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Masetti M, Al-Batran SE, Goetze TO, Thuss-Patience P, Knorrenschild JR, Goekkurt E, Folprecht G, Ettrich TJ, Lindig U, Luley KB, Pink D, Dechow T, Sookthai D, Junge S, Loose M, Pauligk C, Lorenzen S. Efficacy of ramucirumab combination chemotherapy as second-line treatment in patients with advanced adenocarcinoma of the stomach or gastroesophageal junction after exposure to checkpoint inhibitors and chemotherapy as first-line therapy. Int J Cancer 2024; 154:2142-2150. [PMID: 38447003 DOI: 10.1002/ijc.34894] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/20/2023] [Accepted: 01/12/2024] [Indexed: 03/08/2024]
Abstract
FOLFOX plus nivolumab represents a standard of care for first-line therapy of advanced gastroesophageal cancer (aGEC) with positive PD-L1 expression. The efficacy of second-line VEGFR-2 inhibition with ramucirumab (RAM) plus chemotherapy after progression to immunochemotherapy remains unclear. Medical records of patients with aGEC enrolled in the randomized phase II AIO-STO-0417 trial after treatment failure to first-line FOLFOX plus nivolumab and ipilimumab were retrospectively analyzed. Patients were divided into two groups based on second-line therapy: RAM plus chemotherapy (RAM group) or treatment without RAM (control group). Eighty three patients were included. In the overall population, progression-free survival (PFS) in the RAM group was superior to the control (4.5 vs 2.9 months). Responders (CR/PR) to first-line immunochemotherapy receiving RAM containing second-line therapy had prolonged OS from start of first-line therapy (28.9 vs 16.5 months), as well as second-line OS (9.6 vs 7.5 months), PFS (5.6 vs 2.9 months) and DCR (53% vs 29%) compared to the control. PD-L1 CPS ≥1 was 42% and 44% for the RAM and the control, respectively. Patients with CPS ≥1 in the RAM group showed better tumor control (ORR 25% vs 10%) and improved survival (total OS 11.5 vs 8.0 months; second-line OS 6.5 vs 3.9 months; PFS 4.5 vs 1.6 months) compared to the control. Prior exposure to first-line FOLFOX plus dual checkpoint inhibition followed by RAM plus chemotherapy shows favorable response and survival rates especially in patients with initial response and positive PD-L1 expression and has the potential to advance the treatment paradigm in aGEC.
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Affiliation(s)
- Michael Masetti
- Klinikum rechts der Isar, Technische Universität München, Klinik für Innere Medizin III, Munich, Germany
| | - Salah-Eddin Al-Batran
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany and Krankenhaus Nordwest, University Cancer Center Frankfurt, Frankfurt, Germany
| | - Thorsten O Goetze
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany and Krankenhaus Nordwest, University Cancer Center Frankfurt, Frankfurt, Germany
| | - Peter Thuss-Patience
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Eray Goekkurt
- Haematologisch-Onkologische Praxis Eppendorf, Universitäres Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - Gunnar Folprecht
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Udo Lindig
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Kim Barbara Luley
- UKSH Campus Lübeck, Klinik für Hämatologie und Onkologie, Lübeck, Germany
| | - Daniel Pink
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald and Klinik für Hämatologie, Onkologie und Palliativmedizin-Sarkomzentrum, HELIOS Klinikum Bad Saarow, Bad Saarow, Germany
| | | | - Disorn Sookthai
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany
| | - Sabine Junge
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany
| | - Maria Loose
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany
| | - Claudia Pauligk
- Institut für Klinische Krebsforschung IKF am Krankenhaus Nordwest, Frankfurt, Germany
| | - Sylvie Lorenzen
- Klinikum rechts der Isar, Technische Universität München, Klinik für Innere Medizin III, Munich, Germany
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Manigrasso M, D'Amore A, Benatti E, Bracchitta LM, Bracchitta S, Cantarella F, Carpino A, Ferrari F, Gallo G, La Torre M, Magnani C, Magni E, Margiotta A, Masetti M, Mori L, Pata F, Pezza M, Tierno S, Tomassini F, Vanini P, De Palma GD, Milone M. Five-year recurrence after endoscopic approach to pilonidal sinus disease: A multicentre experience. Tech Coloproctol 2023; 27:929-935. [PMID: 37597082 DOI: 10.1007/s10151-023-02846-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/21/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The aim of this study was to evaluate the 5-year recurrence rate of pilonidal sinus disease (PSD) after endoscopic sinusectomy and identify risk factors for recurrence. METHODS All consecutive patients from September 2011 through December 2017 who underwent endoscopic sinusectomy at seven referral centres for pilonidal sinus treatment were retrospectively analysed from a prospectively maintained database. RESULTS Out of 290 patients (185 males versus 105 female, with a mean age of 25.5±6.9), 73 presented recurrence at 5-year follow-up with a recurrence rate of 25.2%. The number of pilonidal sinus with pits off the midline (p = 0.001) and the mean (SD) distance from the most lateral orifice to the midline (p = 0.001) were higher in the group of patients with recurrence at 5-year follow-up. Multivariate analysis demonstrated that the position of the pits off the midline (p = 0.001) and the distance of the most lateral orifice from the midline (p = 0.001) were independent risk factors for recurrence at 5-year follow-up. Receiver operating characteristic (ROC) curve analysis showed that the distance of lateral orifice from midline predicted an 82.2% possibility of recurrence at 5-year follow-up and Youden's test identified the best cut-off as 2 cm for this variable. Out of 195 cases with the most lateral orifice less than 2 cm from the midline, 13 presented recurrence at 5-year follow-up with a recurrence rate of 6.7%. Out of 95 cases with the most lateral orifice more than 2 cm from midline, 60 showed recurrence at 5-year follow-up with a recurrence rate of 63.2%. CONCLUSIONS This data may help guide which disease characteristics predict the optimal use of an endoscopic pilonidal sinus technique.
