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Morieri ML, Targher G, Lapolla A, D'Ambrosio M, Tadiotto F, Rigato M, Frison V, Paccagnella A, Simioni N, Avogaro A, Fadini GP. Changes in markers of hepatic steatosis and fibrosis in patients with type 2 diabetes during treatment with glucagon-like peptide-1 receptor agonists. A multicenter retrospective longitudinal study. Nutr Metab Cardiovasc Dis 2021; 31:3474-3483. [PMID: 34629258 DOI: 10.1016/j.numecd.2021.08.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/16/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023]
Abstract
AIMS Metabolic dysfunction-associated fatty liver disease (MAFLD) is common in people with type 2 diabetes (T2D) and can progress to advanced fibrosis and cirrhosis. In this retrospective study, we explored the longitudinal changes in markers of hepatic steatosis and fibrosis during T2D treatment with glucagon-like peptide-1 receptor agonists (GLP-1RAs). METHODS We analysed observational data from six diabetes outpatient clinics. In the whole T2D population, we calculated the hepatic steatosis index (HSI), which we previously validated against liver ultrasonography, and the Fibrosis (Fib)-4 index. We then identified patients who initiated a GLP-1RA from 2010 to 2018 and for whom data were available to evaluate changes in both HSI and Fib-4 scores over 24 months. RESULTS From 83,116 outpatients with T2D, 41,302 (49.7%) had complete data for calculating HSI and Fib-4. Most of these T2D patients (∼70%) had MAFLD (defined as HSI>36), 9.7% of whom had advanced fibrosis based on Fib-4 thresholds. Patients with low compared to high risk of advanced fibrosis were 5-times more likely to be treated with GLP-1RA. In 535 patients who initiated a GLP-1RA, the prevalence of MAFLD based on HSI declined significantly at 6 and 24 months, but Fib-4 categories did not. HSI improved significantly only in patients receiving human-based but not exendin-based GLP-1RA, while patients concomitantly receiving metformin had less worsening in Fib-4 categories. CONCLUSIONS MAFLD is very common among outpatients with T2D (∼70%) and the estimated prevalence of advanced fibrosis was ∼10%. Treatment with GLP-1RAs significantly improved MAFLD, but not MAFLD-associated advanced fibrosis.
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Affiliation(s)
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Annunziata Lapolla
- Department of Medicine, University of Padova, Padua, Italy; Diabetology Service ULSS6 Padua, Italy
| | | | | | | | - Vera Frison
- Internal Medicine and Diabetology Service, ULSS6, Cittadella, Italy
| | | | - Natalino Simioni
- Internal Medicine and Diabetology Service, ULSS6, Cittadella, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padua, Italy
| | - Gian Paolo Fadini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
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Persano M, Nollino L, Sambataro M, Rigato M, Negro I, Marchetto S, Paccagnella A. Real-world study on the effectiveness and safety of basal insulin IDegLira in type 2 diabetic patients previously treated with multi-injective insulin therapy. Eur Rev Med Pharmacol Sci 2021; 25:923-931. [PMID: 33577047 DOI: 10.26355/eurrev_202101_24661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Achieving glycemic target is paramount to control diabetes mellitus (DM) and reduce micro-vascular and macro-vascular complications. Despite the mostly recent-developed drugs, most patients still show an above desired glycated hemoglobin (HbA1c) level due to DM complex pathophysiology, therapeutic and dietary compliance and clinical inertia in introducing or intensifying insulin therapy. To support the promising results of clinical trials on the effectiveness and safety of the degludec/liraglutide combination (IDegLira) in type 2 DM patients with C-peptide values >1 ng/ml who were previously treated with basal-bolus multiple daily-dose insulin injections. PATIENTS AND METHODS This observational, prospective and non-randomized trial enrolled type 2 DM patients referred to our outpatient clinic between January 2019 and December 2019, who were shifted from multiple daily-dose insulin injection therapy to degludec/liraglutide combination as per the physician's decision. The main assessment was HbA1c variation at 6 months from baseline. Secondary assessments included variation in fasting glycemia, routine anthropometric assessments, blood chemistry, blood pressure and patients' quality of life (measured by the Diabetes Treatment Satisfaction Questionnaire [DTSQ]), from baseline to 6 months. RESULTS HbA1c (8.4 vs. 7.4%; p<0.0001) and body weight (94.1 vs. 93 kg; p<0.0001) were significantly lower after 6 months for patients on the degludec/liraglutide combination. A similar trend was observed in fasting glycemia levels (159 vs. 125 mg/dl; p<0.0001). An improved glycemic control was achieved with degludec/liraglutide despite a reduction in total daily insulin units (42 U at 6 months vs. 22 U at baseline; p<0.0001). In addition, higher scores in the DTSQ were registered after 6 months on degludec/liraglutide (mean score: 27 vs. 20; p<0.0001). The combination therapy also proved more convenient than basal-bolus therapy in terms of costs, with an average per-patient cost difference of €-0.41±0.59/die (p<0.0001). CONCLUSIONS These real-world findings show that degludec/liraglutide seems to be more effective than basal-bolus insulin in achieving glycemic control, allowing cost sustainability and improving patient satisfaction.
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Affiliation(s)
- M Persano
- Endocrine, Metabolism, and Nutrition Disease Unit, Santa Maria di Ca' Foncello Hospital, Treviso, Italy.
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Bonora BM, Rigato M, Frison V, D'Ambrosio M, Tadiotto F, Lapolla A, Simioni N, Paccagnella A, Avogaro A, Fadini GP. Deintensification of basal-bolus insulin after initiation of GLP-1RA in patients with type 2 diabetes under routine care. Diabetes Res Clin Pract 2021; 173:108686. [PMID: 33548335 DOI: 10.1016/j.diabres.2021.108686] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
AIMS We evaluated de-intensification of basal-bolus insulin (BBI) after initiation of a GLP-1 receptor agonist (GLP-1RA) under routine care. RESEARCH DESIGN AND METHODS This retrospective, multicenter study conducted at outpatient clinics in North-East Italy collected data on patients with T2D on BBI who initiated a GLP-1RA. Patients were divided according to whether they de-intensified BBI at the end of observation by stopping prandial insulin. RESULTS We included 425 patients with mean age of 61.3 years and 13 years of diabetes duration. Baseline HbA1c was 8.6% and BMI was 35.5 kg/m2. After 14 months. 58.6% of patients de-intensified BBI after initiating GLP-1RA: they were younger, had a shorter disease duration, lower HbA1c and insulin dose, and less frequent microangiopathy than those who continued BBI. A probability estimation based on these variables was validated in an independent cohort of 40 patients. Body weight improved in both groups, but HbA1c and fasting plasma glucose significantly declined only among patients who de-intensified BBI. Patients who de-intensified BBI and persisted on GLP-1RA at the last observation (80.7%) had greater HbA1c reductions. CONCLUSION Under routine care, GLP-1RA initiation frequently allowed discontinuing BBI, especially among patients with shorter disease duration, lower insulin requirement, and better glucose control.
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Affiliation(s)
| | | | - Vera Frison
- Internal Medicine and Diabetology Service, ULSS6, Cittadella, Italy
| | | | | | - Annunziata Lapolla
- Department of Medicine, University of Padova, 35128 Padova, Italy; Diabetology Service ULSS6, Padova, Italy
| | - Natalino Simioni
- Internal Medicine and Diabetology Service, ULSS6, Cittadella, Italy
| | | | - Angelo Avogaro
- Department of Medicine, University of Padova, 35128 Padova, Italy
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Spinetti G, Sangalli E, Tagliabue E, Maselli D, Colpani O, Ferland-McCollough D, Carnelli F, Orlando P, Paccagnella A, Furlan A, Stefani PM, Sambado L, Sambataro M, Madeddu P. MicroRNA-21/PDCD4 Proapoptotic Signaling From Circulating CD34 + Cells to Vascular Endothelial Cells: A Potential Contributor to Adverse Cardiovascular Outcomes in Patients With Critical Limb Ischemia. Diabetes Care 2020; 43:1520-1529. [PMID: 32358022 PMCID: PMC7305013 DOI: 10.2337/dc19-2227] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/30/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In patients with type 2 diabetes (T2D) and critical limb ischemia (CLI), migration of circulating CD34+ cells predicted cardiovascular mortality at 18 months after revascularization. This study aimed to provide long-term validation and mechanistic understanding of the biomarker. RESEARCH DESIGN AND METHODS The association between CD34+ cell migration and cardiovascular mortality was reassessed at 6 years after revascularization. In a new series of T2D-CLI and control subjects, immuno-sorted bone marrow CD34+ cells were profiled for miRNA expression and assessed for apoptosis and angiogenesis activity. The differentially regulated miRNA-21 and its proapoptotic target, PDCD4, were titrated to verify their contribution in transferring damaging signals from CD34+ cells to endothelial cells. RESULTS Multivariable regression analysis confirmed that CD34+ cell migration forecasts long-term cardiovascular mortality. CD34+ cells from T2D-CLI patients were more apoptotic and less proangiogenic than those from control subjects and featured miRNA-21 downregulation, modulation of several long noncoding RNAs acting as miRNA-21 sponges, and upregulation of the miRNA-21 proapoptotic target PDCD4. Silencing miR-21 in control CD34+ cells phenocopied the T2D-CLI cell behavior. In coculture, T2D-CLI CD34+ cells imprinted naive endothelial cells, increasing apoptosis, reducing network formation, and modulating the TUG1 sponge/miRNA-21/PDCD4 axis. Silencing PDCD4 or scavenging reactive oxygen species protected endothelial cells from the negative influence of T2D-CLI CD34+ cells. CONCLUSIONS Migration of CD34+ cells predicts long-term cardiovascular mortality in T2D-CLI patients. An altered paracrine signaling conveys antiangiogenic and proapoptotic features from CD34+ cells to the endothelium. This damaging interaction may increase the risk for life-threatening complications.
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Morieri ML, Frison V, Rigato M, D'Ambrosio M, Tadiotto F, Paccagnella A, Simioni N, Lapolla A, Avogaro A, Fadini GP. Effectiveness of Dulaglutide in the Real World and in Special Populations of Type 2 Diabetic Patients. J Clin Endocrinol Metab 2020; 105:5821232. [PMID: 32301492 DOI: 10.1210/clinem/dgaa204] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/14/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT In randomized controlled trials (RCTs) on type 2 diabetes (T2D) patients, the glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-RA) dulaglutide reduced HbA1c and body weight, but generalizability of such findings to real-world T2D patients is challenging. OBJECTIVE We evaluated effectiveness of dulaglutide in routine clinical practice, especially in subgroups of patient that are underrepresented in RCTs. DESIGN Retrospective multicenter study. SETTING Diabetes outpatient clinics. PATIENTS AND INTERVENTION All consecutive patients who initiated dulaglutide between 2015 and 2018. MAIN OUTCOME MEASURES Changes in HbA1c and body weight were assessed up to 30 months after baseline. Effectiveness was analyzed in patient subgroups according to: prior use of GLP-1RA, persistence on treatment and dose, age, sex, disease duration, renal function, obesity, cardiovascular disease, or concomitant use of insulin or sulphonylurea. RESULTS From a background population of 83,116 patients, 2084 initiated dulaglutide (15.3% switching from another GLP-1RA), 1307 of whom had at least 1 follow-up visit. Overall, dulaglutide reduced HbA1c by 1.0% and body weight by 2.9 kg at the end of observation. These effects were more pronounced in GLP-1RA-naïve patients and in those with shorter disease duration. Improvement in HbA1c was highly significant and consistent across all subgroups, including those aged ≥ 75 years, nonobese, or with chronic kidney disease. Body weight declined in all subgroups and significantly more with the 1.5-mg versus 0.75-mg dose. CONCLUSIONS In real-world T2D patients, effectiveness of dulaglutide on HbA1c and body weight reduction was highly consistent and significant even in subgroups of patients poorly represented in RCTs.
