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Sighinolfi M, Sarchi L, Assumma S, Cimadamore A, Montironi R, Bonetti LR, Turri F, De Carne C, Maiorana A, Micali S, Rocco B. Focal secondary resection of neurovascular bundles after digital frozen section of prostate surface: a novel tailored surgical approach. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Chen SH, Edwards I, Jayasena R, Ding H, Karunanithi M, Dowling A, Layland J, Maiorana A. Patient Perspectives on Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure (ITEC-CHF): Usability Study. JMIR Cardio 2021; 5:e24611. [PMID: 34519663 PMCID: PMC8479597 DOI: 10.2196/24611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 03/07/2021] [Accepted: 05/31/2021] [Indexed: 01/04/2023] Open
Abstract
Background Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but little is known about the usability and patients’ willingness to engage with this technology. Objective This study aims to evaluate feedback from patients with CHF following participation in the Innovative Telemonitoring Enhanced Care program for CHF (ITEC-CHF) study. Methods The telemonitoring intervention consisted of three components: remote weight monitoring, structured telephone support, and
nurse-led collaborative care. Participants were provided with electronic weighing scales (W550; ForaCare), and a computer tablet (Galaxy Tab A; Samsung). They were asked to weigh themselves on the provided scales daily. Telemonitoring was integrated with a personal assistance call service and a nurse care service according to their workflows in usual care. Feedback on the usability of ITEC-CHF was collected via survey from study participants following 6 months of receiving telemonitoring care for their body weight. Survey responses were provided on a 5-point Likert scale and through open-ended questions to determine participants’ perceived benefits and barriers to using ITEC-CHF. Results A total of 67 participants (49/67, 73% male), with a mean age of 69.8 (SD 12.4) years completed the survey. The majority of participants agreed or strongly agreed that the ITEC-CHF program was easy to use (61/67, 91%), easy to navigate (51/65, 78%), useful (59/65, 91%), and made them feel more confident in managing their weight (57/67, 85%). Themes related to participants’ perceptions of telemonitoring included increased support for early intervention of clinical deterioration, improved compliance to daily weighing, a sense of reassurance, and improved self-care and accountability, among others. Conclusions ITEC-CHF was rated highly on usability and was well accepted by users as part of their routine self-management activities. Participants were willing to use telemonitoring because they perceived a broad spectrum of benefits for CHF management. Trial Registration Australian New Zealand Clinical Trial Registry ID ACTRN 12614000916640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366691.
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Huey Chen S, Boyd J, Randall S, Maiorana A. Community-based nurse practitioner support is associated with better self-care behaviour and quality of life in patients with chronic heart failure. AUST J ADV NURS 2021. [DOI: 10.37464/2020.383.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dolci F, Kilding A, Spiteri T, Chivers P, Piggott B, Maiorana A, Hart NH. Characterising running economy and change of direction economy between soccer players of different playing positions, levels and sex. Eur J Sport Sci 2021; 22:1167-1176. [PMID: 34228596 DOI: 10.1080/17461391.2021.1953151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Traditional movement economy (ME) measures the energetic cost of in-line running. However, it is debatable whether such a measure is representative of movement efficiency for team sport athletes who are required to run and change direction repeatedly. This study evaluated ME during both in-line running and runs with directional changes and provided a preliminary exploration as to whether these abilities discriminate soccer players according to playing position, level, and sex. Forty-three soccer players were assessed for ME as extrapolated from oxygen uptake during in-line running (RE) and running with changes of directions (using 20 and 10 m shuttle runs [SRE20 and SRE10]) at 8.4 km/h mean speed. ME worsened with change of direction frequency (p < 0.001). Coefficient of determination was high between RE and SRE20 (r2 = 0.601) but dropped below 0.5 for RE and SRE10 (r2 = 0.280) as change of direction frequency increased. No significant differences were observed between different player positions, however, centre midfielders reported the best ME across any position and running mode, with the largest differences observed in centre backs over SRE10 (41.9 ± 2.7 ml/kg/min [centre midfielders] vs 45 ± 1.8 ml/kg/min [centre backs]; ES = 1.19). No significant differences were observed for ME over any running condition for male players of different playing levels. Female players exhibited better ME than male players with significant differences observed for SRE10 (41.5 ± 2.6 ml/kg/min [females] vs 44 ± 2.6 ml/kg/min [males]; p = 0.013; ES = 0.94). RE does not adequately account for efficiency during activities that involve changes of direction. SRE10 is a stronger discriminator of ME between soccer players of different position and sex.
