1
|
Kerestes R, Perry A, Vivash L, O'Brien TJ, Alvim MKM, Arienzo D, Aventurato ÍK, Ballerini A, Baltazar GF, Bargalló N, Bender B, Brioschi R, Bürkle E, Caligiuri ME, Cendes F, de Tisi J, Duncan JS, Engel JP, Foley S, Fortunato F, Gambardella A, Giacomini T, Guerrini R, Hall G, Hamandi K, Ives-Deliperi V, João RB, Keller SS, Kleiser B, Labate A, Lenge M, Marotta C, Martin P, Mascalchi M, Meletti S, Owens-Walton C, Parodi CB, Pascual-Diaz S, Powell D, Rao J, Rebsamen M, Reiter J, Riva A, Rüber T, Rummel C, Scheffler F, Severino M, Silva LS, Staba RJ, Stein DJ, Striano P, Taylor PN, Thomopoulos SI, Thompson PM, Tortora D, Vaudano AE, Weber B, Wiest R, Winston GP, Yasuda CL, Zheng H, McDonald CR, Sisodiya SM, Harding IH. Patterns of subregional cerebellar atrophy across epilepsy syndromes: An ENIGMA-Epilepsy study. Epilepsia 2024; 65:1072-1091. [PMID: 38411286 DOI: 10.1111/epi.17881] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE The intricate neuroanatomical structure of the cerebellum is of longstanding interest in epilepsy, but has been poorly characterized within the current corticocentric models of this disease. We quantified cross-sectional regional cerebellar lobule volumes using structural magnetic resonance imaging in 1602 adults with epilepsy and 1022 healthy controls across 22 sites from the global ENIGMA-Epilepsy working group. METHODS A state-of-the-art deep learning-based approach was employed that parcellates the cerebellum into 28 neuroanatomical subregions. Linear mixed models compared total and regional cerebellar volume in (1) all epilepsies, (2) temporal lobe epilepsy with hippocampal sclerosis (TLE-HS), (3) nonlesional temporal lobe epilepsy, (4) genetic generalized epilepsy, and (5) extratemporal focal epilepsy (ETLE). Relationships were examined for cerebellar volume versus age at seizure onset, duration of epilepsy, phenytoin treatment, and cerebral cortical thickness. RESULTS Across all epilepsies, reduced total cerebellar volume was observed (d = .42). Maximum volume loss was observed in the corpus medullare (dmax = .49) and posterior lobe gray matter regions, including bilateral lobules VIIB (dmax = .47), crus I/II (dmax = .39), VIIIA (dmax = .45), and VIIIB (dmax = .40). Earlier age at seizure onset (η ρ max 2 = .05) and longer epilepsy duration (η ρ max 2 = .06) correlated with reduced volume in these regions. Findings were most pronounced in TLE-HS and ETLE, with distinct neuroanatomical profiles observed in the posterior lobe. Phenytoin treatment was associated with reduced posterior lobe volume. Cerebellum volume correlated with cerebral cortical thinning more strongly in the epilepsy cohort than in controls. SIGNIFICANCE We provide robust evidence of deep cerebellar and posterior lobe subregional gray matter volume loss in patients with chronic epilepsy. Volume loss was maximal for posterior subregions implicated in nonmotor functions, relative to motor regions of both the anterior and posterior lobe. Associations between cerebral and cerebellar changes, and variability of neuroanatomical profiles across epilepsy syndromes argue for more precise incorporation of cerebellar subregional damage into neurobiological models of epilepsy.
Collapse
Affiliation(s)
- Rebecca Kerestes
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew Perry
- Monash Bioinformatics Platform, Monash University, Melbourne, Victoria, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Marina K M Alvim
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Donatello Arienzo
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, USA
| | - Ítalo K Aventurato
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Alice Ballerini
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriel F Baltazar
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Núria Bargalló
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
- Department of Radiology of Center of Image Diagnosis, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Benjamin Bender
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Ricardo Brioschi
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Eva Bürkle
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Jerome P Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sonya Foley
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK
| | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Antonio Gambardella
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Thea Giacomini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Renzo Guerrini
- Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
| | - Gerard Hall
- School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK
- Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | | | - Rafael B João
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Simon S Keller
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Benedict Kleiser
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, University of Messina, Messina, Italy
- Regional Epilepsy Center, University of Messina, Messina, Italy
| | - Matteo Lenge
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - Cassandra Marotta
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Mario Mascalchi
- "Mario Serio" Department of Clinical and Experimental Medical Sciences, University of Florence, Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and Network in Oncology of the Tuscany Region, Florence, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria Modena, Modena, Italy
| | - Conor Owens-Walton
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California, USA
| | | | - Saül Pascual-Diaz
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - David Powell
- Monash Bioinformatics Platform, Monash University, Melbourne, Victoria, Australia
| | - Jun Rao
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, USA
| | - Michael Rebsamen
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Reiter
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Freda Scheffler
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Lucas S Silva
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Richard J Staba
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Dan J Stein
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Istituto "Giannina Gaslini", Genoa, Italy
| | - Peter N Taylor
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California, USA
| | | | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria Modena, Modena, Italy
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St. Peter, UK
- Department of Medicine (Division of Neurology), Queen's University Kingston, Kingston, Ontario, Canada
| | - Clarissa L Yasuda
- Department of Neurology, University of Campinas, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Hong Zheng
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California, USA
| | - Carrie R McDonald
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, California, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Chen J, Ngo A, Rodríguez-Cruces R, Royer J, Caligiuri ME, Gambardella A, Concha L, Keller SS, Cendes F, Yasuda CL, Alvim MKM, Bonilha L, Gleichgerrcht E, Focke NK, Kreilkamp B, Domin M, von Podewils F, Langner S, Rummel C, Wiest R, Martin P, Kotikalapudi R, Bender B, O’Brien TJ, Sinclair B, Vivash L, Kwan P, Desmond PM, Lui E, Duma GM, Bonanni P, Ballerini A, Vaudano AE, Meletti S, Tondelli M, Alhusaini S, Doherty CP, Cavalleri GL, Delanty N, Kälviäinen R, Jackson GD, Kowalczyk M, Mascalchi M, Semmelroch M, Thomas RH, Soltanian-Zadeh H, Davoodi-Bojd E, Zhang J, Lenge M, Guerrini R, Bartolini E, Hamandi K, Foley S, Rüber T, Bauer T, Weber B, Caldairou B, Depondt C, Absil J, Carr SJA, Abela E, Richardson MP, Devinsky O, Pardoe H, Severino M, Striano P, Tortora D, Kaestner E, Hatton SN, Arienzo D, Vos SB, Ryten M, Taylor PN, Duncan JS, Whelan CD, Galovic M, Winston GP, Thomopoulos SI, Thompson PM, Sisodiya SM, Labate A, McDonald CR, Caciagli L, Bernasconi N, Bernasconi A, Larivière S, Schrader D, Bernhardt BC. A WORLDWIDE ENIGMA STUDY ON EPILEPSY-RELATED GRAY AND WHITE MATTER COMPROMISE ACROSS THE ADULT LIFESPAN. bioRxiv 2024:2024.03.02.583073. [PMID: 38496668 PMCID: PMC10942350 DOI: 10.1101/2024.03.02.583073] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Objectives Temporal lobe epilepsy (TLE) is commonly associated with mesiotemporal pathology and widespread alterations of grey and white matter structures. Evidence supports a progressive condition although the temporal evolution of TLE is poorly defined. This ENIGMA-Epilepsy study utilized multimodal magnetic resonance imaging (MRI) data to investigate structural alterations in TLE patients across the adult lifespan. We charted both grey and white matter changes and explored the covariance of age-related alterations in both compartments. Methods We studied 769 TLE patients and 885 healthy controls across an age range of 17-73 years, from multiple international sites. To assess potentially non-linear lifespan changes in TLE, we harmonized data and combined median split assessments with cross-sectional sliding window analyses of grey and white matter age-related changes. Covariance analyses examined the coupling of grey and white matter lifespan curves. Results In TLE, age was associated with a robust grey matter thickness/volume decline across a broad cortico-subcortical territory, extending beyond the mesiotemporal disease epicentre. White matter changes were also widespread across multiple tracts with peak effects in temporo-limbic fibers. While changes spanned the adult time window, changes accelerated in cortical thickness, subcortical volume, and fractional anisotropy (all decreased), and mean diffusivity (increased) after age 55 years. Covariance analyses revealed strong limbic associations between white matter tracts and subcortical structures with cortical regions. Conclusions This study highlights the profound impact of TLE on lifespan changes in grey and white matter structures, with an acceleration of aging-related processes in later decades of life. Our findings motivate future longitudinal studies across the lifespan and emphasize the importance of prompt diagnosis as well as intervention in patients.
Collapse
Affiliation(s)
- Judy Chen
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Alexander Ngo
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Raúl Rodríguez-Cruces
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Jessica Royer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | | | - Antonio Gambardella
- Neuroscience Research Center, University Magna Græcia, Catanzaro, CZ, Italy
- Institute of Neurology, University Magna Græcia, Catanzaro, CZ, Italy
| | - Luis Concha
- Institute of Neurobiology, Universidad Nacional Autónoma de México, Querétaro, México
| | - Simon S. Keller
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Fernando Cendes
- Department of Neurology, University of Campinas-–UNICAMP, Campinas, São Paulo, Brazil
| | - Clarissa L. Yasuda
- Department of Neurology, University of Campinas-–UNICAMP, Campinas, São Paulo, Brazil
| | - Marina K. M. Alvim
- Department of Neurology, University of Campinas-–UNICAMP, Campinas, São Paulo, Brazil
| | | | | | - Niels K. Focke
- Department of Neurology, University of Medicine Göttingen, Göttingen, Germany
| | - Barbara Kreilkamp
- Department of Neurology, University of Medicine Göttingen, Göttingen, Germany
| | - Martin Domin
- Institute of Diagnostic Radiology and Neuroradiology, Functional Imaging Unit, University Medicine Greifswald, Greifswald, Germany
| | - Felix von Podewils
- Department of Neurology, University Medicine Greifswald, Epilepsy Center, Greifswald, Germany
| | - Soenke Langner
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Raviteja Kotikalapudi
- Department of Neurology, University of Medicine Göttingen, Göttingen, Germany
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Germany
| | - Terence J. O’Brien
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Sinclair
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Patricia M. Desmond
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Elaine Lui
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Gian Marco Duma
- Scientific Institute IRCCS E.Medea, Epilepsy Unit, Conegliano (TV), Italy
| | - Paolo Bonanni
- Scientific Institute IRCCS E.Medea, Epilepsy Unit, Conegliano (TV), Italy
| | - Alice Ballerini
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Elisabetta Vaudano
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria, Modena, Italy
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Meletti
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria, Modena, Italy
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Manuela Tondelli
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
- Primary Care Department, Azienda Sanitaria Locale di Modena, Modena, Italy
| | - Saud Alhusaini
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Colin P. Doherty
- Department of Neurology, St James’ Hospital, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Gianpiero L. Cavalleri
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Norman Delanty
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Reetta Kälviäinen
- Epilepsy Center, Neuro Center, Kuopio University Hospital, Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Graeme D. Jackson
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010, Australia
| | - Magdalena Kowalczyk
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010, Australia
| | - Mario Mascalchi
- Neuroradiology Research Program, Meyer Children Hospital of Florence, University of Florence, Florence, Italy
| | - Mira Semmelroch
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne VIC 3010, Australia
| | - Rhys H. Thomas
- Transitional and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hamid Soltanian-Zadeh
- Contol and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
- Departments of Research Administration and Radiology, Henry Ford Health System, Detroit, MI, USA
| | | | - Junsong Zhang
- Cognitive Science Department, Xiamen University, Xiamen, China
| | - Matteo Lenge
- Child Neurology Unit and Laboratories, Neuroscience Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Renzo Guerrini
- Child Neurology Unit and Laboratories, Neuroscience Department, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | | | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre (CUBRIC), College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- The Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Sonya Foley
- Cardiff University Brain Research Imaging Centre (CUBRIC), College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Theodor Rüber
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Tobias Bauer
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Benoit Caldairou
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Chantal Depondt
- Department of Neurology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Absil
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah J. A. Carr
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Eugenio Abela
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Mark P. Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Orrin Devinsky
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Heath Pardoe
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Domenico Tortora
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Erik Kaestner
- Department of Radiation Medicine and Applied Sciences; Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, United States
| | - Sean N. Hatton
- Department of Neurosciences, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, United States
| | - Donatello Arienzo
- Department of Radiation Medicine and Applied Sciences; Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, United States
| | - Sjoerd B. Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Mina Ryten
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Bucks, UK
| | - Peter N. Taylor
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- CNNP Lab, ICOS group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John S. Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Christopher D. Whelan
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zürich, Zürich, Switzerland
| | - Gavin P. Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, ON, Canada
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Paul M. Thompson
- Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, Regional Epilepsy Center, University of Messina, Italy
| | - Carrie R. McDonald
- Department of Radiation Medicine and Applied Sciences; Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, United States
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Bucks, UK
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
| | - Dewi Schrader
- BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Boris C. Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| |
Collapse
|
3
|
Micalizzi E, Ballerini A, Giovannini G, Cioclu MC, Scolastico S, Pugnaghi M, Orlandi N, Malagoli M, Genovese M, Todeschini A, Giunta L, Villani F, Meletti S, Vaudano AE. The role of the amygdala in ictal central apnea: insights from brain MRI morphometry. Ann Clin Transl Neurol 2024; 11:121-132. [PMID: 37936526 PMCID: PMC10791031 DOI: 10.1002/acn3.51938] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE Ictal central apnea (ICA) is a frequent correlate of focal seizures, particularly in temporal lobe epilepsy (TLE), and regarded as a potential electroclinical biomarker of sudden unexpected death in epilepsy (SUDEP). Aims of this study are to investigate morphometric changes of subcortical structures in ICA patients and to find neuroimaging biomarkers of ICA in patients with focal epilepsy. METHODS We prospectively recruited focal epilepsy patients with recorded seizures during a video-EEG long-term monitoring with cardiorespiratory polygraphic recordings from April 2020 to September 2022. Participants were accordingly subdivided into two groups: patients with focal seizures with ICA (ICA) and without (noICA). A pool of 30 controls matched by age and sex was collected. All the participants underwent MRI scans with volumetric high-resolution T1-weighted images. Post-processing analyses included a whole-brain VBM analysis and segmentation algorithms performed with FreeSurfer. RESULTS Forty-six patients were recruited (aged 15-60 years): 16 ICA and 30 noICA. The whole-brain VBM analysis showed an increased gray matter volume of the amygdala ipsilateral to the epileptogenic zone (EZ) in the ICA group compared to the noICA patients. Amygdala sub-segmentation analysis revealed an increased volume of the whole amygdala, ipsilateral to the EZ compared to controls [F(1, 76) = 5.383, pFDR = 0.042] and to noICA patients ([F(1, 76) = 5.383, pFDR = 0.038], specifically of the basolateral complex (respectively F(1, 76) = 6.160, pFDR = 0.037; F(1, 76) = 5.121, pFDR = 0.034). INTERPRETATION Our findings, while confirming the key role of the amygdala in participating in ictal respiratory modifications, suggest that structural modifications of the amygdala and its subnuclei may be valuable morphological biomarkers of ICA.
