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Santoleri F, Musicco F, Fulgenzio C, Abrate P, Pestrin L, Pasut E, Modesti G, Giannini R, Rosa SD, Piccoli M, Mingolla G, Zuzolo E, Gazzola P, Roperti M, Pieri G, Montresor V, Martignoni I, Gambera M, Langella R, Tinari G, Spoltore C, Roberti C, Fabio LD, Grossi L, Guarino F, Vita FD, Lasala R, Costantini A. Adherence, persistence and treatment switching in psoriasis. Immunotherapy 2024. [PMID: 38651935 DOI: 10.2217/imt-2023-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Aim: This study aims to investigate drug utilization patterns in the treatment of psoriasis (PsO) from 1 to 5 years in a real-life setting with Adalimumab (Ada), Etanercept (Eta), Ustekinumab (Ust), Golimumab (Gol), Ixekizumab (Ixe), Secukinumab (Sec) and Apremilast (Apr). Materials & methods: Data from an observational study were used to calculate adherence using the Proportion of Days Covered (PDC) method and persistence. Results & conclusion: Treatment adherence was found to be good for all the drugs studied across all years of analysis, while persistence was suboptimal, showing a marked decrease from the third year of study onward. In the treatment of PsO, greater attention needs to be paid to treatment persistence.
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Affiliation(s)
| | - Felice Musicco
- San Gallicano Dermatological Institute - IRCCS, Rome Italy
| | | | | | | | - Enrico Pasut
- Service of Pharmacy, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Germana Modesti
- Service of Pharmacy, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | | | | | | | | | - Eva Zuzolo
- San Gallicano Dermatological Institute - IRCCS, Rome Italy
| | - Pietro Gazzola
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | | | | | - Marco Gambera
- "Ospedale P. Pederzoli" Casa di Cura Privata S.p.A.Via Monte Baldo
| | - Roberto Langella
- Pharmacy Department, Agency for Health Protection (ATS) of Milan,Italy
| | | | | | | | | | - Laura Grossi
- Chieti General Hospital, Via dei Vestini, Chieti Italy
| | | | | | - Ruggero Lasala
- Hospital Pharmacy of Corato, Local Health Unit of Bari, Bari, Italy
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Starace E, De Pasquale G, Morenghi E, Crippa C, Matteucci S, Pieri G, Soekeland F, Gibbi SM, Lo Cricchio G, Reggiani F, Calatroni M, Pastore M, Mazzoleni B, Mancin S. Hospital Malnutrition in the Medicine and Neurology Departments: A Complex Challenge. Nutrients 2023; 15:5061. [PMID: 38140320 PMCID: PMC10745339 DOI: 10.3390/nu15245061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Hospital malnutrition is especially common among elderly patients with neurological deficits or dementia. These conditions can be exacerbated by unpalatable diets and issues such as dysphagia and presbyphagia. Our study aimed to investigate the prevalence of malnutrition in patients on a homogenized diet and to identify potential correlations with specific clinical variables. We conducted a retrospective observational study in compliance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. The study encompassed 82 patients, mainly elderly and diagnosed with neurodegenerative diseases. Upon initial assessment, 46.34% of the sample displayed a risk of malnutrition based on the Malnutrition Universal Screening Tool (MUST), and 62.20% were classified as malnourished based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Only 45.12% retained autonomy in food intake. Weight loss identified prior to the study was closely tied to malnutrition and influenced BMI. Moreover, autonomy in food intake was strongly associated with a prolonged hospital stay (LOS), and a similar trend was observed for water intake. Our findings emphasize the importance of promptly recognizing patients at risk of malnutrition, especially within such a vulnerable population. Autonomy in food intake and hydration emerge as critical indicators in the clinical management of hospitalized patients.
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Affiliation(s)
- Erica Starace
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Giulia De Pasquale
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Camilla Crippa
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Sofia Matteucci
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Gabriella Pieri
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Fanny Soekeland
- School of Health Professions, University of Applied Sciences, 3008 Bern, Switzerland;
| | - Stefano Maria Gibbi
- Department of Drug Science, School of Pharmacy, University of Pavia, 27100 Pavia, Italy;
| | - Giuliana Lo Cricchio
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Francesco Reggiani
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Marta Calatroni
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Manuela Pastore
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Stefano Mancin
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
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Santoleri F, Lasala R, Abrate P, Pestrin L, Pasut E, Modesti G, Musicco F, Fulgenzio C, Zuzolo E, Pieri G, Roperti M, Gazzola P, Gambera M, Martignoni I, Montresor V, De Vita F, Guarino F, Grossi L, Di Fabio L, Roberti C, Spoltore C, Tinari G, De Rosa S, Giannini R, Langella R, Mingolla G, Piccoli M, Costantini A. ADA_ETA_BIO2021: real-world evaluation of adherence, persistence, and cost-effectiveness of originator and biosimilar biologic drugs in the treatment of rheumatoid arthritis: a multicenter study in Italy. Curr Med Res Opin 2023; 39:1729-1735. [PMID: 37994874 DOI: 10.1080/03007995.2023.2287600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/21/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES The objective was to assess the adherence, persistence, and costs of bDMARDs through a multicentre study of nine Italian hospital pharmacies. METHODS The drugs analysed were Abatacept, Adalimumab, Certolizumab, Etanercept, Golimumab and Tocilizumab.Adult subjects with Rheumatoid Arthritis were considered in the analysis.In this study, we calculated the following metrics: Adherence to treatment was evaluated as dose-intensity, which is the ratio between the amount of medication received and probably taken by the patient at home (Received Daily Dose, RDD) and the amount prescribed by the clinician (Prescribed Daily Dose, PDD). Persistence was calculated as the number of days between the first and last dispensing of the same drug. Lastly, costs were assessed based on persistence to treatment and normalized for adherence. RESULTS Adherence to treatment was found to be above 0.8 for all drugs studied. The median persistence for a 5-year treatment period was 1.4 years for Abatacept, 1.7 years for Adalimumab, 1.8 years for Certolizumab, 1.4 years for Etanercept, 1.3 years for Golimumab, and 1.6 years for Tocilizumab. CONCLUSIONS This multicentre retrospective observational study of bDMARDs used in the treatment of RA showed that, for all the drugs studied, there was no problem with adherence to treatment but rather a difficulty in maintaining treatment with the same drug over time.
