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Porcu G, Biffi A, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Cianferotti L, Brandi ML, Corrao G. Refracture following vertebral fragility fracture when bone fragility is not recognized: summarizing findings from comparator arms of randomized clinical trials. J Endocrinol Invest 2024; 47:795-818. [PMID: 37921990 DOI: 10.1007/s40618-023-02222-0] [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: 06/19/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE Since vertebral fragility fractures (VFFs) might increase the risk of subsequent fractures, we evaluated the incidence rate and the refracture risk of subsequent vertebral and non-vertebral fragility fractures (nVFFs) in untreated patients with a previous VFF. METHODS We systematically searched PubMed, Embase, and Cochrane Library up to February 2022 for randomized clinical trials (RCTs) that analyzed the occurrence of subsequent fractures in untreated patients with prior VFFs. Two authors independently extracted data and appraised the risk of bias in the selected studies. Primary outcomes were subsequent VFFs, while secondary outcomes were further nVFFs. The outcome of refracture within ≥ 2 years after the index fracture was measured as (i) rate, expressed per 100 person-years (PYs), and (ii) risk, expressed in percentage. RESULTS Forty RCTs met our inclusion criteria, ranging from medium to high quality. Among untreated patients with prior VFFs, the rate of subsequent VFFs and nVFFs was 12 [95% confidence interval (CI) 9-16] and 6 (95% CI 5-8%) per 100 PYs, respectively. The higher the number of previous VFFs, the higher the incidence. Moreover, the risk of VFFs and nVFFs increased within 2 (16.6% and 8%) and 4 years (35.1% and 17.4%) based on the index VFF. CONCLUSION The highest risk of subsequent VFFs or nVFFs was already detected within 2 years following the initial VFF. Thus, prompt interventions should be designed to improve the detection and treatment of VFFs, aiming to reduce the risk of future FFs and properly implement secondary preventive measures.
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Affiliation(s)
- G Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - A Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Bogini
- Local Health Unit (USL) Umbria, Perugia, Italy
| | - A P Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - S Gonnelli
- Department of Medicine, Surgery, and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - S Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - R Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - T Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - M Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Pennini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - E Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - L Cianferotti
- Italian Foundation for Research on Bone Diseases (FIRMO), Florence, Italy
| | - M L Brandi
- Italian Foundation for Research on Bone Diseases (FIRMO), Florence, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Adami G, Biffi A, Porcu G, Ronco R, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Tarantino U, Brandi ML, Corrao G, Rossini M, Michieli R. A systematic review on the performance of fracture risk assessment tools: FRAX, DeFRA, FRA-HS. J Endocrinol Invest 2023; 46:2287-2297. [PMID: 37031450 PMCID: PMC10558377 DOI: 10.1007/s40618-023-02082-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/27/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Preventing fragility fractures by treating osteoporosis may reduce disability and mortality worldwide. Algorithms combining clinical risk factors with bone mineral density have been developed to better estimate fracture risk and possible treatment thresholds. This systematic review supported panel members of the Italian Fragility Fracture Guidelines in recommending the use of best-performant tool. The clinical performance of the three most used fracture risk assessment tools (DeFRA, FRAX, and FRA-HS) was assessed in at-risk patients. METHODS PubMed, Embase, and Cochrane Library were searched till December 2020 for studies investigating risk assessment tools for predicting major osteoporotic or hip fractures in patients with osteoporosis or fragility fractures. Sensitivity (Sn), specificity (Sp), and areas under the curve (AUCs) were evaluated for all tools at different thresholds. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2; certainty of evidence (CoE) was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Forty-three articles were considered (40, 1, and 2 for FRAX, FRA-HS, and DeFRA, respectively), with the CoE ranging from very low to high quality. A reduction of Sn and increase of Sp for major osteoporotic fractures were observed among women and the entire population with cut-off augmentation. No significant differences were found on comparing FRAX to DeFRA in women (AUC 59-88% vs. 74%) and diabetics (AUC 73% vs. 89%). FRAX demonstrated non-significantly better discriminatory power than FRA-HS among men. CONCLUSION The task force formulated appropriate recommendations on the use of any fracture risk assessment tools in patients with or at risk of fragility fractures, since no statistically significant differences emerged across different prediction tools.
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Affiliation(s)
- G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - A Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - G Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Bogini
- Local Health Unit (USL) Umbria, Perugia, Italy
| | - A P Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy
| | - L Cianferotti
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy.
| | - S Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - S Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - T Nicoletti
- Coordinamento Nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, CnAMC, Rome, Italy
| | - M Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - E Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M L Brandi
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - R Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
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Cianferotti L, Porcu G, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Brandi ML, Corrao G, Biffi A. The integrated structure of care: evidence for the efficacy of models of clinical governance in the prevention of fragility fractures after recent sentinel fracture after the age of 50 years. Arch Osteoporos 2023; 18:109. [PMID: 37603196 PMCID: PMC10442313 DOI: 10.1007/s11657-023-01316-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
Randomized clinical trials and observational studies on the implementation of clinical governance models, in patients who had experienced a fragility fracture, were examined. Literature was systematically reviewed and summarized by a panel of experts who formulated recommendations for the Italian guideline. PURPOSE After experiencing a fracture, several strategies may be adopted to reduce the risk of recurrent fragility fractures and associated morbidity and mortality. Clinical governance models, such as the fracture liaison service (FLS), have been introduced for the identification, treatment, and monitoring of patients with secondary fragility fractures. A systematic review was conducted to evaluate the association between multidisciplinary care systems and several outcomes in patients with a fragility fracture in the context of the development of the Italian Guidelines. METHODS PubMed, Embase, and the Cochrane Library were investigated up to December 2020 to update the search of the Scottish Intercollegiate Guidelines Network. Randomized clinical trials (RCTs) and observational studies that analyzed clinical governance models in patients who had experienced a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using random-effects models. Primary outcomes were bone mineral density values, antiosteoporotic therapy initiation, adherence to antiosteoporotic medications, subsequent fracture, and mortality risk, while secondary outcomes were quality of life and physical performance. RESULTS Fifteen RCTs and 62 observational studies, ranging from very low to low quality for bone mineral density values, antiosteoporotic initiation, adherence to antiosteoporotic medications, subsequent fracture, mortality, met our inclusion criteria. The implementation of clinical governance models compared to their pre-implementation or standard care/non-attenders significantly improved BMD testing rate, and increased the number of patients who initiated antiosteoporotic therapy and enhanced their adherence to the medications. Moreover, the treatment by clinical governance model respect to standard care/non-attenders significantly reduced the risk of subsequent fracture and mortality. The integrated structure of care enhanced the quality of life and physical function among patients with fragility fractures. CONCLUSIONS Based on our findings, clinicians should promote the management of patients experiencing a fragility fracture through structured and integrated models of care. The task force has formulated appropriate recommendations on the implementation of multidisciplinary care systems in patients with, or at risk of, fragility fractures.
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Affiliation(s)
- L Cianferotti
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - G Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - R Ronco
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - R Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Bogini
- Local Health Unit (USL) Umbria, Perugia, Italy
| | - A P Caputi
- Department of Pharmacology, School of Medicine, University of Messina, Sicily, Italy
| | - B Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - S Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - S Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - R Michieli
- Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy
| | - S Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - T Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - M Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - E Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M Rossini
- Rheumatology Unit, University of Verona, Verona, Italy
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - M L Brandi
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - A Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
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Damanti C, Cani A, Lovisa F, Gaffo E, Borile G, Garbin A, Gallingani I, Ferrone L, Tosato A, Contarini G, Carraro E, Pillon M, Bortoluzzi S, Biffi A, Bresolin S, Mussolin L. PLASMA S-Evs miRNAs IN PEDIATRIC B-mALL: TUMOR BIOMARKERS AND TRANSFORMING FACTORS OF BONE MARROW NICHE. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00264-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Palermi S, Brugin E, Compagno S, Pescatore V, Tegon G, Gerbino L, Sarto M, Marin R, Volpato R, Masato M, Panico A, Biffi A, Giada F. P372 PATIENTS WITH MINOR NON–DISABLING STROKE (MINDS): RESULTS OF A STRUCTURED CARDIOVASCULAR REHABILITATION PROGRAM. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non–Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases Purpose To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS
Methods
39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12–sessions in–hospital SPE program, and after 6– and 12–months follow–up during which they could continue their training schedule on their own Results After in–hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6– and 12– months follow–up training, while regressed in the 7 patients who stopped training
Conclusions - Results
of the present study show that a SPE–based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS
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Affiliation(s)
- S Palermi
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - E Brugin
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - S Compagno
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - V Pescatore
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - G Tegon
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - L Gerbino
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - M Sarto
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - R Marin
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - R Volpato
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - M Masato
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - A Panico
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - A Biffi
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - F Giada
- DIPARTIMENTO DI SANITÀ PUBBLICA – UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE – VENEZIA, NOALE; UOC NEUROLOGIA, OSPEDALE DI DOLO, DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
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Compagno S, Palermi S, Pescatore V, Brugin E, Tegon G, Sarto M, Marin R, Calzavara V, Nizzetto M, Scevola M, Albertin C, Biffi A, Giada F. P368 PHYSICAL AND PSYCHOLOGICAL RECONDITIONING IN LONG COVID SYNDROME: RESULTS OF AN OUT–OF–HOSPITAL EXERCISED–BASED CARDIOVASCULAR REHABILITATION PROGRAM. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID–19 infection. Natural history and treatments of this syndrome are still poorly understood, even if evidence suggests the potential role of physical rehabilitation in improving symptoms in these subjects.
