Azienda Ospedaliera San Camillo-Forlanini

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.

Background: Recent advancements in heart failure (HF) therapy have significantly enhanced the management of patients across all phenotypes of left ventricular ejection fraction. However, these multidrug regimens frequently induce alterations in renal function by influencing intrarenal hemodynamics, thereby modifying glomerular capillary pressure. This phenomenon could result in a mild to moderate decline in estimated glomerular filtration rate (eGFR), often classified as “worsening kidney function.” This nomenclature stems from consistent observations of eGFR reductions recorded during HF treatment in clinical trials. This narrative review aims to elucidate why the observed eGFR declines in clinical practice may represent either loss of functioning glomeruli or pharmacologically mediated reductions in intraglomerular pressure that ultimately safeguards long-term renal and cardiovascular outcomes. Methods: By a comprehensive re-examination of data from HF clinical trials conducted with various classes of medications, all affecting eGFR, we sought to provide evidence that the decline in eGFR is associated with the activation of specific mechanisms that collectively contribute to a reduction in glomerular filtration pressure, a prominent factor in maladaptive neurohormonal responses. Results: From the investigation of angiotensin-converting enzyme inhibitors to the more recent non-steroidal mineralocorticoid receptor antagonist, the renal effects of these therapeutic regimens correlate with improvements in patient outcomes. The data consistently indicate that an early decline in eGFR, when coupled with an enhancement in HF outcomes, is associated with a more gradual decline in eGFR during long-term follow-up. Conclusions: Clinicians should recognize early declines in eGFR as indicators of favorable intraglomerular hemodynamic adjustments that mitigate maladaptive neurohormonal responses and contribute to improved long-term outcomes in patients with HF.

Evidence-based practice (EBP) is widely endorsed as a cornerstone for high-quality, patient-centered care. However, its integration into daily clinical routines remains inconsistent, particularly in settings where cultural, educational, and organizational challenges persist. Reliable, contextually adapted tools are essential to measure EBP implementation and guide improvement efforts. This study aimed to validate the Italian versions of the EBP Implementation Scale and its short-form (3-item) version. A cross-sectional survey design was adopted. Both versions of the EBP Implementation Scale were translated and culturally adapted in accordance with internationally recognized guidelines. Data were gathered from a national sample of 405 nurses through a combination of convenience and snowball sampling. Psychometric assessment encompassed confirmatory and Bayesian factor analyses, evaluation of internal consistency and test-retest reliability, and measurement invariance testing. All analyses were performed in R Studio. Confirmatory factor analyses confirmed that both versions (long and short) of the scale measure a single underlying construct. The instruments demonstrated high reliability (ω = 0.96 and 0.87 respectively). Measurement invariance across educational groups was partially established, as the partial scalar invariance model demonstrated acceptable fit (CFI = 0.991, RMSEA = 0.045), suggesting consistent interpretation of the scale across different levels of EBP training. Latent profile analysis revealed distinct subgroups of EBP implementers, with notable differences in latent means (p < 0.001) associated with previous education in evidence-based practice. The Italian EBP Implementation Scales are valid and reliable tools for assessing EBP implementation behaviors. They can support education planning, monitor practice changes over time, and inform interventions aimed at enhancing evidence-based care.

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.

BackgroundThe COVID-19 pandemic highlighted challenges in managing patients with multiple sclerosis (PwMS), as disease-modifying therapies (DMTs) can interfere with immune responses to infections and vaccines.ObjectiveThis study investigates the spike-specific T-cell response after the third dose of mRNA COVID-19 vaccines in PwMS undergoing DMTs, evaluating different cytokines, beyond IFN-γ, and exploring their potential association with SARS-CoV-2 breakthrough infections (BI).MethodsWe prospectively enrolled 31 PwMS and 27 healthcare workers (HCWs). The spike-specific T-cell response was evaluated by measuring Th1 cytokines (IFN-γ, IL-2, TNF-α) and IP-10 using an easy-to-use whole-blood assay.ResultsMost PwMS mounted a Wuhan spike-specific T-cell response by releasing Th1 cytokines (IFN-γ, IL-2, TNF-α) and IP-10, albeit with significantly reduced Th1 cytokine levels compared to HCWs. Fingolimod-treated patients showed the weakest response with significantly reduced IFN-γ and IL-2 levels compared to HCWs (both p<0.0001), as well as to ocrelizumab (p=0.0018 and p=0.0002, respectively) and cladribine/IFN-β-treated patients (p=0.041 and p<0.0001, respectively). Moreover, a cell-mediated response was observed against the Delta spike variant, and all cytokines correlated with each other. BI occurred in 38.7% of PwMS, with predominantly mild COVID-19 cases. Male sex (IRR: 4.05, p=0.017) and primary progressive MS (IRR: 3.65, p=0.052) were associated with a higher BI incidence rate. Spike-specific T-cell response did not associate with a higher protection against BI.ConclusionsThis study provides an in-depth immunological characterization of the spike-specific T-cell response in PwMS under DMTs, evaluating immunological biomarkers whose relevance may extend beyond COVID-19 for studying immune responses to other infections and vaccinations.

