1
|
Nicolini A, Carpi A, Ferrari P, Anselmi L. Clinical use of Tumor Markers in the Postoperative Management of Breast Cancer Patients: New Concepts. Int J Biol Markers 2018; 12:181-6. [PMID: 9582609 DOI: 10.1177/172460089701200408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Nicolini
- Second Medical Clinic, University of Pisa, Italy
| | | | | | | |
Collapse
|
2
|
Nicolini A, Campani D, Miccoli P, Spinelli C, Carpi A, Menicagli M, Ferrari P, Gadducci G, Rossi G, Fini M, Giavaresi G, Bonazzi V, Giardino R. Vascular Endothelial Growth Factor (Vegf) and Other Common Tissue Prognostic Indicators in Breast Cancer: A Case-Control Study. Int J Biol Markers 2018; 19:275-81. [PMID: 15646833 DOI: 10.1177/172460080401900404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/17/2022]
Abstract
VEGF is a specific mitogen and survival factor for endothelial cells and a key promoter of angiogenesis in physiological and pathological conditions. Nevertheless, VEGF tissue evaluation in cancer patients as a prognostic factor compared to the conventional histological and biological parameters is still controversial. In this case-control study, tissue VEGF was retrospectively determined by immunohistochemistry and related to T, N, ER, PgR, c-erbB-2, p53, MIB-1 and cyclin D1 in 129 breast cancer patients. Seventy-four of these patients had developed distant metastases postoperatively. The remaining 55 patients had remained disease-free >10 years after surgery. In 17 (13%) of the 129 patients (six with distant metastases and eleven disease-free) tissue and plasma VEGF were concomitantly evaluated. In univariate analysis no significant differences in VEGF and tumor size were found between metastatic and disease-free patients, whereas there were significant differences in N, ER, PgR, c-erbB-2, p53, MIB-1 and cyclin D1 (p ranging from 0.001 to 0.0001). In multivariate analysis VEGF showed less significance than N, ER, c-erbB-2, MIB-1 and cyclin D1 (p=0.012, p=0.007, p=0.005, p=0.005, p=0.002 and p=0.001, respectively). VEGF was a significant unfavorable prognostic indicator only in the N+ subset (p=0.015), while ER (p=0.05 and p=0.021) and MIB-1 (p=0.031 and p=0.022) were significant in both the N+ and N– subgroups. In multivariate analysis in the 74 metastatic cases VEGF did not show any significance in relation to disease-free interval and overall survival from the time of mastectomy and from the time of relapse, whereas N and PgR did (p ranging from 0.018 to 0.001). In conclusion, tissue VEGF does not seem a suitable candidate to replace conventional histological and other common biological prognostic factors in breast cancer.
Collapse
Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Nicolini A, Perazzo A, Gatto P, Piroddi IMG, Barlascini C, Karamichali S, Strada P. A rare adverse reaction to ethambutol: drug-induced haemolytic anaemia. Int J Tuberc Lung Dis 2017; 20:704-5. [PMID: 27084828 DOI: 10.5588/ijtld.15.0742] [Citation(s) in RCA: 8] [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] [Indexed: 11/10/2022] Open
Abstract
Anti-tuberculosis drugs seldom cause serious haematological side effects. However, among these drugs, isoniazid and rifampicin, especially when administered intermittently, may very rarely be linked to acute autoimmune haemolytic anaemia. Ethambutol (EMB) can cause dose-related retrobulbar neuritis. In this paper, we present the first reported case of acute fatal autoimmune haemolytic anaemia due to EMB.
Collapse
Affiliation(s)
- A Nicolini
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - A Perazzo
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - P Gatto
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - I M G Piroddi
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - C Barlascini
- Hygiene and Health Medicine Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - S Karamichali
- Department of Allergy and Respiratory Diseases, General Hospital, Sestri Levante, Genoa, Italy
| | - P Strada
- Immunohaematology Service, Istituto Di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino Istituto Scientifico Tumori, Genoa, Italy
| |
Collapse
|
4
|
Nicolini A, Barlascini C, Piroddi IMG, Garuti G, Banfi PI. Effectiveness and safety of mouthpiece ventilation and nocturnal non-invasive ventilation in patients with kyphoscoliosis: Short and long-term outcomes after an episode of acute respiratory failure. Rev Port Pneumol (2006) 2015; 22:75-81. [PMID: 26748589 DOI: 10.1016/j.rppnen.2015.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Kyphoscoliosis is a skeletal condition involving the hyperflexion of the thoracic spine. It is characterized by reduced chest wall compliance and impaired respiratory mechanisms leading to progressive hypo-ventilation. We evaluated the effectiveness and the safety of non-invasive ventilation (NIV) in patients after an episode of acute respiratory failure (ARF). METHODS Eighteen patients with severe kyphoscoliosis who had been hospitalized for an episode of ARF were followed for 4 years. NIV was applied via mouthpiece (MPV) during the daytime and via mask during the night. The primary outcomes were changes in physiological and functional parameters as well as quality of life. Secondary outcomes were considered re-hospitalization and mortality rate after discharge. A set of control subjects was used for comparison. RESULTS All patients showed a significant improvement in several clinical, physiological, functional and quality of life parameters. Four of them (22.2%) died during the four year follow-up period. In the uni-variate analysis patients who died had higher cardiac co-morbidity, lower MIP and SNIP, higher paCO2, and oxygen desaturation index at initial admission. CONCLUSIONS Diurnal MPV associated with nocturnal NIV had significantly improved lung function, clinical outcomes and quality of life. It should be considered as a safe alternative to traditional administering of NIV.
Collapse
Affiliation(s)
- A Nicolini
- Respiratory Rehabilitation Unit, ASL 4 Chiavarese, Hospital of Sestri Levante, Italy.
| | - C Barlascini
- Public Health Medicine, ASL 4 Chiavarese, Hospital of Sestri Levante, Italy
| | - I M G Piroddi
- Respiratory Rehabilitation Unit, ASL 4 Chiavarese, Hospital of Sestri Levante, Italy
| | - G Garuti
- Respiratory Diseases Department, Hospital of Mirandola, Modena, Italy
| | - P I Banfi
- Don Gnocchi Foundation, IRCCS, Milan, Italy
| |
Collapse
|
5
|
Piroddi IMG, Karamichali S, Nicolini A, Esquinaz A. Efficacy of non-invasive ventilation for hypercapnic acute respiratory failure in a general ward: details and comments. Intern Med J 2015; 45:1201-2. [PMID: 26563698 DOI: 10.1111/imj.12878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 04/10/2015] [Indexed: 11/30/2022]
Affiliation(s)
- I M G Piroddi
- Respiratory Diseases Unit, Hospital of Sestri Levante, Genoa, Italy
| | - S Karamichali
- Allergy and Respiratory Diseases Department, IRCSS AOU San Martino-IST, Genoa, Italy
| | - A Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Genoa, Italy
| | - A Esquinaz
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain
| |
Collapse
|
6
|
Riva N, Ageno W, Poli D, Testa S, Rupoli S, Santoro R, Lerede T, Piana A, Carpenedo M, Nicolini A, Ferrini PM, Tosetto A. Safety of vitamin K antagonist treatment for splanchnic vein thrombosis: a multicenter cohort study. J Thromb Haemost 2015; 13:1019-27. [PMID: 25845412 DOI: 10.1111/jth.12930] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 03/16/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The treatment of splanchnic vein thrombosis (SVT) is challenging, due to the increased risk of bleeding and potentially life-threatening complications. Current recommendations are based on evidence from the treatment of venous thrombosis in usual sites, but small observational studies in SVT population suggest that the bleeding risk may offset the benefit of anticoagulant treatment in this setting. The aim of this study was to evaluate the safety of vitamin K antagonists (VKAs) in SVT patients. METHODS We retrospectively included SVT patients treated with VKAs followed by 37 Italian anticoagulation clinics, until June 2013. The primary outcome was the incidence of major bleeding (MB), according to the ISTH definition, during VKA treatment. Vascular events, including both arterial and venous thrombosis, and mortality were also documented. RESULTS Three hundred and seventy-five patients were included (median age 53 years; 54.7% males). During a median VKA treatment duration of 1.98 years, 15 MB events occurred, corresponding to an incidence rate of 1.24 (95% confidence interval [CI], 0.75-2.06) per 100 patient-years. Gastrointestinal bleeding represented 40% of all MB events. At multivariate analysis, the presence of esophageal varices emerged as independent predictor of MB (hazard ratio 5.4; 95% CI, 1.4-21.1). The incidence rate of vascular events on treatment was 1.37 (95% CI, 0.84-2.23) per 100 patient-years and the mortality rate was 0.83 (95% CI, 0.44-1.54) per 100 patient-years. CONCLUSIONS Selected SVT patients followed by anticoagulation clinics for the management of VKA treatment show a low rate of major bleeding and vascular events.
