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Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Aceto P, Audisio R, Cherubini A, Cunningham C, Dabrowski W, Forookhi A, Gitti N, Immonen K, Kehlet H, Koch S, Kotfis K, Latronico N, MacLullich AMJ, Mevorach L, Mueller A, Neuner B, Piva S, Radtke F, Blaser AR, Renzi S, Romagnoli S, Schubert M, Slooter AJC, Tommasino C, Vasiljewa L, Weiss B, Yuerek F, Spies CD. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients. Eur J Anaesthesiol 2024; 41:81-108. [PMID: 37599617 PMCID: PMC10763721 DOI: 10.1097/eja.0000000000001876] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/22/2023]
Abstract
Postoperative delirium (POD) remains a common, dangerous and resource-consuming adverse event but is often preventable. The whole peri-operative team can play a key role in its management. This update to the 2017 ESAIC Guideline on the prevention of POD is evidence-based and consensus-based and considers the literature between 01 April 2015, and 28 February 2022. The search terms of the broad literature search were identical to those used in the first version of the guideline published in 2017. POD was defined in accordance with the DSM-5 criteria. POD had to be measured with a validated POD screening tool, at least once per day for at least 3 days starting in the recovery room or postanaesthesia care unit on the day of surgery or, at latest, on postoperative day 1. Recent literature confirmed the pathogenic role of surgery-induced inflammation, and this concept reinforces the positive role of multicomponent strategies aimed to reduce the surgical stress response. Although some putative precipitating risk factors are not modifiable (length of surgery, surgical site), others (such as depth of anaesthesia, appropriate analgesia and haemodynamic stability) are under the control of the anaesthesiologists. Multicomponent preoperative, intra-operative and postoperative preventive measures showed potential to reduce the incidence and duration of POD, confirming the pivotal role of a comprehensive and team-based approach to improve patients' clinical and functional status.
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Affiliation(s)
- César Aldecoa
- From the Department of Anaesthesia and Postoperative Critical Care, Hospital Universitario Rio Hortega, Valladolid, Spain (CA), Department of Biomedical Studies, University of the Republic of San Marino, San Marino (GB), Department of Anesthesiology, Critical Care and Pain Medicine, 'Sapienza' University of Rome, Rome, Italy (FB, AF, LM), Specialty of Anaesthetics & NHMRC Clinical Trials Centre, University of Sydney & Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital (RDS), Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt Universität zu Berlin, Campus Charité Mitte, and Campus Virchow Klinikum (CDS, SK, AM, BN, LV, BW, FY), Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (PA), Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy (PA), Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden (RA), Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy (AC), School of Biochemistry and Immunology and Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland (CC), First Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland (WD), Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland (KI), Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (HK), Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland (KK), Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia (NG, NL, SP, SR), Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy (NL, SP), Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom (AMJM), Department of Anaesthesia and Intensive Care, Nykoebing Hospital; University of Southern Denmark, SDU (SK, FR), Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia (ARB), Center for Intensive Care Medicine, Luzerner Kantonsspital, Lucerne, Switzerland (ARB), Department of Health Science, Section of Anesthesiology, University of Florence (SR), Department of Anaesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy (SR), School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Science, Winterthur, Switzerland (MS), Departments of Psychiatry and Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (AJCS), Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium (AJCS) and Dental Anesthesia and Intensive Care Unit, Polo Universitario Ospedale San Paolo, Department of Biomedical, Surgical and Odontoiatric Sciences, University of Milano, Milan, Italy (CT)
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Adami EC, Magri F, Plotti C, Renzi S, Chiarini G, De Cicco G. Hereditary angioedema in cardiac surgery: Perioperative management considerations for a rare disease. Perfusion 2023:2676591231174773. [PMID: 37157123 DOI: 10.1177/02676591231174773] [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: 05/10/2023]
Abstract
INTRODUCTION Hereditary Angioedema is a rare disease caused by C1 esterase inhibitor deficiency leading to diffuse and potentially life-threatening oedema formation. Preventing attacks is critical, particularly for patients undergoing cardiac surgery. CASE REPORT We report a case of a 71-years-old woman with a history of Hereditary Angioedema scheduled for open-heart surgery on Cardiopulmonary Bypass. Multidisciplinar teamwork and patient-targeted strategy were crucial to obtain a favorable outcome. DISCUSSION Cardiac surgery is a major stressor for Angioedema attacks because of Complement cascade and inflammatory response activation leading to potential life-threatening oedema formation. In literature only few cases of complex open heart surgery under Cardiopulmonary Bypass are described. CONCLUSION Continuous updating and multidisciplinarity are key elements to manage patients with Hereditary Angioedema in cardiac surgery in order to reduce morbidity and mortality.
