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Gonnelli F, Hassan W, Bonifazi M, Pinelli V, Bedawi EO, Porcel JM, Rahman NM, Mei F. Malignant pleural effusion: current understanding and therapeutic approach. Respir Res 2024; 25:47. [PMID: 38243259 PMCID: PMC10797757 DOI: 10.1186/s12931-024-02684-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality and elevated costs to healthcare systems. Over the last decades the understanding of pathophysiology mechanisms, diagnostic techniques and optimal treatment intervention in MPE have been greatly advanced by recent high-quality research, leading to an ever less invasive diagnostic approach and more personalized management. Despite a number of management options, including talc pleurodesis, indwelling pleural catheters and combinations of the two, treatment for MPE remains symptom directed and centered around drainage strategy. In the next future, because of a better understanding of underlying tumor biology together with more sensitive molecular diagnostic techniques, it is likely that combined diagnostic and therapeutic procedures allowing near total outpatient management of MPE will become popular. This article provides a review of the current advances, new discoveries and future directions in the pathophysiology, diagnosis and management of MPE.
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Affiliation(s)
- Francesca Gonnelli
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy
| | - Wafa Hassan
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy
| | | | - Eihab O Bedawi
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK
| | - José M Porcel
- Research Group of Cancer Biomarkers, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Pleural Medicine and Clinical Ultrasound Unit, Department of Internal Medicine, Arnau de Vilanova, University Hospital, Lleida, Spain
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Unit, Oxford, UK
- Chinese Academy of Medicine Oxford Institute, Oxford, UK
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy.
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Mei F, Renzi M, Bonifazi M, Bonifazi F, Pepe N, D'Allura A, Brusasca G, Viegi G, Forastiere F. Long-term effects of air pollutants on respiratory and cardiovascular mortality in a port city along the Adriatic sea. BMC Pulm Med 2023; 23:395. [PMID: 37853365 PMCID: PMC10585890 DOI: 10.1186/s12890-023-02629-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Shipping and port-related air pollution has a significant health impact on a global scale. The present study aimed to assess the mortality burden attributable to long-term exposure to ambient particulate matter (PM2.5, PM10) and nitrogen dioxide (NO2) in the city of Ancona (Italy), with one of the leading national commercial harbours. METHODS Exposure to air pollutants was derived by dispersion models. The relationship between the long-term exposure of air pollution exposure and cause-specific mortality was evaluated by Poisson regression models, after adjustment for gender, age and socioeconomic status. Results are expressed as percent change of risk (and relative 95% confidence intervals) per 5 unit increases in the exposures. The health impact on the annual number of premature cause-specific deaths was also assessed. RESULTS PM2.5 and NO2 annual concentrations were higher in the area close to the harbour than in the rest of the city. Positive associations between each pollutant and most of the mortality outcomes were observed, with estimates of up to 7.6% (95%CI 0.1, 15.6%) for 10 µg/m3 increase in NO2 and cardiovascular mortality and 15.3% (95%CI-1.1, 37.2%) for 10 µg/m3 increase PM2.5 and lung cancer. In the subpopulation living close to the harbour, there were excess risks of up to 13.5%, 24.1% and 37.9% for natural, cardiovascular and respiratory mortality. The number of annual premature deaths due to the excess of PM2.5 and NO2 exposure (having as a reference the 2021 World Health Organization Air Quality Guidelines) was 82 and 25, respectively. CONCLUSIONS Our study confirms the long-term health effects of PM and NO2 on mortality and reveals a higher mortality burden in areas close to shipping and port-related emissions. Estimating the source-specific health burdens is key to achieve a deeper understanding of the role of different emission sources, as well as to support effective and targeted mitigation strategies.
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Affiliation(s)
- Federico Mei
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy.
| | - Matteo Renzi
- Department of Epidemiology of Lazio Region, ASL Roma 1, Rome, Italy.
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Floriano Bonifazi
- Honorary President Associazione Allergologi Immunologi Italiani Territoriali E Ospedalieri, , Firenze, Italy
| | | | | | | | - Giovanni Viegi
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Francesco Forastiere
- Institute of Translational Pharmacology, National Research Council (CNR), Palermo, Italy
- Environmental Research Group, Imperial College, London, UK
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Mei F, Tamburrini M, Gonnelli F, Morandi L, Bonifazi M, Sediari M, Berardino ADM, Barisione E, Failla G, Zuccatosta L, Papi A, Gasparini S, Marchetti G. Management of malignant pleural effusion in Italian clinical practice: a nationwide survey. BMC Pulm Med 2023; 23:252. [PMID: 37430219 DOI: 10.1186/s12890-023-02530-4] [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] [Accepted: 06/22/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Pleural disease (PD), particularly malignant pleural effusion (MPE), is a common cause of hospital admission and its prevalence is rising worldwide. Recent advances in diagnostic and therapeutic options, such as Indwelling Pleural Catheters (IPCs), have simplified PD treatment, allowing an effective outpatients management. Therefore, dedicated pleural services can improve PD care, guaranteeing specialized management and optimizing time and cost. We aimed to provide an overview on MPE management in Italy, mainly focused on distribution and characteristics of pleural services and IPCs use. METHODS A nationwide survey, endorsed by the Italian Thoracic Society, was distributed by email to members of selected subgroups in 2021. RESULTS Ninety (23%) members replied, most of whom being pulmonologists (91%). MPE resulted the most common cause of pleural effusion and was managed with heterogenous approaches, including talc pleurodesis via slurry (43%), talc poudrage (31%), repeated thoracentesis (22%) and IPCs insertion (2%). The setting of IPC insertion was inpatient care in 48% of cases, with a predominance of draining frequency every other day. IPC management mainly relied on caregivers (42%). The presence of a pleural service was reported by 37% of respondents. CONCLUSIONS The present study provides an extensive overview of MPE management in Italy, showing a highly heterogeneous approach, a scarce prevalence of out-patient pleural services, and a still limited adoption of IPCs, mainly due to lack of dedicated community care systems. This survey emphasizes the need of promoting a higher spreading of pleural services and an innovative healthcare delivery with more favourable cost-benefit ratio.
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Affiliation(s)
- Federico Mei
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy.
| | - Mario Tamburrini
- Respiratory Medicine, Emergency Department, Azienda Ospedaliero Universitaria Ferrara, Ferrara, Italy
| | - Francesca Gonnelli
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Luca Morandi
- Respiratory Medicine, Emergency Department, Azienda Ospedaliero Universitaria Ferrara, Ferrara, Italy
| | - Martina Bonifazi
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Michele Sediari
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Alessandro di Marco Berardino
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Emanuela Barisione
- UOC Interventional Pulmonology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giuseppe Failla
- Interventional Pulmunology, Ospedale A. Cardarelli, Napoli, Italy
| | - Lina Zuccatosta
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Alberto Papi
- Respiratory Medicine, Emergency Department, Azienda Ospedaliero Universitaria Ferrara, Ferrara, Italy
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Stefano Gasparini
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
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Faverio P, Ronco R, Monzio Compagnoni M, Franchi M, Franco G, Bonaiti G, Bonifazi M, Mei F, Luppi F, Pesci A, Corrao G. Effectiveness and economic impact of Dupilumab in asthma: a population-based cohort study. Respir Res 2023; 24:70. [PMID: 36882834 PMCID: PMC9990964 DOI: 10.1186/s12931-023-02372-y] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
RATIONALE Severe asthma is burdened by relevant socio-economic and clinical impact. Randomized controlled trials on Dupilumab showed efficacy and a good safety profile, but post-market studies are needed. OBJECTIVES To evaluate the impact of Dupilumab on (i) the use of anti-asthmatic drugs, including oral corticosteroids (OCS), (ii) the rates of asthma exacerbation-related hospital admissions, and (iii) the healthcare costs in patients with asthma. METHODS Data were retrieved from Healthcare Utilization database of Lombardy region (Italy). We compared healthcare resources use between the 6 months after Dupilumab initiation ("post-intervention period") and (i) the 6 months before Dupilumab initiation ("wash-out period") and (ii) the corresponding 6 months of the prior year ("pre-intervention period"). MAIN RESULTS In a cohort of 176 patients, Dupilumab significantly reduced anti-asthmatic drugs use (including OCS and short-acting β2-agonists, inhaled corticosteroids (ICS)/long-acting β2-agonists and ICS alone) when comparing the "pre-intervention" to the "post-intervention" period. When considering hospital admissions, we observed a not statistically or marginally significant reduction between both periods before Dupilumab and the post-intervention period. Six-months discontinuation rate was 8%. Overall healthcare costs had a tenfold increase between the "pre-intervention" and "post-intervention" period, which was mainly led by the biologic drug cost. Conversely, expenditures connected to hospital admissions did not change. CONCLUSIONS Our real-world investigation suggests that Dupilumab reduced anti-asthmatic drugs use, including OCS, in comparison to a corresponding period in the prior year. However, long-term healthcare sustainability remains an open issue.
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Affiliation(s)
- Paola Faverio
- Department of Medicine and Surgery, School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Monza, Italy.
- Respiratory Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy.
| | - Raffaella Ronco
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Franco
- Department of Medicine and Surgery, School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Monza, Italy
| | - Giulia Bonaiti
- Department of Medicine and Surgery, School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Monza, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Universitá Politecnica Delle Marche-Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Universitá Politecnica Delle Marche-Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Fabrizio Luppi
- Department of Medicine and Surgery, School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Monza, Italy
| | - Alberto Pesci
- Department of Medicine and Surgery, School of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Monza, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Ferrarini A, Vacca A, Solimando AG, Tavio M, Acquaviva R, Rocchi M, Nitti C, Salvi A, Menditto V, Luchetti Gentiloni MM, Russo A, Moretti M, Pavani M, Giacometti A, Bonifazi M, Zuccatosta L, Romani L, Racanelli V, Moroncini G, Gabrielli A, Pomponio G. Early administration of tofacitinib in COVID-19 pneumonitis: An open randomised controlled trial. Eur J Clin Invest 2023; 53:e13898. [PMID: 36380693 DOI: 10.1111/eci.13898] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Controversies on sub-populations most sensitive to therapy and the best timing of starting the treatment still surround the use of immunomodulatory drugs in COVID-19. OBJECTIVES We designed a multicentre open-label randomised controlled trial to test the effect of prompt adding of tofacitinib to standard therapy for hospitalised patients affected by mild/moderate COVID-19 pneumonitis. METHODS Patients admitted to three Italian hospitals affected by COVID-19 pneumonitis not requiring mechanical ventilation were randomised to receive standard treatment alone or tofacitinib (10 mg/bid) for 2 weeks, starting within the first 24 h from admission. RESULTS A total of 116 patients were randomised; 49 in the experimental arm completed the 14-day treatment period, 9 discontinued tofacitinib as the disease worsened and were included in the analysis, and 1 died of respiratory failure. All 58 control patients completed the study. Clinical and demographic characteristics were similar between the study groups. In the tofacitinib group, 9/58 (15.5%) patients progressed to noninvasive ventilation (CPAP) to maintain SO2 > 93%, invasive mechanical ventilation or death by day 14 was 15.5%, significantly less than in the control group (20/58, 34.4%, RR 0,45, RRR -55%, NNT 5; p = .018). No differences in severe adverse effect incidence had been observed across the groups. CONCLUSION High-dose tofacitinib therapy in patients with COVID pneumonitis is safe and may prevent deterioration to respiratory failure.
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Affiliation(s)
- Alessia Ferrarini
- Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy.,Gastroenterologia ed Endoscopia Digestiva, Ospedali Riuniti Marche Nord, Fano, Italy
| | - Angelo Vacca
- Dipartimento di Scienze Biomediche e Oncologia Umana U.O.C, Medicina Interna Universitaria "G. Baccelli" A.O.U.C, Policlinico di Bari, Bari, Italy
| | - Antonio Giovanni Solimando
- Dipartimento di Scienze Biomediche e Oncologia Umana U.O.C, Medicina Interna Universitaria "G. Baccelli" A.O.U.C, Policlinico di Bari, Bari, Italy.,IRCCS Istituto Tumori "Giovanni Paolo II" Bari, Bari, Italy
| | - Marcello Tavio
- Malattie Infettive, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Rossella Acquaviva
- Dipartimento di Scienze Biomediche e Oncologia Umana U.O.C, Medicina Interna Universitaria "G. Baccelli" A.O.U.C, Policlinico di Bari, Bari, Italy
| | - Marco Rocchi
- Statistica Medica, Dipartimento di Scienze Biomolecolari, Università di Urbino, Urbino, Italy
| | - Cinzia Nitti
- Medicina Interna e Sub Intensiva, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Aldo Salvi
- Medicina Interna e Sub Intensiva, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Vincenzo Menditto
- Medicina Interna e Sub Intensiva, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Alessandro Russo
- Clinica di Malattie Infettive e Tropicali Dipartimento di Scienze Mediche e Chirurgiche Università "Magna Graecia" di Catanzaro, Catanzaro, Italy
| | - Marco Moretti
- SOD Medicina di Laboratorio Ospedali Riuniti di Ancona, Ancona, Italy
| | - Marianna Pavani
- SOD Medicina di Laboratorio Ospedali Riuniti di Ancona, Ancona, Italy
| | - Andrea Giacometti
- Clinica di Malattie Infettive, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | | | - Laura Romani
- Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Vito Racanelli
- Dipartimento di Scienze Biomediche e Oncologia Umana U.O.C, Medicina Interna Universitaria "G. Baccelli" A.O.U.C, Policlinico di Bari, Bari, Italy
| | - Gianluca Moroncini
- Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy.,Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Armando Gabrielli
- Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy.,Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
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Bedawi EO, Ricciardi S, Hassan M, Gooseman MR, Asciak R, Castro-Añón O, Armbruster K, Bonifazi M, Poole S, Harris EK, Elia S, Krenke R, Mariani A, Maskell NA, Polverino E, Porcel JM, Yarmus L, Belcher EP, Opitz I, Rahman NM. ERS/ESTS statement on the management of pleural infection in adults. Eur Respir J 2023; 61:2201062. [PMID: 36229045 DOI: 10.1183/13993003.01062-2022] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [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: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Abstract
Pleural infection is a common condition encountered by respiratory physicians and thoracic surgeons alike. The European Respiratory Society (ERS) and European Society of Thoracic Surgeons (ESTS) established a multidisciplinary collaboration of clinicians with expertise in managing pleural infection with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified: 1) epidemiology of pleural infection, 2) optimal antibiotic strategy, 3) diagnostic parameters for chest tube drainage, 4) status of intrapleural therapies, 5) role of surgery and 6) current place of outcome prediction in management. The literature revealed that recently updated epidemiological data continue to show an overall upwards trend in incidence, but there is an urgent need for a more comprehensive characterisation of the burden of pleural infection in specific populations such as immunocompromised hosts. There is a sparsity of regular analyses and documentation of microbiological patterns at a local level to inform geographical variation, and ongoing research efforts are needed to improve antibiotic stewardship. The evidence remains in favour of a small-bore chest tube optimally placed under image guidance as an appropriate initial intervention for most cases of pleural infection. With a growing body of data suggesting delays to treatment are key contributors to poor outcomes, this suggests that earlier consideration of combination intrapleural enzyme therapy (IET) with concurrent surgical consultation should remain a priority. Since publication of the MIST-2 study, there has been considerable data supporting safety and efficacy of IET, but further studies are needed to optimise dosing using individualised biomarkers of treatment failure. Pending further prospective evaluation, the MIST-2 regimen remains the most evidence based. Several studies have externally validated the RAPID score, but it requires incorporating into prospective intervention studies prior to adopting into clinical practice.
