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Golijanin B, Malshy K, Bhatt V, Homer A, Ochsner A, Wales R, Khaleel S, Mega A, Pareek G, Hyams E. Response to shared decision making in prostate cancer screening: Different perspective of public health physicians and urologists. Cancer Epidemiol 2024; 90:102570. [PMID: 38641469 DOI: 10.1016/j.canep.2024.102570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/21/2024]
Affiliation(s)
- B Golijanin
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - K Malshy
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - V Bhatt
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - A Homer
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - A Ochsner
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - R Wales
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - S Khaleel
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - A Mega
- Lifespan Cancer Institute, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - G Pareek
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
| | - E Hyams
- The Minimally Invasive Urology Institute at the Miriam Hospital, Lifespan Academic Hospitals, Legoretta Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA
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Singh Solorzano C, Cattane N, Mega A, Orini S, Zanetti O, Chattat R, Marizzoni M, Pievani M, Cattaneo A, Festari C. Psychobiological effects of an eHealth psychoeducational intervention to informal caregivers of persons with dementia: a pilot study during the COVID-19 pandemic in Italy. Aging Clin Exp Res 2023; 35:3085-3096. [PMID: 37943404 PMCID: PMC10721699 DOI: 10.1007/s40520-023-02610-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The workload associated with caring for a person with dementia (PwD) could negatively affect informal caregivers' physical and mental health. According to the recent literature, there is a need for studies testing the implementation of affordable and accessible interventions for improving caregivers' well-being. AIMS This study aimed to explore the feasibility and effectiveness of an 8 week eHealth psychoeducation intervention held during the COVID-19 pandemic in Italy in reducing the psychological burden and neuroendocrine markers of stress in caregivers of PwD. METHODS Forty-one informal caregivers of PwD completed the eHealth psychoeducation intervention. Self-reported (i.e., caregiver burden, anxiety symptoms, depressive symptoms, and caregiver self-efficacy) and cortisol measurements were collected before and after the intervention. RESULTS Following the intervention, the caregivers' self-efficacy regarding the ability to respond to disruptive behaviours improved (t = - 2.817, p = 0.007), anxiety and burden levels decreased (state anxiety: t = 3.170, p = 0.003; trait anxiety: t = 2.327, p = 0.025; caregiver burden: t = 2.290, p = 0.027), while depressive symptoms and cortisol levels did not change significantly. Correlation analyses showed that the increase in self-efficacy was positively associated with the improvement of caregiver burden from pre- to post-intervention (r = 0.386, p = 0.014). The intervention had a low rate of dropout (n = 1, due to the patient's death) and high levels of appreciation. DISCUSSION The positive evidence and participation rate support the feasibility and effectiveness of the proposed eHealth psychoeducational intervention to meet the need for knowledge of disease management and possibly reduce detrimental effects on caregivers' psychological well-being. CONCLUSION Further placebo-controlled trials are needed to test the generalizability and specificity of our results.
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Affiliation(s)
- Claudio Singh Solorzano
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy.
| | - Nadia Cattane
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Anna Mega
- UOC Neurologia, ULSS 9 Scaligera-Distretto 4, Verona, Italy
| | - Stefania Orini
- Alzheimer Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Orazio Zanetti
- Alzheimer Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Rabih Chattat
- Department of Psychology, Università di Bologna, Bologna, Italy
| | - Moira Marizzoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Michela Pievani
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Cristina Festari
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy
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Galluzzi S, Mega A, Di Fede G, Muscio C, Fascendini S, Benussi L, Tagliavini F, Frisoni GB, Di Maria E. Psychological Impact of Predictive Genetic Testing for Inherited Alzheimer Disease and Frontotemporal Dementia: The IT-DIAfN Protocol. Alzheimer Dis Assoc Disord 2022; 36:118-124. [PMID: 35293381 PMCID: PMC9132242 DOI: 10.1097/wad.0000000000000494] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
AIM Our aim was to evaluate the psychological impact of predictive genetic testing in individuals at-risk for inherited dementia who underwent a structured counseling and testing protocol. METHODS Participants were healthy at-risk relatives from families with at least one affected patient, in whom a disease-associated genetic variant had been ascertained. A comprehensive psychological assessment (personality, anxiety and depression, quality of life, coping strategies, resilience and health-related beliefs) was administered at baseline, at 6 months and 12 months follow-up. RESULTS Twenty-four participants from 13 families were included. Sixteen participants underwent blood sampling and genetic analysis; 6 resulted to be carriers of pathogenic variants (1 in PSEN1, 1 in PSEN2, 4 in GRN). Carriers showed higher score on the Resilience Scale for Adults (RSA) - social competence, and on Multidimensional Health Locus of Control - internal, than noncarriers (P=0.03 for both). Ten at-risk relatives who completed the follow-up showed improvement in RSA - planned future (P=0.01) with respect to baseline. DISCUSSION Our case series showed that at-risk individuals undergoing predictive testing showed benefit on personal life and no detrimental impact on a broad range of psychological outcomes. Higher social skills and lower internal health locus of control in carriers may be an early psychological correlate of preclinical dementia.
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Affiliation(s)
| | - Anna Mega
- Laboratory Alzheimer’s Neuroimaging and Epidemiology
| | - Giuseppe Di Fede
- Neurology V – Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano
| | - Cristina Muscio
- Neurology V – Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano
| | | | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia
| | - Fabrizio Tagliavini
- Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano
| | | | - Giovanni B. Frisoni
- Laboratory Alzheimer’s Neuroimaging and Epidemiology
- Memory Clinic, Department of Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Genève, Switzerland
| | - Emilio Di Maria
- Department of Health Sciences, University of Genoa
- Unit of Medical Genetics, Galliera Hospital, Genoa
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Carneiro B, Yin J, Soliman L, De Souza A, Golijanin D, Mega A, Coelho Barata P, Gulati S, Wei S, Geynisman D, Magee D, Korn W, Abuali I, Heath E, Ryan C, Bertone P, El-Deiry W. 632P Differential transcriptomic profiling of BCL2-related genes in primary tumor (PT) and metastatic sites (MS) of prostate cancer (PCa). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pievani M, Mega A, Quattrini G, Guidali G, Ferrari C, Cattaneo A, D'Aprile I, Mascaro L, Gasparotti R, Corbo D, Brignani D, Bortoletto M. Targeting Default Mode Network Dysfunction in Persons at Risk of Alzheimer's Disease with Transcranial Magnetic Stimulation (NEST4AD): Rationale and Study Design. J Alzheimers Dis 2021; 83:1877-1889. [PMID: 34459405 DOI: 10.3233/jad-210659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Default mode network (DMN) dysfunction is well established in Alzheimer's disease (AD) and documented in both preclinical stages and at-risk subjects, thus representing a potential disease target. Multi-sessions of repetitive transcranial magnetic stimulation (rTMS) seem capable of modulating DMN dynamics and memory in healthy individuals and AD patients; however, the potential of this approach in at-risk subjects has yet to be tested. OBJECTIVE This study will test the effect of rTMS on the DMN in healthy older individuals carrying the strongest genetic risk factor for AD, the Apolipoprotein E (APOE) ɛ4 allele. METHODS We will recruit 64 older participants without cognitive deficits, 32 APOE ɛ4 allele carriers and 32 non-carriers as a reference group. Participants will undergo four rTMS sessions of active (high frequency) or sham DMN stimulation. Multimodal imaging exam (including structural, resting-state, and task functional MRI, and diffusion tensor imaging), TMS with concurrent electroencephalography (TMS-EEG), and cognitive assessment will be performed at baseline and after the stimulation sessions. RESULTS We will assess changes in DMN connectivity with resting-state functional MRI and TMS-EEG, as well as changes in memory performance in APOE ɛ4 carriers. We will also investigate the mechanisms underlying DMN modulation through the assessment of correlations with measures of neuronal activity, excitability, and structural connectivity with multimodal imaging. CONCLUSION The results of this study will inform on the physiological and cognitive outcomes of DMN stimulation in subjects at risk for AD and on the possible mechanisms. These results may outline the design of future non-pharmacological preventive interventions for AD.
