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Analysis of Short-Term Outcomes in Pancreatic Surgery with Vascular Resection from a Prospective Multicenter Global Study
No full textBackgroundPancreatic resection with concomitant vascular resection is increasingly practiced with outcomes mainly reported from specialist centers but lacking results from prospective global data. This study aimed to investigate factors associated with short-term outcomes after vascular resections in pancreatic surgery worldwide.Patients and MethodsData were extracted from a prospective, multicenter, international cross-sectional snapshot study in 2021 (pancreasgroup.org) assessing short-term outcomes after pancreatic surgery worldwide (NCT04652271). In the patient cohort of pancreatic surgery with simultaneous vascular resection for various diseases, short-term outcomes were reported and compared with established benchmark values. Factors affecting major complications, mortality, and histopathological resection status were assessed in multivariable logistic regression analyses with interaction testing.ResultsFrom a total of 3926 patients undergoing pancreatic surgery, 565 had associated vascular resections, of which 444 had venous resections alone and 121 had arterial resections alone or with concomitant venous resection. Of the 153 (47%) benchmark cases with pancreatoduodenectomy and venous resection, median postoperative morbidity fell within established benchmark criteria. Median 90-day major complication and mortality rates were similar in pancreatic resection with venous, arterial or no vascular resections (45 and 10%, 47 and 6.6%, 42 and 9.6% respectively). Patients undergoing arterial resections that developed a clinically relevant pancreatic fistula faced substantially elevated odds of 90-day mortality (OR 8.8 CI 1.6-48). In pancreatic ductal adenocarcinoma, the R1 rate was 26%, neoadjuvant chemotherapy being protective for both overall and venous-specific margins.ConclusionsVascular pancreatic surgery is performed across diverse healthcare settings worldwide. While perioperative complications were comparable to nonvascular pancreatic resections, the observed 90-day mortality was considerable overall. International collaborative efforts should focus on understanding practice variations and improve accessibility of optimal perioperative care to promote rescue capabilities
Il soggetto, la coscienza, il corpo. Da Nietzsche a Descartes
No full textIl presente lavoro si articola in cinque sezioni.
L’interrogativo che viene perseguito, come viene indicato nel Cap. I (Introduzione) e Cap. V (Conclusioni), concerne lo statuto storico del soggetto nell’età contemporanea, e viene realizzato tramite un’indagine che mette in relazione, sul piano storiografico, Descartes e Nietzsche.
Più precisamente, ho cercato di mostrare come la decostruzione nietzscheana della nozione di ‘soggetto’ aspiri a contestare il modello della soggettività cartesiana, considerato di tipo sostanzialistico, dualistico e completamente e immediatamente auto-cosciente.
Nel Cap. II (Le fonti cartesiane di Nietzsche), ho mostrato come Nietzsche abbia mutuato le critiche alla sostanza, al dualismo e all’auto-certezza immediata dalla scuola di Schopenhauer e dalle correnti del neo-kantismo e del neo-idealimo, intercettando per ciò stesso le polemiche anti-cartesiane sollevate da Kant e Hegel.
Nel Cap. III (La stanza più angusta. Nietzsche, il soggetto, la coscienza e il corpo), ho invece analizzato la declinazione nietzscheana delle polemiche verso il cartesianesimo. Ho quindi mostrato come Nietzsche, se da un lato polemizza verso l’istanza del soggetto cartesiano e della formula “ego cogito, ergo sum”, dall’altro le contrappone un modello di soggettività diverso, basato sul ridimensionamento dell’orizzonte dell’auto-coscienza e da una valorizzazione del corpo.
Nel Cap. IV (Districarsi nelle tenebre. Descartes, il soggetto, la coscienza e il corpo), ho cercato di mostrare come le critiche di Nietzsche al pensatore francese possano essere usate – paradossalmente – come chiavi di lettura della sua stessa filosofia: esse consentono in effetti di inviduare una duplicità connaturata alla filosofia cartesiana e alla sua tematizzazione del problema del soggetto (il quale risulta iscrivibile soltanto parzialmente al cartesianesimo). Per tali ragioni, ho indicato diverse formulazioni della tesi cartesiana dell’ego, mostrando come alcune di esse non soltanto risultino irriducibili alle obiezioni di Nietzsche (ma anche di Kant, dei neo-kantiani; di Hegel, dei neo-idealisti; e di Husserl o Heidegger, venuti dopo di loro), ma possano addirittura essere interpretate per loro tramite, risultando loro consonanti.