Collapse
Affiliation(s)
- Elisa Micalizzi
- Department of NeuroscienceIRCCS San Martino HospitalGenoaItaly
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Alice Ballerini
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Giada Giovannini
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Maria Cristina Cioclu
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Simona Scolastico
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Matteo Pugnaghi
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Niccolò Orlandi
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | | | | | | | - Leandra Giunta
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Flavio Villani
- Department of NeuroscienceIRCCS San Martino HospitalGenoaItaly
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| |
Collapse
|
4
|
Kerestes R, Perry A, Vivash L, O'Brien TJ, Alvim MKM, Arienzo D, Aventurato ÍK, Ballerini A, Baltazar GF, Bargalló N, Bender B, Brioschi R, Bürkle E, Caligiuri ME, Cendes F, de Tisi J, Duncan JS, Engel JP, Foley S, Fortunato F, Gambardella A, Giacomini T, Guerrini R, Hall G, Hamandi K, Ives-Deliperi V, João RB, Keller SS, Kleiser B, Labate A, Lenge M, Marotta C, Martin P, Mascalchi M, Meletti S, Owens-Walton C, Parodi CB, Pascual-Diaz S, Powell D, Rao J, Rebsamen M, Reiter J, Riva A, Rüber T, Rummel C, Scheffler F, Severino M, Silva LS, Staba RJ, Stein DJ, Striano P, Taylor PN, Thomopoulos SI, Thompson PM, Tortora D, Vaudano AE, Weber B, Wiest R, Winston GP, Yasuda CL, Zheng H, McDonald CR, Sisodiya SM, Harding IH. Patterns of subregional cerebellar atrophy across epilepsy syndromes: An ENIGMA-Epilepsy study. bioRxiv 2023:2023.10.21.562994. [PMID: 37961570 PMCID: PMC10634708 DOI: 10.1101/2023.10.21.562994] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Objective The intricate neuroanatomical structure of the cerebellum is of longstanding interest in epilepsy, but has been poorly characterized within the current cortico-centric models of this disease. We quantified cross-sectional regional cerebellar lobule volumes using structural MRI in 1,602 adults with epilepsy and 1,022 healthy controls across twenty-two sites from the global ENIGMA-Epilepsy working group. Methods A state-of-the-art deep learning-based approach was employed that parcellates the cerebellum into 28 neuroanatomical subregions. Linear mixed models compared total and regional cerebellar volume in i) all epilepsies; ii) temporal lobe epilepsy with hippocampal sclerosis (TLE-HS); iii) non-lesional temporal lobe epilepsy (TLE-NL); iv) genetic generalised epilepsy; and (v) extra-temporal focal epilepsy (ETLE). Relationships were examined for cerebellar volume versus age at seizure onset, duration of epilepsy, phenytoin treatment, and cerebral cortical thickness. Results Across all epilepsies, reduced total cerebellar volume was observed (d=0.42). Maximum volume loss was observed in the corpus medullare (dmax=0.49) and posterior lobe grey matter regions, including bilateral lobules VIIB (dmax= 0.47), Crus I/II (dmax= 0.39), VIIIA (dmax=0.45) and VIIIB (dmax=0.40). Earlier age at seizure onset (ηρ2max=0.05) and longer epilepsy duration (ηρ2max=0.06) correlated with reduced volume in these regions. Findings were most pronounced in TLE-HS and ETLE with distinct neuroanatomical profiles observed in the posterior lobe. Phenytoin treatment was associated with reduced posterior lobe volume. Cerebellum volume correlated with cerebral cortical thinning more strongly in the epilepsy cohort than in controls. Significance We provide robust evidence of deep cerebellar and posterior lobe subregional grey matter volume loss in patients with chronic epilepsy. Volume loss was maximal for posterior subregions implicated in non-motor functions, relative to motor regions of both the anterior and posterior lobe. Associations between cerebral and cerebellar changes, and variability of neuroanatomical profiles across epilepsy syndromes argue for more precise incorporation of cerebellum subregions into neurobiological models of epilepsy.
Collapse
Affiliation(s)
- Rebecca Kerestes
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Andrew Perry
- Monash Bioinformatics Platform, Monash University, Melbourne, VIC, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Marina K M Alvim
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Donatello Arienzo
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Ítalo K Aventurato
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Alice Ballerini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriel F Baltazar
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Núria Bargalló
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Department of Radiology of Center of Image Diagnosis (CDIC), Hospital Clinic de Barcelona, Barcelona, Spain
- CIBERSAM, Madrid, Spain
| | - Benjamin Bender
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Ricardo Brioschi
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Eva Bürkle
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Fernando Cendes
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Jerome P Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sonya Foley
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Antonio Gambardella
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
- Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Thea Giacomini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Renzo Guerrini
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Gerard Hall
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
- The Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | | | - Rafael B João
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Simon S Keller
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Benedict Kleiser
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
- Regional Epilepsy Center, University of Messina, Messina, Italy
| | - Matteo Lenge
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | | | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Mario Mascalchi
- 'Mario Serio' Department of Clinical and Experimental Medical Sciences, University of Florence, Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and network in Oncology of the Tuscany Region, Florence, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria Modena, Modena, Italy
| | - Conor Owens-Walton
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | | | - Saül Pascual-Diaz
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - David Powell
- Monash Bioinformatics Platform, Monash University, Melbourne, VIC, Australia
| | - Jun Rao
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Michael Rebsamen
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Reiter
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Freda Scheffler
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | | | - Lucas S Silva
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Richard J Staba
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dan J Stein
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Monash Bioinformatics Platform, Monash University, Melbourne, VIC, Australia
- Department of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Department of Radiology of Center of Image Diagnosis (CDIC), Hospital Clinic de Barcelona, Barcelona, Spain
- CIBERSAM, Madrid, Spain
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
- Institute of Neurology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
- The Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
- Regional Epilepsy Center, University of Messina, Messina, Italy
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- 'Mario Serio' Department of Clinical and Experimental Medical Sciences, University of Florence, Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and network in Oncology of the Tuscany Region, Florence, Italy
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria Modena, Modena, Italy
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
- IRCCS Istituto 'Giannina Gaslini', Genova, Italy
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany
- Epilepsy Society MRI Unit, Chalfont St Peter, UK
- Department of Medicine (Division of Neurology), Queen's University Kingston, ON, Canada
- Chalfont Centre for Epilepsy, Bucks, UK
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Istituto 'Giannina Gaslini', Genova, Italy
| | - Peter N Taylor
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | | | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria Modena, Modena, Italy
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Epilepsy Society MRI Unit, Chalfont St Peter, UK
- Department of Medicine (Division of Neurology), Queen's University Kingston, ON, Canada
| | - Clarissa L Yasuda
- Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Hong Zheng
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Carrie R McDonald
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Ballerini A, Arienzo D, Stasenko A, Schadler A, Vaudano AE, Meletti S, Kaestner E, McDonald CR. Spatial patterns of gray and white matter compromise relate to age of seizure onset in temporal lobe epilepsy. Neuroimage Clin 2023; 39:103473. [PMID: 37531834 PMCID: PMC10415805 DOI: 10.1016/j.nicl.2023.103473] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Temporal Lobe Epilepsy (TLE) is frequently a neurodevelopmental disorder, involving subcortical volume loss, cortical atrophy, and white matter (WM) disruption. However, few studies have addressed how these pathological changes in TLE relate to one another. In this study, we investigate spatial patterns of gray and white matter degeneration in TLE and evaluate the hypothesis that the relationship among these patterns varies as a function of the age at which seizures begin. METHODS Eighty-two patients with TLE and 59 healthy controls were enrolled. T1-weighted images were used to obtain hippocampal volumes and cortical thickness estimates. Diffusion-weighted imaging was used to obtain fractional anisotropy (FA) and mean diffusivity (MD) of the superficial WM (SWM) and deep WM tracts. Analysis of covariance was used to examine patterns of WM and gray matter alterations in TLE relative to controls, controlling for age and sex. Sliding window correlations were then performed to examine the relationships between SWM degeneration, cortical thinning, and hippocampal atrophy across ages of seizure onset. RESULTS Cortical thinning in TLE followed a widespread, bilateral pattern that was pronounced in posterior centroparietal regions, whereas SWM and deep WM loss occurred mostly in ipsilateral, temporolimbic regions compared to controls. Window correlations revealed a relationship between hippocampal volume loss and whole brain SWM disruption in patients who developed epilepsy during childhood. On the other hand, in patients with adult-onset TLE, co-occurring cortical and SWM alterations were observed in the medial temporal lobe ipsilateral to the seizure focus. SIGNIFICANCE Our results suggest that although cortical, hippocampal and WM alterations appear spatially discordant at the group level, the relationship among these features depends on the age at which seizures begin. Whereas neurodevelopmental aspects of TLE may result in co-occurring WM and hippocampal degeneration near the epileptogenic zone, the onset of seizures in adulthood may set off a cascade of SWM microstructural loss and cortical atrophy of a neurodegenerative nature.
Collapse
Affiliation(s)
- Alice Ballerini
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Department of Psychiatry, University of California, San Diego, USA
| | - Donatello Arienzo
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Alena Stasenko
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Adam Schadler
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Italy
| | - Erik Kaestner
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Carrie R McDonald
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA; Department of Radiation Medicine & Applied Sciences, University of California, San Diego, USA.
| |
Collapse
|
6
|
Ballerini A, Talami F, Molinari MA, Micalizzi E, Scolastico S, Biagioli N, Orlandi N, Pugnaghi M, Giovannini G, Meletti S, Vaudano AE. Exploring the relationship between amygdala subnuclei volumes and cognitive performance in left-lateralized temporal lobe epilepsy with and without hippocampal sclerosis. Epilepsy Behav 2023; 145:109342. [PMID: 37422935 DOI: 10.1016/j.yebeh.2023.109342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Cognitive disruption is a debilitating comorbidity in Temporal Lobe Epilepsy (TLE). Despite recent advances, the amygdala is often neglected in studies that explore cognition in TLE. Amygdala subnuclei are differently engaged in TLE with hippocampal sclerosis (TLE-HS) compared to non-lesional TLE (TLE-MRIneg), with predominant atrophy in the first and increased volume in the latter. Herein, we aim to explore the relationship between the volumes of the amygdala and its substructures with respect to cognitive performances in a population of left-lateralized TLE with and without HS. Twenty-nine TLEs were recruited (14 TLE-HS; 15 TLE-MRIneg). After investigating the differences in the subcortical amygdalae and hippocampal volumes compared to a matched healthy control population, we explored the associations between the subnuclei of the amygdala and the hippocampal subfields with the cognitive scores in TLE patients, according to their etiology. In TLE-HS, a reduced volume of the basolateral and cortical amygdala complexes joined with whole hippocampal atrophy, was related to poorer scores in verbal memory tasks, while in TLE-MRIneg, poorer performances in attention and processing speed tasks were associated with a generalized amygdala enlargement, particularly of the basolateral and central complexes. The present findings extend our knowledge of amygdala involvement in cognition and suggest structural amygdala abnormalities as useful disease biomarkers in TLE.