Aim
The aim of the present study was to evaluate safety, effectiveness and feasibility of a multidisciplinary, out–of–hospital, exercise–based cardiac rehabilitation (EBCR) program, of two months duration, in improving symptoms and physical and psychological parameters in patients with LCS Methods Thirty consecutive patients with LCS (18 males, mean age 58 years) underwent an accurate medical screening process including anthropometric and muscular strength evaluation, cardiopulmonary exercise test (CPET), quality of life (QoL) and psychological appraisal before and after an EBCR program.
Results
At baseline, all LCS patients were strongly symptomatic and showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during the exercise training sessions. After the EBCR program, COVID–19 residual symptoms significantly decreased and significant improvements in upper and lower limb muscular strength, CPET parameters, perceived physical and mental health, depression and anxiety were observed.
Conclusions
The present study confirms the severe physical and psychological impairment of patients with LCS and suggests that a multidisciplinary EBCR program could promote their physical and psychological recovery
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Affiliation(s)
- S Compagno
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - S Palermi
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - V Pescatore
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - E Brugin
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - G Tegon
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - M Sarto
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - R Marin
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - V Calzavara
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - M Nizzetto
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - M Scevola
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - C Albertin
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - A Biffi
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
| | - F Giada
- UOC MEDICINA DELLO SPORT E CARDIOLOGIA RIABILITATIVA, OSPEDALE PF CALVI, NOALE–VENEZIA, NOALE; DIPARTIMENTO DI SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI NAPOLI FEDERICO II, NAPOLI; UOC DI PNEUMOLOGIA, OSPEDALE DI DOLO, DOLO; UOC DI MEDICINA INTERNA, OSPEDALE DI DOLO, DOLO; UOC DI FISIATRIA, OSPEDALE DI DOLO, DOLO; MED–EX, MEDICINE & EXERCISE, MEDICAL PARTNER DELLA SCUDERIA FERRARI, ROMA
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Palermi S, Brugin E, Compagno S, Pescatore V, Tegon G, Sarto M, Marin R, Masato M, Panico A, Biffi A, Giada F. Patients with Minor Non-Disabling Stroke (MiNDS): results of a structured cardiovascular rehabilitation program. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.244] [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: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Ischemic cerebral and cardiac events are the leading causes of mortality and morbidity in Minor non-Disabling Stroke (MiNDS) patients. Control of cardiovascular risk factors, including physical activity levels, is a key strategy in secondary prevention of MiNDS. However, there is a gap between recommendations and real achieved physical activity levels in these patients. Clinical benefits obtained with cardiovascular rehabilitation in cardiac ischemic patients could be obtained with similar programs also in patients with MiNDS, given the common pathophysiological substrate of these two diseases.
Purpose
To evaluate safety, effectiveness and feasibility of a cardiovascular rehabilitation program based on structured physical exercise (SPE) in patients with MiNDS.
Methods
39 MiNDS patients (26 males, mean age 66 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET) and muscular strength assessment, before and after a 12-sessions in-hospital SPE program, and after 6- and 12-months follow-up during which they could continue their training schedule on their own.
Results
After in-hospital rehabilitation program, a significant improvement in CPET parameters, body composition and muscular strength was observed. These modifications persisted in the 32 patients who continued 6- and 12- months follow-up training, while regressed in the 7 patients who stopped training.
Conclusions
Results of the present study show that a SPE-based cardiovascular rehabilitation program provides clinical benefit in patients with MiNDS.
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Affiliation(s)
- S Palermi
- Federico II University Hospital, Naples, Italy
| | - E Brugin
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - S Compagno
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - V Pescatore
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - G Tegon
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - M Sarto
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - R Marin
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | | | | | - A Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - F Giada
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
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Palermi S, Compagno S, Pescatore V, Brugin E, Tegon G, Sarto M, Marin R, Calzavara V, Nizzetto M, Scevola M, Albertin C, Biffi A, Giada F. Physical and psychological reconditioning in long covid syndrome patients: results of a structured physical exercise program. Eur J Prev Cardiol 2022. [PMCID: PMC9383996 DOI: 10.1093/eurjpc/zwac056.218] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID-19 infection. Natural history and treatments of this syndrome is still poorly understood. In literature there is currently a lack of data on the real effectiveness of a multidisciplinary rehabilitation program based on structured physical exercise (SPE) in these patients. Purpose To evaluate safety, effectiveness and feasibility of a structured individualized rehabilitation program in improving physical and psychological parameters in patients with LCS. Methods Twenty-eight patients with LCS (19 males, mean age 57 years) underwent an accurate medical screening process, body composition evaluation, cardiopulmonary exercise test (CPET), muscular strength assessment, quality of life (QoL), psychological assessment and counselling, before and after a 12-sessions SPE program. Results At baseline, all LCS patients showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during training session. After the rehabilitation program, significant improvement in CPET parameters, upper and lower limb muscular strength, perceived physical and mental health, body composition, depression and anxiety and Covid residual symptoms was observed. Conclusions The present study confirms severe impairment of patients with LCS and suggest that a multidisciplinary rehabilitation program based on SPE could promote their physical and psychological recovery.
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Affiliation(s)
- S Palermi
- Federico II University Hospital, Naples, Italy
| | - S Compagno
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - V Pescatore
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - E Brugin
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - G Tegon
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - M Sarto
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - R Marin
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - V Calzavara
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
| | - M Nizzetto
- Sub-Intensive Care COVID Unit in Pneumology, Dolo, Italy
| | - M Scevola
- Non-critical COVID Area in Internal Medicine, Dolo, Italy
| | - C Albertin
- Physical Medicine & Rehabilitation service, Dolo, Italy
| | - A Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - F Giada
- Noale Hospital, Cardiovascular Rehabilitation and Sports Medicine Service, Cardiovascular Department, Noale, Italy
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9
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Campello E, Francavilla A, Pelizza M, Sebellin S, Nosadini M, Pin J, Lorenzoni G, Biffi A, Gregori D, Forestan C, Martinato M, Sartori S, Simioni P. PO-59: Dealing with pediatric cancer associated thrombosis: a case report and a monocentric cohort study. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00249-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Jäger R, Zaragoza J, Purpura M, Iametti S, Marengo M, Tinsley GM, Anzalone AJ, Oliver JM, Fiore W, Biffi A, Urbina S, Taylor L. Probiotic Administration Increases Amino Acid Absorption from Plant Protein: a Placebo-Controlled, Randomized, Double-Blind, Multicenter, Crossover Study. Probiotics Antimicrob Proteins 2021; 12:1330-1339. [PMID: 32358640 PMCID: PMC7641926 DOI: 10.1007/s12602-020-09656-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The fate of dietary protein in the gut is determined by microbial and host digestion and utilization. Fermentation of proteins generates bioactive molecules that have wide-ranging health effects on the host. The type of protein can affect amino acid absorption, with animal proteins generally being more efficiently absorbed compared with plant proteins. In contrast to animal proteins, most plant proteins, such as pea protein, are incomplete proteins. Pea protein is low in methionine and contains lower amounts of branched-chain amino acids (BCAAs), which play a crucial role in muscle health. We hypothesized that probiotic supplementation results in favorable changes in the gut microbiota, aiding the absorption of amino acids from plant proteins by the host. Fifteen physically active men (24.2 ± 5.0 years; 85.3 ± 12.9 kg; 178.0 ± 7.6 cm; 16.7 ± 5.8% body fat) co-ingested 20 g of pea protein with either AminoAlta™, a multi-strain probiotic (5 billion CFU L. paracasei LP-DG® (CNCM I-1572) plus 5 billion CFU L. paracasei LPC-S01 (DSM 26760), SOFAR S.p.A., Italy) or a placebo for 2 weeks in a randomized, double-blind, crossover design, separated by a 4-week washout period. Blood samples were taken at baseline and at 30-, 60-, 120-, and 180-min post-ingestion and analyzed for amino acid content. Probiotic administration significantly increased methionine, histidine, valine, leucine, isoleucine, tyrosine, total BCAA, and total EAA maximum concentrations (Cmax) and AUC without significantly changing the time to reach maximum concentrations. Probiotic supplementation can be an important nutritional strategy to improve post-prandial changes in blood amino acids and to overcome compositional shortcomings of plant proteins. ClinicalTrials.gov Identifier: ISRCTN38903788.
