14 research outputs found
Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic
Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both
Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPDâ+âHF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPDâ+âHF. Patients with COPDâ+âHF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPDâ+âHF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPDâ+âHF for all causes (pâ=â0.010), respiratory causes (pâ=â0.006), cardiovascular causes (pâ=â0.046) and respiratory plus cardiovascular causes (pâ=â0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population
FIBRONECTINA: NUOVO MARKER DI DANNO UROTELIALE NELLA TERAPIA ADIUVANTE INTRAVESCICALE DEI TUMORI VESCICALI NON MUSCOLO INVASIVI
PATIENTâS COMPLIANCE TO BCG. DO WE ADEQUATELY CONSIDER IT?
Introduction: Several studies and meta-analysis demonstrated
that BCG is the best treatment for conservative management of
high-risk NMI-BC with a net benefit in terms of both
recurrence-free and progression-free survival (1, 2).
Maintenance lasting minimum one year is recommended. In
spite of the effectiveness, the amount of patients who complete
the manteinance schedule does not exceed 50% (3). The
reasons of BCG maintenance interruption remain still unclear.
The aim of our study was to investigate the causes of low
adherence to 1-year full dose maintenance BCG in a large
series. Patients and Methods: The clinical files of consecutive
patients affected by T1 HG NMI-BC and undergoing adjuvant
BCG for one year, between 2000 and 2012, were reviewed.
Main exclusion criteria were presence of Tis, previous T1 HG,
number of tumors more than 3 and diameter greater than 3 cm,
genitourinary tract infections or other disease potentially
impacting tolerability and compliance to BCG. One-year BCG
maintenance was scheduled according to the South West
Oncology Group (SWOG) including 3 weekly instillations at
3, 6 and 12 months starting 21-40 days after TUR. No dose
reduction was considered. Both local and systemic side effects
and any reason of treatment suspension were recorded. BCG
tollerability was classified in four grades: 0. no need of
postponement, 1. one-week postponement, 2. two-week
postponement, 3. one single instillation omitted, 4. definitive
stop. Results: The files of 545 consecutive patients with HG
NMI-BC, selected for conservative management at two tertiary
referral centers were reviewed. Out of them, 411 patients
(75.4%) satisfied the inclusion criteria. The induction cycle was
completed and suspended by 380 (92.5%) and 31 (7.5%)
patients respectively. Suspension was due to toxicity in 20
(4.8%) and to no toxicity-related reasons in 11 (2.6%) patients.
Maintenance was initiated by 308 (74.9%) patients while 72
(17.5%) never started. Particularly, 32 (8.4%) patients refused
it due to personal choice and/or practical limitation, 22 (5.8%)
were withdrawn by the urologist before the first planned 3-
week cycle due to persistent haematuria or early recurrence and
18 more patients (4.7%) never started and were lost at followup.
Out of the 308 patients starting the 1-year maintenance, 215
(52.3%) patients completed it, while 93 (30.2%) did not. The
manteinance regimen was interrupted by 9 patients (9.7%) due
to recurrence, while 14 (15.1%) experienced grade 3 toxicity
and 55 (59.1%) refused it in absence of grade 2-3 toxicity or
other evident causes. Grade-I toxicity and/or mild side effects,
not responsible for maintenance treatment modification, were
recorded in 193 (62.7%) patients. Discussion and Conclusion:
The European Association of Urology (EAU) and the National
Comprehensive Cancer Network (NCCN) recommend one year
BCG maintenance as the elective intravesical adjuvant regimen
in intermediate- and high-risk NMI-BC, conservatively treated.
The scientific urologic community does not consider BCGrelated
toxicity as the major limiting factor. In the present study
patientâs compliance during the induction cycle reached 92%.
However during the interval between the induction course and
the first maintenance instillation, 50 patients (13%) became
reluctant to treatment while 22 (6%) were excluded after
cystoscopy for suspicious bladder lesion. Toxicity (moderate to
severe) was responsible for the interruption of BCG
maintenance only in a low number of patients. The high rate
of patients who abandoned the treatment could be attributable
to the persistency of mild symptoms causing consistent
discomfort that justified the reluctance to carry on the therapy.
Moreover the inadequate counseling in everyday clinical
practice when compared to multi-institutional trials should be
taken into account. A structured periodical counseling and a
timely recognition and treatment of symptoms, might
significantly ameliorate the acceptance of BCG maintenance.
Acknowledgements: We wish to thank the GSTU Foundation for
administrative support.
1 Sylvester RJ et al: Intravesical bacillus Calmette-Guerin
reduces the risk of progression in patients with superficial
bladder cancer: a meta-analysis of the published results of
randomized clinical trials. J Urol 168: 1964-1970, 2002.
