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Background: Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. Aim: We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the “Delirium Day project”. Methods: We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the “Delirium Day project” (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. Results: Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17–1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08–2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62–2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10–1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02–1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68–3.36, p value < 0.0001). Conclusion: This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

Nonostante una generale consapevolezza delle potenzialità dei big data per finalità di interesse pubblico, diversi ostacoli ne impediscono l'effettiva condivisione. Questo studio, legando il discorso sui dati ai concetti di data-value e accountability, si propone di emancipare il dibattito scientifico dalla tradizionale enfasi sulla trasparenza amministrativa e sulla tutela della privacy, tracciando nuove prospettive per la ricerca futura. Il paper esamina i principali articoli scientifici pubblicati da Riviste che si sono occupate del valore dei dati e dei connessi profili di accountability nella dimensione sia pubblica che privata. L'analisi bibliometrica condotta indica una propensione della letteratura a considerare il tema della creazione di valore data-driven o solo nella dimensione privata (dati come input per migliorare le performance aziendali o le relazioni con i clienti) o solo nella dimensione pubblica (modelli di open data government). Ne deriva che la ricerca sui dati comportamentali per la governance pubblica è stata finora sottovalutata. Le evidenze dimostrano come la creazione di valore dai big data sia strettamente associata ad un processo collettivo in cui si sviluppano multipli livelli di interazione e condivisione dei dati tra attori pubblici e privati ​​in un multilayered accountability environment.

Recent years have witnessed relevant advancements in the quality of life of persons with lower limb amputations thanks to the technological developments in prosthetics. However, prostheses that provide information about the foot–ground interaction, and in particular about terrain irregularities, are still missing on the market. The lack of tactile feedback from the foot sole might lead subjects to step on uneven terrains, causing an increase in the risk of falling. To address this issue, a biomimetic vibrotactile feedback system that conveys information about gait and terrain features sensed by a dedicated insole has been assessed with intact subjects. After having shortly experienced both even and uneven terrains, the recruited subjects discriminated them with an accuracy of 87.5%, solely relying on the replay of the vibrotactile feedback. With the objective of exploring the human decoding mechanism of the feedback startegy, a KNN classifier was trained to recognize the uneven terrains. The outcome suggested that the subjects achieved such performance with a temporal dynamics of 45 ms. This work is a leap forward to assist lower-limb amputees to appreciate the floor conditions while walking, adapt their gait and promote a more confident use of their artificial limb.

The use of traditional Dye-sensitized solar cells (DSSCs) is limited due to the use of toxic and non-environmentally safe solvents. In this review, water is proposed as a viable alternative to developing green chemistry and sustainable materials for DSSCs. However, water-based DSSCs (WBDSSCs) require improvement in their photovoltaic parameters. The detachment of dye molecules from the semiconductor and the poor solubility of iodine in water are the primary reasons for their low efficiency. This review analyzes the best results achieved by 100% aqueous electrolytes containing synthetic, organic, and natural dyes to identify the best conditions to overcome these limitations. Developing a suitable photoanode/electrolyte interface and finding a compromise in the choice of dye are the main research goals in the coming years. WBDSSCs can contribute significantly to producing clean energy using sustainable and environmentally friendly materials. Furthermore, here we report the state of the art of the emerging technology of underwater dye-sensitized solar cells, which are a promising technology for generating renewable energy in aquatic environments. Recent advancements in material science and device engineering have shown promising results in enhancing their efficiency and durability. Further research and development can make these devices a viable alternative for sustainable energy generation in a wide range of underwater applications.

Context Prevalence of obesity in childhood has increased over the past few decades. The impact of obesity and of obesity-related metabolic disorders on testicular growth is unknown. Objective To evaluate the impact of obesity, hyperinsulinemia, and insulin resistance on testicular volume (TV) in pre-pubertal ( Methods We collected data on TV, age, standard deviation score (SDS) of the body mass index (BMI), insulin, and fasting glycemia in 268 children and adolescents followed-up for weight control. Results Peri-pubertal boys with normal weight had a significantly higher TV compared to those with overweight or obesity. No difference was found in the other age ranges when data were grouped according to BMI. Pre- and post-pubertal children/adolescents with normal insulin levels had significantly higher TV compared to those with hyperinsulinemia. Peri-pubertal boys with hyperinsulinemia had significantly higher TV compared to those with normal insulin levels. Post-pubertal adolescents with insulin resistance had lower TV and peri-pubertal boys had higher TV compared to those without insulin resistance. No difference was found in pre-puberty. Conclusions Closer control of the body weight and the associated metabolic alterations in childhood and adolescence may maintain testicular function later in life.

