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Oliva S, Veraldi S, Russo G, Aloi M, Rizzello F, Gionchetti P, Alvisi P, Labriola F, Vecchi M, Eidler P, Elli L, Dussias N, Tontini GE, Calabrese C. Pan-enteric Capsule Endoscopy to Characterize Crohn's Disease Phenotypes and Predict Clinical Outcomes in Children and Adults: The Bomiro Study. Inflamm Bowel Dis 2024:izae052. [PMID: 38529957 DOI: 10.1093/ibd/izae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Indexed: 03/27/2024]
Abstract
BACKGROUND Pan-enteric capsule endoscopy (PCE) provides useful information for the management of Crohn's disease (CD), especially in children. No study has evaluated the ability of PCE to characterize CD phenotypes and outcomes in children and adults. METHODS In a prospective multicenter observational study, we recruited patients with CD >6 years from 4 centers in Italy. Patients underwent clinical, biomarker assessment and PCE. Lesions were graded using the PCE system. For each segment, the most common lesion (MCL), the most severe lesion (MSL), and the extent of involvement were defined. Disease severity, extent, and clinical outcomes were compared between children and adults. A logistic regression analysis was used to identify predictive factors for negative outcomes in both age groups. RESULTS One hundred ninety-four consecutive patients (adults/children: 144/50) were evaluated for a total of 249 procedures. Children were more likely to have extensive disease, particularly in the colon. Higher MCL scores were independently associated with treatment escalation (odds ratio [OR], 4.09; 95% CI, 1.80-9.25; P = .001), while >30% disease extent was more indicative of clinical and endoscopic relapse (OR, 2.98; 1.26-7.08; P = .013). Disease extent was the only factor associated with endoscopic recurrence in children (OR, 4.50; 95% CI, 1.47-13.77; P = .008), while severe lesions in adults provided a better predictor of treatment escalation (OR, 4.31; 95% CI, 1.52-12.1; P = .006). Postexamination, PCE contributed to a change of therapy in 196/249 (79%) of the procedures. CONCLUSIONS PCE allowed the characterization of CD phenotypes in children and adults by assessing disease severity and extent, which are of different importance in predicting clinical outcomes in these age groups.
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Affiliation(s)
- Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvio Veraldi
- Pediatric Gastroenterology and Liver Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
- Hepatogastroenterology, Nutrition, Digestive Endoscopy and Liver Transplant Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giusy Russo
- Pediatric Gastroenterology and Liver Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Fernando Rizzello
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Paolo Gionchetti
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
- Alma Mater Studiorum, Università di Bologna, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Maggiore Hospital, Largo Bartolo Nigrisoli, 2, 40133 Bologna, Italy
| | - Flavio Labriola
- Pediatric Gastroenterology Unit, Maggiore Hospital, Largo Bartolo Nigrisoli, 2, 40133 Bologna, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, University of Milan, Italy
- Division of Gastroenterology and Endoscopy, Foundation IRCCS Ca' Granda Ospedale Maggiore
| | - Pini Eidler
- Division of Gastroenterology and Endoscopy, Foundation IRCCS Ca' Granda Ospedale Maggiore
| | - Luca Elli
- Division of Gastroenterology and Endoscopy, Foundation IRCCS Ca' Granda Ospedale Maggiore
| | - Nikolas Dussias
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, University of Milan, Italy
- Division of Gastroenterology and Endoscopy, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Calabrese
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
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Saunders R, Calabrese C, Gelli D, Davis J, Torrejon Torres R. Validation of a Model Estimating the Budget Impact of Video Capsule Endoscopy for Surveillance of Crohn's Disease in an Italian Center. J Health Econ Outcomes Res 2024; 11:67-74. [PMID: 38463945 PMCID: PMC10924452 DOI: 10.36469/001c.92880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/30/2024] [Indexed: 03/12/2024]
Abstract
Background: Crohn's disease is a chronic ailment affecting the gastrointestinal tract. Mucosal healing, a marker of reduced disease activity, is currently assessed in the colonic sections using ileocolonoscopy and magnetic resonance enteroscopy. Video capsule endoscopy (VCE) offers visualization of the entire GI mucosae. Objective: To validate a Crohn's disease model estimating the budget impact of VCE compared with the standard of care (SOC) in Italy. Methods: A patient-level, discrete-event simulation was developed to estimate the budget impact of VCE compared with SOC for Crohn's disease surveillance over 5 years in the Italian setting. Input data were sourced from a physician-initiated study from Sant'Orsola-Malpighi Hospital in Bologna, Italy, and the literature. The care pathway followed hospital clinical practice. Comparators were the current SOC (ileocolonoscopy, with or without magnetic resonance enteroscopy) and VCE. Sensitivity analysis was performed using 500-patient bootstraps. A comparative analysis regarding clinical outcomes (biologics use, surgical interventions, symptom remission) was performed to explore the validity of the model compared with real-world data. Cumulative event incidences were compared annually and semi-annually. Bayesian statistical analysis further validated the model. Results: Implementing VCE yielded an estimated €67 savings per patient per year, with savings in over 55% of patients, compared with SOC. While annual costs are higher up to the second year, VCE becomes cost saving from the third year onward. The real-world validation analysis proved a good agreement between the model and real-world patient records. The highest agreement was found for biologics, where Bayesian analysis estimated an 80.4% probability (95% CI: 72.2%-87.5%) that a decision maker would accept the result as an actual reflection of real-world data. Even where trend data diverged (eg, for surgery [43.1% likelihood of acceptance, 95% CI: 33.7%-52.8%]), the cumulative surgery count over 5 years was within the margin of error of the real-world data. Conclusions: Implementing VCE in the surveillance of patients with Crohn's disease and small bowel involvement may be cost saving in Italy. The congruence between model predictions and real-world patient records supports using this discrete-event simulation to inform healthcare decisions.
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Affiliation(s)
| | - Carlo Calabrese
- IBD UnitIRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Università di Bologna, Bologna, Italy
| | - Dania Gelli
- IBD UnitIRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Università di Bologna, Bologna, Italy
| | - Jason Davis
- Coreva Scientific GmbH, Königswinter, Germany
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Dajti E, Frazzoni L, Iascone V, Secco M, Vestito A, Fuccio L, Eusebi LH, Fusaroli P, Rizzello F, Calabrese C, Gionchetti P, Bazzoli F, Zagari RM. Systematic review with meta-analysis: Diagnostic performance of faecal calprotectin in distinguishing inflammatory bowel disease from irritable bowel syndrome in adults. Aliment Pharmacol Ther 2023; 58:1120-1131. [PMID: 37823411 DOI: 10.1111/apt.17754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/29/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Symptoms of inflammatory bowel disease (IBD) often overlap with those of irritable bowel syndrome (IBS). AIM To evaluate the diagnostic performance of faecal calprotectin in distinguishing patients with IBD from those with IBS METHODS: We searched MEDLINE, Embase, Scopus, and Cochrane Library databases up to 1 January 2023. Studies were included if they assessed the diagnostic performance of faecal calprotectin in distinguishing IBD from IBS (defined according to the Rome criteria) using colonoscopy with histology or radiology as reference standard in adults. We calculated summary sensitivity and specificity and their 95% confidence intervals (CI) using a random-effect bivariate model. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies II. RESULTS We included 17 studies with a total of 1956 patients. The summary sensitivity was 85.8% (95% CI: 78.3-91), and the specificity was 91.7% (95% CI: 84.5-95.7). At a prevalence of IBD of 1%, the negative predictive value was 99.8%, while the positive predictive value was only 9%. Subgroup analyses showed a higher sensitivity in Western than in Eastern countries (88% vs 73%) and at a cut-off of ≤50 μg/g than at >50 μg/g (87% vs. 79%), with similar estimates of specificity. All studies were at "high" or "unclear" risk of bias. CONCLUSIONS Faecal calprotectin is a reliable test in distinguishing patients with IBD from those with IBS. Faecal calprotectin seems to have a better sensitivity in Western countries and at a cut-off of ≤50 μg/g.
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Affiliation(s)
- Elton Dajti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Leonardo Frazzoni
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Veronica Iascone
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matteo Secco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Amanda Vestito
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
- Gastro-Esophageal Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Leonardo Henry Eusebi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
- Gastroenterology Unit, Hospital of Imola, Imola, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- IBD Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Carlo Calabrese
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- IBD Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Paolo Gionchetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- IBD Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Gastro-Esophageal Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
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Vanni S, Gallo G, Fausti V, Miserocchi G, Liverani C, Spadazzi C, Cocchi C, Calabrese C, Gabellone S, De Luca G, Bassi M, Gessaroli M, Campobassi A, Pieri F, Ercolani G, Cavaliere D, Gurrieri L, Riva M, Mercatali L, De Vita A. 106P Synergistic effect of CDK4/6 inhibitors and standard chemotherapy sequential treatment on liposarcoma patient-derived primary culture. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101143] [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: 04/05/2023] Open
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Melotti L, Dussias NK, Salice M, Calabrese C, Baldoni M, Scaioli E, Belluzzi A, Mazzotta E, Gionchetti P, Rizzello F. Effectiveness of swapping to ustekinumab after vedolizumab failure in patients with multi-refractory Crohn's disease. Dig Liver Dis 2023; 55:230-234. [PMID: 35879185 DOI: 10.1016/j.dld.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ustekinumab (UST) and vedolizumab (VDZ) are biologic therapies for moderate-to-severe Crohn's disease (CD) in patients who failed or had contraindication to anti-TNF treatment. AIMS To evaluate ustekinumab efficacy as third-line treatment after swapping from VDZ for failure. METHODS We conducted a monocentric, retrospective, observational study where CD patients were followed for 12 months from the beginning of UST therapy. We assessed clinical activity (HBI) and laboratory markers (CRP) at the initiation of UST therapy (T0) and after 2(T2), 6(T6) and 12(T12) months. Endoscopic activity was recorded at T0 and T12. We registered data regarding their clinical history and previous biologic treatments. Steroid-free clinical remission was defined as HBI ≤ 4 without need for steroids. Clinical response was defined as HBI reduction of at least three points or the suspension of steroids. RESULTS 27 CD patients treated with UST after VDZ failure had a minimum follow up of 12 months and were included. All patients had previously been treated with anti-TNF agents. After 12 months, steroid-free clinical remission was evident in 15 (55.5%) patients, 5 (18.5%) had clinical response, while 7 (26%) had suspended for failure or persisted on treatment after optimization. CONCLUSIONS Ustekinumab should be considered as third-line biologic treatment in multi-refractory CD patients.
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Affiliation(s)
- Laura Melotti
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
| | - Nikolas Konstantine Dussias
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
| | - Marco Salice
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Carlo Calabrese
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
| | - Monia Baldoni
- DIMEC, sezione Gastroenterologia, Università degli studi di Perugia, Italy
| | - Eleonora Scaioli
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Andrea Belluzzi
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Elena Mazzotta
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Paolo Gionchetti
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy.
| | - Fernando Rizzello
- IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Alma Mater Studiorum, Università di Bologna, Italy
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Sorge A, Elli L, Rondonotti E, Pennazio M, Spada C, Cadoni S, Cannizzaro R, Calabrese C, de Franchis R, Girelli CM, Marmo R, Riccioni ME, Marmo C, Oliva S, Scarpulla G, Soncini M, Vecchi M, Tontini GE. Enteroscopy in diagnosis and treatment of small bowel bleeding: A Delphi expert consensus. Dig Liver Dis 2023; 55:29-39. [PMID: 36100515 DOI: 10.1016/j.dld.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Enteroscopy plays an important role in the management of small bowel bleeding. However, current guidelines are not specifically designed for small bowel bleeding and recommendations from different international societies do not always align. Consequently, there is heterogeneity in the definitions of clinical entities, clinical practice policies, and adherence to guidelines among clinicians. This represents an obstacle to providing the best patient care and to obtain homogeneous data for clinical research. AIMS The aims of the study were to establish a consensus on the definitions of bleeding entities and on the role of enteroscopy in the management of small bowel bleeding using a Delphi process. METHODS A core group of eight experts in enteroscopy identified five main topics of small bowel bleeding management and drafted statements on each topic. An expert panel of nine gastroenterologists participated in three rounds of the Delphi process, together with the core group. RESULTS A total of 33 statements were approved after three rounds of Delphi voting. CONCLUSION This Delphi consensus proposes clear definitions and a unifying strategy to standardize the management of small bowel bleeding. Furthermore, it provides a useful guide in daily practice for both clinical and technical issues of enteroscopy.
