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Carnovale C, Battini V, Santoro C, Riccio MP, Carucci S, Nobile M, Formisano P, Bravaccio C, Zuddas A, Clementi E, Pozzi M, Pisano S. Umbrella Review: Association Between Antipsychotic Drugs and Metabolic Syndrome Hallmarks in Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2024; 63:313-335. [PMID: 37391174 DOI: 10.1016/j.jaac.2023.04.018] [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: 02/01/2022] [Revised: 04/04/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To summarize the available evidence on metabolic parameters indicating metabolic adverse effects and risk of metabolic syndrome in children and adolescents treated with antipsychotics, following a pre-specified protocol (PROSPERO ID 252336). METHOD We searched PubMed, Embase and PsycINFO until May 14, 2021, to identify systematic reviews (SR), meta-analyses (MA) and network meta-analyses (NMA) examining symptoms associated to metabolic syndrome in patients <18 years of age who required treatment with oral antipsychotic drugs. Evidence from quantitative analyses for all outcomes related to anthropometric, glyco-metabolic, and blood pressure parameters (measured from baseline to intervention-end and/or follow-up, in subjects exposed to antipsychotics and placebo) was reported on the basis of their metrics (median difference [medianD], mean difference [MD], standardized mean difference [SMD], odds ratio [OR], risk ratio ([RR]). A qualitative synthesis was also made. A formal quality assessment of the included studies was carried out by using the AMSTAR 2. We also provided a hierarchical stratification of the evidence from meta-analyses based on the class of evidence. RESULTS A total of 23 articles (13 MA, 4 NMA and 6 SR) were included for review. As compared with placebo, an increase in triglyceride levels was associated with olanzapine (medianD [95% CI]: 37 [12.27, 61.74] mg/dL; MD [95% CI]: 38.57 [21.44, 55.77] mg/dL) and quetiapine (medianD [95% CI]: 21.58 [95% CI]: 4.27, 38.31 mg/dL; MD [95% CI]: 34.87 [20.08, 49.67] mg/dL; SMD [95% CI]: 0.37 [0.06, 0.068]), whereas decreased triglyceride levels were found for lurasidone. Increased total cholesterol level was associated with asenapine (medianD [95% CI]: 9.1 [1.73, 16.44] mg/dL), quetiapine (medianD [95% CI]: 15.60 [7.30, 24.05] mg/dL; olanzapine (MD [95% CI] from 3.67 [1.43, 5.92] mg/dL to 20.47 [13.97, 26.94] mg/dL]; and lurasidone (medianD [95% CI]: 8.94 [1.27, 16.90] mg/dL). Change in glucose levels did not differ among antipsychotics or placebo. Lurasidone, molindone, and ziprasidone were the best tolerated in terms of weight gain. According to the AMSTAR 2 scoring system, 13 (56.5%) reviews were rated as very low quality. According to classes of evidence, most MA were level 4, especially because of their limited total sample size. CONCLUSION By collating meta-analyses assessing biochemical markers of metabolic syndrome in antipsychotic-treated children, we conclude that olanzapine should not be the antipsychotic of choice in patients at risk for hypertriglyceridemia or hypercholesterolemia. Aripiprazole and lurasidone appear to be better tolerated in terms of metabolic adverse events. Insufficient meta-analytic data are available to provide a precise risk estimate of metabolic syndrome, and, overall, the quality of evidence is low. STUDY REGISTRATION INFORMATION Association between the use of antipsychotic drugs and alterations of the parameters defining the Metabolic Syndrome (MetS) in children and adolescents: an umbrella review; https://www.crd.york.ac.uk/prospero/; CRD42021252336.
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Affiliation(s)
- Carla Carnovale
- "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Vera Battini
- "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Claudia Santoro
- Università degli Studi della Campania "Luigi Vanvitelli", Italy
| | | | - Sara Carucci
- University of Cagliari, Cagliari, Italy, and "A.Cao" Pediatric Hospital, Cagliari, Italy
| | - Maria Nobile
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | | | | | - Alessandro Zuddas
- University of Cagliari, Cagliari, Italy, and "A.Cao" Pediatric Hospital, Cagliari, Italy
| | - Emilio Clementi
- "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy; Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy.
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Riccio S, Marzuillo P, Santoro C. Do proton pump inhibitors reduce gastrointestinal complication when starting long-term non-steroidal anti-inflammatory drugs therapy? Arch Dis Child 2024; 109:167-169. [PMID: 37827812 DOI: 10.1136/archdischild-2023-326141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/23/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Simona Riccio
- Department of Women's and Children's Health and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pierluigi Marzuillo
- Department of Women's and Children's Health and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Claudia Santoro
- Department of Women's and Children's Health and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
- Clinic of Child and Adolescent Neuropsychiatry, Departments of Physical and Mental Health, and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Chistolini A, Serrao A, Assanto GM, Genoese A, Baldacci E, Ligia S, Breccia M, Santoro C. Antithrombotic secondary prophylaxis with low dose of apixaban or rivaroxaban in the onco-hematologic patients: comparison with non-neoplastic patients. Ann Hematol 2023; 102:2599-2605. [PMID: 37479891 DOI: 10.1007/s00277-023-05369-1] [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] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
Management of cancer-associated thrombosis (CAT) is usually performed employing low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs). Low-intensity DOACs are the mainstay for extended duration therapy for VTE in non-oncologic patients. The aim of our study was to evaluate the efficacy and the safety of low doses of apixaban or rivaroxaban as secondary prophylaxis in patients affected by hematological malignancies with follow-up > 12 months. We report an observational, retrospective, single-center study that evaluated consecutive patients referred to our center between January 2016 and January 2023. The DOACs were administered at full dose during the acute phase of VTE and then at low dose for the extended phase. We included 154 patients: 53 patients affected by hematological malignancies compared to 101 non-neoplastic patients. During full-dose treatment, no thrombotic recurrences were observed in the two groups. During low-dose therapy, 2 (1.9%) thrombotic events (tAE) were observed in the control group. During full-dose treatment, the rate of bleeding events (bAE) was 9/154 (5.8%): 6/53 (11%) in hematological patients and 3/101 (2.9%) in non-hematological patients (p = 0.0003). During low-dose therapy, 4/154 (2.6%) bAE were observed: 3/53 (5.5%) in the hematologic group and 1 (1%) in the control group (p = 0.07). We found encouraging data on the safety and efficacy of low doses of DOACs as secondary prophylaxis in the onco-hematologic setting; no thrombotic complications were observed, and the incidence of hemorrhagic events was low.
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Affiliation(s)
- A Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy.
| | - A Serrao
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - G M Assanto
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - A Genoese
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - S Ligia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - M Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
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Carotenuto M, Messina G, Esposito M, Santoro C, Iacono D, Spruyt K. Polysomnographic study in pediatric neurofibromatosis type 1. Front Neurol 2023; 14:1213430. [PMID: 37538252 PMCID: PMC10394094 DOI: 10.3389/fneur.2023.1213430] [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: 04/27/2023] [Accepted: 06/29/2023] [Indexed: 08/05/2023] Open
Abstract
Background Neurofibromatosis type 1 (NF1) is a genetic disease that alters neurodevelopment. We aimed to analyze the sleep macrostructure of a sample of children affected by NF1 without neurocognitive co-morbidities and MRI reports of unidentified bright objects (UBOs). Methods A 100 pre-pubertal children participated in the cross-sectional study: 50 subjects were children diagnosed with NF1 and 50 subjects were typically developing healthy children (TDC). All participants underwent polysomnographic evaluation through which conventional sleep parameters were collected: Total sleep time (TST), Sleep latency (SOL), first REM latency (FRL), number of stage shifts/h (SS/h), number of awakenings/h (AWN/h), wake after sleep onset (WASO%), sleep efficiency percentage (SE%), percentage of sleep time spent in sleep stages 1 (N1%) and 2 (N2%), slow-wave sleep (N3%), and REM sleep (REM%). Additionally, nocturnal respiratory events such as apnea/hypopnea index (AHI), oxygen desaturation index (ODI), and periodic limb movement index (PLMI) were recorded. Results Neurofibromatosis type 1 children showed a reduction in sleep duration parameters (TST; p < 0.001), sleep efficiency (SE%; p < 0.001), and stage N2% (p < 0.001). Moreover, the number of awakenings per hour (AWN/h), wake after sleep onset (WASO%), and respiratory events such as AHI, ODI, and PLMI resulted higher in NF1 vs. TDC children. Conclusion The data showed that the sleep macrostructure differs between NF1 and TDC children. These findings suggest that the evaluation of sleep may provide useful support in corroborating the diagnosis and offers additional therapeutic management perspectives in NF1 and genetic neurodevelopmental disorders in general.
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Affiliation(s)
- Marco Carotenuto
- Sleep Lab for Developmental Age, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Clinic, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maria Esposito
- Sleep Lab for Developmental Age, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Clinic, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudia Santoro
- Sleep Lab for Developmental Age, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Clinic, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Women's and Children's Health, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Diego Iacono
- Neuropathology Research, Biomedical Research Institute of New Jersey, BRInj, Cedar Knolls, NJ, United States
- Department of Pediatrics, Neuropathology Research, Mid-Atlantic Neonatology Associates (MANA), Atlantic Health System (AHS), Morristown, NJ, United States
| | - Karen Spruyt
- NeuroDiderot INSERM, Université de Paris, Paris, France
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Ligia S, Musiu P, Serrao A, Santoro C, Taglietti A, Capriata M, Faccini A, Molinari MC, Baldacci E, Chistolini A. Low-dose apixaban or rivaroxaban as secondary prophylaxis of upper extremity deep vein thrombosis. J Thromb Thrombolysis 2023:10.1007/s11239-023-02842-6. [PMID: 37341894 DOI: 10.1007/s11239-023-02842-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
Upper extremity deep vein thrombosis (UEDVT) may occur without inciting factor or may be secondary to malignancy, surgery, trauma, central venous catheter or related to thoracic outlet syndrome (TOS). International guidelines recommend anticoagulant treatment for at least three months, in particular the use of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). No data on extended anticoagulant therapy and reduced dose of DOACs have been reported in patients affected by UEDVT with persistent thrombotic risk (active cancer, major congenital thrombophilia) or without affected vein recanalization. In our retrospective observational study, including 43 patients, we treated secondary UEDVT with DOACs. In the acute phase of thrombosis (median time of 4 months), we used therapeutic dose of DOACs; the 32 patients with permanent thrombotic risk factors or without recanalization of the UEDVT were shifted to low-dose DOACs (apixaban 2.5 mg twice daily or rivaroxaban 10 mg daily). During therapy with full-dose DOACs, 1 patient presented recurrence of thrombosis; no thromboembolic events were observed during treatment with low-dose DOACs. During full-dose treatment, 3 patients presented minor hemorrhagic complications; no hemorrhagic events were observed during DOACs at low dose. We think our preliminary data could support the indication to extend the anticoagulation with dose reduction of DOACs in patients affected by UEDVT and no-transient thrombotic risk. These data should be confirmed in randomized controlled prospective study.
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Affiliation(s)
- S Ligia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - P Musiu
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Serrao
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Taglietti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - M Capriata
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Faccini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - M C Molinari
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy.
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Cavallo ND, Maggi G, Ferraiuolo F, Sorrentino A, Perrotta S, Carotenuto M, Santangelo G, Santoro C. Neuropsychiatric Manifestations, Reduced Self-Esteem and Poor Quality of Life in Children and Adolescents with Neurofibromatosis Type 1 (NF1): The Impact of Symptom Visibility and Bullying Behavior. Children (Basel) 2023; 10:children10020330. [PMID: 36832459 PMCID: PMC9955783 DOI: 10.3390/children10020330] [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] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant condition, associated with neurocutaneous manifestations and neuropsychiatric manifestations. The present study explored the prevalence of bullying/cyberbullying behaviors and victimization behaviors in a cohort of children and adolescents with NF1. Possible gender differences and predictors of psychological symptoms, quality of life (QoL), and self-esteem were also examined. Thirty-eight school-aged participants with NF1 completed a psychological evaluation designed to assess anxiety and depression symptomatology, QoL, self-esteem, and the prevalence and extent of bullying/cyberbullying and victimization behaviors. We found that our participants frequently reported victimization behaviors rather than bullying/cyberbullying ones. Moreover, participants complained of depressive and anxiety symptomatology together with reduced self-esteem, and low psychosocial quality of life, with females reporting more severe performances than males. Furthermore, we found that reduced self-esteem was associated with more visibility of the NF1 symptoms, and victimization behaviors were found to mediate the relationship between anxiety and psychosocial QoL. Our findings indicated the presence of a maladaptive loop in children and adolescents with NF1 patients characterized by psychological symptoms, unfavorable self-perception, low self-esteem, and psychosocial difficulties that might be worsened by experiencing victimization behaviors. These results suggest the need to use a multidisciplinary approach in the diagnosis and treatment of NF1.
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Affiliation(s)
- Nicola Davide Cavallo
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Gianpaolo Maggi
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Francesco Ferraiuolo
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Anna Sorrentino
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Silverio Perrotta
- Department of Women’s and Children’s Health, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Marco Carotenuto
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Clinic, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
- Correspondence:
| | - Claudia Santoro
- Department of Women’s and Children’s Health, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Clinic, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
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Santoro C, Boccia R, Iovino C, Piluso G, Perrotta S, Simonelli F. Patients carrying Arg1809 substitution with no choroidal abnormalities: a further proof of a "Quasi-Incomplete" NF1 phenotype. Eur J Hum Genet 2023; 31:136-137. [PMID: 36404348 PMCID: PMC9905567 DOI: 10.1038/s41431-022-01236-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Claudia Santoro
- Child and Adolescent Neuropsychiatry Clinic, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Italy.
