179 results on '"Marco Lucchi"'
Search Results
2. Outcomes of Patients With Early and Locally Advanced Lung Cancer: Protocol for the Italian Lung Cancer Observational Study (LUCENT)
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Luca Bertolaccini, Oriana Ciani, Marco Lucchi, Francesco Zaraca, Alessandro Bertani, Roberto Crisci, and Lorenzo Spaggiari
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Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundLung cancer, predominantly non-small cell lung cancer (NSCLC), remains a formidable challenge, necessitating an in-depth understanding of evolving treatment paradigms. The Italian Lung Cancer Observational Study (LUCENT) addresses this need by investigating the outcomes of patients with early and locally advanced lung cancer in Italy. ObjectiveWith a focus on real-world data and patient registries, this study aims to provide comprehensive insights into clinical, psychosocial, and economic impacts, contributing to informed decision-making in health care. MethodsLUCENT is a prospective observational multicenter cohort study enrolling patients eligible for minimally invasive manual, robot-assisted, or traditional open surgery. The study will develop a web-based registry to collect longitudinal surgical, oncological, and socioeconomic outcome data. The primary objectives include performance assessment through the establishment of national benchmarks based on risk-adjusted outcomes and processes of care indicators. The secondary objectives encompass economic and psychosocial impact assessments of innovative technologies and treatment pathways. The multicenter design ensures a diverse and representative study population. ResultsThe evolving landscape of NSCLC treatment necessitates a nuanced approach with consideration of the dynamic shifts in therapeutic strategies. LUCENT strives to fill existing knowledge gaps by providing a platform for collecting and analyzing real-world data, emphasizing the importance of patient-reported outcomes in enhancing the understanding of the disease. By developing a web-based registry, the study not only facilitates efficient data collection but also addresses the limitations of traditional methods, such as suboptimal response rates and costs associated with paper-and-pencil questionnaires. Recruitment will be conducted from January 01, 2024, to December 31, 2026. Follow-up will be performed for a minimum of 2 years. The study will be completed in the year 2028. ConclusionsLUCENT’s potential implications are substantial. Establishing national benchmarks will enable a thorough evaluation of outcomes and care processes, guiding clinicians and policymakers in optimizing patient management. Furthermore, the study’s secondary objectives, focusing on economic and psychosocial impacts, align with the contemporary emphasis on holistic cancer care. Insights gained from this study may influence treatment strategies, resource utilization, and patient well-being, thereby contributing to the ongoing refinement of lung cancer management. Trial RegistrationClinicalTrials.gov NCT05851755; https://clinicaltrials.gov/study/NCT05851755. ISRCTN 67197140; https://www.isrctn.com/ISRCTN67197140 International Registered Report Identifier (IRRID)PRR1-10.2196/57183
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- 2024
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3. Comparative analysis of genetic variants in pleural fluids and solid tissue biopsies of pleural mesothelioma patients: Implications for molecular heterogeneity assessment
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Roberto Silvestri, Filomena Rea, Marianna Vitiello, Gabriele Moretti, Vittorio Aprile, Marco Lucchi, Paolo Aretini, Chiara Maria Mazzanti, Stefano Landi, and Federica Gemignani
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Liquid biopsies ,Pleural mesothelioma ,Cancer-specific mutations ,Whole-exome sequencing ,Tumour heterogeneity ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Objectives: This study aims to determine whether the sequencing of DNA extracted from pleural fluids (PFs) of Pleural Mesothelioma (PM) patients accurately represents the genetic information obtained from the solid tissue counterpart biopsies with particular attention to the identification of single nucleotide variants (SNVs). Materials and methods: Single pleural biopsy, PFs, and blood were collected from PM patients. DNA was extracted from these samples and then subjected to Whole-Exome Sequencing. Results: A higher number of SNVs was identified in PFs than in solid tissue biopsies (STBs). Most SNVs were detected in PFs samples but not in STBs samples, while only a few SNVs were detected in STBs samples but not in PFs samples. Conclusion: The current findings support the notion that PFs might offer a more robust depiction of cancer's molecular diversity. Nonetheless, the current outcomes challenge the assertion that liquid biopsies can encompass the entirety of intra-patient variations. Indeed, a subset of potential cancer-driver SNVs was exclusively identified in STBs. However, relying solely on STBs would have precluded the detection of significant SNVs that were exclusively present in PFs. This implies that while PFs serve as a valuable complement to STBs, they do not supplant them.
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- 2024
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4. Somatic mutations of thymic epithelial tumors with myasthenia gravis
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Eleonora Pardini, Federico Cucchiara, Sara Palumbo, Giulia Tarrini, Alessia Di Vita, Fabio Coppedè, Vanessa Nicolì, Melania Guida, Michelangelo Maestri, Roberta Ricciardi, Vittorio Aprile, Marcello C. Ambrogi, Serena Barachini, Marco Lucchi, and Iacopo Petrini
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GTF2I ,thymoma ,next-generation sequencing ,myasthenia gravis ,thymic epithelial tumors ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundThymic epithelial tumors are rare malignant neoplasms that are frequently associated with paraneoplastic syndromes, especially myasthenia gravis. GTF2I is an oncogene mutated in a subgroup of thymomas that is reputed to drive their growth. However, for GTF2I wild-type tumors, the relevant mutations remain to be identified.MethodsWe performed a meta-analysis and identified 4,208 mutations in 339 patients. We defined a panel of 63 genes frequently mutated in thymic epithelial tumors, which we used to design a custom assay for next-generation sequencing. We sequenced tumor DNA from 67 thymomas of patients with myasthenia gravis who underwent resection in our institution.ResultsAmong the 67 thymomas, there were 238 mutations, 83 of which were in coding sequences. There were 14 GTF2I mutations in 6 A, 5 AB, 2 B2 thymomas, and one in a thymoma with unspecified histology. No other oncogenes showed recurrent mutations, while sixteen tumor suppressor genes were predicted to be inactivated. Even with a dedicated assay for the identification of specific somatic mutations in thymic epithelial tumors, only GTF2I mutations were found to be significantly recurrent.ConclusionOur evaluation provides insights into the mutational landscape of thymic epithelial tumors, identifies recurrent mutations in different histotypes, and describes the design and implementation of a custom panel for targeted resequencing. These findings contribute to a better understanding of the genetic basis of thymic epithelial tumors and may have implications for future research and treatment strategies.
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- 2023
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5. Editorial: Advances in malignant pleural mesothelioma: Diagnosis, treatment, and molecular mechanisms
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Maria Giovanna Mastromarino, Vittorio Aprile, and Marco Lucchi
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malignant pleural mesothelioma ,diagnosis ,treatment ,molecular mechanisms ,multimodality strategy ,precision oncology ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2023
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6. New Immunohistochemical Markers for Pleural Mesothelioma Subtyping
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Iosè Di Stefano, Greta Alì, Anello Marcello Poma, Rossella Bruno, Agnese Proietti, Cristina Niccoli, Carmelina Cristina Zirafa, Franca Melfi, Maria Giovanna Mastromarino, Marco Lucchi, and Gabriella Fontanini
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pleural mesothelioma ,subtypes ,immunohistochemistry ,Mesothelin ,Claudin-15 ,Complement Factor B (CFB) ,Medicine (General) ,R5-920 - Abstract
Pleural mesothelioma (PM) comprises three main subtypes: epithelioid, biphasic and sarcomatoid, which have different impacts on prognosis and treatment definition. However, PM subtyping can be complex given the inter- and intra-tumour morphological heterogeneity. We aim to use immunohistochemistry (IHC) to evaluate five markers (Mesothelin, Claudin-15, Complement Factor B, Plasminogen Activator Inhibitor 1 and p21-activated Kinase 4), whose encoding genes have been previously reported as deregulated among PM subtypes. Immunohistochemical expressions were determined in a case series of 73 PMs, and cut-offs for the epithelioid and non-epithelioid subtypes were selected. Further validation was performed on an independent cohort (30 PMs). For biphasic PM, the percentage of the epithelioid component was assessed, and IHC evaluation was also performed on the individual components separately. Mesothelin and Claudin-15 showed good sensitivity (79% and 84%) and specificity (84% and 73%) for the epithelioid subtype. CFB and PAK4 had inferior performance, with higher sensitivity (89% and 84%) but lower specificity (64% and 36%). In the biphasic group, all markers showed different expression when comparing epithelioid with sarcomatoid areas. Mesothelin, Claudin-15 and CFB can be useful in subtype discrimination. PAI1 and PAK4 can improve component distinction in biphasic PM.
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- 2023
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7. Case report: A giant lung leiomyosarcoma: From an accurate diagnosis to a successful surgery. A rare case and brief literature review
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Elisa Sicolo, Maria Giovanna Mastromarino, Giacomo Rabazzi, Diana Bacchin, Greta Ali, Vittorio Aprile, and Marco Lucchi
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primary lung leiomyosarcoma ,lung cancer ,thoracic surgery ,sterno-thoracotomy ,pneumonectomy ,transcatheter arterial embolization ,Surgery ,RD1-811 - Abstract
Primary pulmonary leiomyosarcomas (PPLs) are incredibly rare tumors, characterized by an often-aggressive clinical behavior. Diagnosis is frequently incidental. Whenever present, symptoms are nonspecific, thus PPLs are usually misdiagnosed as other more common respiratory diseases or lung cancer subtypes. Surgery is the best treatment choice and in the therapeutic strategy, timeliness and radicality are of major importance. We report the case of a huge left PPL, successfully treated with salvage surgery after a careful multidisciplinary preoperative assessment, which permitted a prompt diagnostic path and surgery.
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- 2022
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8. New Insights in Pleural Mesothelioma Classification Update: Diagnostic Traps and Prognostic Implications
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Maria Giovanna Mastromarino, Alessandra Lenzini, Vittorio Aprile, Greta Alì, Diana Bacchin, Stylianos Korasidis, Marcello Carlo Ambrogi, and Marco Lucchi
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malignant pleural mesothelioma ,tumor grade ,mesothelioma classification ,histological subtypes ,epithelioid mesothelioma ,histology ,Medicine (General) ,R5-920 - Abstract
The 2021 WHO Classification of Tumors of the Pleura has introduced significant changes in mesothelioma codification beyond the three current histological subtypes—epithelioid, sarcomatoid and biphasic. Major advances since the 2015 WHO classification include nuclear grading and the introduction of architectural patterns, cytological and stromal features for epithelioid diffuse mesothelioma. Mesothelioma in situ has been recognized as a diagnostic category. Demonstration of loss of BAP1 or MTAP by immunohistochemistry, or CDKN2A homozygous deletion by FISH, is valuable in establishing the diagnosis of epithelioid mesothelioma. Recent emerging data proved that grading and histological subtypes have prognostic implications and may be helpful to patient risk stratification and clinical management. Nevertheless, the latest mesothelioma classification increases the already non-negligible diagnostic pitfalls, especially concerning differential diagnosis of pre-invasive tumors. In this review, recent changes in histologic classification of mesothelioma and advances in molecular markers are presented and their relation to diagnostic challenges and prognostic implications is discussed.
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- 2022
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9. Prevalence of Delta-Like Protein 3 in a Consecutive Series of Surgically Resected Lung Neuroendocrine Neoplasms
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Greta Alì, Iosè Di Stefano, Anello Marcello Poma, Stefano Ricci, Agnese Proietti, Federico Davini, Marco Lucchi, Franca Melfi, and Gabriella Fontanini
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lung neuroendocrine tumors ,delta-like protein 3 ,immunohistochemistry ,prognosis ,biomarker ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Delta-like protein 3 (DLL3) is a protein of the Notch pathway, and it is a potential therapeutic target for high-grade lung neuroendocrine tumors (NETs), i.e., small cell lung carcinoma (SCLC) and large cell neuroendocrine carcinoma (LCNEC). However, DLL3 prevalence in lung NETs and its association with clinicopathological characteristics and prognosis remained unclear. We analyzed the immunohistochemical expression of DLL3 and its prognostic role in a consecutive series of 155 surgically resected lung NETs, including typical carcinoid (TC), atypical carcinoid (AC), LCNEC, and SCLC patients. The DLL3 expression was categorized as high (>50% positive tumor cells) or low (
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- 2021
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10. Investigation of MLH1, MGMT, CDKN2A, and RASSF1A Gene Methylation in Thymomas From Patients With Myasthenia Gravis
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Fabio Coppedè, Roberta Ricciardi, Angela Lopomo, Andrea Stoccoro, Anna De Rosa, Melania Guida, Loredana Petrucci, Michelangelo Maestri, Marco Lucchi, and Lucia Migliore
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epigenetics ,DNA methylation ,CDKN2A ,RASSF1A ,MLH1 ,MGMT ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
A feature of thymomas is their frequent association with myasthenia gravis (MG), an autoimmune disease characterized by the production of autoantibodies directed to different targets at the neuromuscular junction. Indeed, almost 30–40% of thymomas are found in patients with a type of MG termed thymoma-associated MG (TAMG). Recent studies suggest that TAMG-associated thymomas could represent a molecularly distinct subtype of thymic epithelial tumors (TETs), but few data are still available concerning the epigenetic modifications occurring in TAMG tissues. The promoter methylation levels of DNA repair (MLH1 and MGMT) and tumor suppressor genes (CDKN2A and RASSF1A) have been frequently investigated in TETs, but methylation data in TAMG tissues are scarce and controversial. To further address this issue, we investigated MLH1, MGMT, CDKN2A, and RASSF1A methylation levels in blood samples and surgically resected thymomas from 69 patients with TAMG and in the adjacent normal thymus available from 44 of them. Promoter methylation levels of MLH1, MGMT, CDKN2A, and RASSF1A genes were not increased in cancer with respect to healthy tissues and did not correlate with the histological or pathological features of the tumor or with the MG symptoms. The present study suggests that hypermethylation of these genes is not frequent in TAMG tissues.
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- 2020
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11. Gene Expression Analysis of Biphasic Pleural Mesothelioma: New Potential Diagnostic and Prognostic Markers
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Rossella Bruno, Anello Marcello Poma, Greta Alì, Claudia Distefano, Agnese Proietti, Antonio Chella, Marco Lucchi, Franca Melfi, Renato Franco, and Gabriella Fontanini
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biphasic pleural mesothelioma ,gene expression ,nanoString system ,diagnosis ,prognosis ,biomarkers ,Medicine (General) ,R5-920 - Abstract
Biphasic is the second most common histotype of pleural mesothelioma (PM). It shares epithelioid and sarcomatoid features and is challenging to diagnose. The aim of this study was to identify biphasic PM markers to improve subtyping and prognosis definition. The expression levels of 117 cancer genes, evaluated using the nanoString system, were compared between the three major histotypes (epithelioid, sarcomatoid, and biphasic), and expression differences within biphasic PM were evaluated in relation to the percentage of epithelioid components. Biphasic PM overexpressed CTNNA1 and TIMP3 in comparison to sarcomatoid, and COL16A1 and SDC1 in comparison to epithelioid PM. CFB, MSLN, CLDN15, SERPINE1, and PAK4 were deregulated among all histotypes, leading to the hypothesis of a gradual expression from epithelioid to sarcomatoid PM. According to gene expression, biphasic PM samples were divided in two clusters with a significant difference in the epithelioid component. ADCY4, COL1A1, and COL4A2 were overexpressed in the biphasic group with a low percentage of epithelioid component. Survival analysis using TCGA data showed that high COL1A1 and COL4A2 expression levels correlate with poor survival in PM patients. Herein, we identified markers with the potential to improve diagnosis and prognostic stratification of biphasic PM, which is still an orphan tumor.
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- 2022
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12. Role of microRNA-33a in regulating the expression of PD-1 in lung adenocarcinoma
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Laura Boldrini, Mirella Giordano, Cristina Niccoli, Franca Melfi, Marco Lucchi, Alfredo Mussi, and Gabriella Fontanini
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miR-33a ,PD-1 ,Lung adenocarcinoma ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 ,Cytology ,QH573-671 - Abstract
Abstract Background MiRNAs are vital in functioning as either oncogenes or tumor suppressors in the cell cycle. Target transcripts for immune checkpoint molecules such as PD-1/PD-L1 and (programmed cell death-1/its ligand and cytotoxic T-lymphocyte antigen 4) have proven to be beneficial against several solid tumors, including lung adenocarcinoma. Methods Simultaneous quantification of the expression level of miR-33a and PD-1, PD-L1 and CTLA4 mRNAs with NanoString technology was performed in 88 lung adenocarcinoma specimens. A cohort of 323 lung adenocarcinoma patients from the cancer genome atlas (TCGA) database was further analyzed, in order to test our hypothesis. Potential interference of PD-1, PD-L1 and CTLA4 gene expression by miR-33a was predicted using the microRNA target prediction program RNA22. Results High miR-33a expression was significantly associated with younger (p = 0.005), female (p = 0.04), patients with low grade (p
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- 2017
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13. Deregulation of miRNAs in malignant pleural mesothelioma is associated with prognosis and suggests an alteration of cell metabolism
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Chiara De Santi, Ombretta Melaiu, Alessandra Bonotti, Luciano Cascione, Gianpiero Di Leva, Rudy Foddis, Alfonso Cristaudo, Marco Lucchi, Marco Mora, Anna Truini, Andrea Tironi, Bruno Murer, Renzo Boldorini, Monica Cipollini, Federica Gemignani, Pierluigi Gasparini, Luciano Mutti, and Stefano Landi
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Medicine ,Science - Abstract
Abstract Malignant pleural mesothelioma (MPM) is an aggressive human cancer and miRNAs can play a key role for this disease. In order to broaden the knowledge in this field, the miRNA expression was investigated in a large series of MPM to discover new pathways helpful in diagnosis, prognosis and therapy. We employed nanoString nCounter system for miRNA profiling on 105 MPM samples and 10 healthy pleura. The analysis was followed by the validation of the most significantly deregulated miRNAs by RT-qPCR in an independent sample set. We identified 63 miRNAs deregulated in a statistically significant way. MiR-185, miR-197, and miR-299 were confirmed differentially expressed, after validation study. In addition, the results of the microarray analysis corroborated previous findings concerning miR-15b-5p, miR-126-3p, and miR-145-5p. Kaplan-Meier curves were used to explore the association between miRNA expression and overall survival (OS) and identified a 2-miRNA prognostic signature (Let-7c-5p and miR-151a-5p) related to hypoxia and energy metabolism respectively. In silico analyses with DIANA-microT-CDS highlighted 5 putative targets in common between two miRNAs. With the present work we showed that the pattern of miRNAs expression is highly deregulated in MPM and that a 2-miRNA signature can be a new useful tool for prognosis in MPM.
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- 2017
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14. Expression of miRNA-25 in young and old lung adenocarcinoma
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Laura Boldrini, Mirella Giordano, Franca Melfi, Marco Lucchi, and Gabriella Fontanini
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lung adenocarcinoma ,micrornas ,mir-25 ,phosphatase and tensin homolog ,young ,Medicine - Abstract
Background: An appropriate personalized molecular testing ensures the most efficacious treatment in lung cancer. It is still controversial whether younger lung adenocarcinoma (LUAD) patients have different molecular features compared with their older counterparts. MicroRNAs have been involved in lung cancer and their altered expression has been suggested as a potential biomarker in the pathogenesis, diagnosis, prognosis, and therapy of LUAD. Materials and Methods: To analyze putative differences in miR-25 expression between young (with age ≤50 years) and old adenocarcinoma patients, we quantified miR-25 levels with NanoString technology in 88 LUAD specimens. We further investigated a cohort of 309 LUAD patients from the cancer genome atlas (TCGA) database to test our hypothesis. Results: miR-25 expression was upregulated in young LUAD patients in comparison to the older ones (P = 0.03) in our series. The analysis of public database TCGA confirmed our results, which miR-25 differentially expressed in the two aged groups (P = 0.0009). Moreover, a consequential pairing of miR-25 with a target region in phosphatase and tensin homolog (PTEN) 3' untranslated region (UTR) and actually low PTEN expression seemed to be associated with high miR-25 (P = 0.001) in young patients. Conclusions: The interaction of miR-25 and PTEN in young LUAD may define a subgroup of patients, highlighting the concept of molecular testing in different age subtypes.
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- 2021
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15. Association of the DNMT3B -579G>T polymorphism with risk of thymomas in patients with myasthenia gravis.
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Fabio Coppedè, Roberta Ricciardi, Maria Denaro, Anna De Rosa, Carlo Provenzano, Emanuela Bartoccioni, Angelo Baggiani, Marco Lucchi, Alfredo Mussi, and Lucia Migliore
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Medicine ,Science - Abstract
Increasing evidence suggests a contribution of epigenetic processes in promoting cancer and autoimmunity. Myasthenia gravis (MG) is an autoimmune disease mediated, in approximately 80% of the patients, by antibodies against the nicotinic acetylcholine receptor (AChR+). Moreover, epithelial tumours (thymomas) are present in about 10-20% of the patients, and there is indication that changes in DNA methylation might contribute to the risk and progression of thymomas. However, the role of epigenetics in MG is still not completely clarified. In the present study we investigated if a common polymorphism (-579G>T: rs1569686) in the promoter of the DNMT3B gene coding for the DNA methyltransferase 3B, an enzyme that mediates DNA methylation, increases the risk to develop MG or MG-associated thymomas. The study polymorphism was selected based on recent reports and a literature meta-analysis suggesting association with increased risk of various types of cancer. We screened 324 AChR+ MG patients (140 males and 184 females, mean age 56.0 ± 16.5 years) and 735 healthy matched controls (294 males and 441 females, mean age 57.3 ± 15.6 years). 94 of the total MG patients had a thymoma. While there was no association with the whole cohort of MG patients, we found a statistically significant association of the DNMT3B-579T allele (OR = 1.51; 95% CI=1.1-2.1, P = 0.01) and the TT homozygous genotype (OR = 2.59; 95% CI=1.4-4.9, P = 0.006) with the risk of thymoma. No association was observed in MG patients without thymoma, even after stratification into clinical subtypes. Present results suggest that the DNMT3B-579T allele might contribute to the risk of developing thymoma in MG patients, particularly in homozygous TT subjects.
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- 2013
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16. Intraoperative prevention and conservative management of postoperative prolonged air leak after lung resection: a systematic review
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Vittorio Aprile, Diana Bacchin, Fabrizia Calabrò, Stylianos Korasidis, Maria Giovanna Mastromarino, Marcello Carlo Ambrogi, and Marco Lucchi
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Pulmonary and Respiratory Medicine - Published
- 2023
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17. Optimism with caution for patients with advanced thymoma and thymic carcinoma
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Marcello Migliore, Marco Lucchi, and Norberto Santana Rodriguez
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- 2023
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18. Thymectomy in severe (Myasthenia Gravis Foundation of America classes IV–V) generalized myasthenia gravis: is the game really worth the candle?
