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Prignano F, Atzori L, Bellinato F, Damiani G, Galeone C, Mariani P, Potenza C, Scopinaro A, Piaserico S, Fabbrocini G. Epidemiology, characteristics of disease and unmet needs of patients with generalized pustular psoriasis: a large Italian Delphi consensus. Dermatology 2024:000538072. [PMID: 38493762 DOI: 10.1159/000538072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Generalized pustular psoriasis (GPP) is a rare and chronic, debilitating skin condition characterised, in its acute flare phase, by clinically severe and potentially life-threatening systemic manifestations. Data on GPP are still scanty, particularly in Europe and at a national level. To provide expert indications on several disease-related and patient-related aspects of GPP, with specific focus to the Italian context. METHODS We conducted an iterative eDelphi study following the recommended criteria for reporting methods and results. After a thorough bibliographic review aimed to identify unknown or controversial issues in GPP, the following areas were investigated through a few specific questions/statements for each area: 1) disease epidemiology; 2) disease characteristics, with specific interest towards GPP flares; 3) diagnosis and diagnostic delay; 4) GPP treatment; 5) GPP patient journey and use of healthcare resources in Italy; 6) unmet needs and quality of life. An Executive Board of 9 principal investigators revised and approved the topics to be examined and overviewed the whole project. A total of 35 experts from different Italian areas, including 34 board-certified Italian dermatologists and one representative of patients' associations, took part in the study. RESULTS A high agreement in responses from Italian experts emerged during two eDelphi iterations on - among several other aspects - GPP prevalence and incidence in Italy, use of European Rare and Severe Psoriasis Expert Network diagnostic criteria, flare frequency and duration, best diagnostic and care pathway, and main unmet needs of Italian patients. On the other hand, a broad spectrum of treatments (of different drug classes) was reported both in the acute and chronic phases of GPP, and no consensus on the issue was thus achieved. CONCLUSIONS Consensus findings from this Delphi study of GPP experts may be useful to fill gaps of knowledge and improve awareness of this rare disease, as well as to help clinical and public health management of GPP in Italy.
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Rossini EE, Galeone C, Lucchetti C, Jommi C. Correction: From Indication-Based Pricing to Blended Approach: Evidence on the Price and Reimbursement Negotiation in Italy. Pharmacoecon Open 2024; 8:345. [PMID: 38345722 PMCID: PMC10883899 DOI: 10.1007/s41669-024-00475-w] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
- Patient Access, Pharmalex Italy Spa, Milan, Italy
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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Rossini EE, Galeone C, Lucchetti C, Jommi C. From Indication-Based Pricing to Blended Approach: Evidence on the Price and Reimbursement Negotiation in Italy. Pharmacoecon Open 2024; 8:251-261. [PMID: 38228997 PMCID: PMC10883902 DOI: 10.1007/s41669-023-00467-2] [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] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND New indications for existing medicines are increasing over time. In most countries, drug pricing and reimbursement conditions are renegotiated every time a new indication is approved. There is a growing interest in the price negotiation model for new indications, specifically comparing an indication-based versus blended approach. However, little evidence currently exists regarding the complexity of these negotiations and their impact on actual prices. Italy has recently transitioned from an indication-based approach to a blended price model. This study aims to measure the impact of price and reimbursement negotiation of new indications on discounts (i.e. actual prices) and on the negotiation duration, used as a proxy of its complexity. METHODS We considered new indications approved through a European centralized procedure from January 2013 to March 2022 for which the price and reimbursement status was approved in Italy between January 2015 and March 2022, amounting to 52 new indications. Data on the timeframe of the Italian price and reimbursement process and its phases were obtained from publicly available sources. Discounts for the first indication and their subsequent increases for new indications were estimated by comparing ex-factory prices and tendered prices. To calculate p-values, we employed the Mann-Whitney test, and multiple regression models were utilized to examine correlations between negotiation time and the characteristics of the medicines. RESULTS The mean time to reimbursement was 603 days, in contrast to 583 days for the first launch. Price negotiation took longer for rare diseases, cancer drugs, and in case of therapies with minor added therapeutic value. On average, the additional discount (on top of discounts for prior indications) was 13%, significantly lower than the mean discount for the first indications approved (24.9%). The discounts increment was lower, but negotiation took longer if a Managed Entry Agreement accompanied the final agreement. Additionally, discounts have increased over the years. CONCLUSION The negotiation for new indications takes longer than the first one, and provides, on average, an additional discount of 13%. While our findings bear the potential for significant policy implications, they necessitate prudent interpretation due to a limited number of observations. The increasing trend in additional discounts over time applied to all indications in recent negotiations, may suggest a descending trend of value for new indications and a shift from an indication-based pricing approach to a blended model. Otherwise, budget impact considerations might have outweighed a value-based approach in the recent negotiations. If so, two potential options for restoring a value-based approach are returning to an indication-based pricing or giving explicit and higher weight to value within a blended model.
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Affiliation(s)
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
- Patient Access, Pharmalex Italy Spa, Milan, Italy
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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Fargnoli MC, Amerio P, Galeone C, Nicoli E, Pedone MP. Multi-dimensional evaluation of dupilumab efficacy in atopic dermatitis patients with a high disease burden. Ital J Dermatol Venerol 2024; 159:63-64. [PMID: 38345292 DOI: 10.23736/s2784-8671.23.07644-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Maria C Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy -
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy -
| | - Paolo Amerio
- Department of Medicine and Ageing Sciences, G. D'Annunzio University, Chieti, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), University of Milano-Bicocca, Milan, Italy
- Unit of Statinfo, Biostatistics and Outcome Research, Statinfo, Milan, Italy
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Castelnuovo G, Capodaglio P, De Amicis R, Gilardini L, Mambrini SP, Pietrabissa G, Cavaggioni L, Piazzolla G, Galeone C, Garavaglia G, Bertoli S. Study protocol of a clinical randomized controlled trial on the efficacy of an innovative Digital thErapy to proMote wEighT loss in patients with obesity by incReasing their Adherence to treatment: the DEMETRA study. Front Digit Health 2023; 5:1159744. [PMID: 38098734 PMCID: PMC10720313 DOI: 10.3389/fdgth.2023.1159744] [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: 03/27/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Despite the increasing importance of innovative medications and bariatric surgery for the treatment of obesity, lifestyle interventions (diet and physical activity) remain the first-line therapy for this disease. The use of digital devices in healthcare aims to respond to the patient's needs, in order to make obesity treatment more accessible, so our study aims to assess the safety and efficacy of a Digital Therapy for Obesity App (DTxO) for achieving weight loss and its maintenance in patients affected with obesity undergoing an experimental non-pharmacological treatment. Here we present the study protocol of a prospective, multicenter, pragmatic, randomized, double-arm, placebo-controlled, parallel, single-blind study on obese patients who will be treated with a new digital therapy to obtain an improvement in their disease condition through the application of different simultaneous strategies (a dietary regimen and personalized advice program, a tailored physical exercise program, a cognitive-behavioural assessment and program, alerts and reminders, dedicated section on prescribed drugs intake, and chat and online visits with clinical professionals). We believe that DTxO will offer a promising intervention channel and self-regulation tool holding the potentiality to decrease treatment burden and treat more patients thanks to the partial replacement of traditional medical consultation with digital or telephone management, improving self- engagement and reducing the high demands the "obesity pandemic" for both patients and national health services in terms of time, cost, and effort. Clinical trial registration: clinicaltrials.gov, identifier, NCT05394779.
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Affiliation(s)
- Gianluca Castelnuovo
- Clinical Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Research Lab in Biomechanics, Rehabilitation and Ergonomics, IRCCS Istituto Auxologico Italiano, Piancavallo, Italy
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, Turin, Italy
| | - Ramona De Amicis
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
- Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Luisa Gilardini
- Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Sara Paola Mambrini
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
- Division of Nutritional Rehabilitation, IRCCS Istituto Auxologico Italiano, Piancavallo, Italy
| | - Giada Pietrabissa
- Clinical Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Luca Cavaggioni
- Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
- Biostatistics & Outcome Research, Statinfo, Milan, Italy
| | | | - Simona Bertoli
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
- Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Neri I, Galeone C, Pelucchi C, Ronci G, Matruglio P, Pedone MP, Galli E. Atopic Dermatitis in Italian Pre-School Children: Literature Review of Epidemiological Data with a Focus on Disease Prevalence and Severity. Children (Basel) 2023; 10:1629. [PMID: 37892292 PMCID: PMC10605831 DOI: 10.3390/children10101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Atopic dermatitis (AD) is one of the most common diseases worldwide. Severe AD has a major impact on the quality of life of patients. We performed a systematic literature review on the epidemiology of AD in Italian pre-school children (age 0-5 years) and we assessed the available data on the severity of AD. In August 2022, we performed a bibliographic search using PubMed/Medline and EMBASE. We identified 10 studies with Italian data on the prevalence and/or incidence of AD in pre-school children. The period (12 months) prevalence of AD varied widely across studies, ranging between 4.0% and 42.2%, with median estimates of 14.3% among all studies and 11.8% among studies from 2010 onwards. Applied to the Italian population, this leads to a prevalence of 309,000-375,000 pre-school AD cases. Only one study computed the incidence of AD, reporting rates of 9 cases per 100 person-years in children aged 0-1 year, and 2.5 cases per 100 person-years in children aged 1-4 years. Severity data from Italy were also reviewed, across three identified three studies. A point estimate found 8.4% of cases were considered severe in one study based on the Patient-Oriented Eczema Measure (POEM), with an overall range of 7.8-11% across different Italian studies and according to various severity score types.
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Affiliation(s)
- Iria Neri
- Dermatology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University of Bologna, 40138 Bologna, Italy
| | - Carlotta Galeone
- Department of Statistics, Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, 20126 Milan, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | | | | | | | - Elena Galli
- UOS Immuno-Allergologia dell’Età Evolutive, Ospedale S. Pietro-Fatebenefratelli, 00189 Rome, Italy
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Mattavelli I, Patuzzo R, Galeone C, Pelucchi C, Gallino G, Leva A, Valeri B, Santinami M, Maurichi A. Potential risk factors, clinicopathological features and determinants of survival for multiple primary melanoma patients compared to single primary melanoma: a large single-center Italian study. Melanoma Res 2023; 33:309-315. [PMID: 37162530 DOI: 10.1097/cmr.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Melanoma patients have a high risk of developing subsequent primary melanomas, a condition known as multiple primary melanoma (MPM). We aimed to compare risk factors of patients with MPM and single primary melanoma (SPM). Primary MPM and SPM consecutively treated at the National Cancer Institute in Milan, Italy, from 1978 to 2021 were retrospectively investigated. Demographic and clinicopathological characteristics were analyzed. Multivariate hazard ratios and mortality were estimated using Cox proportional hazards regression models. Overall, 9122 patients with SPM and 944 with MPM were included. A total of 1437 and 85 deaths occurred in SPM and MPM group, respectively. Of these, 1315 (14.4%) within SPM patients and 60 (6.4%) in MPM group were melanoma-specific deaths (MSDs). Males had a higher risk for MPM (hazard ratio = 1.29), while age was not associated with MPM (hazard ratio = 0.98). The risk of MPM decreased by about 50% for Breslow thickness >1 mm, and by about 45 and 75% in presence of mitoses and ulceration, respectively. The multivariate hazard ratio of death for MPM compared to SPM patients was 0.85 (95% confidence interval, CI: 0.67-1.06), while considering MSD the corresponding hazard ratio was 0.93 (95% CI: 0.71-1.22). Melanoma patients should receive regular follow-up with complete skin examination to detect early subsequent primary melanoma. Patients with more advanced primary have decreased risk of MPM, while males have higher risk. Our study reported no significant difference in mortality between SPM and MPM, but the issue is still open for discussion and further studies.
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Affiliation(s)
- Ilaria Mattavelli
- Department of Surgery, Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori
| | - Roberto Patuzzo
- Department of Surgery, Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori
| | - Carlotta Galeone
- Department of Statistics, Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan
| | - Gianfranco Gallino
- Department of Surgery, Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori
| | - Andrea Leva
- Department of Surgery, Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori
| | - Barbara Valeri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Santinami
- Department of Surgery, Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori
| | - Andrea Maurichi
- Department of Surgery, Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori
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Patuzzo R, Mattavelli I, Gallino G, Galeone C, Valeri B, Mocellin S, Del Fiore P, Ribero S, Mandalà M, Tauceri F, Lombardo M, Maurichi A. The prognostic role of mitotic rate in cutaneous malignant melanoma: Evidence from a multicenter study on behalf of the Italian Melanoma Intergroup. Cancer 2023. [PMID: 37162404 DOI: 10.1002/cncr.34824] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND This study aimed to improve the understanding of the prognostic value of tumor mitotic rate (TMR) in cutaneous melanoma and assessed its significance as a predictor for overall, melanoma-specific, and recurrence-free survival. PATIENTS AND METHODS This is a retrospective multicenter Italian cohort study of 13,016 patients diagnosed with and treated for invasive primary melanoma between 2005 and 2020 with median follow-up of 5.5 years. The survival probability was assessed by Kaplan-Meier method, hazard ratios (HRs), and corresponding 95% confidence interval (CI) of all-cause mortality and recurrence/death by multivariable Cox proportional hazards models. RESULTS Higher dermal mitoses number was associated with decreased overall survival. Among patients with TMR 0/mm2 , 1/mm2 , 2/mm2 -3/mm2 , 4/mm2 -10/mm2 , and >10/mm2 , 5-year overall survival (OS) was 97.3%, 93.6%, 88.3%, 73.0%, and 60.9%, respectively. In multivariate analyses, compared to TMR of 0/mm2 , HRs for all-cause mortality were 1.35 (95% CI, 1.08-1.68), 1.70 (95% CI, 1.40-2.07), 2.04 (95% CI, 1.67-2.49), and 2.39 (95% CI, 1.90-3.00) for 1 mitoses/mm2 , 2 mitoses/mm2 -3 mitoses/mm2 , 4 mitoses/mm2 -10 mitoses/mm2 , and >10 mitoses/mm2 , respectively. A similar increase in risks was observed in melanoma-specific survival (MSS) and recurrence-free survival (RFS). The HRs for MSS and RFS for the highest compared to the lowest TMR category were 3.01 (95% CI, 2.20-4.11) and 2.26 (95% CI, 1.88-2.73), respectively. Sentinel lymph-node biopsy positivity was significantly associated with TMR increase even with adjustment for several potential confounders. CONCLUSIONS A clear association was demonstrated between an increasing TMR and decreased OS, MSS, and RFS, suggesting a reconsideration of TMR prognostic role for future inclusion in the melanoma staging system. PLAIN LANGUAGE SUMMARY The 8th American Joint Committee on Cancer for melanoma staging removed tumor mitotic rate (TMR) from the staging criteria for T1 melanomas, giving way to ulceration and tumor thickness as stronger prognostic predictors. However, it is still recommended that TMR should be assessed and recorded in all primary invasive melanomas. In a large retrospective multicenter study on primary invasive melanomas, we investigated the prognostic value of TMR to assess its significance as survival predictor. Our results showed a clear association between increasing TMR and decreased patients' survival, suggesting that TMR should be considered for inclusion in the melanoma staging system.
