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Tassone P, Di Martino MT, Arbitrio M, Fiorillo L, Staropoli N, Ciliberto D, Cordua A, Scionti F, Bertucci B, Salvino A, Lopreiato M, Thunarf F, Cuomo O, Zito MC, De Fina MR, Brescia A, Gualtieri S, Riillo C, Manti F, Caracciolo D, Barbieri V, Di Paola ED, Di Francesco AE, Tagliaferri P. Safety and activity of the first-in-class locked nucleic acid (LNA) miR-221 selective inhibitor in refractory advanced cancer patients: a first-in-human, phase 1, open-label, dose-escalation study. J Hematol Oncol 2023; 16:68. [PMID: 37365583 DOI: 10.1186/s13045-023-01468-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND We developed a 13-mer locked nucleic acid (LNA) inhibitor of miR-221 (LNA-i-miR-221) with a full phosphorothioate (PS)-modified backbone. This agent downregulated miR-221, demonstrated anti-tumor activity against human xenografts in mice, and favorable toxicokinetics in rats and monkeys. Allometric interspecies scaling allowed us to define the first-in-class LNA-i-miR-221 safe starting dose for the clinical translation. METHODS In this first-in-human, open-label, dose-escalation phase 1 trial, we enrolled progressive cancer patients (aged ≥ 18 years) with ECOG 0-2 into 5 cohorts. The treatment cycle was based on a 30-min IV infusion of LNA-i-miR-221 on 4 consecutive days. Three patients within the first cohort were treated with 2 cycles (8 infusions), while 14 patients were treated with a single course (4 infusions); all patients were evaluated for phase 1 primary endpoint. The study was approved by the Ethics Committee and Regulatory Authorities (EudraCT 2017-002615-33). RESULTS Seventeen patients received the investigational treatment, and 16 were evaluable for response. LNA-i-miR-221 was well tolerated, with no grade 3-4 toxicity, and the MTD was not reached. We recorded stable disease (SD) in 8 (50.0%) patients and partial response (PR) in 1 (6.3%) colorectal cancer case (total SD + PR: 56.3%). Pharmacokinetics indicated non-linear drug concentration increase across the dose range. Pharmacodynamics demonstrated concentration-dependent downregulation of miR-221 and upregulation of its CDKN1B/p27 and PTEN canonical targets. Five mg/kg was defined as the recommended phase II dose. CONCLUSIONS The excellent safety profile, the promising bio-modulator, and the anti-tumor activity offer the rationale for further clinical investigation of LNA-i-miR-221 (ClinTrials.Gov: NCT04811898).
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Affiliation(s)
- Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy.
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy.
| | - Maria Teresa Di Martino
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Mariamena Arbitrio
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Institute of Research and Biomedical Innovation (IRIB), Italian National Council (CNR), Catanzaro, Italy
| | - Lucia Fiorillo
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Nicoletta Staropoli
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Domenico Ciliberto
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Alessia Cordua
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | - Francesca Scionti
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | | | - Angela Salvino
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Mariangela Lopreiato
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | - Fredrik Thunarf
- Biometrics Department, LINK Medical Research AB, Uppsala, Sweden
| | - Onofrio Cuomo
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | | | | | | | - Simona Gualtieri
- Phase 1 and Translational Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Caterina Riillo
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | | | - Daniele Caracciolo
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
| | - Vito Barbieri
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Eugenio Donato Di Paola
- Pharmacology Unit, Department of Science of Health, Magna Graecia University, Catanzaro, Italy
| | | | - Pierosandro Tagliaferri
- Department of Experimental and Clinical Medicine (DMSC), Magna Graecia University, Catanzaro, Italy
- Medical Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