- Department of Women's and Children's Health, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy.
| | - Rosa Boccia
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80132, Napoli, Italy.
| | - Claudio Iovino
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80132, Napoli, Italy
| | - Giulio Piluso
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 7, 80138, Naples, Italy
| | - Silverio Perrotta
- Department of Women's and Children's Health, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via De Crecchio 4, 80138, Naples, Italy
| | - Francesca Simonelli
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80132, Napoli, Italy
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Spitaleri G, Trillo Aliaga P, Catania C, Signore ED, Attili I, Santoro C, Giugliano F, Berton Giachetti PPM, Curigliano G, Passaro A, de Marinis F. Safety of mRNA-COVID-19 Vaccines in Patients With Thoracic Cancers. Clin Lung Cancer 2023; 24:e19-e26. [PMID: 36372676 PMCID: PMC9584758 DOI: 10.1016/j.cllc.2022.10.004] [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] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pivotal trials of COVID-19 vaccines did not include cancer patients with questions remaining in this population. Particularly in patients with thoracic malignancies receiving anticancer treatments, the safety of these vaccines has so far been little investigated. METHODS This is a prospective trial of patients with thoracic cancer receiving anticancer treatments and COVID-19 vaccines at the Division of Thoracic Oncology of European Institute of Oncology between February and September 2021. RESULTS A total 207 patients affected by thoracic cancers (199 lung cancers and 8 mesotheliomas) had received Covid-19 vaccines (206 mRNA vaccines and 1 virus-vectored vaccine). The majority of patients had at least one comorbidity (76.3%). They were concomitantly treating with targeted therapy (TT) (45.9%), immunotherapy (IO) (22.7%), and chemotherapy (CT) (14%). A total of 64 AEs (15.6%) were observed after administration of Sars-Cov-2 vaccine. The majority of AEs were grade 1 [G1] (6.3%) and G2 (8.8%), only two events were G3 (0.5%). The median follow-up was 9 months (range 1-22 months), during this follow-up 21 patients (10.1%) had a positive nasal swab, most of the patients were asymptomatic (67%) and the symptomatic ones (33%) had mild symptoms and fewer complications and hospitalizations. CONCLUSIONS COVID-19 m-RNA vaccines appear to be safe in the cohort of patients with thoracic malignances in active treatment, including those receiving immunotherapy. Considering the high morbidity and mortality associated with COVID-19 in patients with lung cancer receiving active treatments, our study supports the current vaccine prioritization, third and/or fourth dose, of all cancer patients with active treatment.
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Affiliation(s)
- G Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - P Trillo Aliaga
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - I Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Santoro
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - F Giugliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - P P M Berton Giachetti
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - G Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - A Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Paterra R, Bettinaglio P, Borghi A, Mangano E, Tritto V, Cesaretti C, Schettino C, Bordoni R, Santoro C, Avignone S, Moscatelli M, Melone MAB, Saletti V, Piluso G, Natacci F, Riva P, Eoli M. A Translational Approach to Spinal Neurofibromatosis: Clinical and Molecular Insights from a Wide Italian Cohort. Cancers (Basel) 2022; 15:cancers15010059. [PMID: 36612057 PMCID: PMC9817775 DOI: 10.3390/cancers15010059] [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: 11/04/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Spinal neurofibromatosis (SNF), a phenotypic subclass of neurofibromatosis 1 (NF1), is characterized by bilateral neurofibromas involving all spinal roots. In order to deepen the understanding of SNF’s clinical and genetic features, we identified 81 patients with SNF, 55 from unrelated families, and 26 belonging to 19 families with at least 1 member affected by SNF, and 106 NF1 patients aged >30 years without spinal tumors. A comprehensive NF1 mutation screening was performed using NGS panels, including NF1 and several RAS pathway genes. The main features of the SNF subjects were a higher number of internal neurofibromas (p < 0.001), nerve root swelling (p < 0.001), and subcutaneous neurofibromas (p = 0.03), while hyperpigmentation signs were significantly less frequent compared with the classical NF1-affected cohorts (p = 0.012). Fifteen patients underwent neurosurgical intervention. The histological findings revealed neurofibromas in 13 patients and ganglioneuromas in 2 patients. Phenotypic variability within SNF families was observed. The proportion of missense mutations was higher in the SNF cases than in the classical NF1 group (21.40% vs. 7.5%, p = 0.007), conferring an odds ratio (OR) of 3.34 (CI = 1.33−10.78). Two unrelated familial SNF cases harbored in trans double NF1 mutations that seemed to have a subclinical worsening effect on the clinical phenotype. Our study, with the largest series of SNF patients reported to date, better defines the clinical and genetic features of SNF, which could improve the management and genetic counseling of NF1.
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Affiliation(s)
- Rosina Paterra
- Molecular Neuroncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20122 Milano, Italy
| | - Paola Bettinaglio
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Segrate, 20122 Milan, Italy
| | - Arianna Borghi
- Molecular Neuroncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20122 Milano, Italy
| | - Eleonora Mangano
- Institute of Biomedical Technologies (ITB) National Research Center (CNR), ITB-CNR, Segrate, 20122 Milan, Italy
| | - Viviana Tritto
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Segrate, 20122 Milan, Italy
| | - Claudia Cesaretti
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Carla Schettino
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and InterUniversity Center for Research in Neurosciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Roberta Bordoni
- Institute of Biomedical Technologies (ITB) National Research Center (CNR), ITB-CNR, Segrate, 20122 Milan, Italy
| | - Claudia Santoro
- Neurofibromatosis Referral Center, Department of Woman, Child and of General and Specialized Surgery, and Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Sabrina Avignone
- Neuroradiology Department, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Marco Moscatelli
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Mariarosa Anna Beatrice Melone
- Department of Advanced Medical and Surgical Sciences, 2nd Division of Neurology, Center for Rare Diseases and InterUniversity Center for Research in Neurosciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Temple University, Philadelphia, PA 19122, USA
| | - Veronica Saletti
- Developmental Neurology Unit, Mariani Foundation Center for Complex Disabilities, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giulio Piluso
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Federica Natacci
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Paola Riva
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Segrate, 20122 Milan, Italy
- Correspondence: (P.R.); (M.E.); Tel.: +39-02-503130462 (P.R.); +39-02-23942285 (M.E.)
| | - Marica Eoli
- Molecular Neuroncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20122 Milano, Italy
- Correspondence: (P.R.); (M.E.); Tel.: +39-02-503130462 (P.R.); +39-02-23942285 (M.E.)
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Attili I, Valenza C, Santoro C, Antonarelli G, Trillo Aliaga P, Del Signore E, Catania C, Spitaleri G, Passaro A, de Marinis F. 42P Comparative real-world analysis of pembrolizumab plus chemo vs platinum-doublet alone in metastatic non-squamous NSCLC with PD-L1 low. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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De Martino L, Picariello S, Triarico S, Improda N, Spennato P, Capozza MA, Grandone A, Santoro C, Cioffi D, Attinà G, Cinalli G, Ruggiero A, Quaglietta L. Diencephalic Syndrome Due to Optic Pathway Gliomas in Pediatric Patients: An Italian Multicenter Study. Diagnostics (Basel) 2022; 12:diagnostics12030664. [PMID: 35328218 PMCID: PMC8947184 DOI: 10.3390/diagnostics12030664] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/31/2022] [Revised: 02/19/2022] [Accepted: 03/02/2022] [Indexed: 02/07/2023] Open
Abstract
Diencephalic syndrome (DS) is a rare pediatric condition associated with optic pathway gliomas (OPGs). Since they are slow-growing tumors, their diagnosis might be delayed, with consequences on long-term outcomes. We present a multicenter case series of nine children with DS associated with OPG, with the aim of providing relevant details about mortality and long-term sequelae. We retrospectively identified nine children (6 M) with DS (median age 14 months, range 3–26 months). Four patients had NF1-related OPGs. Children with NF1 were significantly older than sporadic cases (median (range) age in months: 21.2 (14–26) versus 10 (3–17); p = 0.015). Seven tumors were histologically confirmed as low-grade astrocytomas. All patients received upfront chemotherapy and nutritional support. Although no patient died, all of them experienced tumor progression within 5.67 years since diagnosis and were treated with several lines of chemotherapy and/or surgery. Long-term sequelae included visual, pituitary and neurological dysfunction. Despite an excellent overall survival, PFS rates are poor in OPGs with DS. These patients invariably present visual, neurological or endocrine sequelae. Therefore, functional outcomes and quality-of-life measures should be considered in prospective trials involving patients with OPGs, aiming to identify “high-risk” patients and to better individualize treatment.
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Affiliation(s)
- Lucia De Martino
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy; (L.D.M.); (S.P.)
| | - Stefania Picariello
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy; (L.D.M.); (S.P.)
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, via L. De Crecchio n° 2, 80138 Naples, Italy; (A.G.); (C.S.)
| | - Silvia Triarico
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy; (S.T.); (G.A.); (A.R.)
| | - Nicola Improda
- Emergency Unit, Department of Emergency, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy;
- Section of Pediatrics, Department of Translational and Medical Sciences, University Federico II, via S. Pansini n° 5, 80138 Naples, Italy
| | - Pietro Spennato
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy; (P.S.); (G.C.)
| | - Michele Antonio Capozza
- Pediatric Oncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children’s Hospital, via Posillipo n° 226, 80123 Naples, Italy;
| | - Anna Grandone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, via L. De Crecchio n° 2, 80138 Naples, Italy; (A.G.); (C.S.)
| | - Claudia Santoro
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, via L. De Crecchio n° 2, 80138 Naples, Italy; (A.G.); (C.S.)
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, via L. De Crecchio n° 2, 80138 Naples, Italy
| | - Daniela Cioffi
- Pediatric Endocrinology Unit, Department of Pediatrics, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy;
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy; (S.T.); (G.A.); (A.R.)
| | - Giuseppe Cinalli
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy; (P.S.); (G.C.)
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy; (S.T.); (G.A.); (A.R.)
| | - Lucia Quaglietta
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy; (L.D.M.); (S.P.)
- Correspondence:
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Benfari G, Mandoli GE, Magne J, Miglioranza M, Ancona R, Reskovic Luksic V, Pastore MC, Santoro C, Michalski B, Muraru D, Donal E, Cosyns B, Edvardsen T, Popescu B, Cameli M. Left atrial strain determinants across heart failure stages; insight from MASCOT registry. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
MASCOT investigators
Background
Few studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. We aimed to analyze the pathophysiological and clinical PALS correlates in a large international prospective registry.
Methods
This is a multicenter prospective observational study enrolling 745 patients with HF stages 0-C from July to October 2018. Data included PALS and left ventricular global longitudinal strain (LV-GLS). Exclusion criteria were: valvular prosthesis; atrial fibrillation; cardiac transplantation; poor acoustic window.
Results
Median global PALS was 17% [24-32]. 29% of patients were in HF-stage 0/A, 35% in stage-B, and 36% in stage-C. Together with age, the echocardiographic determinants of PALS were LA volume and LV-GLS (overall model R²=0.50, p < 0.0001). LV-GLS had the strongest association with PALS at multivariable analysis (beta:-3.60 ± 0.20, p < 0.0001). Among HF-stages (Figure 1), LV-GLS remained the most important PALS predictor (p < 0.0001) whereas age was only associated with PALS in lower HF-stage 0/A or B (R=-0.26 p < 0.0001, R=-0.23 p = 0.0001). LA volume increased its association to PALS moving from stage 0-A (R=-0.11; P = 0.1) to C (R=-0.42; P < 0.0001). PALS was the single most potent echocardiographic parameter in predicting HF stage (AUC for B vs. 0/A 0.81, and AUC vs. 0/A for C 0.76). PALS remained independently associated with HF stages after adjusting for ejection fraction, E/e’ ratio and mitral regurgitation grade (p < 0.0001).
Conclusion
Although influenced by LV-GLS and LA size across HF-stages, PALS is incrementally and independently associated with clinical status. LA function may reflect a substantial part of the hemodynamic consequences of ventricular dysfunction. Abstract Figure 1
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Affiliation(s)
- G Benfari
- University of Verona, Cardiology, Verona, Italy
| | - GE Mandoli
- University of Siena, Cardiovascular Disease, Siena, Italy
| | - J Magne
- University Hospital of Limoges, Limoges, France
| | | | - R Ancona
- Santa Maria delle Grazie Hospital, Pozzuoli, Italy
| | | | - MC Pastore
- University of Siena, Cardiovascular Disease, Siena, Italy
| | | | | | - D Muraru
- Universita Milano-Bicocca, Milan, Italy
| | - E Donal
- University of Rennes 1, Rennes, France
| | - B Cosyns
- University of Brussels, Brussels, Belgium
| | | | - B Popescu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - M Cameli
- University of Siena, Cardiovascular Disease, Siena, Italy
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13
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Gicchino MF, Piluso G, Giugliano T, Cirillo M, Olivieri AN, Santoro C. Expanding the Neuroradiological Phenotype of 18q Deletion Syndrome. Indian Pediatr 2022. [DOI: 10.1007/s13312-021-2405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Yu C, Negishi T, Thavendiranathan P, Pathan F, Penicka M, Côté M, Massey R, Miyazaki S, Shirazi M, Santoro C, Cho G, Popescu B, Vinereanu D, Kosmala W, Thomas L, Marwick T, Negishi K. Baseline Left Atrial Strain is Predictive of Chemotherapy Induced Cardiotoxicity in High-Risk Cancer Patients. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Gicchino MF, Piluso G, Giugliano T, Cirillo M, Olivieri AN, Santoro C. Expanding the Neuroradiological Phenotype of 18q Deletion Syndrome. Indian Pediatr 2021; 58:1187-1188. [PMID: 34939585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Maria Francesca Gicchino
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples Italy
| | - Giulio Piluso
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples Italy
| | - Teresa Giugliano
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Science, University of Campania "Luigi Vanvitelli", Naples Italy
| | - Alma Nunzia Olivieri
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples Italy
| | - Claudia Santoro
- Department of Woman, Child and of General and Specialized Surgery and Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples Italy.
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Mandoli G, Pastore M, Giannoni A, Benfari G, Dini F, Correale M, Carluccio E, Guaricci A, Citro R, Novo G, Pasquini A, Degiovanni A, Santoro C, Malagoli A, Cameli M. Deformation imaging by strain in chronic heart failure over sacubitril/valsartan: a multicenter echocardiographic registry (DISCOVER) ARNI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sacubitril/valsartan changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects morbidity and mortality partly mediated by left ventricular reverse remodeling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration.
Methods
Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centers were included. Echocardiographic indexes including speckle tracking echocardiography (STE) were used to predict LVRR (defined as LV end-systolic volume reduction and ejection fraction [LVEF] improvement >10% at follow-up) at 6 months follow-up as the primary endpoint. Changes in symptoms (NYHA class) and neurohormonal activations (N-terminal-pro-brain natriuretic peptide [NTproBNP]) were also evaluated as secondary endpoints. Patients with poor acoustic windows and missing data were excluded.
