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Schellenberg D, Gabos Z, Duimering A, Debenham BJ, Fairchild A, Huang F, Rowe L, Severin DM, Giuliani M, Bezjak A, Lok BH, Raman S, Chung P, Zhao Y, Ho C, Lock MI, Louie A, Lefresne S, Carolan H, Liu MC, Yau V, Ye AY, Olson RA, Mou B, Mohamed IG, Petrik DW, Dosani M, Pai HH, Valev B, Gaede S, Warner A, Palma DA. Stereotactic Ablative Radiotherapy for Oligo-Progressive Cancers: Results of the Randomized Phase II STOP Trial. Int J Radiat Oncol Biol Phys 2023; 117:S58. [PMID: 37784530 DOI: 10.1016/j.ijrobp.2023.06.353] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the metastatic setting, there is uncertain benefit to localized eradication of one or more lesions that are progressing despite systemic therapy. This randomized phase II trial examined if patients with ≤5 sites of oligoprogression benefited from the addition of stereotactic ablative radiotherapy (SABR) to standard of care (SOC) systemic therapy. MATERIALS/METHODS Eligibility criteria included age ≥18 years, ECOG performance status 0-2, and oligoprogressive disease, defined as 1-5 lesions actively progressing while on systemic therapy. Patients were required to have at least 3 months of disease stability/response on systemic therapy prior to oligoprogression. After stratifying by type of systemic therapy (cytotoxic vs. non-cytotoxic), patients were randomized 2:1 to SABR to all progressing lesions plus SOC (SABR arm) vs. SOC alone (SOC arm). The trial began exclusive to non-small cell lung cancer but did not meet accrual goals and was expanded in 2019 to include all non-hematologic malignancies. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), lesional control, quality of life (QOL), toxicity, and duration of current systemic agent post-SABR. RESULTS Between February 2017 and June 2021, 90 patients with 125 oligoprogressive metastases were enrolled across 8 Canadian institutions, with 59 patients randomized to SABR and 31 to SOC. Median age was 67 years (IQR: 61-73 years) and 39 (43%) were female. The most common primary sites were lung (44% of patients), genitourinary (23%) and breast (13%), with the most common oligo-progressive locations being lung (43%), bone (19%), lymph nodes (14%), and liver (13%). In the SABR arm, the most common fractionations were 35 Gy/5 (38% of lesions) and 50 Gy/5 (18%). Protocol adherence in the SOC arm was suboptimal: 3 patients (10%) withdrew immediately after randomization, and 7 additional patients (23%) received high-dose or ablative therapies. Median follow-up was 31 months. There was no difference in PFS between arms (median PFS 8.4 months in the SABR arm vs. 4.3 months in the SOC arm; however, the curves cross and 2-year PFS was 9% vs. 24% respectively, p = 0.91). Median OS was 31.2 months vs. 27.4 months, respectively (p = 0.22). Lesional control with SABR was 71% vs. 39% with SOC (p = 0.002). Median duration of post-randomization first-line systemic therapy was 10.3 months vs. 7.6 months, respectively (p = 0.71). Treatment was well-tolerated with 2 (3.4%) grade 3 treatment-related toxicities in the SABR arm and no grade 4/5 related events in either arm. QOL did not differ between arms. CONCLUSION Despite being a well-tolerated treatment providing superior lesional control, SABR for oligoprogression did not improve PFS or OS. Results may have been impacted by withdrawals and desire for ablative treatments on the SOC arm, and this lack of equipoise may make accrual to phase III trials difficult, although larger studies in select sub-populations are desired. (NCT02756793).
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Affiliation(s)
| | - Z Gabos
- University of Alberta, Edmonton, AB, Canada
| | | | | | | | - F Huang
- University of Alberta, Edmonton, AB, Canada
| | - L Rowe
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - D M Severin
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - M Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Bezjak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - B H Lok
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - S Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - P Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Y Zhao
- Dalhousie University, Halifax, NS, Canada
| | - C Ho
- BC Cancer - Fraser Valley, Surrey, BC, Canada
| | - M I Lock
- London Health Sciences Centre, London, ON, Canada
| | - A Louie
- Sunnybrook Odette Cancer Centre, TORONTO, ON, Canada
| | - S Lefresne
- BC Cancer Vancouver, Vancouver, BC, Canada
| | | | - M C Liu
- Department of Radiation Oncology, BC Cancer - Vancouver Centre, Vancouver, BC, Canada
| | - V Yau
- BC Cancer - Centre for the North, Prince George, BC, Canada
| | - A Y Ye
- University of British Columbia, Kelowna, BC, Canada
| | - R A Olson
- BC Cancer - Prince George, Prince George, BC, Canada
| | - B Mou
- BC Cancer - Kelowna, Kelowna, BC, Canada
| | | | | | - M Dosani
- BC Cancer - Victoria, Victoria, BC, Canada
| | - H H Pai
- BC Cancer - Victoria, Victoria, BC, Canada
| | - B Valev
- BC Cancer - Victoria, Victoria, BC, Canada
| | - S Gaede
- Department of Medical Physics, Western University, London, ON, Canada
| | - A Warner
- London Health Sciences Centre, London, ON, Canada
| | - D A Palma
- Department of Oncology, Western University, London, ON, Canada
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Palma DA, Bahig H, Hope AJ, Harrow S, Debenham BJ, Louie A, Vu T, Filion EJ, Bezjak A, Campeau MP, Duimering A, Giuliani M, Laba JM, Lang P, Lok BH, Qu MX, Raman S, Rodrigues G, Goodman C, Gaede S, Morisset J, Warner A, Dhaliwal I, Ryerson C. Assessment of Precision Irradiation in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease (ASPIRE-ILD): Primary Analysis of a Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:S28-S29. [PMID: 37784467 DOI: 10.1016/j.ijrobp.2023.06.289] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The use of stereotactic ablative radiotherapy (SABR) in patients with fibrotic interstitial lung disease (ILD) has been associated with an increased risk of toxicity, but patients with ILD and lung cancer may have no other options for curative-intent treatment. The goal of the ASPIRE-ILD trial was to assess the benefits and toxicities of SABR in patients with fibrotic ILD. MATERIALS/METHODS We enrolled patients with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgery. All patients were centrally reviewed prior to enrollment to confirm the presence and subtype of ILD. After stratification by the ILD-GAP score (a measure of ILD severity and prognosis), patients were treated with SABR to a dose of 50 Gy in 5 fractions EOD (BED = 100 Gy10), with a built-in de-escalation protocol in case of unacceptable toxicity. The primary endpoint was overall survival (OS), powered to distinguish 1-year OS >70% vs. an unacceptable rate of ≤50%. Secondary endpoints included toxicity (CTC-AE version 4.0), progression-free survival (PFS), local control (LC), patient-reported outcomes (FACT-L quality of life and cough severity), and changes in pulmonary function tests (PFTs). The study pre-specified that SABR would be considered worthwhile if median OS was >1 year, with a grade 3-4 toxicity risk <35% and a grade 5 toxicity risk <15%. Target accrual was 39 treated patients. RESULTS Thirty-nine patients were enrolled and treated with SABR between March 2019 and January 2022, all to a dose of 50 Gy in 5 fractions, at 5 institutions in Canada and 1 in Scotland. Median age was 78 years (interquartile range: 67-83), 59% were male, and 92% had a history of smoking (median 43 pack-years). At baseline, 70% reported dyspnea, median FEV1 was 80% predicted and median DLCO was 49% predicted. ILD-GAP scores were as follows: ≤2 (i.e., best ILD status): n = 14; 3-5: n = 23; ≥6 (i.e., worst ILD status): n = 2. Median follow-up was 19 months. OS at 1-year was 78.9% (p<0.001 by binomial test vs. the unacceptable rate). Median OS was 25 months, median PFS was 19 months, and 2-year LC was 92%. AE rates (possibly, probably or definitely related) were as follows (highest grade per patient): grade 1-2: n = 12 (31%); grade 3: n = 4 (10%); grade 4; n = 0; grade 5 n = 3 (7.7%, all due to respiratory deterioration). AE rates did not differ by ILD-GAP category or ILD subtype. FACT-L scores trended downward over time (p = 0.07), and cough severity scale scores worsened over time (p = 0.02). Comparing last-available PFTs with baseline, DLCO declined (median: -4%; p = 0.046), FVC trended downward (median: -2.5%; p = 0.11), and FEV1 remained stable (median change: 0%). CONCLUSION The use of SABR in patients with ILD met the pre-specified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits. Further studies exploring pharmacologic options to reduce toxicity may be beneficial in this population. ().
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Affiliation(s)
- D A Palma
- Department of Oncology, Western University, London, ON, Canada
| | - H Bahig
- Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - A J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Harrow
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | | | - A Louie
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - T Vu
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - E J Filion
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - A Bezjak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M P Campeau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - M Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J M Laba
- London Health Sciences Centre, London, ON, Canada
| | - P Lang
- Department of Oncology, Western University, London, ON, Canada
| | - B H Lok
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - M X Qu
- London Regional Cancer Centre, London, ON, Canada
| | - S Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - G Rodrigues
- London Health Sciences Centre, London, ON, Canada
| | - C Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - S Gaede
- Department of Medical Physics, Western University, London, ON, Canada
| | - J Morisset
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - A Warner
- London Health Sciences Centre, London, ON, Canada
| | - I Dhaliwal
- London Health Sciences Centre, London, ON, Canada
| | - C Ryerson
- University of British Columbia, Vancouver, BC, Canada
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Bacon H, McNeil N, Patel T, Welch M, Ye XY, Bezjak A, Lok BH, Raman S, Giuliani M, Cho J, Sun A, Lindsay P, Liu G, Kandel S, McIntosh C, Tadic T, Hope A. Association of Artificial Intelligence-Screened Interstitial Lung Disease with Radiation Pneumonitis and Mortality in Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e4-e5. [PMID: 37785334 DOI: 10.1016/j.ijrobp.2023.06.656] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation pneumonitis (RP) is a common and dose-limiting toxicity following radiotherapy for non-small cell lung cancer (NSCLC). Patients with interstitial lung disease (ILD) are believed to be at increased risk of developing complications including RP, ILD progression, or death. An automated method to identify patients prior to radiotherapy at high risk of developing toxicities or death may allow clinicians to mitigate risk through informed treatment planning and careful patient monitoring. MATERIALS/METHODS All locally advanced NSCLC patients treated with definitive radiation from 2006-2021 with a minimum 1 year of follow-up were assessed. RP and mortality data were prospectively collected and retrospectively reviewed. A convolutional neural network (CNN) was previously developed and validated to identify patients with radiographic ILD using planning computed tomography (CT) images, with an accuracy of 0.82. Planning CT scans for the retrospective cohort were used as input to the CNN, with artificial intelligence-screened ILD (AI-ILD) score as an output. AI-ILD scores above our established threshold were labeled as AI-ILD+. The association between AI-ILD score, AI-ILD+/-, mean lung dose (MLD), and the primary outcome of grade ≥2 (G2+) RP or mortality, as well as the secondary outcomes of G2+ RP and mortality were assessed using Wilcoxon rank sum test, univariate and multivariable logistic regression, and Kaplan-Meier survival analysis. RESULTS Of 799 patients reviewed, 745 eligible patients were included in the analysis; grade 0-5 RP was reported in 51.3%, 27.1%, 16.9%, 4.0%, 0.1%, and 0.5% of patients respectively. Overall, 22.9% of patients were AI-ILD+, and therefore at high risk (>20% chance) of having true ILD. On UVA, AI-ILD score, AI-ILD+ and MLD were significantly associated with the primary outcome of G2+ RP or mortality, as well as the secondary outcome of mortality. However, only MLD was significantly associated with the secondary outcome of G2+ RP. On MVA, both AI-ILD+ (OR 1.42, 95% CI 1.02-1.97, p = 0.04) and MLD (OR 1.13, 95% 1.05-1.21, p = 0.008) were significantly associated with G2+ RP or mortality. On Kaplan-Meier analysis, the median toxicity-free survival (TFS) time for AI-ILD+ and AI-ILD- patients were 1.7 and 3.4 years respectively, with a 2-year TFS of 48.3% vs. 59.3% (log-rank test: p = 0.02). There was no significant difference in rates of G2+ RP. CONCLUSION The AI-ILD algorithm can detect high risk patients with significantly decreased TFS following definitive treatment for NSCLC. AI-ILD classification was not associated with a significant difference in rates of RP when accounting for MLD. Future work will focus on improving the classification algorithm, expert radiologist validation of this dataset, and exploring reasons for the mortality difference in AI-ILD+ patients.
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Affiliation(s)
- H Bacon
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - N McNeil
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - T Patel
- Techna Institute, University Health Network, Toronto, ON, Canada
| | - M Welch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - X Y Ye
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - A Bezjak
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - B H Lok
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - S Raman
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J Cho
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Sun
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - P Lindsay
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - G Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - S Kandel
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - C McIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - T Tadic
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Hope
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Scarafia C, Vaiarelli A, Cimadomo D, Amendola M, Colamaria S, Argento C, Giuliani M, Ferrero S, Gennarelli G, Revelli A, Benedetto C, Alviggi C, Capalbo A, Rienzi L, Ubaldi F. P-621 Different gonadotrophins adopted for controlled ovarian stimulation do not affect metaphase-II oocyte competence. A matched case-control study on 351 patients and 2258 oocytes. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.571] [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] Open
Abstract
Abstract
Study question
Do different gonadotrophins for controlled-ovarian-stimulation (COS) affect metaphase-II (MII) oocyte competence?
