94 results on '"Simone Gambazza"'
Search Results
2. Evidence-informed and consensus-based statements about SAFEty of Physical Agent Modalities Practice in physiotherapy and rehabilitation medicine (SAFE PAMP): a national Delphi of healthcare scientific societies
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Fabio Bandini, Giacomo Rossettini, Stefano Vercelli, Roberto Bortolotti, Silvia Gianola, Silvia Bargeri, Andrea Turolla, Greta Castellini, Simone Cecchetto, Bianca Masturzo, Leonardo Pellicciari, Anna Fulvio, Vincenzo Genovese, Matteo Benedini, Emanuele Proverbio, Simone Gambazza, Chiara Torresetti, Carla Berliri, Mauro Roselli, Marco Scorcu, Giuseppe Botta, Luigi Nappi, Gianmarco Rea, Enrico Marinelli, Viviana Rosati, Armando Perrotta, Gianfranco Lamberti, Monica Pierattelli, and Giancarlo Tancredi
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Medicine - Abstract
Objective A shared consensus on the safety about physical agent modalities (PAMs) practice in physiotherapy and rehabilitation is lacking. We aimed to develop evidence-informed and consensus-based statements about the safety of PAMs.Study design and setting A RAND-modified Delphi Rounds’ survey was used to reach a consensus. We established a steering committee of the Italian Association of Physiotherapy (Associazione Italiana di Fisioterapia) to identify areas and questions for developing statements about the safety of the most commonly used PAMs in physiotherapy and rehabilitation. We invited 28 National Scientific and Technical Societies, including forensics and lay members, as a multidisciplinary and multiprofessional panel of experts to evaluate the nine proposed statements and formulate additional inputs. The level of agreement was measured using a 9-point Likert scale, with consensus in the Delphi Rounds assessed using the rating proportion with a threshold of 75%.Results Overall, 17 (61%) out of 28 scientific and technical societies participated, involving their most representative members. The panel of experts mainly consisted of clinicians (88%) with expertise in musculoskeletal (47%), pelvic floor (24%), neurological (18%) and lymphatic (6%) disorders with a median experience of 30 years (IQR=17–36). Two Delphi rounds were necessary to reach a consensus. The final approved criteria list comprised nine statements about the safety of nine PAMs (ie, electrical stimulation neuromodulation, extracorporeal shock wave therapy, laser therapy, electromagnetic therapy, diathermy, hot thermal agents, cryotherapy and therapeutic ultrasound) in adult patients with a general note about populations subgroups.Conclusions The resulting consensus-based statements inform patients, healthcare professionals and policy-makers regarding the safe application of PAMs in physiotherapy and rehabilitation practice. Future research is needed to extend this consensus on paediatric and frail populations, such as immunocompromised patients.
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- 2024
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3. Feasibility of high-frequency percussions in people with severe acquired brain injury and tracheostomy: an observational study
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Salvatore Andrea Sciurello, Francesca Graziano, Maria Marcella Laganà, Elena Compalati, Gabriele Pappacoda, Simone Gambazza, Jorge Navarro, Pietro Cecconi, Francesca Baglio, and Paolo Banfi
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Brain injuries ,tracheostomy ,pulmonary atelectasis ,respiratory therapy ,Medicine - Abstract
People with severe acquired brain injury (pwSABI) frequently experience pulmonary complications. Among these, atelectasis can occur as a result of pneumonia, thus increasing the chance of developing acute respiratory failure. Respiratory physiotherapy contribution to the management of atelectasis in pwSABI is yet poorly understood. We conducted a retrospective analysis on 15 non-cooperative pwSABI with tracheostomy and spontaneously breathing, hospitalized and treated with high-frequency percussion physiotherapy between September 2018 and February 2021 at the Neurological Rehabilitation Unit of the IRCCS “S.Maria Nascente - Fondazione Don Gnocchi”, Milan. Our primary aim was to investigate the feasibility of such a physiotherapy intervention method. Then, we assessed changes in respiratory measures (arterial blood gas analysis and peripheral night-time oxygen saturation) and high-resolution computed tomography lung images, evaluated before and after the physiotherapy treatment. The radiological measures were a modified radiological atelectasis score (mRAS) assigned by two radiologists, and an opacity score automatically provided by the software CT Pneumonia Analysis® that identifies the regions of abnormal lung patterns. Treatment diaries showed that all treatments were completed, and no adverse events during treatment were registered. Among the 15 pwSABI analyzed, 8 were treated with IPV® and 7 with MetaNeb®. After a median of 14 (I-III quartile=12.5-14.5) days of treatment, we observed a statistical improvement in various arterial blood gas measures and peripheral night-time oxygen saturation measures. We also found radiological improvement or stability in more than 80% of pwSABI. In conclusion, our physiotherapy approach was feasible, and we observed respiratory parameters and radiological improvements. Using technology to assess abnormal tomographic patterns could be of interest to disentangle the short-term effects of respiratory physiotherapy on non-collaborating people.
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- 2024
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4. Setting up and managing the largest COVID-19 mass vaccination center in Lombardy, Italy
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Jessica Graziella Calegari, Alberto Bisesti, Silvia Pazzaglia, Simone Gambazza, Filippo Binda, Martina Bruno, Laura Chiappa, Alessandra Piatti, Navpreet Tiwana, Matteo Letzgus, Silvana Castaldi, Marcello Sottocorno, and Dario Laquintana
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vaccine ,COVID-19 ,mass vaccination center ,vaccination experience ,organizational layout ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundThe rapid global spread of severe acute respiratory syndrome coronavirus (SARS-CoV-2) was met with the rollout of vaccination campaigns at mass vaccination centers. The Palazzo delle Scintille, Milan, was designated by the Lombardy regional administration as a vaccination site with the target of processing about 9,000 users daily.MethodsFor this observational study, we compared data on vaccinations delivered at the Palazzo delle Scintille with coronavirus disease (COVID-19)-related regional data.ResultsBetween 25 April 2021 and 28 February 2023, a total of 1,885,822 COVID-19 doses were administered; the mean hourly rate was 289 (247.2), the mean daily rate was 3185.5 (3104.5), the mean user age was 49.5 years (10.7). The Comirnaty vaccine (Pfizer-BioNTech) was most often given (1,072,030/1,885,822; 56.8%). Between 4 December 2021 and 15 January 2022, the daily dose rate was above the maximum daily capacity set by the regional administration.ConclusionThe trend for daily dose rates administered at the Palazzo delle Scintille center was in line with COVID-19-related regional data. The center played a major role in the regional mass vaccination campaign.
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- 2023
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5. Lung clearance index to characterize clinical phenotypes of children and adolescents with cystic fibrosis
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Simone Gambazza, Federico Ambrogi, Federica Carta, Laura Moroni, Maria Russo, Anna Brivio, and Carla Colombo
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Lung clearance index ,Cystic fibrosis ,Pediatrics ,Phenotypes ,Time-to-event data ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background Lung clearance index (LCI) is accepted as an early marker of lung disease in cystic fibrosis (CF), however the utility of LCI to identify subgroups of CF disease in the paediatric age group has never been explored. The aim of the study was to characterize phenotypes of children with CF using LCI as a marker of ventilation inhomogeneity and to investigate whether these phenotypes distinguished patients based on time to pulmonary exacerbation (PE). Methods Data were collected on patients with CF aged
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- 2022
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6. Prevalence and associated factors of COVID-19 across Italian regions: a secondary analysis from a national survey on physiotherapists
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Simone Gambazza, Silvia Bargeri, Isabella Campanini, Roberto Meroni, Andrea Turolla, Greta Castellini, Silvia Gianola, and Scientific Technical Committee of AIFI
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Physiotherapy ,Physical therapy ,Surveys and questionnaires ,Pandemics ,Coronavirus ,COVID–19 ,Miscellaneous systems and treatments ,RZ409.7-999 - Abstract
Abstract Background Coronavirus disease 2019 (COVID-19) broke out in China in December 2019 and now is a pandemic all around the world. In Italy, Northern regions were hit the hardest during the first wave. We aim to explore the prevalence and the exposure characteristics of physiotherapists (PTs) working in different Italian regions during the first wave of COVID-19. Methods Between April and May 2020 a structured anonymous online survey was distributed to all PTs registered in the National Professional Registry to collect prevalence data of a confirmed diagnosis of COVID-19 (i.e., nasopharyngeal swab and/or serological test). A bottom-up agglomerative nesting hierarchical clustering method was applied to identify groups of regions based on response rate. Multivariable logistic regression was used to explore personal and work-related factors associated with a confirmed diagnosis of COVID-19. Results A total of 15,566 PTs completed the survey (response rate 43.3%). The majority of respondents (57.7%) were from Northern regions. Considering all respondents, the number of confirmed COVID-19 cases in Northern and Central Italy, was higher compared to those in Southern Italy (6.9% vs. 1.8%, P
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- 2021
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7. Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care
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Filippo Binda, Marco Clari, Gabriella Nicolò, Simone Gambazza, Barbara Sappa, Paola Bosco, and Dario Laquintana
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End-of-life ,Hospital death ,Symptom control ,Quality of death ,Palliative care ,Special situations and conditions ,RC952-1245 - Abstract
Abstract Background In the last decade, access to national palliative care programs have improved, however a large proportion of patients continued to die in hospital, particularly within internal medicine wards. Objectives To describe treatments, symptoms and clinical management of adult patients at the end of their life and explore whether these differ according to expectation of death. Methods Single-centre cross-sectional study performed in the medical and surgical wards of a large tertiary-level university teaching hospital in the north of Italy. Data on nursing interventions and diagnostic procedure in proximity of death were collected after interviewing the nurse and the physician responsible for the patient. Relationship between nursing treatments delivered and patients’ characteristics, quality of dying and nurses’ expectation about death was summarized by means of multiple correspondence analysis (MCA). Results Few treatments were found statistically associated with expectation of death in the 187 patients included. In the last 48 h, routine (70.6%) and biomarkers (41.7%) blood tests were performed, at higher extent on patients whose death was not expected. Many symptoms classified as severe were reported when death was highly expected, except for agitation and respiratory fatigue which were reported when death was moderately expected. A high Norton score and absence of anti-bedsore mattress were associated with unexpected death and poor quality of dying, as summarized by MCA. Quality of dying was perceived as good by nurses when death was moderately and highly expected. Physicians rated more frequently than nurses the quality of dying as good or very good, respectively 78.6 and 57.8%, denoting a fair agreement between the two professionals (k = 0.24, P
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- 2021
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8. Association of ventilator-free days with respiratory physiotherapy in critically ill patients with Coronavirus Disease 2019 (COVID-19) during the first pandemic wave. A propensity score-weighted analysis
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Emilia Privitera, Simone Gambazza, Veronica Rossi, Martina Santambrogio, Filippo Binda, Davide Tarello, Salvatore Caiffa, Valentina Turrin, Carolina Casagrande, Denise Battaglini, Mauro Panigada, Roberto Fumagalli, Paolo Pelosi, and Giacomo Grasselli
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respiratory physiotherapy ,Intensive Care Unit ,ventilator-free days ,COVID-19 ,critical illness ,Medicine (General) ,R5-920 - Abstract
BackgroundRespiratory physiotherapy is reported as safe and feasible in mechanically ventilated patients with severe Coronavirus Disease (COVID-19) admitted to Intensive Care Unit (ICU), but the short-term benefits remain unclear.MethodsWe performed a retrospective observational study in four ICUs in Northern Italy. All patients with COVID-19 admitted to ICU and under invasive mechanical ventilation (MV) between March 1st and May 30th, 2020, were enrolled into the study. Overlap weighting based on the propensity score was used to adjust for confounding in the comparison of patients who had or had not been treated by physiotherapists. The primary outcome was the number of days alive and ventilator-free (VFDs). The secondary outcomes were arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (P/F) at ICU discharge, ICU length of stay, ICU and hospital mortality, and survival at 90 days. The trial protocol was registered on clinicaltrials.gov (NCT 05067907).ResultsA total of 317 patients were included in the analysis. The median VFDs was 18 days [interquartile range (IQR) 10; 24] in patients performing physiotherapy and 21 days (IQR 0; 26) in the group without physiotherapy [incidence rate ratio (IRR) 0.86, 95% confidence interval (CI): 0.78; 0.95]. The chance of 0 VFDs was lower for patients treated by physiotherapists compared to those who were not [odds ratio (OR) = 0.36, 95% CI: 0.18–0.71]. Survival at 90 days was 96.0% in the physiotherapy group and 70.6% in patients not performing physiotherapy [hazard ratio (HR) = 0.14, 95% CI: 0.03–0.71]. Number of VFDs was not associated with body mass index (BMI), sex, or P/F at ICU admission for individuals with at least 1 day off the ventilator.ConclusionIn patients with COVID-19 admitted to ICU during the first pandemic wave and treated by physiotherapists, the number of days alive and free from MV was lower compared to patients who did not perform respiratory physiotherapy. Survival at 90 days in the physiotherapy group was greater compared to no physiotherapy. These findings may be the starting point for further investigation in this setting.