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Affiliation(s)
- Roberto Patuzzo
- Melanoma Surgical Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ilaria Mattavelli
- Melanoma Surgical Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Gianfranco Gallino
- Melanoma Surgical Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Barbara Valeri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | - Simone Ribero
- Dermatology Clinic of the Turin University Hospital, Turin, Italy
| | - Mario Mandalà
- University of Perugia, Medical Oncology Unit, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Francesca Tauceri
- General and Oncological Surgery Unit, Morgagni-Pierantoni Hospital, Forli, Italy
| | | | - Andrea Maurichi
- Melanoma Surgical Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Jommi C, Galeone C. The Evaluation of Drug Innovativeness in Italy: Key Determinants and Internal Consistency. Pharmacoecon Open 2023; 7:373-381. [PMID: 36763319 PMCID: PMC10169980 DOI: 10.1007/s41669-023-00393-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Innovative medicines are provided with dedicated funds and immediate market access in Italy. Innovativeness evaluation considers unmet need, added therapeutic value, and quality of the evidence. OBJECTIVE We aimed to evaluate the internal consistency and drivers of the innovativeness appraisal process. METHODS Appraisal reports on innovativeness refer to 1997-2021. We used both a descriptive approach and probabilistic multivariate analysis, using logistic regression models to compute odds ratios and 95% confidence intervals. The dependent variable is innovativeness status (innovative vs. non-innovative; full innovativeness vs. conditional innovativeness). Explanatory variables, besides the three above-mentioned domains, are the year of evaluation, drug type, target disease and population, and the number and type of available studies. RESULTS Among the 141 medicines scrutinized, 31.9%, 29.8%, and 38.3% were evaluated as fully innovative, conditionally innovative, and non-innovative, respectively. Added therapeutic value and the quality of the evidence were associated with the odds of receiving innovative status, and full compared with conditional innovativeness; unmet need was not a predictive variable. Other factors played a minor role: medicines for both solid tumours and rare diseases are more likely to be judged innovative; conditional innovativeness is more probable for medicines for rare diseases. CONCLUSIONS Innovativeness status is driven by the added therapeutic value and quality of evidence. The appraisal process is internally consistent and predictable. This provides industry with a clear indication of what is needed to ensure that access to their medicines is prioritized.
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Affiliation(s)
- Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy.
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi, Bocconi University, Milan, Italy.
| | - Carlotta Galeone
- Biostatistics & Outcome Research, Statinfo, Milan, Italy
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
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Scarpa M, Barbato A, Bisconti A, Burlina A, Concolino D, Deodato F, Di Rocco M, Dionisi-Vici C, Donati MA, Fecarotta S, Fiumara A, Galeone C, Giona F, Giuffrida G, Manna R, Mariani P, Pession A, Scopinaro A, Spada M, Spandonaro F, Trifirò G, Carubbi F, Cappellini MD. Acid sphingomyelinase deficiency (ASMD): addressing knowledge gaps in unmet needs and patient journey in Italy-a Delphi consensus. Intern Emerg Med 2023; 18:831-842. [PMID: 36882619 DOI: 10.1007/s11739-023-03238-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023]
Abstract
Acid sphingomyelinase deficiency (ASMD) is an ultra-rare disease, and several gaps of knowledge on various issues remain, particularly at a regional/national level. Expert opinions collected through well-defined consensus methodologies are increasingly used to make available reliable information in the context of rare/ultra-rare diseases. With the aim to provide indications on infantile neurovisceral ASMD (also formerly known as Niemann-Pick disease type A), chronic neurovisceral ASMD (formerly known as Niemann-Pick disease type A/B) and chronic visceral ASMD (formerly known as Niemann-Pick disease type B) in Italy, we conducted a Delphi consensus of experts focused on five main areas: (i) patients and disease characteristics; (ii) unmet needs and quality of life; (iii) diagnostic issues; (iv) treatment-related aspects; and (v) patient journey. Pre-specified, objective criteria were used to outline the multidisciplinary panel, based on 19 Italian experts in ASMD in paediatric and adult patients from different Italian Regions, including both clinicians (n = 16) and ASMD patients' advocacy or payors with expertise in rare diseases (n = 3). During two Delphi rounds, a high ratio of agreement was found on several topics related to ASMD characteristics, diagnosis, management and disease burden. Our findings may provide valuable indications for management of ASMD at a public health level in Italy.
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Affiliation(s)
- Maurizio Scarpa
- Regional Coordinator Centre for Rare Diseases, Azienda Ospedaliero-Universitaria "Santa Maria Della Misericordia", University Hospital of Udine, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy.
| | - Antonio Barbato
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Annalisa Bisconti
- Associazione Italiana Niemann Pick e Malattie Affini-ONLUS, Lanzo Torinese, TO, Italy
| | - Alberto Burlina
- Division of Inherited Metabolic Diseases, Department of Women's and Children's Health, Reference Centre Expanded Newborn Screening, University Hospital, Padua, Italy
| | - Daniela Concolino
- Pediatrics-Science of Health Department, University "Magna Graecia", Catanzaro, Italy
| | - Federica Deodato
- Division of Metabolism, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Maja Di Rocco
- Department of Pediatrics, Unit of Rare Diseases, Giannina Gaslini Institute, Genoa, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Maria Alice Donati
- Metabolic and Neuromuscular Unit, Meyer Children Hospital-University of Florence, Florence, Italy
| | - Simona Fecarotta
- Department of Maternal and Child Health, Federico II University Hospital, 80131, Naples, Italy
| | - Agata Fiumara
- Regional Referral Centre for Metabolic Diseases (CRR-MET), UOC Pediatric Clinic-Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Department of Economics, Management and Statistics, University of Milano-Bicocca, Milan, Italy
| | - Fiorina Giona
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Gaetano Giuffrida
- Regional Reference Center for Rare Diseases, Clinical Division of Haematology and Transplantation, Azienda Ospedaliera-Universitaria Policlinico-S. Marco, Catania, Italy
| | - Raffaele Manna
- Institute of Internal Medicine, Periodic Fever and Rare Diseases Research Centre, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Paolo Mariani
- Bicocca Applied Statistics Center (B-ASC), Department of Economics, Management and Statistics, University of Milano-Bicocca, Milan, Italy
| | - Andrea Pession
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Annalisa Scopinaro
- Italian Federation of Rare Diseases Patients Associations (UNIAMO FIMR), Rome, Italy
| | - Marco Spada
- Department of Pediatrics, AOU Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | | | - Gianluca Trifirò
- Department of Diagnostics and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Francesca Carubbi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Metabolic Medicine Unit, University Hospital, Modena, Italy
| | - Maria Domenica Cappellini
- Rare Diseases Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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11
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Marcellusi A, Raimondo P, Galeone C, Canonico PL. Time to market access in Italia: durata del processo di P&R per i farmaci per le malattie rare. Glob Reg Health Technol Assess 2023; 10:79-88. [PMID: 37942299 PMCID: PMC10628501 DOI: 10.33393/grhta.2023.2610] [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: 05/25/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023] Open
Abstract
Objective: This paper aims to investigate the duration of the pricing & reimbursement (P&R) procedures submitted in Italy by pharmaceutical marketing authorization holders (MAH) for drugs indicated for rare diseases. Methods: All the data used in this analysis were publicly available on different sources of the Italian Ministry of Health, the Italian Medicines Agency (AIFA) and other official websites. The information was systematically collected to investigate the timeline (days) needed to complete the P&R process. The process was divided into 6 simplified steps and the median and range of days needed for each phase were estimated based on data reported in official/published documents. The analysis was stratified considering every single step of the assessment phase and included segmentation of drugs into indications for rare diseases, Orphan designation, Innovation assessment and Managed entry agreements (MEAs). Results: Overall, 181 first indication procedures were submitted to AIFA in the period considered and, of these, 167 (92.3%) were completed and 129 procedures were considered for the final analysis and the median duration of the entire process (MAH submission to final Gazette publication) was 434 days (range 176.0-918.0). The duration of procedures for rare diseases (n = 53) was longer than those for non-rare-disease procedures (n = 76) (463.0 days vs 407.5 days respectively). Among rare disease procedures, orphan designation and MEAs represent predictors for time prolongation while innovation is associated with a shorter assessment time. Conclusion: The study describes the time spent in each phase of the assessment and the appraisal process and demonstrates that uncertainty represents the main driver for the increment in the overall time.
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Affiliation(s)
- Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA-CEIS), Università degli studi di Roma “Tor Vergata”, Roma - Italy
| | | | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milano - Italy
- Biostatistics & Outcome Research, Statinfo, Milano - Italy
| | - Pier Luigi Canonico
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, Novara - Italy
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12
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Bonkat G, Cai T, Galeone C, Koves B, Bruyere F. Adherence to European Association of Urology Guidelines and State of the Art of Glycosaminoglycan Therapy for the Management of Urinary Tract Infections: A Narrative Review and Expert Meeting Report. EUR UROL SUPPL 2022; 44:37-45. [PMID: 36051173 PMCID: PMC9424561 DOI: 10.1016/j.euros.2022.07.009] [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] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Context Urinary tract infections (UTIs) have a significant impact on patient's quality of life and society. Antibiotic therapy is the primary approach for the management of UTIs; however, it has major limits in the prevention of recurrent UTIs (rUTIs), also increasing the risk of development of multidrug-resistant micro-organisms. Objective The aim of this paper is to discuss the European Association of Urology guidelines for the management of UTIs/rUTIs, the level of adherence to these recommendations, and the available evidence on the use of glycosaminoglycans (GAGs) as a possible alternative treatment to prevent rUTIs. Evidence acquisition This narrative review and expert meeting report is based on a literature search concerning the currently available UTI guidelines, the results of a survey administered to 227 urologists, and the opinion of an expert panel in the field of UTIs. Evidence synthesis Results obtained from the literature search showed that adherence to guidelines is not optimal. The survey demonstrated that antibiotics remain one of the treatments of UTIs. However, most of the urologists are aware of the problem caused by the resistance to antibiotics and prefer alternative methods for the prophylaxis of UTIs. Considering the alternative methods, the authors concluded that GAG therapy is highly effective in preventing rUTIs. Conclusions Adherence to the international guidelines is important to align the clinical practice and avoid the spreading of antibiotic resistance. The survey outlines that the misuse and overuse of antibiotics are major problems; an analysis of clinical evidence confirms that GAG therapy is a valuable therapeutic approach to prevent the recurrence of episodes of UTIs and to limit the onset of antibiotic resistance. Patient summary Although antibiotic therapy is primarily used for the management of urinary tract infections (UTIs), misuse and overuse of antibiotics are of concern. Adherence to the international guidelines is important to prevent the spreading of antibiotic resistance. Clinical evidence confirms that the use of glycosaminoglycans is a valuable therapeutic approach to prevent UTI recurrence and limit the onset of antibiotic resistance.
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Affiliation(s)
- Gernot Bonkat
- Alta uro AG, Merian Iselin Klinik, Centre of Biomechanics & Calorimetry, University of Basel, Basel, Switzerland
| | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milano, Italy.,Biostatistics & Outcome Research, Statinfo, Renate, Italy
| | - Bela Koves
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Franck Bruyere
- Department of Urology, University of Tours, Tours, France
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13
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Dalmartello M, Turati F, Zhang ZF, Lunet N, Rota M, Bonzi R, Galeone C, Martimianaki G, Palli D, Ferraroni M, Yu GP, Morais S, Malekzadeh R, López-Carrillo L, Zaridze D, Maximovitch D, Aragonés N, Fernández-Tardón G, Martin V, Vioque J, Garcia de la Hera M, Curado MP, Coimbra FJF, Assumpcao P, Pakseresht M, Hu J, Hernández-Ramírez RU, Ward MH, Pourfarzi F, Mu L, Tsugane S, Hidaka A, Lagiou P, Lagiou A, Trichopoulou A, Karakatsani A, Boffetta P, Camargo MC, Negri E, La Vecchia C, Pelucchi C. Allium vegetables intake and the risk of gastric cancer in the Stomach cancer Pooling (StoP) Project. Br J Cancer 2022; 126:1755-1764. [PMID: 35210588 PMCID: PMC9174191 DOI: 10.1038/s41416-022-01750-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The role of allium vegetables on gastric cancer (GC) risk remains unclear. METHODS We evaluated whether higher intakes of allium vegetables reduce GC risk using individual participant data from 17 studies participating in the "Stomach cancer Pooling (StoP) Project", including 6097 GC cases and 13,017 controls. Study-specific odds ratios (ORs) were pooled using a two-stage modelling approach. RESULTS Total allium vegetables intake was inversely associated with GC risk. The pooled OR for the highest versus the lowest study-specific tertile of consumption was 0.71 (95% confidence interval, CI, 0.56-0.90), with substantial heterogeneity across studies (I2 > 50%). Pooled ORs for high versus low consumption were 0.69 (95% CI, 0.55-0.86) for onions and 0.83 (95% CI, 0.75-0.93) for garlic. The inverse association with allium vegetables was evident in Asian (OR 0.50, 95% CI, 0.29-0.86) but not European (OR 0.96, 95% CI, 0.81-1.13) and American (OR 0.66, 95% CI, 0.39-1.11) studies. Results were consistent across all other strata. CONCLUSIONS In a worldwide consortium of epidemiological studies, we found an inverse association between allium vegetables and GC, with a stronger association seen in Asian studies. The heterogeneity of results across geographic regions and possible residual confounding suggest caution in results interpretation.
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Affiliation(s)
- Michela Dalmartello
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Turati
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. .,Unit of Medical Statistics and Biometry, National Cancer Institute of Milan, Milan, Italy.
