Reggio nell'Emilia, Italy
Reggio nell'Emilia, Italy

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Loupakis F.,University of Pisa | Cremolini C.,University of Pisa | Masi G.,University of Pisa | Lonardi S.,University of Pisa | And 16 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND A fluoropyrimidine plus irinotecan or oxaliplatin, combined with bevacizumab (a monoclonal antibody against vascular endothelial growth factor), is standard first-line treatment for metastatic colorectal cancer. Before the introduction of bevacizumab, chemotherapy with fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) showed superior efficacy as compared with fluorouracil, leucovorin, and irinotecan (FOLFIRI). In a phase 2 study, FOLFOXIRI plus bevacizumab showed promising activity and an acceptable rate of adverse effects.METHODS We randomly assigned 508 patients with untreated metastatic colorectal cancer to receive either FOLFIRI plus bevacizumab (control group) or FOLFOXIRI plus bevacizumab (experimental group). Up to 12 cycles of treatment were administered, followed by fluorouracil plus bevacizumab until disease progression. The primary end point was progression-free survival.RESULTS The median progression-free survival was 12.1 months in the experimental group, as compared with 9.7 months in the control group (hazard ratio for progression, 0.75; 95% confidence interval [CI], 0.62 to 0.90; P = 0.003). The objective response rate was 65% in the experimental group and 53% in the control group (P = 0.006). Overall survival was longer, but not significantly so, in the experimental group (31.0 vs. 25.8 months; hazard ratio for death, 0.79; 95% CI, 0.63 to 1.00; P = 0.054). The incidences of grade 3 or 4 neurotoxicity, stomatitis, diarrhea, and neutropenia were significantly higher in the experimental group.CONCLUSIONS FOLFOXIRI plus bevacizumab, as compared with FOLFIRI plus bevacizumab, improved the outcome in patients with metastatic colorectal cancer and increased the incidence of some adverse events. (Funded by the Gruppo Oncologico Nord Ovest and others; ClinicalTrials.gov number, NCT00719797.). Copyright © 2014 Massachusetts Medical Society. All rights reserved.


Moya A.,Autonomous University of Barcelona | Garcia-Civera R.,Hospital Clynico | Croci F.,Arrhythmologic Center | Menozzi C.,Arcispedale Santa Maria Nuova | And 7 more authors.
European Heart Journal | Year: 2011

AimsAlthough patients with syncope and bundle branch block (BBB) are at high risk of developing atrio-ventricular block, syncope may be due to other aetiologies. We performed a prospective, observational study of the clinical outcomes of patients with syncope and BBB following a systematic diagnostic approach.Methods and resultsPatients with <1 syncope in the last 6 months, with QRS duration <120 ms, were prospectively studied following a three-phase diagnostic strategy: Phase I, initial evaluation; Phase II, electrophysiological study (EPS); and Phase III, insertion of an implantable loop recorder (ILR). Overall, 323 patients (left ventricular ejection fraction 56 ± 12) were studied. The aetiological diagnosis was established in 267 (82.7) patients (102 at initial evaluation, 113 upon EPS, and 52 upon ILR) with the following aetiologies: bradyarrhythmia (202), carotid sinus syndrome (20), ventricular tachycardia (18), neurally mediated (9), orthostatic hypotension (4), drug-induced (3), secondary to cardiopulmonary disease (2), supraventricular tachycardia (1), bradycardiatachycardia (1), and non-arrhythmic (7). A pacemaker was implanted in 220 (68.1), an implantable cardioverter defibrillator in 19 (5.8), and radiofrequency catheter ablation was performed in 3 patients. Twenty patients (6) had died at an average follow-up of 19.2 ± 8.2 months.ConclusionIn patients with syncope, BBB, and mean left ventricular ejection fraction of 56 ± 12, a systematic diagnostic approach achieves a high rate of aetiological diagnosis and allows to select specific treatment. © 2010 The Author.