Collapse
Affiliation(s)
- N Riva
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - W Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - D Poli
- Department of Heart and Vessels, Thrombosis Centre, AOU-Careggi, Florence, Italy
| | - S Testa
- Haemostasis and Thrombosis Centre, AO Istituti Ospitalieri, Cremona, Italy
| | - S Rupoli
- Division of Hematology, Haemostasis and Thrombosis Center, AOU Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy
| | - R Santoro
- Hemostasis and Thrombosis Unit, Hemophilia Center, Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - T Lerede
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - A Piana
- Department of Internal Medicine, Ospedale S. Martino, Genoa, Italy
| | - M Carpenedo
- Department of Hematology and Transplant Unit, AO San Gerardo, Monza, Italy
| | - A Nicolini
- Department of Internal Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - P M Ferrini
- Dipartimento Emergenza-Urgenza e Area Medica e Specialistica, AOU Parma, Parma, Italy
| | - A Tosetto
- Department of Hematology, Hemostasis and Thrombosis Center, S. Bortolo Hospital, Vicenza, Italy
| |
Collapse
|
7
|
Nicolini A, Santo M, Ferrera L, Ferrari-Bravo M, Barlascini C, Perazzo A. The use of non-invasive ventilation in very old patients with hypercapnic acute respiratory failure because of COPD exacerbation. Int J Clin Pract 2014; 68:1523-9. [PMID: 25283150 DOI: 10.1111/ijcp.12484] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIMS We prospectively enrolled 207 patients (121 were 75 or older and 86 younger than 75) who were admitted to three Respiratory Monitoring Units. The primary outcomes were intubation and mortality rates; the secondary outcomes were changes in arterial blood gases analysis, non-invasive ventilation (NIV) duration and length of hospital stay. RESULTS Hospital mortality was similar in the two groups, as were intubation rates. The proportion who died in the very old patient group was 19.8% (24/121) vs. 10.4% (9/86) in the younger group. Intubation rate was 10.7% (13/121) in the very old patient group and 11.6% (10/86) in the younger group. The presence of comorbidities, the severity of illness (SAPS II), the level of consciousness, NIV failure (intubation), absolute value of pH prior to NIV, as well as the changes in pH and paCO2 and PaO2 /FiO2 after 2 h of NIV, were the variables associated with higher mortality. Very old patients had significantly higher NIV duration than younger patients (69.0 ± 47.0 vs. 57.0 ± 27.0 h) (p ≤ 0.03) and hospital stays (11.6 ± 3.8 vs. 8.4 ± 1.4) (p ≤ 0.02). CONCLUSIONS The use of NIV in very old patients was effective in many cases. Endotracheal intubation after NIV failure was not efficacious in either group.
Collapse
Affiliation(s)
- A Nicolini
- Respiratory Medicine Unit, ASL4 Chiavarese, Sestri Levante, Italy
| | | | | | | | | | | |
Collapse
|
8
|
Rajoria S, Hanly E, Nicolini A, George AL, Geliebter J, Shin EJ, Suriano R, Carpi A, Tiwari RK. Interlinking of hypoxia and estrogen in thyroid cancer progression. Curr Med Chem 2014; 21:1351-60. [PMID: 24304276 DOI: 10.2174/0929867321666131201142434] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 02/04/2013] [Accepted: 02/04/2013] [Indexed: 11/22/2022]
Abstract
Estrogen aids in neo-vascularization of various tumors during hypoxic conditions, however the role of estrogen within the hypoxic environment of thyroid cancer is not known. In a series of experimentations, using human thyroid cancer cells, we observed that estrogen and hypoxia modulate the hypoxia inducible factor-1 (HIF-1) signaling which is abrogated by the anti-estrogen fulvestrant and the HIF-1 inhibitor YC-1 (3-(5'-hydroxymethyl-2'-furyl)-1-benzylindazole). Furthermore, we found that the conditioned medium from estrogen treated thyroid cancer cells lead to enhanced migration and tubulogenesis of human umbilical vein endothelial cells (HUVECs) which is abrogated by HIF-1 inhibitor. These findings, in addition to our previous and other scientific literature data, lead us to conclude that estrogen and hypoxia are interlinked in thyroid cancer and can equally modulate epithelial-endothelial cell interactions by mediating key cellular, metabolic and molecular processes of thyroid cancer progression. We believe that the hormonal component and cellular adaptation to oxygen tension of cancer cells are functionally equivalent with a cellular transition that can be exploited clinically for a combinational approach for thyroid cancer treatment involving antiestrogens as well as anti-hypoxic agents.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - R K Tiwari
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY- 10595, USA.
| |
Collapse
|
9
|
Biava PM, Nicolini A, Ferrari P, Carpi A, Sell S. A systemic approach to cancer treatment: tumor cell reprogramming focused on endocrine-related cancers. Curr Med Chem 2014; 21:1072-81. [PMID: 24304275 DOI: 10.2174/0929867321666131201143124] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/05/2013] [Accepted: 04/20/2013] [Indexed: 11/22/2022]
Abstract
The term "cancer cell reprogramming" is used to define any kind of intervention aimed at transforming cancer cells into terminally differentiated cells. Using this approach, new technologies have been applied with different methods for a more systemic approach to cancer treatment. This review reports on advances of these technologies, including our personal contributions, mainly carried out on endocrine-related cancers. Some of the interventions, aimed at reverting cancer cells into a normal phenotype, are based on the evidence that tumor development is suppressed by the embryonic microenvironment. On the basis of this rationale, experiments have been conducted using stem cell differentiation stage factors (SCDSFs) taken at different stages of development of Zebrafish embryos, oocyte extracts, or naïve human umbilical cord matrix derived stem cells (UMDSCs). SCDSFs induce significant growth inhibition on different tumor cell lines in vitro, likely because of increases in cell cycle regulatory molecules, such as p53 and pRb. Treatment with these factors activates apoptosis and differentiation related to caspase-3. This is achieved via p73 apoptotic-dependent pathway activation with a concurrent normalization of the E-cadherin and beta-catenin ratio. Extracts from prophase amphibian oocytes could reprogram relevant epigenetic alterations in MCF-7 and HCC1954 breast cancer cell lines, while un-engineered (naïve) human UMDSCs attenuated growth of MDA-231 human breast carcinoma cells. A product prepared for human treatments, containing SCDSFs at very low doses, yielded favorable results in breast cancer and in intermediate-advanced hepatocellular carcinoma. Other reprogramming interventions used in the models of breast, prostate and ovarian cancer cell lines are described. Finally, current and future perspectives of this novel technology are discussed and a new hallmark of cancer is suggested: the loss of differentiation of cancer cells.
Collapse
Affiliation(s)
| | | | | | | | - S Sell
- Scientific Institute of Research and Care Multimedica, Milano Italy.
| |
Collapse
|
10
|
Nicolini A, Ferrari P, Biava PM, Carpi A. Changing the endocrine dependence of breast cancer: data and hypotheses. Curr Med Chem 2014; 21:1093-106. [PMID: 24304277 DOI: 10.2174/0929867321666131201141741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 03/21/2013] [Accepted: 04/29/2013] [Indexed: 11/22/2022]
Abstract
Among the most common human cancers, often only breast and prostate cancers have advantage of hormone dependence. For a long time, this advantage permitted breast cancer to be efficaciously managed in the adjuvant and metastatic settings with low side effects by endocrine therapy. Unfortunately, soon or afterward hormone dependence is lost in most patients. In breast cancer, de novo or acquired hormone resistance is an hot issue and the focus of endless debate. Although a lack of oestrogen receptors (ERs) is considered to be the main reason for de novo hormone resistance, many studies have been conducted and many different mechanisms have been hypothesised to account for acquired hormone resistance. Thus far, hormone resistance appears to be occasionally delayed or avoided in "in vivo" experiments. However, this finding did not have a significant benefit in current clinical practice. The principal aim of this review article is to sum up and update the issue of changing the endocrine dependence of breast cancer. Recent molecular insights extensively elucidating and shedding new light on this very controversial issue are considered. Moreover, based on our recent reports, a new mechanistic interpretation of and a therapeutic approach for overcome hormone resistance are proposed.
Collapse
Affiliation(s)
| | | | | | - A Carpi
- Unit of Oncology 2, Department of Oncology, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
| |
Collapse
|
11
|
Cueto A, Burigana F, Nicolini A, Lugnani F. Neuroendocrine tumors of the lung: hystological classification, diagnosis, traditional and new therapeutic approaches. Curr Med Chem 2014; 21:1107-16. [PMID: 24304279 DOI: 10.2174/0929867321666131129125953] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 05/27/2013] [Accepted: 05/27/2013] [Indexed: 11/22/2022]
Abstract
Lung neuroendocrine tumors are neoplasms originating from bronchopulmonary neuroendocrine cells, usually Kulchitsky cells, loaded with argentaffin granules. They account for 20-25% of all primitive lung tumors, the most common being the small-cell undifferentiated carcinoma. They include different tumors, from tumors of low-grade malignancy, especially the typical carcinoids, with high survival rates after surgical therapy, to the high-grade malignancy tumors, especially small-cell undifferentiated carcinomas. The latter have very few indications for surgical treatment with a low survival rate, even after multimodal therapy. The aim of this review is to describe the present knowledge and discuss possible new developments in the management of pulmonary neuroendocrine tumors. The authors examine and discuss in particular the role that surgical techniques should have in the treatment of small-cell lung cancer in opposition to a nihilism position that has limited therapies to non-surgical approaches. The critical review of this attitude opens the door to a more aggressive approach. In the meantime the review shows that it might be possible to include the new minimally invasive percutaneous ablative techniques as cryosurgery, thermotherapy and irreversible electroporation within a modern and flexible framework. The authors also present the hypothesis that cancer stem cells (CSC) are at the basis of recurrences of small-cell lung cancer (SCLC) and therefore that the issue is of difficult solution with the conventional oncologic approach considering the chemo-resistance of CSC to drugs. For these reasons an epigenetic therapy based on differentiation factors is proposed alongside the usual surgical and chemo-radiation protocols.
