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Gender-related differences in patients with carcinoid syndrome: new insights from an Italian multicenter cohort study.
Ruggeri, RM, Altieri, B, Razzore, P, Retta, F, Sperti, E, Scotto, G, Brizzi, MP, Zumstein, L, Pia, A, Lania, A, et al
Journal of endocrinological investigation. 2024;(4):959-971
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Abstract
BACKGROUND The incidence of neuroendocrine neoplasm (NEN) and related carcinoid syndrome (CaS) has increased markedly in recent decades, and women appear to be more at risk than men. As per other tumors, gender may be relevant in influencing the clinical and prognostic characteristics of NEN-associated CS. However, specific data on carcinoid syndrome (CaS) are still lacking. PURPOSE To evaluate gender differences in clinical presentation and outcome of CaS. METHODS Retrospective analysis of 144 CaS patients from 20 Italian high-volume centers was conducted. Clinical presentation, tumor characteristics, therapies, and outcomes (progression-free survival, PFS, overall survival, OS) were correlated to gender. RESULTS Ninety (62.5%) CaS patients were male. There was no gender difference in the site of primary tumor, tumor grade and clinical stage, as well as in treatments. Men were more frequently smokers (37.2%) and alcohol drinkers (17.8%) than women (9.5%, p = 0.002, and 3.7%, p = 0.004, respectively). Concerning clinical presentation, women showed higher median number of symptoms (p = 0.0007), more frequent abdominal pain, tachycardia, and psychiatric disorders than men (53.3% vs 70.4%, p = 0.044; 6.7% vs 31.5%, p = 0.001; 50.9% vs. 26.7%, p = 0.003, respectively). Lymph node metastases at diagnosis were more frequent in men than in women (80% vs 64.8%; p = 0.04), but no differences in terms of PFS (p = 0.51) and OS (p = 0.64) were found between gender. CONCLUSIONS In this Italian cohort, CaS was slightly more frequent in males than females. Gender-related differences emerged in the clinical presentation of CaS, as well as gender-specific risk factors for CaS development. A gender-driven clinical management of these patients should be advisable.
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The Effects of Online Home-Based Pilates Combined with Diet on Body Composition in Women Affected by Obesity: A Preliminary Study.
Greco, F, Tarsitano, MG, Cosco, LF, Quinzi, F, Folino, K, Spadafora, M, Afzal, M, Segura-Garcia, C, Maurotti, S, Pujia, R, et al
Nutrients. 2024;(6)
Abstract
Diet and exercise intervention are the first strategies to counteract obesity. An online home-based exercise program may be a feasible approach in an obese population. Therefore, this study aimed to investigate the effects of twelve weeks of online Pilates plus diet on body composition in individuals affected by obesity. Thirty-five females were randomly assigned to a home-based Pilates group (PG, n = 18) or a group without intervention (control group, CG, n = 17). All participants followed a Mediterranean diet. The PG followed a twelve-week online Pilates Matwork program (three times/week; 180 min/week), while the CG was not involved in any structured physical exercise program. Body composition and handgrip strength were evaluated at baseline (T0) and after the intervention (T1). A significant group × time interaction (p < 0.05) was found for the fat mass percentage (pFM). Specifically, the pFM was significantly lower at T1 than at T0 in the PG. Significant group × time interactions for fat-free mass (p < 0.05), appendicular skeletal muscle mass (p < 0.05), and skeletal muscle mass (p < 0.01) were found. All these variables were significantly higher at T1 than at T0 in the PG (p < 0.05). Home-based Pilates combined with diet intervention may represent an effective strategy to improve body composition in terms of fat mass reduction and muscle mass gain in adults affected by obesity.
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Topical anesthesia versus topical and subconjunctival anesthesia combined in diabetic retinopathy photocoagulation.