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Buscemi S, Maiorana A, Fazzotta S, Incandela D, Palumbo VD, Damiano G, Maffongelli A, Messina M, Bisso C, Anzelmo G, Curione F, Cantavenera V, Bellomo E, Raia VE, Scimeca R, Geraci G, Cudia BM, Lo Monte AI. Scar endometriosis: not a rare cause for a painful scar. LA CLINICA TERAPEUTICA 2021; 172:129-133. [PMID: 33763680 DOI: 10.7417/ct.2021.2299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Conclusion High suspicion of scar endometriosis are painful no-dule in the abdominal scar. Wide surgical excision is the treatment of choice. Introduction Endometriosis has been described as the presence of endometrial tissue outside uterine cavity. Scar endometriosis (SE) is a rare disease reported in 0.03-1.08% of women following gynaecologic surgery. In our retrospective observational cohort study we studied anamnesis, symptoms, surgical procedures and outcomes linked to scar endometriosis in our medical experience from 2004 to 2018. Methods We reviewed the medical records of 46 patients with a histopathological diagnosis of SE. All patients had a history of at least one previous caesarean section (n=46, 100%). Forty-two patients (91,3%) complained gradually growing nodular abdominal mass near or adjacent to caesarean incision scar, while only 4 patients (8,6%) complained aspecific abdominal pain. Ultrasound scan was performed in all patients (n=46, 100%) and mean size of the nodules at US was 26,8 ± 13,8 mm. Results All patients underwent surgery. Seven patients (15,2%) needed mesh implantation, while 39 patients (84,8%) underwent local resection with reconstruction of muscle fascia. Mean follow-up was 31,6 ± 14 months and no patients reported local recurrence of disease.
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Bonfiglio F, Bruscaggin A, Guidetti F, Terzi di Bergamo L, Faderl M, Spina V, Condoluci A, Bonomini L, Forestieri G, Koch R, Piffaretti D, Pini K, Pirosa MC, Cittone MG, Arribas A, Lucioni M, Ghilardi G, Wu W, Arcaini L, Baptista MJ, Bastidas G, Bea S, Boldorini R, Broccoli A, Canzonieri V, Cascione L, Ceriani L, Cogliatti S, Derenzini E, Devizzi L, Dietrich S, Elia AR, Facchetti F, Gaidano G, Garcia JF, Gerber B, Ghia P, Silva MG, Gritti G, Guidetti A, Hitz F, Inghirami G, Ladetto M, Lopez‐Guillermo A, Lucchini E, Maiorana A, Marasca R, Matutes E, Meignin V, Merli M, Moccia A, Mollejo M, Montalban C, Novak U, Oscier DG, Passamonti F, Piazza F, Pizzolitto S, Sabattini E, Salles G, Santambrogio E, Scarfó L, Stathis A, Stüssi G, Geyer JT, Tapia G, Thieblemont C, Tousseyn T, Tucci A, Visco C, Vitolo U, Zenz T, Zinzani PL, Khiabanian H, Calcinotto A, Bertoni F, Bhagat G, Campo E, Leval L, Dirnhofer S, Pileri SA, Piris MÁ, Traverse‐Glehen A, Tzankov A, Paulli M, Ponzoni M, Mazzucchelli L, Cavalli F, Zucca E, Rossi D. GENETIC AND PHENOTYPIC ATTRIBUTES OF SPLENIC MARGINAL ZONE LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.43_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Spinella A, Toss A, Isca C, Vacchi C, Iannone A, Magnani L, Castrignanò P, De Pinto M, Laura C, Maiorana A, Salvarani C, Dominici M, Giuggioli D. AB0425 CLINICAL AND PATHOLOGICAL FEATURES OF BREAST CANCER IN PATIENTS WITH SYSTEMIC SCLEROSIS: PRELIMINARY DATA FROM THE SCLERO-BREAST STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic Sclerosis (SSc) is a rare and life-threatening connective tissue disease characterized by vascular dysfunction, specific autoimmune abnormalities and fibrosis of the skin and internal organs. Previous studies have shown a 1.5-fold increase in cancer risk in SSc patients compared with the general population, including breast