CTO Hospital

Introduction: Idiopathic chronic low back pain (icLBP) represents approximately 90% of chronic low back pain and lacks a clearly identifiable pathological origin. It impacts both productivity and overall quality of life. Auricular acupuncture (AA) is a promising emerging therapy for icLBP. Objective: To verify if there are areas of both the lateral and medial auricle surfaces with greater incidence of neuroreflex points in subjects with icLBP as compared to a group of healthy controls. Methods: A total of 64 subjects with a diagnosis of icLBP and a control group of 64 healthy individuals were evaluated. All sectors of the Romoli Sectogram and the Chinese Standardized Map were examined with the Electrical Skin Resistance Test (ESRT) and with the Pressure Pain Test (PPT) on both the medial and lateral surfaces of each auricle. Results: The icLBP subjects had a significantly higher average number of positive points in sectors 17, 18, and 19 of the Romoli Sectogram and in areas AH9, AH5, TF4, and P1 of the Chinese Standardized Map as compared with the control. In icLBP subjects, the positive points were predominantly grouped into four main areas: area 1 in AH9, area 2 in P1, area 3 in TF4, and area 4 in AH5. In areas 1 and 2, one or more positive points in the vast majority of icLBP subjects were detected. Conclusions: In icLBP, there are four areas of the auricle within which one or more points positive on ESRT and PPT can be detected, identifying potentially specific and effective AA points.

To assess the use of ultrasound (US) to visualize and determine the correct position of a multichannel intraluminal impedance-pH probe (MII-pH). This is a monocenter study recruiting newborns who underwent MII-pH for suspicious of gastroesopahegal reflux (GER). Catheter position was based on US and was confirmed by X-ray. Moreover, the depth of the probe was compared with those calculated with several mathematical formula used for pH impedance. The US was performed using (US) system Alpinion-eCube-i7® in B-mode with linear and convex probe. US was used to evaluate the correct positioning of the MII-pH catheter before the beginning and during the MII-pH execution to evaluate any changes of the position. The results were also compared with retrospective cases collected in our center in previous years. Thirty-six newborns were included. US allowed to visualize the esophageal probe in all the newborn tested. US-based positioning was correct in 100% of patients considering an error acceptance of 1 cm, and 66.7% with an error acceptance of 0.5 cm, compared to X-ray. The median duration of the US was 3.2 min (range 2.5-5.78 min), with prolonged time in crying babies. Previous cohort consisted of 35 newborns who underwent MII-pH: one patient had the probe in the respiratory tract and six patients needed new positioning of the MII-pH probe and second X-ray control because of bad positioning or accidental removal of the probe. US seems to be a valid alternative for the assessment of the MII-pH probe position and the identification of the pH sensor and the lower esophageal sphincter in real time. However, US expertise is needed to provide accurate results.

Background/Objectives: Finger amputation is frequently followed by complications, with reported revision rates of up to 20%. One of the most disabling sequelae is the formation of painful neuromas, occurring in approximately 3-9% of cases. Several biological and mechanical risk factors have been proposed, but the potential influence of psychological traits remains poorly understood. This study aimed to investigate whether a correlation exists between patients' personality traits and the development of neuropathic pain or related symptoms. Methods: A retrospective study was conducted at a Level II Hand Trauma Center, including patients who underwent digital amputation between 2021 and 2023. Neuropathic pain and cold intolerance were assessed using the S-DN4 and CISS questionnaires, respectively. Personality traits were evaluated using the BFI-10 scale. Demographic data and other clinical risk factors, including work-related injuries, psychiatric history, infection, treatment delay, and surgical technique, were also analyzed. Results: A total of 54 patients were included. Neuropathic pain, defined by an S-DN4 score ≥ 4, was identified in 10 patients (18.5%). A significant correlation was found between the occurrence of neuropathic pain, cold intolerance, and the "neuroticism" personality trait. Patients with work-related injuries or psychiatric disorders also showed a higher risk of neuropathic pain and cold intolerance. Conversely, infection and delayed treatment were associated with an increased risk of revision procedures, whereas the type of surgical technique used for nerve stump management was not significantly correlated with pain outcomes. Conclusions: The study demonstrated a meaningful association between the neurotic personality trait and both neuropathic pain and cold intolerance after finger amputation. Additionally, work-related injuries and psychiatric comorbidities were identified as potential risk factors. Patients exhibiting these characteristics may benefit from early psychological assessment and multidisciplinary management to prevent further complications and improve postoperative outcomes.