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Affiliation(s)
| | - Javier Zaragoza
- Human Performance Laboratory, School of Exercise & Sport Science, University of Mary Hardin-Baylor, Belton, TX, USA
| | | | - Stefania Iametti
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milan, Italy
| | - Mauro Marengo
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milan, Italy
| | - Grant M Tinsley
- Energy Balance & Body Composition Laboratory, Texas Tech University, Lubbock, TX, USA
| | | | | | | | | | - Stacie Urbina
- Human Performance Laboratory, School of Exercise & Sport Science, University of Mary Hardin-Baylor, Belton, TX, USA
| | - Lem Taylor
- Human Performance Laboratory, School of Exercise & Sport Science, University of Mary Hardin-Baylor, Belton, TX, USA
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Zaragoza JA, Urbina S, Purpura M, Jaeger R, Tinsley G, Anzalone A, Stone J, Askow AT, Oliver JM, Fiore W, Biffi A, Taylor L. Probiotic administration increases amino acid absorption from plant protein – A placebo‐controlled, randomized, double‐blind, multicenter, crossover study. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.00232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Demonte A, Guanti MB, Liberati S, Biffi A, Fernando F, Fainello M, Pepe P. Bilastine safety in drivers who need antihistamines: new evidence from high-speed simulator driving test on allergic patients. Eur Rev Med Pharmacol Sci 2019; 22:820-828. [PMID: 29461615 DOI: 10.26355/eurrev_201802_14318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Bilastine is a highly selective, non-sedating antihistamine, indicated for the symptomatic treatment of allergic rhinoconjunctivitis and urticaria. Available data suggest that bilastine interferes neither with driving ability nor with flying-related performance. However, no data are available on the effect of bilastine on the driving ability in extreme conditions. Here we analyzed the effect of 7 days treatment with 20 mg bilastine in patients with allergic rhinitis and/or chronic urticaria, on psychophysical performance assessed by the Formula One (F1) high-speed simulator-driving test. PATIENTS AND METHODS This study is a phase IV, interventional, prospective, mono-centric, single arm, open-label trial. Eighteen outpatients affected by allergic rhinitis and/or chronic urticaria, able to perform a preliminary driving test on F1 simulator were considered (V-1). First, the patients had a screening visit to assess their eligibility (V0). Visit 1 (V1), at the end of placebo before bilastine treatment and Visit 2 (V2), at the end of bilastine treatment. The primary variable parameter was the ability to maintain the vehicle in a central position at different speeds (50, 150, and 250 km/h). RESULTS Bilastine had a good safety profile and was well tolerated in terms of adverse events, laboratory parameters and vital signs. Bilastine did not have any negative effect on the ability to maintain the requested path, a constant speed as well as on attention and reactivity levels, even in extreme driving conditions. CONCLUSIONS This study is the first done in patients with allergic rhinitis and/or chronic urticaria using a F1-high speed simulator-driving test evaluating subjects' performance under bilastine treatment.
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Affiliation(s)
- A Demonte
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine; Dermatology Unit; University of Modena and Reggio Emilia, Modena, Italy.
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13
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Biffi A, Rea F, Scotti L, Mugelli A, Lucenteforte E, Bettiol A, Chinellato A, Onder G, Vitale C, Agabiti N, Trifirò G, Roberto G, Corrao G. Antidepressants and the risk of arrhythmia in elderly affected by a previous cardiovascular disease: a real-life investigation from Italy. Eur J Clin Pharmacol 2017; 74:119-129. [PMID: 29046942 DOI: 10.1007/s00228-017-2352-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/04/2017] [Accepted: 10/09/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE The study aimed to fill existing knowledge gaps on the safety of antidepressant drugs (ADs) by estimating the risk of hospitalization for arrhythmia associated with use of selective serotonin reuptake inhibitors (SSRIs) and newer atypical ADs (NAAs) among elderly with previous cardiovascular (CV) events. METHODS The cohort was composed by 199,569 individuals aged ≥ 65 years from five Italian healthcare territorial units who were discharged for cardiovascular outcomes in the years 2008-2010. The 17,277 patients who experienced hospital admission for arrhythmia during follow-up were included as cases. Odds of current ADs use among cases (i.e., 14 days before hospital admission) was compared with (i) odds of current use of 1:5 matched controls (between-patients case-control) and with (ii) odds of previous use during 1:5 matched control periods (within-patient case-crossover). The risk of arrhythmia associated with ADs current use was modelled fitting a conditional logistic regression. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS Current users of SSRIs and NAAs were at increased risk of arrhythmia with case-control odds ratios (OR) of 1.37 (95% confidence interval, CI 1.18 to 1.58) and 1.41 (1.16 to 1.71) and case-crossover OR of 1.48 (1.20 to 1.81) and 1.72 (1.31 to 2.27). An increased risk of arrhythmia was associated with current use of trazodone (NAA) consistently in case-control and case-crossover designs. CONCLUSIONS Evidence that current use of SSRIs and NAAs is associated to an increased risk of arrhythmia among elderly with CV disease was consistently supplied by two observational approaches.
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Affiliation(s)
- A Biffi
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - F Rea
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - L Scotti
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - A Mugelli
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - E Lucenteforte
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - A Bettiol
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy.,Treviso Local Health Unit, Treviso, Italy
| | | | - G Onder
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Vitale
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - N Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - G Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - G Roberto
- Epidemiology Unit, Regional Agency for Healthcare Services of Tuscany, Florence, Italy
| | - G Corrao
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Sottotetti S, Teri A, Biffi A, Girelli D, D'Accico M, Vignati C, Maraschini A, Pizzamiglio G, Arghittu M, Colombo C, Cariani L. 124 Molecular typing of Burkholderia cepacia complex in patients with cystic fibrosis. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30488-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Biffi A, Comoretto R, Arfè A, Scotti L, Merlino L, Vaghi A, Pesci A, de Marco R, Corrao G. Can healthcare utilization data reliably capture cases of chronic respiratory diseases? a cross-sectional investigation in Italy. BMC Pulm Med 2017; 17:20. [PMID: 28103865 PMCID: PMC5248488 DOI: 10.1186/s12890-016-0362-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 12/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare utilization data are increasingly used for chronic disease surveillance. Nevertheless, no standard criteria for estimating prevalence of high-impact diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, are available. In this study an algorithm for recognizing COPD/asthma cases from HCU data is developed and implemented in the HCU databases of the Italian Lombardy Region (about 10 million residents). The impact of diagnostic misclassification for reliably estimating prevalence was also assessed. METHODS Disease-specificdrug codes, hospital discharges together with co-payment exemptions when available, and a combination of them according with patient's age, were used to create the proposed algorithm. Identified cases were considered for prevalence estimation. An external validation study was also performed in order to evaluate systematic uncertainty of prevalence estimates. RESULTS Raw prevalence of COPD and asthma in 2010 was 3.6 and 3.3% respectively. According to external validation, sensitivity values were 53% for COPD and 39% for asthma. Adjusted prevalence estimates were respectively 6.8 and 8.5% for COPD (among person aged 40 years or older) and asthma (among person aged 40 years or younger). CONCLUSIONS COPD and asthma prevalence may be estimated from HCU data, albeit with high systematic uncertainty. Validation is recommended in this setting.
