IRIS UniSR (’Università Vita-Salute San Raffaele)
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Post-myocardial infarction pericarditis: insight from a cardiovascular magnetic resonance study
Full text linkObjective This study aims to investigate the demographic, laboratory, clinical, and cardiovascular magnetic resonance (CMR) correlates of post-myocardial infarction pericarditis (PMIP), as well as its impact on outcomes in patients with ST-segment elevation myocardial infarction (STEMI) Method This retrospective study included CMR scans of 122 consecutive patients with STEMI (92 males, mean age 64.16 ± 10.35 years). Among them, 33 (26 males, mean age 60.81 ± 11.27 years) exhibited PMIP, defined by the presence of pericardial enhancement on T2-STIR and/or late gadolinium enhancement (LGE) sequences. Results Patients with PMIP had a lower left ventricular ejection fraction (p = 0.017) and a higher indexed right ventricular end-systolic volume (p = 0.025) compared to those without PMIP. Patients with PMIP exhibited more impaired atrial reservoir strain, global radial strain, and global longitudinal strain, as well as a greater extent of LGE and papillary muscle involvement compared to those without PMIP (p = 0.001; p = 0.002; p = 0.012; p = 0.001; p = 0.001, respectively). On multivariate analysis, atrial reservoir strain and global longitudinal strain were independently associated with PMIP (β = -2.803, p = 0.009; β = 2.475, p = 0.013). However, the presence of PMIP was not associated with a higher incidence of adverse cardiac events during follow-up. Conclusion PMIP is a well-known complications of STEMI patients and is associated with greater cardiac dysfunction, as well as more extensive myocardial damage. Despite these myocardial alterations, PMIP did not result in a higher incidence of adverse cardiac events during follow-up
Making Nursing Activities Visible in Outpatient Care: A Nationwide Descriptive Study of Nurse‐Led Clinics in Italy (ENLIGHT‐AMB)
Full text linkBackground: Nurse-led clinics (NLCs) are increasingly recognized as a strategic component of outpatient care delivery; however, in many health systems, including Italy, their role remains poorly documented, under-recognized in health information systems, and weakly integrated into organizational governance. This phenomenon contributes to the persistence of “Hidden Nursing Care,”limiting nursing visibility and evidence-based service planning. Purpose: To provide the first nationwide descriptive mapping of NLCs in Italy, examining their distribution, organizational characteristics, activity volumes, service typology, and professional workforce profile. Methods: A national cross-sectional study was conducted as part of the ENLIGHT-IT project. Public healthcare facilities were recruited across Italian regions. Data were collected between January and June 2024 using three structured instruments: (1) facility- level survey on NLC organization and activity; (2) nurse survey including sociodemographic and professional characteristics and the Practice Environment Scale of the Nursing Work Index (PES-NWI); and (3) an annual log of nursing activities performed. Descriptive statistics were used. Results: Twenty-seven healthcare facilities from 12 regions reported data on 279 NLCs and 940 nurses. NLCs delivered 2,047,058 nursing activities and assisted 533,212 patients in 2023. Clinics operated a mean of 4.2 days and 24.3 h per week. The largest service categories were general nursing (55.9%), wound care (11.1%), and chronic care management (10.0%). Most NLCs were administratively affiliated with medical (42.9%) or surgical departments (26.5%). The nursing workforce was predominantly female (76.4%), with a mean age of 51.4 years and extensive experience (mean 26.9 years). PES-NWI results indicated strong leadership support but insufficient staffing. Conclusions: NLCs constitute an established and high-volume component of outpatient care in Italy, yet their organizational positioning remains fragmented. Implications for Public Health Nursing: These findings highlight the need for formal recognition, standardized documenta- tion, and dedicated policy frameworks to support equitable access to nurse-led outpatient services
Macular Edema Resistance in Retinal Vein Occlusion and the Protective Role of PAMM Subtypes