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Nazerian P, Morello F, Prota A, Betti L, Lupia E, Apruzzese L, Oddi M, Grosso F, Grifoni S, Pivetta E, Catini E, Gualtieri S, Casanova B, De Villa E, Cerini G, Lumini E, Gagliano M, Annovi A, Mucaj S, Albanesi M, Cavigli E, Moroni C, Miele V, Lagi F, Fanelli A, Rossolini GM, Turco L, Tomaiuolo M, Paolini D, Tonietti B, Tizzani M, Locatelli SM, Porrino G, Losano I, Leone D, Calzolari G, Versan M, Steri F, Ardito A, Capuano M, Gelardi M, Silvestri G, Tutto S, Avolio M, Cavallo R, Bartalucci A, Paglieri C, Baldassa F, Baron P, Bianchi G, Busso V, Conterno A, Del Rizzo P, Fascio Pecetto P, Giachino F, Iannacone A, Ferrera P, Riccardini F, Sacchi C, Sozzi M, Totaro S, Visconti P, Risi F, Basile F, Baricocchi D, Beaux A, Valentina B, Bima P, Cara I, Chichizola L, Dellavalle F, Labarile G, Ottimo M, Pia I, Scategni V, Surra A. Diagnostic accuracy of physician's gestalt in suspected COVID-19: Prospective bicentric study. Acad Emerg Med 2021; 28:404-411. [PMID: 33576155 PMCID: PMC8014604 DOI: 10.1111/acem.14232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
Objectives Physicians’ gestalt is central in the diagnostic pipeline of suspected COVID‐19, due to the absence of a single tool allowing conclusive rule in or rule out. The aim of this study was to estimate the diagnostic test characteristics of physician's gestalt for COVID‐19 in the emergency department (ED), based on clinical findings or on a combination of clinical findings and bedside imaging results. Methods From April 1 to April 30, 2020, patients with suspected COVID‐19 were prospectively enrolled in two EDs. Physicians prospectively dichotomized patients in COVID‐19 likely or unlikely twice: after medical evaluation of clinical features (clinical gestalt [CG]) and after evaluation of clinical features and results of lung ultrasound or chest x‐ray (clinical and bedside imaging–integrated gestalt [CBIIG]). The final diagnosis was adjudicated after independent review of 30‐day follow‐up data. Results Among 838 ED enrolled patients, 193 (23%) were finally diagnosed with COVID‐19. The area under the curve (AUC), sensitivity, and specificity of CG and CBIIG for COVID‐19 were 80.8% and 91.6% (p < 0.01), 82.9% and 91.4% (p = 0.01), and 78.6% and 91.8% (p < 0.01), respectively. CBIIG had similar AUC and sensitivity to reverse transcription–polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2 on the first nasopharyngeal swab per se (93.5%, p = 0.24; and 87%, p = 0.17, respectively). CBIIG plus RT‐PCR had a sensitivity of 98.4% for COVID‐19 (p < 0.01 vs. RT‐PCR alone) compared to 95.9% for CG plus RT‐PCR (p = 0.05). Conclusions In suspected COVID‐19, CG and CBIIG have fair diagnostic accuracy, in line with physicians’ gestalt for other acute conditions. Negative RT‐PCR plus low probability based on CBIIG can rule out COVID‐19 with a relatively low number of false‐negative cases.
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Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Fulvio Morello
- Department of Emergency Medicine S.C. Medicina d’UrgenzaA.O.U. Città della Salute e della Scienza di TorinoMolinette Hospital Torino Italy
- Department of Medical Sciences University of Turin Turin Italy
| | - Alessio Prota
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Laura Betti
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Enrico Lupia
- Department of Emergency Medicine S.C. Medicina d’UrgenzaA.O.U. Città della Salute e della Scienza di TorinoMolinette Hospital Torino Italy
- Department of Medical Sciences University of Turin Turin Italy
| | - Luc Apruzzese
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Matteo Oddi
- Residency Program in Emergency Medicine University of Torino Torino Italy
| | - Federico Grosso
- Residency Program in Emergency Medicine University of Torino Torino Italy
| | - Stefano Grifoni
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Emanuele Pivetta
- Department of Emergency Medicine S.C. Medicina d’UrgenzaA.O.U. Città della Salute e della Scienza di TorinoMolinette Hospital Torino Italy