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Affiliation(s)
| | - Ruggero Lasala
- Hospital Pharmacy of Corato, Local Health Unit of Bari, Bari, Italy
| | | | | | - Enrico Pasut
- Service of Pharmacy, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Germana Modesti
- Service of Pharmacy, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Felice Musicco
- San Gallicano Dermatological Institute - IRCCS, Rome Italy
| | | | - Eva Zuzolo
- San Gallicano Dermatological Institute - IRCCS, Rome Italy
| | | | | | - Pietro Gazzola
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Gambera
- "Ospedale P. Pederzoli" Casa di Cura Privata S.p.A.Via Monte Baldo
| | | | | | | | | | - Laura Grossi
- Chieti General Hospital, Via dei Vestini, Chieti Italy
| | | | | | | | | | | | | | - Roberto Langella
- Pharmacy Department, Agency for Health Protection (ATS) of Milan,Italy
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Crippa C, Matteucci S, Pastore M, Morenghi E, Starace E, De Pasquale G, Pieri G, Soekeland F, Gibbi SM, Lo Cricchio G, Zorloni A, Mazzoleni B, Mancin S. A Comparative Evaluation of the Caloric Intake and Economic Efficiency of Two Types of Homogenized Diets in a Hospital Setting. Nutrients 2023; 15:4731. [PMID: 38004125 PMCID: PMC10675474 DOI: 10.3390/nu15224731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/26/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
The prevalence of malnutrition is increasing globally due to factors such as age-related pathological conditions and diseases that impact food and beverage intake. In hospital settings, older adult patients often require homogenised diets, which can lead to malnutrition due to poor palatability and limited variety. This study compared the Standard Homogenised Diet (HSD) and a Modified Homogenized Diet (HMD) proposed in a tertiary hospital in Northern Italy. A retrospective and observational design was used to analyse data from 86 adult patients with various conditions requiring a homogenised diet. The primary goal was to compare food intake, rheological characteristics, and palatability of the two diets. The secondary objective was to evaluate the economic impact by comparing costs and quantifying food waste from unused meals. Patients on HMD had a median daily caloric intake of 852 kcal (IQR 787-926 kcal) compared to 631 kcal (IQR 506-797 kcal) in the HSD group. Taste, texture, palatability, and ease of intake for HMD outperformed HSD with scores such as 3.7 ± 0.6 vs. 2.5 ± 0.4 for taste. Economically, HMD was EUR 0.53 less expensive per day than HSD, and food wastage costs were significantly lower for HMD (EUR 2.66 ± 0.81) than HSD (EUR 4.66 ± 1.27). Overall, HMD presented substantial benefits in patient satisfaction and cost-efficiency. This insight may aid diverse care settings to enhance meal acceptance and nutritional intake for patients needing homogenised diets.
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Affiliation(s)
- Camilla Crippa
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Sofia Matteucci
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Manuela Pastore
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.Z.); (B.M.)
| | - Erica Starace
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Giulia De Pasquale
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Gabriella Pieri
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Fanny Soekeland
- School of Health Professions, University of Applied Sciences, 3008 Bern, Switzerland;
| | - Stefano Maria Gibbi
- School of Pharmacy, Department of Drug Science University of Pavia, 27100 Pavia, Italy;
| | - Giuliana Lo Cricchio
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Andrea Zorloni
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.Z.); (B.M.)
- Operating Room Unit Humanitas San Pio X, 20159 Milan, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.Z.); (B.M.)
| | - Stefano Mancin
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.Z.); (B.M.)
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Reggiannini M, Papini O, Pieri G. An Automated Analysis Tool for the Classification of Sea Surface Temperature Imagery. Pattern Recognit Image Anal 2022. [DOI: 10.1134/s1054661822030336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Bramanti S, De Philippis C, Bartoli A, Giordano L, Mariotti J, Sarina B, Mannina D, Valli V, De Gregori S, Roperti M, Pieri G, Castagna L. Feasibility and Efficacy of a Pharmacokinetics-Guided Busulfan Conditioning Regimen for Allogeneic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide as Graft-versus-Host Disease Prophylaxis in Adult Patients with Hematologic Malignancies. Transplant Cell Ther 2021; 27:912.e1-912.e6. [PMID: 34403790 DOI: 10.1016/j.jtct.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Busulfan (Bu) is an alkylating agent routinely used for conditioning regimens before allogeneic stem cell transplantation (allo-SCT). Bu shows wide pharmacokinetic (PK) variability among patients. Patients can have a higher systemic exposure (expressed as area under the curve [AUC]) with an increased risk of toxicity or a lower AUC with a higher probability of graft rejection and/or disease relapse. After i.v. administration, an optimal Bu therapeutic window (AUC target of 16,000 to 24,000 μM·minute) has been identified. The use of PK-guided Bu dosing leads to improved overall survival (OS) and progression-free survival (PFS) compared with fixed-dose administration in a variety of hematologic diseases. The aim of this study was to evaluate the outcomes and feasibility of a reduced-toxicity conditioning (RTC) regimen comprising thiotepa, Bu, and fludarabine (TBF) with therapeutic drug monitoring of Bu in patients with hematologic disorders. We report on 41 adult patients with myeloid or lymphoid malignancies who underwent an allo-SCT with a PK-guided Bu-based RTC regimen between January 2019 and October 2020. Patients received a total Bu dose to achieve a target AUC of 16,000 μM·minute in combination with Flu and thiotepa. The median time to absolute neutrophil count recovery and transfusion-independent platelet count recovery was 23 days (range, 15 to 42 days) and 29 days (range, 14 to 97 days), respectively. The cumulative incidence (CI) of nonrelapse mortality was 7% at 100 days and 13% at 1 year. Grade 3 liver toxicity was observed in 6 patients. One patient developed sinusoidal obstruction syndrome at day +27. Grade 3 mucositis occurred in 18 patients. Looking at grade ≥3 infections, the CI was 29% at 30 days, 34% at 60 days, 44% at 100 days, and 56% at 1 year. The 180-day CI of grade II-IV acute graft-versus-host disease (GVHD) was 15%, and the 1-year CI of overall chronic GVHD was 20%. With a median follow-up of alive patients of 14.4 months (range, 3.2 to 24 months), the CI of relapse at 1 year was 6%. The 1-year PFS was 81%, and 1-year OS was 84%. In conclusion, these data support the efficacy of PK-guided Bu dose in the context of a TBF conditioning regimen and the feasibility of therapeutic dosage monitoring of i.v. Bu for patients with hematologic diseases. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Stefania Bramanti
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | | | - Antonella Bartoli
- Fondazione IRCCS Policlinico San Matteo, Clinical and Experimental Pharmacokinetics Unit(,) Pavia, Italy
| | - Laura Giordano
- Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Jacopo Mariotti
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Barbara Sarina
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Daniele Mannina
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Viviana Valli
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Simona De Gregori
- Fondazione IRCCS Policlinico San Matteo, Clinical and Experimental Pharmacokinetics Unit(,) Pavia, Italy
| | - Martina Roperti
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Gabriella Pieri
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Luca Castagna
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy.
