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Albertelli M, Rossi G, Nazzari E, Genova C, Biello F, Rijavec E, Dal Bello MG, Patti L, Tagliamento M, Barletta G, Morabito P, Boschetti M, Dotto A, Campana D, Ferone D, Grossi F. Improved overall survival in patients developing endocrine toxicity during treatment with nivolumab for advanced non-small cell lung cancer in a prospective study. J Endocrinol Invest 2024:10.1007/s40618-023-02268-0. [PMID: 38683497 DOI: 10.1007/s40618-023-02268-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/01/2023] [Indexed: 05/01/2024]
Abstract
PURPOSE Immune checkpoint inhibitors (ICPIs) disrupting PD-1/PD-L1 axis have revolutionized the management of advanced non-small cell lung cancer (NSCLC). Some studies identified the development of endocrine toxicity as predictor of better survival in cancer patients treated with ICPIs. The aim of study was to evaluate survival and new onset of immune-related endocrine adverse events (irAEs) in patients treated with nivolumab for advanced NSCLC. METHODS In a prospective study, 73 patients with previously treated advanced NSCLC received nivolumab in monotherapy. Blood samples were collected at each cycle to monitor thyroid autoimmunity, thyroid, adrenal and somatotroph axes, while thyroid morphology was evaluated by ultrasonography. RESULTS An impaired thyroid function was recorded in 23.4% of patients (n = 15). Eight patients developed asymptomatic transient thyrotoxicosis (ATT) evolving to hypothyroidism in 50% of cases. In addition, seven patients developed overt hypothyroidism without ATT and with negative autoantibodies. Patients who developed hypothyroidism proved to have better overall survival (OS) as compared with non-developers at both univariate (p = 0.021) and multivariate analyses (p = 0.023). The survival curve of patients with reduced IGF-I at baseline, or displaying its reduction during the follow-up, showed significantly reduced median survival compared to patients with normal/high IGF-I levels (p = 0.031). CONCLUSIONS Thyroid function abnormalities are the major irAEs in patients treated with nivolumab, and hypothyroidism onset is associated with prolonged survival. Our findings indicate that the development of hypothyroidism is a positive predictive biomarker of nivolumab antitumor efficacy in patients with NSCLC. Low IGF-I levels could represent a negative prognostic factor during nivolumab therapy.
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Affiliation(s)
- M Albertelli
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Viale Benedetto XV, 6, 16132, Genova, Italy.
| | - G Rossi
- Lung Cancer Unit, Department of Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - E Nazzari
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Viale Benedetto XV, 6, 16132, Genova, Italy
| | - C Genova
- Academic Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), Università Degli Studi di Genova, Genova, Italy
| | - F Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - E Rijavec
- Unit of Medical Oncology, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Varese, Italy
| | - M G Dal Bello
- Lung Cancer Unit, Department of Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - L Patti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Viale Benedetto XV, 6, 16132, Genova, Italy
| | - M Tagliamento
- Academic Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), Università Degli Studi di Genova, Genova, Italy
| | - G Barletta
- Lung Cancer Unit, Department of Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - P Morabito
- Lung Cancer Unit, Department of Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Boschetti
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Viale Benedetto XV, 6, 16132, Genova, Italy
| | - A Dotto
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Viale Benedetto XV, 6, 16132, Genova, Italy
| | - D Campana
- UO Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - D Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genova, Viale Benedetto XV, 6, 16132, Genova, Italy
| | - F Grossi
- Unit of Medical Oncology, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Varese, Italy
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Teti C, Nazzari E, Graziani G, Bagnasco M. Subacute thyroiditis after SARS-CoV2 vaccine: possible relapse after boosting. J Endocrinol Invest 2022; 45:2019-2020. [PMID: 35790684 PMCID: PMC9255844 DOI: 10.1007/s40618-022-01856-w] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 12/02/2022]
Affiliation(s)
- C Teti
- Endocrinology, Diabetology and Metabolic Diseases Unit, ASL1, Imperia, Italy.
