 10.7417/ct.2023.2497] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives Ten million new cases of dementia are recorded annually worldwide, with agitation and idiopathic weight loss being the most common symptoms. Several pharmacological therapies have emerged in recent years, but the clinical use of cannabis extracts in older patients with AD is constantly growing. This retrospective, analytical, observational, spontaneous trial aimed to enhance the clinical action of THC: CBD cannabis extract administration in AD patients with severe symptoms such as agitation, weight loss, cognitive impairment, and sleep disturbance. Methods Thirty patients (9 men and 21 women) diagnosed with mild, moderate, or severe AD, aged 65-90 years, appealing to our Second Opinion Medical Consultation (Modena, Italy), were enrolled and required to use oil-diluted cannabis extract, Bedrocan® (22% THC, 0.5% CBD, Olive Oil 50 ml), twice a day for 12 weeks. The efficacy of cannabinoid therapy was evaluated at baseline and 12 weeks after therapy, employing three self-administered questionnaires completed by the parents of the enrolled patients: NPI-Q, CMAI, and MMSE. Key findings The NPI-Q demonstrated a reduction (p<0.0001) in agitation, apathy, irritability, sleep disturbances, and eating disturbances, consequently improving caregiver distress. Levels of physically and verbally aggressive behaviours, measured using the CMAI questionnaire, were lower (p<0.0001) in all patients. The MMSSE questionnaire confirmed a significant decrease (p<0.0001) in cognitive impairment in 45% of the patients. Conclusion Our anecdotical, spontaneous, and observational study demonstrated the efficacy and safety of oil-diluted cannabis extract in patients with AD. The limitations of our study are: 1) small patient cohort, 2) absence of control group, 3) self-administered questionnaires that are the most practical but not objective instruments to assess the neurologic functions of AD patients.
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Affiliation(s)
- B Palmieri
- Second Opinion Medical Network, Modena (MO), Italy
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
| | - M Vadalà
- Second Opinion Medical Network, Modena (MO), Italy
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Midena E, Polo C, Frizziero L, Marini MG, Lattanzio R, Vadalà M, Pilotto E, Varano M. The Narrative Medicine Approach in the Treatment of Diabetic Macular Edema: An Italian Experience. IJERPH 2022; 19:ijerph19159367. [PMID: 35954724 PMCID: PMC9368569 DOI: 10.3390/ijerph19159367] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/04/2022]
Abstract
The study retraces the healthcare pathway of patients affected by diabetic macular edema (DME) through the direct voice of patients and caregivers by using a “patient journey” and narrative method approach. The mapping of the patient’s journey was developed by a multidisciplinary board of health professionals and involved four Italian retina centers. DME patients on intravitreal injection therapy and caregivers were interviewed according to the narrative medicine approach. Narratives were analyzed through a quali-quantitative tool, as set by the narrative medicine method. The study involved four specialized retina centers in Italy and collected a total of 106 narratives, 82 from DME patients and 24 from caregivers. The narratives reported their difficulty in identifying the correct pathway of care because of a limited awareness of diabetes and its complications. Patients experienced reduced autonomy due to ocular complications. In the treatment of diabetes and its complications, a multidisciplinary approach currently appears to be missing. DME reduces the quality of life of affected patients. The narrative medicine approach offers qualitative and emotional patient-guided information. The patient journey provides all of those involved in the management of DME with flowcharts to refer to, identifying the critical points in the healthcare journey of DME patients to improve the management of the disease.
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Affiliation(s)
- Edoardo Midena
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
- IRCCS—Fondazione Bietti, 00198 Rome, Italy;
- Correspondence: ; Tel.: +39-049-8212110
| | - Chiara Polo
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
| | - Luisa Frizziero
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
| | | | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute Ospedale San Raffaele, University Vita-Salute, 20132 Milan, Italy;
| | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, 90127 Palermo, Italy;
| | - Elisabetta Pilotto
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
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Palmieri B, Condemi L, Bertozzi E, Garoia F, Vadalà M. Relapsing Vulvovaginal Candidiasis: Treatment with Oxygen Therapy and Hyaluronic Acid. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10129] [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: 11/25/2022] Open
Abstract
OBJECTIVE. The aim of our open, anecdotical, retrospective, spontaneous trial has been to evaluate the efficacy of the association between high concentration oxygen and hyaluronic acid for treatment of relapsing candidiasis.METHODS. 45 women (30.9 ±4.4 years) with relapsing candidiasis, and complaining of dryness, dyspareunia, pain, appealing to our Second Opinion Medical Consultation Network, signed an informed consent form and were treated with oxygen/hyaluronic acid therapy treatment, once a week, for a total of five weeks at the outpatient clinic (Healthy Center, Sirio, Fidenza, Italy). The physicians of the Second Opinion Network followed up weekly from remote (WhatsApp, Skype) each treated patient as to state the effectiveness, tolerability, and side effects of the treatment.RESULTS. The mean VAS and VuAS scores measured at first visit were 2,660 and 2,622 and significantly (p<0,0001) reduced to 1,311 and 0,77 at last visit. The measurements of the vaginal pH and of the vaginal swab after the last treatment session confirmed significantly (p<0.0001) the absence of candidiasis. Three months later in the follow-up, the percentage of patients who had had only one VVC relapse was 4,44% (2/45), a percentage that increased just to 8,8% at six months (4/45). The elastography index was significantly (p<0.0001) increased after the last treatment session (2,55 ± 0,545 vs 4,48 ± 0,505).CONCLUSIONS. The combined oxygen therapy with hyaluronic acid gave definite therapeutic benefits in this cohort of relapsing candidiasis in the acute phase of the infection. The 6-month follow up, also detected a lower reinfection rate compared with the historical available data. The procedure is totally painless with excellent compliance by patients and no untoward effects.
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Scalia F, Barone R, Rappa F, Marino Gammazza A, Lo Celso F, Lo Bosco G, Barone G, Antona V, Vadalà M, Vitale AM, Mangano GD, Amato D, Sentiero G, Macaluso F, Myburgh KH, Conway de Macario E, Macario AJL, Giuffrè M, Cappello F. Muscle Histopathological Abnormalities in a Patient With a CCT5 Mutation Predicted to Affect the Apical Domain of the Chaperonin Subunit. Front Mol Biosci 2022; 9:887336. [PMID: 35720129 PMCID: PMC9201415 DOI: 10.3389/fmolb.2022.887336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Recognition of diseases associated with mutations of the chaperone system genes, e.g., chaperonopathies, is on the rise. Hereditary and clinical aspects are established, but the impact of the mutation on the chaperone molecule and the mechanisms underpinning the tissue abnormalities are not. Here, histological features of skeletal muscle from a patient with a severe, early onset, distal motor neuropathy, carrying a mutation on the CCT5 subunit (MUT) were examined in comparison with normal muscle (CTR). The MUT muscle was considerably modified; atrophy of fibers and disruption of the tissue architecture were prominent, with many fibers in apoptosis. CCT5 was diversely present in the sarcolemma, cytoplasm, and nuclei in MUT and in CTR and was also in the extracellular space; it colocalized with CCT1. In MUT, the signal of myosin appeared slightly increased, and actin slightly decreased as compared with CTR. Desmin was considerably delocalized in MUT, appearing with abnormal patterns and in precipitates. Alpha-B-crystallin and Hsp90 occurred at lower signals in MUT than in CTR muscle, appearing also in precipitates with desmin. The abnormal features in MUT may be the consequence of inactivity, malnutrition, denervation, and failure of protein homeostasis. The latter could be at least in part caused by malfunction of the CCT complex with the mutant CCT5 subunit. This is suggested by the results of the in silico analyses of the mutant CCT5 molecule, which revealed various abnormalities when compared with the wild-type counterpart, mostly affecting the apical domain and potentially impairing chaperoning functions. Thus, analysis of mutated CCT5 in vitro and in vivo is anticipated to provide additional insights on subunit involvement in neuromuscular disorders.
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Affiliation(s)
- Federica Scalia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Rosario Barone
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Francesca Rappa
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Antonella Marino Gammazza
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Fabrizio Lo Celso
- Department of Physics and Chemistry - Emilio Segrè, University of Palermo, Palermo, Italy
- Ionic Liquids Laboratory, Institute of Structure of Matter, Italian National Research Council (ISM-CNR), Rome, Italy
| | - Giosuè Lo Bosco
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
- Department of Mathematics and Computer Science, University of Palermo, Palermo, Italy
| | - Giampaolo Barone
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Palermo, Italy
| | - Vincenzo Antona
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Maria Vadalà
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Alessandra Maria Vitale
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Giuseppe Donato Mangano
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Domenico Amato
- Department of Mathematics and Computer Science, University of Palermo, Palermo, Italy
| | - Giusy Sentiero
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Filippo Macaluso
- SMART Engineering Solutions & Technologies (SMARTEST) Research Center, eCampus University, Palermo, Italy
| | - Kathryn H. Myburgh
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Everly Conway de Macario
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore-Institute of Marine and Environmental Technology (IMET), Baltimore, MD, United States
| | - Alberto J. L. Macario
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore-Institute of Marine and Environmental Technology (IMET), Baltimore, MD, United States
| | - Mario Giuffrè
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Francesco Cappello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
- *Correspondence: Francesco Cappello, @hotmail.com
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Nicolò M, Ciucci F, Nardi M, Parolini B, Russo A, Scupola A, Torregrossa S, Vadalà M. PERSEUS-IT 24-month analysis: a prospective observational study to assess the effectiveness of intravitreal aflibercept in routine clinical practice in Italy in patients with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2022; 260:3185-3195. [PMID: 35511286 PMCID: PMC9477902 DOI: 10.1007/s00417-022-05679-6] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose PERSEUS-IT (NCT02289924) was a prospective, observational, 2-year study evaluating the effectiveness and treatment patterns of intravitreal aflibercept (IVT-AFL) in patients with neovascular age-related macular degeneration (nAMD) in routine clinical practice in Italy. Methods Treatment-naïve patients with nAMD receiving IVT-AFL per routine clinical practice were enrolled. The primary endpoint was mean change in visual acuity (VA; decimals) from baseline to month (M) 12 and M24. Outcomes were evaluated for the overall study population and independently for the 2 treatment cohorts: regular (3 initial monthly doses, ≥ 7 injections by M12, and ≥ 4 injections between M12 and M24) and irregular (any other pattern). Results Of 813 patients enrolled, 709 were included in the full analysis set (FAS); VA assessments were available for 342 patients at M12 (FAS1Y, 140 regular and 202 irregular) and 233 patients at M24 (FAS2Y, 37 regular and 196 irregular). In the overall FAS, the mean ± SD change in VA from baseline to M12 and M24 was + 0.09 ± 0.24 and + 0.02 ± 0.25 decimals, and there was a statistically significant difference between the regular and irregular cohorts in both FAS1Y (p = 0.0034) and FAS2Y (p = 0.0222). Ocular treatment-emergent adverse events were reported in 4.1% (n = 33/810 [safety set]) of patients. Conclusion In PERSEUS-IT, clinically relevant functional and anatomic improvements were observed within the first 12 months of IVT-AFL treatment in routine clinical practice in Italy in patients with treatment-naïve nAMD. These gains were generally maintained across the 2-year study. The safety profile of IVT-AFL was consistent with prior studies. Trial registration number ClinicalTrials.gov Identifier: NCT02289924. Date of registration November 13, 2014. ![]() Supplementary Information The online version contains supplementary material available at 10.1007/s00417-022-05679-6.
