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Moratto D, Mimiola E, Serana F, Garuti M, Giustini V, Roccaro AM, Casari S, Beccaria M, Brugnoni D, Chiarini M, Franchini M. Lack of a prompt normalization of immunological parameters is associated with long-term care and poor prognosis in COVID-19 affected patients receiving convalescent plasma: a single center experience. Diagnosis (Berl) 2023; 10:193-199. [PMID: 36550685 DOI: 10.1515/dx-2022-0112] [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: 10/12/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Being COVID-19 convalescent plasma (CCP) a therapeutic option that can have a potential impact on the normalization of immunological parameters of COVID-19 affected patients, a detailed analysis of post-infusion immunological changes was conducted in CCP treated patients, aiming to identify possible predictive hallmarks of disease prognosis. METHODS This prospective observational study describes a cohort of 28 patients who received CCP shortly after being hospitalized for COVID-19 and diagnosed for Acute Respiratory Distress Syndrome. All patients were subjected to a detailed flow cytometry based evaluation of immunological markers at baseline and on days +3 and +7 after transfusion. RESULTS At baseline almost all patients suffered from lymphopenia (25/28 on T-cells and 16/28 on B-cells) coupled with neutrophil-lymphocyte ratio exceeding normal values (26/28). Lymphocyte subsets were generally characterized by increased percentages of CD19+CD20-CD38hiCD27+ plasmablasts and reduction of CD4+CD45RA+CCR7+CD31+ recent thymic emigrants, while monocytes presented a limited expression of CD4 and HLA-DR molecules. Amelioration of immunological parameters began to be evident from day +3 and became more significant at day +7 post-CCP transfusion in 18 patients who recovered within 30 days from hospitalization. Conversely, baseline immunological characteristics generally persisted in ten critical patients who eventually progressed to death (6) or long-term care (4). CONCLUSIONS This study demonstrates that proper immunophenotyping panels can be potentially useful for monitoring CCP treated patients from the first days after infusion in order to presume higher risk of medical complications.
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Affiliation(s)
- Daniele Moratto
- Flow Cytometry Unit, Clinical Chemistry Laboratory, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Elda Mimiola
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Federico Serana
- Hematology Unit, Clinical Chemistry Laboratory, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Martina Garuti
- Intensive Care Respiratory Unit, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Viviana Giustini
- Flow Cytometry Unit, Clinical Chemistry Laboratory, ASST Spedali Civili di Brescia, Brescia, Italy
- Clinical Research Development and Phase I Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Aldo M Roccaro
- Clinical Research Development and Phase I Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Casari
- Unit of Infectious Diseases, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | | | - Duilio Brugnoni
- Flow Cytometry Unit, Clinical Chemistry Laboratory, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marco Chiarini
- Flow Cytometry Unit, Clinical Chemistry Laboratory, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
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Franchini M, Focosi D, Percivalle E, Beccaria M, Garuti M, Arar O, Pecoriello A, Spreafico F, Greco G, Bertacco S, Ghirardini M, Santini T, Schiavulli M, Stefania M, Gagliardo T, Sammartino JC, Ferrari A, Zani M, Ballotari A, Glingani C, Baldanti F. Variant of Concern-Matched COVID-19 Convalescent Plasma Usage in Seronegative Hospitalized Patients. Viruses 2022; 14:v14071443. [PMID: 35891421 PMCID: PMC9323140 DOI: 10.3390/v14071443] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/27/2022] [Indexed: 12/24/2022] Open
Abstract
COVID-19 convalescent plasma (CCP) has been the only specific anti-viral therapy against SARS-CoV-2 available for more than one year. Following the negative results from most randomized controlled trials on its efficacy in COVID-19 hospitalized patients and the availability of anti-spike monoclonal antibodies (mAbs), the use of CCP has subsequently rapidly faded. However, the continuous appearance of new variants of concern (VOCs), most of which escape mAbs and vaccine-elicited neutralizing antibodies (nAbs), has renewed the interest towards CCP, at least in seronegative immunocompetent patients, and in immunocompromised patients not able to mount a protective immune response. We report here the experience of a single Italian hospital in collecting and transfusing CCP in immunocompromised patients hospitalized for severe COVID-19 between October 2021 and March 2022. During this 6-month period, we collected CCP from 32 vaccinated and convalescent regular blood donors, and infused high nAb-titer CCP units (titered against the specific VOC affecting the recipient) to 21 hospitalized patients with severe COVID-19, all of them seronegative at the time of CCP transfusion. Patients’ median age was 66 years (IQR 50–74 years) and approximately half of them (47.6%, 10/21) were immunocompromised. Two patients were rescued after previous failure of mAbs. No adverse reactions following CCP transfusion were recorded. A 28-day mortality rate of 14.3 percent (3/21) was reported, with age, advanced disease stage and late CCP transfusion associated with a worse outcome. This real-life experience also supports the use of CCP in seronegative hospitalized COVID-19 patients during the Delta and Omicron waves.
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Affiliation(s)
- Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, 46100 Mantua, Italy; (M.Z.); (A.B.); (C.G.)
- Correspondence: ; Tel.: +39-0509-96541; Fax: +39-0376-220144
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, 56124 Pisa, Italy;
| | - Elena Percivalle
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.P.); (J.C.S.); (A.F.)
| | - Massimiliano Beccaria
- Intensive Care Respiratory Unit, Carlo Poma Hospital, 46100 Mantua, Italy; (M.B.); (M.G.); (O.A.); (A.P.); (F.S.); (G.G.); (S.B.)
| | - Martina Garuti
- Intensive Care Respiratory Unit, Carlo Poma Hospital, 46100 Mantua, Italy; (M.B.); (M.G.); (O.A.); (A.P.); (F.S.); (G.G.); (S.B.)
| | - Omar Arar
- Intensive Care Respiratory Unit, Carlo Poma Hospital, 46100 Mantua, Italy; (M.B.); (M.G.); (O.A.); (A.P.); (F.S.); (G.G.); (S.B.)
| | - Antonietta Pecoriello
- Intensive Care Respiratory Unit, Carlo Poma Hospital, 46100 Mantua, Italy; (M.B.); (M.G.); (O.A.); (A.P.); (F.S.); (G.G.); (S.B.)
| | - Fabio Spreafico
- Intensive Care Respiratory Unit, Carlo Poma Hospital, 46100 Mantua, Italy; (M.B.); (M.G.); (O.A.); (A.P.); (F.S.); (G.G.); (S.B.)
| | - Graziana Greco
- Intensive Care Respiratory Unit, Carlo Poma Hospital, 46100 Mantua, Italy; (M.B.); (M.G.); (O.A.); (A.P.); (F.S.); (G.G.); (S.B.)
| | - Stefano Bertacco
- Intensive Care Respiratory Unit, Carlo Poma Hospital, 46100 Mantua, Italy; (M.B.); (M.G.); (O.A.); (A.P.); (F.S.); (G.G.); (S.B.)
| | - Marco Ghirardini
- Department of Medicine, Carlo Poma Hospital, 46100 Mantua, Italy; (M.G.); (T.S.)
| | - Tiziana Santini
- Department of Medicine, Carlo Poma Hospital, 46100 Mantua, Italy; (M.G.); (T.S.)
| | - Michele Schiavulli
- Regional Reference Center for Coagulation Disorders, Santobono-Pausilipon Children’s Hospital, AORN, 80129 Naples, Italy;
| | - Muzzica Stefania
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children’s Hospital, AORN, 80129 Naples, Italy; (M.S.); (T.G.)
| | - Thaililja Gagliardo
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children’s Hospital, AORN, 80129 Naples, Italy; (M.S.); (T.G.)
| | - Josè Camilla Sammartino
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.P.); (J.C.S.); (A.F.)
| | - Alessandro Ferrari
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.P.); (J.C.S.); (A.F.)
| | - Matteo Zani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, 46100 Mantua, Italy; (M.Z.); (A.B.); (C.G.)