cancer (BC). The relationship between BC and SSc has long been discussed but past research has been contradictory and inconclusive on this topic.Objectives:The aim of our project was to analyze clinical and pathological characteristics of BC developed by SSc subjects and possible correlations with scleroderma features. Here we present the preliminary data from the Sclero-Breast study.Methods:Our observational retrospective multicenter study enrolled 33 SSc women with a personal history of BC identified at two Rheumatology/SSc Units in the north of Italy between January 2017 and December 2019 (lc/dcSSc 23/9, 1 unknown; mean age at SSc onset 57 years, range 32-73). All patients underwent general and instrumental assessment: smoking habits; presence of skin ulcers, calcinosis, teleangectasia; presence of gastro-intestinal and kidney involvement; interstitial lung disease (at HR-CT); pulmonary function tests; ECG abnormalities; echocardiographic assessment of pulmonary arterial hypertension (PAH); videocapillaroscopic pattern; autoantibody profile; exposure to immunosuppressive and vasoactive therapies; status at last follow-up evaluation and cause of death. Clinical and pathological characteristics of BC were also evaluated: age at diagnosis; menopausal status; histotype; hormone receptor status; MIB1, HER2 expression; clinical and pathological stage at diagnosis; metastatic sites; type of loco-regional treatment (surgery and radiotherapy); type of systemic treatment (neoadjuvant/adjuvant chemotherapy and endocrine treatment); other cancers and time from diagnosis of the first disorder to the second one.Results:A total of 54.5% of subjects developed BC before SSc (median interval of 5 years), whereas 45.5% of patients developed BC after SSc (median delay of 8 years). 54.5% of patients showed interstitial lung disease and the cause of death of the 6 deceased subjects was PAH. A significant association (p<0.05) was observed between the use of immunosuppressive therapy and diffuse skin extension, negative ACA, positive Anti-Scl-70 and interstitial lung disease, but not with BC status. 93.1% of patients were diagnosed with an early-stage tumor, 70.8% of invasive carcinomas with a low MIB-1, 8.3% with a tubular histotype, while 42.8% presented with a Luminal A-like tumor. 66.6% underwent breast conserving surgery and 55.5% RT after surgery. 40% of patients developed interstitial lung disease after RT and 20% dcSSc.Conclusion:According to our preliminary data, SSc patients developed BC at good prognosis, suggesting a de-escalation strategy of cancer therapies. On these grounds, a proper screening is mandatory in order to allow for early cancer detection in SSc patients. Further investigations on larger numbers of patients are needed. First of all, they would further clarify the intriguing relationship between BC and SSc. Secondly, they would help to explore the common biological and molecular pathways at the basis of these two disorders, with the aim to improve BC diagnosis and prognosis and to personalize oncological targeted treatments in this subset of fragile patients.Disclosure of Interests:None declared
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Holder SM, Bruno RM, Shkredova DA, Dawson EA, Jones H, Hopkins ND, Hopman MTE, Bailey TG, Coombes JS, Askew CD, Naylor L, Maiorana A, Ghiadoni L, Thompson A, Green DJ, Thijssen DHJ. Reference Intervals for Brachial Artery Flow-Mediated Dilation and the Relation With Cardiovascular Risk Factors. Hypertension 2021; 77:1469-1480. [PMID: 33745297 DOI: 10.1161/hypertensionaha.120.15754] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
[Figure: see text].
