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Campanacci DA, Scanferla R, Marsico M, Scolari F, Scoccianti G, Beltrami G, Delcroix L, Innocenti M, Capanna R. Intercalary Resection of the Tibia for Primary Bone Tumors: Are Vascularized Fibula Autografts With or Without Allografts a Durable Reconstruction? Clin Orthop Relat Res 2024:00003086-990000000-01525. [PMID: 38513152 DOI: 10.1097/corr.0000000000003007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 01/23/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Reconstruction with vascularized fibula grafts (VFG) after intercalary resection of sarcoma may offer longevity by providing early graft-host union and fracture healing. The ability of the fibula to hypertrophy under mechanical stress, as well as vascularized bone in the area, may also be advantageous, given that soft tissues may be compromised because of resection, chemotherapy, or radiation therapy. VFG with a massive allograft combines the primary mechanical stability of the graft with the biological potential of the vascularized fibula; however, complications and the durability of this combined reconstruction are not well described. QUESTIONS/PURPOSES (1) What was the proportion of complications after reconstruction with VFG, with or without allografts? (2) What was the functional result after surgical treatment as assessed by the Musculoskeletal Tumor Society (MSTS) score? (3) What was the survivorship of these grafts free from revision and graft removal? METHODS Between 1988 and 2021, 219 patients were treated at our institution for a primary malignant or aggressive benign bone tumor of the tibia with en bloc resection. Of those, 54% (119 of 219) had proximal tibial tumors with epiphyseal involvement and were treated with either intra-articular resection and reconstruction with an osteoarticular allograft, allograft-prosthesis composite (APC), or modular prosthesis according to age, diagnosis, and preoperative or postoperative radiotherapy. Nine percent (20) of patients had distal tibial tumors that were treated with intra-articular resection and reconstruction with ankle arthrodesis using allogenic or autologous grafts, and 0.5% (1 patient) underwent total tibial resection for extensive tumoral involvement of the tibia and reconstruction with an APC. Thirty-six percent (79) of patients had a metadiaphyseal bone tumor of the tibia and were treated with intercalary joint-sparing resection. We routinely use reconstruction with VFG after intercalary tibial resection for primary malignant or aggressive benign bone tumors in patients with long life expectancy and high functional demands and in whom at least 1 cm of residual bone stock of the proximal or distal epiphysis can be preserved. By contrast, we routinely use intercalary massive allograft reconstruction in short resections or in patients with metastatic disease who do not have long life expectancy. We avoid VFG in patients with tibial bone metastasis, patients older than 70 years, or primary bone tumors in patients who may undergo postoperative radiotherapy; in these patients, we use alternative reconstructive methods such as intercalary prostheses, plate and cement, or intramedullary nailing with cement augmentation. According to the above-mentioned indications, 6% (5 of 79) of patients underwent massive allograft reconstruction because they were young and had intercalary resections shorter than 7 cm or had metastatic disease at diagnosis without long life expectancy, whereas 94% (74) of patients underwent VFG reconstruction. The median age at operation was 16 years (range 5 to 68 years). The diagnosis was high-grade osteosarcoma in 22 patients, Ewing sarcoma in 19, adamantinoma in 16, low-grade osteosarcoma in five, fibrosarcoma in three, malignant fibrous histiocytoma and Grade 2 chondrosarcoma in two, and malignant myoepitelioma, angiosarcoma of bone, malignant peripheral nerve sheath tumor of bone, squamous cell carcinoma secondary to chronic osteomyelitis, and desmoplastic fibroma in one patient each. Median follow-up was 12.3 years (range 2 to 35 years). The median tibial resection length was 15 cm (range 7 to 27 cm), and the median fibular resection length was 18 cm (range 10 to 29 cm). VFG was used with a massive allograft in 55 patients, alone in 12 patients, and combined with allogenic cortical bone struts in seven patients. We used VFG combined with a massive allograft in patients undergoing juxta-articular, joint-sparing resections that left less than 3 cm of residual epiphyseal bone, for intra-epiphyseal resections, or for long intercalary resections wherein the allograft can provide better mechanical stability. In these clinical situations, the combination of a VFG and massive allograft allows more stable fixation and better tendinous reattachment of the patellar tendon. VFG was used with cortical bone struts in distal tibia intercalary resections where the narrow diameter of the allograft did not allow concentric assembling with the fibula. Finally, VFG alone was often used after mid- or distal tibia intercalary resection in patients with critical soft tissue conditions because of previous surgery, in whom the combination with massive allograft would result in a bulkier reconstruction. We ascertained complications and MSTS scores by chart review, and survivorship free from revision and graft removal was calculated using the Kaplan-Meier estimator. In our study, however, the occurrence of death as a competing event was observed in a relatively low proportion of patients, and only occurred after the primary event of interest had already occurred. Considering the nature of our data, we did not consider death after the primary event of interest as a competing event. RESULTS In all, 49% (36 of 74) of patients experienced complications and underwent operative treatment. There were 45 complications in 36 patients. There was one instance of footdrop secondary to common peroneal nerve palsy, four wound problems, one acute vein thrombosis of the VFG pedicle and one necrosis of the skin island, two episodes of implant-related pain, 10 nonunions, six fractures, six deep infections, nine local recurrences, one Achilles tendon retraction, one varus deformity of the proximal tibia with postoperative tibial apophysis detachment, one knee osteoarthritis, and one hypometria. The median MSTS score was 30 (range 23 to 30); the MSTS score was assessed only in patients in whom the VFG was retained at the final clinical visit, although if we had considered those who had an amputation, the overall score would be lower. Revision-free survival of the reconstructions was 58% (95% confidence interval 47% to 70%) at 5 years, 52% (95% CI 41% to 65%) at 10 and 15 years, and 49% (95% CI 38% to 63%) at 20 and 30 years. Eight patients underwent VFG removal because of complications, with an overall reconstruction survival of 91% (95% CI 84% to 98%) at 5 years and 89% (95% CI 82% to 97%) at 10 to 30 years. CONCLUSION VFG, alone or combined with an allograft, could be considered in reconstructing a lower extremity after intercalary resections of the tibia for primary bone tumors, and it avoids the use of a large endoprosthesis. However, this procedure was associated with frequent, often severe complications during the first postoperative years and complication-free survival of 58% at 5 years. Nearly 10% of patients ultimately had an amputation. For patients whose reconstruction succeeded, the technique provides a durable reconstruction with good MSTS scores, and we believe it is useful for active patients with long life expectancy. Fractures, frequently observed in the first 5 years postoperatively, might be reduced using long-spanning plate fixation, and that appeared to be the case in our study. Nonbridging fixation can be an option in intraepiphyseal resection when a spanning plate cannot be used or in pediatric patients to enhance fibula hypertrophy and remodeling. We did not directly compare VFG with or without allografts to other reconstruction options, so the decision to use this approach should be made thoughtfully and only after considering the potential serious risks. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Roberto Scanferla
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Mariagrazia Marsico
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Federico Scolari
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Giovanni Beltrami
- Department of Paediatric Orthopaedics, Meyer University Hospital, Florence, Italy
| | - Luca Delcroix
- Department of Plastic Surgery, Careggi University Hospital, Florence, Italy
| | - Marco Innocenti
- Department of Plastic Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Rodolfo Capanna
- Orthopaedic Clinic, Cisanello University Hospital, Pisa, Italy
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Scoccianti G, Innocenti M, Scanferla R, Scolari F, Muratori F, Ungar A, Rostagno C, Campanacci DA. Survival and Results after Resection and Reconstruction with Megaprosthesis at the Hip in Octogenarians. J Clin Med 2023; 12:7740. [PMID: 38137808 PMCID: PMC10743573 DOI: 10.3390/jcm12247740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Few data are available about results after procedures of resection and megaprosthesis at the hip in very elderly patients. The aim of our study was to ascertain survival and complications in patients aged 80 or older undergoing these major orthopedic procedures. A consecutive series of 27 procedures in 26 patients aged 80-93 years was evaluated. In total, 15 procedures were performed due to oncological diseases, 6 were performed following joint arthroplasty failures or periprosthetic fractures, and 6 were performed after trauma or trauma sequelae. Survival of the patients ranged from 0 to 122 months. Overall survival was 56% at 3 years, 24% at 5 years, and 16% at 8 years. An early postoperative death during the first 3 months occurred in five patients (18.5%). The only preoperative parameter negatively affecting survival was preoperative hemoglobin lower than 11 g/dL. Local complications were similar to reported rates in all-age patients' series. In our experience, resection and megaprosthetic reconstruction can also be a valid choice in very elderly patients, with 56% of patients living more than two years from surgery and 24% more than five. Nevertheless, early postoperative deaths are frequent. A multidisciplinary evaluation of frailty of the patient must be accomplished, and patients and relatives must be informed about the risks of the procedure.
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Affiliation(s)
- Guido Scoccianti
- Department of Orthopaedic Oncology, Careggi University Hospital, 50134 Firenze, Italy; (R.S.); (F.M.); (D.A.C.)
| | - Matteo Innocenti
- Orthopaedic Clinic, Careggi University Hospital, 50134 Firenze, Italy;
| | - Roberto Scanferla
- Department of Orthopaedic Oncology, Careggi University Hospital, 50134 Firenze, Italy; (R.S.); (F.M.); (D.A.C.)
| | - Federico Scolari
- Department of Health Sciences, University of Florence, 50121 Florence, Italy;
| | - Francesco Muratori
- Department of Orthopaedic Oncology, Careggi University Hospital, 50134 Firenze, Italy; (R.S.); (F.M.); (D.A.C.)
| | - Andrea Ungar
- Department of Internal and Geriatric Medicine, Careggi University Hospital, 50134 Firenze, Italy;
| | - Carlo Rostagno
- Department of Internal and Postoperative Medicine, Careggi University Hospital, 50134 Firenze, Italy;
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology, Careggi University Hospital, 50134 Firenze, Italy; (R.S.); (F.M.); (D.A.C.)