Summary answer
Euploid blastocyst rate (EBR) per cohort of MII-oocytes, live-birth-rate (LBR) per first vitrified-warmed euploid single-embryo-transfer (SET) and cumulative-LBR are independent from the gonadotrophins used.
What is known already
Controlled-ovarian-stimulation (COS) is a cornerstone of IVF. Its purpose is maximizing ovarian reserve exploitation and obtaining ≥1 euploid blastocyst to transfer. Indeed, ovarian reserve decreases and blastocyst aneuploidy rates increase with increasing maternal age, making this task quite complicated in advanced maternal age. Old-fashioned studies suggested an association between COS and embryonic aneuploidy rates. Conversely, recent studies excluded an impact of COS dosage, duration, ovarian response, and ovulation trigger, on blastocyst aneuploidy rate. An aspect, though, needs more clarity: do different gonadotropins impact oocyte competence after COS, comprehensively defined as EBR per cohort of MII-oocytes?
Study design, size, duration
Out of 3169 PGT cycles with ³1 MII oocyte conducted between 2014-2018, we excluded (i)PGT-M/-SR, (ii)women<35yr, (iii)severe-male-factor, (iv)DuoStim or long-active FSH, (v)culture with sequential-media, and (v)multiple cycles. Among the 784 cycles left, a propensity-score-matching (PSM) based on the number of inseminated MII-oocytes was adopted to match patients using recFSH [without (N = 57; 337 MII-oocytes)/with recLH (N = 55; 374 MII-oocytes)] and Human-Menopausal-Gonadotrophin (HMG; N = 127; 835 MII-oocytes). The patients using recFSH+HMG were all included (N = 112; 712 MII-oocytes).
Participants/materials, setting, methods
Only GnRH-antagonist COS, ICSI with fresh MII-oocytes, single culture in continuous-media, trophectoderm biopsy without assisted-hatching, comprehensive-chromosome-testing to assess full-chromosome non-mosaic aneuploidies and vitrified-warmed euploid SET were conducted. Oocyte competence was comprehensively defined as EBR per cohort of MII-oocytes with all intermediate outcomes (fertilization, blastulation and euploidy). LBR per first vitrified-warmed euploid SET and cumulative-LBR per retrieval were also assessed. Generalized-linear-models and multivariate regressions were adopted to adjust the results for confounders. All cycles were concluded.
Main results and the role of chance
Patients using recFSH+recLH and recFSH+HMG (40.7 yr) were older than patients using recFSH-only or HMG-only (40 yr; ANOVA<0.01). No other difference was reported in the 4 patient populations. The overall gonadotrophins dosage (2615±977, 3601±1889, 3818±946 and 2892±911 IU in the recFSH-only, recFSH+recLH, recFSH+HMG and HMG-only groups, respectively) and duration of COS (9.7±1.9, 9.4±1.5, 9.9±1.8 and 10.2±1.8 days) were different (Kruskal-Wallis tests=0.02). The number of cumulus-oocyte-complexes (9.2±6.5) and MII-oocytes collected (6.4±4.4) were instead well-matched across the groups. The EBR per cohort of inseminated MII-oocytes was different in the four groups (20.7±27.1%, 9.6±12.9%, 12.4±18.5% and 16.9±21.8%, respectively), but, when adjusted for maternal age in a generalized-linear-model, the gonadotrophin used for COS did not show any significant association with this outcome (partial-eta2=0.02, p = 0.1, power=0.6). All intermediate embryological outcomes were also similar. The LBR per first vitrified-warmed euploid SET was comparable in the four groups [N = 14/33 (42%), N = 9/22 (41%), N = 26/62 (45%), N = 24/55 (44%), respectively], as confirmed by the logistic regression adjusted for blastocyst quality (multivariate-OR: 0.97, 95%CI 0.73-1.31, adjusted-p=0.9). Lastly, the cumulative-LBRs per retrieval were equivalent [N = 17/57 (30%), N = 14/55 (26%), N = 34/127 (27%), and N = 33/112 (30%), respectively], as confirmed by the logistic regression adjusted for maternal age (multivariate-OR: 1.01, 95%CI 0.8-1.3, adjusted-p=0.9).
Limitations, reasons for caution
The gonadotrophins were chosen based on patient compliance to their administration route and gynecologist judgement, and only qualitative outcomes were assessed. Therefore, randomized-controlled-trials and cost-effectiveness analysis investigating the efficiency in oocyte recruitment and cumulative-LBR per intention-to-treat are needed.
Wider implications of the findings
Different gonadotrophins might not affect MII-oocyte competence. This information is key since, in view of the optimization of follicle recruitment through personalized-COS, it allows more flexibility in the choice of the most suitable protocol. Therefore, gynecologists might ponder also features like patient reproductive history and compliance to different administration routes.
Trial registration number
none
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Affiliation(s)
- C Scarafia
- Sant' Anna Hospital- University of Turin, Obstetrics and Gynecology 1U- Physiopathology of Reproduction and IVF Unit- Department of Surgical Sciences , Turin, Italy
| | - A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - M.G Amendola
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - S Colamaria
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - C Argento
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - M Giuliani
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - S Ferrero
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | | | - A Revelli
- Livet, GeneraLife IVF , Turin, Italy
| | - C Benedetto
- Sant' Anna Hospital- University of Turin, Obstetrics and Gynecology 1U- Physiopathology of Reproduction and IVF Unit- Department of Surgical Sciences , Turin, Italy
| | - C Alviggi
- University of Naples Federico II, Department of Neuroscience- Reproductive Science and Odontostomatology , Naples, Italy
| | - A Capalbo
- Igenomix, Igenomix Italy , Marostica, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
| | - F.M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF , Rome, Italy
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Stingone C, Latini A, Gianserra L, Salvi M, Donà MG, Giuliani E, Lesnoni La Parola I, Mussi A, Cameli N, Garelli V, Giuliani M, Buonomini AR, Vujovic B, Cerimele M, Morrone A. Author Correction: Features of fragile people with SARS-CoV-2 infection in isolation in a COVID-19 hotel in Rome, Italy. Eur Rev Med Pharmacol Sci 2022; 26:3407. [PMID: 35647819 DOI: 10.26355/eurrev_202205_28832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Correction to: European Review for Medical and Pharmacological Sciences 2022; 26 (7): 2631-2638-DOI: 10.26355/eurrev_202204_28501-PMID: 35442479, published online on 15 April 2022. After publication, at the request of the Italian Ministry of Health, the authors asked to insert the following statement in the Acknowledgments section: "This research was funded by the Italian Ministry of Health (RC 2022)". There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/28501.
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Affiliation(s)
- C Stingone
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
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Stingone C, Latini A, Gianserra L, Salvi M, Donà MG, Giuliani E, Lesnoni La Parola I, Mussi A, Cameli N, Garelli V, Giuliani M, Buonomini AR, Vujovic B, Cerimele M, Morrone A. Features of fragile people with SARS-CoV-2 infection in isolation in a COVID-19 hotel in Rome, Italy. Eur Rev Med Pharmacol Sci 2022; 26:2631-2638. [PMID: 35442479 DOI: 10.26355/eurrev_202204_28501] [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: 06/14/2023]
Abstract
OBJECTIVE Temporary COVID-19 hotels have been established in Italy to assist the homeless people that test positive for SARS-CoV-2 and require isolation. This observational study aimed to investigate the characteristics of the subjects who were isolated at the Casa tra Noi COVID-19 hotel in Rome between October 2020 and May 2021 and to estimate the duration of SARS-CoV-2 positivity according to their main socio-demographic, behavioural and clinical features. SUBJECTS AND METHODS Socio-demographic data, clinical history, and anamnestic data of guests were collected by the clinicians reviewing the medical documentation and face-to-face interviewing. Nasopharyngeal swabs were performed every 7 days and the presence of SARS-CoV-2 was assessed by RT-PCR. Median duration of SARS-CoV-2 positivity according to socio-demographic, behavioral factors and clinical condition was calculated. RESULTS The 196 guests (161 males, 82.1%) had a median age of 41 years (IQR: 30-53), and were mostly African (87, 44.4%). Only asymptomatic/paucisymptomatic infections were observed. Almost half of the individuals (84, 42.9%) were affected by at least one co-morbidity, the frequency of which was higher among women (57.1% vs. 39.8%, p=0.06). The date of the negative SARS-CoV-2 molecular test was known for 144 guests (73.5%). Among these, the median duration of positivity was 21 days (IQR: 14-26) and did not significantly vary with age, country of origin, smoking status, alcohol or drug abuse. Among the co-morbidities, only infectious diseases significantly modified the duration of positivity, which increased from 21 to 34 days (p=0.013). CONCLUSIONS Hotel guests were frequently affected by physical/mental co-morbidities. Duration of SARS-CoV-2 positivity was significantly prolonged only in individuals affected by an infectious disease.
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Affiliation(s)
- C Stingone
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy.
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Vaiarelli A, Cimadomo D, Gennarelli G, Guido M, Alviggi C, Conforti A, Livi C, Revelli A, Colamaria S, Argento C, Giuliani M, De Angelis C, Matteo M, Canosa S, D’Alfonso A, Cimadomo V, Rienzi L, Ubaldi FM. Second stimulation in the same ovarian cycle: an option to fully-personalize the treatment in poor prognosis patients undergoing PGT-A. J Assist Reprod Genet 2022; 39:663-673. [PMID: 35128583 PMCID: PMC8995212 DOI: 10.1007/s10815-022-02409-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Our primary objective was to assess whether immediately undergoing a second stimulation in the same ovarian cycle (DuoStim) for advanced-maternal-age and/or poor-ovarian-reserve (AMA/POR) patients obtaining ≤ 3 blastocysts for preimplantation-genetic-testing-for-aneuploidies (PGT-A) is more efficient than the conventional-approach. METHODS All AMA/POR patients obtaining ≤ 3 blastocysts after conventional-stimulation between 2017 and 2019 were proposed DuoStim, and 143 couples accepted (DuoStim-group) and were matched for the main confounders to 143 couples who did not accept (conventional-group). GnRH-antagonist protocol with recombinant-gonadotrophins and agonist trigger, intra-cytoplasmatic-sperm-injection (ICSI) with ejaculated sperm, PGT-A and vitrified-warmed euploid single-blastocyst-transfer(s) were performed. The primary outcome was the cumulative-live-birth-delivery-rate per intention-to-treat (CLBdR per ITT) within 1 year. If not delivering, the conventional-group had 1 year to undergo another conventional-stimulation. A cost-effectiveness analysis was also conducted. RESULTS The CLBdR was 10.5% in the conventional-group after the first attempt. Only 12 of the 128 non-pregnant patients returned (165 ± 95 days later; drop-out = 116/128,90.6%), and 3 delivered. Thus, the 1-year CLBdR was 12.6% (N = 18/143). In the DuoStim-group, the CLBdR was 24.5% (N = 35/143; p = 0.01), 2 women delivered twice and 13 patients have other euploid blastocysts after a LB (0 and 2 in the conventional-group). DuoStim resulted in an incremental-cost-effectiveness-ratio of 23,303€. DuoStim was costlier and more effective in 98.7% of the 1000 pseudo-replicates generated through bootstrapping, and the cost-effectiveness acceptability curves unveiled that DuoStim would be more cost-effective than the conventional-approach at a willingness-to-pay threshold of 23,100€. CONCLUSIONS During PGT-A treatments in AMA/POR women, DuoStim can be suggested in progress to rescue poor blastocyst yields after conventional-stimulation. It might indeed prevent drop-out or further aging between attempts.
