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Bragonzoni L, Barone G, Benvenuti F, Ripamonti C, Lisi L, Benedetti MG, Marini S, Dallolio L, Maietta Latessa P, Zinno R, Audino G, Kemmler W, Pinelli E. Influence of Coaching on Effectiveness, Participation, and Safety of an Exercise Program for Postmenopausal Women with Osteoporosis: A Randomized Trial. Clin Interv Aging 2023; 18:143-155. [PMID: 36777456 PMCID: PMC9910200 DOI: 10.2147/cia.s389967] [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: 09/15/2022] [Accepted: 12/22/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose We compared two different strategies providing professional coaching to administer an exercise program for women with postmenopausal osteoporosis (POP): individual training (IT) at home with trainer's supervision provided by telephone contacts at regular time-intervals or group training (GT) with trainer's live supervision. Our working hypothesis was that IT is a valid alternative to GT when GT is not feasible. Patients and Methods This was a single-blind, randomized study. We recruited 52 women with POP, without significant comorbidity, and no participation in any structured exercise program within the previous 6 months. They were assigned randomly to IT or GT groups (n = 26 each). Distribution of age (IT: 68±4, GT: 67±8 years) and body mass index (IT: 23.0±2.5, GT: 21.4±5.1) was similar between groups. Each group performed the exercise program in two 1-hour sessions per week for 18 months. Primary outcome measure was Health-Related Quality of Life (HRQoL), as measured by the Short Osteoporosis Quality of Life Questionnaire. Secondary outcome measures focused on domains acknowledged to influence HRQoL (disability, fear of falling, weekly physical activity, physical function) or the effectiveness of the exercise program (retention, adherence, and safety). Significance level was set at p < 0.05. Results No significant differences were observed between IT and GT groups for any domain. Retention, adherence, and safety were also similar. HRQoL, disability and fear of falling did not change between baseline and follow-up for either group. However, for both groups, physical function (knee flexion, shoulder mobility) and functional capacity (6-minute walking test) improved. Weekly physical activity levels increased from moderate range at baseline to intense at final assessment for both groups. Conclusion IT and GT supervised exercise programs for women with POP provide similar effectiveness, participation and safety. Hence, both modalities should be considered for future translation in clinical practice of exercise recommendations for POP.
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Affiliation(s)
- Laura Bragonzoni
- Department for Life Quality Studies, Campus of Rimini, University of Bologna, Bologna, Rimini, Italy
| | - Giuseppe Barone
- Department for Life Quality Studies, Campus of Rimini, University of Bologna, Bologna, Rimini, Italy,Correspondence: Giuseppe Barone, Department for Life Quality Studies, Campus of Rimini, University of Bologna, Via di Barbiano, 1/10, Bologna, Rimini, 40136, Italy, Tel +39 051 636 6507, Email
| | - Francesco Benvenuti
- Department for Life Quality Studies, Campus of Rimini, University of Bologna, Bologna, Rimini, Italy
| | - Claudio Ripamonti
- Center for Osteoporosis and Bone Metabolic Disease, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Lucia Lisi
- Center for Osteoporosis and Bone Metabolic Disease, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Sofia Marini
- Department for Life Quality Studies, Campus of Rimini, University of Bologna, Bologna, Rimini, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Raffaele Zinno
- Department for Life Quality Studies, Campus of Rimini, University of Bologna, Bologna, Rimini, Italy
| | - Giuseppe Audino
- Department for Life Quality Studies, Campus of Rimini, University of Bologna, Bologna, Rimini, Italy
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Erika Pinelli
- Department for Life Quality Studies, Campus of Rimini, University of Bologna, Bologna, Rimini, Italy
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Damico V, Murano L, Margosio V, Ripamonti C. Co-infections among COVID-19 adult patients admitted to intensive care units: results from a retrospective study. Ann Ig 2023; 35:49-60. [PMID: 35195240 DOI: 10.7416/ai.2022.2515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Co-infection rates increase in patients admitted to the Intensive Care Units. The aim of this study was to examine the Healthcare Associated Infections in critically ill adult patients infected with SARS-CoV-2. METHODS A retrospective observational study in adults with confirmed SARS-CoV-2 infection requiring intensive care unit admission was performed. From February 2020 to September 2021, healthcare records from a total of 118 patients were evaluated. RESULTS In the study period, 39 patients were diagnosed with at least 1 Healthcare Associated Infection (33.1%). The co-infection/co-colonisation rate >48 hours after admission was 29.0 per 1,000 person/days (95 % CI 19.1-33.9). A total of 94 isolates were identified, the most common being Klebsiella spp, Clostridium difficile, Acinetobacter baumanii and Enterococcus spp. Associated outcomes for Healthcare Associated Infections have been identified: age >64 years (p= .003), length of Intensive Care Unit stay> 7 days (p= .002), Type 2 Diabetes mellitus (p= .019), cardiovascular disease (p= .021), inserted central venous catheter (p= .014), intubation (p< .001), APACHE II score >25 (p< .001), mechanical ventilation 48 hours (p= .003), and inserted urinary catheter (p= .002). The overall fatality rate of patients included in the study was 41.5% (n= 49), and it was found to be significantly higher in patients who acquired a Healthcare Associated Infection (n=26/39, 66.7%) compared to those who did not acquire it (n= 23/79, 29.1%) (OR= 4.87; 95% CI = 2.14-11.10; p< .001). CONCLUSIONS Our study showed high rates of Healthcare Associated Infections in critically ill adults with COVID-19. Associated factors for Healthcare Associated Infections acquisition and fatality in Intensive Care Units patients were identified as a good reason for a revision of existing infection control policies.
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Affiliation(s)
- V Damico
- Local Health and Social Authority, Province of Lecco, Italy
| | - L Murano
- Sanitary Assistance Residency "Madonna della Neve" Onlus, Premana, LC, Italy
| | - V Margosio
- Local Health and Social Authority, Province of Lecco, Italy
| | - C Ripamonti
- Local Health and Social Authority, Province of Lecco, Italy
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Ripamonti C, Lisi L, Ciaffi J, Buffa A, Caudarella R, Ursini F. Spine Fragility Fracture Prediction Using TBS and BMD in Postmenopausal Women: A Bayesian Approach. Int J Environ Res Public Health 2022; 19:14315. [PMID: 36361195 PMCID: PMC9655521 DOI: 10.3390/ijerph192114315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
The trabecular bone score (TBS) estimates bone microarchitecture and can be used to evaluate the risk of osteoporotic fractures independently of bone mineral density (BMD). In this retrospective case-control study, we tested and compared the ability of TBS and lumbar spine BMD (LS-BMD) to predict vertebral fragility fractures. The inclusion criteria were female sex, age range 50-90 years, menopause, and clinical risk factors for osteoporosis. Patients with secondary osteoporosis were excluded. LS-BMD and TBS were measured at the L1-L4 vertebral level. The ability of the two diagnostic systems in predicting vertebral fragility fractures was assessed by combining LS-BMD and TBS according to the Bayesian "OR rule" (the diagnosis is negative only for those negative for both tests, and it is positive for those who were positive for at least one test) or to the "AND rule" (the diagnosis is positive only for those positive to both tests and is negative for those negative for at least one test). Of the 992 postmenopausal women included, 86 had a documented vertebral fragility fracture. At the cutoff value used in the present study, the TBS and LS-BMD showed a similar diagnostic ability to predict vertebral fragility fractures, having positive predictive values (PPV) of, respectively, 13.19% and 13.24%. Negative predictive values (NPV) were, respectively, 95.40% and 94.95%. Compared to that of each single diagnostic system, the "OR-rule" significantly increased the NPV to 97.89%, while no statistically significant differences were found by using the "AND-rule". In conclusion, the present study highlights the possibility that combining LS-BMD and TBS could improve their predictive ability in diagnosing vertebral fragility fractures, and that there is a significant probability of absence of fractures in women who test negative to both diagnostic systems.