| | - Alessia Ballotari
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, 46100 Mantua, Italy; (M.Z.); (A.B.); (C.G.)
| | - Claudia Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, 46100 Mantua, Italy; (M.Z.); (A.B.); (C.G.)
| | - Fausto Baldanti
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.P.); (J.C.S.); (A.F.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
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3
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Franchini M, Glingani C, Donno GD, Lucchini G, Beccaria M, Amato M, Castelli GP, Bianciardi L, Pagani M, Ghirardini M, Puma G, Presciuttini B, Costantino MT, Frigato M, Crosato V, Tiecco G, Mulè A, Papalia DA, Inglese F, Spreafico F, Garuti M, Pecoriello A, Cervi G, Greco G, Galavotti V, Santini T, Berselli A, Montalto C, Bertoletti R, Bellometti SA, Capuzzo E, Benazzi D, Grisolia G, Pajola F, Stradoni R, Zani M, Verzola A, Codeluppi V, Vesentini S, Bellocchio E, Candini M, Ambrosi G, Carandina F, Scarduelli C, Reggiani A, Casari S. Convalescent Plasma for Hospitalized COVID-19 Patients: A Single-Center Experience. Life (Basel) 2022; 12:life12030420. [PMID: 35330170 PMCID: PMC8950373 DOI: 10.3390/life12030420] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/20/2022] Open
Abstract
In Winter 2020, Italy, and in particular the Lombardy region, was the first country in the Western hemisphere to be hit by the COVID-19 pandemic. Plasma from individuals recovered from COVID-19 (COVID-19 convalescent plasma, CCP) was the first therapeutic tool adopted to counteract the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In this retrospective cohort study, we report the experience of the city hospital of Mantua, Lombardy region, on the compassionate use of CCP in patients hospitalized for severe COVID-19. Between April 2020 and April 2021, 405 consecutive COVID-19 patients received 657 CCP units with a median anti-SARS-CoV-2 neutralizing antibody (nAb) titer of 160 (interquartile range (IQR), 80−320). Their median age was 68 years (IQR, 56−78 years), and 62% were males. At enrollment, 55% of patients had an increased body mass index (BMI), and 25.6% had at least three comorbidities. The 28-day crude mortality rate was 12.6% (51/405). Young age (<68 years), mild disease (admission to low-intensity departments) and early treatment (<7 days from symptoms onset) with high nAb titer (≥320) CCP were found as independently associated with a favorable response to CCP treatment. No safety concerns were recorded, with a rate of CCP-related adverse reactions (all of mild intensity) of 1.3%. In our real-life experience, the first in the western world, early administration of high-titer CCP was a safe and effective treatment for hospitalized COVID-19 patients.
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Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (C.G.); (E.C.); (M.Z.)
- Correspondence: ; Tel.: +39-0376-201234; Fax: +39-0376-220144
| | - Claudia Glingani
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (C.G.); (E.C.); (M.Z.)
| | - Giuseppe De Donno
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.D.D.); (M.B.); (F.I.); (F.S.); (M.G.); (A.P.); (G.C.); (G.G.); (V.G.)
| | - Giuseppe Lucchini
- Biostatistic Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy;
| | - Massimiliano Beccaria
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.D.D.); (M.B.); (F.I.); (F.S.); (M.G.); (A.P.); (G.C.); (G.G.); (V.G.)
| | - Massimo Amato
- Emergency Department, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (M.A.); (D.B.)
| | - Gian Paolo Castelli
- Department of Anesthesiology and Intensive Care, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.P.C.); (A.B.); (C.M.)
| | - Leonardo Bianciardi
- Anesthesiology and Intensive Care Unit, SS Trinità and San Marcellino Muravera (Cagliari) Hospital, ASL 8 Cagliari, 09043 Cagliari, Italy;
| | - Mauro Pagani
- Internal Medicine Unit, Department of Medicine, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (M.P.); (B.P.)
| | - Marco Ghirardini
- Department of Medicine, Hospital of Asola, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (M.G.); (T.S.)
| | - Giuseppe Puma
- Unit of Infectious Diseases, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.P.); (S.C.)
| | - Barbara Presciuttini
- Internal Medicine Unit, Department of Medicine, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (M.P.); (B.P.)
| | - Maria Teresa Costantino
- Allergology and Clinical Immunology Unit, Department of Medicine, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (M.T.C.); (M.F.)
| | - Marilena Frigato
- Allergology and Clinical Immunology Unit, Department of Medicine, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (M.T.C.); (M.F.)
| | - Verena Crosato
- Infectious and Tropical Diseases Clinic, University of Brescia and Azienda Socio Sanitaria Territoriale Spedali Civili, 25123 Brescia, Italy; (V.C.); (G.T.); (A.M.); (D.A.P.)
| | - Giorgio Tiecco
- Infectious and Tropical Diseases Clinic, University of Brescia and Azienda Socio Sanitaria Territoriale Spedali Civili, 25123 Brescia, Italy; (V.C.); (G.T.); (A.M.); (D.A.P.)
| | - Alice Mulè
- Infectious and Tropical Diseases Clinic, University of Brescia and Azienda Socio Sanitaria Territoriale Spedali Civili, 25123 Brescia, Italy; (V.C.); (G.T.); (A.M.); (D.A.P.)
| | - Dorothea Angela Papalia
- Infectious and Tropical Diseases Clinic, University of Brescia and Azienda Socio Sanitaria Territoriale Spedali Civili, 25123 Brescia, Italy; (V.C.); (G.T.); (A.M.); (D.A.P.)
| | - Francesco Inglese
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.D.D.); (M.B.); (F.I.); (F.S.); (M.G.); (A.P.); (G.C.); (G.G.); (V.G.)
| | - Fabio Spreafico
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.D.D.); (M.B.); (F.I.); (F.S.); (M.G.); (A.P.); (G.C.); (G.G.); (V.G.)
| | - Martina Garuti
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.D.D.); (M.B.); (F.I.); (F.S.); (M.G.); (A.P.); (G.C.); (G.G.); (V.G.)
| | - Antonietta Pecoriello
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.D.D.); (M.B.); (F.I.); (F.S.); (M.G.); (A.P.); (G.C.); (G.G.); (V.G.)
| | - Giulia Cervi
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.D.D.); (M.B.); (F.I.); (F.S.); (M.G.); (A.P.); (G.C.); (G.G.); (V.G.)
| | - Graziana Greco
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.D.D.); (M.B.); (F.I.); (F.S.); (M.G.); (A.P.); (G.C.); (G.G.); (V.G.)
| | - Vanni Galavotti
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.D.D.); (M.B.); (F.I.); (F.S.); (M.G.); (A.P.); (G.C.); (G.G.); (V.G.)
| | - Tiziana Santini
- Department of Medicine, Hospital of Asola, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (M.G.); (T.S.)
| | - Angela Berselli
- Department of Anesthesiology and Intensive Care, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.P.C.); (A.B.); (C.M.)
| | - Carlo Montalto
- Department of Anesthesiology and Intensive Care, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.P.C.); (A.B.); (C.M.)
| | - Riccardo Bertoletti
- Medical Direction, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (R.B.); (S.A.B.); (F.P.)
| | - Simona Aurelia Bellometti
- Medical Direction, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (R.B.); (S.A.B.); (F.P.)
| | - Enrico Capuzzo
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (C.G.); (E.C.); (M.Z.)
| | - Dario Benazzi
- Emergency Department, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (M.A.); (D.B.)
