Alessandro Di Marco Berardino

Azienda Ospedaliero Universitaria Ospedali Riuniti

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Lina Zuccatosta

Fatebenefratelli Hospital

Federico Mei

Azienda Ospedaliero Universitaria Ospedali Riuniti

Stefano Gasparini

Ospedali Riuniti di Ancona

Martina Bonifazi

Marche Polytechnic University

Riccardo Inchingolo

Agostino Gemelli University Polyclinic

Salvatore Valente

Università Cattolica del Sacro Cuore

Andrea Smargiassi

Agostino Gemelli University Polyclinic

Giuseppe Maria Corbo

Corvid Technologies (United States)

Francesca Gonnelli

Marche Polytechnic University

Michele Sediari

Azienda Ospedaliero Universitaria Ospedali Riuniti

Cooperative Institutions

Istituti di Ricovero e Cura a Carattere Scientifico

Università Cattolica del Sacro Cuore

Agostino Gemelli University Polyclinic

Marche Polytechnic University

Azienda Ospedaliero Universitaria Ospedali Riuniti

Ospedali Riuniti di Ancona

Catholic University of America

Ospedali Riuniti Umberto I

University of Padua

University of the Sacred Heart

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Empyema Caused by Prevotella bivia Complicating an Unusual Case of Spontaneous Chylothorax

Journal of Clinical Microbiology (2014)

Alessandro Di Marco Berardino Riccardo Inchingolo Andrea Smargiassi Antonina Re Riccardo Torelli

Spontaneous chylothorax is rare in adults. We present an unusual case that was complicated by Prevotella bivia empyema. Full recovery was achieved with chest tube drainage and prompt treatment with intravenous clindamycin.

Chylothorax

Chest tube

Prevotella

10.1128/jcm.03282-13

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Citations (14)

Can the New Global Lung Initiative Equations Better Stratify the Risk of Death in Elderly People with Chronic Obstructive Pulmonary Disease?

Respiration (2016)

Claudio Pedone Alessandro Di Marco Berardino Riccardo Pistelli Francesco Forastiere Vincenzo Bellia

Background: The forced expiratory volume in the first second (FEV1) is commonly expressed as percentage of its value predicted by equations. The most commonly used equations are poorly applicable to elderly people. Recently, a set of equations (Global Lung Initiative, GLI) has been released that is expected to be more appropriate in this population. Objectives: We evaluated the agreement of the GLI, European Respiratory Society (ERS), and National Health and Nutrition Examination Survey (NHANES) equations for prediction of FEV1 and compared their discriminative capacity with respect to mortality, taking as reference the prediction equation developed in the population from which our sample was drawn (SARA). Methods: We studied 264 patients with chronic obstructive pulmonary disease aged ≥70 years. Agreement was evaluated using the Bland-Altman method, discriminative capacity using incidence rate ratios for mortality calculated across quartiles of each measure. Results: The mean age of the sample was 75.8 years (72.7% men). In women, the mean FEV1ERS/FEV1SARA, FEV1NHANES/ FEV1SARA, and FEV1GLI/FEV1SARA were 0.81, 0.91, and 0.966, respectively. The corresponding values in men were 0.959, 0.963, and 1.02, respectively. The overall discriminative capacity with respect to death was equally poor for all equations. Conclusion: The GLI equations for predicting FEV1 provide similar estimates compared to an equation developed in a healthy subset of the population in which they are applied, and higher values compared to the ERS equation, especially in women. However, the use of the GLI equation does not improve the stratification of the risk of mortality in elderly people compared to ERS or NHANES equations.

Quartile

Obstructive lung disease

Discriminative model

10.1159/000447246

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Citations (3)

Diagnostic Accuracy of Slow-Capillary Endobronchial Ultrasound Needle Aspiration in Determining PD-L1 Expression in Non-Small Cell Lung Cancer

Advances in respiratory medicine (2023)

Lina Zuccatosta Federico Mei Michele Sediari Alessandro Di Marco Berardino Martina Bonifazi

The role of EBUS-TBNA in the diagnosis and staging of lung cancer is well established. EBUS-TBNA can be performed using different aspiration techniques. The most common aspiration technique is known as "suction". One alternative to the suction technique is the slow-pull capillary aspiration. To the best of our knowledge, no studies have assessed the diagnostic yield of slow-pull capillary EBUS-TBNA in PD-L1 amplification assessment in NSCLC. Herein, we conducted a single-centre retrospective study to establish the diagnostic yield of slow-pull capillary EBUS-TBNA in terms of PD-L1 in patients with NSCLC and hilar/mediastinal lymphadenopathies subsequent to NSCLC.Patients with hilar and/or mediastinal lymph node (LN) NSCLC metastasis, diagnosed by EBUS-TBNA between January 2021 and April 2022 at Pulmonology Unit of "Ospedali Riuniti di Ancona" (Ancona, Italy) were enrolled. We evaluated patient characteristics, including demographic information, CT scan/ FDG-PET features and final histological diagnoses, including PD-L1 assessment.A total of 174 patients underwent EBUS-TBNA for diagnosis of hilar/mediastinal lymphadenopathies between January 2021 and April 2022 in the Interventional Pulmonology Unit of the "Ospedali Riuniti di Ancona". Slow-pull capillary aspiration was adopted in 60 patients (34.5%), and in 30/60 patients (50.0%) NSCLC was diagnosed. EBUS-TBNA with slow-pull capillary aspiration provided adequate sampling for molecular biology and PD-L1 testing in 96.7% of patients (29/30); in 15/29 (51.7%) samples with more than 1000 viable cells/HPF were identified, whereas in 14/29 (48.3%) samples contained 101-1000 viable cells/HPF.These retrospective study shows that slow-pull capillary aspiration carries an excellent diagnostic accuracy, almost equal to that one reported in literature, supporting its use in EBUS-TBNA for PD-L1 testing in NSCLC.

