1
|
McNeil MJ, Garcia Quintero X, Gonzalez M, Zheng Y, Ugaz Olivares C, Morales R, Boldrini E, Rebollo de Campos D, Ferreira D, Coopasamy K, Caneba J, Padernilla ML, Friedrichsdorf S, Baker JN, Friedrich P. Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries. Cancers (Basel) 2024; 16:1025. [PMID: 38473383 DOI: 10.3390/cancers16051025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the "Children's Comfort Promise", includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the "Global Comfort Promise" was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children's Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child's pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.
Collapse
Affiliation(s)
- Michael J McNeil
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ximena Garcia Quintero
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Miriam Gonzalez
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yawen Zheng
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | | | - Roxana Morales
- Instituto Nacional de Enfermedades Neoplásicas, Lima 15038, Peru
| | - Erica Boldrini
- Hospital de Câncer Infantojuvenil de Barretos, Barretos 14784-400, Brazil
| | | | - Daiane Ferreira
- Hospital de Câncer Infantojuvenil de Barretos, Barretos 14784-400, Brazil
| | | | - Joliza Caneba
- Philippines General Hospital, Manila 1000, Philippines
| | | | - Stefan Friedrichsdorf
- Division of Pediatric Pain, Palliative Care & Integrative Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care, Stanford University, Palo Alto, CA 94305, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| |
Collapse
|
2
|
McNeil MJ, Godfrey A, Loggetto P, de Oliveira Junior A, Job G, Boldrini E, Regina Costa Murra G, Antunes Geronutti Ayub D, Francisco Oliveira de Lima A, Esmeraldo Andrade de Almeida A, Lopes Garcia J, Beatriz Costa Neves do Amaral A, Cristina Cunha Ferreira e Fonseca I, Friedrich P, Metzger ML, Devidas M, Agulnik A, Baker JN. Physician Perceptions of and Barriers to Pediatric Palliative Care for Children With Cancer in Brazil. JCO Glob Oncol 2023; 9:e2300057. [PMID: 37535886 PMCID: PMC10581636 DOI: 10.1200/go.23.00057] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/02/2023] [Accepted: 06/13/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE Early integration of pediatric palliative care (PPC) for children with cancer is critical to improving the quality of life of both the patient and family. Understanding physician perceptions of palliative care and perceived barriers to early integration is necessary to develop PPC in Brazil. METHODS The Assessing Doctors' Attitudes on Palliative Treatment survey was modified for use in Brazil. The survey was open from January 2022 to June 2022 and distributed to physicians of all specialties from participating institutions who treat children with cancer. Statistical analysis was complemented by qualitative analysis of open-ended responses. RESULTS A total of 272 respondents participated. Most respondents reported access to PPC experts for consultation (77.2%) and 34.5% indicated previous palliative care training. Physician knowledge of PPC was generally aligned with WHO guidance (median alignment, 93.0%; range, 80.5%-98.2%). However, about half (53.3%) felt comfortable addressing physical needs of patients receiving PPC, 35.3% addressing emotional needs, 25.8% addressing spiritual needs, and 33.5% addressing grief and bereavement needs. Most respondents (65.4%) felt palliative care should be involved from diagnosis, but only 10.3% stated that this occurred in their setting. The most important barriers identified were physician discomfort (89.0%), limited physician knowledge (88.6%), and lack of home-based services (83.8%). CONCLUSION Despite a strong understanding of the role of palliative care, physicians in Brazil reported low confidence delivering PPC to children with cancer. Additionally, physicians generally believed that PPC should be integrated earlier in the disease trajectory of children with cancer. This work will direct educational and capacity building initiatives to ensure greater access to high-quality PPC for children with cancer in Brazil to address patient and family suffering.
Collapse
Affiliation(s)
- Michael J. McNeil
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Patricia Loggetto
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | | | - Godwin Job
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Erica Boldrini
- Hospital de Câncer Infantojuvenil de Barretos, Barretos, Brazil
| | | | | | | | | | - Julia Lopes Garcia
- Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | | | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
3
|
Menozzi R, Valoriani F, Prampolini F, Banchelli F, Boldrini E, Martelli F, Galetti S, Fari' R, Gabriele S, Palumbo P, Forni D, Pantaleoni M, D'Amico R, Pecchi AR. Impact of sarcopenia in SARS-CoV-2 patients during two different epidemic waves. Clin Nutr ESPEN 2022; 47:252-259. [PMID: 35063210 PMCID: PMC8648616 DOI: 10.1016/j.clnesp.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 01/11/2023]
Abstract
Background Sarcopenia was reported to be associated with poor clinical outcome, higher incidence of community-acquired pneumonia, increased risk of infections and reduced survival in different clinical settings. The aim of our work is to evaluate the prognostic role of sarcopenia in patients with the 2019 novel coronavirus disease (COVID-19). Materials and methods 272 COVID-19 patients admitted to the University Hospital of Modena (Italy) from February 2020 to January 2021 were retrospectively studied. All included patients underwent a chest computed tomography (CT) scan to assess pneumonia during their hospitalization and showed a positive SARS-CoV-2 molecular test. Sarcopenia was defined by skeletal muscle area (SMA) evaluation at the 12th thoracic vertebra (T12). Clinical, laboratory data and adverse clinical outcome (admission to Intensive Care Unit and death) were collected for all patients. Results Prevalence of sarcopenia was high (41.5%) but significantly different in each pandemic wave (57.9% vs 21.6% p < 0.0000). At the multivariate analysis, sarcopenia during the first wave (Hazard Ratio 2.29, 95% confidence intervals 1.17 to 4.49 p = 0.0162) was the only independent prognostic factor for adverse clinical outcome. There were no significant differences in comorbidities and COVID19 severity in terms of pulmonary involvement at lung CT comparing during the first and second wave. Mixed pattern with peripheral and central involvement was found to be dominant in both groups. Conclusion We highlight the prognostic impact of sarcopenia in COVID-19 patients hospitalized during the first wave. T12 SMA could represent a potential tool to identify sarcopenic patients in particular settings. Further studies are needed to better understand the association between sarcopenia and COVID-19.
Collapse
Affiliation(s)
- R Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy.
| | - F Valoriani
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - F Prampolini
- Department of Radiology, University Hospital of Modena, Modena, Italy
| | - F Banchelli
- Unit of Clinical Statistics, University Hospital of Modena, Modena, Italy
| | - E Boldrini
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - F Martelli
- Department of Radiology, University Hospital of Modena, Modena, Italy
| | - S Galetti
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - R Fari'
- Department of Radiology, University Hospital of Modena, Modena, Italy
| | - S Gabriele
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - P Palumbo
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - D Forni
- Department of Radiology, University Hospital of Modena, Modena, Italy
| | - M Pantaleoni
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - R D'Amico
- Unit of Clinical Statistics, University Hospital of Modena, Modena, Italy
| | - A R Pecchi
- Department of Radiology, University Hospital of Modena, Modena, Italy
| |
Collapse
|
4
|
Abrahao-Machado LF, Pinto F, Antunes B, Volc S, Boldrini E, Camargo OPD, Reis RM. Clinical impact of brachyury expression in Ewing sarcoma patients. Adv Med Sci 2021; 66:321-325. [PMID: 34273746 DOI: 10.1016/j.advms.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/21/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The T-box transcription factor brachyury has been demonstrated as a prognostic factor in a variety of cancer types and considered a novel oncotarget in solid tumors. Brachyury acts as a regulator of the epithelial-mesenchymal transition (EMT) process, leading to more aggressive behavior and poorer prognosis. However, recent literature evidence suggests a tumor suppressor role in other neoplasms. In the present study, we aimed to study brachyury expression and its prognostic impact in Ewing sarcoma, an aggressive neoplasm of young individuals. METHODS We analyzed the expression of brachyury by immunohistochemistry in a series of 96 Ewing sarcomas in a tissue microarray and investigated the association of the protein expression with the clinical parameters and overall survival. RESULTS More than half of the cases (51%, n = 49) depicted positive nuclear brachyury expression, while a lack of expression was observed in 49% (n = 47) of cases. Nuclear brachyury staining was significantly associated with non-white ethnicity (p = 0.04) and axial localization (p = 0.025). Importantly, lack of brachyury expression was significantly associated with lower overall survival in multivariate analyses (hazard ratio - HR: 2.227, p = 0.008). CONCLUSIONS Our findings indicate, that brachyury is an independent prognostic biomarker in Ewing sarcoma, which might suggest a tumor suppressor role and which yet to be fully elucidated.