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Affiliation(s)
- Massimo Nicolò
- Clinica Oculistica - DiNOGMI, University of Genoa, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
| | | | | | | | | | - Andrea Scupola
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Maria Vadalà
- BIND Department, University of Palermo, Palermo, Italy
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Bonfiglio V, Rejdak R, Nowomiejska K, Zweifel SA, Justus Wiest MR, Romano GL, Bucolo C, Gozzo L, Castellino N, Patane C, Pizzo C, Reibaldi M, Russo A, Longo A, Fallico M, Macchi I, Vadalà M, Avitabile T, Costagliola C, Jonak K, Toro MD. Efficacy and Safety of Subthreshold Micropulse Yellow Laser for Persistent Diabetic Macular Edema After Vitrectomy: A Pilot Study. Front Pharmacol 2022; 13:832448. [PMID: 35462889 PMCID: PMC9019565 DOI: 10.3389/fphar.2022.832448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Aim: To examine the effect of subthreshold micropulse yellow laser (SMYL) on best-corrected visual acuity (BCVA), central macular thickness (CMT), and optical coherence tomography angiography (OCT-A) changes in eyes with persistent diabetic macular edema (DME) after pars plana vitrectomy (PPV) for tractional DME (TDME).Patients and Methods: In a comparative study, 95 eyes of 95 consecutive patients with persistent DME were prospectively enrolled. The SMYL group (54 eyes) was treated with SMYL 6 months after PPV, while the control group (41 eyes) was followed up without treatment. BCVA and CMT by OCT were analyzed at baseline and 3 and 6 months. Additionally, parameters such as the vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), respectively, and the area of the foveal avascular zone (FAZ) were also evaluated on OCT-A.Results: There were no significant differences between both groups in demographic data. In the SMYL group, mean BCVA was significantly increased [F(2,106) = 17.25; p < 0.001; ηp2 = 0.246] from 51.54 ± 13.81 ETDRS letters at baseline to 57.81 ± 12.82 ETDRS letters at 3 months (p < 0.001) and 57.83 ± 13.95 EDTRS letters at 6 months (p < 0.001), respectively. In comparison to the control group, BCVA values were statistically significantly higher in the SMYL group at 3 and 6 months, respectively. Mean CMT significantly decreased [F(2,106) = 30.98; p < 0.001; ηp2 = 0.368] from the baseline value 410.59 ± 129.91 μm to 323.50 ± 89.66 μm at 3 months (p < 0.001) and to 283.39 ± 73.45 μm at 6 months (p < 0.001). CMT values were significantly lower in the SMYL group (p < 0.001), especially at 6 months follow-up time (p < 0.001) compared with the control group. Parafoveal VD in the SCP and DCP was significantly higher in the SMYL group in comparison to the control group, respectively, at 3-month (SCP p < 0.001; DCP p < 0.001) and 6-month follow-up (SCP p < 0.001; DCP p < 0.001). FAZ area was also significantly smaller in the SMYL group at 6-month follow-up (p = 0.001). There were no adverse SMYL treatment effects.Conclusion: SMYL therapy may be a safe and effective treatment option in eyes with persistent macular edema following PPV for TDME.
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Affiliation(s)
- Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Nowomiejska
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | | | | | - Giovanni Luca Romano
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Catania, Italy
- Center for Research in Ocular Pharmacology—CERFO, University of Catania, Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Catania, Italy
- Center for Research in Ocular Pharmacology—CERFO, University of Catania, Catania, Italy
- *Correspondence: Claudio Bucolo, ; Mario Damiano Toro,
| | - Lucia Gozzo
- Center for Research in Ocular Pharmacology—CERFO, University of Catania, Catania, Italy
| | | | - Clara Patane
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Corrado Pizzo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Antonio Longo
- Center for Research in Ocular Pharmacology—CERFO, University of Catania, Catania, Italy
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Iacopo Macchi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Teresio Avitabile
- Center for Research in Ocular Pharmacology—CERFO, University of Catania, Catania, Italy
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Ciro Costagliola
- Eye Clinic Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Kamil Jonak
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland
- Department of Computer Science, Lublin University of Technology, Lublin, Poland
| | - Mario Damiano Toro
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
- Eye Clinic, Public Health Department, University of Naples Federico II, Naples, Italy
- *Correspondence: Claudio Bucolo, ; Mario Damiano Toro,
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Palmieri G, Vadalà M, Corazzari V, Palmieri B. Insomnia treatment: a new multitasking natural compound based on melatonin and cannabis extracts. Clin Ter 2022; 173:91-96. [PMID: 35147654 DOI: 10.7417/ct.2022.2399] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Our main aim was to investigate the short-term thera-peutic effects, safety/tolerability of natural compound, composed of melatonin (1,5 mg) and cannabis extracts (2.5 mg CBD) in patients with sleep disorders. METHODS In this spontaneous, anecdotal, retrospective, "compas-sionate-use," observational, open-label study, 20 patients (age 43-96 years) were appealed to our "Second Opinion Medical Consulting Net-work" (Modena, Italy), because of a variable pattern of sleep disorders and anxiety and were instructed to take sublingually the compound (20 drops) overnight for 3 months of treatment. Tolerability and adverse effects were assessed monthly during the treatment period through direct contact (email or telephone) or visit if required. RESULTS PSQUI and HAM-A scores evidenced reduction in mood alterations, including anxiety, panic, paranoia, depression (P < 0.03), in pain (P < 0.02) and good general health perceptions. CONCLUSIONS These data suggest that the formula CBD-melatonin could be competitive with the classic hypnotic synthetic drugs, the antioxidant activity of melatonin offers a further benefit to the brain network, restoring the biological clock functions, while CBD, redu-cing chronic pain perception, helps to complete the neuromuscular relaxation and to relieve anxiety fulfilling a very balanced sensation of wellbeing during the sleep.
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Affiliation(s)
| | - M Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy
- Second Opinion Medical Network, Modena, Italy
- Medico Cura Te Stesso Onlus, Modena, Italy
| | - V Corazzari
- Second Opinion Medical Network, Modena, Italy
- Medico Cura Te Stesso Onlus, Modena, Italy
| | - B Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy
- Second Opinion Medical Network, Modena, Italy
- Medico Cura Te Stesso Onlus, Modena, Italy
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17
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Scondotto G, Sultana J, Vadalà M, Avitabile T, Cillino S, Foti SS, Labbate L, Longo A, Mirabelli E, Puzo MR, Rapisarda C, Ibanez Toro P, Trombetta CJ, Trifirò G, Virgili G. Assessment of intravitreal anti-VEGF drugs and dexamethasone for retinal diseases in real world setting: A multi-centre prospective study from Southern Italy. Eur J Ophthalmol 2022; 32:3064-3073. [PMID: 35075918 DOI: 10.1177/11206721211073402] [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] [Indexed: 11/17/2022]
Abstract
Describe drug utilisation and clinical outcomes of intravitreal anti-VEGF drug and dexamethasone use in the real-world setting in Southern Italy using data from multi-centre study of retinal disease. Clinical data of retinal disease patients treated with anti-VEGF drugs and dexamethasone implant in 6 out-patient ophthalmology centres from Southern Italy were collected by means of an electronic case report form. Patients receiving at least one intravitreal injection/implant of the study drugs were followed for up to two years and described in terms of demographics and clinical characteristics. Drug utilisation patterns were described. A sign-rank test was used to compare clinical data on visual acuity and other ophthalmic parameters from baseline at different follow-up times for each indication. Data from 1327 patients was collected. Most patients were diagnosed with age-related macular degeneration (AMD) (660, 49.7%), followed by diabetic macular oedema (423, 31.9%), retinal vein occlusion (164, 12.3%), and myopic choroidal neovascularization (80, 6.0%). Patients were followed for a median of 10.3 months (interquartile range: 3.6 - 24.7 months). Mean patient age was 69.7 (±10.9) years and 54.2% were males. Ranibizumab (55.4%) and aflibercept (27.5%) were the most commonly used drugs. Baseline visual acuity significantly improved by about 0.05 to 0.1 logMAR at all follow-up times for AMD and RVO but less consistently for the other diseases. Intravitreal ranibizumab use accounted for half of all treatment for retinal diseases in a Southern Italian out-patient setting. Patients treated with anti-VEGF drugs for AMD and RVO in Southern Italy experienced significant improvement in VA.
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Affiliation(s)
- Giulia Scondotto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, 18980University of Messina, Messina, Italy
| | - Janet Sultana
- Pharmacy Department, Mater Dei Hospital, Malta.,College of Medicine and Health, University of Exeter, Exeter, Malta
| | - Maria Vadalà
- Institute of European and Mediterranean Science and Technology (IEMEST), Palermo, Italy
| | - Teresio Avitabile
- Department of Ophthalmology, A. O. U. Policlinic-Vittorio Emanuele, Catania, Italy
| | - Salvatore Cillino
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Saveria Serena Foti
- Academic spin-off "INSPIRE - Innovative Solutions For Medical Prediction And Big Data Integration In Real World Setting" - Azienda Ospedaliera Universitaria "G. Martino" Messina, Italy
| | - Luca Labbate
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, 18980University of Messina, Messina, Italy
| | - Antonio Longo
- Department of Ophthalmology, A. O. U. Policlinic-Vittorio Emanuele, Catania, Italy
| | - Eliana Mirabelli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, 18980University of Messina, Messina, Italy
| | - Maria Rosalia Puzo
- Assistance and Pharmaceutical Services Office, Personal Policies Department, Basilicata Region, Potenza, Italy
| | - Carlo Rapisarda
- Department of Ophthalmology, A. O. U. Policlinic-Vittorio Emanuele, Catania, Italy
| | - Patricia Ibanez Toro
- Assistance and Pharmaceutical Services Office, Personal Policies Department, Basilicata Region, Potenza, Italy
| | - Costantino J Trombetta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, 18980University of Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Gianni Virgili
- Department of Neuroscience, Psychology, Drug Research and Clinical Health, University of Florence, Florence, Italy.,Centre for Public Health, Queen's University of Belfast (UK), Belfast, UK
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18
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Vadalà M, Trapani VS, Amato M, Bongiovanni G, Alaimo F, Cillino S, Bonfiglio VME. Intraoperative dexamethasone intravitreal implant in diabetic macular edema patients undergoing phacoemulsification: The CataDex study. Eur J Ophthalmol 2021; 32:2760-2770. [PMID: 34878320 DOI: 10.1177/11206721211062037] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the impact of preoperative intravitreal dexamethasone implant (DexI) on functional and anatomic outcomes in patients with diabetic macular edema (DME) who underwent phacoemulsification cataract surgery. METHODS Prospective and non-comparative study conducted on consecutive DME patients undergoing cataract surgery. DexI was administered 15 days before surgery and in a pro re nata regime after surgery. Main outcome measures were mean change in central retinal thickness (CRT), central subfield thickness (CST), total macular volume (TMV), and central subfield volume (CSV) from baseline to month-12. Secondary outcome was mean change in best corrected visual acuity (BCVA). RESULTS Forty eyes were included in the study. CRT significantly decreased from 410.4 ± 64.8 µm at baseline to 303.2 ± 24.3 µm at month-12, p < 0.0001. Similarly, CST was significantly reduced from 436.4 ± 120.4 µm at baseline to 322.9 ± 54.2 µm at month-12, p < 0.0001. Total macular volume and CSV were significantly reduced from 9.95 ± 1.68 mm3 and 0.38 ± 0.11 mm3 at baseline to 8.49 ± 0.83 mm3 and 0.31 ± 0.05 mm3 at month-12, respectively (p < 0.0001 each, respectively). BCVA significantly improved from 0.26 ± 0.17 Snellen equivalent at baseline to 0.65 ± 0.19 at month-12, p < 0.0001. Mean DexI administered during the study were 2.0 ± 0.3. Neither DME subtype nor previous treatment status had any effect on functional or anatomic outcomes. Regarding safety, one (2.5%) eye developed ocular hypertension, which was successfully controlled with topical hypotensive treatment. CONCLUSIONS DexI was and effective and safe strategy for managing DME in diabetic patients undergoing uneventful cataract surgery.