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Affiliation(s)
- Mario Luca Morieri
- Department of Medicine, University of Padova, Padova, Italy
- Division of Metabolic Diseases, Padova Hospital, Padova, Italy
| | - Vera Frison
- Internal Medicine and Diabetology Service, ULSS6, Cittadella, Italy
| | | | | | | | | | - Natalino Simioni
- Internal Medicine and Diabetology Service, ULSS6, Cittadella, Italy
| | - Annunziata Lapolla
- Department of Medicine, University of Padova, Padova, Italy
- Diabetology Service ULSS6, Padova, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
- Division of Metabolic Diseases, Padova Hospital, Padova, Italy
| | - Gian Paolo Fadini
- Department of Medicine, University of Padova, Padova, Italy
- Division of Metabolic Diseases, Padova Hospital, Padova, Italy
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Morieri ML, Rigato M, Frison V, Simioni N, D'Ambrosio M, Tadiotto F, Paccagnella A, Lapolla A, Avogaro A, Fadini GP. Effectiveness of dulaglutide vs liraglutide and exenatide once-weekly. A real-world study and meta-analysis of observational studies. Metabolism 2020; 106:154190. [PMID: 32109448 DOI: 10.1016/j.metabol.2020.154190] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/14/2020] [Accepted: 02/24/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND AIM Real-word data on the head-to-head comparisons among glucagon-like peptide-1 receptor agonists (GLP-1RA) are scant. Therefore, we aimed to compare the effectiveness of dulaglutide versus liraglutide and exenatide once weekly (exeOW) in type 2 diabetic (T2D) patients under routine care. METHODS This was a retrospective, multicenter, real-world study on patients with T2D (aged 18-80) initiating a GLP-1RA between 2010 and 2018 at specialist outpatient clinics. We compared the effectiveness of dulaglutide versus liraglutide and exeOW on the changes in HbA1c (primary outcome), body weight, blood pressure and fasting glucose (secondary outcomes). Average follow-up was 5.9 months. Channelling biases were addressed with propensity score matching or multivariable adjustment. Meta-analyses of observational studies, covering the same comparisons, are also presented. RESULTS 849, 1371 and 198 patients were included in the dulaglutide, liraglutide and exeOW groups, respectively. The reduction of HbA1c was greater with dulaglutide than with liraglutide (-0.24 ± 0.08%; p = 0.003), and was confirmed in the meta-analysis of observational studies. In our study, dulaglutide showed similar effectiveness compared to exeOW. When these results were pooled with other observational studies, dulaglutide showed a greater reduction of HbA1c (-0.19%; p = 0.003) and body weight (-0.8 kg; p = 0.007). CONCLUSIONS In a real-world scenario, dulaglutide reduced HbA1c more than liraglutide. Conversely, we found similar effect of dulaglutide and exeOW, with statistical differences arising solely when results were meta-analysed with those from other observational studies. Lack of up-titration for liraglutide and higher discontinuation rate for exeOW likely influenced the estimated treatment difference.
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Affiliation(s)
- Mario Luca Morieri
- Department of Medicine, University of Padova, 35128 Padova, Italy; Division of Metabolic Diseases, Padova Hospital, 35128 Padova, Italy
| | | | - Vera Frison
- Internal Medicine and Diabetology Service, ULSS6, 35013 Cittadella, Italy
| | - Natalino Simioni
- Internal Medicine and Diabetology Service, ULSS6, 35013 Cittadella, Italy
| | | | | | | | - Annunziata Lapolla
- Department of Medicine, University of Padova, 35128 Padova, Italy; Diabetology Service ULSS6, 35100 Padova, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, 35128 Padova, Italy; Division of Metabolic Diseases, Padova Hospital, 35128 Padova, Italy
| | - Gian Paolo Fadini
- Department of Medicine, University of Padova, 35128 Padova, Italy; Division of Metabolic Diseases, Padova Hospital, 35128 Padova, Italy.
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Fadini GP, Frison V, Rigato M, Morieri ML, Simioni N, Tadiotto F, D'Ambrosio M, Paccagnella A, Lapolla A, Avogaro A. Trend 2010-2018 in the clinical use of GLP-1 receptor agonists for the treatment of type 2 diabetes in routine clinical practice: an observational study from Northeast Italy. Acta Diabetol 2020; 57:367-375. [PMID: 31673896 DOI: 10.1007/s00592-019-01445-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 09/18/2019] [Accepted: 10/24/2019] [Indexed: 02/07/2023]
Abstract
AIMS Several GLP-1 receptor agonists (GLP-1RA) have become available for the treatment of type 2 diabetes (T2D), and evidence on their beneficial effects has evolved. We evaluated how the clinical phenotype of patients initiating GLP-1RA changed from 2010 to 2018. METHODS This was a retrospective study conducted at six diabetes outpatient clinics in Northeast Italy. We collected data of T2D patients who initiated new GLP-1RA between 2010 and 2018. We recorded baseline characteristics, including demographics, anthropometrics, cardiovascular risk factors, glucose control, lipid profile, liver enzymes, renal function and concomitant medications. We recorded updated HbA1c and body weight at follow-up. RESULTS There were 83,116 T2D patients from a general population of ~ 1,380,000 inhabitants. Among 6167 cases of GLP-1RA initiation, 5408 were analyzed after excluding intra-class switchers. Prescription of GLP-1RA increased exponentially, and the change in the type of GLP-1RA reflected waves of their entering the market. From 2010 to 2018, there were significant increases in baseline age, diabetes duration and prevalence of male sex, of cardiovascular disease and of insulin users. Blood pressure and cholesterol levels decreased concomitantly with increasing use of medications for the control of cardiovascular risk. Baseline average HbA1c (8.3% [67 mmol/mol]) and BMI (34 kg/m2) and their improvement after GLP-1RA initiation did not change over time. CONCLUSIONS Despite the early positioning of GLP-1RA in T2D treatment algorithms, GLP-1RA have been prescribed in patients with progressively more advanced disease stage and especially in the presence of cardiovascular disease. Optimization of GLP-1RA use in routine clinical practice is still needed.
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Affiliation(s)
- Gian Paolo Fadini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
- Division of Metabolic Diseases, Padova Hospital, 35128, Padua, Italy.
| | - Vera Frison
- Internal Medicine and Diabetology Service, ULSS6, 35013, Cittadella, Italy
| | - Mauro Rigato
- ULSS2 Diabetology Service, 31100, Treviso, Italy
| | - Mario Luca Morieri
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | | | | | | | | | - Annunziata Lapolla
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
- Diabetology Service ULSS6, 35100, Padua, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
- Division of Metabolic Diseases, Padova Hospital, 35128, Padua, Italy
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Morieri ML, Rigato M, Frison V, Simioni N, D'Ambrosio M, Tadiotto F, Paccagnella A, Lapolla A, Avogaro A, Fadini GP. Fixed versus flexible combination of GLP-1 receptor agonists with basal insulin in type 2 diabetes: A retrospective multicentre comparative effectiveness study. Diabetes Obes Metab 2019; 21:2542-2552. [PMID: 31364233 PMCID: PMC6852173 DOI: 10.1111/dom.13840] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/08/2019] [Accepted: 07/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The combination of basal insulin (BI) and GLP-1 receptor agonists (GLP-1RAs) is a rational and effective therapy for patients with uncontrolled type 2 diabetes (T2D). We compared the effectiveness of fixed and flexible BI/GLP-1RA combinations using routinely accumulated clinical data. METHODS This was a retrospective, multicentre, real-world study concerning T2D patients initiating a fixed or flexible BI/GLP-1RA combination (NCT03959865). The primary endpoint was change in HbA1c. Secondary endpoints were changes in body weight, fasting plasma glucose (FPG) and systolic blood pressure (SBP). Confounding was addressed by propensity score matching (PSM) or multivariable adjustment (MVA). RESULTS A total of 609 patients were included in the study, 131 in the fixed group and 478 in the flexible group. The two groups differed in terms of diabetes duration, body weight and concomitant medications. After 5.7 months, observed HbA1c reductions were 0.6% and 0.8%, and body weight reductions were 2.8 kg and 1.2 kg in the flexible and fixed groups, respectively. Following PSM, HbA1c declined similarly in the two groups, whereas reduction in body weight was significantly in favour of the flexible combination. Findings were robust in sensitivity analyses, with the exception that, with MVA, a significantly higher reduction in HbA1c was detected in the fixed group. Final doses of BI were higher in the fixed group, whereas those of GLP-1RA were higher in the flexible group. CONCLUSIONS In routine specialist care, initiation of the fixed or flexible BI/GLP-1RA combination allowed similar improvement in glycaemic control, but greater weight loss was observed with the flexible combination. This difference reflected dosages of BI and GLP-1RAs.
