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Cruz-Sanabria F, Bruno S, Bazzani A, Bonelli C, Violi M, Frumento P, Faraguna U. Associations between post-traumatic stress symptoms and sleep/circadian parameters: Exploring the effect of chronotype as a moderator variable. Chronobiol Int 2023:1-15. [PMID: 37042535 DOI: 10.1080/07420528.2023.2189952] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
The present study aimed at evaluating how post-traumatic stress symptoms (PTSS) are associated with rest-activity circadian and sleep-related parameters, assessed both subjectively (via questionnaires) and objectively (via actigraphy). Specifically, we explored whether chronotype could moderate the association between sleep/circadian parameters and PTSS. Participants (n = 120 adults; mean age 35.6 ± 14; 48 male) were assessed through the Trauma and Loss Spectrum Self Report (TALS-SR) for lifetime PTSS, the reduced version of the Morningness-Eveningness Questionnaire (rMEQ) for chronotype, the Pittsburgh Sleep Quality Index (PSQI) for self-reported sleep quality, and wrist actigraphy for sleep and circadian parameters. Eveningness, poor self-reported sleep quality, lower sleep efficiency (SE), lower interdaily stability (IS), and higher intradaily variability (IV) were correlated with higher TALS-SR scores. Regression analyses showed that IV, SE, and PSQI remained associated with TALS symptomatic domains after adjusting for potentially confounding factors (age and gender). Moderation analysis showed that only the PSQI remained significantly associated with TALS symptomatic domains; however, the interaction with chronotype was not significant. Targeting self-reported sleep disturbances and rest-activity rhythms fragmentation could mitigate PTSS. Although the effect of chronotype as a moderator of the associations between sleep/circadian parameters and PTSS was not significant, eveningness was associated with higher TALS scores, thus confirming the vulnerability of evening types to worse stress reactions.
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Affiliation(s)
- F Cruz-Sanabria
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - S Bruno
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - A Bazzani
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - C Bonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Violi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - P Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - U Faraguna
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
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Bruno S, Benedetti D, Ferri F, Granieri I, Bazzani A, Cruz-Sanabria F, d'Ascanio P, Frumento P, Faraguna U. Chronotype predicts sport performance in adolescent male basketball players. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Isoppo E, Bazzani A, Starace F, Di Galante M, Cruz-Sanabria F, Bruno S, Frumento P, Turchetti G, d'Ascanio P, Faraguna U. Circadian typology and cognitive flexibility. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cruz-Sanabria F, Andreoni N, Bazzani A, Starace F, Bruno S, Frumento P, Carmassi C, Faraguna U. Eveningness and ruminations are independently associated with poor sleep quality in healthy youths. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bruno S, Bazzani A, Marantonio S, Cruz-Sanabria F, Benedetti D, Frumento P, Turchetti G, Faraguna U. Poor sleep quality and unhealthy lifestyle during the lockdown: an Italian study. Sleep Med 2022; 90:53-64. [PMID: 35093684 PMCID: PMC8747843 DOI: 10.1016/j.sleep.2022.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/12/2021] [Accepted: 01/04/2022] [Indexed: 12/23/2022]
Abstract
Background The lockdown measure implemented to face the 2019 Coronavirus Disease (COVID-19) first wave deeply modified the lifestyle of the Italian population. Despite its efficacy in limiting the number of infections, forced home confinement was paralleled by sleep/wake cycle disruptions, psychological distress and maladaptive coping strategies (i.e., unhealthy behaviours, such as tobacco and alcohol consumption). Under these unprecedented stress conditions, we explored a possible association between poor sleep quality and increased likelihood of engaging in an unhealthy lifestyle. Methods A cross-sectional study was conducted by disseminating an online survey via social networks and e-mail. We collected information on demographics, COVID-19-related data, sleep quality, chronotype, circadian misalignment, and lifestyle before and during the lockdown (i.e., consumption of cigarettes, alcoholic beverages, coffee, hypnotics, comfort food and fresh food; practice of physical activity). A global healthiness score was computed to assess participants’ modifications in lifestyle since the beginning of the lockdown. Results 1297 respondents were included in the study: 414 (31.9%) from Northern Italy, 723 (55.8%) from Central Italy, 160 (12.3%) from Southern Italy. The following variables were found to be significant predictors of the adoption of an unhealthy lifestyle since the beginning of the lockdown: poor sleep quality, high BMI and considering the measures adopted by the government to fight the pandemic as excessive. Living in Northern Italy, instead, was associated with healthier habits compared to living in Central Italy. Conclusions Poor sleepers may represent the share of the general population who paid the highest price for social isolation. Further investigations are required to explore the role of sleep quality assessment in the identification of individuals vulnerable to unhealthy behaviours under stressful conditions.