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Affiliation(s)
- Maria Vadalà
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy.,IEMEST, Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | | | - Mario Amato
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Giuseppe Bongiovanni
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Francesco Alaimo
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Salvatore Cillino
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
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19
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Bonfiglio V, Ortisi E, Nebbioso M, Reibaldi M, Lupidi M, Russo A, Fallico M, Scollo D, Macchi I, Pizzo A, Panebianco R, Patanè C, Vadalà M, Toro MD, Rejdak R, Nowomiejska K, Avitabile T, Longo A. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY EVALUATION OF PERIPAPILLARY MICROVASCULAR CHANGES AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR. Retina 2021; 41:2540-2548. [PMID: 34851885 DOI: 10.1097/iae.0000000000003253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the radial peripapillary capillary plexus (RPCP) vessel density (VD) and the retinal nerve fiber layer (RNFL) thickness in eyes successfully treated with pars plana vitrectomy for primary rhegmatogenous retinal detachment. METHODS In this cross-sectional multicenter clinical study, eyes with a minimum 12-month follow-up were reexamined. The RPCP VD and RNFL thickness in the rhegmatogenous retinal detachment subfields of the affected eye (study group) were compared with the corresponding areas of the healthy fellow eyes (control group). RESULTS Fifty-three eyes were included in the study. A significantly lower RPCP VD and RNFL thickness were observed in those subfields affected by rhegmatogenous retinal detachment compared with those of the control group (P < 0.001). No statistically significant differences were observed between undetached subfields in the study group and their corresponding images in the control group. In the study group, a significant correlation was found between RPCP VD and RNFL thickness in subfields with detached retina (r = 0.393, P < 0.001) and undetached retina (r = 0.321, P < 0.001). CONCLUSION Radial peripapillary capillary plexus VD changes were found in the subfields of detached retina successfully treated with pars plana vitrectomy and they correlated with RNFL thinning. These data suggest a coexistence of neuronal and microvascular damage in patients affected by rhegmatogenous retinal detachment.
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Affiliation(s)
- Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Elina Ortisi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
| | - Marco Lupidi
- Department of Surgical and Biochemical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy; and
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Davide Scollo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Iacopo Macchi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Alessandra Pizzo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Clara Patanè
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Mario D Toro
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | | | | | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
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20
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Staurenghi G, Bandello F, Viola F, Varano M, Barbati G, Peruzzi E, Bassanini S, Biancotto C, Fenicia V, Furino C, Vadalà M, Reibaldi M, Vujosevic S, Ricci F. Effectiveness of anti-vascular endothelial growth factors in neovascular age-related macular degeneration and variables associated with visual acuity outcomes: Results from the EAGLE study. PLoS One 2021; 16:e0256461. [PMID: 34469431 PMCID: PMC8409622 DOI: 10.1371/journal.pone.0256461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/21/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the overall effectiveness of anti-vascular endothelial growth factor (VEGF) therapy in treatment-naïve patients with neovascular age-related macular degeneration (nAMD) in a clinical practice setting. Study design EAGLE was a retrospective, 2-year, cohort observational, multicenter study conducted in Italy that analyzed secondary data of treatment-naïve patients with nAMD. The primary endpoint evaluated the mean annualized number of anti-VEGF injections at Years 1 and 2. The main secondary endpoints analyzed the mean change in visual acuity (VA) from baseline and variables associated with visual outcomes at Years 1 and 2. Results Of the 752 patients enrolled, 745 (99.07%) received the first dose of anti-VEGF in 2016. Overall, 429 (57.05%) and 335 (44.5%) patients completed the 1- and 2-year follow-ups, respectively. At baseline, mean (standard deviation, SD) age was 75.6 (8.8) years and the mean (SD) VA was 53.43 (22.8) letters. The mean (SD) number of injections performed over the 2 years was 8.2 (4.1) resulting in a mean (SD) change in VA of 2.45 (19.36) (P = 0.0005) letters at Year 1 and −1.34 (20.85) (P = 0.3984) letters at Year 2. Linear regression models showed that age, baseline VA, number of injections, and early fluid resolution were the variables independently associated with visual outcomes at Years 1 and 2. Conclusions The EAGLE study analyzed the routine clinical practice management of patients with nAMD in Italy. The study suggested that visual outcomes in clinical practice may be improved with earlier diagnosis, higher number of injections, and accurate fluid resolution targeting during treatment induction.
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Affiliation(s)
- Giovanni Staurenghi
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
- * E-mail:
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Francesco Viola
- Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Giulia Barbati
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | | | | | | | - Vito Fenicia
- Faculty of Medicine and Psychology, NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Claudio Furino
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico Consorziale Bari, Bari, Italy
| | - Maria Vadalà
- Biomedicine, Neuroscience and Advanced Diagnostic Department, Unit of Ophthalmology, University of Palermo, Palermo, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | | | - Federico Ricci
- Department Experimental Medicine, Tor Vergata University, Viale Oxford, Roma, Italy
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21
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Cimino L, Neri P, Miserocchi E, Paroli MP, Vannozzi L, Mastropasqua L, Gagliano C, Vadalà M, Figus M, Florio FR, Iaccheri B, Mora P, Fossarello M, Balestrieri P, Gualberti G, Marando F, Accorinti M. Non-infectious uveitis burden on quality of life and work impairment assessed through different psychometric questionnaires. Eur J Ophthalmol 2021; 32:2282-2290. [PMID: 34399603 DOI: 10.1177/11206721211034649] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the association between a novel psychometric 12-item questionnaire (U-qest) and other validated questionnaires to assess quality of life and work impairment in patients with non-infectious uveitis. METHODS Data were collected at baseline and 3 months postbaseline using U-qest and two other validated questionnaires: The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) and the 12-Item Short-Form Health Survey (SF-12). RESULTS A total of 136 patients (52.2% female) aged 47.9 ± 14.8 years (mean ± SD) were enrolled in 14 uveitis referral centres. U-qest correlated moderately with VFQ-25 and SF-12 at baseline and at 3 months. Both U-qest and VFQ-25 scores improved as disease improved; however, U-qest also detected improvement in patients for whom VFQ-25 scores did not improve. Disease activity was shown to significantly affect activity impairment. Patients and physicians expressed positive perceptions regarding the use and benefit of this instrument. U-qest showed very good reliability in terms of internal consistency (Cronbach's alpha = 0.91). CONCLUSIONS U-qest can be considered a useful tool to assess the burden of uveitis on quality of life.
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Affiliation(s)
- Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Piergiorgio Neri
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lernear College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Maria Pia Paroli
- Uveitis Center, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Vannozzi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Leonardo Mastropasqua
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. d'Annunzio Chieti-Pescara, Chieti, Italy
| | | | - Maria Vadalà
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Michele Figus
- Department of Surgical, Medical and Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Italy
| | | | - Barbara Iaccheri
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Paolo Mora
- Ophthalmology Unit, University Hospital of Parma, Parma, Italy
| | - Maurizio Fossarello
- Clinica Oculistica, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | | | | | | | - Massimo Accorinti
- Uveitis Center, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Scimone C, Donato L, Alibrandi S, Vadalà M, Giglia G, Sidoti A, D'Angelo R. N-retinylidene-N-retinylethanolamine adduct induces expression of chronic inflammation cytokines in retinal pigment epithelium cells. Exp Eye Res 2021; 209:108641. [PMID: 34058230 DOI: 10.1016/j.exer.2021.108641] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 11/07/2020] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022]
Abstract
Blindness due to photoreceptor degeneration is observed in both genetic and acquired eye disorders. Long blue light exposure can contribute to increase levels of oxidative compounds within the retinal pigment epithelium (RPE), enhancing risk of retinal damage. In retina, reactive oxygen species contribute to the activation of inflammatory cascade. If chronic, this inflammatory response can result in photoreceptor death. Therefore, we investigated the effects of the endogenous adduct N-retinylidene-N-retinylethanolamine (A2E) on RPE cells, in order to identify the most dysregulated cytokines and their related inflammatory pathways. RPE cells were exposed to A2E and blue light for 3h and 6h. By transcriptome analysis, we identified differentially expressed genes in A2E-treated cells, when compared to untreated ones. Expression values were quantified by the Limma R package. Enrichment analysis was performed according to the "Reactome" and the Gene Ontology databases. Expression of pro-inflammatory cytokines increased after 3h of A2E treatment and pathways related to IL-6 and IL-1 signaling resulted enriched. Also the up-regulation of genes having a protective role against inflammation was observed. Moreover, our results show that ferroptosis could contribute to RPE degeneration induced by A2E and blue light. Dysregulated genes related to retinal degeneration triggered by oxidative damage and inflammatory response activation identified in this study can be considered as potential biomarkers for targeted therapies.
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Affiliation(s)
- Concetta Scimone
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy; Department of Biomolecular Strategies, Genetics and Avant-Garde Therapies, I.E.ME.S.T., Via Michele Miraglia, 90139, Palermo, Italy
| | - Luigi Donato
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy; Department of Biomolecular Strategies, Genetics and Avant-Garde Therapies, I.E.ME.S.T., Via Michele Miraglia, 90139, Palermo, Italy.
| | - Simona Alibrandi
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy; Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno d'Alcontres 31, 98166, Messina, Italy
| | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, 90127, Palermo, Italy
| | - Giuseppe Giglia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Section of Human Physiology, University of Palermo, 90134, Palermo, Italy
| | - Antonina Sidoti
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Rosalia D'Angelo
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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23
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Palmieri B, Vadalà M. Letter to the Editor: Corynebacterium Parvum ( Propionibacterium Acnes): Cytokines Cells, Innate Immunity, and Putative Antiviral Adoption. J Interferon Cytokine Res 2021; 41:132-136. [PMID: 33750214 DOI: 10.1089/jir.2020.0216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy.,Clinical Department, Second Opinion Medical Network, Modena, Italy
| | - Maria Vadalà
- Clinical Department, Second Opinion Medical Network, Modena, Italy
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24
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Castellucci M, Novara C, Casuccio A, Cillino G, Giordano C, Failla V, Bonfiglio V, Vadalà M, Cillino S. Bilateral Ultrathin Descemet's Stripping Automated Endothelial Keratoplasty vs. Bilateral Penetrating Keratoplasty in Fuchs' Dystrophy: Corneal Higher-Order Aberrations, Contrast Sensitivity and Quality of Life. ACTA ACUST UNITED AC 2021; 57:medicina57020133. [PMID: 33546152 PMCID: PMC7913208 DOI: 10.3390/medicina57020133] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The objective of this paper is to compare the visual outcomes and quality of life (QoL) after bilateral ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK) with bilateral penetrating keratoplasty (PK) for Fuchs' endothelial dystrophy (FED). Materials and Methods: Retrospective comparative cohort study, including 11 patients with FED who underwent bilateral PK and 13 patients with FED who underwent bilateral UT-DSAEK. All patients were already pseudophakic or had undergone a combined cataract procedure. The main outcomes were corrected distance visual acuity (CDVA) corneal higher-order aberrations (HOAs), contrast sensitivity (CS) and quality of life (QoL). Results: The mean follow-up after the second eye surgery was 32.5 ± 10.2 months in PK and 19.6 ± 8.6 months in UT-DSAEK patients. The CDVA in the UT-DSAEK group was significantly better than in the PK one (0.18 ± 0.07 vs. 0.35 ± 0.16 logMAR, p < 0.0001). The mean anterior corneal total HOAs of the central 5 mm were significantly lower in UT-DSAEK eyes than in PK eyes (0.438 ± 0.078 µ and 1.282 ± 0.330 µ respectively, p < 0.0001), whilst the mean posterior total HOAs did not differ between groups (0.196 ± 0.056 µ and 0.231 ± 0.089 µ, respectively, p = 0.253). The CS was lower at 0.75 and 1.5 cycles/degree in P the K group when compared to the DSAEK one (p = 0.008 and 0.005, respectively). The QoL scores by the NEI RQL-42 test exhibited better values in DSAEK patients in 9 out of 13 scales. Conclusion: Our study confirms that UT-DSAEK provides a better visual function in terms of CDVA and CS, together with lower HOAs, when compared to PK. Hence, the vision-related QoL, binocularly evaluated by the NEI RQL-42 items, indicates a higher satisfaction in UT-DSAEK eyes.