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Lavacchi D, Polvani S, Taddei A, Scolari F, Messerini L, Caliman E, Moraldi L, Guidolin A, Grazi GL, Galli A, Pillozzi S, Antonuzzo L. KRAS-related miR-143 expression is associated with lymph node involvement and correlates with outcome in pancreatic adenocarcinoma patients. Front Oncol 2023; 13:1295936. [PMID: 38130990 PMCID: PMC10735715 DOI: 10.3389/fonc.2023.1295936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Pancreatic adenocarcinoma (PC) is one of the most lethal malignancies; even after resection the patients' 5-year disease-free survival (DFS) is lower than 26%. The genetic mutational landscape of PC is dominated by activating KRAS mutations, that have been reported in approximately 90% of cases; however, beyond KRAS - direct mutations, several KRAS-targeting miRNAs appear to be downregulated, strengthening the already activated RAS signaling. In addition, the interplay between miRNAs and RAS includes poorly investigated downstream miRNAs. The aim of this study was to determine the prognostic value of some of these candidate KRAS-related miRNAs. Patients and methods Between 2015 and 2022, 44 patients with pathologically confirmed PC, who received surgery and were enrolled by the Clinical Oncology Unit, Careggi University Hospital, Florence (Italy). PC Total RNA was extracted from FFPE sections, retro-transcribed and the resulting cDNA was then used for qPCR analysis. A panel of KRAS-related miRNA (miR-155, miR-206 and miR-143) was analyzed. Results In this observational study patients sex distribution was unequal with 34.1% being male and 65.9% female. The most frequent tumor localization was the head of the pancreas (65.9%) and the pathological stages were pT1-2 (45.5%), pT3 (54.5%), pN0 (22.7%), pN+ (77.3%). Adjuvant therapy was administered to 63.6% of patients; disease recurrence was observed in 69% of cases. Twenty-three patients, whose RNA was of adequate quality, were used in the mRNAs expression studies. When comparing the miRNA expression between PC and a pool of healthy tissues, miR-155 was overexpressed and miR-206 downregulated in PC, while miR-143 expression was unchanged. However, when categorized in low- and high- miR-143 expressing PC (according to the median value), high miR-143 was associated with nodal involvement (pN+) (p=0.029), who in turn was linked with shorter DFS (p=0.009) and overall survival (OS) (p=0.021) compared to pN0. A trend toward inferior DFS was observed for higher expression of miR-206 (p=0.095) and miR-143 (p=0.092). Finally, responders to a first-line treatment for advanced disease had miR-155 overexpressed (p=0.048). Conclusions miRNAs are involved in PC tumorigenesis and metastatic spread. In light of miR-143 association with lymphatic spread and poor prognosis, a comprehensive analysis of miRNA interplay with KRAS deserves further investigation.
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Affiliation(s)
- Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Simone Polvani
- Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Antonio Taddei
- HPB Surgery Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Federico Scolari
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Luca Messerini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Enrico Caliman
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Luca Moraldi
- HPB Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Alessia Guidolin
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Gian Luca Grazi
- HPB Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Galli
- Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Serena Pillozzi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Lavacchi D, Gelmini S, Calabri A, Rossi G, Simi L, Caliman E, Mancini I, Salvianti F, Petroni G, Guidolin A, Scolari F, Messerini L, Pillozzi S, Pinzani P, Antonuzzo L. Early changes in circulating tumor DNA (ctDNA) predict treatment response in metastatic KRAS-mutated colorectal cancer (mCRC) patients. Heliyon 2023; 9:e21853. [PMID: 38027900 PMCID: PMC10663919 DOI: 10.1016/j.heliyon.2023.e21853] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
The detection of RAS mutations and co-mutations in liquid biopsy offers a novel paradigm for the dynamic management of metastatic colorectal cancer (mCRC) patients. Expanding the results of the prospective OMITERC (OMIcs application from solid to liquid biopsy for a personalized ThERapy of Cancer) project, we collected blood samples at specific time points from patients who received a first-line chemotherapy (CT) for KRAS-mutated mCRC. CTC quantification was performed by CellSearch® system. Libraries from cfDNA were prepared using the Oncomine™ Colon cfDNA Assay to detect tumour-derived DNA in cfDNA. The analysis involved >240 hotspots in 14 genes. Twenty patients with KRAS-mutated mCRC treated at the Medical Oncology Unit of Careggi University Hospital were prospectively enrolled. Nine patients had available data for longitudinal monitoring of cfDNA. After 6 weeks of first-line CT an increase of KRAS-mutated clone was reported in the only patient who did not obtain disease control, while all patients with decrease of KRAS clones obtained disease control. Overall, in patients with a short (<9 months) progression-free survival (PFS) we registered, at 6 weeks, an increase in cfDNA levels and in KRAS mutations or other co-mutations, i.e. PIK3CA, FBXW7, GNAS, and TP53. In selected cases, co-mutations were able to better anticipate radiological progressive disease (PD) than the increase of KRAS-mutated clones. In conclusion, our study confirms plasma ctDNA as a crucial tool for anticipating PD at an early time point and highlights the value of a comprehensive assessment of clonal dynamics to improve the management of patients with mCRC.
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Affiliation(s)
- Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Stefania Gelmini
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Adele Calabri
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Gemma Rossi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Lisa Simi
- Clinical and Molecular Biochemistry Careggi University Hospital, Florence, Italy
| | - Enrico Caliman
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Irene Mancini
- Clinical and Molecular Biochemistry Careggi University Hospital, Florence, Italy
| | - Francesca Salvianti
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Giulia Petroni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessia Guidolin
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Federico Scolari
- Department of Health Science, University of Florence, Florence, Italy
| | - Luca Messerini
- Pathology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Serena Pillozzi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pamela Pinzani
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
- Clinical and Molecular Biochemistry Careggi University Hospital, Florence, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Gambale E, Scolari F, Scoccianti G, Caliman E, Palomba A, Antonuzzo L, Campanacci D, Pillozzi S. 111P A novel immune cell signature for predicting pleomorphic sarcoma prognosis. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101148] [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: 04/05/2023] Open
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Scoccianti G, Palomba A, Caporalini C, Nozzoli F, Scanferla R, Scolari F, Pillozzi S, Campanacci D. 81P Soft tissue solitary fibrous tumor: Analysis of a single center series with a comparison between three prognostic scores. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101118] [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: 04/05/2023] Open
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Pillozzi S, Scolari F, Scoccianti G, Boddi A, Palchetti I, Antonuzzo L, Campanacci D. 110P Characterization of miRNA-mRNA network in soft tissue sarcoma. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101147] [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: 04/05/2023] Open
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Dorian D, Arnon A, Scolari F, m Habib, Chow C, Bruchal-Garbicz B, Billia F, Chan R, Rakowski H. ASSOCIATION OF DURATION AND INTENSITY OF EXERCISE WITH SEVERITY OF PHENOTYPIC EXPRESSION IN HYPERTROPHIC CARDIOMYOPATHY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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Pasqui A, Boddi A, Campanacci DA, Scoccianti G, Bernini A, Grasso D, Gambale E, Scolari F, Palchetti I, Palomba A, Fancelli S, Caliman E, Antonuzzo L, Pillozzi S. Alteration of the Nucleotide Excision Repair (NER) Pathway in Soft Tissue Sarcoma. Int J Mol Sci 2022; 23:ijms23158360. [PMID: 35955506 PMCID: PMC9369086 DOI: 10.3390/ijms23158360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 02/02/2023] Open
Abstract
Clinical responses to anticancer therapies in advanced soft tissue sarcoma (STS) are unluckily restricted to a small subgroup of patients. Much of the inter-individual variability in treatment efficacy is as result of polymorphisms in genes encoding proteins involved in drug pharmacokinetics and pharmacodynamics. The nucleotide excision repair (NER) system is the main defense mechanism for repairing DNA damage caused by carcinogens and chemotherapy drugs. Single nucleotide polymorphisms (SNPs) of NER pathway key genes, altering mRNA expression or protein activity, can be significantly associated with response to chemotherapy, toxicities, tumor relapse or risk of developing cancer. In the present study, in a cohort of STS patients, we performed DNA extraction and genotyping by SNP assay, RNA extraction and quantitative real-time reverse transcription PCR (qPCR), a molecular dynamics simulation in order to characterize the NER pathway in STS. We observed a severe deregulation of the NER pathway and we describe for the first time the effect of SNP rs1047768 in the ERCC5 structure, suggesting a role in modulating single-stranded DNA (ssDNA) binding. Our results evidenced, for the first time, the correlation between a specific genotype profile of ERCC genes and proficiency of the NER pathway in STS.
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Affiliation(s)
- Adriano Pasqui
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (A.P.); (L.A.); (S.P.)
| | - Anna Boddi
- Orthopaedic Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (A.B.); (D.A.C.); (G.S.); (F.S.)
| | - Domenico Andrea Campanacci
- Orthopaedic Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (A.B.); (D.A.C.); (G.S.); (F.S.)
- Orthopaedic Oncology Unit, Careggi University Hospital, Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Guido Scoccianti
- Orthopaedic Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (A.B.); (D.A.C.); (G.S.); (F.S.)
| | - Andrea Bernini
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy;
- Correspondence:
| | - Daniela Grasso
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy;
| | - Elisabetta Gambale
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Federico Scolari
- Orthopaedic Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (A.B.); (D.A.C.); (G.S.); (F.S.)
| | - Ilaria Palchetti
- Department of Chemistry Ugo Schiff, University of Florence, 50019 Sesto Fiorentino, Italy;
| | - Annarita Palomba
- Histopathology and Molecular Diagnostic Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Sara Fancelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.F.); (E.C.)
| | - Enrico Caliman
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.F.); (E.C.)
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (A.P.); (L.A.); (S.P.)
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy;
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.F.); (E.C.)
| | - Serena Pillozzi
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (A.P.); (L.A.); (S.P.)
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.F.); (E.C.)
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12
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Caliman E, Fancelli S, Ottanelli C, Mazzoni F, Paglialunga L, Lavacchi D, Michelet MRG, Giommoni E, Napolitano B, Scolari F, Voltolini L, Comin CE, Pillozzi S, Antonuzzo L. Absolute eosinophil count predicts clinical outcomes and toxicity in non-small cell lung cancer patients treated with immunotherapy. Cancer Treat Res Commun 2022; 32:100603. [PMID: 35792426 DOI: 10.1016/j.ctarc.2022.100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/15/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Immune checkpoint inhibitors (ICIs) have led to a paradigm shift in non-small cell lung cancer (NSCLC) treatment. We investigated absolute eosinophil count (AEC) as a predictor of clinical outcomes and toxicity in NSCLC patients receiving ICIs. MATERIALS AND METHODS AEC was retrospectively collected at baseline and during treatment from 158 advanced NSCLC patients treated with single agent anti-PD1/anti-PDL1 monoclonal antibody in first or subsequent line of therapy at Medical Oncology Unit, Careggi University Hospital, Florence (Italy), between January 2016 to October 2020. RESULTS We found a significant association between high baseline AEC (≥130/μL) and better clinical outcomes. The response rates were 64.4% and 35.6% for patients with high and low AEC, respectively (p = 0.009). The high-AEC group showed a significantly longer PFS and OS than the low-AEC group (mPFS = 7.0 months, 95% CI 5.0-10.0 vs 2.5 months, 95% CI 2.0-4.0, p = 0.007 and mOS = 9.0 months, CI 95% 7.0-15.0 vs 5.5 months, 95% CI 4.0-8.0, p = 0.009, respectively). An increased risk of immune-related adverse events (irAEs) was reported in the high-AEC group (p = 0.133). IrAEs resulted an independent prognostic factor for both better outcomes (mPFS = 8.0 months, 95% CI 7.0-12.0 vs 2.0 months, 95% CI 2.0-3.0, p<0.001; mOS = 13.0 months 95% CI 9.0-19.0 vs 4.0 months 95% CI 3.0-6-0, p<0.001) and response to ICIs (response rate = 33.8% vs 14.9%, disease control rate = 72.0% vs 32.1%, p<0.001). CONCLUSION High baseline AEC value (≥130/μL) is a predictive biomarker of clinical benefit and irAEs occurrence in NSCLC patients treated with ICIs.
