Prato Hospital

Prato allo Stelvio - Prad am Stilfser Joch, Italy

Prato Hospital

Prato allo Stelvio - Prad am Stilfser Joch, Italy
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Baccini M.,Motion Analysis Laboratory | Baccini M.,Piero Palagi Hospital | Paci M.,Prato Hospital | Del Colletto M.,University of Florence | And 3 more authors.
Attention, Perception, and Psychophysics | Year: 2014

Perception of the subjective visual vertical (SVV) is usually assessed by asking to subjects, in complete darkness, to adjust the position of a luminous rod that is variably tilted (i.e., by the method of adjustment [ADJ]). Conversely, the two-alternative forced choice (2AFC) method requires subjects to categorize, as tilted either clockwise (CW) or counterclockwise (CCW), stimuli that are presented on a computer screen and are variably tilted from vertical. In this study, we aimed to compare the results of these two methods and investigate age-related effects on the SVV. SVV was assessed in 102 healthy individuals, 50 women and 52 men, with a mean age of 45.7 (range 20-91), using both ADJ (ten trials, initial 1°, 2°, 4°, 8°, or 12° bar tilts both CW and CCW) and 2AFC (120 stimuli with a 1°-32° variable tilt). Also, 50 of the subjects performed the ADJ test twice, with different bar lengths. We estimated bias and threshold for the two methods, and found that neither measure differed across the methods. Age was a significant predictor of threshold (2AFC, R 2 = .141; ADJ, R 2 = .190; p < .001), implying lower sensitivity with increasing age. Moreover, the ADJ method showed a significant increase of bias when the initial tilt was farthest from vertical, whereas the rod length was irrelevant. SVV measures obtained with the ADJ and 2AFC methods were comparable, but the latter measures were more resistant to artifacts that might affect the measurement. The lower sensitivity found in older persons may have an influence on their ability to interact with the environment and may contribute to impairment of postural control. © 2013 Psychonomic Society, Inc.

Thomssen C.,Martin Luther University of Halle Wittenberg | Pierga J.-Y.,University of Paris Descartes | Pritchard K.I.,Sunnybrook Health science Center | Biganzoli L.,Prato Hospital | And 5 more authors.
Oncology | Year: 2012

Background: The prognosis for patients with triple-negative breast cancer (TNBC) is poor and treatment options are limited. Bevacizumab improves the efficacy of standard first-line therapy in locally recurrent/metastatic breast cancer (LR/mBC). The benefit of bevacizumab seen in patients with TNBC appears similar to that observed in the overall population. We conducted an exploratory analysis of patients with TNBC treated in the single-arm routine oncology practice ATHENA study. Methods: Patients with previously untreated LR/mBC received standard first-line chemotherapy combined with bevacizumab (10 mg/kg every 2 weeks or 15 mg/ kg every 3 weeks, until progression, unacceptable toxicity, or patient/physician decision). Results: Of 2,264 patients treated in ATHENA, 585 (26%) had TNBC. Most patients received single-agent taxane with bevacizumab. In the TNBC subgroup, the overall response rate was 49%, including complete responses in 10%; only 16% had primary resistant disease. Median time to progression was 7.2 months (95% CI 6.6-7.8) and median overall survival was 18.3 months (95% CI 16.4-19.7). The 1-year overall survival rate was 60%. The safety profile in TNBC was consistent with results in the overall population. Conclusion: This exploratory subgroup analysis suggests that first-line chemotherapy in combination with bevacizumab is an active regimen in patients with metastatic TNBC. Copyright © 2012 S. Karger AG, Basel.

