Rossi A.,Sg Moscati Hospital |
Garassino M.C.,Fatebenefratelli and Oftalmico Hospital |
Cinquini M.,Mario Negri Institute for Pharmacological Research |
Sburlati P.,Fatebenefratelli and Oftalmico Hospital |
And 4 more authors.
Lung Cancer | Year: 2010
Objective: To assess the role of maintenance or consolidation therapy in the treatment of small-cell lung cancer (SCLC), a meta-analysis of all published randomized clinical trials (RCTs) was performed in order to provide an overall meta-analysis and indirectly compare the effect of chemotherapy, interferons, and other biologic agents. Methods: Electronic databases were searched for publication reporting of RCTs comparing maintenance or consolidation therapy versus placebo or follow-up alone until December 2008. Hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS), with their relative 95% confidence intervals (CI), were derived. In the calculation of HRs, the " no maintenance" arm served as a reference. The a priori value of p<0.05 was chosen as significant level for statistical tests. Results: Twenty-one RCTs, encompassing 3,688 patients, were eligible for the present analysis: 11 RCTs employing chemotherapy, 6 interferons (4 alpha and 2 gamma), and 4 other biological agents. Overall, no statistical advantage in OS (HR 0.93, 95% CI 0.87-1.00; p=0.05) or in PFS (HR 0.98, 95% CI 0.91-1.06; p=0.63) was reported for maintenance or consolidation therapy. Statistical evidence of different effects among the four types of therapy was detected for OS (χ2 test for heterogeneity: 8.07 [3 df]; p=0.04), but not for PFS. A statistically significant reduction of mortality was detected in those studies assessing the efficacy of chemotherapy (HR 0.89, 95% CI 0.81-0.98; p=0.02) and of interferon-alpha (HR 0.78, 95% CI 0.64-0.96; p=0.02). Conclusions: The maintenance or the consolidation approach failed to improve the outcomes of SCLC. A survival advantage is suggested for maintenance chemotherapy and interferon-alpha, but its clinical impact needs to be confirmed by further studies. © 2010 Elsevier Ireland Ltd.
Franzoni E.,University of Bologna |
Matricardi S.,University of Chieti Pescara |
Di Pisa V.,University of Bologna |
Capovilla G.,C Poma Hospital |
And 22 more authors.
European Journal of Paediatric Neurology | Year: 2015
Background To evaluate evidence and prognosis of refractory cases of absence seizures. Methods Subjects with refractory absence seizures were identified retrospectively in 17 Italian epilepsy pediatrics Centers. We analyzed age at onset, family history, presence of myoclonic components, seizure frequency, treatment with antiepileptic drugs (AEDs), interictal electroencephalography (EEG) and neuropsychological assessment. Two subgroups were identified: one with patients with current absence seizures and another with patients that had become seizure free with or without AED treatment. The chi-square test was applied. Results A total of 92 subjects with drug-resistant absence seizures were analyzed. 45 subjects still show absence seizures (49%) and the other 47 became seizure free (51%) after a period of drug-resistance. The statistical analysis between these two groups showed no correlation between age of onset, family history and abnormalities at interictal EEG. Statistically significant differences were observed with regard to the number of AEDs used and intellectual disability. Conclusion Typical absence epilepsy classifiable as Childhood Absence Epilepsy could not be considered so "benign", as suggested in literature. A longer duration of disease and a higher frequency of seizure seem to be correlated with a higher presence of cognitive impairment. No significant risk factor was observed to allow the faster and better recognition of patients with worse prognosis. © 2015 Published by Elsevier Ltd on behalf of European Paediatric Neurology Society.
Verrotti A.,University of Perugia |
Cusmai R.,Bambino Gesu Childrens Hospital |
Nicita F.,University of Rome La Sapienza |
Pizzolorusso A.,University of Chieti Pescara |
And 17 more authors.
