Registri di patologia

  • Emanuele Crocetti1

  1. UO Epidemiologia clinica e descrittiva, ISPO Firenze
Emanuele Crocetti -

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Ricerca bibliografica periodo dal 16 aprile 2014– 30 giugno 2014

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(("registries"[MeSH Terms] OR "registries"[All Fields] OR "registry"[All Fields]) OR ("registries"[MeSH Terms] OR "registries"[All Fields])) AND (("italy"[MeSH Terms] OR "italy"[All Fields]) OR italian[All Fields]) AND "humans"[MeSH Terms] AND ("2014/04/16"[PDat] : "2014/06/30"[PDat])
1. Vinceti M(1), Malagoli C, Rothman KJ, Rodolfi R, Astolfi G, Calzolari E, Puccini A, Bertolotti M, Lunt M, Paterlini L, Martini M, Nicolini F. Risk of birth defects associated with maternal pregestational diabetes. Eur J Epidemiol. 2014 Jun;29(6):411-8. doi: 10.1007/s10654-014-9913-4. Epub 2014 May 27.
Author information: (1)CREAGEN - Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Reggio Emilia, Italy,

Abstract Maternal diabetes preceding pregnancy may increase the risk of birth defects in the offspring, but not all studies confirm this association, which has shown considerable variation over time, and the effect of having type 1 versus type 2 diabetes is unclear. We conducted a population-based cohort study in the Northern Italy Emilia-Romagna region linking administrative databases with a Birth Defects Registry. From hospital discharge records we identified all diabetic pregnancies during 1997-2010, and a population of non-diabetic parturients matched for age, residence, year and delivery hospital. We collected available information on education, smoking and drug prescriptions, from which we inferred the type of diabetes. We found 62 malformed infants out of 2,269 births among diabetic women, and 162 out of 10,648 births among non-diabetic women. The age-standardized prevalence ratio (PR) of malformation associated with maternal pregestational diabetes was 1.79 (95 % confidence interval 1.34-2.39), a value that varied little by age. Type of diabetes strongly influenced the PR, with higher values related to type 2 diabetic women. Most major subgroups of anomalies had PRs above 1, including cardiovascular, genitourinary, musculoskeletal, and chromosomal abnormalities. There was an unusually high PR for the rare defect 'extra-ribs', but it was based on only two cases. This study indicates that maternal pregestational type 2 diabetes is associated with a higher prevalence of specific birth defects in offspring, whereas for type 1 diabetic mothers, particularly in recent years, the association was unremarkable.

2. Kumar R(1), Latib A(2), Colombo A(2), Ruiz CE(3). Self-expanding prostheses for transcatheter aortic valve replacement. Prog Cardiovasc Dis. 2014 May-Jun;56(6):596-609. doi: 10.1016/j.pcad.2014.03.002. Epub 2014 Mar 12.
Author information: (1)Division of Cardiology, Sharp Rees-Stealy Medical Group, San Diego, CA. (2)Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. (3)Department of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute, North Shore/LIJ Health System, New York, NY. Electronic address:

Abstract Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement in patients who are considered high surgical risk or inoperable due to advanced age and comorbidities. Randomized trial and registry data have demonstrated the safety and efficacy of TAVR in such patients. Currently available transcatheter heart valves (THVs) employ either balloon-expandable or self-expanding designs, and several new designs have shown promising early results. Differences in valve design may offer specific advantages for accurate deployment and minimizing complications. This article reviews several designs of self-expanding THVs that are currently available or have undergone successful implantation in humans. Additional studies are required to compare the relative performance of these devices.

3. Manzoli L(1), Flacco ME(2), D'Addario M(3), Capasso L(4), De Vito C(5), Marzuillo C(5), Villari P(5), Ioannidis JP(6). Non-publication and delayed publication of randomized trials on vaccines: survey. BMJ. 2014 May 16;348:g3058. doi: 10.1136/bmj.g3058.
Author information: (1)Department of Medicine and Aging Sciences, University of Chieti, Via dei Vestini 5 66013 Chieti, Italy CeSI Biotech, Via Colle dell'Ara, Chieti, Italy (2)Department of Medicine and Aging Sciences, University of Chieti, Via dei Vestini 5 66013 Chieti, Italy Local Health Unit of Pescara, Italy. (3)Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Switzerland Division of International and Environmental Health, Institute of Social and Preventive Medicine, University of Bern, Switzerland. (4)Department of Medicine and Aging Sciences, University of Chieti, Via dei Vestini 5 66013 Chieti, Italy CeSI Biotech, Via Colle dell'Ara, Chieti, Italy. (5)Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy. (6)Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA. Comment in BMJ. 2014;348:g3259.

Abstract OBJECTIVE: To evaluate the extent of non-publication or delayed publication of registered randomized trials on vaccines, and to investigate potential determinants of delay to publication. DESIGN: Survey. DATA SOURCES: Trials registry websites, Scopus, PubMed, Google. STUDY SELECTION: Randomized controlled trials evaluating the safety or the efficacy or immunogenicity of human papillomavirus (HPV), pandemic A/H1N1 2009 influenza, and meningococcal, pneumococcal, and rotavirus vaccines that were registered in, Current Controlled Trials, WHO International Clinical Trials Registry Platform, Clinical Study Register, or Indian, Australian-New Zealand, and Chinese trial registries in 2006-12. Electronic databases were searched up to February 2014 to identify published manuscripts containing trial results. These were reviewed and classified as positive, mixed, or negative. We also reviewed the results available in MAIN OUTCOME MEASURES: Publication status of trial results and time from completion to publication in peer reviewed journals. DATA SYNTHESIS: Cox proportional hazards regression was used to evaluate potential predictors of publication delay. RESULTS: We analysed 384 trials (85% sponsored by industry). Of 355 trials (404,758 participants) that were completed, 176 (n=151,379) had been published in peer reviewed journals. Another 42 trials (total sample 62,765) remained unpublished but reported results in The proportion of trials published 12, 24, 36, and 48 months after completion was 12%, 29%, 53%, and 73%, respectively. Including results posted in, 48 months after study completion results were available for 82% of the trials and 90% of the participants. Delay to publication between non-industry and industry sponsored trials did not differ, but non-industry sponsored trials were 4.42-fold (P=0.008) more likely to report negative or mixed findings. Negative results were reported by only 2% of the published trials. CONCLUSIONS: Most vaccine trials are published eventually or the results posted in, but delays to publication of several years are common. Actions should focus on the timely dissemination of data from vaccine trials to the public.

4. Capodanno D(1), Barbanti M(2), Tamburino C(2), D'Errigo P(3), Ranucci M(4), Santoro G(5), Santini F(6), Onorati F(6), Grossi C(7), Covello RD(8), Capranzano P(2), Rosato S(3), Seccareccia F(3); OBSERVANT Research Group. A simple risk tool (the OBSERVANT score) for prediction of 30-day mortality after transcatheter aortic valve replacement. Am J Cardiol. 2014 Jun 1;113(11):1851-8. doi: 10.1016/j.amjcard.2014.03.014. Epub 2014 Mar 18.
Author information: (1)Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; ETNA Foundation, Catania, Italy. Electronic address: (2)Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; ETNA Foundation, Catania, Italy. (3)National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. (4)Department of Cardiothoracic and Vascular Anesthesia, Intensive Care Unit, IRCCS Policlinico San Donato, Milan, Italy; Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy. (5)Division of Cardiology, Careggi Hospital, Florence, Italy. (6)Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy. (7)Department of Cardiovascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy. (8)IRCCS Department of Anesthesia and Intensive Care, San Raffaele Hospital, Milan, Italy.