Collapse
Affiliation(s)
- Alice Ballerini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Talami
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Italian National Research Council (CNR), Institute of Neuroscience, Parma, Italy
| | | | - Elisa Micalizzi
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy; Neurophysiology Unit, Epilepsy Center, IRCCS San Martino Hospital, Genoa, Italy
| | - Simona Scolastico
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
| | - Niccolò Biagioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
| | - Niccolò Orlandi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
| | | | | | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.
| |
Collapse
|
7
|
Vaudano AE, Ballerini A, Zucchini F, Micalizzi E, Scolastico S, Talami F, Giovannini G, Pugnaghi M, Orlandi N, Biagioli N, Cioclu MC, Vallone S, Genovese M, Todeschini A, Cavalleri F, Malagoli M, Meletti S. Impact of an optimized epilepsy surgery imaging protocol for focal epilepsy: a monocentric prospective study. Epileptic Disord 2023; 25:45-56. [PMID: 36946331 DOI: 10.1002/epd2.20050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/12/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To evaluate in a real clinical scenario the impact of the ILAE-recommended "Harmonized neuroimaging of epilepsy structural sequences"- HARNESS protocol in patients affected by focal epilepsy. METHODS We prospectively enrolled focal epilepsy patients who underwent a structural brain MRI between 2020-2021 at Modena University Hospital. For all patients, MRIs were: a) acquired according to the HARNESS-MRI protocol (H-MRI); b) reviewed by the same neuroradiology team. MRI outcomes measures were: the number of positive (diagnostic) and negative MRI; the type of radiological diagnosis classified in: 1. Hippocampal Sclerosis; 2. Malformations of cortical development (MCD); 3. Vascular malformations; 4. Glial scars; 5. Low-grade epilepsy-associated tumours; 6. Dual pathology. For each patient we verified for previous MRI (without HARNESS protocol, noH-MRI) and the presence of clinical information in the MRI request form. Then the measured outcomes were reviewed and compared as appropriate. RESULTS A total of 131 patients with H-MRI were included in the study. 100 patients out from this cohort had at least one previous noH-MRI scan. Of those, 92/100 were acquired at the same Hospital than H-MRI and 71/92 on a 3T scanner. The HARNESS protocol revealed 81 (62%) positive and 50 (38%) negative MRI, and MCD was the most common diagnosis (60%). Among the entire pool of 100 noH-MRI, 36 resulted positive with a significant difference (p<.001) compared to H-MRI. Similar findings were observed when accounting for the expert radiologists (H-MRI= 57 positive; noH-MRI=33, p<.001) and the scanner field strength (H-MRI 43=positive, noH-MRI=23, p<.001), while clinical information were more present in H-MRI (p<.002). SIGNIFICANCE The adoption of a standardized and optimized MRI acquisition protocol together with adequate clinical information contribute to identify a higher number of potentially epileptogenic lesions (especially FCD) thus impacting concretely on the clinical management of patients with focal epilepsy.
Collapse
Affiliation(s)
- Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, AOU, Modena, Modena, Italy
| | - Alice Ballerini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Elisa Micalizzi
- Neurophysiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Scolastico
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Talami
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giada Giovannini
- Neurology Unit, OCB Hospital, AOU, Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Niccolò Orlandi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Biagioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Cristina Cioclu
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, AOU, Modena, Modena, Italy
| | - Stefano Vallone
- Neuroradiology Unit, OCB Hospital, AOU, Modena, Modena, Italy
| | | | | | | | | | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, OCB Hospital, AOU, Modena, Modena, Italy
| |
Collapse
|
8
|
Micalizzi E, Vaudano AE, Ballerini A, Talami F, Giovannini G, Turchi G, Cioclu MC, Giunta L, Meletti S. Ictal apnea: A prospective monocentric study in patients with epilepsy. Eur J Neurol 2022; 29:3701-3710. [PMID: 36057450 PMCID: PMC9826458 DOI: 10.1111/ene.15547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/28/2022] [Accepted: 08/24/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Ictal respiratory disturbances have increasingly been reported, in both generalized and focal seizures, especially involving the temporal lobe. Recognition of ictal breathing impairment has gained importance for the risk of sudden unexpected death in epilepsy (SUDEP). The aim of this study was to evaluate the incidence of ictal apnea (IA) and related hypoxemia during seizures. METHODS We collected and analyzed electroclinical data from consecutive patients undergoing long-term video-electroencephalographic (video-EEG) monitoring with cardiorespiratory polygraphy. Patients were recruited at the epilepsy monitoring unit of the Civil Hospital of Baggiovara, Modena Academic Hospital, from April 2020 to February 2022. RESULTS A total of 552 seizures were recorded in 63 patients. IA was observed in 57 of 552 (10.3%) seizures in 16 of 63 (25.4%) patients. Thirteen (81.2%) patients had focal seizures, and 11 of 16 patients showing IA had a diagnosis of temporal lobe epilepsy; two had a diagnosis of frontal lobe epilepsy and three of epileptic encephalopathy. Apnea agnosia was reported in all seizure types. Hypoxemia was observed in 25 of 57 (43.9%) seizures with IA, and the severity of hypoxemia was related to apnea duration. Apnea duration was significantly associated with epilepsy of unknown etiology (magnetic resonance imaging negative) and with older age at epilepsy onset (p < 0.001). CONCLUSIONS Ictal respiratory changes are a frequent clinical phenomenon, more likely to occur in focal epilepsies, although detected even in patients with epileptic encephalopathy. Our findings emphasize the need for respiratory polygraphy during long-term video-EEG monitoring for diagnostic and prognostic purposes, as well as in relation to the potential link of ictal apnea with the SUDEP risk.
Collapse
Affiliation(s)
- Elisa Micalizzi
- Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaModenaItaly,Neurology Unit, Civil Hospital of BaggiovaraModena Academic HospitalModenaItaly
| | - Anna Elisabetta Vaudano
- Neurology Unit, Civil Hospital of BaggiovaraModena Academic HospitalModenaItaly,Department of Biomedical, Metabolic, and Neural ScienceUniversity of Modena and Reggio EmiliaModenaItaly
| | - Alice Ballerini
- Department of Biomedical, Metabolic, and Neural ScienceUniversity of Modena and Reggio EmiliaModenaItaly
| | - Francesca Talami
- Department of Biomedical, Metabolic, and Neural ScienceUniversity of Modena and Reggio EmiliaModenaItaly
| | - Giada Giovannini
- Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaModenaItaly,Neurology Unit, Civil Hospital of BaggiovaraModena Academic HospitalModenaItaly
| | - Giulia Turchi
- Neurology Unit, Civil Hospital of BaggiovaraModena Academic HospitalModenaItaly
| | - Maria Cristina Cioclu
- Neurology Unit, Civil Hospital of BaggiovaraModena Academic HospitalModenaItaly,Department of Biomedical, Metabolic, and Neural ScienceUniversity of Modena and Reggio EmiliaModenaItaly
| | - Leandra Giunta
- Neurology Unit, Civil Hospital of BaggiovaraModena Academic HospitalModenaItaly
| | - Stefano Meletti
- Neurology Unit, Civil Hospital of BaggiovaraModena Academic HospitalModenaItaly,Department of Biomedical, Metabolic, and Neural ScienceUniversity of Modena and Reggio EmiliaModenaItaly
| |
Collapse
|
9
|
Dardi F, Ballerini A, Guarino D, Donato F, Bertozzi R, Martini G, Magnani I, Manes A, Palazzini M, Galie' N. A clinical and echocardiographic score to differentiate pulmonary hypertension due to heart failure with preserved ejection fraction from idiopathic pulmonary hypertension: the PH-HFPEF score. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.768] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
One of the most challenging differential diagnoses in pulmonary hypertension clinical practice, is the discrimination between idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF).
Aim
We elaborate a score (considering patient clinical history, demographics, and echocardiographic characteristics) that can predict, noninvasively, PH-HFpEF vs IPAH diagnosis.
Methods
Data were prospectively collected on 466 consecutive patients with a final diagnosis of IPAH or PH-HFpEF referred to a single tertiary pulmonary vascular disease centre. Data included clinical history, demographics, and parameters of an electrocardiogram and a transthoracic echocardiogram. A multivariate regression model was developed to predict a PH-HFpEF diagnosis, and an integer risk score was generated using adjusted regression coefficients of the multivariate logistic regression analysis.
Results
At the multivariate logistic regression a high ratio between left and right ventricular dimensions, a history of atrial fibrillation (AF), a high body mass index (BMI), a reduced mitral deceleration time and a high E-wave at trans-mitral doppler, an advanced age and a high right ventricular fractional area change (FAC) were predictors of PH-HFpEF. The derived PH-HFPEF score is shown in Table 1 and, with a cut-point ≥11, it yielded a specificity/sensitivity, respectively, for the diagnosis of PH-HFpEF, of 100%/49% with an AUC of 0.987.
Conclusions
The PH-HFPEF score can predict PH-HFpEF vs IPAH. The PH-HFPEF score may be used to potentially avoid an invasive diagnostic testing in almost half of PH-HFpEF patients.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- F Dardi
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - A Ballerini
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - D Guarino
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - F Donato
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - R Bertozzi
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - G Martini
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - I Magnani
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - A Manes
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - M Palazzini
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - N Galie'
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| |
Collapse
|
10
|
Ballerini A, Tondelli M, Talami F, Molinari MA, Micalizzi E, Giovannini G, Turchi G, Malagoli M, Genovese M, Meletti S, Vaudano AE. Amygdala subnuclear volumes in temporal lobe epilepsy with hippocampal sclerosis and in non-lesional patients. Brain Commun 2022; 4:fcac225. [PMID: 36213310 PMCID: PMC9536297 DOI: 10.1093/braincomms/fcac225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/12/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022] Open
Abstract
Together with hippocampus, the amygdala is important in the epileptogenic network of patients with temporal lobe epilepsy. Recently, an increase in amygdala volumes (i.e. amygdala enlargement) has been proposed as morphological biomarker of a subtype of temporal lobe epilepsy patients without MRI abnormalities, although other data suggest that this finding might be unspecific and not exclusive to temporal lobe epilepsy. In these studies, the amygdala is treated as a single entity, while instead it is composed of different nuclei, each with peculiar function and connection. By adopting a recently developed methodology of amygdala’s subnuclei parcellation based of high-resolution T1-weighted image, this study aims to map specific amygdalar subnuclei participation in temporal lobe epilepsy due to hippocampal sclerosis (n = 24) and non-lesional temporal lobe epilepsy (n = 24) with respect to patients with focal extratemporal lobe epilepsies (n = 20) and healthy controls (n = 30). The volumes of amygdala subnuclei were compared between groups adopting multivariate analyses of covariance and correlated with clinical variables. Additionally, a logistic regression analysis on the nuclei resulting statistically different across groups was performed. Compared with other populations, temporal lobe epilepsy with hippocampal sclerosis showed a significant atrophy of the whole amygdala (pBonferroni = 0.040), particularly the basolateral complex (pBonferroni = 0.033), while the non-lesional temporal lobe epilepsy group demonstrated an isolated hypertrophy of the medial nucleus (pBonferroni = 0.012). In both scenarios, the involved amygdala was ipsilateral to the epileptic focus. The medial nucleus demonstrated a volume increase even in extratemporal lobe epilepsies although contralateral to the seizure onset hemisphere (pBonferroni = 0.037). Non-lesional patients with psychiatric comorbidities showed a larger ipsilateral lateral nucleus compared with those without psychiatric disorders. This exploratory study corroborates the involvement of the amygdala in temporal lobe epilepsy, particularly in mesial temporal lobe epilepsy and suggests a different amygdala subnuclei engagement depending on the aetiology and lateralization of epilepsy. Furthermore, the logistic regression analysis indicated that the basolateral complex and the medial nucleus of amygdala can be helpful to differentiate temporal lobe epilepsy with hippocampal sclerosis and with MRI negative, respectively, versus controls with a consequent potential clinical yield. Finally, the present results contribute to the literature about the amygdala enlargement in temporal lobe epilepsy, suggesting that the increased volume of amygdala can be regarded as epilepsy-related structural changes common across different syndromes whose meaning should be clarified.
Collapse
Affiliation(s)
- Alice Ballerini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
| | | | - Francesca Talami
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
| | | | - Elisa Micalizzi
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia , Modena 41121 , Italy
| | - Giada Giovannini
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia , Modena 41121 , Italy
| | - Giulia Turchi
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Marcella Malagoli
- Neuroradiology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Maurilio Genovese
- Neuroradiology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| |
Collapse
|
11
|
Santarelli G, Sanfilippo G, Benvenuti F, Santoro L, Nistri A, Innocenti M, Ballerini A, Ricca V. The effect of Working Alliance on drug attitude in patients with Major Depressive Disorder. Eur Psychiatry 2022. [PMCID: PMC9565615 DOI: 10.1192/j.eurpsy.2022.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Working Alliance is defined as the emotional bond and the agreement on therapeutic goals and tasks between patients and therapists. Despite the wide use of the construct of working alliance in research on psychotherapy, few studies have investigated the role of working alliance in influencing adherence to pharmacotherapy, and drug attitude. A deeper knowledge of the interplay between working alliance and drug attitude could help to challenge low adherence to psychopharmacological treatments in Major Depressive Disorder.
Objectives
This study aimed to investigate the relationship between working alliance and drug attitude in patients with Major Depressive Disorder.
