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Perego G, Paris L, Nozza S, Stefanoni P, Franzin M. Treating multiple myeloma in the era of new drugs: What is the right choice? J Oncol Pharm Pract 2023:10781552231176499. [PMID: 37186789 DOI: 10.1177/10781552231176499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
| | - Laura Paris
- Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Nozza
- Pharmacy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Stefanoni
- Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
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Perego G, Longobardo G, Baldisserotto A, Feliciani M, Fazio M. Automated chemotherapy compounding: Process optimization for the preparation of admixture containing high-dose of cyclophosphamide. J Oncol Pharm Pract 2023; 29:208-210. [PMID: 36172633 DOI: 10.1177/10781552221130012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Gianluca Perego
- Pharmacy Unit, 9372IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | | | - Maria Fazio
- Pharmacy Unit, 9372IRCCS San Raffaele Hospital, Milan, Italy
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Perego G, Longobardo G, Viganò L, Locatelli A, Veneziano C, Fazio M. Stability of a standardized preparation of methotrexate, cytarabine, and methylprednisolone hemisuccinate for intrathecal use. J Oncol Pharm Pract 2022:10781552221117228. [PMID: 35892160 DOI: 10.1177/10781552221117228] [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: 11/15/2022]
Abstract
INTRODUCTION Data about the feasibility or stability of drugs prepared for intrathecal administration are scarce, especially concerning the possibility of mixing two or more compounds in the same syringe. We evaluated the stability of an extemporaneously prepared triple intrathecal therapy containing methotrexate, cytarabine, and methylprednisolone hemisuccinate. MATERIALS AND METHODS Six mixtures containing 12.5 mg methotrexate, 50 mg cytarabine, and 40 mg methylprednisolone hemisuccinate, diluted to a final volume of 5 ml with water for injection, were prepared in polypropylene syringes on six different days. Syringes were stored protected from light either at room temperature (20°C) (n = 3) or refrigerated temperature (4°C) (n = 3). Samples were analyzed immediately after preparation and again at 0.5, 2, 4, 6, 8, and 24 h. The analysis was conducted with a high-performance liquid chromatography instrument equipped with a quaternary pump and diode array detector. pH was also assessed before every sample analysis. RESULTS When mixed in a polypropylene syringe, the three drugs were stable at both temperatures tested. No degradation >10% was observed in any sample and pH remained between 7.0 and 7.5 over time. No precipitation or color change occurred. Among the three compounds, methylprednisolone hemisuccinate was the most labile as a slight temperature- and time-dependent degradation was observed. CONCLUSION Triple intrathecal solution of methotrexate, cytarabine, and methylprednisolone hemisuccinate is stable for up to 24 h when stored in polypropylene syringes protected from light at 4°C and 20°C.
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Affiliation(s)
- Gianluca Perego
- Pharmacy Unit, 9372IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Lucia Viganò
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberta Locatelli
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Maria Fazio
- Pharmacy Unit, 9372IRCCS San Raffaele Hospital, Milan, Italy
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Baratto C, Caravita S, Crotti L, Villella F, Rella V, Cecchi F, Badano L, Parati G, Perego G. P232 EXERTIONAL BREATHLESSNESS IN HYPERTROPHIC CARDIOMYOPATHY: OBSTRUCTION–INDEPENDENT SYMPTOMS IN A “PARADOXICAL” RESPONSE TO EXERCISE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A 66–y.o. man with hypertrophic cardiomyopathy presented with residual exertional dyspnea NYHA III a few years after surgical myectomy, mitral valve repair and ICD implantation. Echocardiography showed residual mild septal hypertrophy and mitral regurgitation (MR), and a variable obstruction of left ventricular outflow tract (LVOT), witnessed by a pressure gradient ranging from 15 to 50–70 mmHg (Figure 1). Exercise echocardiography did not suggest exercise–induced LVOT obstruction (LVOTO) or functional MR. We thus performed a thorough invasive hemodynamic evaluation at rest and during exercise. LVOTO was present at rest, with a maximum pressure gradient of 90–100 mmHg and typical “spike–and–dome” configuration of the aortic pulse contour (Figure 2), with LV end–diastolic pressure (LVEDP) at the upper limit of normal (15 mmHg) and normal pulmonary hemodynamics. During exercise, we observed a paradoxical reduction of the LVOTO (30–40 mmHg at peak, Figure 2). Pulmonary hypertension developed during exercise, due to LV diastolic dysfunction, witnessed by a marked increase in pulmonary artery wedge pressure and LVEDP (up to 25 mmHg and 30 mmHg at peak, respectively). Cardiac output (CO) reserve was at the lower limits of normal, mainly due to chronotropic incompetence, responsible for a mildly reduced exercise capacity (peak oxygen consumption was 20 mL/Kg/min, 75% of predicted). Thus, cardiac catheterization confirmed the presence of a relevant LVOTO at rest, that was not directly related to exertional symptoms. These latter were mainly attributable to LV diastolic dysfunction and reduced CO reserve. These findings helped us driving treatment decision in a tailored way: beta–blockers were not uptitrated, because of their negative inotropic effect, and high–risk septal reduction therapies were excluded, since exertional symptoms were unrelated to LVOTO. However, an attempt to reduce LVOTO was done by DDD sequential pacing through the ICD. Pacing could induce mechanical dyssynchrony and reduce LVOTO by increasing the end–systolic LVOT diameter. The simultaneous echocardiographic monitoring highlighted an acute reduction of LVOT gradient from 50–70 mmHg to 20–30 mmHg (Figure 3).
This case suggests that, in well–selected cases, patients’ management based on pathophysiological reasoning may help to define the etiopathogenetic mechanism underlying symptoms, and to drive treatment decision in a patient–centered way.
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Affiliation(s)
- C Baratto
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - S Caravita
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - L Crotti
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - F Villella
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - V Rella
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - F Cecchi
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - L Badano
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - G Parati
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - G Perego
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
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Baratto C, Caravita S, Dewachter C, Faini A, Villella F, Perego G, Muraru D, Badano L, Parati G, Vachiéry J. P284 THE RIGHT HEART ADAPTATS TO EXERCISE MORE EFFICIENTLY IN PULMONARY ARTERIAL HYPERTENSION THAN IN PULMONARY HYPERTENSION DUE TO HEART FAILURE WITH PRESERVED EJECTION FRACTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Right heart failure (RHF) represents the final step of distinct diseases, differently involving the pulmonary circulation, such as pulmonary arterial hypertension (PAH) and pulmonary hypertension (PH) due to heart failure with preserved ejection fraction (HFpEF). Exercise may unmask right heart maladaptation as a sign of RHF, but cut–offs for right atrial pressure (RAP) rise during exercise remain to be defined. We hypothesized that PH–HFpEF may present with worse right heart adaptation to exercise than PAH due to increased chamber stiffness and dysfunctional preload.
Aim
We sought to describe the behavior of RAP during exercise in PAH and in PH–HFpEF, and the mechanisms underlying right heart maladaptation.
Methods
We performed a retrospective analysis of data (2007–2021) obtained from patients with either PAH or PH–HFpEF who underwent a right heart catheterization at rest and during exercise. Right heart adaptation to exercise was described using either absolute or cardiac output (CO)–normalized RAP increase during exercise (RAP/CO slope). Patients with non–cardiac dyspnea (NCD) served to define RAP limits of normality. Estimated stressed blood volume (eSBV), as a measure of effective preload, was computed based on hemodynamics using a commercially–available software.
Results
Ninety–four patients were included (32 PH–HFpEF, 32 PAH and 30 NCD). The upper limit of normal for absolute peak RAP and RAP/CO slope were 12 mmHg and 1.55 mmHg/L/min. Compared with PH–HFpEF, PAH patients showed higher systolic, diastolic and mean pulmonary artery pressure (PAP) as well as higher indices of right ventricular afterload both at rest and during exercise, but lower filling pressures and similar CO (Figure 1).In particular, PH–HFpEF had higher peak RAP and higher RAP/CO slope than PAH (Figure 1,2). Additionally, 78% and 91% of PH–HFpEF, as compared with 47% and 44% of PAH had a RAP/CO slope and a peak RAP above normal, respectively (p < 0.001). PH–HFpEF presented with higher increase in eSBV, and higher peak eSBV values than PAH (p < 0.05), despite similar resting levels. RAP/eSBV slope was upward shifted (at a given effective preload, RAP was higher) while CO/eSBV slope was flatter (at a given effective preload, CO was lower) in PH–HFpEF as compared with PAH (Figure 3).
Conclusions
PH–HFpEF display worse right heart maladaptation to exercise than PAH, likely due to a combination of increased right heart stiffness and a more exhausted Frank–Starling reserve.