Abstract Risk stratification tools used in patients with severe aortic stenosis have been mostly derived from surgical series. Although specific predictors of early mortality with transcatheter aortic valve replacement (TAVR) have been identified, the prognostic impact of their combination is unexplored. We sought to develop a simple score, using preprocedural variables, for prediction of 30-day mortality after TAVR. A total of 1,878 patients from a national multicenter registry who underwent TAVR were randomly assigned in a 2:1 manner to development and validation data sets. Baseline characteristics of the 1,256 patients in the development data set were considered as candidate univariate predictors of 30-day mortality. A bootstrap multivariate logistic regression process was used to select correlates of 30-day mortality that were subsequently weighted and integrated into a scoring system. Seven variables were weighted proportionally to their respective odds ratios for 30-day mortality (glomerular filtration rate <45 ml/min [6 points], critical preoperative state [5 points], New York Heart Association class IV [4 points], pulmonary hypertension [4 points], diabetes mellitus [4 points], previous balloon aortic valvuloplasty [3 points], and left ventricular ejection fraction <40% [3 points]). The model showed good discrimination in both the development and validation data sets (C statistics 0.73 and 0.71, respectively). Compared with the logistic European System for Cardiac Operative Risk Evaluation in the validation data set, the model showed better discrimination (C statistic 0.71 vs 0.66), goodness of fit (Hosmer-Lemeshow p value 0.81 vs 0.00), and global accuracy (Brier score 0.054 vs 0.073). In conclusion, the risk of 30-day mortality after TAVR may be estimated by combining 7 baseline clinical variables into a simple risk scoring system.

5. Sisti G(1), Kanninen TT(2), Asciutti S(3), Sorbi F(4), Fambrini M(4). Rate of second primary tumors following diagnosed choriocarcinoma: a SEER analysis (1973-2010). Gynecol Oncol. 2014 Jul;134(1):90-5. doi: 10.1016/j.ygyno.2014.05.004. Epub 2014 May 14.
Author information: (1)Department of Science for Woman and Child Health, University of Florence, Florence, Italy. Electronic address: (2)Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy. (3)The Icahn School of Medicine at Mount Sinai, Department of Oncological Sciences, New York, NY, United States. (4)Department of Science for Woman and Child Health, University of Florence, Florence, Italy.

Abstract OBJECTIVE: Approximately 1 in 6 of new cancers has been reported to represent a second primary tumor (SPT). Choriocarcinomas (CCs) are of interest in regard to the rate of SPTs because of the potential exposure to carcinogenic therapy and reports of the benefits of its high human gonadotropin (hCG) levels on cancer incidence. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with gestational CC who subsequently developed a SPT. This is a retrospective study, following a cohort of patients during the period 1973-2010. RESULTS: We found 818 patients with primary gestational CC. Nineteen patients had a SPT after the CC. Occurrence of several types of cancer resulted significantly higher when compared to the incidence rate in the general population. In particular the highest incidence rate ratios (IRRs) were registered for acute myeloid leukemia (AML) (6.3) and thyroid cancer (2.6). The expected rate of lung, breast, colorectal and uterine corpus cancers instead resulted lower than the rate in the general population. Regarding the IRR in the population under 50 years of age, the higher IRRs were related to AML (20) and non-Hodgkin lymphoma (NHL) (5). CONCLUSION: The association of thyroid cancer and CC has not been described previously. Increases in hematological cancer following CC lend further support to the established data. The decrease in breast and colon cancers in all age groups supports past data and decreases in uterine and lung cancers are new observations meriting further study.

6. Conrotto F(1), Scacciatella P(2), D'Ascenzo F(3), Chieffo A(4), Latib A(4), Park SJ(5), Kim YH(5), Onuma Y(6), Capranzano P(7), Jegere S(8), Makkar R(9), Palacios I(10), Buszman P(11), Chakravarty T(9), Mehran R(12), Naber C(13), Margey R(10), Leon M(12), Moses J(12), Fajadet J(14), Lefèvre T(15), Morice MC(15), Erglis A(8), Tamburino C(7), Alfieri O(4), D'Amico M(2), Marra S(2), Serruys PW(6), Colombo A(4), Meliga E(16). . Long-term outcomes of percutaneous coronary interventions or coronary artery bypass grafting for left main coronary artery disease in octogenarians (from a Drug-Eluting stent for LefT main Artery registry substudy). Am J Cardiol. 2014 Jun 15;113(12):2007-12. doi: 10.1016/j.amjcard.2014.03.044. Epub 2014 Apr 1
Author information: (1)Department of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy. Electronic address: (2)Department of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy. (3)Division of Cardiology, Department of Internal Medicine, University of Turin, Turin, Italy. (4)Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy. (5)Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. (6)Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. (7)Ferrarotto Hospital, University of Catania, Catania, Italy. (8)Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; Institute of Cardiology, University of Latvia, Riga, Latvia. (9)Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. (10)Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. (11)American Heart of Poland, Medical University of Silesia, Katowice, Poland. (12)Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York. (13)Department of Cardiology, University Hospital, Essen, Germany. (14)Clinique Pasteur, Toulouse, France. (15)Institut Hospitalier Jacques Cartier, Massy, France. (16)Interventional Cardiology Unit, A.O. Ordine Mauriziano Umberto I, Turin, Italy.

Abstract Percutaneous coronary intervention (PCI) with drug-eluting stents is an accepted alternative to surgery for the treatment of unprotected left main coronary artery (ULMCA) disease, but the long-term outcome in elderly patients is unclear. Aim of our study was to compare the clinical outcomes of octogenarians with ULMCA disease treated either with PCI with drug-eluting stents or coronary artery bypass grafting (CABG). The primary study end point was the composite of death, cerebrovascular accident, and myocardial infarction at follow-up. A total of 304 consecutive patients with ULMCA stenosis treated with PCI or CABG and aged ≥80 years were selected and analyzed in a large multinational registry. Two hundred eighteen were treated with PCI and 86 with CABG. During the hospitalization, a trend toward a higher mortality rate was reported in PCI-treated patients (3.5% vs 7.3%, p = 0.32). At a median follow-up of 1,088 days, the incidence of the primary end point was similar in the 2 groups (32.6% vs 30.2%, p = 0.69). Incidence of target vessel revascularization at follow-up was higher in PCI-treated patients (10% vs 4.2%, p = 0.05). At multivariate analysis, left ventricular ejection fraction was the only independent predictor of the primary end point (hazard ratio 0.95, 95% confidence interval 0.91 to 0.98, p = 0.001). After adjustment with propensity score, the revascularization strategy was not significantly correlated to the incidence of the primary end point (hazard ratio 0.98, 95% confidence interval 0.57 to 1.71, p = 0.95). In octogenarians, no difference was observed in the occurrence of the primary end point after PCI or CABG for the treatment of ULMCA disease. However, the rate of target vessel revascularization was higher in the PCI group.

7. Kiviniemi T(1), Puurunen M(2), Schlitt A(3), Rubboli A(4), Karjalainen P(5), Vikman S(6), Niemelä M(7), Lahtela H(8), Lip GY(9), Airaksinen KE(8). Performance of bleeding risk-prediction scores in patients with atrial fibrillation undergoing percutaneous coronary intervention. Am J Cardiol. 2014 Jun 15;113(12):1995-2001. doi: 10.1016/j.amjcard.2014.03.038. Epub 2014 Apr 1.
Author information: (1)Heart Center, Turku University Hospital and University of Turku, Turku, Finland. Electronic address: (2)Hemostasis laboratory, Finnish Red Cross Blood Service, Helsinki, Finland. (3)Medical Faculty, Martin Luther University Halle-Wittenberg and Paracelsus-Harz-Clinic Bad Suderode, Halle-Wittenberg, Germany. (4)Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy. (5)Heart Center, Satakunta Central Hospital, Pori, Finland. (6)Heart Center, Tampere University Hospital, Tampere, Finland. (7)Department of Medicine, Oulu University Hospital, Oulu, Finland. (8)Heart Center, Turku University Hospital and University of Turku, Turku, Finland. (9)University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.

Abstract The hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, and drugs/alcohol (HAS-BLED); anticoagulation and risk factors in atrial fibrillation (ATRIA); modified Outpatient Bleeding Risk Index (mOBRI); and reduction of atherothrombosis for continued health (REACH) schemes are validated bleeding risk-prediction tools, but their predictive performance in patients with AF receiving multiple antithrombotic drugs after percutaneous coronary intervention (PCI) is unknown. We sought to compare the predictive performance of bleeding risk-estimation tools in a cohort of patients with atrial fibrillation (AF) undergoing PCI. Management of patients with AF undergoing coronary artery stenting is a multicenter European prospective registry enrolling patients with AF undergoing PCI. We calculated HAS-BLED, ATRIA, mOBRI, and REACH bleeding risk-prediction scores and assessed the rate of bleeding complications as defined by Bleeding Academic Research Consortium at 12 months follow-up in 929 consecutive patients undergoing PCI. Increasing age, femoral access site, and previous peptic ulcer were independent determinants of bleeding. Low bleeding risk scores as determined by HAS-BLED 0 to 2, ATRIA 0 to 3, mOBRI 0, and REACH 0 to 10 were detected in 23.7%, 73.0%, 7.8%, and 5.7% of patients of the cohort, respectively. No significant differences were detected in the rates of any bleeding or major bleeding events for low versus intermediate/high scores with each risk-prediction tool. In conclusion, the performance of ATRIA, HAS-BLED, mOBRI, and REACH scores in predicting bleeding complications in this high-risk patient subset was useless.