Collapse
|
5
|
Abrahao-Machado LF, Antunes B, Filippi RZ, Volc S, Boldrini E, Menezes WP, Reis RM, de Camargo OP. Loss of MTAP expression is a negative prognostic marker in Ewing sarcoma family of tumors. Biomark Med 2018; 12:35-44. [DOI: 10.2217/bmm-2017-0152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The Ewing sarcoma family of tumors (ESFT) is a group of malignant small round cell neoplasms of bones and soft tissues closely histogenetically related. Methylthioadenosine phosphorylase (MTAP) deficiency has been recently associated with increased tumor aggressiveness and poor outcomes in different types of neoplasms. However, the expression of this biomarker and its biological role in ESFT remain largely unknown. Methods: Immunohistochemical expression of MTAP was accessed in 112 patients with ESFT in a tissue microarray platform and associated with clinicopathological parameters and overall survival (OS). Results: Loss of MTAP expression was significantly associated with lower OS in both univariate and multivariate analyses. Conclusion: Loss of MTAP expression is an independent negative prognostic biomarker in ESFT.
Collapse
Affiliation(s)
| | - Bruno Antunes
- Department of Othopedics Surgery, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Renee Zon Filippi
- Institute of Orthopedics & Traumatology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Sahlua Volc
- Oncology Department, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Erica Boldrini
- Pediatrics Department, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Weder P Menezes
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Rui M Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil
- Life & Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Olavo Pires de Camargo
- Institute of Orthopedics & Traumatology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil
| |
Collapse
|
6
|
Ferreira AJ, Boldrini E, López RVM, Scapulatempo Neto C, Santos JFC, Lopes LF. Characterization, survival analysis, and expression of IGFR in tumor samples from patients diagnosed with Ewing family tumors treated at the Barretos Cancer Hospital. Rev Bras Ortop 2016; 52:705-713. [PMID: 29234655 PMCID: PMC5720841 DOI: 10.1016/j.rboe.2016.10.015] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/04/2016] [Indexed: 01/24/2023] Open
Abstract
Objectives Study the clinical characteristics of patients diagnosed with Ewing family tumors (EFTs) and survival analysis based on risk criteria and expression of the surface protein known as insulin-like growth factor (IGFR). Methods This was a retrospective cohort study based on clinical data from 77 patients diagnosed with EFTs treated by the Department of Pediatric Oncology at the Barretos Cancer Hospital in a period between 2003 and 2012. Biological samples of patients were examined for the presence of the surface receptor IGFR. Results The overall survival rate (OSR) of patients included in the study was 45% at five years, and EFS was 30% at five years. Metastasis at diagnosis was present in 44.2% of the sample; 88.2% of the sample was male (p < 0.001). The evaluation of the expression of IGFR in biological samples of patients was associated with the variable metastasis at diagnosis (p < 0.001). Worse prognosis was observed in patients with extrapulmonary metastasis (p = 0.009). The local treatment of neoplasia presented better prognosis in patients undergoing local surgical treatment (p < 0.001). Conclusions These results showed a higher incidence of metastasis at diagnosis in patients with EFTs treated at the Barretos Cancer Hospital (BCH). Extrapulmonary metastases were a negative prognostic factor in this study. Surgical treatment of the primary tumor was a factor for better prognosis. Strong expression of IGFR was more frequent in patients with metastases at diagnosis, but did not represent a prognostic factor for EFTs.
Collapse
Affiliation(s)
| | - Erica Boldrini
- Hospital de Câncer Infanto-Juvenil de Barretos, Oncologia Pediátrica, Barretos, SP, Brazil
| | | | | | | | - Luiz Fernando Lopes
- Hospital de Câncer Infanto-Juvenil de Barretos, Oncologia Pediátrica, Barretos, SP, Brazil
| |
Collapse
|
7
|
Senerchia AA, Macedo CR, Ferman S, Scopinaro M, Cacciavillano W, Boldrini E, Lins de Moraes VL, Rey G, de Oliveira CT, Castillo L, Almeida MT, Borsato ML, Lima E, Lustosa D, Barreto JH, El-Jaick T, Aguiar S, Brunetto A, Greggiani L, Cogo-Moreira H, Atallah A, Petrilli AS. Results of a randomized, prospective clinical trial evaluating metronomic chemotherapy in nonmetastatic patients with high-grade, operable osteosarcomas of the extremities: A report from the Latin American Group of Osteosarcoma Treatment. Cancer 2016; 123:1003-1010. [PMID: 28263383 DOI: 10.1002/cncr.30411] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Metronomic chemotherapy (MC) consists of the administration of a low dose of chemotherapy on a daily or weekly basis without a long break to achieve an antitumoral effect through an antiangiogenic effect or stimulation of the immune system. The potential effect of MC with continuous oral cyclophosphamide and methotrexate in patients with high-grade operable osteosarcomas (OSTs) of the extremities was investigated. METHODS Patients with high-grade OSTs who were 30 years old or younger were eligible for registration at diagnosis. Eligibility for randomization included 1) nonmetastatic disease and 2) complete resection of the primary tumor. The study design included a backbone of 10 weeks of preoperative therapy with methotrexate, adriamycin, and platinum (MAP). After surgery, patients were randomized between 2 arms to complete 31 weeks of MAP or receive 73 weeks of MC after MAP. The primary endpoint was event-free survival (EFS) from randomization. RESULTS There were 422 nonmetastatic patients registered (May 2006 to July 2013) from 27 sites in 3 countries (Brazil, Argentina and Uruguay), and 296 were randomized to MAP plus MC (n = 139) or MAP alone (n = 157). At 5 years, the EFS cumulative proportions surviving in the MAP-MC group and the MAP-alone group were 61% (standard error [SE], 0.5%) and 64% (SE, 0.5%), respectively, and they were not statistically different (Wilcoxon [Gehan] statistic = 0.724; P =.395). The multivariate analysis showed that necrosis grades 1 and 2, tumor size, and amputation were associated with shorter EFS. CONCLUSIONS According to the current follow-up, EFS with MAP plus MC is not statistically superior to EFS with MAP alone in patients with high-grade, resectable OSTs of the extremities. Cancer 2017;123:1003-10. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Andreza A Senerchia
- Institute of Pediatric Oncology/Support Group for Adolescents and Children With Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Carla Renata Macedo
- Institute of Pediatric Oncology/Support Group for Adolescents and Children With Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Sima Ferman
- National Cancer Institute, Rio de Janeiro, Brazil
| | - Marcelo Scopinaro
- Hospital de Pediatria SAMIC-Professor Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Walter Cacciavillano
- Hospital de Pediatria SAMIC-Professor Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | | | - Guadalupe Rey
- R. Gutierrez Children's Hospital, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio Sergio Petrilli
- Institute of Pediatric Oncology/Support Group for Adolescents and Children With Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
8
|
Anderson PM, Bielack SS, Gorlick RG, Skubitz K, Daw NC, Herzog CE, Monge OR, Lassaletta A, Boldrini E, Pápai Z, Rubino J, Pathiraja K, Hille DA, Ayers M, Yao S, Nebozhyn M, Lu B, Mauro D. A phase II study of clinical activity of SCH 717454 (robatumumab) in patients with relapsed osteosarcoma and Ewing sarcoma. Pediatr Blood Cancer 2016; 63:1761-70. [PMID: 27362300 PMCID: PMC5129487 DOI: 10.1002/pbc.26087] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/19/2016] [Accepted: 04/28/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Robatumumab (19D12; MK-7454 otherwise known as SCH717454) is a fully human antibody that binds to and inhibits insulin-like growth factor receptor-1 (IGF-1R). This multiinstitutional study (P04720) determined the safety and clinical efficacy of robatumumab in three separate patient groups with resectable osteosarcoma metastases (Group 1), unresectable osteosarcoma metastases (Group 2), and Ewing sarcoma metastases (Group 3). PROCEDURE Robatumumab infusions were administered every 2 weeks and were well tolerated with minimal toxicity. Centrally reviewed response data were available for 144 patients. RESULTS Low disease burden was important for osteosarcoma response: three of 31 patients had complete response or partial response (PR) by Response Evaluation Criteria in Solid Tumors (RECIST) in resectable patients (Group 1) versus zero of 29 in unresectable patients (Group 2); median overall survival was 20 months in Group 1 versus 8.2 months in Group 2. In centrally reviewed patients with Ewing sarcoma with PET-CT data (N = 84/115), there were six PR, 23 stable disease, and 55 progression of disease by RECIST at 2 months. Patients with Ewing sarcoma had a median overall survival of 6.9 months. However, responding patients with Ewing sarcoma were allowed to continue on treatment after study closure. A minority of patients with metastatic Ewing sarcoma showed clinical responses and have remained healthy after receiving 25-115 doses of robatumumab with remissions of >4 years duration (N = 6). CONCLUSIONS These findings show that although the IGF-1R remains an attractive treatment target, additional research is needed to identify responders and/or means to achieve durable remissions in order to successfully exploit IGF-1R signal blockade in Ewing sarcoma (clinicaltrials.gov: NCT00617890).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brian Lu
- Merck & Co., IncKenilworthNew Jersey
| | | |
Collapse
|
9
|
Brunetto AL, Castillo LA, Petrilli AS, Macedo CD, Boldrini E, Costa C, Almeida MT, Kirst D, Rodriguez-Galindo C, Pereira WV, Watanabe FM, Pizza M, Benites E, Morais V, Gadelha A, Nakasato A, Abujamra AL, Gregianin LJ. Carboplatin in the treatment of Ewing sarcoma: Results of the first Brazilian collaborative study group for Ewing sarcoma family tumors-EWING1. Pediatr Blood Cancer 2015; 62:1747-53. [PMID: 25917418 DOI: 10.1002/pbc.25562] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/24/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Large cooperative group studies have shown the efficacy of risk-adapted treatment for Ewing sarcoma. However, validation and local adaptation by National cooperative groups is needed. A multicenter protocol to determine the efficacy and safety of a risk-adapted intensive regimen was developed by the Brazilian cooperative group. PROCEDURE Patients <30 years old with Ewing sarcoma were eligible. Induction chemotherapy consisted of two cycles of ICE (ifosfamide, carboplatin, and etoposide) followed by two cycles of VDC (vincristine, doxorubicin, and cyclophosphamide), followed by local control. Patients with low risk (LR) disease (localized resectable with normal LDH) received 10 additional alternating courses of IE with VDC. For patients with high-risk (HR) disease (unresectable, pelvic, metastatic, or high LDH), two additional cycles of ICE were given. RESULTS One-hundred seventy five patients (39% metastatic) were enrolled. Fifty-two patients (29.7%) were LR and 123 (70.3%) were HR. Overall response rate at end of induction was 27.4%. Five-year event-free survival (EFS) and overall survival (OS) estimates were 51.4% and 54.4%, respectively. Patients with localized disease had better outcomes than patients with metastases (5-year EFS 67.9% vs. 25.5%, and 5-year OS 70.3% vs. 29.1%, respectively). On multivariate analysis, the presence of metastatic disease was the only prognostic factor (P < 0.01). CONCLUSION The VDC/ICE protocol was feasible, and considering the high tumor burden in our population, resulted in comparable results to those reported by cooperative groups in high-income countries. Further adaptation to maximize efficacy and minimize toxicity will be required.