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Affiliation(s)
- Michela Pievani
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Anna Mega
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giulia Quattrini
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Giacomo Guidali
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Annamaria Cattaneo
- Biological Psychiatric Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Ilari D'Aprile
- Biological Psychiatric Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Lorella Mascaro
- Medical Physics Unit, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Daniele Corbo
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Debora Brignani
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marta Bortoletto
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Ribaldi F, Altomare D, Jovicich J, Ferrari C, Picco A, Pizzini FB, Soricelli A, Mega A, Ferretti A, Drevelegas A, Bosch B, Müller BW, Marra C, Cavaliere C, Bartrés-Faz D, Nobili F, Alessandrini F, Barkhof F, Gros-Dagnac H, Ranjeva JP, Wiltfang J, Kuijer J, Sein J, Hoffmann KT, Roccatagliata L, Parnetti L, Tsolaki M, Constantinidis M, Aiello M, Salvatore M, Montalti M, Caulo M, Didic M, Bargallo N, Blin O, Rossini PM, Schonknecht P, Floridi P, Payoux P, Visser PJ, Bordet R, Lopes R, Tarducci R, Bombois S, Hensch T, Fiedler U, Richardson JC, Frisoni GB, Marizzoni M. Accuracy and reproducibility of automated white matter hyperintensities segmentation with lesion segmentation tool: A European multi-site 3T study. Magn Reson Imaging 2020; 76:108-115. [PMID: 33220450 DOI: 10.1016/j.mri.2020.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/02/2020] [Accepted: 11/14/2020] [Indexed: 01/18/2023]
Abstract
Brain vascular damage accumulate in aging and often manifest as white matter hyperintensities (WMHs) on MRI. Despite increased interest in automated methods to segment WMHs, a gold standard has not been achieved and their longitudinal reproducibility has been poorly investigated. The aim of present work is to evaluate accuracy and reproducibility of two freely available segmentation algorithms. A harmonized MRI protocol was implemented in 3T-scanners across 13 European sites, each scanning five volunteers twice (test-retest) using 2D-FLAIR. Automated segmentation was performed using Lesion segmentation tool algorithms (LST): the Lesion growth algorithm (LGA) in SPM8 and 12 and the Lesion prediction algorithm (LPA). To assess reproducibility, we applied the LST longitudinal pipeline to the LGA and LPA outputs for both the test and retest scans. We evaluated volumetric and spatial accuracy comparing LGA and LPA with manual tracing, and for reproducibility the test versus retest. Median volume difference between automated WMH and manual segmentations (mL) was -0.22[IQR = 0.50] for LGA-SPM8, -0.12[0.57] for LGA-SPM12, -0.09[0.53] for LPA, while the spatial accuracy (Dice Coefficient) was 0.29[0.31], 0.33[0.26] and 0.41[0.23], respectively. The reproducibility analysis showed a median reproducibility error of 20%[IQR = 41] for LGA-SPM8, 14% [31] for LGA-SPM12 and 10% [27] with the LPA cross-sectional pipeline. Applying the LST longitudinal pipeline, the reproducibility errors were considerably reduced (LGA: 0%[IQR = 0], p < 0.001; LPA: 0% [3], p < 0.001) compared to those derived using the cross-sectional algorithms. The DC using the longitudinal pipeline was excellent (median = 1) for LGA [IQR = 0] and LPA [0.02]. LST algorithms showed moderate accuracy and good reproducibility. Therefore, it can be used as a reliable cross-sectional and longitudinal tool in multi-site studies.
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Affiliation(s)
- Federica Ribaldi
- Laboratory of Alzheimer's Neuroimaging and Alzheimer's Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Memory Clinic, Geneva University Hospitals, Geneva, Switzerland.
| | - Daniele Altomare
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | - Jorge Jovicich
- Center for Mind/Brain Sciences (CIMEC), University of Trento, Rovereto, Italy
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Agnese Picco
- Department of Neuroscience, Ophthalmology, Genetics and Mother-Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | | | | - Anna Mega
- Laboratory of Alzheimer's Neuroimaging and Alzheimer's Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonio Ferretti
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti, Italy; Institute for Advanced Biomedical Technologies (ITAB), University "G. d'Annunzio" of Chieti, Italy
| | - Antonios Drevelegas
- Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece; Department of Radiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Beatriz Bosch
- Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona and IDIBAPS, Barcelona, Spain
| | - Bernhard W Müller
- LVR-Clinic for Psychiatry and Psychotherapy, Institutes and Clinics of the University Duisburg-Essen, Essen, Germany
| | - Camillo Marra
- Center for Neuropsychological Research, Catholic University, Rome, Italy
| | | | - David Bartrés-Faz
- Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona and IDIBAPS, Barcelona, Spain
| | - Flavio Nobili
- Dept. of Neuroscience (DINOGMI), University of Genoa, Italy; IRCCS Ospedale Policlinico San Martino Genova, Italy
| | - Franco Alessandrini
- Radiology, Dept. of Diagnostic and Public Health, Verona University, Verona, Italy
| | - Frederik Barkhof
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Helene Gros-Dagnac
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Université Toulouse 3 Paul Sabatier, UMR 825 Imagerie Cérébrale et Handicaps Neurologiques, F-31024 Toulouse, France
| | - Jean-Philippe Ranjeva
- Institut de Neurosciences de la Timone (INT), Aix-Marseille Université, CNRS, UMR 7289, 13005 Marseille, France
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August University, Göttingen, Germany
| | - Joost Kuijer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Julien Sein
- Institut de Neurosciences de la Timone (INT), Aix-Marseille Université, CNRS, UMR 7289, 13005 Marseille, France
| | | | - Luca Roccatagliata
- IRCCS Ospedale Policlinico San Martino Genova, Italy; Dept. of Health Sciences (DISSAL), University of Genoa, Italy
| | - Lucilla Parnetti
- Section of Neurology, Centre for Memory Disturbances, University of Perugia, Perugia, Italy
| | - Magda Tsolaki
- 1st Department of Neurology, Aristotle University of Thessaloniki, Makedonia, Greece
| | | | | | | | - Martina Montalti
- Laboratory of Alzheimer's Neuroimaging and Alzheimer's Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Massimo Caulo
- Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti, Italy; Institute for Advanced Biomedical Technologies (ITAB), University "G. d'Annunzio" of Chieti, Italy
| | - Mira Didic
- APHM, Timone, Service de Neurologie et Neuropsychologie, APHM Hôpital Timone Adultes, Marseille, France; Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Núria Bargallo
- Department of Neuroradiology and Magnetic Resonance Image Core Facility, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Olivier Blin
- Aix Marseille University, UMR-INSERM 1106, Service de Pharmacologie Clinique, AP-HM, Marseille, France
| | - Paolo M Rossini
- Dept. Neuroscience & Neurorehabilitation, IRCCS-San Raffaele-Pisana, Rome, Italy
| | - Peter Schonknecht
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Piero Floridi
- Neuroradiology Unit, Perugia General Hospital, Perugia, Italy
| | - Pierre Payoux
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Régis Bordet
- Univ. Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition - Degenerative and Vascular Cognitive Disorders-U1172. F-59000 Lille, France
| | - Renaud Lopes
- Univ. Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition - Degenerative and Vascular Cognitive Disorders-U1172. F-59000 Lille, France
| | | | - Stephanie Bombois
- Univ. Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition - Degenerative and Vascular Cognitive Disorders-U1172. F-59000 Lille, France
| | - Tilman Hensch
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Ute Fiedler
- LVR-Clinic for Psychiatry and Psychotherapy, Institutes and Clinics of the University Duisburg-Essen, Essen, Germany
| | - Jill C Richardson
- Neurosciences Therapeutic Area, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, United Kingdom
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | - Moira Marizzoni
- Laboratory of Alzheimer's Neuroimaging and Alzheimer's Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Mega A, Galluzzi S, Bonvicini C, Fostinelli S, Gennarelli M, Geroldi C, Zanetti O, Benussi L, Di Maria E, Frisoni GB. Genetic counselling and testing for inherited dementia: single-centre evaluation of the consensus Italian DIAfN protocol. Alzheimers Res Ther 2020; 12:152. [PMID: 33203472 PMCID: PMC7670800 DOI: 10.1186/s13195-020-00720-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022]
Abstract
Background A consensus protocol for genetic counselling and testing of familial dementia, the Italian Dominantly Inherited Alzheimer’s and Frontotemporal Network (IT-DIAfN) protocol, has been developed in Italy by a network of expert dementia centres. The aim of this study is to evaluate feasibility and acceptability of the genetic counselling and testing process, as undertaken according to the IT-DIAfN protocol in one of the IT-DIAfN dementia research centres. Methods The protocol was tested by a multidisciplinary team at the IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy, on affected individuals with suspected inherited forms of Alzheimer’s disease (AD) or frontotemporal dementia (FTD), and to healthy at-risk relatives. The genetic counselling and testing process consisted of (i) pre-test consultation and psychological assessment (ii) genetic testing, (iii) genetic test result disclosure and (iv) follow-up consultation and psychological assessment. Results Twenty affected individuals from 17 families fulfilled the family history criteria of the IT-DIAfN protocol for suspected inherited dementia (17 for AD, 2 for FTD, 1 for inclusion body myopathy with Paget disease of bone and frontotemporal dementia) and were included in the protocol. Nineteen out of 20 affected individuals received the genetic test result (one left after the pre-test consultation being not ready to cope with an unfavourable outcome). A pathogenic mutation was found in 6 affected individuals (1 in PSEN1, 2 in PSEN2, 1 in GRN, 1 in MAPT, 1 in VCP). Eleven healthy at-risk relatives asked to undergo predictive testing and were included in the protocol. Three completed the protocol, including follow-up; one did not ask for the genetic test result after genetic testing; and eight withdrew before the genetic testing, mainly due to an increased awareness about the possible consequences of an unfavourable test result. To date, no catastrophic reactions were reported at the follow-up. Conclusions Our case series shows that a structured genetic counselling and testing protocol for inherited dementia can be implemented in both affected individuals and at-risk relatives in a research setting. The procedure was shown to be safe in terms of occurrence of catastrophic events. A formal validation in larger cohorts is needed.
