Avelino, Italy

Noninvasive Ventilation Facemasks Favoring Carbon Dioxide Washout

Fundus Camera Module for Early Detection of Alzheimer's Disease

A.I and Machine Learning Based Risk Prediction Model to Improve the Clinical Management of Endometrial Cancer.

Identify new risk factors for endometrial cancer, using an integrated multi-omics approach linked to a specific immune pattern (called MOMIMIC score) useful for improving oncology and surgery precision. The aim is to evaluate the predictive value of the MOMIMIC score for early identification of progression from precancerous lesions to endometrial carcinoma, prognosis and relapses, to help the clinician in the decision to treatments. Through the identification during hysteroscopy of the most appropriate site for biopsies targeted endometrials, through an artificial intelligence algorithm applied to the video system hysteroscopic which, by comparing the information from the omics approach and the hysteroscopic image combined with radiogenomic information, it could help the gynecologist in the procedure and provide information on the prognosis through the omics-iconographic profile in order to calculate a preoperative predictive score. Furthermore by modulating the surgical radicality, according to the information obtained, there will be a tendency to preserve fertility in young patients with a low-risk profile (since currently the risk factors are not sufficient to discriminate for a non-treatment radical). This will help the surgeon through an artificial intelligence algorithm applied to the system robotic/laparoscopic video, will guide the operator in decision-making procedures regarding the resection margins tumor, metastasis localization, pathological lymph node detection, and imaging driven by biomolecular information.

Drug Survival of Target Therapies in Atopic Dermatitis

Atopic dermatitis (AD) is a chronic, inflammatory skin disease with a prevalence of 10% in adults and 20% in children. It is of primary importance to select the best treatment option as as relapses occur quickly after discontinuation. Drug survival rate reflects efficacy, tolerability, and safety of a drug, influencing disease management and healthcare costs. AD treatment has been revolutionized by new treatments that include monoclonal antibodies (dupilumab, tralokinumab) and JAK inhibitors (abrocitinib, baricitinib, upadacitinib). This observational study evaluates the 12-month drug survival of these approved treatments in moderate-to-severe atopic dermatitis, assessing their safety. The study also aims to evaluate the relationship between drug survival and clinical, laboratory, and pharmacological factors. Patients affected by moderate-severe atopic dermatitis who will start therapy with approved target drugs (dupilumab, tralokinumab, upadacitinib, abrocitinib, baricitinib) for AD will be enrolled. Patients already on therapy with these drugs will also be included. During the baseline and follow up visits, clinical and demographic data will be collected, according to ordinary clinical practice. Current or retrospective disease severity scores will also be collected. Among the main: Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), Dermatology Life Quality Index (DLQI), Pruritus Numerical Rating Scale (NRS pruritus), Sleep Numerical Rating Scale (NRS sleep), Patient Oriented Eczema Measure (POEM).

Metabolic Exercise Test Data Combined with Cardiac and Kidney Indexes (MECKI) Score Evolution: Identification of Cardiovascular Risk in Patients with Heart Failure

Heart failure is a complex condition affecting multiple organs beyond the cardiovascular system, influencing disease progression and prognosis. It has become increasingly evident that accurate risk assessment requires considering multiple variables, as no single parameter alone is sufficient for prognosis. These findings have led to the identification and study of prognostic parameters that, when combined, allow for a more precise risk estimation and identification of high-risk patients. Various prognostic scores have been developed, utilizing algorithms that integrate multiple variables to estimate an individual's mortality risk. Some scores are based on clinical evaluation and comorbidities, others on laboratory findings, baroreflex sensitivity, heart rate, sleep abnormalities, echocardiographic imaging, or cardiopulmonary exercise testing (CPET), either alone or in combination with other factors. CPET provides several parameters strongly correlated with prognosis. Since the 1990s, its use-alongside clinical data-has been recommended in heart failure management guidelines. More recently, in addition to peak oxygen consumption, the VE/VCO₂ slope has been recognized as a key prognostic marker, reflecting ventilatory efficiency and ventilation-perfusion mismatch, and has been included in heart transplant assessment criteria. Current risk models in heart failure often omit important prognostic parameters, such as ventilatory indices from CPET, renal function, and hemoglobin levels. Among the numerous prognostic scores available, only the HF Survival Score (HFSS) and the HF Action Predictive Risk Score Model incorporate exercise-related parameters (peak VO₂ in the former and exercise duration in the latter), yet both neglect ventilatory aspects. Even the widely used Seattle Score does not include exercise-related variables. In 2012, the researchers developed the MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) score, integrating oxygen consumption, ventilatory efficiency, and easily accessible biochemical and echocardiographic parameters. Unlike previous models requiring extensive data collection, MECKI is based on just six key variables, making it both practical and effective. Recent studies indicate the need to review and update the cutoff values and parameters used in prognostic models, as the introduction of new therapies and treatment strategies may significantly impact their predictive power in specific patient populations. Study Objectives and Purpose The aim of this study is to expand and update the patient dataset to further develop the MECKI score, optimizing its application in patient subgroups and adapting it to new therapies and treatments introduced in clinical practice. Additionally, the researchers seek to determine whether risk prediction accuracy varies in advanced-stage patients, those with comorbidities, or those receiving different treatments. This could lead to the development of correction factors for the MECKI score, improving its predictive power and applicability across different clinical scenarios. Study Population Patients with systolic heart failure, consecutively enrolled and followed at multiple Heart Failure Units across Italy. Patients undergo assessment through medical history collection, physical examination, laboratory tests, ECG, transthoracic echocardiography, and cardiopulmonary exercise testing (CPET). Follow-up will be conducted according to the protocol of the respective Heart Failure Unit. The follow-up period ends at the last evaluation at the reference center, or upon the patient's death or heart transplantation.

