IRIS UniSR (’Università Vita-Salute San Raffaele)
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Artificial Intelligence in Inflammatory Bowel Disease Endoscopy
No full textInflammatory bowel diseases (IBDs), comprising Crohn’s disease (CD) and ulcerative colitis (UC), are chronic immune-mediated inflammatory diseases of the gastrointestinal (GI) tract with still-elusive etiopathogeneses and an increasing prevalence worldwide. Despite the growing availability of more advanced therapies in the last two decades, there are still a number of unmet needs. For example, the achievement of mucosal healing has been widely demonstrated as a prognostic marker for better outcomes and a reduced risk of dysplasia and cancer; however, the accuracy of endoscopy is crucial for both this aim and the precise and reproducible evaluation of endoscopic activity and the detection of dysplasia. Artificial intelligence (AI) has drastically altered the field of GI studies and is being extensively applied to medical imaging. The utilization of deep learning and pattern recognition can help the operator optimize image classification and lesion segmentation, detect early mucosal abnormalities, and eventually reveal and uncover novel biomarkers with biologic and prognostic value. The role of AI in endoscopy—and potentially also in histology and imaging in the context of IBD—is still at its initial stages but shows promising characteristics that could lead to a better understanding of the complexity and heterogeneity of IBDs, with potential improvements in patient care and outcomes. The initial experience with AI in IBDs has shown its potential value in the differentiation of UC and CD when there is no ileal involvement, reducing the significant amount of time it takes to review videos of capsule endoscopy and improving the inter- and intra-observer variability in endoscopy reports and scoring. In addition, these initial experiences revealed the ability to predict the histologic score index and the presence of dysplasia. Thus, the purpose of this review was to summarize recent advances regarding the application of AI in IBD endoscopy as there is, indeed, increasing evidence suggesting that the integration of AI-based clinical tools will play a crucial role in paving the road to precision medicine in IBDs
Etica tradizionale ed etica critica: rivoluzionare l'etica normativa
No full textTraditional ethics usually starts from general moral theories and applies their principles to specific situations. Yet, this methodology, though extremely useful and often effective, misses the opportunity to questions the causes and the origins of the situations undergoing moral analysis. A critical ethics attempts to clarify both the moral and political causes of situations of injustice, oppression, discrimination and isolation and the way in which moral principles are interpreted in the social, economic and cultural settings. In this way, ethical reflection can be more concrete and effective in pointing at the power relations that have to be changed to face ethical and political issues
[Urge urinary incontinence in women between 40 and 65 years: prevalence, quality of life, social impact, and costs]
No full textBACKGROUND: urge urinary incontinence (UUI) is the involuntary loss of urine accompanied or immediately preceded by a sudden and strong desire to urinate that cannot be delayed or that is difficult to postpone. Data claim that UUI increases significantly from 40 to 65 years, which is why this specific age group, which has been little studied in the literature, deserves to be investigated. Moreover, they are socially active and working women who represent a social and economic resource for the country: therefore, their malaise is not only a personal problem, but also a problem for the society. OBJECTIVES: to investigate the prevalence, quality of life, social impact, and costs of urinary incontinence in women aged 40 to 65 years. METHODS: a narrative review of the literature was performed through the following databases: PubMed, CINAHL, Web of Science, and Embase. The search string was processed using the PEO acronym. Source selection was conducted and reported according to the PRISMA flowchart, following the established inclusion and exclusion criteria. A total of 21 articles were included and analyzed in the review: 11 about the prevalence and 10 about quality of life, social impact, and costs. RESULTS: the prevalence of UUI varies according to the considered age group. In the 40-65-year age range, there is a progressive increase in the onset of UUI symptoms worldwide, with a prevalence of around one fifth of the female population. It also emerged that the quality of life of patients suffering from UUI is negatively affected: urine leakage is accompanied by feelings of embarrassment, frustration, and anxiety, which contribute to reduce the psychosocial, occupational and sexual activities of the affected patients, imposing high costs for the treatment, and management of the disorder and its comorbidities. CONCLUSIONS: considering the wide prevalence of UUI in women aged 40-65 years and given the growth prospects of the phenomenon, it is important to increase the attention of women and health professionals regarding this disorder. In order to support the clinical practice with scientific evidence, it would be appropriate for future research to focus on the predictors of UUI and their prevention, too. The development of new educational and rehabilitative programmes is necessary to increase awareness, prevention, diagnosis, and UUI effective management