Collapse
Affiliation(s)
| | | | - Antonio S Petrilli
- Department of Pediatrics, Pediatric Oncology Institute (IOP/GRAACC/UNIFESP), Federal University of S, ã, o Paulo, São Paulo, SP, Brazil
| | - Carla D Macedo
- Department of Pediatrics, Pediatric Oncology Institute (IOP/GRAACC/UNIFESP), Federal University of S, ã, o Paulo, São Paulo, SP, Brazil
| | - Erica Boldrini
- Fundação Pio XII - Hospital Infantojuvenil, Barretos, SP, Brazil
| | - Cecilia Costa
- Hospital do Câncer AC Camargo, São Paulo, SP, Brazil
| | - Maria T Almeida
- Hospital das Clínicas de São Paulo - ITACI, São Paulo, SP, Brazil
| | - Daniela Kirst
- Hospital da Criança Santo Antonio, Porto Alegre, RS, Brazil
| | | | - Waldir V Pereira
- Hospital Universit, á, rio de Santa Maria, Santa Maria, RS, Brazil
| | | | - Maria Pizza
- Santa Casa de Misericórdia de São Paulo, SP, Brazil
| | - Eliana Benites
- Instituto de Clínicas Pediátricas Bolívar Risso, Jundiaí, SP, Brazil
| | - Vera Morais
- Hospital Universitário Oswaldo Cruz, Recife, PE, Brazil
| | | | | | | | - Lauro J Gregianin
- Hospital São Lucas - PUC-RS, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | |
Collapse
|
10
|
Gregianin LJ, Scopinaro M, Rose A, Boldrini E, Ferman S, Petrilli AS, Costa CMJ, Kirst D, Dufort G, Villarroel M, Salgado C, Almeida MTA, Valero M, Rizzatti M, Castillo LA, Siqueira L, Lustosa D, Pizza M, Rey G, Brunetto A. A multicentric study of interval compressed multiagent chemotherapy and metronomic chemotherapy for patients with Ewing sarcoma family of tumors: The Latin American Pediatric Oncology Group trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps10079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
| | - Marcelo Scopinaro
- Hospital de Pediatria S.A.M.I.C. - Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Adriana Rose
- Hospital Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | - Sima Ferman
- Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
| | | | | | | | - Gustavo Dufort
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | | | | | | | | | - Marcelo Rizzatti
- Instituto de Clínicas Ped. Bolivar Risso-GRENDACC, Sâo Paulo, Brazil
| | | | | | | | - Maria Pizza
- Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Guadalupe Rey
- Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | | |
Collapse
|
11
|
Petrilli AS, Macedo CR, Ferman S, Scopinaro M, Cacciavillano W, Boldrini E, Morais VLL, Rey GL, de Oliveira CT, Castillo LA, Almeida MTA, Borsato ML, Lima E, Lustosa D, Barreto JH, Brunetto AL, Costa TELJAICKB, Dos Santos Aguiar S, Petrilli M, Alves MTDS. Results of a randomized prospective clinical trial evaluating maintenance chemotherapy in patients with high-grade, operable osteosarcoma: A report from the Latin American Group of Osteosarcoma Treatment. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.10532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Carla R. Macedo
- Instituto de Oncologia Pediatrica IOP/GRAACC - UNIFESP, Sao Paulo, Brazil
| | - Sima Ferman
- Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
| | - Marcelo Scopinaro
- Hospital de Pediatria S.A.M.I.C. - Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | - Erica Boldrini
- Hospital de Cancer Barretos - Fundacao Pio XII, Barretos, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Mazzoleni S, Boldrini E, Laschi C, Carrozza MC, Stampacchia G, Rossi B. Changes on EMG activation in healthy subjects and incomplete SCI patients following a robot-assisted locomotor training. IEEE Int Conf Rehabil Robot 2012; 2011:5975467. [PMID: 22275665 DOI: 10.1109/icorr.2011.5975467] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to understand and measure the lower limbs muscular activation patterns both in healthy and spinal cord injured (SCI) subjects during robot-assisted locomotor exercise. Electromyographic (EMG) activity of four leg's muscles (rectus and biceps femoris, tibialis anterioris and gastrocnemius) was recorded and analyzed at two different percentages of body weight support, three stepping velocities and three different modalities. SCI subjects were recorded also after four weeks training to evaluate the effectiveness of lower limb robot-assisted rehabilitative treatment. A multi-factor ANOVA on the integrated muscle activity (IEMG) parameters both in healthy and SCI subjects was performed. Higher muscular activities both in healthy subjects and SCI patients were found during the exercises using the "DGO active" modality and higher stepping velocities. A significant increased bilateral muscular activity was observed in each SCI subject after the rehabilitation treatment. The method proposed to analyze EMG data provides a quantitative description of the lower limb muscular recruitment and can contribute to identify the optimal rehabilitation treatment's conditions.
Collapse
Affiliation(s)
- S Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
| | | | | | | | | | | |
Collapse
|
13
|
Serio SM, Cecchi F, Boldrini E, Laschi C, Sgandurra G, Cioni G, Dario P. Instrumented toys for studying power and precision grasp forces in infants. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2011:2017-20. [PMID: 22254731 DOI: 10.1109/iembs.2011.6090370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Currently the study of infants grasping development is purely clinical, based on functional scales or on the observation of the infant while playing; no quantitative variables are measured or known for diagnosis of eventually disturbed development. The aim of this work is to show the results of a longitudinal study achieved by using a "baby gym" composed by a set of instrumented toys, as a tool to measure and stimulate grasping actions, in infants from 4 to 9 months of life. The study has been carried out with 7 healthy infants and it was observed, during infants development, an increase of precision grasp and a reduction of power grasp with age. Moreover the forces applied for performing both precision and power grasp increase with age. The proposed devices represent a valid tool for continuous and quantitative measuring infants manual function and motor development, without being distressful for the infant and consequently it could be suitable for early intervention training during the first year of life. The same system, in fact, could be used with infants at high risk for developmental motor disorder in order to evaluate any potential difference from control healthy infants.