ANTICANCER RESEARCH 34: 2593-2686 (2014)
2618
2 Malmstrom PU et al: An individual patient data metaanalysis
of the long-term outcome of randomised studies
comparing intravesical mitomycin c versus bacillus
Calmette-Guerin for nonâmuscle-invasive bladder cancer.
Eur Urol 56: 247-256, 2009.
3 Oddens J et al: Final results of an EORTC-GU of EORTC
genito-urinary cancers group randomized study of
maintenance bacillus comparing intravesical instillations of
Calmette-Guerin in intermediate- and high-risk Ta, T1
papillary carcinoma of the urinary bladder: one-third dose
versus full dose and 1 year versus 3 years of maintenance.
Eur Urol 63: 462-472, 2013
409 Fibronectin (FN), epidermal growth factor-receptor (EGF-R) and heparin-binding epidermal growth factor-like (HB-EGF) urinary expressions and topical toxicity of adjuvant intravesical therapy for non muscle invasive bladder cancer (NMI-BC)
FIBRONECTIN (FN) AND UROTHELIAL DAMAGE SECONDARY TO ADJUVANT INTRAVESICAL THERAPY
Introduction and Objectives: Intravesical chemotherapy has
been proven effective in preventing recurrence of low-risk
non-muscle invasive bladder cancer (NMIBC). BCG is recognised as the best conservative treatment for intermediate
and high risk NMIBC. Maintenance for at least one year is
required to ameliorate the efficacy of adjuvant therapy.
Discomfort and toxicity often cause interruption of adjuvant
therapy, BCG particularly. Almost 50% of the patients
undergoing BCG does not complete one year. A biomarker of
urothelium damage would be helpful for timely detection of
toxicity in order to ameliorate patientâs tolerance and
compliance. The aim of the present study was to evaluate the
gene expression of Fibronectin (FN) in bladder washing in
relation with local toxicity due to adjuvant intravesical therapy.
Patients and Methods: Out of 26 asymptomatic patients
undergoing intravesical prophylaxis with mitomycin (40
mg/40 ml), epirubicin (80 mg/50 ml) or BCG Connaught (81
mg/50 ml) and 10 volunteers as control group, 62 samples of
bladder washing were collected before, during and after
therapy. The samples were analyzed by isolation of cellular
RNA using a miRNeasy Mini Kit (QiagenÂź). FN gene
expression was analyzed by RT-PCR. The ÎÎCt method after
normalization with endogenous reference 18s rRNA was
adopted. An average Ct value for each RNA was obtained for
triplicate reactions. Local toxicity was classified into 3 grades:
0-1. mild (no medical therapy); 2. moderate (medical therapy);
3. severe (instillation postponed for 1-2 weeks or intravesical
solution of hyaluronic acid and chondroitin sulphate
administered). Results: FN gene expression, compared to
controls, was increased 1.1 fold after TUR and before
intravesical therapy. During therapy it remained unchanged
(1.0 fold). However it was increased 1.1 fold in absence of
local toxicity, but to a median value of 3.6 fold in presence of
severe toxicity. Particularly, the mean values, compared to
controls, were 2.4 (range: 0.3-6.1), 1.1 (range: 0.1-2.3), 9.3
(range: 0.2-45.2), before therapy, in absence and in presence
of local toxicity, respectively. Of interest, patients receiving
intravesical hyaluronic acid and chondroitin sulphate solution
showed a median FN gene expression of 0.2 fold (range 0.1-
0.7), decreasing from 3 to 0.6 and from 4 to 0.2 fold in two
patients contemporary with symptomatic relief. Discussion:
Few studies have correlated the gene expression of FN to
bladder urothelial damage, in interstitial cystitis (1). FN plays
an important role on BCG activity (2). A marker of topical
toxicity would be helpful to improve the tolerance and to
reduce the drop-out rates of intravesical therapy. The
measurement in bladder washing is a simple and direct
evaluation of urothelial FN gene activity. This method avoids
all the bias due to the evaluation of FN protein expression in
urine. The overexpression of FN gene indicates the presence
of urothelial damage and activation of repairing processes.
Normal and downexpression indicate the absence or healing
of urothelial damage. Preliminarily, our study shows a
significant correlation between FN gene expression on bladder
washing and local toxicity. Furthermore, FN seems to be
reduced by the intravesical administration of intravesical hyaluronic acid and chondroitin sulphate solution. Conclusion:
FN gene expression in bladder washing emerges as a simple
and promising marker of urothelial damage. Further and larger
studies should be justified.
Acknowledgements: We wish to thank IBSA for unrestricted grant
and the GSTU Foundation for administrative support.
