Retrospective evaluation of circulating thyroid hormones in critically ill dogs with systemic inflammatory response syndrome

Massimo Giunti,Roberta Troia,Mara Battilani,Luciana Giardino,Francesco Dondi,Giulia Andreani,Federico Fracassi 대한수의학회 2017 Journal of Veterinary Science Vol.18 No.4

Critical illness can be associated with transient alterations in circulating thyroid hormone concentrations, indicating the presence of non-thyroidal illness (NTI). NTI is well described in humans, but there are few reports on its occurrence and prognostic significance in dogs. This retrospective study assessed the occurrence of NTI in a population of dogs with systemic inflammatory response syndrome (SIRS) and investigated its association with disease severity (APPLEfast scores). A total of 41 SIRS dogs were included and were divided by SIRS origin (non-septic SIRS, n = 10; septic SIRS, n = 41) and final outcome (survivors, n = 37; non-survivors, n = 4). Healthy, age-matched dogs (n = 15) were included as controls. Serum thyroid hormone levels including total T3, free T3, total T4, and reverse T3 were measured upon admission. Compared to controls, there were significant changes in serum thyroid hormone concentrations in SIRS dogs, suggesting the presence of NTI. Septic SIRS dogs had higher APPLEfast scores and lower serum thyroid hormones concentrations than those in non-septic SIRS and control dogs. In conclusion, NTI was frequent in dogs with SIRS and may be associated with the presence of sepsis or high illness severity.

Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture

Girardo Massimo,Massè Alessandro,Risitano Salvatore,Fusini Federico 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.4

Study DesignRetrospective comparative study.PurposeThis study aimed to compare clinical and radiological data and rate of mechanical complications in elderly patients treated with short segment (SSS) or long segment stabilization (LSS) for thoracolumbar junction osteoporotic vertebral fractures (OVFs).Overview of LiteratureA fervent debate is now focused on the treatment of OVF using SSS or LSS. High rate of complications is associated with pedicle screw fixation because of poor bone quality.MethodsPatients over 65 years old with a T-score of <−2.5, affected by (T10–L2) vertebral fracture treated with LSS or SSS pedicle screw fixation, with at least 24 months of follow-up were evaluated. All patients were analyzed with conventional X-ray to evaluate bisegmental kyphotic angle (BKA) and clinically with Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and rate of mechanical complications at 2, 6, 12, and 24 months. Data were expressed as mean±standard deviation. Student t-test was used to compare clinical scores between populations. Mann-Whitney U-test was used to analyze clinical and radiological variable, whereas Fisher’s exact test was used to identify differences in the rate of complications between groups.ResultsA total of 37 patients met the inclusion criteria. Mean follow-up was 33.97±9.26 months. For both groups, ODI and VAS significantly decreased over time with good results (p<0.00001). At the final follow-up, no significant differences were found in terms of ODI and VAS. There was no difference in correction of BKA between groups; however, a significant difference was found in LSS group between pre- and postoperative BKA (p=0.046), whereas no difference was found in SSS group. A significant difference in the rate of mechanical complications was found between groups (p=0.011).ConclusionsBoth treatments showed good clinical and radiological results; however, LSS group showed better BKA correction and lower mechanical complications than SSS group.

Explanation of trial sequential analysis: using a post-hoc analysis of meta-analyses published in Korean Journal of Anesthesiology

De Cassai Alessandro,Tassone Martina,Geraldini Federico,Sergi Massimo,Sella Nicolò,Boscolo Annalisa,Munari Marina 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.5