Guarneri V.,University of Modena and Reggio Emilia | Miles D.,Mount Vernon Cancer Center | Robert N.,U.S. Oncology | Dieras V.,University Pierre and Marie Curie | And 6 more authors.
Breast Cancer Research and Treatment | Year: 2010

Long-term bisphosphonate therapy is associated with increased risk of osteonecrosis of the jaw (ONJ). In a retrospective analysis, a 16% ONJ incidence was reported in patients receiving bisphosphonates with anti-angiogenic therapy (bevacizumab or sunitinib) for bone metastases from breast, colon, or renal cell cancers. To assess ONJ incidence with bevacizumab, we analysed data from 3,560 patients receiving bevacizumab-containing therapy for locally recurrent or metastatic breast cancer (LR/MBC) in two double-blind, randomised trials (AVADO and RIBBON-1) and a large, non-randomised safety study (ATHENA). The overall incidence of ONJ with bevacizumab was 0.3% in the blinded phase of the two randomised trials and 0.4% in the single-arm study. There was a trend towards increased ONJ incidence in patients who received bisphosphonate therapy versus those with no bisphosphonate exposure (0.9 vs. 0.2%, respectively, in the pooled analysis of the randomised trials; 2.4 vs. 0%, respectively, in ATHENA). In conclusion, this is the largest analysis of ONJ in patients receiving bevacizumab for LR/MBC. The 0.3-0.4% incidence is considerably lower than previously suggested with anti-angiogenic therapy in a small retrospective analysis. The risk of ONJ appeared to be increased in patients exposed to bisphosphonates, a pattern consistent with observations before the introduction of anti-angiogenic therapy to breast cancer management. The 0.9-2.4% incidence seen in bisphosphonate-exposed patients receiving bevacizumab is within the 1-6% range reported for bisphosphonates alone. Good oral hygiene, dental examination, and avoidance of invasive dental procedures remain important in patients receiving bisphosphonates, irrespective of bevacizumab administration. © 2010 Springer Science+Business Media, LLC.

von Minckwitz G.,Neu Isenburg and Universitats Frauenklinik Frankfurt | Martin M.,Hospital Universitario Gregorio Maranon | Wilson G.,Christie Hospital | Alba E.,Hospital Clinico Universitario Virgen Of La Victoria | And 3 more authors.
Critical Reviews in Oncology/Hematology | Year: 2013

The first-generation taxanes, conventional paclitaxel and docetaxel, are established treatment options for adjuvant and metastatic breast cancer (MBC). However, these agents have limitations, including primary/secondary resistance and harsh toxicities. The introduction of paclitaxel albumin represents a significant advance in taxane therapy as the first of a new generation of taxanes. This agent utilizes albumin pathways to achieve enhanced and targeted drug delivery to the tumour. The lack of solvent also means that it is well tolerated, despite the lack of premedications. Paclitaxel albumin is licensed in the United States and Europe as ≥2nd-line therapy in MBC (260mg/m2 once every three weeks), but emerging evidence suggests it has activity in various settings as weekly therapy and in combination with other agents. Additional strategies to optimize taxane-based therapy are also being evaluated, including the possibility of tailoring treatment according to patient/disease characteristics, identifying predictive biomarkers and evaluating other novel taxanes. © 2012 Elsevier Ireland Ltd.

Troncati F.,Prato Hospital | Paci M.,Prato Hospital | Myftari T.,University of Florence | Lombardi B.,Prato Hospital
NeuroRehabilitation | Year: 2013

BACKGROUND: Extracorporeal Shock Wave Therapy (ESWT) has been proposed for treatment of abnormal muscle tone only in the last years. The effects on motor impairment are unknown. OBJECTIVE: To assess the long-term effects of ESWT on muscle tone and motricity in upper limb in patients with chronic hemiplegia. METHODS: Twelve patients were selected and treated with two sessions of ESWT. Participants were assessed at baseline, after the treatment, and at 3 and 6 months. Muscle tone of shoulder adductors, elbow, wrist and finger flexors was evaluated at all assessment points using the Modified Ashworth Scale (MAS), while motricity, passive range of motion (PROM) and pain sub-scores of upper extremity part of the Fugl-Meyer scale were used to assess motor recovery. The degree of perceived benefit from treatment was assessed on a visual analogue scale. RESULTS: MAS showed a significant reduction of spasticity and Fugl-Meyer scores improved immediately after treatment. Persistent effects were observed at 3 and 6 months for MAS, and for motricity and PROM subscores of the Fugl-Meyer scale. Clinical improvement was not correlated to the patients' perceived benefit. CONCLUSIONS: Two sessions of ESWT seem to have long-term effects in reducing muscle tone and enhancing motor impairment. © 2013 - IOS Press and the authors. All rights reserved.