Despite the fact that gastric syphilis is considered rare, it is reported as a type of organic involvement that is present in a large proportion of secondary syphilis cases, even though gastritis presenting with symptoms is extremely rare. Clinical, radiological, and endoscopic findings are non-specific and frequently mimic the symptoms of gastric adenocarcinoma or lymphoma, making diagnosis difficult. Immunostaining is required for this diagnosis. We would like to emphasize the importance of being suspicious of GS when a gastric mass exhibits the histologic features of an inflammatory pseudotumor (IPT), as previously reported for nodal IPT caused by luetic infection. We described a 56-year-old man who presented to the oncology department with a 3-month history of anorexia, epigastric pain, nausea, vomiting, and weight loss, as well as an initial radiological and endoscopic suspicion of gastric adenocarcinoma, in which immune staining allowed us to diagnose GS. In addition, we conducted an updated scoping review of the scientific literature to show the clinical, laboratory, and therapeutic findings in GS patients over the last 65 years.

Objectives: To evaluate the diagnostic role of combined electrocochleography and pure-tone audiometry monitoring during dehydrating test in Ménière's disease and consider its suitability as a diagnostic tool to differentiate those patients with unclear differential diagnosis and therefore identify those with clear endolymphatic hydrops responsive to dehydrating test. To study the efficacy of dehydrating therapy on vertiginous symptoms and hearing loss in patients with Ménière's disease. Study design: Prospective case series. Settings: University hospital, secondary referral center. Patients: Thirty patients, 20 women and 10 men, age range of 25 to 75 years, matching the criteria for definite Ménière's disease according to the Barany Society classification. Intervention: Diagnostic. During an active phase of the disease, electrocochleography and pure-tone audiometry were performed, and repeated at 30th, 45th, and 60th minutes after intramuscular injection of 40 mg furosemide and 40 mg methylprednisolone. Main outcome measure: Data related to symptoms, electrocochleography, and pure-tone audiometry during the dehydrating test were collected at different times and statistically analyzed. Results: After the administration of dehydrating therapy, we observed that both summating potential and action potential ratio and summating potential and action potential area ratio were normalized in 21 of 30 subjects. Furthermore, pure-tone audiometry thresholds improved significantly. An improvement of ear fullness was also observed, whereas tinnitus unchangeably persisted. Conclusions: The monitoring of the electrocochleography and pure-tone audiometry thresholds during dehydrating tests with furosemide and methylprednisolone could allow to detect an improvement of instrumental features and clinical symptoms related to endolymphatic hydrops, and therefore, it could be used as a diagnostic tool in the identification of those patients affected by Ménière's disease with unclear differential diagnosis.

Immunosenescence and inflammaging facilitate the insurgence of chronic diseases. The Mediterranean diet is a non-invasive intervention to improve the chronic low-grade inflammatory status associated with aging. Olive oil oleuropein (OLE) and hydroxytyrosol (HT) demonstrated a controversial modulatory action on inflammation in vitro when tested at concentrations exceeding those detectable in human plasma. We studied the potential anti-inflammatory effects of OLE and HT at nutritionally relevant concentrations on peripheral blood mononuclear cells (PBMCs) as regards cell viability, frequency of leukocyte subsets, and cytokine release, performing an age-focused analysis on two groups of subjects: Adult (age 18–64 years) and Senior (age ≥ 65 years). OLE and HT were used alone or as a pre-treatment before challenging PBMCs with lipopolysaccharide (LPS). Both polyphenols had no effect on cell viability irrespective of LPS, but 5 µM HT had an LPS-like effect on monocytes, reducing the intermediate subset in Adult subjects. OLE and HT had no effect on LPS-triggered release of TNF-α, IL-6 and IL-8, but 5 µM HT reduced IL-10 secretion by PBMCs from Adult vs. Senior group. In summary, nutritionally relevant concentrations of OLE and HT elicit no anti-inflammatory effect and influence the frequency of immune cell subsets with age-related different outcomes.

