95 results on '"Micaela Romagnoli"'
Search Results
2. Long-term effectiveness of benralizumab in severe eosinophilic asthma patients treated for 96-weeks: data from the ANANKE study
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Alessandra Vultaggio, Maria Aliani, Elena Altieri, Pietro Bracciale, Luisa Brussino, Maria Filomena Caiaffa, Paolo Cameli, Giorgio Walter Canonica, Cristiano Caruso, Stefano Centanni, Maria D’Amato, Fausto De Michele, Stefano Del Giacco, Fabiano Di Marco, Francesco Menzella, Girolamo Pelaia, Paola Rogliani, Micaela Romagnoli, Pietro Schino, Gianenrico Senna, Marco Benci, Silvia Boarino, and Jan Walter Schroeder
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Benralizumab ,Asthma ,Eosinophils ,Exacerbations ,Long-term ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background The efficacy of benralizumab has been broadly demonstrated in severe eosinophilic asthma (SEA), but only few real-life studies evaluated its long-term effects. Here we present novel data from the ANANKE study in which a large cohort of SEA patients was treated for up to 96 weeks. Methods ANANKE (NCT04272463) is an observational retrospective Italian study investigating the key characteristics of SEA patients (collected during the 12 months prior to benralizumab initiation) and the clinical outcomes during benralizumab treatment (annual exacerbation rate [AER], lung function, asthma control, OCS use, healthcare resource utilization). A post hoc analysis was also conducted in groups of patients based on history of previous biologic therapy (bio-experienced versus naïve patients). Analyses were descriptive only. Results Before benralizumab initiation, evaluable SEA patients (N = 162, 61.1% females, mean age 56.0 ± 12.7) showed a median blood eosinophil count (BEC) of 600 cells/mm3 (IQR: 430–890). Patients experienced frequent exacerbations (annualized exacerbation rate [AER]: 4.10, severe AER: 0.98), with impaired lung function and poor asthma control (median ACT score: 14) despite 25.3% reported oral corticosteroid (OCS) use. Nasal polyposis was present in 53.1% patients; 47.5% patients were atopic. After 96 weeks since the start of benralizumab, nearly 90% patients were still on treatment; benralizumab dramatically decreased exacerbations (AER: − 94.9%; severe AER: − 96.9%), improved respiratory parameters (median increase in pre-bronchodilator forced expiratory volume [pre-BD FEV1]: + 400 mL) and asthma control (median ACT score: 23) while eliminating OCS in 60% patients. Importantly, benralizumab effects were either maintained or progressively improved over time, accompanied by a nearly complete depletion of BEC. Benralizumab reduced AER both in naïve (any AER: − 95.9%; severe AER: − 97.5%) and bio-experienced patients (any AER: − 92.4%; severe AER: − 94.0%). Conclusions Profound and sustained improvements in all asthma outcomes were observed with benralizumab. The correct identification of patients’ eosinophilic-driven asthma phenotype was essential to ensure the achievement of such remarkable results. Trial registration: ClinicalTrials.gov Identifier: NCT04272463.
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- 2023
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3. Tracheal atypical solitary carcinoid in a so called 'difficult asthma': a diagnostic challenge
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Martina Turrin, Francesca Maria Pontoriero, Giordano Fiorentù, Giulia Grisostomi, Francesca Zampieri, Francesca Savoia, Cosimo Catino, Giuseppe Zanardi, Piera Peditto, Nicola Malacchini, Fabiola Zeraj, Matteo Bonato, Diana Sacchi, Maria Guido, Giovanni Morana, and Micaela Romagnoli
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interventional pulmonology ,chronic cough ,tracheal obstruction ,NETs ,Medicine - Abstract
This report describes the case of a 46-year-old non-smoker housewife. She presented to our attention having a diagnosis of “difficult asthma” from another center in the previous two years. She had no allergies and had not been exposed to an excessive amount of noxious stimuli. Her chronic respiratory symptoms (dyspnea on exertion with wheezing) remained uncontrolled despite maximal anti-asthmatic inhaled therapy. An HRCT scan was performed to further investigate other pulmonary diseases that mimic asthma. It revealed a pedunculated endotracheal lesion with regular borders that obstructed 90% of the tracheal lumen. The lesion was removed via rigid bronchoscopy with laser endobronchial; histological examination revealed the presence of atypical carcinoid. Atypical carcinoids are a rare subtype of neuroendocrine lung tumor that accounts for 2% of all thoracic malignancies. They frequently arise from the central airways and cause obstructive symptoms such as coughing, wheezing, chest pain, or recurrent obstructing pneumonia, which is caused by central airway obstruction. Clinical onset is gradual and characterized by non-specific symptoms, which frequently result in misdiagnosis. As a result, in a young patient with progressive dyspnea, chronic cough, and wheezing that is not responding to anti-asthmatic treatment, second-level investigations are required and may lead to a definite diagnosis, allowing the appropriate course of treatment to begin.
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- 2023
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4. ChAracterization of ItaliaN severe uncontrolled Asthmatic patieNts Key features when receiving Benralizumab in a real-life setting: the observational rEtrospective ANANKE study
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Francesco Menzella, Elena Bargagli, Maria Aliani, Pietro Bracciale, Luisa Brussino, Maria Filomena Caiaffa, Cristiano Caruso, Stefano Centanni, Maria D’Amato, Stefano Del Giacco, Fausto De Michele, Fabiano Di Marco, Elide Anna Pastorello, Girolamo Pelaia, Paola Rogliani, Micaela Romagnoli, Pietro Schino, Gianenrico Senna, Alessandra Vultaggio, Lucia Simoni, Alessandra Ori, Silvia Boarino, Gianfranco Vitiello, Elena Altieri, and Giorgio Walter Canonica
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Benralizumab ,Exacerbations ,OCS ,Real world ,Severe eosinophilic asthma ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background Data from phase 3 trials have demonstrated the efficacy and safety of benralizumab in patients with severe eosinophilic asthma (SEA). We conducted a real-world study examining the baseline characteristics of a large SEA population treated with benralizumab in clinical practice and assessed therapy effectiveness. Methods ANANKE is an Italian multi-center, retrospective cohort study including consecutive SEA patients who had started benralizumab therapy ≥ 3 months before enrolment (between December 2019 and July 2020), in a real-world setting. Data collection covered (1) key patient features at baseline, including blood eosinophil count (BEC), number and severity of exacerbations and oral corticosteroid (OCS) use; (2) clinical outcomes during benralizumab therapy. We also conducted two post-hoc analyses in patients grouped by body mass index and allergic status. Analyses were descriptive only. Results Of 218 patients with SEA enrolled in 21 Centers, 205 were evaluable (mean age, 55.8 ± 13.3 years, 61.5% females). At treatment start, the median BEC was 580 cells/mm3 (interquartile range [IQR]: 400–850); all patients were on high-dose inhaled controller therapy and 25.9% were on chronic OCS (median dose: 10 mg/die prednisone-equivalent [IQR: 5–25]); 92.9% experienced ≥ 1 exacerbation within the past 12 months (annualized exacerbation rate [AER] 4.03) and 40.3% reported ≥ 1 severe exacerbation (AER 1.10). During treatment (median duration: 9.8 months [IQR 6.1–13.9]; ≥ 12 months for 34.2% of patients), complete eosinophil depletion was observed; exacerbation-free patients increased to 81% and only 24.3% reported ≥ 1 severe event. AER decreased markedly to 0.27 for exacerbations of any severity (− 93.3%) and to 0.06 for severe exacerbations (− 94.5%). OCS therapy was interrupted in 43.2% of cases and the dose reduced by 56% (median: 4.4 mg/die prednisone-equivalent [IQR: 0.0–10.0]). Lung function and asthma control also improved. The effectiveness of benralizumab was independent of allergic status and body mass index. Conclusions We described the set of characteristics of a large cohort of patients with uncontrolled SEA receiving benralizumab in clinical practice, with a dramatic reduction in exacerbations and significant sparing of OCS. These findings support benralizumab as a key phenotype-specific therapeutic strategy that could help physicians in decision-making when prescribing biologics in patients with SEA. Trial registration ClinicalTrials.gov Identifier: NCT04272463
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- 2022
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5. COVID-19 Pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU
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María Laura Vega, Roberto Dongilli, Gustavo Olaizola, Nicolás Colaianni, Mauro Castro Sayat, Lara Pisani, Micaela Romagnoli, Greta Spoladore, Irene Prediletto, Guillermo Montiel, and Stefano Nava
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High flow nasal cannula ,HFNC ,Non invasive respiratory support ,ROX index ,Acute hypoxemic respiratory failure ,AHRF ,Diseases of the respiratory system ,RC705-779 - Abstract
High flow nasal cannula (HFNC) is used to treat acute hypoxemic respiratory failure (AHRF) even outside the ICU and the ROX index (pulse oximetry/fraction of inspired oxygen/respiratory rate) may predict HFNC failure. Objective: The purpose of this investigation was therefore to verify whether the ROX index is an accurate predictor of HFNC failure for COVID-19 patients treated outside the intensive care unit (ICU) and to evaluate the validity of the previously suggested threshold. Design: Multicenter study. Retrospective observational analysis of prospectively collected data. Setting: 3 centres specialized in non-invasive respiratory support (Buenos Aires, Argentina; Bolzano and Treviso, Italy). Patients treated outside the ICU were analysed Measurements: The variables to calculate the ROX index were collected during the first day of therapy at 2, 6, 12 and 24 hours and then recorded every 24 hours. HFNC failure was defined as escalation of respiratory support to invasive mechanical ventilation (IMV) or death. Main results: A total of 35 (29%) patients failed HFNC and required intubation. ROC analysis identified the 12-hour ROX index as the best predictor of intubation with an AUC of 0.7916[CI 95% 0.6905-0.8927] and the best threshold to be 5.99[Specificity 96% Sensitivity 62%]. In the survival analysis, a ROX value
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- 2022
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6. Comparison between clinical trials and real-world evidence studies on biologics for severe asthma
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Francesco Menzella, Andrea Ballarin, Maria Sartor, Ariel Fabian Floriani, Lorenzo Corsi, Cristina Dartora, Silvia Tonin, and Micaela Romagnoli
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Medicine (General) ,R5-920 - Abstract
In recent years, the more widespread availability of biological drugs with specific mechanisms of action has led to significant breakthroughs in the management of severe asthma. Over time, numerous randomised clinical trials have been conducted to evaluate the efficacy and safety of these biologics and define the eligibility criteria of patients suitable for various therapeutic options. These studies were conducted under controlled conditions not always applicable to real life. For this and other reasons, real-world evidence and pragmatic studies are required to provide useful information on the effectiveness of biological drugs and their safety, even in the long term. Because differences in outcomes have sometimes emerged between clinical trials and real-life studies, it is important to clarify the causes of these discrepancies and define the significance of the results of studies conducted in the course of daily clinical practice. Thus, a scientific debate is ongoing, and no consensus has been reached. The purpose of this narrative review is to analyse the differences between randomised trials and real-world evidence studies, focusing on their roles in guiding clinicians among different therapeutic options and understanding the reasons for the large discrepancies often found in the results obtained.
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- 2022
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7. Switching from one biologic to benralizumab in patients with severe eosinophilic asthma: An ANANKE study post hoc analysis
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Cristiano Caruso, Paolo Cameli, Elena Altieri, Maria Aliani, Pietro Bracciale, Luisa Brussino, Maria Filomena Caiaffa, Giorgio Walter Canonica, Stefano Centanni, Maria D’Amato, Stefano Del Giacco, Fausto De Michele, Elide Anna Pastorello, Girolamo Pelaia, Paola Rogliani, Micaela Romagnoli, Pietro Schino, Marco Caminati, Alessandra Vultaggio, Alessandro Zullo, Sara Rizzoli, Silvia Boarino, Gianfranco Vitiello, Francesco Menzella, and Fabiano Di Marco
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severe eosinophilic asthma ,switch ,benralizumab ,observational ,biologics ,Medicine (General) ,R5-920 - Abstract
BackgroundSevere asthma is a heterogeneous inflammatory disease driven by eosinophilic inflammation in the majority of cases. Despite biologic therapy patients may still be sub-optimally controlled, and the choice of the best biologic is a matter of debate. Indeed, switching between biologics is common, but no official guidelines are available and real-world data are limited.Materials and methodsIn this post hoc analysis of the Italian, multi-center, observational, retrospective study, ANANKE. Patients with severe eosinophilic asthma treated with benralizumab were divided in two groups based on history of previous biologic therapy (biologic-experienced [suboptimal response] vs naïve). Baseline clinical and laboratory characteristics were collected in the 12 months prior to benralizumab treatment. Change over time in blood eosinophils, annualized exacerbation rate (AER), asthma control (ACT), lung function and oral corticosteroid (OCS) use following benralizumab initiation were collected in the two groups.ResultsA total of 147 biologic-naïve and 58 biologic-experienced (34 omalizumab, 19 mepolizumab, and 5 omalizumab-mepolizumab) patients were enrolled. Biologic-experienced patients were more likely to be atopic and have a higher AER despite more frequent OCS use. Similar reductions in AER (>90% in both groups), OCS use (≥49% reduction in dosage and ≥41% able to eliminate OCS), ACT improvement (≥7 points gained in 48 weeks) and lung function (≥300 mL of FEV1 improvement in 48 weeks) were observed after benralizumab introduction within the two groups. There were no registered discontinuations of benralizumab for safety reasons.ConclusionIn this post hoc analysis, patients who were switched to benralizumab because of suboptimal control with a previous biologic therapy were more likely to be atopic and more often treated with omalizumab. Benralizumab is effective in both naïve patients and those previously treated with a biologic.
