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Calari T, Petrarulo S, Dubini A, Piciucchi S, Ravaglia C, Poletti V. Endobronchial ultrasound-guided cryobiopsy for diagnosing a case of granulomatosis with polyangiitis. Respirol Case Rep 2024; 12:e01385. [PMID: 38751968 PMCID: PMC11095993 DOI: 10.1002/rcr2.1385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
EBUS-TBNA has represented a revolution in the diagnosis of intrathoracic pathologies, particularly in lung cancer staging, replacing more invasive methods such as mediastinoscopy. However, its role in diagnosing rare benign or malignant mediastinal disorders is still a matter of debate. Over the past few years, the role of EBUS-guided cryobiopsy has been increasingly emerging as an innovative and minimally invasive technique in diagnosing these disorders, with an excellent safety profile. In this case report, we present the case of a young man brought to our attention after already undergoing a non-diagnostic trans thoracic needle aspiration (TTNA) procedure for lung consolidations. In our department, he underwent an initial EBUS-TBNA procedure with inconclusive rapid on-site evaluation (ROSE), leading to the decision to perform an EBUS-guided cryobiopsy, which yielded a diagnosis of granulomatosis with polyangiitis without complications. This clinical case demonstrates that in specific contexts, EBUS-cryobiopsy represents an excellent diagnostic tool.
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Affiliation(s)
- Teresa Calari
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
- Respiratory and Critical Care UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Simone Petrarulo
- Department of Medical Specialities, Pulmonology UnitGB Morgagni—L. Pierantoni HospitalForlìItaly
| | | | - Sara Piciucchi
- Department of RadiologyGB Morgagni—L. Pierantoni HospitalForlìItaly
| | - Claudia Ravaglia
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
- Department of Medical Specialities, Pulmonology UnitGB Morgagni—L. Pierantoni HospitalForlìItaly
| | - Venerino Poletti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
- Department of Medical Specialities, Pulmonology UnitGB Morgagni—L. Pierantoni HospitalForlìItaly
- Department of Medical and Surgical Sciences (DIMEC)University of Bologna/Forlì CampusForlìItaly
- Department of Respiratory Diseases and AllergyAarhus University HospitalAarhusDenmark
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Poletti V, Femia D, Petrarulo S, Marinelli A, Ravaglia C, Piciucchi S. Pulmonary capillary hemangiomatosis/veno-occlusive disease diagnosed by transbronchial cryobiopsy. Pulmonology 2024; 30:310-312. [PMID: 37806921 DOI: 10.1016/j.pulmoe.2023.08.009] [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: 07/29/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Venerino Poletti
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital /Bologna University-Forlì-Ravenna Campus, Forlì, Italy; Department of Medical and Surgical Sciences (DIMEC), Bologna University, Bologna, Italy; Department of Respiratory Diseases & Allergy, Aarhus University, Aarhus, Denmark.
| | - Davide Femia
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital /Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - Simone Petrarulo
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital /Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - Alessandro Marinelli
- Department of Internal Medicine-Cardiology, GB Morgagni Hospital/Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - Claudia Ravaglia
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital /Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - Sara Piciucchi
- Department of Radiology, GB Morgagni Hospital, Forlì, Italy
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Petrarulo S, Ravaglia C, De Grauw AJ, Oldani S, Paul S, Dubini A, Piciucchi S, Poletti V. Endobronchial Ultrasound-guided Cryobiopsy of Pulmonary Artery Intimal Sarcoma. Am J Respir Crit Care Med 2024. [PMID: 38631018 DOI: 10.1164/rccm.202309-1633im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/16/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Simone Petrarulo
- GB Morgagni-L. Pierantoni Hospital, Forlì, Italy Forlì, IT, Padova, Italy;
| | | | | | - Stefano Oldani
- GB Morgagni-L. Pierantoni Hospital, Forlì, Italy, Forli, Italy
| | - Suman Paul
- Mersey and West Lancashire Teaching Hospitals NHS Trust, UK, Lancashire, United Kingdom of Great Britain and Northern Ireland
| | | | | | - Venerino Poletti
- GB MORGAGNI HOSPITAL, INTERVENTIONAL PNEUMOLOGY, FORLì, FC, Italy
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Kalverda KA, Ninaber MK, Wijmans L, von der Thüsen J, Jonkers RE, Daniels JM, Miedema JR, Dickhoff C, Hölters J, Heineman D, Kant M, Radonic T, Shahin G, Cohen D, Boerrigter B, Nijman S, Nossent E, Braun J, Mathot B, Poletti V, Hetzel J, Dijkgraaf M, Korevaar DA, Bonta PI, Annema JT. Transbronchial cryobiopsy followed by as-needed surgical lung biopsy versus immediate surgical lung biopsy for diagnosing interstitial lung disease (the COLD study): a randomised controlled trial. Lancet Respir Med 2024:S2213-2600(24)00074-2. [PMID: 38640934 DOI: 10.1016/s2213-2600(24)00074-2] [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] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND An adequate diagnosis for interstitial lung disease (ILD) is important for clinical decision making and prognosis. In most patients with ILD, an accurate diagnosis can be made by clinical and radiological data assessment, but in a considerable proportion of patients, a lung biopsy is required. Surgical lung biopsy (SLB) is the most common method to obtain tissue, but it is associated with high morbidity and even mortality. More recently, transbronchial cryobiopsy has been introduced, with fewer adverse events but a lower diagnostic yield than SLB. The aim of this study is to compare two diagnostic strategies: a step-up strategy (transbronchial cryobiopsy, followed by SLB if the cryobiopsy is insufficiently informative) versus immediate SLB. METHODS The COLD study was a multicentre, randomised controlled trial in six hospitals across the Netherlands. We included patients with ILD with an indication for lung biopsy as assessed by a multidisciplinary team discussion. Patients were randomly assigned in a 1:1 ratio to the step-up or immediate SLB strategy, with follow-up for 12 weeks from the initial procedure. Patients, clinicians, and pathologists were not masked to the study treatment. The primary endpoint was unexpected chest tube drainage, defined as requiring any chest tube after transbronchial cryobiopsy, or prolonged (>24 h) chest tube drainage after SLB. Secondary endpoints were diagnostic yield, in-hospital stay, pain, and serious adverse events. A modified intention-to-treat analysis was performed. This trial is registered with the Dutch Trial Register, NL7634, and is now closed. FINDINGS Between April 8, 2019, and Oct 24, 2021, 122 patients with ILD were assessed for study participation; and 55 patients were randomly assigned to the step-up strategy (n=28) or immediate SLB (n=27); three patients from the immediate SLB group were excluded. Unexpected chest tube drainage occurred in three of 28 patients (11%; 95% CI 4-27%) in the step-up group, and the number of patients for whom the chest tube could not be removed within 24 h was 11 of 24 patients (46%; 95% CI 2-65%) in the SLB group, with an absolute risk reduction of 35% (11-56%; p=0·0058). In the step-up strategy, the multidisciplinary team diagnostic yield after transbronchial cryobiopsy alone was 82% (64-92%), which increased to 89% (73-96%) when subsequent SLB was performed after inconclusive transbronchial cryobiopsy. In the immediate surgery strategy, the multidisciplinary team diagnostic yield was 88% (69-97%). Total in-hospital stay was 1 day (IQR 1-1) in the step-up group versus 5 days (IQR 4-6) in the SLB group. One (4%) serious adverse event occurred in step-up strategy versus 12 (50%) in the immediate SLB strategy. INTERPRETATION In ILD diagnosis, if lung tissue assessment is required, a diagnostic strategy starting with transbronchial cryobiopsy, followed by SLB when transbronchial cryobiopsy is inconclusive, appears to result in a significant reduction of patient burden and in-hospital stay with a similar diagnostic yield versus immediate SLB. FUNDING Netherlands Organisation for Health Research and Development (ZonMW) and Amsterdam University Medical Centers.
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Affiliation(s)
- Kirsten A Kalverda
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
| | - Maarten K Ninaber
- Department of Respiratory Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Lizzy Wijmans
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, Netherlands
| | - René E Jonkers
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes M Daniels
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jelle R Miedema
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jürgen Hölters
- Department of Respiratory Diseases, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
| | - David Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Merijn Kant
- Department of Respiratory Diseases, Amphia Hospital, Breda, Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ghada Shahin
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Bart Boerrigter
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Suzan Nijman
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Esther Nossent
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jerry Braun
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Bas Mathot
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, Netherlands
| | - Venerino Poletti
- Department of Medical Specialties, Giovan Battista Morgagni Hospital, University of Forlì, Forlì, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Jürgen Hetzel
- Department of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany; Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Marcel Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel A Korevaar
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Peter I Bonta
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jouke T Annema
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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Damiani A, Orlandi M, Bruni C, Bandini G, Lepri G, Scaletti C, Ravaglia C, Frassanito F, Guiducci S, Moggi-Pignone A, Matucci-Cerinic M, Poletti V, Tofani L, Colby TV, Randone SB, Tomassetti S. The role of lung biopsy for diagnosis and prognosis of interstitial lung disease in systemic sclerosis: a systematic literature review. Respir Res 2024; 25:138. [PMID: 38521926 PMCID: PMC10960984 DOI: 10.1186/s12931-024-02725-1] [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: 09/28/2023] [Accepted: 02/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The prognostic and theragnostic role of histopathological subsets in systemic sclerosis interstitial lung disease (SSc-ILD) have been largely neglected due to the paucity of treatment options and the risks associated with surgical lung biopsy. The novel drugs for the treatment of ILDs and the availability of transbronchial cryobiopsy provide a new clinical scenario making lung biopsy more feasible and a pivotal guide for treatment. The aim of our study was to investigate the usefulness of lung biopsy in SSc ILD with a systematic literature review (SLR). METHODS PubMed, Embase and Cochrane databases were searched up to June 30, 2023. Search terms included both database-specific controlled vocabulary terms and free-text terms relating to lung biopsy and SSc-ILD diagnostic and prognosis. The SLR was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Studies were selected according to the PEO (population, exposure, and outcomes) framework and Quality assessment of diagnostic accuracy studies (QUADAS) were reported. RESULTS We selected 14 articles (comprising 364 SSc-ILD patients). The paucity and heterogeneity of the studies prevented a systematic analysis. Diffuse cutaneous SSc was present in 30-100% of cases. Female predominance was observed in all studies (ranging from 64 to 100%). Mean age ranged from 42 to 64 years. Mean FVC was 73.98 (+/-17.3), mean DLCO was 59.49 (+/-16.1). Anti-Scl70 antibodies positivity was detected in 33% of cases (range: 0-69.6). All patients underwent surgical lung biopsies, and multiple lobes were biopsied in a minority of studies (4/14). Poor HRCT-pathologic correlation was reported with HRCT-NSIP showing histopathologic UIP in up to 1/3 of cases. Limited data suggest that SSc-UIP patients may have a worse prognosis and response to immunosuppressive treatment compared to other histopathologic patterns. CONCLUSIONS The data from this SLR clearly show the paucity and heterogeneity of the studies reporting lung biopsy in SSc ILD. Moreover, they highlight the need for further research to address whether the lung biopsy can be helpful to refine prognostic prediction and guide therapeutic choices.
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Affiliation(s)
- A Damiani
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - M Orlandi
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
- Department of Medical and Surgical for Children and Adults, Modena, Italy
| | - C Bruni
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - G Bandini
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Careggi University Hospital, Florence, Italy
| | - G Lepri
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - C Scaletti
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - C Ravaglia
- Pulmonary Unit, Department of Thoracic Diseases, Azienda USL Romagna, GB Morgagni-L-Pierantoni Hospital, Bologna University, Forlì, Italy
| | - F Frassanito
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - S Guiducci
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - A Moggi-Pignone
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Careggi University Hospital, Florence, Italy
| | - M Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - V Poletti
- Pulmonary Unit, Department of Thoracic Diseases, Azienda USL Romagna, GB Morgagni-L-Pierantoni Hospital, Bologna University, Forlì, Italy
| | - L Tofani
- Department of Statistics, Informatics and Applications, University of Florence, Florence, Italy
| | - T V Colby
- Department of Pathology and Laboratory Medicine (Emeritus), Mayo Clinic, Scottsdale, AZ, 13400, USA
| | - S Bellando Randone
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, University of Florence and Interventional Pulmonology Unit, Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy.
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Tomassetti S, Ciani L, Luzzi V, Gori L, Trigiani M, Giuntoli L, Lavorini F, Poletti V, Ravaglia C, Torrego A, Maldonado F, Lentz R, Annunziato F, Maggi L, Rossolini GM, Pollini S, Para O, Ciurleo G, Casini A, Rasero L, Bartoloni A, Spinicci M, Munavvar M, Gasparini S, Comin C, Cerinic MM, Peired A, Henket M, Ernst B, Louis R, Corhay JL, Nardi C, Guiot J. Utility of bronchoalveolar lavage for COVID-19: a perspective from the Dragon consortium. Front Med (Lausanne) 2024; 11:1259570. [PMID: 38371516 PMCID: PMC10869531 DOI: 10.3389/fmed.2024.1259570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/09/2024] [Indexed: 02/20/2024] Open
Abstract
Diagnosing COVID-19 and treating its complications remains a challenge. This review reflects the perspective of some of the Dragon (IMI 2-call 21, #101005122) research consortium collaborators on the utility of bronchoalveolar lavage (BAL) in COVID-19. BAL has been proposed as a potentially useful diagnostic tool to increase COVID-19 diagnosis sensitivity. In both critically ill and non-critically ill COVID-19 patients, BAL has a relevant role in detecting other infections or supporting alternative diagnoses and can change management decisions in up to two-thirds of patients. BAL is used to guide steroid and immunosuppressive treatment and to narrow or discontinue antibiotic treatment, reducing the use of unnecessary broad antibiotics. Moreover, cellular analysis and novel multi-omics techniques on BAL are of critical importance for understanding the microenvironment and interaction between epithelial cells and immunity, revealing novel potential prognostic and therapeutic targets. The BAL technique has been described as safe for both patients and healthcare workers in more than a thousand procedures reported to date in the literature. Based on these preliminary studies, we recognize that BAL is a feasible procedure in COVID-19 known or suspected cases, useful to properly guide patient management, and has great potential for research.
