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Maines E, Urru SAM, Leonardi L, Fancellu E, Campomori A, Piccoli G, Maiorana A, Soffiati M, Franceschi R. Drug-induced hyperinsulinemic hypoglycemia: An update on pathophysiology and treatment. Rev Endocr Metab Disord 2023; 24:1031-1044. [PMID: 37552352 DOI: 10.1007/s11154-023-09828-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
The initial step for the differential diagnosis of hypoglycemia is to determine whether it is hyperinsulinemic or non hyperinsulinemic. Existing literature discusses drug-related hypoglycemia, but it misses a focus on drug-induced hyperinsulinemic hypoglycemia (DHH). Here we reviewed the association existing between drugs and hyperinsulinemic hypoglycemia. We primarily selected on the main electronic databases (MEDLINE, EMBASE, Web of Science, and SCOPUS) the reviews on drug-induced hypoglycemia. Among the drugs listed in the reviews, we selected the ones linked to an increase in insulin secretion. For the drugs missing a clear association with insulin secretion, we investigated the putative mechanism underlying hypoglycemia referring to the original papers. Our review provides a list of the most common agents associated with hyperinsulinemic hypoglycemia (HH), in order to facilitate both the recognition and the prevention of DHH. We also collected data about the responsiveness of DHH to diazoxide or octreotide.
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Affiliation(s)
- Evelina Maines
- Department of Women's and Children's Health, Pediatric Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy.
| | - Silvana Anna Maria Urru
- Hospital Pharmacy Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy
| | - Letizia Leonardi
- Department of Women's and Children's Health, Pediatric Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy
| | | | - Annalisa Campomori
- Hospital Pharmacy Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy
| | - Giovanni Piccoli
- CIBIO - Department of Cellular, Computational and Integrative Biology, Università degli Studi di Trento, Trento, Italy
| | - Arianna Maiorana
- Division of Metabolism and Research Unit of Metabolic Biochemistry, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Soffiati
- Department of Women's and Children's Health, Pediatric Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy
| | - Roberto Franceschi
- Department of Women's and Children's Health, Pediatric Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy
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Siri B, D'Alessandro A, Maiorana A, Porzio O, Ravà L, Dionisi-Vici C, Cappa M, Martinelli D. Adrenocortical function in patients with Single Large Scale Mitochondrial DNA Deletions: a retrospective single centre cohort study. Eur J Endocrinol 2023; 189:485-494. [PMID: 37815532 DOI: 10.1093/ejendo/lvad137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Single Large Scale Mitochondrial DNA Deletions (SLSMDs), Pearson Syndrome (PS) and Kearns-Sayre Syndrome (KSS), are systemic diseases with multiple endocrine abnormalities. The adrenocortical function has not been systematically investigated with a few anecdotal reports of overt adrenal insufficiency (AI). The study aimed to assess the adrenocortical function in a large cohort of SLSMDs. DESIGN AND METHODS A retrospective monocentric longitudinal study involved a cohort of 18 SLSMDs patients. Adrenocortical function was evaluated by baseline adrenocorticotrophic hormone (ACTH) and cortisol measurements and by high- (HDT) and low-dose (LDT) ACTH stimulation tests and compared with 92 healthy controls (HC). RESULTS Baseline adrenocortical function was impaired in 39% of patients and by the end of the study, 66% of PS and 25% of KSS showed an insufficient increase after ACTH stimulation, with cortisol deficiency due to primary AI in most PS and subclinical AI in KSS. Symptomatic AI was recorded in 44% of patients. Peak cortisol levels after ACTH stimulation tests were significantly lower in patients than in HC (P < .0001), with a more reduced response to LDT vs HDT (P < .05). CONCLUSIONS Our study highlights that cortisol deficiency due to primary AI represents a relevant part of the clinical spectrum in SLSMDs, with more severe impairment in PS than in KSS. Basal and after-stimulus assessment of adrenocortical axis should be early and regularly investigated to identify any degree of adrenocortical dysfunction. The study allowed the elaboration of a diagnostic process designed for the diagnosis, treatment, and follow-up of adrenocortical abnormalities in SLSMDs.
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Affiliation(s)
- Barbara Siri
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
- Department of Paediatrics, Città della Salute e della Scienza, OIRM, University of Turin, 10126 Turin, Italy
| | - Annamaria D'Alessandro
- Clinical Biochemistry Laboratory, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Arianna Maiorana
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Ottavia Porzio
- Clinical Biochemistry Laboratory, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Lucilla Ravà
- Clinical Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Marco Cappa
- Research Area of Innovative Therapies in Endocrinopathies, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Diego Martinelli
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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Maines E, Cardellini MC, Stringari G, Leonardi L, Piccoli G, Urru SAM, Maiorana A, Soffiati M, Franceschi R. Drug-Induced Hypoglycemia in Neonates Born to Nondiabetic Women Treated with Medications during the Pregnancy or the Labor: A Systematic Review of the Literature. Am J Perinatol 2023. [PMID: 37848046 DOI: 10.1055/s-0043-1776061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The prompt identification of at-risk newborns for drug-induced hypoglycemia can minimize the risk for adverse side effects, inappropriate investigations, and considerable unnecessary costs. Existing literature discusses drug-induced hypoglycemia, but a systematic description of neonatal hypoglycemia induced or exacerbated by maternal medications is missing. We reviewed the association between neonatal hypoglycemia and maternal medications. We systematically searched the literature according to the PICOS model on drug-induced hypoglycemia in neonates born to nondiabetic women treated with medications during the pregnancy or the labor. The main outcomes of the review were: (1) prevalence of hypoglycemia, (2) risk factors and potential confounders, (3) time at onset and severity of hypoglycemia, (4) dose-response gradient, (5) metabolic features of hypoglycemia, (6) modalities to treat hypoglycemia, and (7) quality of the studies. We included 69 studies in this review and we identified 11 groups of maternal drugs related to neonatal hypoglycemia. Results were classified for each outcome. Our review aims at supporting clinicians in the identification of the newborn at risk for hypoglycemia and in the differential diagnosis of neonatal hypoglycemia. Further studies are necessary to assess the risk of neonatal hypoglycemia associated with common maternal medications. KEY POINTS: · A systematic description of neonatal hypoglycemia induced or exacerbated by maternal medications is missing.. · In our review we identified 11 groups of maternal drugs related to neonatal hypoglycemia.. · Our review aims at supporting clinicians in the identification of the newborn at risk for hypoglycemia..
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Affiliation(s)
- Evelina Maines
- Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | | | - Giovanna Stringari
- Division of Neonatology, S. Chiara General Hospital, APSS, Trento, Italy
| | - Letizia Leonardi
- Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | - Giovanni Piccoli
- CIBIO - Department of Cellular, Computational and Integrative Biology, Università degli Studi di Trento, Trento, Italy
| | | | - Arianna Maiorana
- Division of Metabolism and Research Unit of Metabolic Biochemistry, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
- Division of Neonatology, S. Chiara General Hospital, APSS, Trento, Italy
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Damiani V, Lamolinara A, Cicalini I, Cufaro MC, Del Pizzo F, Di Marco F, Del Boccio P, Dufrusine B, Hahne M, Lattanzio R, Pieragostino D, Iezzi M, Federici M, Turco MC, Maiorana A, Dionisi-Vici C, De Laurenzi V. Pancreatic beta-cell specific BAG3 knockout results in chronic hyperinsulinemia inducing insulin resistance. Mol Metab 2023:101752. [PMID: 37308077 DOI: 10.1016/j.molmet.2023.101752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Insulin, secreted from pancreatic islets of Langerhans, is of critical importance in regulating glucose homeostasis. Defective insulin secretion and/or the inability of tissues to respond to insulin results in insulin resistance and to several metabolic and organ alterations. We have previously demonstrated that BAG3 regulates insulin secretion. Herein we explored the consequences of beta-cells specific BAG3 deficiency in an animal model. METHODS We generated a beta-cells specific BAG3 knockout mouse model. Glucose and insulin tolerance tests, proteomics, metabolomics, and immunohistochemical analysis were used to investigate the role of BAG3 in regulating insulin secretion and the effects of chronic exposure to excessive insulin release in vivo. RESULTS Beta-cells specific BAG3 knockout results in primary hyperinsulinism due to excessive insulin exocytosis finally leading to insulin resistance. We demonstrate that resistance is mainly muscle-dependent while the liver remains insulin sensitive. The chronically altered metabolic condition leads in time to histopathological alterations in different organs. We observe elevated glycogen and lipid accumulation in the liver reminiscent of non-alcoholic fatty liver disease as well as mesangial matrix expansion and thickening of the glomerular basement membrane, resembling the histology of chronic kidney disease. CONCLUSION Altogether, this study shows that BAG3 plays a role in insulin secretion and provides a model for the study of hyperinsulinemia and insulin resistance.
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Affiliation(s)
- Verena Damiani
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Alessia Lamolinara
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Neurosciences, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Ilaria Cicalini
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Maria Concetta Cufaro
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Del Pizzo
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Federica Di Marco
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Piero Del Boccio
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Pharmacy, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Beatrice Dufrusine
- Department of Bioscience and Technology for Food Agriculture and Environment, University of Teramo, 64100 Teramo, Italy
| | - Michael Hahne
- IGMM, CNRS, University of Montpellier, 34090 Montpellier, France
| | - Rossano Lattanzio
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Damiana Pieragostino
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Manuela Iezzi
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Neurosciences, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Maria Caterina Turco
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Arianna Maiorana
- Division of Metabolism, Department of Pediatrics Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), 00100 Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Department of Pediatrics Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), 00100 Rome, Italy
| | - Vincenzo De Laurenzi
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy.
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Di Carlo C, Maiorana A, Ampollini M, Antignani S, Caprio M, Carpentieri C, Bochicchio F. Models of radon exhalation from building structures: General and case-specific solutions. Sci Total Environ 2023; 885:163800. [PMID: 37149182 DOI: 10.1016/j.scitotenv.2023.163800] [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] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Assessing the radon activity that exhales from building structures is crucial to identify the best strategies to prevent radon from entering a building or reducing its concentration in the inhabited spaces. The direct measurement is extremely difficult, so the common approach has consisted in developing models describing the radon migration and exhalation phenomena for building porous materials. However, due to the mathematical complexity of comprehensively modelling the radon transport phenomenon in buildings, simplified equations have been mostly adopted until now to assess the radon exhalation. A systematic analysis of the models applicable to radon transport has been carried out and it has resulted in four models differing in the migration mechanisms - only diffusive or diffusive and advective - and the presence of inner radon generation. The general solutions have been obtained for all the models. Moreover, three case-specific sets of boundary conditions have been formulated to account for all the actual scenarios occurring in buildings: both perimetral and partition walls and building structures in direct contact with soil or embankments. The corresponding case-specific solutions obtained serve as a key practical tool to improve the accuracy in assessing the contribution of building materials to indoor radon concentration according to the site-specific installation conditions in addition to the material inner properties.
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Affiliation(s)
- C Di Carlo
- Italian National Institute of Health / National Center for Radiation Protection and Computational Physics, Viale Regina Elena, 299, 00161 Rome, Italy.
| | - A Maiorana
- Italian National Institute of Health / National Center for Radiation Protection and Computational Physics, Viale Regina Elena, 299, 00161 Rome, Italy
| | - M Ampollini
- Italian National Institute of Health / National Center for Radiation Protection and Computational Physics, Viale Regina Elena, 299, 00161 Rome, Italy
| | - S Antignani
- Italian National Institute of Health / National Center for Radiation Protection and Computational Physics, Viale Regina Elena, 299, 00161 Rome, Italy
| | - M Caprio
- Italian National Institute of Health / National Center for Radiation Protection and Computational Physics, Viale Regina Elena, 299, 00161 Rome, Italy
| | - C Carpentieri
- Italian National Institute of Health / National Center for Radiation Protection and Computational Physics, Viale Regina Elena, 299, 00161 Rome, Italy
| | - F Bochicchio
- Italian National Institute of Health / National Center for Radiation Protection and Computational Physics, Viale Regina Elena, 299, 00161 Rome, Italy
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6
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Costantino C, Mazzucco W, Bonaccorso N, Sciortino M, Cimino L, Pizzo S, Conforto A, Calò I, Gilimberti D, Gambino CR, Segreto D, Maiorana A, Vitale F, Casuccio A. A cross-sectional study on smartphone uses among pregnant women attending childbirth classes in the Metropolitan Area of Palermo, Italy: The Stop-Phone study. Ann Ig 2023; 35:319-330. [PMID: 36190310 DOI: 10.7416/ai.2022.2543] [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] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Background Prevalence of mobile device addiction has increased over the years; both women and men have assimilated the mobile phone as a central component of their personal existence: integrating it into their lifestyle or becoming so dependent on it that life without it has become unimaginable. Smartphones generate radio-frequency electromagnetic fields. While short-term exposure in adults was considered quite safe, effects of long-term exposure or exposure during pregnancy on fetuses or during breastfeeding on newborns are not well studied yet. The objective of the present study was to investigate the prevalence and usage characteristics of smartphones among a sample of pregnant women, and promote the correct and conscious use of the smartphone. Methods A cross-sectional study was conducted, with a questionnaire administered during childbirth classes and - after the questionnaire administration - an educational intervention focused on promoting the correct and conscious use of smartphones was carried out by psychologists and psychotherapists. Results The findings of our study suggest that a significant number of the participants suffered addiction to mobile phone usage, but were not aware of it. More than two third of the sample (67.2%) have not changed their smartphone use habits since the beginning of their pregnancy and even more significant data shows that almost all future moms (98.3%) never speak with their doctor about smartphone use during pregnancy. Conclusions Data collected suggest a lack of attention to the proposed topic, especially in relation to pregnancy. It seems necessary to sensitize future mothers on this topic. The promotion of a more conscious and controlled use of electronic devices can help reduce the radiation to which the unborn child may be exposed, but has a fundamental role even after birth, to ensure an adequate psychomotor and relational development of the child and do not affect, due to uncontrolled use of smartphones, the mother-child relationship.