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Affiliation(s)
- C Baratto
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CUB – HÔPITAL ERASME, BRUXELLES
| | - S Caravita
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CUB – HÔPITAL ERASME, BRUXELLES
| | - C Dewachter
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CUB – HÔPITAL ERASME, BRUXELLES
| | - A Faini
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CUB – HÔPITAL ERASME, BRUXELLES
| | - F Villella
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CUB – HÔPITAL ERASME, BRUXELLES
| | - G Perego
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CUB – HÔPITAL ERASME, BRUXELLES
| | - D Muraru
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CUB – HÔPITAL ERASME, BRUXELLES
| | - L Badano
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CUB – HÔPITAL ERASME, BRUXELLES
| | - G Parati
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CUB – HÔPITAL ERASME, BRUXELLES
| | - J Vachiéry
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CUB – HÔPITAL ERASME, BRUXELLES
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Caravita S, Baratto C, Curti E, Villella F, Sganzerla P, Perego G, Badano L, Muraru D, Parati G. P245 A RARE CAUSE OF OVERESTIMATION OF PULMONARY PRESSURE BY ECHOCARDIOGRAPHY: WHEN HEMODYNAMICS RELIEVES ECHOCARDIOGRAPHY AND ECHOCARDIOGRAPHY EXPLAINS HEMODYNAMICS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Echocardiography is the gatekeeper of the diagnostic workflow of pulmonary hypertension (PH). However, it lacks precision, and right heart catheterization (RHC) may be needed in selected cases. A morbidly obese 47–year–old woman (BMI= 58 Kg/m2) with dyspnea NYHA II was referred to our Center after a high probability of PH was found at echocardiography, this latter performed as a routine assessment before bariatric surgery. Despite a suboptimal acoustic window, the tricuspid regurgitant jet profile was well–defined, with an estimated systolic pulmonary artery pressure (PAP) of 100 mmHg. There were no overt echocardiographic signs of left heart disease. During RHC, mean PAP was just above normal values, with filling pressures at the upper limit of normal (Figure 1), high cardiac index (3.6 L/min/m2) and normal pulmonary vascular resistance (1.4 WU). The echocardiographic estimate of high systolic PAP was explained by an intraventricular RV pressure gradient of about 100 mmHg (Figure 2). Oximetry ruled out a significant intracardiac shunt. Since resting hemodynamics did not explain the patient’s symptoms, the patient pre–test probability of having heart failure with preserved ejection fraction (HFpEF) was intermediate–high, and PAWP was in a grey–zone. Accordingly, we performed an exercise RHC. The test eventually unmasked HFpEF, as witnessed by an abnormal increase of PAWP and LV end–diastolic pressure (Figure 1 panel C and D). Exercise capacity was mildly reduced (71% of predicted) due to peripheral limitation with normal cardiac and respiratory reserves. Transesophageal echocardiography was then performed. It showed a muscular obstruction below the infundibulum dividing the RV into a high–pressure apical portion and a low–pressure infundibulum (Figure 3). This rare congenital anomaly was also associated with a restrictive perimembranous ventricular septal defect. Double–chambered RV has been reported to present rarely in adults, but it might be a cause of false Doppler echocardiographic estimate of PAP. Based on a meticulous invasive hemodynamic characterization at rest and during exercise, integrated with cardiovascular imaging, we could perform such a diagnosis. This congenital anomaly did not fully explain the patient’s symptoms, which may better be attributed to cardiovascular complication of obesity (HFpEF). Accordingly, we referred the patient for bariatric surgery first, postponing the indication to cardiac surgery during the follow–up.
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Affiliation(s)
- S Caravita
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - C Baratto
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - E Curti
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - F Villella
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - P Sganzerla
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - G Perego
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - L Badano
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - D Muraru
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
| | - G Parati
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO
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Baratto C, Caravita S, Villella F, Sganzerla P, Perego G, Badano L, Parati G. P283 PROGRESSION OF PULMONARY ARTERIAL HYPERTENSION OR LEFT HEART DISEASE? DO EXERCISE! Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
An 80–year–old man, diagnosed with idiopathic pulmonary arterial hypertension (PAH) in 2012 and treated with sildenafil, experienced his first hospitalization for heart failure in June 2019. He had several cardiovascular risk factors (overweight, hypertension, diabetes) and comorbidities (ischemic heart disease, and mild chronic obstructive pulmonary disease), whose progression was excluded. Since this event, he complained a progressive deterioration of the exertional dyspnea (NYHA III), with overt signs of fluid overload, right chambers dilation and high NTproBNP (1366 ng/L). However, the center taking care of this patient neither decided to fully re–evaluate him nor to escalate PAH–treatment due to his clinical profile (high suspicion of left heart disease, LHD). He then came to our pulmonary hypertension (PH) center where we decided to perform a cardiac catheterization, which showed the persistence of precapillary PH with high pulmonary vascular resistance, PVR (7.6 WU), low cardiac output, CO (2.2 L/min/m2), high right atrial pressure, RAP (12 mmHg). Pulmonary artery wedge pressure (PAWP) and left ventricular end–diastolic pressure (LVEDP) were at the upper limits of normal (13 mmHg and 16 mmHg, respectively) (Figure 1). Based on these “borderline” PAWP values, with an intermediate–high pre–test probability of left heart disease, we performed an exercise test with concomitant gas–exchange analysis on a cycle ergometer in the cath lab (Figure 2). Exercise induced a steep increase in pulmonary pressure (TPR 9 WU), unrelated to an exaggerate increase in PAWP or LVEDP (whose peak values reached 20 mmHg, with a PAWP/CO slope <2 mmHg/L/min), but entirely dependent on the precapillary component. Transpulmonary gradient (TPG)/CO slope was high, leading to an absent reduction in PVR (6.4 WU at peak), associated to severe increase in RAP (27 mmHg at peak, RAP/PAWP 1.4) (Figure 3). CO reserve was reduced (at peak 3.4 L/min/m2), due to both reduced increase in stroke volume and chronotropic incompetence. Accordingly, functional capacity was moderately–severely reduced (peak oxygen consumption was 8 ml/kg/min, 39% of predicted), with exercise hyperventilation. Once excluded LHD as the responsible of clinical worsening, and in consideration of the high–intermediate risk profile of this patient, we upgraded the PAH–specific therapy by adding macitentan, obtaining a subjective clinical improvement and a 3–years period of clinical stability.
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Affiliation(s)
- C Baratto
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO
| | - S Caravita
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO
| | - F Villella
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO
| | - P Sganzerla
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO
| | - G Perego
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO
| | - L Badano
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO
| | - G Parati
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO
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Caravita S, Baratto C, Ghiso P, Torlasco C, Senni M, Sganzerla P, Perego G, Badano L, Parati G. P296 HIDDEN PERICARDIAL CONSTRICTION IN A PATIENT WITH CHRONIC PERICARDIAL EFFUSION AND “UNEXPLAINED” DYSPNEA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Constrictive physiology leads to exertional symptoms related to restrained diastolic filling and intracardiac/intrathoracic dissociation. However, these hemodynamic abnormalities might not be evident in some patients. A 55–year–old woman was referred to our center to perform a right and left cardiac catheterization because of “unexplained” dyspnea. Three years before she was found to have a large idiopathic pericardial effusion. Anti–inflammatory therapy did not result in any improvement. Since then, the patient complained dyspnea NYHA II–III, in the absence of any clinical and imaging sign of tamponade/pericardial constriction. At rest, there was no sign of constriction, but a relative hypovolemic status characterized by low pulmonary and filling pressures and cardiac output (CO) at the lower limits of normal. After a 500 mL saline load and passive legs raising, Kussmaul’s and “M” signs appeared on the right atrial pressure curve (Figure 1), the pulmonary artery wedge pressure (PAWP) – left ventricular end–diastolic pressure (LVEDP) gradient difference between expiration and inspiration was >5 mmHg (Figure 2), and ventricular systolic pressures went out of phase by 180°. Both right and left filling pressures as well as pulmonary pressures steeply increased in a concordant manner by about 10 mmHg after fluid load, in absence of a relevant increase in CO (Figure 3). Physical exercise performed thereafter showed an additional mild increase with a plateau pattern of all pressures, suggesting an upward–shift of the pressure/flow relationship (Figure 3). All these signs suggested a latent constrictive physiology. Despite this, the patient showed an optimal CO reserve coupled with a normal exercise capacity (peak oxygen consumption, VO2, 127% of predicted) that would have argued against our hypothesis. We then performed a diagnostic and evacuative pericardiocentesis. After the drainage of 130 ml of pericardial fluid, LV transmural pressure increased and CO at rest was fully normalized. Moreover, no hemodynamic sign of constriction could be observed even after a 1000 ml saline load. The patient reported disappearance of exertional breathlessness, objectivated by an increase in peakVO2 by 20% as compared with the previous test. Thus, our case underscores how subtle the hemodynamic impact of pericardial effusion can be, with the need of well–tailored diagnostic exams to explain otherwise “unexplained” patients’ symptoms, with potential therapeutic implications.