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Affiliation(s)
- A Biffi
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy
| | - R Comoretto
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy
| | - A Arfè
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy.,Department of Decision Sciences, Bocconi University, Milan, Italy
| | - L Scotti
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy
| | - L Merlino
- Operative Unit of Territorial Health Services, Region Lombardia, Milan, Italy
| | - A Vaghi
- Division of Pneumology, "Guido Salvini" Hospital, Garbagnate Milanese, Italy
| | - A Pesci
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Division of Pneumology, "San Gerardo" Hospital, Monza, Italy
| | - R de Marco
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - G Corrao
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy.
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Biffi A, Scotti L, Corrao G. Use of antidepressants and the risk of cardiovascular and cerebrovascular disease: a meta-analysis of observational studies. Eur J Clin Pharmacol 2017; 73:487-497. [DOI: 10.1007/s00228-016-2187-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/19/2016] [Indexed: 01/11/2023]
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17
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Velardo D, Domi T, Porrello E, Capotondo A, Biffi A, Tonlorenzi R, Takeda S, Amadio S, Ruegg M, Previtali S. Combined cell and gene therapy to treat merosin deficient congenital muscular dystrophy. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Cariani L, Biffi A, Guarneri D, Girelli D, Teri A, D'Accico M, Beltrami B, Arghittu M, Torresani E, Colombo C. 56 Colonization by Rasamsonia argillacea in cystic fibrosis patients: A two-year retrospective study. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lorioli L, Cicalese MP, Silvani P, Assanelli A, Salvo I, Mandelli A, Fumagalli F, Fiori R, Ciceri F, Aiuti A, Sessa M, Roncarolo MG, Lanzani C, Biffi A. Abnormalities of acid-base balance and predisposition to metabolic acidosis in Metachromatic Leukodystrophy patients. Mol Genet Metab 2015; 115:48-52. [PMID: 25796965 DOI: 10.1016/j.ymgme.2015.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
Metachromatic Leukodystrophy (MLD; MIM# 250100) is a rare inherited lysosomal storage disorder caused by the deficiency of Arylsulfatase A (ARSA). The enzymatic defect results in the accumulation of the ARSA substrate that is particularly relevant in myelin forming cells and leads to progressive dysmyelination and dysfunction of the central and peripheral nervous system. Sulfatide accumulation has also been reported in various visceral organs, although little is known about the potential clinical consequences of such accumulation. Different forms of MLD-associated gallbladder disease have been described, and there is one reported case of an MLD patient presenting with functional consequences of sulfatide accumulation in the kidney. Here we describe a wide cohort of MLD patients in whom a tendency to sub-clinical metabolic acidosis was observed. Furthermore in some of them we report episodes of metabolic acidosis of different grades of severity developed in acute clinical conditions of various origin. Importantly, we finally show how a careful acid-base balance monitoring and prompt correction of imbalances might prevent severe consequences of acidosis.
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Affiliation(s)
- L Lorioli
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), San Raffaele Hospital, Milano, Italy; Pediatric Immunohematology Unit, San Raffaele Hospital, Milano, Italy; Stem Cell Transplantation Program, San Raffaele Hospital, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - M P Cicalese
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), San Raffaele Hospital, Milano, Italy; Pediatric Immunohematology Unit, San Raffaele Hospital, Milano, Italy
| | - P Silvani
- Departement of Anesthesia and Critical Care, San Raffaele Hospital, Milano, Italy
| | - A Assanelli
- Pediatric Immunohematology Unit, San Raffaele Hospital, Milano, Italy; Stem Cell Transplantation Program, San Raffaele Hospital, Milano, Italy; Bone marrow Transplantation Unit, San Raffaele Hospital, Milano, Italy
| | - I Salvo
- Pediatric Anesthesia and Intensive Care, Buzzi Children Hospital, Milano, Italy
| | - A Mandelli
- Pediatric Anesthesia and Intensive Care, Buzzi Children Hospital, Milano, Italy
| | - F Fumagalli
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), San Raffaele Hospital, Milano, Italy; Neurology Department, Division of Neuroscience, San Raffaele Hospital, Milano, Italy
| | - R Fiori
- Departement of Anesthesia and Critical Care, San Raffaele Hospital, Milano, Italy
| | - F Ciceri
- Bone marrow Transplantation Unit, San Raffaele Hospital, Milano, Italy
| | - A Aiuti
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), San Raffaele Hospital, Milano, Italy; Pediatric Immunohematology Unit, San Raffaele Hospital, Milano, Italy; Stem Cell Transplantation Program, San Raffaele Hospital, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - M Sessa
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), San Raffaele Hospital, Milano, Italy; Neurology Department, Division of Neuroscience, San Raffaele Hospital, Milano, Italy
| | - M G Roncarolo
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), San Raffaele Hospital, Milano, Italy; Pediatric Immunohematology Unit, San Raffaele Hospital, Milano, Italy; Stem Cell Transplantation Program, San Raffaele Hospital, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - C Lanzani
- Nephrology Department, San Raffaele Hospital, Milano, Italy
| | - A Biffi
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), San Raffaele Hospital, Milano, Italy; Pediatric Immunohematology Unit, San Raffaele Hospital, Milano, Italy; Stem Cell Transplantation Program, San Raffaele Hospital, Milano, Italy.
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Touati K, Faure C, Cornet M, Botterel F, Dannaoui E, Morio F, Lepape P, Grenouillet F, Favennec L, Le Gal S, Nevez G, Borman A, Saegeman V, Lagrou K, Gomez E, Caro-Luis M, Canton R, Campana S, Buzina W, Chen S, Meyer W, Roilides E, Simitsopoulou M, Manso E, Cariani L, Biffi A, Fiscarelli E, Riccioti G, Sendid B, Pihet M, Bouchara JP, Delhaes L. Evaluation of the risk of fungal colonization/infection in patients with cystic fibrosis: An international prospective study comparing the performance of media for mycological culturing MucoFong International Project (MFIP). J Mycol Med 2014. [DOI: 10.1016/j.mycmed.2014.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Alicandro G, Faelli N, Gagliardini R, Santini B, Magazzù G, Biffi A, Risé P, Galli C, Tirelli AS, Loi S, Valmarana L, Cirilli N, Palmas T, Vieni G, Bianchi ML, Agostoni C, Colombo C. A randomized placebo-controlled study on high-dose oral algal docosahexaenoic acid supplementation in children with cystic fibrosis. Prostaglandins Leukot Essent Fatty Acids 2013; 88:163-9. [PMID: 23266209 DOI: 10.1016/j.plefa.2012.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 12/21/2022]
Abstract
Low plasma concentrations of docosahexaenoic acid (DHA) are reported in unsupplemented cystic fibrosis (CF) patients. Forty-one CF patients aged from 6 to 12 years were randomized to receive high-dose DHA (100 mg/kg/day in the first month and 1g per day thereafter through a 12-month supplementation) or placebo (germ oil). Primary outcome was percentage change in plasma AA:DHA ratio. Secondary outcomes were changes in the number of pulmonary exacerbations compared to previous year, lung function, BMI, skinfold thicknesses, and body composition assessed by DXA and in serum concentrations of C-reactive protein, cytokines and vitamin (α-tocopherol and retinol). Compared to the control group plasma AA:DHA ratio decreased in the intervention group after 6 months (median percentage changes: -73% in the intervention group vs. -10% in the control group, P=0.001). No differences were detected between groups for secondary outcomes. Despite a decrease of the AA/DHA ratio, DHA supplementation for one year did not induce any significant biochemical and clinical improvement in CF patients.
