Ospedale Humanitas Gradenigo

Abstract Introduction Immune checkpoint inhibitors (ICIs), including PD-1/PD-L1 and CTLA-4 inhibitors, have significantly improved cancer treatment outcomes. Over the past decade, these therapies have demonstrated remarkable efficacy; however, their use is associated with immune-related cardiovascular adverse events (irCVEs), ranging from mild biomarker alterations to severe conditions such as arrhythmias, myocarditis, pericarditis, left ventricular dysfunction, heart failure, and acute coronary syndrome. Moreover, specific risk factors for irCVEs development remain unknown. Purpose This study aims to identify risk factors for irCVEs in cancer patients receiving ICI. Methods A total of 125 patients undergoing immunotherapy were assessed. From July 2022, each patient underwent baseline and on-treatment evaluations, including physical examination, electrocardiography, echocardiography, and measurement of high-sensitivity troponin I and NT-proBNP. Data were collected from medical records and diagnostic assessments. Logistic regression analysis was performed to identify independent risk factors, excluding imbalanced variables. Initial analysis using the Generalised Linear Model (GLM) in R found no significant predictors, leading to the application of a regularised GLM to enhance prediction accuracy and prevent overfitting. The dataset was divided into a training set (87 patients) and a test set (38 patients). Model optimisation involved hyperparameter tuning (penalty: 0.0000000001, mixture: 0), with validation based on key performance metrics (accuracy: 68%, precision: 83%, sensitivity: 77%, specificity: 29%, F-measure: 0.80, Cohen’s Kappa: 0.05). Results Our study identified 17 events, including 6 cases of asymptomatic cardiac biomarker elevation, 3 cases of myocarditis, 1 case of pericarditis, 3 cases of heart failure, 1 case of atrial fibrillation, and 3 cases of acute coronary syndrome, most of which occurred after the first ICI administration. Pre-existing diabetes, dyslipidaemia, atrial fibrillation, and prior treatment with a potentially cardiotoxic regimen emerged as independent predictors of irCVEs development. Additionally, our evaluation proved to be a reliable predictor of irCVEs development in medium- and high-risk patients according to ESC Guidelines 2022. No irCVEs-related deaths were reported. Conclusion Immunotherapy represents a major advancement in cancer care, yet early identification and risk stratification of irCVEs are crucial to minimising complications and optimising patient outcomes. Our findings underscore the need for proactive strategies to improve early irCVEs detection and risk assessment. This study provides real-world insights into irCVEs; however, our findings should be interpreted cautiously due to the limited sample size and low event incidence. Further ongoing research aims to expand patient cohorts and refine predictive models to support standardised prevention strategies.

Abstract With the rising incidence of hip osteoarthritis, the need for reliable tools to assess disease burden has become increasingly important—both for tailoring individualized treatment strategies and for research purposes, where accurate stratification of disease severity is essential for patient profiling. In this context, structured scoring systems applied to imaging modalities can offer reproducible and standardized evaluations of joint involvement. The aim of this work is to provide a methodological narrative review of the most widely used and clinically relevant hip osteoarthritis scoring systems. The focus is strictly methodological: we do not address the pictorial appearance of these systems, nor do we provide image-based examples, as this is not intended to be a pictorial review. The systems included in this review were selected based on their perceived relevance and frequency of use in both clinical and research settings. While we acknowledge the existence of many other valid and potentially useful tools, a comprehensive inclusion was beyond the scope of this paper and would have hindered its methodological focus.

