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Montereale Valcellina, Italy

Polesel J.,Centro Of Riferimento Oncologico | Franceschi S.,International Agency for Research on Cancer | Talamini R.,Centro Of Riferimento Oncologico | Negri E.,Mario Negri Institute for Pharmacological Research | And 8 more authors.
Oral Oncology

Nasopharyngeal carcinoma (NPC) is rare in western Countries. Tobacco smoking is a well-recognised risk factor, whereas the role of alcohol drinking is still in debate. We conducted a hospital-based case-control study in Italy on 150, histologically-confirmed, NPC cases of Caucasian ethnicity, aged 18-76 years, including 118 undifferentiated NPCs and 22 differentiated squamous-cell NPC. Controls were 450 Caucasian cancer-free patients admitted to general hospitals for acute conditions. Cases and controls were matched according to sex, age, and place of residence. Logistic regression was used to estimate odds ratios (OR) and the corresponding 95% confidence intervals (CI) while adjusting for known confounders. No significant association emerged between tobacco smoking and all NPCs (OR for current vs. never smokers = 1.52; 95% CI: 0.89-2.60). Conversely, for differentiated NPC only, statistically significant elevated OR were associated with increasing smoking intensity (OR for ≥ 15 cigarettes/day = 5.40; 95% CI: 1.34-21.76) and duration of the habit (OR for ≥ 32 years = 4.48; 95% CI: 1.11-18.04). Although alcohol drinking was not, per se, significantly associated to NPC risk, the combination of tobacco smoking and alcohol drinking accounted for 57% of differentiated NPCs, whereas it accounted for only 14% of undifferentiated carcinomas. Our findings suggest that, in western populations, NPC includes two separate entities: the differentiated NPC, associated with tobacco smoking like other cancers of head and neck, and the undifferentiated NPC, upon which tobacco smoking has little or no influence. © 2011 Elsevier Ltd. All rights reserved. Source

Damman K.,University of Groningen | Masson S.,Istituto di Ricerche Farmacologiche Mario Negri | Hillege H.L.,University of Groningen | Voors A.A.,University of Groningen | And 8 more authors.
JACC: Heart Failure

Objectives: This study sought to investigate the relationship between tubular damage and worsening renal function (WRF) inchronic heart failure (HF). Background: WRF is associated with poor outcome in chronic HF. It is unclear whether urinary tubular markers may identify patients at risk for WRF. Methods: In 2,011 patients with chronic HF, we evaluated the ability of urinary tubular markers ( N-acetyl-beta- d-glucosaminidase (NAG), kidney injury molecule (KIM)-1, and neutrophil gelatinase-associated lipocalin (NGAL) to predict WRF. Finally, we assessed the prognostic importance of WRF. Results: A total of 290 patients (14.4%) experienced WRF during follow-up, and WRF was a strong and independent predictor of all-cause mortality and HF hospitalizations (hazard ratio [HR]: 2.87; 95% CI: 2.40 to 3.43; p< 0.001). Patients with WRF had lower baseline glomerular filtration rate and higher KIM-1, NAG, and NGAL levels. In a multivariable-adjusted model, KIM-1 was the strongest independent predictor of WRF (HR: 1.23; 95% CI: 1.09 to 1.39 per log increase; p= 0.001). Conclusions: WRF was associated with strongly impaired outcome in patients with chronic HF. Increased level of urinary KIM-1 was the strongest independent predictor of WRF and could therefore be used to identify patients at risk for WRF and poor clinical outcome. (GISSI-HF-Effects of n-3 PUFA and Rosuvastatin on Mortality-Morbidity of Patients With Symptomatic CHF; NCT00336336). © 2013 American College of Cardiology Foundation. Source

Procopio G.,Science Oncologia Medica 1 | Derosa L.,Oncologia Medica 2 Universitaria | Gernone A.,Oncologia Medica Universitaria | Morelli F.,UOC Oncologia | And 19 more authors.
Future Oncology