- BNT Endocrinology Unit, JB Medica, Genoa, Italy.
| | - E Nazzari
- Endocrinology and Diabetology Unit, ASL2, Savona, Italy
- BNT Endocrinology Unit, JB Medica, Genoa, Italy
| | - G Graziani
- Endocrinology and Diabetology Unit, ASL2, Savona, Italy
- BNT Endocrinology Unit, JB Medica, Genoa, Italy
| | - M Bagnasco
- Department of Internal Medicine and Medical Specialties, Endocrinology Clinic, University of the Studies of Genoa, Genoa, Italy
- BNT Endocrinology Unit, JB Medica, Genoa, Italy
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Colombo C, Foppiani A, Bisogno A, Gambazza S, Daccò V, Nazzari E, Leone A, Giana A, Mari A, Battezzati A. Lumacaftor/ivacaftor in cystic fibrosis: effects on glucose metabolism and insulin secretion. J Endocrinol Invest 2021; 44:2213-2218. [PMID: 33586024 PMCID: PMC8421269 DOI: 10.1007/s40618-021-01525-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/30/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE The question whether the new cystic fibrosis transmembrane conductance regulator (CFTR) modulator drugs aimed at restoring CFTR protein function might improve glucose metabolism is gaining attention, but data on the effect of lumacaftor/ivacaftor treatment (LUMA/IVA) on glucose tolerance are limited. We evaluated the variation in glucose metabolism and insulin secretion in CF patients homozygous for Phe508del CFTR mutation after one-year treatment with LUMA/IVA in comparison to patients with the same genotype who did not receive such treatment. METHODS We performed a retrospective case-control study on 13 patients with a confirmed diagnosis of CF, homozygous for the Phe508del CFTR mutation, who received LUMA/IVA for one year (cases) and 13 patients with identical genotype who did not receive this treatment (controls). At the beginning and conclusion of the follow-up, all subjects received a modified 3 h OGTT, sampling at baseline, and at 30 min intervals for plasma glucose, serum insulin, and c-peptide concentrations to evaluate glucose tolerance, and quantify by modeling beta-cell insulin secretion responsiveness to glucose, insulin clearance and insulin sensitivity. RESULTS LUMA/IVA did not produce differences in glucose tolerance, insulin secretory parameters, clearance and sensitivity with respect to matched controls over one-year follow-up. CONCLUSION We found no evidence of improvements in glucose tolerance mechanisms in patients with CF after one-year treatment with LUMA/IVA.
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Affiliation(s)
- C Colombo
- Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - A Foppiani
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - A Bisogno
- Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - S Gambazza
- Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
- Direzione delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Daccò
- Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - E Nazzari
- Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - A Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - A Giana
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - A Mari
- National Research Council (CNR), Institute of Neuroscience, Padua, Italy
| | - A Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
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Albertelli M, Nazzari E, Dotto A, Grasso LF, Sciallero S, Pirchio R, Rebora A, Boschetti M, Pivonello R, Ricci Bitti S, Colao AAL, Ferone D. Possible protective role of metformin therapy on colonic polyps in acromegaly: an exploratory cross-sectional study. Eur J Endocrinol 2021; 184:419-425. [PMID: 33621192 DOI: 10.1530/eje-20-0795] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/13/2021] [Indexed: 11/08/2022]
Abstract
CONTEXT Colonic polyps occur in 30-40% of acromegalic patients, increasing the risk of colon carcinoma. Although debated, there is emerging evidence that metformin may play a protective role in diabetic and non-diabetic patients with colonic polyps and its use in chemoprevention is currently explored. OBJECTIVE Evaluate the prevalence of colonic polyps in acromegalic patients treated or not with metformin and explore its possible protective role. DESIGN Exploratory cross-sectional study in two tertiary Italian referral centres. MET hods: Out of 153 acromegalic patients, we selected 58 patients (36-82 years; f: 33) who had at least one colonoscopy performed within the first 2 years of diagnosis. Presence of colonic polyps/cancer and related risk factors, current metformin and acetylsalicylic acid intake, disease duration, therapies for