Villa E.,University of Modena and Reggio Emilia |
Karampatou A.,University of Modena and Reggio Emilia |
Camm C.,University of Palermo |
Di Leo A.,University of Bari |
And 14 more authors.
Gastroenterology | Year: 2011
Background & Aims: Chronic hepatitis C (CHC) and liver fibrosis progress more rapidly in men and menopausal women than in women of reproductive age. We investigated the associations among menopause, sustained virologic response (SVR), and liver damage in patients with CHC. Methods: We performed a prospective study of 1000 consecutive, treatment-nave patients 18 years of age and older with compensated liver disease from CHC. Liver biopsy samples were analyzed (for fibrosis, inflammation, and steatosis) before patients received standard antiviral therapy. From women (n = 442), we collected data on the presence, type, and timing of menopause; associated hormone and metabolic features; serum levels of interleukin-6; and hepatic tumor necrosis factor (TNF)-α. Results: Postmenopausal women achieved SVRs less frequently than women of reproductive age (46.0% vs 67.5%; P < .0001) but as frequently as men (51.1%; P = .283). By multivariate regression analysis, independent significant predictors for women to not achieve an SVR were early menopause (odds ratio [OR], 8.055; 95% confidence interval [CI], 1.83425.350), levels of γ-glutamyl transpeptidase (OR, 2.165; 95% CI, 1.3643.436), infection with hepatitis C virus genotype 1 or 4 (OR, 3.861; 95% CI, 2.4336.134), and cholesterol levels (OR, 0.985; 95% CI, 0.9710.998). Early menopause was the only independent factor that predicted lack of an SVR among women with genotype 1 hepatitis C virus infection (OR, 3.933; 95% CI, 1.27412.142). Baseline levels of liver inflammation, fibrosis, steatosis, serum interleukin-6 (P = .04), and hepatic TNF-α (P = .007) were significantly higher among postmenopausal women than women of reproductive age. Conclusions: Among women with CHC, early menopause was associated with a low likelihood of SVR, probably because of inflammatory factors that change at menopause. © 2011 AGA Institute.
Montagnani F.,Oncology Unit |
Turrisi G.,Oncology Unit |
Marinozzi C.,AUSL |
Aliberti C.,Interventional Radiology Unit |
Fiorentini G.,Oncology Unit
Gastric Cancer | Year: 2011
Background: Cisplatin has been largely used in the treatment of advanced, unresectable gastric cancer, mainly in combinations with fluoropyrimidines and anthracyclines. Oxaliplatin has been shown to be at least as effective as cisplatin for this disease, but with less toxicity and a better tolerability profile, especially for older patients. We performed a systematic review of the literature to address and quantify differences in the efficacy and the safety between oxaliplatin and cisplatin for the treatment of this disease. Methods: The literature was searched for randomized controlled trials (RCTs) comparing oxaliplatin to cisplatin. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to analyze dichotomous variables. Hazard ratios (HRs) for progression and death were combined with an inverse variance method based on logarithmic conversion. A fixed effect model and Mantel-Haenszel's (M-H) method were used. Heterogeneity was tested with the Q test and the I 2 value. Sensitivity analyses were performed. Results: Three RCTs were identified, involving a total of 1294 patients. Oxaliplatin significantly improved progression-free survival (HR = 0.88, p = 0.02) and overall survival (HR = 0.88, p = 0.04). Moreover, it was associated with less neutropenia (OR = 0.53, p < 0.01) and fewer thromboembolic events (OR = 0.42, p < 0.01), but it was also associated with increased neurotoxicity (OR = 6.91, p < 0.01). Conclusions: Our results support the existence of a small but significant survival benefit of oxaliplatin over cisplatin. Oxaliplatin is associated with less toxicity and better tolerability, especially in older patients and when used in two-drug, bi-weekly regimens. © 2011 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.
