Ospedali Riuniti Umberto I

Elevated low-density lipoprotein cholesterol (LDL-C) represents a key causal factor in atherosclerotic cardiovascular disease. Robust evidence demonstrates that early, marked, and sustained reduction of LDL-C is associated with a significant decrease in the risk of major adverse cardiovascular events. However, a substantial proportion of high-risk patients fail to achieve guideline-recommended LDL-C targets with statin therapy alone, thus requiring additional lipid-lowering treatments. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, particularly the monoclonal antibodies evolocumab and alirocumab, have been shown to reduce LDL-C levels by ∼60% and to provide clear cardiovascular outcome benefits in secondary prevention. More recently, the VESALIUS-CV trial extended these findings to the setting of primary prevention in high cardiovascular risk patients without prior major cardiovascular events. In this trial, evolocumab achieved a significant and sustained reduction in LDL-C levels and significantly reduced the risk of a first cardiovascular event, including myocardial infarction and ischaemia-driven revascularization, while maintaining a safety profile comparable to placebo. Overall, the available evidence supports the role of evolocumab as an effective and safe strategy for cardiovascular risk reduction across the entire risk continuum, from secondary to primary prevention, underscoring the importance of a personalized therapeutic approach based on the patient's global cardiovascular risk profile.

Surgical resection of liver and lung metastases in breast cancer is increasingly considered a viable option for select patients with oligometastatic disease. Historically regarded as palliative, surgery is now supported by retrospective data suggesting potential survival benefits, particularly in patients with hormone receptor-positive or HER2-positive tumors, long disease-free intervals, and limited metastatic burden. This narrative review summarizes recent evidence on the surgical management of breast cancer metastases to the liver and lung, with a focus on patient selection, perioperative outcomes, and long-term survival. Liver metastasectomy has shown 5-year overall survival rates of up to 60% in well-selected patients, while pulmonary metastasectomy is associated with comparable outcomes when resection is complete and nodal involvement is absent. Minimally invasive techniques and non-surgical approaches, such as microwave ablation and stereotactic radiotherapy, expand treatment options for patients unfit for surgery. The review also explores emerging tools influencing surgical decision-making, including circulating tumor DNA for minimal residual disease detection, transcriptomic profiling to predict organotropism, and artificial intelligence (AI)-driven platforms that assist with surgical planning and multidisciplinary case evaluation. While prospective validation remains limited, these technologies may help redefine surgical candidacy through biologically informed algorithms. Ultimately, the integration of surgery within a multimodal, personalized treatment strategy-guided by systemic control, tumor biology, and evolving digital tools-represents an evolving and biologically informed direction for rigorously selected patients with visceral breast cancer metastases.

Percutaneous endovascular embolization (PVE) of male varicocele is a widely adopted procedure performed in healthy young patients with long life expectancy. Dose-optimization systems are therefore essential to minimize procedural radiation risks. We aimed to investigate the effect of a recently implemented dose-reduction technology on dosimetric parameters and its potential implication in the definition of diagnostic reference levels (DRLs). A consecutive series of 113 patients (23.3 ± 9.1 yrs) submitted to PVE between January 2020 and December 2024 were retrospectively reviewed. Two groups based on the angiographic system used, 50 patients treated using the Philips Allura Xper FD20 and 63 patients using the newer Philips Azurion Clarity IQ technology, were compared in terms of demographic, procedural, and dosimetric data. Despite similar fluoroscopy and procedure times, the recently implemented angiographic technology demonstrated a significant reduction in dose area product (DAP) and reference air kerma (Ka.ref) values (4394.5 vs 20,709mGy·cm2 and 20.35 vs 83.6mGy; p < 0.001, respectively) with a percentage reduction of approximately 71.15% and 64.41%, respectively. Subpopulation analyses showed significant dose reductions in younger patient population (< 18years) and in high-grade varicoceles (grades III/IV), with similar fluoroscopy times. The use of advanced dose-optimization technologies, together with standardized protocols and appropriate operator training, leads to a significant reduction in radiation exposure during PVE, particularly in younger patients. These single-center, retrospective results provide preliminary data that may support the future introduction of procedure-specific DRLs for this routinely and widely performed interventional radiology procedure.