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Affiliation(s)
- C Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Italy
| | - W Mazzucco
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Italy
| | - N Bonaccorso
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Italy
| | - M Sciortino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Italy
| | - L Cimino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Italy
| | - S Pizzo
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Italy
| | - A Conforto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Italy
| | - I Calò
- Vivi Sano Onlus, Local Health Unit of Palermo, Italy
| | - D Gilimberti
- Vivi Sano Onlus, Local Health Unit of Palermo, Italy
| | - C R Gambino
- Local Health Unit of Palermo, Palermo, Italy
| | - D Segreto
- Special Office for Communication, Health Department of Sicilian Region, Palermo, Italy
| | - A Maiorana
- HCU Obstetrics and Gynecology ARNAS Di Cristina Benfratelli Hospital, Palermo, Italy
| | - F Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Italy
| | - A Casuccio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Italy
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7
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Maines E, Moretti M, Vitturi N, Gugelmo G, Fasan I, Lenzini L, Piccoli G, Gragnaniello V, Maiorana A, Soffiati M, Burlina A, Franceschi R. Understanding the Pathogenesis of Cardiac Complications in Patients with Propionic Acidemia and Exploring Therapeutic Alternatives for Those Who Are Not Eligible or Are Waiting for Liver Transplantation. Metabolites 2023; 13:563. [PMID: 37110221 PMCID: PMC10143878 DOI: 10.3390/metabo13040563] [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: 02/13/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The guidelines for the management of patients affected by propionic acidemia (PA) recommend standard cardiac therapy in the presence of cardiac complications. A recent revision questioned the impact of high doses of coenzyme Q10 on cardiac function in patients with cardiomyopathy (CM). Liver transplantation is a therapeutic option for several patients since it may stabilize or reverse CM. Both the patients waiting for liver transplantation and, even more, the ones not eligible for transplant programs urgently need therapies to improve cardiac function. To this aim, the identification of the pathogenetic mechanisms represents a key point. Aims: This review summarizes: (1) the current knowledge of the pathogenetic mechanisms underlying cardiac complications in PA and (2) the available and potential pharmacological options for the prevention or the treatment of cardiac complications in PA. To select articles, we searched the electronic database PubMed using the Mesh terms "propionic acidemia" OR "propionate" AND "cardiomyopathy" OR "Long QT syndrome". We selected 77 studies, enlightening 12 potential disease-specific or non-disease-specific pathogenetic mechanisms, namely: impaired substrate delivery to TCA cycle and TCA dysfunction, secondary mitochondrial electron transport chain dysfunction and oxidative stress, coenzyme Q10 deficiency, metabolic reprogramming, carnitine deficiency, cardiac excitation-contraction coupling alteration, genetics, epigenetics, microRNAs, micronutrients deficiencies, renin-angiotensin-aldosterone system activation, and increased sympathetic activation. We provide a critical discussion of the related therapeutic options. Current literature supports the involvement of multiple cellular pathways in cardiac complications of PA, indicating the growing complexity of their pathophysiology. Elucidating the mechanisms responsible for such abnormalities is essential to identify therapeutic strategies going beyond the correction of the enzymatic defect rather than engaging the dysregulated mechanisms. Although these approaches are not expected to be resolutive, they may improve the quality of life and slow the disease progression. Available pharmacological options are limited and tested in small cohorts. Indeed, a multicenter approach is mandatory to strengthen the efficacy of therapeutic options.
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Affiliation(s)
- Evelina Maines
- Division of Pediatrics, Santa Chiara General Hospital, APSS, 38122 Trento, Italy
| | - Michele Moretti
- Division of Cardiology, Santa Chiara General Hospital, APSS, 38122 Trento, Italy
| | - Nicola Vitturi
- Division of Metabolic Diseases, Department of Medicine-DIMED, University Hospital, 35128 Padova, Italy
| | - Giorgia Gugelmo
- Division of Clinical Nutrition, Department of Medicine-DIMED, University Hospital, 35128 Padova, Italy
| | - Ilaria Fasan
- Division of Clinical Nutrition, Department of Medicine-DIMED, University Hospital, 35128 Padova, Italy
| | - Livia Lenzini
- Emergency Medicine Unit, Department of Medicine-DIMED, University Hospital, 35128 Padova, Italy
| | - Giovanni Piccoli
- CIBIO, Department of Cellular, Computational and Integrative Biology, Italy & Dulbecco Telethon Institute, Università degli Studi di Trento, 38123 Trento, Italy
| | - Vincenza Gragnaniello
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Women’s and Children’s Health, University Hospital, 35128 Padova, Italy
| | - Arianna Maiorana
- Division of Metabolism and Research Unit of Metabolic Biochemistry, Bambino Gesù Children’s Hospital-IRCCS, 00165 Rome, Italy
| | - Massimo Soffiati
- Division of Pediatrics, Santa Chiara General Hospital, APSS, 38122 Trento, Italy
| | - Alberto Burlina
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Women’s and Children’s Health, University Hospital, 35128 Padova, Italy
| | - Roberto Franceschi
- Division of Pediatrics, Santa Chiara General Hospital, APSS, 38122 Trento, Italy
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8
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Spagnoletti G, Larghi Laureiro Z, Maria Fratti A, Maiorana A, Garganese MC, Pizzoferro M, Dionisi-Vici C, Spada M. Case report: Pylorus-preserving pancreatoduodenectomy for focal congenital hyperinsulinism in a 5-month-old baby. Front Surg 2023; 9:1085238. [PMID: 36793512 PMCID: PMC9923011 DOI: 10.3389/fsurg.2022.1085238] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/19/2022] [Indexed: 01/31/2023] Open
Abstract
Background In focal congenital hyperinsulinism (CHI), surgery is the gold standard of treatment, even for lesions localized in the head of the pancreas. We report the video of the pylorus-preserving pancreatoduodenectomy performed in a five-month-old child with focal CHI. Operative technique Baby was placed in the supine position with both arms outstretched to the up. After transverse supraumbilical incision and mobilization of ascending and transverse colon, exploration and multiple biopsies of the tail and the body of the pancreas ruled out multifocality. Pylorus-preserving pancreatoduodenectomy was performed according to the following steps: extended Kocher maneuver, followed by retrograde cholecystectomy and common bile duct isolation; division of the gastroduodenal artery and of the gastrocolic ligament; division of the duodenum, Treitz ligament and jejunum; transection of the pancreatic body. The reconstructive time was with: pancreato-jejunostomy; hepaticojejunostomy; pilorus-preserving antecolic duodeno-jejunostomy. The anastomoses were accomplished with synthetic absorbable monofilament sutures; two drains were placed close to the biliary and pancreatic anastomoses and to the intestinal anastomosis, respectively. Total operative time was 6 h, with no blood loss and/or intra-operative complications, immediate normalization of blood glucose levels and discharge from surgical ward 19 days after surgery. Conclusions Surgical treatment of medical unresponsive focal forms of CHI is feasible in very small children: it is mandatory to refer the baby to a high-volume centre for a multidisciplinary management involving hepato-bilio-pancreatic surgeons and experts in metabolic disease.
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Affiliation(s)
- Gionata Spagnoletti
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Zoe Larghi Laureiro
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Alberto Maria Fratti
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Arianna Maiorana
- Division of Metabolic Diseases, Department of Pediatric Specialties, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Maria Carmen Garganese
- Nuclear Medicine, Imaging Department Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - Milena Pizzoferro
- Nuclear Medicine, Imaging Department Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases, Department of Pediatric Specialties, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy,Correspondence: Marco Spada
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Maines E, Maiorana A, Leonardi L, Piccoli G, Soffiati M, Franceschi R. A narrative review on pathogenetic mechanisms of hyperinsulinemic hypoglycemia in Kabuki syndrome. Endocr Regul 2023; 57:128-137. [PMID: 37285460 DOI: 10.2478/enr-2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Objective. Kabuki syndrome (KS) is associated with hyperinsulinemic hypoglycemia (HH) in 0.3-4% of patients, thus exceeding the prevalence in the general population. HH association is stronger for KS type 2 (KDM6A-KS, OMIM #300867) than KS type 1 (KMT2D-KS, OMIM #147920). Both the disease-associated genes, KMD6A and KMT2D, modulate the chromatin dynamic. As such, KS is considered to be the best characterized pediatric chromatinopathy. However, the exact pathogenetic mechanisms leading to HH in this syndrome remain still unclear. Methods. We selected on the electronic database PubMed all articles describing or hypothesizing the mechanisms underlying the dysregulated insulin secretion in KS. Results. The impact on the gene expression due to the KDM6A or KMT2D function loss may lead to a deregulated pancreatic β-cell differentiation during embryogenesis. Moreover, both KMT2D gene and KDM6A gene are implicated in promoting the transcription of essential pancreatic β-cell genes and in regulating the metabolic pathways instrumental for insulin release. Somatic KMT2D or KDM6A mutations have also been described in several tumor types, including insulinoma, and have been associated with metabolic pathways promoting pancreatic cell proliferation. Conclusions. The impact of pathogenic variants in KDM6A and KDM2D genes on β-cell insulin release remains to be fully clarified. Understanding this phenomenon may provide valuable insight into the physiological mechanisms of insulin release and into the pathological cascade causing hyperinsulinism in KS. The identification of these molecular targets may open new therapeutic opportunities based on epigenetic modifiers.
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Affiliation(s)
- Evelina Maines
- 1Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | - Arianna Maiorana
- 2Division of Metabolism and Research Unit of Metabolic Biochemistry, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Letizia Leonardi
- 1Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | - Giovanni Piccoli
- 3CIBIO - Department of Cellular, Computational and Integrative Biology, Università degli Studi di Trento, Italy
| | - Massimo Soffiati
- 1Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | - Roberto Franceschi
- 1Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
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Maiorana A, Tagliaferri F, Dionisi-Vici C. Current understanding on pathogenesis and effective treatment of glycogen storage disease type Ib with empagliflozin: new insights coming from diabetes for its potential implications in other metabolic disorders. Front Endocrinol (Lausanne) 2023; 14:1145111. [PMID: 37152929 PMCID: PMC10160627 DOI: 10.3389/fendo.2023.1145111] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Glycogen storage type Ib (GSDIb) is a rare inborn error of metabolism caused by glucose-6-phosphate transporter (G6PT, SLC37A4) deficiency. G6PT defect results in excessive accumulation of glycogen and fat in the liver, kidney, and intestinal mucosa and into both glycogenolysis and gluconeogenesis impairment. Clinical features include hepatomegaly, hypoglycemia, lactic acidemia, hyperuricemia, hyperlipidemia, and growth retardation. Long-term complications are liver adenoma, hepatocarcinoma, nephropathy and osteoporosis. The hallmark of GSDIb is neutropenia, with impaired neutrophil function, recurrent infections and inflammatory bowel disease. Alongside classical nutritional therapy with carbohydrates supplementation and immunological therapy with granulocyte colony-stimulating factor, the emerging role of 1,5-anhydroglucitol in the pathogenesis of neutrophil dysfunction led to repurpose empagliflozin, an inhibitor of the renal glucose transporter SGLT2: the current literature of its off-label use in GSDIb patients reports beneficial effects on neutrophil dysfunction and its clinical consequences. Surprisingly, this glucose-lowering drug ameliorated the glycemic and metabolic control in GSDIb patients. Furthermore, numerous studies from big cohorts of type 2 diabetes patients showed the efficacy of empagliflozin in reducing the cardiovascular risk, the progression of kidney disease, the NAFLD and the metabolic syndrome. Beneficial effects have also been described on peripheral neuropathy in a prediabetic rat model. Increasing evidences highlight the role of empagliflozin in regulating the cellular energy sensors SIRT1/AMPK and Akt/mTOR, which leads to improvement of mitochondrial structure and function, stimulation of autophagy, decrease of oxidative stress and suppression of inflammation. Modulation of these pathways shift the oxidative metabolism from carbohydrates to lipids oxidation and results crucial in reducing insulin levels, insulin resistance, glucotoxicity and lipotoxicity. For its pleiotropic effects, empagliflozin appears to be a good candidate for drug repurposing also in other metabolic diseases presenting with hypoglycemia, organ damage, mitochondrial dysfunction and defective autophagy.
