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Lum SH, James B, Ottaviano G, Ewins AM, Patrick K, Ali S, Carpenter B, Silva J, Tewari S, Furness C, Thomas A, Shenton G, Bonney D, Moppett J, Hambleton S, Gennery AR, Amrolia P, Gibson B, Hough R, Rao K, Slatter M, Wynn R. Alemtuzumab, Dual Graft-versus-Host Disease Prophylaxis, and Lower CD3 + T Cell Doses Equalize Rates of Acute and Chronic Graft-versus-Host Disease in Pediatric Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation with Matched Unrelated Donor Peripheral Blood Stem Cells or Bone Marrow Grafts. Transplant Cell Ther 2024; 30:314.e1-314.e12. [PMID: 38103787 DOI: 10.1016/j.jtct.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/20/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
Data comparing hematopoietic stem cell transplantation (HSCT) using bone marrow (BM) or peripheral blood stem cell (PBSC) grafts in children after alemtuzumab-based conditioning are lacking. We investigated whether in vivo T cell depletion using alemtuzumab could reduce the risk of severe acute graft-versus-host disease (aGVHD) and chronic GVHD (cGVHD) after HSCT with matched unrelated donor (MUD) BM or PBSCs. This retrospective multicenter study included 397 children (BM group, n = 202; PBSC group, n = 195) who underwent first MUD HSCT at 9 pediatric centers in the United Kingdom between 2015 and 2019. The median age at transplantation was 7.0 years (range, .1 to 19.3 years), and the median duration of follow-up was 3.1 years (range, .3 to 7.5 years). The 3-year overall survival was 81% for the entire cohort (BM group, 80%; PBSC group, 81%). The incidence of grade II-IV aGVHD was significantly higher in the PBSC group (31%) compared to the BM group (31% versus 19%; P = .003), with no difference in the incidence of grade III-IV aGVHD (BM, 7%; PBSC, 12%; P = .17). CD3+ T cell dose >5 × 108/kg and the use of PBSCs were independent predictors of grade II-IV aGVHD. When considering CD3+ T cell dose and GVHD prophylaxis, PBSC transplantation with a calcineurin inhibitor (CNI) and mycophenolate mofetil (MMF) and a CD3+ T cell dose ≤5 × 108/kg had a comparable grade II-IV aGVHD to BM transplantation plus a CNI (20% versus 18%; P = .52). PBSC transplantation was associated with a lower incidence of cGVHD compared to BM transplantation (6% versus 11%; P = .03). Within the limits of this study, we identified a potential strategy to reduce the risk of severe GVHD in pediatric PBSC recipients that includes a combination of in vivo T cell depletion using alemtuzumab and dual GVHD prophylaxis (with a CNI and MMF) and limiting the CD3+ T cell dose to ≤5 × 108/kg.
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Affiliation(s)
- Su Han Lum
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Beki James
- Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds, United Kingdom
| | - Giorgio Ottaviano
- Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Anna-Maria Ewins
- Paediatric Bone Marrow Transplantation Unit, Royal Hospital for Children, Glasgow, United Kingdom
| | - Katharine Patrick
- Department of Paediatric Haematology, Sheffield Children NHS foundation trust, Sheffield, United Kingdom
| | - Salah Ali
- Department of Paediatric Haematology, Sheffield Children NHS foundation trust, Sheffield, United Kingdom
| | - Ben Carpenter
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - Juliana Silva
- Department of Haematology and Oncology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Sanjay Tewari
- Department of Haematology and Oncology, Royal Marsden Hospital, Sutton, United Kingdom
| | - Caroline Furness
- Department of Haematology and Oncology, Royal Marsden Hospital, Sutton, United Kingdom
| | - Arun Thomas
- Department of Haematology and Oncology, Royal Marsden Hospital, Sutton, United Kingdom
| | - Geoff Shenton
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Denise Bonney
- Department of Blood and Marrow Transplantation, Royal Manchester Children's Hospital, United Kingdom
| | - John Moppett
- Department of Haematology and Oncology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Sophie Hambleton
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew R Gennery
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Persis Amrolia
- Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Brenda Gibson
- Paediatric Bone Marrow Transplantation Unit, Royal Hospital for Children, Glasgow, United Kingdom
| | - Rachael Hough
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - Kanchan Rao
- Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Mary Slatter
- Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert Wynn
- Department of Blood and Marrow Transplantation, Royal Manchester Children's Hospital, United Kingdom
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Cinicola BL, Ottaviano G, Hashim IF, Zainudeen ZT, Hamid IJA, Elfeky R. Prevalence and Characteristics of Non-tuberculous Mycobacteria (NTM) Infection in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation: a Systematic Review and Meta-analysis. J Clin Immunol 2023; 44:23. [PMID: 38129624 PMCID: PMC10739425 DOI: 10.1007/s10875-023-01615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/22/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Non-tuberculous mycobacteria (NTM) infections in hematopoietic stem cell transplantation (HSCT) recipients represent a diagnostic and therapeutic challenge. Here, we aimed to review and analyze current literature on incidence, clinical presentation, and outcome of NTM infection after allogeneic HSCT. METHODS We performed a systematic review and meta-analysis of available literature regarding NTM infection in children and adults receiving allogeneic HSCT. RESULTS We identified 56 articles eligible for the analysis. Among 15 studies, describing 15,798 allogeneic HSCT, we estimated a prevalence of 1.26% (95% CI 0.72, 1.93) of NTM after transplant. Analysis of 175 patients with NTM infection showed a median time of diagnosis of 318 days after HSCT, an increased prevalence in adults (82.9%), and a most frequent pulmonary involvement (44%). Comparison between children and adults revealed an earlier post-transplant disease onset (median 130 days vs 287 days) and most frequent non-pulmonary presentation in children. A vast heterogeneity of therapeutic approach reflected the lack of universal recommendations regarding drug combination and duration of therapy. Overall, NTM-related mortality accounted for 33% in this systematic review. CONCLUSION Although rare, NTM infections can complicate post-transplant course with a high mortality rate in children and adults. The lack of prospective studies and guidelines prevents identification of risk factors and therapeutic recommendations.
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Affiliation(s)
- Bianca Laura Cinicola
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgio Ottaviano
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Ilie Fadzilah Hashim
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200, Kepala Batas, Pulau Pinang, Malaysia
| | - Zarina Thasneem Zainudeen
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200, Kepala Batas, Pulau Pinang, Malaysia
| | - Intan Juliana Abd Hamid
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200, Kepala Batas, Pulau Pinang, Malaysia.
| | - Reem Elfeky
- Department of Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK.
- GOS Hospital for Children NHS Foundation Trust, University College London GOS Institute of Child Health, and NIHR GOSH BRC, London, UK.
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Cattoni A, Nicolosi ML, Capitoli G, Gadda A, Molinari S, Louka S, Buonsante A, Orlandi S, Salierno G, Bellani I, Vendemini F, Ottaviano G, Gaiero A, Fichera G, Biondi A, Balduzzi A. Pubertal attainment and Leydig cell function following pediatric hematopoietic stem cell transplantation: a three-decade longitudinal assessment. Front Endocrinol (Lausanne) 2023; 14:1292683. [PMID: 38152128 PMCID: PMC10751351 DOI: 10.3389/fendo.2023.1292683] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/01/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction Impaired testosterone secretion is a frequent sequela following hematopoietic stem cell transplantation (HSCT) in pediatrics, but long-term longitudinal trendlines of clinical and biochemical findings are still scanty. Methods Monocentric, retrospective analysis. Male patients transplanted <18 years between 1992 and 2021, surviving ≥2 years after HSCT and showing, upon enrollment, clinical and biochemical signs consistent with pubertal onset and progression were included. Clinical and biochemical data collected every 6-12 months were recorded. Results Of 130 patients enrolled, 56% were prepubertal, while 44% were peri-/postpubertal upon HSCT. Overall, 44% showed spontaneous progression into puberty and normal gonadal profile, while the remaining experienced pubertal arrest (1%), isolated increase of FSH (19%), compensated (23%) or overt (13%) hypergonadotropic hypogonadism. Post-pubertal testicular volume (TV) was statistically smaller among patients still pre-pubertal upon HSCT (p 0.049), whereas no differences were recorded in adult testosterone levels. LH and testosterone levels showed a specular trend between 20 and 30 years, as a progressive decrease in sexual steroids was associated with a compensatory increase of the luteinizing hormone. A variable degree of gonadal dysfunction was reported in 85%, 51%, 32% and 0% of patients following total body irradiation- (TBI), busulfan-, cyclophosphamide- and treosulfan-based regimens, respectively. TBI and busulfan cohorts were associated with the lowest probability of gonadal event-free course (p<0.0001), while it achieved 100% following treosulfan. A statistically greater gonadotoxicity was detected after busulfan than treosulfan (p 0.024). Chemo-only regimens were associated with statistically larger TV (p <0.001), higher testosterone (p 0.008) and lower gonadotropin levels (p <0.001) than TBI. Accordingly, the latter was associated with a 2-fold increase in the risk of gonadal failure compared to busulfan (OR 2.34, CI 1.08-8.40), whereas being pre-pubertal upon HSCT was associated with a reduced risk (OR 0.15, CI 0.08-0.30). Conclusions a) patients pre-pubertal upon HSCT showed a reduced risk of testicular endocrine dysfunction, despite smaller adult TV; b) patients showed downwards trend in testosterone levels after full pubertal attainment, despite a compensatory increase in LH; c) treosulfan was associated to a statistically lower occurrence of hypogonadism than busulfan, with a trend towards larger TV, higher testosterone levels and lower gonadotropins.
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Affiliation(s)
- Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Laura Nicolosi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giulia Capitoli
- Bicocca Bioinformatics, Biostatistics and Bioimaging B4 Centre, University of Milano-Bicocca, Monza, Italy
| | - Alberto Gadda
- Bicocca Bioinformatics, Biostatistics and Bioimaging B4 Centre, University of Milano-Bicocca, Monza, Italy
| | - Silvia Molinari
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Sotiris Louka
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrea Buonsante
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Simona Orlandi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Gianluca Salierno
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Iacopo Bellani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesca Vendemini
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giorgio Ottaviano
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alberto Gaiero
- Department of Pediatrics and Neonatology, IRCCS Gaslini Savona e Pietra Ligure, Savona, Italy
| | | | - Andrea Biondi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Whitcroft KL, Altundag A, Balungwe P, Boscolo-Rizzo P, Douglas R, Enecilla MLB, Fjaeldstad AW, Fornazieri MA, Frasnelli J, Gane S, Gudziol H, Gupta N, Haehner A, Hernandez AK, Holbrook EH, Hopkins C, Hsieh JW, Huart C, Husain S, Kamel R, Kim JK, Kobayashi M, Konstantinidis I, Landis BN, Lechner M, Macchi A, Mazal PP, Miri I, Miwa T, Mori E, Mullol J, Mueller CA, Ottaviano G, Patel ZM, Philpott C, Pinto JM, Ramakrishnan VR, Roth Y, Schlosser RJ, Stjärne P, Van Gerven L, Vodicka J, Welge-Luessen A, Wormald PJ, Hummel T. Position paper on olfactory dysfunction: 2023. Rhinology 2023; 61:1-108. [PMID: 37454287 DOI: 10.4193/rhin22.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Since publication of the original Position Paper on Olfactory Dysfunction in 2017 (PPOD-17), the personal and societal burden of olfactory disorders has come sharply into focus through the lens of the COVID-19 pandemic. Clinicians, scientists and the public are now more aware of the importance of olfaction, and the impact of its dysfunction on quality of life, nutrition, social relationships and mental health. Accordingly, new basic, translational and clinical research has resulted in significant progress since the PPOD-17. In this updated document, we present and discuss currently available evidence for the diagnosis and management of olfactory dysfunction. Major updates to the current version include, amongst others: new recommendations on olfactory related terminology; new imaging recommendations; new sections on qualitative OD and COVID-19 OD; updated management section. Recommendations were agreed by all co-authors using a modified Delphi process. CONCLUSIONS We have provided an overview of current evidence and expert-agreed recommendations for the definition, investigation, and management of OD. As for our original Position Paper, we hope that this updated document will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency, and generalisability of work in this field.