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Innocenti F, Giordano L, Gualtieri S, Gandini A, Taurino L, Nesa M, Gigli C, Becucci A, Coppa A, Tassinari I, Zanobetti M, Caldi F, Pini R. Prediction of Mortality With the Use of Noninvasive Ventilation for Acute Respiratory Failure. Respir Care 2020; 65:1847-1856. [PMID: 32843508 DOI: 10.4187/respcare.07464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In actuality, it is difficult to obtain an early prognostic stratification for patients with acute respiratory failure treated with noninvasive ventilation (NIV). We tested whether an early evaluation through a predictive scoring system could identify subjects at risk of in-hospital mortality or NIV failure. METHODS This was a retrospective study, which included all the subjects with acute respiratory failure who required NIV admitted to an emergency department-high-dependence observation unit between January 2014 and December 2017. The HACOR (heart rate, acidosis [by using pH], consciousness [by using the Glasgow coma scale], oxygenation [by using [Formula: see text]/[Formula: see text]], respiratory rate) score was calculated before the NIV initiation (T0) and after 1 h (T1) and 24 h (T24) of treatment. The primary outcomes were in-hospital mortality and NIV failure, defined as the need for invasive ventilation. RESULTS The study population included 644 subjects, 463 with hypercapnic respiratory failure and an overall in-hospital mortality of 23%. Thirty-six percent of all the subjects had NIV as the "ceiling" treatment. At all the evaluations, nonsurvivors had a higher mean ± SD HACOR score than did the survivors (T0, 8.2 ± 4.9 vs 6.1 ± 4.0; T1, 6.6 ± 4.8 vs 3.8 ± 3.4; T24, 5.3 ± 4.5 vs 2.0 ± 2.3 [all P < .001]). These data were confirmed after the exclusion of the subjects who underwent NIV as the ceiling treatment (T0, 8.2 ± 4.9 vs 6.1 ± 4.0 [P = .002]; T1, 6.6 ± 4.8 vs 3.8 ± 3.4; T24, 5.3 ± 4.5 vs 2.0 ± 3.2 [all P < .001]). At T24, an HACOR score > 5 (Relative Risk [RR] 2.39, 95% CI 1.60-3.56) was associated with an increased mortality rate, independent of age and the Sequential Organ Failure Assessment score. CONCLUSIONS Among the subjects treated with NIV for acute respiratory failure, the HACOR score seemed to be a useful tool to identify those at risk of in-hospital mortality.
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Affiliation(s)
- Francesca Innocenti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy.
| | - Laura Giordano
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Simona Gualtieri
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Arianna Gandini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Lucia Taurino
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Monica Nesa
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Chiara Gigli
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Alessandro Becucci
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Alessandro Coppa
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Irene Tassinari
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Maurizio Zanobetti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Francesca Caldi
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Riccardo Pini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
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Nazerian P, Mueller C, Soeiro ADM, Leidel BA, Salvadeo SAT, Giachino F, Vanni S, Grimm K, Oliveira MT, Pivetta E, Lupia E, Grifoni S, Morello F, Capretti E, Castelli M, Gualtieri S, Trausi F, Battista S, Bima P, Carbone F, Tizzani M, Veglio MG, Badertscher P, Boeddinghaus J, Nestelberger T, Twerenbold R. Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes. Circulation 2018; 137:250-258. [DOI: 10.1161/circulationaha.117.029457] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/29/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy (P.N., S.V., S.G.)
| | - Christian Mueller
- Cardiovascular Research Institute, University Hospital of Basel, Switzerland (C.M., K.G.)
| | | | - Bernd A. Leidel
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Germany (B.A.L.)
| | | | - Francesca Giachino
- S.C. Medicina d’Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy (F.G., E.P., E.L., F.M.)
| | - Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy (P.N., S.V., S.G.)
| | - Karin Grimm
- Cardiovascular Research Institute, University Hospital of Basel, Switzerland (C.M., K.G.)
| | | | - Emanuele Pivetta
- Cancer Epidemiology Unit and CPO Piemonte, Department of Medical Sciences, Università degli Studi di Torino, Italy (E.P.)
- S.C. Medicina d’Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy (F.G., E.P., E.L., F.M.)
| | - Enrico Lupia
- S.C. Medicina d’Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy (F.G., E.P., E.L., F.M.)
| | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy (P.N., S.V., S.G.)
| | - Fulvio Morello
- S.C. Medicina d’Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy (F.G., E.P., E.L., F.M.)
