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Brandes AA, Franceschi E, Ermani M, Tosoni A, Albani F, Depenni R, Faedi M, Pisanello A, Crisi G, Urbini B, Dazzi C, Cavanna L, Mucciarini C, Pasini G, Bartolini S, Marucci G, Morandi L, Zunarelli E, Cerasoli S, Gardini G, Lanza G, Silini EM, Cavuto S, Baruzzi A, Baruzzi A, Albani F, Calbucci F, D'Alessandro R, Michelucci R, Brandes A, Eusebi V, Ceruti S, Fainardi E, Tamarozzi R, Emiliani E, Cavallo M, Franceschi E, Tosoni A, Cavallo M, Fiorica F, Valentini A, Depenni R, Mucciarini C, Crisi G, Sasso E, Biasini C, Cavanna L, Guidetti D, Marcello N, Pisanello A, Cremonini AM, Guiducci G, de Pasqua S, Testoni S, Agati R, Ambrosetto G, Bacci A, Baldin E, Baldrati A, Barbieri E, Bartolini S, Bellavista E, Bisulli F, Bonora E, Bunkheila F, Carelli V, Crisci M, Dall'Occa P, de Biase D, Ferro S, Franceschi C, Frezza G, Grasso V, Leonardi M, Marucci G, Mazzocchi V, Morandi L, Mostacci B, Palandri G, Pasini E, Pastore Trossello M, Pession A, Ragazzi M, Riguzzi P, Rinaldi R, Rizzi S, Romeo G, Spagnolli F, Tinuper P, Trocino C, Cerasoli S, Dall'Agata M, Faedi M, Frattarelli M, Gentili G, Giovannini A, Iorio P, Pasquini U, Galletti G, Guidi C, Neri W, Patuelli A, Strumia S, Casmiro M, Gamboni A, Rasi F, Cruciani G, Cenni P, Dazzi C, Guidi A, Zumaglini F, Amadori A, Pasini G, Pasquinelli M, Pasquini E, Polselli A, Ravasio A, Viti B, Sintini M, Ariatti A, Bertolini F, Bigliardi G, Carpeggiani P, Cavalleri F, Meletti S, Nichelli P, Pettorelli E, Pinna G, Zunarelli E, Artioli F, Bernardini I, Costa M, Greco G, Guerzoni R, Stucchi C, Iaccarino C, Rizzi R, Zuccoli G, Api P, Cartei F, Fallica E, Granieri E, Latini F, Lelli G, Monetti C, Ramponi V, Saletti A, Schivalocchi R, Seraceni S, Tola MR, Urbini B, Giorgi C, Montanari E, Cerasti D, Crafa P, Dascola I, Florindo I, Mazza S, Servadei F, Silini E, Torelli P, Immovilli P, Morelli N, Vanzo C. Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center? Neurooncol Pract 2014; 1:166-171. [PMID: 26034628 PMCID: PMC4369716 DOI: 10.1093/nop/npu021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years. METHODS Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients. RESULTS Two hundred sixty-seven GBM patients (median age, 64 y; range, 29-84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2-12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0-18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248-0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388-0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328-0.986; P = .0446). CONCLUSIONS The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.
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Rumiato E, Brunello A, Ahcene-Djaballah S, Borgato L, Gusella M, Pasini F, Fiduccia P, Amadori A, Zagonel V, Saggioro D. 651: An array-based pharmacogenetic study on elderly patients with advanced breast cancer treated with aromatase inhibitors. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Boldrin E, Rumiato E, Fassan M, Rugge M, Cagol M, Chiarion-Sileni V, Ruol A, Gusella M, Amadori A, Saggioro D. 948: Genetic variants of susceptibility in second primary esophageal cancer patients. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50840-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cortellini G, Amadori A, Comandini T, Corvetta A. Interferon beta 1a anaphylaxis, a case report. Standardization of non-irritating concentration for allergy skin tests. Eur Ann Allergy Clin Immunol 2013; 45:181-182. [PMID: 24129047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Indexed: 06/02/2023]
Abstract
Multiple sclerosis is a disease with a potentially severe prognosis and epidemiologically increasing. Interferon beta 1a is a very useful maintenance therapy widely used by neurologists. In the literature, there are several case reports of hypersensitivity reactions. In this case report we describe an anaphylactic IgE mediated reaction to interferon beta 1a. We also describe, for the first time in the medical literature, the non-irritating concentration (NIC) to be used for skin tests.