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Bazzani A, Bruno S, Frumento P, Cruz-Sanabria F, Turchetti G, Faraguna U. Sleep quality mediates the effect of chronotype on resilience in the time of COVID-19. Chronobiol Int 2021; 38:883-892. [PMID: 33966553 DOI: 10.1080/07420528.2021.1895199] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to explore the relationship between chronotype and resilience, sleep quality, and post-traumatic stress reactions during the first COVID-19 lockdown in Italy. An online survey was distributed through social networks during forced home confinement, collecting data from1298 participants of 19 different Italian regions. Chronotype was evaluated using the reduced version of the Morningness/Eveningness Questionnaire (rMEQ); sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI); resilience levels were measured by the 10-item version of the Connor-Davidson Resilience Scale (CD-RISC10); post-traumatic stress reactions were assessed by the 6-item version of the Impact of Event Scale (IES6). Resilience and sleep quality were significantly lower in the evening compared to non-evening types, as well as in females as compared to males. Moreover, resilience was negatively correlated with post-traumatic stress reactions and positively correlated with sleep quality. A negative correlation was also reported between sleep quality and post-traumatic stress reactions. Sleep quality was identified as a possible mediator between chronotype and resilience, and between resilience and post-traumatic stress reactions, after controlling for age and sex. These findings provide new insights into the role of chronotype in adapting to continuous stressful situations. Sleep quality seems to mediate the causal path between the antecedents of resilience and the development of trauma. Further research is needed to explore the suitability of primary interventions based on chronobiology and sleep hygiene to mitigate the impact of pandemic-related home confinement measures on mental health among the general population.
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Affiliation(s)
- A Bazzani
- Institute of Management, ScuolaSuperioreSant'Anna, Pisa, Italy
| | - S Bruno
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - P Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - F Cruz-Sanabria
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - G Turchetti
- Institute of Management, ScuolaSuperioreSant'Anna, Pisa, Italy
| | - U Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.,Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
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Pugliese NR, De Biase N, Conte L, Gargani L, Mazzola M, Fabiani I, Natali A, Dini FL, Frumento P, Rosada J, Taddei S, Borlaug BA, Masi S. Predicting heart failure transition and progression: a weighted risk score from bio-humoral, cardiopulmonary and echocardiographic stress testing. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims. We tested the prognostic role of a risk score including bio-humoral evaluation, cardiopulmonary-echocardiographic stress (CPET-ESE) and lung ultrasound, in patients with heart failure (HF) with reduced and preserved ejection fraction (HFrEF and HFpEF), and subjects at risk of developing HF (American College of Cardiology/American Heart Association Stages A and B).
Methods and results. We evaluated 318 subjects: 94 in Stages A-B, 194 in Stage C (85 HFpEF and 109 HFrEF), and 30 age and sex-matched controls (Stage 0). During a median follow-up of 18.5 months, we reported 40 urgent HF visits, 31 HF hospitalisations and 10 cardiovascular deaths. Cox proportional-hazards regression for predicting adverse events identified five independent predictors and each was assigned a number of points proportional to its regression coefficient: Δstress-rest B-lines >10 (3 points), peak oxygen consumption <16 mL/kg/min (2 points), minute ventilation/carbon dioxide production slope ≥36 (2 points), peak systolic pulmonary artery pressure ≥50 mmHg (1 point) and resting N-terminal pro-brain natriuretic peptide (NT-proBNP) >900 pg/mL (1 point). We defined three risk categories: low-risk (<3 points), intermediate-risk (3-6 points), and high-risk (>6 points). The event-free survival probability for these three groups were 93%, 52% and 20%, respectively. Hazard Ratio was 4.55 for each risk category upgrade (95% confidence interval [CI], 3.44-5.93). The area-under-curve for the scoring system to predict events was 0.92 (95% CI 0.88-0.96).
Conclusion. A multiparametric risk score including indices of exercise-induced pulmonary congestion, markers of cardiopulmonary dysfunction and NT-proBNP identifies patients at increased risk for HF events across the HF spectrum.