No full textPurpose: To characterize eyes without macular edema (ME) at presentation in retinal vein occlusion (RVO), evaluate incidence and predictors of ME during follow-up, and assess the prognostic significance of paracentral acute middle maculopathy (PAMM) subtypes. Design: Retrospective cohort study. Participants: 405 treatment-naïve RVO eyes. Methods: Clinical and imaging features were compared between eyes with and without baseline ME. PAMM was classified as arteriolar, fern-like, or globular. Peripheral ischemia was quantified using ultra-widefield fluorescein angiography. Main Outcome Measures: Predictors of ME at baseline and during follow-up identified with logistic and Cox regression. Cumulative ME risk in eyes with PAMM assessed with Kaplan–Meier and multinomial regression analyses. Results: At baseline, 72 eyes (18%) were ME-free. These eyes were younger (49.8 ± 16.6 vs. 65.8 ± 13.6 years), more frequently had CRVO (85% vs. 50%), and fewer systemic comorbidities. PAMM was a strong protective factor against baseline ME (OR 0.05; statistically significant). During follow-up, cumulative ME incidence reached 42% at 1 year and stabilized thereafter. Higher baseline central macular thickness (HR 2.39/100 μm; statistically significant) and ischemic index (HR 1.03/1%; statistically significant) were risk factors, while age <50 years and early anti-VEGF therapy were protective. Globular PAMM, frequently associated with a cilioretinal artery, identified the lowest ME risk profile. Conclusions: Younger patients with CRVO often present without ME. Although nearly half of these eyes develop ME over time, baseline imaging—particularly presence and subtype of PAMM—helps stratify risk. Globular PAMM defines a paradoxical ischemic profile with preserved vascular integrity and minimal susceptibility to fluid accumulation
Adherence and Compliance with Exercise Training in Progressive Multiple Sclerosis: Rates and Correlates from the CogEx Trial
Full text linkBackground: There is limited understanding of adherence and compliance rates for exercise training(ET) in people with progressive multiple sclerosis(PMS). Objectives: This secondary, exploratory data analysis examined rates of adherence and compliance for continuous, moderate intensity training and high-intensity interval training(HIIT) and possible correlates among people with PMS from the CogEx trial. Methods: CogEx was a multi-site, multi-arm, randomized, double-blinded, and sham-controlled trial undertaken by 11 sites in six different countries. Participants(N = 311) were randomized into one of four conditions with different combinations of ET and cognitive rehabilitation, including respective sham conditions, delivered twice weekly over 12 weeks. The analysis focused on adherence and compliance rates and correlates for participants in the pooled ET intervention conditions who received and attempted the ET intervention(n = 152). Results: The rates of adherence and compliance overall(combined for both training stimuli) were 94 % and 66 %, respectively. The rates of adherence and compliance for continuous, moderate-intensity exercise were 95 % and 73 %, respectively, and for HIIT were 92 % and 58 %, respectively. The multivariable regression indicated that better 6MWT performance predicted higher compliance(particularly with HITT), whereas better CVLT-II performance predicted higher adherence and compliance with continuous training in PMS. Conclusion: Our results highlight worse compliance than adherence with ET, particularly for HIIT, in PMS. We further highlight cognitive and physical function as correlates of adherence and compliance for consideration in future clinical trials of ET in PMS
Utility of MRI perilesional biopsy in prostate cancer: impact of the Prostate Imaging-Reporting and Data System and biopsy history
No full textObjective: To investigate the diagnostic performance of perilesional biopsies (PLBx) compared to other biopsy strategies, assessing the impact of the Prostate Imaging-Reporting and Data System (PI-RADS) score and biopsy history in patients with a visible lesion at multiparametric magnetic resonance imaging of the prostate (mpMRI), as the European Association of Urology guidelines recommend combining MRI-targeted biopsies (TBx) with PLBx as an alternative to systematic biopsies (SBx) even though evidence is limited. Patients and Methods: We relied on a cohort of 2852 patients with PI-RADS ≥3 lesions undergoing TBx + SBx at three tertiary referral centres. The primary outcome was detection of clinically significant PCa (csPCa) (International Society of Urological Pathology Grade Group [ISUP GG] ≥2) of TBx + PLBx vs TBx + SBx. Results were stratified by PI-RADS score and biopsy history. The PLBx cores were defined as samples taken from prostate sectors adjacent to the mpMRI lesion. We finally assessed insignificant