Objective
To assess frequency, types, and mechanisms of comorbidities in people with epilepsy and verify their association with disease features and outcome.
Methods
This cohort study was performed ...in 13 Italian epilepsy centers with nationwide distribution and accurate records. Eligible patients were children and adults diagnosed before December 31, 2005, and followed for a minimum of 10 years. Two pairs of raters independently reviewed patients’ records and classified each comorbidity. In case of disagreement, a third reviewer made the final decision. Comorbidities were classified according to type (organ/system) and underlying mechanism (causal, shared risk factors, chance association). Comorbidity types and mechanisms were described in the entire sample and according to epilepsy prognostic patterns (sustained remission, relapsing‐remitting course, no remission).
Results
Of 1006 included patients, 266 (26.4%) had at least one comorbidity. The most common were developmental/perinatal (7.5% of cases), psychiatric (6.2%), cardiovascular (5.3%), and endocrine/metabolic (3.8%). Among 408 reported comorbidities, the underlying mechanisms were, in decreasing order, chance association (42.2%), shared risk factors (31.1%), and causal (26.7%). Psychiatric diseases were present in 13.3% of patients with no remission, 5.9% of patients with relapsing‐remitting course, and 4.8% of patients with sustained remission (p = .016). The corresponding numbers for endocrine/metabolic diseases were respectively, 9.6%, 3.4%, and 2.9% (p = .013); for respiratory diseases were 3.6%, .3%, and .3% (p = .001), and for urogenital diseases were 3.6%, .7%, and 1.6% (p = .048). The association of endocrine/metabolic, psychiatric, and respiratory comorbidities with epilepsy prognosis was confirmed by multivariable analysis adjusted for the main demographic and clinical variables, with patients with these comorbidities showing a lower probability of achieving remission.
Significance
Comorbidities in epilepsy are not uncommon and reflect differing underlying mechanisms. Psychiatric, endocrine/metabolic, and respiratory disorders are associated with a worse long‐term epileptological outcome.
•1/3 of patients with epilepsy in remission stopped antiepileptic drugs.•Treatment stop was associated with younger age and normal psychiatric examination.•The cumulative probability of relapse was ...53% at ten years.•Relapse was associated with age 14+ years and documented etiology of seizures.•Treatment stop should not be excluded but considered in selected cases.
To compare withdrawal of antiseizure medications (ASM) to continued treatment in newly diagnosed individuals achieving seizure freedom, and assess the risk of relapse and factors associated with relapse.
This is a multicenter retrospective cohort study with long-term follow-up. Patients with newly diagnosed epilepsy were identified from the medical records of 13 Italian epilepsy centers and followed up until the most recent visit or death. Seizure-free patients discontinuing treatment were compared to patients who maintained treatment for baseline characteristics. Treatment was stopped upon clinical judgment. The probability of relapse was calculated with the Kaplan–Meier method. Demographic, clinical, and instrumental variables associated with relapse were assessed with Cox proportional hazards models.
One thousand and six patients aged 1 month to 72 years at diagnosis were enrolled and followed up for 17,892 person-years (median follow-up, 9.9 years). Three hundred and twenty patients (31.8%) underwent one or more treatment discontinuations. Factors associated with ASM withdrawal were younger age at remission and normal psychiatric examination. The probability of relapse after the first withdrawal was 16% at six months, 24% at 12 months, and 36%, 45%, and 53% at three, five, and ten years, respectively. The probability of remission after the first relapse was 59% at one month, 67%, 72, and 76% at three, six, and 12 months, respectively. Variables associated with relapse were age 14+ years, structural etiology, abnormal neuroimaging, ASM initiation after a single seizure, and symptomatic/cryptogenic epilepsy.
About one half of seizure-free patients stopping ASM relapse in 10 years. However, the possibility of remission after relapse is high, particularly in children and patients with idiopathic/cryptogenic epilepsy. Treatment deprescription might be encouraged at least in these patients.
Papers presented at the panel "The spatial ramifications of religion: new and traditional legal challenges " held at the Annual Conference 2022 of EuARe (European Academy of Religion), which took ...place in Bologna from 20th to 23rd June 2022 and was organised by FSCIRE.
Previous studies have suggested that mucosal height is related to the bone level and soft tissue thickness. The purpose of this pilot study was to investigate the ratio between the height and width ...of the tissues around single implants with a conical connection and platform switching.
