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Subretinal lavage during diagnostic vitrectomy: an adjunctive technique for cell sampling in suspected vitreoretinal lymphoma
No full textPurpose: Current diagnostic methods for vitreoretinal lymphoma (VRL) with predominant subretinal involvement exhibit limited sensitivity. We introduce a novel subretinal lavage technique intended to enhance diagnostic yields during vitrectomy procedures. Methods: During diagnostic vitrectomy, 0.1-0.3 ml of balanced saline solution (BSS) is injected into the subretinal space, creating a localized retinal detachment. Immediately thereafter, the diluted cellular suspension is gently aspirated manually using a 41-gauge extendable soft needle. Results: The technique was successfully performed in three patients without complications, consistently yielding approximately 0.3 ml of lymphoma cell-enriched fluid. Cytological analysis confirmed the presence of CD20-positive B lymphocytes and the MYD88 L265P mutation in all cases. Vitreous cytology was concurrently positive in two out of the three patients. Conclusions: Subretinal lavage is a safe, straightforward, and effective adjunct to standard vitreous biopsy, significantly improving diagnostic accuracy in VRL cases characterized by predominant subretinal infiltration. Implementation of this technique may lead to improved clinical decision-making and patient outcomes
Psychopathy and Interpersonal Harm
No full textPsychopathy represents a personality disorder that is characterized by a pattern of attributes including affectiveand interpersonal features, and impulsive and antisocial behaviors. Although the rates of psychopathic individuals are particularly elevated in correctional settings, psychopathy can be observed also in clinical and community settings. This chapter provides a review of psychopathy models and major personality dimensions involved in its presentation. It specifically provides a detailed guide to using the ICD-11 dimensional model of personality disorders to capture essential features of psychopathy in clinical populations. Finally, a case vignette is provided to help the reader to translate theoretical descriptions of psychopathy-related dimensions and their ICD-11 counterparts into clinical observation of their manifestations
Niacin ameliorates Charcot-Marie-Tooth 4B1 neuropathy without interfering with nerve regeneration
Get PDFCharcot-Marie-Tooth (CMT) neuropathies represent a broad and very heterogeneous group of disorders for which no therapies are yet available. Due to the huge genetic heterogeneity, therapeutical approaches that can benefit several forms independently of the unique pathogenetic mechanism have been sought. Niacin, nicotinic acid, is a vitamin used for many decades as anti-dyslipidaemic and anti-cholesterol drug product under the commercial name of Niaspan®, the extended-release formulation of niacin. Of note, niacin can have other effects depending on the dose, formulation and physiology and it has been used to reduce inflammation, to promote angiogenesis and to protect neurons, muscle and axons by boosting nicotinamide adenine dinucleotide (NAD+) levels. Niacin also activates TNF-alpha convertase enzyme (TACE) secretase, which negatively regulates Neuregulin type I-mediated signalling in the peripheral nervous system and myelination. We previously postulated that niacin-mediated TACE activation can be effective in reducing aberrant excessive myelin associated with different CMT forms. Here, we explored efficacy of this strategy by performing a long-term preclinical trial and we provided evidence that a novel niacin-based long-lasting formulation ameliorates neurophysiology and reduces fibre degeneration in a model of Charcot-Marie-Tooth type 4B1 (CMT4B1) neuropathy, characterized by aberrant myelin. We also sought to determine whether this strategy might interfere with nerve regeneration, which is dependent on Neuregulin type I signalling. Surprisingly, we found that the Mtmr2 knockout mice, a model of CMT4B1, have a defect in nerve regeneration and that niacin-based treatment is not detrimental to nerve regeneration
Is robotic liver resection feasible in patients with lesions in close proximity to major vessels? A propensity score matching analysis
Get PDFIntroduction: Robotic surgery is widely diffused in the surgical field and is becoming increasingly prevalent, however several aspects need more detailed assessment. One of them concerns the role of robotic liver surgery for lesions in contact with major vascular (CMV) pedicles. The aim of our study is to evaluate and compare intra and post operative outcomes in patients undergoing robotic liver resections between lesions in contact or free from major vessels. Methods: A multicentric retrospective study was performed including 1030 patients who underwent robotic liver resection. Patients were divided into two groups according to vascular contact. Intra and post-operative outcomes were compared between the groups before and after Propensity Score Matching. Results: After propensity score matching 889 patients were included in the study. Among these lesions, 595 were not in contact with major vessels (NCMV) and 294 were in contact with major vessels (CMV). Use of Pringle Manoeuvre was more associated with CMV resections (49.8 % vs 31.2 %, p = 0,0001). No differences in terms of operative time, conversion rate, morbidity and type of complications were observed after PSM. Conclusion: The presents study shows how robotic surgery is a valid and safe technique also for resection of tumors close to vascular pedicles
L'armonia difficile. Il Barocco e Giambattista Vico
No full textLa tesi si propone di indagare la categoria di Barocco da una prospettiva teorica ed estetica, con particolare attenzione ai trattatisti di retorica e poetica tra Cinquecento e Seicento, e al pensiero di Giambattista Vico. L’elaborato si articola in cinque capitoli, ognuno dei quali contribuisce a costruire un quadro teorico coerente attorno alla concezione di Barocco qui proposta.