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Affiliation(s)
- Anna Mega
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Samantha Galluzzi
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Cristian Bonvicini
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Silvia Fostinelli
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Massimo Gennarelli
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Cristina Geroldi
- Alzheimer's Unit - Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Orazio Zanetti
- Alzheimer's Unit - Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Emilio Di Maria
- Department of Health Sciences, University of Genoa, Genoa, Italy. .,Unit of Medical Genetics, Galliera Hospital, Genoa, Italy.
| | - Giovanni B Frisoni
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University Hospitals and University of Geneva, Geneva, Switzerland
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8
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Bonvicini C, Scassellati C, Benussi L, Di Maria E, Maj C, Ciani M, Fostinelli S, Mega A, Bocchetta M, Lanzi G, Giacopuzzi E, Ferraboli S, Pievani M, Fedi V, Defanti CA, Giliani S, Frisoni GB, Ghidoni R, Gennarelli M. Next Generation Sequencing Analysis in Early Onset Dementia Patients. J Alzheimers Dis 2020; 67:243-256. [PMID: 30530974 PMCID: PMC6398561 DOI: 10.3233/jad-180482] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Early onset dementias (EOD) are rare neurodegenerative dementias that present before 65 years. Genetic factors have a substantially higher pathogenetic contribution in EOD patients than in late onset dementia. Objective: To identify known and/or novel rare variants in major candidate genes associated to EOD by high-throughput sequencing. Common-risk variants of apolipoprotein E (APOE) and prion protein (PRNP) genes were also assessed. Methods: We studied 22 EOD patients recruited in Memory Clinics, in the context of studies investigating genetic forms of dementia. Two methodological approaches were applied for the target-Next Generation Sequencing (NGS) analysis of these patients. In addition, we performed progranulin plasma dosage, C9Orf72 hexanucleotide repeat expansion analysis, and APOE genotyping. Results: We detected three rare known pathogenic mutations in the GRN and PSEN2 genes and eleven unknown-impact mutations in the GRN, VCP, MAPT, FUS, TREM2, and NOTCH3 genes. Six patients were carriers of only common risk variants (APOE and PRNP), and one did not show any risk mutation/variant. Overall, 69% (n = 9) of our early onset Alzheimer’s disease (EAOD) patients, compared with 34% (n = 13) of sporadic late onset Alzheimer’s disease (LOAD) patients and 27% (n = 73) of non-affected controls (ADNI, whole genome data), were carriers of at least two rare/common risk variants in the analyzed candidate genes panel, excluding the full penetrant mutations. Conclusion: This study suggests that EOD patients without full penetrant mutations are characterized by higher probability to carry polygenic risk alleles that patients with LOAD forms. This finding is in line with recently reported evidence, thus suggesting that the genetic risk factors identified in LOAD might modulate the risk also in EOAD.
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Affiliation(s)
- Cristian Bonvicini
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Catia Scassellati
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Emilio Di Maria
- Department of Health Sciences, University of Genova and Division of Medical Genetics, Galliera Hospital, Genova, Italy
| | - Carlo Maj
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Institute for Genomic Statistics and Bioinformatics, Bonn, Germany
| | - Miriam Ciani
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Silvia Fostinelli
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Anna Mega
- Laboratory Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Martina Bocchetta
- Laboratory Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Gaetana Lanzi
- A. Nocivelli' Institute for Molecular Medicine Spedali Civili and University of Brescia, Brescia, Italy
| | - Edoardo Giacopuzzi
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Sergio Ferraboli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Michela Pievani
- Laboratory Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Carlo Alberto Defanti
- Fondazione Europea Ricerca Biomedica, Centro di Eccellenza Alzheimer, Ospedale Briolini Gazzaniga, Bergamo, Italy
| | - Silvia Giliani
- A. Nocivelli' Institute for Molecular Medicine Spedali Civili and University of Brescia, Brescia, Italy
| | | | - Giovanni Battista Frisoni
- Laboratory Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Laboratory of Neuroimaging of Aging (LANVIE), University Hospitals and University of Geneva, Geneva, Switzerland; Department of Internal Medicine, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Massimo Gennarelli
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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9
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Bosco P, Redolfi A, Bocchetta M, Ferrari C, Mega A, Galluzzi S, Austin M, Chincarini A, Collins DL, Duchesne S, Maréchal B, Roche A, Sensi F, Wolz R, Alegret M, Assal F, Balasa M, Bastin C, Bougea A, Emek-Savaş DD, Engelborghs S, Grimmer T, Grosu G, Kramberger MG, Lawlor B, Mandic Stojmenovic G, Marinescu M, Mecocci P, Molinuevo JL, Morais R, Niemantsverdriet E, Nobili F, Ntovas K, O'Dwyer S, Paraskevas GP, Pelini L, Picco A, Salmon E, Santana I, Sotolongo-Grau O, Spiru L, Stefanova E, Popovic KS, Tsolaki M, Yener GG, Zekry D, Frisoni GB. The impact of automated hippocampal volumetry on diagnostic confidence in patients with suspected Alzheimer's disease: A European Alzheimer's Disease Consortium study. Alzheimers Dement 2017; 13:1013-1023. [PMID: 28263741 DOI: 10.1016/j.jalz.2017.01.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/25/2016] [Accepted: 01/23/2017] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Hippocampal volume is a core biomarker of Alzheimer's disease (AD). However, its contribution over the standard diagnostic workup is unclear. METHODS Three hundred fifty-six patients, under clinical evaluation for cognitive impairment, with suspected AD and Mini-Mental State Examination ≥20, were recruited across 17 European memory clinics. After the traditional diagnostic workup, diagnostic confidence of AD pathology (DCAD) was estimated by the physicians in charge. The latter were provided with the results of automated hippocampal volumetry in standardized format and DCAD was reassessed. RESULTS An increment of one interquartile range in hippocampal volume was associated with a mean change of DCAD of -8.0% (95% credible interval: [-11.5, -5.0]). Automated hippocampal volumetry showed a statistically significant impact on DCAD beyond the contributions of neuropsychology, 18F-fluorodeoxyglucose positron emission tomography/single-photon emission computed tomography, and cerebrospinal fluid markers (-8.5, CrI: [-11.5, -5.6]; -14.1, CrI: [-19.3, -8.8]; -10.6, CrI: [-14.6, -6.1], respectively). DISCUSSION There is a measurable effect of hippocampal volume on DCAD even when used on top of the traditional diagnostic workup.
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Affiliation(s)
- Paolo Bosco
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alberto Redolfi
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Martina Bocchetta
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Clarissa Ferrari
- IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Anna Mega
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Samantha Galluzzi
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | - D Louis Collins
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; True Positive Medical Devices Inc., Quebec City, Quebec, Canada
| | - Simon Duchesne
- True Positive Medical Devices Inc., Quebec City, Quebec, Canada
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology (HC CMEA SUI DI BM PI), Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, University Hospital (CHUV), Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Alexis Roche
- Advanced Clinical Imaging Technology (HC CMEA SUI DI BM PI), Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, University Hospital (CHUV), Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | | | - Montserrat Alegret
- Alzheimer Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Frederic Assal
- University Hospitals and University of Geneva, Geneva, Switzerland
| | - Mircea Balasa
- Alzheimer's and Other Cognitive Disorder Unit, Hospital Clinic, Barcelona, Spain
| | - Christine Bastin
- GIGA-CRC In vivo Imaging and Memory Clinic, University of Liège, Liège, Belgium
| | - Anastasia Bougea
- First Department of Neurology, Eginition Hospital Kapodistrian University, Medical School of Athens, Athens, Greece
| | - Derya Durusu Emek-Savaş
- Department of Psychology, Dokuz Eylül University, Izmir, Turkey; Izmir International Biomedicine and Genome Center, Dokuz Eylul University, Izmir, Turkey
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium; Memory Clinic and Department of Neurology, Hospital Network Antwerp (ZNA) Hoge Beuken and Middelheim, Antwerp, Belgium
| | - Timo Grimmer
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Galina Grosu
- Radiology and Medical Imagery, Elias University Clinical Hospital, Bucharest, Romania
| | - Milica G Kramberger
- Department of Neurology, Centre for Cognitive Impairments, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Brian Lawlor
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | | | - Mihaela Marinescu
- Department of Geriatrics-Gerontology and Old Age Psychiatry, Elias University Clinic, Bucharest, Romania
| | - Patrizia Mecocci
- Istituto di Gerontologia e Geriatria, Università degli Studi di Perugia, Perugia, Italy
| | - José Luis Molinuevo
- Alzheimer's and Other Cognitive Disorder Unit, Hospital Clinic, Barcelona, Spain
| | - Ricardo Morais
- Medical Imaging Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ellis Niemantsverdriet
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium
| | - Flavio Nobili
- Clinical Neurology (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Konstantinos Ntovas
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sarah O'Dwyer
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - George P Paraskevas
- First Department of Neurology, Eginition Hospital Kapodistrian University, Medical School of Athens, Athens, Greece
| | - Luca Pelini
- Istituto di Gerontologia e Geriatria, Università degli Studi di Perugia, Perugia, Italy
| | - Agnese Picco
- Clinical Neurology (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy; Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Eric Salmon
- GIGA-CRC In vivo Imaging and Memory Clinic, University of Liège, Liège, Belgium
| | - Isabel Santana
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Oscar Sotolongo-Grau
- Alzheimer Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Luiza Spiru
- Carol Davila University of Medicine, Bucharest, Romania; Ana Aslan Intl Foundation-Memory Clinic, Bucharest, Romania
| | - Elka Stefanova
- Institute of Neurology, CCS, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Görsev G Yener
- Izmir International Biomedicine and Genome Center, Dokuz Eylul University, Izmir, Turkey; Department of Neurology, Dokuz Eylül University, Izmir, Turkey; Brain Dynamics Multidisciplinary Research Center, Dokuz Eylül University, Izmir, Turkey
| | - Dina Zekry
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland.
