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2. Anti-LGI1 encephalitis following COVID-19 vaccination: a case series

Author

Asioli, Gian Maria, Muccioli, Lorenzo, Barone, Valentina, Giacomozzi, Sebastiano, Rossi, Simone, Silvestri, Tania, Spinardi, Luca, Mastrangelo, Vincenzo, Bernabè, Giorgia, Leta, Chiara, Brutto, Mariachiara, Faggiano, Chiara, Liguori, Rocco, Bisulli, Francesca, Longoni, Marco, Tinuper, Paolo, Guarino, Maria, and Cortelli, Pietro

Published
2022
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3. Exploring Total Immunoglobulin A's Impact on Non-Biopsy Diagnosis of Celiac Disease: Implications for Diagnostic Accuracy.

Author

Raiteri, Alberto, Granito, Alessandro, Pallotta, Dante Pio, Giamperoli, Alice, Pratelli, Agnese, Monaco, Giovanni, Faggiano, Chiara, and Tovoli, Francesco

Abstract

Objective: In the current debate surrounding the biopsy-free diagnosis of CeD, it is crucial to identify factors influencing the accuracy of results. This study investigated the impact of total IgA on the non-invasive diagnosis of celiac disease (CeD). Methods: We retrospectively assessed total IgA titers' influence on the diagnostic accuracy of different tTG-IgA thresholds compared to the upper reference value (UNL). Results: Of 165 included patients, tTG-IgA values at 10× UNL and 6× UNL showed specificity of 82.6% and 73.9% and sensitivity of 49.3% and 69.0%, respectively, in predicting intestinal villous atrophy (Marsh 3). In 130 patients, total IgA levels were known at baseline. These patients were divided into three tertiles according to total IgA, i.e., patients with lower, intermediate, or higher total IgA within the population. For patients with total IgA ≥ 245 mg/dL, using a tTG-IgA cutoff of 6× UNL instead of 10× UNL resulted in decreased specificity from 71.4% to 42.8% and increased sensitivity from 67.6% to 81.1%. For patients with total IgA < 174 mg/dL and between 174 mg/dL and 245 mg/dL, using a tTG-IgA cutoff of 6× UNL instead of 10× UNL maintained specificity (75.0% and 85.7%, respectively) with increased sensitivity (from 46.2% to 64.1% and from 36.1% to 52.8%, respectively). Conclusions: In conclusion, total IgA influences the diagnostic accuracy of a predetermined tTG-IgA cutoff. Greater consideration should be given to total IgA, beyond its deficiency, in evaluating the applicability and accuracy of non-invasive CeD diagnosis. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Autoimmune Polyendocrine Syndromes in Adult Italian Celiac Disease Patients.

Author

Pallotta, Dante Pio, Granito, Alessandro, Raiteri, Alberto, Boe, Maria, Pratelli, Agnese, Giamperoli, Alice, Monaco, Giovanni, Faggiano, Chiara, and Tovoli, Francesco

Subjects
CELIAC disease, THYROID diseases, ENDOCRINE diseases, AUTOIMMUNE thyroiditis, AUTOIMMUNE diseases, SYNDROMES, AUTOANTIBODIES
Abstract

Celiac disease (CD) is frequently associated with other autoimmune disorders. Different studies have explored the association between CD and single autoimmune endocrine disease (AED), especially autoimmune thyroiditis (AIT) and type-1 diabetes mellitus (T1DM). Data about CD as a component of autoimmune polyendocrine syndrome (APS) are scant. We analyzed a large dataset including prospectively collected data from 920 consecutive adult CD patients diagnosed in a third-level Italian institution in the 2013–2023 period, The prevalence of isolated autoimmune endocrine diseases and APS were collected. A total of 262 (28.5%) CD patients had at least one associated AED, with AIT (n = 223, 24.2%) and T1DM (n = 27, 2.9%) being the most frequent conditions. In most cases (n = 173, 66%), AEDs were diagnosed after CD. Thirteen patients (1.4%) had at least two of the requested three endocrinopathies, satisfying the diagnosis of APS. APS is a rare but not exceptional occurrence among Italian CD patients, underscoring the intricate and multifaceted nature of autoimmune disorders. Periodic evaluations of thyroid function and glycaemia should be recommended after the diagnosis of CD together with testing for autoantibodies that may be helpful in assessing disease risk before disease onset. Likewise, implementation of a systematic screening for CD amongst T1DM and other autoimmune endocrine diseases are paramount. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Low hemoglobin level Predicts early hospital readmission in patients with cirrhosis and acute decompensation

Author

Pompili, Enrico, primary, Baldassarre, Maurizio, additional, Zaccherini, Giacomo, additional, Tufoni, Manuel, additional, Iannone, Giulia, additional, Pratelli, Dario, additional, Palmese, Francesco, additional, Vizioli, Luca, additional, Faggiano, Chiara, additional, Bedogni, Giorgio, additional, Domenicali, Marco, additional, and Caraceni, Paolo, additional

Published
2023
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12. Contributors

