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Mancon A, Rizzo A, Mileto D, Grosso S, Foschi A, Cutrera M, Capetti A, Faggion I, Anselmo A, Monte A, Fillo S, Rizzardini G, Gismondo MR, Micheli V. Viro-immunological evaluation in an immunocompromised patient with long-lasting SARS-CoV-2 infection. Emerg Microbes Infect 2022; 11:786-789. [PMID: 35209808 PMCID: PMC8920372 DOI: 10.1080/22221751.2022.2045877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Mancon
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy
| | - A Rizzo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy
| | - D Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy
| | - S Grosso
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy
| | - A Foschi
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - M Cutrera
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy
| | - A Capetti
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - I Faggion
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - A Anselmo
- Scientific Department Army Medical Center, Rome, Italy
| | - A Monte
- Scientific Department Army Medical Center, Rome, Italy
| | - S Fillo
- Scientific Department Army Medical Center, Rome, Italy
| | - G Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - M R Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy.,L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - V Micheli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco - University of Milan, Milan, Italy
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2
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Gaggiano C, Bardelli M, Tarsia M, Gentileschi S, Maselli A, Grosso S, Cantarini L, Frediani B. Neridronate for transient osteoporosis of the hip in a child. Osteoporos Int 2022; 33:1619-1624. [PMID: 35106625 PMCID: PMC9187543 DOI: 10.1007/s00198-022-06324-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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/24/2022] [Indexed: 12/05/2022]
Abstract
Transient osteoporosis of the hip (TOH) is usually reported in middle-aged men or during pregnancy as a benign self-limiting condition. Nevertheless, its impact on quality of life in terms of pain and disability is considerable. Also, it can lead to insufficiency fractures or, more rarely, evolve into osteonecrosis. This condition is anecdotally described in the pediatric age and very little is known about how it may affect the growing bone. We herein describe a case of TOH in a 10-year-old child treated at our pediatric rheumatology service and summarize the pediatric cases of TOH previously reported in literature. There are two points of interest in our case report, the first one being the unusual complication of TOH with a femoral physis fracture and the second the complete recovery after the off-label therapy with bisphosphonates. We suggest that interventional medical treatment could be considered in selected cases of juvenile TOH, to prevent any possible irreversible damage on the femoral physis. As far as we know, this is the first report of neridronate employment in children affected by TOH.
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Affiliation(s)
- C Gaggiano
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy.
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy.
| | - M Bardelli
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - M Tarsia
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - S Gentileschi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - A Maselli
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - S Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - L Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
| | - B Frediani
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", viale Bracci 1, 53100, Siena, Italy
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Tognetti L, Cinotti E, Coriolani G, Suppa M, Perrot JL, Vascotto M, Grosso S, Rubegni P. Cutaneous lesions of Anderson-Fabry disease examined with a novel technique: Line-field confocal optical coherence tomography. J Eur Acad Dermatol Venereol 2021; 36:e371-e373. [PMID: 34927772 DOI: 10.1111/jdv.17893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/24/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- L Tognetti
- Dermatology Unit, Department of Medical, Surgical and NeuroSciences, University of Siena, Siena, Italy
| | - E Cinotti
- Dermatology Unit, Department of Medical, Surgical and NeuroSciences, University of Siena, Siena, Italy.,Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France
| | - G Coriolani
- U.O.C. Pediatria, Azienda Ospedaliera Universitaria Senese, Siena, Italia
| | - M Suppa
- Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France.,Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - J L Perrot
- Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France.,Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - M Vascotto
- U.O.C. Pediatria, Azienda Ospedaliera Universitaria Senese, Siena, Italia
| | - S Grosso
- Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - P Rubegni
- Dermatology Unit, Department of Medical, Surgical and NeuroSciences, University of Siena, Siena, Italy
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Mileto D, Fenizia C, Cutrera M, Gagliardi G, Gigantiello A, De Silvestri A, Rizzo A, Mancon A, Bianchi M, De Poli F, Cuomo M, Burgo I, Longo M, Rimoldi SG, Pagani C, Grosso S, Micheli V, Rizzardini G, Grande R, Biasin M, Gismondo MR, Lombardi A. SARS-CoV-2 mRNA vaccine BNT162b2 triggers a consistent cross-variant humoral and cellular response. Emerg Microbes Infect 2021; 10:2235-2243. [PMID: 34749573 PMCID: PMC8648019 DOI: 10.1080/22221751.2021.2004866] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 09/15/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 11/06/2022]
Abstract
As the SARS-CoV-2 pandemic continues to rage worldwide, the emergence of numerous variants of concern (VOC) represents a challenge for the vaccinal protective efficacy and the reliability of commercially available high-throughput immunoassays. Our study demonstrates the administration of two doses of the BNT162b2 vaccine that elicited a robust SARS-CoV-2-specific immune response which was assessed up to 3 months after full vaccination in a cohort of 37 health care workers (HCWs). SARS-CoV-2-specific antibody response, evaluated by four commercially available chemiluminescence immunoassays (CLIA), was qualitatively consistent with the results provided by the gold-standard in vitro neutralization assay (NTA). However, we could not observe a correlation between the quantity of the antibody detected by CLIA assays and their neutralizing activity tested by NTA. Almost all subjects developed a SARS-CoV-2-specific T-cell response. Moreover, vaccinated HCWs developed a similar protective neutralizing antibodies response against the EU (B.1), Alpha (B.1.1.7), Gamma (P.1), and Eta (B.1.525) SARS-CoV-2 variants, while Beta (B.1.351) and Delta (B.1.617.2) strains displayed a consistent partial immune evasion. These results underline the importance of a solid vaccine-elicited immune response and a robust antibody titre. We believe that these relevant results should be taken into consideration in the definition of future vaccinal strategies.
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Affiliation(s)
- D. Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - C. Fenizia
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - M. Cutrera
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - G. Gagliardi
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - A. Gigantiello
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - A. De Silvestri
- Clinical Epidemiology and Biometeric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A. Rizzo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - A. Mancon
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - M. Bianchi
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - F. De Poli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - M. Cuomo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - I. Burgo
- Hematology and Transfusion Medicine, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan
| | - M. Longo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - S. G. Rimoldi
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - C. Pagani
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - S. Grosso
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - V. Micheli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - G. Rizzardini
- Division of Infectious Diseases, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - R. Grande
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - M. Biasin
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
| | - M. R. Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
| | - A. Lombardi
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, L. Sacco University Hospital, Milan, Italy
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Grosso S, Tonet S, Bernard I, Corso J, De Marchi D, Dorigo L, Funes G, Lussu M, Oppio N, Pais dei Mori L, Palese A. Non‐nursing tasks as experienced by nurses: a descriptive qualitative study. Int Nurs Rev 2019; 66:259-268. [DOI: 10.1111/inr.12496] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Grosso
- Member of the Nursing Board IPASVI Belluno Italy
| | - S. Tonet
- Member of the Nursing Board IPASVI Belluno Italy
| | - I. Bernard
- Member of the Nursing Board IPASVI Belluno Italy
| | - J. Corso
- Member of the Nursing Board IPASVI Belluno Italy
| | - D. De Marchi
- Member of the Nursing Board IPASVI Belluno Italy
| | - L. Dorigo
- Member of the Nursing Board IPASVI Belluno Italy
| | - G. Funes
- Member of the Nursing Board IPASVI Belluno Italy
| | - M. Lussu
- Member of the Nursing Board IPASVI Belluno Italy
| | - N. Oppio
- Member of the Nursing Board IPASVI Belluno Italy
| | | | - A. Palese
- Nursing Science University of Udine Udine Italy
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6
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Capecchi G, Baldassarri M, Ferranti S, Guidoni E, Cioni M, Nürnberg P, Mencarelli M, Renieri A, Grosso S. CKAP2L
mutation confirms the diagnosis of Filippi syndrome. Clin Genet 2018; 93:1109-1110. [DOI: 10.1111/cge.13188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/27/2022]
Affiliation(s)
- G. Capecchi
- Dipartimento di Medicina molecolare e dello sviluppo; Clinica Pediatrica; Siena Italy
| | - M. Baldassarri
- Medical Genetics; University of Siena; Siena Italy
- Genetica Medica; Azienda Ospedaliera Universitaria Senese; Siena Italy
| | - S. Ferranti
- Dipartimento di Medicina molecolare e dello sviluppo; Clinica Pediatrica; Siena Italy
| | - E. Guidoni
- Dipartimento di Medicina molecolare e dello sviluppo; Clinica Pediatrica; Siena Italy
| | - M. Cioni
- Dipartimento di Medicina molecolare e dello sviluppo; Clinica Pediatrica; Siena Italy
| | - P. Nürnberg
- Cologne Center for Genomics; University of Cologne; Cologne Germany
| | - M.A. Mencarelli
- Genetica Medica; Azienda Ospedaliera Universitaria Senese; Siena Italy
| | - A. Renieri
- Medical Genetics; University of Siena; Siena Italy
- Genetica Medica; Azienda Ospedaliera Universitaria Senese; Siena Italy
| | - S. Grosso
- Dipartimento di Medicina molecolare e dello sviluppo; Clinica Pediatrica; Siena Italy
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7
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Coriolani G, Galimberti D, Guglielmucci D, Caini M, De Francesco S, Esposti G, Bracco S, Galluzzi P, Toti P, Pinto A, Favre C, Grosso S, Hadjistilianou T. Outcome of retinoblastoma patients treated according to the University Hospital of Siena guidelines. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.04142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G. Coriolani
- School of Pediatrics- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - D. Galimberti
- Unit of Pediatrics- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - D.F. Guglielmucci
- Unit of Pediatrics- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - M. Caini