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Affiliation(s)
- Alberto Vaiarelli
- GeneraLife IVF, Clinica Valle Giulia, via G. De Notaris, 2b, 00197, Rome, Italy.
| | - Danilo Cimadomo
- grid.487136.f0000 0004 1756 2878GeneraLife IVF, Clinica Valle Giulia, via G. De Notaris, 2b, 00197 Rome, Italy
| | | | - Maurizio Guido
- grid.158820.60000 0004 1757 2611MeSVA Department, University of L’Aquila, L’Aquila, Italy
| | - Carlo Alviggi
- grid.4691.a0000 0001 0790 385XDepartment of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Alessandro Conforti
- grid.4691.a0000 0001 0790 385XDepartment of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | - Alberto Revelli
- GeneraLife IVF, Livet, Turin Italy ,grid.7605.40000 0001 2336 6580Obstetrics and Gynaecology SCDU1, Physiopathology of Reproduction and IVF Unit, Sant’Anna Hospital, University of Turin, Turin, Italy
| | - Silvia Colamaria
- grid.487136.f0000 0004 1756 2878GeneraLife IVF, Clinica Valle Giulia, via G. De Notaris, 2b, 00197 Rome, Italy
| | - Cindy Argento
- grid.487136.f0000 0004 1756 2878GeneraLife IVF, Clinica Valle Giulia, via G. De Notaris, 2b, 00197 Rome, Italy
| | - Maddalena Giuliani
- grid.487136.f0000 0004 1756 2878GeneraLife IVF, Clinica Valle Giulia, via G. De Notaris, 2b, 00197 Rome, Italy
| | - Carlo De Angelis
- grid.7841.aDepartment of Gynecological, Obstetrical, and Urological Sciences, “Sapienza” University of Rome, Operative Unit of Obstetrics, Fabia Mater Clinic, Rome, Italy
| | - Maria Matteo
- grid.10796.390000000121049995Department of Medical and Surgical Sciences, University of Foggia, Physiopathology and Reproductive Unit, University Hospital of Foggia, Foggia, Italy
| | | | - Angela D’Alfonso
- grid.158820.60000 0004 1757 2611MeSVA Department, University of L’Aquila, L’Aquila, Italy
| | | | - Laura Rienzi
- grid.487136.f0000 0004 1756 2878GeneraLife IVF, Clinica Valle Giulia, via G. De Notaris, 2b, 00197 Rome, Italy
| | - Filippo Maria Ubaldi
- grid.487136.f0000 0004 1756 2878GeneraLife IVF, Clinica Valle Giulia, via G. De Notaris, 2b, 00197 Rome, Italy
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Jacinto J, Huang S, Su J, Kim J, O'Sullivan B, Ringash J, Cho J, Hope A, Bratman S, Giuliani M, Hosni A, Hahn E, Spreafico A, Hansen A, Goldstein D, Tong L, Perez-Ordonez B, Weinreb I, Xu W, Waldron J. Clinical Behavior and Outcome of HPV-Positive Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kordlouie S, David B, Strang B, Croke J, Giuliani M, Ingledew P, Alfieri J. Creation of a National In-Training Examination in Radiation Oncology ― Impact Evaluation. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vaiarelli A, Cimadomo D, Colamaria S, Giuliani M, Argento C, Fabozzi G, Ferrero S, Schimberni M, Holte J, Trabucco E, Livi C, Gennarelli G, Bongioanni F, Rienzi L, Ubaldi FM. P–606 A second stimulation in the same ovarian cycle rescues advanced-maternal-age patients obtaining ≤ 3 blastocysts after the conventional approach by preventing treatment-discontinuation. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.605] [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] Open
Abstract
Abstract
Study question
Is double stimulation in the same ovarian cycle (DuoStim) a valuable strategy to rescue advanced-maternal-age patients obtaining ≤ 3 blastocysts for chromosomal-testing after conventional stimulation?
Summary answer
DuoStim is effective to prevent treatment discontinuation thereby increasing the 1-year cumulative-live-birth-rate among advanced-maternal-age patients obtaining 0–3 blastocysts after a first conventional stimulation.
What is known already
Folliculogenesis is characterized by continuous waves of follicular growth. DuoStim approach exploits these dynamics to conduct two stimulations in a single ovarian cycle and improve the prognosis of advanced-maternal-age and/or reduced-ovarian-reserve women. Independent groups worldwide successfully adopted DuoStim with various regimens reporting similar oocyte/embryo competence after both stimulations. Recently, we have demonstrated the fruitful adoption of DuoStim in patients fulfilling the Bologna criteria, especially because of the prevention of treatment discontinuation. Here we aimed at investigating whether DuoStim can be adopted to rescue poor prognosis patients obtaining 0–3 blastocysts after the conventional approach.
Study design, size, duration
Proof-of-concept matched case-control study. All patients obtaining 0–3 blastocysts after conventional-stimulation between 2015–2018 were proposed DuoStim. The 143 couples who accepted were matched for maternal age, sperm factor, cumulus-oocyte-complexes and blastocysts obtained after the first stimulation to 143 couples who did not. The primary outcome was the 1-year cumulative-live-birth-rate. If not delivering, the control group had 1 year to undergo a second attempt with conventional-stimulation. All treatments were concluded (live-birth achieved or no euploid left).
Participants/materials, setting, methods
Only GnRH-antagonist with recombinant-gonadotrophins and agonist trigger stimulation protocols were adopted. All cycles entailed ICSI with ejaculated sperm, blastocyst culture, trophectoderm biopsy, comprehensive-chromosome-testing and vitrified-warmed euploid single-embryo-transfer(s). Cumulative-live-birth-rate was calculated per patient considering both stimulations in the same ovarian cycle (DuoStim group) or up to two stimulations in 1 year (control group). Treatment discontinuation rate in the control group was calculated as patients who did not return for a second stimulation among non-pregnant ones.
Main results and the role of chance
Among the 286 couples included (41.0±2.9yr;4.9±3.1 cumulus-oocytes-complexes and 0.8±0.9 blastocysts), 126 (63 per group), 98 (49 per group), 52 (26 per group) and 10 (5 per group) obtained 0,1,2 and 3 blastocysts after the first stimulation, respectively. The cumulative-live-birth-rate was 9% in the control group after the first attempt (N = 13/143). Among the 130 non-pregnant patients, only 12 returned within 1-year (165±95days later;discontinuation rate=118/130,91%), and 3 delivered. Thus, the cumulative-live-birth-rate from two stimulations in 1-year was 11% (N = 16/143). In the DuoStim group, the cumulative-live-birth-rate was 24% (N = 35/143; Fisher’s-exact-test< 0.01,power=80%). The odds-ratio of delivering in the DuoStim versus the control group adjusted for all matching criteria was 3.3,95%CI:1.6–7.0,p<0.01. This difference (0%,22%,15% and 20% in the control versus 10%,31%,46% and 40% in the DuoStim group among patients obtaining 0,1,2 and 3 blastocysts at the first stimulation, respectively) is mainly due to treatment discontinuation in the control group (98%,65%,77% and 80% among patients obtaining 0,1,2 and 3 blastocysts at the first stimulation, respectively) and the further increased maternal age at the time of second retrieval (∼6 months). Notably, 2 patients delivered 2 live-births after DuoStim (none in the control) and 14 patients with a live-birth have euploid blastocysts left (2 in the control).
Limitations, reasons for caution
Randomized-controlled-trials and cost-effectiveness analyses are desirable to confirm these data. Moreover, 75% of the patients included were >39yr and 44% obtained no blastocyst after the first stimulation. Therefore future studies among younger women and/or more women obtaining ≥1 blastocyst are advisable to set reasonable cut-off values to apply this strategy.
Wider implications of the findings: A second stimulation in the same ovarian cycle might be envisioned as a rescue strategy for poor IVF outcomes after a first stimulation, so to prevent treatment discontinuation and increase the cumulative-live-birth-rate. This is feasible since 6–7 days span the first and the second stimulation in the DuoStim protocol.
Trial registration number
none
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Affiliation(s)
- A Vaiarelli
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - S Colamaria
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - M Giuliani
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - C Argento
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - G Fabozzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - S Ferrero
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | | | - J Holte
- Carl Von Linné Clinic, GeneraLife IVF, Uppsala, Sweden
| | - E Trabucco
- Clinica Ruesch, GeneraLife IVF, Naples, Italy
| | - C Livi
- Demetra, GeneraLife IVF, Florence, Italy
| | | | | | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
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Giuliani M. SP-0012 ESTRO Curricula done and published - Now what? Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08455-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chiu K, Hosni A, Huang SH, Tong L, Xu W, Lu L, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Spreafico A, Irish J, Gilbert R, Gullane P, Goldstein D, O'Sullivan B, Hope A. The Potential Impact and Usability of the Eighth Edition TNM Staging Classification in Oral Cavity Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e442-e449. [PMID: 34261594 DOI: 10.1016/j.clon.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/15/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
AIMS In the current eighth edition head and neck TNM staging, extranodal extension (ENE) is an adverse feature in oral cavity squamous cell cancer (OSCC). The previous seventh edition N1 with ENE is now staged as N2a. Seventh edition N2+ with ENE is staged as N3b in the eighth edition. We evaluated its potential impact on patients treated with surgery and postoperative intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS OSCC patients treated with primary surgery and adjuvant (chemo)radiotherapy between January 2005 and December 2014 were reviewed. Cohorts with pathological node-negative (pN-), pathological node-positive without ENE (pN+_pENE-) and pathological node-positive with ENE (pN+_pENE+) diseases were compared for local control, regional control, distant control and overall survival. The pN+ cohorts were further stratified into seventh edition N-staging subgroups for outcomes comparison. RESULTS In total, 478 patients were evaluated: 173 pN-; 159 pN+_pENE-; 146 pN+_pENE+. Outcomes at 5 years were: local control was identical (78%) in all cohorts (P = 0.892), whereas regional control was 91%, 80% and 68%, respectively (P < 0.001). Distant control was 97%, 87%, 68% (P < 0.001) and overall survival was 75%, 53% and 39% (P < 0.001), respectively. Overall survival for N1 and N2a subgroups was not significantly different. In the seventh edition N2b subgroup of pENE- (n = 79) and pENE+ (n = 79) cohorts, overall survival was 67% and 37%, respectively. In the seventh edition N2c subgroups, overall survival for pENE- (n = 17) and pENE+ (n = 38) cohorts was 65% and 35% (P = 0.08), respectively. Overall, an additional 128 patients (42% pN+) were upstaged as N3b. CONCLUSIONS When eighth edition staging was applied, stage migration across the N2-3 categories resulted in expected larger separations of overall survival by stage. Patients treated with primary radiation without surgical staging should have outcomes carefully monitored. Strategies to predict ENE preoperatively and trials to improve the outcomes of pENE+ patients should be explored.
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Affiliation(s)
- K Chiu
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada; Department of Head and Neck Oncology, Mount Vernon Cancer Centre, Northwood, London, UK
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - S H Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - L Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - W Xu
- Division of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - L Lu
- Division of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - A Bayley
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - S Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - M Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - A Spreafico
- Department of Medical Oncology, Princess Margaret Cancer Centre/ University of Toronto, Toronto, Ontario, Canada
| | - J Irish
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - R Gilbert
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - P Gullane
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - D Goldstein
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - B O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - A Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
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Bufi E, Piacentini M, Belli P, Conti M, Ciriello G, Franceschini G, Giuliani M, Terribile D, Valente I, Manfredi R. Is subareolar intraoperative biopsy still necessary to predict nipple involvement? Eur Rev Med Pharmacol Sci 2021; 25:661-668. [PMID: 33577020 DOI: 10.26355/eurrev_202101_24627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To predict the occult tumor involvement of nipple-areola complex (NAC) using preoperative MR imaging and to investigate whether the intraoperative histopathological examination of the subareolar tissue is still necessary. PATIENTS AND METHODS Out of 712 patients submitted to nipple-sparing mastectomy (NSM) between 2014 and 2019, we selected 188 patients who underwent preoperative breast MRI. Breast MRI and intraoperative histopathological examination of the subareolar tissue were performed to predict NAC involvement at permanent pathology. All parameters were correlated with final pathological NAC assessment by univariate and multivariate analysis. RESULTS Forty-three patients (22.9%) had tumor involvement of the NAC. At univariate analysis, non-mass enhancement type (p = 0.009), multifocality/multicentricity (p = 0.002), median tumor size (p < 0.001), median tumor-NAC distance measured by MRI (p < 0.001), tumor-NAC distance ≤ 10 mm (p < 0.001) and tumor-NAC distance ≤ 20 mm (p < 0.001), and lymphovascular invasion (p = 0.001) were significantly correlated with NAC involvement. At multivariate analysis, only tumor-NAC distance ≤ 10 mm retained statistical significance. The sensitivity and specificity of MRI tumor-NAC distance ≤ 10 mm were 79.1% and 97.2% and those of intraoperative pathologic assessment were 74,4% and 100%, respectively. CONCLUSIONS Tumor-NAC distance is the only reliable MRI characteristic that can predict NAC involvement in breast cancer patients. Although several cut-offs showed promising performances, intraoperative pathologic assessment is still mandatory.
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Affiliation(s)
- E Bufi
- UOC Radiologia Diagnostica ed Interventistica Generale, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
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Passoni S, Giuliani M, Arigoni M. Increased incidence of complicated acute appendicitis after the first COVID-19 pandemic peak: Have patients a different attitude towards COVID-hospitals? Br J Surg 2021. [PMCID: PMC8195103 DOI: 10.1093/bjs/znab202.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective The 11 March 2020 the World Health Organisation considered the COVID-19 Infection a pandemic disease. Between March and May 2020, the region of southern Switzerland was affected by the first pandemic peak, which was managed by dividing hospitals in Covid and non Covid facilities and by reducing elective surgery. At the end of the pandemic peak hospitals returned to their original structure but there was concern as to possible avoidance of former COVID facilities by patients because of fear of contracting of COVID-19 infection. For acute situations such as acute appendicitis, this could imply a delay of treatment. The aim of this retrospective study is to analyse the increment in incidence of complicated appendicitis in the post-pandemic period at our institution. Methods Clinical data of patients who underwent appendectomies in the period before and after the COVID-19 pandemic were analysed and compared. Diagnosis was based histopathological examination and/or on intra-operative or CT findings. Complicated appendicitis was defined as the presence of perforated or gangrenous appendicitis on histopathology or the presence of an abscess on CT scan. The incidence of complicated appendicitis, the time between onset of symptoms and patient admission (TOSA), the initial inflammatory blood tests and the complication rate was compared between the two periods. Results 79 patients were included in the study, 31 in the post-COVID-19 peak group (A), April - October 2020, and 48 in the pre-pandemic group (B), April - October 2019. Incidence of complicated appendicitis was significantly higher in group A (55% vs 14% p = 0.02). These findings correlate with a greater TOSA (mean time 35 hours vs 17 hours, p = 0.01) and higher inflammatory values in the initial blood test, (mean WBC count 14.8 G/l vs 12.9 G/l, p = 0.08 and mean CRP value 73 mg/l vs 43 mg/l, p = 0.01) in group A. Conclusion Our data show a clear increase of incidence of complicated acute appendicitis after the pandemic peak in our hospital. Indeed patients tended to wait longer to visit our emergency department after the pandemic peak. One explanation is a possible fear by the patients of contracting COVID-19 infection in a former COVID hospital. Management of surgical emergencies during and after a pandemic peak phase should take into account the fact that patients may wait longer to visit a doctor thus aggravating the degree of their disease.
