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The project PRISCA develops digital tools for postoperative monitoring and early detection of wound complications(e.g., infections) through telemedicine solutions. The approach addresses concrete clinical needs, including the follow-up ofpatients discharged from centers of surgical excellence located far from home, the optimization of hospital access, and theearly identification of at-risk situations. The output of the project will be a telemonitoring platform (mobile and web apps),artificial intelligence modules for wound image analysis, and informative content for patients. The technological architectureis designed to support timely intervention in case of wound-related complications, while also reducing unnecessary in-personvisits. The project’s main innovation is the use of an Artificial Intelligence module. It aims to enable healthcare professionalsto perform automated analysis of wound images for early detection of post-surgical complications. The limited availabilityof public data was tackled by applying a data augmentation method and by integrating a generative AI model. It creates newsynthetic images based on real images and textual prompts. All generated images had been validated by clinicians and thenincluded in the final dataset. This approach ensures the model learns from a diverse set of images, increasing its robustnessand accuracy. The adopted detection model is YOLOv11, which localizes the wound and performs a pathological/nonpathologicalclassification. Results show good localization and promising classification accuracy. We performed a comparisonbetween the model trained on the original dataset and the version enhanced with synthetic data, in order to assess relativeimprovements. These comparisons will help refine the model for better performance in real-world scenarios. The first resultsshow an increase in the performance of the model with augmented data but more systematic comparisons are needed.Additional real images from a proprietary dataset currently being collected will also be integrated, further enhancing the AI'sability to identify early complications.

Background: The role of radioiodine (RAI) therapy for differentiated thyroid cancers (DTCs) is still a matter of debate. Low-dose RAI (LDRAI) therapy is a possible treatment for patients at low–intermediate risk of recurrence. The aim of this study was to evaluate the occurrence of post-RAI therapy clinical and biochemical side effects with respect to its dosage. Methods: We retrospectively examined 142 patients who had been administered RAI therapy for DTCs and carried out at least a 12-month follow-up. The incidence of clinical adverse events (CAEs: xerophthalmia, xerostomia, and dysgeusia) and values for hemoglobin (Hb), red blood cells (RBCs), white blood cells (WBCs) and platelets (PLTs) during the first year of follow-up were compared between patients who underwent standard-dose RAI (SDRAI) therapy and LDRAI therapy. Results: Of the 142 patients, 66 were treated with LDRAI and 76 with SDRAI. A higher incidence of CAEs was found in the SDRAI group than in the LDRAI group (p = 0.002). An administered dose above 2849 MBq was associated with CAEs (sensitivity 88.89%, specificity 54.03%, p < 0.001). We found a slight decrease in Hb (p = 0.008), RBCs (p = 0.013), WBCs (p = 0.004) and PLTs (p < 0.001) in the SDRAI group, while in the LDRAI group only WBCs showed a minimal decrease (p = 0.027) with any occurrence of overt bone-marrow disease. Conclusions: According to our data, LDRAI therapy seemed to be associated with a lower incidence of CAEs than SDRAI therapy. Both methods showed an excellent safety profile in terms of hematopoietic effects. However, the effect of SDRAI therapy in this setting might have been more positive than that of LDRAI therapy.

Medical palpation is a key skill for clinicians. It is typically trained using animal and synthetic models, which however raise ethical concerns and produce high volumes of consumables. An alternative could be visuo-haptic simulations, despite their training efficacy has not been proved yet. The assessment of palpatory skills requires objective methods, that can be achieved by combining performance metrics with electroencephalography (EEG). The goals of this study were to: (i) develop a visuo-haptic system to train nodule detection, combining a Geomagic Touch haptic device with a visuo-haptic simulation of a skin patch and a nodule, implemented using SOFA framework; (ii) assess whether this system could be used for training and evaluation. To do so, we collected performance and EEG data of 19 subjects performing multiple repetitions of a nodule detection task. Results revealed that participants could be divided in low and high performers; the former applied a greater pressure when looking for the nodule and showed a higher EEG alpha (8.5 – 13 Hz) peak at rest; The latter explored the skin remaining on its surface and were characterized by low alpha power. Furthermore, alpha power positively correlated with error and negatively with palpation depth. Altogether, these results suggest that alpha power might be an indicator of performance, denoting an increase in vigilance, attention, information processing, cognitive processes, and engagement, ultimately affecting strategy and performance. Also, the combination of EEG with performance data can provide an objective measure of the user's palpation ability.

Article: Effects of magnesium supplementation on post-thyroidectomy hypocalcemia: a prospective single-center study - Minerva Endocrinology 2021 Oct 20 - Minerva Medica - Journals

Up to 25% of patients with acute diverticulitis develop complicated disease. Colocutaneous fistula with lower limb fasciitis secondary to complicated diverticulitis is a rare event. A 71-year-old woman with Class 3 obesity and Type 2 diabetes was admitted to the hospital because of left lower limb fasciitis associated with acute sigmoid diverticulitis complicated by covered perforation. The fasciitis was treated with multiple fasciotomies, antibiotics and hyperbaric oxygen therapy. The patient was readmitted 25 days after discharge because of the formation of a left leg colocutaneous fistula associated with an enterocolic fistula. Patient underwent sigmoid resection with primary anastomosis and ileal loop repair. Three-month follow-up showed fistula healing and absence of symptoms. Fasciitis secondary to acute diverticulitis is a rare clinical scenario. Although our therapeutic strategy was successful, the optimal treatment timing and surgical technique for fasciotomy and colon resection remain to be assessed.