- Unit of Pediatrics- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - S. De Francesco
- Unit of Ophthalmology-Retinoblastoma Referral Center- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - G. Esposti
- School of Ophthalmology- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - S. Bracco
- Unit of Neuroimaging and Neurointervention, NINT- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - P. Galluzzi
- Unit of Neuroimaging and Neurointervention, NINT- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - P. Toti
- Unit of Pathology- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - A.M. Pinto
- Unit of Genetics- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - C. Favre
- Head of the Unit of Pediatric Onco-hematology- Head of the Regional Center of Pediatric Onco-hematology CROP; Azienda Ospedaliero Universitaria Meyer; Florence Italy
| | - S. Grosso
- Head of the Unit of Pediatrics- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
| | - T. Hadjistilianou
- Unit of Ophthalmology- Head of the Retinoblastoma Referral Center- Policlinico “Le Scotte”; Azienda Ospedaliero Universitaria Senese; Siena Italy
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8
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De Liso P, Vigevano F, Specchio N, De Palma L, Bonanni P, Osanni E, Coppola G, Parisi P, Grosso S, Verrotti A, Spalice A, Nicita F, Zamponi N, Siliquini S, Giordano L, Martelli P, Guerrini R, Rosati A, Ilvento L, Belcastro V, Striano P, Vari M, Capovilla G, Beccaria F, Bruni O, Luchetti A, Gobbi G, Russo A, Pruna D, Tozzi A, Cusmai R. Effectiveness and tolerability of perampanel in children and adolescents with refractory epilepsies-An Italian observational multicenter study. Epilepsy Res 2016; 127:93-100. [PMID: 27568598 DOI: 10.1016/j.eplepsyres.2016.08.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/01/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the efficacy and tolerability of Perampanel (PER) in children and adolescents with refractory epilepsies in daily clinical practice conditions. PATIENTS AND METHODS This Italian multicenter retrospective observational study was performed in 16 paediatric epilepsy centres. Inclusion criteria were: (i) ≤18 years of age, (ii) history of refractory epilepsy, (iii) a follow-up ≥5 months of PER add-on therapy. Exclusion criteria were: (i) a diagnosis of primary idiopathic generalized epilepsy, (ii) variation of concomitant AEDs during the previous 4 weeks. Response was defined as a ≥50% reduction in monthly seizure frequency compared with the baseline. RESULTS 62 patients suffering from various refractory epilepsies were included in this study: 53% were males, the mean age was 14.2 years (range 6-18 years), 8 patients aged <12 years. Mean age at epilepsy onset was 3.4 years and the mean duration of epilepsy was 10.8 years (range 1-16), which ranged from 2 seizures per-month up to several seizures per-day (mean number=96.5). Symptomatic focal epilepsy was reported in 62.9% of cases. Mean number of AEDs used in the past was 7.1; mean number of concomitant AEDs was 2.48, with carbamazepine used in 43.5% of patients. Mean PER daily dose was 7.1mg (2-12mg). After an average of 6.6 months of follow-up (5-13 months), the retention rate was 77.4% (48/62). The response rate was 50%; 16% of patients achieved ≥75% seizure frequency reduction and 5% became completely seizure free. Seizure aggravation was observed in 9.7% of patients. Adverse events were reported in 19 patients (30.6%) and led to PER discontinuation in 4 patients (6.5%). The most common adverse events were behaviour disturbance (irritability and aggressiveness), dizziness, sedation and fatigue. CONCLUSION PER was found to be a safe and effective treatment when used as adjunctive therapy in paediatric patients with uncontrolled epilepsy.
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9
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Verrotti A, Laino D, Rinaldi VE, Suppiej A, Giordano L, Toldo I, Margari L, Parisi P, Rizzo R, Matricardi S, Cusmai R, Grosso S, Gaggero R, Zamponi N, Pavone P, Capovilla G, Rauchenzauner M, Cerminara C, Di Gennaro G, Esposito M, Striano P, Savasta S, Coppola G, Siliquini S, Operto F, Belcastro V, Ragona F, Marseglia GL, Spalice A. Clinical dissection of childhood occipital epilepsy of Gastaut and prognostic implication. Eur J Neurol 2015; 23:241-6. [PMID: 26498733 DOI: 10.1111/ene.12840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to describe the clinical and electrical features and the long-term evolution of childhood occipital epilepsy of Gastaut (COE-G) in a cohort of patients and to compare long-term prognosis between patients with and without other epileptic syndromes. METHODS This was a retrospective analysis of the long-term outcome of epilepsy in 129 patients with COE-G who were referred to 23 Italian epilepsy centres and one in Austria between 1991 and 2004. Patients were evaluated clinically and with electroencephalograms for 10.1-23.0 years. The following clinical characteristics were evaluated: gender, patient age at seizure onset, history of febrile seizures and migraine, family history of epilepsy, duration and seizure manifestations, circadian distribution and frequency of seizures, history of medications including the number of drugs, therapeutic response and final outcome. RESULTS Visual hallucinations were the first symptom in 62% and the only manifestation in 38.8% of patients. Patients were subdivided into two groups: group A with isolated COE-G; group B with other epileptic syndromes associated with COE-G. The most significant (P < 0.05) difference concerned antiepileptic therapy: in group A, 45 children responded to monotherapy; in group B only 15 children responded to monotherapy. At the end of follow-up, the percentage of seizure-free patients was significantly higher in group A than in group B. CONCLUSIONS Childhood occipital epilepsy of Gastaut has an overall favourable prognosis and a good response to antiepileptic therapy with resolution of seizures and of electroencephalogram abnormalities. The association of typical COE-G symptoms with other types of seizure could be related to a poor epilepsy outcome.
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Affiliation(s)
- A Verrotti
- Department of Paediatrics, University of Perugia, Perugia, Italy
| | - D Laino
- Department of Paediatrics, University of Perugia, Perugia, Italy
| | - V E Rinaldi
- Department of Paediatrics, University of Perugia, Perugia, Italy
| | - A Suppiej
- Paediatric Neurology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - L Giordano
- Paediatric Neuropsychiatric Division, Spedali Civili, Brescia, Italy
| | - I Toldo
- Paediatric Neurology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - L Margari
- Unit of Child Neuropsychiatry, Department of Basic Medical Sciences, Neuroscience and Sense Organs, 'Aldo Moro' University of Bari, Bari, Italy
| | - P Parisi
- NESMOS Department, Chair of Paediatrics, Paediatric Headache Centre, Paediatric Sleep Centre and Child Neurology, Faculty of Medicine and Psychology, Sant'Andrea Hospital, 'Sapienza University', Roma, Italy
| | - R Rizzo
- Section of Child Neuropsychiatry, Department of Paediatrics, University of Catania, Catania, Italy
| | - S Matricardi
- Departement of Paediatrics, University of Chieti, Chieti, Italy.,Department of Paediatric Neuroscience, Foundation IRCCS Neurological Institute 'C. Besta', Milano, Italy
| | - R Cusmai
- Neurology Unit, 'Bambino Gesù' Children's Hospital, IRCCS, Roma, Italy
| | - S Grosso
- Paediatric Neurology-Immunology and Endocrinology Unit, University of Siena, Siena, Italy
| | - R Gaggero
- Paediatric Unit, San Paolo Hospital, Savona, Italy
| | - N Zamponi
- Child Neuropsychiatry Unit, Polytechnic University of the Marche, Ancona, Italy
| | - P Pavone
- Unit of Paediatrics and Paediatric Emergency 'Costanza Gravina', University-Hospital 'Vittorio Emanuele, Policlinic', University of Catania, Catania, Italy
| | - G Capovilla
- Department of Child Neuropsychiatry, Epilepsy Centre, C. Poma Hospital, Mantova, Italy
| | - M Rauchenzauner
- Department of Paediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - C Cerminara
- Paediatric Neurology, Department of Neurosciences, Tor Vergata University of Rome, Roma, Italy
| | | | - M Esposito
- Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Centre for Childhood Headache, Second University of Naples, Napoli, Italy
| | - P Striano
- Paediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 'G. Gaslini' Institute, Genova, Italy
| | - S Savasta
- Department of Paediatrics, Pavia University Foundation, IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Coppola
- Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Salerno, Italy
| | - S Siliquini
- Child Neuropsychiatry Unit, Polytechnic University of the Marche, Ancona, Italy
| | - F Operto
- Unit of Child Neuropsychiatry, Department of Basic Medical Sciences, Neuroscience and Sense Organs, 'Aldo Moro' University of Bari, Bari, Italy
| | - V Belcastro
- Neurology Unit, Department of Neuroscience, 'Sant'Anna' Hospital, Como, Italy
| | - F Ragona
- Department of Paediatric Neuroscience, Foundation IRCCS Neurological Institute 'C. Besta', Milano, Italy
| | - G L Marseglia
- Department of Paediatrics, Pavia University Foundation, IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Spalice
- Child Neurology, Chair of Paediatrics, II Faculty of Medicine, University of Rome, Roma, Italy
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10
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Filloy J, Grosso S, Bellocq MI. Urbanization altered latitudinal patterns of bird diversity-environment relationships in the southern Neotropics. Urban Ecosyst 2014. [DOI: 10.1007/s11252-014-0429-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Affiliation(s)
- S. Grosso
- Pediatric Neurology-Immunology and Endocrinology Unit; University of Siena; Siena Italy
- Department of Pediatrics; University of Siena; Siena Italy
| | - P. Balestri
- Department of Pediatrics; University of Siena; Siena Italy
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12
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Grosso S, Coppola G, Cusmai R, Parisi P, Spalice A, Foligno S, Verrotti A, Balestri P. Efficacy and tolerability of add-on lacosamide in children with Lennox-Gastaut syndrome. Acta Neurol Scand 2014; 129:420-4. [PMID: 24479878 DOI: 10.1111/ane.12221] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Available data on the efficacy of lacosamide in children with Lennox-Gastaut syndrome (LGS) are scarce and controversial. We present our experience with lacosamide therapy in children affected by LGS. MATERIAL AND METHODS Medical charts of all children affected by LGS receiving oral lacosamide adjunctive therapy in six paediatric neurology centres were retrospectively evaluated. Efficacy was determined according to the frequency of countable seizures during the 4 weeks prior to treatment and the frequency in the last 4 weeks of observation. Patients whose seizure frequency was reduced by at least 50% were defined as responders. RESULTS Eighteen children (mean age 12.3 years) were identified. After a mean follow-up period of 9 months, 33% of patients were responders. None of them was seizure-free during the study period. The overall seizure reduction rate was 29%. The percentage reductions from baseline in tonic seizures and drop-attacks rates were 31% and 20%, respectively. Adverse reactions occurred in 44% of patients. The drug was discontinued in four (22%) patients because of increased seizure frequency (three cases) and walking instability (another patient). CONCLUSIONS A third of children with LGS were responders after lacosamide adjunctive therapy. Although caution is still necessary when the drug is used in children with LGS, our preliminary observations suggest that lacosamide might be effective and represent a possible therapeutic option in children affected by LGS.