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Morello F, Nazerian P, Mueller C, Soeiro A, Leidel B, Salvadeo S, Giachino F, Vanni S, Grimm K, Tavares De Oliveira M, Veglio M, Gualtieri S, Grifoni S, Lupia E. P6021Rule-out of acute aortic syndrome by integration of the aortic dissection detection risk score plus d-dimer: preliminary data from the ADvISED prospective multicenter study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F. Morello
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
| | | | - C. Mueller
- University Hospital Basel, Cardiovascular Research Institute, Basel, Switzerland
| | - A. Soeiro
- University of São Paulo, Heart Institute, Emergency Care Unit, São Paulo, Brazil
| | - B.A. Leidel
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Emergency Medicine, Berlin, Germany
| | - S. Salvadeo
- Policlinic Foundation San Matteo IRCCS, Emergency Medicine, Pavia, Italy
| | - F. Giachino
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
| | - S. Vanni
- A.O.U. Careggi, Emergency, Firenze, Italy
| | - K. Grimm
- University Hospital Basel, Cardiovascular Research Institute, Basel, Switzerland
| | | | - M.G. Veglio
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
| | | | - S. Grifoni
- A.O.U. Careggi, Emergency, Firenze, Italy
| | - E. Lupia
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
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Staropoli N, Ciliberto D, Chiellino S, Caglioti F, Del Giudice T, Gualtieri S, Salvino A, Strangio A, Botta C, Pignata S, Tassone P, Tagliaferri P. Is ovarian cancer a targetable disease? A systematic review and meta-analysis and genomic data investigation. Oncotarget 2016; 7:82741-82756. [PMID: 27764790 PMCID: PMC5347729 DOI: 10.18632/oncotarget.12633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/01/2016] [Accepted: 09/25/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The current gold-standard for the first-line treatment in IIIb/IV stages of epithelial ovarian cancer (EOC) is the combination of carboplatin and paclitaxel plus bevacizumab in some countries. In the era of personalized medicine, there is still uncertainty on the impact of several molecularly targeted agents, which have been investigated for the management of this disease. To shed light on the actual role of targeted therapy in EOC, a systematic review and meta-analysis was performed. METHODS Clinical trials were selected by searching "Pubmed" database and abstracts from major cancer meetings within the time-frame of January 2004-June 2015. The endpoints were survival outcome and response rate (RR). Hazard ratios (HRs) of survival outcomes, with confidence intervals and odds-ratios (ORs) of RR, were extracted from retrieved studies and used for current analysis. Meta-analysis was carried out by random effect model. RESULTS 30 randomized trials for a total of 10,530 patients were selected and included in the final analysis. A benefit in terms of OS (pooled HR 0.915; 95%CI 0.840-0.997; p=0.043), particularly for anti-angiogenetic agents (HR 0.872; 95%CI 0.761-1.000; p=0.049), has been demonstrated for targeted therapy. Moreover, a significant advantage in platinum-resistant subgroup in term of PFS (HR 0.755; 95%CI 0.624-0.912; p=0.004) was found. CONCLUSIONS This systematic review and meta-analysis provide the first evidence that targeted therapy is potentially able to translate into improved survival of EOC patients, with a major role played by anti-angiogenetic drugs. The role of target therapy is underlined in the platinum-resistant setting that represents the "pain in the neck" in EOC management.
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Affiliation(s)
- Nicoletta Staropoli
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Domenico Ciliberto
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Silvia Chiellino
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Francesca Caglioti
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Teresa Del Giudice
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Simona Gualtieri
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Angela Salvino
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Alessandra Strangio
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Cirino Botta
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Sandro Pignata
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples, Naples, Italy
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
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Zanobetti M, Coppa A, Nazerian P, Grifoni S, Scorpiniti M, Innocenti F, Conti A, Bigiarini S, Gualtieri S, Casula C, Ticali PF, Pini R. Chest Abdominal-Focused Assessment Sonography for Trauma during the primary survey in the Emergency Department: the CA-FAST protocol. Eur J Trauma Emerg Surg 2015; 44:805-810. [PMID: 26683569 DOI: 10.1007/s00068-015-0620-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/07/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the feasibility of a new protocol, Chest Abdominal-Focused Assessment Sonography for Trauma (CA-FAST), during the primary survey and to estimate its diagnostic accuracy when compared with thoracoabdominal computed tomography (CT) scan. METHODS A prospective accuracy study was performed from November 2012 to November 2013 at the Emergency Department. Only adult trauma patients who underwent a CA-FAST examination prior to a thoracoabdominal CT scan were enrolled. In addition to standard patterns detected by Extended-FAST (E-FAST) such as pneumothorax (PTX), hemothorax (HTX), pericardial and intraabdominal effusion, CA-FAST protocol also included the research of lung contusions (LCs). RESULTS Six hundred and one patients were enrolled. The mean time for protocol execution was 7 ± 3 min. Chest ultrasonography showed the following results (all p < 0.001): LCs sensitivity 59 %, specificity 98 %, positive predictive value (PPV) 92 %, negative predictive value (NPV) 86 %, accuracy 87 %; PTX sensitivity 84 %, specificity 98 %, PPV 93 %, NPV 95 %, accuracy 95 %; HTX sensitivity 82 %, specificity 97 %, PPV 87 %, NPV 95 %, accuracy 94 %. The standard 4-views FAST examination showed a diagnostic accuracy of 91 % with a sensitivity of 75 %, specificity of 96 %, PPV of 81 % and NPV of 94 %. CONCLUSION According to our results CA-FAST protocol proved to be a rapid bedside method, with good accuracy and high NPV in detection of ultrasonographic patterns suggestive of serious injury in trauma patients; moreover, the additional research of LCs did not cause a delay in the diagnosis. Ultrasonography should be used as initial investigation during the primary survey, sending to further diagnostic studies (CT scan) only those patients not clearly classified.
