20 results on '"Tabbi L."'
Search Results
2. Prevalence and development of chronic critical illness in acute patients admitted to a respiratory intensive care setting
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Marchioni, A., Tonelli, R., Sdanganelli, A., Gozzi, F., Musarò, L., Fantini, R., Tabbì, L., Andreani, A., Cappiello, G., Costi, S., Castaniere, I., and Clini, E.
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- 2020
- Full Text
- View/download PDF
3. Early inspiratory effort assessment by esophageal manometry predicts noninvasive ventilation outcome in de novo respiratory failure: A pilot study
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Tonelli R., Fantini R., Tabbi L., Castaniere I., Pisani L., Pellegrino M. R., Casa G. D., D'Amico R., Girardis M., Nava S., Clini E. M., Marchioni A., Tonelli R., Fantini R., Tabbi L., Castaniere I., Pisani L., Pellegrino M.R., Casa G.D., D'Amico R., Girardis M., Nava S., Clini E.M., and Marchioni A.
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Acute respiratory distress syndrome ,Esophageal pressure swing ,Noninvasive mechanical ventilation ,Respiratory failure ,Transpulmonary pressure - Abstract
Rationale: The role of inspiratory effort still has to be determined as a potential predictor of noninvasive mechanical ventilation (NIV) failure in acute hypoxic de novo respiratory failure. Objectives: To explore the hypothesis that inspiratory effort might be a major determinant of NIV failure in these patients. Methods: Thirty consecutive patients with acute hypoxic de novo respiratory failure admitted to a single center and candidates for a 24-hour NIV trial were enrolled. Clinical features, tidal change in esophageal pressure (ΔPes), tidal change in dynamic transpulmonary pressure (ΔPL), expiratory VT, and respiratory rate were recorded on admission and 2-4 to 12-24 hours after NIV start and were tested for correlation with outcomes. Measurements and Main Results: ΔPes and ΔPes/ΔPL ratio were significantly lower 2 hours after NIV start in patients who successfully completed the NIV trial (n = 18) compared with those who needed endotracheal intubation (n = 12) (median [interquartile range], 11 [8-15] cmH2O vs. 31.5 [30-36] cm H2O; P
- Published
- 2020
4. Epithelial cells respond to proteolytic and non-proteolytic detachment by enhancing interleukin-6 responses
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Miller, Tabbi L. and McGee, Dennis W.
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- 2002
5. INCIDENCE AND PREDICTORS OF DELIRIUM IN PATIENTS WITH ACUTE RESPIRATORY FAILURE UNDERGOING NON-INVASIVE MECHANICAL VENTILATION
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Tabbì, L., Tonelli, R., Fantini, R., Castaniere, I., Bruzzi, G., Nani, C., Caffarri, L., Sacchi, M., Spacone, A., Dongilli, R., Boni, E., Falsini, L., Ribuffo, V., Marchioni, A., and Clini, E.
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- 2020
- Full Text
- View/download PDF
6. Comparative Proteome Analysis of Laboratory Grown Brucella abortus 2308 and Brucella melitensis 16M
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Michel Eschenbrenner, Vito G. DelVecchio, Tabbi L Miller-Scandle, Mary Ann Wagner, Troy A. Horn, and Cesar V. Mujer
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Gel electrophoresis ,Two-dimensional gel electrophoresis ,Proteome ,Brucella abortus ,Gene Expression Regulation, Bacterial ,General Chemistry ,Biology ,biology.organism_classification ,Proteomics ,Peptide Mapping ,Biochemistry ,Genome ,Microbiology ,Bacterial Proteins ,Peptide mass fingerprinting ,Brucella melitensis ,Animals ,Electrophoresis, Gel, Two-Dimensional ,Secretion - Abstract
Brucella species are pathogenic agents that cause brucellosis, a debilitating zoonotic disease that affects a large variety of domesticated animals and humans. Brucella melitensis and Brucella abortus are considered major health threats because of their highly infectious nature and worldwide occurrence. The availability of the annotated genomes for these two species has allowed a comparative proteomics study of laboratory grown B. melitensis 16M and B. abortus 2308 by two-dimensional (2-D) gel electrophoresis and peptide mass fingerprinting. Computer-assisted analysis of the different 2-D gel images of strains 16M and 2308 revealed significant quantitative and qualitative differences in their protein expression patterns. Proteins involved in membrane transport, particularly the high affinity amino acids binding proteins, and those involved in Sec-dependent secretion systems related to type IV and type V secretion systems, were differentially expressed. Differential expression of these proteins may be responsible for conferring specific host preference in the two strains 2308 and 16M.