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Affiliation(s)
- Enrico Caliman
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Sara Fancelli
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | | | - Luca Paglialunga
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | | | - Elisa Giommoni
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | | | - Federico Scolari
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Luca Voltolini
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Camilla Eva Comin
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Section of Surgery, Histopathology and Molecular Pathology, University of Florence, Italy
| | - Serena Pillozzi
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy.
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Italy; Medical Oncology Unit, Careggi University Hospital, Florence, Italy
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13
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Sartori A, Balla A, Botteri E, Scolari F, Podda M, Lepiane P, Guerrieri M, Morales-Conde S, Szold A, Ortenzi M. Laparoscopic approach in emergency for the treatment of acute incarcerated groin hernia: a systematic review and meta-analysis. Hernia 2022; 27:485-501. [PMID: 35618958 DOI: 10.1007/s10029-022-02631-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Minimally invasive approach for acute incarcerated groin hernia repair is still debated. To clarify this debate, a literature review was performed. METHODS Search was performed in PubMed, Embase, Scopus, Web of Science, and Cochrane databases, founding 28,183 articles. RESULTS Fifteen articles, and 433 patients were included (16 bilateral hernia, range 3-8). Three hundred and eighty-eight (75.3%) and 103 patients (22.9%) underwent transabdominal preperitoneal and totally extraperitoneal repair, respectively, and in 5 patients, the defect was buttressed with broad ligament (1.1%) (not specified in 3 patients). Herniated structures were resected in 48 cases (range 1-9). Intraoperative complications and conversion occurred in 4 (range 0-1) and 10 (range 0-3) patients, respectively. Mean operative time and hospital stay ranged between 50 and 147 min, and 2 and 7 days, respectively. Postoperative complications ranged between 1 and 19. Five studies compared laparoscopic and open approaches (163 and 235 patients). Herniated structures were resected in 19 (11.7%) and 42 cases (17.9%) for laparoscopic and open approach, respectively (p = 0.1191). Intraoperative complications and conversion occurred in one (0.6%) and 5 (2.1%) patients (p = 0.4077), and in two (1.2%) and 19 (8.1%) patients (p = 0.0023), in case of laparoscopic or open approach, respectively. Mean operative time and hospital stay were 94.4 ± 40.2 and 102.8 ± 43.7 min, and 4.8 ± 2.2 and 11 ± 3.1 days, in laparoscopic or open approach, respectively. Sixteen (9.8%) and 57 (24.3%) postoperative complications occurred. CONCLUSION Laparoscopy seems to be a safe and feasible approach for the treatment of acute incarcerated groin hernia. Further studies are required for definitive conclusions.
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Affiliation(s)
- A Sartori
- Department of General Surgery, Ospedale Di Montebelluna, Via Palmiro Togliatti, 16, 31044, Montebelluna, Treviso, Italy
| | - A Balla
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, 00053, Civitavecchia, Rome, Italy.
| | - E Botteri
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Via Boccalera 325018, Montichiari, Brescia, Italy
| | - F Scolari
- Department of General Surgery, Ospedale Di Montebelluna, Via Palmiro Togliatti, 16, 31044, Montebelluna, Treviso, Italy
| | - M Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - P Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, 00053, Civitavecchia, Rome, Italy
| | - M Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain
| | - A Szold
- Assia Medical, Assuta Medical Center, Tel Aviv, Israel
| | - M Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
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Aimo A, Tomasoni D, Lombardi C, Panichella G, De Angelis M, Fabiani I, Regazzoni V, Vergaro G, Nardi M, Passino C, Scolari F, Emdin M, Metra M. P286 ECHOCARDIOGRAPHIC FINDINGS IN SUBJECTS WITH AN AMYLOIDOGENIC APOLIPOPROTEIN A1 MUTATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.276] [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: 11/13/2022]
Abstract
Abstract
Background
The APOA1 gene encodes the precursor of apolipoprotein AI (ApoAI), whose mature form is the major component of high–density lipoproteins. APOA1 mutations may cause a form of hereditary amyloidosis (AApoAI). Only very small case series of patients with AApoAI are available.
Methods
We examined 189 consecutive subjects with the heterozygous APOA1 Leu75Pro mutation referred for cardiac screening over a 10–year timespan at the Spedali Civili of Brescia (Italy).
Results
Subjects (men 54%, median age 55 years, renal disease 39%, liver disease 31%) had a median left ventricular ejection fraction (LVEF) of 60% (55–66), did not display a prominent diastolic dysfunction (E/e’ ratio 7 [6–10]) nor LV hypertrophy (LV mass index [LVMI] 92 g/m2 [74–111]). LV global longitudinal strain (GLS) (–19% [–21 to –17]), and mass to strain ratio (MSR) (10.0 [6.8–12.1]) were within normal limits. Age correlated with several echocardiographic parameters, including interventricular septal (IVS) thickness (r = 0.484), LVMI (r = 0.459), E/e’ (r = 0.501), and right ventricular free wall thickness (r = 0.459) (all p < 0.001). Some individuals displayed echocardiographic red flags of cardiac amyloidosis (CA; “granular sparkling” of the IVS, 19%; pericardial effusion, 11%; apical sparing, 10%; thickened atrioventricular valves, 8%). Thirteen out of 96 (14%) fulfilled non–invasive criteria for CA. Twenty–nine subjects died over 5.8 years (4.1–8.0), with 10 deaths for cardiovascular causes; 14 out of 182 (8%) were hospitalized because of HF, and 17 (9%) died for cardiovascular causes or were hospitalized for HF. Individuals with suspected CA had a much higher risk of all–cause death (p = 0.009), cardiovascular death (p < 0.001), cardiovascular death or HF hospitalization (p < 0.001), and HF hospitalization alone (p < 0.001). Furthermore, subjects with either renal or liver involvement had a higher risk of events and a worse outcome.
Conclusions
In subjects with an amyloidogenic APOA1 mutation, transthoracic echocardiography showed only minor signs of cardiac disease. The correlations between age and echocardiographic findings suggested a progressive increase in wall thickness, a decline in systolic and diastolic function, and a greater uncoupling between LV mass and contractility over time. Subjects with both renal and liver disease displayed the most evident signs of biventricular involvement and had a worse outcome.
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Affiliation(s)
- A Aimo
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - D Tomasoni
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - C Lombardi
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - G Panichella
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - M De Angelis
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - I Fabiani
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - V Regazzoni
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - G Vergaro
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - M Nardi
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - C Passino
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - F Scolari
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - M Emdin
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
| | - M Metra
- FTGM, PISA; ASST SPEDALI CIVILI DI BRESCIA, BRESCIA; SCUOLA SUPERIORE SANT‘ANNA, PISA; CREMONA HOSPITAL, CREMONA
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15
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Hastenteufel L, Scolari F, Scussel F, Brum J, Krebs T, Saute J, Clausell N, Goldraich L. Expanding the Diagnosis of Familial Dilated Cardiomyopathy among Heart Transplant Recipients with a Screening Instrument. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1130] [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] Open
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16
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Worme M, Scolari F, Kozuszko S, Alonso-Gonzalez R. Protein Losing Enteropathy - Clinical Resolution Post Heart Transplant and Recurrence after CMV Enteritis. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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17
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GEMBILLO G, Scolari F, Izzi C, Siligato R, Minutoli F, Mazziotti S, Santoro D. POS-425 RECURRENT EPISODES OF FEVER IN A PATIENT WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE AND CAROLI DISEASE. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.448] [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] Open
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18
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Figliozzi S, Camporeale A, Pieroni M, Pieruzzi F, Namdar M, Lusardi P, Spada M, Mignani R, Burlina A, Scolari F, Carrubbi F, Battaglia Y, Graziani F, Boveri S, Lombardi M. Progressive electrocardiographic changes in parallel with cardiac magnetic resonance findings in fabry disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac Magnetic Resonance (CMR) allows to detect progressive stages of cardiac involvement in Fabry Disease (FD). A systematic description of electrocardiographic (ECG) alterations occurring in FD is currently missing.
Purpose
To explore ECG changes in progressive stages of FD cardiomyopathy.
Methods
71 FD patients and 17 healthy controls underwent CMR with T1 mapping and 12-lead ECG. ECG analysis included the duration of the P-wave and the interval between the end of P-wave and the beginning of QRS (PendQ). FD patients in the test cohort were divided into 3 groups with increasing severity of cardiac involvement: A) normal T1, no LVH; B) low T1, no LVH; C) low T1, LVH.
Results
An increase of Pwave/PendQ ratio was observed in Group A compared to Controls (1.08 vs. 0.75, p<0.0001). Higher Pwave/PendQ ratio (1.50 vs. 1.08, p<0.0001), shorter PQc interval (127.9 vs. 159.5, p=0.0007), increased Sokolow-Lyon Index (SLI) (3.2 vs. 2.4, p<0,001) and T wave amplitude (0.6 vs. 0.4 mV, p=0.002) characterized Group B in comparison with Group A. A higher prevalence of left bundle branch blocks (13.6% vs. 0%, p=0.03) and repolarization abnormalities (77.3% vs. 5.7%), wider QRS (120 vs 95 msec, p<0.0001) and QT (460 vs 400 msec, p=0.003) intervals were found in Group C compared to Group B. SLI (AUC 0.769), Pwave/PendQ (AUC 0.778), QRS (AUC 0.703) and QT (AUC 0.769) durations resulted to be independent predictors of low T1 values on CMR at stepwise multivariate analysis.
Conclusion
FD is characterized by progressive ECG changes. The identification of ECG parameters able to predict a lowering of myocardial T1 values on CMR may promote early detection of cardiac involvement, helping to target the therapeutic approach.
Progressive ECG and CMR changes in FD
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This study was partially supported by Ricerca Corrente funding from the Italian Ministry of Health to IRCCS Policlinico San Donato.