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Affiliation(s)
- S. Grosso
- Pediatric Neurology-Immunology and Endocrinology Unit; University of Siena; Siena Italy
- Department of Pediatrics; University of Siena; Siena Italy
| | - G. Coppola
- Institute of Child and Adolescence Neuropsychiatry; University of Salerno; Salerno Italy
| | - R. Cusmai
- Neurology Unit; Bambino Gesù Children's Hospital; Rome Italy
| | - P. Parisi
- Child Neurology; NESMOS Department; Faculty of Medicine and Psychology; Sapienza University of Rome; Italy
| | - A. Spalice
- Department of Pediatrics; Child Neurology Division; Sapienza University of Rome; Rome Italy
| | - S. Foligno
- Child Neurology; NESMOS Department; Faculty of Medicine and Psychology; Sapienza University of Rome; Italy
| | - A. Verrotti
- Clinical Pediatrics; University of Perugia; Perugia Italy
| | - P. Balestri
- Department of Pediatrics; University of Siena; Siena Italy
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13
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Verrotti A, Scaparrotta A, Grosso S, Chiarelli F, Coppola G. Anticonvulsant drugs and hematological disease. Neurol Sci 2014; 35:983-93. [PMID: 24619070 DOI: 10.1007/s10072-014-1701-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
Many antiepileptic drugs (AEDs) are associated with hematological disorders that range from mild thrombocytopenia or neutropenia to anemia, red cell aplasia, until bone marrow failure. Fortunately, potentially fatal hematological disorders such as aplastic anemia are very rare. This review investigates hematological effects associated with classic and newer AEDs: a PubMed search indexed for MEDLINE was undertaken to identify studies in adults, children and animals using the name of all anticonvulsant drugs combined with the terms "hematological disease" and "hematological abnormalities" as key words. The most common hematological alterations occur with older AEDs than newer. Indeed, careful hematological monitoring is needed especially using carbamazepine, phenytoin and valproic acid. The pathogenetic mechanisms are still unknown: they seem to be related to an immunological mechanism, but drugs pharmacokinetics and pharmacodynamics interactions may also play an important role. Further research is needed to assess the real pathogenetic mechanism at the basis of hematological complications caused by AEDs.
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Affiliation(s)
- A Verrotti
- Department of Pediatrics, University of Perugia, Perugia, Italy,
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14
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Grosso S, Doyen J, Parks SK, Bertero T, Paye A, Cardinaud B, Gounon P, Lacas-Gervais S, Noël A, Pouysségur J, Barbry P, Mazure NM, Mari B. MiR-210 promotes a hypoxic phenotype and increases radioresistance in human lung cancer cell lines. Cell Death Dis 2013; 4:e544. [PMID: 23492775 PMCID: PMC3615727 DOI: 10.1038/cddis.2013.71] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The resistance of hypoxic cells to radiotherapy and chemotherapy is a major problem in the treatment of cancer. Recently, an additional mode of hypoxia-inducible factor (HIF)-dependent transcriptional regulation, involving modulation of a specific set of micro RNAs (miRNAs), including miR-210, has emerged. We have recently shown that HIF-1 induction of miR-210 also stabilizes HIF-1 through a positive regulatory loop. Therefore, we hypothesized that by stabilizing HIF-1 in normoxia, miR-210 may protect cancer cells from radiation. We developed a non-small cell lung carcinoma (NSCLC)-derived cell line (A549) stably expressing miR-210 (pmiR-210) or a control miRNA (pmiR-Ctl). The miR-210-expressing cells showed a significant stabilization of HIF-1 associated with mitochondrial defects and a glycolytic phenotype. Cells were subjected to radiation levels ranging from 0 to 10 Gy in normoxia and hypoxia. Cells expressing miR-210 in normoxia had the same level of radioresistance as control cells in hypoxia. Under hypoxia, pmiR-210 cells showed a low mortality rate owing to a decrease in apoptosis, with an ability to grow even at 10 Gy. This miR-210 phenotype was reproduced in another NSCLC cell line (H1975) and in HeLa cells. We have established that radioresistance was independent of p53 and cell cycle status. In addition, we have shown that genomic double-strand breaks (DSBs) foci disappear faster in pmiR-210 than in pmiR-Ctl cells, suggesting that miR-210 expression promotes a more efficient DSB repair. Finally, HIF-1 invalidation in pmiR-210 cells removed the radioresistant phenotype, showing that this mechanism is dependent on HIF-1. In conclusion, miR-210 appears to be a component of the radioresistance of hypoxic cancer cells. Given the high stability of most miRNAs, this advantage could be used by tumor cells in conditions where reoxygenation has occurred and suggests that strategies targeting miR-210 could enhance tumor radiosensitization.
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Affiliation(s)
- S Grosso
- Institut de Pharmacologie Moléculaire et Cellulaire (IPMC), Centre National de la Recherche Scientifique, CNRS UMR 7275, Sophia Antipolis, France
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15
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Cui H, Grosso S, Schelter F, Mari B, Krüger A. On the Pro-Metastatic Stress Response to Cancer Therapies: Evidence for a Positive Co-Operation between TIMP-1, HIF-1α, and miR-210. Front Pharmacol 2012; 3:134. [PMID: 22807917 PMCID: PMC3395024 DOI: 10.3389/fphar.2012.00134] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 06/24/2012] [Indexed: 01/18/2023] Open
Abstract
In contrast to expectations in the past that tumor starvation or unselective inhibition of proteolytic activity would cure cancer, there is accumulating evidence that microenvironmental stress, such as hypoxia or broad-spectrum inhibition of metalloproteinases can promote metastasis. In fact, malignant tumor cells, due to their genetic and epigenetic instability, are predisposed to react to stress by adaptation and, if the stress persists, by escape and formation of metastasis. Recent recognition of the concepts of dynamic evolution as well as population and systems biology is extremely helpful to understand the disappointments of clinical trials with new drugs and may lead to paradigm-shifts in therapy strategies. This must be complemented by an increased understanding of molecular mechanism involved in stress response. Here, we review new roles of Hypoxia-inducible factor-1 (HIF-1), one transcription factor regulating stress response-related gene expression: HIF-1 is crucial for invasion and metastasis, independent from its pro-survival function. In addition, HIF-1 mediates pro-metastatic microenvironmental changes of the proteolytic balance as triggered by high systemic levels of tissue inhibitor of metalloproteinases-1 (TIMP-1), typical for many aggressive cancers, and regulates the metabolic switch to glycolysis, notably via activation of the microRNA miR-210. There is preliminary evidence that TIMP-1 also induces miR-210. Such positive-regulatory co-operation of HIF-1α, miR-210, and TIMP-1, all described to correlate with bad prognosis of cancer patients, opens new perspectives of gaining insight into molecular mechanisms of metastasis-inducing evasion of tumor cells from stress.
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Affiliation(s)
- Haissi Cui
- Klinikum Rechts der Isar der Technischen Universität München, Institut für Experimentelle Onkologie und Therapieforschung München, Germany
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16
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Fenouille N, Grosso S, Yunchao S, Mary D, Pontier-Bres R, Imbert V, Czerucka D, Caroli-Bosc FX, Peyron JF, Lagadec P. Calpain 2-dependent IκBα degradation mediates CPT-11 secondary resistance in colorectal cancer xenografts. J Pathol 2012; 227:118-29. [PMID: 22069124 DOI: 10.1002/path.3034] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 09/20/2011] [Accepted: 10/21/2011] [Indexed: 12/12/2022]
Abstract
CPT-11 (irinotecan), the first-line chemotherapy for advanced stage colorectal cancer, remains inactive in about half of patients (primary chemoresistance) and almost all initial responders develop secondary resistance after several courses of treatment (8 months on average). Nude mice bearing HT-29 colon cancer xenografts were treated with CPT-11 and/or an NF-κB inhibitor for two courses. We confirm that NF-κB inhibition potentiated CPT-11 anti-tumoural effect after the first course of treatment. However, tumours grew again at the end of the second course of treatment, generating resistant tumours. We observed an increase in the basal NF-κB activation in resistant tumours and in two resistant sublines, either obtained from resistant HT-29 tumours (HT-29R cells) or generated in vitro (RSN cells). The decrease of NF-κB activation in HT-29R and RSN cells by stable transfections with the super-repressor form of IκBα augmented their sensitivity to CPT-11. Comparing gene expression profiles of HT-29 and HT-29R cells, we identified the S100A10/Annexin A2 complex and calpain 2 as over-expressed potential NF-κB inducers. SiRNA silencing of calpain 2 but not of S100A10 and/or annexin A2, resulted in a decrease in NF-κB activation, an increase in cellular levels of IκBα and a partial restoration of the CPT-11 sensitivity in both HT-29R and RSN cells, suggesting that calpain 2-dependent IκBα degradation mediates CPT-11 secondary resistance. Thus, targeted therapies directed against calpain 2 may represent a novel strategy to enhance the anti-cancer efficacy of CPT-11.