acromegaly, hormonal and metabolic parameters were assessed. RESULTS An overall prevalence of 36% polyps was found. Based on the presence of polyps, we identified two groups, comparable for age, BMI, disease duration, glucose, insulin, HOMA-IR, HbA1c, GH and IGF-I levels. Of the patients with polyps (including three adenocarcinomas) only 24% were treated with metformin vs 57% of patients without polyps. Multivariate analysis confirmed a significant negative association between colonic polyps and metformin intake (OR: 0.22, 95% CI: 0.06-0.77, P = 0.01), whereas no significant association was found between polyps and age (P = 0.10), overweight/obesity (P = 0.54), smoking (P = 0.15), acetylsalicylic acid intake (P = 0.99), disease duration (P = 0.96), somatostatin analogues treatment (P = 0.70). CONCLUSIONS These findings, though deriving from an exploratory study, could suggest a protective role of metformin on the development of colonic polyps in acromegaly, and need to be confirmed in an extended study population.
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Affiliation(s)
- M Albertelli
- Endocrinology Unit, IRCCS AOU San Martino, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - E Nazzari
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- Endocrinology and Diabetology, ASL2 Savonese, Liguria, Italy
| | - A Dotto
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - L F Grasso
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - S Sciallero
- Medical Oncology Unit 1, IRCCS AOU San Martino, Genoa, Italy
| | - R Pirchio
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - A Rebora
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- SC Diabetology and Metabolic Disease, ASL 3 Genovese, Liguria, Italy
| | - M Boschetti
- Endocrinology Unit, IRCCS AOU San Martino, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - S Ricci Bitti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - A A L Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - D Ferone
- Endocrinology Unit, IRCCS AOU San Martino, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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Nazzari E, Daccò V, Bulfamante A, Borzani I, Corti F, Colombo C. P215 Safety and efficacy of lumacaftor/ivacaftor treatment in cystic fibrosis patients aged 9–11 years: preliminary data. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fatti LM, Cangiano B, Vitale G, Persani L, Mantovani G, Sala E, Arosio M, Maffei P, Dassie F, Mormando M, Giampietro A, Tanda L, Masiello ER, Nazzari E, Ferone D, Corbetta S, Passeri E, Guaraldi F, Grottoli S, Cannavò S, Torre MLT, Soranna D, Zambon A, Cavagnini F, Scacchi M. Arthropathy in acromegaly: a questionnaire-based estimation of motor disability and its relation with quality of life and work productivity. Pituitary 2019; 22:552-560. [PMID: 31032537 DOI: 10.1007/s11102-019-00966-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Arthropathy is a common and disabling complication of acromegaly. Since in this condition radiological findings rarely correspond to functional impairment, we elected to quantify in a large cohort of acromegalic patients: the degree of motor disability compared with data from general population, the impact of joint involvement on quality of life and work productivity, and to look for associated factors. METHODS In 211 acromegalic patients, 131 with controlled disease and 80 with active disease, eight validated scales were used to evaluate the (i) prevalence and distribution of arthropathy, (ii) degree of motor disability and joint symptoms (VAS, AIMS symptoms and WOMAC), (iii) quality of life (AcroQoL and PASQ) and work capability (WPAI:GH) as consequences of joint complications. RESULTS Using the WOMAC questionnaire, for which population based normative values are available, a significantly higher prevalence and severity of motor disability was detected in acromegalics compared to the general population from literature. The results provided by the different questionnaires turned out to be highly concordant. All measures of motor disability correlated both with impaired quality of life and motor disability and were worse in females and in patients with higher BMI. CONCLUSIONS The questionnaires VAS, AIMS symptoms, and WOMAC (this latter both as a whole and with its functionality subscale), with their scores, proved to be the most adequate tools to evaluate motor disability and its consequences on both quality of life and work productivity in acromegaly. Female gender and higher BMI are associated with worse articular symptoms.