Collapse
Affiliation(s)
- S M Serio
- BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
| | | | | | | | | | | | | |
Collapse
|
14
|
Petrilli AS, Macedo CR, Toledo SRC, Pavoni-Ferreira PC, Grings M, Scopinaro M, Ferman S, Boldrini E, Almeida MTA, de Oliveira CT, Rey GL, Castillo LA, Borsato ML, Barreto JH, Morais VLL, Brunetto AL, Lustosa D. Preliminary safety and outcome report of the metronomic therapy from the Latin American osteosarcoma treatment protocol 2006. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10032] [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: 11/20/2022] Open
|
15
|
Brunetto AL, Castillo LA, Petrilli AS, Boldrini E, Gregianin LJ, Costa C, Almeida MT, Rosario K, Rodriguez-Galindo C, Castro CG, Dufort G. Ifosfamide, carboplatin, and etoposide as front-line therapy in patients with Ewing sarcoma family tumors (EFT): A study of the Brazil/Uruguay Cooperative Group. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10547] [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
10547 Background: Chemotherapy (CT) with ifosfamide, carboplatin, and etoposide (ICE) is effective in refractory solid tumors. The aim of this trial was to determine the efficacy and safety of ICE as front line therapy for patients (pts) with newly-diagnosed EFT. Methods: Induction with 2 courses of ICE (ifosfamide 3g/m2/d ×3, carboplatin 450mg/m2 ×1, etoposide 150mg/m2/d ×3) plus 2 of VDC (vincristine 1,5mg/m2/d ×1, doxorubicin 60mg/m2/d ×1, cyclophosphamide 1,5g/m2/d ×1) was followed by surgery and/or radiotherapy. After induction, pts were allocated to low (LR) or high-risk (HR) according to LDH (<or>1,5×NL), site (pelvic/non-pelvic) and resection (complete/unresectable) or metastatic (mets). Postoperative CT included 10 alternating courses of IE and VDC for LR and 12 alternating courses of ICE and VDC for HR. Toxicity was assessed following 523, 648, 268 and 114 courses of ICE, VDC, IE and VC, respectively; 35 site visits were carried out for data quality control. Results: From 10/2003 to 10/2008, 150 of 159 enrolled pts were evaluable; median age 13y (0.2–29.3y). 44 pts were classified as LR and 101 as HR, 56 mts. Toxicity was mainly grade III-IV neutropenia, thrombocytopenia and febrile neutropenia, and was significantly higher following ICE. The 3y EFS and OS were 65% and 27% for localized pts and 80% and 43% for mets pts. 3y EFS for lung and non-lung mets were 40% and 19% (P=0.013). Multivariate analysis showed that mets disease was the only independent prognostic factor (P=0.006) for the entire group. However, when mts pts were analyzed separately, high LDH (P=0.01) and extra-lung site (P=0.016) had significant negative impact on survival. Conclusions: ICE regimen is safe and despite a high proportion of pts with advanced disease the survival are similar to larger series. Elevated LDH and the presence of extra-lung mets were significant negative prognostic factors in mets pts. Randomized trials to identify pts who may benefit from more intensive CT are warranted. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- A. L. Brunetto
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| | - L. A. Castillo
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| | - A. S. Petrilli
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| | - E. Boldrini
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| | - L. J. Gregianin
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| | - C. Costa
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| | - M. T. Almeida
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| | - K. Rosario
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| | - C. Rodriguez-Galindo
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| | - C. G. Castro
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| | - G. Dufort
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Instituto de Oncologia Pediátrica, GRAACC, Sao Paulo, Brazil; Hospital do Cancer de Barretos, Barretos, Brazil; Hospital do Cancer AC Camargo, Sao Paulo, Brazil; Hospital das Clínicas de São Paulo—ITACI, Sao Paulo, Brazil; Hospital da Crianca Santo Antonio, Porto Alegre, Brazil; St. Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
16
|
Mannuccil L, Mannucci F, Falcone G, Boldrini E. 416 Une nouvelle larme artificielle, mucoadhésive, non visqueuse et reépithélisante (Arabinogalactan) : administration directe en collyre ou par lentille de contact. J Fr Ophtalmol 2009. [DOI: 10.1016/s0181-5512(09)73540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
17
|
Mannari C, Santi S, Migliori M, Filippi C, Origlia N, Sansò M, Boldrini E, Giovannini L. Sucralfate modulates uPAR and EGFR expression in an experimental rat model of cervicitis. Int J Immunopathol Pharmacol 2008; 21:651-8. [PMID: 18831933 DOI: 10.1177/039463200802100319] [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: 11/15/2022] Open
Abstract
Sucralfate is a drug used in the treatment of gastric and duodenal ulcer; it is cytoprotective and able to increase the bioavailability of several growth factors, modulating the wound healing process. In this study we tested the possible therapeutic effect of Sucralfate in the treatment of ulcerative lesions occurring in uterine cervix; to investigate such effect we used an experimental rat model of cervicitis in which the uPAR and EGFR expression were evaluated. Cervicitis was induced in wild and ovariectomized Wistar female rats by an acetic acid-soaked tampon. The animals were divided into two main groups (4 and 7 days) and Sucralfate was administered topically until the day they were sacrificed. In order to distinguish physiological and drug-induced healing, quantitative and qualitative uPAR and EGFR expression were evaluated by using Western blot and Immunohistochemistry techniques. Western blot analysis demonstrated an increased expression of both receptors after 4 days from wounding in wild and ovariectomized animals. In particular in ovariectomized animals the expression of uPAR and EGFR increased after 4 days while it reduced following the administration of Sucralfate. In wild rats the same was observed for uPAR expression, while EGFR was different; in fact, its expression increased significantly at day 4 in the animals treated with the drug and only at day 7 in those untreated. Immunohistochemistry highlighted a noteworthy epithelial colocalization of EGFR and uPAR after 4 days in the animals treated with Sucralfate. We conclude that Sucralfate can promote the healing of ulcerative cervicitis and moreover, it reduces the normal healing time because of its modulatory property on uPAR and EGFR expression.
Collapse
Affiliation(s)
- C Mannari
- Department of Neuroscience, Pharmacology section, University of Pisa, Pisa, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Mannucci Lorenzo L, Mannucci F, Boldrini E, Falcone G. 320 L’arabinogalactan comme stimulant de la réépithélisation de la cornée : évaluations expérimentales. J Fr Ophtalmol 2008. [DOI: 10.1016/s0181-5512(08)70917-3] [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: 11/15/2022]
|
19
|
Gigante A, Torcianti M, Boldrini E, Manzotti S, Falcone G, Greco F, Mattioli-Belmonte M. Vitamin K and D association stimulates in vitro osteoblast differentiation of fracture site derived human mesenchymal stem cells. J BIOL REG HOMEOS AG 2008; 22:35-44. [PMID: 18394316] [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: 05/26/2023]
Abstract
There is growing interest in osteoinductive agents for fracture healing especially in patients with non-union or delayed-union fractures. The aim of the present study is the assessment of the association of Vitamins D3 and K1 on proliferation and differentiation of human mesenchymal stem cells (hMSCs) derived from fracture sites in view of a possible clinical use. The synergic effect of Vitamin D3 and Vitamin K2 in preventing osteoporosis has been documented in clinical practice; however no reports investigating this association for fracture healing are present. Our data show a different outcome on cell proliferation linked to the different timing of drug administration as well as a synergic effect of the two vitamins on cell differentiation. The high level of osteocalcin and carboxylated osteocalcin detected in hMSCs treated with the association of the two vitamins in comparison with controls and with single vitamin administration underline the differentiation of these cells into osteoblastic phenotype. Our results indicate for the first time that vitamin D3 and K1 association is able to modulate in vitro the differentiation towards osteoblastic phenotype of hMSCs derived from fracture sites, thus offering clinicians a promising and low-cost strategy for reparative osteogenesis.
Collapse
Affiliation(s)
- A Gigante
- Clinica Ortopedica, Università Politecnica delle Marche, Ancona, Italy.
| | | | | | | | | | | | | |
Collapse
|
20
|
Arioli D, Pipino M, Boldrini E, Amateis E, Cristani A, Ventura P, Romagnoli E, De Santis MC, Zeneroli ML. Tumour markers in internal medicine: a low-cost test or an unnecessary expense? A retrospective study based on appropriateness. Intern Emerg Med 2007; 2:88-94. [PMID: 17622496 DOI: 10.1007/s11739-007-0028-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 11/14/2006] [Indexed: 02/07/2023]
Abstract
OBJECTIVE AND BACKGROUND In the last 35 years tumour markers (TM) have gained currency in clinical practice. However, in the light of indications by international guidelines, their use is often unjustified. Our aim was to quantify the use of some of the most common TM, assessing their appropriateness and their efficacy in an Internal Medicine Unit. METHODS In the three Internal Medicine Units of the Department of Internal Medicine of Policlinico of Modena we have carried out a retrospective analysis of the assessment of the main TM (CEA, CA19.9, CA 125, CA 15.3, NSE). The analysis was divided into two distinct phases: (I) quantitative phase, in order to assess the scale of the problem in economical terms; (II) qualitative phase, in order to assess the efficacy of the tests and the appropriateness of their use. RESULTS (I) At last one of the considered TM was requested in 5102 out of the 8253 admitted patients (62%) (period 2001-2003). The trend was similar in all three units examined. (II) The qualitative analyses revealed: (1) the most common motivation for their use (79%) was diagnostic, mostly prior to any other test; (2) a mere 5% of the requests were appropriate according to the international literature; and (3) TM showed a low positive predictive value when used for diagnosis in an unselected population such as that of an Internal Medicine unit. CONCLUSIONS The results of our study showed that TM determination represents an overall cost for Internal Medicine units and that there is a high inappropriateness in their use compared to what it is suggested by international guidelines. Though the TM is a low-cost test when used correctly, it seems an unnecessary expense if not adequately incorporated into the decision making process.
