Ospedali Riuniti di Foggia

The complex spatial organization and deeply embedded position of the cerebral ventricular system present substantial difficulties for anatomic comprehension, particularly among neurosurgical trainees and residents. These challenges are most pronounced in understanding the supratentorial ventricular system's orientation and its projection to superficial cortical and cranial structures. To investigate how advanced three-dimensional (3D) anatomic reconstructions, using photogrammetry and virtual reality (VR) technologies, may offer an educational tool-providing interactive, high-fidelity visualization that enhances the understanding of the supratentorial ventricular system. Three brain specimens and one head specimen were used. Window craniotomies were performed to expose superficial brain anatomy in relation to cranial landmarks. Each brain was sequentially dissected to expose the anatomy of the lateral and third ventricles. The specimens were photogrammetrically scanned to generate photorealistic 3D models, which were subsequently imported into VR. A segmented ventricular system from an open-access database was fused with a photogrammetric whole brain and a model highlighting craniometric key points to better present the projection of the ventricles to superficial structures. Nine photogrammetric models were created, enabling visualization of the ventricular system in all 3 anatomic planes in relation to superficial cortical and skull landmarks. 3D interaction in VR allowed for better observation of the deep ventricular anatomy sequentially with their corresponding superficial brain structures. In addition, semitransparent renderings of craniometric landmark models, incorporating the segmented ventricle data, allowed for clear identification of their projections over the overlying cortical structures and VR simulation of ventricular entry trajectories. This study integrates traditional dissection techniques with 3D photogrammetry and VR to investigate the cortical projections of the supratentorial ventricular system and its related structures. These photorealistic anatomic models offer a novel, reproducible platform to enhance spatial understanding of the (peri-)ventricular anatomy, with direct implications for neurosurgical training.

Bilateral optic neuritis is a rare condition generally associated with inflammatory, demyelinating, or toxic causes. Its association with glyphosate exposure has rarely been documented. A 66-year-old man with hypertension, hypercholesterolemia, and hypothyroidism developed rapid bilateral vision loss within hours after acute inhalational exposure to glyphosate during agricultural work. MRI showed bilateral optic nerve hyperintensity consistent with optic neuritis. Cerebrospinal fluid and serum anti-NMO antibody tests were negative, while visual evoked potentials demonstrated increased latencies. High-dose corticosteroid therapy led to progressive clinical improvement. At follow-up, MRI revealed no new lesions and the patient experienced near-complete visual recovery. This case suggests a possible link between acute glyphosate exposure and reversible bilateral optic neuritis. Early recognition and corticosteroid therapy may support full functional recovery even in severe presentations.

Pulmonary involvement in cystic fibrosis (CF) is characterised by respiratory infections caused by bacteria, viruses, and fungi, as well as by dysregulated inflammatory and immune responses. Although essential for the host’s initial defence against these microorganisms, the innate immune response is altered in its main cellular (airway epithelial cells (AECs), monocytes, macrophages, and neutrophils) and molecular (cytokines, chemokines, signal transduction pathways, and transcription factors) components. MicroRNAs (miRNAs) form a regulatory network at the level of inflammatory and immune responses, and their dysregulation has been observed in immortalised and primary CF AECs as well as in monocytes, macrophages, and neutrophils from CF patients. Although the study of individual miRNAs is helping to dissect the specific altered events in CF lung disease (CFLD), large-scale genomic and transcriptomic studies are more likely to capture its full complexity. The studies we identified suggest that miRNAs are involved in various processes related to CFLD, including impaired pathogen response, compensation for hyperinflammation, altered antigen presentation, and wound healing in AECs and macrophages. However, clinical studies involving large cohorts of patients are needed to obtain meaningful results and identify new therapeutic targets. Equally important will be the study of the miRNome as circulating biomarkers for the purposes of diagnostic and prognostic precision medicine.

Objectives: To evaluate perioperative outcomes, renal function preservation, and short-term oncologic results of off-clamp, sutureless, or selectively sutured robotic-assisted partial nephrectomy (RAPN) in patients with renal tumors treated at multiple high-volume centers. Methods: This multicenter retrospective study included 250 patients who underwent off-clamp, sutureless/selectively sutured RAPN between January 2018 and December 2024. Patients with solitary kidneys, tumors > 7 cm, or prior renal surgery were excluded. All procedures were performed without renal artery clamping, using hemostatic agents and selective suturing when necessary. Perioperative, functional, and oncologic outcomes were compared with 313 patients who underwent standard RAPN with parenchymal suturing. Results: The median operative time was 110 min (IQR 100–140), and the median estimated blood loss was 180 mL (IQR 100–250). The overall complication rate was 8.4%, predominantly Clavien–Dindo grade I–II, with no conversions to open surgery. The median decline in estimated glomerular filtration rate (eGFR) at three months was 5.5% (IQR 3.5–8.9; p = 0.56), and no cases of acute kidney injury were recorded. The positive surgical margin rate was 3.7%, and no tumor recurrences were observed during the 12-month follow-up period. Conclusions: Off-clamp, sutureless or selectively sutured robotic-assisted partial nephrectomy (RAPN) was not associated with increased perioperative risk, renal functional decline, or compromised short-term oncologic control compared with conventional sutured RAPN. These findings indicate that the technique is feasible and safe in appropriately selected patients, although prospective studies with longer follow-up are needed to confirm long-term outcomes and refine patient selection criteria.