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Affiliation(s)
- Andrea Sorge
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Catholic University of Rome, Rome, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Sergio Cadoni
- Digestive Endoscopy Unit, Centro Traumatologico Ortopedico, Iglesias, Italy
| | - Renato Cannizzaro
- Experimental Oncological Gastroenterology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Istituto Nazionale Tumori IRCCS, Aviano, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater - School of Medicine, Department of Medical and Surgical Sciences - Regional Referral Center for IBD, Bologna, Italy
| | | | | | | | - Maria Elena Riccioni
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Clelia Marmo
- Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Salvatore Oliva
- Gastroenterology and Paeditric Hepatology Unit, Università La Sapienza, Rome, Italy
| | | | - Marco Soncini
- Department of Internal Medicine, "A. Manzoni" Hospital, ASST Lecco, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Calabrese C, Gelli D, Rizzello F, Gionchetti P, Torrejon Torres R, Saunders R, Davis J. Capsule endoscopy in Crohn's disease surveillance: A monocentric, retrospective analysis in Italy. Front Med Technol 2022; 4:1038087. [DOI: 10.3389/fmedt.2022.1038087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
BackgroundCrohn's disease (CD) is a potentially debilitating condition that burdens Italian healthcare substantially. The symptomatic management relies on prompt therapy adjustment to reduce flares and follow-up diagnostic inputs to maximise remission. Capsule endoscopy (CE) has introduced advantages in CD diagnostics, allowing the direct inspection of the entire gastrointestinal mucosa. The diagnostic procedure is comparable in effort to standard ileocolonoscopy (IC) but requires no anaesthesia. Whether CE follow-up improves clinical outcomes remains to be defined.ObjectivesTo provide a preliminary evaluation of CE in terms of clinical outcomes with respect to the standard of care ileocolonoscopy/MRE in Italy.MethodsThis retrospective analysis utilises anonymised, monocentric data from the S. Orsola-Malpighi Hospital IBD database in Bologna, Italy, collected between 1999 and 2019. Out of 421 adult patient records, 100 were included in the analysis (50 per arm, matched per demographic and clinical characteristics). The CE represented the intervention arm, whereas ileocolonoscopy/magnetic resonance enterography was the standard of care. The use of biologics, symptomatology course, and surgery were the outcomes.ResultsThe two techniques performed similarly overall. In general, no significant difference emerged in the use of biologics. The use of biologics appears reduced in the CE group, only in L4 patients after the first follow-up year. Similarly, surgery was seemingly less frequent among L4 patients in the CE group. No difference was found between groups in flare occurrence and duration. CE patients might have experienced longer and earlier first remissions, but no long-term difference persisted.ConclusionsThe CE group showed an apparent reduction in biologics and surgery, limiting to L4 diagnoses. More extensive, prospective, multicentre, randomised studies must corroborate these preliminary findings.
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Lopez-Olivo MA, Ruiz JI, Duhon GF, Altan M, Tawbi H, Diab A, Bingham C, Calabrese C, Volk R, Suarez-Almazor M. AB1441 LEARNING NEEDS ASSESSMENT FOR PATIENTS WITH CANCER AND A PRE-EXISTING AUTOIMMUNE DISEASE WHO ARE CANDIDATES TO RECEIVE IMMUNE CHECKPOINT INHIBITORS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with autoimmune disorders and cancer are at risk of developing immune-related adverse events (irAEs) and increasing flares of their underlying disease with immune checkpoint inhibitors (ICI) and harms and benefits must be weighed.ObjectivesWe conducted an assessment of learning needs.MethodsWe interviewed 19 patients who had received an ICI and 20 physicians who provide care for these patients. We asked what do cancer patients with pre-existing autoimmune diseases need to know in order to make an informed decision about whether to receive an ICI.ResultsFifty-three percent of the patients were female, median age was 62.9 (±10.9). They had rheumatoid arthritis (47.4%), psoriasis (26.3%), Crohn’s disease (10.5%), ankylosing spondylitis (5.3%), systemic lupus erythematosus (5.3%), or ulcerative colitis (5.3%). Half of the patients (52.6%) had a demonstrable disease activity of the autoimmune disease at the time of making the decision on whether to start ICI. Most (84%) of the patients had melanoma, and at the time of the interview 68.4% had completed or discontinued the ICI. Physicians were melanoma oncologists (30%), thoracic-head & neck medical oncologists (25%), rheumatologists (20%), gastroenterologists (10%), and dermatologists (15%) who treat patients with irAEs. Sixty percent were female. Key points mentioned by patients and physicians included information on probability of irAEs and flares of the autoimmune condition with discussion about severity, benefits of ICI, ICI mechanism of action in the context of the autoimmune disease, and management for flare-ups. Key topics raised only by patients included possible reasons for stopping or modifying treatment (for cancer or autoimmune disease), when to contact the provider, possibility of autoimmune disease progression or organ damage, sharing information with other providers, and lifestyle changes that can be done to help.ConclusionAlthough patients and physicians listed common learning points, patients also considered specific needs to increase their self-care. The information derived from this study will be used to develop a decision support tool.Disclosure of InterestsNone declared
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Calabrese C, Kirchner E, Husni ME, Moss B, Fernandez A, Jin Y, Calabrese L. POS0194 MORBIDITY AND MORTALITY OF BREAKTHROUGH COVID-19 IN PATIENTS WITH IMMUNE MEDIATED CONDITIONS ON B CELL DEPLETING THERAPIES AND THE EFFECTS OF MONOCLONAL ANTIBODY TREATMENT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAmong immunocompromised patients with immune mediated inflammatory diseases (IMIDs), those undergoing therapy with B cell depleting agents are among the most vulnerable to both severe COVID-19 disease and sub-optimal response to COVID-19 vaccines(1). Numerous studies have documented suppressed humoral, but relatively maintained cell mediated, responses to COVID-19 vaccines in these patients. However, the clinical significance of such immunity in terms of protection from infection and its sequelae are poorly understood. We have analyzed a large cohort of vaccinated IMIDs patients undergoing B cell depleting therapy for the presence of breakthrough infection and assessed their outcomes.Objectives:To define the frequency and outcomes of COVID-19 breakthrough infection in fully or partially vaccinated IMIDs patients receiving B cell depleting therapies.To assess the characteristics and risk factors for severe outcomes and death.MethodsAll pharmacy records from within a large health care system were electronically searched for patients undergoing B cell depleting therapies with approved monoclonal antibodies in 2020. Records with ICD codes for IMIDs but not malignancies were included; patients must also have had at least one documented COVID-19 vaccine. From this cohort all patients with breakthrough COVID-19 disease from time of 1st vaccination through December 15, 2021 were identified; each record was hand-reviewed to extract clinical data including vaccine history, demographics, comorbidities, use of monoclonal antibodies, dose and timing of B cell depleting therapy, and outcomes as assessed by an 8 point NIH ordinal scale. Univariate and multivariable logistic/proportional-odds regression models were used to examine the risk factors for severe outcomes.ResultsA total of 1677 IMIDs patients were identified who received any B cell depleting monoclonal antibody and at least one COVID-19 vaccine in 2021. From this cohort 74 patients (4.4%) experienced a breakthrough COVID-19 infection. Among the breakthrough patients 34 (46%) had a rheumatic disease (RA 11, AAV 15, SLE 2), 34 (46%) had CNS inflammatory disease (MS 32, 2 other), and 6 (8%) had immune hematologic/miscellaneous diseases. Four patients had a previous history of COVID-19 infection. Overall 24 (35%) were hospitalized with 11 patients requiring critical level care (15%) and 6 deaths (8 %). All fatal cases had rheumatic diseases. Monoclonal antibodies were given as outpatient therapy to 21 patients and among these only 1 patient was hospitalized without requiring O2 and none died. In univariate analysis only number of comorbidities had a significant positive effect (p=.001) on severe outcomes (i.e. groups 1-4 vs. groups 5-8: Table 1) while monoclonal antibody therapy was associated with more favorable outcomes (p=.005 group 1-2 vs.3-8, Table 1). There were no associations between the dose, duration or timing of the B cell therapy, concomitant therapies including glucocorticoids, vaccine status (incomplete, complete, boosted) or date of vaccination with severe outcomes.ConclusionIn IMIDs patients treated with B cell depleting therapies breakthrough infections are common with many experiencing severe outcomes. Concomitant comorbidities were associated with risk of severe disease. Monoclonal antibody therapy was used in only 28% but was associated with enhanced clinical outcomes with only 1 in 21 requiring hospitalization and zero mortality. This population of immunocompromised patients remains vulnerable to COVID-19 disease despite vaccination. More aggressive use of outpatient management with monoclonal antibody therapy and other preventive and therapeutic measures are urgently needed.Reference[1]Samuel Bitoun et al Rituximab impairs B-cell response but not T-cell response to COVID-19 vaccine in auto-immune diseases First published: 28 December 2021 Arthritis and Rheumatology https://doi.org/10.1002/art.42058Disclosure of Interestscassandra calabrese Speakers bureau: Sanofi-regeneron, Consultant of: Sanofi-regeneron, Elizabeth Kirchner Consultant of: Janssen, M Elaine Husni Consultant of: Abbvie, BMS, Novartis, Lilly, Pfizer, UCB, Regeneron, Janssen, Brandon Moss Consultant of: Biogen advisory board, Grant/research support from: Genentech/Roche and Novartis as part of investigator-initiated studies, Anthony Fernandez Consultant of: Consulting: AbbVie, Novartis, Mallinckrodt, UCB, BMS, Boehringer Ingelheim, Alexion, Grant/research support from: Research: AbbVie, Novartis, Pfizer, Corbus, Mallinckrodt, Yuxuan Jin: None declared, Leonard Calabrese Speakers bureau: Sanofi, Janssen, AbbVie, ChemoCentryx, GSK, AstraZeneca, Consultant of: Sanofi, Jansen, AbbVie, ChemoCentryx, GSK, AstraZeneca, BMS, Genentech
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Galloro G, Musella M, Siciliano S, Berardi G, Vitiello A, Velotti N, Rizzello F, Gionchetti P, Calabrese C. New endoscopic capsule vs upper gastrointestinal endoscopy in preoperative work-up of obese candidate for bariatric surgery: Relevance of a pilot study in the COVID-19 era. Endosc Int Open 2022; 10:E183-E191. [PMID: 35178336 PMCID: PMC8847058 DOI: 10.1055/a-1723-3109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background and study aims Obesity represents a major health concern; bariatric surgery is the most effective treatment reducing and maintaining weight loss. The role of a routine esophagogastroduodenoscopy (EGD) prior bariatric surgery is still debated. Moreover, in this scenario of COVID-19 pandemic, EGD is even more questionable due to the procedural risk of viral transmission. A new model of video-endoscopic capsule (VEC) recently has been introduced as a good alternative to the EGD. The aim of this study was to determine if this new capsule is an adequate diagnostic alternative to EGD in the work-up of patients selected for bariatric surgery, particularly in the setting of COVID-19. Patients and methods From January to November 2020, 27 patients selected for bariatric surgery were enrolled in this pilot study to assess for noninferiority of VEC compared to EGD in detection of upper gastrointestinal disease. Results VEC had sensitivity, specificity, and positive and negative predictive values in identification of significant lesions of 91.3 %, 83.33 %, 98.01 %, and 51.57 %, respectively, compared with EGD as the standard criterion. The accuracy was 90.51 % (95 % CI, 73.75 %-98.18 %) and the chi-square statistic is 0.1153 ( P = 0.73). Conclusions Our report confirms the diagnostic noninferiority of VEC in preoperative work-up of patients selected for bariatric surgery, compared to EGD. This is very important, particularly during the COVID-19 pandemic, given the high risk of contamination with EGD. Larger multicenter studies are required to confirm our preliminary results.
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Affiliation(s)
- Giuseppe Galloro
- University of Naples Federico II – School of Medicine, Department of Clinical Medicine and Surgery – Surgical Endoscopy Unit, Naples, Italy
| | - Mario Musella
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Saverio Siciliano
- University of Naples Federico II – School of Medicine, Department of Clinical Medicine and Surgery – Surgical Endoscopy Unit, Naples, Italy
| | - Giovanna Berardi
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Antonio Vitiello
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Nunzio Velotti
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Fernando Rizzello
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
| | - Paolo Gionchetti
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
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Gionchetti P, Calabrese C, Laureti S, Poggioli G, Rizzello F. Pouchitis: Clinical Features, Diagnosis, and Treatment. Int J Gen Med 2021; 14:3871-3879. [PMID: 34335051 PMCID: PMC8318718 DOI: 10.2147/ijgm.s306039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
Procto-colectomy with an ileal pouch anal anastomosis is the procedure of choice for ulcerative colitis patients that require colectomy. Pouchitis is a non-specific inflammation of the ileal reservoir, and the most common, inflammatory and long-term, complication after pouch surgery for ulcerative colitis. The aetiology is still unknown, but many risk factors have been individuated. Pouchitis can be classified based on aetiology, duration, clinical course, and response to antibiotic therapy. Accurate diagnosis and classification is the key factor for an adequate management, and exclusion of secondary causes of pouchitis is pivotal. Most of the patients consistently respond to antibiotic therapy, but management of the subgroup of patients with chronic-antibiotic-resistant-pouchitis is still challenging, being this entity one of the major causes of pouch failure.
