Fondazione Istituto G. Giglio di Cefalù

Transcervical femoral neck fractures (TFNFs) are among the most devastating fragility fractures in theelderly. TFNF are associated with excess 1-year mortality rates ranging from 15% to 30%. Treatments include conservative methods, internal fixation, and arthroplasty (partial or total hip arthroplasty). This study aims to analyze the changes in incidences of TFNF in the Italian population between 2001 and 2023 and the evolution of the choices of treatment. Using hospital discharge record (HDR) data from 2001 to 2023, records with ICD9-CM codes for femoral neck fractures (820.0 and 820.1) among diagnoses were selected and categorized into four treatment groups: totalarthroplasty,partial arthroplasty, fixation, and conservative. Time series were analyzed with stratification by sex and age. The extracted data included 1,120,724 records of TFNFs, with 871,161 cases treated surgically (total or partial arthroplasty or internal fixation) and 249,563 treated conservatively; the average patient age was 79.1years, with a higher proportion of women (72.8%). Partial hip arthroplasty was the preferred treatment overall. For younger patients, in the age classes < 45 and 45-54 years, fixation was the most chosen treatment. Over time, the use of the conservative treatment decreased from 27.5% in 2001 to 14.6% of cases in 2023. The use of partial and total hip arthroplasty increased from 40% and 13.3% in 2001 to 44.5% and 24.3% in 2023, respectively. Over the past two decades, Italy experienced declining age-adjusted incidence rates of TFNF despite persistent crude numbers (approximately 50,000 cases per year) owing to demographic aging. Partial hip arthroplasty (PHA) remained the preferred treatment, while total hip arthroplasty (THA) went from being the least used to the second-most performed treatment through the 23 observed years. Level of evidence level 1, population-based study.

Opioid prescribing practices have come under increased scrutiny due to the ongoing opioid crisis, with efforts focusing on harm reduction strategies such as co-prescription of opioid antagonists. This study analyzes opioid prescribing trends and the frequency of opioid-antagonist co-prescription over the course of 2024. A retrospective analysis was performed using electronic medical record data to identify all opioid prescriptions issued between January 1, 2024, and December 31, 2024. Each opioid prescription was cross-referenced with any concurrent prescription for an opioid antagonist. The analysis did not differentiate opioid type, duration of therapy, or prescribing indication. A total of 68,212 opioid prescriptions were issued in 2024. Quarterly totals were: Q1: 16,574; Q2: 16,882; Q3: 16,922; and Q4: 17,834. Among these, 7,586 (11.1%) were co-prescribed with an opioid antagonist, while 60,626 (88.9%) were not. The distribution across quarters was:Q1: 16,574 prescriptionsQ2: 16,882 prescriptionsQ3: 16,922 prescriptionsQ4: 17,834 prescriptionsOf these, 7,586 (11.1%) were co-prescribed with an opioid antagonist, while 60,626 (88.9%) were prescribed without one. The quarterly breakdown of opioid-antagonist co-prescription was:Q1: 1,874 prescriptions with an antagonist, 14,700 withoutQ2: 1,867 prescriptions with an antagonist, 15,015 withoutQ3: 1,945 prescriptions with an antagonist, 14,977 withoutQ4: 1,900 prescriptions with an antagonist, 15,934 without. Despite ongoing recommendations to increase opioid-antagonist co-prescription, a large majority (88.9%) of opioid prescriptions in 2024 were issued without an antagonist. While there was a modest increase in overall opioid prescriptions over the year, opioid-antagonist co-prescription rates remained relatively stable. These findings highlight the need for further investigation into barriers preventing wider adoption of opioid-antagonist co-prescription and the potential impact on patient safety.

Background: Chronic pain affects nearly one in five adults worldwide and remains a major healthcare burden due to its persistence, multidimensional impact, and resistance to conventional therapies. The opioid crisis has further highlighted the urgent need for safer and more effective alternatives. Psilocybin, a serotonergic psychedelic compound, has re-emerged as a potential therapeutic option for chronic pain given its effects on neuroplasticity, neuroinflammation, and emotional regulation. Methods: This narrative review synthesized evidence from published preclinical and clinical studies. The focus was on the mechanisms of action of psilocybin, animal models of neuropathic and inflammatory pain, and early human trials exploring its effects on pain, mood, and quality of life. Results: Preclinical studies demonstrated that psilocybin promotes synaptogenesis via BDNF-TrkB signalling, modulates 5-HT2A receptor activity, and reduces neuroinflammatory processes, leading to persistent analgesic and anxiolytic effects. Animal models of chemotherapy-induced neuropathy and inflammatory pain showed long-lasting antinociceptive responses. Clinical studies, though limited, reported improvements in depression, anxiety, resilience, and quality of life in patients with advanced cancer and chronic conditions, with preliminary evidence of analgesic benefit. Conclusions: Psilocybin shows promise as a multidimensional therapy for chronic pain, addressing both sensory and affective components. However, ethical issues, safety concerns, and regulatory barriers necessitate careful management, and robust randomized controlled trials are essential to confirm efficacy and guide clinical translation.