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Affiliation(s)
- Sara Tomassetti
- Interventional Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Luca Ciani
- Interventional Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Valentina Luzzi
- Interventional Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Leonardo Gori
- Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Marco Trigiani
- Interventional Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Leonardo Giuntoli
- Interventional Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Federico Lavorini
- Pulmonology Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Claudia Ravaglia
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Alfons Torrego
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Robert Lentz
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Simona Pollini
- Department of Experimental Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Ombretta Para
- Internal Medicine Unit 1, AOU Careggi, Florence, Italy
| | - Greta Ciurleo
- Internal Medicine Unit 2, AOU Careggi, Florence, Italy
| | | | - Laura Rasero
- Department of Health Science, Clinical Innovations and Research Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Spinicci
- Infectious and Tropical Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mohammed Munavvar
- School of Biological Sciences, The University of Manchester, Manchester, United Kingdom
- Department of Respiratory, Lancashire Teaching Hospital NHS Foundation Trust, Preston, United Kingdom
| | - Stefano Gasparini
- Interventional Pulmonology Unit, University Hospital Riuniti di Ancona, Ancona, Italy
| | - Camilla Comin
- Department of Experimental and Clinical Medicine Section of Surgery, Histopathology, and Molecular Pathology, University of Florence, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Peired
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Monique Henket
- Department of Respiratory Medicine, Universitary Hospital of Liège, Liège, Belgium
| | - Benoit Ernst
- Department of Respiratory Medicine, Universitary Hospital of Liège, Liège, Belgium
| | - Renaud Louis
- Department of Respiratory Medicine, Universitary Hospital of Liège, Liège, Belgium
| | - Jean-louis Corhay
- Department of Respiratory Medicine, Universitary Hospital of Liège, Liège, Belgium
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Florence, Italy
| | - Julien Guiot
- Department of Respiratory Medicine, Universitary Hospital of Liège, Liège, Belgium
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Poletti V, Petrarulo S, Piciucchi S, Dubini A, De Grauw AJ, Sultani F, Martinello S, Gonunguntla HK, Ravaglia C. EBUS-guided cryobiopsy in the diagnosis of thoracic disorders. Pulmonology 2024:S2531-0437(23)00223-4. [PMID: 38182468 DOI: 10.1016/j.pulmoe.2023.11.008] [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: 10/18/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Endobronchial Ultrasound (EBUS) has emerged as a crucial tool for diagnosing intrathoracic disorders, particularly in the staging of lung cancer. However, its diagnostic capabilities in the context of benign and rare diseases remain a subject of debate. AIM to investigate the diagnostic yield and safety of EBUS-transbronchial mediastinal cryobiopsy (EBUS-TMC) in comparison to EBUS-transbronchial needle aspiration (TBNA) for a broad spectrum of intrathoracic diseases. METHODS a single-centre retrospective observational study conducted on 48 patients who underwent both EBUS-TBNA and endobronchial ultrasound-transbronchial mediastinal cryobiopsy (EBUS-TMC) in the same procedure between August 2021 and October 2023. RESULTS The overall diagnostic yield of EBUS-TMC surpassed that of EBUS-TBNA (95.8% vs 54.1 %), notably excelling in the diagnosis of sarcoidosis (92.8% vs 78.5 %), rare mediastinal disorders (100% vs 0 %), hyperplastic lymphadenopathy (100% vs 0 %), and lymphoproliferative disease (100% vs 0 %). No significant differences were observed in the diagnosis of NSCLC and SCLC. Samples obtained through EBUS-TMC facilitated the acquisition of NGS and immunohistochemical analyses more readily. CONCLUSION EBUS-TMC may contribute to the precise diagnosis and subtyping of mediastinal diseases, especially lymphomas and rare mediastinal tumors, thereby reducing the number of non-diagnostic procedures.
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Affiliation(s)
- V Poletti
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital, Bologna University-Forlì-Ravenna Campus, Forlì, Italy; Department of Medical and Surgical Sciences (DIMEC), Bologna University, Bologna, Italy; Department of Respiratory Diseases & Allergy, Aarhus University, Aarhus, Denmark.
| | - S Petrarulo
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital, Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - S Piciucchi
- Department of Radiology, GB Morgagni Hospital, Forlì, Italy
| | - A Dubini
- Department of Pathology, GB Morgagni - L.Pierantoni Hospital Forlì Italy
| | - A J De Grauw
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital, Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - F Sultani
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital, Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - S Martinello
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital, Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - H K Gonunguntla
- Division of Interventional Pulmonology, Yashoda Hospitals, Hyderabad, India
| | - C Ravaglia
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital, Bologna University-Forlì-Ravenna Campus, Forlì, Italy; Department of Medical and Surgical Sciences (DIMEC), Bologna University, Bologna, Italy
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8
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Iannella G, Vicini C, Lechien JR, Ravaglia C, Poletti V, di Cesare S, Amicarelli E, Gardelli L, Grosso C, Patacca A, Magistrelli E, De Benedetto M, Toraldo DM, Arigliani M, Cammaroto G, Meccariello G, De Vito A, Magliulo G, Greco A, de Vincentiis M, Ralli M, Pace A, Montincone V, Maniaci A, Cocuzza S, Seligardi M, di Giacinto I, Corso RM. Association Between Severity of COVID-19 Respiratory Disease and Risk of Obstructive Sleep Apnea. Ear Nose Throat J 2024; 103:NP10-NP15. [PMID: 34318690 DOI: 10.1177/01455613211029783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The purpose of this observational retrospective study was to evaluate, in patients with a severe acute respiratory syndrome coronavirus 2 infection, the association between the severity of coronavirus disease 2019 (COVID-19) respiratory illness and the risk of infected patients to develop obstructive sleep apnea (OSA). METHODS Ninety-six patients with confirmed COVID-19 infection were enrolled in the study. The STOP-BANG questionnaire to investigate the risk of the OSA syndrome was filled in by the patients at admission. The enrolled patients were divided into 2 groups according to the respiratory disease: group 1 (72 patients), hospitalized patients undergoing conventional oxygen therapy; group 2 (24 patients), patients requiring enhanced respiratory support. STOP-BANG results of these 2 groups were compared to observe whether patients with high OSA risk more frequently presented a severe form of COVID-19. RESULTS 41.6% of the patients in group 2 had a STOP-BANG score between 5 and 8 (high risk of having apnea); in contrast, 20.8% of the patients in group 1 had a STOP-BANG score between 5 and 8, with a statistically significant difference between the 2 groups (P = .05). A complementary trend was observed regarding the proportion of patients in the range 0 to 2, which classifies patients at a low risk of OSA (48.6% vs 20.8% for groups 1 and 2, P = .01). CONCLUSIONS According to our data, the chances of having a severe case of COVID-19 should be considered in patients at high risk of OSA. CURRENT KNOWLEDGE/STUDY RATIONALE Emerging research suggests that OSA could represent a potentially important risk factor for the severe forms of COVID-19. The purpose of this observational retrospective study was to evaluate the potential association between OSA and the severity of COVID-19 disease. STUDY IMPACT According to our data, the likelihood of contracting a severe form of COVID-19 disease should be considered in patients at high risk of OSA.
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Affiliation(s)
- Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
- Department of ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Jerome R Lechien
- Faculty of Medicine, Laboratory of Anatomy and Cell Biology, University of Mons (UMONS), Mons, Belgium
| | - Claudia Ravaglia
- Pulmonology Unit, Thoracic Diseases Department, G.B. Morgagni Hospital, Forlì, Italy
| | - Venerino Poletti
- Pulmonology Unit, Thoracic Diseases Department, G.B. Morgagni Hospital, Forlì, Italy
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lucia Gardelli
- Medicine Department, G.B. Morgagni Hospital, Forlì, Italy
| | - Carmela Grosso
- Department of Infectious Diseases, G.B. Morgagni Hospital, Forlì, Italy
| | - Aria Patacca
- Department of Infectious Diseases, G.B. Morgagni Hospital, Forlì, Italy
| | | | | | | | | | | | | | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Ospedale "Santa Maria delle Croci", Viale Vincenzo Randi, Ravenna, Italy
| | | | - Antonio Greco
- Department of "Organi di Senso," University "Sapienza," Rome, Italy
| | | | - Massimo Ralli
- Department of "Organi di Senso," University "Sapienza," Rome, Italy
| | - Annalisa Pace
- Department of "Organi di Senso," University "Sapienza," Rome, Italy
| | | | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Matteo Seligardi
- Infectious Disease Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio, Emilia, Italy
| | - Ida di Giacinto
- Anesthesia and Intensive Care, Anestesia e Terapia Intensiva Polivalente, Azienda Ospedaliero-Universitaria, Sant'Orsola-Malpighi - Alma Mater Studiorum, Bologna, Italy
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Tomassetti S, Ravaglia C, Poletti V. Pinocchio and Interstitial Lung Abnormalities: Is It Just Another Lie? Am J Respir Crit Care Med 2023; 208:1341-1342. [PMID: 37856834 PMCID: PMC10765386 DOI: 10.1164/rccm.202309-1683le] [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: 09/26/2023] [Accepted: 10/19/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Sara Tomassetti
- Interventional Pulmonology Unit, Department of Clinical and Experimental Medicine and
| | - Claudia Ravaglia
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy; and
| | - Venerino Poletti
- Pulmonary Unit, Department of Thoracic Diseases, Azienda USL Romagna, GB Morgagni-L-Pierantoni Hospital, Bologna University, Forlì, Italy
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10
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Piciucchi S, Fernades LS, Ravaglia C, Tomassetti S, Garo ML, Poletti V. "Gallia est omnis divisa in partes tres": Is it time to divide Pleuroparenchymal Fibroelastosis in three different forms? Pulmonology 2023; 29:550-554. [PMID: 37210339 DOI: 10.1016/j.pulmoe.2023.04.001] [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: 01/06/2023] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 05/22/2023] Open
Affiliation(s)
- Sara Piciucchi
- Department of Radiology, GB Morgagni Pierantoni Hospital/University of Bologna, Italy.
| | | | - Claudia Ravaglia
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Sara Tomassetti
- Department of Experimental & Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Luisa Garo
- Università Campus Bio-medico di Roma, UOC di Cardiochirurgia, Rome, Italy
| | - Venerino Poletti
- Alma Mater Studiorum University of Bologna, DIMEC, Bologna, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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11
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Chilosi M, Doglioni C, Ravaglia C, Piciucchi S, Dubini A, Stefanizzi L, Poletti V. COVID-19. Biology, pathophysiology, and immunology: a pathologist view. Pathologica 2023; 115:248-256. [PMID: 38054899 DOI: 10.32074/1591-951x-954] [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: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 12/07/2023] Open
Abstract
Even if the SARS-CoV-2 pandemic has been declared over, several risks and clinical problems remain to be faced, including long-COVID sequelae and possible outbreaks of pathogenic variants. Intense research on COVID-19 has provided in these few years a striking amount of data covering different fields and disciplines, which can help to provide a knowledge shield against new potential infective spreads, and may also potentially be applied to other fields of medicine, including oncology and neurology. Nevertheless, areas of uncertainty still remain regarding the pathogenic mechanisms that subtend the multifaceted manifestations of the disease. To better clarify the pathogenesis of the disease, a systematic multidisciplinary evaluation of the many mechanisms involved in COVID-19 is mandatory, including clinical, physiological, radiological, immunological and pathological studies. In COVID-19 syndrome the pathological studies have been mainly performed on autopsy cases, and only a few studies are available on biopsies. Nevertheless, these studies have provided relevant information that can substantially contribute to decipher the complex scenario characterizing the different forms of COVID-19 and long-COVID-19. In this review the data provided by pathological investigations are recapitulated and discussed, in the light of different hypothesis and data provided by clinical, physiological and immunological data.
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Affiliation(s)
- Marco Chilosi
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Claudio Doglioni
- Department of Pathology, San Raffaele Scientific Institute. Milan, Italy
| | - Claudia Ravaglia
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
| | - Sara Piciucchi
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
| | | | | | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
- Department of Pathology, Ospedale GB Morgagni, Forlì, Italy
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12
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Freitag-Wolf S, Schupp JC, Frye BC, Fischer A, Anwar R, Kieszko R, Mihailović-Vučinić V, Milanowski J, Jovanovic D, Zissel G, Bargagli E, Rottoli P, Bumbacea D, Jonkers R, Ho LP, Gaede KI, Dubaniewicz A, Marshall BG, Günther A, Petrek M, Keane MP, Haraldsdottir SO, Bonella F, Grah C, Peroš-Golubičić T, Kadija Z, Pabst S, Grohé C, Strausz J, Safrankova M, Millar A, Homolka J, Wuyts WA, Spencer LG, Pfeifer M, Valeyre D, Poletti V, Wirtz H, Prasse A, Schreiber S, Dempfle A, Müller-Quernheim J. Genetic and geographic influence on phenotypic variation in European sarcoidosis patients. Front Med (Lausanne) 2023; 10:1218106. [PMID: 37621457 PMCID: PMC10446882 DOI: 10.3389/fmed.2023.1218106] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Sarcoidosis is a highly variable disease in terms of organ involvement, type of onset and course. Associations of genetic polymorphisms with sarcoidosis phenotypes have been observed and suggest genetic signatures. Methods After obtaining a positive vote of the competent ethics committee we genotyped 1909 patients of the deeply phenotyped Genetic-Phenotype Relationship in Sarcoidosis (GenPhenReSa) cohort of 31 European centers in 12 countries with 116 potentially disease-relevant single-nucleotide polymorphisms (SNPs). Using a meta-analysis, we investigated the association of relevant phenotypes (acute vs. sub-acute onset, phenotypes of organ involvement, specific organ involvements, and specific symptoms) with genetic markers. Subgroups were built on the basis of geographical, clinical and hospital provision considerations. Results In the meta-analysis of the full cohort, there was no significant genetic association with any considered phenotype after correcting for multiple testing. In the largest sub-cohort (Serbia), we confirmed the known association of acute onset with TNF and reported a new association of acute onset an HLA polymorphism. Multi-locus models with sets of three SNPs in different genes showed strong associations with the acute onset phenotype in Serbia and Lublin (Poland) demonstrating potential region-specific genetic links with clinical features, including recently described phenotypes of organ involvement. Discussion The observed associations between genetic variants and sarcoidosis phenotypes in subgroups suggest that gene-environment-interactions may influence the clinical phenotype. In addition, we show that two different sets of genetic variants are permissive for the same phenotype of acute disease only in two geographic subcohorts pointing to interactions of genetic signatures with different local environmental factors. Our results represent an important step towards understanding the genetic architecture of sarcoidosis.
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Affiliation(s)
- Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
| | - Jonas C. Schupp
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover Medical School (MHH), German Center for Lung Research (DZL), Hannover, Germany
| | - Björn C. Frye
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
| | - Annegret Fischer
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Raihanatul Anwar
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
| | - Robert Kieszko
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | | | - Janusz Milanowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | | | - Gernot Zissel
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplant Unit, University Hospital, Siena, Italy
| | - Paola Rottoli
- Respiratory Diseases and Lung Transplant Unit, University Hospital, Siena, Italy
| | - Dragos Bumbacea
- Department of Cardio-Thoracic Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - René Jonkers
- Pulmonology Department, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Ling-Pei Ho
- Oxford Sarcoidosis Service, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, United Kingdom
| | | | - Anna Dubaniewicz
- Department of Pulmonology, Medical University of Gdansk, Gdansk, Poland
| | - Ben G. Marshall
- Department of Respiratory Medicine, University Hospital, Southampton, United Kingdom
| | - Andreas Günther
- Department of Pneumology and Intensive Care, University Hospital, Giessen, Germany
| | - Martin Petrek
- Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czechia
| | - Michael P. Keane
- Division of Pulmonary and Critical Care Medicine, University College Dublin and St Vincent’s University Hospital, Dublin, Ireland
| | | | - Francesco Bonella
- Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen, Universitätsklinik Essen, Essen, Germany
| | | | | | - Zamir Kadija
- Foundation IRCCS Policlinico San Matteo - Pulmonology Unit, Pavia, Italy
| | - Stefan Pabst
- Department of Pneumology, University Hospital, Bonn, Germany
| | | | | | - Martina Safrankova
- Thomayer Hospital and 1st Faculty of Medicine, Charles University, Praha, Czechia
| | - Ann Millar
- Pulmonary Department, University Hospital, Bristol, United Kingdom
| | - Jiří Homolka
- Prague General Hospital, Charles University, Prague, Czechia
| | - Wim A. Wuyts
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), University Hospital, Leuven, Belgium
| | - Lisa G. Spencer
- Liverpool Interstitial Lung Disease Service, Aintree Chest Centre, Liverpool University Hospitals NHS FT, Liverpool, United Kingdom
| | - Michael Pfeifer
- Department of Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Dominique Valeyre
- Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Service de Pneumologie, Bobigny, France
| | - Venerino Poletti
- Pulmonary Unit, Department of Thoracic Diseases, Azienda USL Romagna, GB Morgagni-L-Pierantoni Hospital, Forlì, Italy
| | - Hubertus Wirtz
- Department of Pneumology, University Hospital Leipzig, Leipzig, Germany
| | - Antje Prasse
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
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Petrarulo S, Lucchin M, Oldani S, Dubini A, Piciucchi S, Gori A, Aiello L, Maitan S, Spagnolo P, Ravaglia C, Poletti V. A complicated case of whole-lung lavage: a case report. Front Med (Lausanne) 2023; 10:1225167. [PMID: 37538311 PMCID: PMC10395095 DOI: 10.3389/fmed.2023.1225167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction We report a life-threatening case of severe respiratory failure due to a pulmonary alveolar proteinosis (PAP) secondary to lysinuric protein intolerance (LPI), complicated by a pre-existing right pneumothorax, which we treated using a rescue whole-lung lavage (WLL). To date, in the literature, there are no cases of WLL performed in this condition. Clinical condition Patient was referred to our center because of rapidly worsening dyspnea and deterioration of gas exchange, caused by a secondary form of PAP which required an immediate therapeutic option such as the one offered by WLL. On physical examination, bilateral crackles were present, and peripheral blood oxygen saturation was 78% on oxygen with a FiO2 of 40%. Interventions After stabilizing the clinical conditions with oxygen therapy erogated through a high-flow nasal cannula, shortly after admission, we performed a rescue WLL among two procedures. The procedure was very effective, and the patient was later discharged without oxygen therapy and in good clinical condition. Conclusion Our case report represents a chance to help fill the gap of knowledge relative to secondary forms of PAP. The patient we presented suffers from a very rare genetic condition (LPI) that only has a few reported cases in the literature and has a very low prevalence which makes it difficult to produce the affected people:newborns ratio. We believe that difficult and rare cases like this one can improve our understanding of the disease and, most importantly, of how much the only therapeutic option we had, a rescue WLL, is effective to improve gas exchange and radiological features, despite being performed in these severe respiratory conditions.
