Background: To provide a comprehensive analysis of the current literature comparing the outcomes of surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS), with particular attention to BAV morphology in patients undergoing TAVR. Methods: Following PRISMA guidelines, all relevant articles with no design restrictions from PubMed, CCTR (Cochrane Controlled Trials Register), and Google Scholar were screened for inclusion. Studies were included if they reported clinical endpoints for SAVR and TAVR or, in BAS treated with TAVR, for type 1 and non-type 1 morphology. Odds ratio and Cohen’s D were considered as effect size measurements for qualitative and quantitative variables, respectively. Results: A total of eight studies comparing short-term outcomes between SAVR and TAVR and nine studies with outcomes data between type 1 and non-type 1 BAS treated with TAVR were considered for the final analysis. No statistically significant difference was found for what concerns the rates of death, stroke, and acute kidney injury between SAVR and TAVR. In comparison to patients undergoing SAVR, the incidence of PPI (permanent pacemaker implantation) was greater in the TAVR group (OR 0.35, 95% CI 0.15–0.79, p = 0.01), and the frequency of bleeding events was found to be higher among patients undergoing SAVR (OR 4.3, 95% CI 2.9–6.4, p < 0.001). The probabilities of 30-day mortality, stroke, and any bleeding were not significantly affected by bicuspid valve morphology in TAVR patients. PPI or development of new conduction anomalies was found to be more frequent in type 1 anatomies (OR 0.46, 95% CI 0.30–0.70, p <0.001). Mildly lower post-procedural transprothesic gradients were found in patients with type 1 morphology. Conclusions: In BAS patients, TAVR has comparable short-term outcomes rates with SAVR, but higher PPI rates and lower incidence of bleeding events. In patients undergoing TAVR, type 1 BAS is associated with lower postoperative transvalvular gradients but higher PPI rates and conduction abnormalities

Given the various clinical manifestations that characterize Coronavirus Disease 2019 (COVID-19), the scientific community is constantly searching for biomarkers with prognostic value. Surfactant proteins A (SP-A) and D (SP-D) are collectins that play a crucial role in ensuring proper alveolar function and an alteration of their serum levels was reported in several pulmonary diseases characterized by Acute Respiratory Distress Syndrome (ARDS) and pulmonary fibrosis. Considering that such clinical manifestations can also occur during Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, we wondered if these collectins could act as prognostic markers. In this regard, serum levels of SP-A and SP-D were measured by enzyme immunoassay in patients with SARS-CoV-2 infection (n = 51) at admission (T0) and after seven days (T1) and compared with healthy donors (n = 11). SP-D increased in COVID-19 patients compared to healthy controls during the early phases of infection, while a significant reduction was observed at T1. Stratifying SARS-CoV-2 patients according to disease severity, increased serum SP-D levels were observed in severe compared to mild patients. In light of these results, SP-D, but not SP-A, seems to be an eligible marker of COVID-19 pneumonia, and the early detection of SP-D serum levels could be crucial for preventive clinical management.

Chimeric antigen receptor T (CAR‐T) cell therapies have revolutionized the treatment of hematological malignancies, achieving high response rates in patients with relapsed or refractory disease. Despite these benefits, CAR‐T cell therapies are associated with unique toxicities, including cytokine release syndrome (CRS), immune effector cell‐associated neurotoxicity syndrome (ICANS), immune cell‐associated hematotoxicity (ICAHT), and immune effector cell‐associated hemophagocytic lymphohistiocytosis‐like syndrome (IEC‐HS), which is characterized by a rare and life‐threatening hyperinflammatory response. This paper presents a case of a 56‐year‐old woman with relapsed mantle cell lymphoma (MCL) treated with the CAR‐T cell therapy, brexucabtagene autoleucel, who had subsequently developed CRS and later IEC‐HS. Initial management included tocilizumab, corticosteroids, and anakinra, followed by the compassionate use of emapalumab, an interferon‐γ blocker. To provide broader context, we conducted a literature review of CAR‐T cell‐related toxicities, focusing on IEC‐HS and its management with emapalumab. Clinical and laboratory manifestations, such as elevated ferritin levels, cytopenias, and organ dysfunction, underpin the diagnostic criteria for IEC‐HS. Vigilant monitoring and tailored therapeutic approaches are required to effectively manage toxicities associated with CAR‐T cell therapy, to maximize its benefits and minimize adverse effects. In more severe IEC‐HS cases, emapalumab may be used as an effective targeted therapy.

