Ospedale di Belcolle

To assess the predictability of Emprint HP-Generator (150W, 2.45GHz) in terms of ablation volume and sphericity both in the ex vivo and in vivo setting. In an ex vivo setting, 48 ablations were performed on porcine livers at varying ablation times with a constant power of 150W. MRI assessment of the ablation volumes was performed. In the in vivo setting consecutive procedures with 150W application with no rampage, single antenna positioning and availability of a contrast-enhanced computed tomography (CECT) immediately after the ablation were included. A semi-automated segmentation tool was used for volume estimation and spherical index (SI) was calculated. In the ex vivo group, mean ablation time was 5.3 ± 2.5min (range 1-10min), mean ablation diameter was 37.7 ± 5.8mm (range 21.3-49mm) and mean ablation volume was 20.1 ± 10.8cm3 (range 3-38.4cm3) with a mean SI of 0.83 ± 0.08. In the in vivo group 78 percutaneous liver ablations (tumour mean diameter 23.2 ± 11mm) in 65 patients (M46; F19; mean age 66.8 ± 11.3) were retrospectively enrolled from two institutions. The mean ablation time was 4,9 ± 2,5min (range 1-10min), mean ablation diameter was 41.3 ± 9.6mm (range 16-73mm) and mean ablation volume was 27.8 ± 15.6cm3(range 6.4-105.6cm3). Mean SI was 0.85 ± 0.11. Ablation volumes tend to be larger in case of hepatocellular carcinoma (HCC) compared to other histology (33.7 ± 21.2cm3 vs 24.8 ± 10.5cm3; p = 0.08). Both in ex vivo and in vivo settings, the SI remained stable regardless of ablation time andvolume (Pearson's r 0.08, p 0.46), while ablation volumes increased linearly with time (Pearson's r 0.79, p < 0.001). Clavien-Dindo 1 complications were registered (4/65, 6.1%). The Emprint HP-generator enables the creation of large predictable volumes in both settings. SI remains consistent regardless of ablation time and volume.

Modern oncology faces the need to integrate high-level evidence, non-pharmacological interventions into care pathways. Among these, structured physical exercise is shifting from a simple "virtuous recommendation" to a treatment that concretely influences clinical outcomes. The phase III CHALLENGE trial, conducted on 889 patients with stage II-III colon cancer, demonstrated a 6.4% absolute increase in 5-year disease-free survival (DFS) (HR 0.72) and a 37% reduction in overall mortality (HR 0.63). Observational evidence further confirms benefits in breast, prostate, and lung cancers. This review summarizes the literature, analyzes barriers and implementation strategies (tele-exercise, dedicated professionals, hub-and-spoke models), and assesses psychological and economic impacts.

Early relapse in multiple myeloma (MM) is a major predictor of poor prognosis, regardless of cytogenetic risk or treatment intensity. Here we analyzed 1026 MM patients treated across 12 Italian hematology centers. FHR was defined as progression-free survival (PFS) ≤18 months in transplant-eligible (TE) and ≤12 months in non-transplant-eligible (NTE) patients. Logistic regression and ROC analysis were used to identify significant predictors of FHR and build a risk score. FHR status was identified in 175 patients (17%). These patients had significantly shorter PFS (7 vs. 57.5 months) and overall survival (19 months vs. not reached; p < 0.001). FHR status was associated with higher median LDH, lower Hb level, higher creatinine level and lower platelets count. Modified EASIX formula was built by these significant continuous variables, to be tested in a logistic analysis: [(LDH × creatinine)/(Hb × PLT) × 100]. A significantly higher rate of FHR was found with a score > 2.0 (89% vs. 11%, p < 0.001). Multivariate logistic analysis selected the above formula, ECOG PS ≥ 2 and ISS III as factors associated with FHR. Scoring these variables according to OR, three groups of patients were segregated with a rate of FHR patients of 7%, 29.5%, and 63.5%, respectively. Treatment with anti-CD38 monoclonal antibodies was associated with lower FHR frequency. This study proposes a simple, clinically applicable model to identify FHR MM patients early in their disease course. However, very in-depth biological tools, not available in clinical practice, are needed to identify singularly risk of becoming FHR.