8. Gandaglia G(1), Sammon JD, Chang SL, Choueiri TK, Hu JC, Karakiewicz PI, Kibel AS, Kim SP, Konijeti R, Montorsi F, Nguyen PL, Sukumar S, Menon M, Sun M, Trinh QD. Comparative effectiveness of robot-assisted and open radical prostatectomy in the postdissemination era. J Clin Oncol. 2014 May 10;32(14):1419-26. doi: 10.1200/JCO.2013.53.5096. Epub 2014 Apr 14.
Author information: (1)Giorgio Gandaglia, Pierre I. Karakiewicz, and Maxine Sun, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Giorgio Gandaglia and Francesco Montorsi, Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy; Jesse D. Sammon and Mani Menon, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; Steven L. Chang, Toni K. Choueiri, Adam S. Kibel, Ramdev Konijeti, Paul L. Nguyen, and Quoc-Dien Trinh, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Jim C. Hu, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Simon P. Kim, Yale University, New Haven, CT; and Shyam Sukumar, University of Minnesota, Minneapolis, MN. Comment in J Clin Oncol. 2014 May 10;32(14):1394-5.

Abstract PURPOSE: Given the lack of randomized trials comparing robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP), we sought to re-examine the outcomes of these techniques using a cohort of patients treated in the postdissemination era. PATIENTS AND METHODS: Overall, data from 5,915 patients with prostate cancer treated with RARP or ORP within the SEER-Medicare linked database diagnosed between October 2008 and December 2009 were abstracted. Postoperative complications, blood transfusions, prolonged length of stay (pLOS), readmission, additional cancer therapies, and costs of care within the first year after surgery were compared between the two surgical approaches. To decrease the effect of unmeasured confounders, instrumental variable analysis was performed. Multivariable logistic regression analyses were then performed. RESULTS: Overall, 2,439 patients (41.2%) and 3,476 patients (58.8%) underwent ORP and RARP, respectively. In multivariable analyses, patients undergoing RARP had similar odds of overall complications, readmission, and additional cancer therapies compared with patients undergoing ORP. However, RARP was associated with a higher probability of experiencing 30- and 90-day genitourinary and miscellaneous medical complications (all P ≤ .02). Additionally, RARP led to a lower risk of experiencing blood transfusion and of having a pLOS (all P < .001). Finally, first-year reimbursements were greater for patients undergoing RARP compared with ORP (P < .001). CONCLUSION: RARP and ORP have comparable rates of complications and additional cancer therapies, even in the postdissemination era. Although RARP was associated with lower risk of blood transfusions and a slightly shorter length of stay, these benefits do not translate to a decrease in expenditures.

9. Pupillo E(1), Messina P, Giussani G, Logroscino G, Zoccolella S, Chiò A, Calvo A, Corbo M, Lunetta C, Marin B, Mitchell D, Hardiman O, Rooney J, Stevic Z, Bandettini di Poggio M, Filosto M, Cotelli MS, Perini M, Riva N, Tremolizzo L, Vitelli E, Damiani D, Beghi E; EURALS Consortium. Physical activity and amyotrophic lateral sclerosis: a European population-based case-control study. Ann Neurol. 2014 May;75(5):708-16. doi: 10.1002/ana.24150. Epub 2014 May 21.
Collaborators: Al-Chalabi A, Chiò A, Hardiman O, Logroscino G, Ludolph A, Mitchell D, Preux PM, Swingler R, van den Berg L, Addison R, Alvisi E, Astegiano G, Bonito V, Bottacchi E, Buzzi P, Canosa A, Capozzo R, Caponnetto C, Cavallo R, Ceroni M, Chiveri L, Corti S, Couratier P, Delodovici L, Durelli L, Ferrarese C, Ferrero B, Fetoni V, Gallo S, Geda C, Ghiglione P, Gionco M, Guaita MC, Joyce G, Launaro N, Lynch C, Lorusso L, Maestri E, Magliola U, Marchet A, Mauro A, Mazzini L, Micheli A, Milicev M, Millul A, Montesano M, Padovani A, Palazzini E, Palermo M, Papurello D, Pastore I, Penza MT, Perrone P, Pisano F, Prelle A, Preux PM, Raineri M, Regio V, Rigamonti A, Sasanelli F, Secchi P, Smith J, Tavernelli F, Vergnano F, Villani A, Arbore G, Case N, Del Sordo N, Di Landro A, Leali N, Masini L, Matuonto V, Monticelli ML, Montini A, Palumbo M, Parati A, Pellegrino S, Sessa A, Severgnini E, Vertué G. Author information: (1)Neurological Diseases Laboratory, Institute of Hospitalization and Scientific Care-Mario Negri Institute, Milan, Italy.

Abstract OBJECTIVE: To assess whether physical activity is a risk factor for amyotrophic lateral sclerosis (ALS). METHODS: From February 2008 to April 2012, 652 patients with ALS from European population-based registries (France, Ireland, Italy, United Kingdom, Serbia) and 1,166 population controls (matched for age, sex, and residency) were assessed. Upon direct interview, data were collected on occupation and history of sport and leisure activities, physical activity, and accidental injuries. Physical exercise was defined as having spent time doing activities that caused an individual to breath hard at least once per month and was coded as none, job-related, and/or sport-related. Sport-related and work-related physical exercise were quantified using metabolic equivalents (METs). Risks were calculated using conditional logistic regression models (adjusting for age, country, trauma, and job-related physical activity) and expressed as odds ratios (ORs) and adjusted ORs (Adj ORs) with 95% confidence intervals (CIs). RESULTS: Overall physical activity was associated with reduced odds of having ALS (Adj OR=0.65, 95% CI=0.48-0.89) as were work-related physical activity (Adj OR=0.56, 95% CI=0.36-0.87) and organized sports (Adj OR=0.49, 95% CI=0.32-0.75). An inverse correlation was observed between ALS, the duration of physical activity (p=0.0041), and the cumulative MET scores, which became significant for the highest exposure (Adj OR=0.34, 95% CI=0.21-0.54). An inverse correlation between ALS and sport was found in women but not in men, and in subjects with repeated traumatic events. INTERPRETATION: Physical activity is not a risk factor for ALS and may eventually be protective against the disease.

10. Manfrini O(1), Morrell C(2), Das R(2), Barth JH(2), Hall AS(2), Gale CP(2), Cenko E(1), Bugiardini R(3); Evaluation of Methods and Management of Acute Coronary Events Study Group. Effects of angiotensin-converting enzyme inhibitors and beta blockers on clinical outcomes in patients with and without coronary artery obstructions at angiography (from a Register-Based Cohort Study on Acute Coronary Syndromes). Am J Cardiol. 2014 May 15;113(10):1628-33. doi: 10.1016/j.amjcard.2014.02.015. Epub 2014 Mar 3.
Author information: (1)Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. (2)C-NET Group, Leeds Institute for Genetics, Health and Therapeutics, Leeds General Infirmary, Leeds, United Kingdom. (3)Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. Electronic address:

Abstract We sought to determine the effectiveness of angiotensin-converting enzyme (ACE) inhibition and β-blocker treatment as a function of the degree of coronary artery disease (CAD) obstruction at angiography. The Evaluation of Methods and Management of Acute Coronary Events registry enrolled patients who had been hospitalized for an acute coronary syndrome. There were 1,602 patients who had cardiac catheterization that were used for this analysis. The main outcome measures were evidence-based therapies prescribed at discharge and 6-month incidence of all-cause mortality. The cohort consisted of 1,252 patients with obstructive CAD (>50% luminal diameter obstructed) and 350 patients with nonobstructive CAD. Multivariate logistic regression analysis adjusted for further medications and other clinical factors was performed. Patients with nonobstructive CAD had significantly (p <0.001) higher rates of β-blocker (77.8% vs 63.3%) and lower rates of ACE-inhibitor (57.7% vs 66.4%) prescriptions. In patients with nonobstructive CAD, ACE-inhibitor therapy was clearly associated with a lower 6-month mortality (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.03 to 0.78, p = 0.004). No significant association between β-blocker use and death was found. In patients with obstructive CAD, both β blockers (OR 0.47, 95% CI 0.32 to 0.67, p <0.001) and ACE inhibitors (OR 0.47, 95% CI 0.26 to 0.87, p = 0.01) were significantly associated with a reduced risk of 6-month mortality. In conclusion, ACE-inhibitor therapy seems to be an effective first-line treatment for preventing the occurrence of mortality in patients with nonobstructive CAD.

