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Torregiani C, Reale M, Confalonieri M, Dore F, Crisafulli C, Baratella E, Salton F, Confalonieri P, Ruaro B, Maiello G. Cardiopulmonary exercise testing complements both spirometry and nuclear imaging for assessing sarcoidosis stage and for monitoring disease activity. Sarcoidosis Vasc Diffuse Lung Dis 2024; 41:e2024017. [PMID: 38567559 PMCID: PMC11008331 DOI: 10.36141/svdld.v41i1.15125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/09/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Pulmonary sarcoidosis is a systemic disease that can confound established follow-up tools. Pulmonary function tests (PFTs) are recommended in initial and follow-up patient evaluations yet are imperfect predictors of disease progression. The cardiopulmonary exercise test (CPET) is another potentially useful monitoring tool, although previous studies report conflicting findings regarding which variables are altered by the disease. Nuclear imaging tests are also employed to assess inflammatory activity and may be predictive of functional deterioration. AIM We asked whether PFTs or CPET are more diagnostic of disease stage, which subsets of functional variables are impacted by the disease, and how these relate to nuclear imaging signs of active inflammation. STUDY DESIGN AND METHODS We collected retrospective data (spirometry, CPET, Gallium-67 scintigraphy, 18F-FDG PET/CT) from 48 patients and 10 controls. Disease severity was assessed following Scadding classification. First, we correlated individual PFTs and CPET parameters to Scadding stage and nuclear imaging data. Next, we performed Principal Component Analysis (PCA) on PFTs and CPET parameters, separated into respiratory, cardiovascular and metabolic subsets. Finally, we constructed multiple regression models to determine which variable subsets were the best predictors of Scadding stage and disease activity. RESULTS The majority of PFTs and CPET single parameters were significantly correlated with patient stage, while only few correlated with disease activity. Nevertheless, multiple regression models were able to significantly relate PFTs and CPET to both disease stage and activity. Additionally, these analyses highlighted CPET cardiovascular parameters as the best overall predictors of disease stage and activity. CONCLUSIONS Our results display how CPET and spirometry data complement each other for sarcoidosis disease staging, and how these tests are able to detect disease activity. Our findings suggest that CPET, a repeatable and non-invasive functional test, should be more routinely performed and taken into account in sarcoidosis patient follow-up.
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Affiliation(s)
| | - Matia Reale
- Pulmonology Unit, Hospital SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Franca Dore
- Nuclear Medicine Unit University Hospital of Cattinara, Trieste, Italy
| | | | - Elisa Baratella
- Institute of Radiology, University Hospital of Cattinara, Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, University Hospital of Cattinara, Trieste, Italy
| | | | - Barbara Ruaro
- Pulmonology Unit, University Hospital of Cattinara, Trieste, Italy
- Share co-senior authorship
| | - Guido Maiello
- School of Psychology, University of Southampton, Southampton, UK
- Share co-senior authorship
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Torregiani C, Baratella E, Segalotti A, Ruaro B, Salton F, Confalonieri P, Tavano S, Lapadula G, Bozzi C, Confalonieri M, Dellaca’ RL, Veneroni C. Oscillometry Longitudinal Data on COVID-19 Acute Respiratory Syndrome Treated with Non-Invasive Respiratory Support. J Clin Med 2024; 13:1868. [PMID: 38610633 PMCID: PMC11012861 DOI: 10.3390/jcm13071868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/02/2024] [Accepted: 03/16/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Oscillometry allows for the non-invasive measurements of lung mechanics. In COVID-19 ARDS patients treated with Non-Invasive Oxygen Support (NI-OS), we aimed to (1) observe lung mechanics at the patients' admission and their subsequent changes, (2) compare lung mechanics with clinical and imaging data, and (3) evaluate whether lung mechanics helps to predict clinical outcomes. Methods: We retrospectively analyzed the data from 37 consecutive patients with moderate-severe COVID-19 ARDS. Oscillometry was performed on their 1st, 4th, and 7th day of hospitalization. Resistance (R5), reactance (X5), within-breath reactance changes (ΔX5), and the frequency dependence of the resistance (R5-R19) were considered. Twenty-seven patients underwent computed tomographic pulmonary angiography (CTPA): collapsed, poorly aerated, and normally inflated areas were quantified. Adverse outcomes were defined as intubation or death. Results: Thirty-two patients were included in this study. At the first measurement, only 44% of them had an abnormal R5 or X5. In total, 23 patients had measurements performed on their 3rd day and 7 on their 7th day of hospitalization. In general, their R5, R5-R19, and ΔX decreased with time, while their X5 increased. Collapsed areas on the CTPA correlated with the X5 z-score (ρ = -0.38; p = 0.046), while poorly aerated areas did not. Seven patients had adverse outcomes but did not present different oscillometry parameters on their 1st day of hospitalization. Conclusions: Our study confirms the feasibility of oscillometry in critically ill patients with COVID-19 pneumonia undergoing NI-OS. The X5 z-scores indicates collapsed but not poorly aerated lung areas in COVID-19 pneumonia. Our data, which show a severe impairment of gas exchange despite normal reactance in most patients with COVID-19 ARDS, support the hypothesis of a composite COVID-19 ARDS physiopathology.
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Affiliation(s)
- Chiara Torregiani
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Elisa Baratella
- Radiology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, 34149 Trieste, Italy
| | - Antonio Segalotti
- Radiology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Stefano Tavano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Giulia Lapadula
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Chiara Bozzi
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Raffaele L. Dellaca’
- Department of Electronics, Information and Biomedical Engineering (DEIB), TechRes Lab, Politecnico di Milano University, 20122 Milano, Italy; (R.L.D.); (C.V.)
| | - Chiara Veneroni
- Department of Electronics, Information and Biomedical Engineering (DEIB), TechRes Lab, Politecnico di Milano University, 20122 Milano, Italy; (R.L.D.); (C.V.)
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Dullin C, Wagner WL, Confalonieri M, Tromba G. Pulmonary phase contrast CT imaging: a novel setup at the Italian synchrotron for the study of fresh lungs at human scale. Eur Respir J 2024; 63:2301604. [PMID: 38272502 PMCID: PMC10973686 DOI: 10.1183/13993003.01604-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
High-resolution computed tomography (HRCT) remains the current gold standard for detailed morphological assessment of the human lung, but is intrinsically limited in spatial resolution to about 0.5 mm, because an increase in spatial resolution is accompanied by a significant increase in the required radiation dose. Propagation-based imaging generates at clinical x-ray dose pulmonary CT images of unprecedented image detail for which the diagnostic value is to be explored. To this end, a dedicated imaging setup was developed that can be assessed via EuroBioImaging. https://bit.ly/491S0FH
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Affiliation(s)
- Christian Dullin
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
- Max Planck Institute for Multidisciplinary Sciences, Goettingen, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Heidelberg, Germany
| | - Willi Linus Wagner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Heidelberg, Germany
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Screm G, Mondini L, Confalonieri P, Salton F, Trotta L, Barbieri M, Mari M, Reccardini N, Della Porta R, Kodric M, Bandini G, Hughes M, Bellan M, Lerda S, Confalonieri M, Ruaro B. Nailfold Capillaroscopy Analysis Can Add a New Perspective to Biomarker Research in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Diagnostics (Basel) 2024; 14:254. [PMID: 38337770 PMCID: PMC10854947 DOI: 10.3390/diagnostics14030254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) includes granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA), all of which are characterised by inflammation of small-medium-sized vessels. Progressive understanding of these diseases has allowed researchers and clinicians to start discussing nailfold video capillaroscopy (NVC) as a future tool for many applications in daily practice. Today, NVC plays a well-established and validated role in differentiating primary from secondary Raynaud's phenomenon correlated with scleroderma. Nevertheless, there has not been sufficient attention paid to its real potential in the ANCA-associated vasculitis. In fact, the role of NVC in vasculitis has never been defined and studied in a multicentre and multinational study. In this review, we carried out a literature analysis to identify and synthesise the possible role of capillaroscopy for patients with ANCA-associated vasculitis. METHODS Critical research was performed in the electronic archive (PUBMED, UpToDate, Google Scholar, ResearchGate), supplemented with manual research. We searched in these databases for articles published until November 2023. The following search words were searched in the databases in all possible combinations: capillaroscopy, video capillaroscopy, nailfold-video capillaroscopy, ANCA-associated vasculitis, vasculitis, granulomatosis with polyangiitis, EGPA, and microscopic polyangiitis. RESULTS The search identified 102 unique search results. After the evaluation, eight articles were selected for further study. The literature reported that capillaroscopy investigations documented non-specific abnormalities in 70-80% of AAV patients. Several patients showed neoangiogenesis, capillary loss, microhaemorrhages, and bushy and enlarged capillaries as the most frequent findings. Furthermore, the difference between active phase and non-active phase in AAV patients was clearly discernible. The non-active phase showed similar rates of capillaroscopy alterations compared to the healthy subjects, but the active phase had higher rates in almost all common abnormalities instead. CONCLUSIONS Microvascular nailfold changes, observed in patients affected by vasculitis, may correlate with the outcome of these patients. However, these non-specific abnormalities may help in the diagnosis of vasculitis. As such, new analysis analyses are necessary to confirm our results.
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Affiliation(s)
- Gianluca Screm
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Marco Mari
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Nicolò Reccardini
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Rossana Della Porta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Metka Kodric
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Giulia Bandini
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Azienda Ospedaliero–Universitaria Careggi (AOUC), 50134 Florence, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Azienda Ospedaliero–Universitaria, Maggiore della Carità, 28100 Novara, Italy
| | - Selene Lerda
- Graduate School, University of Milan, 20149 Milan, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
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Ruaro B, Salotti A, Reccardini N, Kette S, Da Re B, Nicolosi S, Zuccon U, Confalonieri M, Mondini L, Pozzan R, Hughes M, Confalonieri P, Salton F. Functional Progression after Dose Suspension or Discontinuation of Nintedanib in Idiopathic Pulmonary Fibrosis: A Real-Life Multicentre Study. Pharmaceuticals (Basel) 2024; 17:119. [PMID: 38256952 PMCID: PMC10820810 DOI: 10.3390/ph17010119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease with rapidly progressive evolution and an unfavorable outcome. Nintedanib (NTD) is an antifibrotic drug that has been shown to be effective in slowing down the progression of the disease. The aim of our study was to examine the efficacy, especially in terms of the functional decline, and the safety profile of NTD in patients treated with the recommended dose and subjects who reduced or suspended the therapy due to the occurrence of adverse reactions. METHODS We conducted a real-life retrospective study based on the experience of NTD use in two centers between 2015 and 2022. Clinical data were evaluated at baseline, at 6 and 12 months after the NTD introduction in the whole population and in subgroups of patients who continued the full-dose treatment, at a reduced dosage, and at the discontinuation of treatment. The following data were recorded: the demographic features, IPF clinical features, NTD therapeutic dosage, tolerability and adverse events, pulmonary function tests (PFTs), the duration of treatment upon discontinuation, and the causes of interruption. RESULTS There were 54 IPF patients who were included (29.6% females, with a median (IQR) age at baseline of 75 (69.0-79.0) years). Twelve months after the introduction of the NTD therapy, 20 (37%) patients were still taking the full dose, 11 (20.4%) had reduced it to 200 mg daily, and 15 (27.8%) had stopped treatment. Gastrointestinal intolerance predominantly led to the dose reduction (13.0%) and treatment cessation (20.4%). There were two deaths within the initial 6 months (3.7%) and seven (13.0%) within 12 months. Compared to the baseline, the results of the PFTs remained stable at 6 and 12 months for the entire NTD-treated population, except for a significant decline in the DLCO (% predicted value) at both 6 (38.0 ± 17.8 vs. 43.0 ± 26.0; p = 0.041) and 12 months (41.5 ± 15.3 vs. 44.0 ± 26.8; p = 0.048). The patients who continued treatment at the full dose or a reduced dosage showed no significant differences in the FVC and the DLCO at 12 months. Conversely, those discontinuing the NTD exhibited a statistically significant decline in the FVC (% predicted value) at 12 months compared to the baseline (55.0 ± 13.5 vs. 70.0 ± 23.0; p = 0.035). CONCLUSIONS This study highlights the functional decline of the FVC at 12 months after the NTD initiation among patients discontinuing therapy but not among those reducing their dosage.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (A.S.); (N.R.); (S.K.); (B.D.R.); (S.N.); (L.M.); (P.C.)
| | - Andrea Salotti
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (A.S.); (N.R.); (S.K.); (B.D.R.); (S.N.); (L.M.); (P.C.)
| | - Nicolò Reccardini
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (A.S.); (N.R.); (S.K.); (B.D.R.); (S.N.); (L.M.); (P.C.)
| | - Stefano Kette
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (A.S.); (N.R.); (S.K.); (B.D.R.); (S.N.); (L.M.); (P.C.)
| | - Beatrice Da Re
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (A.S.); (N.R.); (S.K.); (B.D.R.); (S.N.); (L.M.); (P.C.)
| | - Salvatore Nicolosi
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (A.S.); (N.R.); (S.K.); (B.D.R.); (S.N.); (L.M.); (P.C.)
| | - Umberto Zuccon
- Pulmonology Unit, General Hospital “Santa Maria degli Angeli”, 33170 Pordenone, Italy; (U.Z.); (R.P.)
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (A.S.); (N.R.); (S.K.); (B.D.R.); (S.N.); (L.M.); (P.C.)
| | - Lucrezia Mondini
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (A.S.); (N.R.); (S.K.); (B.D.R.); (S.N.); (L.M.); (P.C.)
| | - Riccardo Pozzan
- Pulmonology Unit, General Hospital “Santa Maria degli Angeli”, 33170 Pordenone, Italy; (U.Z.); (R.P.)
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK;
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (A.S.); (N.R.); (S.K.); (B.D.R.); (S.N.); (L.M.); (P.C.)