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Affiliation(s)
- Paolo Gionchetti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Bologna, Italia
| | - Carlo Calabrese
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Bologna, Italia
| | - Silvio Laureti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Bologna, Italia
| | - Gilberto Poggioli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Bologna, Italia
| | - Fernando Rizzello
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Bologna, Italia
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Salice M, Rizzello F, Sgambato D, Calabrese C, Manguso F, Laureti S, Rottoli M, Poggioli G, Gionchetti P. Long term remission after ileorectal anastomosis in Crohn's colitis. Dig Liver Dis 2021; 53:592-597. [PMID: 32616463 DOI: 10.1016/j.dld.2020.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Crohn's disease represents a heterogeneous entity, but its location tends to be relatively stable overtime. For extensive refractory Crohn's colitis, ileorectal anastomosis after colectomy is an engaging option, since the necessity of a permanent ileostomy is avoided. AIMS In our study, the long-term outcome of two groups of patients with Crohn's colitis who underwent colectomy and ileorectal anastomosis was compared. The first group had isolated colonic Crohn's disease without rectal involvement and perianal disease, while the second group included patients who had rectal and/or ileal involvement, with or without perianal disease. METHODS Between 1996 and 2016, in a single IBD tertiary center, 80 patients with a history of colectomy and ileorectal anastomosis for refractory Crohn's colitis were retrospectively identified. RESULTS Recurrence of disease was diagnosed in 57/64 of patients with Crohn's colitis with rectal and/or ileal and/or perianal involvement compared with 1/16 of patients with isolated Crohn's colitis without rectal and perianal disease in a median time of recurrence of 2 years (IQR 1-6 years, minimum to maximum, 1-18 years, p < 0.001). Only 6 patients (7,5%) underwent definitive end ileostomy without proctectomy (1 in the noIRP group and 5 in the IRP group). CONCLUSION Our data suggest that colectomy with ileorectal anastomosis may represent a curative option in patients with refractory isolated colitis without rectal and perianal involvement.
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Affiliation(s)
- Marco Salice
- IBD Unit, Department of Medical and Surgical Science, Sant'Orsola-Malpighi Hospital -University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Fernando Rizzello
- IBD Unit, Department of Medical and Surgical Science, Sant'Orsola-Malpighi Hospital -University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Dolores Sgambato
- Division of Hepato-Gastroenterology, Department of Clinical and Experimental Medicine, Second University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Carlo Calabrese
- IBD Unit, Department of Medical and Surgical Science, Sant'Orsola-Malpighi Hospital -University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Francesco Manguso
- Complex Operating Unit of Gastroenterology, AORN 'A. Cardarelli', Naples, Italy
| | - Silvio Laureti
- Surgical unit, Department of Medical and Surgical Science, Sant'Orsola-Malpighi Hospital -University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Matteo Rottoli
- Surgical unit, Department of Medical and Surgical Science, Sant'Orsola-Malpighi Hospital -University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Gilberto Poggioli
- Surgical unit, Department of Medical and Surgical Science, Sant'Orsola-Malpighi Hospital -University of Bologna, via Massarenti 9, 40138 Bologna, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Science, Sant'Orsola-Malpighi Hospital -University of Bologna, via Massarenti 9, 40138 Bologna, Italy.
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Winchester N, Calabrese C, Calabrese L. The Intersection of COVID-19 and Autoimmunity: What is Our Current Understanding? Pathog Immun 2021; 6:31-54. [PMID: 33969248 PMCID: PMC8097827 DOI: 10.20411/pai.v6i1.417] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 12/16/2022] Open
Abstract
Viral infections have historically had a complex relationship with autoimmune diseases. For patients with preexisting autoimmune disorders, often complicated by immunosuppressive therapies, there are numerous potential effects of COVID-19, a disease of complex immunobiology, including the potential for an altered natural history of COVID-19 when infected. In addition, individuals without recognized autoimmune disease may be vulnerable to virally induced autoimmunity in the forms of autoantibody formation, as well as the development of clinical immune-mediated inflammatory diseases. Until quite recently in the pandemic, this relationship between COVID-19 and autoimmune diseases has been relatively underexplored; yet such investigation offers potential insights into immunopathogenesis as well as for the development of new immune-based therapeutics. Our review examines this relationship through exploration of a series of questions with relevance to both immunopathogenic mechanisms as well as some clinical implications.
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Affiliation(s)
- N. Winchester
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - C. Calabrese
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH
| | - L.H. Calabrese
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH
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Rizzello F, Calabrese C, Salice M, Calandrini L, Privitera H, Melotti L, Peruzzi G, Dussias N, Belluzzi A, Scaioli E, Decorato A, Siniscalchi A, Filippone E, Laureti S, Rottoli M, Poggioli G, Gionchetti P. COVID-19 in IBD: The experience of a single tertiary IBD center. Dig Liver Dis 2021; 53:271-276. [PMID: 33451910 PMCID: PMC7764386 DOI: 10.1016/j.dld.2020.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Italy has been one of the most affected countries in the world by COVID-19. There has been increasing concern regarding the impact of COVID-19 on patients with inflammatory bowel disease (IBD), particularly in patients treated with immunosuppressants or biologics. The aim of our study is to understand the incidence of COVID-19 in a large cohort of patients with IBD. Furthermore, we analyzed possible risk factors for infection and severity of COVID-19. METHODS This was an observational study evaluating the impact of COVID-19 on IBD patients in a single tertiary center. A 23 multiple-choice-question anonymous survey was administered to 1200 patients with IBD between March 10th and June 10th 2020. RESULTS 1158 questionnaires were analyzed. The majority of patients had Crohn's disease (CD) (60%) and most of them were in clinical remission. Among the 26 patients (2.2%) who tested positive for COVID-19, only 5 (3CD) were on biological treatment and none required hospitalization. Two patients died and were on treatment with mesalazine only. Of the 1158 patients, 521 were on biological therapy, which was discontinued in 85 (16.3%) and delayed in 195 patients (37.4%). A worsening of IBD symptoms was observed in 200 patients on biological therapy (38.4%). Most of these patients, 189 (94.5%), had stopped or delayed biological treatment, while 11 (5.5%) had continued their therapy regularly (p<0.001). CONCLUSIONS Our data are in line with the current literature and confirm a higher incidence compared to the general population. Biological therapy for IBD seems to not be a risk factor for infection and should not be discontinued in order to avoid IBD relapse.
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Affiliation(s)
- Fernando Rizzello
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Carlo Calabrese
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Marco Salice
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Lucia Calandrini
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Hana Privitera
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Laura Melotti
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Giulia Peruzzi
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Nikolas Dussias
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Andrea Belluzzi
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Eleonora Scaioli
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Anastasio Decorato
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Antonio Siniscalchi
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Eleonora Filippone
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Silvio Laureti
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Matteo Rottoli
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gilberto Poggioli
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Paolo Gionchetti
- Centro di Riferimento Regionale Malattie Infiammatorie Croniche Intestinali, DIMEC Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
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Rondonotti E, Spada C, Cadoni S, Cannizzaro R, Calabrese C, de Franchis R, Elli L, Girelli CM, Hassan C, Marmo R, Riccioni ME, Oliva S, Scarpulla G, Soncini M, Vecchi M, Pennazio M. Quality performance measures for small capsule endoscopy: Are the ESGE quality standards met? Endosc Int Open 2021; 9:E122-E129. [PMID: 33532548 PMCID: PMC7834698 DOI: 10.1055/a-1319-0742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) recently issued a quality performance measures document for small bowel capsule endoscopy (SBCE). The aim of this nationwide survey was to explore SBCE practice with ESGE quality measures as a benchmark. Patients and methods A dedicated per-center semi-quantitative questionnaire based on ESGE performance measures for SBCE was created by a group of SBCE experts. One-hundred-eighty-one centers were invited to participate and were asked to calculate performance measures for SBCE performed in 2018. Data were compared with 10 ESGE quality standards for both key and minor performance measures. Results Ninety-one centers (50.3 %) participated in the data collection. Overall in the last 5 years (2014-2018), 26,615 SBCEs were performed, 5917 of which were done in 2018. Eighty percent or more of the participating centers reached the minimum standard established by the ESGE Small Bowel Working Group (ESBWG) for four performance measures (indications for SBCE, complete small bowel evaluation, diagnostic yield and retention rate). Conversely, compliance with six minimum standards established by ESBWG concerning adequate bowel preparation, patient selection, timing of SBCE in overt bleeding, appropriate reporting, reading protocols and referral to device-assisted enteroscopy was met by only 15.5 %, 10.9 %, 31.1 %, 67.7 %, 53.4 %, and 32.2 % of centers, respectively. Conclusions The present survey shows significant variability across SBCE centers; only four (4/10: 40 %) SBCE procedural minimum standards were met by a relevant proportion of the centers ( ≥ 80 %). Our data should help in identifying target areas for quality improvement programs in SBCE.
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Affiliation(s)
- Emanuele Rondonotti
- Unità Operativa Complessa di Gastroenterologia, Ospedale Valduce, Como, Italy
| | - Cristiano Spada
- Unità Operativa di Endoscopia Digestiva, Università Cattolica, Rome, Italy,Unità Operativa di Endoscopia Digestiva, Fondazione Poliambulanza, Brescia, Italy
| | - Sergio Cadoni
- Unità Operativa di Endoscopia Digestiva, Centro Traumatologico Ortopedico, Iglesias, Italy
| | - Renato Cannizzaro
- Struttura Operativa Complessa di Gastroenterologia Oncologica, Centro di Riferimento Oncologico di Aviano (CRO), Istituto Nazionale Tumori IRCCS, Aviano, Italy
| | - Carlo Calabrese
- Unità Operativa Malattia Infiammatorie Croniche Intestinali, Dipartimento di Medicina e Chirurgia (DIMEC), Ospedale S. Orsola-Malpighi Università di Bologna, Bologna, Italy
| | | | - Luca Elli
- Unità Operativa Complessa di Gastroenterologia ed Endoscopia-Centro per la Prevenzione e Diagnosi della Malattia Celiaca, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Maria Girelli
- Unità Di Gastroenterologia ed Endoscopia Digestiva, Ospedale di Busto Arsizio, Busto Arsizio, Italy
| | - Cesare Hassan
- Unità Operativa di Endoscopia Digestiva, Ospedale Nuovo Regina, Rome, Italy
| | - Riccardo Marmo
- Unità Operativa di Gastroenterologia, Ospedale Curto, Polla, Italy
| | - Maria Elena Riccioni
- Unità Operativa di Endoscopia Digestiva, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Salvatore Oliva
- Unità Operativa di Gastroenterologia e Epatologia Pediatrica, Università La Sapienza, Rome, Italy
| | - Giuseppe Scarpulla
- Unità Operativa di Gastroenterologia, Ospedale M. Raimondi, San Cataldo, Italy
| | - Marco Soncini
- Dipartimento di Medicina Interna, Ospedale Alessandro Manzoni, Lecco, Italy
| | - Maurizio Vecchi
- Dipartimento di Scienze Biomediche, Università degli Studi di Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Pennazio
- Divisione di Gastroenterologia U, Azienda Ospedaliero-Universitaria, Città della Salute e della Scienza, Torino, Italy
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Thompson A, Senders A, Seibel C, Usher C, Borgatti A, Bodden K, Calabrese C, Hagen K, David J, Bourdette D, Shinto L. Qualitative analysis of the Meals, Mindfulness, & Moving Forward (M 3 ) lifestyle programme: Cultivating a 'safe space' to start on a 'new path' for youth with early episode psychosis. Early Interv Psychiatry 2021; 15:87-95. [PMID: 31930650 PMCID: PMC10952130 DOI: 10.1111/eip.12913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/26/2019] [Accepted: 12/14/2019] [Indexed: 11/27/2022]
Abstract
AIM The Meals, Mindfulness, & Moving Forward (M3 ) programme included nutrition education, hands-on cooking classes, mindfulness meditation practice, physical activities and facilitated group sharing. M3 was designed as a supplement to standard care for youths (age 15-25 years) with first-episode psychosis (FEP) who were clients of coordinated specialty care teams. M3 's primary aim was feasibility by demonstrating high programme attendance; secondary aims included cardiometabolic measures. Data collection included quantitative and qualitative outcomes. The aim of the qualitative study was to understand participants' and study partners' experiences during the programme and to understand programme elements that were helpful for young people to sustain healthy lifestyle choices 6 weeks post-programme. METHODS During the last programme session, we conducted two focus groups, one with participants (n = 13) and one with their study partners (n = 11); 6 weeks post-intervention, individual semi-structured interviews were conducted with 11 participants. All interviews were audio recorded and transcribed; grounded theory methods guided thematic analysis. RESULTS Main themes from the focus groups included appreciation for a 'non-stigmatizing' environment providing participants and study partners with a sense of 'dignity' that enabled a 'new path'. Six weeks post-intervention, participants reported continued use of mindfulness practice to stay grounded and assist with making healthful lifestyle changes. However, many were unsure of how to sustain these changes long-term. CONCLUSION The results suggest that young people with FEP value a non-stigmatizing space that allows for social engagement and facilitates healthy behaviours. Short-term, M3 participants reported behaviour change but wanted on-going support to sustain healthy behaviours.
