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Rezoagli E, Xin Y, Signori D, Sun W, Gerard S, Delucchi KL, Magliocca A, Vitale G, Giacomini M, Mussoni L, Montomoli J, Subert M, Ponti A, Spadaro S, Poli G, Casola F, Herrmann J, Foti G, Calfee CS, Laffey J, Bellani G, Cereda M. Phenotyping COVID-19 respiratory failure in spontaneously breathing patients with AI on lung CT-scan. Crit Care 2024; 28:263. [PMID: 39103945 PMCID: PMC11301830 DOI: 10.1186/s13054-024-05046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Automated analysis of lung computed tomography (CT) scans may help characterize subphenotypes of acute respiratory illness. We integrated lung CT features measured via deep learning with clinical and laboratory data in spontaneously breathing subjects to enhance the identification of COVID-19 subphenotypes. METHODS This is a multicenter observational cohort study in spontaneously breathing patients with COVID-19 respiratory failure exposed to early lung CT within 7 days of admission. We explored lung CT images using deep learning approaches to quantitative and qualitative analyses; latent class analysis (LCA) by using clinical, laboratory and lung CT variables; regional differences between subphenotypes following 3D spatial trajectories. RESULTS Complete datasets were available in 559 patients. LCA identified two subphenotypes (subphenotype 1 and 2). As compared with subphenotype 2 (n = 403), subphenotype 1 patients (n = 156) were older, had higher inflammatory biomarkers, and were more hypoxemic. Lungs in subphenotype 1 had a higher density gravitational gradient with a greater proportion of consolidated lungs as compared with subphenotype 2. In contrast, subphenotype 2 had a higher density submantellar-hilar gradient with a greater proportion of ground glass opacities as compared with subphenotype 1. Subphenotype 1 showed higher prevalence of comorbidities associated with endothelial dysfunction and higher 90-day mortality than subphenotype 2, even after adjustment for clinically meaningful variables. CONCLUSIONS Integrating lung-CT data in a LCA allowed us to identify two subphenotypes of COVID-19, with different clinical trajectories. These exploratory findings suggest a role of automated imaging characterization guided by machine learning in subphenotyping patients with respiratory failure. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04395482. Registration date: 19/05/2020.
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Affiliation(s)
- Emanuele Rezoagli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy.
| | - Yi Xin
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA
| | - Davide Signori
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Wenli Sun
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, USA
| | - Sarah Gerard
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Kevin L Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Aurora Magliocca
- Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, Italy
- Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Giovanni Vitale
- Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, Italy
| | - Matteo Giacomini
- Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, Italy
| | - Linda Mussoni
- Istituto per la Sicurezza Sociale, San Marino, San Marino
| | - Jonathan Montomoli
- Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Matteo Subert
- Department of Anesthesia and Intensive Care Medicine, Melzo-Gorgonzola Hospital, Azienda Socio-Sanitaria Territoriale Melegnano e della Martesana, Melegnano, Milan, Italy
| | - Alessandra Ponti
- Department of Anesthesiology and Intensive Care, ASST Lecco, Lecco, Italy
| | - Savino Spadaro
- Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Ferrara, Ferrara, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giancarla Poli
- Department of Anaesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Casola
- Department of Physics, Harvard University, 17 Oxford St., Cambridge, MA, 02138, USA
- Harvard-Smithsonian Centre for Astrophysics, 60 Garden St., Cambridge, MA, 02138, USA
| | - Jacob Herrmann
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy
| | - Carolyn S Calfee
- Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, CA, USA
- Department of Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - John Laffey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland
| | - Giacomo Bellani
- University of Trento, Centre for Medical Sciences-CISMed, Trento, Italy
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, Trento, Italy
| | - Maurizio Cereda
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA
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2
