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Romano IR, D’Angeli F, Gili E, Fruciano M, Lombardo GAG, Mannino G, Vicario N, Russo C, Parenti R, Vancheri C, Giuffrida R, Pellitteri R, Lo Furno D. Melatonin Enhances Neural Differentiation of Adipose-Derived Mesenchymal Stem Cells. Int J Mol Sci 2024; 25:4891. [PMID: 38732109 PMCID: PMC11084714 DOI: 10.3390/ijms25094891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Adipose-derived mesenchymal stem cells (ASCs) are adult multipotent stem cells, able to differentiate toward neural elements other than cells of mesodermal lineage. The aim of this research was to test ASC neural differentiation using melatonin combined with conditioned media (CM) from glial cells. Isolated from the lipoaspirate of healthy donors, ASCs were expanded in a basal growth medium before undergoing neural differentiation procedures. For this purpose, CM obtained from olfactory ensheathing cells and from Schwann cells were used. In some samples, 1 µM of melatonin was added. After 1 and 7 days of culture, cells were studied using immunocytochemistry and flow cytometry to evaluate neural marker expression (Nestin, MAP2, Synapsin I, GFAP) under different conditions. The results confirmed that a successful neural differentiation was achieved by glial CM, whereas the addition of melatonin alone did not induce appreciable changes. When melatonin was combined with CM, ASC neural differentiation was enhanced, as demonstrated by a further improvement of neuronal marker expression, whereas glial differentiation was attenuated. A dynamic modulation was also observed, testing the expression of melatonin receptors. In conclusion, our data suggest that melatonin's neurogenic differentiation ability can be usefully exploited to obtain neuronal-like differentiated ASCs for potential therapeutic strategies.
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Affiliation(s)
- Ivana Roberta Romano
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (I.R.R.); (N.V.); (C.R.); (R.P.); (R.G.); (D.L.F.)
| | - Floriana D’Angeli
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, 00166 Rome, Italy;
| | - Elisa Gili
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (E.G.); (M.F.); (C.V.)
| | - Mary Fruciano
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (E.G.); (M.F.); (C.V.)
| | | | - Giuliana Mannino
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98122 Messina, Italy
| | - Nunzio Vicario
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (I.R.R.); (N.V.); (C.R.); (R.P.); (R.G.); (D.L.F.)
| | - Cristina Russo
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (I.R.R.); (N.V.); (C.R.); (R.P.); (R.G.); (D.L.F.)
| | - Rosalba Parenti
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (I.R.R.); (N.V.); (C.R.); (R.P.); (R.G.); (D.L.F.)
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (E.G.); (M.F.); (C.V.)
| | - Rosario Giuffrida
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (I.R.R.); (N.V.); (C.R.); (R.P.); (R.G.); (D.L.F.)
| | - Rosalia Pellitteri
- Institute for Biomedical Research and Innovation, National Research Council, 95126 Catania, Italy;
| | - Debora Lo Furno
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (I.R.R.); (N.V.); (C.R.); (R.P.); (R.G.); (D.L.F.)
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Schisano M, Libra A, Rizzo L, Morana G, Mancuso S, Ficili A, Campagna D, Vancheri C, Bonsignore MR, Spicuzza L. Distance follow-up by a remote medical care centre improves adherence to CPAP in patients with obstructive sleep apnoea over the short and long term. J Telemed Telecare 2024:1357633X241238483. [PMID: 38532732 DOI: 10.1177/1357633x241238483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Adherence to continuous positive air pressure (CPAP) in patients with obstructive sleep apnoea (OSA) has remained invariably low over the last decades. Remote monitoring of the nocturnal CPAP treatment, within telemedicine (TM)-based follow-up programs, in these patients has been suggested as a potential tool to improve adherence and release the workload of sleep units. The aim of this study was therefore to assess whether a follow-up program carried out by a Remote Medical Care Centre (RMCC), outside the sleep unit, improves adherence to CPAP in the short and long term in patients with OSA. METHODS In this pilot protocol, we enrolled 37 patients starting CPAP in our Sleep Centre (SC). After three months of standard care in our SC, patients initiated a six-month remote follow-up carried out by the RMCC, functioning as an intermediary between patients and SC. Monthly reports and indication for face-to-face visits were sent to the SC for six months. After this period patients returned to usual care for one year. Results were compared with those obtained in 38 patients (controls) followed with usual care over the same time range. RESULTS Mean nightly use of CPAP increased from 3.2 ± 2.4 h pre-RMCC to 5.2 ± 1.9 h post-RMCC (p < 0.0001). Nights/month of CPAP use improved from 19.8 ± 9.2 to 25.2 ± 2.5 (p < 0.05) and nights/month with CPAP use >4 h from 12.5 ± 10 to 21.03 ± 8.9 (p < 0.05). This improvement remained stable after 12 months from the return of patients to usual care. No significant changes in CPAP use were observed in controls over the time. CONCLUSION A six-month follow-up through a remote facility can significantly improve adherence to CPAP in the short and long term. This pilot study provides a solid base for the design of multicentre randomized trials focusing on new models which are able to increase the long-term efficacy of TM programs.
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Affiliation(s)
- Matteo Schisano
- Respiratory Unit, University Hospital Policlinico- San Marco, Catania, Italy
| | - Alessandro Libra
- Respiratory Unit, University Hospital Policlinico- San Marco, Catania, Italy
| | - Ludovica Rizzo
- Respiratory Unit, Department of Translational Medicine, Sant'Anna University Hospital, Ferrara, Italy
| | - Giorgio Morana
- Respiratory Unit, University Hospital Policlinico- San Marco, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Mancuso
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonella Ficili
- Respiratory Unit, University Hospital Policlinico- San Marco, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Davide Campagna
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Emergency Unit, University Hospital Policlinico- San Marco, Catania, Italy
| | - Carlo Vancheri
- Respiratory Unit, University Hospital Policlinico- San Marco, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria R Bonsignore
- PROMISE Department, University of Palermo, Palermo, Italy
- Division of Pneumology, Sleep Disordered Breathing Clinic, V. Cervello Hospital, Palermo, Italy
| | - Lucia Spicuzza
- Respiratory Unit, University Hospital Policlinico- San Marco, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Lombardi C, Passalacqua G, Menzella F, Mauritz Canevari RF, Danesi G, Pusateri AM, Carone M, Vancheri C, Di Marco F, Micheletto C, Manzotti G, Di Gioacchino M, Bilò MB, Gelardi M, Senna G, Canonica GW. Chronic rhinosinusitis with nasal polyposis and biological agents: the ARIA-ITALY Survey. Eur Ann Allergy Clin Immunol 2024. [PMID: 38534135 DOI: 10.23822/eurannaci.1764-1489.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Summary Background. Chronic rhinosinusitis (CRS) is an inflammatory disease that affects the nasal mucosa and the paranasal sinuses. CRS can be associated by nasal polyposis (CRSwNP phenotype) in up to 30% of patients and it is frequently associated with bronchial asthma. CRSwNP shows predominantly an underlying activation of type 2 inflammatory pathways with the involvement of eosinophils, IgE, interleukin (IL)-4, IL-5 and IL-13. Biological drugs that target these inflammatory cytokines are currently a therapeutic option recognized by guidelines for the treatment of uncontrolled form of the disease. Methods. As part of the activity of the "ARIA-Italy" working group, a panel of 255 Italian Ear, Nose and Throat (ENT) specialists, pneumologists and immuno-allergologists actively participated in this national survey and answered a series of questions geared toward understanding the main criteria for patient characterization and therapeutic decision, highlighting multidisciplinarity, and the implementation of the management of CRSwNP patients, as a part of the precision medicine concept and the appropriate use of the biologicals. Results. Two hundred and fifty-five experts and specialists participated in the survey. Conclusions. The results of this survey obtained from an extensive number of active specialists throughout Italy allow some important concluding remarks to be drawn. The main points of agreement were that multidisciplinary care teams provide many benefits but that, once the team is established, meetings and communication between members must be coordinated. Finally, the dissemination of national disease registries and the continuous updating of guidelines and position papers related to CRSwNP and comorbidities should be encouraged.
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Affiliation(s)
- C Lombardi
- Co-Chairman ARIA ITALY; Unit of Allergology, Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - G Passalacqua
- Co-Chairman ARIA-Italy Allergy and Respiratory Diseases, IRCCS Policlinico S. Martino, University of Genoa, Genoa, Italy
| | - F Menzella
- UOC Pulmonary, "S. Valentino" Hospital, AULSS 2 Marca Trevigiana, Montebelluna, Treviso, Italy
| | - R F Mauritz Canevari
- Department of DISC, Otolaryngologist Clinic-IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - G Danesi
- Unità Operativa di Otorinolaringoiatria e Microchirurgia della Base Cranica, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A M Pusateri
- Unità Operativa di Otorinolaringoiatria e Microchirurgia della Base Cranica, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - M Carone
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Telese Terme, Benevento, Italy
| | - C Vancheri
- UOC Respiratory System Diseases, Università degli Studi di Catania, Catania, Italy
| | - F Di Marco
- UOC Respiratory System Diseases, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - C Micheletto
- UOC Pulmonary, Azienda Ospedaliera Universitaria Verona, Verona, Italy
| | - G Manzotti
- Unit of Allergology, Casa di Cura B. Palazzolo, Bergamo, Italy
| | - M Di Gioacchino
- Società Italiana di Asma Allergologia e Immunologia Clinica, University of Chieti, Chieti, Italy
| | - M B Bilò
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Italy
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Gelardi
- ENT Clinic, University of Foggia, Foggia, Italy
| | - G Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - G W Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
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Chessari C, Simonetta E, Amati F, Nigro M, Stainer A, Sotgiu G, Puci M, Gramegna A, Blasi F, Morlacchi LC, Buscemi AAMD, Conio V, Sanci V, Corsico AG, Faverio P, Michalak W, Luppi F, Crimi C, Vancheri C, Campisi R, Vulpi MR, Carpagnano GE, Cicchetti M, Sekretna K, Scichilone N, Battaglia S, Aliberti S. Diagnostic delay in bronchiectasis: an Italian perspective. ERJ Open Res 2024; 10:00713-2023. [PMID: 38500794 PMCID: PMC10945380 DOI: 10.1183/23120541.00713-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/10/2023] [Indexed: 03/20/2024] Open
Abstract
It takes ∼3.5 years to reach a diagnosis of bronchiectasis from onset of symptoms: the long patient's journey in Italy https://bit.ly/46XMWAz.
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Affiliation(s)
- Carlo Chessari
- PROMISE Department, University of Palermo, Palermo, Italy
| | | | - Francesco Amati
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Mattia Nigro
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Anna Stainer
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mariangela Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea Gramegna
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Letizia Corinna Morlacchi
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Agata Alba Maria Domenica Buscemi
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Valentina Conio
- Respiratory Diseases Division, Cardiac, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Vincenzo Sanci
- Respiratory Diseases Division, Cardiac, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Angelo G. Corsico
- Respiratory Diseases Division, Cardiac, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Paola Faverio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Respiratory Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Weronika Michalak
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Respiratory Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabrizio Luppi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Respiratory Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Raffaele Campisi
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
| | - Maria Rosaria Vulpi
- Respiratory Diseases Section, University Hospital Policlinico di Bari, University of Bari, Bari, Italy
| | | | - Marianna Cicchetti
- Respiratory Diseases Section, University Hospital Policlinico di Bari, University of Bari, Bari, Italy
| | - Kseniia Sekretna
- Department of Occupational Diseases, Clinical Immunology and Clinical Pharmacology, Dnipro State Medical University, Dnipro, Ukraine
| | | | | | - Stefano Aliberti
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Libra A, Colaci M, Spicuzza L, Luca G, Fischetti S, Pashalidis G, Ferrara CA, Ielo G, Sambataro D, La Rosa G, Libra F, Palmucci S, Vancheri C, Sambataro G. The Pattern and Progression of "Usual" Interstitial Pneumonia with Autoimmune Features: Comparison with Patients with Classic Interstitial Pneumonia with Autoimmune Features and Idiopathic Pulmonary Fibrosis. J Clin Med 2024; 13:369. [PMID: 38256503 PMCID: PMC10816405 DOI: 10.3390/jcm13020369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND We proposed the term "UIPAF" to define patients with Usual Interstitial Pneumonia (UIP) associated with only one domain of the classification called "Interstitial Pneumonia with Autoimmune Features" (IPAF). The objective of this study was to evaluate the clinical presentation and prognosis of UIPAF patients, compared with two cohorts, composed of IPAF and idiopathic pulmonary fibrosis (IPF) patients, respectively. METHODS The patients were enrolled as IPAF, UIPAF, or IPF based on clinical, serological, and radiological data and evaluated by a multidisciplinary team. RESULTS We enrolled 110 patients with IPF, 69 UIPAF, and 123 IPAF subjects. UIPAF patients were similar to IPAF regarding autoimmune features, except for the prevalence of Rheumatoid Factor in UIPAF and anti-SSA in IPAF. A similar proportion of the two cohorts progressed toward a specific autoimmune disease (SAD), with differences in the kind of SAD developed. The real-life management and prognosis of UIPAF patients proved to be almost identical to IPF. CONCLUSIONS UIPAF shared with IPAF similar autoimmune features, suggesting the opportunity to be considered IPAF, excluding the morphological domain by the classification. However, the real-life management and prognosis of UIPAF are similar to IPF. These data suggest a possible modification in the therapeutic management of UIPAF.
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Affiliation(s)
- Alessandro Libra
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Michele Colaci
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy;
| | - Lucia Spicuzza
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Giuliana Luca
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Sefora Fischetti
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Giorgio Pashalidis
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Chiara Alfia Ferrara
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Giuseppe Ielo
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Domenico Sambataro
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia (CT), Italy;
| | - Giuliana La Rosa
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (G.L.R.); (F.L.)
| | - Federica Libra
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (G.L.R.); (F.L.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Unità Operativa Semplice Dipartimentale di Imaging Polmonare e Tecniche Radiologiche Avanzate (UOSD IPTRA), 95123 Catania, Italy;
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy;
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia (CT), Italy;
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Baughman RP, Caminati A, Ravaglia C, Richeldi L, Rottoli P, Tomassetti S, Vancheri C. Images in Sarcoidosis: new section of our Journal. Sarcoidosis Vasc Diffuse Lung Dis 2023; 40:e2023047. [PMID: 38126493 DOI: 10.36141/svdld.v40i4.15339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 12/23/2023]
Affiliation(s)
| | | | - Claudia Ravaglia
- Editor-in-chief, Sarcoidosis, Vasculitis and Diffuse Lung Diseases.
| | - Luca Richeldi
- Editor-in-chief, Sarcoidosis, Vasculitis and Diffuse Lung Diseases.
| | - Paola Rottoli
- Editor-in-chief, Sarcoidosis, Vasculitis and Diffuse Lung Diseases.
| | - Sara Tomassetti
- Editor-in-chief, Sarcoidosis, Vasculitis and Diffuse Lung Diseases.
| | - Carlo Vancheri
- Editor-in-chief, Sarcoidosis, Vasculitis and Diffuse Lung Diseases.