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Debora Brascia, Marco Lucchi, Vittorio Aprile, Melania Guida, Roberta Ricciardi, Federico Rea, Giovanni Maria Comacchio, Marco Schiavon, Maria Carlotta Marino, Stefano Margaritora, Elisa Meacci, Gregorio Spagni, Amelia Evoli, Giulia Lorenzoni, Giulia De Iaco, Angela De Palma, and Giuseppe Marulli
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
OBJECTIVES Total thymectomy in addition to medical treatment is an accepted standard therapy for myasthenia gravis (MG). Patients with severe generalized MG present life-threatening events, poor prognosis and higher risk of postoperative myasthenic crisis. The aim of our study is to investigate neurological and surgical results in patients with Myasthenia Gravis Foundation of America (MGFA) class IV and V MG following thymectomy. METHODS Data on 76 MG patients with preoperative MGFA classes IV and V who underwent thymectomy were retrospectively collected. Primary end points included short-term surgical outcomes and long-term neurological results including the achievement of complete stable remission and any improvement as defined by MGFA Post-Intervention Status criteria. RESULTS There were 27 (35.5%) males and 49 (64.5%) females; 53 (69.7%) were classified as MGFA class IV and 23 (30.3%) as class V. Thymectomy was performed through sternotomy in 25 (32.9%) patients, Video-assisted thoracic surgery (VATS) in 5 (6.6%) and Robot-assisted thoracic surgery (RATS) in 46 (60.5%). The median operative time was 120 (interquartile range: 95; 148) min. In-hospital mortality was observed in 1 (1.3%) patient and postoperative complications in 14 (18.4%) patients. The median postoperative hospital stay was 4 (interquartile range: 3; 6) days. Pathological examination revealed 31 (40.8%) thymic hyperplasia/other benign and 45 (59.2%) thymomas. Cumulative complete stable remission and improvement probabilities were 20.6% and 83.7% at 5 years and 66.9% and 97.6% at 10 years, respectively. A significant improvement rate was found in patients with age at the time of thymectomy of ≤50 years (P = 0.0236), MGFA class V (P = 0.0154) and acetylcholine receptor antibodies positivity (P = 0.0152). CONCLUSIONS Thymectomy in patients with severe MG yields good perioperative outcomes and satisfactory long-term neurological improvement, especially for patients younger than 50 years, with MGFA class V and anti-AChR+ MG.
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- 2023
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19. Surgery for advanced thymic malignancies: how far can we push the limit?
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Marcello Carlo Ambrogi, Vittorio Aprile, and Marco Lucchi
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Pulmonary and Respiratory Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
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20. The International Association for the Study of Lung Cancer Thymic Epithelial Tumor Staging Project: Unresolved Issues to be Addressed for the Next Ninth Edition of the TNM Classification of Malignant Tumors
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Enrico Ruffini, Ramon Rami-Porta, James Huang, Usman Ahmad, Sarit Appel, Andrea Bille, Souheil Boubia, Cecilia Brambilla, Ayten Kayi Cangir, Vanessa Cilento, Frank Detterbeck, Conrad Falkson, Wentao Fang, Pier Luigi Filosso, Giuseppe Giaccone, Nicolas Girard, Francesco Guerrera, Maurizio Infante, Dong Kwan Kim, Marco Lucchi, Mirella Marino, Edith M. Marom, Andrew G. Nicholson, Meinoshin Okumura, Andreas Rimner, Charles B. Simone, Hisao Asamura, Valerie Rusch, Luiz Henrique Araujo, David Beer, Pietro Bertoglio, Ricardo Beyruti, Elisabeth Brambilla, A.K. Cangir, Casey Connolly, Gail Darling, Daniel Dibaba, Xavier Benoit D’ Journo, Wilfried Eberhardt, Jeremy Erasmus, Dean Fennell, Kwun Fong, Françoise Galateau-Salle, Ritu R. Gill, Dorothy Giroux, Meredith Giuliani, Jin Mo Goo, Fred Hirsch, Hans Hoffman, Wayne Hofstetter, Philippe Joubert, Kemp Kernstine, Keith Kerr, Young Tae Kim, Yolande Lievens, Hui Liu, Donald E. Low, Gustavo Lyons, Heber MacMahon, José-María Matilla, Jan van Meerbeeck, Luis M. Montuenga, Andrew Nicholson, Katie Nishimura, Anna Nowak, Isabelle Opitz, Raymond U. Osarogiagbon, Harvey Pass, Marc de Perrot, David Rice, Adam Rosenthal, Shuji Sakai, Paul Van Schil, Navneet Singh, Francisco Suárez, Ricardo M. Terra, William D. Travis, Ming S. Tsao, Paula Ugalde, Shun-Ichi Watanabe, Ignacio Wistuba, Murry Wynes, Yasushi Yatabe, Samuel Armato, Lawek Berzenji, Alex Brunelli, Giuseppe Cardillo, Keneng Chen, Wendy Cooper, Liyan Jiang, Mark Krasnik, Kauro Kubota, Catherine Labbe, Ho Yun Lee, Eric Lim, Geoffrey Liu, Hongxu Liu, Philip Mack, David Naidich, Mizuki Nishino, Marcin Ostrowski, Charles Powell, Carolyn Presley, Paul Martin Putora, Harry Ren, M. Patricia Rivera, Gaetano Rocco, Maria Teresa Ruiz Tzukazan, Robert Samstein, Yu Yang Soon, Kenichi Suda, Martin Tammemägi, Akif Turna, Benny Weksler, Terence Williams, Dawei Yang, Jeff Yang, Masaya Yotsukura, Conrad B. Falkson, Mark Ferguson, Jennifer Sauter, Andrea Wolf, Pier Liugi Filosso, Hong Kwan Kim, and Hong Kwuan Kim
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Pulmonary and Respiratory Medicine ,Lung Neoplasms ,Oncology ,Humans ,Neoplasms, Glandular and Epithelial ,Thymus Neoplasms ,Prognosis ,Neoplasm Staging - Abstract
Thymic epithelial tumors are presently staged using a consistent TNM classification developed by the International Association for the Study of Lung Cancer (IASLC) and approved by the Union for International Cancer Control and the American Joint Committee on Cancer. The stage classification is incorporated in the eight edition of the TNM classification of thoracic malignancies. The IASLC Staging and Prognostic Factors Committee (SPFC)-Thymic Domain (TD) is in charge for the next (ninth) edition expected in 2024. The present article represents the midterm report of the SPFC-TD: in particular, it describes the unresolved issues identified by the group in the current stage classification which are worth being addressed and discussed for the ninth edition of the TNM classification on the basis of the available data collected in the central thymic database which will be managed and analyzed by Cancer Research And Biostatistics. These issues are grouped into issues of general importance and those specifically related to T, N, and M categories. Each issue is described in reference to the most recent reports on the subject, and the priority assigned by the IASLC SPFC-TD for the discussion of the ninth edition is provided.
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- 2022
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21. Chest wall reconstruction with implantable cross-linked porcine dermal collagen matrix: Evaluation of clinical outcomes
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Alessandro Gonfiotti, Domenico Viggiano, Eduart Vokrri, Marco Lucchi, Duilio Divisi, Roberto Crisci, Felice Mucilli, Federico Venuta, and Luca Voltolini
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latissimus dorsi ,polytetrafluoroethylene ,Pulmonary and Respiratory Medicine ,biological mesh ,PM ,PMCWT ,cross-linked porcine dermal collagen matrix ,LD ,secondary chest wall tumor ,CWR, chest wall reconstruction ,LD, latissimus dorsi ,PACLIDEM, porcine-derived acellular cross-linked dermal matrix ,PCWT, primary chest wall tumor ,PM, pectoral major ,PMCWT, primary malignant chest wall tumor ,PTFE, polytetrafluoroethylene ,SCWT, secondary chest wall tumor ,chest wall reconstruction ,chest wall tumor ,titanium bar ,PACLIDEM ,PCWT ,SCWT ,CWR ,primary malignant chest wall tumor ,porcine-derived acellular cross-linked dermal matrix ,primary chest wall tumor ,Surgery ,pectoral major ,PTFE - Abstract
The aim of the study is to evaluate clinical applications, safety, and effectiveness of a porcine-derived acellular cross-linked dermal matrix biological mesh in chest wall reconstruction.We retrospectively analyzed a prospective multicenter database of chest wall reconstructions using a biological mesh in adult patients undergoing operation between October 2013 and December 2020. We evaluated preoperative data, type of resection and reconstruction, hospitalization, 30-day morbidity and mortality, and overall survival.A total of 105 patients (36 women [34.2%]; mean age, 57.0 ± 16.1 years; range, 18-90 years) were included, they have admitted for: primary chest wall tumor (n = 52; 49.5%), secondary chest wall tumor (n = 29; 27.6%), lung hernia (n = 12; 11.4%), trauma (n = 10; 9.6%), and infections (n = 2; 1.9%). The surgical sites were preoperatively defined as at high risk of infection in 28 patients (26.7%) or as infected in 16 (15.2%) patients. Thirty-days morbidity was 30.5% (n = 32 patients); 14 patients (13.3%) had postoperative complications directly related to chest wall surgical resection and/or reconstruction. We experienced no 30-day mortality; 1-year and 2-year mortality was 8.4% and 16.8%, respectively.Biological mesh represents a valuable option in chest wall reconstruction even when surgical sites are infected or at high-risk of infections. This mesh shows low early and late postoperative complication rates and excellent long-term stability.
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- 2022
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22. Cold coagulation in thoracoscopic treatment of primary pneumothorax: a comparison with apicectomy
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Vittorio Aprile, Diana Bacchin, Elena Marrama, Stylianos Korasidis, Maria Giovanna Mastromarino, Gerardo Palmiero, Marcello Carlo Ambrogi, and Marco Lucchi
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OBJECTIVESPrimary spontaneous pneumothorax is a common disease, whose surgical treatment is still enigmatic in terms of timing and technique. Herein, we reported our experience with the parenchymal-sparing technique via cold coagulation (CC), in comparison to stapler apicectomy (SA).METHODSWe retrospectively collected data of all patients with apical blebs or RESULTSOut of 177 patients enrolled, 77 patients (CC group) underwent cold-coagulation of the apex while 100 patients (SA group) were treated with SA. Two groups were comparable in terms of age, surgical indication, intraoperative findings and affected side. CC group had a mean operative time of 43.2 min (standard deviation ± 19.5), shorter than SA group with 49.3 min (standard deviation ± 20.1, P-value: 0.050). Complication rate was significantly different between 2 groups, 5 (7%) and 16 (16%), for the CC and SA groups, respectively (P: 0.048), even if not in terms of prolonged postoperative air leak (P: 0.16). During the follow-up, 13 homolateral recurrences were reported: 2 (3%) in group CC and 11 (11%) in group SA; with a significant difference (P: 0.044). All reinterventions (postoperative prolonged air leak and recurrences) required an SA.CONCLUSIONSParenchymal-sparing technique through CC of apical blebs and bullae is an effective treatment for primary spontaneous pneumothorax and guarantees a good immediate lung sealing, despite stapling still represents the choice treatment in complex cases.
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- 2023
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23. The International Thymic Malignancy Interest Group Classification of Thymoma Recurrence: Survival Analysis and Perspectives
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Enrico Ruffini, Maria Teresa Congedo, Dania Nachira, Filippo Lococo, Marco Chiappetta, Francesco Guerrera, Elisa Meacci, Stylianos Korasidis, Rossana Moroni, Marco Lucchi, Isabella Sperduti, Marcello Carlo Ambrogi, Pier Luigi Filosso, Vittorio Aprile, Edoardo Zanfrini, and Stefano Margaritora
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Prognosis prediction ,Lung Neoplasms ,Thymoma ,Malignancy ,Survival outcome ,Recurrence ,Settore MED/21 - CHIRURGIA TORACICA ,medicine ,Humans ,Survival analysis ,Retrospective Studies ,business.industry ,Significant difference ,Thymus Neoplasms ,medicine.disease ,ITMIG ,Survival Analysis ,Confidence interval ,Surgery ,Neoplasm Recurrence ,Local ,Public Opinion ,Neoplasm Recurrence, Local ,Oncology ,Interest group ,Radiology ,business - Abstract
Introduction The International Thymic Malignancy Interest Group (ITMIG) classifies thymoma recurrences on the basis of the topographic location, but its effectiveness in prognosis prediction has not been well investigated yet. Aims of this study are to analyze survival outcome of patients surgically treated for thymoma recurrence according to the ITMIG recurrence classification and to investigate possible alternatives. Methods From January 1, 1990, to January 7, 2017, data on 135 surgically treated patients for thymoma recurrence from three high-volume centers were collected and retrospectively analyzed. Patients were classified according to the ITMIG classification as local, regional, and distant. The ITMIG classification and alternative classifications were correlated to overall survival (OS). Results According to the ITMIG classification, recurrence was local in 17 (12.5%), regional in 97 (71.8%), and distant in 21 (15.7%) patients, with single localization in 38 (28.2%) and multiple localizations in 97 (71.8%). The 5- and 10-year OS were 79.9% and 49.7% in local, 68.3% and 52.6% in regional, and 66.3% and 35.4% in distant recurrences, respectively, but differences were not statistically significant (p = 0.625). A significant difference in survival was present considering single versus multiple localizations: 5- and 10-year OS of 86.2% and 81.2% versus 61.3% and 31.5% (p = 0.005, hazard ratio = 7.22, 95% confidence interval: 0.147–0.740), respectively. Combining the localization number with the recurrence site, ITMIG locoregional single recurrence had a statistically significant better survival compared with patients with ITMIG locoregional multiple recurrence or ITMIG distant recurrence (p = 0.028). Similarly, a significant difference was present considering intrathoracic single versus intrathoracic multiple versus distant recurrence (p = 0.024). Conclusions The ITMIG classification for thymoma recurrence did not have significant survival differences comparing local, regional, and distant recurrences. Integrating this classification with the number of the localizations may improve its effectiveness in prognosis prediction.
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- 2021
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24. Stereotactic body radiation therapy for the treatment of pleural metastases in patients with thymoma: a retrospective review of 22 patients
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Maurizio Lucchesi, Marco Lucchi, Roberta Ricciardi, Gabriella Pastore, Giulia Pasquini, Franco Casamassima, Iacopo Petrini, Michelangelo Maestri, Antonio Chella, Sabrina Cappelli, Melania Guida, C. Menichelli, Simona Valleggi, and Maria Grazia Fabrini
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Retrospective review ,Thymoma ,business.industry ,Stereotactic body radiation therapy ,Pleural metastases ,medicine.disease ,medicine ,Original Article ,In patient ,Radiology ,business - Abstract
BACKGROUND: Thymomas can benefit of cytoreductive surgery even if a complete resection is not feasible. The pleural cavity is the most common site of progression and the resection of pleural metastases can be performed in selected patients. We evaluated the results of stereotactic body radiation therapy for the treatment of pleural metastases in patients not eligible for surgery. METHODS: We retrospectively selected 22 patients treated with stereotactic body radiation therapy for pleural metastases between 2013 and 2019. According to RECIST criteria 1.1 modified for thymic epithelial tumors, time to local failure and progression free survival were calculated using Kaplan-Meier method. RESULTS: The median age was 40 years (range, 29–73 years). There were 1 A, 3 AB, 3 B1, 3 B2, 3 B2/B3 and 9 B3 thymomas. Pleural metastases and primary tumor were synchronous in 8 patients. Five patients had a single pleural metastatic site and 17 presented multiple localizations. Sixteen patients received stereotactic body radiation therapy on multiple sites of pleural metastases. The median dose of radiation was 30 Gy (range, 24–40 Gy). With a median follow-up of 33.2 months (95% CI: 13.1–53.3 months), ten patients experienced disease progression with a median progression free survival was 20.4 months (95% CI: 10.7–30.0 months). The disease control rate was 79% and 41% after 1 and 2 years, respectively. Local disease control rate was 92% and 78% after 1 and 2 years, respectively. There were not significant differences in progression free survival between patients diagnosed with synchronous and metachronous metastases (P=0.477), across those treated or not with chemotherapy (P=0.189) and between those who received or not a previous surgical resection of the pleural metastases (P=0.871). There were not grade 3–4 toxicities related to the treatment. CONCLUSIONS: Stereotactic body radiation therapy of pleural metastases is feasible and offers a promising local control of diseases. The impact of this treatment on patients’ survival is hardly predictable because of the heterogeneous clinical behavior of thymomas.
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- 2021
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25. Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review
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Alessandro de Sire, Lorenzo Lippi, Vittorio Aprile, Dario Calafiore, Arianna Folli, Francesco D’Abrosca, Stefano Moalli, Marco Lucchi, Antonio Ammendolia, and Marco Invernizzi
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Medicine (miscellaneous) - Abstract
Osteoporosis is a highly prevalent condition affecting a growing number of patients affected by chronic obstructive pulmonary disease (COPD), with crucial implications for risk of fragility fractures, hospitalization, and mortality. Several risk factors have been identified to have a role in osteoporosis development in COPD patients, including corticosteroid therapy, systemic inflammation, smoke, physical activity levels, malnutrition, and sarcopenia. In this scenario, a personalized multitarget intervention focusing on the pathological mechanisms underpinning osteoporosis is mandatory to improve bone health in these frail patients. Specifically, physical exercise, nutritional approach, dietary supplements, and smoke cessation are the cornerstone of the lifestyle approach to osteoporosis in COPD patients, improving not only bone health but also physical performance and balance. On the other hand, pharmacological treatment should be considered for both the prevention and treatment of osteoporosis in patients at higher risk of fragility fractures. Despite these considerations, several barriers still affect the integration of a personalized approach to managing osteoporosis in COPD patients. However, digital innovation solutions and telemedicine might have a role in optimizing sustainable networking between hospital assistance and community settings to improve bone health and reduce sanitary costs of the long-term management of COPD patients with osteoporosis.
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- 2022
26. Impact of High-Grade Patterns in Early-Stage Lung Adenocarcinoma: A Multicentric Analysis
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Pietro Bertoglio, Vittorio Aprile, Luigi Ventura, Maria Cattoni, Dania Nachira, Filippo Lococo, Maria Rodriguez Perez, Francesco Guerrera, Fabrizio Minervini, Giulia Querzoli, Giovanni Bocchialini, Diana Bacchin, Francesca Franzi, Guido Rindi, Salvatore Bellafiore, Federico Femia, Giuseppe Salvatore Bogina, Piergiorgio Solli, Peter Kestenholz, Enrico Ruffini, Massimiliano Paci, Stefano Margaritora, Andrea Selenito Imperatori, Marco Lucchi, Letizia Gnetti, and Alberto Claudio Terzi
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Pulmonary and Respiratory Medicine ,Lung adenocarcinoma ,Male ,Lung Neoplasms ,TNM staging ,Adenocarcinoma of Lung ,Adenocarcinoma ,Prognosis ,Lung adenocarcinoma, TNM staging, Lung cancer, Adenocarcinoma subtypes ,Adenocarcinoma subtypes ,Humans ,Female ,Lung cancer ,Neoplasm Recurrence, Local ,Neoplasm Staging ,Retrospective Studies - Abstract
Objective The presence of micropapillary and solid adenocarcinoma patterns leads to a worse survival and a significantly higher tendency to recur. This study aims to assess the impact of pT descriptor combined with the presence of high-grade components on long-term outcomes in early-stage lung adenocarcinomas. Methods We retrospectively collected data of consecutive resected pT1-T3N0 lung adenocarcinoma from nine European Thoracic Centers. All patients who underwent a radical resection with lymph-node dissection between 2014 and 2017 were included. Differences in Overall Survival (OS) and Disease-Free Survival (DFS) and possible prognostic factors associated with outcomes were evaluated also after performing a propensity score matching to compare tumors containing non-high-grade and high-grade patterns. Results Among 607 patients, the majority were male and received a lobectomy. At least one high-grade histological pattern was seen in 230 cases (37.9%), of which 169 solid and 75 micropapillary. T1a-b-c without high-grade pattern had a significant better prognosis compared to T1a-b-c with high-grade pattern (p = 0.020), but the latter had similar OS compared to T2a (p = 0.277). Concurrently, T1a-b-c without micropapillary or solid patterns had a significantly better DFS compared to those with high-grade patterns (p = 0.034), and it was similar to T2a (p = 0.839). Multivariable analysis confirms the role of T descriptor according to high-grade pattern both for OS (p = 0.024; HR 1.285 95% CI 1.033–1.599) and DFS (p = 0.003; HR 1.196, 95% CI 1.054–1.344, respectively). These results were confirmed after the propensity score matching analysis. Conclusions pT1 lung adenocarcinomas with a high-grade component have similar prognosis of pT2a tumors.
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- 2022
27. A risk stratification scheme for synchronous oligometastatic non-small cell lung cancer developed by a multicentre analysis
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Marco Lucchi, Lorena Costardi, Angelo Morelli, Domenico Viggiano, Angela De Palma, Filippo Tommaso Gallina, Michele Rusca, Giovanni Muriana, Silvia Ceccarelli, Andrea De Vico, Lorenzo Spaggiari, Giuseppe Marulli, Roberto Crisci, Angelo Carretta, Lorenzo Rosso, Enrico Ruffini, Paolo Mendogni, Francesco Puma, Luigi Ventura, Francesco Londero, Luca Bertolaccini, Edoardo Bottoni, Federico Rea, Marco Alloisio, Giuseppe Cardillo, Marco Schiavon, Maria Teresa Congedo, Nicola Tamburini, Pio Maniscalco, Giampiero Negri, Francesco Facciolo, Sara Ricciardi, Stefano Margaritora, Stefano Bongiolatti, Ilaria Ceccarelli, Luca Voltolini, Spaggiari, Lorenzo, Bertolaccini, Luca, Facciolo, Francesco, Tommaso Gallina, Filippo, Rea, Federico, Schiavon, Marco, Margaritora, Stefano, Congedo, Mariateresa, Lucchi, Marco, Ceccarelli, Ilaria, Alloisio, Marco, Bottoni, Edoardo, Negri, Giampiero, Carretta, Angelo, Cardillo, Giuseppe, Ricciardi, Sara, Ruffini, Enrico, Costardi, Lorena, Muriana, Giovanni, Viggiano, Domenico, Rusca, Michele, Ventura, Luigi, Marulli, Giuseppe, De Palma, Angela, Rosso, Lorenzo, Mendogni, Paolo, Crisci, Roberto, De Vico, Andrea, Maniscalco, Pio, Tamburini, Nicola, Puma, Francesco, Ceccarelli, Silvia, Voltolini Stefano Bongiolatti, Luca, Morelli, Angelo, and Londero, Francesco
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,Lung Neoplasms ,Risk classification ,Kaplan-Meier Estimate ,Biostatistics ,Risk Assessment ,Metastasis ,Oligometastatic ,03 medical and health sciences ,0302 clinical medicine ,Carcinoma, Non-Small-Cell Lung ,Settore MED/21 - CHIRURGIA TORACICA ,Internal medicine ,medicine ,Adjuvant therapy ,Humans ,Radical surgery ,Non-Small-Cell Lung ,Lung cancer ,Aged ,Retrospective Studies ,Thoracic surgery ,Prognosis ,Treatment Outcome ,Proportional hazards model ,business.industry ,Medical record ,Carcinoma ,Retrospective cohort study ,medicine.disease ,030104 developmental biology ,030220 oncology & carcinogenesis ,business ,Risk assessment - Abstract
Backgrounds Oligometastatic Non-Small Cell Lung Cancer (NSCLC) patients represent a category without a standard therapeutic approach. However, in selected oligometastatic NSCLC, radical surgery seems to offer a good prognosis. This retrospective study aimed to analyse the long-term outcomes of synchronous oligometastatic patients treated with curative intent and identify the factors associated with better results and the proposal of a risk stratification system for classifying the synchronous oligometastatic NSCLC. Methods The medical records of patients from 18 centres with pathologically diagnosed synchronous oligometastatic NSCLC were retrospectively reviewed. The inclusion criteria were synchronous oligometastatic NSCLC, radical surgical treatment of the primary tumour with or without neoadjuvant/adjuvant therapy and radical treatment of all metastatic sites. The Kaplan – Meier method estimated survivals. A stratified backward stepwise Cox regression model was assessed for multivariable survival analyses. Results 281 patients were included. The most common site of metastasis was the brain, in 50.89 % patients. Median overall survival was 40 months (95 % CI: 29–53). Age ≤65 years (HR = 1.02, 95 % CI: 1.00–1.05; p = 0.019), single metastasis (HR = 0.71, 95 % CI: 0.45–1.13; p = 0.15) and presence of contralateral lung metastases (HR = 0.30, 95 % CI: 0.15 – 0.62; p = 0.001) were associated with a good prognosis. The presence of pathological N2 metastases negatively affected survival (HR = 2.00, 95 % CI: 1.21–3.32; p = 0.0065). These prognostic factors were used to build a simple risk classification scheme. Conclusions Treatment of selected synchronous oligometastatic NSCLC with curative purpose could be conducted safely and at acceptable 5-year survival levels, especially in younger patients with pN0 disease.