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Affiliation(s)
- Simone Petrarulo
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel Lucchin
- Respiratory and Critical Care Unit, Department of Clinical Integrated and Experimental Medicine (DIMES), IRCCS Azienda Ospedaliero Universitaria Bologna, University Hospital Sant'Orsola—Malpighi, Bologna, Italy
| | - Stefano Oldani
- Department of Medical Specialities, Pulmonology Unit, GB Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Alessandra Dubini
- Department of Pathology, GB Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Sara Piciucchi
- Department of Radiology, GB Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Alberto Gori
- Section of Anesthesia and Intensive Care, Department of Surgery, GB Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Luca Aiello
- Section of Anesthesia and Intensive Care, Department of Surgery, GB Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Stefano Maitan
- Section of Anesthesia and Intensive Care, Department of Surgery, GB Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Claudia Ravaglia
- Department of Medical Specialities, Pulmonology Unit, GB Morgagni—L. Pierantoni Hospital, Forlì, Italy
| | - Venerino Poletti
- Department of Medical Specialities, Pulmonology Unit, GB Morgagni—L. Pierantoni Hospital, Forlì, Italy
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna/Forlì Campus, Forlì, Italy
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Kronborg-White S, Bendstrup E, Madsen LB, Rasmussen F, Poletti V. Association between Parenchymal B-Cell Follicles and CT-Proven Enlarged Mediastinal Lymph Nodes in Patients with Pulmonary Fibrosis. Respiration 2023; 102:515-522. [PMID: 37290416 DOI: 10.1159/000530474] [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: 12/13/2022] [Accepted: 03/24/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Mediastinal lymph node enlargement (MLNE) is a finding described in a subset of patients with idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILDs) and is associated with accelerated disease progression and increased mortality. The cause of MLNE is still not known. Our hypothesis is that there is an association between MLNE and B-cell follicles in lung tissue, another aspect detectable in the lung tissue of patients with IPF and other ILDs. OBJECTIVES The aim of this study was to assess if there is an association between MLNE and B-cell follicles in lung tissue in patients with IPF and other ILDs. METHOD Patients having transbronchial cryobiopsies performed as part of an investigation for ILD were included in this prospective observational study. MLNE (smallest diameter ≥10 mm) were assessed in station 7, 4R, and 4L on high-resolution computed tomography scans. B-cell follicles were assessed on haematoxylin-eosin-stained specimens. Lung function, 6-minute walk test, acute exacerbation, and mortality were registered after 2 years. In addition, we investigated if the finding of B-cell follicles was consistent in patients who underwent both surgical lung biopsies (SLBs) and cryobiopsies. RESULTS In total, 93 patients were included for analysis (46% diagnosed with IPF, 54% diagnosed with other ILDs). MLNE was found in 26 (60%) of the IPF patients and in 23 (46%) of the non-IPF patients (p = 0.164). Diffusing capacity for carbon monoxide was significantly lower (p = 0.03) in patients with MLNE compared to patients without MLNE. B-cell follicles were found in 11 (26%) of the IPF patients and in 22 (44%) of the non-IPF patients (p = 0.064). Germinal centres were not seen in any of the patients. There was no association between MLNE and B-cell follicles (p = 0.057). No significant difference in change of pulmonary function test was seen at 2-year follow-up when comparing the patients with and without MLNE or B-cell follicles. In 13 patients, both SLBs and cryobiopsies were performed. The presence of B-cell follicles was not consistent when comparing the two different methods. CONCLUSION MLNE is evident in a substantial part of patients with ILD and is associated with lower DLCO at inclusion. We could not demonstrate an association between histological B-cell follicles in biopsies and MLNE. A possible explanation for this is that the cryobiopsies might not have captured the changes we sought.
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Affiliation(s)
- Sissel Kronborg-White
- Department of Respiratory Diseases and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Line Bille Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Venerino Poletti
- Department of Respiratory Diseases and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of the Diseases of the Thorax, Ospedale Morgagni, Forli, Italy
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Tomassetti S, Ravaglia C, Piciucchi S, Ryu J, Wells A, Donati L, Dubini A, Klersy C, Luzzi V, Gori L, Rosi E, Lavorini F, Poletti V. Historical eye on IPF: a cohort study redefining the mortality scenario. Front Med (Lausanne) 2023; 10:1151922. [PMID: 37332746 PMCID: PMC10273674 DOI: 10.3389/fmed.2023.1151922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/26/2023] [Indexed: 06/20/2023] Open
Abstract
Rationale Therapies that slow idiopathic pulmonary fibrosis (IPF) progression are now available and recent studies suggest that the use of antifibrotic therapy may reduce IPF mortality. Objectives The aim of the study was to evaluate whether, to what extent, and for which factors the survival of IPF in a real-life setting has changed in the last 15 years. Methods Historical eye is an observational study of a large cohort of consecutive IPF patients diagnosed and treated in a referral center for ILDs with prospective intention. We recruited all consecutive IPF patients seen at GB Morgagni Hospital, Forlì, Italy between January 2002 and December 2016 (15 years). We used survival analysis methods to describe and model the time to death or lung transplant and Cox regression to model prevalent and incident patient characteristics (time-dependent Cox models were fitted). Measurements and main results The study comprised 634 patients. The year 2012 identifies the time point of mortality shift (HR 0.58, CI 0.46-0.63, p < 0.001). In the more recent cohort, more patients had better preserved lung function, underwent cryobiopsy instead of surgery, and were treated with antifibrotics. Highly significant negative prognostic factors were lung cancer (HR 4.46, 95% CI 3.3-6, p < 0.001), hospitalizations (HR 8.37, 95% CI 6.5-10.7, p < 0.001), and acute exacerbations (HR 8.37, 95% CI 6.52-10.7, p < 0.001). The average antifibrotic treatment effect estimated using propensity score matching showed a significant effect in the reduction of all-cause mortality (ATE coeff -0.23, SE 0.04, p < 0.001), acute exacerbations (ATE coeff -0.15, SE 0.04, p < 0.001), and hospitalizations (ATE coeff -0.15, SE 0.04, p < 0.001) but no effect on lung cancer risk (ATE coeff -0.03, SE 0.03, p = 0.4). Conclusion Antifibrotic drugs significantly impact hospitalizations, acute exacerbations, and IPF survival. After the introduction of cryobiopsy and antifibrotic drugs, the prognosis of IPF patients has significantly improved together with our ability to detect IPF at an earlier stage.
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Affiliation(s)
- Sara Tomassetti
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Claudia Ravaglia
- Pulmonary Unit, Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Sara Piciucchi
- Radiology Department, Ospedale GB Morgagni, Forlì, Italy
| | - Jay Ryu
- Respiratory and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Athol Wells
- ILD Unit, Pulmonary Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Luca Donati
- Pulmonary Unit, Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | | | - Catherine Klersy
- Servizio di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Luzzi
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Leonardo Gori
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Elisabetta Rosi
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Federico Lavorini
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Venerino Poletti
- Pulmonary Unit, Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
- Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
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Ravaglia C, Sultani F, Piciucchi S, Dubini A, De Grauw AJ, Martinello S, Oldani S, Maitan S, Stella F, Poletti V. Diagnostic yield and safety of transbronchial lung cryobiopsy for diffuse parenchymal lung diseases diagnosis: Comparison between 1.7-mm and 1.9-mm probes. Pulmonology 2023:S2531-0437(23)00081-8. [PMID: 37210342 DOI: 10.1016/j.pulmoe.2023.04.003] [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: 01/12/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/22/2023] Open
Abstract
PURPOSE OF THE RESEARCH transbronchial lung cryobiopsy has been recently accepted as a valid and less invasive alternative to surgical lung biopsy. The purpose of this randomized controlled study was to evaluate, for the first time, the quality and safety of biopsy specimens obtained by using the new disposable 1.7-mm cryoprobe compared with the standard re-usable 1.9 mm cryoprobe in the diagnosis of diffuse parenchymal lung diseases. METHODS 60 consecutive patients were prospectively enrolled and randomly assigned to two different groups: 1.9 mm (group A) and 1.7 mm (group B); primary endpoints were pathological and multidisciplinary diagnostic yield, sample size and complication rate. PRINCIPAL RESULTS the pathological diagnostic yield of cryobiopsy was 100% in group A and 93.3% in group B (p = 0.718); cryobiopsy median diameter was 6.8 mm in group A and 6.7 mm in group B (p = 0,5241). Pneumothorax occurred in 9 patients in group A and 10 in group B (p = 0.951); mild-to-moderate bleeding in 7 cases and 9 cases in group A and B respectively (p = 0.559). No death or severe adverse events were observed. CONCLUSIONS there was no statistically significant difference between the two groups, regarding diagnostic yield, adverse events and sampling adequacy.
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Affiliation(s)
- C Ravaglia
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy.
| | - F Sultani
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - S Piciucchi
- Radiology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - A Dubini
- Pathology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - A J De Grauw
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - S Martinello
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - S Oldani
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - S Maitan
- Anesthesiology and Intensive Care Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - F Stella
- Alma Mater Studiorum University of Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Bologna, Italy; Thoracic Surgery Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - V Poletti
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy; Alma Mater Studiorum University of Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Bologna, Italy
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17
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Peljto AL, Blumhagen RZ, Walts AD, Cardwell J, Powers J, Corte TJ, Dickinson JL, Glaspole I, Moodley YP, Vasakova MK, Bendstrup E, Davidsen JR, Borie R, Crestani B, Dieude P, Bonella F, Costabel U, Gudmundsson G, Donnelly SC, Egan J, Henry MT, Keane MP, Kennedy MP, McCarthy C, McElroy AN, Olaniyi JA, O’Reilly KMA, Richeldi L, Leone PM, Poletti V, Puppo F, Tomassetti S, Luzzi V, Kokturk N, Mogulkoc N, Fiddler CA, Hirani N, Jenkins RG, Maher TM, Molyneaux PL, Parfrey H, Braybrooke R, Blackwell TS, Jackson PD, Nathan SD, Porteous MK, Brown KK, Christie JD, Collard HR, Eickelberg O, Foster EE, Gibson KF, Glassberg M, Kass DJ, Kropski JA, Lederer D, Linderholm AL, Loyd J, Mathai SK, Montesi SB, Noth I, Oldham JM, Palmisciano AJ, Reichner CA, Rojas M, Roman J, Schluger N, Shea BS, Swigris JJ, Wolters PJ, Zhang Y, Prele CMA, Enghelmayer JI, Otaola M, Ryerson CJ, Salinas M, Sterclova M, Gebremariam TH, Myllärniemi M, Carbone RG, Furusawa H, Hirose M, Inoue Y, Miyazaki Y, Ohta K, Ohta S, Okamoto T, Kim DS, Pardo A, Selman M, Aranda AU, Park MS, Park JS, Song JW, Molina-Molina M, Planas-Cerezales L, Westergren-Thorsson G, Smith AV, Manichaikul AW, Kim JS, Rich SS, Oelsner EC, Barr RG, Rotter JI, Dupuis J, O’Connor G, Vasan RS, Cho MH, Silverman EK, Schwarz MI, Steele MP, Lee JS, Yang IV, Fingerlin TE, Schwartz DA. Idiopathic Pulmonary Fibrosis Is Associated with Common Genetic Variants and Limited Rare Variants. Am J Respir Crit Care Med 2023; 207:1194-1202. [PMID: 36602845 PMCID: PMC10161752 DOI: 10.1164/rccm.202207-1331oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 07/14/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Rationale: Idiopathic pulmonary fibrosis (IPF) is a rare, irreversible, and progressive disease of the lungs. Common genetic variants, in addition to nongenetic factors, have been consistently associated with IPF. Rare variants identified by candidate gene, family-based, and exome studies have also been reported to associate with IPF. However, the extent to which rare variants, genome-wide, may contribute to the risk of IPF remains unknown. Objectives: We used whole-genome sequencing to investigate the role of rare variants, genome-wide, on IPF risk. Methods: As part of the Trans-Omics for Precision Medicine Program, we sequenced 2,180 cases of IPF. Association testing focused on the aggregated effect of rare variants (minor allele frequency ⩽0.01) within genes or regions. We also identified individual rare variants that are influential within genes and estimated the heritability of IPF on the basis of rare and common variants. Measurements and Main Results: Rare variants in both TERT and RTEL1 were significantly associated with IPF. A single rare variant in each of the TERT and RTEL1 genes was found to consistently influence the aggregated test statistics. There was no significant evidence of association with other previously reported rare variants. The SNP heritability of IPF was estimated to be 32% (SE = 3%). Conclusions: Rare variants within the TERT and RTEL1 genes and well-established common variants have the largest contribution to IPF risk overall. Efforts in risk profiling or the development of therapies for IPF that focus on TERT, RTEL1, common variants, and environmental risk factors are likely to have the largest impact on this complex disease.