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Furzer BJ, Wright KE, Edoo A, Maiorana A. Move your mind: embedding accredited exercise physiology services within a hospital-based mental health service. Australas Psychiatry 2021; 29:52-56. [PMID: 32722965 DOI: 10.1177/1039856220943030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Despite support for the role of exercise in improving physical and mental health for various psychiatric disorders, few service implementation evaluations within diverse hospital environments exist. This study presents the feasibility and implementation of a clinical exercise physiology service within a hospital mental health service. METHOD Feasibility and service data were collected from databases and self-report (consumer and staff) for 6 months from the commencement of new exercise services (gym and group sessions) for community and inpatients (one secure and three open wards). RESULTS One hundred and twenty consumers engaged with exercise services with 70 direct referrals over the 6-month audit period (mean age 40 ± 13 years (19-69); 41% male). The overwhelming reason for referral was related to weight loss/management (65.7%), with the majority of patients (51%) presenting with schizophrenia spectrum and other psychotic disorders. Further, 549 exercise service interactions were delivered and 78% gym attendees and 69% group session attendees rated the exercise sessions as 'Good' or 'Great', and intention to return ranged from 78% for inpatient gym sessions to 91% for community gym sessions. CONCLUSIONS Embedding exercise physiology into a mental health service is feasible and well accepted and the evaluation of long-term consumer outcomes in 'real-world' will serve as a crucial step.
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Maiorana A, Scheer A, Ramos de Oliveira B, Shah A, Jacques A, Moreno Suarez J, Green D. Aquatic Exercise in Patients with Stable Coronary Heart Disease: A Randomised, Controlled Trial. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.401] [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]
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Dolci F, Kilding AE, Spiteri T, Chivers P, Piggott B, Maiorana A, Hart N. High-intensity Interval Training Shock Microcycle Improves Running Performance but not Economy in Female Soccer Players. Int J Sports Med 2020; 42:740-748. [PMID: 33307555 DOI: 10.1055/a-1302-8002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to evaluate the effect of high-intensity interval training shock microcycles (HIITSM) on endurance, running economy and change of direction economy in female soccer players. Nineteen sub-elite female soccer players were randomised to two groups: HIITSM (10 HIIT sessions over 13 days) or HIITTRAD (4 HIIT sessions over 13 days) interventions. Endurance performance was evaluated through the 30-15 intermittent fitness test (30-15IFT); running economy over a 5-min treadmill run; and change of direction economy over two conditions: (1) 5-min 20m shuttle run, and (2) 5-min 10m shuttle run. HIITSM significantly improved 30-15IFT scores compared to baseline (+4.4%, p=0.009; d=0.96) and 30-15IFT scores relative to HIITTRAD (p=0.002; d=2.01). There was no significant interaction (group×time) for running economy and change of direction economy. Pre- to post- intervention there was a significant main time effect for blood lactate over 20m and 10m shuttle runs (p<0.001 and p=0.037, respectively), with large (d=0.93) and moderate (d=0.53) changes observed for the HIITSM over the two distances, respectively. HIITSM may be more effective than HIITTRAD to improve 30-15IFT over shorter training periods but may not affect running economy and change of direction economy.