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- 2021
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28. A Delphi Consensus report from the 'Prolonged Air Leak: A Survey' study group on prevention and management of postoperative air leaks after minimally invasive anatomical resections
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Francesco Zaraca, Alessandro Brunelli, Marco Damiano Pipitone, Amr Abdellateef, Firas Abu Akar, Florian Augustin, Tim Batchelor, Alessandro Bertani, Roberto Crisci, Thomas D’Amico, Xavier Benoit D'Journo, Andrea Droghetti, Wentao Fang, Alessandro Gonfiotti, Miroslav Janík, Marcelo Jiménez, Andreas Kirschbaum, Marko Kostic, Richard Lazzaro, Marco Lucchi, Alessandro Marra, Sudish Murthy, Calvin S H Ng, Dania Nachira, Alessandro Pardolesi, Reinhold Perkmann, René Horsleben Petersen, Vadim Pischik, Michele Dario Russo, Isabelle Opitz, Lorenzo Spaggiari, Paula A Ugalde, Fernando Vannucci, Giulia Veronesi, and Luca Bertolaccini
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Segmentectomy ,Pulmonary and Respiratory Medicine ,Consensus ,Delphi Technique ,Delphi methodology ,General Medicine ,Surveys and Questionnaires ,Lobectomy ,Humans ,Postoperative air leaks ,Surgery ,Prospective Studies ,Lung cancer ,Pneumonectomy ,Cardiology and Cardiovascular Medicine - Abstract
OBJECTIVES This study reports the results of an international expert consensus process evaluating the assessment of intraoperative air leaks (IAL) and treatment of postoperative prolonged air leaks (PAL) utilizing a Delphi process, with the aim of helping standardization and improving practice. METHODS A panel of 45 questions was developed and submitted to an international working group of experts in minimally invasive lung cancer surgery. Modified Delphi methodology was used to review responses, including 3 rounds of voting. The consensus was defined a priori as >50% agreement among the experts. Clinical practice standards were graded as recommended or highly recommended if 50–74% or >75% of the experts reached an agreement, respectively. RESULTS A total of 32 experts from 18 countries completed the questionnaires in all 3 rounds. Respondents agreed that PAL are defined as >5 days and that current risk models are rarely used. The consensus was reached in 33/45 issues (73.3%). IAL were classified as mild (400 ml/min; 74%). If mild IAL are detected, 68% do not treat; if moderate, consensus was not; if severe, 90% favoured treatment. CONCLUSIONS This expert consensus working group reached an agreement on the majority of issues regarding the detection and management of IAL and PAL. In the absence of prospective, randomized evidence supporting most of these clinical decisions, this document may serve as a guideline to reduce practice variation.
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- 2022
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29. Laryngotracheal resection for a post-tracheotomy stenosis in a patient with coronavirus disease 2019 (COVID-19)
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Alessandro Ribechini, Vittorio Aprile, Marco Lucchi, Gabriella Fontanini, and Marcello Carlo Ambrogi
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Pulmonary and Respiratory Medicine ,Mechanical ventilation ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,tracheal surgery ,COVID-19 ,tracheostomy ,respiratory system ,medicine.disease ,Laryngotracheal resection ,Intensive care unit ,Article ,law.invention ,Surgery ,Stenosis ,Tracheotomy ,law ,medicine ,Intubation ,laryngo-tracheal stenosis ,business ,Pathological - Abstract
The current COVID-19 pandemic has shown a relevant rate of patients developing an acute respiratory distress syndrome that requires hospitalization. Approximately 3-17% of hospitalized patients require Intensive Care Unit (ICU) and invasive mechanical ventilation. Initial recommendations advocated for early intubation, while early tracheotomy should not be routinely performed in COVID-19 patients. We report the case of a COVID-19 patient developing laryngo-tracheal stenosis secondary to an open surgical tracheotomy in the ICU. A conservative endoscopic management was not successful and we performed a laryngo-tracheal resection. The specimen was negative for COVID-19 but the pathological examination revealed how the virus damaged the trachea. This case is, as far as we are aware, the first case of laryngo-tracheal surgery in a COVID-19 patient and provides an insight to justify the higher rate of tracheal injuries occurring in intubated COVID-19 patients.
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- 2020
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30. Thymoma‐associated <scp>myasthenia gravis</scp> : Clinical features and predictive value of antiacetylcholine receptor antibodies in the risk of recurrence of thymoma
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Loredana Petrucci, Marco Lucchi, Melania Guida, Laura Baglietto, Marco Fornili, Antonio Chella, Michelangelo Maestri Tassoni, Anna De Rosa, Franca Melfi, and Roberta Ricciardi
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Adult ,Male ,0301 basic medicine ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Thymoma ,medicine.medical_treatment ,Antiacetylcholine receptor antibody ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Receptors, Cholinergic ,Stage (cooking) ,Retrospective Studies ,myasthenia gravis ,Proportional hazards model ,business.industry ,thymoma ,thymoma recurrence ,Autoantibody ,Original Articles ,General Medicine ,Middle Aged ,medicine.disease ,Primary tumor ,Myasthenia gravis ,Thymectomy ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,Original Article ,Female ,Neoplasm Recurrence, Local ,business - Abstract
Background Thymoma‐associated myasthenia gravis (TAMG) is one of the subtypes of myasthenia gravis with autoantibodies against the acetylcholine receptor (AChR‐Ab). We analyzed the clinical features of our cohort of TAMG patients and the changes in AChR‐Ab titer before and after thymectomy in order to identify factors predicting thymoma relapses. Methods We retrospectively assessed: age of MG onset, MG clinical status according to MGFA (Myasthenia Gravis Foundation of America), epoch of thymectomy, post‐thymectomy status, oncological features and surgical approach. AChR‐Ab dosages were measured both before and after thymectomy. Linear regression models were applied to identify clinical determinants of AChR‐Ab titers and the Cox regression model was fitted to estimate the factors associated with the risk of thymoma recurrence. Results The study sample included 239 MG patients, 27 of whom experienced one or more recurrences (median follow‐up time: 4.8 years). The AChR‐Ab titers decreased after first thymectomy (P, In our paper, we retrospectively analyzed the changes in antiacetylcholine receptor antibody (AChR‐Ab) titer before and after thymectomy and the clinical features of thymoma‐associated myasthenia gravis (TAMG) patients in order to identify clinical and serological predictors of thymoma recurrence. Our study emphasizes the importance of a multidisciplinary approach among Neurologists, Oncologists and Thoracic Surgeons, and identifies subgroups of MG patients with high risk of thymoma recurrence who therefore need a more accurate follow‐up.
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- 2020
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31. The IASLC Lung Cancer Staging Project: Analysis of Resection Margin Status and Proposals for Residual Tumor Descriptors for Non–Small Cell Lung Cancer
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John G. Edwards, Kari Chansky, Paul Van Schil, Andrew G. Nicholson, Souheil Boubia, Elisabeth Brambilla, Jessica Donington, Françoise Galateau-Sallé, Hans Hoffmann, Maurizio Infante, Mirella Marino, Edith M. Marom, Jun Nakajima, Marcin Ostrowski, William D. Travis, Ming-Sound Tsao, Yasushi Yatabe, Dorothy J. Giroux, Lynn Shemanski, John Crowley, Marc Krasnik, Hisao Asamura, Ramón Rami-Porta, Valerie Rusch, Luiz Henrique Araujo, David Beer, Pietro Bertoglio, Ricardo Beyruti, Andrea Bille, Vanessa Bolejack, James D. Brierley, A.K. Cangir, David Carbone, Gail Darling, Frank Detterbeck, Xavier Benoit D’Journo, Jessica Donnington, Wilfried Eberhardt, John Edwards, Jeremy Erasmus, Conrad Falkson, Wentao Fang, Dean Fennell, Kwun Fong, Françoise Galateau-Salle, Oliver Gautschi, Ritu Gill, Dorothy Giroux, Meredith Giuliani, Jin Mo Goo, Seiki Hasegawa, Fred Hirsch, Hans Hoffman, Wayne Hofstetter, James Huang, Philippe Joubert, Kemp Kernstine, Keith Kerr, Young Tae Kim, Hong Kwan Kim, Hedy Kindler, Yolande Lievens, Hui Liu, Donald E. Low, Gustavo Lyons, Heber MacMahon, Edith Marom, José-María Matilla, Jan van Meerbeeck, Luis M. Montuenga, Andrew Nicholson, Katie Nishimura, Anna Nowak, Isabelle Opitz, Meinoshin Okumura, Raymond U. Osarogiagbon, Harvey Pass, Marc de Perrot, Helmut Prosch, David Rice, Andreas Rimner, Enrico Ruffini, Shuji Sakai, Navneet Singh, Amy Stoll-D’Astice, Francisco Su´rez, Ricardo M. Terra, Ming S. Tsao, Paula Ugalde, David Waller, Shun-ichi Watanabe, Jacinta Wiens, Ignacio Wistuba, Liyan Jiang, Kaoru Kubota, Akif Turna, Benny Weksler, Maria Teresa Tzukazan, Martin Tammemägi, Charles Powell, David Naidich, Hongxu Liu, Samuel Armato, Alex Brunelli, Giuseppe Cardillo, Elizabeth David, Brigitte Fournier, Mark Krasnik, Kauro Kubota, Catherine Labbe, Eric Lim, Paul Martin Putora, Gaetano Rocco, Pier Luigi Filosso, Kazuya Kondo, Dong Kwan Kim, Giuseppe Giaccone, Marco Lucchi, Thomas Rice, Mark Ferguson, Prasad Adsusmilli, William Travis, Francisco Suárez, Kaura Kubota, Hisao Asamura Shun-ichi, Watanabe, Edith Marom Ramón, Rami-Porta, Ming Tsao, Ming Tsao Shun-ichi, Watanabe, Meredith Guiliani, James Brierley, Ricardo Terra, Ray Osarogiagbon, Luis Montuenga, Hongwei Wang, Françoise Galateau, Jim Mo Goo, Bill Travis, Jose Maria Matilla, Carolle St. Pierre, Ma Teresa Tzukazan, Nicholas Girard, Andreas Rimmer, Francoise Galateau, Prasad Adusumilli, Xavier D’Journo, Donald Low, Adam Rosenthal, and Int Assoc Study Lung Canc Staging
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,Neoplasm, Residual ,03 medical and health sciences ,0302 clinical medicine ,Carcinoma, Non-Small-Cell Lung ,Cytology ,medicine ,Humans ,Lung cancer ,Biology ,Lymph node ,Neoplasm Staging ,Retrospective Studies ,Computer. Automation ,business.industry ,Carcinoma in situ ,Margins of Excision ,Prognosis ,medicine.disease ,Clinical trial ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Resection margin ,Human medicine ,Radiology ,Non small cell ,Lung cancer staging ,business ,Mathematics - Abstract
Objective: Our aim was to validate the prognostic relevance in NSCLC of potential residual tumor (R) descriptors, including the proposed International Association for the Study of Lung Cancer definition for uncertain resection, referred to as R(un). Methods: A total of 14,712 patients undergoing resection with full R status and survival were analyzed. The following were also evaluated: whether fewer than three N2 stations were explored, lobe-specific nodal dissection, extracapsular extension, highest lymph node station status, carcinoma in situ at the bronchial resection margin, and pleural lavage cytologic examination result. Revised categories of R0, R(un), R1, and R2 were tested for survival impact. Results: In all, 14,293 cases were R0, 263 were R1, and 156 were R2 (median survivals not reached, 33 months, and 29 months, respectively). R status correlated with T and N categories. A total of 9290 cases (63%) had three or more N2 stations explored and 6641 cases (45%) had lobespecific nodal dissection, correlated with increasing pN2. Extracapsular extension was present in 62 of 364 cases with available data (17%). The highest station was positive in 942 cases (6.4%). The pleural lavage cytologic examination result was positive in 59 of 1705 cases (3.5%): 13 had carcinoma in situ at the bronchial resection margin. After reassignment because of inadequate nodal staging in 56% of cases, 6070 cases were R0, 8185 were R(un), 301 were R1, and 156 were R2. In node-positive cases, the median survival times were 70, 50, and 30 months for RO, R(un) (p < 0.0001), and R1 (p < 0.001), respectively, with no significant difference between RO and R(un) in pN0 cases. Conclusions: R descriptors have prognostic relevance, with R(un) survival stratifying between R0 and R1. Therefore, a detailed evaluation of R factor is of particular importance in the design and analyses of clinical trials of adjuvant therapies. (C) 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
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- 2020
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32. Pathological and clinical features of multiple cancers and lung adenocarcinoma: a multicentre study
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Pietro Bertoglio, Luigi Ventura, Vittorio Aprile, Maria Angela Cattoni, Dania Nachira, Filippo Lococo, Maria Rodriguez Perez, Francesco Guerrera, Fabrizio Minervini, Letizia Gnetti, Alessandra Lenzini, Francesca Franzi, Giulia Querzoli, Guido Rindi, Salvatore Bellafiore, Federico Femia, Giuseppe Salvatore Bogina, Diana Bacchin, Peter Kestenholz, Enrico Ruffini, Massimiliano Paci, Stefano Margaritora, Andrea Selenito Imperatori, Marco Lucchi, Luca Ampollini, and Alberto Claudio Terzi
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Male ,Pulmonary and Respiratory Medicine ,Adenocarcinoma subtype ,Lung adenocarcinoma ,Lung Neoplasms ,Adenocarcinoma of Lung ,Multiple cancers ,Adenocarcinoma ,Prognosis ,Lung cancer ,Thoracic surgery ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,Neoplasm Staging ,Retrospective Studies - Abstract
OBJECTIVES Lung cancer is increasingly diagnosed as a second cancer. Our goal was to analyse the characteristics and outcomes of early-stage resected lung adenocarcinomas in patients with previous cancers (PC) and correlations with adenocarcinoma subtypes. METHODS We retrospectively reviewed data of patients radically operated on for stage I–II lung adenocarcinoma in 9 thoracic surgery departments between 2014 and 2017. Overall survival (OS) and time to disease relapse were evaluated between subgroups. RESULTS We included 700 consecutive patients. PC were present in 260 (37.1%). Breast adenocarcinoma, lung cancer and prostate cancer were the most frequent (21.5%, 11.5% and 11.2%, respectively). No significant differences in OS were observed between the PC and non-PC groups (P = 0.378), with 31 and 75 deaths, respectively. Patients with PC had smaller tumours and were more likely to receive sublobar resection and to be operated on with a minimally invasive approach. Previous gastric cancer (P = 0.042) and synchronous PC (when diagnosed up to 6 months before lung adenocarcinoma; P = 0.044) were related, with a worse OS. Colon and breast adenocarcinomas and melanomas were significantly related to a lower incidence of high grade (solid or micropapillary, P = 0.0039, P = 0.005 and P = 0.028 respectively), whereas patients affected by a previous lymphoma had a higher incidence of a micropapillary pattern (P = 0.008). CONCLUSIONS In patients with PC, we found smaller tumours more frequently treated with minimally invasive techniques and sublobar resection, probably due to a more careful follow-up. The impact on survival is not uniform and predictable; however, breast and colon cancers and melanoma showed a lower incidence of solid or micropapillary patterns whereas patients with lymphomas had a higher incidence of a micropapillary pattern.
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- 2022
33. An asymptomatic giant AB thymoma in a patient with Down syndrome: a case report
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Elisa Sicolo, Vittorio Aprile, Tommaso Ferrarello, Diana Bacchin, Maria Giovanna Mastromarino, Greta Alì, Marcello Carlo Ambrogi, Marco Lucchi, and Stylianos Korasidis
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Pulmonary and Respiratory Medicine ,Oncology ,Endocrinology, Diabetes and Metabolism ,Medicine (miscellaneous) ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2022
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34. Hyperthermic Intrathoracic Chemotherapy for Malignant Pleural Mesothelioma: The Forefront of Surgery-Based Multimodality Treatment
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Filippo Lococo, Marco Lucchi, Giovanni Guglielmi, Diana Bacchin, Alessandra Lenzini, Marcello Carlo Ambrogi, Stylianos Korasidis, Gerardo Palmiero, Maria Giovanna Mastromarino, and Vittorio Aprile
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Chemotherapy ,medicine.medical_specialty ,business.industry ,Pleural mesothelioma ,medicine.medical_treatment ,Multimodality Treatment ,HITHOC ,Hypertermia ,Local treatment ,Mesothelioma ,Review ,General Medicine ,medicine.disease ,chemotherapy ,Surgery ,local treatment ,mesothelioma ,medicine ,Overall survival ,Medicine ,Complication rate ,Cytoreductive surgery ,business ,Radical resection ,hypertermia - Abstract
Introduction: Malignant Pleural Mesothelioma (MPM) is characterized by an aggressive behavior and an inevitably fatal prognosis, whose treatment is still far from being standardized. The role of surgery is questionable since a radical resection is unattainable in most cases. Hyperthermic IntraTHOracic Chemotherapy (HITHOC) combines the advantages of antitumoral effects together with those of high temperature on the exposed tissues with the aim to improve surgical radicality. Material and Methods: this is a narrative review on the role of HITHOC in the management of MPM patients. To provide data on the beginnings and the historical evolution of this technique, we searched the available literature by selecting the more exhaustive papers on this topic. Results: from 1994 to date different authors experimented HITHOC following a cytoreductive surgery in MPM, obtaining in most cases a good local control and a better overall survival associated to very low complication rate. Conclusions: HITHOC may be considered as a safe, feasible and effective procedure although there is a high heterogeneity between different protocols adopted worldwide. More structured studies are needed to reach a unanimous consensus on this technique.
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- 2021
35. Extracorporeal membrane oxygenation in traumatic tracheal injuries: a bold life-saving option
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Marco Lucchi, Vittorio Aprile, Marcello Carlo Ambrogi, and Stylianos Korasidis
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,business.industry ,medicine.medical_treatment ,030105 genetics & heredity ,law.invention ,03 medical and health sciences ,Editorial ,surgical procedures, operative ,0302 clinical medicine ,law ,Anesthesia ,Ventilation (architecture) ,Extracorporeal membrane oxygenation ,Medicine ,Life saving ,business ,030217 neurology & neurosurgery - Abstract
Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary life-support, and may be very useful in selected cases as traumatic tracheo-bronchial injuries, allowing an efficient gas exchange where ventilation is not feasible. Even if, nowadays, little used, ECMO is an additional arrow in the quiver of the doctors, especially in challenging cases.
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- 2019
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36. Surgery for thymomas: is less worthwhile? A clear answer from the European experience
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Vittorio Aprile and Marco Lucchi
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Thymoma ,business.industry ,medicine.medical_treatment ,Extended thymectomy ,Thymus Neoplasms ,General Medicine ,Thymectomy ,medicine.disease ,Surgery ,medicine ,Thymomectomy ,Humans ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
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37. Liquid Biopsies from Pleural Effusions and Plasma from Patients with Malignant Pleural Mesothelioma: A Feasibility Study
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Stefano Landi, Luciano Mutti, Paolo Aretini, Romano Danesi, Alfonso Cristaudo, Chiara Maria Mazzanti, Gabriele Moretti, Marco Lucchi, Guntulu Ak, Federica Gemignani, Muzaffer Metintas, Francesca Lessi, Alessandra Bonotti, Cecilia Lando, Andrea Bottari, Alessandro Apollo, Marzia Del Re, Rudy Foddis, and Rosa Filiberti
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0301 basic medicine ,Cancer Research ,Poor prognosis ,Pathology ,medicine.medical_specialty ,Somatic cell ,cancer biomarkers ,Article ,cancer-specific mutations ,03 medical and health sciences ,Tumor Biomarkers ,liquid biopsies ,0302 clinical medicine ,medicine ,genomics ,malignant pleural mesothelioma ,Digital droplet pcr ,RC254-282 ,plasma ,circulating tumor DNA ,business.industry ,Pleural mesothelioma ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,030104 developmental biology ,Oncology ,Circulating tumor DNA ,030220 oncology & carcinogenesis ,Cancer biomarkers ,business ,Cancer-specific mutations ,Genomics ,Liquid biopsies ,Malignant pleural mesothelioma ,Plasma - Abstract
Background: Malignant pleural mesothelioma (MPM) is a fatal tumor with a poor prognosis. The recent developments of liquid biopsies could provide novel diagnostic and prognostic tools in oncology. However, there is limited information about the feasibility of this technique for MPMs. Here, we investigate whether cancer-specific DNA sequences can be detected in pleural fluids and plasma of MPM patients as free circulating tumor DNA (ctDNA). Methods: We performed whole-exome sequencing on 14 tumor biopsies from 14 patients, and we analyzed 20 patient-specific somatic mutations with digital droplet PCR (ddPCR) in pleural fluids and plasma, using them as cancer-specific tumor biomarkers. Results: Most of the selected mutations could be detected in pleural fluids (94%) and, noteworthy, in plasma (83%) with the use of ddPCR. Pleural fluids showed similar levels of somatically mutated ctDNA (median = 12.75%, average = 16.3%, standard deviation = 12.3) as those detected in solid biopsies (median = 21.95%, average = 22.21%, standard deviation = 9.57), and their paired difference was weakly statistically significant (p = 0.048). On the other hand, the paired difference between solid biopsies and ctDNA from plasma (median = 0.29%, average = 0.89%, standard deviation = 1.40) was highly statistically significant (p = 2.5 × 10−7), corresponding to the important drop of circulating somatically mutated DNA in the bloodstream. However, despite the tiny amount of ctDNA in plasma, varying from 5.57% down to 0.14%, the mutations were detectable at rates similar to those possible for other tumors. Conclusions: We found robust evidence that mutated DNA is spilled from MPMs, mostly into pleural fluids, proving the concept that liquid biopsies are feasible for MPM patients.
