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1. Personalised management of patients with hepatocellular carcinoma: a multiparametric therapeutic hierarchy concept

Author

Vitale, A, Cabibbo, G, Iavarone, M, Vigano, L, Pinato, D, Ponziani, F, Lai, Q, Casadei-Gardini, A, Celsa, C, Galati, G, Gambato, M, Crocetti, L, Renzulli, M, Giannini, E, Farinati, F, Trevisani, F, Cillo, U, Baccarani, U, Brancaccio, G, Cozzolongo, R, Cucchetti, A, De Matthaeis, N, Di Sandro, S, Famularo, S, Finotti, M, Foschi, F, Ghinolfi, D, Guarracino, M, Gruttadauria, S, Guarino, M, Kostandini, A, Lenci, I, Levi Sandri, G, Manzia, T, Marasco, G, Masarone, M, Mazzarelli, C, Melandro, F, Miele, L, Morisco, F, Nicolini, D, Pagano, D, Pelizzaro, F, Pieri, G, Piscaglia, F, Plaz Torres, M, Pravisani, R, Rendina, M, Romano, F, Russo, F, Sacco, R, Sangiovanni, A, Sposito, C, Tortora, R, Tovoli, F, Vigano, M, Violi, P, Vitale A., Cabibbo G., Iavarone M., Vigano L., Pinato D. J., Ponziani F. R., Lai Q., Casadei-Gardini A., Celsa C., Galati G., Gambato M., Crocetti L., Renzulli M., Giannini E. G., Farinati F., Trevisani F., Cillo U., Baccarani U., Brancaccio G., Cozzolongo R., Cucchetti A., De Matthaeis N., Di Sandro S., Famularo S., Finotti M., Foschi F. G., Ghinolfi D., Guarracino M., Gruttadauria S., Guarino M., Kostandini A., Lenci I., Levi Sandri G. B., Manzia T. M., Marasco G., Masarone M., Mazzarelli C., Melandro F., Miele L., Morisco F., Nicolini D., Pagano D., Pelizzaro F., Pieri G., Piscaglia F., Plaz Torres M. C., Pravisani R., Rendina M., Romano F., Russo F. P., Sacco R., Sangiovanni A., Sposito C., Tortora R., Tovoli F., Vigano M., Violi P., Vitale, A, Cabibbo, G, Iavarone, M, Vigano, L, Pinato, D, Ponziani, F, Lai, Q, Casadei-Gardini, A, Celsa, C, Galati, G, Gambato, M, Crocetti, L, Renzulli, M, Giannini, E, Farinati, F, Trevisani, F, Cillo, U, Baccarani, U, Brancaccio, G, Cozzolongo, R, Cucchetti, A, De Matthaeis, N, Di Sandro, S, Famularo, S, Finotti, M, Foschi, F, Ghinolfi, D, Guarracino, M, Gruttadauria, S, Guarino, M, Kostandini, A, Lenci, I, Levi Sandri, G, Manzia, T, Marasco, G, Masarone, M, Mazzarelli, C, Melandro, F, Miele, L, Morisco, F, Nicolini, D, Pagano, D, Pelizzaro, F, Pieri, G, Piscaglia, F, Plaz Torres, M, Pravisani, R, Rendina, M, Romano, F, Russo, F, Sacco, R, Sangiovanni, A, Sposito, C, Tortora, R, Tovoli, F, Vigano, M, Violi, P, Vitale A., Cabibbo G., Iavarone M., Vigano L., Pinato D. J., Ponziani F. R., Lai Q., Casadei-Gardini A., Celsa C., Galati G., Gambato M., Crocetti L., Renzulli M., Giannini E. G., Farinati F., Trevisani F., Cillo U., Baccarani U., Brancaccio G., Cozzolongo R., Cucchetti A., De Matthaeis N., Di Sandro S., Famularo S., Finotti M., Foschi F. G., Ghinolfi D., Guarracino M., Gruttadauria S., Guarino M., Kostandini A., Lenci I., Levi Sandri G. B., Manzia T. M., Marasco G., Masarone M., Mazzarelli C., Melandro F., Miele L., Morisco F., Nicolini D., Pagano D., Pelizzaro F., Pieri G., Piscaglia F., Plaz Torres M. C., Pravisani R., Rendina M., Romano F., Russo F. P., Sacco R., Sangiovanni A., Sposito C., Tortora R., Tovoli F., Vigano M., and Violi P.

Abstract

Advances in the surgical and systemic therapeutic landscape of hepatocellular carcinoma have increased the complexity of patient management. A dynamic adaptation of the available staging-based algorithms is required to allow flexible therapeutic allocation. In particular, real-world hepatocellular carcinoma management increasingly relies on factors independent of oncological staging, including patients’ frailty, comorbid burden, critical tumour location, multiple liver functional parameters, and specific technical contraindications impacting the delivery of treatment and resource availability. In this Policy Review we critically appraise how treatment allocation strictly based on pretreatment staging features has shifted towards a more personalised treatment approach, in which expert tumour boards assume a central role. We propose an evidence-based framework for hepatocellular carcinoma treatment based on the novel concept of multiparametric therapeutic hierarchy, in which different therapeutic options are ordered according to their survival benefit (ie, from surgery to systemic therapy). Moreover, we introduce the concept of converse therapeutic hierarchy, in which therapies are ordered according to their conversion abilities or adjuvant abilities (ie, from systemic therapy to surgery).

Published
2023

2. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma

Author

Lai, Q., De Matthaeis, N., Finotti, M., Galati, G., Marrone, G., Melandro, F., Morisco, F., Nicolini, D., Pravisani, R., Giannini, E. G., Aglitti, A., Aliberti, C., Baccarani, U., Bhoori, S., Borzio, M., Brancaccio, G., Burra, P., Cabibbo, G., Casadei Gardini, A., Carrai, P., Cillo, U., Conti, F., Cucchetti, A., D'Ambrosio, R., Dell'Unto, C., Di Costanzo, G. G., Di Sandro, S., Foschi, F. G., Fucilli, F., Gambato, M., Gasbarrini, A., Giuliante, F., Ghinolfi, D., Grieco, A., Gruttaduria, S., Guarino, M., Kostandini, A., Iavarone, M., Lenci, I., Levi Sandri, G. B., Losito, F., Lupo, L. G., Manzia, T. M., Mazzocato, S., Mescoli, C., Miele, L., Muley, M., Persico, M., Plaz Torres, M. C., Pompili, M., Ponziani, F. R., Rapaccini, G. L., Rendina, M., Renzulli, M., Rossi, M., Rreka, E., Russo, F. P., Sacco, R., Sangiovanni, A., Sessa, A., Simonetti, N., Sposito, C., Tortora, R., Trevisani, F., Vigano, L., Vigano, M., Villa, E., Vincenzi, V., Violi, P., and Vitale, A.

Subjects
clopidogrel, aspirin, Clinical Biochemistry, incidence, occurrence, survival, General Medicine, Biochemistry, Settore MED/18
Abstract

To evaluate the impact of antiplatelet therapy (APT)on the incidence of hepatocellular carcinoma (HCC) and mortality following its treatment.A systematic literature search was performed using PubMed and Cochrane Central Register of Controlled Trials Databases. Two HCC clinical settings were explored: (i) incidence, and (ii) death after any HCC treatment. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to compare the pooled data between patients who received or did not receive APT.A total of 20 studies were identified, of whom 15 focused on HCC incidence, including 2,685,009 patients, and five on post-treatment death, including 3281 patients. APT was associated with an overall reduced risk of HCC incidence (OR: 0.63; 95%CI = 0.51-0.79; p 0.001) as well as of post-treatment mortality (OR: 0.54; 95%CI = 0.35-0.83; p = 0.006).Current data suggest that APT correlated with higher HCC incidence and poor overall survival following tumour treatment.

