IRIS UniSR (’Università Vita-Salute San Raffaele)
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Aetiological phenotypes of atrial and ventricular secondary tricuspid regurgitation and their prognostic implications: insights from the CARE-TR registry
No full textAims: To report prevalence and clinical outcomes of different aetiological phenotypes of atrial and ventricular secondary tricuspid regurgitation (ASTR/VSTR). Methods and results: The Consecutive pAtients with seveRE Tricuspid Regurgitation evaluated in Heart Failure (HF) and Valve Clinics (CARE-TR) registry collected data from patients with at least severe tricuspid regurgitation (TR) enrolled at three Italian centres. The present analysis includes 648 patients with secondary TR, 22.1% with ASTR and 77.9% with VSTR. Patients with ASTR were further stratified in those with atrial fibrillation (AF, 25.2%), HF with preserved ejection fraction (HFpEF, 37.8%), and both (37.0%). Patients with VSTR were subdivided into those with severe left-sided valvular heart disease (LS-VHD, 28.5%), HF with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF, 29.1%), HFpEF (35.5%), pre-capillary pulmonary hypertension (PH, 4.0%) and isolated right ventricular dysfunction (RVD, 2.9%). After a median follow-up of 498 days, 118 (18.2%) patients died and 153 (23.6%) were hospitalized for HF. Two-year survival free from the composite outcome of death or HF hospitalization was higher in patients with ASTR compared with those with VSTR (73.5% vs. 54.4%; p < 0.001). After adjustment for variables related with HF severity, VSTR remained independently associated with an increased risk of events (adjusted hazard ratio 2.00; 95% confidence interval 1.33–3.02; p = 0.001). Among ASTR patients, combined AF and HFpEF was associated with a poorer outcome compared with AF or HFpEF alone (60.2% vs. 80.5% vs. 83.6%; p = 0.022). Among patients with VSTR, overall survival free from the composite outcome was 85%, 65%, 54%, 39% and 38% for RVD, HFpEF, HFrEF/HFmrEF, severe LS-VHD, and pre-capillary PH, respectively (p < 0.001). Conclusions: In a real-world population with at least severe secondary TR, 22% had ASTR and showed better outcomes as compared to VSTR. Among patients with ASTR, combination of AF and HFpEF was common and associated with the worst prognosis. Among patients with VSTR, those with pre-capillary PH had the poorest outcomes, followed by those with LS-VHD
Social Isolation Among Individuals with Incontinence: A Scoping Review
No full textIntroduction: Urinary and fecal incontinence, as well as the presence of an ostomy, are globally prevalent conditions with substantial implications for individuals’ daily lives. Among the psychological consequences, social isolation is a frequently reported experience but remains poorly explored in the existing literature. The aim of this scoping review is to explore how social isolation has been conceptualized and operationalized in research on individuals with incontinence and to synthesize evidence on its antecedents and outcomes. Methods: This review was conducted in accordance with the Joanna Briggs Institute guidelines and reported following the PRISMA-ScR checklist. Data were thematically synthesized and interpreted according to the Middle Range Theory of Social Isolation in Chronic Illness. Results: Twenty-three studies met the inclusion criteria. Findings indicate that social isolation among individuals with incontinence is a complex, multifactorial phenomenon. Predisposing factors included individual needs for social interaction and desire for approval, psychological resilience, toilet accessibility, education, income, gender, and age. Precipitating factors were related to illness trajectory and adaptation processes, including ostomy acceptance, time since ostomy creation or oncological treatment, sense of belonging, perceived social support, stigma, self-esteem, clinical severity, illness-related conditions, and loss of autonomy. Reported outcomes were consistently adverse, encompassing depression, anxiety, and reduced quality of life. Conclusions: Social isolation represents a core dimension of the lived experience of incontinence and should be recognized as a key clinical outcome. Systematic screening and targeted interventions should be integrated into continence care pathways. Future research should adopt longitudinal and interventional designs to clarify causal mechanisms and evaluate strategies to prevent and mitigate isolation
CLINICAL AND ENDOSCOPIC-HISTOLOGICAL FEATURES OF MULTIFOCAL AND CORPUS-RESTRICTED ATROPHIC GASTRITIS PATIENTS WITH NONCARDIA GASTRIC CANCER OR DYSPLASIA: A MULTICENTER, CROSS-SECTIONAL STUDY
No full textBackground: Helicobacter pylori(Hp)-related atrophic gastritis(AG) affects corpus and antral mucosa, resulting in multifocal AG(MF-AG), autoimmunity-driven AG is corpus-restricted(CR-AG). AG carries increased gastric dysplasia(GD) and cancer(GC) risk, well established in MF-AG, but debated in CR-AG. This study aimed to assess clinical, endoscopic-histological characteristics of GD-GC in MF-AG and CR-AG patients. Methods: Multicenter-cross-sectional study across 11 Italian gastroenterology centres on data of non-cardia GD-GC in MF-AG or CR-AG adult patients based on clinical, endoscopic, and histological charts. Results: 84 patients were included with MF-AG and CR-AG in 45(53.6%) and 39(46.4%), respectively. Low-grade(LG)-GD, high-grade(HG)-GD, and GC were diagnosed in 31(36.9%), 6(7.1%), and 47(56.0%). GD-GC similarly occurred in MF-AG and CR-AG patients: HG-GD in 4(8.9%) vs 2(5.1%), LG-GD in 17(37.8%) vs 14(35.9%), GC in 24(53.5%) vs 23(59.0%)(p>0.05). Compared to MF-AG, in CR-AG patients GD-GC were more commonly polypoid (51.6% vs 27.3%, p=0.048) and more frequently in the corpus (55.3% vs 28.6%,p=0.02), but occurred also in the antrum (34.2%) and incisura (10.5%). Surgery was more frequent in CR-AG than in MF-AG (48.6% vs 23.1%,p=0.02). Corpus atrophy severity and intestinal metaplasia were not different (p>0.05), histological Hp positivity was low in both (2.3% vs 2.9%,p=0.87), but in Hp-negatives active inflammation was present in the antrum in 26.7% and 7.7%(p=0.02), in the corpus in 31.1% and 21.5%(p=0.27). Conclusions: Non-cardia GC and GD may occur in both MF-AG and CR-AG, displaying differences in topography and endoscopic presentation but similarities in non-lesional mucosa, differentiation and staging. Surveillance should be considered in corpus AG, regardless of extension and supposed etiology
