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Graziano F, Maugeri R, Giammalva GR, Lo Bue E, Zabbia G, Iacopino DG. Pulsed radiofrequency energy device (PEAK plasmablade™) and CustomBone ® Cranioplasty: an appealing surgical rendez-vous. Br J Neurosurg 2023; 37:518-524. [PMID: 30856015 DOI: 10.1080/02688697.2019.1584267] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/14/2018] [Revised: 12/02/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND CustomBone® prosthesis is a widely recognized effective and successful technique for the reconstruction of cranial bone defects. Prior the cranioplasty implant, meticulous dissection within thick scar tissue is required. During this delicate surgical manoeuvre is vital to avoid damage to the skin flap itself and to the underlying cerebrovascular structures. We report our experience and potential applications of a novel, pulsed monopolar radiofrequency energy device (PEAK PlasmaBlade™, Medtronic plc). It reduced the incidence of post operativesubgaleal hematoma, the operative times and the intra operative blood loss following cranioplasty compared to the traditional scalpel and scissor dissection. METHODS The authors present a one centre case series study to review the indications, safety and efficacy of the PEAK PlasmaBlade™ in adult patientsunderwent cranioplasty. Two surgical techniques for tissue dissection were compared: PEAK PlasmaBlade™ versus scalpel and scissor dissection (SSD). Treatment outcomes following each of these surgical approaches, relative to rate of post-operative subgalealhematoma formation, hospital admission, and operative times were compared. RESULTS A total of 10 patients that had cranioplasty treatment were evaluated. In patients underwent scalp dissection with the PEAKPlasmaBlade™, we observed a reduction in the operative times, in the subgaleal hematoma formation and then in the hospital stay. CONCLUSION PEAK PlasmaBlade™ revealed to be a safe and effective device in tissues dissection for cranioplasty implant. It provided reduction of the rate of subgaleal hematoma formation, operating times and less potential risk to damage cerebrovascular structures.
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Affiliation(s)
- F Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - R Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - G R Giammalva
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - E Lo Bue
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - G Zabbia
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo, Italy
| | - D G Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
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Caravaglios G, Muscoso EG, Blandino V, Di Maria G, Gangitano M, Graziano F, Guajana F, Piccoli T. EEG Resting-State Functional Networks in Amnestic Mild Cognitive Impairment. Clin EEG Neurosci 2023; 54:36-50. [PMID: 35758261 DOI: 10.1177/15500594221110036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Alzheimer's cognitive-behavioral syndrome is the result of impaired connectivity between nerve cells, due to misfolded proteins, which accumulate and disrupt specific brain networks. Electroencephalography, because of its excellent temporal resolution, is an optimal approach for assessing the communication between functionally related brain regions. Objective. To detect and compare EEG resting-state networks (RSNs) in patients with amnesic mild cognitive impairment (aMCI), and healthy elderly (HE). Methods. We recruited 125 aMCI patients and 70 healthy elderly subjects. One hundred and twenty seconds of artifact-free EEG data were selected and compared between patients with aMCI and HE. We applied standard low-resolution brain electromagnetic tomography (sLORETA)-independent component analysis (ICA) to assess resting-state networks. Each network consisted of a set of images, one for each frequency (delta, theta, alpha1/2, beta1/2). Results. The functional ICA analysis revealed 17 networks common to groups. The statistical procedure demonstrated that aMCI used some networks differently than HE. The most relevant findings were as follows. Amnesic-MCI had: i) increased delta/beta activity in the superior frontal gyrus and decreased alpha1 activity in the paracentral lobule (ie, default mode network); ii) greater delta/theta/alpha/beta in the superior frontal gyrus (i.e, attention network); iii) lower alpha in the left superior parietal lobe, as well as a lower delta/theta and beta, respectively in post-central, and in superior frontal gyrus(ie, attention network). Conclusions. Our study confirms sLORETA-ICA method is effective in detecting functional resting-state networks, as well as between-groups connectivity differences. The findings provide support to the Alzheimer's network disconnection hypothesis.
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Affiliation(s)
- G Caravaglios
- U.O.C. Neurologia, A.O. Cannizzaro per l'emergenza, Catania, Italy
| | - E G Muscoso
- U.O.C. Neurologia, A.O. Cannizzaro per l'emergenza, Catania, Italy
| | - V Blandino
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), 18998University of Palermo, Palermo, Italy
| | - G Di Maria
- U.O.C. Neurologia, A.O. Cannizzaro per l'emergenza, Catania, Italy
| | - M Gangitano
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), 18998University of Palermo, Palermo, Italy
| | - F Graziano
- U.O.C. Neurologia, A.O. Cannizzaro per l'emergenza, Catania, Italy
| | - F Guajana
- U.O.C. Neurologia, A.O. Cannizzaro per l'emergenza, Catania, Italy
| | - T Piccoli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), 18998University of Palermo, Palermo, Italy
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Brunetti G, Cavigli L, Graziano F, Cipriani A, Perazzolo Marra M, Bauce B, Corrado D, Zorzi A. Reproducibility of exercise-induced premature ventricular beats predicts concealed non-ischemic left ventricular scar on cardiac magnetic resonance in athletes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Non-ischemic left ventricular scar (NLVS) at cardiac magnetic resonance (CMR) is a common substrate of apparently idiopathic premature ventricular beats (PVBs) in athletes. PVBs morphology, complexity and exercise-behavior are known predictors of NLVS. It remains to be established whether reproducibility of PVBs at exercise testing correlates with CMR findings.
Purpose
We aimed to evaluate the possible role of PVBs reproducibility at repeated exercise testing in predicting the presence of an underlying NLVS in athletes who underwent CMR for apparently idiopathic ventricular arrhythmias.
Methods
We included all consecutive competitive athletes referred to our center for the evidence of PVBs during pre-participation screening, who underwent two maximal exercise testings within one month (the first at the time of pre-participation screening, the second at the time of outpatient evaluation at our sports cardiology clinic). Exclusion criteria were known heart disease, family history of cardiomyopathy or channelopathy, abnormal ECG and echocardiography. We also excluded athletes with “common/usually benign” PVBs (non-exercise-induced infundibular or fascicular PVBs) as well as those on ongoing antiarrhythmic therapy. Reproducibility was defined as the presence of PVBs with same morphology and exercise-behavior in two subsequent tests. LGE on CMR was quantified with 5-SD method, using a threshold of 5% to define the presence of pathological LVNS.
Results
A total of 64 apparently healthy competitive athletes (86% males, mean age of 33±14 years old) were included. On CMR, NLVS was identified in 26 (41%). PVBs reproducibility criteria was met in 32 athletes (50%). A statistically significant difference in PVBs reproducibility was found between patients with and without LVNS [26 (100%) versus 6 (16%), p<0,001], irrespective of other factors such as age, sex, biventricular volumes and function (Figure 1). Among the 26 patients with NLVS, 18 (69%) showed PVBs with right-bundle branch block (R-BBB) with superior axis configuration, alone or associated with other morphologies. These arrhythmic patterns were confirmed by a second test in all cases. Among the 38 patients with normal CMR, the first exercise test showed R-BBB/superior axis PVBs, alone or associated with other morphologies, in 22 (57%); the second test confirmed such pattern in only 6 (16%), showing instead different morphologies in 8 (21%) and no PVBs in 24 (63%). Figure 2 represents an example of two cases included in the study.
Conclusion
In apparently healthy athletes who underwent CMR for “uncommon” PVBs, the presence of underlying LVNS was predicted by ventricular arrhythmia reproducibility. Specifically, reproducibility of PVBs with RBBB/superior axis morphology was highly predictive of a positive CMR. This finding may be very relevant for appropriate prescription of CMR in athletes with apparently idiopathic ventricular arrhythmias.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Brunetti
- University Hospital of Padova , Padua , Italy
| | | | - F Graziano
- University Hospital of Padova , Padua , Italy
| | - A Cipriani
- University Hospital of Padova , Padua , Italy
| | | | - B Bauce
- University Hospital of Padova , Padua , Italy
| | - D Corrado
- University Hospital of Padova , Padua , Italy
| | - A Zorzi
- University Hospital of Padova , Padua , Italy
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Cecere A, Cipriani A, Ravagnin A, Graziano F, Brunetti G, De Conti G, Motta R, De Lazzari M, Iliceto S, Perazzolo Marra M. Quantification of left ventricular fibrosis in arrhythmic mitral valve prolapse patients: comparison of different semi-automated techniques assessed by cardiac magnetic resonance. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) fibrosis has a key role in arrhythmogenesis in mitral valve prolapse (MVP) patients. Cardiac magnetic resonance (CMR) demonstrated able to clearly identify LV fibrosis with the post-contrast late gadolinium enhancement (LGE) images. Despite the pivotal role of LV fibrosis in the arrhythmogenesis, a quantification and identification of reproducible method able to accurately measure LGE in arrhythmic MVP patients has not been recognized.
Purpose
We aimed to measure and compare different semi-quantitative methods for LGE quantification assessed by CMR, in order to identify the most reproducible one, in arrhythmic MVP patients.
Methods
66 arrhythmic MVP patients with normal systolic function and without significant regurgitation were enrolled. Semi-automated gray-scale thresholding technique using full with at half maximum (FWHM) and 2, 3 and 5 standard deviation (SD) above the remote myocardium were used and compared with visual assessment (Fig. 1).
Results
LGE was identified in 41 arrhythmic MVP patients (62%) and quantified (Fig. 2). The mean quantity of LGE visually assessed was 2.40±1.07% or 1.40±0.82 g. With FWHM, LGE resulted 3.56±1.23% or 1.99±1.13 g. Using thresholding, the mean LGE quantity was 9.2±3.1% or 4.82±2.28 g for 2-SD, 5.72±1.75% or 3.06±1.47 g for 3-SD and 2.36±0.99% or 1.29±0.79 g for 5-SD. The 5-SD measurement in percentage demonstrated a good correlation with LGE quantification visually assessed (2.402±1.075 vs 2.363±0.9909, p: 0.543). Despite all semi-quantitative methods for LGE quantification demonstrated a good intra and inter-observer agreement, the 5-SD threshold quantification, both in percentage and in grams, revealed the less intra-observer (respectively, ICC: 0.976 and 0.966) and inter-observer variability (respectively ICC: 0.948 and 0.935) when compared with visual assessment.