Published
2023

3. Overview of prognostic systems for hepatocellular carcinoma and ITA.LI.CA external validation of MESH and CNLC classifications

Author

Vitale, A, Farinati, F, Finotti, M, Di Renzo, C, Brancaccio, G, Piscaglia, F, Cabibbo, G, Caturelli, E, Missale, G, Marra, F, Sacco, R, Giannini, E, Trevisani, F, Cillo, U, Bhoori, S, Borzio, M, Burra, P, Casadei Gardini, A, Carrai, P, Conti, F, Cozzolongo, R, Cucchetti, A, D'Ambrosio, R, Dell'Unto, C, De Matthaeis, N, Di Costanzo, G, Di Sandro, S, Famularo, S, Foschi, F, Fucilli, F, Galati, G, Gambato, M, Gasbarrini, A, Giuliante, F, Ghinolfi, D, Grieco, A, Gruttadauria, S, Guarino, M, Iavarone, M, Kostandini, A, Lai, Q, Lenci, I, Levi Sandri, G, Losito, F, Lupo, L, Marasco, G, Manzia, T, Mazzocato, S, Masarone, M, Melandro, F, Mescoli, C, Miele, L, Morisco, F, Muley, M, Nicolini, D, Pagano, D, Persico, M, Pompili, M, Ponziani, F, Pravisani, R, Rapaccini, G, Rendina, M, Renzulli, M, Romano, F, Rossi, M, Rreka, E, Russo, F, Sangiovanni, A, Sessa, A, Simonetti, N, Sposito, C, Tortora, R, Vigano, L, Vigano, M, Villa, E, Vincenzi, V, Violi, P, Azzaroli, F, Brunetto, M, Di Marco, A, Masotto, A, Mega, A, Nardone, G, Oliveri, F, Raimondo, G, Svegliati Baroni, G, Vidili, G, Zoli, M, Vitale A., Farinati F., Finotti M., Di Renzo C., Brancaccio G., Piscaglia F., Cabibbo G., Caturelli E., Missale G., Marra F., Sacco R., Giannini E. G., Trevisani F., Cillo U., Bhoori S., Borzio M., Burra P., Casadei Gardini A., Carrai P., Conti F., Cozzolongo R., Cucchetti A., D'ambrosio R., Dell'unto C., De Matthaeis N., Di Costanzo G. G., Di Sandro S., Famularo S., Foschi F. G., Fucilli F., Galati G., Gambato M., Gasbarrini A., Giuliante F., Ghinolfi D., Grieco A., Gruttadauria S., Guarino M., Iavarone M., Kostandini A., Lai Q., Lenci I., Levi Sandri G. V., Losito F., Lupo L. G., Marasco G., Manzia T. M., Mazzocato S., Masarone M., Melandro F., Mescoli C., Miele L., Morisco F., Muley M., Nicolini D., Pagano D., Persico M., Pompili M., Ponziani F. R., Pravisani R., Rapaccini G. L., Rendina M., Renzulli M., Romano F., Rossi M., Rreka E., Russo F. P., Sangiovanni A., Sessa A., Simonetti N., Sposito C., Tortora R., Vigano L., Vigano M., Villa E., Vincenzi V., Violi P., Azzaroli F., Brunetto M. R., Di Marco A., Masotto A., Mega A., Nardone G., Oliveri F., Raimondo G., Svegliati Baroni G., Vidili G., Zoli M., Vitale, A, Farinati, F, Finotti, M, Di Renzo, C, Brancaccio, G, Piscaglia, F, Cabibbo, G, Caturelli, E, Missale, G, Marra, F, Sacco, R, Giannini, E, Trevisani, F, Cillo, U, Bhoori, S, Borzio, M, Burra, P, Casadei Gardini, A, Carrai, P, Conti, F, Cozzolongo, R, Cucchetti, A, D'Ambrosio, R, Dell'Unto, C, De Matthaeis, N, Di Costanzo, G, Di Sandro, S, Famularo, S, Foschi, F, Fucilli, F, Galati, G, Gambato, M, Gasbarrini, A, Giuliante, F, Ghinolfi, D, Grieco, A, Gruttadauria, S, Guarino, M, Iavarone, M, Kostandini, A, Lai, Q, Lenci, I, Levi Sandri, G, Losito, F, Lupo, L, Marasco, G, Manzia, T, Mazzocato, S, Masarone, M, Melandro, F, Mescoli, C, Miele, L, Morisco, F, Muley, M, Nicolini, D, Pagano, D, Persico, M, Pompili, M, Ponziani, F, Pravisani, R, Rapaccini, G, Rendina, M, Renzulli, M, Romano, F, Rossi, M, Rreka, E, Russo, F, Sangiovanni, A, Sessa, A, Simonetti, N, Sposito, C, Tortora, R, Vigano, L, Vigano, M, Villa, E, Vincenzi, V, Violi, P, Azzaroli, F, Brunetto, M, Di Marco, A, Masotto, A, Mega, A, Nardone, G, Oliveri, F, Raimondo, G, Svegliati Baroni, G, Vidili, G, Zoli, M, Vitale A., Farinati F., Finotti M., Di Renzo C., Brancaccio G., Piscaglia F., Cabibbo G., Caturelli E., Missale G., Marra F., Sacco R., Giannini E. G., Trevisani F., Cillo U., Bhoori S., Borzio M., Burra P., Casadei Gardini A., Carrai P., Conti F., Cozzolongo R., Cucchetti A., D'ambrosio R., Dell'unto C., De Matthaeis N., Di Costanzo G. G., Di Sandro S., Famularo S., Foschi F. G., Fucilli F., Galati G., Gambato M., Gasbarrini A., Giuliante F., Ghinolfi D., Grieco A., Gruttadauria S., Guarino M., Iavarone M., Kostandini A., Lai Q., Lenci I., Levi Sandri G. V., Losito F., Lupo L. G., Marasco G., Manzia T. M., Mazzocato S., Masarone M., Melandro F., Mescoli C., Miele L., Morisco F., Muley M., Nicolini D., Pagano D., Persico M., Pompili M., Ponziani F. R., Pravisani R., Rapaccini G. L., Rendina M., Renzulli M., Romano F., Rossi M., Rreka E., Russo F. P., Sangiovanni A., Sessa A., Simonetti N., Sposito C., Tortora R., Vigano L., Vigano M., Villa E., Vincenzi V., Violi P., Azzaroli F., Brunetto M. R., Di Marco A., Masotto A., Mega A., Nardone G., Oliveri F., Raimondo G., Svegliati Baroni G., Vidili G., and Zoli M.

Abstract

Prognostic assessment in patients with HCC remains an extremely difficult clinical task due to the complexity of this cancer where tumour characteristics interact with degree of liver dysfunction, patient general health status, and a large span of available treatment options. Several prognostic systems have been proposed in the last three decades, both from the Asian and European/North American countries. Prognostic scores, such as the CLIP score and the recent MESH score, have been generated on a solid statistical basis from real life population data, while staging systems, such as the BCLC scheme and the recent CNLC classification, have been created by experts according to recent HCC prognostic evidences from the literature. A third category includes combined prognostic systems that can be used both as prognostic scores and staging systems. A recent example is the ITA.LI.CA prognostic system including either a prognostic score and a simplified staging system. This review focuses first on an overview of the main prognostic systems for HCC classified according to the above three categories, and, second, on a comprehensive description of the methodology required for a correct comparison between different systems in terms of prognostic performance. In this second section the main studies in the literature comparing different prognostic systems are described in detail. Lastly, a formal comparison between the last prognostic systems proposed for each of the above three categories is performed using a large Italian database including 6882 HCC patients in order to concretely apply the comparison rules previously described.

Published
2021

4. The rule of hydrogen peroxide long term rinse during a particular alveolar bone healing after ONJ injuries in a patient with periodontal disease: a 4-year radiological follow up report of a mental nerve emergence migration

Author

Nocini, R., Santis, D., Luciano, U., Zambotti, T., Pancera, P., Faccioni, P., Zotti, F., Zarantonello, M., Finotti, M., Bertajola, A., Alessandro Zangani, Iurlaro, A., Alberti, C., Capocasale, G., Donadello, D., and Bernardello, F.

Subjects
gingival inflammation, jaw osteonecrosis, Bone Density Conservation Agents, Diphosphonates, Mandibular Nerve, Alveolar Bone Loss, Osteonecrosis, Hydrogen Peroxide, supragingival irrigation, Bisphosphonate, Humans, Bisphosphonate-Associated Osteonecrosis of the Jaw, Periodontal Diseases, Follow-Up Studies
Abstract

Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ) is a pathology initially described in the early 2000s that has become increasingly common in clinical dentistry and maxillofacial practice due to the frequent use of bisphosphonates medical drugs (BPs) to treat various diseases such as osteoporosis, Paget's syndrome, osteomyelitis and in bone metastases secondary to tumors. Supragingival irrigation applied as monotherapy and in combination with root planning or BFs related bone necrosectomy revealed that supragingival irrigation with a variety of agents reduced the gingival microbial load and gingival inflammation. In this 4-year follow-up study we analyze the use of hydrogen peroxide (H2O2) as an antimicrobial agent for maintenance periodontal health, improving the longevity of teeth and oral cavity healing process.

