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Primary mediastinal B-cell lymphoma is a rare subtype of non-Hodgkin lymphoma. Typical symptoms include cough, chest pain, and dyspnea; however, cardiac tamponade as the primary manifestation is exceedingly rare. We hereby present a case of a 83-year-old woman, who presented to our emergency department with dyspnea, cough and hypotension. On admission, echocardiography (transthoracic and transesophageal), computed tomography and cardiac magnetic resonance demonstrated a large 70 x 38 mm pericardial mass, with pericardial effusion and signs of cardiac tamponade. Positron emission tomography highlighted a marked hyperaccumulation of the tracer at the mass level, compatible with high metabolic activity. The patient underwent further workup with diagnostic and therapeutic pericardiocentesis, which demonstrated histopathology consistent with primary mediastinal B-cell lymphoma. This precise and complete diagnosis allowed the start of chemotherapy treatment with complete remission of the disease and regression of the mass in a few months. Our case highlights the importance of a complete and thorough workup for patients with chronic untraditional symptoms, like tamponade as the primary clinical presentation. Advanced multimodality imaging is crucial for early non-invasive assessment of primary cardiac tumors, helps guiding further investigations, treatment decision, assessing for potential complications, and allows documentation of therapeutic success.

Neurodegenerative ataxias represent a heterogeneous group of disorders lacking effective treatments. This double-blind, sham-controlled study investigated the therapeutic potential of cerebellar transcranial Direct Current Stimulation (tDCS) in degenerative ataxia. Sixteen patients were randomized to receive either real or sham tDCS (10 sessions). Clinical evaluation, quantitative assessment of gait and upper limb function (through the "hand-to-mouth" task) and EEG were performed before and after treatment. Clinical outcome tools included the Modified International Cooperative Ataxia Rating Scale (MICARS), the Scale for the Assessment and Rating of Ataxia (SARA) and the Robertson dysarthria profile to rate ataxic and dysarthric symptoms. Quantitative kinematic assessment of upper and lower limb motor function was carried out by means of optical motion capture system. At last, resting state electroencephalography (EEG) enabled evaluation of cortical oscillatory changes. The primary outcomes were change from baseline in SARA and MICARS total scores; secondary outcomes included changes in Robertson dysarthria profile score, spatiotemporal gait and hand‑to‑mouth kinematics and cortical beta/gamma power on resting state EEG. Both real and sham tDCS groups showed improvements in ataxic and dysarthric symptoms, but real tDCS induced greater benefits in posture, gait (MICARS), and upper-limb coordination (SARA) subscales. Although statistical significance was not reached for main gait parameters, a higher proportion of patients receiving real tDCS demonstrated clinically meaningful gains in gait speed and step width. In contrast, hand-to-mouth parameters remained unchanged. EEG showed increases in central/parietal beta and low‑gamma power after active but not sham stimulation, supporting neuromodulatory effects on the cerebello-thalamo-cortical network. Overall, these data support a therapeutic potential of cerebellar tDCS in improving symptoms in degenerative ataxia of different aetiology and contribute to elucidate the mechanisms underlying these effects. ClinicalTrials.gov registration: NCT07250321 (registered 2025-11-18).

BackgroundInsertable cardiac monitors (ICMs) enable continuous arrhythmia monitoring but generate high transmission volumes, increasing clinical workload. The LUX-Dx ICM (Boston Scientific) allows remote reprogramming of device alert settings, potentially reducing in-office visits.ObjectiveThis study aimed to evaluate the real-world use of remote reprogramming after its initial commercialization in Europe and its impact on transmission burden.MethodsDeidentified data were collected from 697 consecutive patients across 23 European centers between 2022 and 2024.ResultsSyncope (48%) was the most frequent indication for ICM implantation. Patients were followed for a median of 9 months (25th–75th percentile 4–13). A total of 401 reprogramming events (0.8 per patient-year) occurred in 230 ICMs, with 38% (95% confidence interval 34–43) of devices reprogrammed within 1 year. Of these, 156 (39%) were performed remotely. The overall transmission rate was 3.0 per patient-month (95% confidence interval 2.9–3.1): alert transmissions (64%), scheduled transmissions (31%), patient-initiated interrogations (4%), and clinician-initiated interrogations (1%). The rate of recorded episodes varied significantly by indication (P < .001), with bradycardia the most frequent across groups. Reprogramming significantly reduced transmission rates (median 57%; 25th–75th percentile 4–86), alerts (78%; 25th–75th percentile 11–96), and recorded episodes (91%; 25th–75th percentile 47–99) (all P < .001).ConclusionICM reprogramming plays a key role in optimizing device performance and reducing remote monitoring burden. Currently used in 39% of cases, remote reprogramming holds potential for broader adoption to minimize in-office visits. Efficiency may be further improved by transitioning to an alert-based monitoring strategy and eliminating scheduled transmissions.

