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Pagano E, Pellegrino L, Robella M, Castiglione A, Brunetti F, Giacometti L, Rolfo M, Rizzo A, Palmisano S, Meineri M, Bachini I, Morino M, Allaix ME, Mellano A, Massucco P, Bellomo P, Polastri R, Ciccone G, Borghi F. Implementation of an enhanced recovery after surgery protocol for colorectal cancer in a regional hospital network supported by audit and feedback: a stepped wedge, cluster randomised trial. BMJ Qual Saf 2024:bmjqs-2023-016594. [PMID: 38423752 DOI: 10.1136/bmjqs-2023-016594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols are known to potentially improve the management and outcomes of patients undergoing colorectal surgery, with limited evidence of their implementation in hospital networks and in a large population. We aimed to assess the impact of the implementation of an ERAS protocol in colorectal cancer surgery in the entire region of Piemonte, Italy, supported by an audit and feedback (A&F) intervention. METHODS A large, stepped wedge, cluster randomised trial enrolled patients scheduled for elective surgery at 29 general surgery units (clusters). At baseline (first 3 months), standard care was continued in all units. Thereafter, four groups of clusters began to adopt the ERAS protocol successively. By the end of the study, each cluster had a period in which standard care was maintained (control) and a period in which the protocol was applied (experimental). ERAS implementation was supported by initial training and A&F initiatives. The primary endpoint was length of stay (LOS) without outliers (>94th percentile), and the secondary endpoints were outliers for LOS, postoperative medical and surgical complications, quality of recovery and compliance with ERAS items. RESULTS Of 2626 randomised patients, 2397 were included in the LOS analysis (1060 in the control period and 1337 in the experimental period). The mean LOS without outliers was 8.5 days during the control period (SD 3.9) and 7.5 (SD 3.5) during the experimental one. The adjusted difference between the two periods was a reduction of -0.58 days (95% CI -1.07, -0.09; p=0.021). The compliance with ERAS items increased from 52.4% to 67.3% (estimated absolute difference +13%; 95% CI 11.4%, 14.7%). No difference in the occurrence of complications was evidenced (OR 1.22; 95% CI 0.89, 1.68). CONCLUSION Implementation of the ERAS protocol for colorectal cancer, supported by A&F approach, led to a substantial improvement in compliance and a reduction in LOS, without meaningful effects on complications.Trial registration number NCT04037787.
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Affiliation(s)
- Eva Pagano
- Unit of Clinical Epidemiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Luca Pellegrino
- Surgical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Manuela Robella
- Surgical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesco Brunetti
- Unit of Clinical Epidemiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lisa Giacometti
- Unit of Clinical Epidemiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Alessio Rizzo
- General Surgery and Oncology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Sarah Palmisano
- Anaesthesia and Intensive Care Unit, S Croce and Carle Cuneo Hospital Districts, Cuneo, Italy
| | - Maurizio Meineri
- Anaesthesia and Intensive Care Unit, S Croce and Carle Cuneo Hospital Districts, Cuneo, Italy
| | - Ilaria Bachini
- Clinical Nutrition and Dietetics Department, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Mario Morino
- Digestive and Oncological Surgery, Center for Minimal Invasive Surgery, Department of Surgery, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Ettore Allaix
- Digestive and Oncological Surgery, Center for Minimal Invasive Surgery, Department of Surgery, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alfredo Mellano
- Surgical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Paolo Massucco
- General Surgery and Oncology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Paola Bellomo
- General Surgery, Presidio Sanitario Gradenigo, Torino, Italy
| | - Roberto Polastri
- Department of Surgery, General Surgery Unit, Hospital of Biella, Ponderano, Biella, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Felice Borghi
- Surgical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
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Piovano E, Puppo A, Camanni M, Castiglione A, Delpiano EM, Giacometti L, Rolfo M, Rizzo A, Zola P, Ciccone G, Pagano E. Implementing Enhanced Recovery After Surgery for hysterectomy in a hospital network with audit and feedback: A stepped-wedge cluster randomised trial. BJOG 2024. [PMID: 38404145 DOI: 10.1111/1471-0528.17797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of implementing the Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing elective hysterectomy in a network of regional hospitals, supported by an intensive audit-and-feedback (A&F) approach. DESIGN A multi-centre, stepped-wedge cluster randomised trial (ClinicalTrials.gov NCT04063072). SETTING Gynaecological units in the Piemonte region, Italy. POPULATION Patients undergoing elective hysterectomy, either for cancer or for benign conditions. METHODS Twenty-three units (clusters), stratified by surgical volume, were randomised into four sequences. At baseline (first 3 months), standard care was continued in all units. Subsequently, the four sequences implemented the ERAS protocol successively every 3 months, after specific training. By the end of the study, each unit had a period in which standard care was maintained (control) and a period in which the protocol, supported by feedback, was applied (experimental). MAIN OUTCOME MEASURES Length of hospital stay (LOS), without outliers (>98th percentile). RESULTS Between September 2019 and May 2021, 2086 patients were included in the main analysis with an intention-to-treat approach: 1104 (53%) in the control period and 982 (47%) in the ERAS period. Compliance with the ERAS protocol increased from 60% in the control period to 76% in the experimental period, with an adjusted absolute difference of +13.3% (95% CI 11.6% to 15.0%). LOS, moving from 3.5 to 3.2 days, did not show a significant reduction (-0.12 days; 95% CI -0.30 to 0.07 days). No difference was observed in the occurrence of complications. CONCLUSIONS Implementation of the ERAS protocol for hysterectomy at the regional level, supported by an A&F approach, resulted in a substantial improvement in compliance, but without meaningful effects on LOS and complications. This study confirms the effectiveness of A&F in promoting important innovations in an entire hospital network and suggests the need of a higher compliance with the ERAS protocol to obtain valuable improvements in clinical outcomes.
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Affiliation(s)
- Elisa Piovano
- Obstetrics and Gynaecology Unit 2U, Sant'Anna Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Puppo
- Obstetrics and Gynaecology Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Marco Camanni
- Obstetrics and Gynaecology Unit, Martini Hospital, ASL Città di Torino, Turin, Italy
| | - Anna Castiglione
- Clinical Epidemiology Unit, AOU Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Elena Maria Delpiano
- Obstetrics and Gynaecology Unit, Martini Hospital, ASL Città di Torino, Turin, Italy
| | - Lisa Giacometti
- Clinical Epidemiology Unit, AOU Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Monica Rolfo
- Healthcare Services Direction, Humanitas Gradenigo, Torino, Italy
| | - Alessio Rizzo
- General Surgery and Oncology Unit, Mauriziano Hospital, Turin, Italy
| | - Paolo Zola
- Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Giovannino Ciccone
- Clinical Epidemiology Unit, AOU Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Eva Pagano
- Clinical Epidemiology Unit, AOU Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
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Curtoni A, Ghibaudo D, Veglio C, Imperatore L, Bianco G, Castiglione A, Ciccone G, Scaglione L, Scabini S, Corcione S, De Rosa FG, Costa C, Cavallo R. Light Scattering Technology and MALDI-TOF MS in the microbiological fast-track of bloodstream infections: potential impact on antimicrobial treatment choices in a real-life setting. J Med Microbiol 2023; 72. [PMID: 36748537 DOI: 10.1099/jmm.0.001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction. Rapid identification (ID) and antimicrobial susceptibility testing (AST) of bloodstream infections (BSI) pathogens are fundamental to switch from empirical to targeted antibiotic therapy improving patients outcome and reducing antimicrobial resistance spreading.Hypothesis. The adoption of a rapid microbiological protocol (RP) based on Matrix-Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (MALDI-TOF MS) and Light Scattering Technology (LST) for rapid diagnosis of BSI could positively impact on patients' antimicrobial management.Aim. The study aim was to evaluate a RP for BSI microbiological diagnosis in terms of accuracy, turnaround time (TAT) and potential therapeutic impact.Methodology. A prospective observational study was conducted: monomicrobial bacterial blood cultures of septic patients were analysed in parallel by RP and standard protocol (SP). In RP the combination of MALDI-TOF MS and LST was used for rapid ID and AST assessments, respectively. To determine the potential impact of RP on antimicrobial therapy management, clinicians were interviewed on therapeutic decisions based on RP and SP results. RP accuracy, TAT and impact were evaluated in comparison to SP results.Results. A total of 97 patients were enrolled. ID and AST concordance between RP and SP were 96.9 and 94.7 %, respectively. RP technical and real-life TAT were lower than SP (6.4 h vs. 18.4 h; 9.5 vs. 27.1 h). The agreement between RP- and SP-based therapeutic decisions was 90.7 (90 % CI 84.4-95.1). RP results could produce 24/97 correct antibiotic changes with 18/97 possible de-escalations and 25/97 prompt applications of infection control precautions.Conclusion. With the application of RP in BSI management, about one-fourth of patients may safely benefit from early targeted antibiotic therapy and infection control policies with one working day in advance in comparison to conventional methods. This protocol is feasible for clinical use in microbiology laboratories and potentially helpful for Antimicrobial Stewardship.
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Affiliation(s)
- Antonio Curtoni
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Davide Ghibaudo
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Caterina Veglio
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Luigi Imperatore
- Internal Medicine Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, University Hospital Città della Salute e della Scienza di Torino and CPO Piemonte, Turin, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, University Hospital Città della Salute e della Scienza di Torino and CPO Piemonte, Turin, Italy
| | - Luca Scaglione
- Internal Medicine Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Silvia Scabini
- Infectious Diseases Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Silvia Corcione
- Infectious Diseases Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Infectious Diseases Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Public Health and Paediatrics, University of Turin, Turin, Italy
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4
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Manzini PM, Ciccone G, De Rosa FG, Cavallo R, Ghisetti V, D’Antico S, Galassi C, Saccona F, Castiglione A, Birocco N, Francisci T, Hu H, Pecoraro C, Danielle F, Labanca L, Bordiga AM, Lorenzi M, Camisasca G, Giachino O, Pagliarino M, Ottone P, Scuvera ITD, Guaschino R, Freilone R, Berti P, Pittaluga F, Avolio M, Costa C, Raso S, Nucci A, Milan M, Baffa A, Russo A, Tornello A, Maddalena L, Delios G, Marletto FP, De Micheli AG, Mattei A, Baldassano S, Canta F, Russo ML, Bergamo D, Vitale F, Liccardi MM, Chinaglia A, Calcagno A, Converso M, Aldieri C, Libanore V, Blangetti I, Benedetti V, Mitola B, Scozzari G, Valfrè A, Rizzioli G, D’Amato T, Crocillà C, Naselli S, Granero V, Cornagliotto G, Lucania G, Scaglia C, Ferro F, Solimine C, Ricotti M, Gilestro C, Roncato R, Palladino A, Ongaro D, Poggio GA, Chiappero C, Pinna SM, Scabini S, Vischia F, Gregoretti MG, Lupia E, Brazzi L, Albera C, Scaglione L, Gallo V, Norbiato C, Albiani R, Sini BL, Fassiola A, Locatelli A, Di Perri G, Navarra M, Gardini I, Ciardiello A, La Grotta R, De Rosa A, Pasquino P, Fiore G, Franza O, Artoni P, Meinardi S, Calosso L, Molino P, Veglio MG, Beltramo T, Camerini O, Giancaspero K, Napoli F, Perboni A, Messa E, Buffolo F, Pagnozzi F, Bertone S, Lutri L, Gravante U, Sacchetti P, Pavan A, Castenetto E, Novelli M, Tucciarone M, Ocello P, Guido G, Frascaroli C, Vivenza DML, Patti F, Lorenzelli L, Balduzzi G, Ratti D, Mazzucco L, Balbo V, Pollis F, Leoncino S, Lupo C, Romano D, Ziccardi S, Marmifero M, Chichino G, Salio M, Aiosa G, Boverio R, Avonto I, Ghiotto S, Balbo R, Nico V, Aguzzi C, Pellegrino MC, Prucca M, Longa LA, Perotti L, Piovano F, Ambrogio L, Formica M, Monge E, Arena F, Barzaghi N, Tavera S, Canepari M, Strani G, Pomero F, Cianci MG, Gianarda M, Ruscitto L, De Martino D, Macchi S, Montagnana M, Grandinetti V, Magnani S, Radin E, Pellu V, Meucci M, Noè E, Torti P, Montagnani L, Doveri G, Giustetto G, Avdis C, Prina M, Eliantonio F, Lemut F, Semino G, Spidalieri P, Vallino D, Prota R, Buono G, Segala V, Milia MG, Aprà F, Livigni S, Manno E, Caula G, Vitali E, Liuzzi N, Pastorelli M, Caironi P, Gamna F, Scapino B, Gurioli L, Magro E, Roberti G, Santamaria GM, Daffonchio A, Varese P, Ghiazza G, Girino M, Pelazza C, Racca F, Grillo M, Del Bono V, Gianotto G, Aluffi E, Ravera E. Convalescent or standard plasma versus standard of care in the treatment of COVID-19 patients with respiratory impairment: short and long-term effects. A three-arm randomized controlled clinical trial. BMC Infect Dis 2022; 22:879. [PMID: 36418984 PMCID: PMC9682750 DOI: 10.1186/s12879-022-07716-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The efficacy of early treatment with convalescent plasma in patients with COVID-19 is debated. Nothing is known about the potential effect of other plasma components other than anti-SARS-CoV-2 antibodies. METHODS To determine whether convalescent or standard plasma would improve outcomes for adults in early phase of Covid19 respiratory impairment we designed this randomized, three-arms, clinical trial (PLACO COVID) blinded on interventional arms that was conducted from June 2020 to August 2021. It was a multicentric trial at 19 Italian hospitals. We enrolled 180 hospitalized adult patients with COVID-19 pneumonia within 5 days from the onset of respiratory distress. Patients were randomly assigned in a 1:1:1 ratio to standard of care (n = 60) or standard of care + three units of standard plasma (n = 60) or standard of care + three units of high-titre convalescent plasma (n = 60) administered on days 1, 3, 5 after randomization. Primary outcome was 30-days mortality. Secondary outcomes were: incidence of mechanical ventilation or death at day 30, 6-month mortality, proportion of days with mechanical ventilation on total length of hospital stay, IgG anti-SARS-CoV-2 seroconversion, viral clearance from plasma and respiratory tract samples, and variations in Sequential Organ Failure Assessment score. The trial was analysed according to the intention-to-treat principle. RESULTS 180 patients (133/180 [73.9%] males, mean age 66.6 years [IQR 57-73]) were enrolled a median of 8 days from onset of symptoms. At enrollment, 88.9% of patients showed moderate/severe respiratory failure. 30-days mortality was 20% in Control arm, 23% in Convalescent (risk ratio [RR] 1.13; 95% confidence interval [CI], 0.61-2.13, P = 0.694) and 25% in Standard plasma (RR 1.23; 95%CI, 0.63-2.37, P = 0.544). Time to viral clearance from respiratory tract was 21 days for Convalescent, 28 for Standard plasma and 23 in Control arm but differences were not statistically significant. No differences for other secondary endpoints were seen in the three arms. Serious adverse events were reported in 1.7%, 3.3% and 5% of patients in Control, Standard and Convalescent plasma arms respectively. CONCLUSIONS Neither high-titer Convalescent nor Standard plasma improve outcomes of COVID-19 patients with acute respiratory failure. Trial Registration Clinicaltrials.gov Identifier: NCT04428021. First posted: 11/06/2020.