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Affiliation(s)
- S Figliozzi
- King's College London, School of Biomedical Engineering and Imaging Sciences - St Thomas' Hospital, London, United Kingdom
| | - A Camporeale
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Section, San Donato Milanese, Italy
| | - M Pieroni
- San Donato Hospital of Arezzo, Department of Cardiology, Arezzo, Italy
| | - F Pieruzzi
- San Gerardo Hospital, Nephrology and Dialysis Unit, Monza, Italy
| | - M Namdar
- University Hospital of Geneva, Cardiology Division, Geneva, Switzerland
| | - P Lusardi
- Gradenigo Hospital, Department of Cardiology, Turin, Italy
| | - M Spada
- University of Turin, Department of Pediatrics, Turin, Italy
| | - R Mignani
- Infermi Hospital of Rimini, Nephrology and Dialysis Department, Rimini, Italy
| | - A Burlina
- Bassano del Grappa General Hospital, Neurological Unit, Bassano Del Grappa, Italy
| | - F Scolari
- Civil Hospital of Brescia, Nephrology and Dialysis Unit, Brescia, Italy
| | - F Carrubbi
- University of Modena & Reggio Emilia, Metabolic Medicine Unit, Modena, Italy
| | - Y Battaglia
- FER University Hospital - Ospedale S. Anna, Nephrology and Dialysis Unit, Ferrara, Italy
| | - F Graziani
- Gemelli University Hospital, Department of Cardiovascular and Thoracic Sciences, Roma, Italy
| | - S Boveri
- IRCCS Policlinico San Donato, Scientific Directorate, San Donato Milanese, Italy
| | - M Lombardi
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Section, San Donato Milanese, Italy
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Falchetto M, Ciossani G, Scolari F, Di Cosimo A, Nenci S, Field LM, Mattevi A, Zhou JJ, Gasperi G, Forneris F. Structural and biochemical evaluation of Ceratitis capitata odorant-binding protein 22 affinity for odorants involved in intersex communication. Insect Mol Biol 2019; 28:431-443. [PMID: 30548711 DOI: 10.1111/imb.12559] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In insects, odorant-binding proteins (OBPs) connect the peripheral sensory system to receptors of olfactory organs. Medfly Ceratitis capitata CcapObp22 shows 37% identity and close phylogenetic affinities with Drosophila melanogaster OBP69a/pheromone-binding protein related protein 1. The CcapObp22 gene is transcribed in the antennae and maxillary palps, suggesting an active role in olfaction. Here, we recombinantly produced CcapObp22, obtaining a 13.5 kDa protein capable of binding multiple strongly hydrophobic terpene compounds, including medfly male pheromone components. The highest binding affinity [half maximal effective concentration (EC50) = 0.48 µM] was to (E,E)-α-farnesene, one of the most abundant compounds in the male pheromone blend. This odorant was used in cocrystallization experiments, yielding the structure of CcapOBP22. The monomeric structure shows the typical OBP folding, constituted by six α-helical elements interconnected by three disulphide bridges. A C-terminal seventh α-helix constitutes the wall of a deep, L-shaped hydrophobic cavity. Analysis of the electron density in this cavity suggested trapping of farnesene in the crystal structure, although with partial occupancy. Superposition of the CcapOBP22 structure with related seven-helical OBPs highlights striking similarity in the organization of the C-terminal segment of these proteins. Collectively, our molecular and physiological data on medfly CcapOBP22 suggest its involvement in intersex olfactory communication.
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Affiliation(s)
- M Falchetto
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - G Ciossani
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - F Scolari
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - A Di Cosimo
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - S Nenci
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - L M Field
- Department of Biointeractions and Crop Protection, Rothamsted Research, Harpenden, UK
| | - A Mattevi
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - J-J Zhou
- Department of Biointeractions and Crop Protection, Rothamsted Research, Harpenden, UK
| | - G Gasperi
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
| | - F Forneris
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
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Daga S, Fallerini C, Furini S, Pecoraro C, Scolari F, Ariani F, Bruttini M, Mencarelli MA, Mari F, Renieri A, Pinto AM. Non-collagen genes role in digenic Alport syndrome. BMC Nephrol 2019; 20:70. [PMID: 30808327 PMCID: PMC6391820 DOI: 10.1186/s12882-019-1258-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/18/2019] [Indexed: 02/04/2023] Open
Abstract
Background Alport syndrome is a clinically heterogeneous nephropathy characterized by severe symptomatology at kidney level due to ultrastructural lesions of the glomerular basement membrane (GBM) as consequence of mutations in COL4 genes. The disease has been linked to COL4A3/COL4A4/COL4A5 mutations, which impair GBM functionality and can be inherited in a dominant, recessive or X-linked transmission. Although a targeted Next Generation Sequencing approach has allowed identifying families with pathogenic mutations in more than one COL4 α3-α4-α5 heterotrimer encoding genes, leading to conclude for a digenic pattern of inheritance, the role of non-collagen genes in digenic Alport syndrome has not yet been established. Methods We employed a whole-exome sequencing approach on three families in whom a digenic pattern of transmission could be suspected because of a likely biparental contribution or an unexplained phenotype in the proband. Results We identified in the three probands hypomorphic LAMA5 mutations co-inherited with pathogenic COL4 α4-α5 chains mutations. Segregation analysis revealed that the combination of LAMA5/COL4 variants co-segregate with a fully penetrant phenotype in line with a digenic inheritance. In one of the three probands an hypomorphic variant in NPHS2 was also found, suggesting that role of other kidney disease related-genes as modifiers. Conclusion These findings validate the impact of LAMA5 mutations in digenic ATS and highlight the role of extracellular matrix’s genes, basement membrane, slit diaphragm and podocyte cytoskeleton in ATS. This underline the need for a more extensive panel approach in the presence of a digenic ATS, in order to better define clinical severity and recurrence risk for family members. Electronic supplementary material The online version of this article (10.1186/s12882-019-1258-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Daga
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
| | - C Fallerini
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
| | - S Furini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - C Pecoraro
- Pediatric Nephrology Unit, Santobono-Pausilipon Hospital, Naples, Italy
| | - F Scolari
- Department of Nephrology, University of Brescia, Brescia, Italy
| | - F Ariani
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - M Bruttini
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - M A Mencarelli
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - F Mari
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - A Renieri
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy. .,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
| | - A M Pinto
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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21
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Mancini E, Perazzini C, Gesualdo L, Aucella F, Limido A, Scolari F, Savoldi S, Tramonti M, Corazza L, Atti M, Severi S, Bolasco P, Santoro A. Intra-dialytic blood oxygen saturation (SO 2): association with dialysis hypotension (the SOGLIA Study). J Nephrol 2016; 30:811-819. [PMID: 27572624 DOI: 10.1007/s40620-016-0346-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/14/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Intradialytic hypotension (IDH) has a dramatic impact on the main outcomes of dialysis patients. Early warning of hemodynamic worsening during dialysis would enable preventive measures to be taken. Blood oxygen saturation (SO2) is used for hemodynamic monitoring in the critical care setting and may provide useful information about IDH onset. AIM To evaluate whether short- and medium-term variations in the SO2 signal (ST-SO2var, MT-SO2var,) during dialysis are a predictor of IDH. METHODS In this 3-month observational cohort study, 51 hypotension-prone chronic hemodialysis (HD) patients, with vascular access by arteriovenous fistula (AVF) or central venous catheter (CVC), were enrolled. Continuous non-invasive blood SO2 was monitored (fc = 0.2 Hz) by an optical sensor on the arterial line of the extracorporeal circulation; blood pressure (every 30 min), symptoms and their time of appearance were noted. Predictive power of IDH was expressed by the area under curve (AUC) sensitivity and specificity based on intradialytic variations in SO2. RESULTS A total of 1290 HD sessions were analyzed. Overall, off-line ST-SO2var analysis proved able to correctly predict IDH in 67 % of the sessions where IDH occurred. The best predictive performance was found in the presence of highly arterialized AVF (SO2 > 95 %) (75 % sensitivity; AUC 0.825; p < 0.05). On the contrary, in sessions with CVC, IDH prediction proved more efficient by MT-SO2var (AUC 0.575; p = 0.01). CONCLUSIONS Intradialytic SO2 variability could be a valid parameter to detect in advance the hemodynamic worsening that precedes IDH. Appropriate timely intervention could help prevent IDH onset.
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Affiliation(s)
- E Mancini
- Nephrology, Dialysis, Hypertension, Teaching Hospital Policlinico S.Orsola-Malpighi, Bologna, Italy.
| | - C Perazzini
- Health Sciences and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Cesena, Italy
| | - L Gesualdo
- Renal, Dialysis and Transplantation Unit, Department of Emergency and Transplantation, University of Bari, Bari, Italy
| | - F Aucella
- Nephrology and Dialysis Department, I.R.C.C.S. "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - A Limido
- Nephrology and Dialysis Unit, Azienda Ospedaliera "Fatebenefratelli e Oftalmico", Milano, Italy
| | - F Scolari
- Division of Nephrology and Dialysis, Azienda Ospedaliera di Montichiari, Brescia, Italy
| | - S Savoldi
- Nephrology and Dialysis Unit, Ospedale Civile, Cirié, Turin, Italy
| | - M Tramonti
- Health Sciences and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Cesena, Italy
| | - L Corazza
- Scientific Affairs Bellco srl, Mirandola, Italy
| | - M Atti
- Scientific Affairs Bellco srl, Mirandola, Italy
| | - S Severi
- Health Sciences and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Cesena, Italy.,Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - P Bolasco
- Territorial Department of Nephrology and Dialysis, ASL 8, Cagliari, Italy
| | - A Santoro
- Nephrology, Dialysis, Hypertension, Teaching Hospital Policlinico S.Orsola-Malpighi, Bologna, Italy
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22
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Mainetti C, Scolari F, Lautenschlager S. The clinical spectrum of syphilitic balanitis of Follmann: report of five cases and a review of the literature. J Eur Acad Dermatol Venereol 2016; 30:1810-1813. [PMID: 27421838 DOI: 10.1111/jdv.13802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/06/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Eugène Follmann first described syphilitic balanitis as a manifestation of primary syphilis in 1948 and since then it has been known as syphilitic balanitis of Follmann (SBF). So far, SBF has rarely been described in literature. OBJECTIVES We are reporting five additional cases of SBF considering the broad differential diagnosis of balanitis. METHODS A review of the available literature of SBF was performed and five additional cases analyzed. RESULTS In our case series, the clinical appearance of SBF shows a heterogeneous spectrum varying from painful oedematous balanoposthitis with beginning paraphimosis to superficial erosive balanitis and even to painless induration of the glans. CONCLUSIONS SBF might be seen more frequently than has been described due to misinterpretation. Therefore primary syphilis should be included in the differential diagnosis of balanitis and balanoposthitis.
