Ospedale Valduce

The ongoing digital transformation is reshaping organizational and care delivery models in cardiology, positioning telemedicine as a pivotal tool to address increasing clinical and demographic complexity. This ANMCO position paper presents a comprehensive and critical overview of telemedicine applications in cardiovascular care, with a focus on its role in strengthening hospital-community integration, its deployment within hospital-based healthcare systems, and the associated regulatory and operational frameworks. The analysis encompasses the management of chronic cardiovascular conditions, such as heart failure and atrial fibrillation, through telemonitoring, telecontrol, televisit, and teleconsultation. Additionally, it explores the use of digital technologies in post-myocardial infarction follow-up, oral anticoagulation management, preoperative assessment, and care for elderly patients. The position paper also highlights the challenges and opportunities linked to digital infrastructure, interoperability, data protection, and healthcare professional training.

The evolution of the mHealth era offers the possibility of behavioral interventions to promote changes in lifestyle habits with prevention relevance. These tools are considered digital therapeutics (DTx) and follow the MDR 745/2017 for testing, validation, and certification. In the frame of the ACTIVE3 project, we developed a platform composed of a mobile app, a wearable device, and a cloud backend to support healthy aging intervention in a population of 60–80-year-old subjects. This paper describes the clinical trial protocol and the baseline data of the recruited population. The explored parameters describe the effect of the DTx in the physical, nutritional (and metabolic), and cognitive domains, leveraging the Walking Group initiatives coordinated by ATS Brianza that are active in the Lecco area; in addition, system usability and acceptance were analyzed. The study started on 1 September 2024, and the analyzed baseline data are presented here. With respect to an expected population of 200 subjects, we received interest and consent to participate from 237 subjects: over-enrollment was allowed and all these subjects were accepted into the study. The characterization of the study population at the initial time of the trial was carried out, and the outcomes are presented here. The population is generally more active than Italian people of the same age. According to the outcome of the 6MWT, the population was divided into three groups: trained participants (42 subjects), active participants (142 subjects), and sedentary participants (58 subjects). The tests at month 12 were recently competed, and the final results will be available in winter 2025–2026.

Instrumental and observational gait analysis are time-consuming and call for adequate operator training. The instrumental analysis calls for dedicated spaces, whilst observational analysis remains strongly operator dependant and subtle information may be missed, despite standardized tools can be adopted by clinicians (i.e., tables with specific features to be looked for in people walking). Markerless motion capture systems, such as pose estimation software based on convolutional neural networks and machine learning algorithms, may overcome the limitations of both the described approaches. This article presents a Markerless Automatic video-based platform for Gait Analysis (MaGA) that, given a predefined clinical tool and starting from the video recording of a person walking, computes the joint kinematics, identifies gait cycle sub-phases, perform a feature extraction and disentangles pathological from physiological walking via support vector machine algorithms, with linear and non-linear kernels. Results reported linear and non-linear models performances in classifying and predicting severity of gait alterations at hip and knee joints, according to the Ranchos Los Amigos scale. The Mean Absolute Error ranged between 0.04 and 0.70 for linear models and was generally lower than 0.50 for non-linear models. F1-scores are generally above 0.70, with a few exceptions. The analysis of three example cases demonstrate the effectiveness of the method in evaluating sagittal hip and knee kinematics, highlighting agreements and a few discrepancies with expert evaluations taken as ground truth. The proposed platform has the potential to be customized for the automatic assessment of individuals’ gait based on various clinical evaluation tools, thereby addressing the common limitations associated with them. Future plans include conducting comprehensive technical and clinical trials to assess the platform’s sensitivity under varying data collection conditions. Additionally, efforts will be made to establish a broader reference dataset, encompassing individuals with diverse disorders and varying levels of pathology severity. • Gait analysis is key for assessing motor impairments in clinical practice. • MaGA is a low-cost, automated tool for improving observational gait analysis (oGA). • MaGA applies machine learning to enhance accuracy and reduce human error in oGA. • Non-linear SVM models in MaGA improve gait classification and reduce overfitting. • Further research will aim to improve likelihood estimates of pathology in MaGA.