Author

Abdelmalak, Basem B., Abu-Omar, Yasir, Achilli, Felice, Adams, Sasha D., Aguirre-Bermeo, Hernán, Ahmed, Anas A., Aiello, Salvatore R., Akbari, Ayub, Alarcon, Louis H., Aldo, F. Luke, Alfaro-Maguyon, Maria Estela, Amin, Arpit, Angeli, Paolo, Annoni, Filippo, Antonelli, Massimo, Antongiorgi, Zarah D., Antoniadou, Anastasia, Arnaoutakis, Dean J., Astiz, Mark E., Azoulay, Élie, Baeza, Cristian, Baldisseri, Marie R., Balogh, Zsolt J., Banerjee, Arna, Bansal, Shweta, Barbier, François, Barjaktarevic, Igor, Bassin, Sarice L., Bastarache, Julie A., Baturin, Brian, Bausch, Daniel G., Beaulieu, Yanick, Beaver, Thomas, Bello, Giuseppe, Bellomo, Rinaldo, Bentea, Georgiana, Bermeo-Ovalle, Adriana C., Bernard, Gordon R., Berry, Cherisse, Bierens, Joost, Biffl, Walter L., Bihari, Shailesh, Bleck, Thomas P., Bledsoe, Thomas A., Bloch, Karen C., Boggild, Andrea K., Boncyk, Christina, Bond, Geoffrey J., Bradshaw, Michael J., Brakenridge, Scott, Branson, Richard D., Brimioulle, Serge, Brinson, Erika L., Brocca, Alessandra, Broman, Marcus Ewert, Brook, Itzhak, Brown, Christian J., Brunsvold, Melissa E., Buetti, Niccolò, Bulger, Eileen M., Cain, Christian, Calverley, Peter M.A., Cappelletty, Diane M., Casado-Arroyo, Ruben, Cecconi, Maurizio, Chae, June M., Chawla, Lakhmir S., Chan, Edward D., Chandrashekaran, Satish, Chandrika, Sharad, Chang, Wan-Tsu W., Chen, Dhruti P., Chopra, Amit, Christie, S. Ariane, Christman, John W., Cioci, Alessia C., Clark, Edward G., Cocanour, Christine, Cohen, Mitchell, Cole, Kelli A., Coleman, Lauren, Collins, Caitlin, Cook, Jared, Cooney, Robert N., Corbridge, Thomas, Cornely, Oliver A., Cortes-Lopez, Roxana, Crandall, Marie L., Čretnik, Andrej, Ashley, Chasen, Crouser, Elliott D., Navarro, Jovany Cruz, Curtis, J. Randall, Dalton, Heidi J., Darby, Joseph M., Davies, John D., Dayton, Orrin L., D’Costa, Rohit L., de Smet, Anne Marie G.A., Desai, Mehul A., Deutschman, Clifford, Dexter, Amanda M., Dhillon, Anahat, Muzio, Francesca Di, Diaz, Jose J., Jr., Dixon, Alexandra L., Doelken, Peter, Doidge, James, Dolinak, Joan, Donahoe, Michael, Driscoll, Ian R., Elhassan, Elwaleed A., Elie-Turenne, Marie Carmelle, Elmufdi, Firas, Ely, E. Wesley, Emlet, Lillian L., Emtiazjoo, Amir M., Ershoff, Brent, Estrera, Anthony L., Faggiano, Chiara, Falk, Ronald J., Farmer, Brenna, Farwell, Alan P., Feild, Carinda, Feller-Kopman, David, Hernandez, Samantha Fernandez, Ferrando-Vivas, Paloma, Ferrer, Miguel, Fisher, Caleb, Fishman, Guy, Flock, Jens, IV, Forman, Lisa, Fortune, Brett E., Freedman, Barry I., Fried, Elchanan, Gambino, Carmine, Gardiner, Dale, Gattinoni, Luciano, Gazmuri, Raúl J., Gehr, Todd W.B., Gerlach, Herwig, Ghobrial, R. Mark, Giamarellou, Helen, Ginsberg, Fredric, Gleason, Thomas G., Gorcsan, John, III, Gozal, Yaacov, Gradon, Jeremy D., Graves, Cornelia R., Greco, Massimiliano, Gregoretti, Cesare, Gropper, Michael A., Gubbins, Paul O., Gudzenko, Vadim, Gunnerson, Kyle J., Gunst, Jan, Gustafson, Kate S., Haase, Michael, Haase-Fielitz, Anja, Habib, Fahim, Harbrecht, Brian G., Harrison, David, Hill, Nicholas S., Hiremath, Swapnil, Hladik, Gerald A., Hoffman, Marcus K., Hollenberg, Steven M., Hoste, Eric A.J., Hsu, Albert, Huang, David T., Huber, Thomas S., Huggins, J. Terrill, Hamera, Joseph A., Ibrahim, Joseph Abdellatif, Isaac, Margaret L., Jabbour, Ibrahim I., Jacquerioz, Frederique A., Jadhav, Ashutosh, P., Jain, Sumeet V., Jansson, Paul S., Jeng, Eric I., Jozwiak, Mathieu, Kabrhel, Christopher, Kain, Taylor, Kaufman, David C., Kaynar, A. Murat, Kellum, John A., Kerwin, Andrew J., Kidd, Jason, Kilic, Arman, Kim, Donghee, Knudson, M. Margaret, Koehler, Philipp, Kollef, Marin H., Kormos, Robert L., Košir, Roman, Kotloff, Robert M., Kotzen, Elizabeth S., Koulenti, Despoina, Kratzert, Wolf Benjamin, Kumar, Anand, Langness, Simone, Lee, Jin, Leisman, Daniel, Leung, Angela M., Levin, Phillip D., Levy, Jerrold H., Levy, Mitchell M., Lewandowski, David C., Lewis, Anthony J., Bassi, Gianluigi Li, Liebman, Scott, Linas, Stuart L., Linefsky, Jason P., Lipman, Jeffrey, Lipsett, Pamela A., Lipshutz, Angela K.M., Loftus, Tyler J., Lopez-Magallon, Alejandro J., Lother, Sylvain, MacIntyre, Neil R., Magder, Sheldon, Maggiolini, Stefano, Mahajan, Aman, Maine, Rebecca, Maisch, Bernhard, Mancebo, Jordi, Mann, Henry J., Manocha, Sanjay, Margulies, Daniel R., Marik, Paul E., Marini, John J., Markan, Sandeep, Martinez-Camacho, Alvaro, Marx, William, Mayr, Florian B., Mazariegos, George V., McClave, Stephen A., McGloughlin, Steven A., McLean, Anna W., McMichael, Ali B.V., Meltzer, Joseph S., Merola, Raffaele, Messina, Antonio, Micek, Scott T., Mohammed, Subhan, Mohr, Alicia M., Monard, Celine, Monnet, Xavier, Montford, John, Moore, Ernest E., Moore, Frederick A., Moore, Hunter B., Moore, Laura J., Moore, Peter K., Mort, Thomas C., Motayar, Nasim, Muñoz, Ricardo A., Naber, Kurt G., Nadkarni, Vinay M., Nair, Girish B., Namias, Nicholas, Krishna, Vinay Narasimha, Nassikas, Nicholas J., New, Melissa L., Nguyen-Lee, Jennifer, Niccum, David E., Niederman, Michael S., Niven, Alexander S., Oddo, Mauro, Omer, Endashaw, Oostdijk, Evelien A.N., Opal, Steven M., Opdam, Helen I., Otto, Catherine M., Pannu, Sonal R., Parrillo, Joseph E., Pasero, Daniela, Patel, Rohit Pravin, Paterson, David L., Pavot, Arthur, Peitzman, Andrew B., Peluso, Lorenzo, Penoyer, Daleen Aragon, Pepe, Judith L., Pergakis, Melissa B., Peters, Steve G., Phelps, Mitch A., Picard, Fabien, Pilatz, Adrian, Piovesana, Giovanni, Pitisci, Lorenzo, Pollandt, Sebastian, Protti, Alessandro, Puyana, Juan Carlos, Puzio, Thaddeus J., Ra, Jin H., Raghu, Vikram K., Ramsingh, Davinder, Ranieri, V. Marco, Reynolds, Joshua C., Rimmelé, Thomas, Ristic, Arsen D., Rizzo, LTC Julie A., Robertson, Claudia S., Robinson, Christopher P., Robinson, Todd W., Roche-Campo, Ferran, Rodriguez, Ryan, Romito, Bryan T., Rosenthal, Martin D., Rowan, Daniel J., Rubenfeld, Gordon D., Rubin, Lewis J., Salgado, Juan C., Sambin, Pauline, Sánchez-de-Toledo, Joan, Santonocito, Cristina, Sappington, Penny Lynn, Sartelli, Massimo, Savelieva, Irina, Schott, Christopher K., Schouten, Jeroen A., Schreiber, Martin A., Schulman, Carl, See, Emily J., Seese, Laura M., Selickman, John, Sempsrott, Justin, Sethuraman, Kinjal N., Shemie, Sam D., Shiloh, Ariel L., Silvis, Jennifer L., Singer, Pierre, Singh, Sumit P., Sreedharan, Roshni, Steinberg, Alexis, Streichenberger, Antoine, Szpilman, David, Szychowiak, Piotr, Taccone, Fabio Silvio, Tanaka, Akiko, Tanner, Colby, Tawfik, Pierre N., Teboul, Jean-Louis, Teitelbaum, Isaac, Terragni, Pierpaolo, Thom, Stephen R., Thompson, Ashley, Timsit, Jean-Francois, Tisherman, Samuel A., Todd, S. Rob, Tolwani, Ashita J., Tonetti, Tommaso, Tonon, Marta, Torres, Antoni, Toscano, Nicole C., Tsai, Lillian L., Turner, Cody D., Tyndall, J. Adrian, Tzeng, Edith, Berghe, Greet Van den, van Zanten, Arthur R.H., Vanommeslaeghe, Floris, Vanzant, Erin L., Venkataraman, Ramesh, Verdiner, Ricardo E., Vincent, Jean-Louis, Wagenlehner, Florian M.E., Walker, Paul Phillip, Walley, Keith, Walter, James, Wang, Tisha, Wang, Kevin K.W., Ward, Nicholas S., Ware, Lorraine B., Warrillow, Stephen, Watson, Gregory A., Wechsler, Lawrence R., Weissman, Charles, Wille, Keith M., Wunderink, Richard G., Yang, Zhihui, Yende, Sachin, Yi, Stephanie Grace, Young, Paul, Zeitler, Evan, and Zhao, Frank Z.

Published
2024
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13. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients

Author

Terragni, Pier Paolo, Antonelli, Massimo, Fumagalli, Roberto, Faggiano, Chiara, Berardino, Maurizio, Pallavicini, Franco Bobbio, Miletto, Antonio, Mangione, Salvatore, Sinardi, Angelo U., Pastorelli, Mauro, Vivaldi, Nicoletta, Pasetto, Alberto, Rocca, Giorgio Della, Urbino, Rosario, Filippini, Claudia, Pagano, Eva, Evangelista, Andrea, Ciccone, Gianni, Mascia, Luciana, and Ranieri, V. Mar

Subjects
Company business management, Critically ill -- Care and treatment, Intensive care units -- Management, Artificial respiration -- Health aspects, Bacterial pneumonia -- Care and treatment, Bacterial pneumonia -- Prevention, Pneumonia -- Care and treatment, Pneumonia -- Prevention, Tracheotomy -- Health aspects
Abstract

A study was conducted to evaluate and compare the efficacy of early tracheotomy as against late tracheotomy for the prevention of pneumonia in mechanically ventilated adult patients in intensive care unit (ICU). Results indicated that in the case of such patients, early tracheotomy did not result in any statistically significant improvement as compared to the late one.