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Affiliation(s)
- Arianna Maiorana
- Division of Metabolism, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
- *Correspondence: Arianna Maiorana,
| | - Francesco Tagliaferri
- SCDU of Pediatrics, Azienda Ospedaliero-Universitaria Maggiore della Carità, University of Piemonte Orientale, Novara, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
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Tagliaferri F, Massese M, Russo L, Commone A, Gasperini S, Pretese R, Dionisi-Vici C, Maiorana A. Hepatic glycogen storage diseases type 0, VI and IX: description of an italian cohort. Orphanet J Rare Dis 2022; 17:285. [PMID: 35854365 PMCID: PMC9295101 DOI: 10.1186/s13023-022-02431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Glycogen storage disease (GSD) type 0, VI and IX are inborn errors of metabolism involving hepatic glycogen synthesis and degradation. We performed a characterization of a large Italian cohort of 30 patients with GSD type 0a, VI, IXa, IXb and IXc. A retrospective evaluation of genetical, auxological and endocrinological data, biochemical tests, and nutritional intakes was assessed. Eventual findings of overweight/obesity and insulin-resistance were correlated with diet composition. Results Six GSD-0a, 1 GSD-VI, and 23 GSD-IX patients were enrolled, with an age of presentation from 0 to 72 months (median 14 months). Diagnosis was made at a median age of 30 months, with a median diagnostic delay of 11 months and a median follow-up of 66 months. From first to last visit, patients gained a median height of 0.6 SDS (from − 1.1 to 2.1 SDS) and a median weight of 0.5 SDS (from − 2.5 to 3.3 SDS); mean and minimal glucose values significant improved (p < 0.05). With respect to dietary intakes, protein intake (g/kg) and protein intake (g/kg)/RDA ratio directly correlated with the glucose/insulin ratio (p < 0.05) and inversely correlated with HOMA-IR (Homeostasis model assessment of insulin resistance, p < 0.05), BMI SDS (p < 0.05) and %ibw (ideal body weight percentage, p < 0.01). Conclusion A prompt establishment of specific nutritional therapy allowed to preserve growth, improve glycemic control and prevent liver complication, during childhood. Remarkably, the administration of a high protein diet appeared to have a protective effect against overweight/obesity and insulin-resistance.
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Affiliation(s)
- Francesco Tagliaferri
- Division of Metabolism, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,SCDU of Pediatrics, Azienda Ospedaliero-Universitaria Maggiore Della Carità, University of Piemonte Orientale, Novara, Italy
| | - Miriam Massese
- Division of Metabolism, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luisa Russo
- Division of Metabolism, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Commone
- Division of Metabolism, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Serena Gasperini
- Metabolic Unit Rare Disease, Pediatric Department, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Roberta Pretese
- Metabolic Unit Rare Disease, Pediatric Department, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Arianna Maiorana
- Division of Metabolism, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Massese M, Tagliaferri F, Dionisi-Vici C, Maiorana A. Glycogen storage diseases with liver involvement: a literature review of GSD type 0, IV, VI, IX and XI. Orphanet J Rare Dis 2022; 17:241. [PMID: 35725468 PMCID: PMC9208159 DOI: 10.1186/s13023-022-02387-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 02/24/2022] [Accepted: 06/06/2022] [Indexed: 12/31/2022] Open
Abstract
Background Glycogen storage diseases (GSDs) with liver involvement are classified into types 0, I, III, IV, VI, IX and XI, depending on the affected enzyme. Hypoglycemia and hepatomegaly are hallmarks of disease, but muscular and renal tubular involvement, dyslipidemia and osteopenia can develop. Considering the paucity of literature available, herein we provide a narrative review of these latter forms of GSDs. Main body Diagnosis is based on clinical manifestations and laboratory test results, but molecular analysis is often necessary to distinguish the various forms, whose presentation can be similar. Compared to GSD type I and III, which are characterized by a more severe impact on metabolic and glycemic homeostasis, GSD type 0, VI, IX and XI are usually known to be responsive to the nutritional treatment for achieving a balanced metabolic homeostasis in the pediatric age. However, some patients can exhibit a more severe phenotype and an important progression of the liver and muscular disease. The effects of dietary adjustments in GSD type IV are encouraging, but data are limited. Conclusions Early diagnosis allows a good metabolic control, with improvement of quality of life and prognosis, therefore we underline the importance of building a proper knowledge among physicians about these rare conditions. Regular monitoring is necessary to restrain disease progression and complications.
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Affiliation(s)
- Miriam Massese
- Division of Metabolism, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.,Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Tagliaferri
- Division of Metabolism, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.,SCDU of Pediatrics, Azienda Ospedaliero-Universitaria Maggiore Della Carità, University of Piemonte Orientale, Novara, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Arianna Maiorana
- Division of Metabolism, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
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Spinella A, Toss A, Isca C, De Pinto M, Vacchi C, Magnani L, Lumetti F, Macripo’ P, Ficarra G, Fabbiani L, Iannone A, Gasparini E, Piana S, Cortesi L, De Santis G, Maiorana A, Dominici M, Salvarani C, Giuggioli D. POS0919 MOLECULAR AND BIOLOGICAL PATHWAYS OF BREAST CANCER IN PATIENTS WITH SYSTEMIC SCLEROSIS: IMMUNOHISTOCHEMICAL INVESTIGATIONS FROM THE SCLERO-BREAST STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSystemic Sclerosis (SSc) is a life-threatening connective tissue disease characterized by endothelial dysfunction, autoimmune abnormalities and aberrant fibrosis. Several reports showed an increased risk of cancer in SSc compared to general population, including breast cancer (BC). The relationship between BC and SSc has long been discussed with contradictory results. In our recent Sclero-Breast study we analyzed clinical-pathological features of BC in SSc; we finally observed the development of BC with early stages and good prognosis among these patients.ObjectivesThe aim of this project was to explore the immunohistochemical (IHC) expression of potential biomarkers involved in the molecular pathways at the basis of SSc and BC etiophatogenesis as update analysis from the Sclero-Breast study.MethodsOur observational multicenter retrospective study, performed at Modena University Hospital and Reggio Emilia Hospital in northern Italy, enrolled 33 SSc women with a personal history of BC between January 2017 and December 2019. Clinical and pathological characteristics of BC and SSc were collected. For 22 patients, BC tissues were available and IHC analysis was performed using specific antibodies to evaluate biomarkers and pathways potentially involved. The antibodies used included: PI3K/mTOR/TGFβ/PDGFRα/PDGFRβ/VEGF/EGFR/IL-6/CTLA-4/PDL1. We also reported TILs percentage (stromal tumor-infiltrating lymphocytes) of each sample. The following scores were assigned for general IHC analysis: (-) negative, (1+) positive tumor cells <20%, (2+) positive tumor cells 20-50%, (3+) positive tumor cells >50%. For PDL1 we considered a positivity in case of PD-L1 expression ≥1% in infiltrating inflammatory cells. For TILs quantification we applied the score: 0 (negative), ≤ 50% (low-median expression), >50% (high expression).ResultsThe first IHC analysis was performed on the samples of invasive BC patients (20 pts) and showed a prevalence of high PI3K expression (score of 3+ in 55% of cases) with mTOR overexpression in 45%. A PDL1 positivity was detected in 30%, with high TILs expression in 30%. Biopsies from the 2 pts with ductal carcinoma in situ were characterized by a negativity of almost all parameters, except for a medium-high TILs expression reported (40%/90% respectively). See Figure 1. IHC analysis was also performed according to BC subtypes. The group of HR+/HER2 negative showed high PI3K expression (score 3+) in most of cases (59%) with mTOR overexpression in 50%. CTLA-4 and PDL1 were positive in 25%, with high TILs expression in 25%. HER2 positive patients showed a high PI3K positivity in 50% of cases with mTOR positivity (score 3+) in 25% and high TGFβ expression (score 3+) in 25%. PDL1 was positive in 50% with high TILs expression in 25%. In Triple Negative group, PI3K overexpression was found in 75% of pts with half of cases represented by mTOR score 3+. PDL1 was positive in 50% with high TILs representation (80% of total cell count) in 50% of pts.Figure 1.IHC analysis and TILs% expression in histological samples of SSc patients with invasive BC.ConclusionAccording to our results, SSc patients with BC showed high positivity for PDL1 and high TILs representations in all subtypes. Furthermore, the high expression of PI3K, did not always correlate with mTOR overexpression. Further investigations on larger numbers are needed; however, these aspects seem to confirm that SSc subjects might develop BC at good prognosis, suggesting again a de-escalation strategy of cancer therapies. Finally, the possibility to personalize oncological targeted treatments in this subset of fragile patients could be promising.Disclosure of InterestsNone declared
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Grünert SC, Derks TGJ, Adrian K, Al-Thihli K, Ballhausen D, Bidiuk J, Bordugo A, Boyer M, Bratkovic D, Brunner-Krainz M, Burlina A, Chakrapani A, Corpeleijn W, Cozens A, Dawson C, Dhamko H, Milosevic MD, Eiroa H, Finezilber Y, Moura de Souza CF, Garcia-Jiménez MC, Gasperini S, Haas D, Häberle J, Halligan R, Fung LH, Hörbe-Blindt A, Horka LM, Huemer M, Uçar SK, Kecman B, Kilavuz S, Kriván G, Lindner M, Lüsebrink N, Makrilkakis K, Mei-Kwun Kwok A, Maier EM, Maiorana A, McCandless SE, Mitchell JJ, Mizumoto H, Mundy H, Ochoa C, Pierce K, Fraile PQ, Regier D, Rossi A, Santer R, Schuman HC, Sobieraj P, Spenger J, Spiegel R, Stepien KM, Tal G, Tanšek MZ, Torkar AD, Tchan M, Thyagu S, Schrier Vergano SA, Vucko E, Weinhold N, Zsidegh P, Wortmann SB. Efficacy and safety of empagliflozin in glycogen storage disease type Ib: Data from an international questionnaire. Genet Med 2022; 24:1781-1788. [PMID: 35503103 DOI: 10.1016/j.gim.2022.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE This paper aims to report collective information on safety and efficacy of empagliflozin drug repurposing in individuals with glycogen storage disease type Ib (GSD Ib). METHODS This is an international retrospective questionnaire study on the safety and efficacy of empagliflozin use for management of neutropenia/neutrophil dysfunction in patients with GSD Ib, conducted among the respective health care providers from 24 countries across the globe. RESULTS Clinical data from 112 individuals with GSD Ib were evaluated, representing a total of 94 treatment years. The median age at start of empagliflozin treatment was 10.5 years (range = 0-38 years). Empagliflozin showed positive effects on all neutrophil dysfunction-related symptoms, including oral and urogenital mucosal lesions, recurrent infections, skin abscesses, inflammatory bowel disease, and anemia. Before initiating empagliflozin, most patients with GSD Ib were on G-CSF (94/112; 84%). At the time of the survey, 49 of 89 (55%) patients previously treated with G-CSF had completely stopped G-CSF, and another 15 (17%) were able to reduce the dose. The most common adverse event during empagliflozin treatment was hypoglycemia, occurring in 18% of individuals. CONCLUSION Empagliflozin has a favorable effect on neutropenia/neutrophil dysfunction-related symptoms and safety profile in individuals with GSD Ib.
