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7. P397 PROGNOSTIC VALUE OF CORONARY CALCIUM IN PATIENTS WITH COVID–19 AND SUSPECTED INTERSTITIAL PNEUMONIA: A CASE–CONTROL STUDY

Author

Carletti, R, primary, Galvani, M, additional, Gardini, E, additional, De Vita, M, additional, Dallaserra, C, additional, Vizzuso, A, additional, Ottani, F, additional, Campacci, F, additional, Grosseto, D, additional, Di Gianuario, G, additional, Rinaldi, G, additional, Vecchio, S, additional, Mantero, F, additional, Mellini, L, additional, Albini, A, additional, Mughetti, M, additional, Gardelli, G, additional, and Piciucchi, S, additional

Published
2022
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8. Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study

Author

Scaramuzzo G., Gamberini L., Tonetti T., Zani G., Ottaviani I., Mazzoli C. A., Capozzi C., Giampalma E., Bacchi Reggiani M. L., Bertellini E., Castelli A., Cavalli I., Colombo D., Crimaldi F., Damiani F., Fusari M., Gamberini E., Gordini G., Laici C., Lanza M. C., Leo M., Marudi A., Nardi G., Papa R., Potalivo A., Russo E., Taddei S., Consales G., Cappellini I., Ranieri V. M., Volta C. A., Guerin C., Spadaro S., Tartaglione M., Chiarini V., Buldini V., Coniglio C., Moro F., Barbalace C., Citino M., Cilloni N., Giuntoli L., Bellocchio A., Matteo E., Pizzilli G., Siniscalchi A., Tartivita C., Matteo F., Marchio A., Bacchilega I., Bernabe L., Guarino S., Mosconi E., Bissoni L., Viola L., Meconi T., Pavoni V., Pagni A., Pompa Cleta P., Cavagnino M., Malfatto A., Adduci A., Pareschi S., Melegari G., Maccieri J., Marinangeli E., Racca F., Verri M., Falo G., Marangoni E., Boni F., Felloni G., Baccarini F. D., Terzitta M., Maitan S., Becherucci F., Parise M., Masoni F., Imbriani M., Orlandi P., Monetti F., Dalpiaz G., Golfieri R., Ciccarese F., Poerio A., Muratore F., Ferrari F., Mughetti M., Franchini L., Neziri E., Miceli M., Minguzzi M. T., Mellini L., Piciucchi S., Bartolucci M., Scaramuzzo G., Gamberini L., Tonetti T., Zani G., Ottaviani I., Mazzoli C.A., Capozzi C., Giampalma E., Bacchi Reggiani M.L., Bertellini E., Castelli A., Cavalli I., Colombo D., Crimaldi F., Damiani F., Fusari M., Gamberini E., Gordini G., Laici C., Lanza M.C., Leo M., Marudi A., Nardi G., Papa R., Potalivo A., Russo E., Taddei S., Consales G., Cappellini I., Ranieri V.M., Volta C.A., Guerin C., Spadaro S., Tartaglione M., Chiarini V., Buldini V., Coniglio C., Moro F., Barbalace C., Citino M., Cilloni N., Giuntoli L., Bellocchio A., Matteo E., Pizzilli G., Siniscalchi A., Tartivita C., Matteo F., Marchio A., Bacchilega I., Bernabe L., Guarino S., Mosconi E., Bissoni L., Viola L., Meconi T., Pavoni V., Pagni A., Pompa Cleta P., Cavagnino M., Malfatto A., Adduci A., Pareschi S., Melegari G., Maccieri J., Marinangeli E., Racca F., Verri M., Falo G., Marangoni E., Boni F., Felloni G., Baccarini F.D., Terzitta M., Maitan S., Becherucci F., Parise M., Masoni F., Imbriani M., Orlandi P., Monetti F., Dalpiaz G., Golfieri R., Ciccarese F., Poerio A., Muratore F., Ferrari F., Mughetti M., Franchini L., Neziri E., Miceli M., Minguzzi M.T., Mellini L., Piciucchi S., and Bartolucci M.

Subjects
medicine.medical_specialty, Supine position, COVID19, medicine.medical_treatment, Respiratory physiology, Prone positioning, ventilatory free days, Critical Care and Intensive Care Medicine, ICU, COVID19, Prone positioning, ventilatory free days, NO, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, medicine, 030212 general & internal medicine, Mechanical ventilation, business.industry, RC86-88.9, Research, Medical emergencies. Critical care. Intensive care. First aid, Oxygenation, respiratory system, respiratory tract diseases, Prone position, 030228 respiratory system, Anesthesia, ICU, Complication, business, Cohort study
Abstract

Background Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (≥ median PaO2/FiO2 variation) or non-responders (2/FiO2 variation) based on the PaO2/FiO2 percentage change between pre-proning and 1 to 3 h after re-supination in the first prone positioning session. Differences among the groups in physiological variables, complication rates and outcome were evaluated. A competing risk regression analysis was conducted to evaluate if PaO2/FiO2 response after the first pronation cycle was associated to liberation from mechanical ventilation. Results The median PaO2/FiO2 variation after the first PP cycle was 49 [19–100%] and no differences were found in demographics, comorbidities, ventilatory treatment and PaO2/FiO2 before PP between responders (96/191) and non-responders (95/191). Despite no differences in ICU length of stay, non-responders had a higher rate of tracheostomy (70.5% vs 47.9, P = 0.008) and mortality (53.7% vs 33.3%, P = 0.006), as compared to responders. Moreover, oxygenation response after the first PP was independently associated to liberation from mechanical ventilation at 28 days and was increasingly higher being higher the oxygenation response to PP. Conclusions Sustained oxygenation improvement after first PP session is independently associated to improved survival and reduced duration of mechanical ventilation in critically ill COVID-19 patients.

Published
2021

10. Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs

Author

Gamberini, L., Tonetti, T., Spadaro, S., Zani, G., Mazzoli, C. A., Capozzi, C., Giampalma, E., Bacchi Reggiani, M. L., Bertellini, E., Castelli, A., Cavalli, I., Colombo, D., Crimaldi, F., Damiani, F., Fogagnolo, A., Fusari, M., Gamberini, E., Gordini, G., Laici, C., Lanza, M. C., Leo, M., Marudi, A., Nardi, G., Ottaviani, I., Papa, R., Potalivo, A., Russo, E., Taddei, S., Volta, C. A., Ranieri, V. M., Tartaglione, M., Chiarini, V., Buldini, V., Coniglio, C., Moro, F., Cilloni, N., Giuntoli, L., Bellocchio, A., Matteo, E., Pizzilli, G., Siniscalchi, A., Tartivita, C., Matteo, F., Marchio, A., Bacchilega, I., Bernabe, L., Guarino, S., Mosconi, G., Bissoni, L., Viola, L., Meconi, T., Pavoni, V., Pagni, A., Pompacleta, P., Cavagnino, M., Malfatto, A., Adduci, A., Pareschi, S., Melegari, G., Maccieri, J., Marinangeli, E., Racca, F., Verri, M., Falo, G., Marangoni, E., Boni, F., Felloni, G., Baccarini, F. D., Terzitta, M., Maitan, S., Imbriani, M., Orlandi, P., Dalpiaz, G., Golfieri, R., Ciccarese, F., Poerio, A., Muratore, F., Ferrari, F., Mughetti, M., Franchini, L., Neziri, E., Miceli, M., Minguzzi, M. T., Mellini, L., Piciucchi, S., Gamberini, Lorenzo, Tonetti, Tommaso, Spadaro, Savino, Zani, Gianluca, Mazzoli, Carlo Alberto, Capozzi, Chiara, Giampalma, Emanuela, Bacchi Reggiani, Maria Letizia, Bertellini, Elisabetta, Castelli, Andrea, Cavalli, Irene, Colombo, Davide, Crimaldi, Federico, Damiani, Federica, Fogagnolo, Alberto, Fusari, Maurizio, Gamberini, Emiliano, Gordini, Giovanni, Laici, Cristiana, Lanza, Maria Concetta, Leo, Mirco, Marudi, Andrea, Nardi, Giuseppe, Ottaviani, Irene, Papa, Raffaella, Potalivo, Antonella, Russo, Emanuele, Taddei, Stefania, Volta, Carlo Alberto, and Ranieri, V Marco

Subjects
medicine.medical_specialty, ARDS, medicine.medical_treatment, artificial, Outcomes, Critical Care and Intensive Care Medicine, law.invention, NO, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, law, Coronavirus disease 2019, Intensive care, Outcomes, mortality, Respiration, artificial, medicine, 030212 general & internal medicine, Renal replacement therapy, business.industry, Research, Respiration, Organ dysfunction, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, Intensive care unit, mortality, Respiratory failure, Emergency medicine, SOFA score, medicine.symptom, business
Abstract

Background A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation. The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. Methods This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. Results Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO2/FiO2 ratio during the first 5 days of MV, respiratory system compliance (CRS) lower than 40 mL/cmH2O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications. ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable. Conclusions Age, SOFA score at ICU admission, CRS, PaO2/FiO2, renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19. Trial registration NCT04411459

Published
2020

13. Variable radiological lung nodule evaluation leads to divergent management recommendations

Author

Nair, A., Bartlett, E. C., Walsh, S. L. F., Wells, A. U., Navani, N., Hardavella, G., Bhalla, S., Calandriello, L., Devaraj, A., Goo, J. M., Klein, J. S., Macmahon, H., Schaefer-Prokop, C. M., Seo, J. -B., Sverzellati, N., Desai, S. R., Ahlfors, F., Bastos, A., Behr, J., Benes, J., Bozovic, G., Buzan, M. T., Castaner, E., Chaves, M., Choi, Y. W., Dalpiaz, G., David, S., De Jong, P. A., Dournes, G., Eberhard, M., Escuissato, D., Farchione, A., Flors, L., Franchi, P., Frauenfelder, T., Fujimoto, K., Gatti, M., Gavelli, G., Grgic, A., Haine, L., Haramati, L., Hartman, T., Hartmann, I., Hering, J. P., Herpels, V., Herraez, I., Hobbs, S., Hochhegger, B., Hursoy, N., Ip, J., Iyengar, S., Jimenez, J. A., Johnson, K., Kanne, J., Kapur, S., Karaman, C. Z., Karl, R., Kirova, G., Ko, J., Kramer, G., Kul, M., Larici, A. R., Lee, Y., Leifels, L., Ley, S., Machnicki, S., Maidas, P., Mak, S. M., Mariani, F., Meirelles, G., Hoesein, F. A. M., Montet, X., Murchison, J., Nath, H., Nenkina, T., Nganga, E., Nguyen-Kim, T. D. L., Niemann, T., Nunez, C. F. M., Occhipinti, M., Oikonomou, A., Ozawa, Y., Pandher, T., Parkar, A. P., Piciucchi, S., Pinheiro, D., Poerio, A., Polverosi, R., Pope, K., Prosch, H., Pulzato, I., Rampinelli, C., Rodrigues, J., Romanos, O., Romei, C., Roos, J., Rossi, S., Rubtsov, R., Ruggirello, M., Sanchez, M., Santos, M. K., Schubert, M., Senbanjo, T., Silva, C., Silva, M., Snoeckx, A., Sonavane, S., Sriharan, M., Stefanidis, K., Taydas, O., Tomiyama, N., Tran, S., Villanueva, A., Williams, M., and Lung Nodule Evaluation Grp