Results
The final population consisted of 341 patients (mean age: 65±10 years; 18% female, median LVEF 30% [interquartile range:25; 34]. At 6 months follow-up, cardiac dimensions and function, including left heart STE parameters, improved (Table 1). Moreover, 82 (24%) patients showed early complete response (LVRR and LVEF ≥35%), 55 (16%) early incomplete response (LVRR and LVEF <35%), 204 (60%) no response (no LVRR and LVEF <35%) after 6 months of sacubitril/valsartan. Among patients with ischemic etiology, 68% (108) did not develop LV RR. Age, sex, general characteristics, baseline NYHA class and NT-pro BNP did not significantly differ between the groups.Conversely, baseline LV dimensions and LVEF showed significant differences between the groups (p<0.0001). Also, STE parameters were considerably better in group 1 compared to group 2 and 3 both at baseline and follow-up. Non-ischemic etiology, a lower left atrial volume index and a higher global longitudinal strain were all independent predictors of LVRR at multivariable logistic analysis (all p<0.01). With ROC and spline curves, LV GLS >−9.3% showed a good accuracy in predicting LV RR (Figure 1). LA strain was the best predictor of positive changes in NYHA class and NT-proBNP (all p<0.05).
Conclusions
STE parameters at baseline could be useful to predict LVRR and early clinical response to sacubitril-valsartan, and thus could be used as a guide for treatment in patients with HFrEF.
Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
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Affiliation(s)
- G.E Mandoli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M.C Pastore
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - A Giannoni
- Fondazione Toscana Gabriele Monasterio, Cardiology and Cardiovascular Medicine Department, Pisa, Italy
| | - G Benfari
- University of Verona, Division of Cardiology, Department of Medicine, Verona, Italy
| | - F.L Dini
- Major Hospital, Centro Medico Sant'Agostino, Milano, Italy, Milano, Italy
| | - M Correale
- University Hospital Ospedali Riuniti, Cardiology Department, Foggia, Italy
| | - E Carluccio
- Hospital Santa Maria Della Misericordia, Cardiology and Cardiovascular Pathophysiology - Heart Failure Unit, Perugia, Italy
| | - A.I Guaricci
- Polyclinic Hospital of Bari, University Cardiology Unit, Cardiothoracic Department, Bari, Italy
| | - R Citro
- AOU San Giovanni di Dio e Ruggi dAragona, Cardio-Thoracic-Vascular Department, Salerno, Italy
| | - G Novo
- University Hospital Paolo Giaccone, Division of Cardiology, Department ProMISE, Palermo, Italy
| | - A Pasquini
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - A Degiovanni
- Hospital Maggiore Della Carita, Department of Thoracic, Heart and Vascular Diseases, Novara, Italy
| | - C Santoro
- Federico II University Hospital, Department of Advanced Biomedical Science, Naples, Italy
| | - A Malagoli
- University of Modena & Reggio Emilia, Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, Modena, Italy
| | - M Cameli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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Santoro C, Gaudino G, Torella A, Piluso G, Perrotta S, Miraglia Del Giudice E, Nigro V, Grandone A. Intermittent macrothrombocytopenia in a novel patient with Takenouchi-Kosaki syndrome and review of literature. Eur J Med Genet 2021; 64:104358. [PMID: 34624555 DOI: 10.1016/j.ejmg.2021.104358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/07/2021] [Accepted: 10/03/2021] [Indexed: 11/28/2022]
Abstract
Takenouchi-Kosaki syndrome (TKS) is a recently delineated syndromic form of thrombocytopenia strictly related to an hot-spot missense variant, p.Tyr64Cys, in CDC42 (Cell Division Control protein 42). Herein we report an additional patient with the p.Tyr64Cys aminoacidic substitution who showed the well-defined phenotypical TKS features and an intermittent, very mild, macrothrombocytopenia at 10.7 years of age (93,000/mL), that was only retrospectively valorized. Outside of this value the PLT count had always been higher than 100,000/mL. We also review literature data from patients carrying this recurrent variant. Our female patient presented with prenatal onset of short stature and microcephaly, camptodactyly, heart defects, typical facial gestalt, developmental delay, and not specific brain abnormalities. After several genetic investigations (karyotype, CGH-Array, targeted NGS analysis for short stature genes), by whole exome sequencing we identified the p.Tyr64Cys in CDC42, occurring de novo. The case presented here provides further evidence that macrothrombocytopenia can be intermittent and thus it might escape attention of clinicians. Without this key feature, TKS clinical presentation can overlap other syndromic forms of short stature. Immunodeficiency, autoimmunity, and malignancies were recently reported in patients with the p.Tyr64Cys substitution, making imperative an early diagnosis of Takenouchi-Kosaki syndrome to organize the most proper follow-up of these pediatric patients. The whole exome sequencing can be a solving tool in the challenge to the rare diseases.
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Affiliation(s)
- Claudia Santoro
- Department of Women, Child, and General and Specialist Surgery, Naples, Italy; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Naples, Italy.
| | - Giuseppina Gaudino
- Department of Women, Child, and General and Specialist Surgery, Naples, Italy
| | - Annalaura Torella
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy
| | - Giulio Piluso
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Silverio Perrotta
- Department of Women, Child, and General and Specialist Surgery, Naples, Italy
| | | | | | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy
| | - Anna Grandone
- Department of Women, Child, and General and Specialist Surgery, Naples, Italy
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18
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Scala MR, Spennato P, Volpe AD, Santoro C, Picariello S, Varricchio AM, Ruggiero C, dé Santi S, Cinalli G. Removal of Koos IV acoustic neuroma and auditory brainstem implant in NF2 patient. Neurosurg Focus Video 2021; 5:V16. [PMID: 36285234 PMCID: PMC9550011 DOI: 10.3171/2021.7.focvid2188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/20/2021] [Indexed: 06/16/2023]
Abstract
The authors present the case of removal of a Koos grade IV right acoustic neuroma in a neurofibromatosis type 2 (NF2) patient, already operated on for left cerebellopontine angle meningioma at 7 years of age and a left acoustic neuroma at 16 years of age. A transpetrosal approach allowed cochlear sensor implantation to detect residual hearing. An enlarged retrosigmoid approach then allowed subtotal microsurgical removal of the lesion; consequently, the authors illustrate the technical nuances of an auditory brainstem implant (ABI). One month after surgery, the ABI was successfully switched on, giving back hearing perception to the patient. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2188.
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Affiliation(s)
| | | | - Antonio Della Volpe
- Otology and Cochlear Implant Unit, Santobono-Pausilipon Children’s Hospital, Naples
| | - Claudia Santoro
- Neurofibromatosis Referral Centre, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples; and
- Departments of Physical and Mental Health, and Preventive Medicine, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Stefania Picariello
- Neurofibromatosis Referral Centre, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples; and
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D'Amico A, Di Stasi M, Ugga L, Perillo T, Santoro C, Melis D. Olfactory bulb enlargement in neurofibromatosis type 1: report of a novel finding. Childs Nerv Syst 2021; 37:2927-2930. [PMID: 33566141 DOI: 10.1007/s00381-021-05077-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a genetic autosomal dominant disease caused by mutation of the protein neurofibromin, a regulator of cell growth. The most frequent intracranial findings are unidentified bright objects (UBOs), thickening of the corpus callosum, sphenoid wing dysplasia, cerebral vasculopathy, optic and non-optic pilocytic astrocytomas, and plexiform neurofibromas. We report two cases of NF1 patients with asymptomatic olfactory bulbs (OBs) enlargement depicted with Magnetic Resonance Imaging (MRI). To the best of our knowledge, this finding has not been reported in the scientific literature so far. We hypothesize that olfactory bulbs enlargement may have a pathogenetic nature like that of the UBOs as in one of our patients there was spontaneous regression during follow-up. The olfactory bulbs enlargement expands the broad neuroradiological spectrum of finding of NF1. More reports are required to better understand incidence, pathogenesis, and clinical behavior of olfactory bulbs enlargement in NF1 patients.
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Affiliation(s)
- Alessandra D'Amico
- Department of Radiology, "Tortorella" Private Hospital, Salerno, Italy.,Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Martina Di Stasi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Teresa Perillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Claudia Santoro
- Clinic of Child and Adolescent Neuropsychiatry, Department of Physical and Mental Health, and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Women, Children, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Daniela Melis
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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Manara R, Ponticorvo S, Perrotta S, Barillari MR, Costa G, Brotto D, Di Concilio R, Ciancio A, De Michele E, Carafa PA, Canna A, Russo AG, Troisi D, Caiazza M, Ammendola F, Roberti D, Santoro C, Picariello S, Valentino MS, Inserra E, Carfora R, Cirillo M, Raimo S, Santangelo G, di Salle F, Esposito F, Tartaglione I. Auditory cortex hypoperfusion: a metabolic hallmark in Beta Thalassemia. Orphanet J Rare Dis 2021; 16:349. [PMID: 34353346 PMCID: PMC8340544 DOI: 10.1186/s13023-021-01969-0] [Citation(s) in RCA: 4] [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: 03/18/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sensorineural hearing loss in beta-thalassemia is common and it is generally associated with iron chelation therapy. However, data are scarce, especially on adult populations, and a possible involvement of the central auditory areas has not been investigated yet. We performed a multicenter cross-sectional audiological and single-center 3Tesla brain perfusion MRI study enrolling 77 transfusion-dependent/non transfusion-dependent adult patients and 56 healthy controls. Pure tone audiometry, demographics, clinical/laboratory and cognitive functioning data were recorded. Results Half of patients (52%) presented with high-frequency hearing deficit, with overt hypoacusia (Pure Tone Average (PTA) > 25 dB) in 35%, irrespective of iron chelation or clinical phenotype. Bilateral voxel clusters of significant relative hypoperfusion were found in the auditory cortex of beta-thalassemia patients, regardless of clinical phenotype. In controls and transfusion-dependent (but not in non-transfusion-dependent) patients, the relative auditory cortex perfusion values increased linearly with age (p < 0.04). Relative auditory cortex perfusion values showed a significant U-shaped correlation with PTA values among hearing loss patients, and a linear correlation with the full scale intelligence quotient (right side p = 0.01, left side p = 0.02) with its domain related to communication skills (right side p = 0.04, left side p = 0.07) in controls but not in beta-thalassemia patients. Audiometric test results did not correlate to cognitive test scores in any subgroup. Conclusions In conclusion, primary auditory cortex perfusion changes are a metabolic hallmark of adult beta-thalassemia, thus suggesting complex remodeling of the hearing function, that occurs regardless of chelation therapy and before clinically manifest hearing loss. The cognitive impact of perfusion changes is intriguing but requires further investigations. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01969-0.
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Affiliation(s)
- Renzo Manara
- Neuroradiology, Department of Neuroscience, University of Padova, Padua, Italy
| | - Sara Ponticorvo
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e della Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy.
| | | | | | | | | | - Angela Ciancio
- Unità Operativa Ematologia - Day Hospital di Talassemia, Ospedale "Madonna Delle Grazie", Matera, Italy
| | - Elisa De Michele
- Medicina Trasfusionale AUO "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | | | - Antonietta Canna
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy
| | - Andrea Gerardo Russo
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy
| | - Donato Troisi
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy
| | - Martina Caiazza
- Dipartimento della Donna, del Bambino e della Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Federica Ammendola
- Dipartimento della Donna, del Bambino e della Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Domenico Roberti
- Dipartimento della Donna, del Bambino e della Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Claudia Santoro
- Dipartimento della Donna, del Bambino e della Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy.,Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefania Picariello
- Dipartimento della Donna, del Bambino e della Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Maria Sole Valentino
- Dipartimento della Donna, del Bambino e della Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Emanuela Inserra
- Dipartimento della Donna, del Bambino e della Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Roberta Carfora
- Dipartimento della Donna, del Bambino e della Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Raimo
- Department of Psychology, University of Campania 'Luigi Vanvitelli', Caserta, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania 'Luigi Vanvitelli', Caserta, Italy
| | - Francesco di Salle
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy
| | - Fabrizio Esposito
- Dipartimento di Medicina e Chirurgia, Scuola Medica Salernitana, Università di Salerno, Fisciano, Italy.,Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Immacolata Tartaglione
- Dipartimento della Donna, del Bambino e della Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
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21
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D'Amico A, Rosano C, Pannone L, Pinna V, Assunto A, Motta M, Ugga L, Daniele P, Mandile R, Mariniello L, Siano MA, Santoro C, Piluso G, Martinelli S, Strisciuglio P, De Luca A, Tartaglia M, Melis D. Clinical variability of neurofibromatosis 1: A modifying role of cooccurring PTPN11 variants and atypical brain MRI findings. Clin Genet 2021; 100:563-572. [PMID: 34346503 DOI: 10.1111/cge.14040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 01/04/2023]
Abstract
Neurofibromatosis 1 (NF1) is a disorder characterized by variable expressivity caused by loss-of-function variants in NF1, encoding neurofibromin, a protein negatively controlling RAS signaling. We evaluated whether concurrent variation in proteins functionally linked to neurofibromin contribute to the variable expressivity of NF1. Parallel sequencing of a RASopathy gene panel in 138 individuals with molecularly confirmed clinical diagnosis of NF1 identified missense variants in PTPN11, encoding SHP2, a positive regulator of RAS signaling, in four subjects from three unrelated families. Three subjects were heterozygous for a gain-of-function variant and showed a severe expression of NF1 (developmental delay, multiple cerebral neoplasms and peculiar cortical MRI findings), and features resembling Noonan syndrome (a RASopathy caused by activating variants in PTPN11). Conversely, the fourth subject, who showed an attenuated presentation, carried a previously unreported PTPN11 variant that had a hypomorphic behavior in vitro. Our findings document that functionally relevant PTPN11 variants occur in a small but significant proportion of subjects with NF1 modulating disease presentation, suggesting a model in which the clinical expression of pathogenic NF1 variants is modified by concomitant dysregulation of protein(s) functionally linked to neurofibromin. We also suggest targeting of SHP2 function as an approach to treat evolutive complications of NF1.
