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Di Pietro S, Ferrari I, Bulgari G, Muiesan ML, Falaschi F, De Silvestri A, Scudeller L, Musella V, Saglio S, Re B, Mattiuzzo E, Cherubini F, Perlini S. Video clips for patient comprehension of atrial fibrillation and deep vein thrombosis in emergency care. A randomised clinical trial. NPJ Digit Med 2024; 7:107. [PMID: 38688958 PMCID: PMC11061292 DOI: 10.1038/s41746-024-01107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
Integrating video clips in the discharge process may enhance patients' understanding and awareness of their condition. To determine the effect of video clip-integrated discharge discussion on patient comprehension of atrial fibrillation (AF) and deep vein thrombosis (DVT), and their main complications (stroke and pulmonary embolism), we designed a multicentre, pragmatic, parallel groups, randomised clinical trial, that was conducted at two Emergency Units in Italy. A convenience sample of 144 adult patients (or their caregivers) discharged home with either AF or DVT were randomised to receive standard verbal instructions (control) or video clip-integrated doctor-patient discharge discussion. Participants were guided by the discharging physician through the clip. Mean score for primary outcome (knowledge of the diagnosis and its potential complication) (range 0-18) was 5.87 (95% CI, 5.02-6.72] in the control group and 8.28 (95% CI, 7.27-9.31) in the intervention group (mean difference, -2.41; 95% CI, -3.73 to -1.09; p < 0.001). Among secondary outcomes, mean score for knowledge of the prescribed therapy (range 0-6) was 2.98 (95% CI, 2.57-3.39) in the control group and 3.20 (95% CI, 2.73-3.67) in the study group (mean difference, -0.22; 95% CI, -0.84 to 0.39). Mean score for satisfaction (range 0-12) was 7.34 (95% CI, 6.45-8.23) in the control arm and 7.97 (95% CI, 7.15-8.78) in the intervention arm (mean difference, -0.625; 95% CI -1.82 to 0.57). Initiation rate of newly prescribed anticoagulants was 80% (36/45) in the control group and 90.2% (46/51) in the intervention group. Among 109 patients reached at a median follow up of 21 (IQR 16-28) months, 5.55% (3/54) in the control arm and 1.82% (1/55) in the intervention arm had developed stroke or pulmonary embolism. In this trial, video clip-integrated doctor-patient discharge discussion, improved participants comprehension of AF and DVT and their main complications. Physicians should consider integrating these inexpensive tools during the discharge process of patients with AF or DVT.Trial Registration: ClinicalTrials.gov Identifier "NCT03734406".
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Affiliation(s)
- Santi Di Pietro
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, Pavia, Italy.
- PhD Program in Experimental Medicine, University of Pavia, Pavia, Italy.
| | - Ilaria Ferrari
- Emergency Department, Humanitas University Hospital, Rozzano, Italy
| | | | - Maria Lorenza Muiesan
- Dipartimento di Scienza Cliniche e Sperimentali, Università di Brescia, Direttore 2° Medicina Generale ASST Spedali Civili, Brescia, Italy
| | - Francesco Falaschi
- Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, GHU Paris-Saclay, Unité Polyvalente Aiguë de Court Séjour, Clamart, France
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and Biostatistics, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Luigia Scudeller
- Research and Innovation Unit, IRCCS Bologna University Hospital, Bologna, Italy
| | - Valeria Musella
- Unit of Clinical Epidemiology and Biostatistics, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Simone Saglio
- Internal Medicine Residency Programme, University of Pavia, Pavia, Italy
| | - Beatrice Re
- Respiratory Medicine Residency Programme, University of Milan, Milan, Italy
| | - Elena Mattiuzzo
- Emergency Physician, Pavia Poison Centre, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy
| | - Fabio Cherubini
- Internal Medicine Residency Programme, University of Brescia, Brescia, Italy
| | - Stefano Perlini
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, Pavia, Italy
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Volonté M, Bonelli A, Isoletta E, Favale EM, Lilleri D, Zelini P, Musella V, Klersy C, Brazzelli V. Waves of SARS-CoV-2 infections in a group of vaccinated psoriatic patients treated with biological drugs: experience from a tertiary hospital located in Northern Italy. Ital J Dermatol Venerol 2023; 158:375-377. [PMID: 37539511 DOI: 10.23736/s2784-8671.23.07592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Martina Volonté
- Institute of Dermatology, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Alice Bonelli
- Institute of Dermatology, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Eugenio Isoletta
- Institute of Dermatology, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Emanuele M Favale
- Institute of Dermatology, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Daniele Lilleri
- Microbiology and Virology Department, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Paola Zelini
- Microbiology and Virology Department, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Valeria Musella
- Unit of Clinical Epidemiology and Biostatistics, Scientific Direction, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Catherine Klersy
- Unit of Clinical Epidemiology and Biostatistics, Scientific Direction, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Valeria Brazzelli
- Institute of Dermatology, Policlinico San Matteo IRCCS Foundation, Pavia, Italy -
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Institute of Dermatology, University of Pavia, Pavia, Italy
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Mongodi S, Salve G, Ravasi M, Rizzi D, Mangiagalli M, Musella V, Klersy C, Ansaloni L, Mojoli F. The mental health toll of COVID-19: significant increase in admissions to ICU for voluntary self-inflicted injuries after the beginning of the pandemic. Int J Ment Health Syst 2023; 17:22. [PMID: 37454115 DOI: 10.1186/s13033-023-00590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND COVID-19 outbreak deeply impacted on mental health, with high rate of psychological distress in healthcare professionals, patients and general population. Current literature on trauma showed no increase in ICU admissions for deliberate self-inflicted injuries in the first weeks after the beginning of COVID-19. OBJECTIVES We tested the hypothesis that self-inflicted injuries/harms of any method requiring ICU admission increased in the year following COVID-19 outbreak. METHODS Retrospective cohort single-center study comparing admissions to ICU the year before and the year after the pandemic start. All patients admitted to polyvalent ICUs-Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy from February 21st, 2019 to February 21st, 2020 (pre-COVID) and from February 22nd, 2020 to February 22nd, 2021 (post-COVID) were enrolled. RESULTS We enrolled 1038 pre-COVID and 854 post-COVID patients. In post-COVID, the incidence of self-inflicted injuries was 32/854 (3.8% [2.5-5.1]), higher than in pre-COVID (23/1038, 2.2%-p = 0.0014-relative increase 72.7%). The increase was more relevant when excluding COVID-19 patients (suicide attempts 32/697 (4.6% [3.0-6.2])-relative increase 109.1%; p < 0.0001). Both in pre-COVID and post-COVID, the most frequent harm mean was poisoning [15 (65.2%) vs. 25 (78.1%), p = 0.182] and the analysed population was younger than general ICU population (p = 0.0015 and < 0.0001, respectively). The distribution of admissions for self-inflicted injuries was homogeneous in pre-COVID along the year. In post-COVID, no admissions were registered during the lockdown; an increase was observed in summer with pandemic curve at minimal levels. CONCLUSIONS An increase in ICU admissions for self-inflicted injuries/harms was observed in the year following COVID-19 outbreak.
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Affiliation(s)
- Silvia Mongodi
- Anesthesia and Intensive Care 1St, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Giulia Salve
- Anesthesia and Intensive Care 1St, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
| | - Marta Ravasi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
| | - Damiano Rizzi
- Psychology department, Fondazione Soleterre, Milan, Italy
- Emergency Room, Department of Intensive Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Mangiagalli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
- Psychology department, Fondazione Soleterre, Milan, Italy
| | - Valeria Musella
- Clinical Epidemiology and Biometrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Ansaloni
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
- General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Mojoli
- Anesthesia and Intensive Care 1St, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
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Suppressa P, Maiorano E, Gaetani E, Matti E, Lenato GM, Serio I, Masala MS, Passali GC, Aguglia M, Crocione C, Lopalco PL, Caneschi F, Musella V, De Silvestri A, Gambini G, Spinozzi G, Sabbà C, Pagella F. Impact of SARS-CoV-2 infection in patients with hereditary hemorrhagic telangiectasia: epidemiological and clinical data from the comprehensive Italian retrospective multicenter study. Intern Emerg Med 2023; 18:1109-1118. [PMID: 37140873 PMCID: PMC10157588 DOI: 10.1007/s11739-023-03287-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023]
Abstract
Rare Disease patients manifested high concern regarding the possible increased risk of severe outcomes and worsening of disease-specific clinical manifestation due to the impact of COVID-19. Our aim was to assess the prevalence, outcomes, and impact of COVID-19 in patients with a rare disease such as Hereditary Hemorrhagic Telangiectasia (HHT) in Italian population. A nationwide, multicentric, cross-sectional observational study was conducted on patients with HHT from five Italian HHT centers by online survey. The association between COVID-19-related signs and symptoms and nosebleeds worsening, the impact of personal protective equipment on nosebleeds pattern, and the relationship between the presence of visceral AVMs and severe outcomes were analyzed. Out of 605 total survey responses and eligible for analysis, 107 cases of COVID-19 were reported. A mild-course COVID-19 disease, not requiring hospitalization, was observed in 90.7% of patients, while the remaining eight cases needed hospitalization, two of them requiring intensive-care access. No fatal outcome was recorded and 79.3% of patients reported a complete recovery. No difference in infection risk and outcome between HHT patients and general population was evidenced. No significative interference of COVID-19 on HHT-related bleeding was found. The majority of patients received COVID-19 vaccination, with relevant impact on symptoms and need for hospitalization in case of infection. COVID-19 in HHT patients had an infection profile similar to the general population. COVID-19 course and outcome were independent from any specific HHT-related clinical features. Moreover, COVID-19 and anti-SARS-CoV-2 measures did not seem to affect significantly HHT-related bleeding profile.
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Affiliation(s)
- Patrizia Suppressa
- "Frugoni" Internal Medicine and Geriatrics Unit, Centro Sovraziendale per le Malattie Rare, DIM-Interdisciplinary Department of Medicine, HHT Interdepartmental Center, VascERN HHT Reference Center, Policlinico Hospital, University of Bari, Bari, Italy.