The immunophenotype of oldest centenarians, i.e., semi- and supercentenarians, could provide important information about their ability to adapt to factors associated with immune changes, including ageing per se and chronic Cytomegalovirus infection. We investigated, by flow cytometry, variations in percentages and absolute numbers of immune cell subsets, focusing on T cells, and pro-inflammatory parameters in a cohort of 28 women and 26 men (age range 19-110 years). We observed variability in hallmarks of immunosenescence related to age and Cytomegalovirus serological status. The eight oldest centenarians showed the lowest percentages of naïve T cells, due to their age, and the highest percentages of T effector memory cells re-expressing CD45RA (TEMRA), according to their Cytomegalovirus status, and high levels of serum pro-inflammatory parameters, although their means were lower than that of remaining 90+ donors. Some of them showed CD8 naïve and TEMRA percentages, exhaustion/pro-inflammatory markers comparable to the younger ones. Our study supports the suggestion that immune ageing, especially of oldest centenarians, exhibits great variability that is not attributable to a single contributor, but should be the full result of a combination of several factors. Everyone ages differently because he/she is unique in genetics and experience of life and this applies even more to the immune system; everybody has had a different immunological history. Furthermore, our findings on inflammatory markers, TEMRA and CMV seropositivity in centenarians, discussed in the light of the most recent literature, suggest that these changes might be not unfavourable for centenarians, and in particular for the oldest ones.

Mycosis fungoides is the most common primary cutaneous T-cell lymphoma, characterized by skin-homing CD4+ T cells derivation, indolent course, and low-grade of malignancy. Mycosis fungoides’s classic type typically onsets with cutaneous erythematous patches, plaque, and tumor. In WHO-EORTC classification, folliculotropic mycosis fungoides, pagetoid reticulosis, and granulomatous slack skin are recognized as distinct variants of mycosis fungoides, because of their clinical and histological features, behavior, and /or prognosis. Mycosis fungoides often shows diagnostic difficulties, due to its absence of specific features and lesional polymorphism. A patient’s treatment requires staging. In about 10% of cases, mycosis fungoides can progress to lymph nodes and internal organs. Prognosis is poor at advanced stage and management needs a multidisciplinary team approach. Advanced stage disease including tumors, erythroderma, and nodal, visceral, or blood involvement needs skin directed therapy associated with systemic drugs. Skin directed therapy includes steroids, nitrogen mustard, bexarotene gel, phototherapy UVB, and photochemiotherapy, i.e., total skin electron radiotherapy. Systemic therapies include retinoids, bexarotene, interferon, histone deacetylase inhibitors, photopheresis, targeted immunotherapy, and cytotoxic chemotherapy. Complexity of mycosis fungoides associated with long-term chronic evolution and multiple therapy based on disease stage need a multidisciplinary team approach to be treated.

Background and Aims Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) improves survival in patients with cirrhosis with refractory ascites and portal hypertensive bleeding. However, the indication for TIPS in older adult patients (greater than or equal to 70 years) is debated, and a specific prediction model developed in this particular setting is lacking. The aim of this study was to develop and validate a multivariable model for an accurate prediction of mortality in older adults. Approach and Results We prospectively enrolled 411 consecutive patients observed at four referral centers with de novo TIPS implantation for refractory ascites or secondary prophylaxis of variceal bleeding (derivation cohort) and an external cohort of 415 patients with similar indications for TIPS (validation cohort). Older adult patients in the two cohorts were 99 and 76, respectively. A cause-specific Cox competing risks model was used to predict liver-related mortality, with orthotopic liver transplant and death for extrahepatic causes as competing events. Age, alcoholic etiology, creatinine levels, and international normalized ratio in the overall cohort, and creatinine and sodium levels in older adults were independent risk factors for liver-related death by multivariable analysis. Conclusions After TIPS implantation, mortality is increased by aging, but TIPS placement should not be precluded in patients older than 70 years. In older adults, creatinine and sodium levels are useful predictors for decision making. Further efforts to update the prediction model with larger sample size are warranted.

A regioselective vinylation of aromatic and aliphatic aldehydes promoted by the merging of photoredox and nickel catalysis is here reported. A comprehensive investigation on the reaction conditions allowed the disclosure of a valid and reproducible protocol based on a nickel-mediated reductive coupling approach under visible light irradiation. The employment of 3CzClIPN (2,4,6-tris(carbazol-9-yl)-5-chloro-isophthalonitrile) as the photocatalyst and Hantzsch's ester as the sacrificial organic reductant replace the use of boron-, silicon- or zinc-based reducing agents, making this method a worthy alternative to the already known protocols. The developed mild reaction conditions allow the access to a wide range of substituents decorating both the aldehyde and the alkyne. Moreover, careful photophysical investigations shed light on the mechanism of the reaction.