Abstract Background and Aims IgM antibodies are not typically detected using traditional crossmatch techniques, and the literature on pre-transplant anti-HLA IgM antibodies remains limited. Consequently, their role in post-transplant outcomes is not yet fully understood. However, existing studies suggest a lower incidence of acute graft rejection in patients with IgM-positive crossmatches. This effect may be partially explained by studies proposing a potential immunoregulatory role of IgM immunoglobulins. The objective of our study was to evaluate post-transplant outcomes based on the presence of anti-HLA IgM antibodies detected during pre-transplant screening. Method This retrospective, single-center study analyzed living-donor kidney transplants performed at Gemelli Hospital in Rome, Italy, over a 5-year period (January 2019–December 2023). The objective was to evaluate post-transplant outcomes based on the presence of anti-HLA IgM antibodies detected during pre-transplant screening. Patients were divided into three groups: (1) anti-HLA IgM-negative, (2) non-donor-specific (DSA) anti-HLA IgM antibodies, and (3) DSA anti-HLA IgM-positive. The primary endpoint was one year graft function, assessed by the eGFR slope and the presence of proteinuria. Secondary endpoints included incidence of rejection, delayed graft function (DGF), infections and tumor during follow-up (until December 2024). Statistical analyses included Shapiro-Wilk, ANOVA, Kruskal-Wallis, and Chi-square tests. Results A total of 116 transplants were performed, 80 patients anti-HLA IgM-negative, 14 with non-DSA anti-HLA IgM, and 22 with DSA anti-HLA IgM. There were no differences in the use of induction and maintenance immunosuppression in the 3 study groups. There were six cases of DGF in group 1 and none in group 2 and 3 (P = 0.04). Group 3 patients had higher eGFR values throughout 1 year follow-up compared to group 1 and 2, although the differences were not statistically significant. Group 2 patients were characterized by a higher incidence of anti-HLA IgG DSA after transplantation (P = 0.0002). Notably, in 54.5% of group 3 patients IgM anti-HLA DSA disappeared during follow-up, whereas only 4.5% developed IgG anti-HLA DSA corresponding to pre-transplant IgM. We observed 4 acute antibody-mediated or cell-mediated acute rejection in group 1, 2 mixed rejections in group 2 and no rejections in group 3 (P = 0.01). Incidence of nephropathy recurrence was similar in the three groups. Finally, group 3 patients exhibited a higher incidence of CMV (P = 0.04) and BK virus (P = 0.023) infections. However, the incidence of other infections and post-transplant neoplasia was similar across groups. Conclusion Our findings suggest a protective role of donor-specific IgM antibodies in reducing acute rejection incidence and other transplant complications, ultimately supporting improved graft survival during follow-up.

Incisional hernia is a complication after abdominal surgery, with an impact on morbidity and mortality rates. Patients with end-stage renal disease who undergo renal transplantation are at high risk of developing incisional hernia as a result of either the adverse effects of uremia on wound healing or the use of immunosuppressive drugs, which can interfere with tissue repair mechanisms. The reported rate of incisional hernia after renal transplantation is up to 18%. Many surgical techniques are utilized for repairing incisional hernia: primary suture or the use of prosthesis, and laparoscopic as well as robot-assisted procedures. The Rutherford-Morrison incision may have a lower rate of incisional hernia compared to a hockey-stick incision. Tailored immunosuppression should be used in high-risk patients.

ABSTRACTBackgroundSkin evaluation in Aesthetic Medicine requires standardized methods to ensure reproducibility. The Mediskin check‐up protocol, first introduced in the late 1970s, provided a systematic approach to skin assessment in non‐pathological contexts. Advances in medicine and cosmetology have since required an update of this methodology.AimsTo present the updated Mediskin check‐up protocol and demonstrate its value for accurate diagnosis and personalized treatment planning in Aesthetic Medicine.Patients/MethodsThe revised protocol integrates updated anamnesis, clinical examination, and instrumental evaluation under standardized conditions to ensure reproducibility.ResultsThe protocol allows for the identification of skin biotypes (normal, seborrheic, dry, or sensitive), defined by combined anamnesis, clinical findings, and instrumental parameters. It establishes a reproducible diagnostic framework that supports follow‐up assessments and individualized treatment regimens.ConclusionsThe updated Mediskin protocol provides a standardized and reproducible method for skin evaluation in Aesthetic Medicine. By integrating clinical and instrumental data, it enhances diagnostic accuracy, guides personalized therapy, and supports safe and effective patient care.

Rigid bronchoscopy is a specialised endoscopic modality utilising a rigid scope instrument to afford direct visualisation and intervention within the central airways. In contradistinction to flexible bronchoscopy, the augmented working channel of the rigid instrument permits the introduction of larger-calibre instrumentation, thereby facilitating complex therapeutic procedures. These procedures encompass, inter alia, foreign body retrieval, endoluminal tumour debulking, airway stent deployment, and the management of life-threatening haemoptysis. While the procedure mandates general anaesthesia and a high level of operator expertise, rigid bronchoscopy provides superior airway control and the capacity to address complex airway pathologies that may be refractory to flexible bronchoscopy.