Endobronchial ultrasound

10.3390/arm91010001

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Citations (2)

Current therapeutic approach in patients with pleural infections: results from a multicentre Italian study (INPLE study)

Francesco Del Bello Francesca Gonnelli Martina Bonifazi Lina Zuccatosta Alessandro Di Marco Berardino

10.1183/13993003.congress-2024.pa2551

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Erratum

Respiration (2014)

Marco Sperandeo David Miedinger Claudia Enz Selina Dürr Sabrina Maier

cheal tube positioned several centimeters above the main carina.We have found that the flexible bronchoscope can easily pass through the endotracheal tube and past the deflated endobronchial blocker en route to the site of biopsy.The cryoprobe is then introduced through the working channel of the bronchoscope, and biopsies are obtained under fluoroscopic guidance as previously described [1][2][3][4] .The endobronchial blocker remains deflated unless needed to assist in controlling bleeding.Upon completion of the procedure, the endobronchial blocker is removed en bloc with the endotracheal tube when the patient is clinically ready for extubation.Cryobiopsies show promise in the diagnosis of diffuse parenchymal lung diseases.While multiple small studies have reported no increased risk for significant bleeding [1][2][3][4]6] , experience with transbronchial cryobiopsy is still limited, and concerns regarding potential complications remain.Use of an endobronchial blocker is helpful to manage procedurally related hemorrhage.Being able to utilize the endobronchial blocker without the use of rigid bronchoscopy increases its availability to bronchoscopists without significant rigid bronchoscopy experience and allows for safer performance of peripheral cryobiopsies.

10.1159/000369284

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Ultrasound analysis of the effect of airways obstruction on diaphragm relaxation pattern

European Respiratory Journal (2013)

Alessandro Zanforlin Andrea Smargiassi Riccardo Inchingolo Alessandro Di Marco Berardino Emilio Ramazzina

Diaphragm motion can be analysed with ultrasound using M-mode in anterior subcostal approach (Testa, A et al. Ultrasound Med Biol 2011;37:44-52). The diaphragm line during a forced expiration shows an initial drop off followed by a plateau in maximum expiration. Maximum expiratory diaphragmatic excursion (EDEMax) and forced expiratory diaphragmatic excursion in the first second (FEDE1) can be measured and considered as phisiopathological analogues of vital capacity (VC) and FEV1. As the ratio FEV1/VC% is used as a marker of obstruction, the aim of our study was to assess if the ratio FEDE1/EDEMax% (M-mode Index of Obstruction [MIO]) is different between normal subjects and patients with obstructive spirometric pattern (Miller, MR. Eur Respir J. 2005;26:319-38). 4 operators in 2 centers examined with ultrasound the diaphragmatic motion of outpatients with known spirometric pattern using M-mode during a maximal forced expiration in semi supine position. FEDE1 and EDEMax were recorded and MIO calculated. 124 patients were examined, 61 normal and 63 obstructed. MIO values: in normal group 72.84 to 100, mean 87.08±6.64, median 87.21; in obstructed group 33.33 to 91.30, mean 67.09±12.49, median 70.48. MIO values of the two groups showed a minimum overlap and a significant difference (p Ultrasound analysis of diaphragmatic motion could potentially identify an obstructive pattern, being a potential add-on screening technique for detecting airways obstruction.

Supine position

Diaphragm (acoustics)

Expiration

Vital capacity

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Citations (1)

Treatment and clinical outcomes in pleural infection: preliminary results from a multi-centre study