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Mandato VD, Abrate M, De Iaco P, Pirillo D, Ciarlini G, Leoni M, Comerci G, Ventura A, Lenzi B, Amadori A, Rosati F, Martinello R, De Palma R, Ventura C, Belotti LMB, Formisano D, La Sala GB. Clinical governance network for clinical audit to improve quality in epithelial ovarian cancer management. J Ovarian Res 2013; 6:19. [PMID: 23547941 PMCID: PMC3623733 DOI: 10.1186/1757-2215-6-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/20/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Epithelial ovarian cancer (EOC) is the most lethal gynecological cancer. Several hospitals throughout the region provide primary treatment for these patients and it is well know that treatment quality is correlated to the hospital that delivers. The aim of this study was to investigate the management and treatment of EOC in a Region of the North Italy (Emilia-Romagna, Italy). METHODS A multidisciplinary group made up of 11 physicians and 3 biostatisticians was formed in 2009 to perform clinical audits in order to identify quality indicators and to develop Region-wide workup in accordance with the principles of evidence-based medicine (EBM). The rationale was that, by setting up an oncogynecology network so as to achieve the best clinical practice, critical points would decrease or even be eliminated. Analysis of cases was based on the review of the medical records. RESULTS 614 EOC patients treated between 2007 and 2008 were identified. We found only 2 high-volume hospitals (≥ 21 patients/year), 3 medium-volume hospitals (11-20 operated patients/year), and 7 low-volume hospitals (≤ 10 operated patients /year). Only 222 patients (76.3%) had a histological diagnosis, FIGO surgical staging was reported only in 206 patients (70.9%) but not all standard surgical procedures were always performed, residual disease were not reported in all patients. No standard number of neoadjuvant chemotherapy cycles was observed. CONCLUSIONS The differences in terms of treatments provided led the multidisciplinary group to identify reference centers, to promote centralization, to ensure uniform and adequate treatment to patients treated in regional centers and to promote a new audit involving all regional hospitals to a complete review of the all the EOC patients.
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Fedrigo M, Poli F, Esposito G, Feltrin G, Toscano G, d'Agostino C, Schiavon B, Gerosa G, Amadori A, Valente M, Thiene G, Angelini A. HLA-DRB1 typing by micro-bead array assay identifies the origin of early lymphoproliferative disorder in a heart transplant recipient. Am J Transplant 2013; 13:802-7. [PMID: 23331771 DOI: 10.1111/ajt.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/01/2012] [Accepted: 11/19/2012] [Indexed: 01/25/2023]
Abstract
We report the case of a 68-year-old woman who underwent heart transplantation for hypertrophic cardiomyopathy. Two months after the transplant she developed mild fever and dyspnea with a marked drop in left ventricle ejection fraction of 31%. Coronary angiography was negative for cardiac allograft vasculopathy. Endomyocardial biopsy revealed ischemic damage with no evidence of acute cellular rejection, antibody-mediated rejection or viral myocarditis. A neoplastic process was suspected even though full-body computerized tomography was negative for malignancy. The patient died 4 months after transplantation. The autopsy showed acute antero-septal myocardial infarction due to a nodular epicardial EBV-related posttransplant lymphoproliferative disorder (PTLD) infiltrating the left anterior descending coronary artery with occlusive neoplastic thrombosis. We highlight two major aspects of this case: (1) the unusual occurrence of early PTLD involving the cardiac allograft and causing a fatal outcome, (2) the application of an immunological technique for HLA-DRB1 typing to posttransplant paraffin-embedded autopsy material to identify the recipient origin of this early malignancy, thus excluding a possible donor-transmitted neoplasm.
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Amantini A, Carrai R, Lori S, Peris A, Amadori A, Pinto F, Grippo A. Neurophysiological monitoring in adult and pediatric intensive care. Minerva Anestesiol 2012; 78:1067-1075. [PMID: 22672930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Clinical neurophysiology is both an extension of clinical examination and an integration of neuroimaging. It plays a role in diagnosis, prognosis and monitoring in the Intensive Care Unit (ICU). Electroencephalography (EEG) and somatosensory evoked potentials (SEPs) are the most informative neurophysiological tests. Both have a major prognostic role in the hypoxic-ischemic encephalopathy and traumatic brain injury (TBI). In the former the absence of bilateral cortical SEPs has an unfavorable prognostic significance of 100%, whereas bilateral normal SEPs has uncertain prognostic value. In TBI these SEP patterns have high early prognostic value for both bad and good outcome. Continuous EEG monitoring is indicated for diagnosis and treatment of non convulsive seizures and status epilepticus (NCSE), whereas SEPs are more able to indicate the occurrence of neurological deterioration. In our opinion EEG-SEP monitoring is also valuable for interpretation and management of ICP trends, contributing to optimise treatment in a single patient. The EEG seems to have the same prognostic utility in pediatric as in adult ICU. Recent reviews supported the use of SEPs in the integrated process of outcome prediction after acute brain injury in children. However differences in interpretation are needed and the issue is whether it is possible to establish an age limit over which the prediction of SEPs is similar to that in adults. There are only a few studies of seizure prevalence in pediatric ICU. The variability of frequency of NCSE in comatose children is high as in adults and, similar to the adult, remains unclear the impact on outcome.
