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Tull TJ, Benton EC, Semkova K, Watson NA, Mee JB, Lopez B, Setterfield J, Carey B, Ajmad S, Robbie SJ, Groves RW, Sanna G, D'Cruz DP. Combined rituximab and belimumab to treat recalcitrant epidermolysis bullosa aquisita associated with systemic lupus erythematosus. Br J Dermatol 2024:ljae141. [PMID: 38561894 DOI: 10.1093/bjd/ljae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
We report two cases of recalcitrant epidermolysis bullosa aquisita with associated systemic lupus erythematosus treated with combination rituximab and belimumab therapy. This resulted in complete resolution of cutaneous lesions and partial response of mucosal lesions. These cases support the use of combined rituximab and belimumab for the treatment of recalcitrant immunobullous disease.
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Affiliation(s)
- Thomas J Tull
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Emma C Benton
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kristina Semkova
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Natalie A Watson
- Ear, Nose and Throat Department, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John B Mee
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Begona Lopez
- Louise Coote Lupus Unit, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane Setterfield
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Barbara Carey
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sajjad Ajmad
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Scott J Robbie
- Department of Ophthalmology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard W Groves
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Giovanni Sanna
- Louise Coote Lupus Unit, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David P D'Cruz
- Louise Coote Lupus Unit, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Conte B, Boni L, Bisagni G, Durando A, Sanna G, Gori S, Garrone O, Tamberi S, De Placido S, Schettini F, Pazzola A, Ponzone R, Montemurro F, Lunardi G, Notaro R, De Angioletti M, Turletti A, Mansutti M, Puglisi F, Frassoldati A, Porpiglia M, Fabi A, Generali D, Scognamiglio G, Rossi M, Brasó-Maristany F, Prat A, Cardinali B, Piccioli P, Serra M, Lastraioli S, Bighin C, Poggio F, Lambertini M, Del Mastro L. SNP of Aromatase Predict Long-term Survival and Aromatase Inhibitor Toxicity in Patients with Early Breast Cancer: A Biomarker Analysis of the GIM4 and GIM5 Trials. Clin Cancer Res 2023; 29:5217-5226. [PMID: 37888299 PMCID: PMC10722129 DOI: 10.1158/1078-0432.ccr-23-1568] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/12/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE In estrogen receptor-positive (ER+) breast cancer, single-nucleotide polymorphisms (SNP) in the aromatase gene might affect aromatase inhibitors (AI) metabolism and efficacy. Here, we assessed the impact of SNP on prognosis and toxicity of patients receiving adjuvant letrozole. EXPERIMENTAL DESIGN We enrolled 886 postmenopausal patients in the study. They were treated with letrozole for 2 to 5 years after taking tamoxifen for 2 to 6 years, continuing until they completed 5 to 10 years of therapy. Germline DNA was genotyped for SNP rs4646, rs10046, rs749292, and rs727479. Log-rank test and Cox model were used for disease-free survival (DFS) and overall survival (OS). Cumulative incidence (CI) of breast cancer metastasis was assessed through competing risk analysis, with contralateral breast cancer, second malignancies and non-breast cancer death as competing events. CI of skeletal and cardiovascular events were assessed using DFS events as competing events. Subdistribution HR (sHR) with 95% confidence intervals were calculated through Fine-Gray method. RESULTS No SNP was associated with DFS. Variants rs10046 [sHR 2.03, (1.04-2.94)], rs749292 [sHR 2.11, (1.12-3.94)], and rs727479 [sHR 2.62, (1.17-5.83)] were associated with breast cancer metastasis. Three groups were identified on the basis of the number of these variants (0, 1, >1). Variant-based groups were associated with breast cancer metastasis (10-year CI 2.5%, 7.6%, 10.7%, P = 0.035) and OS (10-year estimates 96.5%, 93.0%, 89.6%, P = 0.030). Co-occurrence of rs10046 and rs749292 was negatively associated with 10-year CI of skeletal events (3.2% vs. 10%, P = 0.033). A similar association emerged between rs727479 and cardiovascular events (0.3% vs. 2.1%, P = 0.026). CONCLUSIONS SNP of aromatase gene predict risk of metastasis and AI-related toxicity in ER+ early breast cancer, opening an opportunity for better treatment individualization.
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Affiliation(s)
- Benedetta Conte
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Luca Boni
- S.C. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giancarlo Bisagni
- Azienda unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Durando
- Breast Unit Ospedale S Anna, Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Giovanni Sanna
- Azienda Ospedaliera Universitaria – Sassari, Sassari, Italy
| | - Stefania Gori
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Ornella Garrone
- Breast Unit, AO S. Croce e Carle Ospedale di insegnamento, Cuneo, Italy
- Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Milano
| | | | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Spain
| | | | - Riccardo Ponzone
- Candiolo Cancer Institute, FPO-IRCCS, Gynecologic Oncology and Multidisciplinary Outpatient Oncology Clinic, Candiolo, Italy
| | - Filippo Montemurro
- Candiolo Cancer Institute, FPO-IRCCS, Gynecologic Oncology and Multidisciplinary Outpatient Oncology Clinic, Candiolo, Italy
| | - Gianluigi Lunardi
- Laboratorio Analisi Chimico-Cliniche, IRCCS-Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | | | - Maria De Angioletti
- Core Research Laboratory-ISPRO, Firenze, Italy
- National Research Council (CNR) - ICCOM, Firenze, Italy
| | | | - Mauro Mansutti
- Department of Oncology, ASUFC Santa Maria della Misericordia, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy
- Depatment of Medical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - Antonio Frassoldati
- Department of Morphology, Surgery and Experimental medicine, Clinical Oncology, St. Anna University Hospital, Ferrara, Italy
| | - Mauro Porpiglia
- Breast Unit Ospedale S. Anna, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandra Fabi
- Medical Oncology, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Daniele Generali
- Medical Oncology, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Maura Rossi
- SOC Oncologia, ASO SS.Antonio e Biagio, Alessandria, Italy
| | - Fara Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
- Reveal Genomics, Barcelona, Spain
- Institute of Oncology (IOB)-Hospital Quirónsalud, Barcelona, Spain
| | - Barbara Cardinali
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Patrizia Piccioli
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Martina Serra
- Laboratory of Clinical and Experimental Immunology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sonia Lastraioli
- Molecular Diagnostic Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Bighin
- Medical Oncology Department 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Poggio
- Medical Oncology Department 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Lucia Del Mastro
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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3
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Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, Amoura Z, Andrade D, Andreoli L, Artim-Esen B, Atsumi T, Avcin T, Belmont HM, Bertolaccini ML, Branch DW, Carvalheiras G, Casini A, Cervera R, Cohen H, Costedoat-Chalumeau N, Crowther M, de Jesus G, Delluc A, Desai S, De Sancho M, Devreese KM, Diz-Kucukkaya R, Duarte-Garcia A, Frances C, Garcia D, Gris JC, Jordan N, Leaf RK, Kello N, Knight JS, Laskin C, Lee AI, Legault K, Levine SR, Levy RA, Limper M, Lockshin MD, Mayer-Pickel K, Musial J, Meroni PL, Orsolini G, Ortel TL, Pengo V, Petri M, Pons-Estel G, Gomez-Puerta JA, Raimboug Q, Roubey R, Sanna G, Seshan SV, Sciascia S, Tektonidou MG, Tincani A, Wahl D, Willis R, Yelnik C, Zuily C, Guillemin F, Costenbader K, Erkan D. The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis Rheumatol 2023; 75:1687-1702. [PMID: 37635643 DOI: 10.1002/art.42624] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 05/30/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS This international multidisciplinary initiative included 4 phases: 1) Phase I, criteria generation by surveys and literature review; 2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; 3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and 4) Phase IV, validation using independent adjudicators' consensus as the gold standard. RESULTS The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into 6 clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and 2 laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β2 -glycoprotein I antibodies). Patients accumulating at least 3 points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria versus the 2006 revised Sapporo classification criteria had a specificity of 99% versus 86%, and a sensitivity of 84% versus 99%. CONCLUSION These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.
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Affiliation(s)
- Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Stephane Zuily
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Ray Naden
- Department of Medicine and Obstetrics, Auckland City Hospital, Auckland, New Zealand
| | - Alison Hendry
- Department of General Medicine, Middlemore Hospital, Counties Manukau Health District, Auckland, New Zealand
| | - Florian Manneville
- CIC Clinical epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Mary-Carmen Amigo
- Department of Internal Medicine, Service of Rheumatology, ABC Medical Center, Mexico DF, Mexico
| | - Zahir Amoura
- French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome, Service de Medecine Interne 2, Hopital Pitie-Salpetriére; Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universite, Paris, France
| | - Danieli Andrade
- Department of Rheumatology, University of Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Bahar Artim-Esen
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan
| | - Tadej Avcin
- Department of Allergology, Rheumatology, and Clinical Immunology, Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia
| | - H Michael Belmont
- Department of Rheumatology, Hospital for Joint Disease, New York University, New York, New York
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Graziela Carvalheiras
- Unidade de Imunologia Clínica, Departamento de Medicina Interna, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Alessandro Casini
- Division of Angiology and Hemostasis, University Hospital of Geneva, Geneva, Switzerland
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Hannah Cohen
- Department of Haematology, University College London, London, UK
| | - Nathalie Costedoat-Chalumeau
- Service de médecine interne, Centre de reference maladies autoimmunes et systémiques rares Île de France, APHP, Hopital Cochin, Université de Paris, Centre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, F-75004 Paris, France
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guilherme de Jesus
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aurelien Delluc
- Department of Medicine, University Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sheetal Desai
- Division of Rheumatology, University of California, Irvine, California
| | - Maria De Sancho
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York
| | - Katrien M Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, and Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Reyhan Diz-Kucukkaya
- Department of Molecular Biology and Genetics, Istanbul University School of Science, Istanbul, Turkey
| | | | - Camille Frances
- Department of Dermatology-Allergology, Tenon Hospital, Paris, France
| | - David Garcia
- Department of Hematology, University of Washington, Seattle, Washington
| | - Jean-Christophe Gris
- Department of Hematology, CHRU-Nimes, UMR UA11 INSERM-University of Montpellier, France
| | - Natasha Jordan
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK
| | - Rebecca K Leaf
- Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nina Kello
- Division of Rheumatology, Northwell Health, Great Neck, New York
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
| | - Carl Laskin
- Division of Rheumatology, University of Toronto, TRIO Fertility, Toronto, Canada
| | - Alfred I Lee
- Department of Hematology, Yale School of Medicine, New Haven, Connecticut
| | - Kimberly Legault
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - Steve R Levine
- Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York
| | - Roger A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, and GlaxoSmithKline, Collegeville, Pennsylvania
| | - Maarten Limper
- Department of Medicine and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Michael D Lockshin
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | - Jack Musial
- Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Thomas L Ortel
- Division of Hematology, Duke University Medical Center, Durham, North Carolina
| | - Vittorio Pengo
- Department of Cardiology, University Hospital, Padova, Italy
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Guillermo Pons-Estel
- Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Quentin Raimboug
- Department of Nephrology, Bichat University Hospital, Paris, France
| | - Robert Roubey
- Department of Rheumatology, University of North Carolina, Chapel Hill, North Carolina
| | - Giovanni Sanna
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Surya V Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy, and University of Turin, Torino, Italy
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, First Propaedeutic and Internal Medicine Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Denis Wahl
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas
| | - Cecile Yelnik
- Department of Internal Medicine and Immunology, Université de Lille, CHU Lille, INSERM, UMR 1167, F-59000 Lille, France
| | - Catherine Zuily
- Department of Obstetrics, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Francis Guillemin
- CIC Clinical epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Karen Costenbader
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
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4
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Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, Amoura Z, Andrade D, Andreoli L, Artim-Esen B, Atsumi T, Avcin T, Belmont HM, Bertolaccini ML, Branch DW, Carvalheiras G, Casini A, Cervera R, Cohen H, Costedoat-Chalumeau N, Crowther M, de Jesús G, Delluc A, Desai S, Sancho MD, Devreese KM, Diz-Kucukkaya R, Duarte-García A, Frances C, Garcia D, Gris JC, Jordan N, Leaf RK, Kello N, Knight JS, Laskin C, Lee AI, Legault K, Levine SR, Levy RA, Limper M, Lockshin MD, Mayer-Pickel K, Musial J, Meroni PL, Orsolini G, Ortel TL, Pengo V, Petri M, Pons-Estel G, Gomez-Puerta JA, Raimboug Q, Roubey R, Sanna G, Seshan SV, Sciascia S, Tektonidou MG, Tincani A, Wahl D, Willis R, Yelnik C, Zuily C, Guillemin F, Costenbader K, Erkan D. 2023 ACR/EULAR antiphospholipid syndrome classification criteria. Ann Rheum Dis 2023; 82:1258-1270. [PMID: 37640450 DOI: 10.1136/ard-2023-224609] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [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: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS This international multidisciplinary initiative included four phases: (1) Phase I, criteria generation by surveys and literature review; (2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; (3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and (4) Phase IV, validation using independent adjudicators' consensus as the gold standard. RESULTS The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into six clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and two laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β2-glycoprotein I antibodies). Patients accumulating at least three points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria vs the 2006 revised Sapporo classification criteria had a specificity of 99% vs 86%, and a sensitivity of 84% vs 99%. CONCLUSION These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.