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (A.S.); (N.R.); (S.K.); (B.D.R.); (S.N.); (L.M.); (P.C.)
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Confalonieri P, Salton F, Confalonieri M, Pozzan R, Ruaro B. Advances in Diagnostics and Management of Respiratory System Diseases. Diagnostics (Basel) 2023; 14:20. [PMID: 38201329 PMCID: PMC10795565 DOI: 10.3390/diagnostics14010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
Recently, significant innovations in the diagnosis and management of respiratory diseases have been developed [...].
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Affiliation(s)
- Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Azienda Ospedaliera Santa Maria degli Angeli, 33170 Pordenone, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy
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Ruaro B, Pozzan R, Andrisano AG, Confalonieri M, Ambhore NS. Editorial: Evolution in respiratory pharmacology. Front Pharmacol 2023; 14:1329811. [PMID: 38044952 PMCID: PMC10691532 DOI: 10.3389/fphar.2023.1329811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, Trieste, Italy
- Pulmonology Unit, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - Alessia Giovanna Andrisano
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, Trieste, Italy
- Pulmonology Unit, Ospedale Civile di Gorizia, Gorizia, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, Trieste, Italy
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Vetrugno L, Castaldo N, Fantin A, Deana C, Cortegiani A, Longhini F, Forfori F, Cammarota G, Grieco DL, Isola M, Navalesi P, Maggiore SM, Bassetti M, Chetta A, Confalonieri M, De Martino M, Ferrari G, Francisi D, Luzzati R, Meini S, Scozzafava M, Sozio E, Tascini C, Bassi F, Patruno V, De Robertis E, Aldieri C, Ball L, Baratella E, Bartoletti M, Boscolo A, Burgazzi B, Catalanotti V, Confalonieri P, Corcione S, De Rosa FG, De Simoni A, Bono VD, Tria RD, Forlani S, Giacobbe DR, Granozzi B, Labate L, Lococo S, Lupia T, Matellon C, Mehrabi S, Morosi S, Mongodi S, Mura M, Nava S, Pol R, Pettenuzzo T, Quyen NH, Rescigno C, Righi E, Ruaro B, Salton F, Scabini S, Scarda A, Sibani M, Tacconelli E, Tartaglione G, Tazza B, Vania E, Viale P, Vianello A, Visentin A, Zuccon U, Meroi F, Buonsenso D. Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study). Pulmonology 2023; 29:457-468. [PMID: 36669936 PMCID: PMC9684110 DOI: 10.1016/j.pulmoe.2022.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication. METHODS This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death. RESULTS We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001). CONCLUSIONS C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality. TRIAL REGISTRATION this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.
| | - Nadia Castaldo
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Alberto Fantin
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy; Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, AOUP-Pisa, Italy
| | - Gianmaria Cammarota
- Anesthesia and Intensive Care Service 2, University Hospital of Perugia, Perugia, Italy; Department of Medicine and Surgery, Universiy of Perugia, Perugia, Italy
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Department of Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Miriam Isola
- Department of Medicine, University of Udine, Udine, Italy
| | - Paolo Navalesi
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy; Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alfredo Chetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | | | - Giovanni Ferrari
- Pneumologia e Unità di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano, Turin, Italy
| | - Daniela Francisi
- Department of Infectious Disease "S. Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Roberto Luzzati
- Infectious Disease Unit, University of Trieste, Trieste, Italy
| | - Simone Meini
- U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | | | - Emanuela Sozio
- Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy; Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Edoardo De Robertis
- Anesthesia and Intensive Care Service 2, University Hospital of Perugia, Perugia, Italy; Department of Medicine and Surgery, Universiy of Perugia, Perugia, Italy
| | - Chiara Aldieri
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Elisa Baratella
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Annalisa Boscolo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Barbara Burgazzi
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vito Catalanotti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy; Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy
| | - Alessandro De Simoni
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Valerio Del Bono
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Roberta Di Tria
- Pneumologia e Unità di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano, Turin, Italy
| | - Sara Forlani
- Pulmonary Medicine Unit, Lodi General Hospital, Lodi, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Bianca Granozzi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Laura Labate
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Sara Lococo
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Tommaso Lupia
- Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy
| | - Carola Matellon
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Sara Mehrabi
- Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, Verona, Italy
| | - Sabrina Morosi
- Department of Infectious Disease "S. Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Silvia Mongodi
- Anaesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maddalena Mura
- U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy; Respiratory and Critical Care Unit, Sant Orsola University Hospital, Bologna, Italy
| | - Riccardo Pol
- Infectious Disease Unit, University of Trieste, Trieste, Italy
| | - Tommaso Pettenuzzo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Nguyen Hoang Quyen
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Carolina Rescigno
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Elda Righi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Silvia Scabini
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Angelo Scarda
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - Marcella Sibani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Evelina Tacconelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gennaro Tartaglione
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - Beatrice Tazza
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Eleonora Vania
- Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Andrea Vianello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Visentin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Umberto Zuccon
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Di Maggio G, Confalonieri P, Salton F, Trotta L, Ruggero L, Kodric M, Geri P, Hughes M, Bellan M, Gilio M, Lerda S, Baratella E, Confalonieri M, Mondini L, Ruaro B. Biomarkers in Systemic Sclerosis: An Overview. Curr Issues Mol Biol 2023; 45:7775-7802. [PMID: 37886934 PMCID: PMC10604992 DOI: 10.3390/cimb45100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Systemic sclerosis (SSc) is a complex autoimmune disease characterized by significant fibrosis of the skin and internal organs, with the main involvement of the lungs, kidneys, heart, esophagus, and intestines. SSc is also characterized by macro- and microvascular damage with reduced peripheral blood perfusion. Several studies have reported more than 240 pathways and numerous dysregulation proteins, giving insight into how the field of biomarkers in SSc is still extremely complex and evolving. Antinuclear antibodies (ANA) are present in more than 90% of SSc patients, and anti-centromere and anti-topoisomerase I antibodies are considered classic biomarkers with precise clinical features. Recent studies have reported that trans-forming growth factor β (TGF-β) plays a central role in the fibrotic process. In addition, interferon regulatory factor 5 (IRF5), interleukin receptor-associated kinase-1 (IRAK-1), connective tissue growth factor (CTGF), transducer and activator of transcription signal 4 (STAT4), pyrin-containing domain 1 (NLRP1), as well as genetic factors, including DRB1 alleles, are implicated in SSc damage. Several interleukins (e.g., IL-1, IL-6, IL-10, IL-17, IL-22, and IL-35) and chemokines (e.g., CCL 2, 5, 23, and CXC 9, 10, 16) are elevated in SSc. While adiponectin and maresin 1 are reduced in patients with SSc, biomarkers are important in research but will be increasingly so in the diagnosis and therapeutic approach to SSc. This review aims to present and highlight the various biomarker molecules, pathways, and receptors involved in the pathology of SSc.
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Affiliation(s)
- Giuseppe Di Maggio
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Luca Ruggero
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Metka Kodric
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Pietro Geri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK;
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Medicine, Azienda Ospedaliero–Universitaria, Maggiore della Carità, 28100 Novara, Italy
| | - Michele Gilio
- Infectious Disease Unit, San Carlo Hospital, 85100 Potenza, Italy
| | - Selene Lerda
- Graduate School, University of Milan, 20149 Milano, Italy
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
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10
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Cifaldi R, Salton F, Confalonieri P, Trotta L, Barbieri M, Ruggero L, Valeri G, Pozzan R, Della Porta R, Kodric M, Baratella E, Bellan M, Lerda S, Hughes M, Confalonieri M, Cova MA, Gandin I, Mondini L, Ruaro B. Pulmonary Sarcoidosis and Immune Dysregulation: A Pilot Study on Possible Correlation. Diagnostics (Basel) 2023; 13:2899. [PMID: 37761266 PMCID: PMC10530165 DOI: 10.3390/diagnostics13182899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Sarcoidosis is a systemic inflammatory disease characterized by an altered inflammatory response. OBJECTIVE The aim of this study was to evaluate whether immune system alterations detected by lymphocyte typing in peripheral blood correlate with the severity of sarcoidosis, calculated according to two separate severity scores proposed by Wasfi in 2006 and Hamzeh in 2010. MATERIALS AND METHODS Eighty-one patients were recruited, and clinical data and laboratory tests at the time of diagnosis were obtained in order to assess the severity index score and investigate any statistically significant correlation with the cytofluorimetry data. RESULTS Our data demonstrated that none of the two scores show an association with the level of total lymphocytes or lymphocyte subclasses. LIMITATIONS First of all, the sample taken into consideration is small. The assessment was performed only at disease onset and not during the disease. Furthermore, the severity scores do not take into account disease activity (measured by PET/CT or gallium scintigraphy). CONCLUSIONS Lymphocyte subpopulation values at the time of diagnosis do not appear to correlate with disease severity at onset.
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Affiliation(s)
- Rossella Cifaldi
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Luca Ruggero
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Gianmaria Valeri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Rossana Della Porta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Metka Kodric
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Elisa Baratella
- Department of Radiology, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine, University Hospital, Maggiore della Carità, 28100 Novara, Italy
| | - Selene Lerda
- Management Specialization School, University of Milan, 20149 Milano, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Ilaria Gandin
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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11
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Salton F, Confalonieri P, Torregiani C, Ruaro B, Confalonieri M. Higher, but Not Too High, Dose Is Only One Determinant of Corticosteroid Treatment Success in Severe COVID-19. Ann Am Thorac Soc 2023; 20:1371. [PMID: 37343288 PMCID: PMC10502891 DOI: 10.1513/annalsats.202304-329le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/21/2023] [Indexed: 06/23/2023] Open
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12
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Ganzinelli M, Guffanti F, Ianza A, Sobhani N, Crovella S, Zanconati F, Bottin C, Confalonieri M, Fumagalli S, Guglielmi A, Generali D, Damia G. Epithelioid Mesothelioma Patients with Very Long Survival Display Defects in DNA Repair. Cancers (Basel) 2023; 15:4309. [PMID: 37686585 PMCID: PMC10486625 DOI: 10.3390/cancers15174309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
AIM DNA repair has an important role in malignant pleural mesothelioma (MPM) tumorigenesis and progression. Prognostic/predictive biomarkers for better management of MPM patients are needed. In the present manuscript, we analyzed the expression of more than 700 genes in a cohort of MPM patients to possibly find biomarkers correlated with survival. METHODS A total of 54 MPM patients, all with epithelioid histology, whose survival follow-up and formalin-fixed paraffin-embedded tumors were available, were included in the study. Gene expression profiles were evaluated using a Nanostring platform analyzing 760 genes involved in different cellular pathways. The percentages of proliferating tumor cells positive for RAD51 and BRCA1 foci were evaluated using an immunofluorescence assay, as a readout of homologous recombination repair status. RESULTS Patient median survival time was 16.9 months, and based on this value, they were classified as long and short survivors (LS/SS) with, respectively, an overall survival ≥ and <16.9 months as well as very long and very short survivors (VLS/VSS) with an overall survival ≥ than 33.8 and < than 8.45 months. A down-regulation in the DNA damage/repair expression score was observed in LS and VLS as compared to SS and VSS. These findings were validated by the lower number of both RAD51 and BRCA1-positive tumor cells in VLS as compared to VSS. CONCLUSIONS The down-regulation of DNA repair signature in VLS was functionally validated by a lower % of RAD51 and BRCA1-positive tumor cells. If these data can be corroborated in a prospective trial, an easy, cost-effective test could be routinely used to better manage treatment in MPM patients.
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Affiliation(s)
- Monica Ganzinelli
- Unit of Thoracic Oncology, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Federica Guffanti
- Laboratory of Preclinical Gynecological Oncology, Department of Experimental Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Anna Ianza
- Oncology Department, University Health Organization Giuliano Isontina, ASUGI, Piazza Ospitale 1, 34129 Trieste, Italy; (A.I.); (A.G.); (D.G.)
| | - Navid Sobhani
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy; (N.S.); (F.Z.); (C.B.); (M.C.)
| | - Sergio Crovella
- IRCCS Burlo Garofolo, Via dell’Istria 65/1, 34137 Trieste, Italy;
| | - Fabrizio Zanconati
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy; (N.S.); (F.Z.); (C.B.); (M.C.)
| | - Cristina Bottin
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy; (N.S.); (F.Z.); (C.B.); (M.C.)
| | - Marco Confalonieri
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34139 Trieste, Italy; (N.S.); (F.Z.); (C.B.); (M.C.)
| | - Stefano Fumagalli
- Laboratory of Biology of Neurodegenerative Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Alessandra Guglielmi
- Oncology Department, University Health Organization Giuliano Isontina, ASUGI, Piazza Ospitale 1, 34129 Trieste, Italy; (A.I.); (A.G.); (D.G.)
| | - Daniele Generali
- Oncology Department, University Health Organization Giuliano Isontina, ASUGI, Piazza Ospitale 1, 34129 Trieste, Italy; (A.I.); (A.G.); (D.G.)
| | - Giovanna Damia
- Laboratory of Preclinical Gynecological Oncology, Department of Experimental Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
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Volpe MC, Ciucci G, Zandomenego G, Vuerich R, Ring NAR, Vodret S, Salton F, Marchesan P, Braga L, Marcuzzo T, Bussani R, Colliva A, Piazza S, Confalonieri M, Zacchigna S. Flt1 produced by lung endothelial cells impairs ATII cell transdifferentiation and repair in pulmonary fibrosis. Cell Death Dis 2023; 14:437. [PMID: 37454154 PMCID: PMC10349845 DOI: 10.1038/s41419-023-05962-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Pulmonary fibrosis is a devastating disease, in which fibrotic tissue progressively replaces lung alveolar structure, resulting in chronic respiratory failure. Alveolar type II cells act as epithelial stem cells, being able to transdifferentiate into alveolar type I cells, which mediate gas exchange, thus contributing to lung homeostasis and repair after damage. Impaired epithelial transdifferentiation is emerging as a major pathogenetic mechanism driving both onset and progression of fibrosis in the lung. Here, we show that lung endothelial cells secrete angiocrine factors that regulate alveolar cell differentiation. Specifically, we build on our previous data on the anti-fibrotic microRNA-200c and identify the Vascular Endothelial Growth Factor receptor 1, also named Flt1, as its main functional target in endothelial cells. Endothelial-specific knockout of Flt1 reproduces the anti-fibrotic effect of microRNA-200c against pulmonary fibrosis and results in the secretion of a pool of soluble factors and matrix components able to promote epithelial transdifferentiation in a paracrine manner. Collectively, these data indicate the existence of a complex endothelial-epithelial paracrine crosstalk in vitro and in vivo and position lung endothelial cells as a relevant therapeutic target in the fight against pulmonary fibrosis.