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Affiliation(s)
- Mario Luca Morieri
- Department of MedicineUniversity of PadovaPadovaItaly
- Division of Metabolic DiseasesPadova HospitalPadovaItaly
| | | | - Vera Frison
- Internal Medicine and Diabetology Service, ULSS6CittadellaItaly
| | | | | | | | | | - Annunziata Lapolla
- Department of MedicineUniversity of PadovaPadovaItaly
- Diabetology Service, ULSS6PadovaItaly
| | - Angelo Avogaro
- Department of MedicineUniversity of PadovaPadovaItaly
- Division of Metabolic DiseasesPadova HospitalPadovaItaly
| | - Gian Paolo Fadini
- Department of MedicineUniversity of PadovaPadovaItaly
- Division of Metabolic DiseasesPadova HospitalPadovaItaly
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9
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Alterio D, Codecà C, Nolè F, Verri E, Orecchia R, Morelli F, Parisi S, Mastromauro C, Mione CA, Rossetto C, Polsinelli M, Koussis H, Loreggian L, Bonetti A, Campostrini F, Azzarello G, D'Ambrosio C, Bertoni F, Casanova C, Emiliani E, Guaraldi M, Bunkheila F, Bidoli P, Niespolo RM, Gava A, Massa E, Frattegiani A, Valduga F, Pieri G, Cipani T, Da Corte D, Chiappa F, Rulli E. Induction TPF followed by concomitant treatment versus concomitant treatment alone in locally advanced head and neck cancer. A phase II-III trial. Ann Oncol 2018; 28:2206-2212. [PMID: 28911070 DOI: 10.1093/annonc/mdx299] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Platinum-based chemoradiation (CCRT) is the standard treatment for Locally Advanced Head and Neck Squamous-Cell Carcinoma (LAHNSCC). Cetuximab/RT (CET/RT) is an alternative treatment option to CCRT. The efficacy of induction chemotherapy (IC) followed by chemoradiation compared to chemoradiation alone has not been demonstrated in randomized clinical trials. The goals of this phase II-III trial were to assess: (i) the overall survival (OS) of IC versus no-induction (no-IC) and (ii) the Grade 3-4 in-field mucosal toxicity of CCRT versus CET/RT. The present paper focuses on the analysis of efficacy. Materials and methods Patients with LAHNSCC were randomized to receive concomitant treatment alone [CCRT (Arm A1) or CET/RT (Arm A2)], or three cycles of induction docetaxel/cisplatin/5 fluorouracil (TPF) followed by CCRT (Arm B1) or followed by CET/RT (Arm B2). The superiority hypothesis of OS comparison of IC versus no-IC (Arms B1 + B2 versus A1 + A2) required 204 deaths to detect an absolute 3-year OS difference of 12% (HR 0.675, with 80% power at two-sided 5% significance level). Results 414 out of 421 patients were finally analyzed: 206 in the IC and 208 in the no-IC arm. Six patients were excluded because of major violation and one because of metastatic disease at diagnosis. With a median follow-up of 44.8 months, OS was significantly higher in the IC arm (HR 0.74; 95% CI 0.56-0.97; P = 0.031). Complete Responses (P = 0.0028), Progression Free Survival (P = 0.013) and the Loco-regional Control (P = 0.036) were also significantly higher in the IC arm. Compliance to concomitant treatments was not affected by induction TPF. Conclusions IC followed by concomitant treatment improved the outcome of patients with LAHNSCC without compromising compliance to the concomitant treatments. The degree of the benefit of IC could be different according to the type of the subsequent concomitant strategy. Clinical Trial Number NCT01086826, www.clinicaltrials.gov.
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Affiliation(s)
- M G Ghi
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - A Paccagnella
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - D Ferrari
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - P Foa
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | | | - C Codecà
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - F Nolè
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | - E Verri
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | | | | | - S Parisi
- U.O.C. Radiation Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni, Rotondo
| | - C Mastromauro
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - C A Mione
- Radiotherapy Department, Ospedale SS Giovanni e Paolo, Venezia
| | | | - M Polsinelli
- S.O.C. Radiation Oncology, Azienda Ospedaliero-Universitaria S.Maria della Misericordia, Udine
| | - H Koussis
- Medical Oncology Department 2, Istituto Oncologico Veneto- IRCCS, Padova
| | - L Loreggian
- Radiotherapy Department, Istituto Oncologico Veneto - IRCCS, Padova
| | - A Bonetti
- Medical Oncology Department, Ospedale Mater Salutis, Legnago
| | - F Campostrini
- Radiotherapy Department, Ospedale Mater Salutis, Legnago
| | - G Azzarello
- Oncology Unit, Department of Internal Medical Sciences, Mirano
| | | | - F Bertoni
- Radiotherapy Department, Azienda Ospedaliero Universitaria, Modena
| | | | - E Emiliani
- Radiotherapy Department, Azienda USL, Ravenna
| | - M Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - F Bunkheila
- Radiotherapy Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - P Bidoli
- Medical Oncology Department, Ospedale San Gerardo, Monza
| | - R M Niespolo
- Radiotherapy Department, Ospedale San Gerardo, Monza, Ospedale San Gerardo, Monza
| | - A Gava
- Radiotherapy Department, Ospedale Ca' Foncello, Treviso
| | - E Massa
- Department of Medical Science, Università degli Studi di Cagliari, Cagliari
| | - A Frattegiani
- Radiation Oncology Department, Ospedale S. Maria della Misericordia, Perugia
| | - F Valduga
- Medical Oncology Department, Ospedale S. Chiara, Trento
| | - G Pieri
- Medical Oncology Department, AO Triestina, Trieste
| | - T Cipani
- Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milano
| | - D Da Corte
- Oncology Department, Ospedale S. Martino, Belluno
| | - F Chiappa
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
| | - E Rulli
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
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10
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Salvagno L, Pappagallo GL, Chiarion Sileni V, Segati R, Cartei G, Endrizzi L, Paccagnella A, Ongaro G, Bonvicini P, Fiorentino MV. Serum Copper Level in Non-Hodgkin's Lymphomas. Tumori 2018; 68:57-62. [PMID: 7071946 DOI: 10.1177/030089168206800110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Serum copper level (SCL) was studied by the atomic absorption technique in 103 patients with non-Hodgkin's lymphoma. SCL was increased in 61 % of patients at diagnosis or during active disease; values within normal range were found in 88 % of patients in complete remission. The difference between mean SCL during active disease and in remission was highly significant, independently of stage and histologic type, so that: a) Within the same clinical stage high SCL at diagnosis was associated with poorer response to therapy in stage II and stage III (respectively P = 0.033 and P = 0.049), but not in stage IV, where the complete remissions were only 8 out of 42. A shorter 5-year survival was also shown in stages III and IV with high SCL at diagnosis (respectively P < 0.025 and P < 0.05), but not in stage II where the deaths were only 3 out of 24. b) Within histologic types, SCL is a useful prognostic index of response to therapy and survival, although a statistically significant difference was only reached for poorly differentiated lymphocytic lymphoma. We conclude that SCL may be a good parameter of disease activity and a useful index of response to therapy and survival in non-Hodgkin's lymphoma.
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11
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Ferrazzi E, Cartei G, De Besi P, Fornasiero A, Palù G, Paccagnella A, Sperandio P, Fosser V, Grigoletto E, Fiorentino M. Tamoxifen in Disseminated Breast Cancer. Tumori 2018; 63:463-8. [PMID: 601876 DOI: 10.1177/030089167706300507] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
86 postmenopausal women with disseminated breast cancer have been treated orally with 30 mg of Tamoxifen per day (ICI 46474, Nolvadex) for periods of 2 months or more. The overall responders were 28/86 (32.5 %) with a median remission duration of 9 months. In 30 patients already shown to be resistant to cytotoxic chemotherapy, Tamoxifen was used as first hormonal agent; the remission rate in this group was 12/30 (40 %), while it was 28.5 % (16/56) in the others who had already received different hormonal treatments. In 6 early menopausal cases, the treatment had to be stopped for a dangerous « worsening syndrome ». Other side effects were trivial. In 28/35 cases (80%), we have found the reappearance of a pattern of estrogenic activity in vaginal smears during treatment. Hence a « simil-estrogen », more than an « anti-estrogen » mechanism of action is postulated and a selection of patients for treatment in the « mid postmenopausal age » is recommanded.
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12
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Bolzonella S, Paccagnella A, Salvagno L, Chiarion Sileni V, De Besi P, Scalella P, Fiorentino MV. Urinary Hydroxyproline in Multiple Myeloma: Correlation with Clinical Stages and Bone Disease. Tumori 2018; 70:249-53. [PMID: 6740769 DOI: 10.1177/030089168407000309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Twenty-four-hour urinary hydroxyproline excretion (HOP) (normal values: 6–22 mg/day/m2) was measured by the Hypronosticon test in 50 untreated patients with plasma cell myeloma. At diagnosis, HOP was elevated in 36 of 50 patients (72 %) with a mean value of 35.9 mg/day/m2. Extent of bone lesions and clinical stage were accurately assessed in all patients. Higher HOP values were found in patients with a higher degree of bone lesions (multiple lytic areas and/or destruction of skeletal segments). According to clinical stages, HOP was very elevated only in stage III (mean value: 43.7); in stages I and II the mean value (25.2) was just above the normal range. Our data indicate that HOP in multiple myeloma at diagnosis is closely related to the extension of skeletal lesions and that during the clinical course it may be useful in the follow-up of bone disease.
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Paccagnella A, Brandes A, Pappagallo GL, Simioni G, Fosser VP, Vinante O, Salvagno L, De Besi P, Chiarion Sileni V, Fornasiero A. Cisplatin plus Vindesine versus Cisplatin plus VP16 versus Doxorubicin plus Cytoxan in Non-Small-Cell Carcinoma of the Lung. A Randomized Study. Tumori 2018; 72:417-25. [PMID: 3020754 DOI: 10.1177/030089168607200414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
From March 1981 to January 1984, 116 patienst with advanced non-small-cell carcinoma of the lung (NSCCL) were randomly assigned to 3 combinations as follows: CDDP + DVA, CDDP + VP16 and DXR + CTX. 94 patients were evaluable for response, 106 for toxicity and survival. Of 31 patients, 15 (48%; 3 CRs and 12 PRs) responded to CDDP + DVA; of 33 patients, 12 (36%, 2 CRs and 10 PRs) responded to CDDP + VP16; of 30 patients, 3 (10%) obtained a PR with DXR+CTX (CDDP+DVA vs DXR + CTX, P < 0.005; CDDP + VP16 vs DXR + CTX, P < 0.05; CDDP + DVA vs CDDP + VP16, P = NS). The median duration of response was 22 weeks in the CDDP-DVA group, 17 weeks in the CDDP-VP16 group, and 16 weeks in the DXR+CTX group. No significant difference in survival was observed among the 3 groups (median: 43, 47, 41 weeks, respectively). Hematologic and neurologic toxicities were significantly higher in the DVA-containing regimen. Despite the lack of improvement of overall survival with the CDDP-containing combinations over the DXR + CTX control group, the good response rate makes them suitable to be used in combined therapeutic strategies.
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Fornasiero A, Daniele O, Paccagnella A, Fosser V, Cartei G, Ferrazzi E, Fiorentino M. Tossicità della Bleomicina Somministrata in Infusione Continua ad Alte Dosi. Tumori 2018; 66:607-13. [PMID: 6162258 DOI: 10.1177/030089168006600508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sono stati trattati 15 pazienti affetti da carcinoma non seminomatoso del testicolo con un regime polichemioterapico mensile comprendente cis-platino, vinblastina e bleomicina: questo ultimo farmaco veniva somministrato per infusione continua per 5 giorni, alla dose totale di 100 mg/m2 per ciclo. 12 su 15 pazienti hanno raggiunto remissione (10 CR e 2 PR); abbiamo studiato la tossicità di tale farmaco somministrato a dosi relativamente alte con una dose Medicina di 675 mg (range tra 450 e 1050 mg). La tossicità cutanea si è osservata in 2 pazienti su 15. La tossicità polmonare è praticamente nulla; questa è stata controllata con Rxgrafia, indice di Tiffeneau (valore mediano 84) Pa O2 (valore mediano 78). 2 su 15 pazienti hanno evidenziato grave ma reversibile tossicità alla mucosa orofaringea. Alopecia si è evidenziata in tutti i pazienti.
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15
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Abstract
Twenty-one patients with plasma cell tumors received vindesine (VDS) at the dose of 3 mg/m2 i.v. on day 1 plus prednisone at the dose of 100 mg p.o. from day 1 to 5, recycling every 8 days 3 times and then every 10-12 days. In 3 patients with gastric or duodenal ulcer prednisone was not administered. All but one patient were heavily pretreated and resistant to M-2 regimen. Overall there were 4 objective responses (19%): 2 among 15 patients (13%) with multiple myeloma and 2 among 6 patients (33%) with extramedullary plasmacytoma (EMP). The responses lasted for 2, 12, 15 and 48+ months. One previously untreated EMP patient received VDS without prednisone and obtained a complete long-lasting remission. The association of VDS with high-dose prednisone seems to have some activity in plasma cell tumors; probably in multiple myeloma the objective responses are due to the high dose of cortisone rather than to VDS. On the contrary, in EMP patients, VDS may be an active agent, even if administered without cortisone.
