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1. Pharmacy Workload in Clinical Trial Management: A Preliminary Complexity Assessment Tool for Sponsored Oncology and Haematology Trials

Author

Lorenzo Gasperoni, Carla Masini, Giada Toscano, Alessandro Cafaro, Chiara Zani, Cristina Andrianò, Paolo Silimbani, Caterina Donati, Giorgia Bortolin, and Sara Cecco

Subjects
clinical trial, pharmacy, workload, oncology, scoring method, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Investigational drug services need to be organised in a structured approach, especially for sites with a large number of ongoing clinical trials. The aim of this study was to develop a tool to assess the complexity of pharmacy involvement in a sponsored oncology clinical trial. Categorisation into ordinal complexity categories was used to assess the complexity of the clinical trials for consistent pharmacy grant applications. The 15 items of the tool were divided into three sections, and individual item scores were agreed upon among four pharmacists with experience in the conduct of clinical trials at two different centres. A final version of the tool, named Pharm-CAT, was approved. The pharmacists were instructed to use Pharm-CAT to assign a score to each new sponsored trial. To determine the cut-offs for the complexity categories, the scores were sorted in ascending order and the cut-offs corresponding to the first and third tertiles of the score distribution were selected. To verify the reproducibility of the results, Pharm-CAT was applied by two pharmacists independently for each trial. Pharm-CAT proved to be user-friendly. Sixty clinical trials were evaluated and a total of 120 scores were recorded. Low-complexity scores ranged from 0 to 19, medium-complexity scores ranged from 20 to 25, and high-complexity scores were 26 or higher. The average score recorded was 22.88 points. Prospective multicentre validation of Pharm-CAT is needed to confirm its applicability.

Published
2024
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2. A real-world retrospective, observational study of first-line pembrolizumab plus chemotherapy for metastatic non-squamous non-small cell lung cancer with PD-L1 tumor proportion score < 50% (PEMBROREAL)

Author

Alessandro Cafaro, Flavia Foca, Oriana Nanni, Marco Chiumente, Marina Coppola, Paolo Baldo, Sabrina Orzetti, Fiorenza Enrico, Vito Ladisa, Rosa Lerose, Patrizia Nardulli, Piera Maiolino, Federica Gradellini, Anna Rita Gasbarro, Gisella Carrucciu, Riccardo Provasi, Paola Cristina Cappelletto, Alessandra Pasqualini, Stefano Vecchia, Marianna Veraldi, Adele Emanuela De Francesco, Lucio Crinò, Angelo Delmonte, and Carla Masini

Subjects
pembrolizumab, non-small cell lung cancer, real-world data, immunotherapy, observational study, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

IntroductionThe phase III Keynote-189 trial established a first-line treatment combining pembrolizumab with pemetrexed and platinum as a standard treatment for patients with stage IV non-small cell lung cancer (NSCLC) without known EGFR and ALK driver mutations and independent of programmed cell death ligand 1 (PD-L1) expression. However, in Italy, eligibility for the National Health Service payment program is limited to patients with PD-L1

Published
2024
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3. Real-World Safety and Outcome of First-Line Pembrolizumab Monotherapy for Metastatic NSCLC with PDL-1 Expression ≥ 50%: A National Italian Multicentric Cohort ('PEMBROREAL' Study)

Author

Alessandro Cafaro, Flavia Foca, Oriana Nanni, Marco Chiumente, Marina Coppola, Alberto Russi, Elena Svegliati, Paolo Baldo, Sabrina Orzetti, Fiorenza Enrico, Federico Foglio, Davide Pinnavaia, Vito Ladisa, Claudia Lauria Pantano, Rosa Lerose, Patrizia Nardulli, Simona Ferraiuolo, Piera Maiolino, Immacolata De Stasio, Federica Gradellini, Anna Rita Gasbarro, Rossella Santeramo, Gisella Carrucciu, Riccardo Provasi, Mario Cirino, Paola Cristina Cappelletto, Elisabetta Fonzi, Alessandra Pasqualini, Stefano Vecchia, Marianna Veraldi, Adele Emanuela De Francesco, Lucio Crinò, Angelo Delmonte, and Carla Masini

Subjects
non-small cell lung cancer, immunotherapy, retrospective study, real-world data, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Results from the phase III Keynote-024 clinical trial established pembrolizumab monotherapy as the first-line standard of care for patients with metastatic NSCLC who have PD-L1 expression ≥ 50%, EGFR, and ALK wild-type tumors. However, given the differences between patients treated in routine clinical practice and those treated in a clinical trial, real-world data are needed to confirm the treatment benefit in standard practice. Given the lack of data on large cohorts of patients with long follow-ups, we designed an observational retrospective study of patients with metastatic NSCLC who were treated with pembrolizumab, starting from its reimbursement eligibility until December 2020. The primary endpoints were PFS and OS, determined using the Kaplan–Meier method. Response and safety were also evaluated. We followed 880 patients (median follow-up: 35.1 months) until February 2022. Median PFS and OS were 8.6 months (95% CI: 7.6–10.0) and 25.5 months (95% CI: 21.8–31.6), respectively. We also found that ECOG PS, PD-L1 expression, and habitual smoking were prognostic factors for PFS, while age, sex, ECOG PS, habitual smoking and histology had an impact on OS. Multivariable analysis confirms the prognostic role of PD-L1 for PFS and of ECOG for both PFS and OS. 39.9% of patients reported an adverse event, but only 6.3% of patients discontinued therapy due to toxicity. Our results suggest a long-term benefit of pembrolizumab in the first-line setting, as well as a safety profile consistent with the results of Keynote-024. Many collected variables appear to influence clinical outcome, but results from these exploratory unadjusted analyses should be interpreted with caution.

Published
2024
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4. Early acute kidney injury after transcatheter aortic valve implantation: predictive value of currently available risk scores

Author

Francesco Loizzi, Osvaldo Burattini, Alessandro Cafaro, Francesco Spione, Luigi Salemme, Angelo Cioppa, Luigi Fimiani, Flavio Rimmaudo, Antonio Pignatelli, Chiara Palmitessa, Giandomenico Mancini, Armando Pucciarelli, Alessandro S. Bortone, Gaetano Contegiacomo, Tullio Tesorio, and Fortunato Iacovelli

Subjects
aortic stenosis, transcatheter aortic valve implantation (TAVI), acute kidney injury, contrast-induced nephropathy, risk score, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is a frequent complication associated with adverse outcomes and mortality. Various scores have been developed to predict this complication in the coronary setting. However, none have ever been tested in a large TAVI population. This study aimed to evaluate the power of four different scores in predicting AKI after TAVI. Methods: Overall, 1535 consecutive TAVI patients from the observational multicentric “Magna Graecia” TAVI registry were included in the analysis. Of the study population, 235 (15.31%) developed AKI early. The Mehran, William Beaumont Hospital, CR4EATME3AD3, and ACEF scores were calculated retrospectively. Results: The patients who developed TAVI-related AKI had significantly higher absolute values of all risk scores than those who did not. The receiver-operating characteristic analysis also showed a significant correlation between these four scores and AKI, but without a significant difference among all of them (p value = 0.176). Nevertheless, based on their area under the curve values (≤0.604 for all), none had adequate diagnostic accuracy in predicting TAVI-related AKI. Importantly, multivariate analysis identified myocardial revascularization close to the TAVI procedure and implantation of self-expanding prostheses, as well as atrial fibrillation, low-osmolar contrast media administration, corrected contrast medium volume, and any transfusion (p value

Published
2023
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5. The hemodynamic performance of balloon-expandable aortic bioprostheses in the elderly: a comparison between rapid deployment and transcatheter implantation

Author

Fortunato Iacovelli, Paolo Desario, Alessandro Cafaro, Antonio Pignatelli, Rossella Alemanni, Rosamaria Montesanti, Alessandro Santo Bortone, Emanuela De Cillis, Micaela De Palo, Luca Bardi, Gian Luca Martinelli, Tullio Tesorio, Mauro Cassese, and Gaetano Contegiacomo

Subjects
Transcatheter aortic valve implantation (TAVI), rapid deployment valves (RDVs), balloon-expandable (BE) bioprostheses, hemodynamic performance, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Surgical aortic valve replacement with a rapid deployment valve (RDV) is a relatively recent treatment option. The aim of this study was to compare the hemodynamic performance of balloon-expandable (BE)-RDVs and BE-transcatheter heart valves (THVs) in a high surgical risk and frail-elderly population. Methods: BE-THVs and BE-RDVs were implanted in 138 and 47 patients, respectively, all older than 75 years and with a Canadian Study of Health and Aging category of 5 or above. Echocardiographic assessment was performed at discharge and six months later. Results: At discharge, transprosthetic pressure gradients and indexed effective orifice area (iEOA) were similar in both cohorts. At six-month follow-up, BE-RDVs showed lower peak (14.69 vs. 20.86 mmHg; p

Published
2022
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6. Fluoroscopy Time as a New Predictor of Short-Term Outcomes after Transcatheter Aortic Valve Replacement

Author

Alessandro Cafaro, Francesco Spione, Osvaldo Burattini, Daniele De Feo, Alessandro Xhelo, Chiara Palmitessa, Maurizio D’Alessandro, Vincenzo Pio Amendola, Flavio Rimmaudo, Andrea Igoren Guaricci, Alessandro Santo Bortone, Vincenzo Pestrichella, Gaetano Contegiacomo, Tullio Tesorio, Giuseppe Colonna, and Fortunato Iacovelli

Subjects
aortic stenosis, transcatheter aortic valve replacement, fluoroscopy, Valve Academic Research Consortium, technical success, device success, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Transcatheter aortic valve replacement (TAVR) is an almost totally cine-fluoroscopic guided procedure. The amount of radiation used during the procedure is strictly related to the fluoroscopy time (FT), that has already been demonstrated to be associated with outcomes and complexity of coronary procedures. The aim of our study is to demonstrate the relationship between FT and the short-term outcomes after TAVR defined by to the Valve Academic Research Consortium (VARC)-2 and -3 consensus documents. Methods: After splitting 1797 consecutive patients into tertiles of FT, the composite endpoint early safety (ES) was adjudicated according to VARC-2 and VARC-3 definitions, whereas the composite endpoints device success (DS) and technical success (TS) according to VARC-3 criteria. Results: The absence of all these outcomes (VARC-2 ES amd VARC-3 TS, DS, and ES) was significantly associated with longer FT: this association was independent from both intraprocedural complications and other intraprocedural factors linked to longer FT, and still persisted after propensity score matching analysis. Notwithstanding, after receiver operating characteristic analysis, FT had adequate diagnostic accuracy in identifying the absence of only VARC-3 TS and VARC-2 ES. Conclusion: Longer FT is related with periprocedural and short-term outcomes after the procedure, especially in those that are more challenging. A FT duration of more than 30 min has an adequate accuracy in identifying VARC-3 technical failure (TS and DS) and absence of VARC-2 ES, selecting patients who are likely to take advantage from more careful in-hospital follow-up.