Il primo capitolo pone le basi teoriche dell’intera analisi, approfondendo il legame tra retorica e filosofia. Particolare attenzione è dedicata al contributo di Ernesto Grassi, il quale offre una lettura originale di Vico come “ultimo degli umanisti” che getta nuova luce sulla sua filosofia della retorica. L’influenza di Heidegger su Grassi e la sua riflessione sull’Umanesimo italiano, con particolare riferimento ai temi dell’immagine e della fantasia, permettono di contestualizzare e approfondire la concezione di Barocco che si intende sviluppare.
I capitoli secondo e terzo analizzano l’evoluzione della retorica a cavallo tra Cinque e Seicento. Inizialmente, si esamina la rinascita del ciceronianismo e il rapporto tra dialettica e retorica nella cultura umanistico-rinascimentale, con particolare riferimento alle opere di Rudolf Agricola e Pierre de la Ramée. Successivamente, l’attenzione si sposta sulle prime manifestazioni del pensiero barocco, individuabili nel dialogo tra retorica e poetica che caratterizza la produzione di autori come Francesco Patrizi da Cherso, Jacopo Mazzoni e Camillo Pellegrino tra gli anni Ottanta e Novanta del XVI secolo.
Il terzo capitolo è dedicato all’analisi dei principali trattatisti del Barocco, tra cui Maciej Sarbiewski, Matteo Peregrini, Francesco Maria Sforza Pallavicino, Baltasar Gracián ed Emanuele Tesauro. Attraverso l’analisi dei concetti di ingegno, acutezza e arguzia, si offre un’interpretazione estetico-teoretica del Barocco, mettendo in luce l’originalità del contributo di questi autori e il loro ruolo nello sviluppo di un pensiero filosofico innovativo.
Infine, i capitoli quarto e quinto sono dedicati all’approfondimento del pensiero di Vico. Si parte dall’analisi della posizione del giovane Vico degli Affetti di un disperato nel contesto della cultura napoletana di fine Seicento, caratterizzata da una forte influenza barocca. In particolare, si evidenzia l’importanza dell’opera del gesuita Giacomo Lubrano, i cui testi in prosa e in poesia rappresentano un esempio significativo della complessa interazione tra retorica e affetti nel Barocco. Il percorso di ricerca proseguirà con un’indagine delle opere vichiane, a partire dalle orazioni inaugurali fino alle Vici vindiciae. In questa fase, l’attenzione si concentrerà sulla presenza e sulla rilevanza dei
temi retorico-filosofici barocchi individuati e analizzati nei capitoli precedenti. Sarà in questa sezione che la prospettiva di un “Vico barocco” giungerà alla sua completa e definitiva formulazioneThis thesis aims to investigate the category of Baroque from a theoretical and aesthetic perspective, with particular attention to the treatises on rhetoric between the sixteenth and seventeenth centuries and the thought of Giambattista Vico. The work is divided into five chapters, each of which contributes to constructing a philosophical framework around the conception of the Baroque proposed here. The first chapter lays the foundations of the entire analysis, deepening the link betweenrhetoric and philosophy. Particular attention is dedicated to the contribution of Ernesto Grassi, who offers an original reading of Vico as the "last of the humanists" which sheds new light on his philosophy of rhetoric. The influence of Heidegger on Grassi and his reflection on Italian Humanism, with particular reference to the themes of the image and fantasy, allow us to contextualize and deepen the conception of the Baroque that we intend to develop. The second and third chapters analyze the evolution of rhetoric between the sixteenth and seventeenth centuries. Initially, the revival of Ciceronianism and the relationship between dialectic and rhetoric in Humanist-Renaissance culture are examined, with particular reference to the works of Rudolph Agricola and Pierre de la Ramée. Subsequently, attention is shifted to the first manifestations of Baroque thought, which can be identified in the dialogue between rhetoric and poetics that characterizes the production of authors such as Francesco Patrizi da Cherso, Jacopo Mazzoni and Camillo Pellegrino between the eighties and nineties of the sixteenth century. The third chapter is dedicated to the analysis of the main Baroque treatises, including those by Maciej Sarbiewski, Matteo Peregrini, Francesco Maria Sforza Pallavicino, Baltasar Gracián and Emanuele Tesauro. Through the analysis of the concepts of ingegno, acutezza and arguzia, it offers a aesthetic and theoretical interpretation of the Baroque, highlighting the originality of the contribution of these authors and their role in the development of an innovative philosophical thought