Published
2010

16. Occurrence of ventilator associated pneumonia using a tracheostomy tube with subglottic secretion drainage

Author

Terragni, Pierpaolo, primary, Urbino, Rosario, additional, Mulas, Franco, additional, Pistidda, Laura, additional, Cossu, Andrea P., additional, Piredda, Davide, additional, Faggiano, Chiara, additional, Falco, Davide, additional, Magni, Giuseppina, additional, Mascia, Luciana, additional, Filippini, Claudia, additional, and Ranieri, Vito Marco, additional

Published
2020
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19. Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study

Author

Vitale, Alessandro, Farinati, Fabio, Noaro, Giulia, Burra, Patrizia, Pawlik, Timothy M., Bucci, Laura, Giannini, Edoardo G., Faggiano, Chiara, Ciccarese, Francesca, Rapaccini, Gian Lodovico, Di Marco, Maria, Caturelli, Eugenio, Zoli, Marco, Borzio, Franco, Sacco, Rodolfo, Cabibbo, Giuseppe, Virdone, Roberto, Marra, Fabio, Felder, Martina, Morisco, Filomena, Benvegnù, Luisa, Gasbarrini, Antonio, Svegliati-Baroni, Gianluca, Foschi, Francesco Giuseppe, Olivani, Andrea, Masotto, Alberto, Nardone, Gerardo, Colecchia, Antonio, Fornari, Fabio, Marignani, Massimo, Vicari, Susanna, Bortolini, Emanuela, Cozzolongo, Raffaele, Grasso, Alessandro Giovanni, Aliberti, Camillo, Bernardi, Mauro, Frigo, Anna Chiara, Borzio, Mauro, Trevisani, Franco, Cillo, Umberto, Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Vitale, Alessandro, Farinati, Fabio, Noaro, Giulia, Burra, Patrizia, Pawlik, Timothy M., Bucci, Laura, Giannini, Edoardo G., Faggiano, Chiara, Ciccarese, Francesca, Rapaccini, Gian Lodovico, Di Marco, Maria, Caturelli, Eugenio, Zoli, Marco, Borzio, Franco, Sacco, Rodolfo, Cabibbo, Giuseppe, Virdone, Roberto, Marra, Fabio, Felder, Martina, Morisco, Filomena, Benvegnù, Luisa, Gasbarrini, Antonio, Svegliati-Baroni, Gianluca, Foschi, Francesco Giuseppe, Olivani, Andrea, Masotto, Alberto, Nardone, Gerardo, Colecchia, Antonio, Fornari, Fabio, Marignani, Massimo, Vicari, Susanna, Bortolini, Emanuela, Cozzolongo, Raffaele, Grasso, Alessandro Giovanni, Aliberti, Camillo, Bernardi, Mauro, Frigo, Anna Chiara, Borzio, Mauro, Trevisani, Franco, Cillo, Umberto, and Gasbarrini, Antonio (ORCID:0000-0002-7278-4823)

Abstract

Prognostic assessment of patients with hepatocellular carcinoma (HCC) at the time of diagnosis remains controversial and becomes even more complex at the time of restaging when new variables need to be considered. The aim of the current study was to evaluate the prognostic utility of restaging patients before proceeding with additional therapies for HCC. Two independent Italian prospective databases were used to identify 1,196 (training cohort) and 648 (validation cohort) consecutive patients with HCC treated over the same study period (2008-2015) who had complete restaging before decisions about additional therapies. The performance of the Italian Liver Cancer (ITA.LI.CA) prognostic score at restaging was compared with that of the Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer, and Cancer of the Liver Italian Program systems. A multivariable Cox survival analysis was performed to identify baseline, restaging, or dynamic variables that were able to improve the predictive performance of the prognostic systems. At restaging, 35.3% of patients maintained stable disease; most patients were either down-staged by treatment (27.2%) or had disease progression (37.5%). The ITA.LI.CA scoring system at restaging demonstrated the best prognostic performance in both the training and validation cohorts (c-index 0.707 and 0.722, respectively) among all systems examined. On multivariable analysis, several variables improved the prognostic ability of the ITA.LI.CA score at restaging, including progressive disease after the first treatment, Model for End-Stage Liver Disease at restaging, and choice of nonsurgical treatment as additional therapy. A new ITA.LI.CA restaging model was created that demonstrated high discriminative power in both the training and validation cohorts (c-index 0.753 and 0.745, respectively). Conclusion: Although the ITA.LI.CA score demonstrated the best prognostic performance at restaging, other variables should be considered to improve the prognostic a

Published
2018

20. Advanced Distributed Learning and ERP: interaction in augmented reality, haptic manipulation with 3D models and learning styles

Author

INVITTO, SARA, Scalinci, Graziano, Mignozzi, Arianna, Faggiano, Chiara, Invitto, Sara, Scalinci, Graziano, Mignozzi, Arianna, and Faggiano, Chiara

Subjects
haptic manipulation, Augmented reality, event related potential
Abstract

The Advanced Distributed Learning (ADL) is a learning process mediated by new technologies. The ADL also makes use of Augmented Reality, which takes place through processes of virtual manipulation. The experimental research on Augmented Reality markers and 3D objects focuses on the possibilities of interaction and manipulation of virtual forms in reality, that allows us to touch and interact with objects that do not exist but that are observable through a screen. Literature shows that there are different modules within the occipitotemporal cortex that receive both visual and somatosensory inputs and it explains how these can be integrated in the learning process. These cortical modules can be active in the evaluation of the various aspects of surface properties of objects, such as the 3D shape, as well as in visual and tactile movements. The purpose of this work is to analyze ERP components (P1, N2, P3) variations, during two different kinds of learning training (T): the same objects are manipulated either in Augmented Reality or during the condition of real haptic manipulation and the variations due to different learning styles are investigated. 12 university students were recruited for the study (mean age 23.11). The subjects were evaluated through a 4 scales style learning test: Visual Verbal (VV), Visual Non Verbal (VnV), Kinesthetic (K), Analytical (A). The subjects performed a training lasting 5 minutes consisting of haptic manipulation of 3D models, obtained through modeling a 3D Blender 2.74 and manipulation in Augmented Reality, presented through Dune® Aurasma models. After each training the subjects had to perform a recognition task of the same stimuli (presented in 2D), during an EEG recording. A General Linear Model was computed to investigate research hypothesis. Statistical Analysis reveals significance values in ERP components analyzed. N1 showed significant values in Analytic Learning (p = 0.007), Training (p = 0.00) and interaction between A * TL (p = 0.014). N2 showed significant value in Visual non Verbal Learning style (p = 0.00), Training (p = 0.01) and interaction VnV * T (p = 0.00). P3 showed significant value in Visual Verbal Learning style (p = 0.01). The subjects with high scores in Analytic Learning style show higher amplitude in the Pz channel, in P1 component. The subjects with high scores of Visual Non Verbal Learning style show higher amplitude in the Centrals, Occipitals and Parietals Channels, in N2 component. The subjects with Visual Verbal Learning, present higher amplitude in Frontals, Centrals, Parietals, and Occipitals Channels, in P3 component. We can conclude that learning styles are involved in perceptual levels during recognition tasks and according to the prominent style, processing involves different ERP components and different brain areas. The learning style affects more these variations when the mode of training is through Augmented Reality, where the visuomotor process is prevalent.

Published
2015

22. Tidal volume lower than 6 ml/kg enhances lung protection: Role of extracorporeal carbon dioxide removal

Author

Terragni, Pier Paolo, Del Sorbo, Lorenzo, Mascia, Luciana, Urbino, Rosario, Martin, Erica L., Birocco, Alberto, Faggiano, Chiara, Quintel, Michael, Gattinoni, Luciano, Ranieri, VITO MARCO, Terragni, Pier Paolo, Del Sorbo, Lorenzo, MASCIA, LUCIANA, Urbino, Rosario, Martin, Erica L., Birocco, Alberto, Faggiano, Chiara, Quintel, Michael, GATTINONI, LUCIANO, and RANIERI, VITO MARCO

Subjects
Male, Adult, Lung Disease, Positive-Pressure Respiration, Extracorporeal Membrane Oxygenation, Tidal Volume, Cardiac Output, Cytokine, Lung, Tomography, Acidosis, Respiratory, Aged, Air Pressure, Carbon Dioxide, Cytokines, Female, Humans, Hydrogen-Ion Concentration, Lung Diseases, Middle Aged, Pneumonia, Respiration, Artificial, Respiratory Distress Syndrome, Adult, Respiratory Function Tests, Tomography, X-Ray Computed, Anesthesiology and Pain Medicine, Respiratory Function Test, Respiratory Distress Syndrome, Respiration, X-Ray Computed, Acidosi, Artificial, Respiratory, Human
Abstract

BACKGROUND: Tidal hyperinflation may occur in patients with acute respiratory distress syndrome who are ventilated with a tidal volume (VT) of 6 ml/kg of predicted body weight develop a plateau pressure (PPLAT) of 28 < or = PPLAT < or = 30 cm H2O. The authors verified whether VT lower than 6 ml/kg may enhance lung protection and that consequent respiratory acidosis may be managed by extracorporeal carbon dioxide removal. METHODS: PPLAT, lung morphology computed tomography, and pulmonary inflammatory cytokines (bronchoalveolar lavage) were assessed in 32 patients ventilated with a VT of 6 ml/kg. Data are provided as mean +/- SD or median and interquartile (25th and 75th percentile) range. In patients with 28 < or = PPLAT < or = 30 cm H2O (n = 10), VT was reduced from 6.3 +/- 0.2 to 4.2 +/- 0.3 ml/kg, and PPLAT decreased from 29.1 +/- 1.2 to 25.0 +/- 1.2 cm H2O (P < 0.001); consequent respiratory acidosis (Paco2 from 48.4 +/- 8.7 to 73.6 +/- 11.1 mmHg and pH from 7.36 +/- 0.03 to 7.20 +/- 0.02; P < 0.001) was managed by extracorporeal carbon dioxide removal. Lung function, morphology, and pulmonary inflammatory cytokines were also assessed after 72 h. RESULTS: Extracorporeal assist normalized Paco2 (50.4 +/- 8.2 mmHg) and pH (7.32 +/- 0.03) and allowed use of VT lower than 6 ml/kg for 144 (84-168) h. The improvement of morphological markers of lung protection and the reduction of pulmonary cytokines concentration (P < 0.01) were observed after 72 h of ventilation with VT lower than 6 ml/kg. No patient-related complications were observed. CONCLUSIONS: VT lower than 6 ml/Kg enhanced lung protection. Respiratory acidosis consequent to low VT ventilation was safely and efficiently managed by extracorporeal carbon dioxide removal.