All patients receiving single implants (Anyridge
, MegaGen, Gyeongbuk, South Korea) and restored with single crowns, in a three-month period, were included in this study. After a provisionalization of 12 months, precision impressions were taken and stone casts were poured for measurements. For each implant, two values were collected at the buccal site: the mucosal height (MH), calculated from the vestibular shoulder of the implant to the upper gingival margin of the supra-implant tissue; and the mucosal thickness (MT), calculated from the vestibular shoulder of the analogue to the external mucosa point perpendicular to the implant major axis. Mean, standard deviation (SD), and confidence intervals (CI 95%) for MH and MT, as well as their ratios, were calculated. Correlation between MH and MT was assessed by Pearson's correlation coefficient, with significance level set at 0.05.
32 single Anyridge
implants were eligible for this evaluation. The mean MH was 3.44 mm (±1.28), the mean MT was 3.29 (±1.46). The average of the ratio between MH and MT of the supra-implant mucosa was therefore 1:1.19 (±0.55). The relation between MH and MT was statistically significant at p ≤ 0.01 (Pearson two-tailed 95% CI).
Our study found a constant relationship between width and height of the peri-implant mucosa. However, our results are different from those of Nozawa et al., who found a ratio of 1:1.5 between height and thickness of the peri-implant tissues. This may be determined by the different sample and follow-up period, as well as by the implants used in our study.
Abstract Background: Epithelial ovarian cancer (EOC) is the second cause of death among gynaecological cancersworldwide. Mucinous ovarian carcinoma (mEOC) accounts for 3-5% of all EOCs, and when ...diagnosed at anadvanced stage its prognosis is very poor mainly for its limited chemosensitivity. PLK1 is a member of thewell-conserved serine/threonine kinase family, that plays a key role in the progression of mitosis, in the G2/Mcheckpoint regulation, DNA damage replication, stress response, and cell death pathways. mEOC has beenshown to be sensitive to PLK1 inhibition both with siRNA and small molecule inhibitor (onvansertib). Giventhis background and the need for new therapeutic approaches in mEOC, the purposes of this work were toidentify new therapeutic targets in mEOC using CRISPR/Cas9 lentivirus libraries and to find synthetic lethalpartners with the PLK1 inhibitor onvansertib. Methods: We used three different mucinous cell lines: MCAS,EFO27, TOV2414, overexpressing Cas9 gene. We evaluated the Cas9 expression through Western Blotanalysis, and the Cas9 activity through a Fluorescent Activated Cell Sorter- based-GFP assay. We used twodifferent lentiviral gRNAs Libraries (Bassik Library Human CRISPR Deletion Library - Apoptosis and cancer(Addgene #101926)/Drug targets, kinases, and phosphatases (Addgene #101927)). The EFO27 Cas9 cells wereused for the screening experiment. Cells were infected with the lentiviral libraries at MOI of 0.3 and put inpuromycin selection. Six days after puromycin addition (Time point 0) 30x10^6 cells were collected forsequencing. The remaining 30x10^6 cells were split in two: control cells and cells treated with a subtoxic doseof onvansertib (IC30). After 7 days (Time point 1) 30x10^6 cells for each condition were collected forsequencing. The infection of libraries was performed alone and in combination with sub-toxic onvansertibtreatment, to identify genes important for mucinous carcinoma cell survival, and those genes in syntheticlethality with onvansertib. Results: Bioinformatic analyses comparing control cells (time 1 vs time 0) andPLK1 treated and non -treated cells (time 1) allowed the generation of a gene ranking list, including genesinvolved in survival of EFO27 cells like ZC2HC1C, RPA2, POLE3, KIN, TUBG1, SMC2, CDC26, CDC42, HOXA9,TAF10, DCLRE1C, SENP1, MRPS31, COPS2; and genes in synthetic lethality with PLK1 treatment, like JUND,CARD9, BCL2L2. Validation experiments are ongoing and will be presented and discussed. Conclusion: Using a CRISPR-based approach, we identified genes that either alone or in combination with PLK inhibitioncould have therapeutic value in mEOC. Citation Format: Serena Petrella, Marika Colombo, Mirko Marabese, Chiara Grasselli, Andrea Panfili, Ilaria Craparotta, Maria Chiara Barbera, Giada Andrea Cassanmagnago, Marco Bolis, Giovanna Damia. The identification of new therapeutic targets in mucinous ovarian carcinoma abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4685.
