Publications by authors named "Andrea Conti"

198 Publications

Guselkumab: an anti-IL-23 antibody for the treatment of moderate-to-severe plaque psoriasis.

Eur J Dermatol 2021 Feb;31(1):3-16

Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Corso della Repubblica, 7904100 Latina, Rome, Italy.

Guselkumab, a subcutaneously administered fully human IgG1λ monoclonal antibody that selectively inhibits the p19 subunit of interleukin 23, is approved in both the USA and the EU for the treatment of adult patients with moderate-to-severe plaque psoriasis. The efficacy and safety of guselkumab were demonstrated in four randomized, double-blind, Phase III trials (VOYAGE 1 and 2, NAVIGATE, and ECLIPSE), which demonstrated high levels of clinical response over three years of continuous treatment, regardless of sex, age, body weight, and race, maintaining a favourable safety profile and long-term tolerability. Guselkumab was shown to be efficacious in patients with prior failure of other biologics, including adalimumab and ustekinumab, and was superior to both adalimumab and secukinumab in head-to-head trials. Guselkumab efficacy was also observed in the treatment of psoriasis localized in difficult-to-treat body regions including the scalp, palms and/or soles, and fingernails. Treatment with guselkumab improved health-related quality of life and patient-reported signs and symptoms. Guselkumab has a consistently favourable safety profile and is well tolerated over the long-term. Clinical development of guselkumab as a treatment is ongoing for other immune-mediated inflammatory diseases, including psoriatic arthritis, Crohn's disease, and ulcerative colitis. In the overall management of patients with plaque psoriasis, guselkumab is a robust treatment option with durable maintenance of response over time.
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http://dx.doi.org/10.1684/ejd.2021.3965DOI Listing
February 2021

The role of ultrasound imaging in vascular compression syndromes.

Ultrasound J 2021 Feb 8;13(1). Epub 2021 Feb 8.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy.

Vascular compression syndromes are rare alterations that have in common the compression of an arterial and/or venous vessel by contiguous structures and can be congenital or acquired. The best known are the Thoracic Outlet Syndrome, Nutcracker Syndrome, May-Thurner Syndrome, and Dunbar Syndrome. The incidence of these pathologies is certainly underestimated due to the non-specific clinical signs and their frequent asymptomaticity. Being a first-level method, Ultrasound plays a very important role in identifying these alterations, almost always allowing a complete diagnostic classification. If in expert hands, this method can significantly contribute to the reduction of false negatives, especially in the asymptomatic population, where the finding of the aforementioned pathologies often happens randomly following routine checks. In this review, we briefly discuss the best known vascular changes, the corresponding ultrasound anatomy, and typical ultrasound patterns.
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http://dx.doi.org/10.1186/s13089-020-00202-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870731PMC
February 2021

"Nobel Prizes in Medicine as an overview on XX and XXI centuries biomedicine and health sciences: historical and epistemological considerations".

Acta Biomed 2020 06 5;91(4):e2020091. Epub 2020 Jun 5.

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Nobel Prizes are prestigious world awards attributed for intellectual achievements. There are six prizes awarded each year from a fund bequeathed by the Swedish industrialist Alfred Bernhard Nobel (1833-1896). Each Prize consists of a diploma, a gold medal and a sum of money and it may be attributed to one, two or three different persons. The Nobel Prize in Physiology or Medicine is regarded as the most relevant scientific acknowledgement in the biomedical area and is annually assigned to the living researcher, or researchers, who has/have more contributed to progress in this field. Nobel Prizes in Medicine so far attributed are 110 with 219 medicine laureates, of whom the youngest was 32 years old and the oldest 87. Twelve women have been awarded the prize and nobody has been awarded it more than once. The Nobel Prize in Physiology or Medicine is fundamental and its more than secular history certifies this. Generations of distinguished scientists have rightly been awarded it for discoveries, demonstrations and applications of paramount relevance. The geographical distribution and the number of scholars appointed with the Nobel Prize in Medicine, the areas of health sciences and biomedical research related to the awards and the motivations of the annually attributed Nobel Prize in Medicine provide a complete and stimulating historical and epistemological panorama of medicine, biology and health sciences in the course of the XX and XXI centuries.
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http://dx.doi.org/10.23750/abm.v91i4.9585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927541PMC
June 2020

Protective face masks through centuries, from XVII century plague doctors to current health care professionals managing the COVID-19 pandemic.

Acta Biomed 2020 07 16;91(4):e2020124. Epub 2020 Jul 16.

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The adoption of items similar to face masks by human beings dates back to the remote past. With specific regard to the use of face protections for medical purposes, from the beginning of the XVII century onwards in Europe physicians in charge of curing patients with plague wore a complicated, and subsequently typical, costume. The face mask included eye sockets of glass and leather headdresses with long, pointed beaks. These beaks were filled with scented spices, aromatic substances and perfumes to filter out the plague and to mask "bad air", which was considered to be the vehicle of the disease. In the XVIII and XIX centuries a number of advances regarding personal protection devices in health care were achieved. In the course of the 1918 influenza pandemic (Spanish flu), health care professionals began to use face masks in a routine way to protect themselves and their patients. From the sixties (XX century) onwards, the explosion of health care technology has led to a continuous refinement in the study of individual protection devices, also because, even in the presence of an increasing number of powerful antimicrobial agents, infectious diseases have remained dominant during these last decades. It is not by chance, therefore, that one of the consequences of the 2020 ongoing COVID-19 pandemic should be the fact that face masks have become essential again both inside and outside health care environments. Even if more than a century has passed from Fluegge's historical definition of bacteria-laden droplets, the role of certain medical-preventive achievements of the past, including the paradigmatic model of protective face masks, continues to remain pivotal in this third millennium.
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http://dx.doi.org/10.23750/abm.v91i4.10231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927518PMC
July 2020

Posterior nutcracker syndrome: a case report.