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Malipiero G, Paoletti G, Puggioni F, Racca F, Ferri S, Marsala A, Leoncini O, Porli M, Pieri G, Canonica GW, Heffler E. An academic allergy unit during COVID-19 pandemic in Italy. J Allergy Clin Immunol 2020; 146:227. [PMID: 32317114 PMCID: PMC7161527 DOI: 10.1016/j.jaci.2020.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Giacomo Malipiero
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Ornella Leoncini
- Health Information Flow Management, Hospital Health Direction Office, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Monica Porli
- Quality Monitoring Office, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Gabriella Pieri
- Pharmacy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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Pianori D, Avaldi VM, Rosa S, Lenzi J, Ialonardi M, Pieri G, Rossi A, Fantini MP. How do Community Hospitals respond to the healthcare needs of elderly patients? A population-based observational study in the Emilia-Romagna Region. Ann Ig 2019; 30:317-329. [PMID: 29895049 DOI: 10.7416/ai.2018.2223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intermediate Care Services have been developed to provide high-quality and sustainable care to the elderly patients with chronic diseases. Italian Community Hospitals, inspired by the British model, are an example of Intermediate Care. The aim of this study was: (1) to describe the healthcare needs met by the Community Hospitals of Emilia-Romagna, Northern Italy, by depicting the characteristics of hospitalized patients, and (2) to evaluate process and outcome indicators by conducting a comparative assessment of the quality of care. STUDY DESIGN Observational retrospective cohort study. METHODS The study population included patients living in Emilia-Romagna who were discharged during 2016 from the 14 Community Hospitals of the region. Data were retrieved from the Regional Informative System of Community Hospitals database; multi-morbidity profiles were identified through the Hospital Discharge Records Database and the Outpatient Pharmaceutical Database. In-hospital variation of the 5-level Modified Barthel Index and hospital readmissions within 3 months of discharge were retrieved for each patient. The presence of recurrent patterns of multi-morbidity, i.e., clinical conditions that tend to co-occur, was investigated using unsupervised cluster analysis. RESULTS The study population included 2,121 patients. Mean age was 79.5 years, mean Community Hospital stay was 22.4 days (range 13.1 - 31.5 days) and 62.5% of the patients were females. The most common sources of admission were hospital (71.8%) and home (27.0%). Routine discharges were 60.0%, planned home discharges were 13.6%, and transfers to public or private hospitals were 10.8%. We identified two multi-morbidity clusters unevenly distributed across Community Hospitals. Mean number of co-occurring chronic conditions per patient was different in the two clusters (3.0 vs. 4.7, p < 0.004). Mean Modified Barthel Index at admission and discharge was 32.2 and 47.6, respectively. Mean difference of 15.3 between values at admission and discharge was statistically significant (p < 0.001). Three-month hospital readmissions occurred for 20.2% of patients. CONCLUSION The development of Intermediate Care Services, and in particular Community Hospitals, requires guidelines and protocols to define who among the patients can benefit more from this type of care. It is necessary to assess the quality of care provided by these facilities through appropriate and internationally comparable measures, including patient experience indicators.
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Affiliation(s)
- D Pianori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - V M Avaldi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - S Rosa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - J Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - M Ialonardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - G Pieri
- Local Healthcare Authority, Imola (BO), Italy
| | - A Rossi
- Local Healthcare Authority, Imola (BO), Italy
| | - M P Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Roila F, Ruggeri B, Ballatori E, Patoia L, Palazzo S, Colucci G, Di Costanzo F, Cascinu S, Labianca R, Sobrero A, Cortesi E, Bressi C, Ferraldeschi R, Mazzoli M, Evangelista M, Di Fonzo C, Cigolari S, Angelini V, Cioffi A, Guardasole V, Zarra E, Tonato M, Betti M, Marrocolo F, Bon-ciarelli V, Cetto G, Silingardi V, Cognetti F, Beretta G, Pessi A, Mosconi S, Milesi L, Bertetto O, Malacarne P, Marzola M, Margutti G, Modenesi C, Manente P, Comandone A, Oliva C, Berniolo P, Cutin SC, Luporini G, Colucci G, Recaldin E, Nicodemo M, Picece V, Turaz-za M, Ferrazzi E, Solina G, Rosati G, Rossi A, Manzione L, Sozzi P, Fornarini G, Lavarello A, Catalano G, Giordani P, Alessandroni P, Troccoli G, Ramus GV, Tonda L, Sirgiovanni M, Iannello GP, Tinessa V, Ruggiero A, Palazzo S, Barni S, Mandalà M, Cremonesi M, Porcile G, Destefanis M, Testore F, Carteni G, Daniele B, Volta C, Ferraù F, Zaniboni A, Marchetti P, Citone G, Cefaro GA, Iacono C, Musi M, Mozzicafreddo A, Imperiale FN, Filippelli G, Sciacca V, D'Aprile M, Isa L, Recchia F, Spada S, Cascinu S, Carroccio R, Mustacchi G, Ceccherini R, Chetrì M, Rizzo P, Botturi M, Marchei P, Bretti S, Montalbetti L, Reguzzoni G, Massidda B, Ionta M, Cruciani G, Prosperi A, Mantovani G, Sidoti V, Peta A, Greco E, Cicero G, Sobrero A, Marsilio P, Vigevani E, Rimondi G, Gebbia V, Nuzzo A, Biondi E, Caroti C, D'Amico M, Tuveri G, Pieri G, Enrici RM, Tonini G, Santini D, Iannone T, Pizza C, Belli M, Del Prete S, Pizza C, Trevisonne R, Serlenga M, Laricchiuta R, Lacava V, Bumma C, Roselli M, Verderame F, Mascia V, Perrone D, Prantera T, Venuta S, Nastasi G, Bortolussi V, Lembo A. Adjuvant Systemic Therapies in Patients with Colorectal Cancer: An Audit on Clinical Practice in Italy. Tumori 2019; 91:472-6. [PMID: 16457144 DOI: 10.1177/030089160509100605] [Citation(s) in RCA: 5] [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: 11/16/2022]
Abstract
Aims and Background Rarely are conclusions from clinical trials summarized in international consensus conferences and promptly transferred to patient care. The adjuvant therapy for colorectal cancer used in daily clinical practice in Italy is described and compared with the recommendations of the 1990 NIH Consensus Conference. Patients and Methods We audited prescriptions of adjuvant systemic therapies for Italian colorectal cancer patients in 82 centers during a fixed one-week period. Results Among 434 patients receiving adjuvant chemotherapy there were 139 (42.5%) colon cancer patients with N- and 169 (51.7%) with N+ regional nodal involvement. Treatment at academic centers, a young age, T4 and a low total number of lymph nodes removed at surgery were the factors potentially justifying the decision for adjuvant chemotherapy in stage II colon cancer patients. The most common chemotherapy used was a bolus of 5-fluorouracil/folinic acid for 6 months (75.8%). Adjuvant radiotherapy was not administered to 37 (38.5%) of 96 patients with stage II and III rectal cancer. Conclusions The study shows that a substantial proportion of patients on adjuvant treatment at a certain time point in a large enough sample of Italian centers are stage II (potential over-treatment) and that an under-treatment of stage II and III rectal cancer patients (lack of radiotherapy) occurs too often in daily clinical practice in this country.