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Affiliation(s)
- Paola Maria Manzini
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Giovannino Ciccone
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Francesco Giuseppe De Rosa
- grid.7605.40000 0001 2336 6580Department of Medical Science, University of Turin Faculty of Medicine and Surgery, Turin, Italy
| | - Rossana Cavallo
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Valeria Ghisetti
- grid.413671.60000 0004 1763 1028Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, Turin, Italy
| | - Sergio D’Antico
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Claudia Galassi
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Fabio Saccona
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Anna Castiglione
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Nadia Birocco
- Oncology Department, University Hospital City of Science and Health Turin, Turin, Italy
| | - Tiziana Francisci
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Huijing Hu
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Clara Pecoraro
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Franca Danielle
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Luciana Labanca
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Anna Maria Bordiga
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Marco Lorenzi
- Immunohematology and Transfusion Medicine, S Croce and Carle Cuneo Hospital District, Cuneo, Italy
| | - Giovanni Camisasca
- Transfusion Medicine and Blood Establishment, Holy Trinity Hospital Borgomanero, Borgomanero, Italy
| | - Osvaldo Giachino
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Mauro Pagliarino
- Maternal, Pediatric and Trauma Transfusion Medicine, University Hospital City of Science and Health Turin, Turin, Italy
| | - Piero Ottone
- grid.415081.90000 0004 0493 6869Transfusion Medicine, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | | | - Roberto Guaschino
- Transfusion Medicine, Saints Anthony and Biagio and Cesare Arrigo Alessandria National Hospital, Alessandria, Italy
| | | | - Pierluigi Berti
- Immunohematology and Transfusion Medicine, Umberto Parini Hospital, Aosta, Italy
| | - Fabrizia Pittaluga
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Maria Avolio
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Cristina Costa
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Samuele Raso
- Maternal, Pediatric and Trauma Transfusion Medicine, University Hospital City of Science and Health Turin, Turin, Italy
| | - Aurora Nucci
- Maternal, Pediatric and Trauma Transfusion Medicine, University Hospital City of Science and Health Turin, Turin, Italy
| | - Massimo Milan
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Alessandra Baffa
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Alessandra Russo
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Antonella Tornello
- Immunohematology and Transfusion Medicine, S Croce and Carle Cuneo Hospital District, Cuneo, Italy ,Immunohematology and Transfusion Medicine, ASL CN1 Mondovì, Mondovì, Italy
| | - Laura Maddalena
- Immunohematology and Transfusion Medicine, S Croce and Carle Cuneo Hospital District, Cuneo, Italy
| | | | - Fabio Paolo Marletto
- Immunohematology and Transfusion Medicine, Umberto Parini Hospital, Aosta, Italy
| | - Anna Grazia De Micheli
- Medical Emergency Division, University Hospital City of Science and Health Turin, Turin, Italy
| | - Alessio Mattei
- Pulmunology Unit, University Hospital City of Science and Health Turin, Turin, Italy
| | - Stefano Baldassano
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Science, Faculty of Medicine and Surgery, University of Turin, Turin, Italy
| | - Francesca Canta
- Infectious Diseases Unit, University Hospital City of Science and Health Turin, Turin, Italy
| | - Maria Luisa Russo
- Internal Medicine Unit, Santa Croce Hospital of Moncalieri, Moncalieri, Italy
| | - Daniele Bergamo
- Internal Medicine Unit, Santa Croce Hospital of Moncalieri, Moncalieri, Italy
| | - Francesco Vitale
- grid.414700.60000 0004 0484 5983Internal Medicine Unit, Ordine Mauriziano Di Torino Hospital, Turin, Italy
| | | | | | - Andrea Calcagno
- grid.7605.40000 0001 2336 6580Infectious Diseases Unit, Department of Medical Sciences, University of Turin Faculty of Medicine and Surgery, Turin, Italy
| | - Marcella Converso
- grid.415044.00000 0004 1760 7116Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Chiara Aldieri
- Infectious Diseases, S Croce and Carle Cuneo Hospital District, Cuneo, Italy
| | - Valentina Libanore
- grid.492852.0Infectious Diseases Unit, Cardinal Massaia Hospital of Asti, Asti, Italy
| | | | | | - Barbara Mitola
- grid.414700.60000 0004 0484 5983Hospital Medical Direction, Ordine Mauriziano di Torino Hospital, Turin, Italy
| | - Gitana Scozzari
- grid.413005.30000 0004 1760 6850Molinette Hospital Medical Direction, University Hospital City of Science and Health Turin, Turin, Italy
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Zola P, Ciccone G, Piovano E, Fuso L, Di Cuonzo D, Castiglione A, Pagano E, Peirano E, Landoni F, Sartori E, Narducci F, Bertetto O, Ferrero A. Effectiveness of Intensive Versus Minimalist Follow-Up Regimen on Survival in Patients With Endometrial Cancer (TOTEM Study): A Randomized, Pragmatic, Parallel Group, Multicenter Trial. J Clin Oncol 2022; 40:3817-3827. [PMID: 35858170 DOI: 10.1200/jco.22.00471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In the absence of clear evidence from randomized trials, the intensity of follow-up regimens after surgical treatment of endometrial cancer is highly variable in clinical practice. To reduce this uncertainty, we conducted a randomized trial to test whether an intensive (INT) versus a minimalist (MIN) follow-up regimen improves overall survival (OS) in patients undergoing operation for endometrial cancer. METHODS The TOTEM study was a large, pragmatic randomized trial, conducted in 42 hospitals (in Italy and France) including patients surgically treated for endometrial cancer, in complete clinical remission, International Federation of Gynecology and Obstetrics stage I-IV. After stratification by center and risk of relapse (low or high), patients were randomly assigned (1:1) to INT or MIN hospital-based follow-up regimens. The study was powered to demonstrate an absolute improvement of 5% of the 5-year OS with the INT regimen. RESULTS In total, 1,871 patients were randomly assigned between November 2008 and July 2018, and 1,847 patients (98.7%) were available for the final analysis (60% low risk). After a median follow-up of 69 months, the 5-year OS was 90.6% in the INT and 91.9% in the MIN arms (hazard ratio, 1.13, 95% CI, 0.86 to 1.50, P = .380). No differences in OS were found in subgroup analyses considering age, cancer treatment, risk of relapse, and degree of adherence of the center to the scheduled follow-up. The probability of detecting a relapse was slightly higher in the INT arm (hazard ratio, 1.17; 95% CI, 0.92 to 1.48; P = .194). CONCLUSION An INT follow-up in endometrial cancer-treated patients does not improve OS, even in high-risk patients. According to available evidence, there is no need to routinely add vaginal cytology, laboratory, or imaging investigations to the MIN regimens used in this trial.
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Affiliation(s)
- Paolo Zola
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Giovannino Ciccone
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Elisa Piovano
- SC Ginecologia e Ostetricia n. 3, AOU Città della Salute e della Scienza di Torino, Ospedale Sant'Anna, Torino, Italy
| | - Luca Fuso
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Torino, Italy
| | - Daniela Di Cuonzo
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Anna Castiglione
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Eva Pagano
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Elena Peirano
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Fabio Landoni
- Clinica Ginecologica UNIMIB, Ospedale San Gerardo, Monza, Italy
| | - Enrico Sartori
- Divisione di Ostetricia e Ginecologia, Università di Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fabrice Narducci
- Département de Cancérologie Gynécologique, Centre Oscar Lambret, Lille, France
| | - Oscar Bertetto
- AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Annamaria Ferrero
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Torino, Italy
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Dionisi-Vici M, Godono A, Castiglione A, Gatti F, Fortunati N, Clari M, Conti A, Zucchetti G, Biasin E, Varetto A, Pira E, Fagioli F, Brignardello E, Felicetti F. Work Placement and Job Satisfaction in Long-Term Childhood Cancer Survivors: The Impact of Late Effects. Cancers (Basel) 2022; 14:cancers14163984. [PMID: 36010976 PMCID: PMC9406576 DOI: 10.3390/cancers14163984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Late effects of cancer and its treatments during childhood or adolescence can impact work placement and increase the risk of unemployment. The aim of this study is to describe the work placement and the perceived job and economic satisfaction of long-term childhood cancer survivors (CCS). Jobs have been categorized according to the International Standard Classification of Occupations version 08 (ISCO-08), and satisfaction has been evaluated through the Satisfaction Profile (SAT-P). Out of 240 CCS (female = 98) included: 53 were students, 46 were unemployed and 141 were employed. Within unemployed survivors, 89.13% were affected by late effects (n = 41). The presence of at least one severe late effect was significantly associated with the probability of unemployment (OR 3.21; 95% CI 1.13−9.12, p < 0.050), and having any late effect was inversely related to the level of satisfaction of the financial situation of unemployed CCS (b −35.47; 95% CI −59.19, −11.74, p = 0.004). Our results showed that being a survivor with severe comorbidities has a significantly negative impact on occupation and worsens the perception of satisfaction of economic situations. Routinary follow-up care of CCS should include the surveillance of socioeconomic development and provide interventions, helping them to reach jobs suitable for their health.