Abstract Objectives To evaluate functional and satisfaction outcomes of Rigicon Infla 10® and compare with the most widely implanted inflatable prostheses. Methods 15 consecutive ED patients in waiting list for a three-pieces implant (Group 1). All patients underwent implantation of the Rigicon Infla 10® via penoscrotal approach and were followed perspectively. Functional parameters were evaluated using IIEF-5, EHS, Rosenberg Self Esteem Scale, SF-36 before surgery and at 3 and 6 months postoperatively. Satisfaction was assessed using EDITS and QoLSPP questionnaires at 3 and 6 months. The results were compared with prospectively collected data from the last 20 patients who underwent implantation of a DBI CX 700® (Group 2) and a Coloplast Titan® prosthesis (Group 3) in the same centre, and with data available in literature. Statistics: Friedman, Wilcoxon, Kruskal-Wallis. Software: MS Excel. Results The 3 groups resulted homogeneous for age and comorbidity. Mean surgical times were not statistically different among the 3 groups (p = 0.1). No difficult was found in preparation, insertion and connection of the prosthesis. 1 patient was lost at follow-up. No mechanical failures or major complications occurred; in 1 patient a dislocation of the reservoir across the inguinal ring after strong coughing in PO day 1 was recorded and surgically treated. The mean IIEF-5 score improved from 6.33 preoperatively to 19.08 at 6 months (p < 0.05), showing no significant difference compared to the other groups (p = 0.31). The mean EHS score improved from 1 to 3.46 (p < 0.05), with no significant differences from other groups (p = 0.09). The mean scores of self-esteem and quality of life remained stable. The mean EDITS score resulted 76.2% and the mean QoLSPP 70.8%, similar to the other groups (respectively p = 0.089 and p = 0.095). Functional and satisfaction data resulted comparable with those available in literature for DBI and Coloplast prosthesis. Conclusions The Rigicon Infla 10® provided a significant improvement in erectile function and high levels of patient satisfaction. The functional and satisfaction outcomes were comparable to those of the most widely available prostheses on the market. Conflicts of Interest Prostheses provided free-of-charge by Rigicon as a liberal provision.

PurposeThis study investigated the applicability of a validated AI-algorithm for analyzing different retinal biomarkers in eyes affected by epiretinal membranes (ERMs) before and after surgery.MethodsA retrospective study included 40 patients surgically treated for ERMs removal between November 2022 and January 2024. Pars plana vitrectomy with ERM/ILM peeling was performed by a single experienced surgeon. A validated AI algorithm was used to analyze OCT scans, focusing on intraretinal fluid (IRF) and subretinal fluid (SRF) volumes, external limiting membrane (ELM) and ellipsoid zone (EZ) interruption percentages and hyper-reflective foci (HRF) counts.ResultsPostoperative best corrected visual acuity (BCVA) significantly improved (p < 0.01), and central macular thickness (CMT) decreased from 483.61 ± 96.32 to 386.82 ± 94.86 µm (p = 0.001). IRF volume reduced from 0.283 ± 0.39 mm3 to 0.142 ± 0.27 mm3 (p = 0.036) particularly in the central 1 mm-circle. SRF, HRF and EZ/ELM interruption percentages exhibited no significant differences (p > 0.05). Significant correlations (p < 0.05) were found between preoperative BCVA and postoperative BCVA (r = 0.45); CMT reduction and postoperative BCVA (r = 0.42), preoperative IRF and Visual Recovery (r = -0.48), ELM and EZ interruption and visual recovery (r = -0.43 and r = -0.47 respectively). Multivariate analysis demonstrated that fluid distribution, especially in the central subfield, correlated with BCVA recovery (R2 = 0.38; p < 0.05; Pillai's Trace = 0.79).ConclusionThe study highlights AI's potential in quantifying OCT biomarkers in ERMs surgery. The findings suggest that improved BCVA is associated with reduced CMT, IRF, and redistribution of IRF towards the periphery. EZ and ELM integrities remain crucial prognostic factors, emphasizing the importance of the preoperative analysis.

Background: Augmented reality (AR) is a promising tool in orthopedic surgery, particularly in total knee arthroplasty (TKA). AR enables real-time visualization of anatomical structures and surgical plans, enhancing intraoperative precision. However, significant knowledge gaps remain regarding patient-reported outcome measures (PROMs), standardized protocols, and long-term follow-up. This review aims to evaluate current evidence on the effectiveness and limitations of AR in TKA. Methods: A scoping review of English written preclinical and clinical studies published between January 2013 and October 2023 was conducted on PubMed, Scopus, Web of Science, and Google Scholar databases. Eligible studies were in English and reported on AR-assisted TKA systems. Sources included peer-reviewed journals and conference proceedings. Studies with unclear methodology or insufficient comparative data were excluded. Results: The review included five preclinical and six clinical studies. Preclinical studies demonstrated the high precision of AR systems, with tibial cut errors averaging 0.66° [standard deviation (SD) ±0.55°] in the coronal plane and 0.89° (SD ±0.75°) in the sagittal plane. Similarly, femoral cuts exhibited average errors of 1.1° (SD ±0.8°) in the coronal plane and 0.86° (SD ±0.5°) in the sagittal plane. Clinical studies confirmed the non-inferiority of AR systems compared to accelerometer-based navigation, with success rates of alignment within 3° of the mechanical axes reaching 95.4% for AR systems versus 93.2% for accelerometer navigation. Additionally, AR systems showed minimal impact on operative time and blood loss. However, significant heterogeneity in study designs and the lack of standardized PROMs were noted, limiting broader applicability and analysis. Conclusions: AR technology shows promise in improving surgical precision and reducing variability in TKA. However, challenges such as study heterogeneity, and the lack of standardized protocols and long-term outcomes limit its adoption. Future research should focus on standardized methods, patient-centered outcomes, and cost-effectiveness to support broader clinical use.