PCa (insPCa, i.e., ISUP GG 1) detection across biopsy strategies. Differences were assessed using the chi-square test. Results: Detection of csPCa was 48%. Overall, TBx + SBx had a higher csPCa detection rate than TBx + PLBx (50% vs 45%, P = 0.03), particularly in PI-RADS 3 lesions (26% vs 21%, P = 0.02) and active surveillance (AS) patients (46% vs 40%, P = 0.04). No significant differences were found in PI-RADS 4 (53% vs 50%, P > 0.1) or PI-RADS 5 (76% vs 75%, P > 0.1). In the biopsy naïve and previous negative biopsy groups, csPCa detection was similar between strategies (P > 0.1). Conclusions: Overall, TBx + SBx offers the highest detection of csPCa. Even though TBx + PLBx may be considered in PI-RADS 4–5 lesions to reduce insPCa detection, TBx + SBx remains the preferred strategy for PI-RADS 3 and AS patients
TIGIT disruption rescues the antitumor activity of low avidity TCR-engineered T cells by increasing TCR signal strength
No full textT-cell avidity is a major determinant of Adoptive T cell therapy (ACT) efficacy for cancer treatment. However, high-avidity tumor-specific T cells can rarely be isolated from cancer patients, highlighting the need for strategies to enhance the cytotoxic capacity of low-avidity cells. Here, we rescue the anti-tumor functions of low-avidity T cells against pancreatic ductal adenocarcinoma (PDAC) by knocking-out TIGIT, a key inhibitory molecule expressed on exhausted CD8+ T cells infiltrating gastrointestinal tumors. We uncover that TIGIT disruption by base editing boosts the intracellular signal transduction derived from a weak T cell receptor (TCR) engagement enforcing cytoskeletal rearrangements, thus increasing T cell avidity and stabilizing the immunological synapse. Accordingly, TIGIT disruption enables low-avidity T cells to exert robust degranulation, comparable to that of high-avidity T cells, and potent and durable anti-tumor capacity in vivo in male mice. These results highlight TIGIT knockout as a potential strategy to enhance low-avidity T cell function and broaden the repertoire of TCR engineered T cells in the treatment of pancreatic cancer and other solid malignancies
Enhancing NSCLC Histological Subtype Classification: A Federated Learning Approach Using Triplet Loss
No full textLung cancer remains one of the leading causes of cancer-related deaths worldwide, with Non-Small Cell Lung Cancer (NSCLC) accounting for approximately 85% of all cases. Accurate histological subtype classification of NSCLC is crucial for personalized treatment planning and improving patient outcomes. Developing robust classification models for NSCLC subtypes often requires large, diverse datasets, which can be challenging to obtain due to privacy concerns and data silos. This study proposes an approach combining federated learning with triplet loss to address these challenges. We evaluated our method’s performance in classifying NSCLC subtypes using data from multiple institutions while preserving privacy. Our experiments compared the proposed federated learning approach with triplet loss against alternative methods, including local training and softmax loss. Results demonstrated that our federated learning approach with triplet loss consistently outperformed other methods across key metrics. The combination of federated learning and triplet loss showed synergistic effects, leveraging external datasets to improve model performance while maintaining data confidentiality. The source code for the implementation described in this paper is available at https://github.com/aksufatih/federated-triplet-histology
Neuropsychological tests at the Italian Centers for Cognitive Disorders and Dementias: results from a survey on 450 specialized services
Full text linkBackground: The Italian Fund for Alzheimer's and other dementias approved in 2020 enabled the conducting of a survey in the Italian Centers for Cognitive Disorders and Dementias (CCDDs) to analyse the organization, the administrative features and the professionals' characteristics. Aims: To investigate the current use of neuropsychological (NP) tests in Italian CCDDs and the association between the use of a basic set of tests for neuropsychological assessment (NPA) and organizational/structural characteristics of CCDDs. Methods: A survey was conducted with an online questionnaire in all CCDDs between July 2022 and February 2023. To verify the use of a comprehensive NPA in the diagnosis of cognitive disorders and dementia, we identified a minimum core test (MCT). Results: The CCDDs using a Minimum Core Test (MCT) significantly increased from 45.7% in 2015 to