Published
2023
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7. Intracoronary Pacing during 'Chimney Technique' in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation?

Author

Alessandro Cafaro, Francesco Rizzo, Dionigi Fischetti, Luca Quarta, Marco Mussardo, Alessandro Mandurino-Mirizzi, Antonio Tondo, Marco Matteo Ciccone, Fortunato Iacovelli, and Giuseppe Colonna

Subjects
transcatheter aortic valve implantation, valve-in-valve, chimney technique, coronary artery occlusion, intracoronary pacing, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and retrograde left endocardial temporary rapid ventricular pacing (RLE)-TRVP. The first one could be responsible for cardiac tamponade, one of the most serious procedural complications during TAVI, while the second one could often be unsuccessful. Intracoronary (IC)-TRVP through a coronary guidewire has been described as a safe and efficient procedure that could avoid such complications. We describe two clinical cases in which IC-TRVP has been effectively used during valve-in-valve TAVI with coronary protection via the “chimney technique”, after unsuccessful RLE-TRVP.

Published
2023
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8. Surgical Mortality Risk Scores in Transcatheter Aortic Valve Implantation: Is Their Early Predictive Value Still Strong?

Author

Fortunato Iacovelli, Francesco Loizzi, Alessandro Cafaro, Osvaldo Burattini, Luigi Salemme, Angelo Cioppa, Francesco Rizzo, Chiara Palmitessa, Maurizio D’Alessandro, Daniele De Feo, Armando Pucciarelli, Emanuela De Cillis, Vincenzo Pestrichella, Gaetano Contegiacomo, Tullio Tesorio, and Alessandro Santo Bortone

Subjects
aortic stenosis, transcatheter aortic valve implantation, risk scores, early safety, Valve Academic Research Consortium, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Surgical mortality risk scores, even if not properly designed and rarely tested in the transcatheter aortic valve implantation (TAVI) setting, still guide the heart team in managing significant aortic stenosis. Methods: After splitting 1763 consecutive patients retrospectively based on their mortality risk thresholds, the composite endpoint early safety (ES) was adjudicated according to Valve Academic Research Consortium (VARC)-2 and -3 consensus documents. Results: ES incidence was higher if VARC-2 rather than VARC-3 defined. Despite only patients showing VARC-2 ES had significantly lower absolute values of all three main risk scores, these last still failed to foresee both VARC-2 and -3 ES in intermediate-risk patients. The receiver operating characteristic analysis also showed a significant correlation, but with poor diagnostic accuracy, among the three scores and only VARC-2 ES; moreover, the absence of VARC-2 ES and low-osmolar contrast media administration were identified as independent predictors of 1-year mortality and absence of VARC-3 ES, respectively. Finally, even a single complication included in the ES definition could significantly affect 1-year mortality. Conclusion: Currently, the most used mortality risk scores do not have adequate diagnostic accuracy in predicting ES after TAVI. The absence of VARC-2, instead of VARC-3, ES is an independent predictor of 1-year mortality.

Published
2023
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9. Magna Graecia transcatheter aortic valve implantation registry: data on contrast medium osmolality and postprocedural acute kidney injury

Author

Fortunato Iacovelli, Antonio Pignatelli, Alessandro Cafaro, Eugenio Stabile, Luigi Salemme, Angelo Cioppa, Armando Pucciarelli, Francesco Spione, Francesco Loizzi, Emanuela De Cillis, Vincenzo Pestrichella, Alessandro Santo Bortone, Tullio Tesorio, and Gaetano Contegiacomo

Subjects
Transcatheter aortic valve implantation, Acute kidney injury, Contrast medium, Osmolality, Risk factor, Mortality, Computer applications to medicine. Medical informatics, R858-859.7, Science (General), Q1-390
Abstract

A comprehensive description of baseline characteristics, procedural features and outcomes related to the development of acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is reported in our research paper (Impact of contrast medium osmolality on the risk of acute kidney injury after transcatheter aortic valve implantation: insights from the Magna Graecia TAVI registry. Int J Cardiol. DOI: 10.1016/j.ijcard.2020.12.049). Three Italian heart centers were involved in this multicentric observational study. Between March 2011 and February 2019, a total of 888 patients underwent TAVI; according to the inclusion and exclusion criteria, 697 patients were included in the post-hoc analysis. This Data in Brief paper aims to report demographic, clinical, laboratory, echocardiographic, intraprocedural, periprocedural, postprocedural and follow-up data; all of them were prospectively collected from each patient's health record, whereas the analysis was performed retrospectively. Targets of this data analysis were: 1) to evaluate the impact of contrast medium (CM) osmolality on TAVI-related AKI; 2) to identify the most of risk factors involved in the development of such complication, and consequently in the occurrence of 1-year mortality; 3) to estimate the impact of CM osmolality on AKI in specific patient subgroups.

Published
2021
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10. Pembrolizumab in a Patient With Heavily Pre-Treated Squamous Cell Thymic Carcinoma and Cardiac Impairment: A Case Report and Literature Review

Author

Alessandro Cafaro, Alberto Bongiovanni, Valentina Di Iorio, Devil Oboldi, Carla Masini, and Toni Ibrahim

Subjects
pembrolizumab, immune checkpoint inhibitors, thymic cancer, squamous cell, PD-1, PD-L1, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Immunotherapy directed at the programmed cell death-1 receptor (PD-1) or its ligand PD-L1 has proven effective in solid malignancies such as melanoma, non-small cell lung cancer (NSCLC), urothelial cancer, renal cell carcinoma, and head and neck cancer. Compared with cytotoxic chemotherapy, radiotherapy, or molecular targeted agents, immunotherapy is an innovative strategy for treating malignancies, with durable clinical responses and manageable adverse events. Thymic carcinomas are extremely rare, constituting only 0.06% of all malignancies, are much more aggressive tumours than thymomas and have a worse prognosis. Nowadays, first line platinum-based chemotherapy for metastatic tumours are the cornerstone of treatment. However, the results of further therapeutic lines for metastatic or relapsed thymic carcinoma are unsatisfactory, with no regimen showing a consistent benefit. Moreover, the rarity of these tumours makes it difficult to carry out clinical trials. Herein we report a remarkable result of 1 year stable disease with good quality of life and no side effects obtained from the use of immunotherapy with pembrolizumab in a case of heavily pre-treated squamous cell thymic carcinoma and cardiac impairment. We also include a literature review of clinical trials on PD-1/PD-L1 inhibitors for the treatment of thymic epithelial cancers, taking a close look at cardiac toxicity.

Published
2020
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11. FUNCTIONAL MITRAL REGURGITATION: IF THE MYOCARDIUM IS GUILTY DO WE ALSO NEED TO ‘REHABILITATE’ THE VALVE?

Author

Martino Pepe, Valeria Paradies, Alessandro Cafaro, Filippo Masi, Francesco Bartolomucci, Donato Quagliara, and Stefano Favale

Subjects
mitral regurgitation (mr), mitral valve (mv), functional mr pathophysiology, functional mitral regurgitation (fmr), rehabilitation, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Mitral regurgitation (MR) is the most frequent valvulopathy in the general population with an incidence that grows with age and is associated with a poor prognosis. Regardless of its primary cause, which can be both ischaemic and non-ischaemic cardiomyopathy, it finally activates a self-feeding process. Due to the complexity of mitral valve (MV) apparatus and its interaction with the myocardium, even the diagnosis could represent a challenge for physicians. Higher technological instruments such as 3D echocardiography and cardiac magnetic resonance could play an important role in the evaluation of MV. In this paper we reviewed the most salient aspects of functional MR pathophysiology as well as the current diagnostic methods. The management of functional mitral regurgitation (FMR) is even more challenging and controversial; the optimal approach, timing, and effectiveness of interventions are still debated. Treatment of FMR begins with optimal medical therapy for left ventricular dysfunction, including cardiac resynchronisation when indicated. While functional improvement after surgery is well established, the benefits in terms of survival are still questionable. Moreover, in patients with high perioperative risk there is a growing interest in emerging percutaneous techniques. Among a variety of medical, surgical, and percutaneous opportunities, authors support an accurate case-by-case evaluation to find a tailored and stepwise treatment according to anatomical features and patient comorbidities.

Published
2015

12. Surgical Mortality Risk Scores in Transcatheter Aortic Valve Implantation: Is Their Early Predictive Value Still Strong?

Author

Bortone, Fortunato Iacovelli, Francesco Loizzi, Alessandro Cafaro, Osvaldo Burattini, Luigi Salemme, Angelo Cioppa, Francesco Rizzo, Chiara Palmitessa, Maurizio D’Alessandro, Daniele De Feo, Armando Pucciarelli, Emanuela De Cillis, Vincenzo Pestrichella, Gaetano Contegiacomo, Tullio Tesorio, and Alessandro Santo

Subjects
aortic stenosis, transcatheter aortic valve implantation, risk scores, early safety, Valve Academic Research Consortium
Abstract

Background: Surgical mortality risk scores, even if not properly designed and rarely tested in the transcatheter aortic valve implantation (TAVI) setting, still guide the heart team in managing significant aortic stenosis. Methods: After splitting 1763 consecutive patients retrospectively based on their mortality risk thresholds, the composite endpoint early safety (ES) was adjudicated according to Valve Academic Research Consortium (VARC)-2 and -3 consensus documents. Results: ES incidence was higher if VARC-2 rather than VARC-3 defined. Despite only patients showing VARC-2 ES had significantly lower absolute values of all three main risk scores, these last still failed to foresee both VARC-2 and -3 ES in intermediate-risk patients. The receiver operating characteristic analysis also showed a significant correlation, but with poor diagnostic accuracy, among the three scores and only VARC-2 ES; moreover, the absence of VARC-2 ES and low-osmolar contrast media administration were identified as independent predictors of 1-year mortality and absence of VARC-3 ES, respectively. Finally, even a single complication included in the ES definition could significantly affect 1-year mortality. Conclusion: Currently, the most used mortality risk scores do not have adequate diagnostic accuracy in predicting ES after TAVI. The absence of VARC-2, instead of VARC-3, ES is an independent predictor of 1-year mortality.