Table 1 Variable EPYC score EPYC score <3 (low risk) n = 217 EPYC score 3-6 (intermediate risk) n = 70 EPYC score >6 (high risk) n = 31 p-value (between risk categories) Event-free (n = 244) 0 (0 - 2) 210 (97) 32 (46) 2 (6) <0.0001 With events (n = 74) 6 (4 - 9) 7 (3) 38 (54) 29 (94) <0.0001 p-value (event-free vs with events) <0.0001 <0.0001 <0.0001 <0.0001 Stage 0-Controls (n = 30) 0 (0 - 1) 30 0 0 <0.0001 Stages A-B (n = 94) 1 (0 - 2) 85 (45) 6 (9) 3 (10) <0.0001 Stage C-HFpEF (n = 85) 3 (1 - 6)*† 46 (25) 29 (41) 10 (32) <0.0001 Stage C-HFrEF (n = 109) 4 (2 - 7)*† 56 (30) 35 (50) 18 (58) <0.0001 p-value (between HF Stages) <0.0001 <0.0001 <0.0001 <0.0001 Values are mean ± standard deviation, n (%), or median [25th quartile, 75th quartile]. * p < 0.01 vs Stage 0-Controls; † p < 0.01 vs Stages A-B. Abstract Figure 1
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Affiliation(s)
- NR Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Conte
- Castelnuovo Garfagnana Hospital, Castelnuovo Garfagnana, Italy
| | - L Gargani
- National Council of Research, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - I Fabiani
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Natali
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - FL Dini
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - J Rosada
- University Hospital of Pisa, Fourth Unit of Internal Medicine, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - BA Borlaug
- Mayo Clinic, Rochester, United States of America
| | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Pugliese NR, De Biase N, Conte L, Gargani L, Mazzola M, Fabiani I, Natali A, Dini FL, Frumento P, Rosada J, Taddei S, Borlaug BA, Masi S. Cardiac reserve and exercise capacity: insights from combined cardiopulmonary and exercise echocardiography stress testing. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims. Combined cardiopulmonary exercise test (CPET) and exercise stress echocardiography (ESE) provides a non-invasive tool to study cardiopulmonary pathophysiology. We analyzed how cardiac functional reserve during exercise relates to peak oxygen consumption (VO2).
Methods and Results. We performed a symptom-limited graded ramp bicycle CPET-ESE in 30 healthy controls and 357 patients: 113 at risk of developing heart failure (American College of Cardiology/American Heart Association HF Stages A-B) and 244 in HF Stage C with preserved (HFpEF, n = 101) or reduced ejection fraction (HFrEF, n = 143). Peak VO2 significantly decreased from controls to Stage A-B and Stage C (Table 1). A multivariable regression model to predict peak VO2 revealed peak left ventricular systolic annulus tissue velocity (S"), peak TAPSE/PAPs (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) and low-load left atrial reservoir strain/E/e’ were independent predictors, in addition to peak heart rate, stroke volume and workload (adjusted R²=0.76, p < 0.0001). The model was successfully tested in subjects with atrial fibrillation (n = 49), and with (n = 224) and without (n = 163) beta-blockers (all p < 0.01). Peak S’ showed the highest accuracy in predicting peak VO2 < 10 mL/kg/min (cut-point ≤ 7.5 cm/s; AUC = 0.92, p < 0.0001) and peak VO2 > 20 mL/kg/min (cut-point > 12.5 cm/s; AUC = 0.84, p < 0.0001) in comparison to the other cardiac variables of the model (p < 0.05).
Conclusions. A model incorporating different measures of cardiac mechanics is strongly related to peak aerobic capacity and may help in identifying different causes of effort intolerance from HF Stage A to C.
Table 1 Variable Overall population (n = 387) Controls (n = 30) Stage A-B (n = 113) Stage C-HFpEF (n = 101) Stage c-HFrEF (n = 143) p-value Age, years 68.9 ± 11.1 67.1 ± 10.6 67.7 ± 10.4 70.5 ± 10.1 68.5 ± 11 0.1 Male, n (%) 247 (64) 18 (60) 70 (62) 57 (56) 102 (71) 0.1 VO2 @peak, mL/min/kg 15.7 (12.1-19.6) 23 (21.7- 29.7) 18 (15.4- 20.7)* 13.6 (11.8- 16.8)*† 14.2 (10.7- 17.5)*† <0.0001 Workload @peak, W 90 (65-120) 130 (115-195) 110 (84-130)* 70 (55-100)*† 80 (60-110)*† <0.0001 Heart rate @peak, bpm 123 ± 22 142 ± 12 130 ± 20* 115 ± 17*† 119 ± 23*† <0.0001 Stroke volume @peak, mL 83 (71-99) 98 (85-114) 86 (76-107) 83 (74-97)* 75 (63-95)*† <0.0001 Average S" @peak, cm/s 11.2 ± 3.8 17.1 ± 3.9 13.3 ± 2.9* 10.6 ± 2.5*† 8.7 ± 2.7*†‡ <0.0001 TAPSE/PAPs @peak, mm/mmHg 0.75 (0.46-0.97) 1.05 (0.93- 1.16) 0.81 (0.52- 0.91)* 0.52 (0.38- 0.83)*† 0.58 (0.41- 0.89)*† <0.0001 Left atrial reservoir strain/E/e" @low-load, % 2.25 (1.17-5.04) 6.23 (4.45-6.77) 4.34 (3.89- 5.58)* 2.23 (1.31- 2.86)*† 1.91 (1.07-2.44)*†‡ <0.0001 * p < 0.01 vs Controls; † p < 0.01 vs Stage A-B; ‡ p < 0.01 vs Stage C-HFpEF. PAPs systolic pulmonary artery pressure; TAPSE: tricuspid annular plane systolic excursion; VO2: oxygen consumption. Abstract Figure 1
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Affiliation(s)
- NR Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Conte
- Castelnuovo Garfagnana Hospital, Castelnuovo Garfagnana, Italy
| | - L Gargani
- National Council of Research, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - I Fabiani
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Natali
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - FL Dini
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - J Rosada
- University Hospital of Pisa, Fourth Unit of Internal Medicine, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - BA Borlaug
- Mayo Clinic, Rochester, United States of America
| | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Pugliese N, Frassi F, Frumento P, Poggianti E, Mazzola M, De Biase N, Landi P, Masi S, Taddei S, Pang P, Sicari R, Gargani L. Prognostic value of integrated cardiopulmonary ultrasound in inpatients with acute heart failure with preserved and reduced ejection fraction and without heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To assess the prognostic value of B-lines integrated with echocardiography in patients admitted to a Cardiology Department, with and without acute heart failure (AHF).