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Du P, Niu X, Li X, Ying C, Zhou Y, He C, Lv S, Liu X, Du W, Wu W. Automatically transferring supervised targets method for segmenting lung lesion regions with CT imaging. BMC Bioinformatics 2023; 24:332. [PMID: 37667214 PMCID: PMC10478337 DOI: 10.1186/s12859-023-05435-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND To present an approach that autonomously identifies and selects a self-selective optimal target for the purpose of enhancing learning efficiency to segment infected regions of the lung from chest computed tomography images. We designed a semi-supervised dual-branch framework for training, where the training set consisted of limited expert-annotated data and a large amount of coarsely annotated data that was automatically segmented based on Hu values, which were used to train both strong and weak branches. In addition, we employed the Lovasz scoring method to automatically switch the supervision target in the weak branch and select the optimal target as the supervision object for training. This method can use noisy labels for rapid localization during the early stages of training, and gradually use more accurate targets for supervised training as the training progresses. This approach can utilize a large number of samples that do not require manual annotation, and with the iterations of training, the supervised targets containing noise become closer and closer to the fine-annotated data, which significantly improves the accuracy of the final model. RESULTS The proposed dual-branch deep learning network based on semi-supervision together with cost-effective samples achieved 83.56 ± 12.10 and 82.67 ± 8.04 on our internal and external test benchmarks measured by the mean Dice similarity coefficient (DSC). Through experimental comparison, the DSC value of the proposed algorithm was improved by 13.54% and 2.02% on the internal benchmark and 13.37% and 2.13% on the external benchmark compared with U-Net without extra sample assistance and the mean-teacher frontier algorithm, respectively. CONCLUSION The cost-effective pseudolabeled samples assisted the training of DL models and achieved much better results compared with traditional DL models with manually labeled samples only. Furthermore, our method also achieved the best performance compared with other up-to-date dual branch structures.
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Affiliation(s)
- Peng Du
- Hangzhou AiSmartIoT Co., Ltd., Hangzhou, Zhejiang, China
| | - Xiaofeng Niu
- Artificial Intelligence Lab, Hangzhou AiSmartVision Co., Ltd., Hangzhou, Zhejiang, China
| | - Xukun Li
- Artificial Intelligence Lab, Hangzhou AiSmartVision Co., Ltd., Hangzhou, Zhejiang, China
| | - Chiqing Ying
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, 310003, Zhejiang, China
| | - Yukun Zhou
- Artificial Intelligence Lab, Hangzhou AiSmartVision Co., Ltd., Hangzhou, Zhejiang, China
| | - Chang He
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, 310003, Zhejiang, China
| | - Shuangzhi Lv
- Department of Radiology The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoli Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, 310003, Zhejiang, China
| | - Weibo Du
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, 310003, Zhejiang, China.
| | - Wei Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, 310003, Zhejiang, China.
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3
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Chiumello D, Tavelli A, Serio L, De Benedittis S, Pozzi T, Maj R, Velati M, Brusatori S, D'Albo R, Zinnato C, Marchetti G, Camporota L, Coppola S, D'Arminio Monforte A. Differences in clinical characteristics and quantitative lung CT features between vaccinated and not vaccinated hospitalized COVID-19 patients in Italy. Ann Intensive Care 2023; 13:24. [PMID: 37010706 PMCID: PMC10068232 DOI: 10.1186/s13613-023-01103-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/27/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND To evaluate the differences in the clinical characteristics and severity of lung impairment, assessed by quantitative lung CT scan, between vaccinated and non-vaccinated hospitalized patients with COVID-19; and to identify the variables with best prognostic prediction according to SARS-CoV-2 vaccination status. We recorded clinical, laboratory and quantitative lung CT scan data in 684 consecutive patients [580 (84.8%) vaccinated, and 104 (15.2%) non-vaccinated], admitted between January and December 2021. RESULTS Vaccinated patients were significantly older 78 [69-84] vs 67 [53-79] years and with more comorbidities. Vaccinated and non-vaccinated patients had similar PaO2/FiO2 (300 [252-342] vs 307 [247-357] mmHg; respiratory rate 22 [8-26] vs 19 [18-26] bpm); total lung weight (918 [780-1069] vs 954 [802-1149] g), lung gas volume (2579 [1801-3628] vs 2370 [1675-3289] mL) and non-aerated tissue fraction (10 [7.3-16.0] vs 8.5 [6.0-14.1] %). The overall crude hospital mortality was similar between the vaccinated and non-vaccinated group (23.1% vs 21.2%). However, Cox regression analysis, adjusted for age, ethnicity, age unadjusted Charlson Comorbidity Index and calendar month of admission, showed a 40% reduction in hospital mortality in the vaccinated patients (HRadj = 0.60, 95%CI 0.38-0.95). CONCLUSIONS Hospitalized vaccinated patients with COVID-19, although older and with more comorbidities, presented a similar impairment in gas exchange and lung CT scan compared to non-vaccinated patients, but were at a lower risk of mortality.
