7 research outputs found
DS_10.1177_0363546519865529 – Supplemental material for Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years
No full textSupplemental material, DS_10.1177_0363546519865529 for Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years by Pietro Simone Randelli, Alessandra Menon, Elisabetta Nocerino, Alberto Aliprandi, Francesca Maria Feroldi, Manuel Giovanni Mazzoleni, Sara Boveri, Federico Ambrogi and Davide Cucchi in The American Journal of Sports Medicine</p
Type II endoleaks after fenestrated/branched endografting for juxtarenal and pararenal aortic aneurysms
No full textAim: Persistent type 2 endoleaks (EL2p) are not uncommon after endovascular aneurysm repair and their impact on long-term outcomes is well documented. However, their occurrence and natural history after fenestrated/branched endografting (F/B-EVAR) for juxta/para-renal aneurysms (J/P-AAAs) have been scarcely investigated. Aim of this study was to report incidence, risk-factors and natural history of EL2p after F/B-EVAR in J/P-AAAs. Methods: Between 2016 and 2022, all J/P-AAAs undergoing F/B-EVAR were prospectively collected and retrospectively analyzed. EL2 were assessed at the completion angiography, at 30-day and after 6 months as primary outcomes. Preoperative risk-factors for EL2p, follow-up survival, freedom from reinterventions (FFR) and aneurysm shrinkage (>5mm) were considered as secondar outcomes. Results: Out of 132 patients, there were 88(67%) JAAAs and 44(33%) PAAAs. Seventeen (13%) EL2 were detected at the completion angiography and 36(27%) at 30-day computed tomography angiography. The mean follow-up was 28+23 months. Eleven (31%) EL2 sealed spontaneously within six months and 3 new cases were detected, for an overall of 28 EL2p / 107(26%) patients with available radiological follow-up > 6months. Preoperative antiplatelet therapy (OR:4.7;95%CI:1-22.1;P:0.05), aneurysm thrombus volume <40% and >6 patent aneurysm afferent vessels (OR:7.2;95%CI:1.8-29.1;P:.005) were independent risk-factor for EL2p. Estimated 3-year survival was 80%, with no difference between cases with and without EL2p (78% vs 85%; P:.08). Estimated 3-year FFR was 86%, with no difference between cases with and without EL2p (81% vs 87%; P:.41). Four (3%) cases of EL2-related reinterventions were performed. In 65(49%) cases aneurysm shrinkage was detected. EL2p was an independent risk-factor for absence of aneurysm shrinkage during follow-up (HR: 3.2; 95% CI: 1.2-8.3; P:.014). Patients without shrinkage had lower follow-up survival (64% vs 86% at 3-year; P:.009) and FFR (74% vs 90% at 3-year; P:.014) than patients with shrinkage. Conclusion: EL2p is not infrequent (26%) after F/B-EVAR for J/P-AAAs and is correlated with preoperative antiplatelet therapy, aneurysm thrombus volume < 40% and > 6 patent sac afferent vessels. Patients with EL2p have a diminished aneurysm shrinkage, which is correlated with lower follow-up survival and FFR compared with patients with aneurysm shrinkage
The presence of gastroesophageal reflux disease increases the risk of developing post-operative shoulder stiffness after arthroscopic rotator cuff repair
No full textPurpose: Postoperative shoulder stiffness (SS) after arthroscopic rotator cuff (RC) repair has been reported with variable incidence and numerous preoperative risk factors have been described. This prospective study aims to document the incidence of postoperative SS and to evaluate the role of preoperative risk factors in the development of this complication, with special focus on the role of gastroesophageal reflux disease (GERD).
Methods: Preoperative risk factors for SS were prospectively evaluated in 237 consecutive patients undergoing single-row arthroscopic RC repair. The presence of GERD was evaluated with the GerdQ diagnostic tool. Postoperative SS was diagnosed according to the criteria described by Brislin and colleagues in 2007.
Results: The incidence of postoperative SS was 8.02%. The presence of GERD was significantly associated with development of postoperative SS (OR: 5.265; 95% CI, 1.657-1.731; p=0.005). Older age (OR: 0.896; 95% CI, 0.847-0.949; p<0.001), male gender (OR: 0.126; 95% CI, 0.0252-0.632; p=0.012) and number of pregnancies (OR: 0.47; 95% CI, 0.228-0.967; p=0.040) emerged as protective factors.
Conclusions: The presence of GERD significantly influences the development of postoperative SS after single-row arthroscopic RC repair. An underlying a specific pro-inflammatory condition, characterized by increased expression of TNF-α and TGF-β, and disorders in retinoid metabolism are hypothesis which could explain this previously unknown association. The documented incidence of postoperative SS falls among previously reported ranges, with females significantly more affected than men
Different infiltration patterns within the tumor microenvironment can identify mantle cell lymphoma patients with different clinical outcomes. Results from a pilot clinical-pathological study
No full textIntroduction Mantle Cell Lymphoma (MCL) is an aggressive B-cell neoplasm with well-defined histological
features associated with prognosis. Early relapse recently proved to be associated with unfavorable outcomes.