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Affiliation(s)
- K L Whitcroft
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
- and UCL Ear Institute, Faculty of Brain Sciences, University College London, London, UK
- and The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Studies, University of London, London, UK
| | - A Altundag
- Department of Otorhinolaryngology, Istanbul Surgery Hospital, Istanbul, Turkey
| | - P Balungwe
- Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- and Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - P Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - R Douglas
- Department of Otorhinolaryngology, University of Auckland, New Zealand
| | - M L B Enecilla
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Luke's Medical Center, Global City, Philippines
- and Department of Otolaryngology - Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines
- and Department of Otorhinolaryngology, Medical Center Taguig, Taguig, Philippines
| | - A W Fjaeldstad
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Studies, University of London, London, UK
- and Department of Otorhinolaryngology, University Clinic for Flavour, Balance and Sleep, Regional Hospital Gødstrup, Herning, Denmark
- and Department of Clinical Medicine, Flavour Institute, Aarhus University, Aarhus, Denmark
- and Center for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, UK
| | - M A Fornazieri
- Department of Clinical Surgery, Universidade Estadual de Londrina and Pontifícia Universidade Católica do Paraná, Londrina, Brazil
| | - J Frasnelli
- Research Chair in Chemosensory Neuroanatomy, Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- and Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - S Gane
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Studies, University of London, London, UK
- and Royal National Throat Nose and Ear Hospital, UCLH, London
| | - H Gudziol
- Department of Otorhinolaryngology, University of Jena, Jena, Germany
| | - N Gupta
- Department of Otorhinolaryngology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - A Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - A K Hernandez
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
- and Department of Otolaryngology - Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines
- and Department of Otolaryngology - Head and Neck Surgery, Philippine General Hospital, University of the Philippines - Manila, Manila, Philippines
| | - E H Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - C Hopkins
- Guys and St Thomas NHS Trust, London, United Kingdom
| | - J W Hsieh
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - C Huart
- Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- and Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - S Husain
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - R Kamel
- Department of Otorhinolaryngology, Cairo University, Cairo, Egypt
| | - J K Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University, College of Medicine, Seoul, Republic of Korea
| | - M Kobayashi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - I Konstantinidis
- Smell and Taste Clinic, Second Academic Otorhinolaryngology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B N Landis
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - M Lechner
- Division of Surgery and Interventional Science, University College London, London, UK
- and UCL Cancer Institute, University College London, London, UK
- and ENT Department, Homerton Healthcare NHS Foundation Trust, London, UK
| | - A Macchi
- ENT Clinic, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - P P Mazal
- Servicio de Otorrinolaringología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - I Miri
- Service Médecine Physique Réadaptation fonctionnelle, Institut Mohamed Kassab d'Orthopédie, Mannouba, Tunisia
| | - T Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinada, Kahoku, Ishikawa, Japan
| | - E Mori
- Department of Otorhinolaryngology, Jikei University, School of Medicine, Tokyo, Japan
| | - J Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, Universitat de Barcelona
- IDIBAPS
- CIBERES. Barcelona, Catalonia, Spain
| | - C A Mueller
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - G Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University, Padua, Italy
| | - Z M Patel
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK
- and The Smell and Taste Clinic, James Paget University Hospital, Gorleston, UK
| | - J M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - V R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Indiana University of School Medicine, Indianapolis, IN, USA
| | - Y Roth
- The Institute for Nose and Sinus Therapy and Clinical Investigations, Department of Otolaryngology - Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - R J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - P Stjärne
- Section of Rhinology, Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - L Van Gerven
- Department of Otorhinolaryngology, UZ Leuven, Belgium
- and Department of Neurosciences, Experimental Otorhinolaryngology, KU Leuven, Belgium
- and Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Belgium
| | - J Vodicka
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Pardubice, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - A Welge-Luessen
- University Hospital Basel - Otorhinolaryngology, Basel, Switzerland
| | - P J Wormald
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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5
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Chiesa R, Georgiadis C, Syed F, Zhan H, Etuk A, Gkazi SA, Preece R, Ottaviano G, Braybrook T, Chu J, Kubat A, Adams S, Thomas R, Gilmour K, O'Connor D, Vora A, Qasim W. Base-Edited CAR7 T Cells for Relapsed T-Cell Acute Lymphoblastic Leukemia. N Engl J Med 2023; 389:899-910. [PMID: 37314354 DOI: 10.1056/nejmoa2300709] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cytidine deamination that is guided by clustered regularly interspaced short palindromic repeats (CRISPR) can mediate a highly precise conversion of one nucleotide into another - specifically, cytosine to thymine - without generating breaks in DNA. Thus, genes can be base-edited and rendered inactive without inducing translocations and other chromosomal aberrations. The use of this technique in patients with relapsed childhood T-cell leukemia is being investigated. METHODS We used base editing to generate universal, off-the-shelf chimeric antigen receptor (CAR) T cells. Healthy volunteer donor T cells were transduced with the use of a lentivirus to express a CAR with specificity for CD7 (CAR7), a protein that is expressed in T-cell acute lymphoblastic leukemia (ALL). We then used base editing to inactivate three genes encoding CD52 and CD7 receptors and the β chain of the αβ T-cell receptor to evade lymphodepleting serotherapy, CAR7 T-cell fratricide, and graft-versus-host disease, respectively. We investigated the safety of these edited cells in three children with relapsed leukemia. RESULTS The first patient, a 13-year-old girl who had relapsed T-cell ALL after allogeneic stem-cell transplantation, had molecular remission within 28 days after infusion of a single dose of base-edited CAR7 (BE-CAR7). She then received a reduced-intensity (nonmyeloablative) allogeneic stem-cell transplant from her original donor, with successful immunologic reconstitution and ongoing leukemic remission. BE-CAR7 cells from the same bank showed potent activity in two other patients, and although fatal fungal complications developed in one patient, the other patient underwent allogeneic stem-cell transplantation while in remission. Serious adverse events included cytokine release syndrome, multilineage cytopenia, and opportunistic infections. CONCLUSIONS The interim results of this phase 1 study support further investigation of base-edited T cells for patients with relapsed leukemia and indicate the anticipated risks of immunotherapy-related complications. (Funded by the Medical Research Council and others; ISRCTN number, ISRCTN15323014.).
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Affiliation(s)
- Robert Chiesa
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Christos Georgiadis
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Farhatullah Syed
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Hong Zhan
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Annie Etuk
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Soragia Athina Gkazi
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Roland Preece
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Giorgio Ottaviano
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Toni Braybrook
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Jan Chu
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Agnieszka Kubat
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Stuart Adams
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Rebecca Thomas
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Kimberly Gilmour
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - David O'Connor
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Ajay Vora
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Waseem Qasim
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
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Ottaviano G, Georgiadis C, Gkazi SA, Syed F, Zhan H, Etuk A, Preece R, Chu J, Kubat A, Adams S, Veys P, Vora A, Rao K, Qasim W. Phase 1 clinical trial of CRISPR-engineered CAR19 universal T cells for treatment of children with refractory B cell leukemia. Sci Transl Med 2022; 14:eabq3010. [PMID: 36288281 DOI: 10.1126/scitranslmed.abq3010] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Genome editing of allogeneic T cells can provide "off-the-shelf" alternatives to autologous chimeric antigen receptor (CAR) T cell therapies. Disruption of T cell receptor α chain (TRAC) to prevent graft-versus-host disease (GVHD) and removal of CD52 (cluster of differentiation 52) for a survival advantage in the presence of alemtuzumab have previously been investigated using transcription activator-like effector nuclease (TALEN)-mediated knockout. Here, we deployed next-generation CRISPR-Cas9 editing and linked CAR expression to multiplexed DNA editing of TRAC and CD52 through incorporation of self-duplicating CRISPR guide RNA expression cassettes within the 3' long terminal repeat of a CAR19 lentiviral vector. Three cell banks of TT52CAR19 T cells were generated and cryopreserved. A phase 1, open-label, non-randomized clinical trial was conducted and treated six children with relapsed/refractory CD19-positive B cell acute lymphoblastic leukemia (B-ALL) (NCT04557436). Lymphodepletion included fludarabine, cyclophosphamide, and alemtuzumab and was followed by a single infusion of 0.8 × 106 to 2.0 × 106 CAR19 T cells per kilogram with no immediate toxicities. Four of six patients infused with TT52CAR19 T cells exhibited cell expansion, achieved flow cytometric remission, and then proceeded to receive allogeneic stem cell transplantation. Two patients required biological intervention for grade II cytokine release syndrome, one patient developed transient grade IV neurotoxicity, and one patient developed skin GVHD, which resolved after transplant conditioning. Other complications were within expectations, and primary safety objectives were met. This study provides a demonstration of the feasibility, safety, and therapeutic potential of CRISPR-engineered immunotherapy.
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MESH Headings
- Child
- Humans
- Alemtuzumab
- Antigens, CD19/metabolism
- Cyclophosphamide
- Graft vs Host Disease/metabolism
- Immunotherapy, Adoptive
- Leukemia, B-Cell
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/metabolism
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Receptors, Chimeric Antigen/metabolism
- RNA, Guide, CRISPR-Cas Systems/metabolism
- T-Lymphocytes
- Transcription Activator-Like Effector Nucleases/genetics
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Affiliation(s)
- Giorgio Ottaviano
- Great Ormond Street Hospital for Children NHS Trust, WC1N 3JH London, UK
- UCL Great Ormond Street Institute of Child Health, WC1N 1DZ London, UK
| | | | | | - Farhatullah Syed
- UCL Great Ormond Street Institute of Child Health, WC1N 1DZ London, UK
| | - Hong Zhan
- UCL Great Ormond Street Institute of Child Health, WC1N 1DZ London, UK
| | - Annie Etuk
- UCL Great Ormond Street Institute of Child Health, WC1N 1DZ London, UK
| | - Roland Preece
- UCL Great Ormond Street Institute of Child Health, WC1N 1DZ London, UK
| | - Jan Chu
- Great Ormond Street Hospital for Children NHS Trust, WC1N 3JH London, UK
| | - Agnieszka Kubat
- UCL Great Ormond Street Institute of Child Health, WC1N 1DZ London, UK
| | - Stuart Adams
- Great Ormond Street Hospital for Children NHS Trust, WC1N 3JH London, UK
| | - Paul Veys
- Great Ormond Street Hospital for Children NHS Trust, WC1N 3JH London, UK
| | - Ajay Vora
- Great Ormond Street Hospital for Children NHS Trust, WC1N 3JH London, UK
| | - Kanchan Rao
- Great Ormond Street Hospital for Children NHS Trust, WC1N 3JH London, UK
| | - Waseem Qasim
- Great Ormond Street Hospital for Children NHS Trust, WC1N 3JH London, UK
- UCL Great Ormond Street Institute of Child Health, WC1N 1DZ London, UK
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7
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Ottaviano G, Sgrulletti M, Moschese V. Secondary rituximab-associated versus primary immunodeficiencies: The enigmatic border. Eur J Immunol 2022; 52:1572-1580. [PMID: 35892275 DOI: 10.1002/eji.202149667] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/22/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022]
Abstract
Rituximab (RTX), a chimeric monoclonal antibody targeting CD20-positive cells, is a valuable treatment option for malignant and benign immune-related disorders. The rationale of targeting the CD20 antigen relies on depletion of both healthy and autoreactive/malignant CD20-espressing cells, but normal B-cell reconstitution is expected within months after treatment. Nevertheless, a number of recent studies have documented prolonged B-cell deficiency associated with new-onset hypogammaglobulinemia in patients receiving RTX. Awareness of post-RTX hypogammaglobulinemia has become wider among clinicians, with a growing number of reports about the increased incidence, especially in children. Although these patients were previously regarded as affected by secondary/iatrogenic immunodeficiency, atypical clinical and immunological manifestations (e.g., severe or opportunistic infections; prolonged B-cell aplasia) raise concerns of delayed manifestations of genetic immunological disorders that have been unveiled by B-cell perturbation. As more patients with undiagnosed primary immune deficiency receiving RTX have been identified, it remains the challenge in discerning those that might display a higher risk of persistent RTX-associated hypogammaglobulinemia and need a tailored immunology follow-up. In this review, we summarize the principal evidence regarding post-RTX hypogammaglobulinemia and provide a guideline for identifying patients at higher risk of RTX-associated hypogammaglobulinemia that could harbor an inborn error of immunity.
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Affiliation(s)
- Giorgio Ottaviano
- Molecular and Cellular Immunology Unit, UCL Institute of Child Health, London, UK
| | - Mayla Sgrulletti
- Pediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy.,PhD. Program in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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Ottaviano G, Qasim W. Genome-Edited T Cell Therapies. Hematol Oncol Clin North Am 2022; 36:729-744. [PMID: 35773047 DOI: 10.1016/j.hoc.2022.03.006] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Chimeric antigen receptor (CAR) T-cells are widely being investigated against malignancies, and allogeneic 'universal donor' CAR-T cells offer the possibility of widened access to pre-manufactured, off-the-shelf therapies. Different genome-editing platforms have been used to address human leukocyte antigen (HLA) barriers to generate universal CAR-T cell therapy and early applications have been reported in children and adults against B cell malignancies. Recently developed Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-based systems and related technologies offer the prospect of enhanced cellular immunotherapies for a wider range of hematological malignancies.