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy;
| | - Fabio Pajola
- Medical Direction, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (R.B.); (S.A.B.); (F.P.)
| | - Raffaello Stradoni
- General Direction, Azienda Socio Sanitaria Territoriale of Valcamonica, 25043 Breno, Italy;
| | - Matteo Zani
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (C.G.); (E.C.); (M.Z.)
| | - Adriano Verzola
- Management Planning and Control Service, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy;
| | - Vito Codeluppi
- Department of Anesthesiology and Intensive Care, Destra Secchia Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (V.C.); (S.V.); (E.B.); (M.C.); (G.A.); (F.C.)
| | - Silvia Vesentini
- Department of Anesthesiology and Intensive Care, Destra Secchia Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (V.C.); (S.V.); (E.B.); (M.C.); (G.A.); (F.C.)
| | - Elisa Bellocchio
- Department of Anesthesiology and Intensive Care, Destra Secchia Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (V.C.); (S.V.); (E.B.); (M.C.); (G.A.); (F.C.)
| | - Marco Candini
- Department of Anesthesiology and Intensive Care, Destra Secchia Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (V.C.); (S.V.); (E.B.); (M.C.); (G.A.); (F.C.)
| | - Giorgina Ambrosi
- Department of Anesthesiology and Intensive Care, Destra Secchia Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (V.C.); (S.V.); (E.B.); (M.C.); (G.A.); (F.C.)
| | - Francesca Carandina
- Department of Anesthesiology and Intensive Care, Destra Secchia Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (V.C.); (S.V.); (E.B.); (M.C.); (G.A.); (F.C.)
| | - Cleante Scarduelli
- Intensive Cardiopulmonary Rehabilitation Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy;
| | - Albino Reggiani
- Cardiology Unit, Destra Secchia Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy;
| | - Salvatore Casari
- Unit of Infectious Diseases, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale of Mantova, 46100 Mantova, Italy; (G.P.); (S.C.)
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Di Stasi V, Rastrelli G, Inglese F, Beccaria M, Garuti M, Di Costanzo D, Spreafico F, Cervi G, Greco GF, Pecoriello A, Todisco T, Cipriani S, Maseroli E, Scavello I, Glingani C, Franchini M, Maggi M, De Donno G, Vignozzi L. Higher testosterone is associated with increased inflammatory markers in women with SARS-CoV-2 pneumonia: preliminary results from an observational study. J Endocrinol Invest 2022; 45:639-648. [PMID: 34731444 PMCID: PMC8564592 DOI: 10.1007/s40618-021-01682-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/21/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Objective of this study was to assess the association between testosterone (T) levels and biochemical markers in a cohort of female patients admitted for SARS-CoV-2 infection in a respiratory intensive care unit (RICU). METHODS A consecutive series of 17 women affected by SARSCoV-2 pneumonia and recovered in the RICU of the Hospital of Mantua were analyzed. Biochemical inflammatory markers as well as total testosterone (TT), calculated free T (cFT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were determined. RESULTS TT and cFT were significantly and positively associated with PCT, CRP, and fibrinogen as well as with a worse hospital course. We did not observe any significant association between TT and cFT with LH; conversely, both TT and cFT showed a positive correlation with cortisol. By LOWESS analysis, a linear relationship could be assumed for CRP and fibrinogen, while a threshold effect was apparent in the relationship between TT and procalcitonin, LDH and ferritin. When the TT threshold value of 1 nmol/L was used, significant associations between TT and PCT, LDH or ferritin were observed for values above this value. For LDH and ferritin, this was confirmed also in an age-adjusted model. Similar results were found for the association of cFT with the inflammatory markers with a threshold effect towards LDH and ferritin with increased LDH and ferritin levels for values above cFT 5 pmol/L. Cortisol is associated with serum inflammatory markers with similar trends observed for TT; conversely, the relationship between LH and inflammatory markers had different trends. CONCLUSION Opposite to men, in women with SARS-CoV-2 pneumonia, higher TT and cFT are associated with a stronger inflammatory status, probably related to adrenal cortex hyperactivity.
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Affiliation(s)
- V Di Stasi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Careggi Hospital, Viale Pieraccini, 6, 50134, Florence, Italy
| | - G Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Careggi Hospital, Viale Pieraccini, 6, 50134, Florence, Italy
| | - F Inglese
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Mantova, Italy
| | - M Beccaria
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Mantova, Italy
| | - M Garuti
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Mantova, Italy
| | - D Di Costanzo
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Mantova, Italy
| | - F Spreafico
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Mantova, Italy
| | - G Cervi
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Mantova, Italy
| | - G F Greco
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Mantova, Italy
| | - A Pecoriello
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Mantova, Italy
| | - T Todisco
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Careggi Hospital, Viale Pieraccini, 6, 50134, Florence, Italy
| | - S Cipriani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Careggi Hospital, Viale Pieraccini, 6, 50134, Florence, Italy
| | - E Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Careggi Hospital, Viale Pieraccini, 6, 50134, Florence, Italy
| | - I Scavello
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Careggi Hospital, Viale Pieraccini, 6, 50134, Florence, Italy
| | - C Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - M Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Careggi Hospital, Viale Pieraccini, 6, Florence, Italy
| | - G De Donno
- Intensive Care Respiratory Unit, Carlo Poma Hospital, Mantova, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Careggi Hospital, Viale Pieraccini, 6, 50134, Florence, Italy.
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5
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Greco GF, Spreafico F, Di Costanzo D, Pecoriello A, Garuti M, Inglese F, Cervi G, De Donno G, Beccaria M. Hemophagocytic Lymphohistiocytosis in a Patient With Acute Respiratory Distress Syndrome Secondary to SARS-CoV-2 Infection. J Med Cases 2021; 11:327-329. [PMID: 34434340 PMCID: PMC8383600 DOI: 10.14740/jmc3515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/31/2020] [Accepted: 07/10/2020] [Indexed: 11/11/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening entity resulting from the dysregulated activation of T-lymphocytes. Secondary HLH (sHLH) complicates various medical conditions. Similar to 2009 H1N1 influenza, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears to trigger a cytokine storm in a subset of individuals. The patient of 64 years old presented himself in the emergency department with cough and fever, and was subjected to the nasopharyngeal swab and tested positive for SARS-CoV-2, as expected from epidemiological data. Hospitalized in cohort isolation, he initially presented a multi-organ impairment and specifically a worsening of his renal function, initial coagulopathy, lymphopenia modest thrombocytopenia and systemic inflammatory commitment. During the course of the 6th day, a picture of a probable cytokine storm and clear multiple organ failure (MOF) was evident. Therefore a clinical diagnosis was made according to HScore criteria of secondary hemophagocytic lymphohistiocytosis. We started high-dose steroid therapy (dexamethasone 8 mg bid). And after 36 h, the patient was significantly improved: alert, oriented, weaned from non-invasive ventilation (NIV) and stable blood chemistry. In conclusion, in coronavirus disease 2019 (COVID-19) positive patients with evidence of cytokine storm and acute respiratory distress syndrome (ARDS), the levels of blood triglycerides and ferritin are useful and often decisive to comfort the diagnosis of sHLH if cytopenia of one or more lines is revealed.
