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Minnema J, Polinder-Bos HA, Cesari M, Dockery F, Everink IHJ, Francis BN, Gordon AL, Grund S, Perez Bazan LM, Eruslanova K, Topinková E, Vassallo MA, Faes MC, van Tol LS, Caljouw MAA, Achterberg WP, Haaksma ML. The Impact of Delirium on Recovery in Geriatric Rehabilitation after Acute Infection. J Am Med Dir Assoc 2024:105002. [PMID: 38670170 DOI: 10.1016/j.jamda.2024.03.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Delirium is common during acute infection in older patients and is associated with functional decline. Geriatric rehabilitation (GR) can help older patients to return to their premorbid functional level. It is unknown whether delirium affects GR outcomes in patients with acute infection. We evaluated whether delirium affects trajectories of activities of daily living (ADL) and quality of life (QoL) recovery in GR after COVID-19 infection. DESIGN This study was part of the EU-COGER study, a multicenter cohort study conducted between October 2020 and October 2021. SETTING AND PARTICIPANTS Participants were recruited after COVID-19 infection from 59 GR centers in 10 European countries. METHODS Data were collected at GR admission, discharge, and at the 6-week and 6-month follow-ups. Trajectories of ADL [using the Barthel index (BI)] and QoL [using the EuroQol-5 Dimensions-5 Level (EQ-5D-5L)] recovery were examined using linear mixed models. RESULTS Of the 723 patients included (mean age 75.5 ± 9.9 years; 52.4% male), 28.9% had delirium before or during GR admission. Participants with delirium recovered in ADL at approximately the same rate as those without (linear slope effect = -0.13, SE 0.16, P = .427) up to an estimated BI score of 16.1 at 6 months. Similarly, participants with delirium recovered in QoL at approximately the same rate as those without (linear slope effect = -0.017, SE 0.015, P = .248), up to an estimated EQ-5D-5L score of 0.8 at 6 months. CONCLUSIONS AND IMPLICATIONS Presence of delirium during the acute phase of infection or subsequent GR did not influence the recovery trajectory of ADL functioning and QoL.
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Affiliation(s)
- J Minnema
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - H A Polinder-Bos
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Cesari
- IRCCS Istituti Clinici Maugeri, University of Milan, Milan, Italy
| | - F Dockery
- Department of Geriatric Medicine, Beaumont Hospital, Dublin, Ireland
| | - I H J Everink
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - B N Francis
- Fliman Geriatric Rehabilitation Centre, Haifa, Israel; Geriatric Division, Holy Family Hospital, Bar Ilan University, Safad, Israel
| | - A L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, United Kingdom
| | - S Grund
- Centre for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Centre at the Heidelberg University, Heidelberg, Germany
| | - L M Perez Bazan
- RE-FiT Barcelona Research Group, Parc Sanitari Pere Virgili Hospital and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - K Eruslanova
- Russian Clinical and Research Centre of Gerontology, Moscow, Russia
| | - E Topinková
- Department of Geriatric Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic; Faculty of Health and Social Sciences, South Bohemian University, České Budějovice, Czech Republic
| | - M A Vassallo
- Geriatric Medicine Society of Malta & Telghet G'Mangia, Rehabilitation Hospital Karin Grech, Pietà, Malta
| | - M C Faes
- Department of Geriatrics, Amphia Hospital, Breda, the Netherlands
| | - L S van Tol
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - M A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - W P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
| | - M L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
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Azzolino D, Vettoretti S, Poggi MM, Soldati A, Caldiroli L, Dalla Vecchia LA, Cesari M. Poor Nutritional Status Is Associated with Death in a Population of Dialyzed Older Persons. J Frailty Aging 2024; 13:172-178. [PMID: 38616374 DOI: 10.14283/jfa.2024.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Older patients in hemodialysis have high prevalence of malnutrition that is often associated with rapid weight loss till cachexia. OBJECTIVES We aimed to investigate whether in older patients undergoing hemodialysis the association between poor nutritional status and mortality may be independent of comorbidities and other risk factors. DESIGN Retrospective longitudinal study. SETTING Unit of Nephrology, Dialysis and Kidney Transplantation of the Policlinic Hospital of Milan, Milan, Italy. PARTICIPANTS A total of 107 prevalent patients undergoing hemodialysis for at least three months. MEASUREMENTS Sociodemographic, clinical, and biological data were recorded. Unintentional weight loss (UWL) was defined as loss of body weight > 5% in 3 months or > 10% in 6 months. We computed a 21-item Frailty Index that included clinical conditions associated with malnutrition and mortality in this population. Unadjusted and adjusted Cox proportional hazard models were performed to test the association of UWL, albumin and transferrin levels with death. Survival analyses based on Kaplan-Meier estimates were performed. RESULTS Patients' age was 79 (±7.7) years; 38 (35%) were women. Thirty-one patients (29%) died during follow-up. Eighteen (16.8%) patients experienced UWL during the follow-up period. UWL was positively associated with death in the unadjusted model and even after the progressive inclusion of potential confounders. Low albumin levels were positively associated with death only in the unadjusted and partially adjusted models while low transferrin levels were not associated with death in none of the models. Mortality was significantly higher in those patients experiencing both UWL and albumin levels below 3.5 mg/dL. CONCLUSIONS In older patients undergoing chronic hemodialysis UWL is associated with mortality independently of comorbidities and other risk factors. Patients presenting both UWL and low albumin levels were those experiencing the worst outcomes in terms of mortality.
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Affiliation(s)
- D Azzolino
- Dr. Domenico Azzolino, Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via F. Sforza, 35 - 20122 Milan (Italy); ; Twitter: @doazzolino
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Orlandini L, Patrizio E, O'Halloran AM, McGarrigle CA, Romero-Ortuno R, Kenny RA, Proietti M, Cesari M. Social Vulnerability, Frailty and Self-Perceived Health: Findings from The Irish Longitudinal Study on Ageing (TILDA). J Frailty Aging 2024; 13:50-56. [PMID: 38305443 DOI: 10.14283/jfa.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Social vulnerability interacts with frailty and influences individuals' health status. Although frailty and social vulnerability are highly predictive of adverse outcomes, their relationship with self-perceived health(SPH) has been less investigated. METHODS Data are from the Irish Longitudinal Study on Ageing(TILDA), a population-based longitudinal study of ageing. We included 4,222 participants aged ≥50 years (age 61.4±8.5 years;women 56%) from Wave 1 (2009-2011) followed over three longitudinal waves (2012,2014-2015,2016). Participants responded to single questions with five response options to rate their 1)physical health, 2)mental health, and 3)health compared to peers. 30-item Frailty (FI) and Social Vulnerability (SVI) indices were calculated using standardised methods. Multivariable regression analyses were performed to establish the association between FI and SVI cross-sectionally and longitudinally over 6 years. RESULTS Cross-sectionally, SVI (mean:0.40±0.08; range:0.14-0.81) and FI (mean: 0.13±0.08; range:0.10-0.58) were modestly correlated (r=0.256), and independently associated with poor physical health (SVI: OR 1.43, 95%CI 1.15-1.78; FI: OR 3.16, 95%CI 2.54-3.93), poor mental health (SVI: OR 1.65, 95%CI 1.17-2.35; FI: OR 3.64, 95%CI 2.53-5.24), and poor health compared to peers (SVI: OR 1.41,95%CI 1.06-1.89; FI: OR 3.86, 95%CI 2.9-5.14). Longitudinally, FI and SVI were independently and positively associated with poor physical health (SVI: β 1.08, 95%CI 0.76-1.39; FI: β 1.97, 95%CI 1.58-2.36), poor mental health (SVI: β 1.18, 95%CI 0.86-1.5; FI: β 1.58, 95%CI 1.2-1.97), and poor overall health compared to peers (SVI: β 0.78, 95%CI 0.89-1.33; FI: β 1.74, 95%CI 0.47-1.1). CONCLUSIONS In a large cohort of community-dwelling older adults, frailty and social vulnerability were associated with poor SPH and with risk of SPH decline over six years.
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Affiliation(s)
- L Orlandini
- Laura Orlandini, MD, Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri Via Camaldoli 64, 20138, Milan, Italy, e-mail:
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Palmerini E, Frega G, Gambarotti M, Frisoni T, Cesari M, Bazzocchi A, Miceli M, Donati DM, Fanti S, Nanni C, Benini S, Longhi A, Paioli A, Marrari A, Hakim R, Righi A, Ibrahim T. NTRK rearranged sarcoma of the bone. Role for larotrectinib in the neoadjuvant setting of an ultra-rare tumor: a case report. Front Oncol 2023; 13:1252359. [PMID: 37876963 PMCID: PMC10591071 DOI: 10.3389/fonc.2023.1252359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Neurotrophic tyrosine receptor kinase (NTRK) gene-fusion targeted molecules revolutionized the paradigm of treatment of a limited subgroup of cancers of various histologies. Entrectinib and larotrectinib obtained unprecedented response rates in patients with cancer harboring NTRK rearrangements. This evidence recently led to the agnostic approval of these drugs, and evidence (confirmation) of their activity in a broader disease setting is emerging. Here, we report the case of a patient affected by EML4-NTRK3 rearranged undifferentiated spindle cell bone sarcoma treated with larotrectinib, and we argue (discuss about) the incidence and clinical presentation of NTRK gene-fusion positive bone sarcomas, the potential use of upfront treatment with NTRK inhibitors in neoadjuvant setting, and the role of a multidisciplinary tumor board. Despite the rarity of these rearrangements in patients with primitive bone sarcomas, the therapy with NTRK inhibitors represents a highly effective strategy to be pursued in selected cases even in neoadjuvant settings. The management of these very rare cancers should always be discussed in a multidisciplinary board of reference centers.
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Affiliation(s)
- Emanuela Palmerini
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giorgio Frega
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tommaso Frisoni
- Third Orthopaedic Clinic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marilena Cesari
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Maria Donati
- Third Orthopaedic Clinic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Stefano Fanti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Di Sant’Orsola, Bologna, Italy
| | - Cristina Nanni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Di Sant’Orsola, Bologna, Italy
| | - Stefania Benini
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandra Longhi
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Paioli
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Marrari
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rossella Hakim
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Toni Ibrahim
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Setola E, Benini S, Righi A, Gamberi G, Carretta E, Ferrari C, Avnet S, Palmerini E, Magagnoli G, Gambarotti M, Lollini PL, Cesari M, Cocchi S, Paioli A, Longhi A, Scotlandi K, Laginestra MA, Donati DM, Baldini N, Ibrahim T. IDH mutations in G2-3 conventional central bone chondrosarcoma: a mono institutional experience. BMC Cancer 2023; 23:907. [PMID: 37752419 PMCID: PMC10521511 DOI: 10.1186/s12885-023-11396-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Heterozygous isocitrate dehydrogenase (IDH) mutations occur in about half of conventional central bone chondrosarcomas (CCBC). Aim of this study was to assess the frequency and prognostic impact of IDH mutations in high grade CCBC patients. METHODS 64 patients with G2 and G3 CCBC were included. DNA extraction, PCR amplification of IDH1/2 exon 4s, and sequencing analysis with Sanger were performed. RESULTS IDH mutations were detected in 24/54 patients (44%): IDH1 in 18, IDH2 in 4, and both IDH1/2 in 2 patients. The frequency of mutations was 37% in G2 vs. 69% in G3 (p = 0.039), and 100% in three Ollier disease associated chondrosarcoma. 5-year overall survival (OS) at 124 months (range 1-166) was 51%, with no significant difference based on the IDH mutational status: 61% in IDHmut vs. 44% in IDH wild type (IDHwt). The 5-year relapse free survival (RFS) was 33% (95% CI:10-57) for IDHmut vs. 57% (95%CI: 30-77) for IDHwt. Progression free survival (PFS) was 25% (95%CI:1-65) IDHmut vs. 16% (95%CI: 0.7-52) IDHwt. 55% (5/9) of IDHmut G2 became higher grade at the recurrence, as compared with 25% (3/12) of G2 IDHwt. CONCLUSIONS This study shows a higher frequency of IDH mutations in G3 CCBC as compared with G2. No significant differences in OS, RFS, and PFS by mutational status were detected. After relapse, a higher rate of G3 for IDH mutated CCBC was observed.