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Affiliation(s)
- Giorgio Ottaviano
- Infection, Immunity & Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Waseem Qasim
- Infection, Immunity & Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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Martire B, Ottaviano G, Sangerardi M, Sgrulletti M, Chini L, Dellepiane RM, Montin D, Rizzo C, Pignata C, Marseglia GL, Moschese V. Vaccinations in Children and Adolescents Treated With Immune-Modifying Biologics: Update and Current Developments. J Allergy Clin Immunol Pract 2022; 10:1485-1496. [PMID: 35085809 DOI: 10.1016/j.jaip.2022.01.007] [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] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Treatment with immune-modifying biologics has positively impacted disease control and quality of life in many patients with immune-mediated disorders. However, the higher susceptibility to common and opportunistic pathogens is of concern. Thus, immunization strategies to control vaccine-preventable diseases represent a critical issue in this population. However, limited data exist on the safety, immunogenicity, and efficacy of available vaccines in patients on biologics, particularly in children. Here, according to published literature and real-life experience and practice, we report the interim indications of the Italian Society of Pediatric Allergology and Immunology (SIAIP) Vaccine Committee and of the Italian Primary Immunodeficiency Network (IPINet) Centers on immunization of children and adolescents receiving biologics. Our aim is to provide a practical guidance for the clinician to ensure optimal protection for patients and the community.
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Affiliation(s)
- Baldassarre Martire
- Pediatrics and Neonatology Unit, Maternal-Infant Department, Monsignor A. R. Dimiccoli Hospital, Barletta, Italy.
| | - Giorgio Ottaviano
- Molecular and Cellular Immunology Unit, Great Ormond Street Institute of Child Health, University College of London, London, UK
| | - Maria Sangerardi
- Department of Pediatrics and Emergency, Pediatric Hospital, Policlinico - University of Bari, Bari, Italy
| | - Mayla Sgrulletti
- Pediatric Immunopathology and Allergology Unit, University of Rome, Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Loredana Chini
- Pediatric Immunopathology and Allergology Unit, University of Rome, Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Care Unit, Scientific Institute for Research, Hospitalization and Healthcare Foundation (IRCSS); Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Montin
- Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Caterina Rizzo
- Innovation and Clinical Pathways Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Claudio Pignata
- Department of Translational Medical Sciences-Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, IRCCS Foundation, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, University of Rome, Tor Vergata, Policlinico Tor Vergata, Rome, Italy
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Montin D, Ottaviano G, Sangerardi M, Sgrulletti M, Chini L, Dellepiane RM, Martire B, Rizzo C, Moschese V. Novel artful applications of vaccines at the horizon. Pediatr Allergy Immunol 2022; 33 Suppl 27:83-85. [PMID: 35080298 PMCID: PMC9543439 DOI: 10.1111/pai.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Abstract
Some live vaccines, particularly Bacillus Calmette-Guérin (BCG), oral polio vaccine (OPV), and measles vaccine, can reduce the incidence of all-cause mortality by outreaching the mere control of specific infections and exerting off-target effects. Asides from the prevention of viral infection, some other vaccines, such as those against flu or rotavirus, could reduce the risk of developing autoimmunity. The nonspecific effects of vaccines are mediated by the innate immune system, mainly through the so-called trained innate immunity. These observations paved the way for developing tolerogenic and trained immunity-based vaccines with substantial implications for more effective use of vaccines and combat vaccine hesitancy.
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Affiliation(s)
- Davide Montin
- Immunology and Rheumatology Unit, Regina Margherita Children Hospital, Turin, Italy
| | - Giorgio Ottaviano
- Molecular and Cellular Immunology Unit, Great Ormond Street Institute of Child Health, University College of London, London, United Kingdom
| | - Maria Sangerardi
- Department of Pediatrics and Emergency, Azienda Ospedaliero Universitaria Consorziale Policlinico, Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Mayla Sgrulletti
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy.,PhD Program in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Loredana Chini
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Baldassarre Martire
- Pediatrics and Neonatology Unit, Maternal-Infant Department, Monsignor A.R. Dimiccoli Hospital, Barletta, Italy
| | - Caterina Rizzo
- Innovation and Clinical Pathways Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
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11
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Napolitano S, Ottaviano G, Bettini L, Russotto V, Bonanomi S, Rovelli A, Biondi A, Rona R, Balduzzi A. Cytokine release syndrome after CAR infusion in pediatric patients with refractory/relapsed B-ALL: is there a role for diclofenac? Tumori 2021; 108:556-562. [PMID: 34674588 DOI: 10.1177/03008916211053382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cytokine release syndrome (CRS) is a major complication after chimeric-antigen receptor T-cell treatment, characterized by an uncontrolled systemic inflammatory reaction. We investigated the potential role of diclofenac in the management of CRS in five pediatric patients treated for relapsed/refractory B-lineage acute lymphoblastic leukemia. METHODS In case of persistent fever with fever-free intervals shorter than 3 hours, diclofenac continuous infusion was initiated, at the starting dose of 0.5 mg/Kg/day, the lowest effective pediatric dose in our experience, possibly escalated up to 1 mg/Kg/day, as per institutional guidelines. RESULTS CRS occurred at a median of 20 hours (range 8-27) after tisagenlecleucel infusion. Diclofenac was started at a median of 20 hours (range 13-33) after fever onset. A mean of 3.07 febrile peaks without diclofenac and 0.95 with diclofenac were reported (p = 0.02). Clinical benefit was achieved by hampering the progression of tachypnea and tachycardia. Despite fever control, CRS progressed in four of the five patients, and hypotension requiring vasopressors and fluid retention, as well as hypoxia, occurred. Vasopressors were followed by 1-2 doses of tocilizumab (one in patient 2 and two in patients 3, 4, and 5), plus steroids in patients 4 and 5. CONCLUSION Based on a limited number of patients, diclofenac leads to better fever control, which translates into symptom relief and improvement of tachycardia, but could not prevent the progression of CRS.
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Affiliation(s)
- Sara Napolitano
- Hematology-Oncology and Bone Marrow Transplantation Unit, Pediatric Department, and Monza and Brianza Foundation for Children and their Mums, San Gerardo Hospital, Lombardia, Monza, Italy
| | - Giorgio Ottaviano
- Molecular and Cellular Immunology Unit, University College of London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Laura Bettini
- Tettamanti Laboratory, Monza and Brianza Foundation for Children and their Mums, Monza, Lombardia, Italy
| | - Vincenzo Russotto
- Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Sonia Bonanomi
- Hematology-Oncology and Bone Marrow Transplantation Unit, Pediatric Department, and Monza and Brianza Foundation for Children and their Mums, San Gerardo Hospital, Lombardia, Monza, Italy
| | - Attilio Rovelli
- Hematology-Oncology and Bone Marrow Transplantation Unit, Pediatric Department, and Monza and Brianza Foundation for Children and their Mums, San Gerardo Hospital, Lombardia, Monza, Italy
| | - Andrea Biondi
- Hematology-Oncology and Bone Marrow Transplantation Unit, Pediatric Department, and Monza and Brianza Foundation for Children and their Mums, San Gerardo Hospital, Lombardia, Monza, Italy.,University of Milan-Bicocca, Monza, Italy
| | - Roberto Rona
- Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Adriana Balduzzi
- Hematology-Oncology and Bone Marrow Transplantation Unit, Pediatric Department, and Monza and Brianza Foundation for Children and their Mums, San Gerardo Hospital, Lombardia, Monza, Italy.,University of Milan-Bicocca, Monza, Italy
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Ottaviano G, Achini-Gutzwiller F, Kalwak K, Lanino E, Faraci M, Rao K, Chiesa R, Amrolia P, Bonanomi S, Rovelli A, Veys P, Lankester A, Balduzzi A, Lucchini G. Impact of in Vivo Lymphodepletion on Outcome in Children with Nonmalignant Disorders Receiving Peripheral Blood Stem Cell Transplantation. Transplant Cell Ther 2021; 27:1020.e1-1020.e5. [PMID: 34450334 DOI: 10.1016/j.jtct.2021.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/22/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
Peripheral blood stem cell transplantation (PBSCT) with in vivo lymphodepletion can provide faster neutrophil recovery with limited risk of severe graft-versus-host disease (GVHD) in children with nonmalignant disorders (NMDs). We aimed to provide an historical comparison of these 2 strategies regarding the prevalence of GVHD, viral reactivation, timing of immune reconstitution, and final outcomes. Data on 98 children undergoing PBSCT were collected from 5 European pediatric transplantation centers. Only patients with NMDs receiving treosulfan or myeloablative busulfan conditioning and 9-10/10 HLA-matched transplant were included. The patients were divided into 2 groups according to in vivo lymphodepletion with antithymocyte globulin (ATG) or with alemtuzumab. We compared rates of acute and chronic GVHD; Epstein-Barr virus, cytomegalovirus, and adenovirus reactivation; chimerism; lymphocyte recovery; overall survival (OS) and event-free survival (EFS) between the 2 groups. The rate of severe acute GVHD (grade III-IV) was significantly higher in patients receiving ATG (26% vs 10% in alemtuzumab recipients; P < .05), whereas viral reactivations occurred with a similar rate in the 2 groups (alemtuzumab, 56%; ATG, 57%). Alemtuzumab was the major risk factor for delayed T cell immune reconstitution in the first 3 months after transplantation (odds ratio [OR], 6.0; 95% confidence interval [CI], 1.8 to 19; P < .005). Extended chronic GVHD, ADV reactivation, slower CD3+ cell recovery, and HLA-mismatch reduced the probability of survival. Infections were the main cause of mortality in our cohort, and delayed T cell recovery was significantly associated with mortality in multivariate analysis (OR, 12; 95% CI, 1.2 to 114; P < .05). Ultimately, no differences in OS and EFS survival were seen between the ATG and alemtuzumab groups. ATG and alemtuzumab showed similar impacts on outcomes of children undergoing PBSCT for NMDs. The 2 strategies of in vivo lymphodepletion showed specific drawbacks that were counterbalanced by benefits that ultimately led to a comparable survival rate. A patient-centered lymphodepletion strategy can be advised in children undergoing PBSCT for NMDs, by favoring T cell recovery in the presence of invasive infection or GVHD prevention in high-risk mismatched donor transplantation.
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Affiliation(s)
- Giorgio Ottaviano
- Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Federica Achini-Gutzwiller
- Department of Pediatrics, Stem Cell Transplantation Program, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands; Division of Pediatric Stem Cell Transplantation and Children's Research Center (CRC), University Children's Hospital of Zurich, Zurich, Switzerland
| | - Krzysztof Kalwak
- Department and Clinic of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Edoardo Lanino
- Istituto G. Gaslini, Hematopoietic Stem Cell Transplantation Unit- Hematology-Oncology, Genova, Italy
| | - Maura Faraci
- Istituto G. Gaslini, Hematopoietic Stem Cell Transplantation Unit- Hematology-Oncology, Genova, Italy
| | - Kanchan Rao
- Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Robert Chiesa
- Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Persis Amrolia
- Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Sonia Bonanomi
- Clinica Pediatrica, Università degli studi di Milano-Bicocca, Ospedale San Gerardo/Fondazione MBBM, Monza, Italy
| | - Attilio Rovelli
- Clinica Pediatrica, Università degli studi di Milano-Bicocca, Ospedale San Gerardo/Fondazione MBBM, Monza, Italy
| | - Paul Veys
- Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Arjan Lankester
- Department of Pediatrics, Stem Cell Transplantation Program, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Adriana Balduzzi
- Clinica Pediatrica, Università degli studi di Milano-Bicocca, Ospedale San Gerardo/Fondazione MBBM, Monza, Italy
| | - Giovanna Lucchini
- Bone Marrow Transplant Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Ottaviano G, Pendolino AL, Nardello E, Pollis M, Scarpa B, Marchese-Ragona R. The role of peak nasal and oral inspiratory flow in the evaluation of patients with sleep-related breathing disorders. Rhinology 2021; 58:465-470. [PMID: 32291418 DOI: 10.4193/rhin19.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sleep-related breathing disorders (SRBD) are common reported disorders in the adult population. The nose plays an important role in the development of SRBD; thus, the measurement of nasal respiratory function remains an important step in the management of these patients. Peak nasal inspiratory flow (PNIF) is a useful tool to assess nasal airflow and it has recently been studied together with peak oral inspiratory flow (POIF). OBJECTIVE The aim of the present study was to evaluate the role of PNIF and POIF in an adult population of patients affected by SRBD. METHODOLOGY Seventy consecutive adult patients with SRBD were included in the present study. All patients were evaluated with home-based sleep studies (type III), PNIF, POIF, SNOT-22 questionnaire, Epworth Sleepiness Scale test and VAS for nasal obstruction. RESULTS Although PNIF and POIF showed to correlate with each other, no correlations were observed between Apnea Hypopnea index (AHI) and PNIF, POIF or NPI (PNIF/POIF). A further analysis showed a marginal correlation between SNOT- 22 and AHI and between SNOT-22 and POIF. Furthermore, in a multivariate analysis, also POIF marginally correlated with some of the sleep- related SNOT-22 items. CONCLUSIONS In the present study neither PNIF nor POIF were found to be associated with OSAS severity. However, POIF values correlated better than PNIF with sleep related symptoms suggesting that POIF could be a more useful parameter for upper airway assessment in patients with SRBD. In addition, a correlation between OSAS severity, in terms of AHI, and SNOT-22 total score has been reported.
