Azienda Ospedaliera Pugliese Ciaccio

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.

Abstract Background The National Amyloidosis Centre (NAC) and the Columbia Classifications are used to categorize the severity and progression of cardiac amyloidosis. Recent studies indicated that myocardial involvement initially occurs at the atrial level, preceding the manifestation of standard echocardiographic alterations. Understanding how the currently approved clinical classifications correlate with other parameters is pivotal to better define the disease burden at the onset of its manifestation. Purpose To verify the correlation between the two Classifications and other parameters for amyloidotic burden estimation, with a focus on advanced echocardiography techniques (Global Longitudinal Strain, GLS; Peak Atrial Longitudinal Strain, PALS; Peak Atrial Contraction Strain, PACS). Methods A population of 96 patients (age 76.9; 50-91, SD ± 9.2) affected by cardiac amyloidosis was selected: 58 Transthyretin-related Amyloidosis (ATTR), 38 Light-Chain Amyloidosis (AL). Each patient was classified according to both NAC and Columbia systems. Then, NAC and Columbia classifications were correlated with various parameters. The Pearson's correlation was applied to clinical and echocardiographic measurements, such us functional capacity (measured by the 6-min walk test; 6MWT), standard echocardiographic techniques and advanced echocardiographic techniques, including atrial strain (PALS and PACS) and left ventricular strain (GLS). Results The NAC classification shows a positive correlation with the NYHA class (NAC-NYHA, r²=0.281, p£0.005; Columbia-NYHA, r²=0.648, p£0.001), indicating a worsening of the perceived symptoms (NYHA) by patients with increasing NAC class. Both the classifications show a positive correlation with the GLS (NAC-GLS, r²=0.245, p£0.005; Columbia-GLS, r²=0.384, p£0.001), indicating a deterioration of GLS which increases at the worsening of NAC and Columbia classes. Both systems also show a negative correlation with Left Ventricular Ejection Fraction (LVEF; NAC-LVEF, r²=-0.368, p£0.001; Columbia-LVEF, r²=-0.379, p£0.001) and Peak Atrial Longitudinal Strain (PALS; NAC-PALS, r²= -0.255, p£0.005; Columbia-PALS, r²=-0.398, p£0.001), demonstrating a reduction in LVEF and atrial strain with the increasing of NAC and Columbia systems. The latter shows also an inverse correlation with the 6-Min Walk tTest (6MWT; r²-0.472, p£0.001) and a positive correlation with the presence of B-lines on chest ultrasound (r²=0.360, p£0.05). Conclusions The integration between NAC and Columbia values with PALS and GLS can be used to personalize and monitor the therapy over time. The early atrial involvement could be pivotal for developing a new classification that integrates the parameters considered here. Such a classification could assist clinicians in appropriately titrating diuretic therapy, determining the optimal timing for initiating treatment with disease modifier treatments before significant cardiac involvement occurs.

ObjectivesThe identification of metastatic disease in patients with biochemical failure of prostate cancer (PCa) after radical prostatectomy (RP) determines subsequent treatment management. Our objectives were (i) to assess the prevalence of metastatic PCa in patients with biochemical failure following RP and PSA levels ≤ 1 ng/mL, as detected by 18F-PSMA-1007 PET/CT (PSMA-PET), and (ii) to identify predictors of metastatic disease.MethodsFifty-five patients with biochemical recurrence (BCR, n = 47) or persistent disease (n = 8) following RP as their primary and only prior treatment were retrospectively included if presenting with PSA levels ≤ 1 ng/mL. Patients who received any other anticancer treatment were excluded. PSMA-PET findings were categorized as either local recurrence (i.e., prostatic fossa and seminal vesicles) or metastases. Predictors of PSMA-PET positivity were assessed with univariate and multivariate regression analyses both in the whole sample and in two subgroups defined according to PSA levels (Group A = PSA < 0.5 ng/mL; Group B = PSA between 0.5 and 1 ng/mL).ResultsMedian PSA at the time of PET/CT was 0.37 ng/mL (range: 0.13–1.0). PSMA-PET was positive in 22/55 (40%) patients, 14/55 (25%) patients had metastatic disease. Overall, 31 PSMA-positive lesions were identified: 12/31 (39%) and 19/31 (61%) were local recurrences and metastases, respectively. In the whole cohort, ISUP grade > 3 (p = 0.003), pN1 status after surgery (p = 0.011), time to BCR ≤ 26 months (p = 0.03), and persistent disease (p = 0.003) were significantly associated with a higher rate of PSMA-positive metastases. At multivariate analysis, ISUP grade > 3 (p = 0.016) was the only independent predictor of metastases. Metastatic disease was detected in 8/38 (21%) patients in Group A and in 6/17 (35%) patients in Group B, respectively. In Group A, pN1 (p = 0.043) and persistent disease (p = 0.040) were significant predictors of metastases. In Group B, ISUP grade > 3 was the only predictor (p = 0.028).ConclusionsISUP grade > 3, time to BCR ≤ 26 months, pN1 status, and persistent disease after surgery indicated a higher likelihood of PSMA-positive metastatic disease in a homogeneous cohort of patients with biochemical failure and low PSA values. pN1 status and persistent disease were significant predictors of metastatic disease also in patients with PSA levels < 0.5 ng/mL.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12149-026-02153-9.