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Affiliation(s)
- Claudio Ripamonti
- Center for Osteoporosis and Bone Metabolic Diseases, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Lucia Lisi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Angela Buffa
- UOC Medicina Interna ad Indirizzo Reumatologico AUSL, 40133 Bologna, Italy
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Renata Caudarella
- Casa di Cura Privata Villalba, GVM Care & Research, 40136 Bologna, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40127 Bologna, Italy
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4
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Hettchen M, von Stengel S, Kohl M, Murphy MH, Shojaa M, Ghasemikaram M, Bragonzoni L, Benvenuti F, Ripamonti C, Benedetti MG, Julin M, Risto T, Kemmler W. Changes in Menopausal Risk Factors in Early Postmenopausal Osteopenic Women After 13 Months of High-Intensity Exercise: The Randomized Controlled ACTLIFE-RCT. Clin Interv Aging 2021; 16:83-96. [PMID: 33469276 PMCID: PMC7810823 DOI: 10.2147/cia.s283177] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 09/28/2020] [Accepted: 11/19/2020] [Indexed: 12/13/2022] Open
Abstract
The menopausal transition is a critical period in women's lives. Exercise might be the most promising non-pharmaceutic intervention to address the large variety of risk factors related to the pronounced estradiol decline during peri- and early-postmenopause. The aim of this study was to determine the effect of an 18-month multipurpose exercise program on risk factors and symptoms related to the menopausal transition. Fifty-four women 1-5 years postmenopause with osteopenia or osteoporosis were randomly assigned 1) to a high impact weight-bearing/high-intensity/velocity resistance training group (EG: n=27) exercising three times a week or 2) to an attendance control group (CG: n=27) that performed low-intensity exercise once a week. Both groups were supplemented with cholecalciferol and calcium. The primary study endpoint was bone mineral density (BMD) at lumbar spine (LS) and total hip, secondary outcomes were lean body mass (LBM), total and abdominal body percentage, metabolic syndrome Z-Score (MetS-Z), menopausal symptoms and muscle strength and power. Due to COVID-19, the study was stopped after 13 months. We observed significant effects for BMD-LS (EG: 0.002±.018 versus CG: -.009±0.018 mg/cm2, p=0.027) but not for BMD total hip (EG: -0.01±.016 versus CG: -.009±0.020 mg/cm2, p=0.129). LBM improved significantly in the EG and decreased in the CG (0.39±1.08 vs -0.37±1.34 kg, p=0.026). Total and abdominal body fat improved significantly in the EG and was maintained in the CG (-1.44±1.49 vs -0.02±1.55 kg, p=0.002 and -1.50±2.33 vs 0.08±2.07 kg, p=0.011). Significant effects in favor of the EG were also determined for menopausal symptoms (p=0.029), hip/leg extension strength (p<0.001) and power (p<0.001). However, changes of the MetS-Z did not differ significantly (p=0.149) between EG and CG. In summary, with minor exceptions, we demonstrated the effectiveness of a multipurpose exercise protocol dedicated to early-postmenopausal women on various risk factors and complaints related to the menopausal transition.
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Affiliation(s)
- Michael Hettchen
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Simon von Stengel
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
| | - Marie H Murphy
- Doctoral College, Ulster University, Newtownabbey, Antrim, Northern Ireland, UK
| | - Mahdieh Shojaa
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Mansour Ghasemikaram
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Claudio Ripamonti
- Center for Osteoporosis and Bone Metabolic Disease, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS - Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Mikko Julin
- Laurea University of Applied Sciences, Espoo, Finland
| | - Tapani Risto
- Laurea University of Applied Sciences, Espoo, Finland
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Ripamonti C, Steinkuhler C, Cellupica E, Fossati G. HDAC6 inhibitor ITF3791 enhances alloantigen presentation capabilities of myeloid cells modulating PD-L1 expression and co-stimulatory molecules. Eur J Cancer 2019. [DOI: 10.1016/j.ejca.2019.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ripamonti C, Lisi L, Buffa A, Gnudi S, Caudarella R. The Trabecular Bone Score Predicts Spine Fragility Fractures in Postmenopausal Caucasian Women Without Osteoporosis Independently of Bone Mineral Density. ACTA ACUST UNITED AC 2018; 72:46-50. [PMID: 29416218 PMCID: PMC5789571 DOI: 10.5455/medarh.2018.72.46-50] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction The trabecular bone score (TBS) is a gray-level textural metric that can be extracted from the two-dimensional lumbar spine dual-energy X-ray absorptiometry (DXA) image. TBS is related to bone microarchitecture. Several literature data suggest that TBS predicts fracture risk as well as lumbar spine bone mineral density (LS-BMD) measurements in postmenopausal women. Objective A retrospective case-control study assessing the ability of the TBS to predict spine fragility fractures (SFF) in postmenopausal women with or without osteoporosis (diagnosed by T-score≤-2.5). Methods LS-BMD and the TBS were determined in the L1-L4 vertebrae. Statistical analyses were carried out in the entire group of women (entire-group) (n.699), in women both with osteoporosis (osteoporosis-subgroup) (n.253) and those without osteoporosis (non-osteoporosis-subgroup) (n. 446). Results At the unpaired t-test, both the TBS and the LS-BMD (p≤0.001) were lower in women with SFF (n.62) in the entire-group. In the non-osteoporosis subgroup, the TBS (p≤0.009) was lower in women with SFF (n.29). In the osteoporosis subgroup, the LS-BMD (p≤0.003) was lower in women with SFF (n.33). Considering the TBS and LS-BMD separately in a block logistic regression, the TBS was associated with SFF in the entire-group (odds ratio (OR): 1.599, 95% confidence interval (CI): 1.021-2.128) and in the non-osteoporosis-subgroup (OR: 1.725, 95% CI:1.118-2.660) whereas LS-BMD was associated with SFF in the entire-group (OR: 1.611, 95% CI: 1.187-2.187) and in the osteoporosis-subgroup (OR: 2.383, 95% CI: 1.135-5.003). According to forward logistic regression, entering the TBS, LS-BMD and confounders as predictors, the LS-BMD in the entire-group (OR: 1.620, 95% CI: 1.229-2.135) and in the osteoporosis subgroup (OR: 2.344, 95% CI: 1.194-4.600), and the TBS in the non-osteoporosis subgroup (OR: 1.685, 95% CI: 1.131-2.511) were the only predictors of SFFs. Conclusions In the entire-group, the TBS predicted SFFs almost as well as LS-BMD, but not independently of it. The TBS, but not LS-BMD, predicted SFFs in the non-osteoporosis subgroup.
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Affiliation(s)
- Claudio Ripamonti
- Struttura Semplice Osteoporosi e Malattie Metaboliche dello Scheleletro, Bologna, Italy.,Struttura Semplice Dipartimentale Medicina e Reumatologia Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucia Lisi
- Struttura Semplice Dipartimentale Medicina e Reumatologia Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Angela Buffa
- Programma Dipartimentale Gestione delle Malattie Reumatiche e del Connettivo e Malattie Metaboliche dell'osso-Malavolta, Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola, Italy Malpighi, Bologna, Italy
| | | | - Renata Caudarella
- Casa di Cura Privata Villalba, Bologna, GVM Care and Research, Bologna, Italy
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Abstract
Treatment and care of terminal cancer patients are conducted in different ways, according to the cultural, social, political and economical situations of the countries which have progressively adopted and developed them. In Italy there are no specialized structures such as « hospices » or the « palliative care units » like in the Anglo-Saxon world: the care of terminal cancer patients is carried out either in a general hospital or at their own home. In Milan and elsewhere there are home care teams in which doctors, nurses, social workers and volunteers, all work in connection with hospital structures. In this way, patients can receive specialized care for physical, psycological and social problems at home too. To evaluate costs and effectiveness of this program, a comparison was made between the home care and the conventional treatment carried out in general hospitals. Two groups of thirty terminal cancer patients have been studied: the first group was composed of hospital patients in Desio and the second one included patients cared for by the home care service organized by the Floriani Foundation and the Italian League against Cancer (Milan Section). We evaluated intensity and duration of pain, hours of sleep and hours of standing, sitting and lying, presence of side-effects, performance status and therapies. Data were also collected on the quality of life (Spitzer QLI), social and economical needs of the patients, type and quality of care, degree of awareness of the diagnosis by the patient and the family. This data were collected by the nurse who looked after the patient. Care costs were also quantified. The comparison between the two groups significantly favours the home care group as shown by the performance status after 2 weeks of care, the « health scale » and the Total Index of the Spitzer QLI and in general the greater satisfaction of the care received. Home care produces results equivalent to those achieved in hospitals as far as clinical parameters are concerned. An approximate quantification of the costs shows that an average cost for a day's home care was about Lit. 52,500 as compared with Lit. 360,000 for a day's hospitalization.
