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De Carlo M.,Cardiac Catheterization Laboratory | Morici N.,Ospedale Niguarda Ca Granda | Savonitto S.,Ospedale Manzoni | Grassia V.,Ospedale S. Maria Delle Grazie | And 7 more authors.
JACC: Cardiovascular Interventions | Year: 2015

Objectives This study sought to investigate sex-related differences in treatment and outcomes in elderly patients with non-ST-segment elevation acute coronary syndromes (NSTEACS). Background Female sex and older age are usually associated with worse outcome in NSTEACS. The Italian Elderly ACS study enrolled NSTEACS patients aged 75 years of age and older in a randomized trial comparing an early aggressive with an initially conservative strategy and in a registry of patients with ≥1 exclusion criteria of the trial. Methods We compared sexes in the pooled populations of the trial and registry. Results A total of 645 patients (313 from the trial and 332 from the registry), including 301 women (47%), were enrolled. Women were slightly older than men (82.1 ± 5.0 years vs. 81.2 ± 4.5 years; p = 0.02), had lower hemoglobin levels (12.5 ± 1.6 g/dl vs. 13.3 ± 1.9 g/dl; p < 0.001), and underwent fewer coronary revascularizations during the index admission (37.2% vs. 45.0%; p = 0.04). In-hospital adverse event rates were similar in both sexes; severe bleeding was uncommon (0.3% vs. 0%). The 1-year primary endpoint (composite of death, nonfatal myocardial infarction, disabling stroke, cardiac rehospitalization, and severe bleeding) occurred less often in women (27.6% vs. 38.7%; p < 0.01). Women not undergoing revascularization showed a 3-fold higher mortality, both in-hospital (8.5% vs. 2.7%; p = 0.05) and at 1 year (21.6% vs. 8.1%; p = 0.002). Conclusions Elderly women had a similar in-hospital outcome and better 1-year outcome compared with men. Coronary revascularization in women was associated with lower 1-year mortality, without an increase in severe bleeding. Elderly women with NSTEACS should always be considered for early revascularization. © 2015 American College of Cardiology Foundation.

PubMed | University of Padua, Galeazzi Institute IRCCS, I.N.R.C.A., University of Milan and 13 more.
Type: Journal Article | Journal: Journal of endocrinological investigation | Year: 2016

Treatment of osteoporosis is aimed to prevent fragility fractures and to stabilize or increase bone mineral density. Several drugs with different efficacy and safety profiles are available. The long-term therapeutic strategy should be planned, and the initial treatment should be selected according to the individual site-specific fracture risk and the need to give the maximal protection when the fracture risk is highest (i.e. in the late life). The present consensus focused on the strategies for the treatment of postmenopausal osteoporosis taking into consideration all the drugs available for this purpose. A short revision of the literature about treatment of secondary osteoporosis due both to androgen deprivation therapy for prostate cancer and to aromatase inhibitors for breast cancer was also performed. Also premenopausal females and males with osteoporosis are frequently seen in endocrine settings. Finally particular attention was paid to the tailoring of treatment as well as to its duration.

Gradilone A.,University of Rome La Sapienza | Petracca A.,University of Rome La Sapienza | Nicolazzo C.,University of Rome La Sapienza | Gianni W.,INRCA | And 8 more authors.
BJU International | Year: 2010

