Azienda Sanitaria Locale Viterbo

Prolonged monitoring with implantable cardiac monitors (ICMs) effectively detects subclinical atrial fibrillation (SCAF) in patients with cryptogenic stroke (CS). Understanding SCAF progression to higher burdens can affect decisions regarding oral anticoagulant (OAC) and antiarrhythmic therapies. This analysis aimed to quantify initial SCAF burden, its progression, and predictors of progression in CS patients. This multicenter project collected demographics, stroke characteristics, and SCAF daily burden in CS patients implanted with ICM. SCAF progression was defined as an increase in daily burden from initial detection, categorized as: 5 min to 1 h, 1-6 h, 6-24 h, 24 h for < 7 days, and 24 h for ≥ 7 days. Of 593 patients (70.0 ± 11.3 years, 42% female, median CHA2DS2-VASc score 4.7 ± 1.4) monitored over a median of 24.6 months, 32.7% had SCAF detected. While initial SCAF daily burden was < 1 h in 38.7% of SCAF patients, 53.3% progressed to a higher SCAF daily burden, with 30.6% reaching the 24 h burden by 36 months. Higher CHA2DS2-VASc scores and stroke severity were associated with SCAF progression. OAC therapy was initiated in 91.2% patients with a maximum SCAF daily burden < 1 h, while in 98.0% of those with a maximum daily burden ≥ 1 h (p = 0.042). Over half of CS patients with SCAF progressed to a higher burden, and about one-third reached a 24 h SCAF daily burden. These findings highlight the importance of continuous monitoring in CS patients for early SCAF detection and personalized therapy, considering SCAF burden progression and the patient's risk profile.

This study aims at exploring transport accessibility in Italy using data from the Aspect of Daily Life survey conducted by the Italian National Statistical Office (ISTAT). The aim is to identify the main determinants of perceived accessibility, in order to guide targeted policy interventions focused on improving public transport perceptions. The methodological framework is based on Covariance based - Structural Equation Modelling (SEM). The results indicate that confidence towards local and national institutions as well as transport affordability increase the perceived accessibility of public transports. Moreover, the quality of the local viability is negatively related with accessibility perception of public transportation.

Europe has witnessed a significant increase in the number and ferocity of so-called ‘mega-fires’, a phenomenon linked with climate change. Edge/IoT devices, coupled with AI/ML, can play an important role in preventing and fighting wildfires. Information gathered from environmental sensors deployed in the forest not only offers better monitoring but also helps to predict, detect, and manage wildfires. By using a traditional cloud-centric model, near-real-time analytics on the behavior and spread of wildfires cannot be achieved effectively due to the large amount of information to be transmitted. Improving the data processing capabilities of edge applications that are closer to the response teams deployed on the ground can provide a powerful tool for real-time assessment of wildfires.We have developed an innovative sensor which is capable of continuous monitoring of IR temperature with a 768-pixel image for flame detection. It is able to capture a 3MP RGB image under flame trigger and report data on CO2, PM1, PM2.5 and PM10 concentrations and the air quality index. Data are transmitted by NB-IoT LTE and CAT-M2 bands to a cloud server for alarm verification and fire time evolution. Edge AI algorithms are used to detect the onset of the flame. Field tests show the ability to detect a flame at a 90m distance with approximately 50 x 50 x 50 cm flame dimensions. The system has been designed to run with ultra-low power processors and electronics with a battery power supply lasting 6 months. A low-cost design for industrial production was also considered for the potential of large-scale deployments.