Published
2009

23. Ventilatory Management During Normothermic Ex Vivo Lung Perfusion

Author

Terragni, Pier Paolo, primary, Fanelli, Vito, additional, Boffini, Massimo, additional, Filippini, Claudia, additional, Cappello, Paola, additional, Ricci, Davide, additional, Del Sorbo, Lorenzo, additional, Faggiano, Chiara, additional, Brazzi, Luca, additional, Frati, Giacomo, additional, Venuta, Federico, additional, Mascia, Luciana, additional, Rinaldi, Mauro, additional, and Ranieri, V. Marco, additional

Published
2016
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33. Contributors

Author

Abdelmalak, Basem, Abu-Omar, Yasir, Achilli, Felice, Aguirre-Bermeo, Hernán, Akbari, Ayub, Alarcon, Louis H., Aldo, F. Luke, Al-Khafaji, Ali, Amathieu, Roland, Anderson-Dam, John Leo, Aneja, Rajesh K., Antonelli, Massimo, Antongiorgi, Zarah D., Antoniadou, Anastasia, Anupam, Anupam, Appendini, Lorenzo, Argent, Andrew C., Arnold, John H., Ashwal, Stephen, Astiz, Mark E., Baas, Arnold S., Baldisseri, Marie R., Balogh, Zsolt J., Banerjee, Arna, Bansal, Shweta, Banton, Kaysie, Barie, Philip S., Barjaktarevic, Igor, Bass, Barbara L., Bassi, Gianluigi Li, Bassin, Sarice L., Bastarache, Julie A., Bausch, Daniel G., Bayır, Hülya, Beaulieu, Yanick, Beaver, Thomas M., Beilman, Gregory, Bell, Michael J., Bello, Giuseppe, Benharash, Peyman, Bermeo-Ovalle, Adriana, Bernard, Gordon R., Berry, Cherisse D., Besecker, Beth Y., Bierens, Joost, Biffl, Walter L., Bleck, Thomas P., Bledsoe, Thomas A., Bloch, Karen C., Bohn, Desmond, Boldt, David, Bond, Geoffrey J., Bradshaw, Michael J., Brazzi, Luca, Brimioulle, Serge, Brook, Itzhak, Brundage, Richard C., Burgardt, Sara T., Burroughs, Sherilyn Gordon, Callaway, Clifton W., Calverley, Peter M.A., Camm, John, Campbell, Andre, Cappelletty, Diane M., Carcillo, Joseph A., Chan, Edward D., Chandrashekaran, Satish, Chawla, Lakhmir S., Chen, David C., Chopra, Amit, Clark, Robert S.B., Cohen, Jonathan D., Cohn, Stephen M., Cole, Kelli A., Collins, Staci, Com, Gulnur, Cook, Chris C., Cooney, Robert N., Corbridge, Susan J., Corbridge, Thomas C., Cornely, Oliver A., Crandall, Marie L., Čretnik, Andrej, Crippen, David, Croft, Chasen Ashley, Crouser, Elliott D., Cunha, Burke A., Cunha, Cheston B., Curtis, J. Randall, Dalton, Heidi J., Darby, Joseph M., Davies, John D., Dellavolpe, Jeffrey, De Smet, Anne Marie G.A., Dhillon, Anahat, Dhupar, Rajeev, Dicker, Rochelle A., Muzio, Francesca Di, Diringer, Michael N., Diven, Conrad F., Doelken, Peter, Donahoe, Michael, Boyd, Caron L., Eble, Brian K., Edelstein, Charles L., Edwards, Randolph, Elhassan, Elwaleed A., Ely, E. Wesley, Emlet, Lillian L., Emtiazjoo, Amir, English, Shane W., Ershoff, Brent, Ettinger, Joel H., Ettinger, Josh, Evans, David C., Everson, Gregory T., Faggiano, Chiara, Fair, Jeff, Falk, Ronald J., Farmer, Brenna, Farnan, Rory, Farwell, Alan P., Feild, Carinda, Feller-Kopman, David, Felmet, Kathryn, Ferrer, Miguel, Fink, Ericka L., Fink, Mitchell P., Fortune, Brett E., Freedman, Barry I., Fried, Elchanan, Frimpong, Kwame, Garg, Rajeev K., Gazmuri, Raúl J., Geelkerken, Robert H., Gehr, Todd W.B., Gentile, Michael A., George, M. Patricia, Gerlach, Herwig, Giamarellou, Helen, Ginsberg, Fredric, Gleason, Thomas G., Goerlich, Corbin E., Goodman, Diana J., Gopinath, Shankar, Gorcsan, John, III, Gozal, Yaacov, Gradon, Jeremy D., Graves, Cornelia R., Gregoretti, Cesare, Greinacher, Andreas, Gropper, Michael A., Gubbins, Paul O., Gudzenko, Vadim, Gunnerson, Kyle J., Habib, Fahim A., Harbrecht, Brian G., Harper, Yenal I.J., Hassan, Moustafa, Hazelzet, Jan A., Hiatt, Jonathan R., Hickey, Robert W., Higgins, Thomas L., Hill, Nicholas S., Hiremath, Swapnil, Hladik, Gerald A., Hollenberg, Steven M., Hoste, Eric, Hsu, Albert T., Huang, David T., Huggins, J. Terrill, Hull, Russell D., Ibrahim, Joseph Abdellatif, Ingraham, Angie, Isaac, Margaret L., Isbister, James P., Jacquerioz, Frederique A., Jadhav, Ashutosh P., Jiménez, David, Johannes, Jimmy, Jordan, Janeen Rene, Jorens, Philippe G., Jozwiak, Mathieu, Jung, Rose, Kapoor, Aanchal, Kaufman, David C., Kaynar, A. Murat, Kellum, John A., Kirton, Orlando, Knight, Jason, Kochanek, Patrick M., Koehler, Philipp, Kolkman, Jeroen J., Kollef, Marin H., Korb, Cecilia, Kormos, Robert L., Kornblith, Lucy Z., Košir, Roman, Kotloff, Robert M., Kozar, Rosemary A., Kratzert, Wolf Benjamin, Kumar, Anand, Kvetan, Vladimir, Larson, Shawn D., Lebuffe, Gilles, Lee, Constance, Lee, Hans J., Leung, Angela M., Levi, Allan D., Levin, Phillip D., Levy, Jerrold H., Levy, Mitchell M., Lewis, Anthony J., Lewis, Catherine E., Lewis, Susan J., Liebman, Scott, Linas, Stuart L., Linefsky, Jason P., Link, Kerry Michael, Lipsett, Pamela, Lipshutz, Angela K.M., Lopez-Magallon, Alejandro J., Maas, Andrew I.R., MacIntyre, Neil R., Macrae, Duncan, Madigan, Michael C., Maggiolini, Stefano, Mahajan, Aman, Maisch, Bernhard, Mancebo, Jordi, Mann, Henry J., Manocha, Sanjay, Margulies, Daniel R., Marik, Paul E., Marion, Donald W., Markle, Stephanie, Martinez-Camacho, Alvaro, Mayr, Florian B., Mazariegos, George V., Mazzarelli, Joanne, McGloughlin, Steven A., McIntyre, Lauralyn, McLean, Anna W., McNamara, John F., McNutt, Michelle K., Ponce Mejia, Lucido L., Meldrum, Daniel R., Meltzer, Joseph S., Mesotten, Dieter, Meyer, Kimberly S., Micek, Scott T., Michelson, David J., Mills, Dianne, Mitchell, Bartley, Mittel, Aaron M., Monnet, Xavier, Montford, John, Moore, Frederick A., Moore, Laura J., Moores, Lisa K., Moran, Colleen M., Morris, Alison, Mort, Thomas C., Moss, Michele, Mourvillier, Bruno, Muñoz, Ricardo, Naber, Kurt G., Nair, Girish B., Navarro, Jovany Cruz, New, Melissa L., Nguyen-Lee, Jennifer, Niederman, Michael S., Niven, Alexander S., Ochoa, Juan B., Oddo, Mauro, O'Neill, Patrick J., Opal, Steven M., Orlowski, James P., Otto, Catherine M., Page, Aravinda, Parrillo, Joseph E., Patel, Rohit Pravin, Paterson, David L., Peitzman, Andrew B., Penoyer, Daleen Aragon, Pepe, Judith L., Peters, Steve G., Pilatz, Adrian, Piovesana, Giovanni, Plum, Fred, Polderman, Kees H., Pollack, Murray M., Pollandt, Sebastian, Pronovost, Peter J., Puyana, Juan Carlos, Ra, Jin H., Rainey, Thomas G., Ramsingh, Davinder, Ranganathan, Sarangarajan, Ranieri, V. Marco, Rejai, Sepehr, Reyes, Jorge, Reynolds, Joshua C., Ristic, Arsen D., Robertson, Claudia S., Robin, Emmanuel, Robinson, Todd W., Roche-Campo, Ferran, Romito, Bryan, Rosengart, Matthew R., Rubenfeld, Gordon D., Rubin, Lewis J., Rudolph, Jeffrey A., Rueda, Mario, Ruppel, Randall A., Sadasivan, Santhosh, Saft, Howard L., Saggar, Rajan, Saha, Manish K., Salgado, Juan C., Sanchez-de-Toledo, Joan, Sanghani, Vivek R., Santonocito, Cristina, Sappington, Penny Lynn, Sarko, John, Savel, Richard H., Savelieva, Irina, Schoolwerth, Anton C., Schott, Christopher K., Schrier, Robert W., Schulman, Carl, Seger, Donna L., Selleng, Sixten, Sellke, Frank W., Sethuraman, Kinjal N., Sheridan, Robert L., Shiloh, Ariel L., Singer, Pierre, Singh, Sumit P., Slonim, Anthony D., Sodha, Neel R., Squadrone, Vincenzo, Sreedharan, Roshni, Steinberg, Steven M., Steinhorn, David M., Stocchetti, Nino, Stübgen, Joerg-Patrick, Sucher, Joseph F., Szpilman, David, Teboul, Jean-Louis, Teitelbaum, Isaac, Terragni, Pierpaolo, Thom, Stephen R., Thomas, Elizabeth, Timsit, Jean-Francois, Tisherman, Samuel A., Todd, S. Robert, Tolwani, Ashita J., Torres, Antoni, Turner, Cody D., Turner, Krista, Tzeng, Edith, Vallet, Benoît, Van den Berghe, Greet, van Zanten, Arthur R.H., Vanommeslaeghe, Floris, Venkataraman, Ramesh, Ventre, Kathleen M., Vespa, Paul M., Vincent, Jean-Louis, Wagenlehner, Florian M.E., Wagner, Justin P., Walker, Paul Phillip, Walley, Keith R., Walter, Robert J., Wang, Kevin K.W., Wang, Tisha, Ward, Nicholas S., Ware, Lorraine B., Watson, Gregory A., Wechsler, Lawrence R., Weidner, Wolfgang, Weissman, Charles, Wilcox, Mark H., Wille, Keith M., Wolff, Michel, Wunderink, Richard G., Wybourn, Christopher, Yang, Zhihui, Yarmus, Lonny, Yende, Sachin, Yi, Stephanie Grace, Yu, Dongnan, Yu, Felix, Yusen, Roger D., and Zazulia, Allyson R.