Acalabrutinib-obinutuzumab improves survival vs chemoimmunotherapy in treatment-naive CLL in the 6-year follow-up of ELEVATE-TN
No full textAcalabrutinib is a Bruton tyrosine kinase inhibitor approved for the treatment of chronic lymphocytic leukemia. We present results from ELEVATE-TN after a median follow-up of 74.5 months. Overall, 535 patients were randomized (acalabrutinib-obinutuzumab, n = 179; acalabrutinib, n = 179; chlorambucil-obinutuzumab, n = 177). Median age was 70 years, 63.0% had unmutated immunoglobulin heavy chain variable region gene (uIGHV), 13.6% had del(17p) and/or mutated TP53, and 17% had complex karyotype (CK; ≥3 chromosomal abnormalities). Median progression-free survival (PFS) was not reached (NR) for acalabrutinib-obinutuzumab and acalabrutinib vs 27.8 months for chlorambucil-obinutuzumab (both P < .0001); estimated 72-month overall PFS rates were 78.0%, 61.5%, and 17.2%, respectively. Acalabrutinib-obinutuzumab resulted in improved PFS vs acalabrutinib monotherapy (hazard ratio [HR], 0.58; P = .0229). Patients with uIGHV, del(17p) and/or mutated TP53, or CK had significantly improved PFS with acalabrutinib ± obinutuzumab vs chlorambucil-obinutuzumab (P < .0001, P ≤ .0009, and P < .0001 for both acalabrutinib-containing arms, respectively). Median overall survival (OS) was NR for all treatments, with significantly longer OS for acalabrutinib-obinutuzumab than chlorambucil-obinutuzumab (HR, 0.62; P = .0349). Estimated 72-month OS rates were 83.9%, 75.5%, and 74.7% for acalabrutinib-obinutuzumab, acalabrutinib, and chlorambucil-obinutuzumab, respectively. Adverse events (AEs) occurring after >4 years were mostly grade 1 to 2. Rates of AEs, serious AEs, and events of clinical interest were similar between acalabrutinib-containing arms and consistent with the known safety profiles of acalabrutinib and obinutuzumab. Efficacy and safety of acalabrutinib-containing arms were maintained, with longer PFS in both acalabrutinib arms than chlorambucil-obinutuzumab including in patients with high-risk features. This trial was registered at www.ClinicalTrials.gov as #NCT02475681
Supra-annular Prosthesis Anchoring in Bicuspid Aortic Valve: Evidence in Large Annuli Exceeding the Device Sizing Chart Range
No full textChallenges and Opportunities for Women in Vascular Surgery: Summary from an International Roundtable Discussion
No full textBackground: Despite advances in diversity, gender disparities in vascular surgery persist globally, particularly in academic leadership and career progression. This narrative review presents the results of a multinational roundtable held during the 11th Aortic Surgery, Peripheral and Venous: How To Do It Symposium in Milan (December 2024), which convened female vascular surgeons from Latin America, North America, and Europe to discuss challenges and propose strategies for career advancement. Methods: A structured roundtable included vascular surgeons with active roles in education and academic practice. Presentations addressed barriers to leadership, mentorship, academic promotion, work-life balance, and systemic bias. A designated participant collected notes, and a consensual summary of challenges and recommendations was reviewed by the group. Literature from the past two decades was also reviewed to contextualize the discussion. Results: Key challenges identified include underrepresentation in academic and societal