Abstract Background Malnutrition is still underdiagnosed in inflammatory bowel disease (IBD), partly due to the lack of a universally accepted definition. The Global Leadership Initiative on Malnutrition (GLIM) proposed a consensus-based diagnostic criteria in 2018. This study aims to assess the validity of GLIM criteria in identifying malnutrition in IBD outpatients, compare them with other diagnostic tools, and evaluate the association between malnutrition and patients’ quality of life and fatigue. Methods This monocentric, prospective, observational study included all IBD patients attending the IBD outpatient clinic at the Fondazione IRCCS San Gerardo dei Tintori (Monza, Italy) between June and August 2024. Malnutrition risk was assessed using the Malnutrition Universal Screening Tools (MUST), while malnutrition was diagnosed by means of World Health Organization (WHO) criteria, Subjective Global Assessment (SGA), European Society of Clinical Nutrition and Metabolism (ESPEN) criteria, and GLIM criteria. Quality of life and fatigue were assessed with the validated Italian version of the Inflammatory Bowel Disease Questionnaires (IBDQ) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Continuous variables were expressed as mean ± standard deviation (SD) and compared between groups using an independent samples t-test. Agreement among diagnostic criteria was evaluated using Gwet’s AC1, a chance-corrected agreement coefficient, using SGA as the semi-gold standard. Results 99 IBD patients (49 CD, 50 UC; mean age 47.3 ±18.5; 57.6% male) were included. 22% of patients were at risk of malnutrition according to MUST. Malnutrition was diagnosed in 5%, 10% and 7.1%, according to SGA, ESPEN and WHO criteria, respectively. GLIM criteria identified 12 malnourished patients (12.1%), among whom malnutrition was associated with younger age at diagnosis (30.6 vs 35.2 years, p = 0.037), male sex (83.3%, p = 0.006), and more active disease (moderate disease in 50% vs 3.5%, p < 0.0001). GLIM criteria showed substantial agreement with SGA (AC1 0.9045345, CI 0.84112-0.96794) and with ESPEN (AC1 0.8935198, CI 0.82888-0.95816), but poor agreement with WHO criteria (AC1 0.500557, CI 0.38331-0.61781). Quality of life scores were slightly lower among malnourished patients, though without significant differences compared to well-nourished individuals. Conclusion GLIM criteria identified a higher prevalence of malnutrition in IBD outpatients compared to other diagnostic tools and demonstrated substantial concordance with SGA, which is considered the semi-gold standard. These findings support the use of GLIM as an appropriate, accurate and applicable tool for diagnosing malnutrition in IBD outpatients. Conflict of interest: Dr. Laffusa, Alice: No conflict of interest Ratti, Edoardo: No conflict of interest Pirola, Lorena: Consulting fees and participation on advisory board: Abbvie. Honoraria for presentations, speakers bureaus and educational events: Pfizer, Janssen, Takeda. Receipt of equipment and materials: Celltrion. Support for attending meetings and/or travel: Abbvie, Johnson and Johnson, Takeda, Pfizer, Giuliani, Ferring, Eli Lilly, Alfasigma, Cadigroup Mulinacci, Giacomo: No conflict of interest Savino, Alberto: No conflict of interest Fichera, Maria: No conflict of interest Massironi, Sara: None to declare Invernizzi, Pietro: No conflict of interest Galimberti, Stefania: No conflict of interest Viganò, Chiara: Consultancy and lecture fees from: AbbVie, Galapagos, Janssen-Cilag, Johnson & Johnson, Pfizer, Takeda, Celltrion, Alfasigma, Eli Lilly and research grant from Celltrion and Pfizer.

Background/Objectives: Hydroxyapatite (HAp)-based implants and HAp-titanium (HApTi) composites are widely used in orthopedic and dental applications, but their long-term success is limited by peri-implant bone loss. Local delivery of osteoactive molecules from implant surfaces may enhance osseointegration and reduce periprosthetic osteolysis. This study combined in silico modeling and experimental assays to compare calcium fructoborate (CaFb), sodium alendronate, and calcium alendronate as functionalization agents for HAp and HApTi implants. Methods: Molecular docking (AutoDock 4.2.6) and 100 ns molecular dynamics (MD) simulations (AMBER14 force field, SPC water model) were performed to characterize ligand-substrate interactions and to calculate binding free energies (ΔG_binding) and root mean square deviation (RMSD) values for ligand-HAp/HApTi complexes. HAp and HApTi discs obtained by powder metallurgy were subsequently functionalized by surface adsorption with CaFb or alendronate salts. The amount of adsorbed ligand was determined gravimetrically, and in vitro release profiles were quantified by HPTLC-MS for CaFb and by HPLC after FMOC derivatization for alendronates. Results: CaFb-HAp and CaFb-HApTi complexes showed the lowest binding free energies (-1.31 and -1.63 kcal/mol, respectively), indicating spontaneous and stable interactions. For HAp-based complexes, the mean ligand RMSD values over 100 ns were 0.27 ± 0.17 nm for sodium alendronate, 0.72 ± 0.28 nm for calcium alendronate (range 0.35-1.10 nm), and 0.21 ± 0.19 nm for CaFb (range 0.15-0.40 nm). For HApTi-based complexes, the corresponding RMSD values were 0.30 ± 0.15 nm for sodium alendronate, 0.72 ± 0.38 nm for calcium alendronate and 0.26 ± 0.14 nm for CaFb. These distributions indicate that CaFb and sodium alendronate maintain relatively stable binding poses, whereas calcium alendronate shows larger conformational fluctuations, consistent with its less favorable binding energies. Experimentally, CaFb exhibited the greatest chemisorbed amount and percentage on both HAp and HApTi, followed by sodium and calcium alendronate. HApTi supported higher loadings than HAp for all ligands. Release studies demonstrated a pronounced burst and rapid plateau for both alendronate salts, whereas CaFb displayed a slower initial release followed by a prolonged, quasi-linear liberation over 14 days. Conclusions: The convergence between in silico and adsorption-release data highlights CaFb as the most promising candidate among the tested ligands for long-term functionalization of HAp and HApTi surfaces. Its stronger and more stable binding, higher loading capacity and more sustained release profile suggest that CaFb-coated HApTi implants may provide a favorable basis for future in vitro and in vivo studies aimed at improving osseointegration and mitigating periprosthetic osteolysis, although direct evidence for osteolysis prevention was not obtained in the present work.