Collapse
Affiliation(s)
| | | | | | - F Lugnani
- Dept. Surgery Granada University, H.U. Virgen de las Nieves, Granada, Spain.
| |
Collapse
|
12
|
Latt LD, Christopher M, Nicolini A, Burk DR, Dezfuli B, Serack BJ, Fithian DC. A validated cadaveric model of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 2014; 22:2357-63. [PMID: 24807229 DOI: 10.1007/s00167-014-3033-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/19/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE Despite the high prevalence of trochlear dysplasia among patients with patellar instability, it is not well studied and is infrequently addressed surgically. The lack of a validated cadaveric model of trochlear dysplasia may be a contributing factor. The goal of this study was to develop a simple, reproducible, and realistic cadaveric model of trochlear dysplasia by surgically modifying cadaveric femora with normal anatomy and then to validate this model through the use of mechanical and fluoroscopic measurements. METHODS The floor of the trochlear groove was surgically elevated using an inflatable bone tamp in eight cadaveric femora. The trochlear depth (TD) was measured with a custom-designed measuring device, and radiographic markers of dysplasia (sulcus angle, crossing sign, and prominence) were assessed before and after surgical modification. RESULTS The average TD was 3.6±1.4, 4.6±1.1, and 5.1±1.0 mm prior to reverse trochleoplasty (RT) and 1.0±1.8, 2.3±1.3, and 3.3±2.5 mm following RT at 0°, 20°, and 40° of flexion, respectively. These direct measurements of TD were confirmed with fluoroscopy. The sulcus angle averaged 141° prior to RT and 157° after RT. The average prominence across all specimens was 3.3±0.7 mm before RT, and 5.5±1.5 mm after RT. Finally, the crossing sign was found to be absent in all knees prior to RT and present in 7 of the 8 after RT. CONCLUSIONS The results of this study show that elevation of the trochlear floor with an inflatable bone tamp can reproducibly create a simulated dysplastic trochlea. This model may be useful in biomechanical studies of treatments for patellofemoral instability.
Collapse
Affiliation(s)
- L D Latt
- Department of Orthopaedic Surgery, University of Arizona, 1609 N. Warren Ave., P.O. Box 245064, Tucson, AZ, 85724, USA,
| | | | | | | | | | | | | |
Collapse
|
13
|
Nicolini A, Santo M, Ferrari-Bravo M, Barlascini C. Open-Mouthpiece Ventilation Versus Nasal Mask Ventilation in Subjects With COPD Exacerbation and Mild to Moderate Acidosis: A Randomized Trial. Respir Care 2014; 59:1825-31. [DOI: 10.4187/respcare.03009] [Citation(s) in RCA: 9] [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: 11/05/2022]
|
14
|
Nicolini A, Banfi P, Grecchi B, Lax A, Walterspacher S, Barlascini C, Robert D. Non-invasive ventilation in the treatment of sleep-related breathing disorders: A review and update. Rev Port Pneumol 2014; 20:324-35. [PMID: 24954545 DOI: 10.1016/j.rppneu.2014.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 02/08/2014] [Accepted: 03/29/2014] [Indexed: 12/14/2022] Open
Abstract
Non-invasive mechanical ventilation (NIV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases as an alternative to intubation. Over the last thirty years NIV has been used during the night in patients with stable chronic lung diseases such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome and in other conditions such as sleep disorders associated with congestive heart failure. In this review we discuss the different types of NIV, the specific conditions in which they can be used as well as the indications, recommendations, and evidence supporting the efficacy of NIV.
Collapse
Affiliation(s)
- A Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Italy.
| | - P Banfi
- Neuromuscular Diseases Unit, Don Gnocchi Foundation, Milan, Italy
| | - B Grecchi
- Rehabilitation Department ASL 4 Chiavarese, Italy
| | - A Lax
- Neuromuscular Diseases Unit, Don Gnocchi Foundation, Milan, Italy
| | - S Walterspacher
- Department of Pulmonology, University Hospital, Freiburg, Germany
| | | | - D Robert
- Emeritus Professor of Medicine, Claude Bernard University Lyon, France
| |
Collapse
|
15
|
Nicolini A, Gaia G, Duiella SF, Ossola MW, Fedele L. Conservative treatment of giant uterine artery pseudoaneurysm. Ultrasound Obstet Gynecol 2014; 43:602-604. [PMID: 24659469 DOI: 10.1002/uog.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 03/07/2014] [Accepted: 03/14/2014] [Indexed: 06/03/2023]
Affiliation(s)
- A Nicolini
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | |
Collapse
|
16
|
Bonamente E, Merico M, Rinaldi S, Pignatta G, Pisello A, Cotana F, Nicolini A. Environmental Impact of Industrial Prefabricated Buildings: Carbon and Energy Footprint Analysis Based on an LCA Approach. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.egypro.2014.12.319] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Duffy MJ, Lamerz R, Haglund C, Nicolini A, Kalousová M, Holubec L, Sturgeon C. Tumor markers in colorectal cancer, gastric cancer and gastrointestinal stromal cancers: European group on tumor markers 2014 guidelines update. Int J Cancer 2013; 134:2513-22. [PMID: 23852704 PMCID: PMC4217376 DOI: 10.1002/ijc.28384] [Citation(s) in RCA: 224] [Impact Index Per Article: 20.4] [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: 03/15/2013] [Accepted: 06/25/2013] [Indexed: 02/06/2023]
Abstract
Biomarkers currently play an important role in the detection and management of patients with several different types of gastrointestinal cancer, especially colorectal, gastric, gastro-oesophageal junction (GOJ) adenocarcinomas and gastrointestinal stromal tumors (GISTs). The aim of this article is to provide updated and evidence-based guidelines for the use of biomarkers in the different gastrointestinal malignancies. Recommended biomarkers for colorectal cancer include an immunochemical-based fecal occult blood test in screening asymptomatic subjects ≥50 years of age for neoplasia, serial CEA levels in postoperative surveillance of stage II and III patients who may be candidates for surgical resection or systemic therapy in the event of distant metastasis occurring, K-RAS mutation status for identifying patients with advanced disease likely to benefit from anti-EGFR therapeutic antibodies and microsatellite instability testing as a first-line screen for subjects with Lynch syndrome. In advanced gastric or GOJ cancers, measurement of HER2 is recommended in selecting patients for treatment with trastuzumab. For patients with suspected GIST, determination of KIT protein should be used as a diagnostic aid, while KIT mutational analysis may be used for treatment planning in patients with diagnosed GISTs.
Collapse
Affiliation(s)
- M J Duffy
- Clinical Research Center, St Vincent's University Hospital, Dublin 4 and UCD School of Medicine and Medical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | | | | | | | | | | | | |
Collapse
|
18
|
Paneroni M, Clini E, Crisafulli E, Guffanti E, Fumagalli A, Bernasconi A, Cabiaglia A, Nicolini A, Brogi S, Ambrosino N, Peroni R, Bianchi L, Vitacca M. Feasibility and Effectiveness of an Educational Program in Italian COPD Patients Undergoing Rehabilitation. Respir Care 2013; 58:327-33. [DOI: 10.4187/respcare.01697] [Citation(s) in RCA: 7] [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: 11/05/2022]
|
19
|
Nicolini A, Tonveronachi E, Navalesi P, Antonelli M, Valentini I, Melotti RM, Pigna A, Carrassi A, Righini P, Ferrari Bravo M, Pelosi P, Nicoli F, Cosentini R, Vaschetto R, Faenza S, Nava S. Effectiveness and predictors of success of noninvasive ventilation during H1N1 pandemics: a multicenter study. Minerva Anestesiol 2012; 78:1333-1340. [PMID: 23032930] [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
BACKGROUND The use of non-invasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF) due to H1N1 virus infection is controversial. In this multicenter study we aimed to assess the efficacy of NIV in avoiding endotracheal intubation (ETI) and to identify predictors of success or failure. METHODS In this prospective multicenter study, 98 patients with new pulmonary infiltrate(s) sustained by H1N1 virus and a PaO(2)/FiO2<300 were eligible for study; 38/98 required immediate ETI, while the others received NIV as a first line therapy; 13/60 patients failed NIV and were intubated after 5.8+5.5 hours from enrolment. The remaining 47/60 patients were successfully ventilated with NIV. RESULTS Hospital mortality was significantly higher in those patients who failed NIV vs. those who succeeded (53.8% vs. 2.1%; OR=0.52, P<0.001). ETI was associated with higher number of infectious complications, mainly sepsis and septic shock. The OR of having one of these events in the NIV failure group vs. NIV success was 16.7, P<0.001. According to logistic regression model, a SAPS II>29 and a PaO(2)/FIO(2)≤127 at admission and PaO2/FIO(2)≤149 after 1 hr of NIV were independently associated with the need for ETI. CONCLUSION The early application of NIV, with the aim to avoid invasive ventilation, during the H1N1 pandemics was associated with an overall success rate of 47/98 (48%). Patients presenting at admission with an high SAPS II score and a low PaO(2)/FiO(2) ratio and/or unable to promptly correct gas exchange are at high risk of intubation and mortality.