Chiara Fattori Luca Piergentili Martina Bonifazi Francesca Barbisan Gaia Goteri

Background: Pleural infection represents a significant burden of disease to patients and healthcare system, due to substantial morbidity and mortality worldwide, without a definite consensus on the optimal treatment approach and relative outcomes Objectives: To assess type and timing of first-line interventions and clinical outcomes of patients with pleural infection Methods: Patients hospitalized with a diagnosis of pleural infection from 2015 to 2020 are included in this, ongoing, multi-center retrospective study, involving tertiary hospitals across Italy. The following data are collected: clinical features, including effusion aspect, type and timing of first-line treatment (aspiration, drainage and size; medical thoracoscopy-MT; surgery), surgery referral, length of hospital stay, 30-day mortality Results: To date, data from 182 patients (4 centres) have been collected. MT was most frequent first-line approach (41%), followed by chest drain (16%; prevalence of large bore tube), thoracentesis (9%) and surgery (9%). Two thirds (69%) of interventions were performed within the first 48 hours. A subsequent surgery referral was needed in 10% of patients and was most frequent in chest drain subgroup as compared to MT one. Hospital stay was 11.7, 11.4 and 22.5 days in patients who never underwent surgery, who underwent surgery at onset and who underwent second-line surgery, respectively (p<0.01). Mortality at 30-day was 2% Conclusions: Our preliminary data showed that MT was the most common approach to pleural infections, although first-line management was heterogenic. Short-term clinical outcomes were overall favourable, but likely influenced by timely intervention and high level expertise of centres

Thoracentesis

Thoracoscopy

Cardiothoracic surgery

Medical record

10.1183/13993003.congress-2023.pa1779

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A new sensitive and accurate model to predict moderate to severe obstructive sleep apnea in patients with obesity

Medicine (2019)

Sofie Ahlin Melania Manco Simona Panunzi Ornella Verrastro Giulia Giannetti

Abstract Obstructive sleep apnea (OSA) has a high prevalence in patients with obesity. Only patients with clinical symptoms of OSA are admitted to polysomnography; however, many patients with OSA are asymptomatic. We aimed to create and validate a population-based risk score that predicts the severity of OSA in patients with obesity. We here report the cross-sectional analysis at baseline of an ongoing study investigating the long-term effect of bariatric surgery on OSA. One-hundred sixty-one patients of the Obesity Center of the Catholic University Hospital in Rome, Italy were included in the study. The patients underwent overnight cardiorespiratory monitoring, blood chemistry analyses, hepatic ultrasound, and anthropometric measurements. The patients were divided into 2 groups according OSA severity assessed by the apnea-hypopnea index (AHI): AHI < 15 = no or mild and AHI ≥ 15 moderate to severe OSA. A statistical prediction model was created and validated. C statistics was used to evaluate the discrimination performance of the model. The prevalence of OSA was 96.3% with 74.5% of the subjects having moderate/severe OSA. Sex, body mass index, diabetes, and age were included in the final prediction model that had excellent discrimination ability (C statistics equals to 83%). An OSA risk chart score for clinical use was created. Patients with severe obesity are at a very high risk for moderate or severe OSA in particular if they are men, older, more obese, and/or with type 2 diabetes. The OSA risk chart can be useful for general practitioners and patients as well as for bariatric surgeons to select patients with high risk of moderate to severe OSA for further polysomnography.

Severe obesity

Sleep

10.1097/md.0000000000016687

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Citations (19)

La formazione in pneumologia interventistica

Sara Colella Alessandro Di Marco Berardino Alberto Fantin Silvia Puglisi Simone Scarlata

La pneumologia interventistica, disciplina ad alto livello di specializzazione del percorso formativo dello Pneumologo, si occupa delle metodiche invasive e semi-invasive utilizzate nella diagnostica e nella terapia delle patologie del torace coinvolgenti le vie aeree, il parenchima polmonare e la pleura. Negli ultimi anni, la progressione delle tecnologie e l’aumento delle evidenze scientifiche a supporto di tale branca hanno portato le singole istituzioni e le diverse societa scientifiche a riconoscere la necessita di stabilire i criteri per l’esecuzione delle varie procedure che la caratterizzano. Nel seguente articolo verranno descritti i percorsi formativi previsti sia in Italia che all’estero e le singole procedure che delineano la figura dello pneumologo interventista (broncoscopia rigida e flessibile, EUS e EBUS, biopsie percutanee, criobiopsia, toracentesi eco-guidata, drenaggio toracico, toracoscopia medica). Verranno poi esaminati gli attuali strumenti di apprendimento e di verifica delle competenze, alcuni dei quali considerati ormai discutibili sotto diversi punti di vista (mancata dimostrazione in termini di efficacia, criticita dell’apprendimento diretto sul malato, sforzi formativi e logistici richiesti sia al tutor che al discente, problematiche di tipo organizzativo ed assicurativo riscontrate dalla struttura ospedaliera). Infine, verranno discussi alcuni aspetti metodologici e formativi dell’attuale approccio didattico, essenzialmente basato su una didattica frontale, teorica e gerarchica (asimmetria tra docente e discente), proponendo modelli alternativi in grado di prendere in considerazione anche le esigenze ed il background dei discenti e che, se integrati all’utilizzo dei simulatori di realta virtuale nella formazione, potrebbero davvero risultare innovativi.

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Blood gas analysis changes and body position in patients with pneumonia due to SARS-COV-2: a pilot Study

Minerva Medica (2022)

Alessandro Di Marco Berardino Federica Sambuco Francesco Travaglino Antonina Re Emanuele Gilardi

2019-20 coronavirus outbreak

Sars virus

Body position

Betacoronavirus

Blood gas analysis

10.23736/s0026-4806.21.07171-8

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