Published
2017
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34. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial.

Author

Terragni, Pier Paolo, Antonelli, Massimo, Fumagalli, Roberto, Faggiano, Chiara, Berardino, Maurizio, Pallavicini Bobbio, Franco, Miletto, Antonio, Mangione, Salvatore, Sinardi, Angelo, Pastorelli, Mauro, Vivaldi, Nicoletta, Pasetto, Alberto, Della Rocca, Giorgio, Urbino, Rosario, Filippini, Claudia, Pagano, Eva, Evangelista, Andrea, Ciccone, Gianni, Mascia, Luciana, Ranieri, Marco, Antonelli, Massimo (ORCID:0000-0003-3007-1670), Terragni, Pier Paolo, Antonelli, Massimo, Fumagalli, Roberto, Faggiano, Chiara, Berardino, Maurizio, Pallavicini Bobbio, Franco, Miletto, Antonio, Mangione, Salvatore, Sinardi, Angelo, Pastorelli, Mauro, Vivaldi, Nicoletta, Pasetto, Alberto, Della Rocca, Giorgio, Urbino, Rosario, Filippini, Claudia, Pagano, Eva, Evangelista, Andrea, Ciccone, Gianni, Mascia, Luciana, Ranieri, Marco, and Antonelli, Massimo (ORCID:0000-0003-3007-1670)

Abstract

CONTEXT: Tracheotomy is used to replace endotracheal intubation in patients requiring prolonged ventilation; however, there is considerable variability in the time considered optimal for performing tracheotomy. This is of clinical importance because timing is a key criterion for performing a tracheotomy and patients who receive one require a large amount of health care resources. OBJECTIVE: To determine the effectiveness of early tracheotomy (after 6-8 days of laryngeal intubation) compared with late tracheotomy (after 13-15 days of laryngeal intubation) in reducing the incidence of pneumonia and increasing the number of ventilator-free and intensive care unit (ICU)-free days. DESIGN, SETTING, AND PATIENTS: Randomized controlled trial performed in 12 Italian ICUs from June 2004 to June 2008 of 600 adult patients enrolled without lung infection, who had been ventilated for 24 hours, had a Simplified Acute Physiology Score II between 35 and 65, and had a sequential organ failure assessment score of 5 or greater. INTERVENTION: Patients who had worsening of respiratory conditions, unchanged or worse sequential organ failure assessment score, and no pneumonia 48 hours after inclusion were randomized to early tracheotomy (n = 209; 145 received tracheotomy) or late tracheotomy (n = 210; 119 received tracheotomy). MAIN OUTCOME MEASURES: The primary endpoint was incidence of ventilator-associated pneumonia; secondary endpoints during the 28 days immediately following randomization were number of ventilator-free days, number of ICU-free days, and number of patients in each group who were still alive. RESULTS: Ventilator-associated pneumonia was observed in 30 patients in the early tracheotomy group (14%; 95% confidence interval [CI], 10%-19%) and in 44 patients in the late tracheotomy group (21%; 95% CI, 15%-26%) (P = .07). During the 28 days immediately following randomization, the hazard ratio of developing ventilator-associated pneumonia was 0.66 (95% CI, 0.42-1.04), remai

Published
2010

36. Accuracy of Plateau Pressure and Stress Index to Identify Injurious Ventilation in Patients with Acute Respiratory Distress Syndrome

Author

Terragni, Pier Paolo, primary, Filippini, Claudia, additional, Slutsky, Arthur S., additional, Birocco, Alberto, additional, Tenaglia, Tommaso, additional, Grasso, Salvatore, additional, Stripoli, Tania, additional, Pasero, Daniela, additional, Urbino, Rosario, additional, Fanelli, Vito, additional, Faggiano, Chiara, additional, Mascia, Luciana, additional, and Ranieri, V. Marco, additional

Published
2013
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38. Tidal Volume Lower than 6 ml/kg Enhances Lung Protection

Author

Terragni, Pier Paolo, primary, Del Sorbo, Lorenzo, additional, Mascia, Luciana, additional, Urbino, Rosario, additional, Martin, Erica L., additional, Birocco, Alberto, additional, Faggiano, Chiara, additional, Quintel, Michael, additional, Gattinoni, Luciano, additional, and Ranieri, V Marco, additional

Published
2009
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40. Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study

