IRIS UniSR (’Università Vita-Salute San Raffaele)
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Comprehensive CT study to assess local and systemic involvement in patients with infective endocarditis: experience from a multidisciplinary team of a tertiary referral center
No full textPurposeTo evaluate the value of a computed tomography (CT) protocol, including ECG-gated cardiac angiographic and venous phase, in patients with infective endocarditis (IE).Material and methodsFrom January 2019 to October 2022, consecutive patients with IE submitted to total-body CT, including ECG-gated cardiac acquisition in angiographic and venous phase, were enrolled. Transesophageal echocardiography was performed in all cases. Rate of local complications including vegetation, pseudoaneurysm, abscess, fistula and valve dehiscence was compared in CT and echocardiography. Systemic embolization was identified through CT scans.ResultsSeventy-six adults (median age 69 [IQR 55-77] years old; males 54/76, 71%] were enrolled. Most patients underwent surgery (51/76, 67%), and the in-hospital mortality rate was 8% (6/76).CT showed higher detection rate of valve vegetation compared to echocardiography (67/76, 88% vs 58/76, 76%; p = 0.008), including vegetation smaller than 10 mm (24/76, 36% vs..
A novel analysis of interoceptive underpinnings of anxious psychopathology in COVID-19 survivors
No full textIntroduction: SARS-CoV-2 affects brain, body, and their interchange. We investigated interoceptive mechanisms in COVID-19 survivors focusing on their potential link with psychopathology and inflammatory biomarkers. Methods: We assessed interoceptive accuracy (IAc) and time-perceiving (TA) skills of 57 COVID-19 survivors one month after hospital discharge through, respectively, a heartbeats perception task and a time duration task. Each participant was assessed about his interoceptive awareness (IAw) through Multidimensional Assessment of Interoceptive Awareness questionnaire (MAIA) and then, screened for post-traumatic (Impact of Events Scale – IES-R), anxious (State-Trait Anxiety Inventory – STAI-Y1) and depressive (Zung Self-Rating Depression Scale - ZSDS; Beck Depression Inventory - BDI-13) symptoms. Biomarkers of inflammation (platelet count, PC; mean platelet volume, MPV and systemic immune-inflammation index, SII) were obtained in a subsample of 40 survivors by a blood sampling conducted at admission and discharge time from the hospital. Correlational, GLM, GLMZ, and mediation analyses were performed. Results: IAc did not correlate with TA confirming the reliability of interoceptive measure. IAc positively predicts MAIA's Trusting subscale and negatively predicts anxious psychopathology which fully mediates the effect of IAc on Trusting.PC at hospital admission predicts anxiety at one month after recovery. Again, a higher decrease of SII during hospitalization predicts higher IAc skill and lower anxiety state at one month. The link between SII change and anxiety is fully mediated by IAc. Conclusions: Our results unveil a potential key role of interoception and brain-body interchange in the exacerbation and maintenance of anxiety psychopathology in COVID-19 survivors
Gender Discrimination In Italian Academia within Logic and Philosophy of Science
No full textThis feature article reflects on the first meeting of the “MI-FIL/02 - Milano Logic and Philosophy of Science Network”, specifically addressing the outputs from the World Cafe table concerning Gender Discrimination in Italian Academia
Development and Validation of a Rapid Tool to Measure Pragmatic Abilities: The Brief Assessment of Pragmatic Abilities and Cognitive Substrates (APACS Brief)
No full textPragmatics is key to communicating effectively, and its assessment in vulnerable populations is of paramount importance. Although tools exist for this purpose, they are often effortful and time-consuming, with complex scoring procedures, which hampers their inclusion in clinical practice. To address these issues, we present the Brief Assessment of Pragmatic Abilities and Cognitive Substrates (APACS Brief), a rapid (10 min), easy-to-use and freely distributed tool for evaluating pragmatics in Italian, inspired by the existing APACS test and already validated in the remote version (APACS Brief Remote). The APACS Brief test measures-with a simplified scale-the domains of discourse production and figurative language understanding and is developed in two parallel forms, each including novel items differing from APACS. Psychometric properties, cut-off scores, and thresholds for change were computed on 287 adults. The analysis revealed satisfactory internal consistency, good test-retest reliability, and strong concurrent and construct validity. Moreover, APACS Brief showed excellent discriminant validity on a sample of 56 patients with schizophrenia, who were also cross-classified consistently by APACS Brief and APACS cut-off values. Overall, APACS Brief is a reliable tool for evaluating pragmatic skills and their breakdown, with brief administration time and simple scoring making it well-suited for screening in at-risk populations