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Sambataro M, Sambado L, Trevisiol E, Cacciatore M, Furlan A, Stefani PM, Seganfreddo E, Durante E, Conte S, Bella SD, Paccagnella A, Tos AP. Proinsulin‐expressing dendritic cells in type 2 neuropathic diabetic patients with and without foot lesions. FASEB J 2018; 32:3742-3751. [DOI: 10.1096/fj.201701279rr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Maria Sambataro
- Endocrine, Metabolism, and Nutrition Disease UnitDepartment of PathologyHematology UnitImmunohematology and Transfusional Medicine ServiceNeurology UnitSanta Maria di Ca’ Foncello HospitalTrevisoItaly
| | - Luisa Sambado
- Endocrine, Metabolism, and Nutrition Disease UnitDepartment of PathologyHematology UnitImmunohematology and Transfusional Medicine ServiceNeurology UnitSanta Maria di Ca’ Foncello HospitalTrevisoItaly
| | - Enrica Trevisiol
- Department of Pharmaceutical and Pharmacological SciencesUniversity of PaduaPaduaItaly
| | - Matilde Cacciatore
- Department of PathologyHematology UnitImmunohematology and Transfusional Medicine ServiceNeurology UnitSanta Maria di Ca’ Foncello HospitalTrevisoItaly
| | - Anna Furlan
- Hematology UnitImmunohematology and Transfusional Medicine ServiceNeurology UnitSanta Maria di Ca’ Foncello HospitalTrevisoItaly
| | - Piero Maria Stefani
- Hematology UnitImmunohematology and Transfusional Medicine ServiceNeurology UnitSanta Maria di Ca’ Foncello HospitalTrevisoItaly
| | - Elena Seganfreddo
- Immunohematology and Transfusional Medicine ServiceNeurology UnitSanta Maria di Ca’ Foncello HospitalTrevisoItaly
| | - Elisabetta Durante
- Immunohematology and Transfusional Medicine ServiceNeurology UnitSanta Maria di Ca’ Foncello HospitalTrevisoItaly
| | - Stefania Conte
- Neurology UnitSanta Maria di Ca’ Foncello HospitalTrevisoItaly
| | - Silvia Della Bella
- Department of Biomedical Technologies and Translational MedicineUniversity of MilanMilanItaly
- Laboratory of Clinical and Experimental ImmunologyHumanitas Clinical and Research CenterMilanItaly
| | - Agostino Paccagnella
- Endocrine, Metabolism, and Nutrition Disease UnitDepartment of PathologyHematology UnitImmunohematology and Transfusional Medicine ServiceNeurology UnitSanta Maria di Ca’ Foncello HospitalTrevisoItaly
| | - Angelo Paolo Tos
- Department of PathologyHematology UnitImmunohematology and Transfusional Medicine ServiceNeurology UnitSanta Maria di Ca’ Foncello HospitalTrevisoItaly
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Mauri A, Schmidt S, Sosero V, Sambataro M, Nollino L, Fabris F, Corò A, Scantamburlo A, Marcon ML, Cazziola-Merlotto M, Ciani T, Tessarin M, Paccagnella A. A structured therapeutic education program for children and adolescents with type 1 diabetes: an analysis of the efficacy of the "Pediatric Education for Diabetes" project. Minerva Pediatr (Torino) 2017; 73:159-166. [PMID: 28176508 DOI: 10.23736/s2724-5276.17.04634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Therapeutic education for Type 1 Diabetes involves the process of transmitting knowledge and developing the skills and behavior required to treat the disease. guidelines agree on stressing the importance of therapeutic educational intervention in teaching self-management skills to children and adolescents with Type 1 Diabetes (T1D). This study presents the results of the "Pediatric Education for Type 1 Diabetes (T1D)" (PED) project, specifically designed for children and adolescents aged 6 to 16, and structured on guidelines indications, as part of a broader clinical-educational intervention for Type 1 diabetes. METHODS Twenty-four patients with Type 1 diabetes (mean age: 12,13 y; SD=1.48 y; range 9-14) were studied in a 12-month PED structured project followed by an educational summer camp. All the activities were designed and organized by a multidisciplinary team (dietitian, pediatric diabetologist, nurse, psychologist and adult diabetologist). Glycated hemoglobin (HbA1C), knowledge about Type 1 Diabetes (T1D) (self-monitoring and nutrition), self-management (self-monitoring, nutrition and flexibility of medical treatment), and wellbeing were used as outcome measures. RESULTS Data suggest that the PED had a positive impact on all the targeted levels indicated for recommended care. CONCLUSIONS The results of this study seem to confirm the effectiveness in altering the three levels of "knowing," "know-how" and "wellbeing" required to optimize the quality of life of young patients with Type 1 diabetes. In addition, the proposed model, where a pediatric diabetologist always cooperates with an adult diabetologist, seems to be a permanent solution to the transitional gap widely discussed in the literature.
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Affiliation(s)
- Alessandra Mauri
- Department of Psychiatry, Psychological Consulting Service, Local Health Authority (ULSS 9), Treviso, Italy
| | - Susanna Schmidt
- Department of Psychology, University of Turin, Turin, Italy -
| | - Valentina Sosero
- Department of Psychiatry, Psychological Consulting Service, Local Health Authority (ULSS 9), Treviso, Italy
| | - Maria Sambataro
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Laura Nollino
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Francesco Fabris
- Unit of Pediatrics, Department of Pediatrics, Local Health Authority (ULSS 9), Treviso, Italy
| | - Anna Corò
- Unit of Pediatrics, Department of Pediatrics, Local Health Authority (ULSS 9), Treviso, Italy
| | - Antonella Scantamburlo
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Maria L Marcon
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Michela Cazziola-Merlotto
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Tania Ciani
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Michele Tessarin
- General Management and Health, Local Health Authority (ULSS 9), Treviso, Italy
| | - Agostino Paccagnella
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
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18
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Rosati G, Scaramuzza M, Rotilio V, Monaco L, Pasqualotto E, Campolo F, De Toni A, Reggiani C, Naro F, Paccagnella A. Culture Mediums and Buffer Effect on Screen-printed Carbon Electrodes for Continuous Voltammetric Monitoring of in vitro Cell Cultures Lactate Production. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.protcy.2017.04.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Rosati G, Scaramuzza M, Pasqualotto E, De Toni A, Reggiani C, Paccagnella A. Modeling of SAM Impedance Onto Gold and Silver Thin-Film Mass-Produced Electrodes and Their Use for Optimization of Lactic Acid Detection. IEEE Trans Nanobioscience 2016; 15:756-764. [DOI: 10.1109/tnb.2016.2616194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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20
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Paccagnella A, Marcon ML, Baruffi C, Giometto M, Mauri A, Vigo C, Scantamburlo A, Sambado L, Sambataro M, Trevisiol E, Zanin D, Salvat Heras H, De Marco MC. Enteral nutrition at home and in nursing homes: an 11-year (2002-2012) epidemiological analysis. MINERVA GASTROENTERO 2016; 62:1-10. [PMID: 26887795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Home enteral nutrition (HEN) is a well-established extra-hospital therapy that can reduce the risk of malnutrition, ensure the rapid discharge of patients from hospital and significantly reduce health care expenditure. The data reported in this study allow us to understand the relationships between mortality, the place of treatment either at patients' homes (PH) or in nursing homes (NHR) and nutritional status. METHODS Patients were analyzed according to age, gender, underlying disease, the Karnofsky Index, type of enteral access device (nasogastric tube or percutaneous endoscopic gastrostomy), weight and Body Mass Index (BMI). The duration of HEN therapy was then calculated and the outcome was established on patient mortality or survival. RESULTS Over an 11-year period, 3246 subjects were administered HEN therapy. The mean duration of HEN therapy was equal to 312±487 days at PH and 398±573 in NHR. The mean incidence is 406±58 patients/million inhabitants/year at PH and 319±44 in NHR (mean prevalence rate: 464±129 cases/million inhabitants at PH compared to 478±164 in NHR). Analysis of variance was used for continuous variables. The study reveals that >8% (8.6% at PH; 8.5% in NHR) of patients die within 10 days of starting HEN therapy. CONCLUSIONS The study shows a progressive increase in HEN therapy and highlights clinical, organizational and ethical issues, which also need to be analyzed in relation to the progressively aging population.
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Affiliation(s)
- Agostino Paccagnella
- Metabolic and Nutrition Unit, Department of Medicine, Local Health Authority (ULSS 9), Treviso, Italy -
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Caccialanza R, Pedrazzoli P, Cereda E, Gavazzi C, Pinto C, Paccagnella A, Beretta GD, Nardi M, Laviano A, Zagonel V. Nutritional Support in Cancer Patients: A Position Paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). J Cancer 2016; 7:131-5. [PMID: 26819635 PMCID: PMC4716844 DOI: 10.7150/jca.13818] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/01/2015] [Indexed: 12/23/2022] Open
Abstract
Malnutrition is a frequent problem in cancer patients, which leads to prolonged hospitalization, a higher degree of treatment-related toxicity, reduced response to cancer treatment, impaired quality of life and a worse overall prognosis. The attitude towards this issue varies considerably and many malnourished patients receive inadequate nutritional support. We reviewed available data present in the literature, together with the guidelines issued by scientific societies and health authorities, on the nutritional management of patients with cancer, in order to make suitable and concise practical recommendations for appropriate nutritional support in this patient population. Evidence from the literature suggests that nutritional screening should be performed using validated tools (the Nutritional Risk Screening 2002 [NRS 2002], the Malnutrition Universal Screening Tool [MUST], the Malnutrition Screening Tool [MST] and the Mini Nutritional Assessment [MNA]), both at diagnosis and at regular time points during the course of disease according to tumor type, stage and treatment. Patients at nutritional risk should be promptly referred for comprehensive nutritional assessment and support to clinical nutrition services or medical personnel with documented skills in clinical nutrition, specifically for cancer patients. Nutritional intervention should be actively managed and targeted for each patient; it should comprise personalized dietary counseling and/or artificial nutrition according to spontaneous food intake, tolerance and effectiveness. Nutritional support may be integrated into palliative care programs. "Alternative hypocaloric anti-cancer diets" (e.g. macrobiotic or vegan diets) should not be recommended as they may worsen nutritional status. Well-designed clinical trials are needed to further our knowledge of the nutritional support required in different care settings for cancer patients.