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Rossella Bonzi
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Georgia Martimianaki
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hellenic Health Foundation, Athens, Greece
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO, Florence, Italy
| | - Monica Ferraroni
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Guo-Pei Yu
- Medical Informatics Center, Peking University, Peking, China
| | - Samantha Morais
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Zaridze
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Dmitry Maximovitch
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Nuria Aragonés
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Cancer Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain
| | | | - Vicente Martin
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain
| | - Jesus Vioque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL-UMH, 46020, Alicante, Spain
| | - Manoli Garcia de la Hera
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL-UMH, 46020, Alicante, Spain
| | - Maria Paula Curado
- Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Paulo Assumpcao
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Mohammadreza Pakseresht
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada.,Nutritional Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom
| | - Jinfu Hu
- Harbin Medical University, Harbin, China
| | | | - Mary H Ward
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Farhad Pourfarzi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Akihisa Hidaka
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Areti Lagiou
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece.,2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Haidari, Greece
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - M Costanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Eva Negri
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudio Pelucchi
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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14
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Natalicchio A, Sculco C, Belletti G, Fontanelli M, Galeone C, Bossi AC. Patient-Support Program in Diabetes Care During the Covid-19 Pandemic: An Italian Multicentric Experience. Patient Prefer Adherence 2022; 16:113-122. [PMID: 35068927 PMCID: PMC8769051 DOI: 10.2147/ppa.s343949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Telephone coaching and health apps are effective means to support subjects with diabetes. Patient support programs (PSP) on type 2 diabetes are scanty, and none has been conducted in Italy. In a pilot phase, conducted during the COVID-19 pandemic, we aimed to examine the feasibility and acceptance of such program. METHODS The "BE THere for diabetes CARE" (BETHCARE) project is a real-world PSP conducted through telephone and digital coaching system to provide educational and emotional support to Italian adults with diabetes receiving long-acting basal insulin degludec. This pilot phase was conducted in 11 centres that enrolled a total of 63 patients (89% with type-2 diabetes). Counselors contacted patients to define a set of emotional, physical and nutritional targets, and monitoring calls were performed on a monthly basis. Data were collected on socio-demographic and anthropometric characteristics, selected clinical information, quality of life, achievement of targets and patient satisfaction. RESULTS Fifty-eight subjects (92%) chose to participate by telephone and 5 (8%) by mobile app. Most participants (ie, ≥80%) evaluated counselors' calls "useful/very useful", duration of calls "adequate/adequately long", were satisfied with the educational pathway and declared to be more confident in diabetes management after the program. About half of participants were confident to maintain their targets after the PSP. Achievement of nutritional targets improved during counseling, from a mean score of 1.56 at week 1 to 1.88 at week 16 (p-value = 0.03). No significant variations in the achievement of emotional and physical targets emerged. Mean patients weight decreased from 84.9 kg (week 1) to 84.3 kg (week 4) and then levelled off (84.2 kg, week 16). CONCLUSION This project demonstrated the feasibility and patient appreciation of a PSP in diabetes care, which is particularly important for a chronic disease of the elderly and during a pandemic period when face-to-face counseling is problematic.
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Affiliation(s)
- Annalisa Natalicchio
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Camilla Sculco
- Healthcare Network Partners Italy, Bologna, Italy
- Correspondence: Camilla Sculco Email
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15
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Rossini A, Lanzi R, Galeone C, Pelucchi C, Pennacchioni M, Perticone F, Sirtori M, Losa M, Rubinacci A. Bone and body composition analyses by DXA in adults with GH deficiency: effects of long-term replacement therapy. Endocrine 2021; 74:666-675. [PMID: 34331234 DOI: 10.1007/s12020-021-02835-6] [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] [Received: 02/19/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The effects of growth hormone (GH) replacement on bone mass and body composition in adult with GH deficiency (AGHD) are still debated with regard to their persistence in the long term. Moreover, the impact of the gender on the response to GH is controversial. Aim of this study was to evaluate the long-term effects of rhGH replacement on bone mass and body composition in a monocentric cohort of patients with AGHD. METHODS Data from 118 patients with AGHD (34.8 ± 14.4 years, 43 women and 75 men) treated with rhGH for a period of at least 3 years up to a maximum of 10 were retrospectively collected. Bone mineral density (BMD) at the lumbar spine, femur, and 1/3 radius, and total and truncular body composition were evaluated by dual-energy X-ray absorption (DXA) before and during treatment. Clinical and laboratory evaluations were performed before and during the treatment period on an annual basis. RESULTS Lumbar spine BMD consistently increased in males, while it decreased in females after a transient improvement observed during the first 4 years of therapy. There were no significant changes in femoral and 1/3 radial BMD in either sexes. Lean mass significantly increased in both sexes, while fat mass only decreased in males. CONCLUSIONS In AGHD patients long-term rhGH replacement therapy induces a positive effect with regard to bone mass and body composition. A sexual dimorphism in the response to treatment is evident, with males displaying a more favorable outcome.
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Affiliation(s)
- Alessandro Rossini
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, 24127, Italy.
| | - Roberto Lanzi
- Endocrinology Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milano, Lombardia, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mario Pennacchioni
- AnacletoLab, Department of Computer Science, University of Milan, Milan, Italy
| | - Francesca Perticone
- Endocrinology Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marcella Sirtori
- Bone Metabolic Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Losa
- Neurosurgery Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alessandro Rubinacci
- Bone Metabolic Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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16
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Abstract
OBJECTIVE In 2017, the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA) introduced a standardised process to appraise innovativeness of medicines. Innovative medicines are provided speeder market access and dedicated funds. Innovativeness criteria are: unmet therapeutic need, added therapeutic value and quality of the evidence (Grading of Recommendations Assessment, Development and Evaluation method). We investigated the role played by these three criteria on the final decision aimed to understand how the new Italian innovativeness appraisal framework was implemented. DESIGN A desk research gathered AIFA's appraisal reports on innovativeness and data analyses were conducted. No patients were directly involved in this study. SETTING AND PARTICIPANTS We scrutinised all 77 appraisal reports available on AIFA's website (2017-2020). PRIMARY AND SECONDARY OUTCOME MEASURES The impact of the three domains on final decision was investigated through a series of univariate analyses. RESULTS Among 77 appraisal reports on innovativeness available, 49 (64%) and 28 (36%) were for oncology and non-oncology medicines, respectively. The appraisals were equally distributed among 'fully innovative' (36%), 'conditionally innovative' (30%) and 'not innovative' (34%). Added therapeutic value was the most important driver on innovativeness decision, followed by quality of the evidence. Drugs for rare diseases and with paediatric/mixed indications were appraised 'innovative' by a larger proportion, but no statistical significance was found. CONCLUSIONS Despite some limitations, including the moderate number of appraisals, this paper provides an insight into the determinants of innovativeness appraisals for medicines in Italy and the accuracy of the appraisal process. This has important implications in terms of transparency and accountability in the prioritisation process applied to innovative medicines.
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Affiliation(s)
- Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milano, Lombardia, Italy
- Biostatistics & Outcome Research, Statinfo, Renate, Lombardia, Italy
| | - Paolo Bruzzi
- Department of Clinical Epidemiology, IRCCS AOU San Martino, Genova, Liguria, Italy
| | - Claudio Jommi
- CERGAS (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Bocconi University, Milano, Lombardia, Italy
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17
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Monzani R, Barbera G, Restelli U, Galeone C, Petrini F. Protocol Implementation for Normothermia in Surgery Settings in Italy: Budget-Impact Analysis. Risk Manag Healthc Policy 2020; 13:2347-2356. [PMID: 33154686 PMCID: PMC7608003 DOI: 10.2147/rmhp.s267923] [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: 06/16/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Hypothermia is a well-known risk of the perioperative period and considered a preventable effect of anesthesia care. Nevertheless, it is not fully controlled, causing a number of adverse outcomes following surgical operations and thus increasing length of stay in hospital and treatment costs. The aim of this study was to assess the budget impact (BI) of the implementation of proactive strategies to prevent inadvertent perioperative hypothermia (IPH) in surgical patients in Italy, as recommended by international guidelines and by a good clinical practice (GCP) guideline of the Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care. Methods BI was calculated over a 3-year period from the perspective of the Italian National Health Service (NHS). Model inputs were extracted from national literature when available and otherwise from international sources. The reference analytic model was based on the cost-effectiveness analysis of the National Institute for Health and Care Excellence clinical guidance 65. Estimates were based on assessments made about current malpractice in Italy and on a hypothesis of how future practice might change by implementing the GCP. Model output included overall BI results, variations in the number of warmed patients, medical-device average costs and use of mix. Results The base-case estimate quantified a decrease of 35% in extra days of hospital stay due to IPH and a net BI of –€60.92 million. Conclusion Increasing protocol adoption for preventing IPH would lead to both clinical advantages and significant savings for the NHS. Its large diffusion in Italian hospitals is thus desirable.
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Affiliation(s)
- Roberta Monzani
- Day Hospital Chirurgico, IRCCS Humanitas Research Hospital Rozzano, Rozzano, Italy
| | | | - Umberto Restelli
- Centre for Health Economics, Social and Health Care Management Carlo Cattaneo University, Castellanza, Italy.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Flavia Petrini
- Anestesia, Rianimazione e Terapia Intensiva, Università Gabriele d'Annunzio - ASL 2 Abruzzo, Chieti, Italy
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18
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Mattavelli I, Maurichi A, Galeone C, Gallino G, Barbieri C, Leva A, Tolomio E, Valeri B, Cossa M, Patuzzo R, Santinami M. The role of sentinel lymph node status performed in melanoma patients with local recurrence or in transit metastasis. Eur J Surg Oncol 2020; 47:1152-1156. [PMID: 33218700 DOI: 10.1016/j.ejso.2020.10.028] [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] [Received: 03/18/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sentinel Node Biopsy (SNB) is routinely performed for primary melanoma, but its role in the treatment of Local Recurrence (LR) and In-Transit metastasis (IT) is controversial. This study aims to assess the role of SNB in melanoma patients who developed first loco-regional recurrence. METHODS A series of consecutive melanoma patients who received SNB for a first IT or LR at the National Cancer Institute of Milan, Italy, from 2000 to 2015 were selected from a prospective database. Clinicopathological characteristics were analyzed. RESULTS Seventy-two patients met selection criteria. Forty-three patients (59.7%) received SNB for LR and 29 (40.3%) for IT. The average interval between treatment of primitive melanoma and first recurrence diagnosis was 19 months (interquartile range: 6.9-49.0). SN identification rate was 97.2%. SN positivity was detected in 26 (37.1%) patients. The SN-positive ratein melanoma patients who had LR or IT was significantly higher than reported for primary tumours. Of patients with nodal involvement 17 had LR and 9 IT lesions. Disease Free Survival (DFS) was slightly higher in SN negative patients, in the absence of statistically significant differences. Overall Survival (OS) analysis showed similar values in the two groups. CONCLUSION Since DFS and OS do not show significant differences between SN negative and positive patients, our data do not give clear indications about performing SNB in case of first LR or IT. However, we suggest submitting patients with LR to this procedure to obtain a more accurate staging and eventually candidate these patients to adjuvant treatment.
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Affiliation(s)
- Ilaria Mattavelli
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Andrea Maurichi
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianfranco Gallino
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Consuelo Barbieri
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Leva
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Tolomio
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Valeri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mara Cossa
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Patuzzo
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Santinami
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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El Hachem M, Naldi L, Neri I, Pedone MP, Fanelli F, Galeone C. Atopic dermatitis in schoolchildren and adolescents: a critical review of Italian epidemiological data and systemic treatments. Ital J Dermatol Venerol 2020; 156:650-658. [PMID: 33070573 DOI: 10.23736/s2784-8671.20.06669-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The epidemiology of atopic dermatitis (AD) is largely different in pre-school and schoolchildren. We summarized the available epidemiological data on schoolchildren (6-11 years) and adolescents (12-17 years) in Italy and reviewed information on systemic treatments for moderate-to-severe AD in adolescents. EVIDENCE ACQUISITION In January 2019, we searched for data on prevalence and/or incidence of AD and on the efficacy, effectiveness and safety of systemic AD therapies. Papers were evaluated and selected, and relevant information was extracted. Twenty papers from 17 studies reported original epidemiological information on AD in Italy. EVIDENCE SYNTHESIS Most studies were conducted before 2005. Though variations emerged between studies, the lifetime prevalence of AD was estimated between 15-17% in schoolchildren and between 8-13% in adolescents. The (12-months) period prevalence of AD was estimated between 8-10% in children and between 8-11% in adolescents. Up-to-date information on the prevalence of severe AD is not available. Cyclosporine A may be used in pediatric age patients (children and adolescents) with persistent or severe AD refractory to topical treatments, but its use has several limitations, and is not recommended in patients younger than 16 years. The treatment paradigm of AD is still far from being satisfactory. CONCLUSIONS We provided a quantitative synthesis of AD epidemiology in Italian schoolchildren and adolescents. Recent data are needed, as most information dates back to the 1990s or early 2000s, and data on the incidence of AD, the proportion of severe cases, and treatment of severe cases in the real-world setting are scanty.
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Affiliation(s)
- May El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luigi Naldi
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Iria Neri
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | - Carlotta Galeone
- Outcome Research Unit, Statinfo, Renate, Monza e Brianza, Italy -
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20
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El Hachem M, Naldi L, Neri I, Pedone MP, Fanelli F, Galeone C. Atopic dermatitis in schoolchildren and adolescents: a critical review of Italian epidemiological data and systemic treatments. G Ital Dermatol Venereol 2020. [PMID: 33070573 DOI: 10.23736/s0392-0488.20.06669-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The epidemiology of atopic dermatitis (AD) is largely different in preschool and schoolchildren. We summarized the available epidemiological data on schoolchildren (6-11 years) and adolescents (12-17 years) in Italy and reviewed information on systemic treatments for moderate-to-severe AD in adolescents. EVIDENCE ACQUISITION In January 2019, we searched for data on prevalence and/or incidence of AD and on the efficacy, effectiveness and safety of systemic AD therapies. Papers were evaluated and selected, and relevant information was extracted. Twenty papers from 17 studies reported original epidemiological information on AD in Italy. EVIDENCE SYNTHESIS Most studies were conducted before 2005. Though variations emerged between studies, the lifetime prevalence of AD was estimated between 15%-17% in schoolchildren and between 8%-13% in adolescents. The (12-months) period prevalence of AD was estimated between 8%-10% in children and between 8%-11% in adolescents. Up-to-date information on the prevalence of severe AD is not available. Cyclosporine A may be used in pediatric age patients (children and adolescents) with persistent or severe AD refractory to topical treatments, but its use has several limitations, and is not recommended in patients younger than 16 years. The treatment paradigm of AD is still far from being satisfactory. CONCLUSIONS We provided a quantitative synthesis of AD epidemiology in Italian schoolchildren and adolescents. Recent data are needed, as most information dates back to the 1990s or early 2000s, and data on the incidence of AD, the proportion of severe cases, and treatment of severe cases in the Real-World are scanty.