Conclusion
This is the first study that quantified and compared different CMR semi-automated methods for LGE assessment in a population of arrhythmic MVP patients. The 5-SD gray-scale threshold technique in percentage revealed the best correlation with the visual assessment and an optimal reproducibility.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Cecere
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - A Cipriani
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - A Ravagnin
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - F Graziano
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - G Brunetti
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - G De Conti
- University of Padua – Azienda Ospedaliera, Radiology Unit , Padua , Italy
| | - R Motta
- University of Padua – Azienda Ospedaliera, Radiology Unit, Department of Medicine , Padua , Italy
| | - M De Lazzari
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - S Iliceto
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - M Perazzolo Marra
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
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Maiolino G, Del Zingaro M, Manfredini G, Graziano F, Tancredi A, Boni A, Mearini E. Peak systolic velocity at basal penile ultrasound and individual 10-year risk of cardiovascular disease. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01026-6] [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: 11/07/2022] Open
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Garozzo D, Rispoli R, Graziano F, Gerardi RM, Grotenhuis A, Jenkins A, Sammons V, Visocchi M, Pinazzo S, Lima R, Martinez F, Emamhadi M, Pedro MT, Shirwari HS, Guedes F, Bhagavatula ID, Shukla DP, Bhat ID, Ojo OA, Tirsit A, Gonzales-Gonzales ME, Luna F, Kretschmer T, Benzel E, Cappelletto B. Women in Neurosurgery: Historical Path to Self-Segregation and Proposal for an Integrated Future. Front Surg 2022; 9:908540. [PMID: 35836607 PMCID: PMC9274114 DOI: 10.3389/fsurg.2022.908540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the rising percentage of women accessing the medical profession over the last few decades, surgical specialties are still largely male-dominated; in particular, a remarkable gender disparity is evident in neurosurgery, where only 19% of practitioners are females. Although women may be reluctant to choose a challenging specialty like neurosurgery due to concerns around how to balance family and career, it must be admitted that prejudices against female neurosurgeons have been deeply rooted for long, prompting many to give up and switch track to less demanding subspecialties. Among those who have persisted, many, if not most, have experienced difficulties in career progression and received unequal treatment in comparison with their male counterparts. In 1989, a group of 8 female neurosurgeons founded Women in Neurosurgery (WINS), an organization that aimed to guarantee inclusivity in neurosurgery, encouraging a better and more egalitarian working environment. Thereafter, WINS sessions were regularly promoted at international conferences, offering female neurosurgeons a platform to report issues related to gender discrimination. Over recent years, the mission of WINS sessions in national and international conferences has taken an unexpected deviation; they have progressively become supplementary scientific sessions with only women neurosurgeons as speakers, thus paving the road to a form of self-segregation. This tendency has also resulted in the establishment of sections of only female neurosurgeons within some national societies. Although there remains a faction that fiercely supports the WINS mindset of reserved spaces for women, such segregation is an upsetting prospect for those who believe that science and professionalism have no gender; a growing part of the global neurosurgical community believes that the conception of a “female neurosurgery” and a “male neurosurgery” is misguided and counterproductive and consider the existence of the WINS as anachronistic and no longer necessary.
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Affiliation(s)
- D Garozzo
- Department of Neurosurgery, Mediclinic Parkview Hospital, Dubai, UAE
| | - R Rispoli
- SOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario Santa Maria della Misericordia di Udine, Udine, Italy
| | - F Graziano
- Department of Neurosurgery, ARNAS Garibaldi Hospital, Catania, Italy
| | - R M Gerardi
- Department of Neurosurgery, University Hospital, Palermo, Italy
| | - A Grotenhuis
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - A Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - V Sammons
- Department of Neurosurgery, North Shore Private Hospital, Sydney, Australia
| | - M Visocchi
- Department of Neurosurgery, Agostino Gemelli IRCCS, Rome, Italy
| | - S Pinazzo
- Department of Neurosurgery, Hospital Maciel, Montevideo, Uruguay
| | - R Lima
- Department of Neurosurgery, Hospital de Clínicas, Montevideo, Uruguay
| | - F Martinez
- Department of Neurosurgery, Hospital de Clínicas, Montevideo, Uruguay
| | - M Emamhadi
- Brachial plexus and peripheral nerve injury center, Guilan University of Medical Sciences, Rasht, Iran
| | - M T Pedro
- Peripheral Nerve Unit, Department of Neurosurgery, BKH Günzburg at Ulm University, Günzburg, Germany
| | - H S Shirwari
- Department of Neurosurgery, Dawodzai Medical Complex, Jalalabad, Afghanistan
| | - F Guedes
- Division of Neurosurgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - D P Shukla
- Department of Neurosurgery, NIMHANS, Bangalore, India
| | - I D Bhat
- Department of Neurosurgery, RV Astor Hospital Sarakki Jp Nagar, Bengaluru, India
| | - O A Ojo
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - A Tirsit
- Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - M E Gonzales-Gonzales
- Department of Neurosurgery, Hospital Civil de Guadalajara, Guadalajara, Jalisco, Mexico
| | - F Luna
- Departament of Neurosurgery, Hospital Clínico Regional de Concepción, Universidad de Concepción. Concepcion, Chile
| | - T Kretschmer
- Dept. of Neurosurgery & Neurorestoration, Neurosurgical Intensive Care, Neurooncological Centre (DKG) Klinikum Klagenfurt, Klagenfurt, Austria
| | - E Benzel
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States of America
| | - B Cappelletto
- SOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario Santa Maria della Misericordia di Udine, Udine, Italy
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Graziano F, Schiavon M, Paiaro S, Cipriani A, Brunetti G, Corrado D, Zorzi A. Cost-effectiveness of the cardiovascular pre-participation screening in children practicing sport. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
In Italy, preparticipation screening of competitive athletes is mandatory. The age at which pre-participation screening (PPS) should start is established by each sport federation and it is sometimes under 10 years old. The aim of this study is to detect both PPS efficacy and cost in paediatric age and to define the cut-off age from which it is more cost-effective.
Methods
We retrospectively enrolled 25251 athletes aged ≤15 to evaluate the prevalence of cardiovascular (CV) diseases and cost-effectiveness ratio who underwent PPS from 2011 to 2020. In addition, we retrospectively studied a subgroup of 1307 competitive athletes aged 7-15 who underwent PPS from January 2019 to February 2020 for an in-depth analysed regarding costs. Cardiovascular preparticipation screening included first-line investigations (history, physical examination, resting ECG and exercise testing) and further examinations in case of abnormalities at first-line tests.
Results
In the period 2010-2020, 66 athletes were permanently disqualified for a CV disease (0,11%), 26 for a CV disease at risk of sudden cardiac death (0.05%), with a prevalence of 0.15% over 12 years old versus 0.01% under 12 (p<0.001). In the cost analysis subgroup, second-line investigations were prescribed to 5% of athletes because of abnormalities at first line tests: 1 was disqualified for a CV disease (0,07%). The cost for each athlete was 69,80€. Between 2011 and 2020, 58185 PPS were carried out. The overall cost of PPS was about €4 million, the cost for each diagnosis of any CV disease was 61.535€, and for each CV disease at risk of sudden cardiac death was 156.204€.
Conclusion
The cost-effectiveness of PPS before competitive sports in the pediatric age is lower than reported for older athletes in previously published studies. According to our data, starting PPS before 12 years of age does not appear to be justified.
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Affiliation(s)
- F Graziano
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - M Schiavon
- AULSS 6, Department of Sports Medicine, Padova, Italy
| | - S Paiaro
- AULSS 6, Department of Sports Medicine, Padova, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - G Brunetti
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - D Corrado
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - A Zorzi
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
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Brunasso L, Alotta G, Zingales M, Iacopino DG, Graziano F. Can biomechanical analysis shed some light on aneurysmal pathophysiology? Preliminary study on ex vivo cerebral arterial walls. Clin Biomech (Bristol, Avon) 2021; 81:105184. [PMID: 33309932 DOI: 10.1016/j.clinbiomech.2020.105184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The pathophysiology of cerebral aneurysm is complex and poorly understood, and it can have the most catastrophic clinical presentation. Flow dynamics is a key player in the initiation and progression of aneurysm. Better understanding the interaction between hemodynamic loading and biomechanical wall responses can help to add the missing piece on aneurysmal pathophysiology. In this laboratory study we aimed to analyze the effect of the application of a mechanical force to cerebral arterial walls. METHODS Displacement control tests were performed on five porcine cerebral arteries. The test machine was the T150 Nanotensile. The stiffness variation with the increment of the strain level is modeled as the outcome of an isotropic hyperelastic material model. FINDINGS Through the application of an axial force we obtained Stress/Strain curves that showed a marked isotropic hyperelastic behavior, characterized by an increasing of stiffness with the level of strain. This behavior of the cerebral arterial wall is different from the well-established behavior of other arterial vessel (as the aortic vessel) characterized by a marked anisotropic behavior. Additionally, the data scattering observed for higher values of the applied stress are related to different individual packing of collagen fibers that represent the load-bearing mechanics at higher level of the strain. INTERPRETATION The data obtained by test in this paper represent a first step in our ongoing research about the mechanics of multi-axial loads on cerebral arterial walls, and in producing more comprehensive patient-specific calculations for potential applications on cerebral aneurysm management.
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Affiliation(s)
- L Brunasso
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", 90100 Palermo, Italy
| | - G Alotta
- Dipartimento di Ingegneria Civile, dell'Energia, dell'Ambiente, e dei Material, Università degli Studi "Mediterranea" di Reggio Calabria, Via Graziella-Vito, 89122 Reggio Calabria, RC, Italy
| | - M Zingales
- Bio/NanoMechanics for Medical Sciences Laboratory, ATeN-Center, Università degli Studi di Palermo, Viale delle Scienze ed.18, Palermo, Italy; Dipartimento di Ingegneria, Viale delle Scienze, Università degli Studi di Palermo,ed.8, 90128 Palermo, Italy.