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Affiliation(s)
- V Ventafridda
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
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8
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Ripamonti C, Ticozzi C, Zecca E, Rodriguez CH, De Conno F. Continuous Subcutaneous Infusion of Ketorolac in Cancer Neuropathic Pain Unresponsive to Opioid and Adjuvant Drugs. A Case Report. Tumori 2018; 82:413-5. [PMID: 8890983 DOI: 10.1177/030089169608200425] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ketorolac is a new non-steroidal anti-inflammatory drug (NSAID) having a potent nonopioid analgesic activity. Administered by continuous subcutaneous infusion (CSI), its analgesic efficacy has been documented in the treatment of somatic and visceral cancer pain whilst it has been shown to be ineffective in the treatment of neuropathic pain. Here is a description of a cancer patient with neuropathic pain unresponsive to anticonvulsant or antidepressant drugs administered in association or not with oral opioids but who was successfully treated with ketorolac alone via CSI. Furthermore, the analgesia lasted over 75 days of treatment without any significant renal and gastric side effects.
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Affiliation(s)
- C Ripamonti
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
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9
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Abstract
Cancer-related pain is present in 51% of patients at various stages of the disease, and the incidence increases up to 74% in advanced and terminal stages. The World Health Organization proposed and issued very simple guidelines for the pharmacologic treatment of cancer-related pain. According to the guidelines, opioid analgesics are the mainstay of analgesic therapy, and the first choice for drug administration is considered to be the oral route. However, in some clinical situations, the oral route is not feasible, and analgesic drugs consequently have to be administered via an alternative route. For example, this is the case when the patient presents vomiting, bowel obstruction, severe dysphagia, mental confusion and when the opioid dose has to be increased drastically in order to achieve adequate pain control. This review of the literature is aimed at describing the indications, the limits and the main aspects of the pharmacokinetics and pharmacodynamics relative to the alternative routes of administration of opioids most commonly used in clinical practice. Sublingual, rectal, subcutaneous, intravenous, transdermal and spinal administration routes are examined.
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Affiliation(s)
- C Ripamonti
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
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Ripamonti C, Gemlo BT, Bozzetti F, De Conno F. Role of Enteral Nutrition in Advanced Cancer Patients: Indications and Contraindications of the Different Techniques Employed. Tumori 2018; 82:302-8. [PMID: 8890960 DOI: 10.1177/030089169608200402] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the last 20 years there has been great progress regarding total parenteral nutrition and enteral nutrition for patients who cannot take food by mouth or cannot swallow, or so that controlled feeding can be established in anorexic and malnourished patients. The use and the role of artificial nutrition is still controversial in advanced cancer patients. Such controversies often are due to the fact that these patients have a survival expectancy that varies from one to several months. The present review describes the most frequent techniques used for enteral nutrition (nasoenteral tubes, gastrostomy and jejunostomy), their indications, contraindications and complications, and gives an indication regarding which patients may really benefit from enteral nutrition taking into consideration not only the potential advantages but also the discomfort and distress related to enteral nutrition and the different techniques that are employed.
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Affiliation(s)
- C Ripamonti
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
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11
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Abstract
Malignant bowel obstruction is a common complication in patients with advanced abdominal or pelvic cancer. Whereas surgery should be considered in all cases of malignant bowel obstruction, many advanced and terminal cancer patients are considered unfit for surgery. In such patients with a short life expectancy, gastrointestinal symptoms such as nausea, vomiting, continuous and/or colicky pain, can be controlled by using a pharmacologic approach made up of analgesics, antiemetics and antisecretory drugs, without the use of a venting nasogastric tube. Among the antisecretory drugs, octreotide has been shown to reduce nausea and vomiting in bowel-obstructed patients owing to a reduction of gastrointestinal secretions, thus allowing in most patients removal of the nasogastric tube and the associated distress. Preclinical and clinical studies that demonstrated the role of somatostatin and octreotide in bowel obstruction are reviewed.
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Affiliation(s)
- C Ripamonti
- Rehabilitation and Palliative Care Division, National Cancer Institute, Milan, Italy.
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Abstract
Aims and Background Bone metastases are a common feature of advanced neoplastic disease and are considered to be among the most frequent causes of pain and complications in oncologic patients. The main objective of the treatment of such patients is to control their symptoms and improve their quality of life. Pamidronate disodium is a second-generation bisphosphonate capable of inhibiting bone resorption (particularly osteoclast activity) without affecting bone reminerali-zation. After a brief introduction concerning the pathophysiology of bone metastases and neoplastic bone pain, we herein present data on the clinical pharmacology and toxicity of bisphosphonates in general, and pamidronate in particular. We conclude by reviewing the literature on the use of pamidronate in phase II and III trials involving patients with metastatic bone disease. Methods The paper is based on a review of articles published between 1984 and 1997 selected from the Cancerline and Medline databases. Results In the considered phase II and III studies involving patients with bone metastases (breast cancer and multiple myeloma in particular), pamidronate proved to be efficacious in reducing the incidence of pain and skeletal complications, decreasing the excretion of metabolic markers of bone resorption and improving the quality of life. Intravenous infusions of 60-90 mg over a period of 2 hr every 3-4 weeks did not cause any significant toxic effects and was easily managed. Conclusions Pamidronate is a bisphosphonate that is efficacious in the treatment of symptomatic bone metastases and can be considered an important therapeutic option in association with systemic treatments, radiotherapy and normal supportive care, especially in patients with breast cancer and multiple myeloma. Further randomized studies are necessary to confirm the positive preliminary results in other neoplasms, analyze the cost/benefit ratio of the treatment, and verify the possibility that, in addition to being used for palliative purposes, pamidronate may also prevent or delay the appearance of bone metastases.
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Affiliation(s)
- C Ripamonti
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy.
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Ripamonti C, Zecca E, Brunelli C, Groff L, Boffi R, Caraceni A, Galeazzi G, Martini C, Panzeri C, Saita L, Viggiano V, De Conno F. Pain Experienced by Patients Hospitalized at the National Cancer Institute of Milan: Research Project “Towards a Pain-Free Hospital”. Tumori 2018; 86:412-8. [PMID: 11130572 DOI: 10.1177/030089160008600509] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
According to the data of the literature, the prevalence of pain in cancer patients at various stages of the disease and the settings of care range from 38 to 51%, with an increase of up to 74% in the advanced and terminal stages. Despite published World Health Organization (WHO) guidelines for pain management, 42 to 51% of cancer patients receive inadequate analgesia and 30% receive no analgesics at all. A 3-year Research Project “Towards a Pain-free Hospital”, which began one year ago, is ongoing at the National Cancer Institute of Milan. The research is organized in three subsequent steps. In the 1st one, a series of patient- and staff-oriented evaluation tools are used to assess the level of appropriateness of pain communication, assessment, management and control of the in-patients. The 2nd step will implement a number of continuing educational interventions aimed at improving patient awareness and staff knowledge of the appropriate pain assessment and management in order to respond to the patient's pain problem. In the 3rd step, all the assessment tools used in step one will be applied again to establish the prevalence of pain, the causes and intensity and patient satisfaction with pain management and to evaluate the impact of the interventions performed during the 2nd step regarding the overall ability of our hospital to tackle pain emergency in the hospitalized cancer population. The results relative to the 1st step are herein reported, in particular as regards the study on prevalence, causes, severity of pain, the interference of pain with sleep, mood and concentration, the use of pain medications and the relief obtained, the structural validity and internal consistency of the assessment tool used. A total of 258 patients hospitalized for at least 24 h were interviewed by 9 physicians using a brief structured questionnaire prepared ad hoc: 51.5% of the patients presented pain during the previous 24 h caused by surgery (49.6%) or by the tumor mass itself (29.3%). Out of the 133 patients with pain, a high degree (much or very much) of pain at rest was present in 27.1% and pain on movement in 30.8%; 31.6% did not take any analgesic treatment, and 14.3% of the latter reported a high degree of pain at rest and 21.4% on movement. Pain interfered with sleep from much to very much in 28.8% and with irritability and nervousness in 15.9% of the patients. In the 91 patients taking analgesics, 57.2% reported a high degree of pain relief. A high degree of pain and interference, however, was associated with low relief levels. The assessment tool used was shown to have a good structural validity and internal consistency (Chrombach alpha index of interference scale = 0.73). Although the Milan Cancer Institute has the longest tradition in Italy of pain assessment by means of validated tools and pain management according to the WHO guidelines and educational efforts in this field, the results of the study clearly show that it is necessary to persevere with continuing educational and informative programs in order to reduce the frequency and severity of pain and thus improve the quality of life of in-patients.
