Ospedale di Santo Spirito

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 resection of cerebral arteriovenous malformations (AVMs) involving eloquent motor regions remains one of the most challenging tasks in neurosurgery due to the risk of irreversible motor deficits. Historically, such lesions have often been managed conservatively or with radiosurgery, particularly when located near primary motor cortex or corticospinal tracts. However, the advent of intraoperative neurophysiological monitoring (IONM) allows for real-time feedback on motor pathway function, potentially enabling safer resections in areas previously considered inoperable. This study investigates the effectiveness of IONM in reducing motor morbidity during AVM surgery. We prospectively enrolled 48 patients who underwent AVM resection between 2018 and 2025 at a single center. All surgeries incorporated a standardized IONM protocol, including continuous somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and dynamic cortical and subcortical mapping. Patients were stratified into high and low motor-risk groups based on AVM topography. Clinical, imaging, and angioarchitectural data were analyzed. Primary outcomes were new postoperative motor deficits; secondary outcomes included modified Rankin Scale (mRS) scores and residual nidus presence. Statistical analysis included univariate and multivariate regression. Of the 48 patients (mean age 45.2), 42% presented with hemorrhage and 50% had left-hemisphere AVMs. Spetzler-Martin grades ranged from I to IV. Three patients (6.25%) had residual AVM postoperatively, two of which were intentional due to IONM alerts. None developed new deficits. One residual spontaneously thrombosed during follow-up. Multivariate analysis showed preoperative mRS, not motor eloquence, was the main predictor of outcome in ruptured AVMs. No significant difference in postoperative motor function or mRS was found between high- and low-risk groups. IONM enables safe, function-preserving AVM resection in motor eloquent areas. It supports intraoperative decision-making, reducing morbidity and expanding surgical indications guiding a “maximal safe resection” strategy focused on functional preservation rather than angiographic radicality alone.

Most patients with large B-cell lymphoma (LBCL) progressing after CAR-T therapy experience poor survival and lack standardized treatment strategies. Prognostic tools are needed to guide decision-making at relapse. The Post-CAR Prognostic Index (PC-PI), recently proposed by Iacoboni et al., combines five routine clinical variables to stratify outcomes after CAR-T failure: ECOG (> 0), hemoglobin (< 10 g/dL), LDH (≥ 2xULN), number of extranodal sites (> 1) and time from CAR-T to progression (< 4 months). We evaluated the PC-PI in a retrospective multicenter study including 125 LBCL patients relapsing or refractory after axicabtagene-ciloleucel or tisagenlecleucel, treated between 2019 and 2023 across 16 Italian centers belonging to the Fondazione Italiana Linfomi network. Median overall survival (OS) was 4.9 months, with 6- and 12-month OS rates of 44.9% and 28.5%, respectively. The PC-PI discriminated prognosis effectively: high-risk patients had a median OS of 1.8 months, intermediate-high 2.2, intermediate-low 8.7, while in the low-risk group median OS was not reached (p<0.0001). Results remained consistent after excluding patients receiving only palliative care. Post-progression therapy markedly influenced survival: patients receiving active treatment achieved a median OS of 7.3 months versus 0.7 without further therapy (p<0.0001). Bispecific antibodies conferred the best outcomes (HR 0.44, p=0.02), with 6- and 12-month OS rates of 90% and 55%. Our findings confirm the prognostic value of the PC-PI and support its use in clinical practice as a tool for risk-adapted management of LBCL after CAR-T failure.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13045-025-01771-6.