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Affiliation(s)
- Davide Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Via Di Rudini 9, Milan, Italy.
- Department of Health Sciences, University of Milan, Milan, Italy.
- Coordinated Research Center on Respiratory Failure, University of Milan, Milan, Italy.
| | - Alessandro Tavelli
- Infectious Diseases Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Lorenzo Serio
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Sara De Benedittis
- Infectious Diseases Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Tommaso Pozzi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Maj
- Department of Anesthesiology, Medical University of Göttingen, University Medical Center Göttingen, Göttingen, Germany
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mara Velati
- Department of Anesthesiology, Medical University of Göttingen, University Medical Center Göttingen, Göttingen, Germany
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Brusatori
- Department of Anesthesiology, Medical University of Göttingen, University Medical Center Göttingen, Göttingen, Germany
| | - Rosanna D'Albo
- Department of Anesthesiology, Medical University of Göttingen, University Medical Center Göttingen, Göttingen, Germany
| | - Carmelo Zinnato
- Department of Anesthesiology, Medical University of Göttingen, University Medical Center Göttingen, Göttingen, Germany
| | - Giulia Marchetti
- Department of Health Sciences, University of Milan, Milan, Italy
- Infectious Diseases Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Luigi Camporota
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, UK
| | - Silvia Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Via Di Rudini 9, Milan, Italy
| | - Antonella D'Arminio Monforte
- Department of Health Sciences, University of Milan, Milan, Italy
- Infectious Diseases Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
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4
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Antoni G, Lubberink M, Sörensen J, Lindström E, Elgland M, Eriksson O, Hultström M, Frithiof R, Wanhainen A, Sigfridsson J, Skorup P, Lipcsey M. In Vivo Visualization and Quantification of Neutrophil Elastase in Lungs of COVID-19 Patients: A First-in-Humans PET Study with 11C-NES. J Nucl Med 2023; 64:145-148. [PMID: 35680418 PMCID: PMC9841261 DOI: 10.2967/jnumed.122.263974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 01/28/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) can cause life-threatening lung inflammation that is thought to be mediated by neutrophils. The aim of the present work was to evaluate a novel PET tracer for neutrophil elastase (NE). Methods: In this first-in-humans study, 4 patients with hypoxia due to COVID-19 and 2 healthy controls were investigated with PET using 11C-NES and 15O-water for visualization and quantification of NE and perfusion in the lungs, respectively. Results: 11C-NES accumulated selectively in lung areas with COVID-19 opacities on CT scans, suggesting high levels of NE there. In the same areas, perfusion was severely reduced in comparison to healthy lung tissue as measured with 15O-water. Conclusion: The data suggest that NE is associated with severe lung inflammation in COVID-19 patients and that inhibition of NE could potentially reduce the acute inflammatory process and improve the condition.