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Affiliation(s)
- Anna L. Peljto
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Rachel Z. Blumhagen
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
- National Jewish Health, Denver, Colorado
| | | | - Jonathan Cardwell
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Julia Powers
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Tamera J. Corte
- Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Joanne L. Dickinson
- Menzies Institute of Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ian Glaspole
- Allergy, Asthma and Clinical Immunology Clinic, Alfred Health, Sydney, Australia
| | - Yuben P. Moodley
- Department of Respiratory Medicine, University of Western Australia, Perth, Australia
| | | | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jesper R. Davidsen
- South Danish Center for Interstitial Lung Diseases, Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | | | - Bruno Crestani
- Service de Pneumologie A and
- Université Paris Cité, INSERM, Physiopathologie et Épidémiologie des Maladies Respiratoires, Paris, France
| | | | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Jim Egan
- National Lung Transplantation Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael T. Henry
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Michael P. Keane
- St. Vincent’s University Hospital, University College Dublin, Dublin, Ireland
| | - Marcus P. Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Cormac McCarthy
- St. Vincent’s University Hospital, University College Dublin, Dublin, Ireland
| | | | | | | | - Luca Richeldi
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo M. Leone
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, G. B. Morgagni Hospital, Forlì, Italy
- Department of Medical and Surgical Sciences, DIMES University of Bologna, Bologna, Italy
| | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Valentina Luzzi
- Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | | | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Izmir, Turkey
| | | | | | - R. Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Toby M. Maher
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Keck Medicine of USC, University of Southern California, Los Angeles, California
| | - Philip L. Molyneaux
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Helen Parfrey
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Rebecca Braybrooke
- Division of Respiratory Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Peter D. Jackson
- Department of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, Virginia
| | | | - Mary K. Porteous
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Jason D. Christie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold R. Collard
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Oliver Eickelberg
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elena E. Foster
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, California
| | - Kevin F. Gibson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marilyn Glassberg
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Arizona, Phoenix, Arizona
| | - Daniel J. Kass
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - David Lederer
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Angela L. Linderholm
- Department of Internal Medicine, University of California, Davis, Davis, California
| | - Jim Loyd
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sydney B. Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Amy J. Palmisciano
- Division of Pulmonary, Critical Care and Sleep Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Cristina A. Reichner
- Division of Pulmonary, Critical Care and Sleep Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Mauricio Rojas
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus, Ohio
| | - Jesse Roman
- Division of Pulmonary, Allergy, and Critical Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Neil Schluger
- Columbia University Medical Center, New York, New York
| | - Barry S. Shea
- Division of Pulmonary, Critical Care and Sleep Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Paul J. Wolters
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Yingze Zhang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cecilia M. A. Prele
- Institute for Respiratory Health, University of Western Australia, Perth, Australia
| | - Juan I. Enghelmayer
- Brown University, Providence, Rhode Island
- Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Maria Otaola
- Instituto de Rehabilitación Psicofísica de Buenos Aires, Buenos Aires, Argentina
| | - Christopher J. Ryerson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Martina Sterclova
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marjukka Myllärniemi
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | | | - Haruhiko Furusawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Hirose
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Yoshikazu Inoue
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ken Ohta
- National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Shin Ohta
- Department of Medicine, Showa University, Tokyo, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Dong Soon Kim
- Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Annie Pardo
- Faculty of Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Alvaro U. Aranda
- Cardiopulmonary Research Center, Alliance Pulmonary Group, Guaynabo, Puerto Rico
| | - Moo Suk Park
- Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Sun Park
- Seoul National University Bundang Hospital, Seoul National University, Seongnam, Republic of Korea
| | - Jin Woo Song
- Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | | | - Lurdes Planas-Cerezales
- Interstitial Lung Disease Multidisciplinary Unit, University Hospital of Bellvitge, University of Barcelona, Barcelona, Spain
| | | | - Albert V. Smith
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | | | - Stephen S. Rich
- Center for Public Health Genomics, and
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Elizabeth C. Oelsner
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - R. Graham Barr
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Josee Dupuis
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - George O’Connor
- Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts
| | - Ramachandran S. Vasan
- Boston University and National Heart, Lung, and Blood Institute Framingham Heart Study, Boston, Massachusetts; and
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marvin I. Schwarz
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Mark P. Steele
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Joyce S. Lee
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Ivana V. Yang
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | - David A. Schwartz
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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van Huizen LMG, Kalverda KA, Bugiani M, Poletti V, Bonta PI, Annema JT, Groot ML. Rapid On-Site Pathology Visualization of COVID-19 Characteristics Using Higher Harmonic Generation Microscopy. Am J Respir Crit Care Med 2023. [PMID: 36883981 PMCID: PMC10395503 DOI: 10.1164/rccm.202207-1259im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Affiliation(s)
- Laura M G van Huizen
- Vrije Universiteit Amsterdam, 1190, Dept. of Physics, LaserLab Amsterdam, Amsterdam, Netherlands;
| | - Kirsten A Kalverda
- Amsterdam UMC Locatie AMC, 26066, Pulmonology, Amsterdam, North Holland, Netherlands
| | - Marianna Bugiani
- Amsterdam UMC Locatie VUmc, 1209, Pathology, Amsterdam, Noord-Holland, Netherlands
| | - Venerino Poletti
- GB MORGAGNI HOSPITAL, INTERVENTIONAL PNEUMOLOGY, FORLì, FC, Italy
| | - Peter I Bonta
- Amsterdam UMC, 522567, Department of Pulmonology, Amsterdam, Noord-Holland, Netherlands
| | - Jouke T Annema
- Amsterdam UMC Location AMC, 26066, Pulmonology, Amsterdam, North Holland, Netherlands
| | - Marie Louise Groot
- Vrije Universiteit Amsterdam, 1190, Dept. of Physics, LaserLab Amsterdam, Amsterdam, Noord-Holland, Netherlands
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19
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Borie R, Kannengiesser C, Antoniou K, Bonella F, Crestani B, Fabre A, Froidure A, Galvin L, Griese M, Grutters JC, Molina-Molina M, Poletti V, Prasse A, Renzoni E, van der Smagt J, van Moorsel CHM. European Respiratory Society statement on familial pulmonary fibrosis. Eur Respir J 2023; 61:13993003.01383-2022. [PMID: 36549714 DOI: 10.1183/13993003.01383-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022]
Abstract
Genetic predisposition to pulmonary fibrosis has been confirmed by the discovery of several gene mutations that cause pulmonary fibrosis. Although genetic sequencing of familial pulmonary fibrosis (FPF) cases is embedded in routine clinical practice in several countries, many centres have yet to incorporate genetic sequencing within interstitial lung disease (ILD) services and proper international consensus has not yet been established. An international and multidisciplinary expert Task Force (pulmonologists, geneticists, paediatrician, pathologist, genetic counsellor, patient representative and librarian) reviewed the literature between 1945 and 2022, and reached consensus for all of the following questions: 1) Which patients may benefit from genetic sequencing and clinical counselling? 2) What is known of the natural history of FPF? 3) Which genes are usually tested? 4) What is the evidence for telomere length measurement? 5) What is the role of common genetic variants (polymorphisms) in the diagnostic workup? 6) What are the optimal treatment options for FPF? 7) Which family members are eligible for genetic sequencing? 8) Which clinical screening and follow-up parameters may be considered in family members? Through a robust review of the literature, the Task Force offers a statement on genetic sequencing, clinical management and screening of patients with FPF and their relatives. This proposal may serve as a basis for a prospective evaluation and future international recommendations.
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Affiliation(s)
- Raphael Borie
- Université Paris Cité, Inserm, PHERE, Hôpital Bichat, AP-HP, Service de Pneumologie A, Centre Constitutif du Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Paris, France
| | | | - Katerina Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Hospital, University of Essen, European Reference Network (ERN)-LUNG, ILD Core Network, Essen, Germany
| | - Bruno Crestani
- Université Paris Cité, Inserm, PHERE, Hôpital Bichat, AP-HP, Service de Pneumologie A, Centre Constitutif du Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Paris, France
| | - Aurélie Fabre
- Department of Histopathology, St Vincent's University Hospital and UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Antoine Froidure
- Pulmonology Department, Cliniques Universitaires Saint-Luc and Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Liam Galvin
- European Pulmonary Fibrosis Federation, Blackrock, Ireland
| | - Matthias Griese
- Dr von Haunersches Kinderspital, University of Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Jan C Grutters
- ILD Center of Excellence, St Antonius Hospital, Nieuwegein, The Netherlands
- Division of Heart and Lungs, UMC Utrecht, Utrecht, The Netherlands
| | - Maria Molina-Molina
- Interstitial Lung Disease Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, Hospitalet de Llobregat (Barcelona), CIBERES, Barcelona, Spain
| | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
- Department of Experimental, Diagnostics and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Antje Prasse
- Department of Pulmonology, Hannover Medical School, German Center for Lung Research (DZL), BREATH, Hannover, Germany
- Fraunhofer ITEM, Hannover, Germany
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jasper van der Smagt
- Division of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
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20
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Zallocco F, Omenetti A, Poletti V, Cazzato S. Recurrent pneumonia and severe opportunistic infections in declining immunity and autoimmune manifestations. Pulmonology 2023; 29:167-169. [PMID: 35864056 DOI: 10.1016/j.pulmoe.2022.06.004] [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: 03/07/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Federica Zallocco
- Pediatric Unit, Dept of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Alessia Omenetti
- Pediatric Unit, Dept of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Venerino Poletti
- Dept of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy; Dept of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Salvatore Cazzato
- Pediatric Unit, Dept of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy.
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21
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Kronborg-White S, Bendstrup E, Gori L, Luzzi V, Madsen LB, Poletti V, Rasmussen TR, Trigiani M, Vezzosi S, Tomassetti S. A pilot study on the use of the super dimension navigation system for optimal cryobiopsy location in interstitial lung disease diagnostics. Pulmonology 2023; 29:119-123. [PMID: 34526242 DOI: 10.1016/j.pulmoe.2021.07.008] [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: 03/06/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Transbronchial cryobiopsies has become increasingly important in the diagnostic workup for interstitial lung diseases. The rate of complications and mortality are low compared to surgical lung biopsies, but the diagnostic yield is not as high. The reason for the lower diagnostic yield could in some cases be explained by biopsies taken too centrally or in less affected areas. In this pilot study we examined the feasibility of using the electromagnetic navigation system, superDimension (SD), when performing cryobiopsies to increase the diagnostic yield. METHODS Electromagnetic navigation bronchoscopy and cryobiopsies were performed using SD. An electromagnetic board placed on the back of the patient and a position sensor at the tip of the navigational probe created a real-time 3D reconstruction of previously acquired computer tomography images. The procedure was performed with the patients in general anesthesia using a rigid bronchoscope when performed in Florence and with a flexible bronchoscope through an orotracheal tube when performed in Aarhus. RESULTS In total, 18 patients were included. Five patients were excluded, partly due to technical difficulties. Disposable 1.7 mm cryoprobes were used in Aarhus, and reusable 1.9 mm probes in Florence. Pneumothorax was detected in three (23%), mild hemorrhage was seen in one (8%) and moderate hemorrhage in six (46%). The biopsies contributed to the diagnosis in 11 of the patients (85%). CONCLUSION Using superDimension electromagnetic navigation system when performing cryobiopsies is feasible. A larger prospective trial is necessary to homogenize the technique between centres and to evaluate diagnostic advantage and complications.
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Affiliation(s)
- S Kronborg-White
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark.
| | - E Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - L Gori
- Department of Experimental and Clinical Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - V Luzzi
- Department of Experimental and Clinical Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - L B Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - V Poletti
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of the Diseases of the Thorax, Ospedale Morgagni, Forli, Italy
| | - T R Rasmussen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - M Trigiani
- Department of Experimental and Clinical Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - S Vezzosi
- Department of Quality, control and Technology, Careggi University Hospital, Florence, Italy
| | - S Tomassetti
- Department of Experimental and Clinical Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
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22
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Zuccatosta L, Piciucchi S, Martinello S, Sultani F, Oldani S, de Grauw AJ, Maitan S, Corso MR, Poletti V, Ravaglia C. Is there any role for medical thoracoscopy in the treatment of empyema in children? Clin Respir J 2023; 17:105-108. [PMID: 36594222 PMCID: PMC9892693 DOI: 10.1111/crj.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023]
Abstract
It is still controversial whether surgical or nonsurgical treatment approaches are most appropriate for empyema in children, and there are no data regarding the role of medical thoracoscopy in this population. The aim of this study was to describe our experience with medical thoracosocpy in children with multiloculated and organizing pneumonia. We retrospectively reviewed children admitted to our hospital with a diagnosis of empyema from 2011 to 2021 and treated with medical thoracoscopy. A total of six patients with empyema were treated by medical thoracoscopy; empyema was multiloculated in five cases and organized in one case; all children in the study recovered completely with full lung expansion after chest X-rays, and no disease sequelae were reported after clinical follow-up. Our small case series suggests that in selected cases, medical thoracoscopy could safely and effectively treat pleural empyema in children, with less invasiveness and reduced psychological consequences.
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Affiliation(s)
- Lina Zuccatosta
- Pulmonology and Bronchology UnitMarche Polytechnic University HospitalAnconaItaly
| | - Sara Piciucchi
- Radiology UnitG.B. Morgagni Hospital/University of BolognaForlìItaly
| | | | - Fabio Sultani
- Pulmonology UnitG.B. Morgagni Hospital/University of BolognaForlìItaly
| | - Stefano Oldani
- Pulmonology UnitG.B. Morgagni Hospital/University of BolognaForlìItaly
| | | | - Stefano Maitan
- Intensive Care UnitG.B. Morgagni Hospital/University of BolognaForlìItaly
| | | | - Venerino Poletti
- Pulmonology UnitG.B. Morgagni Hospital/University of BolognaForlìItaly,Dipartimento di Scienze Mediche e Chirurgiche (DIMES)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Claudia Ravaglia
- Pulmonology UnitG.B. Morgagni Hospital/University of BolognaForlìItaly
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23
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Karampitsakos T, Spagnolo P, Mogulkoc N, Wuyts WA, Tomassetti S, Bendstrup E, Molina-Molina M, Manali ED, Unat ÖS, Bonella F, Kahn N, Kolilekas L, Rosi E, Gori L, Ravaglia C, Poletti V, Daniil Z, Prior TS, Papanikolaou IC, Aso S, Tryfon S, Papakosta D, Tzilas V, Balestro E, Papiris S, Antoniou K, Bouros D, Wells A, Kreuter M, Tzouvelekis A. Lung cancer in patients with idiopathic pulmonary fibrosis: A retrospective multicentre study in Europe. Respirology 2023; 28:56-65. [PMID: 36117239 DOI: 10.1111/resp.14363] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 02/07/2022] [Accepted: 08/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE There remains a paucity of large databases for patients with idiopathic pulmonary fibrosis (IPF) and lung cancer. We aimed to create a European registry. METHODS This was a multicentre, retrospective study across seven European countries between 1 January 2010 and 18 May 2021. RESULTS We identified 324 patients with lung cancer among 3178 patients with IPF (prevalence = 10.2%). By the end of the 10 year-period following IPF diagnosis, 26.6% of alive patients with IPF had been diagnosed with lung cancer. Patients with IPF and lung cancer experienced increased risk of all-cause mortality than IPF patients without lung cancer (HR: 1.51, [95% CI: 1.22-1.86], p < 0.0001). All-cause mortality was significantly lower for patients with IPF and lung cancer with a monocyte count of either <0.60 or 0.60-<0.95 K/μl than patients with monocyte count ≥0.95 K/μl (HR [<0.60 vs. ≥0.95 K/μl]: 0.35, [95% CI: 0.17-0.72], HR [0.60-<0.95 vs. ≥0.95 K/μl]: 0.42, [95% CI: 0.21-0.82], p = 0.003). Patients with IPF and lung cancer that received antifibrotics presented with decreased all cause-mortality compared to those who did not receive antifibrotics (HR: 0.61, [95% CI: 0.42-0.87], p = 0.006). In the adjusted model, a significantly lower proportion of surgically treated patients with IPF and otherwise technically operable lung cancer experienced all-cause mortality compared to non-surgically treated patients (HR: 0.30 [95% CI: 0.11-0.86], p = 0.02). CONCLUSION Lung cancer exerts a dramatic impact on patients with IPF. A consensus statement for the management of patients with IPF and lung cancer is sorely needed.