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10
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Bocchetta M, Mega A, Bernardi L, Di Maria E, Benussi L, Binetti G, Borroni B, Colao R, Di Fede G, Fostinelli S, Galimberti D, Gennarelli M, Ghidoni R, Piaceri I, Pievani M, Porteri C, Redaelli V, Rossi G, Suardi S, Babiloni C, Scarpini E, Tagliavini F, Padovani A, Nacmias B, Sorbi S, Frisoni GB, Bruni AC. Genetic Counseling and Testing for Alzheimer's Disease and Frontotemporal Lobar Degeneration: An Italian Consensus Protocol. J Alzheimers Dis 2016; 51:277-91. [PMID: 26901402 DOI: 10.3233/jad-150849] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Genetic testing of familial Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) is attracting interest thanks to innovative primary prevention clinical trials and increased request for information by at-risk individuals. However, ethical, social, and psychological implications are paramount and genetic testing must be supported by structured genetic counseling. In Italy, practice parameters and guidelines for genetic counseling in dementia are not available. OBJECTIVE To develop a nationally harmonized protocol for genetic counseling and testing of familial AD and FTLD. METHODS Activities were carried out in the context of the Italian Dominantly Inherited Alzheimer's and Frontotemporal Network (IT-DIAfN) project, a national network of centers of excellence with expertise in managing patients with familial AD and FTLD. A survey of the literature on genetic counseling protocols and guidelines was conducted. Local protocols for genetic counseling were surveyed. Differences and commonalities among protocols were identified and discussed among project partners. Consensus was reached following implicit aggregation methods. RESULTS Consensus was reached on a protocol for patients with clinically diagnosed familial AD or FTLD and a distinct protocol for their at-risk relatives. Genetic counseling should be provided by a multidisciplinary team including a geneticist, a neurologist/geriatrician, and a psychologist/psychiatrist, according to the following schedule: (i) initial consultation with tailored information on the genetics of the dementias; (ii) clinical, psychological, and cognitive assessment; if deemed appropriate (iii) genetic testing following a structured decision tree for gene mutation search; (iv) genetic testing result disclosure; (v) psychological support follow-up. CONCLUSION This genetic counseling protocol provides Italian centers with a line of shared practice for dealing with the requests for genetic testing for familial AD and FTLD from patients and at-risk relatives, who may also be eligible participants for novel prevention clinical trials.
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Affiliation(s)
- Martina Bocchetta
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Anna Mega
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Livia Bernardi
- Centro Regionale di Neurogenetica, ASP Catanzaro, Lamezia terme (CZ) Italy
| | - Emilio Di Maria
- Department of Health Sciences, University of Genova and Division of Medical Genetics, Galliera Hospital, Genova, Italy
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuliano Binetti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Barbara Borroni
- University of Brescia and Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Brescia, Brescia, Italy
| | - Rosanna Colao
- Centro Regionale di Neurogenetica, ASP Catanzaro, Lamezia terme (CZ) Italy
| | | | - Silvia Fostinelli
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Daniela Galimberti
- University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Gennarelli
- Genetic Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Irene Piaceri
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Michela Pievani
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Corinna Porteri
- Bioethics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Giacomina Rossi
- IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Suardi
- IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudio Babiloni
- Departiment of Physiology and Pharmacology, University of Rome "La Sapienza", Rome, Italy; IRCCS San Raffaele Pisana of Rome, Italy
| | - Elio Scarpini
- University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Alessandro Padovani
- University of Brescia and Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, Brescia, Brescia, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Giovanni B Frisoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Amalia C Bruni
- Centro Regionale di Neurogenetica, ASP Catanzaro, Lamezia terme (CZ) Italy
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Frena A, Patauner S, Mega A. 427. Liver adenomatosis: A precancerous entity? Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.267] [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] Open
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12
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Bosco P, Redolfi A, Bocchetta M, Ferrari C, Mega A, Galluzzi S, Assal F, Balasa M, Bastin C, Bougea A, Emek-Savas DD, Engelborghs S, Giannakopoulos P, Gold G, Grimmer T, Grosu G, Kramberger MG, Lawlor B, Stojmenovic GM, Marinescu M, Mecocci P, Molinuevo JL, Morais R, Niemantsverdriet E, Nobili F, Ntovas K, O'Dwyer S, Paraskevas G, Pelini L, Picco A, Salmon E, Santana I, Sotolongo-Grau O, Spiru L, Stefanova E, Popovic KS, Tsolaki M, Yener G, Zekry D, Frisoni GB. P3‐209: Impact of Biomarkers On Diagnostic Confidence in Clinical Assessment of Patients with Suspected Alzheimer's Disease and High Diagnostic Uncertainty: An EADC Study. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Martina Bocchetta
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
- University College LondonLondonUnited Kingdom
| | | | | | - Samantha Galluzzi
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Frederic Assal
- University Hospitals and University of GenevaGenevaSwitzerland
| | | | | | - Anastasia Bougea
- Eginition Hospital Kapodistrian University, Medical School of AthensAthensGreece
| | | | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of AntwerpAntwerpBelgium
- Department of Neurology and Memory Clinic Hospital Network Antwerp (ZNA) Middelheim and Hoge BeukenAntwerpBelgium
| | | | - Gabriel Gold
- Division of Geriatrics University Hospital of GenevaGenevaSwitzerland
| | - Timo Grimmer
- Klinikum Rechts der Isar, Technische Universitaet MuenchenMunichGermany
| | - Galina Grosu
- Elias University Clinical HospitalBucharestRomania
| | | | - Brian Lawlor
- Mercer's Institute for Successful Ageing, St. James's HospitalDublinIreland
| | | | | | | | - Jose Luis Molinuevo
- ICN Hospital Clinic Universitari and Pasqual Maragall FoundationBarcelonaSpain
| | - Ricardo Morais
- Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Ellis Niemantsverdriet
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of AntwerpAntwerpBelgium
| | | | | | - Sarah O'Dwyer
- Mercer's Institute for Successful Ageing, St. James's HospitalDublinIreland
| | - George Paraskevas
- Eginition Hospital Kapodistrian University, Medical School of AthensAthensGreece
| | - Luca Pelini
- Istituto di Gerontologia e Geriatria, Università degli Studi di PerugiaPerugiaItaly
| | - Agnese Picco
- Neurology Unit, IRCCS AOU San Martino University of GenoaGenoaItaly
| | | | | | | | - Luiza Spiru
- Carol Davila University of MedicineBucharestRomania
- Ana Aslan Intl Foundation-Memory ClinicBucharestRomania
| | | | | | - Magda Tsolaki
- Aristotle University of ThessalonikiThessalonikiGreece
| | | | - Dina Zekry
- University Hospitals and University of GenevaGenevaSwitzerland
| | - Giovanni B. Frisoni
- IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
- Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of GenevaGenevaSwitzerland
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Apolo A, Infante J, Hamid O, Patel M, Wang D, Kelly K, Mega A, Britten C, Mita A, Ravaud A, Cuillerot J, Von Heydebreck A, Gulley J. 2630 Avelumab (MSB0010718C), an anti-PD-L1 antibody, in patients with locally advanced or metastatic urothelial carcinoma: A phase Ib trial. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31447-2] [Citation(s) in RCA: 3] [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: 11/27/2022]
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14
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Campanini M, Ciprian R, Bedogni E, Mega A, Chiesi V, Casoli F, de Julián Fernández C, Rotunno E, Rossi F, Secchi A, Bigi F, Salviati G, Magén C, Grillo V, Albertini F. Lorentz microscopy sheds light on the role of dipolar interactions in magnetic hyperthermia. Nanoscale 2015; 7:7717-7725. [PMID: 25835488 DOI: 10.1039/c5nr00273g] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Monodispersed Fe3O4 nanoparticles with comparable size distributions have been synthesized by two different synthesis routes, co-precipitation and thermal decomposition. Thanks to the different steric stabilizations, the described samples can be considered as a model system to investigate the effects of magnetic dipolar interactions on the aggregation states of the nanoparticles. Moreover, the presence of magnetic dipolar interactions can strongly affect the nanoparticle efficiency as a hyperthermic mediator. In this paper, we present a novel way to visualize and map the magnetic dipolar interactions in different kinds of nanoparticle aggregates by the use of Lorentz microscopy, an easy and reliable in-line electron holographic technique. By exploiting Lorentz microscopy, which is complementary to the magnetic measurements, it is possible to correlate the interaction degrees of magnetic nanoparticles with their magnetic behaviors. In particular, we demonstrate that Lorentz microscopy is successful in visualizing the magnetic configurations stabilized by dipolar interactions, thus paving the way to the comprehension of the power loss mechanisms for different nanoparticle aggregates.
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Affiliation(s)
- M Campanini
- Istituto Materiali per l'Elettronica ed il Magnetismo IMEM-CNR, Parco Area delle Scienze 37/A, 43124 Parma, Italy.