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Affiliation(s)
- G Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - A L Pendolino
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - E Nardello
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - M Pollis
- Department of Neurosciences DNS, Odontostomatology Institute, University of Padova, Padova, Italy
| | - B Scarpa
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - R Marchese-Ragona
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy
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14
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Ottaviano G, Baird S, Bonney D, Connor P, Cummins M, Evans P, Gibson B, Hough R, Ingham D, Kelly A, Qureshi A, Lancaster D, Moppett J, Norton A, Payne J, Stockley S, Ghorashian S, Amrolia P, Qasim W, Vora A. The role of immunotherapy in relapse/refractory precursor-B acute lymphoblastic leukaemia: real-life UK/Ireland experience in children and young adults. Br J Haematol 2020; 192:e42-e44. [PMID: 33216967 DOI: 10.1111/bjh.17198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Susan Baird
- Royal Hospital for Sick Children, Edinburgh, UK
| | - Denise Bonney
- Royal Manchester Children's Hospital, Manchester, UK
| | - Philip Connor
- The Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | | | - Pamela Evans
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | | | | | | | | - Waseem Qasim
- Great Ormond Street Hospital for Children, London, UK
| | - Ajay Vora
- Great Ormond Street Hospital for Children, London, UK
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15
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Sgrulletti M, Ottaviano G, Sangerardi M, Chini L, Dellepiane RM, Martire B, Montin D, Rizzo C, Moschese V. One step closer to influenza vaccine inclusiveness. Pediatr Allergy Immunol 2020; 31 Suppl 26:69-71. [PMID: 33236432 PMCID: PMC7753274 DOI: 10.1111/pai.13338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
Abstract
Flu virus infection is a common cause of acute respiratory illness, with the major incidence in pediatric age, high morbidity, and mortality. The flu vaccine is recommended for all people aged ≥6 months, unless specific contraindications are present. Younger and older age, pregnancy, chronic diseases like asthma, and immunodeficiency are risk factors for severe complications following flu infection. Thus, these categories represent the target for flu vaccine strategies in most countries. Inactivated influenza vaccine (IIV), recombinant influenza vaccine (RIV) or live-attenuated influenza virus (LAIV) are currently available, with specific precautions and contraindications. We aim to resume the current indications for vaccines in the vulnerable populations to support flu vaccination inclusiveness, in anticipation of a "universal vaccine" strategy.
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Affiliation(s)
- Mayla Sgrulletti
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Giorgio Ottaviano
- Molecular and Cellular Immunology Unit, Great Ormond Street Institute of Child Health, University College of London, London, UK
| | - Maria Sangerardi
- Department of Pediatrics and Emergency, Azienda Ospedaliero Universitaria Consorziale Policlinico, Ospedale Pediatrico "Giovanni XXIII", Bari, Italy
| | - Loredana Chini
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Baldassarre Martire
- Pediatrics and Neonatology Unit, Maternal-Infant Department, "Monsignor A.R. Dimiccoli" Hospital, Barletta, Italy
| | - Davide Montin
- Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Caterina Rizzo
- Innovation and Clinical Pathways Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
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16
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Ottaviano G, Carecchio M, Scarpa B, Marchese-Ragona R. Olfactory and rhinological evaluations in SARS-CoV-2 patients complaining of olfactory loss. Rhinology 2020; 58:400-401. [PMID: 32338254 DOI: 10.4193/rhin20.136] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since December 2019, a novel coronavirus SARS-CoV-2 (Covid-19) outbreak emerged in China and spread rapidly in several countries. As of April 5, 2020, 1.218.474 cases were confirmed with 65.884 deaths worldwide (1). The clinical manifestations of Covid-19 range from asymptomatic carrier status to severe pneumonia. In a study of 7,736 Covid-19 patients in China, of all the clinical symptoms, hyposmia was not reported in any patient(2). Anyway, it is now clear that olfactory dysfunction may also be present in these patients(3) as the only or prevalent manifestation(4).
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Affiliation(s)
- G Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - M Carecchio
- Department of Neurosciences, Neurological Section, University of Padova, Padova, Italy
| | - B Scarpa
- Department of Statistical Sciences and Department of Mathematics Tullie Levi-Cijita, University of Padova, Padova, Italy
| | - R Marchese-Ragona
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
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17
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Ottaviano G, Lucchini G, Breuer J, Furtado-Silva JM, Lazareva A, Ciocarlie O, Elfeky R, Rao K, Amrolia PJ, Veys P, Chiesa R. Delaying haematopoietic stem cell transplantation in children with viral respiratory infections reduces transplant-related mortality. Br J Haematol 2019; 188:560-569. [PMID: 31566733 PMCID: PMC7161889 DOI: 10.1111/bjh.16216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/31/2019] [Indexed: 01/05/2023]
Abstract
Viral respiratory infections (VRIs) contribute to the morbidity and transplant‐related mortality (TRM) after allogeneic haematopoietic stem cell transplantation (HSCT) and strategies to prevent and treat VRIs are warranted. We monitored VRIs before and after transplant in children undergoing allogeneic HSCT with nasopharyngeal aspirates (NPA) and assessed the impact on clinical outcome. Between 2007 and 2017, 585 children underwent 620 allogeneic HSCT procedures. Out of 75 patients with a positive NPA screen (12%), transplant was delayed in 25 cases (33%), while 53 children started conditioning with a VRI. Patients undergoing HSCT with a positive NPA screen had a significantly lower overall survival (54% vs. 79%) and increased TRM (26% vs. 7%) compared to patients with a negative NPA. Patients with a positive NPA who delayed transplant and cleared the virus before conditioning had improved overall survival (90%) and lower TRM (5%). Pre‐HSCT positive NPA was the only significant risk factor for progression to a lower respiratory tract infection and was a major risk factor for TRM. Transplant delay, whenever feasible, in case of a positive NPA screen for VRIs can positively impact on survival of children undergoing HSCT.
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Affiliation(s)
- Giorgio Ottaviano
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Paediatrics, University of Milano-Bicocca, San Gerardo Hospital/Fondazione MBBM, Monza, Italy
| | - Giovanna Lucchini
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Judith Breuer
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Division of Infection and Immunity, University College London, London, UK
| | - Juliana M Furtado-Silva
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Arina Lazareva
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Oana Ciocarlie
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Reem Elfeky
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kanchan Rao
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Persis J Amrolia
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paul Veys
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Robert Chiesa
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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18
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Ottaviano G, Marinoni M, Graziani S, Sibson K, Barzaghi F, Bertolini P, Chini L, Corti P, Cancrini C, D'Alba I, Gabelli M, Gallo V, Giancotta C, Giordano P, Lassandro G, Martire B, Angarano R, Mastrodicasa E, Bava C, Miano M, Naviglio S, Verzegnassi F, Saracco P, Trizzino A, Biondi A, Pignata C, Moschese V. Rituximab Unveils Hypogammaglobulinemia and Immunodeficiency in Children with Autoimmune Cytopenia. J Allergy Clin Immunol Pract 2019; 8:273-282. [PMID: 31377437 DOI: 10.1016/j.jaip.2019.07.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Rituximab (RTX; anti-CD20 mAb) is a treatment option in children with refractory immune thrombocytopenia, autoimmune hemolytic anemia (AHA), and Evans syndrome (ES). Prevalence and clinical course of RTX-induced hypogammaglobulinemia in these patients are poorly known. OBJECTIVE To evaluate the prevalence and risk factors for persistent hypogammaglobulinemia (PH) after RTX use. METHODS Clinical and immunologic data from children treated with RTX for immune thrombocytopenia, AHA, and ES were collected from 16 Italian centers and 1 UK center at pre-RTX time point (0), +6 months, and yearly, up to 4 years post-RTX. Patients with previously diagnosed malignancy or primary immune deficiency (PID) were excluded. RESULTS We analyzed 53 children treated with RTX for immune thrombocytopenia (n = 36), AHA (n = 13), and ES (n = 4). Median follow-up was 30 months (range, 12-48). Thirty-two percent of patients (17 of 53) experienced PH, defined as IgG levels less than 2 SD for age at last follow-up (>12 months after RTX). Significantly delayed B-cell recovery was observed in children experiencing PH (hazard ratio, 0.55; P < .05), and 6 of 17 (35%) patients had unresolved B-cell lymphopenia at last follow-up. PH was associated with IgA and IgM deficiency, younger age at RTX use (51 vs 116 months; P < .01), a diagnosis of AHA/ES, and better response to RTX. Nine patients with PH (9 of 17 [53%]) were eventually diagnosed with a PID. CONCLUSIONS Post-RTX PH is a frequent condition in children with autoimmune cytopenia; a sizable proportion of patients with post-RTX PH were eventually diagnosed with a PID. In-depth investigation for PID is therefore recommended in these patients.
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Affiliation(s)
| | - Maddalena Marinoni
- Paediatric Department, ASST-Sette Laghi, "F. Del Ponte" Hospital, Varese, Italy
| | - Simona Graziani
- Paediatric Immunopathology and Allergology Unit, Tor Vergata University Hospital, University of Roma Tor Vergata, Rome, Italy
| | - Keith Sibson
- Department of Haematology, Great Ormond Street Hospital, London, United Kingdom
| | - Federica Barzaghi
- Paediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Bertolini
- Paediatric Hematology Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Loredana Chini
- Paediatric Immunopathology and Allergology Unit, Tor Vergata University Hospital, University of Roma Tor Vergata, Rome, Italy
| | - Paola Corti
- Paediatric Haematology, Fondazione MBBM, Monza, Italy
| | - Caterina Cancrini
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Childrens' Hospital Bambino Gesù, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Irene D'Alba
- Paediatric Haematology-Oncology, Maternal Infant Hospital "G. Salesi", Ancona, Italy
| | - Maria Gabelli
- Department of Women's and Children's Health, Pediatric Onco-Hematology Unit, University of Padova, Padova, Italy
| | - Vera Gallo
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Carmela Giancotta
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Childrens' Hospital Bambino Gesù, Rome, Italy
| | - Paola Giordano
- Department of Biomedical Sciences and Human Oncology, University "A. Moro", Bari, Italy
| | - Giuseppe Lassandro
- Department of Biomedical Sciences and Human Oncology, University "A. Moro", Bari, Italy
| | - Baldassare Martire
- Paediatric Hematology Oncology Unit, "Policlinico-Giovanni XXII" Hospital, University of Bari, Bari, Italy
| | - Rosa Angarano
- Paediatric Hematology Oncology Unit, "Policlinico-Giovanni XXII" Hospital, University of Bari, Bari, Italy
| | | | - Cecilia Bava
- Haematology Unit, IRCCS Istituto "G. Gaslini", Genova, Italy
| | - Maurizio Miano
- Haematology Unit, IRCCS Istituto "G. Gaslini", Genova, Italy
| | - Samuele Naviglio
- Pediatric Hematology-Oncology, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Federico Verzegnassi
- Pediatric Hematology-Oncology, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Paola Saracco
- Paediatric Haematology, Department of Paediatrics, University Hospital Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonino Trizzino
- Department of Pediatric Hematology and Oncology, ARNAS Civico Di Cristina and Benfratelli Hospital, Palermo, Italy
| | - Andrea Biondi
- Paediatric Haematology, Milano-Bicocca University, Monza, Italy
| | - Claudio Pignata
- Department of Women's and Children's Health, Pediatric Onco-Hematology Unit, University of Padova, Padova, Italy
| | - Viviana Moschese
- Paediatric Immunopathology and Allergology Unit, Tor Vergata University Hospital, University of Roma Tor Vergata, Rome, Italy
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19
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Rimmer J, Hellings P, Lund VJ, Alobid I, Beale T, Dassi C, Douglas R, Hopkins C, Klimek L, Landis B, Mosges R, Ottaviano G, Psaltis A, Surda P, Tomazic PV, Vent J, Fokkens W. European position paper on diagnostic tools in rhinology. Rhinology 2019; 57:1-41. [PMID: 31376816 DOI: 10.4193/rhin19.410] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The accurate diagnosis of rhinologic disease depends on the clinical history, examination findings and, in many cases, further investigations. There are a wide variety of diagnostic tests available, the choice of which depends upon the condition being assessed. This position paper is intended to provide an up-to-date comprehensive description of the diagnostic tools available to rhinologists, allergists, general otolaryngologists and other physicians with an interest in sinonasal disease. The literature has been reviewed and evidence-based recommendations are included. The relevant history and examination techniques are described, including endoscopic assessment of the nose. General and disease-specific quality of life instruments are an important tool in assessing the impact of rhinologic disease and the response to treatment. Relevant blood tests are discussed, as well as the various methods of allergy testing. Techniques for collecting microbiological and tissue samples are described, as well as the use of more specialised tests such as nasal nitric oxide and those evaluating ciliary structure and function. Imaging techniques and their indications are included. Chemosensory (smell and taste) testing is explained, and the available techniques for objective measurement of nasal airflow and patency are reviewed. Prompt and accurate diagnosis allows appropriate management to be initiated; an understanding of the currently available diagnostic tools is a vital part of the assessment of rhinologic disease.
