The San Raffaele Hospital (also Istituto scientifico universitario San Raffaele or ospedale San Raffaele, HSR or OSR) is a university hospital situated in Segrate, the Province of Milan, Italy. It was founded in 1969 by don Luigi Maria Verzé, president of "San Raffaele del Monte Tabor Foundation". The facility is connected to the Milan Metro by the MeLA people mover.The hospital is affiliated with the School of Medicine and the School of Nursing of the Vita-Salute San Raffaele University.
Gastric bleeding is a major symptom of locally advanced gastric cancer and a significant cause of mortality. Management options include surgery, endoscopic interventions, embolization and radiotherapy (RT). Although palliative RT appears effective for hemorrhage control, evidences are limited to underpowered retrospective studies from Asia, with issues of patient heterogeneity and response evaluation criteria. This study is a multicenter retrospective analysis carried out across Italian radiation oncology centers to evaluate real-world outcomes of hemostatic RT in patients with bleeding gastric cancer. Clinical and dosimetric data were retrospectively collected for patients with active bleeding gastric cancer treated across twelve Italian radiation oncology centers. The primary endpoint was to evaluate hemoglobin stabilization or improvement at four weeks post-treatment. Secondary outcomes included treatment parameters, acute toxicity profile and time to rebleeding. Between January 2018 and October 2024, 100 patients receiving hemostatic RT were collected for the analysis. The median age was 77 years, 68
BACKGROUND:There is a paucity of data informing on the current use, adverse events, outcomes, and prognostic drivers for patients receiving venopulmonary extracorporeal life support (VP ECLS). We aimed to provide a contemporary, large sample size study to describe the real-world outcomes of adults supported with VP ECLS across different clinical conditions. METHODS:We queried the Extracorporeal Life Support Organization Registry to retrieve all adult patients who received VP ECLS as the first support modality from July 2020 to July 2024. Study population was grouped according to hospital death outcome and to the diagnosis leading to VP ECLS use. Adverse outcomes are reported according to the diagnosis leading to VP ECLS use. A time-to-event Cox regression model was applied to identify predictors of death. RESULTS:A total of 838 patients [32.3% females; age 8 (46, 67) years] were included. Patients were treated for heart failure/cardiogenic shock (HF/CS) in 54.4%, for acute respiratory failure/acute respiratory distress syndrome (ARF/ARDS) in 26.6%, for post-cardiotomy shock in 6.7%, for acute coronary syndrome/ischemic heart disease in 5.3%, for valvular heart disease/complications of intracardiac devices in 4.2%, and for pulmonary embolism in 2.9%. Most common adverse events included continuous renal replacement therapy (CRRT) use or acute kidney injury (37.4%), infections (35.4%), cardiac arrhythmias (13.5%), surgical site bleeding (12.1%), gastrointestinal (GI) bleeding (6.1%). Complications were more common in non-survivors and patterns of complications differed among diagnosis groups. The Kaplan-Meier estimated 60-day survival was 49.3 (45.3, 53.1)%. Age (HRadj 1.15 for 5 years increase; 95%CI 1.11, 1.20; p < 0.001), female sex (HRadj 1.40; 95%CI 1.12, 1.76; p = 0.003), body mass index (HRadj 1.02 for 3 kg/m2 increase; 95%CI 1.01, 1.04; p < 0.018), CRRT use prior VP ECLS cannulation (HRadj 1.44; 95%CI 1.11, 1.86; p < 0.006) were independent predictors of death. CONCLUSIONS:In this large Extracorporeal Life Support Organization registry analysis, VP ECLS was chiefly used for HF/CS and ARF/ARDS. Hospital outcomes, complications, and survival differed according to the diagnosis leading to VP ECLS use. Younger age, male sex, lower BMI, and no CRRT use prior to VP ECLS cannulation confer a lower risk of death and provide targets for future research and potential domains for clinical improvement.