OBJECTIVE To evaluate the prognostic significance of survivin in tumour tissues and that of survivin-expressing circulating tumour cells (CTCs) in T1G3 bladder tumours, as the prognosis of T1G3 bladder cancer is highly variable and unpredictable from clinical and pathological prognostic factors. PATIENTS AND METHODS The study included 54 patients with T1G3 non-muscle-invasive bladder cancer. Additional inclusion criteria were: tumour size <3 cm, absence of carcinoma in situ and multifocality. The planned follow-up was 24 months. Survivin was evaluated by reverse transcription-polymerase chain reaction in tumour tissues. CTCs were isolated from blood by CELLectionTM Dynabeads (Invitrogen, Carlsbad, CA, USA) coated with the monoclonal antibody towards the human epithelial cell adhesion molecule. Cells were lysed and Dynabeads Oligo(dT) was used to capture poly A + mRNA. cDNA was synthesized and analysed for the expression of CD45, CK8 and survivin. The primary endpoint was disease-free survival (DFS); the favourable group at 24 months was defined as that with no clinical evidence of disease; the unfavourable group was that with evidence of recurrent disease or progressive disease. Tumour survivin expression and presence of CTC were correlated with DFS. Multivariate analysis was used to investigate whether the presence of CTC was an independent indicator of DFS. RESULTS Survivin was found in half of the tumours; patients with survivin-negative tumours had a longer DFS than those with survivin-positive tumours (chi-square, P = 0.029). CTCs were found in 2454 patients (44%); 92% of CTC expressed survivin. The difference in DFS between CTC-ve and CTC+ve patients was statistically significant (chi-square, P < 0.001). The presence of CTC was an independent prognostic factor for DFS (P < 0.001). CONCLUSION The presence of CTC is an independent prognostic factor in patients with T1G3 bladder cancer. © 2010 BJU INTERNATIONAL.

Savonitto S.,Azienda Ospedaliera Santa Maria Nuova | Cavallini C.,Azienda Ospedaliera Ospedale Santa Maria della Misericordia | Petronio A.S.,Azienda Ospedaliera Universitaria Pisana | Murena E.,Ospedale S. Maria delle Grazie | And 14 more authors.
JACC: Cardiovascular Interventions | Year: 2012

Objectives: This study sought to determine the risk versus benefit ratio of an early aggressive (EA) approach in elderly patients with non-ST-segment elevation acute coronary syndromes (NSTEACS). Background: Elderly patients have been scarcely represented in trials comparing treatment strategies in NSTEACS. Methods: A total of 313 patients <75 years of age (mean 82 years) with NSTEACS within 48 h from qualifying symptoms were randomly allocated to an EA strategy (coronary angiography and, when indicated, revascularization within 72 h) or an initially conservative (IC) strategy (angiography and revascularization only for recurrent ischemia). The primary endpoint was the composite of death, myocardial infarction, disabling stroke, and repeat hospital stay for cardiovascular causes or severe bleeding within 1 year. Results: During admission, 88% of the patients in the EA group underwent angiography (55% revascularization), compared with 29% (23% revascularization) in the IC group. The primary outcome occurred in 43 patients (27.9%) in the EA group and 55 (34.6%) in the IC group (hazard ratio [HR]: 0.80; 95% confidence interval [CI]: 0.53 to 1.19; p = 0.26). The rates of mortality (HR: 0.87; 95% CI: 0.49 to 1.56), myocardial infarction (HR: 0.67; 95% CI: 0.33 to 1.36), and repeat hospital stay (HR: 0.81; 95% CI: 0.45 to 1.46) did not differ between groups. The primary endpoint was significantly reduced in patients with elevated troponin on admission (HR: 0.43; 95% CI: 0.23 to 0.80), but not in those with normal troponin (HR: 1.67; 95% CI: 0.75 to 3.70; p for interaction = 0.03). Conclusions: The present study does not allow a definite conclusion about the benefit of an EA approach when applied systematically among elderly patients with NSTEACS. The finding of a significant interaction for the treatment effect according to troponin status at baseline should be confirmed in a larger size trial. (Italian Elderly ACS Study; NCT00510185) © 2012 American College of Cardiology Foundation.