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Affiliation(s)
- Andie Thompson
- Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands
| | - Angela Senders
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon
| | - Celeste Seibel
- Center for Improvement of Child and Family Services - School of Social Work, Portland State University, Portland, Oregon
| | - Craigan Usher
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Alena Borgatti
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Katheryn Bodden
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon
| | - Carlo Calabrese
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Kirsten Hagen
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Jason David
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Dennis Bourdette
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Lynne Shinto
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
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Lenfant T, Kirchner E, Jin Y, Hajj-Ali R, Calabrese L, Calabrese C. Risques du nouveau vaccin recombinant contre le zona : une étude rétrospective sur 622 patients de rhumatologie. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Insausti A, Calabrese C, Parra M, Usabiaga I, Vallejo-López M, Écija P, Basterretxea FJ, Grabow JU, Caminati W, Lesarri A, Cocinero EJ. Conformational impact of aliphatic side chains in local anaesthetics: benzocaine, butamben and isobutamben. Chem Commun (Camb) 2020; 56:6094-6097. [PMID: 32352456 DOI: 10.1039/d0cc00760a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We studied the impact of aliphatic side chains on the stability and conformational landscape of the local anaesthetics benzocaine, butamben and isobutamben, combining high-resolution rotational spectroscopy in the microwave and millimetre regions and molecular modelling. The study reveals the connections between alkyl chain flexibility and molecular conformations.
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Affiliation(s)
- A Insausti
- Departamento de Química Física, Facultad de Ciencia y Tecnología, Universidad del País Vasco (UPV/EHU), Leioa, 48940, Spain.
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Lenfant T, Calabrese L, Calabrese C. FRI0494 RHEUMATIC IMMUNE RELATED ADVERSE EVENTS OF CHECKPOINT INHIBITORS: A RETROSPECTIVE REVIEW OF 70 PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Immune Checkpoint inhibitors (ICI) have revolutionized cancer therapy by achieving remarkable survival benefits however, at the cost of a myriad of immune-related adverse events (irAEs)[1]. Rheumatic irAE can develop in 5-10% of patients although the true incidence is unknown given the lack of prospective studies [2]. Symptoms are heterogenous and probably underreported with few data available about their management and outcome [3].Objectives:To describe the clinical, biological, and radiological features of the largest cohort of rheumatic irAEs from ICI along with their therapeutic management, outcome and follow-up in real-world practice.Methods:A referral process for emergent rheumatic irAEs was initiated in February 2016 between the oncology and rheumatology departments at the Cleveland Clinic Foundation. All patients were evaluated by authors CC and/or LHC. Patients’ characteristics were retrospectively collected from medical charts after IRB approval.Results:70 patients referred for one or more rheumatic irAEs between February 2016 and January 2020 were included. 66% were male, median age was 60.8 years. Among them, 24 (34%) had pre-existing rheumatic complaints. Melanoma was the most frequent malignancy (56%). ICI therapy included anti-CTLA4 (40%), anti-PD1/L1 (79%), and dual therapy ipilimumab/nivolumab (41%). Rheumatic irAE occurred in a median 4 months after ICI initiation, with phenotypes including inflammatory arthritis (32 patients), sicca-like symptoms (12), polymyalgia rheumatica-like (7), and myositis (2). Oral, intravenous or intraarticular glucocorticoids (GC) were administered to 54 patients (77%). Of these 54 patients, 22 (41%) required long term GC, 19 had bone density scan and 15 received pneumocystis (PJP) prophylaxis. One PJP case, 1 osteoporotic fracture and 2 avascular necrosis cases were reported. 16 patients received conventional DMARDS (23%) and 9 received biologics (13%). ICI therapy was held for rheumatic irAE in 31% of cases and for another systemic irAE in 29%. Median follow-up was 13.6 months, at end of follow-up 51 patients were still on treatment for rheumatic irAE and 41% of them were still symptomatic despite ongoing treatment.Conclusion:Rheumatic irAEs are heterogeneous and often chronic requiring prolonged immunomodulatory therapy. Prospective studies are required to define optimal management of rheumatic irAEs that maintain long-term oncologic outcomes.References:[1]Suarez-Almazor ME, Kim ST, Abdel-Wahab N, Diab A. Review: Immune-Related Adverse Events With Use of Checkpoint Inhibitors for Immunotherapy of Cancer. Arthritis Rheumatol 2017;69:687–99.https://doi.org/10.1002/art.40043.[2]Abdel-Wahab N, Suarez-Almazor ME. Frequency and distribution of various rheumatic disorders associated with checkpoint inhibitor therapy. Rheumatol (United Kingdom) 2019;58:vii40–8.https://doi.org/10.1093/rheumatology/kez297.[3]Kostine M, Rouxel L, Barnetche T, Veillon R, Martin F, Dutriaux C, et al. Rheumatic disorders associated with immune checkpoint inhibitors in patients with cancer-clinical aspects and relationship with tumour response: a single-centre prospective cohort study. Ann Rheum Dis 2018;77:393–8.https://doi.org/10.1136/annrheumdis-2017-212257.Disclosure of Interests:Tiphaine Lenfant: None declared, Leonard Calabrese Consultant of: AbbVie, GSK, Bristol-Myers Squibb, Genentech, Janssen, Novartis, Sanofi, Horizon, Crescendo, and Gilead, Speakers bureau: Sanofi, Horizon, Crescendo, Novartis, Genentech, Janssen, and AbbVie, cassandra calabrese Consultant of: AbbvieGSK, Speakers bureau: Sanofi-Genzyme
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Cappelletti S, Tondo I, Pietrafusa N, Renzetti T, Pannacci I, Gentile S, Perrucci M, Calabrese C, Ferraris PC, Specchio N, Vigevano F. Improvement of quality of life in adolescents with epilepsy after an empowerment and sailing experience. Epilepsy Behav 2020; 106:106957. [PMID: 32193096 DOI: 10.1016/j.yebeh.2020.106957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/07/2020] [Accepted: 01/29/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Epilepsy in adolescents affects their psychological health, independence, and emotional adjustment. Psychological and self-management interventions might give benefits to adolescent with epilepsy in terms of quality of life, emotional well-being, and reduced fatigue. "Fondazione Tender To Nave Italia" promotes a project using sailing activities as an empowerment opportunity. The main aim of our study was to examine the empowerment effects on quality of life of adolescents with epilepsy attending sailing activities, and to compare the results perceived by adolescents and their parents. METHODS Fifty-eight patients with a diagnosis of epilepsy were included in an empowerment project titled "Waves rather than spikes" from June 2013 to July 2018. Intellectual level was based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. Patients were administered Pediatric Quality of Life Inventory (PedsQL), adolescent and parent version. Behavioral data were collected by parent-report Child Behavior Checklist (CBCL). RESULTS Thirty female and 28 male patients with a mean age of 15 years, referred to "Bambino Gesù Children's Hospital" in Italy, were included. Thirty-three (56.9%) patients had a history of refractory epilepsy; 34 (56.2%) received polytherapy, 19 (32.7%) monotherapy, and 5 (8.6%) were not taking antiepileptic drugs. Intellectual functioning was normal in 43 (74.1%), borderline in 9 (15.5%), and mildly impaired in 6 (10.3%). Results from PedsQL adolescent report revealed significant postintervention improvement for total score (p = 0.023) and in two domains: physical health (p = 0.0066) and emotional functioning (p = 0.015). Results from PedsQL parent report showed significant postintervention improvement for the domain of school functioning (p = 0.023). In the multivariate model, a low CBCL value was predicting a higher score in the health subscore difference between pre- and postempowerment activity (p = 000.8). CONCLUSION Empowerments activities are crucial in order to reduce the burden of epilepsy in adolescents, and to improve quality of life. These are critical factors for a well-managed transition phase to adulthood.
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Affiliation(s)
- S Cappelletti
- Clinical Psychology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - I Tondo
- Clinical Psychology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Rare and Complex Epilepsies Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - N Pietrafusa
- Rare and Complex Epilepsies Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - T Renzetti
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - I Pannacci
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Gentile
- Clinical Psychology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Perrucci
- Administrative Staff, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - C Calabrese
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - N Specchio
- Rare and Complex Epilepsies Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - F Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Tontini GE, Rizzello F, Cavallaro F, Bonitta G, Gelli D, Pastorelli L, Salice M, Vecchi M, Gionchetti P, Calabrese C. Usefulness of panoramic 344°-viewing in Crohn's disease capsule endoscopy: a proof of concept pilot study with the novel PillCam™ Crohn's system. BMC Gastroenterol 2020; 20:97. [PMID: 32264831 PMCID: PMC7140388 DOI: 10.1186/s12876-020-01231-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 07/03/2019] [Accepted: 03/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A new capsule endoscopy (CE) system featuring two advanced optics for 344°-viewing and a prolonged operative time has been recently developed for Crohn's disease (CD) patients. Hence, we evaluated, for the first time, the performance of this novel CE and the add-on value of the 344°-viewing in a multi-center real-life setting. METHODS Consecutive patients with suspected or established CD received the PillCam™ Crohn's System as supplementary diagnostic work-up focused on the small-bowel between June 2017 and June 2018. Technical and clinical data, including the panenteric CE diagnostic yield, the Lewis score and the impact of small-bowel findings on clinical management during a 6-months follow-up (new diagnosis, staging or treatment upgrade) were collected, thereby evaluating the added value of the 344° panoramic-view (lesions detected by camera A and B) over the standard 172°-view (lesions detected by one camera only). RESULTS Among 41 patients (aged 43 ± 20 years), 73% underwent CE for suspected CD and 27% for established CD. The rate of complete enteroscopy was 90%. No technical failure or retention occurred. Compared to the standard 172° view, the panoramic 344°-view revealed a greater number of patients with a relevant lesion (56.1% vs. 39.0%; P = 0.023), resulting in higher Lewis score (222,8 vs. 185.7; P = 0.031), and improved clinical management (48.8% vs. 31.7%, P = 0.023). CONCLUSIONS The panoramic 344°-view increases small-bowel CE accuracy, thereby improving the clinical management of CD patients with mild small-bowel active disease. This system should be regarded as a new standard for both small-bowel diagnosis and monitoring in inflammatory bowel diseases.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Fernando Rizzello
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Flaminia Cavallaro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianluca Bonitta
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Dania Gelli
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Luca Pastorelli
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Marco Salice
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Carlo Calabrese
- IBD Unit, Department of Medical and Surgical Sciences (DIMEC), Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
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Calabrese C, Diegoli M, Dussias N, Salice M, Rizzello F, Cappelli A, Ricci C, Gionchetti P. Performance of Capsule Endoscopy and Cross-Sectional Techniques in Detecting Small Bowel Lesions in Patients with Crohn's Disease. Crohns Colitis 360 2020; 2:otaa046. [PMID: 36777299 PMCID: PMC9802189 DOI: 10.1093/crocol/otaa046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) can be classified according to endoscopic and cross-sectional imaging characteristics. Information regarding disease extent and phenotype may be provided by advanced endoscopic and imaging techniques. In this study, we compare the ability of capsule endoscopy (CE) and cross-sectional imaging techniques (CST) (MRE/Computer Tomography Enteroscopy [CTE]) in detecting small bowel (SB) lesions. METHODS We retrospectively analyzed 102 patients with a diagnosis of CD who underwent both CE and CST. Only patients with at least a 12-month follow-up after CE were included. RESULTS Sensitivity and specificity for the detection of SB lesions were, respectively, 100% and 83.3% for CE, 55.1% and 80% for CTE, and 60% and 82.3% for MRE. CE detected proximal CD lesions in 73% of patients, whereas MRE and CTE detected proximal lesions in 41% and 16% of patients, respectively (P < 0.001). Positive findings on CE led to management changes in all patients, in a median follow-up period of 58.7 months. During the follow-up period, 26.5% of patients underwent surgery. Multivariate analysis revealed that moderate-to-severe disease at CE was independently correlated with surgery (P = 0.03). CONCLUSIONS CE has a superior sensitivity for detecting CD lesions in the proximal and medium SB compared with CST. In the terminal ileum, MRE and CTE displayed similar performance to CE.