Abstract Background Patients with Inflammatory Bowel Disease (IBD), i.e. Ulcerative colitis (UC) and Crohn’s Disease (CD), may suffer from genito-urinary tract-related disturbances. Whether lower urinary tract symptoms (LUTS) are more frequent in IBD patients is unclear. Objectives: 1) to assess the prevalence of LUTS in patients with IBD compared to controls (HC); 2) to define the role of clinical-demographic variables in this clinical setting. Methods Real-life, cross-sectional, multi-center study. LUTS were assessed in males and females through the International Prostatic Symptoms Score (IPSS) and the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaires, respectively. IBD activity was assessed in CD by the CDAI, and in UC by PMS and TMS. Significance of differences was assessed by chi2 or Fisher’s exact test or Mann–Whitney or Kruskal–Wallis test, as appropriate. Correlation was tested by Spearman’s analysis. The level of statistical significance, corrected by the Bonferroni method for multiple testing, was set at p &amp;lt; 0.017. Results 1) Two hundred forty-five IBD patients [(35.5% CD, 64.5% UC), 152 males and 93 females, median age 47 yrs (34-61 yrs)] and 142 HC [64 males and 78 females, median age 46 yrs (35-58 yrs)] were included; 2) IPSS total score was higher in IBD patients than in HC [7 (3-12) vs 4 (1-8), respectively, p = 0.002], with no significant differences between CD and UC; 3) IPSS subscores of incomplete emptying and intermittency were significantly higher in IBD patients than in HC (p = 0.001 and p = 0.004, respectively); 4) A significantly higher percentage of IBD patients had moderate to severe IPSS total score compared to HC (28.5% vs 11.2%, p = 0.003); 5) BFLUTS total score, was higher in IBD patients, particularly in UC, than in HC [7 (3–12) vs. 4.5 (2–11.3), p = 0.044); 6) IBD activity showed a weak (i.e. r = 0.2-0.29) to moderate (r = 0.3-0.39) correlation with IPSS or BFLUTS. Conclusion 1) Prevalence of LUTS is higher in IBD patients than in controls with no differences between CD and UC; 2) IPSS moderate to severe total scores are more frequent in IBD patients than in controls; 3) Male IBD patients have significantly higher incomplete emptying and frequency IPSS subscores than controls; 4) IBD patients should be assessed for LUTS through validated questionnaires for prompt diagnosis and treatment.

Aortic surgery carries high risks and complication rates, particularly when extracorporeal life support (ECLS) is required. We compared outcomes of patients receiving post-cardiotomy ECLS after surgeries involving or not involving the thoracic aorta, with a focus on emergency operations. This retrospective multicenter study included adults requiring veno-arterial (V-A) ECLS for post-cardiotomy shock. In-hospital outcomes and long-term survival were analyzed. Among 2,058 patients, 382 (18.6%) underwent aortic and 1,676 (81.4%) non-aortic surgery. Patients undergoing aortic operations were younger (63.0, interquartile range [IQR]: 54.4-70 years; non-aortic: 65.0, IQR: 55-72 years; p = 0.020), with more emergencies (n = 126, 33.1%; non-aortic: n = 402, 24.3%; p < 0.001), longer cross-clamp times (148, IQR: 101-203 mins; non-aortic: 90, IQR: 59-133 mins; p < 0.001) and more postoperative bleeding events (n = 234, 62.4%; non-aortic: n = 922, 56.0%; p = 0.024). Stroke was more frequent after aortic surgery (n = 60, 15.8%; non-aortic: n = 157, 9.4%; p < 0.001), especially in emergency cases (n = 27, 21.6%; p = 0.034). In-hospital mortality was greater after aortic surgery (n = 258, 67.5%; non-aortic: n = 986, 58.8%; p = 0.002), with 49.9% (n = 189) on-ECLS mortality. Neurological injury caused death in 8.9% (n = 22) of patients undergoing aortic and 4.0% (n = 36) non-aortic operations. Post-discharge survival was similar ( p = 0.32), and emergency status did not affect mortality in the aortic group ( p = 0.643). Veno-arterial extracorporeal life support after aortic surgery is associated with higher bleeding, stroke, and in-hospital mortality compared with non-aortic surgery, independent of emergency status.