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Affiliation(s)
- C Ripamonti
- Rehabilitation & Palliative Care Unit, National Cancer Institute of Milan, Italy
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Ventafridda V, Ripamonti C, Caraceni A, Spoldi E, Messina L, De Conno F. The Management of Inoperable Gastrointestinal Obstruction in Terminal Cancer Patients. Tumori 2018; 76:389-93. [PMID: 1697993 DOI: 10.1177/030089169007600417] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of the study was to assess vomit and pain control in terminal cancer patients with inoperable gastrointestinal obstruction, using a pharmacologic symptomatic treatment which prevents recourse to nasogastric tube placement and intravenous hydration, in hospital and home care settings. Twenty-two symptomatic patients, who were judged as inoperable, were treated with a pharmacologic association of morphine hydrochloride and scopolamine butylbromide as analgesics and haloperidol as an antiemetic. The drugs were administered by continuous subcutaneous infusion via a syringe driver or intravenously only when a central venous catheter had been inserted previously. Daily recordings included assessment of pain, number of vomiting episodes, dry mouth, drowsiness, and thirst sensation. Data were examined before starting the treatment (T0), 2 days after (T2) and 2 days before death (T-2). They showed that there was a significant decrease in the pain score (p less than 0.001) on T2 and a further decrease on T-2 (p less than 0.05). Vomiting was controlled in all patients, with the exception of three patients with upper abdomen obstruction who required nasogastric tube placement. Dry mouth showed an upward trend throughout the observation period (p less than 0.05) but was successfully treated by administering liquids by mouth or ice-cubes to suck. Drowsiness too presented an upward trend from T0 to T-2 (p less than 0.001). Only one patient out of 16 who reported to be thirsty required intravenous hydration. We believe that in terminal cancer patients, vomit and pain resulting from inoperable intestinal obstruction, with the exception of obstruction of the upper abdomen, can be controlled through administration of analgesic and antiemetic drugs, in the hospital and at home, without recourse to nasogastric tube placement or intravenous hydration.
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Affiliation(s)
- V Ventafridda
- Division of Pain Therapy and Palliative Care National Cancer Institute, Milan, Italy
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15
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Martinetti A, Seregni E, Ripamonti C, Ferrari L, De Conno F, Miceli R, Pallotti F, Coliva A, Biancolini D, Bombardieri E. Serum Levels of Tartrate-Resistant Acid Phosphatase-5B in Breast Cancer Patients Treated with Pamidronate. Int J Biol Markers 2018; 17:253-8. [PMID: 12521129 DOI: 10.1177/172460080201700406] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A novel immunoassay specific for the osteoclast-produced TRAP isoform 5b has been developed recently. By means of this assay we studied the usefulness of serum TRAP-5b in monitoring the response to palliative treatment with pamidronate in breast cancer patients with bone metastases. We correlated serum TRAP-5b levels with pain intensity and intake of analgesics to assess the possible utility of the marker in identifying patients who could benefit from pamidronate treatment. Twenty-eight advanced breast cancer patients with bone metastases entered the study. Patients were treated according to the following schedule: two two-week cycles of 60 mg/week pamidronate IV, with a three-week interval in between (six infusions over seven weeks), followed by one infusion every three weeks for a total of 24 infusions over a treatment period of 61 weeks. Blood samples were taken before the start of treatment and before each infusion during two treatment cycles. To measure serum TRAP levels we employed the new immunoassay kit BoneTRAP® produced by Suomen Bioanalytiikka Oy (SBA), Oulu, Finland. In order to assess the usefulness of this marker in evaluating the response to pamidronate treatment we divided patients into two groups (group A, worsened; group B, improved) with respect to pain trend and analgesic intake. Our results did not show any statistically significant difference in baseline serum TRAP levels in the two groups. However, one week after the first pamidronate infusion TRAP-5b serum levels decreased by 39% and 18% in groups A and B, respectively (p=0.01); these levels persisted throughout the treatment period. In conclusion, a decrease in TRAP-5b serum levels may reflect the pharmacological activity of pamidronate and seems to predict pain relief and a reduction in analgesic consumption.
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Affiliation(s)
- A Martinetti
- Nuclear Medicine Division, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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16
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Bossi P, Cortinovis D, Fatigoni S, Cossu Rocca M, Fabi A, Seminara P, Ripamonti C, Alfieri S, Granata R, Bergamini C, Agustoni F, Bidoli P, Nolè F, Pessi MA, Macchi F, Michellini L, Montanaro F, Roila F. A randomized, double-blind, placebo-controlled, multicenter study of a ginger extract in the management of chemotherapy-induced nausea and vomiting (CINV) in patients receiving high-dose cisplatin. Ann Oncol 2017; 28:2547-2551. [PMID: 28666335 DOI: 10.1093/annonc/mdx315] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The activity of ginger in the management of chemotherapy-induced nausea and vomiting (CINV) has been suggested, but design inadequacies, heterogeneity of the population, small numbers and poor quality of tested products limit the possibility to offer generalizable results. PATIENTS AND METHODS We conducted a randomized, double-blind, placebo-controlled, multicenter study in patients planned to receive ≥2 chemotherapy cycles with high dose (>50 mg/m2) cisplatin. Patients received ginger 160 mg/day (with standardized dose of bioactive compounds) or placebo in addition to the standard antiemetic prophylaxis for CINV, starting from the day after cisplatin administration. CINV was assessed through daily visual-analogue scale and Functional Living Index Emesis questionnaires. The main objective was protection from delayed nausea; secondary end points included intercycle nausea and nausea anticipatory symptoms. RESULTS In total, 121 patients received ginger and 123 placebo. Lung (49%) and head and neck cancer (HNC; 35%) were the most represented tumors. No differences were reported in terms of safety profile or compliance. The incidence of delayed, intercycle and anticipatory nausea did not differ between the two arms in the first cycle and second cycle. A benefit of ginger over placebo in Functional Living Index Emesis nausea score differences (day 6-day 1) was identified for females (P = 0.048) and HNC patients (P = 0.038). CONCLUSIONS In patients treated with high-dose cisplatin, the daily addition of ginger, even if safe, did not result in a protective effect on CINV. The favorable effect observed on nausea in subgroups at particular risk of nausea (females; HNC) deserves specific investigation.
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Affiliation(s)
- P Bossi
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Scientific Direction, Latis Cro, Genova, Milano;.
| | | | - S Fatigoni
- Medical Oncology, Ospedale Santa Maria, Terni
| | - M Cossu Rocca
- Medical Oncology, Istituto Europeo di Oncologia, Milano
| | - A Fabi
- Medical Oncology, Istituto Nazionale Regina Elena, Roma
| | - P Seminara
- Medical Oncology, Università Sapienza, Roma
| | | | - S Alfieri
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Scientific Direction, Latis Cro, Genova, Milano
| | - R Granata
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Scientific Direction, Latis Cro, Genova, Milano
| | - C Bergamini
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Scientific Direction, Latis Cro, Genova, Milano
| | - F Agustoni
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - P Bidoli
- Medical Oncology, Ospedale San Gerardo, Monza
| | - F Nolè
- Medical Oncology, Istituto Europeo di Oncologia, Milano
| | | | - F Macchi
- Scientific & Clinical Development, Helsinn Integrative Care, Lugano, Switzerland
| | | | - F Montanaro
- Statistical Department, Latis Cro, Genova, Italy
| | - F Roila
- Medical Oncology, Ospedale Santa Maria, Terni
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Granchi D, Caudarella R, Ripamonti C, Spinnato P, Bazzocchi A, Torreggiani E, Massa A, Baldini N. Association between markers of bone loss and urinary lithogenic risk factors in osteopenic postmenopausal women. J BIOL REG HOMEOS AG 2016; 30:145-151. [PMID: 28002912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this study, we explored if urinary lithogenic risk parameters could have some application for monitoring bone health status. We recruited 20 women with postmenopausal osteopenia and a negative medical history for nephrolithiasis. Markers of lithogenic risk were evaluated on 24-h urine and fastingmorning urine. Serum levels of bone turnover markers (BTM) were measured in fasting-blood samples. We found that cross-linked telopeptide of type I collagen (CTX) was significantly correlated with 24-h calcium excretion. N-terminal propeptide of type I procollagen (PINP) correlated with 24-h excretion of potassium, calcium and citrate. CTX had considerably increased in patients with pH less than 5.5. Low citrate levels (less than 3.3 mmol/24 h) were associated with lower levels of CTX and PINP. Our findings suggest that a low-grade acidosis and some lithogenic risk factors are detectable in a proportion of patients with postmenopausal osteopenia. Further studies are necessary to confirm that this evaluation could be clinically relevant.