Direct and indirect healthcare costs of ocular diseases in Italy: a literature review on glaucoma, diabetic retinopathy, and macular degeneration
No full textBackground: Glaucoma, diabetic retinopathy, and age-related macular degeneration impose substantial economic burdens on healthcare systems due to their high prevalence and chronic nature. Nevertheless, comprehensive Italian data is limited. This study aims to collect Italian evidence on the economic impact of these conditions to support more effective healthcare planning. Study design: Systematic review. Methods: A systematic literature search was conducted in accordance with PRISMA guidelines across PubMed, Scopus, Web of Science, and EMBASE databases. Studies reporting cost evaluations of managing glaucoma, diabetic retinopathy, and age-related macular degeneration in Italy were included. Direct, indirect and non-medical costs were considered. Results: The review included 23 studies exhibiting considerable heterogeneity in timeframes, regions, and economic evaluation approaches. For glaucoma, annual direct costs ranged from €788.70 for early-stage cases to €8,368.51 for advanced cases requiring surgery. Annual costs associated with diabetic retinopathy ranged from €4,050 to €5,799 per patient, depending on disease severity and treatment approach. The financial burden of age-related macular degeneration varied considerably, with costs ranging from €1,399.20 for early-stage cases to €3,973.30 for advanced stages. Although non-medical and indirect costs, such as lost productivity and caregiving expenses were less frequently assessed, they represented a significant contributor to the overall financial burden. Conclusions: This study highlights the substantial economic burden ocular diseases place on the Italian healthcare system. Early intervention and preventive strategies could reduce the long-term costs of managing diabetic retinopathy and age-related macular degeneration. Further research into indirect costs and cost-effective interventions is necessary to support more efficient healthcare resource allocation
Effects of rhythmic-cued gait training on gait-like task related brain activation in people with multiple sclerosis
No full textBackground: Walking impairment is one of the most debilitating symptoms of multiple sclerosis (MS). A better understanding of brain mechanisms underlying successful gait training could help to improve development of targeted therapy. We therefore investigated changes in brain activation associated with improvements in walking function after rhythmic-cued gait training. Methods: Thirty-one people with MS (pwMS; median EDSS = 2.5, range:2.0–5.0) and 17 age- and sex-matched healthy controls (HC) completed behavioural and MRI assessments at baseline and post-intervention (four weeks after baseline). All included pwMS received a four-week actual and/or imagined gait training with rhythmic-auditory cueing, while HC received no intervention. All participants performed a bipedal ankle plantar- and dorsiflexion and a corresponding motor-imagery task during fMRI. PwMS displaying a > 5 % walking distance increase in the 2-Minute Walk Test (2MWT) from baseline to post-intervention were defined as responders. Results: Responders did not differ from non-responders in terms of demographics, clinical variables, and walking function at baseline. Responders, non-responders, and HC showed similar movement-related brain activation at baseline. At post-intervention, responders showed decreased brain activation within the premotor cortex, precuneus, and middle frontal gyrus during the movement task. Stronger decreases within these areas were associated with higher walking function improvements in all pwMS after controlling for potential confounders. No association was observed between walking function and motor imagery-related brain activation changes. Conclusion: Improved walking function after rhythmic-cued gait training was associated with reduced brain activation in motor planning and attention areas. This suggests a more efficient recruitment of areas subserving motor function after successful training
Continuous Glucose Monitoring and Long-Term Assessment of Islet Function in Autologous Islet Transplantation after Total Pancreatectomy for Neoplasm: Preliminary Insights from a Prospective Study