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Affiliation(s)
- Elisabetta Setola
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy.
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.
| | - S Benini
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G Gamberi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - E Carretta
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - C Ferrari
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Avnet
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - E Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
| | - G Magagnoli
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - P L Lollini
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - M Cesari
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
| | - S Cocchi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Paioli
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
| | - A Longhi
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
| | - K Scotlandi
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Laginestra
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - D M Donati
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - N Baldini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Biomedical Science and Technologies Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - T Ibrahim
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
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Palmerini E, Gambarotti M, Italiano A, Nathenson MJ, Ratan R, Dileo P, Provenzano S, Jones RL, DuBois SG, Martin-Broto J, de Alava E, Baldi GG, Grignani G, Ferraresi V, Brunello A, Paoluzzi L, Bertulli R, Hindi N, Montemurro M, Rothermundt C, Cocchi S, Salguero-Aranda C, Donati D, Martin JD, Abdelhamid Ahmed AH, Mazzocca A, Carretta E, Cesari M, Pierini M, Righi A, Sbaraglia M, Laginestra MA, Scotlandi K, Dei Tos AP, Ibrahim T, Stacchiotti S, Vincenzi B. A global collaboRAtive study of CIC-rearranged, BCOR::CCNB3-rearranged and other ultra-rare unclassified undifferentiated small round cell sarcomas (GRACefUl). Eur J Cancer 2023; 183:11-23. [PMID: 36791667 DOI: 10.1016/j.ejca.2023.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/16/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Undifferentiated small round cell sarcomas (URCSs) represent a diagnostic challenge, and their optimal treatment is unknown. We aimed to define the clinical characteristics, treatment, and outcome of URCS patients. METHODS URCS patients treated from 1983 to 2019 at 21 worldwide sarcoma reference centres were retrospectively identified. Based on molecular assessment, cases were classified as follows: (1) CIC-rearranged round cell sarcomas, (2) BCOR::CCNB3-rearranged round cell sarcomas, (3) unclassified URCSs. Treatment, prognostic factors and outcome were reviewed. RESULTS In total, 148 patients were identified [88/148 (60%) CIC-rearranged sarcoma (median age 32 years, range 7-78), 33/148 (22%) BCOR::CCNB3-rearranged (median age 17 years, range 5-91), and 27/148 (18%) unclassified URCSs (median age 37 years, range 4-70)]. One hundred-one (68.2%) cases presented with localised disease; 47 (31.8%) had metastases at diagnosis. Male prevalence, younger age, bone primary site, and a low rate of synchronous metastases were observed in BCOR::CCNB3-rearranged cases. Local treatment was surgery in 67/148 (45%) patients, and surgery + radiotherapy in 52/148 (35%). Chemotherapy was given to 122/148 (82%) patients. At a 42.7-month median follow-up, the 3-year overall survival (OS) was 92.2% (95% CI 71.5-98.0) in BCOR::CCNB3 patients, 39.6% (95% CI 27.7-51.3) in CIC-rearranged sarcomas, and 78.7% in unclassified URCSs (95% CI 56.1-90.6; p < 0.0001). CONCLUSIONS This study is the largest conducted in URCS and confirms major differences in outcomes between URCS subtypes. A full molecular assessment should be undertaken when a diagnosis of URCS is suspected. Prospective studies are needed to better define the optimal treatment strategy in each URCS subtype.
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Affiliation(s)
- Emanuela Palmerini
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antoine Italiano
- Early Phase Trial and Sarcoma Unit, Institut Bergonié, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | | | - Ravin Ratan
- Department of Sarcoma Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Palma Dileo
- London Sarcoma Service, University College London Hospital, London, UK
| | - Salvatore Provenzano
- Adult mesenchymal tumours and rare cancers unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden and Institute of Cancer Research, London, UK
| | - Steven G DuBois
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Javier Martin-Broto
- Medical Oncology Department, University Hospital Fundación Jimenez Diaz, Madrid, Spain; University Hospital General de Villalba, Madrid, Spain; Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - Enrique de Alava
- IBIS Instituto de Biomedicina de Sevilla, Sevilla, Spain; Vigem Del Rocio University Hospital/CSIC/University of Seville/CIBERONC, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Spain
| | | | - Giovanni Grignani
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Azienda Ospedaliero-Universitaria CItta della Scienza e della Salute di Torino, Torino, Italy
| | | | - Antonella Brunello
- Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Luca Paoluzzi
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rossella Bertulli
- Adult mesenchymal tumours and rare cancers unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Hindi
- Medical Oncology Department, University Hospital Fundación Jimenez Diaz, Madrid, Spain; University Hospital General de Villalba, Madrid, Spain; Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - Michael Montemurro
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Christian Rothermundt
- Department of Medical Oncology and Haematology Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Stefania Cocchi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Carmen Salguero-Aranda
- IBIS Instituto de Biomedicina de Sevilla, Sevilla, Spain; Vigem Del Rocio University Hospital/CSIC/University of Seville/CIBERONC, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Spain
| | - Davide Donati
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Juan D Martin
- IBIS Instituto de Biomedicina de Sevilla, Sevilla, Spain; Vigem Del Rocio University Hospital/CSIC/University of Seville/CIBERONC, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Spain
| | | | - Alessandro Mazzocca
- Department of Medical Oncology, Università Campus Bio-medico di Roma, Rome, Italy
| | - Elisa Carretta
- Department of Medicine, University of Padua, Padua, Italy
| | - Marilena Cesari
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Michela Pierini
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Maria A Laginestra
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Katia Scotlandi
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Toni Ibrahim
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Stacchiotti
- Adult mesenchymal tumours and rare cancers unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Università Campus Bio-medico di Roma, Rome, Italy
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Crombé A, Spinnato P, Righi A, Leopardi MP, Carpenzano M, Izzo F, Parmeggiani A, Linck PA, Perret R, Cesari M, Longhi A, Miceli M, Kind M, Bianchi G. Imaging presentation of extraskeletal osteosarcomas on CT and MRI and correlation with patients outcome: A two-center retrospective study of 54 patients. Diagn Interv Imaging 2023; 104:297-306. [PMID: 36813659 DOI: 10.1016/j.diii.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The purpose of this study was to analyze the imaging features of extraskeletal osteosarcomas (ESOS) on computed tomography (CT) and magnetic resonance imaging (MRI) and to investigate their associations with overall survival (OS) using uni- and multivariable survival analyses. MATERIALS AND METHODS This two-center retrospective study included all consecutive adult patients between 2008 and 2021 with histopathologically-proven ESOS who underwent pre-treatment CT and/or MRI. Clinical and histological characteristics, ESOS presentation on CT and MRI, treatment and outcomes were reported. Survival analyses were performed using Kaplan-Meier analysis and Cox regressions. Associations between imaging features and OS were searched using uni- and multivariable analyses. RESULTS Fifty-four patients were included (30/54 [56%] men, median age: 67.5 years). Twenty-four died of ESOS (median OS: 18 months). ESOS were mostly deep-seated (46/54, 85%) in the lower limb (27/54, 50%) with a median size of 95 mm (interquartile range: 64, 142; range: 21-289 mm). Mineralization was seen on 26/42 (62%) patients, mainly gross-amorphous (18/26; 69%). ESOS were generally highly heterogeneous on T2-weighted images (38/48; 79%) and contrast-enhanced (CE) T1-weighted images (29/40; 72%), with necrosis (39/40; 97%), well-defined or focally infiltrative margins (39/47; 83%), with moderate peritumoral edema (39/47; 83%) and rim-like peripheral enhancement (17/40; 42%). Size, location, mineralization on CT, signal intensity heterogeneity on T1-, T2- and CE-T1-weighted images and hemorragic signal on MRI were associated with poorer OS (range of log-rank P = 0.0069-0.0485). At multivariable analysis, hemorragic signal and signal intensity heterogeneity on T2-weighted images remained predictive for poorer OS (hazard ratio [HR] = 2.68, P = 0.0299; HR = 9.85, P = 0.0262, respectively) CONCLUSION: ESOS typically presents as mineralized heterogeneous and necrotic soft tissue tumor with a possible rim-like enhancement and limited peritumoral abnormalities. MRI may help estimate outcome of patients with ESOS.
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Affiliation(s)
- Amandine Crombé
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, 33000, Bordeaux, France; Department of Oncologic Imaging, Institut Bergonié, 33076, Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400, Talence, France
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Maria Carpenzano
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federica Izzo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Raul Perret
- Department of Biopathology, Comprehensive Cancer Center, 33000, Bordeaux, France
| | - Marilena Cesari
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessandra Longhi
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Michèle Kind
- Department of Oncologic Imaging, Institut Bergonié, 33076, Bordeaux, France
| | - Giuseppe Bianchi
- Department of Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Bellelli F, Consorti E, Hettiarachchige TMK, Rossi P, Lucchi T, Froldi M, Cesari M. Relationship among Age, Education and Frailty in Older Persons. J Frailty Aging 2023; 12:326-328. [PMID: 38008985 DOI: 10.14283/jfa.2023.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Preliminary data suggest that frailty tend to increase with age and is associated with fewer years of formal education. However, it is still unclear whether age and education synergistically act in the definition of frailty. Aim of the study is to evaluate the interaction between age and education in defining frailty in community-dwelling older persons. We considered 911 community-dwelling older adults (mean age 79.5 years) who underwent a comprehensive geriatric assessment. Our results showed that education and age interact in the definition of frailty following an exponential-type relationship. Whereas age is a non-modifiable risk factor, much can be done to address the social component of frailty here represented by education. The reported interaction suggests that social interventions might be particularly effective at an older age, paving the way for multidisciplinary interventions beyond the clinical field.
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Affiliation(s)
- F Bellelli
- Federico Bellelli, via Camaldoli 64, 20138, Milano (MI), Italy, e-mail:
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Azzolino D, Vettoretti S, Poggi MM, Soldati A, Cesari M. The Number of Medications Is Associated with Fractures in a Population of Dialyzed Older Patients with Frailty. J Frailty Aging 2023; 12:244-246. [PMID: 37493386 DOI: 10.14283/jfa.2023.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Older persons with chronic kidney disease (CKD) undergoing hemodialysis represent a growing portion of patients characterized by high vulnerability but still marginally studied. This study aimed at exploring the relationship between the number of prescriptions and fractures in older patients with CKD undergoing hemodialysis. A 24-item Frailty Index (FI) based on sociodemographic, clinical and biological data was computed. Unadjusted and adjusted logistic regression models were performed to test the association of prescribed medications with history of fractures. A total of 107 older patients undergoing hemodialysis (38 [35.5%] women, mean age 79.1 standard deviation, SD=7.7) were included in the study. Mean number of prescribed medications was 9.9 (SD=3.9) and was significantly associated with fractures (OR 1.18, 95% CI 1.06-1.32, p=0.003), even after adjustment for potential confounders (OR 1.16, 95% CI 1.03-1.30, p=0.016). If these results will be confirmed, interventions based on deprescribing will become essential in older persons undergoing hemodialysis.