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Affiliation(s)
- Alessandra D'Amico
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.,Tortorella Private Hospital, Salerno, Italy
| | - Carmen Rosano
- Translational Medical Sciences Department, University of Naples "Federico II", Naples, Italy
| | - Luca Pannone
- Genetics and Rare Diseases Research Division, Pediatric Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Valentina Pinna
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Antonia Assunto
- Translational Medical Sciences Department, University of Naples "Federico II", Naples, Italy
| | - Marialetizia Motta
- Genetics and Rare Diseases Research Division, Pediatric Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.,Tortorella Private Hospital, Salerno, Italy
| | - Paola Daniele
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Roberta Mandile
- Translational Medical Sciences Department, University of Naples "Federico II", Naples, Italy
| | - Lucio Mariniello
- Translational Medical Sciences Department, University of Naples "Federico II", Naples, Italy
| | - Maria Anna Siano
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Salerno, Italy
| | - Claudia Santoro
- Referral Centre of Neurofibromatosis, Department of Woman and Child, Specialistic and General Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulio Piluso
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simone Martinelli
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Strisciuglio
- Translational Medical Sciences Department, University of Naples "Federico II", Naples, Italy
| | - Alessandro De Luca
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Pediatric Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Daniela Melis
- Translational Medical Sciences Department, University of Naples "Federico II", Naples, Italy.,Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", Salerno, Italy
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22
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Toro G, Santoro C, Ambrosio D, Landi G, Scilipoti M, Moretti A, Paoletta M, Liguori S, Schiavone Panni A, Picariello S, Iolascon G. Natural History of Scoliosis in Children with NF1: An Observation Study. Healthcare (Basel) 2021; 9:healthcare9070881. [PMID: 34356257 PMCID: PMC8303287 DOI: 10.3390/healthcare9070881] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 02/05/2023] Open
Abstract
(1) Background. Scoliosis is the most common musculoskeletal manifestation of Neurofibromatosis type 1 (NF1), and it might be dystrophic (D) or non-dystrophic (ND) depending on the presence of dysplastic changes of the spine. The aim of our study was to describe the characteristics and natural history of patients with NF1 and scoliosis. (2) Methods. We retrospectively reviewed records from patients with NF1 and scoliosis. Scoliosis was classified as D if at least two dystrophic changes were documented at imaging. (3) Results. Of the 438 patients reviewed, 43 fulfilled inclusion criteria; 17 were classified in D group and 26 in ND. The groups did not differ in age and localization of scoliosis curvature. Surgery was needed more often in D group, but the between-group difference was not significant. Male-to-female ratios of 3:1 and 4:1 were reported in surgically treated NF1 patients with ND and D scoliosis, respectively. (4) Conclusions. Our data suggests independently by the presence of dysplastic changes affecting the spine that males with NF1 are more often affected by scoliosis that requires surgery.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (D.A.); (G.L.); (A.M.); (S.L.); (A.S.P.); (G.I.)
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Claudia Santoro
- Department of Woman, Child and of General and Specialised Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.S.); (M.S.); (S.P.)
- Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Daniele Ambrosio
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (D.A.); (G.L.); (A.M.); (S.L.); (A.S.P.); (G.I.)
| | - Giovanni Landi
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (D.A.); (G.L.); (A.M.); (S.L.); (A.S.P.); (G.I.)
| | - Martina Scilipoti
- Department of Woman, Child and of General and Specialised Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.S.); (M.S.); (S.P.)
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (D.A.); (G.L.); (A.M.); (S.L.); (A.S.P.); (G.I.)
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (D.A.); (G.L.); (A.M.); (S.L.); (A.S.P.); (G.I.)
- Correspondence:
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (D.A.); (G.L.); (A.M.); (S.L.); (A.S.P.); (G.I.)
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (D.A.); (G.L.); (A.M.); (S.L.); (A.S.P.); (G.I.)
| | - Stefania Picariello
- Department of Woman, Child and of General and Specialised Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.S.); (M.S.); (S.P.)
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (D.A.); (G.L.); (A.M.); (S.L.); (A.S.P.); (G.I.)
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23
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Piccolo V, Russo T, Di Pinto D, Pota E, Di Martino M, Piluso G, Ronchi A, Argenziano G, Di Brizzi EV, Santoro C. Poikiloderma With Neutropenia and Mastocytosis: A Case Report and a Review of Dermatological Signs. Front Med (Lausanne) 2021; 8:680363. [PMID: 34179048 PMCID: PMC8222900 DOI: 10.3389/fmed.2021.680363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/27/2021] [Indexed: 12/02/2022] Open
Abstract
Poikiloderma with neutropenia (PN) is a very rare genetic disorder mainly characterized by poikiloderma and congenital neutropenia, which explains the recurrence of respiratory infections and risk of developing bronchiectasis. Patients are also prone to develop hematological and skin cancers. Here, we present the case of a patient, the only child of apparently unrelated Serbian parents, affected by PN resulting from the homozygous mutation NM_024598.3:c.243G>A (p.Trp81Ter) of USB1; early onset of poikiloderma (1 year of age) was associated with cutaneous mastocytosis. We also provide a review of the literature on this uncommon condition with a focus on dermatological findings.
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Affiliation(s)
- Vincenzo Piccolo
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Teresa Russo
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Daniela Di Pinto
- Department of Women and Child Health and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elvira Pota
- Department of Women and Child Health and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Martina Di Martino
- Department of Women and Child Health and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulio Piluso
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Ronchi
- Anatomic Pathology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | - Claudia Santoro
- Department of Women and Child Health and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Physical and Mental Health, and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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24
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Malagoli A, Albini A, Mandoli GE, Baggiano A, Vinco G, Bandera F, D'Andrea A, Esposito R, D'Ascenzi F, Sorrentino R, Santoro C, Benfari G, Contorni F, Cameli M. Multimodality imaging of the ischemic right ventricle: an overview and proposal of a diagnostic algorithm. Int J Cardiovasc Imaging 2021; 37:3343-3354. [PMID: 34114150 DOI: 10.1007/s10554-021-02309-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Right ventricular (RV) involvement is frequently detected in patients presenting with acute left ventricular myocardial infarction. The ischemic right ventricle carries a dismal outcome by predisposing the heart to arrhythmic events and mechanical or hemodynamic complications. A comprehensive RV evaluation by multimodality imaging could guide clinical practice but has always been a conundrum for the imagers. Two-dimensional echocardiography is the best first-line tool due to its availability of bedside capabilities. More advanced imaging techniques provide a more comprehensive evaluation of the complex RV geometry but are mostly reserved for the post-acute setting. Three-dimensional echocardiography has improved the evaluation of RV volumes and function. The recent application of speckle-tracking echocardiography to the right ventricle appears promising, allowing the earlier detection of subtle RV dysfunction. Cardiac magnetic resonance imaging is considered the gold standard for the RV assessment. Cardiac multidetector computed tomography could be a reliable alternative. The aim of this review is to focus on the growing importance of multimodality imaging of the ischemic right ventricle and to propose a diagnostic algorithm, in order to reach a comprehensive assessment of this too frequently neglected chamber.
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Affiliation(s)
- A Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy.
| | - A Albini
- Division of Cardiology, Nephro-Cardiovascular Department, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - G E Mandoli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - A Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Vinco
- Department of Medicine, University of Verona, Verona, Italy
| | - F Bandera
- Cardiology University Department, Heart Failure Unit, Department of Biomedical Sciences for Health, IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - A D'Andrea
- Division of Cardiology, Umberto I' Hospital Nocera Inferiore (Salerno), Luigi Vanvitelli University, Caserta, Italy
| | - R Esposito
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - F D'Ascenzi
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - R Sorrentino
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - C Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - G Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - F Contorni
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - M Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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25
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Russo C, Russo C, Cascone D, Mazio F, Santoro C, Covelli EM, Cinalli G. Non-Oncological Neuroradiological Manifestations in NF1 and Their Clinical Implications. Cancers (Basel) 2021; 13:cancers13081831. [PMID: 33921292 PMCID: PMC8070534 DOI: 10.3390/cancers13081831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Central nervous system involvement (CNS) is a common finding in Neurofibromatosis type 1 (NF1). Beside tumor-related manifestations, NF1 is also characterized by a wide spectrum of CNS alterations with variable impacts on functioning and life quality. Here, we propose an overview of non-oncological neuroradiological findings in NF1, with an insight on pathophysiological and embryological clues for a better understanding of the development of these specific alterations. Abstract Neurofibromatosis type 1 (NF1), the most frequent phakomatosis and one of the most common inherited tumor predisposition syndromes, is characterized by several manifestations that pervasively involve central and peripheral nervous system structures. The disorder is due to mutations in the NF1 gene, which encodes for the ubiquitous tumor suppressor protein neurofibromin; neurofibromin is highly expressed in neural crest derived tissues, where it plays a crucial role in regulating cell proliferation, differentiation, and structural organization. This review article aims to provide an overview on NF1 non-neoplastic manifestations of neuroradiological interest, involving both the central nervous system and spine. We also briefly review the most recent MRI functional findings in NF1.
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Affiliation(s)
- Camilla Russo
- Department of Electrical Engineering and Information Technology (DIETI), University of Naples “Federico II”, 80125 Naples, Italy
- Correspondence: ; Tel.: +39-333-7050711
| | - Carmela Russo
- Pediatric Neuroradiology Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (C.R.); (D.C.); (F.M.); (E.M.C.)
| | - Daniele Cascone
- Pediatric Neuroradiology Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (C.R.); (D.C.); (F.M.); (E.M.C.)
| | - Federica Mazio
- Pediatric Neuroradiology Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (C.R.); (D.C.); (F.M.); (E.M.C.)
| | - Claudia Santoro
- Neurofibromatosis Referral Center, Department of Woman, Child, General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Eugenio Maria Covelli
- Pediatric Neuroradiology Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (C.R.); (D.C.); (F.M.); (E.M.C.)
| | - Giuseppe Cinalli
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy;
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26
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Luciano F, Santoro C, Capone V, Casciano O, Canonico ME, Fedele T, Orefice S, Fiorillo L, Esposito R. Usefulness of myocardial work assessment for the understanding of mechanisms underlying sacubitril/valsartan efficacy in patients with heart failure and reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Sacubitril/valsartan has shown the ability in reducing the risk of death and of hospitalization in patients with HF (heart failure) and is recommended in patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite conventional therapies. Strain imaging derived myocardial work (MW) is an emerging tool for the evaluation of left ventricular (LV) mechanics by incorporating both systolic deformation and afterload burden in the analysis.
Aim of the study
To evaluate in a prospective fashion the impact of sacubitril/valsartan therapy in HF patients on MW derived parameters in relation with standard echocardiographic indices.
Methods
We recruited thirteen HF patients with indication to sacubitril/valsartan therapy according to current guidelines. Sacubitril/valsartan therapy titrated at the maximum tolerated dose. A comprehensive echo-Doppler exam, including speckle tracking derived assessment of global longitudinal strain (GLS) (in absolute value), was performed before and after a three months therapy with sacubitril/valsartan. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were calculated according to standardized procedures. Patients with more than mild aortic and mitral stenosis and/or regurgitation were excluded. Other exclusion criteria included permanent and/or persistent atrial fibrillation and inadequate echo images.
Results
The 13 patients (M/F = 11/2, age: 57 ± 8.2 years, aetiology: idiopathic in 3 patients, ischaemic in 7 patients and chemotherapy related cardiotoxicity in 3 patients, NYHA Class: II in 7 and III in 6 patients). All patients tolerated sacubitril/valsartan therapy. After the three months therapy an improvement of LVEF (from 32.3 ± 2% to 36.2± 6%, p = 0.015), GLS (from 9.8 ± 1% to 11.6 ± 2%, p = 0.019), GWI (from 845.0 ± 175.0 mmHg% to 1091.6 ± 336.8 mmHg%, p = 0.003), GCW (from 993.4± 211.6 mmHg% to 1262.7 ± 404 mmHg%, p = 0.002) and GWE (from 77 ± 11% to 81 ± 10%, p = 0.002) was observed, without significant changes in GWW (from 190 ± 121 mmHg% to 211 ± 145 mmHg%, p = 0.307). We also found a positive correlation between the magnitude of LVEF improvement and the baseline values of GCW (r = 0.66, p = 0.014). This relation remained significant even after adjusting for the extent of systolic blood pressure reduction (r = 0.54, p = 0.033).
Conclusion
Three months sacubitril/valsartan therapy significantly improves standard and advanced indices of LV systolic function. This improvement is due to the increase of constructive work more than to the reduction of wasted work and the increase of LVEF can be predicted by the global constructive work levels at baseline. MW assessment may help to understand the mechanisms underlying the sacubitril/valsartan therapy efficacy in HF patients.
Abstract Figure.
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Affiliation(s)
- F Luciano
- Federico II University of Naples, Naples, Italy
| | - C Santoro
- Federico II University of Naples, Naples, Italy
| | - V Capone
- Federico II University of Naples, Naples, Italy
| | - O Casciano
- Federico II University of Naples, Naples, Italy
| | - ME Canonico
- Federico II University of Naples, Naples, Italy
| | - T Fedele
- Federico II University of Naples, Naples, Italy
| | - S Orefice
- Federico II University of Naples, Naples, Italy
| | - L Fiorillo
- Federico II University of Naples, Naples, Italy
| | - R Esposito
- Federico II University of Naples, Naples, Italy
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27
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Santoro C, Soloperto R, Casciano O, Esposito R, Lembo M, Canonico M, Arpino G, Giuliano M, De Placido S, Esposito G. Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure.
Purpose
To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography.
Methods
Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction < 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline >15%.
Results
None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p < 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p < 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p < 0.0001).
Conclusions
Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients.
Abstract Figure.
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Affiliation(s)
- C Santoro
- Federico II University of Naples, Naples, Italy
| | - R Soloperto
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - O Casciano
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - R Esposito
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Lembo
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Canonico
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - G Arpino
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Giuliano
- Federico II University of Naples, Naples, Italy
| | | | - G Esposito
- Federico II University of Naples, Naples, Italy
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28
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Ozarslan B, Russo T, Argenziano G, Santoro C, Piccolo V. Cutaneous Findings in Neurofibromatosis Type 1. Cancers (Basel) 2021; 13:463. [PMID: 33530415 PMCID: PMC7865571 DOI: 10.3390/cancers13030463] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/02/2021] [Accepted: 01/14/2021] [Indexed: 12/15/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a complex autosomal dominant disorder associated with germline mutations in the NF1 tumor suppressor gene. NF1 belongs to a class of congenital anomaly syndromes called RASopathies, a group of rare genetic conditions caused by mutations in the Ras/mitogen-activated protein kinase pathway. Generally, NF1 patients present with dermatologic manifestations. In this review the main features of café-au-lait macules, freckling, neurofibromas, juvenile xanthogranuloma, nevus anemicus and other cutaneous findings will be discussed.
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Affiliation(s)
| | - Teresa Russo
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80100 Naples, Italy; (T.R.); (G.A.)
| | - Giuseppe Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80100 Naples, Italy; (T.R.); (G.A.)
| | - Claudia Santoro
- Department of Woman, Neurofibromatosis Referral Centre, Child and of General and Specialised Surgery, University of Campania Luigi Vanvitelli, 80100 Naples, Italy;
| | - Vincenzo Piccolo
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80100 Naples, Italy; (T.R.); (G.A.)