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- 2022
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8. Benralizumab in Patients With Severe Eosinophilic Asthma With and Without Chronic Rhinosinusitis With Nasal Polyps: An ANANKE Study post-hoc Analysis
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Maria D'Amato, Francesco Menzella, Elena Altieri, Elena Bargagli, Pietro Bracciale, Luisa Brussino, Maria Filomena Caiaffa, Giorgio Walter Canonica, Cristiano Caruso, Stefano Centanni, Fausto De Michele, Fabiano Di Marco, Elide Anna Pastorello, Girolamo Pelaia, Paola Rogliani, Micaela Romagnoli, Pietro Schino, Gianenrico Senna, Alessandra Vultaggio, Alessandra Ori, Lucia Simoni, Silvia Boarino, Gianfranco Vitiello, Maria Aliani, and Stefano Del Giacco
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severe eosinophilic asthma ,chronic rhinosinusitis with nasal polyps ,benralizumab ,observational ,biologics ,Immunologic diseases. Allergy ,RC581-607 - Abstract
BackgroundSevere eosinophilic asthma (SEA) in the presence of chronic rhinosinusitis with nasal polyps (CRSwNP) indicates the presence of a more extensive eosinophilic inflammation. Post-hoc analyses from a pivotal clinical trial have demonstrated the enhanced efficacy of benralizumab on asthma outcomes in patients with CRSwNP as a comorbidity.MethodsThis is a post-hoc analysis from the Italian multi-center observational retrospective ANANKE study. Patients were divided into two groups based on self-reported CRSwNP. Baseline clinical and laboratory features in the 12 months prior to benralizumab prescription were collected. Data of change over time of blood eosinophils, annualized exacerbations rates (AER), asthma control, lung function, oral corticosteroids (OCS) use, and benralizumab discontinuation were collected during the observation period.ResultsAt baseline, the 110 patients with CRSwNP were less frequently female (50.9% vs 74.2%) and obese (9.1% vs. 22.6%) with higher eosinophils (605 vs. 500 cells/mm3) and OCS use when compared to patients without CRSwNP. Similar reductions of AER were seen (-95.8% vs. −91.5% for any exacerbation and −99.1% vs. −92.2% for severe exacerbations in patients with and without CRSwNP, respectively). During benralizumab treatment, comorbid SEA+CRSwNP was associated with a lower risk of any exacerbation (p = 0.0017) and severe exacerbations (p = 0.025). After a mean ± SD exposure of 10.3 ± 5.0 months, half of the SEA+CRSwNP patients eliminated OCS use. No discontinuation for safety reasons was recorded.ConclusionsThis study helped to confirm the baseline clinical features that distinguish patients with and without CRSwNP being prescribed benralizumab. Numerically enhanced OCS reduction and lower exacerbation risk were observed in patients with SEA and comorbid CRSwNP treated with benralizumab.
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- 2022
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9. Risk Factors for Development and Severity of COVID-19 in COPD Patients
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Matteo Bonato, Umberto Semenzato, Mariaenrica Tinè, Erica Bazzan, Marco Damin, Davide Biondini, Alvise Casara, Micaela Romagnoli, Graziella Turato, Manuel G. Cosio, Marina Saetta, and Simonetta Baraldo
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COVID-19 ,COPD comorbidities ,clinical outcome ,emphysema ,DLCO ,Medicine (General) ,R5-920 - Abstract
The impact that COVID-19 could have on patients with COPD is a real concern. In this study we evaluated, in a cohort of longitudinally followed COPD subjects, the incidence of COVID-19, seeking for possible risk factors and prognostic factors predicting the clinical outcome. In our cohort of 370 patients (followed for 5.3 ± 2.7 years), 22 developed COVID-19 (COPD/COVID-19+) between February/November 2020 (5.9%). Cardio-metabolic conditions (hypertension, dyslipidemia, obesity, diabetes) but not respiratory abnormalities (FEV1, DLCO, emphysema and exacerbation history), were risk factors for development of COVID-19 in COPD patients. Out of the 22 COPD/COVID-19+ patients, 10 needed intensive care. Low DLCO and emphysema, but also metabolic comorbidities, were related to the need for intensive care.
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- 2021
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10. Multidimensional 3-Month Follow-Up of Severe COVID-19: Airways beyond the Parenchyma in Symptomatic Patients
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Matteo Bonato, Piera Peditto, Nicholas Landini, Alessia Fraccaro, Cosimo Catino, Maria Cuzzola, Nicola Malacchini, Francesca Savoia, Nicola Roma, Mauro Salasnich, Martina Turrin, Francesca Zampieri, Giuseppe Zanardi, Fabiola Zeraj, Marcello Rattazzi, Mario Peta, Simonetta Baraldo, Marina Saetta, Michele Fusaro, Giovanni Morana, and Micaela Romagnoli
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interstitial pneumonia ,small airways ,fibrosis ,bronchiectasis ,HRCT ,Medicine - Abstract
SARS-CoV-2 may lead to a large spectrum of respiratory manifestations, including pulmonary sequelae. We conducted a single-center longitudinal study of survivors from severe COVID-19 cases who underwent a chest CT during hospitalization (CTH). Three months after being discharged, these patients were evaluated by a clinical examination, pulmonary function tests and a chest-CT scan (CTFU). Sixty-two patients were enrolled. At follow-up, 27% complained of exertional dyspnoea and 12% of cough. Dyspnoeic patients had a lower forced expiratory flow (FEF)25–75 (p = 0.015), while a CT scan (p = 0.016 showed that patients with cough had a higher extent of bronchiectasis. Lung volumes and diffusion of carbon monoxide (DLCO) at follow-up were lower in patients who had been invasively ventilated, which correlated inversely with the length of hospitalization and ground-glass extension at CTH. At follow-up, 14.5% of patients had a complete radiological resolution, while 85.5% presented persistence of ground-glass opacities, and 46.7% showed fibrotic-like alterations. Residual ground-glass at CTFU was related to the length of hospitalization (r = 0.48; p = 0.0002) and to the need for mechanical ventilation or high flow oxygen (p = 0.01) during the acute phase. In conclusion, although patients at three months from discharge showed functional impairment and radiological abnormalities, which correlated with a prolonged hospital stay and need for mechanical ventilation, the persistence of respiratory symptoms was related not to parenchymal but rather to airway sequelae.
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- 2022
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11. Club Cell Loss as a Feature of Bronchiolization in ILD
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Paul Reynaud, Engi Ahmed, Isabelle Serre, Lucie Knabe, Sébastien Bommart, Carey Suehs, Isabelle Vachier, Jean Philippe Berthet, Micaela Romagnoli, Charlotte Vernisse, Jean Pierre Mallet, Anne Sophie Gamez, and Arnaud Bourdin
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club (clara) cell ,idiopathic pulmonary fibrosis ,metaplasia ,SCGB1A1 ,bronchiolization ,interstitial lung disease ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Background: Distal airway metaplasia may precede honeycombing in progressive fibrosing interstitial lung disease (ILD). The SCGB1A1+ bronchiolar-specific club cell may play a role in this aberrant regenerative process.Objective: To assess the presence of club cells in the small airways of patients suffering from ILD.Methods: Small airways (internal diameter
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- 2021
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12. Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy
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Matteo Bonato, Alessia Fraccaro, Nicholas Landini, Giuseppe Zanardi, Cosimo Catino, Francesca Savoia, Nicola Malacchini, Fabiola Zeraj, Piera Peditto, Vito Catalanotti, Elisabetta Marcon, Emanuela Rossi, Alessia Pauletti, Silvia Galvan, Riccardo Adami, Marta Tiepolo, Mauro Salasnich, Maria Cuzzola, Francesca Zampieri, Marcello Rattazzi, Mario Peta, Simonetta Baraldo, Marina Saetta, Giovanni Morana, and Micaela Romagnoli
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case-control ,coronavirus ,SARS-CoV-2 ,pneumothorax ,pneumomediastinum ,COVID-19 ,Medicine - Abstract
Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared. Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017). Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation.
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- 2021
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13. MMP-7 and fcDNA Serum Levels in Early NSCLC and Idiopathic Interstitial Pneumonia: Preliminary Study
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Paola Ulivi, Gian Luca Casoni, Giovanni Foschi, Emanuela Scarpi, Sara Tomassetti, Micaela Romagnoli, Claudia Ravaglia, Marta Mengozzi, Wainer Zoli, and Venerino Poletti
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MMP-7 ,fcDNA ,IPF ,NSIP ,NSCLC ,serum ,IIPs ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
A non-invasive test to facilitate the diagnosis of non-small cell lung cancer (NSCLC) and idiopathic pulmonary fibrosis (IPF) is still not available and represents an important goal. Forty-eight patients with stage I NSCLC, 45 with IPF, 30 with other idiopathic interstitial pneumonias (IIPs) including idiopathic non-specific interstitial pneumonia (NSIP) and chronic hypersensitivity pneumonitis (HP), 35 with diffuse non-malignant disease and 30 healthy donors were enrolled onto the study. Free circulating (fc)DNA and MMP-7 levels were evaluated by Real Time PCR and ELISA, respectively. Median fcDNA levels were similar in NSCLC (127 ng/mL, range 23.6–345 ng/mL) and IPF (106 ng/mL, range 22–224 ng/mL) patients, and significantly lower in IIPs patients, in individuals with other diseases and in healthy donors (p < 0.05). Conversely, median MMP-7 values were significantly higher in IPF patients (9.10 ng/mL, range 3.88–19.72 ng/mL) than in those with NSCLC (6.31 ng/mL, range 3.38–16.36 ng/mL; p < 0.0001), NSIP (6.50 ng/mL, range 1.50–22.47 ng/mL; p = 0.007), other diseases (5.41 ng/mL, range 1.78–15.91, p < 0.0001) or healthy donors (4.35 ng/mL, range 2.45–7.23; p < 0.0001). Serum MMP-7 levels seem to be capable of distinguishing IPF patients from those with any other lung disease. fcDNA levels were similar in NSCLC and IPF patients, confirming its potential role as a biomarker, albeit non-specific, for the differential diagnosis of NSCLC.
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- 2013
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14. Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases.
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Gian Luca Casoni, Sara Tomassetti, Alberto Cavazza, Thomas V Colby, Alessandra Dubini, Jay H Ryu, Elisa Carretta, Paola Tantalocco, Sara Piciucchi, Claudia Ravaglia, Christian Gurioli, Micaela Romagnoli, Carlo Gurioli, Marco Chilosi, and Venerino Poletti
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Medicine ,Science - Abstract
BACKGROUND: Histology is a key element for the multidisciplinary diagnosis of fibrotic diffuse parenchymal lung diseases (f-DPLD) when the clinical-radiological picture is nondiagnostic. Transbronchial lung cryobiopsy (TBLC) have been shown to be useful for obtaining large and well-preserved biopsies of lung parenchyma, but experience with TBLC in f-DPLD is limited. OBJECTIVES: To evaluate safety, feasibility and diagnostic yield of TBLC in f-DPLD. METHOD: Prospective study of 69 cases of TBLC using flexible cryoprobe in the clinical-radiological setting of f-DPLD with nondiagnostic high resolution computed tomography (HRCT) features. RESULTS: SAFETY: pneumothorax occurred in 19 patients (28%). One patient (1.4%) died of acute exacerbation. Feasibility: adequate cryobiopsies were obtained in 68 cases (99%). The median size of cryobiopsies was 43.11 mm(2) (range, 11.94-76.25). Diagnostic yield: among adequate TBLC the pathologists were confident ("high confidence") that histopathologic criteria sufficient to define a specific pattern in 52 patients (76%), including 36 of 47 with UIP (77%) and 9 nonspecific interstitial pneumonia (6 fibrosing and 3 cellular), 2 desquamative interstitial pneumonia/respiratory bronchiolitis-interstitial lung disease, 1 organizing pneumonia, 1 eosinophilic pneumonia, 1 diffuse alveolar damage, 1 hypersensitivity pneumonitis and 1 follicular bronchiolitis. In 11 diagnoses of UIP the pathologists were less confident ("low confidence"). Agreement between pathologists in the detection of UIP was very good with a Kappa coefficient of 0.83 (95% CI, 0.69-0.97). Using the current consensus guidelines for clinical-radiologic-pathologic correlation 32% (20/63) of cases were classified as Idiopathic Pulmonary Fibrosis (IPF), 30% (19/63) as possible IPF, 25% (16/63) as other f-DPLDs and 13% (8/63) were unclassifiable. CONCLUSIONS: TBLC in the diagnosis of f-DPLD appears safe and feasible. TBLC has a good diagnostic yield in the clinical-radiological setting of f-DPLD without diagnostic HRCT features of usual interstitial pneumonia. Future studies should consider TBLC as a potential alternative to SLBx in f-DPLD.