A relevant gradual reduction of both the incidence rate of acute hepatitis B (AHB) and prevalence of chronic hepatitis B has occurred in Italy in the last 50 years, due to substantial epidemiological changes: Improvement in socioeconomic and hygienic conditions, reduction of the family unit, accurate screening of blood donations, abolition of re-usable glass syringes, hepatitis B virus (HBV)-universal vaccination started in 1991, use of effective well tolerated nucleo(t)side analogues able to suppress HBV replication available from 1998, and educational mediatic campaigns against human immunodeficiency virus infection focusing on the prevention of sexual and parenteral transmission of infections. As an example, AHB incidence has gradually decreased from 10/100000 inhabitants in 1985 to 0.21 in 2020. Unfortunately, the coronavirus disease 2019 (COVID-19) pandemic has interrupted the trend towards HBV eradication. In fact, several HBV chronic carriers living in the countryside have become unable to access healthcare facilities for screening, diagnosis, clinical management, and nucleo(t)side analogue therapy in the COVID-19 pandemic, mainly for anxiety of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), movement restrictions, and reduced gains from job loss. In addition, one-third of healthcare facilities and personnel for HBV patients have been devolved to the COVID-19 assistance. (C) The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

We consider a double phase (unbalanced growth) Dirichlet problem with a Carathéodory reaction f ( z , x ) which is superlinear in x but without satisfying the AR-condition. Using the symmetric mountain pass theorem, we produce a whole sequence of distinct bounded solutions which diverge to infinity.

Since anthropo-zoonotic outbreaks of SARS-CoV-2 have been reported in mink farms, it is important to monitor the seroprevalence within this population. To investigate the accuracy of nucleo (N) or spike (S) protein-based assays to detect anti-SARS-CoV-2 antibodies in animal serum, we compared four assays, two commercial N-based enzyme-linked immunosorbent assays (ELISA) validated for animal sera and two luciferase immunoprecipitation systems (LIPS-N and LIPS-S), to the reference standard plaque reduction neutralisation test (PRNT). Samples included in this study were derived from a naturally infected mink population. For the first time in this study, serum samples of mink were collected over a 307-day period, at different time points, thus providing an overview of performances of four different rapid serological tests over time. The assays were compared by performing a correlation analysis using R2, Spearman’s rank-order correlation coefficient, and Fleiss’ and Cohen’s kappa for analysis of agreement to PRNT, and an UpSet chart was created to visualize the number of shared positive samples between assays. Cohen’s kappa test on categorical data showed an excellent agreement between PRNT and LIPS-S, while agreements between PRNT and N-based methods decreased from fair for LIPS-N to poor agreements for the ELISA kits. In addition, LIPS-S revealed the highest number of true-positive SARS-CoV-2 samples compared to N-based methods. Despite an excellent agreement between LIPS-S and PRNT, a weak correlation was detectable between PRNT titres and relative light units. This study shows that the LIPS-S assay can be used for serological surveillance within a naturally exposed mink population, while N-based serological assays are less accurate providing a higher number of false-negative results, especially at a later stage of infection, thus indicating that N antibodies are less persistent in naturally exposed mink. Our findings provide crucial information for veterinarians and competent authorities involved in surveillance and outbreak investigation in wild and farmed minks.

Zygomatic implants imply the use of the zygoma as the implant anchorage and have been proposed as a valuable alternative to the invasive classical procedures in cases of severe maxillary atrophy. Despite the numerous manuscripts published in this field, a quantitative analysis of the research products to infer the trends and the status identification of this specific issue was missing, as well as an objective map of this area. Thus, the present scientometric study analyzed all the research papers published within the interval 1990–2021 that included the keyword “zygomatic implants”. Research papers containing the keywords “zygomatic implants” were collected using Web of Science and analyzed with Cytoscape 3.7.2 and Sci software. A total of 654 studies were published between 1990 and 2020, reaching up to 11639 citations in total, with a mean of 17.8 citations per research study. Data show that the number of publications per year is rapidly increasing, as well as the sum of citations per year. While the USA was identified as the most productive country in this field, followed by Italy, Spain, and Brazil, the National Natural Science Foundation of China stands up as the major funding agency, followed by the National Institutes of Health (NIH) in the USA and the United States Department of Health and Human Services. The analysis of the keywords showed that “zygomatic fractures” represents the most common word within this field, with “complications” as the most recent keyword and “screws” as the keyword used for the longest time. The map of science representing the authors and their collaborations highlighted the existence of multiple small-size research groups that contribute to scientific production, forming highly clustered structures that do not collaborate between them. The present scientometric analysis demonstrates the rising interest in using the zygomatic implants technique as an alternative to the classical ones. The obtained data suggest that the scientific community involved in the study of such a field is highly fragmented, emphasizing the lack of communication among the scientists and research groups.