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Affiliation(s)
- M Zanobetti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
| | - A Coppa
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - P Nazerian
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Grifoni
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - M Scorpiniti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - F Innocenti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - A Conti
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Bigiarini
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - S Gualtieri
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - C Casula
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - P F Ticali
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - R Pini
- Emergency Department, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
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Nazerian P, Tozzetti C, Vanni S, Bartolucci M, Gualtieri S, Trausi F, Vittorini M, Catini E, Cibinel GA, Grifoni S. Accuracy of abdominal ultrasound for the diagnosis of pneumoperitoneum in patients with acute abdominal pain: a pilot study. Crit Ultrasound J 2015; 7:15. [PMID: 26443344 PMCID: PMC4595408 DOI: 10.1186/s13089-015-0032-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumoperitoneum is a rare cause of abdominal pain characterized by a high mortality. Ultrasonography (US) can detect free intraperitoneal air; however, its accuracy remains unclear. The aims of this pilot study were to define the diagnostic performance and the reliability of abdominal US for the diagnosis of pneumoperitoneum. METHODS This was a prospective observational study. Four senior and two junior physicians were shown, in an unpaired randomized order, abdominal US videos from 11 patients with and 11 patients without pneumoperitoneum. Abdominal US videos were obtained from consecutive patients presenting to ED complaining abdominal pain with the diagnosis of pneumoperitoneum established by CT. Abdominal US was performed according to a standardized protocol that included the following scans: epigastrium, right and left hypochondrium, umbilical area and right hypochondrium with the patient lying on the left flank. We evaluated accuracy, intra- and inter-observer agreement of abdominal US when reviewed by senior physicians. Furthermore, we compared the accuracy of a "2 scan-fast exam" (epigastrium and right hypochondrium) vs the full US examination and the accuracy of physicians expert in US vs nonexpert ones. Finally, accuracy of US was compared with abdominal radiography in patients with available images. RESULTS Considering senior revision, accuracy of abdominal US was 88.6 % (95 % CI 79.4-92.4 %) with a sensitivity of 95.5 % (95 % CI 86.3-99.2 %) and a specificity of 81.8 % (95 % CI 72.6-85.5 %). Inter- and intra-observer agreement (k) were 0.64 and 0.95, respectively. Accuracy of a "2 scan-fast exam" (87.5 %, 95 % CI 77.9-92.4 %) was similar to global exam. Sensitivity of abdominal radiography (72.2 %, 95 % CI 54.8-85.7 %) was lower than that of abdominal US, while specificity (92.5 %, 95 % CI 79.5-98.3 %) was higher. Accuracy (68.2 %, 95 % CI 51.4-80.9 %) of junior reviewers evaluating US was lower than senior reviewers. CONCLUSIONS Senior physicians can recognize US signs of pneumoperitoneum with a good accuracy and reliability; sensitivity of US could be superior to abdominal radiography and a 2 fast-scan exam seems as accurate as full abdominal examination. US could be a useful bedside screening test for pneumoperitoneum. Trial registry ClinicalTrials.gov; No.: NCT02004925; URL: http://www.clinicaltrials.gov.
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Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy.