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29
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Bernardo P, Budetta M, Aliberti F, Carpentieri ML, De Brasi D, Sorrentino L, Russo C, D'amico A, Cinalli G, Santoro C, Coppola A. Temporal lobe malformations, focal epilepsy, and FGFR3 mutations: a non-causal association? Neurol Sci 2021; 42:2063-2067. [PMID: 33389251 DOI: 10.1007/s10072-020-04923-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 11/19/2020] [Indexed: 12/01/2022]
Abstract
Temporal lobe abnormalities and focal epilepsy have been documented in FGFR3-related clinical condition, including hypochondroplasia and Muenke syndrome. FGFR3 is expressed in the brain during development and could play a role in nervous system development and hippocampal formation. These observations suggest a non-casual association between temporal malformation, epilepsy, and FGFR3 mutations. Herein, we report clinical, electroclinical, and neuroimaging findings of three additional cases of focal epilepsy and temporal lobe malformations occurring in children with FGFR3 gene mutations.
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Affiliation(s)
- Pia Bernardo
- Department of Neurosciences and Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy. .,Department of Translational Medical Science, Pediatric Section, University of Naples Federico II, Naples, Italy. .,Department of Neurosciences, Pediatric Psychiatry and Neurology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Mauro Budetta
- Paediatric and Child Neurology Unit, Cava de' Tirreni AOU S. Giovanni di Dio e Ruggiero d'Aragona Hospital, Salerno, Italy
| | - Ferdinando Aliberti
- Department of Neurosciences and Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Luisa Carpentieri
- Paediatric and Child Neurology Unit, Cava de' Tirreni AOU S. Giovanni di Dio e Ruggiero d'Aragona Hospital, Salerno, Italy
| | - Daniele De Brasi
- Department of Pediatrics, AORN Santobono Pausilipon, Naples, Italy
| | - Livio Sorrentino
- Paediatric and Child Neurology Unit, Cava de' Tirreni AOU S. Giovanni di Dio e Ruggiero d'Aragona Hospital, Salerno, Italy
| | - Carmela Russo
- Department of Neurosciences, Department of Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Alessandra D'amico
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Giuseppe Cinalli
- Department of Neurosciences and Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Claudia Santoro
- Referral Centre of Neurofibromatosis, Department of Woman and Child, "Luigi Vanvitelli" University of Campania, Naples, Italy.,Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonietta Coppola
- Epilepsy Centre, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
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30
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Di Paola A, Palumbo G, Merli P, Argenziano M, Tortora C, Strocchio L, Roberti D, Santoro C, Perrotta S, Rossi F. Effects of Eltrombopag on In Vitro Macrophage Polarization in Pediatric Immune Thrombocytopenia. Int J Mol Sci 2020; 22:ijms22010097. [PMID: 33374151 PMCID: PMC7796119 DOI: 10.3390/ijms22010097] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 11/30/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 01/12/2023] Open
Abstract
Immune Thrombocytopenia (ITP) is an autoimmune disease characterized by autoantibodies-mediated platelet destruction, a prevalence of M1 pro-inflammatory macrophage phenotype and an elevated T helper 1 and T helper 2 lymphocytes (Th1/Th2) ratio, resulting in impairment of inflammatory profile and immune response. Macrophages are immune cells, present as pro-inflammatory classically activated macrophages (M1) or as anti-inflammatory alternatively activated macrophages (M2). They have a key role in ITP, acting both as effector cells, phagocytizing platelets, and, as antigen presenting cells, stimulating auto-antibodies against platelets production. Eltrombopag (ELT) is a thrombopoietin receptor agonist licensed for chronic ITP to stimulate platelet production. Moreover, it improves T and B regulatory cells functions, suppresses T-cells activity, and inhibits monocytes activation. We analyzed the effect of ELT on macrophage phenotype polarization, proposing a new possible mechanism of action. We suggest it as a mediator of macrophage phenotype switch from the M1 pro-inflammatory type to the M2 anti-inflammatory one in paediatric patients with ITP, in order to reduce inflammatory state and restore the immune system function. Our results provide new insights into the therapy and the management of ITP, suggesting ELT also as immune-modulating drug.
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MESH Headings
- B-Lymphocytes, Regulatory/immunology
- B-Lymphocytes, Regulatory/pathology
- Benzoates/pharmacology
- Child
- Child, Preschool
- Female
- Humans
- Hydrazines/pharmacology
- Macrophage Activation/drug effects
- Macrophages/immunology
- Macrophages/pathology
- Male
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Purpura, Thrombocytopenic, Idiopathic/pathology
- Pyrazoles/pharmacology
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/pathology
- Th1 Cells/immunology
- Th1 Cells/pathology
- Th2 Cells/immunology
- Th2 Cells/pathology
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Affiliation(s)
- Alessandra Di Paola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.D.P.); (M.A.)
| | - Giuseppe Palumbo
- Department of Haematology, Bambino Gesù Hospital, 00165 Rome, Italy; (G.P.); (P.M.); (L.S.)
| | - Pietro Merli
- Department of Haematology, Bambino Gesù Hospital, 00165 Rome, Italy; (G.P.); (P.M.); (L.S.)
| | - Maura Argenziano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.D.P.); (M.A.)
| | - Chiara Tortora
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.T.); (D.R.); (S.P.)
| | - Luisa Strocchio
- Department of Haematology, Bambino Gesù Hospital, 00165 Rome, Italy; (G.P.); (P.M.); (L.S.)
| | - Domenico Roberti
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.T.); (D.R.); (S.P.)
| | - Claudia Santoro
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Silverio Perrotta
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.T.); (D.R.); (S.P.)
| | - Francesca Rossi
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.T.); (D.R.); (S.P.)
- Correspondence: ; Tel.: +39-081-566-5342
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31
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Bernardo P, Santoro C, Rubino A, Mirone G, Cinalli G. Epilepsy surgery in neurofibromatosis type 1: an overlooked therapeutic approach. Childs Nerv Syst 2020; 36:2909-2910. [PMID: 32734402 DOI: 10.1007/s00381-020-04841-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Pia Bernardo
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, 6, Naples, Italy.
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
| | - Claudia Santoro
- Referral Centre of Neurofibromatosis, Department of Woman and Child, Specialistic and General Surgery and Clinic of Child and Adolescent Neuropsychiatry, "Luigi Vanvitelli" University of Campania, Via Luigi de Crecchio, 2, 80138, Naples, Italy
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, "Luigi Vanvitelli" University of Campania, Via Luigi de Crecchio, 2, 80138, Naples, Italy
| | - Alfonso Rubino
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, 6, Naples, Italy
| | - Giuseppe Mirone
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, 6, Naples, Italy
| | - Giuseppe Cinalli
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Via Mario Fiore, 6, Naples, Italy
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32
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Lembo M, Santoro C, Casciano O, Capone V, Fedele T, Luciano F, Canonico M, Buonauro A, Esposito R, Galderisi M. Impact of diastolic blood pressure on speckle tracking derived myocardial work components in a population of normotensive and untreated hypertensive patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Arterial hypertension deeply influences left ventricular (LV) mechanics and global longitudinal strain (GLS). The effect of blood pressure (BP), in particular systolic BP burden, on speckle tracking derived myocardial work (MW) was demonstrated in both hypertensive and healthy subjects.
Purpose
Aim of our study was to evaluate the impact of diastolic BP (DBP) on MW components in a population of newly-diagnosed, never treated hypertensive patients and healthy subjects.
Methods
The study population included 105 newly-diagnosed, never treated hypertensive patients (M/F= 62/43; age=46.1±13.0 years, BP=145.1±10/89.8±7.4 mmHg), and 105 healthy normotensive subjects (BP=121.6±9.8/73.7±7.4mmHg), matched for age and sex. All participants underwent standard echo exam, including GLS evaluation (in absolute value). Cuff BP was employed as a surrogate of LV peak pressure for the assessment of global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Exclusion criteria were diabetes mellitus, coronary artery disease, overt heart failure, valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging. The study population was divided into two groups according to DBP threshold of normalcy defined by 2018 ESH/ESC guidelines: the first group including individuals with normal DBP (n=135, DBP<90mmHg) and the second group including patients with abnormal DBP (n=75, DBP ≥90 mmHg).
Results
The two groups were comparable for sex prevalence, age and heart rate. Body mass index (BMI), systolic and mean BP were higher in the group with abnormal DBP (all p<0.0001). Among echo data, no significant intergroup difference was found in LV mass index, relative wall thickness, ejection fraction and diastolic parameters. GLS was lower in patients with abnormal DBP (20.4±1.9 vs. 22.1±2.1%, p<0.0001). GWI (2443.0±403.1 vs. 2277.3±359.6 mmHg%, p<0.002), GCW (2733.5±406.0 vs. 2556.9±405.6 mmHg%, p=0.003) and GWW (112.8±84.4 vs. 76.8±45.1 mmHg%, p<0.0001) were significantly higher in patients with abnormal DBP, whereas GWE (95.3±2.8 vs. 96.2±1.7%, p<0.002) was lower in this group. In the pooled population, DBP was positively related to GWI, GCW (both r=0.30, p<0.0001) and GWW (r=0.26, p<0.0001), while negatively correlated with GLS (r=−0.37, p<0.0001) and GWE (r=−0.21, p<0.002). By separate multiple linear regression analyses, GWI (β=0.45, p<0.0001), GCW (β=0.47, p<0.0001), GWW (β=0.20, p=0.007) and GWE (β=−0.15, p<0.05) were all independently associated with DBP, after adjusting for male sex, age, BMI, heart rate, GLS and E/e' ratio.
Conclusions
In a population of untreated hypertensive patients and healthy subjects, increased DBP affects longitudinal function and MW. In particular, elevated diastolic BP induces an increase of wasted work which is only partially balanced by the increased constructive work, thus provoking a clear reduced efficiency of myocardial mechanics.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Lembo
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - O Casciano
- University Hospital Federico II, Naples, Italy
| | - V Capone
- University Hospital Federico II, Naples, Italy
| | - T Fedele
- University Hospital Federico II, Naples, Italy
| | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - M Canonico
- University Hospital Federico II, Naples, Italy
| | - A Buonauro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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33
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Santoro C, Soloperto R, Casciano O, Esposito R, Luciano F, Canonico M, Lembo M, Arpino G, De Placido S, Galderisi M. Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure.
Purpose
To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography.
Methods
Fifty Her-2 positive breast cancer women (age = 53.6±11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction <50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline >15%.
Results
None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p<0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p<0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=−0.40, p=0.006) and after TRZ completion (r=−0.62, p<0.0001).
Conclusions
Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients.
LV and RV strain during cancer therapy
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Soloperto
- University Hospital Federico II, Naples, Italy
| | - O Casciano
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - M Canonico
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - G Arpino
- University Hospital Federico II, Naples, Italy
| | | | - M Galderisi
- University Hospital Federico II, Naples, Italy
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34
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Canonico M, Fiorillo L, Santoro C, Lembo M, Esposito L, Capone V, Casciano O, Esposito R, Galderisi M. Prominent involvement of basal left ventricular longitudinal strain in patients with monoclonal gammopathy of undetermined significance. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In cardiac amyloidosis the application of Speckle Tracking Echocardiography allows to identify a specific left ventricular (LV) longitudinal strain (LS) pattern characterized by “apical sparing”, with a prominent involvement of basal and middle segments and normal LS of apical cap. The pattern of regional LS has been never investigated in monoclonal gammopathy of undetermined significance (MGUS), a condition which can predispose to cardiac amyloidosis.
Purpose
To compare LV regional LS patterns and LS base-to-apex behaviour of patients affected by MGUS in comparison with healthy subjects.
Methods
We enrolled 40 patients affected by MGUS (M/F=20/20; age 62.6±13.8 years), asymptomatic for cardiac symptoms, and a control group of 40 healthy subjects, matched for sex and age. Nineteen (47%) MGUS patients showed prevalent free K light chain and 21 (53%) had prevalent free λ light chain. Participants underwent standard echo-Doppler exam, including Speckle Tracking of the three apical views. Global longitudinal strain (GLS), the average LS of six basal (BLS), six middle (MLS), and six apical (ALS) segments (considered in absolute values) and relative regional strain ratio RRSR [=ALS/(BLS+MLS)] were computed. Exclusion criteria were overt heart failure, LV ejection fraction <53%, coronary artery and congenital heart disease, moderate to severe valvular disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging.
Results
The two groups were comparable for body mass index, blood pressure and heart rate. LV mass index, relative wall thickness, left atrial volume index and Doppler-derived LV diastolic parameters did not differ significantly between the two groups. LV ejection fraction was also similar in MGUS and healthy controls. GLS resulted significantly lower in MGUS group than in controls (20.5±3.0 vs. 22.4±2.0%, p<0.02). BLS (17.1±3.7 vs. 19.2±2.2%, p=0.004), MLS (24.9±3.8 vs. 27.1±3.6%, p<0.01) and ALS (25.1±3.8 vs. 27.1±3.5%, p<0.01) were significantly lower in MGUS than in controls. The intergroup difference of RRSR (0.60±0.05 vs. 0.58±0.04) did not achieve the statistical significance (p=0.26) and none of the MGUS patients had RRSR>1. The figure depicts a LS bull'eye of a MGUS patient showing the prominent involvement of LV basal segments.
Conclusions
In presence of a normal LV ejection fraction, MGUS patients show a subclinical LV longitudinal systolic dysfunction. This is testified by a reduction of GLS and of regional LS which involves mainly LV basal segments, without substantial changes of relative regional strain ratio. LV regional longitudinal dysfunction could be useful to monitor LV myocardial mechanics during follow-up of MGUS patients.
LS bull's eye in a MGUS patient
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - L Fiorillo
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - L Esposito
- University Hospital Federico II, Naples, Italy
| | - V Capone
- University Hospital Federico II, Naples, Italy
| | - O Casciano
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Abstract
Epilepsy is one of the possible neurological manifestations of the neurofibromatosis type 1 (NF1) that represents the most common neurocutaneous disorder. We performed a systematic review of the literature on epilepsy associated with NF1 since 1995 in order to better define prevalence and describe type and causes of seizures. Data on type, nature of studies, number of patients, gender, and inheritance of NF1 were recorded as well as data on causes, type, EEGs, brain imaging, intellectual disability (ID), surgical treatment, and outcome of epilepsy. We identified a total of 141 references through the literature search of Pubmed and Embase. After screening, 42 records were identified, including 11617 individuals with NF1 (53% of males). Overall prevalence was estimated at 5.4% lifelong with values that seemed to be slightly lower in children, 3.7% (p 0.0016). Neither gender differences nor correlation with NF1 inheritance was found. Focal with or without bilateral tonic-clonic seizures were the most common seizure type encountered (60.9%). Structural causes were identified in half of cases (114/226). Low-grade gliomas were the most frequent associated lesions followed by mesial temporal sclerosis, malformation of cortical development, dysembryoplastic neuroepithelial tumor, and cerebrovascular lesions. In these cases, the surgical approach improved the epileptic outcome. Prevalence of epilepsy is higher in subjects with NF1 respect of the general population, with values apparently significantly lower in pediatric age. Brain tumors and cytoarchitectural abnormalities are the most frequent causes of epilepsy in this population, although many other brain complications should be taken in account.