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- 2014
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15. Infecções e inflamação das vias aéreas nas exacerbações graves da DPOC: Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations
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Alberto Papi, Cinzia Maria Bellettato, Fausto Braccioni, Micaela Romagnoli, Paolo Casolari, Gaetano Caramori, Leonardo M Fabbri, and Sebastian L Johnston
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Diseases of the respiratory system ,RC705-779 - Published
- 2007
16. Chest radiography findings of COVID-19 pneumonia
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Giovanni Morana, Micaela Romagnoli, Carla Felice, Roberto Rigoli, Cosimo Nardi, Giovanni Tessarin, Martina Orlandi, Luca Saba, Nicholas Landini, Luca Scaldaferri, Alberto Dorigo, Pierluigi Ciet, Giulia Colzani, Luca Bertana, Radiology & Nuclear Medicine, and Pediatrics
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pleural effusion ,Radiography ,SARS-CoV-2 virus ,Logistic regression ,Diagnosis, Differential ,COVID 19 ,diagnostic X-ray ,differential diagnosis ,pneumonitis ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Lung ,Retrospective Studies ,Pneumonitis ,Radiological and Ultrasound Technology ,SARS-CoV-2 ,business.industry ,COVID-19 ,General Medicine ,medicine.disease ,Pleural Effusion ,Pneumonia ,medicine.anatomical_structure ,Radiography, Thoracic ,Radiology ,Differential diagnosis ,Tomography, X-Ray Computed ,business - Abstract
Background Chest radiography (CR) patterns for the diagnosis of COVID-19 have been established. However, they were not ideated comparing CR features with those of other pulmonary diseases. Purpose To create the most accurate COVID-19 pneumonia pattern comparing CR findings of COVID-19 and non-COVID-19 pulmonary diseases and to test the model against the British Society of Thoracic Imaging (BSTI) criteria. Material and Methods CR of COVID-19 and non-COVID-19 pulmonary diseases, admitted to the emergency department, were evaluated. Assessed features were interstitial opacities, ground glass opacities, and/or consolidations and the predominant lung alteration. We also assessed uni-/bilaterality, location (upper/middle/lower), and distribution (peripheral/perihilar), as well as pleural effusion and perihilar vessels blurring. A binary logistic regression was adopted to obtain the most accurate CR COVID-19 pattern, and sensitivity and specificity were computed. The newly defined pattern was compared to BSTI criteria. Results CR of 274 patients were evaluated (146 COVID-19, 128 non-COVID-19). The most accurate COVID-19 pneumonia pattern consisted of four features: bilateral alterations (Expß=2.8, P=0.002), peripheral distribution of the predominant (Expß=2.3, P=0.013), no pleural effusion (Expß=0.4, P=0.009), and perihilar vessels’ contour not blurred (Expß=0.3, P=0.002). The pattern showed 49% sensitivity, 81% specificity, and 64% accuracy, while BSTI criteria showed 51%, 77%, and 63%, respectively. Conclusion Bilaterality, peripheral distribution of the predominant lung alteration, no pleural effusion, and perihilar vessels contour not blurred determine the most accurate COVID-19 pneumonia pattern. Lower field involvement, proposed by BSTI criteria, was not a distinctive finding. The BSTI criteria has lower specificity.
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- 2022
17. Clinical Features and Efficacy of Benralizumab in Patients with Blood Eosinophil Count Between 300 and 450 Cells/mm3: A Post Hoc Analysis from the ANANKE Study
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Gianenrico Senna, Maria Aliani, Elena Altieri, Pietro Bracciale, Luisa Brussino, Maria Filomena Caiaffa, Paolo Cameli, Giorgio Walter Canonica, Cristiano Caruso, Maria D'Amato, Fausto De Michele, Stefano Del Giacco, Fabiano Di Marco, Francesco Menzella, Girolamo Pelaia, Paola Rogliani, Micaela Romagnoli, Pietro Schino, Jan Walter Schroeder, Alessandra Vultaggio, Sara Rizzoli, Alessandro Zullo, Silvia Boarino, Marilena Palmisano, Alessandra Rossi, Gianfranco Vitiello, and Stefano Centanni
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Pulmonary and Respiratory Medicine ,benralizumab ,blood eosinophil count ,observational ,real-life ,real-world evidence ,severe eosinophilic asthma ,Settore MED/10 - Malattie dell'Apparato Respiratorio ,Settore MED/10 ,Journal of Asthma and Allergy ,Immunology and Allergy - Abstract
Gianenrico Senna,1,2 Maria Aliani,3 Elena Altieri,4 Pietro Bracciale,5 Luisa Brussino,6 Maria Filomena Caiaffa,7 Paolo Cameli,8 Giorgio Walter Canonica,9,10 Cristiano Caruso,11 Maria DâAmato,12 Fausto De Michele,13 Stefano Del Giacco,14 Fabiano Di Marco,15 Francesco Menzella,16 Girolamo Pelaia,17 Paola Rogliani,18,19 Micaela Romagnoli,20 Pietro Schino,21 Jan Walter Schroeder,22 Alessandra Vultaggio,23 Sara Rizzoli,24 Alessandro Zullo,24 Silvia Boarino,25 Marilena Palmisano,26 Alessandra Rossi,26 Gianfranco Vitiello,26 Stefano Centanni27 1Department of Medicine, University of Verona, Verona, Italy; 2Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy; 3UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy; 4Reparto di Pneumologia, P.O., Garbagnate Milanese, Italy; 5Reparto di Pneumologia, Ospedale Ostuni, Ostuni, BR, Italy; 6Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I, Torino, Italy; 7Cattedra e Scuola di Allergologia e Immunologia Clinica, Dipartimento di Scienze Mediche, Università di Foggia, Foggia, Italy; 8Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy; 9Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy; 10Personalized Medicine Center: Asthma and Allergology, Humanitas Research Hospital, Rozzano, MI, Italy; 11Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy; 12UOSD Malattie Respiratorie âFederico IIâ, Ospedale Monaldi, AO Dei Colli, Napoli, Italy; 13UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Napoli, Italy; 14Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; 15Department of Health Sciences, Università Degli Studi Di Milano, Pneumologia, ASST Papa Giovanni XXIII, Bergamo, Italy; 16UOC Pneumologia, Ospedale âS. Valentinoâ, AULSS 2 Marca Trevigiana, Montebelluna, TV, Italy; 17Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy; 18Division of Respiratory Medicine, University Hospital âTor Vergataâ, Roma, Italy; 19Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome âTor Vergataâ, Roma, Italy; 20UOC Pneumologia, ULSS 2 Marca Trevigiana, Treviso, Italy; 21Fisiopatologia Respiratoria, Ospedale Generale Regionale, Ente Ecclesiastico âF. Miulliâ, Acquaviva delle Fonti, BA, Italy; 22Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy; 23Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Firenze, Italy; 24Medineos Observational Research - An IQVIA Company, Modena, Italy; 25Medical Evidence R&I, AstraZeneca, Milano, Italy; 26Medical Affairs R&I, AstraZeneca, Milano, Italy; 27Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milano, ItalyCorrespondence: Marilena Palmisano, Medical Affairs R&I, AstraZeneca, Milano, Italy, Email marilena.palmisano@astrazeneca.comPurpose: Benralizumab effectively reduces severe eosinophilic asthma (SEA) exacerbations in patients with a wide range of baseline blood eosinophil count (BEC). Patients included in real-world studies are often characterized by high mean/median BEC, while patients with BEC close to 300 cells/mm3 are poorly represented. This post hoc analysis from the Italian study ANANKE aims to define the clinical features and corroborate the efficacy of benralizumab in real world in the BEC 300â 450 cells/mm3 subset of patients.Patients and Methods: Post hoc analysis of the Italian, multicenter, observational, retrospective real-life study ANANKE (NCT04272463). Baseline clinical and laboratory characteristics were collected in the 12 months prior to benralizumab treatment and presented for a BEC 300â 450 cells/mm3 subgroup of patients. Change over time of BEC, annualized exacerbation rate (AER), asthma control (ACT), lung function and oral corticosteroid (OCS) use at 16, 24 and 48 weeks after benralizumab introduction were collected.Results: A total of 164 patients were analyzed, 34 of whom with a BEC of 300â 450 cells/mm3. This subgroup was more likely to be female (64.7%), with lower rates of severe exacerbations at baseline when compared to the total population (0.69 vs 1.01). After 48 weeks of benralizumab treatment, the BEC 300â 450 subset showed similar reductions in AER (â 94.8% vs â 92.2%) and OCS use (median dose reduction of 100% in both groups), as well as improvement in ACT score (median scores 22.5 vs 22) and lung function (pre-BD FEV1: +200 mL vs +300 mL) when compared to the total population. No discontinuations for safety reasons were registered.Conclusion: At baseline, apart from lower severe exacerbation rate, the BEC 300â 450 cells/mm3 subset of patients is comparable to the total population prescribed with benralizumab. In this real-life study, benralizumab is as effective in BEC 300â 450 patients as in the total population.Keywords: severe eosinophilic asthma, blood eosinophil count, benralizumab, observational, real-world evidence, real-life
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- 2022
18. COVID-19 Pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU
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Gustavo Olaizola, Mauro Castro Sayat, Nicolás Colaianni, Greta Spoladore, Stefano Nava, Irene Prediletto, Roberto Dongilli, Maria Laura Vega, Lara Pisani, Micaela Romagnoli, Guillermo Montiel, Vega M.L., Dongilli R., Olaizola G., Colaianni N., Sayat M.C., Pisani L., Romagnoli M., Spoladore G., Prediletto I., Montiel G., and Nava S.
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Respiratory rate ,medicine.medical_treatment ,Brief Communication ,medicine.disease_cause ,HFNC ,law.invention ,Diseases of the respiratory system ,03 medical and health sciences ,ROX index ,0302 clinical medicine ,Respiratory Rate ,AHRF ,law ,Fraction of inspired oxygen ,Non invasive respiratory support ,Intubation, Intratracheal ,medicine ,Humans ,Intubation ,Oximetry ,030212 general & internal medicine ,Acute hypoxemic respiratory failure ,Survival analysis ,Retrospective Studies ,Mechanical ventilation ,Noninvasive Ventilation ,RC705-779 ,medicine.diagnostic_test ,SARS-CoV-2 ,business.industry ,Oxygen Inhalation Therapy ,COVID-19 ,Intensive care unit ,High flow nasal cannula ,Intensive Care Units ,Pulse oximetry ,030228 respiratory system ,Emergency medicine ,Respiratory Insufficiency ,business ,Nasal cannula - Abstract
High flow nasal cannula (HFNC) is used to treat acute hypoxemic respiratory failure (AHRF) even outside the ICU and the ROX index (pulse oximetry/fraction of inspired oxygen/respiratory rate) may predict HFNC failure. OBJECTIVE: The purpose of this investigation was therefore to verify whether the ROX index is an accurate predictor of HFNC failure for COVID-19 patients treated outside the intensive care unit (ICU) and to evaluate the validity of the previously suggested threshold. DESIGN: Multicenter study. Retrospective observational analysis of prospectively collected data. SETTING: 3 centres specialized in non-invasive respiratory support (Buenos Aires, Argentina; Bolzano and Treviso, Italy). Patients treated outside the ICU were analysed MEASUREMENTS: The variables to calculate the ROX index were collected during the first day of therapy at 2, 6, 12 and 24 hours and then recorded every 24 hours. HFNC failure was defined as escalation of respiratory support to invasive mechanical ventilation (IMV) or death. MAIN RESULTS: A total of 35 (29%) patients failed HFNC and required intubation. ROC analysis identified the 12-hour ROX index as the best predictor of intubation with an AUC of 0.7916[CI 95% 0.6905-0.8927] and the best threshold to be 5.99[Specificity 96% Sensitivity 62%]. In the survival analysis, a ROX value
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- 2022
19. COVID-19 pneumonia in lung transplant recipients: Report of 2 cases
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Micaela Romagnoli, Monica Loy, Sabrina Congedi, Fiorella Calabrese, Emanuele Cozzi, Eleonora Faccioli, Serena Marinello, Anna Maria Cattelan, and Federico Rea
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Mechanical ventilation ,Transplantation ,medicine.medical_specialty ,Lung ,business.industry ,medicine.medical_treatment ,Immunosuppression ,medicine.disease ,Pulmonary function testing ,Calcineurin ,Pneumonia ,medicine.anatomical_structure ,Internal medicine ,Oxygen therapy ,medicine ,Immunology and Allergy ,Pharmacology (medical) ,business ,Oxygen saturation (medicine) - Abstract
Coronavirus disease 2019 (COVID-19) has been declared pandemic since March 2020. In Europe, Italy was the first nation affected by this infection. We report anamnestic data, clinical features, and therapeutic management of 2 lung transplant recipients with confirmed COVID-19 pneumonia. Both patients were in good clinical condition before the infection and were receiving immunosuppression with calcineurin inhibitors (CNI), mycophenolate mofetil, and corticosteroids. Whereas mycophenolate mofetil was withdrawn in both cases, CNI were suspended only in the second patient. The first patient always maintained excellent oxygen saturation throughout hospitalization with no need for additional oxygen therapy. He was discharged with a satisfactory pulmonary function and a complete resolution of radiological and clinical findings. However, at discharge SARS-CoV-2 RNA could still be detected in the nasopharyngeal swab and in the stools. The second patient required mechanical ventilation, had a progressive deterioration of his clinical conditions, and had a fatal outcome. Further insight into SARS-CoV-2 infection is eagerly awaited to improve the outcome of transplant recipients affected by COVID-19 pneumonia.
