Eller-Vainicher C.,Fondazione Instituto Of Ricovero E Cura A Carattere Scientifico Ca Granda Ospedale Maggiore |
Chiodini I.,Fondazione Instituto Of Ricovero E Cura A Carattere Scientifico Ca Granda Ospedale Maggiore |
Santi I.,Instituto Geriatrico Azienda Of Servizi Alla Persona Istituti Milanesi Martinitt elline |
Massarotti M.,Instituto Of Ricovero E Cura A Carattere Scientifico Humanitas |
And 8 more authors.
PLoS ONE | Year: 2011
Background: It is known that bone mineral density (BMD) predicts the fracture's risk only partially and the severity and number of vertebral fractures are predictive of subsequent osteoporotic fractures (OF). Spinal deformity index (SDI) integrates the severity and number of morphometric vertebral fractures. Nowadays, there is interest in developing algorithms that use traditional statistics for predicting OF. Some studies suggest their poor sensitivity. Artificial Neural Networks (ANNs) could represent an alternative. So far, no study investigated ANNs ability in predicting OF and SDI. The aim of the present study is to compare ANNs and Logistic Regression (LR) in recognising, on the basis of osteoporotic risk-factors and other clinical information, patients with SDI≥1 and SDI≥5 from those with SDI = 0. Methodology: We compared ANNs prognostic performance with that of LR in identifying SDI≥1/SDI≥5 in 372 women with postmenopausal-osteoporosis (SDI≥1, n = 176; SDI = 0, n = 196; SDI≥5, n = 51), using 45 variables (44 clinical parameters plus BMD). ANNs were allowed to choose relevant input data automatically (TWIST-system-Semeion). Among 45 variables, 17 and 25 were selected by TWIST-system-Semeion, in SDI≥1 vs SDI = 0 (first) and SDI≥5 vs SDI = 0 (second) analysis. In the first analysis sensitivity of LR and ANNs was 35.8% and 72.5%, specificity 76.5% and 78.5% and accuracy 56.2% and 75.5%, respectively. In the second analysis, sensitivity of LR and ANNs was 37.3% and 74.8%, specificity 90.3% and 87.8%, and accuracy 63.8% and 81.3%, respectively. Conclusions: ANNs showed a better performance in identifying both SDI≥1 and SDI≥5, with a higher sensitivity, suggesting its promising role in the development of algorithm for predicting OF. © 2011 Eller-Vainicher et al.
Hale A.,St Martins Hospital |
Mencacci C.,Azienda Ospedaliera Fatebenefratelli e Oftalmico |
Ruiz J.S.,Hospital Ramon y Cajal |
International Clinical Psychopharmacology | Year: 2010
The objective of this international, 8-week, randomized, double-blind study was to show the superiority of the antidepressant efficacy of agomelatine, the first MT1/MT2 receptor agonist and 5-HT2C receptor antagonist antidepressant, versus fluoxetine in outpatients fulfilling Diagnostic and Statistical Manual of Mental Disorders-volume IV-TR criteria for major depressive disorder of severe intensity, defined by a baseline Hamilton Depression Rating Scale (HAM-D 17) total score of at least 25 and CGI severity of illness score of at least 4. Patients received agomelatine 25-50mg/day (n=252) or fluoxetine 20-40mg/day (n=263) for 8 weeks. The main efficacy outcome measure was HAM-D17 total score (change from baseline to last post-baseline assessment). Secondary outcome measures were Clinical Global Impressions-improvement (CGI), severity (CGI-S), anxiety (HAM-A), and sleep (HAM-D sleep items) scores. The mean decrease in HAM-D17 total score over 8 weeks was significantly greater with agomelatine than fluoxetine with a between-group difference of 1.49 (95% confidence interval, 0.20-2.77; P=0.024). The percentage of responders at last post-baseline assessment was higher with agomelatine on both HAM-D17 (decrease in total score from baseline >50%; 71.7% agomelatine vs. 63.8% fluoxetine; P=0.060) and CGI-improvement (score 1 or 2; 77.7 vs. 68.8%; P=0.023). There was a significant between-group difference of 0.37 (95% confidence interval, 0.06-0.68) in HAM-D sleep subscore in favor of agomelatine (P=0.018). Similar improvements were observed on HAM-A with agomelatine and fluoxetine. Both treatments were safe and well tolerated. In conclusion, in this study, agomelatine showed superior antidepressant efficacy over fluoxetine in treating patients with a severe episode of major depressive disorder after 8 weeks of treatment with a good tolerability profile. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
PubMed | Azienda Ospedaliera San Bortolo, University of Cagliari, Azienda Ospedaliera Universitaria, Ospedale Santa Corona and 14 more.