Becattini C.,University of Perugia | Agnelli G.,University of Perugia | Schenone A.,Galliera Hospital | Eichinger S.,Medical University of Vienna | And 8 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: About 20% of patients with unprovoked venous thromboembolism have a recurrence within 2 years after the withdrawal of oral anticoagulant therapy. Extending anticoagulation prevents recurrences but is associated with increased bleeding. The benefit of aspirin for the prevention of recurrent venous thromboembolism is unknown. METHODS:In this multicenter, investigator-initiated, double-blind study, patients with first-ever unprovoked venous thromboembolism who had completed 6 to 18 months of oral anticoagulant treatment were randomly assigned to aspirin, 100 mg daily, or placebo for 2 years, with the option of extending the study treatment. The primary efficacy outcome was recurrence of venous thromboembolism, and major bleeding was the primary safety outcome. RESULTS:Venous thromboembolism recurred in 28 of the 205 patients who received aspirin and in 43 of the 197 patients who received placebo (6.6% vs. 11.2% per year; hazard ratio, 0.58; 95% confidence interval [CI], 0.36 to 0.93) (median study period, 24.6 months). During a median treatment period of 23.9 months, 23 patients taking aspirin and 39 taking placebo had a recurrence (5.9% vs. 11.0% per year; hazard ratio, 0.55; 95% CI, 0.33 to 0.92). One patient in each treatment group had a major bleeding episode. Adverse events were similar in the two groups. CONCLUSIONS: Aspirin reduced the risk of recurrence when given to patients with unprovoked venous thromboembolism who had discontinued anticoagulant treatment, with no apparent increase in the risk of major bleeding. (Funded by the University of Perugia and others; WARFASA ClinicalTrials.gov number, NCT00222677.) Copyright © 2012 Massachusetts Medical Society.


Longo C.,Skin Cancer Unit | Longo C.,Medical University of Graz | Zalaudek I.,Skin Cancer Unit | Moscarella E.,Skin Cancer Unit | And 4 more authors.
Journal of the European Academy of Dermatology and Venereology | Year: 2014

Background The diagnosis of clonal seborrheic keratosis may be challenging clinically and histologically.Objective In our study, we describe the common aspects of this benign entity that show peculiar dermoscopic and confocal findings.Methods A total of nine clonal seborrheic keratosis were analyzed. Results Upon dermoscopy, it reveals the presence of globular-like structures and sharply demarcated borders whereas confocal microscopy displays the typical intraepidermal nesting of pigmented keratinocytes that permits to have a reliable in vivo diagnosis.Conclusions Dermoscopy and confocal microscopy permit to in vivo diagnose this variant of seborrheic keratosis. © 2013 European Academy of Dermatology and Venereology.


Rivetti S.,Servizio Fisica Sanitaria | Lanconelli N.,University of Bologna | Bertolini M.,Arcispedale Santa Maria Nuova | Nitrosi A.,Arcispedale Santa Maria Nuova | And 2 more authors.
Medical Physics | Year: 2010

Purpose: In this study, five different units based on three different technologies-traditional computed radiography (CR) units with granular phosphor and single-side reading, granular phosphor and dual-side reading, and columnar phosphor and line-scanning reading-are compared in terms of physical characterization and contrast detail analysis. Methods: The physical characterization of the five systems was obtained with the standard beam condition RQA5. Three of the units have been developed by FUJIFILM (FCR ST-VI, FCR ST-BD, and FCR Velocity U), one by Kodak (Direct View CR 975), and one by Agfa (DX-S). The quantitative comparison is based on the calculation of the modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE). Noise investigation was also achieved by using a relative standard deviation analysis. Psychophysical characterization is assessed by performing a contrast detail analysis with an automatic reading of CDRAD images. Results: The most advanced units based on columnar phosphors provide MTF values in line or better than those from conventional CR systems. The greater thickness of the columnar phosphor improves the efficiency, allowing for enhanced noise properties. In fact, NPS values for standard CR systems are remarkably higher for all the investigated exposures and especially for frequencies up to 3.5 lp/mm. As a consequence, DQE values for the three units based on columnar phosphors and line-scanning reading, or granular phosphor and dual-side reading, are neatly better than those from conventional CR systems. Actually, DQE values of about 40% are easily achievable for all the investigated exposures. Conclusions: This study suggests that systems based on the dual-side reading or line-scanning reading with columnar phosphors provide a remarkable improvement when compared to conventional CR units and yield results in line with those obtained from most digital detectors for radiography. © 2010 American Association of Physicists in Medicine.


Rivetti S.,University of Bologna | Lanconelli N.,University of Bologna | Bertolini M.,Arcispedale Santa Maria Nuova | Acchiappati D.,Science di Fisica Sanitaria Azienda USL di Modena
Medical Physics | Year: 2011