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- 2021
38. MA01.03 PREC Multicentre Restrospective Study: A Preoperative Risk Classification for Synchronous Oligometastatic Non-Small Cell Lung Cancer
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Roberto Crisci, Paolo Mendogni, Francesco Facciolo, Stefano Margaritora, Enrico Ruffini, Lorenzo Spaggiari, Francesco Londero, Maria Teresa Congedo, A. De Palma, Edoardo Bottoni, Marco Alloisio, Giuseppe Marulli, Marco Schiavon, Angelo Carretta, Nicola Tamburini, Stefano Bongiolatti, Federico Rea, Giovanni Muriana, Angelo Morelli, Sara Ricciardi, Luca Voltolini, Silvia Ceccarelli, A. De Vico, Francesco Puma, Marco Lucchi, Ilaria Ceccarelli, Laura Ventura, Luca Bertolaccini, Lorena Costardi, Pio Maniscalco, Domenico Viggiano, Giampiero Negri, Filippo Tommaso Gallina, G. Cardillo, Michele Rusca, Lorenzo Rosso, Bertolaccini, L., Spaggiari, L., Facciolo, F., Gallina, F., Rea, F., Schiavon, M., Margaritora, S., Congedo, M. T., Lucchi, M., Ceccarelli, I., Alloisio, M., Bottoni, E., Negri, G., Carretta, A., Cardillo, G., Ricciardi, S., Ruffini, E., Costardi, L., Muriana, G., Viggiano, D., Rusca, M., Ventura, L., Marulli, G., De Palma, A., Rosso, L., Mendogni, P., Crisci, R., De Vico, A., Maniscalco, P., Tamburini, N., Puma, F., Ceccarelli, S., Voltolini, L., Bongiolatti, S., Morelli, A., and Londero, F.
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Pulmonary and Respiratory Medicine ,Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,Preoperative risk ,medicine ,Non small cell ,Lung cancer ,medicine.disease ,business - Published
- 2021
39. Evaluation of the Incidence and Potential Mechanisms of Tracheal Complications in Patients With COVID-19
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Giacomo Fiacchini, Stefano Berrettini, Etrusca Brogi, Luca Bruschini, Alessandro Ribechini, Francesco Forfori, Pietro Bertini, Marco Lucchi, Fabio Guarracino, and Domenico Tricò
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Mechanical ventilation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Tracheoesophageal fistula ,Retrospective cohort study ,030204 cardiovascular system & hematology ,medicine.disease ,Intensive care unit ,Surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Pneumothorax ,Respiratory failure ,Otorhinolaryngology ,law ,medicine ,030212 general & internal medicine ,medicine.symptom ,business ,Subcutaneous emphysema ,Original Investigation ,Cohort study - Abstract
Importance Full-thickness tracheal lesions and tracheoesophageal fistulas are severe complications of invasive mechanical ventilation. The incidence of tracheal complications in ventilated patients with coronavirus disease 2019 (COVID-19) is unknown. Objective To evaluate whether patients with COVID-19 have a higher incidence of full-thickness tracheal lesions and tracheoesophageal fistulas than matched controls and to investigate potential mechanisms. Design, Setting, and Participants This is a retrospective cohort study in patients admitted to the intensive care unit in a tertiary referral hospital. Among 98 consecutive patients with COVID-19 with severe respiratory failure, 30 underwent prolonged (≥14 days) invasive mechanical ventilation and were included in the COVID-19 group. The control group included 45 patients without COVID-19. Patients with COVID-19 were selected from March 1 to May 31, 2020, while the control group was selected from March 1 to May 31, 2019. Exposures Patients with COVID-19 had severe acute respiratory syndrome coronavirus 2 infection diagnosed by nasopharyngeal/oropharyngeal swabs and were treated according to local therapeutic procedures. Main Outcomes and Measures The primary study outcome was the incidence of full-thickness tracheal lesions or tracheoesophageal fistulas in patients with prolonged invasive mechanical ventilation. Results The mean (SD) age was 68.8 (9.0) years in the COVID-19 group and 68.5 (14.1) years in the control group (effect size, 0.3; 95% CI, −5.0 to 5.6). Eight (27%) and 15 (33%) women were enrolled in the COVID-19 group and the control group, respectively. Fourteen patients (47%) in the COVID-19 group had full-thickness tracheal lesions (n = 10, 33%) or tracheoesophageal fistulas (n = 4, 13%), while 1 patient (2.2%) in the control group had a full-thickness tracheal lesion (odds ratio, 38.4; 95% CI, 4.7 to 316.9). Clinical and radiological presentations of tracheal lesions were pneumomediastinum (n = 10, 71%), pneumothorax (n = 6, 43%), and/or subcutaneous emphysema (n = 13, 93%). Conclusions and Relevance In this cohort study, almost half of patients with COVID-19 developed full-thickness tracheal lesions and/or tracheoesophageal fistulas after prolonged invasive mechanical ventilation. Attempts to prevent these lesions should be made and quickly recognized when they occur to avoid potentially life-threatening complications in ventilated patients with COVID-19.
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- 2021
40. Prognostic factors affecting survival after pulmonary resection of metastatic renal cell carcinoma: A multicenter experience
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Marco Mammana, Federico Rea, Marco Chiappetta, Ernesto Rossi, Giovanni Schinzari, Marco Lucchi, Fabrizia Calabrò, Diomira Tabacco, Marcello Carlo Ambrogi, Leonardo Petracca Ciavarella, Lorenzo Spaggiari, Stefano Margaritora, Andrea Lloret Madrid, Maria Letizia Vita, Dania Nachira, Jessica Evangelista, Elizabeth Katherine Anna Triumbari, Francesco Petrella, Elisa Meacci, Edoardo Zanfrini, Maria Teresa Congedo, and Giampaolo Tortora
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Cancer Research ,medicine.medical_specialty ,Metastatic renal cell carcinoma ,030232 urology & nephrology ,Urology ,urologic and male genital diseases ,Article ,03 medical and health sciences ,0302 clinical medicine ,Renal cell carcinoma ,Settore MED/21 - CHIRURGIA TORACICA ,medicine ,In patient ,Lung surgery ,Lung metastases ,Metastasectomy ,neoplasms ,RC254-282 ,Lung ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Histology ,medicine.disease ,female genital diseases and pregnancy complications ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Pulmonary resection ,business ,Clear cell - Abstract
In this paper we aimed to address the role of pulmonary metastasectomy (PM) in patients affected by Lung Metastases (LM) from Renal Cell Carcinoma (RCC) and to analyse prognostic factors affecting overall survival (OS), disease-free interval (DFI) between primary RCC and first LM, and disease-free survival (DFS) after PM and before lung recurrence. Medical records of 210 patients who underwent PM from RCC in 4 Italian Thoracic Centres, from January 2000 to September 2019, were collected and analysed. All patients underwent RCC resection before lung surgery. The main RCC histology was clear cells (188, 89.5%). The 5- and 10-year OS from the first lung operation were 60% and 34%, respectively. LM synchronous with RCC (p = 0.01) and (Karnofsky Performance Status Scale) KPSS <, 80% (p <, 0.001) negatively influenced OS. Five- and 10-year DFI were 54% and 28%, respectively. The main factors negatively influencing DFI were: male gender (p = 0.039), KPSS <, 80% (p = 0.009) and lactate dehydrogenase >, 1.5 times 140 U/L (p = 0.001). Five- and 10-year disease-free survival were 54% and 28%, respectively, multiple LM (p = 0.036), KPSS <, 80% (p = 0.001) and histology of RCC other than clear cells negatively influenced disease-free survival. Conclusions: patients with KPSS >, 80%, single metachronous LM with a long DFI from RCC diagnosis, and clear cell histology, benefit from pulmonary metastasectomy.
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- 2021
41. Hypertermic Intrathoracic Chemotherapy (HITHOC) for thymoma: a narrative review on indications and results
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Vittorio Aprile, Marco Lucchi, Roberta Ricciardi, Stylianos Korasidis, Iacopo Petrini, Marcello Carlo Ambrogi, and Diana Bacchin
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Chemotherapy ,medicine.medical_specialty ,Thymoma ,business.industry ,medicine.medical_treatment ,intracavitary chemotherapy ,Review Article on Hyperthermic Intraoperative Chemotherapy (HITHOC) in Thoracic Surgical Oncology ,General Medicine ,Hypertermic intrathoracic chemotherapy (HITHOC) ,thymoma ,hyperthermia ,redo-surgery ,medicine.disease ,Myasthenia gravis ,Surgery ,Radiation therapy ,Natural history ,Serous fluid ,medicine ,Disseminated disease ,Stage (cooking) ,business - Abstract
OBJECTIVE: With this narrative review, we retraced the history of hypertermic intrathoracic chemotherapy (HITHOC) since the beginning, analyzing literature on operative technique, feasibility and efficacy of this treatment. Moreover, we report the fifteen-year experience of our center in this relatively new technique, for what concerns both early postoperative results and long-term oncological outcomes. BACKGROUND: Thymomas are frequently misdiagnosed and recognized in advanced stage, often with pleural dissemination, especially when not associated to Myasthenia Gravis that allows an early diagnosis during the initial assessment. Moreover, the natural history of locally advanced thymoma is characterized by a high rate of pleural or pericardial relapses. Surgery has always been considered a milestone in thymoma’s treatment, even in case of serous dissemination or relapses, although his role as exclusive therapy does not guarantee an acceptable local disease control. In case of disseminated disease, different multidisciplinary protocols have been experimented, from chemotherapy to radiation therapy, alone or associated to surgery, in order to increase overall and disease-free survival, but the breakthrough happened in the early 90s with the introduction of HITHOC following surgery. Combination of surgery and HITHOC resulted in less toxic than systemic chemotherapy and providing a good local disease control in patients with stage IVa thymomas or thymoma’s pleural recurrences. METHODS: We searched PubMed for relevant literature, up to January 2020, on hypertermic intrapleural chemotherapy for thymomas (TPR or DNT), selecting only those reporting information about HITHOC protocol used, postoperative course and oncological outcomes. CONCLUSIONS: HITHOC is a safe and feasible procedure, with a very low complication rate and negligible systemic effects of chemotherapeutic agents, effective in controlling both TPR and DNT, in particular as regards local disease-free survival. KEYWORDS: Hypertermic intrathoracic chemotherapy (HITHOC); thymoma; intracavitary chemotherapy; hyperthermia; redo-surgery
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- 2021
42. Prevalence of Delta-Like Protein 3 in a Consecutive Series of Surgically Resected Lung Neuroendocrine Neoplasms
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Federico Davini, S. Ricci, Greta Alì, Anello Marcello Poma, Marco Lucchi, Franca Melfi, Iosè Di Stefano, Agnese Proietti, and Gabriella Fontanini
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Cancer Research ,medicine.medical_specialty ,Neuroendocrine tumors ,Gastroenterology ,delta-like protein 3 ,Internal medicine ,medicine ,Stage (cooking) ,RC254-282 ,Original Research ,Lung ,biology ,biomarker ,immunohistochemistry ,lung neuroendocrine tumors ,prognosis ,business.industry ,Chromogranin A ,Cancer ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,medicine.anatomical_structure ,Oncology ,biology.protein ,Biomarker (medicine) ,Immunohistochemistry ,Small Cell Lung Carcinoma ,business - Abstract
Delta-like protein 3 (DLL3) is a protein of the Notch pathway, and it is a potential therapeutic target for high-grade lung neuroendocrine tumors (NETs), i.e., small cell lung carcinoma (SCLC) and large cell neuroendocrine carcinoma (LCNEC). However, DLL3 prevalence in lung NETs and its association with clinicopathological characteristics and prognosis remained unclear. We analyzed the immunohistochemical expression of DLL3 and its prognostic role in a consecutive series of 155 surgically resected lung NETs, including typical carcinoid (TC), atypical carcinoid (AC), LCNEC, and SCLC patients. The DLL3 expression was categorized as high (>50% positive tumor cells) or low (vs.
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- 2021
43. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study
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Dmitri, Nepogodiev, Joana Ff Simoes, Elizabeth, Li, Maria, Picciochi, James, C Glasbey, Glauco, Baiocchi, Ruth, Blanco-Colino, Daoud, Chaudhry, Ehab, Alameer, Kariem, El-Boghdadly, Funmilola, Wuraola, Dhruva, Ghosh, Rohan, R Gujjuri, Ewen, M Harrison, Herman, Lule, Haytham, Kaafarani, Mohammad, Khosravi, Irmgard, Kronberger, Sezai, Leventoğlu, Harvinder, Mann, Kenneth, A Mclean, Mengistu Gebreyohanes Mengesha, Maria Marta Modolo, Faustin, Ntirenganya, Lisa, Norman, Oumaima, Outani, Riinu, Pius, Peter, Pockney, Ahmad Uzair Qureshi, April Camilla Roslani, Sohei, Satoi, Catherine, Shaw, Aneel, Bhangu, Omar, M Omar, Waheed-Ul-Rahman, Ahmed, Leah, Argus, Alasdair, Ball, Edward, P Bywater, Amanpreet, Brar, Brett, E Dawson, Irani, Duran, Muhammed, Elhadi, Conor, S Jones, Sivesh, K Kamarajah, James, M Keatley, Samuel, Lawday, Ella, J Marson, Riinu, Ots, Irène, Santos, Elliott, H Taylor, Isobel, M Trout, Chris, Varghese, Mary, L Venn, William, Xu, Irida, Dajti, Arben, Gjata, Salah Eddine Oussama Kacimi, Luis, Boccalatte, Daniel, Cox, Philip, Townend, Felix, Aigner, Irmgard Elisabeth Kronberger, Elgun, Samadov, Amer, Alderazi, Kamral, Hossain, Greg, Padmore, Gabrielle van Ramshorst, Ismaïl, Lawani, Anis, Cerovac, Samir, Delibegovic, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad, Gohar, Mihail, Slavchev, Chukwuemeka, Nwegbu, Arnav, Agarwal, Janet, Martin, Joshua, Ng-Kamstra, Maricarmen, Olivos, Wenhui, Lou, Dong-Lin, Ren, Jose Andres Calvache, Carlos, J Perez Rivera, Ana Danic Hadzibegovic, Tomislav, Kopjar, Jakov, Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos, Gouvas, Jaroslav, Klat, René, Novysedlák, Nicolas, Amisi, Peter, Christensen, Alaa, El-Hussuna, Sylvia, Batista, Eddy, Lincango-Naranjo, Sameh, Emile, Danilo Alfonso Arévalo Sandoval, Hailu, Dhufera, Samuel, Hailu, Mengistu, G Mengesha, Joonas, H Kauppila, Alexis, P Arnaud, Zaza, Demetrashvili, Markus, Albertsmeier, Hans, Lederhuber, Markus, W Löffler, Daniel Kwesi Acquah, Bernard, Ofori, Stephen, Tabiri, Symeon, Metallidis, Georgios, Tsoulfas, Maria-Lorena, Aguilera-Arevalo, Gustavo, Recinos, Tamás, Mersich, Dániel, Wettstein, Gabriele, Kembuan, Peiman Brouki Milan, Mohammad Hossein Khosravi, Masoud, Mozafari, Ahmed, Hilmi, Helen, Mohan, Oded, Zmora, Gaetano, Gallo, Francesco, Pata, Gianluca, Pellino, Yuki, Fujimoto, Naoto, Kuroda, Mohamad, K Abou Chaar, Faris, Ayasra, Ildar, Fakhradiyev, Intisar Hisham Said Hamdun, Jang, Jin-Young, Mohammad, Jamal, Lina, Karout, Aiste, Gulla, Fanjandrainy, Rasoaherinomenjanahary, Luc Hervé Samison, Iran Irani Durán Sánchez, Diana Samantha Gonzalez, Laura, Martinez, María José Martínez, Alejandra, Nayen, Antonio Ramos-De la Medina, Jade, Nunez, Pueya Rashid Nashidengo, Rakesh, Shah, Ashish Lal Shrestha, Pascal, Jonker, Schelto, Kruijff, Milou, Noltes, Pieter, Steinkamp, Deborah, Wright, Lukman, Abdur-Rahman, Adesoji, Ademuyiwa, Adewale, Adisa, Babatunde, Osinaike, Justina, Seyi-Olajide, Omolara, Williams, Emmanuel, Williams, Sofija, Pejkova, Zainab Al Balushi, Raza, Sayyed, Mustafa Abo Mohsen, Sadi, A Abukhalaf, Moises, Cukier, Hugo, Gomez-Fernandez, Sebastian Shu Yip, Ximena Paola Vasquez Ojeda, Marie Dione Sacdalan, Piotr, Major, José, Azevedo, Miguel, F Cunha, Ahmad, Zarour, Eduard-Alexandru, Bonci, Ionut, Negoi, Sergey, Efetov, Viktor, Kochetkov, Andrey, Litvin, Jc Allen Ingabire, Georges, Bucyibaruta, Ntirenganya, Faustin, Sosthene, Habumuremyi, Alphonsine, Imanishimwe, Haragirimana Jean de Dieu, Emmanuel, Munyaneza, Isaie, Ncogoza, Abdourahmane, Ndong, Dejan, Radenkovic, Min Hoe Chew, Frederick, Koh, James, Ngu, Arpád, Panyko, Uros, Bele, Jurij Aleš Košir, Hassan, Daoud, Ana Maria Minaya Bravo, Umesh, Jayarajah, Dakshitha, Wickramasinghe, Mohammed Elmujtba Adam Essa Adam, Martin, Rutegård, Malin, Sund, Michel, Adamina, Eleftherios, Gialamas, Karoline, Horisberger, Muhammad, Alshaar, Abel, Huang, Varut, Lohsiriwat, Shane, Charles, Haithem, Jlassi, Arda, Isik, Hervé Monka Lekuya, Slava, Kopetskyi, Hayder, Alsaadi, Sattar, Alshryda, Osaid, Alser, Brittany, Bankhead-Kendall, Kerry, Breen, Hassan, Mashbari, Fernando Bonilla Cal, Hamza, Al-Naggar, Mayaba, Maimbo, Dennis, Mazingi, Tom, Abbott, Melika, Akhbari, Ruth, Benson, Shivam, Bhanderi, Bruce, Biccard, Edward, Caruana, Sohini, Chakrabortee, Reema, Chapatwala, Ainhoa, Costas-Chavarri, Andreas, K Demetriades, Anant, Desai, Salomone Di Saverio, Thomas, Drake, John, Edwards, Jonathan, Evans, Marco, Fiore, Samuel, Ford, Christina, Fotopoulou, Alexander, Fowler, Kaori, Futaba, Ian, Ganly, Harelimana Grace James, Ewen, Griffiths, Alessandro, Gronchi, Peter, Hutchinson, Gabriella Yael Hyman, Joseph, Incorvia, Ritu, Jain, Michael, Jenkinson, Tabassum, Khan, Stephen Richard Knight, Angelos, Kolias, Søren, Kudsk-Iversen, Tsun Yu Kwan, Elaine, Leung, Julio, Mayol, Siobhan, Mckay, John, G Meara, Emily, Mills, Susan, Moug, Akshay, Patel, Roberto, Perinotti, Henry, E Rice, Keith, Roberts, Andrew, Schache, Richard, Shaw, Neil, Smart, Matthew, Stephens, Grant, D Stewart, Ella, Teasdale, Peter, Vaughan-Shaw, Raghavan, Vidya, Naomi, Wright, Natalie, Zimmelman, Ervis, Agastra, Dariel, Thereska, Sergio Martin Lucchini, Veronica, Laudani, Carina, Chwat, Ivana Ines Pedraza Salazar, Diana Alejandra Pantoja Pachajoa, Agustin, Duro, José Alfredo Calderón Arancibia, Giuliana, D'Aulerio, Nagendra, Dudi-Venkata, Natasha, Egoroff, Shebani, Farik, Natalie, Lott, Jana-Lee, Moss, Sarah, Rennie, Lorwai, Tan, Uyen Giao