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Affiliation(s)
- Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Stephane Zuily
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Ray Naden
- Department of Medicine and Obstetrics, Auckland City Hospital, Auckland, New Zealand
| | - Alison Hendry
- Department of General Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Florian Manneville
- CIC Clinical Epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Mary-Carmen Amigo
- Department of Internal Medicine, Service of Rheumatology, ABC Medical Center, Mexico, Mexico
| | - Zahir Amoura
- French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome, Service de Medecine Interne 2, Hopital Pitie-Salpetriére; Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universite, Paris, France
| | - Danieli Andrade
- Department of Rheumatology, University of Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Bahar Artim-Esen
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan
| | - Tadej Avcin
- Department of Allergology, Rheumatology, and Clinical Immunology, Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia
| | - H Michael Belmont
- Department of Rheumatology, Hospital for Joint Disease, New York University, New York, New York, USA
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, USA
| | - Graziela Carvalheiras
- Unidade de Imunologia Clínica, Departamento de Medicina Interna, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Alessandro Casini
- Division of Angiology and Hemostasis, University Hospital of Geneva, Geneva, Switzerland
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Hannah Cohen
- Department of Haematology, University College London, London, UK
| | - Nathalie Costedoat-Chalumeau
- Service de médecine interne, Centre de reference maladies autoimmunes et systémiques rares Île de France, APHP, Hopital Cochin, Université de Paris, Centre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, Paris, France
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guilherme de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aurelien Delluc
- Department of Medicine, University Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sheetal Desai
- Division of Rheumatology, University of California, Irvine, California, USA
| | - Maria De Sancho
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Katrien M Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Reyhan Diz-Kucukkaya
- Department of Molecular Biology and Genetics, Istanbul University School of Science, Istanbul, Turkey
| | | | - Camille Frances
- Department of Dermatology-Allergology, Tenon Hospital, Paris, France
| | - David Garcia
- Department of Hematology, University of Washington, Seattle, Washington, USA
| | - Jean-Christophe Gris
- Department of Hematology, CHRU-Nimes, UMR UA11 INSERM-University of Montpellier, Montpellier, France
| | - Natasha Jordan
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK
| | - Rebecca K Leaf
- Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nina Kello
- Division of Rheumatology, Northwell Health, Great Neck, New York, New York, USA
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carl Laskin
- Division of Rheumatology, University of Toronto, TRIO Fertility, Toronto, Ontario, Canada
| | - Alfred I Lee
- Department of Hematology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly Legault
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - Steve R Levine
- Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York, USA
| | - Roger A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Maarten Limper
- Department of Medicine and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Michael D Lockshin
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Jack Musial
- Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giovanni Orsolini
- Department of Rheumatology, University Hospitals of Verona, Verona, Italy
| | - Thomas L Ortel
- Division of Hematology, Duke University Medical Center, Durham, North Carolina, USA
| | - Vittorio Pengo
- Department of Cardiology, University Hospital, Padova, Italy
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guillermo Pons-Estel
- Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Quentin Raimboug
- Department of Nephrology, Bichat University Hospital, Paris, France
| | - Robert Roubey
- Department of Rheumatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Giovanni Sanna
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Surya V Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Savino Sciascia
- Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
- University of Turin, Torino, Italy
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, First Propaedeutic and Internal Medicine Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Denis Wahl
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Cécile Yelnik
- Department of Internal Medicine and Immunology, Université de Lille, CHU Lille, INSERM, UMR 1167, Lille, France
| | - Catherine Zuily
- Department of Obstetrics, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Francis Guillemin
- CIC Clinical Epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Karen Costenbader
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
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Solinas C, Bertaglia V, Parati M, Borgonovo K, De Silva P, Pretta A, Saba G, Migliari M, Bardanzellu F, Murgia S, D’Agata A, Cadoni A, Contu F, Cadeddu M, Sanna G, Luciani A, Novello S, Scartozzi M, Emens L, Petrelli F. P002 Adjuvant chemotherapy for resected early-stage triple negative breast cancer. Breast 2023. [DOI: 10.1016/s0960-9776(23)00121-2] [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: 03/17/2023] Open
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Heller S, Sanna G, Williams V. 004 Dermato myo myelitis: a case of concurrent anti-synthetase syndrome and NMOSD. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 50 year old Afro-Caribbean gentleman with a background of Ro52 and MDA5 antibody positive anti- synthetase syndrome on prednisolone and mycophenolate mofetil presented with a tight band like pain around his thorax and abdominal pain. Examination identified severe dysaesthesia with a T6 spinal level, as well as lower limb and truncal weakness. MRI showed an expansile T2 hyperintense lesion from C7 to T8 with patchy enhancement in keeping with a NMOSD. He had no optic nerve involvement, confirmed by OCT. The weakness and dysaesthesia responded rapidly to high dose methylprednisolone however he developed constipation, recurrent neuropathic pain and tonic spasms. Serum AQP4 antibodies were present. At presentation serum CK was also raised.Up to 25% of patients with NMOSD have co-existing autoimmunity. However, there are very few reports of anti-synthetase syndrome and NMOSD. Ro-antibodies are well documented in studies on Sjögren’s disease and transverse myelitis. Patients with autoimmune connective tissue diseases who develop neurological symptoms should be investigated for neurological autoantibodies too as they are at risk of multiple autoimmune disorders. Furthermore, neurologists should be observant to other systems when presented with a patient with NMOSD as they may have other diseases which are currently asymptomatic or minimally symptomatic.
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Risi E, Vignoli A, Lisanti C, Biagioni C, Paderi A, Cappadona Sciammetta S, Del Monte F, Moretti E, Sanna G, Livraghi L, Malorni L, Benelli M, Puglisi F, Luchinat C, Tenori L, Biganzoli L. 148P Serum metabolomics based risk assessment of disease recurrence in elderly patients with early breast cancer (eBC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sidoli C, Zambon A, Tassistro E, Rossi E, Mossello E, Inzitari M, Cherubini A, Marengoni A, Morandi A, Bellelli G, Tarasconi A, Sella M, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Porcella L, Nardiello I, Chimenti E, Zeni M, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, Pietrogrande L, Mosca M, Corazzin I, Rossi P, Nunziata V, D’Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell’Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Borghi C, Bianchetti A, Crucitti A, DiFrancesco V, Fontana G, Geriatria A, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cassadonte F, Vatrano M, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Seneci F, Fimognari F, Bambar V, Saitta A, Corica F, Braga M, Servi, Ettorre E, Camellini Bellelli CG, Annoni G, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Formilan M, Patrizia G, Santuar L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl’Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, SamySalamaFahmy A, Riccardi A, Paolillo C, DiBari M, Vanni S, Scarpa A, Zara D, Ranieri P, Alessandro M, Calogero P, Corvalli G, Di F, Pezzoni D, Platto C, D’Ambrosio V, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Bonetto M, Grasso M, Troisi E, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Faraci B, Bertoletti E, Vannucci M, Crippa P, Malighetti A, Caltagirone C, DiSant S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D’Amico F, Grippa A, Mazzone A, Cottino M, Vezzadini G, Avanzi S, Brambilla C, Orini S, Sgrilli F, Mello A, Lombardi Muti LE, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D’Amico F, D’Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Cortegiani A, Pistidda L, D’Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D. Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study. Aging Clin Exp Res 2022; 34:1827-1835. [PMID: 35396698 DOI: 10.1007/s40520-022-02099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. AIM We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project". METHODS We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. RESULTS Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001). CONCLUSION This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.
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Conte B, Molinelli C, Bisagni G, Durando A, Sanna G, Gori S, Garrone O, Tamberi S, De Placido S, Schettini F, Pazzola A, Ponzone R, Montemurro F, Lunardi G, Notaro R, Turletti A, Bighin C, Poggio F, Buzzatti G, Lambertini M, Boni L, Del Mastro L. Abstract P3-09-03: Single nucletotide polymorphisms of aromatase gene ( CYP19A1) and toxicity of adjuvant aromatase inhibitors: A translational, prospective study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-09-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Extending adjuvant endocrine treatment (ET) with aromatase inhibitors (AI) to 7-10 years decreases the risk of relapse in hormone receptor-positive (HR+) breast cancer (BC). However, such benefit comes at the price of higher incidence of skeletal and cardiovascular (CV) events. Biomarkers predicting such toxicities might help clinicians in tailoring adjuvant ET to patient’s needs. We conducted a prospective study to assess whether SNPs in the gene encoding for the aromatase enzyme (CYP19A1) affect the risk of skeletal and CV events in HR+ early BC patients enrolled in the GIM4 trial. Methods: The GIM4 trial randomized HR+ BC postmenopausal patients who had been already treated with 2-3 years of adjuvant tamoxifen to either 3-2 years or 5 years of adjuvant letrozole. Four SNPs of CYP19A1 were evaluated: rs10046, rs4646, rs479292 and rs727479. SNPs were genotyped through PCR on DNA obtained from patients’ peripheral blood samples. Skeletal and CV events were assessed from randomization in the GIM4 trial to last follow-up, disease recurrence or death. Skeletal events were defined as the onset of osteoporosis or bone fractures. CV events were defined as the onset of thrombosis, embolism, stroke, myocardial infarction, hearth failure, or arrythmia. Univariate and multivariate logistic regressions were performed to evaluate the association between SNPs and skeletal and CV events. Bonferroni correction for multiplicity was used for univariate SNPs association tests, with a corrected alpha of 0.012. Only associations with an alpha level <0.012 were considered significant and included in multivariate models.Multivariate models’ covariates included: treatment arm (5 vs 3-2 years letrozole), (neo)adjuvant chemotherapy, previous hormone replacement therapy, age, BMI, previous biphosphonates, hypercholesterolemia and hypertension at baseline. SNPs were tested for Hardy–Weinberg equilibrium (HWE) and linkage disequilibrium (LD). Interaction between SNPs of interest and treatment arm was also investigated. Results: Of 2,056 patients enrolled in the GIM4 trial, 647 entered this translational study. All SNPs were in HWE. The CT and TT variants of rs10046 were less associated to skeletal events compared to variant CC, suggesting a dominant effect of the minor T allele (odds ratio [OR]: 0.47,. 95% confidence interval [CI]: 0.28-0.79, p=0.005). The association was independent from the other covariates (adjusted OR [aOR]: 0.43, p=0.002). Patients with rs10046-TT had no significant differences in the odd of skeletal events according to treatment arm. Conversely, in patients with rs10046-CC, skeletal events were more likely with 5-year letrozole (interaction p=0.043). Compared to rs10046-CC, rs10046-TT/CT was also less associated with CV events at both univariate (OR: 0.46 95% CI: 0.27-077, p=0.003) and multivariate analysis (aOR: 0.41, p<0.001).The rs727479—GG variant was associated with more CV events compared to the GT and TT variants (OR: 2.30, 95%CI: 1.27-4.15, p=0.009), suggesting a recessive effect of the minor G allele. The association remained significant at multivariate analysis (aOR: 2.30, p=0.010). No significant interaction was observed among treatment arms, rs10046 or rs272479 variants (interaction p=0.070 and 0.061). Rs10046-CC and rs727479-GG variants were in high LD (D’=0.92, haplotype-CG frequency: 39%). Hence, the association between genotype rs10046-CC/rs727479-GG and CV events was investigated. The association was significant at the multivariate analysis (aOR: 2.79, p=0.002). With such genotype, the odd of CV events was significantly increased with the 5-year letrozole (interaction p=0.046). Conclusions: SNPs of CYP19A1 could be useful biomarkers of long-term toxicity in HR+ BC patients who are candidates for adjuvant AI.