Paci M.,Prato Hospital | Nannetti L.,Prato Hospital | Dippolito P.,Prato Hospital | Lombardi B.,Prato Hospital
European Journal of Physical and Rehabilitation Medicine | Year: 2011

Background. Stroke is a highly heterogeneous disorder with distinct subtypes, each presenting specific clinical aspects. Information on prognosis of ischemic stroke subtypes help to improve clinical management and rehabilitation treatments. Aim. Summarize findings of studies on outcome in stroke subtypes categorized by use of the Oxfordshire Community Stroke Project (OCSP) classification. Design. Systematic review. Setting. Not applicable. Population. Adult post-stroke patients. Methods. Systematic literature research of five databases was undertaken to identify relevant studies. Outcomes were examined in terms of impairment, activity restriction and participation restriction. Quality of Life and mortality was also examined for each study. Results. Sixteen studies met inclusion criteria. Most studies measure outcome in terms of activity limitations and participation restriction. Only one study measures impairment. TACI group have poor outcomes in comparison with other groups. Outcomes of IACI, PACI and POCI groups are controversial. Conclusion. Stroke subtype is a factor influencing outcome. However, differences among groups, overall in terms of impairment, should be further investigated. Clinical rehabilitation impact. Different prognosis of stroke subtypes may imply different rehabilitation managements.

Nannini C.,Rochester College | Nannini C.,Prato Hospital | Jebakumar A.J.,Rochester College | Crowson C.S.,Rochester College | And 2 more authors.
BMJ Open | Year: 2013

Objective: A very few studies describe the epidemiology of primary Sjögren's syndrome (pSS). The reported frequency of pulmonary involvement in pSS varies widely depending on the detection method employed, and consists mainly of various forms of airways disease. We aimed to evaluate the incidence and mortality of pSS and of lung disease in pSS, focusing on interstitial lung disease (ILD). Methods: A population-based incidence cohort of patients diagnosed with pSS in 1976-2005 was assembled. Diagnosis was based on the 2002 American-European Consensus Group criteria for pSS. Cumulative incidence adjusted for the competing risk of death was estimated. A Cox model with a timedependent covariate was used to determine the incidence and the standardised mortality HR of pSS. Results: 85 patients with pSS were identified (mean age 59.9 years; 91% women). The annual incidence of pSS was 4.2, 95% CI (3.3 to 5.1)/100 000 population and it increased with higher age at pSS diagnosis (18-44 years: 2.1/100 000 vs ≥75 years: 12.3/100 000). Standardised mortality ratio in pSS compared with the general population was 0.92, 95% CI (0.57 to 1.41). A total of 105 patients with pSS and ILD were identified (mean age 58.1 years; 91% women). Among patients with pSS without prior ILD, the cumulative incidence of ILD in patients with pSS was 10% (±3%) at 1 year after diagnosis of pSS and increased to 20% (±4%) by 5 years after pSS. The development of lung disease in pSS was associated with poor survival (HR 2.16; 95% CI 0.99 to 4.74). Conclusions: pSS incidence seems to be almost the same as was reported in a previous study conducted among Olmsted County Minnesota population. Survival among patients with pSS and general population does not differ substantially. However, patients with pSS who have ILD likely have increased premature mortality.

Turner N.,Prato Hospital | Pestrin M.,Prato Hospital | Galardi F.,Prato Hospital | De Luca F.,Prato Hospital | And 2 more authors.
Cancers | Year: 2014

Circulating tumor cell (CTC) count has prognostic significance in metastatic breast cancer, but the predictive utility of CTCs is uncertain. Molecular studies on CTCs have often been limited by a low number of CTCs isolated from a high background of leukocytes. Improved enrichment techniques are now allowing molecular characterisation of single CTCs, whereby molecular markers on single CTCs may provide a real-time assessment of tumor biomarker status from a blood test or "liquid biopsy", potentially negating the need for a more invasive tissue biopsy. The predictive ability of CTC biomarker analysis has predominantly been assessed in relation to HER2, with variable and inconclusive results. Limited data exist for other biomarkers, such as the estrogen receptor. In addition to the need to define and validate the most accurate and reproducible method for CTC molecular analysis, the clinical relevance of biomarkers, including gain of HER2 on CTC after HER2 negative primary breast cancer, remains uncertain. This review summarises the currently available data relating to biomarker evaluation on CTCs and its role in directing management in metastatic breast cancer, discusses limitations, and outlines measures that may enable future development of this approach. © 2014 by the authors; licensee MDPI, Basel, Switzerland.

