Società Italiana di Cardiologia

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.

Between the 16th and 19th centuries, numerous masserie are documented in both the coastal areas and the interior of the Abruzzo region through written sources, historical cartography, archaeological evidence, and oral accounts. In several cases, the architectural structures remain extant. These settlements were primarily owned by noble landholding families who oversaw agricultural and pastoral activities linked to transhumance - the seasonal movement of livestock, particularly sheep, between highland and lowland pastures. From the 16th century onward, some complexes incorporated defensive structures and were established both along the Adriatic coast and in the hinterland, often strategically located on transhumance routes. This research investigates different case studies to highlight the interrelationships between rural estates and their territorial contexts. The analysis identifies shared features rooted in the tradition of defensive rural architecture in Southern Italy and in the agro-pastoral economy of the early modern period. At the same time, each complex displays distinctive traits shaped by its function and its relationship with infrastructure, settlement patterns, and local communities. These variations reflect different models of land management, ecological interactions and ownership structures, as well as historical processes that transformed the masserie from productive units into symbols of power. Through this approach, the research contributes to a comprehensive and diachronic understanding of the regional economic system.

Subclinical coronary atherosclerosis is common but its biological aggressiveness and interplay with extracoronary disease in asymptomatic individuals remain unclear. We evaluated the prevalence of high-risk coronary plaques (HRPs) and their relationship with mild carotid atherosclerosis and coronary calcium in a cardiovascular (CV) high-risk cohort in primary prevention. This retrospective multicenter study enrolled 269 asymptomatic adults with multiple CV risk factors who underwent Coronary Computed Tomography Angiography (CCTA) after prior carotid duplex ultrasound (CDUS). Coronary artery disease (CAD) was graded as absent, non-obstructive (<50% stenosis) or obstructive (≥50%), and HRPs were identified by ≥1 adverse morphological feature (low attenuation, positive remodeling, napkin-ring sign, spotty calcification). Carotid disease was classified as CDUS 0 (no plaque), CDUS 1-49% (mild), or CDUS ≥ 50% (significant). Pre-specified analyses explored prevalence of HRPs across CDUS-calcium-score strata (cut-off 100 Agatston) and independent predictors within the CDUS 1-49% subgroup. CAD was absent in 31%, non-obstructive in 41%, and obstructive in 28%. HRPs were present in 30.9% of all cases, in 26.6% of non-obstructive and in 64.6% of obstructive CAD. HRPs prevalence rose step-wise from 10.0% (CDUS 0 + Ca < 100) to 27.7% (CDUS 1-49% + Ca < 100), 41.2% (CDUS 0 + Ca ≥ 100) and 59.4% (CDUS 1-49% + Ca ≥ 100). In patients with CDUS 1-49%, current smoking independently predicted HRPs (OR 2.1, 95% CI 1.0-4.5; p = 0.049). Nearly one-third of asymptomatic adults with high CV risk already showed HRPs. Mild carotid atherosclerosis synergized with a calcium score ≥ 100 to identify a subgroup in which six of ten individuals exhibited HRPs. Smoking was the only independent clinical correlate identified of plaque vulnerability. Combined carotid ultrasound, calcium scoring and CCTA may substantially refine primary prevention risk stratification beyond traditional factors.

Objetivo El objetivo del presente trabajo fue el de describir las modificaciones que el bloqueo completo de rama izquierda (BCRI) produce en las funciones sistólica, diastólica y sistodiastólicas del ventrículo izquierdo (VI) a través de los parámetros del eco-Doppler. Material y métodos Se estudiaron 53 pacientes con BCRI (20 hombres) y 20 sujetos normales como grupo control (grupo 1). Los pacientes con BCRI se dividieron en dos grupos: función sistólica conservada (grupo 2: 28 pacientes); función sistólica deprimida (grupo 3: 25 pacientes). Función sistólica: la fracción de eyección del VI fue determinada visualmente por dos observadores independientes; el desplazamiento sistólico del anillo mitral se midió con modo M (ESPAM). Función diastólica: la función diastólica se estudió con Doppler pulsado del flujo mitral, Doppler pulsado tisular y velocidad de propagación del flujo color en modo M. Función sistodiastólica: se utilizó el índice de Tei. ResultadosFunción sistólica: con respecto a la estimación visual subjetiva de la fracción de eyección del VI hubo una variabilidad interobservador en 4 de los 53 pacientes con BCRI, lo cual repre- sentó el 7,19%, kappa = 0,84 (IC 95% 0,70-0,99); p &lt; 0,001. Los pacientes con función sistólica conservada tuvieron un ESPAM normal mientras que en aquellos con función sistólica deprimida el ESPAM fue anormal. Función diastólica: el estudio de ésta fue anormal en la mayoría de los pacientes con BCRI. Función sistodiastólica: el índice de Tei resultó anormal en la mayoría de los pacientes con BCRI. ConclusionesEn pacientes con BCRI, la evaluación de la función sistólica puede hacerse con empleo del ESPAM. La función diastólica está alterada en la mayoría de los pacientes. El índice de función sistodiastólica tiene limitaciones en este grupo de pacientes.