Gazzaniga P.,University of Rome La Sapienza | Naso G.,University of Rome La Sapienza | Gradilone A.,University of Rome La Sapienza | Cortesi E.,University of Rome La Sapienza | And 8 more authors.
International Journal of Cancer | Year: 2010

The prognostic value associated with the detection of circulating tumor cells (CTCs) in metastatic breast cancer by the CellSearch™ technology raise additional issues regarding the biological value of this information. We postulated that a drug-resistance profile of CTCs may predict response to chemotherapy in cancer patients and therefore could be used for patient selection. One hundred 5 patients with diagnosis of carcinoma were enrolled in a prospective trial. CTCs were isolated from peripheral blood, and positive samples were evaluated for the expression of a panel of genes involved in anticancer drugs resistance. The drug-resistance profile was correlated with disease-free survival (DFS; patients in adjuvant setting) and time to progression (TTP; metastatic patients) in a 24-months follow-up. Objective response correlation was a secondary end point. Fifty-one percent of patients were found positive for CTCs while all blood samples from healthy donors were negative. The drug-resistance profile correlates with DFS and TTP (p < 0.001 in both). Sensitivity of the test: able to predict treatment response in 98% of patients. Specificity of the test: 100%; no sample from healthy subject was positive for the presence of CTCs. Positive and negative predictive values were found to be 96.5 and 100%, respectively. We identified a drug-resistance profile of CTCs, which is predictive of response to chemotherapy, independent of tumor type and stage of disease. This approach may represent a first step toward the individualization of chemotherapy in cancer patients. © 2009 UICC.

Ruggiero C.,University of Perugia | Dellaquila G.,University of Perugia | Gasperini B.,University of Perugia | Onder G.,Catholic University of the Sacred Heart | And 6 more authors.
Drugs and Aging | Year: 2010

Background: Potentially inappropriate medications in older patients increase the risk of adverse drug events, which are an important cause of hospital admission and death among hospitalized patients. Little information is available about the prevalence of potentially inappropriate drug prescriptions (PIDPs) and the related health adverse outcomes among nursing home (NH) residents. Objective: To estimate the prevalence of PIDPs and the association with adverse outcomes in NH residents. Methods: A total of 1716 long-term residents aged 65 years participating in the ULISSE (Un Link Informatico sui Servizi Sanitari Esistenti per lanziano [AComputerized Network on Health Care Services for Older People]) project were evaluated using a standardized comprehensive geriatric assessment instrument, i.e. the interResident Assessment Instrument Minimum Data Set. A thorough evaluation of residents drug use, medical diagnoses and healthcare resource utilization was performed. APIDP was defined according to the most recent update of the Beers criteria. Results: Almost one out of two persons (48%) had at least one PIDP and almost one out of five had two or more PIDPs (18%). Residents with a higher number of PIDPs had a higher likelihood of being hospitalized. Compared with residents without PIDPs, those with two or more PIDPs at baseline had a higher probability of being hospitalized (hazard ratio 1.73; 95% CI 1.14, 2.60) during the following 12 months. Risk of PIDP was positively associated with the total number of drugs and diseases, but negatively with age. PIDPs defined according to specific conditions (n = 780; 55%) were slightly more frequent than PIDPs based on single medications irrespective of specific indication (n = 639; 45%). Conclusions: PIDP is a significant problem among Italian NH residents. There is an urgent need for intervention trials to test strategies to reduce inappropriate drug use and its associated adverse health outcomes. © 2010 Adis Data Information BV. All rights reserved.

Raimondi C.,University of Rome La Sapienza | Gianni W.,I.N.R.C.A. | Cortesi E.,University of Rome La Sapienza | Gazzaniga P.,University of Rome La Sapienza
Current Cancer Drug Targets | Year: 2010

The cancer stem cell (CSC) hypothesis provides an attractive model of tumor development and progression, holding that solid tumors are hierarchically organized and sustained by a minority of the tumor cell population with stem cell properties, such as self-renewal, tumorigenicity and multilineage differentiation capacity. Therapeutic resistance, underlying tumor recurrence and the lack of curative treatments in metastatic disease, raise the question if conventional anti-cancer therapies target the right cells. Indeed, these treatments might miss CSCs, which represent a more chemoresistant and radioresistant subpopulation within cancer. Recently, a direct link between the epithelial-mesenchymal transition process and the gain of stem cell competence were demonstrated in cultured breast cells. In particular, it was shown that the induction of EMT program not only allows cancer cells to disseminate from the primary tumor, but also promotes their self-renewal capability. Furthermore, the expression of stemness and EMT markers in CTCs were associated with resistance to conventional anti-cancer therapies and treatment failure, highlighting the urgency of improving tools for detecting and eliminating minimal residual disease. © 2010 Bentham Science Publishers Ltd.