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Affiliation(s)
- Maria Concetta Volpe
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Giulio Ciucci
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Giulia Zandomenego
- Department of Life Sciences, University of Trieste, Trieste, Italy
- Functional Cell Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Roman Vuerich
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Nadja Anneliese Ruth Ring
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
- Ludwig Boltzmann Gesellschaft Research Group Senescence and Healing of Wounds, Vienna, Austria
| | - Simone Vodret
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, University Hospital of Cattinara, Trieste, Italy
| | - Pietro Marchesan
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Luca Braga
- Functional Cell Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Thomas Marcuzzo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Rossana Bussani
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Colliva
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Silvano Piazza
- Computational Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, University Hospital of Cattinara, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Serena Zacchigna
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy.
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
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Salton F, Confalonieri P, Meduri GU, Mondini L, Trotta L, Barbieri M, Bozzi C, Torregiani C, Lerda S, Bellan M, Confalonieri M, Ruaro B, Tavano S, Pozzan R. Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter-A Critical Review and Viewpoints. Pharmaceuticals (Basel) 2023; 16:924. [PMID: 37513836 PMCID: PMC10385094 DOI: 10.3390/ph16070924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Prolonged, low-dose glucocorticoids (GCs) have shown the highest efficacy among pharmacological and non-pharmacological treatments for COVID-19. Despite the World Health Organization's recommendation against their use at the beginning of the pandemic, GCs at a dose equivalent to dexamethasone 6 mg/day for 10 days are now indicated in all COVID-19 cases who require respiratory support. However, the efficacy of the intervention depends on the timing of initiation, the dose, and other individual factors. Indeed, patients treated with similar GC protocols often experience different outcomes, which do not always correlate with the presence of comorbidities or with the severity of respiratory involvement at baseline. This prompted us to critically review the literature on the rationale, pharmacological principles, and clinical evidence that should guide GC treatment. Based on these data, the best treatment protocol probably involves an initial bolus dose to saturate the glucocorticoid receptors, followed by a continuous infusion to maintain constant plasma levels, and eventually a slow tapering to interruption. Methylprednisolone has shown the highest efficacy among different GC molecules, most likely thanks to its higher ability to penetrate the lung. Decreased tissue sensitivity to glucocorticoids is thought to be the main mechanism accounting for the lower response to the treatment in some individuals. We do not have a readily available test to identify GC resistance; therefore, to address inter-individual variability, future research should aim at investigating clinical, physiological, and laboratory markers to guide a personalized GC treatment approach.
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Affiliation(s)
- Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Gianfranco Umberto Meduri
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Bozzi
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Torregiani
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Selene Lerda
- Business School, University of Milano, 20149 Milano, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- A.O.U. Maggiore della Carità, 28100 Novara, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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15
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Balduit A, Vidergar R, Zacchi P, Mangogna A, Agostinis C, Grandolfo M, Bottin C, Salton F, Confalonieri P, Rocca A, Zanconati F, Confalonieri M, Kishore U, Ghebrehiwet B, Bulla R. Complement protein C1q stimulates hyaluronic acid degradation via gC1qR/HABP1/p32 in malignant pleural mesothelioma. Front Immunol 2023; 14:1151194. [PMID: 37334363 PMCID: PMC10275365 DOI: 10.3389/fimmu.2023.1151194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Complement component C1q can act as a pro-tumorigenic factor in the tumor microenvironment (TME). The TME in malignant pleural mesothelioma (MPM) is rich in C1q and hyaluronic acid (HA), whose interaction enhances adhesion, migration and proliferation of malignant cells. HA-bound C1q is also capable of modulating HA synthesis. Thus, we investigated whether HA-C1q interaction would affect HA degradation, analyzing the main degradation enzymes, hyaluronidase (HYAL)1 and HYAL2, and a C1q receptor candidate. We first proceeded with the characterization of HYALs in MPM cells, especially HYAL2, since bioinformatics survival analysis revealed that higher HYAL2 mRNA levels have an unfavorable prognostic index in MPM patients. Interestingly, Real-Time quantitative PCR, flow cytometry and Western blot highlighted an upregulation of HYAL2 after seeding of primary MPM cells onto HA-bound C1q. In an attempt to unveil the receptors potentially involved in HA-C1q signaling, a striking co-localization between HYAL2 and globular C1q receptor/HABP1/p32 (gC1qR) was found by immunofluorescence, surface biotinylation and proximity ligation assays. RNA interference experiments revealed a potentially regulatory function exerted by gC1qR on HYAL2 expression, since C1QBP (gene for gC1qR) silencing unexpectedly caused HYAL2 downregulation. In addition, the functional blockage of gC1qR by a specific antibody hindered HA-C1q signaling and prevented HYAL2 upregulation. Thus, C1q-HA interplay is responsible for enhanced HYAL2 expression, suggesting an increased rate of HA catabolism and the release of pro-inflammatory and pro-tumorigenic HA fragments in the MPM TME. Our data support the notion of an overall tumor-promoting property of C1q. Moreover, the overlapping localization and physical interaction between HYAL2 and gC1qR suggests a potential regulatory effect of gC1qR within a putative HA-C1q macromolecular complex.
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Affiliation(s)
- Andrea Balduit
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Burlo Garofolo, Trieste, Italy
| | - Romana Vidergar
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Paola Zacchi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Burlo Garofolo, Trieste, Italy
| | - Chiara Agostinis
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Burlo Garofolo, Trieste, Italy
| | - Micaela Grandolfo
- Neuroscience Area, International School for Advanced Studies (SISSA), Trieste, Italy
| | - Cristina Bottin
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Francesco Salton
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Paola Confalonieri
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Andrea Rocca
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Fabrizio Zanconati
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
- Struttura Complessa di Anatomia ed Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Confalonieri
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Uday Kishore
- Department of Veterinary Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Berhane Ghebrehiwet
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Roberta Bulla
- Department of Life Sciences, University of Trieste, Trieste, Italy
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16
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Mondini L, Confalonieri P, Pozzan R, Ruggero L, Trotta L, Lerda S, Hughes M, Bellan M, Confalonieri M, Ruaro B, Salton F, Tavano S. Microvascular Alteration in COVID-19 Documented by Nailfold Capillaroscopy. Diagnostics (Basel) 2023; 13:diagnostics13111905. [PMID: 37296759 DOI: 10.3390/diagnostics13111905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
COVID-19 is a multisystemic disease that mainly affects and causes dysregulation of the endothelium, causing systemic manifestations. A nailfold video capillaroscopy is a safe, easy, and noninvasive method to evaluate microcirculation alteration. In this review, we analyzed the literature available to date regarding the object of nailfold video capillaroscopy (NVC) use in patients with a SARS-CoV-2 infection, both in the acute phase and after discharge. The scientific evidence pointed out the main alterations in capillary circulation shown by NVC, so reviewing the findings of each article allowed us to define and analyze the future prospects and needs for possibly including NVC within the management of patients with COVID-19, both during and after the acute phase.
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Affiliation(s)
- Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Luca Ruggero
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Selene Lerda
- Graduate School, University of Milan, 20149 Milano, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Azienda Ospedaliero-Universitaria, Maggiore della Carità, 28100 Novara, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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Ruaro B, Baron M, Rosato E, Martini R, Confalonieri M. Special Issue "Rheumatic Diseases: Pathophysiology, Targeted Therapy, Focus on Vascular and Pulmonary Manifestations 2022". Pharmaceuticals (Basel) 2023; 16:ph16050652. [PMID: 37242435 DOI: 10.3390/ph16050652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
This Special Issue, titled "Rheumatic Diseases: Pathophysiology, Targeted Therapy, Focus on Vascular and Pulmonary Manifestations", aims to demonstrate recent and new advances and future trends in the field of rheumatic diseases [...].
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Affiliation(s)
- Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, QC 3755, Canada
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Romeo Martini
- Unit of Angiology, AULSS 1 Dolomiti, Ospedale San Martino, 32100 Belluno, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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18
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Ligresti G, Raslan AA, Hong J, Caporarello N, Confalonieri M, Huang SK. Mesenchymal cells in the Lung: Evolving concepts and their role in fibrosis. Gene 2023; 859:147142. [PMID: 36603696 PMCID: PMC10068350 DOI: 10.1016/j.gene.2022.147142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023]
Abstract
Mesenchymal cells in the lung are crucial during development, but also contribute to the pathogenesis of fibrotic disorders, including idiopathic pulmonary fibrosis (IPF), the most common and deadly form of fibrotic interstitial lung diseases. Originally thought to behave as supporting cells for the lung epithelium and endothelium with a singular function of producing basement membrane, mesenchymal cells encompass a variety of cell types, including resident fibroblasts, lipofibroblasts, myofibroblasts, smooth muscle cells, and pericytes, which all occupy different anatomic locations and exhibit diverse homeostatic functions in the lung. During injury, each of these subtypes demonstrate remarkable plasticity and undergo varying capacity to proliferate and differentiate into activated myofibroblasts. Therefore, these cells secrete high levels of extracellular matrix (ECM) proteins and inflammatory cytokines, which contribute to tissue repair, or in pathologic situations, scarring and fibrosis. Whereas epithelial damage is considered the initial trigger that leads to lung injury, lung mesenchymal cells are recognized as the ultimate effector of fibrosis and attempts to better understand the different functions and actions of each mesenchymal cell subtype will lead to a better understanding of why fibrosis develops and how to better target it for future therapy. This review summarizes current findings related to various lung mesenchymal cells as well as signaling pathways, and their contribution to the pathogenesis of pulmonary fibrosis.
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Affiliation(s)
- Giovanni Ligresti
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, US.
| | - Ahmed A Raslan
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, US
| | - Jeongmin Hong
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, US
| | - Nunzia Caporarello
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, US
| | - Marco Confalonieri
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Steven K Huang
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, US
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Mondini L, Salton F, Trotta L, Bozzi C, Pozzan R, Barbieri M, Tavano S, Lerda S, Hughes M, Confalonieri M, Confalonieri P, Ruaro B. Host-Based Treatments for Severe COVID-19. Curr Issues Mol Biol 2023; 45:3102-3121. [PMID: 37185727 PMCID: PMC10136924 DOI: 10.3390/cimb45040203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 05/17/2023] Open
Abstract
COVID-19 has been a global health problem since 2020. There are different spectrums of manifestation of this disease, ranging from asymptomatic to extremely severe forms requiring admission to intensive care units and life-support therapies, mainly due to severe pneumonia. The progressive understanding of this disease has allowed researchers and clinicians to implement different therapeutic alternatives, depending on both the severity of clinical involvement and the causative molecular mechanism that has been progressively explored. In this review, we analysed the main therapeutic options available to date based on modulating the host inflammatory response to SARS-CoV-2 infection in patients with severe and critical illness. Although current guidelines are moving toward a personalised treatment approach titrated on the timing of presentation, disease severity, and laboratory parameters, future research is needed to identify additional biomarkers that can anticipate the disease course and guide targeted interventions on an individual basis.
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Affiliation(s)
- Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Bozzi
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Selene Lerda
- Graduate School, University of Milan, 20149 Milano, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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Ruaro B, Tavano S, Confalonieri P, Pozzan R, Hughes M, Braga L, Volpe MC, Ligresti G, Andrisano AG, Lerda S, Geri P, Biolo M, Baratella E, Confalonieri M, Salton F. Transbronchial lung cryobiopsy and pulmonary fibrosis: A never-ending story? Heliyon 2023; 9:e14768. [PMID: 37025914 PMCID: PMC10070648 DOI: 10.1016/j.heliyon.2023.e14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Background The diagnostic process of pulmonary fibrosis (PF) is often challenging, requires a collaborative effort of several experts, and often requires bioptic material, which can be difficult to obtain, both in terms of quality and technique. The main procedures available to obtain such samples are transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB). Objective The purpose of this paper is to review the evidence for the role of TBLC in the diagnostic-therapeutic process of PF. Methods A comprehensive review was performed to identify articles to date that addressed the role of TBLC in the diagnostic-therapeutic process of PF using the PubMed® database. Results The reasoned search identified 206 papers, including 21 manuscripts (three reviews, one systematic review, two guidelines, two prospective studies, three retrospective studies, one cross-sectional study, one original article, three editorials, three clinical trials, and two unclassifiable studies), which were included in the final review. Conclusions TBLC is gaining increasing efficacy and improving safety profile; however, there are currently no clear data demonstrating its superiority over SLB. Therefore, the two techniques should be considered with careful rationalization on a case-by-case basis. Further research is needed to further optimize and standardize the procedure and to thoroughly study the histological and molecular characteristics of PF.