J Med Case Rep 2021 Feb 1;15(1):42. Epub 2021 Feb 1.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catania, Italy.

Background: Posterior nutcracker syndrome is defined by the compression of the left renal vein between the abdominal aorta and a lumbar vertebral body. It can be clinically manifest with intermittent hematuria, gonadal or spermatic reflux resulting in varicocele. Ultrasound is the first-line imaging which require  more accurate study  with contrast-enhanced computed tomography. Management can be conservative in younger patients with mild hematuria due to the high spontaneous remission rate and invasive with open surgical and endovascular interventions. We describe a very rare case with compression of the left renal vein due to an osteophyte of the spine.

Case Presentation: A 62-year-old Caucasic male came to our radiology department for chronic hepatitis B virus (HBV)-related liver disease follow-up and mild scrotal pain. The ultrasound examination revealed a compression of the left retro-aortic renal vein in the aorto-vertebral space caused by an osteophyte. Duplex Doppler ultrasound revealed flow congestion in the left renal vein and renal failure; power Doppler ultrasound showed left varicocele.

Conclusions: Doppler ultrasound is the first-line imaging and allows the detection of all the typical signs of posterior nutcracker: left renal vein stenosis, flow congestion and renal failure. Nutcracker syndrome should be suspected in older patients with left varicocele associated with hematuria. Failure to diagnose and treat these patients could have serious consequences for their health.
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http://dx.doi.org/10.1186/s13256-020-02617-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849074PMC
February 2021

The clinical spectrum of COVID-19-associated cutaneous manifestations: An Italian multicenter study of 200 adult patients.

J Am Acad Dermatol 2021 Jan 18. Epub 2021 Jan 18.

Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.

Background: COVID-19 is associated with a wide range of skin manifestations.

Objective: To describe the clinical characteristics of COVID-19-associated skin manifestations and explore the relationships among the 6 main cutaneous phenotypes and systemic findings.

Methods: Twenty-one Italian Dermatology Units were asked to collect the demographic, clinical, and histopathologic data of 200 patients with COVID-19-associated skin manifestations. The severity of COVID-19 was classified as asymptomatic, mild, moderate, or severe.

Results: A chilblain-like acral pattern was significantly associated with a younger age (P < .0001) and, after adjusting for age, significantly associated with less severe COVID-19 (P = .0009). However, the median duration of chilblain-like lesions was significantly longer than that of the other cutaneous manifestations taken together (P < .0001). Patients with moderate/severe COVID-19 were more represented than those with asymptomatic/mild COVID-19 among the patients with cutaneous manifestations other than chilblain-like lesions, but only the confluent erythematous/maculo-papular/morbilliform phenotype was significantly associated with more severe COVID-19 (P = .015), and this significance disappeared after adjustment for age.

Limitations: Laboratory confirmation of COVID-19 was not possible in all cases.

Conclusions: After adjustment for age, there was no clear-cut spectrum of COVID-19 severity in patients with COVID-19-related skin manifestations, although chilblain-like acral lesions were more frequent in younger patients with asymptomatic/pauci-symptomatic COVID-19.
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http://dx.doi.org/10.1016/j.jaad.2021.01.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816892PMC
January 2021

Anti-drug antibody detection with label-free electrolyte-gated organic field-effect transistors.

Chem Commun (Camb) 2021 Jan;57(3):367-370

Dipartimento di Scienze della Vita - Università di Modena e Reggio Emilia, Via Campi 103, 41125 Modena, Italy.

The efficacy of immunotherapy can be undermined by the development of an immune response against a drug/antibody mediated by anti-drug antibodies (ADAs) in treated patients. We present the first label-free EGOFET immunosensor that integrates a biological drug, Nivolumab (Opdivo©), as a specific recognition moiety to quantitatively and selectively detect ADAs against the drug. The limit of detection is 100 fM. This demonstration is a prelude to the detection of ADAs in a clinical setting in the treatment of different pathologies, and it also enables rapid screening of biological drugs for immunogenicity.
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http://dx.doi.org/10.1039/d0cc03399eDOI Listing
January 2021

Secukinumab Improves Patient Perception of Anxiety and Depression in Patients with Moderate to Severe Psoriasis: A Post hoc Analysis of the SUPREME Study.

Acta Derm Venereol 2021 03 31;101(3):adv00422. Epub 2021 Mar 31.

Dermatology Unit, Policlinico Tor Vergata, 00133 Rome, Italy.