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Affiliation(s)
- Enrica Chiara Adami
- Cardiothoracic Intensive Care Unit, Cardiothoracic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Federica Magri
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University of Brescia, Brescia, Italy
| | - Chiara Plotti
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University of Brescia, Brescia, Italy
| | - Stefania Renzi
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University of Brescia, Brescia, Italy
| | - Giovanni Chiarini
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University of Brescia, Brescia, Italy
| | - Giuseppe De Cicco
- Cardiac Surgery Division, Cardiothoracic Department, ASST Spedali Civili di Brescia, Brescia, Italy
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Renzi S, Gitti N, Piva S. Delirium in the intensive care unit: a narrative review. JGG 2023. [DOI: 10.36150/2499-6564-n600] [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: 03/15/2023]
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Gitti N, Renzi S, Marchesi M, Bertoni M, Lobo FA, Rasulo FA, Goffi A, Pozzi M, Piva S. Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients. Front Med (Lausanne) 2022; 9:901343. [PMID: 35814788 PMCID: PMC9265444 DOI: 10.3389/fmed.2022.901343] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/20/2022] [Indexed: 12/12/2022] Open
Abstract
The clinical approach to sedation in critically ill patients has changed dramatically over the last two decades, moving to a regimen of light or non-sedation associated with adequate analgesia to guarantee the patient’s comfort, active interaction with the environment and family, and early mobilization and assessment of delirium. Although deep sedation (DS) may still be necessary for certain clinical scenarios, it should be limited to strict indications, such as mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS), status epilepticus, intracranial hypertension, or those requiring target temperature management. DS, if not indicated, is associated with prolonged duration of mechanical ventilation and ICU stay, and increased mortality. Therefore, continuous monitoring of the level of sedation, especially when associated with the raw EEG data, is important to avoid unnecessary oversedation and to convert a DS strategy to light sedation as soon as possible. The approach to the management of critically ill patients is multidimensional, so targeted sedation should be considered in the context of the ABCDEF bundle, a holistic patient approach. Sedation may interfere with early mobilization and family engagement and may have an impact on delirium assessment and risk. If adequately applied, the ABCDEF bundle allows for a patient-centered, multidimensional, and multi-professional ICU care model to be achieved, with a positive impact on appropriate sedation and patient comfort, along with other important determinants of long-term patient outcomes.
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Affiliation(s)
- Nicola Gitti
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Stefania Renzi
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Mattia Marchesi
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Michele Bertoni
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Francisco A. Lobo
- Institute of Anesthesiology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Frank A. Rasulo
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matteo Pozzi
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
- *Correspondence: Simone Piva,
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Sane Schepisi M, Miglietta AS, Cerocchi C, Grillo P, Renzi S, Cirilli R, Pavone R, Vaccarello S, Magrelli F, De Angelis G. Tuberculosis contact investigations in congregate settings in Rome, Italy: contribution of migration. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In middle to low incidence countries tuberculosis (TB) is known to concentrate in big cities as national incidence falls: in the last decade TB incidence in Rome metropolitan area and in Lazio region has been higher than the national estimates; TB incidence among foreign born fell by more than half despite remaining higher than among Italian born.
We aimed to describe the current dynamics of TB transmission among residents of our local health unit in Rome metropolitan area in order to drive specific TB control interventions at local level.
Methods
We retrospectively evaluated characteristics of TB cases and results of contact investigations among the residents of ASL Roma 2 in congregate settings over year 2018.
Results
Overall 217 TB cases were notified, of which 70.5% with pulmonary involvement. Male/female ratio was 2.4/1 and age group most affected was 25-44 among foreign born and >65 among natives. During the study period foreign born cases accounted for 65% of the total number of TB cases. 19/141 (13.5%) foreign born patients were hosted in a reception center. 479 exposed close contacts were screened, with no evidence of secondary TB disease transmission. No identifiable links were found among cases occurred in the same immigrant reception center.
Conclusions
Italian guidelines recommend symptom screening for TB and LTBI testing both of new entrants and of long term residents -including second–generation migrants- from high TB burden countries. These findings suggest that local public health efforts should prioritize the identification of reactivations of remotely acquired latent TB rather than of new postarrival infections acquired in the host county through local transmission.