| | - Camilla Tozzetti
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | - Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | | | - Simona Gualtieri
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | - Federica Trausi
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | - Marco Vittorini
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | - Elisabetta Catini
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | | | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
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9
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Ciliberto D, Staropoli N, Caglioti F, Gualtieri S, Fiorillo L, Chiellino S, De Angelis AM, Mendicino F, Botta C, Caraglia M, Tassone P, Tagliaferri P. A systematic review and meta-analysis of randomized trials on the role of targeted therapy in the management of advanced gastric cancer: Evidence does not translate? Cancer Biol Ther 2015; 16:1148-59. [PMID: 26061272 PMCID: PMC4623405 DOI: 10.1080/15384047.2015.1056415] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/12/2015] [Accepted: 05/24/2015] [Indexed: 12/15/2022] Open
Abstract
It is still uncertain if targeted therapy-based regimens in advanced gastric cancer actually produce survival benefit. To shed light on this important question, we performed a systematic review and meta-analyses on each relevant targeted-pathway. By searching literature databases and proceedings of major cancer meetings in the time-frame 2005-2014, 22 randomized clinical trials exploring targeted therapy for a total of 7022 advanced gastric cancer patients were selected and included in the final analysis. Benefit was demonstrated for antiangiogenic agents in terms of overall survival (HR 0.759; 95%CI 0.655-0.880; p < 0.001). Conversely no benefit was found for EGFR pathway (HR 1.077; 95%CI 0.847-1.370; p = 0.543). Meta-analysis of HER-2 pathway confirmed improvement in terms of survival outcome, already known for this class of drugs (HR 0.823; 95%CI 0.722-0.939; p = 0.004). Pooled analysis demonstrated a significant survival benefit (OS: HR 0.823; PFS: HR 0.762) with acceptable tolerability profile for targeted-based therapies as compared to conventional treatments. This finding conflicts with the outcome of most individual studies, probably due to poor trial design or patients selection. In conclusion, our findings demonstrate a significant survival benefit for targeted therapy in its whole, which can be ascribed to anti-angiogenic and anti-HER2 agents.
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Key Words
- ADME, absorption, distribution, metabolism, and excretion
- Ab, monoclonal antibody
- BSC, best supportive care
- CHT, chemotherapy
- EGFR, epidermal growth factor receptor
- GC, gastric cancer
- HER2, human epidermal growth factor receptor 2
- HER3, human epidermal growth factor receptor 3
- MET, mesenchymal epithelial transition factor
- NGS, next generation sequencing
- NSCLC, non-small cell lung cancer
- OR, odds-ratio
- OS, overall survival
- PARP, poly ADP ribose polymerase
- PFS, progression free survival
- PI3K, phosphatidylinositide 3-kinases
- PRISMA, preferred reporting items for systematic reviews and meta-analyses
- RAF, rapidly accelerated fibrosarcoma
- RAS, rat sarcoma viral oncogene homolog
- RCTs, randomized clinical trials
- RR, response rate
- TKI, tyrosine kinase inhibitor
- VEGF, vascular endothelial growth factor
- VEGFR: VEGF receptor
- aGC, advanced gastric cancer
- angiogenesis
- gastric cancer
- mTOR, mammalian target of rapamycin
- mTORC, mTOR complex
- meta-analysis
- randomized clinical trials
- systemic chemotherapy
- targeted pathways
- targeted therapy
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Affiliation(s)
- Domenico Ciliberto
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
| | - Nicoletta Staropoli
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
| | - Francesca Caglioti
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
| | - Simona Gualtieri
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
| | - Lucia Fiorillo
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
| | - Silvia Chiellino
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
| | - Antonina Maria De Angelis
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
| | - Francesco Mendicino
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
| | - Cirino Botta
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
| | - Michele Caraglia
- Department of Biochemistry; Biophysics and General Pathology; Second University of Naples; Naples, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine; Center for Biotechnology; College of Science and Technology; Temple University; Philadelphia, PA USA
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine; Center for Biotechnology; College of Science and Technology; Temple University; Philadelphia, PA USA
| | - Pierosandro Tagliaferri
- Department of Experimental and Clinical Medicine; Magna Græcia University; Campus Salvatore Venuta; Catanzaro, Italy
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10
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Staropoli N, Ciliberto D, Botta C, Fiorillo L, Gualtieri S, Salvino A, Tassone P, Tagliaferri P. A retrospective analysis of pegylated liposomal doxorubicin in ovarian cancer: do we still need it? J Ovarian Res 2013; 6:10. [PMID: 23388584 PMCID: PMC3599392 DOI: 10.1186/1757-2215-6-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/25/2013] [Indexed: 12/05/2022] Open
Abstract
Background Ovarian cancer (OC) is the sixth most common cancer in women. Currently, carboplatin/paclitaxel ± bevacizumab is the cornerstone of front-line treatment. Conversely, the therapeutic options for recurrent or progressive disease are not well defined. For platinum-sensitive patients the best therapeutic approach is still a re-challenge with a platinum-based regimen. Pegylated liposomal doxorubicin (PLD), is considered one of the most active therapeutic options for recurrent or progressive OC. In this retrospective mono-institutional analysis, we evaluated the impact of PLD on the outcome of OC patients. Patients and methods We performed the retrospective study on a cohort of 108 patients with histologically confirmed serous papillary OC, followed at our Institution between 2001 and 2011. 80 patients were in stage III/IV and 55 of them received a second-line treatment. Thirty patients were treated with PLD. Both groups (PLD-treated versus PLD-untreated) underwent a median of 3 treatment lines and were prognostically balanced. The median follow-up was 60 months. Survival endpoints, toxicity and correlations between patients’ baseline characteristics and treatment efficacy were evaluated. Results Patients who had undergone PLD treatment (PLD group) showed a median overall survival (OS) of 45 months as compared to 65 months of patients not treated with PLD (PLD-free group) (HR 2.50 [0.95-6.67; p = 0.06]). Moreover, the median progression-free survival was 6 months in the PLD group versus 10 months in the PLD-free group (HR 1.75 [0.94-3.34; p = 0.07]). The overall objective response rate in II line treatment was 43% (13% in PLD group versus 57% in PLD-free group). Furthermore, we investigated survival endpoints in platinum-refractory patients who received PLD at least once during the course of disease. No OS advantage was achieved by PLD administration when compared to other therapeutic options (30 versus 32 months; HR 1.16 [0.31-4.34; p = 0.81]). No difference in term of toxicity was observed among different groups. Conclusions No evidence of superiority if PLD was compared to alternative agents was found in this analysis, particularly in the platinum-refractory setting. Our findings indicate a modest therapeutic activity of PLD in OC. Analysis of cost/benefit of PLD in OC is eagerly awaited.