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Affiliation(s)
| | - Fausto Roila
- Divisione Oncologia Medica, Ospedale Policlinico, Perugia
| | | | - Enzo Ballatori
- Unità di Statistica Medica, Dip. Medicina Interna e Sanità Pubblica, Università, L'Aquila
| | - Lucio Patoia
- Dip. Medicina Interna e Scienze Oncologiche, Università, Perugia
| | | | - Giuseppe Colucci
- Oncologia Medica e Sperimentale, Istituto Nazionale Tumori, Bari
| | | | | | | | | | - E. Cortesi
- D.H. Oncologico Policlinico Umberto I, Roma
| | - C. Bressi
- D.H. Oncologico Policlinico Umberto I, Roma
| | | | - M. Mazzoli
- D.H. Oncologico Policlinico Umberto I, Roma
| | | | | | - S. Cigolari
- III Medicina Interna, Università Federico II, Napoli
| | - V. Angelini
- III Medicina Interna, Università Federico II, Napoli
| | - A. Cioffi
- III Medicina Interna, Università Federico II, Napoli
| | - V. Guardasole
- III Medicina Interna, Università Federico II, Napoli
| | - E. Zarra
- III Medicina Interna, Università Federico II, Napoli
| | - M. Tonato
- Divisione Oncologia Medica, Policlinico, Perugia
| | - M. Betti
- Divisione Oncologia Medica, Policlinico, Perugia
| | - F. Marrocolo
- Divisione Oncologia Medica, Policlinico, Perugia
| | | | - G. Cetto
- Divisione Clinicizzata Oncologia Medica, Ospedale Maggiore, Verona
| | | | - F. Cognetti
- Divisione Oncologia Medica, Istituto Nazionale dei Tumori, Roma
| | - G. Beretta
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - A. Pessi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - S. Mosconi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - L. Milesi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - O. Bertetto
- Divisione Oncologia Medica, Ospedale S. Giovanni Molinette, Torino
| | - P. Malacarne
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - M. Marzola
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - G. Margutti
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - C. Modenesi
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - P. Manente
- Divisione Oncologia Medica, Ospedale Civile, Castelfranco Veneto
| | - A. Comandone
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | - C. Oliva
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | - P. Berniolo
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | | | - G. Luporini
- Divisione Oncologia Medica, Ospedale S. Carlo Borromeo, Milano
| | - G. Colucci
- Divisione Oncologia Medica e Sperimentale, Istituto Nazionale Tumori, Bari
| | - E. Recaldin
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - M. Nicodemo
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - V. Picece
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - M. Turaz-za
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - E. Ferrazzi
- Divisione Oncologia Medica, Ospedale Civile, Rovigo
| | - G. Solina
- Divisione Chirurgia Oncologica, Ospedale Cervello, Palermo
| | - G. Rosati
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - A. Rossi
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - L. Manzione
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - P. Sozzi
- Divisione Oncologia Medica, Ospedale degli Infermi, Biella
| | - G. Fornarini
- Divisione Oncologia Medica, Ospedale degli Infermi, Biella
| | - A. Lavarello
- Divisione Oncologia Medica, Ospedale Civile, Sestri Levante
| | - G. Catalano
- Divisione Oncologia Medica, Ospedale S. Salvatore, Pesaro
| | - P. Giordani
- Divisione Oncologia Medica, Ospedale S. Salvatore, Pesaro
| | | | - G. Troccoli
- Divisione Oncologia Medica, Policlinico Universitario, Bari
| | - G. Vietti Ramus
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | - L. Tonda
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | - M.P. Sirgiovanni
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | | | - V. Tinessa
- Divisione Oncologia Medica, Ospedale Civile, Benevento
| | - A Ruggiero
- Divisione Oncologia Medica, Ospedale Civile, Benevento
| | - S. Palazzo
- Divisione Oncologia Medica, Ospedale Mariano Santo, Cosenza
| | - S. Barni
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - M. Mandalà
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - M. Cremonesi
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - G. Porcile
- Divisione Oncologia Medica, Ospedale Civile, Alba
| | | | - F. Testore
- Divisione Oncologia Medica, Ospedale Civile, Asti
| | - G. Carteni
- Divisione Oncologia Medica, Ospedale Cardarelli, Napoli
| | - B. Daniele
- Divisione Oncologia Medica, Istituto Nazionale Tumori, Napoli
| | - C. Volta
- Divisione Oncologia Medica, Ospedale Maggiore della Carità, Novara
| | - F. Ferraù
- Divisione Oncologia Medica, Ospedale Civile, Taormina
| | - A. Zaniboni
- Divisione Oncologia Medica, C. Cura Poliambulanza, Brescia
| | - P. Marchetti
- Divisione Oncologia Medica, Ospedale S. Salvatore, L'Aquila
| | - G. Citone
- Divisione Oncologia Medica, Ospedale S. Salvatore, L'Aquila
| | | | - C. Iacono
- Divisione Oncologia Medica, Ospedale Civile, Ragusa
| | - M. Musi
- Divisione Oncologia Medica, Ospedale Generale, Aosta
| | | | | | | | - V. Sciacca
- Divisione Oncologia Medica, Ospedale S. Maria Goretti, Latina
| | - M. D'Aprile
- Divisione Oncologia Medica, Ospedale S. Maria Goretti, Latina
| | - L. Isa
- Divisione Oncologia Medica, Ospedale Civile, Gorgonzola
| | - F. Recchia
- Divisione Oncologia Medica, Ospedale Civile, Avezzano
| | - S. Spada
- D.H. Oncologico, Ospedale Umberto I, Siracusa
| | - S. Cascinu
- Divisione Oncologia Medica, Ospedale Civile, Parma
| | - R. Carroccio
- Unità Operativa Complessa di Oncologia Medica, Ospedale Umberto I, Enna
| | | | | | - M. Chetrì
- D.H. Oncologico, Ospedale di Summa, Brindisi
| | - P. Rizzo
- D.H. Oncologico, Ospedale di Summa, Brindisi
| | - M. Botturi
- UO Radioterapia, Ospedale Niguarda, Milano
| | - P. Marchei
- Divisione Oncologia Medica, Università La Sapienza, Roma
| | - S. Bretti
- Divisione Oncologia Medica, Ospedale Civile, Ivrea
| | | | - G. Reguzzoni
- D. H. Oncologico, Ospedale Civile, Busto Arsizio
| | - B. Massidda
- Oncologia Medica, Policlinico Universitario, Monserrato, Cagliari
| | - M.T. Ionta
- Oncologia Medica, Policlinico Universitario, Monserrato, Cagliari
| | - G. Cruciani
- Divisione Oncologia Medica, Ospedale Civile, Lugo
| | | | - G. Mantovani
- Divisione Oncologia Medica, Università, Cagliari
| | - V. Sidoti
- Divisione Oncologia Medica, Ospedale Civile, Pinerolo
| | - A. Peta
- Divisione Ematologia Oncologica, Ospedale Pugliese, Catanzaro
| | - E. Greco
- Divisione Oncologia Medica, Ospedale Civile, Lamezia Terme
| | - G. Cicero
- Divisione Oncologia Medica, Ospedale Civile, Castrovillari
| | - A. Sobrero
- Divisione Oncologia Medica, Policlinico Universitario, Udine
| | - P. Marsilio
- Divisione Oncologia Medica, Ospedale Civile, Udine
| | - E. Vigevani
- Divisione Oncologia Medica, Ospedale Civile, Tolmezzo
| | - G. Rimondi
- Divisione Oncologia Medica, Ospedale Civile, Tolmezzo
| | - V. Gebbia
- Divisione Oncologia Medica, Policlinico Universitario, Palermo
| | - A. Nuzzo
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano
| | - E. Biondi
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano
| | - C. Caroti
- Divisione Oncologia Medica, Ospedale Galliera, Genova
| | - M. D'Amico
- Divisione Oncologia Medica, Ospedale Galliera, Genova
| | - G. Tuveri
- Divisione Oncologia Medica, Ospedale della Pietà, Trieste
| | - G. Pieri
- Divisione Oncologia Medica, Ospedale della Pietà, Trieste
| | | | - G. Tonini
- Oncologia Medica, Università Campus Biomedico, Roma
| | - D. Santini
- Oncologia Medica, Università Campus Biomedico, Roma
| | - T. Iannone
- Unità di Radioterapia Oncologica, Ospedale civile, Belluno
| | - C. Pizza
- Divisione Oncologia Medica, Ospedale S. Maria della Pietà, Nola
| | | | - S. Del Prete
- Divisione Oncologia Medica, Ospedale Civile, Frattamaggiore
| | - C. Pizza
- Divisione Oncologia Medica, Ospedale S. Maria della Pietà, Nola
| | - R. Trevisonne