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Kolb M, Flaherty KR, Silva RS, Prasse A, Vancheri C, Mueller H, Sroka-Saidi K, Wells AU. Effect of Nintedanib in Patients with Progressive Pulmonary Fibrosis in Subgroups with Differing Baseline Characteristics. Adv Ther 2023; 40:5536-5546. [PMID: 37751022 PMCID: PMC10611817 DOI: 10.1007/s12325-023-02668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION In the INBUILD trial in patients with progressive pulmonary fibrosis other than idiopathic pulmonary fibrosis (IPF), nintedanib slowed the rate of decline in forced vital capacity (FVC; mL/year) over 52 weeks compared with placebo. We assessed the efficacy of nintedanib across subgroups in the INBUILD trial by baseline characteristics. METHODS We assessed the rate of decline in FVC over 52 weeks and time to progression of interstitial lung disease (ILD) (absolute decline from baseline in FVC % predicted > 10%) or death over the whole trial in subgroups based on sex, age, race, body mass index (BMI), time since diagnosis of ILD, FVC % predicted, diffusing capacity of the lungs for carbon monoxide (DLco) % predicted, composite physiologic index (CPI), GAP (gender, age, lung physiology) stage, use of anti-acid therapy and use of disease-modifying antirheumatic drugs (DMARDs) at baseline. RESULTS The effect of nintedanib versus placebo on reducing the rate of decline in FVC over 52 weeks was consistent across the subgroups by baseline characteristics analysed. Interaction p values did not indicate heterogeneity in the treatment effect between these subgroups (p > 0.05). Over the whole trial (median follow-up time ∼19 months), progression of ILD or death occurred in similar or lower proportions of patients treated with nintedanib than placebo across the subgroups analysed, with no heterogeneity detected between the subgroups. CONCLUSIONS In the INBUILD trial, no heterogeneity was detected in the effect of nintedanib on reducing the rate of ILD progression across subgroups based on demographics, ILD severity or use of anti-acid therapy or DMARDs. These data support the use of nintedanib as a treatment for progressive pulmonary fibrosis. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT02999178.
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Affiliation(s)
- Martin Kolb
- Department of Medicine, McMaster University and St. Joseph's Healthcare, T2117 50 Charlton Ave. E., Hamilton, ON, L8N 4A6, Canada.
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rafael S Silva
- Unidad de Respiratorio, Hospital Regional de Talca, Talca, Chile
| | - Antje Prasse
- Department of Respiratory Medicine, MHH Hannover Medical School, Hannover, Germany
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Heiko Mueller
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Athol U Wells
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, and National Heart and Lung Institute, Imperial College, London, UK
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Palmucci S, Tiralongo F, Galioto F, Toscano S, Reali L, Scavone C, Fazio G, Ferlito A, Sambataro G, Vancheri A, Sciacca E, Vignigni G, Spadaro C, Mauro LA, Foti PV, Vancheri C, Basile A. Histogram-based analysis in progressive pulmonary fibrosis: relationships between pulmonary functional tests and HRCT indexes. Br J Radiol 2023; 96:20221160. [PMID: 37660683 PMCID: PMC10607396 DOI: 10.1259/bjr.20221160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/12/2023] [Accepted: 07/11/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES To investigate relationships between histogram-based high-resolution CT (HRCT) indexes and pulmonary function tests (PFTs) in interstitial lung diseases. METHODS Forty-nine patients having baseline and 1-year HRCT examinations and PFTs were investigated. Histogram-based HRCT indexes were calculated; strength of associations with PFTs was investigated using Pearson correlation. Patients were divided into progressive and non-progressive groups. HRCT indexes were compared between the two groups using the U-test; within each group, baseline and follow-up Wilcoxon analysis was performed. Receiver operating characteristic analysis was used for predicting disease progression. RESULTS At baseline, moderate correlations were observed considering kurtosis and diffusion capacity of the lungs for carbon monoxide (DLCO) (r = 0.54) and skewness and DLCO (r = 0.559), whereas weak but significant correlations were observed between forced vital capacity and kurtosis (r = 0.368, p = 0.009) and forced vital capacity and skewness (r = 0.391, p = 0.005). Negative correlations were reported between HAA% and PFTs (from r = -0.418 up to r = -0.507). At follow-up correlations between quantitative indexes and PFTs were also moderate, except for high attenuation area (HAA)% -700 and DLCO (r = -0.397). In progressive subgroup, moderate and strong correlations were found between DLCO and HRCT indexes (r = 0.595 kurtosis, r = 0.672 skewness, r=-0. 598 HAA% -600 and r = -0.626 HAA% -700). At follow-up, we observed significant differences between the two groups for kurtosis (p = 0.029), HAA% -600 (p = 0.04) and HAA% -700 (p = 0.02). To predict progression, ROC analysis reported sensitivity of 90.9% and specificity of 51.9% using a threshold value of δ kurtosis <0.03. CONCLUSION At one year, moderate correlations suggest that progression could be assessed through HRCT quantification. ADVANCES IN KNOWLEDGE This study promotes histogram-based HRCT indexes in the assessment of progressive pulmonary fibrosis.
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Affiliation(s)
- Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Francesco Tiralongo
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Federica Galioto
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Stefano Toscano
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Linda Reali
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Carlotta Scavone
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Giulia Fazio
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Agata Ferlito
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | | | - Ada Vancheri
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
| | - Enrico Sciacca
- Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanna Vignigni
- Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carla Spadaro
- Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
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Libra A, Ciancio N, Sambataro G, Sciacca E, Muscato G, Marino A, Vancheri C, Spicuzza L. Use of Remdesivir in Patients Hospitalized for COVID-19 Pneumonia: Effect on the Hypoxic and Inflammatory State. Viruses 2023; 15:2101. [PMID: 37896877 PMCID: PMC10612076 DOI: 10.3390/v15102101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Remdesivir is one of the most attractive options for patients with hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). The aim of our study was to evaluate the effect of remdesivir on the hypoxic and inflammatory state in patients with moderate to severe COVID-19. We retrospectively enrolled 112 patients admitted for COVID-19 pneumonia, requiring low-flow oxygen, 57 treated with remdesivir plus standard of care (SoC) and 55 treated only with SoC that were similar for demographic and clinical data. We evaluated changes in hypoxemia and inflammatory markers at admission (Day 0) and after 5 days of treatment (Day 5) and the clinical course of the disease. From Day 0 to Day 5, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F) increased from 222 ± 62 to 274 ± 97 (p < 0.0001) in the remdesivir group and decreased from 223 ± 62 to 183 ± 76 (p < 0.05) in the SoC group. Interleukine-6 levels decreased in the remdesivir (45.9 to 17.5 pg/mL, p < 0.05) but not in the SoC group. Remdesivir reduced the need for ventilatory support and the length of hospitalization. In conclusion, compared to standard care, remdesivir rapidly improves hypoxia and inflammation, causing a better course of the disease in moderate to severe COVID-19.
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Affiliation(s)
- Alessandro Libra
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Nicola Ciancio
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Enrico Sciacca
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Giuseppe Muscato
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Andrea Marino
- Department of Biomedical and Biotechnological Sciences, Unit of Infectious Diseases, University of Catania, 95123 Catania, Italy;
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Lucia Spicuzza
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
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10
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Molina-Molina M, Shull JG, Vicens-Zygmunt V, Rivera-Ortega P, Antoniou K, Bonella F, Renzoni E, Russell AM, Maher TM, Vancheri A, Bachs A, Avilés V, Palma J, Bermudo G, Suarez-Cuartin G, Tebé C, Rigo-Bonnin R, Montes-Worboys A, Wijsenbeek M, Vancheri C. Gastrointestinal pirfenidone adverse events in idiopathic pulmonary fibrosis depending on diet: the MADIET clinical trial. Eur Respir J 2023; 62:2300262. [PMID: 37857429 PMCID: PMC10586233 DOI: 10.1183/13993003.00262-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and lethal interstitial lung disease (ILD) [1, 2]. Antifibrotic medications such as pirfenidone have been a turning point in the management of IPF, slowing of disease progression and improving survival [1–5]. Individuals with IPF who follow a MUFA diet report a lower incidence of pirfenidone gastrointestinal adverse events than those that follow a SFA diet, which could explain the different prevalence in GI pirfenidone AEs reported by countries in IPF cohorts https://bit.ly/3LuzAUJ
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Affiliation(s)
- Maria Molina-Molina
- Interstitial Lung Disease Unit, Respiratory Department, University Hospital of Bellvitge, Research Lab 4126, IDIBELL, UB, Barcelona, Spain
- Spanish Research Network in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Jessica Germaine Shull
- Interstitial Lung Disease Unit, Respiratory Department, University Hospital of Bellvitge, Research Lab 4126, IDIBELL, UB, Barcelona, Spain
| | - Vanesa Vicens-Zygmunt
- Interstitial Lung Disease Unit, Respiratory Department, University Hospital of Bellvitge, Research Lab 4126, IDIBELL, UB, Barcelona, Spain
- Spanish Research Network in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Pilar Rivera-Ortega
- NIHR Manchester Clinical Research Facility, Interstitial Lung Disease Unit, Respiratory Medicine Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Katerina Antoniou
- Laboratory of Cellular and Molecular Pneumonology, Dept of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, University Hospital, University of Duisburg Essen, Essen, Germany
| | - Elisabetta Renzoni
- NIHR Respiratory Clinical Research Facility, Royal Brompton Hospital, and Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, UK
| | - Anne-Marie Russell
- Exeter Respiratory Institute, University of Exeter and Royal Devon University Hospitals NHS Foundation Trust, Exeter, UK
| | - Toby M Maher
- Keck Medicine of University of Southern California, Los Angeles, CA, USA
- National Heart and Lung Institute, Imperial College, London, UK
| | - Ada Vancheri
- Dept of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, University Hospital "Policlinico G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Anna Bachs
- Interstitial Lung Disease Unit, Respiratory Department, University Hospital of Bellvitge, Research Lab 4126, IDIBELL, UB, Barcelona, Spain
| | - Victoria Avilés
- Unit of Nutritional Support, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Josep Palma
- Interstitial Lung Disease Unit, Respiratory Department, University Hospital of Bellvitge, Research Lab 4126, IDIBELL, UB, Barcelona, Spain
| | - Guadalupe Bermudo
- Interstitial Lung Disease Unit, Respiratory Department, University Hospital of Bellvitge, Research Lab 4126, IDIBELL, UB, Barcelona, Spain
- Spanish Research Network in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Guillermo Suarez-Cuartin
- Interstitial Lung Disease Unit, Respiratory Department, University Hospital of Bellvitge, Research Lab 4126, IDIBELL, UB, Barcelona, Spain
- Spanish Research Network in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Cristian Tebé
- Dept of Biostatistics, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Raul Rigo-Bonnin
- Dept of Clinical Laboratory, Bellvitge University Hospital, IDIBELL, Barcelona, Spain
| | - Ana Montes-Worboys
- Interstitial Lung Disease Unit, Respiratory Department, University Hospital of Bellvitge, Research Lab 4126, IDIBELL, UB, Barcelona, Spain
- Spanish Research Network in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Marlies Wijsenbeek
- Dept of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Carlo Vancheri
- Dept of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, University Hospital "Policlinico G. Rodolico - San Marco", University of Catania, Catania, Italy
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Libra A, Muscato G, Ielo G, Spicuzza L, Palmucci S, Fagone E, Fruciano M, Gili E, Sambataro G, Vancheri C. Clinical and Prognostic Significance of p-ANCA Positivity in Idiopathic Pulmonary Fibrosis: A Retrospective Observational Study. Diagnostics (Basel) 2023; 13:diagnostics13111882. [PMID: 37296734 DOI: 10.3390/diagnostics13111882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Perinuclear Anti Neutrophil Cytoplasmic Antibody (p-ANCA) is a serological marker of Microscopic Polyangiitis (MPA), a vasculitis associated with lung involvement potentially mimicking Idiopathic Pulmonary Fibrosis (IPF). In this study, we evaluated the role of p-ANCA in predicting clinical evolution and prognosis in a cohort of IPF patients. In this observational, retrospective, case-control study, we compared 18 patients with an IPF diagnosis and p-ANCA positivity with 36 patients with seronegative IPF, matched for age and sex. IPF patients with and without p-ANCA showed similar lung function decline during the follow-up, but IPF p-ANCA+ showed better survival. Half of IPF p-ANCA+ patients were classified as MPA for the development of renal involvement (55%) or skin signs (45%). The progression towards MPA was associated with high levels of Rheumatoid Factor (RF) at baseline. In conclusion, p-ANCA, mainly when associated with RF, could predict the evolution of Usual Interstitial Pneumonia (UIP) towards a definite vasculitis in patients, with a better prognosis compared with IPF. In this view, ANCA testing should be included in the diagnostic workup of UIP patients.
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Affiliation(s)
- Alessandro Libra
- Regional Referral Centre for Rare Lung Disease, Department of Clinical and Experimental Medicine, University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy
| | - Giuseppe Muscato
- Regional Referral Centre for Rare Lung Disease, Department of Clinical and Experimental Medicine, University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy
| | - Giuseppe Ielo
- Regional Referral Centre for Rare Lung Disease, Department of Clinical and Experimental Medicine, University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy
| | - Lucia Spicuzza
- Regional Referral Centre for Rare Lung Disease, Department of Clinical and Experimental Medicine, University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- Radiology Unit I, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy
| | - Evelina Fagone
- Regional Referral Centre for Rare Lung Disease, Department of Clinical and Experimental Medicine, University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy
| | - Mary Fruciano
- Regional Referral Centre for Rare Lung Disease, Department of Clinical and Experimental Medicine, University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy
| | - Elisa Gili
- Regional Referral Centre for Rare Lung Disease, Department of Clinical and Experimental Medicine, University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Disease, Department of Clinical and Experimental Medicine, University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Disease, Department of Clinical and Experimental Medicine, University Hospital "Policlinico-San Marco", University of Catania, 95123 Catania, Italy
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Sambataro G, Libra A, Spicuzza L, Palmucci S, Conti P, Spagnolo E, Colaci M, Malatino L, Orlandi M, Sambataro D, Vancheri C. Clinical Presentation of Connective Tissue Disease Patients with and without Interstitial Lung Disease: A Retrospective Study. Respiration 2023:1-11. [PMID: 37231870 DOI: 10.1159/000530785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Connective tissue diseases (CTDs) are responsible for about 20% of interstitial lung disease (ILD) cases, but their diagnosis in a pulmonary unit (PU) is not always straightforward due to a heterogeneous clinical picture. OBJECTIVES The aim of this study was to evaluate the clinical presentation of rheumatoid arthritis (RA) and CTD-ILD cases diagnosed in PU, compared to RA and CTD patients diagnosed in a rheumatologic unit (RU). METHODS Patients with RA, systemic sclerosis (SSc), primary Sjӧgren's syndrome (pSS), and idiopathic inflammatory myopathy were retrospectively enrolled from an RU and a PU designated to manage ILD during a period from January 2017 to October 2022. The classification of CTD-PU was carried out in a multidisciplinary setting, including the same rheumatologists that diagnosed CTD in the RU. RESULTS ILD-CTD-PU patients were prevalently male and older. Progression from undifferentiated CTD to a specific condition was more common in ILD-CTD-PU, and those patients generally obtained a lower score on specific classification criteria. RA-PU patients resembled polymyalgia rheumatica in 47.6% of cases, also showing a greater proportion of typical joint deformities (p = 0.02). SSc-PU patients showed a usual interstitial pneumonia pattern in 76% of cases and, compared with SSc-RU, were more commonly seronegative (p = 0.03) and generally lacked fingertip lesions (p = 0.02). The majority of the diagnoses of pSS-PU were in patients with previously diagnosed ILD, in which seropositivity and sicca syndrome developed during follow-up. CONCLUSIONS CTD-ILD patients diagnosed in the PU show severe lung involvement and a nuanced autoimmune clinical picture.