| | - D G Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", 90100 Palermo, Italy
| | - F Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", 90100 Palermo, Italy; Azienda ospedaliera di Rilievo Nazionale e di Alta Specializzazione (ARNAS), "G. Garibaldi", Piazza S. Maria di Gesù n.5, 95124 Catania, Italy
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Baleani M, Bittoni A, Prete MD, Lanese A, Meletani T, Giglio E, Cantini L, Crocetti S, Copparoni C, Lupi A, Lenci E, Bini F, Giulia M, Pecci F, Bisonni R, Alessandroni P, Graziano F, Berardi R, Giampieri R. P-75 Retrospective comparison between FLOT perioperative chemotherapy vs surgery followed by adjuvant chemotherapy: Results from a multicenter analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.157] [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: 10/23/2022] Open
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Persichetti A, Di Stasio E, Coccaro C, Graziano F, Bianchini A, Di Donna V, Corsello S, Valle D, Bizzarri G, Frasoldati A, Pontecorvi A, Papini E, Guglielmi R. Inter- and Intraobserver Agreement in the Assessment of Thyroid Nodule Ultrasound Features and Classification Systems: A Blinded Multicenter Study. Thyroid 2020; 30:237-242. [PMID: 31952456 DOI: 10.1089/thy.2019.0360] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Single-center trials demonstrated moderate-substantial level of interobserver agreement in the evaluation of ultrasound (US) features of thyroid nodules. Multicenter studies on US agreement, however, are scanty, and data on intraobserver agreement are poor. Aim of the study was to assess inter- and intraobserver agreement between different thyroid centers and different specialists. Methods: A blinded analysis of 100 electronically recorded thyroid nodule US images was conducted in three large-volume thyroid centers by seven radiologists and endocrinologists. The evaluation was repeated after randomization 4 months later. The following US characteristics were evaluated: composition, echogenicity, margins, intranodular echogenic spots, vascularity, and shape. Thyroid nodules were also classified according to AACE/ACE/AME, EU-TIRADS, ATA, and ACR-TIRADS US classifications. Intra- and interobserver agreement was calculated using cross-tabulation expressed as mean Cohen's Kappa. Results: Interobserver agreement for US features: K-coefficient was 0.53 for composition, 0.47 for echogenicity, 0.46 for intranodular vascularity, and 0.33 for margins of the nodules. For echogenic foci, the K-coefficient was 0.47 for microcalcifications, 0.38 for macrocalcifications, 0.11 for the subcategory comet-tail artifacts, and 0.42 for shape. Operators resulted uncertain on hyperechoic foci definition in 16% of cases and described them as "hyperechoic foci of uncertain significance." Interobserver Cohen-K for US classification systems was 0.44 for AACE, 0.42 for ACR-TIRADS, 0.39 EU-TIRADS, and 0.34 for ATA. Intraobserver agreement: the K-coefficient for nodule US features was 0.62 for intranodular vascularity, 0.58 for composition, 0.60 for echogenicity, 0.54 for macrocalcifications, 0.55 for microcalcifications, 0.47 for comet tails, 0.39 for margins, and 0.35 for shape. Intraobserver Cohen-K for US classification systems was 0.54 for AACE, 0.49 for ACR-TIRADS, 0.38 for ATA, and 0.33 for EU-TIRADS. Conclusions: Intraobserver reproducibility for thyroid nodule US reporting and US classification systems appears fairly adequate, while the interobserver agreement between different centers is lower than that assessed in single-center trials. Reporting and rating ability of thyroid US examiners still appear not consistent. An unified lexicon of thyroid US features, a simplified method of classification, and a dedicated training in the description of thyroid US findings may increase the observers' agreement and the predictive value of US classification systems in real world practice.
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Affiliation(s)
- Agnese Persichetti
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Roma, Italy
| | - Enrico Di Stasio
- Clinical Biochemistry Institute, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Carmela Coccaro
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Roma, Italy
| | - Filomena Graziano
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Roma, Italy
| | - Antonio Bianchini
- Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Roma, Italy
| | - Vincenzo Di Donna
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Salvatore Corsello
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Dario Valle
- Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Roma, Italy
| | - Giancarlo Bizzarri
- Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Roma, Italy
| | - Andrea Frasoldati
- Endocrinology Unit, Arcispedale S. Maria Nuova, ASL-IRCCS, Reggio Emilia, Italy
| | - Alfredo Pontecorvi
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Roma, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Roma, Italy
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D'Ascenzi F, Anselmi F, Graziano F, Berti B, Franchini A, Bacci E, Ceccon C, Capitani M, Bonifazi M, Mondillo S. 4102QT interval duration, long QT pattern and changes over time in children practicing sport. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Twelve-lead electrocardiogram (ECG) is an established tool in the evaluation of adult athletes, providing information about life-threatening cardiovascular diseases such as long-QT syndrome. However, changes induced by development challenge the interpretation of ECG in the paediatric population, particularly for the repolarisation phase. The aim of this prospective, longitudinal study was to determinate the distribution of QT interval in children practicing sport and to evaluate changes in QT duration during preadolescence.
Methods
A final population of 1473 children practising sport (mean age: 12.0±1.8 years, interval 7–15 years) was analysed. Each athlete was evaluated at baseline, mid-term and end of the study with a mean follow-up of 3±1 years. QT interval was corrected with Bazett (B) and Fridericia (F) formulae.
Results
At baseline QTcB was 412±25ms and QTcF 387±21ms, with no changes during follow-up. Ten children (0.68%) had an abnormal QTc. In children with QTc ≥480ms confirmed both by Bazett and Fridericia formulae, QT duration persisted abnormal during the follow-up and children were disqualified. Conversely, children with borderline QTc intervals (>460 and <480ms) were not disqualified and we found a normalization of QT interval during the development. Mean difference in the calculation of QT between the two formulae was 25±11ms, p<0.0001. For HR values higher than 80 bpm, the QTcF resulted with low fluctuations around the mean was independent from HR values. Conversely, the QTcB revealed significant growing trend as the HR increased and showed higher variability than Fridericia correction.
Dynamic changes in QT interval duration Baseline Mid-term FU Long-term FU p value Intervallo QT 343±25 345±24* 346±25* <0.0001 RR (ms) 599±111 711±111* 721±119*^ <0.0001 QTc Bazett (ms) 412±25 (371–449) 411±25 (367–449) 409±25 (367–446) 0.10 QTc Fredericia (ms) 387±21 (355–418) 387±20 (353–419) 387±20 (353–418) 0.59 FU, follow up; *p<0.0001 vs. baseline; §p<0.0001 vs. mid-term FU; ^p<0.05 vs. mid-term FU.
Conclusions
QT duration does not change over time in children with normal duration. A minority of children has a QT ≥480ms; in these subjects QT interval remains prolonged during the follow-up. Conversely, in children with borderline QT, mid-term follow-up is useful to identify a normalization during the growth. Clinicians should take into account that the use of Bazett and Fridericia correction formulae is not interchangeable and that Fridericia formula should be preferred when resting HR is higher than 80 bpm.
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Affiliation(s)
- F D'Ascenzi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F Anselmi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F Graziano
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - B Berti
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - A Franchini
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - E Bacci
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - C Ceccon
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Capitani
- Center for Sports Medicine, Siena, Italy
| | - M Bonifazi
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - S Mondillo
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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Papini E, Persichetti A, Di Stasio E, Coccaro C, Graziano F, Bianchini A, Di Donna V, Valle D, Frasoldati A, Pontecorvi A, Guglielmi R. OR27-1 Interobserver Agreement in the Assessement of Thyroid Nodules Ultrasound Features: A Blinded Multicenter Study. J Endocr Soc 2019. [PMCID: PMC6554937 DOI: 10.1210/js.2019-or27-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Single-center trials have demonstrated an acceptable level of inter-observer agreement in the evaluation of the ultrasound (US) features of thyroid nodules, but limited data are available about the consistency in the assessment of US findings among different thyroid centers. Aim of the study: to assess the inter-observer agreement between different thyroid centers and among different specialists in the evaluation of the main US features of thyroid nodules. Materials and methods A blinded retrospective analysis of 100 electronically-recorded US images was conducted in three large-volume thyroid centers by seven qualified thyroid imaging experts, two radiologist and five endocrinologists. The following US features were evaluated: composition (solid, predominantly solid, predominantly cystic, and cystic); echogenicity (hyperechoic, isoechoic, mildly and deeply hypoechoic); margins (well-defined, ill-defined, microlobulated, and spiculated); calcifications (absent, microscopic, macroscopic, eggshell); hyperechoic foci of uncertain significance; comet-tail artifacts; vascularity (no vascular signals, perinodular and/or slight intranodular flow, and marked intranodular flow). Thyroid nodules were also classified according to four major US classification systems: AACE/ACE/AME, EU-TIRADS, ATA and ACR. The inter-observer agreement was calculated using cross-tabulation expressed in Cohen's Kappa. Kappa values were evaluated, according to Landis and Koch, as follows: 0-0.20 poor, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 substantial, and 0.81-1.0 almost perfect agreement. A sub-analysis assessed how many times and how many operators evaluated as suspicious for malignancy the US features of each nodule. Results: The inter-observer agreement resulted in a K-correlation coefficient of 34.5%, 44.0%, 42.3% and 38.8% for the ATA, AACE/ACE/AME, ACR, and EU-TIRADS classification systems, respectively. The interobserver agreement for the main thyroid nodule US findings resulted as follows: composition 53.2%; echogenicity 46.9%; margins 33.2%; comet-tail 10.6%, microcalcifications 46.8%; macrocalcifications 37.7%; eggshell calcifications 64.9%; intranodular vascularity 45.9%. Conclusion: The level of agreement among different thyroid centers in the description of suspicious US features in thyroid nodules ranged from fair to moderate, with the lowest level of consistency for the characteristics of margins and the presence of comet-tails. A similar range of variability was demonstrated also for the four US classification systems. An universally accepted lexicon of thyroid US features and a dedicated training in thyroid US findings definition are needed to improve the inter-observer agreement and the predictive value of US classification systems in real world practice.
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Guglielmi R, Grimaldi F, Negro R, Frasoldati A, Misischi I, Graziano F, Cipri C, Guastamacchia E, Triggiani V, Papini E. Shift from Levothyroxine Tablets to Liquid Formulation at Breakfast Improves Quality of Life of Hypothyroid Patients. Endocr Metab Immune Disord Drug Targets 2018; 18:235-240. [PMID: 29376496 PMCID: PMC5997842 DOI: 10.2174/1871530318666180125155348] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/23/2017] [Accepted: 11/28/2017] [Indexed: 12/21/2022]
Abstract
Background: Until recently, treatment of hypothyroidism has been accomplished using monotherapy of synthetic L-thyroxine (L-T4) sodium tablets that should be taken 30-60 minutes before breakfast. Nowadays, a liquid preparation of levothyroxine is available and can effectively replace tablets without the need of waiting before having breakfast. Evidence of Quality of life (QoL) improvement when shifting from the former to the latter preparation, however, is still lacking. Objective: The study aimed to assess changes in QoL of hypothyroid patients dissatisfied with their therapy with L-T4 sodium tablets who were switched from tablets taken 30-60 minutes before breakfast to liquid L-T4 at breakfast. Methods: A total of 418 consecutive hypothyroid subjects treated by means of L-T4 tablets were asked about their satisfaction/dissatisfaction in order to take the medication 30-60 minutes before having breakfast. Overall, 110 patients (26.3%) complained of the timing of their L-T4 therapy (30-60 minutes before breakfast). A dedicated QoL questionnaire (ThyTSQ), taking just a few minutes to be filled in was then administered to these dissatisfied patients. They were therefore switched to L-T4 to be taken at breakfast. Aiming to avoid TSH elevation due to L-T4 tablets malabsorption caused by meal interference and gastric pH changes, patients were invited to take L-T4 liquid form, as this is claimed to be scarcely affected by the non-fasting state. The questionnaire (ThyTSQ) was administered again at the control visit 3 months later. TSH, FT4, FT3 serum concentrations and metabolic parameters were also recorded. Results: An improved QoL, mainly due to an easier adherence to treatment, was reported by 66.6% of 102 patients who completed the study after shifting from taking medication 30-60 minutes before breakfast to at breakfast ingestion (P<0.01). An overall 10.7% of patients found the liquid formulation distasteful. Mean values of TSH, FT4, FT3, and of metabolic parameters did not significantly change but in eight patients (7.7%) who showed a TSH increase > 2mIU/L Conclusion: In hypothyroid subjects dissatisfied with L-T4 tablets ingested 30-60 minutes before breakfast, the shift to the same dose of L-T4 in liquid form taken at breakfast improved QoL in the majority of patients, without affecting thyroid function.