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Affiliation(s)
- Massimo Castellucci
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Costanza Novara
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Alessandra Casuccio
- Department of Health Promotion, Mother Child Care, Internal Medicine and of Excellence, University of Palermo, 90127 Palermo, Italy;
| | - Giovannni Cillino
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Carla Giordano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Section of Endocrinology, Diabetology and Metabolism, University of Palermo, 90127 Palermo, Italy;
| | - Valentina Failla
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Vincenza Bonfiglio
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Maria Vadalà
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
| | - Salvatore Cillino
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Ophthalmology Section, University of Palermo, 90127 Palermo, Italy; (M.C.); (C.N.); (G.C.); (V.F.); (V.B.); (M.V.)
- Correspondence: ; Tel.: +39-0916-553-901; Fax: +39-091-342-770
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Fallico M, Avitabile T, Castellino N, Longo A, Russo A, Bonfiglio V, Parisi F, Furino C, Panozzo G, Scorcia V, Carnevali A, Bandello F, Parodi MB, Cennamo G, Cillino S, Vadalà M, Sunseri Trapani V, Cagini C, Fiore T, Lupidi M, Parravano M, Varano M, Giorno P, Boscia F, Giancipoli E, Eandi C, Le Mer Y, Reibaldi M. Intravitreal dexamethasone implant one month before versus concomitant with cataract surgery in patients with diabetic macular oedema: the dexcat study. Acta Ophthalmol 2021; 99:e74-e80. [PMID: 32588978 DOI: 10.1111/aos.14516] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/04/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To report clinical outcomes of two different timings of intravitreal dexamethasone (DEX) implant administration for prevention of diabetic macular oedema (DME) worsening following cataract surgery. METHODS This multicentre, retrospective study included patients with DME who received an intravitreal DEX implant 1 month before cataract surgery, 'precataract DEX' group, or at the time of cataract surgery, 'concomitant treatments' group. Inclusion criteria were a follow-up ≥3 months and ophthalmological examination with optical coherence tomography (OCT) imaging at baseline (cataract surgery) and throughout follow-up. Anatomical improvement was considered to be a decrease in OCT central subfield (CSF) thickness ≥20% compared to baseline. The primary outcomes were anatomical and functional results at 3 months. RESULTS Two hundred twenty-one patients were included: 136 in the 'precataract DEX' group and 85 in the 'concomitant treatments' group. At 3 months, a reduction of CSF thickness ≥ 20% was found in 7.3% of eyes in the 'precataract DEX group' and in 83.7% of eyes in the 'concomitant treatments' group (p < 0.001), with mean CSF thickness lower in the latter group (371 ± 52 µm versus 325 ± 57 µm, p < 0.001). At 3 months, mean best-corrected visual acuity had improved from baseline in both groups (p < 0.001), with no difference between groups (p = 0. 20). No serious systemic adverse events were reported. CONCLUSION Both approaches prevented a worsening of DME, showing a comparable visual outcome. Dexamethasone (DEX) implant given at the same time as cataract surgery provided a better anatomical outcome.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology University of Catania Catania Italy
- Eye Unit Southampton University Hospital Southampton UK
| | | | | | - Antonio Longo
- Department of Ophthalmology University of Catania Catania Italy
| | - Andrea Russo
- Department of Ophthalmology University of Catania Catania Italy
| | | | | | - Claudio Furino
- Department of Ophthalmology University of Bari Bari Italy
| | - Giacomo Panozzo
- Ophthalmology Unit Bussolengo Hospital Bussolengo Verona Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology University of “Magna Graecia” Catanzaro Italy
| | - Adriano Carnevali
- Department of Ophthalmology University of “Magna Graecia” Catanzaro Italy
| | - Francesco Bandello
- Department of Ophthalmology University Vita‐Salute Hospital San Raffaele Milano Italy
| | | | - Gilda Cennamo
- Department of Public Health University of Naples Federico II Naples Italy
| | - Salvatore Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Valentina Sunseri Trapani
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Carlo Cagini
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Tito Fiore
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Marco Lupidi
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | | | - Monica Varano
- Department of Ophthalmology IRCCS ‐ Fondazione Bietti Rome Italy
| | - Paola Giorno
- Department of Ophthalmology IRCCS ‐ Fondazione Bietti Rome Italy
| | | | | | - Chiara Eandi
- Department of Surgical Science Eye Clinic University of Torino Torino Italy
- Department of Ophthalmology Fondation Ophtalmologique A. De Rothschild Paris France
| | - Yannick Le Mer
- Department of Ophthalmology Fondation Ophtalmologique A. De Rothschild Paris France
| | - Michele Reibaldi
- Department of Ophthalmology University of Catania Catania Italy
- Department of Surgical Science Eye Clinic University of Torino Torino Italy
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26
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Palmieri B, Palmieri L, Mambrini A, Pepe V, Vadalà M. Onco-Esthetics Dilemma: Is There a Role for Electrocosmetic-Medical Devices? Front Oncol 2021; 10:528624. [PMID: 33585180 PMCID: PMC7879986 DOI: 10.3389/fonc.2020.528624] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/15/2020] [Indexed: 11/13/2022] Open
Abstract
Objective The primary aim of this review is to verify whether the warning against the use of electromedical instruments in the cosmetic professional or medical cancer patient settings is consistent with evident oncological risks supported by experimental in vitro/in vivo studies or anecdotal clinical reports, or any other reasonable statement. Methods MEDLINE, PubMed, Embase, AMED, Ovid, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched. Data relating to research design, sample population, type of electro-cosmetic devices used, were extracted. Results The search strategy identified 50 studies, 30 of which were potentially relevant. Conclusions Our research is in favor of moderate periodical use of cosmetic medical devices in patients bearing tumors, in any stage, like in healthy people. Special consideration is dedicated to massage, manipulation, and pressure delivery upon the cytoskeleton of cancer cells that has proven to be sensitive to mechanical stress at least in some specific locally relapsing cancers such as osteosarcoma.
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy.,Second Opinion Medical Network, Modena, Italy
| | - Lucia Palmieri
- Nephrology, Dialysis and Transplantation Complex Structure, Hospital of Modena, Modena, Italy
| | - Andrea Mambrini
- Medical Oncology Department, ASL Toscana Nord Ovest, Carrara, Italy
| | | | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy.,Second Opinion Medical Network, Modena, Italy
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27
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Mulè G, Vadalà M, Sinatra N, Mancia E, Sorce A, Geraci G, Carollo C, Montalbano K, Castellucci M, Guarrasi G, Cillino S, Cottone S. Relationship of choroidal thickness with pulsatile hemodynamics in essential hypertensive patients. J Clin Hypertens (Greenwich) 2021; 23:1030-1038. [PMID: 33492773 PMCID: PMC8678803 DOI: 10.1111/jch.14196] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
Controversy exists about the association of choroidal thickness (CTh) with blood pressure (BP) values. There is some evidence suggesting that central hemodynamics changes are associated with microvascular disease. Our study was aimed to assess the relationships between CTh and clinic and 24‐h BP and between CTh and estimated 24‐h aortic pulse pressure (aPP), 24‐h aortic systolic BP (aSBP), and 24‐h aortic augmentation index (aAIx) in a group of hypertensive patients. We enrolled 158 hypertensive subjects (mean age 48 ± 13 years) all of which underwent evaluation of the choroidal district by Swept‐Source optical coherence tomography (SS‐OCT) and 24‐h BP monitoring, in order to measure peripheral BP and to estimate central hemodynamic parameters. Inverse significant correlations of clinic PP, 24‐h aPP, 24‐h aSBP, and 24‐h aAIx with thicknesses of central ring, inner ring, and outer ring of the choroid and its overall average were found. The strongest of these correlations was that relating 24‐h aPP with overall average choroidal thickness (r = −.531; P < .001). When we divided the study population in subjects with 24‐h aPP above and below the median value (35 mm Hg), CTh were thinner in subjects with higher values of 24‐aPP as compared to those with lower ones, even after adjustment for age, and other potential confounders. The relationships of CTh with 24‐h aPP remained significant also taking into account the effects of various covariates in linear multiple regression analyses. Our findings support the concept of a cross‐talk between macro‐ and microcirculation.