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Affiliation(s)
- Gianluca Sambataro
- Regional Referral Centre for Rare Lung Diseases, AOU "Policlinico G. Rodolico-San Marco", University of Catania, Catania, Italy
- Artroreuma srl Rheumatology Outpatient Clinic associated with the National Health System, Mascalucia (CT), Italy
| | - Alessandro Libra
- Regional Referral Centre for Rare Lung Diseases, AOU "Policlinico G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Lucia Spicuzza
- Regional Referral Centre for Rare Lung Diseases, AOU "Policlinico G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Stefano Palmucci
- Department of Medical-Surgical Sciences and Advanced Technologies G.F. Ingrassia - Radiology I Unit, University Hospital Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Paola Conti
- Regional Referral Centre for Rare Lung Diseases, AOU "Policlinico G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Eugenio Spagnolo
- Regional Referral Centre for Rare Lung Diseases, AOU "Policlinico G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Michele Colaci
- Internal Medicine Unit, Division of Rheumatology, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Lorenzo Malatino
- Internal Medicine Unit, Division of Rheumatology, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Martina Orlandi
- Division of Rheumatology AOUC Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Domenico Sambataro
- Artroreuma srl Rheumatology Outpatient Clinic associated with the National Health System, Mascalucia (CT), Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, AOU "Policlinico G. Rodolico-San Marco", University of Catania, Catania, Italy
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Sambataro G, Sambataro D, Spicuzza L, Meloni F, Lorini G, Malatino L, Colaci M, Sebastiani G, Iuliano A, Canofari C, Luppi F, Franco G, Zanini U, Manfredi A, Gozzi F, Sebastiani M, Palmucci S, Cavagna L, Vancheri C. Progression and prognosis of interstitial pneumonia with autoimmune features: a longitudinal, prospective, multi-centre study. Clin Exp Rheumatol 2023; 41:1140-1148. [PMID: 36189910 DOI: 10.55563/clinexprheumatol/lycdca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate the rate of progression towards specific autoimmune diseases (SADs) of a prospective, multi-centre cohort of patients classifiable as interstitial pneumonia with autoimmune features (IPAF). METHODS IPAF patients were enrolled based on specific research criteria, and jointly followed by rheumatologists and pulmonologists for at least one year with clinical check-ups, serological exams including autoimmunity, capillaroscopy and high-resolution computed tomography (HRCT). Diagnostic assessment was repeated at least once a year, or earlier when deemed useful. RESULTS We enrolled 191 IPAF patients through 95 different combinations of IPAF criteria. Of these, 24.1% progressed towards SAD, mainly in connective tissue diseases but also in microscopic polyangiitis. The IPAF patients who progressed were younger than stable IPAF patients (63±10 years vs. 68±9 years, p=0.002) and had a longer follow-up (36.9±18.7 vs. 29.3±15.7 months, p=0.007), but similar severity. No parameters were associated with overall progression, but some parameters were associated with the development of specific diagnoses: Sjögren's syndrome with positivity for SSA (p=0.007, χ2 7.4); idiopathic inflammatory myopathy with mechanic's hands (p=<0.0001, χ2 12.6), organizing pneumonia pattern (p=0.01, χ2 6.1), positivity for anti-Pm/scl (p=0.04 χ2 4.1) and anti-MDA5 (p=0.04, χ2 4.2); systemic sclerosis with palmar telangiectasias (p=<0.0001 2 18.3), positivity for anti-Scl70 (p=<0.0001 χ2 12.5) and anti-PM/Scl (p=0.001 χ2 10.1). CONCLUSIONS IPAF patients had a rate of progression towards SAD similar to that reported in previous studies on undifferentiated connective tissue diseases, thus including some patients in which lung involvement could represent the first or even the sole clinical manifestation of a SAD.
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Affiliation(s)
- Gianluca Sambataro
- Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico G.Rodolico-San Marco, University of Catania, and Artroreuma srl, Outpatient Clinic of Rheumatology, Mascalucia, Catania, Italy.
| | - Domenico Sambataro
- Artroreuma srl, Outpatient Clinic of Rheumatology, Mascalucia, Catania, and Department of Clinical and Experimental Medicine, Internal Medicine Unit, Division of Rheumatology, Cannizzaro Hospital, University of Catania, Italy
| | - Lucia Spicuzza
- Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico G.Rodolico-San Marco, University of Catania, Italy
| | - Federica Meloni
- Department of Internal Medicine and Therapeutics, U.O.S. Transplant Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Giorgio Lorini
- Department of Internal Medicine and Therapeutics, U.O.S. Transplant Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Lorenzo Malatino
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Division of Rheumatology, Cannizzaro Hospital, University of Catania, Italy
| | - Michele Colaci
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Division of Rheumatology, Cannizzaro Hospital, University of Catania, Italy
| | | | | | | | - Fabrizio Luppi
- Respiratory Diseases Unit, San Gerardo Hospital, Monza University of Milano-Bicocca, Italy
| | - Giovanni Franco
- Respiratory Diseases Unit, San Gerardo Hospital, Monza University of Milano-Bicocca, Italy
| | - Umberto Zanini
- Respiratory Diseases Unit, San Gerardo Hospital, Monza University of Milano-Bicocca, Italy
| | - Andreina Manfredi
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Gozzi
- Respiratory Disease Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Sebastiani
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Palmucci
- Department of Medical-Surgical Sciences and Advanced Technologies G.F. Ingrassia, Radiology I Unit, University Hospital Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico G. Rodolico-San Marco, University of Catania, Italy
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14
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Spicuzza L, Campagna D, Di Maria C, Sciacca E, Mancuso S, Vancheri C, Sambataro G. An update on lateral flow immunoassay for the rapid detection of SARS-CoV-2 antibodies. AIMS Microbiol 2023; 9:375-401. [PMID: 37091823 PMCID: PMC10113162 DOI: 10.3934/microbiol.2023020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
Over the last three years, after the outbreak of the COVID-19 pandemic, an unprecedented number of novel diagnostic tests have been developed. Assays to evaluate the immune response to SARS-CoV-2 have been widely considered as part of the control strategy. The lateral flow immunoassay (LFIA), to detect both IgM and IgG against SARS-CoV-2, has been widely studied as a point-of-care (POC) test. Compared to laboratory tests, LFIAs are faster, cheaper and user-friendly, thus available also in areas with low economic resources. Soon after the onset of the pandemic, numerous kits for rapid antibody detection were put on the market with an emergency use authorization. However, since then, scientists have tried to better define the accuracy of these tests and their usefulness in different contexts. In fact, while during the first phase of the pandemic LFIAs for antibody detection were auxiliary to molecular tests for the diagnosis of COVID-19, successively these tests became a tool of seroprevalence surveillance to address infection control policies. When in 2021 a massive vaccination campaign was implemented worldwide, the interest in LFIA reemerged due to the need to establish the extent and the longevity of immunization in the vaccinated population and to establish priorities to guide health policies in low-income countries with limited access to vaccines. Here, we summarize the accuracy, the advantages and limits of LFIAs as POC tests for antibody detection, highlighting the efforts that have been made to improve this technology over the last few years.
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Affiliation(s)
- Lucia Spicuzza
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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La Rocca G, Ferro F, Baldini C, Libra A, Sambataro D, Colaci M, Malatino L, Palmucci S, Vancheri C, Sambataro G. Targeting intracellular pathways in idiopathic inflammatory myopathies: A narrative review. Front Med (Lausanne) 2023; 10:1158768. [PMID: 36993798 PMCID: PMC10040547 DOI: 10.3389/fmed.2023.1158768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
In recent decades, several pieces of evidence have drawn greater attention to the topic of innate immunity, in particular, interferon (IFN) and Interleukin 6 in the pathogenesis of idiopathic inflammatory myopathies (IIM). Both of these molecules transduce their signal through a receptor coupled with Janus kinases (JAK)/signal transducer and activator of transcription proteins (STAT). In this review, we discuss the role of the JAK/STAT pathway in IIM, evaluate a possible therapeutic role for JAK inhibitors in this group of diseases, focusing on those with the strongest IFN signature (dermatomyositis and antisynthetase syndrome).
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Affiliation(s)
- Gaetano La Rocca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Libra
- Regional Referral Centre for Rare Lung Disease, Azienda Ospedaliero Universitaria Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy
| | | | - Michele Colaci
- Internal Medicine Unit, Rheumatology Clinic, Azienda Ospedaliera per l’Emergenza Cannizzaro, University of Catania, Catania, Italy
| | - Lorenzo Malatino
- Internal Medicine Unit, Rheumatology Clinic, Azienda Ospedaliera per l’Emergenza Cannizzaro, University of Catania, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Disease, Azienda Ospedaliero Universitaria Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Disease, Azienda Ospedaliero Universitaria Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy
- Artroreuma S.R.L., Rheumatology Outpatient Clinic, Catania, Italy
- *Correspondence: Gianluca Sambataro,
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Mondoni M, Varone F, Alfano F, Muscato G, Conti C, Saderi L, Iovene B, Marco FD, Vancheri C, Richeldi L, Centanni S, Sotgiu G. Predictors of Stability/Improvement of Forced Vital Capacity in Patients With Idiopathic Pulmonary Fibrosis After One Year of Treatment With Nintedanib. Arch Bronconeumol 2023:S0300-2896(23)00037-6. [PMID: 36894471 DOI: 10.1016/j.arbres.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Italy.
| | - Francesco Varone
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fausta Alfano
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Italy
| | - Giuseppe Muscato
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, Italy
| | - Caterina Conti
- Respiratory Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Bruno Iovene
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabiano Di Marco
- Respiratory Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; Department of Health Sciences, Università degli Studi di Milano, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, Italy
| | - Luca Richeldi
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Sambataro G, Orlandi M, Fagone E, Fruciano M, Gili E, Libra A, Palmucci S, Vancheri C, Malatino L, Colaci M, Sambataro D. Myositis-Specific and Myositis-Associated Antibodies in Fibromyalgia Patients: A Prospective Study. Biomedicines 2023; 11:biomedicines11030658. [PMID: 36979638 PMCID: PMC10045737 DOI: 10.3390/biomedicines11030658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Fibromyalgia (FM) is a common rheumatologic disorder characterised by widespread muscular pain. Myalgia is also a common clinical feature in Connective Tissue Disease (CTD), and FM should be studied for the concomitant presence of a CTD. The aim of this study is to evaluate the prevalence of Myositis-Specific and Myositis-Associated Antibodies (MSA/MAA) in a cohort of FM patients. We enrolled 233 consecutive FM patients (defined according to the 2016 criteria) that did not report clinical signs of autoimmune disorders and followed them for at least one year. The patients were tested for MSA/MAA with immunoblotting. FM patients were seropositive for Antinuclear Antibodies (ANA) in 24% of cases, for MSA in 9%, and for MAA in 6%. A specific diagnosis of CTD was made in 12 patients (5.2%), namely, 5 cases of primary Sjögren’s Syndrome and 7 of Idiopathic Inflammatory Myopathy. Seropositive patients showed clinical features similar to those who were seronegative at baseline. A CTD diagnosis was associated with ANA positivity (p = 0.03, X2 4.9), the presence of a speckled pattern (p = 0.02, X2 5.3), positivity for MAA (p = 0.004, X2 8.1), and MSA (p = 0.003, X2 9.2). In conclusion, a non-negligible proportion of FM patients may be seropositive for MSA/MAA, and that seropositivity might suggest a diagnosis of CTD.
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Affiliation(s)
- Gianluca Sambataro
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia, CT, Italy
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
- Correspondence:
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC Careggi, University of Florence, 50134 Florence, Italy
| | - Evelina Fagone
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Mary Fruciano
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Elisa Gili
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Alessandro Libra
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Lorenzo Malatino
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy
| | - Michele Colaci
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy
| | - Domenico Sambataro
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia, CT, Italy
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Sambataro G, Vancheri C, Sambataro D. Interstitial Pneumonia with Autoimmune Features (IPAF): time to redefine the classification criteria. Expert Rev Clin Immunol 2023; 19:131-133. [PMID: 36208215 DOI: 10.1080/1744666x.2023.2134119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. "Policlinico-San Marco," University of Catania, Catania, Italy.,Rheumatology Outpatient Clinic, Artroreuma SRL, Mascalucia, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. "Policlinico-San Marco," University of Catania, Catania, Italy
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Spicuzza L, Campisi R, Alia S, Prestifilippo S, Giuffrida ML, Angileri L, Ciancio N, Vancheri C. Female Sex Affects Respiratory Function and Exercise Ability in Patients Recovered from COVID-19 Pneumonia. J Womens Health (Larchmt) 2023; 32:18-23. [PMID: 36450116 DOI: 10.1089/jwh.2022.0104] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Coronavirus-19 Disease (COVID-19) may cause persistent symptoms and functional respiratory impairment, known as long COVID. Determinants of long COVID are unclear. Although males experience more severe acute illness, the impact of sex on the occurrence of long-term sequelae is unknown. The aim of this study was to establish whether sex affects pulmonary function, exercise capacity, and clinical outcomes in patients recovered from COVID-19 pneumonia. Materials and Methods: We performed a retrospective analysis on patients evaluated in our "Post-COVID Clinic" after a median follow-up of 128 days from the acute disease. Tests performed included standard spirometry, diffusion capacity of the lung for carbon monoxide (DLCO), and 6-minute walk test (6-MWT). Results: A total of 157 patients (mean age 59.9 ± 12, 91 males) recovered from mild to severe pneumonia, without previous respiratory disease, were included. No differences in demographic data and in the severity of the acute illness were observed between the two study groups, males and females. Abnormal alveolar diffusion was more common and severe among females (DLCO <80% in 31% of males vs. 53% of females, p < 0.01; DLCO <70%, in 20% of males vs. 40% of females, p < 0.01). Severe reduction in 6-MWT was observed in 20% of males versus 46% of females (p < 0.01). Multiple logistic regression showed that female sex was an independent predictor of abnormal DLCO and 6-MWT. The prevalence of symptoms and radiological abnormalities was similar in the two groups. Conclusions: These data show that at 4 months follow-up women recovered from COVID-19 pneumonia are more likely to exhibit a reduced alveolar diffusion capacity and exercise tolerance than men, although a similar severity of the acute disease.
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Affiliation(s)
- Lucia Spicuzza
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Raffaele Campisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Stefano Alia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Simone Prestifilippo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria Luisa Giuffrida
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lisa Angileri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nicola Ciancio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Mondoni M, Alfano F, Varone F, Muscato G, Conti C, Saderi L, Chiesa A, Di Marco F, Vancheri C, Richeldi L, Centanni S, Sotgiu G. Observational, Multicenter Study on the Efficacy, Tolerability, and Safety of Nintedanib in Patients with Idiopathic Pulmonary Fibrosis Older than 80 Years. Respiration 2022; 102:25-33. [PMID: 36366821 DOI: 10.1159/000527308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) primarily affects old patients. Old age is a predictor of mortality. Nintedanib, the only antifibrotic drug approved in Italy for patients aged >80 years, can slow the progression of IPF by reducing the rate of decline in forced vital capacity (FVC) and the risk of exacerbations. OBJECTIVES The primary aim of the study was to compare the decline of FVC after 12 months of nintedanib in patients aged >80 years versus younger patients. Differences related to other functional data, safety, tolerability, hospitalizations, exacerbations, and mortality were evaluated. METHODS An observational, retrospective, multicenter study was carried out in Italy. RESULTS 159 (122 [76.7%] males) patients were recruited: 106 (66.7%) aged ≤80 years and 53 (33.3%) aged >80 years. FVC decline after 12 months of therapy was not significantly different (-45 mL [-170; 75] vs. -20 mL [-138; 110] mL; p: 0.51). No differences were found for other functional data. Diarrhea was the most frequent adverse event (AE). Rate and type of any AEs, permanent/temporary dose reduction, or drug discontinuation were not significantly different between patients aged ≤80 vs. >80 years. Furthermore, acute exacerbations, hospitalization, and mortality were not significantly different. CONCLUSIONS Nintedanib is effective and safe in patients with IPF aged >80 years, and no significant differences were found when clinical outcomes were compared with those of younger patients. Thus, older age should not be a barrier for the early prescription of antifibrotic treatment in IPF patients.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Fausta Alfano
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Francesco Varone
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Muscato
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, Catania, Italy
| | - Caterina Conti
- Respiratory Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Amerigo Chiesa
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, Catania, Italy
| | - Luca Richeldi
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Zanoli L, Vancheri C. Lung Dysfunction and Increased Arterial Stiffness: Causality or Epiphenomenon? Angiology 2022; 73:901-902. [PMID: 36063090 DOI: 10.1177/00033197221122838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Luca Zanoli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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22
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Spicuzza L, Sambataro G, Schisano M, Ielo G, Mancuso S, Vancheri C. Nocturnal nasal high-flow oxygen therapy in elderly patients with concomitant chronic obstructive pulmonary disease and obstructive sleep apnea. Sleep Breath 2022; 27:1049-1055. [DOI: 10.1007/s11325-022-02702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/23/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Purpose
The coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is known as “overlap syndrome” (OS). Patients with OS are usually older than patients with OSA alone, suffer from more profound oxygen desaturation during the obstructive events often accompanied by sustained nocturnal hypoventilation. Although oxygen-enriched positive airway pressure (PAP) is the treatment of choice in these patients, this therapy is often poorly tolerated particularly by the elderly. The aim of this study was to assess the usefulness of nocturnal oxygen therapy via nasal high flow (NHF-OT) as a possible alternative to PAP in patients with OS.