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Affiliation(s)
- Sarah C Grünert
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
| | - Terry G J Derks
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
| | - Katarina Adrian
- Department of Pediatrics, Queen Silvias Childrens Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Khalid Al-Thihli
- Genetic and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Oman
| | - Diana Ballhausen
- Pediatric Metabolic Unit, Pediatrics, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joanna Bidiuk
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Andrea Bordugo
- Inherited Metabolic Disease Unit, Pediatric Clinic C, Woman and Child Department, Azienda Ospedaliera Università Integrata, Verona, Italy
| | - Monica Boyer
- Division of Metabolic Disorders, CHOC Children's Hospital, Orange, CA
| | - Drago Bratkovic
- Metabolic Clinic, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | | | - Alberto Burlina
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, University Hospital, Padua, Italy
| | - Anupam Chakrapani
- Department of Metabolic Medicine, Great Ormond Street Hospital, London, United Kingdom
| | - Willemijn Corpeleijn
- Department of Pediatrics, Division of Metabolic Disorders, Emma Children's Hospital, Gastroenterology, Endocrinology & Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Alison Cozens
- Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - Charlotte Dawson
- Department of Endocrinology, Diabetes and Metabolism, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Helena Dhamko
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maja Djordjevic Milosevic
- Metabolic and Genetic Department, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Hernan Eiroa
- Servicio de Errores Congenitos del Metabolismo, Hospital de Pediatria "J.P. Garrahan", Buenos Aires, Argentina
| | - Yael Finezilber
- Metabolic Diseases Unit and Internal Medicine Department A, Sheba Medical Center, Ramat Gan, Israel
| | | | | | - Serena Gasperini
- Metabolic Rare Diseases Unit, Paediatric Department, San Gerardo Hospital, Monza, Italy
| | - Dorothea Haas
- Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Häberle
- Division of Metabolism and Children`s Research Center, University Children's Hospital Zurich, Zürich, Switzerland
| | - Rebecca Halligan
- Department of Metabolic Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Law Hiu Fung
- Department of Pediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong Island, Hong Kong
| | | | - Laura Maria Horka
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Martina Huemer
- Division of Metabolism and Children`s Research Center, University Children's Hospital Zurich, Zürich, Switzerland; Department of Paediatrics, University Children's Hospital Basel and University of Basel, Basel, Switzerland
| | - Sema Kalkan Uçar
- Division of Metabolism and Nutrition, Department of Pediatrics, Ege University Children's Hospital, Izmir, Turkey
| | - Bozica Kecman
- Metabolic and Genetic Department, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Sebile Kilavuz
- Division of Pediatric Metabolism, Department of Pediatrics, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Gergely Kriván
- Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation, Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Martin Lindner
- Department of Pediatric Neurology, University Children's Hospital Frankfurt, Frankfurt, Germany
| | - Natalia Lüsebrink
- Department of Pediatric Neurology, University Children's Hospital Frankfurt, Frankfurt, Germany
| | - Konstantinos Makrilkakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - Anne Mei-Kwun Kwok
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - Esther M Maier
- Section of Inborn Errors of Metabolism, Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Arianna Maiorana
- Division of Metabolism, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù, Istituti di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Shawn E McCandless
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Department of Genetics and Metabolism, Children's Hospital Colorado, Aurora, CO
| | - John James Mitchell
- Division of Pediatric Endocrinology, McGill University Health Center, Montreal, Quebec, Canada
| | - Hiroshi Mizumoto
- Department of Pediatrics, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Helen Mundy
- Evelina Children's Hospital, London, United Kingdom
| | - Carlos Ochoa
- Department of Pediatrics, Complejo Asistencial de Zamora, Zamora, Spain
| | | | - Pilar Quijada Fraile
- Reference Center for Inherited Metabolic Disorders, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Debra Regier
- Genetics and Metabolism, Children's National Hospital, Washington DC
| | - Alessandro Rossi
- Section of Paediatrics, Department of Translational Medicine, University of Naples "Federico II", Naples, Italy
| | - René Santer
- Department of Pediatrics, University Medical Center Eppendorf, Hamburg, Germany
| | | | - Piotr Sobieraj
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | | | - Ronen Spiegel
- Pediatric Department B, Emek Medical Center, Afula, Rappaport School of Medicine, Technion, Haifa, Israel
| | - Karolina M Stepien
- Adult Inherited Metabolic Diseases, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Galit Tal
- Metabolic Clinic, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Mojca Zerjav Tanšek
- University Children's Hospital, Department of Endocrinology, Diabetes and Metabolism, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Ana Drole Torkar
- University Children's Hospital, Department of Endocrinology, Diabetes and Metabolism, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Michel Tchan
- Department of Genetic Medicine, Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Santhosh Thyagu
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Erika Vucko
- Division of Genetics, Birth Defects, and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Natalie Weinhold
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Center of Chronically Sick Children, Berlin, Germany
| | - Petra Zsidegh
- Newborn Screening and Metabolic Centre, 1(st) Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Saskia B Wortmann
- University Children's Hospital Salzburg, Salzburg, Austria; Amalia Children's Hospital, Nijmegen, The Netherlands
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Pizzoferro M, Masselli G, Maiorana A, Casciani E, Sollaku S, Dionisi-Vici C, Spada M, Altini C, Villani MF, Rufini V, Gualdi G, Garganese MC. PET/CT in congenital hyperinsulinism: transforming patient's lives by molecular hybrid imaging. Am J Nucl Med Mol Imaging 2022; 12:44-53. [PMID: 35535120 PMCID: PMC9077170] [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] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
Congenital hyperinsulinism (HI) is a life-threatening condition characterized by severe and recurrent episodes of hypoglycaemia due to defects in key genes involved in regulating insulin secretion. The delay in diagnosis and inappropriate management of HI lead to high risk of permanent hypoglycemic brain injury. The management of HI is challenging as each form of HI (focal, diffuse, and atypical) requires its own therapeutic strategy. In HI diagnostic work-up, integrated PET/CT scan is currently the first-line imaging technique allowing to differentiate between diffuse and focal form and, in the latter case, to localize the focus within the pancreas with high precision. Only in focal HI partial pancreatectomy is the treatment of choice and a curative surgical treatment means a real chance of transforming patient's lives and HI patient's future. The aim of this review is to discuss the role of PET/CT imaging in HI scenario, its technical advantages and limitations and how successful surgery is strongly dependent on accurate preoperative assessment (genetic analysis and PET/CT scan). A multidisciplinary approach in HI diagnosis and treatment inside a single team (involving different expertise) allows to manage children safely and properly, supporting their families in an organized care network.
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Affiliation(s)
- Milena Pizzoferro
- Nuclear Medicine Unit/Imaging Department, IRCCS Bambino Gesù Children’s HospitalRome, Italy
| | - Gabriele Masselli
- Nuclear Medicine Section, Pio XI Private HospitalRome, Italy
- Radiology and Molecular Imaging Department, Umberto I Hospital, Sapienza UniversityRome, Italy
| | - Arianna Maiorana
- Division of Metabolic Diseases, Department of Pediatric Specialties, IRCCS Bambino Gesù Children’s HospitalRome, Italy
| | | | - Saadi Sollaku
- Nuclear Medicine Section, Pio XI Private HospitalRome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases, Department of Pediatric Specialties, IRCCS Bambino Gesù Children’s HospitalRome, Italy
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, IRCCS Bambino Gesù Children’s HospitalRome, Italy
| | - Claudio Altini
- Nuclear Medicine Unit/Imaging Department, IRCCS Bambino Gesù Children’s HospitalRome, Italy
| | - Maria Felicia Villani
- Nuclear Medicine Unit/Imaging Department, IRCCS Bambino Gesù Children’s HospitalRome, Italy
| | - Vittoria Rufini
- Institute of Nuclear Medicine, Policlinico Gemelli Foundation, Catholic University of The Sacred HeartRome, Italy
| | | | - Maria Carmen Garganese
- Nuclear Medicine Unit/Imaging Department, IRCCS Bambino Gesù Children’s HospitalRome, Italy
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Santoro L, Pjetraj D, Velmishi V, Campana C, Catassi C, Dionisi-Vici C, Maiorana A. A new phenotype of aldolase a deficiency in a 14 year-old boy with epilepsy and rhabdomyolysis - case report. Ital J Pediatr 2022; 48:39. [PMID: 35246226 PMCID: PMC8895104 DOI: 10.1186/s13052-022-01228-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/15/2022] [Indexed: 01/19/2023] Open
Abstract
Background Glycogen storage disease type XII is a rare metabolic disease resulting from Aldolase A deficiency that causes muscle glycogen accumulation, with crisis of rhabdomyolysis and hemolytic anemia. In the very few cases described, rhabdomyolysis crises are caused by fever and/or exercise and can accompany acute hemolytic anemia. Although currently there is no therapy available for this disease, the guidelines for the management of other forms of glycogen storage diseases recommend a nutritional therapy in order to avoid hypoglycemia or prevent exercise-induced rhabdomyolysis. Case presentation In this case report we describe a new phenotype of the disease in a 14-year-old boy, characterized by seizures and rhabdomyolysis. Beside an antiepileptic treatment, we propose a new therapeutic approach based on ketogenic diet in order to supply an energetic substrate for skeletal muscle and neurons. Conclusions The anti-epileptic therapy and the dietetic approach were well tolerated by the patient who showed good compliance. This led to a deceleration of the disease with no other acute episodes of seizures and rhabdomyolysis, without any side effects observed.
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Affiliation(s)
- Lucia Santoro
- Division of Pediatrics, Polytechnic University of Marche, Ospedale Pediatrico "G. Salesi", Ancona, Italy
| | - Dorina Pjetraj
- Division of Pediatrics, Polytechnic University of Marche, Ospedale Pediatrico "G. Salesi", Ancona, Italy.
| | - Virtut Velmishi
- Pediatric Service Nr 2 "Mother Teresa" Hospital-Trina, Tirana, Albania
| | - Carmen Campana
- Division of Metabolism, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Catassi
- Division of Pediatrics, Polytechnic University of Marche, Ospedale Pediatrico "G. Salesi", Ancona, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Arianna Maiorana
- Division of Metabolism, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Abstract
A large number of inborn errors of metabolism present with hypoglycemia. Impairment of glucose homeostasis may arise from different biochemical pathways involving insulin secretion, fatty acid oxidation, ketone bodies formation and degradation, glycogen metabolism, fructose and galactose metabolism, branched chain aminoacids and tyrosine metabolism, mitochondrial function and glycosylation proteins mechanisms. Historically, genetic analysis consisted of highly detailed molecular testing of nominated single genes. However, more recently, the genetic heterogeneity of these conditions imposed to perform extensive molecular testing within a useful timeframe via new generation sequencing technology. Indeed, the establishment of a rapid diagnosis drives specific nutritional and medical therapies. The biochemical and clinical phenotypes are critical to guide the molecular analysis toward those clusters of genes involved in specific pathways, and address data interpretation regarding the finding of possible disease-causing variants at first reported as variants of uncertain significance in known genes or the discovery of new disease genes. Also, the trio's analysis allows genetic counseling for recurrence risk in further pregnancies. Besides, this approach is allowing to expand the phenotypic characterization of a disease when pathogenic variants give raise to unexpected clinical pictures. Multidisciplinary input and collaboration are increasingly key for addressing the analysis and interpreting the significance of the genetic results, allowing rapidly their translation from bench to bedside.
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Affiliation(s)
- Arianna Maiorana
- Division of Metabolism, Department of Pediatrics Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
- *Correspondence: Arianna Maiorana,
| | - Francesca Romana Lepri
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unity, Ospedale Pediatrico Bambino Gesù, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unity, Ospedale Pediatrico Bambino Gesù, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Department of Pediatrics Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
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Dai L, Gootjes J, Dorje T, Maiorana A, Shah A, Dembo L, Rankin J, Robinson S, Chih H, Atherton J, Reid C, Hillis G. An Audit of Adherence to Guideline-Recommended Treatment at Discharge of Heart Failure Hospitalisation in Cardiology and Non-Cardiology Wards in a Tertiary Hospital in Western Australia. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.059] [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: 10/16/2022]
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Maiorana A, Caviglia S, Greco B, Alfieri P, Cumbo F, Campana C, Bernabei SM, Cusmai R, Mosca A, Dionisi-Vici C. Ketogenic diet as elective treatment in patients with drug-unresponsive hyperinsulinemic hypoglycemia caused by glucokinase mutations. Orphanet J Rare Dis 2021; 16:424. [PMID: 34635134 PMCID: PMC8507241 DOI: 10.1186/s13023-021-02045-3] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hyperinsulinemic hypoglycemia (HI) is the most frequent cause of recurrent hypoglycemia in children. Despite diagnostic and therapeutic advances, it remains an important cause of morbidity, leading to neurological complications, such as psychomotor retardation and epilepsy. Patients with diffuse drug-unresponsive HI manifest neurological impairment and neurobehavioral problems, even though surgically treated with a near-total pancreatectomy. Based on the analogies between HI and GLUT1 deficiency, both presenting with neuroglycopenia and lack of alternative cerebral energy sources, we administered a ketogenic diet (KD) in three drug-unresponsive GCK-HI patients with the aim of preserving neurodevelopment and avoiding the need of a near-total pancreatectomy. They presented recurrent symptomatic hypoglycemia, intellectual disability and refractory epilepsy. Patients were treated with classical KD for 79, 27 and 18 months, respectively. Results All patients became asymptomatic in a few days and showed an important improvement of the alert state. Epilepsy disappeared and no appearance of novel hypoglycemic lesions was detected with a brain MRI. Cognitive and adaptive abilities rapidly improved and normalized. IQ rose significantly from 81 to 111 (p = 0.04) in patient 1, from 82 vs 95 (p = 0.04) in patient 2, from 60 to 90 (p = 0.04) in patient 3. Conclusions We demonstrated the safety and efficacy of KD in the treatment of drug-unresponsive GCK-HI at a short and long-term. The neuroprotective effects of KD determined the recovery from epilepsy and intellectual disabilities and averted the need of a near-total pancreatectomy. All patients and their families reported an improvement of physical and psychosocial well-being, with a substantial improvement of their quality of life. These results might change the course and the quality of life of these patients and their families, having a relevant impact on human lives. Therefore, KD might be considered the elective treatment in unresponsive forms of GCK-HI. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02045-3.