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Affiliation(s)
- Carlo Calabrese
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy
- Address correspondence to: Carlo Calabrese, MD, PhD, Department of Medicine and Surgery, University of Bologna, Italy. Azienda Ospedaliero-Universitaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy ()
| | - Margherita Diegoli
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Nikolas Dussias
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Marco Salice
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Fernando Rizzello
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Alberta Cappelli
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Claudio Ricci
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Paolo Gionchetti
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy
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Calabrese C, Casella D, Di Taranto G, Marcasciano M, Kothari A, Sordi S, Barellini L, Lo Torto F, Tarallo M, Perra A, Fausto A, Ribuffo D. Oncoplastic conservative surgery for breast cancer: long-term outcomes of our first ten years experience. Eur Rev Med Pharmacol Sci 2020; 22:7333-7342. [PMID: 30468478 DOI: 10.26355/eurrev_201811_16270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The main goal of oncoplastic breast surgery (OBS) is to optimize cosmetic outcomes and reduce patient morbidity, while still providing an oncologically-safe surgical outcome and extending the target population of conservative surgery. Although the growing number of reported experiences with oncoplastic surgery, few studies account for the long-term outcomes. PATIENTS AND METHODS Between January 2000 and December 2010, 1024 consecutive oncoplastic surgeries were performed and prospectively included in a database. Demographic data, histological and oncological evaluation and surgical complications were recorded. The role of tumor and patients' characteristics on the development of local recurrence and metastases were assessed by multivariate analysis. RESULTS Median follow up was 74.2 months. The average age of patients was 56.24. In 869 patients (84.9%) an invasive tumor and in 155 (15.1%) an in situ tumor (11% DCIS and 4% LIN) was found. The average size of the tumor was 24.5 mm. A positive margin presented in 67 (6.5%) patients. Forty patients (50%) underwent re-excision and 39 (49.4%) underwent mastectomy. The overall breast conservation rate was 96.2%. Reported complications were: 17 wound infections (1.7%); 106 hematomas (10.4%); 94 lymphorrheas (9.2%), 48 partial wound dehiscence (4.7%). Local recurrences (LR) were observed in 49 patients (4.7%). The risk of local recurrence was significantly higher in the group of patients with lymphovascular invasion and with high grade (G) (p < 0.05). 52 (5.07%) distant metastases were reported and the related risk was significantly higher in the group of patients with lymphovascular invasion and with negative receptors (p < 0.05). CONCLUSIONS Oncoplastic surgery provides an acceptable oncological long-term outcome and can be used to treat with conservative surgery also a selected population of patients who would had otherwise undergone mastectomy in the past.
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Affiliation(s)
- C Calabrese
- Department of Oncologic and Reconstructive Breast Surgery, "Breast Unit Integrata di Livorno, Cecina, Piombino, Elba, Azienda USL Toscana nord ovest", Italy.
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Calabrese C, Kothari A, Badylak S, Di Taranto G, Marcasciano M, Sordi S, Barellini L, Lo Torto F, Tarallo M, Gaggelli I, D'Ermo G, Fausto A, Casella D, Ribuffo D. Oncological safety of stromal vascular fraction enriched fat grafting in two-stage breast reconstruction after nipple sparing mastectomy: long-term results of a prospective study. Eur Rev Med Pharmacol Sci 2019; 22:4768-4777. [PMID: 30070312 DOI: 10.26355/eurrev_201808_15610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Autologous fat transfer (AFT) is commonly used to treat implant palpability and prevent fibrosis and thinning in mastectomy skin flaps. A major limit to this procedure is volume retention over time, leading to the introduction of fat enrichment with stromal vascular fraction (SVF+AFT). Oncological concerns have been raised over the injection of an increased concentration of progenitors cells (ASCs) in the SVF. The aim of the study is to evaluate the long-term cancer recurrence risk of SVF+AFT cases compared to AFT, in patients undergoing Nipple Sparing Mastectomy (NSM). PATIENTS AND METHODS A prospective study was designed to compare three groups of patients undergoing NSM followed by SVF+AFT, AFT or none (control group), after a two-stage breast reconstruction. Patients were strictly followed-up for at least 5-years from the second stage reconstructive procedure. Loco-regional and systemic recurrence rate were evaluated over time as the primary outcome. Logistic regression was used to investigate which factors were associated with recurrence events and independent variables of interest were: surgical technique, age above 50 years old, lympho-vascular invasion, oncological stage, adjuvant or neoadjuvant chemotherapy, adjuvant radiotherapy and adjuvant hormone therapy. RESULTS 41 women were included in G1 (SVF+AFT), 64 in G2 (AFT), and 64 in G3 (control group). Loco-regional recurrence rate was 2.4% for G1, 4.7% for G2, and 1.6% for G3. Systemic recurrence was 7.3%, 3.1%, and 3.1%, respectively. Among the variables included, there were no significant risk factors influencing a recurrence event, either loco-regional or systemic. In particular, SVF+AFT (G1) did not increase the oncological recurrence. CONCLUSIONS Our data suggest that both centrifuged and SVF-enhanced fat transfer have a similar safety level in comparison to patients who did not undergo fat grafting in breast reconstruction after NSM.
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Affiliation(s)
- C Calabrese
- Oncology Department, Oncologic and Reconstructive Surgery Breast Unit, Careggi University Hospital, Florence, Italy.
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Pezzilli R, Cremon C, Calabrese C, Salfi NCM. A rare cause of melena in lung cancer. Dig Liver Dis 2019; 51:1196. [PMID: 31023522 DOI: 10.1016/j.dld.2019.03.029] [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] [Received: 01/31/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Raffaele Pezzilli
- Department of Gastroenterology, Sant'Orsola Hospital, Bologna, Italy; Department of Emergency, Sant'Orsola Hospital, Bologna, Italy.
| | - Cesare Cremon
- Department of Gastroenterology, Sant'Orsola Hospital, Bologna, Italy; Department of Emergency, Sant'Orsola Hospital, Bologna, Italy
| | - Carlo Calabrese
- Department of Gastroenterology, Sant'Orsola Hospital, Bologna, Italy; Department of Emergency, Sant'Orsola Hospital, Bologna, Italy
| | - Nunzio C M Salfi
- Department of Emergency, Sant'Orsola Hospital, Bologna, Italy; Department of Pathology, Sant'Orsola Hospital, Bologna, Italy
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Salice M, Rizzello F, Calabrese C, Privitera Hrustemovic H, Gionchetti P. Budesonide MMX: efficacy and safety profile in the treatment of ulcerative colitis. Expert Rev Gastroenterol Hepatol 2019; 13:607-613. [PMID: 31106602 DOI: 10.1080/17474124.2019.1621745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction: Ulcerative colitis is an idiopathic, chronic inflammatory disease of the colonic mucosa. Its clinical course is unpredictable, marked by alternating periods of exacerbation and remission. Traditional oral corticosteroids are still the mainstay treatment for the induction of ulcerative colitis remission in patients failing or intolerant to aminosalicylates, but the risk of side effects and complications limits their usefulness. Based on these considerations, new steroids with low systemic bioavailability, such as Beclomethasone dipropionate and Budesonide, have been developed. Areas covered: We reviewed the current literature about the efficacy, safety and the role of budesonide MMX in the treatment of ulcerative colitis. The evidence reviewed in this article is a summation of relevant scientific publications, expert opinion statements, and current practice guidelines. Expert opinion: Budesonide MMX is a novel formulation that uses a Multi-Matrix System (MMX) technology to facilitate the release of high concentrations of active drug into the colon. Budesonide MMX at the dose of 9 mg/day for 8 weeks is effective and safe in inducing clinical and endoscopic remission in patients with mild to moderate UC, who had an inadequate response or were intolerant to either first line conventional therapy with topical and oral 5-aminosalicylic acid.
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Affiliation(s)
- Marco Salice
- a IBD unit, Department of Internal Medicine and Gastroenterology , University of Bologna , Bologna , Italy
| | - Fernando Rizzello
- a IBD unit, Department of Internal Medicine and Gastroenterology , University of Bologna , Bologna , Italy
| | - Carlo Calabrese
- a IBD unit, Department of Internal Medicine and Gastroenterology , University of Bologna , Bologna , Italy
| | - Hana Privitera Hrustemovic
- a IBD unit, Department of Internal Medicine and Gastroenterology , University of Bologna , Bologna , Italy
| | - Paolo Gionchetti
- a IBD unit, Department of Internal Medicine and Gastroenterology , University of Bologna , Bologna , Italy
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Abstract
Ulcerative colitis (UC) is a chronic inflammatory condition that causes continuous mucosal inflammation of the colon. New biological drugs have been developed in order to avoid colectomy, but corticosteroids still play a crucial role in management of active UC. Areas covered: We reviewed the current literature about the importance of corticosteroid use in the treatment of ulcerative colitis. The evidence reviewed in this article is a summation of relevant scientific publications, expert opinion statements, and current practice guidelines. This review is a summary of expert opinion in the field without a formal systematic review of evidence. Expert opinion: Corticosteroids represent the mainstay of treatment in patients with severe UC and are very effective in inducing remission in mild to moderate flares not responding to combined oral and topical mesalazine. A valid alternative to systemic corticosteroids is represented by poorly absorbed steroids, such as Beclomethasone dipropionate and Budesonide MMX. In mild-moderate distal disease topical administration of corticosteroids (both systemic and BDP) is an effective alternative to topical mesalazine. However, corticosteroids do not represent a therapeutic option as a maintenance treatment since they are associated with multiple adverse effects.
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Affiliation(s)
- Marco Salice
- a Department of Internal Medicine and Gastroenterology , University of Bologna , Bologna , Italy
| | - Fernando Rizzello
- a Department of Internal Medicine and Gastroenterology , University of Bologna , Bologna , Italy
| | - Carlo Calabrese
- a Department of Internal Medicine and Gastroenterology , University of Bologna , Bologna , Italy
| | - Lucia Calandrini
- a Department of Internal Medicine and Gastroenterology , University of Bologna , Bologna , Italy
| | - Paolo Gionchetti
- a Department of Internal Medicine and Gastroenterology , University of Bologna , Bologna , Italy
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Padwa B, Citron I, Lee C, Calabrese C. Schneiderian membrane thickness in patients with cleft lip/palate: a case control study. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.061] [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: 10/26/2022]
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29
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Casella D, Di Taranto G, Marcasciano M, Lo Torto F, Barellini L, Sordi S, Gaggelli I, Roncella M, Calabrese C, Ribuffo D. Subcutaneous expanders and synthetic mesh for breast reconstruction: Long-term and patient-reported BREAST-Q outcomes of a single-center prospective study. J Plast Reconstr Aesthet Surg 2019; 72:805-812. [DOI: 10.1016/j.bjps.2018.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/24/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
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30
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Rizzello F, Mazza M, Salice M, Calabrese C, Calafiore A, Campieri M, Gionchetti P. The safety of beclomethasone dipropionate in the treatment of ulcerative colitis. Expert Opin Drug Saf 2018; 17:963-969. [DOI: 10.1080/14740338.2018.1510914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Fernando Rizzello
- Department of Medicine and Surgery (DIMEC), IBD unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marta Mazza
- Department of Medicine and Surgery (DIMEC), IBD unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco Salice
- Department of Medicine and Surgery (DIMEC), IBD unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Calabrese
- Department of Medicine and Surgery (DIMEC), IBD unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Calafiore
- Department of Medicine and Surgery (DIMEC), IBD unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Massimo Campieri
- Department of Medicine and Surgery (DIMEC), IBD unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Gionchetti
- Department of Medicine and Surgery (DIMEC), IBD unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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31
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Di Nardo G, Calabrese C, Conti Nibali R, De Matteis A, Casciani E, Martemucci L, Pagliaro G, Pagano N. Enteroscopy in children. United European Gastroenterol J 2018; 6:961-969. [PMID: 30228882 PMCID: PMC6137589 DOI: 10.1177/2050640618789853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/26/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Device-assisted enteroscopy is a new endoscopic technique for the evaluation of small bowel in adults and children. Data in pediatric population are limited. This review aims to identify diagnostic and therapeutic benefits of enteroscopy in children. METHODS We have analysed paediatric literature on device-assisted enteroscopy focusing on indications, technical aspects and complications, with attention given to adult publications that may be applicable to the paediatric population. RESULTS Obscure gastrointestinal bleeding, Crohn's disease and small bowel polyps are the main indications of enteroscopy in children. Device-assisted enteroscopy has high diagnostic yield for the main paediatric indications, but MR-enterography and capsule endoscopy should be used beforehand in diagnostic work-up to better identify candidates for enteroscopy and to improve its diagnostic and therapeutic yield. Major complications are rare and mostly related to therapeutic procedures. CONCLUSION Despite limited data in the paediatric population, device-assisted enteroscopy represents a useful and safe endoscopic technique in children. Its use, combined with MR-enterography and capsule endoscopy, allows identification and treatment of many of the small bowel paediatric diseases with a low risk of complications.