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- 2022
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9. Time Free From Hospitalization in Children and Adolescents With Cystic Fibrosis: Findings From FEV1, Lung Clearance Index and Peak Work Rate
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Simone Gambazza, Alessandra Mariani, Anna Brivio, Federica Carta, Chiara Blardone, Saba Lisiero, Maria Russo, and Carla Colombo
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cystic fibrosis ,lung clearance index (LCI) ,exercise tolerance ,lung function ,hospitalization ,pulmonary exacerbation ,Pediatrics ,RJ1-570 - Abstract
BackgroundAn exercise test combined with a multiple breath washout nitrogen test (MBWN2) may offer a comprehensive clinical evaluation of cystic fibrosis (CF) disease in children with normal spirometry. The purpose of the present study is to explore whether information derived from spirometry, MBWN2, and exercise tests can help the CF multidisciplinary team to characterize time free from hospitalization due to pulmonary exacerbation (PE) in a cohort of pediatric patients with CF.MethodsThis prospective observational study was carried out at the Lombardia Region Reference Center for Cystic Fibrosis in Milano, Italy. In 2015, we consecutively enrolled children and adolescents aged
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- 2022
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10. Lung clearance index in subjects with cystic fibrosis in Italy
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Enrico Lombardi, Simone Gambazza, Ugo Pradal, and Cesare Braggion
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LCI ,Cystic fibrosis ,MBW ,Ventilation inhomogeneity ,Preschool ,Children ,Pediatrics ,RJ1-570 - Abstract
Abstract The Lung Clearance Index (LCI) is an index derived from washout recordings, able to detect early peripheral airway damage in subjects with cystic fibrosis (CF) with a greater sensitivity than spirometry. LCI is a marker of overall lung ventilation inhomogeneity; in fact, as pulmonary ventilation worsens, the number of tidal breaths and the expiratory volumes required to clear the lungs of a marker gas are increased, as documented by a greater value. In the field of CF, LCI allows indirect investigation of the small airways (
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- 2019
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11. Home physiotherapists assisting follow-up treatment in cystic fibrosis: a multicenter observational study
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Anna Brivio, Annalisa Orenti, Mauro Barbisan, Paolo Buonpensiero, Mirco Ros, and Simone Gambazza
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physiotherapy ,home visit ,aerosol ,cystic fibrosis ,Medicine - Abstract
Inhaled therapies are relatively simple and easy to be managed however ineffective use of aerosols when self-administered may occur. We described variation of the number of clinic visits, lung function and number of antibiotic courses performed over 12 months in participants with cystic fibrosis (CF), when supervised or not by physiotherapists (PTs) at home. Participants in 8 Italian CF centers with a prescription of dry-powder antibiotic choose whether to be supervised at home (PT-FU) or not (non-PT-FU), in adjunct to routine clinic visits. PTs assisted participants with their inhaled therapies regimen and reviewed the airway clearance program in use. Mixed-effect regression models were fitted to evaluate the variation of selected endpoints over time. A total of 163 participants were included. Lung function declined over time in both groups, at higher extent in the non-PT-FU group at 6 months (-1.8, 95%CI: -4.4 to 0.7 % predicted), without reaching statistical significance, whereas in the PT-FU group only, nearly one visit less was recorded (p=0.027). Regardless the type of supervision adopted, the number of antibiotic courses did not change compared to the previous year. We counted 19/90 (21.1%) drop-out in the PT-FU, double compared to the group followed up at the clinics (p=0.065). Participants under a course of an inhaled antibiotic therapy showed a 1-year decline in lung function, whereas only the group receiving home supervision counted nearly one visit less at the CF center, whose clinical relevance should be further discussed.
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- 2021
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12. Use of Musical Intervention in the Pediatric Intensive Care Unit of a Developing Country: A Pilot Pre–Post Study
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Federica Buzzi, Nizar Bakir Yahya, Simone Gambazza, Filippo Binda, Alessandro Galazzi, Antonella Ferrari, Stefano Crespan, Hevan Adel Al-Atroushy, Barbara Maria Cantoni, Dario Laquintana, and Collaborative Group
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musical intervention ,nursing care ,pain management ,comfort behavior scale ,developing countries ,pediatric intensive care unit ,Pediatrics ,RJ1-570 - Abstract
Music is frequently used in different clinical settings, and it is implemented as a complementary, low-cost and useful intervention to reduce pain, anxiety and to improve relaxation. This pilot pre–post study aimed to examine the feasibility and preliminary effectiveness of a specific musical intervention in patients ≤16 years admitted to the Pediatric Intensive Care Unit (PICU) of an Iraqi hospital. The COMFORT Behavior Scale (CBS) was used by nurses to assess the level of sedation. Fifty-nine children were enrolled during the study period (March 2020–August 2021). CBS was lowered by 2.2 (95% CI: 1.9 to 2.6) points after 30 min, and by 3.3 (95% CI: 2.9 to 3.6) points after 60 min from music initiation. Thirty minutes after music initiation, heart rate decreased by 6.3 (95% CI: 4.5 to 8.1) beats per minute, whereas at 60 min, heart rate decreased by 9.1 (95% CI: 7.2 to 10.9) beats per minute. No clinically significant variations were detected in the other vital signs (blood pressure, respiratory rate and oxygen saturation). These findings support the feasibility of musical intervention in a developing country. CBS and heart rate variation may be worth following up in larger and conclusive studies.
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- 2022
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13. Pattern of Visits in a Metropolitan Emergency Department in Lombardia (Italy): January 2019–December 2020
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Simone Gambazza, Alessandro Galazzi, Filippo Binda, Onorina Passeri, Paola Bosco, Giorgio Costantino, and Dario Laquintana
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COVID-19 ,Italy ,emergency service ,overcrowding ,primary care ,Medicine - Abstract
During the Coronavirus disease 2019 (COVID-19), a general decrease in the presentations to emergency departments (ED) was reported. However, we suspect that there was a lower number but an unchanged pattern of ED visits for urgent conditions in 2020 compared to 2019. This retrospective study assessed the change in the number of presentations in the ED of a tertiary level university hospital in Milano (Lombardia, Italy). Compared to 2019, a significant drop in ED presentations occurred (−46.4%), and we recorded a −15.7% difference in the proportion of patients admitted with white codes. The pattern of hourly presentations to the ED was unchanged, with overcrowding during the working daytime. COVID-19 changed ED flows, likely causing an overall reduction in the number of deferrable conditions. However, the pattern associated with urgent conditions did not change abruptly in 2020.
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- 2021
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14. Cystic Fibrosis, New Frontier: Exploring the Functional Connectivity of the Brain Default Mode Network. Comment on Elce et al. Impact of Physical Activity on Cognitive Functions: A New Field for Research and Management of Cystic Fibrosis. Diagnostics 2020, 10, 489
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Simone Gambazza, Rita Maria Nobili, Riccardo Biffi, Paul Eugene Summers, Carla Colombo, and Antonella Costa
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n/a ,Medicine (General) ,R5-920 - Abstract
We read with great interest the paper entitled “Impact of physical activity of cognitive functions: a new field for research and management of Cystic Fibrosis” by Elce et al. [...]
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- 2021
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15. Respiratory physiotherapy education in Italy: per aspera ad astra
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Simone Gambazza
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Diseases of the respiratory system ,RC705-779 - Published
- 2018
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16. CPAP after endoscopic procedures as add-on therapy for the treatment of tracheal stenosis: a case series
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Adriano Gesuele, Simone Gambazza, Marta Lazzeri, and Serena Conforti
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Continuous positive airway pressure ,tracheal stenosis ,endoscopy ,Medicine - Abstract
Tracheal stenosis represents a possible complication in intubated or tracheotomised patients. Tracheal resection is currently the gold standard for the treatment of complex stenosis while granulomas and simple stenosis (e.g., web-like) are often treated by endoscopic procedures, which do not consistently give satisfactory long-term results, due to frequent relapses. Administering continuous positive airway pressure (CPAP) after endoscopic procedures might represent a new add-on option for the treatment of this complication. In this case series are presented two patients with tracheal stenosis showed after the removal of tracheostomy tube, both treated with CPAP. The results were straightforward: CPAP treatment helped to keep stable the tracheal lumen, without adverse effects. No further endoscopic dilations were necessary thereafter, with a likely positive impact on patients’ quality of life and on health expenditure.