| | - Eugenia Maiorano
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eleonora Gaetani
- Internal Medicine and Gastroenterology Unit, Department of Medical and Surgical Sciences, Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Elina Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gennaro Mariano Lenato
- "Frugoni" Internal Medicine and Geriatrics Unit, Centro Sovraziendale per le Malattie Rare, DIM-Interdisciplinary Department of Medicine, HHT Interdepartmental Center, VascERN HHT Reference Center, Policlinico Hospital, University of Bari, Bari, Italy
| | - Ilaria Serio
- Division of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | | | - Giulio Cesare Passali
- Division of Otorhinolaryngology, Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Maria Aguglia
- Clinical Pathology Unit, Vito Fazzi Hospital, Lecce, Italy
- HHT Onlus Patient Association, Rome, Italy
| | | | - Pietro Luigi Lopalco
- Department of Biological and Environmental Science and Technologies, University of Salento, Lecce, Italy
| | | | - Valeria Musella
- Clinical Epidemiology and Biometry Unit, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometry Unit, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Gambini
- Clinical Epidemiology and Biometry Unit, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Sabbà
- "Frugoni" Internal Medicine and Geriatrics Unit, Centro Sovraziendale per le Malattie Rare, DIM-Interdisciplinary Department of Medicine, HHT Interdepartmental Center, VascERN HHT Reference Center, Policlinico Hospital, University of Bari, Bari, Italy
| | - Fabio Pagella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
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Del Fante C, Klersy C, Barone E, De Vitis S, Troletti D, Mortellaro C, Musella V, Perotti C. Validation of a new automated irradiation system for off-line ECP. Transfus Apher Sci 2023:103724. [PMID: 37202323 DOI: 10.1016/j.transci.2023.103724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Extracorporeal photopheresis (ECP) is a cell therapy originally employed for cutaneous T cell lymphoma and later for GvHD, solid organ rejection and other immunological diseases demonstrating an excellent safety profile. Mononuclear cell (MNCs) apoptosis triggered by UV-A light irradiation in the presence of 8-methoxypsoralene has a key role in priming the cells, ultimately leading to immunomodulation. We report preliminary data about an evaluation of the new automated irradiator device LUMILIGHT (Pelham Crescent srl) for off-line ECP. Fifteen MNCs samples collected by apheresis from 15 adult patients undergoing ECP at our Center were cultured immediately after irradiation along with untreated samples and evaluated at 24, 48 and 72 h timepoints for T cell apoptosis and viability by flow cytometry with Annexin V and Propide Iodidum staining. Post irradiation Hematocrit (HCT), calculated by the device, was compared with that of the automated cell counter. Bacterial contamination was also tested. In irradiated samples after 24-48 and 72 h, the average total apoptosis was 47 %, 70 % and 82 %, respectively, showing a significant difference from untreated samples; residual viable lymphocytes at 72 h were, on average, 18 %. The greatest initiation of apoptosis occurred from 48 h of irradiation onwards. Average early apoptosis of irradiated samples decreased over time (26 %, 17 % and 10 % at 24, 48 and 72 h, respectively). HCT measured by LUMILIGHT was over-estimated, possibly due to the low pre irradiation red blood cell contamination. Bacterial tests resulted negative. Our study showed the LUMILIGHT device to be a valid instrument for MNCs irradiation with good handling and no major technical problems as well as no adverse events in the patients. Our data need to be confirmed in larger studies.
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Affiliation(s)
- Claudia Del Fante
- Cell manipulation laboratory, Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Catherine Klersy
- Biostatistics and clinical trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eugenio Barone
- Cell manipulation laboratory, Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simona De Vitis
- Cell manipulation laboratory, Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Troletti
- Cell manipulation laboratory, Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristina Mortellaro
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Musella
- Biostatistics and clinical trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cesare Perotti
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Fugazzola P, Cobianchi L, Di Martino M, Tomasoni M, Dal Mas F, Abu-Zidan FM, Agnoletti V, Ceresoli M, Coccolini F, Di Saverio S, Dominioni T, Farè CN, Frassini S, Gambini G, Leppäniemi A, Maestri M, Martín-Pérez E, Moore EE, Musella V, Peitzman AB, de la Hoz Rodríguez Á, Sargenti B, Sartelli M, Viganò J, Anderloni A, Biffl W, Catena F, Ansaloni L. Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study. World J Emerg Surg 2023; 18:20. [PMID: 36934276 PMCID: PMC10024826 DOI: 10.1186/s13017-023-00488-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/04/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models. METHOD The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models-POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade-receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities. RESULTS A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a 'Chole-POSSUM' score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96-97% negative predictive value for major complications. CONCLUSIONS The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action. TRIAL REGISTRATION ClinicalTrial.gov NCT04995380.
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Affiliation(s)
- Paola Fugazzola
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Cobianchi
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy.
| | - Marcello Di Martino
- Hepato-Biliary and Liver Transplantation Department, AORN Cardarelli, Napoli, Italy
| | - Matteo Tomasoni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, University of Pisa, Pisa, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna Del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Tommaso Dominioni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Nikita Farè
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Frassini
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Gambini
- Unit of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marcello Maestri
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Martín-Pérez
- Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Ernest E Moore
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Valeria Musella
- Unit of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Ángela de la Hoz Rodríguez
- Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Benedetta Sargenti
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, 62100, Macerata, Italy
| | - Jacopo Viganò
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
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Fugazzola P, Cobianchi L, Di Martino M, Tomasoni M, Dal Mas F, Abu-Zidan FM, Agnoletti V, Ceresoli M, Coccolini F, Di Saverio S, Dominioni T, Farè CN, Frassini S, Gambini G, Leppäniemi A, Maestri M, Martín-Pérez E, Moore EE, Musella V, Peitzman AB, de la Hoz Rodríguez Á, Sargenti B, Sartelli M, Viganò J, Anderloni A, Biffl W, Catena F, Ansaloni L, Augustin G, Morić T, Awad S, Alzahrani AM, Elbahnasawy M, Massalou D, De Simone B, Demetrashvili Z, Kimpizi AD, Schizas D, Balalis D, Tasis N, Papadoliopoulou M, Georgios P, Lasithiotakis K, Ioannidis O, Bains L, Magnoli M, Cianci P, Conversano NI, Pasculli A, Andreuccetti J, Arici E, Pignata G, Tiberio GAM, Podda M, Murru C, Veroux M, Distefano C, Centonze D, Favi F, Bova R, Convertini G, Balla A, Sasia D, Giraudo G, Gabriele A, Tartaglia N, Pavone G, D’Acapito F, Fabbri N, Ferrara F, Cimbanassi S, Ferrario L, Cioffi S, Ceresoli M, Fumagalli C, Degrate L, Degiuli M, Sofia S, Licari L, Improta M, Patriti A, Coletta D, Conti L, Malerba M, Andrea M, Calabrò M, De Zolt B, Bellio G, Giordano A, Luppi D, Corbellini C, Sampietro GM, Marafante C, Rossi S, Mingoli A, Lapolla P, Cicerchia PM, Siragusa L, Grande M, Arcudi C, Antonelli A, Vinci D, De Martino C, Armellino MF, Bisogno E, Visconti D, Santarelli M, Montanari E, Biloslavo A, Germani P, Zaghi C, Oka N, Fathi MA, Ríos-Cruz D, Hernandez EEL, Garzali IU, Duarte L, Negoi I, Litvin A, Chowdhury S, Alshahrani SM, Carbonell-Morote S, Rubio-Garcia JJ, Moreira CCL, Ponce IA, Mendoza-Moreno F, Campaña AM, Bayo HL, Serra AC, Landaluce-Olavarria A, Serradilla-Martín M, Cano-Paredero A, Dobón-Rascón MÁ, Hamid H, Baraket O, Gonullu E, Leventoglu S, Turk Y, Büyükkasap Ç, Aday U, Kara Y, Kabuli HA, Atici SD, Colak E, Chooklin S, Chuklin S, Ruta F, Estraviz-Mateos B, Markinez-Gordobil I. Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study. World J Emerg Surg 2023; 18:20. [DOI: https:/doi.org/10.1186/s13017-023-00488-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/04/2023] [Indexed: 11/27/2023] Open
Abstract
Abstract
Background
Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models.
Method
The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models—POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade—receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities.
Results
A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a ‘Chole-POSSUM’ score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96–97% negative predictive value for major complications.
Conclusions
The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action.
Trial Registration: ClinicalTrial.gov NCT04995380.
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Zelini P, Isoletta E, Volontè M, Lilleri D, Cassaniti I, Musella V, Klersy C, Baldanti F, Brazzelli V. Dynamics of humoral and cellular immunity elicited by the BNT162b2 mRNA vaccine in psoriatic patients under targeted immunosuppression: A longitudinal cohort study. J Eur Acad Dermatol Venereol 2023; 37:e294-e296. [PMID: 36433886 DOI: 10.1111/jdv.18787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Paola Zelini
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eugenio Isoletta
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Martina Volontè
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Lilleri
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Irene Cassaniti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Musella
- Unit of Clinical Epidemiology & Biostatistics, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Unit of Clinical Epidemiology & Biostatistics, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fausto Baldanti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Valeria Brazzelli
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Institute of Dermatology, Università degli Studi di Pavia, Pavia, Italy
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9
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Ahmed SMA, Volontè M, Isoletta E, Vassallo C, Tomasini CF, Lilleri D, Zelini P, Musella V, Klersy C, Brazzelli V. SARS-CoV-2 serology in patients on biological therapy or apremilast for psoriasis: a study of 93 patients in the Italian red zone. J Eur Acad Dermatol Venereol 2021; 36:e86-e88. [PMID: 34606128 PMCID: PMC8656363 DOI: 10.1111/jdv.17721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/27/2021] [Indexed: 02/04/2023]
Affiliation(s)
- S M A Ahmed
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - M Volontè
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - E Isoletta
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - C Vassallo
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - C F Tomasini
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - D Lilleri
- Molecular Virology Unit, Department of Microbiology and Virology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - P Zelini
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy.,Biochemistry-Biotechnology and Advanced Diagnostics Laboratory, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - V Musella
- Unit of Clinical Epidemiology and Biometrics, Scientific Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - C Klersy
- Unit of Clinical Epidemiology and Biometrics, Scientific Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - V Brazzelli
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
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10
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Caccialanza R, Cereda E, Klersy C, Nardi M, Masi S, Crotti S, Cappello S, Caissutti V, Brovia C, Lobascio F, Formisano E, Colombo S, Filippi AR, Bonzano E, Comoli P, Catenacci L, Alberti A, Musella V, Ferrari A, Imarisio I, Tancredi R, Monaco T, Ghi MG, Bossi P, Pedrazzoli P. The efficacy of immunonutrition in improving tolerance to chemoradiotherapy in patients with head and neck cancer, receiving nutritional counseling: study protocol of a randomized, open-label, parallel group, bicentric pilot study. Ther Adv Med Oncol 2021; 13:17588359211025872. [PMID: 34527079 PMCID: PMC8436314 DOI: 10.1177/17588359211025872] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/28/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Nutritional support, including nutritional counseling and oral nutritional supplements (ONSs), has been recommended at the earliest opportunity in head and neck (H&N) cancer patients. The limited available evidence on the efficacy of immunonutrition during chemoradiotherapy (CT-RT) in H&N cancer patients is positive with regard to some secondary endpoints, but is still scanty, particularly with regard to toxicity and treatment tolerance. We hypothesize that early systematic provision of ONSs with a high-protein–high-calorie mixture containing immunonutrients (Impact) compared to standard high-calorie–high-protein nutritional blends, in addition to nutritional counseling, may be beneficial to patients with H&N cancer during CT-RT. Hence, we designed the present study to evaluate the efficacy, in terms of treatment tolerance, toxicity and response, body weight, body composition, protein-calorie intake, quality of life (QoL), fatigue, muscle strength and immunological profile of the early systematic provision of ONSs enriched in immunonutrients compared to isonitrogenous standard blends, in H&N cancer patients undergoing CT-RT. Methods: This is a pragmatic, bicentric, randomized (1:1), parallel-group, open label, controlled, pilot clinical trial. Discussion: Many efforts are still to be taken to improve the efficacy of nutritional support in oncology. Immunonutrition represents a promising approach also in H&N cancer patients, but the evidence on its efficacy in improving clinical outcomes during CT-RT is still inconclusive. The present pilot study, which guarantees the early provision of nutritional assessment and support to all the enrolled patients in accordance with the recent guidelines and recommendations, could represent one of the first proofs of the clinical effectiveness of early oral immunonutrition in cancer patients undergoing CT-RT and could stimulate further large randomized trials, potentially resulting in the improvement of supportive care quality. Trial registration: This study is registered on ClinicalTrials.gov Identifier: NCT04611113.