Collapse
Affiliation(s)
- A Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
Peritoneal involvement continues to be a rare manifestation of sarcoidosis: its involvement is not always isolated and sarcoid granulomas are also found elsewhere. Peritoneal diseases tend to have an increased incidence in women. Peritoneal involvement presents as ascites, as peritoneal thickening and multiple soft tissue nodules, and can often simulate peritoneal carcinomatosis. We describe a case of a man presenting abdominal pain, nausea, vomiting and a clinical picture of intestinal obstruction, with peritoneal sarcoidosis and abdominal findings suggesting peritoneal carcinomatosis. The diagnosis of sarcoidosis was confirmed by biopsy of the peritoneum during surgical laparotomy. Peritoneal involvement is a rare manifestation of sarcoidosis (less than 30 cases described in English medical literature): to our knowledge this is the first reported case of the disease presenting with an acute abdominal obstruction treated with surgery.
Collapse
Affiliation(s)
- A Nicolini
- Division of Respiratory Diseases, Hospital of Sestri Levante, Genova, Italy.
| | | | | |
Collapse
|
21
|
Nicolini A, Ferrari P, Fini M, Borsari V, Fallahi P, Antonelli A, Berti P, Carpi A, Miccoli P. Stem cells: their role in breast cancer development and resistance to treatment. Curr Pharm Biotechnol 2011; 12:196-205. [PMID: 21044007 DOI: 10.2174/138920111794295657] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 06/29/2010] [Indexed: 11/22/2022]
Abstract
About 20% of the total cells from primary breast tumors could generate palpable tumors in non-obese diabetic severe combined immunodeficient (NOD/SCID) immunocompromised mice. All the tumorigenic cells originate from a normal mammary stem cell. Human mammary stem cells are sensitive to oncogenic mutations and in mouse models they share similarities with breast cancer stem cells (BrCSCs). Tumorigenicity, invasion, progression and metastasization are further BrCSCs properties likely depending on their CD44+/CD24- phenotype. Local invasion and tumor metastasization seem to be facilitated by the epithelial to mesenchymal transition (EMT) program. This program may be reactivated from stable genetic alterations or through exposure of cancer cells to factors present in the surrounding micro-environment, or by an up-regulation of EMT-inducing transcription factors. One main explanation for resistance to treatment by cancer cells is that a rare subpopulation of cells in residual tumors with tumorigenic potential is intrinsically resistant to therapy. Consistent with this hypothesis, in human breast tumors, the subpopulation of tumor-initiating cancer cells with CD44(high)/CD24(low) cell surface-marker profile was found more resistant to cancer therapies (chemo, hormone and radiotherapy) than is the major population of more differentiated breast cancer cells. The reasons for CSC resistance to chemotherapy, hormone therapy and radiotherapy also have been examined and they opened new scenarios for cancer therapy.
Collapse
Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Nicolini A, Ferrari P, Fini M, Borsari V, Fallahi P, Antonelli A, Carpi A, Miccoli P. Cancer stem cells: perspectives of new therapeutical approaches for breast cancer. Front Biosci (Schol Ed) 2011; 3:1486-99. [PMID: 21622284 DOI: 10.2741/239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Currently stem cells are hypothesized to play a central role in the origin, spread and resistance to treatment of breast cancer. Common anticancer therapy is effective but transient, with tumor relapse and metastatic disease often occurring. For therapy to be more effective, debulking of differentiated tumors must occur followed by targeting of the remaining surviving often quiescent tumor stem cells. New therapeutics aimed at cancer stem cells are achieved through non immunological and immunological methods. The former include elective ABC drug transporters or the heat shock protein 90 inhibition, targeting the self-renewal signalling pathways or the EMT program, differentiation therapy, or other interventions to eliminate BrCSCs. The latter include targeting specific antigens expressed on BrCSCs, dendritic cells (DCs) based vaccination and blockers of the extrinsic signals at CSC niche. Here all these novel approaches related to breast cancer stem cells are described.
Collapse
Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, Pisa, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Severe pandemic influenza A virus (H1N1) infection is associated with risk factors such as pregnancy, obesity and immunosuppression. Immunocompromised patients are at increased risk of more severe or prolonged infection. We report a case of a hairy cell leukemia patient with H1N1 pneumonia which caused severe and prolonged illness. H1N1 virus pneumonia with meticillin-resistant Staphilococcus Aerues (MRSA) coinfection causing Acute Lung Injury (ALI) was treated with a double-dose of osentamyvir, a high dose of teicoplanin and a low dose of corticosteroids. Haematological findings included leucopenia, neutropenia, lymphopenia, reduction of gamma-globulins and natural killer (NK) cells. Reduction of NK and gamma-globulins may explain the development of severe illness and the prolonged illness Neutropenia may explain the MRSA co-infection. Lymphopenia is directly associated with virus action and is considered to be a marker of the swine influenza in adults.
Collapse
Affiliation(s)
- A Nicolini
- Division of Respiratory Diseases, General Hospital, Sestri Levante, Genova, Italy.
| | | |
Collapse
|
24
|
Nicolini A, Sangiovanni A, Iavarone M, Martinetti L, Manini MA, Crespi S, Della Corte C, Vavassori S, Colombo M. Chemoembolization with epirubicin drug-eluting beads (DEB-TACE) to treat early and intermediate hepatocellular carcinoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4141] [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: 11/20/2022] Open
|
25
|
Carpi A, Nicolini A, Antonelli A, Ferrari P, Rossi G. Cytokines in the management of high risk or advanced breast cancer: an update and expectation. Curr Cancer Drug Targets 2010; 9:888-903. [PMID: 20025599 DOI: 10.2174/156800909790192392] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Some cytokines (interleukin (IL)-2, IL-11, transforming growth factor(TGF)beta) stimulate, while others (IL-12, IL-18, Interferons (IFNs)) inhibit breast cancer proliferation and/or invasion. So far IL-2, IFNalpha, IFNbeta and occasionally IFNgamma, IL-6, IL-12 have been used for the treatment of advanced breast cancer either to induce or increase hormone sensitivity and/or to stimulate cellular immunity. Only two long term pilot studies suggest that IL-2 and IFNbeta can improve clinical benefit and/or overall survival of metastatic breast cancer patients with minimal residual disease after chemotherapy or with disseminate disease non progressing during endocrine therapy. These results have been interpreted assuming that tumour microenvironment impairs the immune system of the host. Consequently, minimal disease or intense cytostatic effects following chemo or endocrine therapy, respectively, permit the patient's immune system to respond to the stimulatory effect of the cytokines. Therefore a prospective, phase III, randomised, simple blind trial has been planned. The aim is to assess whether the addition of IFNbeta and IL-2 to standard hormone therapy in postmenopausal patients with metastatic breast cancer and positive or unknown positive receptors prolongs the clinical benefit and survival since the metastatic diagnosis and the beginning of first line salvage antiestrogen therapy, compared with the results achieved with standard hormone therapy alone. If this immunotherapy prolongs survival of endocrine dependent metastatic breast cancer patients, IL-2 and IFNbeta can also be evaluated as adjuvant treatment of patients with positive estrogen receptors.
Collapse
Affiliation(s)
- A Carpi
- Department of Reproduction and Ageing, 56126 Pisa, Italy.
| | | | | | | | | |
Collapse
|
26
|
Leonardi S, Arena A, Bruno ME, Cannaò PM, D'Anneo RW, Falagiani P, Gammeri E, Mistrello G, Nicolini A, Ricciardi L, Valenti G, Longo R, La Rosa M. Olea sublingual allergoid immunotherapy administered with two different treatment regimens. Allergy Asthma Proc 2010; 31:e25-9. [PMID: 20406589 DOI: 10.2500/aap.2010.31.3316] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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]
Abstract
Sublingual immunotherapy (SLIT) with monomeric carbamylated allergoid administered in accordance with the standard regimen has proven to be effective and safe. Achieving clinical benefit, however, requires a lengthy period of time so it is not very suitable for short-lasting allergies. We thus performed this study to compare an administration protocol starting in the coseasonal period (with a 4-day build-up phase) with a precoseasonal scheme to verify if the former regimen provides the same benefit in a shorter period of time. The prospective, randomized, drug therapy-controlled study was conducted in 33 rhinitic patients monosensitized to Olea with or without asthma. Ten patients were assigned to the coseasonal therapy with 5000 allergic units (AU)/week for 6 weeks, 11 to the precoseasonal therapy with 3000 AU/week for 10 weeks, and 12 to drug therapy. They were treated from April or May to June 2008. A visual analog scale (VAS) was performed at baseline and after treatment to assess the well being of the patients. Drug consumption was evaluated by means of a monthly diary. There was greater VAS improvement in both the SLIT groups versus the controls, but it was statistically significant only in the coseasonal group (p < 0.01). Furthermore, there was a reduction in the rescue medication only in the coseasonal SLIT (p < 0.05 versus drug therapy). One mild adverse event was observed. The allergoid SLIT was shown to be effective and safe in Olea allergy in particular when a coseasonal regimen was used.