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Affiliation(s)
- L M Fatti
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - B Cangiano
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Vitale
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Sala
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Maffei
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - F Dassie
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - M Mormando
- Pituitary Unit, Section of Endocrinology, Department of Internal Medicine, Catholic University, 'A. Gemelli' University Hospital, Rome, Italy
| | - A Giampietro
- Pituitary Unit, Section of Endocrinology, Department of Internal Medicine, Catholic University, 'A. Gemelli' University Hospital, Rome, Italy
| | - L Tanda
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E R Masiello
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E Nazzari
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - D Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - S Corbetta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - E Passeri
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - F Guaraldi
- Pituitary Unit, Department of Biomedical and Neuromotor Sciences, IRCCS Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
| | - S Grottoli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Cannavò
- Department of Human Pathology, University of Messina, Messina, Italy
- Endocrine Unit, University Hospital of Messina, Messina, Italy
| | - M L T Torre
- Department of Human Pathology, University of Messina, Messina, Italy
| | - D Soranna
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - A Zambon
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - F Cavagnini
- Istituto Auxologico Italiano IRCCS, Center for Biomedical Research and Technology, Cusano Milanino, Milan, Italy
| | - M Scacchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, Ospedale S. Giuseppe, Strada Cadorna 90, 28824, Località Piancavallo, Oggebbio-Verbania, Italy.
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Torretta S, Marchisio P, Rinaldi V, Carioli D, Nazzari E, Pignataro L. In reply to "Commentary to: Endoscopic and clinical benefits of hyaluronic acid in children with chronic adenoiditis and middle ear disease", by Zhengcai Lou. Eur Arch Otorhinolaryngol 2018; 275:829-830. [PMID: 29423745 DOI: 10.1007/s00405-018-4896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
Some considerations will be expressed in consideration of the commentary previously published. In particular, we underline that no other medications were administered to the patients during the study period and any clinical evaluation was postponed in case of acute upper respiratory tract infection in the previous 14 days. We strongly advocate antibiotic treatment during any acute otitis media episode, and we agree that topically administered hyaluronic acid should be considered as a supporting treatment, "complementary to traditional therapies" in children with recurrent disease.
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Affiliation(s)
- S Torretta
- ENT Unit, Department of Clinical Scinces and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - P Marchisio
- Highly Intensive Pediatric Care Unit, Department of Pathophysiology and Transplantations, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Rinaldi
- ENT Unit, Department of Clinical Scinces and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Carioli
- ENT Unit, Department of Clinical Scinces and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Nazzari
- Highly Intensive Pediatric Care Unit, Department of Pathophysiology and Transplantations, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Pignataro
- ENT Unit, Department of Clinical Scinces and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Albertelli M, Nazzari E, Sciallero S, Grillo F, Morbelli S, De Cian F, Cittadini G, Ambrosetti E, Ciarmiello A, Ferone D. Anti-tumoral effects of somatostatin analogs: a lesson from the CLARINET study. J Endocrinol Invest 2017; 40:1265-1269. [PMID: 28550464 DOI: 10.1007/s40618-017-0692-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/13/2017] [Indexed: 12/29/2022]
Abstract
Octreotide and lanreotide, the first-generation somatostatin analogs, successfully control hormone hyperproduction, and related syndromes, in patients with acromegaly and neuroendocrine tumors. However, their anti-tumor effect, rather evident in large number of pituitary adenomas in acromegalic patients, has been hypothesized for a long time in patients with neuroendocrine tumors as well, although a significant tumor shrinkage has rarely been observed. However, the recent publication of the CLARINET study has strengthened the evidence, already emerged with the PROMID trial, that the long-term treatment with the first-generation long-acting somatostatin analogs may exert an anti-tumor activity on G1 and G2 enteropancreatic neuroendocrine tumors, as well. After the publication, majority of international guidelines have updated their algorithms in line with these results and this class of drugs obtained the indication as anti-tumor agents in the majority of patients with neuroendocrine tumors.