SommarioIl Comitato Olimpico Internazionale (CIO) consente alle atlete transgender di gareggiare nelle divisioni femminili se i loro livelli di testosterone sierico sono inferiori a 10 nmol/L dal almeno un anno. Tuttavia, questo valore è nettamente superiore rispetto alle donne cisgender. Gli elevati livelli di testosterone e i loro effetti fisiologici determinano un vantaggio nelle competizioni sportive. La terapia ormonale di affermazione di genere riduce i livelli di testosterone circolante e determina alcune variazioni nella fisiologia del testosterone nelle donne transgender con conseguente modifica delle prestazioni fisiche di queste atlete. Scopo di questa Rassegna è la valutazione dei cambiamenti indotti dalla terapia ormonale e l’analisi degli effetti irreversibili del testosterone e di come essi possano influire sulle capacità fisiche e atletiche di donne transgender, con lo scopo finale di rendere lo sport inclusivo ed equo per tutti gli atleti.

During the COVID-19 pandemic, in adapting to social and work changes and new technological methods for remote teaching, teachers were subjected to increased work pressure, which affected their well-being and led to increased negative stress and burnout. This study was designed to test whether dysfunctional outcomes resulting from adapting to new ways of teaching via technological tools can be mitigated by the protective factors of emotional intelligence and metacognition. The study involved 604 teachers in Sicily filling out a questionnaire consisting of four different scales: (1) the Schutte Self-Report Emotional Intelligence Test (SREIT); (2) the Metacognitive Functions Screening Scale (MFSS-30); (3) the Link Burnout Questionnaire (LBQ); and (4) the Secondary Traumatic Stress Scale STSS-I. The results show that emotional intelligence mediates the relationship between certain remote work risk factors, as well as stress and burnout. In addition, metacognition was found to be a significant moderating factor in the relationship between risk factors and emotional intelligence. With regard to the United Nations’ Agenda 2030 Goals, our results emphasize the importance of teachers’ emotional and metacognitive skills in promoting quality of life and psychological well-being.

Background: Polytherapy and the anticholinergic activity of several drugs negatively influence cognition in the elderly. However, little is known on the effect on Mild Cognitive Impairment (MCI) in Parkinson’s Disease (PD). Methods: Patients with PD belonging to the baseline PACOS cohort with full pharmacological data, have been included in this study. MCI diagnosis was made according to the MDS level II criteria. Polytherapy was defined as patients assuming ≥6 drugs. Anticholinergic burden has been calculated using the Anticholinergic Drug Scale (ADS). Molecules have been classified according to the ATC classification. Association with MCI has been assessed with a multivariate logistic regression analysis with MCI as the dependent variable. Results: Pharmacological data was available for 238 patients (mean age 64.7±9.7). One hundred (42.0%) were diagnosed as MCI. In the full multivariate model (correcting for age, sex, disease duration, education, UPDRS-ME, LEDD-DAs) no association was found with either polytherapy or the ADS. Concerning drug classes, anti-hypertensive medications increased the risk of PD-MCI (OR 2.02;95%CI 1.04-3.89; p=0.035) while gastroprotective agents had a protective effect (OR 0.51; 95%CI 0.27-0.99; p=0.047). Conclusion: The magnitude of polytherapy and anticholinergic drugs burden does not appear to modulate MCI risk in PD, probably due to cautious prescription patterns. The effect of anti-hypertensive and gastroprotective agents on PD-MCI risk, while needing further confirmations, could be relevant for clinical practice.

The refurbishment of public residential districts represents a current and complex problem. The Cappuccinelli Social Housing (SH) district in Trapani, designed in the late 1950s by Michele Valori and built during the 1960s, is emblematic of the architectural quality and technological innovation of the time it was designed, but at the same time represents the physical and social decay that occurred just after its construction. The neighborhood was examined through a combination of inspections and documentary research. The inspections were conducted for the entire district in order to identify the recurrent external degradation of building components and the related causes, both physical and anthropogenic. This paper investigates the physical–mechanical degradation and problems connected to previous renovation work in this district. Furthermore, technological design solutions are discussed for deep renovation and energy efficiency improvement of one of the terraced buildings of the Cappuccinelli SH district.

