Intraoperative imaging system, alternative to the use of radioactive tracers, for the identification of the sentinel lymph node in neoplastic pathologies. It can also be used to verify the vascularity of the flaps after mastectomy to reduce post-surgical complications.

**Units:** Breast Surgery

**Area:** Oncology

**Priority:** Urgent
**Quantity:** 1

Nr. 1 ICG Imaging System

We are a research hospital that treats patients in all medical disciplines, focusing on oncology, neurology, and diagnosis.

The Fondazione Casa Sollievo della Sofferenza – Opera di San Pio da Pietrelcina (transl. Home for the Relief of Suffering Foundation – Work of Saint Pio of Pietrelcina) is a not-for-profit research hospital located in the city of San Giovanni Rotondo (FG), in the Puglia Region, Southern Italy.
As per Canon 1303 §1 of the Code of Canon Law, it has public, canonical and civil legal personality; it is therefore subject to the supervision of the Holy See and, on its behalf, of the pro-tempore Cardinal Secretary of State. 
Many of the stages that have thus far marked the history of the Work of San Pio of Pietrelcina have been achieved thanks to the loving generosity of many benefactors who, sharing the mission indicated by San Pio da Pietrelcina, the relief of suffering, wanted to donate to his work.

HISTORY
The hospital was founded and inaugurated by Saint Pio of Pietrelcina on May 5, 1956 with a capacity of 250 beds. It took on the status of Provincial Hospital on 4 August 1971 and then of Regional General Hospital on 2 June 1980, thus becoming part of the Italian National Healthcare System. Since 16 July 1991, with a Decree of the Minister of Health and the Minister of University and Scientific Research, it has been a Research Hospital. Originally, the object of its scientific activity was limited to genetic and hereditary-familial diseases; subsequently, the Minister of Health, by the 5 December 2012 Decree, extended the research areas of its competence to "Genetic diseases, innovative therapies and regenerative medicine". Recently, on the occasion of the presentation of the research lines for the three-year programme of the Italian Research Hospitals 2022-2024, Casa Sollievo identified “Diagnostic acitivity, Neurology and Oncology” as its main research thematic areas, thus becoming a polythematic Research Hospital.

MISSION
The Foundation's mission is to provide health care and carry out research activities. In addition, the Foundation offers training activities for its personnel.
Around 2,750 people work at the Foundation.
The Foundation (hereinafter “CSS”) consists of three structures based in San Giovanni Rotondo: the hospital Casa Sollievo, the polyclinic Giovanni Paolo II, where outpatient activities are carried out, and the ISBReMIT research center for regenerative medicine (Institute for Stem-cell Biology, Regenerative Medicine and Innovative Therapies); and the Mendel Institute in Rome, where research and diagnostic activities are carried out. In San Giovanni Rotondo, it also owns and runs a retirement home for the elderly.
In addition, CSS owns 3 hospitality facilities where affordable accommodation is offered to hospitalized patients’ relatives who have to assist them; and another facility (Casa Zeni) where accommodation is offered free of charge to the parents of the little patients hospitalized in the oncology-hematology unit.
Moreover, the Foundation includes the Padre Pio Prayer Groups Centre, which was also founded by San Pio and coordinates the Padre Pio prayers groups throughout the world, according to the Founder’s wish that Prayers Groups live and testify the importance of prayer and pray for CSS.
Lastly, CSS publishes a monthly periodical and posts on the Foundation’s official channels on the web updates on its research and clinical activity and its spiritual activity and the teachings of the Founder.
The hospital offers assistance also to people from underdeveloped countries. 
Moreover, a free-of-charge shuttle service has been provided for many years to radiotherapy patients coming from Bari and surrounding cities (Southern Puglia).

THE CLINICAL ACTIVITY
CSS has around 756 beds, 38 medical and surgical inpatient units, 26 operating rooms, in addition to services, diagnostic and multi-specialist outpatient units.
In 2022, the hospital recorded over 30,000 hospitalizations and 870,000 outpatient performances. 
Regarding the advanced technological equipment, CSS has 1 "Da Vinci" surgical robot, 1 PET/CT device, 3 linear accelerators, 4 CT devices, 1 CT simulator for radiotherapy, 4 NMR equipment, 3 digital angiographs, 2 gamma cameras and a RIS/PACS system for the filmless management of the radiology department.
Furthermore, CSS hosts an Umbilical Cord Bank and a Human Milk Bank.
Recent Achievements
In addition to the many important activities carried out in CSS, 3 new units have been opened: 1. a new Emergency Room hosting an Observation and Assessment Ward; 2. an Hematopoietic Stem Cell Transplant Center. 3. an Sub-Intensive Geriatric Unit. 
CSS has also established a Stroke Unit, a Lung Unit, a Breast Unit, a Head and Neck Unit, and a Molecular Tumor Board to guarantee appropriate, quality and homogeneous procedures.
Future goals
Important technological investments have been planned for the years 2023-2025 in the following areas: oncology/nuclear medicine, diagnostic imaging, ICU, and surgery. 