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Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, 27100, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariateresa Nardi
- Clinical Nutrition Service, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Sara Masi
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Cappello
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Caissutti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlotta Brovia
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Formisano
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Colombo
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Elisabetta Bonzano
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Patrizia Comoli
- Cell Factory and Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Catenacci
- Cell Factory and Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Alberti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Valeria Musella
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ferrari
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Imarisio
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Richard Tancredi
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Teresa Monaco
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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11
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Cringoli G, Pepe P, Bosco A, Maurelli MP, Baldi L, Ciaramella P, Musella V, Buonanno ML, Capuano F, Corrado F, Ianniello D, Alves LC, Sarnelli P, Rinaldi L. An integrated approach to control Cystic Echinococcosis in southern Italy. Vet Parasitol 2021; 290:109347. [PMID: 33444910 DOI: 10.1016/j.vetpar.2021.109347] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/13/2020] [Accepted: 12/19/2020] [Indexed: 12/13/2022]
Abstract
Cystic echinococcosis (CE) is a severe zoonosis, caused by the larval stage of the tapeworm Echinococcus granulosus. This helminth infection is of increasing public health and socio-economic concern due to the considerable morbidity rates that cause economic losses both in the public health sector and in the livestock industry. Control programmes against E. granulosus are considered long-term actions which require an integrated approach and high expenditure of time and financial resources. Since 2010, an integrated approach to control CE has been implemented in a highly endemic area of continental southern Italy (Campania region). Innovative procedures and tools have been developed and exploited during the control programme based on the following strategies: i) active and passive surveillance in livestock (using geospatial tools for georeferencing), ii) diagnosis in dogs (using the FLOTAC techniques and molecular analysis), iii) targeted treatment of farm dogs (using purpose-built confinement cages), iv) early diagnosis in livestock (by ultrasonography), v) surveillance in humans (through hospital discharge records analysis), vi) monitoring the food chain (analysing raw vegetables), vii) outreach activities to the general public (through dissemination material, e.g. brochures, gadgets, videos, virtual reality). Over eight years, the integrated approach and the new strategies developed have resulted in a noteworthy reduction of the parasite infection rates in livestock (e.g. up to 30 % in sheep). The results obtained so far highlight that using a one health multidisciplinary and multi-institution effort is of pivotal importance in preparing CE control programmes at regional level and could be extended to other endemic Mediterranean areas.
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Affiliation(s)
- G Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy; Centro Regionale per il Monitoraggio delle Parassitosi (CREMOPAR), Regione Campania, Eboli, SA, Italy; Centro di Riferimento Regionale per le Malattie degli Animali Domestici (CReSan), Regione Campania, Naples, Italy
| | - P Pepe
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy; Centro Regionale per il Monitoraggio delle Parassitosi (CREMOPAR), Regione Campania, Eboli, SA, Italy
| | - A Bosco
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy; Centro Regionale per il Monitoraggio delle Parassitosi (CREMOPAR), Regione Campania, Eboli, SA, Italy
| | - M P Maurelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy; Centro Regionale per il Monitoraggio delle Parassitosi (CREMOPAR), Regione Campania, Eboli, SA, Italy
| | - L Baldi
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - P Ciaramella
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - V Musella
- Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - M L Buonanno
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - F Capuano
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - F Corrado
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - D Ianniello
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy; Centro Regionale per il Monitoraggio delle Parassitosi (CREMOPAR), Regione Campania, Eboli, SA, Italy
| | - L C Alves
- Department of Veterinary Medicine, Federal Rural University of Pernambuco, Recife, Brazil
| | - P Sarnelli
- Centro Regionale per il Monitoraggio delle Parassitosi (CREMOPAR), Regione Campania, Eboli, SA, Italy; UOD Prevenzione e Sanità Pubblica Veterinaria Regione Campania, Naples, Italy
| | - L Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy; Centro Regionale per il Monitoraggio delle Parassitosi (CREMOPAR), Regione Campania, Eboli, SA, Italy; Centro di Riferimento Regionale per le Malattie degli Animali Domestici (CReSan), Regione Campania, Naples, Italy.
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12
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Perotti C, Baldanti F, Bruno R, Del Fante C, Seminari E, Casari S, Percivalle E, Glingani C, Musella V, Belliato M, Garuti M, Meloni F, Frigato M, Di Sabatino A, Klersy C, De Donno G, Franchini M. Mortality reduction in 46 severe Covid-19 patients treated with hyperimmune plasma. A proof of concept single arm multicenter trial. Haematologica 2020; 105:2834-2840. [PMID: 33256382 PMCID: PMC7716363 DOI: 10.3324/haematol.2020.261784] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022] Open
Abstract
Hyperimmune plasma from Covid-19 convalescent is a potential treatment for severe Covid-19. We conducted a multicenter one arm proof of concept interventional study. Patients with Covid-19 disease with moderate-to-severe Acute Respiratory Distress Syndrome, elevated C-reactive Protein and need for mechanical ventilation and/or CPAP were enrolled. One to three 250-300 ml unit of hyperimmune plasma (neutralizing antibodies titer ≥1:160) were administered. Primary outcome was 7-days hospital mortality. Secondary outcomes were PaO2/FiO2, laboratory and radiologic changes, as well as weaning from mechanical ventilation and safety. The study observed 46 patients from March, 25 to April, 21 2020. Patients were aged 63, 61% male, of them, 30 were on CPAP and 7 intubated. PaO2/FiO2 was 128 (SD 47). Bilateral infiltrates on chest X-ray was present in 36 patients (84%). Symptoms and ARDS duration were 14 (SD 7) and 6 days (SD 3). Three patients (6.5%) died within 7 days as compared to an expected 15% from the National Statistics and 30% from a small concurrent cohort of 23 patients. The upper one-sided 90%CI was 13.9%, allowing to reject the null hypothesis of a 15% mortality. PaO2/FiO2 increased by 112 units (95%CI 82 to142) in survivors, the chest radiogram severity decreased in 23% (95%CI 5% to 42%); CRP, Ferritin and LDH decreased by 60, 36 and 20% respectively. Weaning from CPAP was obtained in 26/30 patients and 3/7 were extubated. Five serious adverse events occurred in 4 patients (2 likely, 2 possible treatment related). In conclusion, Hyperimmune plasma in Covid-19 shows promising benefits, to be confirmed in a randomized controlled trial. This proof of concept study could open to future developments including hyperimmune plasma banking, development of standardized pharmaceutical products and monoclonal antibodies.
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Affiliation(s)
- Cesare Perotti
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Fausto Baldanti
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
- University of Pavia, Pavia
| | - Raffaele Bruno
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
- University of Pavia, Pavia
| | - Claudia Del Fante
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Elena Seminari
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Salvatore Casari
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Elena Percivalle
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Claudia Glingani
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Valeria Musella
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Mirko Belliato
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Martina Garuti
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Federica Meloni
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
- University of Pavia, Pavia
| | - Marilena Frigato
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Antonio Di Sabatino
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
- University of Pavia, Pavia
| | - Catherine Klersy
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Intensive Care, Virology and Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Giuseppe De Donno
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Massimo Franchini
- Departments of Immunohematology and Transfusion, Infectious Diseases, Respiratory Diseases, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
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13
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Charlier J, Rinaldi L, Musella V, Ploeger HW, Chartier C, Rose Vineer H, Hinney B, von Samson-Himmelstjerna G, Băcescu B, Mickiewicz M, Mateus TL, Martinez-Valladares M, Quealy S, Azaizeh H, Sekovska B, Akkari H, Petkevicius S, Hektoen L, Höglund J, Morgan ER, Bartley DJ, Claerebout E. Corrigendum to "Initial assessment of the economic burden of major parasitic helminth infections to the ruminant livestock industry in Europe" [Prev. Vet. Med. 182 (2020) 105103]. Prev Vet Med 2020; 188:105213. [PMID: 33261929 DOI: 10.1016/j.prevetmed.2020.105213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Charlier
- Kreavet, H. Mertensstraat 17, 9150 Kruibeke, Belgium.
| | - L Rinaldi
- Department of Veterinary Medicine and Animal Production, CREMOPAR, University of Naples Federico II, 80137 Napoli, Italy
| | - V Musella
- Department of Health Sciences, University of Catanzaro "Magna Græcia", CISVetSUA, 88100 Catanzaro, Italy
| | - H W Ploeger
- Department of Infectious Diseases and Immunology, Clinical Infectiology Division, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands
| | - C Chartier
- INRAE, Oniris, BIOEPAR, 44307, Nantes, France
| | - H Rose Vineer
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst, Neston, Cheshire, CH64 7TE, UK
| | - B Hinney
- Institute of Parasitology, Department of Pathobiology, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210 Wien, Austria
| | - G von Samson-Himmelstjerna
- Freie Universität Berlin, Institute for Parasitology and Tropical Veterinary Medicine, Robert-von-Ostertag-Str. 7-13, 14163 Berlin, Germany
| | - B Băcescu
- Faculty of Veterinary Medicine, Spiru Haret University, Blv. Basarabia 256, Bucharest, Romania
| | - M Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 159c, 02-786 Warsaw, Poland
| | - T L Mateus
- CISAS - Center for Research and Development in Agrifood Systems and Sustainability, Escola Superior Agrária, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial Nun'Álvares, 4900-347 Viana do Castelo, Portugal; EpiUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, 135, 4050-091 Porto, Portugal
| | - M Martinez-Valladares
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Departamento de Sanidad Animal, 24236 Grulleros, León, Spain
| | - S Quealy
- VirtualVet, Grenan Upper, Kilmacthomas, Co., Waterford, Ireland
| | - H Azaizeh
- Institute of Applied Research, University of Haifa, The Galilee Society P.O. Box 437, Shefa-Amr 20200, Israel; Tel Hai College, Department of Environmental Sciences, Upper Galilee 12210, Israel
| | - B Sekovska
- Faculty of Veterinary Medicine, University St. Cyril and Methodius, Skopje, North Macedonia
| | - H Akkari
- Laboratory of Parasitology, University of Manouba, National School of Veterinary Medicine of Sidi Thabet, 2020 Sidi Thabet, Tunisia
| | - S Petkevicius
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine, Veterinary Academy, Lithuanian University of Health Sciences, Tilžės 18, LT-47181 Kaunas, Lithuania
| | - L Hektoen
- Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, P.O. Box 369 Sentrum, 0102 Oslo, Norway
| | - J Höglund
- Swedish University of Agricultural Sciences, Department of Biomedical Sciences and Veterinary Public Health, Section for Parasitology, P.O. Box 7036, SE-750 07 Uppsala, Sweden
| | - E R Morgan
- Institute for Global Food Security, Queen's University Belfast, 19, Chlorine Gardens, Belfast, BT9 5DL, UK
| | - D J Bartley
- Disease Control, Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, EH26 0PZ, UK
| | - E Claerebout
- Ghent University, Faculty of Veterinary Medicine, Laboratory of Parasitology, Salisburylaan 133, 9820 Merelbeke, Belgium
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14
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Brazzelli V, Isoletta E, Barak O, Barruscotti S, Vassallo C, Giorgini C, Michelerio A, Tomasini CF, Musella V, Klersy C. Does therapy with biological drugs influence COVID-19 infection? Observational monocentric prevalence study on the clinical and epidemiological data of psoriatic patients treated with biological drugs or with topical drugs alone. Dermatol Ther 2020; 33:e14516. [PMID: 33169500 DOI: 10.1111/dth.14516] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/13/2020] [Accepted: 11/05/2020] [Indexed: 12/19/2022]
Abstract
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, there has been an open debate on the impact of biological drugs used in the treatment of psoriasis. To define whether patients under treatment with biologics suffer from increased morbidity and mortality from COVID-19, compared to psoriatic patients treated only with topical drugs, we designed an observational monocentric prevalence study recording the personal and clinical data of psoriatic patients, with focus on the presentation of signs and symptoms related to COVID-19 in the period of time ranging from 1 January 2020 to 31 May 2020. A total of 180 patients were enrolled into two groups: 100 patients in the topical therapy group and 80 patients in the biological therapy group. No statistically significant difference was found between the groups regarding the prevalence of COVID-19 infection and symptoms at a bivariable analysis with adjustment for confounders. In conclusion, psoriatic patients under treatment with biologics do not seem to be more susceptible to COVID-19 compared to other psoriatic patients and we suggest not interrupting treatment with biological drugs, even in areas suffering from active outbreaks of the disease.