- Divisione Oncologia Medica e Radioterapia, Ospedale Civile, Ascoli Piceno
| | - M. Serlenga
- Oncologia Radioterapica, Ospedale Civile, Barletta
| | | | - V. Lacava
- D.H. Oncologia, Università La Sapienza, Roma
| | - C. Bumma
- Divisione Oncologia Medica, Ospedale S. Giovanni Vecchio, Torino
| | - M. Roselli
- Oncologia Medica, Università di Roma “Tor Vergata”, Roma
| | | | - V. Mascia
- Divisione Oncologia Medica, Policlinico Universitario, Cagliari
| | - D. Perrone
- Divisione Oncologia Medica, Ospedale Civile, Saluzzo, Cuneo
| | - T. Prantera
- Divisione Oncologia Medica, Ospedale S. Giovanni di Dio, Crotone
| | - S. Venuta
- Divisione Oncologia Medica, Policlinico Universitario, Catanzaro
| | - G. Nastasi
- Divisione Medicina Oncologica, Ospedale Civile, Alzano Lombardo
| | | | - A. Lembo
- Servizio Oncologia Medica, Casa di Cura M. Polo, Roma
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10
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Alterio D, Codecà C, Nolè F, Verri E, Orecchia R, Morelli F, Parisi S, Mastromauro C, Mione CA, Rossetto C, Polsinelli M, Koussis H, Loreggian L, Bonetti A, Campostrini F, Azzarello G, D'Ambrosio C, Bertoni F, Casanova C, Emiliani E, Guaraldi M, Bunkheila F, Bidoli P, Niespolo RM, Gava A, Massa E, Frattegiani A, Valduga F, Pieri G, Cipani T, Da Corte D, Chiappa F, Rulli E. Induction TPF followed by concomitant treatment versus concomitant treatment alone in locally advanced head and neck cancer. A phase II-III trial. Ann Oncol 2018; 28:2206-2212. [PMID: 28911070 DOI: 10.1093/annonc/mdx299] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [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: 11/12/2022] Open
Abstract
Background Platinum-based chemoradiation (CCRT) is the standard treatment for Locally Advanced Head and Neck Squamous-Cell Carcinoma (LAHNSCC). Cetuximab/RT (CET/RT) is an alternative treatment option to CCRT. The efficacy of induction chemotherapy (IC) followed by chemoradiation compared to chemoradiation alone has not been demonstrated in randomized clinical trials. The goals of this phase II-III trial were to assess: (i) the overall survival (OS) of IC versus no-induction (no-IC) and (ii) the Grade 3-4 in-field mucosal toxicity of CCRT versus CET/RT. The present paper focuses on the analysis of efficacy. Materials and methods Patients with LAHNSCC were randomized to receive concomitant treatment alone [CCRT (Arm A1) or CET/RT (Arm A2)], or three cycles of induction docetaxel/cisplatin/5 fluorouracil (TPF) followed by CCRT (Arm B1) or followed by CET/RT (Arm B2). The superiority hypothesis of OS comparison of IC versus no-IC (Arms B1 + B2 versus A1 + A2) required 204 deaths to detect an absolute 3-year OS difference of 12% (HR 0.675, with 80% power at two-sided 5% significance level). Results 414 out of 421 patients were finally analyzed: 206 in the IC and 208 in the no-IC arm. Six patients were excluded because of major violation and one because of metastatic disease at diagnosis. With a median follow-up of 44.8 months, OS was significantly higher in the IC arm (HR 0.74; 95% CI 0.56-0.97; P = 0.031). Complete Responses (P = 0.0028), Progression Free Survival (P = 0.013) and the Loco-regional Control (P = 0.036) were also significantly higher in the IC arm. Compliance to concomitant treatments was not affected by induction TPF. Conclusions IC followed by concomitant treatment improved the outcome of patients with LAHNSCC without compromising compliance to the concomitant treatments. The degree of the benefit of IC could be different according to the type of the subsequent concomitant strategy. Clinical Trial Number NCT01086826, www.clinicaltrials.gov.
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Affiliation(s)
- M G Ghi
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - A Paccagnella
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - D Ferrari
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - P Foa
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | | | - C Codecà
- Medical Oncology Unit, Ospedale San Paolo, Milano
| | - F Nolè
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | - E Verri
- Unit of Urogenital and Head and Neck Oncology, Istituto Europeo di Oncologia, Milano
| | | | | | - S Parisi
- U.O.C. Radiation Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni, Rotondo
| | - C Mastromauro
- Medical Oncology Department, Ospedale dell'Angelo, Venezia
| | - C A Mione
- Radiotherapy Department, Ospedale SS Giovanni e Paolo, Venezia
| | | | - M Polsinelli
- S.O.C. Radiation Oncology, Azienda Ospedaliero-Universitaria S.Maria della Misericordia, Udine
| | - H Koussis
- Medical Oncology Department 2, Istituto Oncologico Veneto- IRCCS, Padova
| | - L Loreggian
- Radiotherapy Department, Istituto Oncologico Veneto - IRCCS, Padova
| | - A Bonetti
- Medical Oncology Department, Ospedale Mater Salutis, Legnago
| | - F Campostrini
- Radiotherapy Department, Ospedale Mater Salutis, Legnago
| | - G Azzarello
- Oncology Unit, Department of Internal Medical Sciences, Mirano
| | | | - F Bertoni
- Radiotherapy Department, Azienda Ospedaliero Universitaria, Modena
| | | | - E Emiliani
- Radiotherapy Department, Azienda USL, Ravenna
| | - M Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - F Bunkheila
- Radiotherapy Department, Policlinico Sant'Orsola-Malpighi, Bologna
| | - P Bidoli
- Medical Oncology Department, Ospedale San Gerardo, Monza
| | - R M Niespolo
- Radiotherapy Department, Ospedale San Gerardo, Monza, Ospedale San Gerardo, Monza
| | - A Gava
- Radiotherapy Department, Ospedale Ca' Foncello, Treviso
| | - E Massa
- Department of Medical Science, Università degli Studi di Cagliari, Cagliari
| | - A Frattegiani
- Radiation Oncology Department, Ospedale S. Maria della Misericordia, Perugia
| | - F Valduga
- Medical Oncology Department, Ospedale S. Chiara, Trento
| | - G Pieri
- Medical Oncology Department, AO Triestina, Trieste
| | - T Cipani
- Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milano
| | - D Da Corte
- Oncology Department, Ospedale S. Martino, Belluno
| | - F Chiappa
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
| | - E Rulli
- Laboratory of Clinical Research, Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
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Ghi CM, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Morelli F, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Massa E, Rossetto C, Bonetti A, Siena S, Frattegiani A, Koussis H, Pieri G, Gava A, Floriani I. OC-006: Concomitant treatment (CRT or cetuximab/RT) with or without induction TPF in Locally Advanced head and neck. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34766-6] [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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12
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Pieri G, Lenzi J, Rucci P, Fantini MP. Prevalence of multimorbidity in Emilia-Romagna Region from 2008 to 2012. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku163.083] [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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D’Acunto M, Pieri G, Righi M, Salvetti O. A methodological approach for combining super-resolution and pattern-recognition to image identification. Pattern Recognit Image Anal 2014. [DOI: 10.1134/s1054661814020023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Morelli F, Azzarello G, D'Ambrosio C, Cruciani G, Guaraldi M, Massa E, Rossetto C, Bonetti A, Siena S, Minotti V, Koussis H, Pieri G, Baggio V, Floriani I. Concomitant chemoradiation (CRT) or cetuximab/RT (CET/RT) versus induction Docetaxel/ Cisplatin/5-Fluorouracil (TPF) followed by CRT or CET/RT in patients with Locally Advanced Squamous Cell Carcinoma of Head and Neck (LASCCHN). A randomized phase III factorial study (NCT01086826). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Daris Ferrari