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Affiliation(s)
- M Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy.
| | - A D'Amore
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - E Benatti
- Proctology Unit, ASL 4 Chiavarese, "E. Riboli" Hospital, Lavagna, GE, Italy
| | - L M Bracchitta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - S Bracchitta
- Coloproctolgy Center, Clinica del Mediterraneo, Ragusa, Italy
| | - F Cantarella
- Centro Proctologico e Perineologico, Ospedali Privati Forlì, Forlì, Italy
| | - A Carpino
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - F Ferrari
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - G Gallo
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - M La Torre
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - C Magnani
- Department of Surgery, AUSL of Imola (BO), Bologna, Italy
| | - E Magni
- Centro Proctologico e Perineologico, Ospedali Privati Forlì, Forlì, Italy
| | - A Margiotta
- Department of Surgery, AUSL of Imola (BO), Bologna, Italy
| | - M Masetti
- Department of Surgery, AUSL of Imola (BO), Bologna, Italy
| | - L Mori
- Proctology Unit, ASL 4 Chiavarese, "E. Riboli" Hospital, Lavagna, GE, Italy
| | - F Pata
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, CS, Italy
| | - M Pezza
- Proctology Unit, ASL 4 Chiavarese, "E. Riboli" Hospital, Lavagna, GE, Italy
| | - S Tierno
- Department of Surgery, Ospedale Vannini, Rome, Italy
| | - F Tomassini
- Department of Surgery, Ospedale Grassi, Rome, Italy
| | - P Vanini
- Centro Proctologico e Perineologico, Ospedali Privati Forlì, Forlì, Italy
| | - G D De Palma
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - M Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
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Scheck MK, Masetti M, Lorenzen S. Neoadjuvant and adjuvant approaches in gastroesophageal cancers. Curr Opin Oncol 2023; 35:318-325. [PMID: 37222198 DOI: 10.1097/cco.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE OF REVIEW Despite advances in the perioperative treatment of locally advanced (T2-4 and/or N+) gastroesophageal cancer with evolving chemoradiotherapy and chemotherapy regimens, prognosis remains poor. Biomarker-based approaches with targeted therapies and immune checkpoint inhibition present a new opportunity to improve response rate and overall survival. This review aims to shed light on the current treatment strategies and therapy options that are under investigation for the curatively intended perioperative treatment of gastroesophageal cancer. RECENT FINDINGS A major step for patients with advanced esophageal cancer and insufficient response to chemoradiotherapy was the implementation of immune checkpoint inhibition in the adjuvant treatment with positive effects on survival duration and quality of life (CheckMate577). Various studies that seek to further integrate immunotherapy or targeted therapy into (neo-) adjuvant treatment are on their way and show promising results. SUMMARY Ongoing clinical research tries to increase the effectivity of standard of care approaches for the perioperative treatment of gastroesophageal cancer. Biomarker based immunotherapy and targeted therapy bear the opportunity to further improve the outcome.
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Affiliation(s)
- Magdalena K Scheck
- III. Medizinische Klinik and Poliklinik, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Potena L, Spitaleri G, Masetti M, Borgese L, Giovannini L, Orsini A, De Nicolò B, Scuppa M, Manno S, Baldovini C, Leone O, Bonora E. Initial Experience with Local Laboratory Run Assay to Detect Donor-Derived Cell Free Dna for Non-Invasive Diagnosis of Acute Myocardial Rejection. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.515] [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: 04/05/2023] Open
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5
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Masetti M, Scuppa M, Giovannini L, Sabatino M, Suarez SM, Potena L. Restrictive Physiology: Playing with Rhc Between Cav and Amr. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.058] [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: 04/05/2023] Open
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Masetti M, Scuppa M, Giovannini L, Borgese L, Aloisio A, Spitaleri G, Giannella M, Potena L. Trying to Protect HT Patients Poor Vaccine Responders: Reducing MMF or Trust Tixagevimab/Cilgavimab? Insights from CONTRAST Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.601] [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: 04/05/2023] Open
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Masetti M, Scuppa F, Sabatino M, Suarez SM, Loforte A, Russo A, Prestinenzi P, Leone O, Potena L. Using Hemodynamics to Define Graft Function: Do We Need It? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.187] [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: 11/30/2022] Open
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8
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Loforte A, Fiorentino F, Gliozzi G, Santamaria V, Cavalli G, Murana G, Mariani C, Botta L, Sabatino M, Masetti M, Potena L, Martin Suarez S, Pacini D. Impact of Recipients Pre-Operative Right Ventricular Dysfunction on Heart Transplantation Outcomes. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1760] [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: 11/29/2022] Open
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Fiorentino M, Suarez SM, Botta L, Loforte A, Murana G, Amodio C, Costantino A, Cavalli G, Tassi S, Russo A, Masetti M, Potena L, Pacini D. Cardiac Transplantation Italian Allocation System Analysis: Single Center Results. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Masetti M, Lindinger M, Lorenzen S. PD-1 Blockade Elicits Ongoing Remission in Two Cases of Refractory Epstein-Barr Virus Associated Metastatic Gastric Carcinoma. Oncol Res Treat 2022; 45:375-379. [DOI: 10.1159/000523754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022]
Abstract
Introduction:
Over the last decade immunotherapy has revolutionized oncological treatment of malignancies across all entities including gastric cancer. The programmed cell death protein 1 (PD-1) inhibitor pembrolizumab has demonstrated durable responses and survival benefit in distinct patient subgroups with advanced gastric cancer. In 2017, pembrolizumab monotherapy was approved by the U.S. Food and Drug Administration (FDA) for the treatment of refractory metastatic gastric cancer overexpressing PD-L1, as well as for refractory advanced tumors with deficient DNA mismatch repair/microsatellite instability (dMMR/MSI) or high tumor mutational burden (TMB-H). However, several biomarker unselected studies have reported only limited single-agent immunotherapeutic efficacy. Thus, the identification of predictive biomarkers to select patient subgroups who are most eligible for immunotherapy is of particular importance. A growing number of studies consider Epstein–Barr virus associated gastric cancer (EBVaGC) as a molecularly distinct and immunogenic subtype which might be particularly sensitive to immune checkpoint inhibition.
Case report:
Here we present two cases of heavily pretreated patients with refractory, metastatic EBVaGC, who experienced a significant and sustained response to monotherapy with the PD-1 checkpoint inhibitor pembrolizumab.
Conclusion:
Comprehensive genetic testing for predictive biomarkers (e.g. PD-L1, MSI/dMMR, tTMB, EBV) to identify patient subgroups most eligible for immunotherapy is of particular importance in advanced gastric cancer, especially in patients that are refractory to conventional chemotherapy.