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Affiliation(s)
- S Passoni
- Department of General Surgery, Cantonal Hospital La Carità, Locarno, Switzerland
| | - M Giuliani
- Department of General Surgery, Cantonal Hospital La Carità, Locarno, Switzerland
| | - M Arigoni
- Department of General Surgery, Cantonal Hospital La Carità, Locarno, Switzerland
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Vaiarelli A, Cimadomo D, Alviggi E, Sansone A, Trabucco E, Dusi L, Buffo L, Barnocchi N, Fiorini F, Colamaria S, Giuliani M, Argento C, Rienzi L, Ubaldi FM. The euploid blastocysts obtained after luteal phase stimulation show the same clinical, obstetric and perinatal outcomes as follicular phase stimulation-derived ones: a multicenter study. Hum Reprod 2021; 35:2598-2608. [PMID: 32951051 DOI: 10.1093/humrep/deaa203] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 04/06/2020] [Revised: 07/13/2020] [Indexed: 01/26/2023] Open
Abstract
STUDY QUESTION Are the reproductive outcomes (clinical, obstetric and perinatal) different between follicular phase stimulation (FPS)- and luteal phase stimulation (LPS)-derived euploid blastocysts? SUMMARY ANSWER No difference was observed between FPS- and LPS-derived euploid blastocysts after vitrified-warmed single embryo transfer (SET). WHAT IS KNOWN ALREADY Technical improvements in IVF allow the implementation non-conventional controlled ovarian stimulation (COS) protocols for oncologic and poor prognosis patients. One of these protocols begins LPS 5 days after FPS is ended (DuoStim). Although, several studies have reported similar embryological outcomes (e.g. fertilization, blastulation, euploidy) between FPS- and LPS-derived cohort of oocytes, information on the reproductive (clinical, obstetric and perinatal) outcomes of LPS-derived blastocysts is limited to small and retrospective studies. STUDY DESIGN, SIZE, DURATION Multicenter study conducted between October 2015 and March 2019 including all vitrified-warmed euploid single blastocyst transfers after DuoStim. Only first transfers of good quality blastocysts (≥BB according to Gardner and Schoolcraft's classification) were included. If euploid blastocysts obtained after both FPS and LPS were available the embryo to transfer was chosen blindly. The primary outcome was the live birth rate (LBR) per vitrified-warmed single euploid blastocyst transfer in the two groups. To achieve 80% power (α = 0.05) to rule-out a 15% difference in the LBR, a total of 366 first transfers were required. Every other clinical, as well as obstetric and perinatal outcomes, were recorded. PARTICIPANTS/MATERIALS, SETTING, METHODS Throughout the study period, 827 patients concluded a DuoStim cycle and among them, 339 did not identify any transferable blastocyst, 145 had an euploid blastocyst after FPS, 186 after LPS and 157 after both FPS and LPS. Fifty transfers of poor quality euploid blastocysts were excluded and 49 patients did not undergo an embryo transfer during the study period. Thus, 389 patients had a vitrified-warmed SET of a good quality euploid blastocyst (182 after FPS and 207 after LPS). For 126 cases (32%) where both FPS- and LPS-derived good quality blastocysts were available, the embryo transferred was chosen blindly with a 'True Random Number Generator' function where '0' stood for FPS-derived euploid blastocysts and '1' for LPS-derived ones (n = 70 and 56, respectively) on the website random.org. All embryos were obtained with the same ovarian stimulation protocol in FPS and LPS (GnRH antagonist protocol with fixed dose of rec-FSH plus rec-LH and GnRH-agonist trigger), culture conditions (continuous culture in a humidified atmosphere with 37°C, 6% CO2 and 5% O2) and laboratory protocols (ICSI, trophectoderm biopsy in Day 5-7 without assisted hatching in Day 3, vitrification and comprehensive chromosome testing). The women whose embryos were included had similar age (FPS: 38.5 ± 3.1 and LPS: 38.5 ± 3.2 years), prevalence of male factor, antral follicle count, basal hormonal characteristics, main cause of infertility and previous reproductive history (i.e. previous live births, miscarriages and implantation failures) whether the embryo came from FPS or LPS. All transfers were conducted after warming in an artificial cycle. The blastocysts transferred after FPS and LPS were similar in terms of day of full-development and morphological quality. MAIN RESULTS AND THE ROLE OF CHANCE The positive pregnancy test rates for FPS- and LPS-derived euploid blastocysts were 57% and 62%, biochemical pregnancy loss rates were 10% and 8%, miscarriage rates were 15% and 14% and LBRs were 44% (n = 80/182, 95% CI 37-51%) and 49% (n = 102/207, 95% CI 42-56%; P = 0.3), respectively. The overall odds ratio for live birth (LPS vs FPS (reference)) adjusted for day of blastocyst development and quality, was 1.3, 95% CI 0.8-2.0, P = 0.2. Among patients with euploid blastocysts obtained following both FPS and LPS, the LBRs were also similar (53% (n = 37/70, 95% CI 41-65%) and 48% (n = 27/56, 95% CI 35-62%) respectively; P = 0.7). Gestational issues were experienced by 7.5% of pregnant women after FPS- and 10% of women following LPS-derived euploid single blastocyst transfer. Perinatal issues were reported in 5% and 0% of the FPS- and LPS-derived newborns, respectively. The gestational weeks and birthweight were similar in the two groups. A 5% pre-term delivery rate was reported in both groups. A low birthweight was registered in 2.5% and 5% of the newborns, while 4% and 7% showed high birthweight, in FPS- and LPS-derived euploid blastocyst, respectively. Encompassing the 81 FPS-derived newborns, a total of 9% were small and 11% large for gestational age. Among the 102 LPS-derived newborns, 8% were small and 6% large for gestational age. No significant difference was reported for all these comparisons. LIMITATIONS, REASONS FOR CAUTION The LPS-derived blastocysts were all obtained after FPS in a DuoStim protocol. Therefore, studies are required with LPS-only, late-FPS and random start approaches. The study is powered to assess differences in the LBR per embryo transfer, therefore obstetric and perinatal outcomes should be considered observational. Although prospective, the study was not registered. WIDER IMPLICATIONS OF THE FINDINGS This study represents a further backing of the safety of non-conventional COS protocols. Therefore, LPS after FPS (DuoStim protocol) is confirmed a feasible and efficient approach also from clinical, obstetric and perinatal perspectives, targeted at patients who need to reach the transfer of an euploid blastocyst in the shortest timeframe possible due to reasons such as cancer, advanced maternal age and/or reduced ovarian reserve and poor ovarian response. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Alberto Vaiarelli
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Danilo Cimadomo
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy.,Clinica Ruesch, GENERA Center for Reproductive Medicine, Napoli, Italy.,GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy.,GENERA Umbria, GENERA Center for Reproductive Medicine, Umbertide, Italy
| | - Erminia Alviggi
- Clinica Ruesch, GENERA Center for Reproductive Medicine, Napoli, Italy
| | - Anna Sansone
- Clinica Ruesch, GENERA Center for Reproductive Medicine, Napoli, Italy
| | | | - Ludovica Dusi
- GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | - Laura Buffo
- GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | | | - Fabrizio Fiorini
- GENERA Umbria, GENERA Center for Reproductive Medicine, Umbertide, Italy
| | - Silvia Colamaria
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Maddalena Giuliani
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Cindy Argento
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Laura Rienzi
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy.,Clinica Ruesch, GENERA Center for Reproductive Medicine, Napoli, Italy.,GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | - Filippo Maria Ubaldi
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy.,Clinica Ruesch, GENERA Center for Reproductive Medicine, Napoli, Italy.,GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
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Rienzi L, Cimadomo D, Maggiulli R, Vaiarelli A, Dusi L, Buffo L, Amendola MG, Colamaria S, Giuliani M, Bruno G, Stoppa M, Ubaldi FM. Definition of a clinical strategy to enhance the efficacy, efficiency and safety of egg donation cycles with imported vitrified oocytes. Hum Reprod 2021; 35:785-795. [PMID: 32240287 DOI: 10.1093/humrep/deaa009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 01/01/2023] Open
Abstract
STUDY QUESTION Which is the most suitable clinical strategy in egg donation IVF cycles conducted with imported donated vitrified oocytes? SUMMARY ANSWER The importation, and allocation, of at least eight vitrified eggs per couple during an egg donation cycle is associated with a high cumulative live birth delivery rate per cycle, as well as the confident adoption of a single blastocyst transfer strategy to minimize the risk of multiple pregnancies. WHAT IS KNOWN ALREADY IVF using donor eggs is commonly used worldwide to treat women who are unable to conceive with their own oocytes. In 2014, the Constitutional Court (n.162/2014) gave permission for gamete donation to be allowed for ART in Italy. Initially recommended as a therapeutic approach for premature ovarian insufficiency, the use of donated oocytes has become more and more common. In countries such as Italy, fresh oocyte donation is theoretically possible, but practically impossible due to the lack of donors. In fact, the Italian law does not allow reimbursement to the young women, who can only voluntarily donate their eggs. Therefore, Italian IVF centers have established several collaborations with international oocyte cryo-banks. The most popular workflow involves the importation of donated oocytes that have been vitrified. However, recent evidence has questioned the overall efficacy of such an approach. This is because detrimental effects arising from oocyte vitrification and warming might reduce the number of eggs available for insemination, with a consequential reduction in the achievable live birth rate per cycle. STUDY DESIGN, SIZE, DURATION This was a longitudinal cohort study, conducted between October 2015 and December 2018 at two private IVF centers. Overall, 273 couples were treated (mean maternal age: 42.5 ± 3.5 years, range: 31-50 years; mean donor age: 25.7 ± 4.2, 20-35 years) with oocytes purchased from three different Spanish egg banks. PARTICIPANTS/MATERIALS, SETTING, METHODS We performed an overall analysis, as well as several sub-analyses clustering the data according to the year of treatment (2015-2016, 2017 or 2018), the number of warmed (6, 7, 8 or 9) and surviving oocytes (≤4, 5, 6, 7, 8 or 9) and the cycle strategy adopted (cleavage stage embryo transfer and vitrification, cleavage stage embryo transfer and blastocyst vitrification, blastocyst stage embryo transfer and vitrification). This study aimed to create a workflow to maximize IVF efficacy, efficiency, and safety, during egg donation cycles with imported vitrified oocytes. The primary outcome was the cumulative live birth delivery rate among completed cycles (i.e. cycles where at least a delivery of a live birth was achieved, or no embryo was produced/left to transfer). All cycles, along with their embryological, obstetric and neonatal outcomes, were registered and inspected. MAIN RESULTS AND THE ROLE OF CHANCE The survival rate after warming was 86 ± 16%. When 6, 7, 8 and 9 oocytes were warmed, 94, 100, 72 and 70% of cycles were completed, resulting in 35, 44, 69 and 59% cumulative live birth delivery rates per completed cycle, respectively. When ≤4, 5, 6, 7, 8 and 9 oocytes survived, 98, 94, 85, 84, 66 and 68% of cycles were completed, resulting in 16, 46, 50, 61, 76 and 60% cumulative live birth delivery rates per completed cycle, respectively. When correcting for donor age, and oocyte bank, in a multivariate logistic regression analysis, warming eight to nine oocytes resulted in an odds ratio (OR) of 2.5 (95% CI: 1.07-6.03, P = 0.03) for the cumulative live birth delivery rate per completed cycle with respect to six to seven oocytes. Similarly, when seven to nine oocytes survived warming, the OR was 2.7 (95% CI: 1.28-5.71, P < 0.01) with respect to ≤6 oocytes. When cleavage stage embryos were transferred, a single embryo transfer strategy was adopted in 17% of cases (N = 28/162); the live birth delivery rate per transfer was 26% (n = 43/162), but among the pregnancies to term, 28% involved twins (n = 12/43). Conversely, when blastocysts were transferred, a single embryo transfer strategy was adopted in 96% of cases (n = 224/234) with a 30% live birth delivery rate per transfer (N = 70/234), and the pregnancies to term were all singleton (n = 70/70). During the study period, 125 babies were born from 113 patients. When comparing the obstetric outcomes for the cleavage and blastocyst stage transfer strategies, the only significant difference was the prevalence of low birthweight: 34 versus 5%, respectively (P < 0.01). However, several significant differences were identified when comparing singleton with twin pregnancies; in fact, the latter resulted in a generally lower birthweight (mean ± SD: 3048 ± 566 g versus 2271 ± 247 g, P < 0.01), a significantly shorter gestation (38 ± 2 versus 36 ± 2 weeks, P < 0.01), solely Caesarean sections (72 versus 100%, P = 0.02), a higher prevalence of low birthweight (8 versus 86%, P < 0.01), small newborns for gestational age (24 versus 57%, P = 0.02) and preterm births (25 versus 86%, P < 0.01). LIMITATIONS, REASONS FOR CAUTION This retrospective study should now be confirmed across several IVF centers and with a greater sample size in order to improve the accuracy of the sub-analyses. WIDER IMPLICATIONS OF THE FINDINGS Single blastocyst transfer is the most suitable approach to achieve high success rates per procedure, thereby also limiting the obstetric complications that arise from twin pregnancies in oocyte donation programs. In this regard, the larger the cohort of imported donated vitrified oocytes, the more efficient the management of each cycle. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER None.