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21
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Apostolo D, D’Onghia D, Tonello S, Minisini R, Baricich A, Gramaglia C, Patrucco F, Zeppegno P, Acquaviva A, Balbo PE, Castello LM, Cappellano G, Chiocchetti A, Gerevini C, Giordano M, Laaguid F, Manfredi M, Raineri D, Rigamonti C, Rolla R, Romano V, Confalonieri M, Savoia P, Zavattaro E, Pirisi M, Ruaro B, Sainaghi PP, Bellan M. Decreased Gas6 and sAxl Plasma Levels Are Associated with Hair Loss in COVID-19 Survivors. Int J Mol Sci 2023; 24:ijms24076257. [PMID: 37047229 PMCID: PMC10094682 DOI: 10.3390/ijms24076257] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Post-acute conditions after coronavirus disease 2019 (COVID-19) are quite common, although the underlying pathogenetic mechanisms leading to these conditions are not yet completely understood. In this prospective observational study, we aimed to test the hypothesis that Growth Arrest-Specific 6 (Gas6) and its soluble receptors, Axl (sAxl) and MerTK (sMer), might be implicated. A total of 263 subjects underwent a structured clinical evaluation one year after their hospital discharge for COVID-19, and they consented to donate a blood sample to measure their circulating Gas6, sAxl, and sMer levels. A total of 98 (37.3%) post-COVID-19 subjects complained of at least one residual physical symptom one year after their hospital discharge. Univariate analysis revealed that sAxl was marginally associated with residual symptoms, but at the level of logistic regression analysis, only the diffusing capacity of the lungs for carbon monoxide (DLCO) (OR 0.98, CI 95%: 0.96–0.99; p = 0.007) and the female sex (OR 2.49, CI 95%: 1.45–4.28; p = 0.001) were independently associated with long-lasting symptoms. A total of 69 (26.2%) subjects had hair loss. At the level of univariate analysis, Gas6, sAxl, DLCO, and the female gender were associated with its development. In a logistic regression analysis model, Gas6 (OR 0.96, CI 95%: 0.92–0.99; p = 0.015) and sAxl (OR 0.98, CI 95%; 0.97–1.0; p = 0.014), along with the female sex (OR 6.58, CI 95%: 3.39–12.78; p = 0.0001), were independent predictors of hair loss. Decreased levels of Gas6 and sAxl were associated with a history of hair loss following COVID-19. This was resolved spontaneously in most patients, although 23.7% complained of persistent hair loss one year after hospital discharge.
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22
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Albers J, Wagner WL, Fiedler MO, Rothermel A, Wünnemann F, Di Lillo F, Dreossi D, Sodini N, Baratella E, Confalonieri M, Arfelli F, Kalenka A, Lotz J, Biederer J, Wielpütz MO, Kauczor HU, Alves F, Tromba G, Dullin C. High resolution propagation-based lung imaging at clinically relevant X-ray dose levels. Sci Rep 2023; 13:4788. [PMID: 36959233 PMCID: PMC10036329 DOI: 10.1038/s41598-023-30870-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
Absorption-based clinical computed tomography (CT) is the current imaging method of choice in the diagnosis of lung diseases. Many pulmonary diseases are affecting microscopic structures of the lung, such as terminal bronchi, alveolar spaces, sublobular blood vessels or the pulmonary interstitial tissue. As spatial resolution in CT is limited by the clinically acceptable applied X-ray dose, a comprehensive diagnosis of conditions such as interstitial lung disease, idiopathic pulmonary fibrosis or the characterization of small pulmonary nodules is limited and may require additional validation by invasive lung biopsies. Propagation-based imaging (PBI) is a phase sensitive X-ray imaging technique capable of reaching high spatial resolutions at relatively low applied radiation dose levels. In this publication, we present technical refinements of PBI for the characterization of different artificial lung pathologies, mimicking clinically relevant patterns in ventilated fresh porcine lungs in a human-scale chest phantom. The combination of a very large propagation distance of 10.7 m and a photon counting detector with [Formula: see text] pixel size enabled high resolution PBI CT with significantly improved dose efficiency, measured by thermoluminescence detectors. Image quality was directly compared with state-of-the-art clinical CT. PBI with increased propagation distance was found to provide improved image quality at the same or even lower X-ray dose levels than clinical CT. By combining PBI with iodine k-edge subtraction imaging we further demonstrate that, the high quality of the calculated iodine concentration maps might be a potential tool for the analysis of lung perfusion in great detail. Our results indicate PBI to be of great value for accurate diagnosis of lung disease in patients as it allows to depict pathological lesions non-invasively at high resolution in 3D. This will especially benefit patients at high risk of complications from invasive lung biopsies such as in the setting of suspected idiopathic pulmonary fibrosis (IPF).
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Affiliation(s)
- Jonas Albers
- Department for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
- Biological X-ray imaging, European Molecular Biology Laboratory, Hamburg Unit c/o DESY, Hamburg, Germany
| | - Willi L Wagner
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University Heidelberg, Heidelberg, Germany
| | - Mascha O Fiedler
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University Heidelberg, Heidelberg, Germany
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Rothermel
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University Heidelberg, Heidelberg, Germany
| | - Felix Wünnemann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University Heidelberg, Heidelberg, Germany
| | | | - Diego Dreossi
- Elettra-Sincrotrone Trieste S.C.p.A., Trieste, Italy
| | - Nicola Sodini
- Elettra-Sincrotrone Trieste S.C.p.A., Trieste, Italy
| | - Elisa Baratella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Fulvia Arfelli
- Department of Physics, University of Trieste and INFN, Trieste, Italy
| | - Armin Kalenka
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University Heidelberg, Heidelberg, Germany
- Department of Anaesthesiology and Intensive Care Medicine, District Hospital Bergstrasse, Heppenheim, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Joachim Lotz
- Department for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Jürgen Biederer
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University Heidelberg, Heidelberg, Germany
- Faculty of Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Mark O Wielpütz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University Heidelberg, Heidelberg, Germany
| | - Frauke Alves
- Department for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
- Department for Haematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
- Translational Molecular Imaging, Max-Plank-Institute for Multidisciplinary Sciences, Goettingen, Germany
| | | | - Christian Dullin
- Department for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University Heidelberg, Heidelberg, Germany.
- Translational Molecular Imaging, Max-Plank-Institute for Multidisciplinary Sciences, Goettingen, Germany.
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Ruaro B, Gandin I, Pozzan R, Tavano S, Bozzi C, Hughes M, Kodric M, Cifaldi R, Lerda S, Confalonieri M, Baratella E, Confalonieri P, Salton F. Nintedanib in Idiopathic Pulmonary Fibrosis: Tolerability and Safety in a Real Life Experience in a Single Centre in Patients also Treated with Oral Anticoagulant Therapy. Pharmaceuticals (Basel) 2023; 16:307. [PMID: 37259452 PMCID: PMC9959830 DOI: 10.3390/ph16020307] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 10/28/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a rare and severe disease with a median survival of ~3 years. Nintedanib (NTD) has been shown to be useful in controlling interstitial lung disease (ILD) in IPF. Here we describe the experience of NTD use in IPF in a real-life setting. Objective. Our objective was to examine the safety profile and efficacy of nintedanib even in subjects treated with anticoagulants. Clinical data of patients with IPF treated with NTD at our center were retrospectively evaluated at baseline and at 6 and 12 months after the introduction of NTD. The following parameters were recorded: IPF clinical features, NTD tolerability, and pulmonary function tests (PFT) (i.e., Forced Vital Capacity (FVC) and carbon monoxide diffusing capacity (DLCO)). In total, 56 IPF patients (34% female and 66% male, mean onset age: 71 ± 11 years, mean age at baseline: 74 ± 9 years) treated with NTD were identified. At enrollment, HRCT showed an UIP pattern in 45 (80%) and a NSIP in 11 (20%) patients. For FVC and FEV1 we found no significant change between baseline and 6 months, but for DLCO we observed a decrease (p = 0.012). We identified a significant variation between baseline and 12 months for FEV1 (p = 0.039) and for DLCO (p = 0.018). No significant variation was observed for FVC. In the cohort, 18 (32%) individuals suspended NTD and 10 (18%) reduced the dosage. Among individuals that suspended the dosage, 14 (78%) had gastrointestinal (GI) collateral effects (i.e., diarrhea being the most common complaint (67%), followed by nausea/vomiting (17%) and weight loss (6%). Bleeding episodes have also not been reported in patients taking anticoagulant therapy. (61%). One patient died within the first 6 months and two subjects died within the first 12 months. In a real-life clinical scenario, NTD may stabilize the FVC values in IPF patients. However, GI side effects are frequent and NTD dose adjustment may be necessary to retain the drug in IPF patients. This study confirms the safety of NTD, even in patients treated with anticoagulant drugs.
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Affiliation(s)
- Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Ilaria Gandin
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Bozzi
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Metka Kodric
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Rossella Cifaldi
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Selene Lerda
- 24ORE Business School, Via Monte Rosa, 91, 20149 Milano, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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24
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Staltari G, Biasin A, Grassi L, Gerin F, Maschio M, Confalonieri M, Grassi G, Grassi M, Abrami M. Rheological and Low Field NMR Characterisation of Cystic Fibrosis Patient’s Sputum. CHEM BIOCHEM ENG Q 2023. [DOI: 10.15255/cabeq.2022.2119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Affiliation(s)
- Giulia Staltari
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127 Trieste, Italy
| | - Alice Biasin
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127 Trieste, Italy
| | - Lucia Grassi
- Department of Engineering and Architecture, University of Trieste, Via Valerio 6/A, I-34127 Trieste, Italy
| | - Fabio Gerin
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149 Trieste, Italy
| | - Massimo Maschio
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via Dell’Istria, 65, I-34137, Trieste, Italy
| | - Marco Confalonieri
- Cattinara University Hospital, Pulmonology Department, Strada di Fiume 447, I-34149, Trieste, Italy
| | - Gabriele Grassi
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149 Trieste, Italy
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25
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Campochiaro C, De Luca G, Lazzaroni MG, Armentaro G, Spinella A, Vigone B, Ruaro B, Stanziola A, Benfaremo D, De Lorenzis E, Moccaldi B, Bosello SL, Cuomo G, Beretta L, Zanatta E, Giuggioli D, Del Papa N, Airo P, Confalonieri M, Moroncini G, Dagna L, Matucci-Cerinic M. Real-life efficacy and safety of nintedanib in systemic sclerosis-interstitial lung disease: data from an Italian multicentre study. RMD Open 2023; 9:rmdopen-2022-002850. [PMID: 36813476 PMCID: PMC9950968 DOI: 10.1136/rmdopen-2022-002850] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Nintedanib (NTD) has been shown to be effective in systemic sclerosis (SSc)-interstitial lung disease (ILD). Here we describe the efficacy and safety of NTD in a real-life setting. METHODS Patients with SSc-ILD treated with NTD were retrospectively evaluated at 12 months prior to NTD introduction; at baseline and at 12 months after NTD introduction. The following parameters were recorded: SSc clinical features, NTD tolerability, pulmonary function tests and modified Rodnan skin score (mRSS). RESULTS 90 patients with SSc-ILD (65% female, mean age 57.6±13.4 years, mean disease duration 8.8±7.6 years) were identified. The majority were positive for anti-topoisomerase I (75%) and 77 (85%) patients were on immunosuppressants. A significant decline in %predicted forced vital capacity (%pFVC) in the 12 months prior to NTD introduction was observed in 60%. At 12 months after NTD introduction, follow-up data were available for 40 (44%) patients and they showed a stabilisation in %pFVC (64±14 to 62±19, p=0.416). The percentage of patients with significant lung progression at 12 months was significantly lower compared with the previous 12 months (60% vs 17.5%, p=0.007). No significant mRSS change was observed. Gastrointestinal (GI) side effects were recorded in 35 (39%) patients. After a mean time of 3.6±3.1 months, NTD was maintained after dose adjustment in 23 (25%) patients. In nine (10%) patients, NTD was stopped after a median time of 4.5 (1-6) months. During the follow-up, four patients died. CONCLUSIONS In a real-life clinical scenario, NTD, in combination with immunosuppressants, may stabilise lung function. GI side effects are frequent and NTD dose adjustment may be necessary to retain the drug in patients with SSc-ILD.
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Affiliation(s)
- Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele, Milan, Italy .,Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria-Grazia Lazzaroni
- Rheumatology and Clinical Immunology, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | | | - Amelia Spinella
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Vigone
- Scleroderma Clinic, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Ruaro
- Unit of Respiratory Medicine, Ospedale di Cattinara, Trieste, Italy
| | - Anna Stanziola
- Unit of Respiratory Medicine, Federico II University Hospital, Naples, Italy
| | - Devis Benfaremo
- Clinica Medica, Polytechnic University of Marche, Ancona, Italy
| | - Enrico De Lorenzis
- Rheumatology, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Rome, Italy
| | | | - Silvia Laura Bosello
- Rheumatology, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Rome, Italy
| | - Giovanna Cuomo
- Precision Medicine, Universita degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Lorenzo Beretta
- Scleroderma Clinic, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Dilia Giuggioli
- Rheumatology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Paolo Airo
- Rheumatology and Clinical Immunology, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Internal Medicine, University of Florence, Florence, Italy
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26
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Confalonieri M, Braga L, Salton F, Ruaro B, Confalonieri P. Chronic Obstructive Pulmonary Disease Definition: Is It Time to Incorporate the Concept of Failure of Lung Regeneration? Am J Respir Crit Care Med 2023; 207:366-367. [PMID: 36174210 PMCID: PMC9896632 DOI: 10.1164/rccm.202208-1508le] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Marco Confalonieri
- University of TriesteTrieste, Italy,University Hospital of CattinaraTrieste, Italy,Corresponding author (e-mail: )
| | - Luca Braga
- International Centre for Genetic Engineering and BiotechnologyTrieste, Italy
| | - Francesco Salton
- University of TriesteTrieste, Italy,University Hospital of CattinaraTrieste, Italy
| | - Barbara Ruaro
- University of TriesteTrieste, Italy,University Hospital of CattinaraTrieste, Italy
| | - Paola Confalonieri
- University of TriesteTrieste, Italy,University Hospital of CattinaraTrieste, Italy
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27
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D’Oria M, Gandin I, Riccardo P, Hughes M, Lepidi S, Salton F, Confalonieri P, Confalonieri M, Tavano S, Ruaro B. Correlation between Microvascular Damage and Internal Organ Involvement in Scleroderma: Focus on Lung Damage and Endothelial Dysfunction. Diagnostics (Basel) 2022; 13:diagnostics13010055. [PMID: 36611347 PMCID: PMC9818898 DOI: 10.3390/diagnostics13010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is an incurable connective tissue disease characterized by decreased peripheral blood perfusion due to microvascular damage and skin thickening/hardening. The microcirculation deficit is typically secondary to structural vessel damage, which can be assessed morphologically and functionally in a variety of ways, exploiting different technologies. OBJECTIVE This paper focuses on reviewing new studies regarding the correlation between microvascular damage, endothelial dysfunction, and internal organ involvement, particularly pulmonary changes in SSc. METHODS We critically reviewed the most recent literature on the correlation between blood perfusion and organ involvement. RESULTS Many papers have demonstrated the link between structural microcirculatory damage and pulmonary involvement; however, studies that have investigated correlations between microvascular functional impairment and internal organ damage are scarce. Overall, the literature supports the correlation between organ involvement and functional microcirculatory impairment in SSc patients. CONCLUSIONS Morphological and functional techniques appear to be emerging biomarkers in SSc, but obviously need further investigation.