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Schenck K, Masetti M, Pfarr N, Lorenzen S. PD-1 Blockade Elicits Ongoing Remission in Two Cases of Refractory Microsatellite-Stable Cancer Harboring a POLE Mutation. Oncol Res Treat 2021; 45:222-226. [PMID: 34875656 DOI: 10.1159/000521332] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In the last decade immune checkpoint therapy has led to a break-through in the treatment of cancer across all entities, while molecular markers have grown in importance for the choice of the appropriate chemotherapeutic agents. Accordingly, in 2017 the U.S. Food and Drug Administration (FDA) approved the programmed cell death protein 1 (PD-1) inhibitor pembrolizumab, a tissue agnostic cancer drug, for the treatment of cancer that displays microsatellite instability (MSI), regardless of histological entity and site of origin. However, a growing number of studies report that cases of microsatellite stable (MSS) tumors harboring a DNA polymerase ε (POLE) mutation, a gene associated with proofreading deficiency, leading to an increased tumor mutational burden (TMB), likewise benefit from immune checkpoint therapy. CASE REPORT Here we present two cases - one advanced adenocarcinoma of the ileum and one mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN), both MSS and carrying a POLE mutation - that were refractory to initial chemotherapy but responded on immunotherapy with pembrolizumab. CONCLUSION Colorectal cancer is a clinically and molecularly heterogenic disease which requires comprehensive genetic testing to screen for rare genetic alterations like POLE mutations to detect tumors harboring an ultramutator phenotype especially in patients that are refractory to standard chemotherapy.
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Affiliation(s)
- Kristina Schenck
- Department of Hematology and Oncology, Klinikum Rechts der Isar der TU Muenchen, Munich, Germany
| | - Michael Masetti
- Department of Hematology and Oncology, Klinikum Rechts der Isar der TU Muenchen, Munich, Germany
| | - Nicole Pfarr
- Institute of Pathology, School of Medicine, Technical University Munich, Munich, Germany
| | - Sylvie Lorenzen
- Department of Hematology and Oncology, Klinikum Rechts der Isar der TU Muenchen, Munich, Germany
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Lorenzen S, Reinacher-Schick A, Masetti M. [Modern concepts of systemic treatment for adjuvant and palliative treatment of locally advanced or metastasized esophageal cancer]. Chirurg 2021; 92:1085-1093. [PMID: 34387700 DOI: 10.1007/s00104-021-01476-9] [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] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The approval of a wide variety of PD-1/PD-L1 and CTLA‑4 inhibitors has sustainably influenced the treatment landscape in many tumor entities and established immunotherapy as a new oncological treatment strategy. OBJECTIVE This article summarizes the current clinical state of treatment for locally advanced and metastatic esophageal cancer and assesses the running and future developmental program and the implementation in the clinical routine. MATERIAL AND METHODS Publications from Medline, ASCO and ESMO were systematically collected and evaluated. RESULTS Many phase I-III trials focusing on immunotherapy for gastrointestinal tumors were carried out in recent years but were however without comparable success to other tumor entities and with only moderate response rates between 10% and 25% in monotherapy. Subgroups such as microsatellite instability (MSI) cancers and tumors overexpressing PD-L1 seem to particularly benefit from treatment with immune checkpoint inhibitors. Routine testing for known molecular alterations should therefore be carried out with all advanced esophageal cancers. Initial promising approaches with a combination of chemotherapy and immunotherapy were recently published and could become new treatment standards for esophageal cancer. CONCLUSION Due to the survival advantage with a combination of chemotherapy and immunotherapy for untreated advanced stage esophageal cancer, it seems likely that this treatment strategy will become established as a new standard of care, assuming approval is granted. Immunotherapy might also become important in the adjuvant treatment of esophageal cancer.
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Affiliation(s)
- Sylvie Lorenzen
- Klinik und Poliklinik für Innere Medizin III, Abteilung für Hämatologie und Onkologie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - Anke Reinacher-Schick
- Medizinische Klinik V, Klinik für Hämatologie und Onkologie mit Palliativmedizin, St. Josef-Hospital, Ruhr-Universität, Bochum, Deutschland
| | - Michael Masetti
- Abteilung für Hämatologie und Onkologie, Klinikum rechts der Isar, TU München, München, Deutschland
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Boschi S, Campedelli L, Valente M, Giovannini L, Golfieri L, Masetti M, Sabatino M, Loforte A, Suarez SM, Grandi S, Pacini D, Potena L. Impact of Major Surgical Procedures on Quality of Life of Patients with Advanced Heart Failure. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Masetti M, Toniolo S, Adorno A, Giovannini L, Prestinenzi P, Sabatino M, Russo A, Suarez SM, Loforte A, Pacini D, Potena L. Telemedicine (TM) during SARS-CoV-2 Outbreak. J Heart Lung Transplant 2021. [PMCID: PMC7979407 DOI: 10.1016/j.healun.2021.01.1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose As Italy faced SARS-CoV-2 outbreak as first country outside China, and our hospital converted most of activities into the ones for COVID-19 patients (pts), we had to manage the need for continuing care of advanced heart failure (HF), heart transplant (HT) and LVAD pts. TM was a possible strategy, but its role in this very sick cohort is unknown. Methods During the lockdown (03-05/2020), we decided to make either a phone (PV) or an in presence (IV) visit, selecting for IV pts listed for HT, with LVAD, recently HT, scheduled for a biopsy within 6 months after HT or a RHC for listing eligibility. In PV, we assessed symptoms, blood pressure, drugs, and programmed a subsequent IV. All pts in IV group were triaged by phone for COVID-19 symptoms or contacts and if scheduled for RHC or biopsy received SARS-CoV-2 swab 48 h before the procedure. Study endpoints were: combined incidence at 6 months of MACE (HF hospitalization, CV death and need for anticipated IV) in HF/VAD group, and MACE, rejection and any cause- hospitalization in HT group. Results Among 448 pts (57±12y, 240 HT, 191 HF, 17 LVAD), 52% were managed by PV and a subsequent IV was scheduled after 3±2 months. Pts managed by PV were healthier: in HF-VAD group they were less frequently listed, had less Afib, LVAD (2/17) (p<0.01 all); post-capillary PH (pC-PH) was similarly distributed; in HT group there were less pts transplanted in the last 5 years (15% vs 52%, p<0.01) and numerically less with 2R rejection in the previous 6 months (8.3% vs 27.1%, p=0.13).The PV group had a lower incidence of the endpoints in both HF/VAD and HT cohorts (92.3±2.3% vs 70.3±4.4%; 97.0±1.7%vs82.5±4.1%, p<0.01). Overall, the predictors of the endpoints at multivariate analysis were pC-PH and PV (HR: 5.2 and 0.1, p<0.03 both) and a recent 2R rejection (HR: 3.6, p=0.05) in the HF/VAD and HT group respectively.There were no cases of COVID-19 in IV; 5 pts got infected at home in a context of infection prevalence of 6/1000 inhabitants in our region and of 40% of hospital beds dedicated to COVID-19 pts. Conclusion In this retrospective study, by reporting an organization set up in a emergency situation, we show that TM can be safely used to manage stable HF, LVAD and HT patients, whereas pC-PH and a recent rejection may identify those needing IV. These data suggest that the availability of devices for monitoring pulmonary pressures may improve safety of PV in HF pts and that TM could be useful not only in a pandemic outbreak but also subsequently.