11. Fine JD(1), Bruckner-Tuderman L(2), Eady RA(3), Bauer EA(4), Bauer JW(5), Has C(2), Heagerty A(6), Hintner H(5), Hovnanian A(7), Jonkman MF(8), Leigh I(9), Marinkovich MP(10), Martinez AE(11), McGrath JA(3), Mellerio JE(12), Moss C(13), Murrell DF(14), Shimizu H(15), Uitto J(16), Woodley D(17), Zambruno G(18). Inherited epidermolysis bullosa: updated recommendations on diagnosis and classification. J Am Acad Dermatol. 2014 Jun;70(6):1103-26. doi: 10.1016/j.jaad.2014.01.903. Epub 2014 Mar 29.
Author information: (1)Vanderbilt University School of Medicine, Nashville, Tennessee; National Epidermolysis Bullosa Registry, Nashville, Tennessee. Electronic address: (2)University Medical Center Freiburg, Freiburg, Germany. (3)St John's Institute of Dermatology, King's College London and Guy's and St Thomas' Hospital National Health Service Foundation Trust, London, England. (4)Stanford University School of Medicine, Stanford, California. (5)Paracelsus Private Medical University, Salzburg, Austria. (6)Heart of England Foundation Trust, Birmingham, England. (7)INSERM and Department of Genetics, Toulouse, France. (8)University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. (9)University of Dundee, Dundee, Scotland. (10)Stanford University School of Medicine, Stanford, California; Dermatology Service, Palo Alto Veterans Affairs Medical Center, Palo Alto, California. (11)Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England. (12)St John's Institute of Dermatology, King's College London and Guy's and St Thomas' Hospital National Health Service Foundation Trust, London, England; Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England. (13)Birmingham Children's Hospital and University of Birmingham, Birmingham, England. (14)St George Hospital and University of New South Wales, Sydney, Australia. (15)Hokkaido University School of Medicine, Sapporo, Japan. (16)Thomas Jefferson University, Philadelphia, Pennsylvania. (17)University of Southern California, Los Angeles, California. (18)Istituto Dermopatico dell' Immacolata, IDI-IRCCS, Rome, Italy.

Abstract BACKGROUND: Several new targeted genes and clinical subtypes have been identified since publication in 2008 of the report of the last international consensus meeting on diagnosis and classification of epidermolysis bullosa (EB). As a correlate, new clinical manifestations have been seen in several subtypes previously described. OBJECTIVE: We sought to arrive at an updated consensus on the classification of EB subtypes, based on newer data, both clinical and molecular. RESULTS: In this latest consensus report, we introduce a new approach to classification ("onion skinning") that takes into account sequentially the major EB type present (based on identification of the level of skin cleavage), phenotypic characteristics (distribution and severity of disease activity; specific extracutaneous features; other), mode of inheritance, targeted protein and its relative expression in skin, gene involved and type(s) of mutation present, and--when possible--specific mutation(s) and their location(s). LIMITATIONS: This classification scheme critically takes into account all published data through June 2013. Further modifications are likely in the future, as more is learned about this group of diseases. CONCLUSION: The proposed classification scheme should be of value both to clinicians and researchers, emphasizing both clinical and molecular features of each EB subtype, and has sufficient flexibility incorporated in its structure to permit further modifications in the future.

12. Verheecke M(1), Halaska MJ(2), Lok CA(3), Ottevanger PB(4), Fruscio R(5), Dahl-Steffensen K(6), Kolawa W(7), Gziri MM(1), Han SN(1), Van Calsteren K(1), Van den Heuvel F(8), De Vleeschouwer S(9), Clement PM(10), Menten J(11), Amant F(12); ESGO Task Force ‘Cancer in Pregnancy’. Primary brain tumours, meningiomas and brain metastases in pregnancy: report on 27 cases and review of literature. Eur J Cancer. 2014 May;50(8):1462-71. doi: 10.1016/j.ejca.2014.02.018. Epub 2014 Mar 14.
Author information: (1)Gynecologic Oncology, University Hospitals Leuven, Herestraat, 49, 3000 Leuven, Belgium; Division of Oncology, KULeuven, Herestraat, 49, 3000 Leuven, Belgium. (2)Department of Obstetrics and Gynecology, 2nd Medical Faculty, Charles University, Ovocný trh, 5, 11636 Prague, Czech Republic. (3)Department of Gynecologic Oncology, Center Gynecologic Oncology, Plesmanlaan, 121, 1066 CX Amsterdam, The Netherlands. (4)Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Geert Grooteplein-Zuid, 10, 6525 GA Nijmegen, The Netherlands. (5)Division of Obstetrics and Gynecology, San Gerardo Hospital, University of Milan-Bicocca, Via Pergolesi, 33, 20900 Monza, Italy. (6)Department of Radiotherapy and Clinical Oncology, Vejle Hospital, Brummersvej, 1, DK-7100 Vejle, Denmark. (7)University Hospital of Krakow (Jagiellonian University), Department of Gynecology and Oncology, Gołębia, 24, Kraków, Poland. (8)Physics Department in Radiation-Oncology, University Hospitals Leuven, Herestraat, 49, 3000 Leuven, Belgium. (9)Neurosurgery, University Hospitals Leuven, Herestraat, 49, 3000 Leuven, Belgium. (10)Division of Oncology, KULeuven, Herestraat, 49, 3000 Leuven, Belgium; General Medical Oncology, University Hospitals Leuven, Herestraat, 49, 3000 Leuven, Belgium. (11)Radiation-Oncology, University Hospitals Leuven, Herestraat, 49, 3000 Leuven, Belgium. (12)Gynecologic Oncology, University Hospitals Leuven, Herestraat, 49, 3000 Leuven, Belgium; Division of Oncology, KULeuven, Herestraat, 49, 3000 Leuven, Belgium. Electronic address:

Abstract BACKGROUND: The concurrence of intracranial tumours with pregnancy is rare. The purpose of this study was to describe all reported patients registered in the international Cancer in Pregnancy registration study (CIP study;, and to review the literature in order to obtain better insight into outcome and possibilities of treatment in pregnancy. METHODS: We collected all intracranial tumours (primary brain tumour, cerebral metastasis, or meningioma) diagnosed during pregnancy, registered prospectively and retrospectively by international collaboration since 1973. Patients diagnosed postpartum were excluded. We summarised the demographic features, treatment decisions, obstetrical and neonatal outcomes. RESULTS: The mean age of the 27 eligible patients was 31years (range 23-41years), of which 13 and 12 patients were diagnosed in the second and third trimesters, respectively. Eight patients (30%) underwent brain surgery, seven patients (26%) had radiotherapy and in three patients (11%) chemotherapy was administered during gestation. Two patients died during pregnancy and four pregnancies were terminated. In 16 (59%) patients elective caesarean section was performed of which 14 (52%) were still preterm (range 30-36weeks, mean 33weeks). Five patients had a vaginal delivery (range 36-40weeks). Of the 21 ongoing pregnancies all children were born alive without visible congenital malformations and the available long-term follow-up data (range 2-25years) of six children were reassuring. CONCLUSION: Adherence to standard protocol for the treatment of brain tumours during pregnancy appears to allow a term delivery and a higher probability of a vaginal delivery.

