Minerva medica最新文献

{"title":"Iron deficiency and risk of acute kidney injury after TAVI: a machine learning analysis.","authors":"Angelica Cersosimo, Crina-Ioana Radulescu, Marianna Adamo, Chiara Camastra, Catalina-Andreea Parasca, Silviu Dumitrascu, Dan Deleanu, Robert Troncea, Vlad A Iliescu, Marco Metra, Ovidiu Chioncel","doi":"10.23736/S0026-4806.26.09884-8","DOIUrl":"https://doi.org/10.23736/S0026-4806.26.09884-8","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve implantation (TAVI) has become the preferred therapeutic option for patients with severe aortic stenosis (SAS) at high or intermediate surgical risk. Despite its minimally invasive nature, TAVI is frequently associated with post-procedural complications, among which acute kidney injury (AKI) represents a major clinical concern. Early identification of patients at increased risk for AKI remains a critical unmet need.</p><p><strong>Methods: </strong>This retrospective, observational, single-center study enrolled consecutive patients with severe aortic stenosis who underwent TAVI between December 2022 and December 2023. The primary endpoint was to identify independent predictors of acute kidney injury (AKI) within 48 hours after TAVI. Secondary endpoint was to identify independent predictors of hospitalization for heart failure (HHF) during follow-up. Predictive modeling was conducted using the eXtreme Gradient Boosting (XGBoost) algorithm, with interpretability enhanced via SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>A total of 116 patients were included (mean age 76±6.5 years; 57% male). Comorbidities were common, including heart failure (41%), coronary artery disease (32%), atrial fibrillation (41%), diabetes mellitus (29%), and chronic kidney disease (34%). Median EuroSCORE II was 2.1 (IQR 1.5-3.9). Median ferritin was 99.5 ng/mL (IQR 40-129), mean hemoglobin 12.3±1.7 g/dL and mean eGFR was 69.9±24.9 mL/min/1.73 m². After TAVI procedure, AKI occurred in 9% of patients within 48 h. According to the SHAP analysis, ferritin and TSAT emerged as the two most influential features in AKI prediction. The machine learning model achieved high sensitivity (96%) and an F1-score of 0.98, suggesting strong clinical utility for early risk stratification.</p><p><strong>Conclusions: </strong>In patients undergoing TAVI, iron deficiency, as reflected by low ferritin and TSAT levels, emerged as independent predictors of early post-procedural AKI.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":"117 3","pages":"103-114"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between heart rate variation and sleep quality and depression in patients with acute myocardial infarction after PCI.","authors":"Jing Liu, Li Li, Yongchao He, Feng Duan, Haiying Zhi","doi":"10.23736/S0026-4806.26.09331-6","DOIUrl":"10.23736/S0026-4806.26.09331-6","url":null,"abstract":"","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"176-178"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy and safety between intravenous recombinant human prourokinase and alteplase in acute ischemic stroke treatment: a meta-analysis of randomized controlled trials.","authors":"Mariana L Maximiano, Ocílio R Gonçalves, Luciano Falcão, João V Fernandes, Kenzo O Donato, Filipe V Ribeiro, Marianna Leite, Lucca T Carretta, Rafael F Santos, Luiz G Almeida, Milene V Sobral, João P Telles","doi":"10.23736/S0026-4806.25.09852-0","DOIUrl":"10.23736/S0026-4806.25.09852-0","url":null,"abstract":"<p><strong>Background: </strong>Recombinant human prourokinase (rhPro-UK) has been investigated as an alternative thrombolytic agent to alteplase for acute ischemic stroke (AIS). While alteplase remains the standard of care, uncertainties persist regarding whether rhPro-UK provides similar efficacy and safety outcomes. This systematic review and meta-analysis aimed to compare intravenous rhPro-UK with alteplase in patients with AIS.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, Embase, and Cochrane Central up to January 2025. Randomized controlled trials (RCTs) comparing intravenous rhPro-UK with alteplase were included. Outcomes of interest were functional recovery (modified Rankin Scale [mRS] 0-1 and 0-2 at 90 days), early neurological improvement (National Institutes of Health Stroke Scale [NIHSS] reduction within 24 hours), intracranial hemorrhage, all-cause mortality, and recurrent stroke. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated under a random-effects model. Risk of bias was assessed with the Cochrane RoB 2 tool.