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Affiliation(s)
- Margherita Dionisi-Vici
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
- Clinical Psychology Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Alessandro Godono
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Filippo Gatti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Nicoletta Fortunati
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Marco Clari
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Alessio Conti
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Giulia Zucchetti
- Division of Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Eleonora Biasin
- Division of Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Antonella Varetto
- Clinical Psychology Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Enrico Pira
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Franca Fagioli
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
- Division of Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Enrico Brignardello
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Francesco Felicetti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-0116336431
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7
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Sacerdote C, Milani L, Castiglione A, Pagano E, Migliore E, Albera C, Bo M, Brazzi L, De Rosa FG, Durazzo M, Lupia E, Montrucchio G, Pivetta E, Porta M, Scaglione L, Veglio F, Zanierato M, Ricceri F, Caramello V, Scozzari G, Scarmozzino A. Risk of Intensive Care Unit admission or mortality in patients hospitalised for COVID-19 during the first two waves: An Italian cohort study. J Infect 2022; 85:436-480. [PMID: 35781015 PMCID: PMC9245397 DOI: 10.1016/j.jinf.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza Hospital, University of Turin and CPO Piemonte, Turin, Italy.
| | - Lorenzo Milani
- Unit of Cancer Epidemiology, Città della Salute e della Scienza Hospital, University of Turin and CPO Piemonte, Turin, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, Città della Salute e della Scienza Hospital, University of Turin and CPO Piemonte, Turin, Italy
| | - Eva Pagano
- Unit of Clinical Epidemiology, Città della Salute e della Scienza Hospital, University of Turin and CPO Piemonte, Turin, Italy
| | - Enrica Migliore
- Unit of Clinical Epidemiology, Città della Salute e della Scienza Hospital, University of Turin and CPO Piemonte, Turin, Italy
| | - Carlo Albera
- Department of Medical Sciences, Unit of Pneumology. University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy
| | - Mario Bo
- Department of Medical Sciences, Section of Geriatrics, University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy; Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marilena Durazzo
- Department of Medical Sciences, Unit of Medicine 3, University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy
| | - Enrico Lupia
- Department of Medical Sciences, University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giuseppe Montrucchio
- Department of Medical Sciences, University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy
| | - Emanuele Pivetta
- Department of General and Specialized Medicine, Division of Emergency Medicine and High Dependency Unit. Città della Salute e della Scienza Hospital, Turin, Italy
| | - Massimo Porta
- Department of Medical Sciences, Unit of Medicine 1, University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy
| | - Luca Scaglione
- Internal Medicine Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Franco Veglio
- Department of Medical Sciences, Internal Medicine and Hypertension Division. University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy
| | | | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology and Public Health, Department of Clinical and Biological Sciences, University of Turin, Orbassano and Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - Valeria Caramello
- Emergency Department and High Dependency Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Gitana Scozzari
- Hospital Medical Direction, Ospedale Molinette, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Antonio Scarmozzino
- Hospital Medical Direction, Ospedale Molinette, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy
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Castiglione A, Brick C, Holden S, Miles-Urdan E, Aron AR. Discovering the psychological building blocks underlying climate action-a longitudinal study of real-world activism. R Soc Open Sci 2022; 9:210006. [PMID: 35706661 PMCID: PMC9156928 DOI: 10.1098/rsos.210006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
We are in a climate emergency. Because governments are reacting too slowly, grassroots collective action is key. Understanding the psychological factors underpinning engagement can facilitate the growth of such collective action. Yet, previous research in psychology rarely provided causal evidence for which factors trigger action, lacked focus on the climate crisis, was mostly self-reported behaviour or intentions rather than objective measures, and was mostly cross-sectional rather than longitudinal. Here we conducted a longitudinal study on the effectiveness of a 12-week video intervention designed to increase psychological predictors of collective action. The intervention boosted affective engagement, collective efficacy, and self-efficacy, but did not increase observed attendance of activism events. Interviews suggested that Zoom fatigue and the online study design undercut the social interaction participants wanted in order to join events. However, a smaller in-person replication did not increase activism either. Debriefings suggested that the replication participants were primarily motivated by payment and lacked time or resources for more engagement. These results highlight the crucial importance of going beyond measures of self-reported attitudes or intentions to objectively measuring activism behaviours and showing the difficulty of fostering event attendance.
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Affiliation(s)
- Anna Castiglione
- Department of Psychology, University of California, San Diego, CA, USA
| | - Cameron Brick
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefanie Holden
- Department of Psychology, University of California, San Diego, CA, USA
| | - Ella Miles-Urdan
- Department of Psychology, University of California, San Diego, CA, USA
| | - Adam R. Aron
- Department of Psychology, University of California, San Diego, CA, USA
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9
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Sacerdote C, Castiglione A, Pagano E, Migliore E, Pivetta E, Auzzas GM, Brenstisci C, Brunetti F, Dafilé C, Gangemi M, Giacometti L, Gilardetti M, Martinis VH, Saccona F, Stura A, Turco D, Balestro C, Zozzoli S, Filandra U, Roggero S, Silvestre C, Scozzari G, Scaramozzino A, Ciccone G. Clinical and epidemiological characteristics associated with pneumonia at disease onset in patients admitted for COVID-19 to the Emergency Department of a large Hospital in Piedmont (North-Western Italy). Epidemiol Prev 2021; 44:216-225. [PMID: 33412813 DOI: 10.19191/ep20.5-6.s2.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to explore clinical and epidemiological characteristics associated with an imaging feature of COVID-19 pneumonia at disease onset, in order to identify factors that may be evaluable by general practitioners at patient's home, and which may lead to identify a more severe disease, needing hospitalization. DESIGN this is a retrospective/prospective observational hospital cohort. SETTING AND PARTICIPANTS the study population includes all patients consecutively admitted to the emergency department of Città della salute e della scienza University Hospital from 01.03 to 31.05.2020 with a confirmed diagnosis of SARS-CoV-2 infection. MAIN OUTCOME MEASURES patients were classified in two groups according to the findings of X-ray imaging, lung ultrasound and chest computer tomography, as pneumonia or not pneumonia patients. RESULTS in multivariable analysis, factors most strongly associated with emergency department admission with pneumonia were age, oxygen saturation <90% (adj OR 4.16 ;95%CI 1.44-12.07), respiratory rate >24 breaths/min (adj OR 6.50; 95%CI 2.36-17.87), fever ≥38° (adj OR 3.05; 95%CI 1.53-6.08) and the presence of gastroenteric symptoms (vomiting and diarrhea). A delay (> 7 days) between the appearance of the initial lung symptoms (cough and dyspnea) and the admission to the emergency department was also related to a higher probability of receiving a positive imaging report (OR 4.99; 95%CI 2,02-12,34). CONCLUSIONS in order to reorganize the management of COVID-19 patients in Italy, in view of the risk of a second wave of epidemic or of local outbreaks, it would be desirable to relocate the triage, and possibly the patient's care, from hospital to home. In this scenario it is important to identify all symptoms and signs associated with COVID-19 pneumonia that would facilitate the decision-making process of GPs leading to patients hospitalization.
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Affiliation(s)
- Carlotta Sacerdote
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino;
| | - Anna Castiglione
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Eva Pagano
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Enrica Migliore
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Emanuele Pivetta
- SC Medicina d'urgenza (MECAU), AOU Città della salute e della scienza di Torino
| | - Grazia Maria Auzzas
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Carol Brenstisci
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Francesco Brunetti
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Corina Dafilé
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Manuela Gangemi
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Lisa Giacometti
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Marco Gilardetti
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Vitor Hugo Martinis
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Fabio Saccona
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Antonella Stura
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Danila Turco
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
| | - Cristina Balestro
- Direzione sanitaria, Presidio ospedaliero Molinette, AOU Città della salute e della scienza di Torino
| | - Susanna Zozzoli
- Direzione sanitaria, Presidio ospedaliero Molinette, AOU Città della salute e della scienza di Torino
| | - Umberto Filandra
- Direzione sanitaria, Presidio ospedaliero Molinette, AOU Città della salute e della scienza di Torino
| | - Stefano Roggero
- Direzione sanitaria, Presidio ospedaliero Molinette, AOU Città della salute e della scienza di Torino
| | - Carlo Silvestre
- Direzione sanitaria, Presidio ospedaliero Molinette, AOU Città della salute e della scienza di Torino
| | - Gitana Scozzari
- Direzione sanitaria, Presidio ospedaliero Molinette, AOU Città della salute e della scienza di Torino
| | - Antonio Scaramozzino
- Direzione sanitaria, Presidio ospedaliero Molinette, AOU Città della salute e della scienza di Torino
| | - Giovannino Ciccone
- SSD Epidemiologia clinica e valutativa, SC Epidemiologia dei tumori, AOU Città della salute e della scienza di Torino - CPO Piemonte, Torino
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10
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Felicetti F, Castiglione A, Biasin E, Fortunati N, Dionisi-Vici M, Matarazzo P, Ciccone G, Fagioli F, Brignardello E. Effects of treatments on gonadal function in long-term survivors of pediatric hematologic malignancies: A cohort study. Pediatr Blood Cancer 2020; 67:e28709. [PMID: 32918795 DOI: 10.1002/pbc.28709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/15/2020] [Accepted: 08/31/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Potentially gonadotoxic protocols are currently used for the treatment of childhood hematologic malignancies. This study aims to evaluate the prevalence of gonadal dysfunction and the most important associated risk factors in a cohort of hematologic malignancy survivors. PROCEDURE We considered all patients referred to our long-term follow-up clinic for childhood cancer survivors, between November 2001 and December 2017. Inclusion criteria were: (a) previous diagnosis of hematologic malignancy; (b) age at hematologic malignancy diagnosis < 18 years; (c) at least five years after the end of anticancer treatments; (d) at least one evaluation of gonadal function after the 18th birthday. Patients diagnosed before January 1, 1990, were excluded. RESULTS Three hundred twenty-seven survivors (males = 196) were included. Isolated spermatogenesis damage was found in 58/196 (29.6%) of males, whereas 18/196 (9.2%) had Leydig cell failure. In females, 35/131 (26.7%) experienced premature ovarian insufficiency. In both sexes, abdominopelvic irradiation and hematopoietic stem cell transplantation were strongly associated with the risk of gonadal dysfunction. For every 1000 mg/m2 increase in cyclophosphamide-equivalent dose exposure, the risk of spermatogenesis damage increased 1.52-fold and that of Leydig cell failure increased 1.34-fold, whereas the risk of premature ovarian insufficiency increased 1.80-fold. About 30% of those males who developed Leydig cell failure did so more than five years after the end of treatments. CONCLUSIONS Gonadal dysfunction is still a significant late effect of therapies for pediatric hematologic malignancies. In males, the reevaluation of Leydig cell function may be useful even several years after the exposure to gonadotoxic treatments.
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Affiliation(s)
- Francesco Felicetti
- Transition Unit for Childhood Cancer Survivors, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, "Città della Salute e della Scienza di Torino" Hospital and CPO Piemonte, Torino, Italy
| | - Eleonora Biasin
- DivisionofPaediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Nicoletta Fortunati
- Transition Unit for Childhood Cancer Survivors, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Margherita Dionisi-Vici
- Transition Unit for Childhood Cancer Survivors, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Patrizia Matarazzo
- DivisionofPaediatric Endocrinology, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, "Città della Salute e della Scienza di Torino" Hospital and CPO Piemonte, Torino, Italy
| | - Franca Fagioli
- DivisionofPaediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy, "Città della Salute e della Scienza" Hospital, Torino, Italy.,Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy
| | - Enrico Brignardello
- Transition Unit for Childhood Cancer Survivors, "Città della Salute e della Scienza" Hospital, Torino, Italy
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Abstract
Quickly preventing the retrieval of (inappropriate) long-term memories might recruit a similar control mechanism as rapid action-stopping. A very specific characteristic of rapid action-stopping is "global motor suppression": When a single response is rapidly stopped, there is a broad skeletomotor suppression. This is shown by the technique of TMS placed over a task-irrelevant part of the primary motor cortex (M1) to measure motor-evoked potentials. Here, we used this same TMS method to test if rapidly preventing long-term memory retrieval also shows this broad skeletomotor suppression effect. Twenty human participants underwent a Think/No-Think task. In the first phase, they learned word pairs. In the second phase, they received the left-hand word as a cue and had to either retrieve the associated right-hand word ("Think") or stop retrieval ("No-Think"). At the end of each trial, they reported whether they had experienced an intrusion of the associated memory. Behaviorally, on No-Think trials, they reported fewer intrusions than Think trials, and the reporting of intrusions decreased with practice. Physiologically, we observed that the motor-evoked potential, measured from the hand (which was irrelevant to the task), was reduced on No-Think trials in the time frame of 300-500 msec, especially on trials where they did report an intrusion. This unexpected result contradicted our preregistered prediction that we would find such a decrease on No-Think trials where the intrusion was not reported. These data suggest that one form of executive control over (inappropriate) long-term memory retrieval is a rapid and broad stop, akin to action-stopping, that is triggered by the intrusion itself.
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12
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Pagano E, Castiglione A, Scozzari G, La Valle G, Angelone L, Agabiti N, Scarmozzino A, Ciccone G. [Audit and Feedback approach in the CoViD-19 emergency: adaptation of the EASY-NET project in the AOU Città della Salute e della Scienza of Turin.]. Recenti Prog Med 2020; 111:487-491. [PMID: 32914776 DOI: 10.1701/3421.34061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CoViD-19 pandemic heavily impacted most on-going research activities, causing delays and need of re-programming. EASY-NET (NET-2016-02364191) is a network project, started in April 2019, co-funded by the Italian Ministry of Health and the participating regions. Within the general project, centred on the evaluation of Audit and Feedback (A&F) strategies in improving quality and equity in different health care contexts, the Piedmont region is responsible of the work package 3 (WP3) on specific oncology pathways and procedures. After a thorough evaluation of the impact of the CoViD-19 emergency on the WP3 activities, at the beginning of March 2020, the decision was to continue, with some adaptations, the audits already started, and to delay those in the early planning phase. The provisional availability of part of the time-persons involved in EASY-NET on one side, and the urgency of acquiring data on the management of the large number of CoViD-19 patients admitted to the study coordinator hospital on the other side, determined the personnel responsible of the WP3, in accordance with the hospital management, to invest these resources in monitoring the CoViD-19 hospitalized patients with both A&F activity and research objectives. Besides periodic reports, a web site, with restricted access to the involved health care personnel, was developed to allow a direct and timely consultation of graphics describing the flow of the patients, their management, and outcomes. This experience was made possible thanks to a favourable combination of different factors: the presence within the hospital of a group of experienced epidemiologists in A&F, the availability of extra resources, the strong support and collaboration by the hospital management and the readiness for authorisation by the Ethics Committee. We underline the need to provide a certain degree of flexibility in the long-term projects funded by the Ministry of Health, the extraordinary adaptability of the A&F approach also to emergency situations and the possibility of combining audit activities and research objectives in the same project.