- Medical Oncology Unit, San Paolo Hospital, Milan, Italy
| | - Paolo Foa
- Medical Oncology, San Paolo Hospital, Milano, Italy
| | - Maria Cossu Rocca
- Medical Oncology Unit of Urogenital and Head and Neck Tumors- European Institute of Oncology, Milano, Italy
| | - Elena Verri
- Medical Oncology Unit of Urogenital and Head and Neck Tumors- European Institute of Oncology, Milano, Italy
| | - Franco Morelli
- U.O.C. Oncologia, IRCCS Caa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Elena Massa
- Dipartimento di Scienze Mediche Internistiche, Cagliari, Italy
| | - Ciro Rossetto
- Department of Oncology University Hospital - Udine, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital-AULSS 21 della Regione Veneto, Legnago, Italy
| | | | - Vincenzo Minotti
- Division of Medical Oncology, Azienda Ospedaliera, Perugia, Italy
| | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | - Vittorio Baggio
- Division of Medical Oncology, Ospedale Cà Foncello, Treviso, Italy
| | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milano, Italy
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Papastergiou V, Tsochatzis EA, Pieri G, Thalassinos E, Dhar A, Bruno S, Karatapanis S, Luong TV, O'Beirne J, Patch D, Thorburn D, Burroughs AK. Nine scoring models for short-term mortality in alcoholic hepatitis: cross-validation in a biopsy-proven cohort. Aliment Pharmacol Ther 2014; 39:721-32. [PMID: 24612165 PMCID: PMC4015369 DOI: 10.1111/apt.12654] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 01/08/2014] [Accepted: 01/20/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several prognostic models have emerged in alcoholic hepatitis (AH), but lack of external validation precludes their universal use. AIM To validate the Maddrey Discriminant Function (DF); Glasgow Alcoholic Hepatitis Score (GAHS); Mayo End-stage Liver Disease (MELD); Age, Bilirubin, INR, Creatinine (ABIC); MELD-Na, UK End-stage Liver Disease (UKELD), and three scores of corticosteroid response at 1 week: an Early Change in Bilirubin Levels (ECBL), a 25% fall in bilirubin, and the Lille score. METHODS Seventy-one consecutive patients with biopsy-proven AH, admitted between November 2007-September 2011, were evaluated. The clinical and biochemical parameters were analysed to assess prognostic models with respect to 30- and 90-day mortality. RESULTS There were no significant differences in the areas under the receiver operating characteristics curve (AUROCs) relative to 30-day/90-day mortality: MELD 0.79/0.84, DF 0.71/0.74, GAHS 0.75/0.78, ABIC 0.71/0.78, MELD-Na 0.68/0.76, UKELD 0.56/0.68. One-week rescoring yielded a trend towards improved predictive accuracies (30-day/90-day AUROCs: 0.69–0.84/0.77–0.86). In patients with admission DF ≥ 32 (n = 31), response to corticosteroids according to ECBL, 25% fall in bilirubin and the Lille model yielded AUROCs of 0.73/0.73, 0.78/0.72 and 0.81/0.82 for a 30-day/90-day outcome respectively. All models showed excellent negative predictive values (NPVs; range: 86–100%), while the positive ones were low (range: 17–50%). CONCLUSIONS MELD, DF, GAHS, ABIC and scores of corticosteroid response proved to be valid in an independent cohort of biopsy-proven alcoholic hepatitis. MELD modifications incorporating sodium did not confer any prognostic advantage over classical MELD. Based on excellent NPVs, the models are best to identify patients at low risk of death.
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Affiliation(s)
- V Papastergiou
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - E A Tsochatzis
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - G Pieri
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - E Thalassinos
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - A Dhar
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - S Bruno
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - S Karatapanis
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - T V Luong
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - J O'Beirne
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - D Patch
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - D Thorburn
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK
| | - A K Burroughs
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free HospitalLondon, UK,Correspondence to:, Prof. A. K. Burroughs, The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, NW3 2QG, London, UK., E-mail:
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Papastergiou V, Tsochatzis EA, Rodriquez-Peralvarez M, Thalassinos E, Pieri G, Manousou P, Germani G, Rigamonti C, Arvaniti V, Karatapanis S, Burroughs AK, Burroughs AK. Biochemical criteria at 1 year are not robust indicators of response to ursodeoxycholic acid in early primary biliary cirrhosis: results from a 29-year cohort study. Aliment Pharmacol Ther 2013; 38:1354-64. [PMID: 24117847 PMCID: PMC4028985 DOI: 10.1111/apt.12522] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/13/2013] [Accepted: 09/17/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND In primary biliary cirrhosis (PBC), biochemical criteria at 1 year are considered surrogates of response to ursodeoxycholic acid (UDCA). However, due to the slow natural history of PBC, evaluation at 1 year may be suboptimal to assess the therapeutic response, particularly in early disease. AIM To determine whether evaluation of biochemical criteria at 1 year is a reliable surrogate of UDCA response in early PBC. METHODS We analysed the prospectively collected data of 215 patients (untreated = 129; UDCA-treated = 86) with early PBC (normal baseline bilirubin/albumin) and a median follow-up of 8 years (range: 1-29.1). The 1-year attainment rates of the Barcelona, Paris-I, Paris-II and Toronto definitions, and their predictive relevance for a poor outcome (death, transplantation, complications of cirrhosis), were assessed either as a result of UDCA or no treatment. Independent associations with attaining each UDCA response definition were identified by multivariate analysis. RESULTS Untreated patients displayed 1-year biochemical features compatible with 'treatment response' at rates (Barcelona: 36.4%, Paris-I: 66.7%, Toronto: 59.7%, Paris-II: 40.3%) similar to those obtained under UDCA. Depending on the definition, baseline ALP≤3xULN (OR: 4.80-35.90), AST≤2xULN (OR: 5.63-9.34) and early histological stage (OR: 3.67-3.87) were the stronger predictors for attaining the criteria. UDCA treatment was associated with attaining Barcelona (OR = 2.16) and Paris-II (OR = 2.84), but not Paris-I, and not Toronto definition when excluding late histological cases. Paris-I criteria were significantly predictive of long-term outcomes (HR = 2.83) in untreated patients. CONCLUSIONS In early PBC, biochemical criteria at 1 year reflect severity of the disease rather than the therapeutic response to UDCA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - A K Burroughs
- Correspondence to:, Prof. A. K. Burroughs, The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free Hospital and UCL, NW3 2QG, London, UK. E-mail:
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Cossu Rocca M, Verri E, Maiello E, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Mantovani G, Rossetto C, Bonetti A, Cipani T, Crino L, Koussis H, Pieri G, Gava A, Floriani I. A phase II-III study comparing concomitant chemoradiotherapy (CRT) versus cetuximab/RT (CET/RT) with or without induction docetaxel/cisplatin/5-fluorouracil (TPF) in locally advanced head and neck squamous cell carcinoma (LASCCHN): Efficacy results (NCT01086826). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6003 Background: This is the first phase III study directly comparing CRT vs CET/RT in LASCCHN. Primary endpoints of this study were to compare: 1) overall survival (OS) of induction vs. no induction arms; 2) Grade 3-4 in-field toxicity of CRT vs. CET/RT. Preliminary toxicity results of concomitant treatments (primary endpoint for this comparison) were reported at the 2012 ASCO meeting. Here we present response rate and survival data for the two concomitant treatments (CRT vs. CET/RT), irrespective of induction chemotherapy. Methods: Untreated patients with unresectable LASCCHN, stage III-IV, ECOG PS 0–1 were randomized to a 2x2 factorial design: Arm A1: CRT (2 cycles of cisplatin/5fluorouracil concomitant to RT); Arm A2: CET/RT; Arm B1: 3 cycles of TPF followed by the same CRT; Arm B2:3 cycles of TPF followed by CET/RT. Results: A total of421 patients were randomized: 261 received CRT (131 Arm A1+ 130 Arm B1) and 160 received CET/RT (80 Arm A2+ 80 Arm B2). 82% were male; median age was 60y; PS of 0 (79%) or 1 (21%). Stage was III (32%) or IV (68%). Sites of disease were: oral cavity 20%, oropharynx 57%, hypopharynx: 23%. No significant differences were observed in patients’ characteristics distribution. At a median follow-up of 32.9 months, a total of 174 deaths occurred (204 required for final OS analysis). Data on activity and efficacy of CRT and CET/RT are shown in the Table. Conclusions: No significant differences were observed in response rate, progression free survival and OS between CRT and CET/RT. Pts are still being followed-up to assess OS of induction vs. no induction arms. Clinical trial information: NCT01086826. [Table: see text]
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Affiliation(s)
| | | | | | - Paolo Foa
- Medical Oncology, San Paolo Hospital, Milano, Italy
| | | | - Elena Verri
- European Institute of Oncology, Milano, Italy
| | - Evaristo Maiello
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Ciro Rossetto
- Department of Oncology University Hospital, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital-AULSS 21 della Regione Veneto, Legnago, Italy
| | - Tiziana Cipani
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Lucio Crino
- Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | - Alessandro Gava
- Radiotherapy Department, Ospedale Ca' Foncello, Treviso, Italy
| | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milano, Italy
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Ghi MG, Paccagnella A, Ferrari D, Foa P, Nole F, Morelli F, Azzarello G, D'Ambrosio C, Casanova C, Guaraldi M, Mantovani G, Rossetto C, Bonetti A, Siena S, Crino L, Buffoli A, Koussis H, Pieri G, Gava A, Floriani I. Cetuximab/radiotherapy (CET+RT) versus concomitant chemoradiotherapy (cCHT+RT) with or without induction docetaxel/cisplatin/5-fluorouracil (TPF) in locally advanced head and neck squamous cell carcinoma (LASCCHN): Preliminary results on toxicity of a randomized, 2x2 factorial, phase II-III study (NCT01086826). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5513 Background: The standard treatment options for LASCCHN are cCHT+RT or CET+RT. Strategies to improve the efficacy with the integration of induction chemotherapy are being investigated. Primary endpoints of this study were to compare: 1) the overall survival (OS) of induction vs. no induction arms; 2) the Grade(G)3-4 in-field toxicity of cCHT+RT vs. CET+RT. Methods: Patients (pts) with unresectable LASCCHN, stage III-IV, ECOG PS 0–1 were randomized to a 2x2 factorial design: Arm A1: cCHT+RT (2 cycles of ciplatin/5fluorouracil); Arm A2: CET+RTX; Arm B1: 3 cycles of TPF followed by the same cCHT+RT; Arm B2: 3 cycles of TPF followed by CET+RT. A total of 204 deaths over 420 pts ( including the 101 randomized in the phase II part of the study comparing cCHT+RT with or w/o induction TPF) were required to detect a HR of death of 0.675 (A1+A2 vs. B1+B2; 2-sided a=0.05; b=0.20) and a 10% difference in G3-4 in-field mucosal toxicity (A1+B1 vs. A2+B2). Results: By February 2012, 387 pts over 413 pts were evaluable for toxicity. 82% of pts were male; median age was 60y; PS: 0=77.8% and 1=22.2%. Disease stage was III (31%) or IV (69%). Sites of disease were oral cavity (21.7%), oropharynx (54.8%), hypopharynx (23.5%). At a median follow-up of 21 months, 126 deaths occurred. Data on G3-4 in-field toxicity (primary endpoint) and compliance to cCHT+RT vs CET+RT are shown in the table. Conclusions: No advantage for CET+RT over cCHT+RT was observed regarding G3-4 in-field toxicities and feasibility. Pts are still being followed-up to assess OS. [Table: see text]
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Affiliation(s)
| | | | | | | | - Franco Nole
- Unit for Medical Care, European Institute of Oncology, Milan, Italy
| | - Franco Morelli
- Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Azzarello
- Department of Internal Medical Sciences,Oncology Unit ASL 13, Mirano, Italy
| | | | | | - Monica Guaraldi
- Medical Oncology Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Ciro Rossetto
- Department of Oncology University Hospital, Udine, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago, Italy
| | - Salvatore Siena
- Department of Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Lucio Crino
- Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | | | - Gabriella Pieri
- Oncology Department, Oncology Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | | | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milan, Italy
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Ottaviani G, Gobbo M, Pieri G, Zacchigna D, Di Lenarda R, Biasotto M. HLLT vs LLLT in the treatment of oral mucositis related to radiotherapy and/or chemotherapy. Med Oral Patol Oral Cir Bucal 2012. [DOI: 10.4317/medoral.17643750] [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: 11/05/2022] Open
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Magrini M, Moroni D, Nastasi C, Pagano P, Petracca M, Pieri G, Salvadori C, Salvetti O. Visual sensor networks for infomobility. Pattern Recognit Image Anal 2011. [DOI: 10.1134/s1054661811010093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Pieri G, Benvenuti M, Carnier E, Salvetti O. Real time object detection and tracking through a robotized system. Pattern Recognit Image Anal 2007. [DOI: 10.1134/s1054661807020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Affiliation(s)
- S B Doldi
- Unità operativa di Chirurgia Generale, Casa di Cura S. Ambrogio, and Cattedra di Chirurgia Generale I, Università degli Studi di Milano, Milan, Italy
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Messina G, Messina M, Nocentini S, Pieri G, Messina GG. [Adhesion of the labia minora in children]. Pediatr Med Chir 1998; 20:345-8. [PMID: 10068985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Vulvar agglutination or vulva connivens in childhood is a common disease and an important source of anxiety for parents. The Authors report on the anatomic classification, the etiology and the prevalence of this genital anomaly in the pediatric age. In the 2021 patients of our series examined in the Department of Pediatrics in Poggibonsi and in the Department of Pediatric Surgery of the University of Siena during a period of 7 years and revisited in the period between January 1995 and December 1996 (follow-up: max 7 years) no cases were observed in the first month of life (793 newborn infants) and this fact might help to exclude a congenital origin. The incidence of vulvar agglutination in 1228 children was 9.8%; in the 3.6% of cases vulvar agglutination was complete, while in the 6.1% it was incomplete. 60% of complete vulvar adhesions were in 3-6 years old patients, while the incomplete one was prevalent during the first 3 years of life. In our series vulvar adhesion was more common than in other studies, but the Author report no cases of correlated urinary or genital infections. It is important to reassure parents and to maintain a conservative approach to this anomaly. Estrogen therapy in this study was applied only in a few cases, because almost all the patients healed before puberty; the surgical division was applied only in case of recurrence.