Randomized Clinical Trial Aimed at Comparing Unclamped Robotic Partial Nephrectomy With or Without Renorrhaphy

Since RR impacts postoperative renal function, we believe the use of cautery instead of suture of the parenchymal breach after tumor enucleation provides at least postoperative functional results not lower, shorten the intervention time and reduce the direct costs associated with the procedure. Based on available pilot studies, SL-ocRPN is safe, fast, and both the transfusion rate and duration of the hospital stay are not affected by the lack of renorrhaphy at the end of the enucleation. At the same time, this surgical approach does not require the use of a robotic needle holder and this can result in a reduction of direct costs related to treatment. Furthermore, based on the preliminary data available, the rate of positive surgical margins would also not result influenced by the absence of RR and the risk of local recurrence could even be reduced by the extended one coagulation of the tumor bed after enucleation.

Analysis of Urinary Methylation Patterns Via Liquid Biopsy as an Early Diagnosis Tool

The study has the primary objective to investigate the diagnostic capacity of methylation levels in urine samples, furthermore it has the secondary objective of applying an NGS test on the urine sample capable of evaluating the highest methylation levels comprehensive, with better analytical performance than the currently available standard on the market, leveraging targeted sequencing of multiple genes or global analysis of the whole methylome. To describe the diagnostic performance of the methods in a real-world clinical environment and identify the characteristic methylation profiles capable of stratifying patients with different prognoses, and finally to explore the potential economic impact of applying such tests as tools alternatives to conventional practices.

Immune Signature of Chronic Hand Eczema Unveiled by Spatial Transcriptomics and Single-Cell Proteomics

Patients aged 18 to 65 affected with chronic hand eczema will be included in the study. As clinical practice, severity of chronic hand eczema will be evaluated by validated scores as HECSI, DLQI, and NRS itch. Moreover patch tests will be performed. Skin biopsies will also be performed to confirm the diagnosis. This study utilizes spatial transcriptomics and single-cell spatial proteomics to analyze biopsies of chronic hand eczema. It aims to identify distinct inflammatory cell subgroups and molecular markers that define the immune landscape of chronic hand eczema. By comparing endogenous (atopic dermatitis, dyshidrotic eczema, idiopathic forms) and exogenous (allergic/irritant) chronic hand eczema, the research wants to describe specific immune endotypes and potential therapeutic targets. The study also includes idiopathic chronic hand eczema subtypes, such as pompholyx and hyperkeratotic eczema, to clarify immune profiling and improve treatment strategies. By identifying molecular signatures unique to each chronic hand eczema subtype, this research could lead to more personalized and effective therapies.

Soft Tissue Sarcoma: Motor Performance, Robotic Rehabilitation, Nutrition, and Quality of Life