Subjects
Pulmonary and Respiratory Medicine, Adult, Male, medicine.medical_specialty, Lung Neoplasms, Computed tomography, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, X ray computed, Pulmonary nodule, Radiologists, medicine, 80 and over, Aged, Aged, 80 and over, Female, Humans, Middle Aged, Multiple Pulmonary Nodules, Observer Variation, Practice Guidelines as Topic, Reproducibility of Results, Solitary Pulmonary Nodule, Tomography, X-Ray Computed, Tomography, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA, Solitary pulmonary nodule, medicine.diagnostic_test, business.industry, Nodule (medicine), medicine.disease, X-Ray Computed, Tomography x ray computed, 030220 oncology & carcinogenesis, Radiological weapon, Human medicine, Radiology, medicine.symptom, business
Abstract

Radiological evaluation of incidentally detected lung nodules on computed tomography (CT) influences management. We assessed international radiological variation in 1) pulmonary nodule characterisation; 2) hypothetical guideline-derived management; and 3) radiologists' management recommendations.107 radiologists from 25 countries evaluated 69 CT-detected nodules, recording: 1) first-choice composition (solid, part-solid or ground-glass, with percentage confidence); 2) morphological features; 3) dimensions; 4) recommended management; and 5) decision-influencing factors. We modelled hypothetical management decisions on the 2005 and updated 2017 Fleischner Society, and both liberal and parsimonious interpretations of the British Thoracic Society 2015 guidelines.Overall agreement for first-choice nodule composition was good (Fleiss' κ=0.65), but poorest for part-solid nodules (weighted κ 0.62, interquartile range 0.50–0.71). Morphological variables, including spiculation (κ=0.35), showed poor-to-moderate agreement (κ=0.23–0.53). Variation in diameter was greatest at key thresholds (5 mm and 6 mm). Agreement for radiologists' recommendations was poor (κ=0.30); 21% disagreed with the majority. Although agreement within the four guideline-modelled management strategies was good (κ=0.63–0.73), 5–10% of radiologists would disagree with majority decisions if they applied guidelines strictly.Agreement was lowest for part-solid nodules, while significant measurement variation exists at important size thresholds. These variations resulted in generally good agreement for guideline-modelled management, but poor agreement for radiologists' actual recommendations.

Published
2018

15. Structured reporting for fibrosing lung disease: a model shared by radiologist and pulmonologist

Author

Sverzellati, N, Odone, A, Silva, M, Polverosi, R, Florio, C, Cardinale, L, Cortese, G, Addonisio, G, Zompatori, M, Dalpiaz, G, Piciucchi, S, Larici, A, Agostini, C, Albera, C, Attinà, D, Battista, G, Bertelli, E, Bertorelli, G, Bnà, C, Bonifazi, M, Bonomo, L, Borghesi, A, Calandriello, L, Caminati, A, Capannelli, D, Cerri, S, Ciccarese, F, Colombi, D, Confalonieri, M, Del Ciello, A, della Casa, G, Dore, R, Falaschi, F, Farchione, A, Feragalli, B, Franchi, P, Gavelli, G, Harari, S, Luppi, F, Maggi, F, Mazzei, M, Mereu, M, Milanese, G, Palmucci, S, Patea, R, Pesci, A, Piolanti, M, Poletti, V, Rea, G, Richeldi, L, Rogliani, P, Romei, C, Rottoli, P, Sanduzzi-Zamparelli, A, Sebastiani, A, Sergiacomi, G, Soardi, G, Spaggiari, L, Spagnolo, P, Tomassetti, S, Trisolini, R, Valentini, A, Vancheri, C, Vespro, V, Volterrani, L, Sverzellati, Nicola, Odone, Anna, Silva, Mario, Polverosi, Roberta, Florio, Carlo, Cardinale, Luciano, Cortese, Giancarlo, Addonisio, Giancarlo, Zompatori, Maurizio, Dalpiaz, Giorgia, Piciucchi, Sara, Larici, Anna Rita, Agostini, Carlo, Albera, Carlo, Attinà, Domenico, Battista, Giuseppe, Bertelli, Elena, Bertorelli, Giuseppina, Bnà, Claudio, Bonifazi, Martina, Bonomo, Lorenzo, Borghesi, Andrea, Calandriello, Lucio, Caminati, Antonella, Capannelli, Diana, Cerri, Stefania, Ciccarese, Federica, Colombi, Davide, Confalonieri, Marco, Del Ciello, Annaemilia, della Casa, Giovanni, Dore, Roberto, Falaschi, Fabio, Farchione, Alessandra, Feragalli, Beatrice, Franchi, Paola, Gavelli, Giampaolo, Harari, Sergio, Luppi, Fabrizio, Maggi, Fabio, Mazzei, Maria Antonietta, Mereu, Manuela, Milanese, Gianluca, Palmucci, Stefano, Patea, Rosa Lucia, Pesci, Alberto, Piolanti, Marco, Poletti, Venerino, Rea, Gaetano, Richeldi, Luca, Rogliani, Paola, Romei, Chiara, Rottoli, Paola, Sanduzzi-Zamparelli, Alessandro, Sebastiani, Alfredo, Sergiacomi, Gianluigi, Soardi, Gian Alberto, Spaggiari, Lucia, Spagnolo, Paolo, Tomassetti, Sara, Trisolini, Rocco, Valentini, Adele, Vancheri, Carlo, Vespro, Valentina, Volterrani, Luca, Sverzellati, N, Odone, A, Silva, M, Polverosi, R, Florio, C, Cardinale, L, Cortese, G, Addonisio, G, Zompatori, M, Dalpiaz, G, Piciucchi, S, Larici, A, Agostini, C, Albera, C, Attinà, D, Battista, G, Bertelli, E, Bertorelli, G, Bnà, C, Bonifazi, M, Bonomo, L, Borghesi, A, Calandriello, L, Caminati, A, Capannelli, D, Cerri, S, Ciccarese, F, Colombi, D, Confalonieri, M, Del Ciello, A, della Casa, G, Dore, R, Falaschi, F, Farchione, A, Feragalli, B, Franchi, P, Gavelli, G, Harari, S, Luppi, F, Maggi, F, Mazzei, M, Mereu, M, Milanese, G, Palmucci, S, Patea, R, Pesci, A, Piolanti, M, Poletti, V, Rea, G, Richeldi, L, Rogliani, P, Romei, C, Rottoli, P, Sanduzzi-Zamparelli, A, Sebastiani, A, Sergiacomi, G, Soardi, G, Spaggiari, L, Spagnolo, P, Tomassetti, S, Trisolini, R, Valentini, A, Vancheri, C, Vespro, V, Volterrani, L, Sverzellati, Nicola, Odone, Anna, Silva, Mario, Polverosi, Roberta, Florio, Carlo, Cardinale, Luciano, Cortese, Giancarlo, Addonisio, Giancarlo, Zompatori, Maurizio, Dalpiaz, Giorgia, Piciucchi, Sara, Larici, Anna Rita, Agostini, Carlo, Albera, Carlo, Attinà, Domenico, Battista, Giuseppe, Bertelli, Elena, Bertorelli, Giuseppina, Bnà, Claudio, Bonifazi, Martina, Bonomo, Lorenzo, Borghesi, Andrea, Calandriello, Lucio, Caminati, Antonella, Capannelli, Diana, Cerri, Stefania, Ciccarese, Federica, Colombi, Davide, Confalonieri, Marco, Del Ciello, Annaemilia, della Casa, Giovanni, Dore, Roberto, Falaschi, Fabio, Farchione, Alessandra, Feragalli, Beatrice, Franchi, Paola, Gavelli, Giampaolo, Harari, Sergio, Luppi, Fabrizio, Maggi, Fabio, Mazzei, Maria Antonietta, Mereu, Manuela, Milanese, Gianluca, Palmucci, Stefano, Patea, Rosa Lucia, Pesci, Alberto, Piolanti, Marco, Poletti, Venerino, Rea, Gaetano, Richeldi, Luca, Rogliani, Paola, Romei, Chiara, Rottoli, Paola, Sanduzzi-Zamparelli, Alessandro, Sebastiani, Alfredo, Sergiacomi, Gianluigi, Soardi, Gian Alberto, Spaggiari, Lucia, Spagnolo, Paolo, Tomassetti, Sara, Trisolini, Rocco, Valentini, Adele, Vancheri, Carlo, Vespro, Valentina, and Volterrani, Luca

Abstract

Objectives: To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution computed tomography (HRCT) of patients with fibrosing lung disease (FLD). Methods: The writing committee selected the HRCT criteria—the Delphi items—for rating from both radiology panelists (RP) and pulmonology panelists (PP). The Delphi items were first rated by RPs as “essential”, “optional”, or “not relevant”. The items rated “essential” by < 80% of the RP were selected for the PP rating. The format of reporting was rated by both RP and PP. Results: A total of 42 RPs and 12 PPs participated to the survey. In both Delphi round 1 and 2, 10/27 (37.7%) items were rated “essential” by more than 80% of RP. The remaining 17/27 (63.3%) items were rated by the PP in round 3, with 2/17 items (11.7%) rated “essential” by the PP. PP proposed additional items for conclusion domain, which were rated by RPs in the fourth round. Poor consensus was observed for the format of reporting. Conclusions: This study provides a template for structured report of FLD that features essential items as agreed by expert thoracic radiologists and pulmonologists

Published
2018

16. Transbronchial Cryobiopsies for the Diagnosis of Diffuse Parenchymal Lung Diseases: Expert Statement from the Cryobiopsy Working Group on Safety and Utility and a Call for Standardization of the Procedure

Author

Hetzel, J., Maldonado, F., Ravaglia, C., Wells, A.U., Colby, Thomas Vail, Tomassetti, S., Ryu, J.H., Fruchter, O., Piciucchi, S., Dubini, A., Cavazza, A., Chilosi, M., Sverzellati, Nicola, Valeyre, D., Leduc, Dimitri, Walsh, S.L.F., Gasparini, S., Hetzel, M., Hagmeyer, L., Haentschel, M., Eberhardt, R., Darwiche, K., Yarmus, L.B., Torrego, A., Krishna, G., Shah, Pallav P.L., Annema, J.T., Herth, Felix F.J.F., Poletti, V., Hetzel, J., Maldonado, F., Ravaglia, C., Wells, A.U., Colby, Thomas Vail, Tomassetti, S., Ryu, J.H., Fruchter, O., Piciucchi, S., Dubini, A., Cavazza, A., Chilosi, M., Sverzellati, Nicola, Valeyre, D., Leduc, Dimitri, Walsh, S.L.F., Gasparini, S., Hetzel, M., Hagmeyer, L., Haentschel, M., Eberhardt, R., Darwiche, K., Yarmus, L.B., Torrego, A., Krishna, G., Shah, Pallav P.L., Annema, J.T., Herth, Felix F.J.F., and Poletti, V.