Published
2021

5. The use of computer-guided flapless dental implant surgery (Nobel guide®) and immediate function to support a fixed full-arch prosthesis in fresh frozen homologous bone grafted patients: a retrospective cohort study with 5 to 8-year follow-up

Author

Santis, D., Gelpi, F., Zambotti, T., Rossetto, A., Luciano, U., Zotti, F., Iurlaro, A., Zarantonello, M., Finotti, M., Alberti, C., Alessandro Zangani, Capocasale, G., Donadello, D., Faccioni, P., and Nocini, P. F.

Subjects
NobelGuide®, Dental Implants, Sweden, flapless surgical procedure, Computer-Assisted, Treatment Outcome, Surgery, Computer-Assisted, Humans, Surgery, computer-assisted surgery, fresh frozen homologous bone grafts, Follow-Up Studies, Retrospective Studies
Abstract

The introduction of computer-assisted and guided surgery has radically improved the possibility of using all available bone for implant support, reducing the need for extensive grafting procedures and allowing for better implant placement and restoration. Moreover, fresh frozen homologous bone (FFB) grafts have shown good osteoconductive properties and biocompatibility with results comparable to autologous bone patients. The purpose of this retrospective cohort study was to evaluate the survival and the success rate of implants and related fixed full arch prosthesis at the 5 to 8 years follow-up when performed with immediate function using a flapless surgical procedure and computer-aided technology (NobelGuide®, Nobel Biocare® AB, Goteborg, Sweden) in patients previously treated with FFB grafts; treated at the University of Verona with the NobelGuide® system from January 2007 to December 2012 with at least 5 years follow-up were reviewed. Survival implants and survival prosthesis' percentage reached 95% in a 5 to 8-year period. This study indicates that patients previously augmented with FFB graft for maxillary or mandibular bone atrophy can be safely treated with implant supported prosthesis based on the NobelGuide® protocol, with the aid of computer-generated guide.

Published
2021

6. Ketamine in dentistry: a useful way for non-compliant pediatric patients

Author

Marinello, L., Zanotti, G., Spinelli, A., Zarantonello, M., Santis, D., Zotti, F., Iurlaro, A., Alberti, C., Alessandro Zangani, Capocasale, G., Bertajola, A., Donadello, D., and Finotti, M.

Subjects
odontophobic patient, Dentistry, Anesthesia, Dental, Conscious Sedation, Humans, Dental, Infant, Ketamine, anesthesia, Anesthesia, General, Child, General, patient/doctor relationship
Published
2020

7. New trends in adjunctive treatment and diagnosis in medication-related osteonecrosis of the jaw: A 10-year review

Author

Santis, D., Gelpi, F., Luciano, U., Zarantonello, M., Poscolere, A., Modena, N., Faccioni, P., Causarano, G., Finotti, M., Zotti, F., Magi, M., Iurlaro, A., Nocini, P. F., Alberti, C., Zangani, A., Giorgia Capocasale, Donadello, D., Nocini, R., and Bernardello, F.

Subjects
bisphosphonate, Treatment Outcome, jaw osteonecrosis, Bone Density Conservation Agents, Diphosphonates, literature review, therapies, Humans, Tocopherols, Bisphosphonate-Associated Osteonecrosis of the Jaw, Laser Therapy, Anti-Bacterial Agents
Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a major disease under study for over the last twenty years. Different classifications have been proposed and many therapies for the different stages have been applied. The evolution of treatments lead to an increasingly conservative approach. Numerous adjuvant treatments have been proposed in the last decade. All these complementary treatments have been proposed mainly to resolve or reduce the painful stress, predominantly caused by bacterial infection, simplifying the wound healing process and improving patients' compliance. Nowadays "secondary" treatments, such as autologous platelet concentrates (APCs, more specifically PRP, PRGF or PRF), hyperbaric oxygen (HBO), Auto/tetracycline fluorescence-guided bone surgery (AF-GBS/TF-GBS), medical drugs like teriparatide or the combination between pentoxifylline and tocopherol, fluorodeoxyglucose positron emission tomography (FDG-PET), laser and/or low-laser therapy and ozone therapy are more or less well documented and known considering their clinical effectiveness. The aim of the present review is the evaluation of the quantity and quality of scientific studies concerning this specific topic.

Published
2020

13. Microwave ablation for breast cancer liver metastasis

Author

Gringeri, E., primary, Boetto, R., additional, Pierobon, S.E., additional, D'Amico, F.E., additional, Bassi, D., additional, Di Giunta, M., additional, Fasolo, E., additional, Finotti, M., additional, Aliberti, C., additional, Ghiotto, C., additional, and Cillo, U., additional

Published
2019
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16. Memantine in moderately-severe-to-severe Alzheimer's disease: a postmarketing surveillance study

Author

Clerici F, Vanacore N, Elia A, Spila Alegiani S, Pomati S, Da Cas R, Raschetti R, Mariani C, Memantine Lombardy Study Group, Altavilla, R, APPOLLONIO, ILDEBRANDO, ISELLA, VALERIA, Avanzi, S, Bargnani, C, Bascelli, C, BELLELLI, GIUSEPPE, Guerini, F, Belotti, G, Bottini, G, Gerini, M, Cheldi, A, Bellotti, M, Chia, F, Cislaghi, G, Cusi, C, Mesina, M, Cuzzoni, G, Farina, E, Alberoni, M, Franceschi, M, Zucchi, M, Guerini, M, Iori, T, Lanza, E, Finotti, M, Lucchelli, F, Maggiore, L, Ratti, PL, Magnani, G, Schiatti, E, Marcone, A, Giusti, MC, Margarito, FP, Martina, A, Mauri, M, Merlo, P, Mazza, S, Moleri, M, Riva, R, Montecalvo, G, Chinaglia, CN, Engaddi, I, Perini, M, Carnicelli, A, Petro, E, Pettenati, C, Perotta, D, Ranzenigo, A, Bertozzi, B, Redaelli, L, Reverberi, F, Salvi, GP, Manzoni, L, Saviotti, FM, Scarpini, E, Guidi, I, Sinforiani, E, Zucchella, C, Tagliavini, F, Marcon, G, Turla, M, Viti, N, Zanetti, O, Alberici, A., Clerici, F, Vanacore, N, Elia, A, Spila Alegiani, S, Pomati S, D, Raschetti, R, Mariani, C, Memantine Lombardy Study, G, Altavilla, R, Appollonio, I, Isella, V, Avanzi, S, Bargnani, C, Bascelli, C, Bellelli, G, Guerini, F, Belotti, G, Bottini, G, Gerini, M, Cheldi, A, Bellotti, M, Chia, F, Cislaghi, G, Cusi, C, Mesina, M, Cuzzoni, G, Farina, E, Alberoni, M, Franceschi, M, Zucchi, M, Guerini, M, Iori, T, Lanza, E, Finotti, M, Lucchelli, F, Maggiore, L, Ratti, P, Magnani, G, Schiatti, E, Marcone, A, Giusti, M, Margarito, F, Martina, A, Mauri, M, Merlo, P, Mazza, S, Moleri, M, Riva, R, Montecalvo, G, Chinaglia, C, Engaddi, I, Perini, M, Carnicelli, A, Petro, E, Pettenati, C, Perotta, D, Ranzenigo, A, Bertozzi, B, Redaelli, L, Reverberi, F, Salvi, G, Manzoni, L, Saviotti, F, Scarpini, E, Guidi, I, Sinforiani, E, Zucchella, C, Tagliavini, F, Marcon, G, Turla, M, Viti, N, Zanetti, O, and Alberici, A

Subjects
Male, medicine.medical_specialty, Postmarketing surveillance, Severity of Illness Index, law.invention, Demenza, malattia di Alzheimer, Randomized controlled trial, law, Alzheimer Disease, Memantine, Internal medicine, medicine, Product Surveillance, Postmarketing, Dementia, Humans, Pharmacology (medical), Adverse effect, Aged, MED/26 - NEUROLOGIA, Aged, 80 and over, Psychiatric Status Rating Scales, business.industry, Odds ratio, medicine.disease, Surgery, Treatment Outcome, Tolerability, Italy, Clinical Global Impression, Female, Geriatrics and Gerontology, business, Excitatory Amino Acid Antagonists, memantina, medicine.drug
Abstract