1 Blalock EM et al: Gene expression analysis of urine
sediment: evaluation for potential noninvasive markers of
interstitial cystitis/bladder pain syndrome. J Urol 187: 725,
2012.
2 Eissa S et al: Diagnostic value of fibronectin and mutant p53
in the urine of patients with bladder cancer: impact on
clinicopathological features and disease recurrence 27: 1286,
2010
Fibronectin (FN), epidermal growth factor-receptor (EGF-R) and heparin-binding epidermal growth factor-like (HB-EGF) urinary expressions and topical toxicity of adjuvant intravesical therapy for non muscle invasive bladder cancer (NMI-BC)
NMI bladder cancer, EGF-R, intravesical therapy. fibronecti
Azione antalgica di Hydrogel nell'orbitopatia basedowiana
La terapia dell'orbitopatia,nella fase acuta,si basa oltre che sulla correzione della turba endocrinologica,sulla protezione della cornea e sull'uso dei corticosteroidi ad alto dosaggio o di farmaci immunosoppressori o, in alternativa,sulla radioterapia orbitaria.Per attenuare la sintomatologia dolorosa,frequente nella fase acuta e che puĂČ inficiare la qualitĂ della vita,data la componente flogistica,abbiamo voluto valutare gli effetti di una terapia antalgica mediante appliocazione sulla superficie palpebrale di un gel chirurgico criogenico decongestinante ( a contenuto di estratto di ananas piĂč acido betaglicirretico),ad oggi utilizzato con risultati soddisfacenti in soggetti sottoposti a trattamenti chirurgici degli annessi oculari.Sono stati studiati in doppio cieco 50 soggetti ( 16 uomini e 34 donne, range etĂ 35-46,5 anni) con orbitopatia basedowiana ( OB) di grado 3,in fase dinamica,secondo la classificazione dell'American Thyroid Association.Tutti i pazienti,egualmente distribuiti in due gruppi,erano in terapia tireostatica con MMI.Nessun effetto collaterale Ăš stato riscontrato.All'esame clinico-strumentale-oftalmologico (visus,motilitĂ oculare,fundus,esoftalmometria e tonometria) non si sono apprezzate variazioni significative pre e post trattamento in nessuno dei due gruppi.2 soggetti del gruppo placebo hanno riferito un miglioramento complessivo della sintomatologia, mentre nel gruppo trattato 24 soggetti hanno riferito un sensibile miglioramento come da questionario validato.Nel nostro studio la terapia con Hydrogel si Ăš rivelata una valida strategia antalgica da associare ai farmaci ad azione sistemica
Prognostic Stratification of Patients With ST-Segment-Elevation Myocardial Infarction (PROSPECT): A Cardiac Magnetic Resonance Study.
Cardiac magnetic resonance (CMR) is a robust tool to evaluate left ventricular ejection fraction (LVEF), myocardial salvage index, microvascular obstruction, and myocardial hemorrhage in patients with ST-segment-elevation myocardial infarction. We evaluated the additional prognostic benefit of a CMR score over standard prognostic stratification with global registry of acute coronary events (GRACE) score and transthoracic echocardiography LVEF measurement.
Two hundred nine consecutive patients with ST-segment-elevation myocardial infarction (age, 61.4±11.4 years; 162 men) underwent transthoracic echocardiography and CMR after succesful primary percutaneous coronary intervention. Major adverse cardiac events (MACE) were assessed at a mean follow-up of 2.5±1.2 years. MACE occurred in 24 (12%) patients who at baseline showed higher GRACE risk score (P<0.01), lower LVEF with both transthoracic echocardiography and CMR, lower myocardial salvage index, and higher per-patient myocardial hemorrhage and microvascular obstruction prevalence and amount as compared with patients without MACE (P<0.01). The best cut-off values of transthoracic echocardiography-LVEF, CMR-LVEF, myocardial salvage index, and microvascular obstruction to predict MACE were 46.7%, 37.5%, 0.4, and 2.6% of left ventricular mass, respectively. Accordingly, a weighted CMR score, including the following 4 variables (CMR-LVEF, myocardial salvage index, microvascular obstruction, and myocardial hemorrhage), with a maximum of 17 points was calculated and included in the multivariable analysis showing that only CMR score (hazard ratio, 1.867 per SD increase [1.311-2.658]; P<0.001) was independently associated with MACE with the highest net reclassification improvement as compared to GRACE score and transthoracic echocardiography-LVEF measurement.
CMR score provides incremental prognostic stratification as compared with GRACE score and transthoracic echocardiography-LVEF and may impact the management of patients with ST-segment-elevation myocardial infarction