Background: Radiofrequency ablation (RFA) and cryoanalgesia are minimally invasive procedures used when conservative medical management fails and there are positive diagnostic blocks. Although both radiofrequency ablation (RFA) and cryoanalgesia are straightforward techniques, the increasing workload of physicians is leading to less time available for patient interaction, including addressing questions about indications, feasibility, long-term effectiveness, and potential complications. Generative artificial intelligence (AI) chatbots, such as ChatGPT, have the potential to reduce physician burden and enhance patient education. Methods: An expert panel compiled thirteen frequently asked questions about RFA and cryoanalgesia, which were subsequently submitted to ChatGPT-4.0. The AI-generated responses were evaluated by 41 participants, including pain physicians, healthcare professionals, and non-healthcare individuals. The Likert scale was used for evaluating the responses, focusing on reliability, accuracy, and comprehensibility using predefined acceptability thresholds. Results: Across all 13 questions, ChatGPT’s responses demonstrated high overall reliability, with a mean score of 4.9 ± 0.7. The mean accuracy score was 2.6 ± 0.3, suggesting alignment with evidence-based standards. Comprehensibility was rated at 2.7 ± 0.2 on average. Pre-procedural questions achieved the highest scores, while post-procedural questions posed more challenges for ChatGPT. Conclusions: ChatGPT demonstrated potential as an adjunct tool for patient education on RFA and cryoanalgesia. Improvements in procedural specificity and medical accuracy are needed before routine clinical implementation.

Amyloidosis is characterised by the extracellular accumulation of misfolded proteins forming amorphous aggregates called amyloid. Cardiac amyloidosis results from myocardial involvement in systemic amyloidosis, leading to impaired heart function. Besides myocardial involvement, cardiac amyloidosis may also directly and indirectly affect the central nervous system. This narrative review summarises current evidence about on central nervous system involvement in cardiac amyloidosis and the pathophysiological mechanisms linking heart and brain in the context of this systemic disease. Although the pathophysiological relationship between cardiac amyloidosis and cognitive decline remains poorly understood, central nervous system involvement likely results from the complex interplay of direct amyloid deposition, cerebrovascular changes, and cardiac dysfunction. The growing awareness of cognitive impairment in patients with cardiac amyloidosis highlights the need for further research and supports a multidisciplinary approach in the assessment and management of affected individuals.

The von Hippel-Lindau (VHL) syndrome is a rare autosomal dominant disorder caused by mutations in the VHL tumor suppressor gene, leading to the development of benign and malignant tumors in multiple organs, including the kidneys, brain, spine, retina, and pancreas. Since its initial description in the early 20th century, significant progress has been made in understanding its pathogenesis, genetic basis, and clinical management. This narrative review provides a comprehensive overview of VHL syndrome, from its discovery to the latest medical and surgical therapies. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, incorporating the Egger test to assess publication bias. The review highlights the evolution of diagnostic criteria, the role of genetic testing, and the development of targeted therapies such as hypoxia-inducible factor 2-alpha (HIF-2α) inhibitors. Surgical interventions, including nephron-sparing surgery and minimally invasive techniques, are also discussed. This review emphasizes the importance of a multidisciplinary approach to managing VHL syndrome and explores emerging therapies that hold promise for improving patient outcomes.