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Affiliation(s)
- S Caravita
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CARDIOVASCULAR DEPARTMENT, ASST PAPA GIOVANNI XXIII, BERGAMO
| | - C Baratto
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CARDIOVASCULAR DEPARTMENT, ASST PAPA GIOVANNI XXIII, BERGAMO
| | - P Ghiso
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CARDIOVASCULAR DEPARTMENT, ASST PAPA GIOVANNI XXIII, BERGAMO
| | - C Torlasco
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CARDIOVASCULAR DEPARTMENT, ASST PAPA GIOVANNI XXIII, BERGAMO
| | - M Senni
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CARDIOVASCULAR DEPARTMENT, ASST PAPA GIOVANNI XXIII, BERGAMO
| | - P Sganzerla
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CARDIOVASCULAR DEPARTMENT, ASST PAPA GIOVANNI XXIII, BERGAMO
| | - G Perego
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CARDIOVASCULAR DEPARTMENT, ASST PAPA GIOVANNI XXIII, BERGAMO
| | - L Badano
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CARDIOVASCULAR DEPARTMENT, ASST PAPA GIOVANNI XXIII, BERGAMO
| | - G Parati
- IRCCS ISTITUTO AUXOLOGICO ITALIANO, UNIVERSITÀ DI BERGAMO, MILANO; IRCCS ISTITUTO AUXOLOGICO ITALIANO, MILANO; CARDIOVASCULAR DEPARTMENT, ASST PAPA GIOVANNI XXIII, BERGAMO
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Parati MC, Pedersini R, Perego G, Reduzzi R, Savio T, Cabiddu M, Borgonovo K, Ghilardi M, Luciani A, Petrelli F. Ribociclib in the Treatment of Hormone-Receptor Positive/HER2-Negative Advanced and Early Breast Cancer: Overview of Clinical Data and Patients Selection. BCTT 2022; 14:101-111. [PMID: 35440873 PMCID: PMC9013420 DOI: 10.2147/bctt.s341857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022]
Abstract
Among pre- and postmenopausal women with hormone receptor-positive (HR+) breast cancer (BC), combinations of an aromatase inhibitor (AI) or fulvestrant with a CDK 4/6 inhibitor (palbociclib, ribociclib, or abemaciclib) have demonstrated improved progression-free survival (PFS) and overall survival (OS) compared to standard single-agent hormone therapy alone as first-line therapy for de novo metastatic disease or relapse during or after adjuvant therapy and no previous therapies in an advanced setting. We here reviewed clinical data about ribociclib in advanced and early BC. Also, we shed light on patient selection and special settings in which medical oncologists urgently await an advance in treatment. Ribociclib was FDA-approved in combination with letrozole based on a Phase III study in which 668 postmenopausal women with HR+, HER2-negative recurrent or metastatic BC were treated with first-line letrozole with or without ribociclib. For patients with metastatic disease at presentation or after a course of AIs, the results of the MONALEESA-3 trial suggest ribociclib’s efficacy in combination with fulvestrant, and this combination is FDA-approved for initial- and subsequent-line endocrine therapy for postmenopausal women with metastatic hormone receptor-positive, HER2-negative BC. In adjuvant and neoadjuvant settings, the use of CDK 4/6 inhibitors may be useful to boost outcomes in high-risk patients with HR+ BC, but data contrast with those of a phase III study, which produced positive results. New combinations are being explored in upfront disease (neoadjuvant) or in association with other targeted agents in metastatic disease. Compared to other CDK 4/6 available, ribociclib has a higher incidence of liver function test abnormalities than the other agents and can cause QTc prolongation, and therefore may be prudently avoided in patients with cardiac morbidities or other risk factors for QTc prolongation (drugs, interactions). In these cases, different agents (palbociclib or abemaciclib) may be used. In conclusion, ribociclib with letrozole or with fulvestrant is effective for the entire spectrum of patients with HR+ BC in the advanced setting. Ribociclib has all the characteristics of an innovative drug able to change the clinical practice and most BC patients’ prognoses.
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Affiliation(s)
- Maria Chiara Parati
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | | | | | | - Tommaso Savio
- Breast Unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Mary Cabiddu
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Karen Borgonovo
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Mara Ghilardi
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Andrea Luciani
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Fausto Petrelli
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Treviglio, BG, Italy
- Correspondence: Fausto Petrelli, Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, Treviglio, 24047, BG, Italy, Tel +390363424420, Fax +390363424380, Email
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Petrelli F, Cabiddu M, Borgonovo K, Parati MC, Ghilardi M, Perego G, Luciani A. Osimertinib-related venous thromboembolism in non small lung cancer. Thromb Res 2021; 210:63-66. [PMID: 35007938 DOI: 10.1016/j.thromres.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/13/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | - Mary Cabiddu
- Oncology Unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | | | | - Mara Ghilardi
- Oncology Unit, ASST Bergamo Ovest, Treviglio, BG, Italy
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11
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Perego G, Ghidini A, Luciani A, Petrelli F. Antibody-drug conjugates in treating older patients suffering from cancer: what is the real value? Hum Vaccin Immunother 2021; 17:5575-5578. [PMID: 34856865 DOI: 10.1080/21645515.2021.1999711] [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: 10/19/2022] Open
Abstract
Immunotherapeutic drugs and target therapies have represented an epochal change in treating cancer patients. They represent an attractive option in oncologists' armamentarium, particularly if we consider the optimal balance between efficacy and toxicity. As a step forward, immuno- and target-therapies have merged intending to improve efficacy: antibody-drug conjugates ensure the perfect combination. They allow the delivery of large amounts of drugs to the target with a limited 'off-target' effect and a low rate of adverse events. These aspects could make immunoconjugates palatable as the first choice for fragile patients, but solid evidence does not exist on the use of these drugs in this population type, especially older people.
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12
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Petrelli F, Perego G, Vavassori I, Luciani A. Neoadjuvant or adjuvant immunotherapy in bladder cancer: biological opportunity or clinical utility? Tumori 2021; 108:510-511. [PMID: 34806495 DOI: 10.1177/03008916211061604] [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: 11/15/2022]
Abstract
In urothelial cancer of the bladder, the introduction of immunotherapy with immune checkpoint inhibitors represents progress in the management of the disease's early and advanced stages. In particular, recent studies have implemented these drugs in the neoadjuvant and adjuvant phases to treat muscle-invasive bladder cancer. In some studies, patients received neoadjuvant immune checkpoint inhibitors alone (PURE and ABACUS) to treat muscle invasive bladder cancer, whereas other studies provided this therapy to cisplatin-ineligible patients. Furthermore, a large Phase III study (CheckMate 247) compared placebo with adjuvant nivolumab therapy in patients with high-risk urothelial cancer after neoadjuvant chemotherapy and surgery or surgery alone. Despite some uncertain niches (nonbladder, PD-L1-negative tumors, and node-negative resected cancers), certain biological opportunities (exploring new targets, evaluating in vivo pathologic response, focusing on biomarkers for response) and clinical uses (avoiding chemotherapy at all or in frail patients, attaining similar pathologic complete response rates as in cisplatin-based chemotherapy) are valid reasons for incorporating these agents into the therapeutic armamentarium of medical uro-oncologists.
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Affiliation(s)
| | | | | | - Andrea Luciani
- Oncology Unit, ASST Bergamo Ovest, Treviglio (BG), Italy
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13
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Petrelli F, Consoli F, Ghidini A, Perego G, Luciani A, Mercurio P, Berruti A, Grisanti S. Efficacy of Immune Checkpoint Inhibitors in Rare Tumours: A Systematic Review. Front Immunol 2021; 12:720748. [PMID: 34616395 PMCID: PMC8488393 DOI: 10.3389/fimmu.2021.720748] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background Rare cancers, as defined by the European Union, occur in fewer than 15 out of 100,000 people each year. The International Rare Cancer Consortium defines rare cancer incidence as less than six per 100,000 per year. There is a growing number of reports of the efficacy of immune checkpoint inhibitor (ICI) therapy in patients with rare tumours, and hence, we conducted a comprehensive review to summarise and analyse the available literature. Methods A literature search of PubMed was performed on January 31, 2021, using the following ICI names as keywords: ipilimumab, tremelimumab, cemiplimab, nivolumab, pembrolizumab, avelumab, atezolizumab, and durvalumab. Studies on patients with rare tumours who were being treated with ICIs were included. We plotted the overall response rate against the corresponding median survival across a variety of cancer types using linear regression. Results From 1,255 publications retrieved during the primary search, 62 publications were selected (with a total of 4,620 patients). Only four were randomised trials. A minority were first-line studies, while the remaining were studies in which ICIs were delivered as salvage therapy in pretreated patients. There was a good correlation between response rate and overall survival (Spearman R2 >0.9) in skin cancers, mesothelioma, and sarcomas. Conclusions Treatment of advanced-stage rare tumours with ICI therapy was found to be associated with significant activity in some orphan diseases (e.g., Merkel cell carcinoma) and hepatocellular carcinoma. Several ongoing prospective clinical trials will expand the knowledge on the safety and efficacy of ICI therapy in patients with these rare cancers.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Ovest, Treviglio, Italy
| | - Francesca Consoli
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
| | | | | | - Andrea Luciani
- Oncology Unit, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Ovest, Treviglio, Italy
| | - Paola Mercurio
- Pathology Unit, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Ovest, Treviglio, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
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Perego G, Longobardo G, Veneziano C, Farina F, Marcatti M. Not only a time-saving approach: Is it the time of subcutaneous formulation for daratumumab administration? J Oncol Pharm Pract 2021; 27:1751-1752. [PMID: 34378463 DOI: 10.1177/10781552211037974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Francesca Farina
- Hematology and Bone Marrow Transplantation Unit, 9372IRCCS San Raffaele Hospital, Italy
| | - Magda Marcatti
- Hematology and Bone Marrow Transplantation Unit, 9372IRCCS San Raffaele Hospital, Italy
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15
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Petrelli F, Luciani A, Perego G, Dognini G, Colombelli PL, Ghidini A. Therapeutic and prognostic role of vitamin D for COVID-19 infection: A systematic review and meta-analysis of 43 observational studies. J Steroid Biochem Mol Biol 2021; 211:105883. [PMID: 33775818 PMCID: PMC7997262 DOI: 10.1016/j.jsbmb.2021.105883] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/01/2022]
Abstract
Vitamin D modulates the systemic inflammatory response through interaction with immune system. As such, it has a possible protective role against the risk of respiratory tract infections and other diseases. It may be useful in particular, during COVID-19 pandemic. PubMed, the Cochrane Library, and EMBASE were searched from inception until January 31, 2021, for observational or clinical studies reporting the prognosis (and therapeutic effect) of COVID-19 infection in patients with deficient vitamin D levels. The infection rate, severity, and death from COVID-19 infection were pooled to provide an odds ratio with a 95 % confidence interval (OR 95 % CI). An OR > 1 was associated with the worst outcome in deficient compared with nondeficient patients. We assessed the association between vitamin D and risk, severity, and mortality for COVID-19 infection, through a review of 43 observational studies. Among subjects with deficient vitamin D values, risk of COVID-19 infection was higher compared to those with replete values (OR = 1.26; 95 % CI, 1.19-1.34; P < .01). Vitamin D deficiency was also associated with worse severity and higher mortality than in nondeficient patients (OR = 2.6; 95 % CI, 1.84-3.67; P < .01 and OR = 1.22; 95 % CI, 1.04-1.43; P < .01, respectively). Reduced vitamin D values resulted in a higher infection risk, mortality and severity COVID-19 infection. Supplementation may be considered as preventive and therapeutic measure.