The management of chronic lymphocytic leukemia (CLL) in older patients requires careful balancing of therapeutic efficacy with the risks of treatment intolerance. Frailty assessment is increasingly recognized as a critical determinant of clinical outcomes, but its specific role in guiding therapy with second-generation Bruton tyrosine kinase inhibitors remains poorly defined. We conducted a prospective, multicenter investigation of 326 consecutive CLL patients aged 65years or older who received zanubrutinib across 52 Italian centers, aiming to evaluate whether the Clinical Frailty Scale (CFS) could predict treatment discontinuation in real-world practice. The cohort was characterized by advanced age (median 78.1years, range 65.1-94.5), with over half of the patients presenting with Binet stage C disease. Two-thirds were treated in the frontline setting, while the remainder received zanubrutinib as salvage therapy. After a median follow-up of 8 months, 48 patients (14.7%) discontinued treatment, most commonly due to toxicity or disease progression. Receiver operating characteristic curve analysis identified a CFS of 3 as the optimal threshold for predicting discontinuation, with an area under the curve of 0.65 (95% CI 0.56-0.73, p<0.001). At 12months, the discontinuation rate was significantly higher among patients with a CFS >3 (29.2%) compared with those with a CFS ≤3 (8.8%) (p<0.001); among conventional prognostic variables, only relapsed/refractory disease demonstrated an independent association with TTD. These findings highlight the CFS as a simple yet powerful clinical tool that provides incremental prognostic information beyond standard disease-related factors. Incorporating frailty assessment into treatment planning may enhance patient selection and optimize therapeutic strategies for elderly CLL patients in daily practice.

COVID-19 infection seems to have among its fundamental pathogenetic mechanisms the appearance of a pro-thrombotic state capable of causing severe damage to various organs (lungs, kidneys, eyes ...). Furthermore, the vaccines marketed in Italy in December 2020, used to slow the spread and mortality of this virus, also seem responsible for a possible pro-thrombotic state in the subjects to which they are inoculated. The authors of this work then wondered if the COVID-19 pandemic may have somehow altered the results of microsurgical anastomoses performed at their centers. More than 270 patients who had at least one microsurgical vascular suture, in one of the three centers involved in this study, in the last four years were then retrospectively evaluated (two years pre-COVID vs. two years post-COVID). Planned surgeries of oncological, post-infection, or post-trauma) patients treated with microsurgical flap and patients who underwent digital or hand reimplantation were included. Failure rates were compared, taking into consideration whether patients had tested positive for COVID-19 or had a COVID-19 vaccine shot in the six months before the surgery. The anastomosis success rate of the entire “pre-COVID” group is 70.4%, while that of the “COVID” group is 73.3%. Different subgroups are analyzed, and the only statistically significant difference in results is obtained by comparing the success rate of the “pre-COVID” group to the subgroup, in the COVID era, of patients who have tested positive for COVID or had at least one dose of vaccine. According to this study, failures of microsurgical anastomoses in patients previously affected by COVID or in previously vaccinated patients do not appear to have increased. On the contrary, COVID and/or vaccines might have a protective action.

To assess inter-reader and intermodality variability in quantifying macular fibrosis in patients with neovascular age-related macular degeneration (AMD) using 4 imaging modalities: color fundus photography (CFP), near-infrared reflectance (NIR), structural optical coherence tomography (OCT), and MultiColor imaging. Prospective, cross-sectional case series. Thirty eyes of 30 patients with neovascular AMD and macular fibrosis, previously treated with anti-vascular endothelial growth factor therapy. Imaging was performed using CFP, NIR, structural OCT, and MultiColor modalities. Two masked graders evaluated the size of macular fibrosis using each modality. The study assessed inter-reader agreement using the intraclass correlation coefficient (ICC), coefficient of variation (CV), and 95% coefficient of repeatability. Intermodality variability was analyzed using repeated measures ANOVA and pairwise comparisons. Structural OCT demonstrated the highest inter-reader agreement (ICC = 0.983; CV = 0.04), while NIR exhibited the lowest (ICC = 0.461; CV = 0.26). The median macular fibrosis size was largest on structural OCT (4.87 mm²) and smallest on MultiColor imaging (2.03 mm²). Significant differences were observed between imaging modalities, with fibrosis measurements from different modalities not consistently comparable. Structural OCT is the most reliable modality for quantifying macular fibrosis in neovascular AMD. The observed intermodality variability highlights the need for standardized criteria in fibrosis assessment across imaging techniques, as differences can impact clinical interpretation and management.