PurposeAnastomotic leaks (AL) remain a major complication following right colectomy for colon cancer. This multicenter, prospective, observational study evaluated the efficacy of Glubran 2, a cyanoacrylate-based sealant, in reducing the incidence of AL by reinforcing ileocolic anastomoses.MethodsThe study enrolled 380 patients undergoing right colectomy for colon cancer across 7 Italian hospitals. Glubran 2 was applied to reinforce ileocolic anastomoses. The primary endpoint was a 50% reduction in AL incidence from a baseline of 6.18% within 10 days after surgery. Secondary endpoints included examining the correlation between AL and preexisting risk factors and determining the rate of anastomotic bleeding. Statistical analyses employed binomial tests and logistic regression.ResultsThe AL rate was reduced to 1.85% compared to the reference rate of 6.18% (P<0.01). Glubran 2 exhibited a protective effect even in patients with preexisting risk factors such as smoking, diabetes, or prior surgeries; none of these factors was significantly associated with AL (P>0.05). Surgical technique (P=0.687), anastomosis technique (P=0.998), and anastomosis type (P=0.998) did not influence AL rates. Operation time was similar across groups (P=0.613), and anastomotic bleeding occurred in 1.3% of cases, with no association with AL (P=0.989).ConclusionGlubran 2 was safely applied to ileocolic anastomoses, significantly reducing AL rates and potentially providing a protective effect even in patients with known risk factors. Its hemostatic and bacteriostatic properties support improved postoperative outcomes, highlighting its potential as an effective adjunct in colorectal surgery. Further studies are warranted to confirm these findings and explore broader applications.

Degenerative and/or herniated discs are a global cause of chronic lower back and neck pain. While multiple treatments exist, the research for long-term effective interventions with minimal side effects continues. The radioplaque gelified ethanol (RGE) (DiscoGel®, Hérouville-Saint-Clair, France), is an addition to the armamentarium of potential treatments. This study aimed to evaluate the long-term efficacy of this device in treating lumbar disc herniation through a 10-year follow-up period. In this bi-centric observational study, patients treated with RGE in the lumbar spine between 2009 and 2011 were evaluated based on specific inclusion and exclusion criteria. Collected data encompassed preoperative imaging, VAS pain scores, ODI functional scores, were recorded through 10-year follow-up. Fifty-two participants (26 males and 26 females) with an average age of 51.7 years were enrolled in the study. Ten years after treatment, there was a statistically significant improvement in VAS pain scores and ODI percentages (p < 0.01). Additionally, significant changes in anterior, medial, and posterior disc dimensions were observed, suggesting structural adaptations due to RGE treatment. A statistically significant difference in the anterior dimension of the treated disc was found 10 years postoperatively compared to preoperative measurements (p = 0.0011). RGE is a promising therapeutic choice for lumbar symptomatic herniation resistant to conservative treatments, offering both immediate relief and enduring benefits. Although our findings are promising, additional randomized controlled trials are essential to compare DiscoGel® with established treatments and substantiate its efficacy.