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- 2019
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17. Clinical research as foundation for the advancement of respiratory physiotherapy
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Marta Lazzeri, Simone Gambazza, Mara Paneroni, and Gabriela P.E. Ferreyra
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Medicine - Abstract
Associazione Riabilitatori dell’Insufficienza Respiratoria (ARIR) is pleased to announce a new editorial project by joining the Monaldi Archives of Chest Disease journal.
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- 2019
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18. Effectiveness of lumacaftor/ivacaftor initiation in children with cystic fibrosis aged 2 through 5 years on disease progression: Interim results from an ongoing registry-based study
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Andreas, Pfleger (AT), Elise, Lammertijn (BE), Duška, Tješić-Drinković (HR), Pavel, Dřevínek (CZ), Milan, Macek, Jr (CZ), Hanne, Vebert Olesen (DK), Nathalie, Senecal (FR), Pierre-Régis, Burgel (FR), Godfrey, Fletcher (IE), Rita, Padoan (IT), Annalisa, Orenti (IT), Federico, Ambrogi (IT), Simone, Gambazza (IT), Elīna, Aleksejeva (LV), Anna-Maria, Charatsi (LU), Domenique, Zomer (NL), Egil, Bakkeheim (NO), Lukasz, Woźniacki (PL), Uroš, Krivec (SI), Christina, Krantz (SE), Anders, Lindblad (SE), Andreas, Jung (CH), Sarah, Clarke (UK), Siobhán B․, Carr (UK), Kim, Claire, Higgins, Mark, Liu, Lingyun, Volkova, Nataliya, Zolin, Anna, and Naehrlich, Lutz
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- 2024
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19. The SINTART 2 Study. A phase II non-randomised controlled trial of induction chemotherapy, photon-, proton- and carbon-ion-based radiotherapy integration in patients with locally advanced unresectable sinonasal tumours
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Paolo Bossi, Ester Orlandi, Carlo Resteghini, Barbara Vischioni, Piero Nicolai, Paolo Castelnuovo, Simone Gambazza, Laura D. Locati, Mario Turri-Zanoni, Marco Ferrari, Nadia Facchinetti, Nicola A. Iacovelli, Giuseppina Calareso, Pasquale Quattrone, Anna Cavallo, Alessandro Tuzi, and Lisa Licitra
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Cancer Research ,Endoscopic surgery ,Heavy ion therapy ,Induction chemotherapy ,Multimodal therapy ,Resectable sinonasal tumours ,Oncology - Published
- 2023
20. The SINTART 1 study. A phase II non-randomised controlled trial of induction chemotherapy, surgery, photon-, proton- and carbon ion-based radiotherapy integration in patients with locally advanced resectable sinonasal tumours
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Carlo Resteghini, Paolo Castelnuovo, Piero Nicolai, Ester Orlandi, Paolo Bossi, Barbara Vischioni, Alberto Schreiber, Simone Gambazza, Nicola Alessandro Iacovelli, Paolo Battaglia, Marco Guzzo, Mario Turri-Zanoni, Davide Mattavelli, Nadia Facchinetti, Giuseppina Calareso, Marco Ravanelli, Carla Facco, Tiziana Tartaro, and Lisa Licitra
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Cancer Research ,Oncology - Published
- 2023
21. Association of Oxygen Therapy with the Natural Disease Progression of Cystic Fibrosis: A Multi-State Model of the European Cystic Fibrosis Society Patient Registry
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Simone Gambazza, Annalisa Orenti, Giovanna Pizzamiglio, Anna Zolin, Carla Colombo, Dario Laquintana, and Federico Ambrogi
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Chemical Health and Safety ,Therapeutics and Clinical Risk Management ,Pharmacology (medical) ,General Medicine ,General Pharmacology, Toxicology and Pharmaceutics ,Safety Research - Abstract
Simone Gambazza,1,2,* Annalisa Orenti,2,* Giovanna Pizzamiglio,3 Anna Zolin,2 Carla Colombo,4,5 Dario Laquintana,1 Federico Ambrogi2,6 On behalf of ECFSPR1Healthcare Professions Department, Fondazione IRCCS Caâ Granda Ospedale Maggiore Policlinico, Milan, Italy; 2Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology âG. A. Maccacaroâ, Università degli Studi di Milano, Milan, Italy; 3Cystic Fibrosis Center â Adult Unit, Fondazione IRCCS Caâ Granda Ospedale Maggiore Policlinico, Milan, Italy; 4Cystic Fibrosis Center, Fondazione IRCCS Caâ Granda Ospedale Maggiore Policlinico, Milan, Italy; 5Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy; 6Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, MI, Italy*These authors contributed equally to this workCorrespondence: Simone Gambazza, Healthcare Professions Department, Fondazione IRCCS Caâ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, 20122, Italy, Email simone.gambazza@policlinico.mi.itBackground: Association between dependence on oxygen therapy (OT) and natural disease progression in people with cystic fibrosis (pwCF) has not been estimated yet. The aim of this study is to understand the prognosis for pwCF on OT, evaluating how the transition probabilities from being alive without lung transplantation (LTx) to LTx and to death, and from being alive after LTx to death change in pwCF with and without OT.Methods: We used 2008â 2017 data from the 35-country European CF Society Patient Registry. A multi-state model was fitted to assess the effects of individual risk factors on transition probabilities.Results: We considered 48,343 pwCF aged from 6 to 50 years. OT (HR 5.78, 95% CI: 5.32â 6.29) and abnormal FEV1 (HR 6.41, 95% CI: 5.28â 7.79) were strongly associated with the probability of having LTx; chronic infection with Burkholderia cepacia complex (HR 3.19, 95% CI: 2.78â 3.67), abnormal FEV1 (HR 5.00, 95% CI: 4.11â 6.08) and the need for OT (HR 4.32, 95% CI: 3.93â 4.76) showed the greatest association with the probability of dying without LTx. Once pwCF received LTx, OT (HR 1.75, 95% CI: 1.41â 2.16) and abnormal FEV1 (HR 1.63, 95% CI: 1.18â 2.25) were the main factors associated with the probability of dying. An association of gross national income with the probability of receiving LTx and with the probability of dying without LTx was also found.Conclusion: Oxygen therapy is associated with poor survival in pwCF with and without LTx; harmonization of CF care throughout European countries and minimization of the onset of pulmonary gas exchange abnormalities using all available means remains of paramount importance.Keywords: cystic fibrosis, oxygen therapy, epidemiology, mortality, lung transplantation
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- 2023
22. Extracellular Vesicle-Encapsulated microRNAs as Novel Biomarkers of Lung Health
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Christina M. Eckhardt, Simone Gambazza, Tessa R. Bloomquist, Peter De Hoff, Aishwarya Vuppala, Pantel S. Vokonas, Augusto A. Litonjua, David Sparrow, Faruque Parvez, Louise C. Laurent, Joel Schwartz, Andrea A. Baccarelli, and Haotian Wu
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Pulmonary and Respiratory Medicine ,Prevention ,spirometry ,Respiratory System ,lung function ,Lung Injury ,Critical Care and Intensive Care Medicine ,Medical and Health Sciences ,microRNAs ,Extracellular Vesicles ,Good Health and Well Being ,Clinical Research ,Genetics ,Respiratory ,Humans ,Longitudinal Studies ,Prospective Studies ,Lung ,Biomarkers ,Biotechnology - Abstract
Rationale: Early detection of respiratory diseases is critical to facilitate delivery of disease-modifying interventions. Extracellular vesicle-enriched microRNAs (EV-miRNAs) may represent reliable markers of early lung injury. Objectives: Evaluate associations of plasma EV-miRNAs with lung function. Methods: The prospective NAS (Normative Aging Study) collected plasma EV-miRNA measurements from 1996-2015 and spirometry every 3-5 years through 2019. Associations of EV-miRNAs with baseline lung function were modeled using linear regression. To complement the individual miRNA approach, unsupervised machine learning was used to identify clusters of participants with distinct EV-miRNA profiles. Associations of EV-miRNA profiles with multivariate latent longitudinal lung function trajectories were modeled using log binomial regression. Biological functions of significant EV-miRNAs were explored using pathway analyses. Results were replicated in an independent sample of NAS participants and in the HEALS (Health Effects of Arsenic Longitudinal Study). Measurements and Main Results: In the main cohort of 656 participants, 51 plasma EV-miRNAs were associated with baseline lung function (false discovery rate-adjusted P value
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- 2023
23. Pressure ulcers after prone positioning in patients undergoing extracorporeal membrane oxygenation: A cross-sectional study
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Filippo Binda, Federica Marelli, Alessandro Galazzi, Simone Gambazza, Elisa Vinci, Paola Roselli, Ileana Adamini, and Dario Laquintana
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pressure ulcers ,intensive care units ,advanced life support ,extracorporeal membrane oxygenation ,respiratory distress syndrome ,Critical Care Nursing ,Settore MED/45 - Scienze Infermieristiche Generali, Cliniche e Pediatriche ,Settore MED/01 - Statistica Medica - Published
- 2023
24. Using electrical impedance tomography to characterize lung impairment of children with primary ciliary dyskinesia: A pilot cross-sectional study
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Mariacarola Pensabene, Simone Gambazza, Federica Carta, Alessia Rocchi, Mara Lelii, Barbara Madini, Vittoria Hassan, Marta Piotto, and Maria Francesca Patria
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Settore MED/38 - Pediatria Generale e Specialistica ,Pulmonary and Respiratory Medicine ,respiratory function ,Pediatrics, Perinatology and Child Health ,primary ciliary dyskinesia ,electrical impedance tomography ,Settore MED/01 - Statistica Medica - Abstract
In children with primary ciliary dyskinesia (PCD), measures more sensitive than spirometry are needed to characterize underlying pulmonary impairment. Electrical impedance tomography (EIT) is a promising noninvasive method for monitoring the distribution of lung ventilation, and it does not require patient collaboration. We aimed to provide an assessment of the feasibility and clinical usefulness of EIT in characterizing lung impairment in children with PCD, compared to spirometry and multiple breath nitrogen washout (MBWNChildren and adolescents with PCD underwent MBWNWe included 12 out of 16 individuals regularly followed at our clinic. A total of 41.7% (5/12) showed abnormal forced expiratory volume in 1 s (FEVEIT appears promising as a noninvasive technique to characterize ventilation distribution in children with PCD, thus providing a complementary assessment to static and dynamic lung function measures of PCD disease.