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Affiliation(s)
- Valeria Brazzelli
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Eugenio Isoletta
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Oren Barak
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Stefania Barruscotti
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Camilla Vassallo
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Chiara Giorgini
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Andrea Michelerio
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Carlo Francesco Tomasini
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Valeria Musella
- Unit of Clinical Epidemiology and Biometrics, Scientific Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Catherine Klersy
- Unit of Clinical Epidemiology and Biometrics, Scientific Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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15
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Silva LMR, Carrau T, Vila-Viçosa MJM, Musella V, Rinaldi L, Failing K, Cortes HCE, Taubert A, Hermosilla C. Analysis of potential risk factors of caprine coccidiosis. Vet Parasitol Reg Stud Reports 2020; 22:100458. [PMID: 33308721 DOI: 10.1016/j.vprsr.2020.100458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/21/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022]
Abstract
Caprine coccidiosis represents a major concern in goat industry worldwide causing high economic losses, mainly due to poor weight gains, treatment costs and even death of kids. Therefore, analyses on risk factors involved in the establishment and outcome of this disease are important to improve infection status and herd management. In Portugal, approximately 400,000 goats are reared every year. The majority of them are allocated in the southern part of the country. In the current study, a representative number of animals (382 goats) and herds (37 herds) from Alentejo were monitored. Faecal samples from five young and five adult goats of each farm were collected rectally and examined individually by using the modified McMaster technique for oocyst counts (oocyst per gram of faeces - OPG). Additionally, a questionnaire on the husbandry conditions and anti-parasitic treatments was performed. Overall, a prevalence of Eimeria infections of 99% and 100% was detected on animal and herd level, respectively. Eimeria arloingi and E. ninakohlyakimovae as the two most pathogenic caprine species also constituted the most prevalent ones (34.91% and 29.90%, respectively), both in the young and the adult goat groups. As expected, OPG vales were significantly higher (p = 0.031) in young than in adult goats. Furthermore, risk factor analyses revealed young age, higher total number of animals on the farm and outdoor kidding as strongly associated with a higher risk of caprine coccidiosis. Overall, the high prevalence of pathogenic Eimeria species on Portuguese goat farms in combination with the occurrence of related risk factors strengthen the importance of coccidiosis control in caprine industry.
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Affiliation(s)
- L M R Silva
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Germany; Laboratório de Parasitologia Victor Caeiro, MED - Mediteranean Institute for Agriculture, Environment and Development, University of Evora, Portugal.
| | - T Carrau
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Ohlebergsweg 12, Giessen 35392, Germany
| | - M J M Vila-Viçosa
- Laboratório de Parasitologia Victor Caeiro, MED - Mediteranean Institute for Agriculture, Environment and Development, University of Evora, Portugal
| | - V Musella
- Department of Health Sciences, University of Catanzaro Magna Graecia, Viale Europa, Catanzaro 88100, Italy
| | - L Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via Delpino 1, Naples 80137, Italy
| | - K Failing
- Unit for Biomathematics and Data Processing, Justus Liebig University Giessen, Germany
| | - H C E Cortes
- Laboratório de Parasitologia Victor Caeiro, MED - Mediteranean Institute for Agriculture, Environment and Development, University of Evora, Portugal
| | - A Taubert
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Germany
| | - C Hermosilla
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Germany
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16
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Charlier J, Rinaldi L, Musella V, Ploeger HW, Chartier C, Vineer HR, Hinney B, von Samson-Himmelstjerna G, Băcescu B, Mickiewicz M, Mateus TL, Martinez-Valladares M, Quealy S, Azaizeh H, Sekovska B, Akkari H, Petkevicius S, Hektoen L, Höglund J, Morgan ER, Bartley DJ, Claerebout E. Initial assessment of the economic burden of major parasitic helminth infections to the ruminant livestock industry in Europe. Prev Vet Med 2020; 182:105103. [PMID: 32750638 DOI: 10.1016/j.prevetmed.2020.105103] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 01/16/2023]
Abstract
We report a European wide assessment of the economic burden of gastrointestinal nematodes, Fasciola hepatica (common liver fluke) and Dictyocaulus viviparus (bovine lungworm) infections to the ruminant livestock industry. The economic impact of these parasitic helminth infections was estimated by a deterministic spreadsheet model as a function of the proportion of the ruminant population exposed to grazing, the infection frequency and intensity, the effect of the infection on animal productivity and mortality and anthelmintic treatment costs. In addition, we estimated the costs of anthelmintic resistant nematode infections and collected information on public research budgets addressing helminth infections in ruminant livestock. The epidemiologic and economic input data were collected from international databases and via expert opinion of the Working Group members of the European Co-operation in Science and Technology (COST) action COMbatting Anthelmintic Resistance in ruminants (COMBAR). In order to reflect the effects of uncertainty in the input data, low and high cost estimates were obtained by varying uncertain input data arbitrarily in both directions by 20 %. The combined annual cost [low estimate-high estimate] of the three helminth infections in 18 participating countries was estimated at € 1.8 billion [€ 1.0-2.7 billion]. Eighty-one percent of this cost was due to lost production and 19 % was attributed to treatment costs. The cost of gastrointestinal nematode infections with resistance against macrocyclic lactones was estimated to be € 38 million [€ 11-87 million] annually. The annual estimated costs of helminth infections per sector were € 941 million [€ 488 - 1442 million] in dairy cattle, € 423 million [€ 205-663 million] in beef cattle, € 151million [€ 90-213 million] in dairy sheep, € 206 million [€ 132-248 million] in meat sheep and € 86 million [€ 67-107 million] in dairy goats. Important data gaps were present in all phases of the calculations which lead to large uncertainties around the estimates. Accessibility of more granular animal population datasets at EU level, deeper knowledge of the effects of infection on production, levels of infection and livestock grazing exposure across Europe would make the largest contribution to improved burden assessments. The known current public investment in research on helminth control was 0.15 % of the estimated annual costs for the considered parasitic diseases. Our data suggest that the costs of enzootic helminth infections which usually occur at high prevalence annually in ruminants, are similar or higher than reported costs of epizootic diseases. Our data can support decision making in research and policy to mitigate the negative impacts of helminth infections and anthelmintic resistance in Europe, and provide a baseline against which to measure future changes.
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Affiliation(s)
- J Charlier
- Kreavet, H. Mertensstraat 17, 9150, Kruibeke, Belgium.
| | - L Rinaldi
- Department of Veterinary Medicine and Animal Production, CREMOPAR, University of Naples Federico II, 80137, Napoli, Italy
| | - V Musella
- Department of Health Sciences, University of Catanzaro "Magna Græcia", CISVetSUA, 88100, Catanzaro, Italy
| | - H W Ploeger
- Department of Infectious Diseases and Immunology, Clinical Infectiology Division, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, the Netherlands
| | - C Chartier
- INRAE, Oniris, BIOEPAR, 44307, Nantes, France
| | - H Rose Vineer
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst, Neston, Cheshire, CH64 7TE, UK
| | - B Hinney
- Institute of Parasitology, Department of Pathobiology, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210, Wien, Austria
| | - G von Samson-Himmelstjerna
- Freie Universität Berlin, Institute for Parasitology and Tropical Veterinary Medicine, Robert-von-Ostertag-Str. 7-13, 14163, Berlin, Germany
| | - B Băcescu
- Faculty of Veterinary Medicine, Spiru Haret University, Blv. Basarabia 256, Bucharest, Romania
| | - M Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 159c, 02-786, Warsaw, Poland
| | - T L Mateus
- CISAS - Center for Research and Development in Agrifood Systems and Sustainability, Escola Superior Agrária, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial Nun'Álvares, 4900-347, Viana do Castelo, Portugal; EpiUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, 135, 4050-091, Porto, Portugal
| | - M Martinez-Valladares
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Departamento de Sanidad Animal. 24236, Grulleros, León, Spain
| | - S Quealy
- VirtualVet, Grenan Upper, Kilmacthomas, Co. Waterford, Ireland
| | - H Azaizeh
- Institute of Applied Research, University of Haifa, The Galilee Society, Israel & Tel Hai College, Department of Environmental Sciences, Upper Galilee 12210, P.O. Box 437, Shefa-Amr, 20200, Israel
| | - B Sekovska
- Faculty of Veterinary Medicine, University St. Cyril and Methodius, Skopje, Macedonia
| | - H Akkari
- Laboratory of Parasitology, University of Manouba, National School of Veterinary Medicine of Sidi Thabet, 2020, Sidi Thabet, Tunisia
| | - S Petkevicius
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine, Veterinary Academy, Lithuanian University of Health Sciences, Tilžės 18, LT-47181, Kaunas, Lithuania
| | - L Hektoen
- Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, P.O.Box 369 Sentrum, 0102, Oslo, Norway
| | - J Höglund
- Swedish University of Agricultural Sciences, Department of Biomedical Sciences and Veterinary Public Health, Section for Parasitology, P.O. Box 7036, SE-750 07, Uppsala, Sweden
| | - E R Morgan
- Institute for Global Food Security, Queen's University Belfast, 19, Chlorine Gardens, Belfast, BT9 5DL, UK
| | - D J Bartley
- Disease Control, Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, EH26 0PZ, UK
| | - E Claerebout
- Ghent University, Faculty of Veterinary Medicine, Laboratory of Parasitology, Salisburylaan 133, 9820, Merelbeke, Belgium
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17
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Lenti MV, Klersy C, Brera AS, Musella V, Benedetti I, Padovini L, Ciola M, Croce G, Ballesio A, Gorgone MF, Bertolino G, Di Sabatino A, Corazza GR. Clinical complexity and hospital admissions in the December holiday period. PLoS One 2020; 15:e0234112. [PMID: 32525896 PMCID: PMC7289422 DOI: 10.1371/journal.pone.0234112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Christmas and New Year’s holidays are risk factors for hospitalization, but the causes of this “holiday effect” are uncertain. In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital during the December holiday period had greater CC compared to those admitted during a contiguous non-holiday period. Methods This is a prospective, longitudinal study conducted in an academic ward of internal medicine in 2017–2019. Overall, 227 consecutive adult patients were enrolled, including 106 cases (mean age 79.4±12.8 years, 55 females; 15 December-15 January) and 121 controls (mean age 74.3±16.6 years, 56 females; 16 January-16 February). Demographic characteristics, CC, length of stay, and early mortality rate were assessed. Logistic regression analyses for the evaluation of independent correlates of being a holiday case were computed. Results Cases displayed greater CC (17.7±5.5 vs 15.2±5.9; p = 0.001), with greater impact of socioeconomic (3.51±1.7 vs 2.9±1.7; p = 0.012) and behavioral (2.36±1.6 vs 1.9±1.8; p = 0.01) CC components. Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; p<0.001), whilst having similar disease burden, as measured by the CIRS comorbidity index. Age (OR 1.02; p = 0.039), low income (OR 1.97, 95% CI 1.10–3.55; p = 0.023), and total CC (OR 1.06; p = 0.014) independently correlated with the cases. Also, cases showed a longer length of stay (median 15.5 vs 11 days; p = 0.0016) and higher in-hospital (12 vs 4 events; p = 0.021) and 30-day (14 vs 6 events; p = 0.035) mortality. Conclusions Patients hospitalized during the December holiday period had worse health outcomes, and this could be attributable to the grater CC, especially related to socioeconomic (social deprivation, low income) and behavioral factors (inappropriate diet). The evaluation of all CC components could potentially represent a useful tool for a more rational resource allocation over this time of the year.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alice Silvia Brera
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Valeria Musella
- Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Irene Benedetti
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Lucia Padovini
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mariella Ciola
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gabriele Croce
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessia Ballesio
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Maria Fortunata Gorgone
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giampiera Bertolino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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18
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Zaninetti C, Gresele P, Bertomoro A, Klersy C, De Candia E, Veneri D, Barozzi S, Fierro T, Alberelli MA, Musella V, Noris P, Fabris F, Balduini CL, Pecci A. Eltrombopag for the treatment of inherited thrombocytopenias: a phase II clinical trial. Haematologica 2019; 105:820-828. [PMID: 31273088 PMCID: PMC7049343 DOI: 10.3324/haematol.2019.223966] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/28/2019] [Indexed: 12/17/2022] Open
Abstract
Patients with inherited thrombocytopenias often require platelet transfusions to raise their platelet count before surgery or other invasive procedures; moreover, subjects with clinically significant spontaneous bleeding may benefit from an enduring improvement of thrombocytopenia. The hypothesis that thrombopoietin-mimetics can increase platelet count in inherited thrombocytopenias is appealing, but evidence is scarce. We conducted a prospective, phase II clinical trial to investigate the efficacy of the oral thrombopoietin-mimetic eltrombopag in different forms of inherited thrombocytopenia. We enrolled 24 patients affected by MYH9-related disease, ANKRD26-related thrombocytopenia, X-linked thrombocytopenia/ Wiskott-Aldrich syndrome, monoallelic Bernard-Soulier syndrome, or ITGB3-related thrombocytopenia. The average pre-treatment platelet count was 40.4 ×109/L. Patients received a 3- to 6-week course of eltrombopag in a dose-escalated manner. Of 23 patients evaluable for response, 11 (47.8%) achieved a major response (platelet count >100 ×109/L), ten (43.5%) had a minor response (platelet count at least twice the baseline value), and two patients (8.7%) did not respond. The average increase of platelet count compared to baseline was 64.5 ×109/L (P<0.001). Four patients with clinically significant spontaneous bleeding entered a program of long-term eltrombopag administration (16 additional weeks): all of them obtained remission of mucosal hemorrhages, with the remission persisting throughout the treatment period. Treatment was globally well tolerated: five patients reported mild adverse events and one patient a moderate adverse event. In conclusion, eltrombopag was safe and effective in increasing platelet count and reducing bleeding symptoms in different forms of inherited thrombocytopenia. Despite these encouraging results, caution is recommended when using thrombopoietinmimetics in inherited thrombocytopenias predisposing to leukemia. ClinicalTrials.gov identifier: NCT02422394.