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Tran DL, Maiorana A, Davis GM, Celermajer DS, d'Udekem Y, Cordina R. Exercise Testing and Training in Adults With Congenital Heart Disease: A Surgical Perspective. Ann Thorac Surg 2020; 112:1045-1054. [PMID: 33285131 DOI: 10.1016/j.athoracsur.2020.08.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/16/2020] [Accepted: 08/31/2020] [Indexed: 01/18/2023]
Abstract
In the current era, the majority of children born with congenital heart disease (CHD) will survive well into adulthood because of major advances in surgical techniques, as well as in critical and medical care. However, reoperation and palliative surgical interventions are increasingly common in the adults with CHD. Tools to risk stratify patients effectively and therapies to improve outcomes are required to optimize the management of adult patients with CHD during the preoperative and postoperative periods and beyond. Exercise testing is an invaluable tool to guide risk stratification. In addition, exercise training in patients with CHD may decrease postoperative complications by enhancing physiological reserve and also has an important role in physical rehabilitation. This review aims to provide individualized recommendations on exercise prescription in patients with CHD in the preoperative and postoperative settings. The response to exercise testing and prognostic implications is also discussed.
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Ding H, Chen SH, Edwards I, Jayasena R, Doecke J, Layland J, Yang IA, Maiorana A. Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis. J Med Internet Res 2020; 22:e20032. [PMID: 33185554 PMCID: PMC7695537 DOI: 10.2196/20032] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/08/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Telemonitoring studies in chronic heart failure are characterized by mixed mortality and hospitalization outcomes, which have deterred the uptake of telemonitoring in clinical practice. These mixed outcomes may reflect the diverse range of patient management strategies incorporated in telemonitoring. To address this, we compared the effects of different telemonitoring strategies on clinical outcomes. OBJECTIVE The aim of this systematic review and subgroup meta-analysis was to identify noninvasive telemonitoring strategies attributing to improvements in all-cause mortality or hospitalization outcomes for patients with chronic heart failure. METHODS We reviewed and analyzed telemonitoring strategies from randomized controlled trials (RCTs) comparing telemonitoring intervention with usual care. For each strategy, we examined whether RCTs that applied the strategy in the telemonitoring intervention (subgroup 1) resulted in a significantly lower risk ratio (RR) of all-cause mortality or incidence rate ratio (IRR) of all-cause hospitalization compared with RCTs that did not apply this strategy (subgroup 2). RESULTS We included 26 RCTs (N=11,450) incorporating 18 different telemonitoring strategies. RCTs that provided medication support were found to be associated with a significantly lower IRR value than RCTs that did not provide this type of support (P=.01; subgroup 1 IRR=0.83, 95% CI 0.72-0.95 vs subgroup 2 IRR=1.02, 95% CI 0.93-1.12). RCTs that applied mobile health were associated with a significantly lower IRR (P=.03; IRR=0.79, 95% CI 0.64-0.96 vs IRR=1.00, 95% CI 0.94-1.06) and RR (P=.01; RR=0.67, 95% CI 0.53-0.85 vs RR=0.95, 95% CI 0.84-1.07). CONCLUSIONS Telemonitoring strategies involving medication support and mobile health were associated with improvements in all-cause mortality or hospitalization outcomes. These strategies should be prioritized in telemonitoring interventions for the management of patients with chronic heart failure.