Background: Postmarketing surveillance studies (PMS) are an important tool for evaluating a drug’s effectiveness and safety in clinical practice. To our knowledge, no PMS on memantine monotherapy for moderately-severe-to-severe Alzheimer’s disease (AD) according to National Institute of Neurological and Communicative Disorders and Stroke — Alzheimer’s Disease and Related Disorders Association criteria has been conducted to date. Objective: The Lombardy Health Office, Italy, promoted this PMS to evaluate the effectiveness and safety of memantine in the treatment of moderately-severe-to-severe AD in clinical practice. Methods: A total of 451 patients with moderately-severe-to-severe AD (mean age 77 ± 7 years; 72% female), free of cholinergic medication, received memantine (standard titration to 10 mg twice daily). After 6 months of therapy, treatment effectiveness was evaluated according to two definitions of response (‘no deterioration’ and ‘improvement’), as measured by changes in baseline scores on the Clinical Global Impression of Change, Mini-Mental State Examination, Neuropsychiatric Inventory and Activities of Daily Living scales. The safety measure was the frequency of adverse events (AEs). Results: At 6-month assessment, 26.8% of subjects showed no deterioration and 3.8% showed improvement. In those showing no deterioration, response to treatment at the 3-month assessment was associated with a greater probability of a response at 6 months (adjusted odds ratio = 8.54; 95% CI 4.54, 16.05). Seventy patients (15.5%) experienced at least one AE and 39 (8.6%) discontinued treatment prematurely because of an AE. Of those who experienced an AE, 27 (38.6%) manifested behavioural and psychological symptoms of dementia. Conclusion: The proportion of responders to memantine treatment in this PMS was similar to that reported in a previous randomized clinical trial (26.8% vs 29%, respectively). The proportion of patients who discontinued treatment prematurely because of an AE (8.6%) was similar to that reported in two previous randomized clinical trials (10% and 12.4%). This PMS provides additional evidence that both the effectiveness and the tolerability of memantine may be transferred into real world medicine, where AD patients receiving treatment are not selected according to strict criteria.

Published
2009

18. Memantine effects on behaviour in moderately severe to severe Alzheimer's disease: a post-marketing surveillance study

Author

Clerici, F, Vanacore, N, Elia, A, Spila-Alegiani, S, Pomati, S, Da Cas, R, Raschetti, R, Mariani, C, Altavilla, R, Appollonio, I, Isella, V, Avanzi, S, Bargnani, C, Bascelli, C, Bellelli, G, Guerini, F, Belotti, G, Bottini, G, Gerini, M, Cheldi, A, Bellotti, M, Chia, F, Cislaghi, G, Cusi, C, Mesina, M, Cuzzoni, G, Farina, E, Alberoni, M, Franceschi, M, Zucchi, M, Guerini, M, Iori, T, Lanza, E, Finotti, M, Lucchelli, F, Maggiore, L, Ratti, Pl, Magnani, G, Schiatti, E, Marcone, A, Giusti, Mc, Margarito, Fp, Martina, A, Mauri, M, Merlo, P, Mazza, S, Moleri, M, Riva, R, Montecalvo, G, Negri Chinaglia, C, Engaddi, I, Perini, M, Carnicelli, A, Petrò, E, Pettenati, C, Perotta, D, Ranzenigo, A, Bertozzi, B, Redaelli, L, Reverberi, F, Salvi, Gp, Manzoni, L, Saviotti, Fm, Scarpini, E, Sinforiani, E, Zucchella, C, Tagliavini, F, Marcon, G, Turla, M, Viti, N, Zanetti, O, Alberici, A., Clerici, F, Vanacore, N, Elia, A, Spila Alegiani, S, Pomati, S, Da Cas, R, Raschetti, R, Mariani, C, Marcon, Gabriella, and Appollonio, I

Subjects
Male, medicine.medical_specialty, Psychosis, Hallucinations, Behavioural and psychological symptoms of dementia, Apathy, Dopamine Agents, Postmarketing surveillance, Dermatology, Anxiety, Neuropsychological Tests, Logistic regression, Disease cluster, Severity of Illness Index, Alzheimer's disease, Memantine, Post-marketing surveillance study, Alzheimer Disease, Internal medicine, Severity of illness, Product Surveillance, Postmarketing, medicine, Humans, Dementia, Psychiatry, BIO/14 - FARMACOLOGIA, Aged, Aged, 80 and over, MED/26 - NEUROLOGIA, treatment, Depression, Feeding Behavior, General Medicine, medicine.disease, Psychiatry and Mental health, Treatment Outcome, Hypomania, Female, Neurology (clinical), medicine.symptom, Psychology, Follow-Up Studies, dementia, medicine.drug
Abstract

The aim of this study is to evaluate memantine effectiveness on behavioural and psychological symptoms of dementia (BPSD) in clinical practice and to identify variables that may predict the therapy effects. The effects of memantine on behaviour were analysed in the database of a post-marketing surveillance study promoted by the Lombardy Region Health Office and involving 43 Alzheimer's disease (AD) Units. From July to December 2005, 399 moderately severe-to-severe AD patients free of cholinergic medications were enrolled, treated with memantine and followed-up for 6 months. BPSD were assessed in a subgroup of 297 patients [mean age 77 ± 8 years; 73% females; mean neuropsychiatric inventory (NPI) score 28 ± 24] for whom the 12-item NPI subscores at baseline, and at 3 and 6 months were available. The 12 BPSD were clustered as follows: affect, physical behaviour, psychosis and hypomania. The main outcome measure was the proportion of individual cluster responders at 6 months of therapy. The proportion of individual cluster responders was 30% affect, 24% physical behaviour, 29% psychosis, 27% hypomania. Patients taking 20 mg memantine daily during the study period had a statistically significant higher probability to experience behavioural improvement than those who discontinued treatment or did not complete memantine titration (affect OR 9.0; 95% CI 3.8-21.6; physical behaviour OR 17.8; 95% CI 5.9-53.6; psychosis OR 23.6; 95% CI 5.1-110.8). The logistic regression analysis was not applicable to the hypomania subsyndrome because of the low cluster prevalence. The standard 20 mg daily memantine treatment regimen was found to be associated with a modest 6-month behavioural improvement in the affect, physical behaviour and psychosis domains in 24-30% of patients.

Published
2012

19. Memantine in moderately-severe-to-severe Alzheimer's disease: a postmarketing surveillance study

Author

Clerici, F, Vanacore, N, Elia, A, Spila-Alegiani, S, Pomati, S, Da Cas, R, Raschetti, R, Mariani, C, Altavilla, R, Appollonio, I, Isella, V, Avanzi, S, Bargnani, C, Bascelli, C, Bellelli, G, Guerini, F, Belotti, G, Bottini, G, Gerini, M, Cheldi, A, Bellotti, M, Chia, F, Cislaghi, G, Cusi, C, Mesina, M, Cuzzoni, G, Farina, E, Alberoni, M, Franceschi, M, Zucchi, M, Guerini, M, Iori, T, Lanza, E, Finotti, M, Lucchelli, F, Maggiore, L, Ratti, P, Magnani, G, Schiatti, E, Marcone, A, Giusti, M, Margarito, F, Martina, A, Mauri, M, Merlo, P, Mazza, S, Moleri, M, Riva, R, Montecalvo, G, Negri Chinaglia, C, Engaddi, I, Perini, M, Carnicelli, A, Petrò, E, Pettenati, C, Perotta, D, Ranzenigo, A, Bertozzi, B, Redaelli, L, Reverberi, F, Salvi, G, Manzoni, L, Saviotti, F, Scarpini, E, Guidi, I, Sinforiani, E, Zucchella, C, Tagliavini, F, Marcon, G, Turla, M, Viti, N, Zanetti, O, and Alberici, A

Published
2009

22. GaSb and InAs: New materials for metal-semiconductor point-contact diodes

Author

Carelli G. 1, De Michele A. 2, Finotti M. 3, K. Bousbahi 4, Ioli N. 5, and Moretti A. 6

Subjects
point-contact diodes, mixers, semiconductors, detectors
Abstract

Metal-semiconductor point contact diodes have proved to be good detectors and mixers for radiation from the far-infrared to visible. Until now GaAs) InSb and INP are the most studied and used semiconductor materials for these devices. In this work we present the performance in the visible and infrared region for metal-semiconductor point-contact diodes with GaSb or InAs as the semiconductor layers. These two new materials have shown good characteristics. These two new materials have shown good characteristics.