Type: Journal Article | Journal: Cardiovascular revascularization medicine : including molecular interventions | Year: 2015
The Absorb BVS is a bioresorbable, everolimus-eluting scaffold approved and marketed for coronary use. Published data on long-term results after treatment are limited to a small number of patients, most of them with elective PCI of simple lesions. The importance of scaffold resorption is variably appreciated among cardiologists, and indications for use from health technology assessment bodies or guidelines are missing. Instruments are needed to collect, share and assess the experience being accumulated with this new device in several centres.The BVS-RAI Registry is a spontaneous initiative of a group of Italian interventional cardiologists in cooperation with Centro di Ricerche Farmacologiche e Biomediche Mario Negri Institute, and is not recipient of funding or benefits originating from the BVS manufacturer. It is a prospective registry with 5-year follow-up of all consecutive patients who have undergone successful implantation of 1 or more coronary BVS following the indications, techniques and protocols used in each of the participating institutions. Outcome measures are BVS target lesion failure within one year and device-oriented major adverse cardiac events within 5years. The registry started in October 2012 and will extend enrolment throughout 2015, with the aim to include about 1000 patients. ClinicalTrials.gov identifier is CT02298413.The BVS-RAI Registry will contribute observational knowledge on the long-term safety and efficacy of the Absorb BVS as used in a number of Italian interventional centres in a broad spectrum of settings. Unrewarded and undirected consecutive patient enrolments are key-features of this observation, which is therefore likely to reflect common clinical practice in those centres.
Saibeni S.,Azienda Ospedaliera Fatebenefratelli e Oftalmico |
Saladino V.,Gastroenterology and Gastrointestinal Endoscopy Service |
Chantarangkul V.,Angelo Bianchi Bonomi Haemophilia and Thrombosis Center |
Villa F.,Gastroenterology and Gastrointestinal Endoscopy Service |
And 5 more authors.
Thrombosis Research | Year: 2010
Background: Inflammatory bowel diseases (IBD) are characterized by an increased thrombotic risk of uncertain etiology. Endogenous thrombin potential (ETP), a parameter of the thrombin generation curve, represents a new tool in the evaluation of thrombotic and bleeding disorders. Aims: To study ETP in IBD patients and to correlate the results with clinical and biochemical features. Methods: Seventy-four IBD patients (37 ulcerative colitis and 37 Crohn's disease) and 74 sex- and age-matched healthy individuals. ETP was measured upon activation of coagulation with small amounts of tissue factor and phospholipids in the presence or absence of thrombomodulin; results were expressed as nM thrombin·minutes. Results: Mean±SD ETP values were significantly higher in patients (1,499 ± 454) than controls (1,261 ± 385) (p < 0.001) only when the test was performed in the presence of thrombomodulin. ETP evaluated as ratio (with/without thrombomodulin), taken as an index of hypercoagulability, was significantly higher in patients (0.69 ± 0.14) than controls (0.62 ± 0.18) (p < 0.006). Patients with increased C-reactive protein (CRP) had significantly higher mean ETP (1,721 ± 458) than those with normal CRP (1,357 ± 394) or controls (1,261 ± 385) (p < 0.001). Patients who at the time of blood sampling were classified as having a clinically active disease had ETP higher than those who were quiescent (1,655 ± 451 versus 1,388 ± 427, p < 0.001) or controls (1,261 ± 385, p < 0.001). Conclusions: ETP measured in the presence of thrombomodulin or as ratio (with/without thrombomodulin) is increased in IBD patients, mainly in those with increased CRP or active disease. It may be considered as a candidate test for prospective studies aimed at assessing the risk of thrombosis in IBD patients. © 2009 Elsevier Ltd. All rights reserved.
Di Meo I.,Institute of Neurology Carlo Besta IRCCS Foundation |
Fagiolari G.,Ferrari |
Prelle A.,Azienda Ospedaliera Fatebenefratelli e Oftalmico |
Viscomi C.,Institute of Neurology Carlo Besta IRCCS Foundation |
And 2 more authors.