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Affiliation(s)
- Nina Fenouille
- INSERM, U895, Centre Méditerranéen de Médecine Moléculaire (C3M), Equipe Inflammation, Cancer, Cellules Souches Cancéreuses, Nice, France
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17
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Ciaramella A, Grosso S, Poli P, Gioia A, Inghirami S, Massimetti G, Conti L. When pain is not fully explained by organic lesion: a psychiatric perspective on chronic pain patients. Eur J Pain 2012; 8:13-22. [PMID: 14690670 DOI: 10.1016/s1090-3801(03)00062-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [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: 11/29/2022]
Abstract
Recent literature demonstrates the relationship between psychopathology and medically unexplained pain, even if the results of several studies show a high degree of variability. The present study was planned with the aim of analysing both the possible relationship between the level (low/high) of organicity and the presence of psychopathology, and the degree to which these differences are related to methodological problems. Between 1998 and 2000, four hundred and thirty six consecutive patients seen at the Pisa Pain Therapy and Palliative Care Unit were requested to fill in a questionnaire, the GHQ-12, to screen the subjects probably with (GHQ-12>3) or without (GHQ-12</=3) psychopathology. All the patients scoring above the GHQ-12 threshold (score of 3), and a randomised sample of those scoring below the GHQ-12 threshold, were included in the study. These patients were then interviewed using three different instruments: the Mini International Neuropsychiatric Interview (MINI) for a standardised psychiatric diagnosis, the Semistructured Interview for Depression (SID) for the characterisation of temperament, and the Italian Pain Questionnaire (IPQ) for the evaluation of pain. Our results suggest that Somatisation Disorders are more frequent in the medically unexplained pain group than in the medically explained pain group, whereas the other psychiatric disorders have a similar prevalence in the two pain groups. Mood and anxiety disorders are correlated with high scores on GHQ-12 and medically explained pain has a higher prevalence of GHQ-12>3 than the medically unexplained pain group. These results confirm that methodology is an important factor that could modify results in psychiatric research. Both medically unexplained pain and the presence of psychopathology are significantly correlated with sex, and age: females and young patients have a higher prevalence of psychopathology and of medically unexplained pain. Our results suggest that in the correlation between the low organicity of pain and psychopathology, the age and sex play a relevant role.
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Affiliation(s)
- A Ciaramella
- Pain Therapy and Palliative Care Unit, Azienda Ospedaliera Pisana, Via Roma 67, Pisa, 56100, Italy.
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18
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Grosso S, Mason G, Ortalda E, Scortichini M. Brenneria salicis Associated with Watermark Disease Symptoms on Salix alba in Italy. Plant Dis 2011; 95:772. [PMID: 30731913 DOI: 10.1094/pdis-11-10-0781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
From 1999 to 2010, withering of white willow was observed on trees growing along roads or irrigation canals in Torino, Alessandria, and Vercelli provinces of Italy, with incidence varying from 15, 25, and 30%, respectively. In spring and autumn 2008, six samples from withering branches with bark cankers were collected. On the bark surface near the cankers, iridescent traces of dried ooze were found. Tissues immediately below the cankers were dark with water-soaked, olive-colored edges. In some cases, the xylem appeared affected. Small fragments taken from the affected tissue on both edges of bark alterations and darkened vessels were crushed into mortars with sterile saline. Ten-fold serial dilutions (10-1, 10-2) were also performed. Aliquots of 0.1 ml were plated on nutrient agar and incubated at 25°C for 4 days. Bacterial colonies were ivory to white, circular, and bright, with a diameter of ~2 mm. Isolates were negative for Gram staining, presence of arginine dehydrolase, oxidase, phenylalanine deaminase, urease, hydrolysis of gelatin and starch, nitrate reduction, acidity from d-arabinose, cellobiose, lactose, maltose, trehalose, xylose, and pectinolytic activity on potato slices; positive for the presence of catalase and levan, fermentative metabolism of glucose, acid production from aesculin, l-arabinose, dextrose, d-galactose, inositol, d-mannitol, α-methylglucoside, raffinose, salicin and sucrose, H2S production from cysteine, and bright yellow pigment production on autoclaved potato tissue. They were not fluorescent on King's medium B and did not induce hypersensitivity reaction on tobacco leaf. Similar results were obtained with Brenneria salicis control strain, LMG 6089, except for acid production from α-methylglucoside (negative) and l-arabinose (negative). Acid production from α-methylglucoside has been reported for the Japanese strains of B. salicis, which do not produce acidity from inositol (4). Genomic DNA was extracted (1) from three isolates, and PCR reactions were performed with Es1A and Es4B primers (2) that amplify a 553-bp fragment from the 16S rDNA of B. salicis. The isolates showed a PCR product of expected size, like the positive control LMB 6089. On the basis of colony features, biochemical tests, and the PCR assay, we conclude that the isolates belong to B. salicis, a pathogen reported in Belgium, Germany, Great Britain, the Netherlands, Hungary, Japan, and New Zealand (2,3) but, as well as watermark disease symptoms, never previously reported in Italy. In summer 2009, pathogenicity tests were performed by inoculating young, white willow plants with B. salicis suspensions of ~1 to 2 × 109 CFU/ml placed with a syringe at the intersection of 1-year-old branches on the trunk. However, a year later, no symptoms of disease have been noted on the inoculated plants. According to the literature, pathogenicity tests rarely lead to the expected results because the bacterium can survive for many years in latent form, breaking out only when proper environmental conditions occur (3). Also the tests with B. salicis LMG 6089 gave negative results. Further investigation is necessary to clarify the relationships between this bacterium and the environment in causing withering of white willows in Piedmont. References: (1) W. P. Chen and T. T. Kuo. Nucleic Acids Res. 21:2260, 1993. (2) L. Hauben et al. Appl. Environ. Microbiol. 64:3966, 1998. (3) M. Maes et al. Environ. Microbiol. 11:1453, 2009. (4) Y. Sakamoto et al. Plant Pathol. 48:613, 1999.
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Affiliation(s)
- S Grosso
- Phytosanitary Service of Piedmont Region, Via Livorno, 60, 10144 Turin, Italy
| | - G Mason
- Phytosanitary Service of Piedmont Region, Via Livorno, 60, 10144 Turin, Italy
| | - E Ortalda
- Phytosanitary Service of Piedmont Region, Via Livorno, 60, 10144 Turin, Italy
| | - M Scortichini
- C.R.A. - Research Unit for Fruit Trees, Via Torrino, 3, 81100 Caserta, Italy
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19
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Coppola G, Grosso S, Franzoni E, Veggiotti P, Zamponi N, Parisi P, Spalice A, Habetswallner F, Fels A, Verrotti A, D’Aniello A, Mangano S, Balestri A, Curatolo P, Pascotto A. Rufinamide in refractory childhood epileptic encephalopathies other than Lennox–Gastaut syndrome. Eur J Neurol 2011; 18:246-251. [DOI: 10.1111/j.1468-1331.2010.03113.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G. Coppola
- Clinic of Child Neuropsychiatry, Second University of Naples, Naples
| | - S. Grosso
- Department of Pediatrics, Pediatric Neurology Section, University of Siena, Siena
| | - E. Franzoni
- Child Neuropsychiatry Unit, Bologna University, Bologna
| | - P. Veggiotti
- Department of Child Neurology and Psychiatry, C. Mondino Institute, University of Pavia, Pavia
| | - N. Zamponi
- Pediatric Neurology Department, G. Salesi Hospital, Ancona
| | - P. Parisi
- Chair of Pediatrics, Second Faculty of Medicine, Sapienza University
| | - A. Spalice
- Department of Pediatrics, First Faculty of Medicine, Sapienza University, Sapienza
| | | | - A. Fels
- Clinical Neurophysiology Unit, Cardarelli Hospital, Naples
| | - A. Verrotti
- Department of Pediatrics, University of Chieti, Chieti
| | - A. D’Aniello
- Clinic of Child Neuropsychiatry, Second University of Naples, Naples
| | - S. Mangano
- Child Neuropsychiatry, Palermo University, Palermo
| | - A. Balestri
- Department of Pediatrics, Pediatric Neurology Section, University of Siena, Siena
| | - P. Curatolo
- Pediatric Neuroscience Unit, Tor Vergata University of Rome, Rome, Italy
| | - A. Pascotto
- Clinic of Child Neuropsychiatry, Second University of Naples, Naples
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Puisségur MP, Mazure NM, Bertero T, Pradelli L, Grosso S, Robbe-Sermesant K, Maurin T, Lebrigand K, Cardinaud B, Hofman V, Fourre S, Magnone V, Ricci JE, Pouysségur J, Gounon P, Hofman P, Barbry P, Mari B. miR-210 is overexpressed in late stages of lung cancer and mediates mitochondrial alterations associated with modulation of HIF-1 activity. Cell Death Differ 2010; 18:465-78. [PMID: 20885442 DOI: 10.1038/cdd.2010.119] [Citation(s) in RCA: 323] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Following the identification of a set of hypoxia-regulated microRNAs (miRNAs), recent studies have highlighted the importance of miR-210 and of its transcriptional regulation by the transcription factor hypoxia-inducible factor-1 (HIF-1). We report here that miR-210 is overexpressed at late stages of non-small cell lung cancer. Expression of miR-210 in lung adenocarcinoma A549 cells caused an alteration of cell viability associated with induction of caspase-3/7 activity. miR-210 induced a loss of mitochondrial membrane potential and the apparition of an aberrant mitochondrial phenotype. The expression profiling of cells overexpressing miR-210 revealed a specific signature characterized by enrichment for transcripts related to 'cell death' and 'mitochondrial dysfunction', including several subunits of the electron transport chain (ETC) complexes I and II. The transcript coding for one of these ETC components, SDHD, subunit D of succinate dehydrogenase complex (SDH), was validated as a bona fide miR-210 target. Moreover, SDHD knockdown mimicked miR-210-mediated mitochondrial alterations. Finally, miR-210-dependent targeting of SDHD was able to activate HIF-1, in line with previous studies linking loss-of-function SDH mutations to HIF-1 activation. miR-210 can thus regulate mitochondrial function by targeting key ETC component genes with important consequences on cell metabolism, survival and modulation of HIF-1 activity. These observations help explain contradictory data regarding miR-210 expression and its putative function in solid tumors.