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Affiliation(s)
- C Mainetti
- Department of Dermatology, Regional Hospital Bellinzona, Bellinzona, Switzerland
| | - F Scolari
- Private Practice, Geneva, Switzerland
| | - S Lautenschlager
- Outpatient Clinic of Dermato-Venereology, Triemli Hospital, Zürich, Switzerland.
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23
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Robinson P, McEwan P, Ong A, Ørskov B, Sandford R, Scolari F, Walz G, Bennet-Wilton H, O'Reilly K. FP064ASSESSING THE LONG TERM OUTCOMES OF AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD) USING THE ADPKD OUTCOMES MODEL: A UK CASE STUDY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv167.20] [Citation(s) in RCA: 1] [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: 11/12/2022] Open
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24
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Savoldi S, Scolari F, Sandrini S, Prati E, Scaini P, Cristinelli L, Maiorca R. Ciclosporin in renal transplantation: identification of two populations with different drug metabolism. Contrib Nephrol 2015; 51:31-8. [PMID: 3552417 DOI: 10.1159/000413091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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25
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Sandrini S, Scolari F, Savoldi S, Brunori G, Callea F, Tardanico R, Facchetti F, Delaini C, Cristinelli L, Maiorca R. Liver disease in renal transplant patients treated with azathioprine or ciclosporin. Contrib Nephrol 2015; 51:114-9. [PMID: 3032510 DOI: 10.1159/000413106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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26
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Maiorca R, Scolari F, Cancarini G, Brunori G, Camerini C. Management of hypertension in chronic renal failure. Contrib Nephrol 2015; 54:190-201. [PMID: 2882951 DOI: 10.1159/000413227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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27
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Maiorca R, Scolari F, Savoldi S, Sandrini S, Scaini P, Cristinelli L, Setti G, Brunori G. Viral infection in kidney-transplanted patients. Contrib Nephrol 2015; 61:266-88. [PMID: 3282785 DOI: 10.1159/000415258] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- R Maiorca
- Division of Nephrology, Spedali Civili and University, Brescia, Italy
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28
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McEwan P, Bennett Wilton H, Robinson P, Hadimeri H, Ong A, Ørskov B, Peces R, Sandford R, Scolari F, Walz G, Woon C, O'Reilly K. Development Of A Model To Predict Disease Progression In Autosomal Dominant Polycystic Kidney Disease (ADPKD). Value Health 2014; 17:A564. [PMID: 27201867 DOI: 10.1016/j.jval.2014.08.1870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P McEwan
- Swansea Centre for Health Economics, Swansea, UK
| | | | - P Robinson
- Otsuka Pharmaceutical Europe Ltd, Wexham, UK
| | - H Hadimeri
- Department of Nephrology, Kärnsjukhuset, Skövde, Sweden
| | - A Ong
- Academic Nephrology Unit, Department of Infection and Immunity, The University of Sheffield Medical School, UK
| | - B Ørskov
- Department of Medicine, Renal Division, Copenhagen University Hospital, Roskilde, Denmark
| | - R Peces
- Hospital Universitario La Paz, Madrid, Spain
| | - R Sandford
- Academic Laboratory of Medical Genetics, Addenbrooke's Treatment Centre, Cambridge, UK
| | - F Scolari
- Department of Nephrology, University of Brescia, Italy
| | - G Walz
- Department of Nephrology, University Medical Centre Freiburg, Zentrale Klinische Forschung, Freiburg, Germany
| | - C Woon
- McCann Complete Medical, Macclesfield, UK
| | - K O'Reilly
- Otsuka Pharmaceutical Europe Ltd, Wexham, UK
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29
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Aketarawong N, Guglielmino CR, Karam N, Falchetto M, Manni M, Scolari F, Gomulski LM, Gasperi G, Malacrida AR. The oriental fruitfly Bactrocera dorsalis s.s. in East Asia: disentangling the different forces promoting the invasion and shaping the genetic make-up of populations. Genetica 2014; 142:201-13. [PMID: 24816716 DOI: 10.1007/s10709-014-9767-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 05/02/2014] [Indexed: 11/30/2022]
Abstract
The Oriental fruit fly, Bactrocera dorsalis sensu stricto, is one of the most economically destructive pests of fruits and vegetables especially in East Asia. Based on its phytophagous life style, this species dispersed with the diffusion and implementation of agriculture, while globalization allowed it to establish adventive populations in different tropical and subtropical areas of the world. We used nine SSR loci over twelve samples collected across East Asia, i.e. an area that, in relatively few years, has become a theatre of intensive agriculture and a lively fruit trade. Our aim is to disentangle the different forces that have affected the invasion pattern and shaped the genetic make-up of populations of this fruit fly. Our data suggest that the considered samples probably represent well established populations in terms of genetic variability and population structuring. The human influence on the genetic shape of populations and diffusion is evident, but factors such as breeding/habitat size and life history traits of the species may have determined the post introduction phases and expansion. In East Asia the origin of diffusion can most probably be allocated in the oriental coastal provinces of China, from where this fruit fly spread into Southeast Asia. The spread of this species deserves attention for the development and implementation of risk assessment and control measures.
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Affiliation(s)
- N Aketarawong
- Department of Biology and Biotechnology, University of Pavia, Via Ferrata 9, 27100, Pavia, Italy
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30
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Cabrera-Lopez C, Ars E, Marti T, Harris PC, Torra R, Clerckx C, Migeon T, Chen Z, Ronco P, Plaisier E, Lamers IJ, Van Reeuwijk J, Azam M, Boldt K, Maria M, Koster-Kamphuis L, Qamar R, Ueffing M, Cremers FP, Roepman R, Arts HH, Papizh S, Dlin V, Leontieva I, Tutelman K, Perrone RD, Bae KT, Chapman AB, Devuyst O, Gansevoort RT, Grantham JJ, Higashihara E, Torres VE, Sergeyeva O, Zhou W, Blais JD, Czerwiec FS, Liu F, Liao Y, Fu P, Casteleijn N, Zittema D, Bakker S, Boertien W, Gaillard C, Meijer E, Spithoven E, Struck J, Gansevoort R, Robinson P, McEwan P, Hadimeri H, Ong ACM, Orskov B, Peces R, Sandford R, Scolari F, Walz G, Cooke C, O'Reilly K, Riwanto M, Kapoor S, Rodriguez D, Edenhofer I, Segerer S, Wuthrich RP, De Rechter S, Bacchetta J, Van Dyck M, Evenepoel P, De Schepper J, Levtchenko E, Mekahli D, Carr A, Makin A, Baker A, Obeidova L, Stekrova J, Seeman T, Puchmajerova A, Reiterova J, Kohoutova M, Tesar V, Treille S, Bailly JM, Guillaume B, Tuta L, Stanigut A, Botea F, Jo HA, Park HC, Kim H, Han M, Huh H, Jeong JC, Oh KH, Yang J, Koo TY, Hwang YH, Ahn C, Pisani A, Remuzzi G, Ruggenenti P, Riccio E, Visciano B, Spinelli L, Kim JI, Park KM, Liu FX, Rutherford P, Smoyer-Tomic K, Martinez Jimenez V, Comas J, Arcos E, Diaz JM, Muray S, Cabezuelo J, Ballarin J, Ars E, Torra R, Miyaoka T, Morimoto S, Kataoka H, Mochizuki T, Tsuchiya K, Ichihara A, Nitta K. RENAL DEVELOPMENT AND CYSTIC DISEASES. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Siciliano P, He XL, Woodcock C, Pickett JA, Field LM, Birkett MA, Kalinova B, Gomulski LM, Scolari F, Gasperi G, Malacrida AR, Zhou JJ. Identification of pheromone components and their binding affinity to the odorant binding protein CcapOBP83a-2 of the Mediterranean fruit fly, Ceratitis capitata. Insect Biochem Mol Biol 2014; 48:51-62. [PMID: 24607850 PMCID: PMC4003389 DOI: 10.1016/j.ibmb.2014.02.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 05/27/2023]
Abstract
The Mediterranean fruit fly (or medfly), Ceratitis capitata (Wiedemann; Diptera: Tephritidae), is a serious pest of agriculture worldwide, displaying a very wide larval host range with more than 250 different species of fruit and vegetables. Olfaction plays a key role in the invasive potential of this species. Unfortunately, the pheromone communication system of the medfly is complex and still not well established. In this study, we report the isolation of chemicals emitted by sexually mature individuals during the "calling" period and the electrophysiological responses that these compounds elicit on the antennae of male and female flies. Fifteen compounds with electrophysiological activity were isolated and identified in male emissions by gas chromatography coupled to electroantennography (GC-EAG). Within the group of 15 identified compounds, 11 elicited a response in antennae of both sexes, whilst 4 elicited a response only in female antennae. The binding affinity of these compounds, plus 4 additional compounds known to be behaviourally active from other studies, was measured using C. capitata OBP, CcapOBP83a-2. This OBP has a high homology to Drosophila melanogaster OBPs OS-E and OS-F, which are associated with trichoid sensilla and co-expressed with the well-studied Drosophila pheromone binding protein LUSH. The results provide evidence of involvement of CcapOBP83a-2 in the medfly's odorant perception and its wider specificity for (E,E)-α-farnesene, one of the five major compounds in medfly male pheromone emission. This represents the first step in the clarification of the C. capitata and pheromone reception pathway, and a starting point for further studies aimed towards the creation of new powerful attractants or repellents applicable in the actual control strategies.
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Affiliation(s)
- P Siciliano
- Department of Biological Chemistry and Crop Protection, Rothamsted Research, Harpenden, Herts. AL5 2JQ, United Kingdom; Dipartimento di Biologia e Biotecnologie, Università di Pavia, Via Ferrata 9, 27100 Pavia, Italia
| | - X L He
- Department of Biological Chemistry and Crop Protection, Rothamsted Research, Harpenden, Herts. AL5 2JQ, United Kingdom
| | - C Woodcock
- Department of Biological Chemistry and Crop Protection, Rothamsted Research, Harpenden, Herts. AL5 2JQ, United Kingdom
| | - J A Pickett
- Department of Biological Chemistry and Crop Protection, Rothamsted Research, Harpenden, Herts. AL5 2JQ, United Kingdom
| | - L M Field
- Department of Biological Chemistry and Crop Protection, Rothamsted Research, Harpenden, Herts. AL5 2JQ, United Kingdom
| | - M A Birkett
- Department of Biological Chemistry and Crop Protection, Rothamsted Research, Harpenden, Herts. AL5 2JQ, United Kingdom
| | - B Kalinova
- Institute of Organic Chemistry and Biochemistry of the AS CR, v.v.i., Flemingovo nám. 2, CZ-166 10 Prague 6, Czech Republic
| | - L M Gomulski
- Dipartimento di Biologia e Biotecnologie, Università di Pavia, Via Ferrata 9, 27100 Pavia, Italia
| | - F Scolari
- Dipartimento di Biologia e Biotecnologie, Università di Pavia, Via Ferrata 9, 27100 Pavia, Italia
| | - G Gasperi
- Dipartimento di Biologia e Biotecnologie, Università di Pavia, Via Ferrata 9, 27100 Pavia, Italia
| | - A R Malacrida
- Dipartimento di Biologia e Biotecnologie, Università di Pavia, Via Ferrata 9, 27100 Pavia, Italia
| | - J J Zhou
- Department of Biological Chemistry and Crop Protection, Rothamsted Research, Harpenden, Herts. AL5 2JQ, United Kingdom.