Journal of Pediatrics | Year: 2013
Objective To describe the electroclinical features and the long-term outcomes of epilepsy in a large cohort of males and females with Down syndrome who developed epilepsy in childhood. Study design Subjects with Down syndrome and cryptogenic epilepsy with onset in childhood were identified retrospectively from the databases of 16 Italian epilepsy centers over a 40-year period. For each subject, age at onset of seizures, seizure semiology and frequency, electroencephalography characteristics, treatment with antiepileptic drugs, and long-term clinical and electroencephalography outcomes were analyzed. Results A total of 104 subjects (64 males [61.5%], 40 females [38.5%]) were identified. Seizure onset occurred within 1 year of birth in 54 subjects (51.9%), between 1 and 12 years in 42 subjects (40.4%), and after 12 years in 8 subjects (7.7%). Males had a younger age of seizure onset than females. Of the 104 subjects, 51 (49.0%) had infantile spasms (IS), 35 (33.7%) had partial seizures (PS), and 18 (17.3%) had generalized seizures (GS). Febrile seizures were recorded in 5 (4.8%) subjects. Intractable seizures were observed in 23 (22.1%) subjects, including 5 (9.8%) with IS, 8 (44.4%) with PS, and 10 (31.3%) with GS. Conclusion Cryptogenic epilepsy in Down syndrome may develop during the first year of life in the form of IS or, successively, as PS or GS. Electroclinical features of IS resemble those of idiopathic West syndrome, with a favorable response to treatment with adrenocorticotropic hormone seen. Patients experiencing PS and GS may be resistant to therapy with antiepileptic drugs. © 2013 Mosby Inc. All rights reserved.
PubMed | University of Genoa, Marche Polytechnic University, Civile Hospital, University of Bologna and 13 more.
Type: Journal Article | Journal: European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society | Year: 2015
To evaluate evidence and prognosis of refractory cases of absence seizures.Subjects with refractory absence seizures were identified retrospectively in 17 Italian epilepsy pediatrics Centers. We analyzed age at onset, family history, presence of myoclonic components, seizure frequency, treatment with antiepileptic drugs (AEDs), interictal electroencephalography (EEG) and neuropsychological assessment. Two subgroups were identified: one with patients with current absence seizures and another with patients that had become seizure free with or without AED treatment. The chi-square test was applied.A total of 92 subjects with drug-resistant absence seizures were analyzed. 45 subjects still show absence seizures (49%) and the other 47 became seizure free (51%) after a period of drug-resistance. The statistical analysis between these two groups showed no correlation between age of onset, family history and abnormalities at interictal EEG. Statistically significant differences were observed with regard to the number of AEDs used and intellectual disability.Typical absence epilepsy classifiable as Childhood Absence Epilepsy could not be considered so benign, as suggested in literature. A longer duration of disease and a higher frequency of seizure seem to be correlated with a higher presence of cognitive impairment. No significant risk factor was observed to allow the faster and better recognition of patients with worse prognosis.
Di Mascio V.,Polytechnic of Milan |
Di Mascio V.,IRCCS Instituto Ortopedico Galeazzi |
Bellini C.M.,IRCCS Instituto Ortopedico Galeazzi |
Galbusera F.,IRCCS Instituto Ortopedico Galeazzi |
And 4 more authors.
Journal of Applied Biomaterials and Biomechanics | Year: 2010
Aim: The aim of this study was to evaluate the biomechanical effects of the Maverick® disc prosthesis at the implanted and adjacent level by the finite element (FE) method. Materials and Methods: A 3D FE model of the L3-L5 segment was built. To simulate the different physiological movements (flexion, extension, lateral bending, axial rotation) pure moments of 10 Nm were applied. To evaluate the effect of the prosthesis, a 3D model of the device was built and inserted in the L3-L5 model. The ROMs obtained with the intact model were imposed as maximal rotations to the instrumented model, therefore implementing the Panjabi hybrid protocol. Results: Increased ROMs at the implanted level and reduced ROMs at the adjacent level were predicted. A similar moment-rotation behavior was calculated after simulation of prosthesis insertion. No significant effect was predicted in terms of von Mises stress at the adjacent level after implantation of the prosthesis. Conclusions: Within the limitations of the models, the numerical results of this study predicted a preserved kinematics and stress at the adjacent segment, after insertion of the prosthesis. © 2010 Società Italiana Biomateriali.