Methods
Patients > 65 years old with OS and nocturnal respiratory failure (time spent below SaO2 90% (T90) > 30%) had cardio-respiratory monitoring performed at baseline, during NHF-OT, or during conventional oxygen therapy (COT).
Results
A total of 40 patients were enrolled in the study. NHF-OT significantly reduced the apnea–hypopnea index (AHI) in all patients compared to baseline and COT. The mean basal AHI was 25.4 ± 8.6. During COT and NHF-OT, the AHI was 19.4 ± 7 and 5.4 ± 4.6, respectively (P < 0.001) and 19 patients reached an AHI < 5 during NHF-OT. The mean nocturnal SaO2% was 86.2 ± 2.6 at baseline and at equivalent FiO2 it significantly increased to 91.8 ± 2.4 during COT and to 93.9 ± 2.5 during NHF-OT (P < 0.001). The T90% was 48.7 ± 20.1 at baseline, 16.8 ± 11.7 during COT, and 8.8 ± 8.0 during NHF-OT (P < 0.001).
Conclusions
In elderly patients with OS, nocturnal treatment with NHF-OT significantly reduces obstructive episodes and improves oxygenation. As the treatment is generally well tolerated compared to PAP, NHF-OT may be a possible alternative therapy in this subgroup of patients.
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Sambataro G, Ferrara CA, Torrisi SE, Spadaro C, Vignigni G, Vancheri A, Del Papa N, Orlandi M, Colaci M, Malatino L, Palmucci S, Cavagna L, Sambataro D, Vancheri C. "Usual" interstitial pneumonia with autoimmune features: a prospective study on a cohort of idiopathic pulmonary fibrosis patients. Clin Exp Rheumatol 2022; 40:1324-1329. [PMID: 35349416 DOI: 10.55563/clinexprheumatol/lqi6z7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The classification interstitial pneumonia with autoimmune features (IPAF) includes patients with interstitial lung disease (ILD) associated with autoimmune characteristics insufficient to reach classification criteria for a specific autoimmune disease (SAD). These criteria are divided into three domains: clinical, serological and morphological. The latter domain does not include the usual interstitial pneumonia (UIP) pattern, which is deemed not to be significantly associated with SAD. Therefore, the enrolment of these patients is more difficult, requiring at least one item from both of the other domains. The objective of this study is to evaluate the rate of progression towards SAD of a cohort of UIP patients satisfying only one IPAF domain (we called this group "UIPAF") compared with classic idiopathic pulmonary fibrosis (IPF). METHODS We prospectively enrolled IPF patients with radiologic and/or histologic UIP pattern, followed jointly by rheumatologists and pulmonologists from January 2017 to January 2021, with a minimum follow-up of 12 months. RESULTS We enrolled 190 IPF patients, 38 (20%) of whom were classified as UIPAF. IPF and UIPAF patients were similar for general characteristics, severity and prognosis, at presentation and at annual check-up. However, 28.9% of UIPAF patients progressed towards SAD, compared with 2% of IPF patients (χ2=30.4, p≤0.0001). CONCLUSIONS The association between a single clinical or serological domain of IPAF and UIP pattern is predictive for the development of a SAD if compared with isolated UIP. ILD can be the first manifestation of SAD, even with a UIP pattern, therefore, the morphological domain of IPAF criteria could be removed.
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Affiliation(s)
- Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, and Outpatient Clinic of Rheumatology, Artroreuma S.r.l., Mascalucia (CT), Italy.
| | - Chiara A Ferrara
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, Italy
| | - Sebastiano E Torrisi
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, Italy
| | - Carla Spadaro
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, Italy
| | - Giovanna Vignigni
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, Italy
| | - Ada Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, Italy
| | - Nicoletta Del Papa
- Day Hospital of Rheumatology, Department of Rheumatology, ASST G.Pini-CTO, Milan, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit 2, University of Florence - AOUC, Florence, Italy
| | - Michele Colaci
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, Italy
| | - Lorenzo Malatino
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, Italy
| | - Stefano Palmucci
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Italy
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Domenico Sambataro
- Outpatient Clinic of Rheumatology, Artroreuma S.r.l., Mascalucia (CT), and 5Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. Policlinico-San Marco, University of Catania, Italy
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Nolasco S, Manti S, Leonardi S, Vancheri C, Spicuzza L. High-Flow Nasal Cannula Oxygen Therapy: Physiological Mechanisms and Clinical Applications in Children. Front Med (Lausanne) 2022; 9:920549. [PMID: 35721052 PMCID: PMC9203852 DOI: 10.3389/fmed.2022.920549] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
High-flow nasal cannula (HFNC) oxygen therapy has rapidly become a popular modality of respiratory support in pediatric care. This is undoubtedly due to its ease of use and safety, which allows it to be used in a wide variety of settings, ranging from pediatric intensive care to patients' homes. HFNC devices make it possible to regulate gas flow and temperature, as well as allowing some nebulized drugs to be administered, features very useful in children, in which the balance between therapeutic effectiveness and adherence to treatment is pivotal. Although the physiological effects of HFNC are still under investigation, their mechanisms of action include delivery of fixed concentration of oxygen, generation of positive end-expiratory pressure, reduction of the work of breathing and clearance of the nasopharyngeal dead space, while providing optimal gas conditioning. Nevertheless, current evidence supports the use of HFNC mainly in moderate-to-severe bronchiolitis, whereas for asthma exacerbations and breath sleeping disorders there is a lack of randomized controlled trials comparing HFNC to continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV), which are essentials for the identification of response and non-response predictors. In this regard, the development of clinical guidelines for HFNC, including flow settings, indications, and contraindications is urgently needed.
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Affiliation(s)
- Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- *Correspondence: Santi Nolasco
| | - Sara Manti
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Leonardi
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lucia Spicuzza
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Spicuzza L, Mancuso S, Campisi R, Vancheri C. Sleep quality and mental health during the COVID-19 pandemic in patients with severe obstructive sleep apnea. J Patient Rep Outcomes 2022; 6:46. [PMID: 35526189 PMCID: PMC9079209 DOI: 10.1186/s41687-022-00454-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background The first wave of the COVID-19 pandemic has produced remarkable effects on the sleep quality and mental status of the general population and more dramatic effects on patients with chronic illness. Patients with obstructive sleep apnea (OSA), already suffering from disordered sleep, might be more susceptible to the effect of the pandemic on their sleep quality and mental health. We therefore performed a case–control study to compare sleep quality, depression and anxiety symptoms reported by patients with severe OSA and age-matched healthy subjects during the first wave of the COVID-19. In June–July 2020 we enrolled a total of 222 patients with severe OSA, all treated with continuous positive airway pressure, and 164 healthy controls. Self-reported sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI). Symptoms of depression were assessed using the Patient Health Questionnaire module 9 (PHQ-9), while the specific “Coronavirus Anxiety Scale” (CAS) evaluated the level of anxiety. Results Patients with OSA (61% males, 65 ± 9.6 years old, BMI 30.5 ± 3.6) and healthy controls had similar characteristics except for BMI slightly lower in controls. The perceived quality of sleep, referred to the pre-pandemic period, was significantly worse in patients with OSA than in controls. During the pandemic the rate of reported sleep disturbance increased from 54 to 66% in patients with OSA and from 29 to 40% in controls. A high percentage of patients and controls reported symptoms of depression (61% OSA and 65% controls), whereas lower levels of anxiety, similar in the two groups, were observed. In patients with OSA the PSQI score significantly positively correlated with the PHQ-9 score (r2 = 0.81) and the CAS score (r2 = 0.65). Conclusion The rate of reported sleep disturbance in patients with OSA during the first wave of the COVID-19 pandemic is one of the highest evidenced in literature so far. As for the general population, in these patients there is a strict link between the perceived sleep quality and the psychological distress caused by the pandemic. A further deterioration of sleep quality is a fearsome event in the life of these patients who face life-long sleep problems.
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Affiliation(s)
- Lucia Spicuzza
- Dipartimento di Medicina Clinica e Sperimentale, UO Pneumologia, Azienda Policlinico-OVE, University of Catania, Via S. Sofia, 95123, Catania, Italy.
| | - Salvatore Mancuso
- Dipartimento di Medicina Clinica e Sperimentale, UO Pneumologia, Azienda Policlinico-OVE, University of Catania, Via S. Sofia, 95123, Catania, Italy
| | - Raffaele Campisi
- Dipartimento di Medicina Clinica e Sperimentale, UO Pneumologia, Azienda Policlinico-OVE, University of Catania, Via S. Sofia, 95123, Catania, Italy
| | - Carlo Vancheri
- Dipartimento di Medicina Clinica e Sperimentale, UO Pneumologia, Azienda Policlinico-OVE, University of Catania, Via S. Sofia, 95123, Catania, Italy
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Spicuzza L, Sambataro G, Bonsignore M, Mancuso S, Pistorio MP, Vancheri C. Point of care antibody detection assays for past SARS-CoV-2 infection are accurate over the time. Infect Dis (Lond) 2022; 54:464-466. [PMID: 35139730 DOI: 10.1080/23744235.2022.2036810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Lucia Spicuzza
- Dipartimento di Medicina Clinica e Sperimentale, University of Catania, Catania, Italy
| | - Gianluca Sambataro
- Dipartimento di Medicina Clinica e Sperimentale, University of Catania, Catania, Italy
| | - Martina Bonsignore
- Dipartimento di Medicina Clinica e Sperimentale, University of Catania, Catania, Italy
| | - Salvatore Mancuso
- Dipartimento di Medicina Clinica e Sperimentale, University of Catania, Catania, Italy
| | | | - Carlo Vancheri
- Dipartimento di Medicina Clinica e Sperimentale, University of Catania, Catania, Italy
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Cavagna L, Meloni F, Meyer A, Sambataro G, Belliato M, De Langhe E, Cavazzana I, Pipitone N, Triantafyllias K, Mosca M, Barsotti S, Zampogna G, Biglia A, Emmi G, De Visser M, Van Der Kooi A, Parronchi P, Hirschi S, da Silva JAP, Scirè CA, Furini F, Giannini M, Martinez Gonzalez O, Damian L, Piette Y, Smith V, Mera-Valera A, Bachiller-Corral J, Cabezas Rodriguez I, Brandy-Garcia AM, Maurier F, Perrin J, Gonzalez-Moreno J, Drott U, Delbruck C, Schwarting A, Arrigoni E, Sebastiani GD, Iuliano A, Nannini C, Quartuccio L, Rodriguez Cambron AB, Blázquez Cañamero MÁ, Villa Blanco I, Cagnotto G, Pesci A, Luppi F, Dei G, Romero Bueno FI, Franceschini F, Chiapparoli I, Zanframundo G, Lettieri S, De Stefano L, Cutolo M, Mathieu A, Piga M, Prieto-González S, Moraes-Fontes MF, Fonseca JE, Jovani V, Riccieri V, Santaniello A, Montfort S, Bilocca D, Erre GL, Bartoloni E, Gerli R, Monti MC, Lorenz HM, Sambataro D, Bellando Randone S, Schneider U, Valenzuela C, Lopez-Mejias R, Cifrian J, Mejia M, Gonzalez Perez MI, Wendel S, Fornaro M, De Luca G, Orsolini G, Rossini M, Dieude P, Knitza J, Castañeda S, Voll RE, Rojas-Serrano J, Valentini A, Vancheri C, Matucci-Cerinic M, Feist E, Codullo V, Iannone F, Distler JH, Montecucco C, Gonzalez-Gay MA. Clinical spectrum time course in non-Asian patients positive for anti-MDA5 antibodies. Clin Exp Rheumatol 2022; 40:274-283. [PMID: 35200123 DOI: 10.55563/clinexprheumatol/di1083] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To define the clinical spectrum time-course and prognosis of non-Asian patients positive for anti-MDA5 antibodies. METHODS We conducted a multicentre, international, retrospective cohort study. RESULTS 149 anti-MDA5 positive patients (median onset age 53 years, median disease duration 18 months), mainly females (100, 67%), were included. Dermatomyositis (64, 43%) and amyopathic dermatomyositis (47, 31%), were the main diagnosis; 15 patients (10%) were classified as interstitial pneumonia with autoimmune features (IPAF) and 7 (5%) as rheumatoid arthritis. The main clinical findings observed were myositis (84, 56%), interstitial lung disease (ILD) (108, 78%), skin lesions (111, 74%), and arthritis (76, 51%). The onset of these manifestations was not concomitant in 74 cases (50%). Of note, 32 (21.5%) patients were admitted to the intensive care unit for rapidly progressive-ILD, which occurred in median 2 months from lung involvement detection, in the majority of cases (28, 19%) despite previous immunosuppressive treatment. One-third of patients (47, 32% each) was ANA and anti-ENA antibodies negative and a similar percentage was anti-Ro52 kDa antibodies positive. Non-specific interstitial pneumonia (65, 60%), organising pneumonia (23, 21%), and usual interstitial pneumonia-like pattern (14, 13%) were the main ILD patterns observed. Twenty-six patients died (17%), 19 (13%) had a rapidly progressive-ILD. CONCLUSIONS The clinical spectrum of the anti-MDA5 antibodies-related disease is heterogeneous. Rapidly-progressive ILD deeply impacts the prognosis also in non-Asian patients, occurring early during the disease course. Anti-MDA5 antibody positivity should be considered even when baseline autoimmune screening is negative, anti-Ro52 kDa antibodies are positive, and radiology findings show a NSIP pattern.