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Affiliation(s)
- G Messina
- U.O. di Pediatria, U.S.L. n. 7, Poggibonsi, SI, Italia
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25
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Doldi SB, Lattuada E, Zappa MA, Cioffi U, Pieri G, Massari M, De Simone M, Peracchia A. Ultrasonographic evaluation of the cervical lymph nodes in preoperative staging of esophageal neoplasms. Abdom Imaging 1998; 23:275-7. [PMID: 9569295 DOI: 10.1007/s002619900338] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The detection of cervical lymph node metastases plays an important role in staging of patients affected by esophageal cancer to perform the best therapeutic approach. METHODS We report our experience concerning the ultrasound evaluation of the cervical area in 174 patients with esophageal cancer. Ultrasonographic evaluation of the neck can be done with a 7.5- or 10 MHz transducer in all cases, with selective scanning of the lymph node chains of the internal jugular veins and supraclavicular regions. The short-to-long axis ratio (S/L) was a useful way to detect lymph node metastasis. Histopathologic diagnoses were obtained by sonographically guided fine-needle aspiration biopsy. RESULTS At ultrasound examination, we found 18 (10.3%) patients with metastatic cervical nodes. Of these, 17 (94.4%) had metastatic cervical lymph nodes confirmed by cytology from fine-needle biopsy. Lymph node exceeding 5 mm in long axis and with an S/L over 0.5 showed a higher incidence of metastasis than those with an S/L under 0.5. Our experience shows a high incidence of lymph node metastases in patients with esophageal cancer localized to the thoracic supracarinal tract and in patients with cervical and lower esophageal cancer. CONCLUSION In the ultrasound evaluation of nodes, the most useful parameters are size of nodes, heterogeneity of internal echoes, morphology of the margins, and the deformation caused by compressive instrumental manipulation. These criteria, indicated by the Japanese Society for Esophageal Diseases, yield a high sensitivity and diagnostic specificity when the ultrasonographic studies are performed.
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Affiliation(s)
- S B Doldi
- Department of General and Oncologic Surgery, Padiglione Monteggia, Ospedale Maggiore Policlinico, Milan, Italy
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Massari M, Lattuada E, Zappa MA, Pieri G, Cioffi U, De Simone M, Segalin A, Bonavina L. Evaluation of leiomyoma of the esophagus with endoscopic ultrasonography. Hepatogastroenterology 1997; 44:727-731. [PMID: 9222681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Fourteen patients with suspected leiomyoma of the esophagus were studied by endoscopic ultrasonography, computed tomography, endoscopy and barium swallow. The results were correlated with the histology of the resected specimens: in 2 patients with a peduncolated leiomyoma originating from the second echographic layer, endoscopic resection was performed. Endoscopic ultrasonography was superior to other imaging techniques in detection and staging of leiomyoma because it can determine the layer of origin, the direction of the growth and the consistency of the tumor.
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Affiliation(s)
- M Massari
- Department of General and Thoracic Surgery, Ospedale Maggiore Policlinico, Milano, Italy
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27
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Doldi SB, Lattuada E, Zappa MA, Cioffi U, Pieri G, Massari M, Peracchia A. Ultrasonographic imaging of neoplasms of the cervical esophagus. Hepatogastroenterology 1997; 44:724-6. [PMID: 9222680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS We studied the effectiveness of ultrasonography in evaluating the cervical esophagus for the presence of large masses arising from the esophageal wall and consequently, the modifications of the visceral lumen. MATERIALS AND METHODS The cervical esophagus can be evaluated by ultrasound with longitudinal and axial scans, using the left thyroid lobe as an acoustic window. The cervical esophagus can be visualized from the C5 to D2 vertebrae. From November 1992 to July 1996, 220 patients with esophageal cancer and 120 subjects without esophageal disease (control group) were examined with ultrasonography. Examination of the cervical esophagus was performed with a linear high definition small parts probe with a frequency of 7.5-10 Mhz. RESULTS In all 31 patients with cancer of the cervical esophagus, ultrasonography of the cervical region showed the presence of an expanding mass from the esophageal wall as well as the modifications in the visceral lumen. The neoplasm of the cervical esophagus was visualized when its diameter exceeded 5 mm. CONCLUSIONS The experience of the authors shows that, during ultrasound examination of the cervical region, it is possible to accurately evaluate the cervical esophagus, either morphologically or functionally.
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Affiliation(s)
- S B Doldi
- University of Milan, Department of General and Oncologic Surgery
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Doldi SB, Lattuada E, Zappa MA, Pieri G, Favara A, Micheletto G. Ultrasonography of extremity lymphedema. Lymphology 1992; 25:129-33. [PMID: 1434788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ultrasonography of the extremities was performed in 91 patients with unilateral or bilateral peripheral lymphedema of the arms or legs. Linear 3.5 to 10 mHz ultrasonographic linear probes were used in accordance with standardized procedure. The data demonstrated a volumetric increase of the lymphedematous limb with increased thickness of both the subcutaneous and subfascial (muscular) compartments consistent with fibrosclerosis in both compartments with chronic disease. Whereas dermal thickening was minimal, subcutaneous and subfascial changes were more prominent in primary than secondary lymphedema. By providing information about the volumetric and structural alterations with chronic lymphedema, ultrasonography safely and simply supplements conventional and isotopic lymphography in assessing patients with chronic lymphedema.
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Affiliation(s)
- S B Doldi
- Istituto di Chirurgia Generale ed Oncologia Chirurgica, Universit Degli Studi di Milano, Italy
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Zanello P, Cinquantini A, Seeber R, Pieri G. Polarographic investigations on uranyl(VI) complexes in dimethylsulfoxide. IV. Ammonia and polyamines. Inorganica Chim Acta 1978. [DOI: 10.1016/s0020-1693(00)89643-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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