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Del Fabbro D, Procopio F, Galvanin J, Costa G, Famularo S, Palmisano A, Donadon M, Torzilli G. Intraoperative cholangio-ultrasonography (IOCUS) during hepatectomy with resection of the biliary confluence: An effective alternative to intraoperative cholangiography. Hepatobiliary Pancreat Dis Int 2024; 23:417-420. [PMID: 37516588 DOI: 10.1016/j.hbpd.2023.07.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Daniele Del Fabbro
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano 20089, Milan, Italy
| | - Fabio Procopio
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano 20089, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele 20072, Milan, Italy
| | - Jacopo Galvanin
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano 20089, Milan, Italy
| | - Guido Costa
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano 20089, Milan, Italy
| | - Simone Famularo
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano 20089, Milan, Italy
| | - Angela Palmisano
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano 20089, Milan, Italy
| | - Matteo Donadon
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano 20089, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele 20072, Milan, Italy
| | - Guido Torzilli
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano 20089, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele 20072, Milan, Italy.
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Cortés-Téllez AA, D'ors A, Sánchez-Fortún A, Fajardo C, Mengs G, Nande M, Martín C, Costa G, Martín M, Bartolomé-Camacho MC, Sánchez-Fortún S. Using single-species and algal communities to determine long-term adverse effects of silver nanoparticles on freshwater phytoplankton. Sci Total Environ 2024; 928:172500. [PMID: 38631630 DOI: 10.1016/j.scitotenv.2024.172500] [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] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
The physical and chemical properties of silver nanoparticles (AgNPs) have led to their increasing use in various fields such as medicine, food, and industry. Evidence has proven that AgNPs cause adverse effects in aquatic ecosystems, especially when the release of Ag is prolonged in time. Several studies have shown short-term adverse effects of AgNPs on freshwater phytoplankton, but few studies have analysed the impact of long-term exposures on these populations. Our studies were carried out to assess the effects of AgNPs on growth rate, photosynthesis activity, and reactive oxygen species (ROS) generation on the freshwater green algae Scenedesmus armatus and the cyanobacteria Microcystis aeruginosa, and additionally on microcystin (MC-LR) generation from these cyanobacteria. The tests were conducted both in single-species cultures and in phytoplanktonic communities exposed to 1 ngL-1 AgNPs for 28 days. The results showed that cell growth rate of both single-species cultures decreased significantly at the beginning and progressively reached control-like values at 28 days post-exposure. This effect was similar for the community-cultured cyanobacteria, but not for the green algae, which maintained a sustained decrease in growth rate. While gross photosynthesis (Pg) increased in both strains exposed in single cultures, dark respiration (R) and net photosynthesis (Pn) decreased in S. armatus and M. aeruginosa, respectively. These effects were mitigated when both strains were exposed under community culture conditions. Similarly, the ROS generation shown by both strains exposed in single-species cultures was mitigated when exposure occurred in community cultures. MC-LR production and release were significantly decreased in both single-species and community exposures. These results can supply helpful information to further investigate the potential risks of AgNPs and ultimately help policymakers make better-informed decisions about their utilization for environmental restoration.
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Affiliation(s)
- A A Cortés-Téllez
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St., 58000 Morelia, Michoacán, Mexico
| | - A D'ors
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - A Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - C Fajardo
- Dpt. of Biomedicine and Biotechnology, Universidad de Alcalá (UAH), w/n San Diego Sq., 28801 Alcalá de Henares, Spain
| | - G Mengs
- Techincal and R&D Department, Ecotoxilab SL. 10 Juan XXIII., 28550 Tielmes, Spain
| | - M Nande
- Dpt. of Biochemistry and Molecular Biology, Complutense University. w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - C Martín
- Dpt. of Biotechnology-Plant Biology, Universidad Politécnica de Madrid (UPM), 3 Complutense Ave., 28040 Madrid, Spain
| | - G Costa
- Department of Animal Physiology, Faculty of Veterinary Sciences, Complutense University. w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - M Martín
- Dpt. of Biochemistry and Molecular Biology, Complutense University. w/n Puerta de Hierro Ave., 28040 Madrid, Spain
| | - M C Bartolomé-Camacho
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St., 58000 Morelia, Michoacán, Mexico
| | - S Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave., 28040 Madrid, Spain.
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Procopio F, Mauri G, Milana F, Braciforte B, Galvanin J, Costa G, Pasetti C, Torzilli G. ICG-Enhanced Compression Anatomical Segment 7 Segmentectomy in Laparoscopic and Robotic Approach. Ann Surg Oncol 2024:10.1245/s10434-024-15162-7. [PMID: 38519782 DOI: 10.1245/s10434-024-15162-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/25/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Minimally invasive anatomical resection (AR) for posterosuperior lesions is technically challenging.1,2 The Glissonean approach or puncture technique is generally selected.3,4 The tumor-feeding portal pedicle compression AR (C-AR) is an established procedure in open surgery.5 This technique has benefited from the association with indocyanine green (ICG) fluorescence, used to enhance the anatomical area to be resected.6 Recently, C-AR via the minimal access approach has been reported.7 Herein, we report the first cases of laparoscopic and robotic segment 7 (S7) segmentectomy using the ICG-enhanced compression technique. PATIENTS AND METHODS Two cases of CHILD-class A hepatocellular carcinoma (HCC) in segment 7 with a liver stiffness less than 7 kPa treated by laparoscopic and robotic anatomical S7 segmentectomies were reported. Using the intraoperative ultrasound (IOUS), the tumor-bearing portal pedicle and the level targeted for compression were identified. The right hemiliver was adequately mobilized to allow handling of the organ during dissection. Using the grasper and the probe itself, the S7 Glissonean pedicle was transparenchymally compressed under real-time IOUS control. To further enhance the visibility of the discolored S7, ICG was administered intravenously, obtaining the compressed area to be resected as a non-stained one. Dissection was performed under intermittent Pringle maneuver up to exposing the right hepatic vein, dividing the Glissonean pedicle to segment 7 and then completing the resection. RESULTS Pathologic findings demonstrated a 4.9 cm and 7.3 cm HCC with a R0-resection margin (> 1 cm in both). Postoperative complications were nil. The patients were discharged 6 days after surgery. CONCLUSIONS This preliminary experience shows that the C-AR is a feasible and reliable technique in laparoscopic and robotic approach for posterosuperior lesions. Further studies are needed to investigate its applicability and standardization.
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Affiliation(s)
- Fabio Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulia Mauri
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, Milan, Italy
| | - Flavio Milana
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, Milan, Italy
| | - Bruno Braciforte
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, Milan, Italy
| | - Jacopo Galvanin
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, Milan, Italy
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, Milan, Italy
| | - Camilla Pasetti
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, Milan, Italy
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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Vitali E, Franceschini B, Milana F, Soldani C, Polidoro MA, Carriero R, Kunderfranco P, Trivellin G, Costa G, Milardi G, Di Tommaso L, Torzilli G, Lleo A, Lania AG, Donadon M. Filamin A is involved in human intrahepatic cholangiocarcinoma aggressiveness and progression. Liver Int 2024; 44:518-531. [PMID: 38010911 DOI: 10.1111/liv.15800] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/19/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND & AIMS Intrahepatic cholangiocarcinoma (iCCA) is a primary liver tumour, characterized by poor prognosis and lack of effective therapy. The cytoskeleton protein Filamin A (FLNA) is involved in cancer progression and metastasis, including primary liver cancer. FLNA is cleaved by calpain, producing a 90 kDa fragment (FLNACT ) that can translocate to the nucleus and inhibit gene transcription. We herein aim to define the role of FLNA and its cleavage in iCCA carcinogenesis. METHODS & RESULTS We evaluated the expression and localization of FLNA and FLNACT in liver samples from iCCA patients (n = 82) revealing that FLNA expression was independently correlated with disease-free survival. Primary tumour cells isolated from resected iCCA patients expressed both FLNA and FLNACT , and bulk RNA sequencing revealed a significant enrichment of cell proliferation and cell motility pathways in iCCAs with high FLNA expression. Further, we defined the impact of FLNA and FLNACT on the proliferation and migration of primary iCCA cells (n = 3) and HuCCT1 cell line using silencing and Calpeptin, a calpain inhibitor. We observed that FLNA silencing decreased cell proliferation and migration and Calpeptin was able to reduce FLNACT expression in both the HuCCT1 and iCCA cells (p < .05 vs. control). Moreover, Calpeptin 100 μM decreased HuCCT1 and primary iCCA cell proliferation (p <.00001 vs. control) and migration (p < .05 vs. control). CONCLUSIONS These findings demonstrate that FLNA is involved in human iCCA progression and calpeptin strongly decreased FLNACT expression, reducing cell proliferation and migration.
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Affiliation(s)
- Eleonora Vitali
- Laboratory of Cellular and Molecular Endocrinology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Barbara Franceschini
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Flavio Milana
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Cristiana Soldani
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Michela A Polidoro
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Roberta Carriero
- Bioinformatics Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Giampaolo Trivellin
- Laboratory of Cellular and Molecular Endocrinology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giulia Milardi
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Pathology Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea G Lania
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matteo Donadon
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
- Department of General Surgery, University Maggiore Hospital, Novara, Italy
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Procopio F, Branciforte B, Galvanin J, Costa G, Franchi E, Cimino M, Torzilli G. Anatomical liver resection using the ultrasound-guided compression technique in minimal access surgery. Surg Endosc 2024; 38:193-201. [PMID: 37957299 DOI: 10.1007/s00464-023-10523-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/08/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Segmental or subsegmental anatomical resection (AR) of hepatocellular carcinoma (HCC) in minimal access liver surgery (MALS) has been technically proposed. The Glissonean approach or dye injection technique are generally adopted. The tumor-feeding portal pedicle compression technique (C-AR) is an established approach in open surgery, but its feasibility in the MALS environment has never been described. METHODS Eligible patients were prospectively enrolled to undergo laparoscopic or robotic ultrasound-guided C-AR based on HCC location and preoperative identification of a single tumor-feeding portal pedicle. Initial C-AR experience was gained with laparoscopic cases in the beginning of 2020. Following our progressive experience in laparoscopic C-AR, patients requiring AR for HCC were consecutively selected for robotic C-AR. RESULTS A total of 10 patients underwent minimal access C-AR. All patients had Child-Pugh A HCC. The surgical procedures included 6 laparoscopic and 4 robotic C-AR. Median tumor size was 3.1 cm (range 2-7 cm). All procedures had R0 margin. Postoperative complications were nil. CONCLUSION C-AR technique is a feasible and promising technique for patients eligible for laparoscopic and robotic AR for HCC. Further data are necessary to validate its applicability to more complex minimal access AR.
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Affiliation(s)
- Fabio Procopio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
- Division of Hepatobiliary & General Surgery, Department of Surgery - IRCCS, Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Bruno Branciforte
- Division of Hepatobiliary & General Surgery, Department of Surgery - IRCCS, Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Jacopo Galvanin
- Division of Hepatobiliary & General Surgery, Department of Surgery - IRCCS, Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Guido Costa
- Division of Hepatobiliary & General Surgery, Department of Surgery - IRCCS, Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Eloisa Franchi
- Division of Hepatobiliary & General Surgery, Department of Surgery - IRCCS, Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Matteo Cimino
- Division of Hepatobiliary & General Surgery, Department of Surgery - IRCCS, Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.
- Division of Hepatobiliary & General Surgery, Department of Surgery - IRCCS, Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy.
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Polidoro MA, Ferrari E, Soldani C, Franceschini B, Saladino G, Rosina A, Mainardi A, D’Autilia F, Pugliese N, Costa G, Donadon M, Torzilli G, Marzorati S, Rasponi M, Lleo A. Cholangiocarcinoma-on-a-chip: A human 3D platform for personalised medicine. JHEP Rep 2024; 6:100910. [PMID: 38074504 PMCID: PMC10698278 DOI: 10.1016/j.jhepr.2023.100910] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/15/2023] [Accepted: 08/31/2023] [Indexed: 12/13/2023] Open
Abstract
BACKGROUND & AIMS Cholangiocarcinoma (CCA) is a primary liver tumour characterised by a poor prognosis and limited therapeutic options. Available 3D human CCA models fail to faithfully recapitulate the tumour niche. We aimed to develop an innovative patient-specific CCA-on-chip platform. METHODS A CCA tumour microenvironment was recapitulated on a microfluidic three-channel chip using primary CCA cells, cancer-associated fibroblasts (CAFs), endothelial cells, and T cells isolated from CCA specimens (n = 6). CAF and CCA cells were co-cultured in the central channel, flanked by endothelial cells in one lateral channel, recreating a tubular structure. An extensive characterisation of this platform was carried out to investigate its diffusion ability, hydrogel properties, and changes in matrix composition. Cell phenotype and functional properties were assessed. RESULTS Primary cells seeded on the microfluidic device were shown to reproduce the architectural structure and maintain the original phenotype and functional properties. The tumour niche underwent a deep remodelling in the 3D device, with an increase in hydrogel stiffness and extracellular matrix deposition, mimicking in vivo CCA characteristics. T cells were incorporated into the device to assess its reliability for immune cell interaction studies. Higher T cell migration was observed using cells from patients with highly infiltrated tumours. Finally, the drug trial showed the ability of the device to recapitulate different drug responses based on patient characteristics. CONCLUSIONS We presented a 3D CCA platform that integrates the major non-immune components of the tumour microenvironment and the T cell infiltrate, reflecting the CCA niche. This CCA-on-chip represents a reliable patient-specific 3D platform that will be of help to further elucidate the biological mechanisms involved in CCA and provide an efficient tool for personalised drug testing. IMPACT AND IMPLICATIONS An innovative patient-specific cholangiocarcinoma (CCA)-on-chip platform was successfully developed, integrating the major components of the tumour microenvironment (tumour cells, cancer-associated fibroblasts, endothelial cells, and immune infiltrate) and faithfully mimicking the CCA niche. This CCA-on-chip represents a powerful tool for unravelling disease-associated cellular mechanisms in CCA and provides an efficient tool for personalised drug testing.