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Affiliation(s)
- Laura Rienzi
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy.,GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | - Danilo Cimadomo
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy.,GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | - Roberta Maggiulli
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Alberto Vaiarelli
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Ludovica Dusi
- GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | - Laura Buffo
- GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | | | - Silvia Colamaria
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Maddalena Giuliani
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Giulietta Bruno
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Marta Stoppa
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Filippo Maria Ubaldi
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy.,GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
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Porro B, Amadio P, Cavalca V, Barbieri S, Eligini S, Gorini A, Fiorelli S, Werba J, Giuliani M, Tremoli E, Trabattoni D. Pathophysiological aspects of takotsubo syndrome: Focus on endothelial dysfunction, oxidative stress and coagulation system. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.784] [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: 11/25/2022]
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18
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Huo M, Morley L, Dawson L, Bissonnette J, Helou J, Giuliani M, Berlin A, Shultz D, Hosni A, Shessel A, Barry A. PO-1757: Peer Review in Stereotactic Body Radiotherapy: The Impact of Case Volume. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Watson E, Xu W, Giuliani M, Huang J, Huang S, O'Sullivan B, Ringash J, Hosni A, Kim J, Waldron J, Bayley A, Cho J, Bratman S, Goldstein D, Maxymiw W, Glogauer M, Hope A. PO-0805: Dental insurance status influences prophylactic dental care prior to head and neck radiation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00822-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Traverso A, Hosni Abdalaty A, Hasan M, Tadic T, Patel T, Giuliani M, Kim J, Ringash J, Cho J, Bratman S, Bayley A, Waldron J, O'Sullivan B, Irish J, Chepeha D, De Almeida J, Goldstein D, Jaffray D, Wee L, Dekker A, Hope A. PO-1549: Non-invasive prediction of lymph node risk in oral cavity cancer patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Latini A, Donà MG, Giuliani M, Magri F, Zaccarelli M. Implications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic for sexual behaviours of men who have sex with men. HIV Med 2020; 22:e7-e8. [PMID: 32892480 DOI: 10.1111/hiv.12954] [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: 06/05/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- A Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - M G Donà
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - M Giuliani
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - F Magri
- Department of Dermatology, Policlinico Umberto I, The Sapienza University of Rome, Rome, Italy
| | - M Zaccarelli
- Clinical Department, National Institute for the Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
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Rienzi L, Cimadomo D, Maggiulli R, Vaiarelli A, Dusi L, Buffo L, Amendola MG, Colamaria S, Giuliani M, Bruno G, Stoppa M, Ubaldi FM. Corrigendum. Definition of a clinical strategy to enhance the efficacy, efficiency and safety of egg donation cycles with imported vitrified oocytes. Hum Reprod 2020; 35:1944. [DOI: 10.1093/humrep/deaa145] [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] [Received: 10/05/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura Rienzi
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
- GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | - Danilo Cimadomo
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
- GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | - Roberta Maggiulli
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Alberto Vaiarelli
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Ludovica Dusi
- GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | - Laura Buffo
- GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
| | | | - Silvia Colamaria
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Maddalena Giuliani
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Giulietta Bruno
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Marta Stoppa
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
| | - Filippo Maria Ubaldi
- Clinica Valle Giulia, GENERA Center for Reproductive Medicine, Rome, Italy
- GENERA Veneto, GENERA Center for Reproductive Medicine, Marostica, Italy
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23
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Giuliani M, Brual J, Cameron E, Chaiton M, Eng L, Haque M, Liu G, Mittmann N, Papadakos J, Saunders D, Truscott R, Evans W. Smoking Cessation in Cancer Care: Myths, Presumptions and Implications for Practice. Clin Oncol (R Coll Radiol) 2020; 32:400-406. [PMID: 32029357 DOI: 10.1016/j.clon.2020.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/26/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
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24
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Day D, Prawira A, Spreafico A, Waldron J, Karithanam R, Giuliani M, Weinreb I, Kim J, Cho J, Hope A, Bayley A, Ringash J, Bratman SV, Jang R, O'Sullivan B, Siu LL, Hansen AR. Phase I trial of alpelisib in combination with concurrent cisplatin-based chemoradiotherapy in patients with locoregionally advanced squamous cell carcinoma of the head and neck. Oral Oncol 2020; 108:104753. [PMID: 32464516 DOI: 10.1016/j.oraloncology.2020.104753] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 04/11/2020] [Accepted: 04/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Deregulation of the PI3K signalling pathway is frequent in squamous cell carcinoma of the head and neck (SCCHN) and may be implicated in radioresistance. We report on the results from a phase I 3 + 3 dose escalation study of alpelisib, a class I α-specific PI3K inhibitor in combination with concurrent cisplatin-based chemoradiation (CRT) in patients with locoregionally advanced SCCHN (LA-SCCHN). METHODS Eligible patients had previously untreated LA-SCCHN and were candidates for CRT. The primary objective was to evaluate safety and determine the recommended phase II dose (RP2D). Alpelisib was given orally once daily at two dose levels: 200 mg and 250 mg. CRT consisted of cisplatin 100 mg/m2 IV every three weeks and standard fractionation radiotherapy (IMRT) 70 Gy in 35 fractions. RESULTS Nine patients were enrolled (six alpelisib 200 mg, three 250 mg). Oropharynx was the primary site in all patients (seven p16-positive; five T1-2N2M0, four T3-4N2-3M0 [AJCC 7th edition]). All patients completed CRT within seven weeks. Grade 3 alpelisib-related toxicities occurred in four patients. No dose-limiting toxicity (DLT) was observed at 200 mg among three DLT-evaluable patients. Two of two DLT-evaluable patients treated at 250 mg experienced DLTs (inability to complete ≥75% alpelisib secondary to radiation dermatitis and febrile neutropenia). Thus, RP2D was declared at 200 mg. After median follow-up of 39.7 months, two patients developed pulmonary metastases despite locoregional control. Three-year overall survival was 77.8% (95% CI 36.5%-93.9%). CONCLUSION Alpelisib at 200 mg has a manageable safety profile in combination with cisplatin-based CRT in LA-SCCHN.
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Affiliation(s)
- D Day
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - A Prawira
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - A Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - J Waldron
- Radiation Medicine Program, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - R Karithanam
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - M Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - I Weinreb
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - J Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - J Cho
- Radiation Medicine Program, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - A Hope
- Radiation Medicine Program, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - A Bayley
- Radiation Medicine Program, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - J Ringash
- Radiation Medicine Program, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - S V Bratman
- Radiation Medicine Program, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - R Jang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - B O'Sullivan
- Radiation Medicine Program, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - L L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - A R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada.
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25
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Giuliani M, Martimianakis MA, Broadhurst M, Papadakos J, Fazelad R, Driessen E, Frambach J. Humanism in global oncology curricula: an emerging priority. ACTA ACUST UNITED AC 2020; 27:46-51. [PMID: 32218660 DOI: 10.3747/co.27.5461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Training in humanism provides skills important for improving the quality of care received by patients, achieving shared decision-making with patients, and navigating systems-level challenges. However, because of the dominance of the biomedical model, there is potentially a lack of attention to humanistic competencies in global oncology curricula. In the present study, we aimed to explore the incorporation of humanistic competencies into global oncology curricula. Methods This analysis considered 17 global oncology curricula. A curricular item was coded as either humanistic (as defined by the iecares framework) or non-humanistic. If identified as humanistic, the item was coded using an aspect of humanism, such as Altruism, from the iecares framework. All items, humanistic and not, were coded under the canmeds framework using 1 of the 7 canmeds competency domains: Medical Expert, Communicator, Collaborator, Leader, Scholar, Professional, or Health Advocate. Results Of 7792 identified curricular items in 17 curricula, 780 (10%) aligned with the iecares humanism framework. The proportion of humanistic items in individual curricula ranged from 2% to 26%, and the proportion increased from 3% in the oldest curricula to 11% in the most recent curricula. Of the humanistic items, 35% were coded under Respect, 31% under Compassion, 24% under Empathy, 5% under Integrity, 2% under Excellence, 1% under Altruism, and 1% under Service. Within the canmeds domains, the humanistic items aligned mostly with Professional (35%), Medical Expert (31%), or Communicator (25%). Conclusions The proportion of humanistic competencies has been increasing in global oncology curricula over time, but the overall proportion remains low and represents a largely Western perspective on what constitutes humanism in health care. The representation of humanism focuses primarily on the iecares attributes of Respect, Compassion, and Empathy.
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Affiliation(s)
- M Giuliani
- Radiation Medicine Program, Princess Margret Cancer Centre, and Department of Radiation Oncology, University of Toronto
| | | | - M Broadhurst
- Cancer Education, Princess Margret Cancer Centre
| | - J Papadakos
- Cancer Education, Princess Margret Cancer Centre
| | - R Fazelad
- Information Sciences, Princess Margret Cancer Centre, Toronto, ON
| | - E Driessen
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences
| | - J Frambach
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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Vaiarelli A, Cimadomo D, Conforti A, Schimberni M, Giuliani M, D'Alessandro P, Colamaria S, Alviggi C, Rienzi L, Ubaldi FM. Luteal phase after conventional stimulation in the same ovarian cycle might improve the management of poor responder patients fulfilling the Bologna criteria: a case series. Fertil Steril 2019; 113:121-130. [PMID: 31837743 DOI: 10.1016/j.fertnstert.2019.09.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 04/19/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the clinical contribution of luteal-phase stimulation (LPS) to follicular-phase stimulation (FPS) in a single ovarian cycle (DuoStim) for poor responder patients fulfilling the Bologna criteria. DESIGN Observational study (years 2015-2017) including women satisfying ≥2 of the following characteristics: maternal age ≥40 years and/or ≤3 oocytes retrieved after previous conventional stimulation and/or reduced ovarian reserve (i.e., antral follicle count <7 follicles or antimüllerian hormone <1.1 ng/mL). The LPS was started regardless of the outcome of the FPS. SETTING Private in vitro fertilization center. PATIENT(S) A total of 100 of 297 patients fulfilling the Bologna criteria chose to undergo DuoStim. INTERVENTION(S) The FPS and LPS with the same antagonist protocol and agonist trigger, intracytoplasmic sperm injection with ejaculated sperm, preimplantation genetic testing for aneuploidies, and vitrified-warmed euploid single blastocyst transfer. MAIN OUTCOME MEASURE(S) The contribution of LPS to the cumulative live birth rate (CLBR) per intention-to-treat (ITT). RESULT(S) Patients (100) underwent FPS (maternal age, 42.1 ± 1.4 y; previous in vitro fertilization cycles with ≤3 collected oocytes, 0.7 ± 0.9; antral follicle count, 3.8 ± 1.2 follicles; and antimüllerian hormone, 0.56 ± 0.3 ng/mL). Ninety-one patients completed DuoStim. All patients were included in the analysis. More oocytes were obtained after LPS with similar developmental and chromosomal competence as paired FPS-derived ones. The CLBR per ITT increased from 7% after FPS to 15% after DuoStim. Conversely, the CLBR per ITT among the 197 patients that chose a conventional controlled ovarian stimulation strategy was 8%, as only 17 patients who were not pregnant returned for a second stimulation after the first attempt (drop-out rate, 81%). CONCLUSION(S) The LPS-derived oocytes increased the CLBR per ITT in a single ovarian cycle in patients fulfilling the Bologna criteria. The DuoStim strategy is promising to manage this thorny population of patients, especially to avoid discontinuation after a first failed attempt.
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Affiliation(s)
- Alberto Vaiarelli
- Clinica Valle Giulia, G.EN.E.R.A., Centers for Reproductive Medicine, BioRoma, Rome, Rome, Italy.
| | - Danilo Cimadomo
- Clinica Valle Giulia, G.EN.E.R.A., Centers for Reproductive Medicine, BioRoma, Rome, Rome, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | | | - Maddalena Giuliani
- Clinica Valle Giulia, G.EN.E.R.A., Centers for Reproductive Medicine, BioRoma, Rome, Rome, Italy
| | - Pietro D'Alessandro
- Clinica Ruesch, G.EN.E.R.A. Centers for Reproductive Medicine, Naples, Italy
| | - Silvia Colamaria
- Clinica Valle Giulia, G.EN.E.R.A., Centers for Reproductive Medicine, BioRoma, Rome, Rome, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Laura Rienzi
- Clinica Valle Giulia, G.EN.E.R.A., Centers for Reproductive Medicine, BioRoma, Rome, Rome, Italy
| | - Filippo Maria Ubaldi
- Clinica Valle Giulia, G.EN.E.R.A., Centers for Reproductive Medicine, BioRoma, Rome, Rome, Italy
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Abdelmutti N, Brual J, Papadakos J, Fathima S, Goldstein D, Eng L, Papadakos T, Liu G, Jones J, Giuliani M. Implementation of a comprehensive smoking cessation program in cancer care. ACTA ACUST UNITED AC 2019; 26:361-368. [PMID: 31896934 DOI: 10.3747/co.26.5201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Quitting smoking after a cancer diagnosis maximizes treatment-related effects, improves prognosis, and enhances quality of life. However, smoking cessation (sc) services are not routinely integrated into cancer care. The Princess Margaret Cancer Centre implemented a digitally-based sc program in oncology, leveraging an e-referral system (cease) to screen all new ambulatory patients, provide tailored education and advice on quitting, and facilitate referrals. Methods We adopted the Framework for Managing eHealth Change to guide implementation of the sc program by integrating 6 key elements: governance and leadership, stakeholder engagement, communication, workflow analysis and integration, monitoring and evaluation, and training and education. Results Incorporating elements of the Framework, we used extensive stakeholder engagement and strategic partnerships to establish a sc program with organizational and provincial accountability. Existing electronic patient-reported assessments were changed to integrate cease. Clinic audits and staff engagement allowed for analysis of workflow, ongoing monitoring and evaluation that aided in establishing a communication strategy, and development of cancer-specific education for patients and health care providers. From April 2016 to March 2018, 22,137 new patients were eligible for screening. Among those new patients, 13,617 (62%) were screened, with 1382 (10%) being current smokers and 532 (4%) having recently quit (within 6 months). Of the current smokers and those who had recently quit, all were advised to quit or to stay smoke-free, and 380 (20%) accepted referral to a sc counselling service. Conclusions Here, we provide a comprehensive practice blueprint for the implementation of digitally based sc programs as a standard of care within comprehensive cancer centres with high patient volumes.