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Affiliation(s)
- M Albertelli
- Endocrinology Unit, Department of Internal Medicine (DiMI), University of Genova, Genoa, Italy
| | - E Nazzari
- Endocrinology Unit, Department of Internal Medicine (DiMI), University of Genova, Genoa, Italy
| | - S Sciallero
- Medical Oncology Unit, IRCCS Policlinico San Martino, Genoa, Italy
| | - F Grillo
- Pathology unit, Department of Health Science (DiSSAL), University of Genova, Genoa, Italy
| | - S Morbelli
- Nuclear Medicine Unit, Department of Health Science (DiSSAL), University of Genova, Genoa, Italy
| | - F De Cian
- Oncologic Surgery Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - G Cittadini
- Department of Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - E Ambrosetti
- Endocrinology Unit, Department of Internal Medicine (DiMI), University of Genova, Genoa, Italy
| | - A Ciarmiello
- Department of Nuclear Medicine, S. Andrea Hospital, La Spezia, Italy
| | - D Ferone
- Endocrinology Unit, Department of Internal Medicine (DiMI), University of Genova, Genoa, Italy.
- Center of Excellence for Biomedical Research (CEBR), University of Genova, Genoa, Italy.
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Nazzari E, Torretta S, Pignataro L, Marchisio P, Esposito S. Role of biofilm in children with recurrent upper respiratory tract infections. Eur J Clin Microbiol Infect Dis 2014; 34:421-9. [PMID: 25318897 DOI: 10.1007/s10096-014-2261-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/06/2014] [Indexed: 12/30/2022]
Abstract
Recurrent respiratory tract infections (RRTIs) are very common in children and a major challenge for pediatricians. In the last few years, bacterial biofilms have been linked to RRTIs and antibiotic resistance, and have raised serious concerns regarding the therapeutic management of recurrent middle ear diseases, chronic rhinosinusitis, and recurrent pharyngotonsillitis. This paper aims to review the new insights into biofilm-related upper respiratory tract infections in children and possible therapeutic strategies. It focuses on the clinical implications for recurrent disease and on studies in pediatric patients. Analysis of the literature showed that the involvement of bacterial biofilm in recurrent upper airway tract infections is an emerging problem that may lead to serious concerns about infection control. Despite the large amount of research within this field, detailed insight into the complex structure of bacterial biofilms and the ultrastructural and biochemical mechanisms responsible for its evasion of the immune system and resistance to treatments is currently lacking. In the future, additional emphasis should be placed on biofilm management as a component of therapeutic strategies. This goal can be attained by finding feasible methods for detecting biofilms in vivo and identifying effective methods for administering treatments that eradicate preexisting bacterial biofilms or hinder bacterial adhesion to respiratory cells.