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Affiliation(s)
- Carlo Zaninetti
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia.,PhD course in Experimental Medicine, University of Pavia, Pavia
| | - Paolo Gresele
- Department of Medicine, University of Perugia, Perugia
| | | | - Catherine Klersy
- Service of Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia
| | - Erica De Candia
- IRCCS Policlinico Universitario A. Gemelli Foundation, Roma.,Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, Roma
| | - Dino Veneri
- Department of Medicine, Section of Hematology, University of Verona, Verona
| | - Serena Barozzi
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia
| | | | | | - Valeria Musella
- Service of Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia
| | - Patrizia Noris
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia
| | | | - Carlo L Balduini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia.,Ferrata-Storti Foundation, Pavia, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia
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19
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Gabetta M, Mirabelli M, Klersy C, Musella V, Rizzo G, Pedrazzoli P, Barbarini N, Bellazzi R, Larizza C. An Extension of the i2b2 Data Warehouse to Support REDCap Dynamic Data Pull. Stud Health Technol Inform 2019; 258:21-25. [PMID: 30942706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
i2b2 and REDCap are two widely adopted solutions respectively to facilitate data re-use for research purpose and to manage non-for-profit research studies. REDCap provides the design specifications to build a web service used to import data from an external source with a procedure called DDP. In this work we have developed a web service that implements these specifications in order to import data from i2b2. Our approach has been tested with a real REDCap study.
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Affiliation(s)
| | - Marco Mirabelli
- Dep. of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy
| | | | | | | | | | | | - Riccardo Bellazzi
- Dep. of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy
| | - Cristiana Larizza
- Dep. of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy
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20
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Di Pietro S, Falaschi F, Bruno A, Perrone T, Musella V, Perlini S. The learning curve of sonographic inferior vena cava evaluation by novice medical students: the Pavia experience. J Ultrasound 2018; 21:137-144. [PMID: 29564661 DOI: 10.1007/s40477-018-0292-7] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 02/28/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The sonographic evaluation of inferior vena cava diameters and its collapsibility-that is also defined as the caval index-has become a popular way to easily obtain a noninvasive estimate of central venous pressure. This is generally considered an easy sonographic task to perform, and according to the American College of Emergency Physicians (ACEP) Guidelines 25 repetitions of this procedure should be sufficient to reach proficiency. However, little is known about the learning process for this sonographic technique. Therefore, we designed this study to investigate the learning curve of inferior vena cava evaluation. METHODS We enrolled a sample of ten ultrasound-naïve medical students who received a preliminary training provided by two Junior Emergency Medicine Residents. Following training, each student performed the sonographic task on 25 different patients who were hospitalized in the internal medicine ward. The students' performance was compared with the results obtained by a consultant in internal medicine with extensive experience in point-of-care ultrasound, who repeated the procedure on the same patients (gold standard). In detail, we evaluated the time to complete the task, the quality of the obtained images, and the ability to visually estimate and measure the caval index. RESULTS Although most students (9/10) reached the pre-defined level of competence, their overall performance was inferior to the one achieved by the gold standard, with little improvement over time. However, repetition was associated with progressive shortening of the time needed to achieve readable images. CONCLUSIONS Overall, these findings suggest that, although allowing to obtain a pre-defined competence, 25 repetitions are not enough to reach a good level of proficiency for this technique, that needs a longer training to be achieved.
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Affiliation(s)
- Santi Di Pietro
- Clinica Medica 2, Department of Internal Medicine, Emergency Medicine Fellowship Program, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Francesco Falaschi
- Clinica Medica 2, Department of Internal Medicine, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alice Bruno
- Clinica Medica 2, Department of Internal Medicine, Emergency Medicine Fellowship Program, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Tiziano Perrone
- Clinica Medica 1, Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Valeria Musella
- Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefano Perlini
- Clinica Medica 2, Department of Internal Medicine, Emergency Medicine Fellowship Program, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Calcaterra V, Winickoff JP, Klersy C, Schiano LM, Bazzano R, Montalbano C, Musella V, Regalbuto C, Larizza D, Cena H. Smoke exposure and cardio-metabolic profile in youth with type 1 diabetes. Diabetol Metab Syndr 2018; 10:53. [PMID: 29989097 PMCID: PMC6035465 DOI: 10.1186/s13098-018-0355-0] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To evaluate the relationship between smoking and metabolic parameters in patients affected by type 1 diabetes (T1D). PATIENTS AND METHODS We enrolled 104 children and young adults (50 females and 54 males) with T1D (aged 16.4 ± 8.6 years). The subjects were divided into three groups according to their smoking habits: no smoking (NS), passive smoking (PS), active smoking (AS). The physical examination of the participants included nutritional status assessment by anthropometry and pubertal stage according to Marshall and Tanner as well as blood pressure measurement. In all patients, metabolic blood assays including fasting blood glucose, insulin, total cholesterol, high-density lipoprotein cholesterol, and triglycerides were measured. Insulin resistance was determined by glucose disposal rate (eGDR). Physical activity was also recorded. RESULTS Significant differences in biochemical and functional parameters among the three groups were demonstrated, in particular for systolic (p = 0.002) and diastolic pressure (p = 0.02) and eGDR (p = 0.039). No differences in daily insulin dose (p = 0.75) and glycated hemoglobin (p = 0.39) were observed. AS group had significantly higher blood pressure (p < 0.05) and lower eGDR (p ≤ 0.001) compared to NS and PS. Significant difference was also detected between PS and NS in systolic and diastolic (p = 0.02) pressure and eGDR (p = 0.01). In a multivariable model adjusted for age, gender, BMI and physical activity, smoking habits did not maintain any independent association with metabolic parameters. CONCLUSION This is the first study in a Mediterranean population, looking at tobacco smoke and cardio-metabolic factors in youth with T1D. The relationship between smoking and unfavorable metabolic profile was demonstrated. On the basis of these findings, smoking tobacco should be considered an important modifiable risk factor for young patients with diabetes mellitus, highlighting the need for intensified smoking prevention and cessation programs.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children’s Health, Fondazione IRCCS Policlinico San Matteo, P.Le Golgi n.2, 27100 Pavia, Italy
| | - Jonathan P. Winickoff
- Department of Pediatrics, Harvard Medical School, MassGeneral Hospital for Children, Boston, MA USA
| | - Catherine Klersy
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Maria Schiano
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children’s Health, Fondazione IRCCS Policlinico San Matteo, P.Le Golgi n.2, 27100 Pavia, Italy
| | - Rossella Bazzano
- Department of Public Health, Experimental and Forensic Medicine, Laboratory of Dietetics and Clinical Nutrition, University of Pavia, Pavia, Italy
| | - Chiara Montalbano
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children’s Health, Fondazione IRCCS Policlinico San Matteo, P.Le Golgi n.2, 27100 Pavia, Italy
| | - Valeria Musella
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Corrado Regalbuto
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children’s Health, Fondazione IRCCS Policlinico San Matteo, P.Le Golgi n.2, 27100 Pavia, Italy
| | - Daniela Larizza
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children’s Health, Fondazione IRCCS Policlinico San Matteo, P.Le Golgi n.2, 27100 Pavia, Italy
| | - Hellas Cena
- Department of Public Health, Experimental and Forensic Medicine, Laboratory of Dietetics and Clinical Nutrition, University of Pavia, Pavia, Italy
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Lisi C, Perotti C, Scudeller L, Sammarchi L, Dametti F, Musella V, Di Natali G. Treatment of knee osteoarthritis: platelet-derived growth factors vs. hyaluronic acid. A randomized controlled trial. Clin Rehabil 2017; 32:330-339. [PMID: 28783969 DOI: 10.1177/0269215517724193] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Aim of this trial was to compare efficacy of activated platelet-rich plasma against hyaluronic acid as intra-articular injections to people with osteoarthritis of the knee. DESIGN Phase-2 randomized controlled trial, with blind patients and outcome assessors. SETTING Outpatient rehabilitation service; years 2011-2013. SUBJECTS Patients with knee osteoarthritis grades 2-3 at magnetic resonance imaging (MRI) were included after consent and randomized. Target sample size was 25 patients per group. INTERVENTIONS Patients received three activated platelet-rich plasma (intervention group) or hyaluronic acid (controls) intra-articular injections at 4-week intervals. MAIN MEASURES Main outcome measure was proportion of patients with >1 grade improvement at six months from last injection, as assessed by a radiologist blind to study group. Patients were evaluated over time clinically and with functional scales (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm, Tegner, American Knee Society Score (AKSS), Lequesne, visual analogue scale (VAS) for pain). RESULTS Overall, 30 patients were randomized to intervention and 28 to control group. For primary outcome, 28 patients (29 knees) in the intervention and 22 (25 knees) in the control group were available. Patients with at least 1 grade improvement at repeat MRI were 14 (48.3%) in the intervention and 2 (8%) in the control group ( P < 0.003). Improvement in symptoms and functional scales was consistently higher in the intervention group. No side-effects were observed in either group. CONCLUSION Activated platelet-rich plasma reduces articular damage as evident at MRI, as soon as six months after treatment; it reduces pain and improves patient's function and overall quality of life.