Key messages
City-specific data on TB incidence trends among native and foreign-born residents help understanding the wider interaction between migration and TB. To prevent TB incidents in congregate settings remotely acquired latent TB should be targeted.
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Affiliation(s)
- M Sane Schepisi
- Dipartimento Prevenzione, Local Health Unit ASL ROMA 2, Rome, Italy
| | - A S Miglietta
- Dipartimento Prevenzione, Local Health Unit ASL ROMA 2, Rome, Italy
| | - C Cerocchi
- Dipartimento Prevenzione, Local Health Unit ASL ROMA 2, Rome, Italy
| | - P Grillo
- Dipartimento Prevenzione, Local Health Unit ASL ROMA 2, Rome, Italy
| | - S Renzi
- Dipartimento Prevenzione, Local Health Unit ASL ROMA 2, Rome, Italy
| | - R Cirilli
- Dipartimento Prevenzione, Local Health Unit ASL ROMA 2, Rome, Italy
| | - R Pavone
- Dipartimento Prevenzione, Local Health Unit ASL ROMA 2, Rome, Italy
| | - S Vaccarello
- Dipartimento Prevenzione, Local Health Unit ASL ROMA 2, Rome, Italy
| | - F Magrelli
- Dipartimento Prevenzione, Local Health Unit ASL ROMA 2, Rome, Italy
| | - G De Angelis
- Dipartimento Prevenzione, Local Health Unit ASL ROMA 2, Rome, Italy
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Verrusio W, Renzi A, Dellepiane U, Renzi S, Zaccone M, Gueli N, Cacciafesta M. A new tool for the evaluation of the rehabilitation outcomes in older persons: a machine learning model to predict functional status 1 year ahead. Eur Geriatr Med 2018; 9:651-657. [PMID: 34654230 DOI: 10.1007/s41999-018-0098-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To date, the assessment of disability in older people is obtained utilizing a Comprehensive Geriatric Assessment (CGA). However, it is often difficult to understand which areas of CGA are most predictive of the disability. The aim of this study is to evaluate the possibility to early predict-1 year ahead-the disability level of a patient using machine leaning models. METHODS Community-dwelling older people were enrolled in this study. CGA was made at baseline and at 1 year follow-up. After collecting input/independent variables (i.e., age, gender, schooling followed, body mass index, information on smoking, polypharmacy, functional status, cognitive performance, depression, nutritional status), we performed two distinct Support Vector Machine models (SVMs) able to predict functional status 1 year ahead. To validate the choice of the model, the results achieved with the SVMs were compared with the output produced by simple linear regression models. RESULTS 218 patients (mean age = 78.01; SD = 7.85; male = 39%) were recruited. The combination of the two SVMs is able to achieve a higher prediction accuracy (exceeding 80% instances correctly classified vs 67% instances correctly classified by the combination of the two linear regression models). Furthermore, SVMs are able to classify both the three categories, self sufficiently, disability risk and disability, while linear regression model separates the population only in two groups (self-sufficiency and disability) without identifying the intermediate category (disability risk) which turns out to be the most critical one. CONCLUSIONS The development of such a model can contribute to the early detection of patients at risk of self-sufficiency loss.