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Bellettini M, Pidello S, Gallone G, Frea S, Masetti M, Sabatino M, Boschi S, Giustetto C, Boffini M, Rinaldi M, Potena L, De Ferrari G. Prognostic value and usefulness of Pulmonary Artery Pulsatility index (PAPi) in evaluation of heart transplant candidates. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1104] [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
Heart transplantation (HTx) is considered the best available treatment for patients with end stage heart failure. Candidate evaluation with right heart catheterization (RHC) is fundamental in order to exclude pulmonary hypertension with irreversible high pulmonary vascular resistance (PVR), which is associated with elevated post-HTx mortality. PVR, rather than directly measured, is derived by cardiac output and pulmonary artery pressures, which are strictly dependent on right ventricular (RV) function. The pulmonary artery pulsatility index (PAPi) is a hemodynamic parameter integrating the information of RV function and of pulmonary circulation, which could be useful in pre-HTx evaluation.
Purpose
We designed this study to evaluate the potential predictive influence of pre-HTx PAPi on post-HTx survival and to assess whether this index could add useful information in the pre-HTx evaluation of patients with advanced heart failure.
Methods
Consecutive adult HTx recipient at two medium-large tranplant centers between 2000 and 2017 with available data on pre-HTx RHC were retrospectively included. PAPi was calculated as the ratio of pulmonary artery pulse pressure to right atrial pressure. PAPi values in the lowest quartile were defined as reduced (PAPi<1.67). The primary endpoint was all-cause mortality at 1-year post-HTx. The association of reduced PAPi with the primary endpoint was evaluated. Cox regression was used to adjust for clinical and hemodynamic variables. Analyses stratified by PVR status (≥3 WU vs. <3 WU) were also performed.
Results
Among 655 HTx recipients (female 20,8%, age 53±11 years), median pre-HTx PAPi was 3.0 (interquartile range 1.67–5.32). Patients in the lowest versus the remaining PAPi quartiles had significantly reduced 1-year survival (78.0% vs 87.2%, p=0.006), also after adjusting for age, estimated glomerular filtration rate, total bilirubin, high PVR and urgent transplantation (adj-hazard ratio: 0.64; 95% confidence interval 0.51–0.82). When stratifying patients by estimated PVR status, reduced PAPi was associated with worse 1-year survival among patients with normal PVR (78.3% vs. 88.3% p=0.011), but not in those with increased PVR (78.0% vs. 82.6%, p=0.36) (Figure 1).
Conclusions
Pre-HTx PAPi, integrating information of RV function and pulmonary circulation, provides incremental prognostic value over traditional clinical and hemodynamic parameters among HTx recipient. The prognostic value appears important among patients with normal estimated PVR, possibly due to an underestimation of PVR in patients with impaired RV function. The integration of PAPi in the pre-HTx evaluation may lead to better patient selection and post-HTx survival.
Figure 1. 1 year survival stratified by PVR status
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Bellettini
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Department of Medical Sciences, Turin, Italy
| | - S Pidello
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Department of Medical Sciences, Turin, Italy
| | - G Gallone
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Department of Medical Sciences, Turin, Italy
| | - S Frea
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Department of Medical Sciences, Turin, Italy
| | - M Masetti
- University Hospital Policlinic S. Orsola-Malpighi, Heart Failure and Heart Transplant Program, Bologna, Italy
| | - M Sabatino
- University Hospital Policlinic S. Orsola-Malpighi, Heart Failure and Heart Transplant Program, Bologna, Italy
| | - S Boschi
- University Hospital Policlinic S. Orsola-Malpighi, Heart Failure and Heart Transplant Program, Bologna, Italy
| | - C Giustetto
- University Hospital Policlinic S. Orsola-Malpighi, Heart Failure and Heart Transplant Program, Bologna, Italy
| | - M Boffini
- A.O.U. Citta della Salute e della Scienza di Torino, Department of Cardiovascular and Thoracic Surgery, Turin, Italy
| | - M Rinaldi
- A.O.U. Citta della Salute e della Scienza di Torino, Department of Cardiovascular and Thoracic Surgery, Turin, Italy
| | - L Potena
- University Hospital Policlinic S. Orsola-Malpighi, Heart Failure and Heart Transplant Program, Bologna, Italy
| | - G.M De Ferrari
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Department of Medical Sciences, Turin, Italy
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Botta L, Murana G, Fiorentino M, Marianna B, Gliozzi G, Masetti M, Potena L, Suarez SM, Pacini D, Loforte A. Impact of Severe Pulmonary Hypertension on Right Heart Hemodynamics and Outcomes Following Cardiac Transplantation: A Single Center Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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17
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Braun O, Brambatti M, Shah P, Cipriani M, Veenis J, Bui Q, Hong K, de Heyning C, Perna E, Timmermans P, Cikes M, Gjesdal G, Partida C, Potena L, Masetti M, Loforte A, Jakus N, Nilsson J, De Bock D, Minto J, Brugts J, Sterken C, Van den Bossche K, Rega F, Sing R, Russo C, Pretorius V, Klein L, Frigerio M, Adler E, Ammirati E. ICD Therapy Confers No Survival Advantage in a Global LVAD Population: Insights from the Trans-Atlantic Registry on VAD and Transplant (TRAViATA). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.783] [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: 11/29/2022] Open
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18
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Masetti M, Moretta A, Sabatino M, Russo A, Martin Suarez S, Loforte A, Galiè N, Potena L. Pulmonary Vascular Resistances among Heart Transplant Candidates: Are We Looking to the Right Player? J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Masetti M, Corazza F, Giovannini L, Russo A, Prestinenzi P, Boschi S, Potena L. Hemodynamic Effects of Sacubitril-Valsartan in Heart Failure with Reduced-Ejection Fraction: Are All Doses Created Equal? J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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20
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Moretta A, Masetti M, Russo A, Dardi F, Palazzini M, Martin Suarez S, Galie' N, Potena L. P6311Is the new PH classification useful to assess the need for heart transplantation? Looking for harder markers for hard patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) is an important prognostic marker among patients (pts) with heart failure. Recent ESC guidelines have introduced the concept of diastolic transpulmonary gradient (DPG) to differentiate combined (CpC) and isolated (IpC) post-capillary PH. However, its validation in a setting of patients evaluated for heart transplantation (HT) has been poorly explored; moreover, it doesn't incorporate right ventricular (RV) function.