Background: The role of Heart Rate Variability (HRV) indices in predicting the outcome of the weaning process remains a subject of debate. The aim of this study is to investigate HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation (IMV). Methods: The protocol of this systematic review was registered with PROSPERO (CRD42024485800). We searched PubMed and Scopus databases from inception till March 2023 to identify randomized controlled trials and observational studies investigating HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation. Our primary outcome was to investigate HRV changes occurring during the weaning from IMV. Results: Seven studies (n = 342 patients) were included in this review. All studies reported significant changes in at least one HRV parameter. The indices Low Frequency (LF), High Frequency (HF), and LF/HF ratio seem to be the most promising in predicting the outcome of weaning with reliability. Some HRV indices showed modification in response to different ventilator settings or modalities. Conclusions: Available data report HRV modifications during the process of weaning and suggest a promising role of some HRV indices in predicting weaning outcomes in critically ill patients. Point-of-care HRV monitoring systems might help to early detect patients at risk of weaning failure.

Background: given the various clinical manifestations that characterize coronavirus disease 2019 (COVID-19), the scientific community is constantly searching for biomarkers with prognostic value. Surfactant protein A (SP-A) and D (SP-D) play a crucial role in ensuring proper alveolar function and an alteration of their serum levels have been reported in several pulmonary diseases characterized by acute respiratory distress syndrome (ARDS) and pulmonary fibrosis. Consid-ering that such clinical manifestations can also occur during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we wondered if these collectins could act as prognostic markers. Methods: in this regard, serum levels of SP-A and SP-D were measured by enzyme immunoassay in patients with SARS-CoV-2 infection (n=51) at admission (T0) and after 7 days (T1) and compared with healthy donors (n=11). Results: SP-D increased in COVID-19 patients com-pared to healthy controls during the early phases of infection, while a significant reduction was observed at T1. Stratifying SARS-CoV-2 patients according to disease severity, increased serum SP-D levels were observed in severe compared to mild patients. Conclusions: In the light of these results SP-D, but not SP-A, seems to be an eligible marker of COVID-19 pneumonia and the early detection of SP-D serum levels could be crucial for a preventive clinical management.

Background: Liver enzyme abnormalities are common in critically ill patients, but the prognostic relevance of graded aminotransferase elevation and its timing remains uncertain. We evaluated whether Liver Enzyme Elevation (LEE) grade at ICU admission provides prognostic information beyond SAPS II in a heterogeneous ICU cohort. Methods: In this single-centre retrospective study, adult patients admitted to a mixed ICU between January 2023 and December 2024 and with ICU length of stay ≥72 h were analysed. LEE grade was assigned from AST and ALT according to predefined multiples of the local upper limit of normal, using the higher grade reached by either enzyme. The primary outcome was ICU mortality. Secondary outcomes included renal replacement therapy, ICU length of stay, and duration of invasive mechanical ventilation. A fixed logistic model including SAPS II and admission LEE grade was internally validated by bootstrap resampling. Results: Among 274 patients, ICU mortality was 27.7%. Admission LEE grade showed an adjusted association with ICU mortality (OR 1.26 per grade increase, 95% CI 1.00–1.58; p = 0.048), while SAPS II remained the dominant predictor (OR 1.04 per point, 95% CI 1.02–1.06; p < 0.001). Adding admission LEE grade to SAPS II yielded a small absolute increase in discrimination (AUC 0.737 vs. 0.703; DeLong p = 0.039). Bootstrap-corrected AUC was 0.730, with acceptable overall calibration. Admission LEE grade was also associated with RRT and longer ICU stay in exploratory secondary analyses. Conclusions: Admission LEE grade may provide modest complementary prognostic information beyond SAPS II. These findings are exploratory and require external validation before clinical implementation.