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Affiliation(s)
- Riccardo Caccialanza
- 1. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- 2. Division of Medical Oncology, Department of Hemato-Oncology Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- 1. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cecilia Gavazzi
- 3. Clinical Nutrition Unit, National Cancer Institute, Milan, Italy
| | - Carmine Pinto
- 4. Medical Oncology, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Agostino Paccagnella
- 5. Endocrinology, Metabolism and Nutrition Unit, Local Health Authority ULSS 9, Treviso, Italy
| | | | - Mariateresa Nardi
- 7. Clinical Nutrition Service, Veneto Institute of Oncology-IRCCS, Padova, Italy
| | | | - Vittorina Zagonel
- 9. Medical Oncology 1, Veneto Institute of Oncology-IRCCS, Padova, Italy
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22
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Dang Z, Maselli D, Spinetti G, Sangalli E, Carnelli F, Rosa F, Seganfreddo E, Canal F, Furlan A, Paccagnella A, Paiola E, Lorusso B, Specchia C, Albiero M, Cappellari R, Avogaro A, Falco A, Quaini F, Ou K, Rodriguez-Arabaolaza I, Emanueli C, Sambataro M, Fadini GP, Madeddu P. Sensory neuropathy hampers nociception-mediated bone marrow stem cell release in mice and patients with diabetes. Diabetologia 2015; 58:2653-62. [PMID: 26358583 PMCID: PMC4589553 DOI: 10.1007/s00125-015-3735-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS Upon tissue injury, peripheral sensory neurons release nociceptive factors (e.g. substance P [SP]), which exert local and systemic actions including the recruitment of bone marrow (BM)-derived haematopoietic stem and progenitor cells (HSPCs) endowed with paracrine pro-angiogenic properties. We herein explore whether diabetic neuropathy interferes with these phenomena. METHODS We first investigated the presence of sensory neuropathy in the BM of patients with type 2 diabetes by immunohistochemistry and morphometry analyses of nerve size and density and assessment of SP release by ELISA. We next analysed the association of sensory neuropathy with altered HSPC release under ischaemia or following direct stimulation with granulocyte colony-stimulating factor (G-CSF). BM and circulating HSPCs expressing the neurokinin 1 receptor (NK1R), which is the main SP receptor, were measured by flow cytometry. We finally assessed whether an altered modulation of SP secretion interferes with the mobilisation and homing of NK1R-HSPCs in a mouse model of type 2 diabetes after limb ischaemia (LI). RESULTS Nociceptive fibres were reduced in the BM of patients and mice with type 2 diabetes. Patients with neuropathy showed a remarkable reduction in NK1R-HSPC mobilisation under ischaemia or upon G-CSF stimulation. Following LI, diabetic mice manifested an altered SP gradient between BM, peripheral blood and limb muscles, accompanied by a depressed recruitment of NK1R-HSPCs to the ischaemic site. CONCLUSIONS/INTERPRETATION Sensory neuropathy translates into defective liberation and homing of reparative HSPCs. Nociceptors may represent a new target for treatment of diabetic complications.
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Affiliation(s)
- Zexu Dang
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Davide Maselli
- I.R.C.C.S. (Scientific Institute of Medical Research) MultiMedica, Milan, Italy
| | - Gaia Spinetti
- I.R.C.C.S. (Scientific Institute of Medical Research) MultiMedica, Milan, Italy
| | - Elena Sangalli
- I.R.C.C.S. (Scientific Institute of Medical Research) MultiMedica, Milan, Italy
| | - Franco Carnelli
- I.R.C.C.S. (Scientific Institute of Medical Research) MultiMedica, Milan, Italy
| | - Francesco Rosa
- I.R.C.C.S. (Scientific Institute of Medical Research) MultiMedica, Milan, Italy
| | - Elena Seganfreddo
- Department of Pathology, Santa Maria of Ca' Foncello Hospital, Treviso, Italy
| | - Fabio Canal
- Department of Pathology, Santa Maria of Ca' Foncello Hospital, Treviso, Italy
| | - Anna Furlan
- Department of Specialized Medicines, Hematology Unit, Santa Maria of Ca' Foncello Hospital, Treviso, Italy
| | - Agostino Paccagnella
- Department of Specialized Medicines, Endocrine, Metabolic and Nutrition Diseases Unit, Santa Maria of Ca' Foncello Hospital, 1 Piazza Ospedale, 31100, Treviso, Italy
| | - Emanuela Paiola
- I.R.C.C.S. (Scientific Institute of Medical Research) MultiMedica, Milan, Italy
| | - Bruno Lorusso
- Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Claudia Specchia
- I.R.C.C.S. (Scientific Institute of Medical Research) MultiMedica, Milan, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Mattia Albiero
- Department of Medicine, University of Padova, Padova, Italy
| | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
| | - Angela Falco
- Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Federico Quaini
- Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Kepeng Ou
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Iker Rodriguez-Arabaolaza
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Costanza Emanueli
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Maria Sambataro
- Department of Specialized Medicines, Endocrine, Metabolic and Nutrition Diseases Unit, Santa Maria of Ca' Foncello Hospital, 1 Piazza Ospedale, 31100, Treviso, Italy.
| | | | - Paolo Madeddu
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Upper Maudlin Street, Bristol, BS2 8HW, UK.
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Ghi CM, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Morelli F, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Massa E, Rossetto C, Bonetti A, Siena S, Frattegiani A, Koussis H, Pieri G, Gava A, Floriani I. OC-006: Concomitant treatment (CRT or cetuximab/RT) with or without induction TPF in Locally Advanced head and neck. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Perino M, Pasqualotto E, Scaramuzza M, De Toni A, Paccagnella A. Enhancement and control of surface plasmon resonance sensitivity using grating in conical mounting configuration. Opt Lett 2015; 40:221-224. [PMID: 25679849 DOI: 10.1364/ol.40.000221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this work we propose a method to enhance and control the angular sensitivity of a grating coupled surface plasmon resonance (GCSPR) sensor. We lighted a silver grating, mounted in conical configuration, with a laser source and we measured the transmittance of the grating as a function of the azimuthal angle. To evaluate the sensitivity, grating surface was functionalized with four different alkanethiol self assembled monolayers (SAM) and the correspondent azimuthal transmittance peak shifts were measured. The sensitivity control was performed by simply change the light incident angle. This method offers the possibility to design dynamic GCSPR sensor benches that can be used to amplify the SPR angle shift at any step of a biological detection process.
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25
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Perino M, Pasqualotto E, De Toni A, Garoli D, Scaramuzza M, Zilio P, Ongarello T, Paccagnella A, Romanato F. Development of a complete plasmonic grating-based sensor and its application for self-assembled monolayer detection. Appl Opt 2014; 53:5969-5976. [PMID: 25321677 DOI: 10.1364/ao.53.005969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/05/2014] [Indexed: 06/04/2023]
Abstract
This work presents an integrated plasmonic biosensing device consisting of a one-dimensional metallic lamellar grating designed to exploit extraordinary transmission of light toward an underlying silicon photodetector. By means of finite element simulations, the grating parameters have been optimized to maximize the light transmission variation induced by the functionalization of the gold nanostructures. An optimized grating was fabricated using an electron beam process and an optoelectronic test bench suitable for sample tests was developed. A clear difference in the grating transmitted light due to surface functionalization was observed in presence of TM polarized illumination.
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Ghi M, Paccagnella A, Orecchia R, Parisi S, Bertoni F, Minguzzi N, Baggio V, Polsinelli M, Bunkheila F, Palazzi M. A Phase 2-3 Study Comparing Concomitant Chemoradiation Therapy (CRT) Versus Cetuximab/RT (CET/RT) With or Without Induction Docetaxel/Cisplatin/5-Fluorouracil (TPF) in Locally-Advanced Head and Neck Squamous Cell Carcinoma (LASCCHN) – Efficacy Results of the GSTTC Italian Study (NCT01086826). Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Ghi M, Paccagnella A, Orecchia R, Parisi S, Bertoni F, Minguzzi N, Baggio V, Turcato G, Polsinelli M, Floriani I. Cetuximab/Radiation Therapy (CET + RT) Versus Concomitant Chemoradiation Therapy (cCHT + RT) With or Without Induction Docetaxel/Cisplatin/5Fluorouracil (TPF) in Locally Advanced Head-and-Neck Squamous Cell Carcinoma (LASCCHN) – Preliminary Results on Toxicity of a Randomized, 2x2 Factorial, Phase II-III Study (NCT01086826). Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Ghi M, Paccagnella A, Ferrari D, Rocca MC, Verri E, Morelli F, Azzarello G, D'Ambrosio C, Casanova C, Floriani I. Concomitant Chemoradiotherapy (CT/RT) or CETUXIMAB/RT (CET/RT) with or Without Induction Docetaxel/Cisplatin/5-Fluorouracil (TPF) in Locally Advanced Head and Neck Cancer (LASCCHN). Preliminary Toxicity Results of a Randomized, 2x2 Factorial, Phase II-III Study. (NCT01086826). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33614-0] [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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29
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Morassutti I, Giometto M, Baruffi C, Marcon ML, Michieletto S, Giometto B, Spinella N, Paccagnella A. Nutritional intervention for amyotrophic lateral sclerosis. MINERVA GASTROENTERO 2012; 58:253-260. [PMID: 22971635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of the study was to assess the consequences of early and systematic nutritional intervention on the clinical conditions of amyotrophic lateral sclerosis (ALS) patients and on the opportunity to maintain a good nutritional status for as long as possible. METHODS Thirty-three subjects with ALS. Protocol Group: 12 subjects (9 M and 3 F) monitored according to a precise nutritional intervention protocol. CONTROL GROUP 21 subjects (10 M and 11 F) monitored before applying the protocol. RESULTS Data recorded at the time of initial assessment were compared and expressed as the mean ± standard deviation for the Protocol Group vs. the CONTROL GROUP BMI (kg/m2) 23.6 ± 4.1 vs. 21.6 ± 3.5; weight loss as a percentage of usual weight 6.6 ± 7.9 vs. 16.3 ± 8.8 (P=0.003). At six months: weight loss as a percentage of usual weight 4.9 ± 6.2 vs. 16.9 ± 10.2 (P=0.002). At 12 months: weight loss as a percentage of usual weight 7.3 ± 7.1 vs. 17.5 ± 11.1 (P=0.03). At the first follow-up visit, fewer patients in the Protocol Group were receiving enteral nutrition (25%) than patients in the CONTROL GROUP (60%). At six-month follow-up visit: 30% vs. 68%. Standard enteral nutrition formulas were used. One year after initial assessment, the mortality rate was 17% for the Protocol Group, whereas it was 24% at six months and 33% after one year for the CONTROL GROUP. CONCLUSION If patients are treated before any significant weight loss occurs, early and specific nutritional intervention allows good nutritional status to be maintained for a longer period; if artificial nutrition is required, standard diets are able to ensure adequate clinical results.
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Affiliation(s)
- I Morassutti
- Metabolic and Nutrition Unit, Local Health Unit (ULSS 9), Treviso, Italy.