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Affiliation(s)
- D Granchi
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| | - R Caudarella
- Villalba Hospital, GVM Care and Research, Bologna, Italy
| | - C Ripamonti
- Osteoporosis and Metabolic Bone Disease Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| | - P Spinnato
- Diagnostic and Interventional Radiology, Rizzoli Orthopedic Institute, Bologna, Italy
| | - A Bazzocchi
- Diagnostic and Interventional Radiology, Rizzoli Orthopedic Institute, Bologna, Italy
| | - E Torreggiani
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| | - A Massa
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
| | - N Baldini
- Orthopedic Pathophysiology and Regenerative Medicine Unit, Rizzoli Orthopedic Institute, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Castagnaro S, Pellegrini C, Pellegrini M, Chrisam M, Sabatelli P, Toni S, Grumati P, Ripamonti C, Pratelli L, Maraldi NM, Cocchi D, Righi V, Faldini C, Sandri M, Bonaldo P, Merlini L. Autophagy activation in COL6 myopathic patients by a low-protein-diet pilot trial. Autophagy 2016; 12:2484-2495. [PMID: 27656840 PMCID: PMC5173266 DOI: 10.1080/15548627.2016.1231279] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A pilot clinical trial based on nutritional modulation was designed to assess the efficacy of a one-year low-protein diet in activating autophagy in skeletal muscle of patients affected by COL6/collagen VI-related myopathies. Ullrich congenital muscular dystrophy and Bethlem myopathy are rare inherited muscle disorders caused by mutations of COL6 genes and for which no cure is yet available. Studies in col6 null mice revealed that myofiber degeneration involves autophagy defects and that forced activation of autophagy results in the amelioration of muscle pathology. Seven adult patients affected by COL6 myopathies underwent a controlled low-protein diet for 12 mo and we evaluated the presence of autophagosomes and the mRNA and protein levels for BECN1/Beclin 1 and MAP1LC3B/LC3B in muscle biopsies and blood leukocytes. Safety measures were assessed, including muscle strength, motor and respiratory function, and metabolic parameters. After one y of low-protein diet, autophagic markers were increased in skeletal muscle and blood leukocytes of patients. The treatment was safe as shown by preservation of lean:fat percentage of body composition, muscle strength and function. Moreover, the decreased incidence of myofiber apoptosis indicated benefits in muscle homeostasis, and the metabolic changes pointed at improved mitochondrial function. These data provide evidence that a low-protein diet is able to activate autophagy and is safe and tolerable in patients with COL6 myopathies, pointing at autophagy activation as a potential target for therapeutic applications. In addition, our findings indicate that blood leukocytes are a promising noninvasive tool for monitoring autophagy activation in patients.
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Affiliation(s)
- Silvia Castagnaro
- a Department of Molecular Medicine , University of Padova , Padova , Italy
| | - Camilla Pellegrini
- b Laboratory of Musculoskeletal Cell Biology, Rizzoli Orthopedic Institute , Bologna , Italy
| | - Massimo Pellegrini
- c Department of Diagnostic , Clinical and Public Health Medicine, University of Modena and Reggio Emilia , Modena , Italy
| | - Martina Chrisam
- a Department of Molecular Medicine , University of Padova , Padova , Italy
| | - Patrizia Sabatelli
- b Laboratory of Musculoskeletal Cell Biology, Rizzoli Orthopedic Institute , Bologna , Italy.,d Institute of Molecular Genetics, CNR National Research Council of Italy, Rizzoli Orthopedic Institute , Bologna , Italy
| | - Silvia Toni
- c Department of Diagnostic , Clinical and Public Health Medicine, University of Modena and Reggio Emilia , Modena , Italy
| | - Paolo Grumati
- e Institute of Biochemistry II, Goethe University School of Medicine , Frankfurt am Main , Germany
| | - Claudio Ripamonti
- f Department of Medicine and Rheumatology , University of Bologna , Bologna , Italy
| | - Loredana Pratelli
- g Clinical Pathology Unit, Rizzoli Orthopedic Institute , Bologna , Italy
| | - Nadir M Maraldi
- b Laboratory of Musculoskeletal Cell Biology, Rizzoli Orthopedic Institute , Bologna , Italy.,d Institute of Molecular Genetics, CNR National Research Council of Italy, Rizzoli Orthopedic Institute , Bologna , Italy
| | - Daniela Cocchi
- h Department of Statistical Sciences , University of Bologna , Bologna , Italy
| | - Valeria Righi
- i Department of Life Quality Studies , Campus Rimini, University of Bologna , Bologna , Italy
| | - Cesare Faldini
- j Department of Orthopedics , University of Bologna , Bologna , Italy
| | - Marco Sandri
- k Department of Biomedical Sciences , University of Padova , Padova , Italy.,l Venetian Institute of Molecular Medicine , Padova , Italy
| | - Paolo Bonaldo
- a Department of Molecular Medicine , University of Padova , Padova , Italy.,m CRIBI Biotechnology Center, University of Padova , Padova , Italy
| | - Luciano Merlini
- b Laboratory of Musculoskeletal Cell Biology, Rizzoli Orthopedic Institute , Bologna , Italy
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Roila F, Spina F, Ripamonti C, Fumi G, Antonuzzo A, Cavanna L, Gori S, Mirabile A, Fabi A, Marzano N, Graiff C, De Sanctis V, Serpentini S, Bocci C, Pino M, Clienti G, Verusio C, Lutrino S, Fatigoni S, Ballatori E. Incidence, characteristics and treatment of fatigue in oncological cancer patients (pts) in italy: a cross-section study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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Stockman A, Ripamonti C. Red-green flicker is encoded by a peak detector and limited by slew rate. J Vis 2014. [DOI: 10.1167/14.10.592] [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: 11/24/2022] Open
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21
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Ripamonti C, Lisi L, Avella M. Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density. Br J Radiol 2014; 87:20130358. [PMID: 24678889 DOI: 10.1259/bjr.20130358] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the specificity of the neck shaft angle (NSA) to predict hip fracture in males. METHODS We consecutively studied 228 males without fracture and 38 with hip fracture. A further 49 males with spine fracture were studied to evaluate the specificity of NSA for hip-fracture prediction. Femoral neck (FN) bone mineral density (FN-BMD), NSA, hip axis length and FN diameter (FND) were measured in each subject by dual X-ray absorptiometry. Between-mean differences in the studied variables were tested by the unpaired t-test. The ability of NSA to predict hip fracture was tested by logistic regression. RESULTS Compared with controls, FN-BMD (p < 0.01) was significantly lower in both groups of males with fractures, whereas FND (p < 0.01) and NSA (p = 0.05) were higher only in the hip-fracture group. A significant inverse correlation (p < 0.01) was found between NSA and FN-BMD. By age-, height- and weight-corrected logistic regression, none of the tested geometric parameters, separately considered from FN-BMD, entered the best model to predict spine fracture, whereas NSA (p < 0.03) predicted hip fracture together with age (p < 0.001). When forced into the regression, FN-BMD (p < 0.001) became the only fracture predictor to enter the best model to predict both fracture types. CONCLUSION NSA is associated with hip-fracture risk in males but is not independent of FN-BMD. ADVANCES IN KNOWLEDGE The lack of ability of NSA to predict hip fracture in males independent of FN-BMD should depend on its inverse correlation with FN-BMD by capturing, as the strongest fracture predictor, some of the effects of NSA on the hip fracture. Conversely, NSA in females does not correlate with FN-BMD but independently predicts hip fractures.