Purpose
To analyze the prognostic role of current classification of PH and its interplay with RV function and diuretic therapy in pts with advanced heart failure referred for HT.
Methods
We included all pts evaluated for HT in our Center (2002–16) undergoing to a right heart cath (RHC), collecting data at first evaluation. Patients were divided into three groups: no PH (mPAP<25 mmHg), IpC-PH (mean PAP >25 mmHg, PVR<3 WU), CpC-PH (mean PAP>25 mmHg, PVR ≥3 WU and/or DPG ≥7 mmHg). Pulmonary artery pulsatility index (PAPi) was analyzed as a marker of RV function; oral furosemide>125 mg/day (median value) or i.v. diuretics/dialysis were considered as high-dose diuretics (HDD). The study endpoint was the combined incidence of death or need for high urgent HT, expressed as 2-yrs survival rate.
Results
Among the overall cohort of 458 pts (53.1±10.9 yrs, 82,6% males, 40.3% CAD, 9.3% on IABP), 57.9% had PH: 30.8% IpC-PH, 27.1% CpC-PH. Only 8 pts (0.2%) had DPG≥7, one with PVR<3. The use of HDD differed significantly according to PH classes (44.6% vs 56.3% vs 68.3%, no PH vs IpC vs CpC-PH respectively, p<0.01) and was associated with a worse outcome (p<0.01). The incidence of the primary endpoint in the overall cohort was 74.1±2.5%. While pts with CpC-PH had the worst prognosis, DPG≥7 did not predict the primary endpoint. At multivariate analysis, PVR ≥3 WU (HR: 16.7), PAPi <3.8 (median value, HR: 4.1), HDD (HR: 5.6) were independent predictors of the primary endpoint, (p<0.04 for all) as well as need for IABP (HR: 19.0, p<0.01), even adjusting for clinical variables. Lower PAPi values carried an higher risk at 2 years both in IpC and CpC PH groups, thus allowing to better stratify the need for urgent HT (81.6±6.6% vs 78.6±5.7% vs 67.3±6.7% vs 49.1±7.9% respectively, p<0.001) (Fig.1).
Figure 1
Conclusion
Our results suggest that, even if current definition of type 2 PH predicts the need of urgent HT, the incorporation of DPG ≥7 is epidemiologically irrelevant and doesn't increase accuracy, whereas combining an indirect marker of RV function (PAPi) with PVR assessment, even correcting for diuretic therapy, could help to better stratify the need of a rare resource like HT in patients with advanced heart failure and pulmonary hypertension.
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Affiliation(s)
- A Moretta
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Masetti
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - A Russo
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - F Dardi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Palazzini
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - S Martin Suarez
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - N Galie'
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - L Potena
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
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Franceschelli A, Colombo F, Masetti M, Gentile G, Piazza P, Bianchi L, Droghetti M, Sadini P, Vagnoni V. PS-07-007 Comparison between two different xenografts in the surgical treatment of Peyronie's Disease: A single-center experience. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Masetti M, Presta E, Corazza F, Laganà N, Boschi S, Giovannini L, Russo A, Grigioni F, Potena L. Back to ECG in Predicting Graft Dysfunction in the Era of Molecular Assays: Einthoven's Revenge? J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Masetti M, Moretta A, Russo A, Dardi F, Palazzini M, Suarez SM, Loforte A, Grigioni F, Galiè N, Potena L. PH in Heart Transplant (HT) Candidates: Don't Look at Ghosts, Search the Evil in the Details. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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24
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Loforte A, Montalto A, Mariani C, Polizzi V, Masetti M, Lilla Della Monica P, Grigioni F, Marinelli G, Musumeci F. Hemocompatibility Related Adverse Events and Competitive Outcomes of Different Generation of Left Ventricular Assist Devices. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.954] [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: 11/30/2022] Open
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25
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Potena L, Gaudenzi A, Chiereghin A, Borgese L, Brighenti A, Piccirilli G, Masetti M, Giovannini L, Boschi S, Lazzarotto T, Grigioni F. Quantiferon Monitor Assay Identifies Over-Immunosuppressed Patients with Adverse Outcomes After Heart Transplantation: Towards the Definition of a Phenotype of Immune Frailty. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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26
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Loforte A, Montalto A, Mariani C, Martin Suarez S, Pilato E, Masetti M, Sbaraglia F, Lilla Della Monica P, Grigioni F, Musumeci F, Marinelli G. Outcomes of Extended Criteria Cardiac Transplantation versus Destination Left Ventricular Assist Device Therapy. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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27
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Borgese L, Potena L, Leone O, Agostini V, Reeve J, Masetti M, Russo A, Grigioni F, Halloran P. Improving the Diagnosis of Rejection by Molecular Phenotype of Endomyocardial Biopsies: Single Center Insights from the Interheart Study. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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28
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Sabatino M, Centritto A, Borgese L, Bertolino E, Masetti M, Rinaldi A, Dardi F, Galie N, Grigioni F, Potena L. P445Pulmonary hypertension in patients with advanced heart failure with reduced ejection fraction: a marker but not a maker. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Borgese L, Gaudenzi A, Agostini V, Masetti M, Corti B, Reeve J, Grigioni F, Leone O, Halloran P, Potena L. Molecular Profiling of Endomyocardial Biopsies and Clinical Phenotype of Graft Dysfunction: Taking Rejection Diagnosis Beyond Pathological Findings. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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30
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Loforte A, Montalto A, Polizzi V, Sbaraglia F, Presti ML, Potena L, Masetti M, Grigioni F, Marinelli G, Musumeci F. Predicting Right Ventricular Failure in the Current Continuous Flow Left Ventricular Assist Device Era. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1206] [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] Open
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31
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Loforte A, Gremolini M, Cefarelli M, Jafrancesco G, Pilato E, Potena L, Masetti M, Grigioni F, Marinelli G. Influence of the MELD-XI (Model of End-Stage Liver Disease Excluding INR) on Heart Transplant Outcomes. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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32
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Potena L, Righini L, Manfredini V, Borgese L, Sgreccia D, Chiereghin A, Piccirilli G, Masetti M, Lazzarotto T, Grigioni F. Quantiferon Monitor: A Novel Assay for Prediction of Infectious Risk in Heart Transplant Recipients. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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33
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Sabatino M, Potena L, Longhi S, Masetti M, Gagliardi C, Milandri A, Manfredini V, Cinelli M, Marinelli G, Pinna A, Rapezzi C, Grigioni F. Outcomes of Heart Transplantation for Transthyretin-Related Amyloid Cardiomyopathy. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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34
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Sabatino M, Barra B, Potena L, Leone O, Manfredini V, Masetti M, Alvaro N, Borgese L, Marinelli G, Rapezzi C, Grigioni F. Improving Donor Selection and Management: Insights From Eurotransplant Donor Score and Pathology Examination of Discarded Hearts. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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35
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Masetti M, Malossi M, Potena L, Prestinenzi P, Manfredini V, Barberini F, Borgese L, Sabatino M, Magnani G, Grigioni F, Rapezzi C. Everolimus (EVE) vs. Mycophenolate (MMF) De Novo After Heart Transplantation (HTx): Does It Matter for Long Term Outcomes? J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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36
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Ferraro M, Masetti M, Recanatini M, Cavalli A, Bottegoni G. Modeling lipid raft domains containing a mono-unsaturated phosphatidylethanolamine species. RSC Adv 2015. [DOI: 10.1039/c5ra02196k] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An advanced coarse-grained model for “atypical” lipid rafts was built and validated to be employed in studies of membrane-protein interactions.