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Affiliation(s)
- D Azzolino
- Dr. Domenico Azzolino, Department of Clinical and Community Sciences, University of Milan, Via Camaldoli, 64 - 20138 Milan (Italy). Mail: ; Phone: +39 02 5072 5218; Twitter: @doazzolino
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10
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Palmerini E, Pazzaglia L, Cevolani L, Pratelli L, Pierini M, Quattrini I, Carretta E, Manara MC, Pasello M, Frega G, Paioli A, Longhi A, Cesari M, Hakim R, Ibrahim T, Campanacci L, Staals EL, Donati DM, Benassi MS, Scotlandi K, Ferrari S. Bone Turnover Marker (BTM) Changes after Denosumab in Giant Cell Tumors of Bone (GCTB): A Phase II Trial Correlative Study. Cancers (Basel) 2022; 14:cancers14122863. [PMID: 35740530 PMCID: PMC9220940 DOI: 10.3390/cancers14122863] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Giant cell tumors of bone (GCTB) are osteolytic tumors. Denosumab, a RANK-L inhibitor, is approved for GCTB. Data on serum bone turnover marker (sBTM) changes are lacking. We present a phase II correlative study on sBTMs in GCTB patients treated with denosumab. Methods: All GCTB patients receiving denosumab within a multicentre, open-label, phase 2 study were enrolled. Serum levels of carboxyterminal-crosslinked-telopeptide of type I collagen (s-CTX), alkaline phosphatase (ALP), bone-alkaline phosphatase (bALP), parathyroid hormone (sPTH), and osteocalcin (OCN) were prospectively assessed (baseline, T0, 3 months, T1, 6 months, T2). The primary endpoint was assessment of sBTM changes after denosumab; the secondary endpoints were disease-free survival (DFS) and sBTM correlation. Results: In 54 cases, sBTMs decreased during denosumab treatment except for sPTH. With a median follow-up of 59 months, 3-year DFS was 65% (%CI 52−79), with a significantly worse outcome for patients with high (≥500 UI/mL) s-CTX at baseline, as compared to low s-CTX (<500 UI/mL) (3-year DFS for high CTX 45% (95%CI 23−67) vs. 75% (95%CI 59−91) for low s-CTX. Higher median ALP and s-CTX were found for patients with tumor size ≥ 5 cm (p = 0.0512; p = 0.0589). Conclusion: Denosumab induces ALP/OCN and s-CTX reduction. High baseline s-CTX identifies a group of patients at higher risk of progression of the disease.
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Affiliation(s)
- Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcoma and Innovative Therapy, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.P.); (E.C.); (G.F.); (A.P.); (A.L.); (M.C.); (R.H.); (T.I.); (S.F.)
- Correspondence:
| | - Laura Pazzaglia
- SSD Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (L.P.); (M.C.M.); (M.P.); (M.S.B.); (K.S.)
| | - Luca Cevolani
- Third Orthopaedic Clinic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (L.C.); (L.C.); (E.L.S.); (D.M.D.)
| | - Loredana Pratelli
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
| | - Michela Pierini
- Osteoncology, Bone and Soft Tissue Sarcoma and Innovative Therapy, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.P.); (E.C.); (G.F.); (A.P.); (A.L.); (M.C.); (R.H.); (T.I.); (S.F.)
| | - Irene Quattrini
- Scientific Direction IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
| | - Elisa Carretta
- Osteoncology, Bone and Soft Tissue Sarcoma and Innovative Therapy, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.P.); (E.C.); (G.F.); (A.P.); (A.L.); (M.C.); (R.H.); (T.I.); (S.F.)
| | - Maria Cristina Manara
- SSD Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (L.P.); (M.C.M.); (M.P.); (M.S.B.); (K.S.)
| | - Michela Pasello
- SSD Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (L.P.); (M.C.M.); (M.P.); (M.S.B.); (K.S.)
| | - Giorgio Frega
- Osteoncology, Bone and Soft Tissue Sarcoma and Innovative Therapy, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.P.); (E.C.); (G.F.); (A.P.); (A.L.); (M.C.); (R.H.); (T.I.); (S.F.)
| | - Anna Paioli
- Osteoncology, Bone and Soft Tissue Sarcoma and Innovative Therapy, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.P.); (E.C.); (G.F.); (A.P.); (A.L.); (M.C.); (R.H.); (T.I.); (S.F.)
| | - Alessandra Longhi
- Osteoncology, Bone and Soft Tissue Sarcoma and Innovative Therapy, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.P.); (E.C.); (G.F.); (A.P.); (A.L.); (M.C.); (R.H.); (T.I.); (S.F.)
| | - Marilena Cesari
- Osteoncology, Bone and Soft Tissue Sarcoma and Innovative Therapy, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.P.); (E.C.); (G.F.); (A.P.); (A.L.); (M.C.); (R.H.); (T.I.); (S.F.)
| | - Rossella Hakim
- Osteoncology, Bone and Soft Tissue Sarcoma and Innovative Therapy, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.P.); (E.C.); (G.F.); (A.P.); (A.L.); (M.C.); (R.H.); (T.I.); (S.F.)
| | - Toni Ibrahim
- Osteoncology, Bone and Soft Tissue Sarcoma and Innovative Therapy, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.P.); (E.C.); (G.F.); (A.P.); (A.L.); (M.C.); (R.H.); (T.I.); (S.F.)
| | - Laura Campanacci
- Third Orthopaedic Clinic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (L.C.); (L.C.); (E.L.S.); (D.M.D.)
| | - Eric Lodewijk Staals
- Third Orthopaedic Clinic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (L.C.); (L.C.); (E.L.S.); (D.M.D.)
| | - Davide Maria Donati
- Third Orthopaedic Clinic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (L.C.); (L.C.); (E.L.S.); (D.M.D.)
| | - Maria Serena Benassi
- SSD Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (L.P.); (M.C.M.); (M.P.); (M.S.B.); (K.S.)
| | - Katia Scotlandi
- SSD Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (L.P.); (M.C.M.); (M.P.); (M.S.B.); (K.S.)
| | - Stefano Ferrari
- Osteoncology, Bone and Soft Tissue Sarcoma and Innovative Therapy, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (M.P.); (E.C.); (G.F.); (A.P.); (A.L.); (M.C.); (R.H.); (T.I.); (S.F.)
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Palmerini E, Righi A, Sbaraglia M, Carretta E, Dei Tos AP, Magagnoli GI, Cesari M, Paioli A, Longhi A, Hakim R, Picci P, Maioli M, Cocchi S, Scotlandi K, Donati DM, Ibrahim T, Gambarotti M. Prevalence of ultra-rare undifferentiated round cells sarcoma of bone and soft tissue after genomic classification. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11559] [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
11559 Background: Over the last decade, the category of undifferentiated round cell sarcomas (URCS), defined by the absence of Ewing sarcoma-associated translocations, has emerged. Aim of this study was to assess prevalence of each entity and outcome after genomic classification. Methods: Ewing sarcoma and other URCS diagnosed between 1920 and 2020 were reviewed. All URCS with available material were analyzed with FISH, RT-qPCR and/or Archer FusionPlex Sarcoma Panel. Demographic and treatment were collected. Survival was analyzed in patients with available follow-up. Results: 1995 cases identified, 20 cases lacked material for further genetic analysis and were excluded. 1975 cases were classified as follows: 1925 Ewing sarcomas (97.47%), 25 CIC-rearranged sarcomas (1.27%), 16 BCOR-CCNB3 rearranged sarcomas (0.81%), 2 EWSR1-NFATC2 sarcoma (0.1%), one each as CIC-LEUTX and FUS-NFATC2 rearranged sarcoma (0.05% each), and 5 as unclassified URCS (0.25%). A different presentation according to tumor type was shown in 43/50 ultra-rare tumors (Table). Forty-one/50 cases had available follow-up: 20/41 patients underwent surgery, 14/41 surgery+radiotherapy, 6 radiotherapy only, and no local treatment for 1 patient. Chemotherapy was administrated to 36/41 patients (Ewing sarcoma drugs in 16/22 CIC-DUX-4 and 8/11 BCOR-CCNB3; osteosarcoma drugs in 2/11 BCOR-CCNB3, and doxorubicin/ifosfamide in 2/22 CIC-DUX4 and 2/5 URCS; not specified in 6 cases). The 3-years overall survival (OS) was 32.7%f for CIC-rearranged sarcomas (75% in localize disease, 7,7% for the advanced disease, p 0.0084), 81.8% for BCOR-CCNB3 sarcomas (87.5% localized, 66.7% advanced; p 0.0734), and 60% for URCS (p 0.057). 1 patient with CIC-LEUTX sarcoma presenting with metastases died 13 months from diagnosis, 1 patient with FUS-NFATC2 and 1 with EWSR1-NFATC2 rearrenged sarcomas were alive without disease at 8 and 5 years from onset. Conclusions: Prevalence of URCS characterized by a combination of morphologic observation ad molecular techniques is provided. The majority of the cases underwent surgery or surgery combined with radiotherapy, and Ewing-like chemotherapy. The survival difference among different entities underscores the need of accurate subclassification of round cell sarcomas. Novel drugs for CIC-DUX-4 sarcomas presenting with metastases are needed. [Table: see text]
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Affiliation(s)
- Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, Orthopaedic Institute Rizzoli, Bologna, Italy
| | | | | | | | | | | | | | - Anna Paioli
- Istituto Ortopedico Rizzoli IRCCS, Bologna, Italy
| | | | | | - Piero Picci
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | | | | | - Toni Ibrahim
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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de Souto Barreto P, Cesari M, Morley JE, Roberts S, Landi F, Cederholm T, Rolland Y, Vellas B, Fielding R. Appetite Loss and Anorexia of Aging in Clinical Care: An ICFSR Task Force Report. J Frailty Aging 2022; 11:129-134. [PMID: 35441188 PMCID: PMC8898654 DOI: 10.14283/jfa.2022.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Appetite loss/anorexia of aging is a highly prevalent and burdensome geriatric syndrome that strongly impairs the quality of life of older adults. Loss of appetite is associated with several clinical conditions, including comorbidities and other geriatric syndromes, such as frailty. Despite its importance, appetite loss has been under-evaluated and, consequently, under-diagnosed and under-treated in routine clinical care. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force met virtually on September 27th 2021 to debate issues related to appetite loss/anorexia of aging. In particular, topics related to the implementation and management of appetite loss in at-risk older adult populations, energy balance during aging, and the design of future clinical trials on this topic were discussed. Future actions in this field should focus on the systematic assessment of appetite in the care pathway of older people, such as the Integrated Care for Older People (ICOPE) program recommended by the World Health Organization. Moreover, clinical care should move from the assessment to the treatment of appetite loss/anorexia. Researchers continue to pursue their efforts to find out effective pharmacologic and non-pharmacologic interventions with a favorable risk/benefit ratio.