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Rumiato E, Cavallin F, Cagol M, Alfieri R, Ruol A, Ancona E, Amadori A, Saggioro D. 941 Genetic Polymorphisms as Predictive/prognostic Biomarkers in Esophageal Cancer Patients Receiving Cisplatin/5-Fluorouracil-based Neoadjuvant Chemotherapy. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sturchio E, Amadori A, Businaro J, Ficociello B, Ferrazza P, Colosio C, Minoia C. [Possible use of microRNAs as biomarkers for monitoring of workers exposed to asbestos]. GIORNALE ITALIANO DI MEDICINA DEL LAVORO ED ERGONOMIA 2012; 34:571-573. [PMID: 23405719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Exposure to asbestos is the predominant cause of pleural mesothelioma (PM). The PM is a tumor difficult to diagnose, chemoresistant, and with rising Incidence. The long latency periods and the lack of preventive and therapeutic strategies for the MP, suggest that asbestos will be a social and health issue in the near future. Therefore, this overview focuses on current knowledge of epigenetic alterations and on the key role of microRNAs, small RNAs that negatively regulate gene expression, as biomarkers in PM development. Dysregulated microRNA expression pattern is specific for different cancers, including MP. MicroRNA expression analysis is a promising tool for diagnosis, typing of MP than normal tissue and other lung tumors and monitoring of new therapies. However, a better knowledge of miRNA signatures in PM is still necessary to verify the contribution of specific miRNAs as diagnostic biomarkers, also compared to different asbestos forms, exposure and subject work history.
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Rumiato E, Pasello G, De Salvo G, Parenti A, Cagol M, Ruol A, Ancona E, Amadori A, Saggioro D. 774 Copy Number Profile of Esophageal Cancer – Comparative Analysis of Adenocarcinoma and Squamous Cell Carcinoma. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bravaccini S, Amadori A, Scarpi E, Tumedei MM, Zoli W, Silvestrini R. Predictive role of telomerase activity in the clinical outcome of patients with benign lesions of the uterine cervix or CIN. ANALYTICAL CELLULAR PATHOLOGY (AMSTERDAM) 2012; 35:377-80. [PMID: 22596181 PMCID: PMC4605540 DOI: 10.3233/acp-2012-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telomerase, a fundamental marker of neoplastic transformation, is widely expressed in both premalignant intraepithelial lesions and in most malignant lesions of the uterine cervix. We determined telomerase activity (TA) in uterine cervix by Repeat Amplification Protocol (TRAP) in a series of 62 cases, 44 with benign diseases (inflammation and/or metaplasia and/or acanthosis) and 18 with cervical intraepithelial neoplasia (CIN). No significant differences in TA were observed between benign lesions (median AEU value 36, range 0–119) and CIN (median AEU value 30, range 0–65). Conversely, TA was significantly higher in subjects who showed CIN evolution (65 range 45–119) than in disease-free individuals (34 range 0–95, p = 0.017) and in 1 patient with a CIN2 lesion who relapsed after 5 years. Our results suggest that TA of the uterine cervix is capable of predicting CIN evolution or relapse, thus indicating its potential usefulness as a prognostic marker in clinical surveillance programs.
