Ospedale San Paolo

Women with aortic stenosis (AS) are underdiagnosed and undertreated compared to men and face a higher mortality risk despite similar symptoms and fewer comorbidities. Sex-specific differences in left ventricular (LV) remodeling may contribute to this disparity. We investigated whether a fully automated, machine-learning-based three-dimensional echocardiography (3DE) approach, the Dynamic Heart Model (DHM), improves the detection of these differences compared to conventional two-dimensional echocardiography (2DE). This study investigates sex-related differences in cardiac remodeling and hemodynamics in AS patients with a preserved ejection fraction (EF ≥ 50%), comparing results from 2D echocardiography (2DE) and 3D echocardiography (3DE) via the DHM. The study included 101 consecutive patients with AS (42% women) who were assessed with 2DE and DHM. Parameters such as LV volumes, mass (LVM), stroke volume (SV), and aortic valve area (AVA) were measured and indexed to body surface area (BSA). Sex-specific differences were analyzed, with a focus on identifying significant remodeling patterns. Women exhibited smaller LV end-diastolic volume (EDV) and end-systolic volume (ESV) by DHM compared to men (115 mL vs. 155 mL, p < 0.001; 51 mL vs. 66 mL, p < 0.001). Indexed EDV (EDVi) and ESV (ESVi) were also significantly lower in women (69 mL/m² vs. 84 mL/m², p < 0.001; 30 mL/m² vs. 34 mL/m², p = 0.002). LVM and indexed LV mass (LVMi) were significantly lower in women when measured by DHM (131g vs. 163g, p < 0.001; 75g/m² vs. 89g/m², p = 0.005), whereas 2DE did not reveal statistically significant differences. Women exhibited a more concentric LV geometry, as reflected by higher relative wall thickness than men (0.42 vs. 0.36; p = 0.04). Despite similar hemodynamic parameters, women had significantly smaller DHM-derived AVA (0.90cm² vs. 1.20cm², p < 0.001), correlating with reduced SV (64 mL vs. 90 mL, p < 0.001). This study highlights that significant sex-related differences in LV remodeling and AS severity are better captured by DHM than 2DE, emphasizing the importance of sex-specific considerations and accurate measurements in evaluating and managing AS.

This study investigates the impact of pressure ulcers (PU) on long-term survival in hospitalized older adults, to understand how frailty and PU interact to influence mortality and to explore their independent prognostic accuracy. Between February 21, 2022, and July 1, 2022, 324 patients (198 female, 126 male; mean age: 86), admitted to the Geriatric Unit and Transitional Care of San Bartolomeo Hospital, Sarzana, Italy, were enrolled. A comprehensive geriatric assessment (CGA) was performed by geriatricians, including the assessment of frailty using the Clinical Frailty Scale (CFS), and PU assessment, carried out by a trained nurse. Long-term mortality (median duration: 18months) was collected through the regional electronic health data system with an 18-month follow-up period. Older adults with PU had advanced frailty, higher nutritional risk, increased disability, and higher polypharmacy. Multivariate analysis showed that both frailty (CFS: HR 1.535, 95% CI 1.314-1.793, p < 0.001) and PU (HR 1.500, 95% CI 1.059-2.126, p = 0.020) were significant predictors of long-term mortality. Namely, each increment in CFS score was associated with a 53% increased risk in PU carriers. No significant interaction between CFS and PU on survival outcomes was found. The study underscored the independent prognostic significance of both PU and frailty in predicting long-term mortality in hospitalized older adults. A multidimensional approach considering both frailty and PU is crucial for accurate prognostication and improving care strategies for older patients.

Green and Blue Infrastructure (GBI) and Nature-Based Solutions (NBS) are becoming increasingly important for sustainable water management and climate change adaptation, especially in urban areas facing greater hydrological pressures. This study uses a literature-based comparative analysis, based on a critical review of scientific publications, technical reports, and design documents. The analysis focuses on two European case studies: the proposed GBI/NBS project in Grundarfjörður, Iceland, and the completed intervention at the Scalo intermodale di Milano–Segrate.The analysis shows that the Grundarfjörður project mainly tackles heavy rainfall and rapid surface runoff by adopting sustainable urban drainage systems combined with microclimatic adaptation strategies. This takes place within a setting of high climatic variability and intricate geopedological conditions. Conversely, the Milan–Segrate case, evaluated solely through published project documents and monitoring records, concentrates on reducing hydraulic risk, environmental regeneration of a key infrastructural zone, and the multifunctional role of open spaces as vital links between hydraulic systems, landscape, and urban areas.The comparison based on the documentary highlights notable differences in bioclimatic conditions, design approaches, and the importance of environmental monitoring for the long-term assessment of GBI/NBS performance. These results underline the need for a unified methodological framework that combines urban hydrology, ecology, and spatial planning to enhance solution transferability and strengthen the reliability of long-term effectiveness evaluations.