Background
Lung-ultrasound (LUS) B-lines are sonographic signs of pulmonary congestion and can be used in the differential diagnosis of dyspnea to rule in or rule out AHF. Their prognostic value at admission is less established, as well as the different role in AHF with reduced and preserved ejection fraction (HFrEF and HFpEF), or patients admitted for cardiac conditions but without overt signs and symptoms of AHF.
Methods
A total of 1021 consecutive in-patients (69±12 years) admitted for various cardiac conditions were enrolled. Patients were classified into three groups: 1) acute HFrEF; 2) acute HFpEF; 3) no AHF. All patients underwent on the admission an echocardiogram coupled with LUS, according to standardised protocols.
Results
Patients were followed-up for a median of 14.4 months (interquartile range: 4.6–24.3) for death and HF readmission (composite endpoint). During the follow-up, 126 events occurred. Kaplan-Meier survival analyses showed admission B-lines >30 identified patients with worse outcome at follow-up in the overall population and each of the three groups (Figure). At multivariable analysis (Table), admission B-lines >30, EF <50%, tricuspid regurgitation velocity >2.8 m/s and tricuspid annular plane systolic excursion (TAPSE) <17 mm resulted in independent predictors of the composite endpoint. B-lines >30 had a strong predictive value in HFpEF and non-AHF, but not in HFrEF.
Conclusions
Ultrasound B-lines can detect subclinical pulmonary interstitial edema in patients thought to be free of congestion, and provide useful information not only for the diagnosis but also for the prognosis in different cardiac conditions. Their added prognostic value among standard echocardiographic parameters is stronger in patients with HFpEF compared to HFrEF.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N.R Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Frassi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - E Poggianti
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - P Landi
- National Council of Research, Pisa, Italy
| | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - P Pang
- Indiana University School of Medicine, Indianapolis, United States of America
| | - R Sicari
- National Council of Research, Pisa, Italy
| | - L Gargani
- National Council of Research, Pisa, Italy
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Ziegler L, Frumento P, Wallen H, De Faire U, Gigante B. P1519IL6 trans-signalling affects risk of cardiovascular events pre-eminently in men. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Interleukin 6 (IL6) is a known cardiovascular risk marker. The pro-atherogenic effects of IL6 are mediated by the IL6 trans-signalling pathway via a binary complex of IL6 and the soluble IL6 receptor (IL6:sIL6R). The binary complex is however neutralised by the natural inhibitor, sgp130 when forming the ternary complex (IL6:sIL6R:sgp130). To assess the risk of cardiovascular events (CVE) with IL6 trans-signalling, a ratio between the active binary complex and the neutralised ternary complex was calculated. We recently demonstrated that high levels of the binary/ternary complex ratio (b/t ratio > the median) representing an excess of the active binary complex, was independently associated with a 44% increased risk of future CVE in subjects free of prevalent cardiovascular disease.
Purpose
In this study we aimed to analyse the risk of CVE and time to event associated with the b/t ratio in men and women separately.
Methods
In a cohort of 60 year old men and women from Stockholm, the molar concentrations of the binary and ternary IL6 complex were estimated at baseline. Subjects free of prevalent cardiovascular disease were followed through national registers to assess future CVE (myocardial infarction, hospitalised angina pectoris and ischemic stroke). During a 16 year follow-up, 525 first time CVEs were registered. The risk for CVE and time to CVE was calculated for men and women, separately. To evaluate the risk associated with IL6 trans-signalling, the b/t ratio dichotomised at the median was modelled in a Cox regression model and risk was expressed as hazard ratios (HR) with 95% confidence intervals (CI). In addition, analysis was performed using censored quantile regression that allows measuring the effect of covariates on different quantiles of the time to CVE.