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Affiliation(s)
- Eihab O Bedawi
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Sara Ricciardi
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
- PhD Program Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Michael R Gooseman
- Department of Thoracic Surgery, Hull University Teaching Hospitals NHS Trust, Hull York Medical School, University of Hull, Hull, UK
| | - Rachelle Asciak
- Department of Respiratory Medicine, Queen Alexandra Hospital, Portsmouth, UK
- Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta
| | - Olalla Castro-Añón
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI Lugo, Cervo y Monforte de Lemos, Lugo, Spain
- C039 Biodiscovery Research Group HULA-USC, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Karin Armbruster
- Department of Medicine, Section of Pulmonary Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Sarah Poole
- Department of Pharmacy and Medicines Management, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elinor K Harris
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Stefano Elia
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
- Thoracic Surgical Oncology Programme, Policlinico Tor Vergata, Rome, Italy
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Alessandro Mariani
- Thoracic Surgery Department, Heart Institute (InCor) do Hospital das Clnicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Jose M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth P Belcher
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Chinese Academy of Medical Health Sciences, University of Oxford, Oxford, UK
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7
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Mei F, Rota M, Bonifazi M, Zuccatosta L, Porcarelli FM, Sediari M, Bedawi EO, Sundaralingam A, Addala D, Gasparini S, Rahman NM. Efficacy of Small versus Large-Bore Chest Drain in Pleural Infection: A Systematic Review and Meta-Analysis. Respiration 2023; 102:247-256. [PMID: 36693327 DOI: 10.1159/000529027] [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: 06/17/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Pleural infection represents a significant clinical challenge worldwide. Although prompt drainage of pleural fluid is thought to play a key role in pleural infection management, the optimal size of intrapleural catheter has yet to be defined. OBJECTIVES The aim of this systematic review and meta-analysis was to summarize data on efficacy and complications of small-bore drain (SBD), defined as ≤14F, in comparison to large-bore drain (LBD) in patients with pleural infection. METHOD We searched MEDLINE and Embase for all studies reporting outcomes of interest published up to October 2021. Two authors reviewed selected full text to identify studies according to predefined eligibility criteria. Summary estimates were derived using the random-effects model. RESULTS Twelve original studies were included for qualitative analysis and 7 of these for quantitative analysis. The surgical referral rate of SBD and LBD were, respectively, 0.16 (95% confidence interval [CI], 0.12-0.21) and 0.20 (95% CI, 0.10-0.32), the pooled mortality were 0.12 (95% CI, 0.05-0.21) and 0.20 (95% CI, 0.10-0.32), and the length of hospital stay was 24 days in both groups. Data on complications suggest similar proportions of tube dislodgement. Intensity of pain was evaluated in one study only, reporting higher scores for LBD. CONCLUSIONS This systematic review and meta-analysis provide the first synthesis of data on performance of SBD and LBD in management of pleural infection, and, overall, clinical outcomes and complications did not substantially differ, although the limited number of studies and the absence of dedicated randomized trials does limit the reliability of results.
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Affiliation(s)
- Federico Mei
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Martina Bonifazi
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Lina Zuccatosta
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Francesco M Porcarelli
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Michele Sediari
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Eihab O Bedawi
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Anand Sundaralingam
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Dinesh Addala
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Stefano Gasparini
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Unit, Oxford, UK
- Chinese Academy of Medicine Oxford Institute, Oxford, UK
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8
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Iommi M, Faragalli A, Bonifazi M, Mei F, Latini LL, Pompili M, Carle F, Gesuita R. Prognosis and Survival in Idiopathic Pulmonary Fibrosis in the Era of Antifibrotic Therapy in Italy: Evidence from a Longitudinal Population Study Based on Healthcare Utilization Databases. Int J Environ Res Public Health 2022; 19:16689. [PMID: 36554568 PMCID: PMC9779053 DOI: 10.3390/ijerph192416689] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/30/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
The aim was to evaluate the determinants of acute exacerbation (AE) and death in new cases of idiopathic pulmonary fibrosis (IPF) using administrative databases in the Marche Region. Adults at their first prescription of antifibrotics or hospitalization with a diagnosis of IPF occurring in 2014-2019 were considered as new cases. Multiple Cox regression was used to estimate the risk of AE and of all-cause mortality adjusted by demographic and clinical characteristics, stratifying patients according to antifibrotic treatment. Overall, 676 new cases of IPF were identified and 276 deaths and 248 AE events occurred. In never-treated patients, the risk of AE was higher in patients with poor health conditions at diagnosis; the risk of death was higher in males, in patients aged ≥75 and in those with poor health conditions at baseline. The increasing number of AEs increased the risk of death in treated and never-treated patients. Within the limits of an observational study based on secondary data, the combined use of healthcare administrative databases allows the accurate analysis of progression and survival of IPF from the beginning of the antifibrotic therapy era, suggesting that timely and early diagnosis is critical to prescribing the most suitable treatment to increase survival and maintain a healthy life expectancy.
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Affiliation(s)
- Marica Iommi
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Andrea Faragalli
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60166 Ancona, Italy
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60166 Ancona, Italy
| | - Lara Letizia Latini
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60166 Ancona, Italy
| | - Marco Pompili
- Regional Health Agency of Marche, 60121 Ancona, Italy
| | - Flavia Carle
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milano, Italy
| | - Rosaria Gesuita
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60121 Ancona, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milano, Italy
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9
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Formenti P, Umbrello M, Castagna V, Cenci S, Bichi F, Pozzi T, Bonifazi M, Coppola S, Chiumello D. Author's response: "Respiratory and peripheral muscular ultrasound characteristics in ICU COVID 19 ARDS patients". J Crit Care 2022; 72:154156. [PMID: 36201979 DOI: 10.1016/j.jcrc.2022.154156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 11/27/2022]
Affiliation(s)
- P Formenti
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
| | - M Umbrello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - V Castagna
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - S Cenci
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - F Bichi
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - T Pozzi
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - M Bonifazi
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - S Coppola
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - D Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy; Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy; Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
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10
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Faverio P, Monzio Compagnoni M, Ronco R, Franchi M, Della Zoppa M, Bonaiti G, Bonifazi M, Mei F, Luppi F, Pesci A, Corrao G. Economic impact of anti-IL-5 agents in patients with severe eosinophilic asthma: A population-based cohort study. J Allergy Clin Immunol Pract 2022; 10:3026-3028.e2. [PMID: 35961616 DOI: 10.1016/j.jaip.2022.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Paola Faverio
- Respiratory Unit, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, San Gerardo Hospital, ASST di Monza, Monza, Italy.
| | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | | | - Giulia Bonaiti
- Respiratory Unit, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Universitá Politecnica delle Marche-Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Universitá Politecnica delle Marche-Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Fabrizio Luppi
- Respiratory Unit, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Alberto Pesci
- Respiratory Unit, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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11
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Zuccatosta L, Latini MA, Mei F, Bonifazi M, Barisione E, Salio M, Gasparini S, Gonnelli F. A lymph node mediastinal foreign body reaction mimicking nodal metastasis: A case series. Front Med (Lausanne) 2022; 9:1014617. [PMID: 36213673 PMCID: PMC9537557 DOI: 10.3389/fmed.2022.1014617] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction In the last decades, many haemostatic substances included oxidized cellulose topically applied have been used during surgery and their use have become a common practice. Oxidized cellulose (OC) is one of the most used haemostatic substances. However, different studies have shown the persistence of OC deposits after surgical procedures that may simulate recurrent malignancies and abscesses. We present a case series of patients with enlarged on CT and PET-FDG positive lymphadenopathies due to foreign body inflammatory reaction to OC after lung surgery for pulmonary malignancies. Methods Retrospective chart review of patients from 2021 to 2022 who underwent EBUS-TBNA for the characterization of hilar and/or mediastinal lymphadenopathies and a histopathological diagnosis of foreign body inflammatory reaction to OC. Results Eight patients were referred to "Ospedali Riuniti di Ancona" (n = 7) and "Ospedale San Martino" (Genoa) (n = 1) Interventional Pulmonology Units for the characterization of hilar and/or mediastinal lymphadenopathies. All the evaluated patients underwent surgical procedures for lung cancers within the previous 12 months. EBUS-TBNA was performed in all the patients to rule out nodal metastasis. The cyto-pathological evaluation revealed amorphous acellular eosinofilic material surrounded by inflammatory reaction. As no other apparent causes might explain this finding and considering the temporal relationship between the lymphadenopathy and the lung surgery, foreign body inflammatory reaction to OC is the most likely cause of the phenomenon. Conclusion In patients who underwent surgery for lung cancer, especially within few months, the development of lymph node foreign body reaction due to surgical material retention should always be considered.
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Affiliation(s)
- Lina Zuccatosta
- Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Ancona, Italy
| | | | - Federico Mei
- Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Ancona, Italy
- Polytechnic University of Marche, Ancona, Italy
| | - Martina Bonifazi
- Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Ancona, Italy
- Polytechnic University of Marche, Ancona, Italy
| | | | - Mario Salio
- Pulmonary Diseases Unit, Ospedale Ss. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Stefano Gasparini
- Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Ancona, Italy
- Polytechnic University of Marche, Ancona, Italy
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12
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Mei F, Dalmartello M, Bonifazi M, Bertuccio P, Levi F, Boffetta P, Negri E, La Vecchia C, Malvezzi M. Chronic obstructive pulmonary disease (COPD) mortality trends worldwide: An update to 2019. Respirology 2022; 27:941-950. [PMID: 35831204 DOI: 10.1111/resp.14328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/05/2022] [Accepted: 06/22/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) incidence, prevalence, mortality and socioeconomic burden are considerable and vary across countries. The aim of the present study was to update the analysis of COPD mortality worldwide using data from the World Health Organization (WHO) up to 2019. METHODS We obtained COPD mortality and population data for 22 European countries and the European Union (EU) as a whole, 10 American countries and six other countries from the WHO mortality database. We calculated age-standardized mortality rates in both sexes and examined trends by country with joinpoint analysis between 1994 and 2019. RESULTS Between 2005-2007 and 2015-2017, overall COPD mortality decreased in EU men (-16.3%) but increased in women (12.7%) to reach rates of 14.0/100,000 in men and of 6.4/100,000 in women. In the United States, mortality declined in men to 21.3/100,000 but rose in women to 18.3/100,000. Mortality declined in most Latin American countries and all Asian countries, while an increase in Australian women was observed. CONCLUSION A steady decrease in COPD mortality was observed in most of countries for men, whilst a different trend was observed in women in several countries. These trends are largely explained by changes in smoking habits, with an additional contribution of air pollution and occupational exposures. Despite past and ongoing tobacco control initiatives, this condition still remains a leading cause of death, in particular in countries with lower socio-demographic indices.