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Affiliation(s)
- Rinaldo Guglielmi
- Department of Endocrinology and Metabolic Diseases, Ospedale Regina Apostolorum, Albano (Rome), Italy
| | - Franco Grimaldi
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Udine, Italy
| | - Roberto Negro
- Division of Endocrinology, "V. Fazzi" Hospital, Lecce, Italy
| | | | - Irene Misischi
- Department of Endocrinology and Metabolic Diseases, Ospedale Regina Apostolorum, Albano (Rome), Italy
| | - Filomena Graziano
- Department of Endocrinology and Metabolic Diseases, Ospedale Regina Apostolorum, Albano (Rome), Italy
| | - Claudia Cipri
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Udine, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases. University of Bari "A. Moro", Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases. University of Bari "A. Moro", Bari, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolic Diseases, Ospedale Regina Apostolorum, Albano (Rome), Italy
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14
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D'Ascenzi F, Anselmi F, Berti B, Capitani E, Franchini A, Graziano F, Focardi M, Capitani M, Corrado D, Bonifazi M, Mondillo S. P663Normalization of T-wave inversion in children practising sport: a prospective, 4-year follow-up study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F D'Ascenzi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F Anselmi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - B Berti
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - E Capitani
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - A Franchini
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - F Graziano
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Focardi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Capitani
- Center for Sports Medicine, Siena, Italy
| | - D Corrado
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - M Bonifazi
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - S Mondillo
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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15
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Cohen F, Candiello A, Lasave L, Zangroniz P, Alonso A, Nitti N, Graziano F, Fernandez Murga A, Ingaramo A, Alderete R, Rodriguez Saavedra A, Cugat G, Birollo O, Belardi J, Berrocal DH. P2679STEMI treatment in octogenarians in the stent save a life initiative in Argentina. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Cohen
- Hospital Italiano de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
| | - A Candiello
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - L Lasave
- Cardiovascular Institute of Rosario (ICR), Rosario, Argentina
| | - P Zangroniz
- Hospital Provincial del Centenario, Rosario, Argentina
| | - A Alonso
- Hospital Argerich, Buenos Aires, Argentina
| | - N Nitti
- Instituto Medico Platense, La Plata, Argentina
| | - F Graziano
- Instituto Medico Quirurgico Garat, Concordia, Argentina
| | | | | | - R Alderete
- Hospital Bernardino Rivadavia, Buenos Aires, Argentina
| | | | - G Cugat
- Sanatorio Argentino de La Plata, La Plata, Argentina
| | - O Birollo
- Sanatorio San Jeronimo, Santa Fe, Argentina
| | - J Belardi
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - D H Berrocal
- Hospital Italiano de Buenos Aires, Ciudad Autόnoma de Buenos Aires, Argentina
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Catalano V, Bergamo F, Cremolini C, Vincenzi B, Negri F, Giordani P, Santini D, Sarti D, Torresi U, Bisonni R, Silva R, Rocchi M, Lonardi S, Falcone A, Mattioli R, Graziano F. Optimizing the use of first-line chemotherapy in metastatic colorectal cancer patients with mucinous histology. A multicenter, retrospective, combined analysis on 897 patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy150.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Until recently, chemotherapy was considered ineffective in pancreatic cancer and these patients received best supportive care only. Now, there is evidence that chemotherapy may influence the natural history of the disease by prolonging survival and there are data on its role as an effective tool for the improvement of physical conditions in patients with advanced disease. The results are far from conclusive, and only partially satisfying but they represent a step forward.
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Affiliation(s)
- F Graziano
- Sezione di Oncologia Sperimentale, Azienda Ospedaliera Ospedale S. Salvatore, Pesaro, Italy
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18
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Graziano F, Cardarelli N, Marcellini M, Menichetti ET, Catalano G, Cascinu S. A Pilot Clinical Trial of Postoperative Intensive Weekly Chemotherapy Using Cisplatin, Epi-Doxorubicin, 5-Fluorouracil, 6S-Leucovorin, Glutathione and Filgrastim in Patients with Resected Gastric Cancer. Tumori 2018; 84:368-71. [PMID: 9678619 DOI: 10.1177/030089169808400311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The study was performed to assess the feasibility and activity of an intensive chemotherapeutic regimen as adjuvant treatment for patients with resected gastric cancer at high risk of recurrence (PT2N1-2; pT3-4Nany M0). Patients and methods Starting 21 to 28 days after potentially curative surgery for primary gastric cancer, 25 patients received 8 weekly cycles of cisplatin 40 mg/m2, 5-fluorouracil 500 mg/m2, epidoxorubicin 35 mg/m2, 6S-stereoisomer of leucovorin at a dose of 250 mg/m2, and glutathione at a dose of 1.5 g/m2. From the day after to the day before each cycle of chemotherapy, filgrastim was administered by subcutaneous injection at a dose of 5 μg/kg. Results After a median follow-up of 33 months, 80% of the patients were alive and disease-free. Five patients had relapsed: three in the liver, one in the peritoneum and one in the lymph nodes. Toxicity was mild: five patients experienced WHO grade III toxicity (three leukopenia, two thrombocytopenia); no toxic deaths occurred. Conclusion Intensive weekly chemotherapy is a feasible postoperative treatment option for patients with resected gastric cancer at high risk of relapse. These data, together with recent results in advanced disease, make this approach of interest for the development of new programs of adjuvant therapy in this setting.
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Affiliation(s)
- F Graziano
- Section of Experimental Oncology, Ospedale S. Salvatore, Pesaro, Italy
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Piga A, Graziano F, Zahra G, Cellerino R. Attitudes of Non-Oncology Physicians Dealing with Cancer Patients. A Survey Based on Clinical Scenarios in Ancona Province, Central Italy. Tumori 2018; 82:423-9. [PMID: 9063516 DOI: 10.1177/030089169608200502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background With this study we attempted to determine to what extent recent acquisitions in clinical oncology had reached categories of physicians involved in the management of patients with cancer, namely general surgeons, internists and family doctors. Methods A questionnaire was prepared with scenarios based on the following clinical situations: Scenario A, Adjuvant therapy in colon cancer; Scenario B, Treatment of small-cell lung cancer; Scenario C, Adjuvant therapy in high-risk, node-negative breast cancer; Scenario D, Treatment of early stage breast cancer; Scenario E, Asymptomatic transient myelosuppression during chemotherapy. Questionnaires were mailed to 365 family doctors, 54 general surgeons and 61 internists of the Province of Ancona in central Italy. Results A total of 198 completed questionnaires were returned (41%). Respondents were 36.7% of family doctors, 54.1% of internists and 57.4% of surgeons. Less than half of respondents selected an adequate approach such as adjuvant chemotherapy for colon cancer and high-risk, node-negative breast cancer or chemotherapy as first-line treatment for small-cell lung cancer. Conservative surgery plus radiotherapy (QUART) for early stage breast cancer was indicated by 69% of respondents. Over three quarters of physicians would give treatment for asymptomatic transient chemotherapy-induced leukopenia. In most of the scenarios, significant differences were detected in the distribution of preferences according to category of physicians. Family doctors and young physicians (<40 years) generally performed worse than hospital-based physicians (general surgeons and internists) and older physicians. Conclusions Non-oncology physicians showed insufficient awareness of currently available knowledge in cancer treatment. Basic concepts in cancer management should be part of the professional knowledge of all medical doctors, and key advances in clinical oncology should spread outside the oncologic environment more promptly, with a wide circulation among all physicians who care for cancer patients.
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Affiliation(s)
- A Piga
- University of Ancona, Ospedale Regionale Torrette, Italy
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20
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Persichetti A, Di Stasio E, Guglielmi R, Bizzarri G, Taccogna S, Misischi I, Graziano F, Petrucci L, Bianchini A, Papini E. Predictive Value of Malignancy of Thyroid Nodule Ultrasound Classification Systems: A Prospective Study. J Clin Endocrinol Metab 2018; 103:1359-1368. [PMID: 29408952 DOI: 10.1210/jc.2017-01708] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/29/2018] [Indexed: 02/02/2023]
Abstract
CONTEXT British Thyroid Association (BTA), American Thyroid Association (ATA), and American Association of Clinical Endocrinologists (AACE/ACE/AME) recommend for thyroid nodules an ultrasound (US)-based stratification of risk of malignancy. Aim of our study was to assess the diagnostic accuracy of US classification systems and their reliability for indication to fine-needle aspiration (FNA). DESIGN Prospective study on 987 thyroid nodules consecutively referred for FNA. US images were independently reviewed by four experts for assignment of malignancy risk. Cytologically benign nodules had confirmation with a second FNA, whereas Bethesda class IV, V, and VI nodules were operated upon. Class III nodules had surgery or follow-up on the basis of clinical, immunocytochemical, and US features. RESULTS BTA: Malignancy rate was 2.8% in benign, 10.0% in indeterminate, 51.3% in suspicion, and 80.9% in malignant US class. Sensitivity was 0.74, specificity was 0.92, and accuracy was 0.89. ATA: Malignancy rate was 0.0% in benign, 2.2% in very low suspicion, 3.0% in low suspicion, 5.8% in intermediate, and 55.0% in high suspicion US class. Sensitivity was 0.81, specificity was 0.87, and accuracy was 0.86. AACE/ACE/AME: Malignancy rate was 1.1% in low-risk, 4.4% in intermediate-risk, and 54.9% in high-risk US class. Sensitivity was 0.82, specificity was 0.87, and accuracy was 0.86. K correlation coefficient was 78.9%, 76.9%, and 82.0% for BTA, ATA, and AACE/ACE/AME classifications. CONCLUSIONS Classification systems had elevated predictive value of malignancy in high-risk classes. ATA and AACE/ACE/AME systems were effective for ruling out indication to FNA in low-US-risk nodules. A similar diagnostic accuracy and a substantial interobserver agreement was provided by the three- and the five-category classifications.