Citation Format: Benedetta Conte, Chiara Molinelli, Giancarlo Bisagni, Antonio Durando, Giovanni Sanna, Stefania Gori, Ornella Garrone, Stefano Tamberi, Sabino De Placido, Francesco Schettini, Antonio Pazzola, Riccardo Ponzone, Filippo Montemurro, Gianluigi Lunardi, Rosario Notaro, Anna Turletti, Claudia Bighin, Francesca Poggio, Giulia Buzzatti, Matteo Lambertini, Luca Boni, Lucia Del Mastro. Single nucletotide polymorphisms of aromatase gene (CYP19A1) and toxicity of adjuvant aromatase inhibitors: A translational, prospective study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-09-03.
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Affiliation(s)
- Benedetta Conte
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Molinelli
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giancarlo Bisagni
- Azienda unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Durando
- Breast Unit Ospedale S Anna, Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Giovanni Sanna
- Azienda Ospedaliera Universitaria – Sassari, Sassari, Italy
| | - Stefania Gori
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Ornella Garrone
- Breast Unit, AO S. Croce e Carle Ospedale di insegnamento, Cuneo, Italy
| | | | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcellona, Spain
| | | | - Riccardo Ponzone
- Candiolo Cancer Institute, FPO-IRCCS, Gynecologic Oncology and Multidisciplinary Outpatient Oncology Clinic, Candiolo (TO), Italy
| | - Filippo Montemurro
- Candiolo Cancer Institute, FPO-IRCCS, Gynecologic Oncology and Multidisciplinary Outpatient Oncology Clinic, Candiolo (TO), Italy
| | - Gianluigi Lunardi
- Laboratorio Analisi Chimico-Cliniche, IRCCS-Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Rosario Notaro
- Core Research Laboratory-Istituto Toscano Tumori, Azienda Universitaria-Ospedaliera Careggi, Firenze, Italy
| | | | - Claudia Bighin
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Poggio
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giulia Buzzatti
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- U.O.C. Clinica di Oncologia Medica, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino and Università di Genova, Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Genova, Italy
| | - Luca Boni
- S.C. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- S.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino and Università di Genova, Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Genova, Italy
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Zucchelli A, Manzoni F, Morandi A, Di Santo S, Rossi E, Valsecchi MG, Inzitari M, Cherubini A, Bo M, Mossello E, Marengoni A, Bellelli G, Tarasconi A, Sella M, Auriemma S, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Margola A, Porcella L, Nardiello I, Chimenti E, Zeni M, Giani A, Famularo S, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Ballestrero A, Minaglia C, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, De F, Pietrogrande L, De B, Mosca M, Corazzin I, Rossi P, Nunziata V, D‘Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell‘Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Bianchetti A, Crucitti A, Di Francesco V, Fontana G, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cannistrà U, Cassadonte F, Vatrano M, Cassandonte F, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Fimognari F, Bambara V, Saitta A, Corica F, Braga M, Ettorre E, Camellini C, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Patrizia G, Santuari L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl‘Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, SamySalamaFahmy A, Riccardi A, Paolillo C, DiBari M, Vanni S, Scarpa A, Zara D, Ranieri P, Calogero P, Corvalli G, Pezzoni D, Gentile S, Morandi A, Platto C, D‘Ambrosio V, Faraci B, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Confente S, Bonetto M, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Bertoletti E, Vannucci M, Tesi F, Crippa P, Malighetti A, Caltagirone C, DiSant S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D‘Amico F, Grippa A, Mazzone A, Riva E, Dell‘Acqua D, Cottino M, Vezzadini G, Avanzi S, Orini S, Sgrilli F, Mello A, Lombardi L, Muti E, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, De F, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D‘Amico F, D‘Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Scapigliati A, Cortegiani A, Vitale F, Pistidda L, D‘Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D. The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017. Aging Clin Exp Res 2022; 34:349-357. [PMID: 34417734 PMCID: PMC8847195 DOI: 10.1007/s40520-021-01950-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/31/2021] [Indexed: 01/22/2023]
Abstract
Introduction Delirium and sarcopenia are common, although underdiagnosed, geriatric
syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium. Methods The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses. Results A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001]. Discussion and conclusion Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01950-8.
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Sanna G, Freiwald A. Deciphering the composite morphological diversity of
Lophelia pertusa
, a cosmopolitan deep‐water ecosystem engineer. Ecosphere 2021. [DOI: 10.1002/ecs2.3802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Giovanni Sanna
- Marine Research Department Senckenberg am Meer Wilhelmshaven 26382 Germany
- Faculty of Geosciences University of Bremen Bremen 28359 Germany
- MARUM—Center for Marine Environmental Sciences University of Bremen Bremen 28359 Germany
| | - André Freiwald
- Marine Research Department Senckenberg am Meer Wilhelmshaven 26382 Germany
- Faculty of Geosciences University of Bremen Bremen 28359 Germany
- MARUM—Center for Marine Environmental Sciences University of Bremen Bremen 28359 Germany
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De Bastiani R, Sanna G, Bertolusso L, Casella G, De Polo M, Zamparella M, Cottone C, Tosetti C, Mancuso M, Pirrotta E, Lanzarotto L, Napoli L, De Bastiani M, Disclafani G, Gambaro P, Scoglio R, Belvedere A, Fasulo S, D'Urso M, Benedetto E, Baldi E, Marchesan F, Abagnale G, Turnava L, Salomè E, Ingravalle F, Tursi A. General practitioners' management of symptomatic uncomplicated diverticular disease of the colon by using rifaximin, a non-adsorbable antibiotic. Eur Rev Med Pharmacol Sci 2021; 25:423-430. [PMID: 33506932 DOI: 10.26355/eurrev_202101_24410] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Symptomatic uncomplicated diverticular disease of the colon (SUDD) is generally managed by gastroenterologists rather than General Practitioners (GPs). The aim of this study was to assess the efficacy of the treatment of SUDD with rifaximin, a non-absorbable antibiotic, in a primary care setting by GPs. PATIENTS AND METHODS This retrospective, observational study investigated the use of rifaximin at a dose of 400 mg b.i.d. for 5, 7 or 10 days monthly, up to 3 months. The symptoms were reported by the patients using a visual analogic scale (VAS) of 0-10. RESULTS 286 SUDD patients were enrolled (44.4% of men, average age 70.92±10.98). Respectively, 15 (5.2%) patients received the treatment for 5 days, 205 (71.7%) for 7 days and 66 (23.1%) for 10 days. After three months, a significant reduction of VAS score was observed in almost all symptoms assessed: 135 (47.2%) patients reported no abdominal pain (p<0.001) and 23 (8.1%) reported no symptom. Adverse events related to the treatment were recorded in 3 (1.04%) patients, all of them mild and not requiring interruption of the treatment. Acute diverticulitis occurred in 9 (3.1%) patients, but only 2 of them [0.7% (n=2)] underwent surgery due to complicated diverticulitis. Analysis within the different treatment groups (5, 7 and 10 days) shows that rifaximin treatment is effective in reducing the severity of symptoms in almost all groups except for the constipation in the 5-day group. CONCLUSIONS Rifaximin can be effectively used by GPs in real-life for the management of SUDD.
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Affiliation(s)
- R De Bastiani
- General Practitioner, Italian Association for Gastroenterology in Primary Care (GIGA-CP), Feltre (BL), Italy.
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13
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Scudiero F, Arcari L, Silverio A, Citro R, Bossone E, Autore C, Muraca I, Chinati P, Sanna G, Piti A, Parodi G. Hyperthyroidism in Takotsubo syndrome: prevalence, clinical features and long-term outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Takotsubo syndrome (TTS) is an increasingly recognized form of transient left ventricular dysfunction, often completely reversible. The exact pathogenesis is not fully understood, but central role of adrenergic dysfunction has been widely accepted. A possible link between hyperthyroidism and TTS has been hypothesized, since thyroid and adrenergic systems are in closely connection. Nevertheless, clinical study to define the association between hyperthyroidism and TTS is still lacking.
Purpose
This study aimed to assess prevalence, clinical features and long-term outcomes of hyperthyroidism at presentation in TTS patients.
Methods
Overall, 590 TTS patients from 23 centers were included in this prospective registry. Thyroid profile was available for 314 patients at time of TTS admission. Patients in hypothyroid state (n=32) according to TSH value were excluded. The remaining 282 patients were divided in normal thyroid state and hyperthyroid state according to TSH value, respectively 240 (85%) and 42 (15%) patients.
Results
The median age was 73±10 and the female rate was 93%. TTS related to physical trigger was mostly detected in hyperthyroidism patients (52% vs 30%, respectively in hyperthyroid state and normal thyroid state; p=0.005); while, TTS related to emotional trigger was less common (19%, vs 38%, respectively in hyperthyroid state and normal thyroid state; p=0.016). In TTS unprovoked by a stress factor, there was no statistical difference in thyroid state (29% vs 31%, respectively in hyperthyroid state and normal thyroid state; p=0.690). Follow-up rate was 95% and follow-up length was 41±36 months. At long-term follow-up, mortality rate was 39% and 20% in hyperthyroidism and normal thyroid state, respectively (p=0.008; Figure 1) and adverse event rates (the composite of all-cause death, myocardial infarction and stroke) were 39% and 24% in hyperthyroid state and normal thyroid state, respectively (p=0.034). At multivariable analysis, hyperthyroidism resulted as a strong predictor of mortality (OR 3.82, 95% CI: 1.71–8.50; p=0.001) and of adverse event rates (OR 2.18, 95% CI: 1.19–3.98; p=0.011).
Conclusion
Hyperthyroidism at presentation is relatively common in TTS patients and associated with physical triggers and unfavorable long-term prognosis.