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Affiliation(s)
- Arianna Maiorana
- Division of Metabolism, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Stefania Caviglia
- Psychology Clinic Unit, Department of Neuroscience, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Benedetta Greco
- Psychology Clinic Unit, Department of Neuroscience, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Paolo Alfieri
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Francesca Cumbo
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Carmen Campana
- Division of Metabolism, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Silvia Maria Bernabei
- Division of Artificial Nutrition, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Raffaella Cusmai
- Neurology Unit, Department of Neuroscience, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Antonella Mosca
- Department of Hepatology, Gastroenterology and Nutrition, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Department of Pediatric Subspecialties, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165, Rome, Italy
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20
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Berlanda N, Alio W, Angioni S, Bergamini V, Bonin C, Boracchi P, Candiani M, Centini G, D'Alterio MN, Del Forno S, Donati A, Dridi D, Incandela D, Lazzeri L, Maiorana A, Mattei A, Ottolina J, Orenti A, Perandini A, Perelli F, Piacenti I, Pino I, Porpora MG, Scaramuzzino S, Seracchioli R, Solima E, Somigliana E, Venturella R, Vercellini P, Viganò P, Vignali M, Zullo F, Zupi E. Impact of endometriosis on obstetric outcome after natural conception: a multicenter Italian study. Arch Gynecol Obstet 2021; 305:149-157. [PMID: 34623489 PMCID: PMC8782812 DOI: 10.1007/s00404-021-06243-z] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy. Methods Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous natural pregnancies. Marginal logistic regression models were fitted to evaluate the impact of endometriosis on obstetric outcome. A post hoc analysis was performed within the endometriosis group comparing women with severe adenomyosis versus women with absent or mild adenomyosis. Results Three hundred and fifty-five pregnancies in endometriosis group and 741 pregnancies in control group were included. Women with endometriosis had a higher risk of preterm delivery < 34 weeks (6.4% vs 2.8%, OR 2.42, 95% CI 1.22–4.82), preterm delivery < 37 weeks (17.8% vs 9.7%, OR 1.98, 95% CI 1.23–3.19), and neonatal admission to Intensive Care Unit (14.1% vs 7.0%, OR 2.04, 95% CI 1.23–3.36). At post hoc analysis, women with endometriosis and severe adenomyosis had an increased risk of placenta previa (23.1% vs 1.8%, OR 16.68, 95% CI 3.49–79.71), cesarean delivery (84.6% vs 38.9%, OR 8.03, 95% CI 1.69–38.25) and preterm delivery < 34 weeks (23.1% vs 5.7%, OR 5.52, 95% CI 1.38–22.09). Conclusion Women with endometriosis who conceive naturally have increased risk of preterm delivery and neonatal admission to intensive care unit. When severe adenomyosis is coexistent with endometriosis, women may be at increased risk of placenta previa and cesarean delivery. Trial registration Clinical trial registration number: NCT03354793.
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Affiliation(s)
- N Berlanda
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - W Alio
- Department of Obstetrics and Gynecology, Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - S Angioni
- Department of Surgical Sciences, Università di Cagliari, Cittadella Universitaria, 09042, Cagliari, Italy
| | - V Bergamini
- Azienda Ospedaliera Universitaria Integrata, Università di Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - C Bonin
- Azienda Ospedaliera Universitaria Integrata, Università di Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - P Boracchi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry "G. A. Maccacaro", Università di Milano, Via Vanzetti 5, 20133, Milan, Italy
| | - M Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - G Centini
- Department of Gynecology, Università di Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, Università di Siena, Strada delle Scotte 4, 53100, Siena, Italy
| | - M N D'Alterio
- Department of Surgical Sciences, Università di Cagliari, Cittadella Universitaria, 09042, Cagliari, Italy
| | - S Del Forno
- Gynaecology and Human Reproduction Physiopathology Unit, Department of Medical and Surgical Sciences, DIMEC, Sant'Orsola Hospital, Università di Bologna, Via Massarenti 13, 40138, Bologna, Italy
| | - A Donati
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - D Dridi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - D Incandela
- Department of Obstetrics and Gynecology, Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - L Lazzeri
- Department of Gynecology, Università di Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, Università di Siena, Strada delle Scotte 4, 53100, Siena, Italy
| | - A Maiorana
- Department of Obstetrics and Gynecology, Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - A Mattei
- Division of Gynaecology and Obstetrics, Santa Maria Annunziata Hospital, USL Toscana Centro, Via Antella 58, 50012, Florence, Italy
| | - J Ottolina
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - A Orenti
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry "G. A. Maccacaro", Università di Milano, Via Vanzetti 5, 20133, Milan, Italy
| | - A Perandini
- Azienda Ospedaliera Universitaria Integrata, Università di Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - F Perelli
- Division of Gynaecology and Obstetrics, Santa Maria Annunziata Hospital, USL Toscana Centro, Via Antella 58, 50012, Florence, Italy
| | - I Piacenti
- Department of Maternal and Child Health and Urology, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - I Pino
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M G Porpora
- Department of Maternal and Child Health and Urology, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - S Scaramuzzino
- Department of Maternal and Child Health and Urology, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - R Seracchioli
- Gynaecology and Human Reproduction Physiopathology Unit, Department of Medical and Surgical Sciences, DIMEC, Sant'Orsola Hospital, Università di Bologna, Via Massarenti 13, 40138, Bologna, Italy
| | - E Solima
- Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Melloni 52, 20129, Milan, Italy
| | - E Somigliana
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy.
| | - R Venturella
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - P Vercellini
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - P Viganò
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - M Vignali
- Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, Milan, Italy
| | - F Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Università di Napoli Federico II, Via Pansini 5, 80131, Naples, Italy
| | - E Zupi
- Department of Gynecology, Università di Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, Università di Siena, Strada delle Scotte 4, 53100, Siena, Italy
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Sighinolfi M, Sarchi L, Assumma S, Cimadamore A, Montironi R, Bonetti LR, Turri F, De Carne C, Maiorana A, Micali S, Rocco B. Focal secondary resection of neurovascular bundles after digital frozen section of prostate surface: a novel tailored surgical approach. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Buscemi S, Maiorana A, Fazzotta S, Incandela D, Palumbo VD, Damiano G, Maffongelli A, Messina M, Bisso C, Anzelmo G, Curione F, Cantavenera V, Bellomo E, Raia VE, Scimeca R, Geraci G, Cudia BM, Lo Monte AI. Scar endometriosis: not a rare cause for a painful scar. Clin Ter 2021; 172:129-133. [PMID: 33763680 DOI: 10.7417/ct.2021.2299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Conclusion High suspicion of scar endometriosis are painful no-dule in the abdominal scar. Wide surgical excision is the treatment of choice. Introduction Endometriosis has been described as the presence of endometrial tissue outside uterine cavity. Scar endometriosis (SE) is a rare disease reported in 0.03-1.08% of women following gynaecologic surgery. In our retrospective observational cohort study we studied anamnesis, symptoms, surgical procedures and outcomes linked to scar endometriosis in our medical experience from 2004 to 2018. Methods We reviewed the medical records of 46 patients with a histopathological diagnosis of SE. All patients had a history of at least one previous caesarean section (n=46, 100%). Forty-two patients (91,3%) complained gradually growing nodular abdominal mass near or adjacent to caesarean incision scar, while only 4 patients (8,6%) complained aspecific abdominal pain. Ultrasound scan was performed in all patients (n=46, 100%) and mean size of the nodules at US was 26,8 ± 13,8 mm. Results All patients underwent surgery. Seven patients (15,2%) needed mesh implantation, while 39 patients (84,8%) underwent local resection with reconstruction of muscle fascia. Mean follow-up was 31,6 ± 14 months and no patients reported local recurrence of disease.
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Affiliation(s)
- S Buscemi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - A Maiorana
- Department of Obstetrics and Gynaecology, ARNAS Civico Hospital, Palermo
| | - S Fazzotta
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - D Incandela
- Department of Obstetrics and Gynaecology, ARNAS Civico Hospital, Palermo
| | - V D Palumbo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - G Damiano
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - A Maffongelli
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - M Messina
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - C Bisso
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - G Anzelmo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - F Curione
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua
| | - V Cantavenera
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - E Bellomo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - V E Raia
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - R Scimeca
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - G Geraci
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - B M Cudia
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - A I Lo Monte
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
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Bonfiglio F, Bruscaggin A, Guidetti F, Terzi di Bergamo L, Faderl M, Spina V, Condoluci A, Bonomini L, Forestieri G, Koch R, Piffaretti D, Pini K, Pirosa MC, Cittone MG, Arribas A, Lucioni M, Ghilardi G, Wu W, Arcaini L, Baptista MJ, Bastidas G, Bea S, Boldorini R, Broccoli A, Canzonieri V, Cascione L, Ceriani L, Cogliatti S, Derenzini E, Devizzi L, Dietrich S, Elia AR, Facchetti F, Gaidano G, Garcia JF, Gerber B, Ghia P, Silva MG, Gritti G, Guidetti A, Hitz F, Inghirami G, Ladetto M, Lopez‐Guillermo A, Lucchini E, Maiorana A, Marasca R, Matutes E, Meignin V, Merli M, Moccia A, Mollejo M, Montalban C, Novak U, Oscier DG, Passamonti F, Piazza F, Pizzolitto S, Sabattini E, Salles G, Santambrogio E, Scarfó L, Stathis A, Stüssi G, Geyer JT, Tapia G, Thieblemont C, Tousseyn T, Tucci A, Visco C, Vitolo U, Zenz T, Zinzani PL, Khiabanian H, Calcinotto A, Bertoni F, Bhagat G, Campo E, Leval L, Dirnhofer S, Pileri SA, Piris MÁ, Traverse‐Glehen A, Tzankov A, Paulli M, Ponzoni M, Mazzucchelli L, Cavalli F, Zucca E, Rossi D. GENETIC AND PHENOTYPIC ATTRIBUTES OF SPLENIC MARGINAL ZONE LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.43_2879] [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: 11/05/2022]
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Spinella A, Toss A, Isca C, Vacchi C, Iannone A, Magnani L, Castrignanò P, De Pinto M, Laura C, Maiorana A, Salvarani C, Dominici M, Giuggioli D. AB0425 CLINICAL AND PATHOLOGICAL FEATURES OF BREAST CANCER IN PATIENTS WITH SYSTEMIC SCLEROSIS: PRELIMINARY DATA FROM THE SCLERO-BREAST STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic Sclerosis (SSc) is a rare and life-threatening connective tissue disease characterized by vascular dysfunction, specific autoimmune abnormalities and fibrosis of the skin and internal organs. Previous studies have shown a 1.5-fold increase in cancer risk in SSc patients compared with the general population, including breast cancer (BC). The relationship between BC and SSc has long been discussed but past research has been contradictory and inconclusive on this topic.Objectives:The aim of our project was to analyze clinical and pathological characteristics of BC developed by SSc subjects and possible correlations with scleroderma features. Here we present the preliminary data from the Sclero-Breast study.Methods:Our observational retrospective multicenter study enrolled 33 SSc women with a personal history of BC identified at two Rheumatology/SSc Units in the north of Italy between January 2017 and December 2019 (lc/dcSSc 23/9, 1 unknown; mean age at SSc onset 57 years, range 32-73). All patients underwent general and instrumental assessment: smoking habits; presence of skin ulcers, calcinosis, teleangectasia; presence of gastro-intestinal and kidney involvement; interstitial lung disease (at HR-CT); pulmonary function tests; ECG abnormalities; echocardiographic assessment of pulmonary arterial hypertension (PAH); videocapillaroscopic pattern; autoantibody profile; exposure to immunosuppressive and vasoactive therapies; status at last follow-up evaluation and cause of death. Clinical and pathological characteristics of BC were also evaluated: age at diagnosis; menopausal status; histotype; hormone receptor status; MIB1, HER2 expression; clinical and pathological stage at diagnosis; metastatic sites; type of loco-regional treatment (surgery and radiotherapy); type of systemic treatment (neoadjuvant/adjuvant chemotherapy and endocrine treatment); other cancers and time from diagnosis of the first disorder to the second one.Results:A total of 54.5% of subjects developed BC before SSc (median interval of 5 years), whereas 45.5% of patients developed BC after SSc (median delay of 8 years). 54.5% of patients showed interstitial lung disease and the cause of death of the 6 deceased subjects was PAH. A significant association (p<0.05) was observed between the use of immunosuppressive therapy and diffuse skin extension, negative ACA, positive Anti-Scl-70 and interstitial lung disease, but not with BC status. 93.1% of patients were diagnosed with an early-stage tumor, 70.8% of invasive carcinomas with a low MIB-1, 8.3% with a tubular histotype, while 42.8% presented with a Luminal A-like tumor. 66.6% underwent breast conserving surgery and 55.5% RT after surgery. 40% of patients developed interstitial lung disease after RT and 20% dcSSc.Conclusion:According to our preliminary data, SSc patients developed BC at good prognosis, suggesting a de-escalation strategy of cancer therapies. On these grounds, a proper screening is mandatory in order to allow for early cancer detection in SSc patients. Further investigations on larger numbers of patients are needed. First of all, they would further clarify the intriguing relationship between BC and SSc. Secondly, they would help to explore the common biological and molecular pathways at the basis of these two disorders, with the aim to improve BC diagnosis and prognosis and to personalize oncological targeted treatments in this subset of fragile patients.Disclosure of Interests:None declared
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Maiorana A, Scheer A, Ramos de Oliveira B, Shah A, Jacques A, Moreno Suarez J, Green D. Aquatic Exercise in Patients with Stable Coronary Heart Disease: A Randomised, Controlled Trial. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.401] [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: 11/29/2022]
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Maines E, Catesini G, Boenzi S, Mosca A, Candusso M, Dello Strologo L, Martinelli D, Maiorana A, Liguori A, Olivieri G, Taurisano R, Piemonte F, Rizzo C, Spada M, Dionisi-Vici C. Plasma methylcitric acid and its correlations with other disease biomarkers: The impact in the follow up of patients with propionic and methylmalonic acidemia. J Inherit Metab Dis 2020; 43:1173-1185. [PMID: 32681732 DOI: 10.1002/jimd.12287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 04/18/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022]
Abstract
Methylcitric acid (MCA) analysis has been mainly utilized for the diagnosis of propionate disorders or as a second-tier test in newborn screening, but its utility for patients monitoring still needs to be established. We explored the potential contribution of MCA in the long-term management of organic acidurias. We prospectively evaluated plasma MCA and its relationship with disease biomarkers, clinical status, and disease burden in 22 patients, 13 with propionic acidemia (PA) and nine with methylmalonic acidemia (MMA) on standard treatment and/or after transplantation. Samples were collected at scheduled routine controls or during episodes of metabolic decompensation (MD), 10 patients were evaluated after transplantation (six liver, two combined liver and kidney, 2 kidney). MCA levels were higher in PA compared to MMA and its levels were not influenced by the clinical status (MD vs well state). In MMA, MCA was higher in elder patients and, along with fibroblast growth factor 21 (FGF21) and plasma methylmalonic acid, negatively correlated with GFR. In both diseases, MCA correlated with ammonia, glycine, lysine, C3, and the C3/C2, C3/C16 ratios. The disease burden showed a direct correlation with MCA and FGF21, for both diseases. All transplanted patients showed a significant reduction of MCA in comparison to baseline values, with some differences dependent on the type of transplantation. Our study provided new insights in understanding the disease pathophysiology, showing similarities between MCA and FGF21 in predicting disease burden, long-term complications and in evaluating the impact of organ transplantation.