Although the intrinsic mechanisms underlying MCL pathogenesis have been elucidated, the extrinsic
mechanisms regulated by tumor microenvironment (TME) are less known. Investigation of the crosstalk
between MCL cells and their microenvironment is of preeminent importance to identify mechanisms of MCL
earlier relapse and improve the effectiveness of treatment.
Objectives To evaluate the histopathological features of relapsed/refractory (R/R) MCL cases, with focus on
T-cells and macrophages infiltration. Correlation between TME, lymphoma characteristics and clinical outcome
was then attempted.
Methods This pilot study is part of the ongoing MANTLE-FIRST BIO study sponsored by Fondazione Italiana
Linfomi (FIL). Thirty-eight histological samples of 28 R/R MCL patients (22 at diagnosis, 16 at relapse) from 3
Italian centers were evaluated by a consensus group of hemo-pathologists. Histopathological evaluation was
performed on lymph nodes sections and included lymphoma cell morphology, patterns of growth, expression of
CD20, CD5, Cyclin D1, Sox11, Bcl2, p53, c-Myc, IgM and Ki67 by immunohistochemistry. TME study included
morphological scoring of histiocytic infiltration and quantitative evaluation of T-cells by CD3, CD4 and CD8
stains. Patients with clinical data available (N=11) were clinically classified as early (N=5) or late (N=6).
progressors by the previously described threshold of 24 months (Progression of Disease, POD24). Association
between pathological-defined groups and clinical parameters was performed using Fisher’s exact test and
Mann-Whitney test. Paired data were compared by exact Wilcoxon signed-rank test and exact McNemar test.
Results By comparing lymphoma samples at diagnosis and relapse, classic morphology and non-diffuse
patterns of growth were most common in the first group. Samples at relapse were characterized by higher
occurrence of diffuse expression of cyclin D1, higher Ki67, higher histocyte infiltration and lower CD4/CD8
T-cell ratio. In the early-POD group the most represented pattern was diffuse, instead, in the late-POD group
nodular, diffuse, and combined patterns were equally represented. Cyclin D1 was mostly diffuse in early-POD,
while occasionally modulated in late-POD. Ki67 was higher in early-POD. Bcl2 ad IgM were diffusely expressed
in all cases; p53 positivity was higher in early-POD than in late-POD, while c-Myc was higher in late-POD. As
regards TME, histocytes score was similar in the two groups (1+ in most cases). Interestingly, median CD3-cell
infiltration was higher in early-POD than in late-POD and the CD4/CD8 ratio was lower in early-POD, indicating
a higher prevalence of CD8-cells in patients that relapsed earlier. Due to the pilot nature of the study the
number of cases analyzed were low and differences were not statistically significant. Though, the
microenvironmental-based clustering demonstrated association with relevant clinical parameters such as POD.
These findings indicate a role of T-cell infiltration in the biological mechanisms associated with MCL early
relapse.
Conclusions Our results suggest that individual differences in TME can reflect clinical outcomes and
responses to therapy, thus highlighting the possible predictive significance of TME infiltration patterns in MCL.
We thank FIL (PGR Ed. 2019) for funding support
Circulating CXCL9, monocyte percentage, albumin, and C-reactive protein as a potential, non-invasive, molecular signature of carotid artery disease in 65+ patients with multimorbidity: a pilot study in Age.It
No full textBackground: Carotid endarterectomy (CEA) for the prevention of upcoming vascular and cerebral events is necessary in patients with high-grade stenosis (≥70%). In the framework of the Italian National project Age.It, a pilot study was proposed aiming at the discovery of a molecular signature with predictive potential of carotid stenosis comparing 65+ asymptomatic and symptomatic inpatients. Methods: A total of 42 inpatients have been enrolled, including 26 men and 16 women, with a mean age of 74 ± 6 years. Sixteen symptomatic and 26 asymptomatic inpatients with ≥70% carotid stenosis underwent CEA, according to the recommendations of the European Society for Vascular Surgery and the Society for Vascular Surgeons. Plaque biopsies and peripheral blood samples from the same individuals were obtained. Hematobiochemical analyses were conducted on all inpatients, and plasma cytokines/molecules, such as microRNAs (miRs), IL-6, sIL-6Ralpha, sgp130, myostatin (GDF8), follistatin, activin A, CXCL9, FGF21, and fibronectin, were measured using the ELISA standard technique. MiR profiles were obtained in the discovery phase including four symptomatic and four asymptomatic inpatients (both plasma and plaque samples), testing 734 miRs. MiRs emerging from the profiling comparison were validated through RT-qPCR analysis in the total cohort. Results and conclusion: The two groups of inpatients differ in the expression levels of blood c-miRs-126-5p and -1271-5p (but not in their plaques), which are more expressed in symptomatic subjects. Three cytokines were significant between the two groups: IL-6, GDF8, and CXCL9. Using receiver operating characteristic (ROC) analysis with a machine learning-based approach, the most significant blood molecular signature encompasses albumin, C-reactive protein (CRP), the percentage of monocytes, and CXCL9, allowing for the distinction of the two groups (AUC = 0.83, 95% c.i. [0.85, 0.81], p = 0.0028). The potential of the molecular signature will be tested in a second cohort of monitored patients, allowing the application of a predictive model and the final evaluation of cost/benefit for an assessable screening test