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Affiliation(s)
- May El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luigi Naldi
- Department of Dermatology, Ospedale San Bortolo, Vicenza, Italy
| | - Iria Neri
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | - Carlotta Galeone
- Outcome Research Unit, Statinfo Srl, Renate, Monza-Brianza, Italy -
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21
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Bossi AC, De Mori V, Galeone C, Bertola DP, Gaiti M, Balini A, Berzi D, Forloni F, Meregalli G, Turati F. PERsistent Sitagliptin treatment & Outcomes (PERS&O 2.0) study, long-term results: a real-world observation on DPP4-inhibitor effectiveness. BMJ Open Diabetes Res Care 2020; 8:8/1/e001507. [PMID: 32900698 PMCID: PMC7478001 DOI: 10.1136/bmjdrc-2020-001507] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/06/2020] [Accepted: 07/30/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Sitagliptin is a dipeptidyl peptidase 4 inhibitor for the treatment of type 2 diabetes (T2D). Limited real-world data on its effectiveness and safety are available from an Italian population. RESEARCH DESIGN AND METHODS We evaluated long-term clinical data from the single-arm PERsistent Sitagliptin Treatment & Outcomes (PERS&O) study, which collected information on 440 patients with TD2 (275 men, 165 women; mean age 64.1 years; disease median duration: 12 years) treated with sitagliptin 'add-on'. For each patient, we estimated the 10-year cardiovascular (CV) risk using the UK Prospective Diabetes Study (UKPDS) Risk Engine (RE). Drug survival was evaluated using Kaplan-Meier survival curves; repeated measures mixed effects models were used to evaluate the evolution of glycated hemoglobin (HbA1c) and CV risk during sitagliptin treatment. RESULTS At baseline, most patients were overweight or obese (median body mass index (BMI) (kg/m2) 30.2); median HbA1c was 8.4%; median fasting plasma glucose: 172 mg/dL; median UKPDS RE score: 24.8%, being higher in men (median 30.2%) than in women (median 17.0%) as expected. Median follow-up from starting sitagliptin treatment was 5.6 years. From Kaplan-Meier curves, the estimated median drug survival was 32.8 months when considering discontinuation for any cause and 58.4 months when considering discontinuation for loss of efficacy. A significant improvement in HbA1c was evident during treatment with sitagliptin (p<0.01): the reduction was rapid (median HbA1c after 4-6 months: 7.5%) and continued at longer follow-up. When comparing patients treated with sitagliptin versus those stopping sitagliptin and switching to another antihyperglycemic drug, we detected a significant difference in the evolution of HbA1c in favor of patients who continued sitagliptin treatment. The UKPDS RE score at 10 years and the BMI significantly improved during treatment with sitagliptin (p<0.001). Adverse events were relatively uncommon. CONCLUSION Patients with T2D treated with sitagliptin achieved an improvement in metabolic control and a reduction in CV risk and did not experience relevant adverse events.
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Affiliation(s)
- Antonio Carlo Bossi
- Endocrine Diseases Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Valentina De Mori
- Endocrine Diseases Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Davide Pietro Bertola
- Endocrine Diseases Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Margherita Gaiti
- Endocrine Diseases Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Annalisa Balini
- Endocrine Diseases Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Denise Berzi
- Endocrine Diseases Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Franco Forloni
- Endocrine Diseases Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Giancarla Meregalli
- Endocrine Diseases Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Federica Turati
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Lombardia, Italy
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22
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Bozzani A, Grattagliano I, Pellegatta G, Furnari M, Galeone C, Savarino V, Savarino E, De Bastiani R. Usefulness of Pep-Test for Laryngo-Pharyngeal Reflux: A Pilot Study in Primary Care. Korean J Fam Med 2020; 41:250-255. [PMID: 32460472 PMCID: PMC7385291 DOI: 10.4082/kjfm.18.0207] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background Gastroesophageal reflux disease is a digestive disorder characterized by nausea, regurgitation, and heartburn. Gastroesophageal reflux is the primary cause of laryngeal symptoms, especially chronic posterior laryngitis. The best diagnostic test for this disease is esophageal impedance-pH monitoring; however, it is poorly employed owing to its high cost and invasiveness. Salivary pepsin measured using a lateral flow device (Pep-test) has been suggested as an indirect marker of laryngopharyngeal reflux (LPR). The present study tested the reliability of Pep-test in diagnosing LPR in uninvestigated primary care attenders presenting with chronic laryngeal symptoms, and evaluated the raw pepsin concentration in patients with LPR. Methods A multicenter, non-interventional pilot study was conducted on 86 suspected patients with LPR and 59 asymptomatic subjects as controls in three Italian primary care settings. A reflux symptom index questionnaire was used to differentiate patients with LPR (score >13) from controls (score <5). Two saliva samples were collected, and comparisons between the groups were performed using two-sided statistical tests, according to variable distributions. Results There was no statistical difference in the salivary pepsin positivity between LPR patients and controls, whereas the pepsin intensity value was higher in controls than in LPR patients. Conclusion A high prevalence of pepsin positivity was observed in asymptomatic controls. Pepsin measurement should not be considered as a diagnostic test for LPR in primary care patients.
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Affiliation(s)
- Alberto Bozzani
- GIGA-CP (Italian Group for Primary Care Gastroenterology), Milan, Italy
| | | | | | | | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Rudi De Bastiani
- GIGA-CP (Italian Group for Primary Care Gastroenterology), Milan, Italy
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23
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Chatenoud L, Bertuccio P, Turati F, Galeone C, Naldi L, Chatenoud L, La Vecchia C, Bach J, Agostinis F, Carminati S, Neri I, Patrizi A, Starace M, Berti S, Gola MF, Gola M, Martelli A, Origgi D, Serradori L, Burroni AG, Ciccarese G, Brena M, Colonna C, Gelmetti C, Esposito S, Montinaro V, Patria MF, Peves Rios W, Tagliabue C, Fontana E, Belloni Fortina A, Peccianti C, Pellegrino M, Trovato E, Di Landro A, Menchini M, Quadri V, Testagrossa O, Boner A, Comberiati P, Peroni D. Markers of microbial exposure lower the incidence of atopic dermatitis. Allergy 2020; 75:104-115. [PMID: 31321780 DOI: 10.1111/all.13990] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/01/2019] [Accepted: 05/23/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The hygiene hypothesis proposes that reduced exposure to infectious agents in early life would explain the increase of allergic and autoimmune diseases observed over the past decades in high-income countries. METHODS We conducted a matched case-control study on incident atopic dermatitis (AD). Cases were 426 outpatient children with a first diagnosis of incident AD. Controls were 426 children attending a pediatric/dermatological visit for nonatopic disorders matched to cases (1:1). Particular attention was paid to the time elapsed between the markers of microbial exposure and disease onset, and we considered for controls the same time window of exposures from birth as his/her matched case. Odds ratios (ORs) were computed using multivariable conditional logistic regression models, according to center, sex, age, and period of enrollment, and including as potential confounders a family history of any allergy in parents, type of delivery, having siblings, keeping pets, age at weaning, and having had ≥4 infections. RESULTS The OR of AD first occurrence was 0.35 (P-value = .039) for children who had experienced ≥4 infections compared with those with no infections. A decreasing trend in risk was observed with increasing number of siblings (P-value = .023), the protective effect reaching about 40% for children with 2 or more siblings (OR = 0.62; P-value = .048). Pet keeping, in particular daily contact with dogs, was inversely associated with AD risk (OR = 0.40; P-value = .004). CONCLUSIONS These results support the hygiene hypothesis in its broad sense. Early-life environmental exposures, including pathogens and commensals, act as "microbes contact carriers" influencing immune system balance early in life.
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Affiliation(s)
- Liliane Chatenoud
- Department of Public Health Laboratory of Clinical Epidemiology ‐ IRCCS Istituto di Ricerche Farmacologiche “Mario Negri” Milan Italy
| | - Paola Bertuccio
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Federica Turati
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Luigi Naldi
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII Centro Studi GISED Bergamo Italy
| | - Lucienne Chatenoud
- Université Paris Descartes Paris France
- INSERM Institut Necker‐Enfants Malades Paris France
- CNRS UMR 8253 Institut Necker‐Enfants Malades Paris France
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Jean‐François Bach
- Université Paris Descartes Paris France
- INSERM Institut Necker‐Enfants Malades Paris France
- CNRS UMR 8253 Institut Necker‐Enfants Malades Paris France
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24
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Chelleri C, Monzani NA, Gelmetti C, Milani GP, Fossali EF, Galeone C, Cavalli R. Residual Lesions After Pharmacological and Dye-Laser Treatment of Infantile Hemangiomas: Critical Review of 432 Cases. Lasers Surg Med 2019; 52:597-603. [PMID: 31828809 DOI: 10.1002/lsm.23205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Infantile hemangiomas (IHs) are the most common benign tumors in infanthood. Although they are often self-limiting, management of IHs is still controversial because residual lesions may persist in some cases. The aim of this study is to report our experience with patients affected with IH and investigate the frequency of residual lesions in treated versus untreated patients. STUDY DESIGN/MATERIALS AND METHODS This retrospective observational study enrolled patients with IHs evaluated over the past 10 years. Patients were managed with systemic or local pharmacotherapy, laser therapy, a combination of them, or with observation only. RESULTS A total of 432 patients were included: 71% received one or more therapies for IHs; 75.2% of untreated patients had at least one residual lesion compared with 41.4% of treated patients (P < 0.001). Patients treated with laser therapy or topical timolol had the lowest rate of residual lesions. CONCLUSIONS This rather large case series suggests that IHs management with pharmacotherapy and especially laser therapy is associated with a lower number of residual lesions than observation only. Although propranolol can be very useful to avoid life-threatening complications and severe tissue impairment, laser therapy and topical timolol are potential effective treatments to decrease the incidence of residual lesions, mostly associated with superficial IHs. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Cristina Chelleri
- Department of Pediatric Dermatology, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
| | - Nicola Adriano Monzani
- Department of Pediatric Dermatology, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
| | - Carlo Gelmetti
- Department of Pediatric Dermatology, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
| | - Gregorio Paolo Milani
- Department of Pediatric Emergency, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
| | - Emilio Filippo Fossali
- Department of Pediatric Emergency, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, 20122, Italy
| | - Riccardo Cavalli
- Department of Pediatric Dermatology, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
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Turati F, Galeone C, Augustin LSA, La Vecchia C. Glycemic Index, Glycemic Load and Cancer Risk: An Updated Meta-Analysis. Nutrients 2019; 11:nu11102342. [PMID: 31581675 PMCID: PMC6835610 DOI: 10.3390/nu11102342] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/30/2019] [Indexed: 12/20/2022] Open
Abstract
Diets high in glycemic index (GI) and glycemic load (GL) have been related to an increased risk of selected cancers, but additional quantification is required. We updated a systematic review and meta-analysis published in 2015 to May 2019 to provide quantitative information on GI/GL and cancer risk. Relative risks (RR) and the corresponding 95 % confidence intervals (CI) for the highest versus the lowest categories of GI and GL were extracted from selected studies and pooled using random-effects models. Twenty reports (>22,000 cancer cases) have become available after January 2015, and 15 were added to the meta-analyses by cancer sites, which considered a total of 88 investigations. The five additional reports were reviewed, but not included in the meta-analyses, since data were inadequate to be pooled. For hormone-related cancers, summary RRs for the highest versus lowest GI and GL intakes were moderately increased. They ranged from 1.04 (breast) to 1.12 (endometrium) for GI and from 1.03 (prostate) to 1.22 (ovary) for GL, of borderline significance. High GI was associated with small increased risks of colorectal (summary RR for GI: 1.20, 95% CI, 1.07–1.34—GL: 1.09, 95% CI, 0.97–1.22, 19 studies), bladder (GI: 1.25, 95% CI, 1.11–1.41—GL: 1.10, 95% CI, 0.85–1.42, four studies) and kidney cancers (GI: 1.16, 95% CI, 1.02–1.32—GL: 1.14, 95% CI, 0.81–1.60, five studies). GL was not significantly related to those cancer sites. Stomach, prostate and lung cancers were not associated with GI and GL. The present analysis, based on an updated comprehensive evaluation of the epidemiological literature, indicates moderate unfavorable effects of high versus low GI on colorectal, and possibly bladder and kidney cancers, and a possible moderate positive association between GL and endometrial cancer.
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Affiliation(s)
- Federica Turati
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133 Milan, Italy.
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133 Milan, Italy.
| | - Livia S A Augustin
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON M5B 1W8, Canada.
- National Cancer Institute, SSD di Epidemiologia, Istituto Nazionale Tumori - IRCCS - "Fondazione G. Pascale", 80131 Naples, Italy.
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133 Milan, Italy.
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Carubbi C, Masselli E, Calabrò E, Bonati E, Galeone C, Andreoli R, Goldoni M, Corradi M, Sverzellati N, Pozzi G, Banchini A, Pastorino U, Vitale M. Sulphurous thermal water inhalation impacts respiratory metabolic parameters in heavy smokers. Int J Biometeorol 2019; 63:1209-1216. [PMID: 31227888 DOI: 10.1007/s00484-019-01737-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 05/21/2023]
Abstract
Sulphurous thermal water inhalations have been traditionally used in the treatment of airway diseases. In vivo and in vitro studies reported that they ameliorate mucus rheology, mucociliary clearance and reduce inflammation. Cigarette smoking induces an inflammatory damage, with consequent remodeling of respiratory airways, which in turn affect pulmonary functions. Despite the anti-inflammatory effects of H2S are clinically documented in several airway inflammatory diseases, data on the effects of sulphurous thermal water treatment on pulmonary function and biomarkers of airways inflammation in smokers are still scant. Therefore, we investigated whether a conventional cycle of sulphurous thermal water inhalation produced changes in markers of respiratory inflammation and function. A cohort of 504 heavy current and former smokers underwent 10-day cycles of sulphurous thermal water inhalation. Pulmonary function and metabolic analyses on exhaled breath condensate were then performed at day 0 and after the 10-day treatment. Spirometric data did not change after spa therapy, while exhaled breath condensate analysis revealed that a single 10-day cycle of sulphurous water inhalation was sufficient to induce a statistically significant increase of citrulline levels along with a decrease in ornithine levels, thus shifting arginine metabolism towards a reduced nitric oxide production, i.e. an anti-inflammatory profile. Overall, sulphurous thermal water inhalation impacts on arginine catatabolic intermediates of airways cells, shifting their metabolic balance towards a reduction of the inflammatory activity, with potential benefits for smokers.
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Affiliation(s)
- Cecilia Carubbi
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Elena Masselli
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Elisa Calabrò
- Department of Internal Medicine, Ospedale Fatebenefratelli Sacco, Piazzale Principessa Clotilde 3, 20121, Milan, Italy
| | - Elisa Bonati
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 19, 20122, Milan, Italy
| | - Roberta Andreoli
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Matteo Goldoni
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Massimo Corradi
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Giulia Pozzi
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Antonio Banchini
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Ugo Pastorino
- Section of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian 1, 20133, Milan, Italy
| | - Marco Vitale
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy.
