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Search Results: 1 - 10 of 135 matches for " Niccolò Marchionni "
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Effects of Glucagon-Like Peptide-1 Receptor Agonists on Body Weight: A Meta-Analysis
Matteo Monami,Ilaria Dicembrini,Niccolò Marchionni,Carlo M. Rotella,Edoardo Mannucci
Experimental Diabetes Research , 2012, DOI: 10.1155/2012/672658
Abstract: Glucagon-Like Peptide-1 receptor agonists (GLP-1RAs), approved as glucose-lowering drugs for the treatment of type 2 diabetes, have also been shown to reduce body weight. An extensive Medline, Cochrane database, and Embase search for “exenatide,” “liraglutide,” “albiglutide,” “semaglutide,” and “lixisenatide” was performed, collecting all randomized clinical trials on humans up to December 15, 2011, with a duration of at least 24 weeks, comparing GLP-1 receptor agonists with either placebo or active drugs. Twenty two (7,859 patients) and 7 (2,416 patients) trials with available results on body weight at 6 and 12 months, respectively, were included. When compared with placebo, GLP-1RAs determine a reduction of BMI at 6 months of −1.0 [−1.3; −0.6] kg/m2. Considering the average BMI at baseline (32.4 kg/m2) these data means a weight reduction of about 3% at 6 months. This result could seem modest from a clinical standpoint; however, it could be affected by many factors contributing to an underestimation of the effect of GLP-1RA on body weight, such as non adequate doses, inclusion criteria, efficacy of GLP-1RA on reducing glycosuria, and association to non-pharmacological interventions not specifically aimed to weight reduction.
Biomarkers of Alzheimer's Disease: From Central Nervous System to Periphery?
Enrico Mossello,Elena Ballini,Anna Maria Mello,Francesca Tarantini,David Simoni,Samuele Baldasseroni,Niccolò Marchionni
International Journal of Alzheimer's Disease , 2011, DOI: 10.4061/2011/342980
Abstract: Alzheimer's Disease (AD) is the most frequent form of dementia and represents one of the main causes of disability among older subjects. Up to now, the diagnosis of AD has been made according to clinical criteria. However, the use of such criteria does not allow an early diagnosis, as pathological alterations may be apparent many years before the clear-cut clinical picture. An early diagnosis is even more valuable to develop new treatments, potentially interfering with the pathogenetic process. During the last decade, several neuroimaging and cerebrospinal fluid (CSF) parameters have been introduced to allow an early and accurate detection of AD patients, and, recently, they have been included among research criteria for AD diagnosis. However, their use in clinical practice suffers from limitations both in accuracy and availability. The increasing amount of knowledge about peripheral biomarkers will possibly allow the future identification of reliable and easily available diagnostic tests.
Effects of Glucagon-Like Peptide-1 Receptor Agonists on Body Weight: A Meta-Analysis
Matteo Monami,Ilaria Dicembrini,Niccolò Marchionni,Carlo M. Rotella,Edoardo Mannucci
Journal of Diabetes Research , 2012, DOI: 10.1155/2012/672658
Abstract: Glucagon-Like Peptide-1 receptor agonists (GLP-1RAs), approved as glucose-lowering drugs for the treatment of type 2 diabetes, have also been shown to reduce body weight. An extensive Medline, Cochrane database, and Embase search for “exenatide,” “liraglutide,” “albiglutide,” “semaglutide,” and “lixisenatide” was performed, collecting all randomized clinical trials on humans up to December 15, 2011, with a duration of at least 24 weeks, comparing GLP-1 receptor agonists with either placebo or active drugs. Twenty two (7,859 patients) and 7 (2,416 patients) trials with available results on body weight at 6 and 12 months, respectively, were included. When compared with placebo, GLP-1RAs determine a reduction of BMI at 6 months of ?1.0 [?1.3; ?0.6]?kg/m2. Considering the average BMI at baseline (32.4?kg/m2) these data means a weight reduction of about 3% at 6 months. This result could seem modest from a clinical standpoint; however, it could be affected by many factors contributing to an underestimation of the effect of GLP-1RA on body weight, such as non adequate doses, inclusion criteria, efficacy of GLP-1RA on reducing glycosuria, and association to non-pharmacological interventions not specifically aimed to weight reduction. 