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Affiliation(s)
- Michela Anna Polidoro
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Erika Ferrari
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Cristiana Soldani
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Barbara Franceschini
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Saladino
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Arianna Rosina
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Andrea Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Francesca D’Autilia
- Unit of Advanced Optical Microscopy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicola Pugliese
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Matteo Donadon
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
- Department of General Surgery, University Maggiore Hospital, Novara, Italy
| | - Guido Torzilli
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Simona Marzorati
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Rasponi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Ana Lleo
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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D'ors A, Sánchez-Fortún A, Cortés-Téllez AA, Fajardo C, Mengs G, Nande M, Martín C, Costa G, Martín M, Bartolomé MC, Sánchez-Fortún S. Adverse effects of iron-based nanoparticles on freshwater phytoplankton Scenedesmus armatus and Microcystis aeruginosa strains. Chemosphere 2023; 339:139710. [PMID: 37532199 DOI: 10.1016/j.chemosphere.2023.139710] [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] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
Zero-valent nano-iron particles (nZVI) are increasingly present in freshwater aquatic environments due to their numerous applications in environmental remediation. However, despite the broad benefits associated with the use and development of nZVI nanoparticles, the potential risks of introducing them into the aquatic environment need to be considered. Special attention should be focused on primary producer organisms, the basal trophic level, whose impact affects the rest of the food web. Although there are numerous acute studies on the acute effects of these nanoparticles on photosynthetic primary producers, few studies focus on long-term exposures. The present study aimed at assessing the effects of nZVI on growth rate, photosynthesis activity, and reactive oxygen activity (ROS) on the freshwater green algae Scenedesmus armatus and the cyanobacteria Microcystis aeruginosa. Moreover, microcystin production was also evaluated. These parameters were assessed on both organisms singly exposed to 72 h-effective nZVI concentration for 10% maximal response for 28 days. The results showed that the cell growth rate of S. armatus was initially significantly altered and progressively reached control-like values at 28 days post-exposure, while M. aeruginosa did not show any significant difference concerning control values at any time. In both strains dark respiration (R) increased, unlike net photosynthesis (Pn), while gross photosynthesis (Pg) only slightly increased at 7 days of exposure and then became equal to control values at 28 days of exposure. The nZVI nanoparticles generated ROS progressively during the 28 days of exposure in both strains, although their formation was significantly higher on green algae than on cyanobacteria. These data can provide additional information to further investigate the potential risks of nZVI and ultimately help decision-makers make better informed decisions regarding the use of nZVI for environmental remediation.
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Affiliation(s)
- A D'ors
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - A Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - A A Cortés-Téllez
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St, 58000, Morelia, (Michoacán), Mexico
| | - C Fajardo
- Dpt. of Biomedicine and Biotechnology, Universidad de Alcalá (UAH), w/n San Diego Sq, 28801, Alcalá de Henares, Spain
| | - G Mengs
- Technical and R&D Department, Ecotoxilab SL, 10 Juan XXIII, 28550, Tielmes, Spain
| | - M Nande
- Dpt. of Biochemistry and Molecular Biology, Complutense University, w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - C Martín
- Dpt. of Biotechnology-Plant Biology, Universidad Politécnica de Madrid (UPM), 3 Complutense Ave, 28040, Madrid, Spain
| | - G Costa
- Department of Animal Physiology, Faculty of Veterinary Sciences, Complutense University, w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - M Martín
- Dpt. of Biochemistry and Molecular Biology, Complutense University, w/n Puerta de Hierro Ave, 28040, Madrid, Spain
| | - M C Bartolomé
- Environmental Toxicology Laboratory, Faculty of Chemistry-Pharmacobiology, Universidad Michoacana de San Nicolás de Hidalgo, 403 Santiago Tapia St, 58000, Morelia, (Michoacán), Mexico.
| | - S Sánchez-Fortún
- Dpt. of Pharmacology and Toxicology, Universidad Complutense de Madrid (UCM), w/n Puerta de Hierro Ave, 28040, Madrid, Spain.
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8
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Laino ME, Fiz F, Morandini P, Costa G, Maffia F, Giuffrida M, Pecorella I, Gionso M, Wheeler DR, Cambiaghi M, Saba L, Sollini M, Chiti A, Savevsky V, Torzilli G, Viganò L. A virtual biopsy of liver parenchyma to predict the outcome of liver resection. Updates Surg 2023; 75:1519-1531. [PMID: 37017906 DOI: 10.1007/s13304-023-01495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
The preoperative risk assessment of liver resections (LR) is still an open issue. Liver parenchyma characteristics influence the outcome but cannot be adequately evaluated in the preoperative setting. The present study aims to elucidate the contribution of the radiomic analysis of non-tumoral parenchyma to the prediction of complications after elective LR. All consecutive patients undergoing LR between 2017 and 2021 having a preoperative computed tomography (CT) were included. Patients with associated biliary/colorectal resection were excluded. Radiomic features were extracted from a virtual biopsy of non-tumoral liver parenchyma (a 2 mL cylinder) outlined in the portal phase of preoperative CT. Data were internally validated. Overall, 378 patients were analyzed (245 males/133 females-median age 67 years-39 cirrhotics). Radiomics increased the performances of the preoperative clinical models for both liver dysfunction (at internal validaton, AUC = 0.727 vs. 0.678) and bile leak (AUC = 0.744 vs. 0.614). The final predictive model combined clinical and radiomic variables: for bile leak, segment 1 resection, exposure of Glissonean pedicles, HU-related indices, NGLDM_Contrast, GLRLM indices, and GLZLM_ZLNU; for liver dysfunction, cirrhosis, liver function tests, major hepatectomy, segment 1 resection, and NGLDM_Contrast. The combined clinical-radiomic model for bile leak based on preoperative data performed even better than the model including the intraoperative data (AUC = 0.629). The textural features extracted from a virtual biopsy of non-tumoral liver parenchyma improved the prediction of postoperative liver dysfunction and bile leak, implementing information given by standard clinical data. Radiomics should become part of the preoperative assessment of candidates to LR.
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Affiliation(s)
- Maria Elena Laino
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesco Fiz
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Pierandrea Morandini
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Fiore Maffia
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Mario Giuffrida
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ilaria Pecorella
- Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Matteo Gionso
- Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Dakota Russell Wheeler
- Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Martina Cambiaghi
- Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Martina Sollini
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Arturo Chiti
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Victor Savevsky
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Luca Viganò
- Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
- Hepatobiliary Unit, Department of Minimally Invasive General and Oncologic Surgery, Humanitas Gavazzeni University Hospital, Viale M. Gavazzeni 21, 24125, Bergamo, Italy.
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9
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De Simone G, Soldani C, Morabito A, Franceschini B, Ferlan F, Costa G, Pastorelli R, Donadon M, Brunelli L. Implication of metabolism in the polarization of tumor-associated-macrophages: the mass spectrometry-based point of view. Front Immunol 2023; 14:1193235. [PMID: 37503340 PMCID: PMC10368868 DOI: 10.3389/fimmu.2023.1193235] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023] Open
Abstract
Tumor-associated macrophages (TAMs) represent one of the main tumor-infiltrating immune cell types and are generally categorized into either of two functionally contrasting subtypes, namely classical activated M1 macrophages and alternatively activated M2 macrophages. TAMs showed different activation states that can be represent by the two extremes of the complex profile of macrophages biology, the M1-like phenotype (pro-inflammatory activity) and the M2-like phenotype (anti-inflammatory activity). Based on the tumor type, and grades, TAMs can acquire different functions and properties; usually, the M1-like phenotype is typical of early tumor stages and is associated to an anti-tumor activity, while M2-like phenotype has a pro-inflammatory activity and is related to a poor patients' prognosis. The classification of macrophages into M1/M2 groups based on well-defined stimuli does not model the infinitely more complex tissue milieu where macrophages (potentially of different origin) would be exposed to multiple signals in different sequential order. This review aims to summarize the recent mass spectrometry-based (MS-based) metabolomics findings about the modifications of metabolism in TAMs polarization in different tumors. The published data shows that MS-based metabolomics is a promising tool to help better understanding TAMs metabolic phenotypes, although it is still poorly applied for TAMs metabolism. The knowledge of key metabolic alterations in TAMs is an essential step for discovering TAMs polarization novel biomarkers and developing novel therapeutic approaches targeting TAM metabolism to repolarize TAMs towards their anti-tumor phenotype.
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Affiliation(s)
- Giulia De Simone
- Laboratory of Metabolites and Proteins in Translational Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- Department of Biotechnologies and Biosciences, Università degli Studi Milano Bicocca, Milan, Italy
| | - Cristiana Soldani
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Aurelia Morabito
- Laboratory of Metabolites and Proteins in Translational Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Barbara Franceschini
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Fabrizio Ferlan
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Guido Costa
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Roberta Pastorelli
- Laboratory of Metabolites and Proteins in Translational Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Matteo Donadon
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
- Department of General Surgery, University Maggiore Hospital, Novara, Italy
| | - Laura Brunelli
- Laboratory of Metabolites and Proteins in Translational Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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10
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Costa G, Cavinato L, Fiz F, Sollini M, Chiti A, Torzilli G, Ieva F, Viganò L. Mapping Tumor Heterogeneity via Local Entropy Assessment: Making Biomarkers Visible. J Digit Imaging 2023; 36:1038-1048. [PMID: 36849835 PMCID: PMC10287605 DOI: 10.1007/s10278-023-00799-9] [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: 05/30/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/01/2023] Open
Abstract
Advanced imaging and analysis improve prediction of pathology data and outcomes in several tumors, with entropy-based measures being among the most promising biomarkers. However, entropy is often perceived as statistical data lacking clinical significance. We aimed to generate a voxel-by-voxel visual map of local tumor entropy, thus allowing to (1) make entropy explainable and accessible to clinicians; (2) disclose and quantitively characterize any intra-tumoral entropy heterogeneity; (3) evaluate associations between entropy and pathology data. We analyzed the portal phase of preoperative CT of 20 patients undergoing liver surgery for colorectal metastases. A three-dimensional core kernel (5 × 5 × 5 voxels) was created and used to compute the local entropy value for each voxel of the tumor. The map was encoded with a color palette. We performed two analyses: (a) qualitative assessment of tumors' detectability and pattern of entropy distribution; (b) quantitative analysis of the entropy values distribution. The latter data were compared with standard Hounsfield data as predictors of post-chemotherapy tumor regression grade (TRG). Entropy maps were successfully built for all tumors. Metastases were qualitatively hyper-entropic compared to surrounding parenchyma. In four cases hyper-entropic areas exceeded the tumor margin visible at CT. We identified four "entropic" patterns: homogeneous, inhomogeneous, peripheral rim, and mixed. At quantitative analysis, entropy-derived data (percentiles/mean/median/root mean square) predicted TRG (p < 0.05) better than Hounsfield-derived ones (p = n.s.). We present a standardized imaging technique to visualize tumor heterogeneity built on a voxel-by-voxel entropy assessment. The association of local entropy with pathology data supports its role as a biomarker.
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Affiliation(s)
- Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Lara Cavinato
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Francesco Fiz
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Ieva
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
- CHDS - Center for Health Data Science, Human Technopole, Milan, Italy.
| | - Luca Viganò
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Hepatobiliary Unit, Department of Minimally Invasive General & Oncologic Surgery, Humanitas Gavazzeni University Hospital, Via M. Gavazzeni 21, 24125, Bergamo, Italy.
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11
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Carnicelli G, Disconzi L, Cerasuolo M, Casiraghi E, Costa G, De Virgilio A, Esposito AA, Ferreli F, Fici F, Lo Casto A, Marra S, Malvezzi L, Mercante G, Spriano G, Torzilli G, Francone M, Balzarini L, Giannitto C. Image-Guided Intraoperative Assessment of Surgical Margins in Oral Cavity Squamous Cell Cancer: A Diagnostic Test Accuracy Review. Diagnostics (Basel) 2023; 13:diagnostics13111846. [PMID: 37296701 DOI: 10.3390/diagnostics13111846] [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: 04/02/2023] [Revised: 05/12/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: The assessment of resection margins during surgery of oral cavity squamous cell cancer (OCSCC) dramatically impacts the prognosis of the patient as well as the need for adjuvant treatment in the future. Currently there is an unmet need to improve OCSCC surgical margins which appear to be involved in around 45% cases. Intraoperative imaging techniques, magnetic resonance imaging (MRI) and intraoral ultrasound (ioUS), have emerged as promising tools in guiding surgical resection, although the number of studies available on this subject is still low. The aim of this diagnostic test accuracy (DTA) review is to investigate the accuracy of intraoperative imaging in the assessment of OCSCC margins. (2) Methods: By using the Cochrane-supported platform Review Manager version 5.4, a systematic search was performed on the online databases MEDLINE-EMBASE-CENTRAL using the keywords "oral cavity cancer, squamous cell carcinoma, tongue cancer, surgical margins, magnetic resonance imaging, intraoperative, intra-oral ultrasound". (3) Results: Ten papers were identified for full-text analysis. The negative predictive value (cutoff < 5 mm) for ioUS ranged from 0.55 to 0.91, that of MRI ranged from 0.5 to 0.91; accuracy analysis performed on four selected studies showed a sensitivity ranging from 0.07 to 0.75 and specificity ranging from 0.81 to 1. Image guidance allowed for a mean improvement in free margin resection of 35%. (4) Conclusions: IoUS shows comparable accuracy to that of ex vivo MRI for the assessment of close and involved surgical margins, and should be preferred as the more affordable and reproducible technique. Both techniques showed higher diagnostic yield if applied to early OCSCC (T1-T2 stages), and when histology is favorable.