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- 2020
20. Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy
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Marcello Rattazzi, Marta Tiepolo, Marina Saetta, Simonetta Baraldo, Matteo Bonato, Giuseppe Zanardi, Mario Peta, Francesca Savoia, Emanuela Rossi, Alessia Pauletti, Riccardo Adami, Fabiola Zeraj, Silvia Galvan, Giovanni Morana, Vito Catalanotti, Elisabetta Marcon, Francesca Zampieri, Nicola Malacchini, Nicholas Landini, Piera Peditto, Mauro Salasnich, Maria Cuzzola, Alessia Fraccaro, Micaela Romagnoli, and Cosimo Catino
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medicine.medical_specialty ,ARDS ,Coronavirus disease 2019 (COVID-19) ,pneumothorax ,coronavirus ,North east ,Article ,Internal medicine ,medicine ,Pneumomediastinum ,case-control ,COVID-19 ,pneumomediastinum ,SARS-CoV-2 ,business.industry ,Incidence (epidemiology) ,Case-control study ,General Medicine ,medicine.disease ,Pneumothorax ,Respiratory failure ,Medicine ,business - Abstract
Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared. Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017). Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation.
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- 2021
21. Real-life impact of weight in severe eosinophilic asthma patients treated with benralizumab
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Silvia Boarino, Stefano Centanni, Pietro Bracciale, Elena Altieri, Gianfranco Vitiello, Micaela Romagnoli, Maria Aliani, Paola Rogliani, Fausto De Michele, Pietro Schino, Girolamo Pelaia, Francesco Menzella, and Fabiano Di Marco
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medicine.medical_specialty ,business.industry ,Phases of clinical research ,Eosinophilic asthma ,medicine.disease ,Benralizumab ,Obesity ,chemistry.chemical_compound ,chemistry ,Asthma control ,Internal medicine ,Medicine ,Risk factor ,Underweight ,medicine.symptom ,business ,Body mass index - Abstract
Background: Safety and efficacy of benralizumab (BEN) for severe eosinophilic asthma (SEA) have been demonstrated in Phase III clinical trials. Obesity is a risk factor for SEA and might affect the beneficial effect of asthma medication. ANANKE is part of AstraZeneca’s global XALOC real-world evidence program for benralizumab. Aims: To explore whether benralizumab efficacy is affected by body mass index (BMI) in SEA patients. Methods: Post-hoc analysis of an observational, multicenter, retrospective Italian study of SEA patients with at least 12 weeks of BEN treatment. Patients were stratified according to BMI: normal/underweight (Nr) (BMI Results: 182 patients were included, Nr=70 (68.6% female, mean age 55±12.8, median BEN duration 9.2 months), OW=79 (48.1% female, mean age 56.6±12.9, median BEN duration 9.4 months), Ob=33 (75.8% female, mean age 56.5±14.7, median BEN duration 10.2 months). Any AER passed from 4.49 to 0.18 (-96%) in Nr (N=66), from 3.99 to 0.32 (-92%) in OW (N=76) and from 3.72 to 0.34 (-90.9%) in Ob (N=30). Severe AER changed from 1.32 to 0.04 (-97%) in Nr, from 1.12 to 0.10 (-91.1%) in OW and from 1.13 to 0.08 (-92.9%) in Ob. ACT increased from a median of 15 in Nr (N=57), 14 in OW (N=61) and 13 in Ob (N=25) to 22 in Nr (N=29) and Ob (N=11) and 23 in Ow (N=35) at week 48. Conclusions: In an Italian real-world setting, the efficacy of BEN in SEA patients seems not to be affected by obesity, leading to asthma control al >90% reduction of AER and severe AER regardless of BMI.
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- 2021
22. COVID-19 prevalence, risk factors and outcomes in COPD
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Marina Saetta, Elisabetta Cocconcelli, Umberto Semenzato, Erica Bazzan, Manuel G. Cosio, Micaela Romagnoli, Matteo Bonato, Graziella Turato, Simonetta Baraldo, and Mariaenrica Tinè
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medicine.medical_specialty ,COPD ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine ,Intensive care medicine ,business ,medicine.disease - Published
- 2021
23. A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation
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Vanina Livi, Daniela Paioli, Marco Ferrari, Alessandra Cancellieri, Annalisa De Silvestri, Micaela Romagnoli, Rocco Trisolini, Filippo Natali, and Carmine Tinelli
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Observational Trial ,Site evaluation ,Malignancy ,Endosonography ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Randomized controlled trial ,law ,Pulmonary Medicine ,medicine ,Humans ,030212 general & internal medicine ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Lymph node ,Aged ,Observer Variation ,business.industry ,Reproducibility of Results ,Pulmonologist ,Gold standard (test) ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,030228 respiratory system ,Female ,Clinical Competence ,Lymph Nodes ,Radiology ,business - Abstract
Background: The widespread use of rapid on-site evaluation is hampered by constraints related to time and resources, inadequate reimbursement, and evidence from randomized trials that show a lack of increase in diagnostic yield and specimen adequacy associated with its usage. Objective: We aimed to verify whether a pulmonologist can assess endosonography-derived lymph node samples after a comprehensive and reproducible training provided by a specialist pathologist. Methods:Prospective, observational trial structured in three phases. In the first (training) phase, a pathologist critically evaluated the smears from 150 archival endosonography cases with a pulmonologist. In the second (test) phase, the pulmonologist was asked to assess 50 archival endosonography-derived samples. In the last (real-life) phase, the pulmonologist classified the samples from 200 patients during the endosonography. The overall agreement between pulmonologist and pathologist (gold standard), assessed through κ-statistics, was the primary outcome. The agreement for the identification of specific cytological categories was the secondary outcome. Results: The overallagreement between pulmonologist and pathologist was 84% (κ0.765, 95% CI 0.732–0.826) in the test phase and 89.7% (κ 0.844, 95% CI 0.799–0.881) in the real-life phase. The agreement for specific cytological categories was 92.7% (95% CI 0.824–0.980) for inadequate samples, 90.3% (95% CI 84.5–94.5%) for reactive lymphadenopathies, 90.5% (95% CI 0.845–0.946) for malignancy, and 73% (95% CI 0.515–0.897) for granulomatous samples. Conclusions: A trained pulmonologist can reliably assess adequacy and malignancy for endosonography-derived samples, which could be useful in institutions where a cytopathologist/cytotechnician is not available regularly.
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- 2019
24. COVID-19 pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU. Authors' reply
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G Olaizola, M C Sayat, Micaela Romagnoli, Irene Prediletto, Nicolás Colaianni, Lara Pisani, Maria Laura Vega, Guillermo Montiel, Roberto Dongilli, Greta Spoladore, Stefano Nava, Vega M.L., Dongilli R., Olaizola G., Colaianni N., Sayat M.C., Pisani L., Romagnoli M., Spoladore G., Prediletto I., Montiel G., and Nava S.
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Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Noninvasive Ventilation ,RC705-779 ,Coronavirus disease 2019 (COVID-19) ,business.industry ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Intensive Care Unit ,COVID-19 ,medicine.disease ,Oxygen ,Diseases of the respiratory system ,Pneumonia ,Intensive Care Units ,Respiratory Rate ,Emergency medicine ,Medicine ,Humans ,business ,Letter to the Editor ,Human - Published
- 2021
25. Transbronchial cryobiopsy in the diagnosis of interstitial lung diseases: methodologies and perspectives from the Cryo-PID and COLDICE studies
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Carey M. Suehs, Nicolas Molinari, Arnaud Bourdin, Micaela Romagnoli, Isabelle Vachier, Département des Maladies Respiratoires [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Fondazione IRCCS Ospedale Ca' Foncello [Treviso, Italy], and MORNET, Dominique
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medicine.medical_specialty ,Lung ,business.industry ,[SDV]Life Sciences [q-bio] ,MEDLINE ,PID controller ,General Medicine ,3. Good health ,[SDV] Life Sciences [q-bio] ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,medicine ,030212 general & internal medicine ,Intensive care medicine ,business ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
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- 2020
26. Upregulation of Suppressors of Cytokine Signalling (SOCS)3 in COPD alveolar macrophages
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Marina Saetta, Erica Bazzan, Mariaenrica Tinè, Manuel G. Cosio, Umberto Semenzato, Micaela Romagnoli, and Graziella Turato
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COPD ,business.industry ,digestive, oral, and skin physiology ,Inflammation ,medicine.disease ,Suppressor of cytokine signalling ,respiratory tract diseases ,Proinflammatory cytokine ,Downregulation and upregulation ,Immunology ,Medicine ,Tumor necrosis factor alpha ,Animal studies ,SOCS3 ,medicine.symptom ,business - Abstract
Background: The Suppressor of Cytokine Signalling (SOCS) proteins, particularly SOCS3, and its regulation by TNF-α, have been originally described in animal and in vitro studies as inhibitors of cytokine-signalling in response to a chronic inflammation. However, more recently, the suppressive role of SOCS3 has been questioned by other animal studies, which suggested an important proinflammatory role for this protein. Aim: To investigate in a human inflammatory disease, COPD, the expression of SOCS3 and its inducer TNF-α in alveolar macrophages (AM). Methods: SOCS3 and TNF-α expression was quantified in alveolar macrophages (SOCS3+AM%, TNF-α+AM%) in lungs from 19 smokers with COPD (COPD) [FEV1: 60±31(%)], 16 smokers without COPD (noCOPD) and 9 nonsmokers (NS) using immunochemistry. Results: The percentage of SOCS3+AM was higher in COPD [68(31-95)%] than in noCOPD [48(22-78)% p=0.04] and NS [10(4-56)% p=0.005]. This pattern was paralleled by the expression of TNF-α in AM, that was higher in COPD [90(52-97)%] than in noCOPD [32(17-60)%] and in NS [1(0-15)% p Conclusions: The increased expression of SOCS3 and its modulator TNF-α in alveolar macrophages of COPD, a chronic inflammatory disease, casts some doubts about SOCS3 suppressor function and rather favours a role for SOCS3 as a proinflammatory mediator.