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Affiliation(s)
- G Alicandro
- Centro Fibrosi Cistica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
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22
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Chutinet A, Biffi A, Kanakis A, Fitzpatrick KM, Furie KL, Rost NS. Severity of leukoaraiosis in large vessel atherosclerotic disease. AJNR Am J Neuroradiol 2012; 33:1591-5. [PMID: 22422177 DOI: 10.3174/ajnr.a3015] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The severity of white matter hyperintensity, or leukoaraiosis, is a marker of cerebrovascular disease. In stroke, WMH burden is strongly linked to lacunar infarction; however, impaired cerebral perfusion due to extracranial or intracranial atherosclerosis may also contribute to WMH burden. We sought to determine whether WMH burden is associated with extracranial or intracranial stenosis in patients with AIS. MATERIALS AND METHODS Patients with AIS with admission head/neck CTA and brain MR imaging were included in this analysis. "Extracranial stenosis" was defined as >50% stenosis in the extracranial ICA, and "intracranial," as >50% stenosis in either the middle, anterior, or posterior cerebral arteries on CTA, on either side. WMHV was determined by using a validated semiautomated protocol. Multiple regression was used to assess the relationship between WMHV and extracranial/intracranial atherosclerosis. RESULTS Of 201 subjects, 51 (25.4%) had extracranial and 63 (31.5%) had intracranial stenosis. Mean age was 62 ± 15 years; 36% were women. Mean WMHV was 12.87 cm(3) in the extracranial and 8.59 cm(3) in the intracranial stenosis groups. In univariate analysis, age (P < .0001), SBP and DBP (P = .004), and HTN (P = .0003) were associated with WMHV. Extracranial stenosis was associated with greater WMHV after adjustment for intracranial stenosis (P = .04). In multivariate analysis including extracranial stenosis, only age (P < .0001) and HTN (P = .03) demonstrated independent effects on WMHV. CONCLUSIONS In our cohort of patients with AIS, age and HTN were the strongest determinants of the WMHV severity. Future studies are warranted to unravel further association between WMHV and cerebral vessel atherosclerosis.
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Affiliation(s)
- A Chutinet
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
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23
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Biffi A, Shulman JM, Jagiella JM, Cortellini L, Ayres AM, Schwab K, Brown DL, Silliman SL, Selim M, Worrall BB, Meschia JF, Slowik A, De Jager PL, Greenberg SM, Schneider JA, Bennett DA, Rosand J. Genetic variation at CR1 increases risk of cerebral amyloid angiopathy. Neurology 2012; 78:334-41. [PMID: 22262751 DOI: 10.1212/wnl.0b013e3182452b40] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Accumulated evidence suggests that a variant within the CR1 gene (single nucleotide polymorphism rs6656401), known to increase risk for Alzheimer disease (AD), influences β-amyloid (Aβ) deposition in brain tissue. Given the biologic overlap between AD and cerebral amyloid angiopathy (CAA), a leading cause of intracerebral hemorrhage (ICH) in elderly individuals, we investigated whether rs6656401 increases the risk of CAA-related ICH and influences vascular Aβ deposition. METHODS We performed a case-control genetic association study of 89 individuals with CAA-related ICH and 280 individuals with ICH unrelated to CAA and compared them with 324 ICH-free control subjects. We also investigated the effect of rs6656401 on risk of recurrent CAA-ICH in a prospective longitudinal cohort of ICH survivors. Finally, association with severity of histopathologic CAA was investigated in 544 autopsy specimens from 2 longitudinal studies of aging. RESULTS rs6656401 was associated with CAA-ICH (odds ratio [OR] = 1.61, 95% confidence interval [CI] 1.19-2.17, p = 8.0 × 10(-4)) as well as with risk of recurrent CAA-ICH (hazard ratio = 1.35, 95% CI 1.04-1.76, p = 0.024). Genotype at rs6656401 was also associated with severity of CAA pathology at autopsy (OR = 1.34, 95% CI 1.05-1.71, p = 0.009). Adjustment for parenchymal amyloid burden did not cancel this effect, suggesting that, despite the correlation between parenchymal and vascular amyloid pathology, CR1 acts independently on both processes, thus increasing risk of both AD and CAA. CONCLUSION The CR1 variant rs6656401 influences risk and recurrence of CAA-ICH, as well as the severity of vascular amyloid deposition.
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Affiliation(s)
- A Biffi
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
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Herrington WG, Rosand J, Biffi A, Greenberg SM. Statin use and outcome after intracerebral hemorrhage: Case-control study and meta-analysis. Neurology 2011; 77:2073; author reply 2073-4. [DOI: 10.1212/wnl.0b013e318239be24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Biffi A, Battey TWK, Ayres AM, Cortellini L, Schwab K, Gilson AJ, Rost NS, Viswanathan A, Goldstein JN, Greenberg SM, Rosand J. Warfarin-related intraventricular hemorrhage: imaging and outcome. Neurology 2011; 77:1840-6. [PMID: 22049204 DOI: 10.1212/wnl.0b013e3182377e12] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Oral anticoagulation therapy (OAT) with warfarin increases mortality and disability after intracerebral hemorrhage (ICH), the result of increased ICH volume and risk of hematoma expansion. We investigated whether OAT also influences risk of development of intraventricular hemorrhage (IVH), the volume of IVH and IVH expansion, and whether IVH is a substantive mediator of the overall effect of OAT on ICH outcome. METHODS We performed a retrospective analysis of a prospectively collected single-center cohort of 1,879 consecutive ICH cases (796 lobar, 865 deep, 153 cerebellar, 15 multiple location, 50 primary IVH) from 1999 to 2009. ICH and IVH volumes at presentation, as well as hematoma expansion (>33% or >6 mL increase) and IVH expansion (>2 mL increase), were determined using established semiautomated methods. Outcome was assessed at 90 days using either the modified Rankin Scale or Glasgow Outcome Scale. RESULTS Warfarin use was associated with IVH risk, IVH volume at presentation, and IVH expansion in both lobar and deep ICH (all p < 0.05) in a dose-response relationship with international normalized ratio. Warfarin was associated with poor outcome in both lobar and deep ICH (p < 0.01), and >95% of this effect was accounted for by baseline ICH and IVH volumes, as well as ICH and IVH expansion. CONCLUSION Warfarin increases IVH volume and risk of IVH expansion in lobar and deep ICH. These findings (along with effects on ICH volume and expansion) likely represent the mechanisms by which anticoagulation worsens ICH functional outcome.
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Affiliation(s)
- A Biffi
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
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26
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Ungaro D, Visigalli I, Ungari S, Amadio S, Butera C, Bianchi F, Biffi A, Comi G, Del Carro U. P10.3 Treating Krabbe disease: neurophysiological assessment of a mouse model. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60370-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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27
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Cariani L, Defilippi G, Clarizia G, D'Accico M, Garlaschi M, Biffi A, Claut L, Torresani E, Colombo C. 138 Genetic fingerprinting of Stenotrophomonas maltophilia strains isolated from cystic fibrosis patients. J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alicandro G, Gagliardini R, Santini B, Rise' P, Biffi A, Tirelli A, Tiso R, Valmarana L, Cirilli N, Colombo C. 290 Oral DHA supplementation in children with cystic fibrosis: a randomized placebo-controlled study. J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60304-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Biffi A, Devan WJ, Anderson CD, Ayres AM, Schwab K, Cortellini L, Viswanathan A, Rost NS, Smith EE, Goldstein JN, Greenberg SM, Rosand J. Statin use and outcome after intracerebral hemorrhage: case-control study and meta-analysis. Neurology 2011; 76:1581-8. [PMID: 21451150 DOI: 10.1212/wnl.0b013e3182194be9] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Intracerebral hemorrhage (ICH) is a highly lethal disease of the elderly. Use of statins is increasingly widespread among the elderly, and therefore common in patients who develop ICH. Accumulating data suggests that statins have neuroprotective effects, but their association with ICH outcome has been inconsistent. We therefore performed a meta-analysis of all available evidence, including unpublished data from our own institution, to determine whether statin exposure is protective for patients who develop ICH. METHODS In our prospectively ascertained cohort, we compared 90-day functional outcome in 238 pre-ICH statin cases and 461 statin-free ICH cases. We then meta-analyzed results from our cohort along with previously published studies using a random effects model, for a total of 698 ICH statin cases and 1,823 non-statin-exposed subjects. RESULTS Data from our center demonstrated an association between statin use before ICH and increased probability of favorable outcome (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.37-3.17) and reduced mortality (OR = 0.47, 95% CI 0.32-0.70) at 90 days. No compound-specific statin effect was identified. Meta-analysis of all published evidence confirmed the effect of statin use on good outcome (OR = 1.91, 95% CI 1.38-2.65) and mortality (OR = 0.55, 95% CI 0.42-0.72) after ICH. CONCLUSION Antecedent use of statins prior to ICH is associated with favorable outcome and reduced mortality after ICH. This phenomenon appears to be a class effect of statins. Further studies are required to clarify the biological mechanisms underlying these observations.