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Affiliation(s)
- Giorgia Carnicelli
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Luca Disconzi
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Michele Cerasuolo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Elena Casiraghi
- AnacletoLab, Department of Computer Science "Giovanni degli Antoni", Università degli Studi di Milano, Via Celoria 18, 20133 Milan, Italy
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, 717 Potter Street, Berkeley, CA 94710, USA
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | | | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Federica Fici
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Antonio Lo Casto
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, 90127 Palermo, Italy
| | - Silvia Marra
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Marco Francone
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Luca Balzarini
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Caterina Giannitto
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
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12
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Garbarino O, Lambroia L, Basso G, Marrella V, Franceschini B, Soldani C, Pasqualini F, Giuliano D, Costa G, Peano C, Barbarossa D, Annarita D, Salvati A, Terracciano L, Torzilli G, Donadon M, Faggioli F. Spatial resolution of cellular senescence dynamics in human colorectal liver metastasis. Aging Cell 2023:e13853. [PMID: 37157887 PMCID: PMC10352575 DOI: 10.1111/acel.13853] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 05/10/2023] Open
Abstract
Hepatic metastasis is a clinical challenge for colorectal cancer (CRC). Senescent cancer cells accumulate in CRC favoring tumor dissemination. Whether this mechanism progresses also in metastasis is unexplored. Here, we integrated spatial transcriptomics, 3D-microscopy, and multicellular transcriptomics to study the role of cellular senescence in human colorectal liver metastasis (CRLM). We discovered two distinct senescent metastatic cancer cell (SMCC) subtypes, transcriptionally located at the opposite pole of epithelial (e) to mesenchymal (m) transition. SMCCs differ in chemotherapy susceptibility, biological program, and prognostic roles. Mechanistically, epithelial (e)SMCC initiation relies on nucleolar stress, whereby c-myc dependent oncogene hyperactivation induces ribosomal RPL11 accumulation and DNA damage response. In a 2D pre-clinical model, we demonstrated that RPL11 co-localized with HDM2, a p53-specific ubiquitin ligase, leading to senescence activation in (e)SMCCs. On the contrary, mesenchymal (m)SMCCs undergo TGFβ paracrine activation of NOX4-p15 effectors. SMCCs display opposing effects also in the immune regulation of neighboring cells, establishing an immunosuppressive environment or leading to an active immune workflow. Both SMCC signatures are predictive biomarkers whose unbalanced ratio determined the clinical outcome in CRLM and CRC patients. Altogether, we provide a comprehensive new understanding of the role of SMCCs in CRLM and highlight their potential as new therapeutic targets to limit CRLM progression.
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Affiliation(s)
| | - Luca Lambroia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Gianluca Basso
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Veronica Marrella
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Institute of Genetics and Biomedical Research, UoS of Milan, National Research Council, Milan, Italy
| | - Barbara Franceschini
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Cristiana Soldani
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Fabio Pasqualini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Science, Humanitas University, Pieve Emanuele (MI), Italy
| | | | - Guido Costa
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Science, Humanitas University, Pieve Emanuele (MI), Italy
| | - Clelia Peano
- Institute of Genetics and Biomedical Research, UoS of Milan, National Research Council, Milan, Italy
- Fondazione Human Technopole, Milan, Italy
| | | | - Destro Annarita
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Andreina Salvati
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luigi Terracciano
- Department of Biomedical Science, Humanitas University, Pieve Emanuele (MI), Italy
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Guido Torzilli
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Science, Humanitas University, Pieve Emanuele (MI), Italy
| | - Matteo Donadon
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Science, Humanitas University, Pieve Emanuele (MI), Italy
| | - Francesca Faggioli
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Institute of Genetics and Biomedical Research, UoS of Milan, National Research Council, Milan, Italy
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13
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Costa G, Sposito C, Soldani C, Polidoro MA, Franceschini B, Marchesi F, Nasir FD, Virdis M, Vingiani A, Leo A, Di Tommaso L, Kotha S, Mantovani A, Mazzaferro V, Donadon M, Torzilli G. Macrophage morphology and distribution are strong predictors of prognosis in resected colorectal liver metastases: results from an external retrospective observational study. Int J Surg 2023; 109:1311-1317. [PMID: 37037585 PMCID: PMC10389408 DOI: 10.1097/js9.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/24/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Tumor-associated macrophages (TAMs) are key components of a tumoral microenvironment and have been shown to impact prognosis in different cancers. Previously reported data showed that TAM morphology correlates with prognosis in colorectal liver metastases (CLMs) after hepatectomy, with smaller TAMs (S-TAMs) conferring a more favorable prognosis than larger ones (L-TAMs). This study aims to externally validate this finding. MATERIAL AND METHODS The external cohort consisted of 84 formalin-fixed and paraffin-embedded surgical samples of CLMs and peritumoral tissue. Two-micrometer-section slides were obtained; the area and perimeter of 21 macrophages in each slide were recorded. The endpoints were TAMs morphometrics and their prognostic significance in relation to disease-free survival (DFS). RESULTS The average macrophage perimeter was 71.5±14.1 μm whilst the average area was 217.7±67.8 μm 2 . At univariate analysis, the TAM area demonstrated a statistically significant association with DFS ( P =0.0006). Optimal area cutoff value was obtained, showing a sensitivity and specificity of 92 and 56%, respectively. S-TAMs and L-TAMs were associated with 3-year DFS rates of 60 and 8.5%, respectively ( P <0.001). Multivariate analysis confirmed the predictive role of TAM area for DFS [hazard ratio (HR)=5.03; 95% CI=1.70-14.94; P =0.003]. Moreover, in a subset of patients ( n =12) characterized by unfavorable ( n =6, recurrence within 3 months) or favorable ( n =6, no recurrence after 48 months) prognosis, TAMs showed a different distribution: L-TAMs were more abundant and closer to the tumor invasive margin in patients that encountered early recurrence and tended to cluster in foci significantly larger ( P =0.02). CONCLUSIONS This external validation confirms that morphometric characterization of TAMs can serve as a simple readout of their diversity and allows to reliably stratify patient outcomes and predict disease recurrence after hepatectomy for CLMs.
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Affiliation(s)
- Guido Costa
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan
- Department of Hepatobiliary and General Surgery
| | - Carlo Sposito
- Department of Oncology and Hemato-Oncology, University of Milan
- Department of Surgery, HPB Surgery and Liver Transplant Unit, Istituto Nazionale Tumori Fondazione IRCCS, Milan
| | | | | | | | - Federica Marchesi
- Department of Biotechnology and Translational Medicine
- Department of Immunology and Inflammation
| | | | | | | | - Ana Leo
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan
- Division of Internal Medicine and Hepatology, Department of Gastroenterology
| | - Luca Di Tommaso
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - Soumya Kotha
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - Alberto Mantovani
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan
- Department of Immunology and Inflammation
- William Harvey Research Institute, Queen Mary University, London, UK
| | - Vincenzo Mazzaferro
- Department of Oncology and Hemato-Oncology, University of Milan
- Department of Surgery, HPB Surgery and Liver Transplant Unit, Istituto Nazionale Tumori Fondazione IRCCS, Milan
| | - Matteo Donadon
- Department of Hepatobiliary and General Surgery
- Department of Surgery, University Maggiore Hospital della Carità
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Guido Torzilli
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan
- Department of Hepatobiliary and General Surgery
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14
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D'Andrea R, Corona C, Poszwa A, Belingard C, Domínguez-Delmás M, Stoffel M, Crivellaro A, Crouzevialle R, Cerbelaud F, Costa G, Paradis-Grenouillet S. Combining conventional tree-ring measurements with wood anatomy and strontium isotope analyses enables dendroprovenancing at the local scale. Sci Total Environ 2023; 858:159887. [PMID: 36351500 DOI: 10.1016/j.scitotenv.2022.159887] [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] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Dendroprovenancing provides critical information regarding the origin of wood, allowing further insights into economic exploitation strategies and source regions of timber products. Traditionally, dendroprovenancing relies on pattern-matching of tree rings, but its spatial resolution is limited by the geographical coverage of species-specific chronologies available for crossdating and, in the case of short-distance trades, by scarce environmental variability. Here, we present an approach to provenance timber with high spatial resolution from forested areas that have been exploited intensively throughout history, with the aim to understand the sustainability of the various woodland management practices used to supply timber products. To this end, we combined tree-ring width (TRW), wood anatomical and geochemical analyses in addition to multivariate statistical validation procedures to trace the origin of living oak trees (Quercus robur) sampled in four stands located within a 30-km radius around the city of Limoges (Haute-Vienne, France). We demonstrate that TRW and wood anatomical variables (and in particular cell density) robustly discriminate the eastern from the western site, while failing to trace the origin of trees from the northern and southern sites. Here, strontium isotopic ratios (87Sr/86Sr) and Ca concentrations identify clusters of trees which could not be identified with TRW or wood anatomy. Ultimately, our study demonstrates that the coupling of wood anatomy with geochemical signatures allows to correctly pinpoint the origin of trees. Given the small geographic scale of our study and the limited differences in elevation and climate between study sites, our results are particularly promising for future dendroprovenancing studies. We thus conclude that the combination of multiple approaches will not only increase the accuracy of dendroprovenancing studies at local scales, but could also be implemented at much larger scales to identify trends in historic timber supply throughout Europe.
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Affiliation(s)
- R D'Andrea
- GEOLAB, Université de Limoges, Limoges, France.
| | - C Corona
- GEOLAB, UMR 6042 CNRS, Université Clermont Auvergne, Clermont-Ferrand, France; Climate Change Impacts and Risks in the Anthropocene, Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland; Department F.A. Forel for Environmental and Aquatic Sciences, University of Geneva, Geneva, Switzerland
| | - A Poszwa
- Laboratoire Interdisciplinaire des Environnements Continentaux, Université de Lorraine, Nancy, France
| | - C Belingard
- GEOLAB, Université de Limoges, Limoges, France
| | - M Domínguez-Delmás
- Amsterdam School for Heritage and Memory Studies, University of Amsterdam, Amsterdam, the Netherlands
| | - M Stoffel
- Climate Change Impacts and Risks in the Anthropocene, Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland; Department F.A. Forel for Environmental and Aquatic Sciences, University of Geneva, Geneva, Switzerland; Department of Earth Sciences, University of Geneva, Geneva, Switzerland
| | - A Crivellaro
- Forest Biometrics Laboratory, Faculty of Forestry, University of Suceava, Suceava, Ukraine; Éveha, Bureau d'étude archéologique, Limoges, France
| | | | - F Cerbelaud
- GEOLAB, Université de Limoges, Limoges, France
| | - G Costa
- Laboratoire PEIRENE, Université de Limoges, Limoges, France
| | - S Paradis-Grenouillet
- GEOLAB, Université de Limoges, Limoges, France; Éveha, Bureau d'étude archéologique, Limoges, France
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15
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Famularo S, Milana F, Cimino M, Franchi E, Giuffrida M, Costa G, Procopio F, Donadon M, Torzilli G. Upfront Surgery versus Neoadjuvant Perioperative Chemotherapy for Resectable Colorectal Liver Metastases: A Machine-Learning Decision Tree to Identify the Best Potential Candidates under a Parenchyma-Sparing Policy. Cancers (Basel) 2023; 15:cancers15030613. [PMID: 36765570 PMCID: PMC9913658 DOI: 10.3390/cancers15030613] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Addressing patients to neoadjuvant systemic chemotherapy followed by surgery rather than surgical resection upfront is controversial in the case of resectable colorectal -liver metastases (CLM). The aim of this study was to develop a machine-learning model to identify the best potential candidates for upfront surgery (UPS) versus neoadjuvant perioperative chemotherapy followed by surgery (NEOS). Patients at first liver resection for CLM were consecutively enrolled and collected into two groups, regardless of whether they had UPS or NEOS. An inverse -probability weighting (IPW) was performed to weight baseline differences; survival analyses; and risk predictions were estimated. A mortality risk model was built by Random-Forest (RF) to assess the best -potential treatment (BPT) for each patient. The characteristics of BPT-upfront and BPT-neoadjuvant candidates were automatically identified after developing a classification -and -regression tree (CART). A total of 448 patients were enrolled between 2008 and 2020: 95 UPS and 353 NEOS. After IPW, two balanced pseudo-populations were obtained: UPS = 432 and NEOS = 440. Neoadjuvant therapy did not significantly affect the risk of mortality (HR 1.44, 95% CI: 0.95-2.17, p = 0.07). A mortality prediction model was fitted by RF. The BPT was NEOS for 364 patients and UPS for 84. At CART, planning R1vasc surgery was the main factor determining the best candidates for NEOS and UPS, followed by primitive tumor localization, number of metastases, sex, and pre-operative CEA. Based on these results, a decision three was developed. The proposed treatment algorithm allows for better allocation according to the patient's tailored risk of mortality.
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Affiliation(s)
- Simone Famularo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Surgical Data Science Team, Institut de Recherche sur les Cancers de l’Appareil Digestif (IRCAD), 67000 Strasbourg, France
| | - Flavio Milana
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Matteo Cimino
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Eloisa Franchi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Mario Giuffrida
- General Surgery Unit, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Guido Costa
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Fabio Procopio
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Matteo Donadon
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
- Department of General Surgery, University Maggiore Hospital Della Carità, 28100 Novara, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Correspondence:
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16
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Cortese N, Carriero R, Barbagallo M, Putignano AR, Costa G, Giavazzi F, Grizzi F, Pasqualini F, Peano C, Basso G, Marchini S, Colombo FS, Soldani C, Franceschini B, Di Tommaso L, Terracciano L, Donadon M, Torzilli G, Kunderfranco P, Mantovani A, Marchesi F. High-resolution analysis of mononuclear phagocytes reveals GPNMB as a prognostic marker in human colorectal liver metastasis. Cancer Immunol Res 2023; 11:405-420. [PMID: 36652202 PMCID: PMC10070171 DOI: 10.1158/2326-6066.cir-22-0462] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/18/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
Patients with colorectal liver metastasis (CLM) present with heterogenous clinical outcomes and improved classification is needed to ameliorate the therapeutic output. Macrophages (MΦ) hold promise as prognostic classifiers and therapeutic targets. Here, stemming from a single-cell analysis of mononuclear phagocytes infiltrating human CLM, we identified two M markers associated with distinct populations with opposite clinical relevance. The invasive margin of CLM was enriched in pro-inflammatory monocyte-derived MΦ (MoMΦ) expressing the monocytic marker SERPINB2, and a more differentiated population, TAMs, expressing GPNMB. SERPINB2+ MoMΦ had an early inflammatory profile, whereas GPNMB+ TAMs were enriched in pathways of matrix degradation, angiogenesis and lipid metabolism and were found closer to the tumor margin, as confirmed by spatial transcriptomics on CLM specimens. In a cohort of patients, a high infiltration of SERPINB2+ cells independently associated with longer disease-free survival (DFS) (P=0.033), whereas a high density of GPNMB+ cells correlated with shorter DFS (P=0.012) and overall survival (OS) (P=0.002). Cell-cell interaction analysis defined opposing roles for MoMΦ and TAMs, suggesting that SERPINB2+ and GPNMB+ cells are discrete populations of MΦ and may be exploited for further translation to an immune-based stratification tool. This study provides evidence of how multi-omics approaches can identify non-redundant, clinically relevant markers for further translation to immune-based patient stratification tools and therapeutic targets. GPNMB has been shown to set macrophages in an immunosuppressive mode. Our high dimensional analyses provide further evidence that GPNMB is a negative prognostic indicator and a potential player in the pro-tumor function of macrophage populations.
