IRIS UniSR (’Università Vita-Salute San Raffaele)
Not a member yet
54666 research outputs found
Sort by
Lesion Location and Functional Connections Reveal Cognitive Impairment Networks in Multiple Sclerosis
No full textObjective: Cognitive impairment, fatigue, and depression are common in multiple sclerosis (MS), potentially due to disruption of regional functional connectivity caused by white matter (WM) lesions. We explored whether WM lesions functionally connected to specific brain regions contribute to these MS-related manifestations. Methods: A total of 596 MS patients underwent 3T brain MRI acquisition, neurologic assessment, and neuropsychological evaluation (Brief Repeatable Battery, Modified Fatigue Impact Scale [MFIS], and Montgomery-Åsberg Depression Rating Scale [MADRS]). Voxel-wise lesion probability maps were compared between subgroups based on cognition, fatigue, or depression. Lesion distributions were linked to a brain functional connectivity atlas to map lesion network associations. Lesion network maps (LNMs) were then compared among subgroups (p < 0.05, FWE-corrected). Results: One hundred twenty-six (27.2%) MS patients were cognitively impaired and showed significantly more widespread WM lesions, more strongly functionally connected to bilateral hippocampi, thalami, cerebellum, and occipital cortices (corrected-p < 0.05) than cognitively preserved patients. Lesion networks were similar for impaired processing speed/attention. Verbal memory deficits were associated with WM lesions connected to parahippocampi, temporal pole, and cerebellum (corrected-p ≤ 0.05), while verbal fluency deficits involved connections to thalami, putamen, caudate nuclei, anterior cingulate cortex, and cerebellum (corrected-p ≤ 0.05). No significant lesion distribution or network connectivity differences were found in patients with visual memory deficits, fatigue (MFIS ≥ 38, 184/493 [37.3%]) or depression (MADRS > 9, 192/495 [38.8%]). Interpretation: Regional WM lesions disrupting connections to the hippocampus, thalamus, cerebellum, and temporo-occipital cortices contribute to cognitive impairment, but not fatigue or depression. LNM may clarify mechanisms underlying cognitive deficits in MS
Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries
No full textIntroduction: While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting. Aim: We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs). Methods: Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in–hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes. Results: Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non–smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non–smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings. Conclusion: The occurrence of PPCs in smokers is not different from non–smokers. Funding: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology through their Clinical Trial Network and the Amsterdam University Medical Centers, Amsterdam, The Netherlands. Registration: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223). Prior presentation: Preliminary study results have been presented at the Euroanaesthesia 2024 International Congress, in Munich, Germany
The role of intravenous immunoglobulin in autoimmune diseases with dermatological implications
No full textIntravenous immunoglobulin (IVIG) therapy has emerged as a promising treatment option for various dermatological autoimmune diseases due to its immunomodulatory potential and low incidence of severe side effects. Despite its widespread use, the mechanism of action of IVIG in treating autoimmune diseases remains a topic of debate. IVIG is derived from the plasma fractionation of a large pool of donors, primarily consisting of the IgG isotype. Its main mechanisms of action involve neutralizing circulating autoantibodies via the F(ab’)2 portion, inhibiting complement-mediated tissue destruction, and reducing the half-life of circulating autoantibodies through the Fc portion. This paper explores the growing utilization of IVIG as an off-label therapy in dermatological autoimmune or immune-mediated diseases, including autoimmune bullous disease (AIBS), dermatomyositis (DM), lupus erythematosus (LE), systemic sclerosis, scleromyxedema, Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), pyoderma gangrenosum (PG), and necrobiotic xanthogranuloma (NXG). In this context, the sole large prospective, randomized trial was the 2022 ProDERM study, which demonstrate efficacy of IVIG in improving cutaneous manifestations among 95 DM patients compared to the placebo group. Moreover, although considered off-label, the use of IVIG is regarded as the first-line therapy for patients with scleromyxedema. As a first line of therapy, IVIg is only approved for Kawasaki Disease (KD) in the setting of vasculitis. The treatment in all other indications is mostly considered as adjuvant therapy only after failure of immunosuppressive therapy or in the presence of contraindications