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27
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Bocchia M, Candoni A, Borlenghi E, Defina M, Filì C, Cattaneo C, Sammartano V, Fanin R, Sciumè M, Sicuranza A, Imbergamo S, Riva M, Fracchiolla N, Latagliata R, Caizzi E, Mazziotta F, Alunni G, Di Bona E, Crugnola M, Rossi M, Consoli U, Fontanelli G, Greco G, Nadali G, Rotondo F, Todisco E, Bigazzi C, Capochiani E, Molteni A, Bernardi M, Fumagalli M, Rondoni M, Scappini B, Ermacora A, Simonetti F, Gottardi M, Lambertenghi Deliliers D, Michieli M, Basilico C, Galeone C, Pelucchi C, Rossi G. Real‐world experience with decitabine as a first‐line treatment in 306 elderly acute myeloid leukaemia patients unfit for intensive chemotherapy. Hematol Oncol 2019; 37:447-455. [DOI: 10.1002/hon.2663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Monica Bocchia
- Unità di Ematologia Azienda Ospedaliera Universitaria Senese e Università di Siena Siena Italy
| | - Anna Candoni
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari Azienda Sanitaria Universitaria Integrata Udine Italy
| | | | - Marzia Defina
- Unità di Ematologia Azienda Ospedaliera Universitaria Senese e Università di Siena Siena Italy
| | - Carla Filì
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari Azienda Sanitaria Universitaria Integrata Udine Italy
| | | | - Vincenzo Sammartano
- Unità di Ematologia Azienda Ospedaliera Universitaria Senese e Università di Siena Siena Italy
| | - Renato Fanin
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari Azienda Sanitaria Universitaria Integrata Udine Italy
| | | | - Anna Sicuranza
- Unità di Ematologia Azienda Ospedaliera Universitaria Senese e Università di Siena Siena Italy
| | - Silvia Imbergamo
- Ematologia ed Immunologia Clinica Azienda Ospedaliero‐Universitaria Padua Italy
| | - Marta Riva
- S.C. Ematologia, Dipartimento di Ematologia e Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano Niguarda Milan Italy
| | | | - Roberto Latagliata
- Ematologia‐Dipartimento di Biotecnologie Cellulari ed Ematologia Università Sapienza Rome Italy
| | - Emanuela Caizzi
- S. C. Ematologia Clinica, Ospedale Maggiore Azienda Sanitaria Universitaria Integrata Trieste Italy
| | - Francesco Mazziotta
- Dipartimento di Oncologia, dei Trapianti e delle Nuove Tecnologie, Sezione di Ematologia Università di Pisa Pisa Italy
| | - Giulia Alunni
- S.C. Oncoematologia con Autotrapianto, Dipartimento di Medicina e Specialità Mediche University of Perugia Perugia Italy
| | - Eros Di Bona
- Unità Operativa Ematologia Ospedale S. Bortolo Vicenza Italy
| | - Monica Crugnola
- Divisione di Ematologia Azienda Ospedaliero‐Universitaria di Parma Parma Italy
| | - Marianna Rossi
- S.O.S. Terapia Cellulare e Chemioterapia Alte Dosi Centro Riferimento Oncologico IRCCS Aviano Italy
| | - Ugo Consoli
- UOC Ematologia ARNAS Garibaldi Catania Italy
| | | | | | - Gianpaolo Nadali
- UOC Ematologia Azienda Ospedaliera Universitaria Integrata Verona Italy
| | | | - Elisabetta Todisco
- Divisione di Onco‐Ematologia IEO Istituto Europeo di Oncologia IRCCS Milan Italy
| | - Catia Bigazzi
- UOC Ematologia e Terapia Cellulare Ospedale C. e G. Mazzoni Ascoli Piceno Italy
| | | | | | - Massimo Bernardi
- UO Ematologia e Trapianto Midollo Osseo IRCCS Istituto Scientifico Universitario San Raffaele Milan Italy
| | - Monica Fumagalli
- UO Ematologia e CTA, ASST Monza Ospedale San Gerardo Monza Italy
| | - Michela Rondoni
- UOC Ematologia Azienda Unità Sanitaria Locale della Romagna Ravenna Italy
| | | | - Anna Ermacora
- UOC Medicina Interna Azienda Ospedaliera S. Maria Angeli Pordenone Italy
| | - Federico Simonetti
- UOC Ematologia Aziendale, Ospedale Versilia Azienda Toscana Nord‐Ovest Lucca Italy
| | - Michele Gottardi
- UOC Ematologia, Azienda ULSS9 Ospedale Ca' Foncello Treviso Italy
| | | | - Mariagrazia Michieli
- S.O.S. Terapia Cellulare e Chemioterapia Alte Dosi Centro Riferimento Oncologico IRCCS Aviano Italy
| | | | - Carlotta Galeone
- Dipartimento di Scienze Cliniche e di Comunità Università di Milano Milan Italy
| | - Claudio Pelucchi
- Dipartimento di Scienze Cliniche e di Comunità Università di Milano Milan Italy
| | - Giuseppe Rossi
- UO Ematologia ASST Spedali Civili di Brescia Brescia Italy
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28
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Rota M, Alicandro G, Pelucchi C, Bonzi R, Bertuccio P, Hu J, Zhang ZF, Johnson KC, Palli D, Ferraroni M, Yu GP, Galeone C, López-Carrillo L, Muscat J, Lunet N, Ferro A, Ye W, Plymoth A, Malekzadeh R, Zaridze D, Maximovitch D, Kogevinas M, Fernández de Larrea N, Vioque J, Navarrete-Muñoz EM, Tsugane S, Hamada GS, Hidaka A, Pakseresht M, Wolk A, Håkansson N, Hernández-Ramírez RU, López-Cervantes M, Ward M, Pourfarzi F, Mu L, Kurtz RC, Lagiou A, Lagiou P, Boffetta P, Boccia S, Negri E, La Vecchia C. Education and gastric cancer risk-An individual participant data meta-analysis in the StoP project consortium. Int J Cancer 2019; 146:671-681. [PMID: 30919464 DOI: 10.1002/ijc.32298] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/30/2019] [Accepted: 02/14/2019] [Indexed: 01/11/2023]
Abstract
Low socioeconomic position (SEP) is a strong risk factor for incidence and premature mortality from several cancers. Our study aimed at quantifying the association between SEP and gastric cancer (GC) risk through an individual participant data meta-analysis within the "Stomach cancer Pooling (StoP) Project". Educational level and household income were used as proxies for the SEP. We estimated pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) across levels of education and household income by pooling study-specific ORs through random-effects meta-analytic models. The relative index of inequality (RII) was also computed. A total of 9,773 GC cases and 24,373 controls from 25 studies from Europe, Asia and America were included. The pooled OR for the highest compared to the lowest level of education was 0.60 (95% CI, 0.44-0.84), while the pooled RII was 0.45 (95% CI, 0.29-0.69). A strong inverse association was observed both for noncardia (OR 0.39, 95% CI, 0.22-0.70) and cardia GC (OR 0.47, 95% CI, 0.22-0.99). The relation was stronger among H. pylori negative subjects (RII 0.14, 95% CI, 0.04-0.48) as compared to H. pylori positive ones (RII 0.29, 95% CI, 0.10-0.84), in the absence of a significant interaction (p = 0.28). The highest household income category showed a pooled OR of 0.65 (95% CI, 0.48-0.89), while the corresponding RII was 0.40 (95% CI, 0.22-0.72). Our collaborative pooled-analysis showed a strong inverse relationship between SEP indicators and GC risk. Our data call for public health interventions to reduce GC risk among the more vulnerable groups of the population.
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Affiliation(s)
- Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianfranco Alicandro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Italian National Institute of Statistics, Rome, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Rossella Bonzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Bertuccio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Jinfu Hu
- Harbin Medical University, Harbin, China
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kenneth C Johnson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO, Florence, Italy
| | - Monica Ferraroni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Guo-Pei Yu
- Medical Informatics Center, Peking University, Peking, China
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Joshua Muscat
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Penn Sylvania State University College of Medicine, Hershey, PA, USA
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Ana Ferro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - David Zaridze
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Dmitry Maximovitch
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Manolis Kogevinas
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,ISGlobal, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Nerea Fernández de Larrea
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Environmental and Cancer Epidemiology Unit, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Jesus Vioque
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Public Health, Miguel Hernandez University, FISABIO-ISABIAL, Alicante, Spain
| | - Eva M Navarrete-Muñoz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Public Health, Miguel Hernandez University, FISABIO-ISABIAL, Alicante, Spain
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | | | - Akihisa Hidaka
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Mohammadreza Pakseresht
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada.,Nutritional Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niclas Håkansson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Raúl Ulises Hernández-Ramírez
- Mexico National Institute of Public Health, Morelos, Mexico.,Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, CT, USA
| | | | - Mary Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Farhad Pourfarzi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Robert C Kurtz
- Department of Medicine, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Areti Lagiou
- Department of Public and Community Health, School of Health Sciences, University of West Attica, Egaleo, Greece
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Stefania Boccia
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia.,Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italia
| | - Eva Negri
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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29
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Zizzo M, Lococo F, Galeone C, Ugoletti L, Braglia L, Nachira D, Siciliani A, Margaritora S, Paci M, Pedrazzoli C. Long-term outcomes after surgical resection for synchronous or metachronous pulmonary and hepatic colorectal metastases. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.068] [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: 10/27/2022] Open
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30
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Bertuccio P, Alicandro G, Rota M, Pelucchi C, Bonzi R, Galeone C, Bravi F, Johnson KC, Hu J, Palli D, Ferraroni M, López‐Carrillo L, Lunet N, Ferro A, Malekzadeh R, Zaridze D, Maximovitch D, Vioque J, Navarrete‐Munoz EM, Pakseresht M, Hernández‐Ramírez RU, López‐Cervantes M, Ward M, Pourfarzi F, Tsugane S, Hidaka A, Zhang Z, Kurtz RC, Lagiou P, Lagiou A, Boffetta P, Boccia S, Negri E, La Vecchia C. Citrus fruit intake and gastric cancer: The stomach cancer pooling (StoP) project consortium. Int J Cancer 2019; 144:2936-2944. [PMID: 30521095 DOI: 10.1002/ijc.32046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Paola Bertuccio
- Department of Clinical Sciences and Community HealthUniversità degli Studi di Milano Milan Italy
| | - Gianfranco Alicandro
- Department of Clinical Sciences and Community HealthUniversità degli Studi di Milano Milan Italy
| | - Matteo Rota
- Department of Clinical Sciences and Community HealthUniversità degli Studi di Milano Milan Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community HealthUniversità degli Studi di Milano Milan Italy
| | - Rossella Bonzi
- Department of Clinical Sciences and Community HealthUniversità degli Studi di Milano Milan Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community HealthUniversità degli Studi di Milano Milan Italy
| | - Francesca Bravi
- Department of Clinical Sciences and Community HealthUniversità degli Studi di Milano Milan Italy
| | - Kenneth C. Johnson
- School of Epidemiology, Public Health and Preventive MedicineUniversity of Ottawa Ottawa ON Canada
| | - Jinfu Hu
- Harbin Medical University Harbin China
| | - Domenico Palli
- Cancer Risk Factors and Life‐Style Epidemiology UnitInstitute for Cancer Research, Prevention and Clinical Network ‐ ISPRO Florence Italy
| | - Monica Ferraroni
- Department of Clinical Sciences and Community HealthUniversità degli Studi di Milano Milan Italy
| | | | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação MédicaFaculdade de Medicina da Universidade do Porto Porto Portugal
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto Porto Portugal
| | - Ana Ferro
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto Porto Portugal
| | - Reza Malekzadeh
- Digestive Oncology Research CenterDigestive Disease Research Institute, Tehran University of Medical Sciences Tehran Iran
| | - David Zaridze
- Department of Epidemiology and PreventionRussian N.N. Blokhin Cancer Research Center Moscow Russia
| | - Dmitry Maximovitch
- Department of Epidemiology and PreventionRussian N.N. Blokhin Cancer Research Center Moscow Russia
| | - Jesus Vioque
- CIBER Epidemiologia y Salud Publica (CIBERESP) Madrid Spain
- Department of Public HealthMiguel Hernandez University, FISABIO‐ISABIAL Alicante Spain
| | - Eva M. Navarrete‐Munoz
- CIBER Epidemiologia y Salud Publica (CIBERESP) Madrid Spain
- Department of Public HealthMiguel Hernandez University, FISABIO‐ISABIAL Alicante Spain
| | - Mohammadreza Pakseresht
- Digestive Oncology Research CenterDigestive Disease Research Institute, Tehran University of Medical Sciences Tehran Iran
- Department of Agricultural, Food and Nutritional SciencesUniversity of Alberta Edmonton AB Canada
- Nutritional Epidemiology Group, Centre for Epidemiology and BiostatisticsUniversity of Leeds Leeds United Kingdom
| | - Raúl U. Hernández‐Ramírez
- Mexico National Institute of Public Health Morelos Mexico
- Department of BiostatisticsYale School of Public Health, Yale School of Medicine New Haven CT USA
| | - Malaquias López‐Cervantes
- Dirección General de Planeación y Desarrollo en SaludSecretaría de Salud. Coyoacán 1501 Ciudad de México Mexico
| | - Mary Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer Institute Rockville MD USA
| | - Farhad Pourfarzi
- Digestive Oncology Research CenterDigestive Disease Research Institute, Tehran University of Medical Sciences Tehran Iran
- Digestive Disease Research CenterArdabil University of Medical Sciences Ardabil Iran
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health SciencesNational Cancer Center Tokyo Japan
| | - Akihisa Hidaka
- Epidemiology and Prevention Group, Center for Public Health SciencesNational Cancer Center Tokyo Japan
| | - Zuo‐Feng Zhang
- Department of EpidemiologyUCLA Fielding School of Public Health and Jonsson, Comprehensive Cancer Center CA Los Angeles USA
| | - Robert C. Kurtz
- Department of MedicineMemorial Sloan Kettering Cancer Centre New York NY USA
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical StatisticsSchool of Medicine, National and Kapodistrian University of Athens Athens Greece
- Department of EpidemiologyHarvard T.H. Chan School of Public Health Boston MA USA
| | - Areti Lagiou
- Department of Public and Community HealthSchool of Health Sciences, University of West Attica Egaleo Greece
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai New York NY USA
| | - Stefania Boccia
- Università Cattolica del Sacro CuoreSezione di Igiene, Istituto di Sanità Pubblica Rome Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCSUOC Igiene Ospedaliera Rome Italia
| | - Eva Negri
- Department of Biomedical and Clinical SciencesUniversità degli Studi di Milano Milan Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community HealthUniversità degli Studi di Milano Milan Italy
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31
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Boeri M, Milione M, Proto C, Signorelli D, Lo Russo G, Galeone C, Verri C, Mensah M, Centonze G, Martinetti A, Sottotetti E, Pastorino U, Garassino MC, Sozzi G. Circulating miRNAs and PD-L1 Tumor Expression Are Associated with Survival in Advanced NSCLC Patients Treated with Immunotherapy: a Prospective Study. Clin Cancer Res 2019; 25:2166-2173. [PMID: 30617131 DOI: 10.1158/1078-0432.ccr-18-1981] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/18/2018] [Accepted: 01/03/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Immune-checkpoint inhibitors (ICI) have improved the survival of patients with non-small cell lung cancer (NSCLC). However, only a subset of patients benefit from ICIs, and the role of PD-L1 as predictive biomarker is still debated. A plasma immune-related miRNA-signature classifier (MSC) was established in lung cancer screening settings to identify the lethal form of the disease in early stages. In this exploratory study, we tested the efficacy of the MSC as prognostic marker in patients with advanced NSCLC treated with ICIs. EXPERIMENTAL DESIGN The MSC risk level was prospectively assessed in a consecutive series of 140 patients with NSCLC before starting treatment with ICIs. Overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) in strata of PD-L1 and MSC alone or combined were considered as endpoints. Multiple plasma samples to monitor MSC risk level during treatment were also profiled. RESULTS Adequate tissue and plasma samples were available from 111 (79%) and 104 (75%) patients with NSCLC, respectively. MSC risk level was associated with ORR (P = 0.0009), PFS [multivariate HR = 0.31; 95% confidence interval (CI), 0.17-0.56; P = 0.0001], and OS (multivariate HR = 0.33; 95% CI, 0.18-0.59; P = 0.0002). The combination of MSC and PD-L1 stratified patients into three risk groups having 39%-18%-0% 1-year PFS (P < 0.0001) and 88%-44%-0% 1-year OS (P < 0.0001), according to the presence of 2-1-0 favorable markers. During treatment, MSC risk level decreased or remained low until tumor progression in patients with responsive or stable disease. CONCLUSIONS The plasma MSC test could supplement PD-L1 tumor expression to identify a subgroup of patients with advanced lung cancer with worse ORR, PFS, and OS in immunotherapy regimens.