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Affiliation(s)
| | - Anna Castiglione
- SSD Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino
| | - Gitana Scozzari
- Direzione Sanitaria, Presidio Molinette, AOU Città della Salute e della Scienza di Torino
| | - Giovanni La Valle
- Direzione Aziendale, AOU Città della Salute e della Scienza di Torino
| | - Lorenzo Angelone
- Direzione Aziendale, AOU Città della Salute e della Scienza di Torino
| | | | - Antonio Scarmozzino
- Direzione Sanitaria, Presidio Molinette, AOU Città della Salute e della Scienza di Torino
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13
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Ciccone G, Deandrea S, Clavenna A, Kirchmayer U, Simeon V, Acampora A, Agabiti N, Angelici L, Banzi R, Cadum E, Castiglione A, Chiodini P, Colombo C, Ferroni E, Migliore E, Nisticò L, Pagano E, Sabelli AM, Sacerdote C, Silvestri C, Soldati S, Stranges S, Tirani M, Davoli M, Galassi C, Forastiere F. [Covid-19 and clinical-epidemiological research in Italy: proposal of a research agenda on priority topics by the Italian association of epidemiology]. Epidemiol Prev 2020; 44:51-59. [PMID: 33412794 DOI: 10.19191/ep20.5-6.s2.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND the Covid-19 pandemic has provoked a huge of clinical and epidemiological research initiatives, especially in the most involved countries. However, this very large effort was characterized by several methodological weaknesses, both in the field of discovering effective treatments (with too many small and uncontrolled trials) and in the field of identifying preventable risks and prognostic factors (with too few large, representative and well-designed cohorts or case-control studies). OBJECTIVES in response to the fragmented and uncoordinated research production on Covid-19, the italian Association of Epidemiology (AIE) stimulated the formation of a working group (WG) with the aims of identifying the most important gaps in knowledge and to propose a structured research agenda of clinical and epidemiological studies considered at high priority on Covid-19, including recommendations on the preferable methodology. METHODS the WG was composed by 25 subjects, mainly epidemiologists, statisticians, and other experts in specific fields, who have voluntarily agreed to the proposal. The agreement on a list of main research questions and on the structure of the specific documents to be produced were defined through few meetings and cycles of document exchanges. RESULTS twelve main research questions on Covid-19 were identified, covering aetiology, prognosis, interventions, follow-up and impact on general and specific populations (children, pregnant women). For each of them, a two-page form was developed, structured in: background, main topics, methods (with recommendations on preferred study design and warnings for bias prevention) and an essential bibliography. CONCLUSIONS this research agenda represents an initial contribution to direct clinical and epidemiological research efforts on high priority topics with a focus on methodological aspects. Further development and refinements of this agenda by Public Health Authorities are encouraged.
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Affiliation(s)
- Giovannino Ciccone
- SSD epidemiologia clinica e valutativa, AOU Città della salute e della scienza di Torino, CPO Piemonte, Torino;
| | - Silvia Deandrea
- Dipartimento di igiene e prevenzione sanitaria, ATS di Pavia
| | | | - Ursula Kirchmayer
- Dipartimento epidemiologia del Servizio sanitario regionale del Lazio, ASL Roma 1, Roma
| | - Vittorio Simeon
- Unità di statistica medica, Università degli Studi della Campania "Luigi Vanvitelli", Napoli
| | - Anna Acampora
- Dipartimento epidemiologia del Servizio sanitario regionale del Lazio, ASL Roma 1, Roma
| | - Nerina Agabiti
- Dipartimento epidemiologia del Servizio sanitario regionale del Lazio, ASL Roma 1, Roma
| | - Laura Angelici
- Dipartimento epidemiologia del Servizio sanitario regionale del Lazio, ASL Roma 1, Roma
| | - Roita Banzi
- Istituto di ricerche farmacologiche Mario Negri IRCCS, Milano
| | - Ennio Cadum
- Dipartimento di igiene e prevenzione sanitaria, ATS di Pavia
| | - Anna Castiglione
- SSD epidemiologia clinica e valutativa, AOU Città della salute e della scienza di Torino, CPO Piemonte, Torino
| | - Paolo Chiodini
- SSD epidemiologia clinica e valutativa, AOU Città della salute e della scienza di Torino, CPO Piemonte, Torino
| | - Cinzia Colombo
- Istituto di ricerche farmacologiche Mario Negri IRCCS, Milano
| | - Eliana Ferroni
- UOC Servizio epidemiologico regionale e registri, Azienda Zero, Regione del Veneto, Padova
| | - Enrica Migliore
- SSD epidemiologia clinica e valutativa, AOU Città della salute e della scienza di Torino, CPO Piemonte, Torino
| | - Lorenza Nisticò
- Centro di riferimento per le scienze comportamentali e la salute mentale, Istituto superiore di sanità, Roma
| | - Eva Pagano
- SSD epidemiologia clinica e valutativa, AOU Città della salute e della scienza di Torino, CPO Piemonte, Torino
| | | | - Carlotta Sacerdote
- SC epidemiologia dei tumori, AOU Città della salute e della scienza di Torino, CPO Piemonte, Torino
| | - Caterina Silvestri
- Osservatorio di epidemiologia, Agenzia regionale di sanità della Toscana, Firenze
| | - Salvatore Soldati
- Dipartimento epidemiologia del Servizio sanitario regionale del Lazio, ASL Roma 1, Roma
| | - Saverio Stranges
- Department of epidemiology and biostatistics, Schulich School of Medicine & Dentistry, Western University, in London, Ontario (Canada)
| | - Marcello Tirani
- Dipartimento di igiene e prevenzione sanitaria, ATS di Pavia
| | - Marina Davoli
- Dipartimento epidemiologia del Servizio sanitario regionale del Lazio, ASL Roma 1, Roma
| | - Claudia Galassi
- SSD epidemiologia clinica e valutativa, AOU Città della salute e della scienza di Torino, CPO Piemonte, Torino
| | - Francesco Forastiere
- Istituto per la ricerca e l'innovazione biomedica, Consiglio nazionale delle ricerche, Palermo
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Corcione S, Pensa A, Castiglione A, Lupia T, Bortolaso B, Romeo MR, Stella M, Rosa FGD. Epidemiology, prevalence and risk factors for infections in burn patients: results from a regional burn centre's analysis. J Chemother 2020; 33:62-66. [PMID: 32588768 DOI: 10.1080/1120009x.2020.1780776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Burn patients are at high risk of infections due to severe impairment of immunity and loss of skin barrier function. We aimed to describe the epidemiology, incidence and risk factors for infection in a cohort of burns patients. Two hundred patients were retrospectively enrolled and subdivided into infected (N = 81) and uninfected groups (N = 119). The cumulative prevalence of infections was 27% on day 7 and 43.8% on day 28. Skin and soft tissue infections (32%) were the most frequent. Carbapenem-resistant Acinetobacter baumannii (28%), Pseudomonas aeruginosa (26%) and methicillin-resistant Staphylococcus aureus (25%) infections were most prevalent. An indwelling central venous catheter (CVC; sub-hazard ratio [SHR] 7.41, 95% confidence interval [CI] 3.78-14.62) and revised Baux score (RBS; SHR 2.08, 95% CI 0.98-4.42) were associated with higher incremental infection rate while surgical treatment resulted in a protective factor (SHR 0.45, 95% CI 0.29-0.75). RBS may be useful to stratify the infection risk: a strict collaboration between surgeons and infectious disease specialists is needed to implement source control and antimicrobial surveillance.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Anna Pensa
- Burn Center, A.O.U Città della Salute e della Scienza, CTO Hospital, Turin, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, A.O.U Città della Salute e della Scienza, Turin, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Barbara Bortolaso
- Laboratory of Clinical Biochemistry, A.O. U Città della Salute e della Scienza, C. T. O Hospital, Turin, Italy
| | - Maria Rosa Romeo
- Burn Center, A.O.U Città della Salute e della Scienza, CTO Hospital, Turin, Italy
| | - Maurizio Stella
- Burn Center, A.O.U Città della Salute e della Scienza, CTO Hospital, Turin, Italy
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Castiglione A, Wagner J, Anderson M, Aron AR. Preventing a Thought from Coming to Mind Elicits Increased Right Frontal Beta Just as Stopping Action Does. Cereb Cortex 2020; 29:2160-2172. [PMID: 30806454 PMCID: PMC6458912 DOI: 10.1093/cercor/bhz017] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 11/14/2022] Open
Abstract
In the stop-signal task, an electrophysiological signature of action-stopping is increased early right frontal beta band power for successful vs. failed stop trials. Here we tested whether the requirement to stop an unwanted thought from coming to mind also elicits this signature. We recorded scalp EEG during a Think/No-Think task and a subsequent stop signal task in 42 participants. In the Think/No-Think task, participants first learned word pairs. In a second phase, they received the left-hand word as a reminder and were cued either to retrieve the associated right-hand word ("Think") or to stop retrieval ("No-Think"). At the end of each trial, participants reported whether they had experienced an intrusion of the associated memory. Finally, they received the left-hand reminder word and were asked to recall its associated target. Behaviorally, there was worse final recall for items in the No-Think condition, and decreased intrusions with practice for No-Think trials. For EEG, we reproduced increased early right frontal beta power for successful vs. failed action stopping. Critically, No-Think trials also elicited increased early right frontal beta power and this was stronger for trials without intrusion. These results suggest that preventing a thought from coming to mind also recruits fast prefrontal stopping.
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Affiliation(s)
- Anna Castiglione
- Department of Psychology, University of California, San Diego, CA, USA
| | - Johanna Wagner
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California, San Diego, CA, USA
| | - Michael Anderson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK
| | - Adam R Aron
- Department of Psychology, University of California, San Diego, CA, USA
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Viora E, Piovano E, Baima Poma C, Cotrino I, Castiglione A, Cavallero C, Sciarrone A, Bastonero S, Iskra L, Zola P. The ADNEX model to triage adnexal masses: An external validation study and comparison with the IOTA two-step strategy and subjective assessment by an experienced ultrasound operator. Eur J Obstet Gynecol Reprod Biol 2020; 247:207-211. [PMID: 32146226 DOI: 10.1016/j.ejogrb.2020.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/15/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The ADNEX (Assessment of Different NEoplasias in the adneXa) model was developed using parameters collected by experienced (level III) ultrasound examiners. Our primary aim was to externally validate the ADNEX model. Then, the discriminatory performance of ADNEX was compared with the two-step strategy and subjective assessment by an experienced ultrasound operator. METHODS Between February 2013 and January 2017, all patients who were scheduled for surgery for an adnexal mass at the Sant'Anna Hospital in Turin were enrolled in this study. Preoperative transvaginal sonography was performed, and the two-step strategy was applied for triage of the adnexal mass. Two ultrasound examiners, IOTA certified, applied the ADNEX model to all the collected masses based on the ultrasound reports. Finally, an experienced operator assigned the subjective assessment based on recorded ultrasound images. The discrimination and calibration performance of ADNEX were evaluated. The AUC was calculated for the basic discrimination between benign and malignant tumours. In addition, AUCs were computed for each pair of tumour types using the conditional risk method. RESULTS A total of 577 patients were included in the analysis: the overall prevalence of malignancy was 25 %. With ADNEX, the AUC to differentiate between benign and malignant masses was 0.9111 (95 % CI 0. 8788-0.9389). At risk cut-offs of 1%, 10 % and 30 %, sensitivities were 100 %, 89.6 % and 79.2 %, respectively, and specificities were 2.8 %, 76.2 % and 89.6 %, respectively. Discrimination between benign and stage II-IV tumours was good (AUC 0.935). The model had the most difficulties discriminating between borderline and stage I tumours (AUC 0.666), and between stages II-IV invasive and secondary metastatic tumours (AUC 0.736). The polytomous discrimination index (PDI) was 0.61 for ADNEX, whereas PDI for random performance would be 0.25. ADNEX proved to be equally or more accurate than the subjective assessment or the two-step strategy in the discrimination between benign and malignant adnexal masses. CONCLUSIONS the ADNEX model could probably be successfully applied when an expert examiner is not available and, therefore both a subjective assessment and the two-step strategy cannot be performed.