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Affiliation(s)
- P de Souto Barreto
- Philipe de Souto Barreto, Gérontopôle de Toulouse, Institut du Vieillissement, 37 Allées Jules Guesde, 31000 Toulouse, France, +33 561 145 636,
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13
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Guidetti R, Cesari M, Giovannini I, Ebel C, Förschler MI, Rebecchi L, Schill RO. Morphology and taxonomy of the genus Ramazzottius (Eutardigrada; Ramazzottiidae) with the integrative description of Ramazzottius kretschmanni sp. nov. The European Zoological Journal 2022. [DOI: 10.1080/24750263.2022.2043468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- R. Guidetti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - M. Cesari
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - I. Giovannini
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - C. Ebel
- Department Visitor Information, Black Forest National Park, Seebach, Germany
| | - M. I. Förschler
- Department of Ecosystem Monitoring, Research and Conservation. Black Forest National Park, Freudenstadt, Germany
| | - L. Rebecchi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - R. O. Schill
- Institute of Biomaterials and Biomolecular Systems, University of Stuttgart, Stuttgart, Germany
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14
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Palmerini E, Meazza C, Tamburini A, Bisogno G, Ferraresi V, Asaftei SD, Milano GM, Coccoli L, Manzitti C, Luksch R, Serra M, Gambarotti M, Donati DM, Scotlandi K, Bertulli R, Favre C, Longhi A, Abate ME, Perrotta S, Mascarin M, D'Angelo P, Cesari M, Staals EL, Marchesi E, Carretta E, Ibrahim T, Casali PG, Picci P, Fagioli F, Ferrari S. Phase 2 study for nonmetastatic extremity high-grade osteosarcoma in pediatric and adolescent and young adult patients with a risk-adapted strategy based on ABCB1/P-glycoprotein expression: An Italian Sarcoma Group trial (ISG/OS-2). Cancer 2022; 128:1958-1966. [PMID: 35201621 PMCID: PMC9305236 DOI: 10.1002/cncr.34131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 12/02/2022]
Abstract
Background According to retrospective osteosarcoma series, ABCB1/P‐glycoprotein (Pgp) overexpression predicts for poor outcomes. A prospective trial to assess a risk‐adapted treatment strategy using mifamurtide in Pgp+ patients was performed. Methods This was a phase 2, multicenter, uncontrolled trial including patients 40 years old or younger with nonmetastatic extremity high‐grade osteosarcoma stratified according to Pgp expression. All patients received high‐dose methotrexate, doxorubicin, and cisplatin (MAP) preoperatively. In Pgp+ patients, mifamurtide was added postoperatively and combined with MAP for a good histologic response (necrosis ≥ 90%; good responders [GRs]) or with high‐dose ifosfamide (HDIFO) at 3 g/m2/d on days 1 to 5 for a histologic response < 90% (poor responders [PRs]). Pgp– patients received MAP postoperatively. After an amendment, the cumulative dose of methotrexate was increased from 60 to 120 g/m2 (from 5 to 10 courses). The primary end point was event‐free survival (EFS). A postamendment analysis was performed. Results In all, 279 patients were recruited, and 194 were included in the postamendment analysis: 70 (36%) were Pgp–, and 124 (64%) were Pgp+. The median follow‐up was 51 months. For Pgp+ patients, 5‐year EFS after definitive surgery (null hypothesis, 40%) was 69.8% (90% confidence interval [CI], 62.2%‐76.2%): 59.8% in PRs and 83.7% in GRs. For Pgp– patients, the 5‐year EFS rate was 66.4% (90% CI, 55.6%‐75.1%). Conclusions This study showed that adjuvant mifamurtide, combined with HDIFO for a poor response to induction chemotherapy, could improve EFS in Pgp+ patients. Overall, the outcomes compared favorably with previous series. Mifamurtide and HDIFO as salvage chemotherapy are worth further study. The expression of ABCB1/P‐glycoprotein (Pgp) at diagnosis has been used to stratify patients with high‐grade osteosarcoma. Adjuvant mifamurtide, combined with high‐dose ifosfamide for a poor response to induction chemotherapy, can improve event‐free survival in Pgp+ patients.
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Affiliation(s)
- Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padua, Italy
| | | | | | - Giuseppe M Milano
- Pediatric Oncology Department, Regina Margherita Children's Hospital, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luca Coccoli
- IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Carla Manzitti
- IRCCS Istituto G. Gaslini-Ospedale Pediatrico, Genoa, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Serra
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide M Donati
- Third Orthopedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Katia Scotlandi
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rossella Bertulli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Favre
- Azienda Ospedaliera Universitaria A. Meyer, Florence, Italy
| | - Alessandra Longhi
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo E Abate
- Pediatric Oncology, National Medical Specialization Center Santobono-Pausilipon, Napoli, Italy
| | - Silverio Perrotta
- Ematologia ed Oncologia Pediatrica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, IRCCS Centro di Riferimento Oncologico, Aviano, Italy
| | | | - Marilena Cesari
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric L Staals
- Third Orthopedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Elisa Carretta
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Toni Ibrahim
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo G Casali
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Franca Fagioli
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Stefano Ferrari
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Canevelli M, Bersani FS, Sciancalepore F, Salzillo M, Cesari M, Tarsitani L, Pasquini M, Ferracuti S, Biondi M, Bruno G. Frailty in Caregivers and Its Relationship with Psychological Stress and Resilience: A Cross-SectionalStudy Based on the Deficit Accumulation Model. J Frailty Aging 2022; 11:59-66. [PMID: 35122092 DOI: 10.14283/jfa.2021.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Studies increasingly suggest that chronic exposure to psychological stress can lead to health deterioration and accelerated ageing, thus possibly contributing to the development of frailty. Recent approaches based on the deficit accumulation model measure frailty on a continuous grading through the "Frailty Index" (FI), i.e. a macroscopic indicator of biological senescence and functional status. OBJECTIVES The study aimed at testing the relationship of FI with caregiving, psychological stress, and psychological resilience. DESIGN Cross-sectional study, with case-control and correlational analyses. PARTICIPANTS Caregivers of patients with dementia (n=64), i.e. individuals a priori considered to be exposed to prolonged psychosocial stressors, and matched controls (n=64) were enrolled. MEASUREMENTS The two groups were compared using a 38-item FI condensing biological, clinical, and functional assessments. Within caregivers, the association of FI with Perceived Stress Scale (PSS) and Brief Resilience Scale (BRS) was tested. RESULTS Caregivers had higher FI than controls (F=8.308, p=0.005). FI was associated directly with PSS (r=0.660, p<0.001) and inversely with BRS (r=-0.637, p<0.001). Findings remained significant after adjusting for certain confounding variables, after excluding from the FI the conditions directly related to psychological stress, and when the analyses were performed separately among participants older and younger than 65 years. CONCLUSIONS The results provide insight on the relationship of frailty with caregiving, psychological stress, and resilience, with potential implications for the clinical management of individuals exposed to chronic emotional strain.
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Affiliation(s)
- M Canevelli
- Marco Canevelli, Francesco Saverio Bersani, Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy, ,
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16
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Guil N, Guidetti R, Cesari M, Marchioro T, Rebecchi L, Machordom A. Molecular Phylogenetics, Speciation, and Long Distance Dispersal in Tardigrade Evolution: A case study of the genusMilnesium. Mol Phylogenet Evol 2022; 169:107401. [PMID: 35031462 DOI: 10.1016/j.ympev.2022.107401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
Microorganisms (sensu lato, i.e., including micrometazoans) are thought to have cosmopolitan geographic distributions due to their theoretically unlimited dispersal capabilities, a consequence of their tiny size, population dynamics, and resistant forms. However, several molecular studies of microorganisms have identified biogeographic patterns indicating cryptic speciation and/or weak species definitions. Using a multi-locus approach with the genus Milnesium (Tardigrada), we aimed to determine the genetic structure of populations worldwide and the effects of long distance dispersal (LDD) on genetic connectivity and relationships across the six continents. Our results on this micrometazoan's genetic structure and LDD at global and micro-local scales indicate contrasting patterns not easily explained by a unique or simple phenomenon. Overall, we report three key findings: (i) confirmation of long distance dispersal for tardigrades, (ii) populations with globally-shared or endemic micro-local haplotypes, and (iii) a supported genetic structure instead of the homogeneous genetic distribution hypothesized for microorganisms with LDD capabilities. Moreover, incongruences between our morphological and molecular results suggest that species delimitation within the genus Milnesium could be problematic due to homoplasy. Duality found for Milnesium populations at the global scale, namely, a molecular phylogenetic structure mixed with widely distributed haplotypes (but without any apparent biogeographic structure), is similar to patterns observed for some unicellular, prokaryotic and eukaryotic, microorganisms. Factors influencing these patterns are discussed within an evolutionary framework.
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Affiliation(s)
- N Guil
- Department of Biodiversity and Evolutionary Biology. Museo Nacional de Ciencias Naturales (MNCN-CSIC). José Gutiérrez Abascal, 2, 28006, Madrid, Spain.
| | - R Guidetti
- Department of Life Sciences. University of Modena and Reggio Emilia, Via Campi 213/D, 41125, Modena, Italy
| | - M Cesari
- Department of Life Sciences. University of Modena and Reggio Emilia, Via Campi 213/D, 41125, Modena, Italy
| | - T Marchioro
- Department of Life Sciences. University of Modena and Reggio Emilia, Via Campi 213/D, 41125, Modena, Italy
| | - L Rebecchi
- Department of Life Sciences. University of Modena and Reggio Emilia, Via Campi 213/D, 41125, Modena, Italy
| | - A Machordom
- Department of Biodiversity and Evolutionary Biology. Museo Nacional de Ciencias Naturales (MNCN-CSIC). José Gutiérrez Abascal, 2, 28006, Madrid, Spain
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17
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Crosignani S, Orlandini L, Baruffi S, Froldi M, Cesari M. Frailty and Persistent Pain in Oncological Patients Undergoing Rehabilitation. J Frailty Aging 2022; 11:286-290. [DOI: 10.14283/jfa.2022.26] [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: 11/11/2022]
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18
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de Souto Barreto P, Cesari M, Morley JE, Gonzalez-Bautista E, Rolland Y, Azzolino D, Vellas B, Fielding RA. Assessment and Management of Appetite Loss in Older Adults: An ICFSR Task Force Report. J Frailty Aging 2022; 12:1-6. [PMID: 36629077 DOI: 10.14283/jfa.2022.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Appetite loss in older people is an important unmet clinical need in geriatrics. The International Conference on Frailty and Sarcopenia Research (ICFSR) organized a Task Force on April 20th 2022, in Boston, to discuss issues related to appetite loss in older people, in particular, the assessment tools currently available, its evaluation in the primary care setting, and considerations about its management. There is a high heterogeneity in terms of the etiology of appetite loss in older people and a gold standard assessment tool for evaluating this condition is still absent. Although this may render difficult the management of poor appetite in clinical practice, validated assessment tools are currently available to facilitate early identification of appetite loss and support care decisions. As research on biomarkers of appetite loss progresses, assessment tools will soon be used jointly with biomarkers for more accurate diagnosis and prognosis. In addition, efforts to foster the development of drugs with a favorable risk/benefit ratio to combat poor appetite should be strengthened.