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Affiliation(s)
- M. Ferraro
- D3 Compunet
- Istituto Italiano di Tecnologia
- Genova
- Italy
| | - M. Masetti
- Department of Pharmacy and Biotechnology
- Alma Mater Studiorum – Università di Bologna
- Bologna
- Italy
| | - M. Recanatini
- Department of Pharmacy and Biotechnology
- Alma Mater Studiorum – Università di Bologna
- Bologna
- Italy
| | - A. Cavalli
- D3 Compunet
- Istituto Italiano di Tecnologia
- Genova
- Italy
- Department of Pharmacy and Biotechnology
| | - G. Bottegoni
- D3 Compunet
- Istituto Italiano di Tecnologia
- Genova
- Italy
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37
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Fiorino S, Bacchi-Reggiani L, Sabbatani S, Grizzi F, di Tommaso L, Masetti M, Fornelli A, Bondi A, de Biase D, Visani M, Cuppini A, Jovine E, Pession A. Possible role of tocopherols in the modulation of host microRNA with potential antiviral activity in patients with hepatitis B virus-related persistent infection: a systematic review. Br J Nutr 2014; 112:1751-68. [PMID: 25325563 DOI: 10.1017/s0007114514002839] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hepatitis B virus (HBV) infection represents a serious global health problem and persistent HBV infection is associated with an increased risk of cirrhosis, hepatocellular carcinoma and liver failure. Recently, the study of the role of microRNA (miRNA) in the pathogenesis of HBV has gained considerable interest as well as new treatments against this pathogen have been approved. A few studies have investigated the antiviral activity of vitamin E (VE) in chronic HBV carriers. Herein, we review the possible role of tocopherols in the modulation of host miRNA with potential anti-HBV activity. A systematic research of the scientific literature was performed by searching the MEDLINE, Cochrane Library and EMBASE databases. The keywords used were 'HBV therapy', 'HBV treatment', 'VE antiviral effects', 'tocopherol antiviral activity', 'miRNA antiviral activity' and 'VE microRNA'. Reports describing the role of miRNA in the regulation of HBV life cycle, in vitro and in vivo available studies reporting the effects of VE on miRNA expression profiles and epigenetic networks, and clinical trials reporting the use of VE in patients with HBV-related chronic hepatitis were identified and examined. Based on the clinical results obtained in VE-treated chronic HBV carriers, we provide a reliable hypothesis for the possible role of this vitamin in the modulation of host miRNA profiles perturbed by this viral pathogen and in the regulation of some cellular miRNA with a suggested potential anti-HBV activity. This approach may contribute to the improvement of our understanding of pathogenetic mechanisms involved in HBV infection and increase the possibility of its management and treatment.
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Affiliation(s)
- S Fiorino
- Unità Operativa di Medicina Interna, Ospedale di Budrio,Via Benni 44,40065Budrio, Bologna,Italy
| | - L Bacchi-Reggiani
- Istituto di Cardiologia, Policlinico S. Orsola-Malpighi, Università degli Studi di Bologna,Bologna,Italy
| | - S Sabbatani
- Istituto di Malattie Infettive, Policlinico S. Orsola-Malpighi, Università degli Studi di Bologna,Bologna,Italy
| | - F Grizzi
- Humanitas Clinical and Research Center,Rozzano, Milano,Italy
| | - L di Tommaso
- Humanitas Clinical and Research Center,Rozzano, Milano,Italy
| | - M Masetti
- Unità Operativa di Chirurgia A, Ospedale Maggiore Bologna,Bologna,Italy
| | - A Fornelli
- Servizio di Anatomia Patologica, Ospedale Maggiore,Bologna,Italy
| | - A Bondi
- Servizio di Anatomia Patologica, Ospedale Maggiore,Bologna,Italy
| | - D de Biase
- Dipartimento di Medicina Sperimentale,Università di Bologna, Ospedale Bellaria,Bologna,Italy
| | - M Visani
- Dipartimento di Farmacia e Biotecnologie,Università di Bologna,Bologna,Italy
| | - A Cuppini
- Unità Operativa di Medicina Interna, Ospedale di Budrio,Via Benni 44,40065Budrio, Bologna,Italy
| | - E Jovine
- Unità Operativa di Chirurgia A, Ospedale Maggiore Bologna,Bologna,Italy
| | - A Pession
- Dipartimento di Farmacia e Biotecnologie,Università di Bologna,Bologna,Italy
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38
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Montalti R, Rompianesi G, Di Benedetto F, Masetti M, De Ruvo N, Ballarin R, Guerrini GP, Smerieri N, Iemmolo RM, De Pietri L, Gerunda GE. Liver transplantation utilizing grafts from donors with genitourinary cancer detected prior to liver implantation. Transplant Proc 2014; 41:1275-7. [PMID: 19460537 DOI: 10.1016/j.transproceed.2009.03.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Expansion of the donor pool has led to reconsideration of selection criteria to obtain the largest number of grafts without compromising recipient outcomes. This reconsideration concerns the utilization of donors with malignancies. Herein we have analyzed the outcomes, survivals, and risks of cancer transmission among patients who received a liver transplant from a donor with a genitourinary malignancy. Six of 363 patients (1.5%) who underwent transplantation at our center received an organ from a donor with a genitourinary cancer which was detected prior to the surgical harvest. Donors affected by low-grade renal cell carcinoma (Fuhrman grade 1 or 2) or low-grade intraprostatic prostate carcinoma (Gleason score <or= 6) were classified as "standard risk" and utilized pending informed consent. Four of 6 patients (66.6%) succumbed, but none consequent to a neoplastic disease. The mean follow-up was 12 +/- 8.1 months; in no patient was there evidence of transmission of a donor malignancy. Despite a relatively high risk of liver metastases among patients with genitourinary neoplasms, the risk of tumor transmission to a liver recipient is low. It seems to be safe to utilize these donors for patients with a high risk of succumbing on the waiting list.