Methods
27 patients admitted in the Psychiatric Unit of Careggi with diagnosis of Major Depressive Disorders were enrolled. Working Alliance Inventory - patient version (WAI-P), Drug Attitude Inventory (DAI) and Beliefs about Medicines (BMQ) were administered. Pearson’s correlation was used to assess relationships between variables.
Results
A significant positive correlation was detected between BMQ total scores, DAI total scores and WAI-P task, bond, and goal subscales.
Correlations between WAI-P subscales and BMQ and DAI total scores
DAI total scores
BMQ total scores
r
p
r
p
WAI-P task
0.551
0.003
0.613
0.001
WAI-P bond
0.430
0.001
0.560
0.004
WAI-P goal
0.621
0.001
0.603
0.002
Conclusions
Such preliminary data suggest a relationship between Working Alliance and drug attitude. This could contribute to provide tools to challenge low adherence to psychopharmacological treatments in patients with Major Depressive Disorder.
Disclosure
No significant relationships.
Collapse
|
12
|
D’Anna G, Rotella F, Ballerini A, Ricca V. Therapeutic drug monitoring of LAI antipsychotics as a predictor of clinical relapse: a one-year follow-up. Eur Psychiatry 2022. [PMCID: PMC9563214 DOI: 10.1192/j.eurpsy.2022.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Clinical relapses in schizophrenia remain a frequent event. Long-acting injectable (LAI) antipsychotics enhance adherence, but low blood levels can sometimes be observed despite an adequate posology. Nonetheless, the evaluation of this parameter is uncommon in clinical practice.
Objectives
To explore the potential advantages of therapeutic drug monitoring (TDM) of LAIs as a predictor of relapse in clinically stable outpatients with schizophrenia.
Methods
44 individuals who had reached the pharmacokinetic steady state of LAI treatment (paliperidone, olanzapine, aripiprazole) underwent an anamnestic and psychopathological assessment. LAI blood levels were measured using liquid chromatography-mass spectrometry and classified as “in range” or “under range” according to the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) guideline values. Individuals who relapsed during the one-year follow-up were compared to non-relapsers (Fisher’s exact test, χ2 or Mann-Whitney U). An exploratory binary logistic regression tested the role of other possible relevant predictors of relapse.
Results
No differences were observed in baseline use of mood stabilisers (p=0.211), antidepressants (p=0.530), or prescribed LAI (p=0.563). Other comparisons are presented in the table: among these variables, in-range LAI levels were the only significant predictor of relapse (F=5.95, p=0.015; OR 0.04, 95%CI 0.02-0.56).
Relapse (n=6)
No relapse (n=38)
p
Age (years)
41.33±10.78
43.95±12.98
0.667
Male
4 (66.7%)
21 (55.3%)
0.600
Illness duration (years)
21.83±2.64
19.13±11.82
0.289
Previous acute episodes
3.50±1.05
3.29±1.47
0.652
PANSS-total
49.33±14.83
42.74±14.14
0.231
In-range LAI
2 (33.3%)
32 (84.2%)
0.006
Conclusions
TDM of LAIs may optimise the clinical management of schizophrenia by highlighting a suboptimal dosage and a consequent higher relapse risk. Large-scale, drug-specific assessments are needed to confirm these findings.
Disclosure
No significant relationships.
Collapse
|
13
|
Santarelli G, Sanfilippo G, Benvenuti F, Santoro L, Nistri A, Ballerini A, Ricca V. Preoccupied attachment style and beliefs about medicines in patients with Major Depressive Disorder. Eur Psychiatry 2022. [PMCID: PMC9566580 DOI: 10.1192/j.eurpsy.2022.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Attachment style is defined by the American Psychological Association as “the characteristic way people relate to others in the context of intimate relationships”. Four attachment styles have been described: secure, fearful, preoccupied, and dismissing. While the effect of attachment style on psychotherapy was widely investigated, few studies have investigated its role in determining beliefs about medicines in patients with Major Depressive Disorder (MDD). Objectives This study aimed to investigate the relationship between preoccupied attachment style and beliefs about medicines in patients with MDD. Methods 27 patients admitted in the Psychiatric Unit of Careggi with diagnosis of MDD were enrolled. Working Alliance Inventory - patient version (WAI-P), Relationship Style Questionnaire (RSQ) and Beliefs about Medicines Questionnaire (BMQ) were administered. An ANCOVA model having BMQ total score as dependent variable and age, sex, RSQ preoccupied attachment subscale and WAI-P task subscale as predictors was considered. WAI-P task was intended to assess the role of agreement on therapeutic choices. Results The overall model was significant (F(4,22)=9,571, P<0.001) and explained 66.8% of BMQ total score variance (R2=0.668). Both RSQ preoccupied attachment subscale (B=3.331, t(22)=3.907, p=0.001) and WAI-P task subscale (B=0.238, t(22)=4.565, p<0.001) showed a positive correlation with BMQ total scores. RSQ preoccupied attachment subscale explained 44.6% of variance of BMQ total scores (partial η2=0.446), WAI-P task explained 52.3% of variance of BMQ total scores (partial η2= 0.523). Age (B=0.059, t(22)=1.588, p=0.129) and sex (F(1,22)=0.035, p=0.854) had no significant effect. ![]()
Conclusions These preliminary data suggest a possible influence of preoccupied attachment style on beliefs about medicines in patients with MDD. Disclosure No significant relationships.
Collapse
|
14
|
Rotunno M, Dardi F, Palazzini M, Guarino D, Zuffa E, Magnani I, De Lorenzis A, Ballerini A, Manes A, Galie N. Echocardiographic predictors of low risk haemodynamic parameters in patients with pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1948] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A periodic and multiparametric assessment of the risk profile of patients with pulmonary arterial hypertension (PAH) is essential for a low-risk oriented treatment strategy. Haemodynamic parameters anyway cannot be collected at each scheduled outpatients clinic follow-up visit.
Purpose
To evaluate echocardiographic predictors of haemodynamic low-risk parameters in patients with PAH.
Methods
Patients with PAH referred to our centre were included up to 31 December 2019. All patients underwent baseline demographic, clinical, WHO functional class, 6-minute walk test, brain natriuretic peptide (BNP), right cardiac catheterization and echocardiographic evaluation. Through a multivariate logistic regression analysis we evaluate the echocardiographic predictors of low risk for: 1) BNP/right atrial pressure (RAP): NT-proBNP <300 ng/l/BNP <50 ng/l AND RAP <8 mmHg; 2) cardiac index (CI)/mixed venous oxygen saturation (SvO2): CI ≥2.5 l/min/m2 AND SvO2 >65%. Echocardiographic parameters cut-offs were chosen on the basis of the ROC curves or Literature data.
Results
1020 patients were included. The two analysis were performed independently.
1. Independent echocardiographic predictors of low-risk BNP/RAP were: indexed right atrial area, mitral E/A ratio, dimension and inspiratory collapse of inferior vena cava and indexed left ventricular diastolic volume. We elaborated a score utilizing these parameter cut-offs: an indexed right atrial area of 10.4–15 cm2/m2, a mitral E/A ratio of 0.8, dimension and inspiratory collapse of inferior vena cava indicative of 0–5 vs 5–10 vs 10–20 mmHg and an indexed left ventricular diastolic volume of 32 ml/m2. The score has AUC: 0.62, specificity: 92%, sensitivity: 33%, negative predictive value: 70%, positive predictive value: 69%.
2. Independent echocardiographic predictors of low-risk CI/SvO2 were: S wave at TDI, Tei index, tricuspid annular plane systolic excursion (TAPSE), indexed left ventricular diastolic volume and the severity of the tricuspid regurgitation. We elaborated a score utilizing these parameter cut-offs: an S wave at TDI of 9.5 cm/s, a Tei index of 0.4, a TAPSE of 1.7 cm, an indexed left ventricular diastolic volume of 32 ml/m2 and a mild vs more than mild tricuspid regurgitation. The score has AUC: 0.70, specificity: 89%, sensitivity: 50%, negative predictive value: 71%, positive predictive value: 77%.
Conclusion
Echocardiographic parameters can be used to rule out the presence of low-risk BNP/RAP values (indexed right atrial area, mitral E/A ratio, dimension and inspiratory collapse of inferior vena cava and indexed left ventricular diastolic volume) and low-risk CI/SvO2 (S wave at TDI, Tei index, TAPSE, indexed left ventricular diastolic volume and severity of tricuspid regurgitation).
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| |
Collapse
|
15
|
Magnani I, Dardi F, Palazzini M, Zuffa E, Guarino D, Daddi N, Dolci G, Antonacci F, Solli P, Paganelli GM, De Lorenzis A, Rotunno M, Ballerini A, Manes A, Galie N. Survival of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension listed for lung transplantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1946] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Lung transplantation (LT) still remains a treatment option for patients with pulmonary arterial hypertension (PAH) and not operable chronic thromboembolic pulmonary hypertension patients (CTEPH).
Purpose
The study is intended to compare the survival of transplant recipients (TR) and the survival of not-transplanted (NT) patients since listing.
Methods
We included all patients with PAH and not-operable CTEPH listed for LT. The survival of NT, TR and of all listed patients was evaluated starting from the date of listing (patients were censored as alive at the time of LT). The survival of TR was also evaluated starting from the date of the LT.
Results
125 patients were included (112, 90% had PAH). Fifty-eight (46%) patients were transplanted, after a mean waiting time of 1.5±1.3 years. Forty-one patients (33%) died while on the list and 25 (20%) patients were alive on the list on December 2019. The survival of NT patients at 1, 3 and 5 years after listing was 74%, 42%, 33%, respectively. The survival of TR patients at 1, 3 and 5 years after listing was 90%, 70%, 63%, respectively. The survival of all patients since listing (intention to treat analysis) at 1, 3 and 5 years was 85%, 59%, 48% respectively. The survival of TR at 1, 3 and 5 years since transplantation was 63%, 61%, 59%, respectively.
Conclusions
Despite biases in the comparison of non-randomized groups, the data confirm a better long-term survival since listing of TR as compared with NT PAH or not-operable CTEPH patients.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Daddi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - G Dolci
- Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Thoracic surgery, Bologna, Italy
| | - F Antonacci
- Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Thoracic surgery, Bologna, Italy
| | - P Solli
- Maggiore Hospital, Bellaria Hospital, Presidio Ospedaliero Bellaria-Maggiore, Thoracic Surgery, Bologna, Italy, Bologna, Italy
| | - G M Paganelli
- Policlinico S. Orsola-Malpighi, Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Pulmonology, Bologna, Italy
| | - A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| |
Collapse
|
16
|
De Lorenzis A, Dardi F, Guarino D, Palazzini M, Magnani I, Zuffa E, Ballerini A, Rotunno M, Manes A, Galie N. Role of cardiac magnetic resonance in stratifying the prognosis of patients with pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1947] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary arterial hypertension (PAH) is a rare disease characterized by a complex remodeling of heart structures. Cardiac magnetic resonance (CMR) is the gold standard for a non-invasive evaluation of right ventricle (RV) volumes and mass.
Purpose
To define the relationship between clinical, functional, biochemical, haemodynamic and CMR parameters and survival in patients with PAH.
Methods
Consecutive patients with PAH referred to our centre underwent clinical, functional, brain natriuretic peptide (BNP) plasma levels, haemodynamic and CMR evaluation. All patients were treated according to current guidelines. Univariate Cox analysis for survival was performed. Parameters with a p-value <0.1 at the univariate analysis were included in the multivariate analysis.
Results
One hundred forty-seven patients with PAH (mean age 49±17 years, 69% female) were included in the study. Etiology of PAH was: idiopathic/heritable (49%), associated with connective tissue disease (19%), congenital heart disease (12%), portal hypertension/HIV infection (12%) and pulmonary veno-occlusive disease (8%). Thirty-six patients died during follow-up. Parameters significantly associated with mortality at the univariate analysis were age [Hazard Ratio (95% Confidence Interval): 1.043 (1.020–1.067); p<0.001], six-minute walk test (6MWT) [HR: 0.995 (0.993–0.998); p<0.001], WHO-functional class [HR: 2.489 (1.025–6.041); p=0.044], idiopathic-heritable-congenital heart disease aetiology [HR: 0.182 (0.085–0.389); p<0.001], connective tissue disease aetiology [HR: 2.274 (1.099–4.704); p=0.027], pulmonary veno-occlusive disease aetiology [HR: 5.864 (2.328–14.773); p<0.001], right atrial pressure [HR: 1.098 (1.032–1.169); p=0.003], pulmonary artery oxygen saturation [HR: 0.947 (0.921–0.975); p<0.001], BNP levels [HR: 2.214 (1.213–4.039); p=0.010], RV wall thickness [HR: 0.633 (0.399–1.006); p=0.053], RV end diastolic volume [HR: 1.012 (1.003–1.021); p=0.007], RV end systolic volume [HR: 1.014 (1.003–1.024); p=0.011]. Parameters independently associated with mortality at the multivariate analysis were age [HR: 1.035 (1.006–1.064); p=0.018], idiopathic-heritable-congenital heart disease aetiology [HR: 0.355 (0.146–0.860); p=0.022], pulmonary veno-occlusive disease aetiology [HR: 3.129 (1.071–9.143); p=0.037], pulmonary artery oxygen saturation [HR: 0.953 (0.919–0.989); p=0.011], RV wall thickness [HR: 0.527 (0.300–0.927); p=0.026], RV end systolic volume [HR: 1.016 (1.003–1.029); p=0.014].