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Affiliation(s)
- Nina Cortese
- IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | | | | | | | | | | | - Fabio Grizzi
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Clelia Peano
- Institute of Genetic and Biomedical Research, Milan, Italy
| | - Gianluca Basso
- Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | | | | | - Cristiana Soldani
- Humanitas University, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy
| | | | - Luca Di Tommaso
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy
| | | | - Matteo Donadon
- Humanitas University, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy
| | - Guido Torzilli
- Humanitas University, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy
| | | | - Alberto Mantovani
- IRCCS Humanitas Clinical and Research Center, Humanitas University, Rozzano, MI, Italy
| | - Federica Marchesi
- IRCCS-Humanitas Clinical and Research Hospital, Pieve Emanuele, Milano, Italy
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17
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Costa G, Oprandi A, Bavestrello G, Castellano M, Bertolino M. Biogenic silica in the Posidonia oceanica “matte”, a tool to discover past dynamics of the sponge community. The European Zoological Journal 2022. [DOI: 10.1080/24750263.2022.2140851] [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: 11/18/2022] Open
Affiliation(s)
- G. Costa
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Milan, Italy
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
| | - A. Oprandi
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
| | - G. Bavestrello
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
- NBFC, National Biodiversity Future Center, Palermo, Italy
| | - M. Castellano
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
| | - M. Bertolino
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, Italy
- NBFC, National Biodiversity Future Center, Palermo, Italy
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18
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Galletti M, Alesini D, Anania MP, Arjmand S, Behtouei M, Bellaveglia M, Biagioni A, Buonomo B, Cardelli F, Carpanese M, Chiadroni E, Cianchi A, Costa G, Del Dotto A, Del Giorno M, Dipace F, Doria A, Filippi F, Franzini G, Giannessi L, Giribono A, Iovine P, Lollo V, Mostacci A, Nguyen F, Opromolla M, Pellegrino L, Petralia A, Petrillo V, Piersanti L, Di Pirro G, Pompili R, Romeo S, Rossi AR, Selce A, Shpakov V, Stella A, Vaccarezza C, Villa F, Zigler A, Ferrario M. Stable Operation of a Free-Electron Laser Driven by a Plasma Accelerator. Phys Rev Lett 2022; 129:234801. [PMID: 36563228 DOI: 10.1103/physrevlett.129.234801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
The breakthrough provided by plasma-based accelerators enabled unprecedented accelerating fields by boosting electron beams to gigaelectronvolt energies within a few centimeters [1-4]. This, in turn, allows the realization of ultracompact light sources based on free-electron lasers (FELs) [5], as demonstrated by two pioneering experiments that reported the observation of self-amplified spontaneous emission (SASE) driven by plasma-accelerated beams [6,7]. However, the lack of stability and reproducibility due to the intrinsic nature of the SASE process (whose amplification starts from the shot noise of the electron beam) may hinder their effective implementation for user purposes. Here, we report a proof-of-principle experiment using plasma-accelerated beams to generate stable and reproducible FEL light seeded by an external laser. FEL radiation is emitted in the infrared range, showing the typical exponential growth of its energy over six consecutive undulators. Compared to SASE, the seeded FEL pulses have energies 2 orders of magnitude larger and stability that is 3 times higher.
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Affiliation(s)
- M Galletti
- Department of Physics, Università di Roma Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- INFN-Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- NAST Center, Via Ricerca Scientifica 1, 00133 Rome, Italy
| | - D Alesini
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M P Anania
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - S Arjmand
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Behtouei
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Bellaveglia
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Biagioni
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - B Buonomo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Cardelli
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Carpanese
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - E Chiadroni
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
- Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - A Cianchi
- Department of Physics, Università di Roma Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- INFN-Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- NAST Center, Via Ricerca Scientifica 1, 00133 Rome, Italy
| | - G Costa
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Del Dotto
- ENEA, C.R. Brasimone, 40032, Camugnano, Bologna, Italy
| | - M Del Giorno
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Dipace
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Doria
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - F Filippi
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - G Franzini
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - L Giannessi
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Giribono
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - P Iovine
- INFN-Napoli, Via Cintia, 80126 Naples, Italy
| | - V Lollo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Mostacci
- Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - F Nguyen
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - M Opromolla
- Università degli Studi di Milano, Via Celoria 16 20133 Milano Italy
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - L Pellegrino
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Petralia
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - V Petrillo
- Università degli Studi di Milano, Via Celoria 16 20133 Milano Italy
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - L Piersanti
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - G Di Pirro
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - R Pompili
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - S Romeo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A R Rossi
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - A Selce
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
- INFN-Roma Tre, Via della Vasca Navale 84, 00146 Roma RM, Italy
| | - V Shpakov
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Stella
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - C Vaccarezza
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Villa
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Zigler
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
- Racah Institute of Physics, Hebrew University, 91904 Jerusalem, Israel
| | - M Ferrario
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
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19
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Alvisi G, Termanini A, Soldani C, Portale F, Carriero R, Pilipow K, Costa G, Polidoro M, Franceschini B, Malenica I, Puccio S, Lise V, Galletti G, Zanon V, Colombo FS, De Simone G, Tufano M, Aghemo A, Di Tommaso L, Peano C, Cibella J, Iannacone M, Roychoudhuri R, Manzo T, Donadon M, Torzilli G, Kunderfranco P, Di Mitri D, Lugli E, Lleo A. Multimodal single-cell profiling of intrahepatic cholangiocarcinoma defines hyperactivated Tregs as a potential therapeutic target. J Hepatol 2022; 77:1359-1372. [PMID: 35738508 DOI: 10.1016/j.jhep.2022.05.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS The landscape and function of the immune infiltrate of intrahepatic cholangiocarcinoma (iCCA), a rare, yet aggressive tumor of the biliary tract, remains poorly characterized, limiting development of successful immunotherapies. Herein, we aimed to define the molecular characteristics of tumor-infiltrating leukocytes with a special focus on CD4+ regulatory T cells (Tregs). METHODS We used high-dimensional single-cell technologies to characterize the T-cell and myeloid compartments of iCCA tissues, comparing these with their tumor-free peritumoral and circulating counterparts. We further used genomics and cellular assays to define the iCCA-specific role of a novel transcription factor, mesenchyme homeobox 1 (MEOX1), in Treg biology. RESULTS We found poor infiltration of putative tumor-specific CD39+ CD8+ T cells accompanied by abundant infiltration of hyperactivated CD4+ Tregs. Single-cell RNA-sequencing identified an altered network of transcription factors in iCCA-infiltrating compared to peritumoral T cells, suggesting reduced effector functions by tumor-infiltrating CD8+ T cells and enhanced immunosuppression by CD4+ Tregs. Specifically, we found that expression of MEOX1 was highly enriched in tumor-infiltrating Tregs, and demonstrated that MEOX1 overexpression is sufficient to reprogram circulating Tregs to acquire the transcriptional and epigenetic landscape of tumor-infiltrating Tregs. Accordingly, enrichment of the MEOX1-dependent gene program in Tregs was strongly associated with poor prognosis in a large cohort of patients with iCCA. CONCLUSIONS We observed abundant infiltration of hyperactivated CD4+ Tregs in iCCA tumors along with reduced CD8+ T-cell effector functions. Interfering with hyperactivated Tregs should be explored as an approach to enhance antitumor immunity in iCCA. LAY SUMMARY Immune cells have the potential to slow or halt the progression of tumors. However, some tumors, such as intrahepatic cholangiocarcinoma, are associated with very limited immune responses (and infiltration of cancer-targeting immune cells). Herein, we show that a specific population of regulatory T cells (a type of immune cell that actually suppresses the immune response) are hyperactivated in intrahepatic cholangiocarcinoma. Targeting these cells could enable cancer-targeting immune cells to act more effectively and should be looked at as a potential therapeutic approach to this aggressive cancer type.
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Affiliation(s)
- Giorgia Alvisi
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alberto Termanini
- Bioinformatics Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Cristiana Soldani
- Laboratory of Hepatobiliary Immunopathology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Federica Portale
- Laboratory of Tumor Microenvironment, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Roberta Carriero
- Bioinformatics Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Karolina Pilipow
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Guido Costa
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy; Division of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Michela Polidoro
- Laboratory of Hepatobiliary Immunopathology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Barbara Franceschini
- Laboratory of Hepatobiliary Immunopathology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Ines Malenica
- Laboratory of Hepatobiliary Immunopathology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Simone Puccio
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy; Institute of Genetic and Biomedical Research, UoS Milan, National Research Council, Rozzano, Milan, Italy
| | - Veronica Lise
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | - Giovanni Galletti
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Veronica Zanon
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Federico Simone Colombo
- Flow Cytometry Core, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Gabriele De Simone
- Flow Cytometry Core, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Michele Tufano
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alessio Aghemo
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy; Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Di Tommaso
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy; Department of Pathology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Clelia Peano
- Institute of Genetic and Biomedical Research, UoS Milan, National Research Council, Rozzano, Milan, Italy; Genomic Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy; Human Technopole, Viale Rita Levi Montalcini 1, 20157, Milan, Italy
| | - Javier Cibella
- Genomic Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Matteo Iannacone
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy; Experimental Imaging Centre, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rahul Roychoudhuri
- Department of Pathology, University of Cambridge, CB2 3QP, United Kingdom
| | - Teresa Manzo
- Department of Experimental Oncology, European Institute of Oncology- IRCCS, Milan, Italy
| | - Matteo Donadon
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy; Division of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Guido Torzilli
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy; Division of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Paolo Kunderfranco
- Bioinformatics Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Diletta Di Mitri
- Laboratory of Tumor Microenvironment, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | - Enrico Lugli
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Ana Lleo
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy; Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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20
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Costa G. Short introduction to JAHEE and Actions. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.433] [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: 11/13/2022] Open
Abstract
Abstract
Reducing health inequalities is on the agenda of many countries. Despite an increasing concern and awareness on health inequalities a wide gap exists in Europe in terms of political response. The main objective of JAHEE was to strengthen a cooperative approach among participating countries and implement concrete actions to reduce health inequalities. The partnership was composed of 24 countries including many strategically most relevant public health institutions in the European Union, which contributed with different backgrounds, skills and know-how to the achievement of the project objectives. The main results will be presented.
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Affiliation(s)
- G Costa
- Piemonte Region , Turin, Italy
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21
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Strippoli E, Zengarini N, Di Girolamo C, Bartolini L, Aversa C, Costa G. Impact of COVID-19 pandemic on inequalities in mortality: an analysis in Piedmont and Emilia-Romagna. Eur J Public Health 2022. [PMCID: PMC9593877 DOI: 10.1093/eurpub/ckac130.028] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Italy was heavily hit by the COVID-19 pandemic. According to official statistics, during 2020 there were more than 75,000 excess deaths compared to the average expected mortality in 2015-2019. General mortality (GM) is a good measure of both the direct and indirect effects of the pandemic because it's exempt from potential bias due to misclassification of events. Evidence shows a greater burden of disease and mortality attributable to COVID-19 among disadvantaged populations, with the risk of an exacerbation of existing health inequalities. We aim to analyse the trend of social inequalities in mortality during the first pandemic year in two Italian regions (Piedmont and Emilia-Romagna) using data from Administrative Population Registries (APR) and statistical databases. Methods Data on deaths occurred between Jan 2015 and Jan 2021 in subjects ≥65, stratified by educational level, were obtained from Regional APR and the Census. Using a time series approach, we computed Standardized Mortality Rates (SMR), Relative Index of Inequalities (RII) and Slope Index of Inequalities (SII), adjusted by age, gender, month and region. SMR, RII and SII from March 2020 were forecasted using Holt-Winters method and compared to the observed values in the same period. Results SMRs were higher than expected during the two 2020 epidemic waves (Mar-Apr, Oct-Dec) in both regions. RII didn't increase significantly. Absolute inequalities instead rose in Piedmont during both pandemic waves, mostly among women, and in Emilia-Romagna in March among men. Conclusions The impact of the pandemic on inequalities in GM has been at least of the same size of the impact of other mechanisms of unequal mortality. APR coupled with sociodemographic data are a quick and reliable source for assessing the unequal impact of the COVID-19 pandemic on health. Further research is needed to explore mechanisms underlying these effects e.g. inequalities in cause-specific mortality and access to health services. Key messages
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Affiliation(s)
- E Strippoli
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
| | - N Zengarini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
| | - C Di Girolamo
- Health and Social Care Agency, Emilia-Romagna Region , Bologna, Italy
| | - L Bartolini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - C Aversa
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
| | - G Costa
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco , Turin, Italy
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22
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De Lucia R, Giannini C, Parollo M, Costa G, Barletta V, Giannotti Santoro M, Primerano C, De Carlo M, Angelillis M, Zucchelli G, Petronio AS. Cardiac arrhythmias and conduction disorders monitoring after transcatheter aortic valve replacement procedure, using a mobile electrocardiogram 6 lead device. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the early post transcatheter aortic valve replacement (TAVR) discharge era, rate of readmission for permanent pacemaker implantation (PPM-I) due to delayed conduction disturbances (CDs) has significantly increased. This issue has powered post procedural ambulatory electrocardiogram (AECG) monitoring by using implantable cardiac monitors or mobile cardiac telemetry devices, despite several disadvantages as frequent electrode changes and costs.