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Locsey L, Seres I, Sztanek F, Harangi M, Padra J, Asztalos L, Paragh G, Hutchison CA, Bevins A, Langham R, Mancini E, Wirta O, Cockwell P, Hutchison CA, Keir R, Vigano M, Stella A, Evans N, Chappell M, Cockwell P, Fabbrini P, Onuigbo M, Onuigbo N, Onuigbo M, Kim S, Chang JH, Jung JY, Lee HH, Chung W, Zanoli L, Rastelli S, Marcantoni C, Tamburino C, Castellino P, Cho A, Choi H, Lee JE, Jang HR, Huh W, Kim YG, Kim DJ, Oh HY, Zanoli L, Rastelli S, Marcantoni C, Tamburino C, Castellino P, Garcia-Fernandez N, Martin-Moreno PL, Varo N, Nunez-Cordoba JM, Schlieper G, Kruger T, Kelm M, Floege J, Westenfeld R, Choi H, Cho AJ, Jang HR, Lee JE, Huh W, Kim YG, Oh HY, Kim DJ, Doganay S, Oguz AK, Ergun I, Bardachenko N, Kuryata O, Bardachenko L, Garcia-Fernandez N, Martin-Moreno PL, Varo N, Nunez-Cordoba JM, Choi H, Cho AJ, Jang HR, Lee JE, Huh W, Kim YG, Oh HY, Kim DJ, Ravani P, Malberti F, Pirelli S, Scolari F, Barrett B, Presta P, Lucisano G, Rubino A, Serraino F, Amoruso T, Renzulli A, Fuiano G, Kielstein JT, Tolk S, Heiden A, Kuhn C, Hoeper MM, Lorenzen J, Broll M, Kaever V, Burhenne H, Hafer C, Haller H, Burkhardt O, Kielstein J, Zahalkova J, Petejova N, Strojil J, Urbanek K, Bertoli S, Musetti C, Cabiati A, Assanelli E, Lauri G, Marana I, De Metrio M, Rubino M, Campodonico J, Grazi M, Moltrasio M, Marenzi G, Unarokov Z, Mukhoedova T, Fidalgo P, Coelho S, Rodrigues B, Fernandes AP, Papoila AL, Liano F, Soto K, Vanmassenhove J, Vanholder R, Glorieux G, Van Biesen W, Challiner R, Ritchie J, Hutchison A, Challiner R, Ritchie J, Hutchison A, Challiner R, Ritchie J, Hutchison A, Zaharie SI, Maria DT, Zaharie M, Vaduva C, Grauntanu C, Cana-Ruiu D, Mota E, Hayer M, Baharani J, Thomas M, Eldehni T, Selby N, McIntyre C, Fluck R, Kolhe N, Fagugli RM, Patera F, Shah PR, Kaswan KK, Kute VB, Vanikar AV, Gumber MR, Patel HV, Munjappa BC, Enginner DP, Sainaresh VV, Trivedi HL, Teixeira C, Nogueira E, Lopes JA, Almeida E, Pais de Lacerda A, Gomes da Costa A, Franca C, Mariano F, Morselli M, Bergamo D, Hollo' Z, Scella S, Maio M, Tetta C, Dellavalle A, Stella M, Triolo G, Cantaluppi V, Quercia AD, Bertinetto P, Giacalone S, Tamagnone M, Basso E, Karvela E, Gai M, Leonardi G, Anania P, Guarena C, Fenocchio CM, Pacitti A, Segoloni GP, Kim YO, Kim HG, Kim BS, Song HCS, Min JK, Kim SY, Park WD, Dalboni M, Narciso R, Quinto M, Grabulosa C, Cruz E, Monte J, Durao M, Cendoroglo M, Santos O, Batista M, Cho A, Choi H, Lee JE, Jang HR, Huh W, Kim YG, Kim DJ, Oh HY, Mancini E, Bellasi A, Giannone S, Mordenti A, Zanoni A, Santoro A, Presta P, Lucisano G, Rubino A, Serraino F, Renzulli A, Fuiano G, Lee JH, Ha SH, Kim JH, Lee GJ, Jung YC, Malindretos P, Koutroumbas G, Patrinou A, Zagkotsis G, Makri P, Togousidis I, Syrganis C, Li Cavoli G, Tortorici C, Bono L, Ferrantelli A, Giammarresi C, Zagarrigo C, Rotolo U, Kim H, Jun K, Choi W, Kim H, Jun K, Choi W, Krzesinski JM, Parotte MC, Vandevelde C, Keenan J, Dieterle F, Sultana S, Pinches M, Ciorciaro C, Schindler R, Schmitz V, Gautier JC, Benain X, Matchem J, Murray P, Adler S, Haase M, Haase-Fielitz A, Devarajan P, Bellomo R, Cruz DN, Wagener G, Krawczeski CD, Koyner JL, Murray PT, Zappitelli M, Goldstein S, Makris K, Ronco C, Martensson J, Martling CR, Venge P, Siew E, Ware LB, Ikizler A, Mertens PR, Lacquaniti A, Buemi A, Donato V, Lucisano S, Buemi M, Vanmassenhove J, Vanholder R, Glorieux G, Van Biesen W, Panagoutsos S, Kriki P, Mourvati E, Tziakas D, Chalikias G, Stakos D, Apostolakis S, Tsigalou C, Gioka T, Konstantinides S, Vargemezis V, Torregrosa I, Montoliu C, Urios A, Aguado C, Puchades MJ, Solis MA, Juan I, Sanjuan R, Blasco M, Pineda J, Carratala A, Ramos C, Miguel A, Niculae A, Checherita IA, Sandulovici R, David C, Ciocalteu A, Espinoza M, Hidalgo J, Lorca E, Santibanez A, Arancibia F, Gonzalez F, Park MY, Kim EJ, Choi SJ, Kim JK, Hwang SD, Lee KH, Seok SJ, Yang JO, Lee EY, Hong SY, Gil HW, Astapenko E, Shutov A, Savinova G, Rechnik V, Melo MJ, Lopes JA, Raimundo M, Viegas A, Camara I, Antunes F, Kim MJ, Kwon SH, Lee SW, Song JH, Lee JW. Acute kidney injury - Human studies. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Scolari F, Siciliano P, Gabrieli P, Gomulski LM, Bonomi A, Gasperi G, Malacrida AR. Safe and fit genetically modified insects for pest control: from lab to field applications. Genetica 2010; 139:41-52. [PMID: 20725766 DOI: 10.1007/s10709-010-9483-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 08/07/2010] [Indexed: 01/10/2023]
Abstract
Insect transgenesis is continuously being improved to increase the efficacy of population suppression and replacement strategies directed to the control of insect species of economic and sanitary interest. An essential prerequisite for the success of both pest control applications is that the fitness of the transformant individuals is not impaired, so that, once released in the field, they can efficiently compete with or even out-compete their wild-type counterparts for matings in order to reduce the population size, or to spread desirable genes into the target population. Recent research has shown that the production of fit and competitive transformants can now be achieved and that transgenes may not necessarily confer a fitness cost. In this article we review the most recent published results of the fitness assessment of different transgenic insect lines and underline the necessity to fulfill key requirements of ecological safety. Fitness evaluation studies performed in field cages and medium/large-scale rearing will validate the present encouraging laboratory results, giving an indication of the performance of the transgenic insect genotype after release in pest control programmes.
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Affiliation(s)
- F Scolari
- Department of Animal Biology, University of Pavia, Pavia, Italy
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Khamis FM, Karam N, Ekesi S, DE Meyer M, Bonomi A, Gomulski LM, Scolari F, Gabrieli P, Siciliano P, Masiga D, Kenya EU, Gasperi G, Malacrida AR, Guglielmino CR. Uncovering the tracks of a recent and rapid invasion: the case of the fruit fly pest Bactrocera invadens (Diptera: Tephritidae) in Africa. Mol Ecol 2009; 18:4798-810. [PMID: 19821903 DOI: 10.1111/j.1365-294x.2009.04391.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Phytophagous insects of the genus Bactrocera are among the most economically important invasive fruit fly pests. In 2003, an unknown Bactrocera species was found in Kenya. First identified as an 'aberrant form' of the Asian B. dorsalis complex, it was later recognized as a new species, Bactrocera invadens. Within 2 years of its discovery, the species was recorded in several African countries, becoming an important quarantine pest. As this invasive fly was discovered only recently, no data are available on its invasion pattern in Africa. This pilot study attempts to infer from genetic data the dynamic aspects of the African invasion of this pest. Using microsatellite markers, we evaluated the level of genetic diversity and the extent of common ancestry among several African populations collected across the invaded areas. A sample from the Asian Sri Lankan population was analysed to confirm the Asian origin of this pest. Genetic data cast no doubt that Sri Lanka belongs to the native range, but only a small percentage of its genotypes can be found in Africa. African populations display relatively high levels of genetic diversity associated with limited geographical structure and no genetic footprints of bottlenecks. These features are indicative of processes of rapid population growth and expansion with possible multiple introductions. In the span of relatively few years, the African invasion registered the presence of at least two uncorrelated outbreaks, both starting from the East. The results of the analyses support that invasion started in East Africa, where B. invadens was initially isolated.