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Affiliation(s)
- Elsa Viora
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Elisa Piovano
- Obstetrics and Gynecology Unit, Regina Montis Regalis Hospital Mondovì CN, Italy
| | - Cinzia Baima Poma
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Ilenia Cotrino
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, CPO Piemonte, AOU Città della Salute e della Scienza Turin, Italy
| | | | - Andrea Sciarrone
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Simona Bastonero
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Lilliana Iskra
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Paolo Zola
- Department of Surgical Sciences, University of Turin -Turin, Italy
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17
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Corcione S, Segala FV, Castiglione A, Lupia T, Angilletta R, Cavallo R, Ciccone G, De Rosa FG. Enteropathogenetic nosocomial infections: predisposing clinical characteristics and risk of recurrent infections. J Chemother 2019; 31:394-400. [PMID: 31556352 DOI: 10.1080/1120009x.2019.1669275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Nosocomial infections caused by Clostridium difficile, CP-Kp, ESBL-E or Candida spp. are usually associated with a high mortality rate. In this retrospective study, we evaluated the association between the patient characteristics and the risk of development of nosocomial BSI due to Candida or CP-Kp or ESBL-E. Moreover, we described the cumulative incidence of recurrent infections according to each group of nosocomial BSI. Enteral or parenteral nutrition and indwelling CVC at time of diagnosis were associated with an increased risk of candidemia or CP-Kp over ESBL-E and CDI. ESBL-E BSI was higher in patients undergoing hemodialysis, hematological stem cell transplant and neutropenic patients. The cumulative incidence for recurrent infections was higher for CP-Kp BSI and lower for candidemia. Our data highlight a different role of single patient comorbidities in the development of infections and the higher incidence of recurrent infections in CP-Kp BSI.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | | | - Anna Castiglione
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Roberto Angilletta
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Department of Public Health and Pediatrics, University of Turin, Laboratory of Microbiology and Virology, Turin, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
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18
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Romano F, Perotto S, Castiglione A, Aimetti M. Prevalence of periodontitis: misclassification, under-recognition or over-diagnosis using partial and full-mouth periodontal examination protocols. Acta Odontol Scand 2019; 77:189-196. [PMID: 30623706 DOI: 10.1080/00016357.2018.1535136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this cross-sectional study was to assess the bias in estimating the prevalence of periodontitis due to partial-mouth periodontal examination protocols (PMPE) and to relate the severity and extent of periodontal damage to periodontitis misclassification when applying case definitions by Centres of Disease Control and Prevention and American Academy of Periodontology (CDC/AAP). MATERIALS AND METHODS A full-mouth periodontal examination (FMPE) was performed in 721 adults living in North Italy to identify moderate and severe periodontitis. These results were compared with those obtained with two PMPE protocols analyzing two interproximal sites on all teeth (fMB-DL) or four interproximal sites in two random diagonal quadrants (pMDB-MDL). RESULTS Both PMPE systems estimated the prevalence of moderate periodontitis with limited bias (-2.79% for pMDB-MDL and -3.49% for fMB-DL), whereas produced larger relative biases for severe periodontitis (-28.74% versus - 14.55%). The percentage of under-recognition of existing periodontal disease was 8.9% under fMB-DL and 15.5% under pMDB-MDL. The diagnosis of moderate and severe periodontal disease was correctly assigned to individuals with on average 8% and 30% of pathological sites, respectively. CONCLUSION These findings suggest that PMPE systems provide high level of bias when using CDC/AAP case definitions.
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Affiliation(s)
- Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School University of Turin, Turin, Italy
| | - Stefano Perotto
- Postgraduate Program in Periodontology, University of Turin, Turin, Italy
| | - Anna Castiglione
- Città della Salute e della Scienza and CPO Piedmont, Unit of Clinical Epidemiology, Turin, Italy
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School University of Turin, Turin, Italy
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Cecchi E, Ciccone G, Chirillo F, Imazio M, Cecconi M, Del Ponte S, Moreo A, Faggiano P, Cialfi A, Squeri A, Enia F, Forno D, De Rosa FG, Rinaldi M, Castiglione A. Mortality and timing of surgery in the left-sided infective endocarditis: an Italian multicentre study. Interact Cardiovasc Thorac Surg 2019; 26:602-609. [PMID: 29272391 DOI: 10.1093/icvts/ivx394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/18/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Observational studies on early surgery in infective endocarditis have conflicting results. This study aims to compare the treatment strategies for early surgery (within 2 weeks of diagnosis) and late surgery/medical therapy in terms of survival among patients with the left-sided infective endocarditis. METHODS This study included patients with the left-sided infective endocarditis registered between 2006 and 2010 in the Italian Registry of Infective Endocarditis (RIEI). A Cox proportional hazards model was used to estimate the effect of these treatment strategies on overall survival and included sociodemographic and clinical characteristics associated with treatment, risk factors for mortality and early surgery as a time-dependent covariate to avoid indication and immortal time biases. RESULTS Among the 502 patients included, 184 (36.7%) underwent early surgery. Of the remaining 318 patients, 138 underwent late surgery. The early surgery group had fewer patients with comorbidities and with enterococcus as the causative microorganism, but this group had more complicated cardiac conditions. No difference in mortality risk was estimated between the treatment groups including early surgery as time-dependent variables (adjusted hazard ratio = 0.95, 95% confidence interval 0.55-1.63), while a distorted and overestimated beneficial effect of surgery was estimated considering surgery as a non-time-dependent variable (adjusted hazard ratio 0.41, 95% confidence interval 0.25-0.70). CONCLUSIONS Our study did not confirm a better overall survival in patients undergoing early surgery. However, even with the use of statistical techniques to control biases, we could not draw definitive conclusions that early surgery is not beneficial. Our results need to be assessed by randomized trials before any changes in clinical practice can be recommended.
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Affiliation(s)
- Enrico Cecchi
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Massimo Imazio
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Moreno Cecconi
- Dipartimento di Scienze Cardiologiche Mediche e Chirurgiche Azienda, Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | | | - Antonella Moreo
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milano, Italy
| | | | | | - Angelo Squeri
- Dipartimento Cardio, Nefro-Polmonare, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Francesco Enia
- Department of Cardiology, Cervello Hospital, Palermo, Italy
| | - Davide Forno
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Molinette Hospital, University of Torino, Torino, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
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Messa E, Gioia D, Masiera E, Castiglione A, Ceccarelli M, Salvi F, Danise P, Sanna A, Allione B, Balleari E, Poloni A, Cametti G, Ferrero D, Tassara R, Finelli C, Bonferroni M, Musto P, Saglio G, Levis A, Santini V. Effects of erythropoiesis-stimulating agents on overall survival of International Prognostic Scoring System Low/Intermediate-1 risk, transfusion-independent myelodysplastic syndrome patients: a cohort study. Haematologica 2018; 104:e4-e8. [PMID: 30076178 DOI: 10.3324/haematol.2017.183590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Emanuela Messa
- Division of Hematology, ASLTO 4, Ivrea (Turin).,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Daniela Gioia
- Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Elisa Masiera
- Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Anna Castiglione
- Unit of Clinical Epidemiology, "Città della Salute e della Scienza di Torino" Hospital, Turin
| | - Manuela Ceccarelli
- Unit of Clinical Epidemiology, "Città della Salute e della Scienza di Torino" Hospital, Turin
| | - Flavia Salvi
- Division of Hematology, "SS. Antonio e Biagio" Hospital, Alessandria.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Paolo Danise
- Division of Onco-Hematology Nocera-Pagani, ASL Salerno.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Alessandro Sanna
- Division of Hematology, Azienda Ospedaliera Universitaria Careggi, University of Florence.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Bernardino Allione
- Division of Hematology, Azienda Ospedaliero-Universitaria "Città della Salute e della Scienza di Torino", Turin.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Enrico Balleari
- Internal Medicine Department, IRCCS San Martino, Genoa, Italy.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Antonella Poloni
- Division of Hematology, "Ospedali Riuniti", Ancona.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Giovanni Cametti
- Division of Internal Medicine ASLTO5 Chieri (Turin).,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Dario Ferrero
- Division of Hematology, Azienda Ospedaliero-Universitaria "Città della Salute e della Scienza di Torino", University of Turin.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Rodolfo Tassara
- Division of Medicine and Hematology, ASL2 Savonese, Savona.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Carlo Finelli
- Institute of Hematology "L. e A. Seràgnoli", "Sant'Orsola-Malpighi" University Hospital, Bologna.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Margherita Bonferroni
- Division of Hematology, "Santa Croce e Carle" Hospital, Cuneo, Italy.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Pellegrino Musto
- IRCCS-CROB Regional Cancer Center of Basilicata, Rionero in Vulture, Potenza.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Giuseppe Saglio
- Division of Hematology, "Mauriziano" Hospital, Turin, Italy.,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Alessandro Levis
- Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
| | - Valeria Santini
- Division of Hematology, Azienda Ospedaliera Universitaria Careggi, University of Florence .,Fondazione Italiana Sindromi Mielodisplastiche Onlus, Alessandria
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Kreifels P, Franke G, Perez-Feliz S, Bodi I, Castiglione A, Ziupa D, Bode C, Odening KE. 5922Oxytocin has harmful cardiac repolarization prolonging effects - Particularly in context of drug-induced LQTS. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5922] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Kreifels
- University of Freiburg, University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - G Franke
- University of Freiburg, University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - S Perez-Feliz
- University of Freiburg, University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - I Bodi
- University of Freiburg, University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - A Castiglione
- University of Freiburg, University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - D Ziupa
- University of Freiburg, University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - C Bode
- University of Freiburg, University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - K E Odening
- University of Freiburg, University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
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22
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Castiglione A, Hornyik T, Franke G, Perez-Feliz S, Bosze Z, Koren G, Varro A, Zehender M, Brunner M, Bode C, Baczko I, Odening KE. P604Docosahexaenoic acid acts as QT-shortening agent with genotype-tspecific beneficial effects in transgenic LQT1, LQT2, LQT5 and LQT2-5 rabbit models. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p604] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Castiglione
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - T Hornyik
- University of Szeged, Department of Pharmacology and Pharmacotherapy, Szeged, Hungary
| | - G Franke
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - S Perez-Feliz
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - Z Bosze
- Agricultural Biotechnology Institute, NARIC, Godollo, Hungary
| | - G Koren
- Brown University, Cardiovascular Research Center, Providence, United States of America
| | - A Varro
- University of Szeged, Department of Pharmacology and Pharmacotherapy, Szeged, Hungary
| | - M Zehender
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - M Brunner
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - C Bode
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - I Baczko
- University of Szeged, Department of Pharmacology and Pharmacotherapy, Szeged, Hungary
| | - K E Odening
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
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23
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Beccari M, Castiglione A, Cavaliere G, D'Aloya G, Fabbri C, Losi B, Ranzini C, Romagnoni G, Sorgato G. Unusual Case of Anuria Due to African Bee Stings. Int J Artif Organs 2018. [DOI: 10.1177/039139889201500505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe a case of multiple African bee stings in which the exceptionally high dose suggests a direct effect of hymenoptera venom on the renal tubules. The case does not follow the previously reported pattern of hypovolemic or anaphylactic shock, hemolysis and/or rhabdomyolysis, despite the potentially lethal amount of venom injected
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Affiliation(s)
- M. Beccari
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - A. Castiglione
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - G. Cavaliere
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - G. D'Aloya
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - C. Fabbri
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - B. Losi
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - C. Ranzini
- Department of Immunohematology and Blood Transfusion, Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - G. Romagnoni
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - G. Sorgato
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
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24
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Messa E, Biale L, Castiglione A, Lunghi M, Bonferroni M, Salvi F, Allione B, Ferrero D, Calabrese C, De Gobbi M, Nicoli P, Gioia D, Levis A, Saglio G, Cilloni D. Erythroid response during iron chelation therapy in a cohort of patients affected by hematologic malignancies and aplastic anemia with transfusion requirement and iron overload: a FISM Italian multicenter retrospective study. Leuk Lymphoma 2017; 58:2752-2754. [DOI: 10.1080/10428194.2017.1312385] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Lucia Biale
- AOU Città della Salute e della Scienza di Torino – Presidio Ospedaliero Molinette – SC Banca del Sangue e del plasma, Turin, Italy
| | - Anna Castiglione
- Unit of Cancer Epidemiology and CPO Piedmont, S. Giovanni Battista Hospital, Torino, Italy
| | - Monia Lunghi
- Division of Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Italy, Novara, Italy
| | | | - Flavia Salvi
- Department of Hematology, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Bernardino Allione
- Division of Hematology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Chiara Calabrese
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Marco De Gobbi
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Paolo Nicoli
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Daniela Gioia
- FISM Registry, SS Antonio e Biagio e C. Arrigo Hospital, Alessandria, Tuscany, Italy
| | - Alessandro Levis
- Department of Hematology, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, Division of Hematology, University of Turin, Turin, Italy
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25
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Messa E, Gioia D, Masiera E, Castiglione A, Ceccarelli M, Salvi F, Danise P, Sanna A, Allione B, Balleari E, Poloni A, Cametti G, Ferrero D, Tassara R, Finelli C, Bonferroni M, Ciccone G, Saglio G, Levis A, Santini V. Effects of Erythropoiesis-Stimulating Agents on Overall Survival of IPSS Low/INT-1 Risk Transfusion Independent Myelodysplastic Syndrome Patients, a FISM Study. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30206-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Brignardello E, Felicetti F, Castiglione A, Gallo M, Maletta F, Isolato G, Biasin E, Fagioli F, Corrias A, Palestini N. Ultrasound surveillance for radiation-induced thyroid carcinoma in adult survivors of childhood cancer. Eur J Cancer 2016; 55:74-80. [DOI: 10.1016/j.ejca.2015.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/04/2015] [Accepted: 12/06/2015] [Indexed: 12/18/2022]
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27
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Aimetti M, Perotto S, Castiglione A, Ercoli E, Romano F. Prevalence estimation of halitosis and its association with oral health-related parameters in an adult population of a city in North Italy. J Clin Periodontol 2015; 42:1105-14. [PMID: 26477536 DOI: 10.1111/jcpe.12474] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2015] [Indexed: 01/22/2023]
Abstract
AIM No epidemiological data on halitosis are available from Italy. Thus, the aim of this population-based cross-sectional study was to estimate the prevalence of halitosis in an urban adult population from North Italy and to explore related oral risk indicators. MATERIALS AND METHODS The survey used a two-stage probability sampling method to collect a representative sample of inhabitants, aged between 20 and 75 years, in the city of Turin. Seven hundred and forty-four adults were clinically examined (47% of sampled subjects) for oral malodor and periodontal conditions. Using a standardized questionnaire social, health and halitosis-related parameters were collected. Logistic models with interaction terms between tongue coating scores (TCS) and periodontal status were used to explore halitosis risk indicators. RESULTS The prevalence estimate of halitosis according to the organoleptic assessment was 53.51% (95% CI: 48.55-58.50). A statistically significant correlation was found between organoleptic and gas chromatography measurements (p < 0.0001). Stronger associations between halitosis and periodontitis were observed in people having higher TCS: adjusted odds ratio considering low and high TCS in individuals with severe periodontitis were 2.95 and 20.77 (p ≤ 0.003). CONCLUSIONS Due to the high prevalence of halitosis in the Turin population, its diagnosis and management should be incorporated in comprehensive dental care.