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Affiliation(s)
- N Abdelmutti
- Cancer Strategy Stewardship Program, Princess Margaret Cancer Centre, Toronto, ON
| | - J Brual
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, ON
| | - J Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, ON.,Patient Education, Cancer Care Ontario, Toronto, ON
| | - S Fathima
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, ON
| | - D Goldstein
- Otolaryngology, Head and Neck Surgery Clinic, Princess Margaret Cancer Centre, Toronto, ON
| | - L Eng
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON
| | - T Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, ON.,Patient Education, Cancer Care Ontario, Toronto, ON
| | - G Liu
- Otolaryngology, Head and Neck Surgery Clinic, Princess Margaret Cancer Centre, Toronto, ON.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON
| | - J Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON
| | - M Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, ON.,Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
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Lajolo C, Leso V, Gioco G, Patini R, Fedele M, Giuliani M, Iavicoli I. Chemical hazard for dental hygienists: a systematic review. Eur Rev Med Pharmacol Sci 2019; 23:7713-7721. [PMID: 31599397 DOI: 10.26355/eurrev_201909_18980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Dental hygienists (DHs) are professionals responsible for oral health. They deal with professional oral hygiene, counselling, and screening patients for oral health, as well as preventing and treating oral diseases. However, DH responsibilities and duties may vary worldwide, characterising changeable occupational exposure scenarios and making it difficult to achieve a suitable evaluation of workplace risks, particularly regarding chemical exposure. Therefore, the aim of the present work was to provide a comprehensive overview on the current knowledge on DH chemical risks. MATERIALS AND METHODS According to the PRISMA guidelines, a systematic review of PubMed, Scopus, and Isi Web of Knowledge databases was performed to retrieve all articles assessing DH occupational chemical exposures. RESULTS Fragmented data are currently available on DH chemical risk, due to the limited number of studies on the topic and few DHs enrolled, as well as their frequent assimilation to other oral healthcare professionals. The majority of the retrieved investigations focused on possible hypersensitivity reactions caused by natural rubber latex exposure, but not on potential risks derived from other currently employed substances or innovative wide-spreading compounds. CONCLUSIONS Future research should be focused on assessing DH chemical risks according to a more comprehensive and toxicologically standardised approach to achieve an appropriate awareness among the DH workforce concerning the possibility for hazardous exposure and adverse health effects. Overall, this may lead to the adoption/implementation of adequate preventive measures to protect the health and safety of these oral healthcare professionals.
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Affiliation(s)
- C Lajolo
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS", School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy.
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29
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Eng L, Su J, Hueniken K, Brown M, Hope A, Bezjak A, Sacher A, Bradbury P, Shepherd F, Leighl N, Pierre A, Selby P, Goldstein D, Xu W, Giuliani M, Evans W, Liu G, Chaiton M. P1.10-05 Tobacco Retail Availability and Tobacco Cessation Among Lung Cancer Survivors. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Donà MG, Chiantore MV, Gheit T, Fiorucci G, Vescio MF, La Rosa G, Accardi L, Costanzo G, Giuliani M, Romeo G, Rezza G, Tommasino M, Luzi F, Di Bonito P. Comprehensive analysis of β- and γ-human papillomaviruses in actinic keratosis and apparently healthy skin of elderly patients. Br J Dermatol 2019; 181:620-622. [PMID: 30825192 DOI: 10.1111/bjd.17836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- M G Donà
- STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - M V Chiantore
- Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - T Gheit
- Department of Infectious Diseases, EVOR Unit, Istituto Superiore di Sanità, Rome, Italy
| | - G Fiorucci
- Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
- Infections and Cancer Biology Group, IARC, Lyon, France
| | - M F Vescio
- Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - G La Rosa
- Institute of Molecular Biology and Pathology, CNR, Rome, Italy
| | - L Accardi
- Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - G Costanzo
- Department of Environment and Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - M Giuliani
- STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - G Romeo
- National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy
| | - G Rezza
- Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - M Tommasino
- Department of Infectious Diseases, EVOR Unit, Istituto Superiore di Sanità, Rome, Italy
| | - F Luzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy
| | - P Di Bonito
- Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute IRCCS, Rome, Italy
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31
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Lajolo C, Favia G, Limongelli L, Tempesta A, Zuppa A, Cordaro M, Vanella I, Giuliani M. Brain abscess of odontogenic origin in children: a systematic review of the literature with emphasis on therapeutic aspects and a new case presentation. ACTA ACUST UNITED AC 2019; 39:67-74. [PMID: 31097823 PMCID: PMC6522858 DOI: 10.14639/0392-100x-2281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/20/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022]
Abstract
Brain abscesses (BAs) are rare but life-threatening infections. BAs of an odontogenic origin should always be considered as a possible aetiological factor, especially when other infectious foci are not present. Clinical presentation in children may be ambiguous and pose a difficult differential diagnosis: the identification of causal bacteria can be difficult and odontogenic origin is often a diagnosis of exclusion. The aim of this paper was to systematically review the literature reports with particular emphasis on therapy and propose a diagnostic flowchart for odontogenic brain abscess in children. A systematic literature review was performed on PubMed, Scopus and ISI Web of Science to identify cases of BAs in children and discuss clinical management: only human research articles, published in peer-reviewed English language journals, were included. Among 109 articles, 7 publications were selected for data analysis: clinical data could be extracted for only 8 subjects; different clinical approaches are descripted in the reports, even if therapy should be started as soon as possible to prevent rapid diffusion to the rest of the central nervous system. Due to their rarity and ambiguous clinical presentation in children, BAs of odontogenic origin are difficult to diagnose. A thorough oral-maxillofacial investigation should always be performed to exclude an oral origin.
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Affiliation(s)
- C Lajolo
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS"; School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Favia
- Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, "Aldo Moro" University, Bari, Italy
| | - L Limongelli
- Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, "Aldo Moro" University, Bari, Italy
| | - A Tempesta
- Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, "Aldo Moro" University, Bari, Italy
| | - A Zuppa
- Department of Women's and Children's Health, Division of Paediatrics, "Fondazione Policlinico Universitario A. Gemelli - IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Cordaro
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS"; School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Vanella
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS"; School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Giuliani
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
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Billfalk Kelly A, Lin L, Xu W, Huang S, Wu R, Bayley A, Bratman S, Kim J, Giuliani M, Ringash J, Waldron J, O”Sullivan B, Cho J, Goldstein D, Hosni A, Hope A. EP-1201 Outcomes in young patients (<40) treated for oral cavity squamous cell carcinoma in the modern era. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31621-4] [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: 11/16/2022]
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Huang S, Yu E, Billfalk-Kelly A, Su J, Waldron J, Bartlett E, Bayley A, Bratman S, Cho J, Giuliani M, Hope A, Hosni A, Kim J, Ringash J, Hansen A, De Almeida J, Tong L, Xu W, O’Sullivan B. OC-007 Radiologic extranodal extension portends worse outcome in TNM-8 cT1-T2N1 HPV + oropharyngeal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30173-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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D'Angelo A, Rinaldi P, Belli P, D'Amico R, Carlino G, Grippo C, Giuliani M, Orlandi A, Infante A, Manfredi R. Usefulness of automated breast volume scanner (ABVS) for monitoring tumor response to neoadjuvant treatment in breast cancer patients: preliminary results. Eur Rev Med Pharmacol Sci 2019; 23:225-231. [PMID: 30657564 DOI: 10.26355/eurrev_201901_16768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We investigated the accuracy of Automated Breast Volume Scanner (ABVS) compared to handheld ultrasound (HHUS) for monitoring tumor response to neoadjuvant treatment (NAT) in breast cancer (BC). PATIENTS AND METHODS All the patients submitted to biopsy in our Institution, from January 2017 to May 2017, proven invasive BC and eligible for NAT, were enrolled in this prospective study. The participants underwent ABVS, HHUS, dynamic contrast-enhanced Magnetic Resonance Imaging (DCE-MRI) and mammography at the beginning of NAT and ABVS, HHUS and DCE-MRI at the halfway point of therapy and before the surgery. DCE-MRI was considered the standard of reference. Two breast radiologists (R1, R2), with fifteen and five years of experience in breast imaging, independently assigned a visibility score (ordinal 5-point scale) to ABVS, HHUS, and DCE-MRI. Diagnostic performance of ABVS and HHUS as measured by sensitivity, specificity, positive and negative predictive values (PPV and NPV) was calculated. Correlations between ABVS and MRI, and between HHUS and MRI were analyzed using Pearson's correlation test. RESULTS A total of 21 patients were enrolled. 189 examinations were performed. The comparison between ABVS and DCE-MRI was similar for the both readers: ABVS had a sensitivity of 63,16%, specificity of 83,58%, PPV of 76,60%, NPV of 72,73%, accuracy of 74,19% (R1) and a sensitivity of 54.54%, specificity of 85.51%, PPV of 75%, NPV of 70,24%, accuracy of 71.77% (R2). The comparison between HHUS and DCE-MRI showed that HHUS had a sensitivity of 63,16 %, specificity of 83,58%, PPV of 76,60%, NPV of 72,73%, accuracy of 74,19% (R1) and a sensitivity of 36.84%, specificity of 85.07%, PPV of 67.74%, NPV of 61.29%, accuracy of 62.90% (R2). The calculated Pearson's correlation coefficient r values were 7.8 for HHUS vs. DCE-MRI and 28.5 for ABVS vs. DCE-MRI (R1) and 7.8 for HHUS vs. DCE-MRI and 22.4 for ABVS vs. DCE-MRI (R2). Statistical significance of ABVS and HHUS was p < 0.0001 and 0.005 < p < 0.01, respectively (R1, R2). CONCLUSIONS DCE-MRI is recommended for the tumor response assessment. ABVS, a product of the biotechnology development, providing reproducible images, in addition to DCE-MRI, can be a potentially useful tool for the monitoring of response to NAT.
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Affiliation(s)
- A D'Angelo
- Dipartimento di Scienze Radiologiche, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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Oar A, Yap M, Rodin D, McNiven A, Papadakos J, Giuliani M. Postgraduate Global Health Competency Profile for Radiation Oncology. Clin Oncol (R Coll Radiol) 2018; 30:810-816. [DOI: 10.1016/j.clon.2018.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022]
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Moraes F, Giuliani M, Quartey N, Cardozo J, Icliates N, Tittenbrun Z, Papadakos J, Brierley J. Closing the Gap on the Availability of Cancer Staging Information for Healthcare Providers in the Global Cancer Community: Development of a Multilingual Cancer Staging Video Series. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.59600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Tumor, Node, Metastases (TNM) classification system provide valuable measures to researchers in facilitating the understanding of disparities in outcomes and allowing for the comparison of these outcomes over time. There is a lack of multimodal formats for disseminating comprehensive information and education about cancer stage to the global cancer community. To address this gap, the Departments of Radiation Oncology and Cancer Education at the Princess Margaret Cancer Centre (PM) (Toronto, Canada) in collaboration with The Union for International Cancer Control (UICC) envisioned the development of a cancer staging video series. Aim: To provide current and accurate information on cancer staging to healthcare professionals and stakeholders for global cancer control. Strategy/Tactics: The Cancer Education program worked with experts in the field of cancer staging to develop 8 videos (average length 4 min) to provide information to the global cancer community about existing information on key issues with cancer staging and how to properly stage patients using the TNM classification. Videos include references to current research and examples of staging across various cancers to illustrate and reinforce the importance of cancer staging. Script development involved defining key messages, refining learning objectives and breaking up information to ensure the content is digestible and easy to understand. Prior to video production, draft scripts were reviewed by international collaborators for completeness of information and accuracy of content. Videos contain appropriate text on screen to reinforce key messages and include a narrated voiceover to orient the learner. To expand the global reach, trained faculties translated the English videos and scripts, into the 5 official United Nations languages: Arabic, Chinese, French, Russian and Spanish. Program/Policy process: Videos in the cancer staging series include: The Importance of Cancer Staging; What is Cancer Stage; General Rules for Cancer Staging; Cancer Staging Examples; Staging Terminology; Importance of a Common Stage Language; Why Stage Language Changes; Essential TNM. Videos will be made available on UICC and PM Web sites (free of charge and globally advertised). Outcomes: The video series will increase education and awareness on the importance of a unified approach to cancer staging among the larger community and have the aim to empower the community on how to access cancer and define prognosis, treatment and or trial eligibility. What was learned: The development and promotion of the cancer staging video series was a meaningful, collaborative and challenging activity. It was learned that educational videos need to be well-designed and simple to provide axiomatic information on cancer stating to the global cancer control community.