1. Introduction Most drugs developed for the therapy of obesity have failed to show a sufficient efficacy and safety for long-term treatment. In particular, agents which stimulate energy expenditure (e.g., thyroid hormones, sympathoadrenergic drugs, or sibutramine) do not have an adequate cardiovascular safety, whereas centrally acting anorexants either are ineffective in the long term (e.g., serotonin reuptake inhibitors) or show neuropsychiatric adverse effects (e.g., amphetamine derivatives or cannabinoid receptor antagonists) [1]. As a result, orlistat, which inhibits lipid absorption, is the only available drug for obesity in many countries. Even for drugs which do not show relevant problems of long-term safety, such as orlistat, the unsatisfactory tolerability profile limits clinical use. Glucagon-like peptide-1 (GLP-1) is a gastrointestinal hormone, produced mainly in the postprandial phase, which stimulates insulin secretion and inhibits glucagon release in a dose-dependent fashion [2]. Due to this properties, the hormone reduces hyperglycemia without inducing hypoglycemia in patients with type 2 diabetes [3]. The rapid inactivation of GLP-1 in vivo and the consequent short half-life (a few minutes after subcutaneous administration) prevents its therapeutic use. Long-acting GLP-1 receptor agonists, which can be administered
Glucagon-Like Peptide-1 Receptor Agonists and Cardiovascular Events: A Meta-Analysis of Randomized Clinical Trials
Matteo Monami,Francesco Cremasco,Caterina Lamanna,Claudia Colombi,Carla Maria Desideri,Iacopo Iacomelli,Niccolò Marchionni,Edoardo Mannucci
Experimental Diabetes Research , 2011, DOI: 10.1155/2011/215764
Abstract: Objective. Data from randomized clinical trials with metabolic outcomes can be used to address concerns about potential issues of cardiovascular safety for newer drugs for type 2 diabetes. This meta-analysis was designed to assess cardiovascular safety of GLP-1 receptor agonists. Design and Methods. MEDLINE, Embase, and Cochrane databases were searched for randomized trials of GLP-1 receptor agonists (versus placebo or other comparators) with a duration ≥12 weeks, performed in type 2 diabetic patients. Mantel-Haenszel odds ratio with 95% confidence interval (MH-OR) was calculated for major cardiovascular events (MACE), on an intention-to-treat basis, excluding trials with zero events. Results. Out of 36 trials, 20 reported at least one MACE. The MH-OR for all GLP-1 receptor agonists was 0.74 (0.50–1.08), =.12 (0.85 (0.50–1.45), =.55, and 0.69 (0.40–1.22), =.20, for exenatide and liraglutide, resp.). Corresponding figures for placebo-controlled and active comparator studies were 0.46 (0.25–0.83), =.009, and 1.05 (0.63–1.76), =.84, respectively. Conclusions. To date, results of randomized trials do not suggest any detrimental effect of GLP-1 receptor agonists on cardiovascular events. Specifically designed longer-term trials are needed to verify the possibility of a beneficial effect.
Comparing the Prognostic Accuracy for All-Cause Mortality of Frailty Instruments: A Multicentre 1-Year Follow-Up in Hospitalized Older Patients
Alberto Pilotto, Franco Rengo, Niccolò Marchionni, Daniele Sancarlo, Andrea Fontana, Francesco Panza, Luigi Ferrucci, on behalf of the FIRI-SIGG Study Group
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0029090
Abstract: Background Frailty is a dynamic age-related condition of increased vulnerability characterized by declines across multiple physiologic systems and associated with an increased risk of death. We compared the predictive accuracy for one-month and one-year all-cause mortality of four frailty instruments in a large population of hospitalized older patients in a prospective multicentre cohort study. Methods and Findings On 2033 hospitalized patients aged ≥65 years from twenty Italian geriatric units, we calculated the frailty indexes derived from the Study of Osteoporotic Fractures (FI-SOF), based on the cumulative deficits model (FI-CD), based on a comprehensive geriatric assessment (FI-CGA), and the Multidimensional Prognostic Index (MPI). The overall mortality rates were 8.6% after one-month and 24.9% after one-year follow-up. All frailty instruments were significantly associated with one-month and one-year all-cause mortality. The areas under the receiver operating characteristic (ROC) curves estimated from age- and sex-adjusted logistic regression models, accounting for clustering due to centre effect, showed that the MPI had a significant higher discriminatory accuracy than FI-SOF, FI-CD, and FI-CGA after one month (areas under the ROC curves: FI-SOF = 0.685 vs. FI-CD = 0.738 vs. FI-CGA = 0.724 vs. MPI = 0.765, p<0.0001) and one year of follow-up (areas under the ROC curves: FI-SOF = 0.694 vs. FI-CD = 0.729 vs. FI-CGA = 0.727 vs. MPI = 0.750, p<0.0001). The MPI showed a significant higher discriminatory power for predicting one-year mortality also in hospitalized older patients without functional limitations, without cognitive impairment, malnourished, with increased comorbidity, and with a high number of drugs. Conclusions All frailty instruments were significantly associated with short- and long-term all-cause mortality, but MPI demonstrated a significant higher predictive power than other frailty instruments in hospitalized older patients.
