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Dive into the research topics where Silvia Terraneo is active.

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Featured researches published by Silvia Terraneo.


Journal of Thrombosis and Haemostasis | 2015

Effect of prasugrel in patients with asthma: results of PRINA, a randomized, double-blind, placebo-controlled, cross-over study.

Federico Lussana; F. Di Marco; Silvia Terraneo; M. Parati; Cristina Razzari; Mariangela Scavone; Eti Alessandra Femia; A. Moro; Stefano Centanni; Maria Grazia Cattaneo

Although experimental studies have demonstrated that platelets are proinflammatory cells, no randomized studies have tested the anti‐inflammatory effect of antiplatelet agents in humans. The platelet P2Y12 receptors mediated bronchial inflammation in a mouse model of asthma, suggesting that P2Y12 represents a pharmacologic target for asthma.


Respiratory Care | 2014

Physical Activity Impairment in Depressed COPD Subjects

Fabiano Di Marco; Silvia Terraneo; Maria Adelaide Roggi; Alice Claudia Repossi; Giulia Michela Pellegrino; Anna Veronelli; Pierachille Santus; Antonio E. Pontiroli; Stefano Centanni

BACKGROUND: Limited exercise tolerance is a cardinal clinical feature in COPD. Depression and COPD share some clinical features, such as reduced physical activity and impaired nutritional status. The aim of the present study was to evaluate maximum and daily physical activities and the nutritional status of COPD patients affected or not by depression. METHODS: In 70 COPD out-patients, daily and maximum physical activities were assessed by multisensor accelerometer armband, 6-min walk test, and cardiopulmonary exercise test. Mental status, metabolic/muscular status, and systemic inflammation were evaluated using the Hospital Anxiety and Depression Scale, by bioelectrical impedance analysis, and with regard to fibrinogen/C-reactive protein, respectively. RESULTS: Depressed subjects (27% of the sample) showed a similar level of respiratory functional impairment but a higher level of shortness of breath and a worse quality of life compared to non-depressed subjects (P < .05). Specifically, they displayed a physical activity impairment consisting of a reduced number of steps per day, a lower peak of oxygen consumption, an early anaerobic threshold, and a reduced distance in the 6-min walk test (P < .05) but the same nutritional status compared to non-depressed subjects. In the multivariate analysis, a reduced breathing reserve, obesity, and a higher level of shortness of breath, but not depression, were found to be independent factors associated with a reduced daily number of steps. CONCLUSIONS: Our study found that depressed COPD patients have a reduced daily and maximum exercise capacity compared to non-depressed patients. This further suggests the potential utility of screening for depression in COPD.


Clinical Microbiology and Infection | 2016

Impact of Candida spp. isolation in the respiratory tract in patients with intensive care unit-acquired pneumonia

Silvia Terraneo; Miquel Ferrer; Ignacio Martin-Loeches; Mariano Esperatti; M. Di Pasquale; V. Giunta; Mariano Rinaudo; F. de Rosa; G. Li Bassi; Stefano Centanni; Antoni Torres

In immunocompetent patients with nosocomial pneumonia, the relationship between Candida spp. isolation in respiratory samples and outcomes or association with other pathogens is controversial. We therefore compared the characteristics and outcomes of patients with intensive care unit-acquired pneumonia (ICUAP), with or without Candida spp. isolation in the respiratory tract. In this prospective non-interventional study, we assessed 385 consecutive immunocompetent patients with ICUAP, according to the presence or absence of Candida spp. in lower respiratory tract samples. Candida spp. was isolated in at least one sample in 82 (21%) patients. Patients with Candida spp. had higher severity scores and organ dysfunction at admission and at onset of pneumonia. In multivariate analysis, previous surgery, diabetes mellitus and higher Simplified Acute Physiology Score II at ICU admission independently predicted isolation of Candida spp. There were no significant differences in the rate of specific aetiological pathogens, the systemic inflammatory response, and length of stay between patients with and without Candida spp. Mortality was also similar, even adjusted for potential confounders in propensity-adjusted multivariate analyses (adjusted hazard ratio 1.08, 95% CI 0.57-2.05, p 0.80 for 28-day mortality and adjusted hazard ratio 1.38, 95% CI 0.81-2.35, p 0.24 for 90-day mortality). Antifungal therapy was more frequently prescribed in patients with Candida spp. in respiratory samples but did not influence outcomes. Candida spp. airway isolation in patients with ICUAP is associated with more initial disease severity but does not influence outcomes in these patients, regardless of the use or not of antifungal therapy.


