IRCCS Ospedale San Raffaele

Robot-assisted partial nephrectomy (RAPN) represents the preferred minimally-invasive approach for localized renal tumors. Increasing attention has focused on optimizing parenchymal preservation, with enucleation proposed as a potentially advantageous strategy. This study aimed to compare perioperative and functional outcomes of enucleation versus enucleoresection in a large, contemporary multicenter RAPN cohort. Data were extracted from the multicentric and multicontinental European Association of Urology Young Academic Urologists (EAU-YAU) Renal Cancer Working Party database. Patients undergoing RAPN between 2015 and 2024 with clearly documented resection technique (enucleation vs enucleoresection) were included. The resection technique was chosen based on the surgeon's preference. Perioperative, pathological, and renal functional outcomes were evaluated. Acute kidney injury (AKI - defined according to the AKIN classification) and chronic kidney disease (CKD) worsening served as primary endpoints. Logistic regression and Cox proportional hazards models were used to assess the association between surgical technique and the risk of AKI and CKD progression; Kaplan-Meier curves were used to depict time-to-event and functional outcomes, while longitudinal eGFR analyses were performed to evaluate renal function trends over time. Among 1260 patients, 527 (42%) underwent enucleation and 733 (58%) enucleoresection. Adoption of both techniques remained stable over time. Baseline characteristics were comparable. Enucleoresection was associated with longer ischemia time, higher intraoperative complication rates, and a lower positive surgical margin rate (5.2% vs 8.3%, p=0.003). Postoperative AKI occurred more frequently after enucleoresection (18% vs 3%, p<0.001), although eGFR recovery was similar at a median follow-up of 12 vs 25 months. In the overall cohort and among patients with baseline CKD stages 1-2, enucleation was associated with a lower risk of CKD progression (p<0.001). Enucleation during RAPN offers a parenchyma-sparing approach with potential functional advantages, particularly in patients with preserved baseline renal function. This benefit must be balanced against a slightly higher risk of positive margins, reinforcing the necessity of thoughtful case selection and standardized surgical technique.

Trained immunity is the ability of the innate immune system to mount a heightened response to an environmental stimulus after a previous encounter with a noxious trigger. This effect is mediated by metabolic rewiring and epigenetic reprogramming in innate immune cells. In the context of neuroinflammation, trained immunity may represent a major contributor to the pathogenesis of neurological diseases, exerting both detrimental and potentially beneficial effects. While the general mechanisms and systemic implications of trained immunity are widely discussed, evidence in central nervous system (CNS) diseases remains fragmented and largely confined to individual pathological conditions. As a result, a comprehensive framework integrating these findings and identifying shared mechanisms across neurological disorders is still lacking. In this review, we explore the concept of trained immunity with a focus on neuroinflammatory and neurodegenerative diseases, synthetizing evidence from multiple CNS pathologies, including multiple sclerosis, Alzheimer's disease, Parkinson's disease, and cerebrovascular disorders. We first critically examine preclinical and experimental studies addressing innate immune memory in the CNS and subsequently integrate these findings with emerging clinical evidence, aiming to identify convergent mechanisms and disease-relevant immune memory signatures. Finally, we discuss potential therapeutic targets identified in preclinical settings and outline key unresolved issues, including the nature of triggering stimuli, thresholds, and temporal dynamics shaping innate immune memory in the CNS. By highlighting current limitations and defining critical questions for future research, this review presents a unifying perspective on trained immunity in neurological diseases and underscores the translational potential to modulate neuroinflammation and to influence disease progression.