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Ferrario A, Scaramuzza M, Pasqualotto E, De Toni A, Paccagnella A. Development of a Disposable Gold Electrodes-Based Sensor for Electrochemical Measurements of cDNA Hybridization. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.proche.2012.10.128] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Paccagnella A, Ghi MG, Floriani I, Gava A, Buffoli A. Concomitant chemoradiation or RT/cetuximab versus induction TPF followed by chemoradiation or RT/cetuximab in locally advanced head and neck squamous cell carcinoma: A randomized phase III factorial study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Rea F, Favaretto AG, Marulli G, Spaggiari L, De Pas TM, Ceribelli A, Paccagnella A, Crivellari G, Russo F, Ceccarelli M, Facciolo F. Phase II trial of neoadjuvant pemetrexed plus cisplatin followed by surgery and radiation in the treatment of malignant pleural mesothelioma (MPM). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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33
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Ghi MG, Paccagnella A, Floriani I, Garavaglia D. Concomitant chemoradiation in locally advanced head and neck squamous cell carcinoma: A literature-based meta-analysis on the platinum concomitant chemotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5534] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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34
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Petit JC, Dran JC, Trotignon L, Casabonne JM, Paccagnella A, Della Mea G. Mechanism of Heavy Element Retention in Hydrated Layers Formed on Leached Silicate Glasses. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-127-33] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTWe have investigated the relationship between hydrated layer formation during aqueous corrosion of silicates and retention of heavy elements (Fe, REE, actinides). Our approach is based on the comparison of the dissolution behaviour of silicate glasses, silicate minerals implanted with increasing doses of lead ions (1×E+12 to 1×E+15 ions/cm2), sorption experiments on silica surfaces and direct precipitation of hydrosilicates. The characterization of reacted surfaces was performed by combining Rutherford backscattering spectrometry (RBS) for profiling heavy elements with Resonant Nuclear Reaction Analysis (RNRA) for hydrogen profilimetry. The accumulation of these elements does not necessarily imply a selective dissolution and can be explained by the “precipitation” of hydroxides or hydrosilicates.
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Blanchard P, Bourredjem A, Bourhis J, Hitt R, Posner M, Vermorken J, Calais G, Paccagnella A, Pignong J. TAXANE-CISPLATIN-5FU AS INDUCTION CHEMOTHERAPY IN LOCALLY ADVANCED HEAD AND NECK SQUAMOUS CELL CARCINOMA: AN INDIVIDUAL PATIENT DATA META-ANALYSIS OF THE MACH-NC GROUP. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70005-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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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36
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Venturini M, Bighin C, Puglisi F, Olmeo N, Aitini E, Colucci G, Garrone O, Paccagnella A, Marini G, Crinò L, Mansutti M, Baconnet B, Barbato A, Del Mastro L. A multicentre Phase II study of non-pegylated liposomal doxorubicin in combination with trastuzumab and docetaxel as first-line therapy in metastatic breast cancer. Breast 2010; 19:333-8. [PMID: 20185313 DOI: 10.1016/j.breast.2010.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 12/23/2009] [Accepted: 01/22/2010] [Indexed: 01/07/2023] Open
Abstract
To evaluate the cardiotoxicity, general toxicity, and activity of non-pegylated liposomal doxorubicin, in combination with docetaxel and trastuzumab, as first-line therapy in metastatic breast cancer. Thirty-one patients with metastatic human epidermal growth factor receptor 2-overexpressing breast cancer, who had not previously received chemotherapy for metastatic disease, received non-pegylated liposomal doxorubicin (50 mg/m(2)), docetaxel (75 mg/m(2)) and trastuzumab (2 mg/kg/week) for up to eight cycles, followed by trastuzumab alone for up to 52 weeks. Cardiotoxicity was defined as a decrease in left ventricular ejection fraction (LVEF) to below 45%, or a decrease in LVEF of at least 20% from baseline. Mean LVEF was maintained at baseline level also in the subset of patients who had received anthracycline previously. Cardiotoxicity developed in three patients during the treatment cycles, and in two further patients after the end of the study. The most common adverse events were haematological toxicity, alopecia, asthenia and fever. The best overall response rate was 65.5%. Median time to progression was 13.0 months. The combination of non-pegylated liposomal doxorubicin, docetaxel and trastuzumab combines acceptable cardiac and general toxicity and promising activity as first-line therapy in metastatic breast cancer.
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Affiliation(s)
- M Venturini
- Oncologia Medica, Ospedale Classificato Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, Negrar, Verona, Italy.
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37
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Paccagnella A, Ghi MG, Loreggian L, Buffoli A, Koussis H, Mione CA, Bonetti A, Campostrini F, Gardani G, Ardizzoia A, Dondi D, Guaraldi M, Cavallo R, Tomio L, Gava A. Concomitant chemoradiotherapy versus induction docetaxel, cisplatin and 5 fluorouracil (TPF) followed by concomitant chemoradiotherapy in locally advanced head and neck cancer: a phase II randomized study. Ann Oncol 2009; 21:1515-1522. [PMID: 20032123 DOI: 10.1093/annonc/mdp573] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Concomitant chemoradiotherapy (CT/RT) is the standard treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN). We evaluated the efficacy of induction docetaxel (Taxotere), cisplatin, and 5-fluorouracil (TPF) before CT/RT versus CT/RT alone. PATIENTS AND METHODS Patients with stage III-IVM0 SCCHN, Eastern Cooperative Oncology Group performance status of zero to one, were randomly assigned to receive CT/RT alone (arm A: two cycles of cisplatin 20 mg/m(2), days1-4, plus 5-fluorouracil 800 mg/m(2)/day 96 h continuous infusion, during weeks 1 and 6 of radiotherapy) or three cycles of TPF (arm B: docetaxel 75 mg/m(2) and cisplatin 80 mg/m(2), day 1, and 5-fluorouracil 800 mg/m(2)/day 96 h continuous infusion, every 3 weeks) followed by the same CT/RT. The primary end point was the rate of radiologic complete response (CR) at 6-8 weeks after the end of CT/RT. RESULTS A total of 101 patients were randomly allocated to the study (51 arm A; 50 arm B). CR rates were 21.2% (arm A) versus 50% (arm B). Median progression-free survival and overall survival were, respectively, 19.7 and 33.3 months (arm A) and 30.4 and 39.6 months (arm B). Hematologic and non-hematologic toxic effects during CT/RT were similar in the two arms. CONCLUSION Induction TPF followed by CT/RT was associated with higher radiologic CR in patients with locally advanced SCCHN with no negative impact on CT/RT feasibility.
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Affiliation(s)
| | - M G Ghi
- Department of Medical Oncology, Venezia
| | - L Loreggian
- Department of Radiotherapy, Istituto Oncologico Veneto, Istituto di Ricerca e Cura a Carattere Scientifico, Padova
| | - A Buffoli
- Department of Radiotherapy, Azienda Ospedaliera Universitaria, Udine
| | - H Koussis
- Department of Medical Oncology, Istituto Oncologico Veneto, IRCCS, Padova
| | - C A Mione
- Department of Radiotherapy, Ospedale SS. Giovanni e Paolo, Venezia
| | - A Bonetti
- Department of Medical Oncology, Ospedale Mater Salutis, Legnago
| | - F Campostrini
- Department of Radiotherapy, Ospedale Mater Salutis, Legnago
| | - G Gardani
- Department of Radiotherapy, S. Gerardo Hospital, Monza
| | - A Ardizzoia
- Department of Medical Oncology, S. Gerardo Hospital, Monza
| | | | - M Guaraldi
- Department of Medical Oncology, S. Orsola-Malpighi Hospital, Bologna
| | - R Cavallo
- Department of Medical Oncology, P. Cosma Hospital, Camposampiero, Padova
| | - L Tomio
- Department of Radiotherapy, S. Chiara Hospital, Trento
| | - A Gava
- Department of Radiotherapy, Ospedale Ca' Foncello, Treviso, Italy
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Morello M, Marcon ML, Laviano A, Giometto M, Baruffi C, Zulian E, Cenerelli P, Faronato P, Tessarin M, Conte A, Paccagnella A. Enteral Nutrition in Nursing Home Residents. Nutr Clin Pract 2009; 24:635-41. [DOI: 10.1177/0884533609342439] [Citation(s) in RCA: 12] [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: 11/16/2022] Open
Affiliation(s)
- Michela Morello
- Nutrition and Diabetic Unit, Treviso Healthcare Authority, Italy
| | - Maria L. Marcon
- Nutrition and Diabetic Unit, Treviso Healthcare Authority, Italy
| | | | - Marta Giometto
- Nutrition and Diabetic Unit, Treviso Healthcare Authority, Italy
| | - Carla Baruffi
- Nutrition and Diabetic Unit, Treviso Healthcare Authority, Italy
| | - Elisa Zulian
- Nutrition and Diabetic Unit, Treviso Healthcare Authority, Italy
| | - Paolo Cenerelli
- Nutrition and Diabetic Unit, Treviso Healthcare Authority, Italy
| | - Pierpaolo Faronato
- Department of Hospital and District Services, Treviso Healthcare Authority, Italy
| | - Michele Tessarin
- Department of Hospital and District Services, Treviso Healthcare Authority, Italy
| | - Amos Conte
- Managing and Economic Control Office, Treviso Healthcare Authority, Italy
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Anker S, Laviano A, Filippatos G, John M, Paccagnella A, Ponikowski P, Schols A. ESPEN Guidelines on Parenteral Nutrition: On Cardiology and Pneumology. Clin Nutr 2009; 28:455-60. [DOI: 10.1016/j.clnu.2009.04.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 04/29/2009] [Indexed: 12/26/2022]
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40
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Vanturini M, Bighin C, Puglisi F, Contu A, Aitini E, Colucci G, Merlano MC, Paccagnella A, Marini G, Crinò L, Djazouli K, Barbato A. A multicenter phase II study of non-pegylated liposomal doxorubicin (MYOCET®) in combination with trastuzumab and docetaxel as first line therapy in metastatic breast cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #3156
The objective of the phase II study is to evaluate the cardiotoxicity, general safety, and efficacy of non-pegylated liposomal doxorubicin, in combination with docetaxel and trastuzumab, as first line treatment of metastatic breast cancer.
 Patients and methods: Patients (n = 31) with metastatic HER2-overexpressing breast cancer, who had not previously received chemotherapy for metastatic disease, received non-pegylated liposomal doxorubicin (50 mg/m2), docetaxel (75 mg/m2) every 3 weeks and trastuzumab (2 mg/kg/week) for up to eight cycles, followed by trastuzumab alone for up to 52 weeks. Cardiotoxicity was defined as signs and/or symptoms of congestive heart failure (CHF) and/or an absolute decrease in left ventricular ejection fraction (LVEF) of ≥ 20 units or a decline to ≤ 45%. Patients were allowed to receive adjuvant doxorubicin or epirubicin to cumulative doses up to 240 mg/m2 or 450 mg/m2, respectively.
 Results: The mean LVEF at baseline was 62.8 ± 7.1% and decreased to 60.2 ± 6.5% at cycle 2, but did not change significantly during the rest of the study; mean values at cycle 8 and at the end of the study were 58.7 ± 7.0% and 57.3 ± 9.5% respectively. One case of symptomatic CHF occurred during the study.
 The most common adverse events were hematologic toxicities, alopecia, asthenia and fever. The Overall Response Rate was 65.5% (CR 31%, PR 34.5%).The median progression free survival was 15.5 months (95% CI 11-24 months). The average overall survival was 27.9 months.Conclusions: These results suggest that the combination of non-pegylated liposomal doxorubicin, docetaxel and trastuzumab has shown a good cardiac safety profile at a long term follow up, comparatively to recent published results data in HET study. A promising efficacy including CR and PFS has been noted in 1st line MBC.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3156.
