IRIS UniSR (’Università Vita-Salute San Raffaele)
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Disability worsening outcome in multiple sclerosis based on EDSS: does half a point matter?
No full textCreation of Side-to-Side Compression Anastomosis Using the GT Metabolic SolutionsTM Magnet System, DI Biofragmentable (MagDITM System) to Achieve Duodeno-Ileal Diversion in Patients with Obesity: Preliminary Italian Multi-Center Results
No full textBackgroundLinear magnetic compression is a novel technique to perform gastrointestinal anastomosis.ObjectiveThis Italian multi-center clinical investigation aimed to evaluate the feasibility, safety and efficacy of the creation of a side-to-side compression anastomosis using the GT Metabolic Solutions (TM) Magnet System, DI Biofragmentable (MagDI (TM) System) to achieve duodeno-ileal diversion.MethodsPatients with a body mass index (BMI) of >= 30 to 50 kg/m2 and weight regain and/or type 2 diabetes mellitus (T2DM) after sleeve gastrectomy (SG) and patients with a BMI of >= 30 to 35 kg/m2 and T2DM underwent a side-to-side duodeno-ileal diversion using the GT Metabolic (TM) DI Magnet (linear, 39 mm).Results28 patients (19 F) underwent surgery in 4 centers in the time between 09/24 and 02/25. Mean age and BMI were 44 years and 36.7 +/- 4.4 kg/m2. Mean operative time and hospital stay were 73.2 min and 1.6 days. Paired magnets were expelled in all patients in a mean of 37.3 days. There were three procedure-related serious adverse events (Clavien Dindo III, one ileal perforation on POD 1, one liver insufficiency leading to reversal on POD 144 and one trocar site hernia on POD 203). Mean BMI, %EWL and %TWL at 90 days (n = 23) were 32.7 +/- 0.8 kg/m2, 36.6 +/- 4.6% and 10.4 +/- 1.1%. Mean HbA1c decreased from 6% at baseline to 5.7% at 30 days and to 5.5% at 90 days.ConclusionPreliminary data shows that side-to-side magnet compression duodeno-ileal anastomosis was feasible, safe and effective. Future follow-up data is necessary
Prevalence and Screening Tools of Intimate Partner Violence Among Pregnant and Postpartum Women: A Systematic Review and Meta-Analysis
No full text(1) Background: Domestic violence (DV), including intimate partner violence (IPV) during pregnancy and the puerperium, represents a major public health issue, significantly affecting maternal and child health. (2) Methods: This systematic review and meta-analysis, conducted according to PRISMA 2020 guidelines, aimed to identify screening tools used to detect DV and IPV among pregnant and postpartum women and to estimate DV prevalence. The protocol was published in PROSPERO in advance (CRD42023473392). (3) Results: A comprehensive literature search across PubMed, EMBASE, Scopus, and Web of Science was conducted on 1 January 2024, resulting in 34,720 records; 98 studies met the inclusion criteria. The included studies were conducted in over 40 countries, and most were cross-sectional. Commonly used screening tools included the WHO Women’s Health and Life Experiences Questionnaire, the Abuse Assessment Screen, and the WHO Violence Against Women Instrument. Meta-analyses showed that 10% of women experienced physical violence, 26% psychological violence, 9% sexual violence, 16% verbal violence, and 13% economic violence. The overall prevalence of IPV during pregnancy and the puerperium was 26%. Despite the widespread use of validated instruments, substantial heterogeneity was observed, underscoring the need for standardization. (4) Conclusion: These findings underline the urgent need to integrate routine IPV screening into maternal care pathways using validated, culturally adapted tools, ensuring women’s safety and confidentiality
Moldable and Particulate Bone Material in Alveolar Ridge Preservation: A Multicenter Randomized Controlled Trial
No full textIncreased preoperative levels of circulating erythrocytic hemoglobin might predict high-grade histology (WHO grade 2-3) in falcine and parasagittal meningiomas