Abstract

Transbronchial cryobiopsies (TBCB) have recently been introduced as a promising and safer alternative to surgical lung biopsy in the diagnostic approach to diffuse parenchymal lung diseases (DPLD). Despite a substantial and expanding body of literature, the technique has not yet been standardized and its place in the diagnostic algorithm of DPLD remains to be defined. In part, this reflects concerns over the diagnostic yield and safety of the procedure, together with the rapid spread of the technique without competency and safety standards; furthermore, there is a substantial procedural variability among centers and interventional pulmonologists. We report this expert statement proposed during the third international conference on "Transbronchial Cryobiopsy in Diffuse Parenchymal Lung Disease" (Ravenna, October 27-28, 2016), which formulates evidence- and expert-based suggestions on the indications, contraindications, patient selection, and procedural aspects of the procedure. The following 5 domains were reviewed: (1) what is the role of TBCB in the diagnostic evaluation of DPLD: patient selection; (2) pathological considerations; (3) contraindications and safety considerations; (4) how should TBCB be performed and in what procedural environment; and (5) who should perform TBCB. Finally, the existence of white paper recommendations may also reassure local hospital credentialing committees tasked with endorsing an adoption of the technique., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2018

20. Idiopathic nonspecific interstitial pneumonia: an interstitial lung disease associated with autoimmune disorders?

Author

Romagnoli, M., primary, Nannini, C., additional, Piciucchi, S., additional, Girelli, F., additional, Gurioli, C., additional, Casoni, G., additional, Ravaglia, C., additional, Tomassetti, S., additional, Gavelli, G., additional, Carloni, A., additional, Dubini, A., additional, Cantini, F., additional, Chilosi, M., additional, and Poletti, V., additional

Published
2011
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22. Intravascular large B cell lymphoma presenting in the lung: The diagnostic value of transbronchial cryobiopsy

Author

Poletti V, Gurioli C, Piciucchi S, Rossi A, Ravaglia C, Dubini A, Asioli S, and Gian Luca Casoni

Subjects
Male, Lung Neoplasms, Lymphoma, B-Cell, lymphoproliferative disorders, Biopsy, Middle Aged, Immunohistochemistry, Intravascular large B-cell lymphoma, Vascular Neoplasms, lung, Cold Temperature, Predictive Value of Tests, Bronchoscopy, Biomarkers, Tumor, transbronchial cryobiopsy, interstitial lung diseases, Humans, Tomography, X-Ray Computed, Aged
Abstract

intravascular large B-cell lymphoma is a distinct subtype of mature B-cell neoplasms, with uncommon primary presentation in the lungs. Diagnosis could be very difficult due to the lack of detectable tumor masses and it is usually made by surgical lung biopsy or autopsy examination.two patients occurred primarily with interstitial lung disease and underwent a pulmonary biopsy using cryoprobes.the pathological analysis of the lung biopsies revealed in both cases a conclusive diagnosis of intravascular large B-cell lymphoma with primary lung involvement and patients have been safely diagnosed using transbronchial cryobiopsy for the first time in the literature.transbronchial cryobiopsy could be used as valid surrogate for surgical lung biopsy in lymphoprolipherative lung disorders (including intravascular lymphomas), as allows larger samples of tissue, greater diagnostic yield, no crush artifacts and much less complications than surgical biopsy.

23. Structured reporting for fibrosing lung disease: a model shared by radiologist and pulmonologist

Author

Sverzellati, Nicola, Odone, Anna, Silva, Mario, Polverosi, Roberta, Florio, Carlo, Cardinale, Luciano, Cortese, Giancarlo, Addonisio, Giancarlo, Zompatori, Maurizio, Dalpiaz, Giorgia, Piciucchi, Sara, Larici, Anna Rita, Agostini, Carlo, Albera, Carlo, Attinà, Domenico, Battista, Giuseppe, Bertelli, Elena, Bertorelli, Giuseppina, Bnà, Claudio, Bonifazi, Martina, Bonomo, Lorenzo, Borghesi, Andrea, Calandriello, Lucio, Caminati, Antonella, Capannelli, Diana, Cerri, Stefania, Ciccarese, Federica, Colombi, Davide, Confalonieri, Marco, Del Ciello, Annaemilia, della Casa, Giovanni, Dore, Roberto, Falaschi, Fabio, Farchione, Alessandra, Feragalli, Beatrice, Franchi, Paola, Gavelli, Giampaolo, Harari, Sergio, Luppi, Fabrizio, Maggi, Fabio, Mazzei, Maria Antonietta, Mereu, Manuela, Milanese, Gianluca, Palmucci, Stefano, Patea, Rosa Lucia, Pesci, Alberto, Piolanti, Marco, Poletti, Venerino, Rea, Gaetano, Richeldi, Luca, Rogliani, Paola, Romei, Chiara, Rottoli, Paola, Sanduzzi-Zamparelli, Alessandro, Sebastiani, Alfredo, Sergiacomi, Gianluigi, Soardi, Gian Alberto, Spaggiari, Lucia, Spagnolo, Paolo, Tomassetti, Sara, Trisolini, Rocco, Valentini, Adele, Vancheri, Carlo, Vespro, Valentina, Volterrani, Luca, Sverzellati, N, Odone, A, Silva, M, Polverosi, R, Florio, C, Cardinale, L, Cortese, G, Addonisio, G, Zompatori, M, Dalpiaz, G, Piciucchi, S, Larici, A, Agostini, C, Albera, C, Attinà, D, Battista, G, Bertelli, E, Bertorelli, G, Bnà, C, Bonifazi, M, Bonomo, L, Borghesi, A, Calandriello, L, Caminati, A, Capannelli, D, Cerri, S, Ciccarese, F, Colombi, D, Confalonieri, M, Del Ciello, A, della Casa, G, Dore, R, Falaschi, F, Farchione, A, Feragalli, B, Franchi, P, Gavelli, G, Harari, S, Luppi, F, Maggi, F, Mazzei, M, Mereu, M, Milanese, G, Palmucci, S, Patea, R, Pesci, A, Piolanti, M, Poletti, V, Rea, G, Richeldi, L, Rogliani, P, Romei, C, Rottoli, P, Sanduzzi-Zamparelli, A, Sebastiani, A, Sergiacomi, G, Soardi, G, Spaggiari, L, Spagnolo, P, Tomassetti, S, Trisolini, R, Valentini, A, Vancheri, C, Vespro, V, Volterrani, L, Sverzellati, N., Odone, A., Silva, M., Polverosi, R., Florio, C., Cardinale, L., Cortese, G., Addonisio, G., Zompatori, M., Dalpiaz, G., Piciucchi, S., Larici, A. R., Agostini, C., Albera, C., Attina, D., Battista, G., Bertelli, E., Bertorelli, G., Bna, C., Bonifazi, M., Bonomo, L., Borghesi, A., Calandriello, L., Caminati, A., Capannelli, D., Cerri, S., Ciccarese, F., Colombi, D., Confalonieri, M., Del Ciello, A., Della Casa, G., Dore, R., Falaschi, F., Farchione, A., Feragalli, B., Franchi, P., Gavelli, G., Harari, S., Luppi, F., Maggi, F., Mazzei, M. A., Mereu, M., Milanese, G., Palmucci, S., Patea, R. L., Pesci, A., Piolanti, M., Poletti, V., Rea, G., Richeldi, L., Rogliani, P., Romei, C., Rottoli, P., Sanduzzi-Zamparelli, A., Sebastiani, A., Sergiacomi, G., Soardi, G. A., Spaggiari, L., Spagnolo, P., Tomassetti, S., Trisolini, R., Valentini, A., Vancheri, C., Vespro, V., Volterrani, L., Sverzellati, Nicola, Odone, Anna, Silva, Mario, Polverosi, Roberta, Florio, Carlo, Cardinale, Luciano, Cortese, Giancarlo, Addonisio, Giancarlo, Zompatori, Maurizio, Dalpiaz, Giorgia, Piciucchi, Sara, Larici, Anna Rita, Agostini, Carlo, Albera, Carlo, Attinà, Domenico, Battista, Giuseppe, Bertelli, Elena, Bertorelli, Giuseppina, Bnà, Claudio, Bonifazi, Martina, Bonomo, Lorenzo, Borghesi, Andrea, Calandriello, Lucio, Caminati, Antonella, Capannelli, Diana, Cerri, Stefania, Ciccarese, Federica, Colombi, Davide, Confalonieri, Marco, Del Ciello, Annaemilia, della Casa, Giovanni, Dore, Roberto, Falaschi, Fabio, Farchione, Alessandra, Feragalli, Beatrice, Franchi, Paola, Gavelli, Giampaolo, Harari, Sergio, Luppi, Fabrizio, Maggi, Fabio, Mazzei, Maria Antonietta, Mereu, Manuela, Milanese, Gianluca, Palmucci, Stefano, Patea, Rosa Lucia, Pesci, Alberto, Piolanti, Marco, Poletti, Venerino, Rea, Gaetano, Richeldi, Luca, Rogliani, Paola, Romei, Chiara, Rottoli, Paola, Sanduzzi-Zamparelli, Alessandro, Sebastiani, Alfredo, Sergiacomi, Gianluigi, Soardi, Gian Alberto, Spaggiari, Lucia, Spagnolo, Paolo, Tomassetti, Sara, Trisolini, Rocco, Valentini, Adele, Vancheri, Carlo, Vespro, Valentina, and Volterrani, Luca

Subjects
Male, Research Report, Radiology, Nuclear Medicine and Imaging, Delphi Technique, Settore MED/10 - Malattie dell'Apparato Respiratorio, Pulmonary Fibrosis, Delphi method, Computed tomography, Standardized report, Consensus,High-resolution computed tomography, Lung fibrosis, Standardized report, Structured report, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Theoretical, Models, Nuclear Medicine and Imaging, Pulmonary Medicine, Prospective Studies, Tomography, Pulmonologists, High-resolution computed tomography, computer.programming_language, medicine.diagnostic_test, General Medicine, Middle Aged, X-Ray Computed, 030220 oncology & carcinogenesis, Consensus, Lung fibrosis, Structured report, Female, Radiology, Delphi round, Adult, Aged, Humans, Models, Theoretical, Tomography, X-Ray Computed, medicine.medical_specialty, Chest Radiology, education, Lung fibrosi, Consensu, 03 medical and health sciences, Settore MED/36 - Diagnostica per Immagini e Radioterapia, Structured reporting, medicine, business.industry, Pulmonologist, Lung disease, business, computer, Delphi
Abstract

Objectives To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution computed tomography (HRCT) of patients with fibrosing lung disease (FLD). Methods The writing committee selected the HRCT criteria—the Delphi items—for rating from both radiology panelists (RP) and pulmonology panelists (PP). The Delphi items were first rated by RPs as “essential”, “optional”, or “not relevant”. The items rated “essential” by

Published
2017

24. Giant cell tumor of bone in an eighteenth-century Italian mummy

Author

Mirko Traversari, Elisabetta Cilli, Enrico Petrella, Luca Ventura, Robin N. M. Feeney, Donata Luiselli, Sara Piciucchi, Ventura L., Petrella E., Piciucchi S., Cilli E., Luiselli D., Feeney R.N.M., and Traversari M.

Subjects
Adult, Pathology, medicine.medical_specialty, Fibrous cortical defect, Osteoclastoma, Chondroblastoma, History, 18th Century, Pathology and Forensic Medicine, Osteoclastic giant cell–rich tumors, Predictive Value of Tests, medicine, Neoplasm, Humans, Molecular Biology, Paleopathology, Giant Cell Tumor of Bone, Benign fibrous histiocytoma, business.industry, Femoral Neoplasms, Cell Biology, General Medicine, Aneurysmal bone cyst, Non-ossifying fibroma, Mummies, medicine.disease, Osteoclastic giant cell–rich tumor, Italy, Giant cell, Original Article, Female, Giant cell tumor, Fibroma, business, Tomography, X-Ray Computed, Giant-cell tumor of bone
Abstract

Giant cell tumor (GCT) of the bone is a locally aggressive and rarely metastasizing neoplasm. It is composed of neoplastic mononuclear stromal cells with a monotonous appearance admixed with macrophages and osteoclast-like giant cells. In a small subset of cases, GCT is malignant. Terminology previously related to this entity, and which is no longer supported by the World Health Organization, includes osteoclastoma and benign fibrous histiocytoma (BFH). Giant cells occur in numerous other pathologic conditions of the bone, which accounts for the misrepresentation of these non-GCT tumors in the early literature. Non-ossifying fibroma (NOF), aneurysmal bone cyst, and chondroblastoma have been erroneously labeled GCT for this reason. A single description of an ancient GCT was reported by Brothwell and Sandison and subsequently mentioned by Aufderheide and Rodrìguez-Martìn who were astonished that more of these tumors had not been identified in archaeological cases. To the best of our knowledge, no other cases of ancient GCT have been cited in the paleopathology literature. The study of this type of neoplasm in antiquity can be used as a means to better understand its characteristics and behavior and to expand the depth of time of the etiology of these lesions. We report a case of GCT of the left femur observed following the total body CT imaging of a partially mummified adult female, dating to eighteenth century.