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Affiliation(s)
- M Vanturini
- 1 Oncology, Ospedale Classificato Sacro Cuore Don Calabria, Negrar-Verona, Italy
| | - C Bighin
- 2 Isitituto Tumori di Genova, Genova, Italy
| | - F Puglisi
- 3 Policlinico Universitario, Udine, Italy
| | - A Contu
- 4 Ospedale Civico, Sassari, Italy
| | - E Aitini
- 5 Ospedale Carlo Poma, Mantova, Italy
| | | | - MC Merlano
- 7 Ospedale Santa Croce e Carle, Cuneo, Italy
| | | | - G Marini
- 9 Spedali Civili, Brescia, Italy
| | - L Crinò
- 10 Azienda Ospedaliera, Perugia, Italy
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Monfardini S, Brunello A, Crivellari D, Puglisi F, Paccagnella A, Molino A, Mustacchi G, Beda M, Luciani A, Simoncini E, Pogliani C, Basso U. Activity and safety of trastuzumab in advanced breast cancer in elderly women (≥ 70 years) in italy. Crit Rev Oncol Hematol 2008. [DOI: 10.1016/s1040-8428(08)70104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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42
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Paccagnella A, Buffoli A, Koussis H, Gava A, Franceschi T, Gardani G, Valduga F, Gaion F, Dondi D, Ghi MG. Concomitant chemoradiotherapy (CT/RT) vs neoadjuvant chemotherapy with docetaxel/cispaltin/5-fluorouracil (TPF) followed by CT/RT in locally advanced head and neck cancer. Final results of a phase II randomized study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6000] [Citation(s) in RCA: 14] [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] [Indexed: 11/20/2022] Open
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Vassanelli S, Bandiera L, Borgo M, Cellere G, Santoni L, Bersani C, Salamon M, Zaccolo M, Lorenzelli L, Girardi S, Maschietto M, Dal Maschio M, Paccagnella A. Space and time-resolved gene expression experiments on cultured mammalian cells by a single-cell electroporation microarray. N Biotechnol 2008; 25:55-67. [PMID: 18504020 DOI: 10.1016/j.nbt.2008.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Revised: 02/07/2008] [Accepted: 03/03/2008] [Indexed: 02/04/2023]
Abstract
Single-cell experiments represent the next frontier for biochemical and gene expression research. Although bulk-scale methods averaging populations of cells have been traditionally used to investigate cellular behavior, they mask individual cell features and can lead to misleading or insufficient biological results. We report on a single-cell electroporation microarray enabling the transfection of pre-selected individual cells at different sites within the same culture (space-resolved), at arbitrarily chosen time points and even sequentially to the same cells (time-resolved). Delivery of impermeant molecules by single-cell electroporation was first proven to be finely tunable by acting on the electroporation protocol and then optimized for transfection of nucleic acids into Chinese Hamster Ovary (CHO-K1) cells. We focused on DNA oligonucleotides (ODNs), short interfering RNAs (siRNAs), and DNA plasmid vectors, thus providing a versatile and easy-to-use platform for time-resolved gene expression experiments in single mammalian cells.
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Affiliation(s)
- S Vassanelli
- University of Padova, Department of Human Anatomy and Physiology, Section of Physiology, via Marzolo 3 - 35131, Padova, Italy.
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Paccagnella A, Michieletto S, Pitassi I, Baruffi C, Pizzolato D, Marcon ML, Saia OS, Toscani P, Moretti G, Foscolo G. [Organisational aspects of a donated breast milk bank: experience of the Treviso hospital]. Minerva Pediatr 2007; 59:337-348. [PMID: 17947840] [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: 05/25/2023]
Abstract
AIM This study analyses the organisational aspects and the volume of milk managed by the donated breast milk bank (banca del latte umano donato, BLUD) in Treviso. METHODS The data gathered refer to the years 2003, 2004 and 2005. In particular the hygiene methodology is described in order to obtain a high-quality product from a clinical point of view which is in line with the recent norms regarding the management of food products. RESULTS During the three-year study 5,647 L of milk were collected (on average: 155 L/month; 5 L/day). Seventy-two percent of breast milk collected was from mothers for their own children; the remaining 28% of milk was from ''donors for the pool''. In the same period 5,053 L of milk was pasteurised and distributed (pool=31%; frozen breast milk=61%; chilled unpasteurized breast milk =8%). Microbiological data show total effectiveness of the methods of pasteurisation used (Holder method). The tracking of the product is possible through the BLUD organisation. CONCLUSION We propose: 1) that scientific organisations and legislators try to optimise the control of this important product by providing guidelines, indications, microbiological parameters and legal obligations for the correct continuation of the work carried out by BLUDs; 2) that BLUDs create a network for rapid communication, integration and possible collaboration; 3) that a study be carried out regarding BLUDs and population density in order to balance costs and benefits.
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Affiliation(s)
- A Paccagnella
- Servizio di Dietetica e Nutrizione Clinica, Dipartimento di Medicina, ULSS 9, Treviso, Italy.
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Paccagnella A, Oniga F, Bearz A, Favaretto A, Barbieri F, Chella A, Ceresoli G, Biason R, D'Amanzo P, Ghi MG. Correlation of tumor response and survival in advanced NSCLC patients treated with paclitaxel plus carboplatin (PC) versus paclitaxel plus carboplatin plus gemcitabine (PCG). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7650 Background: We showed that PCG significantly increases both response rate (RR) (43.6% vs 20%) and median survival (10.8 mo vs 8.3 mo) over PC and that at Cox analysis, the only independent prognostic factors were PS and treatment (Paccagnella et al, J Clin Oncol 2006;24: 681–687). According to the Prentice criteria (Stat Med 1989;8: 431–440), to directly relate response and survival it is necessarily that responding patients (and non responding) of both arms have a similar survival and that the survival difference between the two arms disappear when the response factor is included in the multivariate analysis. Methods: Out of 324 pts included in the original analysis, 26 pts were not evaluable for response (early death, toxicity, refusal) before the planned response evaluation at two months and were excluded (15 pts from PC arm and 11 pts from PCG arm). The analysis however was also performed considering the non evaluable patients as non responders. Results: Overall, Responder patients had a median Survival that nearly doubled that of no responders: 14.73 mo vs 7.67 mo (HR: 0.49; CI: 0.31–0.54; P=0.000). No responder pts from PC and PCG arms had a similar survival (median 7.53 mo and 8.07 mo respectively; P= 0.96) as well as responder (CR + PR) patients (median 14.13 mo and 15.40 mo respectively; P=0.38). The principal difference between the two arms was that more than the double of patients in PCG arm responded (43.6% vs 20%) and consequently had a survival advantage of clinical relevance in comparison to patients in PC arm. When tumor response was introduced in the Cox model (as a four level variable), the difference in Overall Survival between PCG and PC changed from a significant level (HR=1.28; CI 1.00–1.63; P=0.049) to a not significant level (HR=0.99; CI: 0.76 - 1.28; P=0.97). Conclusions: To our knowledge this is the first report showing a significant direct correlation between response and survival in advanced NSCLC according to Prentice criteria. No significant financial relationships to disclose.
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Affiliation(s)
- A. Paccagnella
- Ospedale SS Giovanni E Paolo, Venezia, Italy; Centro di Riferimento Oncologico, Aviano, Italy; Azienda Ospedaliera Padova, Padova, Italy; Policlinico Universitario, Modena, Italy; Cardio-Thoracic Department, Pisa, Italy; IRCCS San Raffaele, Milano, Italy
| | - F. Oniga
- Ospedale SS Giovanni E Paolo, Venezia, Italy; Centro di Riferimento Oncologico, Aviano, Italy; Azienda Ospedaliera Padova, Padova, Italy; Policlinico Universitario, Modena, Italy; Cardio-Thoracic Department, Pisa, Italy; IRCCS San Raffaele, Milano, Italy
| | - A. Bearz
- Ospedale SS Giovanni E Paolo, Venezia, Italy; Centro di Riferimento Oncologico, Aviano, Italy; Azienda Ospedaliera Padova, Padova, Italy; Policlinico Universitario, Modena, Italy; Cardio-Thoracic Department, Pisa, Italy; IRCCS San Raffaele, Milano, Italy
| | - A. Favaretto
- Ospedale SS Giovanni E Paolo, Venezia, Italy; Centro di Riferimento Oncologico, Aviano, Italy; Azienda Ospedaliera Padova, Padova, Italy; Policlinico Universitario, Modena, Italy; Cardio-Thoracic Department, Pisa, Italy; IRCCS San Raffaele, Milano, Italy
| | - F. Barbieri
- Ospedale SS Giovanni E Paolo, Venezia, Italy; Centro di Riferimento Oncologico, Aviano, Italy; Azienda Ospedaliera Padova, Padova, Italy; Policlinico Universitario, Modena, Italy; Cardio-Thoracic Department, Pisa, Italy; IRCCS San Raffaele, Milano, Italy
| | - A. Chella
- Ospedale SS Giovanni E Paolo, Venezia, Italy; Centro di Riferimento Oncologico, Aviano, Italy; Azienda Ospedaliera Padova, Padova, Italy; Policlinico Universitario, Modena, Italy; Cardio-Thoracic Department, Pisa, Italy; IRCCS San Raffaele, Milano, Italy
| | - G. Ceresoli
- Ospedale SS Giovanni E Paolo, Venezia, Italy; Centro di Riferimento Oncologico, Aviano, Italy; Azienda Ospedaliera Padova, Padova, Italy; Policlinico Universitario, Modena, Italy; Cardio-Thoracic Department, Pisa, Italy; IRCCS San Raffaele, Milano, Italy
| | - R. Biason
- Ospedale SS Giovanni E Paolo, Venezia, Italy; Centro di Riferimento Oncologico, Aviano, Italy; Azienda Ospedaliera Padova, Padova, Italy; Policlinico Universitario, Modena, Italy; Cardio-Thoracic Department, Pisa, Italy; IRCCS San Raffaele, Milano, Italy
| | - P. D'Amanzo
- Ospedale SS Giovanni E Paolo, Venezia, Italy; Centro di Riferimento Oncologico, Aviano, Italy; Azienda Ospedaliera Padova, Padova, Italy; Policlinico Universitario, Modena, Italy; Cardio-Thoracic Department, Pisa, Italy; IRCCS San Raffaele, Milano, Italy
| | - M. G. Ghi
- Ospedale SS Giovanni E Paolo, Venezia, Italy; Centro di Riferimento Oncologico, Aviano, Italy; Azienda Ospedaliera Padova, Padova, Italy; Policlinico Universitario, Modena, Italy; Cardio-Thoracic Department, Pisa, Italy; IRCCS San Raffaele, Milano, Italy
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Ghi MG, Paccagnella A, Stanta G, Murer B, Petrera F, Busato S, Bonin S, Medici M, Carnuccio R, Biason R. Retrospective analyses of m-RNA gene expression profile from formalin fixed paraffin embedded (FFPE) specimens in colorectal cancer (CRC) and correlation with chemoresponsiveness. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15039 Background: Patients with chemoresponsive tumors are more likely to have a survival advantage, consequently a great interest is being placed on the identification of predictive markers. Currently, the improving in the extraction techniques allow the detection of gene profile at the mRNA level from FFPE materials. The purpose of the study was to analyse the m-RNA level of specific genes from FFPE (Stanta et al, BioTechniques 1998), both primary tumor (T) and locoregional lymphnodes (N) in CRC patients treated with chemotherapy (CT), and to relate it with chemoresponsiveness. Material and Methods: RNA was extract from FFPE tumor specimen both in T and N. RNA was reversing transcribed to cDNA. From the cDNA sample, BRCA1, ERCC1, CES2 and TS gene transcripts were specifically amplified by PCR. ERCC1 and BRCA1 are involved in platinum-compound resistance; TS is involved in responses to 5Fluorouracil (5FU) and CES2 level expression was recently related to Irinotecan pro-drug activation. Eligible patients included metastatic CRC patients treated from March 2000 to December 2003 as first line CT with Oxaliplatin/5FU or Irinotecan/5FU or 5FU alone. Results: Forty-five consecutive patients were retrospectively analysed. 15 of them received Oxaliplatin/5FU, 15 Irinotecan/5FU and the other 15 5FU alone. Median age was 64 (range 46–75). 13 patients (28%) had received adjuvant CT. 32 patients (72%) had metastatic disease at the time of surgery. Global Response Rate was 44%. All 45 patients received 5FU and they were analysed for the level of TS expression. With Multiple Regression Analysis, no statistical significant relation between TS level expression and response to 5FU was observed (P=0.36). A strong relation was observed between ERCC1 and response to Oxaliplatin (P=0.006) and a possible correlation of BRCA1-exon11 level expression and response to Irinotecan (P=0.06). The analyses of CES2 and the relation between gene expression and survival are ongoing. Conclusions: The analyses of mRNA gene expression profile from FFPE could be use to predicting response to CT in CRC patients. To test this hypothesis, a randomized phase II-III prospective study of tailored therapy in metastatic CRC is planned. No significant financial relationships to disclose.
