Brignole M.,Arrhythmologic Center |
Botto G.L.,Ospedale S. Anna |
Mont L.,Hospital Clinic I Provincial |
Oddone D.,Arrhythmologic Center |
And 11 more authors.
Heart | Year: 2012
Objective: To evaluate the 2-year clinical improvement after 'Ablate and Pace' therapy and to identify the variables able to influence the efficacy of this therapy in patients with permanent atrial fibrillation (AF). Design: Prospective multicentre observational study. Setting: Cardiology departments of 19 general hospitals in Italy, Spain and Greece. Patients: 171 patients with drug-refractory severely symptomatic permanent AF considered for AV junction ablation. Interventions: Patients underwent AV junction ablation, received a right ventricular (RV) pacing or echo-guided cardiac resynchronisation (CRT) pacing and were followed-up to 24 months. Main outcome measures: Non-responders to Ablate and Pace therapy were defined those patients who, during the follow-up period had clinical failure (defined as death or hospitalisation due to heart failure, or worsening heart failure) or showed no improvement in their clinical condition. Results: Responders were 63% of RV-paced patients and 83% of CRT-paced patients. Another 27% showed no clinical improvement (7%) or worsened (20%) (nonresponders group). On multivariable Cox regression analysis, CRT mode and echo-optimised CRT were the only independent protective factors against nonresponse (HR=0.24, 95% CI 0.10-0.58, p=0.001 and HR=0.22, 95% CI 0.07-0.77, p=0.018 respectively). On comparing freedom from non-response, a trend in favour of echo-optimised CRT versus simultaneous biventricular pacing (p=0.077) was seen. Conclusions In patients affected by severely symptomatic permanent AF, Ablate and Pace therapy yielded a clinical benefit in 63% of RV-paced patients and 83% of CRT-paced patients. CRT pacing and echooptimised CRT were the only independent predictor of clinical benefit.
PubMed | Mayo Medical School, Sun Yat Sen University, University of Piemonte Orientale, Istanbul Science University and 10 more.
Type: Journal Article | Journal: Rare tumors | Year: 2014
Approximately, twenty years ago, the Rare Cancer Network (RCN) was formed in Lausanne, Switzerland, to support the study of rare malignancies. The RCN has grown over the years and now includes 130 investigators from twenty-four nations on six continents. The network held its first international symposium in Nice, France, on March 21-22, 2014. The proceedings of that meeting are presented in two companion papers. This manuscript reviews the history of the growth of the RCN and contains the abstracts of fourteen oral presentations made at the meeting of prior RCN studies. From 1993 to 2014, 74 RCN studies have been initiated, of which 54 were completed, 10 are in progress or under analysis, and 9 were stopped due to poor accrual. Forty-four peer reviewed publications have been written on behalf of the RCN.
PubMed | Ospedale di Circolo, Ospedale di Ivrea, IRCSS AOU San Martino IST, Fondazione IRCSS Instituto Nazionale dei Tumori and 18 more.
Type: Journal Article | Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology | Year: 2014
Irradiation of the Pharyngeal Superior Constrictor Muscle (PSCM) seems to play a crucial role in radiation-related swallowing dysfunctions. Purpose of our study was to quantify operator-related variability in the contouring of PSCM on Computed Tomography (CT) scans and adherence with contours derived from MR images.Three sets of treatment planning CT and their corresponding MR images were selected. Contouring of the PSCM was performed using both a literature-based method, derived from literature review, and an optimized method, derived from Magnetic Resonance (MR) images thus obtaining literature-based and optimized contours. Each operator contoured the PSCM on CT scans according to both methods for three times in three different days. Inter- and intra-operator variability and adherence to a contour obtained from MR images (named MR-derived contour) were analyzed.Thirty-four operators participated and 612 contours were obtained. Both intra- and inter-operator variability and adherence to the MR-derived contour were significantly different between the two methods (p0.05). The optimized method showed a lower intra- and inter-operator variability and a higher adherence to the MR-derived contour.The optimized method ameliorates both operator-related variability and adherence with MR images.
