Search Results (7)

Objectives: Residual postoperative pleural space (RPPS) is a common event after pulmonary lobectomy. Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy has been associated with a higher incidence of RPPS. This study aims to evaluate the incidence, the predictors, and potential clinical implications of RPPS following Uniportal VATS lobectomy. Methods: Patients who underwent Uniportal VATS lobectomy, without any previous neoadjuvant treatment, from June 2016 to March 2020, were retrospectively analyzed. RPPS was assessed using the last chest X-Ray prior to discharge and measured by Collins method (%). Results: Among 492 patients who underwent Uniportal VATS lobectomy, 325 (66.1%) developed RPPS. The mean RPPS volume measured by the Collins method was 15.46 ± 8.59% (vs. Collins = 4.2% in no-PRPS). An RPPS > 10.5% of Collins was significantly associated with a higher risk of postoperative air leak (AUC: 0.69, sensitivity: 69%, specificity: 54%, p < 0.001). Multivariable analysis identified the following predictors of RPPS > 10.5%: right-sided surgery (p < 0.001), upper lobectomy (p = 0.01), and prolonged air leak (p = 0.003). Patients with RPPS had a higher risk of only radiologically visible postoperative subcutaneous emphysema on the final chest X-ray (p = 0.041) and were more frequently discharged with a chest tube connected to a Heimlich valve (p < 0.001). Within 90 days post-discharge, 24 (4.9%) patients were readmitted due to increased RPPS (1.4%, requiring drainage in 5 cases [1%]), progression of subcutaneous emphysema (1.6%), and pleural effusion (1.8%, requiring drainage in 6 cases [1.2%]). However, RPPS was not associated with an increased overall risk of postoperative complications (p = 0.31) or 90-day readmission (p = 0.43). Conclusions: RPPS is a common occurrence following Uniportal VATS lobectomy but is not associated with clinically significant complications. The current study findings identified BMI, active smoking, right-sided surgery, and prolonged air leak as significant predictors of RPPS. Full article

The introduction of transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis (AS), leading to significant improvements in patient outcomes. Over time, advancements in device technology have further optimized safety and performance of TAVR. However, as the pool of low-risk patients undergoing TAVR expands, many of whom present with concomitant coronary artery disease (CAD), new challenges have emerged. A large proportion of TAVR candidates suffer from CAD, and the clinical implications of this comorbidity remain a subject of debate. Research on the relationship between AS and CAD has yielded conflicting results, but severe CAD is generally linked to worse outcomes in AS patients. The coexistence of AS and CAD complicates diagnosis and management, requiring a comprehensive understanding of both invasive and non-invasive diagnostic techniques, along with careful revascularization strategies. This review explores the prevalence, clinical impact, and diagnostic challenges of CAD in TAVR patients, highlighting emerging methods for its assessment. Key aspects of treatment, including the timing of coronary revascularization, coronary re-access after TAVR in different settings, as well as practical tips and tricks for coronary cannulation, are also discussed. The complexity of managing AS and CAD is further intensified by the need for individualized approaches, particularly in hybrid procedures and subsequent TAVR interventions. Ongoing research and technological innovations offer promising solutions for refining the management of CAD in AS patients undergoing TAVR, with an emphasis on improving prognostic accuracy, optimizing revascularization strategies, and enhancing post-procedural care. Full article

Background/Objectives: Walking coordination is crucial for maintaining independence and quality of life, but it is significantly affected by aging and cognitive decline. This study investigates how age and cognitive status relate to lower limb coordination during gait, using a network-based analysis of joint kinematics. Methods: Fifty-six healthy participants (31–82 years old) underwent gait analysis with a stereophotogrammetric system and cognitive assessment through standardized neuropsychological tests. Kinematic data were processed to build “kinectomes”, representing the inter-joint coordination across the gait cycle. Results: The results showed that the mean lower limb coordination on the sagittal plane negatively correlated with age and positively with cognitive performance. Detailed analysis revealed that age-related declines in coordination were primarily driven by reduced synchronization at the knees, while cognitive status was associated with overall coordination rather than joint-specific changes. Conclusion: These findings emphasize the knees’ critical role in preserving gait coordination with aging and underline the involvement of cognitive aspects in global coordination mechanisms. In summary, our network-based approach provides a refined perspective on gait dynamics, highlighting the relationship between coordination and both age and cognition. Full article