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- 2020
27. Late Breaking Abstract - BENRALIZUMAB IN SEVERE ASTHMA: PRELIMINARY RESULTS FROM THE ITALIAN ANANKE STUDY
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Elena Ansaldo, Micaela Romagnoli, Pierluigi Bracciale, Fausto De Michele, Maria D'Amato, Elena Altieri, Giorgio Walter Canonica, Girolamo Pelaia, and Maria Filomena Caiaffa
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medicine.medical_specialty ,Exacerbation ,business.industry ,Phases of clinical research ,Retrospective cohort study ,Eosinophil ,Benralizumab ,medicine.disease ,Interim analysis ,Atopy ,chemistry.chemical_compound ,medicine.anatomical_structure ,chemistry ,Internal medicine ,Medicine ,Nasal polyps ,business - Abstract
Introductions: Safety and efficacy of benralizumab for severe eosinophilic asthma (SEA) have been demonstrated in Phase III clinical trials. However real-word evidence in Italy is limited. ANANKE is part of AstraZeneca’s global XALOC RWE program for benralizumab. Objects: To describe the clinical impact of benralizumab on adult patients with SEA in a real-life setting. Methods: This is an ongoing observational, multicentre, retrospective study of the clinical characteristics and asthma exacerbations for SEA patients in Italy with at least 12 weeks of benralizumab treatment. Clinical (including comorbidities and atopic status) and laboratory (blood eosinophil count and total IgE) data have been collected. Annualized exacerbation rates (AER) before and after the first benralizumab injection (index date) were analysed. Results: 61 patients were included in this interim analysis [70.5% female, mean age 52.8 ± 13.9, median duration of disease 9.5 years (IQR 3.7-23.1), median eosinophil count (N=41) 410/mm3 (IQR 300-680/mm3), median total IgE (N=39) 215 IU/L (IQR 83-477 IU/L), atopic status 55.7%]. Comorbidities were frequent (44/61 patients, 72.1%), and 34.4% reported chronic rhinosinusitis with nasal polyps (CRSwNP) in the past year. Patients were treated with benralizumab for a median of 9.3 months (IQR 6.1-11.7).During the year prior to index date, AER was 4.98 for any exacerbation and 1.25 for severe exacerbations (N=52). After index date, AER was reduced to 0.38 for any exacerbation(92.4% reduction) and 0.08 for severe exacerbations (93.6% reduction). Conclusion: benralizumab has been prescribe to adult-onset SEA patients, with high prevalence of CRSwNP, indipendent of atopy. Benralizumab led to 93.6% reduction in severe AER
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- 2020
28. Use of RAAS Inhibitors and Risk of Clinical Deterioration in COVID-19: Results From an Italian Cohort of 133 Hypertensives
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Marcello Rattazzi, Chiara Nardin, Paola Cavasin, Luca Tonon, Luca Scaldaferri, Paolo Pauletto, Ernesto De Menis, Antonio Farnia, Micaela Romagnoli, Roberto Rigoli, Ugo Grossi, Gian Luca Di Tanna, Francesco Cinetto, Carlo Agostini, Enrico Bernardi, Simone Novello, Riccardo Scarpa, and Carla Felice
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Male ,hypertensive patients ,medicine.medical_specialty ,ACEIs/ARBs ,COVID-19 infection ,SARS-COV-2 ,mortality ,Population ,Pneumonia, Viral ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,Brief Communication ,law.invention ,03 medical and health sciences ,Angiotensin Receptor Antagonists ,0302 clinical medicine ,law ,Intensive care ,Internal medicine ,Risk of mortality ,medicine ,Internal Medicine ,Humans ,AcademicSubjects/MED00200 ,030212 general & internal medicine ,education ,Pandemics ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,business.industry ,COVID-19 ,Retrospective cohort study ,Odds ratio ,Middle Aged ,Intensive care unit ,COVID-19 Drug Treatment ,Blood pressure ,Italy ,Cohort ,Hypertension ,AcademicSubjects/SCI00960 ,Female ,business ,Coronavirus Infections - Abstract
BACKGROUND The effect of chronic use of renin–angiotensin–aldosterone system (RAAS) inhibitors on the severity of COVID-19 infection is still unclear in patients with hypertension. We aimed to investigate the association between chronic use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and COVID-19-related outcomes in hypertensive patients. METHODS A single-center study was conducted on 133 consecutive hypertensive subjects presenting to the emergency department with acute respiratory symptoms and/or fever who were diagnosed with COVID-19 infection between 9 and 31 March 2020. RESULTS All patients were grouped according to their chronic antihypertensive medications (ACEIs, N = 40; ARBs, N = 42; not on RAAS inhibitors, N = 51). There was no statistical difference between ACEIs and ARBs groups in terms of hospital admission rate, oxygen therapy, and need for noninvasive ventilation. Patients chronically treated with RAAS inhibitors showed a significantly lower rate of admission to semi-intensive/intensive care units, when compared with the non-RAAS population (odds ratio (OR) 0.25, confidence interval (CI) 95% 0.09–0.66, P = 0.006). Similarly, the risk of mortality was lower in the former group, although not reaching statistical significance (OR 0.56, CI 95% 0.17–1.83, P = 0.341). CONCLUSIONS Our data suggest that chronic use of RAAS inhibitors does not negatively affect clinical course of COVID-19 in hypertensive patients. Further studies are needed to confirm this finding and determine whether RAAS inhibitors may have a protective effect on COVID-19-related morbidity and mortality.
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- 2020
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29. Prolonged low-dose methylprednisolone in patients with severe COVID-19 pneumonia
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Martina Bonifazi, Donato Lacedonia, Anna Talia Gaccione, Luca Guidelli, Barbara Ruaro, Venerino Poletti, Claudia Ravaglia, Marco Confalonieri, Lucio Torelli, Paola Confalonieri, Massimiliano Villani, Alessandro Marcello, Sergio Harari, Francesco Salton, Maria Concetta Volpe, Matteo Davì, G. Umberto Meduri, Mario Tamburrini, Andrea Vianello, Annalisa Casarin, Danilo Licastro, Reba Umberger, Pierachille Santus, Raffaele Scala, Stefano Gasparini, Tiberio Oggionni, Antonella Zucchetto, Stefano Centanni, Maria Pia Foschino Barbaro, Rita Raccanelli, Mara Parati, Marcella Montico, Alberto Fantin, Pierlanfranco D'Agaro, Valentina Vertui, Xueyuan Cao, Dejan Radovanovic, Antonella Caminati, Vincenzo Patruno, Paolo Lucernoni, Alessandro Scartabellati, S. Tomassetti, Micaela Romagnoli, Simone Lanini, Michele Mondoni, Salton, Francesco, Confalonieri, Paola, Umberto Meduri, G, Santus, Pierachille, Harari, Sergio, Scala, Raffaele, Lanini, Simone, Vertui, Valentina, Oggionni, Tiberio, Caminati, Antonella, Patruno, Vincenzo, Tamburrini, Mario, Scartabellati, Alessandro, Parati, Mara, Villani, Massimiliano, Radovanovic, Dejan, Tomassetti, Sara, Ravaglia, Claudia, Poletti, Venerino, Vianello, Andrea, Talia Gaccione, Anna, Guidelli, Luca, Raccanelli, Rita, Lucernoni, Paolo, Lacedonia, Donato, Pia Foschino Barbaro, Maria, Centanni, Stefano, Mondoni, Michele, Davì, Matteo, Fantin, Alberto, Cao, Xueyuan, Torelli, Lucio, Zucchetto, Antonella, Montico, Marcella, Casarin, Annalisa, Romagnoli, Micaela, Gasparini, Stefano, Bonifazi, Martina, D'Agaro, Pierlanfranco, Marcello, Alessandro, Licastro, Danilo, Ruaro, Barbara, Volpe, MARIA CONCETTA, Umberger, Reba, and Confalonieri, Marco
- Subjects
0301 basic medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Methylprednisolone ,Major Articles ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Clinical endpoint ,pneumonia ,Intubation ,SARS-cov-2 ,030212 general & internal medicine ,Mechanical ventilation ,SARS-CoV-2 ,business.industry ,ARDS ,COVID-19 ,Pneumonia ,Hazard ratio ,methylprednisolone ,medicine.disease ,Intensive care unit ,Confidence interval ,Clinical trial ,AcademicSubjects/MED00290 ,030104 developmental biology ,Infectious Diseases ,Oncology ,Anesthesia ,business ,medicine.drug - Abstract
Background In hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia, progression to acute respiratory failure requiring invasive mechanical ventilation (MV) is associated with significant morbidity and mortality. Severe dysregulated systemic inflammation is the putative mechanism. We hypothesize that early prolonged methylprednisolone (MP) treatment could accelerate disease resolution, decreasing the need for intensive care unit (ICU) admission and mortality. Methods We conducted a multicenter observational study to explore the association between exposure to prolonged, low-dose MP treatment and need for ICU referral, intubation, or death within 28 days (composite primary end point) in patients with severe COVID-19 pneumonia admitted to Italian respiratory high-dependency units. Secondary outcomes were invasive MV-free days and changes in C-reactive protein (CRP) levels. Results Findings are reported as MP (n = 83) vs control (n = 90). The composite primary end point was met by 19 vs 40 (adjusted hazard ratio [aHR], 0.41; 95% CI, 0.24–0.72). Transfer to ICU and invasive MV were necessary in 15 vs 27 (P = .07) and 14 vs 26 (P = .10), respectively. By day 28, the MP group had fewer deaths (6 vs 21; aHR, 0.29; 95% CI, 0.12–0.73) and more days off invasive MV (24.0 ± 9.0 vs 17.5 ± 12.8; P = .001). Study treatment was associated with rapid improvement in PaO2:FiO2 and CRP levels. The complication rate was similar for the 2 groups (P = .84). Conclusion In patients with severe COVID-19 pneumonia, early administration of prolonged MP treatment was associated with a significantly lower hazard of death (71%) and decreased ventilator dependence. Treatment was safe and did not impact viral clearance. A large randomized controlled trial (RECOVERY trial) has been performed that validates these findings. Clinical trial registration. ClinicalTrials.gov NCT04323592., This multicenter observational study gave the first evidence that prolonged, low-dose methylprednisolone treatment is associated with a significantly lower hazard of death, reduced ICU burden and decreased ventilator dependence without affecting viral clearance in patients with severe COVID-19 pneumonia/ARDS.
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- 2020
30. Careful consideration of the bleeding caused by transbronchial lung cryobiopsies
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Jean Pierre Mallet, Carey M. Suehs, Isabelle Vachier, Kheira Hireche, Jean Philippe Berthet, Paul Reynaud, Stefano Nava, Nicolas Molinari, Micaela Romagnoli, Anne Sophie Gamez, Arnaud Bourdin, Bourdin A., Romagnoli M., Gamez A.S., Hireche K., Berthet J.P., Mallet J.P., Vachier I., Nava S., Reynaud P., Molinari N., Suehs C., Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département pneumologie et addictologie [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Service de chirurgie thoracique et cardio-vasculaire, and Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve-Université de Montpellier (UM)
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung ,business.industry ,Hemorrhage ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,respiratory system ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,Lung surface ,respiratory tract diseases ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,medicine ,Humans ,030212 general & internal medicine ,Radiology ,business ,Lung Diseases, Interstitial ,ComputingMilieux_MISCELLANEOUS ,Lung function ,Human - Abstract
Lung surface photos show wounds/haemorrhages caused by transbronchial lung cryobiopsy (TBLC). TBLC bleeding can extensively soil airways with consequences for lung function, stressing the need for bleeding prevention and more research via registries.https://bit.ly/34wWAeR
- Published
- 2020
31. Endobronchial ultrasound‐guided transbronchial needle aspiration with the flexible 19‐gauge needle
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Micaela Romagnoli, Marco Ferrari, Daniela Paioli, Vanina Livi, Rocco Trisolini, Alessandra Cancellieri, and Filippo Natali
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,Mediastinal lymphadenopathy ,Small-cell carcinoma ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,Bronchoscopy ,medicine ,Humans ,Immunology and Allergy ,Sampling (medicine) ,Mesothelioma ,Lung cancer ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Lung ,Genetics (clinical) ,Aged ,Retrospective Studies ,business.industry ,Reproducibility of Results ,Middle Aged ,medicine.disease ,030228 respiratory system ,030220 oncology & carcinogenesis ,Adenocarcinoma ,Female ,Biopsy, Large-Core Needle ,Radiology ,Sarcoidosis ,business ,Complication - Abstract
Introduction and Objectives: Endosonography has become standard of care in the diagnostic work-up of mediastinal lymphadenopathy and peribronchial lung lesions, but its success rate in some specific settings/conditions may be hampered by limited needle flexibility and size. We report on our initial experience with the 19G Flex needle, characterized by larger size and greater flexibility as compared with the currently available cytology needles. Methods: Retrospective review of prospectively collected data on the first 13 consecutive patients submitted to endosonography with the 19G Flex needle. Patients were included if they had: a) suspicion of a histologically complex disease (i.e. lymphoma); b) suspicion of an advanced lung cancer possibly requiring extensive genotyping; c) a lesion whose sampling with a 22G needle had failed due to lack of visibility when the needle was loaded into the scope. Results: the 13 patients enrolled had a mean age of 58.15±17 years and a male to female ratio of 8:5. Target lesions (mean size 18.6±6.4 mm) were lymphadenopathies (9 patients), lung lesions (3 patients), and a pleural nodule (1 patient). Histology core/s and a definite diagnosis (adenocarcinoma, 4 cases; lymphoma, 2; mesothelioma, 2, metastases from extrathoracic tumors, 2; non-small-cell lung cancer not otherwise specifiable, 1; small cell carcinoma, 1; sarcoidosis, 1) were obtained in 100% of patients. A single case of self-resolving bleeding was the only complication we observed. Conclusions: Preliminary results obtained with the dedicated Flex 19G needle are promising, as sample size/quality is satisfactory and the needle influence on scope flexibility is minimal. This article is protected by copyright. All rights reserved.