To assess the outcomes of surgical management of aqueous misdirection (AM) by endoscopic pars plana vitrectomy with hyaloido-zonulo-iridectomy. In this prospective, longitudinal, noncomparative interventional study, 53 eyes from 46 patients with AM refractory to medical and laser therapy after intraocular surgery were enrolled. All eyes underwent lens removal (if phakic), endoscopic pars plana vitrectomy, and hyaloido-zonulo-iridectomy. Primary outcomes included intraocular pressure (IOP), best-corrected visual acuity (BCVA), anterior chamber depth (ACD), postoperative complications, relapse rate, and composite surgical success. Surgical success was defined as the combination of IOP control and anterior chamber reformation, using two alternative IOP thresholds ( ≥ 6 and ≤18 mmHg, or ≥6 and ≤21 mmHg). Continuous variables were analysed using linear mixed models and expressed as estimated means (est)± standard error. Mean age was 59.7 ± 12.2 years. The est. IOP decreased from 34.36 ± 0.82 mmHg to 17.47 ± 0.82 mmHg at 12 months (p < 0.001). The est. BCVA improved from 1.50 ± 0.07 to 0.70 ± 0.07 logMAR at 12 months (p < 0.001). The est. ACD increased from 0.70 ± 0.06 to 3.34 ± 0.06 mm (p < 0.001), with complete anterior chamber reformation in all eyes. Postoperative complications occurred in 22 eyes (41.8%), mostly transient and resolved with medical or YAG laser treatment; only one required glaucoma surgery. At 12 months, overall success was 98.1% using the ≤21 mmHg criterion and 75.5% using the ≤18 mmHg criterion. No relapses were observed. Surgical management using lens removal, endoscopic anterior vitrectomy, and hyaloido-zonulo-iridectomy is a significantly effective and safe treatment for AM.

Breast surgery is a cornerstone of breast cancer (BC) treatment and has distinctive features that distinguish it from other subspecialties within general surgery. BC management requires multidisciplinary competencies, with specialized training and dedicated care shown to improve patient outcomes. Breast surgery training should become a critical priority within residency programs. We conducted a cross-sectional survey during the 2025 Italian Society of Breast Surgeon (ANISC) annual meeting, to explore the opinions of breast surgery consultants and residentsregarding the current state of breast surgery training, as well as future perspectives for its improvement. A total of 126 participants (77% consultants, 23% residents) completed the survey. Most of the participants (49.2%) worked in medium-volume Breast Units and had > 10 years of clinical practice (45.2%). Overall, 67.5% of respondents judged their training only partially satisfactory, while 23.8% were completely dissatisfied. The majority (58.7%) supported a hybrid model with three years of general surgery followed by two years exclusively dedicated to breast surgery. Most respondents endorsed mandatory training periods in complementary specialties (79.4%) and rotations in peripheral Breast Units (69.8%). Notably, 88.1% favored the development of a vertical breast surgeon profile, capable of independently managing both oncologic and reconstructive procedures. This is the first national survey exploring breast care professionals’ perspectives on surgical training in Italy. Only 8.7% considered the current system adequate to meet clinical needs. The strong demand for structured and specialized programs, together with the recognition of a vertical breast surgeon figure, highlights the urgent need to redefine breast surgery training pathway.

Magnetic resonance imaging (MRI) is crucial for prostate cancer (Pca) diagnosis, risk stratification, and treatment planning. However, large-scale observational studies require structured MRI data, which are often only obtainable from free-text reports. We aimed to extract information from narrative prostate MRI reports and to describe subsequent biopsy outcomes in a nationwide population-based cohort. We identified 108,361 prostate MRI examinations in Prostate Cancer database Sweden with extended treatments and endpoints data (PCBase Xtend) performed in 2015-2023. A rule-based text recognition algorithm was created and used to extract Prostate Imaging Reporting and Data System (PI-RADS) score and prostate volume from free-text MRI reports. Extracted data were validated against manually extracted information in the National Prostate Cancer Register (NPCR). We examined biopsy rates and Gleason score according to PI-RADS, Prostate Specific Antigen (PSA) density, and calendar year. The proportion of reports with identifiable PI-RADS scores increased from 38% in 2015-2016 to 83% in 2022-2023, with excellent agreement with NPCR data (correlation coefficient r = 0.94). Extracted prostate volumes correlated well with those in NPCR (r = 0.88). Biopsy rates decreased for PI-RADS 3 lesions over time, particularly in men with PSA density < 0.15 ng/ml/ml, while the proportion of men with PI-RADS 5 lesions who underwent biopsy increased. Almost all prostate cancers in men with PI-RADS 3 lesions were Gleason 6 or 7 (3+4). Gleason 9-10 was almost exclusively found in PI-RADS 5 lesions. Automated extraction of information from unstructured MRI reports is feasible and accurate. The observed temporal trends reflecting increasing quality and standardization of prostate MRI support its use in large-scale epidemiological research.

The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.