Mafrici, M, Fragiotta, S, Tarsitano, MG, Lorenzi, U, Toscani, L
European journal of ophthalmology. 2024;(2):529-533
Abstract
PURPOSE comparison between two anesthetic techniques on the ability to reduce pain during panretinal photocoagulation (PRP) treatment. METHODS Observational retrospective single center study. Medical charts of patients who underwent PRP for proliferative diabetic retinopathy were revised. Patients were included if they had the first eye treated with oxybuprocaine hydrochloride drops, and in case of severe pain, the fellow eye received topical anesthesia in combination with 2% subconjunctival lidocaine. The groups were compared for pain perception using an analog visual scale (VAS), number of laser spots, number of interruptions, and laser session duration. RESULTS Forty-two eyes of 21 patients (mean age: 58.3 ± 7.6 years) were analyzed. The mean number of laser spots was significantly higher under combined anesthesia (+84.2 ± 155.9 spots, p = 0.01), with a reduced time for laser execution (-2.5 ± 3.12, p = 0.0008). The use of combined anesthesia significantly decreased the number of interruptions (-40.8%, p < 0.0001) into a single session. On the pain grading scale, the pain perception was significantly lower in the combined anesthesia group (p < 0.0001). In eyes receiving topical anesthesia the treatment was stopped for pain in 5 eyes (23.8%), while 5 eyes under combined anesthesia presented subconjunctival hemorrhage (23.8%). CONCLUSION Using combined anesthesia in patients subjected to PRP appeared to reduce pain perception limiting the treatment duration and the interruptions for pain without significant complications. Further studies on a larger scale would be desirable to replicate such findings and standardize the analgesic procedures in ophthalmology.
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Therapeutic Fasting in Reducing Chemotherapy Side Effects in Cancer Patients: A Systematic Review and Meta-Analysis.
Ferro, Y, Maurotti, S, Tarsitano, MG, Lodari, O, Pujia, R, Mazza, E, Lascala, L, Russo, R, Pujia, A, Montalcini, T
Nutrients. 2023;(12)
Abstract
The aim of this study was to assess the available evidence regarding the effect of a variety of fasting-like regimens on preventing chemotherapy-related side effects. PubMed, Scopus and Embase were used to select the studies for this review, which concluded on 24 November 2022. All types of clinical trials and case series reporting chemotherapy toxicity associated with fasting regimens and any comparison were considered. A total of 283 records were identified, of which 274 were excluded, leaving only nine studies that met the inclusion criteria. Five of these trials were randomized. Overall, moderate to high-quality evidence showed that several fasting regimens did not provide benefits compared to a conventional diet or other comparators in reducing the risk of adverse events. The overall pooled estimate for a variety of fasting regime when compared to non-fasting, indicated no significant difference in the side effects (RR = 1.10; 95% CI: 0.77-1.59; I2 = 10%, p = 0.60), including neutropenia alone (RR = 1.33; 95% CI: 0.90-1.97; I2 = 0%, p = 0.15). A sensitivity analysis confirmed these results. Based on our systematic review and meta-analysis, there is currently no evidence supporting the superiority of therapeutic fasting over non-fasting in preventing chemotherapy toxicity. The development of cancer treatment that do not entail toxicities remains imperative.
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Adherence to the Mediterranean Diet in Preventing Major Cardiovascular Events in Patients with Ischemic Heart Disease: The EVA Study.
Cangemi, R, Miglionico, M, D'Amico, T, Fasano, S, Proietti, M, Romiti, GF, Corica, B, Stefanini, L, Tanzilli, G, Basili, S, et al
Nutrients. 2023;(14)
Abstract
BACKGROUND Adherence to healthy dietary patterns, such as the Mediterranean diet (Med-diet), is recommended for the maintenance of cardiovascular health. The determinants for adherence to Med-diet and its importance in secondary cardiovascular disease prevention are still unclear. The aim of the study was to evaluate the influence of sex- and psycho-socio-cultural (i.e., gender-related) factors on Med-diet adherence and its role in preventing major cardiovascular events (MACEs) in patients with ischemic heart disease (IHD). METHODS Med-diet adherence was evaluated among 503 consecutive adults with IHD. MACEs were collected during a long-term follow-up. RESULTS Male Bem Sex-Role Inventory score (i.e., male personality traits) and physical functional capacity were associated with higher adherence, while cohabitation with a smoker and physical inactivity with poorer adherence. During a median follow-up of 22 months, 48 participants experienced MACEs (17.5%, 8.1%, and 3.9% of patients with low, medium, and high adherence, respectively; p = 0.016). At multivariate Cox--regression analysis, a greater adherence remained inversely associated with MACEs (HR: 0.49; 95% CI: 0.29-0.82; p = 0.006) after adjusting for confounding factors. CONCLUSION The study suggests that gender-related factors have a role in maintaining a healthy dietary pattern. Improving Med-diet adherence may lower the risk of recurring cardiovascular events.