Update on preclinical models of cancer therapy-related cardiac dysfunction: Challenges and perspectives. A scientific statement of the Heart Failure Association (HFA) of the ESC, the ESC Council of Cardio-Oncology, and the ESC Working Group on Cellular Biology of the Heart
No full textNew anticancer therapies with potential cardiovascular side effects are continuously being introduced into clinical practice, with new and often unexpected toxicities becoming apparent only after clinical introduction. These unknown toxicities should be identified and understood beforehand to better prepare patients and physicians, enabling the implementation of effective treatments. Therefore, there is a crucial need for appropriate preclinical models to understand the biological basis of their cardiotoxicity. This scientific statement summarizes the preclinical models hitherto used, from in vitro two- and three-dimensional human systems to small and large animals, to pinpoint the molecular mechanisms behind the cardiotoxicity of new-generation anticancer therapies, particularly immunotherapies, and to develop potential cardioprotective strategies. Furthermore, it discusses how preclinical models have contributed to the provocative concept of heart failure being potentially tumorigenic and how the discovery of drugs with both anticancer and cardioprotective actions has revealed a common mechanistic basis for heart failure and cancer. Finally, it discusses the existing gaps between preclinical models and clinical observations in patients, how these discrepancies affect regulatory pathways and the drug development process in cardio-oncology and provides recommendations for closing these gaps
Protective ileostomy creation after anterior resection of the rectum (PICARR): a decision-making exploring international survey
No full textIn our previous survey of experts, surgeon's decision-making process (DMP) about protective ileostomy (PI) creation after anterior resection was investigated. Based on our previous data, a multiple choice questionnaire has been developed. The aim is to perform a quantitative analysis of the results obtained from an international survey and to describe the clinical practice worldwide. Ten questions were related to participants' demographics and, 20 questions (of which 17 Likert scale questions) investigated the DMP regarding PI creation. To evaluate the tendency of the answers in the Likert-type questions, the mean of the answers obtained was compared with the mean point of the Likert scale. The survey was completed by 1019 physicians. Neoadjuvant chemoradiotherapy and distance of the anastomosis from the anal verge <= 10 cm were each considered alone sufficient to justify creation of a PI, with statistically significant differences in comparison to the mean point of the scales in (p = < 0.0001 in both cases). Total Mesorectal Excision alone was not considered a factor sufficient to create a PI (p = 0.416). Most of the participants agree to define their approach to create a PI "tailored" to patients' risk factors (p = < 0.0001) and "influenced by my experience" in case of patients with low/moderate risk of anastomotic leakage (p = < 0.0001). This study provides useful insights on the worldwide clinical practice regarding creation of PI following anterior resection. Given the lack of standardization and evidence-based guidelines, this analysis may be helpful to assist surgeons' practice
Neuroimaging Approaches to the Study of Visual Attention
No full textSelective attention is a core cognitive ability that enables organisms to effectively process and respond to relevant information while ignoring distracting events. Elucidating the neural bases of selective attention remains a key challenge for neuroscience and represents an essential goal of translational efforts to ameliorate attentional deficits in a variety of neurological and psychiatric disorders. Knowledge of the cognitive and neural mechanisms of attention is crucial for the development and refinement of brain-machine interfaces. In addition, the relevance of attention mechanisms also extends to training and education methods. A more nuanced understanding could enable the development of more effective strategies and programs, enriching the educational landscape. This chapter will examine how functional imaging methods, with a primary focus on fMRI, have deepened our understanding of core aspects of attention, such as how attention is controlled, focused on relevant inputs, and reoriented, and how this control leads to the selection of relevant information. The most relevant studies will be reviewed with a focus on fMRI methods. However, a discussion of electromagnetic recording methods used in conjunction with fMRI, including simultaneous EEG/fMRI methods, will also be included where appropriate