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- 2022
25. Stressful life events and accelerated biological aging over time in youths
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Jennifer A. Sumner, Xu Gao, Simone Gambazza, Christian K. Dye, Natalie L. Colich, Andrea A. Baccarelli, Monica Uddin, and Katie A. McLaughlin
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Psychiatry and Mental health ,Endocrinology ,Endocrine and Autonomic Systems ,Endocrinology, Diabetes and Metabolism ,Biological Psychiatry - Published
- 2023
26. Limitations of the dichotomized 6-minute walk distance when computing lung allocation score for cystic fibrosis: a 16-year retrospective cohort study
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Simone Gambazza, Federica Carta, Federico Ambrogi, Giacomo Bassotti, Anna Brivio, Maria Russo, and Carla Colombo
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exercise capacity ,Rehabilitation ,field walk test ,joint modelling ,Settore MED/48 -Scienze Infermie.e Tecniche Neuro-Psichiatriche e Riabilitattive ,Cystic fibrosis ,lung transplant ,survival ,Settore MED/01 - Statistica Medica - Abstract
The 2010 Lung Allocation Score (LAS) version considers the estimated survival benefit offered by lung transplantation (LTx) and uses 6-minute Walk Test (6MWT) distance as a dichotomous covariate of whether an individual can walk more than 150 ft or 45.7 m in 6 min. This study aimed to provide evidence that 6MWT gives no clinically meaningful information to be used in the current LAS for candidates to LTx with cystic fibrosis (CF).We collected data from 6MWTs performed since 2003 at our CF centre. A joint model was fitted to describe the effect of changes in walked distance on the hazard of LTx or death.Up to 2019, 552 6MWTs were performed on 163 individuals with CF. None of the individuals included walked for less than 45.7 m during the 6MWT. Based on the joint modelling, the association of walked distance with the hazard ratio (HR) of LTx or death was significant (HR 0.99, 95% Credible Interval [CI]: 0.99 to 1.00).When adopted dichotomously for LAS calculation, walked distance does not add any useful information about exercise capacity. Longitudinal trajectories of walked distance may provide complementary information about prognosis in individuals with CF.Implications for rehabilitationDichotomized walked distance does not contribute to lung allocation score in candidates to lung transplantation with cystic fibrosisChanges in the longitudinal trajectory of walked distance can be clinically meaningful for prognostication.Sensitive outcomes to be incorporated in the lung allocation scoring system for individuals with CF are yet needed to catch rapid falls in functional capacity.
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- 2022
27. Lumacaftor/ivacaftor in cystic fibrosis: effects on glucose metabolism and insulin secretion
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Carla Colombo, Arianna Bisogno, Andrea Foppiani, Erica Nazzari, Alessandro Leone, Andrea Mari, Valeria Daccò, Alberto Battezzati, A. Giana, and Simone Gambazza
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Blood Glucose ,Male ,Cystic Fibrosis ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Phe508del ,Luma ,Aminopyridines ,Cystic Fibrosis Transmembrane Conductance Regulator ,Quinolones ,Aminophenols ,Cystic fibrosis ,Ivacaftor ,chemistry.chemical_compound ,0302 clinical medicine ,Endocrinology ,Insulin Secretion ,Genotype ,030212 general & internal medicine ,Chloride Channel Agonists ,biology ,Homozygote ,Lumacaftor ,Glucose tolerance ,Prognosis ,Cystic fibrosis transmembrane conductance regulator ,Female ,Original Article ,medicine.drug ,Adult ,medicine.medical_specialty ,Carbohydrate metabolism ,Young Adult ,03 medical and health sciences ,Internal medicine ,OGTT ,medicine ,Humans ,Benzodioxoles ,Lumacaftor/ivacaftor ,Retrospective Studies ,business.industry ,Insulin ,medicine.disease ,030228 respiratory system ,chemistry ,Case-Control Studies ,Mutation ,biology.protein ,business ,Follow-Up Studies - Abstract
Purpose The question whether the new cystic fibrosis transmembrane conductance regulator (CFTR) modulator drugs aimed at restoring CFTR protein function might improve glucose metabolism is gaining attention, but data on the effect of lumacaftor/ivacaftor treatment (LUMA/IVA) on glucose tolerance are limited. We evaluated the variation in glucose metabolism and insulin secretion in CF patients homozygous for Phe508del CFTR mutation after one-year treatment with LUMA/IVA in comparison to patients with the same genotype who did not receive such treatment. Methods We performed a retrospective case–control study on 13 patients with a confirmed diagnosis of CF, homozygous for the Phe508del CFTR mutation, who received LUMA/IVA for one year (cases) and 13 patients with identical genotype who did not receive this treatment (controls). At the beginning and conclusion of the follow-up, all subjects received a modified 3 h OGTT, sampling at baseline, and at 30 min intervals for plasma glucose, serum insulin, and c-peptide concentrations to evaluate glucose tolerance, and quantify by modeling beta-cell insulin secretion responsiveness to glucose, insulin clearance and insulin sensitivity. Results LUMA/IVA did not produce differences in glucose tolerance, insulin secretory parameters, clearance and sensitivity with respect to matched controls over one-year follow-up. Conclusion We found no evidence of improvements in glucose tolerance mechanisms in patients with CF after one-year treatment with LUMA/IVA.
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- 2021
28. Gene expression profile of normal breast tissue and body mass index
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Simone Gambazza, Federico Ambrogi, Danila Coradini, and Saro Oriana
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0301 basic medicine ,medicine.medical_specialty ,Microarray ,Mammaplasty ,Mammary gland ,Adipose tissue ,Breast Neoplasms ,Comorbidity ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Internal medicine ,Gene expression ,Homeostasis ,Humans ,Medicine ,Gene Regulatory Networks ,Pharmacology (medical) ,Radiology, Nuclear Medicine and imaging ,Obesity ,Epigenetics ,Receptors, Cytokine ,Mammary Glands, Human ,ITGAV ,business.industry ,Gene Expression Profiling ,Histone-Lysine N-Methyltransferase ,General Medicine ,medicine.disease ,Healthy Volunteers ,STAT1 Transcription Factor ,030104 developmental biology ,Endocrinology ,medicine.anatomical_structure ,Adipose Tissue ,Oncology ,030220 oncology & carcinogenesis ,Cytokines ,Female ,Steryl-Sulfatase ,Transcriptome ,business ,Body mass index - Abstract
In human breast, adipose tissue represents up to 80% of the total volume and plays a critical role in mammary gland remodeling. Given the emerging role of obesity in breast cancer growth and development, we explored the relationship between body mass index (BMI), as a proxy of woman’s obesity status, and the expression in normal breast tissue from healthy women of a selected panel of genes, known to be involved in mammary gland homeostasis. Two independent publicly available datasets, composed of 180 specimens of normal breast tissue from reduction mammoplasty were interrogated. Differential gene expression among BMI classes was evaluated by ANOVA, and partial correlation coefficient was used to assay the correlation between genes controlling for BMI. Despite the differences in microarray platforms and analytical procedures, the two datasets shared a core of 9 genes differentially expressed in BMI classes and significantly correlated with BMI. Four (44%) of these genes belong to the functional class of cytokines and cytokine receptors (IL1R1, IL2RA, IL12A, and IL12RB2). The others belong to the functional class of the epigenetic regulation (MEDAG and SETD7), signal transduction (STAT1), cell adhesion (ITGAV), and enzymatic activity (STS). Although exploratory, present findings are in agreement with the role of inflammation modulators in the homeostasis of normal breast tissue and the believe that an increase in body adipose tissue may have a potentially dangerous local effect, through the increased expression of inflammation-related genes and the establishment of a low-grade chronic inflammation.
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- 2020
29. A LONGITUDINAL INVESTIGATION OF EARLY LIFE ADVERSITY, STRESSFUL LIFE EVENTS, AND THE PACE OF THE EPIGENETIC CLOCK IN YOUTHS
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Jennifer Sumner, Xu Gao, Simone Gambazza, Christian Dye, Natalie Colich, Andrea Baccarelli, Monica Uddin, and Katie McLaughlin
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Pharmacology ,Psychiatry and Mental health ,Neurology ,Pharmacology (medical) ,Neurology (clinical) ,Biological Psychiatry - Published
- 2022
30. Epigenetics of early-life adversity in youth: cross-sectional and longitudinal associations
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Jennifer A. Sumner, Simone Gambazza, Xu Gao, Andrea A. Baccarelli, Monica Uddin, and Katie A. McLaughlin
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Epigenomics ,Deprivation ,Pediatric Research Initiative ,Adolescent ,Clinical Sciences ,Abuse ,Epigenesis, Genetic ,Paediatrics and Reproductive Medicine ,Genetic ,Adverse Childhood Experiences ,Clinical Research ,2.3 Psychological ,Behavioral and Social Science ,Genetics ,Humans ,Aetiology ,Child ,Molecular Biology ,Genetics (clinical) ,Neglect ,Threat ,Pediatric ,Violence Research ,DNA methylation ,Human Genome ,DNA Methylation ,Cross-Sectional Studies ,Mental Health ,Good Health and Well Being ,social and economic factors ,Developmental Biology ,Epigenesis - Abstract
Background Altered DNA methylation (DNAm) may be one pathway through which early-life adversity (ELA) contributes to adverse mental and physical health outcomes. This study investigated whether the presence versus absence of ELA experiences reflecting the dimensions of threat and deprivation were associated with epigenome-wide DNAm cross-sectionally and longitudinally in a community-based sample of children and adolescents. Methods In 113 youths aged 8–16 years with wide variability in ELA, we examined associations of abuse (physical, sexual, emotional; indicating threat-related experiences) and neglect (emotional, physical; indicating deprivation-related experiences) with DNAm assessed with the Illumina EPIC BeadChip array, with DNA derived from saliva. In cross-sectional epigenome-wide analyses, we investigated associations of lifetime abuse and neglect with DNAm at baseline. In longitudinal epigenome-wide analyses, we examined whether experiencing abuse and neglect over an approximately 2-year follow-up were each associated with change in DNAm from baseline to follow-up. Results In cross-sectional analyses adjusting for lifetime experience of neglect, lifetime experience of abuse was associated with DNAm for four cytosine-phosphodiester-guanine (CpG) sites (cg20241299: coefficient = 0.023, SE = 0.004; cg08671764: coefficient = 0.018, SE = 0.003; cg27152686: coefficient = − 0.069, SE = 0.012; cg24241897: coefficient = − 0.003, SE = 0.001; FDR SE = 0.006; FDR Conclusions In this study, we identified examples of epigenetic patterns associated with ELA experiences of threat and deprivation that were already observable in youth. We provide novel evidence for change in DNAm over time in relation to ongoing adversity and that experiences reflecting distinct ELA dimensions may be characterized by unique epigenetic patterns.