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Knowledge, experiences, and perceptions relating to obesity management among primary care physicians in the Lazio Region, Italy.
Guglielmi, V, Capoccia, D, Russo, B, Lubrano, C, Mariani, S, Poggiogalle, E, Furia, G, Alizadeh, AH, Patrizi, C, Sapienza, M, et al
Frontiers in endocrinology. 2023;:1249233
Abstract
BACKGROUND Primary care providers (PCPs) play an essential role in obesity care as they represent the first contact for patients seeking weight loss interventions. OBJECTIVE This study explored the knowledge, experiences, and perceptions of PCPs in the Lazio Region of Italy in the management of obesity. DESIGN AND SUBJECTS We conducted an anonymous survey delivered from March to July 2022 via the newsletter of Rome Provincial Order of Physicians and Dentists and at the annual meeting of the regional section of the Italian Obesity Society. APPROACH The survey consisted of 24 closed-ended questions grouped into 5 sections: sociodemographic and work information; assessment of obesity; management of obesity; connections with regional Centres for Obesity Management; attitudes towards obesity. KEY RESULTS A total of 92 PCPs accessed the survey. Of those, 2.2% were excluded because they did not see any patients with obesity. A total of 68 PCPs (75.6%) had complete questionnaires and were included in this analysis. All participants reported asking their patients about their eating habits, lifestyle, and clinical complications at the first assessment. Body weight and blood pressure were measured by 98.5% of participants and 82% calculate body mass index (BMI), while a small proportion of PCPs analysed body composition and fat distribution. Over 80% prescribed laboratory tests and ECG. Approximately 40% of PCPs did not refer patients for nutritional counselling, and most prescribed a low-calorie diet. Sixty-three percent referred patients to an endocrinologist, 48.5% to a psychotherapist, and a minority to specialists for obesity complications. Twenty-three percent prescribed anti-obesity medications and 46.5% referred patients for bariatric surgery only in severe cases. Ninety-one percent stated that obesity is "a complex and multifactorial disease" and 7.4% considered obesity to be secondary to other conditions. CONCLUSIONS Despite most PCPs adopt a correct approach to manage patients with obesity, many aspects could be improved to ensure optimal and multidisciplinary management.
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Effects of licorice on sex hormones and the reproductive system.
Minnetti, M, De Alcubierre, D, Bonaventura, I, Pofi, R, Hasenmajer, V, Tarsitano, MG, Gianfrilli, D, Poggiogalle, E, Isidori, AM
Nutrition (Burbank, Los Angeles County, Calif.). 2022;:111727
Abstract
OBJECTIVES The potential clinical effects of licorice (Glycyrrhiza spp.) and its extracts have been investigated since ancient times. Whether pseudohyperaldosteronism, with consequent arterial hypertension, is the only endocrine effect produced by licorice is uncertain, and a role in the reproductive system has been proposed. This review aimed to summarize the current knowledge on the pharmacologic effects of licorice on male and female reproductive systems. METHODS Overall, 1462 records were extracted from electronic databases and systematically examined. A total of 28 studies were included in the final analysis. RESULTS Preclinical and clinical studies revealed estrogen-like activity of licorice components, especially flavonoids, isoflavonoids, and chalcones, showing a potential role of licorice in ameliorating symptoms associated with estrogen insufficiency. Preclinical studies also showed weak antiandrogen properties and beneficial effects of licorice on gonadal function in both sexes, but clinical studies yield to poor and conflicting results depending on the type and dose of licorice. CONCLUSIONS Licorice consumption can affect the reproductive system. However, its role needs to be further explored, especially due to the great variability of bioactive compounds used in existing studies.
