University of Siena

About: University of Siena is a education organization based out in Siena, Italy. It is known for research contribution in the topics: Population & Cancer. The organization has 12179 authors who have published 33334 publications receiving 1008287 citations. The organization is also known as: Università degli studi di Siena & Universita degli studi di Siena.

Intravenous immunoglobulin versus intravenous methylprednisolone for chronic inflammatory demyelinating polyradiculoneuropathy: a randomised controlled trial

Abstract: Summary Background Intravenous immunoglobulin (IVIg) and corticosteroids are effective as initial treatment in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but little is known about the comparative risk–benefit profile of their long-term use in this disease. We compared the efficacy and tolerability of 6-month therapy with IVIg versus that with intravenous methylprednisolone. Methods We did a multicentre, randomised, double-blind, placebo controlled, parallel-group study in patients with CIDP. We assessed efficacy and tolerability of IVIg (0·5 g/kg per day for 4 consecutive days) and intravenous methylprednisolone (0·5 g in 250 mL sodium chloride solution per day for 4 consecutive days) given every month for 6 months. Eligible patients had to be in an active or stationary phase of the disease. Allocation to treatment was centrally managed with a computer-generated, 1:1 randomisation scheme with a sequential block size of four. All patients and assessors were unaware of the treatment assignment. After therapy discontinuation, patients were followed up for 6 months to assess relapses. The primary outcome was the difference in the number of patients discontinuing either therapy owing to inefficacy or intolerance. Secondary endpoints included the difference in the proportion of patients experiencing adverse events or worsening after therapy discontinuation. This study is registered with EUDRACT, number 2005-001136-76. Findings 45 patients (24 IVIg, 21 intravenous methylprednisolone) completed the study; one was excluded for inappropriate inclusion. More patients stopped methylprednisolone (11 [52%] of 21) than IVIg (three [13%] of 24; relative risk 0·54, 95% CI 0·34–0·87; p=0·0085). When adjusted for sex, age, disease duration, comorbidity, modified Rankin scale and ONLS scores at enrolment, and previous treatment with IVIg and steroids, the difference between the two groups remained significant (odds ratio 7·7, 95% CI 1·7–33·9; p=0·0070). Reasons for discontinuation were lack of efficacy (eight in the methylprednisolone group vs three in the IVIg group), adverse events (one in the methylprednisolone group), or voluntary withdrawal (two in the methylprednisolone group). Two patients on IVIg died during follow-up after the 6-month assessment. The proportion of patients with adverse events did not differ between the intravenous methylprednisolone group (14 [67%] of 21) and the IVIg group (11 [46%] of 24; p=0·1606). After therapy discontinuation, more patients on IVIg worsened and required further therapy (eight [38%] of 21) than did those on methylprednisolone (none of ten; p=0·0317). Interpretation Treatment of CIDP with IVIg for 6 months was less frequently discontinued because of inefficacy, adverse events, or intolerance than was treatment with intravenous methylprednisolone. The longer-term effects of these treatments on the course of CIDP need to be addressed in future studies. Funding Kedrion.

Accumulation Pattern of Butyltin Compounds in Dolphin, Tuna, and Shark Collected from Italian Coastal Waters

Abstract: Tributyltin (TBT) and its breakdown products, mono-(MBT) and dibutyltin (DBT) were determined in bottlenose dolphin (Tursiops truncatus), bluefin tuna (Thunnus thynnus thynnus) and blue shark (Prionace glauca) collected from the Italian coast of the Mediterranean Sea in 1992–1993. Concentrations of total butyltin (BTs) in the liver of dolphin (1,200–2,200 ng/g wet wt) were an order of magnitude higher than in the blubber (48–320 ng/g wet wt). TBT was the predominant butyltin species in the blubber while DBT accounted for an higher proportion in the liver of dolphins. Butyltin concentrations in bluefin tuna were lower than those in dolphins, with TBT highest in the muscle and DBT in the liver. Concentrations of BTs in blue sharks were lower than those in dolphin and tuna, with kidney having the highest concentrations. TBT was the predominant form of butyltin derivatives in all the tissues of shark. Accumulation of butyltin compounds in liver/kidney seems to be associated with the presence of proteins such as glutathione.

A Comparison of 1850 (50 mCi) and 3700 MBq (100 mCi) 131-Iodine Administered Doses for Recombinant Thyrotropin-Stimulated Postoperative Thyroid Remnant Ablation in Differentiated Thyroid Cancer

Abstract: Objective: Recently, a multicenter study in differentiated thyroid cancer (DTC) patients showed that 3700 MBq 131-iodine (131I) after recombinant human TSH (rhTSH) had a successful thyroid ablation rate similar to that obtained after thyroid hormone withdrawal. We investigated whether 1850 MBq 131I had a similar successful rate to 3700 MBq in patients prepared with rhTSH. Design: A total of 72 patients with DTC were randomly assigned to receive 1850 (group A, n = 36) or 3700 MBq (group B, n = 36) 131I after rhTSH. One injection of 0.9 mg rhTSH was administered for 2 consecutive days; 131I therapy was delivered 24 h after the last injection, followed by a posttherapy whole-body scan. Successful ablation was assessed 6–8 months later. Results: Successful ablation (no visible uptake in the diagnostic whole-body scan after rhTSH stimulation) was achieved in 88.9% of group A and B patients. Basal and rhTSH-stimulated serum thyroglobulin was undetectable (<1 ng/ml) in 78.9% of group A and 66.6% of group B patie...