Purpose
In this scenario we aimed to evaluate the incidence of post-TAVR new onset arrhythmias and delayed CDs, performing an AECG monitoring through a 30s spot digital ECG (AeECG), by using a mobile electrocardiogram 6 lead (ME6L) device in a 30 days period after a TAVR procedure.
Methods
Between March 2021 and February 2022 we consecutively enrolled all patients undergoing a TAVR at the University Hospital of Pisa, excepting who already had a PM. At discharge, all patients received ME6L device and were asked to record a spot eECG for 1 month: 1 eECG per day during the first week and then 1 eECG per week. Clinical and follow-up data were collected and analyzed, and eECG scheduling compliance and quality recordings were explored.
Results
Among 185 consecutive TAVR patients, 12 were excluded due to pre-existing pacing device and 33 due to PPM-I <2 days post TAVR; 3 died before enrollment and 10 refused the enrollment; 18 were excluded because failed the ME6L training phase, 6 for severe postprocedural complications and the last 3 because affected by isolated aortic regurgitation.The remaining ones (100) had 30-day AeECG data. Delayed CDs with a Class I/IIa indications for PPM-Ioccurred in 8 patients with a median of 6 days (range 4–8 days) post-TAVR. New onset documented arrhythmias were AT/AF in 3 patients, isolated PVCs in 10 patients, and competitive transitory junctional rhythm in 2 patients. Delayed PPM-I versus non-delayed PPM-Ipatients were more likely to have a non-self-expandable valve (3 vs 69; p=0.02) and longer PR and QRS intervals at discharge (250.00±53,29 ms vs 179.17±39.17 ms; p=0,003; 125±33.38 ms vs 102.55±30.48 ms; p=0,04). The overall eECG schedule level compliance was 96.5%. Out of a total of 965 sent eECGs, 950 (98,4%) have been correctly recorded and transmitted.
Conclusion
Delayed CDs requiring PPM-I are the most important drawback of TAVR procedure. In our study, AeECG was seen to be safe and helpful in the identification and treatment of delayed CDs requiring PPM-I, with a very high eECG schedule level of compliance and quality. Further prospective studies are needed to better identify patient selection for outpatient monitoring, making safer and safer the early post TAVR discharge approach.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R De Lucia
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - C Giannini
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M Parollo
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - G Costa
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - V Barletta
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - M Giannotti Santoro
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - C Primerano
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M De Carlo
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M Angelillis
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - G Zucchelli
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - A S Petronio
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
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23
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes R, Rosa J, Campos G, Baptista R, Monteiro P, Monteiro S, Goncalves F, Madeira M, Goncalves L. Comparing the long-term prognosis of myocardial infarction with non-obstructive coronary arteries to myocardial infarction with obstructive coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The long-term survival rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) patients is lower than in the general population. Nevertheless, there are conflicting results regarding the prognosis of MINOCA patients in comparison to myocardial infarction with obstructive coronary artery disease (MI-CAD) patients.
Purpose
The aim of this study was to assess the long-term all-cause mortality of MINOCA patients and compare it to MI-CAD patients.
Methods
Retrospective analysis of 2443 consecutively admitted patients for acute myocardial infarction (AMI), in a single coronary intensive care unit. Only patients with 5 years of follow-up and those who died before the 5-year mark were considered. Patients were divided into two groups according to the presence or absence of obstructive coronary artery disease on angiography (≥50% stenosis). Demographic characteristics, symptoms at presentation, past medical history, laboratory characteristics and medication at discharge were compared using the Mann-Whitney U or χ2 test (according to variable type) to ensure comparability between groups. Five-year all-cause mortality was the target endpoint. Five-year survival was modelled through the Cox proportional hazard regression model. The variable of interest (MINOCA vs MI-CAD) and possible confounders that displayed statistically significant differences in the initial demographic analysis were included in univariable Cox regressions, and those with statistically significant associations were included in a multivariable model. Those that displayed non-significant associations in the multivariable model were subsequently removed until we were left with significant associations only, giving us an adjusted hazard ratio.
Results
Comparison between groups is presented in table 1. MINOCA patients were younger and more often women. They were less likely to have smoking habits, diabetes, or a previous history of AMI. They had a lower Killip class, as well as lower troponin I, serum creatinine and low-density lipoprotein cholesterol at admission. On the other hand, they had higher left ventricular ejection fractions. They were also less likely to have beta-blockers or aspirin prescribed at discharge.
All-cause mortality at 5 years was 13.1% among MINOCA patients and 28.3% among MI-CAD patients, with an unadjusted hazard ratio (HR) of 0.421 (95% CI 0.322–0.550), p<0.001. Adjusting for known confounders, the HR was 0.461 (95% CI 0.261–0.816), p=0.008.
Conclusions
Compared with MI-CAD patients, those with MINOCA were slightly younger and had fewer comorbidities. In spite of having a worse long-term prognosis when compared to the general population, MINOCA patients have a significantly higher 5-year survival rate than MI-CAD patients, even after adjustment of confounding factors.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto , Porto , Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Gomes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Rosa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Campos
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Baptista
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - P Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - S Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - F Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
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24
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Costa G, Cardoso J, Goncalves L, Teixeira R. Early aortic valve replacement in asymptomatic severe aortic stenosis with preserved ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) is the most common valvular disease in developed countries. Specific timing of intervention for asymptomatic patients with severe aortic stenosis and preserved ejection fraction remains controversial.
Purpose
To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in asymptomatic AS patients with preserved ejection.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in November 2021, for both interventional or observational studies comparing early-AVR with WW in the treatment of asymptomatic severeAS with preserved ejection fraction criteria. Random-effects meta-analysis was performed.
Results
Eight studies were included in which two were randomized clinical trials. A total of 2672 patients were included, providing a 642 pooled death events (327 in early-AVR and 941 in watchful waiting). In our meta-analysis, early-AVR revealed a significant lower all-cause mortality (pooled OR, 0.39; 95% CI [0.30, 0.51], P<0.01; I2=47%). Additionally, the early-AVR group presented a lower rate of cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I2=64%). Both strategies had similar rate of stroke (pooled OR, 1.30; 95% CI [0.39, 4.27], P=0.67; I2=0%) and myocardial infarction (pooled OR, 0.49; 95% CI [0.14, 1.78], P=0.28; I2=0%). Heart Failure hospitalizations presented a lower trend early-AVR group (pooled OR, 0.22; 95% CI [0.05, 1.08], P=0.36; I2=36%).
Conclusion
Our pooled data suggests that early-AVR strategy is preferable for asymptomatic severe AS patients with preserved ejection fraction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - J Cardoso
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic Surgery , Vila Nova de Gaia , Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research , Coimbra , Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
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25
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Costa G, Cardoso J, Goncalves L, Teixeira R. Early intervention versus conservative management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) is the most common valvular disease in developed countries. However, the specific timing of intervention for asymptomatic patients with severe AS remains controversial.
Purpose
To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in asymptomatic patients with AS.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for both interventional or observational studies comparing early AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis was performed.
Results
Thirteen studies were included in which two were randomised clinical trials. A total of 4,679 patients were included, providing a 1,268 pooled death events (327 in early AVR and 941 in WW). Our meta-analysis showed a significantly lower all-cause mortality for the early-AVR compared with WW group, although with a moderate amount of heterogeneity between studies in the magnitude of the effect (pooled odds ratio [OR], 0.41; 95% confidence interval [CI] 0.34, 0.50, P<0.01; I2=60%). An early surgery strategy displayed a significantly lower cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I 2=64%) and heart failure hospitalisations (pooled OR 0.19; 95% CI [0.10, 0.39], P<0.01, I2=7%). However, both groups had similar rates of stroke (pooled OR 1.30; 95% CI [0.73, 2.29], P=0.36, I2=0%) and myocardial infarction (pooled OR 0.49; 95% CI [0.19, 1.27], P=0.14, I2=0%).
Conclusions
Our pooled data suggest that an early-AVR strategy is preferable for asymptomatic patients with severe AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - J Cardoso
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic Surgery , Vila Nova de Gaia , Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research , Coimbra , Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
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26
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Costa G, Marinho V, Costa M, Goncalves L, Teixeira R. Meta-analysis comparing outcomes in patients undergoing transcatheter aortic valve implantation with versus without percutaneous coronary intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Patients having transcatheter aortic valve implantation (TAVI) routinely undergo coronary angiography before the procedure to define the coronary anatomy and to evaluate the extend of coronary artery disease (CAD). Whether percutaneous coronary intervention (PCI) prior/concomitant with TAVI confers any additional clinical benefit in patients with CAD remains unclear.
Purpose
To compare the outcomes of PCI prior to TAVI in patients with significant coronary artery disease and severe aortic stenosis.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in November 2021, for both retrospective and prospective studies comparing TAVI with PCI versus TAVI alone. Random-effects meta-analysis was performed.
Results
Eleven studies were included in which one was a randomized clinical trial. A total of 2530 patients were included, providing a 145 pooled death events (64 in TAVI with PCI and 81 in TAVI only). In terms of 30-day clinical outcomes, our pooled analysis revealed a similar all-cause mortality (pooled OR, 1.24; 95% CI [0.80, 1.93], P=0.34; I2=27% - Figure), cardiovascular mortality (pooled OR, 1.44; 95% CI [0.56, 3.75], P=0.45; I2=57%) and stroke (pooled OR, 1.07; 95% CI [0.53, 2.13], P=0.86; I2=0%). However, our analysis revealed a higher rate of myocardial infarction (pooled OR, 4.28; 95% CI [1.56, 11.69], P<0.01; I2=0%) and major bleeding events (pooled OR, 1.40; 95% CI [1.02, 1.93], P=0.04; I2=0%) in the TAVI with PCI group. A 1-year clinical outcomes analysis revealed a trend for lower all-cause mortality in TAVI only group (pooled OR, 1.37; 95% CI [0.98, 1.91], P=0.06; I2=0%), similar cardiovascular death rate (pooled OR, 1.15; 95% CI [0.70, 1.89], P=0.59; I2=6%) and major bleeding events (pooled OR, 1.62; 95% CI [0.95, 2.76], P=0.07; I2=0%).
Conclusion
Our pooled data suggests that PCI with TAVI in patients with severe aortic stenosis and concomitant CAD grants no additional clinical advantage.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - V Marinho
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - M Costa
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - R Teixeira
- Centro hospitalar de Coimbra , Coimbra , Portugal
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27
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes R, Rosa J, Campos G, Costa S, Baptista R, Franco F, Madeira M, Goncalves L. Maximum dose sacubitril/valsartan in heart failure with reduced ejection fraction: does atrial fibrillation compromise the benefits? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In the PARADIGM-HF trial, sacubitril/valsartan (SV) was shown to be superior to enalapril in reducing hospitalizations for worsening heart failure (HF), cardiovascular mortality, and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). The 2021 ESC Guidelines recommends SV as a replacement for angiotensin-converting-enzyme inhibitors to reduce the risk of HF hospitalization and death. There is little information regarding the effects of SV according to atrial fibrillation (AF) status.
Purpose
The aim of this study was to compare the effects of maximum dose SV regarding symptomatic improvement, change in natriuretic peptides levels (NP) and left ventricular ejection fraction (LVEF) in patients with HFrEF with and without AF.
Methods
Retrospective analysis of 137 patients with HFrEF on maximum dose SV (97/103mg twice daily). Patients were divided into two groups according to AF status. Age, gender, relevant comorbidities, usual medication, baseline symptomatic status, NP levels and LVEF were assessed using the Mann-Whitney U or χ2 test (according to variable type) to ensure comparability between groups. Variation in NYHA class, NP levels and LVEF between baseline and 6-month follow-up was evaluated and compared between groups.
Results
Comparison between groups is presented in Table 1. In our studied population, ischemic aetiology was more common in the sinus rhythm group (49.5% vs 30.4%; p 0.034). There were no significant differences between groups regarding age, gender, hypertension, diabetes, and beta-blocker and mineralocorticoid receptor antagonist usage. At baseline, the AF group had higher NT-proBNP levels [median 1421 mg/dL (IQR 743–3087) vs 467 mg/dL (IQR 140–797); p<0.001]. There were no significant differences regarding baseline NYHA class or LVEF. After 6 months of follow-up, reductions in NYHA class [−1 (IQR −2, −1) for AF; −1 (IQR −1, 0) for SR; p=0.437] and NT-proBNP levels [−358 mg/dL (IQR −2275, −47) for AF; −162 mg/dL (IQR −364, 27) for SR; p=0.156], as well as LVEF improvement [11% (IQR 3–15) for AF; 12% (IQR 7–21) for SR; p=0.201], displayed no statistically significant differences between the two groups.
Conclusions
Our study shows that the beneficial effects of SV on symptomatic status, NP levels and LVEF were not compromised by the presence of AF at baseline.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto , Porto , Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Gomes
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - J Rosa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - G Campos
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - S Costa
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - R Baptista
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - F Franco
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra , Coimbra , Portugal
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28
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Costa G, Cardoso J, Donato H, Goncalves L, Teixeira R. Concomitant tricuspid repair in mitral regurgitation surgery: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Tricuspid Regurgitation (TR) is common in patients with severe mitral disease. However, the evidence is insufficient to inform a decision about whether to perform prophylactic tricuspid-valve repair during mitral-valve surgery in patients who have moderate TR or less-than-moderate regurgitation.
Purpose
To compare the outcomes of concomitant tricuspid repair in mitral valve surgery versus no concomitant tricuspid repair in less-than-severe TR patients.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for interventional studies comparing concomitant tricuspid repair in mitral valve surgery versus no tricuspid intervention. Random-effects meta-analysis was performed.
Results
Four randomised trials were included, providing a total of 651 patients (323 in prophylactic tricuspid intervention group and 328 patients in conservative group). Our meta-analysis showed a similar all-cause mortality for concomitant prophylactic tricuspid repair compared with no tricuspid intervention (pooled OR, 0.54; 95% CI [0.25, 1.15], P=0.11; I2=0%). Additionally, there is a similar New York Heart Association (NYHA) III–IV classes in both groups, despite a lower trend in the tricuspid intervention group (pooled OR, 0.63; 95% CI [0.38, 1.06], P=0.08; I2=0%) (Figure 3). However, there was a significant lower progression of TR (pooled OR, 0.06; 95% CI [0.02, 0.24], P<0.01; I2=0%) and moderate-severe TR (pooled OR, 0.23; 95% CI [0.11, 0.46], P<0.01; I2=27%).