Published
2003

24. Nuovi diodi Schottky a larga banda

Author

Beverini, Nicolo', Carelli, Giorgio, Finotti, M., Moretti, A., Strumia, Franco, Bava, E., Galzerano, G., and Svelto, C.

Published
2002

26. Memantine in moderately-severe-to-severe Alzheimer's disease: a post-marketing surveillance study

Author

Clerici, F, Vanacore, N, Elia, A, Spila Alegiani, S, Pomati S, D, Raschetti, R, Mariani, C, Memantine Lombardy Study, G, Altavilla, R, Appollonio, I, Isella, V, Avanzi, S, Bargnani, C, Bascelli, C, Bellelli, G, Guerini, F, Belotti, G, Bottini, G, Gerini, M, Cheldi, A, Bellotti, M, Chia, F, Cislaghi, G, Cusi, C, Mesina, M, Cuzzoni, G, Farina, E, Alberoni, M, Franceschi, M, Zucchi, M, Guerini, M, Iori, T, Lanza, E, Finotti, M, Lucchelli, F, Maggiore, L, Ratti, P, Magnani, G, Schiatti, E, Marcone, A, Giusti, M, Margarito, F, Martina, A, Mauri, M, Merlo, P, Mazza, S, Moleri, M, Riva, R, Montecalvo, G, Chinaglia, C, Engaddi, I, Perini, M, Carnicelli, A, Petro, E, Pettenati, C, Perotta, D, Ranzenigo, A, Bertozzi, B, Redaelli, L, Reverberi, F, Salvi, G, Manzoni, L, Saviotti, F, Scarpini, E, Guidi, I, Sinforiani, E, Zucchella, C, Tagliavini, F, Marcon, G, Turla, M, Viti, N, Zanetti, O, Alberici, A, Clerici F, Vanacore N, Elia A, Spila Alegiani S, Pomati S, Da Cas R, Raschetti R, Mariani C, Memantine Lombardy Study Group, APPOLLONIO, ILDEBRANDO, ISELLA, VALERIA, BELLELLI, GIUSEPPE, Ratti, PL, Giusti, MC, Margarito, FP, Chinaglia, CN, Salvi, GP, Saviotti, FM, Alberici, A., Clerici, F, Vanacore, N, Elia, A, Spila Alegiani, S, Pomati S, D, Raschetti, R, Mariani, C, Memantine Lombardy Study, G, Altavilla, R, Appollonio, I, Isella, V, Avanzi, S, Bargnani, C, Bascelli, C, Bellelli, G, Guerini, F, Belotti, G, Bottini, G, Gerini, M, Cheldi, A, Bellotti, M, Chia, F, Cislaghi, G, Cusi, C, Mesina, M, Cuzzoni, G, Farina, E, Alberoni, M, Franceschi, M, Zucchi, M, Guerini, M, Iori, T, Lanza, E, Finotti, M, Lucchelli, F, Maggiore, L, Ratti, P, Magnani, G, Schiatti, E, Marcone, A, Giusti, M, Margarito, F, Martina, A, Mauri, M, Merlo, P, Mazza, S, Moleri, M, Riva, R, Montecalvo, G, Chinaglia, C, Engaddi, I, Perini, M, Carnicelli, A, Petro, E, Pettenati, C, Perotta, D, Ranzenigo, A, Bertozzi, B, Redaelli, L, Reverberi, F, Salvi, G, Manzoni, L, Saviotti, F, Scarpini, E, Guidi, I, Sinforiani, E, Zucchella, C, Tagliavini, F, Marcon, G, Turla, M, Viti, N, Zanetti, O, Alberici, A, Clerici F, Vanacore N, Elia A, Spila Alegiani S, Pomati S, Da Cas R, Raschetti R, Mariani C, Memantine Lombardy Study Group, APPOLLONIO, ILDEBRANDO, ISELLA, VALERIA, BELLELLI, GIUSEPPE, Ratti, PL, Giusti, MC, Margarito, FP, Chinaglia, CN, Salvi, GP, Saviotti, FM, and Alberici, A.

Abstract

Background: Postmarketing surveillance studies (PMS) are an important tool for evaluating a drugs effectiveness and safety in clinical practice. To our knowledge, no PMS on memantine monotherapy for moderately-severe-to-severe Alzheimers disease (AD) according to National Institute of Neurological and Communicative Disorders and Stroke Alzheimers Disease and Related Disorders Association criteria has been conducted to date. Objective: The Lombardy Health Office, Italy, promoted this PMS to evaluate the effectiveness and safety of memantine in the treatment of moderately-severe-to-severe AD in clinical practice. Methods: A total of 451 patients with moderately-severe-to-severe AD (meanage 77 7 years; 72% female), free of cholinergic medication, received memantine (standard titration to 10 mg twice daily). After 6 months of therapy, treatment effectiveness was evaluated according to two definitions of response (no deterioration and improvement), as measured by changes in baseline scores on the Clinical Global Impression of Change, Mini-Mental State Examination, Neuropsychiatric Inventory and Activities of Daily Living scales. The safety measure was the frequency of adverse events (AEs). Results: At 6-month assessment, 26.8% of subjects showed no deterioration and 3.8% showed improvement. In those showing no deterioration, response to treatment at the 3-month assessment was associated with a greater probability of a response at 6 months (adjusted odds ratio = 8.54; 95% CI 4.54, 16.05). Seventy patients (15.5%) experienced at least one AE and 39 (8.6%) discontinued treatment prematurely because of an AE. Of those who experienced an AE, 27 (38.6%) manifested behavioural and psychological symptoms of dementia. Conclusion: The proportion of responders to memantine treatment in this PMS was similar to that reported in a previous randomized clinical trial (26.8% vs 29%, respectively). The proportion of patients who discontinued treatment prematurely because of an AE (8.6%) w

Published
2009

27. Platelet rich plasma grafting technique combined with trans-sinusal post-extractive implants placement in the posterior maxilla: A technical report and brief literature review

Author

Gelpi, F., Santis, D., Luciano, U., Bertajola, A., Bernardello, F., Zambotti, T., Causarano, G., Zarantonello, M., Iurlaro, A., Poscolere, A., Modena, N., Zotti, F., Alberti, C., Alessandro Zangani, Capocasale, G., Donadello, D., Faccioni, P., and Finotti, M.

Subjects
Dental Implants, Bone Regeneration, Bone Transplantation, bone regenerative techniques, Platelet-Rich Plasma, Maxilla, Humans, surgical approaches, Maxillary Sinus, atrophic posterior ridges, platelet rich plasma
Abstract

The atrophic posterior ridges are usually characterized by poor bone quality and quantity: this situation requires the use of bone regenerative techniques. Other alternative surgical approaches are investigated. Nowadays the use of trans-sinus implants offers some advantages due to its feasibility. Today, bone grafting may be practical, but depends on many factors, such as the type of bone graft used (autogenous, alloplastic, or xenograft), host response, age of the patient, various complications associated with grafting procedures, infection, and, most importantly, the time spent while the grafted material matures and is taken up by the bone. So, this case report describes the feasibility of an alternative surgical technique associated to PRP (Platelet Rich Plasma).

28. Effects of the sander bite jumping appliance in patients with class ii malocclusion before growth peak

Author

Faccioni, P., Santis, D., Sinigaglia, S., Zarantonello, M., Zotti, F., Pancera, P., Iurlaro, A., Finotti, M., Marchiori, M., Bazzanella, S., Alberti, C., Zangani, A., Giorgia Capocasale, Donadello, D., Faccioni, F., and Nocini, P. F.