This study evaluated whether secukinumab treatment for patients with moderate to severe plaque psoriasis correlates with improvements in symptoms of anxiety and depression. SUPREME was a 24-week, phase IIIb, multicentre, prospective study conducted across 50 centres in Italy with an extension period of up to 72 weeks. Assessments used were: Psoriasis Area Sever-ity Index (PASI), Hospital Anxiety and Depression Scale (HADS) - Anxiety (HADS-A), and HADS - Depression (HADS-D) scores and Dermatology Quality Life Index (DLQI). Compared with baseline, a significantly greater proportion of patients who reported moderate to severe clinical symptoms of anxiety or depression (HADS-A or HADS-D ≥ 11) were free of moderate to severe symptoms at weeks 16 and 48. The PASI and DLQI scores reduced over time with secukinumab treatment. Psoriasis treatment with secukinumab for 48 weeks resulted in significantly improved skin clearance and a parallel improvement in symptoms of anxiety and depression, assessed by HADS.
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http://dx.doi.org/10.2340/00015555-3712DOI Listing
March 2021

Phototherapy: The patients' point of view.

Photodermatol Photoimmunol Photomed 2021 Mar 5;37(2):175-179. Epub 2020 Dec 5.

Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences, Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.

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http://dx.doi.org/10.1111/phpp.12629DOI Listing
March 2021

Characteristic of chronic plaque psoriasis patients treated with biologics in Italy during the COVID-19 Pandemic: Risk analysis from the PSO-BIO-COVID observational study.

Expert Opin Biol Ther 2021 02 13;21(2):271-277. Epub 2021 Jan 13.

Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Dipartimento Scienze Mediche e Chirurgiche , Rome, Italy.

: The susceptibility of patients with chronic plaque psoriasis and the risks or benefits related to the use of biological therapies for COVID-19 are unknown. Few data about prevalence, clinical course and outcomes of COVID-19 among psoriatic patients were reported. The aims of this study were 1) to assess the prevalence and severity of COVID-19 in psoriatic patients treated with biologic agents during the first phase of the emergency (22 February to 22 April 2020) in Italy, and 2) to report the clinical outcomes of patients who have been exposed to individuals with confirmed SARS-CoV-2 infection. : Patients with moderate-to-severe chronic plaque psoriasis, aged ≥18 years and undergoing treatment with biologic agents as of 22 February 2020, were eligible to be included in PSO-BIO-COVID study. Demographic and clinical characteristics of patients using any biologic for psoriasis treatment between 22 February and 22 April 2020 were registered. : A total of 12,807 psoriatic patients were included in the PSO-BIO-COVID study. In this cohort 26 patients (0.2%) had a swab confirmation of SARS-CoV-2 infection. Eleven patients required hospitalization and two died. : The incidence of COVID-19 observed in our cohort of psoriatic patients (0.2%) is similar to that seen in the general population (0.31%) in Italy. However, the course of the disease was mild in most patients. Biological therapies may likely lessen 'cytokine storm' of COVID-19, which sometimes lead to multiple organ failure, ARDS, and death.
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http://dx.doi.org/10.1080/14712598.2021.1853698DOI Listing
February 2021

The Role of Ultrasound in Dunbar Syndrome: Lessons Based on a Case Report.

Am J Case Rep 2020 Nov 8;21:e926778. Epub 2020 Nov 8.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy.

BACKGROUND Dunbar syndrome is a rare vascular alteration caused by the abnormal course of the median arcuate ligament of the diaphragm, which in some patients causes chronic compression of the celiac artery and can cause non-specific symptoms such as diarrhea, retro-sternal pain, vomiting, swelling, and nausea, or a typical symptomatic triad with weight loss, post-prandial abdominal pain, and epigastric murmur. Color Doppler ultrasound and duplex Doppler ultrasound provide a complete diagnostic framework of this disease. CASE REPORT We describe a case of 55-year-old man with post-prandial epigastric pain, significant weight loss, and several episodes of retro-sternal pain. He underwent multidetector computed tomography of the abdomen and color duplex Doppler ultrasound examination of the celiac artery that highlighted stenosis of the celiac artery, more severe in expiratory apnea. The computed tomography showed the typical aspect of the celiac artery, with the "hook sign". A duplex Doppler ultrasound examination showed a significant increase in peak speed (226 cm/s) due to severe stenosis of the celiac artery by the median arched ligament of the diaphragm. CONCLUSIONS This case is unique due to the severity of the celiac artery stenosis and the unusual clinical presentation of the patient who had frequent episodes of retro-sternal pain. The significant increase in peak velocity in the celiac artery in expiratory apnea, if associated with the typical symptomatology in the absence of other alterations of the splanchnic vessels, can be considered, in our opinion, sufficient for the diagnosis of Dunbar syndrome.
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http://dx.doi.org/10.12659/AJCR.926778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656089PMC
November 2020

Incidence rates of hospitalization and death from COVID-19 in patients with psoriasis receiving biological treatment: A Northern Italy experience.

J Allergy Clin Immunol 2021 Feb 5;147(2):558-560.e1. Epub 2020 Nov 5.

Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.

Introduction: Whether biologic therapies enhance the risk of coronavirus 2019 (COVID-19) or affect the disease outcome in patients with chronic plaque psoriasis remains to be ascertained.

Objective: We sought to investigate the incidence of hospitalization and death for COVID-19 in a large sample of patients with plaque psoriasis receiving biologic therapies compared with the general population.

Methods: This is a retrospective multicenter cohort study including patients with chronic plaque psoriasis (n = 6501) being treated with biologic therapy and regularly followed up at the divisions of dermatology of several main hospitals in the Northern Italian cities of Verona, Padua, Vicenza, Modena, Bologna, Piacenza, Turin, and Milan. Incidence rates of hospitalization and death per 10,000 person-months with exact mid-p 95% CIs and standardized incidence ratios were estimated in the patients with psoriasis and compared with those in the general population in the same geographic areas.