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- 2017
32. Reply to Wand
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Arnaud, Bourdin, Carey M, Suehs, Thomas V, Colby, Isabelle, Vachier, Nicolas, Molinari, and Micaela, Romagnoli
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Biopsy ,Correspondence ,Humans ,Longitudinal Studies ,Lung Diseases, Interstitial ,Lung - Published
- 2019
33. Cryobiopsy Compared with Surgical Lung Biopsy in ILD: Reply to Maldonado et al., Froidure et al., Bendstrup et al., Agarwal et al., Richeldi et al., Rajchgot et al., and Quadrelli et al
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Carey M. Suehs, Micaela Romagnoli, Isabelle Vachier, Nicolas Molinari, Arnaud Bourdin, Thomas V. Colby, Alma Mater Studiorum Università di Bologna [Bologna] (UNIBO), Mayo Clinic [Scottsdale], Mayo Clinic, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
Pulmonary and Respiratory Medicine ,interstitial lung disease ,Multidisciplinary assessment ,bronchoscopy ,medicine.diagnostic_test ,business.industry ,Interstitial lung disease ,cryobiopsy ,Lung biopsy ,surgical lung biopsy ,Critical Care and Intensive Care Medicine ,medicine.disease ,multidisciplinary assessment ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Bronchoscopy ,Biopsy ,medicine ,030212 general & internal medicine ,Nuclear medicine ,business ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
- Published
- 2019
34. Suspected pleuroparenchymal fibroelastosis relapse after lung transplantation: a case report and literature review
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Alessandra Cancellieri, Andrea Dell’Amore, Edoardo Rasciti, Maurizio Zompatori, and Micaela Romagnoli
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medicine.medical_specialty ,Lung ,Medical treatment ,business.industry ,medicine.medical_treatment ,Case Report ,General Medicine ,respiratory system ,medicine.disease ,respiratory tract diseases ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,Refractory ,Fibrosis ,030220 oncology & carcinogenesis ,Parenchyma ,medicine ,Lung transplantation ,Radiology ,Respiratory system ,business - Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a very rare lung disease characterized by dense fibrous thickening of the visceral pleura and intraalveolar fibrosis containing prominent elastosis, with typical upper lobe predominance. PPFE usually shows progressive restrictive ventilatory impairment refractory to medical treatment; bilateral lung transplantation currently remains the only available therapeutic option. In this report, we describe a case of suspected PPFE relapse after lung transplantation that, to our knowledge, has never been described in the medical literature. A 48-year-old male with idiopathic pleuroparenchymal fibroelastosis underwent a bilateral lung transplant in our department. 8 months later, he presented with progressively worsening clinical condition, his respiratory state gradually deteriorated. High-resolution CT again showed bilateral diffused parenchymal consolidations, with prevalence in the upper lobes and subpleural regions. A PPFE relapse was therefore suspected, so he was listed for lung retransplantation, which was performed ten months after the first transplant. Histopathological analysis of the second explanted lung again confirmed the diagnosis of PPFE. The case highlights the possibility of PPFE relapse after lung transplantation, that may add to the increasing evidence of an underlying auto-immune mechanism contributing to its pathogenesis.
- Published
- 2019
35. Competence in transbronchial cryobiopsy
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Micaela Romagnoli, Mario Salio, Alessia Praticò, Lorenzo Corbetta, Elena Bargagli, and Emanuela Barisione
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Lung Diseases ,medicine.medical_specialty ,Biopsy ,Bronchi ,Lung biopsy ,030204 cardiovascular system & hematology ,Specific knowledge ,Cryosurgery ,Sensitivity and Specificity ,Education ,Bronchoscopy ,Pulmonary medicine ,Cold Temperature ,Endoscopy ,Humans ,Lung ,Lung Diseases, Interstitial ,Pulmonary Medicine ,Clinical Competence ,03 medical and health sciences ,Idiopathic pulmonary fibrosis ,0302 clinical medicine ,medicine ,Competence (human resources) ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Pulmonologist ,General Medicine ,respiratory system ,medicine.disease ,respiratory tract diseases ,Safety profile ,medicine.anatomical_structure ,Competence, Interventional pulmonology ,Radiology ,business ,Interstitial - Abstract
Over the last decade transbronchial lung cryobiopsy (TBLC) has proven to be an "innovative application" of an "old procedure" for the histologic diagnosis of diffuse interstitial lung diseases (DILDs). Thus, the technique of TBL cryobiopsy is now adopted for diagnostic purposes, transbronchially in peripheral airways to sample lung parenchyma, whereas this same technique was traditionally employed in the past for therapeutic purposes, essentially for the management of malignant obstruction of central airways. When patients with interstitial lung diseases (ILDs) need histopathological data in their diagnostic pathway, this bioptic approach could be a valid alternative to surgical lung biopsy, that is still the gold standard at the moment. TBL cryobiopsy has a good safety profile, its sensitivity and specificity appear good overall in idiopathic pulmonary fibrosis. In the last ten years, many papers have been published about this procedure defining modalities by which cryobiopsy should be performed. These studies have shown that TBL cryobiopsy is feasible, it allows to obtain larger lung parenchymal specimens (3 times larger than "classic" transbronchial biopsies), characterized by unaltered and artefact-free morphology, and it represents a safe and poorly invasive diagnostic tool for the histologic diagnosis of ILDs. The technical aspects are really important, and they still need a complete standardization. TBL cryobiopsy should be part of an equipment of the modern interventional pulmonologist, who should know indications and contraindications of this methodic and the technical aspects of the procedure. This is a complex procedure requiring to be performed by endoscopists working in specialized centers with specific knowledge of DILDs, and a multidisciplinary approach, which represent pre-requisites for admission to training in this procedure.
- Published
- 2019
36. Poor concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in the diagnosis of diffuse interstitial lung diseases
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Isabelle Vachier, Alberto Cavazza, Jean Pierre Mallet, Maurizio Zompatori, Isabelle Serre, Giorgia Dalpiaz, Carey M. Suehs, Alessandra Cancellieri, Paul Reynaud, Nicolas Molinari, Jean Philippe Berthet, Andrea Dell’Amore, Rocco Trisolini, Arnaud Bourdin, Giampiero Dolci, Thomas V. Colby, Laurence Solovei, Stefano Nava, Aldo Guerrieri, Anne Sophie Gamez, Micaela Romagnoli, Sébastien Bommart, Policlinico S. Orsola-Malpighi, Mayo Clinic [Scottsdale], Mayo Clinic, Service de chirurgie thoracique et cardio-vasculaire, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Département pneumologie et addictologie [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Maggiore and S'Orsola-Malpighi hospital, Bologna, Italy., Dept of Oncology and Advanced Technologies - Operative Unit of Oncology, Arcispedale Santa Maria Nuova (ASMN), S. Maria Nuova Hospital-I.R.C.C.S., Univ Bologna, Bellaria hospital, Radiology, Bologna, Italy., Università di Bologna, Malpighi Hospital, Centres de Ressources et de Compétences de la Mucoviscidose [Montpellier] (CRCM [Montpellier]), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve-Service des Maladies Respiratoires, Mathématiques, Informatique et STatistique pour l'Environnement et l'Agronomie (MISTEA), Institut National de la Recherche Agronomique (INRA)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Alma Mater Studiorum Università di Bologna [Bologna] (UNIBO), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Romagnoli M., Colby T.V., Berthet J.-P., Gamez A.S., Mallet J.-P., Serre I., Cancellieri A., Cavazza A., Solovei L., Dell'Amore A., Dolci G., Guerrieri A., Reynaud P., Bommart S., Zompatori M., Dalpiaz G., Nava S., Trisolini R., Suehs C.M., Vachier I., Molinari N., and Bourdin A.
- Subjects
Pulmonary and Respiratory Medicine ,Lung Diseases ,Male ,medicine.medical_specialty ,Concordance ,[SDV]Life Sciences [q-bio] ,Biopsy ,Diagnostic concordance ,Idiopathic pulmonary fibrosis ,Lung biopsy ,Critical Care and Intensive Care Medicine ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,Cryosurgery ,03 medical and health sciences ,0302 clinical medicine ,Bronchoscopy ,medicine ,[SDV.MHEP.AHA]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Tomography ,Aged ,Idiopathic pulmonary fibrosi ,Lung ,Multidisciplinary approach ,medicine.diagnostic_test ,business.industry ,Lung histology ,Interstitial lung disease ,respiratory system ,Middle Aged ,medicine.disease ,respiratory tract diseases ,3. Good health ,X-Ray Computed ,medicine.anatomical_structure ,030228 respiratory system ,Deep sedation ,Female ,Idiopathic Pulmonary Fibrosis ,Lung Diseases, Interstitial ,Tomography, X-Ray Computed ,Radiology ,business ,Interstitial - Abstract
International audience; Rationale: The diagnostic concordance between transbronchial lung cryobiopsy (TBLC)—versus surgical lung biopsy (SLB) as the current gold standard—in interstitial lung disease (ILD) cases requiring histology remains controversial.Objectives: To assess diagnostic concordance between TBLC and SLB sequentially performed in the same patients, the diagnostic yield of both techniques, and subsequent changes in multidisciplinary assessment (MDA) decisions.Methods: A two-center prospective study included patients with ILD with a nondefinite usual interstitial pneumonia pattern (on high-resolution computed tomography scan) confirmed at a first MDA. Patients underwent TBLC immediately followed by video-assisted thoracoscopy for SLB at the same anatomical locations. After open reading of both sample types by local pathologists and final diagnosis at a second MDA (MDA2), anonymized TBLC and SLB slides were blindly assessed by an external expert pathologist (T.V.C.). Kappa-concordance coefficients and percentage agreement were computed for: TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, and blinded pathology versus routine pathology.Measurements and Main Results: Twenty-one patients were included. The median TBLC biopsy size (longest axis) was 7 mm (interquartile range, 5–8 mm). SLB biopsy sizes averaged 46.1 ± 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: κ = 0.22 (95% confidence interval [CI], 0.01–0.44), percentage agreement = 38% (95% CI, 18–62%); MDA2 versus TBLC: κ = 0.31 (95% CI, 0.06–0.56), percentage agreement = 48% (95% CI, 26–70)%; MDA2 versus SLB: κ = 0.51 (95% CI, 0.27–0.75), percentage agreement = 62% (95% CI, 38–82%); two pneumothoraces (9.5%) were recorded during TBLC. TBLC would have led to a different treatment if SLB was not performed in 11 of 21 (52%) of cases.Conclusions: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis retained at MDA
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- 2019
37. Reply to Wand et al.: Role of Transbronchial Cryobiopsy in Interstitial Lung Diseases – An Ongoing Tale
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Carey M. Suehs, Nicolas Molinari, Thomas V. Colby, Micaela Romagnoli, Arnaud Bourdin, Isabelle Vachier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Mayo Clinic [Scottsdale], Mayo Clinic, Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), and MORNET, Dominique
- Subjects
Pulmonary and Respiratory Medicine ,[SDV.MHEP.AHA] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,medicine.medical_specialty ,Lung ,medicine.diagnostic_test ,business.industry ,MEDLINE ,Critical Care and Intensive Care Medicine ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,3. Good health ,lung ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,Biopsy ,medicine ,multidisciplinary approach ,[SDV.MHEP.AHA]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,[SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,pathology ,030212 general & internal medicine ,Intensive care medicine ,business ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
- Published
- 2019
38. Competence in endosonographic techniques
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Loris Ceron, Donatella Dennetta, Piero Candoli, Fausto Leoncini, Francesca Marchesani, Rocco Trisolini, Mariagioconda Zotti, Micaela Romagnoli, Simone Scarlata, Valeria Pasini, Thomas Galasso, Lorenzo Corbetta, and Lucio Michieletto
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Lung Diseases ,Lung Neoplasms ,Mediastinal Neoplasms ,Sensitivity and Specificity ,Endosonography ,Bronchoscopy ,Pulmonary Medicine ,Medicine ,Humans ,Endobronchial ultrasound ,Flexible bronchoscopy ,medicine.diagnostic_test ,business.industry ,Mediastinum ,Virtual Reality ,Ultrasonography, Doppler ,General Medicine ,Equipment Design ,Interventional pulmonology ,Transducer ,Bronchoscopes ,interventional pulmonology, competence ,Clinical Competence ,Lymph Nodes ,Clinical competence ,Ultrasonography ,business ,Artifacts ,Biomedical engineering - Abstract
Endobronchial ultrasound (EBUS) has revolutionized the field of bronchoscopy because it allows to observe peribronchial structures and distal peripheral lung lesions. The use of EBUS was first described by Hurte and Hanrath in 1992. EBUS technology exists in two forms: radial and convex transducer probes. The radial EBUS probe has a 20-MHZ (12-30 MHz available) rotating transducer that can be inserted together with or without a guide sheath through the working channel (2.0-2.8 mm) of a standard flexible bronchoscope. The transducer rotates and produces a 360-degree circular image around the central position of the probe. There are two types of radial EBUS probes: "peripheral" probes, used to identify parenchymal lung lesions, and "central" probes, with balloon sheaths, used for the assessment of airway walls and peribronchial lymph nodes.