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Fossi S, Carrai R, Amadori A, Bucciardini L, Innocenti P, Cossu C, Gabbanini S, Lori S, Pinto F, Grippo A, Amantini A. P11.15 Continuous EEG-SEP monitoring of acute brain injury in neurointensive care unit. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Amantini A, Fossi S, Carrai R, Spalletti M, Amadori A, Bucciardini L, Innocenti P, Cossu C, Lanzo G, Pinto F, Grippo A. P12.1 Nonconvulsive status epilepticus in acute brain injury: a prospective continuous EEG study. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60404-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bertolin M, Pigozzo J, Koussis H, Ghiotto C, Valente S, Michieletto S, Magro C, Rossi E, Zamarchi R, Bozza F, Jirillo A, Chiarion-Sileni V, Amadori A. Circulating tumor cells detection and evaluation of their apoptotic status in patients with localized breast cancer before and after surgery. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e21127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Masiero M, Minuzzo S, Pusceddu I, Moserle L, Persano L, Agnusdei V, Tosello V, Basso G, Amadori A, Indraccolo S. Notch3-mediated regulation of MKP-1 levels promotes survival of T acute lymphoblastic leukemia cells. Leukemia 2011; 25:588-98. [PMID: 21263446 DOI: 10.1038/leu.2010.323] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Activation of the Notch pathway occurs commonly in T acute lymphoblastic leukemia (T-ALL) because of mutations in Notch1 or Fbw7 and is involved in the regulation of cell proliferation and survival. Deregulated Notch3 signalling has also been shown to promote leukemogenesis in transgenic mice, but the targets of Notch3 in human T-ALL cells remain poorly characterized. Here, we show that Notch3 controls levels of mitogen-activated protein kinase (MAPK) phosphatase 1 (MKP-1). In a model of T-ALL cell dormancy, both Notch3 activation and MKP-1 expression were upregulated in aggressive compared with dormant tumors, and this inversely correlated with the levels of phosphorylated p38 and extracellular signal-regulated kinase1/2 (ERK1/2) MAPKs, two canonical MKP-1 targets. We demonstrate that MKP-1 protein levels are regulated by Notch3 in T-ALL cell lines because its silencing by RNA interference or treatment with γ-secretase inhibitors induced strong MKP-1 reduction whereas activation of Notch3 signalling had the opposite effect. Furthermore, MKP-1 has an important role in T-ALL cell survival because its attenuation by short hairpin RNA significantly increased cell death under stress conditions. This protective function has a key role in vivo, as MKP-1-deficient cells showed impaired tumorigenicity. These results elucidate a novel mechanism downstream of Notch3 that controls the survival of T-ALL cells.
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Orzalesi V, Bucciardini L, Amadori A, Marchiani S, Innocenti P. Optic nerve ultrasound for detecting intracranial hypertension. Crit Care 2010. [PMCID: PMC2934005 DOI: 10.1186/cc8532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Moserle L, Amadori A, Indraccolo S. The Angiogenic Switch: Implications in the Regulation of Tumor Dormancy. Curr Mol Med 2009; 9:935-41. [DOI: 10.2174/156652409789712800] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Zovato S, Opocher G, Rossi E, Indraccolo S, Amadori A, Pastorelli D, Lombardi G, Anglani M, Zamarchi R. 7144 Predictive value and biologic significance of circulating tumor cells (CTC) in sporadic and von hippel lindau (VHL) renal cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71477-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Basso U, Rossi E, Indraccolo S, Barile C, Sava T, Aieta M, Brunello A, Jirillo A, Amadori A, Zamarchi R. 7117 Do circulating tumor cells (CTCs) correlate with response to first-line sunitinib in metastatic renal carcinoma? EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71450-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Amadori A, Rossi E, Zamarchi R, Carli P, Pastorelli D, Jirillo A. Circulating and disseminated tumor cells in the clinical management of breast cancer patients: unanswered questions. Oncology 2009; 76:375-86. [PMID: 19407470 DOI: 10.1159/000215581] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 01/26/2009] [Indexed: 11/19/2022]
Abstract
Breast cancer is the most common cancer in women. Although survival rates have improved with the use of new therapeutic agents, many issues remain unresolved and new predictive and prognostic factors are needed in clinical practice. Several studies have suggested a prognostic and predictive role for circulating and disseminated tumor cells in metastatic disease and adjuvant treatment. Because of recent technological advances, oncologists have gained a new perspective on this disease. Circulating tumor cells could be both a new tumor marker as well as a tool to gain novel insight into the natural history of this neoplastic disease.