Background: Renal trauma accounts for approximately 3-5% of all trauma cases, predominantly affecting young males. The most common etiology is blunt trauma, particularly due to road traffic accidents, and it frequently occurs as part of polytrauma involving multiple organ systems. Management strategies are primarily dictated by hemodynamic stability, overall clinical condition, comorbidities, and injury severity graded according to the AAST classification. This study aimed to evaluate the effectiveness of non-operative management (NOM) in high-grade renal trauma (AAST grades III-V), beyond its established role in low-grade injuries (grades I-II). Secondary endpoints included the identification of independent prognostic factors for NOM failure and in-hospital mortality. Methods: We conducted a retrospective observational study including patients diagnosed with blunt renal trauma who presented to the Emergency Department of Policlinico Umberto I in Rome between 1 January 2013 and 30 April 2024. Collected data comprised demographics, trauma mechanism, vital signs, hemodynamic status (shock index), laboratory tests, blood gas analysis, hematuria, number of transfused RBC units in the first 24 h, AAST renal injury grade, ISS, associated injuries, treatment approach, hospital length of stay, and mortality. Statistical analyses, including multivariable logistic regression, were performed using SPSS v28.0. Results: A total of 244 patients were included. Low-grade injuries (AAST I-II) accounted for 43% (n = 105), while high-grade injuries (AAST III-V) represented 57% (n = 139). All patients with low-grade injuries were managed non-operatively. Among high-grade injuries, 124 patients (89%) were treated with NOM, including observation, angiography ± angioembolization, stenting, or nephrostomy. Only 15 patients (11%) required nephrectomy, primarily due to persistent hemodynamic instability. The overall mortality rate was 13.5% (33 patients) and was more closely associated with the overall injury burden than with renal injury severity. Multivariable analysis identified shock index and active bleeding on CT as independent predictors of NOM failure, whereas ISS and age were significant predictors of in-hospital mortality. Notably, AAST grade did not independently predict either outcome. Conclusions: In line with the current international literature, our study confirms that NOM is the treatment of choice not only for low-grade renal injuries but also for carefully selected hemodynamically stable patients with high-grade trauma. Our findings highlight the critical role of physiological parameters and overall ISS in guiding management decisions and underscore the need for individualized assessment to minimize unnecessary nephrectomies and optimize patient outcomes.

Pituitary metastases (PMs) are rare malignancy manifestations, generally deemed to have an extremely poor prognosis. Differential diagnosis from primary pituitary lesions is often difficult, as their features can mimic those of pituitary neuroendocrine tumours (PitNETs). This study aimed to report a single surgeon's experience in managing PMs and to gather the existing evidence on their clinical and neuroradiological presentation to build a model of 'red flags' that help raise the suspicion of PMs in the context of sellar lesions. We retrieved an original 10-year surgical series of patients undergoing endoscopic transsphenoidal (TNS) surgery for suspected PitNETs, and we additionally conducted a systematic review of case reports or series of patients with PMs. The local series consisted of n = 6 PMs. The literature review yielded n = 149 works reporting n = 340 PMs. Overall, the clinical presentation and neuroradiological features of n = 346 PMs were analysed and compared to data retrieved from n = 361 PitNETs from our original cohort. Primary features associated with PMs were: the presence of headaches (OR 1.24, p = 0.001), visual field deficits (OR 1.19, p = 0.02), extraocular nerve palsies (OR 1.23, p = 0.001), diabetes insipidus (OR 2.13, p < 0.001), MRI features of pituitary stalk/infundibular involvement (OR 1.98, p = 0.001), cavernous sinus invasion (OR 1.57, p = 0.004), and T2w flow voids (OR 1.13, p = 0.001). An incidental diagnosis (OR 0.49, p < 0.001) and cystic changes (OR 0.77, p = 0.02) were less common among PMs. Secondary features involved an acute onset of symptoms (OR 1.25, p = 0.001), the presence of oncological history (OR 1.89, p = 0.001), sellar walls erosion (OR 1.55, p = 0.002), and gross appearance of a firm (OR 2.01, p < 0.001) and easily bleeding lesion (OR 1.99, p < 0.001). Sellar enlargement predicted a lower risk of PMs (OR 0.54, p = 0.001). We have compiled a list of primary and secondary red flags, including clinical and neuroradiological features, to serve as a guiding tool for clinicians to raise suspicion of PMs and aid in the differential diagnosis of various lesions centered in the sella.

Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a chronic inflammatory disease. Its severe uncontrolled form may share, with asthma and atopic dermatitis, the pathophysiological mechanism of T helper 2 inflammation, characterized by tissue eosinophilia and high local IgE levels. Comorbidities and the severity of symptoms result in a poor quality of life. CRSwNP is difficult to treat both medically and surgically. Systemic corticosteroids are widely used to manage signs and symptoms of this disease. However, prolonged use of systemic corticosteroids is associated with numerous side effects that limit their long-term use. Alternative therapy with new biologic drugs allows good control of the signs and symptoms of CRSwNP, without the side effects of systemic corticosteroids. Through an interview proposed to patients affected by CRSwNP, the use of systemic corticosteroids, their dosage and the methods of administration were analyzed in the period preceding the start of therapy with biological drugs and the real impact of biological therapy on corticosteroid use.