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Affiliation(s)
| | - Fabio Spreafico
- SC Pneumologia e UTIR, ASST Mantova, Carlo Poma, Via Lago Paiolo 10, 46100 Mantova, Italy
| | - Domenica Di Costanzo
- SC Pneumologia e UTIR, ASST Mantova, Carlo Poma, Via Lago Paiolo 10, 46100 Mantova, Italy
| | - Antonietta Pecoriello
- SC Pneumologia e UTIR, ASST Mantova, Carlo Poma, Via Lago Paiolo 10, 46100 Mantova, Italy
| | - Martina Garuti
- SC Pneumologia e UTIR, ASST Mantova, Carlo Poma, Via Lago Paiolo 10, 46100 Mantova, Italy
| | - Francesco Inglese
- SC Pneumologia e UTIR, ASST Mantova, Carlo Poma, Via Lago Paiolo 10, 46100 Mantova, Italy
| | - Giulia Cervi
- SC Pneumologia e UTIR, ASST Mantova, Carlo Poma, Via Lago Paiolo 10, 46100 Mantova, Italy
| | - Giuseppe De Donno
- SC Pneumologia e UTIR, ASST Mantova, Carlo Poma, Via Lago Paiolo 10, 46100 Mantova, Italy
| | - Massimiliano Beccaria
- SC Pneumologia e UTIR, ASST Mantova, Carlo Poma, Via Lago Paiolo 10, 46100 Mantova, Italy
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6
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Franchini M, Bezzi M, Spreafico F, Glingani C, Beccaria M, Greco GF, Inglese F, Caruso B, Terenziani I, Quintavalle G, De Donno G. Acquired Factor VII Deficiency Associated with Bronchogenic Carcinoma: A Case Report. Semin Thromb Hemost 2021; 47:992-994. [PMID: 34255336 DOI: 10.1055/s-0041-1726340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Michela Bezzi
- Interventional Pulmonology Department, University Hospital Spedali Civili, Brescia, Italy
| | | | - Claudia Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | | | | | | | - Beatrice Caruso
- Laboratory Unit, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | | | - Gabriele Quintavalle
- Regional Reference Centre for Inherited Bleeding Disorders, Parma University Hospital, Parma, Italy
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7
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Scarduelli C, Inglese F, Beccaria M, Spreafico F, Garuti M, Pecoriello A, Cervi G, Greco G, Scarduelli S, Lucchini G, De Donno G, Borghi C. Pulmonary embolism in patients with severe COVID-19 treated with intermediate- to full-dose enoxaparin: A retrospective study. Monaldi Arch Chest Dis 2021; 91. [PMID: 33728885 DOI: 10.4081/monaldi.2021.1758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease (COVID-19) may predispose patients to pulmonary embolism (PE), despite standard thromboprophylaxis. Our retrospective study aimed to report the prevalence of PE in patients with COVID-19 and severe respiratory failure (SRF) treated with intermediate- to full-dose enoxaparin. We analyzed data from patients with COVID-19 pneumonia and SRF admitted to our Respiratory Intensive Care Unit (RICU) from February 27 to April 20, 2020. All patients received at least intermediate-dose enoxaparin (40 mg twice daily). Computed tomography pulmonary angiography (CTPA) was used to detect PE. Ninety-two patients with COVID-19 pneumonia and SRF were admitted to our RICU. Twenty-two patients underwent CTPA (24 %), 11 of whom had PEs (12%). We hypothesize that the enoxaparin treatment may be responsible for the lower prevalence of PE as compared to previous reports of similar patients, even if our report had several limitations, mainly the small sample size.
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Affiliation(s)
| | | | | | - Fabio Spreafico
- Pulmonology and Respiratory Intensive Care Unit ASST Mantova.
| | - Martina Garuti
- Pulmonology and Respiratory Intensive Care Unit ASST Mantova.
| | | | - Giulia Cervi
- Pulmonology and Respiratory Intensive Care Unit ASST Mantova.
| | - Graziana Greco
- Pulmonology and Respiratory Intensive Care Unit ASST Mantova.
| | - Sara Scarduelli
- Internal Medicine Department of Medical and Surgical Sciences Bologna University .
| | | | | | - Claudio Borghi
- Internal Medicine Department of Medical and Surgical Sciences Bologna University.
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8
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Franchini M, Glingani C, Morandi M, Corghi G, Cerzosimo S, Beduzzi G, Storti A, Di Stasi V, Rastrelli G, Vignozzi L, Mengoli C, Garuti M, Beccaria M, Inglese F, Caruso B, Petilino RA, Amato M, Nicchio M, Pagani M, Bellani A, Castelli G, Casari S, De Donno G. Safety and Efficacy of Convalescent Plasma in Elderly COVID-19 Patients: The RESCUE Trial. Mayo Clin Proc Innov Qual Outcomes 2021; 5:403-412. [PMID: 33585799 PMCID: PMC7869678 DOI: 10.1016/j.mayocpiqo.2021.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Indexed: 12/15/2022] Open
Abstract
Objective To assess the safety and efficacy of convalescent plasma (CP) transfusion in elderly people with moderate to severe coronavirus disease 2019 (COVID-19) living in a long-term care facility (LTCF). Patients and Methods Twenty-two consecutive elderly patients with COVID-19 infection living in an LTCF in Lombardy, Italy, who were given CP during May 15 to July 31, 2020, were enrolled in a prospective cohort study. Their clinical, instrumental, and laboratory parameters were assessed following the CP treatment. The overall mortality rate in this group was compared with that recorded in other LTCFs in Lombardy during the 3-month period from March to May 2020. Results Of the 22 patients enrolled, 68.2% (n=15) received 1 CP unit, 27.3% (n=6) received 2 units, and 4.5% (n=1) received 3 units. Of the CP units transfused, 76.7% (23/30) had a neutralizing antibody titer of 1:160 or greater. No adverse reactions were recorded during or after CP administration. Improvements in clinical, functional, radiologic, and laboratory parameters during the 14 days after CP transfusion were observed in all 19 patients who survived. Viral clearance was achieved in all patients by the end of follow-up (median, 66 days; interquartile range, 48-80 days). The overall mortality rate was 13.6% (3/22), which compared favorably with that in the control group (38.3% [281/733]; P=.02) and corresponded to a 65% reduction in mortality risk. Conclusion Early administration of CP with an adequate anti-severe acute respiratory syndrome coronavirus 2 antibody titer to elderly symptomatic patients with COVID-19 infection in an LTCF was safe and effective in eliminating the virus, restoring patients' immunity, and blocking the progression of COVID-19 infection, thereby improving patients' survival. Trial Registration ClinicalTrials.gov: NCT04569188.
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Key Words
- COVID-19, coronavirus disease 2019
- CP, convalescent plasma
- CRP, C-reactive protein
- Fio2, fraction of inspired oxygen
- IL-6, interleukin 6
- IQR, interquartile range
- ISS, Italian National Institute of Health
- LTCF, long-term care facility
- NNT, number needed to treat
- NS, not significant
- PCR, polymerase chain reaction
- RESCUE, Real-time Evaluation of Safety and Efficacy of Convalescent Plasma Units Transfused to Elderly Patients With COVID-19
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Claudia Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Mario Morandi
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | | | - Sara Cerzosimo
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | - Gloria Beduzzi
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | - Andrea Storti
- Green Park Residence, Mantova Salus Group, Mantova, Italy
| | - Vincenza Di Stasi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence-Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, Florence, Italy
| | - Giulia Rastrelli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence-Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, Florence, Italy
| | - Linda Vignozzi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence-Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital, Florence, Italy
| | - Carlo Mengoli
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | | | | | | | | | | | - Massimo Amato
- Emergency Department, Carlo Poma Hospital, Mantova, Italy
| | | | - Mauro Pagani
- Department of Medicine, Ospedale Destra Secchia, Carlo Poma Hospital, Mantova, Italy
| | - Angela Bellani
- Department of Frailty, Carlo Poma Hospital, Mantova, Italy
| | - Gianpaolo Castelli
- Department of Anesthesiology and Intensive Care, Carlo Poma Hospital, Mantova, Italy
| | - Salvatore Casari
- Unit of Infectious Diseases, Carlo Poma Hospital, Mantova, Italy
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9
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Fra V, Beccaria M, Milano G, Guastella S, Bianco S, Porro S, Laurenti M, Stassi S, Ricciardi C. Hydrothermally grown ZnO nanowire array as an oxygen vacancies reservoir for improved resistive switching. Nanotechnology 2020; 31:374001. [PMID: 32492668 DOI: 10.1088/1361-6528/ab9920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Resistive switching (RS) devices based on self-assembled nanowires (NWs) and nanorods (NRs) represent a fascinating alternative to conventional devices with thin film structure. The high surface-to-volume ratio may indeed provide the possibility of modulating their functionalities through surface effects. However, devices based on NWs usually suffer from low resistive switching performances in terms of operating voltages, endurance and retention capabilities. In this work, we report on the resistive switching behaviour of ZnO NW arrays, grown by hydrothermal synthesis, that exhibit stable, bipolar resistive switching characterized by SET/RESET voltages lower than 3 V, endurance higher than 1100 cycles and resistance state retention of more than 105 s. The physical mechanism underlying these RS performances can be ascribed to nanoionic processes involving the formation/rupture of conductive paths assisted by oxygen-related species in the ZnO active layer. The reported results represent, to the best of our knowledge, the best resistive switching performances observed in ZnO NW arrays in terms of endurance and retention.