Figure 1. Kaplan-Meier curves
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Scudiero
- Bolognini Hospital - Seriate, Seriate, Italy
| | - L Arcari
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Rome, Italy
| | - A Silverio
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - R Citro
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - E Bossone
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - C Autore
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Rome, Italy
| | - I Muraca
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - P Chinati
- Bolognini Hospital - Seriate, Seriate, Italy
| | - G Sanna
- University of Sassari, Clinical and Interventional Cardiology, Sassari, Italy
| | - A Piti
- Bolognini Hospital - Seriate, Seriate, Italy
| | - G Parodi
- University of Sassari, Clinical and Interventional Cardiology, Sassari, Italy
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14
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Malorni L, Curigliano G, Minisini AM, Cinieri S, Tondini CA, D'Hollander K, Arpino G, Bernardo A, Martignetti A, Criscitiello C, Puglisi F, Pestrin M, Sanna G, Moretti E, Risi E, Biagioni C, McCartney A, Boni L, Buyse M, Migliaccio I, Biganzoli L, Di Leo A. Palbociclib as single agent or in combination with the endocrine therapy received before disease progression for estrogen receptor-positive, HER2-negative metastatic breast cancer: TREnd trial. Ann Oncol 2019; 29:1748-1754. [PMID: 29893790 DOI: 10.1093/annonc/mdy214] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background The activity of palbociclib as a single agent in advanced breast cancer has not been extensively studied, with the only available clinical data limited to heavily pretreated patients. Preclinical data suggests palbociclib may partially reverse endocrine resistance, though this hypothesis has not been evaluated in previous clinical studies. This phase II, open-label, multicenter study examined the activity of palbociclib monotherapy, as well as palbociclib given in combination with the same endocrine therapy (ET) that was received prior to disease progression, in postmenopausal women with moderately pretreated, estrogen receptor-positive, HER2 negative advanced breast cancer. Patients and methods Eligible women with advanced disease which had progressed on one or two prior ETs were randomized 1 : 1 to receive either palbociclib alone, or palbociclib in combination with the ET as previously received. Primary end point was clinical benefit rate (CBR); secondary end points included progression-free survival (PFS). Results Between October 2012 and July 2016, a total of 115 patients were randomized. The CBR was 54% [95% confidence interval (CI): 41.5-63.7] for combination therapy, and 60% (95% CI: 47.8-72.9) for monotherapy. Median PFS was 10.8 months (95% CI: 5.6-12.7) for combination therapy, and 6.5 months (95% CI: 5.4-8.5) for monotherapy [hazard ratio (HR) 0.69; 95% CI: 0.4-1.1, exploratory P-value = 0.12]. Exploratory analyses revealed the PFS advantage for combination therapy was seen in the subgroup of patients who received prior ET for >6 months (HR 0.53; 95% CI: 0.3-0.9, exploratory P-value = 0.02), but not in those who received prior ET for ≤6 months. Conclusion Palbociclib has clinical activity as a single agent in women with moderately pretreated, oestrogen receptor-positive, HER2-negative advanced breast cancer. Palbociclib may have potential to reverse endocrine resistance in patients with a history of previous durable response to ET. Clinical trial information NCT02549430.
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Affiliation(s)
- L Malorni
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy.
| | - G Curigliano
- Division of Early Drug Development, Department of Haematology and Haemato-Oncology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - A M Minisini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - S Cinieri
- Medical Oncology Department, ASL Brindisi, Brindisi, Italy
| | - C A Tondini
- Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - K D'Hollander
- International Drug Development Institute, Louvain-La-Neuve, Belgium
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples
| | - A Bernardo
- Medical Oncology Department, ICS Maugeri IRCCS, Pavia, Italy
| | - A Martignetti
- Oncology Department, Azienda USL Toscana Sud Est, Hospital Alta Val D'Elsa, Poggibonsi Siena, Italy
| | - C Criscitiello
- Division of Early Drug Development, Istituto Europeo di Oncologia, Milan, Italy
| | - F Puglisi
- Medical Oncology and Cancer Prevention Unit, IRCCS, CRO National Cancer Institute, Aviano; Department of Medicine, University of Udine, Udine, Italy
| | - M Pestrin
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - G Sanna
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - E Moretti
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - E Risi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - C Biagioni
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - A McCartney
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - L Boni
- Clinical Trial Coordinating Center, AOU Careggi, Istituto Toscano Tumori, Florence, Italy
| | - M Buyse
- International Drug Development Institute, San Francisco, USA
| | - I Migliaccio
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - L Biganzoli
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - A Di Leo
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Prato, Italy
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Del Mastro L, Mansutti M, Bisagni G, Ponzone R, Durando A, Amaducci L, Fabi A, Frassoldati A, Michelotti A, Pazzola A, Valle E, Sanna G, Gori S, De Placido S, Garrone O, Donadio M, Bruzzi P, Bighin C, Lambertini M, Poggio F. Benefit from letrozole as extended adjuvant therapy after sequential endocrine therapy: A randomized, phase III study of Gruppo Italiano Mammella (GIM). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.504] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
504 Background: The effect of extended adjuvant endocrine therapy (ET) with aromatase inhibitors (AI) after sequential ET with tamoxifen (Tam) followed by AI for 5 years is still controversial. We conduct a clinical trial to assess different durations of ET of letrozole after tam. Methods: The GIM4 LEAD (Gruppo Italiano Mammella 4- Letrozole adjuvant therapy duration study, ClinicalTrials.gov:NCT01064635 ) was a prospective, randomized, Italian multicentric trial. Post-menopausal patients (pts) with hormone receptor positive early breast cancer free of recurrence after 2-3 years of adjuvant tam, were randomized in a 1:1 ratio to receive 3-2 years (short arm, S) or 5 years (long arm, L) of letrozole. The primary study end point was disease-free survival (DFS). Results: Between August 2005 and May 2010, 2056 pts were randomly assigned to receive 3-2 years (n=1030) or 5 years (n=1026) of letrozole. Main patients characteristics in the S and L arms were, respectively: median age 60 vs 61 years, node negative 56 vs 56%, (neo)adjuvant chemotherapy 53.4 vs 54.1%. The median follow-up was 10 years (IQR range: 8.6-11.4). The 8-year DFS was 80% (95% CI:77.3-82.7) and 85% (95% CI:82.9-87.6) in the S and L arm, respectively (hazard ratio, HR 0.82; 95% CI:0.68-0.98; p=0.031). This effect did not change in a multivariate Cox model that included nodal status, grading and age. No evidence of interaction between random assignment and nodal status, age and grading was observed. Among 1960 pts evaluable for toxicity, osteoporosis was diagnosed in 47 (4.8%) in S arm and 81 (8.3%) pts in L arm (chi-square=9.88; p=0.002). Bone fractures occurred in 5 (0.5%) and 9 (0.9%) pts in S and L arm, respectively ( p=0.29, Fisher exact test). Conclusions: After 2-3 years of adjuvant tam, extended treatment with 5 years of letrozole resulted in significant improvement in DFS compared to the standard duration of 2-3 years of letrozole. Clinical trial information: NCT01064635.
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Affiliation(s)
- Lucia Del Mastro
- Ospedale Policlinico San Martino-Oncologia Medica, Genova, Italy
| | - Mauro Mansutti
- Department of Oncology-ASUI Udine University Hospital, Udine, Italy
| | - Giancarlo Bisagni
- Oncologia Medica Azienda USL/IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Antonio Durando
- Breast Unit, Città della Salute e della Scienza, ASO S. Anna, Torino, Italy
| | - Laura Amaducci
- Ospedale Faenza, Dipartimento Oncologico Area Vasta Romagna, Faenza, Italy
| | - Alessandra Fabi
- Division of Medical Oncology, “Regina Elena” National Cancer Institute, Rome, Italy
| | | | | | - Antonio Pazzola
- Medical Oncology - Ospedale Civile SS. Annunziata, Sassari, Italy
| | - Enrichetta Valle
- Oncologia Medica, Ospedale Oncologico “A. Businco”-AO Brotzu, Cagliari, Italy
| | - Giovanni Sanna
- Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | - Stefania Gori
- Oncology Unit, Ospedale Sacro Cuore-don Calabria, Negrar, Italy
| | - Sabino De Placido
- Oncology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Ornella Garrone
- Breast Unit Medical Oncology S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Michela Donadio
- Oncology Department Aou Città Della Salute e Della Scienza, Torino, Italy
| | - Paolo Bruzzi
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Matteo Lambertini
- Policlinico San Martino Hospital - University of Genova, Genova, Italy
| | - Francesca Poggio
- Ospedale Policlinico San Martino- Oncologia medica, Genova, Italy
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Díaz P, Varcasia A, Pipia AP, Tamponi C, Sanna G, Prieto A, Ruiu A, Spissu P, Díez-Baños P, Morrondo P, Scala A. Molecular characterisation and risk factor analysis of Cryptosporidium spp. in calves from Italy. Parasitol Res 2018; 117:3081-3090. [PMID: 30008134 PMCID: PMC7088234 DOI: 10.1007/s00436-018-6000-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 07/04/2018] [Indexed: 11/27/2022]
Abstract
To provide up-to-date information on the occurrence of Cryptosporidium in pre-weaned calves from Sardinia (Italy), the species implicated and their zoonotic potential, 147 faecal samples from 22 cattle herds were microscopically examined for Cryptosporidium oocysts; positive isolates were molecularly characterised. A questionnaire was developed to identify risk factors for Cryptosporidium infection. Overall, the percentage of positive calves and farms was 38.8 and 68.2%, respectively. The SSU rRNA-based PCR identified two Cryptosporidium species, Cryptosporidium parvum (95.8%) and C. bovis (4.2%). Sequence analyses of the glycoprotein (gp60) gene revealed that all C. parvum isolates belonged to the subtype family IIa (IIaA15G2R1 and IIaA16G3R1), with the exception of three isolates that belonged to the subtype family IId (IIdA20G1b and IIdA20). Mixed logistic regression results indicated that calves aged 15-21 days were more likely to be Cryptosporidium-positive. The risk of being positive was also significantly higher in herds from Central Sardinia and in farms using non-slatted flooring. In addition, the application of disinfectants and milk replacers was significantly associated with higher Cryptosporidium prevalence. In contrast, the risk of being positive was significantly reduced in halofuginone-treated calves. Our results reveal that a significant percentage of suckling calves are carriers of zoonotic subtypes of C. parvum. Thus, both healthy and diarrhoeic calves younger than 1 month may represent a risk for the transmission of cryptosporidiosis in humans and animals.
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Affiliation(s)
- P Díaz
- Investigation in Animal Health: Galicia (INVESAGA Group), School of Veterinary Medicine, Universidade de Santiago de Compostela, Lugo, Spain.
| | - A Varcasia
- Laboratory of Parasitology, Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - A P Pipia
- Laboratory of Parasitology, Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - C Tamponi
- Laboratory of Parasitology, Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - G Sanna
- Laboratory of Parasitology, Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - A Prieto
- Investigation in Animal Health: Galicia (INVESAGA Group), School of Veterinary Medicine, Universidade de Santiago de Compostela, Lugo, Spain
| | - A Ruiu
- Experimental Zooprophylactic Institute of Sardinia, Oristano, Italy
| | - P Spissu
- Regional Association of Sardinian Farmers, Cagliari, Italy
| | - P Díez-Baños
- Investigation in Animal Health: Galicia (INVESAGA Group), School of Veterinary Medicine, Universidade de Santiago de Compostela, Lugo, Spain
| | - P Morrondo
- Investigation in Animal Health: Galicia (INVESAGA Group), School of Veterinary Medicine, Universidade de Santiago de Compostela, Lugo, Spain
| | - A Scala
- Laboratory of Parasitology, Veterinary Teaching Hospital, Department of Veterinary Medicine, University of Sassari, Sassari, Italy
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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease presenting highly heterogeneous clinical manifestations and multi-systemic involvement. Patients are susceptible to relapse- and remission, thus making management challenging. Moreover, a considerable number of side effects may occur with conventional therapies; therefore, there is clearly a need for new therapeutic strategies. Since the pathogenesis of SLE is highly complex, it is far from being fully understood. However, greater understanding of the pathways and of the cellular and molecular mediators involved in SLE is being achieved. Emerging evidence has allowed the development of new biological therapeutic options targeting crucial molecular mediators involved in the pathogenesis of SLE. This literature review analyzes the availability of biological and target-directed treatments, phase II and III trials, and new therapies that are being developed for the treatment of SLE.