Results: The incidence rate of hospitalization for COVID-19 was 11.7 (95% CI, 7.2-18.1) per 10,000 person-months in patients with psoriasis and 14.4 (95% CI, 14.3-14.5) in the general population; the incidence rate of death from COVID-19 was 1.3 (95% CI, 0.2-4.3) and 4.7 (95% CI, 4.6-4.7) in patients with psoriasis and the general population, respectively. The standardized incidence ratio of hospitalization and death in patients with psoriasis compared with those in the general population was 0.94 (95% CI, 0.57-1.45; P = .82) and 0.42 (95% CI, 0.07-1.38; P = .19), respectively.

Conclusions: Our data did not show any adverse impact of biologics on COVID-19 outcome in patients with psoriasis. We would not advise biologic discontinuation in patients on treatment since more than 6 months and not infected with severe acute respiratory syndrome coronavirus 2 to prevent hospitalization and death from COVID-19.
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http://dx.doi.org/10.1016/j.jaci.2020.10.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644231PMC
February 2021

Electrochemotherapy and Simultaneous Photodynamic Bone Stabilization of Upper Limbs in Metastatic Renal Cancer Disease: Case Report and Literature Review.

Case Rep Med 2020 14;2020:8408943. Epub 2020 Oct 14.

Oncologic Orthopaedic Division, Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, Città Della Salute e Della Scienza,Via Gianfranco Zuretti 29, 10126 Turin, Italy.

Introduction: Metastatic bone disease represents a systemic pathology that heavily affects the quality of life of oncologic patients causing pain and functional disability. . We present the case of a patient with a history of renal cell cancer presenting pathologic fractures of both humeri and proximal right radius.

Results: After a careful multidisciplinary approach, an adjuvant anticancer therapy and a photodynamic bone stabilization procedure were performed with a minimally invasive technique aiming to minimize pain and local disease progression, while restoring functional autonomy and improving the patient's quality of life. Electrochemotherapy was delivered on the lytic bone lesions with extraskeletal involvement of the proximal left humerus and the proximal right radius, and then polymeric bone stabilization was performed on both humeri. At two months of follow-up, the patient presented satisfactory functional scores (MSTS score: 12/30 bilaterally; DASH scores: 46.7/100 for the right side and 48.3/100 for the left one), and pain was well controlled with opioid analgesics. Radiographs showed good results in terms of ossification of lytic bone lesions and durability of polymeric stabilization. At four months of follow-up, the patient reported a stable clinical scenario. Six months after surgery, due to extremely poor prognosis after the progression of primary disease, the patient was referred to palliative care and died shortly thereafter.

Conclusion: Over the last decade, the management of metastatic bone disease has changed. Low-toxicity and minimally invasive procedures such as electrochemotherapy and polymeric bone stabilization might be performed concomitantly in selected patients, as an alternative to radiation therapy and to more demanding surgical procedures such as plating and adjuvant cementing.
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http://dx.doi.org/10.1155/2020/8408943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582063PMC
October 2020

Gait analysis: Comparative evaluation of conventional total knee replacement and modular distal femoral megaprosthesis.

Knee 2020 Oct 2;27(5):1567-1576. Epub 2020 Sep 2.

Oncologic Orthopaedic Unit, Department of Orthopaedic and Traumatology, CTO Hospital Città della Salute e della Scienza, Turin, Italy.

Background: Gait alterations have been studied with computer-assisted gait analysis after megaprosthetic replacement for tumors around the knee. It has never been proven that megaprostheses affects gait more than total knee arthroplasty (TKA); this study aims to compare via gait analysis patients who underwent megaprosthesis with patients with TKA.

Methods: We analyzed 26 patients with a megaprosthetic replacement of the distal femur and 21 patients with a standard TKA. For each subject computerized gait analysis was performed. Range of motion (ROM) of the knee was recorded, Quality of Life and functional evaluation in the oncologic group were assessed with the Musculoskeletal Tumor Society (MSTS) questionnaire, while Short Form-36 (SF-36) scores were calculated for both groups.

Results: All patients walked slower than healthy people (P < 0.05). Gait analysis showed a lower cadence than in the healthy population but no significant difference between the two groups. A longer swing and a shorter stance phase were detected in the megaprosthetic sample. The osteoarthritis group showed greater flexion during the phase of loading response, even if this was lower than the contralateral limb or healthy population. There was a statically significant difference between the healthy limb and the operated one in both groups regarding ROM, but no significant difference was registered between the two implants. MSTS score and most of SF-36 parameters showed no significant differences compared with literature data.

Conclusions: Gait analysis shows little discrepancy between the two groups; gait pattern abnormalities do not affect patients with a megaprosthetic replacement more significantly than patients undergoing TKA.
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http://dx.doi.org/10.1016/j.knee.2020.08.004DOI Listing
October 2020

Robot-Assisted Radical Cystectomy for Nonmetastatic Urothelial Carcinoma of Urinary Bladder: A Comparison Between Intracorporeal Versus Extracorporeal Orthotopic Ileal Neobladder.

J Endourol 2021 Feb 30;35(2):151-158. Epub 2020 Oct 30.

Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy.