PurposeSmokers with squamous cell carcinoma (SCC) of the tongue may be particularly prone to experience multifactorial gustatory dysfunction. This study investigates the effects of heavy smoking on taste perception in patients undergoing glossectomy type IIIa (i.e. non-compartment hemiglossectomy) for SCC of the tongue.MethodsGustatory function was assessed in 30 heavy-smoking patients with SCC of the tongue using a validated taste strips test. Psychophysical evaluations were conducted at baseline and at 3, 6, 9, and 12 months post-surgery.ResultsAt baseline, mean taste strip scores (TSS [SD]) were significantly lower in patients compared to controls (8.7 [1.9] vs. 11.6 [2.1], P <.001). Post-treatment, TSS in patients declined to 7.2 [1.0] at 3 months, followed by a gradual recovery to 7.6 [2.3] at 6 months, 8.4 [2.8] at nine months, and 8.9 [3.9] at 12 months. Patients who quit smoking achieved significant recovery, with TSS improving from 7.4 [0.9] at three months to 11.8 [1.4] at twelve months, nearing control values. In contrast, smokers experienced a progressive decline, from 6.8 [1.2] at three months to 4.6 [1.6] at twelve months (P <.001). Adjuvant radiotherapy exacerbated short-term deficits (TSS of 6.6 [1.0] vs. 7.5 [0.9], P =.027 at three months) but showed no significant long-term impact.ConclusionPersistent smoking worsens taste perception and impedes recovery in patients undergoing glossectomy type IIIa for tongue SCC. Smoking cessation significantly enhances sensory restoration, underscoring its importance in post-treatment care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00405-025-09590-8.

Introduction Post-operative hypocalcemia and postoperative persistent hypoparathyroidism remain the most common complications after thyroidectomy. Many approaches have been developed to prevent them, but actually, a common protocol is not yet individuated. Materials and methods We retrospectively analyzed the results of a prospectively collected database. We dosed PTH preoperatively and 4 h after surgery (PTH_4); calcium was evaluated preoperatively, on the first (I_POD) and on the second postoperative day (II_POD). Hypocalcemia was defined when calcium <8 mg/dl. PTH_4 and I_POD calcium serum levels are identified to predict postoperative hypocalcemia. Results Three hundred and forty-eight patients were enrolled, 37 patients resulted as hypocalcemic on I_POD and 41 on the II_POD. PTH_4 is related to I_POD (p < 0.001, r = 0.45) and II_POD (p < 0.001, r = 0.44) calcemia. PTH_4-cut-off predicting I_POD hypocalcemia was 10.50 pg/ml (sensitivity: 78.7%, specificity: 72.7%). A PTH_4 value of 11.5 pg/ml is able to predict hypocalcemia during II_POD (sensitivity: 76.5%, specificity: 69.2%). We set up a combined test to predict II_POD hypocalcemia, using PTH_4 and I_POD calcium (sensitivity: 77.8%, specificity: 89.9%). Conclusion This research shows the association between PTH_4 and postoperative hypocalcemia. The PTH_4 cut-off to predict I_POD-hypocalcemia was 10.5 pg/ml. We analyzed the calcemia trend during the postoperative period and we realized a combined test using PTH_4 and I_POD-calcemia. This test improves the accuracy of the previous test. Further studies, in particular multicentric, with a larger sample are necessary to validate the combined model.