Collapse
|
27
|
Puccini M, Carpi A, Cupisti A, Caprioli R, Iacconi P, Barsotti M, Buccianti P, Mechanick J, Nicolini A, Miccoli P. Total parathyroidectomy without autotransplantation for the treatment of secondary hyperparathyroidism associated with chronic kidney disease: clinical and laboratory long-term follow-up. Biomed Pharmacother 2009; 64:359-62. [PMID: 20435429 DOI: 10.1016/j.biopha.2009.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 06/07/2009] [Indexed: 12/26/2022] Open
Abstract
Forty-six consecutive patients who underwent total parathyroidectomy (tPTX) for hyperparathyroidism associated with end-stage kidney disease (CKD5) in a University Hospital from 1990 to 1999 were included in a long-term observational study. Outcome parameters included symptoms (bone pain, pruritus and muscle weakness evaluated by visual analog scales [VAS]) and laboratory data (intact parathyroid hormone [iPTH], total calcium, and alkaline phosphatase) assessed before, shortly postoperatively and then at a later time point: 40 patients were on maintenance hemodialysis and six on conservative medical therapy. Forty-four patients had four glands removed, while only three glands were found in the remaining two. Perioperative complications consisted of acute symptomatic hypocalcemia in 10 (22%) patients and non-specific complaints in three (7%). No laryngeal nerve palsies occurred. After a median follow-up of eight years, 43 subjects were evaluated: 37 (86%) were cured, three (7%) had persistent and three (7%) recurrent disease. Eleven patients underwent successful renal transplantation and 23 died during the period of observation. iPTH decreased from a mean of 1084+/-505 pg/ml to 120+/-381 pg/ml (p < 0.0001). No subsequent bone fractures, persistent bone pain or disability were reported; this includes patients who later received a functioning renal graft. tPTX was able to correct hyperparathyroidism in most of the patients and was associated with a low long-term relapse rate. iPTH levels remained low in 17 cases without symptoms and no clinically significant side effects. The beneficial effects of tPTX occurred in the majority of patients while renal transplantation was performed in a minority of patients. tPTX should be considered a safe and successful procedure for the treatment of severe secondary hyperparathyroidism associated with chronic kidney disease.
Collapse
Affiliation(s)
- M Puccini
- Department of Surgery, AOUP, S. Chiara Hospital, Pisa, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Duffy MJ, Sturgeon C, Lamerz R, Haglund C, Holubec VL, Klapdor R, Nicolini A, Topolcan O, Heinemann V. Tumor markers in pancreatic cancer: a European Group on Tumor Markers (EGTM) status report. Ann Oncol 2009; 21:441-447. [PMID: 19690057 DOI: 10.1093/annonc/mdp332] [Citation(s) in RCA: 245] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Pancreatic ductal adenocarcinoma is one of the most difficult malignancies to diagnose and treat. The aim of this article is to review how tumor markers can aid the diagnosis and management of patients with this malignancy. The most widely used and best validated marker for pancreatic cancer is CA 19-9. Inadequate sensitivity and specificity limit the use of CA 19-9 in the early diagnosis of pancreatic cancer. In non-jaundiced patients, however, CA 19-9 may complement other diagnostic procedures. In patients with resectable pancreatic cancer, presurgical and postresection CA 19-9 levels correlate with overall survival. In advanced disease, elevated pretreatment levels of CA 19-9 are associated with adverse patient outcome and thus may be combined with other factors for risk stratification. Most, but not all, reports indicate that serial levels of CA 19-9 correlate with response to systemic therapy. Use of CA 19-9 kinetics in conjunction with imaging is therefore recommended in monitoring therapy. Although several potential serum and tissue markers for pancreatic cancer are currently undergoing evaluation, none are sufficiently validated for routine clinical use. CA 19-9 thus remains the serum pancreatic cancer marker against which new markers for this malignancy should be judged.
Collapse
Affiliation(s)
- M J Duffy
- Department of Pathology and Laboratory Medicine, St Vincent's University Hospital, Dublin; UCD School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
| | - C Sturgeon
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R Lamerz
- Medical Klinik II, Klinikum Grosshadern, Munich, Germany
| | - C Haglund
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - V L Holubec
- Second Department of Internal Medicine, University Hospital, Pilsen, Czech Republic
| | - R Klapdor
- Centre for Clinical and Experimental Tumour Diagnosis and Therapy, Hamburg, Germany
| | - A Nicolini
- Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - O Topolcan
- Second Department of Internal Medicine, University Hospital, Pilsen, Czech Republic
| | - V Heinemann
- Medical Clinic III, Klinikum Grosshadern, Munich, Germany
| |
Collapse
|
29
|
Carpi A, Mechanick J, Nicolini A, Bartolazzi A. Galectin-3 immunodetection on large needle aspiration biopsy of thyroid nodules. Pharmacotherapy 2008. [DOI: 10.1016/j.biopha.2008.07.075] [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: 10/21/2022]
|
30
|
Esposito AA, Nicolini A, Meregaglia D, Sangiovanni A, Biondetti P. Role of transjugular liver biopsy in the diagnostic and therapeutic management of patients with severe liver disease. Radiol Med 2008; 113:1008-17. [DOI: 10.1007/s11547-008-0311-4] [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] [Received: 10/05/2007] [Accepted: 11/30/2007] [Indexed: 10/21/2022]
|
31
|
Ghinoi A, Zuccoli G, Nicolini A, Pipitone N, Macchioni L, Bajocchi GL, Nicoli F, Silingardi M, Catanoso MG, Boiardi L, Salvarani C. 1T magnetic resonance imaging in the diagnosis of giant cell arteritis: comparison with ultrasonography and physical examination of temporal arteries. Clin Exp Rheumatol 2008; 26:S76-S80. [PMID: 18799059] [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: 05/26/2023]
Abstract
OBJECTIVE To assess the usefulness of 1T magnetic resonance imaging (MRI) of temporal arteries and to compare 1T MRI with duplex ultrasonography (US) and physical examination of temporal arteries for the diagnosis of giant cell arteritis (GCA) in patients with suspected GCA. METHOD The superficial temporal arteries of 20 consecutive patients with a suspected diagnosis of GCA were examined using a 1T MRI scanner. Fat-saturated multislice T1-weighted spin-echo images were acquired perpendicularly to the orientation of the vessel. In all cases, MRI results were compared to US and temporal artery examination findings. Temporal artery biopsies were performed in all patients. RESULTS Mural contrast enhancement of the temporal arteries on MRI had a sensitivity of only 33.3% and a specificity of 87.5% for the diagnosis of biopsy-proven GCA. Compared with the diagnosis of GCA by the American College of Rheumatology criteria, MRI had a sensitivity and specificity of 27.2% and 88.9%, respectively. Temporal artery abnormalities on physical examination and the presence of a hypoechoic halo on US had a higher sensitivity (66.7% and 77.7%, respectively) and a higher specificity (100% for both) compared to MRI findings. CONCLUSION 1T MRI is not useful for the diagnosis of GCA because of its low sensitivity. US and physical examination of temporal arteries had a better diagnostic accuracy. However, our data does not exclude a diagnostic role for higher-resolution MRI.
Collapse
Affiliation(s)
- A Ghinoi
- Division of Rheumatology, 31st Division of Internal Medicine, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Ghinoi A, Pipitone N, Nicolini A, Salvarani C. Cranial giant cell arteritis evolving into early large-vessel vasculitis. Clin Exp Rheumatol 2008; 26:S97-S100. [PMID: 18799063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- A Ghinoi
- Rheumatology Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | | |
Collapse
|
33
|
Carpi A, Di Coscio G, Iervasi G, Antonelli A, Mechanick J, Sciacchitano S, Nicolini A. Thyroid fine needle aspiration: how to improve clinicians' confidence and performance with the technique. Cancer Lett 2008; 264:163-71. [PMID: 18384937 DOI: 10.1016/j.canlet.2008.02.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 10/20/2007] [Accepted: 02/13/2008] [Indexed: 02/06/2023]
Abstract
Studies from single institutions report an acceptable accuracy rate for thyroid fine needle aspiration (FNA). However, FNA accuracy is much lower in many other centers in Europe and the USA and large multicenter studies indicate that the clinicians' confidence in the FNA technique remains low. One explanation for this is that there is an excess of inadequate and indeterminate findings for a follicular nodule at FNA cytology. In a University Hospital with large and qualified experience on thyroid nodule diagnosis, a review of 320 slides with an FNA diagnosis of indeterminate follicular nodule from different minor Italian Hospitals led to a different diagnosis in 61%. Since ancillary thyroid imaging may be overutilized and only a few authors report a proportion of excised nodules lower than 10%, we suspect that use of the FNA procedure is suboptimal. Several techniques are reported to improve the performance of thyroid FNA. Among these are tumor markers and large needle aspiration biopsy (LNAB). Immunodetection of the tumor marker galectin-3 has been evaluated by large multinational studies. Analysis of LNAB specimens reduces the number of inadequate FNA findings, improves the diagnostic determination of indeterminate follicular FNA findings and represents a better substrate for the determination of galectin-3. Therefore, we propose that clinical practice guidelines reflect these adjuvant techniques to thyroid FNA in order to improve selection criteria for thyroid nodule surgery.