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Affiliation(s)
- Walter Verrusio
- Division of Gerontology, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences (SCReNAG), Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Alessia Renzi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | | | - Stefania Renzi
- ACTOR, Analytic Control Technology Operations Research, Rome, Italy
| | - Mariagrazia Zaccone
- Division of Gerontology, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences (SCReNAG), Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Nicolò Gueli
- Division of Gerontology, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences (SCReNAG), Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Mauro Cacciafesta
- Division of Gerontology, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences (SCReNAG), Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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Bellière-Calandry A, Martin F, Berger L, Renzi S. Comparaisons dosimétriques de la technique d’irradiation de l’aire sus- et sous-claviculaire en deux et trois dimensions dans le cancer du sein. Cancer Radiother 2013. [DOI: 10.1016/j.canrad.2013.07.082] [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: 12/01/2022]
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Renzi S, Riccò S, Dotti S, Sesso L, Grolli S, Cornali M, Carlin S, Patruno M, Cinotti S, Ferrari M. Autologous bone marrow mesenchymal stromal cells for regeneration of injured equine ligaments and tendons: a clinical report. Res Vet Sci 2013; 95:272-7. [PMID: 23419936 DOI: 10.1016/j.rvsc.2013.01.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 12/11/2012] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
Abstract
The use of Mesenchymal Stromal Cells (MSCs) in orthopedic practice has recently and rapidly acquired an important role. Therapies based on the use of MSCs for the treatment of acute injuries as well as chronic inflammatory disorders are gradually becoming clinical routine. These cells have demonstrated intriguing therapeutic potentialities (i.e.: inflammation control, tissue regeneration and pathological scar prevention), that have been taken into consideration for use in both human and veterinary medicine. In particular, horses represent high performance athletes considered models for human pathologies since musculo-skeletal disorders frequently occur in this species. In the past, repair of tendon injures were performed by different methods. In particular, clinical therapy was based on ice application, bandage, box rest and controlled exercise. An alternative approach consisted on the use of corticosteroid (inflammation reduction) and other drugs (sodium hyaluronate, polysulphated glycosaminoglycans, beta aminoproprionitrile fumarate). Furthermore, surgical treatments like accessory ligament desmotomy, local irritation by line firing or pin firing were commonly used. More recently ultrasound, laser therapy, electromagnetic field therapy have been considered. Unfortunately, they did not allow complete tissue healing and quite often animals did not regain competitiveness. In order to minimize this inconvenience, the use of MSCs has been introduced as an alternative to the traditional approach since it represents a potential tool to improve tissue regeneration. Aim of this study was to evaluate the capability of MSCs to improve the functional outcome of horses affected by tendonitis and desmitis. Thirty-three breed and activity-matched horses affected by tendonitis or desmitis, were included in clinical trial scored for lesions and subdivided into two groups. Group 1 animals were treated with autologous MSCs, associated with platelet rich plasma (group 1). Bone marrow samples were collected from the sternum of the treated horses and processed in order to isolate MSCs. Following cell therapy, they were subjected to a rehabilitation period and their ability to resume training was evaluated. In this study, implanted MSCs caused no adverse reactions and thirteen out of the eighteen inoculated horses returned to race competitions. On the contrary, no improvement was seen in the twelve animals of group 2 treated with pin firing, that were not able to resume sport activity. In conclusion the clinical trial proves the safety of equine bone-marrow derived MSCs and a successful outcome of the treated animals that returned to their previous level of sport activity.
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Affiliation(s)
- S Renzi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Via Bianchi 9, 25124 Brescia, Italy.
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Ricco' S, Renzi S, Del Bue M, Conti V, Merli E, Ramoni R, Lucarelli E, Gnudi G, Ferrari M, Grolli S. Allogeneic Adipose Tissue-Derived Mesenchymal Stem Cells in Combination with Platelet Rich Plasma are Safe and Effective in the Therapy of Superficial Digital Flexor Tendonitis in the Horse. Int J Immunopathol Pharmacol 2013; 26:61-8. [DOI: 10.1177/03946320130260s108] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S. Ricco'
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - S. Renzi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell‘ Emilia Romagna, 25121 Brescia, Italy
| | - M. Del Bue
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - V. Conti
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - E. Merli
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - R. Ramoni
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - E. Lucarelli
- Osteoarticular Regeneration Laboratory, Rizzoli Orthopaedic Institute, 40136 Bologna, Italy
| | - G. Gnudi
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - M. Ferrari
- Istituto Zooprofilattico Sperimentale della Lombardia e dell‘ Emilia Romagna, 25121 Brescia, Italy
| | - S. Grolli
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