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Affiliation(s)
- E Nazzari
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda no. 9, 20122, Milan, Italy
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Marra A, Leoncini G, Mussap M, Bovio M, Nazzari E, Giusti M, Minuto F, Murialdo G, Ameri P. Severe vitamin D deficiency is associated with frequently observed diseases in medical inpatients. Int J Clin Pract 2014; 68:647-52. [PMID: 24499046 DOI: 10.1111/ijcp.12323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 01/29/2023] Open
Abstract
INTRODUCTION Vitamin D deficiency consequences may go beyond altered calcium homeostasis and musculoskeletal disease. Medical inpatients are often vitamin D-deficient, but little information is available about the relation of vitamin D status with extra-skeletal disorders in this population. METHODS We analysed the relationship between the concentrations of 25-hydroxyvitamin D [25(OH)D], the marker of vitamin D status, and the conditions most commonly causing admission in 115 consecutive medical inpatients. RESULTS Sixty-five subjects (56.5%) had severe vitamin D deficiency [25(OH)D < 8 ng/ml]. Age (β = -0.35, p = 0.01) and hepatic disease (β = -0.21, p = 0.02) were significant correlates of 25(OH)D levels. Compared with patients with ≥ 8 ng/ml 25(OH)D, those with < 8 ng/ml 25(OH)D had significantly higher parathyroid hormone (PTH) concentrations [123 (92.7-208.2) ng/l vs. 88 (68.5-129.5) ng/l, p < 0.001], were significantly more likely to have arterial hypertension (OR 2.76, 95% CI 1.16-6.58), heart failure (HF) (OR 2.49, 95% CI 1.14-5.47), cerebrovascular disease (OR 3.23, 95% CI 1.41-7.39), and infections (OR 2.44, 95% CI 1.02-5.87), and stayed in hospital significantly longer (10 days vs. 7.5 days, p = 0.01). Only the probability of having an infection remained significantly higher in cases with severe vitamin D deficiency after adjustment for age (OR 2.41, 95% CI 1.03-5.68) and persisted after further correcting for presence of hepatic disease and PTH values (OR 2.66, 95% CI 1.03-6.88). A significant association between PTH and HF (OR 2.32, 95% CI 1.05-5.09) and length of hospitalisation (β = 0.22, p = 0.04) emerged in the fully adjusted regression models. CONCLUSIONS Severe vitamin D deficiency is associated with commonly presenting extra-skeletal diseases in medical inpatients. With the exception of infections, this association is mainly driven by age. Additional studies are needed to determine whether vitamin D testing on admission may help stratifying specific categories of patients by clinical severity.
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Affiliation(s)
- A Marra
- Department of Internal Medicine, IRCCS-AOU San Martino-IST, University of Genova, Genova, Italy
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Ciresi A, Amato MC, Pivonello R, Nazzari E, Grasso LF, Minuto F, Ferone D, Colao A, Giordano C. The metabolic profile in active acromegaly is gender-specific. J Clin Endocrinol Metab 2013; 98:E51-9. [PMID: 23162101 DOI: 10.1210/jc.2012-2896] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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] [Indexed: 11/19/2022]
Abstract
CONTEXT The sexual dimorphism of the somatotroph axis has been documented, but whether the acromegaly-related metabolic alterations are gender-dependent has never been investigated. OBJECTIVE The aim of the study was to evaluate the impact of gender on the metabolic parameters in acromegaly. DESIGN We conducted a retrospective, comparative, multicenter study. PATIENTS The 307 newly diagnosed acromegalic patients included in the study were grouped by gender: 157 men (aged 48.01 ± 14.28 yr), and 150 women (aged 48.67 ± 14.95 yr; of which 77 were premenopausal and 73 postmenopausal). OUTCOME MEASUREMENTS We measured each component of the metabolic syndrome (MS), hemoglobin A1c, the areas under the curve (AUCs) of glucose and insulin during 2-h oral glucose tolerance test, basal insulin resistance using the homeostasis model assessment of the insulin resistance index, stimulated insulin sensitivity using the insulin sensitivity index, early insulin-secretion rate using the insulinogenic index, β-cell function relative to insulin sensitivity using the oral disposition index and the visceral adiposity index (VAI) as the surrogate of visceral fat function. RESULTS Women showed a higher prevalence of MS (P < 0.001), higher fasting insulin levels (P < 0.001), AUC for insulin (P = 0.002), homeostasis model assessment of the insulin resistance index (P < 0.001), and VAI (P < 0.001) and a lower insulin sensitivity index (P = 0.002) than men, whereas no difference was found in fasting glucose, AUC for glucose, hemoglobin A1c, insulinogenic index, and oral disposition index. In women, fasting glucose and fasting insulin showed a significant trend toward increase (P < 0.001) and decrease (P = 0.004), respectively, from the first to the fourth quartiles of age, whereas VAI showed a trend toward increase in both groups (P < 0.001). A significantly higher prevalence of MS (P < 0.001), increased waist circumference (P < 0.001), low high-density lipoprotein cholesterol (P < 0.001), and overt diabetes mellitus (P < 0.001) was found in postmenopausal women compared with premenopausal women, as well as with men. CONCLUSIONS The majority of metabolic features in acromegaly are gender-specific. Active acromegaly in women is strongly associated with higher visceral adiposity dysfunction, insulin resistance, and the features of MS. We suggest more accurate metabolic management in acromegalic women, especially in the postmenopausal years.