Collapse
Affiliation(s)
- D Arioli
- Cattedra e Divisione di Medicina II, Dipartimento di Medicina e Specialità Mediche, Università di Modena e Reggio Emilia Policlinico di Modena, Via del Pozzo 71, Modena, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Mannucci Lorenzo L, Boldrini E. 004 Arabinogalactan : une nouvelle thérapie des kératites dans l’oeil sec. J Fr Ophtalmol 2007. [DOI: 10.1016/s0181-5512(07)79816-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
22
|
Chetoni P, Burgalassi S, Monti D, Najarro M, Boldrini E. Liposome-encapsulated mitomycin C for the reduction of corneal healing rate and ocular toxicity. J Drug Deliv Sci Technol 2007. [DOI: 10.1016/s1773-2247(07)50006-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
23
|
Monti D, Najarro M, Chetoni P, Burgalassi S, Saettone M, Boldrini E. Vehicle and enhancer effects on transdermal permeation of estradiol from gel formulations: evaluation in vitro. J Drug Deliv Sci Technol 2005. [DOI: 10.1016/s1773-2247(05)50090-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Giampietrro O, Moretti L, Boldrini E, Chiti L, Cassetti G, Chesi F, Matteucci E. M.523 IMT measurement in type 2 diabetes: Correlations with metabolic and atherosclerotic parameters. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90521-7] [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: 11/26/2022]
|
25
|
Raimondi L, Lodovici M, Guglielmi F, Banchelli G, Ciuffi M, Boldrini E, Pirisino R. The polysaccharide from Tamarindus indica (TS-polysaccharide) protects cultured corneal-derived cells (SIRC cells) from ultraviolet rays. J Pharm Pharmacol 2003; 55:333-8. [PMID: 12724038 DOI: 10.1211/002235702630] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 10/31/2022]
Abstract
The aim of this work was to investigate the possible protective effect of a new viscosising agent, TS-polysaccharide, on corneal-derived cells (SIRC) exposed to ultraviolet-B rays. To verify this, SIRC cells were first exposed, in the absence or in the presence of TS-polysaccharide (1% w/v), for 9 s at the UV-B source and then post-incubated for 45 min at 37 degrees C. After this period the hydrogen peroxide (H(2)O(2)) accumulated in the medium and the concentration of 8-hydroxy-2'-deoxy-guanosine (8-OHdG) in cell DNA was measured. In addition, the amount of (3)H-methyl-thymidine incorporated in cellular DNA was evaluated after 18 h from irradiation. Our results show that cells exposed to UV-B rays accumulate H(2)O(2), and have higher levels of 8OHdG and a lower amount of (3)H-methyl-thymidine incorporated in DNA than control cells. In the presence of TS-polysaccharide, the H(2)O(2) and 8-OHdG accumulation, and the (3)H-methyl-thymidine incorporation were significantly reduced with respect to the values measured in cells exposed in the absence of the polysaccharide. We propose a protective role of the polysaccharide in reducing UV-B derived DNA damage to eye cells. This finding could be of some clinical importance when the polysaccharide is used as a delivery system for ophthalmic preparations.
Collapse
Affiliation(s)
- L Raimondi
- Dept. of Pharmacology, University of Florence, Italy.
| | | | | | | | | | | | | |
Collapse
|
26
|
Boles Carenini B, Boldrini E, Brogliatti B. Real advantages of preservative-free preparations in special containers for long-term glaucoma therapy. Acta Ophthalmol Scand Suppl 2003; 236:57-9. [PMID: 12390147 DOI: 10.1034/j.1600-0420.80.s236.47.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
27
|
Monti D, Chetoni P, Burgalassi S, Najarro M, Saettone MF, Boldrini E. Effect of different terpene-containing essential oils on permeation of estradiol through hairless mouse skin. Int J Pharm 2002; 237:209-14. [PMID: 11955818 DOI: 10.1016/s0378-5173(02)00032-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [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: 10/27/2022]
Abstract
Purpose of the present investigation was to evaluate six terpene-containing essential oils for their capacity to promote permeation of estradiol (ES) through hairless mouse skin in vitro. Tests on cajuput, cardamom, melissa, myrtle, niaouli and orange oil, all used at the 10% w/w concentration in propylene glycol (PG), evidenced niaouli oil (NIA) as the best permeation promoter for ES. Tests on the main terpene components of NIA (1,8 cineole, alpha-pinene, alpha-terpineol and D-limonene), evaluated neat (10% w/w in PG) or in admixture, confirmed the better promoting activity of whole NIA. The present data point to the validity of complex terpene mixtures, such as that composing NIA, as transdermal penetration enhancers for moderately lipophilic drugs like ES.
Collapse
Affiliation(s)
- D Monti
- Department of Bioorganic Chemistry and Biopharmaceutics, University of Pisa, Via Bonanno 33, I-56126 Pisa, Italy.
| | | | | | | | | | | |
Collapse
|
28
|
Da Settimo F, Primofiore G, Da Settimo A, La Motta C, Taliani S, Simorini F, Novellino E, Greco G, Lavecchia A, Boldrini E. [1,2,4]Triazino[4,3-a]benzimidazole acetic acid derivatives: a new class of selective aldose reductase inhibitors. J Med Chem 2001; 44:4359-69. [PMID: 11728182 DOI: 10.1021/jm0109210] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 11/30/2022]
Abstract
Acetic acid derivatives of [1,2,4]triazino[4,3-a]benzimidazole (TBI) were synthesized and tested in vitro and in vivo as a novel class of aldose reductase (ALR2) inhibitors. Compound 3, (10-benzyl[1,2,4]triazino[4,3-a]benzimidazol-3,4(10H)-dion-2-yl)acetic acid, displayed the highest inhibitory activity (IC(50) = 0.36 microM) and was found to be effective in preventing cataract development in severely galactosemic rats when administered as an eyedrop solution. All the compounds investigated were selective for ALR2, since none of them inhibited appreciably aldehyde reductase, sorbitol dehydrogenase, or glutathione reductase. The activity of 3 was lowered by inserting various substituents on the pendant phenyl ring, by shifting the acetic acid moiety from the 2 to the 3 position of the TBI nucleus, or by cleaving the TBI system to yield benzimidazolylidenehydrazines as open-chain analogues. A three-dimensional model of human ALR2 was built, taking into account the conformational changes induced by the binding of inhibitors such as zopolrestat, to simulate the docking of 3 into the enzyme active site. The theoretical binding mode of 3 was fully consistent with the structure-activity relationships in the TBI series and will guide the design of novel ALR2 inhibitors.
Collapse
Affiliation(s)
- F Da Settimo
- Dipartimento di Scienze Farmaceutiche, Università di Pisa, Via Bonanno 6, 56126 Pisa, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Giampietro O, Boldrini E, Forotti G, Matteucci E, Clerico A. Erythrocyte sedimentation rate (ESR), an old cheap inflammation marker, may be an indicator of atherosclerosis in diabetic people? ATHEROSCLEROSIS SUPP 2001. [DOI: 10.1016/s1567-5688(01)80091-x] [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: 10/18/2022]
|
30
|
Burgalassi S, Chetoni P, Panichi L, Boldrini E, Saettone MF. Xyloglucan as a novel vehicle for timolol: pharmacokinetics and pressure lowering activity in rabbits. J Ocul Pharmacol Ther 2000; 16:497-509. [PMID: 11132897 DOI: 10.1089/jop.2000.16.497] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [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: 11/12/2022] Open
Abstract
This study was aimed at verifying the performances of a mucoadhesive polysaccharide from tamarind seed (xyloglucan or TSP, tamarind seed polysaccharide) as an adjuvant for ophthalmic vehicles containing timolol. Three formulations (one experimental vehicle based on TSP and two reference commercial eye drops) containing 5 mg/ml timolol base equivalents were administered to the eyes of pigmented rabbits. Drug concentrations in tear fluid, cornea, iris-ciliary body, aqueous humor and plasma were determined, as well as intraocular pressure. The polymer under investigation, in spite of a comparatively low viscosity, produced high timolol concentrations in the ocular tissues and a low systemic absorption. The performances of the TSP vehicle were comparable to those of a reference "in situ" gelling formulation (Timoptic XE). The results point to TSP as a potentially useful adjuvant for ophthalmic delivery systems.