Published
2023
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13. Safety and efficacy of coronary sinus narrowing in chronic refractory angina: Insights from the RESOURCE study

Author

Arif A Khokhar, Carlo Zivelonghi, Mirthe Dekker, Geert E. Leenders, Roberto Ferrari, F Sgura, Stefan Verheye, Giuseppe Tarantini, Alessandro Cafaro, Jan-Peter van Kuijk, Stefano Guarracini, Christoph Liebetrau, Maayan Konigstein, Sergio Berti, Dan Ioanes, Matjaž Bunc, Pieter R. Stella, Leo Timmers, Issameddine Ajmi, Antonio Colombo, Shmuel Banai, Ranil de Silva, Francesco Ponticelli, Pierfrancesco Agostoni, Claudio Rapezzi, Max J. M. Silvis, Alfonso Ielasi, Matteo Tebaldi, M. Ciardetti, Jan Sebastian Wolter, Michele Di Mauro, Kevin Cheng, Gianluca Campo, Simon Redwood, Guglielmo Gallone, Francesco Giannini, Tiffany Patterson, Federico De Marco, Gianpiero D'Amico, Steffen Schnupp, and Steven Lindsay

Subjects
Canada, medicine.medical_specialty, medicine.medical_treatment, Chronic coronary syndrome, RESOURCE study, 030204 cardiovascular system & hematology, Refractory angina, NO, Percutaneous coronary intervention, Coronary artery disease, Angina, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Israel, Coronary sinus reducer, Stroke, Coronary sinus, Retrospective Studies, business.industry, Coronary Sinus, Canadian Cardiovascular Society, medicine.disease, United Kingdom, Europe, Treatment Outcome, Cardiology, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

Introduction Refractory angina (RA) is considered the end-stage of coronary artery disease, and often has no interventional treatment options. Coronary sinus Reducer (CSR) is a recent addition to the therapeutic arsenal, but its efficacy has only been evaluated on small populations. The RESOURCE registry provides further insights into this therapy. Methods The RESOURCE is an observational, retrospective registry that includes 658 patients with RA from 20 centers in Europe, United Kingdom and Israel. Prespecified endpoints were the amelioration of anginal symptoms evaluated with the Canadian Cardiovascular Society (CCS) score, the rates of procedural success and complications, and MACEs as composite of all-cause mortality, acute coronary syndromes, and stroke. Results At a median follow-up of 502 days (IQR 225–1091) after CSR implantation, 39.7% of patients improved by ≥2 CCS classes (primary endpoint), and 76% by ≥1 class. Procedural success was achieved in 96.7% of attempts, with 3% of procedures aborted mostly for unsuitable coronary sinus anatomy. Any complication occurred in 5.7% of procedures, but never required bailout surgery nor resulted in intra- or periprocedural death or myocardial infarction. One patient developed periprocedural stroke after inadvertent carotid artery puncture. At the last available follow-up, overall mortality and MACE were 10.4% and 14.6% respectively. At one, three and five years, mortality rate at Kaplan-Meier analysis was 4%, 13.7%, and 23.4% respectively. Conclusions CSR implantation is safe and reduces angina in patients with refractory angina.

Published
2021

14. Usefulness of Coronary Sinus Reducer Implantation for the Treatment of Chronic Refractory Angina Pectoris

Author

Salvatore Saccà, Gianpiero D'Amico, Marco Cerrito, Alessandro Cafaro, Sergio Ghiringhelli, Giuseppe Tarantini, Francesco Versaci, Matteo Tebaldi, F Sgura, Andrea Picchi, Roberto Latini, Francesco Giannini, Giulio G. Stefanini, Marco Ciardetti, Achille Gaspardone, Mauro Massussi, Federico De Marco, and Alfonso Ielasi

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Coronary Angiography, Revascularization, Angina Pectoris, Prosthesis Implantation, Angina, 03 medical and health sciences, 0302 clinical medicine, Refractory, Quality of life, Internal medicine, medicine, Humans, 030212 general & internal medicine, Coronary sinus, Aged, Retrospective Studies, Reducer, business.industry, Coronary Sinus, Retrospective cohort study, medicine.disease, Treatment Outcome, Chronic Disease, Cohort, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

The coronary sinus (CS) Reducer is a novel device designed for the management of patients with severe angina symptoms refractory to optimal medical therapy and not amenable to further revascularization. Aim of this study was to investigate the efficacy and the safety of the CS Reducer device in a real-world, multicenter, and country-level cohort of patients presenting with refractory angina pectoris. The study included patients affected by refractory angina pectoris who underwent CS Reducer implantation in 16 centers. Clinical follow-up was carried as per each center's protocol. One hundred eighty-seven patients were included. Technical and procedural success were achieved in 98% and 95%, respectively. Minor peri-procedural complications were recorded in 8 patients. During a median follow-up of 18.4 months, 135 (82.8%) patients demonstrated at least 1 CCS class reduction after Reducer implantation, and 80 (49%) patients at least 2 CCS class reduction. Mean CCS class improved from 3.05 ± 0.53 at baseline to 1.63 ± 0.98 at follow-up (p < 0.001). Treatment benefit was also reflected in a significant improvement in quality of life scores and in a reduction of the mean number of anti-ischemic drugs prescribed for patient. In conclusion, in this multicenter, country-level study, the implantation of CS Reducer in patients with refractory angina pectoris resulted to be safe and effective in reducing of angina pectoris and improving quality of life.

Published
2021

15. The role of clinical trials in the sustainability of the Italian national health service cancer drug expenditure

Author

Lorenzo Gasperoni, Alessandro Cafaro, Eleonora Ferretti, Valentina Di Iorio, Oriana Nanni, and Carla Masini

Subjects
General Pharmacology, Toxicology and Pharmaceutics
Abstract

Clinical trials offer new and potentially more effective therapeutic options for cancer patients and a potential cost-saving opportunity, especially considering that trial drugs are provided free-of-charge. The aim of this study was to analyse drug-related cost savings in clinical trials in a cancer institute over a 3 year period. The cost savings relate to the pharmaceutical expenditure of our centre, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori".We conducted a retrospective analysis of patients taking part in interventional clinical cancer trials approved by a local independent Ethics Committee between 1 January 2018 and 31 December 2020. The standard of care (SOC) was identified as the standard treatment that would have been offered to a patient if he/she had not been enrolled in the study. The sum of SOC costs of all patients represents the potential cost avoidance during the study period. Results were stratified by year, trial promoter, trial phase and tumour type. The same approach was used to perform a secondary analysis of compassionate use programmes.In the 3 year analysis, 1,257 patients were treated with experimental therapies in 244 clinical trials, of which 157 were profit and 87 academic. Results showed an overall cost savings of €13,266,518, more than 50% of which (€7,035,009) was related to phase III studies. Profit clinical trials generated €9,069,764 (68.4%) of the drug cost savings compared with €4,196,754 (31.6%) of academic studies. The stratification for tumour type was €3,552,592 (26.8%) genitourinary cancer, €3,268,074 (24.6%) melanoma, €2,574,127 (19.4%) haematological malignancies, €2,330,791 (17.6%) lung cancer, €728,149 (5.5%) gastrointestinal cancer, €557,608 (4.2%) rare tumours and €255,178 (1.9%) breast cancer. The secondary analysis on compassionate use included 122 patients involved in 28 different access programmes and revealed cost savings of €1,649,550.The results of our analysis point to the benefits of participating in and planning clinical trials for the public healthcare sector.

Published
2022

16. Brigatinib in the first-line treatment of ALK+ metastatic NSCLC: safety and efficacy

Author

Paola Cravero, Lucio Crinò, Marco Angelo Burgio, Giuseppe Bronte, Kalliopi Andrikou, Ilaria Priano, Alessandro Cafaro, Luigi Pasini, and Angelo Delmonte

Subjects
0301 basic medicine, Lung Neoplasms, Brigatinib, medicine.drug_class, 03 medical and health sciences, 0302 clinical medicine, Organophosphorus Compounds, hemic and lymphatic diseases, Carcinoma, Non-Small-Cell Lung, Medicine, Humans, Pharmacology (medical), Anaplastic Lymphoma Kinase, ALK Rearrangement, Protein Kinase Inhibitors, business.industry, food and beverages, First line treatment, ALK inhibitor, 030104 developmental biology, Pyrimidines, Oncology, 030220 oncology & carcinogenesis, Cancer research, Non small cell, business
Abstract

Introduction: Among the oncogene-addicted non-small cell lung cancer patients, those bearing ALK rearrangement can be currently treated with next-generation ALK inhibitors. Brigatinib was first use...

Published
2021

17. Magna Graecia transcatheter aortic valve implantation registry: data on contrast medium osmolality and postprocedural acute kidney injury

Author

Emanuela De Cillis, Alessandro Santo Bortone, Tullio Tesorio, Angelo Cioppa, Armando Pucciarelli, Fortunato Iacovelli, Eugenio Stabile, Alessandro Cafaro, Francesco Loizzi, Antonio Pignatelli, Luigi Salemme, Gaetano Contegiacomo, Francesco Spione, and Vincenzo Pestrichella

Subjects
Contrast medium, medicine.medical_specialty, Science (General), Transcatheter aortic, Computer applications to medicine. Medical informatics, R858-859.7, Osmolality, 03 medical and health sciences, Q1-390, 0302 clinical medicine, Internal medicine, medicine, Risk factor, Mortality, Data Article, 030304 developmental biology, 0303 health sciences, Transcatheter aortic valve implantation, Multidisciplinary, business.industry, Medical record, Acute kidney injury, medicine.disease, Multivariate analysis, Inclusion and exclusion criteria, Cardiology, Observational study, Complication, business, 030217 neurology & neurosurgery
Abstract

A comprehensive description of baseline characteristics, procedural features and outcomes related to the development of acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is reported in our research paper (Impact of contrast medium osmolality on the risk of acute kidney injury after transcatheter aortic valve implantation: insights from the Magna Graecia TAVI registry. Int J Cardiol. DOI: 10.1016/j.ijcard.2020.12.049). Three Italian heart centers were involved in this multicentric observational study. Between March 2011 and February 2019, a total of 888 patients underwent TAVI; according to the inclusion and exclusion criteria, 697 patients were included in the post-hoc analysis. This Data in Brief paper aims to report demographic, clinical, laboratory, echocardiographic, intraprocedural, periprocedural, postprocedural and follow-up data; all of them were prospectively collected from each patient's health record, whereas the analysis was performed retrospectively. Targets of this data analysis were: 1) to evaluate the impact of contrast medium (CM) osmolality on TAVI-related AKI; 2) to identify the most of risk factors involved in the development of such complication, and consequently in the occurrence of 1-year mortality; 3) to estimate the impact of CM osmolality on AKI in specific patient subgroups.