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Affiliation(s)
- C Ripamonti
- Struttura Semplice Dipartimentale di Medicina Generale, Istituto Ortopedico Rizzoli, Bologna, Italy
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Abstract
INTRODUCTION The development of new megaprosthesis for the treatment of large bone defects provides important options to orthopaedic oncologic surgeons for the replacement of skeletal segments, such as the long bones of the upper and lower limbs and the relative joints. We implanted megaprosthesis using either a one-step or two-step technique depending on the patient's condition. The aim of this study was to evaluate retrospectively both clinical and radiological outcomes in patients who underwent lower limb megaprosthesis implant. MATERIALS AND METHODS A total of 32 patients were treated with mono- and bi-articular megaprosthesis subdivided as follows: proximal femur, distal femur, proximal tibia and total femur. The mean follow-up of patients was about 18 months (range 3 months to 5 years). Clinical and serial radiographic evaluations were conducted using standard methods (X-ray at 45 days, 3, 6, 12, 18 and 24 months) and blood parameters of inflammation were monitored for at least 2 months. RESULTS Although the mean length of follow-up was only 18 months, the first patients to enter the study were monitored for 5 years and showed encouraging clinical results, with good articulation of the segments, no somato-sensory or motor deficit and acceptable functional recovery. During surgery and, more importantly, in pre-operative planning, much attention should be given to the evaluation of the extensor apparatus, preserving it and, when necessary, reinforcing it with tendon substitutes. DISCUSSION Megaprosthesis in extreme cases of severe bone loss and prosthetic failure is a potential solution for the orthopaedic surgeon. In oncological surgery, the opportunity to restore functionality to the patient (although not ad integrum) is important for both the patient and the surgeon. The high mortality associated with cancer precludes long-term patient follow-up; therefore, there is a lack of certainty about the survival of this type of prosthesis and any medium- to long-term complications that may occur. Nevertheless, patients should be considered as an oncologic patient, not because of the disease, but because of the limited therapeutic options available. CONCLUSIONS Megaprosthesis provides a valuable opportunity to restore functionality to patients with highly disabling diseases.
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Affiliation(s)
- G M Calori
- Orthopaedic Institute, G. Pini, University of Milan, Italy.
| | - M Colombo
- Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - C Ripamonti
- Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - E Malagoli
- Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - E Mazza
- Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - P Fadigati
- Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - M Bucci
- Orthopaedic Institute, G. Pini, University of Milan, Italy
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Miscione MT, Bruno F, Ripamonti C, Nervuti G, Orsini R, Faldini C, Pellegrini M, Cocchi D, Merlini L. Body composition, muscle strength, and physical function of patients with Bethlem myopathy and Ullrich congenital muscular dystrophy. ScientificWorldJournal 2013; 2013:152684. [PMID: 24163611 PMCID: PMC3791808 DOI: 10.1155/2013/152684] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/14/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the contributions of body mass, adiposity, and muscularity to physical function and muscle strength in adult patients with Bethlem myopathy (BM) and Ullrich congenital muscular dystrophy (UCMD). MATERIALS AND METHODS Evaluation involved one UCMD and 7 BM patients. Body composition was determined by body mass index (BMI) and dual-energy-X-ray-absorptiometry (DXA), muscle strength by dynamometry, physical function by the distance walked in 6 minutes (6MWD), forced vital capacity (FVC) by a spirometer. RESULTS Six participants were of normal weight and 2 overweight based on BMI; all were sarcopenic based on appendicular fat free mass index (AFFMI); and 7 were sarcopenic obese based on AFFMI and % fat mass. Average muscle strength was reduced below 50% of normal. The 6MWD was in BM patients 30% less than normal. FVC was reduced in 4 of the BM patients. Muscle strength had a good correlation with the physical function variables. Correlation between muscle strength and BMI was poor; it was very high with AFFMI. AFFMI was the best single explicator of muscle strength and physical function. CONCLUSION Muscle mass determined by DXA explains most of the variability of the measures of muscle strength and physical function in patients with BM and UCMD.
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Affiliation(s)
- Maria Teresa Miscione
- Department of Orthopaedics, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy
| | - Francesca Bruno
- Department of Statistical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Claudio Ripamonti
- Medicina Generale, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy
| | - Giuliana Nervuti
- Direzione Sanitaria, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy
| | - Riccardo Orsini
- Department of Orthopaedics, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy
| | - Cesare Faldini
- Department of Orthopaedics, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy
| | - Massimo Pellegrini
- Department of Public Health Sciences, University of Modena and Reggio Emilia, 41122 Modena, Italy
| | - Daniela Cocchi
- Department of Statistical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Luciano Merlini
- Laboratory of Musculoskeletal Cell Biology, Istituto Ortopedico Rizzoli, IRCCS, 40136 Bologna, Italy
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Ripamonti C, Kalwarowsky S, Nardini M. A novel colour discrimination test suitable for low vision observers. J Vis 2013. [DOI: 10.1167/13.9.1023] [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: 11/24/2022] Open
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Stockman A, Henning GB, Ripamonti C. Multiple S-cone signals inferred from flicker measurements suggest a network of indirect connections into luminance. J Vis 2013. [DOI: 10.1167/13.9.297] [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: 11/24/2022] Open
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Calori GM, Colombo M, Mazza E, Ripamonti C, Mazzola S, Marelli N, Mineo GV. Monotherapy vs. polytherapy in the treatment of forearm non-unions and bone defects. Injury 2013; 44 Suppl 1:S63-9. [PMID: 23351875 DOI: 10.1016/s0020-1383(13)70015-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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: 02/02/2023]
Abstract
OBJECTIVE To determinate the efficacy of "polytherapy", a surgical technique that utilize all the components of the diamond concept (mesenchymal stem cells, bone morphogenetic proteins and scaffold) versus a "monotherapy", a surgical technique that utilize only one component of the diamond conceptin the treatment of severe forearm non-unions. METHODS We studied a database of 52 patients with 52 forearm non-unions; we classified the patients with the NUSS SCORE and we divided the patients in two group according to the treatment received. So we distinguished a group of patients treated according to the principles of "monotherapy" (33 patients) and a group of patients treated according to the principles of "polytherapy" (19 patients). The minimum follow up was 12 months. RESULTS In the monotherapy group 21/33 non-unions (63.64%) went on to develop a radiographic and clinical healing within a period of 12 months, the calculated DASH SCORE showed a mean value of 55.15 points. In the polytherapy group 17/19 (89.47%) nonunions went on to develop clinical and radiographic healing within 12 months, and the average DASH score showed a mean value of 45.47 points. CONCLUSION The polytherapy technique with the use of recombinant morphogenetic proteins, autologous MSCs and scaffold in the same surgical time appears to be an effective treatment for patients with severe forearm non-unions.
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Affiliation(s)
- G M Calori
- Reparative Orthopaedic Surgery Department, G. Pini Institute, University of Milan, Milan, Italy.
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Ripamonti C, Henning G, Stockman A. S-cone pathways. J Vis 2012. [DOI: 10.1167/12.9.109] [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: 11/24/2022] Open
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Abstract
INTRODUCTION The gold standard for restoring bone defects is still considered to be autologous bone grafting. However, clinical benefits are not guaranteed and donor-site complications and morbidity is not infrequent. Research is on-going for the development of alternative bone substitutes of both biological and synthetic origin. The purpose of this study was to evaluate the type of materials used and their efficacy for the treatment of large bone defects in traumatology and orthopaedic surgery. MATERIALS AND METHOD A literature review was carried out of Embase and PubMed databases. Inclusion criteria were articles in English language focusing on the use of bone substitutes in trauma and orthopaedic surgery for the treatment of bone defects and included details on the structural, biological or biomechanical properties of the pure product. Furthermore, based on two clinical challenges, fracture non-union and impaction grafting we elaborated on the use of polytherapy for large bone defects as guided by the diamond concept. RESULTS All the products indicated in this manuscript possess osteoconductive activities but have different resorption times and biomechanical properties. Bone graft substitute materials are used for a wide range of clinical applications even when the level of clinical evidence is low. The size and location of the defect and the local biological and mechanical environment as well as the biomechanical characteristics of the material determine the type of device that can be implanted in a bone defect. CONCLUSION Proper assessment of the biological and mechanical environment and accurate patient selection are necessary to judge the extent of therapy the injury warrants. A sound understanding of various aspects of biomaterial properties and their relation and influence towards bone healing is of utmost importance. We suggest the application of polytherapy for the treatment of large bone defects and advocate the use of the diamond concept as a guideline.