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Affiliation(s)
- Giuseppe Mulè
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy.,Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università degli studi di Palermo, Palermo, Italy
| | - Maria Vadalà
- Dipartimento di Biomedicina sperimentale e Neuroscienze cliniche, Università degli studi di Palermo, Palermo, Italy
| | - Nicola Sinatra
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy.,Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università degli studi di Palermo, Palermo, Italy
| | - Ettore Mancia
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy.,Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università degli studi di Palermo, Palermo, Italy
| | - Alessandra Sorce
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy.,Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università degli studi di Palermo, Palermo, Italy
| | - Giulio Geraci
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy.,Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università degli studi di Palermo, Palermo, Italy
| | - Caterina Carollo
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy.,Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università degli studi di Palermo, Palermo, Italy
| | - Katia Montalbano
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy.,Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università degli studi di Palermo, Palermo, Italy
| | - Massimo Castellucci
- Dipartimento di Biomedicina sperimentale e Neuroscienze cliniche, Università degli studi di Palermo, Palermo, Italy
| | - Giulia Guarrasi
- Dipartimento di Biomedicina sperimentale e Neuroscienze cliniche, Università degli studi di Palermo, Palermo, Italy
| | - Salvatore Cillino
- Dipartimento di Biomedicina sperimentale e Neuroscienze cliniche, Università degli studi di Palermo, Palermo, Italy
| | - Santina Cottone
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy.,Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università degli studi di Palermo, Palermo, Italy
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Vadalà M, Cistaro A, Quartuccio N, Calcagni ML, Fania P, Margotti S, Schiera IG, Laurino C, Palmieri B. 18F-FDG-PET brain imaging may highlight brain metabolic alterations in dysautonomic syndrome after human papilloma virus vaccination. Nucl Med Commun 2020; 41:1275-1282. [PMID: 32897935 DOI: 10.1097/mnm.0000000000001280] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to evaluate brain glucose metabolism by means of [18F]-fluoro-deoxygluycose (F-FDG) PET in a group of patients presenting dysautonomic syndrome after human papilloma virus (HPV) immunization. METHODS Medical records of patients, referred to the 'Second Opinion Medical Consulting Network' Medical Centre (Modena, Italy) diagnosed with dysautonomic syndrome were searched. Inclusion criteria were presence in the medical history of adverse drug reactions following HPV vaccine; a Montreal Cognitive Assessment score <25 and good quality of a F-FDG-PET brain scan performed within 12 months from the diagnosis of dysautonomic syndrome. F-FDG-PET images of patients (HPV-group) were compared to a control group, matched for age and sex, using statistical parametric mapping (SPM). RESULTS The F-FDG-PET study was available for five female patients. The SPM-group analysis revealed significant hypometabolism (P < 0.05 false discovery rate corrected) in the right superior and medial temporal gyrus (Brodmann areas 22, 21) and insula (Brodmann area 13). At a threshold of P < 0.001 (uncorrected), further hypometabolic regions were revealed in the right superior temporal gyrus (Brodmann area 42) and caudate head and in the left superior temporal gyrus (Brodmann area 22), frontal subcallosal gyrus (Brodmann area 47) and insula (Brodmann area 13). Relative hypermetabolism (P = 0.001) was revealed in the right premotor cortex (Brodmann area 6). CONCLUSION This study revealed the possibility of altered brain glucose metabolism in subjects with dysautonomic syndrome post-immunization with HPV vaccine. These results could reinforce the hypothesis of a causal relationship between HPV vaccine, or some component included in the vaccine and the development of clinical manifestations.
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Affiliation(s)
- Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic
- Network of the Second Opinion, Modena
| | - Angelina Cistaro
- Nuclear Medicine Department, Galliera Hospital, Genoa
- Coordinator of AIMN Paediatric Study Group, Milan, Italy
| | - Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Civico, Di Cristina and Benfratelli Hospitals, Palermo
| | | | | | | | | | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic
- Network of the Second Opinion, Modena
| | - Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic
- Network of the Second Opinion, Modena
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Palmieri B, Iannitti T, Morales-Medina JC, Vadalà M. Monocentric single-arm study of desmopressin acetate efficacy on nocturnal polyuria in the elderly. Int J Clin Pract 2020; 74:e13612. [PMID: 32668490 DOI: 10.1111/ijcp.13612] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022] Open
Abstract
AIM OF THE STUDY We designed a retrospective, monocentric, observational study to assess the efficacy and short-term side effect profile of desmopressin, a synthetic analogue of antidiuretic hormone, in 42 elderly patients affected by nocturnal polyuria (NP), a subset of nocturia (nocturnal overproduction of urine at night), which is characterised by nocturnal urine volume (NVU) exceeding 33% of the 24-hours total urine output. METHODS USED TO CONDUCT THE STUDY The subjects had NP and included 25 males, which had benign prostatic hyperplasia (12 out of 25 had been surgically or endoscopically operated) and 15 females that had increased urinary frequency, night-time voiding, loss of bladder control and recurrent bladder infections, due to perineal wall weakness and vaginal or bladder prolapse. Patients recorded the number of voids during waking hours using a digital continuous urine meter. The quality of life (QoL) and efficacy of desmopressin were assessed at baseline and 12 weeks after treatment using the International Consultation on Incontinence Questionnaire Nocturia Quality of Life Module (ICIQ-Nqol) and International Prostate Symptom Score questionnaire (IPPS-Q8). The dosage of desmopressin acetate varied according to the discretion of the physician, usually beginning with one tablet before going to bed at night for 3 months. The dose was increased at 1-week intervals if a reduction in the NVU or night-time frequency was not achieved. RESULTS OF THE STUDY We found that desmopressin treatment reduced the nocturnal voided volume (P < .0001), ICIQ-Nqol (P < .0001) and IPPS-Q8 (P < .0001). No significant serum sodium alterations or modifications in serum creatine, potassium, or body weight were observed in all the patients. No adverse effects were observed. CONCLUSIONS DRAWN FROM THE STUDY AND CLINICAL IMPLICATIONS Our findings show efficacy of desmopressin in the elderly for NP treatment supporting further clinical trials in larger cohorts of patients.
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
- Second Opinion Medical Network, Modena (MO), Italy
| | - Tommaso Iannitti
- Charles River Discovery Research Services UK Limited, Portishead, UK
| | - Julio Cesar Morales-Medina
- Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala CP 90000, AP 62, Tlaxcala, México
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Modena (MO), Italy
- Second Opinion Medical Network, Modena (MO), Italy
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30
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Antona V, Scalia F, Giorgio E, Radio FC, Brusco A, Oliveri M, Corsello G, Lo Celso F, Vadalà M, Conway de Macario E, Macario AJL, Cappello F, Giuffrè M. A Novel CCT5 Missense Variant Associated with Early Onset Motor Neuropathy. Int J Mol Sci 2020; 21:ijms21207631. [PMID: 33076433 PMCID: PMC7589105 DOI: 10.3390/ijms21207631] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 12/04/2022] Open
Abstract
Diseases associated with acquired or genetic defects in members of the chaperoning system (CS) are increasingly found and have been collectively termed chaperonopathies. Illustrative instances of genetic chaperonopathies involve the genes for chaperonins of Groups I (e.g., Heat shock protein 60, Hsp60) and II (e.g., Chaperonin Containing T-Complex polypeptide 1, CCT). Examples of the former are hypomyelinating leukodystrophy 4 (HLD4 or MitCHAP60) and hereditary spastic paraplegia (SPG13). A distal sensory mutilating neuropathy has been linked to a mutation [p.(His147Arg)] in subunit 5 of the CCT5 gene. Here, we describe a new possibly pathogenic variant [p.(Leu224Val)] of the same subunit but with a different phenotype. This yet undescribed disease affects a girl with early onset demyelinating neuropathy and a severe motor disability. By whole exome sequencing (WES), we identified a homozygous CCT5 c.670C>G p.(Leu224Val) variant in the CCT5 gene. In silico 3D-structure analysis and bioinformatics indicated that this variant could undergo abnormal conformation and could be pathogenic. We compared the patient’s clinical, neurophysiological and laboratory data with those from patients carrying p.(His147Arg) in the equatorial domain. Our patient presented signs and symptoms absent in the p.(His147Arg) cases. Molecular dynamics simulation and modelling showed that the Leu224Val mutation that occurs in the CCT5 intermediate domain near the apical domain induces a conformational change in the latter. Noteworthy is the striking difference between the phenotypes putatively linked to mutations in the same CCT subunit but located in different structural domains, offering a unique opportunity for elucidating their distinctive roles in health and disease
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Affiliation(s)
- Vincenzo Antona
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (V.A.); (G.C.); (M.G.)
| | - Federica Scalia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, 90127 Palermo, Italy; (F.S.); (M.V.)
- Department of Biomolecular Strategies, Genetics and Advanced Therapies, Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Elisa Giorgio
- Department of Medical Sciences, University of Torino, 10126 Torino, Italy; (E.G.); (A.B.)
| | - Francesca C. Radio
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù IRCSS, 00146 Rome, Italy;
| | - Alfredo Brusco
- Department of Medical Sciences, University of Torino, 10126 Torino, Italy; (E.G.); (A.B.)
| | - Massimiliano Oliveri
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, 90128 Palermo, Italy;
| | - Giovanni Corsello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (V.A.); (G.C.); (M.G.)
| | - Fabrizio Lo Celso
- Department of Physics and Chemistry—Emilio Segrè, University of Palermo, 90128 Palermo, Italy;
- Ionic Liquids Laboratory, Institute of Structure of Matter, Italian National Research Council (ISM-CNR), 00133 Rome, Italy
| | - Maria Vadalà
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, 90127 Palermo, Italy; (F.S.); (M.V.)
- Department of Biomolecular Strategies, Genetics and Advanced Therapies, Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
| | - Everly Conway de Macario
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore-Institute of Marine and Environmental Technology (IMET), Baltimore, MD 21202, USA;
| | - Alberto J. L. Macario
- Department of Biomolecular Strategies, Genetics and Advanced Therapies, Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore-Institute of Marine and Environmental Technology (IMET), Baltimore, MD 21202, USA;
| | - Francesco Cappello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, 90127 Palermo, Italy; (F.S.); (M.V.)
- Department of Biomolecular Strategies, Genetics and Advanced Therapies, Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy;
- Correspondence:
| | - Mario Giuffrè
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (V.A.); (G.C.); (M.G.)
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31
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Vadalà M, Sunseri Trapani V, Guarrasi G, Ventura N, Castellucci M, Cillino S. A Real-World Study of Dexamethasone Implant in Treatment-Naïve Patients with Diabetic Macular Edema: Efficacy and Correlation Between Inflammatory Biomarkers and Treatment Outcome. Clin Ophthalmol 2020; 14:2657-2665. [PMID: 32982158 PMCID: PMC7501979 DOI: 10.2147/opth.s257775] [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: 04/27/2020] [Accepted: 08/07/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose There has been an increasing clinical interest in specific retinal parameters as non-invasive biomarkers of retinal inflammation in diabetic macular edema (DME) that have been shown to have prognostic value, such as hyperreflective retinal fields (HRFs) and subfoveal neuroretinal detachment (SND). Methods We conducted a prospective, non-comparative study of treatment-naïve patients with DME to evaluate the efficacy of a Pro Re Nata (PRN) regimen of intravitreal dexamethasone implant 0.7 mg (DexI, Ozurdex™). After administration, patients underwent subsequent injections according to PRN criteria in case of edema relapse, but not earlier than 4 months after the previous treatment. Patients were evaluated at baseline, within 15 days of injection, and every month thereafter. During all visits, best-corrected visual acuity (BCVA) was recorded; central retinal thickness (CRT), type of edema, presence of SND, and presence and number of HRFs were evaluated using swept-source optical coherence tomography (SS-OCT) 3D. Treatment outcome was defined as changes in BCVA, CRT, SND and HRFs at 12 (T12) and 24 (T24) months compared with baseline (T0). Results The study enrolled 24 eyes of 18 patients. The mean duration of follow-up was 18±6.6 months; for all eyes, T12 data were available, while follow-up reached T24 for 12 eyes. BCVA improved significantly and CRT decreased significantly during treatment; the edema was no longer detectable in 13/24 eyes at T12 and 8/12 eyes at T24. No patient presented SND at T12 and T24, and the mean number of HRFs decreased significantly during treatment. Results with CRT and HRFs correlated with BCVA at 12 and 24 months. No significant adverse events were observed. Conclusion In patients with DME, the intravitreal dexamethasone implant was effective and safe in improving both functional and tomographic parameters. This result is consistent with improvement in biomarkers of inflammation.