Abstract Background Janus kinase inhibitors (JAKi) are a class of oral therapies indicated for moderate-to-severe ulcerative colitis (UC), with three agents approved and broadly comparable efficacy and safety. Although no clear evidence shows that differences in target affinity influence response, switching to a second JAKi is sometimes attempted after failure or intolerance to the first. The main objective is to assess the effectiveness (defined as treatment persistence) and safety of a second JAKi after failure of the first one Methods This retrospective analysis is part of a 12-month, multicentre, ambispective observational study. We included patients who initiated a second JAKi less than 24 months prior to enrolment, following a first-line JAKi course. Demographics, disease features, and clinical, biochemical, and endoscopic data at baseline and at weeks 8, 26, and 52 were recorded in a REDCap database. Data are presented as frequencies and percentages. Treatment persistence was estimated with Kaplan–Meier survival analysis, and rates are reported both as observed and with non-responder imputation (NRI). Safety events were collected throughout follow-up. Recruitment for both retrospective and prospective phases is ongoing and will end in April 2026; this abstract presents preliminary. Results Data from 69 UC patients are currently available: median age 40 years (IQR 27–52); 30 (43.5%) females. Mean disease duration was 10.8±7.9 years. Disease extent: proctitis 3 (4.3%), left-sided colitis 29 (42.0%), extensive colitis 37 (53.7%). Eight patients (11.6%) were smokers, and 11.6% had other cardiovascular risk factors. Most patients (40, 57.9%) had prior exposure to ≥ 3 biologics or small molecules. Tofacitinib was the most common first JAKi (48, 69.6%) prescribed; among those who switched from tofacitinib, 9 (24.3%) moved to filgotinib and 28 (75.7%) to upadacitinib. Reasons for discontinuing the first JAKi were secondary loss of response in 42 patients (62%), primary non-response in 24 (34%), and intolerance in 3 patients (4%). At baseline, the mean Partial Mayo score was 5.1±2.3, and 20 (29%) were on systemic steroids. At week 26, treatment persistence was 87.0% (47/54) as observed and 68.1% (47/69) with NRI; at week 52 it was 85.1% (40/47) as observed and 58.0% (40/69) with NRI. Six patients experienced adverse drug reactions, none leading to discontinuation Conclusion Our preliminary findings suggest that switching from a first to a subsequent JAKi is effective and safe, including for patients with prior exposure to multiple biologic therapies. Further retrospective and prospective analyses will provide more precise estimates

IntroductionThe sacral erector spinae plane (S-ESP) block is a recently described regional anesthesia technique that targets sacral dermatomes. First reported in 2019, it has been increasingly explored as a potential option for perioperative analgesia in surgeries involving the sacral, perineal, and pelvic regions. This review aims to summarize and critically appraise the current anatomical, technical, and clinical evidence on the S-ESP block, outlining its mechanisms of action, approaches, efficacy, and safety while identifying research gaps and future directions.MethodsWe performed a narrative review integrating anatomical descriptions, sonographic techniques, and available randomized controlled trials (RCTs) evaluating the clinical efficacy of the S-ESP block. A comprehensive literature search was conducted in PubMed, Embase, Scopus, Web of Science, and Ovid (Medline) from inception to July 21, 2025, without language or date restrictions. Full-text RCTs investigating ultrasound-guided S-ESP blocks for perioperative analgesia were reviewed and summarized.ResultsFourteen RCTs (published 2023–2025) were included, conducted predominantly in Turkey, India, and Egypt, spanning pediatric (6 months to 12 years) and adult populations undergoing circumcision, hypospadias repair, hemorrhoidectomy, pilonidal sinus surgery, transurethral resection of prostate, lumbar discectomy, and total hip arthroplasty. Most pediatric trials compared midline S-ESP with caudal or penile blocks, generally demonstrating a longer time to first rescue analgesia and reduced postoperative analgesic consumption, although one study reported a superior duration with caudal block. In adults, the S-ESP block consistently reduced pain scores and opioid requirements.ConclusionsCurrent evidence suggests that both midline and paramedian S-ESP techniques are technically feasible, appear safe in the short term, and provide clinically relevant postoperative analgesia in selected pediatric urogenital, adult anorectal, and orthopedic surgeries. However, heterogeneity in techniques, small single-center samples, and a narrow range of indications limit its generalizability. Large, multicenter RCTs with standardized protocols are needed to clarify the optimal approaches, dosing strategies, and comparative role of S-ESP block versus established neuraxial and peripheral techniques.