Ho concluso il mio lavoro ribadendo come, all’interno del medesimo panorama filosofico contemporaneo, lo studio del tema della soggettività non possa prescindere da un esame del suo inventore (Descartes) e del suo più fervente contestatore (Nietzsche).This thesis is comprised of five sections.
As indicated in Chapters I (Introduction) and V (Conclusions), the question that is pursued concerns the historical status of the subject in the contemporary age. This is realised through an investigation that relates Descartes and Nietzsche on a historiographical level.
In more detail, the aim is to demonstrate how Nietzsche's deconstruction of the concept of 'subject' is intended to challenge the Cartesian model of subjectivity, which is regarded as substantialist, dualist and wholly and immediately self-conscious.
In Chapter II (Nietzsche's Cartesian Sources), it was demonstrated how Nietzsche adopted the critique of substance, dualism and immediate self-certainty from the school of Schopenhauer and the currents of neo-Kantianism and neo-idealism, thereby engaging with the anti-Cartesian polemics initiated by Kant and Hegel.
In Chapter III, entitled 'The Narrowest Room. Nietzsche, the Subject, Consciousness and the Body', I instead analysed Nietzsche's declination of polemics towards Cartesianism. I then demonstrated how, on the one hand, Nietzsche engaged in a polemical critique of the Cartesian subject and the formula "ego cogito, ergo sum," while, on the other hand, he proposed an alternative model of subjectivity based on a narrowing of the horizon of self-consciousness and the valorization of the body.
In Chapter IV, entitled 'Untangling in the Darkness', In the previous chapter, I attempted to demonstrate how Nietzsche's critiques of Descartes can be employed, albeit paradoxically, as a means of interpreting his own philosophy. These critiques allow us to identify a duplicity inherent to Cartesian philosophy and its emphasis on the subject, which is only partially attributable to Cartesianism. In light of the aforementioned considerations, I have delineated a number of formulations of the Cartesian thesis of the ego, demonstrating that some of them are not only resistant to Nietzsche's objections (but also those of Kant, the neo-Kantians; of Hegel, the neo-idealists; and of Husserl or Heidegger, who emerged subsequently), but can even be interpreted through them, aligning with them.
In conclusion, it is evident that the study of subjectivity within the contemporary philosophical landscape cannot be separated from an examination of its inventor, Descartes, and its most fervent challenger, Nietzsche
Long-Term Outcomes of Contemporary Surgical Repair for Degenerative Mitral Regurgitation
No full textBackground: There are limited published reports about the long-term outcomes of contemporary surgical mitral repair series for degenerative mitral regurgitation performed at a high-volume center. Objectives: The aim of this study is to report independently adjudicated long-term results of contemporary mitral repair surgery performed at a high-volume center. Methods: A retrospective study was conducted on 3,317 patients who underwent surgical mitral repair for degenerative mitral regurgitation at a tertiary care center between January 1, 2008 and December 31, 2017. Follow-up data, focusing on survival, reinterventions, and heart failure rehospitalizations were adjudicated and analyzed by the Italian National Agency for Regional Healthcare Services. Echocardiographic assessments during follow-up were not included. Complete (100%) data linkage was achieved. Results: The median age of the patients was 57 years, and 68.56% were men. The overall in-hospital mortality was 0.48% (16 of 3,317) for all cases and 0.21% (5 of 2,399) in isolated mitral valve repair. The 10-year survival was 89.65% (95% CI: 88.75%-90.55%), independently associated with preoperative symptoms and anterior leaflet disease. Freedom from reoperation was 96.63% (95% CI: 95.63%-97.63%) at 10 years. Anterior leaflet disease, a second run of cardiopulmonary bypass, and more than mild mitral regurgitation at discharge were associated with increased risk of reoperation. Finally, 10-year freedom from rehospitalization for heart failure was 92.24% (95% CI: 90.62%-93.86%), with age, prior hospitalization for heart failure, preoperative symptoms, and anterior leaflet disease identified as independent risk factors. Conclusions: This contemporary series provides further data on the low in-hospital mortality and excellent long-term outcomes of surgical mitral repair when performed in a high-volume center. Preoperative symptoms are associated with worse outcomes. Isolated anterior leaflet disease increases the risk of reoperation, heart failure rehospitalization, and late mortality compared to posterior or bileaflets pathology