Objectives: This study sought to investigate whether the beneficial impact of high-dose rosuvastatin against contrast-induced acute kidney injury (CI-AKI) in acute coronary syndrome (ACS) patients varied in relation to baseline high-sensitivity C-reactive protein (hs-CRP) levels. Background: High-dose rosuvastatin administered on admission has been shown to prevent CI-AKI and improve short- and mid-term clinical outcome in ACS patients. Methods: All 504 statin-naïve ACS patients enrolled in the PRATO-ACS (Protective Effect of Rosuvastatin and Antiplatelet Therapy on Contrast-Induced Acute Kidney Injury and Myocardial Damage in ACS Patients) study were stratified into baseline hs-CRP tertiles: <2.7 mg/l, ≥2.7 to <7.5 mg/l, and ≥7.5 mg/l. The primary endpoint was CI-AKI occurrence (creatinine ≥0.5 mg/dl or ≥25% above baseline within 72 h). Logistic regression models were used to evaluate the relationship between hs-CRP levels and effects of rosuvastatin. Results: Patients with higher baseline hs-CRP values presented a significantly higher incidence of CI-AKI (5.4%, 8.7%, and 18.3% in the first, second, and third tertiles, respectively; p = 0.0001). The beneficial effect of rosuvastatin was markedly significant in the third hs-CRP tertile (odds ratio: 0.20; 95% confidence interval: 0.07 to 0.54; p = 0.002). Statin-treated patients in the third tertile presented a significantly lower rate of adverse events at 30 days (7.2% vs. 17.4%, p = 0.043) with a trend toward better outcome at 6 months (6.02% vs. 13.04%, p = 0.12). Conclusions: High-dose rosuvastatin administered on admission appears to exert more effective kidney protection in ACS subjects with higher baseline hs-CRP levels resulting in better short- and mid-term clinical outcome. (Protective Effect of Rosuvastatin and Antiplatelet Therapy on Contrast-Induced Nephropathy and Myocardial Damage in Patients With Acute Coronary Syndrome Undergoing Coronary Intervention [PRATO-ACS]; NCT01185938). © 2014 by the American College of Cardiology Foundation.

Objectives This study sought to determine if in addition to standard preventive measures on-admission, high-dose rosuvastatin exerts a protective effect against contrast-induced acute kidney injury (CI-AKI). Background Patients with acute coronary syndrome (ACS) are at high risk for CI-AKI, and the role of statin pre-treatment in preventing renal damage remains uncertain. Methods Consecutive statin-naïve non-ST elevation ACS patients scheduled to undergo early invasive strategy were randomly assigned to receive rosuvastatin (40 mg on admission, followed by 20 mg/day; statin group n = 252) or no statin treatment (control group n = 252). CI-AKI was defined as an increase in creatinine concentration of ≥0.5 mg/dl or ≥25% above baseline within 72 h after contrast administration. Results The incidence of CI-AKI was significantly lower in the statin group than in controls (6.7% vs. 15.1%; adjusted odds ratio: 0.38; 95% confidence interval [CI]: 0.20 to 0.71; p = 0.003). The benefits against CI-AKI were consistent, even applying different CI-AKI definition criteria and in all the pre-specified risk categories. The 30-day incidence of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) was significantly lower in the statin group (3.6% vs. 7.9%, respectively; p = 0.036). Moreover, statin treatment given on admission was associated with a lower rate of death or nonfatal myocardial infarction at 6 month follow-up (3.6% vs. 7.2%, respectively; p = 0.07). Conclusions High-dose rosuvastatin given on admission to statin-naïve patients with ACS who are scheduled for an early invasive procedure can prevent CI-AKI and improve short-term clinical outcome. (Statin Contrast Induced Nephropathy Prevention [PRATO-ACS]; NCT01185938).

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