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Affiliation(s)
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Izmir, Turkey
| | - Wim A Wuyts
- Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Molina-Molina
- Respiratory Department, Unit of Interstitial Lung Diseases, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, 'ATTIKON' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ömer Selim Unat
- Department of Pulmonology, Ege University Hospital, Izmir, Turkey
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumonology Department, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik-University Clinic Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Lykourgos Kolilekas
- 7th Department of Respiratory Medicine, Hospital for Thoracic Diseases, 'SOTIRIA', Athens, Greece
| | - Elisabetta Rosi
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy
| | - Leonardo Gori
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy
| | - Claudia Ravaglia
- Thoracic Diseases Department, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Venerino Poletti
- Thoracic Diseases Department, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Zoe Daniil
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Thomas Skovhus Prior
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Samantha Aso
- Respiratory Department, Unit of Interstitial Lung Diseases, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Stavros Tryfon
- Pulmonary Clinic, NHS General Hospital 'G. Papanikolaou', Thessaloniki, Greece
| | - Despoina Papakosta
- Pulmonary Department, 'G Papanikolaou' General Hospital, Thessaloniki, Greece.,Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Vasillios Tzilas
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, 'SOTIRIA', Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Spyridon Papiris
- 2nd Pulmonary Medicine Department, 'ATTIKON' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Antoniou
- Department of Thoracic Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Crete, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, 'SOTIRIA', Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athol Wells
- Interstitial Lung Disease Unit, Ιmperial College London, Royal Brompton and Harefield, London, UK
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik-University Clinic Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Argyris Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
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24
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Perricone C, Scarsi M, Brucato A, Pisano P, Pigatto E, Becattini C, Cingolani A, Tiso F, Prota R, Tomasoni LR, Cutolo M, Tardella M, Rozza D, Zerbino C, Andreoni M, Poletti V, Bartoloni E, Gerli R. Treatment with COLchicine in hospitalized patients affected by COVID-19: The COLVID-19 trial. Eur J Intern Med 2023; 107:30-36. [PMID: 36396522 PMCID: PMC9618432 DOI: 10.1016/j.ejim.2022.10.016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/12/2022] [Accepted: 10/20/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate whether the addition of colchicine to standard of care (SOC) results in better outcomes in hospitalized patients with COVID-19. DESIGN This interventional, multicenter, randomized, phase 2 study, evaluated colchicine 1.5 mg/day added to SOC in hospitalized COVID-19 patients (COLVID-19 trial) and 227 patients were recruited. The primary outcome was the rate of critical disease in 30 days defined as need of mechanical ventilation, intensive care unit (ICU), or death. RESULTS 152 non-anti-SARS-CoV-2-vaccinated patients (colchicine vs controls: 77vs75, mean age 69.1±13.1 vs 67.9±15 years, 39% vs 33.3% females, respectively) were analyzed. There was no difference in co-primary end-points between patients treated with colchicine compared to controls (mechanical ventilation 5.2% vs 4%, ICU 1.3% vs 5.3%, death 9.1% vs 6.7%, overall 11 (14.3%) vs 10 (13.3%) patients, P=ns, respectively). Mean time to discharge was similar (colchicine vs controls 14.1±10.4 vs 14.7±8.1 days). Older age (>60 years, P=0.025), P/F<275 mmHg (P=0.005), AST>40 U/L (P<0.001), pre-existent heart (P=0.02), lung (P=0.003), upper-gastrointestinal (P=0.014), lower-gastrointestinal diseases (P=0.009) and cancer (P=0.008) were predictive of achieving the primary outcome. Diarrhoea (9.1% vs 0%, p=0.0031) and increased levels of AST at 6 days (76.9±91.8 vs 33.5±20.7 U/l, P=0.016) were more frequent in the colchicine group. CONCLUSION Colchicine did not reduce the rate and the time to the critical stage. Colchicine was relatively safe although adverse hepatic effects require caution. We confirm that older (>60 years) patients with comorbidities are characterized by worse outcome.
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Affiliation(s)
- Carlo Perricone
- Reumatologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | | | - Antonio Brucato
- Università degli Studi di Milano, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Paola Pisano
- Asl Cagliari, Dipartimento di Area Medica, Struttura Complessa Medicina Interna, Italy
| | - Erika Pigatto
- Ospedale Classificato Villa Salus, Mestre (VE), Italy
| | - Cecilia Becattini
- Medicina Interna, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | | | - Francesco Tiso
- Medicina d'urgenza, Ospedale Alto Vicentino - AULSS 7 Pedemontana, Santorso (VI), Italy
| | - Roberto Prota
- Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | | | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology, Division of Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genoa, Italy
| | - Marika Tardella
- Ospedale Carlo Urbani - Università Politecnica delle Marche, Ancona, Italy
| | - Davide Rozza
- Centro Studi SIR, Società Italiana di Reumatologia, Milan, Italy
| | | | - Massimo Andreoni
- Malattie Infettive, Dipartimento Processi Assistenziali Integrati, Policlinico Tor Vergata, Rome, Italy
| | - Venerino Poletti
- Dipartimento Toracico, Azienda AUSL Romagna, Ospedale G.B. Morgagni, Forlì, Italy; Department of Respiratory Diseases and Allergy, Aarhus University, Aarhus, Denmark
| | - Elena Bartoloni
- Reumatologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | - Roberto Gerli
- Reumatologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy.
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25
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Tomassetti S, Ravaglia C, Puglisi S, Wells AU, Ryu JH, Bosi M, Dubini A, Piciucchi S, Girelli F, Parronchi P, Lavorini F, Rosi E, Luzzi V, Cerinic MM, Poletti V. Clinical implications of interstitial pneumonia with autoimmune features diagnostic criteria in idiopathic pulmonary fibrosis: A case control study. Front Med (Lausanne) 2023; 10:1087485. [PMID: 36873871 PMCID: PMC9978138 DOI: 10.3389/fmed.2023.1087485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/10/2023] [Indexed: 02/18/2023] Open
Abstract
Background A subgroup of IPF patients can meet IPAF criteria (features suggesting an underlying autoimmune process without fulfilling established criteria for a CTD). This study was aimed to evaluate whether IPAF/IPF patients compared to IPF patients differ in clinical profile, prognosis and disease course. Methods This is a retrospective, single center, case-control study. We evaluated 360 consecutive IPF patients (Forlì Hospital, between 1/1/2002 and 28/12/2016) and compared characteristics and outcome of IPAF/IPF to IPF. Results Twenty-two (6%) patients met IPAF criteria. IPAF/IPF patients compared to IPF were more frequently females (N = 9/22, 40.9% vs. N = 68/338, 20.1%, p = 0.02), suffered more frequently from gastroesophageal reflux (54.5% vs. 28.4%, p = 0.01), and showed a higher prevalence of arthralgias (86.4% vs. 4.8%, p < 0.0001), myalgias (14.3% vs. 0.3%, p = 0.001) and fever (18.2% vs. 1.9%, p = 0.002). The serologic domain was detected in all cases (the most frequent were ANA in 17 and RF in nine cases) and morphologic domain (histology features) was positive in 6 out of 10 lung biopsies (lymphoid aggregates). Only patients with IPAF/IPF evolved to CTD at follow-up (10/22, 45.5%; six rheumatoid arthritis, one Sjögren's and three scleroderma). The presence of IPAF was a positive prognostic determinant (HR 0.22, 95% CI 0.08-0.61, p = 0.003), whereas the isolated presence of circulating autoantibody did not impact prognosis (HR 1.00, 95% CI 0.67-1.49, p = 0.99). Conclusion The presence of IPAF criteria in IPF has a major clinical impact correlating with the risk of evolution to full blown-CTD during follow-up and identifying a subgroup of patients with a better prognosis.
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Affiliation(s)
- Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy.,Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Claudia Ravaglia
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Silvia Puglisi
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Athol U Wells
- ILD Unit, Pulmonary Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Marcello Bosi
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | | | | | | | - Paola Parronchi
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Elisabetta Rosi
- Pulmonary Unit, Careggi University Hospital, Florence, Italy
| | - Valentina Luzzi
- Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy.,Department Respiratory Diseases & Allergology, Aarhus University Hospital, Aarhus, Denmark
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26
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Funke-Chambour M, Kewalramani N, Machahua C, Poletti V, Wells AU, Cadranel J. Reply to: Pharmacotherapy for lung cancer with comorbid interstitial pneumonia: limited evidence requires appropriate evaluation. ERJ Open Res 2022; 8:00469-2022. [PMID: 36655227 PMCID: PMC9835994 DOI: 10.1183/23120541.00469-2022] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 01/21/2023] Open
Abstract
The divergent views on lung cancer treatments in fibrosing lung patients reflect differences due to variable side-effect incidences in different countries and among ethnicities. International efforts are needed to better define treatment approaches. https://bit.ly/3DX40fq.
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Affiliation(s)
- Manuela Funke-Chambour
- Department for BioMedical Research DBMR, Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Manuela Funke-Chambour ()
| | - Namrata Kewalramani
- Department for BioMedical Research DBMR, Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlos Machahua
- Department for BioMedical Research DBMR, Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Venerino Poletti
- Department of Thoracic Diseases, “G.B. Morgagni” Hospita, Forlì, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES) University of Bologna, Bologna, Italy
| | - Athol U. Wells
- Royal Brompton and Harefield NHS Foundation Trust, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Jacques Cadranel
- Department of Pulmonary Medicine and Thoracic Oncology, Constitutive Reference Center of Rare Pulmonary Diseases, AP-HP, Hôpital Tenon and GRC04 Theranoscan, Sorbonne Université, Paris, France
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27
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Ravaglia C, Ghirotti C, Puglisi S, Piciucchi S, Gurioli C, Fabbri E, Sultani F, Martinello S, Corso RM, Maitan S, Sambri V, Stella F, Poletti V. Medical Thoracoscopy and Intrapleural Fibrinolytic Therapy for the Management of Pleural Empyema: A Cohort Study. Respiration 2022; 102:46-54. [PMID: 36398454 DOI: 10.1159/000527409] [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: 03/04/2022] [Accepted: 09/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pleural empyema is associated with relevant morbidity and mortality, and it may be classified, according to evolution and ultrasound, into three stages: stage I (free-flowing effusion), stage II (viscous effusion with the tendency to loculate), and stage III (organizing phase). According to guidelines, antibiotic therapy and pleural drainage are recommended, with surgery being performed when patients fail and/or in case of organized empyema. OBJECTIVES The aim of the study was to report the efficacy and safety of medical thoracoscopy in patients with pleural empyema stratified by chest ultrasound. METHOD Observational retrospective cohort study analyzing patients with pleural empyema treated with medical thoracoscopy. Procedure success and mortality were evaluated at 30 days and 90 days after the procedure; complications were also reported. RESULTS 131 patients were included. Intrapleural fibrinolytic therapy was performed thereafter in the majority of cases. Medical thoracoscopy was considered successful without subsequent intervention in 99 patients (76%); 19 patients (15%) underwent a second procedure (drainage, thoracoscopy, video-assisted thoracic surgery, or thoracotomy); and 6 patients (5%) died of the evolution of empyema. Patients treated in stages I and II showed significantly better post-procedure results compared with patients treated in stage III (100%, 83.3%, and 58.1%, respectively). Thoracoscopy complications were observed in 18 patients and were reversible in all cases. CONCLUSIONS Patients with pleural empyema treated in earlier stages (free-flowing or multiloculated effusion) with medical thoracoscopy show significantly better results than patients treated in later stages (organized empyema). This approach is safe, minimally invasive, and efficient in these patients with disease having relevant mortality; however, patient selection remains essential.
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Affiliation(s)
- Claudia Ravaglia
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Corrado Ghirotti
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Silvia Puglisi
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Sara Piciucchi
- Radiology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Carlo Gurioli
- Pulmonology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Elisabetta Fabbri
- Programma Unico per l'Innovazione e la Ricerca AUSL, Staff Direzione Sanitaria, Rimini, Italy
| | - Fabio Sultani
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Sabrina Martinello
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Ruggero Massimo Corso
- Anesthesia and Intensive Care Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Stefano Maitan
- Anesthesia and Intensive Care Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Vittorio Sambri
- Alma Mater Studiorum University of Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMES), Bologna, Italy.,Unit of Microbiology, The Greater Romagna Area Hub Laboratory, Pieve Sestina, Italy
| | - Franco Stella
- Alma Mater Studiorum University of Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMES), Bologna, Italy.,Thoracic Surgery Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Venerino Poletti
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy.,Alma Mater Studiorum University of Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMES), Bologna, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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28
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Piciucchi S, Garo ML, Tomassetti S, Ravaglia C, Poletti V. Supine vs prone position in mild to moderate COVID-19 pneumonia: The impact of proning on computed tomography findings. Eur J Intern Med 2022; 104:118-119. [PMID: 35738975 PMCID: PMC9212665 DOI: 10.1016/j.ejim.2022.06.012] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/18/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- S Piciucchi
- Department of Radiology, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy.
| | - M L Garo
- Independent Research, Mathsly, Italy
| | - S Tomassetti
- Department of Experimental and Clinical Medicine Careggi University Hospital Florence, Italy
| | - C Ravaglia
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì
| | - V Poletti
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì; Dipartimento di Medicina Specialistica e Sperimentale (DIMES), University of Bologna, Forlì Campus, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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29
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Cottin V, Selman M, Inoue Y, Wong AW, Corte TJ, Flaherty KR, Han MK, Jacob J, Johannson KA, Kitaichi M, Lee JS, Agusti A, Antoniou KM, Bianchi P, Caro F, Florenzano M, Galvin L, Iwasawa T, Martinez FJ, Morgan RL, Myers JL, Nicholson AG, Occhipinti M, Poletti V, Salisbury ML, Sin DD, Sverzellati N, Tonia T, Valenzuela C, Ryerson CJ, Wells AU. Syndrome of Combined Pulmonary Fibrosis and Emphysema: An Official ATS/ERS/JRS/ALAT Research Statement. Am J Respir Crit Care Med 2022; 206:e7-e41. [PMID: 35969190 PMCID: PMC7615200 DOI: 10.1164/rccm.202206-1041st] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [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] [Indexed: 11/16/2022] Open
Abstract
Background: The presence of emphysema is relatively common in patients with fibrotic interstitial lung disease. This has been designated combined pulmonary fibrosis and emphysema (CPFE). The lack of consensus over definitions and diagnostic criteria has limited CPFE research. Goals: The objectives of this task force were to review the terminology, definition, characteristics, pathophysiology, and research priorities of CPFE and to explore whether CPFE is a syndrome. Methods: This research statement was developed by a committee including 19 pulmonologists, 5 radiologists, 3 pathologists, 2 methodologists, and 2 patient representatives. The final document was supported by a focused systematic review that identified and summarized all recent publications related to CPFE. Results: This task force identified that patients with CPFE are predominantly male, with a history of smoking, severe dyspnea, relatively preserved airflow rates and lung volumes on spirometry, severely impaired DlCO, exertional hypoxemia, frequent pulmonary hypertension, and a dismal prognosis. The committee proposes to identify CPFE as a syndrome, given the clustering of pulmonary fibrosis and emphysema, shared pathogenetic pathways, unique considerations related to disease progression, increased risk of complications (pulmonary hypertension, lung cancer, and/or mortality), and implications for clinical trial design. There are varying features of interstitial lung disease and emphysema in CPFE. The committee offers a research definition and classification criteria and proposes that studies on CPFE include a comprehensive description of radiologic and, when available, pathological patterns, including some recently described patterns such as smoking-related interstitial fibrosis. Conclusions: This statement delineates the syndrome of CPFE and highlights research priorities.