To date, accelerated partial breast irradiation (APBI) regimens are highly heterogeneous. Twice-daily schedules show comparable local control to whole-breast radiotherapy but with worse toxicity and cosmesis profiles. Conversely, once-daily regimens are better tolerated, though dose and number of fractions are yet not standardized. Therefore, the aim of this study was to evaluate the efficacy and tolerability of three different once-daily APBI schedules. Three consecutive phase-2 trials were conducted at a single national cancer center to assess three once-daily APBI schedules (40Gy in 10 fractions, 35Gy in 7 fractions, and 28Gy in 4 fractions) delivered with 3D-conformal radiotherapy. All patients were at least 60 years old and had early-stage breast cancer (pT1-2,pN0-N1mic). Toxicity and cosmesis were evaluated by physicians using the CTCAE 4.0 scale and the Harvard score, respectively. Recurrence rates and survival outcomes at 5 and 10 years were estimated using the Kaplan-Meier method. A total of 189 patients were enrolled, with a median follow-up of 10.2 years. Patients treated with 40Gy in 10 fractions, 35Gy in 7 fractions and 28Gy in 4 fractions were 80 (42%), 73 (39%), and 36 (19%), respectively. Acute toxicity was low and comparable across schedules, whereas grade≥2 late toxicity and poor cosmesis were significantly worse with the shorter schedule. The 10-year estimated in-breast tumour recurrence rate was 5.5%, comparable to the limited literature reporting long-term outcomes. Once-daily APBI delivered with 3D-conformal radiotherapy was effective; however, regimens with fewer than 5 fractions may be associated with increased toxicity and worse cosmesis.

Myelodysplastic neoplasms (MDS) are characterized by ineffective hematopoiesis, peripheral blood cytopenias, and an increased risk of progression to acute myeloid leukemia. One of the main treatment goals is improving quality of life (QoL), particularly for patients with lower-risk MDS (LR-MDS) who may live longer with compromised QoL. The QOL-E© is a patient-reported outcome (PRO) measure specifically developed to address the lack of a health-related QoL questionnaire for patients with MDS. The objective of this study was to evaluate the psychometric performance of the QOL-E in patients with LR-MDS. Data from four clinical trials in MDS (MEDALIST, DARB-MDS, EQoL-MDS, and RevMDS trials) were used to assess construct validity, reliability, and responsiveness. The QOL-E was validated by the European Organization for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire - Core 30 (QLQ-C30) and clinical outcomes. It contains 29 items with the first two items assessing the patient's general well-being and the 27 remaining items grouped into six domain scores: physical well-being (QOL-FIS), functional well-being (QOL-FUN), social/family well-being (QOL-SOC), sexual well-being (QOL-SEX), fatigue (QOL-FAT), and MDS-specific disturbances (QOL-MDSS). Additionally, meaningful within-patient change (MWPC) thresholds were determined for the domains and summary scores of the QOL-E using anchor-based analyses, supported by distribution-based analyses. A total of 458 patients were included in the analyses. The QOL-E domain/summary scores demonstrated acceptable convergent/divergent and known-groups validity. Test-retest reliability and internal consistency was confirmed with intraclass correlation coefficients and Cronbach alpha exceeding 0.70 across most QOL-E domains/summary scores. The QOL-E domains/summary scores, except for QOL-SEX, had an adequate ability to detect change from baseline to Week 24. MWPC thresholds were proposed for all other domains and summary scores. The study results demonstrate that the QOL-E is generally fit for purpose to assess treatment effects in populations with LR-MDS and the proposed MWPC thresholds can be used to assess within-patient treatment effect on PROs, as assessed by the QOL-E, in future studies.

Cow’s milk allergy (CMA) is one of the most frequent causes of food allergy (FA) in children. Dietary avoidance is considered the main treatment for CMA, but it does not promote the development of tolerance. In contrast, milk oral immunotherapy (OIT) and the introduction of baked milk into the diet are two treatment options that may lead to tolerance development. Recently, the “milk ladder” (ML) has emerged as a third therapeutic option. ML can be defined as a gradual home reintroduction of foods containing milk starting from the most easily tolerated forms and progressing to whole cow’s milk. Herein, we assess the impact of different processes on milk protein allergenicity, alongside studies evaluating the efficacy and safety of ML in children with non IgE-mediated and IgE-mediated CMPA. In non-IgE Mediated CMA, excluding FPIES, ML seems to be reasonable since it is not burdened with relevant side effects and is able to promote the early reintroduction of cow’s milk. In IgE mediated CMA, the efficacy of ML seems to be like OIT although it is burdened with similar side effects, even serious as anaphylaxis. If used to perform the first step with baked milk oral challenge seems advisable. The next steps can be done at home. Only children without a clinical history of severe reactions or recurrent wheeziness can be candidates for ML, starting as soon as possible and in any case not in children over 6 years of age.