Published
2021

18. CPX-351 daunorubicin-cytarabine liposome: a novel formulation to treat patients with newly diagnosed secondary acute myeloid leukemia

Author

Paolo Silimbani, Alessandro Cafaro, Delia Cangini, Giorgia Simonetti, Claudio Cerchione, Giovanni Martinelli, Andrea Ghelli Luserna di Rorà, Maria Benedetta Giannini, and Carla Masini

Subjects
Oncology, Antimetabolites, Antineoplastic, medicine.medical_specialty, Myeloid, Anthracycline, Daunorubicin, 03 medical and health sciences, 0302 clinical medicine, hemic and lymphatic diseases, Internal medicine, medicine, Humans, Secondary Acute Myeloid Leukemia, Clinical Trials as Topic, business.industry, Age Factors, Cytarabine, Myeloid leukemia, General Medicine, Middle Aged, Clinical trial, Leukemia, Myeloid, Acute, Regimen, medicine.anatomical_structure, Myelodysplastic Syndromes, 030220 oncology & carcinogenesis, Liposomes, Mutation, 030211 gastroenterology & hepatology, business, medicine.drug
Abstract

Over the last few years, we assisted to an increasing knowledge about acute myeloid leukemia (AML) pathobiology. However, outcomes remain unsatisfactory particularly for adult patients over 60 years old. Not surprisingly several cases of therapy-related AML (tAML) and secondary AML, both characterized by poorer prognosis, are more common in older population. For several decades initial therapy for AML remained unchanged and typically treatment consisted of an anthracycline combined with continuous infusion of cytarabine for 7 days, the so-called "7+3" standard regimen. The efforts made by the researchers to improve this standard schedule, have led to only modest improvement in the response rate (RR) but no change in overall survival (OS), until the recent evolution seen with new target specific mutation therapies. In 2017, a new liposomal-encapsulated formulation with daunorubicin and cytarabine (CPX-351) was approved by the US Food and Drug Administration for the treatment of newly diagnosed tAML or AML with myelodysplasia-related changes (AML-MRCs). Based on the findings that ratiometric delivery may be more effective than administration of either drug at their maximum tolerated dose (MTD), CPX-351 was designed to deliver a fixed 5:1 molar ratio of the two molecules historically used in the standard "7+3" regimen, cytarabine and daunorubicin respectively. CPX-351 did show improvements of overall survival compared to traditional "7+3" in newly diagnosed secondary and therapy-related AML in adult patients. However, questions remain regarding how to select across AML patient subgroups to maximize the clinical benefit. Possible future directions include evaluating CPX-351 dose intensification, combining this liposomal formulation with targeted therapies and not least important a better understanding about the mechanism of improved responses in tAML and AML-MRC, two entities recognized to be less chemo-sensitive than other hematologic malignancies. In summary, CPX-351 offers finally something new in the landscape of AML therapy. Herein we will review the rationale behind this new drug product development, the main pharmacological characteristics, and discuss the results of clinical trials that led to its FDA approval at first and by EMA in 2018.

Published
2020

19. Tagraxofusp and anti-CD123 in blastic plasmacytoid dendritic cell neoplasm: a new hope

Author

Delia Cangini, Paolo Silimbani, Maria Benedetta Giannini, Carla Masini, Giovanni Martinelli, Andrea Ghelli Luserna di Rorà, Alessandro Cafaro, Giorgia Simonetti, and Claudio Cerchione

Subjects
Oncology, medicine.medical_specialty, Recombinant Fusion Proteins, Drug Evaluation, Preclinical, Interleukin-3 Receptor alpha Subunit, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Precision Medicine, Adverse effect, Child, Drug Approval, Transaminases, Aged, Drug Labeling, Diphtheria toxin, biology, business.industry, Interleukin, General Medicine, Dendritic Cells, Precision medicine, Prognosis, Thrombocytopenia, Clinical trial, 030220 oncology & carcinogenesis, Hematologic Neoplasms, biology.protein, 030211 gastroenterology & hepatology, Interleukin-3 receptor, Stem cell, Antibody, business, Capillary Leak Syndrome
Abstract

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy, characterized by poor prognosis if treated with conventional therapy. Allogenic hematologic stem cell transplant can improve survival and can be curative, but it is available in a small percentage of patients given that the median age at diagnosis is 70 years. In this scenario it is assumed that only the development of precision medicine-driven therapy will change BPDCN patient prognosis. CD123 (the α-subunit of interleukin (IL)-3 receptor) is over-expressed on BPDCN cells surface and seems to be the ideal marker to develop antibody-based therapies. Tagraxofusp (Elzonris®), a recombinant immunotoxin consisting of human interleukin-3 fused to a truncated diphtheria toxin, has been approved by FDA in December 2018 for the treatment of BPDCN in adult and pediatric patients. tagraxofusp has shown promising clinical activity, with a high overall response rate and quite manageable safety profile even in elderly patients. It seems to improve overall survival too, but comparative trials are necessary to confirm this. Adverse events are commonly reported and the most important are transaminitis, thrombocytopenia and capillary leak syndrome (CLS). Therefore, to prevent the onset of severe CLS is recommended to reserve tagraxofusp for patients with preserved hepatic and cardiac functions, and to strictly observe serum albumin level. Further studies are required to resolve many several unanswered questions about tagraxofusp. In this review, we will resume and discuss pharmacological characteristic of tagraxofusp, results of clinical trials leading to its approval by FDA in 2018 and future perspectives about its use in BPDCN and other hematological malignancies.

Published
2020

20. Impact of contrast medium osmolality on the risk of acute kidney injury after transcatheter aortic valve implantation: insights from the Magna Graecia TAVI registry

Author

Emanuela De Cillis, Eugenio Stabile, Francesco Loizzi, Tullio Tesorio, Francesco Spione, Alessandro Santo Bortone, Armando Pucciarelli, Fortunato Iacovelli, Vincenzo Pestrichella, Antonio Pignatelli, Luigi Salemme, Gaetano Contegiacomo, Angelo Cioppa, Alessandro Cafaro, Iacovelli, F., Pignatelli, A., Cafaro, A., Stabile, E., Salemme, L., Cioppa, A., Pucciarelli, A., Spione, F., Loizzi, F., De Cillis, E., Pestrichella, V., Bortone, A. S., Tesorio, T., and Contegiacomo, G.

Subjects
Male, medicine.medical_specialty, Transcatheter aortic, medicine.medical_treatment, Population, Renal function, Contrast Media, Osmolality, 030204 cardiovascular system & hematology, Ventricular Function, Left, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Registries, education, Constrast mean, Aged, Aged, 80 and over, education.field_of_study, Transcatheter aortic valve implantation, business.industry, Incidence (epidemiology), Osmolar Concentration, Acute kidney injury, Stroke Volume, Aortic Valve Stenosis, Acute Kidney Injury, medicine.disease, Contrast medium, Treatment Outcome, Aortic Valve, Cardiology, Hemodialysis, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract

Background: Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is frequent and associated with adverse outcomes and mortality; to date, in such setting of patients there is no consistent evidence that either low-osmolar contrast media (LOCM) or iso‐osmolar contrast medium (IOCM) are superior to the other in terms of renal safety. Methods: 697 consecutive patients not in hemodialysis treatment who underwent TAVI (327 males, mean age 81.01 ± 5.75 years, mean european system for cardiac operative risk evaluation II 6.17 ± 0.23%) were enrolled. According to osmolality of the different iodinated CM, the population was divided in 2 groups: IOCM (n = 370) and LOCM group (n = 327). Preoperatively, 40.54% of patients in IOCM vs 39.14% in LOCM group (p = 0.765) suffered from chronic kidney disease (CKD). Results: The incidence of AKI was significantly lower with IOCM (9.73%) than with LOCM (15.90%; p = 0.02), and such significant difference (p < 0.001) in postprocedural change of renal function parameters persisted at discharge too. The incidence of AKI was also significantly lower with IOCM in younger patients, without diabetes, anemia, coronary artery disease history, CKD, chronic or persistent atrial fibrillation, left ventricular ejection fraction ≤35%, and in patients with low operative mortality risk scores, receiving lower amounts of dye (p < 0.05 for all). Importantly, multivariate analysis identified LOCM administration as an independent risk factor for both AKI (p = 0.006) and 1-year mortality (p = 0.001). Conclusions: The use of IOCM have a favorable impact on renal function with respect to LOCM, but it should be considered especially for TAVI patients at lower AKI risk.

Published
2020

21. Pembrolizumab in a Patient With Heavily Pre-Treated Squamous Cell Thymic Carcinoma and Cardiac Impairment: A Case Report and Literature Review

Author

Alberto Bongiovanni, Carla Masini, Devil Oboldi, Toni Ibrahim, Valentina Di Iorio, and Alessandro Cafaro

Subjects
PD-L1, 0301 basic medicine, Oncology, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, cardiotoxicity, Pembrolizumab, lcsh:RC254-282, immune checkpoint inhibitors, 03 medical and health sciences, 0302 clinical medicine, Renal cell carcinoma, Internal medicine, PD-1, medicine, case report, thymic cancer, Thymic carcinoma, squamous cell, business.industry, Melanoma, Head and neck cancer, Immunotherapy, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, medicine.disease, Radiation therapy, Regimen, 030104 developmental biology, 030220 oncology & carcinogenesis, pembrolizumab, business
Abstract

Immunotherapy directed at the programmed cell death-1 receptor (PD-1) or its ligand PD-L1 has proven effective in solid malignancies such as melanoma, non-small cell lung cancer (NSCLC), urothelial cancer, renal cell carcinoma, and head and neck cancer. Compared with cytotoxic chemotherapy, radiotherapy, or molecular targeted agents, immunotherapy is an innovative strategy for treating malignancies, with durable clinical responses and manageable adverse events. Thymic carcinomas are extremely rare, constituting only 0.06% of all malignancies, are much more aggressive tumours than thymomas and have a worse prognosis. Nowadays, first line platinum-based chemotherapy for metastatic tumours are the cornerstone of treatment. However, the results of further therapeutic lines for metastatic or relapsed thymic carcinoma are unsatisfactory, with no regimen showing a consistent benefit. Moreover, the rarity of these tumours makes it difficult to carry out clinical trials. Herein we report a remarkable result of 1 year stable disease with good quality of life and no side effects obtained from the use of immunotherapy with pembrolizumab in a case of heavily pre-treated squamous cell thymic carcinoma and cardiac impairment. We also include a literature review of clinical trials on PD-1/PD-L1 inhibitors for the treatment of thymic epithelial cancers, taking a close look at cardiac toxicity.