Breve commento a cura di E. Crocetti
Questo studio descrittivo presenta le caratteristiche di 27 pazienti e casi di neoplasie cerebrali insorte in donne in stato di gravidanza, valutandone anche il percorso terapeutico e l’aderenza alle linee guida. A parte la rarità degli eventi esaminati, l’aspetto di più generale interesse è quello dell’insorgenza di una neoplasia, non specificamente dell'SNC, nel corso di una gravidanza. Questo evento solleva ancora un ampio dibattito scientifico sia relativamente al particolare stato ormonale delle donne che potrebbe influire sulla biologia dei tumori determinando una prognosi più aggressiva, sia su questioni relative al possibile ritardo diagnostico e terapeutico legato ai timori sugli effetti sul feto e, quindi, sulla possibilità di adottare protocolli standard. Gli autori di questo articolo fanno parte di un gruppo, International network of cancer, infertility and pregnancy, che offre nel proprio sito ( ampio materiale sull’argomento, fra i quali un recente contributo su Lancet oncology sulla prognosi dei tumori al seno insorti in gravidanza che indica una prognosi non diversa dalle forme insorte non in gravidanza.

13. Stegemann C(1), Pechlaner R, Willeit P, Langley SR, Mangino M, Mayr U, Menni C, Moayyeri A, Santer P, Rungger G, Spector TD, Willeit J, Kiechl S, Mayr M. Lipidomics profiling and risk of cardiovascular disease in the prospective population-based Bruneck study. Circulation. 2014 May 6;129(18):1821-31. doi: 10.1161/CIRCULATIONAHA.113.002500. Epub 2014 Mar 12.
Author information: (1)King's British Heart Foundation Centre (C.S., S.R.L., U.M., M. Mayr) and Department of Twin Research & Genetic Epidemiology (M. Mangino, C.M., A.M., T.D.R.), King's College London, London, UK; Department of Neurology, Medical University Innsbruck, Innsbruck, Austria (R.P., P.W., J.W., S.K.); Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (P.W.); and Departments of Laboratory Medicine and Neurology, Bruneck Hospital, Bruneck, Italy (P.S., G.R.). Comment in Circulation. 2014 May 6;129(18):1799-803. BACKGROUND: The bulk of cardiovascular disease risk is not explained by

Abstract traditional risk factors. Recent advances in mass spectrometry allow the identification and quantification of hundreds of lipid species. Molecular lipid profiling by mass spectrometry may improve cardiovascular risk prediction. METHODS AND RESULTS: Lipids were extracted from 685 plasma samples of the prospective population-based Bruneck Study (baseline evaluation in 2000). One hundred thirty-five lipid species from 8 different lipid classes were profiled by shotgun lipidomics with the use of a triple-quadrupole mass spectrometer. Levels of individual species of cholesterol esters (CEs), lysophosphatidylcholines, phosphatidylcholines, phosphatidylethanolamines (PEs), sphingomyelins, and triacylglycerols (TAGs) were associated with cardiovascular disease over a 10-year observation period (2000-2010, 90 incident events). Among the lipid species with the strongest predictive value were TAGs and CEs with a low carbon number and double-bond content, including TAG(54:2) and CE(16:1), as well as PE(36:5) (P=5.1 × 10⁻⁷, 2.2 × 10⁻⁴, and 2.5 × 10⁻³, respectively). Consideration of these 3 lipid species on top of traditional risk factors resulted in improved risk discrimination and classification for cardiovascular disease (cross-validated ΔC index, 0.0210 [95% confidence interval, 0.0010-0.0422]; integrated discrimination improvement, 0.0212 [95% confidence interval, 0.0031-0.0406]; and continuous net reclassification index, 0.398 [95% confidence interval, 0.175-0.619]). A similar shift in the plasma fatty acid composition was associated with cardiovascular disease in the UK Twin Registry (n=1453, 45 cases). CONCLUSIONS: This study applied mass spectrometry-based lipidomics profiling to population-based cohorts and identified molecular lipid signatures for cardiovascular disease. Molecular lipid species constitute promising new biomarkers that outperform the conventional biochemical measurements of lipid classes currently used in clinics.

14. Slaghekke F(1), Lopriore E(2), Lewi L(3), Middeldorp JM(1), van Zwet EW(4), Weingertner AS(5), Klumper FJ(1), DeKoninck P(3), Devlieger R(3), Kilby MD(6), Rustico MA(7), Deprest J(3), Favre R(5), Oepkes D(8). Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. Lancet. 2014 Jun 21;383(9935):2144-51. doi: 10.1016/S0140-6736(13)62419-8. Epub 2014 Mar 7.
Author information: (1)Department of Obstetrics, Leiden University Medical Centre, Leiden, Netherlands. (2)Department of Pediatrics, Leiden University Medical Centre, Leiden, Netherlands. (3)Department of Obstetrics, University Hospitals KU Leuven, Leuven, Belgium. (4)Department of Medical Statistics, Leiden University Medical Centre, Leiden, Netherlands. (5)Department of Obstetrics, University Hospital of Strasbourg, Strasbourg, France. (6)Fetal Medical Centre, Birmingham Women's Foundation Trust and University of Birmingham, Edgbaston, Birmingham, UK. (7)Department of Obstetrics, Fetal Therapy Unit, Children's Hospital Vittore Buzzi, Milan, Italy. (8)Department of Obstetrics, Leiden University Medical Centre, Leiden, Netherlands. Electronic address: Comment in Lancet. 2014 Jun 21;383(9935):2108-9.

Abstract BACKGROUND: Monochorionic twin pregnancies complicated by twin-to-twin transfusion syndrome are typically treated with fetoscopic laser coagulation. Postoperative complications can occur due to residual vascular anastomoses on the placenta. We aimed to assess the efficacy and safety of a novel surgery technique that uses laser coagulation of the entire vascular equator (Solomon technique). METHODS: We undertook an open-label, international, multicentre, randomised controlled trial at five European tertiary referral centres. Women with twin-to-twin transfusion syndrome were randomly assigned by online randomisation (1:1) with permuted blocks to the Solomon technique or standard laser coagulation. The primary outcome was a composite of incidence of twin anaemia polycythaemia sequence, recurrence of twin-to-twin transfusion syndrome, perinatal mortality, or severe neonatal morbidity. Analyses were by intention to treat, with results expressed as odds ratios (ORs) and 95% CIs. This trial is registered with the Dutch Trial Registry, number NTR1245. FINDINGS: Between March 11, 2008, and July 12, 2012, 274 women were randomly assigned to either the Solomon group (n=139) or the standard treatment group (n=135). The primary outcome occurred in 94 (34%) of 274 fetuses in the Solomon group versus 133 (49%) of 270 in the standard treatment group (OR 0•54; 95% CI 0•35-0•82). The Solomon technique was associated with a reduction in twin anaemia polycythaemia sequence (3% vs 16% for the standard treatment; OR 0•16, 95% CI 0•05-0•49) and recurrence of twin-to-twin transfusion syndrome (1% vs 7%; 0•21, 0•04-0•98). Perinatal mortality and severe neonatal morbidity did not differ significantly between the two groups. Outside of the common and well-known complications of twin-to-twin transfusion syndrome and its treatment, no serious adverse events occurred. INTERPRETATION: Fetoscopic laser coagulation of the entire vascular equator reduces postoperative fetal morbidity in severe twin-to-twin transfusion syndrome. We recommend that fetoscopic surgeons consider adopting this strategy for treatment of women with twin-to-twin transfusion syndrome. FUNDING: Netherlands Organization for the Health Research and Development (ZonMw 92003545).

PMID: 24613024 [PubMed - indexed for MEDLINE]

15. Fagioli F(1), Quarello P, Zecca M, Lanino E, Corti P, Favre C, Ripaldi M, Ramenghi U, Locatelli F, Prete A. Haematopoietic stem cell transplantation for Diamond Blackfan anaemia: a report from the Italian Association of Paediatric Haematology and Oncology Registry. Br J Haematol. 2014 Jun;165(5):673-81. doi: 10.1111/bjh.12787. Epub 2014 Feb 24.
Author information: (1)Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Turin, Italy.