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- 2022
31. Video calls at end of life are feasible but not enough: A 1‐year intensive care unit experience during the coronavirus disease‐19 pandemic
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Maura Lusignani, Giacomo Grasselli, Filippo Binda, Simone Gambazza, Dario Laquintana, and Alessandro Galazzi
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SARS-CoV-2 ,business.industry ,MEDLINE ,COVID-19 ,Disease ,Critical Commentary ,Critical Care Nursing ,medicine.disease_cause ,medicine.disease ,Intensive care unit ,law.invention ,Death ,Intensive Care Units ,law ,Pandemic ,Humans ,Medicine ,Medical emergency ,business ,Pandemics ,Coronavirus - Published
- 2021
32. Exercise capacity and ventilation inhomogeneity in cystic fibrosis: A cross‐sectional study
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Marina Mirabella, Simone Gambazza, Riccardo Guarise, Federico Ambrogi, Carla Colombo, Anna Brivio, and F. Carta
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Spirometry ,medicine.medical_specialty ,Adolescent ,Cystic Fibrosis ,Lung Clearance Index ,Incremental exercise ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Forced Expiratory Volume ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,Pseudomonas Infections ,Exercise ,Lung ,Exercise Tolerance ,medicine.diagnostic_test ,business.industry ,Respiration ,Confidence interval ,Cross-Sectional Studies ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Cohort ,Exercise Test ,Breathing ,Exercise intensity ,Cardiology ,Female ,business ,Body mass index - Abstract
BACKGROUND Lung clearance index (LCI2.5 ) is a marker of overall lung ventilation inhomogeneity and has proven to be able to detect early peripheral damage in subjects with cystic fibrosis (CF), with greater sensitivity than conventional spirometry. Combining its sensitivity with the output of an incremental exercise testing, we hypothesized that any sign of ventilation inhomogeneity in subjects without severe airflow obstruction and with a normal exercise tolerance could be relevant for the CF team, tracking early lung disease and potential exercise limiting factors. METHODS Patients with CF in clinical stable conditions were recruited between 2015 and 2017. Available spirometry, nitrogen multiple-breath washout test and symptoms-limited exercise testing performed as parts of patients' annual routine evaluation were considered for this cross-sectional study. To describe the relationship between exercise intensity and ventilation inhomogeneity, a linear regression analysis was performed using backward elimination based on Akaike information criteria. RESULTS Seventy-seven patients (38 females) were included. Sacin and LCI2.5 were significantly higher in patients with an overall reduced exercise tolerance. Peak work developed during exercise was associated with body mass index (b = 5.25; 95% confidence interval [CI] = 1.53-8.98), forced expiratory volume in 1 second (FEV1 ; b = 3.71; 95% CI = 1.96-5.46), Pseudomonas aeruginosa chronic infection (b = -8.84; 95% CI = -15.84 to -1.84) but not with LCI2.5 . CONCLUSION Exercise capacity and airflow obstruction are associated in this Italian CF cohort. Considering the greater discriminatory power of LCI2.5 over FEV1 and peak work, the Godfrey protocol without gas analysis cannot provide detailed information about lung function or efficiency. However, this incremental protocol without gas exchange measures can still provide the CF team with information about exercise tolerance and disability.
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- 2020
33. Association of ventilator-free days with respiratory physiotherapy in critically ill patients with Coronavirus Disease 2019 (COVID-19) during the first pandemic wave. A propensity score-weighted analysis
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Emilia, Privitera, Simone, Gambazza, Veronica, Rossi, Martina, Santambrogio, Filippo, Binda, Davide, Tarello, Salvatore, Caiffa, Valentina, Turrin, Carolina, Casagrande, Denise, Battaglini, Mauro, Panigada, Roberto, Fumagalli, Paolo, Pelosi, and Giacomo, Grasselli
- Subjects
ventilator-free days ,Intensive Care Unit ,respiratory physiotherapy ,COVID-19 ,critical illness ,Settore MED/48 -Scienze Infermie.e Tecniche Neuro-Psichiatriche e Riabilitattive ,General Medicine ,Settore MED/01 - Statistica Medica - Abstract
BackgroundRespiratory physiotherapy is reported as safe and feasible in mechanically ventilated patients with severe Coronavirus Disease (COVID-19) admitted to Intensive Care Unit (ICU), but the short-term benefits remain unclear.MethodsWe performed a retrospective observational study in four ICUs in Northern Italy. All patients with COVID-19 admitted to ICU and under invasive mechanical ventilation (MV) between March 1st and May 30th, 2020, were enrolled into the study. Overlap weighting based on the propensity score was used to adjust for confounding in the comparison of patients who had or had not been treated by physiotherapists. The primary outcome was the number of days alive and ventilator-free (VFDs). The secondary outcomes were arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (P/F) at ICU discharge, ICU length of stay, ICU and hospital mortality, and survival at 90 days. The trial protocol was registered on clinicaltrials.gov (NCT 05067907).ResultsA total of 317 patients were included in the analysis. The median VFDs was 18 days [interquartile range (IQR) 10; 24] in patients performing physiotherapy and 21 days (IQR 0; 26) in the group without physiotherapy [incidence rate ratio (IRR) 0.86, 95% confidence interval (CI): 0.78; 0.95]. The chance of 0 VFDs was lower for patients treated by physiotherapists compared to those who were not [odds ratio (OR) = 0.36, 95% CI: 0.18–0.71]. Survival at 90 days was 96.0% in the physiotherapy group and 70.6% in patients not performing physiotherapy [hazard ratio (HR) = 0.14, 95% CI: 0.03–0.71]. Number of VFDs was not associated with body mass index (BMI), sex, or P/F at ICU admission for individuals with at least 1 day off the ventilator.ConclusionIn patients with COVID-19 admitted to ICU during the first pandemic wave and treated by physiotherapists, the number of days alive and free from MV was lower compared to patients who did not perform respiratory physiotherapy. Survival at 90 days in the physiotherapy group was greater compared to no physiotherapy. These findings may be the starting point for further investigation in this setting.
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- 2022
34. Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care
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Gabriella Nicolò, Marco Clari, Paola Bosco, Simone Gambazza, Barbara Sappa, Filippo Binda, and Dario Laquintana
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Adult ,medicine.medical_specialty ,Palliative care ,Cross-sectional study ,media_common.quotation_subject ,Pain medicine ,Hospital death ,Quality of life (healthcare) ,Quality of death ,Patients' Rooms ,Nursing Interventions Classification ,Humans ,Medicine ,Quality (business) ,media_common ,Terminal Care ,End-of-life ,Symptom control ,Cross-Sectional Studies ,Hospitals ,Quality of Life ,business.industry ,Research ,RC952-1245 ,General Medicine ,Special situations and conditions ,Family medicine ,University teaching ,business ,End-of-life care - Abstract
Background In the last decade, access to national palliative care programs have improved, however a large proportion of patients continued to die in hospital, particularly within internal medicine wards. Objectives To describe treatments, symptoms and clinical management of adult patients at the end of their life and explore whether these differ according to expectation of death. Methods Single-centre cross-sectional study performed in the medical and surgical wards of a large tertiary-level university teaching hospital in the north of Italy. Data on nursing interventions and diagnostic procedure in proximity of death were collected after interviewing the nurse and the physician responsible for the patient. Relationship between nursing treatments delivered and patients’ characteristics, quality of dying and nurses’ expectation about death was summarized by means of multiple correspondence analysis (MCA). Results Few treatments were found statistically associated with expectation of death in the 187 patients included. In the last 48 h, routine (70.6%) and biomarkers (41.7%) blood tests were performed, at higher extent on patients whose death was not expected. Many symptoms classified as severe were reported when death was highly expected, except for agitation and respiratory fatigue which were reported when death was moderately expected. A high Norton score and absence of anti-bedsore mattress were associated with unexpected death and poor quality of dying, as summarized by MCA. Quality of dying was perceived as good by nurses when death was moderately and highly expected. Physicians rated more frequently than nurses the quality of dying as good or very good, respectively 78.6 and 57.8%, denoting a fair agreement between the two professionals (k = 0.24, P Conclusion Staff in medical and surgical wards still deal inadequately with the needs of dying people. Presence of hospital-based specialist palliative care could lead to improvements in the patients’ quality of life.
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- 2021
35. Muscle strength and functional outcome after prone positioning in COVID-19 ICU survivors
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Emilia Privitera, Ileana Adamini, Filippo Binda, Alessandro Galazzi, Dario Laquintana, Federica Marelli, Simone Gambazza, Veronica Rossi, Giacomo Grasselli, and Martina Santambrogio
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Elbow ,Wrist ,Critical Care Nursing ,Article ,law.invention ,Prone ventilation ,Prone position ,law ,medicine ,Humans ,Muscle Strength ,Prospective Studies ,Survivors ,Prospective cohort study ,Physiotherapy ,Mechanical ventilation ,business.industry ,SARS-CoV-2 ,COVID-19 ,Intensive care unit ,Respiration, Artificial ,Intensive Care Units ,medicine.anatomical_structure ,Physical therapy ,Upper limb ,business - Abstract
Objective To evaluate the muscle strength and functional level of patients discharged from intensive care unit (ICU) in relation to the swimmer position as a nurse intervention during pronation. Methods Prospective study conducted in the hub COVID-19 center in Milan (Italy), between March and June 2020. All patients with COVID-19 discharged alive from ICU who received invasive mechanical ventilation were included. Forward continuation ratio model was fitted to explore the statistical association between muscle strength grades and body positioning during ICU stay. Results Over the 128 patients admitted to ICU, 87 patients were discharged alive from ICU, with available follow-up measures at hospital discharge. Thirty-four patients (39.1%) were treated with prone positioning as rescue therapy, for a total of 106 pronation cycles with a median duration of 72 hours (IQR 60–83). Prone positioning did not influence the odds of showing particular level of muscle strength, in any of the evaluated districts, namely shoulder (OR 1.34, 95%CI:0.61–2.97), elbow (OR 1.10, 95%CI:0.45–2.68) and wrist (OR 0.97, 95%CI:0.58–1.63). Only in the shoulder district, age showed evidence of association with strength (OR 1.06, 95%CI:1.02–1.10), affecting people as they get older. No significant sequalae related to swimmer position were reported by physiotherapists or nurses. Conclusion Swimmer position adopted during prone ventilation is not associated with worse upper limb strength or poor mobility level in COVID-19 survivors after hospital discharge.