- Published
- 2018
39. Club cells in histological patterns of interstitial lung diseases
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Gérard Durand, Isabelle Vachier, Arnaud Bourdin, Paul Reynaud, Micaela Romagnoli, Charlotte Vernisse, Isabelle Serre, Yann Cabon, Aurélie Fort, Anne-Sophie Gamez, and Sébastien Bommart
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Pathology ,medicine.medical_specialty ,Lung ,medicine.anatomical_structure ,business.industry ,Medicine ,Club ,business - Published
- 2018
40. Atlas of Diffuse Lung Diseases
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Nicola Sverzellati, Cancellieri Alessandra, Giorgia Dalpiaz, Rocco Trisolini, M. Patelli, Luciano Cardinale, Maurizio Zompatori, Alberto Cavazza, and Micaela Romagnoli
- Subjects
medicine.medical_specialty ,Lung ,medicine.anatomical_structure ,medicine.diagnostic_test ,business.industry ,Atlas (anatomy) ,Medicine ,Computed tomography ,Radiology ,respiratory system ,business ,respiratory tract diseases - Abstract
This atlas is designed as an easy-to-use reference guide that identifi es and illustrates the key patterns of diffuse lung diseases observed on high-resolution computed tomography (HRCT). This atlas documents in great detail each pattern’s signs with close Rad-Path correlations. This book also allows a rapid view of HRCT characteristics and appearances of the individual diseases grouped on the basis of their prevalent radiological pattern.
- Published
- 2017
41. MMP-7 and fcDNA Serum Levels in Early NSCLC and Idiopathic Interstitial Pneumonia: Preliminary Study
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Venerino Poletti, Wainer Zoli, Paola Ulivi, Marta Mengozzi, Sara Tomassetti, Emanuela Scarpi, Micaela Romagnoli, Gian Luca Casoni, Giovanni Foschi, and Claudia Ravaglia
- Subjects
Male ,Pathology ,Lung Neoplasms ,NSIP ,Matrix metalloproteinase ,NSCLC ,Gastroenterology ,lcsh:Chemistry ,Idiopathic pulmonary fibrosis ,Carcinoma, Non-Small-Cell Lung ,lcsh:QH301-705.5 ,Spectroscopy ,General Medicine ,respiratory system ,Middle Aged ,Computer Science Applications ,Real-time polymerase chain reaction ,Area Under Curve ,Matrix Metalloproteinase 7 ,IIPs ,Female ,Non small cell ,Hypersensitivity pneumonitis ,MMP-7 ,medicine.medical_specialty ,fcDNA ,Enzyme-Linked Immunosorbent Assay ,Real-Time Polymerase Chain Reaction ,Sensitivity and Specificity ,Catalysis ,Article ,Inorganic Chemistry ,Diagnosis, Differential ,Internal medicine ,medicine ,Humans ,Interstitial pneumonia ,Idiopathic Interstitial Pneumonias ,Physical and Theoretical Chemistry ,Molecular Biology ,Idiopathic interstitial pneumonia ,Aged ,business.industry ,Organic Chemistry ,DNA ,medicine.disease ,Idiopathic Pulmonary Fibrosis ,respiratory tract diseases ,IPF ,lcsh:Biology (General) ,lcsh:QD1-999 ,ROC Curve ,business ,serum ,Biomarkers - Abstract
A non-invasive test to facilitate the diagnosis of non-small cell lung cancer (NSCLC) and idiopathic pulmonary fibrosis (IPF) is still not available and represents an important goal. Forty-eight patients with stage I NSCLC, 45 with IPF, 30 with other idiopathic interstitial pneumonias (IIPs) including idiopathic non-specific interstitial pneumonia (NSIP) and chronic hypersensitivity pneumonitis (HP), 35 with diffuse non-malignant disease and 30 healthy donors were enrolled onto the study. Free circulating (fc)DNA and MMP-7 levels were evaluated by Real Time PCR and ELISA, respectively. Median fcDNA levels were similar in NSCLC (127 ng/mL, range 23.6–345 ng/mL) and IPF (106 ng/mL, range 22–224 ng/mL) patients, and significantly lower in IIPs patients, in individuals with other diseases and in healthy donors (p <, 0.05). Conversely, median MMP-7 values were significantly higher in IPF patients (9.10 ng/mL, range 3.88–19.72 ng/mL) than in those with NSCLC (6.31 ng/mL, range 3.38–16.36 ng/mL, p <, 0.0001), NSIP (6.50 ng/mL, range 1.50–22.47 ng/mL, p = 0.007), other diseases (5.41 ng/mL, range 1.78–15.91, p <, 0.0001) or healthy donors (4.35 ng/mL, range 2.45–7.23, 0.0001). Serum MMP-7 levels seem to be capable of distinguishing IPF patients from those with any other lung disease. fcDNA levels were similar in NSCLC and IPF patients, confirming its potential role as a biomarker, albeit non-specific, for the differential diagnosis of NSCLC.
- Published
- 2013
42. Current Status of Idiopathic Nonspecific Interstitial Pneumonia
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Venerino Poletti, Marco Chilosi, Sara Piciucchi, and Micaela Romagnoli
- Subjects
Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,transbronchial lung biopsy ,clinical classification ,idiopathic nonspecific interstitial pneumonia ,high-resolution CT scan ,bronchoalveolar lavage ,cyclophosphamide ,rituximab ,Critical Care and Intensive Care Medicine ,Desquamative interstitial pneumonia ,Severity of Illness Index ,Idiopathic pulmonary fibrosis ,Usual interstitial pneumonia ,Pulmonary fibrosis ,medicine ,Humans ,Idiopathic Interstitial Pneumonias ,Diffuse alveolar damage ,Glucocorticoids ,Idiopathic interstitial pneumonia ,business.industry ,Bronchiolitis obliterans organizing pneumonia ,respiratory system ,Prognosis ,medicine.disease ,respiratory tract diseases ,Female ,Tomography, X-Ray Computed ,business ,Immunosuppressive Agents ,Hypersensitivity pneumonitis - Abstract
Pulmonary pathologists were aware of cases of idiopathic interstitial pneumonia (IIP) that morphologically did not fit Liebow's classification scheme. These cases were labeled as "cellular interstitial pneumonia" or "chronic interstitial pneumonia not otherwise specified." The term nonspecific interstitial pneumonia (NSIP) was first used in relation to a pattern of lung interstitial inflammation seen in association with human immunodeficiency virus (HIV) infection. In 1994 NSIP was used to indicate a group of subacute or chronic interstitial pneumonias characterized morphologically by interstitial inflammation or fibrosis or both, with preservation of the lung architecture and the absence of typical findings for any of the other main categories of IIP (mainly usual interstitial pneumonia, desquamative interstitial pneumonia, and bronchiolitis obliterans organizing pneumonia). Although these patients presented with "nonspecific" lung histology (categorized as cellular and fibrotic variants), and with a broad spectrum of associated clinical conditions, such as connective tissue diseases (CTDs), environmental exposure, and previous acute lung injury, they showed some peculiar clinical aspects, including favorable response to corticosteroid treatment and overall good prognosis.The clinical and radiographic profiles were better defined in the last decade. The NSIP pattern is the histological background of a subacute/chronic interstitial pneumonitis that may be observed in many conditions, including CTD, drug-induced lung disease, hypersensitivity pneumonitis, slowly healing diffuse alveolar damage (DAD), relapsing organizing pneumonia, occupational exposure, immunodeficiency (mainly HIV infection), graft versus host disease (GVHD), familial pulmonary fibrosis, immunoglobulin G4 (IgG4)-related sclerosing disease, with or without overlap features with Rosai-Dorfman disease, multicentric Castleman disease, and myelodysplastic syndrome. Rarely, NSIP is the histology recognized in patients with idiopathic interstitial pneumonitis, in whom efforts to find potential causative exposures are futile. This entity occurs mostly in middle-aged, never-smoker women, with a likely association with an autoimmune background. High-resolution computed tomographic (HRCT) scans typically demonstrate ground-glass attenuation with a bibasilar distribution, or in the fibrotic variant, ground-glass attenuation along with reticular lines and traction bronchiectasis. The prognosis is good compared with idiopathic pulmonary fibrosis (IPF), and therapeutic options include mainly corticosteroids and immunosuppressive agents. Recently a more precise definition of clinical profiles and radiographic findings of idiopathic NSIP allows consideration of less invasive diagnostic procedures (bronchoalveolar lavage, transbronchial lung biopsy). Better understanding of pathogenetic mechanisms might widen the therapeutic horizon giving a role to new therapeutic options in more severe cases.
- Published
- 2012
43. Is Medical Thoracoscopy Efficient in the Management of Multiloculated and Organized Thoracic Empyema?
- Author
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Gian Luca Casoni, Claudia Ravaglia, Venerino Poletti, Vanni Agnoletti, Christian Gurioli, Micaela Romagnoli, Carlo Gurioli, and Sara Tomassetti
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,Population ,Young Adult ,medicine ,Thoracoscopy ,Humans ,In patient ,Child ,education ,Empyema, Pleural ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,medicine.diagnostic_test ,Thoracic Surgery, Video-Assisted ,business.industry ,Pleural empyema ,Retrospective cohort study ,Middle Aged ,respiratory system ,medicine.disease ,Empyema ,respiratory tract diseases ,Surgery ,Treatment Outcome ,Effusion ,Cardiothoracic surgery ,Drainage ,Female ,business ,Follow-Up Studies - Abstract
Background: Pleural empyema can be subdivided into 3 stages: exudative, multiloculated, and organizing. In the absence of clear septation, antibiotics plus simple drainage of pleural fluid is often sufficient treatment, whereas clear septation often requires more invasive treatment. Objectives: The aim of this study was to report our experience and analyze the safety and efficacy of medical thoracoscopy in patients with multiloculated and organizing empyema. Methods: We performed a retrospective study reviewing the files of patients referred for empyema and treated by medical thoracoscopy at our department from July 2005 to February 2011. Results: A total of 41 patients with empyema were treated by medical thoracoscopy; empyema was free flowing in 9 patients (22%), multiloculated in 24 patients (58.5%), and organized in 8 patients (19.5%). Medical thoracoscopy was considered successful without further intervention in 35 of 41 patients (85.4%): all of the 9 patients with free-flowing fluid, 22 of the 24 patients with multiloculated empyema (91.7%), and only 4 of the 8 patients with organizing effusion (50%). Conclusions: Our study confirms that multiloculated pleural empyema could safely and successfully be treated with medical thoracoscopy while organizing empyema can be resistant to drainage with medical thoracoscopy, requiring video-assisted thoracic surgery or open surgical decortications; among this population, the presence of separate ‘pockets’ not in apparent communication with each other often leads to a surgical approach.
- Published
- 2012
44. EBUS-TBNA in mediastinal/hilar lymphadenopathies and/or masses: an Italian case series
- Author
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Micaela Romagnoli, Venerino Poletti, Oriana Nanni, Carlo Gurioli, Sara Tomassetti, Claudia Ravaglia, and Gianluca Casoni
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Mediastinum ,Context (language use) ,medicine.disease ,Lymphoma ,medicine.anatomical_structure ,Biopsy ,Immunology and Allergy ,Medicine ,Sampling (medicine) ,Sarcoidosis ,Radiology ,business ,Lung cancer ,Lymph node ,Genetics (clinical) - Abstract
Introduction: Transbronchial needle aspiration (TBNA) is an established method to diagnose hilar/mediastinal lymphadenopathies and/or masses. Real-time endobronchial ultrasound (EBUS) is a method that involves TBNA, and has been shown to increase the diagnostic yield in this context. Objectives: A descriptive study has been conducted to test real-time EBUS in the diagnosis of hilar-mediastinal lymphadenopathies/masses with a shorter diameter less then 2.5 cm or with a previous negative ‘blind’ TBNA. Methods: Consecutive patients referred for EBUS-TBNA of hilar/mediastinal lymph nodes were included in the study, when a node or mass was detected on a chest computed tomography scan. The primary end point was the number of successful biopsy specimens. Lymph node stations were classified according to the American Thoracic Society scheme. Results: Ninety-four patients (66 males, 28 females) of mean age 62 years (range: 17–86) underwent EBUS-TBNA: EBUS-TBNA could be performed in all patients. The procedure was diagnostic in 80 patients (89.4%); positive samples were 73 (52 lung cancer, 18 sarcoidosis and 3 tuberculosis), negative samples were 17, inadequate specimens were obtained in four patients (4.25%) and surgically proven false negative results were found in six cases (6.38%). Biopsy specimens were taken from lymph nodes in region 2L (1 case), 2R (5 cases), 4R (20 cases), 4L (7 cases), 7 (47 cases), 10R (9 cases), 10L (2 cases), 11R (6 cases) and 11L (3 cases). Sensitivity was 92.4%, and specificity was 100%. No complications occurred. Conclusions: EBUS-TBNA is a safe and reliable method for sampling mediastinal lymph nodes. Please cite this paper as: Gurioli C, Ravaglia C, Romagnoli M, Casoni G, Tomassetti S, Nanni O, Poletti V. EBUS-TBNA in mediastinal/hilar lymphadenopathies and/or masses: an Italian case series. Clin Respir J 2012; 6: 3–8.