Vo, David, Watson, David, Watters, Tim, Bright, Paul, Hollington, Xuanyu, Zhou, Hidde, M Kroon, Anthony, Farfus, John, Barker, Eleanor, Watson, Sean, Stevens, Haider, Latif, Amanda Caroline Dawson, Alwin, Chuan, Vijayaragavan, Muralidharan, Enoch, Wong, Travis, Ackermann, Maurizio, Pacilli, Russell, Hodgson, Alexander, Heriot, Peter, Choong, Wendy, Brown, Surjit, Lidder, Justin, Yeung, Luke, Traeger, Guillermo, Regalo, Ralph, Gourlay, Sarit, Badiani, Cherry, Koh, Soni, Putnis, Fayza, Haider, Ashrarur Rahman Mitul, Niels, Komen, Bert, Dhondt, Serge, Cappeliez, Manon, Pigeolet, Martijn, Schoneveld, Jasper, Stijns, Wouter, Oosterlinck, Nicolas, Flamey, Cyrille, Kpangon, Mouhamed, Agbadebo, Sèmèvo Romaric Tobome, Aldo Vieira Barros, Samuel Aguiar Júnior, Heloisa Galvão do Amaral Campos, Jefferson, Gross, Felipe José Fernandez Coimbra, Luiz Paulo Kowalski, Fabiana, Makdissi, Suely, Nakagawa, Joao Pedreira Duprat Neto, Jose Guilherme Vartanian, Guilherme, Yazbek, Stenio, C Zequi, Ronald, Flumignan, Natalia, Jaworska, Angela, Dell, Harsha, Shanthanna, Abdollah, Behzadi, Carolyn, Nessim, Michelle, Mozel, Pascal, St-Germain, Crispin, Russell, Gary, Groot, Najib, Safieddine, Duminda, Wijeysundera, Antoine, Eskander, Sami, Chadi, Shawn, Mackenzie, Alana, Flexman, Fernando, Heredia, Julio, Villanueva, Sofia, Waissbluth, Roberto, Macchiavello, Mario, I Escudero, Tyare, Fuentes, Ximena, Mimica, Dinimo Bolivar Saenz, Lina, Caicedo, Juan Pablo Alzate, Joaquin, Luna, Nestor Fabian Pedraza Alonso, Camilo Ortiz Silva, Juliana, Rodriguez, 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Juliana Sanchez, David Mauricio Solano Varela, Paula Torres Gomez, Marcial, Trillos, Ana María Vargas Patiño, Felipe, Vargas-Barato, Juan Pablo Villate Leon, María Alejandra Wagner Useche, Jesus, Acosta, Adriana, Almeciga, Luis Becerra Mendez, Rafael Jose Beltran, Ana, Bonilla, Miguel, Buitrago, Marino, Cabrera, Pedro Hernando Calderon Quiroz, Diego, Camacho-Nieto, Carlos Andrés Carvajal Fierro, Sergio Cervera Bonilla, Sandra, Diaz, Helena, Facundo, Jorge, Forero, Mauricio Garcia Mora, Karena Victoria Garcia Tirado, German Fabian Godoy Perez, Felipe, Gonzalez, Oscar, Guevara, Jairo Alonso Hernandez, David Ricardo Herrera Mora, Juan David Lalinde, Carlos, Lehmann, Eduardo Leon Llanos, Byron Eduardo Lopez De Mesa Lopez, Ivan, Mariño, Monica, Medina, Raúl Eduardo Pinilla Morales, Angela, Puerto, Andrea, Quintero-Ortíz, Juliana Rendón Hernández, Elio Fabio Sánchez Cortés, Alvaro Eduardo Sánchez Hernández, Raul, Suarez, Oscar, Suescun, Marco, Vanegas, Rodolfo, Varela, Jorge Luis Velez 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Baelum, Mark Bremholm Ellebaek, Signe Bremholm Ellebaek, Anders, Hogh, Maria, Acosta, Yancy, Acosta, Pedro, Baez, Luis Alfredo Betances, Luis Rodolfo Bonilla, Daniel, Cabreja, Wilton Cabrera Cruz, María Mabel Collado Expósito, Aldo, Crespo, Octavio, Cruz-Pineda, Claudio Samuel D'óleo García, Pedro, Díaz, Remberto, Escoto, Jatnna, Figueroa, Luis, Garcia, U Garcia-Dubus Rodriguez, Humberto, Gomez, Adrian, Grullon, Fatherin, Guerrero, Lillian, Guzman, Thelma Rocío Jiménez Mosquea, Engels, Lazala, Ariela, Lopez, Leeany Maletta Francisco, Jhomayri, Mercado, Herisardy, Munoz, Jeffrey, Paulino, Maricely Ambar Perez Fernandez, Rudeily, Reyes, Lilia Rosa Reyes Guilamo, Ruben, Rivas, Claudia Alejandra Rivas Torres, Ada, Rodríguez, Madelin Tamar Rosario Villa, Eleazar, Santana, Joel, Soto, Nassin, Tactuk, Cristina Kristel Tonos Sardiñas, Raul, Ubinas, Jose, Victoria, Aaron, Villegas, Ricardo, Acra-Tolari, Larissa, Beltran, Luis Fernand Betances, Alejandro, Blaubach, Denisse Idalia Campos Mejía, 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Maher, Hosain, Ahmed, Hossam, Hamza Hussein Aly Salama Aly, Mohamed, Ibrahim, Abdelrahman, Ibrahim, Nourhan, Ibrahim, Noha Mohamed Salah Ibrahim Moussa Hamouda, Monica, Iskander, Islam, Khalifa, Mostafa, Kotb, Nada, Mahmoud, Alaa Mahmoud Abo Shabana, Nora, Mamdouh, Maram, Metwalli, Khaled, Metwally, Mahmoud, Moghazy, Moustafa, Mohamed, Mohamed, Mourad, Esraa, Moustafa, Kamilia, Mubarek, Nour Eldin Nader, Ahmed, Nasser, Samaa, Omar, Mostafa Shehata Qatora, Mohamed, Ragab, Marawan, Ragal, Dina, Ramadan, Rana, Ramadan, Sara, Ramadan, John, Romany, Ahmed, Sabry, Yasmeen, Said, Sara, Salamah, Ahmed Mostafa Saleh, Mona Saleh Mesbah Mohamed Elkaffas, Alaa, Salem, Hashem, Salim, Ahmed, Samih, Ahmed Samir Abdelaal, Ahmed, Shaheen, Yassmeen Sharafeldin Mohammed, Abdelrahman, Shehata, Mohamed, Shemeis, Karim, Shenit, Mennatallah, Sheta, Asmaa, Soffar, Yousef, Tanas, Ahmed, Tarek, Nermin, Yehia, Omar Khaled Mohamed Eid, Ammar Yasser Abdulfattah, Ahmed, Elsaghir, Mohamed Fouad Elganainy, Omar Ibrahim Elsayed, Omar, Elmandouh, Omar, Hamam, Mostafa Ahmed Shehata, Areej, A Abdelaziz, Ahmed, M Abbas, Wael Abd El-Ghani, Hossam Aldein, S Abd Elazeem, Mustafa Abd Elsayed, Ahmed Yassien Abd-Elkariem, Shimaa, Abdalla, Mahmoud, Abdel-Aleem, Khaled, Abdelazeem, Mahmoud, Abdelfattah, Mohammed, Abdelhafez, Mohamed, M Abdelkarem, Ali, Abdelraouf, Lamess, Abdullaha, Hossam, Abubeih, Moaiad Eldin Ahmed, Nagm Eldin Abu Elnga Ahmed, Ahmed, Ahmed, Sarah Ahmed Saad, Sherif, Alaa, Ali, Alhussaini, Abdelrahman Ahmed Abdelrahman Ali, Ibrahim, Ali, Wagdi, Ali, Mohamed Ali Mohamed, Mohamed, Ashraf, Muhammad, Bassiouni, Mohamed, G El-Adawy, Mohammad, El-Sharkawi, Hussein, Elkhayat, Khaled, Elmaghraby, Shady, Elsdfy, Mohamed, Elsharkawy, Almoutaz, Eltayeb, Mohamed Esmat Mohamed, Esraa, Essam, Mahmoud, Fahd, Osama, Farouk, Rabea, Gadelkareem, Ahmed, Ghoneim, Mohammed Hamada Takrouney, Ahmed, Hamdan, Abd El-Rahman Hamed, Ahmad, Hasan, Mohamed Abdelghafor Hassanin, Islam, Hawal, Kerollos, Henes, Mohamed Omar Herdan, Helal, F Hetta, Omar, Ibrahem, Mostafa, Ibrahim, Islam, H Ibrahim, Mahmoud, Kamel, Mohamed, Khallaf, Shrouk, M Elghazaly, Abobakr, Mahfouz, Osman, Mahmoud, Wesam, Mahran, Doha, Mahrous, Abadeer, Marsis, Ayman, Mohamed, Aliae Mohamed Hussein, Amr Mohamed Sayed, Mahmoud, M Mohammed, Ahmed, Mokhtar, Fatma, A Monib, Ahmed, Nageeb, Mariam Albatoul Nageh, Mohammed, Nageh, Nehal Gamal Omar, Abdelrahman, Ragab, Abdelrahman, Ramadan, Abdallah Rashad Temerik, Aya, Sabry, Hadeer, Safwat, Omar, Salah, Ahmed Elhussiny Salah Mahmoud, Ahmed, Saleh, Mahmoud, Sallam, Ahmed, Samir, Reem, Sayad, Esraa, Sayed, Ahmed, S Sedik, Mohammed, Shahine, Antonios, Soliman, Wael, Soliman, Mohamed Gamal Taher, Randa, Wanees, Ebrahim Ahmed Yousof, Ahmed, Youssef, Omar Zein Elabedeen, Ahmed Emad Sayed Hassan, Shrouk Abdel Fattah, Ahmed, Abostate, Samar, Ali, Saad Ali Saad Salama, Mohamed, Allam, Ahmed, Alsadek, Ebrahim, Arafa, Ahmed, Barakat, Mohammed El Sherpiny, Gehad, Elbehairy, Mahmoud, Eleisawy, 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Brolo, Ana Lucia Lemus, Jennifer, Greenberg, Krisna Mishel Morales Chew, José Rodrigo Oliva, María Alejandra De León Lima, Ismar Lopez Muralles, Felipe, Solares, Gaby, Ajcip, Claudia, Anton, Jose, Cojulun, Mario-Andrés, Flores, Noriega, José, Carlos Adolfo Marroquín Paiz, Steffanía, Morales, Ramiro, Najera, Eduardo Quiñónez Lorenzana, Pablo, Rivera, Lesly, Rodas, Victor, Santos, Dianne, Sosa, Natalia, Ybarra, José David Pérez Cajti, Carlos, Régil, Walter, A Osorio, Rember Rosales Arriola, Luis-Fernando, Talé-Rosales, Danilo, Herrera, Servio Tulio Torres Rodríguez, Sergio Alejandro Villeda, Joshua, Anicetti, Andrea Michelle Lowey Medina, Javier, Ardebol, Kathia, Barillas, Francis De Leon, Salvador, Recinos, Miguel-Angel, Marroquin-Alpirez, Yessica, Yax, Sophie, Hon, Yuk Ho Liu, Alex Qinyang Liu, Shirley, Liu, Hei Tung Natalie Chiu, Chi Man Tom Chow, Victor, Hau, Ho Wai Ip, Brian, Mak, Chung Ying Mok, Dennis, Ng, Yin Yu Eva Siu, Kiu Fung Wong, Jingya Jane Pu, Yu-Xiong, Su, Kit Ying 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Santhosh Kumar Sampengere Annayappa, Tulika, Agrawal, Premkumar, Anandan, Aditya, Baindur, Manjunath, Bd, Savitha, C, S Anitha, G, Sandeep, Harigond, K Tejeswini, K, Venkatesh, Kesarla, Mallikarjuna, Manangi, B Hareesh, P, Jyothi K, R Ranjan, Athish, Shetty, Santhosh Shivashankar Chikkanayakanahalli, Tanvi, Sunil, Shreya, Syamala, Kavya, Tharanath, Aditya, Atal, Niranjana, Rajagopal, S Srinath, B, Vinod, Nk, L Thirumanikandan, P, Nitu, Mishra, Sushruta, Shrivastava, Rekha, Wadhwani, Reyaz, Ahmad, Zainab Ahmad Haq, Prateek, Behera, Ritika, Dhurwe, Rehan, Haq, Vaibhav, Jain, Anuj, Jain, Sunaina, Karna, Kameshwarachari, Pushpalatha, Sumit, Raj, John Ashutosh Santoshi, Pooja, Singh, Virendra, Verma, Vaishali, Waindeskar, Moorat Singh Yadav, Zaheda, Aziz, Koyel, Chakraborty, Preetam, Chappity, Gurudip, Das, Debajyoti, Datta, Saubhagya Kumar Jena, Madhabananda, Kar, Susanta, Khuntia, Pankaj, Kumar, Ravi, Kumar, Aswathi, Kv, Abhijeet, Mishra, Swastik, Mishra, Yash, Mittal, Dillip, Muduly, 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Matteo, Filardo, Marika Sharmayne Milani, Franco, Ragni, Andrea de Manzoni Garberini, Edoardo, Baldini, Diana, Carpaneto, Michele, Cauteruccio, Corrado, Ciatti, Luigi, Conti, Serena, Gattoni, Pietro, Maniscalco, Gerardo, Palmieri, Calogero Puma Pagliarello, Giuseppe, Caristo, Raffaele, Galleano, Michele, Malerba, Marcello, Calabrò, Francesca, Farnesi, Elia Giuseppe Lunghi, Andrea, Muratore, Nicoletta Sveva Pipitone Federico, Joel Reuben Abel, Lorenzo, Andreani, Darienzo, Antonio, Vittorio, Aprile, Riccardo, Balestri, Giacomo, Benettini, Stefano, Berrettini, Luca, Bruschini, Massimo, Chiarugi, Federico, Coccolini, Simone, Colangeli, Camilla, Cremonini, Lodovica Cristofani Mencacci, Iacopo, Dallan, Silvia De Santi, Gregorio Di Franco, Lorena Di Girolami, Giacomo, Fiacchini, Niccolò, Furbetta, Stylianos, Korasidis, Marco, Lucchi, Andrea, Morandi, Luca, Morelli, Serena, Musetti, Carlo Maria Neri, Matteo, Palmeri, Miriana, Picariello, Francesco, Porcelli, Marco, Puccini, Nicolo, Roffi, 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Lisi, Tommaso Maria Manzia, Lorenzo, Petagna, Bruno, Sensi, Giuseppe, Sica, Leandro, Siragusa, Giuseppe, Tisone, Marco, Assenza, Barbara, Binda, Massimo, Biondi, Gioia, Brachini, Placido, Bruzzaniti, Mauro, Casagrande, Flavia, Ciccarone, Pierfranco Maria Cicerchia, Bruno, Cirillo, Daniele, Crocetti, Giancarlo, D'Ambrosio, Vito, D'Andrea, Francesca De Felice, Giorgio De Toma, Carlo Della Rocca, Giulia, Duranti, Pietro, Familiari, Enrico, Fiori, Giovanni Battista Fonsi, Alessandro, Frati, Stefania La Rocca, Filippo La Torre, Pierfrancesco, Lapolla, Giovanni, Marruzzo, Simona, Meneghini, Andrea, Mingoli, Andrea, Picchetto, Antonella, Polimeni, Diego, Ribuffo, Maurizio, Salvati, Antonio, Santoro, Paolo, Sapienza, Luigi, Simonelli, Valentino, Valentini, Martina, Zambon, Giuseppa, Zancana, Emma, Zuppi, Simone, D'Annunzio, Cosimo De Nunzio, Silvia, Fiorelli, Mohsen, Ibrahim, Chiara, Loffredo, Domenico, Massullo, Cecilia, Menna, Rocco, Monica, Massimiliano, Pelli, Erino Angelo Rendina, Leonardo, Teodonio, Andrea, Tubaro, Giulio, Argenio, Giulio, Accarino, Accarino, Giancarlo, Antonio Nicola Giordano, Luca, Cardinali, Elisa, Sebastiani, Grazia, Travaglini, Erika, Andreatta, Emanuele Luigi Giuseppe Asti, Daniele, Bernardi, Luigi, Bonavina, Caterina, Froiio, Andrea, Lovece, Chiara, Copelli, Alfonso, Manfuso, Pasquale Di Maio, Marco, Giudice, Oreste, Iocca, Rosario, Cennamo, Tommaso, Cornali, Francesco Di Marzo, Cristian, Altana, Francesco, Bussu, Giampiero, Capobianco, Anna Giacomina Carta, Sandro, Ciccarello, Maria Laura Cossu, Pietrina, Cottu, Giacomo De Riu, Salvatore, Dessole, Francesco, Dessole, Salvatora, Dettori, Carlo, Doria, Alessandro, Fancellu, Claudio, F Feo, Giorgio Carlo Ginesu, Giuliana, Giuliani, Marco Giuseppe Iannuccelli, Massimo, Madonia, Roberto, Mancino, Olindo, Massarelli, Gianfranco, Meloni, Fabio, Milia, Andrea, Mulliri, Teresa, Perra, Marco, Petrillo, Antonio, Piras, Franco, Piredda, Francesco, Pisanu, Alberto, Porcu, Davide, Rizzo, Angelino, Sanna, Antonio Mario Scanu, Fabrizio, Scognamillo, Damiano, Soma, Anna Rita Tanca, Alessandro, Tedde, Matteo, Tedde, Luigi Angelo Vaira, Andrea Bartalini Cinughi de Pazzi, Osvaldo Carpineto Samorani, Daniele, Fusario, Luigi, Marano, Gaia, Oldrà, Anna Lisa Pesce, Stefania Angela Piccioni, Luca, Resca, Vincenzo, Ricchiuti, Franco, Roviello, Vinno, Savelli, Alberto, Abrate, Pierpaolo, Bordoni, Lorenzo, Bosio, Guglielmo, Clarizia, Francesco, Fleres, Marco, Franzini, Antonio, Fratto, Pierluigi, Giumelli, Alessandro, Grechi, Alessandro, Longhini, Fabrizio, Lorusso, Elisa, Scarnecchia, Federica, Scolari, Alessandro, Spolini, Vincenzo, Maiuri, Matteo, Papandrea, Arturo, Roncone, Lorenzo, Conti, Andrea, Rizzi, Marco, Rovagnati, Alberto, Brolese, Tommaso, Cai, Francesco Antonio Ciarleglio, Francesca, Dalprà, Gianni, Malossini, Liliana, Mereu, Irene, Tamanini, Saverio, Tateo, Giovanni, Viel, Enrico, Battistella, Paolo Boscolo Rizzo, Cristoforo, Fabbris, Marco, Massani, Giacomo, Spinato, Roberta, Tutino, Ugo, Grossi, Alessandro, Iacomino, Simone, Novello, Maurizio, Romano, Serena, Rossi, Giulio, Santoro, Giacomo, Zanus, Sokol, Trungu, Giada, Aizza, Gabriele, Bellio, Selene, Bogoni, Marina, Bortul, Biagio, Casagranda, Sara, Cortinovis, Nicolò de Manzini, Davide, Drigo, Paola, Germani, Manuela, Mastronardi, Lucia, Paiano, Silvia, Palmisano, Pier Luigi Filosso, Francesco, Guerrera, Matteo, Marro, Mauro, Rinaldi, Enrico, Ruffini, Stefano, Salizzoni, Laura, Bardelli, Mattia, Berselli, Giacomo, Borroni, Eugenio, Cocozza, Matteo, Desio, Bottazzoli, Elisa, Giuseppe, Ietto, Valentina, Iori, Domenico, Iovino, Lorenzo, Livraghi, Valentina, Marchionini, Stefano, Megna, Emma Amal Nahal, Mara, Palumbo, Valeria, Quintodei, Alessandra, Zullo, Lucrezia, D'Alimonte, Giovanni, Pirozzolo, Chiara, Vignotto, Tommaso, Campagnaro, Andrea, Caravati, Simone, Conci, Carlotta De Cristofaro, Gabriele, Gecchele, Tommaso, Giuliani, Jacopo, Graziosi, Alfredo, Guglielmi, Salvatore, Paiella, Corrado, Pedrazzani, Tommaso, Pollini, Simone, Rattizzato, Andrea, Ruzzenente, Roberto, Salvia, Giulia, Turri, Matilde, Bacchion, Giovanni, Butturini, Andrea, Casaril, Alessandro, Giardino, Harmony, Impellizzeri, Marco, Inama, Frigerio, Isabella, Gianluigi, Moretto, Marco De Zuanni, Enrica, Deiana, Mario, Guglielmo, Alessandro, Broglia, Claudia, Casarini, Caterina Costanza Zingaretti, Marta, Bonaldi, Giovanni, Cesana, Francesco, Mastriale, Stefano, Olmi, Matteo Uccelli Yasuyuki Fukami, Takuya, Saito, Tsuyoshi, Sano, Naoki, Hirai, Kazuyoshi, Hirota, Tetsuya, Kushikata, Tasuku, Oyama, Junichi, Saito, Katsuhiko, Ishibashi, Mizue, Kamiyama, Kyongsuk, Son, Kentaroh, Tarao, Takayuki, Yamada, Toshiya, Shiga, Chisaki, Aze, Yoshihiko, Deguchi, Hirotoshi, Hasegawa, Tatsuki, Hoshino, Yasushi, Innami, Hiroyuki, Inoue, Shingo, Ito, Takeshi, Nomura, Tomomi, Ogihara, Reina, Okada, Takashi, Ouchi, Yuri, Sekiya, Keikoku, Tachibana, Emi, Takano, Masae, Yamamoto, Shuko, Matsuda, Yuka, Matsuki, Kenji, Shigemi, Teruyuki, Hiraki, Yui, Inoue, Shosaburo, Jotaki, Tatsuro, Abe, Masatoshi, Eto, Junichi, Inokuchi, Eiji, Kashiwagi, Fumio, Kinoshita, Satoshi, Kobayashi, Ken, Lee, Takashi, Matsumoto, Keisuke, Monji, Hidekazu, Naganuma, Masaki, Shiota, Ario, Takeuchi, Shinju, Obara, Saori, Takatsuki, Saori, Tanaka, Koji, Iida, Kota, Kagawa, Shuichiro, Neshige, Tomohiro, Chaki, Naoyuki, Hirata, Satoshi, Kazuma, Motonobu, Kimizuka, Sho, Kumita, Noriaki, Nishihara, Sato, Satoshi, Atsushi, Sawada, Shunsuke, Tachibana, Michiaki, Yamakage, Yuta, Nakamura, Kozo, Sato, Tomoya, Irie, Tomoko, Irisawa, Eiki, Kanemaru, Yuko, Koga, Yoshihiko, Chiba, Jun, Makino, Shinnosuke, Ohama, Shinichiro, Okada, Kano, Teruaki, Tatsuya, Kida, Tomohide, Takei, Kazuhiro, Hanazaki, Hiroyuki, Kitagawa, Tsutomu, Namikawa, Toshiyuki, Mizota, Chikashi, Takeda, Shintaro, Yagi, Hiroshi, Imai, Makoto, Ishitobi, Manabu, Kato, Kouhei, Nishikawa, Takeshi, Sasaki, Hiroshi, Yonekura, Akihiro, Kanaya, Daisuke, Irimada, Haruka, Ishikawa, Kaiho, 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Mubaydeen, Husam, Sarayrah, Mohammad Abdel Elah, A Tarawneh, Mohammad Yousef Karasneh, Amany, Zurgan, Mohammad, Alassaf, Sayel, H Alzraikat, Justin, Z Amarin, Ahmed, Hijjawi, Haya, H Suradi, Louay, Y Zaghlol, Ahmad, Abdalah, Ghaida, Abdallah, Ammar Abu Tarieh, Tareq, Abu-Libdeh, Faisal, Abualteen, Murad Al Abdallah, Zakaria Al Bdour, Seif Al Dahabrh, Farah, Al-Kasaji, Zaid Al-Sheikh Ali, Mohammad, Al-Thaher, Tareq, Alnajjar, Mohannad, Alqedrh, Mohammad, Alsaleh, Mohammad, Alzaatreh, Ghandi, Amayreh, Yazeed, Ayasra, Ahmad, Eid, Ibrahim, Ghayada, Khaled Moh'd Ahmed Hasanein, Anas, Hassouneh, Raid, Hijazeen, Majedah, Hmeidan, Ahmed, Khaled, Barihan, Khasawneh, Omar, Kifayeh, Yasser, Lafi, Jasem, Seba, Qusai, Semrin, Fda, Sma, Mohammad, Theab, Haitham, Tumeh, Muna Aba Zaid, Alaa, Abazeed, Bader, Abbad, Osaid, Abbadi, Nizar, Abu-Ishkerih, Malk, Al-Osta, Reham, Al-Zyadat, Bashar Omar Falah Alawneh, Majd, Alhattab, Mohd Mujahed Alkurdieh, Ziad, Awwad, Mohammad, Hammouri, Hamzeh, Hussein, 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Fade, Alawneh, Motasem, Al-Latayfeh, Abdel-Ellah, Al-Shudifat, Abd Almonem Shaikh Ahmad, Abdelkarim, Abdeljalil, Haneen, Abdelrahman, Abdulmalek, Abdulmalek, Lina, Abedalqader, Laith Abu Abed, Omar Al Smadi, Salameh, Alarood, Mohammad, Allouzi, Maha, Almansour, Sari, Almi'Ani, Abdulhakim, Alsaiad, Khaled, Alshaikh, Farah, Androus, Mirna, Awbakh, Belal, Azzam, Hammam Bany Yasin, Maher, Daoud, Lujain, Dawod, Omar, Dawod, Reem, Elmusa, Saba, Fadli, Farah, Hammad, Majd, Hunaiti, Mahmoud, Muhtaseb, Rawan, Owaimer, Zaki, Qulaghassi, Saleh, Romman, Rawand, Saket, Said, Sharawi, Alaa, Tawalbeh, Mohammed, Al-Howthi, Laila, Ababneh, Roba, Ababneh, Faris Jamal Abu Za'nouneh, Sajedah Al Dhoun, Ahmad Al Khassawneh, Ahmed Al Sharie, Ayah Ahmad Al Shraideh, Tawfik, Al-Dabaa, Salsabeel, Al-Jarrah, Hothaifa, Al-Jarrah, Hadeel, Al-Othman, Zuhair, Alaradi, Qutaiba, Alshannaq, Rima, Alsulaiman, Motasem, Alzaqh, Yazan, Alzu'Bi, Ziad, Audat, Mohammad, Bahhour, Saja, Bdour, Roa, Khatatbeh, Fares, Marji, Tagleb, Mazahreh, Dina, Nail, Amjad, Nuseir, Asmaa, Rabab'Ah, Taher, Sawadi, Ghina, Zidan, Dima