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- 2021
36. Prevalence and factors associated with urinary incontinence in females with cystic fibrosis: An Italian single-center cross-sectional analysis
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Simone Gambazza, Alessandra Mariani, Valeria Daccò, Anna Bulfamante, Federico Ambrogi, Carla Colombo, F. Carta, Giacomo Bassotti, and Anna Brivio
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,Cystic Fibrosis ,Cross-sectional study ,Urinary incontinence ,Single Center ,Logistic regression ,Risk Factors ,Internal medicine ,Surveys and Questionnaires ,medicine ,Prevalence ,Humans ,Child ,Aged ,Pelvic floor ,business.industry ,Odds ratio ,Confidence interval ,medicine.anatomical_structure ,Cross-Sectional Studies ,Urinary Incontinence ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,Complication ,business - Abstract
BACKGROUND Individuals with cystic fibrosis (CF) are deemed to have a higher risk of developing urinary incontinence (UI), likely due to repeated increasing pressure on the pelvic floor. We aimed to determine the prevalence of female UI in a large CF referral center, and to assess the association between UI and severity of CF disease. METHODS We consecutively recruited female patients regularly attending our CF center, aged ≥6 years and with a confirmed diagnosis of CF. Prevalence, severity, and impact of UI were assessed by administering two validated questionnaires. Relationship between variables was evaluated by means of multiple correspondence analysis, whereas a logistic model was fitted to capture the statistical association between UI and independent variables. RESULTS UI was present in 51/153 (33%, 95% confidence interval [CI]: 26%-41%) females. Among children and adolescents, the prevalence was 12/82 (15%, 95% CI: 8%-25%) whereas among adults was 39/71 (55%, 95% CI: 43%-67%). The only explanatory variable associated with UI was age, with children presenting the lowest risk (odds ratio, 0.32; 95% CI: 0.05-0.93). Females presenting low or high nutritional status show higher profile risk of having UI. CONCLUSIONS Stress UI is a common complication in females with CF since childhood. Although it frequently occurs in older patients with a more severe phenotype, much attention should be paid to adults and to their nutritional status.
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- 2021
37. Lung clearance index to characterize clinical phenotypes of children and adolescents with cystic fibrosis
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Simone, Gambazza, Federico, Ambrogi, Federica, Carta, Laura, Moroni, Maria, Russo, Anna, Brivio, and Carla, Colombo
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Phenotype ,Adolescent ,Cystic Fibrosis ,Respiration ,Humans ,Child ,Lung ,Respiratory Function Tests - Abstract
Lung clearance index (LCI) is accepted as an early marker of lung disease in cystic fibrosis (CF), however the utility of LCI to identify subgroups of CF disease in the paediatric age group has never been explored. The aim of the study was to characterize phenotypes of children with CF using LCI as a marker of ventilation inhomogeneity and to investigate whether these phenotypes distinguished patients based on time to pulmonary exacerbation (PE).Data were collected on patients with CF aged 18 years old, attending the CF Center of Milan during outpatient follow-up visits between October 2014 and September 2019. Cluster analysis using agglomerative nesting hierarchical method was performed to generate distinct phenotypes. Time-to-recurrent event analysis investigated association of phenotypes with PE.We collected 313 multiple breath washout tests on 125 children aged 5.5-16.8 years. Cluster analysis identified two divergent phenotypes in children and adolescents of same age, presenting with almost normal FEVLCI is useful in clinical practice to characterize distinct phenotypes of children and adolescents with mild/normal FEV
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- 2021
38. The Spread of COVID-19 Among 15,000 Physical Therapists in Italy:A Cross-Sectional Study
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Silvia Bargeri, Isabella Campanini, Silvia Gianola, Tiziano Innocenti, Simone Gambazza, Davide Corbetta, Roberto Meroni, Greta Castellini, Andrea Turolla, Gianola S., Bargeri S., Campanini I., Corbetta D., Gambazza S., Innocenti T., Meroni R., Castellini G., Turolla A., Gianola, S, Bargeri, S, Campanini, I, Corbetta, D, Gambazza, S, Innocenti, T, Meroni, R, Castellini, G, Turolla, A, and Health Economics and Health Technology Assessment
- Subjects
Male ,Cross-sectional study ,Physical Therapy ,Logistic regression ,Disease Outbreaks ,Risk Factors ,Surveys and Questionnaires ,Health care ,Coronavirus, COVID-19 ,COVID–19 ,Prevalence ,Medicine ,Surveys and Questionnaire ,Prevention and Control ,Letter to the Editor ,Physiotherapy ,Response rate (survey) ,Disease Outbreak ,Middle Aged ,Severe Acute Respiratory Syndrome Coronavirus 2 ,Test (assessment) ,Italy ,Preparedness ,Female ,Coronavirus Infections ,Human ,Adult ,medicine.medical_specialty ,Infectious Disease Transmission, Patient-to-Professional ,Physical Therapy, Sports Therapy and Rehabilitation ,Prevention & Control ,Young Adult ,Ambulatory care ,SDG 3 - Good Health and Well-being ,Occupational Exposure ,Humans ,Transmission ,Pandemics ,Aged ,Cross-Sectional Studie ,Pandemic ,business.industry ,Coronavirus Infection ,SARS-CoV-2 ,Risk Factor ,COVID-19 ,Odds ratio ,Coronavirus ,Physical Therapists ,Cross-Sectional Studies ,Physical therapy ,AcademicSubjects/MED00110 ,business - Abstract
Objectives The purpose of this study was to explore the prevalence, personal- and work-related exposures, and signs and symptoms among physical therapists during the first wave of coronavirus disease 2019 (COVID-19) in Italy. Methods This cross-sectional, survey-based study collected demographic and exposure data from physical therapists from April to May 2020. All physical therapists working in inpatient and outpatient care in Italy were eligible. A self-administered questionnaire was distributed among all eligible physical therapists to collect (1) demographic characteristics, (2–3) personal- and work-related exposures, and (4) signs and symptoms of COVID-19. Factors associated with a COVID-19–positive nasopharyngeal swab (NPS) were explored through logistic regression models and multivariate methods. Results A total of 15,566 respondents completed the survey, with a response rate of 43.3%, achieving high statistical precision (99% CI, 1% type I error). Among physical therapists who received NPS testing, 13.1% (95% CI = 12.1–14.1%) had a positive result, with a peak reached in March 2020 (36%). The top 5 symptoms were fatigue and tiredness (69.1%), loss of smell (64.5%), aches and pains (60.8%), loss of taste (58.3%), and headache (51.1%). No symptoms were reported by 8.9%. Working in a health care institution (odds ratio [OR] = 12.0; 95% CI = 7.8–18.4), being reallocated to a different unit (OR = 1.9; 95% CI = 1.3–2.7), and changing job tasks (OR = 1.6; 95% CI = 1.2–2.3) increased the risk of being COVID-19 positive. In therapists with a confirmed diagnosis of COVID-19, comorbidities were associated with male sex and age older than 51 years. Conclusion During the first wave in Italy, almost 1 out of 7 physical therapists tested positive on the COVID-19 NPS test. Considering personal- and work-related exposures, health care organizations should adopt prevention measures and adequate preparedness to prevent high rate of infections during future pandemics. Impact This is the largest investigation about the spread of and main risk factors for COVID-19 in the physical therapy field.
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- 2021
39. Facing COVID-19 Pandemic in a Tertiary Hospital in Milan: Prevalence of Burnout in Nursing Staff Working in Sub-Intensive Care Units
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Alberto Bisesti, Filippo Binda, Silvia Pazzaglia, Andrea Mallardo, Simone Gambazza, Dario Laquintana, and Alessandro Galazzi
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Health, Toxicology and Mutagenesis ,education ,Burnout, Psychological ,Nursing Staff, Hospital ,Burnout ,nurses ,Article ,Tertiary Care Centers ,03 medical and health sciences ,stress ,0302 clinical medicine ,Surveys and Questionnaires ,Intensive care ,Pandemic ,Depersonalization ,Health care ,Prevalence ,Humans ,Medicine ,030212 general & internal medicine ,Emotional exhaustion ,Burnout, Professional ,Pandemics ,Sicus ,030504 nursing ,biology ,burnout ,SARS-CoV-2 ,business.industry ,healthcare workers ,Public Health, Environmental and Occupational Health ,COVID-19 ,biology.organism_classification ,Europe ,Intensive Care Units ,Cross-Sectional Studies ,Italy ,Family medicine ,Nursing Staff ,medicine.symptom ,0305 other medical science ,business - Abstract
In early March 2020, Italy became the epicenter of the Coronavirus Disease 2019 (COVID-19) pandemic in Europe. A different organization of hospital units was required to take care of patients affected by acute respiratory failure caused by COVID-19. This study aimed to evaluate the prevalence of burnout in two sub-intensive care units (SICUs) of the COVID-19 hub center of the Lombardia region in Milan (Italy). All nurses and healthcare assistants working in the SICUs during June 2020 were included in the study. Burnout was assessed via the Maslach Burnout Inventory questionnaire. One hundred and five (84%) SICU staff participated in the study. The prevalence of high burnout for nurses and healthcare assistants was 61.9% for emotional exhaustion, 47.6% for depersonalization and 34.3% for personal accomplishment. Depersonalization was significantly more frequent in younger nurses (p = 0.009). Nurses were 4.5 times more likely to have burnout than healthcare assistants. Burnout was a common condition among healthcare workers operating in SICUs during the pandemic. Urgent actions are needed, especially for nurses, as well as preventive strategies for future pandemic scenarios.
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- 2021
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40. Pattern of Visits in a Metropolitan Emergency Department in Lombardia (Italy): January 2019–December 2020
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Onorina Passeri, Dario Laquintana, Giorgio Costantino, Alessandro Galazzi, Simone Gambazza, Paola Bosco, and Filippo Binda
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Leadership and Management ,overcrowding ,Health Informatics ,Primary care ,03 medical and health sciences ,primary care ,0302 clinical medicine ,Health Information Management ,Medicine ,030212 general & internal medicine ,Tertiary level ,emergency service ,business.industry ,Communication ,Health Policy ,COVID-19 ,Retrospective cohort study ,Emergency department ,Overcrowding ,University hospital ,Metropolitan area ,Italy ,Emergency medicine ,business ,030217 neurology & neurosurgery - Abstract
During the Coronavirus disease 2019 (COVID-19), a general decrease in the presentations to emergency departments (ED) was reported. However, we suspect that there was a lower number but an unchanged pattern of ED visits for urgent conditions in 2020 compared to 2019. This retrospective study assessed the change in the number of presentations in the ED of a tertiary level university hospital in Milano (Lombardia, Italy). Compared to 2019, a significant drop in ED presentations occurred (−46.4%), and we recorded a −15.7% difference in the proportion of patients admitted with white codes. The pattern of hourly presentations to the ED was unchanged, with overcrowding during the working daytime. COVID-19 changed ED flows, likely causing an overall reduction in the number of deferrable conditions. However, the pattern associated with urgent conditions did not change abruptly in 2020.