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Affiliation(s)
- Nicoletta Staropoli
- Medical Oncology Unit, Department of Experimental and Clinical Medicine, Magna Græcia University and Tommaso Campanella Cancer Center, Campus Salvatore Venuta, Catanzaro, Italy.
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11
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Iarussi D, Gualtieri S, Tedesco MA, Iacono A. [Cardiovascular toxic effects of drugs not used in cardiology]. Cardiologia 1995; 40:105-11. [PMID: 8998701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D Iarussi
- Cattedra di Cardiologia, Seconda Università degli Studi, Napoli
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12
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Nave C, Giasi A, Lucca P, Cice G, Gualtieri S, Albanese G, D'Amato S, Iacono A. [Infectious endocarditis in dentistry practice: recent controversies and modes of the use of antibiotic prophylaxis]. Cardiologia 1994; 39:777-82. [PMID: 7736477] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A survey by questionnaire to assess the daily practice of the antibiotic prophylaxis of infective endocarditis by physicians attending post-graduate schools of the Institutes of Oral Surgery and Stomatology (Group A n = 83) and Cardiology (Group B n = 46) of the Second University of Naples has been conducted. They were asked about dental procedure and cardiopathies that require prophylaxis for infective endocarditis, the relationship between infective endocarditis and rheumatic disease and the provision of antibiotic. Extraction of tooth and dental and oral surgery have been reported as the most risky procedures. Moreover provision of antibiotic prophylaxis was suggested to patients not at risk (pacemaker or coronary artery bypass), and was not suggested in high risk conditions (mitral valve prolapse with regurgitation and hypertrophic cardiomyopathy). Most of the 50-60% practitioners usually start the prophylaxis 24-48 hours before the procedure and prolong it for 48-72 hours. These results underline the need for improvement of the knowledge for the antibiotic prophylaxis of infective endocarditis.
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Affiliation(s)
- C Nave
- Cattedra di Cardiologia, Università degli Studi, Napoli
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13
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Tedesco M, Iarussi D, Ratti G, Gualtieri S, Irace L, Romano A, Guadagno I, Coppolino P, Iacono A. Doxorubicin cardiotoxicity assessed with vectorcardiographic and echocardiographic techniques. J Electrocardiol 1993. [DOI: 10.1016/0022-0736(93)90029-d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Pisacane C, Iarussi D, Buono S, Gualtieri S, Coppolino P, Iacono A. [Clinical usefulness of quantitative two-dimensional echocardiographic analysis of segmental kinesis of the left ventricle in monitoring of patients with neoplasms treated with anthracyclines]. G Ital Cardiol 1991; 21:1259-67. [PMID: 1818000] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To determine whether serial quantitative two-dimensional echocardiographic analysis of left ventricular wall motion could be effective in selecting patients in whom anthracycline treatment must be stopped, 26 patients (18 M and 8 F, mean age 10 +/- 3, range 6 to 16 years) with malignancy, receiving doxorubicin or daunomycin were followed up. Left ventricular regional wall motion abnormalities were detected in 11 patients (42%), while left ventricular ejection fraction at rest (although progressively decreased from baseline value [63 +/- 2 vs 55 +/- 2%; p = 0.0001]) was still in normal range. The following distribution of left ventricular contraction abnormalities was noted: septal, anteroseptal and posteroseptal akinesis with posterior wall hypokinesis in one patient; septal, anteroseptal and posteroseptal akinesis with anterolateral free-wall hypokinesis in another; septal, anteroseptal and posteroseptal hypokinesis in four; lateral and posterolateral free-wall hypokinesis in one; septal, anteroseptal, posteroseptal and posterior hypokinesis in four. The drug was discontinued in only two patients with akinesis, since we regarded this contraction abnormality as a predictive index of more serious and extensive myocardial damage. We began to detect hypokinesis when cumulative doses of doxorubicin or daunorubicin were 155-420 mg/m2 and 270-285 mg/m2 respectively, while akinesis was seen at doses of 395 mg/m2 of body-surface area for doxorubicin and 575 mg/m2 for daunorubicin. Follow-up examination was conducted six months after the last dose of anthracycline, and improvement or recovery of left ventricular regional wall motion abnormalities was noted in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Pisacane