Aging is a gradual, continuous series of natural changes in biological, physiological, immunological, environmental, psychological, behavioral, and social processes. Aging entails changes in the immune system characterized by a decrease in thymic output of naïve lymphocytes, an accumulated chronic antigenic stress notably caused by chronic infections such as cytomegalovirus (CMV), and immune cell senescence with acquisition of an inflammatory senescence-associated secretory phenotype (SASP). For this reason, and due to the SASP originating from other tissues, aging is commonly accompanied by low-grade chronic inflammation, termed “inflammaging”. After decades of accumulating evidence regarding age-related processes and chronic inflammation, the domain now appears mature enough to allow an integrative reinterpretation of old data. Here, we provide an overview of the topics discussed in a recent workshop “Aging and Chronic Inflammation” to which many of the major players in the field contributed. We highlight advances in systematic measurement and interpretation of biological markers of aging, as well as their implications for human health and longevity and the interventions that can be envisaged to maintain or improve immune function in older people.

Gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) are rare diseases encompassing pancreatic (PanNETs) and ileal NETs (SINETs), characterized by heterogeneous somatostatin receptors (SSTRs) expression. Treatments for inoperable GEP-NETs are limited, and SSTR-targeted Peptide Receptor Radionuclide Therapy (PRRT) achieves variable responses. Prognostic biomarkers for the management of GEP-NET patients are required. 18F-FDG uptake is a prognostic indicator of aggressiveness in GEP-NETs. This study aims to identify circulating and measurable prognostic miRNAs associated with 18F-FDG-PET/CT status, higher risk and lower response to PRRT.MethodsWhole miRNOme NGS profiling was conducted on plasma samples obtained from well-differentiated advanced, metastatic, inoperable G1, G2 and G3 GEP-NET patients enrolled in the non-randomized LUX (NCT02736500) and LUNET (NCT02489604) clinical trials prior to PRRT (screening set, n= 24). Differential expression analysis was performed between 18F-FDG positive (n=12) and negative (n=12) patients. Validation was conducted by Real Time quantitative PCR in two distinct well-differentiated GEP-NET validation cohorts, considering the primary site of origin (PanNETs n=38 and SINETs n=30). The Cox regression was applied to assess independent clinical parameters and imaging for progression-free survival (PFS) in PanNETs. In situ RNA hybridization combined with immunohistochemistry was performed to simultaneously detect miR and protein expression in the same tissue specimens. This novel semi-automated miR-protein protocol was applied in PanNET FFPE specimens (n=9). In vitro functional experiments were performed in PanNET models.ResultsWhile no miRNAs emerged to be deregulated in SINETs, hsa-miR-5096, hsa-let-7i-3p and hsa-miR-4311 were found to correlate with 18F-FDG-PET/CT in PanNETs (p-value:18F-FDG-PET/CT positive PanNETs with worse prognosis after PRRT (p-value:68Gallium-DOTATOC captation values (p-value:SSTR2 when ectopically expressed in PanNET cells (p-value:Conclusionshsa-miR-5096 well performs as a biomarker for 18F-FDG-PET/CT and as independent predictor of PFS. Moreover, exosome-mediated delivery of hsa-miR-5096 may promote SSTR2 heterogeneity and thus resistance to PRRT.

In the context of conservation and dissemination of cultural heritage, noninvasive technologies for the generation of digital models have produced exponential growth in the quality of the data acquired. The digital contents processed allow the use of architectural contexts that no longer exist or sites that are di cult to access, thanks to the visualisation of high-resolution and immersive products. However, the process from acquisition to visualisation requires optimisation strategies and specific operational choices, depending on the design goals. The study describes some results of a broader research within the iHERITAGE Project funded by the ENI CBC MED Program 2014-2020, critically describing the procedures adopted.

Background. Hypercholesterolemia and inflammation both contribute to the pathogenesis of atherosclerosis and its clinical manifestations. Statins, possessing both lipid-lowering and anti-inflammatory properties, are currently recommended in all ischemic syndromes. Purpose. To compare the effects of atorvastatin and rosuvastatin on lipid and inflammatory markers in patients with acute coronary syndromes (ACS). Methods. Two hundred thirty-nine consecutive patients with ACS, without familial hypercholesterolaemia and no statin treatment in the preceding 4 weeks, were randomly assigned within 24 hours after hospital admission to either atorvastatin 80 mg (119 patients) or rosuvastatin 20 mg (120 patients). Lipid and inflammatory markers were assessed before randomization and after 4 and 12 weeks of treatment. Results. Both statins similarly reduced total cholesterol and LDL-cholesterol at 4 weeks, with substantial stability at 12 weeks. At 4 weeks, LDL-cholesterol decreased from 129 mg/dL to 71 mg/dL in atorvastatin group and from 126 mg/dL to 71 mg/dL in rosuvastatin group. Apolipoprotein B significantly decreased in both groups. Otherwise, apolipoprotein A1 increased in rosuvastatin group only. As a consequence, ApoB/ApoA1 ratio decreased more in rosuvastatin group. No significant differences were seen in triglycerides, HDL-cholesterol and Lipoprotein (a) levels. Among inflammatory markers, hs-CRP, interleukin-6, interleukin 1-RA, TGF-β1, and MMP-9 significantly and similarly decreased at 4 and 12 weeks in both groups. Interleukin-10 levels decreased only in patients randomized to atorvastatin. Conclusions. A moderate dose of rosuvastatin provided similar effects, as compared to a high dose of atorvastatin, on a large series of lipid and inflammatory markers. Rosuvastatin was more effective than atorvastatin in reducing ApoB/ApoA1. Considering these findings, rosuvastatin 20 mg daily may be an alternative to atorvastatin 80 mg in acute coronary syndromes.