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16
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Petrelli F, Ghidini A, Cabiddu M, Perego G, Lonati V, Ghidini M, Oggionni E, Galli E, Moleri G, Barni S, Bossi AC, Colombelli PL, Dognini G, Sganzerla P. Effects of hypertension on cancer survival: A meta-analysis. Eur J Clin Invest 2021; 51:e13493. [PMID: 33470426 DOI: 10.1111/eci.13493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/17/2020] [Revised: 01/03/2021] [Accepted: 01/16/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hypertension is usually associated with increased cardiovascular mortality. Uncertainty exists about the possible role of hypertension as a poor prognostic factor for cancer-specific mortality (CSM). To assess the association between pre-existing hypertension and the risk of mortality and relapse after a diagnosis of cancer, we performed a systematic review and meta-analysis of published studies. METHODS PubMed, Scopus, Web of Science, the Cochrane Library and EMBASE were searched from inception until May 2020, without language restrictions, for observational studies reporting the prognosis of patients with hypertension and cancer. The primary outcome of the study refers to CSM in hypertensive vs nonhypertensive patients, and secondary endpoints were overall mortality (OM) and progression- or relapse-free survival. The effect size was reported as hazard ratios (HRs) with 95% CIs. RESULTS Mortality and relapse associated with hypertension in patients with various cancers were evaluated among 1 603 437 participants (n = 66 studies). Overall, diagnosis of cancer and hypertension was associated with an increased independent risk of OM (HR = 1.2 [95% CI, 1.13-1.27], P < .01) and CSM (HR = 1.12 [95% CI, 1.04-1.21], P < .01) but not of relapse (HR = 1.08 [95% CI, 0.98-1.19], P = .14). CONCLUSIONS Among cancer patients, those with pre-existing hypertension have a poorer outcome, probably due to multifactorial reasons. Adequate control of lifestyle, more intensive follow-ups, monitoring for hypertension- and anticancer-related cardiovascular complications, and establishing multidisciplinary cardio-oncology units can be useful measures for reducing mortality and improving care in this setting.
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Affiliation(s)
| | | | - Mary Cabiddu
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | | | | | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Emilio Galli
- Nephrology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Giovanna Moleri
- Direzione Socio-Sanitaria, Centro Servizi, ASST Bergamo Ovest, Treviglio, Italy
| | - Sandro Barni
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Antonio Carlo Bossi
- Endocrine Diseases Unit-Diabetes regional center, ASST Bergamo Ovest, Treviglio, Italy
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Petrelli F, Cherri S, Ghidini M, Perego G, Ghidini A, Zaniboni A. Tocilizumab as treatment for COVID-19: A systematic review and meta-analysis. World J Methodol 2021; 11:95-109. [PMID: 34026583 PMCID: PMC8127418 DOI: 10.5662/wjm.v11.i3.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/01/2020] [Revised: 12/02/2020] [Accepted: 03/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The majority of patients with coronavirus disease 2019 (COVID-19) have good prognoses, but some develop a critical illness that can lead to death. Evidence shows severe acute respiratory syndrome is closely related to the induced cytokine storm. Interleukin-6 is a key player; its role in systemic inflammation is well known. AIM To evaluate the effect of tocilizumab (TCZ), an interleukin-6 receptor antagonist, on the outcomes for patients with COVID-19 pneumonia. METHODS PubMed, EMBASE, SCOPUS, Web of Science, MedRxiv, Science Direct, and the Cochrane Library were searched from inception to 9th June 2020 for observational or prospective studies reporting results of hospitalized adult patients with COVID-19 infection treated with TCZ. Effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CIs), and an OR less than 1 was associated with a better outcome in those treated with TCZ. RESULTS Overall 13476 patients (33 studies; n = 3264 received TCZ) with COVID-19 pneumonia and various degree of severity were included. Outcome was improved with TCZ. In the primary analysis (n = 19 studies reporting data), mortality was reduced in patients treated with TCZ (OR = 0.64, 95%CI: 0.47-0.87; P < 0.01). In 9 studies where risk of death with TCZ use was controlled for other variables mortality was reduced by 57% (OR = 0.43, 95%CI: 0.27-0.7; P < 0.01). Intensive care need (mechanical ventilation) was also reduced (OR = 0.36, 95%CI: 0.14-0.89; P = 0.02). CONCLUSION In COVID-19-infected patients treated with TCZ, outcome may be improved compared to those not treated with TCZ.
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Affiliation(s)
| | - Sara Cherri
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Antonio Ghidini
- Department of Medicine, Casa di Cura Igea, Milano 20100, Italy
| | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
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Perego G, Burgio V, Nozza R, Longobardo G, Bernecich M, Luciani A, Petrelli F. Is there any place for novel agents in treating biliary tract cancer? Med Oncol 2021; 38:19. [PMID: 33543377 DOI: 10.1007/s12032-021-01463-4] [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: 12/07/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
Biliary tract cancer is an uncommon cancer in developed countries. In localized stages, surgery is the cornerstone of treatment with curative purpose. Conversely in advanced stages, chemotherapy with platinum-gemcitabine combination is the standard of care. Biliary tract cancers are a biologically heterogeneous group of malignancies, which perhaps explains the failure of targeted therapies in unselected patient populations to demonstrate benefit in advanced disease, although there are promises in selected populations (e.g. PD1/PD-L1 positive, BRAFV600E-mutated or IDH1-mutant). In view of the limited benefit of second line therapies in metastatic biliary tract cancer, various targeted agents have been tested in progressive disease. Furthermore, several ongoing trials are using next-generation sequencing of multiple genes to identify molecular abnormalities in the tumors of patients with refractory cancers that may potentially be used in pretreated disease (e.g. FGFR or IDH genes). Immunotherapy with immune checkpoint inhibitors may be interesting for patients whose tumors have programmed cell death 1 ligand 1 (PD-L1) overexpression. Ongoing and future trials will further advance our knowledge toward the optimal treatment strategy for the management of biliary tract cancer in its different stages, starting from metastatic and then reaching early stages of disease. We here provided an overview of these novel treatment strategies for advanced biliary tract cancers not amenable of curative treatment modalities.