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Affiliation(s)
- Giovanni Di Nardo
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
- International Hospital Salvator Mundi – UPMC, Rome, Italy
| | - Carlo Calabrese
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Arianna De Matteis
- Department of Translational Medical Science, Section of Pediatrics, University Federico II, Naples, Italy
| | - Emanuele Casciani
- International Hospital Salvator Mundi – UPMC, Rome, Italy
- Department of Emergency Radiology, Sapienza University of Rome, Rome, Italy
| | - Luigi Martemucci
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Giuseppe Pagliaro
- Pediatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nico Pagano
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy
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32
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Casella D, Di Taranto G, Marcasciano M, Sordi S, Kothari A, Kovacs T, Lo Torto F, Cigna E, Ribuffo D, Calabrese C. Nipple-sparing bilateral prophylactic mastectomy and immediate reconstruction with TiLoop® Bra mesh in BRCA1/2 mutation carriers: A prospective study of long-term and patient reported outcomes using the BREAST-Q. Breast 2018; 39:8-13. [DOI: 10.1016/j.breast.2018.02.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/19/2017] [Accepted: 02/06/2018] [Indexed: 11/30/2022] Open
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33
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Calabrese C, Salice M. Revenge of the NERDs: Cadherin Fragments Differentiate Functional Heartburn from Non-erosive Reflux Disease. Dig Dis Sci 2018; 63:547-548. [PMID: 29330729 DOI: 10.1007/s10620-017-4872-8] [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: 12/09/2022]
Affiliation(s)
- Carlo Calabrese
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy. .,Azienda Ospedaliero-Universitaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy.
| | - Marco Salice
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
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34
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Abstract
Introduction Gingival hypertrophy is a frequent condition associated to the increased number of patients taking some categories of drugs. The goal of this work is to emphasize the importance of diagnosis to set a proper therapy. Material and methods The plaque accumulation in patients having a poor oral hygiene damages the periodontium and requires the application of strict professional and home hygiene protocols. Results and conclusion The drug-induced gingival proliferation knowledge is essential in order to succeed in working with the internist and in planning a precise therapy, without interfering with the metabolism of drugs, often necessary and irreplaceable for patients' health.
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Affiliation(s)
- F Luciani
- Catholic University "Our Lady of Good Counsel", Tirana, Albania
| | - G Paolantonio
- Catholic University "Our Lady of Good Counsel", Tirana, Albania
| | - C Calabrese
- Department Odontostomatology ASL RM/B, Rome, Italy
| | - L Calabrese
- University of Rome "Tor Vergata", Director and Chief U.O.C. MaxilloFacial Surgery, Department of Clinical Science and Translational Medicine, PTV Foundation Rome, Rome, Italy
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35
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Richard ML, Liguori G, Lamas B, Brandi G, da Costa G, Hoffmann TW, Pierluigi Di Simone M, Calabrese C, Poggioli G, Langella P, Campieri M, Sokol H. Mucosa-associated microbiota dysbiosis in colitis associated cancer. Gut Microbes 2017; 9:131-142. [PMID: 28914591 PMCID: PMC5989788 DOI: 10.1080/19490976.2017.1379637] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Gut microbiota dysbiosis has been associated with inflammatory bowel diseases (IBD). In colorectal cancer, the gut microbiota has also been recognized as potentially involved in aggravating or favoring the tumor development. However, very little is known on the structure and role of the microbiota in colitis associated cancer (CAC), an important complication of IBD in human. Here we analyzed the bacterial and fungal composition of the mucosa associated microbiota of patients suffering CAC, sporadic cancer (SC) and of healthy subjects (HS) by barcode sequences analysis on the following cohort: 7 CAC patients, 10 SC patients and 10 HS using 16S (MiSeq) and ITS2 (pyrosequencing) sequencing, for bacteria and fungi respectively. Mucosa-associated bacterial microbiota in CAC was significantly different from the ones in SC or in HS, while the fungal showed no differences. Comparison between mucosa-associated microbiota on the tumor site or in normal mucosa near the tumor showed very similar patterns. The global mucosa-associated bacterial microbiota in cancer patients was characterized by a restriction in biodiversity but no change for the fungal community. Compared to SC, CAC was characterized by an increase of Enterobacteriacae family and Sphingomonas genus and a decrease of Fusobacterium and Ruminococcus genus. Our study confirms the alteration of the mucosa-associated bacterial microbiota in IBD and SC. Although the cohort is limited in number, this is the first evidence of the existence of an altered bacterial microbiota in CAC clearly different from the one in SC patients.
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Affiliation(s)
- Mathias L. Richard
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, Jouy en Josas, France,Inflammation-Immunopathology-Biotherapy Département Hospitalo-Universitaire (DHU i2B), Paris, France
| | - Giuseppina Liguori
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Bruno Lamas
- Inflammation-Immunopathology-Biotherapy Département Hospitalo-Universitaire (DHU i2B), Paris, France,Equipe Avenir Gut Microbiota and Immunity, ERL INSERM U 1157/UMR7203, Faculté de Médecine Saint-Antoine, Université Pierre et Marie Curie (UPMC), Paris, France
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Gregory da Costa
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, Jouy en Josas, France,Inflammation-Immunopathology-Biotherapy Département Hospitalo-Universitaire (DHU i2B), Paris, France
| | - Thomas W. Hoffmann
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, Jouy en Josas, France,Inflammation-Immunopathology-Biotherapy Département Hospitalo-Universitaire (DHU i2B), Paris, France
| | | | - Carlo Calabrese
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Gilberto Poggioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Philippe Langella
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, Jouy en Josas, France,Inflammation-Immunopathology-Biotherapy Département Hospitalo-Universitaire (DHU i2B), Paris, France
| | - Massimo Campieri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Harry Sokol
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, Jouy en Josas, France,Inflammation-Immunopathology-Biotherapy Département Hospitalo-Universitaire (DHU i2B), Paris, France,Equipe Avenir Gut Microbiota and Immunity, ERL INSERM U 1157/UMR7203, Faculté de Médecine Saint-Antoine, Université Pierre et Marie Curie (UPMC), Paris, France,Service de Gastroentérologie et Nutrition, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris et Université Paris 6, Paris, France,CONTACT Pr Harry Sokol Service de Gastroentérologie et Nutrition, Hôpital Saint-Antoine 184 rue du faubourg Saint-Antoine, 75571 Paris CEDEX 12, France
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36
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Kawauchi D, Ogg RJ, Liu L, Shih DJH, Finkelstein D, Murphy BL, Rehg JE, Korshunov A, Calabrese C, Zindy F, Phoenix T, Kawaguchi Y, Gronych J, Gilbertson RJ, Lichter P, Gajjar A, Kool M, Northcott PA, Pfister SM, Roussel MF. Novel MYC-driven medulloblastoma models from multiple embryonic cerebellar cells. Oncogene 2017; 36:5231-5242. [PMID: 28504719 PMCID: PMC5605674 DOI: 10.1038/onc.2017.110] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/22/2017] [Accepted: 03/12/2017] [Indexed: 12/17/2022]
Abstract
Group3 medulloblastoma (MBG3) that predominantly occur in young children are usually associated with MYC amplification and/or overexpression, frequent metastasis and a dismal prognosis. Physiologically relevant MBG3 models are currently lacking, making inferences related to their cellular origin thus far limited. Using in utero electroporation, we here report that MBG3 mouse models can be developed in situ from different multipotent embryonic cerebellar progenitor cells via conditional expression of Myc and loss of Trp53 function in several Cre driver mouse lines. The Blbp-Cre driver that targets embryonic neural progenitors induced tumors exhibiting a large-cell/anaplastic histopathology adjacent to the fourth ventricle, recapitulating human MBG3. Enforced co-expression of luciferase together with Myc and a dominant-negative form of Trp53 revealed that GABAergic neuronal progenitors as well as cerebellar granule cells give rise to MBG3 with their distinct growth kinetics. Cross-species gene expression analysis revealed that these novel MBG3 models shared molecular characteristics with human MBG3, irrespective of their cellular origin. We here developed MBG3 mouse models in their physiological environment and we show that oncogenic insults drive this MB subgroup in different cerebellar lineages rather than in a specific cell of origin.
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Affiliation(s)
- D Kawauchi
- Department of Tumor Cell Biology, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
- Division of Pediatric Neuro-Oncology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - R J Ogg
- Department of Radiological Sciences, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - L Liu
- Department of Tumor Cell Biology, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - D J H Shih
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - D Finkelstein
- Department of Computational Biology, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - B L Murphy
- Department of Tumor Cell Biology, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - J E Rehg
- Department of Veterinary Pathology Core, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - A Korshunov
- Clinical Cooperation Unit Neuropathology, German Cancer Research Centre (DKFZ), Department of Neuropathology, University of Heidelberg, Heidelberg, Germany
| | - C Calabrese
- Department of Small Animal Imaging Core, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - F Zindy
- Department of Tumor Cell Biology, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - T Phoenix
- Department of Developmental Neurobiology, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - Y Kawaguchi
- Department of Clinical Application, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan
| | - J Gronych
- Department of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R J Gilbertson
- Department of Developmental Neurobiology, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - P Lichter
- Department of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Gajjar
- Department of Oncology, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - M Kool
- Division of Pediatric Neuro-Oncology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - P A Northcott
- Department of Developmental Neurobiology, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
| | - S M Pfister
- Division of Pediatric Neuro-Oncology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - M F Roussel
- Department of Tumor Cell Biology, St Jude Children’s Research Hospital (SJCRH), Memphis, TN, USA
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Calabrese C, Kirchner E, Kontzias A, Velcheti V, Calabrese LH. Rheumatic immune-related adverse events of checkpoint therapy for cancer: case series of a new nosological entity. RMD Open 2017; 3:e000412. [PMID: 28405474 PMCID: PMC5372131 DOI: 10.1136/rmdopen-2016-000412] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/19/2017] [Accepted: 02/05/2017] [Indexed: 11/29/2022] Open
Abstract
Immunotherapy of cancer with checkpoint inhibitors has been associated with a spectrum of autoimmune and systemic inflammatory reactions known as immune-related adverse events (irAEs). Rheumatic irAEs are infrequently reported and extensively described. Here, we report our experience over an 18-month period with 15 patients evaluated in the rheumatology department for rheumatic irAEs. We identified 13 patients without pre-existing autoimmune disease (AID) who subsequently developed rheumatic irAEs, and two with established AID referred pre-emptively. irAEs encountered included: inflammatory arthritis, sicca syndrome, polymyalgia rheumatica-like symptoms and myositis. All cases required glucocorticoids, and three required a biological agent. Rheumatic irAEs led to temporary or permanent cessation of immunotherapy in all but five patients. One patient with pre-existing AID experienced a flare after starting immunotherapy. Our findings underscore that rheumatic irAEs are complex, at times require additional immunosuppressive therapy, and may influence ongoing immunotherapy regimens for the primary disease. Similar irAEs will be increasingly seen as checkpoint inhibitors adopted as standard of care in the community.
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Affiliation(s)
- C Calabrese
- Cleveland Clinic Foundation, Cleveland, Ohio, USA; Departmentof Rheumatology and Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | - E Kirchner
- Cleveland Clinic Foundation, Cleveland, Ohio, USA; Departmentof Rheumatology and Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | - A Kontzias
- Cleveland Clinic Foundation, Cleveland, Ohio, USA; Departmentof Rheumatology and Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | - V Velcheti
- Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - L H Calabrese
- Cleveland Clinic Foundation, Cleveland, Ohio, USA; Departmentof Rheumatology and Immunology, Cleveland Clinic, Cleveland, Ohio, USA
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Abstract
Spondyloarthritis (SpA) is a group of diseases with similar clinical, radiologic, and serologic features, including SpA associated with inflammatory bowel disease (IBD-associated SpA). SpA is the most frequent extraintestinal manifestation in patients with IBD. Separate recommendations/guidelines are available for the treatment of axial and peripheral SpA and for both Crohn disease and ulcerative colitis. When IBD and SpA coexist, the therapeutic strategy should be modulated taking into account the variable manifestations and complications of IBD in terms of intestinal and extraintestinal features, and the clinical manifestations of SpA.