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Affiliation(s)
- Maria Vadalà
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy.,IEMEST, Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | | | - Giulia Guarrasi
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Nicasio Ventura
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Massimo Castellucci
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Salvatore Cillino
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
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Abstract
Wound healing is the sum of physiological sequential steps, leading to skin restoration. However, in some conditions, such as diabetes, pressure ulcers (PU) and venous legs ulcers (VLU), healing is a major challenge and requires multiple strategies. In this context, some electromedical devices may accelerate and/or support wound healing, modulating the inflammatory, proliferation (granulation) and tissue-remodelling phases. This review describes some helpful electromedical devices including: ultrasonic-assisted wound debridement; electrotherapy; combined ultrasound and electric field stimulation; low-frequency pulsed electromagnetic fields; phototherapy (for example, laser therapy and light-emitting diode (LED) therapy); biophotonic therapies, and pressure therapies (for example, negative pressure wound therapy, and high pressure and intermittent pneumatic compression) The review focuses on the evidence-based medicine and adequate clinical trial design in relation to these devices.
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Via del Pozzo, 71, 41124, Modena, Italy.,Second Opinion Medical Network, Via Ciro Bisi, 125, Modena, Italy
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Via del Pozzo, 71, 41124, Modena, Italy.,Second Opinion Medical Network, Via Ciro Bisi, 125, Modena, Italy
| | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Via del Pozzo, 71, 41124, Modena, Italy.,Second Opinion Medical Network, Via Ciro Bisi, 125, Modena, Italy
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Palmieri B, Vadalà M, Roncati L, Garelli A, Scandone F, Bondi M, Cermelli C. The long-standing history of Corynebacterium parvum, immunity, and viruses. J Med Virol 2020; 92:2429-2439. [PMID: 32472706 PMCID: PMC7300755 DOI: 10.1002/jmv.26100] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
We report a review of all the experimental and clinical studies performed in the last 60 years on the antiviral activity of inactivated Corynebacterium parvum (Cutibacterium acnes). This bacterium has been originally investigated and used for its oncolytic properties linked to immunomodulating activity, but the interest to successfully prevent and treat bacterial, fungal, and viral infections and lethality, uprising the innate immunity barriers produced many experimental models and very few clinical studies. The dramatic defenseless situation due to impending CoViD‐19 pandemic claims to exhume and highlight this aspecific strategy in preventive and therapeutic settings; as a matter of fact, no new or mutated virus can potentially escape to this strong innate immune surveillance strengthened by adequate C. parvum protocols.
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy.,Clinical Research Department, Second Opinion Medical Network, Modena, Italy
| | - Maria Vadalà
- Clinical Research Department, Second Opinion Medical Network, Modena, Italy
| | - Luca Roncati
- Department of Pathology, University Hospital of Modena, Modena, Italy
| | - Andrea Garelli
- Department of Plastic and Reconstructive Surgery, Tor vergata's University, Roma, Italy
| | | | - Moreno Bondi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudio Cermelli
- Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Vadalà M, Laurino C, Corazzari V, Palmieri B. A Proposal for Clinical Biomarkers in Multiple Chemical Sensitivity. Clin Ter 2020; 171:e149-e155. [PMID: 32141487 DOI: 10.7417/ct.2020.2205] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple chemical sensitivity (MCS) is increasingly widespread disease, characterized by non-specific and recurring symptoms from various organs associated with exposure to common chemicals, even if inhaled at low concentrations, usually harmless for normal people. MCS is not yet well recognized from common point of view and for this reason affected patients risk marginalization and their symptoms are often trivialized. It is actually a devastating chronic disease that affects not only the patients in the daily routine but partly conditions their survival. Despite more than 50 years of research, the action mechanisms of MCS is still undefined. In this study we examine the theories about the etiopathogenesis of multiple chemical sensitivity that include genetic susceptibility factors, immunological factors, neurological factors and psychiatric factors. Since no specific diagnostic markers are currently available for the MCS, the diagnosis can only be supposed on the basis symptomatic criteria and patient's medical history. However new biochemical markers and diagnostic imaging techniques have emerged, useful to postulate at least the clinical-diagnostic hypothesis of MCS and in this paper we discuss a list of biomarkers studied for the diagnosis of MCS, based on the available scientific literature. At last but not least, we propose four-levels MCS tests that could help the clinician in the diagnosis of the pathology both through the use of quantifiable serological parameters, both through diagnostic tools, genetic testing and through clinical observation of symptoms.
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Affiliation(s)
- M Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Medical School, Surgical Clinic, Italy - Second Opinion Medical Network, Modena, Italy
| | - C Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Medical School, Surgical Clinic, Italy - Second Opinion Medical Network, Modena, Italy
| | - V Corazzari
- Second Opinion Medical Network, Modena, Italy
| | - B Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Medical School, Surgical Clinic, Italy - Second Opinion Medical Network, Modena, Italy
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Abstract
AIM: The aim of the study was to evaluate the clinical relevance, sensitivity and specificity of in vitro blood test, Memory Lymphocyte ImmunoStimulation Assay (MELISA®), in genetically predisposed patients that suffer by autoimmune/inflammatory syndrome induced by adjuvants, after HPV-vaccination and that could have a high metal hypersensitivity. MATERIALS AND METHODS: Sixteen girls (aged 12–24 years) that developed long-lasting and invalidating somatoform symptoms occurring within 20 days postvaccination are included in this descriptive study. The hypersensitivity to five metals (aluminum, nickel, mercury, methyl mercury, and thimerosal) was measured by MELISA® test. RESULTS: Seven girls showed negativity to all the five metals tested. The findings showed metal hypersensitivity only in nine patients: Toxicity to aluminum (two girls), reactivity to nickel (seven girls), followed by mercury (seven girls). CONCLUSION: The MELISA® assay is neither sensitive nor specific in detecting metal hypersensitivity and associated chronic diseases, including autoimmune pathologies.
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Affiliation(s)
- Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy.,Network of the Second Opinion, Modena, Italy
| | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy.,Network of the Second Opinion, Modena, Italy
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Gagliardo C, Radellini S, Morreale Bubella R, Falanga G, Richiusa P, Vadalà M, Ciresi A, Midiri M, Giordano C. Lacrimal gland herniation in Graves ophthalmopathy: a simple and useful MRI biomarker of disease activity. Eur Radiol 2020; 30:2138-2141. [PMID: 31953667 DOI: 10.1007/s00330-019-06570-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/20/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lacrimal gland (LG) involvement in patients with Graves ophthalmopathy (GO) has been considered as a potential cause of the associated GO symptoms and different studies demonstrated the LG involvement in patients with GO than healthy controls. The aim of this study was to evaluate LG involvement, through measurement of its herniation, using a magnetic resonance imaging (MRI) index, in patients with different GO activities. METHODS Thirty-two consecutive Caucasian patients affected by GO were enrolled and grouped in group A (16 with inactive GO, CAS < 3) and B (16 with active GO, CAS ≥ 3) according to their GO activity. All patients underwent clinical-endocrinological assessment, a complete ocular evaluation, and orbital MRI examination. RESULTS No difference was found between the hormonal parameters, thyroid ultrasound-derived parameters, and thyroid-stimulating hormone (TSH) receptor (TSH-R) antibodies (TRAb) levels in group B and those in group A. The LG herniation (LGH) measurement evaluated by MRI was significantly higher in group B for both right (10.1 (7.3-17) vs. 7 (0-3.4) mm; p = 0.004) and left (8.5 (6.6-13) vs. 5.8 (0-12) mm; p = 0.026) eye than group A. A positive correlation was found between TRAb and LGH herniation (Rho 0.462, p = 0.009). CONCLUSIONS Measurement of LGH seems to be a good marker of the disease and GO activity. KEY POINTS • Lacrimal gland herniation is a simple index related to disease activity • Lacrimal gland herniation is correlated to TRAb levels • Lacrimal gland evaluation could be useful to differentiate active from inactive Graves ophthalmopathy in an early stage of disease.
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Geraci G, Maria Zammuto M, Vadalà M, Mattina A, Castellucci M, Guarrasi G, Nardi E, Maida C, Zanoli L, Cillino S, Cottone S, Mulè G. Choroidal thickness is associated with renal hemodynamics in essential hypertension. J Clin Hypertens (Greenwich) 2020; 22:245-253. [PMID: 31945274 DOI: 10.1111/jch.13777] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 10/26/2019] [Accepted: 11/17/2019] [Indexed: 01/02/2023]
Abstract
The choroid is the most vascularized structure of the eye and plays a central role in the development of the retinal vascular changes that occur in arterial hypertension. Changes of choroidal thickness (ChT) assessed by optical coherence tomography (OCT) technology could reflect the vascular complications of hypertension. Also, intrarenal hemodynamic damage, associated with endothelial dysfunction, demonstrated to be a good indicator of systemic morphofunctional arterial impairment. The aim of this study is to assess the relationship between ChT and renal hemodynamics in subjects with essential hypertension. Routine laboratory tests, clinical history, and physical examination, including blood pressure assessment, were performed in 90 subjects with essential hypertension. All patients underwent Doppler ultrasonographic evaluation of intra-renal hemodynamics and OCT imaging to assess ChT. When subjects were divided in two groups based on renal resistive index (RRI), group I (RRI ≥ 75% percentile) showed significantly lower values of ChT than group II (RRI < 75% percentile) (P < .001). When divided in two groups based on the ChT median values, patients with lower ChT had significantly higher RRI values than those with ChT above the median values (P < .05). In multivariate model including age, eGFR, and other variables as confounding factors, RRI ≥ 75% was independently associated with ChT. ChT was significantly correlated with renal resistive index in subjects with essential hypertension, confirmed in multivariate analyses. This result could be referred to changes in vascular elastic properties that occur in retinal and intrarenal vascular system probably due to oxidative stress and endothelial dysfunction commonly found in early complications of hypertension.
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Affiliation(s)
- Giulio Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy
| | - Marta Maria Zammuto
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy
| | - Maria Vadalà
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Section of Ophthalmology, University of Palermo, Palermo, Italy
| | - Alessandro Mattina
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Internal Medicine, University of Palermo, Palermo, Italy.,IRCCS Centro Neurolesi "Bonibo-Pulejo", Messina, Italy
| | - Massimo Castellucci
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Section of Ophthalmology, University of Palermo, Palermo, Italy
| | - Giulia Guarrasi
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Section of Ophthalmology, University of Palermo, Palermo, Italy
| | - Emilio Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Internal Medicine, University of Palermo, Palermo, Italy
| | - Carlo Maida
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Section of Ophthalmology, University of Palermo, Palermo, Italy
| | - Luca Zanoli
- Clinical and Experimental Medicine, Section of Nephrology, University of Catania, Catania, Italy
| | - Salvatore Cillino
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Section of Ophthalmology, University of Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy
| | - Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy
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Abstract
Nutrition can be outlined in terms of epigenetic signals influencing each of the wound healing steps (haemostasis, inflammatory, proliferative and remodelling phase). Specific nutrients, such as amino acids, minerals, vitamins, natural compounds and herbal extracts, target DNA-regulating transcription factors, cytokines, extracellular matrix proteins and glycosaminoglycan, and are specifically involved in the wound healing process. This review focuses on experimental in vivo and clinical evidence of dietary supplements administration in pressure ulcers. A good nutritional status is, for example, fundamental to the haemostasis phase of skin wounds. In the inflammatory phase, vitamin A enhances cytokine release, bromelain and amino acids prevent prolonged inflammatory events, while vitamin C enhances neutrophil migration and lymphocyte activation. In the proliferative phase, vitamin C and Centella asiatica are required for collagen synthesis. Glucosamine enhances hyaluronic acid production, vitamin A promotes epithelial cell differentiation, zinc is required for DNA and protein synthesis and cell division, and Aloe vera supports granulation tissue generation. Finally, in the remodelling phase, amino acids and proteins play a key role in wound scar stabilisation.