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Affiliation(s)
- Claudio Lisi
- 1 Physical Medicine and Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Cesare Perotti
- 2 Immuno-haematology and Transfusion Service, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Luigia Scudeller
- 3 Clinical Epidemiology Unit, Scientific Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Luigi Sammarchi
- 4 Department of Diagnostic and Interventional Radiology and Neuroradiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesca Dametti
- 1 Physical Medicine and Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Valeria Musella
- 3 Clinical Epidemiology Unit, Scientific Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giuseppe Di Natali
- 1 Physical Medicine and Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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Chaligiannis I, Musella V, Rinaldi L, Cringoli G, de la Fuente J, Papa A, Sotiraki S. Species diversity and spatial distribution of ixodid ticks on small ruminants in Greece. Parasitol Res 2016; 115:4673-4680. [PMID: 27655133 DOI: 10.1007/s00436-016-5259-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Abstract
A cross sectional field study on the distribution of Ixodidae ticks was carried out over two consecutive tick seasons (2012 and 2013) in small ruminants (309 farms) located in mainland and five islands of Greece. A total of 2108 ticks (1199 females, 908 males, and 1 nymph) were collected from sheep and goats. Two species of Rhipicephalus, two of Ixodes, five of Hyalomma, three of Haemaphysalis, and one of Dermacentor were detected. The species with the widest distribution were Rhipicephalus sanguineus s.l. (64.8 %), R. bursa (25.9 %), and Dermacentor marginatus (4.1 %), whereas the least frequently collected species were Ixodes ricinus, I. gibbosus, Haemaphysalis parva, H. sulcata, H. punctata, Hyalomma marginatum, H. excavatum, H. dromedarii, H. rufipes, and H. impeltatum representing together less than 5.3 % of the collections. R. sanguineus s.l. was the predominant species, while D. marginatus and I. gibbosus were restricted to the northeastern Aegean Sea islands. This is the first survey on tick fauna from mainland and islands in Greece.
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Affiliation(s)
- I Chaligiannis
- Veterinary Research Institute - Hellenic Agricultural Organization Demeter, NAGREF Campus Thermi, 57001, Thermi, Thessaloniki, Greece.,Ά Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Musella
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - L Rinaldi
- Department of Veterinary Medicine and Animal Productions, University of Naples, Federico II, Via Della Veterinaria 1, 80137, Naples, Italy
| | - G Cringoli
- Department of Veterinary Medicine and Animal Productions, University of Naples, Federico II, Via Della Veterinaria 1, 80137, Naples, Italy
| | - J de la Fuente
- SaBio. Instituto de Investigación en Recursos Cinegéticos, IREC-CSIC, UCLM, JCCM, Ciudad Real, Spain.,Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Oklahoma, USA
| | - A Papa
- Ά Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Sotiraki
- Veterinary Research Institute - Hellenic Agricultural Organization Demeter, NAGREF Campus Thermi, 57001, Thermi, Thessaloniki, Greece.
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Capuano F, Maurelli M, Rinaldi L, Perugini A, Veneziano V, Musella V, Cringoli G. Cystic echinococcosis in water buffaloes(Bubalus bubalis). Italian Journal of Animal Science 2016. [DOI: 10.4081/ijas.2007.s2.915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Condoleo R, Rinaldi L, Saralli G, Morgoglione M, Schioppi M, Condoleo R, Musella V, Cringoli G. An updating onCryptosporidium parvumin the water buffalo. Italian Journal of Animal Science 2016. [DOI: 10.4081/ijas.2007.s2.917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Callari M, Cappelletti V, D'Aiuto F, Musella V, Lembo A, Petel F, Karn T, Iwamoto T, Provero P, Daidone MG, Gianni L, Bianchini G. Subtype-Specific Metagene-Based Prediction of Outcome after Neoadjuvant and Adjuvant Treatment in Breast Cancer. Clin Cancer Res 2015; 22:337-45. [PMID: 26423797 DOI: 10.1158/1078-0432.ccr-15-0757] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/09/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE In spite of improvements of average benefit from adjuvant/neoadjuvant treatments, there are still individual patients with early breast cancer at high risk of relapse. We explored the association with outcome of robust gene cluster-based metagenes linked to proliferation, ER-related genes, and immune response to identify those high-risk patients. EXPERIMENTAL DESIGN A total of 3,847 publicly available gene-expression profiles were analyzed (untreated, N = 826; tamoxifen-treated, N = 685; chemotherapy-treated, N = 1,150). Genes poorly performing in formalin-fixed samples were removed. Outcomes of interest were pathologic-complete response (pCR) and distant metastasis-free survival (DMFS). In ER(+)HER2(-), the proliferation and ER-related metagenes were combined to define three risk groups. In HER2(+) and ER(-)HER2(-) risk groups were defined by tertiles of an immune-related metagene. RESULTS The high-proliferation/low-ER group of ER(+)HER2(-) breast cancer had significantly higher pCR rate [OR, 5.01 (1.76-17.99), P = 0.005], but poorer outcome [HR = 3.73 (1.63-8.51), P = 0.0018] than the low-proliferation/high-ER. A similar association with outcome applied to patients with residual disease (RD) after neoadjuvant chemotherapy (P = 0.01). In ER(-)HER2(-) and HER2(+) breast cancer, immune metagene in the high tertile was linked to higher pCR [33.7% vs. 11.6% in high and low tertile, respectively; OR, 3.87 (1.79-8.95); P = 0.0009]. In ER(-)HER2(-), after adjuvant/neoadjuvant chemotherapy, 5-year DMFS was 85.4% for high-tertile immune metagene, and 43.9% for low tertile. The outcome association was similar in patients with RD (P = 0.0055). In HER2(+) breast cancer treated with chemotherapy the association with risk of relapse was not significant. CONCLUSIONS We developed metagene-based predictors able to define low and high risk of relapse after adjuvant/neoadjuvant therapy. High-risk patients so defined should be preferably considered for trials with investigational agents.
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Affiliation(s)
- Maurizio Callari
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Vera Cappelletti
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca D'Aiuto
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Musella
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonio Lembo
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Fabien Petel
- Tumor Identity Cards Programme (CIT), Research Department, Ligue Nationale Contre le Cancer, Paris, France
| | - Thomas Karn
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Frankfurt, Germany
| | - Takayuki Iwamoto
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Paolo Provero
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy. Center for Translational Genomics and Bioinformatics, Ospedale San Raffaele, Milan, Italy
| | - Maria Grazia Daidone
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Luca Gianni
- Department of Medical Oncology, Ospedale San Raffaele, Milan, Italy
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Spinella G, Loprete G, Castagnetti C, Musella V, Antonelli C, Vilar JM, Britti D, Capitani O, Valentini S. Evaluation of mean echogenicity of tendons and ligaments of the metacarpal region in neonatal foals: A preliminary study. Res Vet Sci 2015; 101:11-4. [PMID: 26267082 DOI: 10.1016/j.rvsc.2015.05.011] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/20/2015] [Accepted: 05/19/2015] [Indexed: 11/18/2022]
Abstract
The aims of this research were to evaluate mean echogenicity (ME) of the deep and superficial digital flexor tendons (DDFT and SDFT), the interosseous muscle (IM), and the accessory ligament of the deep digital flexor tendon (ALDDFT) of the metacarpal region in neonatal foals, and determine the effect of sex, side and body weight on this quantitative ultrasonographic evaluation. Thirteen orthopedically sound neonatal foals were examined. Four areas of study (1A, 1B, 2A, 2B) were identified. Transverse scans of the DDFT, SDFT, IM and ALDDFT were obtained, recorded, and analyzed. The most echogenic structures were the ALDDFT and DDFT, while the SDFT was significantly less echogenic than all other structures (P<0.05). No influence of sex, forelimb, or body weight was observed. The echogenicity of the tenodesmic structures of foals partially overlapped that reported in the metacarpal region in adult horses, except for IM.
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Affiliation(s)
- G Spinella
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, BO, Italy.
| | - G Loprete
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Germaneto, CZ, Italy
| | - C Castagnetti
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, BO, Italy
| | - V Musella
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Germaneto, CZ, Italy
| | - C Antonelli
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, BO, Italy
| | - J M Vilar
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Trasmontaña S/N, Arucas 35413, Las Palmas, Spain
| | - D Britti
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Germaneto, CZ, Italy
| | - O Capitani
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, BO, Italy
| | - S Valentini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, BO, Italy
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Musella V, Callari M, Di Buduo E, Scuro M, Dugo M, Miodini P, Bianchini G, Paolini B, Gianni L, Daidone MG, Cappelletti V. Use of formalin-fixed paraffin-embedded samples for gene expression studies in breast cancer patients. PLoS One 2015; 10:e0123194. [PMID: 25844937 PMCID: PMC4386823 DOI: 10.1371/journal.pone.0123194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/18/2015] [Indexed: 01/16/2023] Open
Abstract
To obtain gene expression profiles from samples collected in clinical trials, we conducted a pilot study to assess feasibility and estimate sample attrition rates when profiling formalin-fixed, paraffin-embedded specimens. Ten matched fresh-frozen and fixed breast cancer samples were profiled using the Illumina HT-12 and Ref-8 chips, respectively. The profiles obtained with Ref 8, were neither technically nor biologically reliable since they failed to yield the expected separation between estrogen receptor positive and negative samples. With the use of Affymetrix HG-U133 2.0 Plus chips on fixed samples and a quantitative polymerase chain reaction -based sample pre-assessment step, results were satisfactory in terms of biological reliability, despite the low number of present calls (M = 21%±5). Compared with the Illumina DASL WG platform, Affymetrix data showed a wider interquartile range (1.32 vs 0.57, P<2.2 E-16,) and larger fold changes. The Affymetrix chips were used to run a pilot study on 60 fixed breast cancers. By including in the workflow the sample pre-assessment steps, 96% of the samples predicted to give good results (44/46), were in fact rated as satisfactory from the point of view of technical and biological meaningfulness. Our gene expression profiles showed strong agreement with immunohistochemistry data, were able to reproduce breast cancer molecular subtypes, and allowed the validation of an estrogen receptor status classifier derived in frozen samples. The approach is therefore suitable to profile formalin-fixed paraffin-embedded samples collected in clinical trials, provided that quality controls are run both before (sample pre-assessment) and after hybridization on the array.