Aim: The Italian Retrospective Analysis of Sorafenib as First or Second Target Therapy study assessed the efficacy and safety of sorafenib in metastatic renal cell carcinoma patients treated in the community. Patients & methods: Patients receiving first- or second-line single-agent sorafenib between January 2008 and December 2010 were eligible. Retrospective data collection started in 2012 and covers at least 1-year follow-up. The primary end point was overall survival (OS). Results: Median OS was 17.2 months (95% CI: 15.5-19.6): 19.9 months (95% CI: 15.9-25.3) in patients treated with first-line sorafenib and 16.3 months (95% CI: 13.1-18.2) with second-line sorafenib. Overall median (95% CI) progression-free survival was 5.9 months (95% CI: 4.9-6.7): 6.6 (95% CI: 4.9-9.3) and 5.3 months (95% CI: 4.3-6.0) in first- and second-line patients, respectively. Conclusion: The efficacy and safety of sorafenib in routine community practice was generally good, especially in relation to OS in patients treated in the second line, where results were similar to those seen in recent prospective clinical trials. © 2014 Future Medicine Ltd. Source

Agency: Cordis | Branch: FP7 | Program: CP-FP | Phase: HEALTH-2007-3.1-4 | Award Amount: 3.83M | Year: 2009

The main objective of the proposed project is to develop and to validate a system for measurement and feedback of outcome quality and support of decision making. The project will be executed in the areas of postoperative pain management which serves as an example for other fields of medicine with a high variation of care. The project will provide the medical community with a unique, user-friendly system to improve treatment of patients with postoperative pain. We propose to develop and implement a web-based information system, featuring three functions: Feedback and benchmarking system which provides participating sites with continuously updating data and analyses about the quality of care they provide compared to other institutions and allows identification of best clinical practice. Clinical Decision Support System for Post-Operative Pain, which responds to queries made by physicians for advice regarding treatment of individual patients. A Knowledge Library which provides clinicians with easily accessible summaries of evidence-based recommendations tailored to specific post-operative situations. The first two functions will draw their information from a large database or registry. The registry will receive data about post-operative patients from x participating clinical sites across Europe. The third function, the Knowledge Library, will draw its information from published, peer-reviewed studies, and will be updated periodically. To increase the benefit of the system to end-users, the registry will be complemented with patient data on side effects and treatment costs. All of these will be integrated into the feedback system. The proposed project is the first comprehensive, concerted European effort in the field of improving clinical decision making. It integrates experience gained from national initiatives, and the expertise of world-leading, European-based, groups dealing with benchmarking, health outcomes and health care utilization research

Braini A.,Azienda Ospedaliera Santa Maria degli Angeli | Narisetty P.,Azienda Ospedaliera Santa Maria degli Angeli | Favero A.,Azienda Ospedaliera Santa Maria degli Angeli | Calandra S.,Clinica Chirurgica | And 10 more authors.
Surgical Innovation

Introduction. Longo's technique (or PPH technique) is well known worldwide. Meta-analysis suggests that the failure due to persistence or recurrence is close to 7.7%. One of the reasons for the recurrence is the treatment of the advanced hemorrhoidal prolapse with a single stapling device, which is not enough to resect the appropriate amount of prolapse. Materials and methods. We describe the application of "Double PPH Technique" (D-PPH) to treat large hemorrhoidal prolapses. We performed a multicentric, prospective, and nonrandomized trial from July 2008 to July 2009, wherein 2 groups of patients with prolapse and hemorrhoids were treated with a single PPH or a D-PPH. Results were compared. The primary outcome was evaluation of safety and efficacy of the D-PPH procedure in selected patients with large hemorrhoidal prolapse. Results. In all, 281 consecutive patients suffering from hemorrhoidal prolapse underwent surgery, of whom 74 were assigned intraoperatively to D-PPH, whereas 207 underwent single PPH. Postoperative complications were 5% in both groups (P =.32), in particular: postoperative major bleeding 3.0% in PPH versus 4.1% D-PPH (P =.59); pain 37.9 % PPH versus 27.3% D-PPH (mean visual analog scale [VAS] = 2.5 vs 2.9, respectively; P =.72); and fecal urgency 2.1% PPH versus 5.7% D-PPH (P =.8). Persistence of hemorrhoidal prolapse at 12-month follow-up was 3.7% in the PPH group versus 5.9% in the D-PPH group (P =.5). Conclusions. Our data support the hypothesis that an accurate intraoperative patient selection for single (PPH) or double (D-PPH) stapled technique will lower in a significant way the incidence of recurrence after Longo's procedure for hemorrhoidal prolapse. © The Author(s) 2013. Source

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