Eller-Vainicher C.,University of Milan |
Battista C.,Unit of Endocrinology |
Guarnieri V.,Unit of Endocrinology |
Muscarella S.,Unit of Endocrinology |
And 11 more authors.
European Journal of Endocrinology | Year: 2014
Objective: To examine factors, in addition to bone mineral density (BMD), such as the common calcium-sensing receptor (CASR) gene polymorphisms, associated with vertebral fracture (VFx) risk in primary hyperparathyroidism (PHPT).Design and methods: A cross-sectional analysis of 266 Caucasian PHPT seen as outpatients. Serum calcium (sCa) phosphate metabolism parameters were measured. BMD was assessed by dual-energy X-ray absorptiometry (expressed as Z-score) at lumbar spine (Z-LS) and femoral neck, morphometric VFx by radiograph, and CASR A986S/R990G genotypes by PCR amplification and genomic DNA sequencing.Results: Fractured patients (n=100, 37.6%) had lower sCa (10.8±0.7mg/dl) and Z-LS BMD (-1.0±1.44), higher age (61±10 years), and prevalence (51%) of ≥1 S alleles of the CASR A986S single-nucleotide polymorphism (SNP; AS/SS), than those not fractured (nZ166, 11.2±1.0 mg/dl, -0.57±0.97, 58±13 years, and 38% AS/SS, respectively, P!0.05 for all comparisons). Logistic regression, with VFx as dependent variable, showed independent risks associated with increased age (OR 1.03, 95% CI 1.01-1.06, P=0.006), decreased sCa (OR 1.86, 95% CI 1.28-2.7, P=0.001), and Z-LS BMD (OR 1.4, 95% CI 1.12-1.7, P=0.002) and presence of AS/SS (OR 1.8, 95% CI 1.1-2.9, P=0.05). The presence of two out of three factors (age≥58 years, sCa <10.8 and Z-LS BMD≤-1.0, and AS/SS genotype) gave an overall OR of 4.2 (95% CI 2.25-7.85, P<0.0001).Conclusions: In PHPT, VFx is associated positively with age, negatively with sCa and spinal BMD, and presence of at least one copy of the CASR A986S SNP. © 2014 European Society of Endocrinology Printed in Great Britain.
PubMed | IRCCS Instituto Nazionale Tumori, Fatebenefratelli and Oftalmico Hospital and Irccs Instituto Of Ricerche Farmacologiche Mario Negri
Type: | Journal: SpringerPlus | Year: 2016
Predicting the risk of sentinel lymph node (SLN) metastasis is important for clinical decision-making in the setting of early breast cancer (EBC). This study is aimed to identify tumor and patient characteristics that influenced the SLN metastatic involvement, with a focus on luminal subtypes. An observational study including women treated for EBC from 2005 to 2013 was conducted. Regression analyses were used to assess the association between SLN metastasis and age, menopausal status, tumor size, histological grading, presence of extensive in situ carcinoma components, lymphovascular invasion (LVI), and expression of Ki-67, hormone receptors, and HER2. Of 345 women, 84 (24.3%) had at least one SLN metastasis; 63.1% were macrometastases. Among all patients, 31.6% exhibited LVI. In univariate analyses, tumor size, histological grade, and LVI were associated with SLN metastasis. The multivariate model confirmed only the association between LVI and SLN status (OR 3.27, 95%CI 1.85-5.68; p<0.0001). Luminal subtypes were detected in 86.1% of women. In this subgroup, the multivariate model confirmed a significant relationship between LVI and SLN status (OR 3.47, 95%CI 1.90-6.33; p<0.0001). Since a proper histopathological assessment of LVI is not possible prior to surgery, this factor cannot be used to guide decisions on performing SLN biopsies. Nevertheless, when a SLN biopsy is refused or contraindicated, an LVI assessment on an excisional biopsy of the tumor could facilitate prognosis determination and treatment management.