Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

HIV breakthrough infection after 6 years of daily TDF/FTC oral PrEP with objectively documented optimal adherence

Oral Pre-Exposure Prophylaxis (PrEP) is highly effective for HIV prevention when adherence is optimal, with rare HIV breakthrough infections usually happening within 1–2 years since PrEP start. After 6 years of daily PrEP, routine HIV testing identified seroconversion in a 46-yea...

Radiographic accuracy of implant positioning in unicompartmental knee arthroplasty, does an imageless robotic system make a difference?

Abstract Background Robotic-assisted technologies and evolving implant designs have been introduced in unicompartmental knee arthroplasty (UKA) to improve the accuracy and reproducibility of component positioning. However, the relative contribution of robotic assistance compared...

A Scoping Review of Neurobiological and Brain Structural Alterations Following Child Exposure to Intimate Partner Violence

Intimate partner violence (IPV) is one global issue that can lead to neurobiological consequences and affect brain development across the lifetime. However, evidence is scattered across domains and age groups, making it difficult to map the breadth of empirical findings regarding...

Effect Modification of Rescue Stenting in ICAS-Related Middle Cerebral Artery Occlusion: The Role of Thrombectomy Failure, Stenosis Severity, and ASPECTS

Rescue stenting (RS) is increasingly used for intracranial artery stenosis-related large vessel occlusion (ICAS-LVO), but optimal patient selection remains uncertain. We investigated the baseline and procedural factors associated with receiving RS and whether they modified the as...

Defibrillation in refractory cardiac arrest: knowledge gaps and future priorities

PURPOSE OF REVIEW: Refractory shockable cardiac arrest remains associated with poor outcomes despite prompt cardiopulmonary resuscitation and repeated defibrillation. This review summarizes recent evidence on ventricular fibrillation (VF) phenotyping, vector-change (VC) defibrill...

Disappearing Colorectal Liver Metastases: Should the Treatment Sequence Be Reconsidered for Selected Lesions?

Disappearing liver metastases (DLMs) remain a challenging problem in the management of colorectal liver metastases (CRLMs). Although modern systemic therapy may produce complete radiological responses, radiological disappearance does not reliably indicate complete pathological re...

Circulating tumor DNA-guided de-escalation or escalation of adjuvant therapy in high-risk stage II and stage III colon cancer: the phase 2 PEGASUS trial

Oxaliplatin–fluoropyrimidine combinations are standard adjuvant therapy after radical resection of high-risk stage II and stage III colon cancer but expose many patients to toxicity while failing to prevent relapse in others. PEGASUS was a multicenter, single-arm, phase 2 trial e...

Micronutrients in adult critically ill patients: lessons learned and the path toward precision

Purpose of review Despite strong biological plausibility, empiric high-dose micronutrient supplementation has failed to improve outcomes in critically ill patients. This review synthesizes evidence from the past 18 months and outlines the necessary transition toward biomarker-gui...

Real-World Antibiotic Strategies for Multidrug-Resistant Pseudomonas aeruginosa: Evidence from the Italian SUSANA Multicentre Study

Background/Objectives: Multidrug-resistant (MDR) Pseudomonas aeruginosa pneumonia and bloodstream infections (BSI) remain challenging because of their severity, limited therapeutic options, and high mortality, despite the availability of novel β-lactam-based agents. We aimed to d...

Decoding the causes of ischemic stroke despite ongoing oral anticoagulation and their clinical impact: the ASPERA-R study

BACKGROUND: Oral anticoagulants (OACs), including vitamin K antagonists and direct OACs, reduce stroke risk in atrial fibrillation (AF), yet breakthrough ischemic stroke still occurs in 1-2% of patients annually despite adequate therapy. The mechanisms underlying these events rem...

Liver Transplantation Following Hepatocellular Carcinoma Rupture and Long-Term Immunotherapy: A Case Report

Abstract Aim To report a case of advanced hepatocellular carcinoma (HCC) complicated by tumor rupture, successfully downstaged with combined oncolytic immunotherapy (Pexa-Vec) and a PD-1 inhibitor (Nivolumab), ultimately enabling liver transplantation (LT). This report highlights...

Use of the Il-1 Inhibitor (Anakinra) for the Treatment of Acute Myocarditis in Pediatric Patients: A Single-Center Experience

Objectives Myocarditis is an acute inflammatory process of the myocardium characterized by impaired contractile function. The incidence is 1-2 cases/100,000 children, but it has increased since 2020 due to Pediatric Multisystem Inflammatory Syndrome (MIS-C). The pathogenesis invo...