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Affiliation(s)
- Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | | | - Anna Castiglione
- Unit of Clinical Epidemiology, AOU Città della Salute e della Scienza and CPO Piedmont, Turin, Italy
| | - Elena Ercoli
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
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28
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Gallo M, Michelon F, Castiglione A, Felicetti F, Viansone AA, Nervo A, Zichi C, Ciccone G, Piovesan A, Arvat E. Sorafenib treatment of radioiodine-refractory advanced thyroid cancer in daily clinical practice: a cohort study from a single center. Endocrine 2015; 49:726-34. [PMID: 25414068 DOI: 10.1007/s12020-014-0481-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 11/12/2014] [Indexed: 12/13/2022]
Abstract
Treatment options for recurrent or metastatic differentiated thyroid cancer (DTC) refractory to radioactive iodine (RAI) are inadequate. Multitargeted kinase inhibitors have recently shown promising results in phase 2-3 studies. This retrospective study aimed to document our clinical experience on the effects of sorafenib in the setting of daily clinical practice. Retrospective study evaluating the efficacy and safety of sorafenib in a cohort of patients consecutively treated with sorafenib at a single center. Twenty patients with advanced RAI-refractory thyroid carcinoma were enrolled (March 2011-March 2014). Patients generally started with 400 mg of sorafenib twice daily, tapering the dose in case of side effects. Radiological response and toxicity were measured during follow-up, together with safety parameters. CT scans were performed by a single experienced radiologist every 3-4 months. Five patients stopped sorafenib within 90 days due to severe toxicities. Median progression-free survival was 248 days. Five patients had a partial response (PR), achieved in all cases within 3 months, whereas 5 had stable disease (SD) at 12 months. Durable response rate (PR plus SD) for at least 6 months was 50 %, among those who received sorafenib for at least 3 months. Commonest adverse events included skin toxicity, gastrointestinal and constitutional symptoms. In our cohort of patients with advanced RAI-refractory thyroid carcinoma, sorafenib confirmed antitumor activity leading to SD or PR in the majority of cases, at the expense of clinically relevant side effects. More effective and tolerable agents are still needed in the treatment of RAI-refractory DTC.
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Affiliation(s)
- Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Via Genova 3, 10126, Turin, Italy,
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29
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Aimetti M, Perotto S, Castiglione A, Mariani GM, Ferrarotti F, Romano F. Prevalence of periodontitis in an adult population from an urban area in North Italy: findings from a cross-sectional population-based epidemiological survey. J Clin Periodontol 2015; 42:622-31. [PMID: 25970460 DOI: 10.1111/jcpe.12420] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2015] [Indexed: 01/22/2023]
Abstract
AIM There is a paucity of up-to-date data regarding prevalence and risk indicators of periodontitis in Italy. Therefore, the aim of this study was to evaluate the prevalence of periodontitis and its risk indicators among adults from an urban area in North Italy. MATERIAL AND METHODS This cross-sectional survey used a stratified two-stage probability sampling method to draw a representative sample of the adult population of the city of Turin. About 1600 individuals, 20-75 years old, were randomly selected and 736 subjects agreed to participate (47% of the sampled subjects). Clinical parameters were assessed using a full-mouth protocol. Logistic models were applied to assess associations between periodontitis and its putative risk indicators. Age was included as restricted cubic spline. RESULTS Based on CDC/AAP case definition, the prevalence estimates of severe and moderate periodontitis were 34.94% (95% CI: 31.23-38.74) and 40.78% (95% CI: 36.89-44.79). The probability of periodontitis increased in smokers (adjusted OR 2.06, 95% IC: 1.26-3.37, p = 0.004) and with age but leveled off in the 50+ year-old group (p < 0.001). CONCLUSION Periodontitis was highly prevalent in the Turin population. The present data will enable development of appropriate public health programs and allocation of resources.
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Affiliation(s)
- Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | | | - Anna Castiglione
- Unit of Clinical Epidemiology, AOU Città della Salute e della Scienza - Turin and CPO Piedmont, Turin, Italy
| | - Giulia M Mariani
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Francesco Ferrarotti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
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Ariano CC, Salmaggi A, Croci D, Lamperti E, Bottero P, Castiglione A, Venegoni E, La Mantia L, Eoli M. Lupus anticoagulants and antiphospholipid antibodies monitoring in systemic lupus erythematosus. Contrib Nephrol 2015; 99:118-22. [PMID: 1458916 DOI: 10.1159/000421700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C C Ariano
- Istituto Neurologico C. Besta, Milano, Italia
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Ferrario F, Castiglione A, Colasanti G, Barbiano di Belgioioso G, Bertoli S, D'Amico G. Role of monocytes in human glomerulonephritis. Histochemical study. Contrib Nephrol 2015; 45:131-40. [PMID: 3979050 DOI: 10.1159/000410456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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32
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Cecchi E, Chirillo F, Castiglione A, Faggiano P, Cecconi M, Moreo A, Cialfi A, Rinaldi M, Del Ponte S, Squeri A, Corcione S, Canta F, Gaddi O, Enia F, Forno D, Costanzo P, Zuppiroli A, Ronzani G, Bologna F, Patrignani A, Belli R, Ciccone G, De Rosa FG. Clinical epidemiology in Italian Registry of Infective Endocarditis (RIEI): Focus on age, intravascular devices and enterococci. Int J Cardiol 2015; 190:151-6. [PMID: 25918069 DOI: 10.1016/j.ijcard.2015.04.123] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 08/02/2014] [Revised: 04/07/2015] [Accepted: 04/15/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The epidemiology of infective endocarditis (IE) is changing due to a number of factors, including aging and health related comorbidities and medical procedures. The aim of this study is to describe the main clinical, epidemiologic and etiologic changes of IE from a large database in Italy. METHODS We prospectively collected episodes of IE in 17 Italian centers from July 2007 to December 2010. RESULTS We enrolled 677 patients with definite IE, of which 24% health-care associated. Patients were male (73%) with a median age of 62 years (IQR: 49-74) and 61% had several comorbidities. One hundred and twenty-eight (19%) patients had prosthetic left side IE, 391 (58%) native left side IE, 94 (14%) device-related IE and 54 (8%) right side IE. A predisposing cardiopathy was present in 50%, while odontoiatric and non odontoiatric procedures were reported in 5% and 21% of patients respectively. Symptoms were usually atypical and precocious. The prevalent etiology was represented by Staphylococcus aureus (27%) followed by coagulase-negative staphylococci (CNS, 21%), Streptococcus viridans (15%) and enterococci (14%). CNS and enterococci were relatively more frequent in patients with intravascular devices and prosthesis and S. viridans in left native valve. Diagnosis was made by transthoracic and transesophageal echocardiography in 62% and 94% of cases, respectively. The in-hospital mortality was 14% and 1-year mortality was 21%. CONCLUSION The epidemiology is changing in Italy, where IE more often affects older patients with comorbidities and intravascular devices, with an acute onset and including a high frequency of enterococci. There were few preceding odontoiatric procedures.
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Affiliation(s)
- Enrico Cecchi
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Anna Castiglione
- SSCVD Epidemiologia Clinica e Valutativa, Città della Salute e della Scienza di Torino, Italy
| | | | - Moreno Cecconi
- Dipartimento di Scienze Cardiologiche Mediche e Chirurgiche Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Antonella Moreo
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milano, Italy
| | | | - Mauro Rinaldi
- Department of Cardiac Surgery, Molinette Hospital, University of Torino, Torino, Italy
| | | | - Angelo Squeri
- Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliera - Universitaria di Parma, Parma, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
| | | | - Oscar Gaddi
- Department of Cardiology, Reggio Emilia Hospital, Reggio Emilia, Italy
| | - Francesco Enia
- Department of Cardiology, Cervello Hospital, Palermo, Italy
| | - Davide Forno
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Piera Costanzo
- Department of Cardiology, Giovanni Bosco Hospital, Torino, Italy
| | | | | | - Flavio Bologna
- Department of Cardiology, Rimini Hospital, Rimini, Italy
| | - Anna Patrignani
- Department of Cardiology, Senigallia Hospital, Senigallia, Italy
| | - Riccardo Belli
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Giovannino Ciccone
- SSCVD Epidemiologia Clinica e Valutativa, Città della Salute e della Scienza di Torino, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
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Filippi A, Guerrera F, Badellino S, Ceccarelli M, Castiglione A, Guarneri A, Spadi R, Racca P, Ciccone G, Ricardi U, Ruffini E. PO-0770: Stereotactic radiotherapy versus surgery: comparison of survival in lung metastases from colo-rectal cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40762-5] [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: 10/23/2022]
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34
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Brignardello E, Felicetti F, Castiglione A, Fortunati N, Matarazzo P, Biasin E, Sacerdote C, Ricardi U, Fagioli F, Corrias A, Arvat E. GH replacement therapy and second neoplasms in adult survivors of childhood cancer: a retrospective study from a single institution. J Endocrinol Invest 2015; 38:171-6. [PMID: 25344310 DOI: 10.1007/s40618-014-0179-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Growth hormone deficiency (GHD) is the most common endocrine late effect observed in childhood cancer survivors (CCS) previously submitted to cranial irradiation. Radiation therapy can also increase the risk of second neoplasms (SNs). Since in previous studies GH replacement therapy was associated with increased incidence of neoplasia, we explored the association between SNs and GH replacement therapy in a cohort of CCS with GHD. METHODS Within the clinical cohort of CCS referred to the Transition Unit for Childhood Cancer Survivors of Turin between November 2001 and December 2012, we considered all patients who developed GHD as a consequence of cancer therapies. GHD was always diagnosed in childhood. To evaluate the quality of data, our cohort was linked to the Childhood Cancer Registry of Piedmont. RESULTS GHD was diagnosed in 49 out of 310 CCS included in our clinical cohort. At least one SN was diagnosed in 14 patients, meningioma and basal cell carcinoma being the most common SNs. The cumulative incidence of SNs was similar in GH-treated and -untreated patients (8 SNs out of 26 GH-treated and 6 out of 23 GH-untreated patients; p = 0.331). Age, sex and paediatric cancer type had no impact on SNs development. CONCLUSIONS In our CCS, GH replacement therapy does not seem to increase the risk of SNs. Anyway, independently from replacement therapy, in these patients we observed an elevated risk of SNs, possibly related to previous radiation therapy, which suggests the need of a close long-term follow-up.