Conclusion
RV wall thickness and RV end-systolic volume are associated with prognosis in patients with PAH independently from clinical and haemodynamic characteristics. These parameters may be used in the overall risk stratification of PAH patients.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| |
Collapse
|
17
|
D’Anna G, Tatini L, Pietrini F, Ballerini A, Ricca V. Drug attitude inventory is relevant to LAI treatment persistence in schizophrenia: Preliminary results. Eur Psychiatry 2021. [PMCID: PMC9471612 DOI: 10.1192/j.eurpsy.2021.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionPatients’ attitudes and subjective experience are crucial in the management of severe mental illness, but their practical value is overlooked.ObjectivesTo identify predictors of future adherence to LAI antipsychotic maintenance treatment of schizophrenia among socio-demographic, clinical, and psychometric characteristics – including Drug Attitude Inventory-10 (DAI-10) and Subjective Well-being under Neuroleptics short form (SWN-K) scores.MethodsRetrospective baseline data from 53 clinically stable outpatients with schizophrenia switched from oral to LAI therapy were collected. Patients continuing treatment at the time of analysis (n=29) were compared to those who had discontinued it (n=24). Selected variables were further evaluated in survival analyses.ResultsBetween-group differences are presented in Table 1 (**: p<0.01; *: p<0.05).Continued treatmentDiscontinued treatmentχ2 or tTreatment persistence (months)63.79±21.0123.88±25.806.21**Age (years)39.17±10.1135.58±13.391.11Male15 (51.7%)13 (54.1%)0.03Single20 (69.0%)15 (62.5%)0.25Instruction (years)13.28±3.3111.83±3.561.53Employed20 (69.0%)7 (29.2%)8.32**Illness duration (years)17.69±10.5313.42±11.361.42Previous hospitalisations2.10±1.322.67±1.86-1.29MADRS13.59±9.0614.67±8.99-0.43YMRS5.52±5.576.00±9.94-0.22p-PANSS12.17±5.2014.38±6.13-1.41n-PANSS10.90±5.3915.63±7.93-2.48*g-PANSS29.38±10.3333.63±10.26-1.49PANSS52.66±17.5763.96±20.61-2.15*DAI-103.86±4.96-1.13±5.803.38**SWN-K74.93±23.0781.00±15.60-1.09Cox regression analysis included instruction, employment, hospitalisations, PANSS subscales and DAI-10 scores: a protective role against treatment discontinuation was outlined only for employment (HR 0.16; 95%CI 0.05-0.50) and higher DAI-10 scores (HR 0.85; 95%CI 0.78-0.94). DAI-10 scores delineated distinct adherence trajectories (Figure 1).ConclusionsBaseline DAI-10 scores may identify patients at risk of dropout after switching to LAI.DisclosureNo significant relationships.
Collapse
|
18
|
De Lorenzis A, Dardi F, Palazzini M, Zuffa E, Pasca F, Guarino D, Magnani I, Rotunno M, Ballerini A, Manes A, Galie N. Prognostic role of comorbidities in patients with pulmonary arterial hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2236] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Epidemiology of pulmonary arterial hypertension (PAH) is changing and the age at diagnosis and the prevalence of comorbidities are increasing but their prognostic relevance is substantially undefined.
Purpose
To evaluate the prognostic value of comorbidities in patients with PAH and in the different clinical subgroups.
Methods
All patients with PAH referred to a single centre underwent baseline right heart catheterization, brain natriuretic peptide (BNP) plasma levels, 6-min walking distance (6MWD), WHO functional class and anamnestic comorbidities evaluation. Cox regression model was used for analysis (p-value <0.1 was considered for inclusion in multivariate analysis).
Results
1311 patients were included [age 51 years; aetiology: 522 idiopathic/heritable/drug-induced (I/H/D)-PAH, 258 connective tissue disease (CTD)-associated PAH, 242 congenital heart disease (CHD)-associated PAH, 196 portal hypertension/HIV (PoHIV)-associated PAH and 93 pulmonary veno-occlusive disease (PVOD)]. 5% of patients have no comorbidities. At multivariate analysis comorbidities independently associated with prognosis are: systemic hypertension in I/H/D [HR 0.616, p=0.030], mean systemic blood pressure in CTD [HR 0.980, p=0.002] and PVOD [HR 0.962, p=0.006], dyslipidemia in CTD [HR 0.447, p=0.001] and PoHIV [HR 0.201, p=0.026], estimated glomerular filtration rate in PoHIV [HR 1.000, p<0.001] and body mass index (BMI) [HR 0.966, p=0.069] in CTD. In CHD comorbidities are not independent determinants of prognosis. Other variables independently predictive of a worse prognosis are: advanced age in all PAH subgroups except PVOD; male gender in I/H/D; reduced 6MWD in I/H/D, CTD and PVOD; high BNP in I/H/D, CHD and PVOD; low cardiac index in CTD, high right atrial pressure in I/H/D and low mixed venous oxygen saturation in CHD.
Conclusion
The age at PAH diagnosis and the prevalence of comorbidities are increasing but their prognostic role seems of poor relevance as we found a protective role of these variables: high systemic blood pressure (maybe indicative of a better haemodynamic stability) in I/H/D, CTD and PVOD; dyslipidemia and high BMI (maybe indicative of a better nutritional status and a less severe autoimmune disease) in CTD; dyslipidemia and a high glomerular filtration rate (both indicative of a less severe liver disease) in PoHIV.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Pasca
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| |
Collapse
|
19
|
Dardi F, Zuffa E, Palazzini M, Pasca F, De Lorenzis A, Guarino D, Magnani I, Ballerini A, Rotunno M, Manes A, Galie N. Short term effect of Selexipag in comparison to parenteral prostacyclin analogues in pulmonary arterial hypertension patients started on double-combination therapy with ERA and PDE-5 inhibitors. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The event-driven, phase 3, randomized, double-blind, placebo-controlled GRIPHON trial demonstrated that Selexipag reduces the risk of a composite end point of death or morbidity events in patients with pulmonary arterial hypertension (PAH). Despite the advantage of a per os formulation, its efficacy in comparison to parenteral prostacyclin analogues in patients already on oral double-combination therapy with endothelin receptor antagonist (ERA) and phosphodiesterase-5 inhibitor (PDE5-I) is not known.
Purpose
The aim of this study was to compare the effects of Selexipag (S) vs subcutaneous Treprostinil (T) vs intravenous Epoprostenol (E) in PAH patients initially started with double-combination therapy with ERA and PDE5-I.
Methods
We enrolled patients on double combination therapy with ERA + PDE5-I starting S, T or E. Drugs were gradually uptitrated to the maximum tolerated/approved dose. All patients were systematically assessed with WHO-functional class (FC), six minute walk test (6MWT) and right heart catheterization before treatment and 3 months after reaching a stable dose of the drug. Baseline characteristics and changes in 6MWT and haemodynamic parameters were analyzed using Wilcoxon signed-rank test and compared between the 3 drugs with Kruskal-Wallis test.
Results
One hundred and seventy-one patients with PAH were enrolled. Results are shown in the Table. Patients with a complete re-evaluation were 61% of S, 85% of T, 79% with E.
Conclusions
S was prescribed to the oldest and least severe PAH patients. E was prescribed to the youngest and most severe PAH patients and led to the strongest improvement of exercise capacity and haemodynamic profile. T has intermediate characteristics.
Table 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Pasca
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| |
Collapse
|
20
|
Rotunno M, Dardi F, De Lorenzis A, Palazzini M, Zuffa E, Pasca F, Guarino D, Magnani I, Ballerini A, Manes A, Galie N. Additional role of echocardiogram in pulmonary arterial hypertension risk stratification according to current ESC/ERS guidelines. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2238] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Current pulmonary hypertension (PH) guidelines stratify the risk of patients with pulmonary arterial hypertension (PAH) using a multiparametric approach. A simplified risk table has been recently proposed and validated without including echocardiographic parameters.
Purpose
We evaluate the additional role of echocardiogram in PAH risk stratification using the recently proposed simplified risk table in patients with idiopathic/heritable (I/H) PAH and PAH associated with connective tissue disease (CTD) and congenital heart disease (CHD).
Methods
All patients with I/H-PAH, CTD-PAH and CHD-PAH referred to a single centre were included from 2003 to 2017. All patients were treated according to PH guidelines. The simplified risk assessment considered the following criteria: WHO functional class, 6-min walking distance, right atrial (RA) pressure or brain natriuretic peptide (BNP) plasma levels and cardiac index (CI) or mixed venous oxygen saturation (SvO2). For the last 2 criteria the worst parameter was chosen. Risk strata were defined as: Low risk= at least 3 low risk and no high-risk criteria; High risk= at least 2 high risk criteria including CI or SvO2; Intermediate risk= definitions of low or high risk not fulfilled. Then we performed a Cox analysis to evaluate the independent echocardiographic predictors of survival that were subsequently added to the simplified risk table to test their additional role in ameliorating risk stratification.
Results
461 treatment-naïve patients were enrolled. Echocardiographic independent predictors of prognosis were the severity of tricuspid regurgitation [HR (95% CI) = 1.013 (1.006–1.021); p-value = 0.001], right atrial area [HR (95% CI) = 1.028 (1.012–1.045); p-value = 0.001] and the presence of pericardial effusion [HR (95% CI) = 1.533 (1.142–2.057); p-value= 0.004]. Only RA area significantly ameliorate the risk stratification power of the recently validated simplified PAH risk table (likelihood ratio chi2 increased from 63.8 to 68.1, likelihood ratio test = 0.039). Due to the significant correlation between RA area and both RA pressure (r=0.470; p<0.001) and BNP (r=0.372; p=0.004), we elaborate a second risk table in which RA area (utilizing the cut-offs proposed by the current PH guidelines) was considered together within the criteria including RA pressure and BNP (the worst parameter of the 3 was considered). Considering the second risk table including RA area the risk stratification power significantly improved (likelihood ratio chi2 increased from 63.8 to 72.7, AIC/BIC decreased from 1956/1964 to 1947/1955).
Conclusions
Echocardiographic RA area significantly improve the risk discrimination power of the recently proposed simplified risk table for patients with PAH.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Pasca
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| |
Collapse
|
21
|
Perrin E, Anand E, Dyachkova Y, Wagner T, Frediani S, Ballerini A. A prospective, observational study of the safety and effectiveness of intramuscular psychotropic treatment in acutely agitated patients with schizophrenia and bipolar mania. Eur Psychiatry 2020; 27:234-9. [DOI: 10.1016/j.eurpsy.2010.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 03/04/2010] [Accepted: 04/04/2010] [Indexed: 11/15/2022] Open
Abstract
AbstractThis naturalistic, observational pan-European study assessed the safety and early effectiveness of intramuscular (IM) psychotropic treatments in patients with acute agitation suffering from schizophrenia or bipolar mania. One thousand nine hundred and forty of 1945 patients completed the 24-hour observation period after initial IM treatment. Patients from 12 European countries were included (mean age 39 years; 58% male, 66% schizophrenia). IM treatment was at the physician's discretion. The primary objective was to describe the acute tolerability of IM psychotropic therapies in clinical practice, with particular emphasis on EPS. At baseline, 68% of the patients received IM monotherapy, with IM olanzapine most commonly prescribed (36%). During the first 24hours, 190 (9.8%) patients experienced EPS. The occurrence of EPS was statistically significantly lower in patients treated with IM olanzapine compared to those treated with other IM psychotropic medications (mainly typical antipsychotics and benzodiazepines): acute dystonia: 1.1%, 95% CI 0.5–2.3 and 2.9%, CI 2.0–4.0; akathisia: 2.3%, CI 1.3–3.7 and 5.5%, CI 4.3–6.9; Parkinsonism: 2.9%, CI 1.8–4.4 and 7.8%, CI 6.4–9.4, respectively. Anticholinergic treatment was given to 12% IM olanzapine versus 31% non-olanzapine treated patients. Acute agitation after 24hours was reduced by 1.68 (95% CI 1.46–1.91) points on the Clinical Global Impression of Severity (CGI-S) in IM olanzapine patients and 1.51 (95% CI 1.30–1.73) points in non-olanzapine patients. Additional psychotropic medication was required for 90% of the patients during the first 24hours of treatment. Results provide naturalistic evidence for low EPS rates and improvement of agitation with IM psychotropic medications during acute states of patients suffering from acute mania or schizophrenia.