Subjects
Incisor, Cephalometric analyses, Cephalometry, Angle Class II, Sander bite jumping appliance, Andresen activator, Humans, Mandible, Malocclusion, Angle Class II, Class II malocclusion, Malocclusion
Abstract

Sander bite jumping appliance (BJA) is a functional appliance used to correct Class II malocclusion in growing patients. The aim of this study was to identify the dento-skeletal effects in patients treated with BJA before growth peak and to compare these effects with the ones obtained in a similar group treated with the Andresen activator (AA). Twenty subjects with class II relationship of the skeletal bases and cervical vertebrae maturation stage 1 or 2 were enrolled in the study and treated with BJA. This group were compared to 14 subjects treated with AA. Cephalometric analyses were carried out using landmarks derived from the analyses of Pancherz, Ricketts, Tweed and Steiner. After treatment with BJA Pg/OLp increase was 7.40±3.81 mm (P0.001); Pg/OLp+Co/OLp significantly heightened from T0 to T1 (T0: 82.20±4.65 mm vs T1: 89.62±4.27, P0.001). Overjet (is/OLp - ii/OLp) significantly decreased from T0 to T1 (T0: 7.40±2.31 mm vs T1: 3.05±1.34 mm, P0.001). Molar relationship improved passing from 1.46±1.68 mm at T0 to -3.56±2.04 mm at T1 (P0.001). No statistically significant differences were found between BJA and AA groups at T0 and T1. BJA treatment determined a Class II malocclusion correction in all patients. The correction of molar relationship was mainly due to the increase in mandibular length; the correction of the overjet was due to the increase in mandibular length, to the slight pro-inclination of the lower incisors and the mild retro-inclination of the upper incisors. No significant differences were found in effectiveness between BJA and AA.

33. Bone response to orthodontic loading of endosseous implants in the rabbit calvaria: early continuous distalizing forces.

Author

Majzoub, Z, Majzoub, Zeina, Finotti, M, Finotti, Marco, Miotti, F, Miotti, Francesca, Giardino, R, Giardino, Roberto, Aldini, NN, Aldini, Nicolo Nicoli, Cordioli, G, and Cordioli, Giampiero

Subjects
CORRECTIVE orthodontics, ORTHOPEDIC implants
Abstract

The purpose of this experimental study was to evaluate the effect of early orthodontic loading on the stability and bone-implant interface of titanium implants in a rabbit model. Twenty-four short threaded titanium fixtures were inserted in the calvarial mid-sagittal suture of 10 rabbits. Two weeks following insertion, 20 implants (test group) were subjected to continuous distalization forces of 150 g for a period of 8 weeks. The remaining four implants (control group) were left unloaded for the same follow-up interval. Clinically, all implants except for one test fixture were stable, and exhibited no mobility or displacement throughout the experimental loading period. Histologically, all stable implants were well-integrated into bone. No differences could be found between the pressure and tension surfaces of the test implants relative to bone quality and density within a range of 1000 μm from the fixture surface. Similarly, qualitative differences were not observed between the apical and coronal portions of test fixtures. Morphometrically, a mean percentage bone-to-implant contact of 76.00 ± 18.73 per cent was found at the test pressure sides, 75.00 ± 11.54 per cent at the test tension sides, and 68.00 ± 15.55 per cent at the control unloaded surfaces. No statistically significant differences in the percentage of bone-to-metal contact length fraction were found between test pressure surfaces, test tension surfaces, and unloaded control surfaces. Marginal bone resorption around the implant collar or immediately beneath it was found in roughly the same percentage of analysed sites in the test and control fixtures. In contrast, slight bone apposition was demonstrated at the implant collar on the test pressure surfaces, while no apposition ro resorption were observed in the test tension zones. This study suggests that short endosseous implants can be used as anchoring units for orthodontic tooth movement early in the post-insertion hea... [ABSTRACT FROM AUTHOR]

Published
1999
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34. Donne, sogni e fantasmi in Antonio Fogazzaro

Author

Finotti, Fabio, E. Favero, L. Basso, M. Tremolada, G. De Santi, P. Cortiana, M. Bernacchia, R. Nassi, F. Finotti, M. Moretti, E. Grandesso, B. Codogno, M. Benigni, E. Grandesso, C. Toniato, and Finotti, Fabio

Subjects
sogno, Fogazzaro, inconscio, Fogazzaro, inconscio, sogno
Abstract

A partire da "Malombra" Fogazzaro sposta in ambito psicologico (e si direbbe proto-psicanalitico) le tematiche e i luoghi comuni di tanta letteratura gotica e spiritistica: non dall'oltremondo vengono i fanstasmi ma dalla psiche, dalla forza di impulsi non dominati dalla volontà, dall'azione del sogno, dalla crisi della coscienza razionale. L'attenzione vivissima di Fogazzaro alla psicologia del profondo è confermata dal discorso "Per una nuova scienza", dove si propongono ricerche che saranno poi importanti per Pirandello. I romanzi della maturità rappresentano un'estensione della tematica che in "Malombra" è collegata alla psicologia d'eccezione della protagonista. Impulsi, pensieri, sintomi inconsci nei successivi romanzi fogazzariani travolgono anche personaggi che vorrebbero aggrapparsi ostinatamente alla normalità, dando così all'autore la possibilità di rappresentare con efficacia sia la dialettica tra rimozione e ritorno sulla quale si soffermerà Freud, sia la relazione tra pensiero e corporeità.

Published
2012

35. The Dallas Donation after Circulatory Death Transplantation Summit: expanding donation after circulatory death procedures through process improvement, broader utilization, and innovation.

Author

Finotti M, Wall A, D'Alessandro A, Schwartz G, Sonnenday C, Goldberg D, Shah A, Friend P, Orlowski JP, McKenna G, Newton S, Adams B, Chapman WC, Mathur A, Abouljoud M, Pruett T, Hessheimer A, Trotter JF, Asrani SK, and Testa G

Abstract

Despite a significant increase in utilization over the past decade, the number of donation after circulatory death (DCD) organs that are procured and transplanted in the United States (US) remains well below its potential. There is still room for expansion, as utilizing DCD organs to the fullest extent is currently the most viable solution to the persistent mismatch between supply and demand in transplantation. We convened a multidisciplinary transplantation summit to examine various aspects of DCD, with faculty members from around the world with clinical and academic interest in DCD donation and transplantation, including abdominal and cardiothoracic surgeons, organ procurement organization directors, hepatologists, and gastroenterologists. The conference focused on identifying barriers to DCD organ utilization and strategies to overcome these barriers. We divide the barriers to DCD utilization into three mains categories: (I) policy and process variation; (II) logistical and transportation challenges; and (III) higher risk perceptions related to DCD outcomes. For each barrier, we proposed a variety of solutions, providing an overview of the status of DCD donation in the US and suggestions on how to increase the use of DCD. There is a specific focus on ex situ machine perfusion, normothermic regional perfusion, and other opportunities to expand DCD utilization without negatively impacting recipient outcomes., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-23-503/coif). W.C.C. and G.T. serve as the unpaid editorial board members of Hepatobiliary Surgery and Nutrition. The other authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Published
2024
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36. Innovations in Liver Preservation Techniques for Transplants from Donors after Circulatory Death: A Special Focus on Transplant Oncology.

Author

Finotti M, Romano M, Grossi U, Dalla Bona E, Pelizzo P, Piccino M, Scopelliti M, Zanatta P, and Zanus G

Abstract

Liver transplantation is the preferred treatment for end-stage liver disease. Emerging evidence suggests a potential role for liver transplantation in treating liver tumors such as colorectal liver metastases and cholangiocarcinoma. However, due to a limited donor pool, the use of marginal grafts from donation after circulatory death (DCD) donors is increasing to meet demand. Machine perfusion is crucial in this context for improving graft acceptance rates and reducing ischemia-reperfusion injury. Few studies have evaluated the role of machine perfusion in the context of transplant oncology. Perfusion machines can be utilized in situ (normothermic regional perfusion-NRP) or ex situ (hypothermic and normothermic machine perfusion), either in combination or as a complement to conventional in situ cold flush and static cold storage. The objective of this analysis is to provide an up-to-date overview of perfusion machines and their function in donation after circulatory death with particular attention to their current and likely potential effects on transplant oncology. A literature review comparing standard cold storage to machine perfusion methods showed that, so far, there is no evidence that these devices can reduce the tumor recurrence rate. However, some evidence suggests that these innovative perfusion techniques can improve graft function, reduce ischemia-reperfusion injury, and, based on this mechanism, may lead to future improvements in cancer recurrence.

Published
2024
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37. Biliary complications after adult-to-adult living-donor liver transplantation: An international multicenter study of 3633 cases.