Published
2021

25. Covid-19 Interstitial Pneumonia: Histological and Immunohistochemical Features on Cryobiopsies

Author

Vincenzo Bronte, Venerino Poletti, Stefano Maitan, Alessandra Dubini, Marco Chilosi, Franco Stella, Athol U. Wells, Claudio Doglioni, Antonio Vizzuso, Silvia Puglisi, Giovanni Pizzolo, Vanni Agnoletti, Federica Pedica, Claudia Ravaglia, Giulio Rossi, Vittorio Sambri, Giovanni Poletti, Sara Piciucchi, and Doglioni C, Ravaglia C, Chilosi M, Rossi G, Dubini A, Pedica F, Piciucchi S, Vizzuso A, Stella F, Maitan S, Agnoletti V, Puglisi S, Poletti G, Sambri V, Pizzolo G, Bronte V, Wells AU, Poletti V.

Subjects
Pulmonary and Respiratory Medicine, Pathology, medicine.medical_specialty, Coronaviru, Lung biopsy, Lung injury, 03 medical and health sciences, 0302 clinical medicine, Medicine, Cryobiopsy, 030212 general & internal medicine, Diffuse alveolar damage, Lung, Acute respiratory distress syndrome, SARS-CoV-2, business.industry, CD68, pSTAT-3, Hyperplasia, medicine.disease, Coronavirus, Endothelial stem cell, Pneumonia, medicine.anatomical_structure, 030228 respiratory system, Indoleamine 2,3-dioxygenase-1, Covid-19, business
Abstract

Background: The pathogenetic steps leading to Covid-19 interstitial pneumonia remain to be clarified. Most postmortem studies to date reveal diffuse alveolar damage as the most relevant histologic pattern. Antemortem lung biopsy may however provide more precise data regarding the earlier stages of the disease, providing a basis for novel treatment approaches. Objectives: To ascertain the morphological and immunohistochemical features of lung samples obtained in patients with moderate Covid-19 pneumonia. Methods: Transbronchial lung cryobiopsy was carried out in 12 Covid-19 patients within 20 days of symptom onset. Results: Histopathologic changes included spots of patchy acute lung injury with alveolar type II cell hyperplasia, with no evidence of hyaline membranes. Strong nuclear expression of phosphorylated STAT3 was observed in >50% of AECII. Interalveolar capillaries showed enlarged lumen and were in part arranged in superposed rows. Pulmonary venules were characterized by luminal enlargement, thickened walls, and perivascular CD4+ T-cell infiltration. A strong nuclear expression of phosphorylated STAT3, associated with PD-L1 and IDO expression, was observed in endothelial cells of venules and interstitial capillaries. Alveolar spaces macrophages exhibited a peculiar phenotype (CD68, CD11c, CD14, CD205, CD206, CD123/IL3AR, and PD-L1). Conclusions: Morphologically distinct features were identified in early stages of Covid-19 pneumonia, with epithelial and endothelial cell abnormalities different from either classical interstitial lung diseases or diffuse alveolar damage. Alveolar type II cell hyperplasia was a prominent event in the majority of cases. Inflammatory cells expressed peculiar phenotypes. No evidence of hyaline membranes and endothelial changes characterized by IDO expression might in part explain the compliance and the characteristic pulmonary vasoplegia observed in less-advanced Covid-19 pneumonia.

Published
2021

26. Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation

Author

Giorgia Dalpiaz, Lorenzo Gamberini, Aldo Carnevale, Savino Spadaro, Carlo Alberto Mazzoli, Sara Piciucchi, Davide Allegri, Chiara Capozzi, Ersenad Neziri, Maurizio Bartolucci, Francesco Muratore, Francesca Coppola, Antonio Poerio, Emanuela Giampalma, Luca Baldini, Tommaso Tonetti, Iacopo Cappellini, Davide Colombo, Gianluca Zani, Lorenzo Mellini, Vanni Agnoletti, Federica Damiani, Giovanni Gordini, Cristiana Laici, Giuliano Gola, Antonella Potalivo, Jonathan Montomoli, Vito Marco Ranieri, Emanuele Russo, Stefania Taddei, Carlo Alberto Volta, Gaetano Scaramuzzo, Dalpiaz G., Gamberini L., Carnevale A., Spadaro S., Mazzoli C.A., Piciucchi S., Allegri D., Capozzi C., Neziri E., Bartolucci M., Muratore F., Coppola F., Poerio A., Giampalma E., Baldini L., Tonetti T., Cappellini I., Colombo D., Zani G., Mellini L., Agnoletti V., Damiani F., Gordini G., Laici C., Gola G., Potalivo A., Montomoli J., Ranieri V.M., Russo E., Taddei S., Volta C.A., and Scaramuzzo G.

Subjects
Male, Acute respiratory distress syndrome, SARS-CoV-2, Chest Radiology, Novel coronavirus disease 2019, COVID-19, General Medicine, Length of Stay, Middle Aged, Respiration, Artificial, NO, Intensive Care Units, Pulmonary perfusion, Mechanical ventilation, Italy, Microvessels, Thoracic imaging, Humans, Radiology, Nuclear Medicine and imaging, Female, Prospective Studies, Tomography, X-Ray Computed, Lung, Aged
Abstract

Purpose COVID-19-related acute respiratory distress syndrome (ARDS) is characterized by the presence of signs of microvascular involvement at the CT scan, such as the vascular tree in bud (TIB) and the vascular enlargement pattern (VEP). Recent evidence suggests that TIB could be associated with an increased duration of invasive mechanical ventilation (IMV) and intensive care unit (ICU) stay. The primary objective of this study was to evaluate whether microvascular involvement signs could have a prognostic significance concerning liberation from IMV. Material and methods All the COVID-19 patients requiring IMV admitted to 16 Italian ICUs and having a lung CT scan recorded within 3 days from intubation were enrolled in this secondary analysis. Radiologic, clinical and biochemical data were collected. Results A total of 139 patients affected by COVID-19 related ARDS were enrolled. After grouping based on TIB or VEP detection, we found no differences in terms of duration of IMV and mortality. Extension of VEP and TIB was significantly correlated with ground-glass opacities (GGOs) and crazy paving pattern extension. A parenchymal extent over 50% of GGO and crazy paving pattern was more frequently observed among non-survivors, while a VEP and TIB extent involving 3 or more lobes was significantly more frequent in non-responders to prone positioning. Conclusions The presence of early CT scan signs of microvascular involvement in COVID-19 patients does not appear to be associated with differences in duration of IMV and mortality. However, patients with a high extension of VEP and TIB may have a reduced oxygenation response to prone positioning. Trial Registration: NCT04411459 Supplementary Information The online version contains supplementary material available at 10.1007/s11547-021-01444-7.

Published
2022

27. Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study

Author

Antonio Poerio, Andrea Castelli, Sara Piciucchi, Giulia Falò, Davide Allegri, Marco Verri, Andrea Marudi, Massimiliano Mazzolini, Michele Imbriani, Loredana Franchini, Carlo Coniglio, Mirco Leo, Antonella Potalivo, Luigi Lazzari Agli, Roberta Nicali, Marco Cavagnino, Guglielmo Consales, Marina Terzitta, Harri Sintonen, Raffaella Papa, Maria Teresa Minguzzi, Cristiana Laici, Paolo Orlandi, Federica Damiani, Carlo Alberto Mazzoli, Silvia Orlando, Vito Marco Ranieri, Iacopo Cappellini, Valentina Chiarini, Elisa Marinangeli, Stefano Oldani, Virginia Buldini, Marco Tartaglione, Gianluca Zani, Lorenzo Mellini, Carlo Alberto Volta, Irene Ottaviani, Silvia Candini, Filippo Becherucci, Emanuela Giampalma, Maria Concetta Lanza, Federica Ciccarese, Irene Cavalli, Annalisa Marchio, Bruno Balbi, Fabrizio Racca, Matteo Monari, Luca Morini, Anna Malfatto, Elisabetta Bertellini, Francesco Boni, Emanuele Russo, Lorenzo Viola, Michele Valli, Savino Spadaro, Martina Ferioli, Emanuele Matteo, Giovanni Gordini, Marco Contoli, Ilaria Valentini, Chiara Tartivita, Alessia Guzzo, Lorenzo Giuntoli, Gaetano Scaramuzzo, Davide Colombo, Jessica Maccieri, Luca Bissoni, Stefano Nava, Angela Bellocchio, Patrizio Goti, Laura Bernabé, Jonathan Montomoli, Stefano Maitan, Tommaso Meconi, Angelo Senzi, Lorenzo Gamberini, Silvia Pareschi, Stefania Taddei, Angelica Venni, Fabio Ferrari, Marco Miceli, Chiara Capozzi, Elisabetta Marangoni, Lorenzo Tutino, Giulia Felloni, Antonio Siniscalchi, Giacinto Pizzilli, Francesco Muratore, Giorgia Dalpiaz, Federico Moro, Daniele Fecarotti, Vanni Agnoletti, Gabriele Melegari, Rita Golfieri, Federico Domenico Baccarini, Francesca Facondini, Patrizia Pompa Cleta, Marianna Padovani, Eva Bernardi, Tommaso Tonetti, Angelina Adduci, Federico Daniele, Anna Filomena Ferravante, Maurizio Fusari, Igor Bacchilega, Claudia Ravaglia, Nicola Cilloni, Martina Mughetti, Vittorio Pavoni, Ersenad Neziri, Irene Prediletto, Aline Pagni, Gamberini L., Mazzoli C.A., Prediletto I., Sintonen H., Scaramuzzo G., Allegri D., Colombo D., Tonetti T., Zani G., Capozzi C., Dalpiaz G., Agnoletti V., Cappellini I., Melegari G., Damiani F., Fusari M., Gordini G., Laici C., Lanza M.C., Leo M., Marudi A., Papa R., Potalivo A., Montomoli J., Taddei S., Mazzolini M., Ferravante A.F., Nicali R., Ranieri V.M., Russo E., Volta C.A., Spadaro S., Tartaglione M., Chiarini V., Buldini V., Coniglio C., Moro F., Orlando S., Fecarotti D., Cilloni N., Giuntoli L., Bellocchio A., Matteo E., Pizzilli G., Siniscalchi A., Tartivita C., Cavalli I., Castelli A., Marchio A., Bacchilega I., Bernabe L., Facondini F., Morini L., Bissoni L., Viola L., Meconi T., Pavoni V., Venni A., Pagni A., Cleta P.P., Cavagnino M., Guzzo A., Malfatto A., Adduci A., Pareschi S., Bertellini E., Maccieri J., Marinangeli E., Racca F., Verri M., Falo G., Marangoni E., Ottaviani I., Boni F., Felloni G., Baccarini F.D., Terzitta M., Maitan S., Tutino L., Senzi A., Consales G., Becherucci F., Imbriani M., Orlandi P., Candini S., Golfieri R., Ciccarese F., Poerio A., Muratore F., Ferrari F., Mughetti M., Giampalma E., Franchini L., Neziri E., Miceli M., Minguzzi M.T., Mellini L., Piciucchi S., Monari M., Valli M., Daniele F., Ferioli M., Nava S., Lazzari Agli L.A., Valentini I., Bernardi E., Balbi B., Contoli M., Padovani M., Oldani S., Ravaglia C., and Goti P.