Trochoidea caroni (Gastropoda, Geomitridae) is a land snail previously found only in Sicily and Capri (Naples), but it has recently been found in other regions of the Italian peninsula. In this study, we performed karyological and molecular analysis on T. caroni from different sites across this regional range. Karyological analysis was performed on specimens from Palermo (Sicily), Capri (Campania), and Terracina (Lazio) using standard staining and NOR-FISH methods; the latter method was also performed on samples of T. elegans from Rome (Lazio). All T. caroni specimens had 2n = 48 chromosomes, but the 8th and 17th pairs differed morphologically between specimens from Capri and Terracina and those from Sicily. The mitochondrial 16S rRNA analysis grouped Sicilian and non-Sicilian populations of T. caroni in distinct subclades. Superimposing karyological data on their phylogenetic tree suggests that possible chromosomal rearrangements occurred during the diversification of Trochoidea. Our findings provide karyological and molecular evidence for a diversification between Sicilian and non-Sicilian populations of T. caroni. Furthermore, NOR-FISH revealed hybridisation signals on the 16th chromosome pair in both T. caroni and T. elegans (tribe Trochoideini). Similar NOR localisation has also been identified in Cernuella virgata (tribe Cernuellini), suggesting that it was inherited from the common ancestor of Trochoideini and Cernuellini.

IntroductionTreatment optimization in people with HIV (PWH) has increasingly focused on reducing drug burden and improving regimen simplicity. However, comparative real-world evidence on dual therapy (DT) vs. triple therapy (TT), and single-tablet regimens (STR) vs. multi-tablet regimens (MTR), remains limited.MethodsThe MOSAICO study is a multicenter, retrospective observational analysis conducted across 20 centers, including people with HIV on a stable virological suppression who switched antiretroviral therapy between 2017 and 2019. People were followed-up up to 48 months post-switch. Comparative analyses assessed virological suppression (HIV-RNA <50 copies/mL), CD4+ T cell count, CD4/CD8 ratio, and treatment discontinuation. Propensity score weighting was applied to adjust for baseline differences.ResultsFour hundred ninety-one PWH were included. Both DT and triple therapy groups maintained high levels of virological suppression over 48 months (12 months: 97.1% vs. 91.6%; 24 months: 100% vs. 95.6%; 36 months: 100% vs. 96.9%; 48 months: 100% vs. 100%). From 24 months onward, all persons living with HIV remaining on their respective regimens achieved full virological suppression. Immunological recovery (CD4+ count and CD4/CD8 ratio) was comparable across groups, although TT and MTR groups showed greater increases from lower baselines. STRs demonstrated significantly greater treatment durability than MTRs (aHR = 0.56, 95% CI: 0.32–0.97; p = 0.039), while no significant difference in persistence was found between DT and TT. INSTI-based regimens were predominant in DT and MTR arms (DT vs. TT: 84% vs. 46.52%, p < 0.01; MTR vs. STR: 59.38% vs. 47.14%, p < 0.01).DiscussionThe real-world effectiveness of both dual and triple therapies when tailored to appropriate person profiles. STRs offer enhanced long-term persistence compared to MTRs, supporting treatment simplification strategies. These results reinforce the importance of individualized treatment approaches balancing clinical effectiveness with person-centered considerations such as pill burden and tolerability. Limitations include the retrospective design and the lack of quality-of-life data, which may affect interpretation of patient-centered outcomes. Future efforts should expand access to dual-agent STR to further improve Antiretroviral Therapy outcomes.