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Affiliation(s)
- F.Y. Moraes
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Department of Radiation Oncology, Toronto, Canada
| | - M. Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Department of Radiation Oncology, Toronto, Canada
| | - N.K. Quartey
- Princess Margaret Cancer Centre, Toronto, Canada
| | - J. Cardozo
- University Health Network, Toronto, Canada
| | | | - Z. Tittenbrun
- Union for International Cancer Control, Geneva, Switzerland
| | - J. Papadakos
- Princess Margaret Cancer Centre, Toronto, Canada
| | - J. Brierley
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Department of Radiation Oncology, Toronto, Canada
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Eng L, Liu S, Farzanfar D, Alton D, Smith E, Mccartney A, Yeung S, Basgaran A, Balaratnam K, Mattina K, Harper C, Mohan R, Brown M, Hope A, Bradbury P, Sacher A, Leighl N, Shepherd F, Bezjak A, Howell D, Jones J, Xu W, Goldstein D, Evans W, Selby P, Giuliani M, Liu G. MA18.07 Awareness of the Harms of Continued Smoking Among Lung Cancer (LC) Survivors. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abdelmutti N, Brual J, Jones J, Goldstein D, Liu G, Eng L, Papadakos J, Papadakos T, Giuliani M. Implementation of a Comprehensive Hospital-Based Smoking-Cessation Program in Cancer. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.98400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Quitting smoking after a cancer diagnosis minimizes treatment-related effects, improves prognosis and enhances quality of life. However, smoking cessation has yet to be integrated as a standard component of cancer care and cessation programs are underused. Aim: To address this gap between evidence and practice, the Princess Margaret Cancer Centre in Toronto, Canada sought to implement a comprehensive, evidence-based program that would introduce smoking cessation–related screening, referrals and education as standard practice in cancer care. Strategy/Tactics: We adapted the Framework for Managing eHealth Change to guide successful implementation of a Smoking Cessation Program (SCP) utilizing 6 components: 1) Leadership and governance 2) Stakeholder engagement and partnerships 3) Communication 4) Patient and provider education 5) Analysis and clinical integration 6) Monitoring and evaluation of program performance metrics. Program/Policy process: The SCP designed, tested and implemented a multilingual e-referral system (CEASE) to screen patients for smoking status, provide education and advice on quitting, and generate an electronic referral to cessation programs. Partnerships were established with 3 smoking-cessation programs to offer patients a breadth of services tailored to individual needs, preferences and medical history. Patient and provider education was developed to address the unique knowledge gaps, beliefs and stigma associated with smoking and a cancer diagnosis. Outcomes: Program metrics indicate that of 11,366 new patients eligible for screening between April 2017 to March 2018, 62% (n = 6629) were screened with 10% (n = 655) identifying as current smokers and 4% (n = 261) as recent quitters (6 months or less). Of smokers and recent quitters, 21% (n = 170) accepted a referral to a smoking-cessation program. What was learned: The implementation of the SCP presents a comprehensive blueprint to establish a smoking-cessation program as a standard of quality care. Elements of the SCP can be adapted to local, regional and national contexts. Future directions include assessing strategies to increase screening and referral rates, collection of long-term outcomes, and integration into the patient portal.
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Affiliation(s)
- N. Abdelmutti
- Princess Margaret Cancer Centre, Cancer Strategy Stewardship, Toronto, Canada
| | - J. Brual
- Princess Margaret Cancer Centre, Toronto, Canada
| | - J. Jones
- Princess Margaret Cancer Centre, Toronto, Canada
| | - D. Goldstein
- Princess Margaret Cancer Centre, Toronto, Canada
| | - G. Liu
- Princess Margaret Cancer Centre, Toronto, Canada
| | - L. Eng
- Princess Margaret Cancer Centre, Toronto, Canada
| | - J. Papadakos
- Princess Margaret Cancer Centre, Toronto, Canada
| | - T. Papadakos
- Princess Margaret Cancer Centre, Toronto, Canada
| | - M. Giuliani
- Princess Margaret Cancer Centre, Toronto, Canada
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Fabeni L, Alteri C, Di Carlo D, Orchi N, Carioti L, Bertoli A, Gori C, Forbici F, Continenza F, Maffongelli G, Pinnetti C, Vergori A, Mondi A, Ammassari A, Borghi V, Giuliani M, De Carli G, Pittalis S, Grisetti S, Pennica A, Mastroianni CM, Montella F, Cristaudo A, Mussini C, Girardi E, Andreoni M, Antinori A, Ceccherini-Silberstein F, Perno CF, Santoro MM. Dynamics and phylogenetic relationships of HIV-1 transmitted drug resistance according to subtype in Italy over the years 2000-14. J Antimicrob Chemother 2018; 72:2837-2845. [PMID: 29091206 DOI: 10.1093/jac/dkx231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/09/2017] [Indexed: 11/14/2022] Open
Abstract
Background Transmitted drug-resistance (TDR) remains a critical aspect for the management of HIV-1-infected individuals. Thus, studying the dynamics of TDR is crucial to optimize HIV care. Methods In total, 4323 HIV-1 protease/reverse-transcriptase sequences from drug-naive individuals diagnosed in north and central Italy between 2000 and 2014 were analysed. TDR was evaluated over time. Maximum-likelihood and Bayesian phylogenetic trees with bootstrap and Bayesian-probability supports defined transmission clusters. Results Most individuals were males (80.2%) and Italian (72.1%), with a median (IQR) age of 37 (30-45) years. MSM accounted for 42.2% of cases, followed by heterosexuals (36.4%). Non-B subtype infections accounted for 30.8% of the overall population and increased over time (<2005-14: 19.5%-38.5%, P < 0.0001), particularly among Italians (<2005-14: 6.5%-28.8%, P < 0.0001). TDR prevalence was 8.8% and increased over time in non-B subtypes (<2005-14: 2%-7.1%, P = 0.018). Overall, 467 transmission clusters (involving 1207 individuals; 27.9%) were identified. The prevalence of individuals grouping in transmission clusters increased over time in both B (<2005-14: 12.9%-33.5%, P = 0.001) and non-B subtypes (<2005-14: 18.4%-41.9%, P = 0.006). TDR transmission clusters were 13.3% within the overall cluster observed and dramatically increased in recent years (<2005-14: 14.3%-35.5%, P = 0.005). This recent increase was mainly due to non-B subtype-infected individuals, who were also more frequently involved in large transmission clusters than those infected with a B subtype [median number of individuals in transmission clusters: 7 (IQR 6-19) versus 4 (3-4), P = 0.047]. Conclusions The epidemiology of HIV transmission changed greatly over time; the increasing number of transmission clusters (sometimes with drug resistance) shows that detection and proper treatment of the multi-transmitters is a major target for controlling HIV spread.
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Affiliation(s)
- L Fabeni
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - C Alteri
- University of Rome Tor Vergata, Rome, Italy
| | - D Di Carlo
- University of Rome Tor Vergata, Rome, Italy
| | - N Orchi
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - L Carioti
- University of Rome Tor Vergata, Rome, Italy
| | - A Bertoli
- University of Rome Tor Vergata, Rome, Italy
| | - C Gori
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - F Forbici
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - F Continenza
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | | | - C Pinnetti
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - A Vergori
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - A Mondi
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - A Ammassari
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - V Borghi
- Modena University Hospital, Modena, Italy
| | - M Giuliani
- San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - G De Carli
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - S Pittalis
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - S Grisetti
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | | | | | - F Montella
- S. Giovanni Addolorata Hospital, Rome, Italy
| | - A Cristaudo
- San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - C Mussini
- Modena University Hospital, Modena, Italy
| | - E Girardi
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | - M Andreoni
- University Hospital Tor Vergata, Rome, Italy
| | - A Antinori
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
| | | | - C F Perno
- National Institute for Infectious Diseases L Spallanzani, IRCCS, Rome, Italy
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Galli J, Calo L, Meucci D, Giuliani M, Lucidi D, Paludetti G, Torelli R, Sanguinetti M, Parrilla C. Biofilm in voice prosthesis: A prospective cohort study and laboratory tests using sonication and SEM analysis. Clin Otolaryngol 2018; 43:1260-1265. [PMID: 29768730 DOI: 10.1111/coa.13141] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The objective of the study was to compare the biofilm growing pattern and its morphological extent on silicone and a teflon-like material using a sonication process and a Scanning Electron Microscope (SEM). DESIGN A prospective cohort study and a laboratory study. SETTING Otolaryngology -Head and Neck surgery Department and the Microbiology Institute. PARTICIPANTS The participants included fifteen laryngectomised patients with phonatory prostheses, which were removed because of device failure, and two different kinds of phonatory prostheses from the laboratory (Provox 2 and ActiValve) that were artificially colonised by Candida albicans. MAIN OUTCOME MEASURES Tracheo-oesophageal puncture (TEP) is currently considered the gold standard for post-laryngectomy voice rehabilitation. "Leakage" represents the most common cause of substitution and is generated by biofilm colonisation of the prosthesis by mixed mycotic and bacterial agents. New biomaterials have been developed that are deemed to be more resistant to the colonisation of micro-organisms and material deformation. RESULTS The devices showed colonisation by mixed bacterial flora (Staphylococci 13%, Streptococci 9%, and Haemophilus influenzae 5%) and by yeasts (Candida albicans 12%). Moreover, we observed a different distribution of biofilm layers in Provox ActiValve (22.56%) compared to Provox 2 (56.82%) after experimental colonisation by the previously isolated Candida strain. CONCLUSION Resident microbiological species from the upper airways unavoidably colonise the polymer surfaces, and no strategies have been effective except for the manipulation of the chemical-physical properties of the device's polymer. Our study confirms that Provox ActiValve, which is made with a fluoroplastic material (teflon-like), is less subject to in vitro colonisation by Candida, and thus showed a higher clinical resistance to biofilm and a longer lifespan. The sonication seems to significantly improve the knowledge of bacterial and mycotic flora in biofilm colonisation. The design of a device for the daily cleaning capable to reach and brush the oesophageal flange of the prosthesis preserving the valve mechanism could represent a practical and simple help in this still unsolved problem.
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Affiliation(s)
- J Galli
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology and Institute of Microbiology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - L Calo
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology and Institute of Microbiology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - D Meucci
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology and Institute of Microbiology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - M Giuliani
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology and Institute of Microbiology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - D Lucidi
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology and Institute of Microbiology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - G Paludetti
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology and Institute of Microbiology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - R Torelli
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology and Institute of Microbiology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - M Sanguinetti
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology and Institute of Microbiology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - C Parrilla
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology and Institute of Microbiology, Catholic University School of Medicine and Surgery, Rome, Italy
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Ardito F, Perrone D, Giuliani M, Testa NF, Muzio LL. Effects of Curcumin on Squamous Cell Carcinoma of Tongue: An In Vitro Study. Curr Top Med Chem 2018; 18:233-243. [PMID: 29651934 DOI: 10.2174/1568026618666180412153824] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/02/2018] [Accepted: 04/05/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Squamous Cell Carcinoma of the Tongue (TSCC) is the most frequent cancer of oral cavity often characterized by poor prognosis. Conventional therapies are not very efficient and often may cause serious side effects. In this context, introduction of natural substances as possible adjuvant in the treatment and prevention of cancer is becoming a relevant topic. In fact, curcumin has been used for decades in Chinese traditional medicine for its beneficial effects. Curcumin has anticancer properties in many tumors however, its action on the tongue carcinoma is not entirely clear and many other investigations are necessary. OBJECTIVE Curcumin seems to be a good adjuvant in the treatment of head and neck tumors. However, these studies are generic and there are not many specific studies on TSCC, the most frequent and most aggressive cancer of the head-neck region. Our goal is to demonstrate its effectiveness also for TSCC. METHODS In this study, we evaluated the effects of curcumin on TSCC cells using different concentrations (1, 5, 10, 20 and 50 µM) and 3 different treatment times (24, 48 and 72 hours). The inhibition of adhesion, proliferation, viability, migration and apoptosis was studied. RESULTS IC50 value of curcumin is about 10 µM and there have been inhibitory effects even for treatments at low concentrations. Curcumin reduces migration and progression of TSCC cells and it promotes apoptosis and inhibits tumorigenesis. CONCLUSIONS These results suggest the possible use of curcumin as an anti-cancer agent in TSCC. However, in vivo studies are needed to confirm these effects and overcome its low bioavailability.