Conclusions
Our pooled analysis suggests that a tricuspid-valve repair at the time of mitral-valve surgery in patients with moderate or less-than-moderate TR does not impact perioperative or postoperative all-cause mortality, despite reducing TR severity and progression of TR following intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Costa
- Centro hospitalar de Coimbra , Coimbra , Portugal
| | - J Cardoso
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic Surgery , Vila Nova de Gaia , Portugal
| | - H Donato
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research , Coimbra , Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra , Coimbra , Portugal
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de Oliveira V, Santos D, Sinisgalli R, Vancini R, Costa G, Nikolaidis PT, Knechtle B, Weiss K, Andrade M, de Lira C. Factors associated with perceived performance drops and musculoskeletal injuries in Brazilian recreational triathletes. Eur Rev Med Pharmacol Sci 2022; 26:5651-5659. [PMID: 36066136 DOI: 10.26355/eurrev_202208_29498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of the study was to investigate sleep characteristics, use of supplements, and training volume of recreational triathletes, and to verify possible associations with perceived performance drops and occurrence of injuries. MATERIALS AND METHODS Recreational triathletes (n=942) answered a questionnaire inquiring about their demographic characteristics, performance, injuries and training volume. RESULTS When comparing athletes who slept more (9-10 hours) with those who slept less, less sleep was associated with a higher prevalence of perceived performance drops. Regarding difficulties in initiating sleep, the absence of initiating difficulties (p<0.001) was a protective factor against perceived performance drops. Regarding weekly training volume, compared to those who trained more than 20 hours, training less than 3 hours (p<0.001), 3-5 hours (p<0.001), or 12-14 hours (p<0.001) were protective factors against perceived performance drops. Concerning training volume and injuries, we found that compared to those who trained more than 20 hours, training 18-20 hours (p<0.001), 15-17 hours (p<0.001), 12-14 hours (p<0.001), 6-8 hours (p<0.001), or 3-5 hours (p<0.001) were protective factors against injuries. CONCLUSIONS Triathletes with a lower sleep quantity and those who have difficulties initiating sleep frequently experience drops in performance. Training volumes can influence both performance and the likelihood of injuries.
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Affiliation(s)
- V de Oliveira
- Human and Exercise Physiology Division, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil.
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Savino MS, Cavinato L, Costa G, Fiz F, Torzilli G, Vigano L, Ieva F. Distant supervision for imaging-based cancer sub-typing in Intrahepatic Cholangiocarcinoma. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:1032-1035. [PMID: 36086172 DOI: 10.1109/embc48229.2022.9871262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Finding effective ways to perform cancer sub-typing is currently a trending research topic for therapy opti-mization and personalized medicine. Stemming from genomic field, several algorithms have been proposed. In the context of texture analysis, limited efforts have been attempted, yet imaging information is known to entail useful knowledge for clinical practice. We propose a distant supervision model for imaging-based cancer sub-typing in Intrahepatic Cholangiocar-cinoma patients. A clinically informed stratification of patients is built and homogeneous groups of patients are characterized in terms of survival probabilities, qualitative cancer variables and radiomic feature description. Moreover, the contributions of the information derived from the ICC area and from the peri tumoral area are evaluated. The findings suggest the reliability of the proposed model in the context of cancer research and testify the importance of accounting for data coming from both the tumour and the tumour-tissue interface. Clinical relevance - In order to accurately predict cancer prognosis for patients affected by ICC, radiomic variables of both core cancer and surrounding area should be exploited and employed in a model able to manage complex information.
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31
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Viganò L, Branciforte B, Laurenti V, Costa G, Procopio F, Cimino M, Del Fabbro D, Di Tommaso L, Torzilli G. The Histopathological Growth Pattern of Colorectal Liver Metastases Impacts Local Recurrence Risk and the Adequate Width of the Surgical Margin. Ann Surg Oncol 2022; 29:5515-5524. [PMID: 35687176 DOI: 10.1245/s10434-022-11717-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The histopathological growth pattern (HGP) of colorectal liver metastases (CLM) has been associated with prognosis. This study was designed to elucidate if the HGP is associated with local recurrence risk and impacts the adequate width of surgical margin. METHODS All consecutive patients resected for CLM in 2018-2019 were considered. HGP was prospectively classified as follows: desmoplastic, pushing, and replacement. Surgical margin was classified as follows: R0 (margin ≥ 1 mm), R1vasc (0-mm margin, tumor detachment from intrahepatic vessels), and R1par (tumor exposure along transection plane). R0 resections were further distinguished in R0min (1-mm margin) and R0wide (> 1-mm margin). RESULTS A total of 340 resection areas in 136 patients were analyzed (70 R0min, 143 R0wide, 31 R1vasc, 96 R1par). HGP was desmoplastic in 26 cases, pushing in 221, and replacement in 93. Thirty-six local recurrences occurred (11%, median follow-up 21 months): 1 after R0wide, 4 after R0min, 3 after R1vasc, and 28 after R1par resection. In R1par group, local recurrence rate was high independently of HGP (29%). In R1vasc and R0min groups, local recurrence risk was higher in the replacement group (R1vasc: 29% vs. 4% if pushing/desmoplastic; R0min: 11% vs. 4%). In R0wide group, local recurrence risk was low for all HGP ( < 1%). Independent predictors of local recurrence were replacement HGP (odds ratio = 1.654, P = 0.036), and R1par resection (odds ratio = 57.209, P < 0.001 vs. R0). CONCLUSIONS Replacement HGP is associated with an increased risk of local recurrence. In these patients, a wide surgical margin should be pursued, because R1vasc and R0min resections could be insufficient. R1par resection is inadequate, independently of the HGP.
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Affiliation(s)
- L Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - B Branciforte
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - V Laurenti
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - G Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - F Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - M Cimino
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - D Del Fabbro
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy
| | - L Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy.,Pathology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - G Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Milan, Rozzano, Italy. .,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy.
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32
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Viganò L, Branciforte B, Laurenti V, Costa G, Procopio F, Cimino M, Del Fabbro D, Di Tommaso L, Torzilli G. ASO Visual Abstract: The Histopathological Growth Pattern of Colorectal Liver Metastases Impacts Local Recurrence Risk and the Adequate Width of the Surgical Margin. Ann Surg Oncol 2022. [PMID: 35639291 DOI: 10.1245/s10434-022-11854-0] [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: 11/18/2022]
Affiliation(s)
- L Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - B Branciforte
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - V Laurenti
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - M Cimino
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - D Del Fabbro
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - L Di Tommaso
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Pathology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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Pompili R, Alesini D, Anania MP, Arjmand S, Behtouei M, Bellaveglia M, Biagioni A, Buonomo B, Cardelli F, Carpanese M, Chiadroni E, Cianchi A, Costa G, Del Dotto A, Del Giorno M, Dipace F, Doria A, Filippi F, Galletti M, Giannessi L, Giribono A, Iovine P, Lollo V, Mostacci A, Nguyen F, Opromolla M, Di Palma E, Pellegrino L, Petralia A, Petrillo V, Piersanti L, Di Pirro G, Romeo S, Rossi AR, Scifo J, Selce A, Shpakov V, Stella A, Vaccarezza C, Villa F, Zigler A, Ferrario M. Free-electron lasing with compact beam-driven plasma wakefield accelerator. Nature 2022; 605:659-662. [PMID: 35614244 DOI: 10.1038/s41586-022-04589-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/25/2022] [Indexed: 11/09/2022]
Abstract
The possibility to accelerate electron beams to ultra-relativistic velocities over short distances by using plasma-based technology holds the potential for a revolution in the field of particle accelerators1-4. The compact nature of plasma-based accelerators would allow the realization of table-top machines capable of driving a free-electron laser (FEL)5, a formidable tool to investigate matter at the sub-atomic level by generating coherent light pulses with sub-ångström wavelengths and sub-femtosecond durations6,7. So far, however, the high-energy electron beams required to operate FELs had to be obtained through the use of conventional large-size radio-frequency (RF) accelerators, bound to a sizeable footprint as a result of their limited accelerating fields. Here we report the experimental evidence of FEL lasing by a compact (3-cm) particle-beam-driven plasma accelerator. The accelerated beams are completely characterized in the six-dimensional phase space and have high quality, comparable with state-of-the-art accelerators8. This allowed the observation of narrow-band amplified radiation in the infrared range with typical exponential growth of its intensity over six consecutive undulators. This proof-of-principle experiment represents a fundamental milestone in the use of plasma-based accelerators, contributing to the development of next-generation compact facilities for user-oriented applications9.
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Affiliation(s)
- R Pompili
- Laboratori Nazionali di Frascati, Frascati, Italy.
| | - D Alesini
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M P Anania
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - S Arjmand
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Behtouei
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - A Biagioni
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - B Buonomo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Cardelli
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Carpanese
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - E Chiadroni
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Cianchi
- University of Rome Tor Vergata, Rome, Italy.,INFN Tor Vergata, Rome, Italy.,NAST Center, Rome, Italy
| | - G Costa
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Del Dotto
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Del Giorno
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Dipace
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Doria
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - F Filippi
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - M Galletti
- University of Rome Tor Vergata, Rome, Italy.,INFN Tor Vergata, Rome, Italy.,NAST Center, Rome, Italy
| | - L Giannessi
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Giribono
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - V Lollo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - F Nguyen
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | | | - E Di Palma
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - L Pellegrino
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Petralia
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | | | - L Piersanti
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - G Di Pirro
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - S Romeo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - J Scifo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Selce
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - V Shpakov
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Stella
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - C Vaccarezza
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Villa
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Zigler
- Laboratori Nazionali di Frascati, Frascati, Italy.,Racah Institute of Physics, Hebrew University, Jerusalem, Israel
| | - M Ferrario
- Laboratori Nazionali di Frascati, Frascati, Italy
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De Almeida Fernandes D, Guimaraes J, Monteiro E, Costa G, Antonio N, Goncalves L. Tachydysrhythmias in patients admitted with COVID-19 pneumonia: prevalence and impact on in-hospital mortality. Europace 2022. [PMCID: PMC9384055 DOI: 10.1093/europace/euac053.122] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The COVID-19 pandemic has shifted tremendously the paradigm of hospital care and treatment of cardiovascular (CV) patients. According to most recent evidence, due to its multisystemic impact, COVID-19 may lead to an increased risk of cardiac arrhythmias with subsequently increased morbimortality.
Purpose
Determine the prevalence of tachyarrhythmias in patients admitted with COVID-19, possible predictors and impact on in-hospital mortality.
Methods
A retrospective study of 3475 consecutive patients with COVID-19 pneumonia admitted to our hospital between February 2020 and November 2021 were included. The main outcome was tachyarrhythmias (high ventricular rate (HVR) or new-onset atrial fibrillation (AF), HVR or new-onset atrial flutter (AFL), other supraventricular tachycardias (SVT), ventricular tachycardia (VT) and ventricular fibrillation (VF)). Secondary outcome was in-hospital mortality. Sociodemographic variables and clinical data were recorded. Statistical comparison was made between groups, including logistic regression to determine odds ratios (OR).
Results
A total of 215 patients presented HVR AF (6.31%), 79 of which with new-onset AF (36.74%). 8 patients had HVR AFL (0.23%), 5 VT (0.15%), 4 VF (0.12%) and only 3 patients had a SVT identified (0.09%). Patients with tachyarrhythmias were significantly older (77. 74 ± 11.25 68.94 ± 17.51 years, p <0.001) and had more hypertension (p 0.034), heart failure (HF) (p <0.001), severe valvular heart disease (VHD) (p 0.007), coronary artery disease (CAD) (p 0.031), chronic kidney disease (CKD) (p 0.048) and paroxysmal AF (if previously diagnosed (p 0.001). There were no significant differences regarding gender, dyslipidemia, diabetes, cerebrovascular disease and obstructive sleep apnoea (OSA).
Patients with HF had the highest risk of tachyarrhythmia (OR 3.539; 95% CI 2.666-4.698; p <0.001), followed by severe VHD (OR 1.990; 95% CI 1.192-3.365; p 0.009) and CAD (OR 1.575; 95% CI 1.040-2.386; p 0.032). Older patients or patients with hypertension or CKD were also at an increased risk. Also of note, patients previously diagnosed with paroxysmal AF were more likely to have episodes of HVR AF than the ones with persistent or permanent AF (OR 1.819; 95% CI 1.272-2.602; p 0.001)
Regarding the secondary outcome, patients with tachyarrhythmias during hospital stay had an odd almost 3 times higher of death (OR 2.820; 95% CI 2.151-3.695; p <0.001).
Conclusions
Tachyarrhythmias is a common complication in COVID-19 patients during hospital stay that is significantly linked to higher in-hospital mortality. Patients presenting with high CV disease burden are at particularly significant risk and should be carefully managed.