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Affiliation(s)
- Agnese Persichetti
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy
- Department of Molecular Medicine, University La Sapienza, Rome, Italy
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del SacroCuore, Rome, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Giancarlo Bizzarri
- Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Silvia Taccogna
- Department of Pathology, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Irene Misischi
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Filomena Graziano
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Lucilla Petrucci
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Antonio Bianchini
- Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy
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Aloe S, D'Alessandro R, Spila A, Ferroni P, Basili S, Palmirotta R, Carlini M, Graziano F, Mancini R, Mariotti S, Cosimelli M, Roselli M, Guadagni F. Prognostic value of Serum and Tumor Tissue CA 72-4 Content in Gastric Cancer. Int J Biol Markers 2018; 18:21-7. [PMID: 12699059 DOI: 10.1177/172460080301800104] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To date no general agreement has been reached regarding the prognostic significance of CEA, CA 19-9 and CA 72-4 as serum markers in gastric cancer, and only scattered information is available on the predictive value of marker expression in tumor tissue. Therefore, a longitudinal study was designed to analyze the presurgical serum and tumor tissue content of CA 72-4, CEA and CA 19-9 in 166 patients at different stages of gastric cancer, and to evaluate the possible correlation with clinicopathological features in respect to prognostic information on relapse-free survival. The results obtained showed that 48.4% of patients with tumor recurrence had positive presurgical CA 72-4 levels compared to approximately 24% of patients who remained free of disease. Furthermore, the median presurgical serum CA 72-4 levels were significantly elevated in relapsing patients. Serosa and lymph node involvement as well as positive presurgical serum CA 72-4 levels had independent prognostic value in predicting recurrence. A significant association between disease-free survival and lymph node involvement, depth of invasion and tumor tissue content of CA 72-4 was also demonstrated. We may therefore conclude that CA 72-4 antigen can be considered the marker of choice in the follow-up of gastric cancer patients and may be used as a prognostic indicator of relapse.
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Affiliation(s)
- S Aloe
- Laboratory of Clinical Pathology, Regina Elena Cancer Institute, Rome, Italy
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22
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Catalano V, Bergamo F, Cremolini C, Vincenzi B, Negri F, Graziano F, Giordani P, Alessandroni P, Intini R, Rumanò L, Rossini D, Borelli B, Santini D, Sarti D, Rocchi M, Lonardi S, Falcone A, Zagonel V, Mattioli R. Does bevacizumab plus chemotherapy matter in metastatic colorectal cancer patients with mucinous histology? A multicenter, retrospective analysis on 685 patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422] [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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23
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Ruzzo A, Galli F, Galli F, Rulli E, Lonardi S, Zagonel V, Ronzoni M, Ionta M, Pella N, Mucciarini C, Labianca R, Veltri E, Sozzi P, Barni S, Nicolini M, Biondi E, Bramati A, Turci D, Buscaglia M, Magnani M, Graziano F. Germline variants and clinical outcomes of high-risk stage II and stage III colon cancer patients treated with oxaliplatin and fluoropyrimidines adjuvant chemotherapy: a pharmacogenetic ancillary study to TOSCA trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.002] [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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24
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Cameli M, Mandoli G, Sciaccaluga C, Graziano F, Marzotti T, Mondillo S. P2419Atrial strain, ventricular strain and new atrio-ventricular strain analysis in patients with heart failure with preserved, mid-range and reduced ejection fraction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2419] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Pagnini F, Marconi A, Tagliaferri A, Manzoni GM, Gatto R, Fabiani V, Gragnano G, Rossi G, Volpato E, Banfi P, Palmieri A, Graziano F, Castelnuovo G, Corbo M, Molinari E, Riva N, Sansone V, Lunetta C. Meditation training for people with amyotrophic lateral sclerosis: a randomized clinical trial. Eur J Neurol 2017; 24:578-586. [DOI: 10.1111/ene.13246] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/04/2017] [Indexed: 02/02/2023]
Affiliation(s)
- F. Pagnini
- Department of Psychology; Università Cattolica del Sacro Cuore; Milan Italy
- Azienda Ospedaliera Niguarda Ca’ Granda; Milan Italy
| | - A. Marconi
- NEuroMuscular Omnicentre (NEMO) − Fondazione Serena Onlus; Milan Italy
| | | | | | - R. Gatto
- Azienda Ospedaliera Niguarda Ca’ Granda; Milan Italy
| | - V. Fabiani
- Azienda Ospedaliera Niguarda Ca’ Granda; Milan Italy
| | - G. Gragnano
- NEuroMuscular Omnicentre (NEMO) − Fondazione Serena Onlus; Milan Italy
| | - G. Rossi
- NEuroMuscular Omnicentre (NEMO) − Fondazione Serena Onlus; Milan Italy
| | - E. Volpato
- Department of Psychology; Università Cattolica del Sacro Cuore; Milan Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS; Milan Italy
| | - P. Banfi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS; Milan Italy
| | - A. Palmieri
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology; University of Padova; Padua Italy
| | - F. Graziano
- Department of Brain and Behavioural Sciences; Università degli Studi di Pavia; Pavia Italy
| | - G. Castelnuovo
- Department of Psychology; Università Cattolica del Sacro Cuore; Milan Italy
- Psychology Research Laboratory; Istituto Auxologico Italiano IRCCS; Piancavallo Italy
| | - M. Corbo
- Department of Neurorehabilitation Sciences; Casa Cura Policlinico; Milan Italy
| | - E. Molinari
- Department of Psychology; Università Cattolica del Sacro Cuore; Milan Italy
- Psychology Research Laboratory; Istituto Auxologico Italiano IRCCS; Piancavallo Italy
| | - N. Riva
- Department of Neurology; INSPE and Division of Neuroscience; San Raffaele Scientific Institute, Milan Italy
| | - V. Sansone
- NEuroMuscular Omnicentre (NEMO) − Fondazione Serena Onlus; Milan Italy
| | - C. Lunetta
- NEuroMuscular Omnicentre (NEMO) − Fondazione Serena Onlus; Milan Italy
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26
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Morgen EK, Lenz HJ, Jonker DJ, Tu D, Milano G, Graziano F, Zalcberg J, Karapetis CS, Dobrovic A, O'Callaghan CJ, Liu G. Germline polymorphisms as biomarkers of tumor response in colorectal cancer patients treated with anti-EGFR monoclonal antibodies: a systematic review and meta-analysis. Pharmacogenomics J 2016; 17:535-542. [PMID: 27897268 PMCID: PMC9536193 DOI: 10.1038/tpj.2016.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023]
Abstract
Studies of germline polymorphisms as predictors of tumor response to anti-epidermal growth factor receptor (EGFR) monoclonal antibody agents in metastatic colorectal cancer have reported inconsistent results. We performed a systematic review of studies from 1990 to September 2015, followed by random-effects meta-analyses for polymorphisms examined in at least three studies. Of 87 studies, 40 passed the criteria for systematic review and 23 for meta-analysis. The polymorphisms suitable for meta-analysis were CCND1 (rs17852153), COX2 (rs20417), EGF (rs4444903), EGFR (rs712829, rs11543848, 3'UTR CA repeat), FCGR2A (rs1801274), FCGR3A (rs396991), IL8 (rs4073), KRAS (rs61764370) and VEGFA (rs3025039). Meta-analysis yielded nominal significance (at α=0.05) for rs4444903 and rs11543848, but showed no significant results after multiple testing correction; this was unchanged by sensitivity analyses to address subgroups, funnel-plot asymmetries, and study quality. This highlights a tendency for lack of replication in the face of initial positive results, and possibly the unsuitability of relying on tumor response as a surrogate marker in this setting.
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Affiliation(s)
- E K Morgen
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - H-J Lenz
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - D J Jonker
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - D Tu
- Canadian Cancer Trials Group, Queen's University, Kingston, Ontario, Canada
| | - G Milano
- Laboratoire d'Oncopharmacologie EA 3836, Centre Antoine Lacassagne, Nice, France
| | - F Graziano
- Division of Medical Oncology, Azienda "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - J Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - C S Karapetis
- Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - A Dobrovic
- Translational Genomics and Epigenomics Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia.,Department of Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - C J O'Callaghan
- Canadian Cancer Trials Group, Queen's University, Kingston, Ontario, Canada
| | - G Liu
- Departments of Medicine and Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Graziano F, Maugeri R, Giugno A, Iacopino DG. WhatsAPP in neurosurgery: the best practice is in our hands. Acta Neurochir (Wien) 2016; 158:2173-2174. [PMID: 27230911 DOI: 10.1007/s00701-016-2853-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)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022]
Affiliation(s)
- F Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, AOUP "P. Giaccone" Universita' degli Studi di Palermo, Italy, 129, Via del Vespro, 90100, Palermo, Italy.
| | - R Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, AOUP "P. Giaccone" Universita' degli Studi di Palermo, Italy, 129, Via del Vespro, 90100, Palermo, Italy
| | - A Giugno
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, AOUP "P. Giaccone" Universita' degli Studi di Palermo, Italy, 129, Via del Vespro, 90100, Palermo, Italy
| | - D G Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, AOUP "P. Giaccone" Universita' degli Studi di Palermo, Italy, 129, Via del Vespro, 90100, Palermo, Italy
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Graziano F, Ruzzo A, Rulli E, Galli F, Galli F, Menghi M, Viti D, Giacomini E, Lonardi S, Ronzoni M, Massidda B, Pella N, Mucciarini C, Labianca R, Veltri E, Sozzi P, Barni S, Sobrero A, Frontini L, Magnani M. Dihydropyrimidine dehydrogenase (DPYD) gene polymorphisms profiling in colon cancer patients treated with adjuvant chemotherapy in the randomized phase III TOSCA trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw331.02] [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: 11/12/2022] Open
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29
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Graziano F, Grassi M, Bonati MT, Zanchetti A, Biino G. External validation of the MetS score, a prediction tool for metabolic syndrome. Nutr Metab Cardiovasc Dis 2016; 26:359-360. [PMID: 26841678 DOI: 10.1016/j.numecd.2015.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 12/22/2015] [Accepted: 12/26/2015] [Indexed: 11/22/2022]
Affiliation(s)
- F Graziano
- Department of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, Università degli Studi di Pavia, Pavia, Italy
| | - M Grassi
- Department of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, Università degli Studi di Pavia, Pavia, Italy
| | - M T Bonati
- Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - A Zanchetti
- Istituto Auxologico Italiano, IRCCS, Milano, Italy; Centro di Fisiologia Clinica e Ipertensione, Università degli Studi di Milano, Italy
| | - G Biino
- Institute of Molecular Genetics, National Research Council of Italy, Pavia, Italy.