Published
2020

22. Two coronary artery aneurysms complicated by acute myocardial infarction and treated with open chest surgery

Author

Salvatore Zaccaria, Cosimo Angelo Greco, Daniyar Gilmanov, and Alessandro Cafaro

Subjects
Coronary angiography, medicine.medical_specialty, Thoracic Surgical Procedure, business.industry, MEDLINE, Coronary Aneurysm, Myocardial Infarction, Thoracic Surgical Procedures, medicine.disease, Coronary Angiography, Coronary Vessels, medicine.anatomical_structure, Internal medicine, medicine, Cardiology, Humans, Chest surgery, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Artery
Published
2020

23. Time‐dependent benefits of pre‐treatment with new oral P2Y12‐inhibitors in patients addressed to primary PCI for acute ST‐elevation myocardial infarction

Author

Ottavio Di Cillo, Francesco Bartolomucci, Stefano Favale, Valeria Paradies, Francesco Paolo Bianchi, Alessandro Santo Bortone, Eliano Pio Navarese, D. Zanna, Francesco Addabbo, Nicola Signore, Gaetano Contegiacomo, Alessandro Cafaro, Martino Pepe, and Cinzia Forleo

Subjects
medicine.medical_specialty, Prasugrel, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Loading dose, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Conventional PCI, Cardiology, Medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Myocardial infarction, Onset of action, Cardiology and Cardiovascular Medicine, business, Ticagrelor, TIMI, medicine.drug
Abstract

OBJECTIVES The aim of this observational study was to determine the benefits of the novel, orally delivered P2Y12 -inhibitors (Is) in terms of angiographic endpoints and in relation to the time of the loading dose (LD) administration. BACKGROUND The goal of ST-elevation myocardial infarction (STEMI) treatment is timely reperfusion. The P2Y12 -Is prasugrel and ticagrelor have improved the angiographic outcome of primary percutaneous coronary intervention (pPCI) and patients' prognosis. However, their onset of action is impaired in STEMI and delayed by their oral administration. METHODS The 328 eligible patients with STEMI consecutively referred for pPCI were divided into three groups depending on the interval of "P2Y12 -I LD administration-to-balloon time": Group 2 included patients that received P2Y12 -I LD at least 60 min prior to pPCI, Group 1 within 60 min prior to pPCI, and Group 0 at the moment of pPCI. Angiographic, clinical, and biochemical parameters were evaluated. Pre- and post-pPCI TIMI flow grade (TFG) and ST resolution (STR) were used as outcome measures to determine efficacy and optimal timing of pretreatment. RESULTS Pre-pPCI TFG improved with increasing P2Y12 -I LD administration-to-balloon time; pre-PCI TFG 0/1 was 74.5% in Group 0, 65.5% in Group 1 and 54.9% in Group 2 (P

Published
2018

24. Life-threatening acute myocardial infarction due to left main dissection during radiofrequency transcatheter ablation of atrial tachycardia

Author

Elia Iorio, Marco Matteo Ciccone, Martino Pepe, Francesco Giardinelli, Roberta Ruggieri, Annagrazia Cecere, Alessandro Cafaro, Massimo Grimaldi, Tommaso Langialonga, and Vito Casamassima

Subjects
Tachycardia, Supraventricular, medicine.medical_specialty, Myocardial Infarction, Dissection (medical), Coronary Angiography, Electrocardiography, Aneurysm, Percutaneous Coronary Intervention, Internal medicine, medicine, Tachycardia, Supraventricular, Humans, Myocardial infarction, Intraoperative Complications, Atrial tachycardia, Ultrasonography, Interventional, Ultrasonography, Aged, Interventional, medicine.diagnostic_test, business.industry, Coronary Aneurysm, Drug-Eluting Stents, General Medicine, medicine.disease, Coronary Vessels, Interventional Cardiology, Aortic Dissection, Transcatheter ablation, Aneurysm, Dissecting, Catheter Ablation, Female, Follow-Up Studies, Cardiology, Myocardial infarction diagnosis, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Dissecting
Published
2018

25. ‘Broken-heart’ syndrome: ventricular septal perforation in a takotsubo cardiomyopathy

Author

Tommaso Acquaviva, Valeria Paradies, D Quagliara, Emanuela De Cillis, Filippo Masi, Stefano Favale, Alessandro Cafaro, Martino Pepe, and Alessandro Santo Bortone

Subjects
medicine.medical_specialty, Percutaneous, Shock, Cardiogenic, Cardiomyopathy, 030204 cardiovascular system & hematology, Broken heart syndrome, 03 medical and health sciences, 0302 clinical medicine, Takotsubo Cardiomyopathy, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Ventricular Septal Rupture, Aged, 80 and over, Surgical repair, Ventricular Septal Perforation, Interventional cardiology, business.industry, Cardiogenic shock, Prognosis, medicine.disease, Surgery, Cardiology, Molecular Medicine, Female, Cardiology and Cardiovascular Medicine, Complication, business
Abstract

Takotsubo cardiomyopathy (TTC) is a form of acute left ventricular dysfunction usually reversible and with favorable prognosis. Ventricular septal perforation (VSP) is a very rare life-threatening complication. Percutaneous closure of VSP, despite being challenging, is a possible alternative to surgical repair. We present the first case of an 84-year-old patient with a TTC-related VSP treated by percutaneous approach. The case highlights the need of reconsidering the worldwide accepted consideration of TTC as benignant and allows some speculations on the optimal management of VSP in terms of timing, patient selection and possible alternative interventions.

Published
2016

26. Time-dependent benefits of pre-treatment with new oral P2Y

Author

Martino, Pepe, Alessandro, Cafaro, Valeria, Paradies, Nicola, Signore, Francesco, Addabbo, Alessandro Santo, Bortone, Eliano Pio, Navarese, Gaetano, Contegiacomo, Cinzia, Forleo, Francesco, Bartolomucci, Ottavio, Di Cillo, Francesco Paolo, Bianchi, Domenico, Zanna, and Stefano, Favale

Subjects
Blood Platelets, Male, Ticagrelor, Time Factors, Administration, Oral, Middle Aged, Coronary Angiography, Risk Assessment, Drug Administration Schedule, Receptors, Purinergic P2Y12, Time-to-Treatment, Percutaneous Coronary Intervention, Treatment Outcome, Risk Factors, Purinergic P2Y Receptor Antagonists, Humans, ST Elevation Myocardial Infarction, Female, Prasugrel Hydrochloride, Platelet Aggregation Inhibitors, Aged
Abstract

The aim of this observational study was to determine the benefits of the novel, orally delivered P2YThe goal of ST-elevation myocardial infarction (STEMI) treatment is timely reperfusion. The P2YThe 328 eligible patients with STEMI consecutively referred for pPCI were divided into three groups depending on the interval of "P2YPre-pPCI TFG improved with increasing P2YThis observational study suggests that the angiographic benefit of P2Y

Published
2018

27. Role of plasma glucose level on myocardial perfusion in ST-segment elevation myocardial infarction patients

Author

Alfredo Marchese, Alessandro Santo Bortone, Fabrizio Resta, Alessandro Cafaro, Martino Pepe, Stefano Favale, Annagrazia Cecere, Eliano Pio Navarese, D. Zanna, Valeria Paradies, Francesco Addabbo, and Massimo Napodano

Subjects
Blood Glucose, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030204 cardiovascular system & hematology, Coronary Angiography, Culprit, STEMI, Cohort Studies, Myocardial perfusion, 03 medical and health sciences, TIMI frame count, 0302 clinical medicine, Endocrinology, Percutaneous Coronary Intervention, Internal medicine, Diabetes mellitus, Coronary Circulation, Internal Medicine, medicine, ST segment, Humans, 030212 general & internal medicine, Myocardial infarction, Risk factor, Aged, business.industry, Primary percutaneous coronary intervention, Percutaneous coronary intervention, Middle Aged, medicine.disease, Prognosis, Coronary Vessels, Coronary arteries, medicine.anatomical_structure, Treatment Outcome, Hyperglycemia, Blood Flow Velocity, Female, ST Elevation Myocardial Infarction, Cardiology, business, TIMI
Abstract

Hyperglycemia is frequent in patients with ST elevation myocardial infarction (STEMI) and is associated with adverse outcome. Aim of our study was to evaluate the correlation between admission plasma glucose level (PGL) and coronary arteries flow velocity.We enrolled 149 STEMI patients successfully treated with primary percutaneous coronary intervention (pPCI). The study population was divided into two groups based on PGL (or140 mg/dl) and on history of diabetes, and the groups compared in terms of corrected TIMI frame count (cTFC).Hyperglycemic patients had a significantly higher cTFC in both the culprit (p 0.0001) and non-culprit vessel (p: 0.0002); diabetes history impairs as well cTFC of the culprit (p 0.0001) and non-culprit vessel (p: 0.0001). Within the subpopulation of diabetic patients hyperglycemic ones showed higher cTFC in both the culprit (p 0.0013) and non-culprit vessel (p: 0.0006). Moreover in the whole population cTFC values of both arteries increase linearly with the increment of admission PGL.Admission PGL affects coronary flow of both culprit and non-culprit vessel. The impairment of coronary flow is also demonstrated in known diabetic patients, suggesting to consider hyperglycemia an additional risk factor. We finally demonstrated for the first time a positive linear relationship between PGL and cTFC.

Published
2017

28. Emergency coronary and peripheral arteries combined with percutaneous intervention in the elderly: success or therapeutic excess?

Author

Fausto Castriota, Armando Liso, Marianna Miranda, Martino Pepe, Valeria Paradies, Fortunato Iacovelli, Alessandro Furgieri, and Alessandro Cafaro

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, Time Factors, medicine.medical_treatment, Population, Femoral artery, Disease, law.invention, Coronary artery disease, Peripheral Arterial Disease, Percutaneous Coronary Intervention, Randomized controlled trial, law, medicine.artery, Internal medicine, medicine, Humans, Angina, Unstable, Intensive care medicine, education, Aged, 80 and over, education.field_of_study, business.industry, Unstable angina, Angiography, Percutaneous coronary intervention, medicine.disease, Femoral Artery, Cardiology, Molecular Medicine, Stents, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Follow-Up Studies
Abstract

Acute lower extremities peripheral artery disease represents a clinical emergency. Peripheral artery disease incidence ranges from 2.5 to 22% and has progressively increased due to the world population aging phenomenon and associates with coronary artery disease with a rate of 40–60%. The authors present the case of an 89-year-old man coming to their attention with acute lower extremities ischemia and unstable angina. Despite the short-to-midterm favorable outcome, doubts remain about the opportunity of treating ‘very old’ patients. The lack of dedicated randomized trials and of defined guidelines is a problem the scientific community needs to face considering that patients over 85 years represent a raising quote of the whole population of our catheterization laboratories.

Published
2015

29. TCT-808 Comparison between Clopidogrel and the New Oral P2Y12 Inhibitors in the Treatment of Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention

Author

Emanuela De Cillis, Stefano Favale, Martino Pepe, Annagrazia Cecere, O. Burattini, Alessandro Santo Bortone, Alessandro Cafaro, Luca Amato, Nicola Forzati, and Francesco Giardinelli

Subjects
medicine.medical_specialty, Prasugrel, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Clopidogrel, P2Y12, Internal medicine, medicine, Cardiology, In patient, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Ticagrelor, circulatory and respiratory physiology, medicine.drug
Abstract

Dual antiplatelet therapy improves angiographic results of primary percutaneous coronary intervention (pPCI) in patients with STEMI. The new oral P2Y12 inhibitors (P2Y12-I) prasugrel and ticagrelor are the gold-standard drugs because of a faster and more intense effect when compared to clopidogrel.