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Affiliation(s)
- A Biffi
- Center for Human Genetic Research, Massachusetts General Hospital, 185 Cambridge Street, CPZN-6818, Boston, MA 02114, USA
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Rost NS, Rahman RM, Biffi A, Smith EE, Kanakis A, Fitzpatrick K, Lima F, Worrall BB, Meschia JF, Brown RD, Brott TG, Sorensen AG, Greenberg SM, Furie KL, Rosand J. White matter hyperintensity volume is increased in small vessel stroke subtypes. Neurology 2010; 75:1670-7. [PMID: 21060091 DOI: 10.1212/wnl.0b013e3181fc279a] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE White matter hyperintensity (WMH) may be a marker of an underlying cerebral microangiopathy. Therefore, we hypothesized that WMH would be most severe in patients with lacunar stroke and intracerebral hemorrhage (ICH), 2 types of stroke in which cerebral small vessel (SV) changes are pathophysiologically relevant. METHODS We determined WMH volume (WMHV) in cohorts of prospectively ascertained patients with acute ischemic stroke (AIS) (Massachusetts General Hospital [MGH], n = 628, and the Ischemic Stroke Genetics Study [ISGS], n = 263) and ICH (MGH, n = 122). RESULTS Median WMHV was 7.5 cm³ (interquartile range 3.4-14.7 cm³) in the MGH AIS cohort (mean age 65 ± 15 years). MGH patients with larger WMHV were more likely to have lacunar stroke compared with cardioembolic (odds ratio [OR] = 1.87 per SD normally transformed WMHV), large artery (OR = 2.25), undetermined (OR = 1.87), or other (OR = 1.85) stroke subtypes (p < 0.03). These associations were replicated in the ISGS cohort (p = 0.03). In a separate analysis, greater WMHV was seen in ICH compared with lacunar stroke (OR = 1.2, p < 0.02) and in ICH compared with all ischemic stroke subtypes combined (OR = 1.34, p < 0.007). CONCLUSIONS Greater WMH burden was associated with SV stroke compared with other ischemic stroke subtypes and, even more strongly, with ICH. These data, from 2 independent samples, support the model that increasing WMHV is a marker of more severe cerebral SV disease and provide further evidence for links between the biology of WMH and SV stroke.
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Affiliation(s)
- N S Rost
- J. Philip Kistler Stroke Research Center, Center for Human Genetics Research, Massachusetts General Hospital, 175 Cambridge St, Suite 300, Boston, MA 02114, USA.
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Biffi A, Halpin A, Towfighi A, Gilson A, Busl K, Rost N, Smith EE, Greenberg MS, Rosand J, Viswanathan A. Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. Neurology 2010; 75:693-8. [PMID: 20733144 DOI: 10.1212/wnl.0b013e3181eee40f] [Citation(s) in RCA: 228] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To identify and compare clinical and neuroimaging predictors of primary lobar intracerebral hemorrhage (ICH) recurrence, assessing their relative contributions to recurrent ICH. METHODS Subjects were consecutive survivors of primary ICH drawn from a single-center prospective cohort study. Baseline clinical, imaging, and laboratory data were collected. Survivors were followed prospectively for recurrent ICH and intercurrent aspirin and warfarin use, including duration of exposure. Cox proportional hazards models were used to identify predictors of recurrence stratified by ICH location, with aspirin and warfarin exposures as time-dependent variables adjusting for potential confounders. RESULTS A total of 104 primary lobar ICH survivors were enrolled. Recurrence of lobar ICH was associated with previous ICH before index event (hazard ratio [HR] 7.7, 95% confidence interval [CI] 1.4-15.7), number of lobar microbleeds (HR 2.93 with 2-4 microbleeds present, 95% CI 1.3-4.0; HR = 4.12 when >or=5 microbleeds present, 95% CI 1.6-9.3), and presence of CT-defined white matter hypodensity in the posterior region (HR 4.11, 95% CI 1.01-12.2). Although aspirin after ICH was not associated with lobar ICH recurrence in univariate analyses, in multivariate analyses adjusting for baseline clinical predictors, it independently increased the risk of ICH recurrence (HR 3.95, 95% CI 1.6-8.3, p = 0.021). CONCLUSIONS Recurrence of lobar ICH is associated with previous microbleeds or macrobleeds and posterior CT white matter hypodensity, which may be markers of severity for underlying cerebral amyloid angiopathy. Use of an antiplatelet agent following lobar ICH may also increase recurrence risk.
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Affiliation(s)
- A Biffi
- Department of Neurology and Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA 02114, USA
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Faelli N, Tirelli A, Costantini D, Biffi A, Motta V, Conese M, Colombo C. Cytokine profiles in different matrices before and after therapy for acute exacerbation in cystic fibrosis (CF) patients. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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33
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Locatelli A, Zagarella A, Toso L, Assi F, Ghidini A, Biffi A. Serial assessment of amniotic fluid index in uncomplicated term pregnancies: prognostic value of amniotic fluid reduction. J Matern Fetal Neonatal Med 2010; 15:233-6. [PMID: 15280130 DOI: 10.1080/14767050410001668671] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Assessment of amniotic fluid volume in association with a non-stress test is a commonly used method to monitor fetal well-being in high-risk pregnancies. The aims of our study were to determine whether oligohydramnios and the trend in amniotic fluid volume have prognostic significance in low-risk pregnancies between 40.0 and 41.6 weeks' gestation. METHODS Between January 1997 and December 2000, all uncomplicated gestations with a singleton non-anomalous fetus reaching 40.0 weeks' gestation underwent semi-weekly monitoring of amniotic fluid index (AFI) until delivery. Oligohydramnios was defined as an AFI of < or = 5 cm. Changes in AFI were expressed as centimeters per day, and were calculated as: [(last AFI before delivery minus first AFI at 40.0 weeks) / interval in days between the two scans]. Adverse outcome was considered the occurrence of 5-min Apgar score < 7; umbilical artery pH < 7.0; Cesarean section for fetal distress; or fetal death. Comparisons between the groups with favorable and adverse outcomes was performed with chi(2) or Fisher's exact test for categorical variables, and Student's t test for continuous variables. A two-tailed p value < 0.05 was considered significant. RESULTS A total of 3050 women met the study criteria, and underwent a median number of two (range 1-7) sonographic assessments of AFI after 40.0 weeks, with oligohydramnios detected in 341 women. In 1466 women at least two serial AFI determinations were obtained, allowing computation of an AFI trend. Gestations resulting in adverse perinatal outcome (n = 167, 5.5%) had a significantly higher rate of oligohydramnios (33/167, 19.8% vs. 308/2883, 10.7%, p = 0.001), but a similar rate of reduction in AFI ( -0.65 +/- 0.64 vs. - 0.66 +/- 0.66 cm/day; p = 0.85) than those with favorable outcome. The difference in rate of reduction of AFI between the two groups was not significant, even in the subset of gestations that developed oligohydramnios ( -1.08 +/- 0.87 vs. -1.26 +/- 0.89 cm/day; p = 0.27). CONCLUSION A sonographic diagnosis of oligohydramnios carries an increased risk of adverse perinatal outcome, even in low-risk pregnancies after 40 weeks. The trend in amniotic fluid volume reduction does not seem to have prognostic significance.