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Affiliation(s)
- Gunnar Antoni
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden;
| | - Mark Lubberink
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; and
| | - Jens Sörensen
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; and
| | - Elin Lindström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; and
| | - Mathias Elgland
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Olof Eriksson
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; and
| | - Robert Frithiof
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; and
| | - Anders Wanhainen
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; and
| | | | - Paul Skorup
- Department of Medicinal Sciences, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; and
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5
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Perchiazzi G, Larina A, Hansen T, Frithiof R, Hultström M, Lipcsey M, Pellegrini M. Chest dual-energy CT to assess the effects of steroids on lung function in severe COVID-19 patients. Crit Care 2022; 26:328. [PMID: 36284360 PMCID: PMC9595078 DOI: 10.1186/s13054-022-04200-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Steroids have been shown to reduce inflammation, hypoxic pulmonary vasoconstriction (HPV) and lung edema. Based on evidence from clinical trials, steroids are widely used in severe COVID-19. However, the effects of steroids on pulmonary gas volume and blood volume in this group of patients are unexplored. OBJECTIVE Profiting by dual-energy computed tomography (DECT), we investigated the relationship between the use of steroids in COVID-19 and distribution of blood volume as an index of impaired HPV. We also investigated whether the use of steroids influences lung weight, as index of lung edema, and how it affects gas distribution. METHODS Severe COVID-19 patients included in a single-center prospective observational study at the intensive care unit at Uppsala University Hospital who had undergone DECT were enrolled in the current study. Patients' cohort was divided into two groups depending on the administration of steroids. From each patient's DECT, 20 gas volume maps and the corresponding 20 blood volume maps, evenly distributed along the cranial-caudal axis, were analyzed. As a proxy for HPV, pulmonary blood volume distribution was analyzed in both the whole lung and the hypoinflated areas. Total lung weight, index of lung edema, was estimated. RESULTS Sixty patients were analyzed, whereof 43 received steroids. Patients not exposed to steroids showed a more extensive non-perfused area (19% vs 13%, p < 0.01) and less homogeneous pulmonary blood volume of hypoinflated areas (kurtosis: 1.91 vs 2.69, p < 0.01), suggesting a preserved HPV compared to patients treated with steroids. Moreover, patients exposed to steroids showed a significantly lower lung weight (953 gr vs 1140 gr, p = 0.01). A reduction in alveolar-arterial difference of oxygen followed the treatment with steroids (322 ± 106 mmHg at admission vs 267 ± 99 mmHg at DECT, p = 0.04). CONCLUSIONS The use of steroids might cause impaired HPV and might reduce lung edema in severe COVID-19. This is consistent with previous findings in other diseases. Moreover, a reduced lung weight, as index of decreased lung edema, and a more homogeneous distribution of gas within the lung were shown in patients treated with steroids. TRIAL REGISTRATION Clinical Trials ID: NCT04316884, Registered March 13, 2020.
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Affiliation(s)
- Gaetano Perchiazzi
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, Ing 40, 3 tr, 751 85 Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Aleksandra Larina
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Tomas Hansen
- grid.8993.b0000 0004 1936 9457Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Michael Hultström
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, Ing 40, 3 tr, 751 85 Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Mariangela Pellegrini
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, Ing 40, 3 tr, 751 85 Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
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6
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Aramini B, Masciale V, Samarelli AV, Tonelli R, Cerri S, Clini E, Stella F, Dominici M. Biological effects of COVID-19 on lung cancer: Can we drive our decisions. Front Oncol 2022; 12:1029830. [PMID: 36300087 PMCID: PMC9589049 DOI: 10.3389/fonc.2022.1029830] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
COVID-19 infection caused by SARS-CoV-2 is considered catastrophic because it affects multiple organs, particularly those of the respiratory tract. Although the consequences of this infection are not fully clear, it causes damage to the lungs, the cardiovascular and nervous systems, and other organs, subsequently inducing organ failure. In particular, the effects of SARS-CoV-2-induced inflammation on cancer cells and the tumor microenvironment need to be investigated. COVID-19 may alter the tumor microenvironment, promoting cancer cell proliferation and dormant cancer cell (DCC) reawakening. DCCs reawakened upon infection with SARS-CoV-2 can populate the premetastatic niche in the lungs and other organs, leading to tumor dissemination. DCC reawakening and consequent neutrophil and monocyte/macrophage activation with an uncontrolled cascade of pro-inflammatory cytokines are the most severe clinical effects of COVID-19. Moreover, neutrophil extracellular traps have been demonstrated to activate the dissemination of premetastatic cells into the lungs. Further studies are warranted to better define the roles of COVID-19 in inflammation as well as in tumor development and tumor cell metastasis; the results of these studies will aid in the development of further targeted therapies, both for cancer prevention and the treatment of patients with COVID-19.
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Affiliation(s)
- Beatrice Aramini
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
- *Correspondence: Beatrice Aramini,
| | - Valentina Masciale
- Division of Oncology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Laboratory of Cell Therapy, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Valeria Samarelli
- Laboratory of Cell Therapy, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
- Respiratory Disease Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Tonelli
- Respiratory Disease Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Cerri
- Respiratory Disease Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Clini
- Respiratory Disease Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco Stella
- Division of Thoracic Surgery, Department of Experimental, Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Laboratory of Cell Therapy, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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7
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Abstract
Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome arising from multiple causes with a range of clinical severity. In recent years, the potential for prognostic and predictive enrichment of clinical trials has been increased with identification of more biologically homogeneous subgroups or phenotypes within ARDS. COVID-19 ARDS also exhibits significant clinical heterogeneity despite a single causative agent. In this review the authors summarize the existing literature on COVID-19 ARDS phenotypes, including physiologic, clinical, and biological subgroups as well as the implications for improving both prognostication and precision therapy.