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Affiliation(s)
- A Ciresi
- Biomedical Department of Internal and Specialist Medicine, Section of Endocrinology, University of Palermo, 90127 Palermo, Italy
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Marchisio P, Esposito S, Bianchini S, Desantis C, Galeone C, Nazzari E, Pignataro L, Principi N. Effectiveness of a propolis and zinc solution in preventing acute otitis media in children with a history of recurrent acute otitis media. Int J Immunopathol Pharmacol 2010; 23:567-75. [PMID: 20646352 DOI: 10.1177/039463201002300219] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Recurrent acute otitis media (rAOM) is frequently encountered in infants and children and the lack of any definitive treatment has led parents and physicians to try complementary and alternative therapies. We evaluated the efficacy of a propolis and zinc suspension in preventing AOM in 122 children aged 1-5 years with a documented history of rAOM, who were prospectively, blindly, randomized 1:1 to receive the suspension plus elimination of environmental risk factors or elimination of environmental risk factors only. AOM- and respiratory-related morbidity were assessed at study entry and every four weeks. In the 3-month treatment period AOM was diagnosed in 31 (50.8%) children given the propolis and zinc suspension and in 43 (70.5%) controls (p=0.04). The mean number of episodes of AOM per child/month was 0.23+/-0.26 in the propolis and zinc group and 0.34+/-0.29 in controls (reduction 32.0%, p=0.03). The administration of a propolis and zinc suspension to children with a history of rAOM can significantly reduce the risk of new AOM episodes and AOM-related antibiotic courses, with no problem of safety or tolerability, and with a very good degree of parental satisfaction. No effect can be expected on respiratory infections other than AOM.
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Affiliation(s)
- P Marchisio
- Department of Maternal and Pediatric Sciences, University of Milan, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
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Marchisio P, Bianchini S, Capaccio P, Esposito S, Fusi M, Nazzari E, Torretta S, Principi N. Insights into infectious otitis media. Int J Immunopathol Pharmacol 2010; 23:20-23. [PMID: 20152074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Otitis media is a multifactorial disease. It represents a major public health burden, as it is the most common diagnosis in children and is characterized by both immediate and long-term morbidity. For years the knowledge about risk factors and microbiology of otitis media has been relatively stable. In recent years new data have been gathered regarding different microbiological aspects of otitis media. This new knowledge may contribute toward the development and implementation of therapeutic and preventive strategies.
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Affiliation(s)
- P Marchisio
- Departments of Mother and Child, University of Milan, Policlinico, Mangiagalli e Regina Elena, Milan, Italy
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Nazzari E, Griffo R, Bertolotti MC, Caponnetto S. [Effects of the exercise test on changes of repolarization present in the resting electrocardiogram]. Minerva Cardioangiol 1979; 27:445-54. [PMID: 44897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nazzari E, Camerieri A, Caponnetto S. [Association of the cycloergometric test, pharmacological tests and autonomic maneuvers in the diagnosis of coronary insufficiency]. Recenti Prog Med 1977; 62:429-47. [PMID: 577617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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