</p><p><strong>Results: </strong>Three RCTs involving 2295 patients were included (1209 treated with rhPro-UK; 1148 with alteplase). No statistically significant differences were observed between groups for intracranial hemorrhage (OR 1.04; 95% CI: 0.73-1.48), mRS 0-1 at 90 days (OR 0.91; 95% CI: 0.77-1.08), mRS 0-2 at 90 days (OR 0.95; 95% CI: 0.79-1.14), early NIHSS improvement (OR 0.94; 95% CI: 0.79-1.11), all-cause mortality (OR 1.16; 95% CI: 0.66-2.03), or recurrent stroke (OR 0.72; 95% CI: 0.31-1.66).</p><p><strong>Conclusions: </strong>Intravenous rhPro-UK demonstrated comparable efficacy and safety to alteplase in AIS, supporting its role as a potential alternative thrombolytic, particularly in regions with limited access to alteplase.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":"117 3","pages":"139-146"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking habits among adolescents in a northern Italian high school.","authors":"Matteo Della Zoppa, Amelia Grosso, Giulia M Stella, Angelo G Corsico, Davide Piloni","doi":"10.23736/S0026-4806.26.09866-6","DOIUrl":"10.23736/S0026-4806.26.09866-6","url":null,"abstract":"<p><strong>Background: </strong>Tobacco use remains a major global health issue, causing over seven million deaths annually. In Italy, nearly one-quarter of the population are current smokers, with increasing use of electronic and heated tobacco products, particularly among adolescents. The expanding availability of high-nicotine vaping devices highlights the need to better understand smoking behaviors in young people. This study aimed to assess the prevalence and determinants of smoking habits in a high school in northern Italy.</p><p><strong>Methods: </strong>An anonymized online survey was administered to all students of a high school in Pavia between March and October 2025, collecting information on demographics, smoking behaviors, product use, age and context of initiation, and parental smoking.</p><p><strong>Results: </strong>A total of 1179 valid questionnaires were analyzed. Overall, 41.2% of students had used at least one tobacco or nicotine product, with e-cigarette use exceeding traditional cigarette smoking. The mean age at first use was about 14 years. Most adolescents initiated smoking in social settings. Parental smoking was strongly associated with adolescent use of cigarettes (OR=1.69), e-cigarettes (OR=1.68), and cannabis (OR=1.43). Price increases and reduced peer smoking were the most frequently reported motivators for cessation.</p><p><strong>Conclusions: </strong>Adolescent nicotine use in this cohort was markedly higher than national and international estimates, with earlier initiation and narrowing gender differences compared with past data. Parental and peer influences remain key determinants. Early, school-based and family-oriented strategies are essential to reduce experimentation and promote long-term cessation.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"67-71"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual research designs and IRB requirements: clarifying what truly needs ethics approval.","authors":"Shreya Deoghare","doi":"10.23736/S0026-4806.26.09862-9","DOIUrl":"10.23736/S0026-4806.26.09862-9","url":null,"abstract":"","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"96-97"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shortwave diathermy in the management of chronic lymphedema following breast cancer surgery: proof-of-concept findings from a single-arm, pre-post, retrospective observational study.","authors":"Alessandro Picelli, Ermes Vedovi, Chiara Zanfisi, Federica Spiazzi, Roberto Aldegheri, Alberto Bilardo, Rita DI Censo, Vittorio Schweiger, Valentina Varalta, Nicola Smania, Mirko Filippetti","doi":"10.23736/S0026-4806.26.09850-2","DOIUrl":"10.23736/S0026-4806.26.09850-2","url":null,"abstract":"<p><strong>Background: </strong>Chronic lymphedema of the upper limb is a frequent and disabling consequence of breast cancer surgery. It is associated with swelling and reduced quality of life. While manual lymphatic drainage is a standard treatment, additional physical modalities have shown potential to enhance therapeutic outcomes. This study aimed to evaluate the effects of short-wave diathermy combined with manual lymphatic drainage on limb circumferential measurements and quality of life in women with chronic lymphedema following breast cancer surgery.