61 research outputs found
Radioguided Surgery, a Cost-Effective Strategy for Treating Solitary Pulmonary Nodules: 20-Year Experience of a Single Center
No full textSolitary pulmonary nodules are an increasingly common finding worldwide. When surgery is requested for a definitive diagnosis, the international guidelines agree that minimally invasive surgery should be performed. However, can be difficult to localize small, deep, or subsolid nodes during minimally invasive surgery. This large observational cohort study shows that radioguided surgery is a cost-effective strategy with a low conversion rate
Idiopathic interstitial pneumonias: do HRCT criteria established by ATS/ERS/JRS/ALAT in 2011 predict disease progression and prognosis?
No full textPurpose The objective of the study was to determine
whether HRCT criteria for Usual Interstitial Pneumonia
(UIP), possible UIP or no-UIP pattern recommended by
ATS/ERS/JRS/ALAT guidelines 2011 are able to predict
progression and prognosis of the disease in a group of
patients with fibrotic idiopathic interstitial pneumonia (IIP).
Materials and methods This was a retrospective study
conducted with the approval of the ethics committee. Two
radiologists at baseline HRCT distributed 70 patients with
fibrotic IIP into three groups on the basis of the 2011
guidelines: UIP pattern (group 1), possible UIP pattern (group 2), inconsistent with UIP pattern (group 3). The different
abnormalities (honeycombing, reticulation, groundglass
and traction bronchiectasis), fibrotic score (reticulation
+ honeycombing) and overall CT score were visually
scored at baseline and during the follow-up (total HRCT
178). The mortality rate of the three groups was compared.
The baseline abnormalities were then correlated with the
mortality rate in the UIP group.
Results The inter-observer agreement in the classification
of the abnormalities in the three groups was almost perfect
(k = 0.92). After consensus, 44 patients were classified
into group 1, 13 into group 2 and 13 into group 3. During
a mean follow-up of 1386 days, overall CT score, fibrotic
score, honeycombing and traction bronchiectasis showed a
significant progression in group 1. The mortality rate was
significantly higher in group 1 (18 deaths) versus group 2
and 3 (1 death each). In group 1, baseline honeycombing
rate higher than 25 %, fibrotic score higher than 30, overall
CT score greater than 45 and traction bronchiectasis in
more than 4 lobes defined the worst prognosis.
Conclusion HRCT classification based on 2011 guidelines
showed high accuracy in stratifying fibrotic changes
because in our study UIP, possible UIP and inconsistent
with UIP pattern seem to be correlated with different disease
progression and mortality rate
Validation of intensive care unit-acquired infection surveillance in the Italian SPIN-UTI network
No full textValidity is one of the most critical factors concerning surveillance of nosocomial infections (NIs). This article describes the first validation study of the Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) project (SPIN-UTI) surveillance data. The objective was to validate infection data and thus to determine the sensitivity, specificity, and positive and negative predictive values of NI data reported on patients in the ICUs participating in the SPIN-UTI network. A validation study was performed at the end of the surveillance period. All medical records including all clinical and laboratory data were reviewed retrospectively by the trained physicians of the validation team and a positive predictive value (PPV), a negative predictive value (NPV), sensitivity and specificity were calculated. Eight ICUs (16.3%) were randomly chosen from all 49 SPIN-UTI ICUs for the validation study. In total, the validation team reviewed 832 patient charts (27.3% of the SPIN-UTI patients). The PPV was 83.5% and the NPV was 97.3%. The overall sensitivity was 82.3% and overall specificity was 97.2%. Over- and under-reporting of NIs were related to misinterpretation of the case definitions and deviations from the protocol despite previous training and instructions. The results of this study are useful to identify methodological problems within a surveillance system and have been used to plan retraining for surveillance personnel and to design and implement the second phase of the SPIN-UTI project
Sorveglianza attiva prospettica delle infezioni nosocomiali in una unità di terapia intensiva della Sardegna
No full textLong-Term Results of Radiofrequency Ablation Treatment of Stage I Non-small Cell Lung Cancer: A Prospective Intention-to-Treat Study
No full textIntroduction: About one-fifth of patients with resectable non-small cell lung cancer (NSCLC) are unsuitable for surgical treatment. Radiofrequency ablation offers an alternative minimally invasive option. We report the result of an intention-to-treat study with long-term follow-up. Methods: From 2001 to 2009, we performed 80 percutaneous radiofrequency ablations of 59 stage I NSCLC in 57 inoperable patients. Two patients were treated for two separate lesions. The study group consisted of 45 males and 12 females, with mean age of 74 years (range, 40-88 years). All patients had pathological evidence of NSCLC, which was in stage IA in 44 cases and in stage IB in the other 15 cases. The mean size of the lesions was 2.6 cm (range, 1.1-5 cm). Fourteen lesions were retreated up to five times. The procedure was always performed under local anesthesia and conscious sedation. Most of the procedures were performed under computed tomography guidance, with nine under ultrasonography guidance. Results: In all cases, the procedure was technically successful. No mortality was recorded, and major morbidity consisted of four cases of pneumothorax requiring pleural drainage. At a mean follow-up of 47 months, the complete response rate was 59.3% (stage Ia 65.9%, stage Ib 40%, p = 0.01), with a mean local recurrence interval of 25.9 months. Median overall survival and cancer-specific survival were 33.4 and 41.4 months, respectively. Cancer-specific actuarial survival was 89% at 1 year, 59% at 3 years, and 40% at 5 years. Conclusions: Radiofrequency ablation treatment of early-stage NSCLC seems to be a effective minimally invasive therapy even in the long-term period, particularly for stage Ia tumors. Copyright © 2011 by the International Association for the Study of Lung Cancer
Ptx3, a prototypic long pentraxin, is an early marker of acute myocardial infarction in man.
No full text
Combining liquid biopsy and radiomics for personalized treatment of lung cancer patients. State of the art and new perspectives
No full textLung cancer has become a paradigm for precision medicine in oncology, and liquid biopsy (LB) together with radiomics may have a great potential in this scenario. They are both minimally invasive, easy to perform, and can be repeated during patient's follow-up. Also, increasing evidence suggest that LB and radiomics may provide an efficient way to screen and diagnose tumors at an early stage, including the monitoring of any change in the tumor molecular profile. This could allow treatment optimization, improvement of patients' quality of life, and healthcare-related costs reduction. Latest reports on lung cancer patients suggest a combination of these two strategies, along with cutting-edge data analysis, to decode valuable information regarding tumor type, aggressiveness, progression, and response to treatment. The approach seems more compatible with clinical practice than the current standard, and provides new diagnostic companions being able to suggest the best treatment strategy compared to conventional methods. To implement radiomics and liquid biopsy directly into clinical practice, an artificial intelligence (AI)-based system could help to link patients' clinical data together with tumor molecular profiles and imaging characteristics. AI could also solve problems and limitations related to LB and radiomics methodologies. Further work is needed, including new health policies and the access to large amounts of high-quality and well-organized data, allowing a complementary and synergistic combination of LB and imaging, to provide an attractive choice e in the personalized treatment of lung cancer
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