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Affiliation(s)
| | | | - Renata Nozza
- School of Hospital Pharmacy, University of Milan, Milan, Italy
| | | | - Marco Bernecich
- School of Hospital Pharmacy, University of Milan, Milan, Italy
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Perego G, Petrelli F. Surrogate endpoints for new anti-cancer drugs approvals: Are we follow the right way? J Oncol Pharm Pract 2020; 27:448-449. [PMID: 33375904 DOI: 10.1177/1078155220984834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Petrelli F, Damato A, Perego G, Ghidini A, Daniele G, Pinto C. Past, present and future use of cytotoxic agents in oncology practice: A systematic review of Pubmed and ClinicalTrials.gov databases. J Oncol Pharm Pract 2020; 26:2069-2072. [DOI: 10.1177/1078155220951237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Angela Damato
- Oncology Unit, Azienda Unita’ Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Gennaro Daniele
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italia
| | - Carmine Pinto
- Oncology Unit, Azienda Unita’ Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy
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Petrelli F, Bukovec R, Perego G, Luisa R, Luciani A, Zaniboni A, Ghidini A. Association of steroid use with survival in solid tumours. Eur J Cancer 2020; 141:105-114. [PMID: 33130548 DOI: 10.1016/j.ejca.2020.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Steroids are commonly used in patients with solid tumours for supportive therapy. In other cases, they are an essential part of cancer treatment such as prostate cancer. Some preclinical observations lead to the notion that glucocorticoids may modulate growth factors' pathways and may induce the progression of cancers. Glucocorticoids are associated with several side-effects on many organ systems (e.g. serious infections, diabetes, sepsis and thrombosis). We have performed a systematic review and meta-analysis to evaluate the outcome of cancer patients that assume or not steroids. METHODS Published articles that evaluated survival associated with steroids use in cancer patients from inception to June 2020 were identified by searching the PubMed, EMBASE and Cochrane Library databases. The primary outcome of interest was the risk of death, and the secondary end-point was the risk of progression in steroid versus non-steroid users. RESULTS Seventy-six studies were in quantitative synthesis for a total of 83,614 patients. Use of steroids was associated with a reduced survival (hazard ratios (HR) = 1.18, 95% confidence interval (CI): 1.1-1.26; P < .01). Progression-free survival was also decreased in steroid versus non-steroid users (HR = 1.13, 95% CI: 1.01-1.26; P = .03). In patients with lung cancer, advanced disease and supportive care indications were settings where the use of steroids increased the risk of death. CONCLUSIONS In patients with advanced cancers, use of steroids should be reduced and, at best, avoided because it may reduce survival, in particular, for patients with lung cancer and for palliative/supportive care purposes.
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Perego G, Gregis F, Rossi L, Mazzoleni M, Nozza S, Nozza R, Gatti VP. Continuous-infusion and outpatient setting: A chance for patients, a challenge for hospital pharmacists. J Oncol Pharm Pract 2020; 26:1715-1720. [PMID: 32594844 DOI: 10.1177/1078155220937389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/17/2022]
Abstract
The use of continuous-infusion in outpatient setting could be widely used in oncology and haematology care. Many times the lack of data stability about single drug or admixture of drugs, together with patient education and safety, make difficult the transition from inpatient to outpatient setting. Nowadays, this is a big challenge for hospital pharmacists, who must take into consideration the critical issues related to chemical and physical stability, besides microbiological one, in order to ensure high quality preparations and guarantee the safety and quality of care, to protect patients and their health. The aim of this article is to highlight the critical issues concerning the transition from inpatient to outpatient setting, with particular interest regarding chemotherapy protocols, which require preparation with long-term continuous-infusion.
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Affiliation(s)
- Gianluca Perego
- Pharmacy Unit, IRCCS San Raffaele Hospital, Milan, Italy.,School of Hospital Pharmacy, University of Milan, Milan, Italy
| | | | - Laura Rossi
- School of Hospital Pharmacy, University of Milan, Milan, Italy.,Pharmacy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Silvia Nozza
- Pharmacy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Renata Nozza
- School of Hospital Pharmacy, University of Milan, Milan, Italy
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23
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Petrelli F, Iaculli A, Signorelli D, Ghidini A, Dottorini L, Perego G, Ghidini M, Zaniboni A, Gori S, Inno A. Survival of Patients Treated with Antibiotics and Immunotherapy for Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9051458. [PMID: 32414103 PMCID: PMC7290584 DOI: 10.3390/jcm9051458] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/03/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
Abstract
Antibiotics (ABs) are common medications used for treating infections. In cancer patients treated with immune checkpoint inhibitors (ICIs), concomitant exposure to ABs may impair the efficacy of ICIs and lead to a poorer outcome compared to AB non-users. We report here the results of a meta-analysis evaluating the effects of ABs on the outcome of patients with solid tumours treated with ICIs. PubMed, the Cochrane Library and Embase were searched from inception until September 2019 for observational or prospective studies reporting the prognoses of adult patients with cancer treated with ICIs and with or without ABs. Overall survival (OS) was the primary endpoint, and progression-free survival (PFS) was the secondary endpoint. The effect size was reported as hazard ratios (HRs) with a 95% confidence interval (CI) and an HR > 1 associated with a worse outcome in ABs users compared to AB non-users. Fifteen publications were retrieved for a total of 2363 patients. In the main analysis (n = 15 studies reporting data), OS was reduced in patients exposed to ABs before or during treatment with ICIs (HR = 2.07, 95%CI 1.51–2.84; p < 0.01). Similarly, PFS was inferior in AB users in n = 13 studies with data available (HR = 1.53, 95%CI 1.22–1.93; p < 0.01). In cancer patients treated with ICIs, AB use significantly reduced OS and PFS. Short duration/course of ABs may be considered in clinical situations in which they are strictly needed.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio, Italy
- Correspondence:
| | - Alessandro Iaculli
- Oncology Unit, ASST Bergamo Est, 24068 Alzano Lombardo, Italy; (A.I.); (L.D.)
| | - Diego Signorelli
- Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, 20133 Milano, Italy;
| | | | - Lorenzo Dottorini
- Oncology Unit, ASST Bergamo Est, 24068 Alzano Lombardo, Italy; (A.I.); (L.D.)
| | - Gianluca Perego
- Pharmacy Unit, IRCCS San Raffaele Hospital, 20132 Milano, Italy;
| | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy;
| | | | - Stefania Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, 37024 Verona, Italy; (S.G.); (A.I.)
| | - Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, 37024 Verona, Italy; (S.G.); (A.I.)
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Petrelli F, Perego G, Ghidini A, Ghidini M, Borgonovo K, Scolari C, Nozza R, Rampulla V, Costanzo A, Varricchio A, Rausa E, Pietrantonio F, Zaniboni A. A systematic review of salvage therapies in refractory metastatic colorectal cancer. Int J Colorectal Dis 2020; 35:783-794. [PMID: 32219509 DOI: 10.1007/s00384-020-03571-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Established that the only approved agents in previously treated metastatic colorectal cancer (CRC) are trifluoridine/tipiracil and regorafenib, we conducted a systematic review of all the published phase 2-3 trials, with the scope to evaluate the benefit of any later-line regimens in refractory metastatic CRC. METHODS Phase 2-3 studies that enrolled patients with stage IV disease receiving salvage therapies for refractory CRC were identified using electronic databases (Pubmed, EMBASE, and Cochrane Library). Clinical outcomes were pooled using a point estimates for the weighted values of median overall survival (OS), progression-free survival (PFS), response rate (ORR), stable disease rate (SD), and 6-month and 1-year OS. RESULTS Overall, 7556 patients were included from 67 studies (n = 70 arms). Overall, the pooled ORR and SD were 15.4% (95% CI 13-18%) and 36.9% (95% CI 33.5-40.6%). Median PFS, 6-month and 1-year OS, and median OS were 3.2 (95% CI 2.9-3.3) months, 65.4% (95% CI 61.9-68.8%), 36% (95% CI 32.3-39.9%) and 8.8 (95% CI 8.3-9.2) months. Overall survival was different in the monochemotherapy, polychemotherapy, chemotherapy + targeted therapy, and targeted therapy alone arms (7.6, 9.5, 10.3, and 7.9 months, respectively, P for difference = 0.01). Median PFS were respectively 2.3, 3.9, 3.8, and 2.6, respectively (P for difference < 0.01). CONCLUSIONS Overall, combination therapy (polychemotherapy with or without targeted agents) is associated with a higher control of disease and better outcome than approved agents. Treatment, if possible, should be personalized according to the patients' conditions, physician preference and molecular profile of disease.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
| | | | | | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Karen Borgonovo
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | | | - Renata Nozza
- Pharmacy Unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | | - Antonio Costanzo
- Surgical Oncology Unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | | | | - Filippo Pietrantonio
- Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
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Perego G, Nozza R, Oggionni E, Cabiddu M, Scolari C, Omati E, Castelli EA, Petrelli F. Pharmacological issues concerning olaparib capsule and tablet formulations in treating ovarian cancer: Are they really the same drug? J Oncol Pharm Pract 2020; 26:967-971. [DOI: 10.1177/1078155219900913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Olaparib is a first-in-class PARP inhibitor that has demonstrated efficacy as maintenance therapy in patients with ovarian cancer. It has been approved as a capsule formulation and after the publication of data from SOLO2 study became available also as tablet formulation. Due to different pharmacokinetic properties, these different formulations cannot be considered bioequivalent nor interchangeable. The tablet formulation has improved bioavailability, reducing pill burden and offering a more convenient dosage regimen. Furthermore, olaparib tablet formulation had a manageable tolerability profile if compared to capsule one, with most of adverse events of mild or moderate severity. Under this light, olaparib tablet formulation is a useful maintenance strategy for recurrent, platinum-sensitive ovarian cancer, providing a more convenient dosing option than the capsule formulation.