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Affiliation(s)
- E Brignardello
- Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy.
| | - F Felicetti
- Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy
- Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy
| | - A Castiglione
- Unit of Clinical Epidemiology, University of Torino and Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - N Fortunati
- Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy
- Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy
| | - P Matarazzo
- Paediatric Endocrinology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - E Biasin
- Paediatric Hematology/Oncology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - C Sacerdote
- Unit of Clinical Epidemiology, University of Torino and Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - U Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Torino, Turin, Italy
| | - F Fagioli
- Paediatric Hematology/Oncology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - A Corrias
- Paediatric Endocrinology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - E Arvat
- Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy
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Brignardello E, Palestini N, Felicetti F, Castiglione A, Piovesan A, Gallo M, Freddi M, Ricardi U, Gasparri G, Ciccone G, Arvat E, Boccuzzi G. Early surgery and survival of patients with anaplastic thyroid carcinoma: analysis of a case series referred to a single institution between 1999 and 2012. Thyroid 2014; 24:1600-6. [PMID: 25110922 DOI: 10.1089/thy.2014.0004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Extensive resection of the tumor has been associated with better survival of anaplastic thyroid carcinoma (ATC) patients. However, surgery is not the rule for ATC patients with distant metastases at the time of diagnosis (stage IV-C), regardless of tumor resectability. The aim of this work was to explore the potential role of surgery in ATC patients, including those in stage IV-C. METHODS We considered all the consecutive ATC patients referred to our institution from June 1999 to July 2012. Patients with stage IV-A incidentally discovered ATC were excluded because of their better prognosis. All patients eligible for surgery at the time of diagnosis were first operated with the intent to obtain a macroscopically complete resection (R0, R1), or a R2 resection with minimal macroscopical residual tumor. These operations were defined as "maximal debulking," whereas operations that did not achieve this goal were defined as "partial debulking." After surgery, almost all patients received adjuvant chemotherapy, associated to radiotherapy in more than 50% of patients. RESULTS There were 55 eligible patients (34 women; median age 73.15 years). Thirty-one patients had distant metastases (stage IV-C). The median overall survival was 5.55 months [CI 4.94-6.60], with no difference according to stage. "Maximal debulking" was obtained in 70.73% of operated patients as a first modality and resulted associated with better survival than "partial debulking" (6.57 months [CI 5.52-12.09] vs. 3.25 months [CI 0.66-4.80]), without any difference between stage IV-B and IV-C patients. Furthermore, 21% of patients submitted to "maximal debulking" died secondary to local progression of the tumor, whereas this was the case for 69% of patients treated with "partial debulking" or not operated at all. CONCLUSIONS Early "maximal debulking," followed by adjuvant therapy, can improve the survival and ameliorate the quality of residual life preventing the risk of suffocation. This effect is also observed in patients with distant metastasis at diagnosis and treated with this approach: they have an outcome similar to that observed in stage IV-B patients. We thus suggest that surgery may be considered in the management of all ATC patients, and should not be restricted a priori to stages IV-A and IV-B.
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Affiliation(s)
- Enrico Brignardello
- 1 Department of Oncology, AOU Città della Salute e della Scienza di Torino , Turin, Italy
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Trevisan E, Bertero L, Cassoni P, Morra I, Pasqualetti F, Lolli I, Castiglione A, Ciccone G, Ruda R, Soffietti R. O10.06 * A PHASE II STUDY OF AINO (ITALIAN ASSOCIATION OF NEURO-ONCOLOGY) ON BEVACIZUMAB AND FOTEMUSTINE FOR RECURRENT GLIOBLASTOMA: OUTCOME, PATTERNS OF RELAPSE AND SALVAGE TREATMENTS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.87] [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: 11/13/2022] Open
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Soffietti R, Bertero L, Trevisan E, Castiglione A, Fiano V, Trevisan M, Cassoni P, Merletti F, Ruda R. MGMT gene promoter methylation in plasma of glioma patients receiving temozolomide. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2016] [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)
- Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital of Turin, Turin, Italy
| | - Luca Bertero
- Department of Neuro-Oncology, University and City of Health and Science Hospital of Turin, Turin, Italy
| | - Elisa Trevisan
- Department of Neuro-Oncology, University and City of Health and Science Hospital of Turin, Turin, Italy
| | - Anna Castiglione
- Piedmont Reference Center for Epidemiology and Cancer Prevention, University and City of Health and Science Hospital of Turin, Turin, Italy
| | - Valentina Fiano
- Piedmont Reference Center for Epidemiology and Cancer Prevention, University and City of Health and Science Hospital of Turin, Turin, Italy
| | - Morena Trevisan
- Piedmont Reference Center for Epidemiology and Cancer Prevention, University and City of Health and Science Hospital of Turin, Turin, Italy
| | - Paola Cassoni
- Department of Pathology, University and City of Health and Science Hospital of Turin, Turin, Italy
| | - Franco Merletti
- Piedmont Reference Center for Epidemiology and Cancer Prevention, University and City of Health and Science Hospital of Turin, Turin, Italy
| | - Roberta Ruda
- Department of Neuro-Oncology, University and City of Health and Science Hospital of Turin, Turin, Italy
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Soffietti R, Trevisan E, Bertero L, Cassoni P, Morra I, Fabrini MG, Pasqualetti F, Lolli I, Castiglione A, Ciccone G, Rudà R. Bevacizumab and fotemustine for recurrent glioblastoma: a phase II study of AINO (Italian Association of Neuro-Oncology). J Neurooncol 2014; 116:533-41. [PMID: 24293233 PMCID: PMC3905193 DOI: 10.1007/s11060-013-1317-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/17/2013] [Indexed: 01/05/2023]
Abstract
The optimal combination of bevacizumab with cytotoxic or cytostatic drugs in recurrent glioblastoma is unknown. We performed a phase 2 trial of combined bevacizumab and fotemustine for patients with glioblastoma at first relapse after radiotherapy and temozolomide. The primary endpoint was 6-month progression-free survival (PFS), while secondary endpoints were overall survival (OS), response rate based on RANO criteria and toxicity. Fifty-four patients with recurrent GBM were enrolled. The authors observed a 6-month PFS rate of 42.6% (95% CI 29.3-55.2) and a median PFS of 5.2 months (95% CI 3.8-6.6). The median OS was 9.1 months (95% CI 7.3-10.3). Twenty-eight patients (52%) had a radiographic response, and a significant neurological improvement with steroid reduction was observed in 25/42 symptomatic patients (60%). MGMT promoter methylation was significantly associated with improved PFS in univariate analysis. Most unifocal tumors at baseline had a focal enhancing progression (76%), while the diffuse non-enhancing progression accounted for 9.5%. Response or survival were not associated with any pattern of progression. Survival after failure of treatment was short. Twelve out of 54 patients (22%) discontinued fotemustine for grade 3/4 myelotoxicity, while 4/54 (7.4%) discontinued bevacizumab. This study failed to demonstrate a superiority of the combination of bevacizumab and fotemustine over either bevacizumab or fotemustine alone as historical controls. Future studies should explore alternative regimens of combination of the two drugs.
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Affiliation(s)
- Riccardo Soffietti
- Dept. Neuro-Oncology, University and City of Health and Science Hospital of Turin, Via Cherasco 15, 10126, Turin, Italy,
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Castiglione A, Guaran V, Astolfi L, Orioli E, Zeri G, Gemmati D, Bovo R, Montaldi A, Alghisi A, Martini A. Karyotype-phenotype correlation in partial trisomies of the short arm of chromosome 6: a family case report and review of the literature. Cytogenet Genome Res 2013; 141:243-59. [PMID: 23942271 DOI: 10.1159/000353846] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 11/19/2022] Open
Abstract
The first child (proband) of nonconsanguineous Caucasian parents underwent genetic investigation because she was affected with congenital choanal atresia, heart defects and kidney hyposplasia with mild transient renal insufficiency. The direct DNA sequencing after PCR of the CHD7 gene, which is thought to be responsible for approximately 60-70% of the cases of CHARGE syndrome/association, found no mutations. The cytogenetic analysis (standard GTG banding karyotype) revealed the presence of extrachromosomal material on 10q. The chromosome analysis was completed with array CGH (30 kb resolution), MLPA and FISH, which allowed the identification of three 6p regions (6p.25.3p23 × 3): 2 of these regions are normally located on chromosome 6, and the third region is translocated to the long arm of chromosome 10. The same chromosomal rearrangement was subsequently found in the father, who was affected with congenital ptosis and progressive hearing loss, and in the proband's sister, the second child, who presented at birth with choanal atresia and congenital heart defects. The mutated karyotypes, which were directly inherited, are thought to be responsible for a variable phenotype, including craniofacial dysmorphisms, choanal atresia, congenital ptosis, sensorineural hearing loss, heart defects, developmental delay, and renal dysfunction. Nevertheless, to achieve a complete audiological assessment of the father, he underwent further investigation that revealed an increased level of the coagulation factor XIII (300% increased activity), fluctuating levels of fibrin D-dimer degradation products (from 296 to 1,587 ng/ml) and a homoplasmic mitochondrial DNA mutation: T961G in the MTRNR1 (12S rRNA) gene. He was made a candidate for cochlear implantation. Preoperative high-resolution computed tomography and magnetic resonance imaging of the temporal bone revealed the presence of an Arnold-Chiari malformation type I. To the best of our knowledge, this study is the second report on partial 6p trisomy that involves the 10q terminal region. Furthermore, we report the first case of documented Arnold-Chiari malformation type I and increased factor XIII activity associated with 6p trisomy. We present a comprehensive report of the familial cases and an exhaustive literature review.
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Affiliation(s)
- A Castiglione
- Department of Neurosciences, Complex Operative Unit of Otorhinolaryngology and Otosurgery, Padua University Hospital, Padua, Italy
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Rudà R, Magliola U, Bertero L, Trevisan E, Bosa C, Mantovani C, Ricardi U, Castiglione A, Monagheddu C, Soffietti R. Seizure control following radiotherapy in patients with diffuse gliomas: a retrospective study. Neuro Oncol 2013; 15:1739-49. [PMID: 23897633 DOI: 10.1093/neuonc/not109] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little information is available regarding the effect of conventional radiotherapy on glioma-related seizures. METHODS In this retrospective study, we analyzed the seizure response and outcome following conventional radiotherapy in a cohort of 43 patients with glioma (33 grade II, 10 grade III) and medically intractable epilepsy. RESULTS At 3 months after radiotherapy, seizure reduction was significant (≥ 50% reduction of frequency compared with baseline) in 31/43 patients (72%) of the whole series and in 25/33 patients (76%) with grade II gliomas, whereas at 12 months seizure reduction was significant in 26/34 (76%) and in 19/25 (76%) patients, respectively. Seizure reduction was observed more often among patients displaying an objective tumor response on MRI, but patients with no change on MRI also had a significant seizure reduction. Seizure freedom (Engel class I) was achieved at 12 months in 32% of all patients and in 38% of patients with grade II tumors. Timing of radiotherapy and duration of seizures prior to radiotherapy were significantly associated with seizure reduction. CONCLUSIONS This study showed that a high proportion of patients with medically intractable epilepsy from diffuse gliomas derive a significant and durable benefit from radiotherapy in terms of epilepsy control and that this positive effect is not strictly associated with tumor shrinkage as shown on MRI. Radiotherapy at tumor progression seems as effective as early radiotherapy after surgery. Prospective studies must confirm and better characterize the response to radiotherapy.
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Affiliation(s)
- Roberta Rudà
- Corresponding Author: Roberta Rudà, MD, Department of Neuro-Oncology, Via Cherasco 15, 10126 Torino, Italy.
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Busca A, Pecoraro C, Giaccone L, Bruno B, Allione B, Corsetti MT, Pini M, Marmont F, Audisio E, D’Ardia S, Frairia C, Castiglione A, Ciccone G, Levis A, Vitolo U, Falda M. Allogeneic stem cell transplant for adults with myelodysplastic syndromes: relevance of pre-transplant disease status. Leuk Lymphoma 2013; 55:863-9. [DOI: 10.3109/10428194.2013.816422] [Citation(s) in RCA: 4] [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: 11/13/2022]
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Bo S, Castiglione A, Ghigo E, Gentile L, Durazzo M, Cavallo-Perin P, Ciccone G. Mortality outcomes of different sulphonylurea drugs: the results of a 14-year cohort study of type 2 diabetic patients. Eur J Endocrinol 2013; 169:117-26. [PMID: 23660643 DOI: 10.1530/eje-13-0299] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Available data about mortality of type 2 diabetic patients treated with different sulphonylureas are scarce and contradictory. DESIGN We evaluated the associations between all-cause and cause-specific mortality and treatments with different sulphonylureas in a retrospective cohort of type 2 diabetic patients from a diabetes clinic. METHODS All 1277 patients treated with sulphonylureas during 19961997 were enrolled: 159 patients were treated with tolbutamide, 977 glibenclamide and 141 gliclazide. The baseline data (centralised laboratory parameters, anthropometric data and presence of chronic complications) were abstracted from the clinical records. Information on vital status was collected from demographic files after 14-year follow-up. Adjusted hazard ratios (HR) were estimated with Cox (all-cause mortality) or Fine and Gray models (cause-specific mortality), including several potential confounders. RESULTS Five hundred and fifty-six patients died during the follow-up: 262 from cardiovascular causes, 158 from cancer and 136 from other causes. When compared with the glibenclamide users, the gliclazide and tolbutamide users showed a significantly lower cancer mortality (HR=0.30; 95% CI 0.16-0.55, and HR=0.48; 95% CI 0.29-0.79 respectively). These results were strongly confirmed in the 555 patients on sulphonylurea monotherapy. None of the patients who were treated with gliclazide monotherapy died from cancer during the follow-up, and the patients on tolbutamide treatment exhibited a lower cancer mortality than the glibenclamide users (HR=0.40; 95% CI 0.22-0.71). Data did not change after stratification for the duration of sulphonylurea treatment from diabetes diagnosis to the study enrollment. CONCLUSIONS Cancer mortality was markedly reduced in the patients on gliclazide and tolbutamide treatment. These results suggest additional benefits for these drugs beyond their blood glucose-lowering effect and strongly advocate for further investigation.