Summary
Objective
The new epilepsy definition adopted by the International League Against Epilepsy (ILAE) includes patients with one unprovoked seizure with a probability of further seizures, similar ...to the general recurrence risk after two unprovoked seizures, occurring in a 10‐year period. Long‐term follow‐up of patients diagnosed after a single seizure is needed to assess the applicability of the new epilepsy definition in clinical practice.
Methods
Patients with newly diagnosed epilepsy were recruited retrospectively with a minimum follow‐up of 10 years. Patients were stratified in two groups depending on the occurrence of one (new definition, ND) or two or more unprovoked seizures (traditional definition, TD) at the time of epilepsy diagnosis and compared for disease characteristics and factors predicting seizure recurrence. The primary outcome was the occurrence of a new unprovoked seizure during follow‐up in the ND group. The secondary outcome was the achievement of an early remission in both groups.
Results
Among 1,006 patients with newly diagnosed epilepsy, 152 (15.1%) were diagnosed after a single seizure. Compared to patients diagnosed using the TD, patients diagnosed according to the ND showed a higher proportion of subjects with an abnormal neurologic examination (19.9% vs. 13.7%, p = 0.0504) and with focal seizures (69.3% vs. 60.4%, p = 0.0021). The two samples differed in the presence of at least one of the factors predicting seizure recurrence (focal seizures or abnormal findings in at least one among the following: neurologic examination, electroencephalography EEG, and neuroimaging) (94.6% vs. 89.1%, p = 0.0376). Long‐term recurrence in patients diagnosed with the new definition was 83.6% at 10 years and 89.1% at 15 years. The probability of early remission did not differ between the two groups.
Significance
Our results support the applicability of the new epilepsy definition in clinical practice. Individual patient characteristics and a personalized diagnostic approach can justify treatment after a single unprovoked seizure.
▪
Background Immunotherapy using patient-derived CAR T cells has achieved complete remission and durable response in highly refractory populations. However, logistical complexity and high costs of ...manufacturing autologous viral products limit CAR T cell availability. Allogeneic Cytokine Induced Killer (CIK) cells, a T-cell population characterized by the enrichment of CD3+CD56+ cells, have demonstrated a high profile of safety in acute lymphoblastic leukemia (ALL) patients (Introna M et al. Biol Blood Marrow Transplant. 2017). CIK cells could be easily engineered by the non-viral Sleeping Beauty (SB) transposon for the clinical application (Magnani CF et al, Hum Gene Ther. 2018, Biondi A et al. J Autoimmun. 2017).
Methods CIK cells were generated from 50 ml of donor-derived peripheral blood (PB) by electroporation with the GMP-grade CD19.CAR/pTMNDU3 and pCMV-SB11 plasmids according to the method enclosed in the filed patent EP20140192371. After lymphodepletion with Fludarabine (30 mg/m2/day) x 4 days and Cyclophosphamide (300 mg/m2/day) x 2 days, CARCIK-CD19 were infused in pediatric and adult B-cell ALL (B-ALL) patients relapsed after allogeneic hematopoietic stem cell transplantation (HSCT). The clinical trial follows a four-dose escalation scheme (1x106, 3x106, 7.5x106 and 15x106 transduced CAR+ T cells/kg) using the novel Bayesian Optimal Interval Design (BOIN). During the cell manufacturing period, bridging anti leukemic therapy from patient registration to the beginning of the lymphodepletion, was allowed. The primary endpoint was to define the Maximum Tolerated Dose (MTD) and a safety assessment. Key secondary endpoints included the assessment of complete hematologic response (CR), defined as < 5% bone marrow (BM) blasts, circulating blasts < 1%, no clinical evidence of extramedullary disease, as well as the characterization of CARCIK-CD19 persistence in PB and BM (NCT03389035).