Antioxidants and Redox Signaling | Year: 2011
Ethylmalonic encephalopathy (EE) is an autosomal recessive, invariably fatal disorder associated with mutations in ETHE1, a gene encoding a mitochondrial sulfur dioxygenase (SDO). The main consequence of the absence of Ethe1-SDO is the accumulation of sulfide (H 2S) in critical tissues, including colonic mucosa, liver, muscle, and brain. To make progress in the elucidation of the biochemical mechanisms leading to cytochrome c oxidase (COX) deficiency, we (i) generated tissue-specific conditional Ethe1 knockout mice to clarify the different contributions of endogenous and exogenous H 2S production, and (ii) studied the development of H 2S-driven COX deficiency in Ethe1 -/- mouse tissues and human cells. Ethe1 -/- conditional animals displayed COX deficiency limited to the specific targeted tissue. The accumulation of H 2S over time causes progressive COX deficiency in animal tissues and human cells, which is associated with reduced amount of COX holoenzyme, and of several COX subunits, including mitochondrially encoded cytochrome c oxidase 1 (MTCO1), MTCO2, COX4, and COX5A. This reduction is not paralleled by consistent downregulation in expression of the corresponding mRNAs. Tissue-specific ablation of Ethe1 causes COX deficiency in targeted organs, suggesting that failure in neutralizing endogenous, tissue-specific production of H 2S is sufficient to cause the biochemical defect but neither to determine a clinical impact nor to induce the biomarker profile typical of EE. The mechanism by which H 2S causes COX deficiency consists of rapid heme a inhibition and accelerated long-term degradation of COX subunits. However, the pleiotropic devastating effects of H 2S accumulation in EE cannot be fully explained by the sole defect of COX in critical tissues, but are likely consequent to several toxic actions on a number of enzymatic activities in different tissues, including endothelial lining of the small vessels, leading to multiorgan failure. © Copyright 2011, Mary Ann Liebert, Inc.
La Verde N.,Azienda Ospedaliera Fatebenefratelli e Oftalmico |
Piva S.,Azienda Ospedaliera Fatebenefratelli e Oftalmico |
Ganzinelli M.,Irccs Instituto Of Ricerche Farmacologiche Mario Negri |
Farina G.,Azienda Ospedaliera Fatebenefratelli e Oftalmico |
And 5 more authors.
Future Oncology | Year: 2013
Eribulin mesylate is approved for the treatment of metastatic breast cancer after progression with anthracyclines and taxanes. Here we report the case of a woman with triple-negative breast cancer who, after nine lines of chemotherapy, showed striking primary tumor shrinkage and regression of metastatic lesions with eribulin treatment. This response allowed the patient to undergo debulking surgery. Even though the patient was heavily pretreated, eribulin was well tolerated and improved her quality of life. Biological analysis of tumor specimens was performed to investigate the underlying mechanism of action of the drug. © 2013 Future Medicine Ltd.
Tontini G.E.,University of Milan |
Rondonotti E.,University of Milan |
Saladino V.,Fondazione IRCCS Ospedale Policlinico |
Saibeni S.,Azienda Ospedaliera Fatebenefratelli e Oftalmico |
And 2 more authors.
Digestion | Year: 2010
Aims: To evaluate health-related quality of life (HRQoL) in celiac disease (CD) patients at the time of diagnosis and during a gluten-free diet (GFD). Patients and Methods: We enrolled 43 adult CD patients (18 with a typical and 15 with an atypical clinical presentation, and 10 with dermatitis herpetiformis, DH) and 86 age- and sex-matched healthy controls. We administered the Short Form 36 Health Survey (SF-36) questionnaire at diagnosis and after 1, 12 and 24 months of a GFD. Results: At the time of diagnosis CD patients showed significantly lower SF-36 scores than controls; this figure was observed in women but not in men. At baseline, both typical and atypical CD patients had lower SF-36 scores than controls, while DH patients showed a SF-36 profile comparable to that of controls. During a GFD the SF-36 scores improved continuously in CD patients and in the female subgroup, becoming similar to those of matched controls at 1-year follow-up. After gluten withdrawal typical and atypical CD patients improved their SF-36 scores and reached values comparable to those of controls. Conclusions: At diagnosis, CD patients perceived a poor HRQoL; this figure appears to be mostly associated with female gender. In all subgroups of CD patients with a low HRQoL at diagnosis, the GFD allowed progressive restoration of HRQoL perception. Copyright © 2010 S. Karger AG, Basel.