Author

Vitale, A, Farinati, F, Noaro, G, Burra, P, Pawlik, Tm, Bucci, L, Giannini, Eg, Faggiano, C, Ciccarese, F, Rapaccini, Gl, Di Marco, M, Caturelli, E, Zoli, M, Borzio, F, Sacco, R, Cabibbo, G, Virdone, R, Marra, F, Felder, M, Morisco, F, Benvegnù, L, Gasbarrini, A, Svegliati-Baroni, G, Foschi, Fg, Olivani, A, Masotto, A, Nardone, G, Colecchia, A, Fornari, F, Marignani, M, Vicari, S, Bortolini, E, Cozzolongo, R, Grasso, A, Aliberti, C, Bernardi, M, Frigo, Ac, Borzio, M, Trevisani, F, Cillo, U, CA) group, Italian Liver Cancer (ITA. LI., Vitale, Alessandro, Farinati, Fabio, Noaro, Giulia, Burra, Patrizia, Pawlik, Timothy M., Bucci, Laura, Giannini, Edoardo G., Faggiano, Chiara, Ciccarese, Francesca, Rapaccini, Gian Lodovico, Di Marco, Maria, Caturelli, Eugenio, Zoli, Marco, Borzio, Franco, Sacco, Rodolfo, Cabibbo, Giuseppe, Virdone, Roberto, Marra, Fabio, Felder, Martina, Morisco, Filomena, Benvegnù, Luisa, Gasbarrini, Antonio, Svegliati-Baroni, Gianluca, Foschi, Francesco Giuseppe, Olivani, Andrea, Masotto, Alberto, Nardone, Gerardo, Colecchia, Antonio, Fornari, Fabio, Marignani, Massimo, Vicari, Susanna, Bortolini, Emanuela, Cozzolongo, Raffaele, Grasso, Alessandro, Aliberti, Camillo, Bernardi, Mauro, Frigo, Anna Chiara, Borzio, Mauro, Trevisani, Franco, and Cillo, Umberto

Subjects
Male, Oncology, Databases, Factual, Liver cancer, non surgical therapy, prognostic system, surgical therapy, survival, hepatocellular carcinoma, stage, treatment, Kaplan-Meier Estimate, Cohort Studies, Liver disease, 0302 clinical medicine, Middle Aged, Sorafenib, Prognosis, Italy, 030220 oncology & carcinogenesis, Catheter Ablation, Disease Progression, Female, 030211 gastroenterology & hepatology, medicine.drug, Cohort study, medicine.medical_specialty, Carcinoma, Hepatocellular, Settore MED/12 - GASTROENTEROLOGIA, Clinical Decision-Making, Risk Assessment, Disease-Free Survival, Statistics, Nonparametric, 03 medical and health sciences, Internal medicine, medicine, Hepatectomy, Humans, Infusions, Intra-Arterial, Neoplasm Invasiveness, Survival analysis, Aged, Neoplasm Staging, Retrospective Studies, Analysis of Variance, Hepatology, business.industry, Reproducibility of Results, Cancer, Retrospective cohort study, medicine.disease, Survival Analysis, business, Progressive disease
Abstract

Prognostic assessment of patients with hepatocellular carcinoma (HCC) at the time of diagnosis remains controversial and becomes even more complex at the time of restaging when new variables need to be considered. The aim of the current study was to evaluate the prognostic utility of restaging patients before proceeding with additional therapies for HCC. Two independent Italian prospective databases were used to identify 1,196 (training cohort) and 648 (validation cohort) consecutive patients with HCC treated over the same study period (2008-2015) who had complete restaging before decisions about additional therapies. The performance of the Italian Liver Cancer (ITA.LI.CA) prognostic score at restaging was compared with that of the Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer, and Cancer of the Liver Italian Program systems. A multivariable Cox survival analysis was performed to identify baseline, restaging, or dynamic variables that were able to improve the predictive performance of the prognostic systems. At restaging, 35.3% of patients maintained stable disease; most patients were either down-staged by treatment (27.2%) or had disease progression (37.5%). The ITA.LI.CA scoring system at restaging demonstrated the best prognostic performance in both the training and validation cohorts (c-index 0.707 and 0.722, respectively) among all systems examined. On multivariable analysis, several variables improved the prognostic ability of the ITA.LI.CA score at restaging, including progressive disease after the first treatment, Model for End-Stage Liver Disease at restaging, and choice of nonsurgical treatment as additional therapy. A new ITA.LI.CA restaging model was created that demonstrated high discriminative power in both the training and validation cohorts (c-index 0.753 and 0.745, respectively). Conclusion: Although the ITA.LI.CA score demonstrated the best prognostic performance at restaging, other variables should be considered to improve the prognostic assessment of patients at the time of deciding additional therapies for HCC.

Published
2018

41. Celiac disease diagnosed through screening programs in at-risk adults is not associated with worse adherence to the gluten-free diet and might protect from osteopenia/osteoporosis

Author

Vito Sansone, Alessandro Granito, Giulia Negrini, Francesco Tovoli, Teresa Catenaro, Luigi Bolondi, Chiara Faggiano, Tovoli, Francesco, Negrini, Giulia, Sansone, Vito, Faggiano, Chiara, Catenaro, Teresa, Bolondi, Luigi, and Granito, Alessandro

Subjects
Adult, Male, medicine.medical_specialty, Gluten sensitivity, Osteoporosis, lcsh:TX341-641, Disease, Article, Osteopenia osteoporosis, Metabolic bone disease, Diet, Gluten-Free, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Screening programs, Humans, Mass Screening, Medicine, Celiac disease, 030212 general & internal medicine, Retrospective Studies, Outcome, Nutrition and Dietetics, business.industry, Medical record, Osteoporosi, Middle Aged, medicine.disease, osteoporosis, Osteopenia, Gluten-free diet, Screening, Patient Compliance, Female, 030211 gastroenterology & hepatology, Gluten free, business, lcsh:Nutrition. Foods and food supply, Gluten, Food Science
Abstract

Screening strategies to detect celiac disease (CD) in at-risk subjects are of paramount importance to prevent the possible long-term complications of this condition. It is therefore of strategic relevance to understand whether patients diagnosed through screening follow a strict gluten-free diet (GFD), as the non-compliance to this diet can make screening efforts pointless. Currently, no studies have verified whether CD patients diagnosed in their adulthood are adhering to the GFD years after the diagnosis. We retrospectively evaluated the medical records of 750 CD patients diagnosed in our center during January 2004&ndash, December 2013 to verify differences between screening detected and clinically diagnosed patients. The groups shared a similar adherence to the GFD (91.2 versus 89.8%, p = 0.857). Moreover, the rates of non-responsive CD, GFD-induced metabolic alterations, and persistence in controls were also similar. Instead, screening-detected patients had a significantly lower rate of osteopenia/osteoporosis at diagnosis (31.3 versus 46%, p &lt, 0.001). In conclusion, screening strategies for CD in at-risk groups should be encouraged even in the adult population. Patients diagnosed through these strategies had no additional problems compared to those diagnosed for clinical suspicion and might benefit from a protective effect against metabolic bone disease.

Published
2018

42. Systemic treatments for hepatocellular carcinoma: challenges and future perspectives

Author

Elisabetta Goio, Alessandro Granito, Francesca Benevento, Giulia Negrini, Francesco Tovoli, Chiara Faggiano, Tovoli, Francesco, Negrini, Giulia, Benevento, Francesca, Faggiano, Chiara, Goio, Elisabetta, and Granito, Alessandro

Subjects
Sorafenib, Oncology, medicine.medical_specialty, Cabozantinib, medicine.medical_treatment, Phases of clinical research, Review, lenvatinib, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, cabozantinib, Internal medicine, Regorafenib, systemic therapies, medicine, neoplasms, metronomic capecitabine, Hepatology, business.industry, Immunotherapy, hepatocellular carcinoma, medicine.disease, digestive system diseases, chemistry, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, 030211 gastroenterology & hepatology, regorafenib, sorafenib, immunotherapy, Lenvatinib, business, medicine.drug
Abstract

Sorafenib has been the only approved systemic treatment of hepatocellular carcinoma (HCC) for almost a decade. Recently, two new drugs showed positive results in two Phase III studies. The RESORCE trial identified regorafenib as a valid second-line treatment for patients progressing to sorafenib, the REFLECT trial showed that lenvatinib is noninferior to sorafenib as front-line treatment. Following these trials, the therapeutic scenario will be dominated by anti-VEGFR drugs, with three different molecules showing a proven anticancer activity. Some open problems still remain and different immunotherapy trials are underway, following promising preliminary results. In this review we analyze: the most recent advancements about patients treated with sorafenib; the results of RESORCE and REFLECT trials; and the ongoing Phase III clinical trials. Finally, we discuss how they could address the current problems and possibly reshape the future of the systemic treatments for HCC.