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Affiliation(s)
- A Locatelli
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy
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34
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Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, Biffi A, Buja G, Delise P, Gussac I, Anastasakis A, Borjesson M, Bjornstad HH, Carre F, Deligiannis A, Dugmore D, Fagard R, Hoogsteen J, Mellwig KP, Panhuyzen-Goedkoop N, Solberg E, Vanhees L, Drezner J, Estes NM, Iliceto S, Maron BJ, Peidro R, Schwartz PJ, Stein R, Thiene G, Zeppilli P, McKenna WJ. Corrigendum to: 'Recommendations for interpretation of 12-lead electrocardiogram in the athlete' [Eur Heart J 2010;31:243-259]. Eur Heart J 2010. [DOI: 10.1093/eurheartj/ehp606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Participation in sports activity and regular physical training is associated with physiological structural and electrical changes in the heart (athlete's heart) that enable sustained increases in cardiac output for prolonged periods. Cardiovascular remodelling in the conditioned athlete is often associated with ECG changes. In rare cases, abnormalities of an athlete's ECG may reflect an underlying heart disease which puts the athlete at risk of arrhythmic cardiac arrest during sport. It is mandatory that ECG abnormalities resulting from intensive physical training and those of a potential cardiac pathology are properly defined. This article provides a modern approach to interpreting 12-lead ECGs of athletes based on recently published new findings. The main objective is to distinguish between physiological adaptive ECG changes and pathological ECG abnormalities. The most important aims are to prevent physiological changes in the athlete being erroneously attributed to heart disease, or signs of life-threatening cardiovascular conditions being dismissed as a normal variant of athlete's heart. As pathological ECG abnormalities not only cause alarm but also require action with additional testing to exclude (or confirm) the suspicion of a lethal cardiovascular disorder, appropriate interpretation of an athlete's ECG will prevent unnecessary distress and also result in considerable cost saving in the context of a population-based preparticipation screening programme.
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Affiliation(s)
- D Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Via Giustiniani 2, 35121 Padova, Italy.
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Aiuti A, Cappelli B, Biffi A, Marktel S, Roncarolo MG. [Gene therapy in pediatrics]. Minerva Pediatr 2009; 61:775-778. [PMID: 19935549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- A Aiuti
- ImmunoEmatologia Pediatrica e Trapianto di Midollo Osseo, IRCSS San Raffaele, Milano
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Eichler F, Grodd W, Grant E, Sessa M, Biffi A, Bley A, Kohlschuetter A, Loes DJ, Kraegeloh-Mann I. Metachromatic leukodystrophy: a scoring system for brain MR imaging observations. AJNR Am J Neuroradiol 2009; 30:1893-7. [PMID: 19797797 DOI: 10.3174/ajnr.a1739] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Metachromatic leukodystrophy (MLD) is a devastating demyelinating disease for which novel therapies are being tested. We hypothesized that MR imaging of brain lesion involvement in MLD could be quantified along a scale. MATERIALS AND METHODS Thirty-four brain MR images in 28 patients with proved biochemical and genetic defects for MLD were reviewed: 10 patients with late infantile, 16 patients with juvenile, and 2 patients with adult MLD. All MR images were reviewed by experienced neuroradiologists and neurologists (2 readers in Germany, 2 readers in the United States) for global disease burden, as seen on the T2 and fluid-attenuated inversion recovery images. A visual scoring method was based on a point system (range, 0-34) derived from the location of white matter involvement and the presence of global atrophy, analogous to the scoring system developed for adrenoleukodystrophy. The readers were blinded to the neurologic findings. RESULTS Thirty-three of 34 MR images showed confluent T2 hyperintensities of white matter. The inter-rater reliability coefficient was 0.988. Scores between readers were within 2 points of each other. Serial MR imaging studies in 6 patients showed significant progressive disease in 3 patients (initial score average, 4; mean follow-up, 24.3) and no change or 1 point progression in 3 patients (initial score average, 12; mean follow-up, 12.66). Projection fibers and the cerebellum tended to be involved only in advanced stages of disease. CONCLUSIONS The MLD MR severity scoring method can be used to provide a measure of brain MR imaging involvement in MLD patients.
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Affiliation(s)
- F Eichler
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Cariani L, Defilippi G, Costantini D, Colombo C, Garlaschi M, Torresani E, Biffi A. Antibiotics sensitivity in mucoid and non mucoid Pseudomonas aeruginosa isolates from cystic fibrosis patients. J Cyst Fibros 2009. [DOI: 10.1016/s1569-1993(09)60162-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Biffi A, Cesani M, Fumagalli F, Del Carro U, Baldoli C, Canale S, Gerevini S, Amadio S, Falautano M, Rovelli A, Comi G, Roncarolo MG, Sessa M. Metachromatic leukodystrophy - mutation analysis provides further evidence of genotype-phenotype correlation. Clin Genet 2008; 74:349-57. [PMID: 18786133 DOI: 10.1111/j.1399-0004.2008.01058.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Metachromatic leukodystrophy (MLD) is a rare lysosomal storage disorder resulting from the inherited deficiency of the arylsulfatase A (ARSA) enzyme. Currently, no valid therapeutic options are available for affected patients. A thorough knowledge of disease progression in its diverse clinical variants, together with the identification of reliable prognostic factors, could be instrumental in accurate patient selection for new upcoming therapeutic opportunities, such as enzyme replacement and gene therapy. The described correlation between genotype and clinical presentation proved helpful in predicting patient's prognosis, only in the minority of MLD patients harboring common mutations. Molecular characterization of a cohort of 26 MLD patients allowed us to identify 18 mutations, excluding the common 0 and R alleles, 10 of which are rare and 8 are novel. By categorizing the rare mutations, we were able to confirm a correlation between ARSA gene mutations, age at onset and patterns of disease progression, not only in those patients bearing common mutations, but also in those carrying rare mutant alleles. Moreover, in the case of absent or delayed molecular diagnosis, or of newly identified mutations, the involvement of peripheral nervous system from disease onset proved to be a sensitive prognostic marker predicting a severe progression.
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Affiliation(s)
- A Biffi
- San Raffaele Telethon Institute for Gene Therapy Paediatric Clinical Research Unit, San Raffaele Scientiffic Institute, Milan, Italy
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Costantini D, Biffi A, Garlaschi M, Zazzeron L, Clarizia G, Colombo C, Cariani L. ACHROMOBACTER XYLOSOXIDANS: FOLLOW-UP OF 20 PATIENTS WITH CHRONIC INFECTION. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60551-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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Colombo C, Faelli N, Tirelli A, Conese M, Costantini D, Biffi A, Motta V. CYTOKINE PROFILES IN DIFFERENT MATRIXES (SERUM, SPUTUM AND EXHALATE) OF CYSTIC FIBROSIS PATIENTS. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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Biffi A, Costantini D, Colombo C, Zazzeron L, Garlaschi M, Torresani E, Cariani L. Diagnostic value of antibody anti Pseudomonas aeruginosa in early lung infection in cystic fibrosis patients. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Giada F, Carlon R, Delise P, Biffi A, Priori S, Raviele A, Santini M, Fattirolli F, Guiducci U, Penco M, Belardinelli R, Agostoni PG. [Consensus Statement of Multisocietary Task Force--prescription of physical exercise in the cardiological environment (third part)]. Monaldi Arch Chest Dis 2008; 68:134-48. [PMID: 18361210 DOI: 10.4081/monaldi.2007.446] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
The purpose of this study was to evaluate the impact of a long-term athletic training on the clinical course of bicuspid aortic valve. A group of 81 athletes (73 M, 8 F, 22.7 +/- 5.6 years) with bicuspid aortic valve was collected. Based on clinical and echocardiographic criteria, athletes were initially divided into 2 groups: the low-risk (51 athletes) and the high-risk group (30 athletes). The high-risk athletes were disqualified from training and competitions after the first evaluation. Over the follow-up period, all of them showed significant worsening of morphologic and hemodynamic features of bicuspid aortic valve; two underwent surgical valvular repair and one of them died suddenly. Over the same period, six of the initially low-risk athletes (7%) showed significant worsening of morphologic features of bicuspid aortic valve and/or incidence of symptoms which led to their disqualification from competition. At the end of follow-up, we observed that in high-risk subjects the progression of valvular disease occurred independently from the former athletic activity and that the majority of athletes with mild bicuspid aortic valve had a benign clinical course. However, athletes with bicuspid aortic valve should be viewed with caution, and continued clinical surveillance would be mandatory.
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Affiliation(s)
- A Spataro
- Department of Cardiology, National Institute of Sport Medicine, Rome, Italy.