BackgroundFascia, once viewed as a passive structural tissue, is now recognized as a biologically active interface integral to musculoskeletal stability, force transmission, proprioception, and nociception. Despite the increasing clinical use of fascial plane blocks, the microanatomy of fasciae relevant to regional anesthesia remains poorly characterized. Understanding their histological features—including innervation, vascularization, and microstructure—is critical to optimizing anesthetic efficacy and elucidating mechanisms of pain and tissue response.MethodsThis systematic review was prospectively registered on the Open Science Framework (reference: yk4ua, 19 September 2025) and reported according to PRISMA guidelines. MEDLINE, Embase, and Cochrane CENTRAL were searched from inception to September 2025 without language or date restrictions. Eligible studies included histological or microanatomical investigations of human fascial planes relevant to regional anesthesia (e.g., pectoral, thoracolumbar, abdominal, and fascia lata). Data were extracted independently by multiple reviewers, and study quality was assessed using the Anatomical Quality Assessment (AQUA) tool. Findings were synthesized qualitatively by anatomical region.ResultsSeventeen studies met inclusion criteria, encompassing fasciae from the thoracic, abdominal, lumbar, and lower limb regions. Fasciae exhibited considerable structural heterogeneity but shared a multi-layered organization of dense and loose connective tissue laminae rich in type I collagen. The fascia lata and thoracolumbar fascia demonstrated highly ordered collagen fiber orientation, multilaminar organization, and dense innervation, whereas thinner fasciae (e.g., pectoral fascia) showed simpler single-layer structures with fewer neural and vascular elements. Hyaluronic acid content ranged from 29 to 35 µg/g, with fasciacytes identified as the principal secretory cells. Nerve fibers—often associated with vessels and collagen bundles—were consistently present across all deep fasciae, with regional variations in density and mechanoreceptor type. Pathological changes, such as thickening, increased vascularization, and inflammatory infiltration, were reported in chronic pain states.ConclusionsThe fascia should be viewed as a dynamic, active tissue network rather than a passive sheath. Methodological limitations—including small sample sizes, regional heterogeneity, and histological artifacts—restrict current understanding. Future multimodal studies integrating histology, imaging, and biomechanics are warranted to clarify how fascial microstructure affects anesthetic diffusion, pain modulation, and postoperative recovery.Supplementary InformationThe online version contains supplementary material available at 10.1186/s44158-025-00322-2.

Asprosin, a novel adipokine primarily secreted by white adipose tissue, has been implicated in the pathogenesis of insulin resistance and metabolic dysfunction. Its elevated levels characterize patients with polycystic ovary syndrome (PCOS) exhibiting metabolic alterations. Aim of this work was to evaluate the effects of insulin sensitizer administration, as inositols, on asprosin levels and then compare these results with the effects of metformin treatment. 30 patients with PCOS were enrolled in this study and randomly divided into two groups: (i) group 1 assumed a dietary supplement based on 40:1 myo-inositol (MI)/D-chiro-inositol (DCI), (ii) group 2 assumed metformin (MET), for 12-16 weeks of treatment. The reduction of serum asprosin levels in patients with PCOS after treatment with MET and MI/DCI is the most intriguing result. Its levels decreased more in the inositol group, although they did not reach statistical significance probably due to the lower number of patients. The observed dysregulation of asprosin levels in PCOS highlights a potential link between this novel adipokine and the pathophysiology of the disorder, suggesting a modulatory effect of the combined 40:1 MI/DCI on asprosin levels. Of course, further studies may contribute to disclosing molecular mechanisms underlying asprosin reduction and open toward new perspectives.

The primary objective of this review is to assess the survival outcomes of patients affected by oral cavity and oropharyngeal squamous cell carcinoma (SCC) treated with electrochemotherapy (ECT). Secondarily, the authors aim to quantify these outcomes according to treatment intent (curative versus palliative) and to evaluate potential prognostic factors influencing survival. A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines. A comprehensive search was carried out in Embase, PubMed, Scopus, and the Cochrane Library databases to identify studies published between January 1998 and April 2025. Sixteen studies comprising a total of 120 patients were analysed. Overall, ECT was generally well tolerated, with acceptable and manageable adverse events. In the curative-intent cohort, a complete response was achieved in 74% of cases, with a recurrence rate of 12%. One- and two-year disease-free survival (DFS) rates were 94.8% and 77.5%, respectively. Prognostic factors associated with improved survival included early tumor stage, use of adjuvant therapy, and tumors located in the anterior oral cavity. In the palliative-intent cohort, a partial or complete response was observed in 74% of patients, with a one-year DFS of 29.3%. Negative prognostic factors included recurrent disease, prior treatments, and the presence of distant metastases. ECT appears to be a promising therapeutic strategy for selected patients with oral cavity and oropharyngeal SCC, particularly in early-stage, treatment-naïve cases. Accurate prognostic stratification is essential to optimize patient selection and improve clinical outcomes.