Published
2017

43. Long term effects of gluten-free diet in non-celiac wheat sensitivity

Author

Giulia Negrini, Luigi Bolondi, Alessandro Granito, Chiara Faggiano, Elena Guidetti, Francesco Tovoli, Tovoli, Francesco, Granito, Alessandro, Negrini, Giulia, Guidetti, Elena, Faggiano, Chiara, and Bolondi, Luigi

Subjects
Quality of life, Adult, Male, medicine.medical_specialty, Adolescent, Non-celiac gluten sensitivity, Disease, Wheat Hypersensitivity, Critical Care and Intensive Care Medicine, Time, 03 medical and health sciences, Diet, Gluten-Free, Young Adult, 0302 clinical medicine, Gluten free diet, Internal medicine, Surveys and Questionnaires, Celiac disease, Medicine, Humans, 030212 general & internal medicine, Outcome, Aged, Nutrition and Dietetics, business.industry, nutritional and metabolic diseases, Reproducibility of Results, Middle Aged, Treatment Outcome, 030211 gastroenterology & hepatology, Gluten free, Female, business, Gluten
Abstract

Information about the clinical outcome of patients with non-celiac wheat sensitivity (NCWS) treated with gluten-free diet (GFD) derive from studies assessing the symptom response in the first few weeks of treatment. We aimed to evaluate the clinical response to the GFD and the quality of life (QoL) of NCWS patients in the long term.Forty-four NCWS (diagnosed according to the Salerno criteria) participated in the study. Participants rated their symptoms according to a 0-10 scale patients and filled in a QoL questionnaire (CDQ) before the beginning of the GFD and during a follow-up evaluation performed after at least one year. To assess the reliability of the questionnaire we also included a control group of 43 matched patients with celiac disease (CD).Upon diagnosis, NCWS patients had a high prevalence of intestinal and extraintestinal symptoms. Also, most symptoms were described as severe and the QoL questionnaire showed high scores. On follow-up, both prevalence and severity of the most common symptoms were significantly reduced. However, persistent intestinal and extraintestinal symptoms of mild severity were found in 65.9 and 72.7% of NCWS patients. In comparison, in the CD group, the prevalence was lower (32.6 and 23.2% respectively) and consistent with previous studies. The analyses of the determinant of QoL showed that, upon diagnosis, NCWS patients had higher scores in the CDQ "gastrointestinal symptoms" (p 0.001), "emotional aspects" (p 0.001) and "social problems" (p 0.001) subclasses compared to CD patients. After the GFD, NCWS and CD patients shared similar scores in all of the subclasses.A significant proportion of NCWS patients still complains of intestinal and extraintestinal symptoms, even if significantly attenuated by the GFD, even years after the diagnosis. A comprehensive nutritional evaluation of these patients is required to further improve their symptoms and their QoL.

Published
2017

44. Ventilatory Management During Normothermic Ex Vivo Lung Perfusion: Effects on Clinical Outcomes

Author

Giacomo Frati, Mauro Rinaldi, Pierpaolo Terragni, Vito Fanelli, Chiara Faggiano, Luciana Mascia, Luca Brazzi, Claudia Filippini, Paola Cappello, Massimo Boffini, Vito Marco Ranieri, Davide Ricci, Lorenzo Del Sorbo, Federico Venuta, Terragni, Pier Paolo, Fanelli, Vito, Boffini, Massimo, Filippini, Claudia, Cappello, Paola, Ricci, Davide, Del Sorbo, Lorenzo, Faggiano, Chiara, Brazzi, Luca, FRATI, GIACOMO, VENUTA, Federico, MASCIA, LUCIANA, Rinaldi, Mauro, and RANIERI, VITO MARCO

Subjects
Male, Extracorporeal Circulation, medicine.medical_treatment, Transplants, 030204 cardiovascular system & hematology, Transplant, law.invention, 0302 clinical medicine, law, Medicine, 030212 general & internal medicine, Lung, Respiration, respiratory system, Middle Aged, Intensive care unit, Tissue Donors, Perfusion, medicine.anatomical_structure, Treatment Outcome, Anesthesia, Artificial, Female, Human, Lung Transplantation, Adult, Risk, medicine.medical_specialty, Stre, Tissue Donor, Lung injury, Stress, 03 medical and health sciences, Pressure, Lung transplantation, Humans, Mechanical ventilation, Transplantation, business.industry, Extracorporeal circulation, Mechanical, Respiration, Artificial, Surgery, respiratory tract diseases, Reperfusion, Stress, Mechanical, Primary Graft Dysfunction, business, Airway
Abstract

During ex vivo lung perfusion (EVLP), fixed ventilator settings and monitoring of compliance are used to prevent ventilator-induced lung injury (VILI). Analysis of the airway pressure-time curve (stress index) has been proposed to assess the presence of VILI. We tested whether currently proposed ventilator settings expose lungs to VILI during EVLP and whether the stress index could identify VILI better than compliance.Flow, volume, and airway opening pressure were collected continuously during EVLP. Durations of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay were recorded in lung recipients.Fourteen lungs underwent EVLP and were transplanted. In 5 lungs, 95 ± 2% of the stress index values were within the 0.95 to 1.05 range (protected); in the remaining nine lungs, 69 ± 1% of the values were greater than 1.05 and 15 ± 3% were less than 0.95 (nonprotected). There was a significant (P < 0.05) increase in cytokine concentrations after 4 hours of EVLP in the nonprotected lungs. Durations of mechanical ventilation, ICU, and hospital lengths of stay were shorter in recipients of protected than that of nonprotected lungs (P < 0.05). There was no correlation between compliance during EVLP and duration of mechanical ventilation or ICU and hospital lengths of stay in recipients, but the stress index during EVLP was significantly correlated with the duration of mechanical ventilation and with ICU and hospital lengths of stay (P < 0.05).This small, preliminary study shows that ventilator settings currently proposed for EVLP may expose lungs to VILI. Use of the stress index to personalize ventilator settings needs to be tested in further clinical studies.

Published
2016

45. Interactive Entertainment, Virtual Motion Training and Brain Ergonomy

Author

Valerio De Luca, Lucio Tommaso De Paolis, Silvia Sammarco, Chiara Faggiano, Sara Invitto, Invitto, Sara, Faggiano, Chiara, Sammarco, Silvia, DE LUCA, VALERIO VINCENZO, and DE PAOLIS, Lucio Tommaso

Subjects
Multimedia, Computer science, media_common.quotation_subject, Interactive game, Event-related potentials, Cognitive Neuroscience, Virtual Training, Cognitive neuroscience, Virtual reality, computer.software_genre, Motion (physics), Task (project management), Event-related potential, Perception, Virtual training, Affordance, computer, Cognitive psychology, media_common
Abstract

Aim of this work was to study the perception of affordances in VR according to a cognitive neuroscience. In order to investigate this topic we focused our analysis on the perception of affordances during a game, the Leap Motion Controller (LM). The sample was composed of 10 university students matched by age and sex. The subjects performed in Thinking training and in Immersive Affordance Condition (a virtual training with LM and a Real training). After each training the subject had to perform a recognition task. During the task ERP components were measured through EEG. The results highlighted that, during the LM training, attentional components changed. In the occipital lobes, which is entrusted to visual sensory, we got increased latencies; on the contrary, in frontal lobe, where the brain mainly activates for attention and action planning, we got decreased latencies.

Published
2015

46. Accuracy of plateau pressure and stress index to identify injurious ventilation in patients with acute respiratory distress syndrome

Author

Daniela Pasero, Alberto Birocco, Luciana Mascia, Vito Fanelli, Pierpaolo Terragni, Arthur S. Slutsky, T. Tenaglia, Chiara Faggiano, Salvatore Grasso, Tania Stripoli, Rosario Urbino, V. Marco Ranieri, Claudia Filippini, Terragni, Pier Paolo, FILIPPINI, CLAUDIA, Slutsky, Arthur S., Birocco, Alberto, Tenaglia, Tommaso, Grasso, Salvatore, Stripoli, Tania, Pasero, Daniela, Urbino, Rosario, Fanelli, Vito, Faggiano, Chiara, MASCIA, LUCIANA, and RANIERI, VITO MARCO

Subjects
Adult, Male, Stre, Stress index, Physiological, Ventilator-Induced Lung Injury, Reproducibility of Result, Respiratory physiology, Acute respiratory distress, Female, Humans, Lung, Middle Aged, ROC Curve, Reproducibility of Results, Respiration, Artificial, Respiratory Distress Syndrome, Adult, Respiratory Mechanics, Sensitivity and Specificity, Stress, Physiological, Tidal Volume, Anesthesiology and Pain Medicine, Stress, Plateau pressure, Medicine, Respiratory system, Tidal volume, Respiratory Distress Syndrome, Respiratory Mechanic, business.industry, Respiration, Environmental air flow, Anesthesia, Artificial, Breathing, business, Human
Abstract