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Affiliation(s)
- P de Souto Barreto
- Philipe de Souto Barreto, Gérontopôle de Toulouse, Institut du Vieillissement, 37 Allées Jules Guesde, 31000 Toulouse, France, +33 561 145 636,
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Canevelli M, Bruno G, Valletta M, Cesari M. Could there Be Frailty in the Discrepancy between Lesions and Symptoms of Alzheimer’s Disease? J Frailty Aging 2022; 11:248-249. [DOI: 10.14283/jfa.2022.43] [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: 11/11/2022]
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Cesari M, Canevelli M, Calvani R, Aprahamian I, Inzitari M, Marzetti E. The Management of Frailty: Barking Up the Wrong Tree. J Frailty Aging 2022; 11:127-128. [DOI: 10.14283/jfa.2022.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
- L Calcaterra
- Laura Calcaterra, Geriatric Fellowship Program, University of Milan, Milan 20122, Italy,
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22
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Maltese G, Basile G, Meehan H, Fuller M, Cesari M, Fountoulakis N, Karalliedde J. Frailty Is Associated with Impaired Diabetic Foot Ulcer Healing and All-Cause Re-Hospitalization. J Nutr Health Aging 2022; 26:169-173. [PMID: 35166310 DOI: 10.1007/s12603-022-1726-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diabetic Foot Ulcers (DFUs) are a common and feared complication of type 1 and type 2 diabetes. People with DFUs often present a significant clinical complexity due to multimorbidity, frailty, polypharmacy, and disabling conditions. Frailty, defined using the accumulation of health deficits model, has shown to predict worsening health status, hospitalizations, and death in older persons. There are no clinical studies, to date, that have examined the prevalence and effect of frailty on DFUs outcomes. The aim of our study was to explore the impact of frailty on DFUs healing and re-hospitalization in a cohort of patients hospitalized with DFUs. DESIGN prospective cohort study. SETTING AND PARTICIPANTS The frailty status of 76 consecutive hospitalized patients with DFUs was assessed by using the Frailty Index (FI). MEASUREMENTS The primary outcome was the non-healing of the DFU. Secondary outcome was re-hospitalization events (for any cause) within 6 months from hospital discharge. Frailty was defined as FI>0.25. RESULTS Out of 76 patients (median age 65 years, range 31-84), 56 (74%) were frail. At six months, 81.5% of frail patients had non-healing of the DFU compared to 55% in non-frail patients (p=0.02). The rate of of re-hospitalization was also higher in frail compared to non-frail (90.3% vs 54%, respectively; p=0.01) patients. In multivariable analyses, frailty was significantly associated with a more than fivefold increased risk of DFU non-healing [odds ratio 5.54 (95% confidence interval 1.28-23.91), p=0.02]. Similarly, re-hospitalization was also significantly higher in frail patients compared to the non-frail ones. CONCLUSIONS In hospitalized patients with DFUs, frailty was highly prevalent. Frailty emerged as an independent risk factor for DFU non-healing and re-hospitalization events. Patients with DFUs require a comprehensive assessment of their frailty status which would enable personalization of their management and interventions.
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Affiliation(s)
- G Maltese
- Dr Giuseppe Maltese, School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences, King's College London, 150 Stamford Street, London SE1 9NH, UK, , Twitter: @docmaltese
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23
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Cesari M, Bernabei R, Vellas B, Fielding RA, Rooks D, Azzolino D, Mariani J, Oliva AA, Bhasin S, Rolland Y. Challenges in the Development of Drugs for Sarcopenia and Frailty - Report from the International Conference on Frailty and Sarcopenia Research (icfsr) Task Force. J Frailty Aging 2022; 11:135-142. [PMID: 35441189 PMCID: PMC9017069 DOI: 10.14283/jfa.2022.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sarcopenia and frailty represent two burdensome conditions, contributing to a broad spectrum of adverse outcomes. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force met virtually in September 2021 to discuss the challenges in the development of drugs for sarcopenia and frailty. Lifestyle interventions are the current mainstay of treatment options in the prevention and management of both conditions. However, pharmacological agents are needed for people who do not respond to lifestyle modifications, for those who are unable to adhere, or for whom such interventions are inaccessible/unfeasible. Preliminary results of ongoing trials were presented and discussed. Several pharmacological candidates are currently under clinical evaluation with promising early results, but none have been approved for either frailty or sarcopenia. The COVID-19 pandemic has reshaped how clinical trials are conducted, in particular by enhancing the usefulness of remote technologies and assessments/interventions.
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Affiliation(s)
- M Cesari
- Prof. Matteo Cesari; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri; Via Camaldoli 64, 20138 Milano, Italy; Twitter: @macesari; E-mail:
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24
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Spinnato P, Clinca R, Vara G, Cesari M, Ponti F, Facchini G, Longhi A, Donati DM, Bianchi G, Sambri A. MRI Features as Prognostic Factors in Myxofibrosarcoma: Proposal of MRI Grading System. Acad Radiol 2021; 28:1524-1529. [PMID: 32928636 DOI: 10.1016/j.acra.2020.08.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES Myxofibrosarcoma (MFS) is a common soft tissue sarcoma in the elderly patients with both clinical and magnetic resonance imaging (MRI) peculiar features: very high recurrence rate, relatively low risk of distant metastases. On MRI it shows an infiltrative pattern ("tail sign") and high myxoid matrix content with water-like appearance on fluid-sensitive sequences. Due to these unusual characteristics, we propose a specific MRI grading system to stratify the risk of local recurrence (LR) and offer other prognostic information. MATERIALS AND METHODS Two expert radiologists retrospectively and blindly reviewed preoperative MRI of 150 patients affected by MFS of the extremities treated at a single Institution. Myxoid matrix component and contrast enhancement of the tumor were evaluated and graded with a semiquantitative method. The presence of an infiltrative pattern, the depth of the tumor (deep and/or superficial) and tumor sizes were also recorded. MRI features were analyzed separately and correlated to LR risk, sarcoma specific survival and distant metastases rate. Then, according to the statistical significance of the correlation between MRI features and prognosis a 3-grade scoring system was proposed and evaluated to assess the risk of LR. RESULTS Mean age was 66.1 ± 14.4 years; mean follow-up was 16 ± 28.3 months. The MRI features most associated with higher risk of LR resulted to be: lesion sizes (both volume and maximum diameter with a cut-off of 20 cm - p = 0.01), the "tail sign" (p = 0.045), and high myxoid matrix content with MRI water-like appearance (p = 0.0493). Ninety-four patients (94 of 150- 62.7%) were grade 1, 33 (22.0%) grade 2, and 23 (15.3%) grade 3. Interobserver agreement was substantial with K= 0.779 (95%CI 0.685-0.874). Higher grades of MRI grading system proposed were significantly associated with an increased LR risk, hazard ratio = 2.031 (95%CI 1.366-3.019; p < 0.001). CONCLUSION This is the largest series evaluating MRI features as prognostic factors for MFS. The MRI grading system proposed is significantly able to stratify the risk of LR in MFS of the extremities. The system is applicable to all the standard MRI studies protocols, might help in surgical planning, and may offer prognostic information.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n.1, 40136, Bologna, Italy.
| | - Roberta Clinca
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n.1, 40136, Bologna, Italy
| | - Giulio Vara
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n.1, 40136, Bologna, Italy
| | - Marilena Cesari
- Department of Chemotherapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n.1, 40136, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n.1, 40136, Bologna, Italy
| | - Alessandra Longhi
- Department of Chemotherapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Giuseppe Bianchi
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Sambri
- Department of Orthopaedics, AOSP Sant'Orsola Malpighi, Bologna, Italy
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25
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Proietti M, Romiti G, Raparelli V, Diemberger I, Boriani G, Marzetti E, Lip G, Cesari M. Prevalence and impact of frailty in patients with atrial fibrillation: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Frailty is a clinical syndrome characterized by a reduced physiologic function, increased vulnerability to stressors, and an increased risk of adverse outcomes. Patients with Atrial Fibrillation (AF) are often burdened with a high number of comorbidities and prone to frailty. The prevalence of frailty, its management and association with major outcomes in patients with AF are still unclear.
Purpose
To estimate the pooled prevalence of frailty in patients with AF, as well as its association with AF-related risk factors and comorbidities, oral anticoagulants (OAC) prescription, and major outcomes.
Methods
We systematically searched PubMed and EMBASE, from inception to 31st January 2021, for studies reporting the prevalence of frailty (irrespective of the tool used for assessment). Pooled prevalence, odds ratio (OR), and 95% Confidence Intervals (CI) were computed using random-effect models; heterogeneity was assessed through the inconsistency index (I2). This study was registered in PROSPERO: CRD42021235854.
Results
A total of 1,116 studies were retrieved from the literature search, and 31 were finally included in the systematic review (n=842,521 patients). The frailty pooled prevalence was 39.6% (95% CI=29.2%-51.0%, I2=100%; Figure 1). Significant subgroup differences were observed according to geographical location (higher prevalence found in European-based cohorts; p=0.003) and type of tool used for the assessment (higher prevalence in studies using the Clinical Frailty Scale and Tilburg Frailty Index tools; p<0.001). Meta-regressions showed that study-level mean age and prevalence of hypertension, diabetes, and history of stroke were directly associated with frailty prevalence. Frailty was significantly associated with a 29% reduced probability of OAC prescription in observational studies (OR=0.71, 95% CI=0.62–0.81). Frail patients with AF were at higher risk of all-cause death (OR=4.12, 95% CI=3.15–5.41), ischemic stroke (OR=1.55, 95% CI=1.01–2.38), and bleeding (OR=1.55, 95% CI=1.12–2.14), compared to non-frail patients with AF.
Conclusions
In this systematic review and meta-analysis analysis, the prevalence of frailty was high in patients with AF, and associated with study-level mean age and prevalence of several stroke risk factors. Frailty may influence the management of patients, and worsening the prognosis for all major AF-related outcomes.
Funding Acknowledgement
Type of funding sources: None. Prevalence of Frailty among AF patients
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Affiliation(s)
| | - G.F Romiti
- Sapienza University of Rome, Rome, Italy
| | | | | | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - E Marzetti
- Catholic University of the Sacred Heart, Rome, Italy
| | - G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
| | - M Cesari
- University of Milan, Milan, Italy
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Cesari M, Vellas B. Older Persons "Lost" to the COVID-19 Vaccination: Where Are They? J Frailty Aging 2021; 10:308-309. [PMID: 34549242 PMCID: PMC8445017 DOI: 10.14283/jfa.2021.37] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Cesari
- Matteo Cesari, MD, PhD. IRCCS Istituti Clinici Scientifici Maugeri; via Camaldoli 64, 20138 Milan - Italy. ; Twitter: @macesari
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Cesari M, Calvani R, Canevelli M, Aprahamian I, de Souto Barreto P, Azzolino D, Fielding RA, Vanacore N, Inzitari M, Marzetti E. On Schrödinger's Cat and Evaluation of Trials Disrupted by the Covid19 Pandemic: A Critical Appraisal. J Frailty Aging 2021; 10:310-312. [PMID: 34549243 PMCID: PMC8140750 DOI: 10.14283/jfa.2021.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
From the beginning of 2020, the world has been fighting the SARS-Cov-2 outbreak. The life of each one of us has profoundly changed. Unavoidably, our clinical routine has drastically modified in its priorities and methodologies (1). The COVID-19 pandemic has also raised significant issues in the field of research. The investigators’ responsibility has increased with the need to thoughtfully weigh the risk-benefit ratio for each protocol in an emergency and evolving scenario (2).