PubMed | San Filippo Neri Hospital, Fatebenefratelli Hospital Rome, Ospedale Niguarda Ca Grande, Ospedale S. Anna and 9 more.
Type: | Journal: International journal of cardiology | Year: 2017
Atrial tachyarrhythmias (AT/AF) have been associated with an increased risk of mortality, morbidity and ischemic stroke. Up to now, single chamber ICD diagnostics was not able to detect AT/AF, therefore the incidence of new onset AT/AF in patients with single chamber ICD is not known.To evaluate incidence and predictors of AT/AF occurrence in patients with dual-chamber ICD with no pacing indications and no history of AT/AF that strictly mimic single chamber ICD recipient.Consecutive dual-chamber ICD patients were prospectively followed by 47 Italian cardiologic centers in an observational research. Clinical and device data were reviewed by expert cardiologists to assess AT/AF occurrence. Multivariate regression analysis evaluated the risk of new-onset AT/AF and its association with patients baseline characteristics and with CHADSOur observations in a population of dual-chamber ICD patients with no pacing indications and no history of AT/AF, who strictly mimic single-chamber ICD recipients, highlight that AT/AF episodes occurred in the 37.5% of the population and CHADS
Bolis G.,University of Milan |
Scarfone G.,University of Milan |
Raspagliesi F.,Instituto Nazionale Tumori |
Mangili G.,Vita-Salute San Raffaele University |
And 6 more authors.
European Journal of Cancer | Year: 2010
Objective: The objective of this prospective randomized phase III trial was to compare paclitaxel plus carboplatin (PC) versus topotecan plus carboplatin and paclitaxel (TPC) in women with suboptimal stage III (residual tumour >1 cm) or stage IV ovarian cancer to evaluate the survival rate and toxicities. Methods: Eligible for the study were patients aged at least 18 years old with histological/cytological diagnosis of FIGO stages III (residual tumour ≥1 cm after primary surgery) - IV epithelial ovarian cancer. Patients were randomized to iv PC on day 1, every 21 days or iv topotecan daily for three days and PC on day 3, every 21 days. Results: The intention to treat population was made of 326 patients in total, 170 in the PC group and 156 in the TPC group. The life table estimates of survival probabilities at one, three and five years were, respectively, 0.94 (95% CI: 0.88-0.97), 0.53 (95% CI: 0.44-0.62) and 0.32 (95%CI: 0.23-0.42) in the PC group, and 0.92 (95% CI: 0.86-0.95), 0.52 (95% CI: 0.42-0.61), and 0.32(95%CI: 0.22-0.43) in the TPC group (log-rank test at 5 years: ns). The results of the survival analysis based on Cox regression model showed no statistically significant differences between groups (p-value: ns). The number of subjects with at least one event with possible relationship to study medication was 151 (88.8%) in the PC group and 139 (89.1%) in the TPC group (p = ns). In the PC group, 79 patients (23.6%) experienced at least one Adverse Event (AE) graded as severe and 16 patients (4.8%) at least one life-threatening AE, whilst in the TPC group, the number of patients who presented at least one severe or life-threatening AE was 86 (24%) and 37 (10.3%), respectively. Conclusion: The results of the present study show that the addition of topotecan to a standard paclitaxel/carboplatin regimen in the treatment of advanced epithelial ovarian cancer did not result in significant advantages in terms of survival rate. A slightly worse toxicity profile for TPC was observed. © 2010 Elsevier Ltd. All rights reserved.