No full textBackground: Falcine/parasagittal lesions account for the largest rate of high-grade (WHO grade 2-3) lesions. The ability to preoperatively estimate the tumors' grade and outcome would be of great value in customizing treatment. Methods: This is a single-center, retrospective study designed to assess the pre-operative peripheral blood markers' diagnostic and prognostic role in patients harboring falcine (FM) and parasagittal (PM) high-grade meningiomas. N=116 patients undergoing surgical resection were included. A propensity score-matched analysis accounted for gender imbalances in low-grade (LG) vs. high-grade (HG) cohorts. Results: Seventy-three (N.=73) FM (63%) and 43 PM (37%) lesions were included. Patients harboring HG lesions showed significantly higher Hb levels than LG (mean 14.5±1.40 vs. 13.5±1.16 g/dL, P<0.001). Multivariate analysis controlling for demographics, lesion characteristics, blood markers, and steroid dose confirmed preoperative Hb as an independent predictive value of lesion grade (OR 1.75, 95% CI:1.01-3.07, P=0.04). Accordingly, patients showing increased Hb levels >15.4 g/dL achieved shorter OS (60.4 months, 95% CI: 14.7-106.1 vs. 134.7 months, 95% CI: 111.2-158.2) compared to patients with lower Hb values, P<0.001. Data were confirmed in matched cohorts. Conclusions: Increased levels of circulating erythrocytic hemoglobin might be independent predictors for high-grade histology and be associated with shorter overall survival in falcine and parasagittal meningiomas
Legislation on Medical Assistance in Dying (MAID): Preliminary Consideration on the First Regional Law in Italy
Get PDFMedical assistance in dying (MAID) remains a sensitive and evolving issue in Europe, frequently linked with discussions about human freedom, life dignity, and healthcare policy. While national consensus in Italy is absent, the Region of Tuscany has enacted Law No. 16/2025, which establishes a MAID procedure based on recent Constitutional Court rulings. The commentary aims to provide a preliminary analysis of the new law, addressing ethical, medico-legal, and social issues that emerge in relation to the Italian and global debate on the topic. The law establishes a three-stage process based on four eligibility criteria: irreversible disease, psycho-physical suffering, life-support dependence, and informed consent. However, Tuscany’s model poses medico-legal and ethical concerns, particularly about the boundaries of regional legislative competence, the duties of healthcare professionals, and the possibility of intra-national inequity or “health migration.” In addition, critical organisational implications derived from informed consent and lethal drug self-administration impede clinical implementation in some individuals with mental or neurological disorders. The lack of clarity in the different steps of the procedure, the uncertain supervision system, and the potential consequences for specific categories of vulnerable people underline the need for comprehensive national regulation. A future regulatory framework must balance procedural clarity with individual autonomy and equitable access, bringing Italy in line with larger European context for end-of-life care
Long-term outcomes of pancreatic islet transplantation alone in type 1 diabetes: a 20-year single-centre study in Italy
No full textBackground: Islet transplantation has the potential to cure type 1 diabetes by restoring endogenous insulin production. However, its success relies on balancing improved glycaemic control with the risks of immunosuppressive therapy. This study aimed to evaluate long-term outcomes of islet transplantation alone for type 1 diabetes, focusing on the effects of islet mass and immunosuppressive regimens on graft survival and insulin independence, and weighing glycaemic control benefits against the risks of immunosuppressive therapy. Methods: This cohort study retrospectively analysed individuals aged 18–67 years with type 1 diabetes who received intraportal islet transplantation alone at IRCCS Ospedale San Raffaele, Milan, Italy. Inclusion criteria comprised adults with type 1 diabetes diagnosed before the age of 55 years with severe recurrent hypoglycaemia or glycaemic instability. Major exclusion criteria included a HbA1c of more than 12·5%, a BMI of more than 30 kg/m2, and insulin requirements exceeding 1·2 IU/kg per day, along with contraindications to immunosuppressive therapy. Participants were recruited from the hospital's islet transplant registry. Follow-up was conducted through regular clinical visits, with data collected retrospectively. Outcomes assessed included patient survival, graft survival, insulin independence, glycaemic control, and adverse events. Data were analysed using an intention-to-treat method, mixed-effects models, Kaplan–Meier estimates, and Cox and logistic regression to identify factors linked to metabolic success and reduced risks. Findings: 79 patients underwent intrahepatic or intraportal islet transplantation alone between Feb 16, 2001, and June 1, 2023, and received a total of 159 islet infusions, with a median total islet mass of 9637 islet equivalents (IEQ) per kg. Complications were infrequent and mostly involved minor bleeding, with