Central Bouquet Hemorrhages in Retinal Vein Occlusion: A Distinct Pathway to Macular Atrophy
No full textPurpose: To characterize central bouquet hemorrhages (CBHs) in retinal vein occlusion (RVO) and evaluate their association with long-term visual and anatomical outcomes, in particular macular atrophy. This is a retrospective longitudinal cohort study of 403 treatment-naïve eyes with RVO (mean age, 62.9 ± 15.4 years; 59% male). Methods: CBH was identified on spectral-domain optical coherence tomography as vertically oriented light-absorbing masses centered at the fovea, above the external limiting membrane. Clinical characteristics, imaging findings, and intravitreal treatment frequency were compared between eyes with and without CBH. Baseline and longitudinal visual acuity analyzed with multivariable regression models, the prevalence of CBH-related features, and the cumulative incidence and predictors of macular atrophy assessed with Cox regression models were assessed. Results: CBH were observed in 28% of eyes (n = 111) at baseline. Affected eyes were older, had more systemic vascular comorbidities, and presented with more severe macular edema, peripapillary hemorrhages, and cotton-wool spots (all P < 0.001). Ischemic markers-including arteriolar paracentral acute middle maculopathy (P = 0.04) and increased ischemic index on fluorescein angiography (P = 0.02)-were more common in CBH eyes. Over time, CBH reabsorbed, often leaving a plaque-like RPE thickening, which progressed to outer retinal atrophy in 69% of cases over 36 months. Severe cystoid macular edema and full-thickness macular holes were also common. CBH was independently associated with worse baseline visual acuity (β = 0.09 logMAR; 95% confidence interval [CI], 0.01-0.18; P = 0.04) and slower visual recovery (β for CBH × Time = -0.002 logMAR/month; P < 0.001). Intravitreal treatments reduced the risk of macular atrophy (hazard ratio, 0.28; 95% CI, 0.08-0.96; P = 0.04), and each additional injection conferred a protective effect (hazard ratio, 0.96; 95% CI, 0.93-0.99; P = 0.02). Conclusions: CBH represents a characteristic hemorrhagic manifestation in RVO, likely reflecting the localized effects of elevated venous pressure and macular ischemia that contribute to structural disruption and poor visual outcomes. Its presence warrants close monitoring and sustained treatment to mitigate long-term retinal damage
Diagnostic accuracy of late iodine enhancement on cardiac CT for myocardial tissue characterization: a systematic review and meta-analysis
No full textPurpose: to evaluate the diagnostic accuracy of late iodine enhancement (LIE) in cardiac computed tomography (CCT) compared to late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) for myocardial tissue characterization. Materials and methods: EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting the accuracy of LIE with LGE as the gold standard of reference. QUADAS-2 tool was used to assess the risk of bias. A bivariate random-effects model was used to analyze, pool, and plot the diagnostic performance measurements across studies. Pooled sensitivity, specificity, positive (+LR) and negative (−LR) likelihood ratio, diagnostic odds ratio (DOR), and hierarchical summary ROC curve (HSROC) were computed. Prospero registration number: CRD42023484045. Results: Fourteen studies involving 526 patients and 5758 myocardial segments were included. At the patient level, LIE in CCT showed a pooled sensitivity of 0.96 (95% CI: 0.88–0.99), specificity of 0.95 (95% CI: 0.88–0.98) and the HSROC AUC of 0.98 (95% CI: 0.97–0.99). The +LR was 20.97 (95% CI: 7.54–58.38) and the −LR was 0.04 (95% CI: 0.01–0.13), resulting in a DOR of 535 (95% CI: 94–3024). At the segment level, sensitivity was 0.86 (95% CI: 0.79–0.91), specificity was 0.98 (95% CI: 0.96–0.99), and the HSROC AUC was 0.97 (95% CI:0.95–0.98). The +LR was 55.08 (95% CI: 19.94–152.16) and the −LR was 0.14 (95% CI: 0.09–0.22) with a DOR of 388 (95% CI: 113–1333). Dual-energy CCT improved segment-level sensitivity to 0.93 (95% CI: 0.88–0.96). Conclusion: LIE in CCT shows excellent diagnostic accuracy when compared to LGE in CMR for myocardial tissue characterization, suggesting its potential as a promising alternative to CMR. Key Points: Question How does myocardial tissue characterization by late iodine enhancement (LIE) on cardiac CT (CCT) compare to late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR)? Findings LIE in CCT demonstrates excellent diagnostic accuracy, with high sensitivity and specificity at both patient and segment levels, using LGE in CMR as the reference. Clinical relevance LIE in CCT provides a reliable alternative to LGE in CMR, especially for patients for whom CMR is not available or feasible or is contraindicated, thus improving access to myocardial tissue characterization