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Affiliation(s)
- Gianluca Perego
- Pharmacy Unit, Asst Bergamo Ovest, University of Milan, School of Hospital Pharmacy, Milano, Italy
| | - Renata Nozza
- Pharmacy Unit, Asst Bergamo Ovest, University of Milan, School of Hospital Pharmacy, Milano, Italy
| | - Emanuela Oggionni
- Pharmacy Unit, Asst Bergamo Ovest, University of Milan, School of Hospital Pharmacy, Milano, Italy
| | - Mary Cabiddu
- Oncology Unit, Asst Bergamo Ovest, Treviglio (BG), Italy
| | - Cinzia Scolari
- Pharmacy Unit, Asst Bergamo Ovest, University of Milan, School of Hospital Pharmacy, Milano, Italy
| | - Elena Omati
- Pharmacy Unit, Asst Bergamo Ovest, University of Milan, School of Hospital Pharmacy, Milano, Italy
| | - Emanuela A Castelli
- Pharmacy Unit, Asst Bergamo Ovest, University of Milan, School of Hospital Pharmacy, Milano, Italy
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Consoli F, Bersanelli M, Perego G, Grisanti S, Merelli B, Berruti A, Petrelli F. Network indirect comparison of 3 BRAF + MEK inhibitors for the treatment of advanced BRAF mutated melanoma. Clin Transl Oncol 2019; 22:900-907. [DOI: 10.1007/s12094-019-02207-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 09/13/2019] [Indexed: 12/19/2022]
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Petrelli F, Ghidini M, Ghidini A, Perego G, Cabiddu M, Khakoo S, Oggionni E, Abeni C, Hahne JC, Tomasello G, Zaniboni A. Use of Antibiotics and Risk of Cancer: A Systematic Review and Meta-Analysis of Observational Studies. Cancers (Basel) 2019; 11:cancers11081174. [PMID: 31416208 PMCID: PMC6721461 DOI: 10.3390/cancers11081174] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/10/2019] [Accepted: 08/11/2019] [Indexed: 12/19/2022] Open
Abstract
The association between antibiotic use and risk of cancer development is unclear, and clinical trials are lacking. We performed a systematic review and meta-analysis of observational studies to assess the association between antibiotic use and risk of cancer. PubMed, the Cochrane Library and EMBASE were searched from inception to 24 February 2019 for studies reporting antibiotic use and subsequent risk of cancer. We included observational studies of adult subjects with previous exposure to antibiotics and available information on incident cancer diagnoses. For each of the eligible studies, data were collected by three reviewers. Risk of cancer was pooled to provide an adjusted odds ratio (OR) with a 95% confidence interval (CI). The primary outcome was the risk of developing cancer in ever versus non-antibiotic users. Cancer risk’s association with antibiotic intake was evaluated among 7,947,270 participants (n = 25 studies). Overall, antibiotic use was an independent risk factor for cancer occurrence (OR 1.18, 95%CI 1.12–1.24, p < 0.001). The risk was especially increased for lung cancer (OR 1.29, 95%CI 1.03–1.61, p = 0.02), lymphomas (OR 1.31, 95%CI 1.13–1.51, p < 0.001), pancreatic cancer (OR 1.28, 95%CI 1.04–1.57, p = 0.019), renal cell carcinoma (OR 1.28, 95%CI 1.1–1.5, p = 0.001), and multiple myeloma (OR 1.36, 95%CI 1.18–1.56, p < 0.001). There is moderate evidence that excessive or prolonged use of antibiotics during a person’s life is associated with slight increased risk of various cancers. The message is potentially important for public health policies because minimizing improper antibiotic use within a program of antibiotic stewardship could also reduce cancer incidence.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, Oncology Department, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy.
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Antonio Ghidini
- Medical Oncology Unit, Casa di Cura Igea, 20129 Milan, Italy
| | - Gianluca Perego
- Pharmacy Unit, School of Hospital Pharmacy-University of Milan, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy
| | - Mary Cabiddu
- Oncology Unit, Oncology Department, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy
| | - Shelize Khakoo
- Department of Medicine, Royal Marsden Hospital, London and Surrey, Sutton SM2 5PT, UK
| | | | - Chiara Abeni
- Oncology Unit, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Jens Claus Hahne
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton, London SM2 5NG, UK
| | - Gianluca Tomasello
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
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Giardino R, Nicolialdini N, Perego G, Cella G, Maltarello M, Fini M, Rocca M, Giavaresi G. Biological and Synthetic Conduits in Peripheral Nerve Repair: A Comparative Experimental Study. Int J Artif Organs 2018. [DOI: 10.1177/039139889501800408] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Two different types of conduits, one biological, obtained with homologous glutaraldehyde preserved vein segments and the other synthetic bioabsorbable, made with Poly [L-lactide-co-6-caprolactone], were evaluated as guides for nerve repair in alternative to autologous grafts in an experimental animal model. Under general anesthetic, the ischiatic nerve of a number Wistar rats was transected to create a 1 cm gap, which was then repaired by means of the conduits or autologous grafts. Controls were performed at 1, 3 and 6 months; nerve regeneration was effective with both conduits, but the count of myelinated axons showed a significant difference between the synthetic and biological tubes (p<0.001). The Poly [L-lactide-co-6-caprolactone] guide was still intact 30 days after implant; progressive signs of degradation were present at 90 and 180 days. These results show that the synthetic conduits are better than those obtained with preserved vein segments and might be considered in alternative to autologous grafts in peripheral nerve reconstruction
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Affiliation(s)
- R. Giardino
- Experimental Surgery Unit, Codvilla Putti I.O.R. Research Institute, Bologna and Chair of Surgical Physiopathology, University of Bologna, Bologna
| | - N. Nicolialdini
- Experimental Surgery Unit, Codvilla Putti I.O.R. Research Institute, Bologna and Chair of Surgical Physiopathology, University of Bologna, Bologna
| | | | | | - M.C. Maltarello
- Cellular Biology and Electronic Microscopy Laboratories, Codvilla Putti I.O.R. Research Institute, Bologna
| | - M. Fini
- Experimental Surgery Unit, Codvilla Putti I.O.R. Research Institute, Bologna and Chair of Surgical Physiopathology, University of Bologna, Bologna
| | - M. Rocca
- Experimental Surgery Unit, Codvilla Putti I.O.R. Research Institute, Bologna and Chair of Surgical Physiopathology, University of Bologna, Bologna
| | - G. Giavaresi
- Experimental Surgery Unit, Codvilla Putti I.O.R. Research Institute, Bologna and Chair of Surgical Physiopathology, University of Bologna, Bologna
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Affiliation(s)
- M Trucco
- Headache Centre, Department of Neurology, Azienda Ospedaliera S. Corona, Pietra Ligure (SV) and Headache Centre, Department of Neurosciences, Padua University, Padua, Italy.
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torlasco C, Cecchi F, Schwartz PJ, Parati G, Crotti L, dagradi F, Bilo B, Perego G, Revera M, Di Blasio AM, Kotta MC, Ghidoni A, Girardengo G, Calcagnino M. Biventricular Arrhythmogenic Cardiomyopathy: a paradigmatic case. ScienceOpen Research 2015. [DOI: 10.14293/s2199-1006.1.sor-med.azgtgz.v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<p>We present a case of arrhythmogenic cardiomyopathy with biventricular involvement and strong arrhythmic substrate, highlighting the need to consider more than a single diagnostic option when facing arrhythmic presentations in young patients and the growing contribution provided by the genetic laboratory and contrast CMR to clinical management.</p>
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31
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Styczkiewicz K, Spadacini G, Tritto M, Moretti P, Perego G, Facchini M, Bilo G, Castiglioni P, Di Rienzo M, Kawecka-Jaszcz K, Salerno-Uriate JA, Parati G. Pulmonary Vein Isolation for Atrial Fibrillation and Baroreflex-Mediated Heart Control. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00086] [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: 11/02/2022] Open
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32
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Giglio A, Blengino S, Malfatto G, Boarin S, Branzi G, Villani A, Perego G, Revera M, Bilo G, Mancia G, Parati G. A Non-Invasive Method to Assess Haemodynamic Variations in Patients with Chronic Heart Failure. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00085] [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: 11/02/2022] Open
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Kramm B, Bruns H, Valsecchi S, Perego G. 880 What is the best optimization strategy using AV and VV delay in cardiac resynchronization therapy? Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.214-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- B. Kramm
- Medtronic Bakken Research Center, Heart Failure Management Dept., Maastricht, Netherlands
| | - H. Bruns
- Bakken Research Center, CRM Research, Maastricht, Netherlands
| | - S. Valsecchi
- Bakken Research Center, CRM Research, Maastricht, Netherlands
| | - G. Perego
- Ospedale S. Luca, Cardiology, Milan, Italy
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Stegemann B, Bruns HJ, Valsecchi S, Perego G. Comparison of optimization strategy for cardiac resynchronization therapy. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.900] [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: 11/30/2022]
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Valero-Cabré A, Tsironis K, Skouras E, Perego G, Navarro X, Neiss WF. Superior muscle reinnervation after autologous nerve graft or poly-L-lactide-epsilon-caprolactone (PLC) tube implantation in comparison to silicone tube repair. J Neurosci Res 2001; 63:214-23. [PMID: 11169632 DOI: 10.1002/1097-4547(20010115)63:2<214::aid-jnr1014>3.0.co;2-d] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [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: 11/09/2022]
Abstract
Recovery after peripheral nerve injury depends not only on the amount of reinnervation, but also on its accuracy. The rat sciatic nerve was subjected to an 8 mm long gap lesion repaired either by autograft (AG, n = 6) or tubulization with impermeable silicone tube (SIL, n = 6) or permeable tube of poly-L-lactide-epsilon-caprolactone (PLC, n = 8). Recordings of the compound muscle action potential (CMAP) from gastrocnemius (mGC), tibialis anterior (mTA) and plantar (mPL) muscles were performed 90 days after injury to assess the amount of muscle reinnervation. The CMAP amplitude achieved in mGC, mTA and mPL was similar in after nerve autograft (39%, 42%, 22% of control values) and PLC tube implantation (37%, 36%, 24%) but lower with SIL tube (29%, 30%, 14%). The nerve fascicles projecting into each of these muscles were then transected and retrograde tracers (Fluoro Gold, Fast Blue, DiI) were applied to quantify the percentage of motoneurons with single or multiple branches to different targets. The total number of labeled motoneurons for the three muscles did not differ in autografted rats (1186 +/- 56; mean +/- SEM) with respect to controls (1238 +/- 82), but was reduced with PLC tube (802 +/- 101) and SIL tube (935 +/- 213). The percentage of neurons with multiple projections was lower after autograft and PLC tube (6%) than with SIL tube (10%). Considering the higher CMAP amplitude and lower number of neurons with multiple projections, PLC nerve conduits seem superior to SIL tubes and a suitable alternative to autografts for the repair of long gaps.