Published
2018

30. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part one

Author

F. De Benedetti, J. Anton, M. Gattorno, H. Lachmann, I. Kone-Paut, S. Ozen, J. Frenkel, A. Simon, A. Zeft, E. Ben-Chetrit, H. M. Hoffman, Y. Joubert, K. Lheritier, A. Speziale, J. Guido, Roberta Caorsi, Federica Penco, Alice Grossi, Antonella Insalaco, Maria Alessio, Giovanni Conti, Federico Marchetti, Alberto Tommasini, Silvana Martino, Romina Gallizzi, Annalisa Salis, Francesca Schena, Francesco Caroli, Alberto Martini, Gianluca Damonte, Isabella Ceccherini, Marco Gattorno, Marie-Louise Frémond, Carolina Uggenti, Lien Van Eyck, Isabelle Melki, Darragh Duffy, Vincent Bondet, Yoann Rose, Bénédicte Neven, Yanick Crow, Mathieu P. Rodero, Yvonne Kusche, Johannes Roth, Katarzyna Barczyk-Kahlert, Giovanna Ferrara, Annalisa Chiocchetti, Silvio Polizzi, Josef Vuch, Diego Vozzi, Anna Mondino, Erica Valencic, Serena Pastore, Andrea Taddio, Flavio Faletra, Umberto Dianzani, Ugo Ramenghi, Qing Zhou, Xiaomin Yu, Erkan Demirkaya, Natalie Deuitch, Deborah Stone, Wanxia Tsai, Amanda Ombrello, Tina Romeo, Elaine F. Remmers, JaeJin Chae, Massimo Gadina, Steven Welch, Seza Ozen, Rezan Topaloglu, Mario Abinun, Daniel L. Kastner, Ivona Aksentijevich, Donatella Vairo, Rosalba Monica Ferraro, Giulia Zani, Jessica Galli, Micaela De Simone, Marco Cattalini, Elisa Fazzi, Silvia Giliani, Ebun Omoyinmi, Ariane Standing, Dorota Rowczenio, Annette Keylock, Sonia Melo Gomes, Fiona Price-Kuehne, Sira Nanthapisal, Claire Murphy, Thomas Cullup, Lucy Jenkins, Kimberly Gilmour, Despina Eleftheriou, Helen Lachmann, Philip Hawkins, Nigel Klein, Paul Brogan, Anita Dhanrajani, Mercedes Chan, Stephanie Pau, Janet Ellsworth, Jaime Guzman, Florence A. Aeschlimann, Marinka Twilt, Simon W. Eng, Shehla Sheikh, Ronald M. Laxer, Diane Hebert, Damien Noone, Christian Pagnoux, Susanne M. Benseler, Rae S. Yeung, Christoph Kessel, Katrin Lippitz, Toni Weinhage, Claas Hinze, Helmut Wittkowski, Dirk Holzinger, Niklas Grün, Dirk Föll, Pieter Van Dijkhuizen, Federica Del Chierico, Clara Malattia, Alessandra Russo, Denise Pires Marafon, Nienke M. ter Haar, Silvia Magni-Manzoni, Sebastiaan J. Vastert, Bruno Dallapiccola, Berent Prakken, Fabrizio De Benedetti, Lorenza Putignani, Berna Eren Fidanci, Kenan Barut, Serap Arıcı, Dogan Simsek, Mustafa Cakan, Ezgi D. Batu, Sezgin Şahin, Ayşenur Kısaarslan, Ebru Yilmaz, Özge Basaran, Ferhat Demir, Kubra Ozturk, Zübeyde Gunduz, Betül Sozeri, Balahan Makay, Nuray Ayaz, Onder Yavascan, Ozlem Aydog, Yelda Bilginer, Zelal Ekinci, Dilek Yıldız, Faysal Gök, Muferret Erguven, Erbil Unsal, Ozgur Kasapcopur, For the FMF Arthritis Vasculitis and Orphan Disease Research in Paediatric Rheumatology (FAVOR), Hafize E. Sönmez, Betül Sözeri, Yonatan Butbul, Seza Özen, Claudia Bracaglia, Giusi Prencipe, Manuela Pardeo, Geneviève Lapeyre, Emiliano Marasco, Walter Ferlin, Robert Nelson, Cristina de Min, N. Ruperto, H. I. Brunner, P. Quartier, T. Constantin, E. Alexeeva, K. Marzan, N. Wulffraat, R. Schneider, S. Padeh, V. Chasnyk, C. Wouters, J. B. Kuemmerle-Deschner, T. Kallinich, B. Lauwerys, E. Haddad, E. Nasonov, M. Trachana, O. Vougiouka, K. Leon, E. Vritzali, A. Martini, D. Lovell, PRINTO/PRCSG, Stefano Volpi, Claudia Pastorino, Francesca Kalli, Alessia Omenetti, Sabrina Chiesa, Arinna Bertoni, Paolo Picco, Gilberto Filaci, Elisabetta Traggiai, Marie-Louise Fremond, Naoki Kitabayashi, Olivero Sacco, Isabelle Meyts, Marie-Anne Morren, Carine Wouters, Eric Legius, Isabelle Callebaut, Christine Bodemer, Frederic Rieux-Laucat, Mathieu Rodero, Nadia Jeremiah, Alexandre Belot, Eric Jeziorski, Didier Bessis, Guilhem Cros, Gillian I. Rice, Bruno Charbit, Anne Hulin, Nihel Khoudour, Consuelo Modesto Caballero, Monique Fabre, Laureline Berteloot, Muriel Le Bourgeois, Philippe Reix, Thierry Walzer, Despina Moshous, Stéphane Blanche, Alain Fischer, Brigitte Bader-Meunier, Frédéric Rieux-Laucat, K. Annink, N. ter Haar, S. Al-Mayouf, G. Amaryan, K. Barron, S. Benseler, P. Brogan, L. Cantarini, M. Cattalini, A. Cochino, F. Dedeoglu, A. De Jesus, O. Dellacasa, E. Demirkaya, P. Dolezalova, K. Durrant, G. Fabio, R. Gallizzi, R. Goldbach-Mansky, E. Hachulla, V. Hentgen, T. Herlin, M. Hofer, H. Hoffman, A. Insalaco, A. Jansson, I. Koné-Paut, A. Kozlova, J. Kuemmerle-Deschner, R. Laxer, S. Nielsen, I. Nikishina, A. Ombrello, E. Papadopoulou-Alataki, A. Ravelli, D. Rigante, R. Russo, Y. Uziel, Nienke ter Haar, Jerold Jeyaratnam, Anna Simon, Matteo Doglio, Jordi Anton, Consuelo Modesto, Pierre Quartier, Esther Hoppenreijs, Luca Cantarini, Loredana Lepore, Inmaculada Calvo Penades, Christina Boros, Rita Consolini, Donato Rigante, Ricardo Russo, Jana Pachlopnik Schmid, Thirusha Lane, Nicolino Ruperto, Joost Frenkel, Chiara Passarelli, Elisa Pisaneschi, Virginia Messia, Antonio Novelli, Fabrizio Debenedetti, P. A. Brogan, X. Wei, Martina Finetti, Francesca Orlando, Elisabetta Cortis, Angela Miniaci, Nicola Ruperto, Charlotte Eijkelboom, Pavla Dolezalova, Isabelle Koné-Paut, Marija Jelusic-Drazic, Liliana Bezrodnik, Mari Carmen Pinedo, Valda Stanevicha, Marielle van Gijn, Silvia Federici, Hermann Girschick, Gerd Ganser, Susan Nielsen, Troels Herlin, Sulaiman Mohammed Al-Mayouf, Michael Hofer, Jasmin Kuemmerle-Deschner, Susanne Schalm, Annette Jansson, on behalf of PRINTO and Eurofever registry, Marta Marchi, Chiara Marini, Angelo Ravelli, Alberto Garaventa, Sonia Carta, Enrica Balza, Patrizia Castellani, Caterina Pellecchia, Silvia Borghini, Maria Libera Trotta, Anna Rubartelli, Andrew Henrey, Thomas Loughin, Roberta Berard, Natalie Shiff, Roman Jurencak, Susanne Benseler, Lori Tucker, on behalf of ReACCh-Out Investigators, Charalampia Papadopoulou, Ying Hong, Petra Krol, Yiannis Ioannou, Clarissa Pilkington, Hema Chaplin, Stephania Simou, Marietta Charakida, Lucy Wedderburn, Lynn R. Spiegel, Sara Ahola Kohut, Jennifer Stinson, Paula Forgeron, Miriam Kaufman, Nadia Luca, Khush Amaria, Mary Bell, J Swart, F. Boris, E. Castagnola, A. Groll, G. Giancane, G. Horneff, H. I. Huppertz, T. Wolfs, E. Alekseeva, V. Panaviene, F. Uettwiller, V. Stanevicha, L. M. Ailioaie, E. Tsitami, S. Kamphuis, G. Susic, F. Sztajnbok, B. Flato, A. Pistorio, Stephanie J. W. Shoop, Suzanne M. M. Verstappen, Janet E. McDonagh, Wendy Thomson, Kimme L. Hyrich, CAPS, Maarit Tarkiainen, Pirjo Tynjala, Pekka Lahdenne, Janne Martikainen, Acute-JIA Study Group, Meredyth Wilkinson, Christopher Piper, Georg Otto, Claire T. Deakin, Stefanie Dowle, Stefania Simou, Daniel Kelberman, Claudia Mauri, Elizabeth Jury, David Isenberg, Lucy R. Wedderburn, Kiran Nistala, I. Foeldvari, D. J. Lovell, G. Simonini, M. Bereswill, J. Kalabic, Kiem Oen, Brian M. Feldman, Brenden Dufault, Jennifer Lee, Karen Watanabe Duffy, Ciaran Duffy, ReACCh-Out Investigators, N. Tzaribachev, G. Vega-Cornejo, I. Louw, A. Berman, I. Calvo, R. Cuttica, F. Avila-Zapata, R. Cimaz, E. Solau-Gervais, R. Joos, G. Espada, X. Li, M. Nys, R. Wong, S. Banerjee, For Pediatric Rheumatology International Trials Organization (PRINTO)/Pediatric Rheumatology Collaborative Study Group (PRCSG), Rebecca Nicolai, Margherita Verardo, Adele D’Amico, Luisa Bracci-Laudiero, Gian Marco Moneta, Gillian Rice, Anne-Laure Mathieu, Sulliman O. Omarjee, Tracy A. Briggs, James O’Sullivan, Simon Williams, Rolando Cimaz, Eve Smith, Michael W. Beresford, Yanick J. Crow, GENIAL Investigators, UK JSLE Study Group, Madeleine Rooney, Nick Bishop, joyce davidson, Clarissa pilkington, Michael Beresford, Jacqui Clinch, Rangaraj Satyapal, Helen Foster, Janet Gardner Medwin, Janet McDonagh, Sue Wyatt, On Behalf of the British Society for Paediatric and Adolescent Rheumatology, Valentina Litta Modignani, Francesco Baldo, Stefano Lanni, Alessandro Consolaro, Giovanni Filocamo, Helen J. Lachmann, on behalf of Eurofever Registry, Gianmarco Moneta, Camilla