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- 2006
7. Comparative Secretome Analyses of Three Bacillus anthracis Strains with Variant Plasmid Contents
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Janine M. Lamonica, Tabbi L. Miller, Guy Patra, Mary Ann Wagner, Michel Eschenbrenner, Leanne E. Williams, and Vito G. DelVecchio
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Gel electrophoresis ,Proteome ,Anthrax toxin ,Immunology ,Virulence ,Biology ,biology.organism_classification ,Molecular Pathogenesis ,Microbiology ,Bacillus anthracis ,Infectious Diseases ,Plasmid ,Bacterial Proteins ,Peptide mass fingerprinting ,Biochemistry ,Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ,Extracellular ,Electrophoresis, Gel, Two-Dimensional ,Parasitology ,Plasmids - Abstract
Bacillus anthracis , the causative agent of anthrax, secretes numerous proteins into the extracellular environment during infection. A comparative proteomic approach was employed to elucidate the differences among the extracellular proteomes (secretomes) of three isogenic strains of B. anthracis that differed solely in their plasmid contents. The strains utilized were the wild-type virulent B. anthracis RA3 (pXO1 + pXO2 + ) and its two nonpathogenic derivative strains: the toxigenic, nonencapsulated RA3R (pXO1 + pXO2 − ) and the totally cured, nontoxigenic, nonencapsulated RA3:00 (pXO1 − pXO2 − ). Comparative proteomics using two-dimensional gel electrophoresis followed by computer-assisted gel image analysis was performed to reveal unique, up-regulated, or down-regulated secretome proteins among the strains. In total, 57 protein spots, representing 26 different proteins encoded on the chromosome or pXO1, were identified by peptide mass fingerprinting. S-layer-derived proteins, such as Sap and EA1, were most frequently observed. Many sporulation-associated enzymes were found to be overexpressed in strains containing pXO1 + . This study also provides evidence that pXO2 is necessary for the maximal expression of the pXO1-encoded toxins lethal factor (LF), edema factor (EF), and protective antigen (PA). Several newly identified putative virulence factors were observed; these include enolase, a high-affinity zinc uptake transporter, the peroxide stress-related alkyl hydroperoxide reductase, isocitrate lyase, and the cell surface protein A.
- Published
- 2005
8. Epithelial cells respond to proteolytic and non-proteolytic detachment by enhancing interleukin-6 responses
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Tabbi L. Miller and Dennis W. McGee
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Proteases ,Cell Survival ,medicine.medical_treatment ,Blotting, Western ,Immunology ,Enzyme-Linked Immunosorbent Assay ,Enhancer binding ,Endopeptidases ,In Situ Nick-End Labeling ,medicine ,Animals ,Immunology and Allergy ,Trypsin ,Secretion ,RNA, Messenger ,Intestinal Mucosa ,Chemokine CCL2 ,biology ,Interleukin-6 ,Reverse Transcriptase Polymerase Chain Reaction ,Monocyte ,Epithelial Cells ,Original Articles ,Rats ,Cell biology ,medicine.anatomical_structure ,Cytokine ,Cell culture ,Neutrophil elastase ,CCAAT-Enhancer-Binding Proteins ,biology.protein ,Leukocyte Elastase ,Transcription Factor CHOP ,Interleukin-1 ,Transcription Factors ,medicine.drug - Abstract
Intestinal inflammatory disease or infection often results in the loss of the epithelial layer as a result mainly of the action of proteases, including the leucocyte serine proteinases (neutrophil elastase), lysosomal cathepsins and the matrix metalloproteinases from recruited inflammatory cells. Previous studies have shown that bronchial or intestinal epithelial cells (IEC) can respond to proteolytic attack by producing cytokines. In this study, we have determined the effect of protease treatment on interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1) production by IEC lines. Both neutrophil elastase and trypsin treatment induced elevated levels of mRNA for IL-6 in rat IEC-6 cells. Non-proteolytic detachment of the IEC-6 cells also induced elevated levels of IL-6 mRNA, suggesting that the effect was not caused by a specific protease or degradation product, but probably by an effect on cell shape or cell detachment. Similar results were seen with the IEC-18 cell line. Trypsin treatment of the IEC-6 cells also enhanced unstimulated and IL-1 beta costimulated IL-6 secretion, but not MCP-1 secretion or mRNA levels. Finally, nuclear levels of the CCAAT/enhancer binding protein-beta (C/EBP-beta) were rapidly enhanced after proteolytic detachment of the IEC-6 cells, suggesting a mechanism for the enhancement of IL-6 mRNA responses. These data indicate that epithelial cells can respond to proteolytic attack or cell detachment by producing IL-6, a cytokine with several anti-inflammatory and antiprotease effects, which may be important in moderating the loss of the epithelial layer by its effects on nearby epithelial or inflammatory cells.