Marine animal forests, composed of sessile suspension feeders such as gorgonians are known to host rich communities that support important ecosystem functions and services. These habitats are undergoing severe loss due to multiple pressures, with potential cascading effects on associated communities and their functions that remain poorly understood. To address this critical knowledge gap, we used fine-scale data to assess the role of Paramuricea clavata forests in supporting biodiversity and ecosystem functioning at multiple locations, in the Gulf of Naples (Italy, Western Mediterranean Sea). Through functional trait analysis, we compared taxonomic and functional diversity of benthic assemblages inside and outside P. clavata forests and investigated the loss of traits as a consequence of forest loss. Analyses revealed significant enhancements in both taxonomic and functional diversity within P. clavata forests, with observed increased species and functional richness. Trait-based investigations revealed a higher abundance of colonial heterotrophic species within forests, while outside, assemblages were dominated by low-longevity autotrophs, suggesting that P. clavata modifies environmental variables creating unique ecological conditions that favor specific traits. β-diversity measurements demonstrated increased compositional and functional turnover inside forests, indicating that P. clavata provides more available niches, supporting the replacement of species and functions. Our findings offer insights into how marine animal forests can structure marine communities, with broader implications for understanding biodiversity loss in changing marine ecosystems.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-26902-4.

Transthyretin amyloid cardiomyopathy (ATTR-CM) has a specific pathophysiology, with myocardial stiffening and systolic dysfunction only in advanced stages. We aimed to investigate the response to cardiac resynchronization therapy (CRT) in ATTR-CM compared with heart failure. In this multicenter, observational study, patients with ATTR-CM receiving CRT (n=101) were matched to patients without amyloid cardiomyopathy by sex, age, and implantation type (CRT with versus without defibrillator versus conduction system pacing, upgrade versus first implant). We evaluated changes in QRS duration and echocardiographic parameters following CRT implantation and at the most recent available assessments. The study end points were all-cause death alone or combined with heart failure hospitalization. Patients with ATTR-CM (median age, 76 [interquartile range, 72-83] years, 98% men, left ventricular (LV) ejection fraction 30% [26-33]) showed greater QRS shortening after CRT implantation (P=0.012), but not after a median of around 1 year (P=0.152). There were no significant differences in the absolute LV ejection fraction changes immediately after implantation (+7 [+2/+10] versus +3 [0/+9] units; P=0.124), or to the last echo (P=0.796), which was performed after 1.3 years in patients with ATTR-CM and 2.9 years in patients without amyloid cardiomyopathy. Patients with ATTR-CM had a shorter survival than controls (P<0.001 for both end points). Patients with ATTR-CM experiencing an early improvement in LV ejection fraction had a longer survival (log-rank, 4.3; P=0.038). Following CRT implantation, patients with ATTR-CM show QRS narrowing and improvement in LV ejection fraction, not different from patients without amyloid cardiomyopathy. Early favorable LV remodeling seems to be associated with a lower risk of all-cause death.

Creation and evaluation of a structured report (SR) for lumbar spine magnetic resonance imaging (MRI), with the implementation of a previously clinically validated grading system that differentiates lumbar stenosis based on the location and underlying causes, with particular attention to the often underestimated aspect of spinal epidural lipomatosis (SEL). This prospective single-center study enrolled all the MRIs of the lumbar spine performed at our institution within one month. A (SR) was created using the RSNA's platform "RadReport.org" and submitted to radiologists of our center. Both free-text reports and SR were then evaluated by referring clinicians. The radiologists' intra- (after 2 months) and inter-operator agreement on the new grading system in a SR was assessed using Cohen's Kappa index. Subsequently, an evaluation survey was carried out among the 12 radiologists and 16 clinicians in our hospital, using a five-point Likert scale. In a period of 1 month, a total of 150 structured reports were generated (86 women, average age 58 ± 22 years). An almost perfect intra-operator (Kc = 0.955) and inter-operator (Kc = 0.838) agreement was detected. The survey showed almost complete satisfaction (89%) and perception of ease of use (83%) of the SR. The new grading system was preferred over the previous ones by 96% of clinicians and 81% of radiologists. An MRI SR of the lumbar spine could be a valid and appreciated tool to improve communication between specialists, allowing a better multidisciplinary evaluation.