INTRODUCTION:The oncologic impact of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (iCCA) remains unclear. We hypothesized that the prognostic relevance of LND may vary according to tumor burden. Therefore, this study sought to evaluate the interaction between tumor burden and adequate LND among patients who underwent curative-intent resection for iCCA. METHODS:Patients who underwent curative-intent liver resection for iCCA were identified from a large international multi-institutional database. Overall survival (OS) was evaluated using multivariable Cox regression models that included an interaction term between tumor burden score (TBS) and adequate LND. RESULTS:Among 1,558 patients, 872 (56.0%) underwent LND and 322 (20.7%) underwent adequate LND, defined as retrieval of at least six lymph nodes. The median TBS was 6.1 (interquartile range [IQR] 4.1-8.6). On multivariable Cox regression analysis, a significant interaction was observed between TBS and adequate LND (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.87-0.95, p < 0.001). Among 542 (34.8%) patients with TBS < 5.0, adjusted OS did not differ according to adequate LND status (HR 1.23, 95% CI 0.86-1.76, p = 0.265). In contrast, among 1,016 (65.2%) patients with TBS ≥ 5.0, adequate LND was associated with improved adjusted OS (HR 0.65, 95% CI 0.51-0.82, p < 0.001). Similar findings were observed for recurrence-free survival (RFS). CONCLUSIONS:The prognostic relevance of adequate LND in patients undergoing curative-intent resection for iCCA appears to vary according to tumor burden. Adequate LND was associated with improved OS and RFS among patients with high TBS, but not among those with low TBS.
Functional/Secondary tricuspid regurgitation (STR) accounts for over 85% of clinically significant tricuspid regurgitation (TR) and is associated with adverse prognosis and impaired quality of life. Advances in percutaneous tricuspid valve (TV) interventions underscore the need to differentiate TR etiologies, mechanisms, and phenotypes. STR is subdivided into atrial (A-STR), caused by right atrial dilation and tricuspid annular enlargement without significant leaflet tethering, and ventricular (V-STR), resulting from right ventricular dilation/dysfunction with leaflet tethering. A-STR, increasingly prevalent with aging and atrial fibrillation, typically presents with preserved right ventricular function, whereas V-STR reflects more advanced disease, is associated with RV dysfunction and, often, left ventricular systolic dysfunction and remodeling and/or left-sided valve disease, carrying higher mortality, compared with A-STR. Cardiac implantable electronic device (CIED) related TR is emerging as a distinct entity, while organic-TR arises from intrinsic structural abnormalities of the valve apparatus. Echocardiography, particularly three-dimensional imaging, is essential for accurate phenotyping and helps in procedural planning. Medical therapy remains primarily symptomatic, with diuretics as first-line therapy and targeted treatment of underlying cardiac pathology. In A-STR, rhythm control strategies, including catheter ablation for atrial fibrillation, may reverse annular remodeling. Surgical repair, preferably annuloplasty, is recommended in selected patients, often when concomitant left-sided surgery is needed. Transcatheter edge-to-edge repair offers a safe and increasingly used alternative, providing symptomatic improvement. The effects on outcomes are likely dependent on the time of intervention and the STR phenotype.
Objective:This study investigates gender disparities in clinical outcomes among patients with systemic sclerosis (SSc)-associated pulmonary arterial hypertension (PAH), focusing on cardiovascular events, right ventricular function, and survival. Introduction:PAH is a severe and life-threatening complication of SSc, with male patients often experiencing worse outcomes despite its higher prevalence in women. Comparative data on gender differences in this population remain limited. Methods:We conducted a retrospective, single-center study including 61 patients with SSc-associated PAH (52 women, 9 men), confirmed by right heart catheterization. Clinical, serological, pulmonary, and echocardiographic data were analyzed. Differences between sexes in cardiovascular events, right ventricular dilation, and survival were evaluated using appropriate statistical methods. Results:Male patients had a significantly higher incidence of cardiovascular events (median: 2.00 vs 1.00 in women; P = .031) and a greater prevalence of right ventricular dilation (100.00% vs 44.23%; P = .002). Kaplan-Meier analysis demonstrated reduced cardiovascular event-free survival (P = .001) and overall survival (P = .014) in men. Although mortality was higher in men (88.89%) than in women (57.69%), the difference was not statistically significant (P = .134). Conclusion:Men with SSc-associated PAH experience worse clinical outcomes, including more frequent cardiovascular events and reduced survival. The absence of estrogen's protective effects and the adverse influence of testosterone on cardiac remodeling may contribute to these disparities. These findings highlight the importance of early gender-specific risk stratification and the need for tailored therapeutic strategies to improve outcomes in this high-risk group.