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- 2002
9. Comparative Proteome Analysis of Laboratory Grown Brucella abortus 2308 and Brucella melitensis 16M
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Eschenbrenner, Michel, primary, Horn, Troy A., additional, Wagner, Mary Ann, additional, Mujer, Cesar V., additional, Miller-Scandle, Tabbi L., additional, and DelVecchio, Vito G., additional
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- 2006
- Full Text
- View/download PDF
10. Urgent care center pediatric telephone advice
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Richard P. O'Brien and Tabbi L. Miller
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Male ,Emergency Medical Services ,business.industry ,Home Nursing ,Infant ,Care center ,General Medicine ,Community Health Centers ,medicine.disease ,Advice (programming) ,Telephone advice ,Hotlines ,Emergency Medicine ,Medicine ,Humans ,Medical emergency ,InformationSystems_MISCELLANEOUS ,Emergencies ,business ,Algorithms - Abstract
Pediatric telephone advice is sought frequently by members of the community. This study was undertaken to evaluate the quality and accuracy of pediatric telephone advice given by free-standing urgent care centers. One hundred such facillities were telephoned and advice was requested by a research assistant. A case was presented that could have represented a pediatric medical emergency. Overall only 17 centers gave adequate advice. The data suggest that under some circumstances free-standing urgent care center pediatric telephone advice may be inaccurate and inappropriate. Workable policies and protocols for pediatric telephone advice should be instituted by these facillties.
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- 1990
11. Comparative Secretome Analyses of Three Bacillus anthracis Strains with Variant Plasmid Contents
- Author
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Lamonica, Janine M., primary, Wagner, MaryAnn, additional, Eschenbrenner, Michel, additional, Williams, Leanne E., additional, Miller, Tabbi L., additional, Patra, Guy, additional, and DelVecchio, Vito G., additional
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- 2005
- Full Text
- View/download PDF
12. Urgent care center pediatric telephone advice
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O'Brien, Richard P., primary and Miller, Tabbi L., additional
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- 1990
- Full Text
- View/download PDF
13. Comparative Secretome Analyses of Three Bacillus anthracisStrains with Variant Plasmid Contents
- Author
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Lamonica, Janine M., Wagner, MaryAnn, Eschenbrenner, Michel, Williams, Leanne E., Miller, Tabbi L., Patra, Guy, and DelVecchio, Vito G.
- Abstract
ABSTRACTBacillus anthracis, the causative agent of anthrax, secretes numerous proteins into the extracellular environment during infection. A comparative proteomic approach was employed to elucidate the differences among the extracellular proteomes (secretomes) of three isogenic strains of B. anthracisthat differed solely in their plasmid contents. The strains utilized were the wild-type virulent B. anthracisRA3 (pXO1+pXO2+) and its two nonpathogenic derivative strains: the toxigenic, nonencapsulated RA3R (pXO1+pXO2−) and the totally cured, nontoxigenic, nonencapsulated RA3:00 (pXO1−pXO2−). Comparative proteomics using two-dimensional gel electrophoresis followed by computer-assisted gel image analysis was performed to reveal unique, up-regulated, or down-regulated secretome proteins among the strains. In total, 57 protein spots, representing 26 different proteins encoded on the chromosome or pXO1, were identified by peptide mass fingerprinting. S-layer-derived proteins, such as Sap and EA1, were most frequently observed. Many sporulation-associated enzymes were found to be overexpressed in strains containing pXO1+. This study also provides evidence that pXO2 is necessary for the maximal expression of the pXO1-encoded toxins lethal factor (LF), edema factor (EF), and protective antigen (PA). Several newly identified putative virulence factors were observed; these include enolase, a high-affinity zinc uptake transporter, the peroxide stress-related alkyl hydroperoxide reductase, isocitrate lyase, and the cell surface protein A.
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- 2005
- Full Text
- View/download PDF
14. Stenting versus balloon dilatation in patients with tracheal benign stenosis: The STROBE trial
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Alessandro Marchioni, Dario Andrisani, Roberto Tonelli, Alessandro Andreani, Gaia Francesca Cappiello, Margherita Ori, Filippo Gozzi, Giulia Bruzzi, Chiara Nani, Raimondo Feminò, Linda Manicardi, Serena Baroncini, Francesco Mattioli, Matteo Fermi, Riccardo Fantini, Luca Tabbì, Ivana Castaniere, Livio Presutti, Enrico Clini, Marchioni A., Andrisani D., Tonelli R., Andreani A., Cappiello G.F., Ori M., Gozzi F., Bruzzi G., Nani C., Femino R., Manicardi L., Baroncini S., Mattioli F., Fermi M., Fantini R., Tabbi L., Castaniere I., Presutti L., and Clini E.