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Affiliation(s)
- Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
| | - Massimo Radin
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
| | - Giovanni Sanna
- Louise Coote Lupus Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King’s College London, London, UK
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Sciascia S, Radin M, Sanna G, Cecchi I, Roccatello D, Bertolaccini ML. Clinical utility of the global anti-phospholipid syndrome score for risk stratification: a pooled analysis. Rheumatology (Oxford) 2018; 57:661-665. [PMID: 29342292 DOI: 10.1093/rheumatology/kex466] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Recently, our group conceived a risk score for clinical manifestations of APS (the global APS score, or GAPSS) that takes into account the combination of independent cardiovascular risk factors and the aPL positivity profile. These include hyperlipidaemia, arterial hypertension, aCL, anti-β2 glycoprotein-I, aPS-PT and the LA. A complementary version, the adjusted GAPSS (aGAPSS), which excludes aPS-PT, was also designed. The aim of our study was to systematically review the literature to assess the clinical utility of the GAPSS and aGAPSS for risk stratification of any APS clinical manifestation. Methods We pooled data from available cohort studies, including a total of 10 studies, comprising 2273 patients, in which the GAPSS has been applied. A search strategy was developed a priori to identify an available cohort that reported findings which investigated the clinical utility of GAPSS or aGAPSS. Results Seven studies used the GAPSS in their cohort, whereas three studies used the aGAPSS. In brief, we found a statistically significant difference in the cumulative GAPSS and aGAPSS between patients that experienced an arterial and/or venous thrombotic event [cumulative mean GAPSS (s.d.) 10.6 (4.74) and aGAPSS 7.6 (3.95)], patients without any thrombotic manifestation [cumulative GAPSS 7.01 (5.46) and aGAPSS 4.9 (4.33)] and patients with pregnancy morbidity [cumulative GAPSS 8.79 (2.59) and aGAPSS 6.7 (2.8)]. The highest levels of GAPSS were found in patients that experienced arterial thrombosis [mean GAPSS 12.2 (5.2)] and patients that experienced any recurrences of clinical manifestations of APS [mean GAPSS 13.7 (3.1)]. Conclusion GAPSS may represent a useful tool to assess the thrombosis or pregnancy loss risk in aPL-positive patients, switching from the concept of aPL as a sole diagnostic antibody to aPL as risk factors for clinical events.
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Affiliation(s)
- Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin and S. Giovanni Bosco Hospital Turin, Italy.,Nephrology and Dialysis Unit, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Massimo Radin
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin and S. Giovanni Bosco Hospital Turin, Italy
| | - Giovanni Sanna
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Irene Cecchi
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin and S. Giovanni Bosco Hospital Turin, Italy
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin and S. Giovanni Bosco Hospital Turin, Italy.,Nephrology and Dialysis Unit, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, London, UK
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Casian A, Kronbichler A, Sangle S, Robson M, Brown H, Abbs I, Mercer S, Sanna G, D'Cruz D. 134 Calcineurin inhibitors as adjunctive therapy for lupus nephritis: a retrospective study from two European centres. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.358] [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: 11/12/2022] Open
Affiliation(s)
- Alina Casian
- Lupus Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UNITED KINGDOM
| | | | - Shirish Sangle
- Lupus Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UNITED KINGDOM
| | - Michael Robson
- Nephrology, Guy's and St. Thomas' NHS Foundation Trust, London, UNITED KINGDOM
| | - Heather Brown
- Nephrology, Guy's and St. Thomas' NHS Foundation Trust, London, UNITED KINGDOM
| | - Ian Abbs
- Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UNITED KINGDOM
| | - Scott Mercer
- Pharmacy, Guy's and St. Thomas' NHS Foundation Trust, London, UNITED KINGDOM
| | - Giovanni Sanna
- Lupus Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UNITED KINGDOM
| | - David D'Cruz
- Lupus Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UNITED KINGDOM
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Bertolaccini ML, Sanna G, Ralhan S, Gennari LC, Merrill JT, Khamashta MA, Hughes GRV. Antibodies directed to protein S in patients with systemic lupus erythematosus: prevalence and clinical significance. Thromb Haemost 2017; 90:636-41. [PMID: 14515184 DOI: 10.1160/th03-03-0151] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryAntibodies directed against protein S (anti-ProtS) may be involved in the development of thrombosis in patients with the antiphospholipid syndrome. We assessed the prevalence and clinical significance of anti-ProtS and evaluated their immunological characteristics in 184 patients with SLE and 99 healthy donors. All patients were tested for IgG anti-ProtS by an in-house ELISA. Plasma levels and functional activity of protein S were also tested.Anti-ProtS were found in 57 patients (31%) and 4 healthy controls (4%). Patients with thrombosis had anti-ProtS more frequently than controls (29% vs 4%, OR 9.5 [95% CI 3.07-29.3], p<0.0001). Anti-ProtS were more frequent in patients with venous thrombosis and in those with arterial thrombosis, than in controls (41% vs. 4%, OR 16.5 [95% CI 5-54], p< 0.0001 and 23% vs. 4%, OR 7 [95%CI 2.1-23.5], p=0.0008, respective-ly). Patients with prematurity, preeclampsia and intra-uterine growth restriction had anti-ProtS more frequently than the control group (36%, 47% and 44% vs. 4%; OR 13.6 [95% CI 2.8-66], p=0.003, OR 21 [95% CI 5-86], p<0.0001 and OR 19 [95% CI 4-99], p=0.0014, respectively). Plasma levels of free protein S were not statistically different between patients with and without anti-ProtS and controls (77.9% [20.7-100] vs. 83.7% [52.7-100] vs. 89% [62-101], respectively). Free protein S functional activity was no different between subgroups (105% [48-230] in anti-ProtS positive vs. 123% [95-283] in anti-ProtS negative vs. 136% [60-174] in controls).Anti-ProtS are frequent in SLE patients with thrombosis and pregnancy morbidity. These antibodies do not interfere with free protein S in plasma since its level and/or functional activity are not impaired.
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Cooray S, Zhang H, Breen R, Carr-White G, Howard R, Cuadrado M, D’Cruz D, Sanna G. Cerebral tuberculosis in a patient with systemic lupus erythematosus following cyclophosphamide treatment: a case report. Lupus 2017; 27:670-675. [DOI: 10.1177/0961203317722849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S Cooray
- Louise Coote Lupus Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK
- Department of Respiratory Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - H Zhang
- Louise Coote Lupus Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - R Breen
- Department of Respiratory Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - G Carr-White
- Cardiothoracic Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - R Howard
- Department of Neurology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - M Cuadrado
- Louise Coote Lupus Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - D D’Cruz
- Louise Coote Lupus Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - G Sanna
- Louise Coote Lupus Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK
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22
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Azara E, Longheu C, Sanna G, Tola S. Biofilm formation and virulence factor analysis ofStaphylococcus aureusisolates collected from ovine mastitis. J Appl Microbiol 2017; 123:372-379. [DOI: 10.1111/jam.13502] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 02/04/2023]
Affiliation(s)
- E. Azara
- Istituto Zooprofilattico Sperimentale of Sardinia”G. Pegreffi”; Sassari Italy
| | - C. Longheu
- Istituto Zooprofilattico Sperimentale of Sardinia”G. Pegreffi”; Sassari Italy
| | - G. Sanna
- Istituto Zooprofilattico Sperimentale of Sardinia”G. Pegreffi”; Sassari Italy
| | - S. Tola
- Istituto Zooprofilattico Sperimentale of Sardinia”G. Pegreffi”; Sassari Italy
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23
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Tamponi C, Varcasia A, Pinna S, Melis E, Melosu V, Zidda A, Sanna G, Pipia AP, Zedda MT, Pau S, Brianti E, Scala A. Endoparasites detected in faecal samples from dogs and cats referred for routine clinical visit in Sardinia, Italy. Vet Parasitol Reg Stud Reports 2017; 10:13-17. [PMID: 31014584 DOI: 10.1016/j.vprsr.2017.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 06/20/2017] [Accepted: 07/04/2017] [Indexed: 12/12/2022]
Abstract
This study aimed to update data on the prevalence of intestinal and lung parasitic infections in owned dogs and cats in Sardinia, Italy. Examinations on faecal samples from 619 dogs and 343 cats routinely referred to the Veterinary Teaching Hospital of the University of Sassari were performed between the years of 2011 and 2015. Individual faecal samples were analysed using the Wisconsin technique for copro-microscopic examination and the Baermann technique for the presence of lungworm larvae. Endoparasites were found in 34.9% and 43.4% of examined dogs and cats, respectively. Helminthic infections (21.2% in dogs and 32.6% in cats) occurred more frequently than protozoan infections (17.9% in dogs and 17.8% in cats). In both dogs and cats, the most common parasites were ascarids (12.1% and 15.7%), Cystoisospora spp. (10.2% and 10.8%), Giardia duodenalis (9.4% and 8.5%), and hookworms (7.9% and 5.5%). Evidence of bronchopulmonary nematode infections were found in 0.8% of examined dogs and in 15.8% of examined cats. Age was identified as a risk factor, with animals younger than 6months more frequently infected than older animals, while no significant association was observed for gender. This study demonstrated that endoparasites in owned dogs and cats of Sardinia have considerably high prevalence. Veterinary practitioners and pet owners should be more aware of these infections and should adopt more effective and standardized control practices.
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Affiliation(s)
- C Tamponi
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy
| | - A Varcasia
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy.
| | - S Pinna
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy
| | - E Melis
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy
| | - V Melosu
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy
| | - A Zidda
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy
| | - G Sanna
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy
| | - A P Pipia
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy
| | - M T Zedda
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy
| | - S Pau
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy
| | - E Brianti
- Dipartimento di Scienze Veterinarie, Università degli Studi di Messina, Messina, Italy
| | - A Scala
- Laboratorio di Parassitologia, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Italy
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Abstract
AbstractWhile lupus anticoagulant (LA), anticardiolipin antibodies (aCL), anti-β2 glycoprotein I (anti-β2GPI) antibodies represent the best available and the most widely used tests in the investigation for antiphospholipid syndrome (APS), evidence gathered in recent years indicates that other antiphospholipid antibodies (aPL) specificities may also play a role in the syndrome. Several autoantibodies have been shown to be complexed with phospholipids other than cardiolipin, or to some domains of β2GPI, or else directed to other proteins of the coagulation cascade, and these have also been proposed to be of relevance to APS, and their diagnostic value and clinical utility are the focus of current research.