- Published
- 2011
45. Prospective evaluation of drug-induced lung toxicity with high-resolution CT and transbronchial biopsy
- Author
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Sara Piciucchi, Marco Chilosi, Bruno Beomonte Zobel, Micaela Romagnoli, Angelo Carloni, Venerino Poletti, Giampaolo Gavelli, Alessandra Dubini, and C. Bigliazzi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Interstitial lung diseases ,Drug-Related Side Effects and Adverse Reactions ,Pulmonary toxicity ,Biopsy ,Bronchoalveolar Lavage ,Transbronchial biopsy ,Bronchoscopy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Prospective cohort study ,Aged ,Neuroradiology ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Interstitial lung disease ,Interventional radiology ,General Medicine ,Middle Aged ,respiratory system ,medicine.disease ,respiratory tract diseases ,HRCT ,Bronchoalveolar lavage ,Female ,Radiology ,Lung Diseases, Interstitial ,Tomography, X-Ray Computed ,business - Abstract
This study compared the results of high-resolution computed tomography (HRCT) and cytohistology after transbronchial biopsy in the evaluation of drug-related interstitial lung disease (DR-ILD).Patients with a clinical and imaging diagnosis of DR-ILD were prospectively included in a study protocol lasting 5 years. All patients were evaluated by bronchoscopy with transbronchial biopsy or bronchoalveolar lavage (BAL) following an HRCT examination that raised a suspicion of DR-ILD. Two radiologists (one senior and one junior), unaware of the diagnosis, reported the single HRCT findings, their distribution and predominant pattern. In the event of disagreement, the diagnosis was subsequently reached by consensus. Cytohistological examination was considered the gold standard in the diagnosis of DR-ILD. Patients who were unable to undergo the endoscopic procedure were excluded from the study.The study included 42 patients (25 men, 17 women; age range 20-84 years). Transbronchial biopsy was performed in all but four patients (one case of alveolar haemorrhage and three cases of lipoid pneumonia) in whom the diagnosis was established with BAL. Assessment of the HRCT images revealed the following patterns: noncardiogenic pulmonary oedema (n=13); organising pneumonia (OP) (n=9); hypersensitivity pneumonitis (HP) (n=2); alveolar haemorrhage (AH) (n=2); nonspecific interstitial pneumonia (NSIP) (n=5); lipoid pneumonia (LP) (n=1); sarcoid-like pattern (n=1). Cytohistological diagnosis revealed diffuse alveolar damage (DAD) in 11 patients, OP in seven, HP in three, AH in three, chronic interstitial pneumonia (CIP) in eight, LP in three and pseudosarcoidosis in one. Subdivision of the drugs into antineoplastic and nonantineoplastic agents showed that the most common patterns were CIP (n=6), DAD (n=2) and OP (n=2) in the antineoplastic group and DAD (n=9) and OP (n=5) in the nonantineoplastic group. Sensitivity and specificity of the radiological analysis was excellent, especially for patterns such as OP and DAD (sensitivity 0.86 and specificity 0.88 for OP; sensitivity 1 and specificity 0.93 for DAD).HRCT demonstrated excellent sensitivity and specificity. In cases in which its specificity was low, HRCT was nonetheless useful for biopsy planning and clinical-radiological monitoring after discontinuation of the drug treatment.
- Published
- 2010
46. Systemic autoimmune disease in asbestosis rapidly responding to anti-interleukin-1beta antibody canakinumab: a case report
- Author
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Emanuele Cassarà, Carlotta Nannini, Laura Niccoli, Olga Kaloudi, Micaela Romagnoli, and Fabrizio Cantini
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Canakinumab ,Interleukin-1beta ,Asbestosis ,Case Report ,Autoimmunity ,Disease ,Antibodies, Monoclonal, Humanized ,medicine.disease_cause ,Severity of Illness Index ,Autoimmune Diseases ,Immune system ,Rheumatology ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Lung ,biology ,business.industry ,Remission Induction ,Antibodies, Monoclonal ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Immunology ,biology.protein ,Antibody ,Tomography, X-Ray Computed ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Background Asbestosis is characterized by lung and pleural fibrosis and by immune system dysregulation, with autoantibody production and systemic immune-mediated disease. No specific therapies are available for asbestosis. Recently, the pivotal pathogenic role exerted by interleukin-1beta has been recently reported. Case presentation We treated with anti-interleukin 1 beta targeted antibody canakinumab a 67 year old man with asbestosis and long lasting systemic autoimmune features. A dramatic improvement in clinical manifestations was observed at 1 week after the first injection, with complete clinical remission at 4 months. Conclusion This case suggests new perspectives for the treatment of asbestosis and its systemic features.
- Published
- 2015
47. The use of auto-antibody testing in the evaluation of interstitial lung disease (ILD)--A practical approach for the pulmonologist
- Author
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Thomas Bahmer, Micaela Romagnoli, Klaus F. Rabe, Martin Claussen, and Francesco Girelli
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Intensive care medicine ,Idiopathic interstitial pneumonia ,Pulmonologists ,Autoantibodies ,030203 arthritis & rheumatology ,Lung ,business.industry ,Interstitial lung disease ,Pulmonologist ,medicine.disease ,Connective tissue disease ,respiratory tract diseases ,medicine.anatomical_structure ,Early Diagnosis ,030228 respiratory system ,Rheumatoid arthritis ,Immunology ,business ,Vasculitis ,Lung Diseases, Interstitial ,Algorithms - Abstract
Interstitial lung diseases (ILD), also defined as diffuse parenchymal lung diseases (DPLD) include a heterogeneous group of pulmonary disorders. They may be caused by an underlying connective tissue disease (CTD), Rheumatoid Arthritis (RA) or ANCA-associated Vasculitis (AAV). Pulmonary manifestations of these conditions may also precede systemic onset and therefore, pulmonologists may be confronted with diagnosing a systemic rheumatic disease. For the discrimination of CTD-related ILD and idiopathic interstitial pneumonia (IIP), serological testing is recommended. After careful reviewing the available literature, we suggest a serologic diagnostic algorithm for pulmonologists dealing with ILD-patients. This algorithm depicts the consensus for antibody testing that was reached amongst authors. Obviously this consensus approach requires further validation in everyday practice and leaves room for local adaption of the diagnostic strategy depending on the availability of diagnostic capacity and cost. It is our hope, however, that the rational and stepwise approach of serological testing for ILD will ultimately save unnecessary expenses associated with general laboratory screening. Finally a broader consensus on the strategy for laboratory testing in ILD in general might also improve the detection level of these relatively rare diseases and this will ultimately improve management and care of patients suffering from these complex disorders.
- Published
- 2015
48. Non Infectious Cavitary Exogenous Lipoid Pneumonia: A Case-Based Short Review
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Aless, Laura Bivona, ra Dubini, Sara Piciucchi, Angelo Carloni, Venerino Poletti, Raffaele Campisi, Micaela Romagnoli, Vittorio Pietrangeli, and Giuseppe Di Maria
- Subjects
Pathology ,medicine.medical_specialty ,Necrosis ,Lung ,business.industry ,Adipose tissue ,medicine.disease ,Pathogenesis ,Pneumonia ,medicine.anatomical_structure ,Fibrosis ,Parenchyma ,medicine ,Respiratory system ,medicine.symptom ,business - Abstract
Lipoid pneumonia (LP) is due to the accumulation of either endogenous or exogenous lipids in the alveoli. The exogenous LP (ELP) results from the chronic aspiration or inhalation of animal, vegetable, or mineral oils or fatty substances that by reaching the pulmonary alveoli cause a foreign body-type inflammatory reaction of lung parenchyma, associated with fibrosis, necrosis, and possible cavitation. Pulmonary reaction is characterised by symptoms and radiological findings that are common to other pulmonary diseases. The radiologic presentation of ELP includes lung consolidations and ground-glass opacities, with predominant involvement of the lower lobes. Thickening of interlobular septa, adipose or not adipose single mass, and poorly marginated nodules may also occur. Cavitation, when present, is mainly associated with infection by non-tuberculous mycobacteria or fungi. Thus in patients exposed to lipoid aspiration presenting with cavitated mass on CT scan, possible infection should be thoroughly ascertained, and adequate treatment promptly initiated. Hereby, we report three cases of non-infectious cavitary exogenous lipoid pneumonia. In all three patients, one with acute onset and two with chronic recurrent form, the ELP diagnosis was confirmed by both cytological and histological findings, whereas microbiological examination gave negative results. Moving from these three cases, we review the pathogenesis, clinical and radiological manifestation of ELP.
- Published
- 2015
49. Contents Vol. 73, 2006
- Author
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David A. Bradshaw, Andrew R. Haas, Nina Jeske, Nikolaos Siafakas, Stefania Costi, Josep Roca, Stamatis Katsenos, Olivier Durieux, Daniela Lugli, Caglar Cuhadaroglu, Tsering Y. Sherpa, M.E. Lewis, Rita Ambruzsova, C. Lewis, Jordi Vilaró, Prashant N. Chhajed, G. Polidori, Polytimi Panagiotopoulou-Gartagani, Andreas von Leupoldt, M. Sharma, Cristina Lorenzi, Maite Figueras Polo, Roberto A Rabinovich, Stavros H. Constantopoulos, Maria Tsoumakidou, Asuman Kaftan, Enrico Clini, Mehmet Meriç, P. Goldstraw, Georgios Daskalopoulos, Gladstone Huggins, Asimina Zachariadi-Xypolita, E. Caresta, Miltiadis P. Vassiliou, Kostas N. Priftis, Ernesto Crisafulli, Huseyin Oflaz, Simone Nordmeyer, Alfredo Chetta, Burak Pamukcu, Turhan Ece, Ana Maria Mayer, Omur Kuru, Athanasios G. Paliatsos, Nikolaos Tzanakis, Seung Whan Kim, Ioanna Tsiligianni, M. Piastra, Georgios Chrysofakis, P. John Rees, Seung Kyoon Woo, Photini Saxoni-Papageorgiou, Neil S. Cherniack, Isabelle Decamps, Harun Evrengul, Halil Tanriverdi, Daniela Dell’Orso, Georgios Maltezakis, Eun Suk Koh, Soo Hyun Park, M. Antonelli, Frank T. Grassi, Mee Rie Sheen, Balakrishnan Menon, Esther Ardite, A. Chiaretti, Mustafa Kilic, Polyxeni Nicolaidou, Micaela Romagnoli, Erdem Kasikcioglu, Alain Palot, Seyhan Tanriverdi, Do Jin Kim, Cuneyt Orhan Kara, Gene R. Pesola, Bernhard Dahme, Un Sil Jeon, Liam J. Cormican, Wolf Langewitz, Nevres Koylan, Polyxeni Tapratzi-Potamianou, Roberto Duranti, Alexandros Charisis, Sibel Ozkurt, Jai Kripalani, Josep M. Argilés, Sudhir Jain, J.F.K. Marzouk, Marco Confalonieri, Hervé Dutau, G. Conti, Michael Tamm, Amit Sharma, and P.A. Catarino
- Subjects
Pulmonary and Respiratory Medicine ,Traditional medicine ,business.industry ,Medicine ,business - Published
- 2006
50. Inpatient pulmonary rehabilitation: does it make sense?
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Micaela Romagnoli and Enrico Clini
- Subjects
Lung Diseases ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Respiratory impairment ,MEDLINE ,03 medical and health sciences ,Indirect costs ,0302 clinical medicine ,medicine ,Humans ,Pulmonary rehabilitation ,030212 general & internal medicine ,Clinical efficacy ,Inpatients ,COPD ,business.industry ,Rehabilitation ,Economics ,Exercise ,medicine.disease ,Hospitalization ,030228 respiratory system ,Physical therapy ,Candidacy ,business ,Inpatient rehabilitation - Abstract
Among the nonpharmacological therapies, pulmonary rehabilitation (PR) is particularly appropriate for patients with chronic respiratory impairment who, despite any optimal drug management, are still symptomatic and experience restriction in every day activities. Pulmonary rehabilitation performed in inpatient, outpatient, or home settings demonstrates short–and long–term clinical efficacy. Although disease severity does not inherently dictate candidacy for exercise training, the degree of physiological and functional impairment may influence setting in which the training should occur. Therefore, inpatient rehabilitation is generally best–suited for the most sick and most disabled patients. The overall results from the literature confirm that the inpatient setting for a PR program is a feasible option and does not necessarily result in higher direct costs when balanced against duration and effectiveness in terms of improved outcomes.
- Published
- 2005
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