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benign tracheal stenosis ,benign tracheal stenosis, tracheal stenting, balloon dilatation, rigid bronchoscopy ,balloon dilatation ,tracheal stenting ,rigid bronchoscopy ,General Medicine ,benign tracheal stenosi - Abstract
Background: It is well known that benign tracheal stenosis represents an obstacle to open surgery, and that its treatment could be challenging. Two endoscopic techniques have so far been adopted to restore tracheal patency: balloon dilatation (BA) through laryngoscopy, and tracheal stenting (ST) with rigid bronchoscopy. The main objective of this study was to compare the efficacy of BA and ST to treat benign tracheal stenosis not eligible for surgery. We also compared the rate of adverse events in the two treatment groups. Methods: A retrospective, observational cohort study was carried out at the University Hospital of Modena (Italy) from November 2012 to November 2017 in two separate departments. Patients were considered to be “stabilized” (primary outcome) if they did not report significant respiratory symptoms, or restenosis in the long-term (2 years) following the endoscopic procedure. Results: Sixty-six patients were included in the study (33 in the BA and 33 in the ST group, respectively). Unadjusted Kaplan–Meier estimates showed a greater therapeutic effect of ST compared to BA at 2 years (hazard ratio=3.9 95%CI [1.5–9.8], p=.01). After adjusting for confounders, stratified analyses showed that this effect was significant in patients with complex stenosis, idiopathic etiology, and degree of stenosis >70%. Compared with BA, ST showed a higher rate of adverse events (p=.01). Conclusions: Compared to BA, ST seems to be more effective in achieving stabilization of tracheal patency in complex benign tracheal stenosis, although burdened with a significantly higher number of adverse effects. These findings warrant future prospective study for confirmation. Level of evidence: 3.
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- 2022
15. Early awake proning in critical and severe COVID-19 patients undergoing noninvasive respiratory support: A retrospective multicenter cohort study
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Luca Tabbì, Giulia Bruzzi, Enrico Clini, Linda Manicardi, Stefano Nava, Stefano Busani, Gabriele Corsi, Cristina Mussini, Irene Prediletto, Vittoria Comellini, Roberto D'Amico, Ilaria Bassi, Riccardo Fantini, Ivana Castaniere, Federico Tagariello, Massimo Girardis, Filippo Gozzi, Marco Carpano, Lara Pisani, Alessandro Marchioni, Roberto Tonelli, Dario Andrisani, Tonelli R., Pisani L., Tabbi L., Comellini V., Prediletto I., Fantini R., Marchioni A., Andrisani D., Gozzi F., Bruzzi G., Manicardi L., Busani S., Mussini C., Castaniere I., Bassi I., Carpano M., Tagariello F., Corsi G., d'Amico R., Girardis M., Nava S., and Clini E.
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Pulmonary and Respiratory Medicine ,Coronavirus disease 2019 (COVID-19) ,ARF, acute respiratory failure ,Vt, tidal volume ,medicine.medical_treatment ,RR, respiratory rate ,Acute respiratory failure ,NRS, non-invasive respiratory support ,law.invention ,Cohort Studies ,03 medical and health sciences ,Prone position ,0302 clinical medicine ,Randomized controlled trial ,law ,ICU, Intensive Care Unit ,medicine ,Humans ,Intubation ,030212 general & internal medicine ,Wakefulness ,APACHE II, acute physiology and chronic health evaluation II score ,HFNC, High Flow Nasal Cannulae ,Retrospective Studies ,COVID-19, Acute respiratory failure, Non-invasive mechanical ventilation, Prone position ,NIV, non-invasive mechanical ventilation ,business.industry ,ETI, endotracheal intubation ,CPAP, continuous positive airways pressure ,Confounding ,COVID-19 ,MV, mechanical ventilation ,Retrospective cohort study ,SAPS II, simplified acute physiology score ,PSV, pressure support ventilation ,HR, hazard ratio ,SOFA, subsequent organ failure assessment ,OR, odds ratio ,030228 respiratory system ,PEEP, positive end expiratory pressure ,Anesthesia ,Breathing ,Original Article ,Non-invasive mechanical ventilation ,Respiratory Insufficiency ,business ,Cohort study - Abstract
