IRIS UniSR (’Università Vita-Salute San Raffaele)
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The role of cardiac surgeons in transcatheter structural heart disease interventions: The evolution of cardiac surgery
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Challenges and solutions to the sustainability of gene and cell therapies
No full textThe promise of gene and cell therapy has become a clinical reality for several devastating diseases. However, major hurdles constrain their economic sustainability and endanger their survival on the drug market, especially those for rare diseases, which calls for innovative solutions
Donor heart allocation systems in Europe. A scientific statement of the Heart Failure Association of the ESC
No full textHeart transplantation remains the gold standard for treatment of most patients with advanced heart failure (HF), but despite improvements of organ recovery and utilization, donor heart scarcity remains a critically limiting factor. Detailed heart allocation systems (HASs) are in place to ensure use of organs for appropriate candidates, In Europe multiple, different HASs have evolved in different countries or communities of collaborating countries, like Eurotransplant or Scandiatransplant. In this scientific statement, we review the generic ethical and practical principles underlying allocation principles and examine and describe different European HASs with the purpose of discussing impact of outcomes for patients with advanced HF. It is shown that European HASs differ significantly with respect to which patients are prioritized and the methods by which the prioritization is performed. It is argued that the most commonly used parameter to describe success of a HAS, namely 1-year survival after heart transplantation, is a poor metric of HAS performance. The impact of HASs should be evaluated by several measures such as survival from listing, time to transplantation, the characteristics of patients undergoing heart transplantation, and over a longer time interval to understand the balance of early and late post-transplant risks and benefit. Mapping European HASs is a step towards understanding these factors and further research should determine the optimal HAS in a given HF population at a given time
fMRI in Psychiatric Disorders
No full textFunctional neuroimaging has become an important tool for clinical research, with the potentiality to provide information on psychiatric disease pathology and treatment response. We review functional magnetic resonance imaging (fMRI) research findings for five psychiatric disorders: schizophrenia, major depressive disorder, bipolar disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Brain functional abnormalities and possible underlying mechanisms for disease symptoms are discussed, with a focus on future clinical implications for fMRI in psychiatric disease
Endoscopic management of Zenker's diverticulum: need for standardization for high-quality comparative data
No full textA Multinational Randomized Trial of Mega-Dose Esomeprazole As Anti-Inflammatory Agent in Sepsis
No full textObjectives: Proton pump inhibitors have dose-dependent immunomodulatory effects. We tested the hypothesis that mega-dose esomeprazole therapy would reduce organ dysfunction in patients with sepsis or septic shock. Design: A multinational, randomized, double-blind, placebo-controlled clinical trial. Setting: Seventeen ICUs or emergency departments in three countries. Patients: Adult patients with sepsis or septic shock. Interventions: Mega-dose (1024 mg) esomeprazole or placebo over a 72-hour period. Measurements and main results: The primary outcome was mean daily Sequential Organ Failure Assessment (SOFA) score to day 10. Secondary outcomes included antibiotics-free days, ICU-free days at day 28, and all-cause mortality. We also conducted a mechanistic study of the in vitro effects of esomeprazole in sepsis. We randomized 307 patients and assigned 148 to esomeprazole and 159 to placebo. Mean age was 71 years; 166 patients (54%) had septic shock and median SOFA score at randomization was 7. The median mean daily SOFA score in the first 10 days post-randomization was 5 (interquartile range [IQR], 3-9) in the esomeprazole group and 5 (IQR, 3-8) in the placebo group (risk difference, 0.1; 95% CI, -0.8 to 1.0; p > 0.99). No differences were observed in secondary outcomes. Monocytes isolated from patients' peripheral blood and activated with a toll-like receptor agonist exhibited a pro-inflammatory phenotype, which was not affected by esomeprazole therapy. Conclusions: Among patients with sepsis or septic shock, mega-dose esomeprazole did not reduce organ dysfunction or other patient-related or biological secondary outcomes
The Effects of Online Yoga Practice on Cancer Patients: A Systematic Review
Full text linkBackground: Cancer remains a leading cause of death, with 9.7 million deaths in 2022. Despite advancements in diagnosis and treatment, many cancer patients experience side effects that significantly impact their quality of life, including chronic pain, anxiety, depression, sleep disturbances, and cancer-related fatigue. Non-pharmacological interventions, such as yoga, have gained attention for their potential to reduce stress and improve overall well-being. However, barriers such as fatigue, pain, and transportation issues limit access to in-person yoga, leading to the growing adoption of online yoga as a viable alternative. Objective: This systematic review synthesizes research on the effectiveness of online yoga for cancer patients. A comprehensive search was conducted across Medline, PsycINFO, and Scopus databases on 24 October 2024. The methodological quality of the studies was assessed using the CASP Checklist. Of 6266 articles initially identified, 14 studies met the inclusion criteria, comprising qualitative (n = 4) and quantitative (n = 10) studies. Results: The results suggest that online yoga can improve stress and sleep quality, with moderate effects on anxiety, depression, and fatigue. However, variability in study designs and methodological limitations complicate the evaluation of its overall effectiveness. Conclusions: Online yoga offers a practical, accessible option for cancer patients unable to attend in-person sessions, showing the potential to enhance mental and physical health outcomes. Nevertheless, the variability in study methodologies highlights the need for more standardized research to establish its role as a supportive intervention in oncology care
Rethinking chromatin accessibility: from compaction to dynamic interactions
Full text link: The genome is traditionally divided into condensed heterochromatin and open euchromatin. However, recent findings challenge this binary classification and the notion that chromatin condensation solely governs the accessibility of transcription factors (TFs) and, consequently, gene expression. Instead, chromatin accessibility is emerging as a factor-specific property that is influenced by multiple determinants. These include the mobility of the chromatin fiber, the capacity of TFs to engage repeatedly with it through multivalent interactions, and the four-dimensional organization of its surrounding diffusible space. Unraveling the molecular and biophysical principles that render a genomic target truly accessible remains a significant challenge, but innovative methods for locally perturbing chromatin, coupled with microscopy techniques that offer single-molecule sensitivity, provide an exciting experimental playground to test new hypotheses