Abstract Allogeneic haematopoietic stem cell transplantation (HSCT) is the only curative option for patients with Diamond Blackfan anaemia (DBA). We report the transplantation outcome of 30 Italian DBA patients referred to the Italian Association of Paediatric Haematology and Oncology Registry between 1990 and 2012. This is one of the largest national registry cohorts of transplanted DBA patients. Most patients (83%) were allografted after 2000. A matched sibling donor was employed in 16 patients (53%), the remaining 14 patients (47%) were transplanted from matched unrelated donors. Twenty-eight of the 30 patients engrafted. One patient died at day +6 due to veno-occlusive disease without achieving neutrophil recovery and another patient remained transfusion-dependent despite the presence of a full donor chimerism. The 5-year overall survival and transplant-related mortality was 74•4% and 25•6%, respectively. Patients younger than 10 years as well as those transplanted after 2000 showed a significantly higher overall survival and a significantly lower risk of transplant-related mortality. No difference between donor type was observed. Our data suggest that allogeneic HSCT from a related or unrelated donor was a reasonable alternative to transfusion therapy in young and well chelated DBA patients.

16. Sung PL(1), Chang YH(1), Chao KC(2), Chuang CM(3); Task Force on Systematic Review and Meta-analysis of Ovarian Cancer. Global distribution pattern of histological subtypes of epithelial ovarian cancer: a database analysis and systematic review. Gynecol Oncol. 2014 May;133(2):147-54. doi: 10.1016/j.ygyno.2014.02.016. Epub 2014 Feb 17.
Author information: (1)Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. (2)Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan. (3)Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, School of Medicine, National Yang-Ming University, Taiwan. Electronic address:

Abstract BACKGROUND: Epithelial ovarian cancer is basically a heterogeneous disease with different chemosensitivity and distinct molecular alternations for each histological subtype. In order to assess whether the results of clinical trials can be extrapolated to a new country, it is critical to first examine whether the relative frequencies is homogenous across countries. METHODS: Cancer registry database from a single institution in Taiwan combined with systematic review of the global literature on the relative frequencies of histological subtypes between 2003 and 2012 was provided. RESULTS: Of 175 titles identified, 41 studies met inclusion/exclusion criteria. Globally, for each subtype, the median value of relative frequencies for serous subtype was 45.0%, with the Philippines (16.0%), Indonesia (22.7%), and Brazil (30.1%) as the three lowest countries and South Africa (68.0%), Greece (71.5%), and India (86.7%) as the three highest countries; for mucinous subtype, 11.4%, Italy (3.0%), Australia (3.4%), and Japan (5.4%) were the three lowest countries, while Indonesia (29.1%), Singapore (30.3%), and South Korea (38.6%) were the three highest countries; for endometrioid subtype, 12.6%, India (1.6%), Greece (5.7%), and Portugal (7.6%) were the three lowest countries, while Taiwan (24.8%), Egypt (25.0%), and Austria (25.5%) were the three highest countries; and for clear cell subtype, 5.3%, Pakistan (1.0%), Iran (2.0%), and Brazil (2.1%) were the three lowest countries while Thailand (16.0%), Taiwan (16.8%), and Spain (18.8%) were the three highest countries. CONCLUSIONS: Relative frequencies of subtypes were not homogenous across countries. This diversity may reflect the geographical and ethnic variations. Globally, epithelial ovarian cancer is a heterogeneous disease with a heterogeneous distribution pattern.

17. Longo N(1), Minervini A(2), Antonelli A(3), Bianchi G(4), Bocciardi AM(5), Cunico SC(3), Fiori C(6), Fusco F(7), Giancane S(2), Mari A(2), Martorana G(8), Mirone V(1), Morgia G(9), Novara G(10), Porpiglia F(6), Raspollini MR(11), Rocco F(12), Rovereto B(13), Schiavina R(8), Serni S(2), Simeone C(3), Verze P(1), Volpe A(14), Ficarra V(10), Carini M(2). Simple enucleation versus standard partial nephrectomy for clinical T1 renal masses: perioperative outcomes based on a matched-pair comparison of 396 patients (RECORd project). Eur J Surg Oncol. 2014 Jun;40(6):762-8. doi: 10.1016/j.ejso.2014.01.007. Epub 2014 Feb 1.
Author information: (1)Policlinico Federico II, Università di Napoli, Italy. (2)Clinica Urologica I, AOUC, Università di Firenze, Italy. (3)Unità Operativa di Urologia Dipartimento di NefroUrologia, Azienda AO Spedali Civili di Brescia, Italy. (4)Policlinico di Modena, Clinica Urologica, Università di Modena, Italy. (5)Dipartimento Chirurgico Polispecialistico, Urologia, Azienda Ospedaliera Ospedale Riguarda Ca' Granda, Milano, Italy. (6)Divisione di Urologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino, Italy. (7)Policlinico Federico II, Università di Napoli, Italy. Electronic address: (8)Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy. (9)LUNA Foundation, Italy. (10)Clinica Urologica, Università di Padova, Padova, Italy. (11)Department of Pathology, University of Florence, Careggi Hospital, Florence, Italy. (12)Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Università di Milano, Italy. (13)I.R.C.C.S. Policlinico San Matteo - Struttura Di Urologia, Italy. (14)Dipartimento di Urologia, Azienda Ospedaliera Maggiore della Carità, Novara, Italy.

Abstract OBJECTIVES: To compare simple enucleation (SE) and standard partial nephrectomy (SPN) in terms of surgical results in a multicenter dataset (RECORd Project). MATERIALS AND METHODS: patients treated with nephron sparing surgery (NSS) for clinical T1 renal tumors between January 2009 and January 2011 were evaluated. Overall, 198 patients who underwent SE were retrospectively matched to 198 patients who underwent SPN. The SPN and SE groups were compared regarding intraoperative, early post-operative and pathologic outcome variables. Multivariable analysis was applied to analyze predictors of positive surgical margin (PSM) status. RESULTS: SE was associated with similar WIT (18 vs 17.8 min), lower intraoperative blood loss (177 vs 221 cc, p = 0.02) and shorter operative time (121 vs 147 min; p < 0.0001). Surgical approach (laparoscopic vs. open), tumor size and type of indication (elective/relative vs absolute) were associated with WIT >20 min. The incidence of PSM was significantly lower in patients treated with SE (1.4% vs 6.9%; p = 0.02). At multivariable analysis, PSM was related to the surgical technique, with a 4.7-fold increased risk of PSM for SPN compared to SE. The incidence of overall, medical and surgical complications was similar between SE and SPN. CONCLUSIONS: Type of NSS technique (SE vs SPN) adopted has a negligible impact on WIT and postoperative morbidity but SE seems protective against PSM occurrence.

18. Kyrø C(1), Olsen A(1), Bueno-de-Mesquita HB(2), Skeie G(3), Loft S(4), Åman P(5), Leenders M(6), Dik VK(6), Siersema PD(6), Pischon T(7), Christensen J(1), Overvad K(8), Boutron-Ruault MC(9), Fagherazzi G(9), Cottet V(9), Kühn T(10), Chang-Claude J(10), Boeing H(11), Trichopoulou A(12), Naska A(12), Oikonomidou D(12), Masala G(13), Pala V(14), Tumino R(15), Vineis P(16), Mattiello A(17), Peeters PH(18), Bakken T(3), Weiderpass E(3), Asli LA(3), Sánchez S(19), Jakszyn P(20), Sánchez MJ(21), Amiano P(22), Huerta JM(23), Barricarte A(23), Ljuslinder I(24), Palmqvist R(25), Khaw KT(26), Wareham N(26), Key TJ(27), Travis RC(27), Slimani N(28), Freisling H(28), Ferrari P(28), Gunter MJ(29), Murphy N(29), Riboli E(29), Tjønneland A(1), Landberg R(5). Plasma alkylresorcinol concentrations, biomarkers of whole-grain wheat and rye intake, in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Br J Nutr. 2014 May 28;111(10):1881-90. doi: 10.1017/S0007114513004388. Epub 2014 Feb 13.
Author information: (1)Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen Ø 2100, Denmark. (2)National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. (3)Department of Community Medicine, University of Tromsø, Tromsø, Norway. (4)Section of Environmental Health, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. (5)Department of Food Science, BioCenter, Swedish University of Agricultural Sciences, Uppsala, Sweden. (6)Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. (7)Molecular Epidemiology Group, Max-Delbrück-Center for Molecular Medicine Berlin-Buch, Berlin, Germany. (8)Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark. (9)INSERM, Centre for Research in Epidemiology and Population Health (CESP), Villejuif Cedex, France. (10)Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany. (11)Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany. (12)Hellenic Health Foundation, Athens, Greece. (13)Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy. (14)Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. (15)Cancer Registry and Histopathology Unit, "Civile - M.P. Arezzo" Hospital, ASP Ragusa, Italy. (16)MRC/HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK. (17)Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy. (18)Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. (19)Public Health Directorate, Asturias, Spain. (20)Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain. (21)Andalusian School of Public Health, Granada, Spain. (22)Public Health Division of Guipuzkoa, Basque Regional Health Department, San Sebastian, Spain. (23)CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. (24)Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden. (25)Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden. (26)Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. (27)Cancer Epidemiology Unit, University of Oxford, Oxford, UK. (28)International Agency for Research on Cancer (IARC-WHO), Lyon, France. (29)Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