Nel contesto di una società in continua e rapida evoluzione, la morte si ripresenta come una ineludibile tematica di peculiare urgenza esistenziale. Sebbene, infatti, il progresso tecnologico e delle scienze mediche abbia facilitato una risposta tecnica alla domanda di salute che sempre di più incontra metodiche multimodali e multidisciplinari di terapia, la tecnologia di cura relega spesso il paziente ad una solitudine esistenziale dove, pur in presenza di una terapia per la sua malattia, non trova spazio una relazione di cura per la sua sofferenza. Questa dicotomia della cura, che si suddivide da una parte nel “trattare” dall’altra nell’“essere presente”, porta, soprattutto nel contesto del fine vita, al rischio di attestare la cura al solo livello tecnico, rendendo ‘giustificata’ la richiesta del paziente al medico di ‘somministrare il fine vita’, sopprimendo l’eco relazionale di ritorno del medico di fronte al bisogno umano del paziente. Lo scopo di questo articolo è di recuperare le riflessioni legate all’esperienza clinica ed umana propedeutiche ad accompagnare il paziente in un percorso relazionale offrendogli, nelle varie fasi della cura, una “eco di ritorno”, utili a non comprimere la percezione del medico a livello di somministratore automatico.

Disorders of consciousness (DoC) are acquired conditions of severely altered consciousness. Electroencephalography (EEG)-derived biomarkers have been studied as clinical predictors of consciousness recovery. Therefore, this study aimed to systematically review the methods, features, and models used to derive prognostic EEG markers in patients with DoC in a rehabilitation setting.We conducted a systematic literature search of EEG-based strategies for consciousness recovery prognosis in five electronic databases.The search resulted in 2964 papers. After screening, 15 studies were included in the review. Our analyses revealed that simpler experimental settings and similar filtering cut-off frequencies are preferred. The results of studies were categorised by extracting qualitative and quantitative features. The quantitative features were further classified into evoked/event-related potentials, spectral measures, entropy measures, and graph-theory measures. Despite the variety of methods, features from all categories, including qualitative ones, exhibited significant correlations with DoC prognosis. Moreover, no agreement was found on the optimal set of EEG-based features for the multivariate prognosis of patients with DoC, which limits the computational methods applied for outcome prediction and correlation analysis to classical ones. Nevertheless, alpha power, reactivity, and higher complexity metrics were often found to be predictive of consciousness recovery.This study's findings confirm the essential role of qualitative EEG and suggest an important role for quantitative EEG. Their joint use could compensate for their reciprocal limitations.This study emphasises the need for further efforts toward guidelines on standardised EEG analysis pipeline, given the already proven role of EEG markers in the recovery prognosis of patients with DoC.

After 2 years of COVID-19 restrictions, the 8th Young Scientist Symposium was organized again as a face-to-face meeting covering a broad array of scientific presentations. As in the previous editions, the meeting was organized by young scientists for young scientists under the umbrella of the European Bioanalysis Forum and in collaboration with academia. The traditional Science Café was again included as an interactive round table session. This year, the main focus was on the challenges of communication. New for the 8th edition was a session connecting the young scientists with more seasoned experts in an effort to bridge talent and experience. In this article, we share the feedback of the scientific sessions and the Science Café held at the symposium.