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Affiliation(s)
- Evelina Maines
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giulio Catesini
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Sara Boenzi
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Antonella Mosca
- Division of Hepatology, Gastroenterology and Nutrition, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Manila Candusso
- Division of Hepatology, Gastroenterology and Nutrition, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Diego Martinelli
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Arianna Maiorana
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandra Liguori
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giorgia Olivieri
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Roberta Taurisano
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Fiorella Piemonte
- Unit of Muscular and Neurodegenerative Diseases, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Cristiano Rizzo
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Sighinolfi M, Sarchi L, Ticonosco M, Filippi B, Assumma S, Calcagnile T, Morini E, Bonfante G, Sandri M, Puliatti S, Amato M, Micali S, Bianchi G, Maiorana A, Bonetti L, Rocco B. The Prediction of extracapsular extension of prostate cancer: First external validation study of the PRECE model. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Maiorana A, Sabia A, Corsetti T, Dionisi-Vici C. Safety of vaccines administration in hereditary fructose intolerance. Orphanet J Rare Dis 2020; 15:274. [PMID: 33004052 PMCID: PMC7528578 DOI: 10.1186/s13023-020-01552-z] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
Patients with hereditary fructose intolerance need to follow a life-long fructose dietary and drug restriction to prevent symptoms of intoxication. Concerns about vaccines administration have been manifested overtime, for the risk of a life-threatening acute intoxication. For this reason, at Ospedale Pediatrico Bambino Gesù we performed a deepen research from open sources, datasheets and Pharmaceutical Companies informations from the most common Italian and European vaccines, which are carried out in infancy and childhood. As a safe threshold of 2.4 mg/kg/dose was recently established for oral and parenteral (other than i.v.) route, the manuscript clarifies the safe administration of majority of vaccines in patients with hereditary fructose intolerance.
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Affiliation(s)
- Arianna Maiorana
- Division of Metabolism, Ospedale Pediatrico Bambino Gesù, IRCSS, piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Antonella Sabia
- Hospital Pharmacy, Ospedale Pediatrico Bambino Gesù, IRCSS, Rome, Italy
| | - Tiziana Corsetti
- Hospital Pharmacy, Ospedale Pediatrico Bambino Gesù, IRCSS, Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Ospedale Pediatrico Bambino Gesù, IRCSS, piazza S. Onofrio 4, 00165, Rome, Italy
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Rocco B, Sighinolfi M, Paterlini M, Mazzucchelli R, Lopez-Beltran A, Cimadamore A, Puliatti S, Eissa A, Volavsek M, Reggiani Bonetti L, Maiorana A, Sandri M, Iseppi A, Spandri V, Bertoni L, Azzoni P, Micali S, Bianchi G, Pellacani G, Montironi R. Digital prostate biopsy: Interim analysis from an international multicentric study evaluating the role of fluorescence confocal microscopy for prostate cancer diagnosis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Rossi A, Hoogeveen IJ, Bastek VB, de Boer F, Montanari C, Meyer U, Maiorana A, Bordugo A, Dianin A, Campana C, Rigoldi M, Kishnani PS, Pendyal S, Strisciuglio P, Gasperini S, Parenti G, Parini R, Paci S, Melis D, Derks TGJ. Dietary lipids in glycogen storage disease type III: A systematic literature study, case studies, and future recommendations. J Inherit Metab Dis 2020; 43:770-777. [PMID: 32064649 PMCID: PMC7383479 DOI: 10.1002/jimd.12224] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 12/28/2022]
Abstract
A potential role of dietary lipids in the management of hepatic glycogen storage diseases (GSDs) has been proposed, but no consensus on management guidelines exists. The aim of this study was to describe current experiences with dietary lipid manipulations in hepatic GSD patients. An international study was set up to identify published and unpublished cases describing hepatic GSD patients with a dietary lipid manipulation. A literature search was performed according to the Cochrane Collaboration methodology through PubMed and EMBASE (up to December 2018). All delegates who attended the dietetics session at the IGSD2017, Groningen were invited to share unpublished cases. Due to multiple biases, only data on GSDIII were presented. A total of 28 cases with GSDIII and a dietary lipid manipulation were identified. Main indications were cardiomyopathy and/or myopathy. A high fat diet was the most common dietary lipid manipulation. A decline in creatine kinase concentrations (n = 19, P < .001) and a decrease in cardiac hypertrophy in paediatric GSDIIIa patients (n = 7, P < .01) were observed after the introduction with a high fat diet. This study presents an international cohort of GSDIII patients with different dietary lipid manipulations. High fat diet may be beneficial in paediatric GSDIIIa patients with cardiac hypertrophy, but careful long-term monitoring for potential complications is warranted, such as growth restriction, liver inflammation, and hepatocellular carcinoma development.
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Affiliation(s)
- Alessandro Rossi
- Department of Translational Medicine, Section of PediatricsUniversity of Naples “Federico II”NaplesItaly
| | - Irene J. Hoogeveen
- Section of Metabolic DiseasesBeatrix Children's Hospital, University Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Vanessa B. Bastek
- Section of Metabolic DiseasesBeatrix Children's Hospital, University Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Foekje de Boer
- Section of Metabolic DiseasesBeatrix Children's Hospital, University Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Chiara Montanari
- Department of PediatricsSan Paolo Hospital, ASST Santi Paolo e Carlo, University of MilanMilanItaly
| | - Uta Meyer
- Department of PediatricsHannover Medical SchoolHannoverGermany
| | - Arianna Maiorana
- Division of Metabolic Diseases, Department of Pediatric SpecialtiesBambino Gesù Children's HospitalRomeItaly
| | - Andrea Bordugo
- Inherited Metabolic Diseases Unit, Department of Paediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine DiseasesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Alice Dianin
- Inherited Metabolic Diseases Unit, Department of Paediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine DiseasesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Carmen Campana
- Division of Metabolic Diseases, Department of Pediatric SpecialtiesBambino Gesù Children's HospitalRomeItaly
| | - Miriam Rigoldi
- Rare Diseases CenterASST Monza, San Gerardo HospitalMonzaItaly
| | - Priya S. Kishnani
- Division of Medical Genetics, Department of PediatricsDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Surekha Pendyal
- Division of Medical Genetics, Department of PediatricsDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Pietro Strisciuglio
- Department of Translational Medicine, Section of PediatricsUniversity of Naples “Federico II”NaplesItaly
| | - Serena Gasperini
- Rare Metabolic Diseases Pediatric Center, Pediatric Clinic, Fondazione MBBM, San Gerardo HospitalMonzaItaly
| | - Giancarlo Parenti
- Department of Translational Medicine, Section of PediatricsUniversity of Naples “Federico II”NaplesItaly
| | - Rossella Parini
- Rare Metabolic Diseases Pediatric Center, Pediatric Clinic, Fondazione MBBM, San Gerardo HospitalMonzaItaly
| | - Sabrina Paci
- Department of PediatricsSan Paolo Hospital, ASST Santi Paolo e Carlo, University of MilanMilanItaly
| | - Daniela Melis
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana"Section of Pediatrics, University of SalernoBaronissi (SA)Italy
| | - Terry G. J. Derks
- Section of Metabolic DiseasesBeatrix Children's Hospital, University Medical Center Groningen, University of GroningenGroningenThe Netherlands
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De Luca R, Meraviglia S, Blasi L, Maiorana A, Cicero G. Nivolumab in metastatic melanoma: good efficacy and tolerability in elderly patients. ACTA ACUST UNITED AC 2020; 27:e75-e80. [PMID: 32489255 DOI: 10.3747/co.27.5293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Nivolumab is an anti-PD-1 antibody that restores the antitumour immune function of T cells, blocking the binding of PD-1 with its ligand PD-L1. PD-1 is expressed on T cells and interacts with PD-L1 on tumour cells. The PD-1-PD-L1 link inhibits T cell activation. In metastatic melanoma, PD-1-PD-L1 binding plays a critical role, and the advent of the immune checkpoint inhibitor nivolumab has delivered new and effective treatment options with proven clinical benefit. In the present study, we evaluated the efficacy of nivolumab in elderly patients with metastatic melanoma. Methods The study enrolled 55 elderly patients (75 years of age and older) with a diagnosis of metastatic melanoma. Primary endpoints of the study were progression-free survival (pfs) and the objective response rate; secondary endpoints were overall survival, reduction in serum lactate dehydrogenase (ldh) from before to after treatment, and tolerability. Results Nivolumab was well tolerated and resulted in good disease control, with a manageable toxicity profile and significant clinical benefit. The duration of pfs was 5.1 months (95% confidence interval: 3.5 months to 6.8 months). A significant correlation was observed between reduction in serum ldh and pfs: 0.60 (95% confidence interval: 0.28 to 0.86; p = 0.002). Conclusions Nivolumab is an immunotherapy treatment that has proved to be an effective and well-tolerated therapeutic option in elderly patients with metastatic melanoma.
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Affiliation(s)
- R De Luca
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - S Meraviglia
- Central Laboratory of Advanced Diagnosis and Biomedical Research, Palermo, Italy
| | - L Blasi
- Medical Oncology Unit, arnas Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - A Maiorana
- Department of Surgical, Oncological and Oral Sciences, Section of Surgical Oncology, University of Palermo, Palermo, Italy
| | - G Cicero
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
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Dieci MV, Conte P, Bisagni G, Brandes AA, Frassoldati A, Cavanna L, Musolino A, Giotta F, Rimanti A, Garrone O, Bertone E, Cagossi K, Sarti S, Ferro A, Piacentini F, Maiorana A, Orvieto E, Sanders M, Miglietta F, Balduzzi S, D'Amico R, Guarneri V. Association of tumor-infiltrating lymphocytes with distant disease-free survival in the ShortHER randomized adjuvant trial for patients with early HER2+ breast cancer. Ann Oncol 2020; 30:418-423. [PMID: 30657852 PMCID: PMC6442655 DOI: 10.1093/annonc/mdz007] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is the need to identify new prognostic markers to refine risk stratification for HER2-positive early breast cancer patients. The aim of this study was to evaluate the association of tumor-infiltrating lymphocytes (TILs) with distant disease-free survival (DDFS) in patients with HER2-positive early breast cancer enrolled in the ShortHER adjuvant trial which compared 9 weeks versus 1-year trastuzumab in addition to chemotherapy, and to test the interaction between TILs and treatment arm. PATIENTS AND METHODS Stromal TILs were assessed for 866 cases on centralized hematoxylin and eosin-stained tumor slides. The association of TILs as 10% increments with DDFS was assessed with Cox models. Kaplan-Meier curves were estimated for patients with TILs ≥20% and TILs <20%. Median follow-up was 6.1 years. RESULTS Median TILs was 5% (Q1-Q3 1%-15%). Increased TILs were independently associated with better DDFS in multivariable model [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.59-0.89, P = 0.006, for each 10% TILs increment]. Five years DDFS rates were 91.1% for patients with TILs <20% and 95.7% for patients with TILs ≥20% (P = 0.025). The association between 10% TILs increments and DDFS was significant for patients randomized to 9 weeks of trastuzumab (HR 0.60, 95% CI 0.41-0.88) but not for patients treated with 1 year of trastuzumab (HR 0.89, 95% CI 0.71-1.12; test for interaction P = 0.088). For patients with TILs <20%, the HR for the comparison between the short versus the long arm was 1.75 (95% CI 1.09-2.80, P=0.021); whereas, for patients with TILs ≥20% the HR for the comparison of short versus long arm was 0.23 (95% CI 0.05-1.09, P = 0.064), resulting in a significant interaction (P = 0.015). CONCLUSIONS TILs are an independent prognostic factor for HER2-positive early breast cancer patients treated with adjuvant chemotherapy and trastuzumab and may refine the ability to identify patients at low risk of relapse eligible for de-escalated adjuvant therapy.
