To provide a clinically oriented synthesis of the epidemiology, pathophysiology, and management of bronchiectasis in patients with inflammatory bowel disease (IBD), and to clarify the key mechanisms underlying this association. Emerging evidence suggests a non-random association between IBD and bronchiectasis, with prevalence estimates varying widely according to study design and diagnostic approach. Mechanistic insights support a role for gut–lung axis dysfunction, including loss of mucosal tolerance, microbial dysbiosis, and immune cell trafficking. Clinically, bronchiectasis in IBD appears heterogeneous and may occur independently of intestinal disease activity. The increasing use of biologic therapies further complicates management, particularly regarding infection risk. Bronchiectasis should be recognised as a relevant extra-intestinal manifestation of IBD with important implications for diagnosis and management. A pragmatic, multidisciplinary approach is required, and further research is needed to define optimal screening strategies and tailored therapeutic pathways. Bronchiectasis is a frequent but under-recognized extra-intestinal manifestation of IBD. Awareness of the gut–lung axis and early multidisciplinary management are essential to balance inflammation control, infection risk, and respiratory outcomes in the era of biologic therapies.
Well-differentiated neuroendocrine tumors, grade 3 (NETs G3) of the digestive system are high-grade neuroendocrine neoplasms characterized by well-differentiated neuroendocrine morphology and high proliferative activity. Their molecular identity and therapeutic vulnerabilities remain incompletely defined. We performed a transcriptomic analysis and a comprehensive genomic profiling of 40 cases, including 26 NETs G3, 8 NETs G1/G2, and 6 neuroendocrine carcinomas (NECs). Targeted sequencing assessed alterations at both the DNA and RNA level, and gene expression profiling was conducted using a targeted immune-oncology panel. NETs G3 retained recurrent alterations in chromatin-regulatory genes characteristic of well-differentiated tumors and largely lacked the consistent TP53 and RB1 inactivation typical of NECs. Transcriptomic and genomic analysis demonstrated separation of NECs from NETs, with NETs G3 partially overlapping with NETs G1/G2 supporting a model of molecular relatedness. However, when compared with NETs G1/G2, NETs G3 showed upregulation of extracellular matrix remodeling, metabolic reprogramming, and cytokine signaling pathways. NETs G3 were heterogeneous in terms of number of genomic alterations per case and involved genes. A distinctive genomic feature was the predominance of large-segment copy-number losses, frequently involving chromatin-regulatory regions on chromosomes X and 10. Potentially targetable alterations were detected in up to 25% of NETs G3. Analysis of immune microenvironment supported a poorly inflamed tumor status, with individual cases harboring microsatellite instability or enrichment in tumor-infiltrating lymphocytes potentially amenable to immunotherapy.
Background: Augmented reality (AR) has rapidly emerged as an important navigational technology in spine surgery, with growing interest in its potential to reduce dependence on fluoroscopy and mitigate radiation exposure for both patients and operating room staff. Methods: This systematic review examined current evidence on radiation-related outcomes of AR-assisted spine procedures. A PRISMA-guided search of PubMed, Embase, and Scopus identified twelve eligible studies, including randomized trials, prospective and retrospective clinical cohorts, and cadaveric or synthetic-model investigations. Results: Across the included studies, AR was consistently associated with reduced fluoroscopy use, with several studies demonstrating statistically significant reductions in exposure time compared with conventional fluoroscopy. Two clinical studies directly measured occupational radiation and reported substantially lower staff doses when AR-based navigation and optimized shielding strategies were employed. Patient radiation exposure was similarly decreased in most studies, particularly when AR was integrated with low-dose cone-beam CT protocols. Operative time findings were mixed, reflecting early learning curves and variability in AR systems, but accuracy remained high across platforms. Conclusion: Current evidence suggests that AR may reduce intraoperative radiation exposure without compromising workflow or surgical precision, available studies are limited by small sample sizes, heterogenous methodologies, and a paucity of direct staff-dosimetry data. Larger, high-quality multicenter studies are needed to clarify the magnitude of AR’s radiation-sparing benefits and to define its role in modern spine surgery.
The bone tissue is endowed with intrinsic regenerative capacity. This is compromised in cases of major alterations like in trauma, surgical removal of cancer lesions, and infections. Osteomyelitis (OM) is an infectious disease of the bone primarily caused by the gram-positive bacterium Staphylococcus aureus and characterized by extensive tissue remodelling and inflammation. Local and systemic antimicrobial treatments are the standard of care; however their efficacy is often limited by immune-mediated vascular damage and biofilm formation. Antimicrobial-loaded biomaterials offer a promising alternative. In this regard, hybrid scaffolds made of hydroxyapatite nanocrystals grown on collagen fibers and mimetic of bone extracellular matrix has already demonstrated to support cell functions and resorb over time. Also, they can be doped with bioactive and antimicrobial ions and release them in a controlled and sustained manner during scaffold degradation and tissue regeneration. In this study, we incorporated Cu²⁺-doped hydroxyapatite into collagen scaffolds (Col/CuHA) with the aim of developing a biomaterial capable at a time to prevent/treat bone infections and promote tissue regeneration. These matrices recapitulated the architecture of bone tissue and released Cu²⁺ ions with bactericidal activity towards a biofilm-forming isolate of Staphylococcus aureus. In vitro experiments in conditions mimicking dynamic fluid exchanges allowed identification of optimal Cu²⁺ loads with balanced antimicrobial activity and cytocompatibility. In vivo preliminary observations from a murine model of ectopic scaffold implantation suggested that these biomaterials can be integrated in the host tissue, thus further corroborating their biocompatibility with the applied loads of Cu2+. Our results point to Col/CuHA scaffolds as promising candidates for the prevention and/or treatment of osteomyelitis and the promotion of bone repair, and suggest that they might provide an innovative alternative to conventional antibiotic-based strategies.
This study evaluates the efficacy of a post-discharge follow-up program in patients recovering from acute heart failure (AHF) hospitalized in internal medicine (IM) and in cardiology (CA) wards. Patients hospitalized for AHF between October 2020 and November 2022 at a third-level center were retrospectively analyzed according to their hospitalization ward in CA vs IM. Patients deemed eligible for inclusion were ≥ 18 years-old and hospitalized for AHF. Only patients discharged alive were included in the post–AHF follow-up program. The primary endpoint was a composite of time to first HF hospitalization or cardiovascular (CV) death at 6 months, while secondary endpoints were its individual components, all-cause death and a composite of time to first HF hospitalization or all-cause mortality at 6 months. Out of 230 patients, 122 were hospitalized in CA and 108 in IM wards. Patients hospitalized in CA were younger and less frequently affected by extra-cardiac comorbidities compared to patients managed in IM. At 6 months, no difference in the primary endpoint was registered in the two groups (IM 16.6