Celani, Bilade Cherqaoui, Linda Rossi-Semerano, Perrine Dusser, Véronique Hentgen, Claire Grimwood, Linda Rossi, Isabelle Kone Paut, Veronique Hentgen, Denise Lasigliè, Denise Ferrera, Giulia Amico, Marco Di Duca, Laura Obici, Roberto Ravazzolo, Ryuta Nishikomori, Juan Arostegui, Andrea Petretto, Chiara Lavarello, Elvira Inglese, Federica Vanoni, Michaël Hofer, on behalf of EUROFEVER PROJECT, P. N. Hawkins, T. van der Poll, U. A. Walker, H. H. Tilson, Pascal N. Tyrrell, Raphaela Goldbach-Mansky, Norbert Blank, Hal M. Hoffman, Elisabeth Weissbarth-Riedel, Boris Huegle, Tilmann Kallinich, Ahmet Gul, Marlen Oswald, Fatma Dedeoglu, Aki Hanaya, Takako Miyamae, Manabu Kawamoto, Yumi Tani, Takuma Hara, Yasushi Kawaguchi, Satoru Nagata, Hisashi Yamanaka, Almira Ćosićkić, Fahrija Skokić, Belkisa Čolić, Sanimir Suljendić, Anna Kozlova, Irina Mersiyanova, Mariya Panina, Lily Hachtryan, Vasiliy Burlakov, Elena Raikina, Alexey Maschan, Anna Shcherbina, Banu Acar, Meryem Albayrak, Betul Sozeri, Sezgin Sahin, Amra Adrovic, Nese Inan, Serhan Sevgi, Caroline M. Andreasen, Anne Grethe Jurik, Mia B. Glerup, Christian Høst, Birgitte T. Mahler, Ellen-Margrethe Hauge, Cecilia Lazea, Laura Damian, Calin Lazar, Rodica Manasia, Chloe M. Stephenson, Vimal Prajapati, Paivi M. Miettunen, Dilek Yılmaz, Yavuz Tokgöz, Yasin Bulut, Harun Çakmak, Ferah Sönmez, Elif Comak, Gülşah Kaya Aksoy, Mustafa Koyun, Sema Akman, Yunus Arıkan, Ender Terzioğlu, Osman Nidai Özdeş, İbrahim Keser, Hüseyin Koçak, Ayşen Bingöl, Aygen Yılmaz, Reha Artan, X. Xu, Fatemeh F. Mehregan, Vahid Ziaee, Mohammad H. Moradinejad, Francesco La Torre, Clotilde Alizzi, Pio D’Adamo, G. Junge, J. Gregson, Hasmik Sargsyan, Hulya Zengin, Berna E. Fidanci, Cagla Kaymakamgil, Dilek Konukbay, Dilek Yildiz, Faysal Gok, Iris Stoler, Judith Freytag, Banu Orak, Christine Seib, Lars Esmann, Eva Seipelt, Faekah Gohar, Dirk Foell, Ismail Dursun, Sebahat Tulpar, Sibel Yel, Demet Kartal, Murat Borlu, Funda Bastug, Hakan Poyrazoglu, Zubeyde Gunduz, Kader Kose, Mehmet E. Yuksel, Abdullah Calıskan, Ahmet B. Cekgeloglu, Ruhan Dusunsel, Katerina Bouchalova, Jana Franova, Marcel Schuller, Marie Macku, Katerina Theodoropoulou, Raffaella Carlomagno, Annette von Scheven-Gête, Claudia Poloni, Laura O. Damian, Dan Cosma, Amanda Radulescu, Dan Vasilescu, Liliana Rogojan, Simona Rednic, Mihaela Lupse, Lien De Somer, Pierre Moens, Rocio Galindo Zavala, Laura Martín Pedraz, Esmeralda Núñez Cuadros, Gisela Díaz-Cordovés Rego, Antonio L. Urda Cardona, Ilaria Dal Forno, Sara Pieropan, Ombretta Viapiana, Davide Gatti, Gloria Dallagiacoma, Paola Caramaschi, Domenico Biasi, Daniel Windschall, Ralf Trauzeddel, Hartwig Lehmann, Rainer Berendes, Maria Haller, Manuela Krumrey-Langkammerer, Antje Nimtz-Talaska, Philipp Schoof, Ralf Felix Trauzeddel, Christine Nirschl, Estefania Quesada-Masachs, Carla Aguilar Blancafort, Sara Marsal Barril, Francisca Aguiar, Rita Fonseca, Duarte Alves, Ana Vieira, Alberto Vieira, Jorge A. Dias, Iva Brito, Gordana Susic, Vera Milic, Goran Radunovic, Ivan Boricic, Pauline Marteau, Catherine Adamsbaum, Michel De Bandt, Irène Lemelle, Chantal Deslandre, Tu Anh Tran, Anne Lohse, Elisabeth Solau-Gervais, Pascal Pillet, Julien Wipff, Cécile Gaujoux-Viala, Sylvain Breton, Valérie Devauchelle-Pensec, Sandra Gran, Olesja Fehler, Stefanie Zenker, Michael Schäfers, Thomas Vogl, Severine Guillaume Czitrom, EH Pieter Van Dijkhuizen, Silvia Magni Manzoni, Francesca Magnaguagno, Laura Tanturri de Horatio, Nienke M. Ter Haar, Annemieke S. Littooij, Vitor A. Teixeira, Raquel Campanilho-Marques, Ana F. Mourão, Filipa O. Ramos, Manuela Costa, Wafa A. Madan, Orla G. Killeen, Adriana Rodriguez Vidal, Diana Sueiro Delgado, Maria Isabel Gonzalez Fernandez, Berta Lopez Montesinos, Aleksey Kozhevnikov, Nina Pozdeeva, Mikhail Konev, Evgeniy Melchenko, Vladimir Kenis, Gennadiy Novik, Aysenur Pac Kısaarslan, Butsabong Lerkvaleekul, Suphaneewan Jaovisidha, Witaya Sungkarat, Niyata Chitrapazt, Praman Fuangfa, Thumanoon Ruangchaijatuporn, Soamarat Vilaiyuk, Dan Ø. Pradsgaard, Arne Hørlyck, Anne H. Spannow, Carsten W. Heuck, Talia Diaz, Fernando Garcia, Lorenia De La Cruz, Nadina Rubio, Joanna Świdrowska-Jaros, Elzbieta Smolewska, Mirta Lamot, Lovro Lamot, Mandica Vidovic, Edi Paleka Bosak, Ivana Rados, Miroslav Harjacek, Nikolay Tzaribachev, Polymnia Louka, Romiesa Hagoug, Chiara Trentin, Olga Kubassova, Mark Hinton, Mikael Boesen, Olena A. Oshlianska, Illya A. Chaikovsky, G. Mjasnikov, A. Kazmirchyk, Umberto Garagiola, Irene Borzani, Paolo Cressoni, Fabrizia Corona, Eszter Dzsida, Giampietro Farronato, Antonella Petaccia, Alenka Gagro, Agneza Marija Pasini, Goran Roic, Ozren Vrdoljak, Lucija Lujic, Matija Zutelija-Fattorini, Monika M. Esser, Deepthi R. Abraham, Craig Kinnear, Glenda Durrheim, Mike Urban, Eileen Hoal, Victoria B. Nikolayenko, Kubilay Şahin, Yasar Karaaslan, Adele Civino, Giovanni Alighieri, Sergio Davì, Roberto Rondelli, Andrea Magnolato, Francesca Ricci, Alma Olivieri, Valeria Gerloni, Bianca Lattanzi, Francesca Soscia, Alessandro De Fanti, Stefania Citiso, Lorenzo Quartulli, Maria Cristina Maggio, Manuela Marsili, Maria Antonietta Pelagatti, Valentino Conter, Franca Fagioli, Andrea Pession, Marco Garrone, Mariangela Rinaldi, Jaime De Inocencio, Stella Garay, Daniel J. Lovell, Berit Flato, EPOCA Study Group, Angela Aquilani, Simona Cascioli, Ivan Caiello, Denise Pires-Marafón, Rita Carsetti, Emily Robinson, Salvatore Albani, Wilco de Jager, Sytze de Roock, Trang Duong, Justine Ellis, Kimme Hyrich, Laetitia Jervis, Daniel Lovell, Lucy Marshall, Elizabeth D. Mellins, Kirsten Minden, Jane Munro, Peter A. Nigrovic, Jason Palman, Sunil Sampath, Laura E. Schanberg, Susan D. Thompson, Richard Vesely, Chris Wallace, Chris Williams, Qiong Wu, Nico Wulffraat, Rae S. M. Yeung, M. B. Seyger, D. Arikan, J. K. Anderson, A. Lazar, D. A. Williams, C. Wang, R. Tarzynski-Potempa, J. S. Hymans, Gabriele Simonini, Erika Scoccimarro, Irene Pontikaki, Teresa Giani, Alessandro Ventura, Pier Luigi Meroni, Gaetana Minnone, Marzia Soligo, Luigi Manni, Luisa Bracci Laudiero, Noortje Groot, I. Grein, N. M. Wulffraat, R. Schepp, G. Berbers, C. C. Barbosa Sandoval de Souza, V. Paes Leme Ferriani, G. Pileggi, S. de Roock, Ingrid H. R. Grein, Silvia Scala, Elisa Patrone, Casper Schoemaker, on behalf of Dutch JIA patient organization, Wendy Costello, on behalf of ENCA, Suzanne Parsons, Jean-David Cohen, Damien Bentayou, Marc-Antoine Bernard Brunel, Sonia Trope, Jens Klotsche, Miriam Listing, Martina Niewerth, Gerd Horneff, Angelika Thon, Hans-Iko Huppertz, Kirsten Mönkemöller, Ivan Foeldvari, ICON study group, Achille Marino, Stefano Stagi, Niccolò Carli, Federico Bertini, Adriana S. Díaz-Maldonado, Sally Pino, Pilar Guarnizo, Alfonso Ragnar Torres-Jimenez, Berenice Sanchez-Jara, Eunice Solis-Vallejo, Adriana Ivonne Cespedes-Cruz, Maritza Zeferino-Cruz, Julia Veronica Ramirez-Miramontes, Ankur Kumar, Anju Gupta, Deepti Suri, Amit Rawat, Nandita Kakkar, Surjit Singh, Özge A. Gücenmez, Erbil Ünsal, Bo Magnusson, Karina Mördrup, Anna Vermé, Christina Peterson, Board of the Swedish Pediatric Rheumatology Registry, Caroline Freychet, Jean Louis Stephan, Cathryn E. Harkness, Leanne Foster, Emma Henry, Pauline Taggart, Coskun F. Ozkececi, Esra Kurt, Gokalp Basbozkurt, Daiva Gorczyca, Jacek Postępski, Aleksandra Czajkowska, Bogumiła Szponar, Mariola Paściak, Anna Gruenpeter, Iwona Lachór-Motyka, Daria Augustyniak, Edyta Olesińska, Emediong S. Asuka, Tatyana Golovko, Samuel U. Aliejim, Emilio Inarejos Clemente, Estibaliz Iglesias Jimenez, Joan Calzada Hernandez, Sergi Borlan Fernandez, Clara Gimenez Roca, David Moreno Romo, Natalia Rodriguez Nieva, Juan Manuel Mosquera Angarita, Jordi Anton Lopez, Esmeralda Nuñez-Cuadros, Gisela Diaz-Cordovés, Rocío Galindo-Zavala, Antonio Urda-Cardona, Antonio