No full textBackground and Aims: Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical option to mitigate the risk of anastomotic complications and preserve endogenous insulin secretion in patients undergoing pancreaticoduodenectomy. However, the utility of continuous glucose monitoring (CGM) in assessing islet graft performance remains poorly characterized. Thereby, the aim of this study was to investigate the relationship between CGM-derived glycemic metrics and islet function following TPIAT. Materials and Methods: Ten patients with pancreatic neoplasms (male/female 5/5, median age 60 [IQR 55–68] years) underwent TPIAT between September 2023 and March 2025 at the Verona University Hospital, receiving a median islet dose of 1912 IEQ/kg [IQR 1724–3074]. CGM data were collected at 3 (n = 10), 6 (n = 8), and 12 (n = 7) months post-transplantation. Islet metabolic function was assessed using Igls criteria and BETA-2 score. CGM metrics were compared across Igls-defined graft function categories and correlated with BETA-2 scores. Results: Of 25 total assessments, islet function was classified as optimal (n = 10), good (n = 6), marginal (n = 8), or failure (n = 1). Median BETA-2 score decreased significantly across these groups (19.4, 13.6, 5.3, 1.4, respectively; P < 0.001). Optimal function was associated with superior glycemic control (time in range, TIR: 97.0%; time in tight range, TITR: 86.5%; time above range, TAR: 1.5%) and lower glycemic variability (coefficient of variation, CV: 20.5%; glycemia risk index, GRI: 44.0), compared with good and marginal groups (all P < 0.01). These same CGM metrics were significantly correlated with both Igls classification and BETA-2 score (all P < 0.015). Conclusions: CGM parameters reflect islet graft performance following TPIAT and are strongly correlated with established markers of β-cell function. Metrics such as TIR, TITR, TAR, CV, and GRI may serve as practical and sensitive tools for post-transplant metabolic surveillance in endocrine clinical practice
Constructing the relationship between language and emotion: Evidence from monolingual and bilingual speakers.
No full textA growing body of evidence shows that emotional stimuli tend to be perceived as
having a different impact depending on whether they are processed in one’s mother
tongue or in a foreign language. According to constructionist theories of emotion, such
language-related differences in the perception and experience of emotions arise from the
fact that language provides the context for the construction of emotion. Language is
thought to interpret sensations in terms of discrete emotions through the words stored in
conceptual knowledge. Languages that encode different emotion words would thus differ
with respect to what is perceived as an emotion and how it is experienced. Experiencing
emotions differently according to the language of processing should also have a relevant
impact on cognition and behavior, including decision-making. Indeed, making choices in
a native vs. foreign language has been shown to lead to decision outcomes that are
systematically different. The present dissertation aims to provide additional evidence of
the role of language in emotion perception and experience. Findings from both
monolingual and bilingual speakers support the claim that language is a necessary
ingredient in the construction of emotions, as it supports the development and
organization of conceptual knowledge which is accessed to make emotions meaningful.
Accordingly, our results show that such access is triggered to a greater extent by stimuli
presented in the native vs. foreign language, leading to a deeper and more intense
emotional resonance. Nevertheless, a higher proficiency in the foreign language seems to
induce a native-like access to conceptual knowledge and, thus, emotional experience.
Moreover, findings indicate that language-related differences in decision-making, when
present, are mediated not by a different emotionality but by a different access to the social
concepts encoded in conceptual knowledge. Yet individual differences in bilingual
language background seem to significantly affect decisions and judgments, above and
beyond the simple effect of the language of processing. Therefore, the current dissertation
provides original findings that contribute to our understanding of the dynamic interplay
between language and emotion, also revealing insightful bilingualism-related effects on