To compare MRI-based graft maturation and tibial tunnel behavior in all-inside anterior cruciate ligament (ACL) reconstruction using either a quadrupled semitendinosus (ST4) graft or a standard doubled semitendinosus-gracilis (DSTG) technique and to assess mid-term clinical outcomes. This is a single-center prospective comparative cohort with sequential, non-randomized allocation. Primary imaging endpoints were graft signal-to-noise quotient (SNQ, PD-FS) and tibial tunnel cross-sectional area (CSA) change; clinical endpoints included PROMs and laxity at ≥ 24 months. Reliability was assessed with two independent evaluators and reported using ICC (two-way random, absolute agreement) with 95% CIs. Forty patients (n = 20 per group) completed MRI at 12 months and clinical follow-up at 24 months. SNQ was similar between groups (ST4 1.94 [95% CI 1.28-2.60] vs DSTG 2.84 [1.93-3.75]; difference - 0.90 [- 1.99 to 0.19], P = 0.39). Tibial tunnel widening was lower with ST4 (45.5% [23.7-67.3]) versus DSTG (106.7% [78.3-135.1]); difference - 61.2% [- 95.8 to - 26.6]; P = .02. PROMs and laxity were comparable. AI-ST4 and DSTG ACL reconstruction demonstrated similar graft maturation at 12months, with less tibial tunnel widening after AI-ST4. At 24months, clinical outcomes were equivalent between groups; although SNQ and tibial tunnel CSA demonstrated good reproducibility, these imaging differences were not demonstrably associated with functional superiority.

Cyclase-associated protein 2 (CAP2) is a synaptic actin-binding protein involved in cofilin-mediated spine remodelling, Alzheimer’s Disease synaptic failure and myofibril maintenance, indicating its potential involvement in motor neuron disease (MND). This study examined cerebrospinal fluid (CSF) levels of CAP2 in 60 patients with MND and 40 healthy controls (HC) to assess its diagnostic and prognostic value and its relationship with neuronal, glial and synaptic markers. Glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), phosphorylated and total tau (p-Tau 181, t-Tau), CAP2 and synaptosomal-associated protein 25 (SNAP-25) were quantified using ELISA, Lumipulse and SIMOA platforms. MND patients displayed increased GFAP, NfL, t-Tau, p-Tau 181 levels and CAP2 while SNAP-25 was reduced. CAP2 correlated with tau markers, but not with NfL or GFAP. Unlike NfL, which was higher in upper motor neuron–predominant cases and predicted faster progression and poorer survival, CAP2 did not vary with disease subtypes or severity. The study showed that CAP2 is associated with MND independently from neuronal, glial and presynaptic dysfunction. Integrating CAP2 into multi-marker panels could enhance understanding of synaptic pathology in MND.

Post-tuberculosis lung disease (PTLD) is an increasingly recognized condition that significantly affects survivors' quality of life, creating disability and incrementing the risk of mortality. PTLD includes a spectrum of structural and functional lung impairments such as obstructive, restrictive, and mixed patterns, bronchiectasis, and pulmonary fibrosis that persist beyond microbiological cure. Global prevalence data highlight a heavy burden of PTLD, especially in high-incidence regions, driven by late diagnosis and suboptimal treatment. Functional and radiological evaluation remains critical for timely diagnosis, with spirometry and imaging revealing lasting abnormalities in a large proportion of TB survivors. Multidisciplinary care is essential and includes bronchodilator therapy, infections/complications management and prevention, pulmonary rehabilitation, and, in selected cases, surgical intervention. Despite increasing recognition, standardized diagnostic and therapeutic pathways for PTLD are still lacking, and data on optimal follow-up, rehabilitation strategies, and preventive measures remain limited. Prospective studies, better stratification tools, and patient education initiatives are urgently needed to reduce PTLD morbidity and mortality. This narrative review synthesizes current evidence on PTLD epidemiology, clinical evaluation and management while offering practical suggestions for clinicians taking care of people with TB and addressing research needs.

Background: The Rives–Stoppa retromuscular repair remains the reference standard for open ventral hernia repair. Advances in robotic surgery have expanded the minimally invasive options for extraperitoneal mesh placement, enabling both retromuscular and preperitoneal approaches. The robotic ventral transabdominal preperitoneal repair (Rv-TAPP), has seen increasing adoption, but comparative evidence with the robotic retromuscular techniques remains limited. Methods: A systematic review and meta-analysis were reported in accordance with PRISMA and AMSTAR II guidelines (PROSPERO 2025: CRD420251173188). Searches of PubMed, Embase, Scopus, and Cochrane Library were searched to identify comparative studies evaluating robotic preperitoneal and retromuscular ventral hernia repair. Random-effects models (DerSimonian–Laird) were used to pool weighted mean differences (WMD) and risk ratios (RR) with 95% confidence intervals (CI). Results: Six retrospective studies including 3704 patients (2326 preperitoneal, 1378 retromuscular) were included. Preperitoneal cases involved smaller, predominantly primary defects (mean 3.0 cm vs 6.3 cm). Operative time was significantly shorter for Rv-TAPP (WMD = −39.4 min, 95% CI −58.5 to −20.2; p< 0.001). Overall postoperative complications occurred in 7.2% vs 15.6%, (RR= 1.65, 95% CI 1.21–2.26), with wound-related morbidity also lower with Rv-TAPP (RR = 1.81, 95% CI 1.25–2.63). Recurrence rates were comparable (1.9% vs 0.5%; RR = 0.95, 95% CI 0.29–3.11). Conclusions: Both robotic extraperitoneal approaches are safe and effective. Rv-TAPP offers shorter operative time and lower wound morbidity without increasing recurrence rates, favouring its use in small to medium-sized or primary ventral defects. Retromuscular repair remains preferred for large or complex hernias, underscoring their complementary roles in contemporary hernia repair. Supplementary InformationThe online version contains supplementary material available at 10.1007/s11701-025-03076-9.