Author

Li Z, Rammohan A, Gunasekaran V, Hong S, Chih-Yi Chen I, Kim J, Hervera Marquez KA, Hsu SC, Kirimker EO, Akamatsu N, Shaked O, Finotti M, Yeow M, Genedy L, Dutkowski P, Nadalin S, Boehnert MU, Polak WG, Bonney GK, Mathur A, Samstein B, Emond JC, Testa G, Olthoff KM, Rosen CB, Heimbach JK, Taner T, Wong TC, Lo CM, Hasegawa K, Balci D, Cattral M, Sapisochin G, Selzner N, Jeng LB, Broering D, Joh JW, Chen CL, Suh KS, Rela M, and Clavien PA

Subjects
Humans, Male, Female, Retrospective Studies, Middle Aged, Adult, Risk Factors, Follow-Up Studies, Prognosis, Anastomotic Leak etiology, Biliary Tract Diseases etiology, Incidence, Survival Rate, Liver Transplantation adverse effects, Living Donors, Postoperative Complications etiology, Graft Survival
Abstract

In living-donor liver transplantation, biliary complications including bile leaks and biliary anastomotic strictures remain significant challenges, with incidences varying across different centers. This multicentric retrospective study (2016-2020) included 3633 adult patients from 18 centers and aimed to identify risk factors for these biliary complications and their impact on patient survival. Incidences of bile leaks and biliary strictures were 11.4% and 20.6%, respectively. Key risk factors for bile leaks included multiple bile duct anastomoses (odds ratio, [OR] 1.8), Roux-en-Y hepaticojejunostomy (OR, 1.4), and a history of major abdominal surgery (OR, 1.4). For biliary anastomotic strictures, risk factors were ABO incompatibility (OR, 1.4), blood loss >1 L (OR, 1.4), and previous abdominal surgery (OR, 1.7). Patients experiencing biliary complications had extended hospital stays, increased incidence of major complications, and higher comprehensive complication index scores. The impact on graft survival became evident after accounting for immortal time bias using time-dependent covariate survival analysis. Bile leaks and biliary anastomotic strictures were associated with adjusted hazard ratios of 1.7 and 1.8 for graft survival, respectively. The study underscores the importance of minimizing these risks through careful donor selection and preoperative planning, as biliary complications significantly affect graft survival, despite the availability of effective treatments., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Published
2024
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38. Novel Benchmark for Adult-to-Adult Living-donor Liver Transplantation: Integrating Eastern and Western Experiences.

Author

Li Z, Rammohan A, Gunasekaran V, Hong S, Chen IC, Kim J, Hervera Marquez KA, Hsu SC, Kirimker EO, Akamatsu N, Shaked O, Finotti M, Yeow M, Genedy L, Dutkowski P, Nadalin S, Boehnert MU, Polak WG, Bonney GK, Mathur A, Samstein B, Emond JC, Testa G, Olthoff KM, Rosen CB, Heimbach JK, Taner T, Wong TC, Lo CM, Hasegawa K, Balci D, Cattral M, Sapisochin G, Selzner N, Bin Jeng L, Broering D, Joh JW, Chen CL, Suk KS, Rela M, and Clavien PA

Subjects
Adult, Humans, Living Donors, Benchmarking, Treatment Outcome, Retrospective Studies, Severity of Illness Index, Graft Survival, Liver Transplantation, End Stage Liver Disease surgery, Liver Diseases complications, Thrombosis
Abstract

Objective: To define benchmark values for adult-to-adult living-donor liver transplantation (LDLT)., Background: LDLT utilizes living-donor hemiliver grafts to expand the donor pool and reduce waitlist mortality. Although references have been established for donor hepatectomy, no such information exists for recipients to enable conclusive quality and comparative assessments., Methods: Patients undergoing LDLT were analyzed in 15 high-volume centers (≥10 cases/year) from 3 continents over 5 years (2016-2020), with a minimum follow-up of 1 year. Benchmark criteria included a Model for End-stage Liver Disease ≤20, no portal vein thrombosis, no previous major abdominal surgery, no renal replacement therapy, no acute liver failure, and no intensive care unit admission. Benchmark cutoffs were derived from the 75th percentile of all centers' medians., Results: Of 3636 patients, 1864 (51%) qualified as benchmark cases. Benchmark cutoffs, including posttransplant dialysis (≤4%), primary nonfunction (≤0.9%), nonanastomotic strictures (≤0.2%), graft loss (≤7.7%), and redo-liver transplantation (LT) (≤3.6%), at 1-year were below the deceased donor LT benchmarks. Bile leak (≤12.4%), hepatic artery thrombosis (≤5.1%), and Comprehensive Complication Index (CCI ® ) (≤56) were above the deceased donor LT benchmarks, whereas mortality (≤9.1%) was comparable. The right hemiliver graft, compared with the left, was associated with a lower CCI ® score (34 vs 21, P < 0.001). Preservation of the middle hepatic vein with the right hemiliver graft had no impact neither on the recipient nor on the donor outcome. Asian centers outperformed other centers with CCI ® score (21 vs 47, P < 0.001), graft loss (3.0% vs 6.5%, P = 0.002), and redo-LT rates (1.0% vs 2.5%, P = 0.029). In contrast, non-benchmark low-volume centers displayed inferior outcomes, such as bile leak (15.2%), hepatic artery thrombosis (15.2%), or redo-LT (6.5%)., Conclusions: Benchmark LDLT offers a valuable alternative to reduce waitlist mortality. Exchange of expertise, public awareness, and centralization policy are, however, mandatory to achieve benchmark outcomes worldwide., Competing Interests: The authors report no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2023
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40. Bile Duct Lithiasis Mimicking a Perihilar Cholangiocarcinoma-An Endless Dilemma: A Case Report.

Author

Piccino M, Hoxhaj I, Grossi U, Romano M, Brizzolari M, Scopelliti M, Finotti M, and Zanus G

Abstract

Hilar bile duct strictures are mostly caused by malignant lesions. The morphological appearance of perihilar cholangiocarcinomas in various imaging modalities have other malignant and even benign mimics, which pose challenges to an accurate diagnosis and treatment and drive to futile surgery. Herein, we present the case of a 50-year-old woman admitted with jaundice and abdominal pain, elevated bilirubin level, liver function tests and carbohydrate antigen 19-9 level. Magnetic resonance cholangio-pancreatography (MR-CP) and the computed tomography with contrast enhancement revealed a suspected extrahepatic cholangiocarcinoma of the common bile duct. Further spontaneous resolution of the scenario, confirmed by diagnostic assessment, changed the clinical hypothesis in favor of a non-oncological disease. Indeed, the multidisciplinary evaluation supported a diagnosis of transient cholangitis secondary to non-evident intrahepatic lithiasis rather than cholangiocarcinoma. After a 26-month follow-up, the patient was asymptomatic with normal tumor markers and laboratory data. Consecutive MR-CPs showed no suspicion of malignancy. This case report underlines the need for an accurate preoperative assessment in patients with suspected cholangiocarcinoma.

Published
2023
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43. A narrative review of the current and future role of robotic surgery in liver surgery and transplantation.

Author

Finotti M, D'Amico F, Mulligan D, and Testa G

Abstract

Background: Minimally invasive surgery (MIS) is the technique of choice in selected patients for the treatment of liver tumors. The robotic approach is considered today the natural evolution of MIS. The application of the robotic technique in liver transplantation (LT) has been recently evaluated, especially in the living donation. The aim of this paper is to review the current role of the MIS and robotic donor hepatectomy in the literature and to evaluate the possible future implication in the transplant field., Methods: We conducted a narrative review using PubMed and Google Scholar for reports published so far, using the following keywords: minimally invasive liver surgery, laparoscopic liver surgery, robotic liver surgery, robotic living donation, laparoscopic donor hepatectomy and robotic donor hepatectomy., Results: Several advantages have been claimed in favor of robotic surgery: three-dimensional (3-D) imaging with stable and high-definition view; a more rapid learning curve than the laparoscopic one; the lack of hand tremors and the freedom of movements. Compared to open surgery, the benefits showed in the studies evaluating the robotic approach in the living donation are: less postoperative pain, the shorter period before returning to normal activity despite sustaining longer operation time. Furthermore, the 3-D and magnification view makes the technique excellent in distinguishing the right plane of transection, vascular and biliary anatomy, associated with high precision of the movements and a better bleeding control (essential for donor safety) and lower rate of vascular injury., Conclusions: The current literature does not fully support the superiority of the robotic approach versus laparoscopic or open method in living donor hepatectomy. Robotic donor hepatectomy performed by teams with high expertise and in properly selected living donors is safe and feasible. However, further data are necessary to evaluate properly the role of robotic surgery in the field of living donation., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-21-115/coif). GT serves as the unpaid editorial board member of Hepatobiliary Surgery and Nutrition. The other authors have no conflicts of interest to declare., (2023 Hepatobiliary Surgery and Nutrition. All rights reserved.)