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Affiliation(s)
- F M Khamis
- Dipartimento di Biologia Animale, Università di Pavia, Pavia 27100, Italy
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Passerini P, Scolari F, Frasca' GM, Leoni A, Venturelli C, Dallera N, Ravera S, Balestra E, Freddi P, Fanciulli E, D'Arezzo M, Sagripanti S. [Controversial issues in the Giornale Italiano di Nefrologia: how to treat patients with focal segmental glomerular sclerosis]. G Ital Nefrol 2009; 26:563-576. [PMID: 19802802] [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: 05/28/2023]
Abstract
Primary focal segmental glomerular sclerosis (FSGS) commonly presents with nephrotic syndrome. Spontaneous remission is rare and persistent nephrotic syndrome is a marker of poor prognosis. For this reason, obtaining remission using drugs with minimal side effects is desirable. The treatment of FSGS, however, represents a challenge. Not only is there a lack of prospective controlled trials, but FSGS is a syndrome of unknown pathophysiology, generally treated with drugs having a mechanism of action that is poorly understood in this setting, the use of which has often drawn criticism because it is based on empirical assumptions rather than pathogenetic evidence. At present, corticosteroids are the standard first-line approach in patients with idiopathic FSGS. Cytotoxic agents and cyclosporin A constitute a good therapeutic option for steroid-dependent patients or frequent relapsers. Mycophenolate mofetil, rituximab and plasmapheresis should be used as rescue treatment because further studies are required to determine their safety and efficacy. Clearly, real progress in FSGS treatment can only be obtained by research focused on the pathophysiology of this disease, so that a therapeutic approach can be defined that is based on reason rather than chance.
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Affiliation(s)
- P Passerini
- U.O. Nefrologia e Dialisi, Fondazione, Ospedale Maggiore, Policlinico ''Mangiagalli e Regina Elena'', Milano, Italy.
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Turina S, Mazzola G, Venturelli C, Valerio F, Dallera N, Kenou R, Sottini L, Maffeo D, Tardanico R, Faggiano P, Scolari F. [Atheroembolic renal disease]. G Ital Nefrol 2009; 26:181-190. [PMID: 19382074] [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: 05/27/2023]
Abstract
Atheroembolic renal disease can be defined as renal failure due to occlusion of the renal arterioles by cholesterol crystal emboli usually dislodged from ulcerated atherosclerotic plaques of the aorta. Atheroembolic renal disease is part of multisystem disease, since the embolization usually involves other organ systems such as the gastrointestinal system, central nervous system, and lower extremities. The kidney is frequently involved because of the proximity of the renal arteries to the abdominal aorta, where erosion of atheromatous plaques is most likely to occur. Embolization may occur spontaneously or after angiographic procedures, vascular surgery, and anticoagulation. In the last decade, atheroembolic renal disease has become a recognizable cause of renal disease. An ante-mortem diagnosis of the disease is possible in a significant proportion of cases as long as the level of diagnostic suspicion is high. The disease can severely affect kidney and patient survival. Although no specific treatment has been proven efficacious, use of statins may be justifiable and such therapy would be a reasonable choice for future treatment trials.
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Affiliation(s)
- S Turina
- Cattedra di Nefrologia, Università di Brescia, Brescia
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Valerio F, Sottini L, Turina S, Dallera N, Faberi E, Kenou R, Mazzola G, Scolari F. [Choosing the right treatment approach in focal and segmental glomerular sclerosis with chronic renal failure]. G Ital Nefrol 2008; 25 Suppl 44:S88-S98. [PMID: 19048592] [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: 05/27/2023]
Abstract
Focal and segmental glomerular sclerosis (FSGS) is a heterogeneous disease from a clinical, etiological and clinical point of view. FSGS may be idiopathic, usually associated with nephrotic syndrome, which requires an ''etiological'' treatment approach. In addition, hereditary and secondary forms of FSGS have been described. The response to therapy, including steroids, cytotoxic drugs and calcineurin inhibitors, is considered the best clinical indicator of outcome. Many uncertainties exist regarding the best therapeutic approach to FSGS in patients presenting with chronic renal failure. In this setting, before planning any treatment, the physician should always assess the presence of superimposed functional renal insufficiency and evaluate the severity of the renal impairment, the histological picture, previous immunosuppressive treatments, and the individual patient's risk for side effects. Keeping in mind these considerations and in the absence of appropriate studies, we can formulate the following suggestions: 1. there is no absolute contraindication to the use of full-dose prednisone as initial therapy, although the likelihood of a good response is low; 2. the use of cytotoxic drugs is not recommended unless the patient presents with a steroid-responsive form of the disease; 3. in patients with a glomerular filtration rate of less than 40 mL/min, the use of calcineurin inhibitors should be avoided.
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Affiliation(s)
- F Valerio
- Cattedra e Divisione di Nefrologia, Università e Spedali Civili, Brescia, Italy
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Scolari F, Ravani P, Gaggi R, Santostefano M, Rollino C, Stabellini N, Colla L, Viola BF, Maiorca P, Ventrurelli C, Bonardelli S, Faggiano P, Barrett BJ. The challenge of diagnosing atheroembolic renal disease clinical features and prognostic factors. Circulation 116. Clin J Am Soc Nephrol 2008; 3:317-323. [PMID: 37001143 DOI: 10.2215/01.cjn.0000926960.01383.34] [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: 03/30/2023]
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Scolari F, La Manna G, Comai G, Cappuccilli ML, Todeschini P, Ciavatti A, Persici E, Feliciangeli G, Stefoni S. [Low-toxicity immunosuppressive therapy in renal transplant]. G Ital Nefrol 2007; 24 Suppl 38:44-48. [PMID: 17922447] [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: 05/25/2023]
Abstract
INTRODUCTION Renal allograft loss in the long term may be due to the death of a patient with a functioning graft or to chronic allograft nephropathy. One of the most important factors in the development of chronic allograft nephropathy is drug nephrotoxicity. The term nephrotoxicity comprises two distinct forms of renal injury: acute and chronic. Immunosuppressive drugs, and in particular calcineurin inhibitors, have a variety of side effects including nephrotoxicity. The nephrotoxicity associated with calcineurin inhibitors is well known; this association has also been described for the newer agents. METHODS We reviewed a large number of recent studies that attempted to reduce the toxicity of immunosuppressive regimens. RESULTS A number of low-toxicity protocols have been developed. Encouraging results have been obtained with regimens that reduce or eliminate nephrotoxicity-inducing calcineurin inhibitors and with regimens that reduce or eliminate steroids, which are responsible for many diseases that may lead to the death of the patient, even with a functioning graft. CONCLUSION All immunosuppressive drugs may be nephrotoxic, even if they act through different mechanisms. Combining different drugs at low dosage would therefore seem the best solution. It is not yet clear which regimens will be the most effective from the point of view of maximizing patient and graft survival, minimizing rejection, and minimizing adverse events.
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Affiliation(s)
- F Scolari
- UO di Nefrologia, Dialisi e Trapianto Renale, Policlinico S Orsola, Bologna, Italy.
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Schena FP, Cerullo G, Torres DD, Zaza G, Cox S, Bisceglia L, Scolari F, Frascá G, Ghiggeri GM, Amoroso A. Searching for IgA nephropathy candidate genes: genetic studies combined with high throughput innovative investigations. Contrib Nephrol 2007; 157:80-9. [PMID: 17495441 DOI: 10.1159/000102308] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Idiopathic IgA Nephropathy (IgAN) is the most common biopsy-proven glomerulonephritis worldwide. All races with the exception of Blacks and Indians are involved. Families with two or more relatives affected by IgAN may be observed in 15-20% of pedigrees of IgAN patients. Genome wide linkage study has been considered the most promising approach to identify IgAN susceptibility genes. Therefore, some European investigators constituted the European IgAN Consortium which was initially funded by the European Union. Data from linkage analysis studies, family association studies and case-control association studies are reported. To date, the Consortium has identified two loci (located on chromosomes 4q26-31 and 17q12-22), in addition to the previous study which described the first IgAN locus on chromosome 6q22-23. The functional mapping of genes involved in the disease proceeds from the identification of susceptibility loci identified by linkage analysis (step 1) to the isolation of candidate genes within gene disease-susceptibility loci, after obtaining information by microarray analysis carried out on peripheral leukocytes and renal tissue samples (step 2). Then, the process will proceed from the design of RNA interferenceagents against selected genes (step 3) to the application of systematically tested effect of RNA agents on functional cellular assay (step 4). The above combined high-throughput technologies will give information on the pathogenic mechanisms of IgAN. In addition, these data may indicate potential targets for screening, prevention and early diagnosis of the disease and more appropriate and effective treatment.
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Affiliation(s)
- F P Schena
- Renal, Dialysis and Transplant Unit, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy.
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Guerini S, Cavazzana I, Venturelli C, Rozzi M, Turina S, Sottini L, Tardanico R, Franceschini F, Scolari F. [Renal involvement in systemic sclerosis]. G Ital Nefrol 2007; 24:295-310. [PMID: 17659501] [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: 05/16/2023]
Abstract
Systemic sclerosis is an autoimmune disease characterized by fibrosis of the skin and internal organs. Raynaud's phenomenon generally precedes other disease manifestations. The distribution of skin lesions and the internal organ involvement are the basis for the classification into limited and diffuse forms of the disease. Clinically evident renal disease is observed in 10-40% of patients. The most common renal presentation is renal crisis, characterized by acute onset of renal failure and severe hypertension; some patients remain normotensive, showing microangiopathic hemolytic anemia. Renal complications due to penicillamine may occur in some patients. Finally, ANCA-associated glomerulonephritis is a rare complication of the disorder. In spite of treatment with ACE inhibitors, 20-50% of patients with renal crisis progress to end-stage renal disease. In the absence of a specific therapy, there is accumulating evidence supporting the effectiveness of prostacyclin derivatives, antifibrotic and immunosuppressive drugs. The evidence is strong that the ACE inhibitors that are used in renal crisis are disease modifying. In our series including 193 patients with systemic sclerosis, renal involvement was observed in 19 patients; 11 presented renal crisis (hypertensive in 8; normotensive in 3); 5 had chronic nephropathy; 2 developed penicillamine-induced nephrotic syndrome, and 1 ANCA-associated glomerulonephritis. Renal disease occurs in a minority of patients with systemic sclerosis, and may have a variable clinicopathological picture. As renal involvement is associated with a worse prognosis, careful monitoring of blood pressure, urine chemistry and renal function is required, particularly in patients with diffuse skin disease.