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Affiliation(s)
- M-P Puisségur
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS UMR6097, Sophia Antipolis, France
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21
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Galluzzi P, Grosso S, Cerase A, Monti L, Balestri P, Bellini M, Venturi C. L-2 Hydroxyglutaric Aciduria: Magnetization Transfer Contrast and Diffusion Weighted Magnetic Resonance Imaging Findings. Neuroradiol J 2010; 23:402-6. [DOI: 10.1177/197140091002300404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Accepted: 04/27/2010] [Indexed: 11/16/2022] Open
Abstract
We describe the case of a 13-year-old male with ù aciduria. Conventional magnetic resonance imaging and diffusion weighted imaging disclosed some previously unreported findings. In particular, we observed an almost total sparing of early myelinated regions, and a restricted diffusion pattern in the dentate nuclei. Magnetization transfer contrast showed a normal range of values in early myelinated regions, and revealed abnormal values in the subcortical temporal white matter, internal capsule and globi palladi.
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Affiliation(s)
- P. Galluzzi
- Neuroimaging and Neurointerventional Division, Siena University Hospital; Siena, Italy
| | - S. Grosso
- Paediatric Clinic, Siena University Hospital; Siena, Italy
| | - A. Cerase
- Neuroimaging and Neurointerventional Division, Siena University Hospital; Siena, Italy
| | - L. Monti
- Neuroimaging and Neurointerventional Division, Siena University Hospital; Siena, Italy
| | - P. Balestri
- Paediatric Clinic, Siena University Hospital; Siena, Italy
| | - M. Bellini
- Neuroimaging and Neurointerventional Division, Siena University Hospital; Siena, Italy
| | - C. Venturi
- Neuroimaging and Neurointerventional Division, Siena University Hospital; Siena, Italy
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Grosso S, Katayama M, Roela R, Nonogaki S, Soares F, Brentani M, Goes J. Transcriptional Profile Changes Induced by Rapamycin in Breast Cancer Maintained in Organ Culture. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-6129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: mTOR (mammalian target of rapamycin) is a serine threonine kinase, member of the AKT/PI3K pathway, which is involved in multiple biologic functions such as transcription, translation, protein degradation and ribosome biogenesis. The activation of this protein results in phosphorilation and activation of S6K1 and 4EBP1. Rapamycin is a potent fungicide, immunossupressive and anti-cancer agent that inhibits the mTOR pathway and is an emerging cancer therapeutic. Objective: The aim of this study was to determine genes regulated by rapamycin in samples of ductal invasive breast cancer to identify novel markers of rapamycin response. Material and Methods: Inhibition of some elements of AKT pathway was assessed by immunohistochemistry in samples of breast carcinoma maintained in organ culture of fresh cut slices that preserves the interaction between epithelium and stroma before and after treatment with rapamycin. Additionally changes of the gene expression profile was analyzed by microarray in these samples subdivided in positive and negative Erb-B2. Results: Immunohistochemistry analysis indicated a significant decrease of 4EBP1 in the samples of tumor treated with rapamycin compared with the control cases. Microarray analysis revealed that few common genes were regulated in both tumor types but rapamycin affected the expression of genes mainly involved in cellular transcription and translation in both groups. To confirm the results obtained through microarray technique, RT-PCR analysis was performed in independent samples and we validated the genes WWOX, EXT1 and GTF2E2 in 60% of our cases. Over expression of the autophagy related beclin 1 indicated a contribution of autophagy to cytotoxicity of rapamycin. Conclusion: The organ culture represents a simple method to determine the effects of rapamycin and using gene profile analysis, novel genes that possible could be used as markers of mTOR inhibition were identified. Supported by FAPESP nº 04/04607-8
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6129.
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Affiliation(s)
- S. Grosso
- 1Instituto Brasileiro de Controle do Cancer, Sao Paulo, Brazil
| | - M. Katayama
- 2Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - R. Roela
- 2Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - F. Soares
- 3Hospital AC Camargo, Sao Paulo, Brazil
| | - M. Brentani
- 2Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - J. Goes
- 1Instituto Brasileiro de Controle do Cancer, Sao Paulo, Brazil
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Moreira-Filho C, Ramos P, Ramos P, Barreta L, Brentani H, Corradini B, Maciel M, Carraro D, Achatz M, Michelli R, Lyra E, Grosso S, Folgueira M, Katayama M, Brentani M. Differential Gene Expression Profiles in Breast Cancer Tumors from Young and Post-Menopausal Patients. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-6138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Breast cancer in young patients (<35 yrs) has been hypothesized to be more histologically aggressive than those occurring in older cohorts, based mainly in their histopahtological features and worse prognosis. Our current knowledge of the genes involved in such differences is limited. To obtain insight into the molecular processes underlying tumorigenesis in young women we have used 44K cDNA microarrays (Agilent) to compare the gene expression profiles of 30 samples obtained from patients younger than 35 years (median 32,5, range 25-35) and 19 post-menopausal patients (median 66, range 55-88 ), all of them with ductal invasive carcinoma. Both age groups showed similar incidence of ER and PR-positive cases (70 and 60%, respectively). We considered as differentially expressed genes those presenting a p value below 0.01(t test) and fold variation of+/- 2.5.Gene ontology was performed using the GOTree machine tool (GOTM). By such criteria, 121 genes (86% down-regulated) were identified between the two groups here analyzed. In tumors arising in younger women we found an overrepresentation of genes involved with G-protein receptor signaling,cytoskeleton and muscle development, including ankyrin 3,filamin B, gfsarcoglycan and small proline- rich protein, one of the cornified-envelope structural precursor protein. In addition, solely in the younger women set we compared the gene profiles between women with (n =19) or without (n = 10) familial history of breast carcinoma. Using the same criteria, 59 transcripts distinguished the two subsets: GO categories over represented in tumors from patients with familial history included cell-cell adhesion, cytoskeleton organization,cell motility and protein binding related genes. These results indicate that breast cancer tumors arising in young women, besides their uniqueness regarding tumorigenesis, also differ among familial and non-familial cases as revealed by gene expression profiles.Support: FAPESP 04/14029-1
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6138.
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Affiliation(s)
| | - P. Ramos
- 1Faculdade de Medicina da USP, SP, Brazil
| | - P. Ramos
- 6Instituto Israelita de Ensino e Pesquisa, SP, Brazil
| | | | | | | | | | | | | | - R. Michelli
- 3Hospital do Câncer de Barretos, SP, Brazil
| | - E. Lyra
- 4Instituto Brasileiro de Controle do Câncer, SP, Brazil
| | - S. Grosso
- 4Instituto Brasileiro de Controle do Câncer, SP, Brazil
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Verrotti A, Parisi P, Loiacono G, Mohn A, Grosso S, Balestri P, Tozzi E, Iannetti P, Chiarelli F, Curatolo P. Levetiracetam monotherapy for childhood occipital epilepsy of gastaut. Acta Neurol Scand 2009; 120:342-6. [PMID: 19754870 DOI: 10.1111/j.1600-0404.2009.01264.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of this open label pilot study was to evaluate the efficacy and tolerability of levetiracetam (LEV) as 'de novo' monotherapy in children and adolescents with late onset childhood occipital epilepsy-Gastaut type (COE-G). MATERIAL AND METHODS Twelve patients suffering from COE-G were enrolled in this prospective study. The age of seizures onset ranged from 6.1 to 16.2 years with a peak of frequency at mean (+/-SD) 10.54 +/- 2.77 years. Therapy with LEV was started at 10 mg/kg/day and, after titration, the final dose was generally achieved within 4 weeks and ranged from 20.7 to 45.2 mg/kg/day. RESULTS At the 6 month evaluation, 11 (91.6%) of the 12 patients studied were seizure free, and one (8.3%) showed four additional episodes. Electroencephalography (EEG) activity was normal in six (54.5%) patients, unchanged in two (18.1%) children, and in four (33.3%) patients sporadic occipital abnormalities persisted. At the 12-month evaluation all patients were completely seizure free. Four patients (33.3%) continued to show some EEG abnormalities, while eight (72.8%) patients had normal EEG. At the 18-month evaluation all patients were seizure free and 10 patients (83.3%) showed a complete normalization of EEG abnormalities. DISCUSSION Monotherapy with LEV was effective and well tolerated in patients with COE-G. Nevertheless, prospective, large, long-term double-blind studies are needed to confirm these findings.