Daily sodium butyrate enema for the prevention of radiation proctitis in prostate cancer patients undergoing radical radiation therapy: Results of a multicenter randomized placebo-controlled dose-finding phase 2 study
Maggio A.,San Raffaele Scientific Institute |
Magli A.,Ospedale S. Maria della Misericordia |
Rancati T.,Fondazione IRCCS Instituto Nazionale Dei Tumori |
Fiorino C.,San Raffaele Scientific Institute |
And 8 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2014
Purpose To evaluate the efficacy of sodium butyrate enemas (NABUREN) in prostate cancer radiation therapy (RT) in reducing the incidence, severity, and duration of acute RT-induced proctitis. Methods and Materials 166 patients, randomly allocated to 1 of 4 groups (rectal sodium butyrate 1 g, 2 g, or 4 g daily or placebo), were treated with NABUREN during and 2 weeks after RT. The grade of proctitis was registered in a daily diary. The correlation between NABUREN and proctitis was investigated through χ2 statistics. The toxicity endpoints considered were as follows: total number of days with grade ≥1 proctitis (≥G1); total number of days with grade ≥2 proctitis (≥G2); ≥G1 and ≥G2 proctitis lasting at least 3 and 5 consecutive days starting from week 4 (≥G1+3d, ≥G2+3d); damaging effects of RT on rectal mucosa as measured by endoscopy. The relationship between endpoints and pretreatment morbidities, hormonal therapy, presence of diabetes or hypertension, abdominal surgery, or hemorrhoids was investigated by univariate analysis. Results The patients were randomly allocated to the 4 arms. No difference in the distribution of comorbidities among the arms was observed (P>.09). The mean ≥G1 and ≥G2 proctitis were 7.8 and 4.9 for placebo and 8.9 and 4.7 for the NABUREN group, respectively. No favorable trend in reduction of incidence, severity, and duration of ≥G1 and ≥G2 proctitis was observed with NABUREN use. In univariate analysis, ≥G1+3d toxicity was found to be related to hemorrhoids (P=.008), and a slight correlation was found between ≥G2 proctitis and hormonal therapy (P=.06). The RT effects on rectal mucosa as based on endoscopic assessment were mainly related to diabetes (P<.01). Endoscopy data at 6 week showed no significant difference between the placebo and butyrate arms. The other investigated endpoints were not correlated with any of the clinical risk factors analyzed. Conclusion There was no evidence of efficacy of NABUREN in reducing the incidence, severity, and duration of acute radiation proctitis. There was a correlation between some endpoints and clinical risk factors. © 2014 Elsevier Inc. All rights reserved.
Brignole M.,Arrhythmologic Center |
Botto G.,Ospedale S. Anna |
Mont L.,University of Barcelona |
Iacopino S.,Clinica S. Anna |
And 6 more authors.
European Heart Journal | Year: 2011
Aims On the basis of the current knowledge, cardiac resynchronization therapy (CRT) cannot be recommended as a first-line treatment for patients with severely symptomatic permanent atrial fibrillation undergoing atrioventricular (AV) junction ablation. We examined whether CRT was superior to conventional right ventricular (RV) pacing in reducing heart failure (HF) events. Methods and resultsIn this prospective, multi-centre study, we randomly assigned 186 patients, in whom AV junction ablation and CRT device implantation had been successfully performed, to receive optimized echo-guided CRT (97 patients) or RV apical pacing (89 patients). The data were analysed according to the intention-to-treat principle. During a median follow-up of 20 months (interquartile range 1124), the primary composite endpoint of death from HF, hospitalization due to HF, or worsening HF occurred in 11 (11) patients in the CRT group and 23 (26) patients in the RV group [CRT vs. RV group: sub-hazard ratio (SHR) 0.37 (95 CI 0.180.73), P 0.005]. In the CRT group, compared with the RV group, fewer patients had worsening HF [SHR 0.27 (95 CI 0.120.58), P 0.001] and hospitalizations for HF [SHR 0.20 (95 CI 0.060.72), P 0.013]. Total mortality was similar in both groups [hazard ratio (HR) 1.57 (95 CI 0.584.27), P 0.372]. The beneficial effects of CRT were consistent in patients who had ejection fraction ≤35, New York Heart Association Class
Ostinelli A.,Ospedale S. Anna |
Pozzi G.,Polytechnic of Milan |
Vassena A.,Ospedale S. Anna
Proceedings - 2015 IEEE International Conference on Healthcare Informatics, ICHI 2015 | Year: 2015
Use of X-ray radiations in bio-medical imaging, including computerized tomography (CT) examinations, may trigger biological effects to be taken in the proper account. In order to do that, the pure amount of radiations absorbed by the patient may not suffice, as the same quantity of radiations may trigger different biological effects according to the type of tissue actually irradiated. Despite most standards for bio-images include the storage of alpha-numerical tags (as the DICOM format does), the description of the anatomical district covered by the image may sometimes be incomplete, missing, or even erroneous. Anatomical District Recognition (ADR) aims at properly identifying the anatomical district depicted by an X-ray bio-image, without requiring any additional information but the image itself. By this paper, we propose a novel approach which reads the scout image of a CT examination and identifies the involved anatomical district(s), so that proper evaluations, including dose estimation, can then be performed. © 2015 IEEE.