Fernández-Nebro, Daniel Álvarez de la Sierra, Marina Garcia Prat, Mónica Martínez Gallo, Ricardo Pujol Borrell, Ana M. Marín Sánchez, Etienne Merlin, Sylvie Fraitag, Jean-Louis Stephan, Federico Annoni, Giancarla Di Landro, Sofia Torreggiani, Marta Torcoletti, Georgina Tiller, Jo Buckle, Angela Cox, Peter Gowdie, Roger C. Allen, Jonathan D. Akikusa, Hayde G. Hernández-Huirache, Edel R. Rodea-Montero, William Fahy, Christelle Sordet, Karin B. Berggren, Johanna T. Kembe, Joyce Bos, Wineke Armbrust, Marco van Brussel, Jeanette Cappon, Pieter Dijkstra, Jan Geertzen, Elizabeth Legger, Marion van Rossum, Pieter Sauer, Otto Lelieveld, Levent Buluc, Gur Akansel, Bahar Muezzinoglu, Ljubov Rychkova, Tatyana Knyazeva, Anna Pogodina, Tatyana Belova, Tamara Mandzyak, Ekaterina Kulesh, Alessandro Cafarotti, Cosimo Giannini, Roberta Salvatore, Giuseppe Lapergola, Caterina Di Battista, Maria Loredana Marcovecchio, Raffaella Basilico, Piernicola Pelliccia, Francesco Chiarelli, Luciana Breda, Beverley Almeida, Sarah Tansley, Harsha Gunawardena, Neil McHugh, Juvenile Dermatomyositis Research Group (JDRG), Jessie Aouizerate, Marie De Antonio, Christine Barnerias, Guillaume Bassez, Isabelle Desguerre, Romain Gherardi, Jean-Luc Charuel, François-Jérôme Authier, Cyril Gitiaux, C. H. Spencer, Rabheh Abdul Aziz, Chack-Yung Yu, Brent Adler, Sharon Bout-Tabaku, Katherine Lintner, Melissa Moore-Clingenpeel, Liza McCann, Nicola Ambrose, Mario Cortina-Borja, Juvenile Dermatomyositis Cohort and Biomarker Study (JCDBS), Prasad T. Oommen, Fabian Speth, Johannes-Peter Haas, Working Group “Juvenile Dermatomyositis” of the German Society for Paediatric and Adolescent Rheumatology (GKJR), Claudio Lavarello, Gabriella Giancane, Angela Pistorio, Lisa Rider, Rohit Aggarwal, Sheila K. Oliveira, Ruben Cuttica, Michel Fischbach, Gary Sterba, Karine Brochard, Frank Dressler, Patrizia Barone, Ruben Burgos-Vargas, Elizabeth Candell Chalom, Marine Desjonqueres, Graciela Espada, Anders Fasth, Stella Maris Garay, Rose-Marie Herbigneaux, Claire Hoyoux, Chantal Job Deslandre, Frederick W. Miller, Jiri Vencovsky, Erdal Sag, Gulsev Kale, Haluk Topaloglu, Beril Talim, Francesco Zulian, Tadej Avcin, Roberto Marini, Anne Pagnier, Michel Rodiere, Christine Soler, Rebecca Ten Cate, Yosef Uziel, Jelena Vojinovic, Ana V. Villarreal, Nydia Acevedo, Yuridiana Ramirez, Enrique Faugier, Rocio Maldonado, Bita Arabshahi, John H. Lee, Ian Leibowitz, Lawrence O. Okong’o, Jo Wilmshurst, Monika Esser, Christiaan Scott, Ezgi Deniz Batu, Nagehan Emiroglu, Hafize Emine Sonmez, Gokcen Dilsa Tugcu, Zehra Serap Arici, Ebru Yalcin, Deniz Dogru, Ugur Ozcelik, Mithat Haliloglu, Nural Kiper, Masato Yashiro, Mutsuko Yamada, Toshihiko Yabuuchi, Tomonobu Kikkawa, Nobuyuki Nosaka, Yosuke Fujii, Yukie Saito, Hirokazu Tsukahara, Sulaiman M. Al-Mayouf, Nora AlMutiari, Mohammed Muzaffer, Rawiah shehata, Adel Al-Wahadneh, Reem Abdwani, Safia Al-Abrawi, Mohammed Abu-shukair, Zeyad El-Habahbeh, Abdullah Alsonbul, Aleksandra Szabat, Monika Chęć, Violetta Opoka-Winiarska, Biman Saikia, Ranjana W. Minz, Christine Arango, Clara Malagon, Maria D. P. Gomez, Angela C. Mosquera, Ricardo Yepez, Tatiana Gonzalez, Camilo Vargas, GRIP study group, Marta Balzarin, Biagio Castaldi, Elena Reffo, Francesca Sperotto, Giorgia Martini, Alessandra Meneghel, Ornella Milanesi, Ozgur Kasapçopur, Maria Teresa Terreri, Ekaterina Alexeeva, Maria Katsicas, Mikhail Kostik, Thomas Lehman, W.-Alberto Sifuentes-Giraldo, Vanessa Smith, Flavio Sztajnbok, Tadey Avcin, Maria Jose Santos, Dana Nemcova, Cristina Battagliotti, Liora Harel, Mahesh Janarthanan, Kathryn Torok, Nicola Helmus, Eileen Baildem, Michael Blakley, Kim Fligelstone, Antonia Kienast, Clare Pain, Amanda Saracino, Gabriele Simoni, Lisa Weibel, Maria K. Osminina, Nathalia A. Geppe, Olga V. Niconorova, Olesya V. Karashtina, Oksana V. Abbyasova, Olga V. Shpitonkova, Sinem Durmus, Hafize Uzun, Angela Mauro, Eleonora Fanti, Fabio Voller, Franca Rusconi, Fernando Garcia-Rodriguez, Ana V. Villarreal-Treviño, Angel J. Flores-Pineda, Paola B. Lara-Herrea, Diego R. Salinas-Encinas, Talia Diaz-Prieto, Maria R. Maldonado-Velazquez, Sarbelio Moreno-Espinosa, Enrique Faugier-Fuentes, Mirella Crapanzano, Ilaria Parissenti, Man S. Parihar, Pandiarajan Vignesh, ManojKumar Rohit, Kavitha Gopalan, Savita V. Attri, Alan Salama, David Jayne, Mark Little, Yulia Kostina, Galina Lyskina, Olga Shpitonkova, Alena Torbyak, Olga Shirinsky, Maria Francesca Gicchino, Maria Cristina Smaldone, Mario Diplomatico, Alma Nunzia Olivieri, C H. Spencer, Richard McClead, Hiren Patel, Chung-Yung Yu, Dita Cebecauerová, Tomáš Dallos, Edita Kabíčková, Martin Kynčl, Daniela Chroustová, Jozef Hoza, Dana Němcová, Vladimír Tesař, Pavla Doležalová, Tuncay Hazirolan, Fatih Ozaltin, Fabiola Almeida, Isabela H. Faria de Paula, Maíra M. Sampaio, Fernando N. Arita, Andressa G. Alves, Maria Carolina Santos, Eunice M. Okuda, Silvana B. Sacchetti, Fernanda Falcini, Marini Francesca, Gemma Lepri, Marco Matucci-Cerinic, Maria Luisa Brandi, Hakan Kisaoglu, Sema Misir, Selim Demir, Yuksel Aliyazicioglu, Mukaddes Kalyoncu, Carlos Eduardo Ramalho, Fabiola D. Almeida, Joan Calzada-Hernández, Rosa Bou, Estíbaliz Iglesias, Judith Sánchez-Manubens, Fredy Hermógenes Prada Martínez, Clara Giménez Roca, Sergi Borlan Fernández, Marek Bohm, Kamran Mahmood, Valentina Leone, Mark Wood, Ken-Ichi Yamaguchi, Satoshi Fujikawa, Working Group of Behçet’s Disease, Pediatric Rheumatology Association of Japan (PRAJ), Kyu Yeun Kim, Do Young Kim, Dong Soo Kim, Maka Ioseliani, Ivane Chkhaidze, Maia Lekishvili, Nana Tskhakaia, Shorena Tvalabeishvili, Aleksandre Kajrishvili, Maiko Takakura, Masaki Shimizu, Natsumi Inoue, Mao Mizuta, Akihiro Yachie, Giovanni Corsello, Maryam Piram, Carla Maldini, Sandra Biscardi, Nathalie Desuremain, Catherine Orzechowski, Emilie Georget, Delphine Regnard, Isabelle Kone-Paut, Alfred Mahr, Mihaela Sparchez, Zeno Sparchez, Nydia Acevedo Silva, Ana V. Villarreal Treviño, Yuridiana Ramirez Loyola, Talia Diaz Prieto, Enrique Faugier Fuentes, Maria D. R. Maldonado Velazquez, Pilar Perez, Sagar Bhattad, Ranjana Minz, Jitendra Shandilya, Pediatric Allergy and Immunology Unit, PGIMER, Chandigarh, Ana Villarreal, Yuridiana Ramírez, Zeynep Birsin Özçakar, Suat Fitoz, Fatos Yalcinkaya, Annacarin Horne, Francesca Minoia, Francesca Bovis, Sergio Davi, Priyankar Pal, Kimo Stein, Sandra Enciso, Michael Jeng, Despoina Maritsi, Randy C. Cron, Anne Thorwarth, Sae Lim von Stuckrad, Angela Rösen-Wolff, Hella Luksch, Patrick Hundsdoerfer, Peter Krawitz, Nuray Aktay Ayaz, Doğan Simsek, Şebnem Sara Kılıc, Emine Sonmez, Aysenur Pac Kisaarslan, Ozge Altug Gucenmez, Z. Serap Arıcı, Fatih Kelesoglu, Zelal Ekinci Ekinci, Maria Miranda-Garcia, Carolin Pretzer, Michael Frosch, F. Gohar, Angela McArdle, Niamh Callan, Belinda Hernandez, Miha Lavric, Oliver FitzGerald, Stephen R. Pennington, Joachim Peitz, Joern Kekow, Ariane Klein, Anna C. Schulz, Frank Weller-Heinemann, Anton Hospach, J-Peter Haas, BIKER collaborative group, Karen Put, Jessica Vandenhaute, Anneleen Avau, Annemarie van Nieuwenhuijze, Ellen Brisse, Tim Dierckx, Omer Rutgeerts, Josselyn E. Garcia-Perez, Jaan Toelen, Mark Waer, Georges Leclercq, An Goris, Johan Van Weyenbergh, Adrian Liston, Patrick Matthys, Carine H. Wouters, Yasuo Nakagishi, Michael J. Ombrello, Victoria Arthur, Anne Hinks, Patricia Woo, International Childhood Arthritis Genetics (INCHARGE) Consortium, Barbara Stanimirovic, Biljana Djurdjevic-Banjac, Olivera Ljuboja, Boris Hugle, MArgarita Onoufriou, Olga Vougiouka, Kenza Bouayed, Sanae El Hani, Imane Hafid, Nabiha Mikou, Nunu Shelia, Mari Laan, Jaanika Ilisson, and Chris Pruunsild

Subjects
Pediatrics, RJ1-570, Diseases of the musculoskeletal system, RC925-935
Published
2017
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