To compare surgical, oncologic, functional outcomes and complication rate between intracorporeal neobladder (ICNB) and extracorporeal neobladder (ECNB) orthotopic ileal neobladder of robot-assisted radical cystectomy (RARC) in patients with nonmetastatic bladder carcinoma (BC). From 2014 to 2019, we prospectively collected and retrospectively analyzed 101 patients with nonmetastatic BC treated with RARC and ortothopic neobladder. Chi-squared test estimated differences in proportions of functional and oncologic outcomes. Multivariable logistic regression models (MLRMs) focused on overall, early (<30 days from discharge), and late complication rate (>30 days from discharge) in ICNB ECNB. Of all patients, 57 (56.4%) ICNB and 44 (43.6%) ECNB patients were identified. At least one complication occurred in 75.4% 72.7% in ICNB ECNB, respectively ( = 0.9). In MLRMs, focusing on complication rate, there was no statistically significant difference between ICNB ECNB for overall ( = 0.8), early ( = 0.6), and late complications ( = 0.8). No statistically significant differences were recorded for tumor relapse rate, cancer-specific and other cause mortality. No positive surgical margins were recorded in both groups. Daytime and nighttime continence recovery were 89.4% 87.1% ( = 1.0) and 63.8% 51.6% ( = 1.0) for ICNB ECNB. Potency recovery was 59.1% 54.3% ( = 0.5) for ICNB ECNB. No statistically significant differences in complication rate (overall, early, or late) were identified, when ICNB and ECNB were compared. Similarly, no statistically significant difference was found in oncologic and functional outcomes.
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http://dx.doi.org/10.1089/end.2020.0622DOI Listing
February 2021

Patients' demographic and socioeconomic characteristics influence the therapeutic decision-making process in psoriasis.

PLoS One 2020 12;15(8):e0237267. Epub 2020 Aug 12.

Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.

Background: Knowledge regarding differences in care for psoriatic patients is limited. The aim of this study was to investigate factors influencing prescription of systemic treatments for patients with psoriasis with a special focus on socioeconomic factors.

Methods And Findings: This was a non-interventional, cross-sectional study, conducted in 18 Italian University and/or hospital centers with psoriasis-specialized units. Questionnaires evaluating demographic and socioeconomic characteristics were administered to participants. Overall, 1880 consecutive patients affected by mild-to-severe psoriasis were recruited. Univariate and multivariable logistic regression analyses of systemic therapy prescription, with a special focus on biologics, accounting for the above mentioned characteristics were performed. Our analysis showed that all analyzed patients' characteristics were significantly associated with biological therapy compared to non-biological systemic one. Particularly, women were less likely to receive biologics than men (OR = 0.66; 95% CI, 0.57-0.77). Elderly patients (≥65 years) and subjects with a BMI ≥30 had lower odds to receive biologics respect to adults (≥35-64 years) (OR = 0.33; 95% CI, 0.25-0.40), and subjects with BMI≥25<30 (OR = 0.64; 95% CI, 0.53-0.77), respectively. Northern and Southern patients were both less likely to receive biologics than Central patients (OR = 0.75; 95% CI, 0.63-0.89, and OR = 0.56; 95% CI,0.47-0.68, respectively). Lower economic profile and never reading books were both associated with decreased odds of receiving biological therapy.

Conclusions: This study shows that sex, age, comorbidities, and socioeconomic characteristics influence the prescription of systemic treatments in psoriasis, highlighting that there are still unmet needs influencing the therapeutic decision-making process that have to be addressed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237267PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423114PMC
October 2020

"A hundred years since the birth of Rosalind Elsie Franklin, a brilliant and gifted scientist".

Intern Emerg Med 2021 Mar 23;16(2):531-532. Epub 2020 Jul 23.

Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Largo Brambilla 3, 50134, Florence, Italy.

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http://dx.doi.org/10.1007/s11739-020-02449-2DOI Listing
March 2021

Radical penectomy, a compromise for life: results from the PECAD study.

Transl Androl Urol 2020 Jun;9(3):1306-1313

Department of Urology, ASL 2 Abruzzo, Hospital "S. Pio da Pietrelcina", Vasto, Italy.

Background: The use of organ sparing strategies to treat penile cancer (PC) is currently supported by evidence that has indicated the safety, efficacy and benefit of this surgery. However, radical penectomy still represents up to 15-20% of primary tumor treatments in PC patients. The aim of the study was to evaluate efficacy in terms of overall survival (OS) and disease-free survival (DFS) of radical penectomy in PC patients.

Methods: Data from a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 13 European and American urological centers (Hospital "Sant'Andrea", Sapienza University, Roma, Italy; "G.D'Annunzio" University, Chieti and ASL 2 Abruzzo, Hospital "S. Pio da Pietrelcina", Vasto, Italy; Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Hospital of Budapest, Hungary; Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Italy; Hospital "Spedali Civili", Brescia, Italy; Istituto Europeo di Oncologia, University of Milan, Milan, Italy; University of Modena & Reggio Emilia, Modena, Italy; Hospital Universitario La Paz, Madrid, Spain; Ceara Cancer Institute, Fortaleza, Brazil; Virginia Commonwealth University, Richmond, VA, USA; Aristotle University of Thessaloniki, Thessaloniki, Greece; Maria Skłodowska-Curie Memorial Cancer Center, Warsaw, Poland) between 2010 and 2016 were used. Medical records of patients who specifically underwent radical penectomy were reviewed to identify main clinical and pathological variables. Kaplan-Meier method was used to estimate 1- and 5-year OS and DFS.