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Affiliation(s)
- Paolo Gionchetti
- From the Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.P. Gionchetti, MD, Associate Professor of Internal Medicine; C. Calabrese, PhD, Researcher; F. Rizzello, PhD, Researcher.
| | - Carlo Calabrese
- From the Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.P. Gionchetti, MD, Associate Professor of Internal Medicine; C. Calabrese, PhD, Researcher; F. Rizzello, PhD, Researcher
| | - Fernando Rizzello
- From the Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.P. Gionchetti, MD, Associate Professor of Internal Medicine; C. Calabrese, PhD, Researcher; F. Rizzello, PhD, Researcher
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39
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Vatrella A, Calabrese C, Mattiello A, Panico C, Costigliola A, Chiodini P, Panico S. Abdominal adiposity is an early marker of pulmonary function impairment: Findings from a Mediterranean Italian female cohort. Nutr Metab Cardiovasc Dis 2016; 26:643-648. [PMID: 27107841 DOI: 10.1016/j.numecd.2015.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/07/2015] [Accepted: 12/28/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS Abdominal adiposity may influence the respiratory function, especially in women. The aim of this prospective study is to evaluate the predictive role of body mass index (BMI) and waist circumference (WC) on lung function in healthy women. METHODS AND RESULTS In 600 women randomly selected from the cohort of the "Progetto ATENA," anthropometric measures such as BMI, WC, and weight gain were recorded at baseline, and the spirometric parameters were measured 10 years later. The percentage values of forced expiratory volume in 1 s (FEV1%) and forced vital capacity (FVC%) and the ratio of FEV1/FVC were compared with the anthropometric measures after adjustment for several variables measured at baseline such as age, height, socioeconomic status, smoking habits, and history of respiratory allergies grouped in a basal model. WC is significantly associated with a decreased FVC (p = 0.008) and an increased ratio of FEV1/FVC (p = 0.031) after adjustment for the covariates of the basal model. The association between BMI and spirometric parameters reaches borderline significance only with the ratio of FEV1/FVC (p = 0.052). CONCLUSIONS We suggest measuring both BMI and WC to assess the risk of future respiratory impairment.
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Affiliation(s)
- A Vatrella
- Department of Medicine and Surgery, Section of Respiratory Diseases, University of Salerno, Salerno, Italy.
| | - C Calabrese
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - A Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - C Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - A Costigliola
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - P Chiodini
- Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Naples, Italy
| | - S Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
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Abstract
Pouchitis is the most frequent long-term complication of pouch surgery for ulcerative colitis. There is consistent evidence on the implication of bacterial flora in the pathogenesis of pouchitis, and there is evidence for a therapeutic role of antibiotics and probiotics in therapy of this disease. Antibiotics, particularly ciprofloxacin and metronidazole, are the mainstay of treatment for acute pouchitis. In chronic refractory pouchitis, after having excluded other diagnoses (infections, Crohn's disease of the pouch, ischemia and irritable pouch), antibiotic combination therapy is the treatment of choice. The highly concentrated probiotic mixture VSL#3 has been shown to be effective in prevention of pouchitis onset and in maintaining antibiotic-induced remission.
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Affiliation(s)
- Paolo Gionchetti
- a Department of Medical and Surgical Sciences (DIMEC), University of Bologna-Italy, Bologna, Italy
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41
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Calabrese C, Rizzello F, Gionchetti P, Calafiore A, Pagano N, De Fazio L, Valerii MC, Cavazza E, Strillacci A, Comelli MC, Poggioli G, Campieri M, Spisni E. Can supplementation of phytoestrogens/insoluble fibers help the management of duodenal polyps in familial adenomatous polyposis? Carcinogenesis 2016; 37:600-6. [PMID: 27207660 DOI: 10.1093/carcin/bgw041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 03/29/2016] [Indexed: 02/07/2023] Open
Abstract
Familial adenomatous polyposis (FAP) is an autosomal dominant inherited disorder, and prophylactic colectomy has been shown to decrease the incidence of colorectal cancer (CRC). Duodenal cancer and desmoids are now the leading causes of death in FAP. We evaluate whether 3 months of oral supplementation with a patented blend of phytoestrogens and indigestible insoluble fibers (ADI) help the management of FAP patients with ileal pouch-anal anastomosis (IPAA). In a prospective open label study, we enrolled 15 FAP patients with IPAA and duodenal polyps who underwent upper gastrointestinal endoscopy at baseline and after 3 months of treatment. The primary endpoint was the change in gene expression in polyp mucosa, whereas the secondary endpoint was the reduction in polyp number and size. After 3 months of ADI treatment, all patients showed a reduction in the number and size of duodenal polyps (P = 0.021). Analysis of the expression of CRC promoting/inhibiting genes in duodenal polyps biopsies demonstrated that different CRC-promoting genes (PCNA, MUC1 and COX-2) were significantly downregulated, whereas CRC-inhibiting genes (ER-β and MUC2) were significantly upregulated after ADI treatment. In conclusion, ADI proved to be safe and effective, and its long-term effects on FAP patients need further investigation. Judging from the results we observed on COX-2 and miR-101 expression, the short-term effects of ADI treatment could be comparable with those obtained using COX-2 inhibitors, with the advantage of being much more tolerable in chronic therapies and void of adverse events.
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Affiliation(s)
| | | | | | | | | | - Luigia De Fazio
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy and
| | - Maria Chiara Valerii
- Department of Medicine and Surgery and Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy and
| | - Elena Cavazza
- Department of Medicine and Surgery and Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy and
| | - Antonio Strillacci
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy and
| | | | | | | | - Enzo Spisni
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy and
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42
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Liguori G, Lamas B, Richard ML, Brandi G, da Costa G, Hoffmann TW, Di Simone MP, Calabrese C, Poggioli G, Langella P, Campieri M, Sokol H. Fungal Dysbiosis in Mucosa-associated Microbiota of Crohn's Disease Patients. J Crohns Colitis 2016; 10:296-305. [PMID: 26574491 PMCID: PMC4957473 DOI: 10.1093/ecco-jcc/jjv209] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/12/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Gut microbiota is involved in many physiological functions and its imbalance is associated with several diseases, particularly with inflammatory bowel diseases. Mucosa-associated microbiota could have a key role in induction of host immunity and in inflammatory process. Although the role of fungi has been suggested in inflammatory disease pathogenesis, the fungal microbiota has not yet been deeply explored. Here we analysed the bacterial and fungal composition of the mucosa-associated microbiota of Crohn's disease patients and healthy subjects. METHODS Our prospective, observational study evaluated bacterial and fungal composition of mucosa-associated microbiota of 23 Crohn's disease patients [16 in flare, 7 in remission] and 10 healthy subjects, using 16S [MiSeq] and ITS2 [pyrosequencing] sequencing, respectively. Global fungal load was assessed by real time quantitative polymerase chain reaction. RESULTS Bacterial microbiota in Crohn's disease patients was characterised by a restriction in biodiversity. with an increase of Proteobacteria and Fusobacteria. Global fungus load was significantly increased in Crohn's disease flare compared with healthy subjects [p < 0.05]. In both groups, the colonic mucosa-associated fungal microbiota was dominated by Basidiomycota and Ascomycota phyla. Cystofilobasidiaceae family and Candida glabrata species were overrepresented in Crohn's disease. Saccharomyces cerevisiae and Filobasidium uniguttulatum species were associated with non-inflamed mucosa, whereas Xylariales order was associated with inflamed mucosa. CONCLUSIONS Our study confirms the alteration of the bacterial microbiota and is the first demonstration of the existence of an altered fungal microbiota in Crohn's disease patients, suggesting that fungi may play a role in pathogenesis.
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Affiliation(s)
- Giuseppina Liguori
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Bruno Lamas
- Equipe Avenir Gut Microbiota and Immunity, U1157/UMR7203, Faculté de Médecine Saint-Antoine, Université Pierre et Marie Curie, Paris, France,Inflammation-Immunopathology-Biotherapy Département, Hospitalo-Universitaire, Paris, France
| | - Mathias L. Richard
- Inflammation-Immunopathology-Biotherapy Département, Hospitalo-Universitaire, Paris, France,INRA, UMR1319 MICALIS, Jouy en Josas, France,AgroParisTech, UMR1319 MICALIS, Jouy en Josas, France
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna,Bologna, Italy
| | - Gregory da Costa
- Inflammation-Immunopathology-Biotherapy Département, Hospitalo-Universitaire, Paris, France,INRA, UMR1319 MICALIS, Jouy en Josas, France,AgroParisTech, UMR1319 MICALIS, Jouy en Josas, France
| | - Thomas W. Hoffmann
- Inflammation-Immunopathology-Biotherapy Département, Hospitalo-Universitaire, Paris, France,INRA, UMR1319 MICALIS, Jouy en Josas, France,AgroParisTech, UMR1319 MICALIS, Jouy en Josas, France
| | | | - Carlo Calabrese
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Gilberto Poggioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Philippe Langella
- Inflammation-Immunopathology-Biotherapy Département, Hospitalo-Universitaire, Paris, France,INRA, UMR1319 MICALIS, Jouy en Josas, France,AgroParisTech, UMR1319 MICALIS, Jouy en Josas, France
| | - Massimo Campieri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Harry Sokol
- Equipe Avenir Gut Microbiota and Immunity, U1157/UMR7203, Faculté de Médecine Saint-Antoine, Université Pierre et Marie Curie, Paris, France,Inflammation-Immunopathology-Biotherapy Département, Hospitalo-Universitaire, Paris, France,INRA, UMR1319 MICALIS, Jouy en Josas, France,AgroParisTech, UMR1319 MICALIS, Jouy en Josas, France,Service de Gastroentérologie et Nutrition, Assistance Publique Hôpitaux de Paris et Université Paris6, Paris, France
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43
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Calabrese C, Carpagnano GE, Patella V, Vatrella A, Santus P. Asymmetric dimethylarginine (ADMA): will be or will not be a new revolutionary biomarker of bronchial asthma. Minerva Med 2015:R10Y9999N00A150026. [PMID: 26583284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Carraro et al. measured asymmetric dimethylarginine (ADMA) in the exhaled breath condensate (EBC) obtained from children with asthma and from healthy subjects. The authors demonstrated higher levels of ADMA in EBC of asthmatics compared to controls. ADMA levels in EBC did not correlate with serum levels, lung function parameters, and fractional exhaled nitric oxide. ADMA levels in EBC did not significantly differ between asthmatic patients regularly treated with inhaled steroids and those who were steroid naïve. Further studies are necessary in order to evaluate the role of this biomarker in the characterization of phenotypes of severe bronchial asthma.
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Affiliation(s)
- C Calabrese
- Department of Cardio-thoracic and Respiratory Sciences, Second University of Naples, Naples, Italy -
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44
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Zagari RM, Romano M, Ojetti V, Stockbrugger R, Gullini S, Annibale B, Farinati F, Ierardi E, Maconi G, Rugge M, Calabrese C, Di Mario F, Luzza F, Pretolani S, Savio A, Gasbarrini G, Caselli M. Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015. Dig Liver Dis 2015; 47:903-12. [PMID: 26253555 DOI: 10.1016/j.dld.2015.06.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/27/2015] [Accepted: 06/26/2015] [Indexed: 02/08/2023]
Abstract
Knowledge on the role of Helicobacter pylori (HP) infection is continually evolving, and treatment is becoming more challenging due to increasing bacterial resistance. Since the management of HP infection is changing, an update of the national Italian guidelines delivered in 2007 was needed. In the III Working Group Consensus Report 2015, a panel of 17 experts from several Italian regions reviewed current evidence on different topics relating to HP infection. Four working groups examined the following topics: (1) "open questions" on HP diagnosis and treatment (focusing on dyspepsia, gastro-oesophageal reflux disease, non-steroidal anti-inflammatory drugs or aspirin use and extra-gastric diseases); (2) non-invasive and invasive diagnostic tests; (3) treatment of HP infection; (4) role of HP in the prevention of gastric cancer. Statements and recommendations were discussed and a consensus reached in a final plenary session held in February 2015 in Bologna. Recommendations are based on the best current evidence to help physicians manage HP infection in Italy. The guidelines have been endorsed by the Italian Society of Gastroenterology and the Italian Society of Digestive Endoscopy.