Collapse
Affiliation(s)
- S Burgalassi
- Department of Bioorganic Chemistry and Biopharmaceutics, University of Pisa, Italy.
| | | | | | | | | |
Collapse
|
31
|
Ghelardi E, Tavanti A, Celandroni F, Lupetti A, Blandizzi C, Boldrini E, Campa M, Senesi S. Effect of a novel mucoadhesive polysaccharide obtained from tamarind seeds on the intraocular penetration of gentamicin and ofloxacin in rabbits. J Antimicrob Chemother 2000; 46:831-4. [PMID: 11062209 DOI: 10.1093/jac/46.5.831] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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: 11/12/2022] Open
Abstract
This report describes the efficacy of a novel mucoadhesive polymer, the tamarind seed polysaccharide, as a delivery system for the ocular administration of hydrophilic and hydrophobic antibiotics. Healthy rabbits were subjected to repeated ocular instillations with either conventional gentamicin or ofloxacin or these agents viscosified with the tamarind seed polysaccharide. Administration of viscosified preparations produced antibiotic concentrations both in the aqueous humour and cornea that were significantly higher than those achieved with the drugs alone. The increased drug absorption and the prolonged drug elimination phase obtained with the viscosified formulations indicate the usefulness of the tamarind seed polysaccharide as an ophthalmic delivery system for topical administration of antibiotics.
Collapse
Affiliation(s)
- E Ghelardi
- Dipartimento di Patologia Sperimentale, Biotecnologie Mediche, Infettivologia ed Epidemiologia, Università degli Studi di Pisa, Pisa, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Burgalassi S, Panichi L, Chetoni P, Saettone MF, Boldrini E. Development of a simple dry eye model in the albino rabbit and evaluation of some tear substitutes. Ophthalmic Res 2000; 31:229-35. [PMID: 10224507 DOI: 10.1159/000055537] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [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: 11/19/2022]
Abstract
The present paper is concerned with the development of a simple dry eye model in the rabbit, induced by daily repeated instillations of 1.0% atropine sulphate. The evolution of the dry eye syndrome in the animals was assessed by the Schirmer I test and by examination of the cornea after fluorescein staining. The model produced rapidly some typical dry eye symptoms and could be satisfactorily used for a preliminary assessment of the protective activity of some polymeric tear substitutes. These were based on hydroxypropylmethylcellulose, sodium hyaluronate, sodium polyacrylate or tamarind gum. The latter polymer showed the best overall results. Ferning tests on the formulations were also performed: their validity as predictors of the efficacy of tear substitutes is discussed.
Collapse
Affiliation(s)
- S Burgalassi
- Department of Pharmaceutical Sciences, University of Pisa, Pisa, Italy.
| | | | | | | | | |
Collapse
|
33
|
Burgalassi S, Raimondi L, Pirisino R, Banchelli G, Boldrini E, Saettone MF. Effect of xyloglucan (tamarind seed polysaccharide) on conjunctival cell adhesion to laminin and on corneal epithelium wound healing. Eur J Ophthalmol 2000; 10:71-6. [PMID: 10744209 DOI: 10.1177/112067210001000112] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [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
PURPOSE To explore the role of a natural polysaccharide extracted from tamarind seed (xyloglucan, or tamarind seed polysaccharide, TSP) on the integrin-substrate recognition system and on repair of corneal wounds. METHODS a) Cultured human conjunctival cells were labeled by addition of a tritiated amino acid mixture. Their adhesion to laminin-coated culture wells in the absence or presence of TSP was checked by radioactivity count. b) The corneal epithelium of albino rabbits was damaged by applying a paper disc soaked with n-heptanol. The eyes were then treated with TSP, with a hyaluronate reference formulation and with normal saline solution (controls). The diameter of corneal wounds was measured daily, after fluorescein staining. RESULTS Compared to hyaluronate, TSP slightly but significantly increased the wound healing rate. TSP 1.0% exerted a positive influence on cell adhesion to laminin, up to a certain laminin concentration. CONCLUSIONS The ability of the polysaccharide to promote corneal wound healing might depend on its influence on the integrin recognition system.
Collapse
Affiliation(s)
- S Burgalassi
- Department of Bioorganic Chemistry and Biopharmaceutics, University of Pisa, Italy.
| | | | | | | | | | | |
Collapse
|
34
|
Banditelli S, Boldrini E, Vilardo PG, Cecconi I, Cappiello M, Dal Monte M, Marini I, Del Corso A, Mura U. A new approach against sugar cataract through aldose reductase inhibitors. Exp Eye Res 1999; 69:533-8. [PMID: 10548473 DOI: 10.1006/exer.1999.0729] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [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: 01/04/2023]
Abstract
Aldose reductase inhibition is one of the therapeutic strategies that has been proposed to prevent or ameliorate long term diabetic complications including retinopathy and sugar cataract. Rats were fed with a galactose rich diet and the aldose reductase inhibitor Tolrestat was topically delivered by ocular instillation. The levels of lens aldose reductase activity, galactitol and the onset of cataract were evaluated during and after treatment with the inhibitor. Topical application of 1-3% Tolrestat (10 microl) four times daily resulted, after 9 days, in a significant decrease in the enzyme activity. Well after interrupting treatment with the drug, the enzyme activity remained impaired and galactose induced cataract was prevented. Our findings may represent the basis for therapeutic plans to prevent sugar cataract by long term cyclic treatments with aldose reductase inhibitors, with reduction in drug doses and side effects.
Collapse
Affiliation(s)
- S Banditelli
- Università di Pisa, Dipartimento di Fisiologia e Biochimica, Laboratorio di Biochimica, via S. Maria, 55, Pisa, 56100, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Cioni G, Turrini F, Tincani E, D'Alimonte P, Cristani A, Boldrini E, Baraldi E, Pedrazzini PG, Ventura P, Ventura E. Prevention of a first episode of variceal bleeding: role of duplex Doppler sonographic measurement of the acute response to beta-blockers. J Ultrasound Med 1999; 18:633-638. [PMID: 10478972 DOI: 10.7863/jum.1999.18.9.633] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The aim of our study was to assess whether acute variations in portal vein Doppler sonographic parameters induced by administration of a single beta-blocker agent are predictive of the long-term effects of these drugs in the prevention of a first episode of variceal bleeding. In 30 patients with liver cirrhosis at high risk for variceal bleeding, duplex Doppler sonographic parameters (maximal portal flow velocity, portal blood flow, and congestion index) were measured before and 4 h after the administration of 40 mg of propranolol. Twenty-three of these patients started chronic therapy with propanolol and were evaluated periodically (seven patients were excluded because they did not continue the therapy). The percentage of patients free from bleeding was 86.9% at the first year and 77.8% at the second year. Among a series of clinical, laboratory, and instrument-based parameters, the only one related to first bleeding, selected by the Cox regression model, was the percentage decrease in maximal portal flow velocity observed after initial administration of propranolol (P < 0.01). The best cutoff value for the percentage decrease in portal flow velocity (portal flow velocity test) was 12%. The prevalence of bleeding had been 25% (3 of 12) in patients with positive portal flow velocity test results (12% decrease or more), versus 64% (7 of 11) in patients with negative portal flow velocity test results. The actuarial probability of remaining free from bleeding (Kaplan-Meier analysis) was different in these two groups (log rank P < 0.01). The portal flow velocity test represents a safe and feasible method to predict the efficacy of beta-blockers in the prevention of a first bleeding episode in patients with cirrhosis. In patients with negative results on the portal flow velocity test, an alternative therapeutic approach should be considered.
Collapse
Affiliation(s)
- G Cioni
- Department of Internal Medicine, Azienda Ospedaliera Policlinico, Modena, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Giampietro O, Bay P, Orlandi MC, Ferdeghini M, Boldrini E, Forotti G, Matteucci E. Relation of fetal growth to maternal responses to oral glucose tolerance test throughout gestation. Acta Diabetol 1999; 36:127-32. [PMID: 10664316 DOI: 10.1007/s005920050155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Fetal growth is dependent on transplacental supply of fuels. We aimed to assess the effect of serial changes in maternal glucose tolerance and insulin secretion with advancing pregnancy on maternal-fetal outcomes. Sixty-nine healthy pregnant women were studied over the course of gestation for glucose tolerance, by oral glucose tolerance test (OGTT), and hemoglobin A(1c) (HbA(1c)), fetal intrauterine growth (by ultrasound) and pregnancy outcome. Seven women had an abnormal OGTT in the third trimester developing gestational diabetes mellitus (GDM), but none of the 12 mothers of large babies (> 3.9 kg) had GDM: the former had the highest post-load glycemic increment, despite an apparently 'normal' insulin secretory response, the latter showed the lowest post-load glucose increase in the face of the lowest insulinemic response. Neonatal body weight correlated with maternal gestational weight gain, placental weight, third trimester ratio of incremental plasma insulin and glucose integrated areas under the curve and first and second trimester HbA(1c) levels. Fetal growth indices (femur length, biparietal diameter and abdominal circumference) were correlated with both HbA(1c) and 2h OGTT. Fetal growth rate is confirmed as being associated with maternal glycemic equilibrium, but one of the main determinants of high infant birthweight seems to be an enhanced maternal insulin sensitivity, accompanied by remarkable gestational weight gain.