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Affiliation(s)
- A Valero-Cabré
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Spain
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Navarro X, Rodríguez FJ, Labrador RO, Butí M, Ceballos D, Gómez N, Cuadras J, Perego G. Peripheral nerve regeneration through bioresorbable and durable nerve guides. J Peripher Nerv Syst 2000; 1:53-64. [PMID: 10970120] [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: 02/17/2023]
Abstract
We compared reinnervation of target organs after sciatic nerve resection and repair by tubulization with biodurable tubes of silicone and teflon, or bioresorbable nerve guides of collagen and poly(L-lactide-co-6-caprolactone) (PLC) leaving a 6 mm gap in different groups of mice. All tubes were of 1 mm inside diameter and thin-walled (50 to 250 microm). Functional reinnervation was assessed by noninvasive methods to determine recovery of sweating, sensory and motor functions in the hindpaw repeatedly during 5 months postoperation. PLC guides allowed faster and higher levels of reinnervation for the four functions tested than collagen and silicone tubes, while teflon tubes gave the lowest levels of recovery. Regenerative reinnervation by thin nociceptive and sudomotor fibers was higher than by large sensory and alphamotor fibers in all groups. Resorbable tubes promoted regeneration in a higher proportion of mice than durable tubes. In cases with effective regeneration the nerve cable was multifascicular, with mild to moderate mononuclear cell infiltrates and a thin newly formed perineurium. The number of myelinated fibers was higher in PLC and silicone tubes than in collagen and teflon tubes. There was only minimal inflammatory reaction within the remnants of collagen tubes, but not in the other materials. PLC tubes of slow reabsorption rate seem useful for repairing long gaps in injured nerves.
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Affiliation(s)
- X Navarro
- Departamento de Biologia Cel.lular i Fisiologia, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Nobili F, Copello F, Vitali P, Prastaro T, Carozzo S, Perego G, Rodriguez G. Timing of disease progression by quantitative EEG in Alzheimer' s patients. J Clin Neurophysiol 1999; 16:566-73. [PMID: 10600024 DOI: 10.1097/00004691-199911000-00008] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This prospective study was planned to assess whether quantitative EEG (qEEG) can give an estimate of the timing of achievement of three endpoints (loss of activities of daily living, incontinence, and death) in 72 consecutive patients (53 females, 19 males; mean age, 70.8) affected with probable Alzheimer's disease, as defined according to the NINCDS-ADRDA criteria. Power-weighted, log-transformed relative values of the four conventional EEG bands were considered in a central-posterior temporal region for each hemisphere. The hypothesis was tested by the lifereg procedure of the Statistical Analysis System package (first significance level accepted, P < or = 0.01). Because patients were in different stages of the disease, the statistical analysis was performed in the entire group as well as in the subgroup of 41 patients (mean age, 69.6) with mild dementia (scoring 3 or 4 on the global deterioration scale). In the whole group, the loss of activities of daily living was predicted by delta power in either side (P = 0.01), incontinence was predicted by alpha power in the right side (P < 0.01), whereas the statistical significance was not reached for death (P < 0.05). In the subgroup of mild demented patients, the loss of activities of daily living was predicted by delta power in the left side (P = 0.01), incontinence by both delta (P < 0.01) and alpha (P < 0.001) power in the right side, and death was not significantly predicted (P = 0.08). Quantitative EEG is a low-cost, discomfort-free technique which may be used to obtain information on the timing of disease evolution. The results showed in mild Alzheimer's disease appear especially interesting to attempt a prediction of the future time course of the disease from its beginning.
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Affiliation(s)
- F Nobili
- Department of Internal Medicine, University of Genova, S. Martino Hospital, Italy
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Abstract
OBJECTIVE The present study was undertaken to investigate whether a synoptic parameter of quantitative EEG (qEEG), such as the power spectral profile, may be used as a simple marker to stage Alzheimer's disease (AD) in the clinical setting. METHODS To this purpose, the qEEG spectral profile was examined in 48 patients (mean age: 73 years) with probable (NINCDS-ADRDA criteria) AD, who were divided into 4 groups, according to the Global Deterioration Scale (GDS; score: 3-6). The spectral profile of each patient was expressed by the relative power of seven frequency bands (2-3.5, 4-5.5, 6-7.5, 8-9.5, 10-11.5, 12-13.5, 14-22.5 Hz). Mean values in each of the four GDS groups as well as in a control group of 18 healthy elderly subjects underwent multivariate analysis of variance. RESULTS A normally shaped but shifted-to-the left spectral profile was found in GDS 3 group, whereas a reduced background rhythm with various increase in slow activity power characterized both GDS 4 and 5 groups. Finally, an 'exponential asymptotic' profile with the highest power in the lowest frequencies was the hallmark of GDS 6 group. Overall, the 4-5.5 Hz and the 10-11.5 Hz band powers showed the highest statistical significance in differentiating the patient groups between one another and from controls (P < 0.0001). CONCLUSIONS These data show that spectral profile is a very simple parameter which can be used to stage the disease on a pathophysiological basis.
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Affiliation(s)
- G Rodriguez
- Department of Internal Medicine, University of Genova, Italy.
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Rodríguez FJ, Gómez N, Perego G, Navarro X. Highly permeable polylactide-caprolactone nerve guides enhance peripheral nerve regeneration through long gaps. Biomaterials 1999; 20:1489-500. [PMID: 10458562 DOI: 10.1016/s0142-9612(99)00055-1] [Citation(s) in RCA: 134] [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: 11/22/2022]
Abstract
We compared regeneration and functional reinnervation after sciatic nerve resection and tubulization repair with bioresorbable guides of poly(L-lactide-co-epsilon-caprolactone) (PLC) and permanent guides of polysulfone (POS) with different degrees of permeability, leaving a 6 mm gap in different groups of mice. Functional reinnervation was assessed to determine recovery of motor, sensory and sweating functions in the hindpaw during four months postoperation. Highly permeable PLC guides allowed for faster and higher levels of reinnervation for the four functions tested than impermeable or low-permeable PLC guides, while semipermeable 30 and 100 kDa POS tubes yielded very low levels of reinnervation. The regeneration success rate was higher with PLC than with POS tubes. Morphometrical analysis of cross-sectional nerves under light microscopy showed the highest number of regenerated myelinated fibers at mid tube and distal nerve in high-permeable PLC guides. Impermeable PLC guides allowed slightly worse levels of regeneration, while low-permeable PLC guides promoted neuroma and limited distal regeneration. The lowest number of regenerated fibers were found in POS tubes. In summary, highly permeable bioresorbable PLC guides offer a suitable alternative for repairing long gaps in injured nerves, approaching the success of autologous nerve grafts.
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Affiliation(s)
- F J Rodríguez
- Department of Cell Biology and Physiology, Universitat Autònoma de Barcelona, Bellaterra, Spain
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41
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Condat CA, Delsanto PP, Ruffino E, Perego G. Effect of transport and competition on ligand binding. Biophys Chem 1999; 76:185-98. [PMID: 17027464 DOI: 10.1016/s0301-4622(98)00224-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/1998] [Accepted: 08/10/1998] [Indexed: 11/30/2022]
Abstract
We present a model to describe the physics of chemoreception in processes determined by competitive ligand binding. Our model describes the competition between various populations, such as ligands vs. blockers and receptors vs. decoys, in protein activation when diffusion is rate-determining. Full spatio-temporal solutions can be obtained numerically. The model structure is kept simple enough as to permit its easy generalization to describe a large subset of the manifold of possible situations occurring in nature. The power and simplicity of the proposed method are exhibited through the solution of several examples which are discussed in detail.