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Affiliation(s)
- Federico Mei
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Michela Dalmartello
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - Martina Bonifazi
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Fabio Levi
- Department of Epidemiology and Health Services Research, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Eva Negri
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Department of Humanities, Pegaso Online University, Naples, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - Matteo Malvezzi
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
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13
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Mondoni M, Gasparini S, Varone F, Trisolini R, Mancino L, Rossi G, Carlucci P, Bonifazi M, Mei F, Zuccatosta L, Michieletto L, Pitari F, Saderi L, Richeldi L, Centanni S, Sotgiu G. Accuracy and Predictors of Success of EUS-B-FNA in the Diagnosis of Pulmonary Malignant Lesions: A Prospective Multicenter Italian Study. Respiration 2022; 101:775-783. [PMID: 35483329 DOI: 10.1159/000524398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/03/2021] [Accepted: 03/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The role of endoscopic ultrasound with bronchoscope fine-needle aspiration (EUS-B-FNA) in the diagnosis of suspected malignant pulmonary lesions adjacent to the esophagus has been poorly investigated. The aim of the present study was to assess the accuracy of EUS-B-FNA for the diagnosis and molecular profiling of paraesophageal pulmonary lesions, as well as its predictors of success. MATERIALS AND METHODS Patients who underwent EUS-B-FNA for the diagnosis of paraesophageal lesions were consecutively enrolled in four Italian centers. Demographic, clinical, procedural, pathological, and molecular characteristics of the malignant samples were collected. The primary outcome was the diagnostic accuracy for pulmonary malignancies. Secondary outcomes were diagnostic yield and predictors of success for diagnosis and molecular profiling. RESULTS 107 adult patients (60 [56.1%] males; median (interquartile range) age: 69 [60-70] years) were enrolled. The diagnostic accuracy of EUS-B-FNA was 95.3% in the overall cohort and 95.2% in the 99 patients with a final diagnosis of malignancy. Neither clinical nor procedural variables significantly affected the diagnostic accuracy, whereas rapid on-site evaluation (ROSE), performed by pathologists or trained pulmonologists, was a strong predictor for a complete molecular profiling (OR [95% CI]: 12.9 [1.2-137.4]; p value: 0.03). CONCLUSION EUS-B-FNA is a safe and accurate method for the diagnosis of paraesophageal pulmonary lesions. The presence of ROSE is relevant for a complete molecular profiling in this selected cohort of patients with advanced lung cancer.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Stefano Gasparini
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Varone
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Mancino
- Pulmonology Unit, Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Dell'Angelo Hospital, Ancona, Italy
| | - Giulio Rossi
- Pathology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Paolo Carlucci
- Respiratory Unit, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Martina Bonifazi
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Federico Mei
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Lina Zuccatosta
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Lucio Michieletto
- Pulmonology Unit, Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Dell'Angelo Hospital, Ancona, Italy
| | - Federica Pitari
- Respiratory Unit, 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
| | - Luca Richeldi
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Centanni
- Respiratory Unit, 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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14
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Iommi M, Bonifazi M, Faragalli A, Latini LL, Mei F, Spazzafumo L, Skrami E, Ferrante L, Carle F, Gesuita R. Occurrence of Idiopathic Pulmonary Fibrosis in Italy: Latest Evidence from Real-World Data. Int J Environ Res Public Health 2022; 19:ijerph19052510. [PMID: 35270205 PMCID: PMC8909740 DOI: 10.3390/ijerph19052510] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/04/2022] [Accepted: 02/20/2022] [Indexed: 12/04/2022]
Abstract
The aim of the study was to evaluate the trend in the incidence of idiopathic pulmonary fibrosis (IPF) in a real-world setting of the Marche region, a region of Central Italy, between 2014 and 2019. This observational prospective study was based on administrative databases of hospital discharges and drug prescriptions. All adult residents in the Marche Region with a first prescription of antifibrotic drugs, or a first hospitalization with a diagnosis of IPF during the study period, were identified as incident cases of IPF. A multiple Poisson regression analysis was used to estimate the IPF incidence trend, adjusted for age, sex, and health conditions. The mean incidence rate was 9.8 cases per 100,000 person-years. A significant increasing trend of 6% per year was observed. The incidence rates were significantly higher in males than females, older subjects, and those with poorer health conditions. To our knowledge, this is the first study evaluating incidences of IPF over a 6-year period in Italy, combining hospital discharge and drug prescription databases. The study highlights that the combined use of two secondary sources is a reliable strategy to accurately identify new cases of IPF when the appropriate disease registry is lacking.
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Affiliation(s)
- Marica Iommi
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.B.); (L.L.L.); (F.M.)
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
| | - Andrea Faragalli
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
| | - Lara Letizia Latini
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.B.); (L.L.L.); (F.M.)
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.B.); (L.L.L.); (F.M.)
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
| | | | - Edlira Skrami
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milano, Italy
| | - Luigi Ferrante
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
| | - Flavia Carle
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milano, Italy
- Correspondence: ; Tel.: +39-071-2206020
| | - Rosaria Gesuita
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60126 Ancona, Italy; (M.I.); (A.F.); (E.S.); (L.F.); (R.G.)
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milano, Italy
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15
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Levi G, Rocchetti C, Mei F, Stella GM, Lettieri S, Lococo F, Taccari F, Seguiti C, Fantoni M, Natali F, Candoli P, Bortolotto C, Pinelli V, Mondoni M, Carlucci P, Fabbri A, Trezzi M, Vannucchi L, Bonifazi M, Porcarelli F, Gasparini S, Sica G, Valente T, Biondini D, Damin M, Liani V, Tamburrini M, Sorino C, Mezzasalma F, Scaramozzino MU, Pini L, Bezzi M, Marchetti GP. Diagnostic role of internal mammary lymph node involvement in tuberculous pleurisy: a multicenter study. Pulmonology 2022:S2531-0437(22)00022-8. [PMID: 35190300 DOI: 10.1016/j.pulmoe.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/17/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Diagnosis of tuberculous pleurisy (TP) may be challenging and it often requires pleural biopsy. A tool able to increase pre-test probability of TP may be helpful to guide diagnostic work-up and enlargement of internal mammary lymph node (IMLN) has been suggested to play a potential role. The aim of the present investigation was to assess role of IMLN involvement in TP in a multi-centric case-control study, by comparing its prevalence and test performance to those observed in patients with infectious, non-tuberculous pleurisy (NTIP), and in controls free from respiratory diseases (CP). METHODS A total of 419 patients, from 14 Pulmonology Units across Italy were enrolled (127 patients affected by TP, 163 affected by NTIP and 129 CP). Prevalence, accuracy and predictive values of ipsilateral IMLN involvement between cases and control groups were assessed, as well as concordance between chest computed tomography (CT scan) and thoracic ultrasound (TUS) measurements. RESULTS The prevalence of ipsilateral IMLN involvement in TP was significantly higher than that observed in NTIP and CP groups (respectively 77.2%, 39.3% and 14.7%). Results on test performance, stratified by age, revealed a high positive predictive value in patients aged ≤50 years, while a high negative predictive value in patients aged >50 years. The comparison between CT scan and ultrasound showed moderate agreement (Kappa=0.502). CONCLUSIONS Evaluation of IMLN involvement plays a relevant role in assessing the pre-test probability of TP. Considering the increasing global prevalence of mycobacterial infections, a tool able to guide diagnostic work-up of suspected TP is crucial, especially where local sources are limited.
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Affiliation(s)
- G Levi
- Interventional Pulmonology Unit, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy.
| | - C Rocchetti
- Interventional Pulmonology Unit, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - F Mei
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy; Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - G M Stella
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - S Lettieri
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - F Lococo
- Thoracic Unit, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - F Taccari
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - C Seguiti
- Security and Bioethics department, Catholic University of the Sacred Heart, Rome, Italy; Security and Bioethics department, Catholic University of the Sacred Heart, Rome, Italy
| | - M Fantoni
- Security and Bioethics department, Catholic University of the Sacred Heart, Rome, Italy; Security and Bioethics department, Catholic University of the Sacred Heart, Rome, Italy
| | - F Natali
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi IRCCS, Bologna, Italy
| | - P Candoli
- Interventional Pulmonology Unit, Policlinico Sant'Orsola-Malpighi IRCCS, Bologna, Italy
| | - C Bortolotto
- Department of Intensive Medicine, Unit of Radiology, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - V Pinelli
- Pneumology Division, ASL5 Spezzino, Italy
| | - M Mondoni
- Respiratory Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - P Carlucci
- Respiratory Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - A Fabbri
- Pneumology Unit, Azienda USL Toscana Centro, Pistoia, Italy
| | - M Trezzi
- Infectious Diseases Unit, Azienda USL Toscana Centro, Pistoia, Italy
| | - L Vannucchi
- Department of Radiology, Azienda USL Toscana Centro, Pistoia, Italy
| | - M Bonifazi
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy; Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - F Porcarelli
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy; Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - S Gasparini
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy; Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - G Sica
- Radiology Unit, Azienda Ospedali dei Colli, Monaldi Hospital, Napoli, Italy
| | - T Valente
- Radiology Unit, Azienda Ospedali dei Colli, Monaldi Hospital, Napoli, Italy
| | - D Biondini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - M Damin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - V Liani
- Pulmonology Unit, AO Friuli Occidentale, Pordenone, Italy
| | - M Tamburrini
- Pulmonology Unit, AO Friuli Occidentale, Pordenone, Italy
| | - C Sorino
- Division of Pulmonology, Sant'Anna Hospital, Como, Italy; University of Insubria, Faculty of Medicine and Surgery, Varese, Italy
| | - F Mezzasalma
- Diagnostic and Interventional Bronchoscopy Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS, Siena, Italy
| | - M U Scaramozzino
- Complex structure Pneumology unit, Civil hospital - Regional centre of excellence for immunoallergological diseases, Locri, Italy
| | - L Pini
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy; Respiratory Medicine Unit, ASST Spedali Civili, Brescia, Italy
| | - M Bezzi
- Interventional Pulmonology Unit, ASST Spedali Civili, Brescia, Italy
| | - G P Marchetti
- Pulmonology Unit, ASST Spedali Civili, Brescia, Italy
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16
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Formenti P, Umbrello M, Castagna V, Cenci S, Bichi F, Pozzi T, Bonifazi M, Coppola S, Chiumello D. Respiratory and peripheral muscular ultrasound characteristics in ICU COVID 19 ARDS patients. J Crit Care 2022; 67:14-20. [PMID: 34600218 PMCID: PMC8480969 DOI: 10.1016/j.jcrc.2021.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 04/30/2021] [Revised: 08/06/2021] [Accepted: 09/05/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Severe cases of coronavirus disease 2019 develop ARDS requiring admission to the ICU. This study aimed to investigate the ultrasound characteristics of respiratory and peripheral muscles of patients affected by COVID19 who require mechanical ventilation. MATERIALS AND METHODS This is a prospective observational study. We performed muscle ultrasound at the admission of ICU in 32 intubated patients with ARDS COVID19. The ultrasound was comprehensive of thickness and echogenicity of both parasternal intercostal and diaphragm muscles, and cross-sectional area and echogenicity of the rectus femoris. RESULTS Patients who survived showed a significantly lower echogenicity score as compared with those who did not survive for both parasternal intercostal muscles. Similarly, the diaphragmatic echogenicity was significantly different between alive or dead patients. There was a significant correlation between right parasternal intercostal or diaphragm echogenicity and the cumulative fluid balance and urine protein output. Similar results were detected for rectus femoris echogenicity. CONCLUSIONS The early changes detected by echogenicity ultrasound suggest a potential benefit of proactive early therapies designed to preserve respiratory and peripheral muscle architecture to reduce days on MV, although what constitutes a clinically significant change in muscle echogenicity remains unknown.
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Affiliation(s)
- P. Formenti
- SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy,Corresponding author at: SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Via Di Rudinì, 8, 20142 Milan, Italy
| | - M. Umbrello
- SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - V. Castagna
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - S. Cenci
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - F. Bichi
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - T. Pozzi
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - M. Bonifazi
- SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - S. Coppola
- SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - D. Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy,Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy,Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
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17
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Abstract
PURPOSE OF REVIEW Over the last decades, in addition to the traditional fluoroscopy, various and innovative guidance systems have been adopted in clinical practice for transbronchial approach to peripheral pulmonary lesions (PPLs). The aim of this article is to summarize the most recent data on available guidance systems and sampling tools, evaluating also advantages and limitations of each technique. RECENT FINDINGS Although several studies have been published over the last years, large randomized studies comparing the different techniques are scanty. Fluoroscopy is the traditional and still most widely utilized guidance system. New guidance systems (electromagnetic navigation bronchoscopy, ultrasound miniprobe, cone beam computed tomography) seems to provide a better sensitivity, especially for small lesions not visualized by fluoroscopy. Among the sampling instruments, there is a good evidence that flexible transbronchial needle provides the better diagnostic yield and that sensitivity may increase if more than one sampling instrument is used. SUMMARY Even if great progress has been done since the first articles on the transbronchial approach to PPLs, better scientific evidence and more reliable randomized trials are needed to guide interventional pulmonologists in choosing the best technique according to different clinical scenarios and source availability.
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Affiliation(s)
- Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Federico Mei
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Lina Zuccatosta
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
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18
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Torrego A, Herth FJ, Munoz-Fernandez AM, Puente L, Facciolongo N, Bicknell S, Novali M, Gasparini S, Bonifazi M, Dheda K, Andreo F, Votruba P, Langton D, Flandes J, Fielding D, Bonta PI, Skowasch D, Schulz C, Darwiche K, McMullen E, Grubb GM, Niven R. Bronchial Thermoplasty Global Registry (BTGR): 2-year results. BMJ Open 2021; 11:e053854. [PMID: 34916324 PMCID: PMC8679080 DOI: 10.1136/bmjopen-2021-053854] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/25/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Bronchial thermoplasty (BT) is a device-based treatment for subjects ≥18 years with severe asthma not well controlled with inhaled corticosteroids and long-acting beta-agonists. The Bronchial Thermoplasty Global Registry (BTGR) collected real-world data on subjects undergoing this procedure. DESIGN The BTGR is an all-comer, prospective, open-label, multicentre study enrolling adult subjects indicated for and treated with BT. SETTING Eighteen centres in Spain, Italy, Germany, the UK, the Netherlands, the Czech Republic, South Africa and Australia PARTICIPANTS: One hundred fifty-seven subjects aged 18 years and older who were scheduled to undergo BT treatment for asthma. Subjects diagnosed with other medical conditions which, in the investigator's opinion, made them inappropriate for BT treatment were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Baseline characteristics collected included demographics, Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Test (ACT), medication usage, forced expiratory volume in one second and forced vital capacity, medical history, comorbidities and 12-month baseline recall data (severe exacerbations (SE) and healthcare utilisation). SE incidence and healthcare utilisation were summarised at 1 and 2 years post-BT. RESULTS Subjects' baseline characteristics were representative of persons with severe asthma. A comparison of the proportion of subjects experiencing events during the 12 months prior to BT to the 2-year follow-up showed a reduction in SE (90.3% vs 56.1%, p<0.0001), emergency room visits (53.8% vs 25.5%, p<0.0001) and hospitalisations (42.9% vs 23.5 %, p=0.0019). Reductions in asthma maintenance medication dosage were also observed. AQLQ and ACT scores improved from 3.26 and 11.18 at baseline to 4.39 and 15.54 at 2 years, respectively (p<0.0001 for both AQLQ and ACT). CONCLUSIONS The BTGR demonstrates sustained improvement in clinical outcomes and reduction in asthma medication usage 2 years after BT in a real-world population. This is consistent with results from other BT randomised controlled trials and registries and further supports improvement in asthma control after BT. TRIAL REGISTRATION NUMBER NCT02104856.