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Graziano F, Ruzzo A, Giacomini E, Ricciardi T, Aprile G, Loupakis F, Lorenzini P, Ongaro E, Zoratto F, Catalano V, Sarti D, Rulli E, Cremolini C, De Nictolis M, De Maglio G, Falcone A, Fiorentini G, Magnani M. Glycolysis gene expression analysis and selective metabolic advantage in the clinical progression of colorectal cancer. Pharmacogenomics J 2016; 17:258-264. [DOI: 10.1038/tpj.2016.13] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 01/16/2023]
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Graziano F, Rulli E, Biagioli E, Catalano V. Number needed to treat for pricing costly anticancer drugs: the example of regorafenib in metastatic colorectal cancer. Ann Oncol 2016; 27:747-8. [PMID: 26787235 DOI: 10.1093/annonc/mdw024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Graziano
- Department of Onco-Hematology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Pesaro
| | - E Rulli
- Clinical Research Laboratory, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - E Biagioli
- Clinical Research Laboratory, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - V Catalano
- Department of Onco-Hematology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Pesaro
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32
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Poli G, Graziano F, Vicenzi E. Towards achieving a state of reversible HIV-1 latency in primary monocyte-derived macrophages (MDM) by M1 polarization. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)31341-8] [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: 10/23/2022] Open
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33
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Fiorentini G, Aliberti C, Sarti D, Coschiera P, Tilli M, Mulazzani L, Giordani P, Graziano F, Marqués Gonzalez A, García Marcos R, Gómez Mugnoz F, Cantore M, Ricci S, Catalano V, Mambrini A. DEBIRI and cetuximab (DEBIRITUX) as a secondline treatment for unresectable colorectal liver metastases (UCLM): results of a phase II trial exploring a new sequence. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.23] [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: 11/14/2022] Open
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34
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Ongaro E, Ruzzo A, Giacomini E, Ricciardi T, Aprile G, Loupakis F, Lorenzini P, Zoratto F, Cremolini C, Catalano V, Sarti D, Rullia E, De Nictolis M, DeMaglio G, Falcone A, Fiorentini G, Magnani M, Graziano F. Glucose metabolism enzymes gene expression analysis and selective metabolic advantage in the clinical progression of colorectal cancer (CRC). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.49] [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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35
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Graziano F, Grassi M, Sacco S, Concas MP, Vaccargiu S, Pirastu M, Biino G. Probing the factor structure of metabolic syndrome in Sardinian genetic isolates. Nutr Metab Cardiovasc Dis 2015; 25:548-555. [PMID: 25836955 DOI: 10.1016/j.numecd.2015.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/05/2015] [Accepted: 02/12/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Owing to the multiplicity of the key components of metabolic syndrome (MetS), its diagnosis is very complex. The lack of a unique definition is responsible for the prevalence variability observed among studies; therefore, a definition based on continuous variables was recommended. The aim of this study was to compare competing models of the MetS factor structure for selecting the one that explains the best clustering pattern and to propose an algorithm for computing MetS as a continuous variable. METHODS AND RESULTS Data were from isolated Sardinian populations (n = 8102). Confirmatory factor analysis (CFA) and two-group CFA by gender were performed to evaluate the sex-specific factor structure of MetS. After selecting the best model, an algorithm was obtained using factor loadings/residual variances. The quality of the MetS score was evaluated by the receiver operating characteristics curve and the area under the curve. Cross-validation was performed to validate the score and to determine the best cut point. The best fit model was a bifactor one with a general factor (MetS) and three specific factors (f1: obesity/adiposity trait; f2: hypertension/blood pressure trait; and f3: lipid trait). Gender-specific algorithms were implemented to obtain MetS scores showing a good diagnostic performance (0.80 specificity and 0.80 sensitivity for the cut point). Furthermore, cross-validation confirmed these results. CONCLUSION These analyses suggested that the bifactor model was the most representative one. In addition, they provided a score and a cut point that are both clinically accessible and interpretable measures for MetS diagnosis and likely useful for evaluating the association with adverse cardiovascular disease and diabetes and for investigating the MetS genetic component.
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Affiliation(s)
- F Graziano
- Department of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, Università degli Studi di Pavia, Pavia, Italy
| | - M Grassi
- Department of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, Università degli Studi di Pavia, Pavia, Italy
| | - S Sacco
- Department of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, Università degli Studi di Pavia, Pavia, Italy
| | - M P Concas
- Institute of Population Genetics, National Research Council of Italy, Sassari, Italy
| | - S Vaccargiu
- Institute of Population Genetics, National Research Council of Italy, Sassari, Italy
| | - M Pirastu
- Institute of Population Genetics, National Research Council of Italy, Sassari, Italy
| | - G Biino
- Institute of Molecular Genetics, National Research Council of Italy, Pavia, Italy.
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Visani G, Loscocco F, Ruzzo A, Voso M, Fabiani E, Finelli C, Graziano F, Barulli S, Volpe A, Magro D, Piccaluga P, Fuligni F, Gabucci E, Giacomini E, Vignetti M, Fazi P, Piciocchi A, Rocchi M, Magnani M, Isidori A. 251 TS, MTHFR AND XRCC1 GENETIC VARIANTS INFLUENCE THE OUTCOME OF MDS PATIENTS IRRESPECTIVELY OF IPSS RISK. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30252-6] [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: 10/23/2022]
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Graziano F, Ganau M, Meccio F, Iacopino DG, Ulm AJ. The Transcallosal Anterior Interfoniceal Approach: A Microsurgical Anatomy Study. J Neurol Surg B Skull Base 2014. [PMID: 26225299 DOI: 10.1055/s-0034-1396595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objectives A plethora of surgical strategies have been described to reach deep-seated lesions situated within the third ventricle including the Rosenfeld, or transcallosal anterior interfoniceal (TAIF), approach. First introduced in 2001, it consists of a small callosotomy followed by the midline transseptal dissection of fornices to enter the roof of the third ventricle. The aim of this microsurgical anatomy study is to describe and show each stage of the surgical procedure, focusing on the possible trajectories to anatomical landmarks. Participants A total of 20 adult cadaveric specimens were used in this study. Using ×3 to ×40 magnifications, the surgical dissection was performed in a stepwise fashion, and the transcallosal anterior interforniceal approach was performed, analyzed, and described. Results In 5 specimens of 10, a cavum septum pellucidum was depicted. In 5 cases of 20 after the callosotomy ,the lateral ventricular cavities were reached. Different orientation of the microscope allowed us to define three surgical trajectories to visualize the region of interest without exposing important functional areas. Conclusion The TAIF represents a minimally invasive approach to the third ventricle; its tricky surgical steps make appropriate anatomical dissection training essential to become confident and skilled in performing this approach.
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Affiliation(s)
- F Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, AOPU "P. Giaccone" Universita' degli Studi di Palermo, Italy ; Department of Neurosurgery, Louisiana State University, New Orleans, Louisiana, United States
| | - M Ganau
- Harvard Medical School, Cambridge, Massachusetts, United States ; Department of Biomedical Engineering, University of Cagliari, Italy
| | - F Meccio
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, AOPU "P. Giaccone" Universita' degli Studi di Palermo, Italy
| | - D G Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, AOPU "P. Giaccone" Universita' degli Studi di Palermo, Italy
| | - A J Ulm
- Department of Neurosurgery, Louisiana State University, New Orleans, Louisiana, United States
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38
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Graziano F, Ruzzo A, Galli F, Giacomini E, Floriani I, Galli F, Rulli E, Lonardi S, Ronzoni M, Massidda B, Zagonel V, Pella N, Mucciarini C, Labianca R, Veltri E, Sozzi P, Barni S, Ricci V, Sobrero A, Magnani M. Pharmacogenetic Profiling for Toxicity of Oxaliplatin and Fluoropyrimidines. Final Report from an Ancillary Protocol to the Tosca (Three or Six Colon Adjuvant) Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.78] [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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39
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Chianelli M, Bizzarri G, Todino V, Misischi I, Bianchini A, Graziano F, Guglielmi R, Pacella CM, Gharib H, Papini E. Laser ablation and 131-iodine: a 24-month pilot study of combined treatment for large toxic nodular goiter. J Clin Endocrinol Metab 2014; 99:E1283-6. [PMID: 24684455 DOI: 10.1210/jc.2013-2967] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT It is normally recognized that the preferred treatment in large toxic thyroid nodules should be thyroidectomy. OBJECTIVE The aim of the study was to assess the efficacy of combined laser ablation treatment (LAT) and radioiodine 131 (131I) treatment of large thyroid toxic nodules with respect to rapidity of control of local symptoms, of hyperthyroidism, and of reduction of administered 131I activity in patients at refusal or with contraindications to surgery. DESIGN AND SETTING We conducted a pilot study at a single center specializing in thyroid care. PATIENTS Fifteen patients were treated with LAT, followed by 131I (group A), and a series of matched consecutive patients were treated by 131I only (group B). INTERVENTION(S) Laser energy was delivered with an output power of 3 W (1800 J per fiber per treatment) through two 75-mm, 21-gauge spinal needles. Radioiodine activity was calculated to deliver 200 Gy to the hyperfunctioning nodule. MAIN OUTCOME MEASURE(S) Thyroid function, thyroid peroxidase antibody, thyroglobulin antibody, ultrasound, and local symptoms were measured at baseline and up to 24 months. RESULTS Nodule volume reduction at 24 months was: 71.3 ± 13.4 vs 47.4 ± 5.5%, group A (LAT+131I) vs group B (131I), respectively; P < .001). In group A (LAT+131I), a reduction in radioiodine-administered activity was obtained (-21.1 ± 8.1%). Local symptom score demonstrated a more rapid reduction in group A (LAT+131I). In three cases, no 131I treatment was needed after LAT. CONCLUSIONS In this pilot study, combined LAT/131I treatment induced faster and greater improvement of local and systemic symptoms compared to 131I only. This approach seems a possible alternative to thyroidectomy in patients at refusal of surgery.