Collapse
Affiliation(s)
- A Carpi
- Department of Reproduction and Ageing, University Hospital, Ospedale Santa Chiara, Via Roma, 67, 56126 Pisa, Italy.
| | | | | | | | | | | | | |
Collapse
|
34
|
Nicolini A, Carpi A, Ferrari P, Rossi G. Immunotherapy prolongs the serum CEA-TPA-CA15.3 lead time at the metastatic progression in endocrine-dependent breast cancer patients: a retrospective longitudinal study. Cancer Lett 2008; 263:122-9. [PMID: 18241981 DOI: 10.1016/j.canlet.2007.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 12/12/2007] [Accepted: 12/14/2007] [Indexed: 11/19/2022]
Abstract
In metastatic breast cancer tumour markers' increase predicts, by a few months (lead time) disease progression. In breast cancer patients with endocrine dependent metastatic disease, we reported a prolonged clinical benefit and overall survival when first line conventional antiestrogen hormone therapy was started at the lead time and also when an immunotherapy schedule was added to the same conventional hormone treatment. Thirty-two of these last patients were considered (group a). In 27 (group b) of these 32 patients who progressed during first line salvage hormone plus immunotherapy the lead time at the progression of metastatic disease during therapy was compared with that at the onset of metastases when the same patients were without treatment and with that of a control group (group c) who did not receive immunotherapy. At disease progression, CEA-TPA-CA15.3 sensitivity was 92.5% in the group b (studied patients) and 88.5% in the group c (controls). At the progression in the group b, CEA-TPA-CA15.3 lead time (m+/-sd, months) was significantly longer than in group c (12.1+/-12.9 vs 2.4+/-4.0) (P=0.000). Besides, in group b the lead time was significantly longer at the progression than at the metastatic onset (P=0.003) while in the group c the difference was near to significance (P=0.05). The CEA-TPA-CA15.3 tumour marker panel accurately predicted metastatic disease progression and immunotherapy significantly prolonged the CEA-TPA-CA15.3 lead time. This can be used for anticipating salvage treatment in these patients.
Collapse
Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
| | | | | | | |
Collapse
|
35
|
Carpi A, Nicolini A, Marchetti C, Iervasi G, Antonelli A, Carpi F. Percutaneous large-needle aspiration biopsy histology of palpable thyroid nodules: technical and diagnostic performance. Histopathology 2007; 51:249-57. [PMID: 17650219 DOI: 10.1111/j.1365-2559.2007.02764.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 01/31/2023]
Abstract
AIM To report original and review existing data on safety and performance of large-needle aspiration biopsy (LNAB) histology in the preoperative selection of palpable thyroid nodule. METHODS AND RESULTS The English literature and original data were reviewed or analysed. The literature on LNAB of thyroid nodules did not report any complications. A study on needle dimensions has explained why LNAB obtains more tissue than fine-needle aspiration (FNA) and is safe. LNAB histology has higher specificity than FNA cytology and markedly reduces the number of inadequate and indeterminate FNA findings. A comparison of 150 FNA-derived cell blocks with 200 LNAB-derived histological blocks after galectin-3 determination in a large nationwide (Italian) study has shown that one to two sections in 10% of the FNA cell blocks and at least five sections in 90% of the LNAB blocks were available for further determinations of thyroid tumour markers. CONCLUSION LNAB merits further consideration for the preoperative selection of thyroid nodules.
Collapse
Affiliation(s)
- A Carpi
- Department of Reproduction and Ageing, University Hospital, Pisa, Italy.
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
In recent decades many advances have occurred in the understanding of the role of cytokines in breast cancer. New signalling pathways of interleukin (IL)-1 family, IL-6, IL-11, IL-18, interferons (IFNs) and interferon regulatory factors 1 (IRF-1) and 2 (IRF-2) have been found within tumour microenvironments and in metastatic sites. Some cytokines (IL-1, IL-6, IL-11, TGFbeta) stimulate while others (IL-12, IL-18, IFNs) inhibit breast cancer proliferation and/or invasion. Similarly, high circulating levels of some cytokines seem to be favourable (soluble IL-2R) while others are unfavourable (IL-1beta, IL-6, IL-8, IL-10, IL-18, gp130) prognostic indicators. So far IL-2, IFNalpha, IFNbeta and occasionally IFNgamma, IL-6, IL-12 have been the cytokines used for anti tumour treatment of advanced breast cancer either to induce or increase hormone sensitivity and/or to stimulate cellular immunity. Disappointing results occurred in most trials; however, two long-term pilot studies suggest that IL-2 and IFNbeta, when used appropriately can have a positive effect on clinical benefit and overall survival of patients with minimal residual disease after chemotherapy or with disseminated disease controlled by conventional endocrine therapy.
Collapse
Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
| | | | | |
Collapse
|
37
|
Giardino R, Fini M, Bonazzi V, Cadossi R, Nicolini A, Carpi A. Electrochemotherapy a novel approach to the treatment of metastatic nodules on the skin and subcutaneous tissues. Biomed Pharmacother 2006; 60:458-62. [PMID: 16930935 DOI: 10.1016/j.biopha.2006.07.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Electrochemotherapy (ECT) is a new treatment for metastatic nodules of solid tumors on the skin or subcutaneous tissue. ECT is a combination of a physical effect, cell membrane poration, and cytotoxic drug administration. Cell membrane poration is achieved by applying short intense electric filed pulses. Pore formation on the cell membrane allows low permeant drugs like bleomycin or cisplatin to enter the cell and thus locally increase their toxicity: up to 10.000 times for bleomycin and 80 times for cisplatin. ECT has been investigated in a multicenter study European Standard Operating Procedures for Electrochemotherapy (ESOPE) that demonstrates how by ECT over 80% of the cutaneous or subcutaneous metastatic nodules can be healed, thus confirming the results of previous studies. ECT efficacy is independent of tumor histology. The experience gathered in the ESOPE study allowed to prepare standard operating procedures that are key to the dissemination of the technology. ECT is safe effective, the treatment is completed in one session usually on an out-patient basis with minimum side-effects. ECT is cost-effective and, although palliative, it ameliorates patients' quality of life. ECT is the treatment of choice for tumors refractory to conventional treatment, can be used in form of cytoreductive therapy before conventional treatment for organ sparing and functions saving, finally can be adopted to treat hemorrhagic or painful nodules, it can be applied in previously irradiated areas.
Collapse
Affiliation(s)
- R Giardino
- Department of Experimental Surgery, Codivilla-Putti Research Insitute, Rizzoli Institute of Orthopaedics Via di Barbiano, Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
38
|
Carpi A, Di Coscio G, Iervasi G, Nicolini A, Mantuano E, Bartolazzi A. Galectin-3 detection on large needle aspiration biopsy of thyroid nodules: retrospective and prospective studies. Pharmacotherapy 2006. [DOI: 10.1016/j.biopha.2006.07.067] [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: 12/01/2022]
|
39
|
Nicolini A, Giardino R, Carpi A, Ferrari P, Anselmi L, Colosimo S, Conte M, Fini M, Giavaresi G, Berti P, Miccoli P. Metastatic breast cancer: an updating. Biomed Pharmacother 2006; 60:548-56. [PMID: 16950593 DOI: 10.1016/j.biopha.2006.07.086] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 07/28/2006] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED This article reports on recent advances on metastatic breast cancer. Detection, prognostic factors, predictors of response to therapy and therapy, with particular regard to targeted therapies, were examined. DETECTION Unlike current guidelines that yet do not routinely recommend intensive clinical-instrumental post-operative follow-up of breast cancer patients, relatively large data collected in the last decades have shown that an intensive post-operative follow-up with 'dynamic evaluation' of a suitable tumour marker panel precedes a few months as average the clinical and/or instrumental sign of a pending relapse in most relapsed patients and largely limits the use of the common instrumental examinations. PROGNOSIS AND THERAPY PREDICTORS Disease-free interval (DFI)<or=24 months, adjuvant chemotherapy, liver and distant soft tissue involvement or DFI>24 months and disease confined to bony skeleton are prognostic factors more often correlated with relatively poor or prolonged survival, respectively. Estrogen receptor (ER) expression in primary tumour and at the relapse correlates strongly with response to salvage hormone therapy and data from large trials showed that 38-59% of ER and/or PR+ post-menopausal patients had clinical benefit from first line tamoxifen or aromatase inhibitors. An inverse correlation of ER with epidermal growth factor receptor (EGFR) has been found. The co-expression of HER-2/neu and/or elevated serum HER-2/neu protein level were associated with a low rate and shorter duration of response of ER+ patients to first line hormone therapy. Accordingly, ER-EGFR- compared with ER-EGFR+ tumours are usually more responsive to endocrine therapy. High class III beta-tubulin expression or fall in insulin-like growth factor binding protein-3 (IGFBP-3) from baseline levels have been found to significantly predict resistance to chemotherapeutic agents. THERAPY Liposomes as carrier of doxorubicin (Caelix, Evacet, Myocet) is one approach to decrease the anthracycline-related cardiac toxicity. Weekly paclitaxel or docetaxel and oral formulation of vinorelbine and 5-fluorouracil (5-FU) (capecitabine) provide new effective and well tolerated options that reach greater dose intensity and cumulative dose than with the conventional schedules. As to the so called 'tailored' or targeted therapies, the more potent and highly selective third generation of aromatase inhibitors (letrozole, anastrozole, exemestane) targeting ER+ tumours by estrogen deprivation, challenge tamoxifen as current standard first line therapy in postmenopausals. One pilot study showed that stimulation of cellular immunity by the addition of beta-interferon-interleukin-2 sequence in patients on clinical benefit on first line tamoxifen significantly prolonged median overall survival (OS) and duration of response compared to that observed in similar patients only treated with tamoxifen. Trastuzumab, a humanised monoclonal antibody to extracellular domain of HER-2, plus conventional chemotherapy has become a standard of care for women with overexpressing HER-2 tumours. Bevacizumab is a recombinant humanised monoclonal antibody to vascular endothelial growth factor (VEGF) that in refractory metastatic breast cancer doubled the response rate of capecitabine although it did not affect survival. Finally, the so called 'oligometastatic' and a few stage IV diseases are conditions amenable to be rendered with no evidence of disease (NED) after local surgery and/or radiation. In both, as well as in complete responders to chemotherapy, minimal residual disease (m.r.d.) likely continues to be present. Recent data suggest that 'biological' therapy (immunomodulators and/or retinoids with or without hormone therapy), might be suitable to be successfully tested in these patients as maintenance treatment given soon after local intervention or chemotherapy.