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Affiliation(s)
- V Fra
- Department of Applied Science and Technology, Politecnico di Torino, c.so Duca degli Abruzzi 24, I-10129, Torino, Italy
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10
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Grisolia G, Franchini M, Glingani C, Inglese F, Garuti M, Beccaria M, Capuzzo M, Pinto A, Pavan G, Righetto L, Perotti C, Zampriolo P, De Donno G. Convalescent plasma for coronavirus disease 2019 in pregnancy: a case report and review. Am J Obstet Gynecol MFM 2020; 2:100174. [PMID: 32838270 PMCID: PMC7332432 DOI: 10.1016/j.ajogmf.2020.100174] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Claudia Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | | | | | | | - Martina Capuzzo
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Pinto
- Department of Surgery, Odontostomatology and Maternal and Child Health, University of Verona, Verona, Italy
| | - Giorgia Pavan
- Department of Surgery, Odontostomatology and Maternal and Child Health, University of Verona, Verona, Italy
| | - Lara Righetto
- Department of Surgery, Odontostomatology and Maternal and Child Health, University of Verona, Verona, Italy
| | - Cesare Perotti
- Immunohematology and Transfusion Service, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Paolo Zampriolo
- Obstetrics and Gynecology Unit, Carlo Poma Hospital, Mantova, Italy
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11
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Rastrelli G, Di Stasi V, Inglese F, Beccaria M, Garuti M, Di Costanzo D, Spreafico F, Greco GF, Cervi G, Pecoriello A, Magini A, Todisco T, Cipriani S, Maseroli E, Corona G, Salonia A, Lenzi A, Maggi M, De Donno G, Vignozzi L. Low testosterone levels predict clinical adverse outcomes in SARS-CoV-2 pneumonia patients. Andrology 2020; 9:88-98. [PMID: 32436355 PMCID: PMC7280645 DOI: 10.1111/andr.12821] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The pandemic of new severe acute respiratory syndrome (SARS) due to coronavirus (CoV) 2 (SARS-CoV-2) has stressed the importance of effective diagnostic and prognostic biomarkers of clinical worsening and mortality. Epidemiological data showing a differential impact of SARS-CoV-2 infection on women and men have suggested a potential role for testosterone (T) in determining gender disparity in the SARS-CoV-2 clinical outcomes. OBJECTIVES To estimate the association between T level and SARS-CoV-2 clinical outcomes (defined as conditions requiring transfer to higher or lower intensity of care or death) in a cohort of patients admitted in the respiratory intensive care unit (RICU). MATERIALS AND METHODS A consecutive series of 31 male patients affected by SARS-CoV-2 pneumonia and recovered in the respiratory intensive care unit (RICU) of the "Carlo Poma" Hospital in Mantua were analyzed. Several biochemical risk factors (ie, blood count and leukocyte formula, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), ferritin, D-dimer, fibrinogen, interleukin 6 (IL-6)) as well as total testosterone (TT), calculated free T (cFT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were determined. RESULTS Lower TT and cFT were found in the transferred to ICU/deceased in RICU group vs groups of patients transferred to IM or maintained in the RICU in stable condition. Both TT and cFT showed a negative significant correlation with biochemical risk factors (ie, the neutrophil count, LDH, and PCT) but a positive association with the lymphocyte count. Likewise, TT was also negatively associated with CRP and ferritin levels. A steep increase in both ICU transfer and mortality risk was observed in men with TT < 5 nmol/L or cFT < 100 pmol/L. DISCUSSION AND CONCLUSION Our study demonstrates for the first time that lower baseline levels of TT and cFT levels predict poor prognosis and mortality in SARS-CoV-2-infected men admitted to RICU.
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Affiliation(s)
- Giulia Rastrelli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence - Careggi Hospital, Florence, Italy
| | - Vincenza Di Stasi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence - Careggi Hospital, Florence, Italy
| | | | | | | | | | | | | | | | | | - Angela Magini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence - Careggi Hospital, Florence, Italy
| | - Tommaso Todisco
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence - Careggi Hospital, Florence, Italy
| | - Sarah Cipriani
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence - Careggi Hospital, Florence, Italy
| | - Elisa Maseroli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence - Careggi Hospital, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, La Sapienza University of Rome, Rome, Italy
| | - Mario Maggi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Endocrinology Unit, University of Florence, Careggi Hospital, Florence, Italy.,I.N.B.B. - Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
| | | | - Linda Vignozzi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence - Careggi Hospital, Florence, Italy.,I.N.B.B. - Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
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12
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Abstract
The extreme vulnerability of humans to new and old pathogens is constantly highlighted by unbound outbreaks of epidemics. This vulnerability is both direct, producing illness in humans (dengue, malaria), and also indirect, affecting its supplies (bird and swine flu, Pierce disease, and olive quick decline syndrome). In most cases, the pathogens responsible for an illness spread through vectors. In general, disease evolution may be an uncontrollable propagation or a transient outbreak with limited diffusion. This depends on the physiological parameters of hosts and vectors (susceptibility to the illness, virulence, chronicity of the disease, lifetime of the vectors, etc.). In this perspective and with these motivations, we analyzed a stochastic lattice model able to capture the critical behavior of such epidemics over a limited time horizon and with a finite amount of resources. The model exhibits a critical line of transition that separates spreading and non-spreading phases. The critical line is studied with new analytical methods and direct simulations. Critical exponents are found to be the same as those of dynamical percolation.
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Affiliation(s)
- E. Alfinito
- Dipartimento di Ingegneria dell’Innovazione, Università del Salento, Lecce, Italy
| | - M. Beccaria
- Dipartimento di Matematica e Fisica “Ennio de Giorgi”, Università del Salento, Lecce, Italy
- INFN (Istituto Nazionale di Fisica Nucleare) Sezione di Lecce - Via Arnesano 73100 Lecce,Italy.
| | - G. Macorini
- Dipartimento di Matematica e Fisica “Ennio de Giorgi”, Università del Salento, Lecce, Italy
- INFN (Istituto Nazionale di Fisica Nucleare) Sezione di Lecce - Via Arnesano 73100 Lecce,Italy.
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13
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Beccaria M, Dovier GO, Macorini G, Mirabella E, Panizzi L, Renard FM, Verzegnassi C. Semi-inclusive bottom-Higgs production at LHC: The complete one-loop electroweak effect in the MSSM. Int J Clin Exp Med 2010. [DOI: 10.1103/physrevd.82.093018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hirschler V, Molinari C, Beccaria M, Maccallini G, Aranda C. Comparison of various maternal anthropometric indices of obesity for identifying metabolic syndrome in offspring. Diabetes Technol Ther 2010; 12:297-305. [PMID: 20210569 DOI: 10.1089/dia.2009.0164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several maternal anthropometric markers have been associated with the metabolic syndrome (MS) in offspring. The objectives of this study were (1) to determine the association between children's MS and maternal anthropometric markers such as body mass index (BMI), waist circumference (WC), WC/height, weight/sitting height squared, and WC/sitting height and (2) to compare the abilities of these five indices to identify children with MS. METHODS Data were collected cross-sectionally from five elementary schools between April 2007 and March 2008. BMI, WC, WC/height, weight/sitting height squared, and WC/sitting height were acquired in mothers and their children. Tanner stage, blood pressure, glucose, lipids, and insulin were measured in children. Criteria analogous to Adult Treatment Panel III for MS were used for children. RESULTS Of 624 children (307 boys) 8.96 +/- 1.86 years old, with their mothers being 36.25 +/- 7.14 years old, examined, 107 (17.1%) of children were obese (BMI >95th percentile per Centers for Disease Control and Prevention norms), and 95 (15.2%) were overweight (OW) (85th percentile < or =BMI < 95th percentile). Of the mothers, 109 (30.4%) were obese (BMI > 30 kg/m(2)), and 206 (33.0%) were OW (25 kg/m(2) < BMI < 30 kg/m(2)). Approximately 68% of the children were prepubertal. The prevalence of MS was 3.5% overall: 6.7% in OW and 13.9% in obese children. To determine which marker was a better predictor for MS, a receiver operating characteristics (ROC) curve was generated for the five maternal anthropometric measures, with children's MS as the dichotomous variable. The areas under the ROC curves were 0.697 +/- 0.07 for BMI, 0.698 +/- 0.07 for WC, 0.717 +/- 0.07 for WC/height, 0.725 +/- 0.07 for WC/sitting height, and 0.704 +/- 0.07 for weight/sitting height squared. There was no significant difference between the areas of the five maternal anthropometric markers as predictors of children's MS. CONCLUSIONS Measurement of maternal sitting height had no advantages over total height in the prediction of children's MS. All maternal anthropometric measures identified the MS in their children consistent with known familial associations of obesity and type 2 diabetes.