Efficacy and safety of ublituximab for relapsing multiple sclerosis patients: current evidence and expert opinion
Full text link: Ublituximab, a newly launched anti-CD20 monoclonal antibody, represents a substantial advancement in the treatment landscape for relapsing multiple sclerosis (RMS). Its unique glycoengineered design enhances antibody-dependent cellular cytotoxicity, enabling rapid and effective B-cell depletion. Phase III randomized controlled trials ULTIMATE I and II confirmed superior efficacy of ublituximab over teriflunomide, achieving substantial reductions in annualized relapse rates, near-complete suppression of gadolinium-enhancing T1 lesions and new/enlarging T2-hyperintense white matter lesions, as well as higher rates of no evidence of disease activity 3. Safety data indicate that ublituximab is generally well tolerated, with mild, manageable infusion-related reactions as the most common adverse event. Its streamlined infusion protocol, requiring maintenance doses administered in just 1 h twice a year, provides a practical solution to the clinical and logistical challenges of MS management. Its rapid B-cell depletion, high efficacy, and convenient twice-yearly short infusion regimen make it particularly suitable for treatment-naïve patients with high disease activity who may benefit from early and robust disease control as well as for those who have experienced suboptimal responses, poor tolerability, or safety concerns with prior disease-modifying therapies. Although ublituximab shows great promise and five-year data are already available, further research is required to fully explore its potential in limiting disability progression and neurodegeneration, as well as to confirm its long-term safety. Real-world evidence, extended follow-ups, and comprehensive biomarker assessment specific to MS-related pathology will be essential to confirm its efficacy and optimize RMS patients' management. This review synthesizes discussions from two meetings of Italian Neurologists held in 2024 and 2025, focusing on efficacy and safety data of ublituximab, and providing a comprehensive and in-depth analysis of its current and future role in RMS treatment
VEXAS associated acute disseminated Encephalo-Myelitis (ADEM)-like syndrome: A case report and review of the literature
No full textPainting the Landscape. The Landscape that Makes Us Think
Full text linkThe article aims to show how landscape is not a natural datum but a typically modern cultural produc
Oncological Feasibility of Limited Neck Dissection in cN0 Supraglottic Laryngeal Cancer
Full text linkBackground: Supraglottic squamous cell carcinoma (SCC) is a significant portion of head and neck cancers, with the management of clinically negative necks (cN0) through selective neck dissection (SND) being debated due to potential morbidities and low metastasis rates in levels IIb and IV. Methods: This study is a retrospective, multicenter examination of the potential feasibility of limited neck dissection (LND), including only levels IIa and III in cN0 supraglottic SCC patients. It analyzed occult metastasis rates and explored relapse occurrences alongside potential predictors of lymph node metastasis. Results: Among 425 patients, predominantly male (85.6%) with a mean age of 63 years, the occult metastasis rate was 28.9%, and 13.7% experienced relapses during a mean follow-up of 52 months. Advanced clinical stage, higher grading, and other risk factors emerged as predictors of occult lymph node metastasis at level IIb. Conclusions: The study supports LND potential feasibility for cN0 supraglottic SCC, suggesting level IIb dissection can be omitted in specific early-stage cases to reduce morbidity without affecting outcomes
ANGIOTENSIN II FOR CATECHOLAMINE-RESISTANT VASODILATORY SHOCK IN PATIENTS WITH ACUTE KIDNEY INJURY: A POST HOC ANALYSIS OF THE ATHOS-3 TRIAL