Introduction. Prognosis and response to treatment in Multiple Myeloma (MM) patients are profoundly influenced by genetic and cytogenetic alterations, either primary and secondary. The gold standard in clinical practice to detect these alterations is represented by fluorescence in situ hybridization (FISH) on purified or enriched plasma cells. Current guidelines recommend routine use of FISH to identify the following key high-risk prognostic markers: t(4;14), t(14;16), t(14;20), del(17p), gain(1q) and/or del(1p). In this context, aberrations involving the MYC family oncogenes [C-MYC (8q24) and, to a lesser extent, N-MYC (2p24)], are crucial progression events but are not currently evaluated in the clinical routine.Methods. Conventional cytogenetic analysis was done using G-banding (GTG) on whole bone marrow cells. FISH was performed on isolated PC initially with standard probes from MM panel, followed by the MYC probe after evidence of karyopypic alterations involving MYC loci.Results. The clinical and therapeutic results in three patients with MYC rearrangements at the conventional cytogenetic analysis followed by FISH confirmation with specific MYC probes are reported. Clinical data of the three patients are reported in the Table. Conventional cytogenetic analysis revealed C-MYC rearrangements in two cases (pt 1 and 2) and N-MYC rearrangement in one case (pt 3). These rearrangements were confirmed by FISH. From a prognostic point of view, according to the International Scoring System (ISS) classification one out three patients (pt 1) was at low-risk, while according to the Revised ISS (R-ISS) all three patients were at intermediate risk. All three patients were treated frontline with standard VTD scheme: pt 1 achieved a very good partial response (VGPR) but relapsed after 36 months and became resistant thereafter, pt 2 achieved a VGPR but had an early relapse and became resistant after a 2nd short partial response, pt 3 remained always in stable disease during three different lines of therapy with subsequent progression.Conclusions. Cytogenetic risk assessment is essential to identify high-risk abnormalities. While C-MYC and N-MYC play a key role among the genes involved in progression in about 15% of patients with MM and are associated with an unfavorable outcome, their evaluation is not considered in the standard FISH analysis and in the standard high-risk classification: as a consequence, their role is underestimated in the current clinical practice. Our three cases highlight the bad prognosis of patients carrying MYC alterations: it should be emphasized that these alterations would have not reported if only the conventional FISH panel on plasma cells had been used. Therefore, the inclusion of MYC rearrangements in the FISH panel is essential for a comprehensive and timely risk assessment in MM, reducing the proportion of patients with the so called “functional high-risk”.

To assess the predictability of Emprint HP-Generator (150W, 2.45GHz) in terms of ablation volume and sphericity both in the ex vivo and in vivo setting. In an ex vivo setting, 48 ablations were performed on porcine livers at varying ablation times with a constant power of 150W. MRI assessment of the ablation volumes was performed. In the in vivo setting consecutive procedures with 150W application with no rampage, single antenna positioning and availability of a contrast-enhanced computed tomography (CECT) immediately after the ablation were included. A semi-automated segmentation tool was used for volume estimation and spherical index (SI) was calculated. In the ex vivo group, mean ablation time was 5.3 ± 2.5min (range 1-10min), mean ablation diameter was 37.7 ± 5.8mm (range 21.3-49mm) and mean ablation volume was 20.1 ± 10.8cm3 (range 3-38.4cm3) with a mean SI of 0.83 ± 0.08. In the in vivo group 78 percutaneous liver ablations (tumour mean diameter 23.2 ± 11mm) in 65 patients (M46; F19; mean age 66.8 ± 11.3) were retrospectively enrolled from two institutions. The mean ablation time was 4,9 ± 2,5min (range 1-10min), mean ablation diameter was 41.3 ± 9.6mm (range 16-73mm) and mean ablation volume was 27.8 ± 15.6cm3(range 6.4-105.6cm3). Mean SI was 0.85 ± 0.11. Ablation volumes tend to be larger in case of hepatocellular carcinoma (HCC) compared to other histology (33.7 ± 21.2cm3 vs 24.8 ± 10.5cm3; p = 0.08). Both in ex vivo and in vivo settings, the SI remained stable regardless of ablation time andvolume (Pearson's r 0.08, p 0.46), while ablation volumes increased linearly with time (Pearson's r 0.79, p < 0.001). Clavien-Dindo 1 complications were registered (4/65, 6.1%). The Emprint HP-generator enables the creation of large predictable volumes in both settings. SI remains consistent regardless of ablation time and volume.

Modern oncology faces the need to integrate high-level evidence, non-pharmacological interventions into care pathways. Among these, structured physical exercise is shifting from a simple "virtuous recommendation" to a treatment that concretely influences clinical outcomes. The phase III CHALLENGE trial, conducted on 889 patients with stage II-III colon cancer, demonstrated a 6.4% absolute increase in 5-year disease-free survival (DFS) (HR 0.72) and a 37% reduction in overall mortality (HR 0.63). Observational evidence further confirms benefits in breast, prostate, and lung cancers. This review summarizes the literature, analyzes barriers and implementation strategies (tele-exercise, dedicated professionals, hub-and-spoke models), and assesses psychological and economic impacts.