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Affiliation(s)
- Alfons Torrego
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Felix J Herth
- Thoraxklinik, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | | | - Luis Puente
- Respiratory Department, Hospital General Universitario Gregorio Marañon-Facultad de Medicina Universidad Complutense, Madrid, Spain
| | - Nicola Facciolongo
- AUSL-IRCCS Reggio Emilia Pulmonology Unit, IRCCS Reggio Emilia Pulmonology Unit, Santa Maria Nuova, Italy
| | - Stephen Bicknell
- Respiratory Department, Gartnavel General Hospital, Glasgow, Glasgow, UK
| | - Mauro Novali
- Respiratory Department, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Lombardia, Italy
| | - Stefano Gasparini
- Respiratory Department, Università Politecnica delle Marche, Ancona, Marche, Italy
| | - Martina Bonifazi
- Respiratory Department, Università Politecnica delle Marche, Ancona, Marche, Italy
| | - Keertan Dheda
- Respiratory Department, University of Cape Town, Cape Town, South Africa
| | - Felipe Andreo
- Pulmonology Department, Hospital Universitari Germans Trias i Pujol-CIBERES, Badalona, Barcelona, Spain
| | - Praha Votruba
- Respiratory Department, Klinika Tuberkulozy a Respiracnich Onemocneni, Prague, Czech Republic
| | - David Langton
- Respiratory Department, Frankston Hospital Peninsula Health, Frankston, Victoria, Australia
| | - Javier Flandes
- Respiratory Department, Hospital Universitario Fundacion Jimenez Diaz-CIBERES IIS-FJD, Madrid, Spain
| | - David Fielding
- Respiratory Department, Royal Brisbane and Women's Hospital-Brisbane/AUS, Brisbane, Queensland, Australia
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Dirk Skowasch
- Department of Cardiology and Pneumology, University of Bonn, Medizinische Klinik II, Bonn, Germany
| | - Christian Schulz
- Respiratory Department, University Hospital Regensburg, Regensburg, Bayern, Germany
| | - Kaid Darwiche
- Respiratory Department, Ruhrlandklinik-West German Lung Center, University Medicine Essen, Essen, Germany
| | | | - G Mark Grubb
- Boston Scientific Corp, Marlborough, Massachusetts, USA
| | - Robert Niven
- Respiratory Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Greater Manchester, UK
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19
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Menditto VG, Mei F, Fabrizzi B, Bonifazi M. Role of bronchoscopy in critically ill patients managed in intermediate care units - indications and complications: A narrative review. World J Crit Care Med 2021; 10:334-344. [PMID: 34888159 PMCID: PMC8613715 DOI: 10.5492/wjccm.v10.i6.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/15/2021] [Revised: 06/18/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Flexible bronchoscopy (FB) has become a standard of care for the triad of inspection, sampling, and treatment in critical care patients. It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit (ICU). Less is known about its role outside the ICU, particularly in the intermediate care unit (IMCU), a specialized environment, where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided. In the IMCU, the leading indications for a diagnostic work-up are: To visualize airway system/obstructions, perform investigations to detect respiratory infections, and identify potential sources of hemoptysis. The main procedures for therapeutic purposes are secretion aspiration, mucus plug removal to solve atelectasis (total or lobar), and blood aspiration during hemoptysis. The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients. Serious adverse events related to FB are relatively uncommon, but they may be due to lack of expertise or appropriate precautions. Finally, nowadays, during dramatic recent coronavirus disease 2019 (COVID-19) pandemic, the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined. Hence, we provide a concise review on the role of FB in an IMCU setting, focusing on its indications, technical aspects and complications.
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Affiliation(s)
- Vincenzo G Menditto
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
| | - Federico Mei
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
| | - Benedetta Fabrizzi
- Cystic Fibrosis Regional Reference Center, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona 60126, Italy
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Mondoni M, Carlucci P, Cipolla G, Vanoni N, Fois A, Pirina P, Arcadu A, Gasparini S, Bonifazi M, Marani S, Comel A, Saderi L, Pavesi S, Alfano F, Rinaldo R, Veronesi G, Centanni S, Sotgiu G. Predictors of Malignancy in Patients With Haemoptysis. Arch Bronconeumol 2021; 58:618-620. [DOI: 10.1016/j.arbres.2021.11.002] [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] [Received: 09/16/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/02/2022]
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21
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Mei F, Di Marco Berardino A, Bonifazi M, Latini LL, Zuccatosta L, Gasparini S. Validation of remote dielectric sensing (ReDS) in COVID-19. Imaging 2021. [DOI: 10.1183/13993003.congress-2021.pa362] [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: 11/05/2022] Open
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22
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Tomassetti S, Oggionni T, Barisione E, Bargagli E, Bonifazi M, Confalonieri M, Caminati A, Scala R, Gasparini S, Harari S, Klersy C, Meloni F, Torricella A, Aloe T, Luzzi V, Gori L, Ferraro S, Biadene G, Cozzi D, Cavigli E, Miele V, Piciucchi S, Sverzellati N, Puglisi S, Poletti V, Ravaglia C. A Multidisciplinary Multicenter Study Evaluating Risk Factors, Prevalence and Characteristics of Post-COvid-19 Interstitial Lung Syndrome (PCOILS). Imaging 2021. [DOI: 10.1183/13993003.congress-2021.oa1567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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23
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Mondoni M, Carlucci P, Cipolla G, Pagani M, Tursi F, Fois A, Pirina P, Canu S, Gasparini S, Bonifazi M, Marani S, Comel A, Saderi L, De Pascalis S, Alfano F, Centanni S, Sotgiu G. Long-term prognostic outcomes in patients with haemoptysis. Respir Res 2021; 22:219. [PMID: 34348724 PMCID: PMC8336236 DOI: 10.1186/s12931-021-01809-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/14/2021] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background Haemoptysis is a challenging symptom that can be associated with potentially life-threatening medical conditions. Follow-up is key in these patients to promptly detect new or misdiagnosed pathologic findings. Few prospective studies have evaluated long-term prognostic outcomes in patients with haemoptysis. Furthermore, the role played by antiplatelet and anticoagulant drugs on mortality and recurrence rates is unclear. The aim of this study was to assess mortality after 18 months of follow-up. Furthermore, the incidence of recurrence and the risk factors for recurrence and death were evaluated (including the role played by anticoagulant and antiplatelet drugs). Methods Observational, prospective, multicentre, Italian study. Results 451/606 (74.4%) recruited patients with haemoptysis completed the 18 months follow-up. 22/604 (3.6%) diagnoses changed from baseline to the end of the follow-up. 83/604 (13.7%) patients died. In 52/83 (62.7%) patients, death was the outcome of the disease which caused haemoptysis at baseline. Only the diagnosis of lung neoplasm was associated with death (OR (95%CI): 38.2 (4.2–347.5); p-value: 0.0001). 166 recurrences were recorded in 103/604 (17%) patients. The diagnosis of bronchiectasis was significantly associated with the occurrence of a recurrence (OR (95% CI): 2.6 (1.5–4.3)); p-value < 0.0001). Anticoagulant, antiaggregant, and anticoagulant plus antiaggregant drugs were not associated with an increased risk of death and recurrence. Conclusions Our study showed a low mortality rate in patients with haemoptysis followed-up for 18 months. Pulmonary malignancy was the main aetiology and the main predictor of death, whereas bronchiectasis was the most frequent diagnosis associated with recurrence. Antiplatelet and/or anticoagulant therapy did not change the risk of death or recurrence. Follow-up is recommended in patients initially diagnosed with lower airways infections and idiopathic bleeding. Trial registration: NCT02045394
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudinì n.8, 20142, Milan, Italy.
| | - Paolo Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudinì n.8, 20142, Milan, Italy
| | | | - Matteo Pagani
- UO Pneumologia ed Endoscopia Toracica, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Francesco Tursi
- UOS Servizio Pneumologia, Ospedale di Codogno, ASST Lodi, Codogno (Lodi), Italy
| | - Alessandro Fois
- Lung Disease Unit, Dept of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Pietro Pirina
- Lung Disease Unit, Dept of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Sara Canu
- Lung Disease Unit, Dept of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Stefano Gasparini
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy
| | - Martina Bonifazi
- Pulmonary Disease Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy
| | - Silvia Marani
- UO Medicina Interna, AUSL Modena, Ospedale di Carpi, Carpi (Modena), Italy
| | - Andrea Comel
- UO Pneumologia, Ospedale P. Pederzoli, Peschiera del Garda (Verona), Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sabrina De Pascalis
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudinì n.8, 20142, Milan, Italy
| | - Fausta Alfano
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudinì n.8, 20142, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudinì n.8, 20142, Milan, 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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Di Marco Berardino A, Rendina EA, Bonifazi M, Zuccatosta L, Latini LL, Gonnelli F, Latini A, Cirilli L, Gasparini S. Intrapleural Foreign Body: Case Report. Respiration 2021; 100:1005-1008. [PMID: 34134111 DOI: 10.1159/000516507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/14/2021] [Accepted: 04/06/2021] [Indexed: 11/19/2022] Open
Abstract
The detection of foreign bodies in the pleural cavity is rare and mostly consequent to iatrogenic or traumatic events. The migration of an inhaled foreign body from the airways to the pleural space through a bronchopleural fistula is an exceptional event. We report a case of a pleural empyema consequent to an inhaled wooden skewer. CT scan and bronchoscopy were unable to identify the foreign body, due to its migration in the peripheral airways. The thin and pointed foreign body perforated the visceral pleural surface emerging in the pleural cavity.
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Affiliation(s)
| | | | - Martina Bonifazi
- Department of Internal Medicine, Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Lina Zuccatosta
- Department of Internal Medicine, Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Ancona, Italy
| | - Letizia Lara Latini
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Francesca Gonnelli
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Agnese Latini
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Laura Cirilli
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Stefano Gasparini
- Department of Internal Medicine, Pulmonary Diseases Unit, Azienda Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
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25
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D"ascenzi F, Valentini F, Pistoresi S, Frascaro F, Pietro P, Cavigli L, Focardi M, Cameli M, Bonifazi M, Metra M, Mondillo S. Causes of sudden cardiac death in young athletes and nonathletes: systematic review and meta-analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.378] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction. The etiology of sudden cardiac death (SCD) in young people is still debated. The aim of this meta-analysis was to identify the most frequent causes of SCD in individuals aged ≤35 years, the differences between athletes and nonathletes and among geographic areas.
Methods. Studies published between 01/01/1990 and 01/31/2020 and evaluating post-mortem the etiology of SCD in young individuals (≤35 years) were included. Individuals were divided in athletes and nonathletes. Studies that did not report separately data between athletes and nonathletes were excluded.
Results. Thirty-four studies met the inclusion criteria and a total population of 5,060 victims of SCD were analysed (2,890 athletes, 2,170 nonathletes). Structurally normal heart, hypertrophic cardiomyopathy (HCM), idiopathic left ventricular hypertrophy, and anomalous origin of coronary arteries (AOCA) were the most frequent causes of SCD in athletes while coronary artery disease (CAD), arrhythmogenic cardiomyopathy (ACM), and channelopathies were frequent causes of SCD in nonathletes. The number of SCDs due to ischemic heart disease (19.6% vs. 9.1%, p = 0.009), ACM (11.5% vs. 4.7%, p = 0.03) and channelopathies (8.4% vs. 1.9%, p = 0.02) was higher in nonathletes comparing with athletes. SCD due to non-ischemic left ventricular scar (5.1% vs. 1.1%, p = 0.01) was more frequent in athletes. HCM (p = 0.01) and AOCA (p = 0.004) were more frequently cause of SCD in US while ACM (p = 0.001), structurally normal heart (p = 0.02), and channelopathies (p = 0.02) in Europe.
Conclusions. Structurally normal heart, HCM, AOCA were frequent causes of SCD in athletes while CAD, ACM and channelopathies in nonathletes. The causes of SCD differ between US and Europe.
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Affiliation(s)
- F D"ascenzi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F Valentini
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - S Pistoresi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F Frascaro
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - P Pietro
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - L Cavigli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Focardi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Cameli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Bonifazi
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - M Metra
- Civil Hospital of Brescia, Department of Medical and Surgical Specialties, Cardiology Unit, Brescia, Italy
| | - S Mondillo
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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26
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Cavigli L, Di Florio A, Fusi C, Anselmi F, Focardi M, Cameli M, Valente S, Bonifazi M, Zorzi A, Corrado D, Mondillo S, D"ascenzi F. Clinical management of young competitive athletes with premature ventricular beats: a prospective cohort study. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.375] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Premature ventricular beats (PVBs) are not an unusual finding and their interpretation is sometimes challenging. Unfortunately, few data on the characteristics of PVBs that correlate with the risk of an underlying heart disease are available in athletes.