Abstract Whole-grain intake has been reported to be associated with a lower risk of several lifestyle-related diseases such as type 2 diabetes, CVD and some types of cancers. As measurement errors in self-reported whole-grain intake assessments can be substantial, dietary biomarkers are relevant to be used as complementary tools for dietary intake assessment. Alkylresorcinols (AR) are phenolic lipids found almost exclusively in whole-grain wheat and rye products among the commonly consumed foods and are considered as valid biomarkers of the intake of these products. In the present study, we analysed the plasma concentrations of five AR homologues in 2845 participants from ten European countries from a nested case-control study in the European Prospective Investigation into Cancer and Nutrition. High concentrations of plasma total AR were found in participants from Scandinavia and Central Europe and lower concentrations in those from the Mediterranean countries. The geometric mean plasma total AR concentrations were between 35 and 41 nmol/l in samples drawn from fasting participants in the Central European and Scandinavian countries and below 23 nmol/l in those of participants from the Mediterranean countries. The whole-grain source (wheat or rye) could be determined using the ratio of two of the homologues. The main source was wheat in Greece, Italy, the Netherlands and the UK, whereas rye was also consumed in considerable amounts in Germany, Denmark and Sweden. The present study demonstrates a considerable variation in the plasma concentrations of total AR and concentrations of AR homologues across ten European countries, reflecting both quantitative and qualitative differences in the intake of whole-grain wheat and rye.

19. Lip GY(1), Laroche C(2), Dan GA(3), Santini M(4), Kalarus Z(5), Rasmussen LH(6), Ioachim PM(7), Tica O(7), Boriani G(8), Cimaglia P(8), Diemberger I(8), Hellum CF(6), Mortensen B(6), Maggioni AP(2). 'Real-world' antithrombotic treatment in atrial fibrillation: The EORP-AF pilot survey. Am J Med. 2014 Jun;127(6):519-29.e1. doi: 10.1016/j.amjmed.2013.12.022. Epub 2014 Jan 28.
Author information: (1)University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom. Electronic address: (2)EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France. (3)Department of Cardiology, Colentina University Hospital, Bucharest, Romania. (4)Cardiovascular Department, San Filippo Neri Hospital, Rome, Italy. (5)Department of Cardiology, Silesian Center for Heart Disease, Zabrze, Poland. (6)Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine Aalborg University, Aalborg, Denmark. (7)Cardiology Department, Faculty of Medicine Oradea, Emergency Clinical County Hospital of Oradea, Oradea, Romania. (8)Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.

Abstract BACKGROUND: Current guidelines strongly recommend that oral anticoagulation should be offered to patients with atrial fibrillation and ≥1 stroke risk factors. The guidelines also recommend that oral anticoagulation still should be used in the presence of stroke risk factors irrespective of rate or rhythm control. METHODS: In an analysis from the dataset of the EURObservational Research Programme on Atrial Fibrillation Pilot Survey (n = 3119), we examined antithrombotic therapy prescribing, with particular focus on the risk factors determining oral anticoagulation or antiplatelet therapy use. RESULTS: When oral anticoagulation was used among admitted patients in whom no pharmacologic cardioversion, electrical cardioversion, or catheter ablation was performed or planned, vitamin K antagonist therapy was prescribed in the majority (72.2%), whereas novel oral anticoagulants were used in the minority (7.7%). There was no significant difference in bleeding risk factors among the patients treated with the different types of antithrombotic therapies, except for those with chronic kidney disease, in whom oral anticoagulation was less commonly used (P = .0318). Antiplatelet therapy was more commonly used in patients with a high Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly score (≥2) (P < .0001). More oral anticoagulation use was associated with female gender (P = .0245). Less novel oral anticoagulant use was associated with valvular heart disease (P < .0001), chronic heart failure (P = .0010), coronary artery disease (P < .0001), and peripheral artery disease (P = .0092). Coronary artery disease was the strongest reason for combination therapy with oral anticoagulation plus antiplatelet drug (odds ratio, 8.54; P < .0001). When the Congestive heart failure, Hypertension, Age ≥75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [female] score was used, 95.6% of patients with a score ≥1 received antithrombotic therapy, with 80.5% of patients with a score ≥1 receiving oral anticoagulation. Of note, 83.7% of those with a score ≥2 received antithrombotic therapy. Of the latter, 70.9% of those with a score ≥2 received oral anticoagulation, vitamin K antagonists were used in 64.1%, and novel oral anticoagulants were used in 6.9%. CONCLUSIONS: The EURObservational Research Programme on Atrial Fibrillation Pilot Survey provides contemporary data on oral anticoagulation prescribing by European cardiologists for atrial fibrillation. Although the uptake of oral anticoagulation (mostly vitamin K antagonist therapy) has improved since the Euro Heart Survey a decade ago, antiplatelet therapy is still commonly prescribed, with or without oral anticoagulation, whereas elderly patients are commonly undertreated with oral anticoagulation.

20. Ungar A(1), Ceccofiglio A. Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention. J Intern Med. 2014 Jun;275(6):605-7. doi: 10.1111/joim.12206. Epub 2014 Feb 10.
Author information: (1)Geriatric Cardiology and Medicine, AOU Careggi, Firenze and University of Florence, Florence, Italy. PMID: 24450536 [PubMed - indexed for MEDLINE]
21. Pediatr Blood Cancer. 2014 Jun;61(6):1088-93. doi: 10.1002/pbc.24904. Epub 2013 Dec 27. The economic burden of caregiving on families of children and adolescents with cancer: a population-based assessment. Pagano E(1), Baldi I, Mosso ML, di Montezemolo LC, Fagioli F, Pastore G, Merletti F. Author information: (1)Cancer Epidemiology Unit, "Città della Salute e della Scienza" Hospital, Torino, Italy; Childhood Cancer Registry CPO-Piemonte, Torino, Italy.

Abstract BACKGROUND: Childhood cancer represents a relevant economic burden on families. The preferred tool to investigate family expenditure is the retrospective questionnaire, which is subject to recall errors and selection bias. Therefore, in the present study the economic burden of caregiving on families of children and adolescents (0-19 years of age) with cancer was analysed using administrative data as an alternative to retrospective questionnaires. PROCEDURE: Incident cases of cancer diagnosed in children and adolescents in 2000-2005 (N = 917) were identified from the Piedmont Childhood Cancer Registry and linked to available administrative databases to identify episodes of care during the 3 years after diagnosis (N = 13,433). The opportunity cost of informal caregiving was estimated as the value of the time spent by one of the parents, and was assumed to be equal to the number of days during which the child received inpatient care, day-care or outpatient radiotherapy. Factors affecting the level of economic burden of caregiving on families were analysed in a multivariable model. RESULTS: The economic burden of caregiving increased when care was supplied at the Regional Referral Centre, or when treatment complexity was high. Families with younger children had a higher level of economic burden of caregiving. Leukaemia required a higher family commitment than any other cancer considered. CONCLUSIONS: Estimates of the economic burden of caregiving on families of children and adolescents with cancer derived from administrative data should be considered a minimum burden. The estimated effect of the covariates is informative for healthcare decision-makers in planning support programmes.