Background: Trial sequential analysis (TSA) is a recent cumulative meta-analysis method used to weigh type I and II errors and to estimate when the effect is large enough to be unaffected by further studies. The aim of this study was to illustrate possible TSA scenarios and their significance using meta-analyses published in the Korean Journal of Anesthesiology (KJA) as working material. Methods: We performed a systematic medical literature search for meta-analyses published in the KJA. TSA was performed on each main outcome, estimating the required sample size on the calculated effect size for the intervention, considering a type I error of 5% and a power of 90% or 99%. Results: Six meta-analyses with a total of ten main outcomes were included in the analysis. Seven TSAs confirmed the results of the meta-analyses. However, only three of them reached the required sample size. In the two TSAs, the cumulative z-lines were not statistically significant. One TSA boundary for effect was reached with the 90% analysis, but not with the 99% analysis. Conclusions: In TSA, a meta-analysis pooled effect may be established to assess if the cumulative sample size is large enough. TSA can be used to add strength to the conclusions of meta-analyses; however, pre-registration of the TSA protocol is of paramount importance. This study could be useful to better understand the use of TSA as an additional statistical tool to improve meta-analysis quality.

Accuracy of capillary blood 3-β-hydroxybutyrate determination for the detection and treatment of canine diabetic ketoacidosis

Francesca Bresciani,Marco Pietra,Sara Corradini,Massimo Giunti,Federico Fracassi 대한수의학회 2014 Journal of Veterinary Science Vol.15 No.2

In human medicine, diagnosis of diabetic ketoacidosis(DKA) is usually based on measurement of capillary3-β-hydroxybutyrate (3-HB) with a hand held ketonesensor. This study was conducted to determine ifmeasurement of capillary 3-HB could be useful for thediagnosis and monitoring of canine DKA. Fifteen dogs withdiabetic ketosis and 10 with DKA were evaluated. Pairedmeasurements of 3-HB of capillary and venous bloodsamples were analysed by the electrochemical sensor andreference method. Use of capillary 3-HB measurementduring DKA management was then evaluated throughsimultaneous measurements of capillary 3-HB, urinaryAcAc and venous blood gas analysis. Good agreementbetween capillary and venous 3-HB measurement wasdetected by the electrochemical sensor and referencemethod. Monitoring treatment of DKA revealed asignificant correlation between capillary 3-HB and acidosismarkers, while no significant correlation was observedbetween AcAc and acidosis markers. A cut-off value ofcapillary blood 3-HB >3.8 mmol/L for diagnosis of DKAresulted in 70% and 92% sensitivity and specificity. Theelectrochemical sensor accurately measures 3-HBconcentration in both capillary and venous blood samples, isaccurate in diagnosing canine DKA, and appears to reflectthe patient’s metabolic status during DKA treatment.

Rectosigmoid resection during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer: morbidity of gynecologic oncology vs. colorectal team

Roberto Tozzi,Gaetano Valenti,Daniele Vinti,Riccardo Garruto Campanile,Massimo Cristaldi,Federico Ferrari 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.3

Objective: This study investigates the specific morbidity of rectosigmoid resection (RSR)during Visceral-Peritoneal Debulking (VPD) in a consecutive series of patients with stage IIIC-IVovarian cancer and compares the results of the colo-rectal vs. the gynaecologic oncology team. Methods: All patients with the International Federation of Gynecology and Obstetrics(FIGO) stage IIIC–IV ovarian cancer who had VPD and RSR were included in the study. Between 2009 and 2013 all operations were performed by the gynecologic oncology teamalone (group 1). Since 2013 the RSR was performed by the colorectal team together withthe gynecologic oncologist (group 2). All pre-operative information and surgical detailswere compared to exclude significant bias. Intra- and post-operative morbidity events wererecorded and compared between groups. Results: One hundred and sixty-two patients had a RSR during VPD, 93 in group 1 and 69in group 2. Groups were comparable for all pre-operative features other than: albumin (1<2)hemoglobin (2<1) and up-front surgery (1>2). Overall morbidity was 33% vs. 40% (p=0.53),bowel specific morbidity 11.8% vs. 11.5% (p=0.81), anastomotic leak 4.1% vs. 6.1% (p=0.43)and re-operation rate 9.6% vs. 6.1% (p=0.71) in groups 1 and 2, respectively. None of themwere significantly different. The rate of bowel diversion was 36.5% in group 1 vs. 46.3% ingroup 2 (p=0.26). Conclusions: Our study failed to demonstrate any significant difference in the morbidity rateof RSR based on the team performing the surgery. These data warrant further investigation asthey are interesting with regards to education, finance, and medico-legal aspects.