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Affiliation(s)
- Susannah Empson
- Department of Anesthesiology, Perioperative, and Pain Medicine, 300 Pasteur Drive, H3580, Stanford, CA 94305, USA.
| | - Angela J Rogers
- Department of Pulmonary, Allergy & Critical Care Medicine, 300 Pasteur Drive, H3153, Stanford, CA 94305, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, 900 Welch Road, Suite 350, Stanford, CA 94305, USA
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8
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Ball L, Scaramuzzo G, Herrmann J, Cereda M. Lung aeration, ventilation, and perfusion imaging. Curr Opin Crit Care 2022; 28:302-307. [PMID: 35653251 PMCID: PMC9178949 DOI: 10.1097/mcc.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Lung imaging is a cornerstone of the management of patients admitted to the intensive care unit (ICU), providing anatomical and functional information on the respiratory system function. The aim of this review is to provide an overview of mechanisms and applications of conventional and emerging lung imaging techniques in critically ill patients. RECENT FINDINGS Chest radiographs provide information on lung structure and have several limitations in the ICU setting; however, scoring systems can be used to stratify patient severity and predict clinical outcomes. Computed tomography (CT) is the gold standard for assessment of lung aeration but requires moving the patients to the CT facility. Dual-energy CT has been recently applied to simultaneous study of lung aeration and perfusion in patients with respiratory failure. Lung ultrasound has an established role in the routine bedside assessment of ICU patients, but has poor spatial resolution and largely relies on the analysis of artifacts. Electrical impedance tomography is an emerging technique capable of depicting ventilation and perfusion at the bedside and at the regional level. SUMMARY Clinicians should be confident with the technical aspects, indications, and limitations of each lung imaging technique to improve patient care.
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Affiliation(s)
- Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze, Genoa, Italy
| | - Gaetano Scaramuzzo
- Department of Translational medicine, University of Ferrara, Ferrara, Italy
- Anesthesia and intensive care, Arcispedale Sant’Anna, Ferrara, Italy
| | - Jake Herrmann
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, United States of America
| | - Maurizio Cereda
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Shafqat A, Shafqat S, Salameh SA, Kashir J, Alkattan K, Yaqinuddin A. Mechanistic Insights Into the Immune Pathophysiology of COVID-19; An In-Depth Review. Front Immunol 2022; 13:835104. [PMID: 35401519 PMCID: PMC8989408 DOI: 10.3389/fimmu.2022.835104] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/02/2022] [Indexed: 12/15/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which causes coronavirus-19 (COVID-19), has caused significant morbidity and mortality globally. In addition to the respiratory manifestations seen in severe cases, multi-organ pathologies also occur, making management a much-debated issue. In addition, the emergence of new variants can potentially render vaccines with a relatively limited utility. Many investigators have attempted to elucidate the precise pathophysiological mechanisms causing COVID-19 respiratory and systemic disease. Spillover of lung-derived cytokines causing a cytokine storm is considered the cause of systemic disease. However, recent studies have provided contradictory evidence, whereby the extent of cytokine storm is insufficient to cause severe illness. These issues are highly relevant, as management approaches considering COVID-19 a classic form of acute respiratory distress syndrome with a cytokine storm could translate to unfounded clinical decisions, detrimental to patient trajectory. Additionally, the precise immune cell signatures that characterize disease of varying severity remain contentious. We provide an up-to-date review on the immune dysregulation caused by COVID-19 and highlight pertinent discussions in the scientific community. The response from the scientific community has been unprecedented regarding the development of highly effective vaccines and cutting-edge research on novel therapies. We hope that this review furthers the conversations held by scientists and informs the aims of future research projects, which will potentially further our understanding of COVID-19 and its immune pathogenesis.
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Affiliation(s)
- Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Junaid Kashir
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Center of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khaled Alkattan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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