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Affiliation(s)
- Mattia Boeri
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Massimo Milione
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carla Verri
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mavis Mensah
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Centonze
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Clinical Research Lab (CRAB), Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonia Martinetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Sottotetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo Pastorino
- Unit of Thoracic Surgery, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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32
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Oliva F, Rugiero C, Giai Via A, Baldassarri M, Bernardi G, Biz C, Bossa M, Buda R, Buonocore D, Chianca V, Collina A, De Carli A, De Luna A, Di Lanno I, Di Lorenzo L, Di Pietto F, Dossena M, Fantoni I, Farsetti P, Fini M, Finotti P, Forte A, Foti C, Frizziero A, Gaj E, Galeone C, Gamberini J, Gasparini M, Innocenti B, Lupariello D, Mahmoud A, Marsilio E, Moretti B, Natali S, Padulo J, Pellicciari L, Perazzo L, Piccirilli E, Picerno P, Ruggeri P, Tarantino U, Vadalà A, Veronesi F, Verri M, Vetrano M, Vulpiani M, Zappia M, Maffulli N. I.S.Mu.L.T. Achilles tendon ruptures guidelines. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2018.03] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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]
Affiliation(s)
- F. Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Roma, Italy
| | - C. Rugiero
- Department of Orthopaedics and Traumatology, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - A. Giai Via
- Department of Orthopaedic and Traumatology, Hip Surgery Center, IRCCS San Donato Hospital, San Donato Milanese, Milan, Italy
| | - M. Baldassarri
- Department of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - G. Bernardi
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Roma, Italy
| | - C. Biz
- Orthopaedics Unit, Department of Surgical, Oncologic and Gastroenterological Sciences DiSCOG, University of Padua, Padua, Italy
| | - M. Bossa
- Department of Physical and Rehabilitation Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - R. Buda
- Department of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - D. Buonocore
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - V. Chianca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - A. Collina
- Department of Diagnostic Imaging, Campolongo Hospital, Eboli (SA), Italy
| | - A. De Carli
- Department of Orthopaedics and Traumatology, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - A.V. De Luna
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Roma, Italy
| | - I. Di Lanno
- Department of Diagnostic Imaging, Campolongo Hospital, Eboli (SA), Italy
| | - L. Di Lorenzo
- Department of Diagnostic Imaging, Campolongo Hospital, Eboli (SA), Italy
| | - F. Di Pietto
- Department of Diagnostic Imaging, AORNA, Cardarelli Hospital, Naples, Italy
| | - M. Dossena
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - I. Fantoni
- Orthopaedics Unit, Department of Surgical, Oncologic and Gastroenterological Sciences DiSCOG, University of Padua, Padua, Italy
| | - P. Farsetti
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Roma, Italy
| | - M. Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - P. Finotti
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy
| | - A.M. Forte
- Centre of Rehabilitation and Biomedical Research, Biomedical Research Center Gruppo Forte, Salerno, Italy
| | - C. Foti
- Department of Physical and Rehabilitation Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - A. Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy
| | - E. Gaj
- Department of Orthopaedics and Traumatology, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - C. Galeone
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - J. Gamberini
- Department of Physical and Rehabilitation Medicine, University of Padua, Padua, Italy
| | - M. Gasparini
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Roma, Italy
| | - B. Innocenti
- BEAMS Department (Bio Electro Mechanical System), ècole polytechnique de Bruxelles, Universitè Libre de Bruxelles, Brussels, Belgium
| | - D. Lupariello
- Department of Orthopaedics and Traumatology, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - A. Mahmoud
- Department of Physical and Rehabilitation Medicine, University of Rome "Tor Vergata", Rome, Italy
- Department of Physical Medicine, Rheumatology and Rehabilitation, University of Cairo "Ain Shams", Cairo, Egypt
| | - E. Marsilio
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Roma, Italy
| | - B. Moretti
- Department of Orthopaedics and Traumatology, Bari Hospital, Bari, Italy
| | - S. Natali
- Department of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - J. Padulo
- Sport Science, University e-Campus, Novedrate, Italy; Tunisian Laboratory of Research for Sporty Perfomance Optimization, National Center of Medicine and Sport Sciences, Tunis, Tunisia
| | - L. Pellicciari
- Department of Physical and Rehabilitation Medicine, University of Rome "Tor Vergata", Rome, Italy
- Sport Science, University e-Campus, Novedrate, Italy; Tunisian Laboratory of Research for Sporty Perfomance Optimization, National Center of Medicine and Sport Sciences, Tunis, Tunisia
| | - L. Perazzo
- Department of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - E. Piccirilli
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Roma, Italy
| | - P. Picerno
- Telematics University e-Campus, Novedrate, Italy
| | - P. Ruggeri
- Orthopaedics Unit, Department of Surgical Oncologic and Gastroenterogical Sciences DISCOG, University of Padua, Padua, Italy
| | - U. Tarantino
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Roma, Italy
| | - A. Vadalà
- Department of Orthopaedics and Traumatology, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - F. Veronesi
- Rizzoli Orthopaedic Institute, Bologna, Italy
| | - M. Verri
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - M. Vetrano
- Department of Physical and Rehabilitation Medicine, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - M.C. Vulpiani
- Department of Physical and Rehabilitation Medicine, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - M. Zappia
- Department of Medicine and Health Science, University of Molise, Campobasso, Italia; Varelli Institute, Naples, Italy
| | - N. Maffulli
- Department of Physical and Rehabilitation Medicine, San Giovanni di Dio e Ruggi d'Aragona Hospital, University of Salerno, Italy; University of London Queen Mary, Barts and the London School of Medicine Dentistry, Sport Medicine Center, Mile End Hospital, London, UK
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Guercio V, Donato F, Pelucchi C, Verga F, Passini V, Galeone C, Negri E, Garzaro G, Boffetta P, La Vecchia C, Tavani A, Pira E. Plasma levels of polychlorinated biphenyls (PCB) and the risk of soft tissue sarcoma. Med Lav 2019; 110:342-352. [PMID: 31659991 PMCID: PMC7810016 DOI: 10.23749/mdl.v110i5.8490] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/09/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Soft tissue sarcoma (STS) is a heterogeneous group of rare neoplasms whose aetiology is largely unknown. Dioxin and dioxin-like compounds, including 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD) and polychlorinated biphenyls (PCBs), are potential risk factors for STS. OBJECTIVES To investigate the relation of 17 PCBs congeners, assessed in human plasma, with STS risk. METHODS We conducted a case-control study in Italy, including 52 STS cases and 99 hospital-based controls. Selected PCB were extracted by high-performance liquid chromatography (HPLC) and measured with gas chromatography-mass spectrometry (GC-MS). Odds ratios (OR), and the corresponding 95% confidence intervals (CI), were estimated through multivariate logistic regression models. RESULTS The most frequently detected PCB congeners were 138, 170, 180 and 149 (detected in 40-77% of controls). The OR for the sum of all 17 PCB congeners was 1.20 (95% CI 0.50-2.92). In categorical analysis no consistent association was found for individual congeners and for groups based on Wolff's classification or the degree of chlorination. For continuous estimates, borderline positive associations emerged for Wolff's groups 2A (OR 1.23, 95% CI 0.97-1.55), 2B (OR 1.34, 95% CI 1.00-1.77, and 3 (OR 1.19, 95% CI 0.96-1.49), for moderately (OR 1.20, 95% CI 0.96-1.51) and highly (OR 1.18, 95% CI 0.99-1.41) chlorinated PCBs, and for congeners 170 (OR 1.26, 95% CI 0.98-1.63), 180 (OR 1.26, 95% CI 0.97-1.64) and 138 (OR 1.45, 95% CI 1.02-2.04). DISCUSSION Most associations between PCBs and STS risk were not significant, but, given the limited sample size, we cannot exclude moderate associations.
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Affiliation(s)
- Valentina Guercio
- Department of Biomedical and Clinical Sciences, Hospital L.Sacco, University of Milan, Milan, Italy
| | - Francesca Donato
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Verga
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Valter Passini
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eva Negri
- Department of Biomedical and Clinical Sciences, Hospital L.Sacco, University of Milan, Milan, Italy
| | - Giacomo Garzaro
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Paolo Boffetta
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandra Tavani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Enrico Pira
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
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Silva M, Prokop M, Jacobs C, Capretti G, Sverzellati N, Ciompi F, van Ginneken B, Schaefer-Prokop CM, Galeone C, Marchianò A, Pastorino U. Long-Term Active Surveillance of Screening Detected Subsolid Nodules is a Safe Strategy to Reduce Overtreatment. J Thorac Oncol 2018; 13:1454-1463. [PMID: 30026071 DOI: 10.1016/j.jtho.2018.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 02/07/2018] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Lung cancer presenting as subsolid nodule (SSN) can show slow growth, hence treating SSN is controversial. Our aim was to determine the long-term outcome of subjects with unresected SSNs in lung cancer screening. METHODS Since 2005, the Multicenter Italian Lung Detection (MILD) screening trial implemented active surveillance for persistent SSN, as opposed to early resection. Presence of SSNs was related to diagnosis of cancer at the site of SSN, elsewhere in the lung, or in the body. The risk of overall mortality and lung cancer mortality was tested by Cox proportional hazards model. RESULTS SSNs were found in 16.9% (389 of 2303) of screenees. During 9.3 ± 1.2 years of follow-up, the hazard ratio of lung cancer diagnosis in subjects with SSN was 6.77 (95% confidence interval: 3.39-13.54), with 73% (22 of 30) of cancers not arising from SSN (median time to diagnosis 52 months from SSN). Lung cancer-specific mortality in subjects with SSN was significantly increased (hazard ratio = 3.80; 95% confidence interval: 1.24-11.65) compared to subjects without lung nodules. Lung cancer arising from SSN did not lead to death within the follow-up period. CONCLUSIONS Subjects with SSN in the MILD cohort showed a high risk of developing lung cancer elsewhere in the lung, with only a minority of cases arising from SSN, and never representing the cause of death. These results show the safety of active surveillance for conservative management of SSN until signs of solid component growth and the need for prolonged follow-up because of high risk of other cancers.
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Affiliation(s)
- Mario Silva
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy; Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Colin Jacobs
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Giovanni Capretti
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Nicola Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Francesco Ciompi
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bram van Ginneken
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Cornelia M Schaefer-Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands; Department of Radiology, Meander Medical Center, Amersfoort, Netherlands
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alfonso Marchianò
- Department of Radiology, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
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Ferro A, Morais S, Rota M, Pelucchi C, Bertuccio P, Bonzi R, Galeone C, Zhang ZF, Matsuo K, Ito H, Hu J, Johnson KC, Yu GP, Palli D, Ferraroni M, Muscat J, Malekzadeh R, Ye W, Song H, Zaridze D, Maximovitch D, Fernández de Larrea N, Kogevinas M, Vioque J, Navarrete-Muñoz EM, Pakseresht M, Pourfarzi F, Wolk A, Orsini N, Bellavia A, Håkansson N, Mu L, Pastorino R, Kurtz RC, Derakhshan MH, Lagiou A, Lagiou P, Boffetta P, Boccia S, Negri E, La Vecchia C, Peleteiro B, Lunet N. Alcohol intake and gastric cancer: Meta-analyses of published data versus individual participant data pooled analyses (StoP Project). Cancer Epidemiol 2018; 54:125-132. [PMID: 29727805 DOI: 10.1016/j.canep.2018.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Individual participant data pooled analyses allow access to non-published data and statistical reanalyses based on more homogeneous criteria than meta-analyses based on systematic reviews. We quantified the impact of publication-related biases and heterogeneity in data analysis and presentation in summary estimates of the association between alcohol drinking and gastric cancer. METHODS We compared estimates obtained from conventional meta-analyses, using only data available in published reports from studies that take part in the Stomach Cancer Pooling (StoP) Project, with individual participant data pooled analyses including the same studies. RESULTS A total of 22 studies from the StoP Project assessed the relation between alcohol intake and gastric cancer, 19 had specific data for levels of consumption and 18 according to cancer location; published reports addressing these associations were available from 18, 5 and 5 studies, respectively. The summary odds ratios [OR, (95%CI)] estimate obtained with published data for drinkers vs. non-drinkers was 10% higher than the one obtained with individual StoP data [18 vs. 22 studies: 1.21 (1.07-1.36) vs. 1.10 (0.99-1.23)] and more heterogeneous (I2: 63.6% vs 54.4%). In general, published data yielded less precise summary estimates (standard errors up to 2.6 times higher). Funnel plot analysis suggested publication bias. CONCLUSION Meta-analyses of the association between alcohol drinking and gastric cancer tended to overestimate the magnitude of the effects, possibly due to publication bias. Additionally, individual participant data pooled analyses yielded more precise estimates for different levels of exposure or cancer subtypes.