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Affiliation(s)
- M Cesari
- Matteo Cesari, MD, PhD. IRCCS Istituti Clinici Scientifici Maugeri; Via Camaldoli 64, 20138 Milan, Italy. ; Twitter: @macesari
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28
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Wood SJ, Bell JS, Magliano DJ, Fanning L, Cesari M, Keen CS, Ilomäki J. Impact of Age, Frailty, and Dementia on Prescribing for Type 2 Diabetes at Hospital Discharge 2012-2016. J Frailty Aging 2021; 10:343-349. [PMID: 34549249 DOI: 10.14283/jfa.2021.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The risks of intensive blood glucose lowering may outweigh the benefits in vulnerable older people. OBJECTIVES Our primary aim was to determine whether age, frailty, or dementia predict discharge treatment types for patients with type 2 diabetes (T2D) and related complications. Secondly, we aimed to determine the association between prior hypoglycemia and discharge treatment types. DESIGN, SETTING AND PARTICIPANTS We conducted a cohort study involving 3,067 patients aged 65-99 years with T2D and related complications, discharged from Melbourne's Eastern Health Hospital Network between 2012 and 2016. MEASUREMENTS Multinomial logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CI) for the association between age, frailty, dementia and hypoglycemia, and being prescribed insulin-only, non-insulin glucose-lowering drugs (GLDs) or combined insulin and non-insulin GLDs compared to no GLD. International Classification of Diseases-10 codes were used to identify dementia status and prior hypoglycemia; frailty was quantified using the Hospital Frailty Risk Score. RESULTS Insulin-only, non-insulin GLDs, combined insulin and non-insulin GLDs, and no GLDs were prescribed to 19%, 39%, 20%, and 23% of patients, respectively. Patients >80 years were less likely than patients aged 65-80 to be prescribed any of the GLD therapies, (eg. non-insulin GLDs [OR 0.67; 95%CI 0.55-0.82]), compared to no GLD. Similarly, high vs. low frailty scores were associated with not being prescribed any of the three GLD therapies, (eg. non-insulin GLDs [OR 0.63; 95%CI 0.45-0.87]). However, dementia was not associated with discharge prescribing of GLD therapies. Patients with a hypoglycemia-related admission were more likely than those not hospitalized with hypoglycemia to receive insulin-only (OR 4.28; 95%CI 2.89-6.31). CONCLUSIONS Clinicians consider age and frailty when tailoring diabetes treatment regimens for patients discharged from hospital with T2D and related complications. There is scope to optimize prescribing for patients with dementia and for those admitted with hypoglycemia.
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Affiliation(s)
- S J Wood
- Stephen Wood, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University Melbourne, Australia, 3052, Tel: +61 423301741, E-mail:
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Abstract
Detection of sarcopenia in primary care is a first and essential step in community-dwelling older adults before implementing preventive interventions against the onset of disabling conditions. In fact, leaving this condition undiagnosed and untreated can impact on the individual's quality of life and function, as well as on healthcare costs. This article summarizes the many instruments today available for promoting an earlier and prompter detection of sarcopenia in primary care, combining insights about its clinical management. Primary care physicians may indeed play a crucial role in the identification of individuals exposed to the risk of sarcopenia or already presenting this condition. To confirm the suspected diagnosis, several possible techniques may be advocated, but it is important that strategies are specifically calibrated to the needs, priorities and resources of the setting where the evaluation is conducted. To tackle sarcopenia, nutritional counselling and physical activity programs are today the two main interventions to be proposed. Multicomponent and personalized exercise programs can (and should) be prescribed by primary care physicians, taking advantage of validated programs ad hoc designed for this purpose (e.g., the Vivifrail protocol). It is possible that, in the next future, new pharmacological treatments may become available for tackling the skeletal muscle decline. These will probably find application in those individuals non-responding to lifestyle interventions.
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Affiliation(s)
- S Crosignani
- Silvia Crosignani, MD, Fellowship in Geriatrics and Gerontology, University of Milan, Milan, Italy,
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Longhi A, Carella A, Broll V, Palmerini E, Cesari M, Paioli A, Hakim R, Gambarotti M, Righi A. Localized osteosarcoma analysis of very poor responders subgroup (Huvos I). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e22010] [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
e22010 Background: Osteosarcoma is a malignant primitive bone tumor whose prognosis is not changed since 4 decades, after the introduction of neoadjuvant chemotherapy with Methotrexate, Cisplatin, Doxorubicine and Ifosfamide. Histologic response to preoperative chemotherapy is a significant prognostic factor. Huvos I (necrosis ≤ 50%) has worst prognosis . Previous studies reported a 3 years EFS of this Huvos I patients around 25% (Tsuda Y,2020). In order to evaluate if survival has changed in recent years in this unfavourable prognostic group we evaluated the outcome of osteosarcoma patients with Huvos I. Methods: from our Pathology archieves we retrieved all cases of localized osteosarcoma treated at Rizzoli with neoadjuvant chemotherapy who reported an histologic necrosis below or equal to 50% (Huvos I grade) after preoperative chemotherapy MAP (Ethical C. Approval 917/2020/Oss/IOR). Results: from 2003 to 2019 we had 70 cases of localized osteosarcoma with Huvos I necrosis after neoadjuvant chemotherapy ( MAP in 66 and MAPI in 4) evaluable. Median age 21,5 (3-70); M:F = 44:26. 10/70 had axial localization vs extremity(60), subhistotype distribution:46 osteoblastic,11 chondroblastic, 7 fibroblastic, 5 teleangectatic, one not classified. In 24 cases PgP was available(14 PgP positive). With a median follow up of 86.7 ms (IQR 41-136) 43/70 had already relapsed. The median EFS was 25 ms (95% CI 15-42) and the 3 yrs EFS was 40.6% (95% CI 29-52). The 3 yrs overall survival was 80% (95%CI 68-88) and median OS was not reached. Axial tumor site was associated with significant inferior EFS (P = .004). Conclusions: these data confirm the poor prognosis of patients with necrosis ≤50% and the need of new drugs to improve their survival in this sub-group.
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Affiliation(s)
| | | | | | | | | | - Anna Paioli
- Istituto Ortopedico Rizzoli IRCCS, Bologna, Italy
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Longhi A, Broll V, Righi A, Carella A, Pierini M, Ferrari C, Cesari M, Hakim R, Paioli A, Palmerini E. Metastatic osteosarcoma at diagnosis: Analysis of 92 cases from a single institution. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e23506] [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
e23506 Background: Metastatic osteosarcoma (MOS) with synchronous metastases accounts for 20-25% of all new cases of osteosarcoma. Lungs are the most common site of metastases at presentation (80%) followed by Bone (10%). 5- years Overall Survival (OS) of MOS ranges from 11 to 40%. In a previous study from our institution (Bacci G 2006) on 57 pts < 40 years old (1995-2000) the 2- and 5-year OS were 55% and 18%. Methods: Data of patients with pathologic and radiologic confirmed MOS with adequate follow up were reviewed (EC Approval N 916/2020/Oss/IOR). Time-to-event outcomes were estimate with Kaplan-Meier method and compared between groups with log-rank test and Cox model. Results: From August 2000 to October 2018, 92 patients had a diagnosis of MOS: median age 16.5 yrs (6-73, twelve pts > 40 ), gender rate was M 51/F 41, axial primary tumor in 15 cases, extremity in 77. Lung only metastases were described in 66 (71.7%). In 75/90 cases primary tumor was surgically removed, 43 (46%) cases had at least one surgical metastasectomy. All patients received chemotherapy: preoperative only in 6 cases, postoperative in 6, and pre and postoperative in 66 patients. The 1st line chemotherapy was a combination of drugs: Adriamycin in 91/92 pts, Cisplatin in 89/92, Ifosfamide in 88/92, Methotrexate in 83/92; 59 patients received a 2nd line chemotherapy, 34 pts received a 3rd line; most employed regimen were Gemcitabine-Docetaxel, Ifosfamide 15 gr/m2, Cyclophosphamyde-Etoposide, TKI (Pazopanib, Sorafenib), and a few received experimental drugs. Complete remission (CR) was obtained in 26/92 (28%), in 19 cases after surgical metastasectomy.In 30 pts the information of PGP (P- glycoprotein) was available; patients with positive PGP (19/30) had a worst overall survival as compared to those PGP negative (P = 0.038). Of those in Complete Remission 14/26 relapsed. At December 2020 with a median follow-up of 95 ms (IQR 34-159): 65/92 (70%) died , 12 are alive and free from disease , 6 are alive with disease, 9 were lost . The 2-yrs OS for all 92 pts from diagnosis was 66% (95%CI 55-75) and 5-yrs OS was 26% (95% CI 16-37). From the end of treatment, for those who reached a CR the 5-year OS was 57% vs 9% for those who did not (P < 0.001). At univariate analysis, primary tumor site (2-y OS 48% axial vs 72% extremity, P < 0.001), site of metastases (2-y OS 74% only lung vs 48% other, P = 0.004) and number of lung nodules (P = 0.007), were significantly associated to OS. At multivariate analysis, only site of metastases (other vs. only lung HR = 2.26, 95%CI: 1.21-4.22) and number of lung nodules (≥10 nodules vs ≤3 HR = 2.44, 95%CI: 1.24-4.81) were confirmed as significant for OS. Conclusions: Compared to our previous report from 20 yrs ago, 2-years and 5 yrs OS of MOS has improved but it remain unsatisfactory (66% vs 55% and 26% vs 18%).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anna Paioli
- Istituto Ortopedico Rizzoli IRCCS, Bologna, Italy
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Affiliation(s)
- P Astrone
- Paolo Astrone, MD. Viale Guglielmo Marconi, 1, 26845 Codogno, Lodi, Italy.
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Abstract
The evaluation of the physical domain represents a critical part of the assessment of the older person, both in the clinical as well as the research setting. To measure physical function, clinicians and researchers have traditionally relied on instruments focusing on the capacity of the individual to accomplish specific functional tasks (e.g., the Activities of Daily Living [ADL] or the Instrumental ADL scales). However, a growing number of physical performance and muscle strength tests has been developed in parallel over the past three decades. These measures are specifically designed to: 1) provide objective results (not surprisingly, they are frequently timed tests) taken in standardized conditions, whereas the traditional physical function scales are generally self- or proxy-reported measures; 2) be more sensitive to changes; 3) capture the real biology of the function through the assessment of standardized tasks mirroring specific functional subdomains; and 4) mirror the quality of specific mechanisms underlying more complex and multidomain functions. Among the most commonly used instruments, the usual gait speed test, the Short Physical Performance Battery, the handgrip strength, the Timed Up-and-Go test, the 6-minute walk test, and the 400-meter walk test are widely adopted by clinicians and researchers. The clinical and research importance of all these instruments has been demonstrated by their predictive capacity for negative health-related outcomes (i.e., hospitalization, falls, institutionalization, disability, mortality). Moreover, they have shown to be associated with subclinical and clinical conditions that are also not directly related to the physical domain (e.g., inflammation, oxidative stress, overall mortality). For this reason, they have been repeatedly indicated as markers of wellbeing linked to the burden of multiple chronic conditions rather than mere parameters of mobility or strength. In this work protocols of the main tests for the objective assessment of physical function in older adults are presented.