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Affiliation(s)
- Beniamino Palmieri
- Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con Interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università degli Studi di Modena e Reggio Emilia, Modena, Italy. Second Opinion Medical Network
| | - Maria Vadalà
- Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con Interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università degli Studi di Modena e Reggio Emilia, Modena, Italy. Second Opinion Medical Network
| | - Carmen Laurino
- Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con Interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università degli Studi di Modena e Reggio Emilia, Modena, Italy. Second Opinion Medical Network
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Palmieri B, Vadalà M, Laurino C. The FIT therapy for the treatment of musculoskeletal and neurological disorders related symptoms: A retrospective observational study. Asian J Med Sci 2019. [DOI: 10.3126/ajms.v10i5.21230] [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: 11/18/2022] Open
Abstract
Background: Far Infrared Waves (FIW) with frequency range among few hundreds gigahertz (GHz) and few terahertz (THz) display some positive effects on neurological and musculoskeletal disorders.
Aims and Objectives: Our retrospective observational study describes the benefits observed by the administration of an infrared –trapping and focusing plaster (FIT-PATCH) in patients affected by different musculoskeletal and neurological symptoms.
Materials and Methods: 100 patients were retrospectively reviewed through the Second Opinion Medical Network. Each patient sticked a FIT-PATCH every 5 days for 1 month upon the skin in the painful/inflamed area. Quality of life (QOL) assessment was evaluated by the Short Form-36 (SF-36) health survey questionnaire before starting the treatment and after the fourth week and the Visual Analogue Scale (VAS) completed the pre-post treatment subjective pain record.
Results: SF-36 showed significantly improvement of the pre-post treatment scores (P < 0.03), pain score (P < 0.02), general health score (P < 0.03) and in the emotional component scores (P < 0.03). The VAS pain score was either improved (P < 0.02) after plaster administration. No side effects or allergenic skin reactions were reported along the study.
Conclusions: The FIT patches improved the symptoms probably through a mechanism involving the sebaceous/sweat glands system spreading the fit irradiating infrared THz waves energy, to the surrounding tissues with both a thermal and electromagnetic putative effect.The occlusive mechanism of the patch on the skin surface increasing the local thermic gradient cannot be adequately supposed to be therapeutically effective, because the FIT patch locally applied induces haemodynamic microvascular modification, not only locally but also remote. Thus, the intrinsic chemical properties of the FIT formulation absorbs and concentrates the endogenous infrared waves amplifying and reverberating them into the underlying tissues near and far, through low-Q-factor helical antennas of the sweat glands spreading the energy all over the body. Hence, the claim is that fit basically absorbs and concentrates the endogenous infrared waves into the affected districts and accelerates symptoms recovery.
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Abstract
The restoration of the skin barrier in acute and chronic wounds is controlled by several molecular mechanisms that synergistically regulate cell kinetics, enzymatic functions, and neurovascular activation. These pathways include genetic and epigenetic activation, which modulate physiological wound healing. Our review describes the genetic background of skin repair, namely transcription-independent diffusible damage signals, individual variability, epigenetic mechanism, controlled qualitative traits, post-translational mechanisms, antioxidants, nutrients, DNA modifications, bacteria activation, mitochondrial activity, and oxidative stress. The DNA background modulating skin restoration could be used to plan new diagnostics and therapeutics.
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Affiliation(s)
- B Palmieri
- Associated Professor, Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con Interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università degli Studi di Modena e Reggio Emilia, Modena, Italy; Network del Secondo Parere, Modena (MO), Italy
| | - M Vadalà
- Biologist Researcher, Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con Interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università degli Studi di Modena e Reggio Emilia, Modena, Italy; Network del Secondo Parere, Modena (MO), Italy
| | - C Laurino
- Biologist Researcher, Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con Interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università degli Studi di Modena e Reggio Emilia, Modena, Italy; Network del Secondo Parere, Modena (MO), Italy
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Palmieri B, Laurino C, Vadalà M. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars. Clin Ter 2019; 170:e93-e99. [PMID: 30993303 DOI: 10.7417/ct.2019.2116] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the therapeutic effect of CBD-ointment administered on severe skin chronic diseases and/or on their outcome scars. METHODS A spontaneous, anecdotal, retrospective study of 20 patients with two most frequent skin disorders: psoriasis (n: 5 patients), atopic dermatitis (n: 5) and resulting outcome scars (n: 10). The subjects were instructed to administer topical CBD-enriched ointment to lesioned skin areas twice daily for three months treatment. RESULTS Based on skin evaluations (hydration, TEWL, elasticity), clinical questionnaires (SCORAD, ADI, PASI), and supported by photographic data and investigators' clinical assessment, the results showed that topical treatment with CBD-enriched ointment significantly improved the skin parameters, the symptoms and also the PASI index score. No irritant or allergic reactions were documented during the period treatment. CONCLUSIONS The topical administration of CBD ointment, without any THC, is a safe and effective non-invasive alternative for improve the quality of life in patients with some skin disorders, especially on inflammatory background.
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Affiliation(s)
- B Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena - Second Opinion Medical Network, Modena (MO), Italy
| | - C Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena - Second Opinion Medical Network, Modena (MO), Italy
| | - M Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena - Second Opinion Medical Network, Modena (MO), Italy
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Palmieri B, Laurino C, Vadalà M. Spontaneous, anecdotal, retrospective, open-label study on the efficacy, safety and tolerability of cannabis galenical preparation (Bedrocan). Int J Pharm Pract 2019; 27:264-270. [PMID: 30768819 PMCID: PMC6593769 DOI: 10.1111/ijpp.12514] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Our main aim was to investigate the short-term therapeutic effects, safety/tolerability and potential side effects of the cannabis galenical preparation (Bedrocan) in patients with a range of chronic conditions unresponsive to other treatments. METHODS In this retrospective, 'compassionate use', observational, open-label study, 20 patients (age 18-80 years) who had appealed to our 'Second Opinion Medical Consulting Network' (Modena, Italy), were instructed to take sublingually the galenical oil twice a day for 3 months of treatment. The usual starting dose was low (0.5 ml/day) and gradually titrated upward to the highest recommended dose (1 ml/day). Tolerability and adverse effects were assessed at baseline and monthly thereafter during the treatment period through direct contact (email or telephone) or visit if required. Patients' quality of life was evaluated at baseline and 3 months using the medical outcome short-form health survey questionnaire (SF-36). KEY FINDINGS From baseline to 6 months post-treatment, SF-36 scores showed: reductions in total pain (P < 0.03); improvements in the physical component (P < 0.02); vitality (P < 0.03); social role functioning (P < 0.02); and general health state (P < 0.02). No changes in role limitations (P = 0.02) due to emotional state (e.g. panic, depression, mood alteration) were reported. Monthly reports of psychoactive adverse effects showed significant insomnia reduction (P < 0.03) and improvement in mood (P < 0.03) and concentration (P < 0.01). CONCLUSIONS These data suggest that a cannabis galenical preparation may be therapeutically effective and safe for the symptomatic treatment of some chronic diseases. Further studies on the efficacy of cannabis as well as cannabinoid system involvement in the pathophysiology are warranted.
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical SpecialtiesUniversity of Modena and Reggio Emilia Medical School, Surgical ClinicModenaItaly
- Second Opinion Medical NetworkModenaItaly
| | - Carmen Laurino
- Department of General Surgery and Surgical SpecialtiesUniversity of Modena and Reggio Emilia Medical School, Surgical ClinicModenaItaly
- Second Opinion Medical NetworkModenaItaly
| | - Maria Vadalà
- Department of General Surgery and Surgical SpecialtiesUniversity of Modena and Reggio Emilia Medical School, Surgical ClinicModenaItaly
- Second Opinion Medical NetworkModenaItaly
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Vadalà M, Castellucci M, Guarrasi G, Terrasi M, La Blasca T, Mulè G. Retinal and choroidal vasculature changes associated with chronic kidney disease. Graefes Arch Clin Exp Ophthalmol 2019; 257:1687-1698. [PMID: 31147842 DOI: 10.1007/s00417-019-04358-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 11/17/2018] [Revised: 05/04/2019] [Accepted: 05/14/2019] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Retinal and choroidal microvascular changes can be related to renal impairment in hypertension and chronic kidney disease (CKD). The study examines the association between retinochoroidal parameters and renal impairment in hypertensive, non-diabetic patients. METHODS This is a cross-sectional study on Caucasian patients with systemic arterial hypertension with different levels of renal function. All subjects were studied by blood chemistry, urine examination, microalbuminuria and blood pressure. Complete eye examination was completed with swept source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCTA) scans of macular region. Patients were divided in groups: LowGFR and HighGFR and CKD- and CKD+, according to the value of glomerular filtrate (GFR) and albuminuria. LowGFR and CKD+ groups included patients with clinical kidney impairment. RESULTS One hundred and twenty eyes of 120 hypertensive patients were evaluated. The mean retinal thickness was thinner in CKD+ versus CKD- group (p < 0.009). LowGFR and CKD+ groups showed thinner choroidal values than HighGFR (p < 0.02) and CKD- (p < 0.001) groups. OCTA showed lower density in LowGFR than in HighGFR group (p < 0.001) and in CKD+ versus CKD- group (p < 0.001). Albuminuria was inversely related to choroidal and retinal thickness measures (p < 0.001) and to the indices of superficial parafoveal (p < 0.05) and foveal (p < 0.05) vascular densities. CONCLUSIONS CKD is associated with retinal thinning, eGFR and decreasing renal function with progressive reduction of choroidal and retinal vascular density. SS-OCT and OCTA documented close association between CKD and reduction of both choroidal thickness and paracentral retinal vascular density in hypertensive patients.
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Affiliation(s)
- Maria Vadalà
- Dipartimento di Biomedicina Sperimentale e Neuroscienze cliniche, Sezione di Oftalmologia, University of Palermo, Via Liborio Giuffrè 13, 90127, Palermo, Italy.
| | - Massimo Castellucci
- Dipartimento di Biomedicina Sperimentale e Neuroscienze cliniche, Sezione di Oftalmologia, University of Palermo, Via Liborio Giuffrè 13, 90127, Palermo, Italy
| | - Giulia Guarrasi
- Dipartimento di Biomedicina Sperimentale e Neuroscienze cliniche, Sezione di Oftalmologia, University of Palermo, Via Liborio Giuffrè 13, 90127, Palermo, Italy
| | - Micol Terrasi
- Dipartimento di Biomedicina Sperimentale e Neuroscienze cliniche, Sezione di Oftalmologia, University of Palermo, Via Liborio Giuffrè 13, 90127, Palermo, Italy
| | - Tiziana La Blasca
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
| | - Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
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Mulè G, Vadalà M, La Blasca T, Gaetani R, Virone G, Guarneri M, Castellucci M, Guarrasi G, Terrasi M, Cottone S. Association between early-stage chronic kidney disease and reduced choroidal thickness in essential hypertensive patients. Hypertens Res 2019; 42:990-1000. [DOI: 10.1038/s41440-018-0195-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 01/01/2023]
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Iannitti T, Morales-Medina JC, Merighi A, Boarino V, Laurino C, Vadalà M, Palmieri B. A hyaluronic acid- and chondroitin sulfate-based medical device improves gastritis pain, discomfort, and endoscopic features. Drug Deliv Transl Res 2018; 8:994-999. [PMID: 29796851 PMCID: PMC6133073 DOI: 10.1007/s13346-018-0531-7] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Gastritis is an inflammation of the gastric mucosa. In this study, we investigated the efficacy of a medical device, Esoxx®, based on hyaluronic acid and chondroitin sulfate on gastritis-related upper abdominal pain/discomfort and endoscopic features. Fifty patients, affected by gastritis, were randomised to receive the medical device or placebo. The primary endpoint was the medical device efficacy on upper abdominal pain/discomfort associated with gastritis and measured by Visual Analogue Scale (VAS). The secondary endpoints were the efficacy of the medical device on gastritis-related mucosal erosions, blood oozing, and hyperemia (redness)/edema, as assessed by endoscopy, and the patients’ rating of their compliance with the treatments. A significant reduction in VAS pain was observed in the treatment group after a 5-week treatment, if compared with placebo (p < 0.001). In summary, administration of a medical device, based on hyaluronic acid and chondroitin sulfate, improves gastritis-related upper abdominal pain/discomfort and decreases mucosal erosions, blood oozing, and hyperemia (redness)/edema at 5-week follow-up in patients affected by gastritis.