Background: Guidelines suggest a plateau pressure (Pplat) of 30 cm H2O or less for patients with acute respiratory distress syndrome, but ventilation may still be injurious despite adhering to this guideline. The shape of the curve plotting airway pressure versus time (StressIndex) may identify injurious ventilation. The authors assessed accuracy of Pplat and StressIndex to identify morphological indexes of injurious ventilation. Methods: Indexes of lung aeration (computerized tomography) associated with injurious ventilation were used as a “reference standard.” Threshold values of Pplat and StressIndex were determined assessing the receiver-operating characteristics (“training set,” N = 30). Accuracy of these values was assessed in a second group of patients (“validation set,” N = 20). Pplat and StressIndex were partitioned between respiratory system (Pplat,Rs and StressIndex,rs) and lung (Pplat,l and StressIndex,l; esophageal pressure; “physiological set,” N = 50). Results: Sensitivity and specificity of Pplat of greater than 30 cm H2O were 0.06 (95% CI, 0.002–0.30) and 1.0 (95% CI, 0.87–1.00). Pplat of greater than 25 cm H2O and a StressIndex of greater than 1.05 best identified morphological markers of injurious ventilation. Sensitivity and specificity of these values were 0.75 (95% CI, 0.35–0.97) and 0.75 (95% CI, 0.43–0.95) for Pplat greater than 25 cm H2O versus 0.88 (95% CI, 0.47–1.00) and 0.50 (95% CI, 0.21–0.79) for StressIndex greater than 1.05. Pplat,Rs did not correlate with Pplat,l (R2 = 0.0099); StressIndex,rs and StressIndex,l were correlated (R2 = 0.762). Conclusions: The best threshold values for discriminating morphological indexes associated with injurious ventilation were Pplat,Rs greater than 25 cm H2O and StressIndex,rs greater than 1.05. Although a substantial discrepancy between Pplat,Rs and Pplat,l occurs, StressIndex,rs reflects StressIndex,l.

Published
2013

47. Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study.

Author

Vitale A, Farinati F, Noaro G, Burra P, Pawlik TM, Bucci L, Giannini EG, Faggiano C, Ciccarese F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cabibbo G, Virdone R, Marra F, Felder M, Morisco F, Benvegnù L, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Olivani A, Masotto A, Nardone G, Colecchia A, Fornari F, Marignani M, Vicari S, Bortolini E, Cozzolongo R, Grasso A, Aliberti C, Bernardi M, Frigo AC, Borzio M, Trevisani F, and Cillo U

Subjects
Aged, Analysis of Variance, Carcinoma, Hepatocellular mortality, Catheter Ablation, Cohort Studies, Databases, Factual, Disease-Free Survival, Female, Hepatectomy methods, Humans, Infusions, Intra-Arterial, Italy, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Invasiveness pathology, Prognosis, Reproducibility of Results, Retrospective Studies, Risk Assessment, Sorafenib therapeutic use, Statistics, Nonparametric, Survival Analysis, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular therapy, Clinical Decision-Making methods, Disease Progression, Neoplasm Staging methods
Abstract

Prognostic assessment of patients with hepatocellular carcinoma (HCC) at the time of diagnosis remains controversial and becomes even more complex at the time of restaging when new variables need to be considered. The aim of the current study was to evaluate the prognostic utility of restaging patients before proceeding with additional therapies for HCC. Two independent Italian prospective databases were used to identify 1,196 (training cohort) and 648 (validation cohort) consecutive patients with HCC treated over the same study period (2008-2015) who had complete restaging before decisions about additional therapies. The performance of the Italian Liver Cancer (ITA.LI.CA) prognostic score at restaging was compared with that of the Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer, and Cancer of the Liver Italian Program systems. A multivariable Cox survival analysis was performed to identify baseline, restaging, or dynamic variables that were able to improve the predictive performance of the prognostic systems. At restaging, 35.3% of patients maintained stable disease; most patients were either down-staged by treatment (27.2%) or had disease progression (37.5%). The ITA.LI.CA scoring system at restaging demonstrated the best prognostic performance in both the training and validation cohorts (c-index 0.707 and 0.722, respectively) among all systems examined. On multivariable analysis, several variables improved the prognostic ability of the ITA.LI.CA score at restaging, including progressive disease after the first treatment, Model for End-Stage Liver Disease at restaging, and choice of nonsurgical treatment as additional therapy. A new ITA.LI.CA restaging model was created that demonstrated high discriminative power in both the training and validation cohorts (c-index 0.753 and 0.745, respectively)., Conclusion: Although the ITA.LI.CA score demonstrated the best prognostic performance at restaging, other variables should be considered to improve the prognostic assessment of patients at the time of deciding additional therapies for HCC., (© 2018 by the American Association for the Study of Liver Diseases.)

Published
2018
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48. A new training approach in endoscopic percutaneous tracheostomy using a simulation model based on biological tissue.

Author

Terragni P, Mascia L, Faggiano C, Tenaglia T, Morello E, Succo G, Ranieri M, and Brazzi L

Subjects
Animals, Clinical Competence, Cricoid Cartilage surgery, Female, Learning Curve, Male, Models, Animal, Sheep, Anesthesiology education, Endoscopy education, Tracheostomy education
Abstract

Background: Ciaglia et al. originally proposed the percutaneous tracheostomy in 1985 as an alternative to the surgical approach. Several variants have been developed in the years with a convincing evidence that, compared to surgical tracheostomy, the percutaneous approach is more cost-effective without compromising safety. However the procedure is not immune from complications and requires procedural skills and adequate level of expertise with a steep learning curve. In this contest, to optimize safety and efficacy of percutaneous tracheostomy in different clinical scenarios, physicians should be familiar with the different available percutaneous techniques. Traditionally, the training has been performed using manikins or animal models. However, by definition the manikin is not able to replicate the complex anatomy and does not provide a realist model for learning., Methods: A sheep model was implemented and was tested in a simulation-based course for percutaneous dilational tracheostomy and cricothyrotomy organized by the Department of Surgical Sciences of University of Turin at the Special Educational Section of the Veterinary Sciences Department (University of Turin)., Results: From September 2012 to December 2014, 2 sessions of the training course were performed. Thirty-two anesthesiologists (16 men and 16 women, mean (SD) age 40.4 (SD 8.6) attended the course. A quality assessment of the course was then collected by participants., Conclusions: The biological model we implemented proved to be adequate and effective. Future studies are required to compare its efficacy with previously proposed training methods.

Published
2016

49. Extracorporeal CO2 removal.

Author

Terragni PP, Birocco A, Faggiano C, and Ranieri VM

Subjects
Assisted Circulation instrumentation, Assisted Circulation methods, Carbon Dioxide blood, Carbon Dioxide isolation & purification, Cardiopulmonary Bypass, Clinical Trials as Topic, Equipment Design, Femoral Artery physiopathology, Femoral Vein physiopathology, Humans, Lung Diseases therapy, Respiratory Distress Syndrome mortality, Survival Rate, Continuous Positive Airway Pressure methods, Extracorporeal Membrane Oxygenation methods, Positive-Pressure Respiration methods, Respiratory Distress Syndrome therapy
Abstract

The extracorporeal carbon dioxide removal (ECCO(2)R) concept, used as an integrated tool with conventional ventilation, plays a role in adjusting respiratory acidosis consequent to tidal volume (Vt) reduction in a protective ventilation setting. This concept arises from the extracorporeal membrane oxygenation (ECMO) experience. Kolobow and Gattinoni were the first to introduce extracorporeal support, with the intent to separate carbon dioxide removal from oxygen uptake; they hypothesized that to allow the lung to 'rest' oxygenation via mechanical ventilation could be dissociated from decarboxylation via extracorporeal carbon dioxide removal. Carbon dioxide is removed by a pump-driven modified ECMO machine with veno-venous bypass, while oxygenation is accomplished by high levels of positive end-expiratory pressure, with a respiratory rate of 3-5 breaths/min. The focus was that, in case of acute respiratory failure, CO(2) extraction facilitates a reduction in ventilatory support and oxygenation is maintained by simple diffusion across the patient's alveoli, called 'apneic oxygenation'. Concerns have been raised regarding the standard use of extracorporeal support because of the high incidence of serious complications: hemorrhage; hemolysis, and neurological impairments. Due to the negative results of a clinical trial, the extensive resources required and the high incidence of side effects, low frequency positive pressure ventilation ECCO(2)R was restricted to a 'rescue' therapy for the most severe case of acute respiratory distress syndrome (ARDS). Technological improvement led to the implementation of two different CO(2) removal approaches: the iLA called 'pumpless arteriovenous ECMO' and the veno-venous ECCO(2)R. They enable consideration of extracorporeal support as something more than mere rescue therapy; both of them are indicated in more protective ventilation settings in case of severe ARDS, and as a support to the spontaneous breathing/lung function in bridge to lung transplant. The future development of more and more efficient devices capable of removing a substantial amount of carbon dioxide production (30-100%) with blood flows of 250-500 ml/min is foreseeable. Moreover, in the future ARDS management should include a minimally invasive ECCO(2)R circuit associated with noninvasive ventilation. This would embody the modern mechanical ventilation philosophy: avoid tracheal tubes; minimize sedation, and prevent ventilator-induced acute lung injury and nosocomial infections., (2010 S. Karger AG, Basel.)

Published
2010
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