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O'Dea CA, Logie K, Wilson AC, Pillow JJ, Murray C, Banton G, Simpson SJ, Hall GL, Maiorana A. Lung abnormalities do not influence aerobic capacity in school children born preterm. Eur J Appl Physiol 2020; 121:489-498. [PMID: 33141263 DOI: 10.1007/s00421-020-04530-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/12/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Children born preterm have impaired lung function and altered lung structure. However, there are conflicting reports on how preterm birth impacts aerobic exercise capacity in childhood. We aimed to investigate how neonatal history and a diagnosis of bronchopulmonary dysplasia (BPD) impact the relationship between function and structure of the lung, and aerobic capacity in school-aged children born very preterm. METHODS Preterm children (≤ 32 w completed gestation) aged 9-12 years with (n = 38) and without (n = 35) BPD, and term-born controls (n = 31), underwent spirometry, lung volume measurements, gas transfer capacity, a high-resolution computer tomography (CT) scan of the chest, and an incremental treadmill exercise test. RESULTS Children born preterm with BPD had an elevated breathing frequency to tidal volume ratio compared to term controls (76% vs 63%, p = 0.002). The majority (88%) of preterm children had structural changes on CT scan. There were no differences in peak V̇O2 (47.1 vs 47.7 mL/kg/min, p = 0.407) or oxygen uptake efficiency slope when corrected for body weight (67.6 vs 67.3, p = 0.5) between preterm children with BPD and term controls. There were no differences in any other exercise outcomes. The severity of structural lung disease was not associated with exercise outcomes in this preterm population. CONCLUSION Children born preterm have impaired lung function, and a high prevalence of structural lung abnormalities. However, abnormal lung function and structure do not appear to impact on the aerobic exercise capacity of preterm children at school age.
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Sighinolfi M, Sarchi L, Ticonosco M, Filippi B, Assumma S, Calcagnile T, Morini E, Bonfante G, Sandri M, Puliatti S, Amato M, Micali S, Bianchi G, Maiorana A, Bonetti L, Rocco B. The Prediction of extracapsular extension of prostate cancer: First external validation study of the PRECE model. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ding H, Jayasena R, Chen SH, Maiorana A, Dowling A, Layland J, Good N, Karunanithi M, Edwards I. The Effects of Telemonitoring on Patient Compliance With Self-Management Recommendations and Outcomes of the Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure: Randomized Controlled Trial. J Med Internet Res 2020; 22:e17559. [PMID: 32673222 PMCID: PMC7381046 DOI: 10.2196/17559] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/02/2020] [Accepted: 04/22/2020] [Indexed: 01/16/2023] Open
Abstract
Background Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but the objective assessment of patient compliance with self-management recommendations has seldom been studied. Objective This study aimed to evaluate patient compliance with self-management recommendations of an innovative telemonitoring enhanced care program for CHF (ITEC-CHF). Methods We conducted a multicenter randomized controlled trial with a 6-month follow-up. The ITEC-CHF program comprised the provision of Bluetooth-enabled scales linked to a call center and nurse care services to assist participants with weight monitoring compliance. Compliance was defined a priori as weighing at least 4 days per week, analyzed objectively from weight recordings on the scales. The intention-to-treat principle was used to perform the analysis. Results A total of 184 participants (141/184, 76.6% male), with a mean age of 70.1 (SD 12.3) years, were randomized to receive either ITEC-CHF (n=91) or usual care (control; n=93), of which 67 ITEC-CHF and 81 control participants completed the intervention. For the compliance criterion of weighing at least 4 days per week, the proportion of compliant participants in the ITEC-CHF group was not significantly higher than that in the control group (ITEC-CHF: 67/91, 74% vs control: 56/91, 60%; P=.06). However, the proportion of ITEC-CHF participants achieving the stricter compliance standard of at least 6 days a week was significantly higher than that in the control group (ITEC-CHF: 41/91, 45% vs control: 23/93, 25%; P=.005). Conclusions ITEC-CHF improved participant compliance with weight monitoring, although the withdrawal rate was high. Telemonitoring is a promising method for supporting both patients and clinicians in the management of CHF. However, further refinements are required to optimize this model of care. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12614000916640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366691