BACKGROUND/MATERIALS AND METHODS: This retrospective cohort study was conducted in two teaching hospitals over a 3-month period (March 2010-June 2020) comparing severe and critical COVID-19 patients admitted to Respiratory Intensive Care Unit for non-invasive respiratory support (NRS) and subjected to awake prone position (PP) with those receiving standard care (SC). Primary outcome was endotracheal intubation (ETI) rate. In-hospital mortality, time to ETI, tracheostomy, length of RICU and hospital stay served as secondary outcomes. Risk factors associated to ETI among PP patients were also investigated. RESULTS: A total of 114 patients were included, 76 in the SC and 38 in the PP group. Unadjusted Kaplan-Meier estimates showed greater effect of PP compared to SC on ETI rate (HRâ¯=â¯0.45 95% CI [0.2-0.9], pâ¯=â¯0.02) even after adjustment for baseline confounders (HRâ¯=â¯0.59 95% CI [0.3-0.94], pâ¯=â¯0.03). After stratification according to non-invasive respiratory support, PP showed greater significant benefit for those on High Flow Nasal Cannulae (HRâ¯=â¯0.34 95% CI [0.12-0.84], pâ¯=â¯0.04). Compared to SC, PP patients also showed a favorable difference in terms of days free from respiratory support, length of RICU and hospital stay while mortality and tracheostomy rate were not significantly different. CONCLUSIONS: Prone positioning in awake and spontaneously breathing Covid-19 patients is feasible and associated with a reduction of intubation rate, especially in those patients undergoing HFNC. Although our results are intriguing, further randomized controlled trials are needed to answer all the open questions remaining pending about the real efficacy of PP in this setting.
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- 2022
16. Molecular Mechanisms and Physiological Changes behind Benign Tracheal and Subglottic Stenosis in Adults
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Alessandro Marchioni, Roberto Tonelli, Alessandro Andreani, Gaia Francesca Cappiello, Matteo Fermi, Fabiana Trentacosti, Ivana Castaniere, Riccardo Fantini, Luca Tabbì, Dario Andrisani, Filippo Gozzi, Giulia Bruzzi, Linda Manicardi, Antonio Moretti, Serena Baroncini, Anna Valeria Samarelli, Massimo Pinelli, Giorgio De Santis, Alessandro Stefani, Daniele Marchioni, Francesco Mattioli, Enrico Clini, Marchioni A., Tonelli R., Andreani A., Cappiello G.F., Fermi M., Trentacosti F., Castaniere I., Fantini R., Tabbi L., Andrisani D., Gozzi F., Bruzzi G., Manicardi L., Moretti A., Baroncini S., Samarelli A.V., Pinelli M., De Santis G., Stefani A., Marchioni D., Mattioli F., and Clini E.
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tracheostomy ,Granulomatosis with polyangiiti ,Mechanotransduction, Cellular ,Subglottic stenosis ,tracheal stenosis ,relapsing polychondritis ,granulomatosis with polyangiitis ,web-like stenosis ,Catalysis ,Inorganic Chemistry ,Tracheostomy ,Laryngostenosi ,Web-like stenosi ,Intercellular Signaling Peptides and Protein ,Humans ,Genetic Predisposition to Disease ,Physical and Theoretical Chemistry ,Cytokine ,Molecular Biology ,Spectroscopy ,Relapsing polychondriti ,Organic Chemistry ,Laryngostenosis ,Biomarker ,General Medicine ,Subglottic stenosi ,Biomechanical Phenomena ,Computer Science Applications ,Tracheal stenosi ,Cytokines ,Intercellular Signaling Peptides and Proteins ,Tracheal Stenosis ,Biomarkers ,Human - Abstract
Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different aetiology. Although iatrogenic aetiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent aetiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS.