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Affiliation(s)
- R Montalti
- Liver and Multivisceral Transplant Centre, Azienda Ospedaliero-Universitaria-Policlinico di Modena, Modena, Italy.
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39
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Potena L, Borgese L, Resciniti E, Capelli S, Bontadini A, Iannelli S, Sabatino M, Pece V, Masetti M, Prestinenzi P, Manfredini V, Rapezzi C, Grigioni F. Angiotensin Type 1 Receptor Antibodies and Cardiac Allograft Vasculopathy Late After Heart Transplantation: A New Pathway for Coronary Endothelial Injury? Transplantation 2014. [DOI: 10.1097/00007890-201407151-00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Masetti M, Aliabadi A, Sabatino M, Delle-Karth G, Prestinenzi P, Rödler S, Uyanik Uenal K, Gökler J, Laufer G, Rapezzi C, Grigioni F, Zuckermann A, Potena L. Static Versus Dynamic Angiographic CAV Evaluation: Prognostic Stratification Beyond ISHLT Grading. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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41
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Masetti M, Potena L, Nardozza M, Prestinenzi P, Taglieri N, Saia F, Pece V, Magnani G, Fallani F, Coccolo F, Russo A, Rapezzi C, Grigioni F, Branzi A. Differential effect of everolimus on progression of early and late cardiac allograft vasculopathy in current clinical practice. Am J Transplant 2013; 13:1217-26. [PMID: 23621161 DOI: 10.1111/ajt.12208] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/21/2013] [Accepted: 01/27/2013] [Indexed: 01/25/2023]
Abstract
Randomized trials showed that mTOR inhibitors prevent early development of cardiac allograft vasculopathy (CAV). However, the action of these drugs on CAV late after transplant is controversial, and their effectiveness for CAV prevention in clinical practice is poorly explored. In this observational study we included 143 consecutive heart transplant recipients who underwent serial intravascular ultrasound (IVUS), receiving either everolimus or mycophenolate as adjunctive therapy to cyclosporine. Ninety-one recipients comprised the early cohort, receiving IVUS at weeks 3-6 and year 1 after transplant, and 52 the late cohort, receiving IVUS at years 1 and 5 after transplant. Everolimus independently reduced the odds for early CAV (0.14 [0.01-0.77]; p = 0.02) but it did not appear to influence late CAV progression. High-dose statins were found to be associated with reduced CAV progression both early and late after transplant (p ≤ 0.05). Metabolic abnormalities, such as high triglycerides, were associated with late, but not with early CAV progression. By highlighting a differential effect of everolimus and metabolic abnormalities on early and late changes of graft coronary morphology, this observational study supports the hypothesis that everolimus may be effective for CAV prevention but not for CAV treatment, and that risk factors intervene in a time-dependent sequence during CAV development.
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Affiliation(s)
- M Masetti
- Cardiovascular Department of the University of Bologna, Bologna, Italy.
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Masetti M, Potena L, Nardozza M, Prestinenzi P, Taglieri N, Saia F, Pece V, Magnani G, Fallani F, Coccolo F, Russo A, Rapezzi C, Grigioni F, Branzi A. Differential Effect of Everolimus on Progression of Early and Late Cardiac Allograft Vasculopathy in Current Clinical Practice. Am J Transplant 2013. [DOI: 10.1002/ajt.12208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- M. Masetti
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - L. Potena
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - M. Nardozza
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - P. Prestinenzi
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - N. Taglieri
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - F. Saia
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - V. Pece
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - G. Magnani
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - F. Fallani
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - F. Coccolo
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - A. Russo
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - C. Rapezzi
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - F. Grigioni
- Cardiovascular Department of the University of Bologna; Bologna; Italy
| | - A. Branzi
- Cardiovascular Department of the University of Bologna; Bologna; Italy
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Masetti M, Potena L, Pece V, Prestinenzi P, Bianchi I, Lonetti C, Taglieri N, Russo A, Magnani G, Grigioni F, Branzi A. Late Changes in Maximal Intimal Thickness after Heart Transplant: Prognostic Implications and Risk Factors. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lonetti C, Manfredini V, Potena L, Pece V, Masetti M, Martin-Suarez S, Pilato E, Loforte A, Magnani G, Grigioni F, Arpesella G, Branzi A. Role of Donor-Recipient Match in Determining the Risk for Primary Graft Failure after Heart Transplantation. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Fiorino S, Chili E, Bacchi-Reggiani L, Masetti M, Deleonardi G, Grondona AG, Silvestri T, Magrini E, Zanini N, Cuppini A, Nardi R, Jovine E. Association between hepatitis B or hepatitis C virus infection and risk of pancreatic adenocarcinoma development: a systematic review and meta-analysis. Pancreatology 2013; 13:147-60. [PMID: 23561973 DOI: 10.1016/j.pan.2013.01.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 01/02/2013] [Accepted: 01/19/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatic adenocarcinoma (PAC) is an aggressive cancer with a poor prognosis. To date, PAC causes are still largely unknown. Antigens and replicative sequences of oncogenic hepatitis B (HBV) and hepatitis C (HCV) virus were detected in different extra-hepatic tissues, including pancreas. OBJECTIVE a systematic review and meta-analysis of epidemiological studies assessing PAC risk in patients with HBV/HCV chronic infections. METHODS In September 2012, we extracted the articles published in Medline, Embase and the Cochrane Library, using the following search terms: "chronic HBV" and "HCV", "hepatitis", "PAC", "risk factors", "epidemiology". Only case/control (C/C), prospective/retrospective cohort studies (PCS/RCS) written in English were collected. RESULTS four hospital-based C/C studies and one PCS, in HBV-infected patients and two hospital-based C/C studies and one RCS in HCV-infected subjects met inclusion criteria. In these studies HBsAg positivity enhanced significantly PAC risk (RR = 1.18, 95% CI:1.04-1.33), whereas HBeAg positivity (RR = 1.31, 95% CI:0.85-2.02) as well as HBsAg negative/HBcAb positive/HBsAb positive pattern (RR = 1.12, 95% CI:0.78-1.59) and HBsAg negative/HBcAb positive/HBsAb negative pattern (RR = 1.30, 95% CI:0.93-1.84) did not. Relationship between PAC risk and anti-HCV positivity was not significant, although it reached a borderline value (RR = 1.160, 95% CI:0.99-1.3). CONCLUSIONS HBV/HCV infection may represent a risk factor for PAC, but the small number of available researches, involving mainly populations of Asian ethnicity and the substantial variation between different geographical areas in seroprevalence of HBV/HCV-antigens/antibodies and genotypes are limiting factors to present meta-analysis.