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Affiliation(s)
- M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova.
| | - G Bisagni
- Oncology Unit, Department of Oncology and Advanced Technologies, Azienda USL-IRCCS, Reggio Emilia
| | - A A Brandes
- Medical Oncology, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna
| | - A Frassoldati
- Clinical Oncology, Department of Morphology, Surgery and Experimental Medicine, S Anna University Hospital, Ferrara
| | - L Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza
| | - A Musolino
- Medical Oncology Unit, University Hospital of Parma, Piacenza
| | - F Giotta
- Division of Medical Oncology, IRCCS, Istituto Tumori "Giovanni Paolo II", Bari
| | - A Rimanti
- Medical Oncology, Azienda Ospedaliera di Mantova, Mantova
| | - O Garrone
- Medical Oncology, A.O. S. Croce and Carle Teaching Hospital, Cuneo
| | - E Bertone
- Medical Oncology, S. Anna Hospital, Torino
| | - K Cagossi
- Breast Unit Ausl Modena, Ramazzini Hospital, Carpi
| | - S Sarti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola
| | - A Ferro
- Rete Clinica Senologica - Oncologia Medica S. Chiara, Trento
| | - F Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena; Azienda Ospedaliero-Universitaria di Modena, Modena
| | - A Maiorana
- Department of Diagnostic, Clinical Medicine and Public Health, University Hospital of Modena, Modena
| | - E Orvieto
- Pathology Unit, Ulss 5 Polesana, Rovigo, Italy
| | - M Sanders
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - F Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova
| | - S Balduzzi
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Italy
| | - R D'Amico
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
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Sighinolfi M, Bertoni L, Puliatti S, Reggiani Bonetti L, Maiorana A, Eissa A, Azzoni P, Bevilacqua L, Zoeir A, Spandri V, Micali S, Bianchi G, Pellacani G, Rocco B, Montironi R. Ex-vivo fluorescence confocal microscopy: Prostatic tissue atlas. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Puliatti S, Bertoni L, Reggiani Bonetti L, Maiorana A, Eissa A, Azzoni P, Bevilacqua L, Zoeir A, Spandri V, Sighinolfi M, Micali S, Bianchi G, Pellacani G, Rocco B, Montironi R. Ex-vivo fluorescence confocal microscopy: Evaluation of the learning curve for interpretation of prostatic benign and malignant tissues. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kamaladasa Y, Tran D, Phillip M, Kotchetkova I, D’Souza M, Celermajer D, Maiorana A, Cordina R. 661 Estimating Exercise Intensity Using Heart Rate in Adolescents and Adults With Congenital Heart Disease: Are Established Methods Valid? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.668] [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: 11/29/2022]
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Abstract
The histology of signet-ring cell carcinoma (SRC) of the stomach has been revisited with the support of current immuno- histochemical techniques in order to explain particular features of this tumor; its great capacity of local diffusion and lymph node metastasis, also through a neo-lymphoangiogenesis. An observational retrospective study on 50 cases of SRC in stage II and III has been performed with the addition of histochemical (Alcian Blue, DDD-Fast Blue B, Mercury Orange) and immunohistochemical (cytocheratin, CD3, CD4, CD8, CD10, CD56, CD68, perforin, granzyme B, podoplanin, collagen type IV) investigations for each case. The signet ring cells, typical for this tumor, show abundant content of electro-negative sialomucins and demonstrate a great capacity of diffusion through the gastric wall. They evoke production and deposition of collagen type IV in the sub-mucosa layer through the local action of fibroblasts. The immunological response to this tumor in the gastric wall and in the metastatic lymph nodes is represented by an increase of B and T-helper lymphocytes, but not of T-killers or natural killers. The neoplastic cells are curiously able to avoid these newly formed 'lymph nodules'. An extended neo-lymphangiogenesis has been observed around the primary tumor and in metastatic lymph nodes. A careful immunohistochemical characterization has allowed a better knowledge of SRC, regarding especially the peculiar behavior of local diffusion of its cells, the associated neo-lymph angiogenesis, and poor immunological reaction.
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Affiliation(s)
- L Roncati
- Department of Diagnostic and Clinical Medicine and of Public Health, Institute of Pathology, University of Modena and Reggio Emilia, Modena (MO), Italy
| | - A Manenti
- Department of Medical and Surgical Sciences, Institute of Surgery, University of Modena and Reggio Emilia, Modena (MO), Italy
| | - G Barbolini
- Department of Diagnostic and Clinical Medicine and of Public Health, Institute of Pathology, University of Modena and Reggio Emilia, Modena (MO), Italy
| | - A Maiorana
- Department of Diagnostic and Clinical Medicine and of Public Health, Institute of Pathology, University of Modena and Reggio Emilia, Modena (MO), Italy
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Alio L, Angioni S, Arena S, Bartiromo L, Bergamini V, Berlanda N, Bonin C, Busacca M, Candiani M, Centini G, D’Alterio MN, Di Cello A, Exacoustos C, Fedele L, Frattaruolo MP, Incandela D, Lazzeri L, Luisi S, Maiorana A, Maneschi F, Martire F, Massarotti C, Mattei A, Muzii L, Ottolina J, Perandini A, Perelli F, Pino I, Porpora MG, Raimondo D, Remorgida V, Seracchioli R, Solima E, Somigliana E, Sorrenti G, Venturella R, Vercellini P, Viganó P, Vignali M, Zullo F, Zupi E. When more is not better: 10 'don'ts' in endometriosis management. An ETIC * position statement. Hum Reprod Open 2019; 2019:hoz009. [PMID: 31206037 PMCID: PMC6560357 DOI: 10.1093/hropen/hoz009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/09/2018] [Indexed: 02/07/2023] Open
Abstract
A network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF; do not remove uncomplicated deep endometriotic lesions in asymptomatic women, and also in symptomatic women not seeking conception when medical treatment is effective and well tolerated; do not systematically request second-level diagnostic investigations in women with known or suspected non-subocclusive colorectal endometriosis or with symptoms responding to medical treatment; do not recommend repeated follow-up serum CA-125 (or other currently available biomarkers) measurements in women successfully using medical treatments for uncomplicated endometriosis in the absence of suspicious ovarian cysts; do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception without post-operative long-term treatment with estrogen-progestins or progestins; do not perform laparoscopy in adolescent women (<20 years) with moderate-severe dysmenorrhea and clinically suspected early endometriosis without prior attempting to relieve symptoms with estrogen-progestins or progestins; do not prescribe drugs that cannot be used for prolonged periods of time because of safety or cost issues as first-line medical treatment, unless estrogen-progestins or progestins have been proven ineffective, not tolerated, or contraindicated; do not use robotic-assisted laparoscopic surgery for endometriosis outside research settings. Our proposal is to better address medical and surgical approaches to endometriosis de-implementing low-value interventions, with the aim to prevent unnecessary morbidity, limit psychological distress, and reduce the burden of treatment avoiding medical overuse and allowing a more equitable distribution of healthcare resources.
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Ponzi E, Alesi V, Lepri FR, Genovese S, Loddo S, Mucciolo M, Novelli A, Dionisi-Vici C, Maiorana A. Uniparental isodisomy of chromosome 1 results in glycogen storage disease type III with profound growth retardation. Mol Genet Genomic Med 2019; 7:e634. [PMID: 30916492 PMCID: PMC6503021 DOI: 10.1002/mgg3.634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/14/2019] [Accepted: 02/11/2019] [Indexed: 01/04/2023] Open
Abstract
Background Glycogen storage disease type III (GSDIII) is caused by mutations of AGL gene with debranching enzyme deficiency. Patients with GSDIII manifest fasting hypoglycemia, hepatomegaly, hepatopathy, myopathy, and cardiomyopathy. We report on an 18‐year‐old boy with a profound growth retardation (<3 SD) besides typical clinical features of GSDIII, whereby endocrinological studies were negative. Methods and Results Molecular analysis of AGL gene revealed the homozygous reported variant c.3903_3904insA. Since discordant results from segregation studies showed the carrier status in one parent only, SNP array and short tandem repeats analyses were performed, revealing a paternal disomy of chromosome 1 (UPD1). Conclusion This study describes the first case of GSDIII resulting from UPD1. UPD can play an important role even in case of imprinted genes. DIRAS3 is a maternally imprinted tumor suppressor gene, located on chromosome 1p31, and implicated in growth and oncogenesis. It can be speculated that DIRAS3 overexpression might have a role in the severe short stature of our patient. The study emphasizes the importance of parental segregation analysis especially in patients with recessive conditions to look for specific genetic causes of disease and to estimate properly the risk of family recurrence.
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Affiliation(s)
- Emanuela Ponzi
- Division of Metabolism, Department of Pediatrics Specialties, Bambino Gesù Children's Hospital, Rome, Italy
| | - Viola Alesi
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca R Lepri
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Silvia Genovese
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sara Loddo
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mafalda Mucciolo
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Novelli
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Department of Pediatrics Specialties, Bambino Gesù Children's Hospital, Rome, Italy
| | - Arianna Maiorana
- Division of Metabolism, Department of Pediatrics Specialties, Bambino Gesù Children's Hospital, Rome, Italy
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Alio L, Angioni S, Arena S, Bartiromo L, Bergamini V, Berlanda N, Bonanni V, Bonin C, Buggio L, Candiani M, Centini G, D'Alterio MN, De Stefano F, Di Cello A, Exacoustos C, Fedele L, Frattaruolo MP, Geraci E, Lavarini E, Lazzeri L, Luisi S, Maiorana A, Makieva S, Maneschi F, Martire F, Massarotti C, Mattei A, Muzii L, Ottolina J, Pagliardini L, Perandini A, Perelli F, Pino I, Porpora MG, Remorgida V, Scagnelli G, Seracchioli R, Solima E, Somigliana E, Sorrenti G, Ticino A, Venturella R, Viganò P, Vignali M, Zullo F, Zupi E. Endometriosis: seeking optimal management in women approaching menopause. Climacteric 2019; 22:329-338. [PMID: 30628469 DOI: 10.1080/13697137.2018.1549213] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 02/06/2023]
Abstract
The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding hormonal treatment and the possibility for malignant transformation, considering the increased cancer risk in patients with a long-standing history of the disease. This state-of-the-art review aims for the first time to assess the benefits of the available therapies to help guide treatment decisions for the care of endometriosis in women approaching menopause. Progestins are proven effective in reducing pain and should be preferred in these women. According to the international guidelines that lack precise recommendations, hysterectomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have completed their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal of affected gonads should be considered in cases of long-standing or recurrent endometriomas, especially in the presence of modifications of ultrasonographic cyst patterns. Although rare, malignant transformation of various tissues in endometriosis patients has been described, and management is herein discussed.