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15
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Pantazopoulos C, Floros I, Mega A, Rigas C, Pavleas I, Vernikos P, Archontoulis N, Xanthis D, Iacovidou N, Xanthos T. 1036. Comparison of the hemodynamic parameters of two external chest compression devices (LUCAS versus AUTOPULSE) in a swine model of ventricular fibrillation. Intensive Care Med Exp 2014. [PMCID: PMC4798117 DOI: 10.1186/2197-425x-2-s1-p83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pantazopoulos C, Floros I, Mega A, Rigas C, Pavleas I, Vernikos P, Archontoulis N, Xanthis D, Iacovidou N, Xanthos T. 0391. Comparison of the histopathologic effects on the lungs of two external chest compression devices (lucas versus autopulse) in a swine model of ventricular fibrillation. Intensive Care Med Exp 2014. [PMCID: PMC4797847 DOI: 10.1186/2197-425x-2-s1-p24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mega A, Sleire L, Hagerstrand D, Enger PO, Nister M, Ostman A. ME-14 * PRO-MIGRATORY AND -PROLIFERATIVE EFFECTS OF ASTROCYTES ON GBM CELLS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou261.13] [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: 11/14/2022] Open
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Bocchetta M, Pievani M, Babiloni C, Bruni AC, Scarpini E, Sorbi S, Tagliavini F, Padovani A, Benussi L, Bernardi L, Binetti G, Borroni B, Di Fede G, Di Maria E, Fostinelli S, Galimberti D, Gennarelli M, Ghidoni R, Marzano N, Mega A, Nacmias B, Piaceri I, Porteri C, Rossi G, Suardi S, Vecchio F, Frisoni GB. P4‐074: ITALIAN NETWORK FOR AUTOSOMAL DOMINANT ALZHEIMER'S DISEASE AND FRONTOTEMPORAL LOBAR DEGENERATION (ITALIANDIAFN). Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Elio Scarpini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | | | | | | | - Luisa Benussi
- IRCCS Centro S. Giovanni di Dio, FatebenefratelliBresciaItaly
| | - Livia Bernardi
- Centro Regionale di NeurogeneticaLamezia Terme (CZ)Italy
| | | | | | | | | | | | | | | | - Roberta Ghidoni
- IRCCS Centro S. Giovanni di Dio, FatebenefratelliBresciaItaly
| | | | - Anna Mega
- IRCCS Centro S. Giovanni di Dio, FatebenefratelliBresciaItaly
| | | | | | - Corinna Porteri
- IRCCS Centro S. Giovanni di Dio, FatebenefratelliBresciaItaly
| | - Giacomina Rossi
- IRCCS Fondazione Istituto Neurologico “Carlo Besta”MilanItaly
| | - Silvia Suardi
- IRCCS Fondazione Istituto “Carlo Besta" Neurological InstituteMilanItaly
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Bocchetta M, Pievani M, Babiloni C, Bruni AC, Scarpini E, Sorbi S, Tagliavini F, Padovani A, Benussi L, Bernardi L, Binetti G, Borroni B, Di Fede G, Di Maria E, Fostinelli S, Galimberti D, Gennarelli M, Ghidoni R, Marzano N, Mega A, Nacmias B, Piaceri I, Porteri C, Rossi G, Suardi S, Vecchio F, Frisoni GB. IC‐P‐069: ITALIAN NETWORK FOR AUTOSOMAL DOMINANT ALZHEIMER'S DISEASE AND FRONTOTEMPORAL LOBAR DEGENERATION (ITALIANDIAFN). Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | | | - Elio Scarpini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | | | | | | | - Luisa Benussi
- IRCCS Instituto Centro S. Giovanni di Dio FatebenefratelliBresciaItaly
| | | | - Giuliano Binetti
- IRCCS Instituto Centro S. Giovanni di Dio FatebenefratelliBresciaItaly
| | | | | | | | | | | | | | - Roberta Ghidoni
- IRCCS Instituto Centro S. Giovanni di Dio FatebenefratelliBresciaItaly
| | | | - Anna Mega
- IRCCS Centro San Giovanni di Dio, FatebenefratelliBresciaItaly
| | | | | | - Corinna Porteri
- IRCCS Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Giacomina Rossi
- IRCCS Fondazione Instituto Neurologico Carlo BestaMilanoItaly
| | - Silvia Suardi
- IRCCS Fondazione Instituto Neurologico Carlo BestaMilanItaly
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Petrylak D, Kantoff P, Mega A, Stephenson J, Vogelzang N, Fleming M, Blattman S, Stambler N, D'Ambrosio P, Israel R. 244 Prostate Specific Membrane Antigen Antibody Drug Conjugate (PSMA ADC): a Phase 1 Trial in Castration-Resistant Metastatic Prostate Cancer (mCRPC). Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72042-7] [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]
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Giamarellos-Bourboulis EJ, Norrby-Teglund A, Mylona V, Savva A, Tsangaris I, Dimopoulou I, Mouktaroudi M, Raftogiannis M, Georgitsi M, Linnér A, Adamis G, Antonopoulou A, Apostolidou E, Chrisofos M, Katsenos C, Koutelidakis I, Kotzampassi K, Koratzanis G, Koupetori M, Kritselis I, Lymberopoulou K, Mandragos K, Marioli A, Sundén-Cullberg J, Mega A, Prekates A, Routsi C, Gogos C, Treutiger CJ, Armaganidis A, Dimopoulos G. Risk assessment in sepsis: a new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor. Crit Care 2012; 16:R149. [PMID: 22873681 PMCID: PMC3580738 DOI: 10.1186/cc11463] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/08/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Early risk assessment is the mainstay of management of patients with sepsis. APACHE II is the gold standard prognostic stratification system. A prediction rule that aimed to improve prognostication by APACHE II with the application of serum suPAR (soluble urokinase plasminogen activator receptor) is developed. METHODS A prospective study cohort enrolled 1914 patients with sepsis including 62.2% with sepsis and 37.8% with severe sepsis/septic shock. Serum suPAR was measured in samples drawn after diagnosis by an enzyme-immunoabsorbent assay; in 367 patients sequential measurements were performed. After ROC analysis and multivariate logistic regression analysis a prediction rule for risk was developed. The rule was validated in a double-blind fashion by an independent confirmation cohort of 196 sepsis patients, predominantly severe sepsis/septic shock patients, from Sweden. RESULTS Serum suPAR remained stable within survivors and non-survivors for 10 days. Regression analysis showed that APACHE II ≥ 17 and suPAR ≥ 12 ng/ml were independently associated with unfavorable outcome. Four strata of risk were identified: i) APACHE II <17 and suPAR <12 ng/ml with mortality 5.5%; ii) APACHE II < 17 and suPAR ≥ 12 ng/ml with mortality 17.4%; iii) APACHE II ≥ 17 and suPAR <12 ng/ml with mortality 37.4%; and iv) APACHE II ≥ 17 and suPAR ≥ 12 ng/ml with mortality 51.7%. This prediction rule was confirmed by the Swedish cohort. CONCLUSIONS A novel prediction rule with four levels of risk in sepsis based on APACHE II score and serum suPAR is proposed. Prognostication by this rule is confirmed by an independent cohort.
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Poukoulidou T, Spyridaki A, Mihailidou I, Kopterides P, Pistiki A, Alexiou Z, Chrisofos M, Dimopoulou I, Drimoussis P, Giamarellos-Bourboulis EJ, Koutelidakis I, Marioli A, Mega A, Orfanos SE, Theodorakopoulou M, Tsironis C, Maggina N, Polychronopoulos V, Tsangaris I. TREM-1 expression on neutrophils and monocytes of septic patients: relation to the underlying infection and the implicated pathogen. BMC Infect Dis 2011; 11:309. [PMID: 22050935 PMCID: PMC3241479 DOI: 10.1186/1471-2334-11-309] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 11/04/2011] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Current knowledge on the exact ligand causing expression of TREM-1 on neutrophils and monocytes is limited. The present study aimed at the role of underlying infection and of the causative pathogen in the expression of TREM-1 in sepsis. METHODS Peripheral venous blood was sampled from 125 patients with sepsis and 88 with severe sepsis/septic shock. The causative pathogen was isolated in 91 patients. Patients were suffering from acute pyelonephritis, community-acquired pneumonia (CAP), intra-abdominal infections (IAIs), primary bacteremia and ventilator-associated pneumonia or hospital-acquired pneumonia (VAP/HAP). Blood monocytes and neutrophils were isolated. Flow cytometry was used to estimate the TREM-1 expression from septic patients. RESULTS Within patients bearing intrabdominal infections, expression of TREM-1 was significantly lower on neutrophils and on monocytes at severe sepsis/shock than at sepsis. That was also the case for severe sepsis/shock developed in the field of VAP/HAP. Among patients who suffered infections by Gram-negative community-acquired pathogens or among patients who suffered polymicrobial infections, expression of TREM-1 on monocytes was significantly lower at the stage of severe sepsis/shock than at the stage of sepsis. CONCLUSIONS Decrease of the expression of TREM-1 on the membrane of monocytes and neutrophils upon transition from sepsis to severe sepsis/septic shock depends on the underlying type of infection and the causative pathogen.
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Affiliation(s)
- Thekla Poukoulidou
- 4th Department of Internal Medicine, University of Athens, Medical School, ATTIKON General Hospital, 1 Rimini Str,, 12462 Athens, Greece.