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Affiliation(s)
- Valeria Musella
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maurizio Callari
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eleonora Di Buduo
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Manuela Scuro
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Dugo
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Miodini
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Biagio Paolini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Gianni
- Department of Medical Oncology, Ospedale San Raffaele, Milan, Italy
| | - Maria Grazia Daidone
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- * E-mail:
| | - Vera Cappelletti
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Musella V, Pietrantonio F, Di Buduo E, Iacovelli R, Martinetti A, Sottotetti E, Bossi I, Maggi C, Di Bartolomeo M, de Braud F, Daidone MG, Cappelletti V. Circulating tumor cells as a longitudinal biomarker in patients with advanced chemorefractory, RAS-BRAF wild-type colorectal cancer receiving cetuximab or panitumumab. Int J Cancer 2015; 137:1467-74. [PMID: 25704501 DOI: 10.1002/ijc.29493] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/12/2015] [Indexed: 11/10/2022]
Abstract
A still relevant number of patients with RAS-BRAF wild-type colorectal cancer (CRC) do not respond to treatment with antiepidermal growth factor receptor (EGFR) monoclonal antibodies cetuximab and panitumumab, suggesting that additional biomarkers to guide patient selection are urgently needed. Circulating tumor cells (CTCs) may represent such a biomarker. In this prospective study, 38 patients with advanced RAS-BRAF-wild-type CRC received third-line therapy with cetuximab-irinotecan or panitumumab. Peripheral blood samples for CTC status determination were collected at baseline, during treatment at early (2-4 weeks) and at later (8-10 weeks) times. CTC enrichment was done with the AdnaTest ColonCancerSelect kit, whereas CTC detection was done with the AdnaTest ColonCancerDetect kit. CTC status positivity was defined according to the kit manufacturer's thresholds. Fifty percent of patients were defined as CTC positive at baseline and the overall RECIST response rate was 26%. CTC baseline status was not associated with treatment response, whereas early CTC status and CTC status changes during treatment were significantly associated with tumor response. Kaplan-Meier analysis showed a significantly shorter progression-free survival (median, 2.0 versus 4.0 months, p = 0.004) and overall survival (4.7 versus11.4, p = 0.039) in patients with early CTC + status compared with CTC - ones. In multivariable analysis including classical prognostic factors, the CTC status changes profile during treatment was an independent predictor of both progression-free survival (p < 0.001) and overall-survival (p = 0.001). CTC status assessed early during treatment with anti-EGFR monoclonal antibodies may predict treatment failure in advance compared to imaging-based tools.
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Affiliation(s)
- Valeria Musella
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Eleonora Di Buduo
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Roberto Iacovelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Antonia Martinetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Elisa Sottotetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Ilaria Bossi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Claudia Maggi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Maria Grazia Daidone
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
| | - Vera Cappelletti
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, 20133, Italy
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Musella V, Pietrantonio F, Di Buduo E, Bossi I, Iacovelli R, Maggi C, Martinetti A, Sottotetti E, Di Bartolomeo M, de Braud F, Cappelletti V. Circulating Tumor Cells (CTCS) as Prognostic Biomarker in Patients with Advanced Chemorefractory, Ras Wild-Type Colorectal Cancer (CRC) Treated with Cetuximab or Panitumumab. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu164.11] [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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Callari M, Musella V, Di Buduo E, Sensi M, Miodini P, Dugo M, Orlandi R, Agresti R, Paolini B, Carcangiu ML, Cappelletti V, Daidone MG. Subtype-dependent prognostic relevance of an interferon-induced pathway metagene in node-negative breast cancer. Mol Oncol 2014; 8:1278-89. [PMID: 24853384 DOI: 10.1016/j.molonc.2014.04.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 04/09/2014] [Accepted: 04/14/2014] [Indexed: 12/31/2022] Open
Abstract
The majority of gene expression signatures developed to predict the likelihood to relapse in breast cancer (BC) patients assigns a high risk score to patients with Estrogen Receptor (ER) negative or highly proliferating tumors. We aimed to identify a signature of differentially expressed (DE) metagenes, rather than single DE genes, associated with distant metastases beyond classical risk factors. We used 105 gene expression profiles from consecutive BCs to identify metagenes whose prognostic role was defined on an independent series of 92 ESR1+/ERBB2- node-negative BCs (42 cases developing metastases within 5 years from diagnosis and 50 cases metastasis-free for more than 5 years, comparable for age, tumor size, ER status and surgery). Findings were validated on publicly available datasets of 684 node-negative BCs including all the subtypes. Only a metagene containing interferon-induced genes (IFN metagene) proved to be predictive of distant metastasis in our series of patients with ESR1+/ERBB2- tumors (P = 0.029), and such a finding was validated on 457 ESR1+/ERBB2- BCs from public datasets (P = 0.0424). Conversely, the IFN metagene was associated with a low risk of metastasis in 104 ERBB2+ tumors (P = 0.0099) whereas it did not prove to significantly affect prognosis in 123 ESR1-/ERBB2- tumors (P = 0.2235). A complex prognostic interaction was revealed in ESR1+/ERBB2- and ERBB2+ tumors when the association between the IFN metagene and a T-cell metagene was considered. The study confirms the importance of analyzing prognostic variables separately within BC subtypes, highlights the advantages of using metagenes rather than genes, and finally identifies in node-negative ESR1+/ERBB2- BCs, the unfavorable role of high IFN metagene expression.
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Affiliation(s)
- Maurizio Callari
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo, 42, 20133 Milan, Italy
| | - Valeria Musella
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo, 42, 20133 Milan, Italy
| | - Eleonora Di Buduo
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo, 42, 20133 Milan, Italy
| | - Marialuisa Sensi
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo, 42, 20133 Milan, Italy
| | - Patrizia Miodini
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo, 42, 20133 Milan, Italy
| | - Matteo Dugo
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo, 42, 20133 Milan, Italy
| | - Rosaria Orlandi
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo, 42, 20133 Milan, Italy
| | - Roberto Agresti
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133 Milan, Italy
| | - Biagio Paolini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133 Milan, Italy
| | - Maria Luisa Carcangiu
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133 Milan, Italy
| | - Vera Cappelletti
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo, 42, 20133 Milan, Italy.
| | - Maria Grazia Daidone
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo, 42, 20133 Milan, Italy.
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Pietrantonio F, Biondani P, Ciurlia E, Fanetti G, Tessari A, Bertarelli G, Bossi I, Musella V, Melotti F, Di Bartolomeo M, Valvo F, Pellegrinelli A, Milione M, Perrone F, de Braud F. Role of BAX for outcome prediction in gastrointestinal malignancies. Med Oncol 2013; 30:610. [PMID: 23700226 DOI: 10.1007/s12032-013-0610-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/13/2013] [Indexed: 12/14/2022]
Abstract
Our group and numerous others have shown in both preclinical and clinical studies that the proapoptotic mediator BAX may be deregulated through gene mutation or loss of protein expression, affecting resistance to chemotherapy and radiotherapy in several cancer types. However, BAX is also involved in cancer development and may related to prognosis, independently of treatment outcome. The clinical impact of BAX status in gastrointestinal malignancies remains controversial, although it is generally hypothesized that high expression may be a positive prognostic factor and predict increased efficacy of chemotherapy (with particular regard to platinum derivatives). The present review aims to provide updated information on BAX as potential prognostic and/or predictive biomarker in gastroesophageal and colorectal cancers, as well as in other less studied gastrointestinal malignancies.
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Affiliation(s)
- Filippo Pietrantonio
- Medical Oncology Unit 1, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133 Milan, Italy.
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Bianchini G, Cappelletti V, Callari M, Carcangiu ML, Eiermann W, Semiglazov V, Guillem V, Lluch A, Mansutti M, Zambetti M, Mariani G, Magazzu D, Valagussa P, Paolini B, Musella V, Di Buduo E, Miodini P, Scuro M, Daidone MG, Gianni L. Proliferation-, estrogen-, and T-cell-related metagenes to predict outcome after adjuvant/neoadjuvant chemotherapy for operable breast cancer in the ECTO trial. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1014 Background: Predicting recurrence in operable breast cancer (BC) despite optimal chemotherapy would be relevant to new drug development and tailored treatments. Methods: A large series (n=3,154) of public Affymetrix gene-expression profiles (GEP) was used to define prognostic/predictive metagenes in different BC subtypes. In ER+/HER2- a proliferation and an ER-related metagene were combined to predict low, intermediate and high risk of recurrence. In TN and in HER2+ a T cell metagene was used to predict low, intermediate and high risk (higher expression associated with lower risk). The metagenes were validated in patients enrolled in the phase III ECTO trial (Gianni L. JCO 2009) and treated with the same taxane-anthracycline-CMF regimen as neoadjuvant or adjuvant therapy before endocrine therapy if indicated. The outcome was distant event free survival (DEFS). Results: 283 good quality GEPs were obtained (neoadjuvant n=121; adjuvant n=162) from 464 retrospectively collected samples. Median follow-up was 8.9 years. In ER+/HER2- tumors the 10-yrs DEFS was 92.3, 81.2 and 66.6% in low, intermediate and high risk groups, respectively [high vs low HR 4.38 (1.01-19.1) p=.048] according to proliferation and ER-related metagenes. In HER2+ and TN subgroup the 10-yrs DEFS was 97.2, 75.6 and 78.8% in low, intermediate and high risk groups, respectively [high vs low HR 8.73 (1.09-69.8) p=.041]. In TN tumors, the pCR rate was 20% in the high and 61.5% in the low risk group. By combining the predicted risk group in each molecular subtype the 10-yrs DEFS was 95.3, 79.2 and 71.5% in low (24.2%), intermediate (42.7%) and high (33.1%) risk group, respectively [logrank p=0.003; high vs low HR 6.22 (1.87-20.6) p=.002]. ER, PGR, Ki67 and lymphocyte infiltration (LI) by IHC underperformed compared to genomic predictors. Conclusions: BC patients at higher risk of relapse despite optimal standard treatment can be identified who should be spared ineffective and toxic therapy and considered for investigational new strategies. In TN and HER2+, high T cell metagene and to a lesser extent LI are prognostic/predictive and associated with an extremely low risk of DEFS after chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Ana Lluch
- Hospital Clínico de Valencia - INCLIVA Health Research Institute, University of Valencia., Valencia, Spain
| | | | | | | | | | | | - Biagio Paolini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Musella
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Manuela Scuro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Musella V, Verderio P, Reid JF, Pizzamiglio S, Gariboldi M, Callari M, Massimo M, De Cecco L, Veneroni S, Pierotti MA, Daidone MG. Effects of warm ischemic time on gene expression profiling in colorectal cancer tissues and normal mucosa. PLoS One 2013; 8:e53406. [PMID: 23308215 PMCID: PMC3538764 DOI: 10.1371/journal.pone.0053406] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 11/30/2012] [Indexed: 01/09/2023] Open
Abstract
Background Genome-wide gene expression analyses of tumors are a powerful tool to identify gene signatures associated with biologically and clinically relevant characteristics and for several tumor types are under clinical validation by prospective trials. However, handling and processing of clinical specimens may significantly affect the molecular data obtained from their analysis. We studied the effects of tissue handling time on gene expression in human normal and tumor colon tissues undergoing routine surgical procedures. Methods RNA extracted from specimens of 15 patients at four time points (for a total of 180 samples) after surgery was analyzed for gene expression on high-density oligonucleotide microarrays. A mixed-effects model was used to identify probes with different expression means across the four different time points. The p-values of the model were adjusted with the Bonferroni method. Results Thirty-two probe sets associated with tissue handling time in the tumor specimens, and thirty-one in the normal tissues, were identified. Most genes exhibited moderate changes in expression over the time points analyzed; however four of them were oncogenes, and two confirmed the effect of tissue handling by independent validation. Conclusions Our results suggest that a critical time point for tissue handling in colon seems to be 60 minutes at room temperature. Although the number of time-dependent genes we identified was low, the three genes that already showed changes at this time point in tumor samples were all oncogenes, hence recommending standardization of tissue-handling protocols and effort to reduce the time from specimen removal to snap freezing accounting for warm ischemia in this tumor type.