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Affiliation(s)
- M. G. Ghi
- Ospedale Umberto I, Mestre-Venezia, Italy; Molecular Hystopathology Lab, Trieste Unversity, Italy; Pathology Dept, Umberto I Hospital, Venezia Mestre, Italy; Azienda Ospedaliera, Padova, Italy
| | - A. Paccagnella
- Ospedale Umberto I, Mestre-Venezia, Italy; Molecular Hystopathology Lab, Trieste Unversity, Italy; Pathology Dept, Umberto I Hospital, Venezia Mestre, Italy; Azienda Ospedaliera, Padova, Italy
| | - G. Stanta
- Ospedale Umberto I, Mestre-Venezia, Italy; Molecular Hystopathology Lab, Trieste Unversity, Italy; Pathology Dept, Umberto I Hospital, Venezia Mestre, Italy; Azienda Ospedaliera, Padova, Italy
| | - B. Murer
- Ospedale Umberto I, Mestre-Venezia, Italy; Molecular Hystopathology Lab, Trieste Unversity, Italy; Pathology Dept, Umberto I Hospital, Venezia Mestre, Italy; Azienda Ospedaliera, Padova, Italy
| | - F. Petrera
- Ospedale Umberto I, Mestre-Venezia, Italy; Molecular Hystopathology Lab, Trieste Unversity, Italy; Pathology Dept, Umberto I Hospital, Venezia Mestre, Italy; Azienda Ospedaliera, Padova, Italy
| | - S. Busato
- Ospedale Umberto I, Mestre-Venezia, Italy; Molecular Hystopathology Lab, Trieste Unversity, Italy; Pathology Dept, Umberto I Hospital, Venezia Mestre, Italy; Azienda Ospedaliera, Padova, Italy
| | - S. Bonin
- Ospedale Umberto I, Mestre-Venezia, Italy; Molecular Hystopathology Lab, Trieste Unversity, Italy; Pathology Dept, Umberto I Hospital, Venezia Mestre, Italy; Azienda Ospedaliera, Padova, Italy
| | - M. Medici
- Ospedale Umberto I, Mestre-Venezia, Italy; Molecular Hystopathology Lab, Trieste Unversity, Italy; Pathology Dept, Umberto I Hospital, Venezia Mestre, Italy; Azienda Ospedaliera, Padova, Italy
| | - R. Carnuccio
- Ospedale Umberto I, Mestre-Venezia, Italy; Molecular Hystopathology Lab, Trieste Unversity, Italy; Pathology Dept, Umberto I Hospital, Venezia Mestre, Italy; Azienda Ospedaliera, Padova, Italy
| | - R. Biason
- Ospedale Umberto I, Mestre-Venezia, Italy; Molecular Hystopathology Lab, Trieste Unversity, Italy; Pathology Dept, Umberto I Hospital, Venezia Mestre, Italy; Azienda Ospedaliera, Padova, Italy
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Paccagnella A, Mauri A, Berto R, Falchero S, Baruffi C, Marcon ML, Faronato PP, Dal Ben G, Foscolo G. Biopsychosocial approach to home enteral nutrition: measure of subjective satisfaction and quality of life. Minerva Med 2007; 98:5-17. [PMID: 17372577] [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: 05/14/2023]
Abstract
AIM Home enteral nutrition (HEN) has become a therapeutic option used to prolong considerably the life of those patients who were previously doomed to malnutrition. The recent biopsychosocial suggests to consider the person in a global vision that takes into account not only the physiological but also the psychological and social implications of any treatment we use. In such a vision the wellness of the patients treated in HEN has to be considered in a more general view that considers the effect of the therapy related to quality of life of the person itself. In this study the effects of HEN on the quality of life of the patients and of their primary caregivers was assessed. METHODS Twenty patients, 12 males and 8 females, were included in the study. Twelve patients were excluded from the study due to their inability to give informed consent due to a decrease in consciousness and/or cognitive functioning. The 20 patients' mean age was 59.5+14 years with average of 7 years of school education. Twenty-nine caregivers, 25 females and 4 males (mean age = 55.3+/-9 years), were also considered. RESULTS The patients' condition was good since none showed symptoms related to the therapy. Of the 20 patients, 14 were hospitalized in the past 12 months and since their clinical conditions were stable they were sent back home, while 4 were hospitalized because of HEN issues. None of the patients showed gastro-enteric complications related to their disease state during the previous 12 months, although 5 patients had constipation, and 2 had temporary diarrhea (spontaneously receded) which reduced the infused caloric intake for 2-3 days from the symptom onset. CONCLUSIONS The biopsychosocial approach we used in this study shows that aspects traditionally treated as ''positive'' and desirable by health-care professionals (i.e. the possibility to provide home care) do not have a straightforward correspondence in the emotional sphere of the patient undergoing HEN. On the contrary, in some cases, the subjective perception of the health related quality of life tends to be lower than expected, since the patient endures a treatment which appears to be essentially ineffective in modifying the prognosis of the basal disease.
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Affiliation(s)
- A Paccagnella
- Service of Dietetics and Clinical Nutrition, Department of Medicine, Hospital of Treviso, Treviso, Italy.
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Turcato G, Buffoli A, Loreggian L, Gava A, Campostrini F, Gardani G, Polsinelli M, Tomio L, Villa B, Paccagnella A. 1107. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.372] [Citation(s) in RCA: 2] [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: 11/24/2022]
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Pagan V, Ceron L, Paccagnella A, Pizzi G. 5-year prospective results of trimodality treatment for malignant pleural mesothelioma. J Cardiovasc Surg (Torino) 2006; 47:595-601. [PMID: 17033611] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM Even though followed by a prolonged survival in highly selected patients, the promising results of Sugarbaker's trimodality treatment for malignant pleural mesothelioma (MPM) are debated and not yet uniformly replicated. The purpose of this study is to evaluate prospectively the reproducibility of the trimodality treatment results in a patient population with mesothelioma staged by the IMIG classification. METHODS Fifty-four patients with MPM have been judged candidable to extended pleuropneumonectomy (EPP), to be followed by chemotherapy (paclitaxel+carboplatin) and radiotherapy (50 Gy). RESULTS At thoracotomy, 44 of the 54 surgical candidates (81%) underwent EPP; 73% of the operated patients completed the entire adjuvant chemo-radiotherapy with no major toxicity. The 30-day or in-hospital operative mortality rate was 4.5% (2 deaths), the major morbidity 36%, and the overall complication rate 50%. At 5 years the projected survival of the 42 surgical survivors submitted to EPP is 19%; median survival is 20 months. The restricted group of patients with epithelial, N0-1, completely resected MPM (microscopic negative margins) exhibits a projected 50% 5-year survival. Clinical understaging has shown up to be noticeable both at the thoracotomy exploration and pathology examination. Most of the disease recurrences are loco-regional and the current insufficiency of intraoperative or postsurgical radicality needs improvement, along with earlier diagnosis, more accurate staging, and preoperative induction for the multimodality treatment of pleural mesothelioma to become an established curative option. CONCLUSIONS This series confirms the reproducibility of the trimodality treatment for MPM,which is associated with prolonged survival for early-stage tumors at the cost of a not prohibitive treatment-related mortality rate.
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Affiliation(s)
- V Pagan
- Division of Thoracic Surgery, Umberto I General Hospital, Venezia-Mestre, Italy.
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Paccagnella A, Mauri A, Baruffi C, Berto R, Zago R, Marcon ML, Pizzolato D, Fontana F, Rizzo L, Bisetto M, Agostini S, Foscolo G. Application criteria of enteral nutrition in patients with anorexia nervosa: correlation between clinical and psychological data in a "lifesaving" treatment. JPEN J Parenter Enteral Nutr 2006; 30:231-9. [PMID: 16639070 DOI: 10.1177/0148607106030003231] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Data and research increasingly point to multiple factors in the genesis of eating-behavior disorders, but the lack of a clear etiological definition prevents a unique therapeutic or prognostic approach from being defined. Therapeutic approaches, as well as scientific research, have separately analyzed the psychological aspects and the clinical-nutrition aspects without integrating the variables or correlating clinical and psychological data. This work has several goals because it aims at considering the problem from the 2 different perspectives. Psychological and clinical variables are analyzed both separately and together in order to assess (a) the minimal criteria to define a cure as "lifesaving" and submit a patient to artificial nutrition; (b) the kind of implementation artificial nutrition should follow; (c) which indicators of the efficacy of artificial nutrition must be taken into account; (d) the results in nutrition terms that may be obtained during the follow-up; (e) if artificial nutrition may be used as a therapeutic tool; (f) if there are any psychological effects after artificial nutrition; (g) if there are any effects due to the patients' age; and (h) the correlation between the psychological profile of a patient and the acceptance of the nutrition treatment. METHODS Several psychological and pharmacologic variables, together with clinical and anthropometric data and blood chemical values, were all considered. CONCLUSIONS Besides defining minimal criteria for a "lifesaving" cure and proposing 2 ad hoc scales for the assessment of patients' subjective willingness toward feeding and for the objective measurement of feeding itself, clinical data and correlations with psychological data evidenced the importance of artificial nutrition and specifically of enteral nutrition as a therapeutic tool, allowing us to define the modalities of implementation of enteral nutrition. Results show that, because enteral nutrition did not deteriorate the psychological state of the patients, and was found to be accepted more positively than feeding orally in the most critical initial phase, it should be included in the therapy.
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