Collapse
Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
The effects of systemic administration of glucocorticoids (GC) on Achilles tendons of rats was studied. After the animal euthanasia, Achilles tendons were removed in sterile conditions from Sprague Dawley adult female rats to isolate tenocytes. Animals have been daily treated for 8 weeks with 4 mg/kg methylprednisolone or Sham-treated with saline solution. In vitro, cell proliferation (WST-1), extra-cellular matrix (ECM) synthesis (collagen type I, CICP; proteoglycans, PG; and fibronectin, FBN), and transforming growth factor (TGF-beta1) were evaluated at 3 and 7 days of culture. The effect of glucocorticoids (GC) on tenocytes was evident both at 3 and 7 days of culture, and caused a significant decreases in cell proliferation (P<0.01), CICP (P<0.01) and PG synthesis (P<0.01) as compared to NT tenocytes. In conclusion, GC systemic treatment seems to compromise the normal proliferation rate and synthetic activity of cultured tenocytes. This study was helpful in understanding the fundamental biological processes that occur during corticosteroid systemic administration and tenocyte cultures may be used to further study to improve knowledge of these cell behaviour also in the ambit of tendon tissue-engineered therapies.
Collapse
Affiliation(s)
- P Torricelli
- Laboratory of Experimental Surgery, Research Institute Codivilla-Putti, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
41
|
Giardino R, Nicoli Aldini N, Fini M, Tanzi MC, Faré S, Draghi L, Carpi A, Nicolini A, Giavaresi G. Bioabsorbable scaffold for in situ bone regeneration. Biomed Pharmacother 2006; 60:386-92. [PMID: 16930938 DOI: 10.1016/j.biopha.2006.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 11/30/2022] Open
Abstract
A non-porous poly-DL-lactide tubular chamber filled by demineralised bone matrix (DBM) and bone marrow stromal cells (BMSC) in combination, was evaluated as a scaffold for guided bone regeneration (GBR) in an experimental model using the rabbit radius. The tubular chamber had an internal diameter of 4.7 mm, a wall thickness of 0.4 mm and a length of 18 mm. Autologous BMSC were obtained, under general anaesthesia from rabbit iliac crest and isolated by centrifugation technique. Allogenic DBM was obtained from cortico-cancellous bone of rabbits. In general anaesthesia, a 10-mm defect was bilaterally created in the radii of 10 rabbits. On the right side (experimental side) the defect was bridged with the chamber filled with both BMSC and DBM. On the left side (control side) the defect was treated by positioning DBM and BMSC between the two stumps. At an experimental time of 4 months histology and histomorphometry demonstrated that the presence of a tubular chamber significantly improved bone regrowth in the defect The mean thickness of newly-formed bone inside the chamber was about 56.7+/-3.74% of the normal radial cortex, in comparison with 46.7+/-10.7% when DBM and BMSC without the chamber were placed in the defect, P<0.05). These results confirmed the effectiveness of the chamber as a container for factors promoting bone regeneration.
Collapse
Affiliation(s)
- R Giardino
- Experimental Surgery Department, Codivilla Putti Research Institute, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10 40136, Bologna, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Carpi A, Mechanick JI, Nicolini A, Rubello D, Iervasi G, Bonazzi V, Giardino R. Thyroid nodule evaluation: what have we really learned from recent clinical guidelines? Biomed Pharmacother 2006; 60:393-5. [PMID: 16905290 DOI: 10.1016/j.biopha.2006.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/18/2022] Open
Abstract
Recent guidelines for the evaluation of thyroid nodules clarify the diagnostic algorithm while also reporting important differences. The performance of fine needle aspiration (FNA) for cytological examination follows serum TSH determination and thyroid ultrasonography. Thyroid scintigraphy is recommended following a low TSH value and/or FNA yielding an indeterminate follicular cytology. The use of thyroid ultrasonography is the source of some controversy: though it is recommended as a principal first test, its real-time use to guide FNA ranges from routine to only following an FNA yielding an inadequate or nondiagnostic cytological result. In clinical practice, the proportion of physicians utilizing ultrasonography, scintigraphy and FNA varies and frequently deviates from recommended guidelines. The development of guidelines is necessary to bring about consistency and optimization to the diagnostic work-up of thyroid nodules. It is likely that novel diagnostic procedures, such as molecular markers, large needle aspiration biopsy and thyroid imaging with tracers beyond conventional radioactive iodine or (99m)Tc pertechnetate, will lead to improved performance and implementation of guidelines.
Collapse
Affiliation(s)
- A Carpi
- Department of Reproduction and Ageing, University of Pisa, Italy.
| | | | | | | | | | | | | |
Collapse
|
43
|
Carpi A, Naccarato AG, Iervasi G, Nicolini A, Bevilacqua G, Viacava P, Collecchi P, Lavra L, Marchetti C, Sciacchitano S, Bartolazzi A. Large needle aspiration biopsy and galectin-3 determination in selected thyroid nodules with indeterminate FNA-cytology. Br J Cancer 2006; 95:204-9. [PMID: 16804521 PMCID: PMC2360621 DOI: 10.1038/sj.bjc.6603232] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Thyroid fine-needle aspiration biopsy (FNA)-cytology is widely used for the preoperative characterisation of thyroid nodules but this task is difficult for follicular lesions, which often remain undefined. We propose a strategy for improving the preoperative characterisation of selected follicular thyroid proliferations, which is based on large needle aspiration biopsy (LNAB) and galectin-3 expression analysis. Eighty-five thyroid specimens were obtained by LNAB (20-gauge needles) from thyroid nodules with indeterminate follicular FNA-cytology. Aspirated material was processed as a tissue microbiopsy to obtain cell blocks for both cyto/histo-morphological evaluation and galectin-3 expression analysis, by using a purified monoclonal antibody to galectin-3 and a biotin-free immunoperoxidase staining method. Preoperative diagnosis was compared to the final histology. LNAB and cell-block technique allow a preliminary distinction between nodules with a homogeneous microfollicular/trabecular structure, as frequently observed in tumours, and lesions with mixed normo-micro-macrofollicular architecture, as observed in goitre. Furthermore, LNAB provides optimal substrates for galectin-3 expression analysis. Among 85 cases tested, 14 galectin-3-positive cases were discovered preoperatively (11 thyroid cancers and three adenomas confirmed at the final histology), whereas galectin-3-negative cases were 71 (one carcinoma and 70 benign proliferations at the final histology). Sensitivity, specificity and diagnostic accuracy of this integrated morphologic and phenotypic diagnostic approach were 91.6, 97.2 and 95.3%, respectively. In conclusion, LNAB plus galectin-3 expression analysis when applied preoperatively to selected thyroid nodules candidate to surgery can potentially reduce unnecessary thyroid resections.
Collapse
Affiliation(s)
- A Carpi
- Departments of Reproduction and Ageing, University of Pisa, Pisa 56024, Italy
| | - A G Naccarato
- Department of Oncology, Divisions of Surgical, Molecular and Ultrastructural Pathology, University of Pisa, Pisa 56024, Italy
| | - G Iervasi
- Institute of Clinical Physiology, CNR, Pisa Italy
| | - A Nicolini
- Department of Internal Medicine, University of Pisa, Pisa 56024, Italy
| | - G Bevilacqua
- Department of Oncology, Divisions of Surgical, Molecular and Ultrastructural Pathology, University of Pisa, Pisa 56024, Italy
| | - P Viacava
- Department of Oncology, Divisions of Surgical, Molecular and Ultrastructural Pathology, University of Pisa, Pisa 56024, Italy
| | - P Collecchi
- Department of Oncology, Divisions of Surgical, Molecular and Ultrastructural Pathology, University of Pisa, Pisa 56024, Italy
| | - L Lavra
- Department of Experimental Medicine and Endocrinology, University La Sapienza, and Ospedale San Pietro Fatebenefratelli, Associazione Fatebenefratelli per la Ricerca, Rome 00158 Italy
| | - C Marchetti
- Department of Pathology, St Andrea University Hospital, Via di Grottarossa 1035, Rome 00158, Italy
| | - S Sciacchitano
- Department of Experimental Medicine and Endocrinology, University La Sapienza, and Ospedale San Pietro Fatebenefratelli, Associazione Fatebenefratelli per la Ricerca, Rome 00158 Italy
| | - A Bartolazzi
- Department of Pathology, St Andrea University Hospital, Via di Grottarossa 1035, Rome 00158, Italy
- Cellular and Molecular Tumor Pathology Laboratory, Cancer Center Karolinska, CCK R8:04, Karolinska Hospital, Stockholm S-17176, Sweden
- Department of Pathology, St Andrea University Hospital, Via di Grottarossa 1035, Rome 00158, Italy. E-mail:
| |
Collapse
|
44
|
Pavone P, Nicolini A, Armenia R, D'Orazio A, Nunnari G, Nicolini E. Kawasaki's disease with paralytic ileus. A case report. Minerva Pediatr 2006; 58:193-7. [PMID: 16835578] [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: 05/10/2023]
Abstract
The authors report on an 18 month-old boy affected by Kawasaki's disease (KD). The diagnosis of KD was made after exclusion of conditions with similar presentation. Two days after admission the child presented vomiting, abdominal distension, meteorism and increase of scrotal swelling with edema. An abdominal X-ray showed the presence of multiple water and gas levels in the ileum and subsequent diagnosis of paralitic ileus was made. After several evacuative enema the intestinal symptomatology resolved. The patient was treated twice (2 g/kg day and after 3 days again 2 g/kg day) with intravenous immunoglobulin following which he made an uneventful recovery. The authors conclude that the presence of paralytic ileus in a febrile child may represent an unusual clinical sign of KD and justify a timely commencement of intravenous immuno-globulin therapy.