Results: Of the entire cohort of 425 patients, 72 patients (16.9%) treated with radical penectomy were extracted and were considered for the analysis. The median age was 64.5 (IQR, 57.5-73.2) years. Of all, 41 (56.9%) patients had pT3/pT4 and 31 (43.1%) pT1/pT2. Moreover, 36 (50.0%) were classified as pN1-3 and 5 (6.9%) M1. Furthermore, 61 (84.7%) had a high grade (G2-G3) with 6 (8.3%) positive surgical margins. The 1- and 5-year OS rates were respectively 73.3% and 59.9%, while the 1- and 5-year DFS rates were respectively 67.3% and 35.1%.

Conclusions: PC is an aggressive cancer particularly in more advanced stage. Overall, more than a third of patients do not survive at 5 years and more than 60% report a disease recurrence, despite the use of a radical treatment.
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http://dx.doi.org/10.21037/tau.2020.04.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354339PMC
June 2020

Just-in-Time Training in a Tertiary Referral Hospital During the COVID-19 Pandemic in Italy.

Acad Med 2021 03;96(3):336-339

F. Della Corte is full professor and director, CRIMEDIM-Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy.

The COVID-19 pandemic is threatening health systems worldwide, requiring extraordinary efforts to contain the virus and prepare health care systems for unprecedented situations. In this context, the entire health care workforce must be properly trained to guarantee an effective response. Just-in-time training has been an efficient solution for rapidly equipping health care workers with new knowledge, skills, and attitudes during emergencies; thus, it could also be an effective training technique in the context of the response to the COVID-19 pandemic. Because of the unexpected magnitude of this health crisis, the health care workforce must be trained in 2 areas: (1) basic infection prevention and control, including public health skills that are the core of population-based health management and (2) disaster medicine principles, such as surge capacity, allocation of scarce resources, triage, and the ethical dilemmas of rationing medical care. This Perspective reports how just-in-time training concepts and methods were applied in a tertiary referral hospital in March 2020, during the COVID-19 pandemic in Northern Italy, one of the hardest hit places in the world. The COVID-19 just-in-time training was designed to provide hospital staff with the competencies they need to work proficiently and safely inside the hospital, including an understanding of the working principles and standard operating procedures in place and the correct use of personal protective equipment. Moreover, this training was intended to address the basic principles of disaster medicine applied to the COVID-19 pandemic. Such training was essential in enabling staff to rapidly attain competencies that most of them lacked because disaster medicine and global health are not included in the curricula of Italian medical and nursing schools. Although a formal evaluation was not performed, this is a useful example of how to create just-in-time training in a large hospital during a crisis of an unprecedented scale.
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http://dx.doi.org/10.1097/ACM.0000000000003575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363358PMC
March 2021

Combination treatment with secukinumab and dimethyl fumarate in a patient with psoriasis and recent diagnosis of multiple sclerosis.

Dermatol Ther 2020 11 14;33(6):e13943. Epub 2020 Jul 14.

Dermatology Unit, Surgical, Medical, and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.

The therapeutic approach to patients with psoriasis and concomitant multiple sclerosis is challenging. We report the clinical case of a 44-year-old man affected by psoriasis and psoriatic arthritis treated with secukinumab for 2 years, who received also dimethyl fumarate because of a recent diagnosis of relapsing remitting multiple sclerosis. Moreover, a mini-review of the available literature regarding the use of secukinumab in patients with psoriasis or ankylosing spondylitis and coexisting central nervous system demyelinating diseases was performed. To the best of our knowledge, this is the first case of successfully combining secukinumab and dimethyl fumarate for the treatment of two different immune mediated inflammatory diseases with good response and safety outcomes. Our case emphasizes the potential efficacy of this combination therapy, which may represent an effective synergistic strategy to manage such challenging patients.
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http://dx.doi.org/10.1111/dth.13943DOI Listing
November 2020

May Thurner syndrome: description of a case with unusual clinical onset.

J Ultrasound 2020 Jun 23. Epub 2020 Jun 23.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catania, Italy.

May-Thurner syndrome (MTS) is a congenital vascular alteration that is part of a restricted category of very rare vascular syndromes that have in common the compression of an arterial or venous vessel. MTS, first described in 1957, is due to compression of the left common iliac vein against the lumbar spine by the adjacent common iliac artery. It can cause chronic thrombosis of the left lower limb and can give edema, pain, claudication, thrombophlebitis, and, in severe cases, pulmonary embolism. Color Doppler and duplex Doppler ultrasound allow us to easily locate the deep vein thrombosis, to measure its extension, and to highlight the vascular changes typical of MTS: compression and consequent hypertension of the left common iliac vein. The therapy depends on the degree of venous stasis and on the presence of venous thrombosis; generally, it consists of the administration of short- or long-term anticoagulant and thrombolytic drugs. In cases of severe stenosis of the left common iliac vein, the first-choice treatment consists of positioning a vascular stent, which resolves compression and significantly reduces chronic thrombotic episodes. We describe a case of MTS with an unusual clinical onset with pulmonary embolism.
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http://dx.doi.org/10.1007/s40477-020-00497-0DOI Listing
June 2020

True congenital multicystic disease of the pancreas in the infant: a very rare case.

J Ultrasound 2020 May 22. Epub 2020 May 22.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catania, Italy.

