AOL (United States)

Direct current stimulation (DCS) -i.e., the application of a static electric field to the brain through surface scalp electrodes- emerged as a novel therapy for neuropsychiatric disorders. In this study, DCS-induced changes in gene expression were assessed on Botryllus schlosseri, a ubiquitous simple colonial chordate living in temperate seas and sharing genetic remarkable similarities with mammals. Colonies underwent either sham or real DCS stimulation. Behavioral assessments, including the Siphon Stimulation Test and heart-rate measurements, were conducted before and at three intervals post-stimulation (3, 24, and 48h). Gene expression was analyzed with sequencing reads via Trimmomatic®. Analysis of heart rate frequency revealed post-treatment differences between the groups immediately after stimulation (p=0.001), with the effect decreasing over time. Real DCS differentially expressed 191 genes at three h post-DCS, 104 at 24h, and 529 at 48h. Our study introduces a novel pre-clinical model for DCS application demonstrating for the first in vivo time an after-effect on gene expression related to inflammation, human development, and neurodegeneration. To the best of our knowledge, this is the first paper addressing DCS effects on gene expression in a living animal model.

The ongoing digital transformation is reshaping organizational and care delivery models in cardiology, positioning telemedicine as a pivotal tool to address increasing clinical and demographic complexity. This ANMCO position paper presents a comprehensive and critical overview of telemedicine applications in cardiovascular care, with a focus on its role in strengthening hospital-community integration, its deployment within hospital-based healthcare systems, and the associated regulatory and operational frameworks. The analysis encompasses the management of chronic cardiovascular conditions, such as heart failure and atrial fibrillation, through telemonitoring, telecontrol, televisit, and teleconsultation. Additionally, it explores the use of digital technologies in post-myocardial infarction follow-up, oral anticoagulation management, preoperative assessment, and care for elderly patients. The position paper also highlights the challenges and opportunities linked to digital infrastructure, interoperability, data protection, and healthcare professional training.

The introduction of novel robotic platforms has expanded surgical options for robot-assisted radical prostatectomy (RARP). However, comparative outcomes with da Vinci multiport (MP) system remain unclear. This systematic review and network meta-analysis aimed to compare perioperative, early oncological, and functional outcomes of RARP performed with novel robotic platforms versus the da Vinci MP system. A systematic literature search was conducted in PubMed, Scopus, and Embase (updated December 22, 2024) following PRISMA guidelines. Eligible studies compared RARP performed with alternative robotic platforms versus da Vinci MP, reporting perioperative, oncological, or functional outcomes. A network meta-analysis was conducted using a random-effects model. Outcomes were expressed as mean differences for continuous variables and odds ratios (OR) for dichotomous variables, with 95% confidence intervals (CI). Thirty-three studies for a total of 5987 patients were included. Compared to da Vinci MP, da Vinci SP had lower odds of lymph node dissection (OR 0.39, 95% CI 0.26-0.61) and nerve-sparing (OR 0.11, 95% CI 0.02-0.61) but was associated with shorter catheterization (-1.18 days, 95% CI -2.05 to -0.31) and hospital stay (-0.68 days, 95% CI -1.05 to -0.31). Versius, KangDuo, and SHURUI SP had significantly longer operative times (MD 74.00, 95% CI 42.49-105.51; MD 53.96, 95% CI 18.26-89.67; MD 103.88, 95% CI 69.99-137.78, respectively). Hugo RAS had higher intraoperative malfunction rates (OR 6.53, 95% CI 2.17-19.63). Positive surgical margin rates were lower for da Vinci SP (OR 0.70, 95% CI 0.53-0.92) but higher with the perineal approach (OR 6.30, 95% CI 1.53-25.94). PSA persistence, biochemical recurrence, continence and erectile function rates were comparable across platforms. This is the first network meta-analysis comparing robotic platforms for RARP. While perioperative differences exist, oncological and functional outcomes appear comparable. Future studies should address learning curve effects, cost-effectiveness, and long-term functional outcomes to optimize robotic platform selection.