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Affiliation(s)
| | - Marco Romano
- Department of Clinical and Experimental Medicine "F. Magrassi", Second University of Naples, Italy
| | - Veronica Ojetti
- Department of Internal Medicine and Gastroenterology, Catholic University, Rome, Italy
| | | | - Sergio Gullini
- School of Gastroenterology, University of Ferrara, Italy
| | - Bruno Annibale
- Department of Digestive and Liver Disease, University Sapienza, Rome, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, Section of Gastroenterology, University of Padua, Italy
| | - Enzo Ierardi
- Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Italy
| | - Massimo Rugge
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padua, Italy
| | - Carlo Calabrese
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Francesco Di Mario
- Department of Clinical and Experimental Medicine, University of Parma, Italy
| | - Francesco Luzza
- Department of Health Science, University of Catanzaro "Magna Graecia", Italy
| | | | - Antonella Savio
- Fondazione Poliambulanza, Department of Histopathology, Brescia, Italy
| | - Giovanni Gasbarrini
- Department of Internal Medicine and Gastroenterology, Catholic University, Rome, Italy
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45
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Calabrese C, Carpagnano GE, Patella V, Vatrella A, Santus P. Asymmetric dimethylarginine (ADMA): will be or will not be a new revolutionary biomarker of bronchial asthma? Minerva Med 2015; 106:9-11. [PMID: 27427261] [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: 06/06/2023]
Abstract
Carraro et al. measured asymmetric dimethylarginine (ADMA) in the exhaled breath condensate (EBC) obtained from children with asthma and from healthy subjects. The authors demonstrated higher levels of ADMA in EBC of asthmatics compared to controls. ADMA levels in EBC did not correlate with serum levels, lung function parameters, and fractional exhaled nitric oxide. ADMA levels in EBC did not significantly differ between asthmatic patients regularly treated with inhaled steroids and those who were steroid naïve. Further studies are necessary in order to evaluate the role of this biomarker in the characterization of phenotypes of severe bronchial asthma.
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Affiliation(s)
- C Calabrese
- Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Naples, Italy -
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46
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Lanzillo B, Matarazzo G, Calabrese C, Vitale DF. Normalization of Functional Independence Measure variation improves assessment of stroke rehabilitation outcome. Eur J Phys Rehabil Med 2015; 51:587-596. [PMID: 25573600] [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: 06/04/2023]
Abstract
BACKGROUND Assessment of rehabilitation outcome is based on measuring the change in Functional Independence Measure (FIMTM) score between the start and end of rehabilitation. However, the raw FIMTM score gain is subject to a ceiling effect. Proposed solutions to this problem have incongruities that limit their use. AIM The aim of this study was to determine the factors that influence functional outcome in stroke rehabilitation, exploring the possibility of developing an outcome index free of the ceiling effect and of the incongruities revealed by the proposed solutions. DESIGN Retrospective study of the electronic clinical records of patients admitted to a rehabilitation unit over a period of 5 years. SETTING Rehabilitation unit. POPULATION A total of 224 patients admitted for first post-stroke rehabilitation of either ischaemic or hemorrhagic etiology. METHODS Rehabilitation outcome was evaluated based on changes in both raw and "normalized" FIMTM motor and cognitive scores observed between hospital admission and discharge. Normalized differences are in the range 0-1 and may be considered an estimate of the actually attained fraction of the maximum expected recovery, while the modified algebraic formula (+1 to both numerator and denominator) is intended to correct the incongruities observed in available solutions. Seventeen prognostic factors were selected as possible effect modifiers of the outcome. A multivariable model-building strategy, based on fractional polynomials, was adopted to select the significant factors, and the stability of the results. RESULTS The procedure adopted to normalize both FIMTM outcomes resolves the ceiling effect and corrects the incongruities noted with available solutions. The level of disability at admission is confirmed as the strongest prognostic factor associated with both cognitive and motor outcomes. The onset-admission interval negatively influence motor recovery, bat not cognitive one. CONCLUSION There is strong evidence to support the proposal that it is advantageous to measure functional recovery by means of the normalized change in FIMTM score. Following a rehabilitation programme, functional recovery should be evaluated separately for motor and cognitive domains. Rehabilitation program should begin as soon as possible. CLINICAL REHABILITATION IMPACT Improved assessment of rehabilitation outcome leads to increased achievement of a favourable treatment outcome.
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Affiliation(s)
- B Lanzillo
- Department of Neurorehabilitation,Fondazione "S. Maugeri" IRCCS Centro di Telese Terme,Telese Terme, Benevento, Italy -
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47
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Calabrese C, Gionchetti P, Calafiore A, Pagano N, Campieri M, Rizzello F. Sporadic small bowel tumors detected by capsule endoscopy in patients with occult gastrointestinal bleeding. Intern Emerg Med 2015; 10:781-5. [PMID: 26350281 DOI: 10.1007/s11739-015-1314-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/24/2015] [Indexed: 12/16/2022]
Abstract
Intestinal tumors represent less than 6% of digestive tumors, and, because of the limitations of intestinal investigations, these tumors are difficult to diagnose. In this context, capsule endoscopy has proven effective, especially in patients with obscure digestive bleeding. In a large series of patients undergoing capsule endoscopy, small bowel tumors are found in 2.4-8.9% of cases. The aim of this retrospective, single-center study, based on prospective database, is to evaluate the frequency of small bowel tumors detected by capsule endoscopy in patients with occult gastrointestinal bleeding. During 2004-2014, 849 consecutive patients underwent CE at our Department for occult gastrointestinal bleeding. Following capsule endoscopy, the medical records of the study population were reviewed. Results of double-balloon enteroscopy or surgery performed after capsule endoscopy were retrieved. Capsule endoscopy identified 55 small bowel tumors (6.5%), of which 28 malignancies (51%) and 27 benign neoplasms (49%) underwent surgery or endoscopic treatment. Malignancies included adenocarcinoma (18.7%), gastrointestinal stromal tumors (GIST) (12%) and lymphoma (6.7%). Benign neoplasms included dysplastic adenomatous polyps (36%) and hyperplastic polyps (25.3%). Non-neoplastic masses included one inflammatory polyp. Capsule retention occurred in four patients (5.3%) and the retained capsule was retrieved during surgery. In our experience neoplasms of small bowel are found in 6.5% of patients with occult gastrointestinal bleeding. Of these malignancies, small bowel neoplasms are found in 3.3% of cases. Capsule endoscopy is an effective and sensitive diagnostic tool, and plays an important role in the algorithm for the diagnostic workup of suspected small bowel tumors.
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Affiliation(s)
- Carlo Calabrese
- DIMEC, Azienda Ospedaliero Univeristaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy.
| | - Paolo Gionchetti
- DIMEC, Azienda Ospedaliero Univeristaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Andrea Calafiore
- DIMEC, Azienda Ospedaliero Univeristaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Nico Pagano
- DIMEC, Azienda Ospedaliero Univeristaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Massimo Campieri
- DIMEC, Azienda Ospedaliero Univeristaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Fernando Rizzello
- DIMEC, Azienda Ospedaliero Univeristaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
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48
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Menard MB, Weeks J, Anderson B, Meeker W, Calabrese C, O'Bryon D, Cramer GD. Consensus Recommendations to NCCIH from Research Faculty in a Transdisciplinary Academic Consortium for Complementary and Integrative Health and Medicine. J Altern Complement Med 2015; 21:386-94. [PMID: 26133203 PMCID: PMC4505754 DOI: 10.1089/acm.2014.0295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This commentary presents the most impactful, shared priorities for research investment across the licensed complementary and integrative health (CIH) disciplines according to the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). These are (1) research on whole disciplines; (2) costs; and (3) building capacity within the disciplines' universities, colleges, and programs. The issue of research capacity is emphasized. DISCUSSION ACCAHC urges expansion of investment in the development of researchers who are graduates of CIH programs, particularly those with a continued association with accredited CIH schools. To increase capacity of CIH discipline researchers, we recommend National Center for Complementary and Integrative Health (NCCIH) to (1) continue and expand R25 grants for education in evidence-based healthcare and evidence-informed practice at CIH schools; (2) work to limit researcher attrition from CIH institutions by supporting career development grants for clinicians from licensed CIH fields who are affiliated with and dedicated to continuing to work in accredited CIH schools; (3) fund additional stand-alone grants to CIH institutions that already have a strong research foundation, and collaborate with appropriate National Institutes of Health (NIH) institutes and centers to create infrastructure in these institutions; (4) stimulate higher percentages of grants to conventional centers to require or strongly encourage partnership with CIH institutions or CIH researchers based at CIH institutions, or give priority to those that do; (5) fund research conferences, workshops, and symposia developed through accredited CIH schools, including those that explore best methods for studying the impact of whole disciplines; and (6) following the present NIH policy of giving priority to new researchers, we urge NCCIH to give a marginal benefit to grant applications from CIH clinician-researchers at CIH academic/research institutions, to acknowledge that CIH concepts require specialized expertise to translate to conventional perspectives. SUMMARY We commend NCCIH for its previous efforts to support high-quality research in the CIH disciplines. As NCCIH develops its 2016-2020 strategic plan, these recommendations to prioritize research based on whole disciplines, encourage collection of outcome data related to costs, and further support capacity-building within CIH institutions remain relevant and are a strategic use of funds that can benefit the nation's health.
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Affiliation(s)
| | - John Weeks
- 2 Academic Consortium for Complementary and Alternative Health Care , Seattle, WA
| | | | | | | | - David O'Bryon
- 6 Association of Chiropractic Colleges , Bethesda, MD
| | - Greg D Cramer
- 7 National University of Health Sciences , Lombard, IL
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Astarita G, Gutiérrez S, Kogovsek N, Mormandi E, Otero P, Calabrese C, Alcaraz G, Vázquez A, Abalovich M. False positive in the measurement of thyroglobulin induced by rheumatoid factor. Clin Chim Acta 2015; 447:43-6. [PMID: 25979693 DOI: 10.1016/j.cca.2015.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 04/07/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND We report a case of interference in thyroglobulin (Tg) measurement in a woman with differentiated thyroid cancer and rheumatoid arthritis history. Due to discordant Tg in relation to TSH concentrations and negative images, we investigated possible interference in the measurement of Tg. METHODS During the follow-up we measured Tg by chemiluminescence (TgQL) using Immulite 2000 immunoassay system. To investigate possible interference in Tg measurement, we made serial dilutions, re-testing of Tg by an alternative method: electrochemiluminescence, Cobas 6000 analyzer (TgEQL), recovery test of Tg and polyethylene glycol (PEG) 6000 precipitation. RESULTS During the patient follow-up, the TgQL ranged between <0.3 and 16.1ng/ml. In the evaluated serum samples very high titers of rheumatoid factor (RF) were found. When RF titers were lowered post PEG precipitation, Tg QL concentrations became undetectable. CONCLUSION We describe an unusual case of interference in Tg assay due to RF. When disagreement among Tg concentrations, images and clinical features is observed, we suggest taking into account the evaluation of possible Tg interference to avoid unnecessary complementary exams and inappropriate treatment.
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Affiliation(s)
- G Astarita
- Endocrinology Division, Durand Hospital, Buenos Aires, Argentina..
| | - S Gutiérrez
- Endocrinology Division, Durand Hospital, Buenos Aires, Argentina
| | - N Kogovsek
- Endocrinology Division, Durand Hospital, Buenos Aires, Argentina
| | - E Mormandi
- Endocrinology Division, Durand Hospital, Buenos Aires, Argentina
| | - P Otero
- Endocrinology Division, Durand Hospital, Buenos Aires, Argentina
| | - C Calabrese
- Endocrinology Division, Durand Hospital, Buenos Aires, Argentina
| | - G Alcaraz
- Endocrinology Division, Durand Hospital, Buenos Aires, Argentina
| | - A Vázquez
- Endocrinology Division, Durand Hospital, Buenos Aires, Argentina
| | - M Abalovich
- Endocrinology Division, Durand Hospital, Buenos Aires, Argentina
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Calabrese C, Tosco A, Abete P, Carnovale V, Basile C, Magliocca A, Quattrucci S, De Sanctis S, Alatri F, Mazzarella G, De Pietro L, Turino C, Melillo E, Buonpensiero P, Di Pasqua A, Raia V. Randomized, single blind, controlled trial of inhaled glutathione vs placebo in patients with cystic fibrosis. J Cyst Fibros 2015; 14:203-10. [DOI: 10.1016/j.jcf.2014.09.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 09/28/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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