Abu Muhfouz, Abdullah, Nael, Ahmad, Qasim, Amar, Al-Jarrah, Faisal, Rawagah, Dima, Y Abu Ismail, Wedad, Al-Dolat, Mai, Alzoubi, Malak, Alzoubi, Mu'Taz, Alzu'Bi, Ruba, Asha, Ali, Guboug, Hasan, Hussein, Shireen, Rawashdeh, Mohammad, Sanwar, Adnan, Ababneh, Basil, Abu-Eisheh, Haneen Ahmad Alhami, Saif Aldeen Al Dwairi, Hana' Al Shurman, Zakaria Al Yahya, Hussam, Al-Atiyah, Hasan, Al-Balas, Anas, Aljaiuossi, Shatha, Alqawasmi, Sadeel, Alqudah, Mahmoud, Alshourman, Abdulsalam Bani Hamad, Anas Bany Issa, Raed, Ennab, Sara, Hamdoni, Zaid, Hijazi, Ali, Khafaja, Mohamed, Mraiyan, Riyad, Obeidat, Dina, Olaywah, Mohamad, Qudah, Mhamdd, Talal, Askar, Aidarov, Aisulu, Sarmenova, Almat, Kodasbaev, Orazbek, Sakhov, Shynar, Tanabayeva, Sultan, Amrayev, Berik, Dzhumabekov, Maulen, Malgazhdarov, Kanat, Tezekbaev, Yerlan, Kukubassov, Alima, Satanova, Michael, Mwachiro, Robert, Parker, Ian, Simel, Shamshuddin, 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Farah, Abojeila, Mohamed, Aliwa, Sana, Shagour, Ahmed, Altobal, Omar, Aljuroushi, Hadeel, Almadani, Hajer, Attia, Amal Sharif Eljali, Ayyah, Emran, Mabruka, Omar, Radhwan, Salim, Ashraf, Samer, Nayrouz Abdullah Abulshuwashi, Emadeddin T, M Ben Khalifa, Hdaya Abdalla, S Benabdalla, Hatem, Elnageh, Ali, Hammad, Duha Milad Abdullah, Marwa, Abusalem, Esraa Ben Esmael, Fatma, Benmasoud, Laila, Debri, Randa, Elmokhtar, Manal Ezeddin Kamel Sheta, Bushra Sayeh Mohamed Elhabashi, Balkees, Younis, Amna, Elmabrouk, Ahmed, Momen, Abdalrahem Essied Alzubi Alzoubi, Kusay, Ayad, Ameerah Mahdi Abraheem Hasan, Fawzie, Musrati, Malek, Abusannoga, Ans, Malek, Hatem, Ajaj, Eman, Abdulwahed, Mohammed, Aboubeirah, Aya, Alqurpaa, Entisar, Alshareea, Sarra, Aribi, Tomather, Aribi, Marwa, Biala, Reem, Ghamgh, Mohannned, Issa, Amani Hamid Lamari, Mohammed, Mufth, Omar Sudig Abboud, Muad Fathi Khalleefah Abu Hallalah, Saleh, Abumahara, Sarah, Aburima, Mohammed, Adrees, Abdurahman, Ahtash, Asmaa Al Shukri, Hind, 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Rakotoarisoa, Maharo, Ramifehiarivo, Solonirina Harinarindra Ranaivoson, Hajamihamina Marina Parfaite Randriantsoa, Narindra Njarasoa Mihaja Razafimanjato, Jeannie Ba Razafindrahita, Solofoarimanana, Solofoarimanana, Guillaume Odilon Tsiambanizafy, Rakotonaivo Mamisoa Judicaël, Corinne Eulalie Solo, Tojomamy Herinjaka Ralaizafindraibe, Fanonjomahasoa Safiry Andofenohasina, Hanta, Rasataharifetra, Vanona Barijaona Razafindraibe, Angelin Sablon Herinirina, Andre, Das, Thanga, Ganapathy, Yohesuwary, Gunarasa, Kalyani, Mariapan, Maathichsudhaar, Muniandy, Mohd Firdauss Osman, Mohd Azem Fathi Mohammad Azmi, Jien Yen Soh, Wan Zainira Wan Zain, Andee Dzulkarnaen Zakaria, Zaidi, Zakaria, Kheng Hooi Chan, Firdaus, Hayati, Syamim, Johan, Jin Jiun Mah, Ratha Krishnan Sriram, Sentilnathan, Subramaniam, Nur Shahirah Binti Muhammad Shahimi, Khairul Hazim Hamdan, Mohd Razali Ibrahim, Guhan, Muthkumaran, Ju Ann Tan, Mohana Raj Thanapal, Dayang Anita Abdul Aziz, Mae-Lynn, Bastion, Mohd Hairul Nizam 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Sainal, Mat Salleh Sarif, Richelle, Chua, Aini Fahriza Ibrahim, Abdul Rauf Bin Ahmad, Yii Ling Lau, Ka Yee Liew, Kandasami, Palayan, Hui Yu Wong, Jasiah, Zakaria, Nor Azimah Abd Aziz, Norazila Abdul Rahim, Noorneza Abdul Rahman, Bahiyah, Abdullah, Mohamed Faizal Bin Sikkandar, Fatin, Firman, Nik Mohd Hazleigh, Intan Kartika Kamarudin, Shahril, Khalid, Mohd Fairudz Mohd Miswan, Akmal Zulayla Mohd Zahid, Norasyikin, Mustafa, Kadhim, Obaid, Mohd Yusoff Bin Yahaya Yahaya, Ahmad Ramzi Yusoff, Predrag, Andrejevic, Jeremy Borg Myatt, Svetlana, Brincat, Clifford, Caruana, Kurt Lee Chircop, Francesca, Chircop, Daniel Mario Chircop, Charles, Cini, Viktoria, Czok, Melanie, Farrugia, Gabriella, Grima, Fatimah Mj Hassan Almukhariq, Esther, Muscat, Darryl, Pisani, Mohsin Hassan Khan Roshan, Nicholas, Schembri, Mohamed, Shoukry, Neville, Spiteri, Gilbert, Tanti, Ziad Aboharp Hasan, Alberto Bazan Soto, Cedillo Rodrìguez Jonathan Rubén, Gustavo Esteban Lugo Zamudio, David Gerardo Miranda Gómez, José 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Uros, Bumbasirevic, Zoran, Dzamic, Boris, Kajmaković, Bogomir, Milojevic, Nebojša, Prijović, Marko, Zivkovic, Aleksandar, Lazic, Nebojsa, Mitrovic, Dejan, Stevanovic, Marko, Buta, Ana, Cvetkovic, Igor, Djurisic, Merima, Goran, Zorka, Inic, Andjela, Ivezić, Nikola, Jeftic, Marko, Jevric, Vladimir, Jokic, Milan, Kocic, Zoran, Kozomara, Ivan, Markovic, Srdjan, Nikolic, Nada, Santrac, Nevena, Savković, Igor, Spurnic, Dobrica, Stevic, Dejan, Stojiljkovic, Jovana, Tripkovic, Nikola, Vucic, Milan, Zegarac, Tatjana, Dejanovic, Vladimir, Djukic, Srdjan, Marinković, Miljan, Milanovic, Nemanja, Pijanovic, Milena, Radosavljevic, Predrag, Savic, Dejan, Stojakov, Rastko, Živić, Sinisa, Ducic, Mikan, Lazovic, Jovana, Bojičić, Vladica, Cuk, Jovan, Juloski, Aleksandar, Karamarkovic, Marko, Kenic, Bojan, Kovacevic, Igor, Krdzic, Vladan, Milutinović, Vladimir, Djan, Velicko, Trajkovic, Dragana, Zivkovic, Aleksandar, Đermanović, Danica, Golijanin, Dejan, Lukic, Zoran, Radovanovic, Dragana, Radovanovic, 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Raquel Angulo Artal, Luis, Barbier, Guillermo, García-Operé, Marta, Jiménez-Jiménez, Héctor, Marín, Mikel, Oñate, Luis Antonio Pascua-Gómez, María Alexandra Pesántez Peralta, Ibabe Villalabeitia Ateca, Ladislao Cayetano Paniagua, Joan, Camí, Pablo, Collera, Martínez, David, Carlos Javier Gómez Díaz, Jordi Querolt Coll, M Dolors Rosines Cubells, Cristina Soto Montesinos, Guillermo, Triana, Marina, Xicola, Alfonso, Alias, Albert, Baduell, Mariano, Balaguer-Castro, María Pilar Camacho Carrasco, Marina Cámara Vallejo, Borja Campuzano Bitterling, Guillem, Claret, Francisco, J Cuesta-González, Alberto Di Somma, Joaquim Enseñat Nora, Neus, Fabregas, Ada Ferrer Fuertes, Abel, Ferrés, Cesar, Ginesta, Jose Juan Gonzalez Sanchez, Isabel, Gracia, Jhon Alexander Hoyos Castro, Montsant, Jornet-Gibert, Xavier, Morales, Alejandra, Mosteiro-Cadaval, Leire, Pedrosa, José Poblete Carrizo, Marina, Renau-Cerrillo, Luis Alberto Reyes Figueroa, Pedro Roldan Ramos, Jordi Rumià Arboix, Marta, Sabater-Martos, Josep, M Segur, Thomaz, E Topczewski, Jorge, Torales, Ramon, Torné, Pere, Torner, Ricard, Valero, Marian, Vives-Barquiel, Eulalia, Ballester, Alberto Basterra Rincon, Vitiello, Giulia, Belén Martin Arnau, Marta, Gil, Silvia, Martin, Monica, Serrano-Navidad, Mauricio Agüero Mariño, Núria Casanova Torrequebrada, Berta Fabregó Capdevila, Adrián López Campillo, Gemma, Mancebo, Ester, Miralpeix, Blanca, Montcusí, Marina, Munarriz, Ariadna, Salvadó, Josep, M Sole-Sedeno, Clara Téllez Marquès, Ana Centeno Álvarez, Ruth Lopez Gonzalez, Luisana Riba Combatti, Andrea Sanz Llorente, Miguel Bejarano Serrano, Blanca Capdevila Vilaró, Maria Coronas Soucheiron, Mario Cuesta Argos, Irene de Haro Jorge, Yaiza Galvañ Félix, Luis, García-Aparicio, Rebeca, Leal, Albert Malet Contreras, Irene, Martínez-Padilla, Clara, Massaguer, Ines Moraleda Gudayol, María Elena Muñoz Fernández, Paco, Parri, Cristina Pérez Costoya, Javier, Rojas-Ticona, Leopoldo Tapia Moral, Francisco, Vicario, Francesc Angles Crespo, David Bosch Garcia, Berta, Escudero, Carlos Garcia Cardona, Sergi, Bellmunt-Montoya, Javier de la Torre, Úrsula, Acosta, Iago Alvarez Saez, Eva Andreu Riobello, Fernando Ascanio Gosling, Jose, Bagan, Irene, Brana, Bartomeu, Caimari, Marta Cicuendez López Ocaña, Anna, Conesa, Alba de Pablo García-Cuenca, Natalija, Dediulia, Francesc, Duran-Valles, Jordi Giralt López de Sagredo, Maria Jose Gomez-Jurado, Ernesto, Guerra-Farfan, Juan Sebastian Guillén, María Guisasola Rabés, Viviana Andrea Hernández Angel, Maria Jurado Ruiz, Yuri, Loaiza, Manuel, Lopez, Susana, Manrique, Maria Dolores Mateo Arzo, Joan, Minguell-Monyart, Enric Miret Alomar, Sonia Monreal Clua, Víctor Morales Ariza, Clara Morales Comas, Judith, Murillo, Jose Maria Nieto Rodriguez, Elena Vilardell Ortiz, Jorge, Pamias, Montserrat Pascual Pascual Arellano, Remei Perera Sarri, Aleix Pons Bartroli, Nil, Prat, Alfredo Pueyo Ferrer, Rosa Pujol Pina, Jordi, Raurich-Leandro, Maria José Reche Padilla, Joaquín Rivero Déniz, Natalia, 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Alexia Victoria Paluso Montero, Natalia Pérez Romero, Adriana, Poch, Jaime Rodríguez de Alarcón, Adriana Ruano Campos, Rebeca Ruiz Roman, Patricia Saez Carlin, Cristina Sánchez Del Pueblo, Lidia Sotillo Valenzuela, Armando, Galvan, Miguel Ángel García Ureña, Enrique, González, Manuel Medina Pedrique, Alvaro Robin Valle de Lersundi, Carlos San Miguel, Juan, Aragón-Chamizo, Monica, Ballon, Jose, M Barrio, Beatriz Castro Catalan, Laura Cebolla Rojas, Renan Carlo Colombari, Miguel Cuende Diez, Paula Dujovne Lindenbaum, Oscar, Gil-de-Sagredo, Silvia Kayser Mata, Pablo Lozano Lominchar, Yeniffer Tatiana Moreno Salazar, Angela, Moreno-Gutierrez, Melanie, Morote, Uxue, Murgoitio, Nikolas Palma Caucig, Lucía Polanco Pujol, Alejandro, Prosperi, María Belén Ramírez Senent, Diego Fernando Ruiz Chiriboga, Mercedes, Sanz, Maria, Tudela, María Adrien Lara, Raquel, Alarza, Isabel Alonso Sebastian, Mariano Artés Caselles, Laura, Calles-Sastre, Marcos Casas Sánchez, Aritz Equisoain Azcona, Lucía, 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Barbara, Algar-Yañez, Gutiérrez, Bérénice, Olga De La Varga-Martínez, Paula, Fernandez-Valdes-Bango, Sandra Maria Gadin-Lopez, José María Martínez-Gómiz, Elena, Nieto-Moreno, Ana, Nieto-Moreno, Montserrat Ocampos Hernandez, Maria Laura Pelegrina-Lopez, Alicia Ruiz Escobar, Elena, Sáez-Ruiz, Beatriz, Vazquez-Rivero, Antonio, Lara, Belén Vielva Del Campo, Fernando Alcaide Matas, Simbad, Costas-Ochoa, José María García Pérez, Elizabeth, Marmol, Paula Troncoso Pereira, Maria Del Pilar Concejo Cutoli, Juan Ramón Gómez López, Juan Carlos Martín Del Olmo, Paloma Guillamot Ruano, Javier Páramo Zunzunegui, Antonio Albarracín Marín Blázquez, Alfonso, Aliaga-Sanchez, Marta María Arroyo Domingo, Miriam Artés Artés, Ana Isabel Avellaneda Camarena, Aida, Blaya, Emny Rochell Bobadilla Romero, Pedro Vicente Fernández-Fernández, Lorena Galindo Iñiguez, Víctor Javier García Porcel, Clara Giménez Francés, Antonio Javier Gomez Poveda, Rebeca Gonzalez Celdran, Francisco Miguel González Valverde, Laura 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López, Ruth Marquina González, Tania, Pastor, Adrián Recio Ayesa, Ana Paula Riverola Aso, Carballo, Rodríguez, Araceli, Rodrìguez, Maria Inmaculada Ruiz Montesinos, Patricia, Torres, Jose, Undabeitia, Ainara, Villafruela, Maria Barrionuevo Ramos, David, Blanco, Marta, Calderón, Eva Corral Rubio, Angel, Cuadrado-García, Daniela, Cubek, Ignacio, Fariña, Maria Fernandez LLorente, Natalia Flores Amador, Mariana García Virosta, Luis Garcia-Sancho Tellez, Adelina Gonzalez Martinez, María, Hernandez, Rubén Herreros Ruiz-Valdepeñas, Carmen Jimenez Sanchez, Eduardo Llamazares Cobo, María, López, Javier, López-Martin, Teresa Martínez Marivela, Luis Miguel Martinez Parra, Paloma Maté Mate, Paloma, Medrano, Manuel Moriche Carretero, Sara Núñez O'Sullivan, Manuel Ortega Oria de Rueda, María Begoña Pastor Nieto, Clara, Pérez, Antonio, L Picardo, Remedios Revilla Amores, Carmen Rodríguez Haro, Jose Alberto Rojo López, Fatima Sanchez Cabezudo Noguera, Cristina, Sanz, Daniel Serralta de Colsa, Cristina Valor Garcia, Marta Velasco Martinez, Iván Andújar Lara, Aranzazu, Calero-Lillo, Enrique, López-Ruiz, Alberto Díaz García, Alejandro Menéndez Moreno, Luis Eduardo Pérez-Sánchez, Ángela, Pascual, Miguel Adeba García, Marta Alonso Fernández, Javier Alvarez Gama, Roberto, Ballestero, Loreto Berjon De La Vega, Paola Calleja Hermosa, Mariana, Carrillo-Rivas, Alfonso, Casado, Andrea, Cerveró, Bonifacio Cimadevilla Calvo, Patricia Corriols Noval, Paloma de la Dehesa Cueto-Felgueroso, Miren Jasone Diez Zapirain, José Estevez Tesouro, José Antonio Fernández-Dívar Sánchez, Lucia Garcia Alcalde, Juan García Cardo, Tito García Moreno, Daniel, García-López, Belen Garcia-Montesinos Perea, Miren Gonzalez Benito, Rocio, Gonzalez-Aguado, Miguel Ángel Gordo Vega Gordo-Vega, Jose, Gutierrez-Banos, Jaime Jimeno Fraile, Yolanda Jubete Castañeda, Patricia Lopez Gomez, Antonia Jesús López López, David Mato Mañas, Carmelo, Morales-Angulo, Dieter, Morales-Garcia, Sara, Naranjo, Jose Luis Rabago, Jose Manuel Rabanal, Rocio Revuelta Zorrilla, Adriana Reyes Echeverría, Juan Carlos Rodríguez-Sanjuán, Juan Ramón Sanz, Isabel Simal Badiola, Guillermo, Tejón, Enrique Toledo Martínez, Raquel Varea Malo, Begoña, Fadrique, Tania, Funes, Elena González Revilla, Isaias, Alarcón, Daniel Aparicio Sánchez, Pablo Beltran Miranda, Carmen, Cepeda-Franco, María Josefa Cuevas López, Sandra, Dios-Barbeito, Virginia María Durán Muñoz-Cruzado, Carlos Gonzalez De Pedro, Rosa, M Jimenez-Rodriguez, Francisco, Manresa-Manresa, Gabriel, Marin, Cristobalina, Martin-Garcia, Sara, Martínez-Núñez, Juan Manuel Martos Martinez, Lucas, Mengíbar, Felipe Pareja Ciuro, Eduardo Perea Del Pozo, Veronica Pino Diaz, José, Pintor-Tortolero, Claudia, Quintero-Pérez, Maria Luisa Reyes Diaz, Mercedes Rubio Manzanares Dorado, Alejandro Sanchez Arteaga, Ana, Senent-Boza, Luis, Tallon-Aguilar, Jose, Tinoco-Gonzalez, Luis-Cristobal, Capitan-Morales, Juan Cintas Catena, Javier, Valdes-Hernandez, María Del Campo Lavilla, Alina López De Fernández, Miriam Abellan Lucas, Alba Diaz Padillo, Maria Gómez Romero, Linda Grace Puerto Tamayo, El Mostafa El Yaqine Er Raoudi, Melody García Domínguez, María Ángeles Gascón Domínguez, Marta González Pérez, Alba Hernáez Arzoz, Joana San Anton, Cristian, Ruminot, Hander Guillermo Acosta Diaz, Daniella, Laguado, Kristina, Aghababyan, Alba, Jr, Enrique, Artigues, Rocío, Belda, Miguel, Beltran, Jose Ignacio Blanes, Elena Campos Carot, Miriam, Cantos, Laura, Costa, Carolina Ferrer Gomez, José María Gallego Sánchez, Oscar, Gil-Albarova, Juan, Gilabert-Estellés, Emilio Lopez Alcina, Isabel López Sánchez, Severiano Marin Bertolin, Carolina, Martinez-Perez, Antonio Melero Abellán, Claudia Mulas Fernández, Beatriz, Novoa, Ruth, Nuñez, Pablo Renovell Ferrer, Guijarro-Jorge, Ricardo, Carolina Soledad Romero Garcia, Miguel Sanfeliu Giner, Silvia, M West, Enrique, Zapater, Ignacio, Miranda, Ana, Monís, Alejandro Roselló Añón, María José Sangüesa, Jorge Sanz Romera, Marcos, Adrianzén, Maria Barrios Carvajal, Mireia, Bauzá, Ana Benítez Riesco, Jose Antonio Carbonell Lopez, María-Carmen, Fernández-Moreno, Ricardo Gadea Mateo, Francisco, Garcia, Maris Luisa García-Pérez, Luisa Paola Garzon, Ana, Izquierdo, Maria Lapeña Rodríguez, Carlos, León-Espinoza, Fernando, Lopez, Rosa Martí Fernández, Sara Martínez Castro, Berta Monleón López, Isabel Mora Oliver, David, Moro-Valdezate, Ernesto Muñoz Sornosa, Sara Palomares Casasús, Leticia Pérez Santiago, Mara Albert Fort, Reyes, Balanzá, Lorena Bermell Marco, Carla Carratalá Pérez, Claudia Pilar Clemente Tomas, Marta, Córcoles, Jose Ángel Diez Ares, Carlos Domingo Del Pozo, Nuria Estellés Vidagany, Gonzalo, Garrigos, Mar Gimeno Gimeno Vicente, Blanca Alastrue Giner, Segundo, Gomez-Abril, Paloma, Gonzalez, Paula Gonzálvez Guardiola, Guillermo Sebastian Martínez Fernández, Charo Martínez García, Lucía, Martínez-Costa, Luz María Moratalla Charcos, Sergio Navarro Martínez, Carmen, Payá-Llorente, Álvaro Pérez Rubio, Nuria, Peris, Eduardo Picazo Pineda, Jordi Planelles Gómez, Francisco Ripoll Vidal, Andrea, Roca, Enrique, Salmerón-González, Raquel Segura Roselló, Ramon Trullenque Juan, Cristina Verdejo Gimeno, Jose Miguel Zaragozá García, Gema Zomeño Bravo, Marcos Bruna Esteban, Hanna, Cholewa, Milton de Jesus, Matteo, Frasson, Luis Oliver García, Héctor, J Aguado, Antonio Jose Alonso Villalba, Francisco, Ardura, Carmen Elena Badillo Bercebal, María Bedate Núnez, Alvarez-Ramos Begoña Aranzazu, Juan Beltrán de Heredia, Hugo, Bermejo, Juan Berrocal Cuadrado, Maria Bragado González, Juan, Bustamante-Munguira, Raul Calvo Gonzalez, Yolanda, Carrascal, Ana Belén Casas Marcos, María Carmen Cervera, Sergio Chávez Valladares, Ángel Cilleruelo Ramos, Susana, Cortes, Jesús, Crespo-Sanjuán, María, Cuaresma, Luis Antonio Cuellar Martin, Carlos Ferreras García, Alvaro, Fuentes-Martín, Abel, Ganso, Elena García García, Luis, Garcia-Florez, Virginia, Garcia-Virto, Juan, Gatón, Julio Alberto Gobernado Tejedor, Tania Gómez Sanz, Jose Ignacio González Martín, María Begoña Gregorio Crespo, Ana Herranz Arriero, Jose, Herreros, Marta Ibáñez Nieto, César, Infante, Carlos, Jezieniecki, Moises, Juarez, Gregorio de Jesus Labrador Hernandez, Ana Patricia Legido Morán, Ricardo León Fernández, Alejandro, Leon-Andrino, Almudena, Llorente, Maria Lopez Pais, Mauricio Loucel Bellino, Sergio, Martin, Miguel Angel Martin-Ferrero, Gonzalo Martinez Municio, Elvira Mateos Alvarez, José María Matilla, Luis María Merino Peñacoba, Mario, Montes-Manrique, Fernando Natal Álvarez, David, C Noriega, Henar Nuñez Del Barrio, Francisco Javier Ortiz de Solórzano Aurusa, Lucía, Pañeda, Victoria Pascual Escudero, Miguel Pascual Samaniego, Adela, Pereda, Marta Pérez Febles, Laura, Pesquera, Maria, Plata, Emma Puertas Ruiz, Mario, Rodriguez-Lopez, Alejandro Romero de Diego, Ana, Ruano, María Ruiz Soriano, Cristina Sánchez Torralvo, Silvia Santiago Maniega, Bárbara, Segura-Méndez, Clarisa Simon Perez, José, Soro-García, Paula Suárez Mansilla Suárez-Mansilla, Jeancarlos Trujillo Díaz, Mª Esther Valsero Herguedas, Andrea Vazquez Fernandez, Eduardo Velasco García, Ana, Zabalza, Álvaro Zamora Horcajada, Fernando Acebes García, Enrique Asensio Díaz, Martín, Bailón, Alejandro David Bueno Cañones, Alvaro Centeno Velasco, Ekta Choolani Bhojwani, Fernando Labarga Rodríguez, Sara, Mambrilla, Pablo, Marcos-Santos, Toledano, Miguel, David Pacheco Sánchez, Baltasar, Pérez-Saborido, Pilar, Pinto, Katherine, Plua, Javier Sanchez Gonzalez, Vicente, Simo, Rosalía Velasco López, Sandra Veleda Belanche, Fabiola Eugenia Michel Campos, Iciar Muñoz