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Affiliation(s)
- M Chianelli
- Endocrinology Unit (M.C., I.M., F.G., R.G., E.P.), Nuclear Medicine Unit (V.T.), and Interventional Radiology, Department Of Diagnostic Imaging (G.B., A.B., C.M.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Rome, Italy; and Endocrinology Division (H.G.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
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Graziano F, Russo VM, Wang W, Khismatullin D, Ulm AJ. 3D computational fluid dynamics of a treated vertebrobasilar giant aneurysm: a multistage analysis. AJNR Am J Neuroradiol 2013; 34:1387-94. [PMID: 23306008 DOI: 10.3174/ajnr.a3373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The treatment of giant aneurysms of the vertebrobasilar junction remains a challenging task in neurosurgical practice, and the reference standard therapy is still under debate. Through a detailed postmortem study, we analyzed the hemodynamic factors underlying the formation and recanalization of an aneurysm located at this particular site and its anatomic configuration. METHODS An adult fixed cadaveric specimen with a known VBJ GA, characterized radiographically and treated with endovascular embolization, was studied. 3D computational fluid dynamic models were built based on the specific angioarchitecture of the specimen, and each step of the endovascular treatment was simulated. RESULTS The 3D CFD study showed an area of hemodynamic stress (high wall shear stress, high static pressure, high flow velocity) at the neck region of the aneurysm, matching the site of recanalization seen during the treatment period. CONCLUSIONS Aneurysm morphologic features, location, and patient-specific angioarchitecture are the principal factors to be considered in the management of VBJ giant aneurysms. The 3D CFD study has suggested that, in the treatment of giant aneurysms, the intra-aneurysmal environment induced by partial coil or Onyx embolization may lead to hemodynamic stress at the neck region, potentially favoring recanalization of the aneurysm.
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Affiliation(s)
- F Graziano
- Clinica Neurochirurgica, AOU G. Rodolico Universita' degli Studi di Catania, Italy.
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Trimboli P, Guglielmi R, Monti S, Misischi I, Graziano F, Nasrollah N, Amendola S, Morgante SN, Deiana MG, Valabrega S, Toscano V, Papini E. Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography: a prospective multicenter study. J Clin Endocrinol Metab 2012; 97:4524-30. [PMID: 23066117 DOI: 10.1210/jc.2012-2951] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CONTEXT Thyroid nodules are selected for biopsy on the basis of clinical and ultrasound (US) findings. Ultrasonography detects nodules at risk of malignancy, but its diagnostic accuracy does not rule out with certainty the possibility of cancer in lesions without suspicious findings. OBJECTIVE The objective of the study was to evaluate the diagnostic accuracy of real-time elastography (RTE) in thyroid nodules and to assess the improvement provided by combination of RTE, B-mode US, and color flow Doppler (CFD). DESIGN This was a prospective multicenter study. PATIENTS A consecutive series of 498 thyroid nodules was blindly evaluated by US, CFD, and RTE before biopsy or surgery. Nodules were classified at RTE by four-class color scale. Patients with benign cytology underwent follow-up over 12 months, whereas patients with indeterminate, suspicious, or malignant cytology were surgically treated. RESULTS At follow-up, 126 nodules were malignant and 372 benign. RTE classes III-IV showed 81% sensitivity and 62% specificity. The presence of at least one US risk factor (hypoechogenicity, microcalcifications, irregular margins, intranodular vascularization, and taller than wide shape) had 85% sensitivity and 91% negative predictive value. When RTE was combined with US, the presence of at least one of the six parameters had 97% sensitivity and 97% negative predictive value, with an odds ratio of 15.8 (95% confidence interval 5.7-43.8). CONCLUSIONS RTE is a valuable tool for detecting malignant thyroid lesions with a sensitivity similar to traditional US and CFD features. By adding RTE evaluation, the sensitivity for malignancy of US findings is markedly increased and the selection of nodules that do not need cytology is made more reliable.
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Affiliation(s)
- Pierpaolo Trimboli
- Section of Endocrinology and Diabetology, Ospedale Israelitico, 00148 Rome, Italy
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Crea F, Fornaro L, Paolicchi E, Masi G, Frumento P, Loupakis F, Salvatore L, Cremolini C, Schirripa M, Graziano F, Ronzoni M, Ricci V, Farrar WL, Falcone A, Danesi R. An EZH2 polymorphism is associated with clinical outcome in metastatic colorectal cancer patients. Ann Oncol 2012; 23:1207-1213. [PMID: 21926398 DOI: 10.1093/annonc/mdr387] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite therapeutic innovations, metastatic colorectal cancer (mCRC) is still characterized by poor prognosis and few molecular markers predict the risk of progression. Polycomb group genes (PcGs) are epigenetic modifiers involved in tumor suppressor gene silencing. PcG member EZH2 mediates gene silencing through histone-H3 lysine-27 methylation. In colorectal cancer (CRC), EZH2 overexpression predicts shorter survival. Recently, four EZH2 single-nucleotide polymorphisms (SNPs) have been described. The present study was aimed at evaluating the correlation between EZH2 SNPs and outcome parameters in mCRC patients. PATIENTS AND METHODS DNA was extracted from blood samples of 110 mCRC patients treated with first-line 5-fluorouracil, folinic acid, irinotecan (FOLFIRI) and bevacizumab. Genotyping was carried out by real-time PCR. Genotype was used to predict objective response, progression-free survival (PFS) and overall survival (OS). EZH2 messenger RNA levels were evaluated on lymphocytes of a parallel cohort of 50 CRC patients. RESULTS One allelic variant (rs3757441 C/C versus C/T or T/T) was significantly associated with shorter PFS and OS (P < 0.01 and P < 0.05, respectively). At multivariate analysis, the same variant resulted an independent predictor of PFS and OS (P < 0.05). The C/C variant was associated with significantly higher EZH2 expression (P < 0.05). CONCLUSION An EZH2 SNP may be useful to predict clinical outcome in mCRC patients.
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Affiliation(s)
- F Crea
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa.
| | - L Fornaro
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - E Paolicchi
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa
| | - G Masi
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - P Frumento
- Unit of Biostatistics, Institute of Environmental Health, Karolinska Institutet, Stockholm, Sweden
| | - F Loupakis
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - L Salvatore
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - C Cremolini
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - M Schirripa
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - F Graziano
- Medical Oncology Unit, Department of Onco-Hematology, Azienda Ospedaliera S. Salvatore, Pesaro
| | - M Ronzoni
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - V Ricci
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - W L Farrar
- Cancer Stem Cell Section, Laboratory of Cancer Prevention, National Institute of Cancer-Frederick, Frederick, USA
| | - A Falcone
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - R Danesi
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa
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Fornaro L, Crea F, Masi G, Paolicchi E, Loupakis F, Graziano F, Salvatore L, Ronzoni M, Ricci V, Cremolini C, Schirripa M, Danesi R, Falcone A. EZH2 polymorphism and benefit from bevacizumab in colorectal cancer: another piece to the puzzle. Ann Oncol 2012; 23:1370-1371. [PMID: 22383679 DOI: 10.1093/annonc/mds031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Fornaro
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa.
| | - F Crea
- Department of Internal Medicine, Division of Pharmacology, University of Pisa, Pisa
| | - G Masi
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
| | - E Paolicchi
- Department of Internal Medicine, Division of Pharmacology, University of Pisa, Pisa
| | - F Loupakis
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
| | - F Graziano
- Medical Oncology Unit, Department of Onco-Hematology, Azienda Ospedaliera S. Salvatore, Pesaro
| | - L Salvatore
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
| | - M Ronzoni
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - V Ricci
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - C Cremolini
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
| | - M Schirripa
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
| | - R Danesi
- Department of Internal Medicine, Division of Pharmacology, University of Pisa, Pisa
| | - A Falcone
- Department of Oncology, Transplants and New Technologies in Medicine, Division of Medical Oncology, University of Pisa, Pisa
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Catalano V, Loupakis F, Graziano F, Bisonni R, Torresi U, Vincenzi B, Mari D, Giordani P, Alessandroni P, Salvatore L, Fornaro L, Santini D, Baldelli AM, Rossi D, Giustini L, Silva RR, Falcone A, D'Emidio S, Rocchi M, Luzi Fedeli S. Prognosis of mucinous histology for patients with radically resected stage II and III colon cancer. Ann Oncol 2012; 23:135-141. [PMID: 21531784 DOI: 10.1093/annonc/mdr062] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previous studies investigating the prognostic role of mucinous histology of colorectal cancer produced conflicting results. This retrospective analysis was carried out in order to explore whether mucinous adenocarcinoma (MC) is associated with a comparatively worse prognosis than that of nonmucinous adenocarcinoma (NMC) for patients undergoing curative resection for stage II and III colon cancer. PATIENTS AND METHODS This study involved 1025 unselected patients who underwent curative surgery for sporadic colon cancer and follow-up procedures at six different oncology departments. RESULTS MCs accounted for 17.4% (n=178) of tumours. Patients with MC had 5- and 8-year overall survival rates of 78.6% and 68.8%, respectively, compared with 72.3% and 63.8%, respectively, for patients with nonmucinous tumours. Multivariate analysis using the Cox proportional hazards model showed that the clinically significant prognostic factors were stage of disease and adjuvant chemotherapy. No statistically significant interaction between mucinous histology and adjuvant chemotherapy was found. CONCLUSIONS For patients with stage II and III colon cancer who underwent curative surgery, mucinous histology has no significant correlation with prognosis compared with NMC. This retrospective analysis suggests a comparable benefit from adjuvant chemotherapy for MC compared with NMC.