Results
Approximately half of the population were men and 64% of the CVE occurred in men. The risk of CVE during follow-up was significantly higher in men with b/t ratio > median (HR 1.70; 95% CI 1.35–2.15), while no significant difference was found in women (HR 1.12; 95% CI 0.84–1.50). Consistently, quantile regression showed that, men with a b/t ratio > median suffered their CVEs at an earlier time point. The time at which 15% of the male population was observed to have experienced CVE was 5.6 years shorter (95% CI: 4.0–7.2) in the high b/t ratio group. In women there was no significant difference in time to CVE.
Conclusion
The risk of CVE and early events associated with IL6 trans-signalling estimated by a b/t ratio >median is significantly increased in men.
Acknowledgement/Funding
The Stockholm County Council ALF project, Strategic research in Epidemiology
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Affiliation(s)
- L Ziegler
- Karolinska Institute, Stockholm, Sweden
| | - P Frumento
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
| | - H Wallen
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - U De Faire
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
| | - B Gigante
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
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Ziegler L, Lundqvist J, Perisic L, Gajulapuri A, Dreij K, Frumento P, Paulsson-Berne G, Wallen H, De Faire U, Hedin U, Gigante B. P2625The soluble IL6 receptor and ischemic cerebrovascular disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Ziegler
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - J Lundqvist
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
| | - L Perisic
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - A Gajulapuri
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
| | - K Dreij
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
| | - P Frumento
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
| | | | - H Wallen
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - U De Faire
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
| | - U Hedin
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - B Gigante
- Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
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Laguzzi F, Risérus U, Marklund M, Vikström M, Sjögren P, Gigante B, Alsharari ZD, Hellénius ML, Cederholm T, Frumento P, de Faire U, Leander K. Circulating fatty acids in relation to alcohol consumption: Cross-sectional results from a cohort of 60-year-old men and women. Clin Nutr 2017; 37:2001-2010. [PMID: 29032841 DOI: 10.1016/j.clnu.2017.09.007] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/01/2017] [Accepted: 09/09/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Alcohol consumption is considered to affect circulating fatty acids (FAs) but knowledge about specific associations is limited. We aimed to assess the relation between alcohol consumption and serum FAs in 60-year-old Swedish men and women. METHODS In a random sample of 1917 men and 2058 women residing in Stockholm county, cross-sectional associations between different categories of alcohol consumption and FAs were assessed using linear regression; β1 coefficients with 95% confidence interval (CI) were calculated. Self-reported alcohol consumption was categorized as none, low (≤9.9 g/day) (reference), moderate (10-29.9 g/day) and high (≥30 g/day). Moderate alcohol consumption was further subdivided into consumption of beer, wine, liquor and their combinations. Thirteen serum cholesterol ester FAs were measured by gas chromatography and individual FAs were expressed as percentage of total FAs. RESULTS Increasing alcohol consumption was associated to linear increase of saturated myristic acid, monounsaturated FAs and n-6 polyunsaturated (PUFA) arachidonic acid, whereas linear decrease was noted for saturated pentadecanoic acid and for n-6 PUFA linoleic acid. With non-linear associations, increasing alcohol consumption also associated to decreased saturated stearic acid, n-6 PUFA dihomo-gamma-linolenic acid, and n-3 PUFA docosahexaenoic acid and increased saturated palmitic acid, n-6 PUFA gamma-linolenic acid and n-3 PUFA eicosapentaenoic acid. Among types of beverages, wine consumption was associated with n-6 PUFA arachidonic acid (β1 0.59; 95% CI: 0.30;0.88) and the n-3 PUFAs eicosapentaenoic acid (β1 0.54; 95% CI: 0.30;0.78), and docosahexaenoic acid (β1 0.06; 95% CI: 0.00;0.12). CONCLUSIONS These findings may give important basis for further investigations to better understand biological mechanisms behind the dose-dependent associations between alcohol consumption and health outcomes observed in many previous studies.
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Affiliation(s)
- F Laguzzi
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden.