22. Ficarra V(1), Minervini A, Antonelli A, Bhayani S, Guazzoni G, Longo N, Martorana G, Morgia G, Mottrie A, Porter J, Simeone C, Vittori G, Zattoni F, Carini M. A multicentre matched-pair analysis comparing robot-assisted versus open partial nephrectomy. BJU Int. 2014 Jun;113(6):936-41. doi: 10.1111/bju.12570. Epub 2014 May 22.
Author information: (1)Department of Urology, University of Udine, Udine, Italy.

Abstract OBJECTIVE: To compare the perioperative, pathological and functional outcomes in two contemporary, large series of patients in different institutions and who underwent open partial nephrectomy (OPN) or robot-assisted PN (RAPN) for suspected renal tumours. PATIENTS AND METHODS: This was a retrospective, multicentre, international, matched-pair analysis comparing patients who underwent RAPN or OPN for suspected renal cell carcinoma. Data on patients who underwent OPN were extracted by an Italian observational registry collecting data from 19 different centres. Data on patients who received RAPN were extracted from a multicentre, international database collecting cases treated in four high-volume referral centres of robotic surgery. The matching was in a 1:1 ratio for the surgical approach and included 200 patients in each arm. RESULTS: The mean warm ischaemia time was shorter in the OPN group than in the RAPN group, at a mean (SD) of 15.4 (5.9) vs 19.2 (7.3) min (P < 0.001). Conversely, the median (interquartile range) estimated blood loss was 150 (100-300) mL in the OPN group and 100 (50-150) mL in the RAPN group (P < 0.001). There were no differences in operating time (P = 0.18) and the intraoperative complication rate (P = 0.31) between the approaches. Postoperative complications were recorded in 43 (21.5%) patients who underwent OPN and in 28 (14%) who received RAPN (P = 0.02). Moreover, major complications (grade 3-4) were reported in nine (4.5%) patients after OPN and in nine (4.5%) after RAPN. Positive margins were detected in nine (5.5%) patients after OPN and in nine (5.7%) after RAPN (P = 0.98). The mean (SD) 3-month estimated glomerular filtration rate declined by 16.6 (18.1) mL/min from the preoperative value in the OPN group and by 16.4 (22.9) mL/min in the RAPN group (P = 0.28). CONCLUSION: RAPN can achieve equivalent perioperative, early oncological and functional outcomes as OPN. Moreover, RAPN is a less invasive approach, offering a lower risk of bleeding and postoperative complications than OPN.

23. Onorati F(1), D'Errigo P(2), Barbanti M(3), Rosato S(2), Covello RD(4), Maraschini A(2), Ranucci M(5), Santoro G(6), Tamburino C(3), Grossi C(7), Santini F(8), Menicanti L(5), Seccareccia F(2); OBSERVANT Research Group. Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: Results of the multicenter Italian OBSERVANT Registry. J Thorac Cardiovasc Surg. 2014 May;147(5):1529-39. doi: 10.1016/j.jtcvs.2013.05.039. Epub 2013 Jul 13.
Collaborators: Seccareccia F, D'Errigo P, Rosato S, Maraschini A, Badoni G, Tamburino C, Santoro G, Santini F, Grossi C, Ranucci M, Milanese S, Covello RD, Fusco D, De Palma R, Scondotto S, Tamburino C, Barbanti M, Santini F, Onorati F, Milanese S, Covello RD, Orlando A, Copello F, Zanier L, Zocchetti C, Cecchi M, Borgia P, Celentano E, Mauro A, De Luca G, Marchetta F, Antonelli A, Porcu R, Marra S, D'Amico M, Gaita F, Moretti C, De Benedictis M, Aranzulla T, Pistis G, Reale M, Bedogni F, Brambilla N, Colombo A, Chieffo A, Ferrari A, Inglese L, Casilli F, Ettori F, Frontini M, Antona C, Piccaluga E, Klugmann S, De Marco F, Tespili M, Saino A, Maria S, Isabella G, Fraccaro C, Proclemer A, Bisceglia T, Armellini I, Vischi M, Parodi E, Petronio S, Giannini C, Pierli C, Iadanza A, Santoro G, Meucci F, Tomai F, Ghini A, Sardella G, Mancone M, Ribichini F, Vassanelli C, Dandale R, Giudice P, Vigorito F, Bortone A, De Luca Tupputi Schinosa L, De Cillis E, Indolfi C, Spaccarotella C, Stabile A, Gandolfo C, Emanuele V, Tamburino C, Ussia G, Rinaldi M, Salizzoni S, Grossi C, Di Gregorio O, Arrigo C, Scoti P, Costa R, Casabona R, Del Ponte S, Panisi P, Spira G, Troise G, Messina A, Viganò M, Aiello M, Alfieri O, Denti P, Menicanti L, Agnelli B, Muneretto C, Frontini M, Rambaldini M, Frontini, Gamba A, Tasca G, Ferrazzi P, Terzi A, Antona C, Gelpi G, Martinelli L, Bruschi G, Chiara S, Graffigna A, Mazzucco A, Pappalardo A, Gatti G, Livi U, Pompei E, Parodi E, Bortolotti U, Pratali S, Stefano P, Blanzola C, Glauber M, Cerillo A, Chiaramonti F, Pardini A, Fioriello F, Torracca L, Rescigno G, De Paulis R, Nardella S, Musumeci F, Luzi G, Possati G, Bonalumi G, Covino E, Pollari F, Sinatra R, Roscitano A, Chiariello L, Nardi P, Lonobile T, Baldascino F, Di Benedetto G, Mastrogiovanni G, Piazza L, Marmo J, Vosa C, De Amicis V, Fazzi V, Villani M, Pano M, Cassese M, Antonazzo A, Patanè L, Gentile M, Tribastone S, Follis F, Montalbano G, Pilato M, Stringi V, Patanè F, Salamone G, Ruvolo G, Pisano C, Mignosa C, Bivona A, Cirio E, Lixi G. Author information: (1)Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy. Electronic address: (2)National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. (3)Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, and ETNA Foundation, Catania, Italy. (4)IRCCS Department of Anesthesia & Intensive Care, San Raffaele, Milan, Italy. (5)Department of Cardiothoracic and Vascular Anesthesia, Intensive Care Unit and Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. (6)Division of Cardiology, Careggi Hospital, Florence, Italy. (7)Department of Cardiovascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy. (8)Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.

Abstract BACKGROUND: Despite the widespread use of transcatheter aortic valve implantation (TAVI), the role of sex on outcome after TAVI or surgical aortic valve replacement (AVR) has been poorly investigated. We investigated the impact of sex on outcome after TAVI or AVR. METHODS: There were 2108 patients undergoing TAVI or AVR who were enrolled in the Italian Observational Multicenter Registry (OBSERVANT). Thirty-day mortality, major periprocedural morbidity, and transprosthetic gradients were stratified by sex according to interventions. RESULTS: Female AVR patients showed a worse risk profile compared with male AVR patients, given the higher mean age, prevalence of frailty score of 2 or higher, New York Heart Association class of 3 or higher, lower body weight, and preoperative hemoglobin level (P ≤ .02). Similarly, female TAVI patients had a different risk profile than male TAVI patients, given a higher age and a lower body weight and preoperative hemoglobin level (P ≤ .005), but with a similar New York Heart Association class, frailty score, EuroSCORE (P = NS), a better left ventricular ejection fraction and a lower prevalence of left ventricular ejection fraction less than 30%, porcelain aorta, renal dysfunction, chronic obstructive pulmonary disease, arteriopathy, and previous cardiovascular surgery or percutaneous coronary intervention (P ≤ .01). Women showed a smaller aortic annulus than men in both populations (P < .001). Female sex was an independent predictor in the AVR population for risk-adjusted 30-day mortality (odds ratio [OR], 2.34; P = .043) and transfusions (OR, 1.47; P = .003), but not for risk-adjusted acute myocardial infarction, stroke, vascular complications, permanent atrioventricular block (P = NS). Female sex was an independent predictor in the TAVI population for risk-adjusted major vascular complications (OR, 2.92; P = .018) and transfusions (OR, 1.93; P = .003), but proved protective against moderate to severe postprocedural aortic insufficiency (P = .018). CONCLUSIONS: Female sex is a risk factor for mortality after aortic valve replacement, for major vascular complications after TAVI, and for transfusions after both approaches.

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