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Affiliation(s)
| | - J Guimaraes
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - E Monteiro
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - G Costa
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - N Antonio
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - L Goncalves
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
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De Almeida Fernandes D, Guimaraes J, Costa P, Monteiro E, Costa G, Antonio N, Martins P, Goncalves L. Prevalence and impact of dysrhythmias in COVID-19 intensive care patients. Europace 2022. [PMCID: PMC9384148 DOI: 10.1093/europace/euac053.123] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Background The COVID-19 pandemic has had a dramatic impact on clinical practice, amounting to more emergency department and intensive care unit (ICU) admissions. Due to their frequent multiple comorbidities, management in the ICU is challenging. Early studies suggest that cardiac injury is frequent in hospitalized patients with COVID-19, and it is plausible that these patients have a higher risk of cardiac dysrhythmias. Purpose To determine the prevalence of dysrhythmias in ICU patients with COVID-19 pneumonia, identify major predictors and determine the impact on in-hospital mortality. Methods A retrospective study of 98 consecutive patients with COVID-19 Pneumonia admitted to the ICU of a tertiary hospital in 2020. The main outcome was dysrhythmias (including significant bradycardia, high/slow ventricular rate or new-onset atrial fibrillation (AF) or atrial flutter, other supraventricular tachycardias, ventricular tachycardia and ventricular fibrillation). Significant bradycardia was defined as heart rate lower than 40 or need of treatment. Sociodemographic variables and clinical data were retrieved for each patient, severity scores at admission (Apache II, SOFA and SAPS II), number of days on mechanical ventilation or high-flow oxygen and placement on Venovenous Extracorporeal Membrane Oxygenation (ECMO) or prone position were recorded. Statistical comparison was made between groups, including logistic regression adjusting for confounding variables. Results The most frequent arrhythmia was significant sinus bradycardia (28, 28.5%) followed by high ventricular rate AF (14, 14.2%). Patients who had dysrhythmias were older (66.24 ± 10.13 vs 60.85 ± 12.69 years, p 0.024), more severe (SAPS II score 42.55 ± 11.08 vs 35.98 ± 11.26, p 0.006), had more atrial fibrillation (AF) (p 0.022), had higher maximum C-reactive protein (mCRP) (6.56 ± 2.68 vs 6.24 vs 2.86, p 0.009), were mechanically ventilated for a longer time (15.64 ± 13.18 vs 8.92 ± 8.85 days, p 0.004), had longer intubation time (14.52 ± 9.39 vs 8.70 ± 8.21 days, p 0.002) and had higher usage of dexamethasone (p 0.042) and prone position (p 0.016). When adjusted for confounding variables, prone was the most significant predictor (OR 2.800; 95% CI 1.203-6.516) followed by use of dexamethasone (OR 2.484; 95% CI 1.020-6.050). Days intubated, days on mechanical ventilation, age, mCRP and SAPS II on admission were also predictors of dysrhythmia. Regarding mortality, patients with arrhythmic events had a tendency for greater in-hospital death (OR 2.440; 95% CI 0.950-6.310; p 0.065). Conclusions COVID-19 ICU patients are a subset of patients at risk of cardiac arrhythmias. Use of prone position was the main contributor to these events, but clinical history, severity and treatment may also play an important role. Efforts must be made to optimize ventilatory support and treatment in order to reduce the risk of dysrhythmias.
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Affiliation(s)
| | - J Guimaraes
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - P Costa
- Coimbra Hospital and University Center, Intensive Care Medicine, Coimbra, Portugal
| | - E Monteiro
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - G Costa
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - N Antonio
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
| | - P Martins
- Coimbra Hospital and University Center, Intensive Care Medicine, Coimbra, Portugal
| | - L Goncalves
- Coimbra Hospital and University Center, Cardiology, Coimbra, Portugal
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Rosato S, Biancari F, D‘errigo P, Tarantini G, Costa G, Baglio G, Seccareccia F, Tamburino C. P326 SURGICAL VERSUS TRANSCATHETER AORTIC VALVE REPLACEMENT WITH NEWER GENERATION DEVICES IN REAL–WORLD PRACTICE: ONE–YEAR OUTCOMES FROM THE ITALIAN OBSERVANT STUDIES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.313] [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: 11/14/2022]
Abstract
Abstract
Objective
To compare the early and 1–year outcomes after transcatheter aortic valve replacement (TAVR) with new–generation devices over surgical replacement (SAVR) among patients with severe aortic stenosis (AS).
Background
TAVR is gaining acceptance for the treatment of lower risk patients with AS after several randomized and observational studies confirmed comparable early results to SAVR. On the other hand, clinical studies have shown that SAVR is still widely used in intermediate and high risk patients. There is need of data from large clinical registries to demonstrate the efficacy and safety of TAVR in the real–world setting, particularly after the introduction of new TAVR technology.
Methods
A total of 5706 AS patients who underwent SAVR and 2989 AS patients who underwent TAVR enrolled in the national, prospective OBSERVANT and OBSERVANT II studies, respectively in 2010–2012 and 2016–2018, were analyzed. Outcomes were adjusted using the propensity score matching. The primary outcomes of interest were all–cause mortality, major adverse cardiac and cerebrovascular events (MACCEs) and hospital readmission due to heart failure at 1–year. Secondary outcomes were major adverse events occurring during the index hospitalization.
Results
Among 1008 propensity score matched pairs, TAVR was associated with significantly lower 30–day mortality (1.8 vs. 3.5%, p = 0.020), stroke (0.8 vs. 2.3%, p = 0.005), acute kidney injury (0.6 vs. 8.2%, p < 0.001), infectious complications (3.8 vs. 6.5%, p = 0.006) and cardiogenic shock (1.4 vs. 5.1%, p < 0.001) compared to SAVR. Moderate–to–severe paravalvular regurgitation (5.9 vs. 2.0%, p < 0.001), major vascular complications requiring invasive treatment (2.2 vs. 0.1%, p < 0.001) and permanent pacemaker implantation (during the index hospitalization, 13.8 vs. 3.3%, p < 0.001) were more frequent after TAVR. At 1–year, TAVR was associated with lower risk of all–cause death (7.9 vs. 11.5%, p = 0.006), MACCE (12.0 vs. 15.8%, p = 0.011), readmission due to heart failure (10.8 vs. 15.9%, p < 0.001) and stroke (3.2 vs. 5.1%, p = 0.033) compared to SAVR.
Conclusions
In a real–world setting, patients with intermediate operative risk treated with newer generation TAVR devices had a low risk of major adverse events during the index–hospitalization and at 1–year follow–up. TAVR could become the treatment of choice for AS in the elderly provided that its durability is proved by long–term follow–up studies.
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Affiliation(s)
- S Rosato
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - F Biancari
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - P D‘errigo
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - G Tarantini
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - G Costa
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - G Baglio
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - F Seccareccia
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
| | - C Tamburino
- ISTITUTO SUPERIORE DI SANITÀ, ROMA; CLINICA MONTEVERGINE, GVM CARE AND RESEARCH, MERCOGLIANO; DIVISION OF CARDIOLOGY, DEPARTMENT OF CARDIAC THORACIC AND VASCULAR SCIENCES, UNIVERSITY OF PADOVA, PADOVA; DIVISION OF CARDIOLOGY, AOU POLICLINICO “G. RONDOLINO– SAN MARCO”, UNIVERSITY OF CATANIA, CATANIA ; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICE, ROMA; ISTITUTO SUPERIORE DI SANITÀ, ROMA
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes A, Saleiro C, Campos D, Sousa J, Lopes J, Puga L, Teixeira R, Lourenco C, Madeira M, Goncalves L. Inflammation in acute coronary syndrome: prognostic significance. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In patients with acute coronary syndrome (ACS) the acute phase reactant, C-reactive protein (CRP), might be significantly elevated. Several reports suggest that CRP may play a direct pathophysiological role on the development and progression of atherosclerosis, and CRP values correlate with infarct size when measured by magnetic resonance imaging.
Purpose
The aim of the present study was to evaluate the prognostic value of CRP in patients presenting with an ACS.
Methods
Retrospective analysis of 635 consecutively admitted patients due to ACS in a single coronary intensive care unit. CRP levels were measured at admission. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether CRP was an independent predictor of outcome.
Results
In the studied sample, 75% were male. Median age was 69 [interquartile range (IQR) 57–78]. ST-elevation myocardial infarction (STEMI) occurred in 39.6%, non-ST segment elevation myocardial infarction in 44.9% and unstable angina in 15.5% of the patients. Median left ventricular ejection fraction (LVEF) was 48% (IQR 40–55%) and median CRP level at admission 0.7 mg/dL (IQR 0.5–1.9 mg/dL). Regarding important comorbidities and past medical history, 75.9% had hypertension (HTN), 34.0% diabetes, 20.3% chronic kidney disease (CKD), 68.6% dyslipidaemia and 17.3% heart failure (HF). The median follow-up was 34 months (IQR 22–72). In univariate analysis, CRP was significantly associated with all-cause mortality (HR 1.06 per 1 mg/dL increase, 95% CI 1.04–1.08, p<0.001), as was gender, age, LVEF, STEMI and previous history of diabetes, HTN, CKD or HF. In multivariate analysis, CRP remained significantly associated with the primary endpoint (HR 1.02, 95% CI 1.00–1.05, p=0.033), as did age, LVEF and previous history of HF.
Conclusions
In our study, CRP at admission was an independent risk factor for all-cause mortality following an ACS. This finding indicates that inflammation associated with the acute event has a significant impact in the long-term prognosis. More evidence is needed to determine if treating inflammation (and when, in the course of the disease) could result in better outcomes.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto, Porto, Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - A Gomes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - D Campos
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - L Puga
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - R Teixeira
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
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38
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Forresi B, Michelini G, Sapuppo W, Costa G, Castellini G, Livellara S, Gregori Grgič R. Anger, personality traits and psychopathological symptoms in subjects exposed to negative interpersonal actions in workplaces: an observational study in a large sample attending a Center for Occupational Stress. Int Arch Occup Environ Health 2022; 95:1763-1773. [PMID: 35511292 DOI: 10.1007/s00420-022-01868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The association between adverse working conditions and mental disorders is well established. In addition to psychopathological symptoms, this study aimed at investigating anger and personality traits in a clinical sample of subjects referring negative interpersonal experiences in workplaces. METHODS 1676 workers attending a Centre for Occupational Stress in Milan (from 2014 to 2016) were administered an assessment protocol including SCL-90 for general psychopathology, STAXI for anger intensity and expression, and MMPI-2 for personality traits. A qualitative checklist was used to collect negative experiences in workplaces. RESULTS Patients reported they were exposed to "threats to the task or the professional career" more than to "attacks to the person". Over 80% scored above the cutoff in all the subscales of the SCL-90, with highest scores in Depression, Obsessive-Compulsive Disorder, Anxiety, Somatization and Paranoia. 60% scored above the 90th percentile in the AX/in subscale, showing intense anger feelings that they mostly suppress. Abnormal elevations at the MMPI scales of Hypochondria, Depression, Hysteria, and Paranoia were found in over 50% of the sample. Women reported higher psychological difficulties and internalized anger than men. Anger towards objects and people, instead, was more common in males. No differences were observed by work sector or employment status. CONCLUSIONS In addition to severe psychological difficulties, individuals reporting negative interpersonal experiences in workplaces have high levels of internalized anger and a distinctive profile of personality traits. While a deeper investigation is needed, anger expression should be considered in future treatment programs.
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Affiliation(s)
- Barbara Forresi
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy.
| | - G Michelini
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy
| | - W Sapuppo
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy.,London South Bank University, London, UK
| | - G Costa
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - G Castellini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Livellara
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy
| | - R Gregori Grgič
- Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20139, Milan, Italy
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39
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Fiz F, Masci C, Costa G, Sollini M, Chiti A, Ieva F, Torzilli G, Viganò L. PET/CT-based radiomics of mass-forming intrahepatic cholangiocarcinoma improves prediction of pathology data and survival. Eur J Nucl Med Mol Imaging 2022; 49:3387-3400. [DOI: 10.1007/s00259-022-05765-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/11/2022] [Indexed: 12/18/2022]
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40
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Fransvea P, Costa G, Pepe G, La Greca A, Magalini S, Puccioni C, d'Agostino L, Altieri G, Borello A, Cozza V, Sganga G. Acute intestinal ischemia in patients with COVID-19: single-centre experience and literature review. Eur Rev Med Pharmacol Sci 2022; 26:1414-1429. [PMID: 35253199 DOI: 10.26355/eurrev_202202_28135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Acute Intestinal ischemia (AII) may involve the small and/or large bowel after any process affecting intestinal blood flow. COVID-19-related gastrointestinal manifestations, including AII, have been attributed to pharmacologic effects, metabolic disorders in ICU patients and other opportunistic colonic pathogens. AII in COVID-19 patients may be due also to "viral enteropathy" and SARS-CoV-2-induced small vessel thrombosis. A critical appraisal of personal experience regarding COVID-19 and AII was carried out comparing this with a systematic literature review of published series. PATIENTS AND METHODS A retrospective observational clinical cohort study and a systematic literature review including only COVID-19 positive patients with acute arterial or venous intestinal ischemia were performed. The primary endpoint of the study was the mortality rate. Secondary endpoints were occurrence of major complications and length of hospital stay. RESULTS Patient mean age was 62.9±14.9, with a prevalence of male gender (23 male, 72% vs. 9 female, 28%). The mean Charlson Comorbidity Index was 3.1±2.7. Surgery was performed in 24/32 patients (75.0%), with a mean delay time from admission to surgery of 6.0 ±5.6 days. Small bowel ischemia was confirmed to be the most common finding at surgical exploration (22/24, 91.7%). Acute abdomen at admission to the ED (Group 1) was observed in 10 (31.2%) cases, while 16 (50%) patients developed an acute abdomen condition during hospitalization (Group 2) for SARS-CoV-2 infection. CONCLUSIONS Our literature review showed how intestinal ischemia in patients with SARS-CoV-2 has been reported all over the world. The majority of the patients have a high CCI with multiple comorbidities, above all hypertension and cardiovascular disease. GI symptoms were not always present at the admission. A high level of suspicion for intestinal ischemia should be maintained in COVID-19 patients presenting with GI symptoms or with incremental abdominal pain. Nevertheless, a prompt thromboelastogram and laboratory test may confirm the need of improving and fastening the use of anticoagulants and trigger an extended indication for early abdominal CECT in patients with suggestive symptoms or biochemical markers of intestinal ischemia.
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Affiliation(s)
- P Fransvea
- Emergency Surgery and Trauma - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
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41
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Vigano L, Terrone A, Costa G, Franchi E, Cimino M, Procopio F, Del Fabbro D, Torzilli G. Effect of chemotherapy on tumour-vessel relationship in colorectal liver metastases. Br J Surg 2022; 109:401-404. [PMID: 35165692 DOI: 10.1093/bjs/znac010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Luca Vigano
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alfonso Terrone
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Eloisa Franchi
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matteo Cimino
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Fabio Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Daniele Del Fabbro
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Mazzon G, Ferretti S, Acquati P, Nazzani S, Campobasso D, Germinale F, Filippi B, Micali S, Pavan N, De Marco G, Vismara Fugini A, Morena T, Peroni A, Celentano G, Creta M, Serafin E, Costa G, Rocco B, Maestrani U, Vaccaro C, Carmignani L, Trombetta C, Cerruto M, Antonelli A, Celia A. The effect of COVID-19 outbreak on endourological treatments for urinary stones: A retrospective multicentric study. Eur Urol 2022. [PMCID: PMC9155269 DOI: 10.1016/s0302-2838(22)00335-9] [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: 11/18/2022]
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43
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Ceresoli M, Carissimi F, Nigro A, Fransvea P, Lepre L, Braga M, Costa G. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry. Hernia 2022; 26:165-175. [PMID: 32737706 PMCID: PMC8881429 DOI: 10.1007/s10029-020-02269-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 05/03/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. METHODS This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson's comorbidity index, P-POSSUM and CR-POSSUM were assessed. RESULTS 259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson's comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality CONCLUSION: Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson's comorbidity index could be adopted to select patients for elective operation.