| | - U Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Box 609, 751 25 Uppsala, Sweden
| | - M Marklund
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Box 609, 751 25 Uppsala, Sweden
| | - M Vikström
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden
| | - P Sjögren
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Box 609, 751 25 Uppsala, Sweden
| | - B Gigante
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital University, 182 88 Stockholm, Sweden
| | - Z D Alsharari
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Box 609, 751 25 Uppsala, Sweden
| | - M-L Hellénius
- Cardiology Unit, Department of Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - T Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Box 609, 751 25 Uppsala, Sweden
| | - P Frumento
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden
| | - U de Faire
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden; Cardiology Unit, Department of Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - K Leander
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden
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Olén O, Askling J, Sachs MC, Frumento P, Neovius M, Smedby KE, Ekbom A, Malmborg P, Ludvigsson JF. Childhood onset inflammatory bowel disease and risk of cancer: a Swedish nationwide cohort study 1964-2014. BMJ 2017; 358:j3951. [PMID: 28931512 PMCID: PMC5605779 DOI: 10.1136/bmj.j3951] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective To assess risk of cancer in patients with childhood onset inflammatory bowel disease in childhood and adulthood.Design Cohort study with matched general population reference individuals using multivariable Cox regression to estimate hazard ratios.Setting Swedish national patient register (both inpatient and non-primary outpatient care) 1964-2014.Participants Incident cases of childhood onset (<18 years) inflammatory bowel disease (n=9405: ulcerative colitis, n=4648; Crohn's disease, n=3768; unclassified, n=989) compared with 92 870 comparators from the general population matched for sex, age, birth year, and county.Main outcome measures Any cancer and cancer types according to the Swedish Cancer Register.Results During follow-up through adulthood (median age at end of follow-up 27 years), 497 (3.3 per 1000 person years) people with childhood onset inflammatory bowel disease had first cancers, compared with 2256 (1.5 per 1000 person years) in the general population comparators (hazard ratio 2.2, 95% confidence interval 2.0 to 2.5). Hazard ratios for any cancer were 2.6 in ulcerative colitis (2.3 to 3.0) and 1.7 in Crohn's disease (1.5 to 2.1). Patients also had an increased risk of cancer before their 18th birthday (2.7, 1.6 to 4.4; 20 cancers in 9405 patients, 0.6 per1000 person years). Gastrointestinal cancers had the highest relative risks, with a hazard ratio of 18.0 (14.4 to 22.7) corresponding to 202 cancers in patients with inflammatory bowel disease. The increased risk of cancer (before 25th birthday) was similar over time (1964-1989: 1.6, 1.0 to 2.4; 1990-2001: 2.3, 1.5 to 3.3); 2002-06: 2.9, 1.9 to 4.2; 2007-14: 2.2, 1.1 to 4.2).Conclusion Childhood onset inflammatory bowel disease is associated with an increased risk of any cancer, especially gastrointestinal cancers, both in childhood and later in life. The higher risk of cancer has not fallen over time.
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Affiliation(s)
- O Olén
- Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - J Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - M C Sachs
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - P Frumento
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - K E Smedby
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - A Ekbom
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - P Malmborg
- Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
- Department of Women's and Children's health, Karolinska Institutet, Stockholm, Sweden
| | - J F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Pediatrics, Orebro University Hospital, Orebro, Sweden
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, US
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Ziegler L, Gajulapuri A, Frumento P, Wallen H, De Faire U, Gigante B. 4159The soluble IL6 receptor as a predictor for early cardiovascular events. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Montagnani F, Fornaro L, Frumento P, Falcone A, Fioretto L. Mixed meta-analysis of treatment options for locally advanced oesophageal squamous-cell carcinoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw333.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Sandberg M, Westerlind H, Saevarsdottir S, Frumento P, Klareskog L, Alfredsson L. OP0307 No Long-Term Effect on Disease Activity and Pain of Physical Activity Found in Prospective Observational Study of Early Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Moreno Velasquez I, Frumento P, Berglund A, Johansson K, De Faire U, Leander K, Gigante B. Interleukin 8 serum levels and the risk of myocardial infarction. Results from the Stockholm Heart Epidemiology program. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Crea F, Fornaro L, Paolicchi E, Masi G, Frumento P, Loupakis F, Salvatore L, Cremolini C, Schirripa M, Graziano F, Ronzoni M, Ricci V, Farrar WL, Falcone A, Danesi R. An EZH2 polymorphism is associated with clinical outcome in metastatic colorectal cancer patients. Ann Oncol 2012; 23:1207-1213. [PMID: 21926398 DOI: 10.1093/annonc/mdr387] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite therapeutic innovations, metastatic colorectal cancer (mCRC) is still characterized by poor prognosis and few molecular markers predict the risk of progression. Polycomb group genes (PcGs) are epigenetic modifiers involved in tumor suppressor gene silencing. PcG member EZH2 mediates gene silencing through histone-H3 lysine-27 methylation. In colorectal cancer (CRC), EZH2 overexpression predicts shorter survival. Recently, four EZH2 single-nucleotide polymorphisms (SNPs) have been described. The present study was aimed at evaluating the correlation between EZH2 SNPs and outcome parameters in mCRC patients. PATIENTS AND METHODS DNA was extracted from blood samples of 110 mCRC patients treated with first-line 5-fluorouracil, folinic acid, irinotecan (FOLFIRI) and bevacizumab. Genotyping was carried out by real-time PCR. Genotype was used to predict objective response, progression-free survival (PFS) and overall survival (OS). EZH2 messenger RNA levels were evaluated on lymphocytes of a parallel cohort of 50 CRC patients. RESULTS One allelic variant (rs3757441 C/C versus C/T or T/T) was significantly associated with shorter PFS and OS (P < 0.01 and P < 0.05, respectively). At multivariate analysis, the same variant resulted an independent predictor of PFS and OS (P < 0.05). The C/C variant was associated with significantly higher EZH2 expression (P < 0.05). CONCLUSION An EZH2 SNP may be useful to predict clinical outcome in mCRC patients.