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Affiliation(s)
- Lorenzo Cavagna
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
| | - Federica Meloni
- Transplant Centre Unit, IRCCS San Matteo Foundation and University of Pavia, Italy
| | - Alain Meyer
- Rheumatology, Centre de Référence des Maladies Auto-Immunes Rares, Service de Physiologie et Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, France
| | | | - Mirko Belliato
- UOC Anestesia e Rianimazione 2 Cardiopolmonare, Foundation IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | | | | | - Marta Mosca
- Rheumatology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Simone Barsotti
- Rheumatology, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Alessandro Biglia
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Giacomo Emmi
- Internal Interdisciplinary Unit, Lupus Clinic, Careggi University Hospital and Department of Experimental and Clinical Medicine, University of Firenze, Italy
| | | | | | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Sandrine Hirschi
- Pneumology, NHC, Strasbourg University Hospital, Strasbourg University, France
| | | | | | - Federica Furini
- Rheumatology, Azienda Ospedaliero Universitaria S. Anna, Ferrara, Italy
| | - Margherita Giannini
- Rheumatology, Centre de Référence des Maladies Auto-Immunes Rares, Service de Physiologie et Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, France
| | | | - Laura Damian
- Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital; Department of Internal Medicine, Ghent University; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital; Department of Internal Medicine, Ghent University; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Antonio Mera-Valera
- Rheumatology, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | | | | | | | | | - Julie Perrin
- Pneumology HPMetz, Hopital Belle-Ile, Metz, France
| | - Juan Gonzalez-Moreno
- Rheumatology, Internal Medicine Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | - Ulrich Drott
- Rheumatology, Johann Wolfgang Goethe-Universität, Frankfurt, Germany
| | | | | | | | | | | | | | - Luca Quartuccio
- Rheumatology Unit, Department of Medicine (DAME), University of Udine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy
| | | | | | | | | | - Alberto Pesci
- Pneumology, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | - Fabrizio Luppi
- Pneumology, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | - Giulia Dei
- Pneumology, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy
| | | | | | | | - Giovanni Zanframundo
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Sara Lettieri
- Pneumology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Ludovico De Stefano
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Maurizio Cutolo
- Rheumatology, University of Genova, DIMI, IRCCS San Martino, Genova, Italy
| | - Alessandro Mathieu
- Rheumatology, University Clinic and Azienda Ospedaliera Universitaria of Cagliari, Italy
| | - Matteo Piga
- Rheumatology, University Clinic and Azienda Ospedaliera Universitaria of Cagliari, Italy
| | | | | | - Joao Eurico Fonseca
- Serviço Reumatologia, Centro Hospitalar Lisboa Norte and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal
| | - Vega Jovani
- Rheumatology, University Hospital, Alicante, Spain
| | - Valeria Riccieri
- Rheumatology, University La Sapienza and Policlinico Umberto I, Rome, Italy
| | - Alessandro Santaniello
- Scleroderma Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Gian Luca Erre
- Rheumatology, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | | | | | - M Cristina Monti
- Biostatistics Unit, Department of Public Health, University of Pavia, Italy
| | | | - Domenico Sambataro
- Artroreuma srl, Outpatient of Rheumatology accredited with the Italian National Health System, Mascalucia, Catania, Italy
| | | | - Udo Schneider
- Rheumatology, Charité - Universitätsmedizin Berlin, Germany
| | - Claudia Valenzuela
- Pneumology, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID Future), Universidad Autonoma, Madrid, Spain
| | - Raquel Lopez-Mejias
- Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Jose Cifrian
- Pneumology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Mayra Mejia
- Pneumology, Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, Mexico
| | - Monserrat-Ixchel Gonzalez Perez
- Pneumology, Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, Mexico
| | - Sarah Wendel
- Rheumatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | - Giacomo De Luca
- Rheumatology, Università Vita-Salute, San Raffaele, Milano, Italy
| | | | | | - Philippe Dieude
- Rheumatology, Hôpital Bichat-Claude Bernard, Université Paris Diderot, Paris, France
| | | | - Santos Castañeda
- Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID Future), Universidad Autonoma, Madrid, Spain
| | - Reinhard E Voll
- Rheumatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Jorge Rojas-Serrano
- Rheumatology, Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, México
| | - Adele Valentini
- Radiology, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Carlo Vancheri
- Pulmonology, Azienda Ospedaliera Universitaria Catania, Italy
| | | | - Eugen Feist
- Rheumatology, Charité - Universitätsmedizin Berlin, Germany
| | - Veronica Codullo
- Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | | | | | | | - Miguel A Gonzalez-Gay
- Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
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Harari S, Pesci A, Albera C, Poletti V, Amici C, Crespi G, Campolo B, Vancheri C. Nintedanib in IPF: Post hoc Analysis of the Italian FIBRONET Observational Study. Respiration 2022; 101:577-584. [PMID: 35078170 DOI: 10.1159/000521138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The FIBRONET study was an observational study of patients with idiopathic pulmonary fibrosis (IPF) in Italy. OBJECTIVES In this post hoc descriptive analysis, we describe changes in lung function, anxiety/depression, coughing, exacerbations, and adverse events (AEs) in patients receiving nintedanib treatment. METHODS Patients with IPF from 20 centers in Italy, aged ≥40 years who received nintedanib for ≥7 months, were followed up for 12 months from study enrollment, attending clinic visits every 3 months. Outcomes included change in forced vital capacity (FVC)% predicted from baseline to 12 months, anxiety/depression measured by the Hospital Anxiety and Depression Scale (HADS), and the proportion of patients with cough, AEs, and exacerbations. RESULTS In total, 52 patients received nintedanib (mean duration of 11.6 months). Ten patients had dose reductions from 150 mg to 100 mg twice daily, due to AEs. FVC% predicted was unchanged in the overall nintedanib population (78.7% at baseline; 79.8% at 12 months) and those with a reduced dose (77.7% at baseline; 81.0% at 12 months). HADS score was low at baseline and throughout the study. The proportion of patients with cough decreased from 50.0% to 21.2% over 12 months. Two patients experienced exacerbations, 2 patients discontinued treatment, and 27 (51.9%) reported AEs. The most common AE was diarrhea (34.6%). CONCLUSIONS In patients with IPF who received nintedanib in the FIBRONET study, FVC% predicted was stable over 12 months, and the proportion of patients with cough decreased. The safety profile was consistent with the known safety profile for nintedanib in IPF.
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Affiliation(s)
- Sergio Harari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Ospedale San Giuseppe, IRCCS MultiMedica, Milan, Italy
| | - Alberto Pesci
- Department of Medicine, Respiratory Unit, University of Milano-Bicocca, ASST Monza, Monza, Italy
| | - Carlo Albera
- SC Pneumologia U, A.O.U. Città Della Scienza e della Salute (Molinette), University of Torino, Turin, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy.,Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, University-Hospital "Policlinico G. Rodolico", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Vancheri C, Luppi F. Identifying the Risk of Acute Exacerbation in Idiopathic Pulmonary Fibrosis: Another Step Forward. Am J Respir Crit Care Med 2022; 205:489-491. [PMID: 35077663 PMCID: PMC8906478 DOI: 10.1164/rccm.202110-2244ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Carlo Vancheri
- University of Catania, Department of Internal and Specialistic Medicine, Catania, Italy;
| | - Fabrizio Luppi
- University of Milan Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
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Fagone E, Fruciano M, Gili E, Sambataro G, Vancheri C. Developing PI3K Inhibitors for Respiratory Diseases. Curr Top Microbiol Immunol 2022; 436:437-466. [DOI: 10.1007/978-3-031-06566-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Torrisi SE, Kahn N, Wälscher J, Polke M, Lee JS, Molyneaux PL, Sambataro FM, Heussel CP, Vancheri C, Kreuter M. Outcomes and Incidence of PF-ILD According to Different Definitions in a Real-World Setting. Front Pharmacol 2021; 12:790204. [PMID: 34975486 PMCID: PMC8718675 DOI: 10.3389/fphar.2021.790204] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/22/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Almost one-third of fibrosing ILD (fILDs) have a clinical disease behavior similar to IPF, demonstrating a progressive phenotype (PF-ILD). However, there are no globally accepted criteria on the definition of a progressive phenotype in non-IPF fILD yet. Four different definitions have been used; however, no internationally accepted definition currently exists. Research Question: To compare the clinical and functional characteristics of progressive fILD according to the currently available definitions. Study design and methods: Cases of fILD were identified retrospectively from the database of the tertiary referral center for ILD in Heidelberg. Lung function, clinical signs of progression, and radiological changes were evaluated. Patients with fILD were considered to have progression according to each of the four available definitions: Cottin (CO), RELIEF (RE), INBUILD (IN), and UILD study. Lung function changes, expressed as mean absolute decline of FVC%, were reported every 3 months following diagnosis and analyzed in the context of each definition. Survival was also analyzed. Results: A total of 566 patients with non-IPF fILD were included in the analysis. Applying CO-, RE-, IN-, and UILD-definitions, 232 (41%), 183 (32%), 274 (48%), and 174 (31%) patients were defined as PF-ILD, respectively. RE- and UILD-criteria were the most stringent, with only 32 and 31% patients defined as progressive, while IN- was the most broad, with almost 50% of patients defined as progressive. CO- definition was in-between, classifying 41% as progressive. PF ILD patients with a UILD definition had worse prognosis. Interpretation: Depending on the definition used, the existing criteria identify different groups of patients with progressive fILD, and this may have important prognostic and therapeutic implications.
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Affiliation(s)
- Sebastiano Emanuele Torrisi
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
- Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-San Marco, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Julia Wälscher
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Markus Polke
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Joyce S. Lee
- Anschutz Medical Campus, Department of Medicine, University of Colorado Denver, Aurora, CO, United States
| | - Philip L. Molyneaux
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton Hospital, London, United Kingdom
| | - Francesca Maria Sambataro
- Radiology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Claus Peter Heussel
- Radiology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-San Marco, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
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Bassetti M, Giacobbe DR, Bruzzi P, Barisione E, Centanni S, Castaldo N, Corcione S, De Rosa FG, Di Marco F, Gori A, Gramegna A, Granata G, Gratarola A, Maraolo AE, Mikulska M, Lombardi A, Pea F, Petrosillo N, Radovanovic D, Santus P, Signori A, Sozio E, Tagliabue E, Tascini C, Vancheri C, Vena A, Viale P, Blasi F. Clinical Management of Adult Patients with COVID-19 Outside Intensive Care Units: Guidelines from the Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP). Infect Dis Ther 2021; 10:1837-1885. [PMID: 34328629 PMCID: PMC8323092 DOI: 10.1007/s40121-021-00487-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP) constituted an expert panel for developing evidence-based guidance for the clinical management of adult patients with coronavirus disease 2019 (COVID-19) outside intensive care units. METHODS Ten systematic literature searches were performed to answer ten different key questions. The retrieved evidence was graded according to the Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). RESULTS AND CONCLUSION The literature searches mostly assessed the available evidence on the management of COVID-19 patients in terms of antiviral, anticoagulant, anti-inflammatory, immunomodulatory, and continuous positive airway pressure (CPAP)/non-invasive ventilation (NIV) treatment. Most evidence was deemed as of low certainty, and in some cases, recommendations could not be developed according to the GRADE system (best practice recommendations were provided in similar situations). The use of neutralizing monoclonal antibodies may be considered for outpatients at risk of disease progression. For inpatients, favorable recommendations were provided for anticoagulant prophylaxis and systemic steroids administration, although with low certainty of evidence. Favorable recommendations, with very low/low certainty of evidence, were also provided for, in specific situations, remdesivir, alone or in combination with baricitinib, and tocilizumab. The presence of many best practice recommendations testified to the need for further investigations by means of randomized controlled trials, whenever possible, with some possible future research directions stemming from the results of the ten systematic reviews.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy.
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy.
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Paolo Bruzzi
- Clinical Epidemiology Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Emanuela Barisione
- Interventional Pulmonology, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Stefano Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Nadia Castaldo
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Guido Granata
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Angelo Gratarola
- Department of Emergency and Urgency, San Martino Policlinico Hospital, IRCCS, Genoa, Italy
| | | | - Malgorzata Mikulska
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- SSD Clinical Pharmacology Unit, University Hospital, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
- Infection Control and Infectious Disease Service, University Hospital "Campus-Biomedico", Rome, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Emanuela Sozio
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - Elena Tagliabue
- Interventional Pulmonology, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Carlo Tascini
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases-University Hospital "Policlinico G. Rodolico", Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Infectious Diseases Unit, University Hospital IRCCS Policlinico Sant'Orsola, Bologna, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
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Polke M, Kondoh Y, Wijsenbeek M, Cottin V, Walsh SLF, Collard HR, Chaudhuri N, Avdeev S, Behr J, Calligaro G, Corte TJ, Flaherty K, Funke-Chambour M, Kolb M, Krisam J, Maher TM, Molina Molina M, Morais A, Moor CC, Morisset J, Pereira C, Quadrelli S, Selman M, Tzouvelekis A, Valenzuela C, Vancheri C, Vicens-Zygmunt V, Wälscher J, Wuyts W, Bendstrup E, Kreuter M. Management of Acute Exacerbation of Idiopathic Pulmonary Fibrosis in Specialised and Non-specialised ILD Centres Around the World. Front Med (Lausanne) 2021; 8:699644. [PMID: 34646836 PMCID: PMC8502934 DOI: 10.3389/fmed.2021.699644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is a severe complication associated with a high mortality. However, evidence and guidance on management is sparse. The aim of this international survey was to assess differences in prevention, diagnostic and treatment strategies for AE-IPF in specialised and non-specialised ILD centres worldwide. Material and Methods: Pulmonologists working in specialised and non-specialised ILD centres were invited to participate in a survey designed by an international expert panel. Responses were evaluated in respect to the physicians' institutions. Results: Three hundred and two (65%) of the respondents worked in a specialised ILD centre, 134 (29%) in a non-specialised pulmonology centre. Similarities were frequent with regards to diagnostic methods including radiology and screening for infection, treatment with corticosteroids, use of high-flow oxygen and non-invasive ventilation in critical ill patients and palliative strategies. However, differences were significant in terms of the use of KL-6 and pathogen testing in urine, treatments with cyclosporine and recombinant thrombomodulin, extracorporeal membrane oxygenation in critical ill patients as well as antacid medication and anaesthesia measures as preventive methods. Conclusion: Despite the absence of recommendations, approaches to the prevention, diagnosis and treatment of AE-IPF are comparable in specialised and non-specialised ILD centres, yet certain differences in the managements of AE-IPF exist. Clinical trials and guidelines are needed to improve patient care and prognosis in AE-IPF.
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Affiliation(s)
- Markus Polke
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Marlies Wijsenbeek
- Department of Respiratory Medicine, Centre for Interstitial Lung Diseases and Sarcoidosis, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Vincent Cottin
- National Coordinating Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Simon L F Walsh
- Imperial College, National Heart and Lung Institute, London, United Kingdom
| | - Harold R Collard
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Nazia Chaudhuri
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom
| | - Sergey Avdeev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum, University of Munich, Munich, Germany.,German Center for Lung Research (DZL), Marburg, Germany
| | - Gregory Calligaro
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tamera J Corte
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Kevin Flaherty
- Department of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Manuela Funke-Chambour
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Kolb
- Department of Medicine, Firestone Institute for Respiratory Health, Research Institute at St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Toby M Maher
- Hastings Centre for Pulmonary Research and Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Interstitial Lung Disease Unit, Imperial College London, National Heart and Lung Institute, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Maria Molina Molina
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Antonio Morais
- Department of Pneumology, Faculdade de Medicina, Centro Hospitalar São João, Universidade do Porto, Porto, Portugal
| | - Catharina C Moor
- Department of Respiratory Medicine, Centre for Interstitial Lung Diseases and Sarcoidosis, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Julie Morisset
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Carlos Pereira
- Lung Disease Department, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Silvia Quadrelli
- Hospital Británico, Buenos Aires, Argentina.,Sanatorio Güemes, Buenos Aires, Argentina
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Argyrios Tzouvelekis
- Department of First Academic Respiratory, Sotiria General Hospital for Thoracic Diseases, University of Athens, Athens, Greece
| | - Claudia Valenzuela
- ILD Unit, Pulmonology Department Hospital Universitario de La Princesa, Universidad Autonoma de Madrid, Madrid, Spain
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Vanesa Vicens-Zygmunt
- Unit of Interstitial Lung Diseases, Department of Pneumology, Pneumology Research Group, IDIBELL, L'Hospitalet de Llobregat, University Hospital of Bellvitge, Barcelona, Spain
| | - Julia Wälscher
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Department of Pulmonary Medicine, Centre for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital Essen, Essen, Germany
| | - Wim Wuyts
- Unit for Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus C, Denmark
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,German Center for Lung Research (DZL), Marburg, Germany
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Orlandi M, Landini N, Sambataro G, Nardi C, Tofani L, Bruni C, Bellando-Randone S, Blagojevic J, Melchiorre D, Hughes M, Denton CP, Luppi F, Ruaro B, Della Casa F, Rossi FW, De Luca G, Campochiaro C, Spinicci M, Zammarchi L, Tomassetti S, Caminati A, Cavigli E, Albanesi M, Melchiorre F, Palmucci S, Vegni V, Guiducci S, Moggi-Pignone A, Allanore Y, Bartoloni A, Confalonieri M, Dagna L, De Cobelli F, De Paulis A, Harari S, Khanna D, Kuwana M, Taliani G, Lavorini F, Miele V, Morana G, Pesci A, Vancheri C, Colagrande S, Matucci-Cerinic M. THE ROLE OF CHEST CT IN DECIPHERING INTERSTITIAL LUNG INVOLVEMENT: SYSTEMIC SCLEROSIS VERSUS COVID-19. Rheumatology (Oxford) 2021; 61:1600-1609. [PMID: 34320649 DOI: 10.1093/rheumatology/keab615] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify the main computed tomography (CT) features that may help distinguishing a progression of interstitial lung disease (ILD) secondary to Systemic sclerosis (SSc) from COVID-19 pneumonia. METHODS This multicentric study included 22 international readers divided in the radiologist group (RAD) and non-radiologist group (nRAD). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study. RESULTS Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p < 0.0001) and signs of fibrosis in GGO in the lower lobes (p < 0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. A predictive score was created which resulted positively associated with the COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity). CONCLUSION The CT differential diagnosis between COVID-19 pneumonia and SSc-ILD is possible through the combination the proposed score and the radiologic expertise. The presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.