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Affiliation(s)
- G M Calori
- COR, Orthopaedic Institute, G Pini, University of Milan, Italy.
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Calori G, Colombo M, Ripamonti C, Bucci M, Fadigati P, Mazza E, Mulas S, Tagliabue L. Polytherapy in Bone Regeneration: Clinical Applications and Preliminary Considerations. Int J Immunopathol Pharmacol 2011; 24:85-90. [DOI: 10.1177/03946320110241s216] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Polytherapy, namely the simultaneous application of three fundamental elements necessary for bone regeneration (growth factors, osteogenic cells and osteocnductive scaffolds) seems to lead to a very high success rate in the treatment of complex non-union (NU) cases and critical bone defects. NU are reported in 5–10% of long bone fractures. The use of autologous bone grafts has been long-considered the gold standard for the treatment of these cases. However the harvesting procedure from the iliac crest increases surgery time and presents some donor site complications which may be elevated. In recent years, surgeons have some alternatives to autologous grafting such as: application of organic or synthetic bone substitute, application of mesenchymal stromal cells (MSC) or growth factors (GF). In the literature there are many studies available about their application in monotherapy, but unfortunately the healing rate doesn't exceed 90%. Polytherapy seems to be a logical option to improve the healing rate, nevertheless, there are not still extensive studies that validate this strategy and moreover, some questions are not resolved.
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Affiliation(s)
- G.M. Calori
- C.O.R., Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - M. Colombo
- C.O.R., Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - C. Ripamonti
- C.O.R., Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - M. Bucci
- C.O.R., Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - P. Fadigati
- C.O.R., Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - E. Mazza
- C.O.R., Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - S. Mulas
- C.O.R., Orthopaedic Institute, G. Pini, University of Milan, Italy
| | - L. Tagliabue
- C.O.R., Orthopaedic Institute, G. Pini, University of Milan, Italy
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Stockman A, Ripamonti C, Henning GB, Robbie SJ, Moore AT, Bainbridge JW, Ali RR. Restoration of rod function following gene therapy in patients with mutations in the gene encoding the RPE65 protein required for recycling all-trans-retinal to 11-cis-retinal. J Vis 2010. [DOI: 10.1167/10.15.59] [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: 11/24/2022] Open
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Ripamonti C. Illusory backward motion occurs only with a luminance component. J Vis 2010. [DOI: 10.1167/10.7.441] [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: 11/24/2022] Open
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Ripamonti C, Crowther E, Stockman A. The S-cone luminance input depends on the level of M-cone adaptation. J Vis 2010. [DOI: 10.1167/8.6.956] [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: 11/24/2022] Open
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Stockman, Crowther E, Ripamonti C. Silent surrounds: the M-cones gate the S-cone input to luminance. J Vis 2010. [DOI: 10.1167/7.15.108] [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: 11/24/2022] Open
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Ripamonti C, Westland S. Perceptual transparency determines illusory motion. J Vis 2010. [DOI: 10.1167/6.6.715] [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: 11/24/2022] Open
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Stockman A, Smithson H, Aboshiha J, West P, Ripamonti C. Chromatic appearance depends on the rate of change of the colour signal (the "slew" rate). J Vis 2010. [DOI: 10.1167/8.6.1098] [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: 11/24/2022] Open
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Lovell PG, Tolhurst DJ, Ripamonti C, To M, Troscianko T. What makes two images look different from each other? J Vis 2010. [DOI: 10.1167/6.6.562] [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: 11/24/2022] Open
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Ripamonti C, Maniezzo M, Ghiringhelli R, Cislaghi E, Mariani L. Medical Ozone (O3) Oil or Gas Applications Heal Osteonecrosis of the Jaw (ONJ) in Patients Treated with Bisphosphonates (BPs). Preliminary Results of a Single Arm Study. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-5046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Treatment of bone metastasis with BP is aimed at preventing skeletal related events (SREs) and rarely leads to ONJ (<1%) (Hoff, JBMR. 2008). Preventive dental care is a simple and effective way to reduce the risk reduction of ONJ in 75% of the cases (Ripamonti, Ann Oncol. 2009). To date, there are still no standardized therapy for the treatment of ONJ. We report the effect of localized of O3 oil or gas application in cancer patients (12 breast cancer, 4 prostate cancer, 2 lung cancer, 1 NHL, 3 multiple myeloma) with ONJ observed in our institution. Patients had previously received nitrogene-BPs treatment in the absence of odontoiatric preventive measures. All the patients were in had stable disease without progression; 10 of them had ONJ lesions ≤ to 2.5 cm.O3 oil suspension applications on ONJ lesions ≤ 2.5 cm was carried out with localized applications directly on the lesions; patients with larger lesions (≥ 2.5 cm) were treated with the ozone gas locally applied. All the patients received treatment of O3 oil every third day and all of them were treated with antibiotic therapy (azithromycin, 500 mg/day) 10 days prior the initiation of the treatment with O3 oil. The statistical analysis is based on a Simon two-stage design, the second stage is on-going. In this preliminary analysis we focus on 10 patients treated with O3 oil with a medium follow up of 8 months, and 12 patients on medical gas ozone.73% of the patients (n=16) showed complete response in terms of radiological lesion disappearance with complete reconstruction of oral tissue. Among them, fourteen patients developed spontaneous sequestrum with expulsion of the necrotic bone whereas in 2 patients with large extension of bone involvement surgical intervention was necessary.Seventy percent of the patients treated with O3 oil experienced a complete response after 4 applications whereas patients treated with gas needed 4 to 16 applications (depending on the severity of the lesion). No patients presented adverse events related to the use of ozone treatments. Six patients are still on treatment and are improving as well.According to these results few application of O3 oil suspension in patients with smaller lesions and gas medical ozone for wider lesions following antibiotic therapy can rapidly lead to complete healing of ONJ. Further cases and complete follow-up data are required. These data indicate that ONJ is a manageable condition which can be not only prevented by means previously dental examination but also healed with medical ozone applications.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5046.
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Affiliation(s)
- C. Ripamonti
- 1National Cancer Institute of Milan, Milan, Italy
| | - M. Maniezzo
- 2National Cancer Institute of Milan, Milan, Italy
| | | | - E. Cislaghi
- 2National Cancer Institute of Milan, Milan, Italy
| | - L. Mariani
- 4National Cancer Institute of Milan, Milan, Italy
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Bandieri E, Chiarolanza A, Luppi M, Magrini N, Marata A, Ripamonti C. Prescription of opioids in Italy: everything, but the morphine. Ann Oncol 2009; 20:961-2. [DOI: 10.1093/annonc/mdp041] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Costantini M, Ripamonti C, Beccaro M, Montella M, Borgia P, Casella C, Miccinesi G. Prevalence, distress, management, and relief of pain during the last 3 months of cancer patients’ life. Results of an Italian mortality follow-back survey. Ann Oncol 2009; 20:729-35. [DOI: 10.1093/annonc/mdn700] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ripamonti C, Woo WL, Crowther E, Stockman A. The S-cone contribution to luminance depends on the M- and L-cone adaptation levels: Silent surrounds? J Vis 2009; 9:10.1-16. [DOI: 10.1167/9.3.10] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Larkin PJ, Sykes NP, Centeno C, Ellershaw JE, Elsner F, Eugene B, Gootjes JRG, Nabal M, Noguera A, Ripamonti C, Zucco F, Zuurmond WWA. The management of constipation in palliative care: clinical practice recommendations. Palliat Med 2008; 22:796-807. [PMID: 18838491 DOI: 10.1177/0269216308096908] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [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: 01/14/2023]
Abstract
Constipation is one of the most common problems in patients receiving palliative care and can cause extreme suffering and discomfort. The aims of this study are to raise awareness of constipation in palliative care, provide clear, practical guidance on management and encourage further research in the area. A pan-European working group of physicians and nurses with significant experience in the management of constipation in palliative care met to evaluate the published evidence and produce these clinical practice recommendations. Four potentially relevant publications were identified, highlighting a lack of clear, practical guidance on the assessment, diagnosis and management of constipation in palliative care patients. Given the limited data available, our recommendations are based on expert clinical opinion, relevant research findings from other settings and best practice from the countries represented. Palliative care patients are at a high risk of constipation, and while general principles of prevention should be followed, pharmacological treatment is often necessary. The combination of a softener and stimulant laxative is generally recommended, and the choice of laxatives should be made on an individual basis. The current evidence base is poor and further research is required on many aspects of the assessment, diagnosis and management of constipation in palliative care.