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Affiliation(s)
- F Crea
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa.
| | - L Fornaro
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - E Paolicchi
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa
| | - G Masi
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - P Frumento
- Unit of Biostatistics, Institute of Environmental Health, Karolinska Institutet, Stockholm, Sweden
| | - F Loupakis
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - L Salvatore
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - C Cremolini
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - M Schirripa
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - F Graziano
- Medical Oncology Unit, Department of Onco-Hematology, Azienda Ospedaliera S. Salvatore, Pesaro
| | - M Ronzoni
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - V Ricci
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - W L Farrar
- Cancer Stem Cell Section, Laboratory of Cancer Prevention, National Institute of Cancer-Frederick, Frederick, USA
| | - A Falcone
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - R Danesi
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa
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19
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Pereira L, Ruiz-Hurtado G, Morel E, Dominguez A, Benitah JP, Bers DM, Lezoualc'h F, Gomez A, Collins TP, Sikkel MB, O' Gara P, Lyon AR, Harding SE, Macleod KT, Wantha S, Alard JE, Doering Y, Drechsler M, Megens RT, Hackeng T, Weber C, Soehnlein O, Dietel B, Cicha I, Altendorf R, Daniel WG, Garlichs CD, Mukherjee U, Ong SB, Davidson SM, Szabadkai G, Yellon DM, Hausenloy DJ, Neary MT, Hall AR, Hirst E, Ong SB, Mohun TJ, Hausenloy DJ, Breckenridge RA, Akhmedov A, Camici GG, Stivala S, Holy EW, Breitenstein A, Lohmann C, Beer JH, Tanner FC, Matter CM, Luescher TF, Hulsmans M, Geeraert B, Arnould T, Tsatsanis C, Holvoet P, Hermida N, Markl A, Hamelet J, Herijgers P, Horman S, Noppe G, Beauloye C, Van Bilsen M, Dessy C, Balligand JL, Del Giorno R, Moreno Velasquez I, Leander K, Frumento P, Vikstrom M, Pirro M, Mannarino MR, Mannarino E, De Faire U, Gigante B, Chaudhry B, Chrystal P, Henderson DJ, Fulcoli FG, Chen L, Martucciello S, Illingworth E, Baldini A, Mavroidis M, Davos C, Psarras S, Varela A, Kostavasili I, Capetanaki Y, Engstrom Klarstrom K, Skoglund C, Kalvegren H, Bengtsson T, Drawnel F, Wachten D, Molkentin JD, Sjaastad I, Liu N, Mikoshiba K, Bootman MD, Roderick HL, Di Gregoli K, Salter R, Johnson JL. Oral abstract presentations. Cardiovasc Res 2012. [DOI: 10.1093/cvr/cvr331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Belcari F, Placidi G, Guzzetta A, Tonacchera M, Ciampi M, Bartoli A, Scaramuzzo RT, Frumento P, Cioni G, Pinchera A, Boldrini A, Ghirri P. Thyroid-stimulating hormone levels in the first days of life and perinatal factors associated with sub-optimal neuromotor outcome in pre-term infants. J Endocrinol Invest 2011; 34:e308-13. [PMID: 21659794 DOI: 10.3275/7795] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To identify perinatal factors associated with sub-optimal neuromotor outcome in infants without evident central nervous system lesions (intraventricular hemorrhage/ periventricular leukomalacia), with gestational age ≤30 (group I) and of 31-32 weeks (group II). PATIENTS AND METHODS A total of 102 premature infants admitted to the Neonatal Intensive Care Unit of Pisa, at 26-32 weeks of gestation, were studied. Data about perinatal factors and TSH values at 3-4 days of life were collected. The assessment of neuromotor development was performed at 18 months of corrected age, using the locomotor subscale of the Griffiths Scales of Mental Development. RESULTS Risk factors supposed to be predictive of sub-optimal neuromotor outcome (odds ratio >1) were at ≤30 weeks: male sex, small for gestational age, patent duct arterious, respiratory distress syndrome, and at 31-32 weeks: Apgar at 5 min <7, respiratory distress syndrome, patent duct arterious and birth weight <1500 g. A strong correlation was also found between TSH screening values >4,3 mU/l and suboptimal neuromotor outcome in both groups. CONCLUSIONS Several perinatal factors, acting on an immature and more vulnerable nervous system, such as the pre-term one, different for different gestational ages, are associated with a sub-optimal neuromotor outcome. Higher, but within the normal range, TSH values at screening seem to be a strong risk factor for neuromotor outcome in preterm infants without intraventricular hemorrhage or periventricular leukomalacia.