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Health-related quality of life, Population, Article, NO, Pulmonary function testing, 03 medical and health sciences, 0302 clinical medicine, Quality of life, DLCO, Acute respiratory distress syndrome, COVID-19, Dyspnea, Respiratory function tests, Internal medicine, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Survivors, education, Aged, Mechanical ventilation, Health related quality of life, education.field_of_study, Respiratory Distress Syndrome, business.industry, Middle Aged, Respiration, Artificial, Patient Discharge, humanities, 3. Good health, Intensive Care Units, 030228 respiratory system, Italy, Quality of Life, Female, business, Icu discharge, Follow-Up Studies
Abstract

Background Health-related quality of life (HRQoL) impairment is often reported among COVID-19 ICU survivors, and little is known about their long-term outcomes. We evaluated the HRQoL trajectories between 3 months and 1 year after ICU discharge, the factors influencing these trajectories and the presence of clusters of HRQoL profiles in a population of COVID-19 patients who underwent invasive mechanical ventilation (IMV). Moreover, pathophysiological correlations of residual dyspnea were tested. Methods We followed up 178 survivors from 16 Italian ICUs up to one year after ICU discharge. HRQoL was investigated through the 15D instrument. Available pulmonary function tests (PFTs) and chest CT scans at 1 year were also collected. A linear mixed-effects model was adopted to identify factors associated with different HRQoL trajectories and a two-step cluster analysis was performed to identify HRQoL clusters. Results We found that HRQoL increased during the study period, especially for the significant increase of the physical dimensions, while the mental dimensions and dyspnea remained substantially unchanged. Four main 15D profiles were identified: full recovery (47.2%), bad recovery (5.1%) and two partial recovery clusters with mostly physical (9.6%) or mental (38.2%) dimensions affected. Gender, duration of IMV and number of comorbidities significantly influenced HRQoL trajectories. Persistent dyspnea was reported in 58.4% of patients, and weakly, but significantly, correlated with both DLCO and length of IMV. Conclusions HRQoL impairment is frequent 1 year after ICU discharge, and the lowest recovery is found in the mental dimensions. Persistent dyspnea is often reported and weakly correlated with PFTs alterations. Trial registration NCT04411459.

Published
2021

28. Increased frequency of bronchiolar histotypes in lung carcinomas associated with idiopathic pulmonary fibrosis

Author

Alessandra Cancellieri, Sara Tomassetti, Mattia Barbareschi, Veronica Lever, Giuseppe Pelosi, Marco Chilosi, Andrea Rossi, Alberto Cavazza, Matteo Brunelli, Rodolfo Carella, Venerino Poletti, Claudio Doglioni, Bruno Murer, Sara Piciucchi, Eliana Gilioli, Alessia Nottegar, Giulio Rossi, Anna Caliò, Marianne Kambouchner, Alessandra Dubini, Paolo Graziano, Caliò, A, Lever, V, Rossi, A, Gilioli, E, Brunelli, M, Dubini, A, Tomassetti, S, Piciucchi, S, Nottegar, A, Rossi, G, Kambouchner, M, Cancellieri, A, Barbareschi, M, Pelosi, G, Doglioni, C, Cavazza, A, Carella, R, Graziano, P, Murer, B, Poletti, V, and Chilosi, M

Subjects
0301 basic medicine, Histotypes, Pathology, medicine.medical_specialty, Lung Neoplasms, Histology, Lung Carcinoma, Biology, Pathology and Forensic Medicine, Idiopathic Pulmonary Fibrosis, Immunohistochemistry, 03 medical and health sciences, Idiopathic pulmonary fibrosis, medicine, Carcinoma, Humans, Lung cancer, CDX2, Lung, General Medicine, respiratory system, medicine.disease, respiratory tract diseases, 030104 developmental biology, medicine.anatomical_structure, Adenocarcinoma, Honeycomb lung
Abstract

Aims: The association between lung cancer and idiopathic pulmonary fibrosis (IPF) is well known, but the significance of this association is poorly understood. Bronchiolar honeycomb cysts have been proposed as possible precursors for the development of carcinoma, but limited evidence in support of this hypothesis is available. The aim of this study was to investigate this hypothesis analysing a series of carcinomas arising in IPF by immunohistochemistry. Methods and results: Thirty-three lung carcinomas arising in patients with IPF were analysed with a panel of immunohistochemical markers. The antibodies included those against pneumocyte markers [thyroid transcription factor 1 (TTF1), napsin-A, and surfactant protein A], the goblet cell marker mucin 5AC, markers of basal/squamous cell differentiation [cytokeratin (CK) 5/6 and ΔN-p63] , and markers related to enteric differentiation (CDX2, mucin 2, CK20, and villin). A series of 100 consecutive lung adenocarcinomas arising in smokers without IPF were investigated as controls. All carcinomas arising in IPF patients were peripherally located on imaging analysis. The diagnoses were: eight squamous cell carcinomas, 20 adenocarcinomas, three small-cell carcinomas (including one composite small-cell carcinoma and adenocarcinoma), and two large-cell carcinomas. Among adenocarcinomas, a 'pneumocyte' profile (TTF1/napsin-A/SPA1-triple-positive) was observed in seven of 20 (35% versus 84% in non-IPF controls, P = 0.0001). The remaining 13 adenocarcinomas (65%) showed rare histotypes: four invasive mucinous adenocarcinomas (20% in IPF patients versus 1% in non-IPF controls, P = 0.002), seven tumours (35%) that were characterized by variable expression of markers of enteric differentiation, and two tumours (10%) that showed a peculiar basaloid component. Conclusions: The immunohistochemical characterization of carcinomas arising in IPF patients shows striking divergence from that in non-IPF smokers. The prevalence of rare entities showing bronchiole-related markers is in line with the hypothesis that these tumours arise from transformed small airways in honeycomb lung areas where abnormal bronchiolar proliferation takes place. © 2017 John Wiley & Sons Ltd.

Published
2017

29. Pleuroparenchymal fibroelastosis: the prevalence of secondary forms in hematopoietic stem cell and lung transplantation recipients

Author

Stefano Fanti, Beatrice Gatti, Maurizio Zompatori, Venerino Poletti, Sara Piciucchi, Alberto Rocca, Francesca Bonifazi, Sara Tomassetti, Alberto Cavazza, Francesca Mariani, Mariani, F, Gatti, B, Rocca, A, Bonifazi, F, Cavazza, A, Fanti, S, Tomassetti, S, Piciucchi, S, Poletti, V, and Zompatori, M

Subjects
Adult, Male, Pathology, medicine.medical_specialty, medicine.medical_treatment, Pulmonary Fibrosis, Hematopoietic stem cell transplantation, 03 medical and health sciences, 0302 clinical medicine, Chest Imaging, Fibrosis, Parenchyma, Pulmonary fibrosis, medicine, Prevalence, Lung transplantation, Humans, Radiology, Nuclear Medicine and imaging, Parenchymal Tissue, Retrospective Studies, Lung, business.industry, Late complication, Hematopoietic Stem Cell Transplantation, Hematopoietic stem cell, respiratory system, Middle Aged, medicine.disease, respiratory tract diseases, pleuroparenchymal fibroelastosis, surgical procedures, operative, medicine.anatomical_structure, 030228 respiratory system, 030220 oncology & carcinogenesis, Pleura, Female, Cardiology and Cardiovascular Medicine, business, Lung Diseases, Interstitial, Tomography, X-Ray Computed, Lung Transplantation
Abstract

Pleuroparenchymal fibroelastosis (PPFE) is a rare form of interstitial pneumonia, characterized by elastotic fibrosis involving the pleura and subpleural parenchyma, predominantly in the upper lobes. PPFE can be either idiopathic or secondary and mostly occurs as a late complication of lung or hematopoietic stem cell transplantation (HSCT). The aim of this study was to evaluate the prevalence of secondary forms in transplant recipients.An expert thoracic radiologist retrospectively reviewed high-resolution computed tomography exams of 700 HSCT recipients and 53 lung transplant recipients from the database of the Radiology Department of S. Orsola-Malpighi Hospital dating back from 2007. For each case that radiologically fulfilled PPFE criteria, the following details were retrieved: clinical characteristics, laboratory and functional data, pathologic findings (obtained from one patient) and metabolic data (obtained from three patients).Six cases clinically and radiologically consistent with PPFE were identified: two HSCT recipients (0.28%) and four lung transplant recipients (7.54%).In this study, PPFE was strongly associated with lung transplants as a late complication, with a prevalence of 7.54%.

Published
2016

30. Prognostic Value of Coronary Artery Calcification in Patients with COVID-19 and Interstitial Pneumonia: A Case-Control Study.

Author

Dall'Ara G, Piciucchi S, Carletti R, Vizzuso A, Gardini E, De Vita M, Dallaserra C, Campacci F, Di Giannuario G, Grosseto D, Rinaldi G, Vecchio S, Mantero F, Mellini L, Albini A, Giampalma E, Poletti V, and Galvani M

Abstract

Background: Patients suffering from coronavirus disease-19 (COVID-19)-related interstitial pneumonia have variable outcomes, and the risk factors for a more severe course have yet to be comprehensively identified. Cohort studies have suggested that coronary artery calcium (CAC), as estimated at chest computed tomography (CT) scan, correlated with patient outcomes. However, given that the prevalence of CAC is gender- and age-dependent, the influence of baseline confounders cannot be completely excluded. Methods: We designed a retrospective, multicenter case-control study including patients with COVID-19, with severe course cases selected based on death within 30 days or requiring invasive ventilation, whereas controls were age- and sex-matched patients surviving up to 30 days without invasive ventilation. The primary outcome was the analysis of moderate-to-severe CAC prevalence between cases and controls. Results: A total of 65 cases and 130 controls were included in the study. Cases had a significantly higher median pulmonary severity score at chest CT scan compared to controls (10 vs. 8, respectively; p = 0.0001), as well as a higher CAC score (5 vs. 2; p = 0.009). The prevalence of moderate-to-severe CAC in cases was significantly greater (41.5% vs. 23.8%; p = 0.013), a difference mainly driven by a higher prevalence in those who died within 30 days ( p = 0.000), rather than those requiring invasive ventilation ( p = 0.847). White blood cell count, moderate-to-severe CAC, the need for antibiotic therapy, and severe pneumonia at CT scan were independent primary endpoint predictors. Conclusions: This case-control study demonstrated that the CAC burden was higher in COVID-19 patients who did not survive 30 days or who required mechanical ventilation, and CAC played an independent prognostic role.

Published
2024
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33. Transbronchial lung cryobiopsy under real-time radial EBUS: First report on a novel twist of the classical technique.