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Affiliation(s)
- Giovanni Sanna
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Maria Bertolaccini
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, United Kingdom
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Di Leo A, Pestrin M, Siclari O, Sanna G, Moretti E, Biganzoli L. De-escalating and escalating treatment beyond endocrine therapy in patients with luminal breast cancer. Breast 2017. [DOI: 10.1016/s0960-9776(17)30100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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26
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Lachowicz JI, Palomba S, Meloni P, Carboni M, Sanna G, Floris R, Pusceddu V, Sarigu M. Multi analytical technique study of human bones from an archaeological discovery. J Trace Elem Med Biol 2017; 40:54-60. [PMID: 28159222 DOI: 10.1016/j.jtemb.2016.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/11/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Abstract
In 1953, during the building restoration of San Michele church (Bono, Sardinia, 16th-19th Century), a high number of disarticulated skeletons were recovered. From a group of 412 hip bones, two of these, affected by several pathological lesions, were analysed. The two coxal bones can be referred to the same individual, an adult man. A multi-analytical study, started with the purpose of investigating the bone pathology, was extended to characterize the mineral components of a large representative set of bones from the same ossuary, all attributed to adult men who lived in the region four-two centuries ago. A quantitative ICP-AES analysis for Ca, Fe, Mg, Mn, Na, Pb and Zn was executed, and a chemometric investigation on the results was performed. This approach gave evidence of the effects of diagenesis, allowed some hypothesis of the incidence of the known dietary habits on bone composition, and completely differentiated the pathological bones from those of a normal population on the basis of the mineral composition. Moreover, porosity, crystallinity and FT-IR analysis were conducted on both non- and pathological sample.
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Affiliation(s)
- J I Lachowicz
- Dipartimento di Scienze Chimiche e Geologiche, Università di Cagliari, Cittadella Universitaria, I-09042 Monserrato, Cagliari, Italy.
| | - S Palomba
- Dipartimento di Scienze Chimiche e Geologiche, Università di Cagliari, Cittadella Universitaria, I-09042 Monserrato, Cagliari, Italy
| | - P Meloni
- Università Degli Studi di Cagliari, Dipartimento di Ingegneria Meccanica, Chimica e Dei Materiali (DIMCM), Via Marengo, 2, Cagliari, Italy
| | - M Carboni
- Dipartimento di Chimica e Farmacia, Università di Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - G Sanna
- Dipartimento di Chimica e Farmacia, Università di Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - R Floris
- Dipartimento di Scienze della Vita e dell Ambiente, Università di Cagliari, Cittadella Universitaria, I-09042 Monserrato, Cagliari, Italy
| | - V Pusceddu
- Dipartimento di Scienze della Vita e dell Ambiente, Università di Cagliari, Cittadella Universitaria, I-09042 Monserrato, Cagliari, Italy
| | - M Sarigu
- Dipartimento di Scienze della Vita e dell Ambiente, Università di Cagliari, Cittadella Universitaria, I-09042 Monserrato, Cagliari, Italy
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27
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Abstract
Antiphospholipid syndrome (APS), also known as Hughes Syndrome, is a systemic autoimmune disease characterized by thrombosis and/or pregnancy morbidity in the presence of persistently positive antiphospholipid antibodies. A patient with APS must meet at least one of two clinical criteria (vascular thrombosis or complications of pregnancy) and at least one of two laboratory criteria including the persistent presence of lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and/or anti-b2 glycoprotein I (anti-b2GPI) antibodies of IgG or IgM isotype at medium to high titres in patient’s plasma. However, several other autoantibodies targeting other coagulation cascade proteins (i.e. prothrombin) or their complex with phospholipids (i.e. phosphatidylserine/prothrombin complex), or to some domains of β2GPI, have been proposed to be also relevant to APS. In fact, the value of testing for new aPL specificities in the identification of APS in thrombosis and/or pregnancy morbidity patients is currently being investigated.
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Affiliation(s)
- Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, London, UK
| | - Giovanni Sanna
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
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28
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Bertolaccini ML, Contento G, Lennen R, Sanna G, Blower PJ, Ma MT, Sunassee K, Girardi G. Complement inhibition by hydroxychloroquine prevents placental and fetal brain abnormalities in antiphospholipid syndrome. J Autoimmun 2016; 75:30-38. [PMID: 27160365 PMCID: PMC6203312 DOI: 10.1016/j.jaut.2016.04.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [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] [Received: 03/09/2016] [Revised: 04/21/2016] [Accepted: 04/24/2016] [Indexed: 11/24/2022]
Abstract
Placental ischemic disease and adverse pregnancy outcomes are frequently observed in patients with antiphospholipid syndrome (APS). Despite the administration of conventional antithrombotic treatment a significant number of women continue to experience adverse pregnancy outcomes, with uncertain prevention and management. Efforts to develop effective pharmacological strategies for refractory obstetric APS cases will be of significant clinical benefit for both mothers and fetuses. Although the antimalarial drug, hydroxychloroquine (HCQ) is increasingly used to treat pregnant women with APS, little is known about its efficacy and mechanism of action of HCQ. Because complement activation plays a crucial and causative role in placental ischemia and abnormal fetal brain development in APS we hypothesised that HCQ prevents these pregnancy complications through inhibition of complement activation. Using a mouse model of obstetric APS that closely resembles the clinical condition, we found that HCQ prevented fetal death and the placental metabolic changes -measured by proton magnetic resonance spectroscopy in APS-mice. Using 111In labelled antiphospholipid antibodies (aPL) we identified the placenta and the fetal brain as the main organ targets in APS-mice. Using this same method, we found that HCQ does not inhibit aPL binding to tissues as was previously suggested from in vitro studies. While HCQ did not affect aPL binding to fetal brain it prevented fetal brain abnormal cortical development. HCQ prevented complement activation in vivo and in vitro. Complement C5a levels in serum samples from APS patients and APS-mice were lower after treatment with HCQ while the antibodies titres remained unchanged. HCQ prevented not only placental insufficiency but also abnormal fetal brain development in APS. By inhibiting complement activation, HCQ might also be an effective antithrombotic therapy.
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Affiliation(s)
| | - Gregorio Contento
- Division of Women's Health, St Thomas' Hospital, King's College London, London, SE1 7EH, UK
| | - Ross Lennen
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Giovanni Sanna
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, UK
| | - Philip J Blower
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, SE1 7EH, UK
| | - Michelle T Ma
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, SE1 7EH, UK
| | - Kavitha Sunassee
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, SE1 7EH, UK
| | - Guillermina Girardi
- Division of Women's Health, St Thomas' Hospital, King's College London, London, SE1 7EH, UK; MRC Centre for Inflammation Research, Queen's Medical Research Institute University of Edinburgh, Edinburgh, EH16 4TJ, UK.
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Palomba G, Doneddu V, Cossu A, Paliogiannis P, Manca A, Casula M, Colombino M, Lanzillo A, Defraia E, Pazzola A, Sanna G, Putzu C, Ortu S, Scartozzi M, Ionta MT, Baldino G, Sarobba G, Capelli F, Sedda T, Virdis L, Barca M, Gramignano G, Budroni M, Tanda F, Palmieri G. Prognostic impact of KRAS, NRAS, BRAF, and PIK3CA mutations in primary colorectal carcinomas: a population-based study. J Transl Med 2016; 14:292. [PMID: 27737711 PMCID: PMC5064898 DOI: 10.1186/s12967-016-1053-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023] Open
Abstract
Background Activation of oncogenes downstream the EGFR gene contributes to colorectal tumorigenesis and determines the sensitivity to anti-EGFR treatments. The aim of this study was to evaluate the prognostic value of KRAS, BRAF, NRAS and PIK3CA mutations in a large collection of CRC patients from genetically-homogeneous Sardinian population. Methods A total of 1284 Sardinian patients with histologically-proven diagnosis of colorectal carcinoma (CRC) and presenting with metastatic disease were included into the study. Genomic DNA was isolated from formalin-fixed, paraffin-embedded primary tumour tissue samples of CRC patients and screened for mutations in RAS and BRAF genes, using pyrosequencing assays, and in PIK3CA gene, using automated DNA sequencing assays. Results Overall, mutation rates were 35.6 % for KRAS, 4.1 % for NRAS, and 2.1 % for BRAF. Among available DNA samples, 114/796 (14.3 %) primary CRCs were found to carry a mutation in the PIK3CA gene. In this subset of patients analysed in all four genes, a pathogenetic mutation of at least one gene was discovered in about half (378/796; 47.5 %) of CRC cases. A mutated BRAF gene was found to steadily act as a negative prognostic factor for either time to progression as metastatic disease (from detection of primary CRC to diagnosis of first distant metastasis; p = 0.009) or partial survival (from diagnosis of advanced disease to the time of death or last control; p = 0.006) or overall survival (p < 0.001). No significant impact on prognosis was observed for mutated KRAS, NRAS, and PIK3CA genes or combined RAS mutations (all RAS). Conclusions Our study defines both prevalence and prognostic role of main activated oncogenes in a population-based large collection of CRC patients. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-1053-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Grazia Palomba
- Institute of Biomolecular Chemistry, CNR, Sassari, Italy
| | - Valentina Doneddu
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, PC, Italy
| | - Antonio Cossu
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, PC, Italy
| | - Panagiotis Paliogiannis
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, PC, Italy.
| | | | - Milena Casula
- Institute of Biomolecular Chemistry, CNR, Sassari, Italy
| | | | | | | | - Antonio Pazzola
- Medical Oncology Unit, University-Hospital of Sassari (AOU), Sassari, Italy
| | - Giovanni Sanna
- Medical Oncology Unit, University-Hospital of Sassari (AOU), Sassari, Italy
| | - Carlo Putzu
- Medical Oncology Unit, University-Hospital of Sassari (AOU), Sassari, Italy
| | | | - Mario Scartozzi
- Department of Medical Oncology, University of Cagliari, Cagliari, Italy
| | | | | | | | | | - Tito Sedda
- Oncology Unit, Local Health Agency, Oristano, Italy
| | - Luciano Virdis
- Oncology Unit, Local Health Agency, Carbonia-Iglesias, Italy
| | | | | | - Mario Budroni
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, PC, Italy
| | - Francesco Tanda
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, PC, Italy
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Sanna G, Mislang A, Pestrin M, Biagioni C, Risi E, Cappadona S, Moretti E, Gabellini S, Di Leo A, Biganzoli L. A single centre pilot study aiming to determine the recommended dose (RD) of metronomic oral vinorelbine in combination with oral cyclophosphamide and bevacizumab in advanced breast cancer (ABC) patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.47] [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: 11/14/2022] Open
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Abstract
Headache is a common feature in patients with systemic lupus erythematosus (SLE) and represents a significant source of patient discomfort. The exact prevalence of headache in SLE is unknown. The results of different studies widely vary, most likely due to the use of different classification for headache and the lack of controls in most studies. The relationshipbetween headache and SLE is also unclear since it is difficult to determine which degree and type of headaches can be explained on the basis of chronic illness, or as part of the disease spectrum of SLE. No pathogenic mechanism has so far been described that can fully explain headache induced by SLE. The role of circulating cytokines, vascular injury, neuronal damage or antiphospholipid antibodies (aPL) in the development of headache in SLE patients is also a matter of debate. Other concomitant causes such as infection or hypertension should be excluded before assuming that headache is a feature of SLE activity. Therapeutic approach of headache SLE-related remains empirical and based on clinical experience.
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Affiliation(s)
- M J Cuadrado
- Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, London, UK.