Lindez, Maria, Balluerca, Maite, Camuera, Pablo, Helguera, Imanol, Herrero, Patricia Paunero Vazquez, María, Sánchez-Rubio, Isami, Soeda, María Dolores Arribas Del Amo, Vicente Manuel Borrego Estella, Estefania, Casas, Néstor Castán Villanueva, Daniel Delfau Lafuente, Elena Delgado Blanco, María, Domingo, Ismael Gil Romea, Azucena, Gonzalo, Emilio Lagunas Lostao, Noelia Lete Aguirre, Yaiza Martinez Lahoz, Jesús Víctor Pérez-Tierra Ruiz, Maria Del Mar Soriano, Isabel Valero Lázaro, Esmeralda Carnicer Escusol, Guillermo Pola Bandres, Juan Luis Blas Laina, Beatriz, Cros, Patricio Andrés Freile Pazmiño, David, Garcia-Aguilera, Ana Mejía Casado, Ana, Nogués, Issa Talal El-Abur, Carlos, Yánez, Isabel Gascon Ferrer, Carlos, Gracia-Roche, Ursula María Jariod Ferrer, María Victoria Simón Sanz, Tomas, Uson, Waseem, Ahamed, Sumudu, Jayasinghe, Eranda, Karunadasa, Prathibha, Nelihela, Sujeewa Priyantha Bandara Thalgaspitiya, Dickson, Wickramarathna, Nagenthiram, Harivallavan, Pirashanthan, Nagarasa, Eranga, Perera, Kanapathipillai, Piratheep, Vithranage Srimantha Dewsiri Rodrigo, Meera, Thayalan, Rajendram, Thayaparren, Arulprashanth, Arulanantham, Kanishka De Silva, Gagana, Ganga, Anuja Nadeeshan Kumarasinghe, Mahanada, Udukala, Koculen, Vimaleswaran, Prashanthan, Yogarajah, Ravindri, Jayasinghe, Probhodana, Ranaweera, Mohamed, Rishard, Dharmabandhu, N Samarasekera, Sanjeewa, Seneviratne, Sivasuriya, Sivaganesh, Chamal, Fernando, Nishantha, Mendis, Balasingam, Balagobi, Balasupramaniam, Sathesan, Lanka, Dasanayake, Malitha, Patabendige, Wickramasooriya, Dj, Kugarajh, Ganeshapillai, Sathyamoorthy, Prasanna, Dileepa, Ediriweera, Sumudu, Kumarage, Asanka, Jayawardane, Athula, Kaluarachchi, Pituwala Liyanage Adithya Sirisena, Abubakr, Abubakr, Hozifa, Mohamed, Ismail, Mustafa, Mogahid, Sharfeldein, Samir, Ismail, Reem, Musa, Monira, Sarih, Mussab, Abaker, Eman Adam Abdalla, Mohamad, Abdelbagi, Alsafe, Adlan, Ahmed, Alnaeem, Safa, Atyah, Yasir, Awad, Rsheeda, Dawelbait, Mohamed El Hag, Ibrahim, Elbashir, Sami, Eldirdiri, Samwal, Eldirdiri, Mohammed Eltahier Abdalla Omer, Lana Abdalgadir Ahmed Mohamed, Hiba Hassan Rehmtallah Ahmed, Mohammed Balla Yousif Balla, Abdulmoiz, Aljafari, Abdulmalek, Aljafari, Elsagad, Mohamed, Abdulkader, Mohammad, Abdulkader, Shaar, Mohamed Nafea Shaar, Maab Hussein Yousif Elhafiz, Mohammed Husien Yosif Elhafiz, Abubakr Ali Mohammed Alhassan Humidan, Almigdad, Ali, Hisham, Eljack, Mohamedyasin, Elrashid, Manhal, Ahmed, Albrra, Alhag, Douaa, Ali, Mohammed Ahmed Babikir, Imad, Bakheit, Hytham K, S Hamid, Sami, Mohamed, Walid, Shaban, Nidhal, Siddig, Mohamed, Suliman, Rihab Yasir Abdelmagid, Abubaker, Yassin, Omer, Abbas, Eltahir, Abdelrahim, Muhammed, Ahmed, Mohamed, Elobaid, Adil, Hashim, Ali, Mohamed, Omer, Mohamed, Khalid, Osman, Abdallah, Yousif, Safaa, Abdulaal, Marwa, Elsadig, Mohammed, Hussain, Malaz Amir Ataalmanan, Doha Amir AtaAlmanan, Tebyan Amir AtaAlmanan, Alaa, Elgaili, Maria, Mohamed, Usra, Omara, Alkhansa, Osman, Amna, Osman, Safaa, Saad, Abdelkareem, Ahmed, Ali Adil Ali Karar, Aya, Alhassan, Mohanad, Alsidig, Mohamed, Eljack, Mohammed Ibrahim Mohammed Ali, Awad Kamal Awad Osman, Liena, Mohamed, Samah Ibrahim Omer Mohamed Osman Mohamed Osman, Altayeb, Mohammed, Ayman, Mohammed, Khadija, Muhmmed, Eltahir, Musa, Egbal Sahal Abdelmajed, Khalid Z M, Y Hamid, Omnia M, M Yousif, Mahmoud, Saleh, Osman, Bashir, Yassein, Elhussein, Omar, Madani, Eva, Angenete, Jennifer, Park, Lars, Gillberg, Monir, Jawad, Linas, Pieteris, Yousif, Saeed, Sergej, Safonov, Martin, Spångfors, Henrik, Andersson, Hans, Bahlmann, Karin Björnström Karlsson, Michelle, Chew, Lara, Daham, Lina De Geer, Helen, Didriksson, Gunilla, Gagnö, Carina, Jonsson, Anna, Oscarsson, Pamela, Buchwald, Mathilde, Delorme, Marie-Louise, Lydrup, Shahin, Mohseni, Arvid, Pourlotfi, Souheil, Reda, Kajsa, Anderin, Nina, Blomme, Josefin, Segelman, Malin, Simlund, Anders, Thorell, Fredrik, Wogensen, Daniel, Danielsson, Peter, Elbe, Rebecka, Hultgren, Boel, Hynning, Fredrik, Klevebro, Karin, Lind, Ebba, K Lindqvist, Carl, Montan, Ernesto, Sparrelid, Clara Svenberg Lind, Jeremy, Wales, Andreas, Älgå, Martin, Nordberg, Emil, Pieniowski, Ioannis, Gkekas, Niklas, Löfgren, Karolina, Niska, Robert, Zürner, Silvio, Däster, Otto, Kollmar, Savas, Soysal, Stephanie, Taha-Mehlitz, Athanasios, Tampakis, Dominik Valentin Flury, Marie, Heyne-Pietschmann, Gregor Jan Kocher, Ana, M Calinescu, Barbara, Wildhaber, Markus, Gass, Jürg, Metzger, Andreas, Scheiwiller, Lukas, Briner, Oliver, Dwidar, Steven, Grandjean, Pietro, Ricciardi, Alexandra, Calmels, Christodoulou, Michel, Morena, Antonilli, Dimitrios, Christoforidis, Alessandra, Cristaudi, Jacopo, Galafassi, Maria Luisa Gasparri, Francesco, Mongelli, Martino, Munini, Andrea, Papadia, Sotirios Georgios Popeskou, Alex, Alfieri, Thomas, Bächler, Matteo, Giardini, Christian, Gingert, Laura, Guglielmetti, Inna, Meyer, Tobias, Müller, Daniel, Schöni, Folco, Solimene, Frank, Weidner, Marco, Bueter, Daniel, Gero, Amelie, Müller, Carmen, Portenkirchner, Andreas, Thalheimer, Jeannette, Widmer, Ahmad, Hmaideh, Alaa, Kour, Saleem, Swaes, Omar, Alannaz, Ramez, Aljasem, Ezeddin, Dabbagh, M Wafa Hamoud Alhussein, Amr, Hamza, Mazen, Mohammad, Abd El-Fattah Mouhandes, Mohamad, Shareeda, Mohammad Nour Shashaa, Mousa, Sifat, Sheraa, Tahhan, Rahaf, Toutounji, Mohamed, Abdulrahman, Albaraa, Abdulsalam, Ziad Al Jarad, Hala, Alayyoubi, Dina, Alfarra, Ahmad, Alhamid, Mahmoud, Alnasser, Mulham, Gharib, Ruwaid, Gharib, Obaida, Kabel, Osama, Kherallah, Abdulqader, Klaho, Mohamed Shukri Najjar, Ahmad, Razouk, Joud, Shiekhoni, Wael, Alkhaleel, Amira, Almosa, Mohammad, Aloulou, Maen, Alzaeem, Khaled, Arnaout, Muhamad Zakaria Brimo Alsaman, Mohamad, Estanbouli, Hanadi, Hawa, Ahmad Nbrass Kabawi, Ghina, Maarawi, Yehia, Mashhadany, Sana Shaikh Torab, Waleed, Abd, Tayma Abd Alghafour, Hani, Abdalnour, Nazeeh Al Aktaa, Marwan Al Aliwy, M Maher Al Arje, Tasneem Al Najjar, Ahmad, Al-Mouakeh, Ahmad, Aldakhil, Aos, Alhamid, Hasan, Alhasan, Mohamad Shadi Alkarrash, Jumaa, Alkhamis, Sara, Alshekh, Ahmad Yamen Arnaout, Oula, Azizeh, Mohammed, Dalaleh, Aghyad, Danial, Zain, Douba, Raghad, Ghadri, Mohammad Maen Ghannam, Anas, Ghawi, Luma Haj Kassem, M Yasser Halwani, Shahed, Hamadieh, Mohammad, Hanino, Ala Aldeen Hasan, Haya, Jawish, Nasr Ullah Kabbani, Saadullah, Kabbany, Mohamad, Kadi, Lama, Kadoura, Ahmad Amir Kayali, Ammar, Kayyali, Aya, Kelzia, Amana, Kezze, Abdullah, Khalaf, Maymona, Khayata, Mohammad Nour Kitaz, Mohammad, Kour, Raghad, Makki, Ruqaya, Masri, Joseph, Masri, Noor, Masri, Muhammad, Mazketly, Shiar, Mustafa, Ezzeldin, Nashed, Yaman Qoudra Danial, Hasan, Raslan, Rima, Salem, Mohammed Asaad Salem, Thabet Sayed Bakir, Manaf, Sharabaji, Majd Sheikh Alganameh, Duaa Sheikh Kadro, Joudy, Shurbatji, Mohammad Noor Sultan, Dana, Sultan, Hala, Swied, Bakri Tarras Jarkas, Tayf, Toutounji, Fadi, Ward, Rama, Zazo, Aya, Zazo, Zainab, Zeino, Mohamed, Alaktaa, Wael, Alsado, Hala, Fares, Nouran, Hawa, Hamza, Ibrahim, Abdulmonem, Kawas, Mourad, Niazi, Bayan, Toutounji, Mohammad, Abdow, Mohamad, Ahmad, Tareq, Ahmad, Rawan Al Azhar, Hiba Al Hage Diab, Rahaf Al Mulke, Mohammad, Al-Jadaan, Ahmad, Alhussein, Zahra, Alnajem, Omar, Alneser, Bayan, Alsaid, Elias, Azar, Lubna, Bakr, Ammar, Hamza, Yara, Houdifa, Sami, Jomaa, Samer, Kefo, Hiba, Mardini, Alaa, Mohammad, Fadi, Rayya, Fatima, Razzouk, Mohannad, Saleh, Anwar, Shamandi, Ammar Youzkatli Alkhatib, Omar Abdul Salam, Dany, Ajami, Mohammad, Alhamid, Ahmad, Alkhaledi, Danny, Hadidi, Massa, Jabra, Mamdouh, Kallas, Antoine, Laktine, Joelle, Naem, Naya, Naoum, Ghena Mohammed Fawaz Ashour, Ahmad, Alhouri, Deema, Fallouh, Ahmad, N Mohammad, Ahmad, Rmman, Ali, Slitin, Christine, Tanos, Ibrahim, Wakim, Hanaa, Zahrawi, Majd, Abouassi, Layth, Abouassi, Ayham, Aboutrab, Basel, Ahmad, Ahmad Mustafa Ahmad, Aya, Ahmad, Afaf, Ahmad, Mohamad, Alabras, Mohammad, Albasheer, Ola, Alkasser, Mhd Khaled Alkasser, Ali, Alkhdor, Marah, Azkoul, Mohammad Karam Chaaban, Haya, Deeb, Basel, Jazieh, Basel, Kouz, Youssef, Kozah, Raied, Mohamad, Ammar, Mohammad, Mhd Zied Nasri, Mohammed Mouaz Shebani, Mohammed, Shwin, Alaa, Sommaq, Amal, Youssef, Tala Al Asadi, Suhad, Alkhateb, Rasha Khalil Alsayyad, Roula, Altom, Mhd Amin Alzabibi, Batoul, Bakkar, Hlma, Ismail, Salma Khadem Alsrouji, Sara, Melhem, Mohamad, Sankari, Mosa, Shibani, Noura, Shujaa, Ibrahim, Adham, Salma, Al-Houssami, Maram, Balouli, Yazan, Rahmeh, Simon, Yanni, Sally, Yousef, Aline, Ahmad, Marah, Ali, Abdulrahman, Almjersah, Aya, Almoustafa, Hiba, Dahhan, Bashar Haj Hassan, Alaa, Hamdan, Salah, Hammed, Rawan, Harfoush, Rama, Hasan, Natalie, Jarkas, Moufid, Mahfoud, Ahmed, Moussa, Alaa, Sulaiman, Siba, Suliman, Yu-Ning, Hu, Jun-Neng, Roan, Meng-Ta, Tsai, Yi-Chen, Wang, Thammawat, Parakonthun, Nicha, Srisuworanan, Voraboot, Taweerutchana, Somcharoen, Saeteng, Sophon, Siwachat, Apichat, Tantraworasin, Danielle, Dimsoy, Shane, Khan, Akash, Ramsaroop, Shivanand, Ramsubhagh, Karim, Ayed, Oussama, Baraket, Mohamed Hedi Ghalloussi, Abbassi, Imed, Nahla, Kechiche, Waad, Farhat, Ammar, Houssem, Erdal Birol Bostanci, Volkan, Oter, Erol, Pişkin, Cihangir, Akyol, Sibel, Demirel, Mehmet Ali Koç, Can, Konca, Özge, Yanık, Basak, Bolukbasi, Huseyin, Gobut, Emre, Gülçek, Kerim, Karabulut, Ramazan, Kozan, Farshad, Noori, Elif, Özeller, Can, Şahin, Ali, Yalcinkaya, Mesut, Yavaş, Aydın, Yavuz, Utku, Akgor, Omer, Cennet, Hilmi Anil Dincer, Murat, Gultekin, Nazlı, Orhan, Mustafa, Oruç, Serdar, Culcu, Lütfi, Doğan, Cemil, Yüksel, Alp, Yildiz, Aybala, Yildiz, Perihan, Ekmekçi, Baturay Kansu Kazbek, Ülkü Ceren Köksoy, Deniz Serim Korkmaz, Zeynep Şahan Çetinkaya, Elif Aybeniz Yildirim, Hakan, Yilmaz, Metin, Yığman, Nasuh Utku Dogan, Selen, Doğan, Mehmet, Sakinci, Ozgen, Isik, Murat, Şen, Tuncay, Yılmazlar, Utku, Özgen, Ugur, Sungurtekin, Yener, Aydin, Ilker, Ince, Ali Bilal Ulas, Hüseyin Cahit Yalçın, Mehmet, Kaplan, Tuğba, Kaplan, Elif Tugce Kaplan, Afag, Aghayeva, Bilgi, Baca, Inci, Sahin, Zumrud, Aliyeva, Akif Enes Arikan, Erman, Aytac, Onur, Dülgeroğlu, Volkan, Ozben, Cihan, Uras, Emre, Sivrikoz, Ismail Ahmet Bilgin, Bahadır, Bozkırlı, Güralp Onur Ceyhan, Ismail, Hamzaoglu, Halil, Kara, Tayfun, Karahasanoğlu, Olus, Api, Mehmet, Ceyhan, Aylin Pelin Cil, Telce Aysen Gurbuz, Cumhur, B Lent Urman, Ahmet, Akbas, Yunus Emre Aktimur, Yuksel, Altinel, Fikret, Calikoglu, Serdar, 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Malaz, Abbakar, Vanessa, Badas, Radu, Chirvasuta, Joe, Drybrough, Alexandra, Hamshere, Annabelle, Harrison, Rebecca, Ireson, Nelson, Kamali, Abigail, Lau, Sumant, Luhana, Luisa, Macdonald, Barbara, Ribeiro, Alistair, Savage, Tanisha, Sharma, Paul, Swift, Rachel, Taute, Stephanie, Alford, Chase, Elswick, J Quentin Clemens, John Michael DiBianco, Anna, Faris, Mark, Hemmila, Giulia, I Lane, Lena, Napolitano, Jane, J Wong, Shelly, Abramowicz, Dina, Amin, Steven, Roser, Daniel, Beswick, Elisa, Birnbaum, Khaled, Campa, Carolyn, Chabuz, Brandon, Chapman, Nicole, Christian, Marco Del Chiaro, Adam, Dyas, Anna, Gergen, Anne, Getz, Ana, Gleisner, Ryan, Griffin, Laura, Harmon, Scott, Hirsch, Victoria, Huynh, Juan Pablo Idrovo, Laura, Leonard, Helen, Madsen, Robert, Mcintyre, Robert, Meguid, Kenny, Rodriguez, Richard, Schulick, Christopher, Scott, Lauren, Steward, Camille, Stewart, Malcolm, Su, Sarah, Tevis, Daniel, Thieu, Shane, Urban, Catherine, Velopulos, Jon, Vogel, Thomas, Vogler, Kristen, Vossler, Michael, Weyant, Franklin, Wright, Erika, Bengtson, Mary, Bokenkamp, Hannah, Chacon, W Drew Fielder, Alex, Haynes, Charlotte, Heron, Charles, Hill, Cole, Holan, Hannah, Kay, Brian, Kelley, Sabino, Lara, Kathryn, Mcelhinney, E Charles Osterberg, Sharmila, Paul, Christopher, Riley, Ayane, Rossano, Romil, Shah, Ifeoluwa, Shoyombo, Pooja, Srikanth, Pedro, Teixeira, Marc, Trust, Marian, Williams-Brown, Benjamin, Bigelow, Ijezie, Ikwuezunma, Amit, Jain, Harsha, Malapati, Ivy, Mannoh, Adam, Margalit, Sarah, Rapaport, Srikrishna Vangipuram Suresh, Dominique, Vervoort, Lekha, Yesantharao, Zhang, Bo, Hossam, Abdou, Megan, Anders, Jose, Diaz, Michael, Mazzeffi, Peter, Rock, Salim, Afshar, Andrea, Balthazar, Laura, Carlson, Karen, Carver, Michael, Kurtz, Craig, D McClain, Meena, Nathan, Caleb, Nelson, Nathalie, Roy, Rachel, Saunders, Amir, Taghinia, Vivian, Williams, Allison, Brown, Zara, Cooper, Joshua, Jolissaint, David, Mahvi, Barbara, Okafor, Chandrajit, Raut, Vanessa, Roxo, Ciersten, 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Batko, Anthony, Colon, Sofia, Gabrilovich, Carma, Goldstein, Christina, Gory, Janmejay, Hingu, Brian, Leoce, Anh, Nguyen, Guergana, Panayotova, Ruchi, Ram, Deviney, Rattigan, Jerette, Schultz, Sara, Solar, John, Stein, Grace, Tsui, Elizabeth, Warnack, Apostolos, Gaitanidis, Leon, Naar, Robert, Sinyard, Sophia, Angelides, Laura, Fitzmaurice, Alexander, Himstead, Mehraneh, Jafari, Zeljka, Jutric, Kari, Kansal, Lydia, Kirillova, Isabella, Kuo, Kapila, Patel, Erika Linmey Tay Lasso, Maki, Yamamoto, Maleeha, Ahmad, Steven, Chang, Gary Alan Bass, Benjamin, Braslow, Daniel, Dempsey, Caoimhe, Duffy, Daniel, Holena, Jonathan, Imran, John, Keogh, Cara, Lorenzi, Niels, Martin, Mark, Seamon, Lauren, Huckaby, Katrina, Morgan, Caroline, Rieser, Lauren, Rosenblum, Cindy, Teng, J Michael DiMaio, Mohanad, Hamandi, Mary, Hoffman, Allison, T Lanfear, Michael, Connolly, Benjamin, Hall, Tareq, Kheirbek, Elizabeth, Renaud, Kevin, Behm, Judy, Boughey, Kristin Cardiel Nunez, Sean, Cleary, Mihai, Dumbrava, Travis, Grotz, James, Jakub, Rahul, Kanade, David, Larson, Sherief, Shawki, Dennis, Wigle, Haradeen, Dhillon, Avni, Suri, Leonardo Weber Graeff, Ahmed, Elshabrawy, Grace Ihsiu Todd, Mark, Davies, Yan, Qi, Walter, Biffl, Kathryn, Schaffer, Sarah, Averbach, Terry, Curry, Alexandra, Schwartz, Mary Kathryn Abel, Veronica, Andaya, Kristina, Benirschke, Katherine, Bigay, Marissa, Boeck, Lee-Lynn, Chen, Lee-May, Chen, Huey-Lan, Chern, Amanda, Compadre, Patricia, Conroy, Alexa, Glencer, Patrick, Ha, Barbara Cs Hamilton, Johannes, R Kratz, Rondall, Lane, Rex, H Lee, Brenda, Nunez-Garcia, Richard, O'Donnell, Doruk, Ozgediz, Paul, Park, Ankit, Sarin, Ipsit, Shah, Bonnie, Sheu, Madhulika, Varma, Katherine, Wai, Rosanna, Wustrack, Mary Jue Xu, Melissa, Zimel, Pedro, Escobar, Meredid Maldonado Santiago, Mohammad, Azam, Asad, Choudhry, Eric, Hammond, William, Marx, Jihad, Abbas, Somya, Al-Embideen, Carol, Angel, Bailea, Bobich, Raul, Bosio, Gregory, Georgiadis, Tahir, Jamil, Maria, Kenner, Meghan, Lark, Tamara, Maghathe, Sonia, Masih, Gabriel, Naimy, Kristin, O'Mara-Gardner, Emily, Rady, Roberta, Redfern, Jack, Sample, Joseph, Sferra, Kaitlyn, Sharp, Jessica, Shoemaker, Stephen, Stanek, John, Stengle, Hibba, Sumra, Jeffrey, M Sutton, Faris, Azar, Anne, Fischer, Jaymie, Henry, Lawrence, Lottenberg, Mario, Rueda, Sasha, Thiel, Adel, Bozorgzadeh, John, Kelly, Armando Salim Munoz Abraham, Erin, Scott, Camila, Haro, Andrés, Pouy, Gastón, Acuña, Sofia, Álvarez, Ana Carmen Carbajal, Fabiola, Castedo, Diego, Pereiranuñez, Helena, Sobrero, Josefina, Tarigo, Rafat, Al-Saban, Fatima, Al-Eryani, Siham Al Maqtari, Sahar, Al-Maqtari, Mahmmoud, Abdualqader, Majed, Aeed, Ghadeer Al Sanany, Anwaar Al Dhafif, Buthina Al Jarmozi, Saba, Al-Ameri, Awsan, Al-Dhaheri, Dhyia Alhuq Al-Surimi, Amira, Alakhdury, Sabreen, Alashmali, Zainab, Alattas, Manar, Alduba'Ai, Hamdan, Aldumaini, Wafa, Alhaddad, Abdelrahman, Alharazi, Nawal, Alhemyari, Adnan, Alhumaida, Maniee, Aljabri, Hassan, Almarashi, Zuhoor, Almohanady, Marwa, Alodine, Nooraldin, Alqasemi, Basma, Alqudaimi, Ansam Mohammed Ghaleb Alrobaiee, Mohammed, Alsabri, Radfan, Alsalal, Ramzi, Alsayadi, Musaed, Alsayadi, Reem, Alshaipani, Ebrahim, Alsharabi, Nora, Atiah, Hadeel, Bajjah, Muhib, Esmael, Asma, Ghallab, Rana, Ghannam, Adwa'A, Hamid, Lina, Hashem, Sara, Saif, Shaima, Sayad, Nawras, Shaban, Amatallah Hadi Shamsan, Sarah, Shream, Amal, Shukri, Shahd, Zeid, Nabila, Abdullah, Abdulrahman Faisal Al-Garadi, Ahmed, M Ali Al-Radhi, Norhan, Naji, Shaima'A, Nasser, Areej Taha Al Anaib, Ebrahim, Abdurab, Fadhl Al Muhtadi, Amer, Al-Hebbah, Ahmed, Al-Madhrahi, Shehab, Al-Mahdi, Sakhr Abdulhakeem Al-Maswari, Ayman, Al-Oqabi, Zakarya Abdullah Al-Zaazaai, Karim, Al-Zazay, Ali, Alafif, Asem, Albzzaz, Lina, Alqalisi, Mohammed, Alrezami, Haneen, Alshargabi, Mokhtar, Alshargabi, Hossam, Ghanem, Kareem, Saeed, Rasheed, Shalabi, Fareed, Showqi, Miriam, Maimbo, Catherine, Mkandawire, Mulaya, Mubambe, Theresa, Nkole, Vanessa, Savopoulos, Patricia, Shinondo, Chabwera, Shumba, Penias, Tembo, Shelton, Chivanga, Ngqabutho, Dube, Handsome, Dube, Daniel, Dzinotyiwei, Ronald, Makanda, Moses, Mangena, Partson, Maphosa, Derek, Matsika, Proud, Mawere, Nkosikhona, Moyo, Assel, Moyo, Arnold, Muguwu, Simbarashe, Mungazi, Garikai, Mwale, Gamuchirai, Ndabvonga, Mambote Crispin Olivier Ntoto, Hardlife, Ranganai, Ernesto Sánchez Castillo, Oltah, Tshuma, Grace, Gwini, Vimbai Moyana Muguto, Gilbert, Moyo, Trust, Mushawarima, Tinashe, Shoko, Rorisang, Jamela, Marvellous, Machiri, Eric, Shumba, Antony, Chengahomwe, Yemurai, Bikwa, Maxwell, Chimhina, Jeremy, Marume, Kudzayi, Munanzvi, Precious G, T Mutambanengwe, Federico, Ferrari, Marco, Fontanella, Franco, Odicino, Romano, Vito, Nepogodiev D, Emanuele Cammarata, Sofia Campanella, Daniela Canzonieri, Adriana Cordova, Federico De Michele, Ettore Dinoto, Mara Franza, Leo Licari, Daniele Matta, Domenico Mirabella, Felice Pecoraro, Roberto Pirrello, Pierfrancesco Pugliese, Fernando Rosatti, Giuseppe Salamone, Francesca Toia, Massimiliano Tripoli, Nepogodiev, D, Rosati, R, Surgery, Medicine and Pharmacy academic/administration, Basic (bio-) Medical Sciences, Surgical clinical sciences, Faculty of Medicine and Pharmacy, Gastroenterology, Medical Oncology, Clinical sciences, Breda, João, ARD - Amsterdam Reproduction and Development, Paediatric Surgery, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, AGEM - Endocrinology, metabolism and nutrition, Graduate School, Tytgat Institute for Liver and Intestinal Research, Laura