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Affiliation(s)
- Martina Orlandi
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Nicholas Landini
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - AOUC, Largo Brambilla 3, 50134, Florence, Italy.,Department of Radiology, Ca' Foncello General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Dept. ofClinical and Experimental Medicine, University of Catania, Catania, Italy.,Artroreuma S.R.L., Rheumatology Outpatient Clinic Associated with the National Health System, Mascalucia(Catania), Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - AOUC, Largo Brambilla 3, 50134, Florence, Italy
| | - Lorenzo Tofani
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Cosimo Bruni
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Jelena Blagojevic
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Daniela Melchiorre
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Michael Hughes
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | - Fabrizio Luppi
- Respiratory Unit, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy
| | - Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | - Francesca Della Casa
- Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences. University ofNaples Federico II, Napoli, Italy
| | - Francesca W Rossi
- Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences. University ofNaples Federico II, Napoli, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, and Infectious and TropicalDiseases Unit, AOUC, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, and Infectious and TropicalDiseases Unit, AOUC, Florence, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | - Edoardo Cavigli
- SOD Radiodiagnostica Emergenza-Urgenza, AOU Careggi, Florence, Italy
| | - Marco Albanesi
- SOD Radiodiagnostica Emergenza-Urgenza, AOU Careggi, Florence, Italy
| | - Fabio Melchiorre
- Department of Radiology Sant'Andrea Hospital Vercelli, ASLVC Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, Department of Medical Surgical Sciences and Advanced Technologies"GF Ingrassia", University of Catania, Italy
| | | | - Serena Guiducci
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, AOU Careggi Hospital, University of Florence MedicalSchool, Florence, Italy
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, and Infectious and TropicalDiseases Unit, AOUC, Florence, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan,Italy
| | - Amato De Paulis
- Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences. University ofNaples Federico II, Napoli, Italy
| | - Sergio Harari
- U.O. di Pneumologia, Ospedale San Giuseppe MultiMedica, IRCCS.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Gloria Taliani
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Federico Lavorini
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Vittorio Miele
- SOD Radiodiagnostica Emergenza-Urgenza, AOU Careggi, Florence, Italy
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Alberto Pesci
- Respiratory Unit, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. "Policlinico G. Rodolico - San Marco" Dept. ofClinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - AOUC, Largo Brambilla 3, 50134, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, University of Florence, University of Florence, Division of Rheumatology AOUC, Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, VitaSalute San Raffaele University, Milan, Italy
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Oldham JM, Vancheri C. Rethinking Idiopathic Pulmonary Fibrosis. Clin Chest Med 2021; 42:263-273. [PMID: 34024402 DOI: 10.1016/j.ccm.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating disease for patients and their loved ones. Since initial efforts to characterize this disease in the 1960s, understanding of IPF has evolved considerably. Such evolution has continually challenged prior diagnostic and treatment paradigms, ushering in an era of higher confidence diagnoses with less invasive procedures and more effective treatments. This review details how research and clinical experience over the past half century have led to a rethinking of IPF. Here, the evolution in understanding of IPF pathogenesis, diagnostic evaluation and treatment approach is discussed.
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Affiliation(s)
- Justin M Oldham
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, 4150 V Street Suite 3400, Sacramento, CA 95817, USA.
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Regional Referral Center for Rare Lung Diseases, University-Hospital "Policlinico -Vittorio Emanuele", Catania, Italy
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36
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Wijsenbeek MS, Bendstrup E, Valenzuela C, Henry MT, Moor CC, Jouneau S, Fois AG, Moran-Mendoza O, Anees S, Mirt M, Bengus M, Gilberg F, Kirchgaessler KU, Vancheri C. Disease Behaviour During the Peri-Diagnostic Period in Patients with Suspected Interstitial Lung Disease: The STARLINER Study. Adv Ther 2021; 38:4040-4056. [PMID: 34117601 PMCID: PMC8195454 DOI: 10.1007/s12325-021-01790-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/13/2021] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Disease behaviour may guide diagnosis and treatment decisions in patients with interstitial lung disease (ILD). STARLINER aimed to characterise disease behaviour in patients with suspected ILD during the peri-diagnostic period using real-time home-based assessments. METHODS STARLINER (NCT03261037) was an international, multicentre study. Patients ≥ 50 years old with suspected ILD were followed throughout the peri-diagnostic period, consisting of a pre-diagnostic period (from enrolment to diagnosis) and a post-diagnostic period (from diagnosis to treatment initiation). Study length was variable (≤ 18 months). The primary endpoint was time-adjusted semi-annual forced vital capacity (FVC) change measured during the peri-diagnostic period using daily home spirometry in patients with idiopathic pulmonary fibrosis (IPF). Secondary outcomes included changes in FVC (home spirometry) in patients with non-IPF ILD, changes in FVC (site spirometry), changes in physical functional capacity measured by daily home accelerometry and site 6-min walk distance (6MWD), and changes in patient-reported outcomes (PROs) in IPF or non-IPF ILD. RESULTS Of the 178 patients enrolled in the study, 68 patients were diagnosed with IPF, 62 patients were diagnosed with non-IPF ILD, 9 patients received a non-ILD diagnosis and 39 patients did not receive a diagnosis. Technical and analytical issues led to problems in applying the prespecified linear regression model to analyse the home FVC data. Time-adjusted median (quartile [Q]1, Q3) semi-annual FVC change during the peri-diagnostic period measured using home and site spirometry, respectively, was - 147.7 (- 723.8, 376.2) ml and - 149.0 (- 314.6, 163.9) ml for IPF and 19.1 (- 194.9, 519.0) ml and - 23.4 (- 117.9, 133.5) ml in non-IPF ILD. A greater decline in steps per day was observed for IPF versus non-IPF ILD, whereas an increase in 6MWD was observed for patients with IPF versus a decline in 6MWD for patients with non-IPF ILD. No clear patterns of disease behaviour were observed for IPF versus non-IPF ILD for PROs. CONCLUSIONS Despite home spirometry being feasible for most patients and centres, technical and analytical challenges in the home-based assessments prevented firm conclusions regarding disease behaviour. This highlights that further optimisation of the technology and analysis methods is required before widespread implementation. TRIAL REGISTRATION NCT03261037.
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Kalluri M, Luppi F, Vancheri A, Vancheri C, Balestro E, Varone F, Mogulkoc N, Cacopardo G, Bargagli E, Renzoni E, Torrisi S, Calvello M, Libra A, Pavone M, Bonella F, Cottin V, Valenzuela C, Wijsenbeek M, Bendstrup E. Patient-reported outcomes and patient-reported outcome measures in interstitial lung disease: where to go from here? Eur Respir Rev 2021; 30:30/160/210026. [PMID: 34039675 PMCID: PMC9488962 DOI: 10.1183/16000617.0026-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/02/2021] [Indexed: 12/03/2022] Open
Abstract
Patient-reported outcome measures (PROMs), tools to assess patient self-report of health status, are now increasingly used in research, care and policymaking. While there are two well-developed disease-specific PROMs for interstitial lung diseases (ILD) and idiopathic pulmonary fibrosis (IPF), many unmet and urgent needs remain. In December 2019, 64 international ILD experts convened in Erice, Italy to deliberate on many topics, including PROMs in ILD. This review summarises the history of PROMs in ILD, shortcomings of the existing tools, challenges of development, validation and implementation of their use in clinical trials, and the discussion held during the meeting. Development of disease-specific PROMs for ILD including IPF with robust methodology and validation in concordance with guidance from regulatory authorities have increased user confidence in PROMs. Minimal clinically important difference for bidirectional changes may need to be developed. Cross-cultural validation and linguistic adaptations are necessary in addition to robust psychometric properties for effective PROM use in multinational clinical trials. PROM burden of use should be reduced through appropriate use of digital technologies and computerised adaptive testing. Active patient engagement in all stages from development, testing, choosing and implementation of PROMs can help improve probability of success and further growth. PROMs are essential tools for research and care in ILD and IPF. They report patient perceptions of the impact of disease and its treatments on whole-person wellbeing and can guide research to make care more patient-centred.https://bit.ly/3s7Y0a8
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Affiliation(s)
- Meena Kalluri
- Division of Pulmonary Medicine, University of Alberta, Edmonton, AB, Canada .,Shared first and last authorship
| | - Fabrizio Luppi
- Respiratory Diseases Unit, University of Milano-Bicocca. "S. Gerardo" Hospital, Monza, Italy.,Shared first and last authorship
| | - Ada Vancheri
- Regional Referral Center for Rare Lung Diseases, University - Hospital "Policlinico G. Rodolico - San Marco", Catania, Italy
| | - Carlo Vancheri
- Dept of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, University - Hospital "Policlinico G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Elisabetta Balestro
- Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Francesco Varone
- UOC Pneumologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Nesrin Mogulkoc
- Dept of Pulmonology, Ege University Hospiral, Bornova, Izmir, Turkey
| | - Giulia Cacopardo
- UOSD UTIR, A.R.N.A.S. Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Siena University, Siena, Italy
| | - Elizabeth Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Sebastiano Torrisi
- Dept of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, University - Hospital "Policlinico G. Rodolico - San Marco", University of Catania, Catania, Italy
| | | | - Alessandro Libra
- Regional Referral Center for Rare Lung Diseases, University - Hospital "Policlinico G. Rodolico - San Marco", Catania, Italy
| | - Mauro Pavone
- Dept of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, University - Hospital "Policlinico G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Francesco Bonella
- Pneumology Dept, Centre for Interstitial and Rare Lung Disease, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Vincent Cottin
- Dept of Respiratory Medicine, National Reference Coordinating Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,University of Lyon, INRAE, IVPC, Lyon, France
| | - Claudia Valenzuela
- Pulmonology Dept, Hospital Universitario de la Princesa, Universidad Autonoma Madrid, Madrid, Spain.,Shared first and last authorship
| | - Marlies Wijsenbeek
- Centre of excellence, Interstitial Lung Diseases and Sarcoidosis, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Shared first and last authorship
| | - Elisabeth Bendstrup
- Dept of Respiratory Diseases and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Shared first and last authorship
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Funke-Chambour M, Albera C, Bendstrup E, Costabel U, Grutters JC, Harari S, Johannson KA, Kreuter M, Strambu I, Vancheri C, Varone F, Vitulo P, Wuyts WA, Martinez F, Raghu G. Suggestions for improving clinical utility of future guidelines for diagnosis and management of idiopathic pulmonary fibrosis: results of a Delphi survey. Eur Respir J 2021; 57:13993003.04219-2020. [PMID: 33419886 DOI: 10.1183/13993003.04219-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/09/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Manuela Funke-Chambour
- Dept of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlo Albera
- Dipartimento di Scienze Mediche, Università di Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Elisabeth Bendstrup
- Dept of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, University Hospital Essen, Essen, Germany
| | - Jan C Grutters
- ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Sergio Harari
- University of Milan, Dept of Medicine, Division of Internal Medicine, Division of Pulmonary Disease, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | | | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik - University Hospital Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Irina Strambu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | | | | | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, Dept of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Fernando Martinez
- Weill Cornell Medicine Pulmonary and Critical Care Medicine, New York, NY, USA.,Co-senior authors
| | - Ganesh Raghu
- Center for Interstitial Lung diseases, Depts of Medicine; Laboratory Medicine and Pathology (adjunct), University of Washington, Seattle, WA, USA.,Co-senior authors
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Poletti V, Vancheri C, Albera C, Harari S, Pesci A, Metella RR, Campolo B, Crespi G, Rizzoli S. Clinical course of IPF in Italian patients during 12 months of observation: results from the FIBRONET observational study. Respir Res 2021; 22:66. [PMID: 33627105 PMCID: PMC7903602 DOI: 10.1186/s12931-021-01643-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/29/2021] [Indexed: 01/20/2023] Open
Abstract
Background FIBRONET was an observational, multicentre, prospective cohort study investigating the baseline characteristics, clinical course of disease and use of antifibrotic treatment in Italian patients with idiopathic pulmonary fibrosis (IPF).
Methods Patients aged ≥ 40 years diagnosed with IPF within the previous 3 months at 20 Italian centres were consecutively enrolled and followed up for 12 months, with evaluations at 3, 6, 9 and 12 months. The primary objective was to describe the clinical course of IPF over 12 months of follow-up, including changes in lung function measured by % predicted forced vital capacity (FVC% predicted). Results 209 patients (82.3% male, mean age 69.54 ± 7.43 years) were enrolled. Mean FVC% predicted was relatively preserved at baseline (80.01%). The mean time between IPF diagnosis and initiation of antifibrotic therapy was 6.38 weeks; 72.3% of patients received antifibrotic therapy within the first 3 months of follow-up, and 83.9% within 12 months of follow-up. Mean FVC% predicted was 80.0% at baseline and 82.2% at 12 months, and 47.4% of patients remained stable (i.e. had no disease progression) in terms of FVC% predicted during the study. Conclusions FIBRONET is the first prospective, real-life, observational study of patients with IPF in Italy. The short time between diagnosis and initiation of antifibrotic therapy, and the stable lung function between baseline and 12 months, suggest that early diagnosis and prompt initiation of antifibrotic therapy may preserve lung function in patients with IPF. Trial registration: NCT02803580
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Affiliation(s)
- V Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy.,Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - C Vancheri
- Regional Referral Centre for Rare Lung Diseases-University Hospital "Policlinico G. Rodolico", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - C Albera
- S.C. Pneumologia U., A.O.U. Città Della Scienza E Della Salute (Molinette), University of Torino, Torino, Italy
| | - S Harari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Medicine, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | - A Pesci
- Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - R R Metella
- Dipartimento di Scienze Mediche Chirurgiche e Neuroscienze, Università degli Studi di Siena, Siena, Italy
| | | | - G Crespi
- Boehringer Ingelheim, Milan, Italy
| | - S Rizzoli
- MediNeos Observational Research, Modena, Italy
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Milanese M, Corsico AG, Bellofiore S, Carrozzi L, Di Marco F, Iovene B, Richeldi L, Sanna A, Santus P, Schisano M, Scichilone N, Vancheri C, Cerveri I. Suggestions for lung function testing in the context of COVID-19. Respir Med 2021; 177:106292. [PMID: 33440299 PMCID: PMC7773526 DOI: 10.1016/j.rmed.2020.106292] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/15/2020] [Accepted: 12/27/2020] [Indexed: 12/17/2022]
Abstract
The 2019 coronavirus disease (COVID-19) pandemic is currently a challenge worldwide. Due to the characteristics of lung function tests, the risk of cross infection may be high between health care workers and patients. The role of lung function testing is well defined for the diagnosis of various diseases and conditions. Lung function tests are also indispensable in evaluating the response to medical treatment, in monitoring patient respiratory and systemic pathologies, and in evaluating preoperative risk in cardiothoracic and major abdominal surgeries. However, lung function testing represents a potential route for COVID-19 transmission, due to the aerosol generated during the procedures and the concentration of patients with pulmonary diseases in lung function laboratories. Currently, the opportunities for COVID-19 transmission remain partially unknown, and data are continuously evolving. This review provides useful information on the risks and recommendations for lung function testing, which have varied according to the phase of the pandemic. This information may support national and regional boards and the health authorities to which they belong. There is a need for rapid re-opening of lung function laboratories, but maximum safety is required in the COVID-19 era.