To evaluate the association between time to biochemical recurrence (ttBCR) and cancer-specific mortality (CSM) after prostatectomy or radiotherapy. This population-based study included 3606 patients experiencing BCR after prostatectomy or radiotherapy in Stockholm, Sweden, between 2003 and 2019. We tested the association between ttBCR and CSM using Cox models adjusted for clinical and pathological characteristics and estimated conditional cancer-specific survival by ttBCR and EAU risk group. Among prostatectomy (n = 2392) vs radiotherapy patients (n = 1214), 589 vs 170 (25 vs 14%), 1205 vs 387 (50 vs 32%), 598 vs 657 (25 vs 54%) were low, intermediate, and high EAU risk group, respectively. The median ttBCR was 29 (interquartile range (IQR):11, 58) and 33 months (IQR:16, 60) among prostatectomy and radiotherapy patients, respectively. At a median follow-up for survivors of 52 months after BCR, 823 patients died, including 394 of PCa (104 in the prostatectomy and 290 in the radiotherapy group). At Cox multivariable models, ttBCR was associated with CSM in prostatectomy patients (HR:0.87; p:0.012) and radiotherapy patients (HR:0.69; p < 0.001). Adjusted cancer-specific survival probability was strongly influenced by ttBCR and EAU risk group. For instance, intermediate-risk patients with BCR after prostatectomy had a 10-year survival probability ranging from 0.74 to 0.98 for a ttBCR of 0 to 10 years. Limitations included the retrospective nature of the study. These findings demonstrate a strong association between ttBCR and CSM. These results suggest that ttBCR should be used to risk-stratify patients experiencing BCR after either RP or RT. The high survival probability observed in low- and intermediate-risk PCa patients who experience BCR after a prolonged period post-treatment should inform decisions regarding the intensity and duration of oncological follow-up for these patients.

Introduction. Metastases to the paranasal sinuses from primary lung cancer are exceedingly rare and often present with nonspecific symptoms such as epistaxis, facial pain, and nasal congestion. These lesions usually indicate advanced, disseminated disease with poor prognosis. Management is primarily palliative, focusing on symptom relief. Case report. An 82-year-old man presented with recurrent epistaxis and other nonspecific symptoms. Imaging revealed metastatic involvement, among others, of multiple paranasal sinuses characterized by a lepidic-like growth pattern without bone erosion. Biopsy confirmed EGFR -mutated lung adenocarcinoma. Palliative hemostatic radiotherapy was administered to the sinonasal region, achieving rapid bleeding control. EGFR -targeted therapy was initiated, but the patient died shortly thereafter due to systemic progression and renal failure. Conclusions. Paranasal sinus metastases from lung cancer represent an uncommon, late-stage manifestation associated with dismal outcomes. Early recognition and multidisciplinary palliative approaches are crucial. Further molecular research is needed to improve systemic treatments in EGFR -mutated advanced lung adenocarcinoma.