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Abstract
Management of central nervous system (CNS) involvement still remains one of the most challenging problems in systemic lupus erythematosus (SLE). The best available evidence for the treatment of CNS lupus is largely based on retrospectiveseries, case reports and expert opinion. Current therapy is empirical and tailored to the individual patient. Symptomatic, immunosuppressiveand anticoagulant therapies are the main strategies for the management of CNS lupus. The choice depends on the most probable underlying pathogenic mechanism and the severity of the presenting neuropsychiatric symptoms. Thrombotic and nonthrombotic CNS disease needs to be differentiated and requires different management strategies. However, this is often challenging since many, if not most CNS manifestations, may be due to a combination of different pathogenic mechanisms and multiple CNS events may occur in the individual patient. Patients with mild manifestations may need symptomatic treatment only, whereas more severe acute nonthrombotic CNS manifestations may require pulse intravenouscyclophosphamide.Plasmapheresismay also be added in patients with more severe illness refractory to conventionaltreatment. Recently, the use of intrathecalmethotrexateand dexamethasone has been reported in a small series of patients, with a good outcome in patients with severe CNS manifestations.Anticoagulationis warranted in patients with thrombotic disease, particularlyin those with the antiphospholipid syndrome (APS). This article reviews the clinical approach to therapy in patients with CNS lupus.
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Affiliation(s)
- G Sanna
- Department of Rheumatology, Homerton University Hospital, London E9 6SR, UK.
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Palomba G, Cossu A, Paliogiannis P, Pazzola A, Baldino G, Scartozzi M, Ionta MT, Ortu S, Capelli F, Lanzillo A, Sedda T, Sanna G, Barca M, Virdis L, Budroni M, Palmieri G. Prognostic role of KRAS mutations in Sardinian patients with colorectal carcinoma. Oncol Lett 2016; 12:1415-1421. [PMID: 27446446 PMCID: PMC4950545 DOI: 10.3892/ol.2016.4798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 05/16/2016] [Indexed: 12/13/2022] Open
Abstract
The presence of mutations in the KRAS gene is a predictor of a poor clinical response to EGFR-targeted agents in patients affected by colorectal cancer (CRC), but its significance as a global prognostic factor remains unclear. The aim of the present study was to evaluate the impact of the KRAS mutational status on time to first metastasis (TTM) and overall survival (OS) in a cohort of Sardinian CRC patients. A total of 551 patients with metastatic CRC at the time of enrolment were included. Clinical and pathological features of the disease, including follow-up information, were obtained from medical records and cancer registry data. For mutational analysis formalin-fixed paraffin-embedded tissue samples were processed using a standard protocol. The coding sequence and splice junctions of exons 2 and 3 of the KRAS gene were screened for mutations by direct automated sequencing. Overall, 186 KRAS mutations were detected in 183/551 (33%) patients: 125 (67%) were located in codon 12, 36 (19%) in codon 13, and 18 (10%) in codon 61. The remaining mutations (7; 4%) were detected in uncommonly-affected codons. No significant correlation between KRAS mutations and gender, age, anatomical location and stage of the disease at the time of diagnosis was identified. Furthermore, no prognostic value of KRAS mutations was found considering either TTM or OS. When patients were stratified by KRAS mutational status and gender, males were significantly associated with a longer TTM. The results of the present study indicate that KRAS mutation correlated with a slower metastatic progression in males with CRC from Sardinia, irrespective of the age at diagnosis and the codon of the mutation.
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Affiliation(s)
- Grazia Palomba
- Institute of Biomolecular Chemistry, CNR, 07100 Sassari, Italy
| | - Antonio Cossu
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Panagiotis Paliogiannis
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Antonio Pazzola
- Oncology Unit, Local Health Unit (ASL1), 07100 Sassari, Italy
| | | | - Mario Scartozzi
- Department of Medical Oncology, University of Cagliari, 09042 Cagliari, Italy
| | - Maria Teresa Ionta
- Department of Medical Oncology, University of Cagliari, 09042 Cagliari, Italy
| | - Salvatore Ortu
- Oncology Unit, Local Health Unit (ASL2), 07026 Olbia, Italy
| | | | | | - Tito Sedda
- Oncology Unit, Local Health Unit (ASL), 09170 Oristano, Italy
| | - Giovanni Sanna
- Department of Medical Oncology, Hospital University (AOU), 07100 Sassari, Italy
| | - Michela Barca
- Oncology Unit, Local Health Unit (ASL4), 08045 Lanusei, Italy
| | - Luciano Virdis
- Oncology Unit, Local Health Unit (ASL7), 09013 Carbonia-Iglesias, Italy
| | - Mario Budroni
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, 07100 Sassari, Italy
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Sanna G, Dei Giudici S, Bacciu D, Angioi PP, Giammarioli M, De Mia GM, Oggiano A. Improved Strategy for Molecular Characterization of African Swine Fever Viruses from Sardinia, Based on Analysis of p30, CD2V and I73R
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Variable Regions. Transbound Emerg Dis 2016; 64:1280-1286. [DOI: 10.1111/tbed.12504] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- G. Sanna
- Istituto Zooprofilattico Sperimentale della Sardegna; Sassari Italy
| | - S. Dei Giudici
- Istituto Zooprofilattico Sperimentale della Sardegna; Sassari Italy
| | - D. Bacciu
- Istituto Zooprofilattico Sperimentale della Sardegna; Sassari Italy
| | - P. P. Angioi
- Istituto Zooprofilattico Sperimentale della Sardegna; Sassari Italy
| | - M. Giammarioli
- Istituto Zooprofilattico Sperimentale dell'Umbria e Marche; Perugia Italy
| | - G. M. De Mia
- Istituto Zooprofilattico Sperimentale dell'Umbria e Marche; Perugia Italy
| | - A. Oggiano
- Istituto Zooprofilattico Sperimentale della Sardegna; Sassari Italy
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Sanna G, Pipia A, Tamponi C, Manca R, Varcasia A, Traversa D, Scala A. Anthelmintics efficacy against intestinal strongyles in horses of Sardinia, Italy. Parasite Epidemiol Control 2016; 1:15-19. [PMID: 29988184 PMCID: PMC5991823 DOI: 10.1016/j.parepi.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/03/2022] Open
Abstract
Intestinal strongyles (IS) are the most important parasites of equids, due to their high prevalence worldwide, pathogenicity and the spread of drug-resistant populations. Despite the large number of horses bred in Sardinia Island, Italy, no data are available on the efficacy of anthelmintic compounds in the control of horse strongylosis. Therefore the aim of the present study was to evaluate the efficacy of five commercial anthelmintic formulations containing fenbendazole (FBZ), pyrantel (PYR), moxidectin (MOX) and two ivermectin formulations (IVM1 and IVM2) against IS in Sardinia by performing a fecal egg count reduction test (FECRT) and investigating the egg reappearance period (ERP) after treatment. In total, 74 horses from 7 farms were examined. Coprocultures performed for individual fecal samples collected at the day of the treatment revealed that cyathostomins were the predominant parasitic species (98.6%). The FECR for all horses belonging to the treatment groups after two weeks was ≥ 95% with a 95% C.I. > 90%. The expected ERP did not decrease in any of the treatment group as FECR values < 90% were found at D60 for FBZ, at D90 for PYR and IVM1, at D150 for IVM2. All horses treated with MOX showed FECRT > 90% for the entire duration of the trial until D150. The results of the present survey indicate that drug-resistant cyathostomin populations are not present in the examined horse population, contrariwise to what observed in other Italian and European regions. The reasons and implications of these results are discussed.
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Affiliation(s)
- G. Sanna
- Dipartimento di Medicina Veterinaria, Settore di Parassitologia e Malattie Parassitarie, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - A.P. Pipia
- Dipartimento di Medicina Veterinaria, Settore di Parassitologia e Malattie Parassitarie, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - C. Tamponi
- Dipartimento di Medicina Veterinaria, Settore di Parassitologia e Malattie Parassitarie, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - R. Manca
- Veterinary practitioner, Sassari, Italy
| | - A. Varcasia
- Dipartimento di Medicina Veterinaria, Settore di Parassitologia e Malattie Parassitarie, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy
- Corresponding author at: Via Vienna 2, 07100 Sassari, Italy.
| | - D. Traversa
- Facoltà di Medicina Veterinaria, Università degli Studi di Teramo, Piazza A. Moro 45, 64100 Teramo, Italy
| | - A. Scala
- Dipartimento di Medicina Veterinaria, Settore di Parassitologia e Malattie Parassitarie, Università degli Studi di Sassari, Via Vienna 2, 07100 Sassari, Italy
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Sanna G, Varcasia A, Serra S, Salis F, Sanabria R, Pipia AP, Dore F, Scala A. Calicophoron daubneyi in sheep and cattle of Sardinia, Italy. Helminthologia 2016. [DOI: 10.1515/helmin-2015-0069] [Citation(s) in RCA: 5] [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: 11/15/2022] Open
Abstract
Summary
This study aimed to investigate the prevalence of paramphistomosis and confirm the species identity of rumen flukes from sheep and cattle of Sardinia (Italy), by molecular methods. From 2011 to 2014, 381 sheep and 59 cattle farms were selected and individual faecal samples were run on 15 sheep and 5 cattle for each farm, respectively. The prevalence at the slaughterhouse was calculated by examination of 356 sheep and 505 cattle. 13adult flukes collected from sheep and cattle and 5 belonging to the historical collection of Laboratory of Parasitology at the Department of Veterinary Medicine of Sassari, previously classified as Paramphistomum spp., were used for PCR amplification and sequencing of the ITS2+ rDNA. Previously classified Paramphistomum leydeni from South America were used as controls.
The EPG prevalence was 13.9 % and 55.9 % for sheep and cattle farms respectively. At slaughterhouses, paramphistomes were found in 2 % of the sheep and 10.9 % of the examined cows. Conversely to the latest reports, the sequences comparison showed that all the Sardinian rumen flukes belong to Calicophoron daubneyi.