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Affiliation(s)
- M Ceresoli
- General and Emergency Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, via Pergolesi 33, 20900, Monza, Italy.
| | - F Carissimi
- General and Emergency Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - A Nigro
- General and Emergency Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - P Fransvea
- UOC Chirurgia D'Urgenza E del Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - L Lepre
- UOC Chirurgia Generale, Ospedale Santo Spirito in Sassia, ASL Roma 1, Roma, Italy
| | - M Braga
- General and Emergency Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - G Costa
- Surgical and Medical Department of Translational Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Roma, Roma, Italy
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Pereira D, Costa G, Catarino R, Pina-Vaz T, Silva J. Testicular disorders’ awareness and knowledge among Portuguese high-school students. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03175-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: 10/19/2022] Open
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Catarino R, Alves L, Pereira J, Pereira D, Costa G, Cardoso A, Braga I, Freitas R, Correia T, Cerqueira M, Carmo Reis F, Lobo F, Morais A, Silva V, Magalhães S, Prisco R. Neoadjuvant chemotherapy in patients with urothelial bladder cancer. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03227-4] [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: 11/17/2022] Open
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46
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Cigliano F, Boccuzzi A, Basile V, Ferraro A, Macciotta A, Catalano A, Costa G, Vineis P, Sacerdote C, Caramello V. Are antigen tests useful as screening for the identification of SARS-CoV-2 in emergency rooms? Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.813] [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: 11/14/2022] Open
Abstract
Abstract
Background
A quick and accurate case identification in the Emergency Department (ED) during the SARS-CoV-2 pandemic is crucial for clinical management and to prevent spread of infections. The gold standard for diagnosing SARS-CoV-2 infection is the real-time reverse transcription polymerase chain reaction (RT-PCR) test in upper airways swabs. However, the procedure is available in few specialized laboratories and requires an average sample processing time of about 6 hours from its inception. The development of reliable but cheaper and faster point-of-care tests was expected to be useful either for population-screening or as first aid tests in the ED. Rapid antigenic diagnostic tests (Ag-RDTs), directly detect SARS-CoV-2 proteins produced by the replicating virus in respiratory specimens, were proved to be candidates in both cases. However, data on their effectiveness are still few and controversial. The aim of the study is to establish the accuracy of antigen tests to identify SARS-CoV-2 in a high prevalence setting.
Methods
Results of 324 patients, consecutively admitted to the ED of San Luigi Gonzaga University Hospital in Orbassano (Turin, Italy) between 26 October and 10 November 2020 and subjected to both molecular and antigen tests, were compared.
Results
Using RT-PCR as gold standard, specificity and sensitivity of Ag-RDT were 0.94 (95%CI: 0.90-0.98) and 0.80 (95%CI: 0.75-0.85), respectively. The Ag-RDT positive predictive value was 0.96 (95%CI 0.93- 0.99), and the negative predictive value was 0.72 (95% CI: 0.65-0.79). Patients that tested negative to Ag-RDT but presented with fever and cough or had pneumonia at imaging were more likely to be false negatives. Ag-RDTs best performance occurs in the first days after symptom onset.
Conclusions
These results confirm the limits of antigenic tests as first line screening tests and suggest that the antigenic test should be integrated with clinical judgement, based on physical and instrumental examinations.
Key messages
Antigenic tests have a limited effectiveness as first line screening tests. In a high-prevalence setting these tests incorrectly judge as negative many COVID-19 symptomatic patients, making necessary to integrate their results with clinical judgement.
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Affiliation(s)
- F Cigliano
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - A Boccuzzi
- Emergency Department and High Dependency Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - V Basile
- Emergency Department and High Dependency Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - A Ferraro
- Emergency Department and High Dependency Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - A Macciotta
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - A Catalano
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - G Costa
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Epidemiology Unit, Regional Health Service ASLTO3, Grugliasco, Italy
| | - P Vineis
- MRC Centre for Environment and Health, Imperial College, London, UK
| | - C Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy
| | - V Caramello
- Emergency Department and High Dependency Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
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Favaro E, Saugo C, Sandu B, DeMaria M, Gnavi R, Lefevre C, Costa G. Estimation of Excess Deaths in Turin from COVID-19 and other causes, October to November 2020. Eur J Public Health 2021. [PMCID: PMC8574562 DOI: 10.1093/eurpub/ckab164.554] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Understanding the effect of COVID-19 on mortality during this emergency and evaluating unexplained increases in deaths due to nonspecific outcomes can provide a more complete picture of this period and give better instrument to deal with the pandemy in the future.
Objective
The aim is to evaluate in the city of Turin the excess in the number of deaths from October to November 2020.
Methods
The number of excess deaths was defined as the difference between the deaths observed in the pandemic period of 2020 and the deaths expected for the years 2014-2019.
Results
There were approximately 2047 total all causes deaths in Turin October 1 to November 30 2020, representing 630 more deaths than would typically be expected at that time of year. This excess was higher between men than in women. The number of excess all cause death was higher in 80 years old, less evident between 60-79 years old and very few between under 60 years old. Regarding the place of death, the number of excess all cause death was higher in hospital or in some health institutions for old people. Regarding the causes of deaths the explanation of these excess of deaths was COVID-19 infection only for a part of deaths and there are some excess of deaths not caused by COVID-19. The cause of excess of death not COVID-19 seems to be due to cardiovascular diseases, respiratory diseases, psychiatric disorders, neurological diseases, diabetes or nephrological diseases and to other undefinited causes.
Conclusions
The results showed during pandemic an increase of mortality respect to the expected mortality. Only a part of this excess deaths is due to COVID-19 but there is a relevant percentage of excess of deaths apparentely not due to COVID-19 but probably due to other causes. A better knowledge of these phenomena could help to improve any gaps in territorial assistance and provide indications for the future management of the pandemic in Europe.
Key messages
Increase of mortality in pandemic respect to the expected mortality. There is an excess of deaths apparentely not due to COVID-19.
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Affiliation(s)
- E Favaro
- University of Turin, Turin, Italy
| | - C Saugo
- University of Turin, Turin, Italy
| | - B Sandu
- University of Turin, Turin, Italy
| | - M DeMaria
- Servizio Epidemiologia Piemonte, Turin, Italy
| | - R Gnavi
- Servizio Epidemiologia Piemonte, Turin, Italy
| | - C Lefevre
- Servizio Epidemiologia Piemonte, Turin, Italy
| | - G Costa
- University of Turin, Turin, Italy
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48
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Costa G. Impact of the COVID-19 pandemic on emotional status of the adult and older population in Italy. Data from the behavioural risk factor surveillance systems PASSI and PASSI d’Argento, 2020-2021. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.544] [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: 11/14/2022] Open
Abstract
Abstract
PASSI and PASSI d'Argento are two nationwide ongoing population-based surveillance systems in Italy which targeting, respectively, adults aged 18-69 and over-65, aim at monitoring people health profile, as per health behaviours and their determinants. The Italian National Institute of Health is in charge of the central coordination, but the Local Health Units (LHUs) develop these surveillances. Specifically trained LHUs personnel conduct phone-interviews on gender and age-representative monthly samples of residents in Italy by using a standardised questionnaire. Within both systems, depressive symptoms are under investigation through the Patient Health Questionnaire-2. Since August 2020 to date, PASSI and PASSI d'Argento annexed a specific COVID module in addition to the standard questionnaires' sections. In this way, we have been studying the impact of the COVID-19 pandemic on economic and working conditions, emotional status and other health-related aspects, as well as those concerning contagion risk perception and its outcomes or citizens compliance with pandemic control measures. In detail, two questions detect the impact of the pandemic on emotional status: ‘intrusive thinking' as dimension of psychological stress associated to experiencing COVID-19 emergency, and ‘degree of concern' about the current situation as a dimension of anxiety. Even if the two items are not precise tools to assess mental health symptoms, they are in the condition to give hints for an estimation of the pandemic impact on the psychological well-being in the general population. Preliminary findings, from the analysis of 5,000 interviews, show quite direct experience of COVID (bereavements in family or COVID-positive friends), worsened economic resources among the working-age individuals, and social isolation in the elderly, as the main determinants of intrusive thinking. Being worried about pandemic also correlates with experience of COVID, showing significant differences by gender.
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Affiliation(s)
- G Costa
- Epidemiologia Piemonte, Grugliasco, Italy
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49
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Monteiro E, Pedro Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes A, Saleiro C, Campos D, Sousa J, Lopes J, Puga L, Teixeira R, Lourenco C, Madeira M, Goncalves L. Prognostic significance of percutaneous coronary intervention associated blood loss in acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Antiplatelet and anticoagulants are one of the mainstay treatment of acute coronary syndrome (ACS), however they are associated with a significant increase of bleeding risk. While anaemia is a recognized predictor of adverse outcomes, it is unknown if a variation of haemoglobin (HB) levels, even without associated anaemia, has the same impact.
Purpose
The aim of this study was to determine the prognostic impact of HB variation after percutaneous coronary intervention (PCI) in ACS patients.
Methods
Retrospective analysis of 822 consecutive patients admitted due to ACS and treated with PCI, in a single coronary intensive care unit. Delta HB – ΔHB – (HB at admission – HB 24 hours after PCI) was calculated. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether ΔHB was independent from other known factors in predicting the outcome.
Results
In the studied sample, 75.4% were male. Mean age was 66.4±13.1. ST-elevation myocardial infarction (STEMI) occurred in 45.5%, non-ST segment elevation myocardial infarction in 42.6% and unstable angina in 11 9% of the studied population. Moderate to severe systolic dysfunction was present in 23.5% of the cases. Regarding comorbidities and past medical history, 76% had hypertension (HTN), 30.3% diabetes, 16.4% chronic kidney disease (CKD), 62.2% dyslipidaemia and 10.5% heart failure (HF). Mean HB at admission was 13.8±1.8 g/dL, mean HB after PCI was 12.9±1.9 g/dL and mean ΔHB was 0.9±1.1 g/dL. The mean follow-up was 51.6±30.6 months. In univariate analysis, ΔHB was significantly associated with all-cause mortality (HR 1.15 per 1 g/dL loss, 95% CI 1.01–1.30, p=0.04), as was HB at admission, HB after PCI, age, sex, diabetes, HTN, dyslipidaemia, CKD and moderate to severe systolic dysfunction. In multivariate analysis, ΔHB remained significantly associated with the endpoint and gained even more statistical power (HR 1.25, 95% CI 1.10–1.43, p<0.01). HB at admission and after PCI, age, CKD and moderate to severe systolic dysfunction were also independent predictors of this outcome.
Conclusions
In our study, irrespective of the admission and discharge HB, ΔHB was associated with more adverse outcomes in patients submitted to PCI. Hence, even patients with a normal HB after PCI have a worse long-term prognosis if a negative variation of HB occurs. This highlights the importance of identifying and optimising all the correctable factors that might lead to an increased bleeding risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | | | - J Guimaraes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Fernandes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - G Costa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - A Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - R Teixeira
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - M Madeira
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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50
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Costa G, Goncalves L, Teixeira R. Efficacy and safety of direct oral anticoagulants with diabetes and nonvalvular atrial fibrillation: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Diabetes Mellitus (DM) is an independent risk factor for stroke and atrial fibrillation (AF). Therefore, the risk/benefit profile of the direct oral anticoagulants (DOAC) is of clinical interest.
Purpose
To compare efficacy and safety outcomes of DOAC for nonvalvular AF in patients with DM versus without DM.
Methods
We systematically searched PubMed, Embase and Cochrane databases, in January 2020, for interventional studies comparing DOAC efficacy and safety in patients with AF and diabetes versus without diabetes.
Results
Four randomized clinical trials were included, providing a total of 63987 patients, 18860 with DM and 45127 without DM. In terms of efficacy, our meta-analysis revealed a similar rate of stroke/systemic embolism (pooled OR 1.02 [0.79, 1.31], P=0.87, I2=83%), stroke (pooled OR 1.98 [0.68, 1.40], P=0.90, I2=90%) and all-cause mortality (pooled OR 1.18 [0.97, 1.43], P=0.10, I2=87%), albeit with a significant heterogeneity. However, in direct factor Xa inhibitors sub analysis, diabetic patients had a lower trend of systemic embolism/stroke (pooled OR 0.90 [0.79, 1.02], P=0.09, I2=18%), significantly lower stroke rate (pooled OR 0.82 [0.73, 0.93], P<0.01, I2=0%), but a higher all-cause mortality (pooled OR 1.08 [1.00, 1.16], P<0.01, I2=0%). In terms of safety, the diabetic patients receiving DOAC had higher rates of major bleeding events (pooled OR 1.28 [1.14, 1.45], P<0.01, I2=50%), although with significant heterogeneity. Direct factor Xa inhibitors sub analysis also revealed a higher rate of major bleeding events (pooled OR 1.22 [1.08, 1.38], P<0.01, I2=24%), but a similar intracranial bleeding events (pooled OR 1.03 [0.86, 1.24], P=0.72, I2=0%).
Conclusion
Our pooled analysis suggests that diabetic patients on DOAC have an higher bleeding risk on DOAC, although with a superior embolic protection.
Funding Acknowledgement
Type of funding sources: None. Systemic Embolism/Stroke in DM vs. NonDM
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Affiliation(s)
- G Costa
- Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Coimbra Institute for Clinical and Biomedical Research, Coimbra, Portugal
| | - R Teixeira
- Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
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