IRIS UniSR (’Università Vita-Salute San Raffaele)
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The added value of artificial intelligence using Quantib Prostate for the detection of prostate cancer at multiparametric magnetic resonance imaging
No full textPurpose: Artificial intelligence (AI) has been proposed to assist radiologists in reporting multiparametric magnetic resonance imaging (mpMRI) of the prostate. We evaluate the diagnostic performance of radiologists with different levels of experience when reporting mpMRI with the support of available AI-based software (Quantib Prostate). Material and methods: This is a single-center study (NCT06298305) involving 110 patients. Those with a positive mpMRI (PI-RADS ≥ 3) underwent targeted plus systematic biopsy (TBx plus SBx), while those with a negative mpMRI but a high clinical suspicion of prostate cancer (PCa) underwent SBx. Three readers with different levels of experience, identified as R1, R2, and R3 reviewed all mpMRI. Inter-reader agreement among the three readers with or without the assistance of Quantib Prostate as well as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for the detection of clinically significant PCa (csPCa) were assessed. Results: 102 patients underwent prostate biopsy and the csPCa detection rate was 47%. Using Quantib Prostate resulted in an increased number of lesions identified for R3 (101 vs. 127). Inter-reader agreement slightly increased when using Quantib Prostate from 0.37 to 0.41 without vs. with Quantib Prostate, respectively. PPV, NPV and diagnostic accuracy (measured by the area under the curve [AUC]) of R3 improved (0.51 vs. 0.55, 0.65 vs.0.82 and 0.56 vs. 0.62, respectively). Conversely, no changes were observed for R1 and R2. Conclusions: Using Quantib Prostate did not enhance the detection rate of csPCa for readers with some experience in prostate imaging. However, for an inexperienced reader, this AI-based software is demonstrated to improve the performance. Trial registration: Name of registry: clinicaltrials.gov. Trial registration number: NCT06298305. Date of registration: 2022-09
Malnutrition and outcomes in patients with tricuspid regurgitation undergoing transcatheter tricuspid valve repair
No full textAims: The impact of malnutrition in patients with tricuspid regurgitation (TR) undergoing tricuspid transcatheter edge-to-edge repair (T-TEER) is not well established. We evaluated the impact of malnutrition among patients with symptomatic TR undergoing T-TEER. Methods and results: Baseline nutritional status was evaluated using the geriatric nutritional risk index (GNRI), based on serum albumin concentrations and body weight to ideal body weight ratio, among patients with symptomatic TR undergoing T-TEER, enrolled in the multicentre EuroTR registry between March 2016 and February 2024. Malnutrition was defined as GNRI ≤98. The primary outcome of interest was all-cause mortality. A total of 1034 patients were included (mean age 78.4 ± 7.3 years, 47.7% male). Among them, GNRI ≤98 (i.e. malnutrition) was observed in 211 patients (20.4%). Estimated rates of all-cause death at 2 years were 45.9% and 28.2% in patients with and without malnutrition, respectively (log-rank p < 0.001). After multivariable adjustment, malnutrition was independently associated with an increased risk of mortality (adjusted hazard ratio 1.53, 95% confidence interval 1.11–2.10, p = 0.009), also confirmed at inverse probability of treatment weighting-adjusted analysis. As compared to post-procedural residual TR ≥3+, residual TR ≤2+ was associated with a similar lower risk of mortality in patients with and without malnutrition (interaction p = 0.947). Conclusion: In the large, real-world, multicentre EuroTR registry, malnutrition was present in one out of five patients with symptomatic TR undergoing T-TEER and was independently associated with increased mortality. The prognostic benefit of successful T-TEER in reducing mortality was consistently observed in patients with and without malnutrition
Pancreatic Stone Protein as Sepsis Biomarker in Patients Requiring Mechanical Circulatory Support: A Pilot Observational Study