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Affiliation(s)
- Pia Bernardo
- Pediatric Psychiatry and Neurology, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy.,Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Cinalli
- Pediatric Neurosurgery, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Claudia Santoro
- Pediatric Psychiatry and Neurology, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy. .,Pediatric Neurosurgery, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy. .,Referral Centre of Neurofibromatosis, Department of Woman and Child, Specialistic and General Surgery, "Luigi Vanvitelli" University of Campania, Via Luigi de Crecchio, 2, 80138, Naples, Italy.
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Santoro C, Giugliano T, Bernardo P, Palladino F, Torella A, Del Vecchio Blanco F, Onore ME, Carotenuto M, Nigro V, Piluso G. A novel RAB39B mutation and concurrent de novo NF1 mutation in a boy with neurofibromatosis type 1, intellectual disability, and autism: a case report. BMC Neurol 2020; 20:327. [PMID: 32873259 PMCID: PMC7460788 DOI: 10.1186/s12883-020-01911-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mutations in RAB39B at Xq28 causes a rare form of X-linked intellectual disability (ID) and Parkinson's disease. Neurofibromatosis type 1 (NF1) is caused by heterozygous mutations in NF1 occurring de novo in about 50% of cases, usually due to paternal gonadal mutations. This case report describes clinical and genetic findings in a boy with the occurrence of two distinct causative mutations in NF1 and RAB39B explaining the observed phenotype. CASE PRESENTATION Here we report a 7-year-old boy with multiple café-au-lait macules (CALMs) and freckling, severe macrocephaly, peculiar facial gestalt, severe ID with absent speech, epilepsy, autistic traits, self-harming, and aggressiveness. Proband is an only child born to a father aged 47. Parents did not present signs of NF1, while a maternal uncle showed severe ID, epilepsy, and tremors.By RNA analysis of NF1, we identified a de novo splicing variant (NM_000267.3:c.6579+2T>C) in proband, which explained NF1 clinical features but not the severe ID, behavioral problems, and aggressiveness. Family history suggested an X-linked condition and massively parallel sequencing of X-exome identified a novel RAB39B mutation (NM_171998.2:c.436_447del) in proband, his mother, and affected maternal uncle, subsequently validated by Sanger sequencing in these and other family members. CONCLUSIONS The case presented here highlights how concurrent genetic defects should be considered in NF1 patients when NF1 mutations cannot reasonably explain all the observed clinical features.
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Affiliation(s)
- Claudia Santoro
- Department of Physical and Mental Health, and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Women, Children, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Teresa Giugliano
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio,7 -, 80138, Naples, Italy
| | - Pia Bernardo
- Department of Neurosciences, Pediatric Hospital Santobono-Pausilipon, Naples, Italy
| | - Federica Palladino
- Department of Women, Children, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalaura Torella
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio,7 -, 80138, Naples, Italy
| | - Francesca Del Vecchio Blanco
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio,7 -, 80138, Naples, Italy
| | - Maria Elena Onore
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio,7 -, 80138, Naples, Italy
| | - Marco Carotenuto
- Department of Physical and Mental Health, and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio,7 -, 80138, Naples, Italy.,Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Giulio Piluso
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio,7 -, 80138, Naples, Italy.
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Ferretti A, Baldacci E, Fazio F, Abbruzzese R, Barone F, De Luca ML, Petrucci MT, Chistolini A, Mazzucconi MG, Santoro C. Acquired FXIII deficiency and AL amyloidosis: A case of a rare association. Transfus Apher Sci 2020; 59:102903. [PMID: 32839100 DOI: 10.1016/j.transci.2020.102903] [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] [Received: 05/29/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022]
Affiliation(s)
- A Ferretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy.
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - F Fazio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - R Abbruzzese
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - F Barone
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M L De Luca
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M T Petrucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - A Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M G Mazzucconi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
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Precenzano F, Parisi L, Lanzara V, Vetri L, Operto FF, Pastorino GMG, Ruberto M, Messina G, Risoleo MC, Santoro C, Bitetti I, Marotta R. Electroencephalographic Abnormalities in Autism Spectrum Disorder: Characteristics and Therapeutic Implications. ACTA ACUST UNITED AC 2020; 56:medicina56090419. [PMID: 32825169 PMCID: PMC7559692 DOI: 10.3390/medicina56090419] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 07/03/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/03/2022]
Abstract
A large body of literature reports the higher prevalence of epilepsy in subjects with Autism Spectrum Disorder (ASD) compared to the general population. Similarly, several studies report an increased rate of Subclinical Electroencephalographic Abnormalities (SEAs) in seizure-free patients with ASD rather than healthy controls, although with varying percentages. SEAs include both several epileptiform discharges and different non-epileptiform electroencephalographic abnormalities. They are more frequently associated with lower intellectual functioning, more serious dysfunctional behaviors, and they are often sign of severer forms of autism. However, SEAs clinical implications remain controversial, and they could represent an epiphenomenon of the neurochemical alterations of autism etiology. This paper provides an overview of the major research findings with two main purposes: to better delineate the state-of-the-art about EEG abnormalities in ASD and to find evidence for or against appropriateness of SEAs pharmacological treatment in ASD.
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Affiliation(s)
- Francesco Precenzano
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
| | - Lucia Parisi
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy
| | - Valentina Lanzara
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
| | - Luigi Vetri
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
- Correspondence: or ; Tel.: +39-328-643-4126
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Grazia Maria Giovanna Pastorino
- Inter-University Group for Study and Research on Neurodevelopmental Disorders in Children and Adolescents; (L.P.); (G.M.G.P.)
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Maria Ruberto
- Centro Pro Juventute Minerva SRL, 80131 Napoli, Italy;
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Maria Cristina Risoleo
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
- Department of Medical and Surgical Science, University “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Claudia Santoro
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
| | - Ilaria Bitetti
- Epilepsy and EEG lab for Developmental Age; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (F.P.); (V.L.); (M.C.R.); (C.S.); (I.B.)
| | - Rosa Marotta
- Department of Medical and Surgical Science, University “Magna Graecia”, 88100 Catanzaro, Italy;
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D'Amico A, Ugga L, Cocozza S, Giorgio SMDA, Cicala D, Santoro C, Melis D, Cinalli G, Brunetti A, Pappatà S. Multimodal evaluation of the cerebrovascular reserve in Neurofibromatosis type 1 patients with Moyamoya syndrome. Neurol Sci 2020; 42:655-663. [PMID: 32651859 PMCID: PMC7843564 DOI: 10.1007/s10072-020-04574-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/24/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022]
Abstract
Purpose Moyamoya syndrome (MMS) is a rare intracranial arterial vasculopathy which can occur in neurofibromatosis type 1 (NF1) disease, representing a cause of cerebrovascular reserve (CVR) impairment, possibly leading to ischemic stroke. Here, we evaluated noninvasive imaging techniques used to assess CVR in MMS patients, describing clinical and imaging findings in patients affected by MMS-NF1. Methods Following strict inclusion and exclusion criteria, in this retrospective observational study, we evaluated imaging data of nine consecutive MMS-NF1 patients (M/F = 5/4, mean age: 12.6 ± 4.0). Subjects underwent a multimodal evaluation of cerebral vascular status, including intracranial arterial MR Angiography (MRA), MRI perfusion with dynamic susceptibility contrast (DSC) technique, and 99mTc-hexamethylpropyleneamine oxime (HMPAO) SPECT. Results In 8 out 9 patients (88.8%, 6/8 symptomatic), time-to-peak maps were correlated with the involved cerebral hemisphere, while in 6 out 9 patients (66.6%, 5/6 symptomatic), mean transit time (MTT) maps showed correspondence with the affected cerebrovascular territories. Cerebral blood flow (CBF) calculated using DSC perfusion failed to detect the hypoperfused regions instead identified by SPECT-CBF in all patients, while MTT maps overlapped with SPECT-CBF data in all cases and time-to-peak maps in 60.0%. Conclusions Although SPECT imaging still represents the gold standard for CBF assessment, our results suggest that data obtained using DSC perfusion technique, and in particular MTT maps, might be a very useful and noninvasive tool for evaluating hemodynamic status in MMS-NF1 patients. Electronic supplementary material The online version of this article (10.1007/s10072-020-04574-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessandra D'Amico
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
| | | | - Domenico Cicala
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Claudia Santoro
- Referral Centre of Neurofibromatosis, Department of Woman and Child, Specialistic and General Surgery, University "Luigi Vanvitelli", Naples, Italy
| | - Daniela Melis
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Sabina Pappatà
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
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40
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Santoro C, Perrotta S, Picariello S, Scilipoti M, Cirillo M, Quaglietta L, Cinalli G, Cioffi D, Di Iorgi N, Maghnie M, Gallizia A, Parpagnoli M, Messa F, De Sanctis L, Vannelli S, Marzuillo P, Miraglia Del Giudice E, Grandone A. Pretreatment Endocrine Disorders Due to Optic Pathway Gliomas in Pediatric Neurofibromatosis Type 1: Multicenter Study. J Clin Endocrinol Metab 2020; 105:5820449. [PMID: 32294191 DOI: 10.1210/clinem/dgaa138] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 11/21/2019] [Accepted: 03/13/2020] [Indexed: 12/18/2022]
Abstract
CONTEXT Up to 20% of children with neurofibromatosis type 1 (NF1) develop low-grade optic pathway gliomas (OPGs) that can result in endocrine dysfunction. Data on prevalence and type of endocrine disorders in NF1-related OPGs are scarce. OBJECTIVES The aim of the study was to determine the prevalence of endocrine dysfunctions in patients with NF1 and OPGs and to investigate predictive factors before oncological treatment. DESIGN Multicenter retrospective study. SETTINGS AND PATIENTS Records were reviewed for 116 children (64 females, 52 males) with NF1 and OPGs followed at 4 Italian centers. MAIN OUTCOME MEASURES We evaluated endocrine function and reviewed brain imaging at the time of OPG diagnosis before radio- and chemotherapy and/or surgery. OPGs were classified according to the modified Dodge classification. RESULTS Thirty-two children (27.6%) with a median age of 7.8 years had endocrine dysfunctions including central precocious puberty in 23 (71.9%), growth hormone deficiency in 3 (9.4%), diencephalic syndrome in 4 (12.5%), and growth hormone hypersecretion in 2 (6.2%). In a multivariate cox regression analysis, hypothalamic involvement was the only independent predictor of endocrine dysfunctions (hazard ratio 5.02 [1.802-13.983]; P = .002). CONCLUSIONS Endocrine disorders were found in approximately one-third of patients with Neurofibromatosis type 1 and OPGs before any oncological treatment, central precocious puberty being the most prevalent. Sign of diencephalic syndrome and growth hormone hypersecretion, although rare, could be predictive of optic pathway gliomas in NF1. Tumor location was the most important predictor of endocrine disorders, particularly hypothalamic involvement.
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Affiliation(s)
- Claudia Santoro
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefania Picariello
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Martina Scilipoti
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Cirillo
- Dipartimento di Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Daniela Cioffi
- Department of Pediatrics Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Natascia Di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health University of Genova, Genova, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health University of Genova, Genova, Italy
| | - Annalisa Gallizia
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health University of Genova, Genova, Italy
| | | | | | - Luisa De Sanctis
- Pediatric Endocrinology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Silvia Vannelli
- Pediatric Endocrinology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Pierluigi Marzuillo
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Grandone
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
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Santoro C, Picariello S, Palladino F, Spennato P, Melis D, Roth J, Cirillo M, Quaglietta L, D’Amico A, Gaudino G, Meucci MC, Ferrara U, Constantini S, Perrotta S, Cinalli G. Retrospective Multicentric Study on Non-Optic CNS Tumors in Children and Adolescents with Neurofibromatosis Type 1. Cancers (Basel) 2020; 12:E1426. [PMID: 32486389 PMCID: PMC7353051 DOI: 10.3390/cancers12061426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 02/01/2023] Open
Abstract
s: The natural history of non-optic central nervous system (CNS) tumors in neurofibromatosis type 1 (NF1) is largely unknown. Here, we describe prevalence, clinical presentation, treatment, and outcome of 49 non-optic CNS tumors observed in 35 pediatric patients (0-18 years). Patient- and tumor-related data were recorded. Overall survival (OS) and progression-free survival (PFS) were evaluated. Eighteen patients (51%) harbored an optic pathway glioma (OPG) and eight (23%) had multiple non-optic CNS lesions. The majority of lesions (37/49) were managed with a wait-and-see strategy, with one regression and five reductions observed. Twenty-one lesions (42.9%) required surgical treatment. Five-year OS was 85.3%. Twenty-four patients progressed with a 5-year PFS of 41.4%. Patients with multiple low-grade gliomas progressed earlier and had a lower 5-year PFS than those with one lesion only (14.3% vs. 57.9%), irrespective of OPG co-presence. Non-optic CNS tumors are common in young patients with NF1. Neither age and symptoms at diagnosis nor tumor location influenced time to progression in our series. Patients with multiple lesions tended to have a lower age at onset and to progress earlier, but with a good OS.
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Affiliation(s)
- Claudia Santoro
- Neurofibromatosis Referral Center, Department of Women’s and Children’s Health, and General and Specialized Surgery, “Luigi Vanvitelli” University of Campania, Via Luigi de Crecchio 2, 80138 Naples, Italy; (S.P.); (F.P.); (G.G.); (S.P.)
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, “Luigi Vanvitelli” University of Campania, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Stefania Picariello
- Neurofibromatosis Referral Center, Department of Women’s and Children’s Health, and General and Specialized Surgery, “Luigi Vanvitelli” University of Campania, Via Luigi de Crecchio 2, 80138 Naples, Italy; (S.P.); (F.P.); (G.G.); (S.P.)