this relationship.Numerose evidenze mostrano che gli stimoli emotivi sono percepiti come aventi un impatto diverso a seconda del fatto che siano processati nella lingua madre o in una lingua straniera. Secondo le teorie costruttiviste delle emozioni, queste differenze legate alla lingua nella percezione ed esperienza delle emozioni derivano dal fatto che il linguaggio costituisce il contesto per la costruzione delle emozioni. Si ritiene che il linguaggio interpreti le sensazioni in termini di emozioni discrete attraverso le parole immagazzinate nella conoscenza concettuale. Pertanto, lingue che codificano differenti parole emotive dovrebbero differire rispetto a cosa è percepito come un'emozione e come è esperito. Esperire le emozioni in modo diverso a seconda della lingua in uso dovrebbe avere un rilevante impatto anche su cognizione e comportamento, inclusa la presa di decisioni. Infatti, prendere decisioni nella lingua madre vs. straniera si è rilevato portare a scelte che sono sistematicamente diverse. La presente tesi di ricerca mira a fornire ulteriori evidenze a supporto del ruolo del linguaggio nella percezione ed esperienza emotiva. I risultati ottenuti da parlanti monolingue e bilingue supportano l'affermazione secondo cui il linguaggio è un ingrediente necessario per la costruzione delle emozioni, giacché supporta l'acquisizione e l'organizzazione della conoscenza concettuale a cui si accede per dare significato alle emozioni. Di conseguenza, i nostri risultati mostrano che questo accesso è innescato in misura maggiore da stimoli presentati nella lingua madre, rispetto ad una straniera, portando a una risonanza emotiva più profonda e intensa. Tuttavia, una maggior padronanza della lingua straniera sembra indurre un accesso quasi-nativo alla conoscenza concettuale e, quindi, una maggiore esperienza emotiva. Inoltre, i risultati indicano che le differenze linguaggio-correlate nella presa di decisioni, quando presenti, sono mediate non da una diversa emotività ma da un diverso accesso ai concetti sociali immagazzinati nella conoscenza concettuale. Tuttavia, le differenze individuali nel background bilingue sembrano influenzare significativamente le decisioni e i giudizi, al di là del semplice effetto della lingua in uso. Quindi, la presente tesi fornisce risultati originali che contribuiscono alla conoscenza della dinamica interazione tra linguaggio ed emozioni, rivelando inoltre interessanti effetti dell'esperienza bilingue su questa relazione
Impact of intraoperative blood loss on postoperative morbidity after liver resection for primary and secondary liver cancer
No full textBackground: We sought to determine the association between intraoperative blood loss (IBL) and postoperative morbidity among patients undergoing surgery for liver cancer. Methods: Patients undergoing surgery for primary and secondary liver cancer were identified from a multi-institutional database. Adjusted blood loss (aBL) was calculated by normalizing IBL to body weight; the comprehensive complication index (CCI) was used to evaluate postoperative complications. Results: A total of 2491 patients were included. Mean CCI was 10.6 (±5.2) for patients with aBL <10 mL/kg versus 15.2 (±7.2) for individuals with aBL ≥10 mL/kg (p < 0.001). On cubic spline regression, a nonlinear correlation between aBL and CCI was observed. CCI increased exponentially for aBL ranging from 5 to 10 mL/kg, then reached a plateau between an aBL of 10–30 mL/kg before dramatically increasing for aBL >30 mL/kg. Recursive partitioning technique demonstrated that an aBL threshold of 8.5 mL/kg best distinguished CCI (p < 0.001). Additionally, patients with an aBL ≥8.5 mL/kg had worse recurrence-free and overall survival versus patients with an aBL <8.5 mL/kg. Conclusion: A nonlinear incremental correlation between aBL and CCI was identified among patients undergoing surgery for liver cancer. Maintaining an aBL <8.5 mL/kg during LR may help reduce postoperative morbidity
Factors influencing the feeling of shame in individuals with incontinence: The INCOTEST study
No full textIntroduction: Shame is defined as a negative emotion associated with intense distress and self-blame. It strongly manifests in conditions such as urinary or fecal incontinence. This study aimed to explore the feeling of shame experienced by individuals with incontinence when discussing their condition with others. Additionally, the study sought to identify factors associated with this emotion. Methods: A prospective observational study was conducted with 220 patients with incontinence who filled in a 17-item online survey. Multivariate linear regression analysis was used to identify factors related to shame. Results: A significant sense of shame was reported by 39.1% of participants when discussing their incontinence. The highest levels of shame were observed among women with poorer health status who initially sought advice from general practitioners, had limited knowledge of incontinence, and relied primarily on the internet for information. Conclusion: This study highlights the importance of adopting a comprehensive approach that includes incontinence's emotional and psychological aspects. Educational and awareness interventions are crucial to enhance understanding, provide reliable information, and reduce social stigma. Creating a trusting environment is essential to enable individuals with incontinence to feel comfortable discussing their condition with healthcare professionals, promoting open and supportive communication