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- 2022
17. Ventilatory support and mechanical properties of the fibrotic lung acting as a 'squishy ball'
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Alessandro, Marchioni, Tonelli, Roberto, Giulio, Rossi, Paolo, Spagnolo, Fabrizio, Luppi, Cerri, Stefania, Elisabetta, Cocconcelli, Pellegrino, Maria Rosaria, Davide, Campana, Riccardo, Fantini, Luca, Tabbì, Castaniere, Ivana, Lorenzo, Ball, Malbrain, Manu L. N. G., Paolo, Pelosi, Clini, Enrico, Marchioni, A, Tonelli, R, Rossi, G, Spagnolo, P, Luppi, F, Cerri, S, Cocconcelli, E, Pellegrino, M, Fantini, R, Tabbi, L, Castaniere, I, Ball, L, Malbrain, M, Pelosi, P, Clini, E, Supporting clinical sciences, and Intensive Care
- Subjects
Artificial ventilation ,medicine.medical_specialty ,ARDS ,Interstitial lung diseases ,Exacerbation ,medicine.medical_treatment ,Interstitial lung disease ,Review ,mechanical ventilation ,Respiratory failure ,Lung injury ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,Mechanical ventilation ,0302 clinical medicine ,Acute respiratory distress syndrome ,Ventilator-induced lung injury ,interstitial lung diseases ,Medicine ,Intensive care medicine ,Medicine(all) ,Lung ,business.industry ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,respiratory failure ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,ventilator-induced lung injury ,acute respiratory distress syndrome ,respiratory system ,medicine.disease ,respiratory tract diseases ,medicine.anatomical_structure ,030228 respiratory system ,business ,interstitial lung diseases, acute respiratory distress syndrome, respiratory failure, mechanical ventilation, ventilator-induced lung injury - Abstract
Protective ventilation is the cornerstone of treatment of patients with the acute respiratory distress syndrome (ARDS); however, no studies have yet established the best ventilatory strategy to adopt when patients with acute exacerbation of interstitial lung disease (AE-ILD) are admitted to the intensive care unit. Due to the severe impairment of the respiratory mechanics, the fibrotic lung is at high risk of developing ventilator-induced lung injury, regardless of the lung fibrosis etiology. The purpose of this review is to analyze the effects of mechanical ventilation in AE-ILD and to increase the knowledge on the characteristics of fibrotic lung during artificial ventilation, introducing the concept of “squishy ball lung”. The role of positive end-expiratory pressure is discussed, proposing a “lung resting strategy” as opposed to the “open lung approach”. The review also discusses the practical management of AE-ILD patients discussing illustrative clinical cases.
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- 2020
18. Feasibility and clinical impact of out-of-ICU noninvasive respiratory support in patients with COVID-19-related pneumonia
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Emanuele Alberto Negri, Annalisa Carlucci, V. Marco Ranieri, Nicola Facciolongo, Gioachino Schifino, Luca Guidelli, Roberto Tonelli, Greta Spoladore, Paolo Amedeo Tillio, Cinzia Lastoria, Stefano Nava, Giovanna Arcaro, Andrea Vianello, Lara Pisani, Giovanni Guaraldi, Raffaele Scala, Mario Malerba, Roberto Dongilli, Luca Tabbì, C. Franco, Enrico Clini, Franco C., Facciolongo N., Tonelli R., Dongilli R., Vianello A., Pisani L., Scala R., Malerba M., Carlucci A., Negri E.A., Spoladore G., Arcaro G., Tillio P.A., Lastoria C., Schifino G., Tabbi L., Guidelli L., Guaraldi G., Marco Ranieri V., Clini E., and Nava S.
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Male ,medicine.medical_treatment ,medicine.disease_cause ,law.invention ,Cohort Studies ,law ,80 and over ,Continuous positive airway pressure ,Hospital Mortality ,Viral ,Aged, 80 and over ,Mortality rate ,Middle Aged ,Intensive care unit ,Pulmonology ,Original Article ,Female ,Coronavirus Infections ,Nasal cannula ,Human ,Cohort study ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Critical Care ,Pneumonia, Viral ,Aged ,COVID-19 ,Feasibility Studies ,Humans ,Length of Stay ,Pandemics ,SARS-CoV-2 ,Betacoronavirus ,Noninvasive Ventilation ,noninvasive ventilatory support, acute respiratory failure, SARS ,Internal medicine ,medicine ,SARS ,acute respiratory failure ,Pandemic ,Betacoronaviru ,Coronavirus Infection ,business.industry ,Pneumonia ,medicine.disease ,Comorbidity ,Feasibility Studie ,noninvasive ventilatory support ,Emergency medicine ,Observational study ,Cohort Studie ,business - Abstract
Introduction The Coronavirus 2(SARS-CoV-2) outbreak spread rapidly in Italy and the lack of intensive care unit(ICU) beds soon became evident, forcing the application of noninvasive respiratory support(NRS) outside the ICU, raising concerns over staff contamination. We aimed to analyse the safety of the hospital staff, the feasibility, and outcomes of NRS applied to patients outside the ICU. Methods In this observational study, data from 670 consecutive patients with confirmed COVID-19 referred to the Pulmonology Units in nine hospitals between March 1st and May 10th,2020 were analysed. Data were collected including medication, mode and usage of the NRS (i.e. high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), noninvasive ventilation(NIV)), length of stay in hospital, endotracheal