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DeRose ER, Pleet A, Seery VJ, Lee M, Renzi S, Sullivan RJ, Atkins MB. Utility of 3-year torso CT and head imaging in asymptomatic patients with high-risk melanoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Frankenthaler A, Lee M, Seery V, Renzi S, Kinnaman M, Liu V, Friedman E, Atkins MB. Impact of concomitant immunosuppression on the presentation and prognosis of patients with melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9070] [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
9070 Background: Melanoma has been reported to be susceptible to immune control. Therefore, we hypothesized that concomitant immune suppression might impact the course of the disease. Methods: We examined the Beth Israel Deaconess Medical Center Cutaneous Oncology Program database for pts with immune suppression at the time of melanoma diagnosis. The demographics and stage of these pts were compared to those in the database as a whole. In addition, 3 controls matched for age, gender, stage and tumor location were identified for each case and disease outcome was compared between cases and controls. Results: 19 pts were identified with melanoma and concomitant immune suppression in a database of 1820 melanoma pts. Other diagnoses included renal transplant (4) inflammatory arthritis (8), Multiple Sclerosis (2), and ulcerative colitis (3). Immunosuppressive meds included methotrexate, azothioprine, cyclosporine, prednisone, infliximab, and natalizumab. Melanoma stages at diagnosis were in situ 1, IB 7, IIA 1, IIB 1, IIIB 3, IIIC 5, and IV 1. Compared to the database as a whole, cases were more likely to be female (84% vs 45%) and have a higher disease stage (42% stage IIIB/C vs 26%). In addition, more cases appeared to have an amelanotic primary (21% vs. 5.4%) or an atypical mole syndrome (21% vs 10.2%). For pts who relapsed, the cases had a shorter disease free interval (DFI) (2.1 vs 9.7 yrs) than the controls. At a median f/up of 52 mos, 37% of the cases had relapsed and all of these pts had died. At a median f/up of 76 mos, 30% of the controls had relapsed yet only 47% of these pts had died. As a consequence, cases appeared more likely to have died of their disease than controls (42% vs 23%) (p=0.10). Conclusions: Compared to the general melanoma population, pts with concomitant immune suppression appear more likely to be female, have an amelanotic primary or atypical mole syndrome and more advanced disease at presentation. Although pts with concomitant immune suppression are equally likely to relapse compared to matched controls, those that relapse appear to have a shorter DFI and to be less likely to be salvaged, suggesting more aggressive tumor behavior in this setting. Thus, diagnosis and treatment of a primary melanoma at an early stage appears especially important in an immunosuppressed population. No significant financial relationships to disclose.
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Affiliation(s)
| | - M. Lee
- Beth Israel Deaconess Medical Center, Boston, MA
| | - V. Seery
- Beth Israel Deaconess Medical Center, Boston, MA
| | - S. Renzi
- Beth Israel Deaconess Medical Center, Boston, MA
| | - M. Kinnaman
- Beth Israel Deaconess Medical Center, Boston, MA
| | - V. Liu
- Beth Israel Deaconess Medical Center, Boston, MA
| | - E. Friedman
- Beth Israel Deaconess Medical Center, Boston, MA
| | - M. B. Atkins
- Beth Israel Deaconess Medical Center, Boston, MA
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Djikeng A, Ferreira L, D'Angelo M, Dolezal P, Lamb T, Murta S, Triggs V, Ulbert S, Villarino A, Renzi S, Ullu E, Tschudi C. Characterization of a candidate Trypanosoma brucei U1 small nuclear RNA gene. Mol Biochem Parasitol 2001; 113:109-15. [PMID: 11254959 DOI: 10.1016/s0166-6851(00)00384-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We have previously shown that the poly(A) polymerase (PAP) gene of Trypanosoma brucei is interrupted by an intervening sequence. It was postulated that removing this intron by cis-splicing requires a yet unidentified U1 small nuclear RNA (snRNA), which in other organisms engages in base-pair interactions across the 5' splice site during early spliceosome assembly. Here we present a characterization of a 75 nucleotide long candidate T. brucei U1 snRNA. Immunoprecipitation studies indicate that a trimethylguanosine cap structure is present at the 5' end and that the RNA is bound to core proteins common to spliceosomal ribonucleoprotein particles. The U1 snRNA has the potential for extensive intermolecular base pairing with the PAP 5' splice site. We used block replacement mutagenesis to identify sequences necessary for in vivo expression of U1 snRNA. We found that at least two cis-acting elements, tRNA-like A and B boxes, located in the 5'-flanking region are necessary for U1 snRNA synthesis; no internal sequences close to the transcription start site are essential, suggesting a promoter architecture distinct from other trypanosome U-snRNA genes.
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MESH Headings
- 5' Untranslated Regions/genetics
- Animals
- Base Sequence
- Blotting, Northern
- Genome, Protozoan
- Introns
- Molecular Sequence Data
- Mutation
- RNA, Protozoan/analysis
- RNA, Protozoan/chemistry
- RNA, Protozoan/genetics
- RNA, Small Nuclear/analysis
- RNA, Small Nuclear/chemistry
- RNA, Small Nuclear/genetics
- RNA, Spliced Leader/analysis
- RNA, Spliced Leader/genetics
- Sequence Alignment
- Spliceosomes/genetics
- Transcription, Genetic
- Trypanosoma brucei brucei/genetics
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Affiliation(s)
- A Djikeng
- Department of Internal Medicine, Yale University School of Medicine, PO Box 208022, 333 Cedar Street, New Haven, CT 06520-8022, USA
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