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Affiliation(s)
- Ana Ferro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600, Porto, Portugal
| | - Samantha Morais
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600, Porto, Portugal
| | - Matteo Rota
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Paola Bertuccio
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Rossella Bonzi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hidemi Ito
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Jinfu Hu
- Department of Epidemiology, Harbin Medical University, Harbin, China
| | - Kenneth C Johnson
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Guo-Pei Yu
- Medical Informatics Center, Peking University, Peking, China
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | - Monica Ferraroni
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Joshua Muscat
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - David Zaridze
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Dmitry Maximovitch
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Nerea Fernández de Larrea
- Environmental and Cancer Epidemiology Unit, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Manolis Kogevinas
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Jesus Vioque
- Miguel Hernandez University and ISABIAL-FISABIO Foundation, Campus San Juan, Alicante, Spain
| | - Eva M Navarrete-Muñoz
- Miguel Hernandez University and ISABIAL-FISABIO Foundation, Campus San Juan, Alicante, Spain
| | - Mohammadreza Pakseresht
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada; Nutritional Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Farhad Pourfarzi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Digestive Diseases Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala Sweden
| | - Nicola Orsini
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Bellavia
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niclas Håkansson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Roberta Pastorino
- Section of Hygiene - Institute of Public Health; Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico "Agostino Gemelli", L.go F. Vito, 1 - 00168, Rome, Italy
| | - Robert C Kurtz
- Department of Medicine, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Mohammad H Derakhshan
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom; Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Areti Lagiou
- Department of Public Health and Community Health, School of Health Professions, Athens Technological Educational Institute, Athens, Greece
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefania Boccia
- Section of Hygiene - Institute of Public Health; Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico "Agostino Gemelli", L.go F. Vito, 1 - 00168, Rome, Italy
| | - Eva Negri
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
| | - Bárbara Peleteiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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Costanzo A, Malara G, Pelucchi C, Fatiga F, Barbera G, Franchi A, Galeone C. Effectiveness End Points in Real-World Studies on Biological Therapies in Psoriasis: Systematic Review with Focus on Drug Survival. Dermatology 2018; 234:1-12. [DOI: 10.1159/000488586] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/17/2018] [Indexed: 12/26/2022] Open
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Moro M, Bertolini G, Caserini R, Borzi C, Boeri M, Fabbri A, Leone G, Gasparini P, Galeone C, Pelosi G, Roz L, Sozzi G, Pastorino U. Author Correction: Establishment of patient derived xenografts as functional testing of lung cancer aggressiveness. Sci Rep 2018; 8:3965. [PMID: 29487345 PMCID: PMC5829074 DOI: 10.1038/s41598-018-21279-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.
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Affiliation(s)
- Massimo Moro
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Giulia Bertolini
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Caserini
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Borzi
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mattia Boeri
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Fabbri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giorgia Leone
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Pelosi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Roz
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Ugo Pastorino
- Thoracic Surgery Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Facciolongo N, Di Stefano A, Pietrini V, Galeone C, Bellanova F, Menzella F, Scichilone N, Piro R, Bajocchi GL, Balbi B, Agostini L, Salsi PP, Formisano D, Lusuardi M. Nerve ablation after bronchial thermoplasty and sustained improvement in severe asthma. BMC Pulm Med 2018; 18:29. [PMID: 29422039 PMCID: PMC5806286 DOI: 10.1186/s12890-017-0554-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/07/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Bronchial thermoplasty (BT) is a non-pharmacological intervention for severe asthma whose mechanism of action is not completely explained by a reduction of airway smooth muscle (ASM). In this study we analyzed the effect of BT on nerve fibers and inflammatory components in the bronchial mucosa at 1 year. METHODS Endobronchial biopsies were obtained from 12 subjects (mean age 47 ± 11.3 years, 50% male) with severe asthma. Biopsies were performed at baseline (T0) and after 1 (T1), 2 (T2) and 12 (T12) months post-BT, and studied with immunocytochemistry and microscopy methods. Clinical data including Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Questionnaire (ACQ) scores, exacerbations, hospitalizations, oral corticosteroids use were also collected at the same time points. RESULTS A statistically significant reduction at T1, T2 and T12 of nerve fibers was observed in the submucosa and in ASM compared to T0. Among inflammatory cells, only CD68 showed significant changes at all time points. Improvement of all clinical outcomes was documented and persisted at the end of follow up. CONCLUSIONS A reduction of nerve fibers in epithelium and in ASM occurs earlier and persists at one year after BT. We propose that nerve ablation may contribute to mediate the beneficial effects of BT in severe asthma. TRIAL REGISTRATION Registered on April 2, 2013 at ClinicalTrials.gov Identifier: NCT01839591 .
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Affiliation(s)
- N Facciolongo
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova - IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy.
| | - A Di Stefano
- Pulmunology Unit and Laboratory of Citoimmunopatology, Istituti Clinici Scientifici Maugeri SpA, SB, IRCCS, Veruno (NO), Italy
| | - V Pietrini
- Department of Neurosciences, Laboratory of Neuropathology, University of Parma, Parma, Italy
| | - C Galeone
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova - IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - F Bellanova
- Department of Neurosciences, Laboratory of Neuropathology, University of Parma, Parma, Italy
| | - F Menzella
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova - IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - N Scichilone
- Departement of Biomedicine and Medical Specialties, Pulmonology Unit, University of Palermo, Palermo, Italy
| | - R Piro
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova - IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - G L Bajocchi
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - B Balbi
- Pulmunology Unit and Laboratory of Citoimmunopatology, Istituti Clinici Scientifici Maugeri SpA, SB, IRCCS, Veruno (NO), Italy
| | - L Agostini
- Department of Medical Specialties, Pulmonology Unit, Arcispedale Santa Maria Nuova - IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - P P Salsi
- Anesthesiology and Critical Care Unit, Arcispedale Santa Maria Nuova -IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - D Formisano
- Research and Statistics, Arcispedale Santa Maria Nuova -IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - M Lusuardi
- Pulmonary Rehabilitation, S. Sebastiano Hospital, Correggio (RE), Azienda USL di Reggio Emilia, Reggio Emilia, Italy
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Silva M, Sverzellati N, Colombi D, Milanese G, La Vecchia C, Galeone C, Marchianò A, Pastorino U. Pleural plaques in lung cancer screening by low-dose computed tomography: prevalence, association with lung cancer and mortality. BMC Pulm Med 2017; 17:155. [PMID: 29178853 PMCID: PMC5702182 DOI: 10.1186/s12890-017-0506-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background To report the prevalence of pleural plaques in a lung cancer screening trial by low-dose computed tomography (LDCT) and to test the association with incidence of lung cancer and mortality. Methods The LDCT of 2303 screenees were retrospectively reviewed with the specific aim of describing the prevalence and features of pleural plaques. Self-administered questionnaire was used to assess asbestos exposure. Frequency of lung cancer, lung cancer mortality, and overall mortality were detailed according to presence of pleural findings. Statistical analyses included comparison of mean or median, contingency tables, and Cox model for calculation of hazard ratio (HR) and its 95% confidence interval (CI). Results Among male screenees, 31/1570 (2%) showed pleural abnormalities, 128/1570 (8.2%) disclosed asbestos exposure, 23/31 (74.2%) subjects with pleural plaques consistently denied exposure to asbestos. There was a trend for higher frequency of lung cancer among subjects with pleural plaques (9.7% vs 4.2%). Lung cancer in subjects with pleural plaques was always diagnosed in advanced stage. Subjects with pleural plaques showed HR 5.48 (95% CI 1.61–18.70) for mortality from lung cancer. Conclusions Pleural plaques are a risk factor for lung cancer mortality that can be detected in lung cancer screening by LDCT, also in subjects that are not aware of asbestos exposure. Trial registration NCT02837809 - Retrospectively registered July 1, 2016 - Enrolment of first participant September 2005.
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Affiliation(s)
- Mario Silva
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy. .,Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy.,Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Colombi
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy
| | - Gianluca Milanese
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy.,Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alfonso Marchianò
- Department of Radiology and Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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40
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Tenconi S, Galeone C, Fugazzaro S, Rapicetta C, Piro R, Formisano D. F-079PERIOPERATIVE AND LONG-TERM EFFECTS OF COMPREHENSIVE PULMONARY REHABILITATION ON EXERCISE CAPACITY, POSTOPERATIVE OUTCOME AND QUALITY OF LIFE IN PATIENTS UNDERGOING LUNG RESECTION: A RANDOMIZED CONTROLLED TRIAL GRANTED BY THE MINISTRY OF HEALTH. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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41
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Furia S, Cadenelli P, Andriani F, Scanagatta P, Duranti L, Spano A, Galeone C, Porcu L, Pastorino U. Autologous fat tissue grafting improves pulmonary healing after laser metastasectomy. Eur J Surg Oncol 2017; 43:2315-2323. [PMID: 29111365 DOI: 10.1016/j.ejso.2017.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/31/2017] [Accepted: 09/18/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Extensive clinical experience has demonstrated the potential usefulness of autologous fat tissue (AFT) graft in tissue reconstruction, repair or regeneration. In the present study, we evaluated the feasibility and safety of AFT in the repair of surgically injured lung surface. METHODS Eighty consecutive procedures of pulmonary metastasectomy by laser precision resection, were performed in 66 patients between March 2010 and December 2012. In the first 20 procedures, AFT graft was applied on the wounded pulmonary surface without closure of parenchymal surface. The following 40 procedures were carried on without AFT (20 leaving the resection margins open and 20 closing the resection margins with a running suture). In the remaining 20 procedures, AFT was applied and the resection margins closed. The efficacy of this technique was evaluated by comparing the AFT group with the non-AFT group, with respect to prolonged alveolar air leakage (PAAL), time to drain removal, length of hospital stay, and patient survival at four years. RESULTS The occurrence of PAAL was lower in the AFT group as compared to non-AFT group (17.5% versus 42.5%, p = 0.027), and median time to drain removal shorter (4 versus 6 days respectively, p = 0.016). Overall 4-year survival was 70% for AFT group, and 59% for non-AFT group (p = 0.34). CONCLUSIONS This prospective cohort observational study demonstrated the feasibility and safety of AFT pulmonary grafting after laser metastasectomy. AFT graft improved pulmonary healing, by reducing the incidence and severity of PAAL. Moreover, there was no evidence of tumor promotion in the metastatic setting, with a similar overall survival at 4 years.
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Affiliation(s)
| | | | - Francesca Andriani
- Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G.Venezian 1, 20133 Milan, Italy
| | | | | | - Andrea Spano
- Division of Plastic and Reconstructive Surgery, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via Privata Giuseppe La Masa, 19, 20156 Milan, Italy
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42
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Sestini S, Boeri M, Marchianò A, Silva M, Calareso G, Galeone C, Sozzi G, Pastorino U. [Lung cancer screening in high-risk subjects: early detection with LDCT and risk stratification using miRNA-based blood test]. Epidemiol Prev 2017; 40:42-50. [PMID: 26951732 DOI: 10.19191/ep16.1s1.p042.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lung cancer still remains a high mortality disease in the face of developments in diagnostic and therapeutic methods that occurred in the last 20 years. The analysis of the experiences from the first studies - in which chest X-ray (CXR) was adopted, associated or not with sputum cytology - has failed to show a reduction in lung cancer specific mortality. Subsequent screening studies that have introduced the use of low-dose computed tomography (LDCT) have revealed a large number of early-stage lung cancers, thus potentially curable; however, this has not allowed us to demonstrate a decrease in lung cancer-specific mortality. With the results of the American study National Lung ScreeningTrial (NLST), published in 2011, for the first time a lung cancer-specific mortality reduction by 20% thanks to the use of LDCT compared to RXT, was highlighted. However, a false discovery rate of 96.4% was also described with an overdiagnosis that can be up to 78.9% for bronchioalveolar lung cancer. Due to the high sensitivity of LDCT, able to identify a non-calcified pulmonary nodule in one subject on two, it becomes necessary to avail instruments to more accurately identify suspicious nodules. Until some time ago, the possible use of lung tumour markers was not viable in view of the poor organ specificity. The study and development was, then, pushed to organ- and tissue-specific markers such as microRNA (miRNA), noncoding RNA sequences involved in many processes and expression of oncogenic activity of the microenvironment. The use of biomarkers such as circulating miRNA implemented in LDCT screening has highlighted a reduction of 5 times for the rate of false positives, going from 19.4% to 3.7%, with a sensitivity of 87%, a specificity of 81%, and a negative predictive value of 99%. The need to appropriately use the available resources commensurate with the disease to treat will push more and more towards the implementation of LDCT biomarkers based screenings, stable and easily reproducible, as circulating miRNAs, obviating to problems such as false positives, unnecessary procedures of invasive surgery for benign lesions, and optimizing the cost benefit ratios.The development of new specific biomarkers appears to offer new promising prospects.
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Affiliation(s)
- Stefano Sestini
- Struttura complessa di chirurgia toracica, Fondazione IRCCS Istituto nazionale dei tumori, Milano
| | - Mattia Boeri
- Struttura complessa di genomica tumorale, Dipartimento di oncologia sperimentale, Fondazione IRCCS Istituto nazionale dei tumori, Milano
| | - Alfonso Marchianò
- Dipartimento di diagnostica per immagini e radioterapia, Fondazione IRCCS Istituto nazionale dei tumori, Milano
| | - Mario Silva
- Dipartimento di scienze cliniche, Unità operativa di radiologia, Università di Parma
| | - Giuseppina Calareso
- Dipartimento di diagnostica per immagini e radioterapia, Fondazione IRCCS Istituto nazionale dei tumori, Milano
| | - Carlotta Galeone
- Dipartimento di statistica e metodi quantitativi, divisione di biostatistica, epidemiologia e salute pubblica, Unità di ricerca sanitaria e farmacoepidemiologia, Università degli Studi di Milano-Bicocca
| | - Gabriella Sozzi
- Struttura complessa di genomica tumorale, Dipartimento di oncologia sperimentale, Fondazione IRCCS Istituto nazionale dei tumori, Milano
| | - Ugo Pastorino
- Struttura complessa di chirurgia toracica, Fondazione IRCCS Istituto nazionale dei tumori, Milano.
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Rota M, Pelucchi C, Bertuccio P, Matsuo K, Zhang ZF, Ito H, Hu J, Johnson KC, Palli D, Ferraroni M, Yu GP, Muscat J, Lunet N, Peleteiro B, Ye W, Song H, Zaridze D, Maximovitch D, Guevara M, Fernández-Villa T, Vioque J, Navarrete-Muñoz EM, Wolk A, Orsini N, Bellavia A, Håkansson N, Mu L, Persiani R, Kurtz RC, Lagiou A, Lagiou P, Galeone C, Bonzi R, Boffetta P, Boccia S, Negri E, La Vecchia C. Alcohol consumption and gastric cancer risk-A pooled analysis within the StoP project consortium. Int J Cancer 2017; 141:1950-1962. [PMID: 28718913 DOI: 10.1002/ijc.30891] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/22/2017] [Accepted: 05/29/2017] [Indexed: 01/11/2023]
Abstract
An association between heavy alcohol drinking and gastric cancer risk has been recently reported, but the issue is still open to discussion and quantification. We investigated the role of alcohol drinking on gastric cancer risk in the "Stomach cancer Pooling (StoP) Project," a consortium of epidemiological studies. A total of 9,669 cases and 25,336 controls from 20 studies from Europe, Asia and North America were included. We estimated summary odds-ratios (ORs) and the corresponding 95% confidence intervals (CIs) by pooling study-specific ORs using random-effects meta-regression models. Compared with abstainers, drinkers of up to 4 drinks/day of alcohol had no increase in gastric cancer risk, while the ORs were 1.26 (95% CI, 1.08-1.48) for heavy (>4 to 6 drinks/day) and 1.48 (95% CI 1.29-1.70) for very heavy (>6 drinks/day) drinkers. The risk for drinkers of >4 drinks/day was higher in never smokers (OR 1.87, 95% CI 1.35-2.58) as compared with current smokers (OR 1.14, 95% CI 0.93-1.40). Somewhat stronger associations emerged with heavy drinking in cardia (OR 1.61, 95% CI 1.11-2.34) than in non-cardia (OR 1.28, 95% CI 1.13-1.45) gastric cancers, and in intestinal-type (OR 1.54, 95% CI 1.20-1.97) than in diffuse-type (OR 1.29, 95% CI 1.05-1.58) cancers. The association was similar in strata of H. pylori infected (OR = 1.52, 95% CI 1.16-2.00) and noninfected subjects (OR = 1.69, 95% CI 0.95-3.01). Our collaborative pooled-analysis provides definite, more precise quantitative evidence than previously available of an association between heavy alcohol drinking and gastric cancer risk.