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Affiliation(s)
- S Fiorino
- Unità Operativa di Medicina Interna, Ospedale di Budrio, Via Benni 44, 40065 Budrio, Bologna, Italy.
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Fiorino S, Lorenzini S, Masetti M, Deleonardi G, Grondona AG, Silvestri T, Chili E, Del Prete P, Bacchi-Reggiani L, Cuppini A, Jovine E. Hepatitis B and C virus infections as possible risk factor for pancreatic adenocarcinoma. Med Hypotheses 2012; 79:678-97. [PMID: 22959312 DOI: 10.1016/j.mehy.2012.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 07/20/2012] [Accepted: 08/09/2012] [Indexed: 12/14/2022]
Abstract
Pancreatic adenocarcinoma (PAC) is a very aggressive and lethal cancer, with a very poor prognosis, because of absence of early symptoms, advanced stage at presentation, early metastatic dissemination and lack of both specific tests to detect its growth in the initial phases and effective systemic therapies. To date, the causes of PAC still remain largely unknown, but multiple lines of evidence from epidemiological and laboratory researches suggest that about 15-20% of all cancers are linked in some way to chronic infection, in particular it has been shown that several viruses have a role in human carcinogenesis. The purpose of this report is to discuss the hypothesis that two well-known oncogenic viruses, Human B hepatitis (HBV) and Human C hepatitis (HCV) are a possible risk factor for this cancer. Therefore, with the aim to examine the potential link between these viruses and PAC, we performed a selection of observational studies evaluating this association and we hypothesized that some pathogenetic mechanisms involved in liver carcinogenesis might be in common with pancreatic cancer development in patients with serum markers of present or past HBV and HCV infections. To date the available observational studies performed are few, heterogeneous in design as well as in end-points and with not univocal results, nevertheless they might represent the starting-point for future larger and better designed clinical trials to define this hypothesized relationship. Should these further studies confirm an association between HBV/HCV infection and PAC, screening programs might be justified in patients with active or previous hepatitis B and C viral infection.
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Affiliation(s)
- S Fiorino
- Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, Bologna, Italy.
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Masetti M, Potena L, Nardozza M, Prestinenzi P, Pece V, Taglieri N, Saia F, Magnani G, Coccolo F, Fallani F, Grigioni F, Branzi A. 491 Differential Effect of Everolimus and Metabolic Risk Factors on Early vs. Late Progression of Allograft Vasculopathy: Dissecting Two Faces of the Same Disease. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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48
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Petrisli E, Potena L, Bianchi I, Chiereghin A, Masetti M, Prestinenzi P, Barberini F, Angeli F, Magnani G, Lazzarotto T, Grigioni F, Branzi A. 402 Reconstitution of CMV-Specific Immunity after Heart Transplantation Is Modulated by mTOR Inhibition, but Not by Antiviral Strategy. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.412] [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: 11/29/2022] Open
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Fabbri C, Luigiano C, Fuccio L, Polifemo AM, Ferrara F, Ghersi S, Bassi M, Billi P, Maimone A, Cennamo V, Masetti M, Jovine E, D'Imperio N. EUS-guided biliary drainage with placement of a new partially covered biliary stent for palliation of malignant biliary obstruction: a case series. Endoscopy 2011; 43:438-41. [PMID: 21271507 DOI: 10.1055/s-0030-1256097] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endoscopic ultrasonography-guided biliary drainage (EUS-BD) has been developed as an alternative drainage technique in patients with obstructive jaundice where endoscopic retrograde cholangiopancreatography (ERCP) has failed. Between July 2008 and December 2009, 16 patients (9 men; median age 79 years) with biliopancreatic malignancy, who were candidates for alternative techniques of biliary decompression because ERCP had been unsuccessful, underwent EUS-BD with placement of a transmural or transpapillary partially covered nitinol self-expandable metal stent (SEMS). EUS-assisted cholangiography was successful in all patients, with definition of the relevant anatomy, but biliary drainage was successfully performed in only 12 (75 %) of the 16 patients (9 choledochoduodenostomies with SEMS placement and 3 biliary rendezvous procedures with papillary SEMS placement), with regression of the cholestasis. No major complications and no procedure-related deaths occurred. There was one case of pneumoperitoneum which was managed conservatively. The median follow-up was 170 days. During the follow-up, eight patients of the 12 patients in whom biliary draining was successful died; four are currently alive. None of the patients required endoscopic reintervention. This series demonstrated that EUS-BD with a partially covered SEMS has a high rate of clinical success and low complication rates, and could represent an alternative choice for biliary decompression.
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Affiliation(s)
- C Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Largo Nigrisoli 2, Bologna, Italy.
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Prestinenzi P, Potena L, Bianchi I, Masetti M, Romani P, Magnani G, Fallani F, Coccolo F, Russo A, Grigioni F, Branzi A. 206 Improvement of Renal Function after Cyclosporine Reduction Is Influenced by Baseline Proteinuria in Patients Converted to Everolimus: Long Term Follow-Up of the Shirakiss Randomized Study. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.213] [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] Open
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