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Affiliation(s)
| | - Angelo Guido Corsico
- UOC Pneumology, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Italy
| | - Salvatore Bellofiore
- Ambulatorio di Pneumology and Respiratory Physiopathology, Thoracic Surgery Department, AOU Policlinico - Vittorio Emanuele, Catania, Italy
| | - Laura Carrozzi
- Pneumology Department, University Teaching Hospitals Pisa, Dept. of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Pneumology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Bruno Iovene
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Sanna
- Central Tuscany Azienda USL, SOS Pneumology and Bronchial Endoscopy, Ospedale San Jacopo (St. James Hospital), Pistoia, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, "L. Sacco" University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Nicola Scichilone
- Pneumology Unit, Department of Maternal-Infant Health, Internal Medicine Promotion and Excellence Specialists "G. D'Alessandro", University of Palermo, Italy
| | - Carlo Vancheri
- "Regional Reference Centre for Rare Lung Diseases." A.O.U. "Policlinico - Vitt. Emanuele", Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Isa Cerveri
- Department of Internal Medicine and Medical Therapy, University of Pavia, Italy.
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Orlandi M, Landini N, Bruni C, Sambataro G, Nardi C, Bargagli E, Tomassetti S, Occhipinti M, Bellando Randone S, Guiducci S, Vancheri C, Colagrande S, Matucci-Cerinic M. Pleuroparenchymal fibroelastosis in rheumatic autoimmune diseases: a systematic literature review. Rheumatology (Oxford) 2021; 59:3645-3656. [PMID: 33313932 DOI: 10.1093/rheumatology/keaa451] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/08/2020] [Accepted: 06/30/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Pleuroparenchymal fibroelastosis (PPFE) is characterized by predominantly upper lobe pleural and subjacent parenchymal fibrosis; PPFE features were described in patients with rheumatic autoimmune diseases (RAID). A systematic literature review was performed to investigate the prevalence, prognosis and potential association of PPFE with previous immunosuppression in RAID. METHODS EMBASE, Web of Science and PubMed databases were questioned from inception to 1 September 2019. Articles published in English and addressing PPFE in patients with RAID were selected. RESULTS Twenty out of 794 papers were selected with a total of 76 cases of RAID-PPFE patients (20 SSc, 9 RA, 6 IIM6 primary SS, 5 overlap syndromes, 3 ANCA-associated vasculitides, 2 granulomatosis with polyangiitis, 1 microscopic polyangiitis, 1 UCTD, 1 SLE, 1 GCA and 21 patients with non-specified RAID). Dyspnoea was the most frequently reported symptom (37/48 patients, 77%). Patients frequently presented with a restrictive pattern and decline in diffusing lung capacity for carbon monoxide. During the follow-up, 7/12 patients had progression at imaging, 22/39 presented a generic clinical worsening, 19/38 had a functional deterioration and 15/43 remained stable. CONCLUSION The present systematic literature review confirms that PPFE features are present in RAID. Rheumatologists should be aware of this new radiological pattern that holds a bad prognosis.
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Affiliation(s)
- Martina Orlandi
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Nicholas Landini
- Department of Radiology, Ca' Foncello Regional Hospital, Treviso.,Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit no. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. 'Policlinico-Vittorio Emanuele', Catania
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit no. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Elena Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation, Regional Referral Centre for Sarcoidosis and ILD, Siena University, Siena
| | - Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence
| | - Mariaelena Occhipinti
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit no. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Silvia Bellando Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. 'Policlinico-Vittorio Emanuele', Catania
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit no. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence.,Division of Rheumatology, Department of Geriatric Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Tzouvelekis A, Antoniou K, Kreuter M, Evison M, Blum TG, Poletti V, Grigoriu B, Vancheri C, Spagnolo P, Karampitsakos T, Bonella F, Wells A, Raghu G, Molina-Molina M, Culver DA, Bendstrup E, Mogulkoc N, Elia S, Cadranel J, Bouros D. The DIAMORFOSIS (DIAgnosis and Management Of lung canceR and FibrOSIS) survey: international survey and call for consensus. ERJ Open Res 2021; 7:00529-2020. [PMID: 33532484 PMCID: PMC7837280 DOI: 10.1183/23120541.00529-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022] Open
Abstract
Background Currently there is major lack of agreement on the diagnostic and therapeutic management of patients with idiopathic pulmonary fibrosis (IPF) and lung cancer. Our aim was to identify variations in diagnostic and management strategies across different institutions and provide rationale for a consensus statement on this issue. Methods This was a joint-survey by European Respiratory Society (ERS) Assemblies 8, 11 and 12. The survey consisted of 25 questions. Results Four hundred and ninety-four (n=494) physicians from 68 different countries and five continents responded to the survey. Ninety-four per cent of participants were pulmonologists, 1.8% thoracic surgeons and 1.9% oncologists; 97.7% were involved in multidisciplinary team approaches on diagnosis and management. Regular low-dose high-resolution computed tomography (HRCT) scan was used by 49.5% of the respondents to screen for lung cancer in IPF. Positron emission tomography (PET) scan and endobronchial ultrasound (EBUS) is performed by 60% and 88% to diagnose nodular lesions with mediastinal lymphadenopathy in patients with advanced and mild IPF, respectively. Eighty-three per cent of respondents continue anti-fibrotics following lung cancer diagnosis; safety precautions during surgical interventions including low tidal volume are applied by 67%. Stereotactic radiotherapy is used to treat patients with advanced IPF (diffusing capacity of the lung for carbon monoxide (D LCO) <35%) and otherwise operable nonsmall cell lung cancer (NSCLC) by 54% of respondents and doublet platinum regimens and immunotherapy for metastatic disease by 25% and 31.9%, respectively. Almost all participants (93%) replied that a consensus statement for the management of these patients is highly warranted. Conclusion The diagnosis and management of IPF-lung cancer (LC) is heterogeneous with most respondents calling for a consensus statement.
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Affiliation(s)
- Argyris Tzouvelekis
- Dept of Internal and Respiratory Medicine, Medical School University of Patras, Patras, Greece
| | | | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,German Center for Lung Research, Heidelberg, Germany
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Torsten G Blum
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | | | - Bogdan Grigoriu
- Service des Soins Intensifs et Urgences Oncologiques & Oncologie thoracique, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Brussels, Belgium
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, AOU "Policlinico-Vittorio Emanuele" Dept of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Theodoros Karampitsakos
- Dept of Internal and Respiratory Medicine, Medical School University of Patras, Patras, Greece
| | - Francesco Bonella
- Dept of Pneumology and Allergy, Ruhrlandklinik Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Athol Wells
- Interstitial Lung Disease Unit, Dept of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ganesh Raghu
- Center for Interstitial Lung Disease, University of Washington, Seattle, WA, USA
| | - Maria Molina-Molina
- Hospital Universitari de Bellvitge, L'Hospitalet de LLobregat, Barcelona, Spain
| | | | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Nesrin Mogulkoc
- Dept of Pulmonology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Stefano Elia
- Thoracic Surgery Unit, Tor Vergata University, Rome, Italy
| | - Jacques Cadranel
- Service de Pneumologie, APHP, Hôpital Tenon and Sorbonne Université, Paris, France
| | - Demosthenes Bouros
- First Academic Dept of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Dal Negro RW, Carone M, Cuttitta G, Gallelli L, Pistolesi M, Privitera S, Ceriana P, Pirina P, Balbi B, Vancheri C, Gallo FM, Chetta A, Turco P. Prevalence and clinical features of most frequent phenotypes in the Italian COPD population: the CLIMA Study. Multidiscip Respir Med 2021; 16:790. [PMID: 34733506 PMCID: PMC8506204 DOI: 10.4081/mrm.2021.790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/16/2021] [Indexed: 01/12/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a complex, progressive respiratory condition characterized by heterogeneous clinical presentations (phenotypes). The aim of this study was to assess the prevalence of the main COPD phenotypes and match of each phenotype to the most fitting clinical and lung function profile. Methods the CLIMA (Clinical Phenotypes in Actual Clinical Practice) study was an observational, cross-sectional investigation involving twenty-four sites evenly distributed throughout Italy. Patients were tentatively grouped based on their history and claimed prevailing symptoms at recruitment: chronic cough (CB, suggesting chronic bronchitis); dyspnoea (possible emphysema components, E); recurrent wheezing (presuming asthma components, A). Variables collected were: anagraphics; smoking habit; history of asthma; claim of >1 exacerbations in the previous year; blood eosinophil count; total blood IgE and alpha1 anti-trypsin (α1-AT) levels; complete lung function, and the chest X-ray report. mMRC, CAT, BCS, EQ5d-5L were also used. The association between variables and phenotypes were checked by Chi-square test and multinomial logistic regression. Results The CB phenotype was prevalent (48.3%), followed by the E and the A phenotypes (38.8% and 12.8%, respectively). When dyspnoea was the prevailing symptom, the probability of belonging to the COPD-E phenotype was 3.40 times higher. Recurrent wheezing was mostly related to the COPD-A phenotype. Lung function proved more preserved in the COPD-CB phenotype. Smoke; n. exacerbations/year; VR, and BODE index were positively correlated with the COPD-E phenotype, while SpO2, FEV1/FVC, FEV1/VC, and FEV1 reversibility were negatively correlated. Lower DLco values were highly probative for the COPD-E phenotype (p<0.001). Conversely, smoke, wheezing, plasma eosinophils, FEV1 reversibility, and DLco were positively correlated with the COPD-A phenotype. The probability of belonging to the COPD-A phenotype raised by 2.71 times for any increase of one unit in % plasma eosinophils (p<0.001). Also multiparametrical scores contributed to discriminate the three phenotypes. Conclusion The recognition of the main phenotypes of COPD can be effectively pursued by means of a few clinical and instrumental parameters, easy to obtain also in current daily practice. The phenotypical approach is crucial in the management of COPD as it allows to individualize the therapeutic strategy and to obtain more effective clinical outcomes.
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Affiliation(s)
- Roberto W Dal Negro
- National Center for Respiratory Pharmacoeconomics and Pharmacoepidemiology, Verona
| | | | - Giuseppina Cuttitta
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo
| | - Luca Gallelli
- Pharmacology Operative Unit, University Hospital Authority "Mater Domini", Catanzaro
| | - Massimo Pistolesi
- Pneumologia e Fisiopatologia Toraco-Polmonare, Azienda Ospedaliera Universitaria Careggi, Firenze
| | | | - Piero Ceriana
- Occupational Health and Rehabilitation Clinic, ICS Maugeri IRCCS, Pavia
| | - Pietro Pirina
- Pneumology Operative Unit, University Hospital Authority, Sassari
| | - Bruno Balbi
- Pneumology Rehabilitation Unit, ICS Maugeri IRCCS, Veruno (NO)
| | - Carlo Vancheri
- Pneumology Rehabilitation Unit, University Hospital Authority, Policlinico Vittorio Emanuele, Catania
| | - Franca M Gallo
- Departmental Structure for Territorial Pneumology, Local Health Authority, Matera
| | - Alfredo Chetta
- Pneumology Clinic, University Hospital Authority, Hospital "G. Rasori", Parma
| | - Paola Turco
- Research and Clinical Governance, Verona, Italy
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44
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Di Mauro S, Scamporrino A, Fruciano M, Filippello A, Fagone E, Gili E, Scionti F, Purrazzo G, Di Pino A, Scicali R, Di Martino MT, Malaguarnera R, Malatino L, Purrello F, Vancheri C, Piro S. Circulating Coding and Long Non-Coding RNAs as Potential Biomarkers of Idiopathic Pulmonary Fibrosis. Int J Mol Sci 2020; 21:ijms21228812. [PMID: 33233868 PMCID: PMC7709007 DOI: 10.3390/ijms21228812] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Idiopathic Pulmonary Fibrosis (IPF) is a chronic degenerative disease with a median survival of 2-5 years after diagnosis. Therefore, IPF patient identification represents an important and challenging clinical issue. Current research is still searching for novel reliable non-invasive biomarkers. Therefore, we explored the potential use of long non-coding RNAs (lncRNAs) and mRNAs as biomarkers for IPF. METHODS We first performed a whole transcriptome analysis using microarray (n = 14: 7 Control, 7 IPF), followed by the validation of selected transcripts through qPCRs in an independent cohort of 95 subjects (n = 95: 45 Control, 50 IPF). Diagnostic performance and transcript correlation with functional/clinical data were also analyzed. RESULTS 1059 differentially expressed transcripts were identified. We confirmed the downregulation of FOXF1 adjacent non-coding developmental regulatory RNA (FENDRR) lncRNA, hsa_circ_0001924 circularRNA, utrophin (UTRN) and Y-box binding protein 3 (YBX3) mRNAs. The two analyzed non-coding RNAs correlated with Forced Vital Capacity (FVC)% and Diffusing Capacity of the Lung for carbon monoxide (DLCO)% functional data, while coding RNAs correlated with smock exposure. All analyzed transcripts showed excellent performance in IPF identification with Area Under the Curve values above 0.87; the most outstanding one was YBX3: AUROC 0.944, CI 95% = 0.895-0.992, sensitivity = 90%, specificity = 88.9%, p-value = 1.02 × 10-13. CONCLUSIONS This study has identified specific transcript signatures in IPF suggesting that validated transcripts and microarray data could be useful for the potential future identification of RNA molecules as non-invasive biomarkers for IPF.
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Affiliation(s)
- Stefania Di Mauro
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, 95122 Catania, Italy; (S.D.M.); (A.S.); (A.F.); (G.P.); (A.D.P.); (R.S.); (F.P.); (S.P.)
| | - Alessandra Scamporrino
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, 95122 Catania, Italy; (S.D.M.); (A.S.); (A.F.); (G.P.); (A.D.P.); (R.S.); (F.P.); (S.P.)
| | - Mary Fruciano
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (M.F.); (E.F.); (E.G.)
| | - Agnese Filippello
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, 95122 Catania, Italy; (S.D.M.); (A.S.); (A.F.); (G.P.); (A.D.P.); (R.S.); (F.P.); (S.P.)
| | - Evelina Fagone
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (M.F.); (E.F.); (E.G.)
| | - Elisa Gili
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (M.F.); (E.F.); (E.G.)
| | - Francesca Scionti
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (F.S.); (M.T.D.M.)
| | - Giacomo Purrazzo
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, 95122 Catania, Italy; (S.D.M.); (A.S.); (A.F.); (G.P.); (A.D.P.); (R.S.); (F.P.); (S.P.)
| | - Antonino Di Pino
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, 95122 Catania, Italy; (S.D.M.); (A.S.); (A.F.); (G.P.); (A.D.P.); (R.S.); (F.P.); (S.P.)
| | - Roberto Scicali
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, 95122 Catania, Italy; (S.D.M.); (A.S.); (A.F.); (G.P.); (A.D.P.); (R.S.); (F.P.); (S.P.)
| | - Maria Teresa Di Martino
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (F.S.); (M.T.D.M.)
| | - Roberta Malaguarnera
- School of Human and Social Sciences, “Kore” University of Enna, 94100 Enna, Italy;
| | - Lorenzo Malatino
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Azienda Ospedaliera Cannizzaro, University of Catania, 95100 Catania, Italy;
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, 95122 Catania, Italy; (S.D.M.); (A.S.); (A.F.); (G.P.); (A.D.P.); (R.S.); (F.P.); (S.P.)
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (M.F.); (E.F.); (E.G.)
- Correspondence: ; Tel.: +390-9-5378-1774 (ext. 1424)
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, 95122 Catania, Italy; (S.D.M.); (A.S.); (A.F.); (G.P.); (A.D.P.); (R.S.); (F.P.); (S.P.)