- Department of Advanced Medical and Surgical Sciences, “Luigi Vanvitelli” University of Campania, P.zza L. Miraglia 2, 80138 Naples, Italy
| | - Federica Palladino
- Neurofibromatosis Referral Center, Department of Women’s and Children’s Health, and General and Specialized Surgery, “Luigi Vanvitelli” University of Campania, Via Luigi de Crecchio 2, 80138 Naples, Italy; (S.P.); (F.P.); (G.G.); (S.P.)
| | - Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore 6, 80129 Naples, Italy; (P.S.); (M.C.M.); (G.C.)
| | - Daniela Melis
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, Via Salvador Allende, Baronissi, 84081 Salerno, Italy;
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (J.R.); (S.C.)
| | - Mario Cirillo
- Department of Medicine, Surgery, Neurology, Metabolism and Geriatrics, “Luigi Vanvitelli” University of Campania, Piazza Luigi Miraglia 2, 80138 Naples, Italy;
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore 6, 80129 Naples, Italy;
| | - Alessandra D’Amico
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, Via Sergio Pansini 5, 80100 Naples, Italy;
| | - Giuseppina Gaudino
- Neurofibromatosis Referral Center, Department of Women’s and Children’s Health, and General and Specialized Surgery, “Luigi Vanvitelli” University of Campania, Via Luigi de Crecchio 2, 80138 Naples, Italy; (S.P.); (F.P.); (G.G.); (S.P.)
| | - Maria Chiara Meucci
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore 6, 80129 Naples, Italy; (P.S.); (M.C.M.); (G.C.)
| | - Ursula Ferrara
- Section of Pediatrics, Department of Translational Medical Science, “Federico II” University of Naples, Via Sergio Pansini 5, 80100 Naples, Italy;
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (J.R.); (S.C.)
| | - Silverio Perrotta
- Neurofibromatosis Referral Center, Department of Women’s and Children’s Health, and General and Specialized Surgery, “Luigi Vanvitelli” University of Campania, Via Luigi de Crecchio 2, 80138 Naples, Italy; (S.P.); (F.P.); (G.G.); (S.P.)
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore 6, 80129 Naples, Italy; (P.S.); (M.C.M.); (G.C.)
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Zaja F, Carpenedo M, Baratè C, Borchiellini A, Chiurazzi F, Finazzi G, Lucchesi A, Palandri F, Ricco A, Santoro C, Scalzulli P. Tapering and discontinuation of thrombopoietin receptor agonists in immune thrombocytopenia: Real-world recommendations. Blood Rev 2020; 41:100647. [DOI: 10.1016/j.blre.2019.100647] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 01/23/2023]
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Sorrentino R, Capone V, Esposito L, Lo Iudice F, De Roberto AM, Lembo M, Santoro C, Esposito R, Canonico ME, Galderisi M. P1288 Male gender and left atrial volume index predict non valvular atrial fibrillation recurrence. The NeAfi echo registry. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In non-valvular atrial fibrillation (AF) patients, risk stratification scores such as CHA2DS2VASc and HASBLED allow the prediction of thromboembolic and bleeding risks, respectively. However, no risk score for the prediction of AF recurrence has been yet validated.
Purpose
To evaluate the mayor anthropometric and echocardiographic determinants of AF recurrence in non-valvular paroxysmal AF patients at 1 year follow-up.
Methods
Among 395 consecutive adult patients with non valvular AF enrolled in the Neapolitan Atrial Fibrillation (NeAfi) Echo registry, 177 (F/M = 87/90, age = 66.5± 11.9 years) had paroxismal AF and underwent 1-year follow-up. Fifteen patients had AF recurrence. Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc and HASBLED scores were calculated. At baseline, patients underwent a comprehensive echo-Doppler exam, including quantification of left atrial (LA) size measurements, peak atrial longitudinal strain (PALS) and left ventricular (LV) global longitudinal strain (GLS). Binary logistic regression analysis was used to establish a mathematical model of the relationship between the variables and AF recurrence. The covariates for regression analysis were chosen as potential confounding factors based on their significance in independent T test analyses for continuous variables of chi-square for dichotomous variables, or on their biological plausibility.
Results
AF recurrence was higher in male than in female patients (14.4 vs 2.3%, p = 0.008). Patients with AF recurrence had similar body mass index, systolic and diastolic BP and heart rate compared to those without. The two groups were similar for LV end-systolic and end-diastolic volumes, ejection fraction, LV mass index, diastolic indexes, pulmonary artery systolic pressure and GLS. LA diameter (p = 0.235) and PALS (p = 0.375) were also similar between the two groups, whereas LA volume index (LAVi) was greater in patients experiencing AF recurrence (45.5 ± 15.7 vs. 36.7 ± 10.4 ml/m², p = 0.003). Binomial multiple regression analysis model explained 25% (Nagelkerke R²) of the variance in AF recurrence and correctly classified 95.0% of cases. Males were 8.9 times more likely to exhibit AF recurrence than females (p = 0.04). Greater LAVi was associated with an increased likelihood of exhibiting AF recurrence (OR = 1.07, p = 0.03), whereas CHA2DS2VASc >1 in men and >2 in women, HASBLED >3 and greater LA diameter or lower PALS did not add significant information to the model.
Conclusions
Male gender and, with a lower extent, LAVi appear to be major determinants of AF recurrence in non-valvular paroxysmal AF. The quantification of PALS does not seem to add valuable information in the prediction of recurrent AF.
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Affiliation(s)
| | - V Capone
- University Hospital Federico II, Naples, Italy
| | - L Esposito
- University Hospital Federico II, Naples, Italy
| | - F Lo Iudice
- University Hospital Federico II, Naples, Italy
| | | | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | | | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Casciano O, Luciano F, Cocozza S, Sorrentino R, Lembo M, Sellitto V, Santoro C, Esposito R, Rivellese A, Galderisi M. 433 Independent impact of metabolic syndrome on left ventricular longitudinal dysfunction in type 2 diabetes mellitus. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The risk of cardiovascular (CV) disease in type 2 diabetes mellitus (T2DM) is highly heterogeneous and an adequate risk stratification is needed. CV risk mainly depends on concomitant risk factors, combined in the metabolic syndrome (MetS). Echocardiography is an useful tool for diagnosis of cardiac organ damage and CV risk stratification in T2DM.
Purpose
To investigate the effects of MetS on left ventricular (LV) structure and function in patients with T2DM with normal LV ejection fraction (LVEF) and without overt coronary artery disease (CAD) and heart failure symptoms/signs.
Methods
We prospectively recruited 384 consecutive, uncomplicated T2DM patients. All patients underwent clinical exam, blood sampling and complete echo-Doppler exam, including determination of 2D-echo derived global longitudinal strain (GLS). LV mass index ≥45 g/m^2.7 in women and ≥49 g/m^2.7 in men was used to characterize LV hypertrophy. LV longitudinal dysfunction was assumed for GLS < 20% in absolute values. LV diastolic dysfunction was identified according to 2016 ASE/EACVI recommendations. MetS was defined according to NCEP-ATP III criteria. Significant CAD including previous myocardial infarction, LV systolic dysfunction (= LVEF <50%), hemodinamically significant valvular heart disease, primary cardiomyopathies, permanent atrial fibrillation, glomerular filtration rate <30 ml/min and inadequate echo images were exclusion criteria. The study population was divided according to presence of MetS.
Results
66% of the patients (254/384) met the criteria for MetS diagnosis. They had comparable age and heart rate with controls. Diabetic patients with MetS had higher glycated haemoglobin (HbA1c) (7.2 ± 1.3 vs. 6.9 ± 1.0%, p = 0.023) and uric acid (5.5 ± 1.4 vs. 4.9 ± 1.3 mg/dl, p = 0.001) than those without, and lower glomerular filtration rate (69.5 ± 15.0 vs 74.0 ± 12,1 ml/min, p = 0.004). MetS patients showed a higher LV mass index (p < 0.0001) and a greater prevalence of both LV hypertrophy (31.9 vs 12.5%, p < 0.0001) and diastolic dysfunction (52.6 vs. 32.8%, p = 0.007) (Figure). T2DM patients with MetS also had lower GLS (20.6 ± 2.1 vs. 21.9 ± 2.2%, p = 0.001), with a greater prevalence of LV longitudinal dysfunction (38.2 vs. 24.7%, p = 0.049) (Figure). After adjusting for age, T2DM duration, sex, HbA1c, uric acid, LV mass index and LV diastolic dysfunction by a multiple regression analysis in the pooled population, GLS reduction was independently associated with MetS (β coefficient = -0.184, p < 0.02) and LV mass index (β= -0.94, p = 0.04).
Conclusion
In patients with T2DM, the presence of MetS induces a greater prevalence not only of LV hypertrophy and diastolic dysfunction but also of LV longitudinal deformation impairment. GLS reduction in diabetic patients is associated with MetS independently of confounders including glycemic control and diabetic duration.
Abstract 433 Figure. Rate of LV alterations according to MetS
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Affiliation(s)
- O Casciano
- University Hospital Federico II, Naples, Italy
| | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - S Cocozza
- University Hospital Federico II, Naples, Italy
| | | | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - V Sellitto
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - A Rivellese
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Canonico ME, Santoro C, Prastaro M, Sorrentino R, Luciano F, Lembo M, Esposito R, Galderisi M. P291 Additional value of myocardial work in detecting subclinical systolic dysfunction in patients with bicuspid aortic valve and left ventricular hypertrophy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
An impairment of speckle tracking derived left ventricular (LV) global longitudinal strain (GLS) has been observed in patients with bicuspid aortic valve (BAV) and referred to abnormalities of aortic elasticity properties. The impact of LV mass on myocardial deformation has still not been investigated. This issue can be now better addressed by myocardial work software, which incorporates both deformation and hemodynamic load in the analysis.
Aim of the study
To analyse the impact of both deformation and strain derived myocardial work in BAV patients with and without LV hypertrophy (LVH).
Methods
Sixty-five patients with BAV underwent a comprehensive echo exam, including speckle tracking derived calculation of GLS (in absolute value). Parameters of myocardial work such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were measured according to standardized procedures. Patients with reduced LV ejection fraction and with more than mild aortic stenosis and/or regurgitation were excluded. Other exclusion criteria included coronary artery disease, concomitant valvular heart disease, heart failure, primary cardiomyopathies, permanent and/or persistent atrial fibrillation and inadequate echo images. BAV patients were divided according to presence of LVH: 10 with LVH (LV mass index >47 g/m^2.7 in women and >50 g/m^2.7 in men) and 55 without LVH.
Results
The two groups were comparable for sex, age and heart rate whereas systolic blood pressure (p = 0.006) and pulse pressure (p = 0.002) were higher in patients with LVH, who also had higher relative diastolic wall thickness (p < 0.02). No significant difference in ejection fraction (p = 0.56), transmitral E/A ratio (p = 0.504) and E/e" (p = 0.311) was found between the two groups. GLS (19.1 ± 2.5 in LVH group and. 20.0 ± 2.4% in patients without LVH, p = 0.290), GWI (p = 0.356) and GCW (p = 0.396) did not differ significantly whereas GWW was higher (119.5 ± 72.9 vs. 72.3 ± 38.7 mmHg%, p = 0.003) and GWE lower (94.4 ± 3.0 vs. 92.2 ± 1.6%, p = 0.007) in BAV patients with LVH (Figure). In the pooled population, LV mass index was related with GWW (r = 0.26, p = 0.03) and GWE (r=-0.30, p < 0.01) but not with GLS (r=-0.22, p = 0.08). The relation between GWE and LV mass index remained significant even after adjusting for pulse pressure (partial r=-0.28, p < 0.02).
Conclusion
In patients with BAV, LVH plays a detrimental effect on LV systolic function which cannot be identified by ejection fraction and GLS assessment but is unmasked by the application of myocardial work. In presence of LVH, the wasted work of BAV patients is increased and myocardial efficiency is substantially reduced, it being negatively related to LV mass even after adjusting for a raw index of aortic stiffness such as pulse pressure.
Abstract P291 Figure. GLS, GWW and GWE according to LVH
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Affiliation(s)
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Prastaro
- University Hospital Federico II, Naples, Italy
| | | | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Lembo M, Esposito R, Santoro C, Sorrentino R, Luciano F, Casciano O, Fiorillo L, La Mura L, Canonico M, Galderisi M. 1033 Prominent longitudinal strain involvement of left ventricular basal segments in native hypertensive patients without clear-cut hypertrophy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) global longitudinal strain (GLS) is able to detect an early subclinical dysfunction and it has been demonstrated to be a prognosticator in arterial hypertension. Information of regional longitudinal strain (LS) pattern has not been investigated in this clinical setting.
Purpose
We analyzed regional LV patterns of LS and base-to-apex behaviour of LS in newly diagnosed and never-treated hypertensive patients (HTN) without clear-cut LV hypertrophy (LVH).
Methods
166 HTN (M/F = 107/59; age 43.9 ± 14.3 years, blood pressure [BP] = 146.5± 10.7/90.1 ± 7.5 mmHg) and a control group of 94 healthy subjects (M/F = 58/36; age 41.2 ± 15.0 years) underwent standard echo-Doppler exam, including speckle tracking quantification of regional LS and GLS (considered in absolute values). The average LS of six basal (BLS), six middle (MLS), and six apical (ALS) segments and relative regional strain ratio - RRSR = [ALS/(BLS + MLS)] - were also computed. Exclusion criteria were LVH (LV mass index ≥45 g/m^2.7 in females and ≥49 g/m^2.7 in males), diabetes mellitus, coronary artery disease, overt heart failure, hemodynamically significant valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging.
Results
The two groups were comparable for sex, age, heart rate and LV ejection fraction (EF). Body mass index (BMI), systolic (SBP), diastolic (DBP) and mean BP (MBP) (all p < 0.0001), LV mass index (p = 0.03), relative wall thickness (RWT) (p < 0.02) and E/e’ ratio (p < 0.01) were higher, and GLS lower (21.6 ± 2.0 vs. 22.2 ± 2.1%, p < 0.02) in HTN. By analyzing regional LS, BLS (18.2 ± 2.1% vs. 19.2 ± 2.1%, p < 0.0001) and MLS (20.7 ± 2.0 vs. 21.4 ± 2.1%, p = 0.007) resulted significantly lower in HTN, without significant difference in ALS (26.0 ± 3.6 vs. 25.9 ± 3.8%, p = 0.98). Accordingly, RRSR was higher in HTN (0.67 ± 0.09 vs. 0.64 ± 0.09, p < 0.01). Even after excluding patients with LV concentric remodeling (RWT > 0.42) (n = 34), BLS (p < 0.0001) and MLS (p < 0.002) were again lower and RRSR (p < 0.01) higher in HTN than in controls. In the pooled population, BLS negatively correlated with SBP (r=-0.22), DBP (r=-0.25) and MBP (r=-0.26) (Figure) (all p < 0.0001). By a multiple linear regression analysis, after adjusting for age, sex, BMI and RWT, the association between BLS and MBP remained significant (β coefficient=-0.23, p < 0.0001), with an additional significant impact of male sex (β=-0.33, p < 0.0001) (cumulative R²=0.18, SEE = 1.9%, p < 0.0001).