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Affiliation(s)
- Simona Bo
- Department of Internal Medicine, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy.
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Irace L, Gabrielli R, Rosati MS, Giannoni MF, Castiglione A, Laurito A, Gossetti B. Carotid artery free-floating thrombus caused by paradoxical embolization from greater saphenous vein ascending thrombophlebitis. Ann Vasc Surg 2013; 27:499.e13-7. [PMID: 23618593 DOI: 10.1016/j.avsg.2012.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/21/2012] [Accepted: 06/11/2012] [Indexed: 10/26/2022]
Abstract
Stroke of unknown origin in young patients is seen to be closely correlated with patent foramen ovale (PFO) than stroke in patients with established stroke mechanisms. We report a case of a young woman without cardiovascular risk factors who was admitted to our emergency department with listlessness and altered mental status. The clinical examination revealed right lower limb swelling. Magnetic resonance imaging and contrast-enhanced computed tomographic scans revealed a free floating thrombus of the left internal carotid artery (ICA) with a large bilateral frontal ischemic lesion. The diagnosis of a medium-sized PFO with moderate right-to-left contrast shunting was made after transesophageal echocardiography. No other cardiac sources for embolization were detected, while an ascending thrombophlebitis of the right greater saphenous vein was detected by venous Doppler ultrasonography. These findings support the diagnosis of ICA free-floating thrombus caused by paradoxical embolization (via the PFO) of clot from the greater saphenous vein. The patient underwent emergency saphenofemoral disconnection with femoral vein thrombectomy and subsequently carotid artery thrombectomy under general anesthesia. No carotid atheromatous wall lesions were detected at surgical exploration; no immunologic pathology, hypercoagulable status, or malignancy were recorded. No hemorrhagic cerebral complications were observed in the postoperative period, and the patient had an improvement of her neurologic status (a reduction of the National Institutes of Health Stroke Scale score from 7 to 3). Her recovery was uneventful. The patient was transferred for rehabilitation on postoperative day 5 with oral anticoagulation. Six-month ultrasound follow-up revealed deep and superficial venous system and carotid artery patency. The patient was asymptomatic and anticoagulation was discontinued. Paradoxical cerebral embolization through a PFO is a rare phenomenon that, in our patient, appeared to have resulted in stroke caused by a free-floating thrombus in the ICA. Accurate evaluation of carotid and lower limb veins by duplex scan is mandatory in cases of stroke of unknown origin, and urgent surgical repair can be useful in order to improve the clinical outcome.
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Affiliation(s)
- Luigi Irace
- Department of Emergency Policlinico Umberto I, Sapienza University of Rome, Rome Italy
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Fiano V, Trevisan M, Sacerdote C, Castiglione A, Trevisan E, Senetta R, Gillio Tos A, De Marco L, Cassoni P, Soffietti R, Merletti F. Abstract 653: Gliomas: methylation status of MGMT gene monitoring in plasma DNA of patients receiving chemotherapy with alkylating agents. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The protein MGMT (O6-methylguanine-DNA-methyltransferase) is responsible for the DNA repair from damage in O6 position of guanine induced by alkylating agent such as temozolomide, which represent the conventional treatment of gliomas. Silencing of the MGMT gene by epigenetic methylation of its promoter may disable this repair mechanism, thus increasing the cytotoxicity of chemotherapy. Previous studies showed that glioblastama patients, with a methylated MGMT gene promoter in tumour tissue, are more sensitive to the action of alkylating agents and experience higher survival.
The aim of the study was to verify the feasibility and the utility of monitoring the state of methylation of MGMT in circulating DNA as a predictive marker of prognosis and response to treatment.
Fiftyeight patients with glioma (12 with low and 46 with high grade) who underwent surgical resection and who were eligible for therapy with temozolomide, were enrolled in the study. Blood samples for the analysis of MGMT methylation status were collected before any treatment (T0) and during the treatment at the time of each magnetic resonance imaging (about every 3 months). The methylation status of the MGMT gene promoter in circulating DNA was investigated using PCR with a specific probe for the methylated sequence.
The MGMT promoter methylation status in tumour tissue and in plasma was highly concordant: in the 79% of the patients the MGMT promoter was methylated both in tumour tissue and plasma, while in the 21% of patients MGMT promoter was methylated in tissue but not in plasma (Cohen's kappa coefficient = 0.75, p <0.001). The overall survivals (OS) was higher in methylated versus unmethylated MGMT promoter patients both in tumour tissue and plasma, even if with a borderline statistically significance (p = 0.06 by the log-rank test for plasma).
The risk of death increased in patients with unmethylated MGMT promoter both in tumour tissue (Adjusted HR=2.23; 95%CI 0.99-5.04) and in plasma (Adjusted HR1.73; 95%CI 0.92-3.22)
Finally, in all patients after one year from diagnosis we noticed a decrease of the state of methylation of MGMT promoter in plasma. At the end of follow up in the 98% of patients who presented the methylation of the MGMT promoter at T0, a complete unmethylation was observed.
In conclusion the results of this study confirm the feasibility of monitoring the state of methylation of MGMT in circulating DNA in glioma patients. MGMT promoter methylation status may be a prognostic marker of clinical interest in tissue and in plasma. Furthermore the complete unmethylation of MGMT promoter in the 98% of the glioma patients after one year from diagnosis, is a potentially important finding for future researches on biological history and treatment of gliomas.
Citation Format: Valentina Fiano, Morena Trevisan, Carlotta Sacerdote, Anna Castiglione, Elisa Trevisan, Rebecca Senetta, Anna Gillio Tos, Laura De Marco, Paola Cassoni, Riccardo Soffietti, Franco Merletti. Gliomas: methylation status of MGMT gene monitoring in plasma DNA of patients receiving chemotherapy with alkylating agents. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 653. doi:10.1158/1538-7445.AM2013-653
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Affiliation(s)
| | | | | | | | - Elisa Trevisan
- 2Clinic of Neurooncology, Dept of neuroscience, Turin, Italy
| | | | | | | | - Paola Cassoni
- 3Unit of Pathology, Molinette Hospital, Turin, Italy
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Faccenna F, Alunno A, Castiglione A, Carnevalini M, Venosi S, Gossetti B. Large aortic pseudoaneurysm and subsequent spondylodiscitis as a complication of endovascular treatment of iliac arteries. Thorac Cardiovasc Surg 2013; 61:606-9. [PMID: 23564532 DOI: 10.1055/s-0033-1333843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Both aortic pseudoaneurysm following endovascular aortoiliac reconstruction and spondylodiscitis subsequent to endograft infections are rare complications. We present a case of aortic false aneurysm following iliac arteries treatment complicated by spondylodiscitis after its endovascular repair. In this patient, a huge aortic pseudoaneurysm was diagnosed and treated in an emergency setting a few days after the procedure. A left aortomonoiliac endograft was placed and a femoro-femoral crossover bypass was performed. Afterward, the patient developed a stent graft infection and a lumbar spondylodiscitis. The patient was managed with a conservative treatment and, after 4 years, he continues to live. Analyzing this case, we would like to point out the following aspects: any procedure, although well established and technically simple, can cause life-threatening complications; hematomas resulting from endovascular exclusion of large pseudoaneurysms could be drained, to prevent bacterial infections.
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Affiliation(s)
- Federico Faccenna
- Division of Vascular Surgery, Department of Surgery and Transplant "P. Stefanini," Sapienza University of Rome, Rome, Italy
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Bo S, Ciccone G, Castiglione A, Gambino R, De Michieli F, Villois P, Durazzo M, Cavallo-Perin P, Cassader M. Anti-Inflammatory and Antioxidant Effects of Resveratrol in Healthy Smokers A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Trial. Curr Med Chem 2013; 20:1323-31. [DOI: 10.2174/0929867311320100009] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/17/2012] [Accepted: 12/27/2012] [Indexed: 11/22/2022]
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Brignardello E, Felicetti F, Castiglione A, Chiabotto P, Corrias A, Fagioli F, Ciccone G, Boccuzzi G. Endocrine health conditions in adult survivors of childhood cancer: the need for specialized adult-focused follow-up clinics. Eur J Endocrinol 2013; 168:465-72. [PMID: 23258270 DOI: 10.1530/eje-12-1043] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Survival rates among childhood cancer survivors (CCS) have enormously increased in the last 40 years. However, this improvement has been achieved at the expense of serious late effects that frequently involve the endocrine system. AIM To evaluate the cumulative incidence of endocrine diseases in a cohort of long-term CCS. MATERIALS AND METHODS We analyzed the clinical data of 310 adults, followed for a median time of 16.0 years after the first cancer diagnosis. The monitoring protocols applied to each patient were personalized on the basis of cancer diagnosis and previous treatments, according to the Children's Oncology Group guidelines. RESULTS The cumulative incidence of endocrine late effects steadily increased over time. At the last follow-up visit available, 48.46% of females and 62.78% of males were affected by at least one endocrine disease. The most common disorders were gonadal dysfunction, primary hypothyroidism, and GH deficiency (GHD). The main risk factors for endocrine disease were male sex (hazard ratio (HR)=1.45, 95% confidence interval (95% CI) 1.05-1.99), radiotherapy (HR=1.91, 95% CI 1.28-2.84), hematopoietic stem cells transplantation (HR=3.11, 95% CI 2.23-4.34), and older age at cancer diagnosis (HR=1.89, 95% CI 1.25-2.85). Male sex was associated with a higher risk of gonadal disorders, whereas radiotherapy specifically increased the risk of GHD and thyroid dysfunction. CONCLUSIONS Endocrine disorders among CCS have a high prevalence and increase over time. Thus, endocrinologists need to cope with an increasing demand for health care in a field that is still little developed and that, in perspective, could also be extended to some selected types of adult cancer survivors.
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Affiliation(s)
- E Brignardello
- Transition Unit for Childhood Cancer Survivors, San Giovanni Battista Hospital, Via Cherasco 15, 10126 Turin, Italy.
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D'Amico L, Satolli MA, Mecca C, Castiglione A, Ceccarelli M, D'Amelio P, Garino M, De Giuli M, Sandrucci S, Ferracini R, Roato I. Bone metastases in gastric cancer follow a RANKL-independent mechanism. Oncol Rep 2013; 29:1453-8. [PMID: 23404437 DOI: 10.3892/or.2013.2280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 12/27/2012] [Indexed: 01/06/2023] Open
Abstract
Gastric cancer is one of the most common and lethal malignancies worldwide. Bone metastases in gastric cancer are less common than in other solid tumors, but when they occur the prognosis is generally poor. Increased osteoclastogenesis and osteoclast activity are common features in bone metastases caused by different osteotropic cancer. We investigated osteoclastogenesis and its mechanisms in gastric cancer by enrolling 31 newly diagnosed gastric cancer patients and 45 healthy controls. We studied in vitro osteoclastogenesis in the peripheral blood mononuclear cell cultures of patients and controls, showing spontaneous osteoclastogenesis for half of the patients. This osteoclastogenesis was RANKL- and TNF-α-independent. We analyzed primary tumor and bone metastatic tissues of gastric cancer for the expression of genes involved in osteoclastogenesis. The expression of transforming growth factor-β (TGF-β), osteoprotegerin (OPG), IL-7 and dickkopf-1 (DKK-1) was higher in primary tumors than in bone metastases. RANKL was not detectable in primary tumor or in bone metastatic tissue. The serum RANKL level was significantly higher in healthy controls than in patients, and it was not related to osteoclastogenesis, thereby suggesting that RANKL is not involved in the bone metastatic mechanisms in gastric cancer. We hypothesized a role of RANKL in angiogenesis, thus we compared the serum levels of RANKL to those of VEGF, since VEGF is directly related to angiogenesis. Different from RANKL, the VEGF serum levels were higher in gastric patients than in controls, suggesting a block of the angiogenesis inhibition due to RANKL. RANKL and VEGF serum levels were not predictive of overall survival in our cohort of gastric patients.
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Affiliation(s)
- Lucia D'Amico
- CeRMS (Center for Experimental Research and Medical Studies), Department of Medical Oncology, San Giovanni Battista Hospital, and Department of Surgical and Medical Discplines, University of Turin, Turin, Italy
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Bo S, Ciccone G, Castiglione A, Gambino R, De Michieli F, Villois P, Durazzo M, Cavallo-Perin P, Cassader M. Anti-Inflammatory and Antioxidant Effects of Resveratrol in Healthy Smokers A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Trial. Curr Med Chem 2013. [DOI: 10.2174/09298673113208880014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Faccenna F, Alunno A, Castiglione A, Felli MMG, Venosi S, Gattuso R, Gossetti B. Persistent Type II Endoleak: Two Cases of Successful Sacotomy. Ann Vasc Surg 2013; 27:240.e9-240.e11. [DOI: 10.1016/j.avsg.2012.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 06/11/2012] [Indexed: 11/16/2022]
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