BackgroundThe Micra leadless pacemaker provides a lead-free alternative to traditional transvenous pacemakers, significantly reducing complications associated with leads and device pockets. Although the initial application of leadless pacemakers was limited to centers with on-site cardiac surgery due to the technical demands, recent evidence suggests that implantation can be safely extended to centers without cardiac surgery capabilities. However, comprehensive comparisons of outcomes between these settings remain scarce.AimsThis study aimed to assess the safety, feasibility, and clinical outcomes of Micra leadless pacemaker implantation across centers with and without cardiac surgery. The analysis focused on acute complications, device performance, and patient follow-up.MethodsA retrospective study was conducted on 1,899 patients who received a Micra pacemaker between May 2015 and September 2024 at 23 centers participating in the One Hospital Clinical Service (OHCS) initiative. Patients were classified into two groups: those treated at centers with cardiac surgery (CS, n=1,025) and those without (No-CS, n=874). The primary endpoint was the rate of acute complications within 15 days post-implantation. Secondary endpoints included device performance and clinical outcomes at 12 months.ResultsThe overall acute complication rate was 0.6%, with no significant difference between CS (0.5%) and No-CS (0.8%; p=0.391) groups. Procedural times were shorter in No-CS centers (41.2 ± 19.8 minutes) compared to CS centers (46.1 ± 19.3 minutes; p<0.001), and fluoroscopy times also tended to be lower. Both groups showed comparable device performance and patient outcomes during the follow-up period. Differences in procedural techniques were noted; for example, No-CS centers more frequently utilized venography to facilitate the introduction of the delivery system, while CS centers used contrast imaging more often before device release.ConclusionThe findings of this study support that Micra leadless pacemaker implantation can be safely performed in centers without cardiac surgery, achieving comparable outcomes to those with on-site surgical facilities. These results suggest that with adequate training and emergency protocols, non-surgical centers can safely adopt leadless pacemaker technology, potentially expanding access to this advanced pacing solution across diverse healthcare settings.

Lower gastrointestinal bleeding (LGIB) is a common condition linked to increased morbidity, healthcare costs, and mortality. Currently, no prospectively validated prognostic model exists to predict mortality in patients with LGIB. Our aim was to develop and validate a risk score that could accurately predict in-hospital mortality of patients admitted for LGIB. Patient data from a nationwide cohort study in 15 centers in Italy (2019-2020) were used to derive the risk score, the Acute Lower gastrointestinal Bleeding and In-hospital mortality (ALIBI) score; the model was then externally validated in a cohort of consecutive patients hospitalized for LGIB in 12 centers from six countries (Italy, Spain, France, Greece, Iran, and Brazil) from 2022 to 2024. The main outcome was in-hospital mortality; we also reported rebleeding rates and the in-hospital mortality rate stratified by risk score and timing of colonoscopy. RESULTS : Among 1198 patients in the derivation cohort, 105 (8.8%) re-bled and 41 (3.4%) died. Age, Charlson Co-morbidity Index, in-hospital onset, hemodynamic instability, and creatinine level were independent predictors of in-hospital mortality. The model demonstrated excellent discrimination (area under the receiver operating curve [AUROC] 0.81, 95%CI 0.75-0.87) and calibration. In the validation cohort (n = 752 patients), the model's good discrimination (AUROC 0.79, 95%CI 0.72-0.86) and calibration were confirmed. Patients were categorized as low (0-4 points; 1% mortality), intermediate (5-9 points; 4.6% mortality), or high risk (10-13 points; 19.1% mortality). CONCLUSION : A new validated score effectively predicts in-hospital mortality in patients with LGIB, aiding in their risk stratification and management.

Chronic knee pain from osteoarthritis (OA) affects a significant proportion of adults over 40. Total knee arthroplasty (TKA) remains the standard for advanced OA, yet up to 20% of patients experience chronic postsurgical pain (CPSP). Genicular nerve radiofrequency ablation (GNRFA) can alleviate pain in those unresponsive to conservative treatments or TKA. However, anatomical variability of the genicular nerves may limit treatment durability. This retrospective, single-center observational study investigated whether using a novel V-shaped active tip needle-which creates larger lesions-could improve outcomes. Fifty patients with symptomatic knee OA or CPSP, who had a ≥50% reduction in pain after diagnostic genicular nerve blocks, underwent GNRFA with a V-shaped active tip needle between September 2020 and January 2022. Pain and function were assessed using the visual analogue scale (VAS) at rest and during movement, Western Ontario and McMaster Universities Arthritis Index (WOMAC), Douleur Neuropathique en 4 Questions (DN4), and EuroQol-5 Dimensions (EQ-5D) at baseline and 1, 3, 6, and 9 months post-procedure. By 6 months, 64% of patients showed ≥50% reduction in VAS pain scores, sustained at 9 months (p<0.0001). Median WOMAC scores improved from 62.0 at baseline to 40.0 at 6 months (p<0.0001). DN4 scores declined from a median of 4.0 at baseline to 2.0 at 6 months and 1.0 at 9 months (p<0.001). EQ-5D scores demonstrated significant enhancement in quality of life (p<0.01). Pain intensity differences at rest and during movement remained substantially improved at 9 months (p<0.0001). GNRFA using a V-shaped active tip needleis a promising intervention for chronic knee pain, offering significant and sustained pain relief and functional improvement. Larger lesions created by the novel needle may overcome anatomical challenges, though further randomized studies are warranted to validate efficacy and safety.