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Affiliation(s)
- Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | | | | | - Tamera J. Corte
- Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | | | | | - Joseph Jacob
- University College London, London, United Kingdom
| | - Kerri A. Johannson
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Joyce S. Lee
- University of Colorado Denver Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Katerina M. Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | | | - Fabian Caro
- Hospital de Rehabilitación Respiratoria "María Ferrer", Buenos Aires, Argentina
| | | | - Liam Galvin
- European idiopathic pulmonary fibrosis and related disorders federation
| | - Tae Iwasawa
- Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | | | | | - Andrew G. Nicholson
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | | | - Don D. Sin
- University of British Columbia, Vancouver, Canada
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Claudia Valenzuela
- Pulmonology Department, Hospital Universitario de la Princesa, Departamento Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Poletti E, Galvani M, Dubini A, Poletti V, Piciucchi S. Correlations between radiological and histological findings in patients with pulmonary vein stenosis after radiofrequency ablation: A case series. Pulmonology 2022; 28:396-398. [PMID: 35896431 DOI: 10.1016/j.pulmoe.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/02/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- E Poletti
- IRCCS Policlinico San Donato, Milan/University of Milano Statale, Milan, Italy.
| | - M Galvani
- Department of Cardiology, GB Morgagni Hospital, Forlì/University of Bologna, Italy
| | - A Dubini
- Department of Pathology, GB Morgagni Hospital, Forlì/University of Bologna, Italy
| | - V Poletti
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì/University of Bologna, Italy; Department of Respiratory Disease & Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - S Piciucchi
- Department of Radiology, GB Morgagni Hospital, Forlì/University of Bologna, Italy
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31
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Tomassetti S, Poletti V, Ravaglia C, Sverzellati N, Piciucchi S, Cozzi D, Luzzi V, Comin C, Wells AU. Incidental discovery of interstitial lung disease: diagnostic approach, surveillance and perspectives. Eur Respir Rev 2022; 31:31/164/210206. [PMID: 35418487 PMCID: PMC9488620 DOI: 10.1183/16000617.0206-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
The incidental discovery of pre-clinical interstitial lung disease (ILD) has led to the designation of interstitial lung abnormalities (ILA), a radiological entity defined as the incidental finding of computed tomography (CT) abnormalities affecting more than 5% of any lung zone. Two recent documents have redefined the borders of this entity and made the recommendation to monitor patients with ILA at risk of progression. In this narrative review, we will focus on some of the limits of the current approach, underlying the potential for progression to full-blown ILD of some patients with ILA and the numerous links between subpleural fibrotic ILA and idiopathic pulmonary fibrosis (IPF). Considering the large prevalence of ILA in the general population (7%), restricting monitoring only to cases considered at risk of progression appears a reasonable approach. However, this suggestion should not prevent pulmonary physicians from pursuing an early diagnosis of ILD and timely treatment where appropriate. In cases of suspected ILD, whether found incidentally or not, the pulmonary physician is still required to make a correct ILD diagnosis according to current guidelines, and eventually treat the patient accordingly. In patients with interstitial lung abnormalities (ILA), monitoring of those at risk of progression is currently recommended, and pulmonary physicians should pursue an early diagnosis when ILA become clinically significant to facilitate timely treatment https://bit.ly/3HKOQc8
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Affiliation(s)
- Sara Tomassetti
- Dept of Experimental and Clinical Medicine, Florence University, Florence, Italy .,Interventional Pneumology, Careggi University Hospital, Florence, Italy
| | - Venerino Poletti
- Dept of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Claudia Ravaglia
- Dept of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | | | | | - Diletta Cozzi
- Dept of Emergency Radiology, University Hospital Careggi, Florence, Italy
| | - Valentina Luzzi
- Interventional Pneumology, Careggi University Hospital, Florence, Italy
| | - Camilla Comin
- Dept of Experimental and Clinical Medicine, Florence University, Florence, Italy
| | - Athol U Wells
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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Korevaar DA, Colella S, Fally M, Camuset J, Colby TV, Hagmeyer L, Hetzel J, Maldonado F, Morais A, Ravaglia C, Spijker R, Tomassetti S, Troy LK, Verschakelen JA, Wells AU, Tonia T, Annema JT, Poletti V. European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases. Eur Respir J 2022; 60:13993003.00425-2022. [PMID: 35710261 DOI: 10.1183/13993003.00425-2022] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND In patients with interstitial lung diseases (ILD), histopathological input is often required to obtain a diagnosis. Surgical lung biopsy (SLB) is considered the reference standard, but many patients are clinically unfit to undergo this invasive procedure, and adverse events, length of hospitalization and costs are considerable. This guideline provides evidence-based clinical practice recommendations for the role of transbronchial lung cryobiopsy (TBLC) in obtaining tissue-based diagnosis in patients with undiagnosed ILD. MATERIALS AND METHODS The European Respiratory Society task force consisted of clinical experts in the field of ILD and/or TBLC, and methodological experts. Four PICO questions and two narrative questions were formulated. Systematic literature searches were performed in Medline and Embase (up to June 2021). GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology was applied. RESULTS In patients with undiagnosed ILD and an indication to obtain histopathological data: 1) TBLC is suggested as replacement test in patients considered eligible to undergo SLB, 2) TBLC is suggested in patients not considered eligible to undergo SLB, 3) SLB is suggested as add-on test in patients with a non-informative TBLC, 4) no recommendation is made for or against second TBLC in patients with a non-informative TBLC, and 5) TBLC-operators should undergo training, but no recommendation is made for the type of training required. CONCLUSION TBLC provides important diagnostic information in patients with undiagnosed ILD. Diagnostic yield is lower compared to SLB, at reduced serious adverse events and length of hospitalization. Certainty of the evidence is mostly "very low".
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Affiliation(s)
- Daniël A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Sara Colella
- Pulmonary Unit, "G. Mazzini" Hospital, Teramo, Italy
| | - Markus Fally
- Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Juliette Camuset
- Department of Thoracic and Vascular Surgery, Tenon Hospital AP-HP Paris, France
| | - Thomas V Colby
- Department of Laboratory Medicine and Pathology (Emeritus), Mayo Clinic, Scottsdale, AZ, USA
| | - Lars Hagmeyer
- Bethanien Hospital Solingen, Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Germany.,Institute of Pneumology, University of Cologne, Solingen, Germany
| | - Juergen Hetzel
- Department of Medical Oncology and Pulmonary Medicine, University Hospital Tuebingen, Tuebingen, Germany.,Department of Internal Medicine, Division of Pneumology, Kantonssiptal Winterthur, Winterthur, Switzerland
| | | | - Antonio Morais
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Claudia Ravaglia
- Department of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - René Spijker
- Medical Library, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital and University of Florence, Florence, Italy
| | - Lauren K Troy
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Johny A Verschakelen
- Department of Radiology, Pulmonary Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Athol U Wells
- Interstitial Lung Disease Unit, Pulmonary Medicine, Royal Brompton Hospital, London, UK.,Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Shared senior authorship
| | - Venerino Poletti
- Department of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy .,Shared senior authorship
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Terwiel M, Borie R, Crestani B, Galvin L, Bonella F, Fabre A, Froidure A, Griese M, Grutters JC, Johannson K, Kannengiesser C, Kawano-Dourado L, Molina-Molina M, Prasse A, Renzoni EA, van der Smagt J, Poletti V, Antoniou K, van Moorsel CHM. Genetic testing in interstitial lung disease: An international survey. Respirology 2022; 27:747-757. [PMID: 35652243 DOI: 10.1111/resp.14303] [Citation(s) in RCA: 10] [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: 01/12/2022] [Accepted: 05/05/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Genetic analysis is emerging for interstitial lung diseases (ILDs); however, ILD practices are not yet standardized. We surveyed patients', relatives' and pulmonologists' experiences and needs on genetic testing in ILD to evaluate the current situation and identify future needs. METHODS A clinical epidemiologist (MT) together with members of the ERS taskforce and representatives of the European Idiopathic Pulmonary Fibrosis and related disorders Federation (EU-IPFF) patient organisation developed a survey for patients, relatives and pulmonologists. Online surveys consisted of questions on five main topics: awareness of hereditary ILD, the provision of information, genetic testing, screening of asymptomatic relatives and clinical impact of genetic analysis in ILD. RESULTS Survey respondents consisted of 458 patients with ILD, 181 patients' relatives and 352 pulmonologists. Most respondents think genetic testing can be useful, particularly for explaining the cause of disease, predicting its course, determining risk for developing disease and the need to test relatives. Informing patients and relatives on genetic analysis is primarily performed by the pulmonologist, but 88% (218) of pulmonologists identify a need for more information and 96% (240) ask for guidelines on genetic testing in ILD. A third of the pulmonologists who would offer genetic testing currently do not offer a genetic test, primarily because they have limited access to genetic tests. Following genetic testing, 72% (171) of pulmonologists may change the diagnostic work-up and 57% (137) may change the therapeutic approach. CONCLUSION This survey shows that there is wide support for implementation of genetic testing in ILD and a high need for information, guidelines and access to testing among patients, their relatives and pulmonologists.
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Affiliation(s)
- Michelle Terwiel
- ILD Center of Excellence, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Raphael Borie
- Service de Pneumologie A, Hôpital Bichat, APHP, Paris, France.,INSERM, Unité 1152, Université de Paris, Paris, France
| | - Bruno Crestani
- Service de Pneumologie A, Hôpital Bichat, APHP, Paris, France.,INSERM, Unité 1152, Université de Paris, Paris, France
| | - Liam Galvin
- European Idiopathic Pulmonary Fibrosis and Related Disorders Federation, Overijse, Belgium
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Aurelie Fabre
- Department of Histopathology, St Vincent's University Hospital & School of Medicine, University College Dublin, Dublin, Ireland
| | - Antoine Froidure
- Service de Pneumologie, Cliniques universitaires Saint-Luc and Institut de Recherche Expérimentale et Clinique, UC Louvain, Bruxelles, Belgium
| | - Matthias Griese
- Dr. von Hauner Children's Hospital, Ludwig-Maximilians University Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Jan C Grutters
- ILD Center of Excellence, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Kerri Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Caroline Kannengiesser
- INSERM, Unité 1152, Université de Paris, Paris, France.,Laboratoire de Génétique, Hôpital Bichat, APHP, Paris, France
| | - Leticia Kawano-Dourado
- INSERM, Unité 1152, Université de Paris, Paris, France.,Pneumologie, Hôpital Bichat, APHP, Paris, France.,HCOR Research Institute, Hospital do Coracao, Sao Paulo, Brazil
| | - Maria Molina-Molina
- ILD Unit, Respiratory Department, Bellvitge University Hospital-IDIBELL, CIBERES, Barcelona, Spain
| | - Antje Prasse
- Pneumologie, Hannover Hochschule, Hannover, Germany
| | - Elisabetta A Renzoni
- Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Margaret Turner Warwick Centre for Fibrosing Lung Diseases, NHLI, Imperial College, London, UK
| | - Jasper van der Smagt
- Klinische Genetica, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Venerino Poletti
- Department of Diseases of the Thorax, University of Bologna/GB Morgagni Hospital, Forli, Italy
| | - Katerina Antoniou
- Department of Thoracic Medicine, University of Crete, Heraklion, Greece
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Piciucchi S, Poletti V. Diffuse pulmonary ill-defined centrilobular opacities: Not only bronchiolitis. Eur J Intern Med 2022; 100:125-126. [PMID: 35346567 DOI: 10.1016/j.ejim.2022.03.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 11/20/2022]
Affiliation(s)
- S Piciucchi
- Department of Radiology, Ospedale GB Morgagni/University of Bologna, Forlì, Italy.
| | - V Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, DIMES University of Bologna, Forlì; Department of Respiratory Diseases and Allergy, Aarhus University, Aarhus, Denmark
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Kewalramani N, Machahua C, Poletti V, Cadranel J, Wells AU, Funke-Chambour M. Lung cancer in patients with fibrosing interstitial lung diseases – An overview of current knowledge and challenges. ERJ Open Res 2022; 8:00115-2022. [PMID: 35747227 PMCID: PMC9209850 DOI: 10.1183/23120541.00115-2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Patients with progressive fibrosing interstitial lung diseases (fILD) have increased morbidity and mortality. Lung fibrosis can be associated with lung cancer. The pathogenesis of both diseases shows similarities, although not all mechanisms are understood. The combination of the diseases is challenging, due to the amplified risk of mortality, and also because lung cancer treatment carries additional risks in patients with underlying lung fibrosis. Acute exacerbations in fILD patients are linked to increased mortality, and the risk of acute exacerbations is increased after lung cancer treatment with surgery, chemotherapy or radiotherapy. Careful selection of treatment modalities is crucial to improve survival while maintaining acceptable quality of life in patients with combined lung cancer and fILD. This overview of epidemiology, pathogenesis, treatment and a possible role for antifibrotic drugs in patients with lung cancer and fILD is the summary of a session presented during the virtual European Respiratory Society Congress in 2021. The review summarises current knowledge and identifies areas of uncertainty. Most current data relate to patients with combined idiopathic pulmonary fibrosis and lung cancer. There is a pressing need for additional prospective studies, required for the formulation of a consensus statement or guideline on the optimal care of patients with lung cancer and fILD. Lung fibrosis can be associated with lung cancer. More and better-designed studies are needed to determine the true incidence/prevalence of lung cancer in fILD. Optimal treatment strategies urgently need to be defined and evaluated.https://bit.ly/37CzTMu
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Raghu G, Remy-Jardin M, Richeldi L, Thomson CC, Inoue Y, Johkoh T, Kreuter M, Lynch DA, Maher TM, Martinez FJ, Molina-Molina M, Myers JL, Nicholson AG, Ryerson CJ, Strek ME, Troy LK, Wijsenbeek M, Mammen MJ, Hossain T, Bissell BD, Herman DD, Hon SM, Kheir F, Khor YH, Macrea M, Antoniou KM, Bouros D, Buendia-Roldan I, Caro F, Crestani B, Ho L, Morisset J, Olson AL, Podolanczuk A, Poletti V, Selman M, Ewing T, Jones S, Knight SL, Ghazipura M, Wilson KC. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2022; 205:e18-e47. [PMID: 35486072 PMCID: PMC9851481 DOI: 10.1164/rccm.202202-0399st] [Citation(s) in RCA: 683] [Impact Index Per Article: 341.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: This American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax guideline updates prior idiopathic pulmonary fibrosis (IPF) guidelines and addresses the progression of pulmonary fibrosis in patients with interstitial lung diseases (ILDs) other than IPF. Methods: A committee was composed of multidisciplinary experts in ILD, methodologists, and patient representatives. 1) Update of IPF: Radiological and histopathological criteria for IPF were updated by consensus. Questions about transbronchial lung cryobiopsy, genomic classifier testing, antacid medication, and antireflux surgery were informed by systematic reviews and answered with evidence-based recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 2) Progressive pulmonary fibrosis (PPF): PPF was defined, and then radiological and physiological criteria for PPF were determined by consensus. Questions about pirfenidone and nintedanib were informed by systematic reviews and answered with evidence-based recommendations using the GRADE approach. Results:1) Update of IPF: A conditional recommendation was made to regard transbronchial lung cryobiopsy as an acceptable alternative to surgical lung biopsy in centers with appropriate expertise. No recommendation was made for or against genomic classifier testing. Conditional recommendations were made against antacid medication and antireflux surgery for the treatment of IPF. 2) PPF: PPF was defined as at least two of three criteria (worsening symptoms, radiological progression, and physiological progression) occurring within the past year with no alternative explanation in a patient with an ILD other than IPF. A conditional recommendation was made for nintedanib, and additional research into pirfenidone was recommended. Conclusions: The conditional recommendations in this guideline are intended to provide the basis for rational, informed decisions by clinicians.