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Affiliation(s)
- G. Sanna
- Laboratory of Parasitology, Veterinary Teaching Hospital, Veterinary Department, University of Sassari, Italy
| | - A. Varcasia
- Laboratory of Parasitology, Veterinary Teaching Hospital, Veterinary Department, University of Sassari, Italy
| | - S. Serra
- Laboratory of Parasitology, Veterinary Teaching Hospital, Veterinary Department, University of Sassari, Italy
| | - F. Salis
- Veterinary Practitioner, Martini Zootecnica, Italy
| | - R. Sanabria
- Veterinary Faculty, National University of La Plata, Buenos Aires, Argentine. National Scientific and Technical Research Council (CONICET), Argentine
| | - A. P. Pipia
- Laboratory of Parasitology, Veterinary Teaching Hospital, Veterinary Department, University of Sassari, Italy
| | - F. Dore
- Laboratory of Parasitology, Veterinary Teaching Hospital, Veterinary Department, University of Sassari, Italy
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Palomba G, Cossu A, Paliogiannis P, Pazzola A, Baldino G, Scartozzi M, Ionta M, Ortu S, Capelli F, Lanzillo A, Sedda T, Sanna G, Barca M, Virdis L, Colombino M, Casula M, Manca A, Tanda F, Budroni M, Palmieri G. Disease progression and overall survival in sardinian patients with colorectal cancer according to the kras mutational status. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.29] [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: 11/13/2022] Open
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Casaretti R, Comella P, Carlomagno C, Maiorino L, Greco E, Russo A, Sanna G, Barzelloni M, Massidda B, Formica V, Serci C, Defraia S, Palmieri G, Ionta M. A Single Arm Clinical Trial to Assess the Efficacy and Safety of Panitumumab (Vectibix®) in combination with FOLFOX4 Chemotherapy as 1st line treatment in Subjects with Metastatic Gastric or Gastroesophageal Junction adenocarcinoma (VEGA trial). A multicenter Phase II SICOG trial 0802. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv344.08] [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: 11/14/2022] Open
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Giordano G, Febbraro A, Vaccaro V, Zagonel V, De Giorgi U, Melisi D, Vasile E, Bianco R, Lo Re G, Valente M, Formica V, Montesarchio V, Maiorino L, Sanna G, Bittoni A, Ricci V, Santini D, Zaniboni A, Milella M, De Vita F. 2334 Nab Paclitaxel (Nab-P) and Gemcitabine (G) as first line chemotherapy (CT) in advanced pancreatic cancer (APDAC) patients (pts): An Italian “real life” study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta M, Bertolaccini M. FRI0425 The Global Antiphospholipid Syndrome Score (GAPSS) Differentiates Between Transient Ischemic Attack and Stroke in Patients with Antiphospholipid Antibodies. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6107] [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: 11/03/2022]
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Scala A, Pipia AP, Dore F, Sanna G, Tamponi C, Marrosu R, Bandino E, Carmona C, Boufana B, Varcasia A. Epidemiological updates and economic losses due to Taenia hydatigena in sheep from Sardinia, Italy. Parasitol Res 2015; 114:3137-43. [PMID: 25968992 DOI: 10.1007/s00436-015-4532-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/06/2015] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the epidemiology and transmission of Taenia hydatigena in sheep and dogs from Sardinia and the economic estimation of losses due to this metacestodosis in lambs. A total of 7781 Sarda breed lambs were examined at abattoirs for the detection of Cysticercus tenuicollis or necrotic-haemorrhagic tracks of their migration. Morphological and molecular identification of parasites was carried out. Individual faecal samples from 300 dogs were examined for copromicroscopic investigations and coproELISA assay. An overall prevalence of 14.6% for T. hydatigena cysticercosis was found in the examined lambs. In total, 10,807 parasitary tracks were found, with an abundance of 1.39 and an average intensity of 9.52. The molecular analysis of the isolates showed an overall pairwise nucleotide divergence for the CO1 and ND1 was of 0-3.1 and 0-3.3%, respectively. Low intra- and interspecific variation was recorded for C. tenuicollis isolates used in this study which suggested the absence of differentiation. Microscopic examination of dog faeces showed a total prevalence of 31.3% for endoparasites in the examined samples (94/300). Taeniid eggs were found in 8.3% of the dogs. The results of the monoclonal antibody ATH4 ELISA test showed a prevalence of 11% (33/300) for T. hydatigena coproantigens. The total economic costs related to cysticercosis amounted to almost € 330,000. The prevalence of C. tenuicollis in 14.6% of 30-40-day-old lambs highlights the high parasitic pressure by T. hydatigena in the territory of Sardinia, Italy.
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Affiliation(s)
- A Scala
- Laboratorio di Parassitologia e Malattie Parassitarie, Ospedale Didattico Veterinario, Dipartimento di Medicina Veterinaria, Università degli Studi di Sassari, Via Vienna 2, 07100, Sassari, Italy
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Zucchelli P, Zuccalà A, Borghi M, Fusaroli M, Sasdelli M, Stallone C, Sanna G, Gaggi R, Degli Esposti E, Vendramin G. Comparison of calcium channel blocker and ACE inhibitor therapy on the progression of renal insufficiency. Contrib Nephrol 2015; 81:255-63. [PMID: 2093506 DOI: 10.1159/000418761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- P Zucchelli
- Department of Nephrology, University of Modena, Italy
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Sanna G, Farci P, Busonera B, Murgia G, La Colla P, Giliberti G. Antiviral properties from plants of the Mediterranean flora. Nat Prod Res 2015; 29:2065-70. [DOI: 10.1080/14786419.2014.1003187] [Citation(s) in RCA: 17] [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: 12/22/2022]
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Piga M, Peltz MT, Montaldo C, Perra D, Sanna G, Cauli A, Mathieu A. Twenty-year brain magnetic resonance imaging follow-up study in Systemic Lupus Erythematosus: Factors associated with accrual of damage and central nervous system involvement. Autoimmun Rev 2015; 14:510-6. [PMID: 25617815 DOI: 10.1016/j.autrev.2015.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
To evaluate the long-term progression of cerebral MRI abnormalities in patients with longstanding SLE, 30 patients (age 53.5 ± 11.3) underwent brain MRI at baseline (b-MRI) and after 19.4 ± 3.7 years of follow-up (fu-MRI). Two neuroradiologists visually analyzed the MRIs comparing: 1) white matter hyperintensities (WMHIs), 2) cerebral volume, and 3) parenchymal defects; these outcomes were also built in a modified MRI scoring system (mMSS) to estimate the cumulative parenchymal damage. The independent risk factors for accrual of MRI brain damage, as well as the association between MRI abnormalities and the development of new neuropsychiatric (NP) manifestations classified according to the 1999 ACR case definition were also analyzed. Twenty-three patients (76.7%) showed worsening of mMSS; 19 (63.3%) had increased number and volume of WMHIs, 8 (26.7%) had significant cerebral volume loss, and 6 (20%) showed new ischemic parenchymal lesions. Only 6 patients had normal MRI. Antimalarial agents (p=0.006; OR 0.08) were protective against worsening of WMHIs. High cumulative dose of corticosteroids (p=0.026; OR 8.8) and dyslipidemia (p=0.044; OR 10.1) were associated with increased mMSS and cerebral volume loss, respectively. Higher mMSS score at baseline was independently associated with worsening of WMHIs (p=0.001; OR 5.7) and development of new NP events (p=0.019; OR 2.0); higher load of deep WMHIs at b-MRI (p=0.018; OR 2.0) was independently associated with stroke risk. This study shows that MRI brain damage in SLE patients progresses independently from NP involvement as effect of potentially modifiable risk factors and it is associated with increased risk of new NP events.
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Affiliation(s)
- Matteo Piga
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy.
| | | | | | - Daniela Perra
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy.
| | - Giovanni Sanna
- Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, London, UK; Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
| | - Alberto Cauli
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy.
| | - Alessandro Mathieu
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy.
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Sciascia S, Cuadrado MJ, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. Thrombotic Risk Assessment in Systemic Lupus Erythematosus: Validation of the Global Antiphospholipid Syndrome Score in a Prospective Cohort. Arthritis Care Res (Hoboken) 2014; 66:1915-20. [DOI: 10.1002/acr.22388] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/17/2014] [Indexed: 11/10/2022]
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Sanna G, Lecca V, Foddai A, Tola S. Development of a specific immunomagnetic capture-PCR for rapid detection of viable Mycoplasma agalactiae in sheep milk samples. J Appl Microbiol 2014; 117:1585-91. [PMID: 25272958 DOI: 10.1111/jam.12657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/27/2014] [Accepted: 09/26/2014] [Indexed: 11/29/2022]
Abstract
AIMS To develop an immunomagnetic capture (IMC) to detect viable Mycoplasma agalactiae in routine ovine milk samples. METHODS AND RESULTS Polyclonal antibodies against two M. agalactiae membrane surface proteins (P80 and P55) were covalently conjugated to magnetic beads (MBs) to form MB-Ab80 and MB-Ab55. Mycoplasma agalactiae cells were captured by a specific antigen-antibody reaction and magnetic separation. Immunomagnetic capture (IMC) was used to isolate and concentrate M. agalactiae in serial decimal dilutions and in artificially contaminated milk to facilitate subsequent detection by PCR. A 375-bp fragment of M. agalactiae was amplified using a pair of M. agalactiae-specific primers in PCR. The limit of detection of IMC-PCR method ranged from 10 to 10(2) CCU ml(-1) when mycoplasmas were resuspended in PBS and from 10(2) to 10(3) CCU ml(-1) when mycoplasmas were resuspended in uncontaminated ovine milk. This study also describes the application of IMC-PCR method to test for M. agalactiae in 516 milk samples collected from sheep with suspected contagious agalactia. Its performance was evaluated relative to culture. CONCLUSIONS This report has demonstrated for the first time, the effective use of rapid and reliable IMC combined with PCR assay for the detection of viable M. agalactiae. SIGNIFICANCE AND IMPACT OF THE STUDY The method IMC-PCR provides an alternative to conventional microbiological detection, method and it could be applied to quick detection of M. agalactiae in routine sheep milk samples.
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Affiliation(s)
- G Sanna
- Istituto ZooprofilatticoSperimentale della Sardegna "G. Pegreffi", Sassari, Italy
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Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. The global anti-phospholipid syndrome score in primary APS. Rheumatology (Oxford) 2014; 54:134-8. [DOI: 10.1093/rheumatology/keu307] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Scala A, Varcasia A, Dore F, Solinas C, Mula P, Carta A, Mura M, Pipia A, Sanna G. Evaluation of efficacy of toltrazuril and diclazuril in the control of subclinical eimeriosis in weaned lambs. Small Rumin Res 2014. [DOI: 10.1016/j.smallrumres.2014.05.015] [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: 10/25/2022]
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Sciascia S, Bertolaccini ML, Roccatello D, Khamashta MA, Sanna G. Autoantibodies involved in neuropsychiatric manifestations associated with systemic lupus erythematosus: a systematic review. J Neurol 2014; 261:1706-14. [DOI: 10.1007/s00415-014-7406-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/05/2014] [Accepted: 06/06/2014] [Indexed: 11/28/2022]
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Sciascia S, Sanna G, Khamashta MA, Cuadrado MJ, Erkan D, Andreoli L, Bertolaccini ML. The estimated frequency of antiphospholipid antibodies in young adults with cerebrovascular events: a systematic review. Ann Rheum Dis 2014; 74:2028-33. [PMID: 24942381 DOI: 10.1136/annrheumdis-2014-205663] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/01/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Around 10% of all thrombotic cerebrovascular events (CVE) occur in young population and in a large proportion of those the trigger remains undetermined. Antiphospholipid antibodies (aPL) are recognised risk factors for ischaemic stroke and recurrent thrombotic events; however, the frequency of aPL in young people with CVE is still an unresolved issue. OBJECTIVES To estimate the frequency of aPL in young adults with CVE and to determine whether aPL-positive young individuals are at greater risk of CVE when compared with individuals without aPL by systematically reviewing the literature. METHODS Medline reports published between 1970 and 2013 investigating the presence of aPL in young patients (<50 years old) with CVE were included. The median frequency for positive aPL, including lupus anticoagulant, anticardiolipin antibodies (aCL) and antibodies against β2Glycoprotein I (anti-β2GPI), was calculated for stroke and transient ischaemic attacks. FINDINGS This systematic review is based on available data from 5217 patients and controls from 43 studies analysing the frequency of aPL in young patients with CVE. The overall aPL frequency was estimated as 17.4% (range 5%-56%) for any CVE, 17.2% (range 2%-56%) for stroke and 11.7% (range 2%-45%) for transient ischaemic attack (TIA). The presence of aPL increased the risk for CVE by 5.48-fold (95% CI 4.42 to 6.79). Based on available data, the frequency of aPL in young patients with CVE can be estimated at 17%, rising up to 22% for aCL in patients with stroke. The presence of aPL seems to confer a fivefold higher risk for stroke or TIA when compared with controls. However, variability in test reproducibility and cut-off definition still represent an important methodological limitation for the current diagnostic testing for aPL. These observations should be confirmed by appropriately designed population studies.
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Affiliation(s)
- Savino Sciascia
- Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, London, UK Centro di Ricerche di Immunologia Clinica ed Immunopatologia e Documentazione su Malattie Rare (CMID), Università di Torino, Torino, Italy
| | - Giovanni Sanna
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Munther A Khamashta
- Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, London, UK Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Maria Jose Cuadrado
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, and Weill Medical College of Cornell University, New York
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Laura Bertolaccini
- Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, London, UK
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