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Affiliation(s)
- E Patrizio
- Enrica Patrizio, Azienda di Servizi alla Persona Istituti Milanesi Martinitt e Stelline e Pio Albergo Trivulzio, Milan, Italy,
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Rolland Y, Cesari M, Fielding RA, Reginster JY, Vellas B, Cruz-Jentoft AJ. Osteoporosis in Frail Older Adults: Recommendations for Research from the ICFSR Task Force 2020. J Frailty Aging 2021; 10:168-175. [PMID: 33575707 DOI: 10.14283/jfa.2021.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interactions among physiological pathways associated with osteoporosis and sarcopenia are thought to contribute to the onset of frailty. The International Conference on Frailty and Sarcopenia Research Task Force thus met in March 2020 to explore how emerging interventions to manage fracture and osteoporosis in older adults may reduce frailty, disability, morbidity, and mortality in the older population. Both pharmacological and non-pharmacological interventions (including nutritional intervention, exercise, and other lifestyle changes) were discussed, including nutritional intervention, exercise, and other lifestyle changes. Pharmacological treatments for osteoporosis include bone-forming and antiresorptive agents, which may optimally be used in sequential or combination regimens. Since similar mechanisms related to resorption underlie physiological changes in muscle and bone, these interventions may provide benefits beyond treating osteoporosis. Clinical trials to test these interventions, however, often exclude frail older persons because of comorbidities (such as mobility disability and cognitive impairment) or polypharmacy. The Task Force recommended that future clinical trials use harmonized protocols, including harmonized inclusion criteria and similar outcome measures; and that they test a range of multidomain therapies. They further advocated more high-quality research to develop interventions specifically for people who are frail and old. The ICOPE program recommended by WHO appears to be highly recommended to frail older adults with osteoporosis.
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Affiliation(s)
- Y Rolland
- Yves Rolland, Service de Médecine Interne et Gérontologie Clinique, Gérontopôle, CHU Toulouse, INSERM 1027, France,
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Piau A, Steinmeyer Z, Cesari M, Kornfeld J, Beattie Z, Kaye J, Vellas B, Nourhashemi F. Intrinsic Capacitiy Monitoring by Digital Biomarkers in Integrated Care for Older People (ICOPE). J Frailty Aging 2021; 10:132-138. [PMID: 33575701 DOI: 10.14283/jfa.2020.51] [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] [Indexed: 11/11/2022]
Abstract
The WHO action plan on aging expects to change current clinical practices by promoting a more personalized model of medicine. To widely promote this initiative and achieve this goal, healthcare professionals need innovative monitoring tools. Use of conventional biomarkers (clinical, biological or imaging) provides a health status assessment at a given time once a capacity has declined. As a complement, continuous monitoring thanks to digital biomarkers makes it possible to remotely collect and analyze real life, ecologically valid, and continuous health related data. A seamless assessment of the patient's health status potentially enables early diagnosis of IC decline (e.g. sub-clinical or transient events not detectable by episodic evaluations) and investigation of its probable causes. This narrative review aims to develop the concept of digital biomarkers and its implementation in IC monitoring.
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Affiliation(s)
- A Piau
- Antoine Piau, La Cité de la Santé, Bâtiment Ex-Biochimie, Hôpital La Grave, Place Lange, TSA 60033, 31059 Toulouse Cedex 9, France, E-mail address: , Phone number: +335 61 32 30 10, Fax number: +335 61 77 64 75
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Nunziata V, Proietti M, Saporiti E, Calcaterra L, Rolland Y, Vellas B, Cesari M. Pain Management in Nursing Home Residents: Results from the INCUR Study. J Nutr Health Aging 2021; 24:1019-1022. [PMID: 33155631 DOI: 10.1007/s12603-020-1443-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVES Pain is very common among older persons living in nursing home, affecting 45% to 80% of residents, interfering with daily activities and quality of life. Aims of the study are: 1) to measure the analgesics non-prescription in nursing home residents who present pain symptoms; 2) to identify the main determinants of analgesics non-prescription. DESIGN Retrospective cross-sectional analysis. SETTING Data from an observational study ('Incidence of pNeumonia and related ConseqUences in nursing home Residents' [INCUR] study). PARTICIPANTS 800 older persons living in 13 French nursing homes. Measurments: Pain symptoms were definied by one of the following criteria: i) Presence of pain affecting the individual's function in the Activities of Daily Living; ii) Presence of daily pain, and/or; iii) Severe pain measured with a visual analogue scale. RESULTS Among the patients originally included in the study, 288 (36%) reported pain symptomatology (mean age 86.9 [SD 7.2] years, 220 (76%) participants women). Amongst these, 138 (47.9%) were treated with non-opioid analgesic drugs, 52 (18.1%) with opioids, and 98 (34%) did not receive any analgesic prescription. An adjusted logistic regression analysis found that the strongest determinant of analgesics non-prescription was the number of concomitantly prescribed drugs (p<0.001). Age, education, and frailty were not associated with prescription of analgesic drugs. CONCLUSIONS Pain undertreatment is very common among older persons living in nursing homes. The number of prescribed medications represents the most relevant risk factor for the analgesics non-prescription. Our findings document the importance of reviewing prescriptions in nursing home residents.
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Affiliation(s)
- V Nunziata
- Marco Proietti, Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy, e-mail:
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Ruiz JG, Dent E, Morley JE, Merchant RA, Beilby J, Beard J, Tripathy C, Sorin M, Andrieu S, Aprahamian I, Arai H, Aubertin-Leheudre M, Bauer JM, Cesari M, Chen LK, Cruz-Jentoft AJ, De Souto Barreto P, Dong B, Ferrucci L, Fielding R, Flicker L, Lundy J, Reginster JY, Rodriguez-Mañas L, Rolland Y, Sanford AM, Sinclair AJ, Viña J, Waters DL, Won Won C, Woo J, Vellas B. Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines. J Nutr Health Aging 2021; 24:920-927. [PMID: 33155616 PMCID: PMC7568453 DOI: 10.1007/s12603-020-1492-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J G Ruiz
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA, , Twitter: @drjohnmorley
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Tsukamoto S, Tanzi P, Mavrogenis AF, Akahane M, Kido A, Tanaka Y, Cesari M, Donati DM, Longhi A, Errani C. Upfront surgery is not advantageous compared to more conservative treatments such as observation or medical treatment for patients with desmoid tumors. BMC Musculoskelet Disord 2021; 22:12. [PMID: 33402184 PMCID: PMC7784367 DOI: 10.1186/s12891-020-03897-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/21/2020] [Indexed: 01/02/2023] Open
Abstract
Background This study compared the clinical and functional outcomes of patients initially treated with observation or medical treatment with those of patients treated with local treatment (surgery alone or surgery with adjuvant radiotherapy) to confirm whether observation or medical treatment is an appropriate first-line management approach for patients with desmoid tumors. Methods We retrospectively reviewed the medical records of 99 patients with histologically confirmed primary desmoid tumors treated between 1978 and 2018. The median follow-up period was 57 months. We evaluated event-free survival, defined as the time interval from the date of initial diagnosis to the date of specific change in treatment strategy or recurrence or the last follow-up. Results An event (specific change in treatment strategy or recurrence) occurred in 28 patients (28.3%). No significant difference in event-free survival was found between the first-line observation/medical treatment and local treatment groups (p = 0.509). The median Musculoskeletal Tumor Society score of the patients treated with first-line local treatment was 29 (interquartile range [IQR], 23–30), whereas that of the patients managed with first-line observation or medical treatment was 21 (IQR, 19–29.5). First-line observation or medical treatment was more frequently chosen for larger tumors (p = 0.045). In the patients treated with local treatment, local recurrence was not related to the surgical margin (p = 0.976). Conclusion Upfront surgery is not advantageous compared to more conservative treatments such as observation or medical treatment for patients with desmoid tumors. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03897-9.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan.
| | - Piergiuseppe Tanzi
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako-shi, Saitama, 351-0197, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-cho, Kashihara-city, Nara, 634-8521, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan
| | - Marilena Cesari
- Department of Medical Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Alessandra Longhi
- Department of Medical Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Calcaterra L, Cesari M. Post Acute Care for Frail Older Persons: Time for a Standardized Model of Care. J Frailty Aging 2021; 11:1-2. [DOI: 10.14283/jfa.2021.52] [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: 11/11/2022]
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Abstract
Nutrition plays a critical role in the definition of the individual's wellbeing. Nutritional interventions have been repeatedly advocated as of potential interest for preventing or delaying the cognitive decline, also in the context of neurodegenerative conditions. The idea of targeting the initial phases of dementia, when the process is theoretically still amenable of correction, via lifestyle modifications (including healthy diet or supplementation of specific micro-/macro-nutrients) is extremely appealing. In this perspective paper, we describe the most recent evidence on the topic and discuss how the nutritional assessment should be nested within a comprehensive approach to the aging person with initial signs of dementia for promoting his/her optimal management.
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Affiliation(s)
- M Cesari
- Matteo Cesari, MD, PhD. IRCCS Istituti Clinici Scientifici Maugeri; Via Camaldoli 64 - 20138 Milan, Italy. Phone: +39 02 50725136. . Twitter: @macesari
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Azzolino D, Cesari M. Multicomponent Interventions Against Frailty. JAR Life 2021; 10:17-18. [PMID: 36923516 PMCID: PMC10002870 DOI: 10.14283/jarlife.2021.3] [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] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/11/2022]
Abstract
The prevention and management of frailty imply the delay of functional decline. Recently, there has been a growing interest in the adoption of multicomponent interventions, usually incorporating nutrition and physical activity strategies targeted to age-related risk conditions like frailty and sarcopenia (1). The protocol published by Low et al. (2) is based on a 4-month program including a combination of group exercise (1 hour, once a week) and the prescription of home-based exercises, together with group-based educational seminars (i.e., six sessions) on nutrition. As outlined in the manuscript, the beneficial effects of nutrition and physical activity as strategies to prevent and manage frailty are well established. However, a challenge in delivering nutritional education programs to older people is represented by the difficulty in motivating persons at acquiring new dietary habits because of multiple reasons (e.g., sociocultural, economic, or clinical issues). The personalization of the interventions may represent an effective strategy to promote these changes (3).