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Kalverda KA, Vaselli M, Wijmans L, de Bruin DM, Jonkers RE, Poletti V, de Boer J, Annema JT, Bonta PI. Endobronchial Optical Coherence Tomography: Shining New Light on Diagnosing Usual Interstitial Pneumonitis? Am J Respir Crit Care Med 2022; 205:967-968. [PMID: 35148494 PMCID: PMC9838632 DOI: 10.1164/rccm.202111-2619le] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Kirsten A. Kalverda
- Amsterdam University Medical CentersAmsterdam, the Netherlands,Corresponding author (e-mail: )
| | | | - Lizzy Wijmans
- Amsterdam University Medical CentersAmsterdam, the Netherlands
| | | | - René E. Jonkers
- Amsterdam University Medical CentersAmsterdam, the Netherlands
| | - Venerino Poletti
- Ospedale GB MorgagniForli, Italy,Aarhus University HospitalAarhus, Denmark
| | | | - Jouke T. Annema
- Amsterdam University Medical CentersAmsterdam, the Netherlands
| | - Peter I. Bonta
- Amsterdam University Medical CentersAmsterdam, the Netherlands
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Cottin V, Tomassetti S, Valenzuela C, Walsh S, Antoniou K, Bonella F, Brown KK, Collard HR, Corte TJ, Flaherty K, Johannson KA, Kolb M, Kreuter M, Inoue Y, Jenkins G, Lee JS, Lynch DA, Maher TM, Martinez FJ, Molina-Molina M, Myers J, Nathan SD, Poletti V, Quadrelli S, Raghu G, Rajan SK, Ravaglia C, Remy-Jardin M, Renzoni E, Richeldi L, Spagnolo P, Troy L, Wijsenbeek M, Wilson KC, Wuyts W, Wells AU, Ryerson C. Integrating Clinical Probability into the Diagnostic Approach to Idiopathic Pulmonary Fibrosis: An International Working Group Perspective. Am J Respir Crit Care Med 2022; 206:247-259. [PMID: 35353660 DOI: 10.1164/rccm.202111-2607pp] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND When considering the diagnosis of idiopathic pulmonary fibrosis (IPF), experienced clinicians integrate clinical features that help to differentiate IPF from other fibrosing interstitial lung diseases, thus generating a "pre-test" probability of IPF. The aim of this international working group perspective was to summarize these features using a tabulated approach similar to chest HRCT and histopathologic patterns reported in the international guidelines for the diagnosis of IPF, and to help formally incorporate these clinical likelihoods into diagnostic reasoning to facilitate the diagnosis of IPF. METHODS The committee group identified factors that influence the clinical likelihood of a diagnosis of IPF, which was categorized as a pre-test clinical probability of IPF into "high" (70-100%), "intermediate" (30-70%), or "low" (0-30%). After integration of radiological and histopathological features, the post-test probability of diagnosis was categorized into "definite" (90-100%), "high confidence" (70-89%), "low confidence" (51-69%), or "low" (0-50%) probability of IPF. FINDINGS A conceptual Bayesian framework was created, integrating the clinical likelihood of IPF ("pre-test probability of IPF") with the HRCT pattern, the histopathology pattern when available, and/or the pattern of observed disease behavior into a "post-test probability of IPF". The diagnostic probability of IPF was expressed using an adapted diagnostic ontology for fibrotic interstitial lung diseases. INTERPRETATION The present approach will help incorporate the clinical judgement into the diagnosis of IPF, thus facilitating the application of IPF diagnostic guidelines and, ultimately improving diagnostic confidence and reducing the need for invasive diagnostic techniques.
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Affiliation(s)
- Vincent Cottin
- Louis Pradel University Hospital, Respiratory Medicine, Lyon, France;
| | | | - Claudia Valenzuela
- Servicio de Neumología, Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Madrid, Spain
| | - Simon Walsh
- Imperial College London, 4615, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Katerina Antoniou
- Medical School, University of Crete, Heraklion, Greece, Department of Thoracic Medicine, Laboratory of Molecular and Cellular Pneumonology, Heraklion, Greece.,University Hospital of Heraklion, Heraklion, Greece, Department of Thoracic Medicine, Heraklion, Greece
| | | | - Kevin K Brown
- National Jewish Health, 2930, Denver, Colorado, United States
| | - Harold R Collard
- University of California, San Francisco, Department of Medicine, San Francisco, California, United States
| | - Tamera J Corte
- Royal Prince Alfred Hospital, Department of Respiratory Medicine, Sydney, New South Wales, Australia.,University of Sydney, 4334, Medical School, Sydney, New South Wales, Australia
| | - Kevin Flaherty
- University of Michigan, Division of Pulmonary and Critical Care Medicine, Ann Arbor, Michigan, United States
| | | | - Martin Kolb
- McMaster University, Hamilton, Ontario, Canada
| | - Michael Kreuter
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research Germany, Heidelberg, Germany
| | - Yoshikazu Inoue
- National Hospital Organization, Kinki-Chuo Chest Medical Center, Clinical Research Center, Osaka, Japan
| | - Gisli Jenkins
- Imperial College London, 4615, National Heart & Lung Institute, London, United Kingdom of Great Britain and Northern Ireland.,NIHR Nottingham Biomedical Research Centre, 574111, Respiratory Research Unit, Nottingham, United Kingdom of Great Britain and Northern Ireland.,University of Nottingham School of Medicine, 170718, Division of Respiratory Medicine, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Joyce S Lee
- University of Colorado, School of Medicine, Department of Medicine, Aurora, Colorado, United States
| | - David A Lynch
- National Jewish Health, Radiology, Denver, Colorado, United States
| | - Toby M Maher
- University of Southern California Keck School of Medicine, 12223, PCCSM, Los Angeles, California, United States
| | | | - Maria Molina-Molina
- Pneumology, ILD Unit. University Hospital of Bellvitge, Hospitalet de Llobregat, Spain
| | - Jeff Myers
- University of Michigan, Division of Anatomic Pathology, Ann Arbor, Michigan, United States
| | - Steven D Nathan
- Inova Fairfax Hospital, 23146, Advanced Lung Disease and Transplant Program, Falls Church, Virginia, United States
| | - Venerino Poletti
- GB MORGAGNI HOSPITAL, Department of Diseases of the Thorax, FORLI, Italy
| | - Silvia Quadrelli
- Sanatorio Guemes, 62948, Pulmonary Medicine, Buenos Aires, Argentina
| | - Ganesh Raghu
- University of Washington Medical Center, 21617, Division of Pulmonary and Critical Care Medicine, Seattle, Washington, United States
| | - Sujeet K Rajan
- Bombay Hospital Institute f Medical Sciences and Bhatia Hospital, Mumbai, India
| | | | | | - Elisabetta Renzoni
- Royal Brompton Hospital, Interstitial Lung Disease Unit, London, United Kingdom of Great Britain and Northern Ireland
| | - Luca Richeldi
- Universita Cattolica del Sacro Cuore Sede di Roma, 96983, Pulmonary Medicine, Roma, Italy
| | - Paolo Spagnolo
- Canton Hospital Baselland, and University of Basel, Medical University Clinic, Liestal, Switzerland
| | - Lauren Troy
- Royal Prince Alfred Hospital, 2205, Respiratory Medicine, Sydney, New South Wales, Australia
| | - Marlies Wijsenbeek
- Erasmus University Rotterdam, 6984, Rotterdam, Zuid-Holland, Netherlands
| | - Kevin C Wilson
- American Thoracic Society, 44197, Documents Department, New York, New York, United States.,Boston University, Medicine, Boston, Massachusetts, United States
| | - Wim Wuyts
- K U Leuven, respiratory medicine, Leuven, Belgium
| | - Athol U Wells
- Royal Brompton Hospital, Interstitial Lung Disease Unit, London, United Kingdom of Great Britain and Northern Ireland
| | - Christopher Ryerson
- University of British Columbia, Medicine, Vancouver, British Columbia, Canada
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Agnoletti V, Gamberini E, Circelli A, Martino C, Santonastaso DP, Bolondi G, Bastoni G, Spiga M, Ceccarelli P, Montaguti L, Catena F, Poletti V, Lusenti C, Lazzari C, Altini M, Russo E. Description of an Integrated and Dynamic System to Efficiently Deal With a Raging COVID-19 Pandemic Peak. Front Med (Lausanne) 2022; 9:819134. [PMID: 35372442 PMCID: PMC8971195 DOI: 10.3389/fmed.2022.819134] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to describe an innovative and functional method to deal with the increased COVID-19 pandemic-related intensive care unit bed requirements. Methods We described the emergency creation of an integrated system of internistic ward, step-down unit, and intensive care unit, physically located in reciprocal vicinity on the same floor. The run was carried out under the control of single intensive care staff, through sharing clinical protocols and informatics systems, and following single director supervision. The intention was to create a dynamic and flexible system, allowing for rapid and fluid patient admission/discharge, depending on the requirements due to the third Italian peak of the COVID-19 pandemic in March 2021. Results This study involved 142 COVID-19 patients and 66 non-COVID-19 patients who were admitted; no critical patient was left unadmitted and no COVID-19 severe patients referring to our center had to be redirected to other hospitals due to bed saturation. This system allowed shorter hospital length-of-stay in general wards (5.9 ± 4 days) than in other internistic COVID-19 wards and overall mortality in line with those reported in literature despite the peak raging. Conclusion This case report showed the feasibility and the efficiency of this dynamic model of hospital rearrangement to deal with COVID-19 pandemic peaks.
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Affiliation(s)
- Vanni Agnoletti
- Department of Emergency Surgery and Trauma, Anesthesia and Intensive Care Unit, M Bufalini Hospital, Cesena, Italy
- *Correspondence: Vanni Agnoletti
| | - Emiliano Gamberini
- Department of Emergency Surgery and Trauma, Anesthesia and Intensive Care Unit, M Bufalini Hospital, Cesena, Italy
| | - Alessandro Circelli
- Department of Emergency Surgery and Trauma, Anesthesia and Intensive Care Unit, M Bufalini Hospital, Cesena, Italy
| | - Costanza Martino
- Department of Emergency Surgery and Trauma, Anesthesia and Intensive Care Unit, M Bufalini Hospital, Cesena, Italy
| | - Domenico Pietro Santonastaso
- Department of Emergency Surgery and Trauma, Anesthesia and Intensive Care Unit, M Bufalini Hospital, Cesena, Italy
| | - Giuliano Bolondi
- Department of Emergency Surgery and Trauma, Anesthesia and Intensive Care Unit, M Bufalini Hospital, Cesena, Italy
| | | | - Martina Spiga
- Nursing Department, M Bufalini Hospital, Cesena, Italy
| | | | - Luca Montaguti
- Department of Internal Medicine, M Bufalini Hospital, Cesena, Italy
| | - Fausto Catena
- Department of Emergency Surgery and Trauma, M Bufalini Hospital, Cesena, Italy
| | - Venerino Poletti
- Department of Respiratory Diseases, AUSL Romagna-Morgagni Hospital, Forlì, Italy
| | - Carlo Lusenti
- Hospital Direction M Bufalini Hospital, Cesena, Italy
| | | | - Mattia Altini
- Hospital Direction Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy
| | - Emanuele Russo
- Department of Emergency Surgery and Trauma, Anesthesia and Intensive Care Unit, M Bufalini Hospital, Cesena, Italy
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Ravaglia C, Doglioni C, Chilosi M, Piciucchi S, Dubini A, Rossi G, Pedica F, Puglisi S, Donati L, Tomassetti S, Poletti V. Clinical, radiological, and pathological findings in patients with persistent lung disease following SARS-CoV-2 infection. Eur Respir J 2022; 60:13993003.02411-2021. [PMID: 35301248 PMCID: PMC8932282 DOI: 10.1183/13993003.02411-2021] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 02/13/2022] [Indexed: 12/18/2022]
Abstract
Some patients experience pulmonary sequelae after SARS-CoV-2 infection, ranging from self-limited abnormalities to major lung diseases. Morphological analysis of lung tissue may help our understanding of pathogenic mechanisms and help to provide consistent personalised management. The aim of this study was to ascertain morphological and immunomolecular features of lung tissue. Transbronchial lung cryobiopsy was carried out in patients with persistent symptoms and computed tomography suggestive of residual lung disease after recovery from SARS-CoV-2 infection. 164 patients were referred for suspected pulmonary sequelae after COVID-19; 10 patients with >5% parenchymal lung disease underwent lung biopsy. The histological pattern of lung disease was not homogeneous and three different case clusters could be identified, which was mirrored by their clinical and radiological features. Cluster 1 (“chronic fibrosing”) was characterised by post-infection progression of pre-existing interstitial pneumonias. Cluster 2 (“acute/subacute injury”) was characterised by different types and grades of lung injury, ranging from organising pneumonia and fibrosing nonspecific interstitial pneumonia to diffuse alveolar damage. Cluster 3 (“vascular changes”) was characterised by diffuse vascular increase, dilatation and distortion (capillaries and venules) within otherwise normal parenchyma. Clusters 2 and 3 had immunophenotypical changes similar to those observed in early/mild COVID-19 pneumonias (abnormal expression of STAT3 in hyperplastic pneumocytes and PD-L1, IDO and STAT3 in endothelial cells). This is the first study correlating histological/immunohistochemical patterns with clinical and radiological pictures of patients with post-COVID lung disease. Different phenotypes with potentially different underlying pathogenic mechanisms have been identified. Post-COVID lung disease is not a single entity, but includes different subtypes, each of them potentially requiring separate and different managementhttps://bit.ly/3BJDeUF
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Affiliation(s)
- Claudia Ravaglia
- Department of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Claudio Doglioni
- Department of Pathology, University Vita-Salute, Milan and San Raffaele Scientific Institute, Milan, Italy
| | - Marco Chilosi
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Sara Piciucchi
- Department of Radiology, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Alessandra Dubini
- Department of Pathology, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Giulio Rossi
- Department of Pathology, Fondazione Poliambulanza Istituto Ospedaliero Multispecialistico, Brescia, Italy
| | - Federica Pedica
- Department of Pathology, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Puglisi
- Department of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Luca Donati
- Biostatistics and Clinical Trial Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori"-IRST S.r.l., IRCCS, Meldola, Italy
| | - Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Firenze, Italy
| | - Venerino Poletti
- Department of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy.,DIMES, University of Bologna, Bologna, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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41
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Antoniou KM, Vasarmidi E, Russell AM, Andrejak C, Crestani B, Delcroix M, Dinh-Xuan AT, Poletti V, Sverzellati N, Vitacca M, Witzenrath M, Tonia T, Spanevello A. European Respiratory Society Statement on Long COVID-19 Follow-Up. Eur Respir J 2022; 60:13993003.02174-2021. [PMID: 35144991 PMCID: PMC9349784 DOI: 10.1183/13993003.02174-2021] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022]
Abstract
Patients diagnosed with coronavirus disease 2019 (COVID-19) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection frequently experience symptom burden post-acute infection or post-hospitalisation. We aimed to identify optimal strategies for follow-up care that may positively impact the patient's quality of life (QoL). A European Respiratory Society (ERS) Task Force convened and prioritised eight clinical questions. A targeted search of the literature defined the timeline of “long COVID” as 1–6 months post-infection and identified clinical evidence in the follow-up of patients. Studies meeting the inclusion criteria report an association of characteristics of acute infection with persistent symptoms, thromboembolic events in the follow-up period, and evaluations of pulmonary physiology and imaging. Importantly, this statement reviews QoL consequences, symptom burden, disability and home care follow-up. Overall, the evidence for follow-up care for patients with long COVID is limited. Follow-up care of patients infected with SARS-CoV-2 is crucial and may improve their quality of life. More evidence and research is emerging to understand the causes, mechanisms and risks of long COVID consequences.https://bit.ly/3J1WMWy
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Affiliation(s)
- Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Eirini Vasarmidi
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece.,Université de Paris, Inserm U1152, Labex Inflamex, Paris, France.,Authors contributed equally
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, Exeter, UK.,Authors contributed equally
| | - Claire Andrejak
- Service de Pneumologie, CHU Amiens-Picardie, UR 4294 AGIR, université Picardie Jules-Verne, Amiens, France
| | - Bruno Crestani
- Université de Paris, Inserm U1152, Labex Inflamex, Paris, France.,Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), AP-HP, Service de Pneumologie, Hôpital Bichat, Paris, France
| | - Marion Delcroix
- Department of Pneumonology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Anh Tuan Dinh-Xuan
- AP-HP Centre, Hôpital Cochin, Respiratory Physiology Unit, Thoracic Diseases Department, Université de Paris, Paris, France
| | - Venerino Poletti
- Pulmonology Unit, Thoracic Diseases Department, G.B. Morgagni Hospital, Forlì, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Nicola Sverzellati
- Division of Radiology, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Martin Witzenrath
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese.,Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Varese, Italy
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Piciucchi S, Ravaglia C, Vizzuso A, Giampalma E, Poletti V. Awake prone positioning for COVID-19 acute respiratory failure: imaging and histological background. The Lancet Respiratory Medicine 2022; 10:e14. [PMID: 35120610 PMCID: PMC8806195 DOI: 10.1016/s2213-2600(21)00554-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 10/26/2022]
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Harari S, Pesci A, Albera C, Poletti V, Amici C, Crespi G, Campolo B, Vancheri C. Nintedanib in IPF: Post hoc Analysis of the Italian FIBRONET Observational Study. Respiration 2022; 101:577-584. [PMID: 35078170 DOI: 10.1159/000521138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The FIBRONET study was an observational study of patients with idiopathic pulmonary fibrosis (IPF) in Italy. OBJECTIVES In this post hoc descriptive analysis, we describe changes in lung function, anxiety/depression, coughing, exacerbations, and adverse events (AEs) in patients receiving nintedanib treatment. METHODS Patients with IPF from 20 centers in Italy, aged ≥40 years who received nintedanib for ≥7 months, were followed up for 12 months from study enrollment, attending clinic visits every 3 months. Outcomes included change in forced vital capacity (FVC)% predicted from baseline to 12 months, anxiety/depression measured by the Hospital Anxiety and Depression Scale (HADS), and the proportion of patients with cough, AEs, and exacerbations. RESULTS In total, 52 patients received nintedanib (mean duration of 11.6 months). Ten patients had dose reductions from 150 mg to 100 mg twice daily, due to AEs. FVC% predicted was unchanged in the overall nintedanib population (78.7% at baseline; 79.8% at 12 months) and those with a reduced dose (77.7% at baseline; 81.0% at 12 months). HADS score was low at baseline and throughout the study. The proportion of patients with cough decreased from 50.0% to 21.2% over 12 months. Two patients experienced exacerbations, 2 patients discontinued treatment, and 27 (51.9%) reported AEs. The most common AE was diarrhea (34.6%). CONCLUSIONS In patients with IPF who received nintedanib in the FIBRONET study, FVC% predicted was stable over 12 months, and the proportion of patients with cough decreased. The safety profile was consistent with the known safety profile for nintedanib in IPF.