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Capotondo A, Cesani M, Pepe S, Fasano S, Gregori S, Tononi L, Venneri MA, Brambilla R, Quattrini A, Ballabio A, Cosma MP, Naldini L, Biffi A. Safety of Arylsulfatase A Overexpression for Gene Therapy of Metachromatic Leukodystrophy. Hum Gene Ther 2007; 18:821-36. [PMID: 17845130 DOI: 10.1089/hum.2007.048] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [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] [Indexed: 01/07/2023] Open
Abstract
Successful gene therapy approaches for metachromatic leukodystrophy (MLD), based either on hematopoietic stem/progenitor cells (HSPCs) or direct central nervous system (CNS) gene transfer, highlighted a requirement for high levels of arylsulfatase A (ARSA) expression to achieve correction of disease manifestations in the mouse model. Full assessment of the safety of ARSA expression above physiological levels thus represents a prerequisite for clinical translation of these approaches. Here, using lentiviral vectors (LVs), we generated two relevant models for the stringent evaluation of the consequences of ARSA overexpression in transduced cells. We first demonstrated that ARSA overexpression in human HSPCs does not affect their clonogenic and multilineage differentiation capacities in clonogenic assays and in a neonatal hematochimeric mouse model. Further, we studied ARSA overexpression in all body tissues by generating transgenic mice overexpressing the ARSA enzyme by LV up to 15-fold above the normal range and carrying multiple copies of LV in their genome. Characterization of these mice demonstrated the safety of ARSA overexpression in two main gene therapy targets, HSPCs and neurons, with maintenance of the complex functions of the hematopoietic and nervous system in the presence of supraphysiological enzyme levels. The activity of other sulfatases dependent on the same common activator, sulfatase-modifying factor-1 (SUMF1), was tested in ARSA-overexpressing HSPCs and in transgenic mice, excluding the occurrence of saturation phenomena. Overall, these data indicate that from the perspective of clinical translation, therapeutic levels of ARSA overexpression can be safely achieved. Further, they demonstrate an experimental platform for the preclinical assessment of the safety of new gene therapy approaches.
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MESH Headings
- Animals
- Animals, Newborn
- Antigens, CD34/immunology
- Antigens, CD34/metabolism
- Blotting, Southern
- Cell Differentiation
- Cell Lineage
- Cell Proliferation
- Cerebroside-Sulfatase/adverse effects
- Cerebroside-Sulfatase/analysis
- Cerebroside-Sulfatase/metabolism
- Colony-Forming Units Assay
- Feasibility Studies
- Genetic Therapy
- Genetic Vectors
- Hematopoietic Stem Cells/cytology
- Hematopoietic Stem Cells/metabolism
- Humans
- Lentivirus/genetics
- Leukodystrophy, Metachromatic/genetics
- Leukodystrophy, Metachromatic/metabolism
- Leukodystrophy, Metachromatic/pathology
- Leukodystrophy, Metachromatic/therapy
- Mice
- Mice, Transgenic
- Models, Animal
- Neurons/cytology
- Neurons/metabolism
- Polymerase Chain Reaction
- Spleen/cytology
- Transduction, Genetic
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Affiliation(s)
- A Capotondo
- San Raffaele Telethon Institute for Gene Therapy, 20132 Milan, Italy
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Pirovano M, Quintè A, Masseroni S, Romanelli A, Biffi A, Scaglione F, Fraschini F, Sestini S, Valsecchi R, Tabiadon D. Chronomodulated delivery schedule of oxaliplatin, 5 fluorouracil and folinic acid (FFL4/10) as first line treatment in metastatic colorectal cancer: Preliminary data of a phase II study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Pirovano
- San Carlo B.Hosp, Milan, Italy; Università degli Studi di Milano- Pharmacology Dep, Milan, Italy
| | - A. Quintè
- San Carlo B.Hosp, Milan, Italy; Università degli Studi di Milano- Pharmacology Dep, Milan, Italy
| | - S. Masseroni
- San Carlo B.Hosp, Milan, Italy; Università degli Studi di Milano- Pharmacology Dep, Milan, Italy
| | - A. Romanelli
- San Carlo B.Hosp, Milan, Italy; Università degli Studi di Milano- Pharmacology Dep, Milan, Italy
| | - A. Biffi
- San Carlo B.Hosp, Milan, Italy; Università degli Studi di Milano- Pharmacology Dep, Milan, Italy
| | - F. Scaglione
- San Carlo B.Hosp, Milan, Italy; Università degli Studi di Milano- Pharmacology Dep, Milan, Italy
| | - F. Fraschini
- San Carlo B.Hosp, Milan, Italy; Università degli Studi di Milano- Pharmacology Dep, Milan, Italy
| | - S. Sestini
- San Carlo B.Hosp, Milan, Italy; Università degli Studi di Milano- Pharmacology Dep, Milan, Italy
| | - R. Valsecchi
- San Carlo B.Hosp, Milan, Italy; Università degli Studi di Milano- Pharmacology Dep, Milan, Italy
| | - D. Tabiadon
- San Carlo B.Hosp, Milan, Italy; Università degli Studi di Milano- Pharmacology Dep, Milan, Italy
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Del Carro U, Biffi A, Baldoli C, Gerevini S, Amadio S, Fumagalli F, Roncarolo MG, Sessa M. Clinical history and new prognostic indicators in metachromatic leukodystrophy. J Peripher Nerv Syst 2004. [DOI: 10.1111/j.1085-9489.2004.009209ab.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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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48
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Quattrini A, Biffi A, Amadio S, Bertani I, Dina G, Del Carro U, Previtali S, Bordignon C, Naldini L. Correction of metachromatic leukodystrophies (MLD) in the mouse model by transplantation of genetically modified hematopoietic stem cells. J Peripher Nerv Syst 2004. [DOI: 10.1111/j.1085-9489.2004.009209af.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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Assanelli D, Cottarelli C, Salvadori G, Rubino F, Fernando F, Biffi A. [Work, cardiopathy, and sports]. Med Lav 2004; 95:119-23. [PMID: 15218743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Heart disease is the main cause of early disability and premature death in Europe. Regular physical activity may prevent heart disease, diabetes, ictus, and obesity. Nevertheless, a certain resistance to a dynamic lifestyle, lack of free time, lack of motivation and other factors are frequently encountered. OBJECTIVES To stress the importance of physical activity in the prevention of cardiovascular disease. METHODS A literature review of the main risk factors for cardiovascular disease was carried out. RESULTS AND CONCLUSION It has been shown that physical exercise is beneficial to the cardiovascular apparatus and to the bones and joints, by improving some metabolic parameters. Recent studies have shown that a personalized, moderate physical activity should be suggested for primary and secondary prevention, in particular for subjects with coronary artery disease and left ventricular dysfunction. An increase in sports activity and physical exercise at work and at school is recommended so as to improve quality of life and promote home rehabilitation. Some promising experience has already been made among workers and their families with excellent results, as shown by a follow-up period of three years.
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Affiliation(s)
- D Assanelli
- Università degli Studi di Brescia, P.le Spedali Civili 1, 25123 Brescia.
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Coradini D, Biffi A, Costa A, Pellizzaro C, Pirronello E, Di Fronzo G. Effect of sodium butyrate on human breast cancer cell lines. Cell Prolif 2003; 30:149-59. [PMID: 9375027 PMCID: PMC6496195] [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: 02/05/2023] Open
Abstract
We have investigated the effects exerted by sodium butyrate (NaBu) on the growth and cell cycle perturbations of four human breast cancer cell lines (MCF7, T47D, MDA-MB231 and BT20) with different steroid receptor profiles. Moreover, since one of the supposed mechanisms of action for NaBu activity involves the induction of apoptosis, we have studied the effects of NaBu on DNA fragmentation by agarose gel electrophoresis and flow cytometry. In all investigated cell lines, NaBu exerted a time- and dose-dependent inhibition of growth and caused a maximum inhibitory effect (85% to 90%) at the concentration of 2.5 mM. The inhibition was already evident after 3 days of treatment. The antiproliferative effect of NaBu was associated with a persistent block of cells in the G2M phase. The block was associated with apoptosis only in oestrogen-receptor positive cell lines. The inhibiting effect of NaBu in hormone-dependent and independent cell lines and its ability to induce apoptosis through a cell cycle perturbation in hormone-dependent cell lines may have important implications in the treatment of human tumours including breast cancer.
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Affiliation(s)
- D Coradini
- Oncologia Sperimentale C. Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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