PubMed | University of Palermo and Ospedale S. Anna
Type: Journal Article | Journal: Drugs & aging | Year: 2016
Asthma and chronic obstructive pulmonary disease (COPD) are two distinct diseases that share a condition of chronic inflammation of the airways and bronchial obstruction. In clinical settings, it is not rare to come across patients who present with clinical and functional features of both diseases, posing a diagnostic dilemma. The overlap condition has been termed asthma-COPD overlap syndrome (ACOS), and mainly occurs in individuals with long-standing asthma, especially if they are also current or former smokers. Patients with ACOS have poorer health-related quality of life and a higher exacerbation rate than subjects with asthma or COPD alone. Whether ACOS is a distinct nosological entity with genetic variants or rather a condition of concomitant diseases that overlap is still a matter of debate. However, there is no doubt that extended life expectancy has increased the prevalence of asthma and COPD in older ages, and thus the probability that overlap conditions occur in clinical settings. In addition, age-associated changes of the lung create the basis for the two entities to converge on the same subject. ACOS patients may benefit from a stepwise treatment similar to that of asthma and COPD; however, the proposed therapeutic algorithms are only speculative and extrapolated from studies that are not representative of the ACOS population. Inhaled corticosteroids are the mainstay of therapy, and always in conjunction with long-acting bronchodilators. The potential heterogeneity of the overlap syndrome in terms of inflammatory features (Thelper-1 vs. T helper-2 pathways) may be responsible for the different responses to treatments. The interaction between respiratory drugs and concomitant diseases should be carefully evaluated. Similarly, the effect of non-respiratory drugs, such as aspirin, statins, and -blockers, on lung function needs to be properly assessed.
Monti A.F.,Ospedale Niguarda Ca Granda |
Berlusconi C.,Ospedale S. Anna |
Gelosa S.,Ospedale S. Anna
Physica Medica | Year: 2013
Intensity Modulated Radiation Therapy (IMRT) is a complex treatment modality that requires pre-treatment patient-specific quality control (QC) in order to assess a correct treatment delivery. The aim of this work is to investigate pre-treatment patient-specific per-field QCs performed with an on-board EPID at the gantry angle of 0° and at the treatment ones, and to asses if measurements executed at 0° are able to guarantee a correct treatment.Ten patients with prostate cancer were evaluated. Two " verification" plans were created for each patient in order to calculate the dose at the EPID surface: one with all fields positioned at 0° and one with all fields at the actual treatment angles.EPID's mechanical shifts due to gravity effects were always taken into account and corrected.0 and no-0 plans were compared using a gamma-index method (3%, 3 mm). The gamma index was found dependent on gantry angles but the difference between 0 and no-0 samples was small (-0.3% mean value) and the criteria of acceptability of the gamma method was always satisfied for every field delivered at angles different from 0.Therefore patient-specific pre-treatment QCs should be done at treatments angles, but, if periodical quality assurance is performed on dynamic MLC for different gantry angles, this requirement was shown not strictly mandatory and pre-treatment IMRTQC can be reasonably executed at 0° angles too. © 2012 Associazione Italiana di Fisica Medica.