Ultrafast Radiationless Deactivation of Organic Dyes: Evidence for a Two-State Two-Mode Pathway in Polymethine Cyanines

Abstract: CASSCF quantum chemical calculations (including dynamics) have been used to investigate the ultrafast photoisomerization of three symmetric cyanine dye models of different chain lengths. For the “model” trimethine cyanine, the photochemical isomerization path can be divided into two phases: initial barrierless skeletal stretching coupled with torsional motion and the decay process that takes place in the region of the twisted intramolecular charge-transfer (TICT) minimum state with an adjacent conical intersection. The path is consistent with both biexponential decay of fluorescence without rise time at short wavelengths and the rise time followed by monoexponential decay at long wavelengths observed in time-resolved experiments. For penta- and heptamethine cyanines, the photoisomerization about different C−C bonds is shown to be an activated process, where the torsional reaction path terminates, again, at a TICT state and the decay takes place at a twisted S1/S0 conical intersection. In agreement with t...

Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes.

Abstract: STUDY QUESTION What is the relationship between endometriosis phenotypes superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), deep infiltrating endometriosis (DIE) and the adenomyosis appearance by magnetic resonance imaging (MRI)? SUMMARY ANSWER Focal adenomyosis located in the outer myometrium (FAOM) was observed more frequently in women with endometriosis, and was significantly associated with the DIE phenotype WHAT IS KNOWN ALREADY An association between endometriosis and adenomyosis has been reported previously, although data regarding the association between MRI appearance of adenomyosis and the endometriosis phenotype are currently still lacking STUDY DESIGN, SIZE, DURATION This was an observational, cross-sectional study using data prospectively collected from non-pregnant patients who were between 18 and 42 years of age, and who underwent surgery for symptomatic benign gynecological conditions between January 2011 and December 2014 For each patient, a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon during the month preceding the surgery Only women with preoperative standardized uterine MRIs were retained for this study PARTICIPANTS/MATERIALS, SETTING, METHODS Surgery was performed on 292 patients with signed consent and available preoperative MRIs After a thorough surgical examination of the abdomino-pelvic cavity, 237 women with histologically proven endometriosis were allocated to the endometriosis group and 55 symptomatic women without evidence of endometriosis to the endometriosis free group The existence of diffuse or FAOM was studied in both groups and according to surgical endometriosis phenotypes (SUP, OMA and DIE) MAIN RESULTS AND THE ROLE OF CHANCE Adenomyosis was observed in 599% (n = 175) of the total sample population (n = 292) Based on MRI, the distribution of adenomyosis was as follows: isolated diffuse adenomyosis (53 patients; 182%), isolated FAOM (74 patients; 253%), associated diffuse and FAOM (48 patients; 164%) Diffuse adenomyosis (isolated and associated to FAOM) was observed in one-third of the patients regardless of whether they were endometriotic patients or endometriosis free women taken as controls (342% (81 cases) versus 364% (20 cases)); P = 0764 Among endometriotic women, diffuse adenomyosis (isolated and associated to FAOM) failed to reach significant correlation with the endometriosis phenotypes (SUP, 200% (8 cases); OMA, 452% (14 cases) and DIE, 355% (59 cases); P = 0068) In striking contrast, there was a significant increase in the frequency of FAOM in endometriosis-affected women than in controls (119 cases (502%) versus 54% (3 cases); P < 0001) FAOM correlated with the endometriosis phenotypes, significantly with DIE (SUP, 75% (3 cases); OMA, 193% (6 cases) and DIE, 663% (110 cases); P < 0001) LIMITATIONS, REASONS FOR CAUTION There was a possible selection bias due to the specificity of the study design, as it only included surgical patients in a referral center that specializes in endometriosis surgery Therefore, women referred to our center may have suffered from particularly severe forms of endometriosis This could explain the high number of women with DIE (166/237-70%) in our study group This referral bias for women with severe lesions may have amplified the difference in association of FAOM with the endometriosis-affected patients compared to women without endometriosis Furthermore, according to inclusion criteria, women in the endometriosis free group were symptomatic women This may introduce some bias as symptomatic women may be more prone to have associated adenomyosis that in turn could have been overrepresented in the endometriosis free group Whether this selection could have introduced a bias in the relationship between endometriosis and adenomyosis remains unknown WIDER IMPLICATIONS OF THE FINDINGS This study opens the door to future epidemiological, clinical and mechanistic studies aimed at better characterizing diffuse and focal adenomyosis Further studies are necessary to adequately determine if diffuse and focal adenomyosis are two separate entities that differ in terms of pathogenesis STUDY FUNDING/COMPETING INTEREST(S) No funding supported this study The authors have no conflict of interest to declare