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Agosta S, Mega A, Sartori G. Detrimental effects of using negative sentences in the autobiographical IAT. Acta Psychol (Amst) 2011; 136:269-75. [PMID: 21232728 DOI: 10.1016/j.actpsy.2010.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 12/25/2009] [Revised: 05/25/2010] [Accepted: 05/30/2010] [Indexed: 11/15/2022] Open
Abstract
The autobiographical Implicit Association Test (aIAT) is a method that accurately identifies which one of two contrasting autobiographical events is true for the subject. The aIAT indexes the real autobiographical event (e.g. I was in Paris for Christmas) on the basis of the facilitating effect because it maps the real autobiographical event with true sentences (e.g. I am in front of a computer) on the same motor response. In this paper we focus on the conditions under which the autobiographical IAT accurately and reliably identifies autobiographical memories. A recent study showed a reduction in the accuracy of the aIAT when negative sentences are used. We have investigated the detrimental effect on aIAT accuracy of such negative sentence items, used to describe autobiographical events, compared with affirmative sentence items. While we highlight the reliability of the results obtained using negative sentences, we also show that the use of affirmative sentences in describing autobiographical events guarantees high accuracy and reliability of results in identifying the true autobiographical event. Finally, we summarise the criteria for preparing stimuli for an effective aIAT in order to maximise correct classifications of individual subjects.
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Affiliation(s)
- Sara Agosta
- Department of Psychology, University of Padua, via Venezia 8, 35131 Padua, Italy
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Rizack T, Mega A, Berz D. Is squamous cell histology an adverse prognosticator for survival of malignancies of the upper urinary tract? J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6617] [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
6617 Background: Carcinomas of the renal pelvis and ureter are rare diseases, accounting for only about 1% of all urogenital malignancies. Previous reports suggest that squamous cell histology is associated with inferior survival. We present the largest population based analysis to date of survival in patients with upper urinary tract malignancies. Methods: We analyzed the Surveillance, Epidemiology and End Results database for cancer specific survival rates in patients with renal pelvis and ureteral malignancies who were diagnosed between 1973 and 2003 in the SEER catchment geographic areas. The primary exposure of interest was the underlying histology, squamous cell versus transitional cell differentiation. We performed descriptive statistics, non parametric survival analysis, and cox proportional hazard analysis. Results: We identified 13,213 eligible patients, 7,716 renal pelvis and 5,497 ureteral carcinomas. Among this cohort, 179 patients had squamous cell carcinoma (SCC), 12,395 had transitional cell carcinoma (TCC), including 121 papillary, and 619 had other histologies. Overall, patients with SCC histology fared worse. The median overall survival time was 10 months for SCC and 63 months for TCC. The cox analysis revealed a HR 0.42 (95% CI 0.36–0.47) for TCC when compared to SCC and corrected for decade of diagnosis, age, gender, prior treatment, and race. The difference between the two groups was entirely attributable to survival differences in patients with loco-regional disease. However, when stratified by lymph node involvement this difference disappeared for patients with locally involved lymph nodes (p = 0.84) and for patients with clear lymph nodes (p = 0.92). Conclusions: SCCs of the upper urinary tract present at a higher clinical stage and appear to represent more aggressive disease when compared to other histologies. However, when appropriately staged according to lymph node status, the survival of TCC and SCC of the upper urinary tract is identical when compared stage by stage. No significant financial relationships to disclose.
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Affiliation(s)
| | - A. Mega
- Brown University, Providence, RI
| | - D. Berz
- Brown University, Providence, RI
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Vernikos P, Topalis T, Mega A, Tzifas A, Archontoulis N, Floros J. Systemic rheumatic diseases in the ICU. Crit Care 2009. [PMCID: PMC4084348 DOI: 10.1186/cc7626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Skiada A, Pavleas J, Thomopoulos G, Stefanou I, Mega A, Archodoulis N, Vernikos P, Rigas K, Rigas A, Kaskantamis A, Zerva A, Pagalou E, Floros J. Trends of resistance of Gram-negative bacteria in the ICU during a 3-year period. Crit Care 2008. [PMCID: PMC4088406 DOI: 10.1186/cc6256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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27
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Hebert HD, Butera J, Mega A. Are we training our fellows adequately in delivering bad news to patients? A survey of hematology/oncology program directors. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9023] [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
9023 Background: Medical Oncologists are often in a situation of delivering bad news (dbn). We were interested in the extent of formal training in dbn in Hematology/Oncology fellowships in the United States. Methods: An e-mail survey was conducted of all Hematology/Oncology Program Directors (PDs) in the United States to elicit subjective responses as to the degree of formal training fellows receive in dbn, the adequacy, perceived necessity and quality of this training as well as institutional support provided. The surveys were e- mailed to 124 PDs and responses were received either via e-mail or regular mail. Results: 49 surveys were completed and returned (40% response rate). The majority of programs, 82%, are in an urban setting and 96% of the primary teaching hospitals are considered tertiary care centers. 45% of programs carry an NCI designation; the median number of fellows in a training program is 6, with the range being 3 to 42. 90% of PDs reported that they received little to no formal training in dbn. In contrast, they report that 31% of current fellows receive little to no formal training with 43% receiving some training and additional 26% receiving moderate to extensive training. 36% of PDs felt that formal training is important for skill development in dbn while only 4% did not feel so and an additional 31% felt that some training is useful. 50% of PDs would like to see some improvements in how their fellows are trained and 28% would like to see moderate to extensive improvement. 44% reported little to no institutional support for training while 22% reported moderate to full support. Conclusions: Of the Hematology/Oncology Program Directors who responded to our survey, a large majority did not have formal training in dbn. Despite this lack of training, most PDs felt that some training was useful for skill development in dbn and the majority of today's fellows do receive training in delivering bad news. However, there was still a significant percentage of PDs who reported little or no formal training for fellows and most PDs would still like to see some improvements in how fellows are trained. Specific institutional support for training fellows in dbn remains lacking. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - A. Mega
- Brown University, Providence, RI
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Giamarellos-Bourboulis EJ, Mega A, Pavleas I, Archontoulis N, Rigas K, Vernikos P, Giamarellou H, Thomopoulos G. Impact of carbapenem administration on systemic endotoxemia in patients with severe sepsis and Gram-negative bacteremia. J Chemother 2007; 18:502-6. [PMID: 17127227 DOI: 10.1179/joc.2006.18.5.502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/31/2022]
Abstract
In order to investigate the effect of carbapenems on systemic endotoxemia, 20 patients with severe sepsis due to ventilator-associated pneumonia and Gram-negative bacteremia were enrolled; 10 (group A) were administered 1 g t.i.d. of imipenem/cilastatin and 10 (group B) 2 g t.i.d. of meropenem. Blood was sampled at 0 time and after 1, 2, 4, 6, 12, 24, 36, 48, 60, 72, 84 and 96 hours for detection of endotoxins (LPS), interleukin-6 (IL-6), C-reactive protein (CRP) and drug levels. LPS were determined by the QCL-1000 LAL assay, IL-6 by an enzymeimmunoassay, CRP by nephelometry and carbapenem levels by a microbiological assay. We did not find that carbapenems had any effect on the kinetics of LPS and CRP; IL-6 of group A was lower than group B at 72 and 84 hours. No correlation was observed between drug levels of any carbapenem and LPS, IL-6 or CRP. It is concluded that in septic patients with Gram-negative bacteremia administration of either imipenem or meropenem did not affect systemic endotoxemia. The above data support the safe administration of both carbapenems in patients with severe sepsis.
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Pavleas J, Skiada A, Salatas K, Koufakos K, Rigas A, Archontoulis N, Vernikos P, Mega A, Thomopoulos G, Rigas K. O318 Bloodstream infections due to Klebsiella pneumoniae in an intensive care unit in Greece: susceptibility patterns and clinical characteristics. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Amplatz S, Piazzi L, Felder M, Comberlato M, Benvenuti S, Zancanella L, Di Fede F, de'Guelmi A, Bertozzo A, Farris P, Grasso T, Mega A, Chilovi F. Extracorporeal shock wave lithotripsy for clearance of refractory bile duct stones. Dig Liver Dis 2007; 39:267-72. [PMID: 17275426 DOI: 10.1016/j.dld.2006.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 11/11/2006] [Accepted: 11/14/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Following endoscopic sphincterotomy, 90% of bile duct stones can be removed with a Dormia basket or balloon catheter. The removal can fail in patients with large stones, intrahepatic stones, bile duct strictures or a difficult anatomy. The aim of this retrospective study is to investigate the efficacy and safety of extracorporeal shock wave lithotripsy in fragmenting and allowing the extraction of bile duct stones that could not be cleared by routine endoscopic means including mechanical lithotripsy. PATIENTS AND METHODS From 1989 to January 2005, we treated with extracorporeal shock wave lithotripsy 376 patients (133 males and 243 females, median age 71.4 years) with bile duct stones that were not removable following endoscopic sphincterotomy, using the extracorporeal shock wave lithotripsy Lithostar Plus machine built by Siemens Co. of Erlangen, Germany. Stone targeting was performed fluoroscopically following injection of contrast via nasobiliary drain or T-tube in 362 patients and by ultrasonography in eight patients. Residual fragments were cleared at endoscopic retrograde cholangiopancreatograhy. Two hundred and ten of the 370 patients treated (56.7%) showed only 1 stone, 57 (15.4%) showed 2, 45 (12.1%) showed 3, 58 (15.6%) showed more than 3 stones. The median diameter of the stones was 21mm (range 7-80mm). RESULTS Complete stone clearance was achieved in 334 of the 376 patients who underwent the extracorporeal shock wave lithotripsy procedure (90.2%). Six patients (1.5%) dropped out of treatment during their first sessions, mainly because of intolerance. Each patient averaged 3.7 treatments (1-12), at an average rate of 3470 shocks per session (1500-5400), at an average energy level of 3.4mJ (1-7). Complications were recorded in 34 patients (9.1%); 22 patients experienced symptomatic cardiac arrhythmia, 4 haemobilia, 2 cholangitis, 3 haematuria, 3 dyspnoea; no deaths were associated with the procedure. CONCLUSIONS Extracorporeal shock wave lithotripsy is a safe and effective therapy in those patients in whom endoscopic techniques have failed with a clearing rate of 90.2% of refractory bile duct stones with a low rate of complications.