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Amantini A, Fossi S, Grippo A, Innocenti P, Amadori A, Bucciardini L, Cossu C, Nardini C, Scarpelli S, Roma V, Pinto F. Continuous EEG-SEP monitoring in severe brain injury. Neurophysiol Clin 2009; 39:85-93. [PMID: 19467438 DOI: 10.1016/j.neucli.2009.01.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 01/07/2009] [Accepted: 01/18/2009] [Indexed: 02/06/2023] Open
Abstract
AIMS To monitor acute brain injury in the neurological intensive care unit (NICU), we used EEG and somatosensory evoked potentials (SEP) in combination to achieve more accuracy in detecting brain function deterioration. METHODS Sixty-eight patients (head trauma and intracranial hemorrhage; GCS<9) were monitored with continuous EEG-SEP and intracranial pressure monitoring (ICP). RESULTS Fifty-five patients were considered "stable" or improving, considering the GCS and CT scan: in this group, SEP didn't show significant changes. Thirteen patients showed neurological deteriorations and, in all patients, cortical SEP showed significant alterations (amplitude decrease>50% often till complete disappearance). SEP deterioration anticipated ICP increase in 30%, was contemporary in 38%, and followed ICP increase in 23%. Considering SEP and ICP in relation to clinical course, all patients but one with ICP less than 20 mmHg were stable, while the three patients with ICP greater than 40 mmHg all died. Among the 26 patients with ICP of 20-40 mmHg, 17 were stable, while nine showed clinical and neurophysiological deterioration. Thus, there is a range of ICP values (20-40 mmHg) were ICP is scarcely indicative of clinical deterioration, rather it is the SEP changes that identify brain function deterioration. Therefore, SEP have a twofold interest with respect to ICP: their changes can precede an ICP increase and they can constitute a complementary tool to interpret ICP trends. It has been very important to associate SEP and EEG: about 60% of our patients were deeply sedated and, because of their relative insensitivity to anesthetics, only SEP allowed us to monitor brain damage evolution when EEG was scarcely valuable. CONCLUSIONS We observed 3% of nonconvulsive status epilepticus compared to 18% of neurological deterioration. If the aim of neurophysiological monitoring is to "detect and protect", it may not be limited to detecting seizures, rather it should be able to identify brain deterioration, so we propose the combined monitoring of EEG with SEP.
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Frosini C, Amadori A, Bucciardini L, Bacci I, Gandini E, Marinoni M, Mangiafico S, Innocenti P. Diagnosis and treatment of subarachnoid hemorrhage-induced vasospasm. Crit Care 2009. [PMCID: PMC4083988 DOI: 10.1186/cc7266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Berardi D, Tarricone I, Poggi F, Salvatori F, Morri M, Fini C, Amadori A. The Bologna multiethnic mental health centre. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Macor P, Piovan E, Zorzet S, Tripodo C, Marzari R, Amadori A, Tedesco F. Neutralizing human antibodies against CD55 and CD59 targeted to lymphoma cells in vivo potentiate the therapeutic effect of Rituximab. Mol Immunol 2007. [DOI: 10.1016/j.molimm.2006.07.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fossi S, Amantini A, Grippo A, Innocenti P, Amadori A, Bucciardini L, Cossu C, Scarpelli S, Bruni I, Sgalla R, Pinto F. Continuous EEG–SEP monitoring of severely brain injured patients in NICU: methods and feasibility. Neurophysiol Clin 2006; 36:195-205. [PMID: 17095409 DOI: 10.1016/j.neucli.2006.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS To evaluate the feasibility of a continuous neurophysiologic monitoring (electroencephalography (EEG)-somatosensory evoked potentials (SEPs)) in the neuro-intensive care unit (NICU), taking into account both the technical and medical aspects that are specific of this environment. METHODS We used an extension of the recording software that is routinely used in our unit of clinical neurophysiology. It performs cycles of alternate EEG and SEP recordings. Raw traces and trends are simultaneously displayed. Patient head and stimulator box are placed behind the bed and linked to the ICU monitoring terminal through optic fibers. The NICU staff has been trained to note directly clinical events, main artefacts and therapeutic changes. The hospital local area network (LAN) enables remote monitoring survey. RESULTS Continuous EEG (CEEG)-SEP monitoring was performed in 44 patients. Problems of needle detachment were seldomly encountered, thanks to the use of a sterile plastic dressing, which covers needles. We never had infection or skin lesions due to needles or the electrical stimulator. The frequent administration of sedative at high doses prevented us from having a clinically valuable EEG in several cases but SEPs were always monitorable, independently of the level of EEG suppression. The diagnosis of seizures and non-epileptic status was based on raw EEG, while quantitative EEG (QEEG) was used to quantify ictal activity as a guide to treatment. CONCLUSIONS EEG and EP waveforms collected in NICU were of comparable quality to routine clinical measurements and contained the same clinical information. A continuous SEP monitoring in a comatose and sedated patient in NICU is not technically more difficult and potentially less useful than in operating room. This monitoring appears to be feasible provided the observance of some requirement regarding setting, electrodes, montages, personnel integration, consulting and software.
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