leadership, slower promotion rates, pay inequities, disproportionate caregiving responsibilities, lack of structured mentorship, and cultural bias in professional environments. The group proposed eight areas for action: (1) transparent leadership pathways, (2) mentor- ship and sponsorship networks, (3) institutional reforms for equity and inclusion, (4) academic support for research and publication, (5) improved work-life integration policies, (6) early exposure to vascular surgery during training, (7) building supportive peer and ally networks, and (8) long-term cultural strategies. One immediate outcome was the proposal to include a gender equity-focused plenary session at the 2026 How To Do It Symposium. Conclusions: Although access to vascular surgery training has improved, persistent disparities in leadership and aca- demic progression remain. Addressing these gaps requires sustained, evidence-based strategies. This review summarizes key challenges and proposes actionable, inclusive solutions to support the advancement of women in vascular surgery
Adjuvant Chemotherapy After Resection of Localized Pancreatic Adenocarcinoma Following Preoperative FOLFIRINOX
No full textImportance The effect of adjuvant chemotherapy following resection of pancreatic adenocarcinoma after preoperative (m)FOLFIRINOX (combination leucovorin calcium [folinic acid], fluorouracil, irinotecan hydrochloride, and oxaliplatin in full or modified dosing) chemotherapy on overall survival (OS) is unclear because current studies do not account for the number of cycles of preoperative chemotherapy and adjuvant chemotherapy regimen. Objective To investigate the association of adjuvant chemotherapy following resection of pancreatic adenocarcinoma after preoperative (m)FOLFIRINOX with OS, taking into account the number of cycles of preoperative chemotherapy and adjuvant chemotherapy regimen. Design, Setting, and Participants This retrospective cohort study included patients with localized pancreatic adenocarcinoma treated with 2 to 11 cycles of preoperative (m)FOLFIRINOX followed by resection across 48 centers in 20 countries from 2010 to 2018. Patients who died within 3 months after surgery were excluded (landmark). Data were analyzed from February 1 to December 31, 2023. Exposures Preoperative (m)FOLFIRINOX chemotherapy followed by resection and eventually followed by adjuvant chemotherapy. Main Outcomes and Measures The primary outcome was OS, calculated from the 3-month landmark. Cox regression analysis, including interaction analyses, was performed to investigate the association of adjuvant chemotherapy with OS. Results Overall, 767 patients were included after resection of pancreatic adenocarcinoma (median [IQR] age, 62 [55-67] years; 404 [52.7%] male). Adjuvant chemotherapy was independently associated with prolonged OS (hazard ratio [HR], 0.66; 95% CI, 0.49-0.87), confirmed by adjusted OS curves. The interaction analysis to assess estimated treatment effect across subgroups was not statistically significant. The forest plot and interaction test suggest that the association of adjuvant chemotherapy was lower among patients receiving 8 or more cycles of preoperative (m)FOLFIRINOX, those who had radiological response, and those with ypN0 disease. Compared to no adjuvant chemotherapy, both adjuvant (m)FOLFIRINOX (HR, 0.57; 95% CI, 0.40-0.80) and other multiagent adjuvant regimens (HR, 0.61; 95% CI, 0.41-0.92) were associated with prolonged OS, whereas single-agent adjuvant chemotherapy was not (HR, 0.75; 95% CI, 0.55-1.03). Conclusions and Relevance In this cohort study, adjuvant (m)FOLFIRINOX and other multiagent chemotherapy regimens were associated with improved OS following resection of localized pancreatic adenocarcinoma after preoperative (m)FOLFIRINOX, whereas single-agent adjuvant chemotherapy was not. The impact of adjuvant chemotherapy on OS may be lower in subgroups such as patients with 8 or more preoperative cycles of (m)FOLFIRINOX, those having radiological response, and those with ypN0