Glucagon-Like Peptide-1 Receptor Agonists and Cardiovascular Events: A Meta-Analysis of Randomized Clinical Trials
Matteo Monami,Francesco Cremasco,Caterina Lamanna,Claudia Colombi,Carla Maria Desideri,Iacopo Iacomelli,Niccolò Marchionni,Edoardo Mannucci
Journal of Diabetes Research , 2011, DOI: 10.1155/2011/215764
Abstract: Objective. Data from randomized clinical trials with metabolic outcomes can be used to address concerns about potential issues of cardiovascular safety for newer drugs for type 2 diabetes. This meta-analysis was designed to assess cardiovascular safety of GLP-1 receptor agonists. Design and Methods. MEDLINE, Embase, and Cochrane databases were searched for randomized trials of GLP-1 receptor agonists (versus placebo or other comparators) with a duration ≥12 weeks, performed in type 2 diabetic patients. Mantel-Haenszel odds ratio with 95% confidence interval (MH-OR) was calculated for major cardiovascular events (MACE), on an intention-to-treat basis, excluding trials with zero events. Results. Out of 36 trials, 20 reported at least one MACE. The MH-OR for all GLP-1 receptor agonists was 0.74 (0.50–1.08), (0.85 (0.50–1.45), , and 0.69 (0.40–1.22), , for exenatide and liraglutide, resp.). Corresponding figures for placebo-controlled and active comparator studies were 0.46 (0.25–0.83), , and 1.05 (0.63–1.76), , respectively. Conclusions. To date, results of randomized trials do not suggest any detrimental effect of GLP-1 receptor agonists on cardiovascular events. Specifically designed longer-term trials are needed to verify the possibility of a beneficial effect. 1. Introduction Cardiovascular safety is a growing concern for drugs used for chronic conditions, such as diabetes. Among glucose-lowering agents, sulfonylureas [1, 2], insulin [3, 4], and thiazolidinediones [5–7], have been suspected of adverse cardiovascular effects, although some of those preoccupations have not been confirmed [8–11]. Following these concerns, the Food and Drug Administration issued a guidance for companies submitting new chemical entities as treatments for type 2 diabetes, requiring that, either in phase II-III trials, or in a subsequent phase IV specifically designed randomized clinical trial, a sufficient amount of information is collected so as to exclude a risk increase of over 30% (i.e., the upper limit—two-sided—of 95% confidence interval for major cardiovascular events, in comparison with placebo and/or other treatments, should not exceed 1.30; http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM071627.pdf). Two GLP-1 receptor agonists (exenatide and liraglutide) have been approved for human use, and several others are currently under clinical development. It has been observed that chronic stimulation of GLP-1 receptors could produce beneficial effects on several cardiovascular risk factors [12]; furthermore, preliminary data on
Digital Media in Archaeological Areas, Virtual Reality, Authenticity and Hyper-Tourist Gaze  [PDF]
Niccolò Costa, Marxiano Melotti
Sociology Mind (SM) , 2012, DOI: 10.4236/sm.2012.21007
Abstract: The increasingly widespread use of digital media and “virtual reality” in archaeological areas seems to confirm the passage from the traditional tourist gaze to a new hyper-tourist gaze. Archaeological areas, incessantly re-presented in virtual reality, are already part of an ageographical city, characterized by new kinds of flows. The “virtual reality” of archaeological areas helps to “mark” a new phase in the economic and cultural history of tourism. A comparative presentation of some important activities carried out in these areas and the forms of multimedia communication related to archaeological tourism illustrates this trend. Notwithstanding the sceptical or conservative attitude of many institutions, this use of digital media does not generate cultural perplexity in the general public, which instead seeks and rewards the most innovative initiatives that best combine entertainment and educational aspects.
Glucagon-Like Peptide-1, Diabetes, and Cognitive Decline: Possible Pathophysiological Links and Therapeutic Opportunities
Enrico Mossello,Elena Ballini,Marta Boncinelli,Matteo Monami,Giuseppe Lonetto,Anna Maria Mello,Francesca Tarantini,Samuele Baldasseroni,Edoardo Mannucci,Niccolò Marchionni
Experimental Diabetes Research , 2011, DOI: 10.1155/2011/281674
Abstract: Metabolic and neurodegenerative disorders have a growing prevalence in Western countries. Available epidemiologic and neurobiological evidences support the existence of a pathophysiological link between these conditions. Glucagon-like peptide 1 (GLP-1), whose activity is reduced in insulin resistance, has been implicated in central nervous system function, including cognition, synaptic plasticity, and neurogenesis. We review the experimental researches suggesting that GLP-1 dysfunction might be a mediating factor between Type 2 diabetes mellitus (T2DM) and neurodegeneration. Drug treatments enhancing GLP-1 activity hold out hope for treatment and prevention of Alzheimer's disease (AD) and cognitive decline.