Aging, longevity, and healthy aging: the public health approach
Full text linkBackground: Population aging is one of the most significant global demographic changes of the 21st century, driven by increased life expectancy and declining fertility rates. This phenomenon presents both achievements and challenges for public health systems worldwide. Aims: On the one hand, advances in healthcare and socio-economic conditions have contributed to longer lives and improved quality of life for older adults. On the other hand, aging populations are increasingly affected by chronic diseases, greriatric syndromes, and multimorbidity, leading to greater healthcare demands and higher associated costs. Methods: This manuscript explores evidence on regards of the impact of aging on healthcare and economic systems, emphasizing the need for a paradigm shift toward healthy aging. Results: Healthy aging, as defined by the World Health Organization, focuses on the maintenance of intrinsic capacity, physical, mental, and social well-being throughout life. It highlights the importance of preventive healthcare, proper nutrition, and regular physical activity in delaying the onset of chronic conditions and maintaining functional independence. Furthermore, the manuscript addresses the challenges faced by healthcare infrastructures and pension systems as they adapt to aging populations, with particular attention to the strain caused by workforce shortages and the rising need for long-term care. Discussion: A coordinated public health approach is essential to promote healthy aging and mitigate the economic and societal impacts of population aging. Conclusions: This paper underscores the need for integrated health policies and multidisciplinary care models to ensure that longer life expectancy is accompanied by better quality of life for older individuals
Ferrara’s Principles of Constitutional Legitimacy: From Plato to Rawls, and Backwards?
No full textIn his latest book, Sovereignty Across Generations: Constituent Power and Political Liberalism, Alessandro Ferrara explores the grounds, norms and scope of liberal constitutions’ legitimacy. Specifically, Ferrara develops Rawls’s political liberalism by exploring liberal legitimacy in a constitutional direction. Indeed, while the grounds of constitutions’ legitimacy were not the primary focus of Rawls’s own investigations, Ferrara believes that political liberalism must now be extended in this direction – for both theoretical and political reasons. In this review, we examine Ferrara’s proposal, bearing in mind his project’s Rawlsian roots. Specifically, we examine the relationship between reasonableness and constitutional legitimacy; we suggest that some of Ferrara’s conclusions – especially his intergenerational conception of the people as sovereign – might stand in tension with the Rawlsian framework within which he has drawn them
Subventricular Zone Microstructure in Pediatric-Onset Multiple Sclerosis
No full textObjective: The aim of this study was to explore the microstructural dynamics of the subventricular zone (SVZ) with aging and their associations with clinical disability and brain structural damage in pediatric-onset multiple sclerosis (MS) patients. Methods: One-hundred and forty-one pediatric-onset MS patients (67 pediatric and 74 adults with pediatric-onset) and 233 healthy controls (HC) underwent neurological and 3.0 T MRI assessment. Fractional anisotropy (FA) and mean diffusivity (MD) were extracted from the SVZ and the thalamus (as control region). Results: In HC, SVZ FA was higher until age 40 then declined, whereas MD was lower until age 35 before rising (false discovery rate p value [pFDR] ≤ 0.008). Thalamic FA was higher until age 30 and then declined, whereas MD was higher until age 50 (pFDR ≤ 0.007). Pediatric MS patients showed significantly higher SVZ FA than pediatric HC (pFDR < 0.001), while adult patients showed no differences compared to adult HC (pFDR ≤ 0.724). Adult..
Assessment of Image Quality Performance of a Photon-Counting Computed Tomography Scanner Approved for Whole-Body Clinical Applications
No full textBackground: Photon-counting computed tomography (PCCT) represents a major technological advance in clinical CT imaging, offering superior spatial resolution, enhanced material discrimination, and potential radiation dose reduction compared to conventional energy-integrating detector systems. As the first clinically approved PCCT scanner becomes available, establishing a comprehensive characterization of its image quality is essential to understand its performance and clinical impact. Methods: Image quality was evaluated using a commercial quality assurance phantom with acquisition protocols typically used for three anatomical regions—head, abdomen/thorax, and inner ear—representing diverse clinical scenarios. Each region was scanned using both ultra-high-resolution (UHR, 120 × 0.2 mm slices) and conventional (144 × 0.4 mm slices) protocols. Conventional metrics, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), slice thickness accuracy, and uniformity, were assessed following international standards. Task-based analysis was also performed through target transfer function (TTF), noise power spectrum (NPS), and detectability index (d′) to evaluate diagnostic relevance. Results: UHR protocols provided markedly improved spatial resolution, particularly in the inner ear imaging, as confirmed by TTF analysis, though with increased noise and reduced low-contrast detectability in certain conditions. CT numbers showed linear correspondence with known attenuation coefficients across all protocols. Conclusions: This study establishes a detailed technical characterization of the first clinical PCCT scanner, demonstrating significant improvements in terms of spatial resolution and accuracy of the quantitative image analysis, while highlighting the need for noise–contrast optimization in high-resolution imaging