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Affiliation(s)
- J Rimmer
- Department of Otolaryngology Head and Neck Surgery, Monash Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - P Hellings
- Upper Airways Research Laboratory and ENT Department, University Hospital Ghent, Ghent, Belgium.,Department of Otorhinolaryngology - Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Otorhinolaryngology, Amsterd
| | - V J Lund
- Royal National Throat Nose and Ear Hospital, University College London Hospitals, London, UK
| | - I Alobid
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic de Barcelona, Universidad de Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - T Beale
- University College London Hospitals Foundation Trust, London, UK
| | - C Dassi
- Department of Otolaryngology, Auckland City Hospital, Auckland, New Zealand
| | - R Douglas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - C Hopkins
- Ear, Nose and Throat Department, Guys and St. Thomas' Hospital, London, UK
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - B Landis
- Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland
| | - R Mosges
- Institute of Medical Statistics, Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany.,ClinNovis GmbH, Cologne, Germany
| | - G Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - A Psaltis
- Department of Otolaryngology Head and Neck Surgery, University of Adelaide and Queen Elizabeth Hospital, Adelaide, South Australia
| | - P Surda
- Ear, Nose and Throat Department, Guys and St. Thomas' Hospital, London, UK
| | - P V Tomazic
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - J Vent
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Cologne, Cologne Germany.,Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - W Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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20
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Ottaviano G, Savietto E, Scarpa B, Bertocco A, Maculan P, Sergi G, Martini A, Manzato E, Marioni G. Influence of number of drugs on olfaction in the elderly. Rhinology 2019; 56:351-357. [PMID: 29938715 DOI: 10.4193/rhin17.152] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The etiology of age-related olfactory loss is still unclear, but it has been claimed that polypharmacotherapy may contribute to olfactory dysfunction, particularly in the elderly, who are more likely to need multiple drugs. The present pilot study investigated the relationship between smell and the number and type of drugs taken in a group of elderly. METHODOLOGY 50 elderly volunteers (over 64 years old) who were healthy from the sinonasal standpoint (SNOT-22 under 1) and had no cognitive impairments [Mini Mental State Examination (MMSE over 18) were administered the Screening 12 test and tested on their n-butanol olfactory threshold. Their olfactory performance was then connected with the number and type of drugs participants used. RESULTS The mean age of the included volunteers was 74 plus/minus 7 years. No association emerged between odor identification and number of drugs taken. The number of drugs taken correlated directly with a worse olfactory threshold and with a worse MMSE score, meaning a worse cognitive status. Odor identification significantly worsened with age. Comparing those volunteers taking only one drug known to not influence olfaction with another sub-group of volunteers taking five or more drugs, it was evident that subjects taking only one drug scored significantly better in olfactory threshold test and MMSE, and marginally better in olfactory identification test. For what concerns the difference between male and female volunteers, no difference in olfactory test result was shown, both for threshold and identification. Univariate analysis showed a direct correlation between the consumption of calcium channel blockers, beta-blockers, acetylsalicylic acid and olfactory threshold, meaning a worse sense of smell. Acetylsalicylic acid also correlated inversely with odor identification, meaning again a worse sense of smell, and so did potassium-sparing diuretics. Multivariate analysis showed that MMSE scores correlated with a better sense of smell, that is a lower olfactory threshold, and that beta-blockers and acetylsalicylic acid negatively affected olfactory threshold, meaning a worse sense of smell. Acetylsalicylic acid also correlated inversely with odor identification, meaning again a worse sense of smell. CONCLUSIONS The number of drugs taken demonstrated to be significantly correlated with a worse olfactory threshold and worse MMSE. Larger studies on elderly volunteers are needed to confirm these preliminary findings.
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Affiliation(s)
- G Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - E Savietto
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - B Scarpa
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - A Bertocco
- Geriatric Unit, Department of Medicine, University of Padova, Padova, Italy
| | - P Maculan
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - G Sergi
- Geriatric Unit, Department of Medicine, University of Padova, Padova, Italy
| | - A Martini
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - E Manzato
- Geriatric Unit, Department of Medicine, University of Padova, Padova, Italy
| | - G Marioni
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
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21
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Elfeky R, Shah RM, Unni MNM, Ottaviano G, Rao K, Chiesa R, Amrolia P, Worth A, Flood T, Abinun M, Hambleton S, Cant AJ, Gilmour K, Adams S, Ahsan G, Barge D, Gennery AR, Qasim W, Slatter M, Veys P. New graft manipulation strategies improve the outcome of mismatched stem cell transplantation in children with primary immunodeficiencies. J Allergy Clin Immunol 2019; 144:280-293. [PMID: 30731121 DOI: 10.1016/j.jaci.2019.01.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 01/11/2019] [Accepted: 01/17/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Mismatched stem cell transplantation is associated with a high risk of graft loss, graft-versus-host disease (GvHD), and transplant-related mortality. Alternative graft manipulation strategies have been used over the last 11 years to reduce these risks. OBJECTIVE We investigated the outcome of using different graft manipulation strategies among children with primary immunodeficiencies. METHODS Between 2006 and 2017, 147 patients with primary immunodeficiencies received 155 mismatched grafts: 30 T-cell receptor (TCR) αβ/CD19-depleted grafts, 43 cord blood (CB) grafts (72% with no serotherapy), 17 CD34+ selection with T-cell add-back grafts, and 65 unmanipulated grafts. RESULTS The estimated 8-year survival of the entire cohort was 79%, transplant-related mortality was 21.7%, and the graft failure rate was 6.7%. Posttransplantation viral reactivation, grade II to IV acute graft-versus-host disease (aGvHD), and chronic graft-versus-host disease (cGvHD) complicated 49.6%, 35%, and 15% of transplantations, respectively. Use of TCRαβ/CD19 depletion was associated with a significantly lower incidence of grade II to IV aGvHD (11.5%) and cGvHD (0%), although with a greater incidence of viral reactivation (70%) in comparison with other grafts. T-cell immune reconstitution was robust among CB transplants, although with a high incidence (56.7%) of grade II to IV aGvHD. Stable full donor engraftment was significantly greater at 80% among TCRαβ+/CD19+-depleted and CB transplants versus 40% to 60% among the other groups. CONCLUSIONS Rapidly accessible CB and haploidentical grafts are suitable alternatives for patients with no HLA-matched donor. Cord transplantation without serotherapy and TCRαβ+/CD19+-depleted grafts produced comparable survival rates of around 80%, although with a high rate of aGvHD with the former and a high risk of viral reactivation with the latter that need to be addressed.
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Affiliation(s)
- Reem Elfeky
- Molecular and Cellular Immunology Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Paediatric Allergy and Immunology, Ain Shams University, Cairo, Egypt.
| | - Ravi M Shah
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom; Department of Paediatric Oncology and BMT, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Mohamed N M Unni
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Giorgio Ottaviano
- Department of Paediatrics, Fondazione MBBM University of Milan-Bicocca, Monza, Italy
| | - Kanchan Rao
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Robert Chiesa
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Persis Amrolia
- Molecular and Cellular Immunology Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom; Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Austen Worth
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Terry Flood
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Mario Abinun
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Sophie Hambleton
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Andrew J Cant
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Kimberly Gilmour
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Stuart Adams
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Gul Ahsan
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Dawn Barge
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Andrew R Gennery
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Waseem Qasim
- Molecular and Cellular Immunology Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mary Slatter
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Paul Veys
- Molecular and Cellular Immunology Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom; Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
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Ottaviano G, Maculan P, Borghetto G, Favero V, Galletti B, Savietto E, Scarpa B, Martini A, Stellini E, De Filippis C, Favero L. Nasal function before and after rapid maxillary expansion in children: A randomized, prospective, controlled study. Int J Pediatr Otorhinolaryngol 2018; 115:133-138. [PMID: 30368373 DOI: 10.1016/j.ijporl.2018.09.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 05/22/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Children can well detect and respond to odours in order to have information about food and environment. Rapid Maxillary Expansion seems to improve dental and skeletal crossbite and increase nasal patency correcting oral respiration in children. A previous pilot study suggested that Rapid Maxillary Expansion may lead to improved N-Butanol olfactory thresholds, and peak nasal inspiratory flow values (PNIF). The aim of the present study was to prospectively evaluate olfactory threshold, nasal flows and nasal resistances in children aged from 6 to 11 years before and after Rapid Maxillary Expansion, comparing treated children with a control group of similar age, growth stage (prepubertal) and transversal skeletal deficiency. METHODS N-butanol olfactory thresholds, anterior active rhinomanometry (AAR) and PNIF were measured in 11 children (6-11 years) before (T0), immediately and 6 months after Rapid Maxillary Expansion application (T1 and T2 respectively), and in a control group of 11 children (6-11 years) whose members remained under observation for the period of the study. RESULTS Considering the study group, PNIF values improved at T1 respect to the T0 values (p = 0.003), while T2 values were significantly higher than T0 ones (p = 0.0002). N-Butanol Olfactory Threshold significantly improved at each control (p = 0.01, p = 0,01 and p = 0.0003, for T1 vs T0, T2 vs T1, T2 vs T0 respectively). No differences on AAR values were found during the six months follow-up in this group. Considering the control group, no significant differences were found for any of the considered variables during the time of the study. Comparing the two groups, there was a significant increase of PNIF values in the study group compared to the control group (p = 0.003) at T1, which was even more evident six months after Rapid Maxillary Expansion (p = 0.0005). This improvement was not shown by AAR values. N-Butanol Olfactory Threshold showed a significant improvement at T2 respect to T1 (p = 0.002) and T0 (p = 0.0005). CONCLUSION Rapid Maxillary Expansion seems to significantly improve the respiratory capacity of treated patients, at least in terms of PNIF, and their olfactory function, measured by N-Butanol Olfactory Threshold Test. Further studies should be performed to evaluate if also changes in nasal resistances, measured by AAR, could occur, maybe considering a larger group of subjects and possibly using 4-phase rhinomanometry in order to evaluate the effective resistances during the entire breath.
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Affiliation(s)
- G Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy.
| | - P Maculan
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - G Borghetto
- Department of Neurosciences DNS, Odontostomatology Institute, University of Padova, Padova, Italy
| | - V Favero
- Department of Surgery, Dentistry and Maxillofacial Unit, University of Verona, Verona, Italy
| | - B Galletti
- Department of Otorhinolaryngology, University of Messina, Messina, Italy
| | - E Savietto
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - B Scarpa
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - A Martini
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - E Stellini
- Department of Neurosciences DNS, Odontostomatology Institute, University of Padova, Padova, Italy
| | - C De Filippis
- Department of Neuroscience, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy
| | - L Favero
- Department of Neurosciences DNS, Odontostomatology Institute, University of Padova, Padova, Italy
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Ottaviano G, Salvatore S, Salvatoni A, Martelossi S, Ventura A, Naviglio S. Ocular Manifestations of Paediatric Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2018. [PMID: 29518184 DOI: 10.1093/ecco-jcc/jjy029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Ocular extraintestinal manifestations [O-EIMs] are known complications of Crohn's disease [CD], ulcerative colitis [UC], and inflammatory bowel disease unclassified [IBD-U]. However, data on their prevalence in children are scarce and there are no clear recommendations on what follow-up should be offered. We aimed to review available data on O-EIMs in children. METHODS In January 2018, we performed a systematic review of published English literature using PubMed and EMBASE databases and disease-specific queries. RESULTS Fifteen studies [7467 patients] reported data on O-EIMs prevalence in children. Overall prevalence of O-EIMs was 0.62-1.82%. Uveitis was the most common O-EIM. Meta-analysis showed that children with CD are at increased risk of O-EIMs as compared with children with UC and IBD-U (odds ratio [OR] 2.70, 95% confidence interval [CI] 1.51-4.83). Five studies [357 patients] reported data on ophthalmological screening in asymptomatic children: mild asymptomatic uveitis was identified in a variable proportion of patients [1.06-23.1%], more frequently in male patients with CD and colonic involvement. No evidence of ocular complications from untreated uveitis was detected. A total of 23 case reports [24 patients] were identified. CONCLUSIONS Data on O-EIMs in children are scarce. Prevalence of O-EIMs is lower than in adults but may be underestimated because of the possibility of asymptomatic uveitis; however, the long-term significance of this condition is unknown. Children with CD may be at increased risk of O-EIMs. No recommendations on routine ophthalmological examination can be made, but a low threshold for ophthalmological referral should be maintained. Larger studies in paediatric IBD populations are needed.