Author

Anagnostopoulos N, Petrarulo S, Ravaglia C, Dubini A, Piciucchi S, Stratakos G, and Poletti V

Abstract

Transbronchial lung cryobiopsy (TBLC) is a relatively new technique for obtaining lung biopsies, known for being the least invasive method while offering a high diagnostic yield, a favourable safety profile, and a significant reduction in morbidity, mortality, and hospital stay length compared to surgical lung biopsy. Radial-EBUS (r-EBUS) represent a cornerstone modality for accessing 'invisible' peripheral pulmonary lesions. However, a major drawback of these techniques is the lack of 'real-time' visualization of the biopsy being obtained. In this case report, we present a young woman who was referred to us with a cough, haemoptysis, and a non-resolving lung consolidation. She underwent TBLC under real-time rEBUS guidance. This clinical case demonstrates that, in specific clinical scenarios, TBLC with real-time rEBUS is an excellent diagnostic tool., Competing Interests: None declared., (© 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.)

Published
2024
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34. Case Report: Asymptomatic SARS-COV2 infection triggering recurrent Takotsubo syndrome.

Author

Dall'Ara G, Compagnone M, Carletti R, Piciucchi S, Gardini E, and Galvani M

Abstract

Takotsubo syndrome (TTS) is a rare disease mimicking acute coronary syndrome, often triggered by physical or emotional stress, and characterized by transient left ventricular dysfunction. Recurrences are described in about 5% of cases and may have different clinical and imaging patterns. In the present report, SARS-COV-2 infection, even in the absence of symptoms and overt emotional stress, seems correlated with recurrence of TTS, due to the absence of other recognized triggers. The hypothesis is that in predisposed patients, events like catecholamine-induced myocyte injury, direct viral damage, cytokine storm, immune-mediated damage, and procoagulant state, all possibly induced by the infection, may elicit endothelial dysfunction as substrate for TTS onset., Competing Interests: The authors declare the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Dall'Ara, Compagnone, Carletti, Piciucchi, Gardini and Galvani.)

Published
2024
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35. Endobronchial ultrasound-guided cryobiopsy for diagnosing a case of granulomatosis with polyangiitis.

Author

Calari T, Petrarulo S, Dubini A, Piciucchi S, Ravaglia C, and Poletti V

Abstract

EBUS-TBNA has represented a revolution in the diagnosis of intrathoracic pathologies, particularly in lung cancer staging, replacing more invasive methods such as mediastinoscopy. However, its role in diagnosing rare benign or malignant mediastinal disorders is still a matter of debate. Over the past few years, the role of EBUS-guided cryobiopsy has been increasingly emerging as an innovative and minimally invasive technique in diagnosing these disorders, with an excellent safety profile. In this case report, we present the case of a young man brought to our attention after already undergoing a non-diagnostic trans thoracic needle aspiration (TTNA) procedure for lung consolidations. In our department, he underwent an initial EBUS-TBNA procedure with inconclusive rapid on-site evaluation (ROSE), leading to the decision to perform an EBUS-guided cryobiopsy, which yielded a diagnosis of granulomatosis with polyangiitis without complications. This clinical case demonstrates that in specific contexts, EBUS-cryobiopsy represents an excellent diagnostic tool., Competing Interests: None declared., (© 2024 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.)

Published
2024
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36. Pulmonary capillary hemangiomatosis/veno-occlusive disease diagnosed by transbronchial cryobiopsy.

Author

Poletti V, Femia D, Petrarulo S, Marinelli A, Ravaglia C, and Piciucchi S

Subjects
Humans, Biopsy methods, Bronchoscopy methods, Lung pathology, Lung diagnostic imaging, Lung Neoplasms pathology, Lung Neoplasms diagnosis, Pulmonary Veno-Occlusive Disease diagnosis, Pulmonary Veno-Occlusive Disease pathology, Tomography, X-Ray Computed methods, Hemangioma, Capillary diagnosis, Hemangioma, Capillary pathology
Abstract

Competing Interests: Conflicts of Interest The authors have no conflicts of interest to declare.

Published
2024
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39. COVID-19. Biology, pathophysiology, and immunology: a pathologist view.

Author

Chilosi M, Doglioni C, Ravaglia C, Piciucchi S, Dubini A, Stefanizzi L, and Poletti V

Subjects
Humans, Pathologists, Post-Acute COVID-19 Syndrome, SARS-CoV-2, Biology, COVID-19
Abstract

Even if the SARS-CoV-2 pandemic has been declared over, several risks and clinical problems remain to be faced, including long-COVID sequelae and possible outbreaks of pathogenic variants. Intense research on COVID-19 has provided in these few years a striking amount of data covering different fields and disciplines, which can help to provide a knowledge shield against new potential infective spreads, and may also potentially be applied to other fields of medicine, including oncology and neurology. Nevertheless, areas of uncertainty still remain regarding the pathogenic mechanisms that subtend the multifaceted manifestations of the disease. To better clarify the pathogenesis of the disease, a systematic multidisciplinary evaluation of the many mechanisms involved in COVID-19 is mandatory, including clinical, physiological, radiological, immunological and pathological studies. In COVID-19 syndrome the pathological studies have been mainly performed on autopsy cases, and only a few studies are available on biopsies. Nevertheless, these studies have provided relevant information that can substantially contribute to decipher the complex scenario characterizing the different forms of COVID-19 and long-COVID-19. In this review the data provided by pathological investigations are recapitulated and discussed, in the light of different hypothesis and data provided by clinical, physiological and immunological data., (Copyright © 2023 Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.)

Published
2023
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40. A complicated case of whole-lung lavage: a case report.

Author

Petrarulo S, Lucchin M, Oldani S, Dubini A, Piciucchi S, Gori A, Aiello L, Maitan S, Spagnolo P, Ravaglia C, and Poletti V

Abstract

Introduction: We report a life-threatening case of severe respiratory failure due to a pulmonary alveolar proteinosis (PAP) secondary to lysinuric protein intolerance (LPI), complicated by a pre-existing right pneumothorax, which we treated using a rescue whole-lung lavage (WLL). To date, in the literature, there are no cases of WLL performed in this condition., Clinical Condition: Patient was referred to our center because of rapidly worsening dyspnea and deterioration of gas exchange, caused by a secondary form of PAP which required an immediate therapeutic option such as the one offered by WLL. On physical examination, bilateral crackles were present, and peripheral blood oxygen saturation was 78% on oxygen with a FiO 2 of 40%., Interventions: After stabilizing the clinical conditions with oxygen therapy erogated through a high-flow nasal cannula, shortly after admission, we performed a rescue WLL among two procedures. The procedure was very effective, and the patient was later discharged without oxygen therapy and in good clinical condition., Conclusion: Our case report represents a chance to help fill the gap of knowledge relative to secondary forms of PAP. The patient we presented suffers from a very rare genetic condition (LPI) that only has a few reported cases in the literature and has a very low prevalence which makes it difficult to produce the affected people:newborns ratio. We believe that difficult and rare cases like this one can improve our understanding of the disease and, most importantly, of how much the only therapeutic option we had, a rescue WLL, is effective to improve gas exchange and radiological features, despite being performed in these severe respiratory conditions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Petrarulo, Lucchin, Oldani, Dubini, Piciucchi, Gori, Aiello, Maitan, Spagnolo, Ravaglia and Poletti.)

Published
2023
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41. Historical eye on IPF: a cohort study redefining the mortality scenario.

Author

Tomassetti S, Ravaglia C, Piciucchi S, Ryu J, Wells A, Donati L, Dubini A, Klersy C, Luzzi V, Gori L, Rosi E, Lavorini F, and Poletti V

Abstract

Rationale: Therapies that slow idiopathic pulmonary fibrosis (IPF) progression are now available and recent studies suggest that the use of antifibrotic therapy may reduce IPF mortality., Objectives: The aim of the study was to evaluate whether, to what extent, and for which factors the survival of IPF in a real-life setting has changed in the last 15 years., Methods: Historical eye is an observational study of a large cohort of consecutive IPF patients diagnosed and treated in a referral center for ILDs with prospective intention. We recruited all consecutive IPF patients seen at GB Morgagni Hospital, Forlì, Italy between January 2002 and December 2016 (15 years). We used survival analysis methods to describe and model the time to death or lung transplant and Cox regression to model prevalent and incident patient characteristics (time-dependent Cox models were fitted)., Measurements and Main Results: The study comprised 634 patients. The year 2012 identifies the time point of mortality shift (HR 0.58, CI 0.46-0.63, p < 0.001). In the more recent cohort, more patients had better preserved lung function, underwent cryobiopsy instead of surgery, and were treated with antifibrotics. Highly significant negative prognostic factors were lung cancer (HR 4.46, 95% CI 3.3-6, p < 0.001), hospitalizations (HR 8.37, 95% CI 6.5-10.7, p < 0.001), and acute exacerbations (HR 8.37, 95% CI 6.52-10.7, p < 0.001). The average antifibrotic treatment effect estimated using propensity score matching showed a significant effect in the reduction of all-cause mortality (ATE coeff -0.23, SE 0.04, p < 0.001), acute exacerbations (ATE coeff -0.15, SE 0.04, p < 0.001), and hospitalizations (ATE coeff -0.15, SE 0.04, p < 0.001) but no effect on lung cancer risk (ATE coeff -0.03, SE 0.03, p = 0.4)., Conclusion: Antifibrotic drugs significantly impact hospitalizations, acute exacerbations, and IPF survival. After the introduction of cryobiopsy and antifibrotic drugs, the prognosis of IPF patients has significantly improved together with our ability to detect IPF at an earlier stage., Competing Interests: ST declares speaker's fee from Boehringer-Ingelheim, Roche, Erbe, PulmoniX. VP declares speaker's fees from Boehringer-inghelhem, Erbe, Ambu, and Roche. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Tomassetti, Ravaglia, Piciucchi, Ryu, Wells, Donati, Dubini, Klersy, Luzzi, Gori, Rosi, Lavorini and Poletti.)

Published
2023
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42. Clinical implications of interstitial pneumonia with autoimmune features diagnostic criteria in idiopathic pulmonary fibrosis: A case control study.

Author

Tomassetti S, Ravaglia C, Puglisi S, Wells AU, Ryu JH, Bosi M, Dubini A, Piciucchi S, Girelli F, Parronchi P, Lavorini F, Rosi E, Luzzi V, Cerinic MM, and Poletti V

Abstract

Background: A subgroup of IPF patients can meet IPAF criteria (features suggesting an underlying autoimmune process without fulfilling established criteria for a CTD). This study was aimed to evaluate whether IPAF/IPF patients compared to IPF patients differ in clinical profile, prognosis and disease course., Methods: This is a retrospective, single center, case-control study. We evaluated 360 consecutive IPF patients (Forlì Hospital, between 1/1/2002 and 28/12/2016) and compared characteristics and outcome of IPAF/IPF to IPF., Results: Twenty-two (6%) patients met IPAF criteria. IPAF/IPF patients compared to IPF were more frequently females ( N = 9/22, 40.9% vs. N = 68/338, 20.1%, p = 0.02), suffered more frequently from gastroesophageal reflux (54.5% vs. 28.4%, p = 0.01), and showed a higher prevalence of arthralgias (86.4% vs. 4.8%, p < 0.0001), myalgias (14.3% vs. 0.3%, p = 0.001) and fever (18.2% vs. 1.9%, p = 0.002). The serologic domain was detected in all cases (the most frequent were ANA in 17 and RF in nine cases) and morphologic domain (histology features) was positive in 6 out of 10 lung biopsies (lymphoid aggregates). Only patients with IPAF/IPF evolved to CTD at follow-up (10/22, 45.5%; six rheumatoid arthritis, one Sjögren's and three scleroderma). The presence of IPAF was a positive prognostic determinant (HR 0.22, 95% CI 0.08-0.61, p = 0.003), whereas the isolated presence of circulating autoantibody did not impact prognosis (HR 1.00, 95% CI 0.67-1.49, p = 0.99)., Conclusion: The presence of IPAF criteria in IPF has a major clinical impact correlating with the risk of evolution to full blown-CTD during follow-up and identifying a subgroup of patients with a better prognosis., Competing Interests: ST declares speaker’s fee from Boehringer-Ingelheim, Roche, Erbe, PulmoniX; and VP declares speaker’s fees from Boehringer-inghelhem, Erbe, Ambu, and Roche. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Tomassetti, Ravaglia, Puglisi, Wells, Ryu, Bosi, Dubini, Piciucchi, Girelli, Parronchi, Lavorini, Rosi, Luzzi, Cerinic and Poletti.)