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Affiliation(s)
- A Verrotti
- Department of Paediatrics, University of Chieti, Chieti, Italy.
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25
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Orrico A, Galli L, Grosso S, Buoni S, Pianigiani R, Balestri P, Sorrentino V. Mutational analysis of the SCN1A, SCN1B and GABRG2 genes in 150 Italian patients with idiopathic childhood epilepsies. Clin Genet 2009; 75:579-81. [PMID: 19522081 DOI: 10.1111/j.1399-0004.2009.01155.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Pollazzon M, Grosso S, Papa F, Katzaki E, Marozza A, Mencarelli M, Uliana V, Balestri P, Mari F, Renieri A. A 9.3Mb microdeletion of 3q27.3q29 associated with psychomotor and growth delay, tricuspid valve dysplasia and bifid thumb. Eur J Med Genet 2009; 52:131-3. [DOI: 10.1016/j.ejmg.2009.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 03/13/2009] [Indexed: 11/27/2022]
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27
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Grosso S, Maria Cordelli D, Coppola G, Franzoni E, Verrotti A, Berardi R, Balestri P. Efficacy and safety of felbamate in children under 4 years of age: a retrospective chart review. Eur J Neurol 2008; 15:940-6. [DOI: 10.1111/j.1468-1331.2008.02215.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Puissant A, Grosso S, Jacquel A, Belhacene N, Colosetti P, Cassuto JP, Auberger P. Imatinib mesylate-resistant human chronic myelogenous leukemia cell lines exhibit high sensitivity to the phytoalexin resveratrol. FASEB J 2008; 22:1894-904. [PMID: 18245170 DOI: 10.1096/fj.07-101394] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Imatinib is successfully used in the treatment of chronic myelogenous leukemia (CML), and the main mechanisms of resistance in refractory patients are now partially understood. In the present study, we investigated the mechanism of action of resveratrol in imatinib-sensitive (IM-S) and -resistant (IM-R) CML cell lines. Resveratrol induced loss of viability and apoptosis in IM-S and IM-R in a time- and dose-dependent fashion. Inhibition of cell viability was detected for concentrations of resveratrol as low as 5 microM, and the IC(50) values for viability, clonogenic assays, apoptosis, and erythroid differentiation were in the 10-25 microM range. The effect of imatinib and resveratrol was additive in IM-S but not in IM-R clones in which the resveratrol effect was already maximal. The effect of resveratrol on apoptosis was partially rescued by zVAD-fmk, suggesting a caspase-independent contribution. Resveratrol action was independent of BCR-ABL expression and phosphorylation, and in agreement was additive to BCR-ABL silencing. Finally, phytoalexin inhibited the growth of BaF3 cells expressing mutant BCR-ABL proteins found in resistant patients, including the multiresistant T315I mutation. Our findings show that resveratrol induces apoptosis, caspase-independent death, and differentiation that collectively contribute to the specific elimination of CML cells. Resveratrol should provide therapeutic benefits in IM-R patients and in other hematopoietic malignancies.
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Grosso S, Lucini V, Pannacci M, Caronno A, Scaglione F. H2S AGISCE SUL KILLING MACROFAGICO DI CANDIDA ALBICANS MODULANDO I LIVELLI DI GSH. Microbiol Med 2007. [DOI: 10.4081/mm.2007.2770] [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: 11/23/2022] Open
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30
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Malandrin S, L. M, Cocca G, Vella P, Grosso S, Saudelli M. SORVEGLIANZA ATTIVA IN ICU: FATTORI DI RISCHIO PER ACQUISIZIONE DI MRSA E CARATTERIZZAZIONE DEI CEPPI ISOLATI. Microbiol Med 2007. [DOI: 10.4081/mm.2007.2869] [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: 11/23/2022] Open
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31
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Affiliation(s)
- S Grosso
- Department of Pediatrics, Pediatric Neurology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
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Grosso S, Lasorella G, Russo A, Galluzzi P, Morgese G, Balestri P. Aicardi syndrome with favorable outcome: case report and review. Brain Dev 2007; 29:443-6. [PMID: 17207597 DOI: 10.1016/j.braindev.2006.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 11/13/2006] [Accepted: 11/17/2006] [Indexed: 11/21/2022]
Abstract
Aicardi syndrome is a congenital disorder characterized by severe psychomotor retardation, corpus callosum agenesis, chorioretinal lacunae, and early-onset infantile spasms. The prognosis is generally poor for children with the classical form. We report a peculiar case of Aicardi syndrome characterized by corpus callosum hypoplasia, brain malformations with subependymal heterotopias, extensive chorioretinal lacunae, seizures, and normal cognitive functions. Therefore, the clinical picture of the syndrome is broader than originally described. Cognitive disorders should not be considered inevitable and the prognosis not ineludibly poor.
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Affiliation(s)
- S Grosso
- Pediatrics Department, Pediatric Neurology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy.
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Caruso V, Alberto F, Meschengieser S, Vizcaychipi K, Grosso S, Sánchez-Luceros A, Casais P, Hendler M, Lazzari M. HEMOSTATIC MARKERS AS PROGNOSTIC FACTORS IN ATRIAL FIBRILLATION. PRELIMINARY RESULTS OF A PROSPECTIVE STUDY. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb01821.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Grosso S, Cordelli DM, Franzoni E, Coppola G, Capovilla G, Zamponi N, Verrotti A, Morgese G, Balestri P. Efficacy and safety of levetiracetam in infants and young children with refractory epilepsy. Seizure 2007; 16:345-50. [PMID: 17368928 DOI: 10.1016/j.seizure.2007.02.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 09/19/2006] [Accepted: 02/20/2007] [Indexed: 11/30/2022] Open
Abstract
The aim of this multicentric, retrospective, and uncontrolled study was to evaluate the efficacy and safety of levetiracetam (LEV) in 81 children younger than 4 years with refractory epilepsy. At an average follow-up period of 9 months, LEV administration was found to be effective in 30% of patients (responders showing more than a 50% decrease in seizure frequency) of whom 10 (12%) became seizure free. This efficacy was observed for focal (46%) as well as for generalized seizures (42%). In addition, in a group of 48 patients, we compared the initial efficacy (evaluated at an average of 3 months of follow-up) and the retention at a mean of 12 months of LEV, with regard to loss of efficacy (defined as the return to the baseline seizure frequency). Twenty-two patients (46%) were initial responders. After a minimum of 12 months of follow-up, 9 of 48 patients (19%) maintained the improvement, 4 (8%) of whom remained seizure free. A loss of efficacy was observed in 13 of the initial responders (59%). Maintained LEV efficacy was noted in patients with focal epilepsy and West syndrome. LEV was well tolerated. Adverse events were seen in 18 (34%) patients. The main side effects were drowsiness and nervousness. Adverse events were either tolerable or resolved in time with dosage reduction or discontinuation of the drug. We conclude that LEV is safe and effective for a wide range of epileptic seizures and epilepsy syndromes and, therefore, represents a valid therapeutic option in infants and young children affected by epilepsy.
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Affiliation(s)
- S Grosso
- Pediatrics Department, University of Siena, Italy
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35
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Grosso S, Brogna A, Bazzotti S, Renieri A, Morgese G, Balestri P. Seizures and electroencephalographic findings in CDKL5 mutations: case report and review. Brain Dev 2007; 29:239-42. [PMID: 17049193 DOI: 10.1016/j.braindev.2006.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 08/24/2006] [Accepted: 09/02/2006] [Indexed: 11/18/2022]
Abstract
Mutations in the X-linked gene cyclin-dependent kinase-like 5 (CDKL5) have been detected in patients presenting with seizures in the first few months of life and Rett syndrome features. Twenty-seven cases have been detected to date. Generalized intractable seizures, as infantile spasms, and generalized tonic-clonic seizures and myoclonic seizures characterize the clinical picture of CDKL5 mutations. Here we report on a patient who presented with sleep-related hyperkinetic seizures. Our observation and review of the literature suggest that a broader polymorphic electroclinical pattern with both generalized and focal seizures may occur in patients with CDKL5 mutations. A screen for CDKL5 mutations is useful in patients, mainly females, with a history of early onset intractable seizures and becomes mandatory when idiopathic infantile spasms and/or atypical Rett syndrome features are also present.
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Affiliation(s)
- S Grosso
- Department of Pediatrics, Pediatric Neurology Section, University of Siena, "Santa Maria alle Scotte" Hospital, 53100 Siena, Italy.
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36
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Grosso S, Farnetani MA, Bernardoni E, Morgese G, Balestri P. Intractable reflex audiogenic seizures in Aicardi syndrome. Brain Dev 2007; 29:243-6. [PMID: 17084998 DOI: 10.1016/j.braindev.2006.09.005] [Citation(s) in RCA: 5] [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: 07/03/2006] [Revised: 08/20/2006] [Accepted: 09/02/2006] [Indexed: 11/25/2022]
Abstract
Aicardi syndrome (AS) is a rare disorder which includes the triad of total or partial agenesis of the corpus callosum, infantile spasms, and chorioretinal anomalies. Seizures and electroencephalogram findings observed in AS are polymorphic with both focal and generalized seizures. We first report on a patient affected by AS who presented with reflex audiogenic seizures specifically triggered by the starting tune of a popular television news. No other type of stimuli, either simple or complex, were able to precipitate the seizures in the patient. The severe cortical-subcortical lesions commonly observed in AS are associated with hyperexcitability of the cortices and may well account for the broad electroclinical patterns noted in this group of patients. From our report, the context of these patterns should be extended to include reflex audiogenic seizures.