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Affiliation(s)
- Giorgio Ottaviano
- Pediatric Department, Ospedale 'F. Del Ponte', Università dell'Insubria, Varese, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale 'F. Del Ponte', Università dell'Insubria, Varese, Italy
| | - Alessandro Salvatoni
- Pediatric Department, Ospedale 'F. Del Ponte', Università dell'Insubria, Varese, Italy
| | - Stefano Martelossi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Alessandro Ventura
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Samuele Naviglio
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
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Pendolino A, Nardello E, Lund V, Maculan P, Scarpa B, Martini A, Ottaviano G. Comparison between unilateral PNIF and rhinomanometry in the evaluation of nasal cycle. Rhinology 2018; 56:122-126. [DOI: 10.4193/rhin17.168] [Citation(s) in RCA: 13] [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] [Indexed: 11/08/2022]
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Lovato A, Restivo DA, Ottaviano G, Marioni G, Marchese-Ragona R. Botulinum toxin therapy: functional silencing of salivary disorders. Acta Otorhinolaryngol Ital 2018; 37:168-171. [PMID: 28516981 PMCID: PMC5463526 DOI: 10.14639/0392-100x-1608] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 01/21/2023]
Abstract
Botulinum toxin (BTX) is a neurotoxic protein produced by Clostridium botulinum, an anaerobic bacterium. BTX therapy is a safe and effective treatment when used for functional silencing of the salivary glands in disorders such as sialoceles and salivary fistulae that may have a post-traumatic or post-operative origin. BTX injections can be considered in sialoceles and salivary fistulae after the failure of or together with conservative treatments (e.g. antibiotics, pressure dressings, or serial aspirations). BTX treatment has a promising role in chronic sialadenitis. BTX therapy is highly successful in the treatment of gustatory sweating (Frey's syndrome), and could be considered the gold standard treatment for this neurological disorder.
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Affiliation(s)
- A Lovato
- Department of Neuroscience DNS, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy
| | - D A Restivo
- Department of Internal Medicine, Neurologic Unit, Nuovo "Garibaldi" Hospital, Catania, Italy
| | - G Ottaviano
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, Italy
| | - G Marioni
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, Italy
| | - R Marchese-Ragona
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, Italy
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Hummel T, Whitcroft KL, Andrews P, Altundag A, Cinghi C, Costanzo RM, Damm M, Frasnelli J, Gudziol H, Gupta N, Haehne A, Holbrook E, Hong SC, Hornung D, Hüttenbrink KB, Kamel R, Kobayashi M, Konstantinidis I, Landis BN, Leopold DA, Macchi A, Miwa T, Moesges R, Mullol J, Mueller CA, Ottaviano G, Passali GC, Philpott C, Pinto JM, Ramakrishnan VJ, Rombaux P, Roth Y, Schlosser RA, Shu B, Soler G, Stjärne P, Stuck BA, Vodicka J, Welge-Luessen A. Position paper on olfactory dysfunction. Rhinology 2018. [PMID: 29528615 DOI: 10.4193/rhino16.248] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major
health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following:
• Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy
with small diameter endoscopes.
• Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability.
• Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour
threshold, and/or one of odour identification or discrimination.
• Comprehensive chemosensory assessment should include gustatory screening.
• Smell training can be helpful in patients with olfactory loss of several aetiologies. Conclusions We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.
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Ottaviano G, Lund V, Nardello E, Scarpa B, Frasson G, Staffieri A, Scadding G. Comparison between unilateral PNIF and rhinomanometry in healthy and obstructed noses. Rhinology 2017; 52:25-30. [PMID: 24618624 DOI: 10.4193/rhino13.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS Peak Nasal Inspiratory Flow (PNIF) is an easy method to assess nasal patency. Normative unilateral PNIF data in adults have been proposed. The study purpose was to compare PNIF and unilateral PNIF values to total and unilateral nasal resistances measured by anterior active rhinomanometry (AAR) in subjects with and without nasal obstruction to see whether unilateral PNIFis sensitive to detect nasal obstruction. METHODS AND RESULTS Measurements of PNIF, unilateral PNIF and AAR were performed in 125 volunteers. Seventy of them were healthy subjects not complaining of nasal symptoms and entered into the study as the'normal' group. The other group consisted of fifty-five symptomatic subjects.Data were analysed to show the correlation between PNIF, unilateral PNIF and nasal resistances. The ability of PNIF and AAR in predicting pathologies were compared by receiver operating characteristic (ROC) analysis indicating that PNIF and AAR have a similar and significant power to discriminate pathologic from healthy subjects. CONCLUSION The measurement of unilateral PNIF could be a helpful method to support the diagnosis of nasal blockage also in those cases with single nostril obstruction, but, in cases of doubt, AAR should also be performed to improve diagnostic accuracy.
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Affiliation(s)
- G Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - V Lund
- Ear Institute, University College London, London, United Kingdom
| | - E Nardello
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - B Scarpa
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - G Frasson
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - A Staffieri
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - G Scadding
- Ear Institute, University College London, London, United Kingdom
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Hernán Gómez Llambí H, Cao G, Donato M, Suárez D, Ottaviano G, Müller A, Buchholz B, Gelpi R, Otero-Losada M, Milei J. Left ventricular hypertrophy does not prevent heart failure in experimental hypertension. Int J Cardiol 2017; 238:57-65. [PMID: 28410843 DOI: 10.1016/j.ijcard.2017.03.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/21/2016] [Revised: 03/04/2017] [Accepted: 03/24/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) secondary to hypertension has been accepted to prevent heart failure (HF) while paradoxically increasing cardiovascular morbi-mortality. OBJECTIVES To evaluate whether antihypertensive treatment inhibits LVH, restores beta-adrenergic response and affects myocardial oxidative metabolism. METHODS Ninety spontaneously hypertensive rats (SHR) were distributed into groups and treated (mg/kg, p.o.) with: losartan 30 (L), hydralazine 11 (H), rosuvastatin 10 (R), carvedilol 20 (C). Hypertension control group comprised 18 normotensive rats (Wistar-Kyoto, WKY). Following euthanasia at 16months, contractility was measured in 50% of rats (Langendorff system) before and after isoproterenol (Iso) 10-9M, 10-7M and 10-5M stimulation. Left ventricular weight (LVW) was measured in the remaining hearts, and normalized by BW. Expression of thioredoxin 1 (Trx-1), peroxyredoxin 2 (Prx-2), glutaredoxin 3 (Grx-3), caspase-3 and brain natriuretic peptide (BNP) was determined. RESULTS Systolic blood pressure (mmHg): 154±3 (L), 137±1 (H), 190±3 (R)*, 206±3 (SHR)*, 183±1 (C)**, and 141±1 (WKY) (*p<0.05 vs. L, H, WKY, **p<0.05 vs. L, H, WKY, SHR). LVW/BW was higher in SHR and R (p<0.05). Groups SHR, R and C evidenced baseline contractile depression. Response to Iso 10-5M was similar in WKY and L. Expression of Trx-1, Prx-2 and Grx-3 increased in C, H, R and L (p<0.01). CONCLUSIONS Present findings argue against the traditional idea and support that LVH might not be required to prevent HF. Increased expression of thioredoxins by antihypertensive treatment might be involved in protection from HF.
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Affiliation(s)
- H Hernán Gómez Llambí
- Institute of Cardiological Research, School of Medicine, University of Buenos Aires, UBA-CONICET, Buenos Aires, Argentina
| | - G Cao
- Institute of Cardiological Research, School of Medicine, University of Buenos Aires, UBA-CONICET, Buenos Aires, Argentina
| | - M Donato
- Institute of Cardiovascular Pathophysiology, School of Medicine, University of Buenos Aires, UBA-CONICET, Buenos Aires, Argentina
| | - D Suárez
- Institute of Cardiological Research, School of Medicine, University of Buenos Aires, UBA-CONICET, Buenos Aires, Argentina
| | - G Ottaviano
- Institute of Cardiological Research, School of Medicine, University of Buenos Aires, UBA-CONICET, Buenos Aires, Argentina
| | - A Müller
- Institute of Cardiological Research, School of Medicine, University of Buenos Aires, UBA-CONICET, Buenos Aires, Argentina
| | - B Buchholz
- Institute of Cardiovascular Pathophysiology, School of Medicine, University of Buenos Aires, UBA-CONICET, Buenos Aires, Argentina
| | - R Gelpi
- Institute of Cardiovascular Pathophysiology, School of Medicine, University of Buenos Aires, UBA-CONICET, Buenos Aires, Argentina
| | - M Otero-Losada
- Institute of Cardiological Research, School of Medicine, University of Buenos Aires, UBA-CONICET, Buenos Aires, Argentina.
| | - J Milei
- Institute of Cardiological Research, School of Medicine, University of Buenos Aires, UBA-CONICET, Buenos Aires, Argentina
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Hummel T, Whitcroft KL, Andrews P, Altundag A, Cinghi C, Costanzo RM, Damm M, Frasnelli J, Gudziol H, Gupta N, Haehner A, Holbrook E, Hong SC, Hornung D, Hüttenbrink KB, Kamel R, Kobayashi M, Konstantinidis I, Landis BN, Leopold DA, Macchi A, Miwa T, Moesges R, Mullol J, Mueller CA, Ottaviano G, Passali GC, Philpott C, Pinto JM, Ramakrishnan VJ, Rombaux P, Roth Y, Schlosser RA, Shu B, Soler G, Stjärne P, Stuck BA, Vodicka J, Welge-Luessen A. Position paper on olfactory dysfunction. Rhinology 2017. [PMID: 28623665 DOI: 10.4193/rhin16.248] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following: - Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy with small diameter endoscopes. - Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability. - Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour threshold, and/or one of odour identification or discrimination. - Comprehensive chemosensory assessment should include gustatory screening. - Smell training can be helpful in patients with olfactory loss of several aetiologies. CONCLUSIONS We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.
