Humanitas Castelli

ABSTRACT Introduction Metastasis-directed treatment (MDT) is progressively expanding its scope in the treatment of metastatic renal cell carcinoma (mRCC), finding application both in cases of oligometastatic disease, whether synchronous or metachronous, and in oligo-progression during systemic therapy (ST). This updated narrative review incorporates recent advancements in managing oligometastatic and oligo-progressive RCC. A PubMed literature search using keywords related to mRCC and its treatments was made. Observational studies, clinical trials, and reviews were analyzed, selecting the most relevant articles based on evidence strength. Areas covered We analyzed the current role of surgery, both on the primary than on metastatic sites, and the recent advantages in both radiotherapy, ST and focal therapies. Lastly, we focused on single metastatic sites of interest. Expert opinion Nowadays personalized tailored treatments are the key, integrating multimodal approaches like metastasectomy, radiotherapy, and ST. While the role of cytoreductive nephrectomy remains debated, metastasectomy and radiotherapy demonstrates potential in managing both oligometastatic and oligo-progressive disease, either alone or in synergy with ST, though more robust evidence is needed. Future research should focus on identifying biomarkers for treatment selection, optimizing therapy timing, and refining patient stratification to enhance outcomes.

In windy conditions, the measurement of liquid and solid atmospheric precipitation is still a challenge even using the most advanced automatic instrumentation (Cauteruccio et al., 2021). The measurement accuracy is affected by various environmental sources of bias, including siting issues and exposure. These add to the instrumental bias, which can be minimized in case of accurate instrument calibration. Wind is however recognised as the most impactful source of environmental bias, outperforming by 3 to 50 times the total impact of all other environmental factors. Computational Fluid Dynamics simulation with embedded liquid (raindrops) and solid (snowflakes) particle tracking is here used to quantify the wind-induced bias of catching-type precipitation gauges. Starting from the numerically calculated catch ratios, six common commercial gauges having different outer geometry are compared in terms of their expected performance under various precipitation intensity and wind speed conditions. Preliminary wind tunnel experiments allowed full validation of the simulated aerodynamic behaviour and its effect on water drop trajectories. The overall collection efficiency is shown to depend on the precipitation intensity and its functional dependence is quantitatively derived as a measure of the instrument performance under a wind climatology characterised by a uniform probability density function. A less pronounced diversion of hydrometeor trajectories is shown – at any given size – by instruments with aerodynamic design than in case of more traditional geometry. Chimney-shaped instruments rank low in case of liquid precipitation measurements, while a high performance is shown by inverted conical and Nipher shielded instruments and the investigated quasi-cylindrical gauges have intermediate behaviour, which depends on their specific aerodynamic features. All instruments rank low at light to moderate precipitation intensity for the measurement of solid precipitation, except the Nipher shielded gauge. This work provides the basic information needed to apply adjustments to the measured data and supports manufacturers in upgrading instruments with an existing design by introducing on-board adjustments of the measured precipitation. These would only require contemporary measurement of the wind velocity (often included in typical meteorological stations). The full work and the numerically derived adjustments for the six investigated commercial gauges are published in Cauteruccio et al. (2024).

Si discute di un farmaco innovativo per l’emofilia B, riportando tutti quelli che sono gli aspetti delle frontiere delle nuove terapie (molecolari, genetiche) che devono fare “i conti” con la sostenibilità economica e con nuove regole che dovranno riguardare il mercato farmaceutico.

The Covid-19 pandemic in 2020 had negative consequences on the global health of children through direct and indirect effects. Among the negative effects, a significant one is represented by the increase in overweight and obesity in the paediatric population. The isolation imposed by the law in addition to the suspension of motor and play activities have resulted in the strengthening of negative factors such as stress and depression, associated with the increase in the consumption of high-calorie foods, rich in sugars and saturated fats. Since 2010 the 12 family paediatricians from the Vercelli ASL (Italy) have collected data, included BMI. <br> During 2020 a significative increase in the BMI compared to 2019 was observed. The lockdown almost eliminated counselling regarding education for healthy life-styles and obesogenic environment was pervasive.