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Affiliation(s)
- Mario D’Oria
- Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Ilaria Gandin
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy
| | - Pozzan Riccardo
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Michael Hughes
- Northern Care Alliance NHS Foundation Trust, Salford Care Organisation and Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M6 8HD, UK
| | - Sandro Lepidi
- Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
- Correspondence: ; Tel.: +39-040-399-4871
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28
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Papa S, Badagliacca R, D´alto M, Ghio S, Argiento P, Brunetti N, Casu G, Cedrone N, Confalonieri M, Corda M, Correale M, D´agostino C, Galgano G, Manzi G, Mercurio V, Mulè M, Paciocco G, Romeo E, Scelsi L, Stolfo D, Vitulo P, Vizza CD. 121 RELEVANCE OF COMORBIDITIES ON INITIAL COMBINATION THERAPY IN PULMONARY ARTERIAL HYPERTENSION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Rationale
Demographic characteristics of pulmonary arterial hypertension (PAH) patients have changed over time, but the effects of cardiovascular risk factors on risk status and pulmonary vascular resistance (PVR) reduction with initial oral combination therapy are not known. Therefore, we tested the relevance of cardiovascular comorbidities in this setting.
Methods
The study enrolled 181 treatment-naive PAH patients with a 6- months (IQR 144-363 days) right heart catheterization and risk assessment after initial oral combination therapy.
Results
Group-A, 96 (53.0%) patients without cardiac comorbidities; Group-B, 54 (29.8%) patients with one cardiac comorbidity; Group-C, 31 (17.1%) patients with ≥2 cardiac comorbidities. Group-C patients were older with a balanced gender distribution. There was a significant difference in PVR reduction moving from the absence to one or ≥2 cardiac comorbidities, respectively, median -45.0%, -30.3%, -24.3%. A ERS/ESC low-risk status was present at first follow-up in 50 (52.0%) patients in Group-A, 19 (35.1%) in Group-B, and 9 (29.0%) in Group-C; a REVEAL 2.0 low-risk status was present at first follow-up in 41 (42.0%) patients in Group-A, 15 (27.7%) in Group-B, and 7 (22.6%) in Group-C. Group-A patients were 2.3 times more likely to achieve/maintain a low risk status compared with Group-B and -C (OR 2.27, 95% C.I. 1.15-4.54, p=0.02). No significant difference was observed between patients with non-cardiac comorbidities and those without comorbidities.
Conclusion
Initial oral combination therapy seems associated with a less effective response for patients with cardiovascular comorbidities compared with the others, related to the magnitude of treatment- induced decrease in PVR.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Marco Confalonieri
- University Of Trieste Clinical Department Of Medical Surgical And Health Sciences
| | | | | | | | | | | | | | | | | | | | | | | | - Patrizio Vitulo
- Istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione
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Salton F, Kette S, Confalonieri P, Fonda S, Lerda S, Hughes M, Confalonieri M, Ruaro B. Clinical Evaluation of the ButterfLife Device for Simultaneous Multiparameter Telemonitoring in Hospital and Home Settings. Diagnostics (Basel) 2022; 12:diagnostics12123115. [PMID: 36553122 PMCID: PMC9777180 DOI: 10.3390/diagnostics12123115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
We conducted a two-phase study to test the reliability and usability of an all-in-one artificial intelligence-based device (ButterfLife), which allows simultaneous monitoring of five vital signs. The first phase of the study aimed to test the agreement between measurements performed with ButterfLife vs. standard of care (SoC) in 42 hospitalized patients affected by acute respiratory failure. In this setting, the greatest discordance between ButterfLife and SoC was in respiratory rate (mean difference -4.69 bpm). Significantly close correlations were observed for all parameters except diastolic blood pressure and oxygen saturation (Spearman's Rho -0.18 mmHg; p = 0.33 and 0.20%; p = 0.24, respectively). The second phase of the study was conducted on eight poly-comorbid patients using ButterfLife at home, to evaluate the number of clinical conditions detected, as well as the patients' compliance and satisfaction. The average proportion of performed tests compared with the scheduled number was 67.4%, and no patients reported difficulties with use. Seven conditions requiring medical attention were identified, with a sensitivity of 100% and specificity of 88.9%. The median patient satisfaction was 9.5/10. In conclusion, ButterfLife proved to be a reliable and easy-to-use device, capable of simultaneously assessing five vital signs in both hospital and home settings.
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Affiliation(s)
- Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
- Correspondence:
| | - Stefano Kette
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Sergio Fonda
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Selene Lerda
- 24ORE Business School, Via Monte Rosa, 91, 20149 Milan, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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30
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Salton F, Confalonieri P, Centanni S, Mondoni M, Petrosillo N, Bonfanti P, Lapadula G, Lacedonia D, Voza A, Carpenè N, Montico M, Reccardini N, Meduri GU, Ruaro B, Confalonieri M. Prolonged higher dose methylprednisolone vs. conventional dexamethasone in COVID-19 pneumonia: a randomised controlled trial (MEDEAS). Eur Respir J 2022; 61:13993003.01514-2022. [PMID: 36356972 PMCID: PMC9650195 DOI: 10.1183/13993003.01514-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/23/2022] [Indexed: 11/12/2022]
Abstract
IntroductionDysregulated systemic inflammation is the primary driver of mortality in severe COVID-19 pneumonia. Current guidelines favor a 7–10-day course of any glucocorticoid equivalent to dexamethasone 6 mg·day−1. A comparative RCT with a higher dose and a longer duration of intervention was lacking.MethodsWe conducted a multi-center, open-label RCT to investigate methylprednisolone 80 mg as a continuous daily infusion for 8 days followed by slow taperingversusdexamethasone 6 mg daily for up to 10 days in adult patients with COVID-19 pneumonia requiring oxygen or noninvasive respiratory support. Primary outcome: reduction in 28-day mortality. Secondary outcomes: mechanical ventilation-free days at 28 days, need for ICU referral, length of hospitalisation, need for tracheostomy, changes in PaO2:FiO2 ratio, C-reactive protein levels and WHO clinical progression scale at days 3, 7, and 14.Results677 randomised patients were included. Findings are reported as methylprednisolone (n=337)versusdexamethasone (n=340). By day 28, there were no significant differences in mortality (35[10.4%]versus41[12.1%]; p=0.49), nor in the median mechanical ventilation-free days (23[14]versus24[16]; p=0.49). ICU referral was necessary in 41[12.2%]versus45[13.2%]; p=0.68 and tracheostomy in 8[2.4%]versus9[2.6%]; p=0.82. Survivors in the methylprednisolone group required a longer median hospitalisation (15[11]versus14[11] days; p=0.005) and experienced an improvement in C-reactive protein levels, but not in PaO2:FiO2ratio, at days 7 and 14. There were no differences in disease progression at the prespecified timepoints.ConclusionProlonged, higher dose methylprednisolone did not reduce mortality at 28 days compared to conventional dexamethasone in COVID-19 pneumonia.
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Antonaglia C, Vidoni G, Contardo L, Giudici F, Salton F, Ruaro B, Confalonieri M, Caneva M. Low Arousal Threshold Estimation Predicts Failure of Mandibular Advancement Devices in Obstructive Sleep Apnea Syndrome. Diagnostics (Basel) 2022; 12:diagnostics12102548. [PMID: 36292237 PMCID: PMC9600433 DOI: 10.3390/diagnostics12102548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The treatment of choice for obstructive sleep apnea syndrome (OSAS) is continuous positive airway pressure (CPAP). However, CPAP is usually poorly tolerated and mandibular advancement devices (MADs) are an alternative innovative therapeutic approach. Uncertainty still remains as to the most suitable candidates for MAD. Herein, it is hypothesized that the presence of low arousal threshold (low ArTH) could be predictive of MAD treatment failure. Methods: A total of 32 consecutive patients, with OSAS of any severity, who preferred an alternate therapy to CPAP, were treated with a tailored MAD aimed at obtaining 50% of their maximal mandibular advancement. Treatment response after 6 months of therapy was defined as AHI < 5 events per hour or a reduction of AHI ≥ 50% from baseline. Low ArTH was predicted based on the following polysomnography features, as previously shown by Edwards et al.: an AHI of 82.5% and a hypopnea fraction of total respiratory events of >58.3%. Results: There were 25 (78.1%) responders (p-value < 0.01) at 6 months. Thirteen patients (40.6%) in the non-severe group reached AHI lower than 5 events per hour. MAD treatment significantly reduced the median AHI in all patients from a median value of 22.5 to 6.5 (74.7% of reduction, p-value < 0.001). The mandibular advancement device reduced AHI, whatever the disease severity. A significant higher reduction of Delta AHI, after 6 months of treatment, was found for patients without low ArTH. Conclusions: Low ArTH at baseline was associated with a poorer response to MAD treatment and a lower AHI reduction at 6 months. A non-invasive assessment of Low ArTH can be performed through the Edwards’ score, which could help to identify an endotype with a lower predicted response to oral appliances in a clinical setting.
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Affiliation(s)
- Caterina Antonaglia
- Pulmonology Department, University Hospital of Cattinara, 34149 Trieste, Italy
- Correspondence:
| | - Gabriele Vidoni
- Department of Medicine, Surgery and Health Sciences, School of Dentistry, University of Trieste, 34127 Trieste, Italy
| | - Luca Contardo
- Department of Medicine, Surgery and Health Sciences, School of Dentistry, University of Trieste, 34127 Trieste, Italy
| | - Fabiola Giudici
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, 91190 Gif-sur-Yvette, France
| | - Francesco Salton
- Pulmonology Department, University Hospital of Cattinara, 34149 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Department, University Hospital of Cattinara, 34149 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Department, University Hospital of Cattinara, 34149 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Martina Caneva
- Department of Medicine, Surgery and Health Sciences, School of Dentistry, University of Trieste, 34127 Trieste, Italy
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Ruaro B, Matucci Cerinic M, Salton F, Baratella E, Confalonieri M, Hughes M. Editorial: Pulmonary fibrosis: One manifestation, various diseases. Front Pharmacol 2022; 13:1027332. [PMID: 36324683 PMCID: PMC9620474 DOI: 10.3389/fphar.2022.1027332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences. University Hospital of Cattinara, University of Trieste, Trieste, Italy
- *Correspondence: Barbara Ruaro,
| | - Marco Matucci Cerinic
- Unit of Immunology, Rheumatology, Department of Experimental and Clinical Medicine, IRCCS San Raffaele Hospital, University of Florence and Division of Rheumatology AOUC & Scleroderma Unit, Allergy and Rare Diseases (UnIRAR), Milan, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences. University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Elisa Baratella
- Department of Radiology, Department of Medicine, Surgery and Health Science, University of Trieste, Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences. University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester, United Kingdom
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Badagliacca R, D'Alto M, Ghio S, Argiento P, Brunetti ND, Casu G, Cedrone N, Confalonieri M, Corda M, Correale M, D'Agostino C, De Michele L, Di Marino S, Filomena D, Galgano G, Greco A, Lombardi C, Manzi G, Mercurio V, Mulè M, Paciocco G, Papa S, Romeo E, Scelsi L, Stolfo D, Vitulo P, Vizza CD. Relevance of comorbidities on initial combination therapy in pulmonary arterial hypertension. ERJ Open Res 2022; 8:00298-2022. [DOI: 10.1183/23120541.00298-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
RationaleDemographic characteristics of pulmonary arterial hypertension (PAH) patients have changed over time, but the effects of cardiovascular risk factors on risk status and pulmonary vascular resistance (PVR) reduction with initial oral combination therapy are not known. Therefore, we tested the relevance of cardiovascular comorbidities in this setting.MethodsThe study enrolled 181 treatment-naive PAH patients with a 6-months (IQR 144–363 days) right heart catheterization and risk assessment after initial oral combination therapy.ResultsGroup-A, 96 (53.0%) patients without cardiac comorbidities; Group-B, 54 (29.8%) patients with one cardiac comorbidity; Group-C, 31 (17.1%) patients with ≥2 cardiac comorbidities. Group-C patients were older with a balanced gender distribution. There was a significant difference in PVR reduction moving from the absence to one or ≥2 cardiac comorbidities, respectively, median −45.0%, −30.3%, −24.3%. A ERS/ESC low-risk status was present at first follow-up in 50 (52.0%) patients in Group-A, 19 (35.1%) in Group-B, and 9 (29.0%) in Group-C; a REVEAL 2.0 low-risk status was present at first follow-up in 41 (42.0%) patients in Group-A, 15 (27.7%) in Group-B, and 7 (22.6%) in Group-C. Group-A patients were 2.3 times more likely to achieve/maintain a low risk status compared with Group-B and -C (OR 2.27, 95% C.I. 1.15–4.54, p=0.02). No significant difference was observed between patients with non-cardiac comorbidities and those without comorbidities.ConclusionInitial oral combination therapy seems associated with a less effective response for patients with cardiovascular comorbidities compared with the others, related to the magnitude of treatment-induced decrease in PVR.