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Rocco B, Sighinolfi M, Paterlini M, Mazzucchelli R, Lopez-Beltran A, Cimadamore A, Puliatti S, Eissa A, Volavsek M, Reggiani Bonetti L, Maiorana A, Sandri M, Iseppi A, Spandri V, Bertoni L, Azzoni P, Micali S, Bianchi G, Pellacani G, Montironi R. Digital prostate biopsy: Interim analysis from an international multicentric study evaluating the role of fluorescence confocal microscopy for prostate cancer diagnosis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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De Luca R, Meraviglia S, Blasi L, Maiorana A, Cicero G. Nivolumab in metastatic melanoma: good efficacy and tolerability in elderly patients. ACTA ACUST UNITED AC 2020; 27:e75-e80. [PMID: 32489255 DOI: 10.3747/co.27.5293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Nivolumab is an anti-PD-1 antibody that restores the antitumour immune function of T cells, blocking the binding of PD-1 with its ligand PD-L1. PD-1 is expressed on T cells and interacts with PD-L1 on tumour cells. The PD-1-PD-L1 link inhibits T cell activation. In metastatic melanoma, PD-1-PD-L1 binding plays a critical role, and the advent of the immune checkpoint inhibitor nivolumab has delivered new and effective treatment options with proven clinical benefit. In the present study, we evaluated the efficacy of nivolumab in elderly patients with metastatic melanoma. Methods The study enrolled 55 elderly patients (75 years of age and older) with a diagnosis of metastatic melanoma. Primary endpoints of the study were progression-free survival (pfs) and the objective response rate; secondary endpoints were overall survival, reduction in serum lactate dehydrogenase (ldh) from before to after treatment, and tolerability. Results Nivolumab was well tolerated and resulted in good disease control, with a manageable toxicity profile and significant clinical benefit. The duration of pfs was 5.1 months (95% confidence interval: 3.5 months to 6.8 months). A significant correlation was observed between reduction in serum ldh and pfs: 0.60 (95% confidence interval: 0.28 to 0.86; p = 0.002). Conclusions Nivolumab is an immunotherapy treatment that has proved to be an effective and well-tolerated therapeutic option in elderly patients with metastatic melanoma.
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Gower B, Girard D, Mitchell BL, Gehling T, Maiorana A, Davison K. Lack of Cited Evidence Underpinning Recommendations for Objective Assessment of Cardiovascular Function to Inform Exercise Prescription: A Systematic Review. Sports Med 2020; 50:1469-1481. [PMID: 32297250 DOI: 10.1007/s40279-020-01283-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The effectiveness of exercise in managing cardiovascular (CV) health and function is well established. Less clear is the process for optimising the safety and efficacy of an intervention, particularly how objective assessments might inform this process. OBJECTIVE The aim of this review was to investigate the cited evidence underpinning recommendations for assessing CV function to inform the safe and effective prescription of exercise in populations with established CV disease, as published in documents to guide practice authored by prominent organisations in cardiology and sports medicine. METHODS A systematic review of position statements and guiding documents on exercise prescription for CV health was conducted. Included documents were published between 1997 and 2016. RESULTS Following removal of duplicates, 3158 documents were considered, with full-text screening required for 334. Twenty-seven documents were included which provided 106 individual recommendations for specific objective assessments. Of the total number of recommendations, 60% had no accompanying citation and 28% of recommendations provided citations that did not directly support the statement made. Additionally, 52% of included documents did not state the methods of document development. That is, it was not clear if there was a literature review and/or expert consensus that was used to form recommendations included within. CONCLUSION Almost no cited evidence underpinning the extracted recommendations from the included guiding documents, nor any acknowledgement of this deficiency was established. There were limited explanations found for the methods involved in developing such guiding documents.