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Affiliation(s)
- Valeria Musella
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Verderio
- Unit of Medical Statistics and Biometry, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - James Francis Reid
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Molecular Genetics of Cancer, Fondazione Istituto FIRC di Oncologia Molecolare, Milano, Italy
| | - Sara Pizzamiglio
- Unit of Medical Statistics and Biometry, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Manuela Gariboldi
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Molecular Genetics of Cancer, Fondazione Istituto FIRC di Oncologia Molecolare, Milano, Italy
| | - Maurizio Callari
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Milione Massimo
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Loris De Cecco
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Veneroni
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Maria Grazia Daidone
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- * E-mail:
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Callari M, Dugo M, Musella V, Marchesi E, Chiorino G, Grand MM, Pierotti M, Daidone M, Canevari S, De Cecco L. 812 Comparison of Microarray Platforms for Measuring Differential MicroRNA Expression in Paired Normal/cancer Colon Tissues. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71445-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cappelletti V, Fina E, Miodini P, Callari M, Musella V, Agresti R, Moliterni A, Daidone M. PP 83 Gene expression profiling of circulating tumor cells in breast cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72635-1] [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: 10/15/2022]
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Callari M, Dugo M, Cappelletti V, Musella V, Agresti R, Daidone M. PP 77 Dissecting time- from tumor-related gene expression variability in the bilateral breast cancer model. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72634-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rinaldi L, Coles G, Maurelli M, Musella V, Cringoli G. Calibration and diagnostic accuracy of simple flotation, McMaster and FLOTAC for parasite egg counts in sheep. Vet Parasitol 2011; 177:345-52. [DOI: 10.1016/j.vetpar.2010.12.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 12/02/2010] [Accepted: 12/09/2010] [Indexed: 11/24/2022]
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Rinaldi L, Genchi C, Musella V, Genchi M, Cringoli G. Geographical information systems as a tool in the control of heartworm infections in dogs and cats. Vet Parasitol 2011; 176:286-90. [DOI: 10.1016/j.vetpar.2011.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Musella V, Catelan D, Rinaldi L, Lagazio C, Cringoli G, Biggeri A. Covariate selection in multivariate spatial analysis of ovine parasitic infection. Prev Vet Med 2010; 99:69-77. [PMID: 21167615 DOI: 10.1016/j.prevetmed.2010.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 11/15/2010] [Accepted: 11/15/2010] [Indexed: 11/26/2022]
Abstract
Gastrointestinal (GI) strongyle and fluke infections remain one of the main constraints on health and productivity in sheep dairy production. A cross-sectional survey was conducted in 2004-2005 on ovine farms in the Campania region of southern Italy in order to evaluate the prevalence of Haemonchus contortus, Fasciola hepatica, Dicrocoelium dendriticum and Calicophoron daubneyi from among other parasitic infections. In the present work, we focused on the role of the ecological characteristics of the pasture environment while accounting for the underlying long range geographical risk pattern. Bayesian multivariate spatial statistical analysis was used. A systematic grid (10 km×10 km) sampling approach was used. Laboratory procedures were based on the FLOTAC technique to detect and count eggs of helminths. A Geographical Information System (GIS) was constructed by using environmental data layers. Data on each of these layers were then extracted for pasturing areas that were previously digitalized aerial images of the ovine farms. Bayesian multivariate statistical analyses, including improper multivariate conditional autoregressive models, were used to select covariates on a multivariate spatially structured risk surface. Out of the 121 tested farms, 109 were positive for H. contortus, 81 for D. dendriticum, 17 for C. daubneyi and 15 for F. hepatica. The statistical analysis highlighted a north-south long range spatially structured pattern. This geographical pattern is treated here as a confounder, because the main interest was in the causal role of ecological covariates at the level of each pasturing area. A high percentage of pasture and impermeable soil were strong predictors of F. hepatica risk and a high percentage of wood was a strong predictor of C. daubneyi. A high percentage of wood, rocks and arable soil with sparse trees explained the spatial distribution of D. dendriticum. Sparse vegetation, river, mixed soil and permeable soil explained the spatial distribution of the H. contortus. Bayesian multivariate spatial analysis of parasitic infections with covariates from remote sensing at a very small geographical level allowed us to identify relevant risk predictors. All the covariates selected are consistent with the life cycles of the helminths investigated. This research showed the utility of appropriate GIS-driven surveillance systems. Moreover, spatial features can be used to tailor sampling design where the sampling fraction can be a function of remote sensing covariables.
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Affiliation(s)
- V Musella
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Italy.
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Fiorenzano G, Santoriello C, Musella V, Polverino M. Exercise capacity in chronic respiratory diseases. Eur Respir J 2010; 35:1193-4. [PMID: 20436181 DOI: 10.1183/09031936.00204009] [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: 11/05/2022]
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Rinaldi L, Maurelli M, Musella V, Santaniello A, Coles G, Cringoli G. FLOTAC: An improved method for diagnosis of lungworm infections in sheep. Vet Parasitol 2010; 169:395-8. [DOI: 10.1016/j.vetpar.2010.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 11/30/2009] [Accepted: 01/05/2010] [Indexed: 11/30/2022]
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Cringoli G, Musella V, Maurelli MP, Morgoglione ME, Santaniello A, Condoleo R, Guariglia I, Rinaldi L. Helminths and arthropoda in buffalo farms from the Lazio region (Italy). Vet Res Commun 2009; 33 Suppl 1:129-31. [PMID: 19588261 DOI: 10.1007/s11259-009-9268-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G Cringoli
- Dipartimento di Patologia e Sanità Animale, Università degli Studi di Napoli Federico II, via della Veterinaria 1, 80137, Naples, Italy.
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De Cecco L, Musella V, Veneroni S, Cappelletti V, Bongarzone I, Callari M, Valeri B, Pierotti MA, Daidone MG. Impact of biospecimens handling on biomarker research in breast cancer. BMC Cancer 2009; 9:409. [PMID: 19930681 PMCID: PMC2787533 DOI: 10.1186/1471-2407-9-409] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 11/24/2009] [Indexed: 01/07/2023] Open
Abstract
Background Gene expression profiling is moving from the research setting to the practical clinical use. Gene signatures able to correctly identify high risk breast cancer patients as well as to predict response to treatment are currently under intense investigation. While technical issues dealing with RNA preparation, choice of array platforms, statistical analytical tools are taken into account, the tissue collection process is seldom considered. The time elapsed between surgical tissue removal and freezing of samples for biological characterizations is rarely well defined and/or recorded even for recently stored samples, despite the publications of standard operating procedures for biological sample collection for tissue banks. Methods Breast cancer samples from 11 patients were collected immediately after surgical removal and subdivided into aliquots. One was immediately frozen and the others were maintained at room temperature for respectively 2, 6 and 24 hrs. RNA was extracted and gene expression profile was determined using cDNA arrays. Phosphoprotein profiles were studied in parallel. Results Delayed freezing affected the RNA quality only in 3 samples, which were not subjected to gene profiling. In the 8 breast cancer cases with apparently intact RNA also in sample aliquots frozen at delayed times, 461 genes were modulated simply as a function of freezing timing. Some of these genes were included in gene signatures biologically and clinically relevant for breast cancer. Delayed freezing also affected detection of phosphoproteins, whose pattern may be crucial for clinical decision on target-directed drugs. Conclusion Time elapsed between surgery and freezing of samples appears to have a strong impact and should be considered as a mandatory variable to control for clinical implications of inadequate tissue handling.
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Affiliation(s)
- Loris De Cecco
- Fondazione Istituto FIRC di Oncologia Molecolare, Via Adamello16, 20139 Milano, Italy.
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Cappelletti V, Callari M, De Cecco L, Miodini P, Musella V, Sensi L, Carcangiu M, Veneroni S, Daidone M. PP108 Genes associated to development of distant metastases in node negative breast cancer patients. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)72147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Musella V, Miodini P, Callari M, Carbone A, Daidone M, Cappelletti V. PP110 Effect of fixative and sample age on success rate in gene profiling studies. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)72192-5] [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: 10/20/2022] Open
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Rinaldi L, Veneziano V, Morgoglione M, Pennacchio S, Santaniello M, Schioppi M, Musella V, Fedele V, Cringoli G. Is gastrointestinal strongyle faecal egg count influenced by hour of sample collection and worm burden in goats? Vet Parasitol 2009; 163:81-6. [DOI: 10.1016/j.vetpar.2009.03.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 03/17/2009] [Accepted: 03/26/2009] [Indexed: 11/28/2022]
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Santoriello C, Fiorenzano G, Musella V, De Rosa C, Polverino M. Long-term physical training allows high exercise performance in moderate chronic obstructive pulmonary disease (COPD). J Sports Med Phys Fitness 2009; 49:184-186. [PMID: 19528897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major health problem, because of its prevalence, morbidity and mortality. As a result of symptoms such as cough and dyspnea patients with COPD suffer from exercise limitation and reduced health related quality of life. The present paper reports the case of a 67-year old ex-smoker patient with COPD, who had exercised regularly since when he was young, and maintained a better exercise capacity than healthy people of the same age, despite a forced expiratory volume in 1 second of the 60% of the predicted normal value. This case suggests that regular physical exercise in COPD patients may prevent the loss of exercise capacity despite significant airway obstruction.
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Affiliation(s)
- C Santoriello
- Respiratory Phisiopathology, High-specialized Regional Center, Cava de' Tirreni Hospital, Local Health Unit Salerno 1, Salerno, Italy
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Pozio E, Rinaldi L, Marucci G, Musella V, Galati F, Cringoli G, Boireau P, La Rosa G. Hosts and habitats of Trichinella spiralis and Trichinella britovi in Europe. Int J Parasitol 2008; 39:71-9. [PMID: 18708065 DOI: 10.1016/j.ijpara.2008.06.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 06/04/2008] [Accepted: 06/07/2008] [Indexed: 10/21/2022]
Abstract
Trichinella spiralis and Trichinella britovi are the two most common species of Trichinella circulating in Europe. Based on data provided to the International Trichinella Reference Centre over the past 20 years (data referring to 540 isolates of T. spiralis and 776 isolates of T. britovi), we describe the host species and habitat characteristics for these two pathogens in Europe. A Geographical Information System was constructed using administrative boundaries, a Corine Land Cover (CLC) map, and an elevation map. In most countries, T. britovi is more widespread (62.5-100% of the isolates) than T. spiralis (0.0-37.5%), although in Finland, Germany, Poland and Spain, T. spiralis is more prevalent (56.3-84.2% of the isolates). Trichinella britovi is more widespread than T. spiralis in sylvatic carnivores (89% versus 11%), whereas T. spiralis is prevalent in both wild boars (62% versus 38%) and domestic swine (82% versus 18%), as well as in rodents (75% versus 25%). Trichinella spiralis and T. britovi circulate in the same environments: 41.1% and 46.0%, respectively, in agricultural areas, and 45.5% and 46.6% in forested and semi-natural areas. Although both pathogens can be transmitted by domestic and sylvatic cycles, their epidemiology is strongly influenced by the higher adaptability of T. spiralis to swine and of T. britovi to carnivores. These results are important because they include information on the countries at risk for these pathogens, the role played by specific species as reservoirs, the role of the pathogens in domestic and sylvatic cycles, and the role of the habitat in their circulation. The results can also be used to identify the most suitable animal species for the monitoring of these pathogens in Europe.
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Affiliation(s)
- E Pozio
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy.
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