Published
2023
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44. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma.

Author

Lai Q, De Matthaeis N, Finotti M, Galati G, Marrone G, Melandro F, Morisco F, Nicolini D, Pravisani R, and Giannini EG

Subjects
Humans, Incidence, Carcinoma, Hepatocellular epidemiology, Liver Neoplasms epidemiology
Abstract

Aim: To evaluate the impact of antiplatelet therapy (APT)on the incidence of hepatocellular carcinoma (HCC) and mortality following its treatment., Methods: A systematic literature search was performed using PubMed and Cochrane Central Register of Controlled Trials Databases. Two HCC clinical settings were explored: (i) incidence, and (ii) death after any HCC treatment. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to compare the pooled data between patients who received or did not receive APT., Results: A total of 20 studies were identified, of whom 15 focused on HCC incidence, including 2,685,009 patients, and five on post-treatment death, including 3281 patients. APT was associated with an overall reduced risk of HCC incidence (OR: 0.63; 95%CI = 0.51-0.79; p < 0.001) as well as of post-treatment mortality (OR: 0.54; 95%CI = 0.35-0.83; p = 0.006)., Conclusions: Current data suggest that APT correlated with higher HCC incidence and poor overall survival following tumour treatment., (© 2022 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.)

Published
2023
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45. Colorectal Liver Metastases: A Literature Review of Viable Surgical Options with a Special Focus on Microwave Liver Thermal Ablation and Mini-Invasive Approach.

Author

Finotti M, D'Amico FE, Romano M, Brizzolari M, Scopelliti M, and Zanus G

Abstract

Colorectal cancer (CRC) is the third most common tumor worldwide and it is characterized in 20-30% of cases by liver involvement, which strongly affects the long-term patient outcome. There are many available therapies for liver colorectal metastases (CRLMs); the current standard of care is represented by liver resection, and when feasible, associated with systemic chemotherapy. Microwave thermal ablation (MWA) is a viable option in unresectable patients or to achieve treatment with a parenchymal spearing approach. A literature review was performed for studies published between January 2000 and July 2022 through a database search using PUBMED/Medline and the Cochrane Collaboration Library with the following MeSH search terms and keywords: microwave, ablation, liver metastases, colorectal neoplasm, and colon liver rectal metastases. The recurrence rate and overall patients' survival were evaluated, showing that laparoscopic MWA is safe and effective to treat CRLMs when resection is not feasible, or a major hepatectomy in fragile patients is necessary. Considering the low morbidity of this procedure, it is a viable option to treat patients with recurrent diseases in the era of effective chemotherapy and multimodal treatments.

Published
2022
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46. Comment on: " A review on radiofrequency, microwave and high-intensity focused ultrasound ablations for hepatocellular carcinoma with cirrhosis ".

Author

Finotti M, Romano M, Brizzolari M, Scopelliti M, and Zanus G

Abstract

Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-22-202/coif). The authors have no conflicts of interest to declare.

Published
2022
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47. The current and future role of robotic surgery in liver surgery and transplantation.

Author

Finotti M, D'Amico F, and Testa G

Subjects
Hepatectomy methods, Humans, Liver surgery, Living Donors, Laparoscopy methods, Robotic Surgical Procedures methods
Abstract

Minimally invasive surgery (MIS) is gaining interest in all surgical fields, especially in the hepatobiliary and liver transplant branch with excellent outcomes. However, its application especially in the living donation, is at the beginning and still controversial, with few published studies. A literature review was performed using the following keywords reviewing the current role of robotic donor hepatectomy in the literature and to evaluate the possible future implication in the transplant field: minimally invasive liver surgery, laparoscopic liver surgery, robotic liver surgery, robotic living donation, laparoscopic donor hepatectomy, robotic donor hepatectomy. 3-D imaging with high definition and stable view, a more rapid learning curve than the laparoscopic one and the lack of hand tremors and the freedom of movements are all important advantages claimed in favor of robotic surgery. Furthermore, most of the studies showed, compared to open surgery, less postoperative pain, less intraoperative blood loss, and a shorter period before returning to normal activity to the detriment of longer operation time. The excellent outcome can be explained thanks to the three-dimensional and magnification view that allows for better evaluation compared to the laparoscopic approach to the right plane of transection, vascular and biliary anatomy, and thanks to the precision of the movements a better bleeding control. Robotic approach, especially in living donor hepatectomy, is considered safe and feasible, even if its superiority compared to the open and laparoscopic approaches needs further evaluation.

Published
2022
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48. Early outcomes of kidney transplant recipients from donors with severe SARS-CoV-2 pneumonia: A report of 5 cases.

Author

Wall AE, Finotti M, Rosenzweig M, Martinez E, Gupta A, McKenna GJ, Bayer J, Yango A, Sam T, Spak C, Fischbach B, and Testa G

Subjects
Graft Survival, Humans, SARS-CoV-2, Tissue Donors, Transplant Recipients, COVID-19 epidemiology, Kidney Transplantation adverse effects, Kidney Transplantation methods, Tissue and Organ Procurement
Abstract

Background: Transplanting kidneys from donors with a recent history of severe SARS-CoV-2 pneumonia is uncommon due to concerns about the risk of viral transmission and the quality of kidneys from these donors. To date, there are no conclusive data on viral transmission from extrapulmonary solid organ transplants. Given the prevalence of SARS-CoV-2 infections in potential donors, shortage of kidneys available for transplantation, and low risk of viral transmission, we developed a clinical protocol for accepting kidneys from donors with recent severe SARS-CoV-2 pneumonia who demonstrate preserved kidney function., Materials and Methods: We collected data on early outcomes of 5 kidney transplant recipients from 4 deceased donors hospitalized for severe SARS-CoV-2 infection., Results: Donor creatinine ranged from 0.51 to 0.60 mg/dL and kidney donor profile index (KDPI) from 14 to 52%. Three of the five kidneys were from donation after circulatory death. All recipients were fully vaccinated, and 4/5 received post-exposure prophylactic monoclonal antibody treatment. While 3 recipients had delayed graft function, all had excellent graft function at 3 or 4 weeks post-operatively. None of the recipients displayed signs or symptoms of SARS-CoV-2 infection post-transplant., Conclusion: Our findings suggest that kidney grafts from donors with a recent history of severe SARS-CoV-2 infection but with preserved kidney function can be safely used and have good early outcomes.

Published
2022
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50. Pulsed Microwave Liver Ablation: An Additional Tool to Treat Hepatocellular Carcinoma.

Author

Zanus G, Tagliente G, Rossi S, Bonis A, Zambon M, Scopelliti M, Brizzolari M, Grossi U, Romano M, and Finotti M

Abstract

This study aimed to analyze the outcomes of HCC patients treated with a novel technique-pulsed microwave ablation (MWA)-in terms of safety, local tumor progression (LTP), intrahepatic recurrence (IHR), and overall survival (OS). A total of 126 pulsed microwave procedures have been performed in our center. We included patients with mono- or multifocal HCC (BCLC 0 to D). The LTP at 12 months was 9.9%, with an IHR rate of 27.8% at one year. Survival was 92.0% at 12 months with 29.4% experiencing post-operative complications (28.6% Clavien-Dindo 1-2, 0.8% Clavien-Dindo 3-4). Stratifying patients by BCLC, we achieved BCLC 0, A, B, C, and D survival rates of 100%, 93.2%, 93.3%, 50%, and 100%, respectively, at one year, which was generally superior to or in line with the expected survival rates among patients who are started on standard treatment. The pulsed MWA technique is safe and effective. The technique can be proposed not only in patients with BCLC A staging but also in the highly selected cases of BCLC B, C, and D, confirming the importance of the concept of stage migration. This procedure, especially if performed with a minimally invasive technique (laparoscopic or percutaneous), is repeatable with a short postoperative hospital stay.

Published
2022
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