Purpose: Here, we present a physical and psychophysical characterization of a new clinical unit (named AcSelerate) for digital radiography based on a thick a-Se layer. We also compared images acquired with and without a software filter (named CRF) developed for reducing sharpness and noise of the images and making them similar to images coming from traditional computed radiography systems. Methods: The characterization was achieved in terms of physical figures of merit modulation transfer function (MTF), noise power spectra (NPS), detective quantum efficiency (DQE), and psychophysical parameters (contrast-detail analysis with an automatic reading of CDRAD images). We accomplished measurements with four standard beam conditions: RAQ3, RQA5, RQA7, and RQA9. Results: The system shows an excellent MTF (about 50 at the Nyquist frequency). The DQE is about 55 at 0.5 lpmm and above 20 at the Nyquist frequency and is almost independent from exposure. The contrast-detail curves are comparable to some of the best published data for other systems devoted to imaging in general radiography. The CRF filter influences both the MTF and NPS, but it does lead to very small changes on DQE. Also the visibility of CDRAD details is basically unaltered, when the filter is activated. Conclusions: As normally happens with detector based on direct conversion, the system presents an excellent MTF. The improved efficiency caused by the thick layer allows getting good noise characteristics and DQE results better (about 10 on average) than many of the computed radiography (CR) systems and comparable to those obtained by the best systems for digital radiography available on the market. © 2011 American Association of Physicists in Medicine.


Maraldi T.,University of Modena and Reggio Emilia | Riccio M.,University of Modena and Reggio Emilia | Pisciotta A.,University of Modena and Reggio Emilia | Zavatti M.,University of Modena and Reggio Emilia | And 5 more authors.
Stem Cell Research and Therapy | Year: 2013

Introduction. The main aim of this study is to evaluate potential human stem cells, such as dental pulp stem cells and amniotic fluid stem cells, combined with collagen scaffold to reconstruct critical-size cranial bone defects in an animal model. Methods. We performed two symmetric full-thickness cranial defects on each parietal region of rats and we replenished them with collagen scaffolds with or without stem cells already seeded into and addressed towards osteogenic lineage in vitro. After 4 and 8 weeks, cranial tissue samples were taken for histological and immunofluorescence analysis. Results: We observed a new bone formation in all of the samples but the most relevant differences in defect correction were shown by stem cell-collagen samples 4 weeks after implant, suggesting a faster regeneration ability of the combined constructs. The presence of human cells in the newly formed bone was confirmed by confocal analysis with an antibody directed to a human mitochondrial protein. Furthermore, human cells were found to be an essential part of new vessel formation in the scaffold. Conclusion: These data confirmed the strong potential of bioengineered constructs of stem cell-collagen scaffold for correcting large cranial defects in an animal model and highlighting the role of stem cells in neovascularization during skeletal defect reconstruction. © 2013 Maraldi et al.; licensee BioMed Central Ltd.


Valli R.,Arcispedale Santa Maria Nuova | Piana S.,Arcispedale Santa Maria Nuova | Capodanno I.,Arcispedale Santa Maria Nuova | Cavazza A.,Arcispedale Santa Maria Nuova
International Journal of Surgical Pathology | Year: 2011

Primary renal lymphomas are very rare, and primary kidney-limited lymphomas with cystic presentation have never been described before. This study reports a case of diffuse large B-cell lymphoma associated with chronic inflammation occurring in a renal pseudocyst: an infrequent neoplasm with an unusual and subtle clinical presentation. © 2011 The Author(s).


Pipitone N.,Arcispedale Santa Maria Nuova | Salvarani C.,Arcispedale Santa Maria Nuova
Arthritis Research and Therapy | Year: 2011

Aortitis is a general term denoting inflammation of the aortic wall. Various infectious and non-infectious diseases can be complicated by aortitis; in addition, isolated idiopathic aortitis has also been described. In a 12-year nationwide Danish population-based study, the prevalence of aortitis among 1,210 resected thoracic aorta samples was 6.1%, with nearly three-quarters of cases being idiopathic. Identified risk factors for aortitis included advanced age, a history of connective tissue disease, diabetes mellitus, and heart valve pathology. As in virtually all pathological studies, this study has a bias toward reporting the most severe cases of aortitis requiring surgical repair. © 2011 BioMed Central Ltd.


Pipitone N.,Arcispedale Santa Maria Nuova
Current Opinion in Rheumatology | Year: 2016

PURPOSE OF REVIEW: This review aims at covering the role of muscle MRI in supporting the diagnosis of myositis, in aiding to differentiate it from other muscle disorders, and in monitoring myositis patients over time by assessing response to treatment and by discriminating between muscle inflammation and chronic damage. RECENT FINDINGS: MRI can assist in ‘pattern recognition’ of muscle involvement across numerous myopathies, including myositis. Novel applications of magnetic resonance such as cardiac MRI, MR elastography and blood oxigenation level-dependent magnetic resonance can shed light on different aspects of myositis and usefully complement conventional MRI in assessing patients with myositis. SUMMARY: MRI can guide therapy by determining whether muscle weakness is related to edema (active inflammation) or muscle atrophy/fat replacement (chronic damage). There is a need to better standardize the assessment of MRI findings in myositis to provide defined outcome measures for use in clinical trials. VIDEO ABSTRACT: Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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