No full textObjective: The combination of catecholamine-resistant vasodilatory shock and acute kidney injury (AKI) is associated with high morbidity and mortality. The role of angiotensin II (ANGII) in this setting is unclear. Methods: We conducted a post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock (ATHOS) -3 trial which assessed the effect of Intravenous ANG II or placebo in patients with refractory vasodilatory shock in 75 intensive care units across nine countries in North America, Australasia, and Europe. We included patients with all stages AKI at initiation of ANG II or placebo and assessed 28-day mortality as primary outcome. We studied mean arterial pressure (MAP) response and days alive and free from renal replacement therapy (RRT) up to day seven as secondary outcome. Results: Of 321 ATHOS-3 patients, 203 (63%) had AKI at randomization, with stage 3 AKI being dominant (67%). Median age was 63 years and median APACHE II score was 30. By day 28, overall, 118 (58%) of patients had died (53% with ANGII vs. 63% with placebo, HR = 0.75, 95% CI [0.52-1.08], p=0.121). Among AKI stage 3 patients, however, ANGII was associated with significantly lower mortality (48% vs. 67%, HR = 0.57, 95% CI [0.36-0.91], p=0.024). Additionally, in this subgroup, compared with placebo, patients receiving ANGII were more likely to achieve a MAP response (p<0.001) and had more days alive and free from RRT (p<0.001). Conclusions: Compared with placebo, in patients with catecholamine-resistant vasodilatory shock and stage 3 AKI, ANGII is associated with lower 28-day, greater likelihood of MAP response, and more days alive and free from RRT. These findings support the conduct of future ANGII trials in patients with stage 3 AKI
MAMBA (Moisture Assisted Multiple BipolAr) technique vs Robo-lap approach in robotic liver resection. Is it possible a full robotic approach for parenchymal transection? A propensity score matching analysis
No full textBackground: Robotic surgery is becoming more and more widespread. Despite its diffusion, parenchymal transection still remains a matter of debate. Up to now, in minimally invasive surgery, most of liver resection were performed laparoscopically with the support of ultrasonic dissector. The absence of robotic ultrasonic dissector is replaced by the hybrid (Robo-lap) technique in which the use of laparoscopic ultrasonic dissector is merged with the use of robotic energy devices in order to perform parenchymotomy. On the other side, some surgical groups perform liver resection using only Da Vinci energy devices, focusing on the simultaneous use of the double bipolar forceps (Maryland and bipolar) and applying the clamp-crush technique during robotic resection (MAMBA—Moisture Assisted Multiple BipolAr). Aim of our study is to compare intra- and post-operative outcomes of these two techniques. Methods: We collected a multicenter retrospective database, including 1070 consecutive robotic liver resection in 10 European Hospital Centers. Among these, 921 patients underwent liver resection for malignancies. Perioperative data for each patient were analyzed. Patients were also divided in two groups according to parenchymal transection technique (MAMBA vs robo-lap). Perioperative data were compared between 2 groups before and after 1:1 Propensity Score Matching. Results: 755 resection were performed by MAMBA technique, 166 resection by Robo-lap. After PSM, 91 patients were included in each group. There were no significant differences between two groups regarding operative time, estimated blood loss, conversion rate, and post-operative complications. Conclusion: MAMBA technique is a valid alternative in robotic liver parenchymal transection, overcoming the lack of ultrasound devices
Will the autofluorescence take over inadvertent parathyroidectomy? Results from a multicentre cohort study
No full textBackground: Recently, several devices exploiting the near-infrared autofluorescence (NIR-AF) of parathyroid glands (PGs) have been developed. Nevertheless, their impact on both preserving PGs from inadvertent surgical dissection and on post-surgical hypoparathyroidism (hypoPTH) is controversial. Methods: A retrospective study of 845 patients undergoing thyroid surgery in 2 academic tertiary centres was conducted. In 291 patients, a NIR-AF device was used during surgery to identify PGs. The characteristics of the cohort were examined. The number of PGs identified during surgery, missed PGs, auto-transplants, inadvertent parathyroidectomies, as well as the occurrence of transient and permanent hypoPTH, were analysed. Results: The use of NIR-AF device resulted in a higher identification of PGs (92% versus 88%, p = 0.0008), and a significant reduction in the number of PGs inadvertently removed and detected on histopathological examination (4.7% versus 6.5%, p = 0.045). An increase in PG auto-transplantations was observed in the NIR-AF + group (10.4% versus 3.5%, p < 0.0001). The use of NIRAF did not significantly impact the occurrence of either transient or permanent hypoPTH. Conclusion: Intraoperative NIR-AF detection is a promising technology to reduce incidental parathyroidectomies in thyroid surgery. The impact of this technology on the occurrence of post-surgical hypoPTH needs to be furtherly investigated