Collapse
Affiliation(s)
- O Giampietro
- Clinical Medicine II, Department of Internal Medicine, Via Roma 67, I-56100 Pisa, Italy
| | | | | | | | | | | | | |
Collapse
|
37
|
D’Amico M, Di Filippo C, Lampa E, Boldrini E, Rossi F, Ruggiero A, Filippelli A. Effects of Timolol and of Timolol with Tamarind Seed Polysaccharide on Intraocular Pressure in Rabbits. ACTA ACUST UNITED AC 1999. [DOI: 10.1211/146080899128734974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
38
|
Di Bello V, Giampietro O, Pedrinelli R, Matteucci E, Giorgi D, Bertini A, Bianchi M, Ferdeghini M, Boldrini E, Dell'Omo G, Paterni M, Giusti C. Can insulin action induce myocardial texture alterations in essential hypertension? Am J Hypertens 1999; 12:283-90. [PMID: 10192231 DOI: 10.1016/s0895-7061(98)00227-1] [Citation(s) in RCA: 4] [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: 11/30/2022] Open
Abstract
The prevalence of hyperinsulinemia/insulin resistance in hypertensive individuals, as well as the effects of insulin on myocytic and fibroblastic growth, are well known in both epidemiologic and animal models. To check whether there are any links between ultrasonic myocardial texture parameters and insulin level in essential hypertensives, we compared 18 essential hypertensive men (Group 1, H) with 18 age- and gender-matched healthy controls (Group 2, C) (age, 57 +/- 10 years). For all study subjects we performed ambulatory blood pressure monitoring (ABPM); conventional 2-D Doppler echocardiography for the assessment of the left ventricular mass index (LVMi) and function; quantitative analysis of digitized echocardiographic images for evaluation of cyclic variation (CVI) of mean gray level (MGL) at the septum and posterior wall levels; and 75-g 3-h oral glucose tolerance test (OGTT) for analysis of area under glycemic curve (AUGC, g/min/dL) and insulinemic curve (AUIC, mU/min/mL), as well as serum glucose and insulin peaks. Both the daily mean blood pressure (H: 109 +/- 4.6 v C: 94.6 +/- 4.6, P < .0001) and LVMi (adjusted for body surface) (H: 133 +/- 24 v C: 97 +/- 21 g/m2, P < .0001) were significantly higher in hypertensives. Values for AUIC were significantly higher in hypertensives (10.37 +/- 5.53 v 6.33 +/- 5.28), P < .032); CVI was also significantly higher in group C, for both septum (C: 40.2 +/- 16.9 v H: 15.9 +/- 18.1, P < .0001) and posterior wall (C: 44.5 +/- 19.6 v H: 20 +/- 17.5; P < .0001). There was a significant inverse correlation between AUIC and CVI for both septum (r: -0.57, P < .001) and posterior wall (r: -0.50, P < .002). The significantly higher impairment of myocardial ultrasonic texture and the higher level of the AUIC insulinemia in hypertensives, as well as the significant inverse relationship between CVI and hyperinsulinemia, are our major findings. Hyperinsulinemia/insulin resistance could cause an altered collagen/muscular ratio, which could potentially explain, at least in part, the CVI alterations detected in hypertensive patients.
Collapse
Affiliation(s)
- V Di Bello
- Dipartimento di Medicina Interna, Centro di Medicina Nucleare, Università di Pisa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Ghelardi E, Tavanti A, Lupetti A, Celandroni F, Boldrini E, Campa M, Senesi S. Control of Candida albicans murine vaginitis by topical administration of polycarbophil-econazole complex. Antimicrob Agents Chemother 1998; 42:2434-6. [PMID: 9736578 PMCID: PMC105848 DOI: 10.1128/aac.42.9.2434] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 11/20/2022] Open
Abstract
The complexation of econazole with the mucoadhesive polycarbophil was found to significantly improve the therapeutic benefit of the drug in the topical treatment of experimental vaginal candidiasis in mice, while no difference in the antimycotic activity exerted by econazole and polycarbophil-econazole could be detected in vitro.
Collapse
Affiliation(s)
- E Ghelardi
- Dipartimento di Biomedicina Sperimentale, Infettiva e Pubblica, Università degli Studi di Pisa, 56127 Pisa, Italy.
| | | | | | | | | | | | | |
Collapse
|
40
|
Matteucci E, Milioni C, Biasci E, Bertoni C, Boldrini E, Giampietro O. With regard to glycohemoglobin measurement: are we sure that high-performance liquid chromatography currently works in the clinical routine? Acta Diabetol 1998; 35:41-7. [PMID: 9625288 DOI: 10.1007/s005920050099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The clinical usefulness of glycated hemoglobin (HbA1C) depends crucially on the accuracy and precision of its assay. When we compared an immunological bench-top analyzer (DCA 2000, Bayer Diagnostici, Milan) to the high-performance liquid chromatography (HPLC) reference method used in a routine hospital laboratory (Diamat and Fast Diamat, Bio-Rad Lab., Milan) by assaying multiple control sera, we found so many sources of systematic analytical errors in the routine use of HPLC as to compromise between-assay precision. DCA 2000 showed intra- and interassay coefficients of variation (CV) of 1.1% and 2.3% with the normal standard serum, 1.0% and 4.2% with the pathological one; Diamat yielded CVs of 1.3% and 7.0%, 1.3% and 5.7%, respectively. Although the measurement of 161 blood samples showed that Diamat usually overestimated HbA1C (paired t-test, P<0.001), a great variability of Diamat performance became evident when the relationship Diamat vs DCA was evaluated day by day over 17 days of observation (analysis of variance, ANOVA, P<0.001). Intra- and interassay CVs of Fast Diamat initially (new instrument still on approval) were 0.6% and 2.5% (normal standard serum), 0.3% and 1.9% (high standard serum), yet after 6 months of routine laboratory use, they became 3.1% and 3.2%, 1% and 12.3%, respectively. Main sources of error were: inaccurate autodilution, unsuitable parameter settings, disregard of the maintenance schedule. We conclude that the tendency to overlook major critical aspects in the routine use of HPLC is detrimental to the quality of HbA1C determination and implies the loss of HbA1C value in clinical practice. Both carefully supervising laboratory quality and checking the likelihood of the analytical result with the clinical setting appear even more important.
Collapse
Affiliation(s)
- E Matteucci
- II Medical Clinic, University of Pisa, Italy
| | | | | | | | | | | |
Collapse
|
41
|
Matera MG, Lampa E, Imperatore A, Berrino L, Russo F, Boldrini E, Rossi F. Bioavailability of timolol and aceclidine after ocular instillation in the rabbit. Res Commun Mol Pathol Pharmacol 1998; 100:35-42. [PMID: 9644717] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The bioavailability of timolol and aceclidine after the ocular instillation of each drug (timolol 0.5% or aceclidine 2%) or both combined (timolol 0.5% + aceclidine 2%) has been evaluated in rabbits. 15 male albino rabbits were treated by the instillation of timolol and aceclidine alone or combined in the conjunctival sac of the right eye. Timolol concentrations in humor aqueous were assayed at 10 min, 30 min, 1 hr, 2 hr, 4 hr and 6 hr after instillation by high-performance liquid chromatography (HPLC). Aceclidine was assayed by a pharmacodynamic method: pupillary diameter at the following time intervals 0 (basal value), 1 min, 5 min, 30 min, 1 hr, 2 hr, 4 hr, 6 hr after treatment. Our results demonstrated that no differences in timolol and aceclidine bioavailability were found between simple-drug preparations and their combination.