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Trevisan M, Kang EM, Tommasini A, Confalonieri M. Hematopoietic Stem Cell Transplantation in Late-onset X-linked Chronic Granulomatous Disease in a Female Carrier. J Clin Immunol 2022; 42:1396-1399. [PMID: 35771399 PMCID: PMC9675691 DOI: 10.1007/s10875-022-01310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Matteo Trevisan
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.
| | - Elizabeth M Kang
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alberto Tommasini
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
- Cardiovascular Department, Cardiac Surgery Unit, Ospedali Riuniti di Trieste, Trieste, Italy
| | - Marco Confalonieri
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Bethesda, MD, USA
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Ruaro B, Baratella E, Confalonieri M, Antonaglia C, Salton F. Editorial: Obstructive sleep apnea syndrome (OSAS). What's new? Front Med (Lausanne) 2022; 9:1009410. [PMID: 36186790 PMCID: PMC9521371 DOI: 10.3389/fmed.2022.1009410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, Trieste, Italy
- *Correspondence: Barbara Ruaro
| | - Elisa Baratella
- Department of Radiology, Department of Medicine, Surgery and Health Science, University of Trieste, Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Caterina Antonaglia
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, Trieste, Italy
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Agostinis C, Toffoli M, Spazzapan M, Balduit A, Zito G, Mangogna A, Zupin L, Salviato T, Maiocchi S, Romano F, Crovella S, Fontana F, Braga L, Confalonieri M, Ricci G, Kishore U, Bulla R. SARS-CoV-2 modulates virus receptor expression in placenta and can induce trophoblast fusion, inflammation and endothelial permeability. Front Immunol 2022; 13:957224. [PMID: 36177036 PMCID: PMC9513489 DOI: 10.3389/fimmu.2022.957224] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
SARS-CoV-2 is a devastating virus that induces a range of immunopathological mechanisms including cytokine storm, apoptosis, inflammation and complement and coagulation pathway hyperactivation. However, how the infection impacts pregnant mothers is still being worked out due to evidence of vertical transmission of the SARS-CoV-2, and higher incidence of pre-eclampsia, preterm birth, caesarian section, and fetal mortality. In this study, we assessed the levels of the three main receptors of SARS-CoV-2 (ACE2, TMPRSS2 and CD147) in placentae derived from SARS-CoV-2 positive and negative mothers. Moreover, we measured the effects of Spike protein on placental cell lines, in addition to their susceptibility to infection. SARS-CoV-2 negative placentae showed elevated levels of CD147 and considerably low amount of TMPRSS2, making them non-permissive to infection. SARS-CoV-2 presence upregulated TMPRSS2 expression in syncytiotrophoblast and cytotrophoblast cells, thereby rendering them amenable to infection. The non-permissiveness of placental cells can be due to their less fusogenicity due to infection. We also found that Spike protein was capable of inducing pro-inflammatory cytokine production, syncytiotrophoblast apoptosis and increased vascular permeability. These events can elicit pre-eclampsia-like syndrome that marks a high percentage of pregnancies when mothers are infected with SARS-CoV-2. Our study raises important points relevant to SARS-CoV-2 mediated adverse pregnancy outcomes.
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Affiliation(s)
- Chiara Agostinis
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| | - Miriam Toffoli
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| | | | - Andrea Balduit
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
- *Correspondence: Andrea Balduit,
| | - Gabriella Zito
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| | - Luisa Zupin
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| | - Tiziana Salviato
- Department of Diagnostic, Clinic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Serena Maiocchi
- Department of Life Sciences, University of Trieste, Trieste, Italy
- Functional Cell Biology Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Federico Romano
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| | - Sergio Crovella
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Francesco Fontana
- Division of Laboratory Medicine, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Trieste, Italy
| | - Luca Braga
- Functional Cell Biology Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Marco Confalonieri
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Uday Kishore
- Biosciences, College of Health, Medicine and Life Sciences, Brunel University of London, London, United Kingdom
- Department of Veterinary Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Roberta Bulla
- Department of Life Sciences, University of Trieste, Trieste, Italy
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Confalonieri M. In moderate-to-severe asthma, as-needed albuterol-budesonide reduced severe exacerbations vs. albuterol alone. Ann Intern Med 2022; 175:JC106. [PMID: 36063557 DOI: 10.7326/j22-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Papi A, Chipps BE, Beasley R, et al. Albuterol-budesonide fixed-dose combination rescue inhaler for asthma. N Engl J Med. 2022;386:2071-83. 35569035.
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Ruaro B, Confalonieri P, Caforio G, Baratella E, Pozzan R, Tavano S, Bozzi C, Lerda S, Geri P, Biolo M, Cortale M, Confalonieri M, Salton F. Chronic Thromboembolic Pulmonary Hypertension: An Observational Study. Medicina (Kaunas) 2022; 58:medicina58081094. [PMID: 36013561 PMCID: PMC9415110 DOI: 10.3390/medicina58081094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 01/29/2023]
Abstract
Background and Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) has a high mortality. The treatment of CTEPH could be balloon pulmonary angioplasty (BPA), medical (MT) or pulmonary endarterectomy (PEA). This study aims to assess the clinical characteristics of CTEPH patients, surgically or medically treated, in a pulmonology referral center. Materials and Methods: A total of 124 patients with PH with suspected CTEPH (53 male subjects and 71 female subjects; mean age at diagnosis 67 ± 6) were asked to give informed consent and then were evaluated. The presence of CTEPH was ascertained by medical evaluations, radiology and laboratory tests. Results: After the evaluation of all clinical data, 65 patients met the inclusion criteria for CTEPH and they were therefore enrolled (22 males and 43 females; mean age at diagnosis was 69 ± 8). 26 CTEPH patients were treated with PEA, 32 with MT and 7 with BPA. There was a statistically significant age difference between the PEA and MT groups, at the time of diagnosis, the PEA patients were younger than the MT patients, whereas there was no statistically significant difference in other clinical characteristics (e.g., smoking habit, thrombophilia predisposition), as well as functional and hemodynamic parameters (e.g., 6-min walk test, right heart catheterization). During three years of follow-up, no patients in the PEA groups died; conversely, eleven patients in the MT group died during the same period (p < 0.05). Furthermore, a significant decrease in plasma BNP values and an increase in a meter at the six-minute walk test, 1 and 3 years after surgery, were observed in the PEA group (p < 0.05). Conclusions: This study seems to confirm that pulmonary endarterectomy (PEA) can provide an improvement in functional tests in CTEPH.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
- Correspondence: ; Tel.: +39-040-399-4871
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Gaetano Caforio
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Bozzi
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Selene Lerda
- 24ore Business School, Via Monte Rosa, 91, 20149 Milan, Italy
| | - Pietro Geri
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Marco Biolo
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Maurizio Cortale
- Department of Medical, Surgical, & Health Sciences, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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Trevisan M, Kang EM, Tommasini A, Confalonieri M. Correction to: Hematopoietic Stem Cell Transplantation in late-onset X-linked Chronic Granulomatous Disease in a female carrier. J Clin Immunol 2022; 42:1400. [PMID: 35951147 DOI: 10.1007/s10875-022-01334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Matteo Trevisan
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34137, Trieste, Italy.
| | - Elizabeth M Kang
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MD, Bethesda, USA
| | | | - Alberto Tommasini
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34137, Trieste, Italy.,Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Confalonieri
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34137, Trieste, Italy.,Pulmonology Department, University Hospital of Trieste, Trieste, Italy
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Campochiaro C, De Luca G, Lazzaroni MG, Armentaro G, Spinella A, Vigone B, Ruaro B, Stanziola A, Benfaremo D, De Lorenzis E, Benvenuti F, Bosello SL, Moroncini G, Cuomo G, Confalonieri M, Beretta L, Zanatta E, Giuggioli D, Del Papa N, Airò P, Dagna L, Matucci-Cerinic M. POS0890 NINTEDANIB REAL-LIFE EFFICACY AND SAFETY IN SYSTEMIC SCLEROSIS (SSc)-INTERTISTIAL LUNG DISEASE (ILD): AN ITALIAN MULTICENTRE PRELIMINARY STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundNintedanib (NTD) has been approved for Systemic Sclerosis (SSc)-Interstitial Lung Disease (ILD) following the positive results of the SENSCIS trial.Objectivesto describe the efficacy and safety of NTD in SSc-ILD in a real-life setting.MethodsThe clinical data of SSc-ILD patients treated with NTD from 10 Italian SSc centres were retrospectively evaluated at baseline, 6 and 12 months: SSc clinical features, NTD tolerability, pulmonary function tests (PFTs) and modified Rodnan skin score (mRSS) were recorded.Results69 SSc-ILD patients (22 males [32%], mean age 60±12 years, disease onset 50±13 years, 4 [6%] anti-centromere, 53 [77%] anti-topoisomerase I, 3 [4%] anti-RNA-polimerase III) were identified. The vast majority (84%) was previously treated with immunosuppressants: 27 (39%) cyclophosphamide, 45 (65%) mycophenolate mofetil, 6 (9%) methotrexate, 9 (13%) azathioprine, 6 (9%) tocilizumab and 22 (32%) rituximab. In 11 (16%) patients, NTD was the first treatment for SSc-ILD. At baseline, 57 patients (83%) were on corticosteroids (mean daily prednisone dose 6±5 mg), 58 (84%) on immunosuppressants, 47 (68%) on mycophenolate mofetil, 14 (20%) on rituximab, 3 (4%) on tocilizumab, 2 on methotrexate (3%) and 1 (1%) on azathioprine. At baseline HRCT showed UIP pattern in 27 (39%) and NSIP pattern in 42 (61%) patients. The modifications of PFTs and mRSS over time are shown in Table 1. Since NTD introduction, gastro-intestinal (GI) side effects were recorded in 34 (49%) patients, with diarrhoea being the most common complaint (35%), followed by nausea/vomiting (23%) and weight loss (16%). In 21 (30%) patients, after a mean time of 2.6±3.4 months, NTD was maintained after dose adjustment. In 5 (7%) patients NTD was stopped after a median time of 5 (1-6) months due to subocclusion and persistent diarrhoea in 3 patients, untreatable nausea and vomiting in one patient and liver toxicity in 1 patient. During the follow-up after a median time of 10 (6 – 33) months, 4 patients died.Table 1.Pulmonary function tests and mRSS at baseline, 6 and 12 months in SSc-ILD on NTD.Baseline6 monthsP valueBaseline12 monthsP valueFVC (% predicted)64 ± 1865 ± 18 (33 pts)0.63870 ± 1969 ± 18 (20 pts)0.586TLC (% predicted)64 ± 1561 ± 14 (27 pts)0.15464 ± 1465 ± 18 (16 pts)0.944DLCO (% predicted)40 ± 1741 ± 18 (29 pts)0.66040 ± 1838 ± 18 (20 pts)0.304mRSS9 ± 68 ± 6 (26 pts)0.0027 ± 48 ± 6 (15 pts)0.334pts= patientsConclusionOur preliminary data confirm that in a real-life clinical scenario NTD, in combination with immunosuppressants, may stabilize PFT. However, despite the fact that GI side effects are frequent, they may be controlled with NTD dose adjustment thus retaining the drug in SSc-ILD patients. The NTD efficacy on skin involvement needs to be thoroughly evaluated on a larger SSc population.Disclosure of InterestsCorrado Campochiaro Speakers bureau: Boeboehringer ingelheim, Giacomo De Luca Speakers bureau: boehringer ingelheim, Maria Grazia Lazzaroni Grant/research support from: boehringer ingelheim, Giuseppe Armentaro: None declared, Amelia Spinella: None declared, Barbara Vigone: None declared, Barbara Ruaro: None declared, Anna Stanziola: None declared, Devis Benfaremo: None declared, Enrico De Lorenzis: None declared, Francesco Benvenuti: None declared, Silvia Laura Bosello Speakers bureau: boehringer ingelheim, Gianluca Moroncini: None declared, Giovanna Cuomo: None declared, Marco Confalonieri: None declared, Lorenzo Beretta: None declared, Elisabetta Zanatta: None declared, Dilia Giuggioli: None declared, Nicoletta Del Papa: None declared, Paolo Airò: None declared, Lorenzo Dagna: None declared, Marco Matucci-Cerinic Speakers bureau: boehringer ingelheim
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Ruaro B, Confalonieri P, Torregiani C, Pichierri S, Confalonieri M, Salton F. AB1297 EVALUATION OF POSSIBLE RISK FACTOR OF PULMONARY EMBOLISM IN SARCOIDOSIS PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSome studies reported a correlation between sarcoidosis and an increased risk of pulmonary embolism (PE) 1,2.ObjectivesTo assess possible risk factors of PE in sarcoidosis patients.MethodsWe enrolled 260 sarcoidosis patients (170 females and 90 males; mean age at diagnosis 46 ± 9), after giving written informed consent. We perform clinical evaluations, laboratory tests and radiology features.ResultsOur study population included 20 sarcoidosis patients with PE (14 females and 6 males; mean age at diagnosis 45 ± 10), diagnosed by lung scintigraphy and 240 sarcoidosis patients without PE (170 females and 70 males; mean age at diagnosis 46 ± 11). There was a significant increase of the presence of antiphospholipid antibodies in the sarcoidosis group with pulmonary embolism (55%) than in group without PE (9%) (p-value<0.01). There was no statistically significant difference between the two groups on smoking habit, obesity, treatments and hereditary thrombophilia frequency (p > 0.05, respectively).ConclusionThis study demonstrated an increased of antiphospholipid antibodies positivity in sarcoidosis patients with pulmonary embolism. Furthermore, we propose screening for these antibodiesin all sarcoidosis patients.References[1]Turetz M, et al. Semin Intervent Radiol 2018;35:92–98[2]Larsson J, et al. Sarcoidosis Vasc Diffuse Lung Dis 2020; 37: 104-135Disclosure of InterestsNone declared
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Salton F, Confalonieri P, Campisciano G, Cifaldi R, Rizzardi C, Generali D, Pozzan R, Tavano S, Bozzi C, Lapadula G, Meduri GU, Confalonieri M, Comar M, Lerda S, Ruaro B. Cytokine Profiles as Potential Prognostic and Therapeutic Markers in SARS-CoV-2-Induced ARDS. J Clin Med 2022; 11:jcm11112951. [PMID: 35683340 PMCID: PMC9180983 DOI: 10.3390/jcm11112951] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 01/27/2023] Open
Abstract
Background. Glucocorticoids (GCs) have been shown to reduce mortality and the need for invasive mechanical ventilation (IMV) in SARS-CoV-2-induced acute respiratory distress syndrome (ARDS). It has been suggested that serum cytokines levels are markers of disease severity in ARDS, although there is only limited evidence of a relationship between the longitudinal cytokine profile and clinical outcomes in patients with SARS-CoV-2-induced ARDS treated with GC. Methods. We conducted a single-center observational study to investigate serial plasma cytokine levels in 17 patients supported with non-invasive ventilation (NIV) in order to compare the response in five patients who progressed to IMV versus 12 patients who continued with NIV alone. All patients received methylprednisolone 80 mg/day continuous infusion until clinical improvement. Results. The study groups were comparable at baseline. All patients survived. Although IL-6 was higher in the NIV group at baseline, several cytokines were significantly higher in the IMV group on day 7 (IL-6, IL-8, IL-9, G-CSF, IP-10, MCP-1, MIP-1α) and 14 (IL-6, IL-8, IL-17, G-CSF, MIP-1α, RANTES). No significant differences were observed between groups on day 28. Conclusions. Patients in the IMV group had higher inflammation levels at intubation than the NIV group, which may indicate a higher resistance to glucocorticoids. Higher GC doses or a longer treatment duration in these patients might have allowed for a better control of inflammation and a better outcome. Further studies are required to define the prognostic value of cytokine patterns, in terms of both GC treatment tailoring and timely initiation of IMV.