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Affiliation(s)
- V Hirschler
- Department of Nutrition, University of Buenos Aires, Buenos Aires, Argentina.
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15
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Droghetti A, Schiavini A, Muriana P, Comel A, De Donno G, Beccaria M, Canneto B, Sturani C, Muriana G. Autologous blood patch in persistent air leaks after pulmonary resection. J Thorac Cardiovasc Surg 2006; 132:556-9. [PMID: 16935110 DOI: 10.1016/j.jtcvs.2006.05.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 05/22/2006] [Accepted: 05/23/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Persistent air leak is among the most common complications after pulmonary resection, leading to prolonged hospitalization and increased costs. At present there is not yet a consensus on their treatment. METHODS During a 7-year experience, 21 patients submitted to pulmonary resection were postoperatively treated with an autologous blood patch for persistent air leaks. Persistent air leaks were catalogued twice daily according to the classification previously reported by Cerfolio and associates. Chest radiographs showed a fixed pleural space deficit in 18 (86%) patients. A total of 50 to 150 mL of autologous blood was drawn from the patient and injected into the chest tube, which was removed 48 hours after cessation of the air leak. RESULTS We observed a 4% incidence of persistent air leaks after pulmonary resection in our series. Persistent air leaks were categorized as follows: 14% forced expiratory, 57% expiratory, 29% continuous, and 0% inspiratory. The mean duration of prolonged air leaks was 11 days after surgery. In 81% of the cases examined, a blood patch was only carried out once and gave successful results within 24 hours. In the remaining 19% of cases, the air leak ceased within 12 hours after the second procedure. Mean hospital stay was 15 days. In our experience this procedure had a 100% success rate. CONCLUSIONS Pleurodesis with an autologous blood patch is well tolerated, safe, and inexpensive. This procedure is an effective technique for treatment of postoperative persistent air leaks, even in the presence of an associated fixed pleural space deficit.
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Beccaria M, Macorini G, Renard FM, Verzegnassi C. AssociatedtWproduction at CERN LHC: A complete calculation of electroweak supersymmetric effects at one loop. Int J Clin Exp Med 2006. [DOI: 10.1103/physrevd.73.093001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Zoia MC, Corsico AG, Beccaria M, Guarnone R, Cervio G, Testi R, Bressan MA, Pozzi E, Cerveri I. Exacerbations as a starting point of pro-active chronic obstructive pulmonary disease management. Respir Med 2005; 99:1568-75. [PMID: 15890509 DOI: 10.1016/j.rmed.2005.03.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Indexed: 10/25/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) exacerbations could represent an opportunity for pro-active COPD management rather than mere treatment if previously unknown disease is discovered; the extent of underdiagnosis and undertreatment of COPD in patients attending an emergency department (ED) with an exacerbation is not known. During 2002, we recalled 131 COPD patients in stable conditions, 4-8 weeks after they had attended the ED or been discharged from our University Hospital (North-West of Italy). Information on diagnosis and management prior to the ED attendance were collected; spirometry and arterial blood gas analyses were performed. One-third of patients had never been diagnosed and treated even though 83% of them had moderate-to-very-severe COPD and about 30% already had respiratory failure. Only 20% had received information on the nature of the disease and none had received a written action plan. Only 60% were receiving long-acting bronchodilators and 41% of patients with respiratory failure were receiving long-term oxygen. A substantial number of undiagnosed and untreated patients with moderate-to-very-severe COPD came to our attention through an exacerbation. This enforces the importance of exacerbations as the starting point of pro-active COPD management and of the ED as a valuable sentinel to identify this subset of patients.
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Affiliation(s)
- Maria C Zoia
- IRCCS Policlinico S. Matteo, Division of Respiratory Diseases, via Taramelli 5, Pavia, 27100, Italy
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Beccaria M, De Angelis GF. Exact ground state and finite-size scaling in a supersymmetric lattice model. Phys Rev Lett 2005; 94:100401. [PMID: 15783463 DOI: 10.1103/physrevlett.94.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Indexed: 05/24/2023]
Abstract
We study a model of strongly correlated fermions in one dimension with extended N = 2 supersymmetry. The model is related to the spin S = 1/2 XXZ Heisenberg chain at anisotropy Delta = -1/2 with a real magnetic field on the boundary. We exploit the combinatorial properties of the ground state to determine its exact wave function on finite lattices with up to 30 sites. We compute several correlation functions of the fermionic and spin fields. We discuss the continuum limit by constructing lattice observables with well defined finite-size scaling behavior. For the fermionic model with periodic boundary conditions we give the emptiness formation probability in closed form.
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Affiliation(s)
- M Beccaria
- Dipartimento di Fisica and INFN, Università di Lecce, Via Arnesano, 73100 Lecce, Italy
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Beccaria M, Luisetti M, Rodi G, Corsico A, Zoia MC, Colato S, Pochetti P, Braschi A, Pozzi E, Cerveri I. Long-term durable benefit after whole lung lavage in pulmonary alveolar proteinosis. Eur Respir J 2004; 23:526-31. [PMID: 15083749 DOI: 10.1183/09031936.04.00102704] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Whole lung lavage (WLL) is still the gold-standard therapy for pulmonary alveolar proteinosis (PAP). The few studies on the duration of the effect of WLL, belonging to a rather remote period, show significant but transient benefits. In 21 patients with idiopathic PAP, the duration of any benefit and, in 16 of them, the time course of lung function improvement (at baseline, 1 week, 6 months, 1 yr and then every 2 yrs after WLL) were evaluated. The present WLL technique takes longer, is invasively monitored and partially modified with respect to past techniques. More than 70% of patients remained free from recurrent PAP at 7 yrs. The bulk of the improvement in spirometric results was almost completely gained in the immediate post-WLL period due to the efficient clearance of the alveoli. At a median of 5 yrs, recovery of diffusing capacity of the lung for carbon monoxide was incomplete (75 +/- 19% of the predicted value) and there were residual gas exchange abnormalities (alveolar to arterial oxygen tension difference 3.6 +/- 1.5 kPa (27 +/- 11 mmHg)) and exercise limitation, probably explained by engorgement of lymphatic vessels. In conclusion, whole lung lavage for idiopathic pulmonary alveolar proteinosis is currently a safe procedure in an experienced setting, and provides long-lasting benefits in the majority of patients.
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Affiliation(s)
- M Beccaria
- Respiratory Diseases Division, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico S. Matteo, University of Pavia, Pavia, Italy.