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Affiliation(s)
- F Ardito
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - D Perrone
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - M Giuliani
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - N F Testa
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - L Lo Muzio
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
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Hosni A, Huang S, Chiu K, Xu W, Su J, Tong L, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, O’Sullivan B, Ringash J, Waldron J, De Almeida J, Chepeha D, Goldstein D, Hope A. OC-0277: Development and validation of distant metastases risk group classification in oral cavity cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Hosni A, Huang S, Chiu K, Xu W, Su J, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, O’Sullivan B, Ringash J, Hansen A, De Almeida J, Monteiro E, Chepeha D, Gilbert R, Irish J, Goldstein D, Waldron J, Hope A. PO-0709: Postoperative salvage therapy for early recurrence in oral cavity squamous cell carcinoma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Scasso F, Ferrari G, DE Vincentiis GC, Arosio A, Bottero S, Carretti M, Ciardo A, Cocuzza S, Colombo A, Conti B, Cordone A, DE Ciccio M, Delehaye E, Della Vecchia L, DE Macina I, Dentone C, DI Mauro P, Dorati R, Fazio R, Ferrari A, Ferrea G, Giannantonio S, Genta I, Giuliani M, Lucidi D, Maiolino L, Marini G, Marsella P, Meucci D, Modena T, Montemurri B, Odone A, Palma S, Panatta ML, Piemonte M, Pisani P, Pisani S, Prioglio L, Scorpecci A, Scotto DI Santillo L, Serra A, Signorelli C, Sitzia E, Tropiano ML, Trozzi M, Tucci FM, Vezzosi L, Viaggi B. Emerging and re-emerging infectious disease in otorhinolaryngology. Acta Otorhinolaryngol Ital 2018; 38:S1-S106. [PMID: 29967548 PMCID: PMC6056203 DOI: 10.14639/0392-100x-suppl.1-38-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.
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Affiliation(s)
- F Scasso
- SOC Otorinolaringoiatria, ASL 3 Genovese, Ospedale P.A. Micone, Genova, Italy
| | - G Ferrari
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - G C DE Vincentiis
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - A Arosio
- Clinica Otorinolaringoiatria, Ospedale Macchi, ASST Settelaghi, Varese, Italy
| | - S Bottero
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M Carretti
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - A Ciardo
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - S Cocuzza
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - A Colombo
- SOC Otorinolaringoiatria, Ospedale Cardinal Massaia, Asti, Italy
| | - B Conti
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - A Cordone
- SOC Otorinolaringoiatria, ASL 3 Genovese, Ospedale P.A. Micone, Genova, Italy
| | - M DE Ciccio
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - E Delehaye
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - L Della Vecchia
- Clinica Otorinolaringoiatria, Ospedale Macchi, ASST Settelaghi, Varese, Italy
| | - I DE Macina
- SOC Malattie Infettive, ASL 1 Imperiese, Ospedale di Sanremo, Italy
| | - C Dentone
- SOC Malattie Infettive, ASL 1 Imperiese, Ospedale di Sanremo, Italy
| | - P DI Mauro
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - R Dorati
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - R Fazio
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - A Ferrari
- Direzione Sanitaria, AOU Parma, Italy
| | - G Ferrea
- SOC Malattie Infettive, ASL 1 Imperiese, Ospedale di Sanremo, Italy
| | - S Giannantonio
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - I Genta
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - M Giuliani
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - D Lucidi
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - L Maiolino
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - G Marini
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - P Marsella
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - D Meucci
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - T Modena
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - B Montemurri
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - A Odone
- Facoltà di Medicina e Chirurgia, Università Vita-Salute San Raffaele, Milano, Italy
| | - S Palma
- SOC Otorinolaringoiatria, Azienda Sanitaria Universitaria di Udine (ASUIUD), Italy
| | - M L Panatta
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M Piemonte
- SOC Otorinolaringoiatria, Azienda Sanitaria Universitaria di Udine (ASUIUD), Italy
| | - P Pisani
- SOC Otorinolaringoiatria, Ospedale Cardinal Massaia, Asti, Italy
| | - S Pisani
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - L Prioglio
- SOC Otorinolaringoiatria, ASL 3 Genovese, Ospedale P.A. Micone, Genova, Italy
| | - A Scorpecci
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | | | - A Serra
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - C Signorelli
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy; Facoltà di Medicina e Chirurgia, Università Vita-Salute San Raffaele, Milano, Italy
| | - E Sitzia
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M L Tropiano
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M Trozzi
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - F M Tucci
- UOS Chirurgia Cervicale ORL, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - L Vezzosi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy; Dipartimento di Medicina Sperimentale, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - B Viaggi
- SOC Neuroanestesia e Rianimazione, A.O.U. Careggi, Firenze, Italy
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Peulen H, Sonke J, Van Werkhoven E, Werner-Wasik M, Grills I, Giuliani M, Hope A, Mantel F, Guckenberger M, Belderbos J. PV-0042: SBRT for peripheral lung tumors >5 cm: first results of the multicenter phase I/II VOLUMES trial. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Adamo D, Sardella A, Varoni E, Lajolo C, Biasotto M, Ottaviani G, Vescovi P, Simonazzi T, Pentenero M, Ardore M, Spadari F, Bombeccari G, Montebugnoli L, Gissi DB, Campisi G, Panzarella V, Carbone M, Valpreda L, Giuliani M, Aria M, Lo Muzio L, Mignogna MD. The association between burning mouth syndrome and sleep disturbance: A case-control multicentre study. Oral Dis 2018; 24:638-649. [DOI: 10.1111/odi.12807] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 01/03/2023]
Affiliation(s)
- D Adamo
- Oral Medicine Complex Unit; Head & Neck Clinical Section; Department of Neurosciences, Reproductive and Odontostomatological Sciences; “Federico II” University of Naples; Naples Italy
| | - A Sardella
- Unit of Oral Pathology, Oral Medicine and Gerodontology; Department of Biomedical, Surgical and Dental Sciences; AO San Paolo Hospital of Milan; University of Milan; Milan Italy
| | - E Varoni
- Unit of Oral Pathology, Oral Medicine and Gerodontology; Department of Biomedical, Surgical and Dental Sciences; AO San Paolo Hospital of Milan; University of Milan; Milan Italy
| | - C Lajolo
- Oral Pathology and Medicine; School of Dentistry; Catholic University of Rome; Rome Italy
| | - M Biasotto
- Oral Medicine and Pathology Unit; Department of Medical, Surgical and Health Sciences; University of Trieste; Trieste Italy
| | - G Ottaviani
- Oral Medicine and Pathology Unit; Department of Medical, Surgical and Health Sciences; University of Trieste; Trieste Italy
| | - P Vescovi
- Unit of Oral Pathology, Medicine and Laser Surgery; Department of Biomedical, Biotechnological and Translational Sciences; University of Parma; Parma Italy
| | - T Simonazzi
- Unit of Oral Pathology, Medicine and Laser Surgery; Department of Biomedical, Biotechnological and Translational Sciences; University of Parma; Parma Italy
| | - M Pentenero
- Oral Medicine and Oral Oncology Unit; Department of Oncology; University of Turin; Turin Italy
| | - M Ardore
- Oral Medicine and Oral Oncology Unit; Department of Oncology; University of Turin; Turin Italy
| | - F Spadari
- Unit of Oral Pathology and Medicine; Department of Biomedical, Surgical and Dental Sciences; University of Milan; Ospedale Maggiore Policlinico IRCCS Ca’ Granda Foundation; Milan Italy
| | - G Bombeccari
- Unit of Oral Pathology and Medicine; Department of Biomedical, Surgical and Dental Sciences; University of Milan; Ospedale Maggiore Policlinico IRCCS Ca’ Granda Foundation; Milan Italy
| | - L Montebugnoli
- Unit of Oral Pathology and Medicine; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - DB Gissi
- Unit of Oral Pathology and Medicine; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - G Campisi
- Department of Surgical, Oncological, and Oral Sciences; Sector of Oral Medicine “Valerio Margiotta”; University of Palermo; Palermo Italy
| | - V Panzarella
- Department of Surgical, Oncological, and Oral Sciences; Sector of Oral Medicine “Valerio Margiotta”; University of Palermo; Palermo Italy
| | - M Carbone
- Oral Medicine Section; Department of Surgical Sciences; CIR Dental School; University of Turin; Turin Italy
| | - L Valpreda
- Oral Medicine Section; Department of Surgical Sciences; CIR Dental School; University of Turin; Turin Italy
| | - M Giuliani
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - M Aria
- Laboratory and Research Group STAD Statistics, Technology; Data Analysis Department of Economics and Statistics; “Federico II University of Naples”; Naples Italy
| | - L Lo Muzio
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - MD Mignogna
- Oral Medicine Complex Unit; Head & Neck Clinical Section; Department of Neurosciences, Reproductive and Odontostomatological Sciences; “Federico II” University of Naples; Naples Italy
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Giuliani M, Bartolini E, Galli B, Santini L, Lo Surdo P, Buricchi F, Bruttini M, Benucci B, Pacchiani N, Alleri L, Donnarumma D, Pansegrau W, Peschiera I, Ferlenghi I, Cozzi R, Norais N, Giuliani MM, Maione D, Pizza M, Rappuoli R, Finco O, Masignani V. Human protective response induced by meningococcus B vaccine is mediated by the synergy of multiple bactericidal epitopes. Sci Rep 2018; 8:3700. [PMID: 29487324 PMCID: PMC5829249 DOI: 10.1038/s41598-018-22057-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/13/2018] [Indexed: 12/21/2022] Open
Abstract
4CMenB is the first broad coverage vaccine for the prevention of invasive meningococcal disease caused by serogroup B strains. To gain a comprehensive picture of the antibody response induced upon 4CMenB vaccination and to obtain relevant translational information directly from human studies, we have isolated a panel of human monoclonal antibodies from adult vaccinees. Based on the Ig-gene sequence of the variable region, 37 antigen-specific monoclonal antibodies were identified and produced as recombinant Fab fragments, and a subset also produced as full length recombinant IgG1 and functionally characterized. We found that the monoclonal antibodies were cross-reactive against different antigen variants and recognized multiple epitopes on each of the antigens. Interestingly, synergy between antibodies targeting different epitopes enhanced the potency of the bactericidal response. This work represents the first extensive characterization of monoclonal antibodies generated in humans upon 4CMenB immunization and contributes to further unraveling the immunological and functional properties of the vaccine antigens. Moreover, understanding the mechanistic nature of protection induced by vaccination paves the way to more rational vaccine design and implementation.
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Affiliation(s)
| | | | | | | | | | | | - M Bruttini
- GSK, Siena, Italy.,University of Siena, Siena, Italy
| | - B Benucci
- GSK, Siena, Italy.,University of Siena, Siena, Italy
| | | | | | | | | | - I Peschiera
- GSK, Siena, Italy.,University of Bologna, Bologna, Italy
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Cadoni G, Giraldi L, Petrelli L, Pandolfini M, Giuliani M, Paludetti G, Pastorino R, Leoncini E, Arzani D, Almadori G, Boccia S. Prognostic factors in head and neck cancer: a 10-year retrospective analysis in a single-institution in Italy. Acta Otorhinolaryngol Ital 2017; 37:458-466. [PMID: 28663597 PMCID: PMC5782422 DOI: 10.14639/0392-100x-1246] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/15/2017] [Indexed: 12/30/2022]
Abstract
This study was undertaken to evaluate the association between demographics, lifestyle habits, and clinical data and overall survival (OS), recurrence and second primary cancer (SPC) in patients with first primary head and neck cancer (HNC). We retrospectively reviewed data from 482 patients treated at the "Agostino Gemelli" Teaching Hospital, Rome, between 2002-2012 for primary HNC. Individual parameters were evaluated for association with specific outcomes such as OS, cancer recurrence and second primary cancer (SPC) appearance using hazard ratios (HR) and 95% confidence intervals (CIs). Five-year OS was 60.6% for all HNC cases, 49.0% for oral cavity, 54.8% for oropharynx, 50.0% for hypopharynx and 63.4% for larynx. Predictors of OS were older age (HR = 1.04; 95% CI: 1.02-1.05) and advanced tumour stage (HR = 2.00; 95% CI: 1.41-2.84). The risk of recurrence was associated with drinking 8-14 drinks per week (HR = 1.73; 95% CI: 1.00-2.97). The risk of developing SPC increased with advanced tumour stage (HR = 2.75; 95% CI: 1.39-5.44) and with smoking for more than 40 years (HR = 3.68; 95% CI: 1.10-12.30). OS differed among HNC sites. Increasing age was an unfavourable predictor of HNC OS. Tumour stage was a prognostic factor both for OS and for risk of developing SPC. Alcohol and tobacco consumption were prognostic factors for recurrence and SPC, respectively.
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Affiliation(s)
- G. Cadoni
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
| | - L. Giraldi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L. Petrelli
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
| | - M. Pandolfini
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
| | - M. Giuliani
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
| | - G. Paludetti
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
| | - R. Pastorino
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E. Leoncini
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D. Arzani
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G. Almadori
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
| | - S. Boccia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
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Raziee H, Hope A, Bezjak A, Sun A, Cho J, Bissonnette J, Vines D, Driscoll B, Giuliani M. P1.14-016 Assessing the Feasibility of FLT-PET for Evaluation of Non-Small Cell Lung Cancer (NSCLC) Treated with Stereotactic Body Radiotherapy (SBRT). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1034] [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: 11/16/2022]
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Giuliani M, Hope A, Guckenberger M, Mantel F, Sonke J, Peulen H, Belderbos J, Werner-Wasik M, Ye H, Grills I. MA 13.09 Toxicity and Second Primary Lung Cancers in Late Survivors Following Lung SBRT. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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