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Affiliation(s)
- Francesco Salton
- Pulmonology Unit, University Hospital of Trieste, University of Trieste, 34149 Trieste, Italy; (P.C.); (R.C.); (R.P.); (S.T.); (C.B.); (G.L.); (M.C.); (B.R.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
- Correspondence: ; Tel.: +39-040-399-4871
| | - Paola Confalonieri
- Pulmonology Unit, University Hospital of Trieste, University of Trieste, 34149 Trieste, Italy; (P.C.); (R.C.); (R.P.); (S.T.); (C.B.); (G.L.); (M.C.); (B.R.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
| | - Giuseppina Campisciano
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Rossella Cifaldi
- Pulmonology Unit, University Hospital of Trieste, University of Trieste, 34149 Trieste, Italy; (P.C.); (R.C.); (R.P.); (S.T.); (C.B.); (G.L.); (M.C.); (B.R.)
| | - Clara Rizzardi
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
- Department of Pathology, University Hospital of Trieste, 34149 Trieste, Italy
| | - Daniele Generali
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
- Department of Pathology, University Hospital of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, University Hospital of Trieste, University of Trieste, 34149 Trieste, Italy; (P.C.); (R.C.); (R.P.); (S.T.); (C.B.); (G.L.); (M.C.); (B.R.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
| | - Stefano Tavano
- Pulmonology Unit, University Hospital of Trieste, University of Trieste, 34149 Trieste, Italy; (P.C.); (R.C.); (R.P.); (S.T.); (C.B.); (G.L.); (M.C.); (B.R.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
| | - Chiara Bozzi
- Pulmonology Unit, University Hospital of Trieste, University of Trieste, 34149 Trieste, Italy; (P.C.); (R.C.); (R.P.); (S.T.); (C.B.); (G.L.); (M.C.); (B.R.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
| | - Giulia Lapadula
- Pulmonology Unit, University Hospital of Trieste, University of Trieste, 34149 Trieste, Italy; (P.C.); (R.C.); (R.P.); (S.T.); (C.B.); (G.L.); (M.C.); (B.R.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
| | - Gianfranco Umberto Meduri
- Department of Medicine, Pulmonary, Critical Care, and Sleep Medicine Division, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Marco Confalonieri
- Pulmonology Unit, University Hospital of Trieste, University of Trieste, 34149 Trieste, Italy; (P.C.); (R.C.); (R.P.); (S.T.); (C.B.); (G.L.); (M.C.); (B.R.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
| | - Manola Comar
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Selene Lerda
- 24ore Business School, Via Monte Rosa 91, 20149 Milano, Italy;
| | - Barbara Ruaro
- Pulmonology Unit, University Hospital of Trieste, University of Trieste, 34149 Trieste, Italy; (P.C.); (R.C.); (R.P.); (S.T.); (C.B.); (G.L.); (M.C.); (B.R.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (C.R.); (D.G.); (M.C.)
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Pelosi P, Tonelli R, Torregiani C, Baratella E, Confalonieri M, Battaglini D, Marchioni A, Confalonieri P, Clini E, Salton F, Ruaro B. Different Methods to Improve the Monitoring of Noninvasive Respiratory Support of Patients with Severe Pneumonia/ARDS Due to COVID-19: An Update. J Clin Med 2022; 11:jcm11061704. [PMID: 35330029 PMCID: PMC8952765 DOI: 10.3390/jcm11061704] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023] Open
Abstract
The latest guidelines for the hospital care of patients affected by coronavirus disease 2019 (COVID-19)-related acute respiratory failure have moved towards the widely accepted use of noninvasive respiratory support (NIRS) as opposed to early intubation at the pandemic onset. The establishment of severe COVID-19 pneumonia goes through different pathophysiological phases that partially resemble typical acute respiratory distress syndrome (ARDS) and have been categorized into different clinical–radiological phenotypes. These can variably benefit on the application of external positive end-expiratory pressure (PEEP) during noninvasive mechanical ventilation, mainly due to variable levels of lung recruitment ability and lung compliance during different phases of the disease. A growing body of evidence suggests that intense respiratory effort producing excessive negative pleural pressure swings (Ppl) plays a critical role in the onset and progression of lung and diaphragm damage in patients treated with noninvasive respiratory support. Routine respiratory monitoring is mandatory to avoid the nasty continuation of NIRS in patients who are at higher risk for respiratory deterioration and could benefit from early initiation of invasive mechanical ventilation instead. Here we propose different monitoring methods both in the clinical and experimental settings adapted for this purpose, although further research is required to allow their extensive application in clinical practice. We reviewed the needs and available tools for clinical–physiological monitoring that aims at optimizing the ventilatory management of patients affected by acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.
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Affiliation(s)
- Paolo Pelosi
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (P.P.); (D.B.)
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences SMECHIMAI, University of Modena Reggio Emilia, 41121 Modena, Italy; (R.T.); (A.M.); (E.C.)
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41121 Modena, Italy
| | - Chiara Torregiani
- Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (C.T.); (M.C.); (P.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy;
| | - Marco Confalonieri
- Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (C.T.); (M.C.); (P.C.); (F.S.)
| | - Denise Battaglini
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (P.P.); (D.B.)
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy
| | - Alessandro Marchioni
- Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences SMECHIMAI, University of Modena Reggio Emilia, 41121 Modena, Italy; (R.T.); (A.M.); (E.C.)
| | - Paola Confalonieri
- Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (C.T.); (M.C.); (P.C.); (F.S.)
| | - Enrico Clini
- Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences SMECHIMAI, University of Modena Reggio Emilia, 41121 Modena, Italy; (R.T.); (A.M.); (E.C.)
| | - Francesco Salton
- Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (C.T.); (M.C.); (P.C.); (F.S.)
| | - Barbara Ruaro
- Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy; (C.T.); (M.C.); (P.C.); (F.S.)
- Correspondence:
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Badagliacca R, Papa S, D'Alto M, Ghio S, Agostoni P, Ameri P, Argiento P, Brunetti ND, Casamassima V, Casu G, Cedrone N, Confalonieri M, Corda M, Correale M, D'Agostino C, De Michele L, Famoso G, Galgano G, Greco A, Lombardi CM, Manzi G, Madonna R, Mercurio V, Mulè M, Paciocco G, Romaniello A, Romeo E, Scelsi L, Serra W, Stolfo D, Toma M, Vatrano M, Vitulo P, Vizza CD. The paradox of pulmonary arterial hypertension in Italy in the COVID-19 era: is risk of disease progression around the corner? Eur Respir J 2022; 60:13993003.02276-2021. [PMID: 35301247 PMCID: PMC9535117 DOI: 10.1183/13993003.02276-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/09/2022] [Indexed: 01/01/2023]
Abstract
Objective The coronavirus disease 2019 (COVID-19) outbreak has led to significant restrictions on routine medical care. We conducted a multicentre nationwide survey of patients with pulmonary arterial hypertension (PAH) to determine the consequences of governance measures on PAH management and risk of poor outcome in patients with COVID-19. Materials and methods The present study, which included 25 Italian centres, considered demographic data, the number of in-person visits, 6-min walk and echocardiographic test results, brain natriuretic peptide/N-terminal pro-brain natriuretic peptide test results, World Health Organization functional class assessment, presence of elective and non-elective hospitalisation, need for treatment escalation/initiation, newly diagnosed PAH, incidence of COVID-19 and mortality rates. Data were collected, double-checked and tracked by institutional records between March 1 and May 1, 2020, to coincide with the first peak of COVID-19 and compared with the same time period in 2019. Results Among 1922 PAH patients, the incidences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 were 1.0% and 0.46%, respectively, with the latter comparable to that in the overall Italian population (0.34%) but associated with 100% mortality. Less systematic activities were converted into more effective remote interfacing between clinicians and PAH patients, resulting in lower rates of hospitalisation (1.2% versus 1.9%) and related death (0.3% versus 0.5%) compared with 2019 (p<0.001). A high level of attention is needed to avoid the potential risk of disease progression related to less aggressive escalation of treatment and the reduction in new PAH diagnoses compared with 2019. Conclusion A cohesive partnership between healthcare providers and regional public health officials is needed to prioritise PAH patients for remote monitoring by dedicated tools. COVID-19 showed low incidence among PAH patients, but high mortality rates. A high level of attention is needed to avoid the potential risk of disease progression in the near future.https://bit.ly/3s1lEYM
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Affiliation(s)
- Roberto Badagliacca
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Papa
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli", Naples, Italy
| | - Stefano Ghio
- Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
| | - Piergiuseppe Agostoni
- Departement of Clinical and Community Sciences, University of Milan, Milan, Italy.,Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Pietro Ameri
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Paola Argiento
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli", Naples, Italy
| | | | - Vito Casamassima
- Department of Cardiology, "F.Miulli" Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Gavino Casu
- ATS Sardegna-ASSL Nuoro, San Francesco Hospital Nuoro, Nuoro, Italy.,University of Sassari, Sassari, Italy
| | - Nadia Cedrone
- Unità di Medicina Interna, Ospedale S. Pertini, Rome, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Heart-Thorax-Vessels Department, University Hospital of Cattinara, Trieste, Italy
| | - Marco Corda
- Cardiology Unit, Azienda Ospedaliera "G. Brotzu" San Michele, Cagliari, Italy
| | - Michele Correale
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Carlo D'Agostino
- Cardiology Department, University Hospital Policlinico Consorziale Bari, Bari, Italy
| | - Lucrezia De Michele
- Cardiology Department, University Hospital Policlinico Consorziale Bari, Bari, Italy
| | - Giulia Famoso
- Department of Cardiac Thoracic Vascular Sciences and Public Health Padua, Padua, Italy
| | | | | | | | - Giovanna Manzi
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Rosalinda Madonna
- Cardiology Unit, Department of Surgical, Medical and Molecular Pathology and of Critical Sciences, University of Pisa - UNIPI, Pisa, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Giuseppe Paciocco
- Dipartimento Cardio-Toraco-Vascolare, Clinica Pneumologica, Azienda Ospedaliera San Gerardo, Monza, Italy
| | | | - Emanuele Romeo
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli", Naples, Italy
| | - Laura Scelsi
- Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
| | - Walter Serra
- Cardiology Unit, University Hospital of Parma, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Matteo Toma
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, Univeristy of Genova, Genova, Italy
| | - Marco Vatrano
- Azienda Ospedaliera Pugliese - Ciaccio di Catanzaro, Catanzaro, Italy
| | - Patrizio Vitulo
- Pulmonology Unit, IRCCS - Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Carmine Dario Vizza
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
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Vianello A, De Vita N, Scotti L, Guarnieri G, Confalonieri M, Bonato V, Molena B, Maestrone C, Airoldi G, Olivieri C, Sainaghi PP, Lionello F, Arcaro G, Della Corte F, Navalesi P, Vaschetto R. Clinical Outcomes in Patients Aged 80 Years or Older Receiving Non-Invasive Respiratory Support for Hypoxemic Acute Respiratory Failure Consequent to COVID-19. J Clin Med 2022; 11:jcm11051372. [PMID: 35268463 PMCID: PMC8911338 DOI: 10.3390/jcm11051372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 12/10/2022] Open
Abstract
As the clinical outcome of octogenarian patients hospitalised for COVID-19 is very poor, here we assessed the clinical characteristics and outcomes of patients aged 80 year or older hospitalised for COVID-19 receiving non-invasive respiratory support (NIRS). A multicentre, retrospective, observational study was conducted in seven hospitals in Northern Italy. All patients aged ≥80 years with COVID-19 associated hypoxemic acute respiratory failure (hARF) undergoing NIRS between 24 February 2020, and 31 March 2021, were included. Out of 252 study participants, 156 (61.9%) and 163 (64.6%) died during hospital stay and within 90 days from hospital admission, respectively. In this case, 228 (90.5%) patients only received NIRS (NIRS group), while 24 (9.5%) were treated with invasive mechanical ventilation (IMV) after NIRS failure (NIRS+IMV group). In-hospital mortality did not significantly differ between NIRS and NIRS+IMV group (61.0% vs. 70.8%, respectively; p = 0.507), while survival probability at 90 days was significantly higher for NIRS compared to NIRS+IMV patients (0.379 vs. 0.147; p = 0.0025). The outcome of octogenarian patients with COVID-19 receiving NIRS is quite poor. Caution should be used when considering transition from NIRS to IMV after NIRS failure.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
- Correspondence: ; Tel.: +39-049-821-8587; Fax: +39-049-821-7791
| | - Nello De Vita
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Lorenza Scotti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Marco Confalonieri
- Pneumologia, Azienda Sanitaria Universitaria Giuliano Isontina, Via Giacomo Puccini, 50, 34148 Trieste, Italy;
| | - Valeria Bonato
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia, 16, 15121 Alessandria, Italy;
| | - Beatrice Molena
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Carlo Maestrone