Objectives. The aim of this prospective study was to investigate the diagnostic and prognostic value of PVBs characteristics in competitive athletes.
Methods. From a cohort of 1,751 athletes evaluated at our sports cardiology centre, we enrolled 112 competitive athletes <40 years of age (mean age 21 ± 10 years) and with no known heart disease referred for PVBs. All athletes underwent physical examination, ECG, 12-lead ambulatory ECG monitoring, exercise testing, and echocardiography. Further investigations including cardiac magnetic resonance were performed for abnormal findings at first-line evaluation or for specific PVBs characteristics.
Results. The majority (79%) of athletes exhibited monomorphic PVBs with a fascicular or infundibular pattern (common morphologies). A definitive diagnosis of cardiac disease was reached in 26 athletes (23% of the entire population) and correlated with uncommon PVBs morphology (p < 0.001) and arrhythmia complexity (p < 0.001). The number of PVBs/24-hour was lower in athletes with cardiac disease than in those with normal heart (p < 0.05). During the follow-up a spontaneous reduction of PVBs and no adverse events were observed.
Conclusions. Infundibular and fascicular PVBs were the most common morphologies observed in athletes with ventricular arrhythmias referred for cardiological evaluation. Morphology and complexity of PVBs, but not their number, predicted the probability of an underlying disease. Athletes with PVBs and negative investigation showed a good prognosis.
Abstract Figure.
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Affiliation(s)
- L Cavigli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - A Di Florio
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - C Fusi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F Anselmi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Focardi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Cameli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - S Valente
- University Hospital of Siena, Cardio-Thoracic and Vascular Department, Clinical and Surgical Cardiology Unit, Siena, Italy
| | - M Bonifazi
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - A Zorzi
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padova, Italy
| | - D Corrado
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padova, Italy
| | - S Mondillo
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F D"ascenzi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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27
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Anselmi F, Cavigli L, Pagliaro A, Valente S, Valentini F, Cameli M, Focardi M, Mochi N, Mondillo S, Dendale P, Hansen D, Bonifazi M, Halle M, D"ascenzi F. The importance of first and second ventilatory thresholds to define aerobic exercise intensity in cardiac patients and in healthy subjects: what is essential can be visible to the eyes. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.346] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Although structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT1) and second ventilatory threshold (VT2) in cardiac patients, sedentary subjects and athletes comparing VT1 and VT2 with EI defined by recommendations.
Methods. We prospectively enrolled 350 subjects (mean age: 50.7 ± 12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO2, peak heart rate (HR), and HR reserve were obtained at VT1 and VT2, and compared with EI definition proposed by the recommendations.
Results. VO2 at VT1 corresponded to high rather than moderate EI in 67.1% and in 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most of cardiac patients had VO2 values at VT2 corresponding to very-high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory-thresholds and recommended EI domains was observed in healthy subjects and in athletes (90% and 93.9%, respectively).
Conclusions. EI definition based on percentages of peak HR and peak VO2 may misclassify the effective EI and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold-based rather than a range-based approach is advisable in order to define an appropriate level of EI.
Abstract Figure.
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Affiliation(s)
- F Anselmi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - L Cavigli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - A Pagliaro
- University Hospital of Siena, Cardio-Thoracic and Vascular Department, Clinical and Surgical Cardiology Unit, Siena, Italy
| | - S Valente
- University Hospital of Siena, Cardio-Thoracic and Vascular Department, Clinical and Surgical Cardiology Unit, Siena, Italy
| | - F Valentini
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Cameli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Focardi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - N Mochi
- Azienda USL Toscana Centro, Sports Medicine Unit, Florence, Italy
| | - S Mondillo
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - P Dendale
- Heart Centre Hasselt, Hasselt, Belgium
| | - D Hansen
- Hasselt University, Hasselt, Belgium
| | - M Bonifazi
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - M Halle
- Technical University of Munich, Department of Preventive Sports Medicine and Sports Cardiology, Munich, Germany
| | - F D"ascenzi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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28
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Pomponio G, Ferrarini A, Bonifazi M, Moretti M, Salvi A, Giacometti A, Tavio M, Titolo G, Morbidoni L, Frausini G, Onesta M, Amico D, Rocchi MLB, Menzo S, Zuccatosta L, Mei F, Menditto V, Svegliati S, Donati A, D'Errico MM, Pavani M, Gabrielli A. Tocilizumab in COVID-19 interstitial pneumonia. J Intern Med 2021; 289:738-746. [PMID: 33511686 PMCID: PMC8013903 DOI: 10.1111/joim.13231] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Published reports on tocilizumab in COVID-19 pneumonitis show conflicting results due to weak designs or heterogeneity in critical methodological issues. METHODS This open-label trial, structured according to Simon's optimal design, aims to identify factors predicting which patients could benefit from anti-IL6 strategies and to enhance the design of unequivocal and reliable future randomized trials. A total of 46 patients with COVID-19 pneumonia needing of oxygen therapy to maintain SO2 > 93% and with recent worsening of lung function received a single infusion of tocilizumab. Clinical and biological markers were measured to test their predictive values. Primary end point was early and sustained clinical response. RESULTS Twenty-one patients fulfilled pre-defined response criteria. Lower levels of IL-6 at 24 h after tocilizumab infusion (P = 0.049) and higher baseline values of PaO2/FiO2 (P = 0.008) predicted a favourable response. CONCLUSIONS Objective clinical response rate overcame the pre-defined threshold of 30%. Efficacy of tocilizumab to improve respiratory function in patients selected according to our inclusion criteria warrants investigations in randomized trials.
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Affiliation(s)
- G Pomponio
- From the, Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A Ferrarini
- From the, Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Bonifazi
- Pneumologia, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Moretti
- SOD Medicina di Laboratorio Ospedali Riuniti di Ancona, Ancona, Italy
| | - A Salvi
- Medicina Interna e Sub Intensiva, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A Giacometti
- Clinica di Malattie Infettive, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Tavio
- Malattie Infettive, Ospedali Riuniti di Ancona, Ancona, Italy
| | - G Titolo
- Medicina di Urgenza, Ospedali Riuniti Marche Nord, Pesaro/Fano, Italy
| | - L Morbidoni
- Medicina Interna, Ospedale di Senigallia, Senigallia, Italy
| | - G Frausini
- Medicina Interna, Ospedali Riuniti Marche Nord, Pesaro/Fano, Italy
| | - M Onesta
- Medicina Interna, Ospedale di Fabriano, Fabriano, Italy
| | - D Amico
- Pneumologia, Ospedali Riuniti Marche Nord, Pesaro/Fano, Italy
| | - M L B Rocchi
- Statistica Medica, Dipartimento di Scienze Biomolecolari, Università di Urbino, Urbino, Italy
| | - S Menzo
- Virologia, Ospedali Riuniti di Ancona, Ancona, Italy
| | - L Zuccatosta
- Pneumologia, Ospedali Riuniti di Ancona, Ancona, Italy
| | - F Mei
- Pneumologia, Ospedali Riuniti di Ancona, Ancona, Italy
| | - V Menditto
- Medicina Interna e Sub Intensiva, Ospedali Riuniti di Ancona, Ancona, Italy
| | - S Svegliati
- Clinica Medica, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
| | - A Donati
- Clinica di Rianimazione, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M M D'Errico
- Dip. Scienze biomediche e sanità pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - M Pavani
- Laboratorio di Patologia Sperimentale, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
| | - A Gabrielli
- From the, Clinica Medica, Ospedali Riuniti di Ancona, Ancona, Italy.,Clinica Medica, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
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29
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Menditto VG, Fulgenzi F, Bonifazi M, Gnudi U, Gennarini S, Mei F, Salvi A. Predictors of readmission requiring hospitalization after discharge from emergency departments in patients with COVID-19. Am J Emerg Med 2021; 46:146-149. [PMID: 33932638 PMCID: PMC8061182 DOI: 10.1016/j.ajem.2021.04.055] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Little is known on prevalence of early return hospital admission of subjects with COVID-19 previously evaluated and discharged from emergency departments (EDs). This study aims to describe readmission rate within 14 days of patients with COVID-19 discharged from ED and to identify predictors of return hospital admission. Methods We performed a retrospective cohort study of adult patients with COVID-19 discharged from two EDs. Return hospital admission was defined as an unscheduled return ED visit within 14 days after initial ED evaluation and discharge. We compared the group of patients who had a return hospital admission to those who did not. We also evaluated selected clinical characteristics (age, neutrophilia, SOFA, lactate dehydrogenase, C-reactive protein and D-dimer) associated with return hospital admission. Results Of 283 patients included in the study, 65 (22.9%) had a return ED visit within 14 days. 32 of those patients (11%) were then hospitalized, while the remaining 33 were again discharged. Patients requiring a return hospital admission was significantly older, had higher pro-calcitonin and D-dimer levels. Major predictors of return hospital admission were cognitive impairment (OR 17.3 [CI 4.7–63.2]), P/F < 300 mmHg (OR 8.6 [CI 1.6–44.3]), being resident in geriatric care facility (OR 7.6 [CI 2.1–26.4]) and neutrophilia (OR 5.8 [CI 1.6–22.0]). Conclusion Several factors are associated with 14-day return hospital admission in COVID-19 subjects. These should be considered when assessing discharge risk in ED clinical practice.
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Affiliation(s)
- Vincenzo G Menditto
- Emergency Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy.
| | | | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Umberto Gnudi
- Emergency Department, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Silvia Gennarini
- Emergency Department, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Federico Mei
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Aldo Salvi
- Emergency Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
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30
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Mei F, Bonifazi M, Rota M, Cirilli L, Grilli M, Duranti C, Zuccatosta L, Bedawi EO, McCracken D, Gasparini S, Rahman NM. Diagnostic Yield and Safety of Image-Guided Pleural Biopsy: A Systematic Review and Meta-Analysis. Respiration 2020; 100:77-87. [PMID: 33373985 DOI: 10.1159/000511626] [Citation(s) in RCA: 20] [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] [Received: 07/07/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnostic yield (DY) and safety of computed tomography (CT)- and thoracic ultrasound (TUS)-guided biopsies in the diagnosis of pleural lesions have been investigated in a number of studies, but no synthesis of data from the literature has ever been performed. OBJECTIVES We aimed to provide the first systematic review and meta-analysis on the DY and safety of CT- versus TUS-guided biopsy in the diagnosis of pleural lesions. METHOD We searched MEDLINE and EMBASE for all studies reporting outcomes of interest published up to April 2018. Two authors reviewed all titles/abstracts and retrieved selected full text to identify studies according to predefined selection criteria. Summary estimates were derived using the random-effects model. Cumulative meta-analysis assessed the influence of increasing adoption of the procedures over time. RESULTS Thirty original studies were included in the present review; the number of studies on TUS-guided biopsy was almost three-fold higher than those on CT-guided biopsy. The pooled DYs of the 2 procedures were overall excellent and differed <10%, being 84% for TUS-guided biopsy and 93% for CT-guided biopsy. Safety profiles were reassuring for both the techniques, being 7 and 3% for CT- and TUS-guided biopsy, respectively. DY of ultrasound technique significantly improved over time, while no time effect was observed for CT-guided biopsy. CONCLUSIONS Data show that CT- and TUS-guided biopsies in the diagnosis of pleural lesions are both excellent procedures, without meaningful differences in DYs and safety. Considering that TUS is non-ionizing and easily performed at the bedside, it should be the preferred approach in presence of adequate skills.