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Comelli A, Coronnello C, Dahiya N, Benfante V, Palmucci S, Basile A, Vancheri C, Russo G, Yezzi A, Stefano A. Lung Segmentation on High-Resolution Computerized Tomography Images Using Deep Learning: A Preliminary Step for Radiomics Studies. J Imaging 2020; 6:125. [PMID: 34460569 PMCID: PMC8321165 DOI: 10.3390/jimaging6110125] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this work is to identify an automatic, accurate, and fast deep learning segmentation approach, applied to the parenchyma, using a very small dataset of high-resolution computed tomography images of patients with idiopathic pulmonary fibrosis. In this way, we aim to enhance the methodology performed by healthcare operators in radiomics studies where operator-independent segmentation methods must be used to correctly identify the target and, consequently, the texture-based prediction model. METHODS Two deep learning models were investigated: (i) U-Net, already used in many biomedical image segmentation tasks, and (ii) E-Net, used for image segmentation tasks in self-driving cars, where hardware availability is limited and accurate segmentation is critical for user safety. Our small image dataset is composed of 42 studies of patients with idiopathic pulmonary fibrosis, of which only 32 were used for the training phase. We compared the performance of the two models in terms of the similarity of their segmentation outcome with the gold standard and in terms of their resources' requirements. RESULTS E-Net can be used to obtain accurate (dice similarity coefficient = 95.90%), fast (20.32 s), and clinically acceptable segmentation of the lung region. CONCLUSIONS We demonstrated that deep learning models can be efficiently applied to rapidly segment and quantify the parenchyma of patients with pulmonary fibrosis, without any radiologist supervision, in order to produce user-independent results.
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Affiliation(s)
- Albert Comelli
- Ri.MED Foundation, 90133 Palermo, Italy;
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (V.B.); (G.R.); (A.S.)
| | | | - Navdeep Dahiya
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (N.D.); (A.Y.)
| | - Viviana Benfante
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (V.B.); (G.R.); (A.S.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology Unit I, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (S.P.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology Unit I, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (S.P.); (A.B.)
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy;
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (V.B.); (G.R.); (A.S.)
| | - Anthony Yezzi
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (N.D.); (A.Y.)
| | - Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (V.B.); (G.R.); (A.S.)
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Crimi C, Impellizzeri P, Campisi R, Spicuzza L, Vancheri C, Crimi N. Resumption of respiratory outpatient services in the COVID-19 era: Experience from Southern Italy. Am J Infect Control 2020; 48:1087-1089. [PMID: 32621858 PMCID: PMC7329653 DOI: 10.1016/j.ajic.2020.06.210] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 12/03/2022]
Abstract
COVID-19 pandemic turned the entire health-care system organization upside-down, suspending elective activities and outpatient services. In Italy, we are entering a second phase of the pandemic and several strategies have been developed to “re-open” the country, some businesses, and also health care outpatient activities. This manuscript describes the experience of a Southern Italy Respiratory Unit for safely resuming outpatient respiratory services and preventing COVID-19 transmission.
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Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele," Catania, Italy.
| | - Pietro Impellizzeri
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele," Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Raffaele Campisi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele," Catania, Italy
| | - Lucia Spicuzza
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele," Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele," Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nunzio Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele," Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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George PM, Spagnolo P, Kreuter M, Altinisik G, Bonifazi M, Martinez FJ, Molyneaux PL, Renzoni EA, Richeldi L, Tomassetti S, Valenzuela C, Vancheri C, Varone F, Cottin V, Costabel U. Progressive fibrosing interstitial lung disease: clinical uncertainties, consensus recommendations, and research priorities. The Lancet Respiratory Medicine 2020; 8:925-934. [DOI: 10.1016/s2213-2600(20)30355-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022]
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Sambataro G, Giuffrè M, Sambataro D, Palermo A, Vignigni G, Cesareo R, Crimi N, Torrisi SE, Vancheri C, Malatino L, Colaci M, Del Papa N, Pignataro F, Roman-Pognuz E, Fabbiani M, Montagnani F, Cassol C, Cavagna L, Zuccaro V, Zerbato V, Maurel C, Luzzati R, Di Bella S. The Model for Early COvid-19 Recognition (MECOR) Score: A Proof-of-Concept for a Simple and Low-Cost Tool to Recognize a Possible Viral Etiology in Community-Acquired Pneumonia Patients during COVID-19 Outbreak. Diagnostics (Basel) 2020; 10:E619. [PMID: 32825763 PMCID: PMC7555441 DOI: 10.3390/diagnostics10090619] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
This study aims to assess the peripheral blood cell count "signature" of Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) to discriminate promptly between COronaVIrus Disease 19 (COVID-19) and community-acquired pneumonia (CAP). We designed a retrospective case-control study, enrolling 525 patients (283 COVID-19 and 242 with CAP). All patients had a fever and at least one of the following signs: cough, chest pain, or dyspnea. We excluded patients treated with immunosuppressants, steroids, or affected by diseases known to modify blood cell count. COVID-19 patients showed a significant reduction in white blood cells (neutrophils, lymphocytes, monocytes, eosinophils) and platelets. We studied these parameters univariately, combined the significant ones in a multivariate model (AUROC 0.86, Nagelkerke PSEUDO-R2 0.5, Hosmer-Lemeshow p-value 0.9) and examined its discriminative performance in an internally-randomized validation cohort (AUROC 0.84). The cut-off selected according to Youden's Index (-0.13) showed a sensitivity of 84% and a specificity of 72% in the training cohort, and a sensitivity of 88% and a specificity of 73% in the validation cohort. In addition, we determined the probability of having COVID-19 pneumonia for each Model for possible Early COvid-19 Recognition (MECOR) Score value. In conclusion, our model could provide a simple, rapid, and cheap tool for prompt COVID-19 diagnostic triage in patients with CAP. The actual effectiveness should be evaluated in further, prospective studies also involving COVID-19 patients with negative nasopharyngeal swabs.
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Affiliation(s)
- Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (G.V.); (N.C.); (S.E.T.); (C.V.)
| | - Mauro Giuffrè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.G.); (V.Z.); (C.M.); (R.L.); (S.D.B.)
- Italian Liver Foundation, Basovizza, 34149 Trieste, Italy
| | - Domenico Sambataro
- Artroreuma S.R.L., Outpatient of Rheumatology Associated with the National Health System corso S. Vito 53, Mascalucia, 95030 Catania, Italy;
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, via Messina 829, 95100 Catania, Italy; (L.M.); (M.C.)
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Giovanna Vignigni
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (G.V.); (N.C.); (S.E.T.); (C.V.)
| | - Roberto Cesareo
- Unit of Metabolic Diseases, “S.M. Goretti” Hospital, 04100 Latina, Italy;
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (G.V.); (N.C.); (S.E.T.); (C.V.)
| | - Sebastiano Emanuele Torrisi
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (G.V.); (N.C.); (S.E.T.); (C.V.)
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Respiratory Medicine Unit, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (G.V.); (N.C.); (S.E.T.); (C.V.)
| | - Lorenzo Malatino
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, via Messina 829, 95100 Catania, Italy; (L.M.); (M.C.)
| | - Michele Colaci
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, via Messina 829, 95100 Catania, Italy; (L.M.); (M.C.)
| | - Nicoletta Del Papa
- Dept Rheumatology, ASST Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy; (N.D.P.); (F.P.)
| | - Francesca Pignataro
- Dept Rheumatology, ASST Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy; (N.D.P.); (F.P.)
| | - Erik Roman-Pognuz
- Department of Perioperative Medicine, Intensive Care and Emergency, University Hospital, 34151 Trieste, Italy;
| | - Massimiliano Fabbiani
- Infectious and Tropical Disease Unit, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (M.F.); (F.M.); (C.C.)
| | - Francesca Montagnani
- Infectious and Tropical Disease Unit, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (M.F.); (F.M.); (C.C.)
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Chiara Cassol
- Infectious and Tropical Disease Unit, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (M.F.); (F.M.); (C.C.)
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Lorenzo Cavagna
- Rheumatology Division, University and IRCCS Policlinico San Matteo Foundation, Lombardia, 27100 Pavia, Italy;
| | - Valentina Zuccaro
- Infectious Diseases Clinic, University and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy;
| | - Verena Zerbato
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.G.); (V.Z.); (C.M.); (R.L.); (S.D.B.)
| | - Cristina Maurel
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.G.); (V.Z.); (C.M.); (R.L.); (S.D.B.)
| | - Roberto Luzzati
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.G.); (V.Z.); (C.M.); (R.L.); (S.D.B.)
| | - Stefano Di Bella
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.G.); (V.Z.); (C.M.); (R.L.); (S.D.B.)
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Galioto F, Palmucci S, Astuti GM, Vancheri A, Distefano G, Tiralongo F, Libra A, Cusumano G, Basile A, Vancheri C. Complications in Idiopathic Pulmonary Fibrosis: Focus on Their Clinical and Radiological Features. Diagnostics (Basel) 2020; 10:diagnostics10070450. [PMID: 32635390 PMCID: PMC7399856 DOI: 10.3390/diagnostics10070450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/09/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease with uncertain origins and pathogenesis; it represents the most common interstitial lung disease (ILD), associated with a pathological pattern of usual interstitial pneumonitis (UIP). This disease has a poor prognosis, having the most lethal prognosis among ILDs. In fact, the progressive fibrosis related to IPF could lead to the development of complications, such as acute exacerbation, lung cancer, infections, pneumothorax and pulmonary hypertension. Pneumologists, radiologists and pathologists play a key role in the identification of IPF disease, and in the characterization of its complications-which unfortunately increase disease mortality and reduce overall survival. The early identification of these complications is very important, and requires an integrated approach among specialists, in order to plane the correct treatment. In some cases, the degree of severity of patients having IPF complications may require a personalized approach, based on palliative care services. Therefore, in this paper, we have focused on clinical and radiological features of the complications that occurred in our IPF patients, providing a comprehensive and accurate pictorial essay for clinicians, radiologists and surgeons involved in their management.
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Affiliation(s)
- Federica Galioto
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Via Santa Sofia n. 78, 95123 Catania, Italy; (F.G.); (G.M.A.); (G.D.); (F.T.); (A.B.)
| | - Stefano Palmucci
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Via Santa Sofia n. 78, 95123 Catania, Italy; (F.G.); (G.M.A.); (G.D.); (F.T.); (A.B.)
- Correspondence: ; Tel.: +39-347-833-0775
| | - Giovanna M. Astuti
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Via Santa Sofia n. 78, 95123 Catania, Italy; (F.G.); (G.M.A.); (G.D.); (F.T.); (A.B.)
| | - Ada Vancheri
- Regional Centre for Interstitial and Rare Lung Disease, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy; (A.V.); (A.L.); (G.C.); (C.V.)
| | - Giulio Distefano
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Via Santa Sofia n. 78, 95123 Catania, Italy; (F.G.); (G.M.A.); (G.D.); (F.T.); (A.B.)
| | - Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Via Santa Sofia n. 78, 95123 Catania, Italy; (F.G.); (G.M.A.); (G.D.); (F.T.); (A.B.)
| | - Alessandro Libra
- Regional Centre for Interstitial and Rare Lung Disease, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy; (A.V.); (A.L.); (G.C.); (C.V.)
| | - Giacomo Cusumano
- Regional Centre for Interstitial and Rare Lung Disease, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy; (A.V.); (A.L.); (G.C.); (C.V.)
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies—University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Via Santa Sofia n. 78, 95123 Catania, Italy; (F.G.); (G.M.A.); (G.D.); (F.T.); (A.B.)
| | - Carlo Vancheri
- Regional Centre for Interstitial and Rare Lung Disease, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy; (A.V.); (A.L.); (G.C.); (C.V.)
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Cavagna L, Seminari E, Zanframundo G, Gregorini M, Di Matteo A, Rampino T, Montecucco C, Pelenghi S, Cattadori B, Pattonieri EF, Vitulo P, Bertani A, Sambataro G, Vancheri C, Biglia A, Bozzalla-Cassione E, Bonetto V, Monti MC, Ticozzelli E, Turco A, Oggionni T, Corsico A, Bertuccio F, Zuccaro V, Codullo V, Morosini M, Marena C, Gnecchi M, Pellegrini C, Meloni F. Calcineurin Inhibitor-Based Immunosuppression and COVID-19: Results from a Multidisciplinary Cohort of Patients in Northern Italy. Microorganisms 2020; 8:E977. [PMID: 32629788 PMCID: PMC7409165 DOI: 10.3390/microorganisms8070977] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 12/23/2022] Open
Abstract
The role of immunosuppression in SARS-CoV-2-related disease (COVID-19) is a matter of debate. We here describe the course and the outcome of COVID-19 in a cohort of patients undergoing treatment with calcineurin inhibitors. In this monocentric cohort study, data were collected from the COVID-19 outbreak in Italy up to April 28th 2020. Patients were followed at our hospital for solid organ transplantation or systemic rheumatic disorders (RMDs) and were on calcineurin inhibitor (CNI)-based therapy. Selected patients were referred from the North of Italy. The aim of our study was to evaluate the clinical course of COVID-19 in this setting. We evaluated 385 consecutive patients (220 males, 57%; median age 61 years, IQR 48-69); 331 (86%) received solid organ transplantation and 54 (14%) had a RMD. CNIs were the only immunosuppressant administered in 47 patients (12%). We identified 14 (4%) COVID-19 patients, all transplanted, mainly presenting with fever (86%) and diarrhea (71%). Twelve patients were hospitalized and two of them died, both with severe comorbidities. No patients developed acute respiratory distress syndrome or infectious complications. The surviving 10 patients are now fully recovered. The clinical course of COVID-19 patients on CNIs is generally mild, and the risk of superinfection seems low.
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Affiliation(s)
- Lorenzo Cavagna
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Elena Seminari
- Infectious Diseases Clinic, University of Pavia and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy; (E.S.); (A.D.M.); (V.Z.)
| | - Giovanni Zanframundo
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Marilena Gregorini
- Nephrology, Dialysis and Transplantation Unit, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (M.G.); (T.R.); (E.F.P.)
| | - Angela Di Matteo
- Infectious Diseases Clinic, University of Pavia and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy; (E.S.); (A.D.M.); (V.Z.)
| | - Teresa Rampino
- Nephrology, Dialysis and Transplantation Unit, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (M.G.); (T.R.); (E.F.P.)
| | - Carlomaurizio Montecucco
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Stefano Pelenghi
- Division of Cardiac Surgery, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (S.P.); (B.C.); (C.P.)
| | - Barbara Cattadori
- Division of Cardiac Surgery, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (S.P.); (B.C.); (C.P.)
| | - Eleonora Francesca Pattonieri
- Nephrology, Dialysis and Transplantation Unit, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (M.G.); (T.R.); (E.F.P.)
| | - Patrizio Vitulo
- Pulmonology Unit, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (ISMETT), 90100 Palermo, Italy;
| | - Alessandro Bertani
- Thoracic Surgery Unit, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (ISMETT), 90100 Palermo, Italy;
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (G.S.); (C.V.)
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, A. O. U. “Policlinico-Vittorio Emanuele” Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (G.S.); (C.V.)
| | - Alessandro Biglia
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Emanuele Bozzalla-Cassione
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Valentina Bonetto
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Maria Cristina Monti
- Department of Public Health, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, 27100 Pavia, Italy;
| | - Elena Ticozzelli
- General Surgery Unit, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
| | - Annalisa Turco
- Cardiology Department, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
| | - Tiberio Oggionni
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Angelo Corsico
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Francesco Bertuccio
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Valentina Zuccaro
- Infectious Diseases Clinic, University of Pavia and IRCCS Policlinico S. Matteo Foundation, 27100 Pavia, Italy; (E.S.); (A.D.M.); (V.Z.)
| | - Veronica Codullo
- Rheumatology Division, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (G.Z.); (C.M.); (A.B.); (E.B.-C.); (V.C.)
| | - Monica Morosini
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
| | - Carlo Marena
- SC Direzione Medica di Presidio, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
| | - Massimiliano Gnecchi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Department of Medical Sciences and Infectious Disease, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy;
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, 27100 Pavia, Italy
| | - Carlo Pellegrini
- Division of Cardiac Surgery, IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (S.P.); (B.C.); (C.P.)
| | - Federica Meloni
- Department of Respiratory Diseases, University of Pavia and IRCCS Policlinico S. Matteo Foundation of Pavia, 27100 Pavia, Italy; (T.O.); (A.C.); (F.B.); (M.M.); (F.M.)
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