- Published
- 2021
41. Cystic Fibrosis, New Frontier: Exploring the Functional Connectivity of the Brain Default Mode Network. Comment on Elce et al. Impact of Physical Activity on Cognitive Functions: A New Field for Research and Management of Cystic Fibrosis. Diagnostics 2020, 10, 489
- Author
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R. Nobili, Simone Gambazza, Riccardo Biffi, Carla Colombo, Antonella Costa, and Paul Summers
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Cognitive science ,Medicine (General) ,Field (Bourdieu) ,Functional connectivity ,Clinical Biochemistry ,Comment ,Physical activity ,Cognition ,medicine.disease ,Cystic fibrosis ,03 medical and health sciences ,0302 clinical medicine ,n/a ,R5-920 ,030228 respiratory system ,medicine ,Psychology ,030217 neurology & neurosurgery ,Default mode network - Abstract
We read with great interest the paper entitled “Impact of physical activity of cognitive functions: a new field for research and management of Cystic Fibrosis” by Elce et al. [...]
- Published
- 2021
42. Ventilation inhomogeneity is associated with OGTT-derived insulin secretory defects in cystic fibrosis
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Alberto Battezzati, Palmiro Mileto, Andrea Mari, Maria Chiara Russo, Gianfranco Alicandro, Simone Gambazza, Carla Colombo, Erica Nazzari, and Eleonora Grespan
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Adult ,Blood Glucose ,Male ,Pulmonary and Respiratory Medicine ,Spirometry ,medicine.medical_specialty ,Adolescent ,Cystic Fibrosis ,medicine.medical_treatment ,Cystic fibrosis ,Pulmonary function testing ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Insulin-Secreting Cells ,030225 pediatrics ,Diabetes mellitus ,Internal medicine ,Linear regression ,Humans ,Insulin ,Medicine ,Lung function ,medicine.diagnostic_test ,business.industry ,Glucose Tolerance Test ,medicine.disease ,Breath Tests ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,Pulmonary Ventilation ,business - Abstract
Progressive deterioration of β-cell function is the main mechanism underlying diabetes in cystic fibrosis (CF). Diabetes negatively impacts the clinical status of CF patients years before its onset. We aimed to evaluate if OGTT-derived indices of β-cell function are associated with early markers of lung disease. We carried out a cross-sectional study on 80 CF patients who performed OGTT, spirometry, and nitrogen-multiple breath washout test. β-cell glucose sensitivity and the insulinogenic indices were used as markers of β-cell function and first-phase insulin response to glucose stimulus. We used sex- and age-adjusted multiple linear regression models to estimate the association between OGTT-derived indices and lung function measures. An increment of β-cell glucose sensitivity equal to its interquartile range was associated with an increase in ppFEV1 of 7.6 points (95%CI: 0.8; 14.4) as well as with a decrease in LCI of -1.96 units (95%CI: -3.40; -0.51) and in Scond of -0.016 L-1 (95%CI: -0.026; -0.007). The corresponding figures for insulinogenic index were: 8.6 (95%CI: 3.4; 13.9) for ppFEV1 , -2.03 (95%CI: -3.13; -0.94) for LCI, and -0.014 L-1 (95%CI: -0.021; -0.071) for Scond . When adjusting also for 2-h plasma glucose, both β-cell glucose sensitivity and insulinogenic index remained inversely associated with Scond . Deterioration of β-cell function is related to early lung disease in young patients with mild to normal pulmonary function. This relationship is independent from hyperglycemia and mainly involves conductive airways.
- Published
- 2018
43. Remote support by multidisciplinary teams: A crucial means to cope with the psychological impact of the SARS‐COV‐2 pandemic on patients with cystic fibrosis and inflammatory bowel disease in Lombardia
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L. Claut, R. Nobili, Carla Colombo, Anna Brivio, Lorenzo Norsa, Erika Rizzato, Alessandra Mariani, Anna Bulfamante, Naire Sansotta, Simone Gambazza, Anna Luisa Tutino, Loredana Moioli, Maria Simonetta Spada, and N. Faelli
- Subjects
medicine.medical_specialty ,Cystic Fibrosis ,Referral ,Cross-sectional study ,media_common.quotation_subject ,education ,MEDLINE ,Context (language use) ,Empathy ,030204 cardiovascular system & hematology ,Pediatrics ,Inflammatory bowel disease ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,Humans ,Medicine ,030212 general & internal medicine ,Disease management (health) ,Child ,Pandemics ,media_common ,Patient Care Team ,Original Paper ,SARS-CoV-2 ,business.industry ,COVID-19 ,General Medicine ,Inflammatory Bowel Diseases ,medicine.disease ,Original Papers ,Cross-Sectional Studies ,Family medicine ,business - Abstract
Background During Coronavirus Disease 2019 (COVID‐19) outbreak in Lombardia, people were recommended to avoid visiting emergency departments and attending routine clinic visits. In this context, it was necessary to understand the psychological reactions of patients with chronic diseases. We evaluated the psychological effects on patients with chronic respiratory conditions and inflammatory bowel disease (IBD) through the analysis of their spontaneous contacts with their referral centres. Methods Cross‐sectional study was conducted from February 23 to April 27, 2020 in patients, or their parents, who contacted their multidisciplinary teams (MDT). E‐mails and phone calls directed to the MDT of the centre for cystic fibrosis (CF) in Milano and for paediatric IBD in Bergamo, were categorised according to their contents as information on routine disease management, updates on the patient's health status, COVID‐19 news monitoring, empathy towards health professionals, positive feedback and concern of contagion during the emergency. Results One thousand eight hundred and sixteen contacts were collected during the study period. In Milano, where the majority of patients were affected by CF, 88.7% contacted health professionals by e‐mail, with paediatricians receiving the largest volume of emails and phone calls compared with other professionals (P
- Published
- 2021
44. Time to active sitting position: One-year findings from a temporary COVID-19 intensive care unit
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Veronica Rossi, Cesare Del Monaco, Simone Gambazza, Martina Santambrogio, Filippo Binda, Mariangela Retucci, Emilia Privitera, Marco Mantero, Nicola Bottino, Dario Laquintana, and Francesco Blasi
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Intensive Care Units ,Sitting Position ,SARS-CoV-2 ,COVID-19 ,Humans ,Female ,Prospective Studies - Abstract
To investigate the association between time to active sitting position and clinical features in people with COVID-19 admitted to intensive care unit (ICU) and referred to physiotherapists.Prospective study conducted in the largest temporary ICU in Lombardy (Italy) between April 2020 and June 2021. All individuals with COVID-19 who received physiotherapy were included. Multivariable Cox proportional hazard model was fitted to explore the statistical association between active sitting position and characteristics of patients referred to physiotherapists, also accounting for the different multidisciplinary teams responsible for patients.284 individuals over 478 (59.4%) had access to physiotherapy, which was performed for a median of 8 days, without difference between multidisciplinary teams (P = 0.446). The active sitting position was reached after a median of 18 (IQR: 10.0-32.0) days. Sex was the only characteristic associated with the time to active sitting position, with males showing a reduced hazard by a factor of 0.65 (95% CI: 0.48-0.87; P = 0.0042) compared to females. At ICU discharge, nearly 50% individuals increased Manchester Mobility Score by 3 points. During physiotherapy no major adverse event was recorded.Individuals with COVID-19 take long time to reach active sitting position in ICU, with males requiring longer rehabilitation than females.
- Published
- 2022
45. Home physiotherapists assisting follow-up treatment in cystic fibrosis: a multicenter observational study
- Author
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Mauro Barbisan, Mirco Ros, Anna Brivio, Annalisa Orenti, Simone Gambazza, P. Buonpensiero, Brivio, Anna, Orenti, Annalisa, Barbisan, Mauro, Buonpensiero, Paolo, Ros, Mirco, and Gambazza, Simone
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Airway clearance ,Cystic Fibrosis ,aerosol ,Cystic fibrosis ,03 medical and health sciences ,0302 clinical medicine ,Statistical significance ,Internal medicine ,Administration, Inhalation ,medicine ,Humans ,Clinical significance ,030212 general & internal medicine ,Medical prescription ,Lung function ,physiotherapy ,business.industry ,medicine.disease ,home visit ,Anti-Bacterial Agents ,Physical Therapists ,Regimen ,030228 respiratory system ,Cystic fibrosi ,Medicine ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Inhaled therapies are relatively simple and easy to be managed however ineffective use of aerosols when self-administered may occur. We described variation of the number of clinic visits, lung function and number of antibiotic courses performed over 12 months in participants with cystic fibrosis (CF), when supervised or not by physiotherapists (PTs) at home. Participants in 8 Italian CF centers with a prescription of dry-powder antibiotic choose whether to be supervised at home (PT-FU) or not (non-PT-FU), in adjunct to routine clinic visits. PTs assisted participants with their inhaled therapies regimen and reviewed the airway clearance program in use. Mixed-effect regression models were fitted to evaluate the variation of selected endpoints over time. A total of 163 participants were included. Lung function declined over time in both groups, at higher extent in the non-PT-FU group at 6 months (-1.8, 95%CI: -4.4 to 0.7 % predicted), without reaching statistical significance, whereas in the PT-FU group only, nearly one visit less was recorded (p=0.027). Regardless the type of supervision adopted, the number of antibiotic courses did not change compared to the previous year. We counted 19/90 (21.1%) drop-out in the PT-FU, double compared to the group followed up at the clinics (p=0.065). Participants under a course of an inhaled antibiotic therapy showed a 1-year decline in lung function, whereas only the group receiving home supervision counted nearly one visit less at the CF center, whose clinical relevance should be further discussed.