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Affiliation(s)
- Sergio Harari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Ospedale San Giuseppe, IRCCS MultiMedica, Milan, Italy
| | - Alberto Pesci
- Department of Medicine, Respiratory Unit, University of Milano-Bicocca, ASST Monza, Monza, Italy
| | - Carlo Albera
- SC Pneumologia U, A.O.U. Città Della Scienza e della Salute (Molinette), University of Torino, Turin, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy.,Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, University-Hospital "Policlinico G. Rodolico", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Guler SA, Cuevas-Ocaña S, Nasser M, Wuyts WA, Wijsenbeek MS, Froidure A, Bargagli E, Renzoni EA, Veltkamp M, Spagnolo P, Nunes H, McCarthy C, Molina-Molina M, Bonella F, Poletti V, Kreuter M, Antoniou KM, Moor CC. ERS International Congress 2021: highlights from the Interstitial Lung Diseases Assembly. ERJ Open Res 2022; 8:00640-2021. [PMID: 35615418 PMCID: PMC9124869 DOI: 10.1183/23120541.00640-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/04/2021] [Indexed: 11/05/2022] Open
Abstract
This article provides an overview of scientific highlights in the field of interstitial lung disease (ILD), presented at the virtual European Respiratory Society Congress 2021. A broad range of topics was discussed this year, ranging from translational and genetic aspects to novel innovations with the potential to improve the patient pathway. Early Career Members summarize a selection of interesting findings from different congress sessions, together with the leadership of Assembly 12 – Interstitial Lung Disease.
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45
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Ravaglia C, Poletti V. Transbronchial lung cryobiopsy for the diagnosis of interstitial lung diseases. Curr Opin Pulm Med 2022; 28:9-16. [PMID: 34750300 DOI: 10.1097/mcp.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Transbronchial lung cryobiopsy has shown promise in several studies in providing meaningful histological information in the multidisciplinary team diagnosis of fibrotic interstitial lung diseases. The purpose of this review is to describe recent literature providing support for the formal integration of cryobiopsy into the algorithm for interstitial lung disease diagnosis. RECENT FINDINGS Histopathological concordance between cryobiopsy and surgical biopsy and diagnostic agreement at multidisciplinary discussion have been reported good; furthermore, cryobiopsy may provide an increased diagnostic confidence to a level likely to influence management. Finally, although cryobiopsy is more likely to provide a probable usual interstitial pneumonia (UIP) pattern than a definite UIP pattern, given the limited sampling of sub-pleural lung parenchyma in most cases, finding of a probable UIP pattern at cryobiopsy samples is strongly predictive of a definite UIP pattern in the corresponding surgical biopsy and when a UIP pattern is found on cryobiopsy sample, this is associated with higher mortality compared with other histological patterns. SUMMARY Cryobiopsy is becoming a valid alternative to surgical lung biopsy for making histopathological diagnosis in patients with interstitial lung diseases of undetermined type in experienced centres, with standardized protocols, in order to have the best risks/diagnostic yields ratio.
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Affiliation(s)
- Claudia Ravaglia
- Department of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Venerino Poletti
- Department of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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46
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Tomassetti S, Colby TV, Wells AU, Poletti V, Costabel U, Matucci-Cerinic M. Bronchoalveolar lavage and lung biopsy in connective tissue diseases, to do or not to do? Ther Adv Musculoskelet Dis 2021; 13:1759720X211059605. [PMID: 34900002 PMCID: PMC8664307 DOI: 10.1177/1759720x211059605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/26/2021] [Indexed: 12/25/2022] Open
Abstract
Bronchoalveolar lavage and lung biopsy (LBx) are helpful in patients with connective tissue diseases (CTD) and interstitial lung diseases (ILD) regardless of cause, including infectious, noninfectious, immunologic, or malignant. The decision whether to perform only bronchoalveolar lavage (BAL), and eventually a subsequent LBx in case of a nondiagnostic lavage, or one single bronchoscopy combining both sampling methods depends on the clinical suspicion, on patient’s characteristics (e.g. increased biopsy risk) and preferences, and on the resources and biopsy techniques available locally (e.g. regular forceps versus cryobiopsy). In CTD-ILD, BAL has major clinical utility in excluding infections and in the diagnosis of specific patterns of acute lung damage (e.g. alveolar hemorrhage, diffuse alveolar damage, and organizing pneumonia). LBx is indicated to exclude neoplasm or diagnose lymphoproliferative lung disorders that in CTD patients are more common than in the general population. Defining BAL cellularity and characterizing the CTD-ILD histopathologic pattern by LBx can be helpful in the differential diagnosis of cases without established CTD [e.g. ILD preceding full-blown CTD, interstitial pneumonia with autoimmune features (IPAF)], but the prognostic and theragnostic role of those findings remains unclear. Few studies in the pretranscriptomics era have investigated the diagnostic and prognostic role of BAL and LBx in CTD-ILD, and it is reasonable to hypothesize that future studies conducted applying innovative techniques on BAL and LBx might open new and unexpected avenues in pathogenesis, diagnosis, and treatment approach to CTD-ILD. This is particularly desirable now that a new drug treatment era is emerging, in which we have more than one therapeutic choice (immunosuppressive agents, antifibrotic drugs, and biological agents). We hope that future research will pave the path toward precision medicine providing data for a more accurate ILD-CTD endotyping that will guide the physicians through targeted therapeutic choices, rather than to the approximative approach ‘one drug fits them all’.
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Affiliation(s)
- Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital and University of Florence, 50121 Florence, Italy
| | - Thomas V Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Athol U Wells
- ILD Unit, Pulmonary Medicine, Royal Brompton Hospital, London, UK
| | - Venerino Poletti
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, ItalyUnit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
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Tomassetti S, Maldonado F, Poletti V. COUNTERPOINT: Should Surgical Lung Biopsy Still Be Performed for Interstitial Lung Disease Evaluation? No. Chest 2021; 160:2011-2014. [PMID: 34872666 DOI: 10.1016/j.chest.2021.06.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sara Tomassetti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy.
| | | | - Venerino Poletti
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of Diseases of the Thorax, G.B. Morgagni Hospital/Bologna University, Forlì, Italy
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Kronborg-White S, Madsen LB, Bendstrup E, Poletti V. PD-L1 Expression in Patients with Idiopathic Pulmonary Fibrosis. J Clin Med 2021; 10:jcm10235562. [PMID: 34884264 PMCID: PMC8658518 DOI: 10.3390/jcm10235562] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 09/20/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) is the most common and severe form within the group of idiopathic interstitial pneumonias. It is characterized by repetitive alveolar injury in genetically susceptible individuals and abnormal wound healing, leading to dysregulated bronchiolar proliferation and excessive deposition of extracellular matrix, causing complete architectural distortion and fibrosis. Epithelial-to-mesenchymal transition is considered an important pathogenic event, a phenomenon also observed in various malignant neoplasms, in which tumor cells express programmed death-ligand one (PD-L1). The aim of this study was to assess the presence of PD-L1 in patients with IPF and other interstitial lung diseases (ILDs). Method: Patients with a clinically and radiologically suspected idiopathic interstitial pneumonia or other ILDs undergoing transbronchial cryobiopsy to confirm the diagnosis at the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, were included in this prospective observational study. Cellular membrane PD-L1 expression in epithelial cells was determined using the DAKO PD-L1 IHC 22C3 PharmDx Kit. Results: Membrane-bound PD-L1 (mPD-L1) was found in twelve (28%) of the forty-three patients with IPF and in five (9%) of the fifty-five patients with other ILDs (p = 0.015). When adjusting for age, gender and smoking status, the odds ratio of having IPF when expressing mPD-L1 in alveolar and/or bronchiolar epithelial cells was 4.3 (CI: 1.3–14.3). Conclusion: Expression of mPD-L1 in epithelial cells in the lung parenchymal zones was detected in a consistent subgroup of patients with IPF compared to other interstitial pneumonias. Larger studies are needed to explore the role of mPD-L1 in patients with IPF.
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Affiliation(s)
- Sissel Kronborg-White
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (V.P.)
- Correspondence:
| | - Line Bille Madsen
- Department of Pathology, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (V.P.)
| | - Venerino Poletti
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (V.P.)
- Department of the Diseases of the Thorax, Ospedale Morgagni, University of Bologna, 47121 Forli, Italy
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Renzoni EA, Poletti V, Mackintosh JA. Disease pathology in fibrotic interstitial lung disease: is it all about usual interstitial pneumonia? Lancet 2021; 398:1437-1449. [PMID: 34499865 DOI: 10.1016/s0140-6736(21)01961-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022]
Abstract
The interstitial pneumonias comprise a diverse group of diseases that are typically defined by their cause (either idiopathic or non-idiopathic) and their distinct histopathological features, for which radiology, in the form of high-resolution CT, is often used as a surrogate. One trend, fuelled by the failure of conventional therapies in a subset of patients and the broad-spectrum use of antifibrotic therapies, has been the focus on the progressive fibrosing phenotype of interstitial lung disease. The histological pattern, known as usual interstitial pneumonia, is the archetype of progressive fibrosis. However, it is clear that progressive fibrosis is not exclusive to this histological entity. Techniques including immunohistochemistry and single-cell RNA sequencing are providing pathogenetic insights and, if integrated with traditional histopathology, are likely to have an effect on the pathological classification of interstitial lung disease. This review, which focuses on the histopathology of interstitial lung disease and its relationship with progressive fibrosis, asks the question: is it all about usual interstitial pneumonia?
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Affiliation(s)
- Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK; Margaret Turner Warwick Centre for Fibrosing Lung Diseases, National Heart and Lung Institute, Imperial College London, London, UK
| | - Venerino Poletti
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Thoracic Diseases Department, GB Morgagni Hospital/University of Bologna, Forlì, Italy
| | - John A Mackintosh
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.
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Gamberini E, Poletti V, Russo E, Circelli A, Benni M, Scognamiglio G, Santonastaso DP, Martino C, Domenichini L, Biondi R, Bastoni G, Brogi E, Ansaloni L, Coccolini F, Fugazzola P, Spiga M, Agnoletti V. Massive aspiration syndrome: a possible indication for "emergent" veno-venous extracorporeal membrane oxygenation?: a case report. J Med Case Rep 2021; 15:499. [PMID: 34625110 PMCID: PMC8499513 DOI: 10.1186/s13256-021-03050-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 08/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is usually performed in cases of severe respiratory failure in which conventional and advanced mechanical ventilation strategies are ineffective in achieving true lung-protective ventilation, thus triggering ventilatory-induced lung injury. If circulatory failure coexists, veno-arterial ECMO (VA-ECMO) may be preferred over VV-ECMO because of its potential for circulatory support. In VA-ECMO, the respiratory contribution is less effective and the complication rate is higher than in the VV configuration. Case presentation The authors present a case in which VV-ECMO was performed in an emergency setting to treat a 68-year-old White male patient who experienced acute respiratory failure after massive aspiration. Despite intubation and intensive care unit admission, multiple organ failure occurred suddenly, thus prompting referral to a level-1 trauma center with an ECMO facility. The patient’s condition slowly improved with VV-ECMO support along with standard treatment for hemodynamic impairment. VV-ECMO was discontinued on day 8. The patient was extubated on day 14 and discharged home fully recovered 34 days after the event. Conclusions Attention was focused on the decision to initiate VV-ECMO support even in the presence of severe hemodynamic derangement, although VA-ECMO could have provided better hemodynamic support but less effective respiratory support.
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Affiliation(s)
- Emiliano Gamberini
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy.
| | - Venerino Poletti
- Chest and Respiratory Diseases Division, Interventional Pneumology Department, Morgagni-Pierantoni Hospital, 47121, Forlì, Italy
| | - Emanuele Russo
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Alessandro Circelli
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Marco Benni
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Giovanni Scognamiglio
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Domenico Pietro Santonastaso
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Costanza Martino
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Linda Domenichini
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Romina Biondi
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Giorgia Bastoni
- Emergency, General and Trauma Surgery Department, Level-1 Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Etrusca Brogi
- Anaesthesia and Intensive Care Department, Level-1 Pisa University Hospital, Pisa, Italy
| | - Luca Ansaloni
- Unit of General Surgery, "San Matteo" Foundation Hospital, Pavia University, Pavia, Italy
| | - Federico Coccolini
- Emergency, General and Trauma Surgery Department, Level-1 Pisa University Hospital, Pisa, Italy
| | - Paola Fugazzola
- Emergency, General and Trauma Surgery Department, Level-1 Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Martina Spiga
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
| | - Vanni Agnoletti
- Anaesthesia and Intensive Care Department, Major Trauma Centre "Maurizio Bufalini" Hospital, 47251, Cesena, Italy
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