Santoro D.,University of Milan |
Colombo I.,University of Milan |
Ghione I.,University of Milan |
Peverelli L.,University of Milan |
And 3 more authors.
Neurological Sciences | Year: 2011
Hashimoto's encephalopathy (HE) is a rare neurological disorder with a heterogeneous group of neurological symptoms associated with high titres of antithyroid antibodies. Clinical manifestations may include encephalopathic features such as seizures, behavioural and psychiatric manifestations, movement disorders and coma. The objective of this presentation is to describe a patient with this rare and controversial clinical syndrome mimicking Creutzfeldt-Jakob disease, associated with a Hashimoto euthyroid thyroiditis and with a significant response to high dose intravenous prednisone. The responsiveness of this syndrome to steroids suggests that this disorder involves immune pathogenic mechanisms, as previous reviews reported. © 2011 Springer-Verlag.
Rubrichi S.,University of Pavia |
Battistotti A.,Azienda Ospedaliera Fatebenefratelli e Oftalmico |
Quaglini S.,University of Pavia
Journal of Biomedical Informatics | Year: 2014
Effective communication between patients and health services providers is a key aspect for optimizing and maintaining these services. This work describes a system for the automatic evaluation of users' perception of the quality of SmsCup, a reminder system for outpatient visits based on short message service (SMS). The final purpose is the creation of a closed-loop control system for the outpatient service, where patients' complaints and comments represent a feedback that can be used for a better implementation of the service itself. Methods: SmsCup was adopted since about eight years by an Italian healthcare organization, with very good results in reducing the no-show (missing visits) phenomenon. During these years, a number of citizens, even if not required, sent a message back, with comments about the service. The automatic interpretation of the content of those SMS may be useful for monitoring and improving service performances.Yet, due to the complex nature of SMS language, their interpretation represents an ongoing challenge. The proposed system uses conditional random fields as the information extraction method for classifying messages into several semantic categories. The categories refer to appreciation of the service or complaints of various types. Then, the system analyzes the extracted content and provides feedback to the service providers, making them learning and acting on this basis. Results: At each step, the content of the messages reveals the actual state of the service as well as the efficacy of corrective actions previously undertaken. Our evaluations showed that: (i) the SMS classification system has achieved good overall performance with an average F1-measure and an overall accuracy of about 92%; (ii) the notification of the patients' feedbacks to service providers showed a positive impact on service functioning. Conclusions: Our study proposed an interactive patient-centered system for continuous monitoring of the service quality. It has demonstrated the feasibility of a tool for the analysis and notification of the patients' feedback on their service experiences, which would support a more regular access to the service. © 2014 Elsevier Inc.
PubMed | Azienda Ospedaliera Fatebenefratelli e Oftalmico
Type: Case Reports | Journal: Anti-cancer drugs | Year: 2012
Breast cancer is the leading cause of neoplasia-related deaths among women, but no data are available in the literature on the safe use of oncological treatments in glucose 6-phosphate dehydrogenase (G6PD)-deficient patients. This case report describes, for the first time, the treatment of a G6PD-deficient woman diagnosed with breast cancer who underwent adjuvant treatment after quadrantectomy and axillary node dissection. After conservative surgery, many patients require adjuvant treatment with hormone therapy (HT) and/or chemotherapy. Anthracyclines are considered a cornerstone in this setting but, because of their oxidative properties, are contraindicated in G6PD-deficient patients. Despite the absence of data in the literature on their use in G6PD-deficient patients, we chose to use docetaxel and cyclophosphamide because these agents were not predicted to elicit oxidative stress. The patient completed six cycles of docetaxel and cyclophosphamide chemotherapy, and no adverse reactions were observed. Tamoxifen was excluded as a HT as a nonoxidative agent was required; therefore, an aromatase inhibitor was used as adjuvant therapy. Considering the high frequency of breast cancer and G6PD deficiency worldwide, there are little data available in the literature on the oxidative properties of oncological drugs. The oncological community must report cases in which patients with hereditary enzymatic deficiencies are treated successfully with anticancer agents. This would enable clinicians to have access to data that would be very useful in the choice of a safe treatment program.