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Affiliation(s)
- C A Condat
- Department of Physics, University of Puerto Rico, Mayaguez, PR, USA
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Orlando R, Millini R, Perego G, Dovesi R. Catalytic properties of F-centres at the magnesium oxide surface: hydrogen abstraction from methane. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s1381-1169(96)00489-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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43
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Orlando R, Corà F, Millini R, Perego G, Dovesi R. Hydrogen abstraction from methane by Li doped MgO: A periodic quantum mechanical study. J Chem Phys 1996. [DOI: 10.1063/1.472623] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [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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Nicoli Aldini N, Perego G, Cella GD, Maltarello MC, Fini M, Rocca M, Giardino R. Effectiveness of a bioabsorbable conduit in the repair of peripheral nerves. Biomaterials 1996; 17:959-62. [PMID: 8736729 DOI: 10.1016/0142-9612(96)84669-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.5] [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: 02/01/2023]
Abstract
A new conduit made with a bioabsorbable copolymer, poly (L-lactide-co-6-caprolactone), was evaluated in an animal model as a guide for nerve regeneration. The conduit had an inner diameter of 1.3 mm and a wall thickness of 175 microns. Segments of length 1.2 cm were interposed between the proximal and distal stumps of transected ischiatic nerves in Wistar rats, bridging a nerve gap of 1 cm. All of the procedure was performed under general anaesthesia using microsurgical techniques. Controls were performed at 1, 3 and 6 months and it was demonstrated that the conduit was still undamaged after 30 d. Progressive signs of degradation appeared at 90 and 180 d. Nerve regeneration in the lumen was effective as confirmed by histological and electron microscopical investigations. These preliminary results emphasize the interesting properties of the conduit with regard to the achievement of a neural prosthesis.
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Affiliation(s)
- N Nicoli Aldini
- Servizio di Chirurgia Sperimentale, Istituto di Ricerca Codivilla Putti I.O.R., Bologna, Italy
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Millini R, Perego G, Parker W, Bellussi G, Carluccio L. Layered structure of ERB-1 microporous borosilicate precursor and its intercalation properties towards polar molecules. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/0927-6513(95)00013-y] [Citation(s) in RCA: 175] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Giardino R, Nicoli Aldini N, Perego G, Cella G, Maltarello MC, Fini M, Rocca M, Giavaresi G. Biological and synthetic conduits in peripheral nerve repair: a comparative experimental study. Int J Artif Organs 1995; 18:225-30. [PMID: 8530203] [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: 01/31/2023]
Abstract
Two different types of conduits, one biological, obtained with homologous glutaraldehyde preserved vein segments and the other synthetic bioabsorbable, made with Poly [L-lactide-co-6-caprolactone], were evaluated as guides for nerve repair in alternative to autologous grafts in an experimental animal model. Under general anesthetic, the ischiatic nerve of a number Wistar rats was transected to create a 1 cm gap, which was then repaired by means of the conduits or autologous grafts. Controls were performed at 1, 3 and 6 months; nerve regeneration was effective with both conduits, but the count of myelinated axons showed a significant difference between the synthetic and biological tubes (p < 0.001). The Poly [L-lactide-co-6-caprolactone] guide was still intact 30 days after implant; progressive signs of degradation were present at 90 and 180 days. These results show that the synthetic conduits are better than those obtained with preserved vein segments and might be considered in alternative to autologous grafts in peripheral nerve reconstruction.
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Affiliation(s)
- R Giardino
- Experimental Surgery Unit, Codvilla Putti I.O.R. Research Institute, Bologna, Italy
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Lauri G, Marenzi G, Agostoni PG, Grazi S, Perego G, Salvioni A, Assanelli E, Capobianco C, Maggi G, Guazzi MD. [Moderate cardiac failure: oxygen consumption during exercise predicts ultrafiltration results]. Cardiologia 1994; 39:253-9. [PMID: 8062296] [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: 01/28/2023]
Abstract
Extracorporeal ultrafiltration (UF) can improve the clinical condition, as assessed by cardiopulmonary exercise evaluation, of patients with moderate heart failure (HF); the pre-UF level of physical performance above which UF does not induce clinical benefits, is not defined. For this purpose, we studied 29 patients with stable HF in functional class II-III (NYHA), who underwent UF (veno-venous bypass, removal of 1,830 +/- 550 ml of plasma water), regardless their baseline oxygen consumption at peak exercise (VO2p) and at anaerobic threshold (VO2AT). All patients experienced cardiopulmonary exercise tests (cycloergometer, increasing workloads of 25 W every 3 min) before (pre-UF), and 4 days and 3 months following UF. According to VO2 changes following UF 2 groups of patients were identified: in Group I (9 patients) no differences in VO2p and VO2AT were observed, while in Group II (18 patients) VO2p rose by 2.7 ml/min/kg (p < 0.001) at 4 days and 4.5 ml/min/kg (p = 0.04) at 3 months, and VO2AT rose by 1.2 ml/min/kg (p < 0.001) at 4 days and 2.8 ml/min/kg (p = 0.03) at 3 months. In unresponsive patients baseline values of VO2p > or = 18 ml/min/kg and VO2AT +/- 13 ml/min/kg were detected. Pre-UF VO2p inversely correlated with the shift of VO2p (delta VO2p) both at 4 days (r = -0.62, p < 0.001) and at 3 months (r = -0.53, p = 0.005), and pre-UF VO2AT inversely correlated with delta VO2AT at 4 days (r = -0.71, p < 0.001) and at 3 months (r = -0.63, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Lauri
- Istituto di Cardiologia, Università degli Studi, Centro di Studio per le Ricerche Cardiovascolari del CNR, Fondazione I Monzino, IRCCS, Milano
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Agostoni P, Marenzi G, Lauri G, Perego G, Schianni M, Sganzerla P, Guazzi MD. Sustained improvement in functional capacity after removal of body fluid with isolated ultrafiltration in chronic cardiac insufficiency: failure of furosemide to provide the same result. Am J Med 1994; 96:191-9. [PMID: 8154506 DOI: 10.1016/0002-9343(94)90142-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study was designed to investigate whether a subclinical accumulation of fluid in the lung interstitium associated with moderate congestive heart failure interferes with the patient's functional capacity, and whether furosemide treatment can promote reabsorption of the excessive fluid. BACKGROUND In patients with moderate congestive heart failure, pulmonary overhydration may be detected by chest roentgenography even if therapy is optimized to keep the urinary output normal and to prevent weight gain and dependent edema formation. Removal of the overhydration may help define its significance. METHODS Patients, whose regimens of digoxin, oral furosemide, and angiotensin-converting enzyme (ACE) inhibitor therapy were kept constant, were randomly allocated to receive ultrafiltration (8 cases) or an intravenous bolus of supplemental furosemide (mean dose: 248 mg; 8 cases). The amount of body fluid removed with each method approximated 1600 mL. Functional performance was assessed with cardiopulmonary exercise tests. RESULTS Soon after fluid withdrawal by either method, the filling pressures of the two ventricles and body weight were reduced and plasma renin activity, norepinephrine, and aldosterone were augmented. After furosemide administration, hormone levels remained elevated for the next 4 days, and during this period, patients had positive water metabolism, recovery of the elevated ventricular filling pressures, and re-occurrence of lung congestion with no improvement in functional capacity. After ultrafiltration, levels of renin, norepinephrine, and aldosterone fell to below control values within the first 48 hours and water metabolism was equilibrated at a new set point (less fluid intake and diuresis without weight gain). The favorable circulatory and ventilatory adjustments consequent to the reabsorption of lung water improved the functional capacity of these patients. That may also have restored the lung's ability to clear norepinephrine, thus restraining its facilitation of renin release. The improvement continued 3 months after the procedure. CONCLUSIONS In patients with congestive heart failure the set point of fluid balance is altered in spite of oral furosemide therapy; supplemental intravenous furosemide does not shift the set point, at least not when combined with ACE inhibition. Excessive, although asymptomatic, lung water limits the functional capacity of the patient.
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Affiliation(s)
- P Agostoni
- Instituto di Cardiologia dell'Università degli Studi, Fondazione I Monzino, Istituto G. Sisini, Milan, Italy
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Abstract
A copolymer of L-lactide and 6-caprolactone (50:50, w/w) was synthesized and characterized. The thermal behaviour of this material did not show any crystallinity for several months; only after more than 1 yr of aging at room temperature and, particularly, in the in vitro degradation tests did it partially crystallize. The values of tensile strength, percent elongation at break and elastic modulus were, respectively, 25 MPa, 490% and 3 MPa. Transparent, elastic nerve guides having inner diameter of 1.3 mm and wall thickness of 175 microns were prepared.
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Bellussi G, Perego C, Carati A, Peratello S, Massara EP, Perego G. Amorphous mesoporous silica-alumina with controlled pore size as acid catalysts. Studies in Surface Science and Catalysis 1994. [DOI: 10.1016/s0167-2991(08)64100-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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