Immediate breast reconstruction (IBR) with polyurethane (PU)-coated implants has usually been performed to mitigate the capsular contracture (CC) rate, particularly in patients requiring post-mastectomy radiotherapy (PMRT). This retrospective study aimed to evaluate the long-term outcomes of direct-to-implant (DTI) reconstruction using Microthane® PU-coated implants placed prepectorally without additional devices. A total of 143 consecutive patients underwent mastectomy, followed by IBR with Microthane® implants in the prepectoral position. Demographic and clinical data, including complications and CC incidence, were retrospectively collected. Statistical analyses comprised descriptive statistics, Kaplan-Meier survival curves, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire for patient-reported outcomes. Over a median follow-up of 4.5 years, 18.9 % of patients experienced at least one complication, with adjuvant radiotherapy being the only factor significantly associated with increased complications (p = 0.0229). Kaplan-Meier analysis indicated a complication-free survival rate of 57.85 % for the patient and 58.00 % for the implant, and a contracture-free survival rate of 79.46 % and 81.56 %, respectively. Severe CC (Baker grade III/IV) occurred only in 9.1 % of patients, including several who underwent adjuvant radiotherapy (p = 0.0215). These rates remain notably lower than those historically reported with textured implants. Moreover, DASH scores revealed minimal disability (an overall mean score of 8.17 %), reflecting favorable patient-reported outcomes. Microthane® breast implants in a prepectoral position demonstrated low CC rates and high patient satisfaction, even among those receiving radiotherapy, benefiting from all the prepectoral surgical approaches. In addition, this technique obviates the need for supplementary devices such as meshes or acellular dermal matrices (ADMs), thereby reducing costs, operative times, and potential complications. The large cohort size and substantial follow-up strengthen these findings. The results support prepectoral reconstruction with Microthane® implants as a safe and effective option in breast reconstruction, offering both aesthetic and functional benefits.

Early relapse in multiple myeloma (MM) is a major predictor of poor prognosis, regardless of cytogenetic risk or treatment intensity. Here we analyzed 1026 MM patients treated across 12 Italian hematology centers. FHR was defined as progression-free survival (PFS) ≤18 months in transplant-eligible (TE) and ≤12 months in non-transplant-eligible (NTE) patients. Logistic regression and ROC analysis were used to identify significant predictors of FHR and build a risk score. FHR status was identified in 175 patients (17%). These patients had significantly shorter PFS (7 vs. 57.5 months) and overall survival (19 months vs. not reached; p < 0.001). FHR status was associated with higher median LDH, lower Hb level, higher creatinine level and lower platelets count. Modified EASIX formula was built by these significant continuous variables, to be tested in a logistic analysis: [(LDH × creatinine)/(Hb × PLT) × 100]. A significantly higher rate of FHR was found with a score > 2.0 (89% vs. 11%, p < 0.001). Multivariate logistic analysis selected the above formula, ECOG PS ≥ 2 and ISS III as factors associated with FHR. Scoring these variables according to OR, three groups of patients were segregated with a rate of FHR patients of 7%, 29.5%, and 63.5%, respectively. Treatment with anti-CD38 monoclonal antibodies was associated with lower FHR frequency. This study proposes a simple, clinically applicable model to identify FHR MM patients early in their disease course. However, very in-depth biological tools, not available in clinical practice, are needed to identify singularly risk of becoming FHR.

ABSTRACTBackgroundA low fT3/fT4 ratio has been associated with poorer prognosis in several diseases. Inflammatory indexes (IIs) and the skeletal muscle index (SMI) are established prognostic factors in various cancer types. However, their interplay and individual contributions to the prognosis of cervical cancer remain unclear. This study aimed to evaluate the impact of these biomarkers on survival outcomes in cervical cancer patients treated with innovative immunotherapy.MethodsThis retrospective study included 101 patients with cervical cancer treated with cemiplimab at 12 Italian oncology centres. Patients with thyroid comorbidities or missing fT3/fT4 ratio data were excluded. The primary endpoint was overall survival (OS) in relation to the fT3/fT4 ratio. Secondary endpoints included progression‐free survival (PFS) and correlations between the fT3/fT4 ratio, ECOG Performance Status, IIs and SMI.ResultsAn optimal fT3/fT4 cutoff for OS prediction was identified at 0.29. Median OS was 10.9 months for patients with a low fT3/fT4 ratio, while it was not reached for those with high fT3/fT4 levels (HR = 2.70; 95% CI: 1.17–6.22; p = 0.02). Multivariate analysis confirmed that both the fT3/fT4 ratio and ECOG PS independently influenced OS. Among the IIs analysed, the systemic inflammatory index (SII) demonstrated the strongest correlation with fT3/fT4 levels (OR = 3.82; 95% CI: 1.39–10.50; p = 0.0092). Exploratory analysis also revealed significantly lower SMI values in patients with lower fT3/fT4 ratios (p = 0.034).ConclusionsThis study highlights the prognostic significance of the fT3/fT4 ratio, IIs, and SMI in cervical cancer patients treated with cemiplimab. Given the exploratory nature of these findings, further validation in larger, prospective cohorts is warranted to support their integration into clinical practice and the development of innovative prognostic tools.