Collapse
|
22
|
Fagiolini A, Aguglia E, Ballerini A, Callista G, Carpiniello B, Clerici M, Corrivetti G, De Fazio P, De Filippis S, De Giorgi S, Favaretto G, Ferri E, Gargiulo G, Giustra MG, La Barbera D, Maina G, Mencacci C, Montagnani G, Panariello A, Pigato G, Tortorella A, Vernacotola L, Vita A. Real-world effectiveness of long acting aripiprazole: Treatment persistence and its correlates in the Italian clinical practice. Psychiatry Res 2019; 272:698-706. [PMID: 30832189 DOI: 10.1016/j.psychres.2019.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify the variables that are associated with persistence to Aripiprazole-Long Acting (A-LAI), in adult patients with schizophrenia. METHODS Observational, retrospective, non-interventional study involving 261 patients with schizophrenia. RESULTS Eighty-six percent of study subjects were persistent for at least 6 months. All subjects with baseline CGI-S of 1 or 2, 95% of subjects with CGI-S of 3, 86% with CGI-S of 4, 82% of subjects with CGI-S of 5, 73% of subjects with CGI of 6 and 90% of subjects with CGI of 7 were persistent. A-LAI treatment continuation rate was higher in patients with: 1) baseline CGI score ≤ 4; 2) schizophrenia dimension (LDPS) mania score ≤ 5; 3) psychotic spectrum schizoid score ≤ 11. CONCLUSIONS A relatively high number of patients (n = 225, 86%) were persistent to A-LAI for at least 6 months. Not surprisingly, very severe patients were more unlikely to be persistent. However, it is noteworthy that a large number of subjects with high CGI score at the time when A-LAI was started (82% of subjects with CGI-S of 5, 73% of subjects with CGI of 6 and 90% of subjects with CGI of 7) were persistent. Larger, controlled, prospective and longer studies are warranted.
Collapse
Affiliation(s)
| | | | - A Ballerini
- U Sod di Psichiatria, AOU Careggi Firenze, Italy
| | - G Callista
- UOSD S.P.D.C. P.O. Giulianova Asl Teramo, Italy
| | | | | | | | - P De Fazio
- University Magna Graecia, Catanzaro, Italy
| | - S De Filippis
- Neuropsychiatric clinic villa von Siebenthal-Rome, Italy
| | - S De Giorgi
- Department of Mental Health, ASL Lecce, Italy
| | - G Favaretto
- Department of Mental Health, Ulss2 Marca Trevigiana, Italy
| | | | - G Gargiulo
- Area Vasta2, Ancona-A.S.U.R.Marche, Italy
| | | | | | | | - C Mencacci
- DSMD - Neuroscienze Asst Fatebenefratelli- Sacco, Milano, Italy
| | | | | | - G Pigato
- University of Padova Medical Center, Italy
| | | | | | - A Vita
- University of Brescia, Italy
| |
Collapse
|
23
|
Mallardo L, Campone B, Tofani T, Ciampi E, Corsi E, Baschirotto C, Appignanesi C, Lelli L, Pietrini F, Rotella F, Ricca V, Ballerini A. Is There an Association Between Body Uneasiness and Aberrant Salience in Anorexic Patients? A Preliminary Study. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The process whereby objects and representations come to be attention grabbing and capture thought and behaviour is called salience, and it is defined as aberrant when a significance is allocated to neutral stimuli. The Aberrant Salience Inventory (ASI) is a scale to measure aberrant salience, characterized by 29 dichotomic items. By now, a correlation between aberrant salience and eating disorders is unknown. Aim of this study is to evaluate an alteration of salience in patients with anorexia nervosa, to estimate the existance of a correlation between aberrant salience and the experience of body shape.MethodsTwenty-six female patients with AN (diagnosed using DSM-5) were enrolled at the Psychiatry Department of Florence. Psychopathological features were assessed at the time of enrollment using the following scales: SCL-90-R, BUT, EDE-Q. Salience alteration was assessed by the means of the ASI. Statistical analysis were realized using SPSS 20.0 with Spearman bivariate correlation.ResultsMean age was (mean ± SD) 26.2 ± 8.72 and mean Body Mass Index (BMI) 16.1 ± 2.46. Global Severity Index (GSI), Positive Symptom Total (PST) and Positive Symptom Distress Symptom Index (PSDI) were estimated for BUT and SCL-90-R and compared to total value of ASI. Thus, we found a statistical significant (P < 0.05) direct correlation between ASI and BUTpsdi and ASI and SCL-90-Rgsi (correlation coefficient of 0.446 and 0.398, respectively).ConclusionIn this study, we found a significant direct correlation between Aberrant Salience Inventory (ASI) values and one dimension of body uneasiness in anorexic patients. These preliminary data need further studies with a wider sample to confirm the above-mentioned data.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
24
|
Marcellusi A, Mennini F, Brugnoli R, Rapinesi C, Kotzalidis G, De Filippis S, Carrus D, Ballerini A, Francomano A, Ducci G, Del Casale A, Girardi P. Economic Aspects in the Treatment of Schizophrenia in Italy: Cost Consequences of an Early Long-acting Injectable Anti-Psychotics (lais) Approach. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PurposeThe aim of this analysis was to evaluate the economic consequences of a new treatment approach in the treatment of schizophrenia in the Italian setting. In terms of direct costs, in Italy was estimated that the main driver were represented by hospitalization and residential cost (71% of total direct cost per patient), followed by semi-residential services (13%), anti-psychotic and other drugs (8%) and ambulatory services (8).MethodsA probabilistic cost consequence model was developed to estimate the potential cost reductions derived from an early treatment with atypical long-acting injectable anti-psychotics (aLAIs) drugs. A systematic literature review was carried out to identify direct and indirect costs associated to the management of schizophrenic patients in Italy. The model projects a scenario analysis in order to estimate potential cost reductions applying a new model management (MoMa) based on patient recovery and early aLAIs treatment.ResultsOverall, the total economic burden associated with schizophrenia was estimated at €2.7 billion per year. A total of 50.5% of the economic burden was related to indirect costs and 49.5% to direct costs. Drug costs correspond to 10% of the total expenditure in terms of direct costs, while hospitalization and residential costs accounts for 81%. Scenario analysis demonstrate a potential cost reduction between 200 million and 300 million based on the effects of MoMa over the reduction of hospitalization and residential costs.ConclusionsThis analysis was the first attempt to translate clinical management aspects in economic consequences and will be a useful instruments for decision maker.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
25
|
Calderani E, Pietrini F, Burian I, Chiarello F, Dahlke D, Gemignani S, Marino P, Talamba G, Poli L, Santangelo A, Ricca V, Ballerini A. Long acting antipsychotics treatment of schizophrenia: A 24-month prospective study on patient's attitude towards treatment. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IntroductionLong-acting injectable (LAI) second-generation antipsychotics (SGAs) are considered an alternative to oral antipsychotics for schizophrenic patients with low adherence to therapy. However, it is still a matter of debate whether LAI-SGAs are able to significantly improve patient's attitudes towards treatment (ATT) [1].ObjectiveTo investigate the impact of LAI on ATT over 24 months.MethodsNineteen schizophrenic patients were switched from either oral olanzapine (11) or paliperidone (8) to the corresponding LAI. Patients were assessed at baseline (T0), after 6 (T1), 12 (T2) and 24 months (T3). Drug Attitude Inventory-10 (DAI-10) [2] was used to assess ATT. Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), Positive and Negative Syndrome Scale (PANSS), and Short Form Health Survey (SF-36) were used for psychopathology evaluations.ResultsEleven patients reached T3. Eight patients were excluded (4 olanzapine, 4 paliperidone): 4 required a significant change in concomitant treatment, 4 a change of antipsychotic (metabolic comorbidity). No changes in psychopathology occurred between T2 and T3, some scales improved from baseline to T2. DAI-10 mean scores were improved after 12 months, thus not significantly, and were further improved at 24 months (P = .008 vs baseline).ConclusionsATT keeps improving after one year of LAI treatment, unrelated to clinical response.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
26
|
Filgueira CS, Nicolov E, Hood RL, Ballerini A, Garcia-Huidobro J, Lin JZ, Fraga D, Webb P, Sabek OM, Gaber AO, Phillips KJ, Grattoni A. Sustained zero-order delivery of GC-1 from a nanochannel membrane device alleviates metabolic syndrome. Int J Obes (Lond) 2016; 40:1776-1783. [PMID: 27460601 DOI: 10.1038/ijo.2016.129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/16/2016] [Accepted: 06/25/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Our objective was to assess the sustained, low-dose and constant administration of the thyroid receptor-β (TRβ)-selective agonist GC-1 (sobetirome) from a novel nanochannel membrane device (NMD) for drug delivery. As it known to speed up metabolism, accomplish weight loss, improve cholesterol levels and possess anti-diabetic effects, GC-1 was steadily administered by our NMD, consisting of an implantable nanochannel membrane, as an alternative to conventional daily administration, which is subject to compliance issues in clinical settings. SUBJECTS/METHODS Diet-induced obese C57BL/J6 male mice were fed a very high-fat diet (VHFD) and received NMD implants subcutaneously. Ten mice per group received capsules containing GC-1 or phosphate-buffered saline (control). Weight, lean and fat mass, as well as cholesterol, triglycerides, insulin and glucose, were monitored for 24 days. After treatment, plasma levels of thyroid-stimulating hormone (TSH) and thyroxine were compared. mRNA levels of a panel of thermogenic markers were examined using real-time PCR in white adipose tissue (WAT) and brown adipose tissue (BAT). Adipose tissue, liver and local inflammatory response to the implant were examined histologically. Pancreatic islet number and β-cell area were assessed. RESULTS GC-1 released from the NMD reversed VHFD-induced obesity and normalized serum cholesterol and glycemia. Significant reductions in body weight and fat mass were observed within 10 days, whereas reductions in serum cholesterol and glucose levels were seen within 7 days. The significant decrease in TSH was consistent with TRβ selectivity for GC-1. Levels of transcript for Ucp1 and thermogenic genes PGC1a, Cidea, Dio2 and Cox5a showed significant upregulation in WAT in NMD-GC-1-treated mice, but decreased in BAT. Although mice treated by NMD-GC-1 showed a similar number of pancreatic islets, they exhibited significant increase in β-cell area. CONCLUSIONS Our data demonstrate that the NMD implant achieves steady administration of GC-1, offering an effective and tightly controlled molecular delivery system for treatment of obesity and metabolic disease, thereby addressing compliance.
Collapse
Affiliation(s)
- C S Filgueira
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - E Nicolov
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - R L Hood
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - A Ballerini
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - J Garcia-Huidobro
- Deparment of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - J Z Lin
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA
| | - D Fraga
- Department of Surgery, The Methodist Hospital, Houston, TX, USA
| | - P Webb
- Genomic Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
| | - O M Sabek
- Department of Surgery, The Methodist Hospital, Houston, TX, USA.,Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - A O Gaber
- Department of Surgery, The Methodist Hospital, Houston, TX, USA.,Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - K J Phillips
- Department of Molecular & Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - A Grattoni
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| |
Collapse
|
27
|
Pietrini F, Spadafora M, Tatini L, Talamba GA, Andrisano C, Boncompagni G, Manetti M, Ricca V, Ballerini A. LAI versus oral: A case-control study on subjective experience of antipsychotic maintenance treatment. Eur Psychiatry 2016; 37:35-42. [PMID: 27442981 DOI: 10.1016/j.eurpsy.2016.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/05/2016] [Accepted: 05/13/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To present real-world evidence on the differences between long-acting injectable (LAI) and oral antipsychotic maintenance treatment (AMT) in terms of subjective well-being, attitudes towards drug and quality of life in a sample of remitted schizophrenic subjects. METHODS Twenty outpatients with remitted schizophrenia treated with either olanzapine or paliperidone and switching from the oral to the LAI formulation of their maintenance treatment were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matching main sociodemographic, clinical and treatment variables made up the control group (oral-AMT group). All participants were assessed in terms of objective (PANSS, YMRS, MADRS) and subjective (SWN-K, DAI-10, SF-36) treatment outcomes at baseline (T0) and after 6 months (T1). RESULTS Between T0 and T1, general psychopathology of the PANSS, DAI-10, and all but one of the SWN-K dimensions (except for social integration), showed significantly higher percentages of improvement in the LAI-AMT group compared to the oral-AMT group. A generalized expansion of health-related quality of life, with better functioning in almost all areas of daily living, was reported by the LAI-AMT group after the 6-month period. In contrast, the oral-AMT group reported a significant worsening of health-related quality of life in the areas of emotional role and social functioning in the same period. CONCLUSIONS Our study indicates possible advantages of LAI over oral antipsychotic formulation in terms of subjective experience of maintenance treatment in remitted schizophrenic patients. Size and duration of this study need to be expanded in order to produce more solid and generalizable results.