This review explores established risk factors for keratoconus and current insights into tear film immune biomarkers, with a focus on the role of chronic low-grade inflammation in disease pathogenesis and emerging targeted therapies. Growing evidence supports immune dysregulation as a key driver in the onset and progression of keratoconus. Genetics establish a foundation for a dysregulated inflammatory response in the ocular surface and corneal microenvironment, which sustains and accelerates disease progression. Elevated tear levels of IL-1, IL-6, TNF-α, HMGB1, and MMP9 reflect these inflammatory changes. Chronic inflammation and repeated mechanical trauma from eye rubbing, especially in adolescents and young adults, are major risk factors for disease progression. Timely screening and regular corneal topography in adolescents with allergic or atopic disorders are essential for early diagnosis and prevention of vision loss. The tear film and corneal microenvironment contain valuable immune markers that shed light on keratoconus pathophysiology. Advances in precision and predictive medicine hold promise for safer, more effective strategies to halt disease progression.

Cryoballoon pulmonary vein isolation has become an established treatment for atrial fibrillation (AF). However, data on long-term outcomes beyond 5 years are scarce. This prospective analysis aimed to evaluate the long-term outcome after cryoballoon pulmonary vein isolation. Data from consecutive patients treated with cryoballoon pulmonary vein isolation for symptomatic AF between 2012 and 2018 in 13 institutions were analyzed. Patients with ≥5-year follow-up after the index procedure were included. Arrhythmia recurrence was defined as AF or atrial tachycardia lasting >30 seconds beyond a 3-month blanking period. A total of 1330 patients were enrolled (28.4% female patients, mean age was 60.1±10.5 years). Patients with paroxysmal AF accounted for 73.1%; the median history of AF was 36.0 (13.0-75.0) months. The rate of AF/atrial tachycardia recurrences progressively increased over time (event rate: 52.5% [49.4%-55.8%] at 8-year follow-up). A low incidence of progression to permanent AF was seen in the entire cohort (7.0%). Importantly, 15.7% of patients underwent a redo ablation for AF during follow-up; in 45.9% of these cases, all PVs were isolated at the redo procedure, with a median number of PVs isolated after the index procedure being 3 (1-4) veins. Independent predictors of arrhythmia recurrences were AF type (persistent AF: hazard ratio, 1.36 [95% CI, 1.14-1.62]; P<0.001) and chronic kidney disease (hazard ratio, 1.77 [95% CI, 1.12-2.81]; P=0.016) in multivariate analysis. Cryoballoon pulmonary vein isolation as the index procedure for AF ablation resulted in a favorable long-term outcome in patients with symptomatic AF, with limited progression towards permanent AF during follow-up. Persistent AF was the strongest predictor of recurrences at long-term follow-up.

Background: Pulsed field ablation (PFA) is a novel non-thermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF), offering myocardial selectivity through irreversible electroporation while sparing surrounding structures. However, concerns have emerged regarding potential subclinical hemolysis, reflected by alterations in biochemical markers such as lactate dehydrogenase (LDH). Methods: We conducted a retrospective, single-center study involving 249 patients undergoing PVI: 121 treated with PFA (PulseSelect or FARAPULSE) and 128 with radiofrequency (RF) ablation (PVAC catheter). Laboratory parameters were assessed at baseline, post-procedure, and at discharge, including hemoglobin, hematocrit, red blood cell (RBC) count, platelet count, creatinine, and LDH. The primary endpoint was the variation in blood cell indices; the secondary endpoint was the evaluation of LDH and hematocrit changes. Statistical analysis included t-tests and chi-square tests. Results: Baseline characteristics and pre-procedural labs did not differ significantly between groups. No significant changes in hemoglobin, hematocrit, RBC count, platelet count, or creatinine were observed post-ablation or at discharge. However, LDH levels significantly increased in the PFA group both post-procedurally and at discharge (p < 0.001), without concurrent changes in other blood cell parameters. Conclusions: PFA and RF ablation yield comparable hematological profiles after PVI, with no significant impact on key blood cell parameters. Nonetheless, the consistent rise in LDH levels in the PFA group suggests mild, subclinical hemolysis or tissue injury due to more extensive lesions. While supporting the hematologic safety of PFA, these findings underscore the need for further studies to assess the clinical significance of these biochemical alterations, particularly in high-risk patients or extensive ablation settings.