Background: Venous thromboembolism (VTE) is a serious and common complication in cancer patients, and it is the second leading cause of death after cancer itself. Cancer-associated thrombosis (CAT) is an indicator of a poorer prognosis and can lead to treatment delays and increased healthcare costs. This review aims to provide a comprehensive update on the efficacy and safety of tinzaparin in the treatment and prophylaxis of VTE in cancer patients. Methods: This is a narrative review that examines the pharmacological properties of tinzaparin, as well as the results from clinical studies and meta-analyses. It includes a discussion of tinzaparin's role in special patient populations and its comparison with other anticoagulants. Results: Tinzaparin is a low-molecular-weight heparin (LMWH) that does not accumulate in patients with renal insufficiency, eliminating the need for dose adjustments. Studies have shown that tinzaparin is a safe and effective treatment for CAT, with a favorable safety profile regarding hemorrhagic complications. In the CATCH study, tinzaparin showed a significant reduction in clinically relevant non-major bleeding compared to warfarin. Tinzaparin has also been shown to be more effective than vitamin K antagonists (VKAs) in promoting the recanalization of venous thrombi. A meta-analysis confirmed that tinzaparin was superior to VKAs in preventing VTE recurrence in the long term. Conclusions: While direct oral anticoagulants (DOACs) offer convenience, LMWHs like tinzaparin remain crucial, especially for patients with specific characteristics such as renal insufficiency, complex drug interactions, or a high risk of gastrointestinal bleeding. Tinzaparin's favorable safety and efficacy, along with its unique pharmacological properties, make it a valuable option for managing VTE in the complex oncology population.

Background: Fibromyalgia syndrome (FS) is one of the most common causes of chronic generalised pain and often complicates the therapeutic management of inflammatory chronic arthritis (ICA), negatively impacting both the real assessment of disease activity and the perception of response. Our study aims to evaluate in a group of patients with ICA, multi-resistant to biologic/target synthetic disease-modifying antirheumatic drugs (b/ts-DMARDs), both the impact of FS on the possibility of achieving low disease activity (LDA) or remission (REM) and the possible improvement in the severity of FS symptoms, after starting b/ts-DMARDs with different a mechanism of action (MoA). Methods: A prospective study was conducted, from January 2023 to December 2024, on patients who fulfil the classification criteria for psoriatic arthritis (PsA) or fulfil the 2010 American College of Rheumatology criteria for RA. Results: Sixty-four Caucasian patients with ICA, of which 47 with FS, were enrolled in the study. At the baseline visit, FS patients had a significantly shorter ICA disease duration, worse fibromyalgia symptom-related indices (such as Fibromyalgia Severity Scale (FSS), Widespread Pain Index (WPI), and Symptom Severity Scale (SSS)) and functional and disability scores (such as health assessment questionnaire (HAQ) and Functional Assessment of Chronic Illness Therapy (FACIT)), and a higher basal value of Disease Activity in Psoriatic Arthritis (DAPSA) score compared to patients without FS. After 6 months of starting b/ts-DMARDs, no differences in severity of arthritis clinimetric indices (disease activity score (DAS) 28 (erythrocyte sedimentation (ESR)) and DAPSA) and Visual Analogue Scale (VAS) pain were found between the patients with FS compared to those without. At the follow-up visit, 36% of the whole group of patients were in LDA (36% ICA patients with FS vs. 35% of ICA patients without FS; p = 0.080), while 17% of patients reached REM (11% ICA with FS vs. 35% ICA without FS patients; p = 0.031). The FS presence appeared to be a factor associated with failure to reach REM (OR 4.5 (95%CI: 1.1-17.8), p = 0.028), but not for achieving LDA (OR 2.7 (95%CI: 0.8-8.9), p = 0.099). The overall retention rate at 6 months was 79%; in particular, 11 patients discontinued treatment with b/ts-DMARD, 69% of whom belonged to the FS group (p = 0.489). Among the group of patients with ICA and FS, patients in LDA/REM presented an important improvement in FSS, SSS, and VAS pain, with the best percentage variation from the baseline of these indices compared to patients who did not achieve the LDA/REM. Of note, sixteen patients with FS at the baseline no longer met the diagnostic criteria for FS after 6 months of follow-up. Conclusions: The presence of FS seems to negatively impact the achievement of REM, but not LDA, in both RA and PsA patients, even in b/ts-DMARDs patients with multi-failure of at least two different MOAs. Only a cluster of patients with FS, presumably those with FS triggered and/or amplified by the chronic joint inflammatory process, appear to improve their perception of FS severity by achieving ICA LDA/REM. However, these findings require further supporting data for more accurate validation.