Increased Incidence of Breast Cancer in Postmenopausal Women with High Body Mass Index at the Modena Screening Program

Federica Sebastiani,Laura Cortesi,Milena Sant,Valeria Lucarini,Claudia Cirilli,Elisabetta De Matteis,Isabella Marchi,Rossella Negri,Ennio Gallo,Massimo Federico 한국유방암학회 2016 Journal of breast cancer Vol.19 No.3

Purpose: We conducted a study to evaluate the relationship between body mass index (BMI) and the risk of breast cancer (BC) and outcome in a population of 14,684 women aged 55 to 69 years eligible to participate in the Mammography Screening Program (MSP) in the Province of Modena, Italy. Methods: The study population was drawn from women who underwent mammography screening between 2004 and 2006 in the Province of Modena. Women were subdivided into obese, overweight, and normal-weight categories according to BMI and followed until July 31, 2010, to evaluate the BC incidence. The clinicopathological characteristics of BC were also evaluated in different groups of patients classified according to BMI. After BC diagnosis, patients were followed for a median period of 65 (range, 2–104) months. Second events (recurrences and second tumors) were recorded, and the 5-year event-free survival (EFS) was calculated. Results: After a period of 73 months, 366 cases of BC were diagnosed. Compared with normal-weight women, obese women had a significantly higher incidence of BC (relative risk [RR], 1.32; p=0.040) (RR=1), larger tumors (27% of tumors were larger than T2 size), and more nodal involvement (38.5% of tumors were node-positive). Furthermore, a significantly higher rate of total events was seen in obese women compared with overweight and normal-weight patients, respectively (17.9% vs. 11.4% vs. 10.8%, p=0.032). The 5-year EFS was 89.0%, 89.0%, and 80.0% for normal-weight, overweight, and obese patients, respectively. Conclusion: We observed a significantly higher risk of BC in obese women among those eligible to participate in the MSP in the Province of Modena. Finally, obese women had more second events and poorer EFS compared to nono bese women.

Risk of Second Primary Malignancy in Breast Cancer Survivors: A Nested Population-Based Case-Control Study

Raffaella Marcheselli,Luigi Marcheselli,Laura Cortesi,Alessia Bari,Claudia Cirilli,Samantha Pozzi,Paola Ferri,Martina Napolitano,Massimo Federico,Stefano Sacchi 한국유방암학회 2015 Journal of breast cancer Vol.18 No.4

Purpose: Evolving therapies have improved the prognoses of patients with breast cancer; and currently, the number of longterm survivors is continuously increasing. However, these patients are at increased risk of developing a second cancer. Thus, late side effects are becoming an important issue. In this study, we aimed to investigate whether patient and tumor characteristics, and treatment type correlate with secondary tumor risk. Methods: This case-control study included 305 patients with a diagnosed second malignancy after almost 6 months after the diagnosis of primary breast cancer and 1,525 controls (ratio 1:5 of cases to controls) from a population-based cohort of 6,325 women. The control patients were randomly selected from the cohort and matched to the cases according to age at diagnosis, calendar period of diagnosis, disease stage, and time of followup. Results: BRCA1 or BRCA2 mutation, human epidermal growth factor receptor 2 (HER2)+ status, chemotherapy, and radiotherapy were related to increased risk of developing a second cancer, whereas hormonotherapy showed a protective effect. Chemotherapy, radiotherapy, and estrogenic receptor level <10% increased the risk of controlateral breast cancer. HER2+ status increased the risk of digestive system and thyroid tumors, while BRCA1 or BRCA2 mutation increased the risk of cancer in the genital system. Conclusion: Breast cancer survivors are exposed to an excess of risk of developing a second primary cancer. The development of excess of malignancies may be related either to patient and tumor characteristics, such as BRCA1 or BRCA2 mutation and HER2+ status, or to treatments factors.