intubation(ETI) and deaths. Results Forty-two health-care workers (11.4%) tested positive for infection, but only three of them required hospitalisation. Data are reported for all patients (69.3% male), whose mean age was 68 (sd 13) years. The PaO2/FiO2 ratio at baseline was 152±79, and the majority of patients (49.3%) were treated with CPAP. The overall unadjusted 30-day mortality rate was 26.9% with 16%, 30%, and 30%, while the total ETI rate was 27% with 29%, 25% and 28%, for HFNC, CPAP, and NIV, respectively, and the relative probability to die was not related to the NRS used after adjustment for confounders. ETI and length of stay were not different among the groups. Mortality rate increased with age and comorbidity class progression. Conclusions The application of NRS outside the ICU is feasible and associated with favourable outcomes. Nonetheless, it was associated with a risk of staff contamination., In patients with Coronavirus 2 infection and Acute Respiratory Failure, we demonstrated that the utilization of noninvasive respiratory support delivered outside the ICU, was feasible and effective, but associated with a risk of staff contamination
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- 2020
19. Tocilizumab in patients with severe COVID-19: a retrospective cohort study
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Ivana Castaniere, Jovana Milic, Marianna Menozzi, Maddalena Giannella, Marianna Meschiari, Lucio Brugioni, Alessandro Cozzi-Lepri, Massimo Girardis, Cinzia Puzzolante, Enrico Clini, Margherita Di Gaetano, Vanni Borghi, Sara K. Tedeschi, Erica Franceschini, Michele Bartoletti, Gabriella Orlando, Luca Tabbì, Antonella Santoro, Andrea Bedini, Carlo Salvarani, Federica Carli, Federico Pea, Antonello Pietrangelo, Luca Corradi, Gianluca Cuomo, Roberto Tonelli, Pierluigi Viale, Riccardo Fantini, Andrea Cossarizza, Giovanni Guaraldi, Renato Pascale, Cristina Mussini, Marco Massari, Giovanni Dolci, Guaraldi G., Meschiari M., Cozzi-Lepri A., Milic J., Tonelli R., Menozzi M., Franceschini E., Cuomo G., Orlando G., Borghi V., Santoro A., Di Gaetano M., Puzzolante C., Carli F., Bedini A., Corradi L., Fantini R., Castaniere I., Tabbi L., Girardis M., Tedeschi S., Giannella M., Bartoletti M., Pascale R., Dolci G., Brugioni L., Pietrangelo A., Cossarizza A., Pea F., Clini E., Salvarani C., Massari M., Viale P.L., and Mussini C.
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Mechanical ventilation ,medicine.medical_specialty ,medicine.drug_class ,business.industry ,medicine.medical_treatment ,Immunology ,Low molecular weight heparin ,Retrospective cohort study ,Azithromycin ,medicine.disease ,Article ,chemistry.chemical_compound ,Pneumonia ,Tocilizumab ,chemistry ,Rheumatology ,Internal medicine ,severe covid-19, tocilizumab ,medicine ,Clinical endpoint ,Immunology and Allergy ,business ,Letters to the Editor ,Cohort study ,medicine.drug - Abstract
Background: No therapy is approved for COVID-19 pneumonia. The aim of this study was to assess the role of tocilizumab in reducing the risk of invasive mechanical ventilation and death in patients with severe COVID-19 pneumonia who received standard of care treatment. Methods: This retrospective, observational cohort study included adults (≥18 years) with severe COVID-19 pneumonia who were admitted to tertiary care centres in Bologna and Reggio Emilia, Italy, between Feb 21 and March 24, 2020, and a tertiary care centre in Modena, Italy, between Feb 21 and April 30, 2020. All patients were treated with the standard of care (ie, supplemental oxygen, hydroxychloroquine, azithromycin, antiretrovirals, and low molecular weight heparin), and a non-randomly selected subset of patients also received tocilizumab. Tocilizumab was given either intravenously at 8 mg/kg bodyweight (up to a maximum of 800 mg) in two infusions, 12 h apart, or subcutaneously at 162 mg administered in two simultaneous doses, one in each thigh (ie, 324 mg in total), when the intravenous formulation was unavailable. The primary endpoint was a composite of invasive mechanical ventilation or death. Treatment groups were compared using Kaplan-Meier curves and Cox regression analysis after adjusting for sex, age, recruiting centre, duration of symptoms, and baseline Sequential Organ Failure Assessment (SOFA) score. Findings: Of 1351 patients admitted, 544 (40%) had severe COVID-19 pneumonia and were included in the study. 57 (16%) of 365 patients in the standard care group needed mechanical ventilation, compared with 33 (18%) of 179 patients treated with tocilizumab (p=0·41; 16 [18%] of 88 patients treated intravenously and 17 [19%] of 91 patients treated subcutaneously). 73 (20%) patients in the standard care group died, compared with 13 (7%; p
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- 2020
20. Respiratory Mechanics and Diaphragmatic Dysfunction in COPD Patients Who Failed Non-Invasive Mechanical Ventilation
- Author
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Marchioni, Alessandro, Tonelli, Roberto, Fantini, Riccardo, Tabbì, Luca, Castaniere, Ivana, Livrieri, Francesco, Bedogni, Sabrina, Ruggieri, Valentina, Pisani, Lara, Nava, Stefano, Clini, Enrico, Marchioni A., Tonelli R., Fantini R., Tabbi L., Castaniere I., Livrieri F., Bedogni S., Ruggieri V., Pisani L., Nava S., and Clini E.