</p><p><strong>Methods: </strong>This single-arm, pre-post, retrospective observational study included twenty female patients treated between January 2023 and January 2025. All participants received nine sessions of short-wave diathermy over four weeks, followed by manual lymphatic drainage, with concurrent compression therapy as per routine care. Limb circumference was measured at nine anatomical sites before and after treatment. Quality of life was assessed using the Italian version of the Lymphedema Quality of Life Questionnaire. Statistical analysis was performed using paired t-tests.</p><p><strong>Results: </strong>Significant reductions in limb circumference were observed at seven of the nine measurement sites (P<0.05), particularly in the mid and proximal forearm and upper arm. The mean baseline overall score on the Lymphedema Quality of Life Questionnaire was 7.8, indicating moderate to severe impact. No adverse events were reported during the treatment period.</p><p><strong>Conclusions: </strong>Short-wave diathermy combined with manual lymphatic drainage appears to be a safe and effective adjunctive treatment for chronic upper limb lymphedema in breast cancer survivors. These findings support its integration into multidisciplinary rehabilitation programs.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"61-66"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular lithotripsy-assisted carotid artery stenting for calcified carotid stenosis: a systematic review and meta-analysis.","authors":"Anderson Matheus P DA Silva, Ocílio R Gonçalves, João V Andrade Fernandes, Mariana L DE Bastos Maximiano, Luciano Falcão, Ariane B M Cunha, Lana N G B Saraiva, Gabrielle S Vieira, Lucca T Alves-Carretta, Ahmet Günkan, Gustavo S Noleto","doi":"10.23736/S0026-4806.26.09869-1","DOIUrl":"10.23736/S0026-4806.26.09869-1","url":null,"abstract":"<p><strong>Introduction: </strong>Severely calcified carotid artery stenosis (CCS) limits the effectiveness and safety of conventional carotid artery stenting (CAS); this systematic review and meta-analysis evaluated the efficacy and safety of intravascular lithotripsy-assisted CAS (IVL+CAS) in CCS.</p><p><strong>Evidence acquisition: </strong>PubMed, Embase, MEDLINE, Scopus, and ScienceDirect were systematically searched from inception to December 2024. Eligible studies included adult patients with CCS treated with IVL+CAS and reporting at least one predefined outcome. Primary endpoints were technical success, residual stenosis <30%, and stent restenosis. Secondary endpoints included stroke, transient ischemic attack (TIA), myocardial infarction (MI), and all-cause mortality. Single-proportion meta-analyses were performed using random-effects models. Heterogeneity was assessed with the I² statistic, and Baujat and leave-one-out sensitivity analyses were conducted when heterogeneity exceeded 35%.</p><p><strong>Evidence synthesis: </strong>Three observational studies comprising 96 patients were included. The pooled technical success rate was 99% (95% CI: 0.96-1.00; I²=0%). Residual stenosis <30% was achieved in 91% of cases (95% CI: 0.71-1.00; I²=77%). Stent restenosis occurred in 3% (95% CI: 0.00-0.07; I²=0%). The pooled incidence of TIA was 6% (95% CI: 0.01-0.11; I²=0%), and combined stroke/TIA was 4% (95% CI: 0.00-0.10; I²=45%). MI occurred in 2% (95% CI: 0.00-0.05; I²=0%), and all-cause mortality was 2% (95% CI: 0.00-0.05; I²=0%). Sensitivity analysis confirmed the robustness of the primary efficacy outcomes.</p><p><strong>Conclusions: </strong>IVL+CAS demonstrates high procedural success, low restenosis, and favorable short-term safety in patients with CCS, supporting its role as a viable endovascular option in complex calcified carotid disease.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"88-95"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of prokinetics in preventing pneumonia in post-stroke patients with nasogastric tubes: a systematic review and meta-analysis of randomized controlled trials.","authors":"Lucca T A Carretta, Pedro R Teixeira, Lucas C Faria, Nicole B DE Oliveira, Eduarda E DE Freitas, Raiza B Cipriano, Felipe F Pinto, Luiz F Dos Santos, Sandy Souza, Christian K Fukunaga, Lucas L Mendes, Rudolfh B Arend, Mariana L Maximiano, Daniel M Kieling, Carolina B Moura, Italla M Bezerra, Fernando R Oliveira","doi":"10.23736/S0026-4806.26.09880-0","DOIUrl":"10.23736/S0026-4806.26.09880-0","url":null,"abstract":"<p><strong>Introduction: </strong>Post-stroke patients with nasogastric tubes are at higher risk of aspiration pneumonia. In such cases, prokinetics have been linked with improved gastric emptying and reduced reflux, even though their effectiveness is controversial. This research aims to assess the application of prokinetics for the prevention of post-stroke pneumonia.