BackgroundNeck fractures of the fifth metacarpal are frequent hand injuries. Surgical intervention is indicated for fractures with > 30° flexion angulation, rotational deformities, or shortening > 3 mm. Various techniques, including K-wire fixation, plating, and minimally invasive systems can be used. This study evaluates the efficacy of the Minimally Invasive Reduction and Osteosynthesis System (MIROS) for treating displaced fifth metacarpal neck fractures.MethodsA retrospective review of patients treated with MIROS between 2019 and 2024 was conducted. Patients aged 18–80 years with unstable neck fractures of the fifth metacarpal were included, excluding open, pathological, or polytrauma cases. Radiological outcomes were assessed through Palmar Tilt Angle (PTA) and Lateral Tilt Angle (LTA) measurements pre- and postoperatively. Secondary outcomes included surgery duration, radiation exposure, healing time, and complications.ResultsFifty-two patients (44 men) were included, with a mean age of 35.1 ± 15.1 years. Postoperative improvements in PTA (from 35.4 ± 16.6 to 15.9° ± 9.3; p < 0.0001) and LTA (from 56.7 ± 14.7 to 29.3 ± 11.9; p < 0.0001) were significant. Mean surgery duration was 37.4 ± 18.1 min, and radiological healing time averaged 2.3 ± 1.4 months. The complication rate was 7.7%, with three cases of K-wire infection and one case of finger overlap.ConclusionMIROS demonstrated effective anatomical restoration, and a low complication rate, proving to be a reliable surgical technique for fifth metacarpal neck fractures. Further prospective, multicenter trials with longer follow-up are necessary to validate these findings.

IntroductionDesmoplastic small round cell tumor (DSRCT) is a rare and aggressive mesenchymal malignancy driven by the EWS-WT1 gene fusion. Prognosis remains poor despite intensive multimodal therapy. Preclinical studies indicate that trabectedin combined with irinotecan exerts synergistic antitumor effects in translocation-driven sarcomas.Case descriptionWe report a case series of eight young patients (age range 11-23 years) with advanced and relapsed DSRCT treated between 2021 and 2024 at five Italian pediatric oncology centers. The trabectedin-irinotecan combination (given on compassionate grounds) was administered as second-line therapy in six cases, and third-line in two. The regimen included trabectedin at 1.3 mg/m², 24-hour infusion, day 1, and irinotecan at 20 mg/m², days 8-12. Observed outcomes included: one complete remission, three partial responses, two minor responses, one mixed response, one progressive disease. The chemotherapy combination was overall well tolerated, with good preservation of patients' quality of life, and no life-threatening adverse events reported.Conclusions:This descriptive case series of trabectedin-irinotecan in DSRCT supports preclinical evidence of synergistic activity. The regimen was well tolerated and showed potential clinical benefit even in heavily pre-treated patients, providing a rationale for further studies to optimize dosing and explore early integration.

Introduction: The Uremic Pruritus in Dialysis Patients (UP-DIAL)—14-item scale is a validated, multidimensionaltool for assessing pruritus severity and clinical burden among patients with chronic kidney disease-associatedpruritus (CKD-aP). While the scale has been developed in Thai and other non-Thai languages, an Italian versionand cross-cultural adaptation have not been established for Italian-speaking CKD-aP populations.Aims: This study aimed to translate and validate an Italian version of the UP-Dial—14-item questionnaire for useamong hemodialysis (HD) patients.Materials and Methods: Following international guidelines, a rigorous translation process was undertaken,including independent forward and backward translations to ensure linguistic and conceptual equivalence. Thevalidation cohort comprised HD patients with CKD-aP from seven centers across Calabria, Italy. Patients andhealthcare professionals reviewed the Italian version to evaluate usability, readability, and cultural adaptation.Internal consistency was assessed using Cronbach’s alpha, and test-retest reliability was evaluated with the intraclass correlation coefficient (ICC) over a 7-day interval.Results: Of 323 HD patients screened, 132 with CKD-aP were included. Both patients and professionals confirmedsatisfactory face validity and adaptation. The Italian UP-DIAL—14-item demonstrated excellent internal consistency(Cronbach’s α = 0.91; 95% CI: 0.89-0.93) and reproducibility (ICC = 0.92; 95% CI: 0.90-0.94).Conclusions: The Italian version of the UP-DIAL—14-item is a valid, reliable, and reproducible instrument forassessing CKD-aP in HD patients. It is suitable as a patient-reported outcome measure for both clinical practiceand research.