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Affiliation(s)
- Federico Mei
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy,
| | - Martina Bonifazi
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Laura Cirilli
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Martina Grilli
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Claudia Duranti
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Lina Zuccatosta
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Eihab O Bedawi
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, United Kingdom
| | - David McCracken
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, United Kingdom
| | - Stefano Gasparini
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy.,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, United Kingdom.,Oxford NIHR Biomedical Research Unit, Oxford, United Kingdom
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31
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Mondoni M, Sferrazza Papa GF, Rinaldo R, Faverio P, Marruchella A, D'Arcangelo F, Pesci A, Pasini S, Henchi S, Cipolla G, Tarantini F, Giuliani L, Di Marco F, Saracino L, Tomaselli S, Corsico A, Gasparini S, Bonifazi M, Zuccatosta L, Saderi L, Pellegrino G, Davì M, Carlucci P, Centanni S, Sotgiu G. Utility and safety of bronchoscopy during the SARS-CoV-2 outbreak in Italy: a retrospective, multicentre study. Eur Respir J 2020; 56:13993003.02767-2020. [PMID: 32859682 PMCID: PMC7453732 DOI: 10.1183/13993003.02767-2020] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 06/05/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the related disease (coronavirus disease 2019; COVID-19) has been notified throughout Italy since February 2020. Intensive care unit (ICU) admission rate increased following the high incidence of pneumonia-related respiratory failure [1]. Utility and safety of bronchoscopy during the SARS-CoV-2 outbreakhttps://bit.ly/3ish52k
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Dept of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Francesco Sferrazza Papa
- Dept of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Dipartimento di Scienze Neuroriabilitative, Casa di Cura del Policlinico, Milan, Italy
| | - Rocco Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Dept of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paola Faverio
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Almerico Marruchella
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Francesca D'Arcangelo
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Alberto Pesci
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | | | | | | | - Lisa Giuliani
- Respiratory Unit, Papa Giovanni XXIII Hospital, Dept of Health Sciences, Università degli Studi di Milano, Bergamo, Italy
| | - Fabiano Di Marco
- Respiratory Unit, Papa Giovanni XXIII Hospital, Dept of Health Sciences, Università degli Studi di Milano, Bergamo, Italy
| | - Laura Saracino
- Respiratory Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Tomaselli
- Respiratory Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Angelo Corsico
- Respiratory Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Dept of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Stefano Gasparini
- Pulmonary Disease Unit, Dept of Internal Medicine, Azienda Ospedali Riuniti, Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Martina Bonifazi
- Pulmonary Disease Unit, Dept of Internal Medicine, Azienda Ospedali Riuniti, Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Lina Zuccatosta
- Pulmonary Disease Unit, Dept of Internal Medicine, Azienda Ospedali Riuniti, Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giulia Pellegrino
- Dept of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Dipartimento di Scienze Neuroriabilitative, Casa di Cura del Policlinico, Milan, Italy
| | - Matteo Davì
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Dept of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paolo Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Dept of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Dept of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy
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Salton F, Confalonieri P, Meduri GU, Santus P, Harari S, Scala R, Lanini S, Vertui V, Oggionni T, Caminati A, Patruno V, Tamburrini M, Scartabellati A, Parati M, Villani M, Radovanovic D, Tomassetti S, Ravaglia C, Poletti V, Vianello A, Gaccione AT, Guidelli L, Raccanelli R, Lucernoni P, Lacedonia D, Foschino Barbaro MP, Centanni S, Mondoni M, Davì M, Fantin A, Cao X, Torelli L, Zucchetto A, Montico M, Casarin A, Romagnoli M, Gasparini S, Bonifazi M, D'Agaro P, Marcello A, Licastro D, Ruaro B, Volpe MC, Umberger R, Confalonieri M. Prolonged Low-Dose Methylprednisolone in Patients With Severe COVID-19 Pneumonia. Open Forum Infect Dis 2020; 7:ofaa421. [PMID: 33072814 PMCID: PMC7543560 DOI: 10.1093/ofid/ofaa421] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background In hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia, progression to acute respiratory failure requiring invasive mechanical ventilation (MV) is associated with significant morbidity and mortality. Severe dysregulated systemic inflammation is the putative mechanism. We hypothesize that early prolonged methylprednisolone (MP) treatment could accelerate disease resolution, decreasing the need for intensive care unit (ICU) admission and mortality. Methods We conducted a multicenter observational study to explore the association between exposure to prolonged, low-dose MP treatment and need for ICU referral, intubation, or death within 28 days (composite primary end point) in patients with severe COVID-19 pneumonia admitted to Italian respiratory high-dependency units. Secondary outcomes were invasive MV-free days and changes in C-reactive protein (CRP) levels. Results Findings are reported as MP (n = 83) vs control (n = 90). The composite primary end point was met by 19 vs 40 (adjusted hazard ratio [aHR], 0.41; 95% CI, 0.24-0.72). Transfer to ICU and invasive MV were necessary in 15 vs 27 (P = .07) and 14 vs 26 (P = .10), respectively. By day 28, the MP group had fewer deaths (6 vs 21; aHR, 0.29; 95% CI, 0.12-0.73) and more days off invasive MV (24.0 ± 9.0 vs 17.5 ± 12.8; P = .001). Study treatment was associated with rapid improvement in PaO2:FiO2 and CRP levels. The complication rate was similar for the 2 groups (P = .84). Conclusion In patients with severe COVID-19 pneumonia, early administration of prolonged MP treatment was associated with a significantly lower hazard of death (71%) and decreased ventilator dependence. Treatment was safe and did not impact viral clearance. A large randomized controlled trial (RECOVERY trial) has been performed that validates these findings. Clinical trial registration. ClinicalTrials.gov NCT04323592.
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Affiliation(s)
- Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | - G Umberto Meduri
- Pulmonary, Critical Care, and Sleep Medicine Service and Research Service, Memphis VA Medical Center and Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, "L. Sacco" University Hospital, ASST-Fatebenefratelli-Sacco, Milano, Italy
| | - Sergio Harari
- Department of Medical Sciences, San Giuseppe Hospital MultiMedica IRCCS, and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Simone Lanini
- National Institute for the Infectious Diseases "L. Spallanzani," Rome, Italy
| | | | | | - Antonella Caminati
- Division of Pulmonary and Critical Care Medicine, San Giuseppe Hospital MultiMedica IRCCS, Milan, Italy
| | - Vincenzo Patruno
- Pulmonology Department, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Mario Tamburrini
- S.C. Pneumologia, Azienda Ospedaliera Friuli Occidentale, Pordenone, Italy
| | | | - Mara Parati
- Department of Pulmonology and Respiratory High-Dependency Unit, Ospedale Maggiore, Crema, Italy
| | - Massimiliano Villani
- Department of Pulmonology and Respiratory High-Dependency Unit, Ospedale Maggiore, Crema, Italy
| | - Dejan Radovanovic
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, "L. Sacco" University Hospital, ASST-Fatebenefratelli-Sacco, Milano, Italy
| | - Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Claudia Ravaglia
- Department of Respiratory and Thorax Diseases, GB Morgagni Hospital, Forlì, Italy
| | - Venerino Poletti
- Department of Respiratory and Thorax Diseases, GB Morgagni Hospital, Forlì, Italy
| | - Andrea Vianello
- Division of Respiratory Pathophysiology and Intensive Care, University-City Hospital, Padova, Italy
| | | | - Luca Guidelli
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Rita Raccanelli
- Division of Pulmonary and Critical Care Medicine, San Giuseppe Hospital MultiMedica IRCCS, Milan, Italy
| | - Paolo Lucernoni
- Pulmonology Department, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Science-University of Foggia, Policlinico Riuniti, Italy
| | | | | | | | - Matteo Davì
- Pulmonology Department, S. Paolo Hospital, Milan, Italy
| | - Alberto Fantin
- Pulmonology Department, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Xueyuan Cao
- Department of Acute and Tertiary Care, College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lucio Torelli
- Department of Clinical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Antonella Zucchetto
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Marcella Montico
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Annalisa Casarin
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
| | | | - Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Region-Azienda Ospedali Riuniti, Ancona, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Region-Azienda Ospedali Riuniti, Ancona, Italy
| | - Pierlanfranco D'Agaro
- Laboratorio di Riferimento per SARS-CoV-2, Regione Friuli-Venezia Giulia, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Alessandro Marcello
- Laboratory of Molecular Virology, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Danilo Licastro
- ARGO Open Lab Platform for Genome Sequencing, Area Science Park, Trieste, Italy
| | - Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | | | - Reba Umberger
- Department of Acute and Tertiary Care, College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy.,University of Trieste, Trieste, 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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34
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Bonifazi M, Sverzellati N, Negri E, Jacob J, Egashira R, Moser J, Piciucchi S, Mei F, De Lauretis A, Visca D, Goh N, Bonini M, Cirilli L, La Vecchia C, Chua F, Kouranos V, Margaritopoulos G, Kokosi M, Maher TM, Gasparini S, Gabrielli A, Wells AU, Renzoni EA. Pleuroparenchymal fibroelastosis in systemic sclerosis: prevalence and prognostic impact. Eur Respir J 2020; 56:1902135. [PMID: 32299855 PMCID: PMC7615192 DOI: 10.1183/13993003.02135-2019] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 11/03/2019] [Accepted: 03/25/2020] [Indexed: 12/23/2022]
Abstract
Interstitial lung disease (ILD) in systemic sclerosis (SSc) is a major cause of morbidity and mortality, mostly presenting as non-specific interstitial pneumonia. Little is known about the prevalence of pleuroparenchymal fibroelastosis (PPFE), a specific entity affecting the visceral pleura and subpleural parenchyma. We set out to estimate PPFE prevalence in two large cohorts of SSc patients and to assess its impact on survival and functional decline.A total of 359 SSc patients, derived from two referral centres in two different countries (UK and Italy), were included. The first available high-resolution computed tomography scan was independently evaluated by two radiologists blind to clinical information, to quantify ILD extent, freestanding bronchial abnormalities, and lobar percentage involvement of PPFE on a four-point categorical scale. Discordant scores were adjudicated by a third scorer. PPFE extent was further classified as limited (≤2/18) or extensive (>2/18). Results were evaluated against functional decline and mortality.The overall prevalence of PPFE in the combined SSc population was 18% (11% with extensive PPFE), with no substantial difference between the two cohorts. PPFE was significantly linked to free-standing bronchial abnormalities (61% versus 25% in PPFE versus no PPFE; p<0.0001) and to worse survival, independently of ILD severity or short-term lung function changes (HR 1.89, 95% CI 1.10-3.25; p=0.005).In the current study, we provide an exhaustive description of PPFE prevalence and clinical impact in the largest cohort of SSc subjects published so far. PPFE presence should be carefully considered, due to its significant prognostic implications.
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Affiliation(s)
- Martina Bonifazi
- Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
- Pulmonary Disease Unit, Dept of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Nicola Sverzellati
- Radiology, Dept of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Eva Negri
- Dept of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Joseph Jacob
- Dept of Respiratory Medicine, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Ryoko Egashira
- Dept of Radiology, Faculty of Medicine, Saga University, Saga city, Japan
| | - Joanna Moser
- Dept of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Federico Mei
- Pulmonary Disease Unit, Dept of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Angelo De Lauretis
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
- Pulmonary Diseases Unit, Azienda Ospedaliera "Guido Salvini", Garbagnate Milanese, Italy
| | - Dina Visca
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
- Division of Pulmonary Rehabilitation, Istituti Clinic Scientifici Maugeri, IRCCS, Tradate, Italy
| | - Nicole Goh
- Dept of Respiratory Medicine, Austin Hospital, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Matteo Bonini
- National Heart and Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, UK
- Dept of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A.Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Cirilli
- Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo La Vecchia
- Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - George Margaritopoulos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
- Interstitial Lung Disease Unit, Manchester University Hospital NHS FT, Wythenshawe Hospital, Manchester, UK
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Stefano Gasparini
- Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
- Pulmonary Disease Unit, Dept of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Armando Gabrielli
- Dept of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
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35
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Bonifazi M, Sverzellati N, Negri E, Pomponio G, Seletti V, Bonini M, Fraticelli P, Paolini L, Mattioli M, Franchi M, Tramacere I, Poletti V, La Vecchia C, Gasparini S, Gabrielli A. Increased prevalence of small airways dysfunction in patients with systemic sclerosis as determined by impulse oscillometry. Rheumatology (Oxford) 2020; 59:641-649. [PMID: 31436799 DOI: 10.1093/rheumatology/kez340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/24/2018] [Revised: 04/15/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The prevalence and clinical implications of small airways involvement in SSc are still to be fully elucidated. The goal of the present work is to assess the prevalence of small airways dysfunction by impulse oscillometry and to determine whether it correlates with selected disease-related features and respiratory-related quality of life. METHODS Ninety-four SSc patients and 93 healthy controls were studied by impulse oscillometry measurements. Small airways dysfunction was defined as the difference between resistance at low frequency, i.e. 5 Hz, and resistance at high frequency, i.e. 20 Hz, termed 'R5-R20', ⩾0.07 kPa/l/s. The St George's Respiratory Questionnaire was used to measure health impairment in SSc patients. Radiological features of small airways disease and parenchymal abnormalities on high resolution CT chest scans were jointly assessed by two thoracic radiologists. RESULTS Small airways dysfunction was present in 21.5% of the SSc patient cohort, with a prevalence almost 5-fold higher compared with controls, and it was significantly associated with worse respiratory-related quality of life. Radiological features consistent with small airways abnormalities were detected in 25% of SSc patients, mostly in the absence of interstitial lung changes. Combining functional and radiological evaluations, one-third of the SSc cohort showed at least one feature of small airways involvement, which was associated with the lcSSc phenotype and with longer disease duration. CONCLUSION The current study strengthens the hypothesis that small airway dysfunction might be a feature of SSc-related lung involvement, providing the first data on its significant impact on respiratory-related quality of life. A full assessment of lung function in SSc patients should include impulse oscillometry as a complementary technique, due to potential clinical and therapeutic implications.
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Affiliation(s)
- Martina Bonifazi
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Italy.,Unità Operativa di Pneumologia, Azienda Ospedaliero Universitaria "Ospedali Riuniti" - Ancona, Ancona, Italy
| | - Nicola Sverzellati
- Dipartimento di Medicina e Chirurgia, Università di Parma, Radiologia, Italy
| | - Eva Negri
- Dipartimento di Scienze Biomediche e Cliniche, "Luigi Sacco", Università degli Studi di Milano, Milano, Italy
| | - Giovanni Pomponio
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Valeria Seletti
- Dipartimento di Medicina e Chirurgia, Università di Parma, Radiologia, Italy
| | - Matteo Bonini
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Paolo Fraticelli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Paolini
- Unità Operativa di Pneumologia, Azienda Ospedaliero Universitaria "Ospedali Riuniti" - Ancona, Ancona, Italy
| | - Massimo Mattioli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Matteo Franchi
- Dipartimento di Statistica e Metodi Quantitativi, Divisione di Biostatistica, Epidemiologia e Salute Pubblica, Università di Milano-Bicocca, Milano, Italy
| | - Irene Tramacere
- Dipartimento Gestionale di Ricerca e Sviluppo Clinico, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Venerino Poletti
- Dipartimento Toracico, Ospedale GB Morgagni, Forlì, Italy.,Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
| | - Carlo La Vecchia
- Dipartimento di Scienze Cliniche e Salute Pubblica, Università degli Studi di Milano, Milano, Italy
| | - Stefano Gasparini
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Italy.,Unità Operativa di Pneumologia, Azienda Ospedaliero Universitaria "Ospedali Riuniti" - Ancona, Ancona, Italy
| | - Armando Gabrielli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
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36
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Mei F, Bonifazi M, Menzo S, Di Marco Berardino A, Sediari M, Paolini L, Re A, Gonnelli F, Duranti C, Grilli M, Vennarucci GS, Latini MA, Zuccatosta L, Gasparini S. First Detection of SARS-CoV-2 by Real-Time Reverse Transcriptase-Polymerase Chain Reaction Assay in Pleural Fluid. Chest 2020; 158:e143-e146. [PMID: 32534909 PMCID: PMC7287448 DOI: 10.1016/j.chest.2020.05.583] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 04/21/2020] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 12/25/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a pandemic infection due to the spread of a novel coronavirus (severe acute respiratory syndrome coronavirus 2), resulting in a wide range of clinical features, from asymptomatic carriers to ARDS. The gold standard for diagnosis is nucleic acid detection by real-time reverse transcriptase-polymerase chain reaction in nasopharyngeal swabs. However, due to limitations in this technique’s sensitivity, thoracic imaging plays a crucial, complementary role in diagnostic evaluation and also allows for detection of atypical findings and potential alternative targets for sampling (eg, pleural effusion). Although less common, pleural involvement has been described in a minority of patients. This report describes the first case of reverse transcriptase-polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2 in pleural fluid obtained by means of ultrasound-guided thoracentesis, and its main characteristics are detailed. Pleural effusion is not a common finding in COVID-19 infection, but a prompt recognition of this potential localization may be useful to optimize diagnostic evaluation as well as the management of these patients.