- Anestesia Rianimazione ASL VCO, Dipartimento Chirurgico, Presidio Ospedaliero Domodossola e Verbania, Largo Caduti Lager Nazisti, 1, 28845 Domodossola, Italy;
| | - Gianluca Airoldi
- Medicina Interna, Ospedale Ss. Trinità, Viale Zoppis, 10, 28021 Borgomanero, Italy;
| | - Carlo Olivieri
- Department of Anesthesia and Critical Care, Azienda Ospedaliera Sant’Andrea, Corso M. Abbiate, 21, 13100 Vercelli, Italy;
| | - Pier Paolo Sainaghi
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Federico Lionello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Giovanna Arcaro
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Francesco Della Corte
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Paolo Navalesi
- Istituto di Anestesia e Rianimazione, Dipartimento di Medicina-DIMED-Università di Padova, Azienda Ospedale-Università di Padova, Via Gallucci, 13, 35121 Padova, Italy;
| | - Rosanna Vaschetto
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
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Ruaro B, Salton F, Baratella E, Confalonieri P, Geri P, Pozzan R, Torregiani C, Bulla R, Confalonieri M, Matucci-Cerinic M, Hughes M. An Overview of Different Techniques for Improving the Treatment of Pulmonary Hypertension Secondary in Systemic Sclerosis Patients. Diagnostics (Basel) 2022; 12:diagnostics12030616. [PMID: 35328169 PMCID: PMC8947575 DOI: 10.3390/diagnostics12030616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
In systemic sclerosis (SSc) mortality is mainly linked to lung involvement which is characterized by interstitial lung disease (ILD) and pulmonary hypertension (PH). In SSc, PH may be due to different etiologies, including ILD, chronic thromboembolic disease, pulmonary veno-occlusive disease, and pulmonary arterial hypertension (PAH). The main tool to screen PAH is transthoracic echocardiography (TTE), which has a sensitivity of 90%, even if definitive diagnosis should be confirmed by right heart catheterization (RHC). The radiological evaluation (i.e., HRTC) plays an important role in defining the possible causes and in monitoring the evolution of lung damage. For PAH, identifying individuals who have borderline elevation of pulmonary arterial pressure needs to be appropriately managed and followed. In the past few years, the strategy for the management of PAH has significantly evolved and new trials are underway to test other therapies. This review provides an overview of the tools to evaluate PAH in SSc patients and on treatment options for these patients.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
- Correspondence: ; Tel.: +39-3470502394
| | - Francesco Salton
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy;
| | - Paola Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Pietro Geri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Riccardo Pozzan
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Chiara Torregiani
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Roberta Bulla
- Department of Life Sciences, University of Trieste, 34149 Trieste, Italy;
| | - Marco Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, 50139 Florence, Italy;
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Michael Hughes
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne OL6 9RW, UK;
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester M1 1AA, UK
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Baratella E, Roman-Pognuz E, Zerbato V, Minelli P, Cavallaro MFM, Cova MA, Luzzati R, Lucangelo U, Sanson G, Friso F, Bussani R, Pinamonti M, Busetti M, Salton F, Confalonieri M, Ruaro B, Di Bella S. Potential links between COVID-19-associated pulmonary aspergillosis and bronchiectasis as detected by high resolution computed tomography. Front Biosci (Landmark Ed) 2021; 26:1607-1612. [PMID: 34994174 DOI: 10.52586/5053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this observational study was to highlight high resolution CT scan characteristics of COVID-19-associated pulmonary aspergillosis (CAPA) with a focus on the detection of de-novo appeared or evolved bronchiectasis. METHODS From March 2020 to May 2021, we enrolled 350 consecutive mechanically ventilated ICU patients with COVID-19. Patients with CAPA and at least one chest CT scan performed within 15 days from the diagnosis were included. Two radiologists were asked to identify typical and atypical signs of COVID-19 pneumonia. Bronchiectasis locations were described and a modified Reiff score was calculated, as severity score. A total of 19 CAPA patients (median age 71.0, Interquartile range (IQR) 62.5-75.0; male 16, 84.2%) were included. RESULTS According to the 2020 ECMM/ISHAM criteria, 18 patients had probable CAPA and one had proven CAPA. The median time between hospital admission and CT scan was 21 days (IQR 14.5-25.0). The incidence of bronchiectasis in the study population was 57.9% (n = 11). Tubular bronchiectasis was detected in 10 patients and were scored as follows: three patients had a score of 1, three patients had a score of score 2, one patient had a score of 5 and four patients had a score of 6. Eight patients had a previous CT scan (performed at hospital admission), among them: 5 patients developed de-novo bronchiectasis, while 2 patients demonstrated a volumetric increase of bronchiectasis. At the 6-months follow-up, the mortality rate for patients with CAPA was >60%. CONCLUSION the radiologic detection of de-novo appearance or volumetric increase of bronchiectasis in COVID-19 should lead clinicians to search for fungal superinfections.
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Affiliation(s)
- Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
| | - Erik Roman-Pognuz
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy
| | - Verena Zerbato
- Department of Medicine, Surgery and Health Science, University of Trieste, 34128 Trieste, Italy
| | - Pierluca Minelli
- Department of Radiology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
| | | | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
| | - Roberto Luzzati
- Department of Medicine, Surgery and Health Science, University of Trieste, 34128 Trieste, Italy
| | - Umberto Lucangelo
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy
| | - Gianfranco Sanson
- Department of Medical, Surgical and Health Sciences, School of Nursing, University of Trieste, 34128 Trieste, Italy
| | - Federica Friso
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy
| | - Rossana Bussani
- Department of Pathology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
| | - Maurizio Pinamonti
- Department of Pathology, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
| | - Marina Busetti
- Microbiology Unit, Azienda Sanitaria Universitaria integrata di Trieste ASUGI-Trieste, 34128 Trieste, Italy
| | - Francesco Salton
- Department of Pneumology, Cattinara Hospital, 34128 Trieste, Italy
| | | | - Barbara Ruaro
- Department of Pneumology, Cattinara Hospital, 34128 Trieste, Italy
| | - Stefano Di Bella
- Department of Medicine, Surgery and Health Science, University of Trieste, 34128 Trieste, Italy
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Ruaro B, Guiducci S, da Silva JAP, Wade B, Baratella E, Confalonieri M. Editorial: Osteoporosis in Rheumatic Diseases, What's New? Front Med (Lausanne) 2021; 8:808345. [PMID: 34926536 PMCID: PMC8677666 DOI: 10.3389/fmed.2021.808345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Barbara Ruaro
- Pulmonology Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - José A P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Barbara Wade
- Azienda Ospedaliero Universitaria (AOU) City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Elisa Baratella
- Department of Radiology, Department of Medicine, Surgery and Health Science, University of Trieste, Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
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Toma M, Miceli R, Bonsante E, Confalonieri M, Garascia A, Ghio S, Lattanzio M, Lombardi CM, Paciocco G, Piccinino C, Rota I, Scelsi L, Scuri P, Stolfo D, Vincenzi A, Vicenzi M, Ameri P. 380 Left heart disease phenotype and use of pulmonary vasodilators in elderly patients with pulmonary arterial hypertension: the Patriarca registry. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab133.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
The prevalence of occult left heart disease (LHD) and the feasibility of vasodilator therapy in the progressively growing population of elderly subjects with pulmonary arterial hypertension (PAH) are under scrutiny. We evaluated the presence of a LHD phenotype and the patterns of vasodilator treatment in such patients.
Methods and results
The PATRIARCA registry collected cross-sectional data from 180 subjects with PAH or chronic thromboembolic pulmonary hypertension and ≥70 years of age in 11 Italian centres between 1 December 2019 and 15 September 2020. After excluding patients with CTEPH or incomplete follow-up haemodynamic parameters, 77 individuals with PAH diagnosed at ≥ 65 years of age according to current guidelines were included in the analysis. A LHD phenotype was defined as follows, expanding the criteria adopted in the AMBITION trial: (i) ≥3 among body mass index ≥30 kg/m2, systemic hypertension, diabetes, and significant coronary artery disease; (ii) 2 of the risk factors for LHD above and ≥1 among permanent atrial fibrillation, left ventricular (LV) hypertrophy, LV ejection fraction <50%, at least moderate mitral or aortic valve disease, and left atrial dilation; (iii) pulmonary vascular resistance (PVR) between 3 and 3.75 WU or PVR between 3.75 and 6.25 WU in the presence of a pulmonary artery wedge pressure (PAWP) of 13–15 mmHg. Forty-one (53%) patients had a LHD phenotype according to the most recent clinical and haemodynamic evaluation, which was performed 16 (4–35) months after diagnosis (Figure). As per definition, they had higher rates of comorbidities and more often echocardiographic signs of LHD (not shown). The frequency of NYHA classes I–II was comparable between the two groups, while the 6 min-walking distance tended to be lower in subjects with a LHD phenotype than in those without (Figure, left panel). Furthermore, these latter had lower PVR and higher PAWP. No differences were seen in treatment with pulmonary vasodilators, with around 50% of patients receiving double oral combination therapy in both groups (Figure, right panel). During the study period, 7 (17%) and 4 (11%) patients died in the LHD and no-LHD groups, respectively (P = 0.40).
Conclusions
In this real-world cohort of elderly patients, a LHD phenotype was common despite an initial haemodynamic diagnosis of PAH. However, it did not appear to cause simplification or discontinuation of pulmonary vasodilator therapy. Longitudinal studies are needed to determine whether and how a LHD phenotype affects the use and effects of PAH drugs in the elderly.
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Affiliation(s)
- Matteo Toma
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Roberta Miceli
- Cardiovascular Disease Unit, E.O. Ospedali Galliera, Genova, Italy
| | - Edoardo Bonsante
- Department of Cardiology, S. Maurizio Regional Hospital of Bolzano, Italy
| | - Marco Confalonieri
- Pulmonology Department, University Hospital of Cattinara, Trieste, Italy
| | - Andrea Garascia
- ‘De Gasperis’ Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariangela Lattanzio
- Cardiology Unit, Ospedale Universitario di Circolo e Fondazione Macchi, ASST dei Sette Laghi di Varese, Italy
| | - Carlo Mario Lombardi
- Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - Giuseppe Paciocco
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Cristina Piccinino
- Cardiology Unit, Azienda Ospedaliero-Universitaria Maggiore Della Carità di Novara, Italy
| | - Irene Rota
- Cardiovascular Disease Unit, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piermario Scuri
- Department of Cardiology, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Stolfo
- Pulmonology Department, University Hospital of Cattinara, Trieste, Italy
| | - Antonella Vincenzi
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Marco Vicenzi
- Cardiovascular Disease Unit, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Ruaro B, Baratella E, Confalonieri P, Confalonieri M, Vassallo FG, Wade B, Geri P, Pozzan R, Caforio G, Marrocchio C, Cova MA, Salton F. High-Resolution Computed Tomography and Lung Ultrasound in Patients with Systemic Sclerosis: Which One to Choose? Diagnostics (Basel) 2021; 11:2293. [PMID: 34943531 PMCID: PMC8700001 DOI: 10.3390/diagnostics11122293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
Imaging plays a pivotal role in systemic sclerosis for both diagnosis management of pulmonary complications, and high-resolution computed tomography (HRCT) is the most sensitive technique for the evaluation of systemic sclerosis-associated interstitial lung disease (SSc-ILD). Indeed, several studies have demonstrated that HRCT helps radiologists and clinicians to make a correct diagnosis on the basis of recognised typical patterns for SSc-ILD. Most SSc patients affected by ILD have a non-specific interstitial pneumonia pattern (NISP) on HRCT scan, whilst a minority of cases fulfil the criteria for usual interstitial pneumonia (UIP). Moreover, several recent studies have demonstrated that lung ultrasound (LUS) is an emergent tool in SSc diagnosis and follow-up, although its role is still to be confirmed. Therefore, this article aims at evaluating the role of LUS in SSc screening, aimed at limiting the use of CT to selected cases.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Paola Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Marco Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Fabio Giuseppe Vassallo
- Department of Pulmonology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy;
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10124 Torino, Italy;
| | - Pietro Geri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Riccardo Pozzan
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Gaetano Caforio
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Cristina Marrocchio
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Francesco Salton
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
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