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Affiliation(s)
- T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - K L Whitcroft
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - P Andrews
- UCL Ear Institute, Faculty of Brain Sciences, University College London, London, UK
| | - A Altundag
- Department of Otorhinolaryngoglogy, Istanbul Surgery Hospital, Istanbul, Turkey
| | - C Cinghi
- Department of Otolaryngology; Eskisehir Osmangazi University, Istanbul, Turkey
| | - R M Costanzo
- Smell and Taste Disorders Center, Department of Otolaryngology Head and Neck Surgery, VCU School of Medicine, Richmond, VA, USA
| | - M Damm
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne Medical Center, Cologne, Germany
| | - J Frasnelli
- Research Chair in Chemosensory Neuroanatomy, Department of Anatomy, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, QC, Canada
| | - H Gudziol
- Department of Otorhinolaryngology, University of Jena, Jena, Germany
| | - N Gupta
- Department of Otorhinolaryngology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - A Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - E Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - S C Hong
- Department of Otorhinolaryngology, Konkuk University Medical Center, Hwayang-dong, Gwangjin-gu, Seoul, South Korea
| | - D Hornung
- Dept. of Biology, St. Lawrence University, Canton, NY, USA
| | | | - R Kamel
- Department of Otorhinolaryngology, Cairo University, Cairo, Egypt
| | - M Kobayashi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - I Konstantinidis
- Smell and Taste Clinic, Second Academic Otorhinolaryngology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B N Landis
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - D A Leopold
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - A Macchi
- ENT Clinic, University of Insubria, ASST, sette laghi, Varese, Italy
| | - T Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinada, Kahoku, Ishikawa, Japan
| | - R Moesges
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - J Mullol
- Rhinology Unit and Smell Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - C A Mueller
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - G Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University, Padua, Italy
| | - G C Passali
- Head and Neck section, Department of Aging, Neurosciences, Head and Neck and Orthopedic; Catholic University of Sacred heart, A. Gemelli Hospital Foundation, Rome, Italy
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - V J Ramakrishnan
- Departments of Otolaryngology and Neurosurgery, University of Colorado, Aurora, CO, USA
| | - P Rombaux
- Universite Catholique de Louvain, Institute of Neurosciences, Unit of Otorhinolaryngology, Brussels, Belgium
| | - Y Roth
- The Institute for Nose and Sinus Therapy and Clinical Investigations, Department of Otolaryngology - Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - R A Schlosser
- Department of Otolaryngology, Head and Neck Surgery, Medical Univeristy of South Carolina, Charleston, SC, USA
| | - B Shu
- Department of Otolaryngology, Taipei Veterans General Hospital, National Yang Ming University School of Medicine Faculty of Medicine, Taipei, Taiwan
| | - G Soler
- Division of Otorhinolaryngology, Area of Smell and Taste, Hospital de Clinicas, University of Buenos Aires, Buenos Aires City, Argentina
| | - P Stjärne
- Section of Rhinology, Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - B A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Germany
| | - J Vodicka
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Pardubice, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - A Welge-Luessen
- University Hospital Basel - Otorhinolaryngology, Basel, Switzerland
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Ottaviano G, Scadding G, Iacono V, Scarpa B, Martini A, Lund V. Peak nasal inspiratory flow and peak expiratory flow. Upright and sitting values in an adult population. Rhinology 2016. [DOI: 10.4193/rhin15.180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Incardona C, Lombardo P, Feleder EC, Yerino GA, Halabe EK, Milei J, Ottaviano G, Muller A, Roldán EJ. Plasma Enalapril Kinetics of Two Modified Formulations Tested in Healthy Volunteers. A Pilot Trial Searching for an Optimum Blood Pressure Control. ACTA ACUST UNITED AC 2016; 10 Suppl 1:e3-e4. [PMID: 27677135 DOI: 10.1016/j.jash.2016.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C Incardona
- Medical Direction, Gador S.A., Buenos Aires, Argentina
| | - P Lombardo
- Medical Direction, Gador S.A., Buenos Aires, Argentina
| | - E C Feleder
- Clinical Research Unit, F.P. Clinical Pharma, Buenos Aires, Argentina
| | - G A Yerino
- Clinical Research Unit, F.P. Clinical Pharma, Buenos Aires, Argentina
| | - E K Halabe
- Clinical Research Unit, F.P. Clinical Pharma, Buenos Aires, Argentina
| | - J Milei
- Institute of Cardiological Research Prof. Dr. Alberto C. Taquini, Buenos Aires, Argentina
| | - G Ottaviano
- Institute of Cardiological Research Prof. Dr. Alberto C. Taquini, Buenos Aires, Argentina
| | - A Muller
- Institute of Cardiological Research Prof. Dr. Alberto C. Taquini, Buenos Aires, Argentina
| | - E J Roldán
- Medical Direction, Gador S.A., Buenos Aires, Argentina
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Ottaviano G, Fokkens WJ. Measurements of nasal airflow and patency: a critical review with emphasis on the use of peak nasal inspiratory flow in daily practice. Allergy 2016; 71:162-74. [PMID: 26447365 DOI: 10.1111/all.12778] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 12/26/2022]
Abstract
Objective measures can be used to assist the clinician to diagnose and treat nasal obstruction and also to quantify nasal obstruction in research. Objective measurements of nasal obstruction are as important as objective measurements of lung function. peak nasal inspiratory flow (PNIF), acoustic rhinometry (AR) and rhinomanometry (RM), with their specific peculiarity, assess different aspects of nasal obstruction. From the studies available in the literature, it seems that these methods roughly correlate with each other and that all of them can be alternatively utilized very well in research as well as in clinical practice. This review describes the various methods that can be used to measure nasal patency, airflow and resistance, mainly peak nasal inspiratory flow, rhinomanometry and acoustic rhinometry. PNIF has been demonstrated to be reproducible and as good an indication of objective nasal patency as formal rhinomanometry and has the advantage to be cheap, simple and suitable for serial measurements and for home use even in the paediatric population. PNIF normative data are available for children, adults and elderly subjects, and the availability of unilateral PNIF normal values allows evaluation of nasal sides separately. Just as in the lower airways, objective and subjective evaluation gives different information that together optimizes the diagnosis and the treatment of our patients. We argue that PNIF should be used regularly in every outpatient clinic that treats patients with nasal obstruction.
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Affiliation(s)
- G. Ottaviano
- Otolaryngology Section; Department of Neurosciences; University of Padova; Padova Italy
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
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Castiello MC, Scaramuzza S, Pala F, Ferrua F, Uva P, Brigida I, Sereni L, van der Burg M, Ottaviano G, Albert MH, Grazia Roncarolo M, Naldini L, Aiuti A, Villa A, Bosticardo M. B-cell reconstitution after lentiviral vector-mediated gene therapy in patients with Wiskott-Aldrich syndrome. J Allergy Clin Immunol 2015; 136:692-702.e2. [PMID: 25792466 PMCID: PMC4559137 DOI: 10.1016/j.jaci.2015.01.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/15/2015] [Accepted: 01/23/2015] [Indexed: 11/30/2022]
Abstract
Background Wiskott-Aldrich syndrome (WAS) is a severe X-linked immunodeficiency characterized by microthrombocytopenia, eczema, recurrent infections, and susceptibility to autoimmunity and lymphomas. Hematopoietic stem cell transplantation is the treatment of choice; however, administration of WAS gene–corrected autologous hematopoietic stem cells has been demonstrated as a feasible alternative therapeutic approach. Objective Because B-cell homeostasis is perturbed in patients with WAS and restoration of immune competence is one of the main therapeutic goals, we have evaluated reconstitution of the B-cell compartment in 4 patients who received autologous hematopoietic stem cells transduced with lentiviral vector after a reduced-intensity conditioning regimen combined with anti-CD20 administration. Methods We evaluated B-cell counts, B-cell subset distribution, B cell–activating factor and immunoglobulin levels, and autoantibody production before and after gene therapy (GT). WAS gene transfer in B cells was assessed by measuring vector copy numbers and expression of Wiskott-Aldrich syndrome protein. Results After lentiviral vector-mediated GT, the number of transduced B cells progressively increased in the peripheral blood of all patients. Lentiviral vector-transduced progenitor cells were able to repopulate the B-cell compartment with a normal distribution of B-cell subsets both in bone marrow and the periphery, showing a WAS protein expression profile similar to that of healthy donors. In addition, after GT, we observed a normalized frequency of autoimmune-associated CD19+CD21−CD35− and CD21low B cells and a reduction in B cell–activating factor levels. Immunoglobulin serum levels and autoantibody production improved in all treated patients. Conclusions We provide evidence that lentiviral vector-mediated GT induces transgene expression in the B-cell compartment, resulting in ameliorated B-cell development and functionality and contributing to immunologic improvement in patients with WAS.
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Affiliation(s)
- Maria Carmina Castiello
- San Raffaele Telethon Institute for Gene Therapy (TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samantha Scaramuzza
- San Raffaele Telethon Institute for Gene Therapy (TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Pala
- San Raffaele Telethon Institute for Gene Therapy (TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ferrua
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Uva
- CRS4, Science and Technology Park Polaris, Pula, Cagliari, Italy
| | - Immacolata Brigida
- San Raffaele Telethon Institute for Gene Therapy (TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Sereni
- San Raffaele Telethon Institute for Gene Therapy (TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mirjam van der Burg
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Giorgio Ottaviano
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michael H Albert
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maria Grazia Roncarolo
- San Raffaele Telethon Institute for Gene Therapy (TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy (TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of System Medicine, Tor Vergata University, Rome, Italy
| | - Anna Villa
- San Raffaele Telethon Institute for Gene Therapy (TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy; IRGB CNR, Milan Unit, Milan, Italy.
| | - Marita Bosticardo
- San Raffaele Telethon Institute for Gene Therapy (TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
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Manara R, Salvalaggio A, Citton V, Palumbo V, D'Errico A, Elefante A, Briani C, Cantone E, Ottaviano G, Pellecchia MT, Greggio NA, Weis L, D'Agosto G, Rossato M, De Carlo E, Napoli E, Coppola G, Di Salle F, Brunetti A, Bonanni G, Sinisi AA, Favaro A. Brain anatomical substrates of mirror movements in Kallmann syndrome. Neuroimage 2014; 104:52-8. [PMID: 25300200 DOI: 10.1016/j.neuroimage.2014.09.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022] Open
Abstract
Among male patients affected by Kallmann syndrome, a genetically determined disease due to defective neural migration leading to hypogonadropic hypogonadism and hypo/anosmia, about 40% present the peculiar phenomenon of mirror movements, i.e. involuntary movements mirroring contralateral voluntary hand movements. Several pathogenic hypotheses have been proposed, but the ultimate neurological mechanisms are still elusive. The aim of the present study was to investigate brain anatomical substrates of mirror movements in Kallmann syndrome by means of a panel of quantitative MRI analyses. Forty-nine male Kallmann syndrome patients underwent brain MRI. The study protocol included 3D-T1-weighted gradient echo, fluid attenuated inversion recovery and diffusion tensor imaging. Voxel-based morphometry, sulcation, curvature and cortical thickness analyses and tract based spatial statistics were performed using SPM8, Freesurfer and FSL. All patients underwent a complete physical and neurological examination including the evaluation of mirror movements (according to the Woods and Teuber criteria). Kallmann syndrome patients presenting with mirror movements (16/49, 32%) displayed the following brain changes: 1) increased gray matter density in the depth of the left precentral sulcus behind the middle frontal gyrus; 2) decreased cortical thickness in the precentral gyrus bilaterally, in the depth of right precentral sulcus and in the posterior portion of the right superior frontal gyrus; and 3) decreased fractional anisotropy in the left hemisphere involving the temporal lobe and peritrigonal white matter. No differences were shown by cortical curvature and sulcation analyses. The composite array of brain changes observed in Kallmann syndrome patients with mirror movements likely represents the anatomical-structural underpinnings leading to the peculiar derangement of the complex circuitry committed to unilateral hand voluntary movements.
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Affiliation(s)
- R Manara
- Neuroradiology, Dept. of Medicine and Surgery, University of Salerno, Italy.
| | - A Salvalaggio
- Neuroradiology, Dept. of Scienze Biomediche Avanzate, Federico II University, Napoli, Italy.
| | - V Citton
- IRCCS S. Camillo, Venezia, Italy.
| | - V Palumbo
- Dept. of Clinical and Experimental Medicine and Surgery, Endocrinology and Medical Andrology Section, Second University of Napoli, Italy.
| | - A D'Errico
- Neuroradiology, Dept. of Scienze Biomediche Avanzate, Federico II University, Napoli, Italy.
| | - A Elefante
- Neuroradiology, Dept. of Scienze Biomediche Avanzate, Federico II University, Napoli, Italy.
| | - C Briani
- Neurology, Dept. of Neurosciences, University of Padova, Italy.
| | - E Cantone
- Ent. Section, Dept. of Neurosciences, "Federico II" University, Napoli, Italy; Dept. of Molecular and Cellular Biology and Pathology, "Federico II" University, Napoli, Italy.
| | - G Ottaviano
- Otolaryngology Section, Dept. of Neurosciences, University of Padova, Italy.
| | - M T Pellecchia
- Neurology, Dept. of Medicine and Surgery, University of Salerno, Italy.
| | - N A Greggio
- UOS di Endocrinolgia Pediatrica e Adolescentologia, D.A.I.S. per la Salute della Donna e del Bambino, Azienda Ospedaliera - University of Padova, Italy.
| | - L Weis
- Neuroradiology, Dept. of Scienze Biomediche Avanzate, Federico II University, Napoli, Italy.
| | - G D'Agosto
- Medicanova, Diagnostic Center, Battipaglia (SA), Italy.
| | - M Rossato
- Clinica Medica III, Dept. of Medicine (DIMED), University of Padova, Italy.
| | - E De Carlo
- Clinica Medica III, Dept. of Medicine (DIMED), University of Padova, Italy.
| | - E Napoli
- Medicanova, Diagnostic Center, Battipaglia (SA), Italy.
| | - G Coppola
- Child and Adolescent Neuropsychiatry, University of Salerno, Italy.
| | - F Di Salle
- Neuroradiology, Dept. of Medicine and Surgery, University of Salerno, Italy.
| | - A Brunetti
- Neuroradiology, Dept. of Scienze Biomediche Avanzate, Federico II University, Napoli, Italy.
| | - G Bonanni
- Unità di Endocrinologia, Dept. of Medicine (DIMED), University of Padova, Italy.
| | - A A Sinisi
- Dept. of Clinical and Experimental Medicine and Surgery, Endocrinology and Medical Andrology Section, Second University of Napoli, Italy.
| | - A Favaro
- Psychiatry, Dept. of Neurosciences, University of Padova, Italy.
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Ottaviano G, Frasson G, Favero V, Boato M, Schembri E, Marchese-Ragona R, Mucignat-Caretta C, Stellini E, Staffieri A, Favero L. N-butanol olfactory threshold and nasal patency before and after palatal expansion in children. A preliminary study. Int J Pediatr Otorhinolaryngol 2014; 78:1618-23. [PMID: 25081605 DOI: 10.1016/j.ijporl.2014.07.006] [Citation(s) in RCA: 7] [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: 05/23/2014] [Revised: 07/02/2014] [Accepted: 07/05/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Olfaction is based on the function of the nasal olfactory receptors. Children can well detect and respond to odors in order to have information about food and environment. Rapid maxillary expansion seems to improve dental class and increase nasal patency correcting oral respiration in children. Nevertheless, there are no studies demonstrating that expansion in pediatric patients could influence olfactory sensitivity. The aim of this study was to evaluate olfactory threshold and nasal patency in children aged from 6 to 12 years before and after rapid maxillary expansion. METHOD N-butanol olfactory thresholds, anterior active rhinomanometry, and peak nasal inspiratory flow were measured in 12 children (6-12 years) before (T0), 20 days (T1), and 6 months after rapid maxillary expansion application (T2). RESULTS A significant lower olfactory threshold was found comparing T2 and T0 N-butanol olfactory threshold values (p=0.038). Peak nasal inspiratory flow showed a significant improvement both at T1 and T2, with respect to T0 values (p=0.043 and p=0.0001, respectively). T2 nasal resistances showed a trend towards a significant reduction when compared with T1 values (p=0.15). CONCLUSION This pilot study suggested that rapid maxillary expansion may lead to improved N-butanol olfactory thresholds, at least 6 months after palatal expansion. Furthermore, rapid maxillary expansion seems to improve peak nasal inspiratory flow values, and finally although with lower sensitivity, reduce nasal resistances as measured by rhinomanometry.