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Affiliation(s)
- D Azzolino
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - M Cesari
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
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Rolland Y, Cesari M, Morley JE, Merchant R, Vellas B. Editorial: COVID19 Vaccination in Frail People. Lots of Hope and Some Questions. J Nutr Health Aging 2021; 25:146-147. [PMID: 33491026 PMCID: PMC7816745 DOI: 10.1007/s12603-021-1591-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Y Rolland
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University SLUCare Academic Pavilion, Section 2500, 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA, , Twitter: @drjohnmorley
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Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25:824-853. [PMID: 34409961 DOI: 10.1007/s12603-021-1665-8] [Citation(s) in RCA: 318] [Impact Index Per Article: 106.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
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Affiliation(s)
- M Izquierdo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876
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Simo N, Cesari M, Tchiero H, Rolland Y, de Souto Barreto P, Dartigues JF, Vellas B, Tabue-Teguo M. Frailty Index, Hospital Admission and Number of Days Spent in Hospital in Nursing Home Residents: Results from the Incur Study. J Nutr Health Aging 2021; 25:155-159. [PMID: 33491028 DOI: 10.1007/s12603-020-1561-7] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the predictive capacity of an age-related deficit accumulation index (the so-called Frailty Index [FI] proposed by Rockwood) for hospital admission (HA) and number of days spent in hospital (DSH) among nursing home residents. DESIGN, SETTING AND PARTICIPANTS Data are from a longitudinal cohort study, the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR), of 768 elder people (75.4% women) living in 13 nursing homes in France. MEASUREMENTS The FI was computed taking into account 30 possible deficits at the baseline visit. Hospital admissions were defined as all urgent and involuntary admissions including unplanned readmissions. The length of stay was the total number of days spent by the resident in the hospital. Cox proportional hazard models in the presence of competing risks (death) were performed to study the relationship between the FI and HA over a 12-month follow-up. A Zero-inflated negative binomial regression was performed to study the association between the FI and DSH. RESULTS Mean age of participants was 86.7 (standard deviation [SD] 6.9) years, with a mean FI of 0.37 (SD 0.11). At the end of the follow-up, 238 (30.9%) HA events were recorded. Positive associations of the FI with DSH and HA were reported (per 0.01 FI increment: age- and gender-adjusted hazard ratio 1.15, 95% confidence interval 1.020-1.297, p=0.02 and OR 1.209 (1.075 - 1.359, p<0.001, respectively). CONCLUSIONS AND IMPLICATIONS The FI is a strong predictor of negative health-related outcomes as HA and DSH events, even with very old and complex nursing home residents.
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Affiliation(s)
- N Simo
- Maturin Tabue-Teguo, MD, PhD. CHU de Pointe-à-Pitre (Guadeloupe), Equipe LAMIA, Université des Antilles (Guadeloupe), Centre de Recherche INSERM, U1219, 146 rue Léo Saignat, 33076 Bordeaux cedex, France, E-mail:
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Canevelli M, Remoli G, Toccaceli Blasi M, Tariciotti L, Sarli G, Valletta M, D'Antonio F, Vanacore N, Cesari M, Bruno G. Ongoing Research Protocols for the Pharmacological Treatment of Neuropsychiatric Symptoms in Dementia. J Frailty Aging 2020; 10:22-30. [PMID: 33331618 DOI: 10.14283/jfa.2020.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The implementation of effective interventions for neuropsychiatric symptoms (NPS) is perceived as one of the most pressing research priorities in the field of dementia and one of the main unmet needs from the perspective of affected individuals and their caregivers and relatives. Nevertheless, to date, only a relatively marginal part of dementia research has focused on NPS. This study aimed to describe and discuss the state of the art concerning the identification and development of new pharmacological treatments for NPS in dementia. A review of 320 ongoing phase 1, 2, 3, and 4 protocols registered in the clinicaltrials.gov database was performed. All the trials enrolling patients with dementia were selected. Only studies adopting clinical measures of NPS frequency and/or severity as primary outcome were retained and analyzed. Overall, only a minority of ongoing phase 1, 2, 3 and 4 protocols on dementia (i.e., 9.0%) is primarily targeting NPS. Most of these studies are adopting a placebo-controlled parallel assignment design, testing oral compounds, and targeting specific NPS (mostly agitation and/or aggression). A total of 3,445 subjects with dementia will tentatively be recruited in these trials. The methodologies adopted in these studies, the characteristics of the tested interventions, the eligibility criteria, and the operational definitions of NPS are presented and discussed. The relevance of NPS is not yet matched by an adequate research effort. The current tendency at privileging disease-modifying approaches and other symptoms of dementia and the methodological complexity of studying NPS are still substantially contributing to the gap between research activities and clinical needs.
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Affiliation(s)
- M Canevelli
- Marco Canevelli, MD, PhD, Department of Human Neuroscience, "Sapienza" University of Rome, Viale dell'Università 30, 00185 Rome, Italy, Tel/fax +39 (0)6 49914604;
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Ruiz JG, Dent E, Morley JE, Merchant RA, Beilby J, Beard J, Tripathy C, Sorin M, Andrieu S, Aprahamian I, Arai H, Aubertin-Leheudre M, Bauer JM, Cesari M, Chen LK, Cruz-Jentoft AJ, Barreto PDS, Dong B, Ferrucci L, Fielding R, Flicker L, Lundy J, Reginster JY, Rodriguez-Mañas L, Rolland Y, Sanford AM, Sinclair AJ, Viña J, Waters DL, Won CW, Woo J, Vellas B. Erratum to: Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines. J Nutr Health Aging 2020. [PMCID: PMC7790018 DOI: 10.1007/s12603-020-1547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Palmerini E, Setola E, Grignani G, D’Ambrosio L, Comandone A, Righi A, Longhi A, Cesari M, Paioli A, Hakim R, Pierini M, Marchesi E, Vanel D, Pignochino Y, Donati DM, Picci P, Ferrari S. High Dose Ifosfamide in Relapsed and Unresectable High-Grade Osteosarcoma Patients: A Retrospective Series. Cells 2020; 9:E2389. [PMID: 33142760 PMCID: PMC7692098 DOI: 10.3390/cells9112389] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 01/20/2023] Open
Abstract
Background: The evidence on high-dose ifosfamide (HD-IFO) use in patients with relapsed osteosarcoma is limited. We performed a retrospective study to analyze HD-IFO activity. Methods: Patients with osteosarcoma relapsed after standard treatment [methotrexate, doxorubicin, cisplatin +/- ifosfamide (MAP+/-I)] with measurable disease according to RECIST1.1 were eligible to ifosfamide (3 g/m2/day) continuous infusion (c.i.) days 1-5 q21d. RECIST1.1 overall response rate (ORR) (complete response (CR) + partial response (PR)), progression-free survival at 6-month (6m-PFS), duration of response (DOR), and 2-year overall survival (2y-OS) were assessed. PARP1 expression and gene mutations were tested by immunohistochemistry and next-generation sequencing. Results: 51 patients were included. ORR was 20% (1 CR + 9 PR). Median DOR was 5 months (95%CI 2-7). Median PFS, 6m-PFS, OS, and 2y-OS were 6 months (95%CI 4-9), 51%, 15 months (10-19), and 30%, respectively. A second surgical complete remission (CR2) was achieved in 26 (51%) patients. After multivariate analysis, previous use of ifosfamide (HR 2.007, p = 0.034) and CR2 (HR 0.126, p < 0.001) showed a significant correlation with PFS and OS, respectively. No significant correlation was found between outcomes and PARP1 or gene mutations. Conclusions: HD-IFO should be considered as the standard first-line treatment option in relapsed osteosarcoma and control arm of future trial in this setting.
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Affiliation(s)
- Emanuela Palmerini
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (E.S.); (A.L.); (M.C.); (A.P.); (R.H.); (M.P.); (S.F.)
| | - Elisabetta Setola
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (E.S.); (A.L.); (M.C.); (A.P.); (R.H.); (M.P.); (S.F.)
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS. St. Provinciale 142, Km 3.95, 10060 Candiolo, Torino, Italy; (G.G.); (Y.P.)
| | - Lorenzo D’Ambrosio
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS. St. Provinciale 142, Km 3.95, 10060 Candiolo, Torino, Italy; (G.G.); (Y.P.)
| | | | - Alberto Righi
- Pathology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (A.R.); (D.V.)
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (E.S.); (A.L.); (M.C.); (A.P.); (R.H.); (M.P.); (S.F.)
| | - Marilena Cesari
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (E.S.); (A.L.); (M.C.); (A.P.); (R.H.); (M.P.); (S.F.)
| | - Anna Paioli
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (E.S.); (A.L.); (M.C.); (A.P.); (R.H.); (M.P.); (S.F.)
| | - Rossella Hakim
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (E.S.); (A.L.); (M.C.); (A.P.); (R.H.); (M.P.); (S.F.)
| | - Michela Pierini
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (E.S.); (A.L.); (M.C.); (A.P.); (R.H.); (M.P.); (S.F.)
| | - Emanuela Marchesi
- Italian Sarcoma Group, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.M.); (P.P.)
| | - Daniel Vanel
- Pathology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (A.R.); (D.V.)
| | - Ymera Pignochino
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS. St. Provinciale 142, Km 3.95, 10060 Candiolo, Torino, Italy; (G.G.); (Y.P.)
| | - Davide Maria Donati
- Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Piero Picci
- Italian Sarcoma Group, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.M.); (P.P.)
| | - Stefano Ferrari
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.P.); (E.S.); (A.L.); (M.C.); (A.P.); (R.H.); (M.P.); (S.F.)
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Coelho-Junior HJ, Marzetti E, Picca A, Calvani R, Cesari M, Uchida MC. Prevalence of Prefrailty and Frailty in South America: A Systematic Review of Observational Studies. J Frailty Aging 2020; 9:197-213. [PMID: 32996556 DOI: 10.14283/jfa.2020.22] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The present study aimed at investigating the prevalence of prefrailty and frailty in South American older adults according to the setting and region. DESIGN A literature search combining the terms "frailty", "South America" or a specific country name was performed on PubMed, EMBASE, Lilacs, and Scielo to retrieve articles published in English, Portuguese or Spanish on or before August 2019. PARTICIPANTS Older adults aged 60+ years from any setting classified as frail according to a validated scale were included in the study. MEASUREMENTS Frailty assessment by a validated scale. RESULTS One-hundred eighteen reports (98 performed from Brazil, seven from Chile, five from Peru, four from Colombia, two from Ecuador, one from Argentina, and one from Venezuela) were included in the study. The mean prevalence of prefrailty in South America was 46.8% (50.7% in older in-patients, 47.6% in the community, and 29.8% in nursing-home residents). The mean prevalence of frailty in South America was 21.7% (55.8% in nursing-home residents, 39.1% in hospitalized older adults, and 23.0% in the community). CONCLUSIONS Prefrailty and frailty are highly prevalent in South American older adults, with rates higher than those reported in Europe and Asia. In the community, almost one-in-two is prefrail and one-in-five is frail, while hospitalized persons and nursing-home residents are more frequently affected. These findings indicate the need for immediate attention to avoid frailty progression toward negative health outcomes. Our findings also highlight the need for specific guidelines for the management of frailty in South America.
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Affiliation(s)
- H J Coelho-Junior
- Hélio J. Coelho-Junior, Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario «Agostino Gemelli» IRCCS, Università Cattolica del Sacro Cuore. L.go F. Vito 1, Rome 00168, Italy. Tel.: +39 (06) 3015-5559. Fax: +39 (06) 3051-911, E-mail:
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Kim S, Pollett A, Tone A, Cesari M, Clarke B, Eiriksson L, Hart T, Holter S, Kim R, Lu L, Lytwyn A, Oldfield L, Pugh T, Van de Laar E, Vicus D, Ferguson S. Understanding the clinical implication of mismatch repair deficiency in endometrioid endometrial cancer through a prospective study. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.381] [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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Cusimano M, Vicus D, Pulman K, Bernardini M, Laframboise S, May T, Bouchard-Fortier G, Hogen L, Gien L, Covens A, Kupets R, Clarke B, Cesari M, Rouzbahman M, Mirkovic J, Turashvili G, Maganti M, Zia A, Ene G, Ferguson S. Sentinel lymph node biopsy versus lymphadenectomy for high-grade endometrial cancer staging (SENTOR trial): A prospective multicenter cohort study. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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