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Male ,Diaphragm ,transdiaphragmatic pressure ,International Journal of Chronic Obstructive Pulmonary Disease ,Respiratory failure ,Pulmonary Disease, Chronic Obstructive ,Pressure ,Humans ,Prospective Studies ,Treatment Failure ,Lung ,Original Research ,Aged ,lcsh:RC705-779 ,Acute exacerbation of COPD ,non-invasive mechanical ventilation ,Noninvasive Ventilation ,respiratory failure ,lcsh:Diseases of the respiratory system ,Middle Aged ,acute exacerbation of COPD ,Respiratory Mechanics ,Female ,Non-invasive mechanical ventilation ,Lung Volume Measurements ,Transdiaphragmatic pressure - Abstract
Alessandro Marchioni,1 Roberto Tonelli,1,2 Riccardo Fantini,1 Luca Tabbì,1 Ivana Castaniere,1,2 Francesco Livrieri,1,3 Sabrina Bedogni,4 Valentina Ruggieri,1 Lara Pisani,5 Stefano Nava,5 Enrico Clini1 1University Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy; 2PhD Course in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy; 3Respiratory Disease Unit, Hospital Carlo Poma, Mantova, Italy; 4School of Medicine, University of Modena and Reggio Emilia, Modena, Italy; 5Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, ItalyCorrespondence: Roberto TonelliUniversity Hospital of Modena, Pneumology Unit and Center for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71 – 41125, Modena, ItalyTel +39-342-7241672Email roberto.tonelli@me.com Skype roberto.tonelli150288Background: Although non-invasive mechanical ventilation (NIV) is the gold standard treatment for patients with acute exacerbation of COPD (AECOPD) developing respiratory acidosis, failure rates still range from 5% to 40%. Recent studies have shown that the onset of severe diaphragmatic dysfunction (DD) during AECOPD increases risk of NIV failure and mortality in this subset of patients. Although the imbalance between the load and the contractile capacity of inspiratory muscles seems the main cause of AECOPD-induced hypercapnic respiratory failure, data regarding the influence of mechanical derangement on DD in this acute phase are lacking. With this study, we investigate the impact of respiratory mechanics on diaphragm function in AECOPD patients experiencing NIV failure.Methods: Twelve AECOPD patients with respiratory acidosis admitted to the Respiratory ICU of the University Hospital of Modena from 2017 to 2018 undergoing mechanical ventilation (MV) due to NIV failure were enrolled. Static respiratory mechanics and end-expiratory lung volume (EELV) were measured after 30 mins of volume control mode MV. Subsequently, transdiaphragmatic pressure (Pdi) was calculated by means of a sniff maneuver (Pdisniff) after 30 mins of spontaneous breathing trial. Linear regression analysis and Pearson’s correlation coefficient served to assess associations.Results: Average Pdisniff was 23.3 cmH2O (standard deviation 29 cmH2O) with 3 patients presenting bilateral diaphragm palsy. Pdisniff was directly correlated with static lung elastance (r=0.69, p=0.001) while inverse correlation was found with dynamic intrinsic PEEP (r=−0.73, p=0.007). No significant correlation was found with static intrinsic PEEP (r=−0.55, p=0.06), EELV (r=−0.4, p=0.3), airway resistance (r=−0.2, p=0.54), chest wall, and total elastance (r=−0-01, p=0.96 and r=0.3, p=0.36, respectively). Significant linear inverse correlation was found between Pdisniff and the ratio betweenPdi assessed at tidal volume and Pdi sniff (r=−0.82, p=0.02).Conclusion: The causes of extreme DD in AECOPD patients who experienced NIV failure might be predominantly mechanical, driven by a severe dynamic hyperinflation that overlaps on an elastic lung substrate favoring volume overload.Keywords: acute exacerbation of COPD, non-invasive mechanical ventilation, respiratory failure, transdiaphragmatic pressure
- Published
- 2019
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