Chest | 2015

Endotracheal Tubes for Critically Ill Patients: An In Vivo Analysis of Associated Tracheal Injury, Mucociliary Clearance, and Sealing Efficacy

Gianluigi Li Bassi; Nestor Luque; Joan Daniel Marti; Eli Aguilera Xiol; Marta Di Pasquale; Valeria Giunta; Talitha Comaru; Montserrat Rigol; Silvia Terraneo; Francesca De Rosa; Mariano Rinaudo; Ernesto Crisafulli; Rogelio Cesar Peralta Lepe; Carmen Lucena; Miguel Ferrer; Laia Fernandez; Antoni Torres

BACKGROUND Improvements in the design of the endotracheal tube (ETT) have been achieved in recent years. We evaluated tracheal injury associated with ETTs with novel high-volume low-pressure (HVLP) cuffs and subglottic secretions aspiration (SSA) and the effects on mucociliary clearance (MCC). METHODS Twenty-nine pigs were intubated with ETTs comprising cylindrical or tapered cuffs and made of polyvinylchloride (PVC) or polyurethane. In specific ETTs, SSA was performed every 2 h. Following 76 h of mechanical ventilation, pigs were weaned and extubated. Images of the tracheal wall were recorded before intubation, at extubation, and 24 and 96 h thereafter through a fluorescence bronchoscope. We calculated the red-to-green intensity ratio (R/G), an index of tracheal injury, and the green-plus-blue (G+B) intensity, an index of normalcy, of the most injured tracheal regions. MCC was assessed through fluoroscopic tracking of radiopaque markers. After 96 h from extubation, pigs were killed, and a pathologist scored injury. RESULTS Cylindrical cuffs presented a smaller increase in R/G vs tapered cuffs (P = .011). Additionally, cuffs made of polyurethane produced a minor increase in R/G (P = .012) and less G+B intensity decline (P = .022) vs PVC cuffs. Particularly, a cuff made of polyurethane and with a smaller outer diameter outperformed all cuffs. SSA-related histologic injury ranged from cilia loss to subepithelial inflammation. MCC was 0.9 ± 1.8 and 0.4 ± 0.9 mm/min for polyurethane and PVC cuffs, respectively (P < .001). CONCLUSIONS HVLP cuffs and SSA produce tracheal injury, and the recovery is incomplete up to 96 h following extubation. Small, cylindrical-shaped cuffs made of polyurethane cause less injury. MCC decline is reduced with polyurethane cuffs.


Respiratory Medicine | 2014

Severity and outcomes of community acquired pneumonia in asthmatic patients

Silvia Terraneo; Eva Polverino; Catia Cilloniz; Rosanel Amaro; Mª del Carmen Vennera; Albert Gabarrus; Beatriz Montull; Encarnación Moreno; Rosario Menéndez; Stefano Centanni; Antoni Torres

BACKGROUND Limited information is available about clinical outcomes and microbiology of community-acquired pneumonia in asthma. METHODS We prospectively studied 4079 CAP patients over a 12-years period and found 139 (3.4%) asthmatic patients. RESULTS Asthmatics showed younger age (57 ± 19 vs. 66 ± 19 years), less males (32% vs. 68%) and less active smokers (15% vs. 25%). Moreover, they had used more frequently inhaled corticosteroids (ICs, 53% vs. 17%, p < 0.001) and antibiotics (32% vs. 24%, p = 0.041). In comparison with non asthma-CAP, asthmatics showed at admission more pleuritic pain and dyspnoea but less severe pneumonia (PSI, CURB-65, PaO(2)/FIO(2) ratio; p < 0.05). No differences were observed in CAP microbiology, being Streptococcus pneumoniae the most frequent isolate. Clinical outcomes in asthmatic patients were similar to the general population (mortality, mechanical ventilation, etc.) but with a shorter median length of stay (6 [3; 9] vs. 7 [4; 10] days, p = 0.023). The chronic use of ICs did not influence clinical presentation and outcomes among asthmatic patients. CONCLUSIONS Asthmatics were younger and showed similar clinical presentation. Consistently with PSI, asthmatics showed similar outcomes than the general population. The microbial aetiology of CAP in asthma did not differ from the general population and antibiotic therapy should follow current guidelines.