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Beccaria M, Eberl H, Renard FM, Verzegnassi C. Supersymmetry tests from a combined analysis of a chargino and charged Higgs boson pair production at a 1 TeV linear collider. Int J Clin Exp Med 2004. [DOI: 10.1103/physrevd.69.091301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cerveri I, Accordini S, Corsico A, Zoia MC, Carrozzi L, Cazzoletti L, Beccaria M, Marinoni A, Viegi G, de Marco R. Chronic cough and phlegm in young adults. Eur Respir J 2004; 22:413-7. [PMID: 14516128 DOI: 10.1183/09031936.03.00121103] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines underline that the presence of chronic cough and sputum production before airflow obstruction offers a unique opportunity to identify subjects at risk of chronic obstructive pulmonary disease for an early intervention. Current epidemiological data on these subjects are scant. Between 1998-2000, the authors evaluated the prevalence and characteristics of these symptoms by a multicentre cross-sectional survey of Italian people aged between 20-44 yrs from the general population (Italian Study on Asthma in Young Adults (ISAYA)). Besides the questions on asthma, more than 18,000 subjects answered the question: "Have you had cough and phlegm on most days for as much as 3 months per year and for at least two successive years?" The adjusted prevalence of subjects with chronic cough and phlegm was 11.9%, being 11.8% in males and 12.0% in females. From these subjects approximately 20% reported coexisting asthma and approximately 30%, predominately females, were nonsmokers. The survey showed that sex (female), smoking and low socioeconomic status were significantly and independently associated with chronic cough and phlegm, current smoking playing the major role. The prevalence of subjects with chronic cough and phlegm is startlingly high among young adults. Further follow-up studies are needed to establish how many of them will go on to develop chronic obstructive pulmonary disease.
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Affiliation(s)
- I Cerveri
- Division of Respiratory Diseases, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
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Ferrarotti I, Zorzetto M, Beccaria M, Gilè LS, Porta R, Ambrosino N, Pignatti PF, Cerveri I, Pozzi E, Luisetti M. Tumour necrosis factor family genes in a phenotype of COPD associated with emphysema. Eur Respir J 2003; 21:444-9. [PMID: 12661999 DOI: 10.1183/09031936.03.00051303] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Genetic factors are believed to play a role in the individual susceptibility to chronic obstructive pulmonary disease (COPD). Tumour necrosis factor (TNF) family genes have been widely investigated but inconsistent results may lie either in the genetic heterogeneity of populations or in the poor phenotype definition. A genetic study was performed using a narrower phenotype of COPD. The authors studied 86 healthy smokers and 63 COPD subjects who were enrolled based on irreversible airflow obstruction (forced expiratory volume in one second/forced vital capacity <70% predicted) and a diffusing capacity for carbon monoxide <50% predicted (moderate-to-severe COPD associated with pulmonary emphysema). The following polymorphisms were investigated: TNF-308, the biallelic polymorphism located in the first intron of the lymphotoxin-alpha gene, and exon 1 and exon 6 of the TNF receptor 1 and 2 genes, respectively. No significant deviations were found concerning the four polymorphisms studied between the two populations. The authors confirm that the tumour necrosis factor family genes, at least for the polymorphisms investigated, are not major genetic risk factors for chronic obstructive pulmonary disease in Caucasians, either defined in terms of emphysema (this study) or airflow obstruction (previous studies). Nevertheless, the authors would like to emphasise the importance of narrowing the phenotype in the search for genetic risk factors in chronic obstructive pulmonary disease.
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Affiliation(s)
- I Ferrarotti
- Dept of Respiratory Diseases, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
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Corsico A, Fulgoni P, Beccaria M, Zoia MC, Barisione G, Pellegrino R, Brusasco V, Cerveri I. Effects of exercise and beta 2-agonists on lung function in chronic obstructive pulmonary disease. J Appl Physiol (1985) 2002; 93:2053-8. [PMID: 12391117 DOI: 10.1152/japplphysiol.00490.2002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The effects of inhaled bronchodilators at rest and during exercise were studied in 15 subjects with chronic obstructive pulmonary disease. In a crossover study against placebo, albuterol caused a significant increase in expiratory flow and reduced lung hyperinflation and dyspnea at rest, but this was not associated with differences in symptoms with exercise or any relevant parameter of physical performance. Dynamic hyperinflation occurred during exercise similarly after placebo or albuterol and was associated with a reduction of forced expiratory flows. This, in turn, was correlated with the bronchoconstrictor effect of deep inhalation determined at rest. In a parallel group study, expiratory flow was increased by 3-wk treatment with salmeterol (n = 9) but not with placebo (n = 6). However, in neither group was the response to exercise different from baseline. These results suggest that in chronic obstructive pulmonary disease effective pharmacological bronchodilation at rest may not be predictive of benefits of exercise tolerance. This may be related to the occurrence of airway narrowing during exercise, particularly when a deep inhalation at rest is followed by a decrease in expiratory flow.
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Affiliation(s)
- Angelo Corsico
- Laboratorio di Fisiopatologia Respiratoria, Clinica Malattie Apparato Respiratorio, Università di Pavia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, 27100 Pavia, Italy
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Zoia MC, D'Armini AM, Beccaria M, Corsico A, Fulgoni P, Klersy C, Piovella F, Viganò M, Cerveri I. Mid term effects of pulmonary thromboendarterectomy on clinical and cardiopulmonary function status. Thorax 2002; 57:608-12. [PMID: 12096204 PMCID: PMC1746368 DOI: 10.1136/thorax.57.7.608] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) can be successfully treated surgically by pulmonary thromboendarterectomy (PTE) but there are few data on mid-term cardiopulmonary function, particularly on exertion, and clinical benefits following pulmonary PTE. METHODS A 2 year follow up study was undertaken of clinical status, haemodynamic and lung function indices, gas exchange, and exercise tolerance in 38 patients of mean (SD) age 50 (15) years who had undergone PTE. RESULTS In-hospital mortality was about 10%. Before PTE all the patients were severely impaired (NYHA classes III-IV). There was no time difference in the improvement in the parameters: nearly all the improvement in cardiac output, gas exchange, and clinical status was achieved in the first 3 months as a result of the relief of pulmonary obstruction. At 3 months the percentage of patients with normal cardiac output and PaO(2) and of those with reduced clinical impairment increased to 97%, 59%, and 87%, respectively, without any further change. Only mean pulmonary artery pressure (mPAP), carbon monoxide transfer factor (TLCO), and exercise tolerance improved gradually during the second year, probably due to the recovery of the damaged small vessels. TLCO was overestimated before PTE but afterwards the trend was similar to that of mPAP. CONCLUSIONS At mid term only a few patients did not have a satisfactory recovery because of lack of operative success, hypertension relapse, or the effect of preoperative hypertension on vessels in non-obstructed segments. Most of the patients, even the more compromised ones, had excellent long lasting results.
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Affiliation(s)
- M C Zoia
- Clinic of Respiratory Diseases, IRCCS San Matteo Hospital, University of Pavia, Italy
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Cerveri I, Fulgoni P, Giorgiani G, Zoia MC, Beccaria M, Tinelli C, Locatelli F. Lung function abnormalities after bone marrow transplantation in children: has the trend recently changed? Chest 2001; 120:1900-6. [PMID: 11742920 DOI: 10.1378/chest.120.6.1900] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To evaluate early and late lung function abnormalities and their predictors in a large sample of children who underwent bone marrow transplantation (BMT) for leukemias in the 1990s, highlighting changes with respect to the 1980s. DESIGNS Prospective cohort. SETTING A university department of pediatrics. PARTICIPANTS Seventy-five consecutive children who underwent BMT were enrolled in the study (median age, 11 years; range, 6 to 19 years; 45 male and 30 female children). Twenty-three children received autologous BMT, and 52 children received allogeneic BMT; 50 children completed the study. MEASUREMENTS Clinical examinations and lung function tests were performed before BMT, and 3 to 6 months, 12 months, and 24 months after BMT. RESULTS Before BMT, at 3 to 6 months after BMT, and at 24 months after BMT, 44%, 85%, and 62% of children, respectively, had altered lung function in the absence of persistent respiratory symptoms. Between 3 months and 6 months after BMT, a restrictive pattern was the most frequent abnormality. The only predictive factors for late abnormalities were transplantation performed in the advanced disease phase (odds ratio [OR], 6.75; p = 0.005) and bronchopulmonary infections (OR, 3.9; p < 0.05). CONCLUSIONS These data suggest that a significant proportion of children who undergo BMT, especially if for leukemia in advanced phase, have early and late pulmonary abnormalities. These abnormalities, especially the late ones, seem to be more severe than patients reported in studies analyzing children undergoing BMT in the 1980s. This could be due to the more intensive front-line treatment protocols employed for treatment of children with acute leukemia in the 1990s.