only 3% (two of 79) of patients requiring surgical intervention. Glycaemic control improved significantly after infusion, with a reduction of HbA1c by –10·04 mmol/mol (–13·63 to –6·46), and a decrease in daily insulin requirements by –13·35 units per day (–17·04 to –9·65). The intention-to-treat analysis showed a median graft survival (fasting C peptide ≥0·3 ng/mL) of 3·9 years (95% CI 1·6 to 6·2) and 44% (35/79) insulin independence for a median of 6 years (95% CI 2·88 to 9·08). Patients receiving more than 10 000 IEQ/kg with BAS, FK506, and Rapa therapy had a median graft survival of 9·7 years (3·1–16·0) and 73% (16 of 22) insulin independence. Kaplan–Meier estimates indicated graft survival rates of 86% at 1 year, 65% at 5 years, 47% at 10 years, 47% at 15 years, and 40% at 20 years. Overall survival was 92% (73 of 79) over a median follow-up of 13·1 years, with a 20-year survival probability of 84%. Adverse events related to immunosuppressive therapy were reported in 44% (35 of 79) of patients, with allosensitisation rates increasing from 6% at baseline to 42% after therapy discontinuation. Interpretation: This analysis of a large islet transplantation alone cohort provides valuable insights into factors influencing outcomes and highlights potential risks, supporting informed clinical decision making and the optimisation of future β-cell replacement strategies. Funding: None
The Role of Artificial Intelligence and Machine Learning Models in Antimicrobial Stewardship in Public Health: A Narrative Review
Get PDFAntimicrobial resistance (AMR) poses a critical global health threat, necessitating innovative approaches in antimicrobial stewardship (AMS). Artificial intelligence (AI) and machine learning (ML) have emerged as transformative tools in this domain, enabling data-driven interventions to optimize antibiotic use and combat resistance. This comprehensive review explores the multifaceted role of AI and ML models in enhancing antimicrobial stewardship efforts across healthcare systems. AI-powered predictive analytics can identify patterns of resistance, forecast outbreaks, and guide personalized antibiotic therapies by leveraging large-scale clinical and epidemiological data. ML algorithms facilitate rapid pathogen identification, resistance profiling, and real-time monitoring, enabling precise decision making. These technologies also support the development of advanced diagnostic tools, reducing the reliance on broad-spectrum antibiotics and fostering timely, targeted treatments. In public health, AI-driven surveillance systems improve the detection of AMR trends and enhance global monitoring capabilities. By integrating diverse data sources—such as electronic health records, laboratory results, and environmental data—ML models provide actionable insights to policymakers, healthcare providers, and public health officials. Additionally, AI applications in antimicrobial stewardship programs (ASPs) promote adherence to prescribing guidelines, evaluate intervention outcomes, and optimize resource allocation. Despite these advancements, challenges such as data quality, algorithm transparency, and ethical considerations must be addressed to maximize the potential of AI and ML in this field. Future research should focus on developing interpretable models and fostering interdisciplinary collaborations to ensure the equitable and sustainable integration of AI into antimicrobial stewardship initiatives
Narrative Knowledge, Archaeology, and Gender Roles: How We Use Today’s Stories to Make Sense of the Past
No full textUsing the Venus of Willendorf as a foundational example I explore the interplay between narrative knowledge and the construction of gender roles in archaeological interpretation. Archaeological narratives, often developed from sparse data and bridged by speculative connective elements, significantly shape public perception and academic understanding. These narratives, while attempting to fill gaps in archaeological records, inadvertently reflect contemporary societal structures, particularly in the assignment of gender roles. The study scrutinises the tendency within archaeology to project modern gender norms onto the past. This projection frequently occurs in the absence of definitive evidence, leading to reconstructions that may not only misrepresent but also oversimplify the complex nature of past gender roles. By critically analysing these narrative practices and their reliance on cognitive biases, the research aims to reveal how historical gender roles are constructed and the potential inaccuracies this process entails