PLOS ONE | 2016

Women with TSC: Relationship between Clinical, Lung Function and Radiological Features in a Genotyped Population Investigated for Lymphangioleiomyomatosis

Fabiano Di Marco; Silvia Terraneo; Gianluca Imeri; Giuseppina Palumbo; Francesca La Briola; Silvia Tresoldi; Angela Volpi; Lorenzo Gualandri; Filippo Ghelma; Rosa Maria Alfano; E. Montanari; Alfredo Gorio; Elena Lesma; Angela Peron; Maria Paola Canevini; Stefano Centanni

The advent of pharmacological therapies for lymphangioleiomyomatosis (LAM) has made early diagnosis important in women with tuberous sclerosis complex (TSC), although the lifelong cumulative radiation exposure caused by chest computer tomography (CT) should not be underestimated. We retrospectively investigated, in a cohort of TSC outpatients of San Paolo Hospital (Milan, Italy) 1) the role of pulmonary function tests (PFTs) for LAM diagnosis, 2) the association between LAM and other features of TSC (e.g. demography, extrapulmonary manifestations, genetic mutations, etc.), and 3) the characteristics of patients with multifocal micronodular pneumocyte hyperplasia (MMPH). Eighty-six women underwent chest CT scan; pulmonary involvement was found in 66 patients (77%; 49% LAM with or without MMPH, and 28% MMPH alone). LAM patients were older, with a higher rate of pneumothorax, presented more frequently with renal and hepatic angiomyolipomas, and tended to have a TSC2 mutation profile. PFTs, assessed in 64% of women unaffected by cognitive impairments, revealed a lower lung diffusion capacity in LAM patients. In multivariate analysis, age, but not PFTs, resulted independently associated with LAM diagnosis. Patients with MMPH alone did not show specific clinical, functional or genetic features. A mild respiratory impairment was most common in LAM-TSC patients: In conclusions, PFTs, even if indicated to assess impairment in lung function, are feasible in a limited number of patients, and are not significantly useful for LAM diagnosis in women with TSC.


Chest | 2015

Impact of COPD in the Outcome of ICU-Acquired Pneumonia With and Without Previous Intubation

Mariano Rinaudo; Miquel Ferrer; Silvia Terraneo; Francesca De Rosa; Rogelio Peralta; Laia Fernández-Barat; Gianluigi Li Bassi; Antoni Torres

BACKGROUND COPD seems related to poor outcome in patients with ventilator-associated pneumonia (VAP). However, many patients in the ICU with COPD do not require intubation but can also develop pneumonia in the ICU. We, therefore, compared the characteristics and outcomes of patients with ICU-acquired pneumonia (ICUAP) with and without underlying COPD. METHODS We prospectively assessed the characteristics, microbiology, systemic inflammatory response, and survival of 279 consecutive patients with ICUAP clustered according to underlying COPD or not. The primary end point was 90-day survival. RESULTS Seventy-one patients (25%) had COPD. The proportion of VAP was less frequent in patients with COPD: 30 (42%) compared with 126 (61%) in patients without COPD (P = .011). Patients with COPD were older; were more frequently men, smokers, and alcohol abusers; and more frequently had previous use of noninvasive ventilation. The rate of microbiologic diagnosis was similar between groups, with a higher rate of Aspergillus species and a lower rate of Enterobacteriaceae in patients with COPD. We found lower levels of IL-6 and IL-8 in patients with COPD without previous intubation. The 90-day mortality was higher in patients with COPD (40 [57%] vs 74 [37%] in patients without COPD, P = .003). Among others, COPD was independently associated with decreased 90-day survival in the overall population (adjusted hazard ratio, 1.94; 95% CI, 1.11-3.40; P = .020); this association was observed only in patients with VAP but not in those without previous intubation. CONCLUSIONS COPD was independently associated with decreased 90-day survival in patients with VAP but not in those without previous intubation.


European Journal of Medical Genetics | 2018

Deep phenotyping of patients with Tuberous Sclerosis Complex and no mutation identified in TSC1 and TSC2

Angela Peron; Aglaia Vignoli; Francesca La Briola; Emanuela Morenghi; Lucia Tansini; Rosa Maria Alfano; Gaetano Bulfamante; Silvia Terraneo; Filippo Ghelma; Giuseppe Banderali; David H. Viskochil; John C. Carey; Maria Paola Canevini