Published
2023
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43. Is there any role for medical thoracoscopy in the treatment of empyema in children?

Author

Zuccatosta L, Piciucchi S, Martinello S, Sultani F, Oldani S, de Grauw AJ, Maitan S, Corso MR, Poletti V, and Ravaglia C

Subjects
Humans, Child, Retrospective Studies, Thoracoscopy, Lung surgery, Empyema, Pleural diagnostic imaging, Empyema, Pleural surgery, Pneumonia
Abstract

It is still controversial whether surgical or nonsurgical treatment approaches are most appropriate for empyema in children, and there are no data regarding the role of medical thoracoscopy in this population. The aim of this study was to describe our experience with medical thoracosocpy in children with multiloculated and organizing pneumonia. We retrospectively reviewed children admitted to our hospital with a diagnosis of empyema from 2011 to 2021 and treated with medical thoracoscopy. A total of six patients with empyema were treated by medical thoracoscopy; empyema was multiloculated in five cases and organized in one case; all children in the study recovered completely with full lung expansion after chest X-rays, and no disease sequelae were reported after clinical follow-up. Our small case series suggests that in selected cases, medical thoracoscopy could safely and effectively treat pleural empyema in children, with less invasiveness and reduced psychological consequences., (© 2023 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)

Published
2023
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44. Clinical, radiological and pathological findings in patients with persistent lung disease following SARS-CoV-2 infection.

Author

Ravaglia C, Doglioni C, Chilosi M, Piciucchi S, Dubini A, Rossi G, Pedica F, Puglisi S, Donati L, Tomassetti S, and Poletti V

Subjects
B7-H1 Antigen, Endothelial Cells, Humans, Lung diagnostic imaging, Lung pathology, SARS-CoV-2, COVID-19 complications
Abstract

Some patients experience pulmonary sequelae after SARS-CoV-2 infection, ranging from self-limited abnormalities to major lung diseases. Morphological analysis of lung tissue may help our understanding of pathogenic mechanisms and help to provide consistent personalised management. The aim of this study was to ascertain morphological and immunomolecular features of lung tissue. Transbronchial lung cryobiopsy was carried out in patients with persistent symptoms and computed tomography suggestive of residual lung disease after recovery from SARS-CoV-2 infection. 164 patients were referred for suspected pulmonary sequelae after COVID-19; 10 patients with >5% parenchymal lung disease underwent lung biopsy. The histological pattern of lung disease was not homogeneous and three different case clusters could be identified, which was mirrored by their clinical and radiological features. Cluster 1 ("chronic fibrosing") was characterised by post-infection progression of pre-existing interstitial pneumonias. Cluster 2 ("acute/subacute injury") was characterised by different types and grades of lung injury, ranging from organising pneumonia and fibrosing nonspecific interstitial pneumonia to diffuse alveolar damage. Cluster 3 ("vascular changes") was characterised by diffuse vascular increase, dilatation and distortion (capillaries and venules) within otherwise normal parenchyma. Clusters 2 and 3 had immunophenotypical changes similar to those observed in early/mild COVID-19 pneumonias (abnormal expression of STAT3 in hyperplastic pneumocytes and PD-L1, IDO and STAT3 in endothelial cells). This is the first study correlating histological/immunohistochemical patterns with clinical and radiological pictures of patients with post-COVID lung disease. Different phenotypes with potentially different underlying pathogenic mechanisms have been identified., Competing Interests: Conflict of interest: The authors report no competing interests., (Copyright ©The authors 2022.)

Published
2022
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45. Incidental discovery of interstitial lung disease: diagnostic approach, surveillance and perspectives.

Author

Tomassetti S, Poletti V, Ravaglia C, Sverzellati N, Piciucchi S, Cozzi D, Luzzi V, Comin C, and Wells AU

Subjects
Disease Progression, Humans, Incidental Findings, Lung diagnostic imaging, Tomography, X-Ray Computed, Idiopathic Pulmonary Fibrosis diagnostic imaging, Idiopathic Pulmonary Fibrosis epidemiology, Lung Diseases, Interstitial diagnosis, Lung Diseases, Interstitial epidemiology, Lung Diseases, Interstitial therapy
Abstract

The incidental discovery of pre-clinical interstitial lung disease (ILD) has led to the designation of interstitial lung abnormalities (ILA), a radiological entity defined as the incidental finding of computed tomography (CT) abnormalities affecting more than 5% of any lung zone. Two recent documents have redefined the borders of this entity and made the recommendation to monitor patients with ILA at risk of progression. In this narrative review, we will focus on some of the limits of the current approach, underlying the potential for progression to full-blown ILD of some patients with ILA and the numerous links between subpleural fibrotic ILA and idiopathic pulmonary fibrosis (IPF). Considering the large prevalence of ILA in the general population (7%), restricting monitoring only to cases considered at risk of progression appears a reasonable approach. However, this suggestion should not prevent pulmonary physicians from pursuing an early diagnosis of ILD and timely treatment where appropriate. In cases of suspected ILD, whether found incidentally or not, the pulmonary physician is still required to make a correct ILD diagnosis according to current guidelines, and eventually treat the patient accordingly., Competing Interests: Conflict of interest: S. Tomassetti declares consultancy and speaker's fees from Roche and Boehringer Ingelheim, outside this project. Conflict of interest: V. Poletti has nothing to disclose. Conflict of interest: C. Ravaglia has nothing to disclose. Conflict of interest: N. Sverzellati has nothing to disclose. Conflict of interest: S. Piciucchi has nothing to disclose. Conflict of interest: D. Cozzi has nothing to disclose. Conflict of interest: V. Luzzi has nothing to disclose. Conflict of interest: C. Comin has nothing to disclose. Conflict of interest: A.U. Wells has nothing to disclose., (Copyright ©The authors 2022.)

Published
2022
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46. The pathogenic role of epithelial and endothelial cells in early-phase COVID-19 pneumonia: victims and partners in crime.

Author

Chilosi M, Poletti V, Ravaglia C, Rossi G, Dubini A, Piciucchi S, Pedica F, Bronte V, Pizzolo G, Martignoni G, and Doglioni C

Subjects
B7-H1 Antigen metabolism, Biopsy, COVID-19 metabolism, COVID-19 mortality, COVID-19 virology, Cytokines metabolism, Endothelial Cells metabolism, Endothelial Cells virology, Epithelial Cells metabolism, Epithelial Cells virology, Humans, Indoleamine-Pyrrole 2,3,-Dioxygenase metabolism, Lung metabolism, Lung virology, Phosphorylation, Prognosis, STAT3 Transcription Factor metabolism, Signal Transduction, COVID-19 pathology, Cell Communication, Endothelial Cells pathology, Epithelial Cells pathology, Lung pathology
Abstract

Current understanding of the complex pathogenesis of COVID-19 interstitial pneumonia pathogenesis in the light of biopsies carried out in early/moderate phase and histology data obtained at postmortem analysis is discussed. In autopsies the most observed pattern is diffuse alveolar damage with alveolar-epithelial type-II cell hyperplasia, hyaline membranes, and frequent thromboembolic disease. However, these observations cannot explain some clinical, radiological and physiopathological features observed in SARS-CoV-2 interstitial pneumonia, including the occurrence of vascular enlargement on CT and preserved lung compliance in subjects even presenting with or developing respiratory failure. Histological investigation on early-phase pneumonia on perioperative samples and lung biopsies revealed peculiar morphological and morpho-phenotypical changes including hyper-expression of phosphorylated STAT3 and immune checkpoint molecules (PD-L1 and IDO) in alveolar-epithelial and endothelial cells. These features might explain in part these discrepancies., (© 2021. The Author(s), under exclusive licence to United States & Canadian Academy of Pathology.)

Published
2021
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47. Predictors of Worse Prognosis in Young and Middle-Aged Adults Hospitalized with COVID-19 Pneumonia: A Multi-Center Italian Study (COVID-UNDER50).

Author

Bonifazi M, Mei F, Skrami E, Latini LL, Amico D, Balestro E, Bini F, Bonifazi F, Caminati A, Candoli P, Cinti S, Contucci S, Di Marco Berardino A, Harari S, Levi G, Lococo S, Menditto V, Marchetti G, Piciucchi S, Poletti V, Ravaglia C, Saetta M, Svegliati-Baroni G, Tomassetti S, Tamburrini M, Zanforlin A, Zuccon U, Zuccatosta L, Gasparini S, and Carle F

Abstract

Obesity as well as metabolic and cardiovascular comorbidities are established, significant predictors of worse prognosis in the overall COVID-19 population, but limited information is available on their roles in young and middle-aged adults (aged ≤ 50 years). The main objectives of the present Italian multi-center study were to describe clinical characteristics and role of selected prognostic predictors in a large cohort of young and middle-aged hospitalized patients. Nine pulmonology units, across north and center of Italy, were involved in this retrospective study. Comorbidities were classified according to their known or potential association with COVID-19. A total of 263 subjects were included. The prevalence of obesity was 25.9%, mechanical ventilation (MV) was needed in 27.7%, and 28 in-hospital deaths occurred (10.6%). Obesity and older age were the only independent, significant predictors for MV. Comorbidities, such as hypertension, diabetes, asthma, and increased D-dimer levels were significantly associated with higher mortality risk, regardless of age, body mass index, and MV. Obesity in young and middle-aged adults is a strong predictor of a more complicated COVID-19, without, however, evidence of a significant effect on in-hospital mortality. Selected comorbidities, including hypertension, diabetes and asthma, significantly impact survival even in a younger population, suggesting the need for prompt recognition of these conditions.

Published
2021
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48. Transbronchial cryobiopsy increases diagnostic confidence in interstitial lung disease: a prospective multicentre trial.