Erratum to “Stability of radiomic features in magnetic resonance imaging of the female pelvis: A multicentre phantom study” [Phys. Medica 130 (2025) 104895](S1120179725000055)(10.1016/j.ejmp.2025.104895)
No full textThe publisher regrets to miss the abstract of the above article. Please find the details below: Abstract Background. Radiomics has emerged as a promising tool for extracting large amounts of quantitative features from conventional biomedical imaging. Multicentre studies have investigated reproducibility and repeatability of radiomic features for different approaches in acquisition and image reconstruction for several imaging modalities. This study aimed to compare the impact of scanners and centre-specific parameter settings on the radiomic features calculated on images of a phantom. Methods. This is a MRI multicentre phantom study gathering ten centres and 19 scanners of the Italian “Alleanza contro il Cancro” network. The participant centres were asked to acquire repeated T2-weighted images of a dedicated pelvis-shaped phantom filled with silicon oil with four embedded inserts filled with polyethylene spheres and an agar solution, resulting in different heterogeneity textures. Each centre acquired the images using the local protocol for female pelvis investigation. For each MRI acquisition, radiomic features were extracted with and without image preprocessing. Results. Feature repeatability was assessed by calculating the coefficient of variation, while the agreement between different scanners was evaluated through the intraclass correlation coefficient. The coefficient of variation was lower than 7% for all the families of features and turned out to be unaffected by image preprocessing. Most families of features showed higher reproducibility when images underwent the preprocessing steps typically employed in an MR radiomic study. Discussion. Preliminary tests on phantoms can be preparatory to multicenter clinical radiomic studies to quantify the inherent variability in feature extraction due to the use of different MR scanners, sequences and image processing. The publisher would like to apologise for any inconvenience caused
Unveiling a silent threat: slowly expanding spinal cord lesion linked to clinical worsening in multiple sclerosis: a case report
No full textDifferences in resting-state functional connectivity between depressed bipolar and major depressive disorder patients: A machine learning study
No full textNearly 60 % of individuals with bipolar disorder (BD) are initially classified as major depressive disorder (MDD) patients, resulting in inappropriate drug treatment. Identifying reliable biomarkers for the differential diagnosis between MDD and BD patients may allow to define the best treatment option since the early phases. In this study, we deployed machine learning predictive models to classify 62 MDD and 63 BD patients with a current depressive episode from resting functional neuroimaging feature (rs-fMRI), including fractional amplitude of low-frequency fluctuations, regional homogeneity, atlas-based connectivity across 434 regions of interest, seed-based connectivity maps for 44 seeds, and 14 dual regression components. Models were also compared to 76 healthy controls. Only the model trained on seed-based connectivity reached the statistical significance in permutation test reaching the highest classification performance (69.36 % of accuracy for BD and 63.08 % for MDD). Seed-based connectivity also reached the best performance in identifying MDD (78.33 %) and BD (71.67 %) relative to controls. Connectivity patterns in key brain regions of the reward and aversion systems appeared crucial in differentiating the disorders, possibly identifying distinct clinical phenotypes of disorders, beyond the depressive ongoing episode
Meta-analysis of randomized controlled trials for the development of the International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) guidelines on multimodal strategies for the surgical treatment of obesity