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Affiliation(s)
- S Amplatz
- Gastrointestinal Unit, Ospedale Centrale, Bolzano, Italy.
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Gori E, Arpinati M, Bonifazi F, Errico A, Mega A, Alberani F, Sabbi V, Costazza G, Leanza S, Borrelli C, Berni M, Feraut C, Polato E, Altieri MC, Pirola E, Loddo MC, Banfi M, Barzetti L, Calza S, Brignoli C, Bandini G, De Vivo A, Bosi A, Baccarani M. Cryotherapy in the prevention of oral mucositis in patients receiving low-dose methotrexate following myeloablative allogeneic stem cell transplantation: a prospective randomized study of the Gruppo Italiano Trapianto di Midollo Osseo nurses group. Bone Marrow Transplant 2007; 39:347-52. [PMID: 17277790 DOI: 10.1038/sj.bmt.1705590] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Severe oral mucositis is a major cause of morbidity following allogeneic hematopoietic stem cell transplantation (AHSCT). Cryotherapy, that is, the application of ice chips on the mucosa of the oral cavity during the administration of antineoplastic agents, may reduce the incidence and severity of chemotherapy-related oral mucositis. In this multicenter randomized study, we addressed whether cryotherapy during MTX administration is effective in the prevention of severe oral mucositis in patients undergoing myeloablative AHSCT. One hundred and thirty patients undergoing myeloablative AHSCT and MTX-containing GVHD prophylaxis were enrolled and randomized to receive or not receive cryotherapy during MTX administration. The incidence of severe (grade 3-4) oral mucositis, the primary end point of the study, was comparable in patients receiving or not cryotherapy. Moreover, no difference was observed in the incidence of oral mucositis grade 2-4 and the duration of oral mucositis grade 3-4 or 2-4, or in the kinetics of mucositis over time. In univariate and multivariate analysis, severe oral mucositis correlated with TBI in the conditioning regimen and lack of folinic acid rescue following MTX administration. Thus, cryotherapy during MTX administration does not reduce severe oral mucositis in patients undergoing myeloablative allogeneic HSCT. Future studies will assess cryotherapy before allogeneic HSCT.
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Affiliation(s)
- E Gori
- Department of Hematology and Medical Oncology Seragnoli, University of Bologna, Bologna, Italy
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Pavleas J, Skiada A, Daikos GL, Rigas K, Mega A, Archondoulis N, Vernikos P, Salatas K, Thomopoulos G. Colistin in the treatment of life-threatening infections. Int J Antimicrob Agents 2006; 28:374-6. [PMID: 16963234 DOI: 10.1016/j.ijantimicag.2006.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2006] [Revised: 05/15/2006] [Accepted: 05/19/2006] [Indexed: 10/24/2022]
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Pavleas J, Skiada A, Rigas K, Salatas K, Belivanakis G, Archodoulis N, Mega A, Vernikos P, Thomopoulos G. Crit Care 2006; 10:P100. [DOI: 10.1186/cc4447] [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: 11/10/2022] Open
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Vernikos P, Xanthis D, Georgiou S, Archontoulis N, Mega A, Rigas K, Pavleas J, Katsarou O, Thomopoulos G. The use of recombinant factor VIIa as a haemostatic agent in ICU patients. Crit Care 2004. [PMCID: PMC4099722 DOI: 10.1186/cc2602] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Giamarellos-Bourboulis EJ, Mega A, Grecka P, Scarpa N, Koratzanis G, Thomopoulos G, Giamarellou H. Procalcitonin: a marker to clearly differentiate systemic inflammatory response syndrome and sepsis in the critically ill patient? Intensive Care Med 2002; 28:1351-6. [PMID: 12209289 DOI: 10.1007/s00134-002-1398-z] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.0] [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: 05/14/2001] [Accepted: 05/06/2002] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To define the role of procalcitonin in the differential diagnosis, prognosis and follow-up of critically ill patients. DESIGN Prospective study during the 2-year period from January 1998-2000. PATIENTS One hundred nineteen critically ill patients: 29 with systemic inflammatory response syndrome (SIRS) without any signs of infection, 11 with sepsis, 17 with severe sepsis, 10 with septic shock and 52 controls. Daily measurements of procalcitonin were performed by an immunocheminoluminometric assay, and values were correlated to the clinical characteristics of the patients. RESULTS Mean concentrations of procalcitonin were 5.45 (95% CI: 2.11, 8.81), 7.29 (95% CI: -1.92,14.59), 6.26 (95% CI: -1.32, 13.85) and 38.76 ng/ml (95% CI: 0.15, 77.38) on the 1st day in patients with SIRS, sepsis, severe sepsis and septic shock, respectively, and were statistically superior to those of control patients. Procalcitonin was gradually diminished over time with the resolution of the syndrome, while it was sustained in the same or more augmented levels upon worsening. Mean concentrations of procalcitonin on the 1st day for patients finally progressing to ARDS, to ARDS and acute renal failure, to ARDS, acute renal failure and DIC and to ARDS, acute renal failure, DIC and hepatic failure were 10.48, 8.08, 32.72 and 43.35 ng/ml, respectively. ROC curves of the sensitivity and specificity of procalcitonin for the evaluation of SIRS and sepsis were similar. CONCLUSIONS The definite differential diagnosis between SIRS and sepsis may not rely on a single application of procalcitonin but on the complete clinical and laboratory evaluation of the patient with procalcitonin playing a considerable role. Procalcitonin is an early prognostic marker of the advent of MODS; therefore, daily determinations might help in the follow-up of the critically ill patient.
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Affiliation(s)
- Evangelos J Giamarellos-Bourboulis
- Fourth Department of Internal Medicine, Athens Medical School, Sismanoglion General Hospital, 1 Sismanogliou Str., 15126 Maroussi Attikis, Greece
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Floreani A, Mega A, Tizian L, Burra P, Boccagni P, Baldo V, Fagiuoli S, Naccarato R, Luisetto G. Bone metabolism and gonad function in male patients undergoing liver transplantation: a two-year longitudinal study. Osteoporos Int 2001; 12:749-54. [PMID: 11605741 DOI: 10.1007/s001980170051] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Osteodystrophy is a major complication of end-stage liver disease, especially in postmenopausal women. Our aim in this study was to evaluate bone metabolism and gonad function in men undergoing orthotopic liver transplantation (OLTx). Twenty-three consecutive men (mean age 48+/-13 years) evaluated for OLTx were studied, assessing the following parameters at baseline and 3, 6, 12 and 24 months after OLTx: lumbar spine (L2-L4) bone mineral density (BMD), parathyroid hormone (PTH), osteocalcin (BGP), 25-hydroxyvitamin D (25OHD), free testosterone (FT) and gonadotropins (FSH, LH). At baseline, 12 patients (52%) had a T-score <-2.5 SD and the mean BMD was 0.806+/-0.11 g/cm2 (range 0.470-1.045 g/cm2). The BMD was lower 3 months after OLTx and significantly higher 12 and 24 months after OLTx. A significant increase in serum BGP was observed at 6, 12 (p<0.05) and 24 months (p<0.005) after OLTx. The mean serum PTH level was 26.6+/-3.1 pg/ml at baseline and increased significantly at 12 and 24 months (to 49.4+/-9.9 and 61.2+/-10.1 pg/ml, respectively; p<0.05). 25OHD serum levels were low at baseline and returned to the normal range after 12 and 24 months (baseline, 8.73+/-1.54 ng/ ml; 12 months, 16.4+/-2.6 ng/ml; 24 months, 17.67+/-3.1 ng/ml; p<0.05). FT was significantly lower at baseline than in a group of 10 healthy controls (5.09+/-10.99. vs 10.3+/-1.1 pg/ml; p<0.0001). After OLTx a significant increase in FT was recorded at 6, (p<0.05) and 24 months (p<0.005). FT was not correlated with BMD, however. After OLTx an increase in FSH and LH was observed (but failed to reach statistical significance) at 3 and 6 months, followed by a slight reduction at 12 and 24 months. Thus a high proportion of men with end-stage liver disease do have osteoporosis. After OLTx, an early recovery of gonad function is observed, followed by an increase in bone mass, which occurs from the sixth month onward.
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Affiliation(s)
- A Floreani
- Department of Surgical and Gastroenterological Sciences, University of Padua, Italy.
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Abstract
While t(1;19) and t(8;14) have been reported singly in pre-B-ALL and Burkitt's lymphoma, respectively, the occurrence of both translocations simultaneously in the same patient is rare. Indeed, a review of the English literature from 1966 to 1999 revealed no case reports with these findings. We report here an 88-year-old patient who was clinically diagnosed to have chronic lymphocytic leukemia and who carried both translocations in her peripheral blood cells. The patient refused to give consent for a bone marrow sample, the preferred tissue for study. The patient's clinical findings are discussed, although the relationship between the clinical information and cytogenetic findings, if any, is not known. Study of additional cases identical to ours will be helpful in determining the correlation, if any, between the patient's phenotype and the occurrence of the two translocations.