BACKGROUND: A positive correlation between calcium and magnesium serum levels is well known and depends upon various factors. This study aims at verifying the existence of this association in a retrospective series of patients who underwent thyroid surgery. METHODS: Two hundred and eighty-five consecutive patients (202 female, 83 male, mean age 57 years) who underwent at least total thyroidectomy (TT) and had a complete clinical and biochemical pre- and postoperative evaluation were included in the study. Patients were evaluated with regard to: sex, age, indications for surgery, operative time, number of accidentally removed parathyroids, extent and time of surgery. thyroiditis, final histology, pre- and postoperative levels of calcium, magnesium, vitamin D, and creatinine, presence of symptoms of hypocalcemia. Statistical analysis was performed using the R software. RESULTS: In the postoperative period, biochemical hypocalcemia (<8.5 mg/AL) was observed in 126 patients (44%) and severe hypocalcemia (<7.5 mg/dL, a level indicating the need for longer hospitalization) was seen in 40 (14%). When analyzing patients with and without postoperative hypocalcemia, the factors affecting postoperative biochemical hypocalcemia were: older age (P=0.019), longer operative time (P=0.039). and a highly significant correlation between postoperative calcium and magnesium levels (r=0.432; P<0.001). CONCLUSIONS: The only factor among the ones we analyzed in this retrospective study that would appear to be linked to the onset of clinically relevant hypocalcemia is low magnesium levels in the postoperative period. A prospective randomized study with a group of patients undergoing magnesium replacement in the postoperative period can clarify the possible role of magnesium repletion on hypocalcemia.

The increasing use of arm totally implantable vascular access devices for breast cancer patients who require chemotherapy has led to a greater risk of complications and failures and, in particular, to upper extremity deep vein thrombosis. This study aims to investigate the outcomes of the arm peripherally inserted central catheter-PORT technique in breast cancer patients. The peripherally inserted central catheter-PORT technique is an evolution of the standard arm-totally implantable vascular access device implant based on guided ultrasound venous access in the proximal third of the upper limb with subsequent placement of the reservoir at the middle third of the arm. A prospective study was conducted on 418 adult female breast cancer patients undergoing chemotherapy. The primary study outcome was peripherally inserted central catheter-PORT failure. Median follow-up was 215 days. Complications occurred in 29 patients (6.9%) and failure resulting in removal of the device in 11 patients (2.6%). The main complication we observed was upper extremity deep vein thrombosis, 10 (2.4%); all patients were rescued by anticoagulant treatment without peripherally inserted central catheter-PORT removal. The main reason for removal was reservoir pocket infection: 4 (0.9%) with an infection rate of 0.012 per 1000 catheter days. Cumulative 1-year risk of failure was 3.6% (95% confidence interval, 1.3%–7.1%). With regard to the patients’ characteristics, body mass index p = 0.027). The peripherally inserted central catheter-PORT is a safe vascular device for chemotherapy delivery that achieves similar clinical results as traditional long-term vascular access devices (peripherally inserted central catheter and arm totally implantable vascular access device, in particular) in breast cancer patients.

Incretin-based therapies have been introduced in clinical practice for type 2 diabetes mellitus (T2DM) treatment in the last few years. Current available medications of this class include glucagon-like peptide 1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors. In addition to GLP-1, DPP-4 is able to inactivate many others peptides as hypothalamic growth hormone-releasing hormone (GHRH). The aim of this exploratory study was to evaluate, on adult diabetic patients, the impact of therapy with incretins, particularly DPP-4 inhibitors on GH/IGF-I axis.

We report a case of an elderly woman presenting with a huge cervical mass invading the tracheal lumen. Diagnosed as invasive poorly differentiated thyroid cancer, after an endotracheal biopsy, stenting and radiotherapy, it was judged eligible for total thyroidectomy, but surgery was delayed due to pulmonary thromboembolism. The patient was therefore treated with lenvatinib with a neoadjuvant intent until hemodynamic stability was obtained. Thyroidectomy and radioiodine therapy were then performed and the postdose scan revealed an area of modest uptake in the anterior part of the neck. The patient is now in a good clinical status and she continues her follow-up program without any adjuvant therapy.

Background This study investigates the incidence of post-operative complications and risk factors of sentinel lymph node biopsy (SLNB) in melanoma patients. Methods A retrospective cohort study was conducted at a single cancer institution on 408 consecutive SLNBs. Results Fifty-five post-operative complications occurred in 39 (9.5%) patients and included: wound infection in 24 (5.9%), seroma and lymphorrhea in 15 (3.7%), wound dehiscence in seven (1.7%), lymphocele in six (1.5%) and others in three (0.7%). Univariate analysis failed to identify possible risk factors (i.e. gender, age, lymph node region, number of excised lymph nodes, Breslow index, pT levels, comorbidities, length of surgery and hospital stay). Metastatic sentinel nodes occurred in four of 135 (3%) patients with thin melanoma (Breslow 1 mm. Conclusion For patients with thin melanoma in whom the incidence of lymph node metastasis is low, the reported post-operative morbidity of almost 10% of SLNB highlights the need for careful patient selection.