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Affiliation(s)
- P J Larkin
- School of Nursing and Midwifery, Aras Moyola, The National University of Ireland, Galway, Ireland.
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Ripamonti C, Maniezzo M, Cislaghi E, Campa T, Fagnoni E, Saibene G, Bareggi C, Ascani L, Brunelli C. Application of preventive measures minimizes the occurrence of osteonecrosis of the jaw (ONJ) in bisphosphonate treated breast cancer patients with bone metastases. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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De Conno F, Ripamonti C, Fagnoni E, Brunelli C, Luzzani M, Maltoni M, Arcuri E, Bertetto O. The MERITO Study: a multicentre trial of the analgesic effect and tolerability of normal-release oral morphine during 'titration phase' in patients with cancer pain. Palliat Med 2008; 22:214-21. [PMID: 18477715 DOI: 10.1177/0269216308088692] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [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: 11/17/2022]
Abstract
Adequate and rapid pain control is one of the main goals of cancer pain treatment. The objective of this study was to assess the effect and tolerability of oral normal-release morphine during the initial phase of treatment in patients with moderate-to-severe cancer pain. Consecutive patients naïve to strong opioids received normal-release morphine 5 or 10 mg every 4 h during the titration phase (first 5 days), depending on previous analgesic therapy. Pain intensity was assessed using an 11-point Numerical Rating Scale (0-10), and data were recorded in a patient-compiled diary. The primary endpoint was the proportion of time with pain control (a reduction of at least 50% with respect to the baseline pain score) during the titration phase. A total of 159 consecutive patients (102 men; mean age 65 years) with cancer-related pain were enrolled. Pain control was observed for 75% (95% CI 70-80) of the follow-up period in the intent-to-treat population. Overall, 50% and 75% of patients achieved pain control within 8 and 24 h after starting normal-release morphine therapy respectively. The mean pain score was 7.63 points at baseline, and decreased to 2.43 and 1.67 points (both P<0.001) at days 3 and 5 respectively. The most commonly reported adverse events were somnolence (24% of patients), constipation (22%), vomiting (13%), nausea (10%) and confusion (7%). Normal-release morphine results in rapid and satisfactory pain control, and is well tolerated, during the strong-opioid titration phase in patients with moderate-to-severe cancer pain.
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Affiliation(s)
- F De Conno
- Rehabilitation and Palliative Care Operative Unit, IRCCS Foundation, National Cancer Institute, Milano, Italy
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Body J, Coleman R, Clezardin P, Ripamonti C, Rizzoli R, Aapro M. 1302 POSTER Updated International Society of Geriatric Oncology (SIOG) recommendations for the use of bisphosphonates in elderly cancer patients with bone metastases. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Martinetti A, Ripamonti C, Miceli R, Seregni E, Mariani L, De Conno F, Bajetta E, Bombardieri E. Short-term effects of pamidronate on bone turnover: can bone markers be considered predictive of the analgesic response? Oncol Rep 2007; 17:1533-40. [PMID: 17487415 DOI: 10.3892/or.17.6.1533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Few data are available on the ability of bone markers to predict the symptomatic response to bisphosphonate therapy in patients with painful bone metastases. We evaluated the levels of bone markers in patients with bone metastases receiving pamidronate and determined the corresponding analgesic response. Forty-two patients were administered two two-week cycles of intravenous pamidronate 60 mg/week with a three-week interval in between. Serum levels of bone formation, resorption and other bone-associated markers (osteoprotegerin, osteopontin and calcium) were measured. Levels of two urinary markers were also measured and the intensity of pain and analgesic drug consumption evaluated. A mixed effects linear modelling approach was adopted to account for possible correlation among marker levels and time on study or analgesic response. We created an indicator variable that classified the patients' analgesic response as 'improved/stationary' or 'worsened' determined by patient reported intensity of pain and analgesic drug consumption. Eighteen patients 'worsened' and 24 were 'improved/stationary'. The results of the mixed effects models for testing the association between marker levels and time on study or analgesic response showed: i) the changes in marker levels over time did not significantly differ between the two groups; ii) the overall test for time on study was not statistically significant for C-terminal telopeptide of type I collagen (ICTP), osteoprotegerin and osteopontin; iii) in contrast, ICTP and osteoprotegerin were significantly associated with analgesic response. Biochemical markers of bone turnover, in particular ICTP and osteoprotegerin seem promising for predicting and objectively assessing the analgesic response to pamidronate treatment.
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Affiliation(s)
- A Martinetti
- Medical Oncology Operative Unit II, National Cancer Institute of Milano, I-20133 Milano, Italy
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Ripamonti C, Fagnoni E, Campa T, Giardina V, Brunelli C, De Conno F. Pain on movement and pain at rest decrease after zoledronic acid infusion in patients with bone metastases due to breast or prostate cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18582 Background: There is no study on bisphosphonates assessing separately pain at rest and incident pain. Aim of the study was to evaluate the reduction in pain at rest and incident pain after treatment (up to 6 infusions) with 4 mg zoledronic acid (ZA) I.V. every 28 days in patients with bone metastases. Methods: All consecutive patients with bone metastases from breast or prostate cancer starting ZA treatment (August 2002 - May 2004) at NCI of Milan were enrolled in this observational prospective longitudinal study. Pain at rest and incident pain referred to the prior week were measured by a six level verbal scale (0–5 score) at baseline and on each infusion as well as at follow-up visit (2 weeks after every infusion). The two main endpoints (estimated reduction in pain at rest and incident pain) were defined as the difference between the baseline score and the average of all the post-treatment scores for each patient, and are presented with their respective 95% Confidence Interval. Positive values indicate reduction. Because of the potential confounding effect of analgesics intake, patients without any increase in analgesic consumption while on study were also analyzed as a separate subgroup. Results: 48 patients (mean age 66 years, 33 female), with breast (34) or prostate cancer (14) were enrolled. 30 patients underwent 4 to 6 infusions while 7 dropped out before the first follow-up visit. The analysis was performed on the 41 patients with at least one follow-up evaluation (average number of evaluations = 8.1 range = 1–13). The estimated reduction in pain at rest and incident pain was 0.55 (0.19–0.91) and 0.73 (0.31–1.14) respectively. In the 13 patients who did not report increased analgesic consumption, the estimated reduction was still substantial: 0.61 (0.25–0.97) 1.12 (0.41–1.83) respectively. Conclusions: This is the first study showing that in patients with painful multiple bone metastases, ZA reduces both pain at rest and incident pain in patients with painful bone metastases. [Table: see text]
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Affiliation(s)
- C. Ripamonti
- National Cancer Institute of Milano, Milan, Italy
| | - E. Fagnoni
- National Cancer Institute of Milano, Milan, Italy
| | - T. Campa
- National Cancer Institute of Milano, Milan, Italy
| | - V. Giardina
- National Cancer Institute of Milano, Milan, Italy
| | - C. Brunelli
- National Cancer Institute of Milano, Milan, Italy
| | - F. De Conno
- National Cancer Institute of Milano, Milan, Italy
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Zipeto D, Matucci A, Rossolillo P, Ripamonti C, Scarlatti G, Lopalco L, Hazan U, Bertazzoni U. Fusion Complexes and CD4-independent gp120s for the Induction of HIV-1 Neutralizing Antibodies. Retrovirology 2005. [DOI: 10.1186/1742-4690-2-s1-s121] [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: 11/10/2022] Open
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Casali PG, Stacchiotti S, Messina A, Tamborini E, Martini C, Ripamonti C, Crippa F, Spreafico C, Colecchia M, Pilotti S. Imatinib mesylate in 18 advanced chordoma patients. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - F. Crippa
- Inst Nazionale Tumori, Milano, Italy
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