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Affiliation(s)
- Federico Mei
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
| | - Martina Bonifazi
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy; Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Stefano Menzo
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Di Marco Berardino
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Michele Sediari
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Luca Paolini
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Antonina Re
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Francesca Gonnelli
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Claudia Duranti
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Martina Grilli
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giacomo Spurio Vennarucci
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Maria Agnese Latini
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Lina Zuccatosta
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Stefano Gasparini
- Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy; Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
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37
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D'Ascenzi F, Anselmi F, Graziano F, Berti B, Franchini A, Bacci E, Ceccon C, Capitani M, Bonifazi M, Mondillo S. 4102QT interval duration, long QT pattern and changes over time in children practicing sport. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0114] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Twelve-lead electrocardiogram (ECG) is an established tool in the evaluation of adult athletes, providing information about life-threatening cardiovascular diseases such as long-QT syndrome. However, changes induced by development challenge the interpretation of ECG in the paediatric population, particularly for the repolarisation phase. The aim of this prospective, longitudinal study was to determinate the distribution of QT interval in children practicing sport and to evaluate changes in QT duration during preadolescence.
Methods
A final population of 1473 children practising sport (mean age: 12.0±1.8 years, interval 7–15 years) was analysed. Each athlete was evaluated at baseline, mid-term and end of the study with a mean follow-up of 3±1 years. QT interval was corrected with Bazett (B) and Fridericia (F) formulae.
Results
At baseline QTcB was 412±25ms and QTcF 387±21ms, with no changes during follow-up. Ten children (0.68%) had an abnormal QTc. In children with QTc ≥480ms confirmed both by Bazett and Fridericia formulae, QT duration persisted abnormal during the follow-up and children were disqualified. Conversely, children with borderline QTc intervals (>460 and <480ms) were not disqualified and we found a normalization of QT interval during the development. Mean difference in the calculation of QT between the two formulae was 25±11ms, p<0.0001. For HR values higher than 80 bpm, the QTcF resulted with low fluctuations around the mean was independent from HR values. Conversely, the QTcB revealed significant growing trend as the HR increased and showed higher variability than Fridericia correction.
Dynamic changes in QT interval duration Baseline Mid-term FU Long-term FU p value Intervallo QT 343±25 345±24* 346±25* <0.0001 RR (ms) 599±111 711±111* 721±119*^ <0.0001 QTc Bazett (ms) 412±25 (371–449) 411±25 (367–449) 409±25 (367–446) 0.10 QTc Fredericia (ms) 387±21 (355–418) 387±20 (353–419) 387±20 (353–418) 0.59 FU, follow up; *p<0.0001 vs. baseline; §p<0.0001 vs. mid-term FU; ^p<0.05 vs. mid-term FU.
Conclusions
QT duration does not change over time in children with normal duration. A minority of children has a QT ≥480ms; in these subjects QT interval remains prolonged during the follow-up. Conversely, in children with borderline QT, mid-term follow-up is useful to identify a normalization during the growth. Clinicians should take into account that the use of Bazett and Fridericia correction formulae is not interchangeable and that Fridericia formula should be preferred when resting HR is higher than 80 bpm.
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Affiliation(s)
- F D'Ascenzi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F Anselmi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F Graziano
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - B Berti
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - A Franchini
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - E Bacci
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - C Ceccon
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Capitani
- Center for Sports Medicine, Siena, Italy
| | - M Bonifazi
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - S Mondillo
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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38
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D'Ascenzi F, Anselmi F, Piu P, Fiorentini C, Focardi M, Bonifazi M, Mondillo S. P4127CMR normal reference values of biventricular size and function in male athletes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Exercise-induced enlargement of cardiac chambers is commonly observed in competitive athletes. However, ventricular dilatation is also a common phenotypic expression of life-threatening cardiomyopathies. The use of cardiac magnetic resonance (CMR) for the exclusion of pathology is growing. However, normal reference values have not been established for athletes. The aim of this meta-analysis was to derive normal reference values of biventricular size and function estimated by CMR in competitive athletes.
Methods
We conducted a systematic review of English-language studies in the MEDLINE, Scopus, and Cochrane databases investigating biventricular size and function by CMR in athletes. Athletes were divided into endurance, combined, and mixed groups according to the sport practiced. The potential impact of training volume was also evaluated.
Results
Twenty-seven studies and 983 competitive athletes were included for CMR quantification of biventricular size and function. In this review, normal reference values are presented for biventricular size and function to be applied to male competitive athletes according to the disciplines practiced. A significant impact of training volume was demonstrated for the right ventricle: athletes practicing the largest number of training hours per week were those exhibiting the greatest degree of right ventricular remodeling (Figure 1). Notably, biventricular function was not significantly affected by training volume.
Figure 1
Conclusions
The present meta-analysis defines the normal limits of biventricular size and function estimated by CMR in competitive athletes. The authors suggest using these normal reference values as an alternative to standard upper limits derived from the general population when interpreting CMR images in athletes.
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Affiliation(s)
- F D'Ascenzi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F Anselmi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - P Piu
- University of Siena, Department of Medicine, Surgery, and Neuroscience, Siena, Italy
| | - C Fiorentini
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Focardi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Bonifazi
- University of Siena, Department of Medicine, Surgery, and Neuroscience, Siena, Italy
| | - S Mondillo
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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39
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Colella S, Scarlata S, Bonifazi M, Ravaglia C, Naur TMH, Pela R, Clementsen PF, Gasparini S, Poletti V. Biopsy needles for mediastinal lymph node sampling by endosonography: current knowledge and future perspectives. J Thorac Dis 2018; 10:6960-6968. [PMID: 30746242 DOI: 10.21037/jtd.2018.11.35] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/22/2022]
Abstract
Due to the increasing role of endosonography [endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and esophageal ultrasound-guided fine needle aspiration (EUS-FNA)] in the diagnosis of several lung diseases, the knowledge of technical aspects is mandatory to optimize the success of the procedure. Among those technicalities related to the procedure, the choice of a needle over another one-either in terms of dimension and type-may have a role in the diagnostic process, especially in some diseases such as lymphoproliferative disorders. In this review, we analyze the current knowledge about the biopsy needle for endosonography, providing also some hints for the future.
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Affiliation(s)
- Sara Colella
- Pulmonary Unit, "C. & G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Simone Scarlata
- Geriatrics, Department of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Rome, Italy
| | - Martina Bonifazi
- Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Claudia Ravaglia
- Pulmonology Unit, Department of Thoracic Diseases, G B Morgagni L Pierantoni Hospital, Forli, Italy
| | | | - Riccardo Pela
- Pulmonary Unit, "C. & G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Stefano Gasparini
- Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Venerino Poletti
- Pulmonology Unit, Department of Thoracic Diseases, G B Morgagni L Pierantoni Hospital, Forli, Italy.,Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
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40
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Visca D, Mori L, Tsipouri V, Fleming S, Firouzi A, Bonini M, Pavitt MJ, Alfieri V, Canu S, Bonifazi M, Boccabella C, De Lauretis A, Stock CJW, Saunders P, Montgomery A, Hogben C, Stockford A, Pittet M, Brown J, Chua F, George PM, Molyneaux PL, Margaritopoulos GA, Kokosi M, Kouranos V, Russell AM, Birring SS, Chetta A, Maher TM, Cullinan P, Hopkinson NS, Banya W, Whitty JA, Adamali H, Spencer LG, Farquhar M, Sestini P, Wells AU, Renzoni EA. Effect of ambulatory oxygen on quality of life for patients with fibrotic lung disease (AmbOx): a prospective, open-label, mixed-method, crossover randomised controlled trial. The Lancet Respiratory Medicine 2018; 6:759-770. [DOI: 10.1016/s2213-2600(18)30289-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 01/23/2023]
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41
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D'Ascenzi F, Anselmi F, Berti B, Capitani E, Franchini A, Graziano F, Focardi M, Capitani M, Corrado D, Bonifazi M, Mondillo S. P663Normalization of T-wave inversion in children practising sport: a prospective, 4-year follow-up study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p663] [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: 11/13/2022] Open
Affiliation(s)
- F D'Ascenzi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - F Anselmi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - B Berti
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - E Capitani
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - A Franchini
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - F Graziano
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Focardi
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M Capitani
- Center for Sports Medicine, Siena, Italy
| | - D Corrado
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - M Bonifazi
- University of Siena, Department of Medicine, Surgery, and NeuroScience, Siena, Italy
| | - S Mondillo
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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42
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Harari S, Caminati A, Poletti V, Confalonieri M, Gasparini S, Lacedonia D, Luppi F, Pesci A, Sebastiani A, Spagnolo P, Vancheri C, Balestro E, Bonifazi M, Cerri S, De Giacomi F, Della Porta R, Foschino Barbaro MP, Fui A, Pasquinelli P, Rosso R, Tomassetti S, Specchia C, Rottoli P. A Real-Life Multicenter National Study on Nintedanib in Severe Idiopathic Pulmonary Fibrosis. Respiration 2018; 95:433-440. [PMID: 29587263 DOI: 10.1159/000487711] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 10/11/2017] [Accepted: 02/13/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Two therapeutic options are currently available for patients with mild-to-moderate idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. To date, there is still insufficient data on the efficacy of these 2 agents in patients with more severe disease. OBJECTIVES This national, multicenter, retrospective real-life study was intended to determine the impact of nintedanib on the treatment of patients with severe IPF. METHODS All patients included had severe IPF and had to have at least 6 months of follow-up before and at least 6 months of follow-up after starting nintedanib. The aim of the study was to compare the decline in lung function before and after treatment. Patient survival after 6 months of therapy with nintedanib was assessed. RESULTS Forty-one patients with a forced vital capacity (FVC) ≤50% and/or a diffusing capacity of the lung for carbon monoxide (DLCO) ≤35% predicted at the start of nintedanib treatment were enrolled. At the 6-month follow-up, the decline of DLCO (both absolute and % predicted) was significantly reduced compared to the pretreatment period (absolute DLCO at the -6-month, T0, and +6-month time points (5.48, 4.50, and 5.03 mmol/min/kPa, respectively, p = 0.03; DLCO% predicted was 32.73, 26.54, and 29.23%, respectively, p = 0.04). No significant beneficial effect was observed in the other functional parameters analyzed. The 1-year survival in this population was 79%, calculated from month 6 of therapy with nintedanib. CONCLUSIONS This nationwide multicenter experience in patients with severe IPF shows that nintedanib slows down the rate of decline of absolute and % predicted DLCO but does not have significant impact on FVC or other lung parameters.