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MESH Headings
- Aged
- Aged, 80 and over
- Chromosome Banding
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 19/genetics
- Chromosomes, Human, Pair 8/genetics
- Female
- Humans
- Karyotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/classification
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Translocation, Genetic/genetics
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Affiliation(s)
- H F Mark
- Rhode Island Hospital, Brown University School of Medicine, Providence 02806, USA
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Mylonakis E, Mega A, Schiffman FJ. What do program directors in internal medicine think about international medical graduates? Results of a pilot study. Acad Med 1999; 74:452. [PMID: 10219231 DOI: 10.1097/00001888-199904000-00046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- E Mylonakis
- Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA.
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Mylonakis E, Dickinson BP, Mileno MD, Flanigan T, Schiffman FJ, Mega A, Rich JD. Persistent parvovirus B19 related anemia of seven years' duration in an HIV-infected patient: complete remission associated with highly active antiretroviral therapy. Am J Hematol 1999; 60:164-6. [PMID: 9929113 DOI: 10.1002/(sici)1096-8652(199902)60:2<164::aid-ajh16>3.0.co;2-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [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: 11/10/2022]
Abstract
A human immunodeficiency virus (HIV)-infected individual was first diagnosed with red blood cell aplasia due to B19 parvovirus infection in late 1989. Over the subsequent seven-year period, he received a total of 119 units of red blood cells (RBCs) and intravenous immunoglobulin every 2-3 weeks. In 1996 combination antiretroviral treatment with a protease inhibitor was initiated. He received four more units during the following two months and then required no more transfusions for the subsequent 24 months of follow-up. His CD4 count progressively increased and DNA polymerase chain reaction for parvovirus B19 became undetectable. Aggressive antiretroviral treatment may effectively diminish transfusion requirements among HIV-infected individuals with pure RBC aplasia resulting from parvovirus B19 infection.
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Affiliation(s)
- E Mylonakis
- Department of Medicine, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode Island 02906, USA.
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Safran H, Cioffi W, Iannitti D, Mega A, Akerman P. Paclitaxel and concurrent radiation for locally advanced pancreatic carcinoma. Front Biosci 1998; 3:E204-6. [PMID: 9792903 DOI: 10.2741/a378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An effective local-regional therapy is needed for adenocarcinomas of the pancreas. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton NJ) may enhance the effect of radiation therapy. Paclitaxel synchronizes cells at G2/M, a relatively radiosensitive phase of the cell cycle. We have shown that response to paclitaxel and concurrent radiation (paclitaxel/RT) was not affected by p53 mutations in non-small cell lung cancer (NSCLC). This suggested that paclitaxel/RT was a rationale treatment approach for other malignancies which frequently harbor p53 mutations such as upper gastrointestinal malignancies. We have completed a phase I study of paclitaxel/RT for locally advanced pancreatic and gastric cancers. The maximum tolerated dose (MTD) of paclitaxel was 50 mg/m2/week for 6 weeks with abdominal radiation. The dose limiting toxicities were abdominal pain within the radiation field, nausea and anorexia. Twenty-five patients with locally advanced pancreatic cancer have now completed treatment at the phase II dose level of paclitaxel 50 mg/m2/week with 50 Gy concurrent RT. Thus far, the only grade 3/4 toxicities have been hypersensitivity reactions in 2 patients, asymptomatic grade 4 neutropenia in 3 patients, and non-neutropenic biliary sepsis in 1 patient. Of the first 22 assessable patients treated at the phase II study, 8 obtained a partial response (PR) for a preliminary response rate of 36%. These findings demonstrate that paclitaxel/RT is well tolerated with substantial activity for locally advanced pancreatic cancer.
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Affiliation(s)
- H Safran
- Brown University Oncology Group and The Brown University School of Medicine, Providence, RI 02908, USA.
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Mark HF, Alter DN, Mega A. FISH as an adjunct to conventional cytogenetics. Med Health R I 1998; 81:328-30. [PMID: 9805893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- H F Mark
- Brown University School of Medicine, USA
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Schiffman FJ, Mega A, Lopez F. Paraneoplastic limbic encephalitis. Lancet 1997; 350:1251. [PMID: 9652588 DOI: 10.1016/s0140-6736(05)63484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Mega A. The longest night. Med Health R I 1997; 80:262-3. [PMID: 9283182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
MESH Headings
- Adult
- Diagnosis, Differential
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Priapism/etiology
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Affiliation(s)
- A Mega
- Miriam Hospital, Providence, RI 02906, USA
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Abstract
OBJECTIVE To determine why residents present certain cases and not others at morning report (MR) in an institution that permits residents the free choice of cases. DESIGN/PARTICIPANTS Prospective survey of 10 second- and third-year residents assigned to the medical service. SETTING A 241-bed teaching hospital with 55 categorical internal medicine residents. MEASUREMENTS AND MAIN RESULTS Over a 4-week period, there were 194 admissions to the medical service on 18 call days preceding MR. Of these admissions, 30 (15%) were presented at MR. Cases were more likely to be presented if they were considered unusual or rare in presentation or incidence (P = .001), involved significant management issues (p = .001), or were associated with remarkable imaging studies or other visual material (p = .006). Residents were more likely to present cases in which they disagreed with attending physicians on management plans (p = .005). Overall, residents rated few admissions as having notable physical examination findings (29/194) or ethical or cost issues (6/194). Of the seven most common admitting diagnoses, representing 44% of admissions, residents did not present cases involving four of these diagnoses. CONCLUSIONS Residents presented cases at MR that they felt were unique or rare in presentation or incidence for purposes of discussing management issues. Complete resident freedom in choosing MR cases may narrow the scope of MR and exclude common diagnoses and other issues of import such as medical ethics or economics.
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Affiliation(s)
- B Ramratnam
- Department of Medicine, Miriam Hospital, Providence, RI 02906, USA
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Mega A. A lump in the throat follows a pain in the neck: a teenager with a nasopharyngeal mass following infectious mononucleosis. Med Health R I 1997; 80:126-7. [PMID: 9130833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A Mega
- Miriam Hospital, Providence, RI 02906, USA
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De Blasi RA, Ferrari M, Natali A, Conti G, Mega A, Gasparetto A. Noninvasive measurement of forearm blood flow and oxygen consumption by near-infrared spectroscopy. J Appl Physiol (1985) 1994; 76:1388-93. [PMID: 8005887 DOI: 10.1152/jappl.1994.76.3.1388] [Citation(s) in RCA: 218] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We applied near-infrared spectroscopy (NIRS) for the simultaneous measurement of forearm blood flow (FBF) and oxygen consumption (VO2) in the human by inducing a 50-mmHg venous occlusion. Eleven healthy subjects were studied both at rest and after hand exercise during vascular occlusion. FBF was also measured by strain-gauge plethysmography. FBF measured by NIRS was 1.9 +/- 0.8 ml.100 ml-1.min-1 at rest and 8.2 +/- 2.9 ml.100 ml-1.min-1 after hand exercise. These values showed a correlation (r = 0.94) with those obtained by the plethysmography. VO2 values were 4.6 +/- 1.3 microM O2 x 100 ml-1.min-1 at rest and 24.9 +/- 11.2 microM O2 x 100 ml-1.min-1 after hand exercise. The scatter of the FBF and VO2 values showed a good correlation between the two variables (r = 0.93). The results demonstrate that NIRS provides the particular advantage of obtaining the contemporary evaluation of blood flow and VO2, allowing correlation of these two variables by a single maneuver without discomfort for the subject.
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Affiliation(s)
- R A De Blasi
- Istituto di Anestesiologia e Rianimazione, I Università di Roma, Italy
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Nattie EE, Wood J, Mega A, Goritski W. Rostral ventrolateral medulla muscarinic receptor involvement in central ventilatory chemosensitivity. J Appl Physiol (1985) 1989; 66:1462-70. [PMID: 2496097 DOI: 10.1152/jappl.1989.66.3.1462] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [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: 01/01/2023] Open
Abstract
The muscarinic receptor antagonist atropine (105 mM) dramatically decreased the response to increased CO2 when applied by cotton pledgets to the rostral ventrolateral medulla ventilatory chemosensitive area in anesthetized, paralyzed, vagotomized, glomectomized, and servoventilated cats with integrated phrenic nerve activity used as respiratory center output. Lower dose atropine (4.4 mM) and the M1-muscarinic receptor subtype antagonist pirenzepine (10 mM) also significantly decreased the mean CO2 response slope 48.3 +/- 6.2 and 40.7 +/- 6.0% (SE), respectively, and significantly decreased the maximum response value 26.3 +/- 8.1 and 19.2 +/- 3.2%, respectively, without significant effects on blood pressure or on the phrenic response to carotid sinus nerve stimulation. The M2-muscarinic receptor subtype antagonist AF-DX 116 (10 mM) had no significant effect on phrenic output or blood pressure. Application of carbachol (10 mM) at the rostral area augmented eucapnic phrenic output and the maximum value of the CO2 response but decreased the initial slope, effects blocked by atropine. Carbachol also decreased the response to carotid sinus nerve stimulation, suggesting that the system was saturated by carbachol stimulation. Muscarinic cholinergic receptors accessible to surface application at the rostral ventrolateral medulla antagonized by pirenzepine but not AF-DX 116 appear to be involved in the central chemoreceptor process.
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Affiliation(s)
- E E Nattie
- Department of Physiology, Dartmouth Medical School, Hanover, New Hampshire 03756
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