the current 57.1%. Territorial CCDDs using MCT significantly increased from 24.9% in 2015 to 37% in 2022 (p = 0.004). As multivariable results, the presence of psychologist/neuropsychologist in the staff and the University-based/IRCCS CCDDs increased the probability of using MCT (OR = 9.2; 95% CI 5.6-15.0; p < 0.001 and OR = 5.4; 95% CI 1.9-15.9; p = 0.002, respectively), while CCDDs in Southern Italy-Islands showed a lower probability than those in the North (OR = 0.4; 95% CI 0.2-0.7; p = 0.001). Discussion: Almost half of CCDDs (43%) do not use MCT in their clinical practice. The presence of the psychologist/neuropsychologist on the staff has a key role in the adoption of MCT and regional differences have increased over the past years. NPA is crucial in the diagnostic process and in characterizing risk profiles in order to implement targeted interventions for risk reduction. Conclusions: Our results could help to identify good practices aimed at improving dementia diagnosis. An intervention by health policymakers is urgently needed with the aim of improving diagnostic appropriateness and overcoming regional differences.Background: The Italian Fund for Alzheimer’s and other dementias approved in 2020 enabled the conducting of a survey in the Italian Centers for Cognitive Disorders and Dementias (CCDDs) to analyse the organization, the administrative features and the professionals’ characteristics. Aims: To investigate the current use of neuropsychological (NP) tests in Italian CCDDs and the association between the use of a basic set of tests for neuropsychological assessment (NPA) and organizational/structural characteristics of CCDDs. Methods: A survey was conducted with an online questionnaire in all CCDDs between July 2022 and February 2023. To verify the use of a comprehensive NPA in the diagnosis of cognitive disorders and dementia, we identified a minimum core test (MCT). Results: The CCDDs using a Minimum Core Test (MCT) significantly increased from 45.7% in 2015 to the current 57.1%. Territorial CCDDs using MCT significantly increased from 24.9% in 2015 to 37% in 2022 (p = 0.004). As multivariable results, the presence of psychologist/neuropsychologist in the staff and the University-based/IRCCS CCDDs increased the probability of using MCT (OR = 9.2; 95% CI 5.6–15.0; p < 0.001 and OR = 5.4; 95% CI 1.9–15.9; p = 0.002, respectively), while CCDDs in Southern Italy-Islands showed a lower probability than those in the North (OR = 0.4; 95% CI 0.2–0.7; p = 0.001). Discussion: Almost half of CCDDs (43%) do not use MCT in their clinical practice. The presence of the psychologist/neuropsychologist on the staff has a key role in the adoption of MCT and regional differences have increased over the past years. NPA is crucial in the diagnostic process and in characterizing risk profiles in order to implement targeted interventions for risk reduction. Conclusions: Our results could help to identify good practices aimed at improving dementia diagnosis. An intervention by health policymakers is urgently needed with the aim of improving diagnostic appropriateness and overcoming regional differences
Impact of GDMT on outcomes after mitral valve edge-to-edge repair stratified by SMR proportionality
No full textDiabetes mellitus and pregnancy in Wolfram syndrome type 1: a case report with review of clinical and pathophysiological aspects
Full text linkWolfram syndrome type 1 (WS1) is a rare genetic disorder characterized primarily by non-autoimmune diabetes mellitus, optic atrophy, deafness, and diabetes insipidus. It may include other endocrine, urological, psychiatric, and neurological disorders. The syndrome arises from mutations in the WFS1 gene, which encodes the Wolframin protein, a key regulator of endoplasmic reticulum (ER) function in pancreatic beta-cells and other tissues. Diabetes in WS1 typically has an early-onset, progresses slowly, and is characterized by insulin deficiency, low insulin requirement, and a lower incidence of chronic complications compared to type 1 autoimmune diabetes. Nowadays, there is no cure for WS1, and management relies on the treatment of the different associated conditions. Fertility can be compromised due to hypogonadism, although cases of successful pregnancy have been reported. These are high-risk pregnancies due not only to hyperglycemia, but also to the other comorbidities of the WS1. This review discusses the peculiarities of diabetes associated with WS1 and the reproductive outcomes in WS1, reporting a case of successful pregnancy in a woman with WS1 treated with a hybrid closed-loop insulin pump