With the advent of agents targeting distinct inflammatory pathways, therapeutic sequencing after anti-tumor necrosis factor alpha (TNF-α) failure in ulcerative colitis (UC) represents a major challenge. We compared the real-world effectiveness and safety of vedolizumab, ustekinumab, and Janus kinase inhibitors (JAKis) in anti-TNF-α-exposed patients. In this retrospective, multicenter European study, adults with UC initiating second-line vedolizumab, ustekinumab, or a JAKi after anti-TNF-α were evaluated. Baseline confounding was addressed by applying energy balancing weights (EBWs). Effectiveness outcomes included probability of steroid-free clinical remission (SFCR) and biochemical SFCR at 12 months, analyzed using EBW-weighted Royston-Parmar survival models to derive adjusted time-averaged hazard ratios (aHRs). Adverse event (AE) rates were compared using EBW-weighted Poisson regression. A total of 596 patients were included (301 vedolizumab, 149 ustekinumab, 146 JAKi); 54.7% were male, with a mean age of 43.9 ± 15.5 years. Clinical activity, endoscopic scores, and biomarker levels were broadly comparable across treatment groups. Infliximab was the most common prior anti-TNF-α (74.8%), and secondary failure was the predominant discontinuation reason (47.3%). Compared with vedolizumab, both ustekinumab and JAKi showed significantly higher probability of SFCR (aHR, 1.54; 95% confidence interval [CI], 1.09-2.07; and aHR, 1.66; 95% CI, 1.07-2.53, respectively) and biochemical SFCR (aHR, 2.26; 95% CI, 1.48-3.28 and 3.37; 95% CI, 2.01-5.36, respectively) at 12 months, with no differences between them. JAKi recipients experienced an approximately 4-fold higher incidence of AEs, compared with both vedolizumab and ustekinumab, with no differences between ustekinumab and vedolizumab. Ustekinumab and JAKi were more effective than vedolizumab in inducing steroid-free and biochemical remission following anti-TNF-α failure. Safety concerns with JAKi warrant careful patient selection in clinical practice. gov, Number: NCT06691061.

Valued above all others, the white truffle species (Tuber magnatum Picco) is highly dependent on the forest ecosystem and its underground biology. Despite its economic importance, knowledge of its biology and mycorrhizal symbioses remains limited; moreover, natural yields have sharply declined, and cultivation efforts have produced inconsistent results. This study evaluated various forest and mycorrhizal inoculation techniques to promote T. magnatum mycelium development in three Tuscan sites converted to truffle cultivation, using qPCR analysis. Alongside conventional practices like irrigation, mulching, and tillage, an experimental method with a sterile, spore-inoculated soil barrier was tested to improve host root establishment, enhance mycorrhization, and maintain long-term symbiosis for healthy truffle ecosystems. Soil analyses nine months after planting Quercus robur L. seedlings showed significant differences in Tuber magnatum mycelium abundance across sites and treatments. The MA treatment—mycorrhized seedlings combined with a sterile, inoculated substrate and separation diaphragm—produced the highest mycelial levels, underscoring the importance of initial mycorrhization and soil manipulation. These findings provide valuable insights for optimizing forest management and improving truffle cultivation by enhancing mycelial development, a key step toward increasing truffle production.

Accurate placement of central venous catheter tips is crucial for preventing complications, such as arrhythmias and vascular injuries. Intracavitary electrocardiography (I-EKG) has emerged as a reliable alternative to chest X-rays for catheter tip positioning, offering real-time results without radiation exposure. This study evaluates the quality of I-EKG tracings using two methods: the saline column method with the alligator clip and spindle system (Deltamed, Viadana, Italy) and the pure saline column method using the "red" connector cable (Vygon Card® Vygon, Ecouen, France) and the "yellow" connector cable (Fast Tip® ATL Milano, Assago, Italy). Twelve patients undergoing a peripherally inserted central catheter (PICC) placement were enrolled in this prospective study at Luigi Sacco Hospital, Milan. I-EKG tracings were recorded using all three devices, yielding a total of 36 tracings. Objective measurements of P, QR, and RS wave amplitudes were taken over five heartbeats per tracing, while twelve experienced operators performed subjective evaluations using a 5-point scale. Statistical analyses compared the three techniques. There were no significant differences in tracing quality among the methods. Objective analyses of wave amplitude ratios confirmed equivalent performance across approaches. Subjective evaluations yielded comparable scores for the "alligator-spindle," "red," and "yellow" connector techniques, with no statistically significant variation. With the limits of the small sample size, the pure saline column methods ("red" and "yellow" connectors) present similar EKG trace quality while offering procedural simplicity and enhanced safety. By eliminating the need for a spindle, these may reduce the risk of arrhythmia and avoid possible effects of guidewire contamination. These findings support the broader adoption of pure saline column techniques to optimize catheter placement procedures.