Collapse
Affiliation(s)
- P Pavone
- Pediatrics Unit, Civil Hospital OMPA, Ragusa, Italy.
| | | | | | | | | | | |
Collapse
|
45
|
Fini M, Giavaresi G, Carpi A, Nicolini A, Setti S, Giardino R. Effects of pulsed electromagnetic fields on articular hyaline cartilage: review of experimental and clinical studies. Biomed Pharmacother 2005; 59:388-94. [PMID: 16084055 DOI: 10.1016/j.biopha.2005.02.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 02/02/2005] [Indexed: 11/22/2022] Open
Abstract
Osteoarthritis (OA) is the most common disorder of the musculoskeletal system and is a consequence of mechanical and biological events that destabilize tissue homeostasis in articular joints. Controlling chondrocyte death and apoptosis, function, response to anabolic and catabolic stimuli, matrix synthesis or degradation and inflammation is the most important target of potential chondroprotective treatment, aimed to retard or stabilize the progression of OA. Although many drugs or substances have been recently introduced for the treatment of OA, the majority of them relieve pain and increase function, but do not modify the complex pathological processes that occur in these tissues. Pulsed electromagnetic fields (PEMFs) have a number of well-documented physiological effects on cells and tissues including the upregulation of gene expression of members of the transforming growth factor beta super family, the increase in glycosaminoglycan levels, and an anti-inflammatory action. Therefore, there is a strong rationale supporting the in vivo use of biophysical stimulation with PEMFs for the treatment of OA. In the present paper some recent experimental in vitro and in vivo data on the effect of PEMFs on articular cartilage were reviewed. These data strongly support the clinical use of PEMFs in OA patients.
Collapse
Affiliation(s)
- M Fini
- Experimental Surgery Department, Research Institute Codivilla-Putti-Rizzoli, Orthopedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
46
|
Carpi A, Nicolini A, Gross MD, Fig LM, Shapiro B, Fanti S, Rampin L, Polico C, Rubello D. Controversies in diagnostic approaches to the indeterminate follicular thyroid nodule. Biomed Pharmacother 2005; 59:517-20. [PMID: 16202555 DOI: 10.1016/j.biopha.2005.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 04/25/2005] [Indexed: 11/29/2022] Open
Abstract
In this paper we review the controversies in diagnostic approaches to follicular thyroid nodules with indeterminate cytology. The authors consider some of the controversies surrounding the indeterminate follicular thyroid nodule, including the definition and the postoperative outcome. Among the techniques that may improve preoperative diagnostic accuracy are large needle aspiration biopsy and immunohistochemistry for galectin-3.
Collapse
MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Biopsy, Fine-Needle
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/pathology
- Diagnosis, Differential
- Humans
- Immunohistochemistry
- Preoperative Care
- Thyroid Nodule/diagnosis
- Thyroid Nodule/metabolism
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
Collapse
Affiliation(s)
- A Carpi
- Internal Medicine Department, University of Pisa Medical School, Pisa, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Nicolini A, Ferrari P, Anselmi L, Metelli MR, Carpi A, Spisni R, Conte M, Berti P, Miccoli P. Recurrences of colorectal cancer: time distribution and diagnostic sensitivity of serum CEA, TPA, CA19.9, CA72.4 tumour markers. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
48
|
Brera S, Nicolini A. Respiratory manifestations due to nickel. Acta Otorhinolaryngol Ital 2005; 25:113-5. [PMID: 16116834 PMCID: PMC2639879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Nickel sulphate more frequently determines allergic dermatitis due to contact (contact eczema); less known are nasal inflammation (rhinitis) and bronchial asthma caused by nickel sulphate. Sporadic cases, often related to patients' work have been reported in the literature. The research described herein refers to 20 patients presenting clear nickel allergy with rhinitis (associated in 11 cases with asthma). The patients, all females, revealed positivity to this kind of allergy: patch test, prick tests with nickel sulphate, nasal provocation test by nickel sulphate, computed tomography of paranasal sinuses, spirometry and bronchial provocation test with metacholine, oral provocation test with nickel sulphate were employed. A strict long-term diet with food with low nickel content (2-4 months at least) led to a progressive reduction of nasal symptoms (rhinorrea, sneezing, nasal obstruction) and an improvement in bronchial symptoms and functional parameters.
Collapse
Affiliation(s)
- S Brera
- Department of Otolaryngology, ASL 4 Chiavarese, Chiavari, Genova, Italy
| | | |
Collapse
|
49
|
Fini M, Giavaresi G, Torricelli P, Borsari V, Giardino R, Nicolini A, Carpi A. Osteoporosis and biomaterial osteointegration. Biomed Pharmacother 2005; 58:487-93. [PMID: 15511604 DOI: 10.1016/j.biopha.2004.08.016] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2004] [Indexed: 01/02/2023] Open
Abstract
Biomaterial osteointegration depends not only on the properties of the implanted material but also on the characteristics and regenerative capability of the host bone. For this reason, researchers involved in biomaterial evaluation now place great importance on the various pathologies often present in orthopaedic patients which can negatively affect the success of surgical implants. Osteoporosis is undoubtedly one of the most frequently encountered of such diseases. Models reproducing the osteoporotic condition can be useful to understand the influence of the pathology on cell behaviour, bone regeneration and osteointegration processes, thus increasing our basic knowledge and allowing the development of surgical techniques and implant biomaterials more suitable for use in the surgical treatment of fractures in osteoporotic patients. The present paper is a literature review and, after a short description of how the presence of osteoporosis could influence bone regenerative processes, the results of the main studies on biomaterial biocompatibility and osteointegration both in vitro and in vivo in the presence of osteoporotic condition are reported. Both cell cultures and animal models are able to demonstrate the different response of bone to biomaterials by comparing healthy and pathological conditions. The use of pathological bone-derived cells and pathological animals is therefore recommended to test candidate orthopaedic materials.
Collapse
Affiliation(s)
- M Fini
- Experimental Surgery Department, Research Institute Codivilla Putti, Rizzoli Orthopaedic Institute, Via di Barbiano, 1/10, 40136 Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
50
|
Giavaresi G, Borsari V, Fini M, Martini L, Tschon M, De Terlizzi F, Nicolini A, Carpi A, Giardino R. Different diagnostic techniques for the assessment of cortical bone on osteoporotic animals. Biomed Pharmacother 2004; 58:494-9. [PMID: 15511605 DOI: 10.1016/j.biopha.2004.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Indexed: 10/26/2022] Open
Abstract
The aim of this study was to assess the capability of ultrasonography and densitometry to predict the mechanical competence of cortical bone in healthy and osteopenic rats, respectively. Thirty 10-month-old Sprague-Dawley retired breeder female rats were used and randomized into three groups of 10 animals each. A group underwent bilateral ovariectomy by dorsal approach (Ovx), another group underwent a simulated ovariectomy (Sham-Ovx), and the last group served as a sham-aged control group (Control). Sixteen weeks after surgery, the animals were euthanized and the femurs of each rat excised for ultrasonographic and densitometric measurements, and mechanical analyses. The Ovx Group had a significantly decreased amplitude dependent speed of sound (AD-SoS-about 7-8%) when compared to the other groups (p<0.0005). For Ovx animals compared with Sham-Ovx and Control rats, significant decreases in densitometric data were observed (6-13%), as well as significant decreases in femoral Max. Load (about 18%) and flexural rigidity (about 30%). The best correlation (R2=0.55, p<0.0005) found was between SoS and femoral shaft bone mineral density (SBMD). The regression coefficient R2 increased when power-law fits were used, particularly from 0.34 (p<0.001) to 0.36 (p<0.0005) in the correlation between SoS and Max. Load and from 0.21 (p<0.05) to 0.25 (p<0.01) in the correlation between SBMD and Max. Load. The ability of QUS or DXA to accurately predict the actual mechanical characteristics of bone, and in particular bone elasticity, remained relatively poor and the improvement of the power-law model did not describe exhaustively the relationships between the variables tested. The DXA and QUS capability to discriminate between ovariectomized and non-ovariectomized rats did not improve when tested together.
Collapse
Affiliation(s)
- G Giavaresi
- Department of Experimental Surgery, Istituti Ortopedici Rizzoli, Istituto di Ricerca Codivilla-Putti, Via di Barbiano, 1/10, 40136 Bologna, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|