Conclusions
Besides normal LV EF, GLS is lower in HTN. LS dysfunction involves basal and, with a lower extent, middle myocardial segments, with a compensation of apical segments. RRSR appears to be significantly higher in HTN. These results are even confirmed in hypertensive patients with normal LV geometry. The association of BLS and BP appears to be independent on several confounders. Regional LS pattern might be useful to detect very early LV systolic abnormalities in arterial hypertension.
Abstract 1033 Figure. Relation between MBP and BLS
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Affiliation(s)
- M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | | | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - O Casciano
- University Hospital Federico II, Naples, Italy
| | - L Fiorillo
- University Hospital Federico II, Naples, Italy
| | - L La Mura
- University Hospital Federico II, Naples, Italy
| | - M Canonico
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Sorrentino R, Fiorillo L, Canonico ME, Lembo M, Luciano F, Santoro C, Esposito R, Borgia F, Galderisi M. P1782 Left ventricular deformation proprieties in aortic coarctation: insights from multilayer strain imaging. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with coarctation of the aorta (CoA) have proven impaired left ventricular (LV) myocardial deformation that will persist even after successful transcatheter intervention compared to normal controls. However, little is known about layer specific contraction in this clinical setting.
Purpose
To investigate multi-layer longitudinal strain in patients with repaired CoA, compared with a control group of healthy subjects.
Methods
In a case-control study, 13 CoA patients (F/M = 9/4, age = 15.1 ± 4.4 years) and 13 healthy age- and sex-matched controls, underwent a complete echocardiogram, including speckle tracking assessment for quantification of LV transmural global longitudinal strain (GLS), subendocardial longitudinal strain (LSsubendo), subepicardial longitudinal strain (LSsubepi), and myocardial longitudinal strain gradient (LSsubendo - LSsubpepi).
Results
CoA patients had similar blood pressure, heart rate, and body surface area in comparison with healthy controls. The two groups did not differ for ejection fraction and LV diastolic indices. Increased maximal gradient (>20 mmHg) in descending aorta was found in 9 (69.2%) CoA patients. In CoA population, 5 (38.5%) had LV concentric remodeling (RWT > 0.42) and 2 (15.4%) LV hypertrophy (Z score >2.0). LV mass index (92.4 ± 31.1 vs. 60.9 ± 12.5 g/m^2.7, p = 0.002), septal wall thickness (8.7 ± 2.0 vs 6.6 ± 0.9 mm p = 0.002), posterior wall thickness (8.2 ± 1.7 vs. 6.6 ± 1.4 mm, p = 0.02) and RWT (0.38 ± 0.06 vs. 0.27 ± 0.08, p < 0.001) were greater in CoA patients. By multi-layer deformation analysis, GLS (21.2 ± 1.9 vs. 22.9 ± 1.4%, p < 0.01), LSsubepi (19.3 ± 1.6 vs. 21.0 ± 1.6%, p < 0.01), LSsubendo (22.9 ± 1.8 vs. 25.4 ± 1.9%, p = 0.003) and longitudinal strain gradient (3.6 ± 1.1 vs. 4.7 ± 1.1, p < 0.02) were lower in CoA patients than in healthy controls. Separate sub-analyses in patients without LV hypertrophy, substantially confirmed the same results: GLS 20.9 ± 1.6 vs. 22.8 ± 0.9%, p = 0.004; LSsubepi 19.0 ± 1.4 vs. 21.1 ± 1.3%, p = 0.004; and LSsubendo 22.4 ± 1.2 vs. 25.3 ± 1.4%, p < 0.0001; strain gradient 3.4 ± 1.0 vs. 4.6 ± 1.1, p = 0.02. Notably, LSsubepi (18.6 ± 1.4 vs. 20.6 ± 1.0%, p = 0.03) and, with greater significance, LSsubendo (22.1 ± 1.1 vs. 24.7 ± 1.8%, p < 0.0001) were lower in CoA patients with increased aortic gradient versus those without significant gradient increase.
Conclusions
In CoA patients, layer specific strain imaging highlights an impairment of LV longitudinal deformation, which mainly involves LSsubendo and causes reduction of longitudinal strain gradient. This preferential impairment of subendocardium is particularly evident in patients with residual aortic gradient and is independent of LV hypertrophy.
Abstract P1782 Figure. Multilayer strain in CoA vs. controls
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Affiliation(s)
| | - L Fiorillo
- University Hospital Federico II, Naples, Italy
| | | | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - F Borgia
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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48
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Esposito R, Sorrentino R, Ponsiglione A, Santoro C, Lembo M, Riccio E, Imbriaco M, Pisani A, Galderisi M. P678 Late gadolinium enhancement cardiac magnetic resonance and layer-specific longitudinal strain in treatment naive Anderson Fabry disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In Anderson-Fabry disease (AFD), the accumulation of glycosphingolipids in cardiomyocytes causes inflammation, hypertrophy and interstitial fibrosis which is first limited to the mid-myocardial layers, then spreads to transmural fibrosis. Speckle tracking echocardiography allows the estimation of layer-specific strain, differentiating longitudinal strain (LS) at subendocardium and subepicardium (LSsubendo and LSsubepi, respectively).
Purpose
To investigate the matching of functional and structural abnormalities in newly diagnosed, never treated AFD patients by comparing multi-layer LS and late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR).
Methods
Twenty newly diagnosed, never treated AFD patients (age = 37 ± 13 years; F/M =10/10) and 20 healthy controls, matched for age and sex, underwent comprehensive evaluation of target organs and a standard echo-Doppler exam, including assessment of relative diastolic wall thickness (RWT) and left ventricular mass index (LVMI). Left ventricular hypertrophy (LVH) was defined as LVMi > 47 g/m^2.7 in women and >50 g/m^2.7 in men. Speckle tracking echocardiography derived left ventricular transmural global longitudinal strain (GLS), LSsubendo, LSsubepi and LS gradient (LSsubendo - LSsubpepi) were also determined. CMR sequences including assessment of LGE were also performed.
Results
AFD patients had normal renal function and comparable body mass index, blood pressure, heart rate, ejection fraction and diastolic indices with healthy controls. LVMi (p = 0.006) and RWT (p < 0.02) were greater in AFD patients than in controls. GLS (p = 0.006), LSsubendo (p = 0.005) and LSsubepi (p < 0.001) were lower in AFD patients. By CMR, only four patients (F/M = 3/1), 3 with LVH (75%), exhibited focal LGE, always localized in the midwall. LGE was detected at basal lateral wall in three patients and at the septal insertional points with the right ventricle in the remaining one. AFD patients with LGE had higher LVMi than those without LGE (47.2 ± 11.0 vs. 34.5 ± 11.6 g/m^2.7, p = 0.04). There was no correspondence of LGE with both regional LS and layer specific LS impairment (Figure). However, AFD patients with LGE had higher LS gradient compared to those without LGE (5.8 ± 0.65 vs. 4.8 ± 0.66, p < 0.02).
Conclusions
Treatment naïve AFD patients show a reduction of longitudinal deformation, which involves both subendocardial and subepicardial layers. Patients with LGE present higher LV mass and increased LS gradient, without a correspondence of LGE with both regional and layer specific LS impairment. Accordingly, this impairment might due to myocardial inflammation occurring in the early disease stages more than to myocardial fibrosis itself.
Abstract P678 Figure. Multilayer bull"s eye and LGE-CMR in AFD
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Affiliation(s)
- R Esposito
- University Hospital Federico II, Naples, Italy
| | | | | | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - E Riccio
- University Hospital Federico II, Naples, Italy
| | - M Imbriaco
- University Hospital Federico II, Naples, Italy
| | - A Pisani
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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49
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Lembo M, Sorrentino R, Santoro C, Esposito R, Scalamogna M, Avvedimento M, Magliulo F, Franzone A, Cirillo P, Esposito G, Galderisi M. P753 Impact of transcatheter aortic valve implantation on concomitant mitral regurgitation in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Severe aortic stenosis (AS) and functional mitral regurgitation (MR) frequently coexist. There is no consensus about the optimal therapeutic strategy for patients with combined valve disease. Evidence has shown that double valve surgery is associated with high complication rates and mortality, whereas MR severity may improve after transcatheter aortic valve implantation (TAVI).
Purpose
Aim of our study was to evaluate hemodynamic parameters and cardiac function in patients with severe AS and concomitant MR undergoing TAVI.
Methods
We prospectively enrolled consecutive TAVI patients with concomitant MR. Exclusion criteria were primary cardiomyopathies, prior valve surgery, permanent atrial fibrillation and inadequate echocardiographic imaging. Echo-Doppler assessment, including global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS) (absolute value), was performed before TAVI and after 1-3 months. MR grading was assessed according to quantitative methods (vena contracta and/or PISA). Changes (Δ) of the main echo parameters before and after intervention were computed. On the basis of MR grading changes, the study population was divided in two groups: no improvement in MR grading (NIMR) and improvement in MR grading (IMR).
Results
Of 49 included patients (M/F = 20/29, age 80.7 ± 5.6 years), 23 had mild MR and 26 moderate to severe MR before TAVI. After the procedure, MR grading improved in 11 (IMR) and remained stable in 38 (NIMR) patients. The two groups were comparable for sex, age, body mass index, blood pressure and heart rate. After TAVI, both groups showed an improvement in GLS (17.8 ± 4.7 to 20.1 ± 4.4%, p < 0.0001 and 16.8 ± 3.8 to 19.0 ± 3.1%, p < 0.01, in NIMR and IMR respectively) and in PALS (20.4 ± 7.4 to 24.2 ± 7.3%, p < 0.0001 in NIMR and 19.5 ± 4.5 to 26.7 ± 6.1%, p < 0.001, in NIMR and IMR respectively), without significant changes in ejection fraction (p = 0.12). Only in IMR group, a significant decrease of systolic pulmonary arterial pressure (sPAP) (45.5 ± 10.6 to 36.3 ± 6.9 mmHg, p < 0.001) and left atrial volume index (54.9 ± 14.8 to 48.9 ± 13.3 ml/m², p < 0.01) was observed after TAVI. Changes of sPAP (ΔsPAP) (9.1 ± 6.4 vs. -0.07 ± 6.7, p < 0.0001) was higher and ΔPALS (-7.2 ± 5.1 vs. -3.8 ± 4.3, p < 0.03) lower in IMR compared with NIMR group (Figure). By a multiple linear regression analysis performed in the pooled population, after adjusting for ΔPALS, Δ aortic valve area and ΔGLS, the association between ΔsPAP and MR grading improvement remained significant (beta = 0.53, p < 0.001) (cumulative R²=0.31, SEE = 6.9 mmHg, p = 0.007).
Conclusion
Afterload reduction following TAVI may induce hemodynamic changes determining also a reduction in MR severity. This mechanism implies a reduction in left atrial pressure, whose PALS is a reliable marker, and a consequent reduction of post-capillary pulmonary hypertension. The association between MR improvement and ΔsPAP reduction is independent on echocardiographic confounders.
Abstract P753 Figure. ΔsPAP and ΔPALS in NIMR and IMR
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Affiliation(s)
- M Lembo
- University Hospital Federico II, Naples, Italy
| | | | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | | | | | - F Magliulo
- University Hospital Federico II, Naples, Italy
| | - A Franzone
- University Hospital Federico II, Naples, Italy
| | - P Cirillo
- University Hospital Federico II, Naples, Italy
| | - G Esposito
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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50
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Esposito L, Sorrentino R, Capone V, Santoro C, Lembo M, Esposito R, Lo Iudice F, De Roberto AM, Tufano A, Galderisi M. P814 Independent association of body mass index and left atrial strain in patients with non valvular atrial fibrillation. The NeAfib-Echo registry. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Overweight and obesity are related to the risk of new-onset atrial fibrillation (AF). Peak atrial longitudinal strain (PALS) is an advanced echocardiographic parameter of left atrial (LA) function with a recognized diagnostic and prognostic role in both the general population and AF.
Purpose
To investigate the impact of body mass index (BMI) on LA function by utilizing standard and advanced echocardiography in patients with non-valvular AF.
Methods
In the NeAfib-Echo registry, 395 consecutive adult patients with non-valvular AF (F/M: 175/220; mean age 70.6 ± 11 years, BMI: 27.8 ± 5.6 kg/m²) were enrolled. 215 patients (54.1%) had permanent/persistent AF (prAF) and 178 (45.9%) had paroxysmal AF (pxAF). Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc score was calculated. Patients underwent a complete echo-Doppler exam, including determination of PALS and left ventricular (LV) global longitudinal strain (GLS) (both reported in absolute values). The overall population was divided according to BMI tertiles: first tertile <25.3 Kg/m² (n = 127); second tertile 25.3-29 Kg/m² (n = 137); third tertile > 29.3 Kg/m² (n = 130).
Results
No significant difference of sex prevalence, age, systolic BP and heart rate was found among the three BMI tertiles, whereas diastolic BP was higher in the third tertile (p < 0.001). CHA2DS2VASc score did not significantly differ among tertiles. In the pooled population LV mass index (LVMi) (p = 0.001) progressively increased from the first to the third tertile (p < 0.001), whereas LA volume index, LV ejection fraction (EF), GLS and E/e" ratio were not significantly different among the three groups. PALS was lower in third tertile (14.3 ± 8.2%) versus both the first (19.0 ± 11.5%) and the second tertile (17.7 ± 10.6%) (p < 0.002). In separate sub-analyses according to AF type, PALS was significantly lower in the first than the third tertile in the PxAF group (p < 0.01) but not in patients with PrAF (p = 0.158). In the pooled population PALS was significantly related with BMI (r= -0.17, p < 0.001) (Figure) but also with age, heart rate, LVMi, LV EF, GLS, E/e’ ratio and pulmonary artery systolic pressure (PAPS). By a multilinear regression analysis, after adjusting for CHA2DS2VASc score, LV mass index, LV EF, E/e’ ratio and PAPs, BMI remained independently associated with PALS (standardized β coefficient = -0.127, p < 0.02) (cumulative R² =0.41, SEE = 8.5%, p < 0.0001).
Conclusions
In patients with non valvular AF, overweight and obesity exert a detrimental effect on LA function as testified by the gradual PALS reduction with the increase of BMI tertiles. BMI is associated with PALS independently of several confounders including CHA2DS2VASc. Besides CHA2DS2VASc score, BMI could be considered as an additional factor for evaluating cardiovascular risk in non valvular AF.
Abstract P814 Figure. Relation between BMI and PALS
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Affiliation(s)
- L Esposito
- University Hospital Federico II, Naples, Italy
| | | | - V Capone
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - F Lo Iudice
- University Hospital Federico II, Naples, Italy
| | | | - A Tufano
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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