Italian Journal of Medicine | Year: 2013
Traditional anticoagulants, such as low molecular weight heparin, unfractionated heparin, fondaparinux and vitamin K antagonists, have been the mainstay of treatment of venous thromboembolism (VTE) in the clinical hospital setting and after discharge. These anticoagulants are effective, but are associated with some limitations that may lead to their underuse in many settings. Based on the results of large, randomized clinical trials, new oral anticoagulants have been validated for the treatment of acute deep vein thrombosis and pulmonary embolism, and for the prevention of recurrent VTE. These drugs represent a landmark shift in anticoagulation care and may overcome some of the limitations of traditional agents, with the potential of improving adherence to anticoagulation therapy. ©Copyright D. Imberti, 2013.
Marchesi C.,University of Parma |
Ossola P.,University of Parma |
Tonna M.,AUSL |
De Panfilis C.,University of Parma
Comprehensive Psychiatry | Year: 2014
Background This study evaluates whether the difference in Toronto Alexithymia Scale-20 item (TAS-20) between patients with major depression (MD), panic disorder (PD), eating disorders (ED), and substance use disorders (SUD) and healthy controls persisted after controlling for the severity of anxiety and depression. Methods Thirty-eight patients with MD, 58 with PD, 52 with ED, and 30 with SUD and 78 healthy controls (C) completed the TAS-20, the Hamilton Rating Scale for Anxiety (Ham-A), the Hamilton Rating Scale for Depression (Ham-D). Results The differences in TAS-20 scores observed between patient groups, regardless of the type of their disorders, and controls disappeared after controlling for the effect of anxiety and depression severity. In contrast, the differences in severity of anxiety and depression between patients and controls were still present, after excluding the effect of alexithymic levels. Conclusions Our data suggest that alexithymic levels, as measured by the TAS-20, are modulated by the severity of symptoms, supporting the view that alexithymia can represent a state phenomenon in patients with MD, PD, ED and SUD, because the TAS-20 seems overly sensitive to a general distress syndrome, and it is more likely to measure negative affects rather than alexithymia itself. © 2014 Elsevier Inc.
Cravaro V.R.,University of Florence |
Journal of Psychopathology | Year: 2014
During the last 20 years, early phases of psychotic disorders have become one of the major clinical and research issues in psychiatry. It is well known since the last century that schizophrenia and psychotic disorders are characterised by a subclinical prodromal phase that can last weeks, months, or even years before the onset of overt psychotic symptoms. The prodromal phase is important in defining potential risk-markers of progression to psychotic illness and as a target for new biological and psychological treatments to prevent a transition to psychosis. Furthermore, the focus on early phases of psychotic disorders may improve the long term outcomes of patients by reducing the duration of untreated illness 1-3. For all these reasons, during the last two decades a clinical "At Risk Mental State" syndrome and its operational criteria have been described leading to the development of two main early detection approaches: the ultra high risk approach (UHR) and the basic symptoms (BS) approach, each with its assessing instruments. Beside these, another important research front is that of anomalous self-experiences (ASE). ASE have been already widely detailed in early phenomenological descriptions of the core features of schizophrenia that might surface in the prodromal phases. The integration of these approaches could be of great value to enrich current operational criteria with a deeper, experience-close understanding of the unique, subjective perspective of individuals at risk of developing a psychosis. However, the integration of these approaches is not a mere juxtaposition of terms. Indeed, the field of early detection is vexed by an increasing terminological confusion related to the lack of an international consensus catalogue of terms that facilitate the bibliometric proliferation of new expressions that do not allow facile comparison of results from all the early psychosis research groups worldwide 4. Likewise, to date, a diagnostic category for prodromal phases has not yet been included in DSM or ICD despite the presence of the "attenuated psychotic syndrome" in the appendix of the new DSM-5 as a condition for further study 5. From a conceptual point of view, the integration of UHR, BS and ASE approaches awaken the discussion about the existence or not of a psychotic continuum with schizophrenic and affective psychoses at the extremes. Indeed, if the former has been used for the evaluation and monitoring of individuals at high risk of developing a psychotic disorder, the latter describes and assesses a set of symptoms characteristic of schizophrenia spectrum disorders. In closing, we describe the clinical staging model as well as the clinical and research benefits and disadvantages that it could bring for early psychosis.