No full textObjectives: To demonstrate for the first time the performance of the novel biomarker pancreatic stone protein (PSP) in predicting the occurrence of sepsis in cardiogenic shock patients requiring mechanical circulatory support. Many patients with cardiogenic shock develop sepsis and the timely identification and treatment of sepsis remains a key factor to improve outcome and avoid unnecessary antibiotics treatment. Design: Observational study recording PSP values for 5 days or until intensive care unit discharge (whichever came first) to analyze its kinetic and evaluate a potential correlation with sepsis development. Setting: Cardiac intensive care unit. Participants: 32 adult patients with cardiogenic shock requiring mechanical circulatory support, 28% women with a median age of 68 years (range, 60-72 years). Interventions: None. Measurements and Main Results: The main causes of cardiogenic shock were postcardiotomy (50%) and acute myocardial infarction (25%). Patients were supported with and intra-aortic balloon pump (62.5%), Impella (6.3%), or venoarterial extracorporeal membrane oxygenation (3.1%); 28% of patients had more than 1 support device. Forty percent of patients developed sepsis during their intensive care unit stay. The overall median peak PSP reached was 389.5 ng/mL (interquartile range, 222-601 ng/mL), with a peak on day 2. The peak was higher in patients who developed sepsis (601 ng/mL [interquartile range, 556-601 ng/mL] in patients with sepsis v 257 ng/mL [interquartile range, 207-576 ng/mL] in patients without ). In these patients also daily PSP values from day 2 to 5 were higher. Conclusions: Patients supported with mechanical circulatory support who develop sepsis present with significantly higher PSP values than those who do not develop sepsis. PSP values are generally high in this population, even in patients not developing sepsis
Boosting Tolvaptan Tolerance in ADPKD: Low-Dose Hydrochlorothiazide Improves Patient Well-being Without Compromising Efficacy – A Case Report
No full text: ADPKD is the most common inherited kidney disorder, marked by numerous renal cysts, increased total kidney volume and progressive renal function decline. Mutations in the PKD1 and PKD2 genes, leading to altered cAMP signaling, drive cyst growth. Elevated antidiuretic hormone (ADH) levels further exacerbate cystogenesis. Tolvaptan, a vasopressin V2 receptor antagonist, is the only approved treatment for slowing ADPKD progression, but its use often results in significant polyuria and thirst, affecting patient quality of life. This case report presents a 31-year-old female with ADPKD, classified as Mayo Class 1D, who showed improved tolerance to tolvaptan after co-administering low-dose hydrochlorothiazide (HCT). The patient experienced a significant reduction in polyuria and thirst while maintaining stable kidney function over four years. The annual decline in eGFR was less than expected for her disease class and improved compared to the first year of tolvaptan therapy. This case suggests that HCT may enhance tolvaptan tolerability without reducing its efficacy. Ongoing studies, such as the HYDRO-PROTECT trial, aim to further explore the benefits of combining HCT with tolvaptan in ADPKD management
La realtà è sopravvalutata. Filosofia e multiverso
No full textC’è stato un tempo in cui i filosofi sostenevano che il nostro fosse il migliore dei mondi possibili. Era la sua esistenza a dimostrarlo: tra infinite alternative concepite dalla mente di Dio, solo questo mondo era degno di essere creato. Ma se non fosse così? Se la realtà fosse aperta, plurale e tutt’altro che unica o perfetta? Questa ipotesi, che potrebbe sembrare fantascientifica, affonda le sue radici nella filosofia. Da sempre, il pensiero filosofico ha esplorato la possibilità di realtà molteplici, e oggi, mentre la fisica quantistica e le simulazioni digitali aprono scenari e prospettive da multiverso, la filosofia può offrire gli strumenti per comprenderne le implicazioni. La realtà – o, almeno, questa realtà – non ci basta più. Per questo la scienza, l’arte e la filosofia non si limitano a descriverla o rappresentarla, ma ne dilatano i confini, spingendo sempre più in là le “porte della percezione” e dell’ontologia. Se la nostra realtà è solo una tra tante, abbiamo bisogno di una filosofia capace di esplorarne le molteplicità. Questo saggio raccoglie la sfida, portando alle estreme conseguenze le ipotesi della tecnologia del virtuale, i multiversi dell’immaginario Marvel e le speculazioni più avanzate della fisica quantistica. Un viaggio attraverso le frontiere della conoscenza, per ripensare i limiti della realtà e della nostra esperienz
Microbiota-produced immune regulatory bile acid metabolites control central nervous system autoimmunity