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Affiliation(s)
- Tommaso Iannitti
- KWS BioTest, 47-48 Martingale Way, Marine View Office Park, BS20 7AW, Portishead, Somerset, UK.
| | - Julio César Morales-Medina
- Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, AP 62, CP 90000, Tlaxcala, Mexico
| | - Alberto Merighi
- Department of Gastroenterology, Division of Digestive Endoscopy, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Valentina Boarino
- Department of Gastroenterology, Division of Digestive Endoscopy, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, 41124, Modena, Italy.,Second Opinion Medical Network, Modena, Italy
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, 41124, Modena, Italy.,Second Opinion Medical Network, Modena, Italy
| | - Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, 41124, Modena, Italy.,Second Opinion Medical Network, Modena, Italy
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Imperatori L, Giardini D, Latini G, Migliori G, Blasi C, Bunkheila F, Breschi C, Mattioli R, Pelliccioni S, Laurino C, Vadalà M, Palmieri B, Iannitti T. Feasibility single-arm study of a medical device containing Desmodium adscendens and Lithothamnium calcareum combined with chemotherapy in head and neck cancer patients. Cancer Manag Res 2018; 10:5433-5438. [PMID: 30519091 PMCID: PMC6234998 DOI: 10.2147/cmar.s165746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Neoplasms of the head and neck represent approximately 5% of cancers and they require complex multidisciplinary clinical management. Desmodium adscendens (Desmodium) is a plant that possesses anti-allergic, antioxidant and hepatoprotective properties. Lithothamnium calcareum (Lithothamnium) is a calcified seaweed that possesses remineralization properties and the ability to maintain homeostasis. Aim In this single-arm study, we investigated the efficacy of a combination therapy based on Desmovit® which contains Desmodium and Lithothamnium, and chemotherapy in patients with head and neck cancer. Methods Twelve patients with histological or cytological diagnosis of stage IV head and neck cancer were enrolled in this study that was approved by the ethics committee of the Unità Operativa Complessa (UOC) di Oncologia Medica Azienda Ospedaliera Ospedali Riuniti Marche Nord and followed the Declaration of Helsinki guidelines. The patients were monitored by investigation of the performance status according to the Glasgow Prognostic Score (GPS), which evaluates the plasma level of C-reactive protein and albumin levels, and the Eastern Cooperative Oncology Group (ECOG) examination. Pain and fatigue were also monitored using the visual analog scale and visual analog fatigue scale, respectively. All the above parameters were assessed biweekly to week 10. Results GPS, ECOG, and albumin remained stable throughout the study with a trend towards a decrease in GPS and albumin at week 10 post-treatment. Pain significantly improved at week 8 (P<0.05) while fatigue improved at weeks 8 and 10 (all P<0.01). Conclusion We found that chemotherapy, combined with Desmodium and Lithothamnium, improved pain and fatigue in head and neck cancer patients, although we cannot confirm if this was due to Desmodium and Lithothamnium or chemotherapy. The improvement in pain and fatigue was supported by the ECOG performance status remaining stable with the highest score being equal to 2 throughout the study and a trend towards an improvement in GPS performance status and albumin levels.
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Affiliation(s)
- Luca Imperatori
- UOC Oncologia Medica Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Damiano Giardini
- UOC Otorinolaringoiatria Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Gino Latini
- UOC Otorinolaringoiatria Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Giuseppe Migliori
- UOC Otorinolaringoiatria Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Claudio Blasi
- UOC Radioterapia Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Feisal Bunkheila
- UOC Radioterapia Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Cesare Breschi
- UOC Anestesia e Rianimazione Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Rodolfo Mattioli
- UOC Oncologia Medica Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Silvia Pelliccioni
- UOC Oncologia Medica Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
| | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy
| | - Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy
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Palmieri B, Vadalà M, Laurino C. Clinical effects of overwintered-stressed Chondrus Crispus and non-overwintered-stressed Chondrus crispus dietary supplementations. Asian J Med Sci 2018. [DOI: 10.3126/ajms.v9i6.20978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Chondrus crispus is red seaweed widespread in the northern Atlantic coasts due to the high proteins, burden it is quite helpful supplement for some symptoms such as fatigue, asthenia, and weakness and for supporting skeletal muscles in sports athletes.Aims and Objectives: This retrospective observational “not inferiority” study investigates and compares the clinical effects of overwintered-stressed Chondrus Crispus and non-overwintered-stressed Chondrus crispus dietary supplementations for the treatment of musculoskeletal and articular symptomatology related diseases.Materials and Methods: Eighty patients were retrospectively reviewed through the Second Opinion Medical Network. Patients were prescribed 3 capsules/day after the main meals for 3 weeks of overwintered-stressed Chondrus Crispus or non-overwintered stressed Chondrus crispus dietary supplementations. Quality of life (QOL) assessment was evaluated by the Short Form-36 (SF-36) health survey questionnaire before starting the treatment and after the third week. Benefits declared by patients were also reported after the treatment in addition to some subjective observations related to the symptomatology and to the health status.Results: Fifty patients were treated with overwintered-stressed Chondrus Crispus and 30 patients were treated with the non-overwintered-stressed Chondrus crispus dietary supplementation. The general benefit of treatment with overwintered-stressed Chondrus Crispus was 76%, while that obtained with non-overwintered-stressed Chondrus crispus was 33.3% (P <0.01). Results of SF-36 general health status after the treatment demonstrated that 37 patients (74%) and 11 patients (36.7%) felt better than before in the overwintered-stressed Chondrus Crispus group and non-overwintered-stressed Chondrus crispus group, respectively (P < 0.01). A great improvement of subjective exhaustion, fatigue, pain, digestive, and peristalsis disturbances symptoms, in addition to mood and concentration amelioration that would be a consequence of symptomatology regression, was also observed.Conclusions: This retrospective observational comparative study evidences that overwintered-stressed Chondrus Crispus improved musculoskeletal and articular symptomatology related diseases better than non-overwintered-stressed Chondrus crispus.Asian Journal of Medical Sciences Vol.9(6) 2018 7-13
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Palmieri B, Poddighe D, Vadalà M, Laurino C, Carnovale C, Clementi E. Severe somatoform and dysautonomic syndromes after HPV vaccination: case series and review of literature. Immunol Res 2018; 65:106-116. [PMID: 27503625 PMCID: PMC5406435 DOI: 10.1007/s12026-016-8820-z] [Citation(s) in RCA: 32] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Human papilloma virus (HPV) is recognized as a major cause for cervical cancer among women worldwide. Two HPV vaccines are currently available: Gardasil® and Cervarix®. Both vaccines enclose viral antigenic proteins, but differ as to the biological systems of culture and the adjuvant components. Recently, a collection of symptoms, indicating nervous system dysfunction, has been described after HPV vaccination. We retrospectively described a case series including 18 girls (aged 12–24 years) referred to our “Second Opinion Medical Network” for the evaluation of “neuropathy with autonomic dysfunction” after HPV vaccination. All girls complained of long-lasting and invalidating somatoform symptoms (including asthenia, headache, cognitive dysfunctions, myalgia, sinus tachycardia and skin rashes) that have developed 1–5 days (n = 11), 5–15 days (n = 5) and 15–20 days (n = 2) after the vaccination. These cases can be included in the recently described immune dysfunction named autoimmune/inflammatory syndrome induced by adjuvants (ASIA). HPV vaccine, through its adjuvant component, is speculated to induce an abnormal activation of the immune system, involving glia cells in the nervous system too. Further researches should aim at defining the pathological and clinical aspects of these post-vaccination diseases and identifying a genetic background predisposing to these adverse reactions.
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Affiliation(s)
- Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy.
| | - Dimitri Poddighe
- Department of Paediatrics, ASST Melegnano e Martesana, Vizzolo Predabissi, MI, Italy.
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy
| | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, National Research Council-Institute of Neuroscience, University Hospital L. Sacco, University of Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, National Research Council-Institute of Neuroscience, University Hospital L. Sacco, University of Milano, Milan, Italy
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Mulè G, Vadalà M, Geraci G, Cottone S. Retinal vascular imaging in cardiovascular medicine: New tools for an old examination. Atherosclerosis 2017; 268:188-190. [PMID: 29145994 DOI: 10.1016/j.atherosclerosis.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/01/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy.
| | - Maria Vadalà
- Dipartimento di Biomedicina Sperimentale e di Neuroscienze Cliniche (BIONEC), Ophthalmology Section, Università di Palermo, Palermo, Italy
| | - Giulio Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, Università di Palermo, Palermo, Italy
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50
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Vadalà M, Poddighe D, Laurino C, Palmieri B. Vaccination and autoimmune diseases: is prevention of adverse health effects on the horizon? EPMA J 2017; 8:295-311. [PMID: 29021840 DOI: 10.1007/s13167-017-0101-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [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: 05/11/2017] [Accepted: 05/31/2017] [Indexed: 12/28/2022]
Abstract
Autoimmune diseases, including multiple sclerosis and type 1 diabetes mellitus, affect about 5% of the worldwide population. In the last decade, reports have accumulated on various autoimmune disorders, such as idiopathic thrombocytopenia purpura, myopericarditis, primary ovarian failure, and systemic lupus erythematosus (SLE), following vaccination. In this review, we discuss the possible underlying mechanisms of autoimmune reactions following vaccinations and review cases of autoimmune diseases that have been correlated with vaccination. Molecular mimicry and bystander activation are reported as possible mechanisms by which vaccines can cause autoimmune reactions. The individuals who might be susceptible to develop these reactions could be especially not only those with previous post-vaccination phenomena and those with allergies but also in individuals who are prone to develop autoimmune diseases, such as those with a family history of autoimmunity or with known autoantibodies, and the genetic predisposed individuals. Further research is encouraged into the direct associations between vaccines and autoimmune conditions, and the biological mechanisms behind them.
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Affiliation(s)
- Maria Vadalà
- Department of General Surgery and Surgical Specialties, Medical School, Surgical Clinic, University of Modena and Reggio Emilia, Modena, Italy.,Network of the Second Opinion, Modena, MO Italy
| | - Dimitri Poddighe
- Department of Pediatrics, ASST Melegnano e Martesana, Milano, Italy
| | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, Medical School, Surgical Clinic, University of Modena and Reggio Emilia, Modena, Italy.,Network of the Second Opinion, Modena, MO Italy
| | - Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, Medical School, Surgical Clinic, University of Modena and Reggio Emilia, Modena, Italy.,Network of the Second Opinion, Modena, MO Italy
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