Collapse
Affiliation(s)
- F Pietrini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy.
| | - M Spadafora
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - L Tatini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - G A Talamba
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - C Andrisano
- Department of biomedical and neuromotor sciences, university of Bologna, Bologna, Italy
| | - G Boncompagni
- Department of mental health and substance abuse, local health trust of Bologna, Bologna, Italy
| | - M Manetti
- Therapeutic psychiatric community, Campo del Vescovo Union, La Spezia, Italy
| | - V Ricca
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - A Ballerini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| |
Collapse
|
28
|
Moneglia M, Santangelo A, Ballerini A, Ricca V, Zignego A. New interferon-free therapies on HCV+ chronic hepatitis: Overcoming psychiatric side effects in a real world setting. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IntroductionInterferon-alpha (IFNα) was the backbone therapy for HCV+ related chronic hepatitis (CH-C). However, it was associated with significant neuropsychiatric side effects and impaired health-related quality of life. Second Generation IFNα-free direct-acting antiviral agents (DAAs) seem to be associated with fewer side effects, better tolerability, high efficacy rates and better patient reported outcomes (PROs) [Younoussi, 2014].AimsTo describe the neuropsychiatric symptoms and PROs during Second Generation DAAs plus ribavirin oral treatment in a group of CH-C real world patients.MethodsNineteen CH-C outpatients, scheduled for IFNα-free treatment, were assessed at enrolment (T0), at 4 (T1) and at 12 (T2) weeks, the end of treatment, by means of MDRS, HAM-D, HAM-A, MRS, Y-BOCS and SF-36. A pharmacological therapy, based on clinical evidence, was provided at psychiatric symptoms onset.ResultsDuring the treatment, we didn’t report any worsening in the administred psychometric scales. Furthermore, we observed a general improvement at week 12 (T2), statistically significant only for MRS (P < 0.05). Any statistically significant difference was found for SF-36 mean scores comparing T0, T1 and T2. However, SF-36 cluster analysis showed between T0 and T2 a meaningful and significant rise of global health clusters “General health perceptions” (P < 0.05), “Change in overall health status” (P < 0.001) and a significant impairment in cluster “Emotional role functioning” (P < 0.05).ConclusionsOur real world data are consistent with trial setting results [Younoussi, 2014]. Contrary to previous IFNα-based therapy, new regimens don’t seem to be associated with psychiatric side effects and suggest an immediate gain in general health PROs over the treatment period.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
29
|
Pietrini F, Spadafora M, Tatini L, Talamba G, Burchi E, Calderani E, Gemignani S, Mallardo L, Andrisano C, Boncompagni G, Manetti M, Ballerini A, Ricca V. LAI versus oral antipsychotic maintenance treatment of schizophrenia: A case-control study on subjective experience of treatment. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionLimited research has been devoted to the subjective impact of switching antipsychotic maintenance treatment (AMT) from oral to LAI formulation in schizophrenia.ObjectiveTo compare LAI AMT with oral AMT in terms of subjective experience of treatment, taking into account the effects on psychopathology.MethodsTwenty outpatients (7 males, mean age 40.55 ± 11.00 years) with remitted schizophrenia treated with either olanzapine or paliperidone and switching from oral to LAI AMT were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matched for the main socio-demographic, clinical and treatment variables made up the controls (oral-AMT group). All participants were assessed by means of the PANSS and of the SWN-K at baseline (T0) and after 6 months (T1).ResultsBetween T0 and T1, general psychopathology of the PANSS and all but one of the SWN-K dimensions (except for “social integration”), showed significantly higher percent improvements in the LAI-AMT group compared to the oral-AMT group. After 6 months (T1), the LAI-AMT group showed significantly lower PANSS total and general psychopathology scores, as well as higher mean score of perceived “mental functioning” compared to the oral-AMT group. Item analysis of the general PANSS at T1 showed significant differences between the two groups in anxiety, tension, depression, guilt feelings, poor attention, and active social avoidance.ConclusionsOur data on switching from oral to LAI AMT in remitted schizophrenia suggest a better efficacy of the latter in terms of improvement of general psychopathology and subjective experience of treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
30
|
Light D, Griffin M, Srivastava K, Danelli P, Ballerini A, Leone N, Bondurri A, Khare R, Shabbir A, Wijerathne S, So JBY, Clara E, Tang SW, Tan WB, Hu J, Lomanto D, Ji Z, Li J, East B, Pazdirek F, Hoch J, Ji ZL, Malik D, Reddy P, Sahu D, Forgione U, Gianatiempo M, Xiong M, Chen B, Zhang JW, Li T, Luo XG, Li Q, Yu X, Zhao XD, Chen HY, Sun FX, Feng GZ, Zhang JP, Yu CZ, Aboulwafa A, Mahfouz A, Khairat M, Althani H, Albosoum E, Alebrahim H. Rare & Special Cases. Hernia 2015; 19 Suppl 1:S19-24. [PMID: 26518798 DOI: 10.1007/bf03355321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- D Light
- Royal Victoria Infimrary, Newcastle upon Tyne, UK
| | | | | | | | | | | | | | - R Khare
- Al Zahra Hospital, Dubai, United Arab Emirates
| | - A Shabbir
- National University Health System, Singapore, Singapore
| | - S Wijerathne
- National University Health System, Singapore, Singapore
| | - J B Y So
- National University Health System, Singapore, Singapore
| | - E Clara
- National University Health System, Singapore, Singapore
| | - S W Tang
- National University Health System, Singapore, Singapore
| | - W B Tan
- National University Health System, Singapore, Singapore
| | - J Hu
- National University Health System, Singapore, Singapore
| | - D Lomanto
- National University Health System, Singapore, Singapore
| | - Z Ji
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - J Li
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - B East
- Motol Faculty Hospital, Surgery Departmet of 2nd medical Faculty of Charles University, Prague, Czech Republic
| | - F Pazdirek
- Motol Faculty Hospital, Surgery Departmet of 2nd medical Faculty of Charles University, Prague, Czech Republic
| | - J Hoch
- Motol Faculty Hospital, Surgery Departmet of 2nd medical Faculty of Charles University, Prague, Czech Republic
| | - Z L Ji
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - D Malik
- Metro MAS Heart Care & Multispecialty Hospital, Jaipur, India
| | - P Reddy
- Apollo Hospital, Chennai, India
| | | | - U Forgione
- Hospital General de Agudos Dr Teodoro Alvarez, Buenos Aires, Argentina
| | | | - M Xiong
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | | | | | | | | | | | - X D Zhao
- Department of Thoracic surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - H Y Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - F X Sun
- Department of Intensive Care Unit, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - G Z Feng
- Department of Respiratory, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Nanjing, China
| | | | - C Z Yu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | | | | | | | | | | |
Collapse
|
31
|
DeAsis F, Gitelis M, Chao S, Lapin B, Linn J, Denham W, Haggerty S, Carbray J, Ujiki M, Olory-Togbe JL, Gbessi DG, Dossou FM, Lawani I, Souaibou YI, Gnangnon I, Denakpo M, Soton RR, Djrouo G, Gogan P, Trukhalev W, Kukosh M, Panyushkin A, Safronova E, Jairam A, Kaufmann R, Jeekel J, Lange JF, Volmer U, Kersten CC, Arlt G, Skach J, Harcubova R, Petrakova V, Mandoboy JD, Ngom G, Faye AL, Ndour O, Sankale AA, Ndoye M, Daneiii P, Leone N, Ballerini A, Bondurri A, Cavallaro G, Silecchia G, Raparelli L, Greco F, Iorio O, Iossa A, De Angelis F, Rizzello M, Olmi S, Cesana G, Baldazzi G, Manoocheri F, Campanile FC, Munipalle P, Khan S, Gwiti P, Kanakala V, Viswanath Y, Kokotovic D, Sjølander H, Gögenur I, Helgstrand F, Devadhar S, Hounnou G, Elegbede OTA, Hadonou AA, Mensah ED, Agossou-Voyeme AK, Konate I, Toure AO, Cisse M, Zaki M, Diao ML, Tendeng JN, Toure FB, Toure CT, Subramanian V, Froghi F, de Carvalho FC, Salimin L, Drabble E. Humbilical & Epigastric Hernia. Hernia 2015; 19 Suppl 1:S35-42. [PMID: 26518843 DOI: 10.1007/bf03355324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F DeAsis
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - M Gitelis
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - S Chao
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - B Lapin
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - J Linn
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - W Denham
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - S Haggerty
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - J Carbray
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - M Ujiki
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | | | - D G Gbessi
- Faculté des sciences de la Santé, Foto, Benin
| | - F M Dossou
- Faculté des sciences de la Santé, Foto, Benin
| | - I Lawani
- Faculté des sciences de la Santé, Foto, Benin
| | | | - I Gnangnon
- Faculté des sciences de la Santé, Foto, Benin
| | - M Denakpo
- Faculté des sciences de la Santé, Foto, Benin
| | - R R Soton
- Faculté des sciences de la Santé, Foto, Benin
| | - G Djrouo
- Faculté des sciences de la Santé, Foto, Benin
| | - P Gogan
- Faculté des sciences de la Santé, Foto, Benin
| | - W Trukhalev
- State Medical Academy, Nizhnij Novgorod, Russia
| | - M Kukosh
- State Medical Academy, Nizhnij Novgorod, Russia
| | | | | | - A Jairam
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - R Kaufmann
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus Medical Centre, Rotterdam, Netherlands
| | - J F Lange
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - U Volmer
- Department of Surgery, Park-Klinik Weissensee, Berlin, Germany
| | | | | | - J Skach
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - R Harcubova
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - V Petrakova
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - J Danga Mandoboy
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - G Ngom
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - A L Faye
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - O Ndour
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - A A Sankale
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - M Ndoye
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | | | | | | | | | - G Cavallaro
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - G Silecchia
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - L Raparelli
- General Surgery Unit, GB Grassi Hospital, Rome, Italy
| | - F Greco
- General Surgery Unit, Andosilla Hospital, Civita Castellana, VT, Italy
| | - O Iorio
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - A Iossa
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - F De Angelis
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - M Rizzello
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - S Olmi
- General and Oncologic Surgery Unit, San Marco Hospital, Zingonia, BG, Italy
| | - G Cesana
- General and Oncologic Surgery Unit, San Marco Hospital, Zingonia, BG, Italy
| | - G Baldazzi
- General and Mini-invasive Surgery Unit, Abano Terme Hospital, Abano Terme, PD, Italy
| | - F Manoocheri
- General and Mini-invasive Surgery Unit, Abano Terme Hospital, Abano Terme, PD, Italy
| | - F C Campanile
- General Surgery Unit, Andosilla Hospital, Civita Castellana, VT, Italy
| | - P Munipalle
- James Cook University Hospital, Middlesbrough, UK
| | | | | | | | | | - D Kokotovic
- Dept. of Surgery, Køge Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - S Devadhar
- Department of Surgery, Pune India, Devadhar Nursing Home, Pune, India
| | - G Hounnou
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - O T A Elegbede
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - A A Hadonou
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - E D Mensah
- CHD/B, Service de Chirurgie Générale, Parakou, Benin
| | - A K Agossou-Voyeme
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - I Konate
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - A O Toure
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M Cisse
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M Zaki
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M L Diao
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - J N Tendeng
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - F B Toure
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - C T Toure
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | | | - F Froghi
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | | | - L Salimin
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - E Drabble
- Plymouth Hospitals NHS Trust, Plymouth, UK
| |
Collapse
|
32
|
Godini L, Talamba G, Lelli L, Pietrini F, Arcabasso S, Spadafora M, Lo Sauro C, Ballerini A. EPA-1128 – Long-acting second-generation antipsychotics: Improving subjective experience of pharmacological treatment and quality of life. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
33
|
Lelli L, Godini L, Spadafora M, Pietrini F, Lo Sauro C, Ballerini A. 1029 – Relationship between aberrant salience processing and psychotic symptoms in a clinical trans-diagnostic sample: preliminary data. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
34
|
Talamba G, Arcabasso S, Spadafora M, Ballerini A. 1360 – Long acting second generation antipsychotic therapy, from compliance to improving quality of life: the florence depot clinic preliminary report. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76405-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
35
|
Bonnett-Perrin E, Ballerini A, Dyachkova Y, Godanci S, Reiter S, Wagner T, OBS-IM Study Group. Safety and effectiveness of intramuscular psychotropic drugs in acutely agitated patients - a Pan-European study. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.480] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
36
|
Civitareale C, Fiori M, Ballerini A, Brambilla G. Identification and quantification method of spiramycin and tylosin in feedingstuffs with HPLC-UV/DAD at 1 ppm level. J Pharm Biomed Anal 2005; 36:317-25. [PMID: 15496324 DOI: 10.1016/j.jpba.2004.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 11/13/2003] [Revised: 06/15/2004] [Accepted: 06/16/2004] [Indexed: 11/28/2022]
Abstract
The use of the two macrolides antibiotics Spiramycin (S) and Tylosin (T) as growth promoters in animal feeding has been recently withdrawn in the European Union due to a concern about the outbreaks of farmacoresistance fenomena as a possible hazard for humans. For feed additives monitoring purposes, an analytical method has been developed for their extraction, purification and identification in different animal feedingstuffs (pelleted beef, pig, poultry feeds and calves milk replacer) at a minimum performance required limit (MRPL) of 1 microg g(-1) (ppm). Such limit has been established according to the lowest dosage of additives still able to elicit an appreciable growth promoting effect. Blank feeds were spiked at two concentration levels, 1.0 and 2.5 ppm in six replicates. After methanolic extraction, samples were cleaned up on SPE CN columns and extracts analysed in HPLC-UV/DAD, using a gradient elution. Detection limits, calculated as the tree time mean noise of 20 blank feeds, were 176 and 118 ng g(-1) for S and T, respectively. Results show good repeatability (CV% not exceeding the value of 15) and mean recovery in the range of 99-74% and 81-53% for S and T, respectively, at 1 ppm. When the standards were injected up to 250 ng the chromatographic method can resolve the components of analytes (Spiramycin I, II and III; Tylosin A and B) but can not resolve the components on real feed samples at the spiked levels considered. For this reason the identification and quantification of analytes on matrix were carried out considering the main compound of the drugs (Spiramycin I and Tylosin A). As a verification, the overlapping of UV spectra in the range 220-350 nm between analytical standards and the compounds in the matrix were considered.