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Dieci MV, Conte P, Bisagni G, Brandes AA, Frassoldati A, Cavanna L, Musolino A, Giotta F, Rimanti A, Garrone O, Bertone E, Cagossi K, Sarti S, Ferro A, Piacentini F, Maiorana A, Orvieto E, Sanders M, Miglietta F, Balduzzi S, D'Amico R, Guarneri V. Association of tumor-infiltrating lymphocytes with distant disease-free survival in the ShortHER randomized adjuvant trial for patients with early HER2+ breast cancer. Ann Oncol 2020; 30:418-423. [PMID: 30657852 PMCID: PMC6442655 DOI: 10.1093/annonc/mdz007] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is the need to identify new prognostic markers to refine risk stratification for HER2-positive early breast cancer patients. The aim of this study was to evaluate the association of tumor-infiltrating lymphocytes (TILs) with distant disease-free survival (DDFS) in patients with HER2-positive early breast cancer enrolled in the ShortHER adjuvant trial which compared 9 weeks versus 1-year trastuzumab in addition to chemotherapy, and to test the interaction between TILs and treatment arm. PATIENTS AND METHODS Stromal TILs were assessed for 866 cases on centralized hematoxylin and eosin-stained tumor slides. The association of TILs as 10% increments with DDFS was assessed with Cox models. Kaplan-Meier curves were estimated for patients with TILs ≥20% and TILs <20%. Median follow-up was 6.1 years. RESULTS Median TILs was 5% (Q1-Q3 1%-15%). Increased TILs were independently associated with better DDFS in multivariable model [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.59-0.89, P = 0.006, for each 10% TILs increment]. Five years DDFS rates were 91.1% for patients with TILs <20% and 95.7% for patients with TILs ≥20% (P = 0.025). The association between 10% TILs increments and DDFS was significant for patients randomized to 9 weeks of trastuzumab (HR 0.60, 95% CI 0.41-0.88) but not for patients treated with 1 year of trastuzumab (HR 0.89, 95% CI 0.71-1.12; test for interaction P = 0.088). For patients with TILs <20%, the HR for the comparison between the short versus the long arm was 1.75 (95% CI 1.09-2.80, P=0.021); whereas, for patients with TILs ≥20% the HR for the comparison of short versus long arm was 0.23 (95% CI 0.05-1.09, P = 0.064), resulting in a significant interaction (P = 0.015). CONCLUSIONS TILs are an independent prognostic factor for HER2-positive early breast cancer patients treated with adjuvant chemotherapy and trastuzumab and may refine the ability to identify patients at low risk of relapse eligible for de-escalated adjuvant therapy.
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Sighinolfi M, Bertoni L, Puliatti S, Reggiani Bonetti L, Maiorana A, Eissa A, Azzoni P, Bevilacqua L, Zoeir A, Spandri V, Micali S, Bianchi G, Pellacani G, Rocco B, Montironi R. Ex-vivo fluorescence confocal microscopy: Prostatic tissue atlas. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Martin S, Kovacevic AM, Roberts-Thomson P, Stanton T, Hamilton-Craig C, Wahi S, Hare J, Selvanayagam J, Maiorana A, Venn A, Sharman J. 4.8 Reference Values for Submaximal Exercise Blood Pressure: the EXERcise Stress Test CollaboratION (EXERTION). Artery Res 2020. [DOI: 10.2991/artres.k.191224.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Puliatti S, Bertoni L, Reggiani Bonetti L, Maiorana A, Eissa A, Azzoni P, Bevilacqua L, Zoeir A, Spandri V, Sighinolfi M, Micali S, Bianchi G, Pellacani G, Rocco B, Montironi R. Ex-vivo fluorescence confocal microscopy: Evaluation of the learning curve for interpretation of prostatic benign and malignant tissues. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Holder S, Bruno RM, Shkredova D, Thompson A, Dawson E, Jones H, Hopkins N, Hopman M, Bailey T, Coombes J, Askew C, Naylor L, Maiorana A, Ghiadoni L, Green D, Thijssen D. 3.3 Age- and sex-specific reference intervals for brachial artery flow-mediated dilation in healthy individuals and the relation with cardiovascular risk factors. Artery Res 2020. [DOI: 10.2991/artres.k.191224.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kamaladasa Y, Tran D, Phillip M, Kotchetkova I, D’Souza M, Celermajer D, Maiorana A, Cordina R. 661 Estimating Exercise Intensity Using Heart Rate in Adolescents and Adults With Congenital Heart Disease: Are Established Methods Valid? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.668] [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]
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