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Affiliation(s)
- S Grosso
- Department of Pediatrics, Pediatric Neurology Section, University of Siena, Italy.
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37
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Verrotti A, Coppola G, Manco R, Ciambra G, Iannetti P, Grosso S, Balestri P, Franzoni E, Chiarelli F. Levetiracetam monotherapy for children and adolescents with benign rolandic seizures. Seizure 2007; 16:271-5. [PMID: 17204435 DOI: 10.1016/j.seizure.2006.12.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 12/04/2006] [Indexed: 11/27/2022] Open
Abstract
To assess the efficacy, tolerability and safety of Levetiracetam (LEV) therapy, we identified 21 (15 male; 6 female) patients with a history of benign epilepsy with centrotemporal spikes (BECTS), with and without secondarily generalization in children and adolescents aged between 5.0 and 12.1 years. LEV was administered as a first drug (number of patients=9) or converted after previous treatment with other AEDs (number of patients=12). The patients were subdivided into two groups: "newly diagnosed" patients and "converted" patients. Patients were followed up for 12 months and all patients were able to continue on LEV treatment. At the end of follow-up (12 months), all patients were seizure free or showed a reduction of seizures >50%. LEV dosage ranged from 1000 to 2500mg/daily. Overall, 100% of patients completed the 12 months study, without any important side effect. Somnolence and irritability occurred in two (9.5%) patients. Our results support findings that LEV monotherapy is effective and well tolerated in children with BECTS. Prospective, large, long-term double-blind studies are needed to confirm these findings.
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Affiliation(s)
- A Verrotti
- Department of Pediatrics, University of Chieti, Policlinico Universitario, Via dei Vestini 5, 66100 Chieti, Italy.
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38
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Pescucci C, Caselli R, Grosso S, Mencarelli MA, Mari F, Farnetani MA, Piccini B, Artuso R, Bruttini M, Priolo M, Zuffardi O, Gimelli S, Balestri P, Renieri A. 2q24–q31 Deletion: Report of a case and review of the literature. Eur J Med Genet 2007; 50:21-32. [PMID: 17088112 DOI: 10.1016/j.ejmg.2006.09.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 09/08/2006] [Indexed: 10/24/2022]
Abstract
We report a patient with a de novo interstitial deletion of the long arm of chromosome 2 involving bands 2q24.3-q31.1. The patient shows postnatal growth retardation, microcephaly, ptosis, down-slanting palpebral fissures, long eyelashes and micrognathia. Halluces are long, broad and medially deviated, while the other toes are laterally deviated and remarkably short with hypoplastic phalanges. She also showed developmental delay, seizures, lack of eye contact, stereotypic and repetitive hand movements and sleep disturbances with breath holding. Prenatal and three independent postnatal karyotypes were normal. Array-CGH analysis allowed us to identify and characterize a "de novo" 2q interstitial deletion of about 10.4Mb, involving segment between cytogenetic bands 2q24.3 and 2q31.1. The deletion was confirmed by quantitative PCR. About 30 children with 2q interstitial deletion have been reported. The deletion described here is overlapping with 15 of these cases. We have attempted to compare the clinical features of our patient with 15 overlapping cases. The emerging phenotypes include low birth weight, postnatal growth retardation, mental retardation and developmental delay, microcephaly, and peculiar facial dysmorphisms. Peculiar long and broad halluces with an increased distance between the first and the second toe are ("sandal gap" sign) present in most of the described patients. The gene content analysis of the deleted region revealed the presence of some genes that may be indicated as good candidates in generating both neurological and dysmorphic phenotype in the patient. In particular, a cluster of SCNA genes is located within the deleted region and it is known that loss of function mutations in SCNA1 gene cause a severe form of epilepsy.
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Affiliation(s)
- C Pescucci
- Medical Genetics, University of Siena, Italy
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Jacquel A, Colosetti P, Grosso S, Belhacene N, Puissant A, Marchetti S, Breittmayer JP, Auberger P. Apoptosis and erythroid differentiation triggered by Bcr-Abl inhibitors in CML cell lines are fully distinguishable processes that exhibit different sensitivity to caspase inhibition. Oncogene 2006; 26:2445-58. [PMID: 17043649 DOI: 10.1038/sj.onc.1210034] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [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: 11/08/2022]
Abstract
Imatinib targets the Bcr-Abl oncogene that causes chronic myelogenous leukemia (CML) in humans. Recently, we demonstrated that besides triggering apoptosis in K562 cells, imatinib also mediated their erythroid differentiation. Although both events appear to proceed concomitantly, it is not known at present whether or not imatinib-induced apoptosis and differentiation are interdependent processes. Hence, we investigated the requirements for Bcr-Abl inhibitor-mediated apoptosis and erythroid differentiation in several established and engineered CML cell lines. Imatinib triggered apoptosis and erythroid differentiation of different CML cell lines, but only apoptosis exhibited sensitivity to ZVAD-fmk inhibition. Conversely, the p38 mitogen-activated protein (MAP) kinase inhibitor, SB202190, significantly slowed down erythroid differentiation without affecting caspase activation. Furthermore, imatinib and PD166326, another Bcr-Abl inhibitory molecule, triggered erythroid differentiation of K562 cell clones, nevertheless resistant to Bcr-Abl inhibitor-induced apoptosis. Finally, short hairpin RNA inhibitor (shRNAi) silencing of caspase 3 efficiently inhibited caspase activity but had no effect on erythroid differentiation, whereas silencing of Bcr-Abl mimicked imatinib or PD166326 treatment, leading to increased apoptosis and erythroid differentiation of K562 cells. Taken together, our findings not only demonstrate that Bcr-Abl inhibitor-mediated apoptosis and differentiation are fully distinguishable events, but also that caspases are dispensable for erythroid differentiation of established CML cell lines.
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MESH Headings
- Apoptosis/drug effects
- Benzamides
- Caspase Inhibitors
- Caspases/metabolism
- Cell Differentiation/drug effects
- Cell Line, Tumor
- Enzyme Activation/drug effects
- Enzyme Inhibitors/pharmacology
- Erythroid Cells/cytology
- Erythroid Cells/enzymology
- Erythroid Cells/pathology
- Fusion Proteins, bcr-abl
- Humans
- Imatinib Mesylate
- K562 Cells
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Piperazines/pharmacology
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/blood
- Pyridines/pharmacology
- Pyrimidines/pharmacology
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Affiliation(s)
- A Jacquel
- INSERM, U526, Cell Death Differentiation and Cancer Team, Equipe labellisée par la Ligue Nationale contre le Cancer, Nice, France
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40
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Grosso S, Balestri M, Di Bartolo RM, Corbini L, Vatti G, Curatolo P, Balestri P. Oxcarbazepine and atypical evolution of benign idiopathic focal epilepsy of childhood. Eur J Neurol 2006; 13:1142-5. [PMID: 16987169 DOI: 10.1111/j.1468-1331.2006.01464.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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: 11/29/2022]
Abstract
Patients that have benign epilepsy with centrotemporal spikes (BECTS) may occasionally experience an atypical development in their course when treated with drugs such as carbamazepine. Three patients with electroclinical patterns consistent with BECTS showed seizure exacerbation during oxacarbazepine (OXC) therapy. Two manifested atypical absences, neuropsychological disturbances, and generalized spike-and-wave discharges in their electroencephalograms (EEGs) that became continuous during sleep. The third patient showed, during OXC therapy, more frequent partial motor seizures which ended with ictal vomiting and post-ictal obnubilation. EEGs recorded during sleep showed discontinuous paroxysmal activity in the right centrotemporal area. Symptoms were reversed following discontinuation of the OXC therapy. Although electroclinical findings were consistent with a BECTS diagnosis, all patients had some atypical features. Our observations show that BECTS patients, in particular those presenting with atypical findings, might be at risk for developing paradoxical reactions to OXC therapy. We suggest that OXC should be included in the list of drugs that may cause electroclinical deterioration in these patients.
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Affiliation(s)
- S Grosso
- Department of Pediatrics, Pediatric Neurology Section, University of Siena, Siena, Italy
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41
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Grosso S, Lucini V, Pannacci M, Malandrin S, Scaglione F. PRESENZA DI CHLAMYDOPHILA PNEUMONIAE IN PLACCHE ATEROSCLEROTICHE MEDIANTE REAL TIME PCR. Microbiol Med 2006. [DOI: 10.4081/mm.2006.3149] [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: 11/23/2022] Open
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42
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Grosso S, Lucini V, Pannacci M, Malandrin S, Scaglione F. INFLUENZA DELL’EQUILIBRIO REDOX SULLE INFEZIONI DA CANDIDA ALBICANS. Microbiol Med 2006. [DOI: 10.4081/mm.2006.3180] [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: 11/23/2022] Open
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43
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Grosso S, Gazzolo D, Longini M, Marzocchi B, Perrone S, Buonocore G. 157 Biological Markers of Oxidative Stress in Progressive Muscular Dystrophies: A Preliminary Study. Pediatr Res 2005; 58:381-381. [DOI: 10.1203/00006450-200508000-00186] [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: 09/17/2023]
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Grosso S, Franzoni E, Coppola G, Iannetti P, Verrotti A, Cordelli DM, Marchiani V, Pascotto A, Spalice A, Acampora B, Morgese G, Balestri P. Efficacy and safety of levetiracetam: An add-on trial in children with refractory epilepsy. Seizure 2005; 14:248-53. [PMID: 15911359 DOI: 10.1016/j.seizure.2005.02.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Indexed: 11/21/2022] Open
Abstract
The aim of this multicentric, prospective and uncontrolled study was to evaluate the efficacy and safety of levetiracetam in 110 children with refractory epilepsy, of whom 21 were less than 4 years old. After a median follow-up period of 7 months, levetiracetam administration was effective (responders with >50% decrease in seizure frequency) in 39% of children, of whom 10 (9%) became seizure-free. The efficacy was higher in patients with localization-related epilepsy (58% of responders) than in those with generalized epilepsy (37% of responders). Levetiracetam was well tolerated. The main side effects of somnolence and irritability occurred in 14% of patients. In one patient acute choreoathetosis occurred after few doses of levetiracetam. Overall, the adverse effects were not severe. Children younger than 4 years were particularly tolerant. In conclusion, the present study confirms that levetiracetam is effective and well tolerated as an add-on treatment in children with refractory epilepsy. Our preliminary data also indicate that levetiracetam may be a valid therapeutic option for epilepsy in infants and young children.