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Affiliation(s)
- I Cerveri
- Clinic of Respiratory Diseases, Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico "San Matteo", Pavia, Italy.
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Beccaria M, Corsico A, Fulgoni P, Zoia MC, Casali L, Orlandoni G, Cerveri I. Lung cancer resection: the prediction of postsurgical outcomes should include long-term functional results. Chest 2001; 120:37-42. [PMID: 11451813 DOI: 10.1378/chest.120.1.37] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To assess (1) the possibility of predicting long-term postoperative lung function, and (2) the usefulness of maximal oxygen consumption (O(2)max) as a criterion for operability and as a predictor of long-term disability. DESIGN Prospective study. SETTING Outpatients and inpatients of a university hospital. PARTICIPANTS Sixty-two consecutive patients (mean +/- SD age, 62 +/- 8 years; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 48]). MEASUREMENTS Clinical examination and recorded respiratory symptoms and spirometry results before surgery and 6 months after surgery. If predicted postoperative FEV(1) (ppoFEV(1)) was < 40%, patients underwent exercise testing; if O(2)max was between 10 mL/kg/min and 20 mL/kg/min, patients underwent a split-function study. RESULTS All the patients with ppoFEV(1) > or = 40%-even those patients (26%) with FEV(1) < 80%-underwent thoracotomy without further tests. Seven patients with ppoFEV(1) < 40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; including six patients with COPD and one patient with asthma) had immediate postoperative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV(1) > or = 40%. ppoFEV(1) significantly underestimated the actual postoperative FEV(1) (poFEV(1); p < 0.001) 6 months after pneumonectomy or bilobectomy but was reliable for actual poFEV(1) after lobectomy. Two patients with predicted postoperative O(2)max > 10 mL/kg/min became oxygen dependent and had marked limitation of daily living. CONCLUSIONS ppoFEV(1) > or = 40% reliably identifies patients not requiring further tests and not at long-term risk of respiratory disability. O(2)max, effective for defining the immediate surgical risk, is not useful in predicting long-term disability.
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Affiliation(s)
- M Beccaria
- Clinic of Respiratory Diseases, University of Pavia-IRCCS, Policlinico "S.Matteo", Pavia, Italy
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Abstract
STUDY OBJECTIVES To evaluate lung function in patients cured from childhood acute lymphoblastic leukemia (ALL) with chemotherapy alone or plus bone marrow transplantation (BMT). Pulmonary toxicity is a well-recognized side effect of many ALL treatments. DESIGN Cross-sectional study conducted at least 3 years after cessation of therapy. SETTING Outpatient pneumology department of the University Hospital. PATIENTS Forty-four subjects (age range at observation, 6 to 23 years): 21 treated only with intensive Berlin-Frankfurt-Munster (BFM)-type chemotherapy for newly diagnosed ALL (group A), and 23 treated with chemotherapy plus BMT (group B). MEASUREMENTS A detailed history of smoking habit, respiratory symptoms, and diseases was recorded directly from the patients with the aid of their parents. A complete physical examination and lung function testing (lung volumes and diffusion capacity for carbon monoxide [DLCO]) were performed in all subjects. RESULTS No patient reported acute or chronic respiratory symptoms or diseases. In group A patients, lung function was in the normal range, except for three subjects in whom there was an isolated impairment of DLCO. In group B patients, lung function was markedly impaired, with more than half the patients having an abnormal DLCO. A statistically significant difference was found between the two groups for FVC (p = 0.022) and DLCO (p = 0.004). CONCLUSIONS Intensive, BFM-type frontline chemotherapy is not associated with late pulmonary dysfunction; however, retreatment including BMT can frequently injure the lung. Thus, in patients who undergo BMT and whose life expectancy is long, careful monitoring of lung function and counseling about avoiding additional lung risk factors is recommended.
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Affiliation(s)
- P Fulgoni
- Institute of Respiratory Diseases, IRCCS Policlinico "S. Matteo," University of Pavia, Italy
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Luisetti M, Massi G, Massobrio M, Guarraci P, Menchicchi FM, Beccaria M, Balbi B. A national program for detection of alpha 1-antitrypsin deficiency in Italy. Gruppo I.D.A. Respir Med 1999; 93:169-72. [PMID: 10464873 DOI: 10.1016/s0954-6111(99)90003-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
alpha 1-antitrypsin (AAT) deficiency is an inherited condition characterized by low serum levels of AAT and an increased risk of developing pulmonary emphysema. The disease occurs mainly in Caucasians, but Southern Europe, including Italy, is considered a low prevalence area. We developed a national program in Italy in order to improve our knowledge of the epidemiology of AAT deficiency and to establish a registry of the AAT-deficient individuals. The program had two phases: the first lasted 36 months, during which blood from coupons mailed by respiratory physicians from throughout the country, was isoelectrofocused by the Central Laboratory in Rome. The second phase started in February 1996, and the Registry was established. Up to August 1998, 151 subjects with AAT deficiency have been identified and 64 have been enrolled in the Registry. We believe that such a program plays a crucial role in identifying AAT deficiency in a country such as Italy, with low prevalence and low awareness of this rare condition.
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Affiliation(s)
- M Luisetti
- Istituto di Tisiologia e Malattie Respiratorie, IRCCS Policlinico San Matteo, Università di Pavia, Italy.
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Caron B, Dominjon A, Drezen C, Flaminio R, Grave X, Marion F, Massonnet L, Mehmel C, Morand R, Mours B, Sannibale V, Yvert M, Babusci D, Bellucci S, Candusso S, Giordano G, Matone G, Mackowski JM, Pinard L, Barone F, Calloni E, Di Fiore L, Flagiello M, Garuti F, Grado A, Longo M, Lops M, Marano S, Milano L, Solimeno S, Brisson V, Cavalier F, Davier M, Hello P, Heusse P, Mann P, Acker Y, Barsuglia M, Bhawal B, Bondu F, Brillet A, Heitmann H, Innocent JM, Latrach L, Man C, Pham-Tu M, Tournier E, Taubmann M, Vinet JY, Boccara C, Gleyzes P, Loriette V, Roger JP, Cagnoli G, Gammaitoni L, Kovalik J, Marchesoni F, Punturo M, Beccaria M, Bernardini M, Bougleux E, Braccini S, Bradaschia C, Cella G, Ciampa A, Cuoco E, Curci G, Del Fabbro R, De Salvo R, Di Virgilio A, Enard D, Ferrante I, Fidecaro F, Giassi A, Giazotto A, Holloway L, La Penna P, Losurdo G, Mancini S, Mazzoni M, Palla F, Pan HB, Passuello D, Pelfer P, Poggiani R, Stanga R, Vicere' A, Zhang Z, Ferrari V, Majorana E, Puppo P, Rapagnani P, Ricci F. The VIRGO interferometer for gravitational wave detection. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s0920-5632(97)00109-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Beccaria M, Curci G. Numerical simulation of the Kardar-Parisi-Zhang equation. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 1994; 50:4560-4563. [PMID: 9962534 DOI: 10.1103/physreve.50.4560] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Beccaria M, Curci G, Viceré A. Numerical solutions of first-exit-time problems. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 1993; 48:1539-1546. [PMID: 9960744 DOI: 10.1103/physreve.48.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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