Raimondi C.,University of Rome La Sapienza | Naso G.,University of Rome La Sapienza | Gradilone A.,University of Rome La Sapienza | Gianni W.,I.N.R.C.A. | And 2 more authors.
Current Cancer Drug Targets | Year: 2010

What clinical oncologists learned about the metastatic process, is that it is the main cause of cancer-related deaths. What scientists learned about the metastatic disease, is that it is due to a highly selective process, which involves a minority of tumor cells that are able to survive within the bloodstream, and to initiate a new growth in distant sites. These cells "in transit" are known as circulating tumor cells (CTCs). Although their nature is not fully understood, what is widely accepted, is that they are drug resistant, and that their presence may represent the main reason for treatment failure. Despite this body of evidence, the pharmacological approach against cancer, with both chemotherapic and biological drugs, is still targeted on the primary tumor, raising the question as to whether we are missing the target. Targeting circulating tumor cells, may represent a new promising approach to individualize anticancer therapy. © 2010 Bentham Science Publishers Ltd.

Colloca G.,ASL 1 Imperiese | Venturino A.,ASL 1 Imperiese | Vitucci P.,AOU Ospedali Riuniti Umberto I Lancisi Salesi | Gianni W.,INRCA
Cancer Investigation | Year: 2010

Anaemia is a frequent complication of prostate cancer and of its treatments. In Europe prostate cancer accounts for the 10.8% of all malignant neoplasms. Iatrogenic hypogonadism and age-related physiologic changes along with nutritional deficits contribute to increase prevalence of prostate cancer related anaemia. The reason of the present review is to provide clinicians with all aspects of a frequent and multifactorial co-morbidity, whose effects are often underestimated. Erythropoiesis pathology and causes of anaemia in prostate cancer are reviewed. Critical issues of clinical management of anaemia in prostate cancer are discussed. Copyright © 2010 Informa Healthcare USA, Inc.

PubMed | INRCA, Unita Operativa di Cardiologia, Beata Vergine Hospital, Ospedale Civile and Como Cuore Onlus
Type: Journal Article | Journal: The international journal of cardiovascular imaging | Year: 2016

The prognosis for abdominal aortic aneurysm (AAA) rupture is poor. Long-term follow-up of population-based randomized trials has demonstrated that ultrasound (US) screening for abdominal aortic aneurysms (AAAs) measuring 3cm or greater decreases AAA-related mortality rates and is cost-effective. We though to prospectively perform during a 26-month period a limited US examination of the infrarenal aorta in volunteers of both gender aged 60-85years without history of AAA living in the area of Como, Italy. From September 2010 to November 2013 ComoCuore, a no-profit nongovernmental association, enrolled 1555 people (aged 68.86.8years; 48.6% males). Clinical data and a US imaging of the aorta were collected for each participant. AAA was found in 22 volunteers (1.4%) mainly males (2.5% in males vs. 0.4% in females p=0.005). Overall, the prevalence of cardiovascular risk factors was higher in patients with vs. without AAA (mean 2.93.0 vs. 1.41.0 respectively, p<0.0001). Independent predictors of AAA on multivariate analysis were age (OR 1.14, 1.06-1.22; p<0.0001), male gender (OR 8.23, 1.79-37.91; p=0.007), and both current (OR 4.98, 1.57-15.79; p=0.007) and previous smoking (OR 2.76, 1.12-8.94; p=0.03). Our study confirms the feasibility of one time US screening for AAA in a large cohort of asymptomatic people. Independent predictors of AAA were male sex, older age and a history of smoking. Accordingly to recent data the prevalence of AAA seems to be declining, maybe due to a reduction of smoking in Italy.

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