- Published
- 2020
46. Molecular characterization of Mycobacterium abscessus subspecies isolated from patients attending an Italian Cystic Fibrosis Centre
- Author
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Antonio, Teri, Samantha, Sottotetti, Milena, Arghittu, Daniela, Girelli, Arianna, Biffi, Monica, D'Accico, Valeria, Daccò, Simone, Gambazza, Giovanna, Pizzamiglio, Alberto, Trovato, Enrico, Tortoli, Carla, Colombo, and Lisa, Cariani
- Subjects
Cystic Fibrosis ,Italy ,Mycobacterium abscessus ,Clarithromycin ,RNA, Ribosomal, 16S ,Drug Resistance, Bacterial ,Humans ,Mycobacterium Infections, Nontuberculous ,Macrolides ,Microbial Sensitivity Tests ,Anti-Bacterial Agents ,Retrospective Studies - Abstract
Mycobacterium abscessus (MABS) infection represents significant management challenge in cystic fibrosis (CF) patients. This retrospective study (2005-2016) aims to determine the prevalence of the subspecies of MABS isolated from CF patients, to evaluate the persistence over the years of a single subspecies of MABS and to correlate mutations responsible for macrolides and amikacin resistance with MIC values. We investigated 314 strains (1 isolate/patient/year) isolated from the lower respiratory tract of 51 chronically infected CF patients. Sequencing of rpoB gene was performed to identify the MABS subspecies. The erm(41) gene was sequenced to differentiate the strains with and without inducible macrolide resistance. Regions of 23S and 16S rRNA were sequenced to investigate mutations responsible for constitutive resistance to macrolides and aminoglycosides, respectively. Antibiotic susceptibility, using commercial microdilution plates, was evaluated according to CLSI. M. abscessus subsp. abscessus accounted for 64% of the isolates, bolletii subspecies for 16% and massiliense subspecies for 20%. All the massiliense strains presented truncated erm(41) gene while 12 abscessus strains presented the mutation T28-C in the erm(41) gene, which makes it inactive. The 23S rRNA analysis did not show constitutive resistance to macrolides in any strain. Mutation of the 16S rRNA gene was highlighted in 2 strains out of 314, in agreement with high MIC values. The correct identification at the subspecies level and the molecular analysis of 23S rRNA, 16S rRNA and erm gene is useful to guide the treatment strategy in patients with M. abscessus lung infection.
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- 2020
47. Adipokines expression and epithelial cell polarity in normal and cancerous breast tissue
- Author
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Saro Oriana, Federico Ambrogi, Simone Gambazza, and Danila Coradini
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0301 basic medicine ,Leptin ,Cancer Research ,Mammaplasty ,Cell ,Adipokine ,Breast Neoplasms ,Biology ,03 medical and health sciences ,0302 clinical medicine ,Adipokines ,Cell polarity ,medicine ,Humans ,Computer Simulation ,Breast ,Receptor ,Epithelial polarity ,Adiponectin ,Cell Polarity ,Epithelial Cells ,General Medicine ,gamma-Glutamyltransferase ,Epithelium ,Receptors, Adipokine ,Gene Expression Regulation, Neoplastic ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Cancer research ,Receptors, Leptin ,Female ,Transcriptome - Abstract
Cell polarity is crucial for the correct structural and functional organization of epithelial tissue. Its disruption can lead to loss of the apicobasal polarity, alteration in the intracellular components, misregulation of the pathways involved in cell proliferation and cancer promotion. Very recent in vitro/in vivo findings demonstrated that obesity-associated alterations in tissue adipokines protein level negatively affect epithelial polarity. We performed an in silico study to investigate whether such alterations also occur in surgical samples. We aimed to explore the relationship among the expression of the genes coding for leptin (LEP), adiponectin (ADIPOQ), adipokine receptors (LEPR, ADIPOR1 and ADIPOR2), and a panel of polarity-associated genes in normal tissue from breast reduction mammoplasty, and a series of paired samples of histologically normal (HN) tissue and invasive cancer. Results indicated that, in normal tissue, the expression of adipokines and their receptors negatively correlated with that of the polarity-associated genes and GGT1, which codes for γ-glutamyl transferase (GGT) enzyme, a marker of cell distress and membrane disruption. This negative correlation progressively decreased in HN and cancerous tissue, and loss of correlation between ADIPOR2 and polarity-associated genes appeared the most noticeable alteration. Given the growing role of obesity in breast cancer etiology and the opposite action of leptin and adiponectin in epithelial tissue remodeling, ADIPOR2 loss could be addressed as a key mechanism leading to an unbalanced leptin stimulatory activity, subsequent cell polarity disruption and eventually tumor initiation, a finding that requires to be confirmed also at the protein level and with in vivo models.
- Published
- 2020
48. Complications of prone positioning in patients with COVID-19: A cross-sectional study
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Simone Gambazza, Dario Laquintana, Lucia Villa, Filippo Binda, Elisa Vinci, Alessandro Galazzi, Ileana Adamini, and Federica Marelli
- Subjects
Male ,medicine.medical_specialty ,Supine position ,Coronavirus disease 2019 (COVID-19) ,Cross-sectional study ,medicine.medical_treatment ,Critical Care Nursing ,Logistic regression ,Article ,Patient Positioning ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Prone Position ,medicine ,Pressure Ulcers ,Humans ,In patient ,Obesity ,Mechanical ventilation ,Respiratory Distress Syndrome ,030504 nursing ,SARS-CoV-2 ,business.industry ,COVID-19 ,030208 emergency & critical care medicine ,Respiration, Artificial ,Intensive care unit ,Intensive Care Units ,Prone position ,Cross-Sectional Studies ,Emergency medicine ,0305 other medical science ,business - Abstract
Objective To determine the prevalence of complications in patients with COVID-19 undergone prone positioning, focusing on the development of prone-related pressure ulcers. Methods Cross-sectional study conducted in the hub COVID-19 center in Milan (Italy), between March and June 2020. All patients with COVID-19 admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning were included. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. Results A total of 219 proning cycles were performed on 63 patients, aged 57.6 (10.8) and predominantly obese males (66.7%). The main complications recorded were: prone-related pressure ulcers (30.2%), bleeding (25.4%) and medical device displacement (12.7%), even if none unplanned extubation was recorded. Bleeding of upper airways represented the most common site (17.5%). Only 15 prone positioning cycles (6.8%) were interrupted, requiring staff to roll the patient back in the supine position. The likelihood of pressure ulcers development was independently associated with the duration of prone positioning, once adjusting for age, hypoxemic level, and nutritional status (OR 1.9, 95%CI 1.04 to 3.6). Conclusion The use of prone positioning in patients with COVID-19 was a safe and feasible treatment, also in obese patients, who might deserve more surveillance and active prevention by intensive care unit staff.
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- 2021
49. 868P A phase II trial of induction chemotherapy (IC), photon-, proton- and carbon ion-based radiotherapy (RT) integration in locally advanced inoperable sinonasal epithelial tumors patients (pts)
- Author
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E. Orlandi, M. Franceschini, Simone Gambazza, Carlo Resteghini, Paolo Bossi, Lisa Licitra, N. Facchinetti, Marco Ferrari, Piero Nicolai, Paolo Castelnuovo, Giuseppina Calareso, A. Cavallo, Luigi Mariani, Rossana Ingargiola, Pasquale Quattrone, V. Rampelli, A. Tuzi, Mario Turri-Zanoni, and Barbara Vischioni
- Subjects
Radiation therapy ,Carbon ion ,Oncology ,Proton ,business.industry ,medicine.medical_treatment ,Phase (matter) ,medicine ,Locally advanced ,Induction chemotherapy ,Hematology ,business ,Nuclear medicine - Published
- 2021
50. The SINTART 1 study: A phase II trial of induction chemotherapy (IC), surgery, photon-, proton-and carbon ion-based radiotherapy (RT) integration in locally advanced operable sinonasal epithelial tumors patients (pts)
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Andrea Pietro Sponghini, Paolo Battaglia, Lisa Licitra, Marco Ravanelli, Giuseppina Calareso, Barbara Vischioni, T. Tartaro, Paolo Castelnuovo, Alberto Schreiber, Carla Facco, Luigi Mariani, Ester Orlandi, Simone Gambazza, Carlo Resteghini, Fabio Pagella, Nadia Facchinetti, Nicola Alessandro Iacovelli, Davide Mattavelli, Piero Nicolai, and Paolo Bossi
- Subjects
Cancer Research ,Poor prognosis ,medicine.medical_specialty ,Carbon ion ,business.industry ,medicine.medical_treatment ,Locally advanced ,Induction chemotherapy ,Multimodal therapy ,Surgery ,Radiation therapy ,Oncology ,medicine ,business ,Standard therapy - Abstract
6066 Background: Sinonasal epithelial tumors are rare diseases with several histotypes and poor prognosis. Multimodal approach including surgery is widely used, although no standard therapy has been established in prospective trials. This study assessed activity and safety of an innovative integration of multimodality treatment - IC, surgery and RT - modulated by histology, molecular profile and response to IC. Methods: Pts with untreated, operable squamous cell carcinoma (SCC), p53 wild type intestinal type adenocarcinoma (ITAC), sinonasal undifferentiated and neuroendocrine carcinoma (SNUC, SNEC) were enrolled in a single-arm, phase II, multicenter clinical trial from 2014 to 2018. Pts was treated with up to 5 IC cycles, whose regimen was selected according to histotype, followed either by curative radio-chemotherapy (CRT) (pts with ≥80% reduction of initial tumor volume (TV)) or surgery and adjuvant (C)RT. Photon and/or proton/carbon ion-based RT was employed according to disease site and stage. Primary endpoint was 5 years PFS, secondary endpoints were OS, IC ORR per RECIST 1.1 and safety. Results: Out of 39 enrolled pts, 35 pts were evaluable for primary endpoint. Two pts were only considered for safety analyses because definitive diagnosis on surgical specimen did not meet the study entry criteria; other two pts were screening failure due to inoperable disease. Five-year PFS was 38% (95% CI, 21 – 69), with a median PFS of 26 months. Five-year OS was 46% (95% CI, 28 – 75), with a median OS of 36 months. Responses to IC are reported in table. Globally, 15 pts avoided surgery. Overall treatment safety was in line with multimodality intensive head and neck cancer treatments (5% of pts with G3-4 adverse event during IC). One sudden cardiac death was recorded. At a median follow up of 27 months, 5 G3-4 RT related late adverse events have been recorded (1 G3 neurotoxicity, 2 G3 hearing impairment, 2 G3 xerostomia). Three-year PFS - OS for pts achieving PR/CR vs SD/PD to IC were 49.8% - 56.7% vs 43.2% - 53%, respectively. Conclusions: Treatment of advanced SNC with histology-driven IC followed by locoregional therapy tailored to response to IC was safe and showed survival rate similar to surgery containing case series. In the first prospective study, a surgery sparing multimodal approach proved feasible and effective in IC responsive pts. Clinical trial information: NCT02099175. [Table: see text]
- Published
- 2021
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