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Affiliation(s)
- S Grosso
- Pediatrics Department, University of Siena, Ospedale Santa Maria alle Scotte, Via M. Bracci, 53100 Siena, Italy
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45
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Grosso S, Pucci L, Di Bartolo RM, Gobbi G, Bartalini G, Anichini C, Scarinci R, Balestri M, Farnetani MA, Cioni M, Morgese G, Balestri P. Chromosome 18 aberrations and epilepsy: a review. Am J Med Genet A 2005; 134A:88-94. [PMID: 15690352 DOI: 10.1002/ajmg.a.30575] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Epilepsy is commonly observed in patients with chromosomal aberrations. We evaluated epilepsy and electroencephalographic (EEG) features in a group of patients carrying aberrations of chromosome 18. Fourteen patients were recruited: five with an 18p deletion syndrome (18pDS); six with an 18q deletion syndrome (18qDS); two with trisomy 18p syndrome; and one with a 45,XY,t(17-18) (cen-q11.2) karyotype. Patients with 18pDS had neither epilepsy nor EEG anomalies; four patients with 18qDS had epilepsy with partial seizures occurring during infancy or early childhood. Partial seizures were also present in both patients with trisomy 18p. By contrast, mixed seizures were observed in the patient carrying a translocation between chromosomes 17 and 18. Our data and a re-evaluation of the literature suggest that epilepsy is infrequent in patients with 18pDS. Conversely, partial seizures and focal EEG anomalies may be observed in those with patients with 18qDS. Our observations suggest that the haplo-insufficiency of genes located on the long arm of chromosome 18 is more likely to be associated with epilepsy, than is haplo-insufficiency of genes located on the short arm. While further EEG/clinical investigations are needed to validate these observations, this study indicates a possible relationship between chromosome 18 genes and epilepsy.
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Affiliation(s)
- S Grosso
- Department of Pediatrics, University of Siena, Siena, Italy
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46
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Grosso S, Galimberti D, Farnetani MA, Cioni M, Mostardini R, Vivarelli R, Di Bartolo RM, Bernardoni E, Berardi R, Morgese G, Balestri P. Efficacy and safety of topiramate in infants according to epilepsy syndromes. Seizure 2005; 14:183-9. [PMID: 15797353 DOI: 10.1016/j.seizure.2005.01.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Studies of the efficacy of topiramate (TPM) in infants and young children are few. Here we report an open, prospective, and pragmatic study of effectiveness of TPM in terms of epilepsy syndromes, in children aged less than 2 years. The median follow-up period was 11 months. We enrolled 59 children in the study: 22 affected by localization-related epilepsy (LRE), 23 by generalized epilepsy, six by Dravet's syndrome, and eight with unclassifiable epilepsy. TPM was effective (responders showed a decrease of more than 50% in seizure frequency) in 47% of patients, including 13% who were seizure-free at the last visit. TPM was more effective in localization-related epilepsy (48% of responders) than in generalized epilepsy (32% of responders). In the latter group, 19 patients suffered from infantile spasms. Four of six patients with cryptogenic infantile spasms became seizure-free. Of the 13 patients with symptomatic infantile spasms, only one was seizure-free. Results were poor for patients with Dravet's syndrome. In general, TPM was well tolerated. The most frequently reported adverse effects were drowsiness, irritability, hyperthermia, and anorexia. The present study concludes that TPM is effective for a broad range of seizures in infants and young children and represents a valid therapeutic option in this population.
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Affiliation(s)
- S Grosso
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Via M. Bracci, Le Scotte 53100, Siena, Italy
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47
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Grosso S, Margollicci MA, Bargagli E, Buccoliero QR, Perrone A, Galimberti D, Morgese G, Balestri P, Rottoli P. Serum levels of chitotriosidase as a marker of disease activity and clinical stage in sarcoidosis. Scand J Clin Lab Invest 2004; 64:57-62. [PMID: 15025429 DOI: 10.1080/00365510410004092] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Sarcoidosis is a systemic granulomatous disease characterized by T-lymphocyte activation and lymphocyte migration into involved organs, usually the lungs. The amounts of a number of biochemical markers, such as angiotensin converting enzyme (ACE) activity, increase in the serum of patients with sarcoidosis. Chitotriosidase is an enzyme secreted by activated macrophages able to catalyze the hydrolysis of both chitin and chitin-like substrates. Chitotriosidase is involved in defense against, and in degradation of chitin-containing pathogens such as fungi, nematodes, and insects. METHODS Forty-three patients affected by chronic sarcoidosis, in active (23 patients) or inactive (20 patients) phase, were studied. Serum levels of chitotriosidase and ACE activity were evaluated and compared with those of 32 healthy subjects. Serum chitotriosidase concentration and ACE activity were also correlated with radiographic stage of disease. RESULTS Individuals with chronic sarcoidosis have higher serum chitotriosidase concentrations and ACE activity than those of normal subjects. Sarcoidosis patients in the active phase of the disease had significantly higher chitotriosidase and ACE levels than those in the inactive phase. In contrast to serum ACE activity, a significant relationship between serum levels of chitotriosidase and the four radiographic stages of the disease was observed. CONCLUSION Although the data need to be validated by further investigation, the observations made in this study seem to indicate that serum chitotriosidase concentrations may be a useful marker for monitoring sarcoidosis disease activity and prognosis.
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Affiliation(s)
- S Grosso
- Department of Pediatrics, University of Siena, Italy.
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48
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Camporese A, Boschian M, Grosso S, Favero L, Zigante P, Tizianel G. INDICATORI DI QUALITA’ E DI OUTCOME IN MICROBIOLOGIA CLINICA: UN ESEMPIO APPLICATO ALLA DIAGNOSTICA DELLE UROCOLTURE. Microbiol Med 2004. [DOI: 10.4081/mm.2004.3805] [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: 11/23/2022] Open
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49
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Balestri P, Vivarelli R, Grosso S, Santori L, Farnetani MA, Galluzzi P, Vatti GP, Calabrese F, Morgese G. Malformations of cortical development in neurofibromatosis type 1. Neurology 2003; 61:1799-801. [PMID: 14694053 DOI: 10.1212/01.wnl.0000099080.90726.ba] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors report three patients with neurofibromatosis type 1 and different types of malformations of cortical development: Patient 1 had a possible transmantle cortical dysplasia involving the right temporoinsuloparieto-occipital areas; Patient 2 had a periventricular band of heterotopic gray matter with an overlying pachygyric cerebral cortex; and Patient 3 had a left perisylvian polymicrogyria. Because all of these lesions result from different pathogenetic mechanisms, neurofibromin may play a role during several stages of cortical development.
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Affiliation(s)
- P Balestri
- Department of Pediatrics, University of Siena, Le Scotte, Italy.
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50
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Pluderi M, Lucini V, Caronzolo D, Pannacci M, Costa F, Carrabba G, Giussani C, Grosso S, Colleoni F, Scaglione F, Villani R, Bikfalvi A, Bello L. Long-term inhibition of glioma growth by systemic administration of human PEX. J Neurosurg Sci 2003; 47:69-78. [PMID: 14618134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
AIM The growth of gliomas depends on the balance of factors stimulating or inhibiting angiogenesis, tumor cell invasion and proliferation. The administration of endogenous inhibitors to experimental human gliomas in animal models resulted in a significant inhibition of tumor growth. It is becoming apparent that resistance can develop over time to many types of endogenous inhibitors and seems to be influenced by the tumor type and system of delivery. METHODS We recently isolated a potent endogenous inhibitor, called human PEX, from human glioma cells in culture. Human PEX is a potent inhibitor of angiogenesis, tumor and endothelial cell proliferation and migration. In this paper, we investigated the ability of human PEX to sustain inhibition of glioma growth for a prolonged period of time. We initially developed a recombinant form of the inhibitor and showed that this form had similar in vitro and in vivo activities to the natural one. Human PEX was then administered to nude mice intracranial human glioma model, in combination with metronomic chemotherapy, for a period of 185 days, starting 15 days after tumor cells implantation. RESULTS Our data showed that the systemic administration of human PEX mantained a very prolonged inhibition of glioma growth (50% survival of animals treated with 2 mg/kg/days was 160 days vs 24 days of the control) and had a synergistic effect with low dose chemotherapy. Histological analysis of tumors, showed that treatment with PEX was associated with a decrease of vascularity, cell proliferation, and increase in apoptosis. CONCLUSION These data indicate that human PEX controls tumor growth by separate mechanisms. In addition, treatment with PEX produced well delineated tumors, indicating the persistence of a direct anti-invasive effect of the molecule even after a prolonged period of treatment.
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Affiliation(s)
- M Pluderi
- Neurosurgery, Department of Neurological Sciences, University of Milan, Milan, Italy
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