Alberici, Filippo Antonacci, Alessandro Arena, Angela Belvedere, Fabio Bernagozzi, Paolo Bernante, Pietro Bertoglio, Lorenzo Bianchi, Maria Bisulli, Barbara Bonfanti, Safia Boussedra, Jury Brandolini, Crescenzo Cacciapuoti, Stefano Cardelli, Riccardo Casadei, Matteo Cescon, Alessandro Cipolli, Riccardo Cipriani, Alfredo Conti, Luca Contu, Francesco Costa, Niccolo’ Daddi, Eugenia De Crescenzo, Pierandrea De Iaco, Alessandra De Palma, Massimo Del Gaudio, Anna Nunzia Della Gatta, Giampiero Dolci, Giulia Dondi, Matteo Droghetti, Sergio Nicola Forti Parri, Elena Garelli, Chiara Gelati, Giuliana Germinario, Federico A. Giorgini, Carlo Ingaldi, Elio Jovine, Kenji Kawamukai, Antonio Lanci Lanci, Raffaele Lombardi, Maria Elisa Lozano Miralles, Claudio Marchetti, Michele Masetti, Francesco Minni, Daniele Morezzi, Daniele Parlanti, Alice Pellegrini, Anna Myriam Perrone, Anna paola Pezzuto, Marco Pignatti, Gianluigi Pilu, Valentina Pinto, Gilberto Poggioli, Silvana Bernadetta Puglisi, Diego Raimondo, Matteo Ravaioli, Claudio Ricci, Sara Ricciardi, Francesco Ricotta, Roberta Rizzo, Angela Romano, Matteo Rottoli, Riccardo Schiavina, Renato Seracchioli, Matteo Serenari, Margherita Serra, Piergiorgio Solli, Gioia Sorbi, Mario Taffurelli, Marta Tanzanu, Achille Tarsitano, Marco Tesei, Gabriele Vago, Tommaso Violante, Simone Zanotti, Tommaso Frisoni, leonardo solaini, giorgio ercolani, Fruscio, R, Ornaghi, S, Collaborative, Covidsurg, Collaborative, Globalsurg, Palmisano, Silvia, de Manzini, Nicolo', Žundienė, Laura, Dulskas, Audrius, Kuliavas, Justas, Čekauskas, Albertas, Kielaitė-Gulla, Aistė, Poškus, Tomas, Strupas, Kęstutis, Želvys, Arūnas, COVIDSurg Collaborative, GlobalSurg Collaborative, Department of Surgery, HUS Abdominal Center, Simoes, Jff, Li, E, Picciochi, M, Glasbey, Jc, Baiocchi, G, Blanco-Colino, R, Chaudhry, D, Alameer, E, El-Boghdadly, K, Wuraola, F, Ghosh, D, Gujjuri, Rr, Harrison, Em, Lule, H, Kaafarani, H, Khosravi, M, Kronberger, I, Leventoglu, S, Mann, H, Mclean, Ka, Mengistu, Gm, Modolo, Mm, Ntirenganya, F, Norman, L, Outani, O, Pius, R, Pockney, P, Qureshi, Au, Roslani, Ac, Satoi, S, Shaw, C, Bhangu, A, Omar, Om, Ahmed, Wur, Argus, L, Ball, A, Bywater, Ep, Brar, A, Dawson, Be, Duran, I, Elhadi, M, Jones, C, Kamarajah, Sk, Keatley, Jm, Lawday, S, Marson, Ej, Ots, R, Santos, I, Taylor, Eh, Trout, Im, Varghese, C, Venn, Ml, Xu, W, Dajti, I, Gjata, A, Kacimi, Seo, Boccalatte, L, Cox, D, Townend, P, Aigner, F, Kronberger, Ie, Samadov, E, Alderazi, A, Hossain, K, Padmore, G, van Ramshorst, G, Lawani, I, Cerovac, A, Delibegovic, S, Gomes, Gma, Buarque, Il, Gohar, M, Slavchev, M, Nwegbu, C, Agarwal, A, Martin, J, Ng-Kamstra, J, Olivos, M, Lou, Wh, Ren, Dl, Calvache, Ja, Rivera, Cjp, Hadzibegovic, Ad, Kopjar, T, Mihanovic, J, Jimenez, Pma, Gouvas, N, Klat, J, Novysedlak, R, Amisi, N, Christensen, P, El-Hussuna, A, Batista, S, Lincango-Naranjo, E, Emile, S, Sandoval, Daa, Dhufera, H, Hailu, S, Mengesha, Mg, Kauppila, Jh, Arnaud, Ap, Demetrashvili, Z, Albertsmeier, M, Lederhuber, H, Loffler, Mw, Acquah, Dk, Ofori, B, Tabiri, S, Metallidis, S, Tsoulfas, G, Aguilera-Arevalo, Ml, Recinos, G, Mersich, T, Wettstein, D, Kembuan, G, Milan, Pb, Khosravi, Mh, Mozafari, M, Hilmi, A, Mohan, H, Zmora, O, Gallo, G, Pata, F, Pellino, G, Fujimoto, Y, Kuroda, N, Abou Chaar, Mk, Ayasra, F, Fakhradiyev, I, Hamdun, Ih, Jin-Young, J, Jamal, M, Karout, L, Gulla, A, Rasoaherinomenjanahary, F, Samison, Lh, Sanchez, Iid, Gonzalez, D, Martinez, L, Martinez, Mj, Nayen, A, and Ramos-De la Medina, A
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Male ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,MULTICENTER ,infectious diseases ,0302 clinical medicine ,030202 anesthesiology ,Anesthesiology ,Cirugía ,80 and over ,Prospective Studies ,Young adult ,Child ,Lung ,Aged, 80 and over ,COVID-19 ,delay ,SARS-CoV-2 ,surgery ,timing ,SARS‐CoV‐2 infection ,Operative ,Child, Preschool ,Pneumonia & Influenza ,Infection ,Cohort study ,Human ,medicine.medical_specialty ,Clinical Sciences ,Sars-cov-2 ,GlobalSurg Collaborative ,Settore MED/28 - MALATTIE ODONTOSTOMATOLOGICHE ,03 medical and health sciences ,Clinical Research ,Biodefense ,Correspondence ,Humans ,PULMONARY COMPLICATIONS ,CRIANÇAS EM IDADE PRÉ-ESCOLAR ,Aged ,Science & Technology ,Cirurgia ,Prevention ,Infant ,Odds ratio ,Pneumonia ,Prospective Studie ,Clinical research ,Surgery ,Human medicine ,610 Medizin und Gesundheit ,1109 Neurosciences ,Internationality ,Settore MED/29 - CHIRURGIA MAXILLOFACCIALE ,Settore MED/18 - CHIRURGIA GENERALE ,Adolescent ,Adult ,Cohort Studies ,Female ,Middle Aged ,Surgical Procedures, Operative ,Time ,Young Adult ,Practice Guidelines as Topic ,gastroenterology ,Medicine and Health Sciences ,030212 general & internal medicine ,Prospective cohort study ,Mortality rate ,Covid19 ,Infectious Diseases ,Patient Safety ,medicine.symptom ,6.4 Surgery ,Life Sciences & Biomedicine ,610 Medicine & health ,COVID-19, SARS-CoV-2, delay, surgery, timing ,Asymptomatic ,NO ,COVIDSurg Collaborative ,Vaccine Related ,All institutes and research themes of the Radboud University Medical Center ,medicine ,Mortalitat ,ddc:610 ,Mortality ,Preschool ,LS7_4 ,Surgical Procedures ,business.industry ,Neurosciences ,Evaluation of treatments and therapeutic interventions ,1103 Clinical Sciences ,3126 Surgery, anesthesiology, intensive care, radiology ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Anesthesiology and Pain Medicine ,Emerging Infectious Diseases ,Good Health and Well Being ,Mortalidad ,Cohort Studie ,business - Abstract
Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay. ispartof: ANAESTHESIA vol:76 issue:6 pages:748-758 ispartof: location:England status: published
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- 2021
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44. Not one less, the role of 4L in left-sided lung cancer: the message from the Polish experience
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Marco Lucchi and Vittorio Aprile
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Lung cancer ,Lymph node dissection ,Paratracheal lymph nodes ,Surgery ,Survival ,Humans ,Poland ,Carcinoma, Non-Small-Cell Lung ,Lung Neoplasms ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Carcinoma ,General Medicine ,medicine.disease ,Left sided ,medicine ,Radiology ,Non-Small-Cell Lung ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
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- View/download PDF
45. Investigation of
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Fabio, Coppedè, Roberta, Ricciardi, Angela, Lopomo, Andrea, Stoccoro, Anna, De Rosa, Melania, Guida, Loredana, Petrucci, Michelangelo, Maestri, Marco, Lucchi, and Lucia, Migliore
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CDKN2A ,myasthenia gravis ,DNA methylation ,epigenetics ,hemic and lymphatic diseases ,MLH1 ,RASSF1A ,Brief Research Report ,thymoma ,MGMT ,neoplasms ,digestive system diseases ,Neuroscience - Abstract
A feature of thymomas is their frequent association with myasthenia gravis (MG), an autoimmune disease characterized by the production of autoantibodies directed to different targets at the neuromuscular junction. Indeed, almost 30–40% of thymomas are found in patients with a type of MG termed thymoma-associated MG (TAMG). Recent studies suggest that TAMG-associated thymomas could represent a molecularly distinct subtype of thymic epithelial tumors (TETs), but few data are still available concerning the epigenetic modifications occurring in TAMG tissues. The promoter methylation levels of DNA repair (MLH1 and MGMT) and tumor suppressor genes (CDKN2A and RASSF1A) have been frequently investigated in TETs, but methylation data in TAMG tissues are scarce and controversial. To further address this issue, we investigated MLH1, MGMT, CDKN2A, and RASSF1A methylation levels in blood samples and surgically resected thymomas from 69 patients with TAMG and in the adjacent normal thymus available from 44 of them. Promoter methylation levels of MLH1, MGMT, CDKN2A, and RASSF1A genes were not increased in cancer with respect to healthy tissues and did not correlate with the histological or pathological features of the tumor or with the MG symptoms. The present study suggests that hypermethylation of these genes is not frequent in TAMG tissues.
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- 2020
46. The International Association for the Study of Lung Cancer Thymic Tumors Staging Project: The Impact of the Eighth Edition of the Union for International Cancer Control and American Joint Committee on Cancer TNM Stage Classification of Thymic Tumors
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Giuseppe Giaccone, Andrew G. Nicholson, Ayten Kayi Cangir, Pier Luigi Filosso, Wentao Fang, Ramón Rami-Porta, Hisao Asamura, Andrea Bille, Souheil Boubia, Kazuya Kondo, James Huang, Meinoshin Okumura, Nicolas Girard, Dong Kwan Kim, Marco Lucchi, Francesco Guerrera, Frank C. Detterbeck, Maurizio Infante, Conrad Falkson, Edith M. Marom, Mirella Marino, Enrico Ruffini, and Andreas Rimner
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,Oncology ,medicine.medical_specialty ,Survey ,Thymic carcinoma ,Thymic tumors ,Thymoma ,TNM ,Asia ,Cross-Sectional Studies ,Europe ,Humans ,Neoplasm Staging ,Prognosis ,United States ,Lung Neoplasms ,Thymus Neoplasms ,Cross-sectional study ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Lung cancer ,Lymph node ,business.industry ,Cancer ,Perioperative ,medicine.disease ,Dissection ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Lung cancer staging ,business - Abstract
Objectives The International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee-Thymic Domain conducted a web-based cross-sectional survey to assess the acceptance of the TNM thymic staging system in the thoracic community. Methods A 50-item, web-based questionnaire was circulated among the members of the major thymic organizations worldwide from September to December 2018. The survey consisted of six sections (general information; overall perception of the TNM system; pretreatment staging; T category; N category; and perioperative treatments). Results In total, 217 responses were collected from 37 countries in four continents. The TNM classification was considered useful by 78% of the responders (N = 169); the Masaoka-Koga staging system was being used by 87% of the responders (N = 189). With regard to the T category, most responders (mostly surgeons) felt that the capsular and mediastinal pleural involvements should be considered separate T categories. As for the N category, 48% of the responders (N = 105) used the International Thymic Malignancies Interest Group/International Association for the Study of Lung Cancer thymic nodal map, and lymph node dissection (N1/N2) was performed for 50%/21% thymomas and 66%/41% thymic carcinomas. While analyzing the results by the three continents (Europe, Asia, and Americas), responders in Asia were found to report the largest use of the TNM system, the greatest attention to the N category, and the best participation in international thymic databases. Conclusions The survey indicates that the Union for International Cancer Control/American Joint Committee on Cancer TNM stage classification of thymic tumors is gaining acceptance among the scientific community. The present results will guide the work of the Staging and Prognostic Factors Committee-Thymic Domain for the revision of the ninth edition of the TNM stage classification of thymic tumors.
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- 2020
47. A narrative review on lymphadenectomy: from open to minimally invasive surgery
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Diana Bacchin, Elisa Sicolo, Stylianos Korasidis, Maria Giovanna Mastromarino, Ilaria Ceccarelli, Marcello Carlo Ambrogi, Marco Lucchi, and Vittorio Aprile
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,thoracotomy (TX) ,business.industry ,General surgery ,medicine.medical_treatment ,Lymphadenectomy ,video-assisted thoracic surgery (VATS) ,Computer Science Applications ,robotic-assisted thoracic surgery (RATS) ,non-small cell lung cancer (NSCLC) ,Invasive surgery ,medicine ,Surgery ,Narrative review ,business - Published
- 2022
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48. OA06.02 High-Grade Patterns Cause the Upstaging of Lung Adenocarcinomas From T1 to T2a: A Multicentric Analysis
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Peter Kestenholz, M. Rodriguez-Perez, Giulia Querzoli, F. Lococo, Alberto Terzi, Diana Bacchin, Vittorio Aprile, G. Bocchialini, Piergiorgio Solli, Francesco Guerrera, Stefano Margaritora, Enrico Ruffini, D. Nachira, Fabrizio Minervini, Federico Femia, Massimiliano Paci, Marco Lucchi, P. Bertoglio, Giuseppe Bogina, Francesca Franzi, Andrea Imperatori, G. Rindi, Salvatore Bellafiore, Maria Cattoni, Luigi Ventura, and Letizia Gnetti
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Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,Lung ,medicine.anatomical_structure ,Oncology ,business.industry ,Medicine ,business - Published
- 2021
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49. Role of microRNA-33a in regulating the expression of PD-1 in lung adenocarcinoma
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Marco Lucchi, Mirella Giordano, Franca Melfi, Gabriella Fontanini, Alfredo Mussi, Cristina Niccoli, and Laura Boldrini
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0301 basic medicine ,Lung adenocarcinoma ,Cancer Research ,Cell ,Population ,PD-1 ,miR-33a ,Biology ,Bioinformatics ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,Antigen ,microRNA ,Genetics ,medicine ,Cytotoxic T cell ,lcsh:QH573-671 ,education ,Gene ,education.field_of_study ,lcsh:Cytology ,Cell cycle ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Cancer research ,Adenocarcinoma ,Primary Research - Abstract
Background MiRNAs are vital in functioning as either oncogenes or tumor suppressors in the cell cycle. Target transcripts for immune checkpoint molecules such as PD-1/PD-L1 and (programmed cell death-1/its ligand and cytotoxic T-lymphocyte antigen 4) have proven to be beneficial against several solid tumors, including lung adenocarcinoma. Methods Simultaneous quantification of the expression level of miR-33a and PD-1, PD-L1 and CTLA4 mRNAs with NanoString technology was performed in 88 lung adenocarcinoma specimens. A cohort of 323 lung adenocarcinoma patients from the cancer genome atlas (TCGA) database was further analyzed, in order to test our hypothesis. Potential interference of PD-1, PD-L1 and CTLA4 gene expression by miR-33a was predicted using the microRNA target prediction program RNA22. Results High miR-33a expression was significantly associated with younger (p = 0.005), female (p = 0.04), patients with low grade (p
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- 2017
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50. Serum Mesothelin, Osteopontin and Vimentin: Useful Markers for Clinical Monitoring of Malignant Pleural Mesothelioma
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Marco Lucchi, Alfredo Mussi, Antonio Chella, Nicolino Ambrosino, Alfonso Cristaudo, Elena Donadio, S Simonini, Rudy Foddis, Laura Giusti, Letizia Marconi, Maria Rosa Mazzoni, Alessandra Bonotti, and E Pantani
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Male ,Mesothelioma ,0301 basic medicine ,Cancer Research ,Pathology ,medicine.medical_specialty ,Lung Neoplasms ,Pleural Neoplasms ,Clinical Biochemistry ,Enzyme-Linked Immunosorbent Assay ,Vimentin ,GPI-Linked Proteins ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Biomarkers, Tumor ,Humans ,Medicine ,Mesothelin ,Osteopontin ,Survival rate ,Aged ,Neoplasm Staging ,biology ,Pleural mesothelioma ,business.industry ,Mesothelioma, Malignant ,Prognosis ,medicine.disease ,Combined Modality Therapy ,Survival Rate ,Rare tumor ,030104 developmental biology ,ROC Curve ,Oncology ,030220 oncology & carcinogenesis ,Disease Progression ,biology.protein ,Female ,Neoplasm staging ,business ,Follow-Up Studies - Abstract
Introduction Malignant pleural mesothelioma (MPM) is a relatively rare tumor, with the epithelioid type occurring more frequently. Several biomarkers have been suggested for screening and early diagnosis of MPM. Currently, high levels of soluble mesothelin-related peptides (SMRP), plasma osteopontin (pOPN) and vimentin have been reported in patients with MPM as promising markers for diagnosis, but their clinical use in monitoring is still discussed. The aim of our study was to evaluate the usefulness of these substances as markers of the clinical response to treatment in patients suffering from epithelioid mesothelioma. Methods 219 serum samples from 56 patients were collected during follow-up and the clinical response to therapy was recorded. Percentage differences between 2 consecutive measurements of SMRP, osteopontin and vimentin (Δ markers) by means of commercially available kits were correlated with changes in the clinical course. Results Δ SMRP, Δ pOPN and Δ vimentin showed statistically significant differences between the disease categories stable disease, partial response and disease progression (p = 0.0001, p = 0.035 and p = 0.0025 for SMRP, pOPN and vimentin, respectively). Moreover, contingency table analysis showed statistically significant differences between clinical response and Δ of each marker clustered into 3 groups (+20%). Conclusions The time course of Δ SMRP and Δ vimentin was strongly associated with disease status, and so was the time course of pOPN, albeit to a lesser extent. These markers appear to be particularly effective in cases of partial response and disease progression, while their possible use in stable disease should be better investigated.
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- 2017
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