Hospital of Prato

The role of routine terminal ileal intubation (TII) in asymptomatic patients undergoing colonoscopy for colorectal cancer (CRC) screening or post-polypectomy surveillance is debated. While considered a quality indicator in some settings, its clinical utility in this population remains unclear. This systematic review and meta-analysis aimed to evaluate the diagnostic yield, clinical utility and procedural impact of routine TII in patients undergoing CRC screening or post-polypectomy surveillance. We conducted a systematic search of PubMed and Embase up to September 2025, according to PRISMA guidelines. We included studies reporting TII diagnostic yield in asymptomatic adults undergoing CRC screening or post-polypectomy surveillance colonoscopy. Data were synthesized using random-effects models. The primary outcome was the overall diagnostic yield of TII. Secondary outcomes included the diagnostic yield for clinically significant findings, Crohn's disease, and the impact of TII on procedure duration. Eleven studies involving 25659 patients, of whom 13672 underwent TII, were included. The pooled overall diagnostic yield for any ileal finding was 1.74% (95%CI 1.18%-2.57%), with most abnormalities being non-specific and not requiring clinical action. The diagnostic yield for clinically significant pathology was substantially lower at 0.28% (95%CI 0.07%-1.05%), while the yield for detecting Crohn's disease was only 0.1% (95%CI 0.02%-0.44%), corresponding to one case per 1000 ileoscopies during colonoscopy for CRC screening. Routine TII in asymptomatic patients undergoing screening or surveillance colonoscopy provides a negligible diagnostic yield for clinically significant pathology, including Crohn's disease. Our findings do not support performing routine TII during colonoscopy in this patient population.

Most patients with large B-cell lymphoma (LBCL) progressing after CAR-T therapy experience poor survival and lack standardized treatment strategies. Prognostic tools are needed to guide decision-making at relapse. The Post-CAR Prognostic Index (PC-PI), recently proposed by Iacoboni et al., combines five routine clinical variables to stratify outcomes after CAR-T failure: ECOG (> 0), hemoglobin (< 10 g/dL), LDH (≥ 2xULN), number of extranodal sites (> 1) and time from CAR-T to progression (< 4 months). We evaluated the PC-PI in a retrospective multicenter study including 125 LBCL patients relapsing or refractory after axicabtagene-ciloleucel or tisagenlecleucel, treated between 2019 and 2023 across 16 Italian centers belonging to the Fondazione Italiana Linfomi network. Median overall survival (OS) was 4.9 months, with 6- and 12-month OS rates of 44.9% and 28.5%, respectively. The PC-PI discriminated prognosis effectively: high-risk patients had a median OS of 1.8 months, intermediate-high 2.2, intermediate-low 8.7, while in the low-risk group median OS was not reached (p<0.0001). Results remained consistent after excluding patients receiving only palliative care. Post-progression therapy markedly influenced survival: patients receiving active treatment achieved a median OS of 7.3 months versus 0.7 without further therapy (p<0.0001). Bispecific antibodies conferred the best outcomes (HR 0.44, p=0.02), with 6- and 12-month OS rates of 90% and 55%. Our findings confirm the prognostic value of the PC-PI and support its use in clinical practice as a tool for risk-adapted management of LBCL after CAR-T failure.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13045-025-01771-6.

We performed a randomized, double-blind, placebo-controlled, trial to investigate the changes in microbiome composition induced by Butyrate-Lsc-Microincapsulated (BLM) supplementation in IBD patients and its impact on disease activity. 140 IBD patients (n=60 Crohn's disease, CD and n=80 Ulcerative Colitis, UC) were randomized to oral administration of BLM, plus conventional therapy. Stool samples were assessed by 16S sequencing and fecal calprotectin (fCal) analysis. For the microbiota analysis, the Firmicutes/Bacteroidota (F/B) ratio was used. Clinical disease activity was assessed by using the Harvey-Bradshaw-Index (HBI) for CD and partial-Mayo-Score for UC, Quality-of-life (QoL) by using Inflammatory-Bowel-Disease-Questionnaire-32 (IBDQ) and adherence-dietary-recommendation was evaluated before and after supplementation RESULTS: microbiota analysis revealed two principal enterotypes, defined by the F/B ratio, in both CD and UC patients. BLM exerted a more pronounced effect on Enterotype 1 (low F/B ratio), resulting in greater clinical and biochemical improvements and potentially identifying a target population. After supplementation, clinical disease activity (p=0.013) and fCal (p=0.047) improved significantly in CD, while fCal showed a marginal reduction in UC (p=0.09). QoL increased significantly in both CD (p<0.001) and UC (p=0.003). Supplementation with BLM, by modulating the gut microbiota, significantly improved disease outcomes and QoL in patients with IBD. NCT04879914.

Background: Pulmonary embolism (PE) is a life-threatening condition in which early diagnosis and prompt treatment are essential to reduce morbidity and mortality. Recent advances in radiomics have introduced software tools for PE detection on CT pulmonary angiography (CTPA), but their application to non-contrast chest CT remains unexplored. Methods: We retrospectively identified 57 CTPA examinations performed between January 2020 and March 2023. Patients were randomly assigned to training and validation cohorts; an additional 14 PE-negative patients were included in the validation cohort. Spherical regions of interest (ROIs) were manually placed within emboli and within normal-flow pulmonary arteries. From each ROI, 836 radiomic features were extracted. Statistically significant features were identified using the Wilcoxon test. A logistic regression classifier was then developed to discriminate between embolus and control ROIs based on their radiomic signatures. Results: Of the 836 features, 242 (all derived from wavelet-filtered images) showed significant differences between embolus and normal-flow ROIs on unenhanced CT. The classifier demonstrated high diagnostic performance in the validation cohort, with an AUC of 0.87 (95% CI: 0.86–0.88) and an accuracy of 0.77 (95% CI: 0.76–0.79), with only a limited number of misclassified ROIs. Conclusions: This preliminary study demonstrates the potential of radiomics to identify thrombi on unenhanced chest CT scans, offering a promising avenue for the early detection of acute PE. The proposed model showed satisfactory diagnostic accuracy with low few misclassifications, supporting further validation in larger cohorts.