Glucagon-Like Peptide-1, Diabetes, and Cognitive Decline: Possible Pathophysiological Links and Therapeutic Opportunities
Enrico Mossello,Elena Ballini,Marta Boncinelli,Matteo Monami,Giuseppe Lonetto,Anna Maria Mello,Francesca Tarantini,Samuele Baldasseroni,Edoardo Mannucci,Niccolò Marchionni
Journal of Diabetes Research , 2011, DOI: 10.1155/2011/281674
Abstract: Metabolic and neurodegenerative disorders have a growing prevalence in Western countries. Available epidemiologic and neurobiological evidences support the existence of a pathophysiological link between these conditions. Glucagon-like peptide 1 (GLP-1), whose activity is reduced in insulin resistance, has been implicated in central nervous system function, including cognition, synaptic plasticity, and neurogenesis. We review the experimental researches suggesting that GLP-1 dysfunction might be a mediating factor between Type 2 diabetes mellitus (T2DM) and neurodegeneration. Drug treatments enhancing GLP-1 activity hold out hope for treatment and prevention of Alzheimer's disease (AD) and cognitive decline. 1. Insulin Resistance and Cognitive Decline During the last years, Alzheimer’s disease (AD) and clinical syndromes associated to insulin resistance have shown an ever-increasing prevalence in Western countries. These conditions pose a great threat to present and future population’s health and represent two of the main causes of disability and health expenditures. Several research lines during the last decade have suggested an association among Type 2 diabetes mellitus (T2DM), insulin resistance, and cognitive decline, both in cross-sectional and in longitudinal studies. Cross-sectional studies have found that older subjects with T2DM on average show a poorer cognitive performance than age-matched controls [1]. This association seems independent of other vascular risk factors and is attributable not only to a greater extent of white matter lesions but also to a more severe cortical atrophy [2], especially in temporo-mesial areas (hippocampus, amygdala) [3]. Moreover insulin resistance is associated to a worse cognitive performance in nondiabetic subjects too [4]. On the other hand cross-sectional studies have observed a significant association of dementia, AD in particular, with T2DM [5] and insulin resistance [6]. Also several longitudinal studies have observed an association of T2DM with dementia risk over years [7]. Moreover it has been observed that older nondiabetic subjects with metabolic syndrome and increased level of inflammatory markers have an increased risk of subsequent cognitive decline [8]. Recently published data have shown that, among nondiabetic nondemented older subjects, insulin resistance is associated with AD incidence after a few years [9]. In keeping with this observation, insulin resistance has been associated recently with a greater extent of AD-like neuropathology at autopsy [10]. Therefore it is plausible that, among older
Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients)
Mussi Chiara,Galizia Gianluigi,Abete Pasquale,Morrione Alessandro,Maraviglia Alice,Noro Gabriele,Cavagnaro Paolo,Ghirelli Loredana,Tava Giovanni,Rengo Franco,Masotti Giulio,Salvioli Gianfranco,Marchionni Niccolò,Ungar Andrea
Current Gerontology and Geriatrics Research , 2013, DOI: 10.1155/2013/928603
Abstract: To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age years, range 65–101). Falls were defined “accidental” (fall explained by a definite accidental cause), “medical” (fall caused directly by a specific medical disease), “dementia-related” (fall in patients affected by moderate-severe dementia), and “unexplained” (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury. 1. Introduction Falls in older people are a major public health concern in terms of morbidity, mortality, and health and social services costs [1]. Falls are the leading cause of injury-related visits to emergency department in the United States. Trauma is the fifth leading cause of death in people starting from 65 years, and falls are responsible for 70% of accidental death in people starting from 75 years. More than a third of older adults falls each year [2]. About one-third of community-dwelling elderly people and up to 60% of nursing home residents fall each year; one half of these “fallers” have multiple episodes [3]. Nearly all hip fractures occur as a fall result [4]. Fall-related injuries among older adults, especially among older women, are associated with substantial economic costs, mostly because of hip fractures and their subsequent disability [5]. Data regarding fall types in patients admitted to orthopaedic wards because of fall-related injury are lacking: the UFO study (Unexplained Falls in Older Patients) was made to assess the incidence and the clinical characteristics of unexplained falls in this specific group of elderly subjects affected by fall-related fractures. 2. Methods 2.1.
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