The most frequent pancreatic cysts in patients of developmental age are pseudocysts, neoplastic cysts, posttraumatic cysts, and parasitic cysts. Retention cysts, duplication cysts, and congenital cysts are called true cysts. Among the true cysts, congenital cysts are very rare and include 1% of all pancreatic cysts. The finding of true congenital pancreatic cysts in children under 3 years represents a very rare event; less than 30 have been described in the literature. We describe the case of a 3-year-old male who came to our observation for abdominal pain and underwent an abdomen ultrasound examination. The ultrasound examination showed unilocular sub-centimeter cystic lesions, distributed throughout the pancreatic parenchyma. The patient was, therefore, not subjected to any treatment, and after a few days, the symptoms regressed spontaneously. This description probably represents the first case in the literature of "congenital multicystic disease" of the pancreas.
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http://dx.doi.org/10.1007/s40477-020-00472-9DOI Listing
May 2020

Historical and methodological highlights of quarantine measures: from ancient plague epidemics to current coronavirus disease (COVID-19) pandemic.

Acta Biomed 2020 05 11;91(2):226-229. Epub 2020 May 11.

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The ongoing 2020 coronavirus disease (COVID-19) pandemic is an enormous challenge for the health systems and the entire societies of the countries involved. Since at present the outbreak continues to evolve (April 2020), the World Health Organization (WHO) has declared it a public health emergency of international concern, specifying that public health interventions aimed at the prevention of the further spread of this disease include quarantine. Quarantine, that may be defined as a restraint on the activities of people or on the traffic of goods, targeted to the prevention of the diffusion of communicable pathologies, is a health concept profoundly rooted in the history of mankind. The lessons of the past are always pertinent for the present and for the future, in particular from a public health standpoint. One of the most relevant of them is connected with previous influenza pandemics, similar to the current COVID-19 2019/2020 pandemic, and it indicates that it is practically impossible, even in recent times, to contain the infection in the geographic area where it has risen and to prevent its trans-national disseminated spread. With specific reference to the COVID-19 pandemic, therefore, health authorities still adopt "classical" preventive interventions, namely workplace social distancing measures and quarantine, to reduce the transmission of the disease. Only the future will testify the precise overall effectiveness of preventive public health measures in containing the impact of the present coronavirus pandemic. However, what in this epidemiological scenario is already known, is that the multi-century international health value of quarantine remains essential and unavoidable.
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http://dx.doi.org/10.23750/abm.v91i2.9494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569636PMC
May 2020

TNF-α inhibitors biosimilars as first line systemic treatment for moderate-to-severe chronic plaque psoriasis.

Expert Rev Clin Immunol 2020 06 4;16(6):591-598. Epub 2020 Jun 4.

Department of Medicine, Section of Dermatology and Venereology, University of Verona , Verona, Italy.

Introduction: Biologics have revolutionized the therapy of moderate-to-severe plaque psoriasis. Despite their greater efficacy over conventional systemic therapies their high cost has represented a burden for health-care systems, which limited their use. The availability of biosimilars at low cost is changing the place in therapy of biologics for psoriasis.

Areas Covered: The role of TNF- α inhibitors in the management of plaque psoriasis, their efficacy and safety profile are presented. Phase 3 clinical trials and real-life data from the use of TNF- α inhibitor biosimilars in the treatment of plaque psoriasis are also reviewed in detail. Furthermore, arguments in favor of the use of TNF- α inhibitor biosimilars as a first-line therapy in moderate-to-severe plaque psoriasis are discussed.

Expert Opinion: An increasing amount of data show that biosimilars represent a safe and effective alternative to the originator biologics. In the face of ever-increasing health-care costs, switching to biosimilars and starting naïve patients on the best-value biologic can reduce expenditure for patients and payers while maintaining a high-quality care. Moreover, as the cost of biosimilars is approaching the cost of conventional systemic treatments, TNF-α inhibitors biosimilars may represent a first-line systemic treatment for psoriasis patients because they are effective and safe.
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http://dx.doi.org/10.1080/1744666X.2020.1771182DOI Listing
June 2020

Chronische Nierenerkrankung bei Psoriasis: eine Kohortenstudie.

J Dtsch Dermatol Ges 2020 May;18(5):438-446

Nephrology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.

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http://dx.doi.org/10.1111/ddg.14087_gDOI Listing
May 2020

A Preliminary Study on the Mechanical Reliability and Regeneration Capability of Artificial Bone Grafts in Oncologic Cases, With and Without Osteosynthesis.

J Clin Med 2020 May 8;9(5). Epub 2020 May 8.

Oncologic Orthopaedic Division, Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy.