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Affiliation(s)
- F Belcari
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, S. Chiara Hospital, University of Pisa, Via Roma 35, 56100 Pisa, Italy
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Crea F, Fornaro L, Paolicchi E, Masi G, Frumento P, Loupakis F, Salvatore L, Cremolini C, Schirripa M, Graziano F, Ronzoni M, Ricci V, Farrar WL, Falcone A, Danesi R. An EZH2 polymorphism is associated with clinical outcome in metastatic colorectal cancer patients. Ann Oncol 2011. [PMID: 21926398 DOI: 10.1093/annonc/mdr387.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite therapeutic innovations, metastatic colorectal cancer (mCRC) is still characterized by poor prognosis and few molecular markers predict the risk of progression. Polycomb group genes (PcGs) are epigenetic modifiers involved in tumor suppressor gene silencing. PcG member EZH2 mediates gene silencing through histone-H3 lysine-27 methylation. In colorectal cancer (CRC), EZH2 overexpression predicts shorter survival. Recently, four EZH2 single-nucleotide polymorphisms (SNPs) have been described. The present study was aimed at evaluating the correlation between EZH2 SNPs and outcome parameters in mCRC patients. PATIENTS AND METHODS DNA was extracted from blood samples of 110 mCRC patients treated with first-line 5-fluorouracil, folinic acid, irinotecan (FOLFIRI) and bevacizumab. Genotyping was carried out by real-time PCR. Genotype was used to predict objective response, progression-free survival (PFS) and overall survival (OS). EZH2 messenger RNA levels were evaluated on lymphocytes of a parallel cohort of 50 CRC patients. RESULTS One allelic variant (rs3757441 C/C versus C/T or T/T) was significantly associated with shorter PFS and OS (P < 0.01 and P < 0.05, respectively). At multivariate analysis, the same variant resulted an independent predictor of PFS and OS (P < 0.05). The C/C variant was associated with significantly higher EZH2 expression (P < 0.05). CONCLUSION An EZH2 SNP may be useful to predict clinical outcome in mCRC patients.
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Affiliation(s)
- F Crea
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa.
| | - L Fornaro
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - E Paolicchi
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa
| | - G Masi
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - P Frumento
- Unit of Biostatistics, Institute of Environmental Health, Karolinska Institutet, Stockholm, Sweden
| | - F Loupakis
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - L Salvatore
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - C Cremolini
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - M Schirripa
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - F Graziano
- Medical Oncology Unit, Department of Onco-Hematology, Azienda Ospedaliera S. Salvatore, Pesaro
| | - M Ronzoni
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - V Ricci
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - W L Farrar
- Cancer Stem Cell Section, Laboratory of Cancer Prevention, National Institute of Cancer-Frederick, Frederick, USA
| | - A Falcone
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - R Danesi
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa
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Loupakis F, Cremolini C, Fioravanti A, Orlandi P, Salvatore L, Masi G, Di Desidero T, Canu B, Schirripa M, Frumento P, Di Paolo A, Danesi R, Falcone A, Bocci G. Pharmacodynamic and pharmacogenetic angiogenesis-related markers of first-line FOLFOXIRI plus bevacizumab schedule in metastatic colorectal cancer. Br J Cancer 2011; 104:1262-9. [PMID: 21407216 PMCID: PMC3078596 DOI: 10.1038/bjc.2011.85] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [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] [Indexed: 11/25/2022] Open
Abstract
Background: The identification of molecular and genetic markers to predict or monitor the efficacy of bevacizumab (BV) represents a key issue in the treatment of metastatic colorectal cancer (mCRC). Methods: Plasma levels of vascular endothelial growth factor (VEGF), placental growth factor (PlGF), soluble VEGF receptor 2 (sVEGFR-2) and thrombospondin-1 (TSP-1) were assessed by ELISA assay at different time points in a cohort of 25 patients enroled in a phase II trial of GONO-FOLFOXIRI plus BV as first-line treatment of mCRC. VEGF: −2578A/C, −1498C/T, −1154A/G, −634C/G and 936C/T; and VEGFR-2: −604A/G, +1192C/T and +1719A/T, polymorphisms were assessed in a total of 54 patients. Results: Treatment with GONO-FOLFOXIRI plus BV determined a prolonged and significant reduction in plasma free, biologically active VEGF concentration. Interestingly, VEGF concentrations remained lower than at baseline also at the time of PD. Conversely, PlGF levels increased during the treatment if compared with baseline, suggesting a possible role in tumour resistance; moreover, sVEGFR-2 increased at the time of PD, as well as TSP-1. No association of assessed polymorphisms with outcome was found. Conclusion: Our study suggested the possible mechanisms of resistance to combined therapy in those patients with a progressive disease to be tested in ongoing phase III randomised studies.
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Affiliation(s)
- F Loupakis
- Unit of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Via Roma, 67, Pisa, 56126, Italy
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