Background: Prostate-specific membrane antigen (PSMA)-PET imaging has significantly improved prostate cancer (PCa) staging, yet its interpretation remains challenging, even for experienced specialists. No prior study has assessed urologists’ ability to interpret PSMA-PET. Methods: We conducted a multicenter prospective study involving 63 urologists from eight Italian institutions. Participants evaluated 20 PSMA-PET scans of high-risk PCa cases, with no clinical information provided. Proficiency was defined as correctly identifying at least two of three staging components (T, N, M) in ≥75% of cases. Associations between performance and factors such as hierarchy (resident vs. consultant), institution type, surgical volume, and multidisciplinary team (MDT) presence were analyzed using univariable and multivariable logistic regression. Results: Only one participant achieved full staging proficiency, while 44% reached the ≥75% threshold for partial (almost correct) staging. Urologists from centers with ≥300 PCa diagnoses per year demonstrated better T and M stage identification. Institutions with ≥150 robot-assisted radical prostatectomies (RARPs) per year and those with MDTs showed higher accuracy in M staging. No significant predictors of proficiency emerged in the multivariable analysis, although hierarchy and surgical volume approached significance for nodal metastasis detection. Conclusion: PSMA-PET interpretation is complex for urologists, with particular challenges in T and M staging. High institutional case volumes and MDT involvement may enhance interpretation skills. Structured training programs and increased exposure to multidisciplinary imaging discussions are essential to optimize urologists’ diagnostic proficiency and ultimately improve patient care. Full article

Background: Vitamin D deficiency is associated with several obstetric complications in singleton pregnancy. The aim of this study was to assess whether vitamin D levels affect the outcomes of twin pregnancy and if targeted supplementation can improve perinatal outcomes. Methods: The serum vitamin D levels of 143 women with twin pregnancies were measured during their first trimester. Those with insufficient (10–30 ng/mL; IL group) or severely deficient (<10 ng/mL, DL group) vitamin D levels were supplemented. In the third trimester, vitamin D levels were reassessed. Perinatal outcomes of the IL and DL groups were compared with those of patients with sufficient levels (>30 ng/mL, SL group) since the beginning of pregnancy. Results: Women in the IL and DL groups had a higher incidence of hypertensive disorders of pregnancy (HDP) compared to the SL group (24.8% and 27.8% vs. 12.5%, p = 0.045): OR = 1.58 for the IL group and 1.94 for the DL group compared to the SL group. In patients whose vitamin D levels were restored after supplementation, HDP incidence was lower than in patients who remained in the IL or DL groups (23.4% vs. 27.3%) but higher than those who were always in the SL group (12.5%). Conclusions: Insufficient or severely deficient levels of vitamin D in the first trimester are associated with an increased risk of HDP in twin pregnancy. The beneficial effect of targeted vitamin D supplementation in reducing HDP seems limited. Full article

Community-acquired urinary tract infections represent the most common infectious diseases in the community setting. Knowing the antibiotic resistance patterns of uropathogens is crucial for establishing empirical treatment. The aim of the current study is to determine the incidence of the causative agents of UTIs and their resistance profiles. Patients of all ages and both sexes were enrolled in the study, and admitted to San Ciro Diagnostic Center in Naples between January 2019 and Jun 2020. Bacterial identification and antibiotic susceptibility testing were carried out using Vitek 2 system. Among the 2741 urine samples, 1702 (62.1%) and 1309 (37.9%) were negative and positive for bacterial growth, respectively. Of 1309 patients with infection, 760 (73.1%) were females and 279 (26.9%) were males. The greatest number of positive cases were found in the in the elderly (>61 years). Regarding uropathogens, 1000 (96.2%) were Gram-negative while 39 (3.8%) were Gram-positive strains. The three most isolated pathogenic strains were Escherichia coli (72.2%), Klebsiella pneumoniae (12.4%), and Proteus mirabilis (9.0%). Strong biofilm formation ability was observed in about 30% of the tested isolates. The low resistance rates recorded against nitrofurantoin, fosfomycin, piperacillin–tazobactam, and gentamicin could suggest them as the most appropriate therapies for CA-UTIs. Full article

The cold dark-matter model successfully explains both the emergence and evolution of cosmic structures on large scales and, when we include a cosmological constant, the properties of the homogeneous and isotropic Universe. However, the cold dark-matter model faces persistent challenges on the scales of galaxies. Indeed, N-body simulations predict some galaxy properties that are at odds with the observations. These discrepancies are primarily related to the dark-matter distribution in the innermost regions of the halos of galaxies and to the dynamical properties of dwarf galaxies. They may have three different origins: (1) the baryonic physics affecting galaxy formation is still poorly understood and it is thus not properly included in the model; (2) the actual properties of dark matter differs from those of the conventional cold dark matter; (3) the theory of gravity departs from General Relativity. Solving these discrepancies is a rapidly evolving research field. We illustrate some of the solutions proposed within the cold dark-matter model, and solutions when including warm dark matter, self-interacting dark matter, axion-like particles, or fuzzy dark matter. We also illustrate some modifications of the theory of gravity: Modified Newtonian Dynamics (MOND), MOdified Gravity (MOG), and $f\left(R\right)$ gravity. Full article