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Affiliation(s)
- L Alio
- a Department of Obstetrics and Gynecology , Civico Hospital , Palermo , Italy
| | - S Angioni
- b Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - S Arena
- c Department of Obstetrics and Gynecology , Azienda Ospedaliera Perugia , Perugia , Italy
| | - L Bartiromo
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - V Bergamini
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - N Berlanda
- f Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - V Bonanni
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - C Bonin
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - L Buggio
- g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - M Candiani
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - G Centini
- i Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - M N D'Alterio
- b Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - F De Stefano
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - A Di Cello
- j Department of Clinical and Experimental Medicine, Obstetrics and Gynecology , Università degli Studi Magna Graecia , Catanzaro , Italy
| | - C Exacoustos
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
| | - L Fedele
- f Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - M P Frattaruolo
- g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - E Geraci
- l Department of Obstetrics and Gynecology , Asola Hospital , Mantova , Italy
| | - E Lavarini
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - L Lazzeri
- i Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - S Luisi
- i Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - A Maiorana
- a Department of Obstetrics and Gynecology , Civico Hospital , Palermo , Italy
| | - S Makieva
- m Division of Genetics and Cell Biology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - F Maneschi
- n Department of Obstetrics and Gynecology , San Giovanni Addolorata Hospital , Roma , Italy
| | - F Martire
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
| | - C Massarotti
- o Academic Unit of Obstetrics and Gynaecology , Ospedale Policlinico San Martino , Genoa , Italy.,p Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - A Mattei
- q Department of Minimally Invasive Gynaecological Surgery , Centre Tuscany USL , Florence , Italy
| | - L Muzii
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - J Ottolina
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - L Pagliardini
- m Division of Genetics and Cell Biology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - A Perandini
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - F Perelli
- r Department of Experimental, Clinical and Biomedical Sciences, Obstetrics and Gynaecology , University of Florence , Florence , Italy
| | - I Pino
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - M G Porpora
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - V Remorgida
- o Academic Unit of Obstetrics and Gynaecology , Ospedale Policlinico San Martino , Genoa , Italy.,p Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - G Scagnelli
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - R Seracchioli
- t Gynecology and Physiopathology of Human Reproductive Unit , University of Bologna, S. Orsola-Malpighi Hospital of Bologna , Bologna , Italy
| | - E Solima
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - E Somigliana
- f Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - G Sorrenti
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
| | - A Ticino
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - R Venturella
- j Department of Clinical and Experimental Medicine, Obstetrics and Gynecology , Università degli Studi Magna Graecia , Catanzaro , Italy
| | - P Viganò
- m Division of Genetics and Cell Biology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - M Vignali
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - F Zullo
- u Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine , University of Naples Federico II , Naples , Italy
| | - E Zupi
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
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Dorje T, Zhao G, Scheer A, Tsokey L, Wang J, Chen Y, Tso K, Tan BK, Ge J, Maiorana A. MS10.9 Smartphone and Social Media-based Cardiac Rehabilitation and Secondary Prevention (SMART-CR/SP) In China: Results From A Randomised, Controlled Trial. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.043] [Citation(s) in RCA: 1] [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: 10/28/2022] Open
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Ponzi E, Maiorana A, Lepri FR, Mucciolo M, Semeraro M, Taurisano R, Olivieri G, Novelli A, Dionisi-Vici C. Persistent Hypoglycemia in Children: Targeted Gene Panel Improves the Diagnosis of Hypoglycemia Due to Inborn Errors of Metabolism. J Pediatr 2018; 202:272-278.e4. [PMID: 30193751 DOI: 10.1016/j.jpeds.2018.06.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/19/2017] [Revised: 05/26/2018] [Accepted: 06/14/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the role of next generation sequencing in genetic diagnosis of pediatric patients with persistent hypoglycemia. STUDY DESIGN Sixty-four patients investigated through an extensive workup were divided in 3 diagnostic classes based on the likelihood of a genetic diagnosis: (1) single candidate gene (9/64); (2) multiple candidate genes (43/64); and (3) no candidate gene (12/64). Subsequently, patients were tested through a custom gene panel of 65 targeted genes, which included 5 disease categories: (1) hyperinsulinemic hypoglycemia, (2) fatty acid-oxidation defects and ketogenesis defects, (3) ketolysis defects, (4) glycogen storage diseases and other disorders of carbohydrate metabolism, and (5) mitochondrial disorders. Molecular data were compared with clinical and biochemical data. RESULTS A proven diagnosis was obtained in 78% of patients with suspicion for a single candidate gene, in 49% with multiple candidate genes, and in 33% with no candidate gene. The diagnostic yield was 48% for hyperinsulinemic hypoglycemia, 66% per fatty acid-oxidation and ketogenesis defects, 59% for glycogen storage diseases and other carbohydrate disorders, and 67% for mitochondrial disorders. CONCLUSIONS This approach provided a diagnosis in ~50% of patients in whom clinical and laboratory evaluation did not allow identification of a single candidate gene and a diagnosis was established in 33% of patients belonging to the no candidate gene class. Next generation sequencing technique is cost-effective compared with Sanger sequencing of multiple genes and represents a powerful tool for the diagnosis of inborn errors of metabolism presenting with persistent hypoglycemia.
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Affiliation(s)
- Emanuela Ponzi
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy
| | - Arianna Maiorana
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Romana Lepri
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mafalda Mucciolo
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michela Semeraro
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy
| | - Roberta Taurisano
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giorgia Olivieri
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy; Unit of Child Neurology, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Antonio Novelli
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy.
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Losi L, Bertolini F, Scurani L, Guaitoli G, Baldessari C, Ambrosini Spaltro A, Botticelli L, Maiorana A, Barbieri F, Cascinu S. Role of evaluating tumor infiltrating lymphocytes, programmed death-ligand 1 and mismatch-repair proteins expression in malignant mesothelioma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy301.002] [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: 11/14/2022] Open
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Dieci M, Conte P, Bisagni G, Brandes A, Frassoldati A, Cavanna L, Musolino A, Giotta F, Rimanti A, Garrone O, Bertone E, Cagossi K, Sarti S, Ferro A, Omarini C, Maiorana A, Orvieto E, Sanders M, D'Amico R, Guarneri V. Tumor-infiltrating lymphocytes (TILs) as an independent prognostic factor for early HER2+ breast cancer patients treated with adjuvant chemotherapy and trastuzumab in the randomized shortHER trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.183] [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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Guarneri V, Dieci MV, Bisagni G, Brandes AA, Frassoldati A, Cavanna L, Musolino A, Giotta F, Cavazzini G, Garrone O, Bertone E, Cagossi K, Nanni O, Ferro A, Donadio M, Aieta M, Zamagni C, Piacentini F, Maiorana A, Ragazzi M, Cucchi MC, Querzoli P, Orsi N, Curtarello M, Urso L, Amadori A, Orvieto E, Vicini R, Balduzzi S, D'Amico R, Conte P. Abstract P1-13-02: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-02] [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
This abstract was withdrawn by the authors.
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Affiliation(s)
- V Guarneri
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - MV Dieci
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - G Bisagni
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - AA Brandes
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Frassoldati
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - L Cavanna
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Musolino
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - F Giotta
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - G Cavazzini
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - O Garrone
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - E Bertone
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - K Cagossi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - O Nanni
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Ferro
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Donadio
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Aieta
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - C Zamagni
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - F Piacentini
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Maiorana
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Ragazzi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - MC Cucchi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - P Querzoli
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - N Orsi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Curtarello
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - L Urso
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Amadori
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - E Orvieto
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - R Vicini
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - S Balduzzi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - R D'Amico
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - P Conte
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
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45
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Abstract
The aim of the study was to investigate the clinical value of the serum CA 125 level for diagnosing and determining the severity of endometriosis and pelvic pain associated with endometriosis. Eighty-six women who underwent operative laparoscopy were enrolled. Sixty-nine women with endometriosis and 17 without endometriosis participated in this study. In all of the patients, endometriosis was diagnosed and classified into stages according to the Revised American Fertility Society (R-AFS) classification. The mean serum CA 125 levels were determined in each patient. We also investigated the relationship between serum CA 125 concentration and the intensity of dysmenorrhea and dyspareunia in the study group. The mean serum CA 125 levels of women with endometriosis were higher than those of the control group (p<0.050). However, the mean serum CA 125 levels were higher in stage IV than in other stages of endometriosis according to the R-AFS classification. On the other hand, the percentage of patients with serum CA 125 levels >35 U/mL was elevated in the subgroups with severe dyspareunia and severe dysmenorrhea versus the asymptomatic subgroup but the differences had no statistical significance. In conclusion, CA 125 serum levels were related to endometriosis and R-AFS score in the evaluated patient series. No correlation was found between serum levels of CA 125 and pelvic pain in patients with endometriosis.
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Affiliation(s)
- A. Maiorana
- I-II Units of Obstetrics and Gynecology, Civic Hospital, Palermo - Italy
| | - C. Cicerone
- I-II Units of Obstetrics and Gynecology, Civic Hospital, Palermo - Italy
| | - M. Niceta
- I-II Units of Obstetrics and Gynecology, Civic Hospital, Palermo - Italy
| | - L. Alio
- I-II Units of Obstetrics and Gynecology, Civic Hospital, Palermo - Italy
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Roncati L, Manenti A, Pusiol T, Mataca E, Nosseir S, Piscioli F, Maiorana A, Barbolini G. Exploring the mesenteric lymphatic apparatus: A morphological and immunohistochemical investigation with clinical correlations. Lymphology 2018; 51:73-78. [PMID: 30253458] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Modern immunohistochemical techniques allow a detailed study of the lymphatic system in many organs and areas of the body. We performed an in-depth study on lymphatic vessels of the ileal and colonic mesenteries, together with the greater omentum where they appear particularly numerous and mainly represented by capillaries interconnected among themselves and with lymph nodes. The capillary wall consists of a fine single sheath of endothelial cells wrapped around by a subtle collagen membrane and deprived of valves. The progression of lymph flow is promoted by external forces acting on the capillary walls. Only at the mesenteric roots can pre- and post-lymph nodal collector vessels be observed. Our observations help to explain different patho-physiological correlations and the possible presence of skip lymph node metastases.
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Affiliation(s)
- L Roncati
- Department of Diagnostic and Clinical Medicine, University of Modena and Reggio Emilia, Moderna, Italy
- Department of Public Health, University of Modena and Reggio Emilia, Moderna, Italy
- Provincial Health Care Services, Rovereto, Italy
| | - A Manenti
- Department of Diagnostic and Clinical Medicine, University of Modena and Reggio Emilia, Moderna, Italy
- Department of Public Health, University of Modena and Reggio Emilia, Moderna, Italy
- Department of Surgery and Surgical Specialities, University of Modena and Reggio Emilia, Moderna, Italy
- Provincial Health Care Services, Rovereto, Italy
| | - T Pusiol
- Provincial Health Care Services, Rovereto, Italy
| | - E Mataca
- Department of Diagnostic and Clinical Medicine, University of Modena and Reggio Emilia, Moderna, Italy
- Department of Public Health, University of Modena and Reggio Emilia, Moderna, Italy
| | - S Nosseir
- Department of Diagnostic and Clinical Medicine, University of Modena and Reggio Emilia, Moderna, Italy
- Department of Public Health, University of Modena and Reggio Emilia, Moderna, Italy
| | - F Piscioli
- Provincial Health Care Services, Rovereto, Italy
| | - A Maiorana
- Department of Diagnostic and Clinical Medicine, University of Modena and Reggio Emilia, Moderna, Italy
- Department of Public Health, University of Modena and Reggio Emilia, Moderna, Italy
- Department of Surgery and Surgical Specialities, University of Modena and Reggio Emilia, Moderna, Italy
- Provincial Health Care Services, Rovereto, Italy
| | - G Barbolini
- Department of Diagnostic and Clinical Medicine, University of Modena and Reggio Emilia, Moderna, Italy
- Department of Public Health, University of Modena and Reggio Emilia, Moderna, Italy
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47
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Abstract
Hereditary tyrosinemia type 1 (HT1) is characterized by severe progressive liver disease and renal tubular dysfunction. Kidney involvement is characterized by hypophosphatemic rickets and Fanconi syndrome. Different animal models were useful to investigate the pathophysiology of the disease and the effects of NTBC therapy on liver and kidney function. NTBC has revolutionized the prognosis of HT1 and its acute and chronic effects on renal tubular function have been proved, with normalization of tubular function within a few weeks, particularly hypophosphatemia and proteinuria. NTBC therapy is highly effective in improving renal function both at short and long-term. However, its efficacy critically depends on the age at start of treatment with normal outcome in patients diagnosed at birth by newborn screening.
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Affiliation(s)
- Arianna Maiorana
- Metabolic Unit, Department of Pediatric Specialties, Bambino Gesù Children's Research Hospital, Rome, Italy.
| | - Carlo Dionisi-Vici
- Metabolic Unit, Department of Pediatric Specialties, Bambino Gesù Children's Research Hospital, Rome, Italy
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48
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Chasland L, Naylor L, Clark A, Smith K, Haynes A, Maiorana A, Nosaka K, Dembo L, Green D. Responses to eccentric and concentric cycling in patients with chronic heart failure: Comparison to age-matched healthy controls. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.09.362] [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: 11/17/2022]
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49
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Omarini C, Kaleci S, Guaitoli G, Bettelli S, Caprera C, Manfredini S, Caggia F, Baschieri M, Moscetti L, Maiorana A, Cascinu S, Piacentini F. Differential gene expression patterns in HER2 positive metastatic breast cancer patients according to hormone receptor status. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.049] [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: 11/14/2022] Open
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50
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Maiorana A, Dionisi-Vici C. Hyperinsulinemic hypoglycemia: clinical, molecular and therapeutical novelties. J Inherit Metab Dis 2017; 40:531-542. [PMID: 28656511 DOI: 10.1007/s10545-017-0059-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 01/01/2023]
Abstract
Hyperinsulinemic hypoglycemia (HI) is the most common cause of hypoglycemia in children. Impairment of cellular pathways involved in insulin secretion from pancreatic β-cells, broadly classified as channelopathies and metabolopathies, have been discovered in the past two decades. The increasing use of NGS target panels, combined with clinical, biochemical and imaging findings allows differentiating the diagnostic management of children with focal forms, surgically curable, from those with diffuse forms, more conservatively treated with pharmacological and nutritional interventions. Specific approaches according to the subtype of HI have been established and novel therapies are currently under investigation. Despite diagnostic and therapeutic advances, HI remains an important cause of morbidity in children, still accounting for 26-44% of permanent intellectual disabilities, especially in neonatal-onset patients. Initial insult from recurrent hypoglycemia in early life greatly contributes to the poor outcomes. Therefore, patients need to be rapidly identified and treated aggressively, and require at follow-up a complex and regular monitoring, managed by a multidisciplinary HI team. This review gives an overview on the more recent diagnostic and therapeutic tools, on the novel drug and nutritional therapies, and on the long-term neurological outcomes.
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Affiliation(s)
- Arianna Maiorana
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy
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