No full textBackground: Randomized, controlled trials (RCTs) comparing the effectiveness of metabolic bariatric surgery (MBS) in addition to one or more treatment interventions for obesity (i.e., lifestyle structured interventions—LSI, medical therapy—MT, obesity management medication—OMM or endobariatric procedures—EP) are lacking. This study aims to assess the effectiveness of multiple simultaneous (before or immediately after MBS) interventions for treating obesity. Methods: We performed a meta-analysis including all RCTs enrolling patients undergoing different MBS procedures add-on to other anti-obesity strategies (LSI, MT, OMM or ES) versus MBS alone, with a duration of at least 6 months. The primary outcome was BMI at the end-point; secondary end-points included percentage total and excess weight loss (%TWL%, and EBWL%), total weight loss (TWL), fasting plasma glucose (FPG), HbA1c, surgical and non-surgical severe adverse events (SAE), mortality, remission of type 2 diabetes, hypertension, dyslipidemia and health-related quality of life (HR-QoL). Results: A total of 25 RCTs were retrieved. The addition of either OMM (i.e., liraglutide) or EP (i.e., intragastric balloon—IB, endosleeve-ES) to MBS was associated with a significantly lower BMI at the end-point (p = 0.040). The addition of liraglutide only to MBS was associated with a greater %EWL%, but not %TWL and TBWL (p = 0.008). Three trials evaluated end-point HbA1c, showing a significant reduction in favour of liraglutide as an add-on therapy to MBS (p = 0.007). There was no mortality. Conclusions: MBS combined with non-surgical approaches appears more effective than MBS alone in reducing BMI. Further RCTs on combined therapies to MBS for severe obesity are needed to enhance the tailoring of treatment for severe obesity
Evaluation of external validity of the distal pancreatectomy fistula risk score (D-FRS) in a high-volume center
No full textBackground: To reduce the risk of Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) following distal pancreatectomy (DP), preoperative and intraoperative Distal Pancreatectomy Fistula Risk Scores (D-FRS) were developed. While these models have demonstrated strong internal discrimination, external validation is needed. Therefore, this study aims to evaluate the discrimination and calibration of both risk models in an external cohort of patients undergoing DP. Methods: This retrospective cohort study included adult patients undergoing DP in a high-volume center (2020—2024). Preoperatively, all patients underwent a triple-phase CT scan measuring the pancreatic duct diameter (MPD, mm), neck thickness (mm), and late-early (L/E) phase attenuation ratio (L/E < 1 = soft texture). Preoperative D-FRS was calculated as the predicted probability based on MPD and neck thickness. Intraoperative D-FRS was calculated using MPD, neck thickness, body mass index (BMI, kg/m2), intraoperative time, and L/E ratio. CR-POPF was defined according to ISGPS criteria. Models’ discrimination and calibration were assessed using the Area Under Curve (AUC) and calibration plot (ideal intercept = 0; slope = 1). Results: A total of 521 patients were included, 58% of whom underwent laparoscopic DP. CR-POPF occurred in 128 (25%) patients. CR-POPF was significantly associated with a higher BMI (p = 0.019) but not with pancreatic duct diameter, thickness, operative time, or L/E ratio. Both preoperative and intraoperative D-FRS models demonstrated poor discrimination, with an AUC of 0.51 (95% CI: 0.45–0.56) and 0.52 (95% CI: 0.46–0.58), respectively. The preoperative D-FRS exhibited poor calibration, with an intercept of 0.342 and a slope of -0.052, while the intraoperative D-FRS showed an intercept of 0.892 and a slope of -0.008. Conclusion: Both preoperative and intraoperative D-FRS had poor discrimination and calibration ability and tended to overestimate the risk of fistula. In our clinical context, D-FRS cannot be applied without further adjustment and recalibration
Continuous intraperitoneal insulin infusion as a valuable approach in patients with unstable type 1 diabetes: two case reports and a mini review of the literature
No full textIn recent years, continuous intraperitoneal insulin infusion (CIPII) has become a valid therapeutic option to achieve good glycemic control for patients with unstable type 1 diabetes and subcutaneous insulin resistance, mainly due to the absorption of insulin through the portal venous system. This route improves hepatic uptake and reduces peripheral plasma insulin levels, also optimizing glucagon secretion and hepatic glucose production. CIPII can lead to better blood glucose control and more predictable insulin profiles, especially after meals, compared to subcutaneous injections. Therefore, some studies suggest that CIPII may reduce the risk of hypoglycemia compared to subcutaneous insulin as well as improving patient satisfaction. Actually, among CIPII delivery systems, DiaPort particularly stands out for its low side effects, proven clinical efficacy, and potential for integration into closed-loop systems