Author

Hetzel J, Wells AU, Costabel U, Colby TV, Walsh SLF, Verschakelen J, Cavazza A, Tomassetti S, Ravaglia C, Böckeler M, Spengler W, Kreuter M, Eberhardt R, Darwiche K, Torrego A, Pajares V, Muche R, Musterle R, Horger M, Fend F, Warth A, Heußel CP, Piciucchi S, Dubini A, Theegarten D, Franquet T, Lerma E, Poletti V, and Häntschel M

Subjects
Biopsy, Humans, Lung, Prospective Studies, Bronchoscopy, Lung Diseases, Interstitial diagnosis
Abstract

Introduction: The accurate diagnosis of individual interstitial lung diseases (ILD) is often challenging, but is a critical determinant of appropriate management. If a diagnosis cannot be made after multidisciplinary team discussion (MDTD), surgical lung biopsy is the current recommended tissue sampling technique according to the most recent guidelines. Transbronchial lung cryobiopsy (TBLC) has been proposed as an alternative to surgical lung biopsy., Methods: This prospective, multicentre, international study analysed the impact of TBLC on the diagnostic assessment of 128 patients with suspected idiopathic interstitial pneumonia by a central MDTD board (two clinicians, two radiologists, two pathologists). The level of confidence for the first-choice diagnoses were evaluated in four steps, as follows: 1) clinicoradiological data alone; 2) addition of bronchoalveolar lavage (BAL) findings; 3) addition of TBLC interpretation; and 4) surgical lung biopsy findings (if available). We evaluated the contribution of TBLC to the formulation of a confident first-choice MDTD diagnosis., Results: TBLC led to a significant increase in the percentage of cases with confident diagnoses or provisional diagnoses with high confidence (likelihood ≥70%) from 60.2% to 81.2%. In 32 out of 52 patients nondiagnostic after BAL, TBLC provided a diagnosis with a likelihood ≥70%. The percentage of confident diagnoses (likelihood ≥90%) increased from 22.7% after BAL to 53.9% after TBLC. Pneumothoraces occurred in 16.4% of patients, and moderate or severe bleeding in 15.7% of patients. No deaths were observed within 30 days., Interpretation: TBLC increases diagnostic confidence in the majority of ILD patients with an uncertain noninvasive diagnosis, with manageable side-effects. These data support the integration of TBLC into the diagnostic algorithm for ILD., Competing Interests: Conflict of interest: J. Hetzel reports grants from ERBE Elektromedizin GmbH, during the conduct of the study; and personal fees from Erbe Elektromedizin GmbH, outside the submitted work. Conflict of interest: A.U. Wells reports grants from ERBE Elektromedizin GmbH, during the conduct of the study. Conflict of interest: U. Costabel reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidisciplinary team discussion. There was no payment for participation. Conflict of interest: T.V. Colby reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidisciplinary team discussion. There was no payment for participation. Conflict of interest: S.L.F. Walsh reports grants from ERBE Elektromedizin GmbH, personal fees from Boehringer Ingelheim, Roche, The Open Source Imaging Consortium, Intermmune, Sanofi-Genzyme and Bracco; and grants from National Institute for Health and Research, during the conduct of the study. Conflict of interest: J. Verschakelen reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidisciplinary team discussion. There was no payment for participation. Conflict of interest: A. Cavazza reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering accommodation costs for the central multidisciplinary team discussion. There was no payment for participation. Conflict of interest: S. Tomassetti has nothing to disclose. Conflict of interest: C. Ravaglia has nothing to disclose. Conflict of interest: M. Böckeler reports personal fees from Erbe Elektromedizin GmbH, outside the submitted work. Conflict of interest: W. Spengler has nothing to disclose. Conflict of interest: M. Kreuter reports grants and personal fees from Roche and Boehringer Ingelheim outside the submitted work. Conflict of interest: R. Eberhardt reports personal fees from Olympus Europa, Pulmonx, Broncus/Uptake medical and BTG/PneumRx, outside the submitted work. Conflict of interest: K. Darwiche received speakers fee and travel grants from ERBE Elektromedizin GmbH, outside the submitted work. Conflict of interest: A. Torrego has nothing to disclose. Conflict of interest: V. Pajares has nothing to disclose. Conflict of interest: R. Muche has nothing to disclose. Conflict of interest: R. Musterle reports grants from ERBE Elektromedizin GmbH, during the conduct of the study. Conflict of interest: M. Horger has nothing to disclose. Conflict of interest: F. Fend has nothing to disclose. Conflict of interest: A. Warth has nothing to disclose. Conflict of interest: C.P. Heußel reports personal fees from Novartis, Basilea and Bayer, outside the submitted work. In addition, Dr Heußel has a patent Method and Device For Representing the Microstructure of the Lungs (IPC8 Class: AA61B5055FI, PAN: 20080208038 issued and Stock ownership in medical industry: GSK). Conflict of interest: S. Piciucchi has nothing to disclose. Conflict of interest: A. Dubini has nothing to disclose. Conflict of interest: D. Theegarten has nothing to disclose. Conflict of interest: T. Franquet has nothing to disclose. Conflict of interest: E. Lerma has nothing to disclose. Conflict of interest: V. Poletti reports personal fees from ERBE Elektromedizin GmbH, outside the submitted work. Conflict of interest: M. Häntschel reports grants from ERBE Elektromedizin GmbH, during the conduct of the study; and personal fees from Erbe Elektromedizin GmbH, outside the submitted work., (Copyright ©ERS 2020.)

Published
2020
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49. Transbronchial cryobiopsy: an effective tool in the diagnosis of lymphoproliferative disorders of the lung.

Author

Bianchi R, Dubini A, Asioli S, Ravaglia C, Tomassetti S, Puglisi S, Piciucchi S, Gurioli C, Gurioli C, Fiocca R, and Poletti V

Abstract

Introduction: Malignant lymphoproliferative disorders are rarely observed in the lung and, considering their clinical and radiological heterogeneity, diagnosis is often difficult and may require invasive methods. Transbronchial cryobiopsy has been confirmed as a new tool in the diagnosis of interstitial lung diseases, given its fewer risks and costs compared to surgical approach. This study is aimed at assessing the effectiveness of cryobiopsy in the diagnosis of lymphoproliferative disorders., Materials and Methods: Among 970 consecutive cryobiopsies, performed between January 2011 and June 2018 at Morgagni Hospital of Forlì, Italy, 13 cases of lymphoproliferative disorders were collected., Results: In 12 out of 13 cases a precise pathological diagnosis could be reached with the support of immunohistochemistry (IHC) and molecular ancillary studies. In the only case in which cryobiopsy did not lead to a definitive diagnosis, the subsequent surgical biopsy also did not help to clarify the diagnosis. Severe bleeding or pneumothorax did not occur in any case. On average, five biopsies were obtained per case, with a mean total area of 1161 mm 2 , and only 5 out of 65 specimens were inadequate for diagnosis. Instant freezing did not produce tissue artefacts nor did it affect IHC and molecular tests. In all cases the amount of available tissue was sufficient for all ancillary studies., Conclusions: Transbronchial lung cryobiopsy is safe and effective for diagnosis in patients with suspected pulmonary involvement by lymphoproliferative disorders and it should therefore be considered a valid alternative to surgical biopsy in such cases., Competing Interests: Conflict of interest: R. Bianchi has nothing to disclose. Conflict of interest: A. Dubini has nothing to disclose. Conflict of interest: S. Asioli has nothing to disclose. Conflict of interest: C. Ravaglia has nothing to disclose. Conflict of interest: S. Tomassetti has nothing to disclose. Conflict of interest: S. Puglisi has nothing to disclose. Conflict of interest: S. Piciucchi has nothing to disclose. Conflict of interest: C. Gurioli has nothing to disclose. Conflict of interest: C. Gurioli has nothing to disclose. Conflict of interest: R. Fiocca has nothing to disclose. Conflict of interest: V. Poletti has nothing to disclose., (Copyright ©ERS 2020.)

Published
2020
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50. Pleuroparenchymal fibroelastosis in systemic sclerosis: prevalence and prognostic impact.

Author

Bonifazi M, Sverzellati N, Negri E, Jacob J, Egashira R, Moser J, Piciucchi S, Mei F, De Lauretis A, Visca D, Goh N, Bonini M, Cirilli L, La Vecchia C, Chua F, Kouranos V, Margaritopoulos G, Kokosi M, Maher TM, Gasparini S, Gabrielli A, Wells AU, and Renzoni EA

Subjects
Humans, Italy, Prevalence, Prognosis, Lung Diseases, Interstitial complications, Lung Diseases, Interstitial diagnosis, Lung Diseases, Interstitial epidemiology, Scleroderma, Systemic complications, Scleroderma, Systemic epidemiology
Abstract

Interstitial lung disease (ILD) in systemic sclerosis (SSc) is a major cause of morbidity and mortality, mostly presenting as non-specific interstitial pneumonia. Little is known about the prevalence of pleuroparenchymal fibroelastosis (PPFE), a specific entity affecting the visceral pleura and subpleural parenchyma. We set out to estimate PPFE prevalence in two large cohorts of SSc patients and to assess its impact on survival and functional decline.A total of 359 SSc patients, derived from two referral centres in two different countries (UK and Italy), were included. The first available high-resolution computed tomography scan was independently evaluated by two radiologists blind to clinical information, to quantify ILD extent, freestanding bronchial abnormalities, and lobar percentage involvement of PPFE on a four-point categorical scale. Discordant scores were adjudicated by a third scorer. PPFE extent was further classified as limited (≤2/18) or extensive (>2/18). Results were evaluated against functional decline and mortality.The overall prevalence of PPFE in the combined SSc population was 18% (11% with extensive PPFE), with no substantial difference between the two cohorts. PPFE was significantly linked to free-standing bronchial abnormalities (61% versus 25% in PPFE versus no PPFE; p<0.0001) and to worse survival, independently of ILD severity or short-term lung function changes (HR 1.89, 95% CI 1.10-3.25; p=0.005).In the current study, we provide an exhaustive description of PPFE prevalence and clinical impact in the largest cohort of SSc subjects published so far. PPFE presence should be carefully considered, due to its significant prognostic implications., Competing Interests: Conflict of interest: M. Bonifazi reports personal fees from Boehringer Ingelheim and Roche, outside the submitted work. Conflict of interest: N. Sverzellati reports personal fees from Boehringer Ingelheim and Roche, outside the submitted work. Conflict of interest: E. Negri has nothing to disclose. Conflict of interest: J. Jacob reports personal fees from Roche and Boehringer Ingelheim, grants from GlaxoSmithKline, outside the submitted work. Conflict of interest: R. Egashira reports personal fees and non-financial support from Shionogi, Boehringer Ingelheim Japan, Bayer Yakuhin, Eisai, Daiichi Sankyo and AstraZeneca, non-financial support from Kyorin, outside the submitted work. Conflict of interest: J. Moser has nothing to disclose. Conflict of interest: S. Piciucchi has nothing to disclose. Conflict of interest: F. Mei has nothing to disclose. Conflict of interest: A. De Lauretis has nothing to disclose. Conflict of interest: D. Visca has nothing to disclose. Conflict of interest: N. Goh has nothing to disclose. Conflict of interest: M. Bonini has nothing to disclose. Conflict of interest: L. Cirilli has nothing to disclose. Conflict of interest: C. La Vecchia has nothing to disclose. Conflict of interest: F. Chua has no conflict of interest to declare Conflict of interest: V. Kouranos has nothing to disclose. Conflict of interest: G. Margaritopoulos has nothing to disclose. Conflict of interest: M. Kokosi has nothing to disclose. Conflict of interest: T.M. Maher has, via his institution, received industry-academic funding from GlaxoSmithKline R&D and UCB and has received consultancy or speakers fees from Apellis, Astra Zeneca, Bayer, Blade Therapeutics, Boehringer Ingelheim, Bristol-Myers Squibb, Galapagos, GlaxoSmithKline R&D, Indalo, Novartis, Pliant, ProMetic, Respivnat, Roche, Samumed and UCB. Conflict of interest: S. Gasparini has nothing to disclose. Conflict of interest: A. Gabrielli has nothing to disclose. Conflict of interest: A.U. Wells reports personal fees from Boehringer Ingelheim, Roche and Bayer, outside the submitted work. Conflict of interest: E.A. Renzoni reports personal fees from Boehringer Ingelheim and Roche, outside the submitted work., (Copyright ©ERS 2020.)

Published
2020
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