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Affiliation(s)
- Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, IRCCS MultiMedica, Milan, Italy
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, IRCCS MultiMedica, Milan, Italy
| | - Venerino Poletti
- U.O. di Pneumologia, Dipartimento dell'Apparato Respiratorio e del Torace, Ospedale G.P. Morgagni-L. Pierantoni, Forlì, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Trieste, Trieste, Italy
| | - Stefano Gasparini
- Pulmonology Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Azienda Ospedaliera-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Fabrizio Luppi
- Center for Rare Lung Diseases, University Hospital Policlinico di Modena, Modena, Italy
| | - Alberto Pesci
- Respiratory Unit, Department of Health Science, University of Milano-Bicocca, AO San Gerardo, Monza, Italy
| | - Alfredo Sebastiani
- Department of Respiratory Diseases, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Paolo Spagnolo
- Section of Respiratory Disease, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Disease, University of Catania, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Elisabetta Balestro
- Section of Respiratory Disease, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Martina Bonifazi
- Pulmonology Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Azienda Ospedaliera-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Stefania Cerri
- Center for Rare Lung Diseases, University Hospital Policlinico di Modena, Modena, Italy
| | - Federica De Giacomi
- Respiratory Unit, Department of Health Science, University of Milano-Bicocca, AO San Gerardo, Monza, Italy
| | - Rossana Della Porta
- Department of Pulmonology, University Hospital of Cattinara, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Trieste, Trieste, Italy
| | | | - Annalisa Fui
- Respiratory Diseases and Lung Transplant Unit, Department of Internal and Specialist Medicine, AOUS, Siena, Italy
| | | | - Roberta Rosso
- Regional Referral Centre for Rare Lung Disease, University of Catania, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Sara Tomassetti
- U.O. di Pneumologia, Dipartimento dell'Apparato Respiratorio e del Torace, Ospedale G.P. Morgagni-L. Pierantoni, Forlì, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,IRCCS MultiMedica, Milan, Italy
| | - Paola Rottoli
- Respiratory Diseases and Lung Transplant Unit, Department of Internal and Specialist Medicine, AOUS, Siena, Italy
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43
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Carioli G, Bonifazi M, Rossi M, Zambelli A, Franchi M, Zocchetti C, Gasparini S, Corrao G, La Vecchia C, Negri E. Management and Survival of Pleural Mesothelioma: A Record Linkage Study. Respiration 2018; 95:405-413. [PMID: 29421798 DOI: 10.1159/000486578] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/02/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pleural mesothelioma (PM) is a rare, highly lethal tumor. A definite consensus on its management has yet to be established. OBJECTIVES To assess management, overall survival (OS), and their predictors in a cohort of patients from Lombardy, the largest Italian region (about 10 million inhabitants). METHODS Through a record linkage between Lombardy health care administrative databases, we identified patients diagnosed with PM in 2006-2011 without history of cancer, evaluating their management. OS from PM diagnosis was estimated using the Kaplan-Meier method. Predictors of OS and of treatment were assessed using Cox regression models with time-dependent covariates when appropriate. RESULTS Out of 1,326 patients, 754 (56.9%) received treatment for PM: 205 (15.5%) underwent surgery, and 696 (52.5%) used chemotherapy. Surgery was spread across several hospitals, and most patients diagnosed in nonspecialized centers (70%) underwent surgery in the same centers. Age at diagnosis was a strong inverse determinant of surgery. Determinants of receiving chemotherapy were younger age, a more recent first diagnosis, and first diagnosis in a specialized center. OS was 45.4% at 1 year, 24.8% at 2 years, and 9.6% at 5 years (median 11 months). OS decreased with age, and was higher for those who underwent surgery, but not for those treated with chemotherapy. CONCLUSIONS Management of PM varied widely in clinical practice, and significant predictors of treatment were younger age and recent diagnosis, though a high proportion of patients were not treated. Patients were treated in various hospitals, indicating the importance of concentrating serious rare neoplasms in Comprehensive Cancer Centers (as recognized by the Italian Health Ministry).
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Affiliation(s)
- Greta Carioli
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Universitá Politecnica delle Marche, and Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Marta Rossi
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - Alberto Zambelli
- Department of Medical Oncology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Matteo Franchi
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Carlo Zocchetti
- RESISS - Ricerche e Studi in Sanità e Salute, Gallarate, Italy
| | - Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Universitá Politecnica delle Marche, and Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Giovanni Corrao
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - Eva Negri
- Department of Biomedical and Clinical Sciences, Universitá degli Studi di Milano, Milan, Italy
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Mondoni M, Carlucci P, Job S, Parazzini EM, Cipolla G, Pagani M, Tursi F, Negri L, Fois A, Canu S, Arcadu A, Pirina P, Bonifazi M, Gasparini S, Marani S, Comel AC, Ravenna F, Dore S, Alfano F, Sferrazza Papa GF, Di Marco F, Centanni S, Sotgiu G. Observational, multicentre study on the epidemiology of haemoptysis. Eur Respir J 2018; 51:51/1/1701813. [PMID: 29301924 DOI: 10.1183/13993003.01813-2017] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/20/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Paolo Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Sara Job
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Elena Maria Parazzini
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | - Alessandro Fois
- Lung Disease Unit, Dept of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Sara Canu
- Lung Disease Unit, Dept of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Antonella Arcadu
- Lung Disease Unit, Dept of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Pietro Pirina
- Lung Disease Unit, Dept of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Martina Bonifazi
- Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.,Pulmonology Unit, AOU "Ospedali Riuniti", Ancona, Italy
| | - Stefano Gasparini
- Dept of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.,Pulmonology Unit, AOU "Ospedali Riuniti", Ancona, Italy
| | - Silvia Marani
- ASST Mantova, Dipartimento Cardio-Toraco-Vascolare, Unità Operativa di Pneumologia e UTIR, Mantova, Italy
| | | | - Franco Ravenna
- ASST Mantova, Dipartimento Cardio-Toraco-Vascolare, Unità Operativa di Pneumologia e UTIR, Mantova, Italy
| | - Simone Dore
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Fausta Alfano
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Francesco Sferrazza Papa
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Casa di Cura del Policlinico, Dipartimento di Scienze Neuroriabilitative, Milan, Italy
| | - Fabiano Di Marco
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy
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D'Ascenzi F, Solari M, Loiacono F, Caselli S, Focardi M, Pelliccia A, Bonifazi M, Mondillo S. P3989Normative reference values for the right ventricle in competitive athletes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3989] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
AbstractSarcoidosis is a systemic granulomatous disorder of unknown etiology, with a predilection for the respiratory system, involved in more than 90% of cases, with considerable variability in terms of patterns and prognostic implications. A protean interplay between genetic susceptibility and antigen exposure in selected environmental contexts is likely to define not only the risk for disease but also the different clinical phenotypes. Advances in imaging and functional tests over the past decades have increasingly broadened the awareness of the wide spectrum of features potentially occurring in pulmonary sarcoidosis, while the evolution of diagnostic techniques in interventional pulmonology has increased the possibility of obtaining tissue characterization more easily, by means of ultrasound-guided tools and cryotechnology. However, histological proof is not always needed, as, in selected scenarios with compatible clinical and imaging picture, a confirmatory biopsy is perceived as redundant. The diagnostic workup should be tailored on a case-by-case basis, according to an integrated assessment of clinical features, local resources, and expertise availability. Owing to the heterogeneity of possible clinical scenarios and the paucity of evidence-based data on treatments, a standardized clinical management has yet to be established, and general approach usually reflects expert opinion from accumulated clinical data. Key elements of decision-making process are to assess the baseline severity of disease, to stratify the risk of progression, and to define the goals of treatment.
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Affiliation(s)
- Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy.,Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy.,Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Veronica Alfieri
- Respiratory Disease and Lung Function Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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Bonifazi M, Tramacere I, Zuccatosta L, Mei F, Sediari M, Paonessa MC, Gasparini S. Conventional versus Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Hilar/Mediastinal Lymph Adenopathies: A Randomized Controlled Trial. Respiration 2017; 94:216-223. [PMID: 28531883 DOI: 10.1159/000475843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/18/2017] [Accepted: 04/18/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Conventional transbronchial needle aspiration (c-TBNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are both valuable diagnostic techniques for the diagnosis of hilar/mediastinal lesions. Although a superiority of EBUS-TBNA over c-TBNA may be expected, evidence-based data on a direct comparison between these 2 procedures are still lacking. OBJECTIVES We aimed to test the superiority of EBUS-TBNA over c-TBNA in a randomized trial and to evaluate the cost-effectiveness profile of a staged strategy, including c-TBNA as initial test followed by EBUS-TBNA, in case of inconclusive results at rapid on-site evaluation. METHODS Eligible patients were randomized 1:1 to either the EBUS-TBNA or c-TBNA group. The primary endpoint was to test the superiority of EBUS-TBNA sensitivity over c-TBNA. The secondary endpoints included the sensitivity of the staged strategy, as well as costs and safety related to each procedure and to their sequential combination. RESULTS A total of 253 patients were randomized to either EBUS-TBNA (n = 127) or c-TBNA (n = 126), and 31 patients of the c-TBNA group subsequently underwent EBUS-TBNA. The sensitivity of EBUS-TBNA was higher, but not significantly superior to that of c-TBNA (respectively. 92% [95% CI 87-97] and 82% [95% CI 75-90], p > 0.05). The sensitivity of the staged strategy was 94% (95% CI 89-98). No major adverse events occurred. CONCLUSIONS EBUS-TBNA was the single best diagnostic tool, although not significantly superior to c-TBNA. Due to the favorable cost-effectiveness profile of their sequential combination, in selected scenarios with a high probability of success from the standard procedure, these should not be necessarily intended as competitive and the staged strategy could be considered in clinical practice.
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Affiliation(s)
- Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
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48
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Labelle AJ, Bonifazi M, Tian Y, Wong C, Hoogland S, Favraud G, Walters G, Sutherland B, Liu M, Li J, Zhang X, Kelley SO, Sargent EH, Fratalocchi A. Broadband Epsilon-near-Zero Reflectors Enhance the Quantum Efficiency of Thin Solar Cells at Visible and Infrared Wavelengths. ACS Appl Mater Interfaces 2017; 9:5556-5565. [PMID: 28156089 DOI: 10.1021/acsami.6b13713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The engineering of broadband absorbers to harvest white light in thin-film semiconductors is a major challenge in developing renewable materials for energy harvesting. Many solution-processed materials with high manufacturability and low cost, such as semiconductor quantum dots, require the use of film structures with thicknesses on the order of 1 μm to absorb incoming photons completely. The electron transport lengths in these media, however, are 1 order of magnitude smaller than this length, hampering further progress with this platform. Herein, we show that, by engineering suitably disordered nanoplasmonic structures, we have created a new class of dispersionless epsilon-near-zero composite materials that efficiently harness white light. Our nanostructures localize light in the dielectric region outside the epsilon-near-zero material with characteristic lengths of 10-100 nm, resulting in an efficient system for harvesting broadband light when a thin absorptive film is deposited on top of the structure. By using a combination of theory and experiments, we demonstrate that ultrathin layers down to 50 nm of colloidal quantum dots deposited atop the epsilon-near-zero material show an increase in broadband absorption ranging from 200% to 500% compared to a planar structure of the same colloidal quantum-dot-absorber average thickness. When the epsilon-near-zero nanostructures were used in an energy-harvesting module, we observed a spectrally averaged 170% broadband increase in the external quantum efficiency of the device, measured at wavelengths between 400 and 1200 nm. Atomic force microscopy and photoluminescence excitation measurements demonstrate that the properties of these epsilon-near-zero structures apply to general metals and could be used to enhance the near-field absorption of semiconductor structures more widely. We have developed an inexpensive electrochemical deposition process that enables scaled-up production of this nanomaterial for large-scale energy-harvesting applications.
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Affiliation(s)
- A J Labelle
- Department of Electrical and Computer Engineering, University of Toronto , 10 Kings College Road, Toronto, Ontario M5S 3G4, Canada
| | | | | | - C Wong
- Department of Electrical and Computer Engineering, University of Toronto , 10 Kings College Road, Toronto, Ontario M5S 3G4, Canada
| | - S Hoogland
- Department of Electrical and Computer Engineering, University of Toronto , 10 Kings College Road, Toronto, Ontario M5S 3G4, Canada
| | | | - G Walters
- Department of Electrical and Computer Engineering, University of Toronto , 10 Kings College Road, Toronto, Ontario M5S 3G4, Canada
| | - B Sutherland
- Department of Electrical and Computer Engineering, University of Toronto , 10 Kings College Road, Toronto, Ontario M5S 3G4, Canada
| | - M Liu
- Department of Electrical and Computer Engineering, University of Toronto , 10 Kings College Road, Toronto, Ontario M5S 3G4, Canada
| | | | | | | | - E H Sargent
- Department of Electrical and Computer Engineering, University of Toronto , 10 Kings College Road, Toronto, Ontario M5S 3G4, Canada
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Abstract
Purpose of the review Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare fibrosing lung disease, affecting the visceral pleura and the subpleural parenchyma with an upper lobe predilection, included as a distinct clinicopathologic entity in the latest international multidisciplinary classification of the idiopathic interstitial pneumonias (IIP). We aim to summarize the current evidence on IPPFE, in terms of clinical features and potential treatments. Recent findings Overall, there is increasing awareness of PPFE in association with a separate ILD pattern. Although an agreed consensus on diagnosis has yet to be defined, a list of radiological and histopathological criteria has been proposed. Due to the unfavorable risk-benefit profile of surgical lung biopsy in a significant proportion of patients, a potential role for transbronchial lung cryobiopsy has been suggested. At present, lung transplantation remains the only curative option. Summary The increasing awareness of this condition among specialists has led to more frequent identification of IPPFE. Large international studies are needed to better characterize pathogenesis and pheno/endotypes of disease, a key step towards the development of effective treatments.
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Affiliation(s)
- Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.,Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - M Angeles Montero
- Department of Histopathology, Imperial College, London Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, UK
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK
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50
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Conti C, Montero-Fernandez A, Borg E, Osadolor T, Viola P, De Lauretis A, Stock CJ, Bonifazi M, Bonini M, Caramori G, Lindahl G, Blasi FB, Nicholson AG, Wells AU, Sestini P, Renzoni E. Mucins MUC5B and MUC5AC in Distal Airways and Honeycomb Spaces: Comparison among Idiopathic Pulmonary Fibrosis/Usual Interstitial Pneumonia, Fibrotic Nonspecific Interstitial Pneumonitis, and Control Lungs. Am J Respir Crit Care Med 2016; 193:462-4. [PMID: 26871672 DOI: 10.1164/rccm.201507-1322le] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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] Open
Affiliation(s)
- Caterina Conti
- 1 Imperial College London London, United Kingdom and.,2 Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Ca'Granda Ospedale Maggiore Policlinico Milan, Italy
| | | | - Elaine Borg
- 4 University College London Hospital London, United Kingdom
| | - Tina Osadolor
- 3 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom
| | - Patrizia Viola
- 3 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom
| | | | | | | | - Matteo Bonini
- 1 Imperial College London London, United Kingdom and
| | | | | | - Francesco B Blasi
- 2 Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Ca'Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Andrew G Nicholson
- 3 Royal Brompton and Harefield NHS Foundation Trust London, United Kingdom
| | - Athol U Wells
- 1 Imperial College London London, United Kingdom and
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