The epidemiological transition has led to an increase in life expectancy and to a growing population of chronic patients, often with heart failure. These patients are frequently affected by comorbidities and frailty, which in turn increase the risk of disability and worsening quality of life, requiring an accurate multidimensional assessment (MDA). In this context, MDA is crucial for integrated and holistic management of elderly patients, considering not only the pathology but the patient in his complexity. MDA requires a multidisciplinary team to ensure a comprehensive and integrated assessment of the elderly patient. MDA tools assess various domains of health, using scales and validated tools to explore physical, functional, mental and socio-economic status. MDA is applied in two phases: an initial screening procedure and an in-depth analysis of individual problems for targeted interventions. MDA can be performed in various care settings, including outpatient clinics, hospitals, nursing homes, home care, and rehabilitation centers. Several studies show that MDA improves survival as well as functional and mental status, reducing hospitalization times and the frequency of institutionalization. This ANMCO position paper discusses MDA tools of older adults with chronic heart disease, highlighting the need for a holistic approach to address comorbidities and frailty in a growing population.

IntroductionThis observational prospective longitudinal multicenter study examines the occurrence and characteristics of long COVID (LC) in the Italian pediatric population.MethodsConducted across 12 Pediatric Units in Italy from January to March 2022, the study involved 1129 children diagnosed with SARS-CoV-2 infection. Data were collected via self-administered questionnaires at 1-3 months, 3-6 months, and 6-12 months post-infection, with LC defined as symptoms persisting for at least 2 months and occurring 3 months post-diagnosis.ResultsResults revealed that 68.6% of children reported at least one post-COVID symptom, with 16.2% experiencing LC. The most frequent symptoms included respiratory issues (43.4%), neurological and cognitive dysfunction (27.7%), gastrointestinal symptoms (22.1%), fatigue (21.6%), and sleep disturbances (18.8%). Age and gender differences were significant, with older children and females more prone to cardiovascular and neurological & cognitive dysfunction.DiscussionThe study highlights that LC in children presents similarly to adults, though less frequently. The occurrence of LC was lower compared to adult populations, likely due to the generally milder course of COVID-19 in children. The findings underscore the need for targeted follow-up and support for affected children, especially considering the long-term persistence of symptoms. Further research is necessary to explore the impact of COVID-19 vaccines on pediatric LC and the effects of different SARS-CoV-2 variants. These insights are crucial for developing strategies to manage and mitigate long-term impacts in children recovering from COVID-19.

Background and Clinical Significance: Chryseobacterium gleum is a Gram-negative opportunistic and emerging pathogen able to induce systemic manifestations (e.g., peritonitis, pneumonia, urinary tract infections, meningitis) in immunocompromised patients. No data on children have been published. Case Presentation: A 2-year-old child presented in the pediatric ambulatory room with recurrent fever, submandibular lymphadenopathy, and skin rash. Laboratory findings revealed the presence of microcytic anemia with an increase in c-reactive protein. Chest X-ray reported mild accentuation of the bronchial structure, especially on the right side and middle–lower zone. In the peripheral blood smear, anisopoikilocytosis and elliptical red cells were evident. Clinical evaluation revealed the presence of conjunctivitis and polymorphic erythema, hyperemic pharynx and tonsils, SPO2 99%, auscultation of the chest, harsh vesicular murmur all over the area, and some wheezing. Microbiological analysis of sputum and throat swabs revealed the presence of numerous colonies of Chryseobacterium gleum confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS score > 2.2). Conclusions: This is the first case of Chryseobacterium gleum post-COVID in a child. We suggest that a quick identification and an appropriate treatment represent the critical factors able to prevent the adverse outcomes related to C. gleum infection.

This review focuses on the use of conventional gel or coil and "new" generation hydrogel used as an embolic agent in endovascular applications. In general, embolic agents have deep or multidistrict vascular penetration properties as they ensure complete occlusion of vessels by exploiting the patient's coagulation system, which recognises them as substances foreign to the body, thus triggering the coagulation cascade. This is why they are widely used in the treatment of endovascular corrections (EV repair), arteriovenous malformations (AVM), endoleaks (E), visceral aneurysms or pseudo-aneurysms, and embolisation of pre-surgical or post-surgical (iatrogenic) lesions. Conventional gels such as Onyx or coils are now commercially available, both of which are frequently used in endovascular interventional procedures, as they are minimally invasive and have numerous advantages over conventional open repair (OR) surgery. Recently, these agents have been modified and optimised to develop new embolic substances in the form of hydrogels based on alginate, chitosan, fibroin and other polymers to ensure embolisation through phase transition phenomena. The main aim of this work was to expand on the data already known in the literature concerning the application of these devices in the endovascular field, focusing on the advantages, disadvantages and safety profiles of conventional and innovative embolic agents and also through some clinical cases reported. The clinical case series concerns the correction and exclusion of endoleak type I or type II appeared after an endovascular procedure of exclusion of aneurysmal abdominal aortic (EVAR) with a coil (coil penumbra released by a LANTERN microcatheter), the exclusion of renal arterial malformation (MAV) with a coil (penumbra coil released by a LANTERN microcatheter) and the correction of endoleak through the application of Onyx 18 in the arteries where sealing by the endoprosthesis was not guaranteed.