Results We manufactured eighteen batches by seeding a median of 126.8x106 allogeneicPBMCs. At the end of expansion, the mean harvesting was 6.46x109 nucleated cells (range 1.39 - 16.00x109). Manufactured cells were mostly CD3+ lymphocytes (mean 98.90% ±SE 0.30%). Of these, 43.57%±3.73% were CAR+, 47.07%±2.74% were CD56+, 80.44%±2.53% were CD8+. The quality requirements for batch release were met in 17 productions. As of the data cut-off date (July 19, 2019), 4 pediatric and 7 adult patients were infused with a single dose of CARCIK-CD19 (n=2 HLA identical sibling, n=4 MUD, n=5 haploidentical donor). The leukemic burden in the BM post lymphodepletion/pre-infusion ranged from 0% to 96%. CARCIK-CD19 were characterized by a high profile of safety in all treated patients. Toxicities reported were a grade I cytokine release syndrome and an infusion-related DMSO-associated seizure, with absence of dose-limiting toxicities, neurotoxicity and graft-versus-host disease (GvHD) in any of the treated patients. Four out of 5 patients, receiving the highest doses, achieved CR and CRi at day 28. The 3 patients in CR were also MRD- (by flow cytometry and RT-PCR) while the CRi was MRD+ and relapsed at day+49. Robust expansion was achieved in the majority of the patients as defined by detectable CAR T-cell detection (vector copy number VCN, range 4645-977992 transgene copies/ug) and flow (range 0.5-30%) in PB. The median time to peak engraftment was 14 days. The magnitude of expansion was correlated with the CD19+ burden in the BM at the time of the infusion (P value = 0.0006, R square 0.7469). CD8+ T cells represented the predominant CARCIK-CD19 T-cell subset (78.88%±5.33% d14 n=6) along with CD3+CD56+ CIK cells and CD4+ T cells to a lesser extent. The majority of CAR T cells had a central and effector memory phenotype. CAR T cells were measurable by VCN up to 6 months with a mean persistence of 70.5 ± 14.85 days (follow up ranging from 28 days to 1 year). No major difference was observed by integration analyses of the patients' PB and the cell products. The vector integration sites reflected the classical random distribution of SB without any tendency for gene dense regions.
Conclusions Our ongoing phase I/II trial demonstrates that SB-engineered CARCIK-CD19 cells are able to expand and persist in pediatric and adult B-ALL patients relapsed after HSCT, with important implications for a non-viral technology. These encouraging results prompted us to expand our study.
Gritti:Autolus Ltd: Honoraria; Roche: Other: Not stated; Abbvie: Other: Not stated; Becton Dickinson: Other: Not stated. Rambaldi:Celgene: Membership on an entity's Board of Directors or advisory committees, Other: travel support, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding, Speakers Bureau; Jazz: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau, travel support; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Gilead: Membership on an entity's Board of Directors or advisory committees, Other: travel support, Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Other: travel support, Speakers Bureau; Italfarmaco: Membership on an entity's Board of Directors or advisory committees, Other: travel support, Research Funding, Speakers Bureau; Omeros: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
Based on a study that we carried out in Geneva between 2013 and 2015, this paper suggests that the anti-begging law adopted by the Geneva High Council in 2007 can be understood a way of managing ...urban cohabitation with marginalized populations. In response to this “poverty management”, we argue that the continued occupation of the public space by the people who practice begging can be understood as them implementing their own “right to the city” anyway, in the subversive sense meant by Lefebvre.
A cytokine storm, autoimmune features and dysfunctions of myeloid cells significantly contribute to severe coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome ...coronavirus 2 (SARS-CoV-2) infection. Genetic background of the host seems to be partly responsible for severe phenotype and genes related to innate immune response seem critical host determinants. The C9orf72 gene has a role in vesicular trafficking, autophagy regulation and lysosome functions, is highly expressed in myeloid cells and is involved in immune functions, regulating the lysosomal degradation of mediators of innate immunity. A large non-coding hexanucleotide repeat expansion (HRE) in this gene is the main genetic cause of frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS), both characterized by neuroinflammation and high systemic levels of proinflammatory cytokines, while HREs of intermediate length, although rare, are more frequent in autoimmune disorders. C9orf72 full mutation results in haploinsufficiency and intermediate HREs seem to modulate gene expression as well and impair autophagy. Herein, we sought to explore whether intermediate HREs in C9orf72 may be a risk factor for severe COVID-19. Although we found intermediate HREs in only a small portion of 240 patients with severe COVID-19 pneumonia, the magnitude of risk for requiring non-invasive or mechanical ventilation conferred by harboring intermediate repeats >10 units in at least one C9orf72 allele was more than twice respect to having shorter expansions, when adjusted for age (odds ratio (OR) 2.36; 95% confidence interval (CI) 1.04–5.37, p = 0.040). The association between intermediate repeats >10 units and more severe clinical outcome (p = 0.025) was also validated in an independent cohort of 201 SARS-CoV-2 infected patients. These data suggest that C9orf72 HREs >10 units may influence the pathogenic process driving more severe COVID-19 phenotypes.
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