Tuberous Sclerosis Complex (TSC) is a multisystemic condition caused by mutations in TSC1 or TSC2, but a pathogenic variant is not identified in up to 10% of the patients. The aim of this study was to delineate the phenotype of pediatric and adult patients with a definite clinical diagnosis of TSC and no mutation identified in TSC1 or TSC2. We collected molecular and clinical data of 240 patients with TSC, assessing over 50 variables. We compared the phenotype of the homogeneous group of individuals with No Mutation Identified (NMI) with that of TSC patients with a TSC1 and TSC2 pathogenic variant. 9.17% of individuals were classified as NMI. They were diagnosed at an older age (p = 0.001), had more frequent normal cognition (p < 0.001) and less frequent epilepsy (p = 0.010), subependymal nodules (p = 0.022) and giant cell astrocytomas (p = 0.008) than patients with TSC2 pathogenic variants. NMI individuals showed more frequent bilateral and larger renal angiomyolipomas (p = 0.001; p = 0.003) and pulmonary involvement (trend) than patients with TSC1 pathogenic variants. Only one NMI individual had intellectual disability. None presented with a subependymal giant cell astrocytoma. Other medical problems not typical of TSC were found in 42.86%, without a recurrent pattern of abnormalities. Other TSC-associated neuropsychiatric disorders and drug-resistance in epilepsy were equally frequent in the three groups. This study provides a systematic clinical characterization of patients with TSC and facilitates the delineation of a distinctive phenotype indicative of NMI patients, with important implications for surveillance.


Critical Care Medicine | 2014

Oropharyngeal decontamination with antiseptics to prevent ventilator-associated pneumonia: rethinking the benefits of povidone-iodine.

Gianluigi Li Bassi; Francesca Rosa; Joan Daniel Marti; Silvia Terraneo

The colonization of the oropharynx plays a pivotal role in the pathogenesis of ventilator-associated pneumonia (VAP). Analysis of the oropharyngeal microbiota of healthy humans, using real-time PCR, demonstrated an extensive bacterial diversity comprising species of Streptococcus, Gemella, Eubacterium, Selenomonas, Veillonella, Actinomyces, Atopobium, Rothia, Neisseria, Eikenella, Campylobacter, Porphyromonas, Prevotella, Capnocytophaga, Fusobacterium, and Leptotrichia{\). Oropharyngeal colonization with respiratory pathogens is prevented by the physical-chemical properties of the oral mucosa surface, the salivary enzymatic content, and specific proteases and immunoglobulins. Conversely, in the critically ill tracheally intubated patient, the oral flora shifts to a predominance of Gram-negative and Gram-positive aerobic pathogens, that is, Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (2). The main reasons for such overgrowth of pathogens are difficulties in oral hygiene, changes in salivary properties during critical illness, and antibiotic therapy (2, 3). Once the oropharynx becomes colonized, microbes translocate into the airways because of endotracheal tubes (ETTs) comprising high-volume lowpressure cuffs. These cuffs are not leak-proof and promote a continuous seepage of bacteria-laden oropharyngeal contents into the airways (4). Heo et al (5) compared genetic features of microbes obtained from oral, trachea!, and bronchoalveolar


ERJ Open Research | 2018

Dynamic hyperinflation during the 6-min walk test in severely asthmatic subjects

Alida Benfante; Fabiano Di Marco; Silvia Terraneo; Stefano Centanni; Nicola Scichilone

We tested the hypothesis that dynamic hyperinflation develops in severe asthmatic subjects during exercise. Changes in inspiratory capacity (IC) were measured during the 6-min walk test (6MWT) in severe asthmatic subjects compared with chronic obstructive pulmonary disease (COPD) subjects with a similar degree of bronchial obstruction. We assessed whether changes in IC were associated with changes in dyspnoea perception. 27 severe asthmatic subjects (10 males and 17 females) and 43 COPD subjects (35 males and eight females) were recruited. The two groups performed similarly in the 6MWT (p=0.90). At the end of the test, the Borg score increased significantly in both groups (mean difference: for asthmatic subjects 1.7±1.6; p<0.0001; for COPD subjects 3.1±1.9; p<0.0001). IC measured at the beginning of 6MWT was not different between groups (2.25±0.47 L in asthmatic subjects versus 2.38±0.60 L in COPD subjects; p=0.32) and decreased in both groups (mean difference: for asthmatic subjects 0.160 L; p=0.02; for COPD subjects 0.164 L; p<0.0001). However, changes in IC were significantly associated with changes in the Borg score in the COPD group (r2=0.17; p=0.006), but not in the asthma group (r2=0.06; p=0.20). In severe asthmatic subjects, IC significantly drops during the 6MWT to the same extent as COPD subjects with a similar degree of lung impairment, indicating the development of dynamic hyperinflation. Contrary to COPD, in asthmatic subjects the occurrence of dynamic hyperinflation was not associated with changes in dyspnoea perception. Severe asthma is characterised by occurrence of dynamic hyperinflation during exercise; inspiratory capacity drops in severe asthmatic subjects during the 6MWT to the same extent as in COPD subjects with similar lung impairment http://ow.ly/InfQ30jjivW

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