Several bone grafts are available for clinical use, each with their own peculiar biological and mechanical properties. A new bone graft was obtained by combining mineral structures from natural bovine bones with bioresorbable polymers and cellular nutrients. The study aims to evaluate the clinical, biological and structural properties of this bone graft and its reliability in orthopedic oncology. 23 adult patients (age range 18-85 years) were treated between October 2016 and December 2018; the oncologicdiagnoses were heterogeneous. After surgical curettage and bone grafting, a clinical-radiological follow up was conducted. Radiographs were used to evaluate graft integration according to the usual bone healing and oncologic follow up. Local complications (infection, local recurrence, wound dehiscence, fracture or early reabsorption) were evaluated. The mean followup was of 18.34 ± 4.83 months. No fracture or infection occurred. One case of patellar Giant Cell Tumor (GCT) and one of proximal tibia low-grade chondrosarcoma recurred after about one year. Two wound dehiscences occurred (one required a local flap). Follow-up X-rays showed good to excellent graft integration in most patients (20 out of 21). The investigated graft has a mechanical and structural function that can allow early weight-bearing and avoid a preventive bone fixation (only needed in four patients in this series). The graft blocks are different for shapes and dimensions, but they can be customized by the producer or sawcut by the surgeon in the operating theatre to fit the residual bone cavity. The complication rate was low, and a rapid integration was observed with no inflammatory reaction in the surrounding tissues. Further studies are mandatory to confirm these promising results.
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http://dx.doi.org/10.3390/jcm9051388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291150PMC
May 2020

Long-Term Follow-Up Outcomes after Percutaneous US/CT-Guided Radiofrequency Ablation for cT1a-b Renal Masses: Experience from Single High-Volume Referral Center.

Cancers (Basel) 2020 May 7;12(5). Epub 2020 May 7.

Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Milan 20122, Italy.

Image-guided thermal ablations are increasingly applied in the treatment of renal cancers, under the guidance of ultrasound (US) or computed tomography (CT). Sometimes, multiple ablations are needed. The aim of the present study was to evaluate the long-term results in patients with renal mass treated with radiofrequency ablation (RFA) with both US and CT, with a focus on the multiple ablations rate. 149 patients (median age 67 years) underwent RFA from January 2008 to June 2015. Median tumor diameter was 25 mm (IQR 17-32 mm). Median follow-up was 54 months (IQR 44-68). 27 (18.1%) patients received multiple successful ablations, due to incomplete ablation (10 patients), local tumor progression (8 patients), distant tumor progression (4 patients) or multiple tumor foci (5 patients), with a primary and secondary technical efficacy of 100%. Complications occurred in 13 (8.7%) patients (6 grade A, 5 grade C, 2 grade D). 24 patients died during follow-up, all for causes unrelated to renal cancer. In conclusion, thermal ablations with the guidance of US and CT are safe and effective in the treatment of renal tumors in the long-term period, with a low rate of patients requiring multiple treatments over the course of their disease.
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http://dx.doi.org/10.3390/cancers12051183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281086PMC
May 2020

A Case of Nutcracker Syndrome Combined with Wilkie Syndrome with Unusual Clinical Presentation.

Am J Case Rep 2020 Apr 22;21:e922715. Epub 2020 Apr 22.

Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy.

BACKGROUND Nutcracker syndrome and Wilkie's syndrome are rare vascular diseases due to the abnormal course of the superior mesenteric artery originating from the abdominal aorta with reduced angle (<22°) and consequent compression of the left renal vein (nutcracker) and duodenum (Wilkie). Here, we report the case of a patient with a rare combination of these 2 syndromes and with unusual clinical manifestation of post-prandial pain. CASE REPORT We describe the case of a young male patient with rapid weight loss, coupled with post-prandial abdominal pain, with sub-acute onset, not associated with other symptoms. The ultrasound examination found an aorto-mesenteric angle of 18° and compression of the left renal vein and left varicocele. A CT study was performed to exclude oncological diseases and/or other pathologies responsible for the pain and weight loss, which confirmed the ultrasound findings and showed compression of the third part of the duodenum. The patient underwent endovascular treatment, with stent placement in the left renal vein, which resolved the vascular compression and of the duodenum, with regression of symptoms. CONCLUSIONS The ultrasound scan promptly highlighted the reduction of the aorto-mesenteric angle and the signs of venous congestion of the left renal vein. Based on this experience, in patients with weight loss and post-prandial pain, in our opinion, diagnostic investigations should also be extended to the study of the aorto-mesenteric angle to confirm or exclude any vascular and/or duodenal compression.
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http://dx.doi.org/10.12659/AJCR.922715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193224PMC
April 2020

Chronic kidney disease in psoriasis: a cohort study.

J Dtsch Dermatol Ges 2020 05 20;18(5):438-445. Epub 2020 Apr 20.

Nephrology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.

Background: Psoriasis is a chronic, relapsing disease often associated with comorbidities. While its associations with cardiovascular and metabolic factors have been investigated, little is known about its association with impairment of renal function.

Materials And Methods: We performed a cohort study of 219 psoriatic patients in which we evaluated chronic kidney disease (CKD) and eGFR as well as albuminuria according to their KDIGO stratification risk criteria. We also evaluated circulating immunoglobulins (IgG, IgA, IgM), C3-C4 levels and the urinary albumin-to-creatinine ratio. We divided the patients into two groups, according to the presence or absence of known and established CKD risk factors.

Results: In our population, the risk of CKD was moderate in 17.35 % of patients, high in 5.02 % and very high in 3.66 %. The risk prevalence for CKD was slightly greater in the group without established risk factors than the risk prevalence reported in NHANES 1999-2006. The presence of psoriatic arthritis, duration of psoriasis (≥ 21 years) and magnitude of the PASI score showed a positive correlation with the urinary albumin-to-creatinine ratio.

Conclusions: We found an association between microalbuminuria and the duration of psoriasis, as well as with psoriatic arthritis. Moreover, patients with microalbuminuria exhibited a higher Kidney Disease Improving Global Outcome stratification risk.
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http://dx.doi.org/10.1111/ddg.14087DOI Listing
May 2020