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Advances in Phenotyping Obesity and in Its Dietary and Pharmacological Treatment: A Narrative Review.
Pujia, R, Tarsitano, MG, Arturi, F, De Lorenzo, A, Lenzi, A, Pujia, A, Montalcini, T
Frontiers in nutrition. 2022;:804719
Abstract
In recent times, it has become evident that there are individuals who, from a metabolic point of view, are affected by obesity but have a normal body mass index. There are also metabolically healthy individuals with a high body mass index who are thus are considered as to be affected by obesity obese. Understanding that individuals with obesity are phenotypically heterogeneous is a relatively novel concept which, although present in the scientific literature, unfortunately has not yet had an impact in clinical practice. However, common dietary approaches are not effective in treating large numbers of obese patients with obesity. This narrative review, based on the material searched via PubMed and the Web of Science up to October 2021, proposes a downsizing of the role of the body mass index in identifying the individual with "true obesity" since it is only partially useful, and suggests a new approach which also integrates the body composition and assessment of metabolic parameters. This approach leads to personalized therapies that work best for each obesity phenotype in reducing the risk of non-communicable diseases.
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Safety and efficacy of continuous or intermittent enteral nutrition in patients in the intensive care unit: Systematic review of clinical evidence.
De Lazzaro, F, Alessandri, F, Tarsitano, MG, Bilotta, F, Pugliese, F
JPEN. Journal of parenteral and enteral nutrition. 2022;(3):486-498
Abstract
The best mode of delivering enteral nutrition (EN) in the intensive care unit (ICU) is still debated: several consensus guidelines (American Society for Parenteral and Enteral Nutrition [ASPEN] and the European Society for Parental and Enteral Nutrition [ESPEN]) suggest that EN in ICU should be preferably delivered continuously rather intermittently, but some authors highlight that the first is unphysiological. The aim of this systematic review (SR) is to summarize available clinical evidence related to safety and efficacy of continuous EN (C-EN) or intermittent EN (I-EN) in patients in the ICU, in relation to appropriated supply on nutrition status, gastrointestinal symptoms or tolerance, and risks on respiratory tract infections. A literature search of PubMed, EMBASE, and Google Scholar was performed comparing C-EN vs I-EN, and 4196 published studies were screened. Nineteen studies were selected for this SR reporting types of ICU, nutrition protocols, and study period. Effects of C-EN vs I-EN were presented according to the impact on nutrition status, digestive tract, and respiratory tract. The contrasting results confirmed that the optimal delivering mode of EN remains controversial. Future studies dedicated to identifying the benefits and limitations of C-EN or I-EN should be realized.
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Epicardial Adipose Tissue: A Novel Potential Imaging Marker of Comorbidities Caused by Chronic Inflammation.
Tarsitano, MG, Pandozzi, C, Muscogiuri, G, Sironi, S, Pujia, A, Lenzi, A, Giannetta, E
Nutrients. 2022;(14)
Abstract
The observation of correlations between obesity and chronic metabolic and cardiovascular diseases has led to the emergence of strong interests in "adipocyte biology", in particular in relation to a specific visceral adipose tissue that is the epicardial adipose tissue (EAT) and its pro-inflammatory role. In recent years, different imaging techniques frequently used in daily clinical practice have tried to obtain an EAT quantification. We provide a useful update on comorbidities related to chronic inflammation typical of cardiac adiposity, analyzing how the EAT assessment could impact and provide data on the patient prognosis. We assessed for eligibility 50 papers, with a total of 10,458 patients focusing the review on the evaluation of EAT in two main contexts: cardiovascular and metabolic diseases. Given its peculiar properties and rapid responsiveness, EAT could act as a marker to investigate the basal risk factor and follow-up conditions. In the future, EAT could represent a therapeutic target for new medications. The assessment of EAT should become part of clinical practice to help clinicians to identify patients at greater risk of developing cardiovascular and/or metabolic diseases and to provide information on their clinical and therapeutic outcomes.