Abstract Background Black African/African-Caribbean individuals with hypertension (BH) are at greater risk of heart failure than those of white European ethnicity (WH). The mechanisms underlying this dissimilarity remain poorly understood. Purpose To investigate the influence of ethnicity on left ventricular (LV) remodelling using multi-parametric cardiovascular magnetic resonance (CMR). Methods BH (n=44), WH (n=38) and healthy-volunteers (HV; n=25, 5 of black ethnicity) underwent comprehensive CMR. The exam included: i) Arterial Stiffness/Afterload pulse-wave-velocity (PWV), aortic elastance (Ea) and systemic vascular resistance (SVR) by phase-contrast velocity-encoding imaging; ii) Ventricular remodelling/Function LV and right ventricular (RV) volumes, mass, ejection fraction (EF), LV peak-filling rate by short-axis cine images; myocardial strains were measured by feature tracking; iii) Left atrial (LA) remodelling/Function volumes and functions by long-axis cine images; iv) Tissue characterisation: extracellular volume by pre/post-contrast T1-mapping and late gadolinium enhancement (LGE) for interstitial and replacement myocardial fibrosis, respectively. Multivariate linear regression models were developed to investigate how LV remodelling associates with ethnicity, arterial afterload, including elastance (Ea) and stiffness [PW], and SVR. Models were adjusted for age, gender, body-mass-index, LV volumes or function and LA volumes. Results Subject characteristics are summarised in the Table. PWV and Ea and SVR were greater in hypertensives, particularly in BH, than HV; this was paralleled by higher LV mass, interventricular septum thickness (IVS), LA volumes but lower LV-EF. These findings were confirmed after adjusting for age. On the Model-1, IVS was associated with Ea (β=0.335, P=0.008) and black ethnicity (β=0.226, P=0.019) but not with SVR or PWV. For each increment of Ea there was a similar increase of IVS in BH and WH (P=0.602 for interaction), however BH had greater IVS than WH at each Ea value (Figure, fully-adjusted Model-1). On Model-2, LV end-diastolic volume was associated with Ea (β=−0.268, P=0.001), SVR (β=−0.319, P=0.019) but not with PWV or ethnicity. However, the inverse relation between LV size and Ea was significantly attenuated in BH (P=0.039 for interaction), (Figure, fully-adjusted Model-2). On model-3, LV-EF was associated with Ea (β=0.223, P=0.009) but not with ethnicity, PWV or SVR. LV-EF reduction for each Ea increment was similar for BH and WH (P=0.597 for interaction). Conclusion BH and WH show a distinctive LV remodelling phenotype. BH had a greater susceptibility to hypertrophy and an attenuated reduction of chamber size in response to arterial afterload. Further research to disentangle the genetic and environmental factors underlying these ethnic group-specific differences is utterly required. Funding Acknowledgement Type of funding sources: None. Figure 1Table 1

PurposeTo assess outcomes and recovery strategy of patients undergoing intravitreal injections for exudative age-related macular degeneration who experienced COVID-19 related interruption in treatment during complete lockdown.MethodsThis was a retrospective, observational case study. We used a mixed effect model with random intercepts to evaluate best corrected visual acuity (BCVA) accounting for measured central macular thickness (CMT) and individual variability of each eye. Furthermore, we analysed measures of the pigmented epithelium detachment as well as presence of subretinal fluid and intraretinal cysts.ResultsWe included 39 patients and we found a significant reduction in the BCVA between the pre- and post-lockdown controlling for CMT. There was no significant difference in pigmented epithelium detachment and in presence of subretinal fluid and intraretinal cysts.ConclusionWe detected a significant loss in visual function. The magnitude of the average loss was, however, limited suggesting good efficacy of the recovery strategy.

IntroductionTemporary ileostomy is a valuable aid in reducing the severity of complications related to rectal cancer surgery. However, it is still unclear what is the best timing of its closure in relation to the feasibility of an adjuvant treatment, especially considering patient-reported outcomes and health system costs. The aim of the study is to compare the results of an early versus late closure strategy in patients with indication to adjuvant chemotherapy after resection for rectal cancer.Methods and analysisThis is a prospective multicentre randomised trial, sponsored by Rete Oncologica Piemonte e Valle d’Aosta (Oncology Network of Piedmont and Aosta Valley-Italy). Patients undergone to rectal cancer surgery with temporary ileostomy, aged >18 years, without evidence of anastomotic leak and with indication to adjuvant chemotherapy will be enrolled in 28 Network centres. An early closure strategy (between 30 and 40 days from rectal surgery) will be compared with a late one (after the end of adjuvant therapy). Primary endpoint will be the compliance to adjuvant chemotherapy with and without ileostomy. Complications associated with stoma closure as well as quality of life, costs and oncological outcomes will be assessed as secondary endpoints.Ethics and disseminationThe trial will engage the Network professional teams in a common effort to improve the treatment of rectal cancer by ensuring the best results in relation to the most correct use of resources. It will take into consideration both the patients’ point of view (patient-reported outcome) and the health system perspective (costs analysis). The study has been approved by the Ethical Review Board of Città della Salute e della Scienza Hospital in Turin (Italy). The results of the study will be disseminated by the Network website, medical conferences and peer-reviewed scientific journals.Trial registration numberNCT04372992.