Collapse
Affiliation(s)
- M G Matera
- Institute of Pharmacology and Toxicology, Faculty of Medicine and Surgery, Second University of Naples, Italy
| | | | | | | | | | | | | |
Collapse
|
42
|
Matteucci E, Carmellini M, Bertoni C, Boldrini E, Mosca F, Giampietro O. Urinary excretion rates of multiple renal indicators after kidney transplantation: clinical significance for early graft outcome. Ren Fail 1998; 20:325-30. [PMID: 9574459 DOI: 10.3109/08860229809045118] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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: 11/13/2022] Open
Abstract
Post-reperfusion inflammation as well as anti-allograft response occur following kidney transplantation. We evaluated tissue damage by multiple renal indicators and searched for rejection predictors forewarning serum creatinine upturns. Twenty recipients (43 +/- 9 y; donors' age 35 +/- 16 y) of first renal grafts were studied. All through their hospital stay (35 +/- 18 d, range 17-75 d) we measured serum levels of urea, creatinine and electrolytes along with urinary excretion rates of total protein, albumin, enzymes (GGT, NAG, AAP) and electrolytes. During the period of observation, peaks were seen on the 1st day for serum creatinine, serum K+ and urine albumin output; on the 2nd day for urine Na+, GGT, AAP and protein excretion rates; on the 4th day for urea and creatinine outputs; on the 5th day for NAG output. On the 14th day, serum urea and creatinine as well as urine GGT, NAG, AAP, albumin and total protein were still elevated compared to 20 healthy control subjects. Delayed/slow graft function was observed in six recipients with higher pre-transplantation plasma lipids and lower donor HDL cholesterol. Hospital stay time was correlated with need for post-transplantation dialysis (p = 0.01) and recipient proteinuria by time 0 (TO) to day 3 (p = 0.02). Cold ischemia time was positively associated with 0-3 d serum creatinine, 0-3 d urinary urea and protein outputs (multiple r 0.9, p < 0.001). Multivariate analysis of longitudinal data showed that recipients' serum creatinine was positively correlated (p < 0.001) with urine AAP and negatively correlated with urine albumin, with diuresis volume and urine creatinine (p < 0.01). Serum creatinine elevations were preceded (previous 1-7 d) by increases in urinary indicators, the probability being higher in the presence of multiple simultaneous abnormalities. Useful parameters predictive of favorable graft outcome prior to transplantation included a brief cold ischemia time and a normal donor/recipient serum lipoprotein profile. Following transplantation, useful parameters were a high diuresis volume at time zero along with low urine NAG and high albumin outputs; early (first opst-graft 3 d) polyuria, low urea and GGT, high K, NAG and total protein excretions.
Collapse
Affiliation(s)
- E Matteucci
- Istituto di Clinica Medica II, University of Pisa, Italy
| | | | | | | | | | | |
Collapse
|
43
|
Carneglia L, Griesi E, Nannelli A, Boldrini E, Virgone E, Matteucci E, Giampietro O. Biomedical characteristics of nine year old school children and their relationship with familiar risk factors for obesity and cardiovascular disease. Pharmacotherapy 1998. [DOI: 10.1016/s0753-3322(98)80044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
44
|
Matteucci E, Carmellini M, Bertoni C, Boldrini E, Cosi C, Mosca F, Giampietro O. Role of donor/recipient Na+/H+ antiport activity as a nonimmunologic predictor of kidney graft outcome. Transplant Proc 1997; 29:3600-1. [PMID: 9414854 DOI: 10.1016/s0041-1345(97)01040-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- E Matteucci
- Istituto di Clinica Medica II, Università di Pisa, Italy
| | | | | | | | | | | | | |
Collapse
|
45
|
Boldrini E, Cristani A. [Blood doping]. Recenti Prog Med 1997; 88:559-61. [PMID: 9522595] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- E Boldrini
- Istituto di Medicina II, Azienda Policlinico, Modena
| | | |
Collapse
|
46
|
Primofiore G, Da Settimo F, La Motta C, Simorini F, Minutolo A, Boldrini E. Benzisothiazole-1,1-dioxide alkanoic acid derivatives as inhibitors of rat lens aldose reductase. Farmaco 1997; 52:583-8. [PMID: 9507669] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Derivatives of 4-substituted 1,2-benzisothiazole-1,1-dioxide alkanoic acids were prepared and their in vitro aldose reductase inhibitory activity was tested in rat lens enzyme. The acetic derivatives 10, 12, and 16a-d proved to be much more potent inhibitors than the propionic derivatives 11, 13, and 17a-d. The presence of an acyl moiety on the amino group in position 4 of the acetic derivatives 16a-d led to a significant increase in activity with respect to the parent compound 14. One of the most active compounds in vitro, 10, was also evaluated in vivo as an inhibitor of glutathione lens depletion in galactosemic rats, but it did not show any activity in maintaining the rat lens glutathione level, probably due to problems of ocular bioavailability or metabolism.
Collapse
Affiliation(s)
- G Primofiore
- Dipartimento di Scienze farmaceutiche dell'Università di Pisa, Italy
| | | | | | | | | | | |
Collapse
|
47
|
Cristani A, Boldrini E, Turrini F, Cioni G, Piccinini N. [Pseudoanemia due to sports]. Recenti Prog Med 1997; 88:461-2. [PMID: 9471640] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A Cristani
- Divisione di Medicina II, Azienda Policlinico, Università, Modena
| | | | | | | | | |
Collapse
|
48
|
Giampietro O, Di Bello V, Matteucci E, Talarico L, Ruberti F, Boldrini E, Giorgi D, Giusti C. Erythrocyte Na+/H+ exchange and preclinical abnormalities of the left ventricular diastolic function in normotensive type 1 (insulin-dependent) diabetic patients. Acta Diabetol 1997; 34:223-9. [PMID: 9401645 DOI: 10.1007/s005920050078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We assessed the relationship between erythrocyte Na+/H+ antiport activity and myocardial anatomical-functional parameters (by Doppler echocardiography) in normotensive IDDM patients, with and without microalbuminuria. We studied 33 normotensive IDDM subjects and 14 matched healthy controls (group 4). Based on urinary albumin excretion rate (UAER), 23 diabetics were normoalbuminuric, 10 microalbuminuric (group 3). Normoalbuminurics were divided up for normal (group 1, n = 13) or high (group 2, n = 10) antiport activity. We evaluated fasting glycaemia and 24-h urine glucose output, HbA1c, plasma lipids, urea, creatinine and electrolyte clearances, UAER, erythrocyte Na+/H+ countertransport, M-Mode and 2D echocardiograms with Doppler analysis. Antiport, which was higher in diabetics than controls, was significantly overactive in groups 2 and 3 vs group 4, independently from UAER. Diabetics showed left ventricular volume, cardiac mass and systolic function within the control range. In left ventricular diastolic filling, while peak E was similar in diabetic and healthy people, the late peak transmitral flow velocity (peak A) was significantly higher in diabetics than controls, and this was also true in groups 2 and 3 vs group 4. Antiport activity was positively related to peak A (p < 0.03). These observations suggest that (a) the Na+/H+ antiport may be overactive in diabetes, apart from microalbuminuria; (b) increased Na+/H+ antiport activity, in normotensive IDDM people, may be associated with preclinical diastolic myocardial dysfunction ("incipient diabetic cardiomyopathy"?).
Collapse
Affiliation(s)
- O Giampietro
- Istituto di Clinica Medica II, Università degli Studi di Pisa, Italy
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Boldrini E, Cristani A, Cioni G, Roccato S, De Santis M, Bonilauri S, Berselli T, Melotti G. A difficult early diagnosis of pancreatic body neoplasia. Hepatogastroenterology 1996; 43:730-3. [PMID: 8799421] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The Authors report the case of a 60-year-old man, V.A., a smoker with type II diabetes and cholelithiasis. One month after the onset of symptoms in March 1995, his clinical picture led us to suspect a pancreatic adenocarcinoma. Only 110 days after the initial discovery of a high CA 19-9, following the failure of numerous techniques and the solution of various problems of differential diagnosis, the first unclear X-ray image of a suspected pancreatic neoplasia was obtained. A new computed tomography scan and a further increase in CA 19-9 later confirmed the diagnosis. Duodenopancreatectomy with splenectomy for adenocarcinoma was performed. The thread connecting 150 days of clinical history is CA 19-9, which acted as an ideal marker. It enabled a clinical "rarity" (pancreatic neoplasia in its initial stages) to be diagnosed and it increased as the neoplasia developed. After surgical removal of the tumor, the marker is now returning to normal levels and will be used to monitor the post-operative phase, when any increase in level could mean a recrudescence of the disease.
Collapse
Affiliation(s)
- E Boldrini
- Department of Internal Medicine, Policlinico, Modena University
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Da Settimo A, Primofiore G, La Motta C, Da Settimo F, Simorini F, Boldrini E, Bianchini P. Acid derivatives of benzisothiazole-1,1-dioxide as inhibitors of rat lens aldose reductase. Farmaco 1996; 51:261-7. [PMID: 8645413] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A number of 6-substituted 1, 2-benzisothiazole-1, 1-dioxide alkanoic acids were synthesized and evaluated for crude rat lens aldose reductase inhibitory activity. The inhibitory potency of the acetic (6a, 10a), propionic (6b, 10b, 11b), and isopropionic (6c, 10c, 11c) derivatives was very similar and generally lower than that of the reference compound, Sorbinil. The presence of an acyl moiety on the amino group in position 6, as in the acetic and propionic derivatives 14a-f and 15a, b, respectively, resulted in a significant increase in activity. A good potency was shown by compounds 14g and 15g, in which a second carboxylic function is present on the 6-acylamino group. Also the open products 16, which contain the phenylsulfonyl fragment found in several known inhibitors of aldose reductase, were obtained and tested in the rat lens assay.
Collapse
Affiliation(s)
- A Da Settimo
- Dipartimento di Scienze Farmaceutiche dell'Università di Pisa, Italy
| | | | | | | | | | | | | |
Collapse
|