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Affiliation(s)
- S Guerini
- Cattedra e Divisione di Nefrologia, Università e Spedali Civili, Brescia
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Di Duca M, Oleggini R, Sanna-Cherchi S, Pasquali L, Di Donato A, Parodi S, Bertelli R, Caridi G, Frasca G, Cerullo G, Amoroso A, Schena FP, Scolari F, Ghiggeri GM. Cis and trans regulatory elements in NPHS2 promoter: implications in proteinuria and progression of renal diseases. Kidney Int 2006; 70:1332-41. [PMID: 16900088 DOI: 10.1038/sj.ki.5001767] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 11/08/2022]
Abstract
Podocin (NPHS2) expression in podocytes is associated with variable degrees of proteinuria and progression to renal failure in different glomerular diseases that suggests different expression profiles in NPHS2 promoter. Three functional polymorphisms in NPHS2 promoter (-51T, -116T, and -535 insCTTTTTT(3)) were found determining strong downregulation (-73, -59, and -82%, respectively) of the reporter gene expression when transfected in podocytes. Electrophoretic mobility shift assay experiments showed that all wild-type variants (-51G, -116C, and -535 insCTTTTTT(2)) formed specific DNA-protein complexes with podocyte nuclear extracts that were abolished by the presence of the rare forms (-51T, -116T, and -535 insCTTTTTT(3)). In the case of -51G, upstream stimulatory factor-1 (USF1) was identified as the specific trans element in accord to binding inhibition experiments and USF1 RNAi silencing. Haplotype analysis of 204 normal controls and 545 patients with renal diseases (308 immunoglobulin (Ig)A nephropathy and 237 focal segmental glomerulosclerosis) evidenced that -116/-51 and -535/P2OL formed two blocks in strong linkage disequilibrium in both normal and pathological cohorts. The high NPHS2 promoter profile -116C/-51G haplotype was more frequent in patients with IgA nephropathy (P-value=0.005) and was associated with a better clinical outcome in terms of proteinuria and creatinine levels. Overall our study describes functional variants of NPHS2 promoter and characterizes trans-acting elements that modulate podocin expression in the kidney. High producer NPHS2 promoter haplotypes seem protective in patients with chronic glomerular diseases.
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Affiliation(s)
- M Di Duca
- Laboratory on Pathophysiology of Uremia, G Gaslini Children Hospital, Genoa, Italy
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Izzi C, Sanna-Cherchi S, Prati E, Belleri R, Remedio A, Tardanico R, Foramitti M, Guerini S, Viola BF, Movilli E, Beerman I, Lifton R, Leone L, Gharavi A, Scolari F. Familial aggregation of primary glomerulonephritis in an Italian population isolate: Valtrompia study. Kidney Int 2006; 69:1033-40. [PMID: 16528253 PMCID: PMC5849459 DOI: 10.1038/sj.ki.5000185] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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] [Indexed: 01/21/2023]
Abstract
Hereditary factors are suspected to contribute to the pathogenesis of sporadic primary glomerulonephritis, but their contribution is difficult to delineate in the general population. We studied the prevalence of primary glomerulonephritis in an isolated population from the extreme northern Valtrompia valley, Northern Italy. Investigation of medical records, community urinary screening program and molecular characterization of the population's ancestry were performed; genealogies of affected individuals were researched. Forty-three patients with primary glomerulonephritis were identified: 25 had biopsy-proven disease (11 immunoglobulin A (IgA) nephropathy; eight mesangial proliferative glomerulonephritis without IgA deposits; four focal segmental glomerular sclerosis; two membranous nephropathy), and 18 had clinical glomerulonephritis. All 43 patients originated from three mountain villages (Collio, San Colombano, and Bovegno). In contrast, we found only four cases of primary glomerulonephritis in two nearby villages (Pezzaze and Tavernole) that shared similar population histories and lifestyles, demonstrating heterogeneity of risk factors for glomerulonephritis (P=3 x 10(-5)). All 43 affected individuals could be traced back to common ancestors (XVI-XVII centuries), enabling the construction of three large pedigree including three parent-child affected pairs and five affected siblings pairs. Molecular data showed lower genetic diversity and increased inbreeding in the Valtrompia population compared to the control population. Molecular and genealogical evidence of limited set of founders and the absence of shared nephritogenic environmental factors suggest that our patients share a common genetic susceptibility to the development of primary glomerulonephritis. Further molecular study of our families will offer the possibility to shed light on the genetic background underlying these glomerular disorders.
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Affiliation(s)
- C Izzi
- Division of Nephrology, Brescia University, Italy
| | - S Sanna-Cherchi
- Division of Nephrology, Columbia University, New York, New York, USA
| | - E Prati
- Dialysis Unit, Ospedale di Desenzano, Brescia, Italy
| | - R Belleri
- Azienda Sanitaria Locale of Brescia, Italy
| | - A Remedio
- Azienda Sanitaria Locale of Brescia, Italy
| | - R Tardanico
- Pathology Department, Spedali Civili, Brescia, Italy
| | - M Foramitti
- Division of Nephrology, Brescia University, Italy
| | - S Guerini
- Division of Nephrology, Brescia University, Italy
| | - BF Viola
- Division of Nephrology, Brescia University, Italy
| | - E Movilli
- Division of Nephrology, Brescia University, Italy
| | - I Beerman
- Departments of Genetics, Howard Hughes Medical Institute, Yale University, New Haven, Connecticut, USA
| | - R Lifton
- Departments of Genetics, Howard Hughes Medical Institute, Yale University, New Haven, Connecticut, USA
| | - L Leone
- Azienda Sanitaria Locale of Brescia, Italy
| | - A Gharavi
- Division of Nephrology, Columbia University, New York, New York, USA
| | - F Scolari
- Division of Nephrology, Brescia University, Italy
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Rastaldi MP, Candiano G, Musante L, Bruschi M, Armelloni S, Rimoldi L, Tardanico R, Sanna-Cherchi S, Cherchi SS, Ferrario F, Montinaro V, Haupt R, Parodi S, Carnevali ML, Allegri L, Camussi G, Gesualdo L, Scolari F, Ghiggeri GM. Glomerular clusterin is associated with PKC-alpha/beta regulation and good outcome of membranous glomerulonephritis in humans. Kidney Int 2006; 70:477-85. [PMID: 16775601 DOI: 10.1038/sj.ki.5001563] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 11/08/2022]
Abstract
Mechanisms for human membranous glomerulonephritis (MGN) remain elusive. Most up-to-date concepts still rely on the rat model of Passive Heymann Nephritis that derives from an autoimmune response to glomerular megalin, with complement activation and membrane attack complex assembly. Clusterin has been reported as a megalin ligand in immunodeposits, although its role has not been clarified. We studied renal biopsies of 60 MGN patients by immunohistochemistry utilizing antibodies against clusterin, C5b-9, and phosphorylated-protien kinase C (PKC) isoforms (pPKC). In vitro experiments were performed to investigate the role of clusterin during podocyte damage by MGN serum and define clusterin binding to human podocytes, where megalin is known to be absent. Clusterin, C5b-9, and pPKC-alpha/beta showed highly variable glomerular staining, where high clusterin profiles were inversely correlated to C5b-9 and PKC-alpha/beta expression (P=0.029), and co-localized with the low-density lipoprotein receptor (LDL-R). Glomerular clusterin emerged as the single factor influencing proteinuria at multivariate analysis and was associated with a reduction of proteinuria after a follow-up of 1.5 years (-88.1%, P=0.027). Incubation of podocytes with MGN sera determined strong upregulation of pPKC-alpha/beta that was reverted by pre-incubation with clusterin, serum de-complementation, or protein-A treatment. Preliminary in vitro experiments showed podocyte binding of biotinilated clusterin, co-localization with LDL-R and specific binding inhibition with anti-LDL-R antibodies and with specific ligands. These data suggest a central role for glomerular clusterin in MGN as a modulator of inflammation that potentially influences the clinical outcome. Binding of clusterin to the LDL-R might offer an interpretative key for the pathogenesis of MGN in humans.
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Affiliation(s)
- M P Rastaldi
- Renal Immunopathology Laboratory, Fondazione D'Amico per la Ricerca sulle Malattie Renali, Nuova Nefrologia Research Association, c/o San Carlo Borromeo Hospital, Milan, Italy
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Scarpioni R, Michieletti E, Cristinelli L, Ugolotti U, Scolari F, Venturelli C, Cancarini G, Pecchini P, Malberti F, Maroldi R, Rozzi G, Olivetti L. Atherosclerotic renovascular disease: medical therapy versus medical therapy plus renal artery stenting in preventing renal failure progression: the rationale and study design of a prospective, multicenter and randomized trial (NITER). J Nephrol 2005; 18:423-8. [PMID: 16245247] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Many studies suggest a major prevalence of atherosclerotic renovascular disease (ARVD), caused by mono or bilateral renal artery stenosis (RAS). Unfortunately, there is no definite therapy to cure this disease to date; therefore, ARVD is burdened by important clinical complications with high social and economic costs. The last few years have seen important advancements in both medical therapy and in interventional radiology (for example, percutaneous transluminal renal artery stenting (PTRS)). All of them could affect, in some way, the natural history of ARVD, but to date the optimal strategy has not been established. METHODS The protocol of a prospective, multicenter, randomized trial "Nephropathy Ischemic Therapy (NITER)" is presented. It enrolls patients with stable renal failure (glomerular filtration rate (GFR) >or=30 ml/min) and hypertension, and hemodynamically significant atherosclerotic ostial RAS (>or=70%) diagnosed by duplex Doppler (DD) ultrasonography and confirmed by magnetic resonance angiography (MRA). This study aims to evaluate whether medical therapy plus interventional PTRS is superior to medical therapy alone according to the following combined primary endpoint: death or dialysis initiation or reduction by >20% in estimated GFR after 0.5, 1, and 2 yrs of follow-up and an extended follow-up until the 4th year. Medical therapy means drugs to control hypertension, improve dyslipidemia and optimize platelet anti-aggregant therapy. The sample size is estimated in 50 patients per group to achieve a statistical significance of 0.05 in case of a reduction by 50% in the combined endpoints.
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Affiliation(s)
- R Scarpioni
- Division of Nephrology and Dialysis, "da Saliceto" Hospital, Piacenza - Italy.
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Manganoni AM, Venturini M, Scolari F, Tucci G, Facchetti F, Graifemberghi S, Calzavara-Pinton PG. The importance of skin biopsy in the diverse clinical manifestations of cholesterol embolism. Br J Dermatol 2004; 150:1230-1. [PMID: 15214931 DOI: 10.1111/j.1365-2133.2004.06000.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Scolari F, Viola BF, Prati E, Ghiggeri GM, Caridi G, Amoroso A, Casari G, Maiorca R. Medullary cystic kidney disease: past and present. Contrib Nephrol 2002:68-78. [PMID: 11688405 DOI: 10.1159/000060180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- F Scolari
- Cattedra di Nefrologia, Università dell'Insubria, Varese, Italy.
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Scolari F, Viola BF, Grazioli L, Longa L, Migone N, Maiorca R. Two different types of renal involvement in tuberous sclerosis complex. Contrib Nephrol 2002:318-24. [PMID: 11688400 DOI: 10.1159/000060207] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- F Scolari
- Cattedra di Nefrologia, Università dell'Insubria, Varese, Italia.
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Scolari F, Viola BF, Grazioli L, Maiorca R. Von Hippel-Lindau syndrome presenting as pancreatic cysts. Contrib Nephrol 2002:325-30. [PMID: 11688401 DOI: 10.1159/000060208] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- F Scolari
- Cattedra di Nefrologia, Università dell'Insubria, Varese, Italia.
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