Background/Objectives: Coagulopathy is a common complication of liver cirrhosis, partly due to impaired synthesis of vitamin K-dependent coagulation factors. Despite its frequent use, the efficacy of vitamin K in this setting remains uncertain. This study aimed to evaluate the effect of vitamin K administration on coagulation parameters in patients with cirrhosis. Methods: We performed a retrospective study of 122 cirrhotic patients hospitalized between 2020 and 2024, who received vitamin K for coagulopathy correction. Coagulation and liver function parameters were monitored over time. Results: An early and progressive improvement in INR values was observed, in a subset of patients, following vitamin K administration. INR values across time points were strongly correlated, while only weak associations were observed with bilirubin levels. These findings support a selective therapeutic effect, rather than universal efficacy. Discussion: Despite current guidelines discouraging routine vitamin K use in cirrhosis, our findings suggest that selected patients—particularly those with reversible deficiency—may benefit from supplementation. The observed decrease in INR values supports a targeted, context-based approach rather than empirical management. Conclusions: However, due to the retrospective design and absence of a control group, the observed improvements cannot be conclusively attributed to vitamin K administration. Vitamin K may improve coagulation in cirrhotic patients with reversible deficiency, but its efficacy is not universal. Its use should be individualized and guided by clinical and biochemical context, as part of a broader treatment strategy.

Body ownership relies on the integration of multisensory signals coming from the environment and the body itself. Considering the substantial neurophysiological and sensory modifications occurring across the lifespan, this study aims to quantitatively evaluate age-related changes in hand ownership and its underlying bottom-up sensory and top-down components from adolescence to advanced aging. Ninety-two healthy women aged 15–83 underwent a virtual-reality based visuo-proprioceptive disparity task in which they performed reiterative reaching movements towards visual targets while observing a virtual-hand that could be spatially congruent or displaced at different disparities from the real hand’s position. Ownership was assessed by collecting reaching errors (implicit) and asking ownership judgments toward the virtual-hand (explicit). Errors were modeled using a Bayesian Causal Inference framework in which ownership for the virtual-hand resulted from a weighted average between pure visual and pure proprioceptive guidance according to their relative precision (i.e., bottom-up sensory components), and to the a priori probability that the virtual-hand was one’s own (i.e., top-down prior). Results showed that both explicit and implicit ownership towards spatially incongruent virtual-hands was higher with advancing age. Moreover, the sensory components extracted from the model revealed higher proprioceptive and lower visual variability in older adults, suggesting that as proprioception declines, visual input increasingly assumes a dominant role. No age-effect was found on the prior (i.e., top-down component). We concluded that ownership progressively changes from adolescence to old age, mostly driven by a physiological reduction in proprioceptive abilities. The sensory recalibration toward visual reliance might reflect a compensatory mechanism to maintain coherent body ownership despite age-related sensory decline.

Bowel preparation is a significant challenge for patients undergoing colonoscopy, especially in Inflammatory Bowel Disease (IBD) patients. Oral mannitol (OM), an ultra-low-volume, single-dose osmotic laxative with a sweet taste, could improve patient tolerability. We performed a post-hoc analysis of the phase 3, multicentre, randomized, endoscopist-blinded SATISFACTION trial to compare same-day OM versus standard split-dose 2L polyethylene glycol plus ascorbate (PEG-ASC) for bowel preparation in IBD patients. Fifty-five IBD patients (24 OM, 31 PEG-ASC) were assessed for bowel cleansing efficacy, endoscopic outcomes, safety, and patient satisfaction. OM demonstrated superior tolerability, including ease of use (88% vs. 71%), taste satisfaction (75% vs. 6%), and willingness to reuse (96% vs. 71%). OM also reduced intake duration (32 vs. 107 minutes) and time to evacuation (57 vs. 91 minutes), with comparable efficacy, cleansing quality, and safety. In conclusion, same-day OM preparation enhances satisfaction and adherence in IBD patients, offering a safe, effective alternative to standard protocols.