This is a non-profit, multicenter, non-controlled interventional study aimed at evaluating the main characteristics of motor disability and the impact of personalized robotic rehabilitation in patients undergoing surgical treatment for localized soft tissue sarcoma (STS). Aim 1: Identify the clinical characteristics and motor deficits following surgical intervention for soft tissue sarcoma (STS). Aim 2: Evaluate the impact of a personalized robotic rehabilitation treatment on motor recovery in patients with STS. Aim 3: Assess the impact of perioperative treatments and surgery on quality of life and nutritional status in patients with STS. The primary endpoint of the study is the assessment of functional deficits and motor quality in patients with STS who have undergone surgical treatment, both after surgery and after a personalized rehabilitation program. The evaluation of functional deficits will include the analysis of functional impairment, activity limitations, and pain, which will be assessed using validated clinical scales. Motor quality will be measured using MIMU and EMG sensors and motor tests to study muscle activity. The secondary endpoints will include: 1. a comprehensive patient and disease assessment, recording: demographic information and patient characteristics; past medical history; tumor location; histopathological tumor characteristics; details on neoadjuvant therapies and surgical procedures. 2. the Quality of life assessment of the patients; 3. the nutritional status assessment of the patients. Study Procedures and Interventions: Comprehensive assessments-including general, clinical, instrumental, quality of life, and nutritional evaluations-will be conducted at: T0 (at diagnosis) to establish aims to characterize the impact of the tumor on the patient's functional abilities. T0+ (after radio-chemotherapy, if applicable) to assess the potential effects of radio-chemotherapy before surgery. Patients eligible for rehabilitation treatment will follow a structured evaluation process: T1 (within one month after surgery): reassessment to determine the functional impact of surgery. Rehabilitation phase: Patients will undergo conventional and robotic rehabilitation therapies tailored to the upper or lower limbs. T2 (after two months of rehabilitation): reassessment to measure functional recovery and rehabilitation outcomes. T3 (within eight-months from surgery): follow-up. The sample size was calculated based on a change after the rehabilitation program at least equal to the MCID of the scale. Specifically, 67 individuals are necessary considering a 2-sided, paired t-test, an MCID of 7 points, a common standard deviation of 20 points, a correlation coefficient between paired samples of 0.5, a significance threshold of 0.05, and a power of 0.80. This sample size will be increased to 90 individuals to account for a 25% loss at T2 owing to patients who will be unable to begin the rehabilitation intervention or who will develop clinical complications during the rehabilitation intervention. The power calculation was limited to patients with RPS and lower limb ESTS since the MCID of the TESS for the upper limb module has not been published. Moreover, we will enroll 30 patients with upper limb ESTS, based on number of patients referred and operated at our units (UO1 and UO3) in the last 2 years. Findings achieved in these patients will be considered exploratory for the scanty information currently available in the literature. All participating centers will follow a standardized operating procedure regarding treatment and outcome assessment to ensure consistency across all sites. Data will be systematically collected using the REDCap (Research Electronic Data Capture) platform.

Role of MRI Assessment in Fertility Sparing Treatment for Cervical Cancer at Staging and Follow-up and for Identification of Risk Factors for Aggressive Disease.

Cervical cancer represents the fourth-most common cancer in women and the leading gynaecologic malignancies, accounting approximately 570,000 cases and 311,000 deaths in 2018 worldwide. In Europe, during last years, both mean age of pregnant women and number of nulliparous women have increased (2). Age-specific incidence data indicate that 43% of patients with cervical cancer have less than 45 years. As consequence, numerous young women diagnosed with cervical cancer are still desiring to become pregnant. In women with early-stage cervical cancer (ECC), fertility-sparing surgery techniques include laparoscopic, abdominal or vaginal radical trachelectomy (RT) and cold knife conization (CKC) with or without pelvic lymph nodes dissection. Currently, RT is proposed as fertility-sparing surgery (FSS), alternative to radical hysterectomy, in patients with ECC staged IA1-IB1, as by the 2018 International Federation of Gynecology and Obstetrics (FIGO) classification. According to a recent metanalysis, RT and CKC present similar oncologic outcomes in terms of recurrence rates but CKC presents better obstetrical outcomes in terms of pregnancy rate (36% for CKC vs. 20% for RT) . NCCN suggested RT as an alternative to radical hysterectomy (RH) in young women desiring to preserve fertility with: disease limited to cervix, tumor size < 2 cm (or < 2.5 cm if exophytic lesion), absence of parametrial extension, an estimated distance of ≥ 1 cm from the proximal aspect of the tumor to the internal os, absence of lymphadenopathies or metastatic disease. Some authors have proposed neoadjuvant chemotherapy (NACT) followed by CKC as a safe and effective approach in ECC FIGO stage IB2. In 2018 FIGO staging was revised allowing the use of any of the imaging modalities (i.e. ultrasound, CT, MRI, positron emission tomography (PET)), to provide information on tumor size, nodal status, and local or systemic spread. MRI is reported to be very accurate in selecting patients eligible for FSS, in tumor size evaluation and deep stromal invasion assessment. In the evaluation of parametrial invasion, the specificity and negative predictive value of MRI were 97% and 100%, respectively. Furthermore, MRI has demonstrated very high sensitivity and specificity in assessment of internal os involvement, 90% and 98% respectively. Moreover, MRI including diffusion-weighted imaging (DWI) assumes an important role in the evaluation of tumor response after chemotherapy. In addition, MRI is highly sensitive and accurate (90.7% and 91.7% respectively) in tumor size evaluation after FSS, especially in patients who have undergone cone biopsy before MRI examination. The purpose of this study is to investigate the role of MRI, including DWI, in the staging and evaluation of response to fertility sparing treatment, including both primary surgery (RT or CKC) or after NACT, followed by CKC, in patients with ECC (FIGO 2018 stage IB1- IIA1), desiring to preserve their fertility.