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Affiliation(s)
- V Catalano
- Department of Oncology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Presidio San Salvatore, Pesaro.
| | - F Loupakis
- Department of Medical Oncology, 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - F Graziano
- Department of Oncology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Presidio San Salvatore, Pesaro
| | - R Bisonni
- Department of Oncology, Ospedale 'A. Murri', Fermo
| | - U Torresi
- Department of Oncology, Ospedale di Macerata, Macerata
| | - B Vincenzi
- Department of Oncology, Università Campus BioMedico, Rome
| | - D Mari
- Department of Oncology, Ospedale 'E. Profili', Fabriano
| | - P Giordani
- Department of Oncology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Presidio San Salvatore, Pesaro
| | - P Alessandroni
- Department of Oncology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Presidio San Salvatore, Pesaro
| | - L Salvatore
- Department of Medical Oncology, 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - L Fornaro
- Department of Medical Oncology, 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - D Santini
- Department of Oncology, Università Campus BioMedico, Rome
| | - A M Baldelli
- Department of Oncology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Presidio San Salvatore, Pesaro
| | - D Rossi
- Department of Oncology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Presidio San Salvatore, Pesaro
| | - L Giustini
- Department of Oncology, Ospedale 'A. Murri', Fermo
| | - R R Silva
- Department of Oncology, Ospedale 'E. Profili', Fabriano
| | - A Falcone
- Department of Medical Oncology, 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - S D'Emidio
- Department of Oncology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Presidio San Salvatore, Pesaro
| | - M Rocchi
- Istituto di Biomatematica, Università degli Studi di Urbino, Urbino, Italy
| | - S Luzi Fedeli
- Department of Oncology, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Presidio San Salvatore, Pesaro
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Rossi D, Pistilli B, Morale D, Baldelli, Casadei V, Benedetti G, Alessandroni P, Catalano V, Giordani P, Graziano F, Fedeli SL, Fiorentini G. "Short Course" of Nonpegylated Liposomal Doxorubicin Plus Paclitaxel and Trastuzumb as Primary Systemic Therapy for Operable and Locally-Advanced Breast Cancer: A Phase II Study (PacLiDox 07). World J Oncol 2011; 2:245-251. [PMID: 29147255 PMCID: PMC5649686 DOI: 10.4021/wjon393w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2011] [Indexed: 11/29/2022] Open
Abstract
Background Schedules with anthracyclines and taxanes are one of the best options for primary chemotherapy. The addition of trastuzumab showed an impressive percentage of pathological complete responses in Buzdar trial (66.7%). Recently, nonpegylated liposome-encapsulated doxorubicin (NLD) has been widely used in advanced breast cancer with high response rates (98.1 % in Cortes study). The aims of our study were to assess pathological responses and toxicity of NLD plus paclitaxel (and trastuzumab in patients with HER2 overexpression). Methods Thirty patients entered the study: 9 locally advanced and 21 operable. Median age was 58.5 years (range: 31-73). 23 patients without HER2 overexpression (or FISH not amplified) were treated with NLD 50 mg/m2 every three weeks for 3 courses and weekly paclitaxel 80 mg/m2 for 8 courses. 7 patients with HER2 overexpression or FISH amplified were treated with the same schedules plus trastuzumab (Herceptin) 4 mg/kg for the first administration and 2 mg/kg for the following 7 weekly administrations. Results Pathological complete response (pCR) was documented in 1 patient (treated with trastuzumab); no residual tumor (infiltrating or “in situ”) on breast was documented in other 2 patients. Objective clinical responses were documented in 22 patients (73.3%): 8 complete, 10 partial and 4 “minimal” responses. 7 patients have shown stable and 1 progressive disease. Clinical response in patients with HER2 overexpression treated with trastuzumab was 100% (4 complete and 3 partial responses). Conservative surgery was performed in 8 (38%) and mastectomy in 13 (62%) out of 21 operable patients; however, 7 out of 14 responding patients with operable disease underwent quadrantectomy (50%). Main toxicity was neutropenia: febrile in 2 patients (7%) and gr. 3-4 in 13 (43%). Other grade 3 toxicities were as follows: vomiting in 1 patient, asthenia in 1 patient, joint symptom in 1 patient. 3 patients were withdrawn from the study. No episodes of left ventricular ejection fraction (LVEF) < 50% were recorded (with a median reduction of 8%). Conclusions A “short course” of paclitaxel and NLD is active in terms of clinical response and conservative surgery for patients with potentially operable and locally advanced breast cancer; toxicity was manageable. High activity of the combination with trastuzumab has been confirmed. However, with this “short course” schedule, the result in term of clinical responses didn't turn into complete pathological responses.
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Affiliation(s)
- D Rossi
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - B Pistilli
- Oncolgy Unit, Macerata General Hospital, Italy
| | - D Morale
- Oncology Unit, Ascoli Piceno General Hospital, Italy
| | - Baldelli
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - V Casadei
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - G Benedetti
- Oncolgy Unit, Macerata General Hospital, Italy
| | - P Alessandroni
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - V Catalano
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - P Giordani
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - F Graziano
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - S Luzi Fedeli
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
| | - G Fiorentini
- Oncology Unit, Marche Nord Hospital, S. Salvatore, Italy
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Crea F, Fornaro L, Paolicchi E, Masi G, Frumento P, Loupakis F, Salvatore L, Cremolini C, Schirripa M, Graziano F, Ronzoni M, Ricci V, Farrar WL, Falcone A, Danesi R. An EZH2 polymorphism is associated with clinical outcome in metastatic colorectal cancer patients. Ann Oncol 2011. [PMID: 21926398 DOI: 10.1093/annonc/mdr387.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite therapeutic innovations, metastatic colorectal cancer (mCRC) is still characterized by poor prognosis and few molecular markers predict the risk of progression. Polycomb group genes (PcGs) are epigenetic modifiers involved in tumor suppressor gene silencing. PcG member EZH2 mediates gene silencing through histone-H3 lysine-27 methylation. In colorectal cancer (CRC), EZH2 overexpression predicts shorter survival. Recently, four EZH2 single-nucleotide polymorphisms (SNPs) have been described. The present study was aimed at evaluating the correlation between EZH2 SNPs and outcome parameters in mCRC patients. PATIENTS AND METHODS DNA was extracted from blood samples of 110 mCRC patients treated with first-line 5-fluorouracil, folinic acid, irinotecan (FOLFIRI) and bevacizumab. Genotyping was carried out by real-time PCR. Genotype was used to predict objective response, progression-free survival (PFS) and overall survival (OS). EZH2 messenger RNA levels were evaluated on lymphocytes of a parallel cohort of 50 CRC patients. RESULTS One allelic variant (rs3757441 C/C versus C/T or T/T) was significantly associated with shorter PFS and OS (P < 0.01 and P < 0.05, respectively). At multivariate analysis, the same variant resulted an independent predictor of PFS and OS (P < 0.05). The C/C variant was associated with significantly higher EZH2 expression (P < 0.05). CONCLUSION An EZH2 SNP may be useful to predict clinical outcome in mCRC patients.
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Affiliation(s)
- F Crea
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa.
| | - L Fornaro
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - E Paolicchi
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa
| | - G Masi
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - P Frumento
- Unit of Biostatistics, Institute of Environmental Health, Karolinska Institutet, Stockholm, Sweden
| | - F Loupakis
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - L Salvatore
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - C Cremolini
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - M Schirripa
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - F Graziano
- Medical Oncology Unit, Department of Onco-Hematology, Azienda Ospedaliera S. Salvatore, Pesaro
| | - M Ronzoni
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - V Ricci
- Division of Medical Oncology, S. Raffaele Scientific Institute, Milano, Italy
| | - W L Farrar
- Cancer Stem Cell Section, Laboratory of Cancer Prevention, National Institute of Cancer-Frederick, Frederick, USA
| | - A Falcone
- Division of Medical Oncology, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - R Danesi
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa
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Papini E, Guglielmi R, Hosseim G, Misischi I, Graziano F, Chianelli M, Crescenzi A, Bianchini A, Valle D, Bizzarri G. Ultrasound-guided laser ablation of incidental papillary thyroid microcarcinoma: a potential therapeutic approach in patients at surgical risk. Thyroid 2011; 21:917-20. [PMID: 21595556 PMCID: PMC3148119 DOI: 10.1089/thy.2010.0447] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Incidental papillary thyroid microcarcinoma (PTMC), a frequent clinical problem, is usually associated with a favorable outcome. During long-term follow-up, only a minority of cases show aggressive behavior with either lymph node or distant metastases. Recently, we had an opportunity to evaluate the efficacy of nonsurgical, ultrasound (US)-guided percutaneous laser ablation (PLA) for local treatment of PTMC in an otherwise inoperable patient. PATIENT AND METHODS Neck US examination revealed an incidental, solitary, 8 × 7 × 7 mm hypoechoic nodule with microcalcifications of the right thyroid lobe. The patient suffered from decompensated liver cirrhosis, renal failure, and recent surgery followed by external beam radiation therapy for breast cancer. Cytologic diagnosis showed papillary thyroid carcinoma, but the patient declined surgery because of high risk of thyroid surgery. After local anesthesia with 2% xylocaine, PLA was performed according to the previously reported procedure with an Nd:YAG laser. SUMMARY The procedure was well tolerated, without side effects, and the patient required no analgesics. US-guided fine-needle aspiration biopsy and core-needle biopsy were performed at 1 and 12 months after PLA, which demonstrated necrotic material and inflammatory cells with no viable neoplastic cell. At the 24 months US follow-up examination, the area of necrosis further decreased, demonstrating a 4 × 4 mm hypoechoic zone and a small hyperechoic area due to fibrotic changes. A fine-needle aspiration biopsy confirmed the absence of malignant cells. CONCLUSIONS Laser-induced thermal ablation was a safe and effective ablative treatment for a patient with PTMC confined to the thyroid gland who was at high surgical risk. This approach should be considered only in elderly patients and/or in those with comorbidities that might expose the patients to an undue high surgical risk and only after the evaluation by neck US, computed tomography, magnetic resonance imaging, or positron emission tomography/computed tomography rules out lymph-node involvement or metastatic disease.
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Affiliation(s)
- Enrico Papini
- Department of Endocrinology, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Gharib Hosseim
- Department of Endocrinology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Irene Misischi
- Department of Endocrinology, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Filomena Graziano
- Department of Endocrinology, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Marco Chianelli
- Department of Endocrinology, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Anna Crescenzi
- Department of Anatomic Pathology, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Antonio Bianchini
- Department of Diagnostic Imaging, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Dario Valle
- Department of Diagnostic Imaging, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Giancarlo Bizzarri
- Department of Diagnostic Imaging, Regina Apostolorum Hospital, Albano, Rome, Italy
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Galluccio N, Ruzzo A, Canestrari E, Lorenzini P, d'Emidio S, Sisti V, Catalano V, Andreoni F, Zingaretti C, De Nictolis M, Ligorio C, Cappuzzo F, Magnani M, Graziano F. C-MET gene copy number variation (CNV) analysis by quantitative PCR (qPCR) assay in Caucasian patients with gastric cancer (GC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4038] [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: 11/20/2022] Open
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49
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Canestrari E, Ruzzo A, Vincenzi B, Galluccio N, Perrone G, Andreoni F, Lorenzini P, Rulli E, d'Emidio S, Catalano V, Loupakis F, Bisonni R, Floriani I, De Nictolis M, Santini D, Salvatore L, Tonini G, Falcone A, Magnani M, Graziano F. Let-7a microRNA levels in KRAS-mutated colorectal carcinomas determine survival differences in patients treated with anti-EGFR. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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50
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Ruzzo A, Canestrari E, Galluccio N, Santini D, Vincenzi B, Tonini G, Magnani M, Graziano F. Role of KRAS let-7 LCS6 SNP in metastatic colorectal cancer patients. Ann Oncol 2011; 22:234-235. [DOI: 10.1093/annonc/mdq472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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