Near-Infrared Spectroscopy (NIRS) is a non-invasive technique that measures the oxygenation variations of brain tissue in response to different stimuli. It has many advantages such as being easy to use, portable, and non-invasive. Several studies over the years have demonstrated the usefulness of NIRS in neurological and neurodegenerative diseases. NIRS remains relatively underutilized in clinical practice. The aim of this brief review was to describe the use of NIRS in neurological and neurodegenerative diseases and how its use can modify clinical, therapeutic, and rehabilitative approaches. A total of 54 relevant articles were selected from the PUBMED research database related to the diagnostic and prognostic role of fNIRS in the main neurological and neurodegenerative diseases; significant outcomes have been reported in a descriptive form with careful considerations. In addition, we excluded studies using fNIRS in co-registration with other neurophysiological techniques. The use of NIRS should be applied even in the field of neurological and neurodegenerative diseases; in dementia, NIRS can aid in differential diagnosis and predict possible evolutions from Mild Cognitive Impairment (MCI) to Alzheimer's Disease (AD) stage; in stroke, it plays an important role especially in the post-acute phase, giving information about the patient's chances of recovery; in Parkinson's Disease (PD), the results showed the important role of cognitive aspects; in epilepsy, NIRS can localize the epileptic focus or potentially predict seizure onset.

We performed a retrospective immunological analysis of the antibody response in serum and in nasopharyngeal swabs (NPS) obtained from 46 individuals infected with ancestral SARS-CoV-2 Wuhan-Hu-1 strain during the first COVID-19 wave in Cagliari (Sardinia, Italy), with a 4-month follow-up after the hospital admission. We implemented a comprehensive antibody response in serum and in mucosal samples using assays established in our laboratories. In NPS we evaluated the viral load by real time PCR, presence and kinetics of anti-Spike IgG and IgA by ELISA as well as their anti-Wuhan neutralization activity, showing induction and persistence of anti-viral immunity at the mucosal level. Neutralizing antibodies were measured in serum and NPS using a safe pseudovirus-based assay validated after comparison with a standard neutralization test using live SARS-CoV-2. We evaluated cross-neutralizing antibodies against all the major early variants of concerns (VoC) in sera. Of note, we detected a remarkable reduction of neutralizing activity against BA.1 compared to BA.2 and BA.5 Omicron subvariants, which was confirmed in sera from an analogous cohort of patients at the San Raffaele hospital in Milan, a geographically distant region of Italy, infected with the ancestral virus during the same period of time.

The patient activation measure (PAM), a recognized measure of how active patients are in their care, is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation. This study aimed to assess the psychometric properties and construct validity of the Italian version of the 13-item Patient Activation Measure (PAM13-I) among patients undergoing elective laparoscopic cholecystectomy. A multicenter study was conducted across 111 surgical units in Italy. This study involved the preoperative administration of the PAM questionnaire to 4532 patients. The psychometric properties of the PAM were evaluated using Rasch analysis. The PAM13-I demonstrated good internal consistency (Cronbach's α = 0.95) and reliability indices. While fit statistics were acceptable, ceiling effects were observed. No significant differential item functioning was found. However, issues with targeting and local response dependency were identified. The Italian PAM-13 showed promising psychometric properties among surgical patients, indicating its potential utility in assessing patient activation. However, concerns regarding ceiling effects and targeting suggest the need for further refinement and validation in surgical populations.

Background: Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. Despite advancements in surgical techniques and perioperative care, patient outcomes vary significantly across healthcare institutions. Textbook outcome (TO), a composite metric representing an ideal postoperative course, has been proposed as a standard for assessing the quality of surgical care in CRC. However, its impact on patient outcomes remains underexplored, particularly across diverse clinical settings. Objective: This study aims to explore surgeons’ adherence to TO criteria and identify patient-specific and procedural risk factors associated with TO failure. The study will also evaluate TO as a quality metric in CRC surgery, examining its association with short-term and long-term clinical outcomes in a multicenter cohort. Methods: This multicenter, retrospective cohort study will include all adult patients undergoing CRC resection between 1 January 2022 and 31 December 2024 across multiple centers in Italy, on behalf of the Italian Surgical Association (ACOI, Associazione Chirurghi Ospedalieri Italiani). The study will collect and analyze demographic, clinical, and surgical data to determine TO incidence and its association with key outcomes, including radical resection, 30-day mortality, morbidity, no reintervention, no ostomy placement, and a hospital stay of 14 days or less. Conclusions: This study will offer valuable insights into the utility of TO as a metric for evaluating the quality of care in CRC surgery. These findings may inform future guidelines and policies aimed at improving CRC surgical outcomes.