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Affiliation(s)
- G Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy.
| | - G Frasson
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - V Favero
- Department of Surgery, Dentistry and Maxillofacial Unit, University of Verona, Verona, Italy
| | - M Boato
- Department of Neurosciences, Odontostomatology Institute, University of Padova, Padova, Italy
| | - E Schembri
- Department of Neurosciences, Odontostomatology Institute, University of Padova, Padova, Italy
| | - R Marchese-Ragona
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | | | - E Stellini
- Department of Neurosciences, Odontostomatology Institute, University of Padova, Padova, Italy
| | - A Staffieri
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - L Favero
- Department of Neurosciences, Odontostomatology Institute, University of Padova, Padova, Italy
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Ottaviano G, Picardi L, Pillon M, Ronsivalle C, Sandri S. The radiation fields around a proton therapy facility: A comparison of Monte Carlo simulations. Radiat Phys Chem Oxf Engl 1993 2014. [DOI: 10.1016/j.radphyschem.2013.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ottaviano G, Lund V, Nardello E, Scarpa B, Frasson G, Staffieri A, Scadding G. Comparison between unilateral PNIF and rhinomanometry in healthy and obstructed noses. Rhinology 2014. [DOI: 10.4193/rhin13.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ottaviano G, Zuccarello D, Menegazzo M, Perilli L, Marioni G, Frigo AC, Staffieri A, Foresta C. Human olfactory sensitivity for bourgeonal and male infertility: a preliminary investigation. Eur Arch Otorhinolaryngol 2013; 270:3079-86. [PMID: 23525651 DOI: 10.1007/s00405-013-2441-0] [Citation(s) in RCA: 9] [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: 01/09/2013] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
Abstract
Olfactory receptor (OR) expression is also present in the sperm cells and could mediate sperm chemotaxis. OR1D2 was the first OR expressed in the testis demonstrated to be involved in chemotaxis and to be expressed also in the nose with a similar behavior. Bourgeonal is the OR1D2 most potent known agonist. Infertility affects ~15 % of couples in western countries and sometimes it is unexplained. This pilot study compared the bourgeonal olfactory thresholds, the ability of sperm to sense the bourgeonal and the frequency of 13 single nucleotide polymorphisms (SNPs) of OR1D2 gene in nine males suffering of unexplained infertility with a control group of 15 healthy males. The mean olfactory threshold for bourgeonal was statistically different between the study group (10.5 ± 3.7; median 12.3) and the control group (14.0 ± 2.8; median 15.5) (p = 0.006). Statistical analysis showed a significantly higher percentage of spermatozoa that migrated toward the capillaries filled with bourgeonal in the control group compared to the study group (p < 0.0001). Sperm migration was equally inhibited in both groups of subjects when, together with bourgeonal, capillaries were filled with undecanal, a strong bourgeonal inhibitor (p = 0.42). The 13 SNPs of OR1D2 revealed a statistically significant difference for allele and genotype frequency of rs769423 in study group versus control group (p = 0.02). The present preliminary study seems to confirm the important role of OR1D2 both in nose and spermatozoa and may explain the idiopathic infertility of the study group. Further studies on larger series are mandatory to confirm our preliminary evidence.
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Affiliation(s)
- G Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128, Padua, Italy,
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Ottaviano G, Staffieri A, Stritoni P, Ermolao A, Coles S, Zaccaria M, Marioni G. Nasal dysfunction induced by chlorinate water in competitive swimmers. Rhinology 2013; 50:294-8. [PMID: 22888487 DOI: 10.4193/rhino11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS Swimmers commonly complain of nasal symptoms probably due to mucosal irritation caused by chlorinated water. The aim of the present prospective study was to investigate changes in nasal function and cytology in a cohort of 15 volunteer competitive swimmers, as compared with a control group of 15 competitive athletes practicing other sports. METHODS Olfactory threshold for n-butanol was measured in a population of competitive swimmers. Changes in nasal function and cytology were compared between the two groups of volunteer competitive athletes. RESULTS There were no significant differences between the two groups in terms of mean 20-Item Sino-Nasal Outcome Test scores, peak nasal inspiratory flow, pulmonary peak expiratory flow, or total nasal resistance on anterior active rhinomanometry. Nasal mucociliary transport time (MCTt) was significantly shorter for the non-swimmers than for the swimmers. The mean olfactory threshold for n-butanol in the swimmers was significantly lower than in the other group of athletes. CONCLUSIONS Data seem to confirm the utility of MCTt in studying nasal mucosa damage caused by chlorinated water. The present results also support the hypothesis of a role for the olfactory threshold in evaluating damage to the olfactory mucosa exposed to chlorinated water.
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Affiliation(s)
- G Ottaviano
- Department of Neurosciences, University of Padova, Padova, Italy.
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41
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Lionello M, Manara R, Lora L, Mylonakis I, Fasanaro E, La Torre FB, Ottaviano G, Staffieri A, Ragona RM. Case report of cholesteatoma recurrence with Bezold's abscess presenting as a deep neck infection. B-ENT 2013; 9:255-258. [PMID: 24273959] [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: 06/02/2023] Open
Abstract
Cervical masses are a common clinical finding, but differential diagnosis is often challenging. Acute neck swellings are often due to deep cervical space infections that have originated at oral or oropharyngeal sites. Deep neck infections originating elsewhere are not rare; however, they are difficult to diagnose, and their origins remain obscure in 20% of cases. Neck swellings that originate in the middle ear are very rare, with only a few reported in the scientific literature. Here we report an atypical case of Bezold's abscess caused by the recurrence of a middle ear cholesteatoma. In patients with neck swelling and a history of primary cholesteatoma of the middle ear, otolaryngologists should consider regional recurrence of disease a possibility even several years after the primary surgery.
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Affiliation(s)
- M Lionello
- Department of Neuroscience, Otolaryngology Section, University of Padua, Padua, Italy.
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Ottaviano G, Staffieri A, Stritoni P, Ermolao A, Coles S, Zaccaria M, Marioni G. Nasal dysfunction induced by chlorinate water in competitive swimmers. Rhinology 2012. [DOI: 10.4193/rhin11.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ottaviano G, Scadding G, Scarpa B, Accordi D, Staffieri A, Lund V. Unilateral peak nasal inspiratory flow, normal values in adult population. Rhinology 2012. [DOI: 10.4193/rhin12.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Marioni G, Ottaviano G, Staffieri A, Zaccaria M, Lund VJ, Tognazza E, Coles S, Pavan P, Brugin E, Ermolao A. Nasal functional modifications after physical exercise: olfactory threshold and peak nasal inspiratory flow. Rhinology 2010; 48:277-80. [PMID: 21038016 DOI: 10.4193/rhino09.141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STATEMENT OF PROBLEM The respiratory nasal effects of physical exercise have been extensively investigated; on the other hand there are no data regarding olfactory threshold modification after aerobic physical exercise. METHODS The present prospective study investigated the modifications in nasal respiratory flows and olfactory thresholds after controlled aerobic physical exercise in a cohort of 15 adult, healthy volunteers. The Peak Nasal Inspiratory Flow (PNIF), and the Sniffin’ Sticks olfactory threshold test were used for our determinations. MAIN RESULTS The mean PNIF after physical exercise was significantly higher than the mean PNIF value found before physical exercise. Statistical analysis ruled out any significant difference between mean olfactory thresholds pre vs post physical exercise. PRINCIPAL CONCLUSIONS These outcomes confirmed PNIF sensitivity and reliability also in determining the changes in nasal patency occurring after physical exercise. The active vasoconstriction of nasal mucosa associated with the reduction of blood flow to the olfactory epithelium due to physical exercise may be compensated for by the increase of olfactory molecules that reach the olfactory mucosa because of nasal mucosal shrinkage: this mechanism could explain the stability of mean olfactory threshold after physical exercise.
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Affiliation(s)
- G Marioni
- Department of Medical and Surgical Specialties, Section of Otolaryngology, University of Padova, Padova, Italy.
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Marioni G, Ottaviano G, Staffieri A, Zaccaria M, Lund V, Tognazza E, Coles S, Pavan P, Brugin E, Ermolao A. Nasal functional modifications after physical exercise: olfactory threshold and peak nasal inspiratory flow. Rhinology 2010; 48:277-280. [DOI: 10.4193/rhin09.141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Ottaviano G, Marioni G, Marchese-Ragona R, Trevisan CP, De Filippis C, Staffieri A. Anosmia associated with hearing loss and benign positional vertigo after head trauma. Acta Otorhinolaryngol Ital 2009; 29:270-273. [PMID: 20162029 PMCID: PMC2821127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 12/27/2008] [Indexed: 05/28/2023]
Abstract
It is well known that head trauma may cause hearing loss, which can be either conductive or sensorineural. Benign paroxysmal positional vertigo and olfactory dysfunction due to head trauma are also well known. The association between sensorineural hearing loss and anosmia, following head trauma, is extremely rare. Two rare cases of post-traumatic occurrence of hearing loss, olfactory dysfunction and benign positional vertigo are reported and the pathophysiology of the association between sensorineural hearing loss, anosmia and benign paroxysmal positional vertigo, after head injury, are briefly discussed. ENT specialists should, in the authors' opinion, be aware of the possible association between anosmia, sensorineural hearing loss and benign paroxysmal positional vertigo after head injury, even in the absence of skull fracture.
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Affiliation(s)
- G Ottaviano
- Department of Otolaryngology-Head and Neck Surgery, University of Padua, Via Giustiniani 2, Padua, Italy.
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Galzignato P, Marchese Ragona R, Guarda-Nardini L, Vianello A, Gallan F, Ottaviano G, Staffleri A, Ferronato G. O.289 The Sleep-Nasoendoscopy in patients with OSAHS. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71413-6] [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: 11/25/2022] Open
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48
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Marioni G, Rinaldi R, Staffieri C, Ottaviano G, Marchese-Ragona R, Giacomelli L, Ferraro SM, Staffieri A. Burkholderia cepacia complex nasal isolation in immunocompetent patients with sinonasal polyposis not associated with cystic fibrosis. Eur J Clin Microbiol Infect Dis 2006; 26:73-5. [PMID: 17180349 DOI: 10.1007/s10096-006-0233-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- G Marioni
- Department of Medical and Surgical Specialties, Section of Otolaryngology, University of Padova, Padova, Italy.
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Marioni G, Ottaviano G, Giacomelli L, Staffieri C, Casarotti-Todeschini S, Bonandini E, Staffieri A, Blandamura S. CD105-assessed micro-vessel density is associated with malignancy recurrence in laryngeal squamous cell carcinoma. Eur J Surg Oncol 2006; 32:1149-53. [PMID: 16979866 DOI: 10.1016/j.ejso.2006.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 08/03/2006] [Indexed: 11/21/2022] Open
Abstract
AIMS Angiogenesis is essential for malignancies growth. CD105 is a proliferation-associated protein abundantly expressed in angiogenic endothelial cells. The aim of this study has been to determine the expression of CD105 in laryngeal squamous cell carcinoma (SCC) and to investigate the role of CD105-assessed mean vascular density (MVD) in predicting patients' prognosis. METHODS The sections of 43 consecutive cases of laryngeal SCC were stained with mouse monoclonal antibody CD105. All the measures were performed by a computer-based image analysis system. The percentage of the fields occupied by CD105-assessed micro-vessels was determined. RESULTS The mean CD105-assessed MVD were 11% and 6% in laryngeal SCC with and without malignancy recurrence, respectively. Multivariate logistic regression stated that CD105-assessed MVD was significantly related to disease recurrence (p=0.030). CONCLUSIONS Our preliminary results suggest that CD105-assessed MVD may be a valuable parameter for predicting patients having an increased risk of developing laryngeal carcinoma loco-regional recurrence.
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Affiliation(s)
- G Marioni
- Department of Medical and Surgical Specialties, Section of Otolaryngology, University of Padova, Via Giustiniani 2, 35100 Padova, Italy.
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Marchese-Ragona R, Restivo DA, Marioni G, Ottaviano G, Masiero S, Staffieri A. Evaluation of swallowing disorders in multiple sclerosis. Neurol Sci 2006. [DOI: 10.1007/s10072-006-0654-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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