THE RESEARCH ACTIVITY
The research activity is conducted in the Polyclinic, the ISBReMIT research center and at the Mendel Institute, for a total of 17 research groups.
Recent achievements
The consolidated experience of the staff working in CSS in the study of genetic diseases since 1991 and the continuous updating of technologies, instrumentation and genomics and post-genomics skills have made it possible to direct the research and clinical-assistance activity towards two complementary research lines: "personalized medicine - system biomedicine" and "regenerative medicine" based on the study of tumor stem cells and the use of normal stem cells.
The scientific fields in which the Institute is mostly involved in "personalized medicine" concern the identification of the genetic causes of rare diseases and the identification of diagnostic, prognostic and predictive markers in complex pathologies, including tumor pathologies. Regarding the identification of the genetic causes of rare diseases, we use the new next generation sequencing (NGS) technologies and the skills acquired by the bioinformatics unit, one of the first established at national level. In parallel, the Institute boasts a large collection of induced pluripotent stem cells (iPSCs), produced from patient fibroblasts, in which pathogenetic variants have been identified, and use the skills acquired in differentiating them into mature cells, in particular astrocytes, neurons and oligodendrocytes.
Regarding regenerative medicine, two important studies were conducted and concluded: a phase I trial on anti-Multiple Sclerosis therapy based on the use of human neural stem cells, approved by the Ministry of Health and the Italian Medicines Authority AIFA (EudraCT code 2015-004855-37); and a phase I/II trial on anti-glioma therapy with biological drugs (EudraCT code: 2016-001761-92). The results of these studies will published in prestigious international journals.
In 2015, the new ISBReMIT Regenerative Medicine Research Center was started. It is a cutting-edge structure in terms of conception and equipment in the field of translational medicine for genetic, degenerative and oncological diseases. The structure hosts, together with the highly technologically equipped laboratories, a cell factory and a laboratory for the production of biopharmaceuticals under Good Manufacturing Practice, i.e. for clinical use, including somatic stem cells and iPS, vectors for gene therapy and biomaterials.
It should be noted that CSS has recently become part of three Networks of the Italian Research Centers: since 2016 it has been an Ordinary Associate of Alleanza Contro il Cancro; since December 2018, of the National Research Network on Aging; and, finally, since March 2020 of the Neuroscience Network. Starting from 2022, CSS has been part of the European reference networks for rare and uncommon diseases (European Reference Networks - ERN), in particular ERN-SKIN on diseases of dermatological interest, and ERN ReCONNET on musculoskeletal diseases and pathologies of the connective tissue.
Researchers publish about 200 scientific articles in the most renowned journals (Science, New England Journal of Medicine, Nature Genetics) every year. They are engaged both as Principal Investigators and as partners in research projects in the biomedical field and ICT, obtaining funds from the EU (H2020 and FP7) and national or regional calls.
CSS is also a partner in Research and Innovation projects funded by private and public bodies, e.g. from the EU both under Horizon 2020 and Horizon Europe, in the field of digital transformation of healthcare. The main areas of involvement concern Assistive Robotics, Artificial Intelligence, Big Data generated by consumer devices, eHealth, Digital Therapies, the Internet of Things and Cybersecurity.
Future goals
Starting from the identification of the genetic causes of diseases, the goal is to develop advanced therapies to bring to the patient's bedside and tailored to him/her.
Furthermore, at the end of 2023, the phase II study "Neural Stem Cell Treatment for Amyotrophic Lateral Sclerosis: A multicenter, randomized placebo controlled and biological endpoints clinical Trial" (EudraCt 2018-002373-22) will be launched. This involves the use of neural stem cells on patients suffering from Amyotrophic Lateral Sclerosis.

CONCLUSION
Casa Sollievo della Sofferenza was born of the visionary mind of a poor friar, one of the most important, recent and internationally recognized and prayed Saints, Saint Pio of Pietrelcina, right after the II World War, in a poor corner of the Southern Italy of those times. 
CSS, by its Statutes, is a not-for-profit organization. All the good work that has been done until now for the sick has been possible thanks to the generosity of donors and to the public and private funds that have been collected through the hard work of the Foundation’s researchers and clinicians, thus contributing importantly to the care of citizens from Southern Italy and underdeveloped countries and to the world research.

Fondazione di Religione e di Culto Casa Sollievo della Sofferenza - Opera di San Pio da Pietrelcina

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Fondazione di Religione e di Culto Casa Sollievo della Sofferenza - Opera di San Pio da Pietrelcina