- Istituto Medico-Chirurgico di Cardiologia, Universitá Degli Studi di Napoli Federico II
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15
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Sinforiani E, Trucco M, Pacchetti C, Gualtieri S. [Evaluation of the effects of citicoline in chronic cerebrovascular diseases]. Minerva Med 1986; 77:51-7. [PMID: 3511406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A double-blind random block trial was carried out on 58 patients suffering from chronic cerebrovascular diseases as defined by the "Ad Hoc Committee, Paris 1980". The trial was carried out to assess the effects of citicoline on chronic cerebrovascular disease. Particular attention was paid to the selection of the assessment tools (neuropsychological and psychological tests). Citicoline treatment brought about an improvement in awareness and perceptive-motor faculties. This effect can be attributed to an overall drug action on neural energy metabolism.
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16
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Moglia A, Sinforiani E, Zandrini C, Gualtieri S, Corsico R, Arrigo A. Activity of Oxiracetam in Patients with Organic Brain Syndrome. Clin Neuropharmacol 1986. [DOI: 10.1097/00002826-198609003-00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Sinforiani E, Trucco M, Cavallini A, Gualtieri S, Verri AP, Spignoli G. [Reversibility of cognitive disorders among chronic alcoholics in phases of withdrawal. Effect of arginine pyroglutamate]. Minerva Psichiatr 1985; 26:339-46. [PMID: 3912647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Aiello C, Groothold G, Gualtieri S, Irace L, Marini IL, Perna B, Romano A. Haemodynamic effects of indenolol at rest and after a submaximal workload in essential hypertension. Eur J Clin Pharmacol 1985; 28:501-5. [PMID: 3899670 DOI: 10.1007/bf00544058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The effect of indenolol on heart rate and blood pressure at rest and after submaximal workload has been studied in 19 patients with established essential hypertension. A stepwise increase from moderate to submaximal exercise was chosen to mimic challenges normally occurring in daily life. After 4 weeks of once a day indenolol therapy a significant, gradual reduction in the following cardiovascular parameters was observed: heart rate at rest fell by 20%, 30% after exercise and 31% after recovery; systolic blood pressure showed a fall of 15% at rest, 19% after workload and 14% after recovery; the reduction in diastolic blood pressure was 15% at rest, 11% after exercise and 12% after recovery. The rate-pressure product was decreased by 32% at rest, 43% after exercise and 42% after recovery. It is concluded that the most important pharmacological effect of indenolol is the significant decrease in myocardial oxygen demand. In patients with essential hypertension indenolol not only produces a definite antihypertensive effect, but it also increases workload tolerance and decreases subjective symptoms during physical activity. Compliance was good and no severe side effects were observed.
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19
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Iarussi D, Bordi B, Vitale P, Gualtieri S, Pisacane C, Tommasino C, Iaccarino G. [Left ventricular function in subjects with porphyria cutanea tarda]. Cardiologia 1984; 29:387-94. [PMID: 6239638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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20
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Iarussi D, Gualtieri S, Coppolino P, Fulgione C, Battaglia S. [Disappearance of a left intraventricular thrombus documented by bidimensional echocardiography]. Cardiologia 1983; 28:353-7. [PMID: 6687174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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21
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Iarussi D, Gualtieri S, Caso P, Aiello C, Ferrante MR, Raucci D, Jacono A. [Ventricular extrasystoles: useful pathological phenomenon in clinical medicine]. Recenti Prog Med 1980; 68:150-88. [PMID: 6154303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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