Treatment of partial rotator cuff lesions is associated with a higher frequency of post-operative shoulder stiffness. A prospective investigation on the role of surgery-related risk factors for this complication
No full textPURPOSE: Post-operative shoulder stiffness (SS) is a common complication after arthroscopic rotator cuff (RC) repair. The aim of this prospective study is to evaluate the role of surgical risk factors in the development of this complication, with special focus on the characteristics of the RC tears. METHODS: Two-hundred and twenty patients who underwent arthroscopic RC repair for degenerative posterosuperior RC tears were included. Surgery-related risk factors for development of post-operative SS belonging to the following five categories were documented and analyzed: previous surgery, RC tear characteristics, hardware and repair type, concomitant procedures, time and duration of surgery. The incidence of post-operative SS was evaluated according to the criteria described by Brislin and colleagues. RESULTS: The incidence of post-operative SS was 8.64%. The treatment of partial lesions by tear completion and repair technique was significantly associated with development of post-operative SS (p = 0.0083, pc = 0.04). A multivariate analysis revealed that treatment of partial lesions in patients younger than 60 years was associated to a higher risk of developing post-operative SS (p = 0.007). Previously known pre-operative risk factors such as female sex and younger age were confirmed. No other significant associations were documented. CONCLUSION: The treatment of partial lesions of the RC may lead to a higher risk of post-operative SS than the treatment of complete lesions, in particular in patients younger than 60 years. Possible explanations of this finding are the increased release of pro-inflammatory cytokines caused by the additional surgical trauma needed to complete the lesion and the different pain perception of the subgroup of patients who require surgical treatment already for partial tears. EVIDENCE: A higher risk of post-operative SS should be expected after tear completion and repair of partial lesions, especially in young patients. Appropriate pre-operative counseling and post-operative rehabilitation should be considered when approaching this subgroup of RC tears. LEVEL OF EVIDENCE: Prognostic study, level II. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00402-021-04285-1
Circulating CXCL9, monocyte percentage, albumin, and C-reactive protein as a potential, non-invasive, molecular signature of carotid artery disease in 65+ patients with multimorbidity: a pilot study in Age.It
No full textBackgroundCarotid endarterectomy (CEA) for the prevention of upcoming vascular and cerebral events is necessary in patients with high-grade stenosis (≥70%). In the framework of the Italian National project Age.It, a pilot study was proposed aiming at the discovery of a molecular signature with predictive potential of carotid stenosis comparing 65+ asymptomatic and symptomatic inpatients.MethodsA total of 42 inpatients have been enrolled, including 26 men and 16 women, with a mean age of 74 ± 6 years. Sixteen symptomatic and 26 asymptomatic inpatients with ≥70% carotid stenosis underwent CEA, according to the recommendations of the European Society for Vascular Surgery and the Society for Vascular Surgeons. Plaque biopsies and peripheral blood samples from the same individuals were obtained. Hematobiochemical analyses were conducted on all inpatients, and plasma cytokines/molecules, such as microRNAs (miRs), IL-6, sIL-6Ralpha, sgp130, myostatin (GDF8), follistatin, activin A, CXCL9, FGF21, and fibronectin, were measured using the ELISA standard technique. MiR profiles were obtained in the discovery phase including four symptomatic and four asymptomatic inpatients (both plasma and plaque samples), testing 734 miRs. MiRs emerging from the profiling comparison were validated through RT-qPCR analysis in the total cohort.Results and conclusionThe two groups of inpatients differ in the expression levels of blood c-miRs-126–5p and -1271–5p (but not in their plaques), which are more expressed in symptomatic subjects. Three cytokines were significant between the two groups: IL-6, GDF8, and CXCL9. Using receiver operating characteristic (ROC) analysis with a machine learning-based approach, the most significant blood molecular signature encompasses albumin, C-reactive protein (CRP), the percentage of monocytes, and CXCL9, allowing for the distinction of the two groups (AUC = 0.83, 95% c.i. [0.85, 0.81], p = 0.0028). The potential of the molecular signature will be tested in a second cohort of monitored patients, allowing the application of a predictive model and the final evaluation of cost/benefit for an assessable screening test