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Affiliation(s)
- Matteo Rota
- Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Claudio Pelucchi
- Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Paola Bertuccio
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Jinfu Hu
- Department of Epidemiology, Harbin Medical University, Harbin, China
| | - Kenneth C Johnson
- School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, ON, Canada
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | - Monica Ferraroni
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Guo-Pei Yu
- Medical Informatics Center, Peking University, Peking, China
| | - Joshua Muscat
- Department of Public Health Sciences, Tobacco Center of Regulatory Science, Penn Sylvania State University College of Medicine, Hershey, PA
| | - Nuno Lunet
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal.,Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Bárbara Peleteiro
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal.,Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Zaridze
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Dmitry Maximovitch
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Marcela Guevara
- Public Health Institute of Navarra, IdiSNA, Pamplona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Tania Fernández-Villa
- Research Group on Gene-Environment Interactions (GIGAS), University of Leòn, Leòn, Spain
| | - Jesus Vioque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain.,Department of Public Health, Miguel Hernandez University, Campus San Juan, Alicante, Spain
| | - Eva M Navarrete-Muñoz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain.,Department of Public Health, Miguel Hernandez University, Campus San Juan, Alicante, Spain
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nicola Orsini
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Bellavia
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niclas Håkansson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, NY
| | - Roberto Persiani
- Department of Surgical Sciences, Division of General Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
| | - Robert C Kurtz
- Department of Medicine, Memorial Sloan Kettering Cancer Centre, NY
| | - Areti Lagiou
- Department of Public Health and Community Health, School of Health Professions, Athens Technological Educational Institute, Athens, Greece
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Rossella Bonzi
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, NY
| | - Stefania Boccia
- Section of Hygiene - Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli,", Rome, Italy
| | - Eva Negri
- Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Italy
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Moro M, Bertolini G, Caserini R, Borzi C, Boeri M, Fabbri A, Leone G, Gasparini P, Galeone C, Pelosi G, Roz L, Sozzi G, Pastorino U. Establishment of patient derived xenografts as functional testing of lung cancer aggressiveness. Sci Rep 2017; 7:6689. [PMID: 28751748 PMCID: PMC5532258 DOI: 10.1038/s41598-017-06912-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022] Open
Abstract
Despite many years of research efforts, lung cancer still remains the leading cause of cancer deaths worldwide. Objective of this study was to set up a platform of non-small cell lung cancer patient derived xenografts (PDXs) faithfully representing primary tumour characteristics and offering a unique tool for studying effectiveness of therapies at a preclinical level. We established 38 PDXs with a successful take rate of 39.2%. All models closely mirrored parental tumour characteristics although a selective pressure for solid patterns, vimentin expression and EMT was observed in several models. An increased grafting rate for tumours derived from patients with worse outcome (p = 0.006), higher stage (p = 0.038) and higher CD133+/CXCR4+/EpCAM− stem cell content (p = 0.019) was observed whereas a trend towards an association with SUVmax higher than 8 (p = 0.084) was detected. Kaplan Meier analyses showed a significantly worse (p = 0.0008) overall survival at 5 years in patients with grafted vs not grafted PDXs also after adjusting for tumour stage. Moreover, for 63.2% models, grafting was reached before clinical recurrence occurred. Our findings strengthen the relevance of PDXs as useful preclinical models closely reflecting parental patients tumours and highlight PDXs establishment as a functional testing of lung cancer aggressiveness and personalized therapies.
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Affiliation(s)
- Massimo Moro
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Giulia Bertolini
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Caserini
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Borzi
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mattia Boeri
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Fabbri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giorgia Leone
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Pelosi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Roz
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Tumor Genomics Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Ugo Pastorino
- Thoracic Surgery Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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45
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Mattavelli I, Patuzzo R, Torri V, Gallino G, Maurichi A, Lamera M, Valeri B, Bolzonaro E, Barbieri C, Tolomio E, Moglia D, Nespoli AM, Galeone C, Saw R, Santinami M. Prognostic factors in Merkel cell carcinoma patients undergoing sentinel node biopsy. Eur J Surg Oncol 2017; 43:1536-1541. [PMID: 28583789 DOI: 10.1016/j.ejso.2017.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Debate remains about prognostic factors in primary Merkel cell carcinoma (MCC). We investigated clinicopathological factors as determinants of survival in patients with MCC submitted to sentinel node biopsy. METHODS Sixty-four consecutive patients treated for a primary MCC were identified from a prospectively maintained database at Fondazione IRCCS Istituto Nazionale dei Tumori, Milan. Time to events outcome were described by product limit estimators and proportional hazards model was used to investigate the association between outcome and potential predictors. RESULTS The most common site of primary tumor was lower limbs (56.3%). The size of primary lesion was ≤2 cm in 67.2% of cases. Presence of residual disease after the diagnostic surgical excision was observed in 28% of cases. All patients received sentinel node biopsy (SNB) and a SN positivity was detected in 26.6%. The median follow up was 78 months. Disease recurrence occurred in 17 patients (26.6%). In the SN negative group 10 recurrences occurred (21.3%), whereas 7 (41.2%) were found in SN positive one. Nine patients SN negative (19.1%) died of disease and 3 (17.6%) among SN positive. SN status was not associated with survival (p = 0.78). Neither age, gender, size and site of primary tumor resulted predictors of patients' outcome. The presence of residual tumor in the specimen of the wide local excision, after the diagnostic surgical excision, was the only variable associated with survival (p = 0.03). CONCLUSIONS Presence of residual tumor in the specimen of the wide local excision is the main prognostic factor in MCC patients.
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Affiliation(s)
- I Mattavelli
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - R Patuzzo
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - V Torri
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - G Gallino
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - A Maurichi
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - M Lamera
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - B Valeri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - E Bolzonaro
- Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
| | - C Barbieri
- Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
| | - E Tolomio
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - D Moglia
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - A M Nespoli
- Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
| | - C Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - R Saw
- Division of Surgery Royal Prince Alfred Hospital and Melanoma Institute Australia, Sydney, Australia.
| | - M Santinami
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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46
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Galeone C, Pelucchi C, Barbera G, Citterio C, La Vecchia C, Franchi A. Crohn's disease in Italy: A critical review of the literature using different data sources. Dig Liver Dis 2017; 49:459-466. [PMID: 28109766 DOI: 10.1016/j.dld.2016.12.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Incidence and prevalence of Crohn's disease (CD) have increased during the last decades in several world areas. Italian data on CD are scattered between various administrative, educational and scientific sources, and findings are poorly summarized. AIMS We conducted a review focusing not only on prevalence and incidence of CD in Italy, but also on mortality, treatments, delayed diagnosis and hospitalization. METHODS In October 2015, we searched for quantitative epidemiological data of CD using PubMed/Medline, EMBASE, and the Cochrane Database of Systematic Reviews. We also conducted searches on selected web resources for databases and educational publications. RESULTS Sixteen studies reporting data on incidence of CD from Italy were found. Incidence rates of CD in the early 2010's in Italy were 3.5-4 cases per 100,000 inhabitants per year. Ten investigations provided data on CD prevalence, with large variability between Italian areas. Most studies considering data at two or more time points or across consecutive time periods reported increasing incidence or prevalence of CD. CONCLUSION This review of Italian epidemiological data indicates that CD incidence and prevalence are continuing to (moderately) increase. Diagnostic delay, treatments, hospitalization and surgery for CD in Italy were also reviewed and quantified, though information is somewhat limited.
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Affiliation(s)
- Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
| | | | | | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
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Leuzzi G, Galeone C, Taverna F, Suatoni P, Morelli D, Pastorino U. C-reactive protein level predicts mortality in COPD: a systematic review and meta-analysis. Eur Respir Rev 2017; 26:26/143/160070. [PMID: 28143876 DOI: 10.1183/16000617.0070-2016] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/06/2016] [Indexed: 12/12/2022] Open
Abstract
The prognostic role of baseline C-reactive protein (CRP) in chronic obstructive pulmonary disease (COPD) is controversial. In order to clarify this issue, we performed a systematic review and meta-analysis to assess the predictive effect of baseline CRP level in COPD patients. 15 eligible articles focusing on late mortality in COPD were included in our study. We performed a random-effects meta-analysis, and assessed heterogeneity and publication bias. We pooled hazard ratio (HR) estimates and their 95% confidence intervals on mortality for the comparison between the study-specific highest category of CRP level versus the lowest category. In overall analysis, elevated baseline CRP levels were significantly associated with higher mortality (HR 1.53, 95% CI 1.32-1.77, I2=68.7%, p<0.001). Similar results were observed across subgroups. However, higher mortality risk was reported in studies using a cut-off value of 3 mg·L-1 (HR 1.61, 95% CI 1.12-2.30) and in those enrolling an Asiatic population (HR 3.51, 95% CI 1.69-7.31). Our analysis indicates that baseline high CRP level is significantly associated with higher late mortality in patients with COPD. Further prospective controlled studies are needed to confirm these data.
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Affiliation(s)
- Giovanni Leuzzi
- Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Carlotta Galeone
- Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Taverna
- Immunohematology and Transfusion Medicine Service, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Paola Suatoni
- Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Daniele Morelli
- Dept of Pathology and Laboratory Medicine, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
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Girelli L, Locati L, Galeone C, Scanagatta P, Duranti L, Licitra L, Pastorino U. Lung metastasectomy in adenoid cystic cancer: Is it worth it? Oral Oncol 2016; 65:114-118. [PMID: 28341276 DOI: 10.1016/j.oraloncology.2016.10.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Adenoid cystic carcinoma (ACC) of salivary glands is characterized by long-term distant metastasis, most commonly in lungs. No agreement has been reached about the role of surgical treatment of pulmonary lesions. We evaluated the long-term results of lung metastasectomy for ACC in order to identify factors that should be taken into account in selecting patients eligible for surgery and treatment planning. PATIENTS AND METHODS A retrospective study was conducted on 109 patients selected from our institutional experience and from the International Registry of Lung Metastases. Survival was calculated by Kaplan-Meier estimate and prognostic factors endowed with a predictive power for most other metastatic cancers were investigated. RESULTS The cumulative survival was 66.8% at 5years and 40.5% at 10years. In patients with a disease-free interval (DFI) greater than 36months, the overall survival was 76.5% at 5years. Survival in case of complete surgical resection was 69.5% at 5years. Multivariate analysis confirmed DFI and completeness of resection resulted in the best prognostic variables. DISCUSSION Lung metastasectomy should be considered as a therapeutic option to achieve local control of disease when 2 conditions are met: (1) complete surgical resection is feasible and (2) the time to pulmonary relapse after primary tumor treatment is greater than 36months. Symptomatic benefits of an incomplete lung resection in slow-growing tumors such as ACC remain uncertain. The turning point in the management of disseminated cancers will be clarified with biological profiling of ACC and the development of targeted therapies.
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Affiliation(s)
- Lara Girelli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Laura Locati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; Medical Oncology Unit/Head and Neck Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlotta Galeone
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Paolo Scanagatta
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Leonardo Duranti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; Medical Oncology Unit/Head and Neck Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo Pastorino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milan, Italy; Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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49
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Tognoli E, Luigi Giuseppe Leoni M, Morelli D, Sottotetti E, Martinetti A, Signoroni S, Galeone C, Gallino G. Serum soluble urokinase-type plasminogen activator receptor as a serum marker of inflammatory response that leads to tissue damage and surgical complication. Wound Repair Regen 2016; 24:1036-1040. [PMID: 27759946 DOI: 10.1111/wrr.12493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 10/02/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
Abstract
Unrestrained activation of the proteolytic systems in anastomotic tissue during repair has been implicated in the pathogenesis of anastomotic leakage. We hypothesized that this mechanism may promote an up-regulation of the urokinase-type plasminogen activator system and a spillover of soluble urokinase-type plasminogen activator receptor (suPAR) into blood. In this retrospective analysis patients with anastomotic leakage were compared with a group of matched uncomplicated patients. Anastomotic leakage complicated patients had significantly higher suPAR (p = 0.04) levels until day 3 after surgery. The area under the receiver-operating characteristic (ROC) for suPAR was higher than that CRP (0.874 vs. 0.836). Their analysis suggests the possible use of suPAR as serum marker to characterize the persistent inflammatory response that lead to tissue damage and surgical complication.
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Affiliation(s)
- Emiliano Tognoli
- Department of Anesthesia, Intensive Care and Palliative Care, Istituto Nazionale Tumori, IRCCS Foundation
| | - Matteo Luigi Giuseppe Leoni
- Department of Anesthesia, Intensive Care and Palliative Care, Istituto Nazionale Tumori, IRCCS Foundation.,Department of Pathophysiology and Transplantation, University of Milan
| | - Daniele Morelli
- Department of Pathology and Laboratory Medicine, Istituto Nazionale Tumori, IRCCS Foundation
| | - Elisa Sottotetti
- Medical Oncology Department, Istituto Nazionale Tumori, IRCCS Foundation
| | - Antonia Martinetti
- Medical Oncology Department, Istituto Nazionale Tumori, IRCCS Foundation
| | - Stefano Signoroni
- Department of Preventive and Predictive Medicine, Unit of Hereditary Digestive Tract Tumors, Istituto Nazionale Tumori, IRCCS Foundation
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, and
| | - Gianfranco Gallino
- Department of Surgery, Istituto Nazionale Tumori, IRCCS Foundation, Milan, Italy
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Lococo F, Rapicetta C, Formisano D, Galeone C, Filice A, Fioroni F, Bellafiore S, Ricchetti T, Taddei S, Paci M. F-03718-F FDG PET/CT SCAN IN SOLID-TYPE STAGE-I PULMONARY ADENOCARCINOMAS: WHAT CAUSES FALSE-NEGATIVE CASES? Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.37] [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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