Collapse
Affiliation(s)
- C Civitareale
- Istituto Superiore di Sanità, Laboratorio Medicina Veterinaria, Viale Regina Elena, 299 I-00161 Rome, Italy
| | | | | | | |
Collapse
|
37
|
Ballerini A, Civitareale C, Fiori M, Regini M, Betti M, Brambilla G. Traceability of inbred and crossbred Cinta Senese pigs by evaluating the oxidative stress. J Vet Med A Physiol Pathol Clin Med 2003; 50:113-6. [PMID: 12757547 DOI: 10.1046/j.1439-0442.2003.00508.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous studies on the oxidative stress in swine indicated a strong link between the values of reactive oxygen metabolites (ROMs), the subsequent antioxidant adaptive response (OXY) and the genetic selection. Such findings, mainly related to a cardiovascular inadequacy in lean, large muscle blocks and fast growing breeds, is associated with specific metabolic diseases such as porcine stress syndrome and mulberry heart disease. In this study, we investigated the oxidative stress parameters to trace the genetics of Cinta Senese (CS) pigs, a historical breed free-range reared in Siena countryside. Sera from CS (n = 24) and Large White x CS (LW x CS) (n = 24) groups around 120 kg body weight fed the same diet were sampled at slaughter. Sera from wild boars (WB) (n = 24) hunted in the same district were also considered. ROMs and OXY were evaluated in the three groups of swine. Significant differences by one-way anova (P < 0.05) between groups were found for both procedures. ROM levels were lower in WB (9.79 +/- 5.76 mm H2O2) and CS (18.02 +/- 7.42 mm H2O2), and highest in LW x CS (42.78 +/- 8.61 mm H2O2). OXY values ranged from 271.37 +/- 50.90 microm neutralized HOCl (WB) to 343.21 +/- 57.45 microm neutralized HOCl (LW x CS). Results indicated that the evaluation of the oxidative stress can effectively trace the CS pigs, thus aiding in preserving the overall specific traits of such a historical animal.
Collapse
Affiliation(s)
- A Ballerini
- Istituto Superiore di Sanita', Laboratorio di Medicina Veterinaria, Viale Regina Elena, 299 I 00161 Rome, Italy
| | | | | | | | | | | |
Collapse
|
38
|
Ballerini A, Ballerini AC. Dysphoria: a key for 'understanding' delusion? Psychopathology 2000; 33:215-9. [PMID: 10867580 DOI: 10.1159/000029146] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The 'nonunderstandability' that traditional psychopathology attributes to 'true' delusion does not have a clear demarcation line, but, rather, it is a continuum of various delusional experiences. The attention paid to emotional situations and, specifically, to dysphoria, often contributes to making the delusional phenomenon, and, above all, its persistence, more understandable. A positive correlation between productive psychotic symptoms and the dysphoric mood often prevails in delusions with unfavorable prognoses.
Collapse
Affiliation(s)
- A Ballerini
- Psychiatric Specialization School, University of Florence, Florence, Italy.
| | | |
Collapse
|
39
|
Confalonieri F, Ballerini A. [Palliative cholangiojejunostomy on the duct of hepatic segment III. Our experience]. MINERVA CHIR 1998; 53:709-14. [PMID: 9866936] [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: 02/09/2023]
Abstract
BACKGROUND Aim of the paper is to prove that indications for cholangiojejunostomy, in cases when a mean and long term palliation may be expected, are better than those offered by the use of prostheses, without the well known and early bile duct complications. METHODS Between 1984 and 1995, 12 patients with obstructive jaundice due to malignancy at the hepatic hilum were treated by segment III Roux-en-y or omega cholangiojejunostomy. In 1 patient with no communication between right and left lobe of the liver, biliary-enteric bypass to segment VI duct was also undertaken; in another with neoplastic stenosis of pylorus gastrojejunostomy was performed. Seven patients had carcinoma of the gallbladder, three hilar cholangiocarcinoma, one gastric carcinoma and one recurrent pancreatic carcinoma. RESULTS There were two postoperative deaths, one for myocardial infarction and one for biliary peritonitis. Six patients had complications: four biliary fistulas with spontaneous resolution and two wound infections. Seven of the ten surviving patients experienced complete resolution of jaundice for at least 4 months. The mean survival of surviving patients was 9.7 months. Nine patients developed recurrent jaundice. CONCLUSIONS Segment III cholangiojejunostomy is a good palliative treatment in most patients with malignant hilar obstruction.
Collapse
Affiliation(s)
- F Confalonieri
- Azienda USSL Ambito Territoriale N. 31, Presidio Ospedaliero Città di Sesto San Giovanni, Milano
| | | |
Collapse
|
40
|
Russo R, Vertemati G, Carzaniga PL, Ballerini A, Rossi G, Zuccoli E. [Castleman's disease with abdominal localization. Report of an unusual case]. MINERVA CHIR 1995; 50:901-3. [PMID: 8684639] [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: 02/01/2023]
Abstract
Castleman's disease is an unusual condition characterized by uncontrolled growth of lymphoid tissue. The first case was recorded by Castleman in 1956. In this paper a case of the above-mentioned disease is reported with regard to its unusual clinica-histologic aspect (localized form of plasmacellular type) and surgical therapeutic strategies.
Collapse
Affiliation(s)
- R Russo
- Divisione di Chirurgia I, Ospedale di Lecco
| | | | | | | | | | | |
Collapse
|
41
|
Vertemati G, Russo R, Semeraro MV, Ballerini A, Carzaniga PL, Gatti A. [Hemobilia secondary to percutaneous hepatic biopsy. Report of a clinical case]. MINERVA CHIR 1995; 50:409-12. [PMID: 7675291] [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: 01/26/2023]
Abstract
The increasingly frequent use of invasive diagnostic and therapeutic procedures concerning the hepatobiliary system has led to a rise in the incidence of hemobilia as well as altering its etiological status. The authors report a clinical case of hemobilia secondary to percutaneous hepatic biopsy which was brought to their attention. This is followed by a short discussion of the etiopatogenesis and diagnostic and therapeutic strategies with special reference to the ratio between the advantages/limits of the methods now available.
Collapse
Affiliation(s)
- G Vertemati
- Divisione di Chirurgia I, Ospedale, Lecco, Regione Lombardia, USSL n. 16, Lecco, Como
| | | | | | | | | | | |
Collapse
|
42
|
Confalonieri F, Ballerini A, Santangelo A, Turra G. [Cholecystolithotomy with cholecystojejunostomy as surgical solution for cholelithiasis in portal hypertension caused by hepatic cirrhosis]. MINERVA CHIR 1995; 50:253-6. [PMID: 7659260] [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: 01/26/2023]
Abstract
Cholecystolithotomy and cholecystojejunostomy has been carried out on 11 patients with severe hypertension from cirrhosis. The indications were frequently recurring attacks of biliary cholic or acute cholecystitis at onset. There was 1 postoperative death from cardiac infarction and only minor in-hospital morbidity. None of the remaining patients has to date developed post-cholecystojejunostomy sequelae. Except the case of extensive inflammation on gangrena, this procedure appears to be a safe and definitive operation, alternative to subtotal cholecystectomy.
Collapse
Affiliation(s)
- F Confalonieri
- Divisione Chirurgica I Zinelli, Regione Lombardia-USSL n. 65, Ospedale, Città di Sesto San Giovanni, Sesto San Giovanni, Milano
| | | | | | | |
Collapse
|
43
|
Abstract
The concept of 'dysphoria', as defined by the Vienna Group from the psychopathological point of view, is analyzed on the anthropological level. In an anthropological perspective, personality is conceived as a factor modulating affective disorders, and the manifold clinical expressions of affective disorders are viewed as functions of the relationship between the entity of the 'endothymic' fluctuations and the amalgam of the person who is in charge to confront and cope with the thymic experience. The hypothesis that dysphoria may be interpreted as a sthenic, oppositional and therefore irritated and hostile personological reaction to the occurrence of endogenous 'restrictive' or 'expansive' mood swings is discussed.
Collapse
|
44
|
Sforza M, Ballerini A, Russo R, Carzaniga PL, Vertemati G. [Contact thermography in breast pathology. A critical review]. MINERVA CHIR 1991; 46:375-7. [PMID: 1870737] [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: 12/29/2022]
Abstract
The paper reports the Authors' experience in over 12,000 patients affected by manifest or presumed breast pathologies examined using contact thermography and assess the number of correct responses. This technique proved reliable in patients aged under 30 with benign pathologies or palpable nodules. On the other hand, it was not reliable in the case of pathologies with negative objectivity, and therefore in the context of screening programmes for the early diagnosis of tumours.
Collapse
Affiliation(s)
- M Sforza
- Divisione Chirurgia I, Ospedale di Lecco
| | | | | | | | | |
Collapse
|
45
|
Leprini A, Valente U, Barocci S, Fontana I, Angelini G, Bottero S, Ballerini A, Nocera A. [Modulation of the expression of histocompatibility antigens class I (HLA-A,B,C) in the human pancreas]. Boll Soc Ital Biol Sper 1989; 65:187-94. [PMID: 2569881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this study the expression of HLA class I molecules was analysed on caudal portions of ten pancreata from cadaver donors by means of indirect immunoperoxidase and immunophosphatase techniques. In 7 out of ten pancreata the results showed that islets tissue was almost negative for the expression of HLA Class I antigens as opposed to exocrine tissue that appeared positive. Within exocrine tissue and large sized islets strongly positive interstitial cells were also detected. Double stainings showed that the strongly positive interstitial cells expressed also Leu M1 antigens. Preliminary studies on the remaining three pancreata demonstrate an increase of hematic interstitial cells together with a parallel increase of HLA class I antigens by endocrine parenchyma. The above data suggest that an increase of interstitial cells within pancreas may influence islets antigenicity.
Collapse
|
46
|
Abstract
The problem of the relationship between obsession and delusion is dealt with from descriptive, anthropoanalytical and purely phenomenological points of view. The main differential aspects are focused. The phenomenological concept of the progressive fading of the 'feeling of Ego activity' is proposed as the functional bias at the basis of the continuum linking obsessive symbolic awareness to delusional perception.
Collapse
|
47
|
Abstract
The plasma levels of clomipramine (CI) and its major metabolite desmethylclomipramine (DMCI) may be related to clinical response during treatment of depression. Not all workers have been able to demonstrate such a relationship. The many factors which may affect clinical response include sample selection, assessment and its quantification and kinetic factors. A further investigation into the relationship between plasma levels and response was, therefore, carried out taking these into account and attempting to control them. Sixty-two patients with depressive illness were included. The plasma levels of CI + DMCI as measured on the 28th day of treatment were correlated against clinical response at the time. Patients with the highest combined plasma levels showed the best response. Patients with intermediate plasma levels showed more modest response, whilst lowest plasma levels tended to be shown by patients who exhibited an inadequate response or who relapsed during subsequent outpatient follow-up. The threshold value for satisfactory antidepressant effect appeared to be a combined CI + DMCI plasma level of 160-200 mg/ml.
Collapse
|
48
|
Faravelli C, Broadhurst AD, Ambonetti A, Ballerini A, De Biase L, La Malfa G, Das M. Double-blind trial with oral versus intravenous clomipramine in primary depression. Biol Psychiatry 1983; 18:695-706. [PMID: 6871303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Intravenous clomipramine and oral clomipramine at a daily dose of 2 mg/kg body weight were compared in a double-blind study of 40 inpatients with primary depressive illness. No significant differences between the two routes of clomipramine administration were found, either in response or in side effects. Steady state was not attained at the 4th week of treatment in 30% of patients. However, combined plasma levels of clomipramine (CI) plus desmethylclomipramine (DMCI) were similar in the two groups at all stages of treatment. The only significant pharmacokinetic difference that was found was in the ratio of DMCI to CI, which was higher among the patients who received the drug orally, but this did not correlate with clinical response. Conversely, Day 28 plasma concentrations of CI, DMCI, and the sum CI + DMCI were significantly related to clinical outcome in the patients treated orally. Among the patients who received the drug intravenously only CI was significantly associated with the percentage reduction of symptoms. By pooling the two groups, CI, DMCI, and their sum all bore relationships to clinical response significant at the 0.01 level.
Collapse
|
49
|
Ballerini A. [Prospects for general psychopathology in modern psychiatry]. Riv Patol Nerv Ment 1982; 102:211-225. [PMID: 7156796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The Author describes the interest and the meaning of General Psychopathology in today's Psychiatry. The Author defines the methodological aspects necessary in psychopathology as well as their gnoseological and formative value. The "-structural constants" defined in psychopathology appear irreplaceable in the basic aspects of psychotic mind models, and other dimensions of contemporary psychiatry cannot disregard them. The Author emphasise the risk of an inaccurate and irresponsibly exhaustive use of psychopathological categories in psychiatric practice. However it seems that a conscious exercise of psychopathological methods can avoid confusion about investigatory psychiatric research, and may help recognizing basic structures of psychotic experience. These structures are not only necessary in a diagnostic field, but also for a correct pharmacotherapeutical epproach.
Collapse
|
50
|
|