No full textThe commensal gut microbiota has a role in the pathogenesis of extra-intestinal autoimmune diseases such as multiple sclerosis (MS) with unknown mechanisms. Deoxycholic acid (DCA) and lithocholic acid (LCA) are secondary bile acid metabolites (BAMs) produced from primary bile acids by gut microbiota that play key immune regulatory functions by promoting FOXP3+ regulatory T (Treg) cell differentiation at the expense of Th17 cells. Here, we show that bacteria releasing enzymes responsible for secondary BAMs production are under-represented in the gut of MS patients, resulting in significantly reduced intestinal concentration of DCA and immune dysregulation with increased percentage of Th17 cells. We validated our human findings in a preclinical model of MS by showing that DCA/LCA administration prevents experimental autoimmune encephalomyelitis (EAE) by dampening Th17 cell differentiation and the effector phenotype of myelin-reactive T cells. Our data highlight the key role of immune regulatory BAMs for the prevention of central nervous system (CNS) autoimmunity
Real-world effectiveness of hepatitis B vaccination in dialysis patients
Get PDFChronic kidney disease is (CKD) a highly prevalent condition worldwide, with an increasing prevalence in the general population. Effective vaccination strategies are crucial in this population to prevent hepatitis B virus (HBV)-related complications. This study aimed to evaluate the effectiveness of different HBV vaccines in patients with CKD undergoing dialysis, focusing on seroconversion rates and overall immune response. A non-concurrent prospective cohort study was conducted on 160 outpatient long-term dialysis patients at the G. Martino Hospital in Messina. Patients were vaccinated with either FENDRIX (HB-AS04), HBVAXPRO 40 mg, or a combination, and their immune responses were assessed one month after the completion of the vaccination course. The study achieved 100 % vaccination coverage. The overall seroconversion rate was 62.5 %, with mean anti-HBs titers of 604.15 mIU/mL (±437.23 SD) across the cohorts. No significant differences were observed between responders and non-responders concerning demographic, clinical, and biochemical characteristics. The study confirms the effectiveness of HBV vaccines in patients with CKD, though with a lower and delayed response compared to the general population. Establishing a diagnostic-therapeutic care pathway that integrates vaccination from the early stages of CKD is essential to improve outcomes in this high-risk grou
Minimally Invasive vs Open Left Pancreatectomy for Resectable Pancreatic Cancer: Long-Term Results of the Randomized DIPLOMA Trial
No full textIMPORTANCE The DIPLOMA trial showed comparable radical resection rates after minimally invasive left pancreatectomy (MILP) and open left pancreatectomy (OLP) in patients with upfront resectable pancreatic cancer. Data on long-term overall survival (OS) and disease-free survival (DFS) are currently lacking, but are required before the oncological efficacy of MILP can be confirmed. OBJECTIVE To determine the long-term oncological outcome, including OS and DFS, of MILP vs OLP in patients with upfront resectable left-sided pancreatic cancer in the DIPLOMA trial. DESIGN, SETTING, AND PARTICIPANTS The randomized, patient-blinded and pathologist-blinded DIPLOMA trial was conducted between 2018 and 2021, with a follow-up duration of at least 36 months. It was a multicenter international trial that took place in 35 centers in 12 countries worldwide. Patients with upfront resectable pancreatic ductal adenocarcinoma of the body or tail of the pancreas were included. INTERVENTIONS Participants were randomly assigned to undergo MILP (laparoscopic and robotic) or OLP. Patients were blinded for the surgical approach. MAIN OUTCOMES AND MEASURES Main outcomes included OS and DFS. Other outcomes include receipt of adjuvant therapy and time to start of adjuvant therapy. RESULTS Between May 2018 and May 2021, 258 patients were randomized to the MILP (131 patients) and OLP (127 patients) groups. After a median follow-up of 38 (IQR 36-46) months, 134 patients (52%) had died and 127 patients (55%) experienced disease recurrence. OS did not differ significantly between the MILP and OLP groups (median, 32 vs 34 months; stratified hazard ratio, 1.02; 95% CI, 0.72-1.44; P = .92). Also, DFS did not significantly differ between the MILP and OLP groups (median, 21 vs 17 months; stratified hazard ratio, 0.96; 95% CI, 0.68-1.35; P = .81). Adjuvant therapy was administered in 79 patients after MILP (79 of 113 [70%]) and 79 patients after OLP (79 of 110 [72%]) (P = .63). Time to adjuvant therapy was comparable between groups (median 59 vs 56 days; P = .92). CONCLUSIONS AND RELEVANCE In this long-term follow-up of the randomized DIPLOMA trial in patients with upfront resectable pancreatic cancer, oncological outcomes after MILP and OLP did not differ significantly, confirming the oncological safety of MILP. TRIAL REGISTRATION International Standard Registered Clinical/Social Study Number Registry Identifier: ISRCTN4489726