</p><p><strong>Evidence acquisition: </strong>We searched the databases Cochrane, PubMed, Embase, Web of Science and Scopus for RCTs up to November 2024. The outcome of interest was incidence pneumonia, and we assessed bias using RoB 2 and ROBINS-1.</p><p><strong>Evidence synthesis: </strong>Overall, 326 articles were screened and 3 RCTs, comprising 600 patients, were included. There were 291 patients in the intervention group and 309 in the control group. Risk ratio for pneumonia was 0.80 (95% CI: 0.50-1.27, P>0.05), which showed no significant reduction. High heterogeneity was observed (I²=87%, P<0.001). Thirty- and 90-day mortality was not significantly different (RR=0.93, 95% CI: 0.75-1.17, P=0.349, I²=5%). Functional independence (mRS) was marginally better in some cases but not of clinical significance, with high heterogeneity (I²=82.2%). Neurological improvement (NIHSS) had variable results, with no overall benefit that reached statistical significance (pooled effect size = -0.05, 95% CI: -0.62-0.51, P=0.057, I²=72.4%). The variation observed limits the confidence in these findings.</p><p><strong>Conclusions: </strong>Prokinetics have no relationship with pneumonia in patients with nasogastric tubes according to the existing evidence. More trials are needed since there are no established guidelines.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"80-87"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of chronic kidney disease on efficacy and safety outcomes of endovascular thrombectomy in acute ischemic stroke patients: a systematic review and meta-analysis.","authors":"Anderson M DA Silva, Ocílio R Gonçalves, João V Andrade Fernandes, Luciano Falcão, Filipe V Ribeiro, Ariane B Cunha, Kenzo O Donato, Marcelo Costa, Saul Dominici, Beatriz Araújo, Ahmet Günkan, João P Telles","doi":"10.23736/S0026-4806.26.09870-8","DOIUrl":"10.23736/S0026-4806.26.09870-8","url":null,"abstract":"<p><strong>Introduction: </strong>The effect of chronic kidney disease (CKD) on outcomes of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) remains uncertain. We evaluated the impact of CKD on the efficacy and safety of EVT in patients with AIS.</p><p><strong>Evidence acquisition: </strong>PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 2024 for studies comparing EVT outcomes in AIS patients with and without CKD. Primary outcomes included functional independence at 3 months (modified Rankin Scale [mRS] 0-2), mRS shift at 3 months, in-hospital mortality, and 3-month mortality. Secondary outcomes included successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] 2b-3), National Institutes of Health Stroke Scale (NIHSS) score at 24 hours, time to recanalization, and intracranial hemorrhage. Risk of bias was assessed using the ROBINS-I tool. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models.</p><p><strong>Evidence synthesis: </strong>Seven studies including 27,572 patients were analyzed. Compared with non-CKD patients, those with CKD had a lower likelihood of achieving functional independence at 3 months (RR=0.70, 95% CI 0.60-0.82) and higher 3-month mortality (RR=2.12, 95% CI: 1.88-2.39). In-hospital mortality was also increased in the CKD group. No significant differences were observed in successful reperfusion, NIHSS score at 24 hours, time to recanalization, or intracranial hemorrhage.</p><p><strong>Conclusions: </strong>Chronic kidney disease is associated with poorer functional outcomes and increased mortality in AIS patients treated with EVT, despite similar procedural efficacy and safety.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"72-79"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study on the practical effect of quality control circle in reducing the non-standard rate of operating room cleaning standards.","authors":"Wenqing Kong, Lei Ma, Yongchao He, Huijun Sun, Xiaoyi Yuan","doi":"10.23736/S0026-4806.24.09381-9","DOIUrl":"10.23736/S0026-4806.24.09381-9","url":null,"abstract":"","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"97-99"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146109286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}