Anxiety symptoms and anxiety disorders are frequent in patients with schizophrenia and are associated with greater severity of both positive and negative symptoms, cognitive impairment, poorer functioning and quality of life. Accumulating evidence suggests that atypical antipsychotics may have a role in treating comorbid anxiety symptoms. A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting randomized control trials (RCTs) that evaluated efficacy of olanzapine on anxiety symptoms in patients diagnosed with schizophrenia and included anxiety evaluation scales. We searched PubMed and Web of Science databases for articles in English language available until September 2021. We selected 7 studies (3 with primary data analysis, 4 with secondary data analysis) regarding the use of olanzapine in patients with schizophrenia. In fours studies olanzapine was superior to haloperidol in improving anxiety symptoms. Four studies compared olanzapine versus risperidone: in two of them risperidone was superior to olanzapine, although one study was limited by a relatively small sample size. In the other two there were no significant differences between olanzapine and risperidone-treated patients. One study found that olanzapine and clozapine were comparable in terms of efficacy. Although olanzapine was superior to haloperidol in treating anxiety, this symptom was a secondary outcome measure in most of the considered studies. Future RCTs comparing different antipsychotics and larger sample sizes may allow to develop more solid treatment strategies.

The Radiofrequency Refocused Echo Spin-Echo Echo-Train Rapid-Acquisition sequences, known as Turbo Spin Echo or Fast Spin Echo are the most commonly used sequences in Magnetic Resonance as they provide a notable contribution in morphological and anatomical terms, thanks to their high spatial and contrast resolution. Furthermore, they allow a higher signal noise ratio than the other families of sequences thanks to the numerous refocusing pulses and thanks to a TR so long as to allow sampling as many K-space phase encodings as possible and with a complete recovery of the Longitudinal Magnetization. Finally, the multiple 180 ° pulses of these sequences reduce the inhomogeneities of the Magnetic Field by minimizing the phenomena of magnetic susceptibility. However, their application, especially in scanners with a high intensity of static magnetic field B0(1.5T and/or 3T)is prevented by the deposition of RF due to the long echo trains, which sometimes involve exceeding the limits of the specific absorption rate for patient safety. Over time, a common solution to the SAR problem has been the use of refocusing angles smaller than 180°(160°-140°-120°),which lead to its reduction at the cost, however, of an obvious penalty in terms of signal-to-noise ratio. In this study we present a modulation method of the Refocus Flip-Angle applied to the DP-TSE sequences in the evaluation of meniscal lesions in the study protocol of the Magnetic Resonance of the Knee, which exploits the phenomenon of the Pseudo-Steady-State(PSS), leading to a noticeable SARreduction without loss of SNR and also providing excellent contrast resolution

Canine parvovirus (CPV-2) modified-live virus vaccine strain can replicate in lymphoid tissues and intestinal mucosa after administration, being shed through canine faeces. Detection of vaccine strains has been reported in the bloodstream and faeces, potentially interfering with molecular diagnostic tests. The persistence of these strains in canine tissues has not yet been described. With this aim, canine tissues were tested during a molecular survey to screen for the presence of canine enteric viruses. Tissue samples from 165 dead dogs were tested by a conventional PCR assay. Positive samples and five commercial vaccines were subjected to sequence analysis. Vaccinal strains were detected and virus load was measured by using a set of real-time PCR assays using minor-groove binder (MGB) probes. Seventy-five dogs (45.4%) tested positive for CPV-2. Strains from 70 dogs were characterised as field variants. The presence of CPV sequences of vaccine origin was observed in the spleen, intestine, and mesenteric lymph nodes of five young dogs. Vaccinal strains were detected from 12 to 24 days after the last vaccine administration. Viral loads comprised between 6.3 × 10

Background: The combination of atezolizumab-bevacizumab has been proven to be superior to sorafenib for the treatment of unresectable hepatocellular carcinoma not amenable to locoregional treatments, be-coming the standard of care of systemic therapy.Aim: This study aimed at assessing real-world feasibility of atezolizumab-bevacizumab in patients treated with tyrosine-kinase inhibitors.Methods: Among 1447 patients treated with tyrosine-kinase inhibitors from January 2010 to December 2020, we assessed the percentage of those potentially eligible to atezolizumab-bevacizumab (according to IMbrave-150 trial criteria), and the overall survival of eligible and non-eligible patients.Results: 422 (29%) patients were qualified for atezolizumab-bevacizumab therapy. The main exclusion causes were Child-Pugh class and Performance Status. Adopting the more permissive inclusion criteria of SHARP trial, 535 patients became eligible. The median overall survival of tyrosine-kinase inhibitors patients was 14.9 months, longer in eligible patients than in their counterpart due to better baseline liver function and oncological features.Conclusion: Real-world data indicate that less than one-third of hepatocellular carcinoma patients treated with tyrosine-kinase inhibitors are potentially eligible to atezolizumab-bevacizumab according to the reg-istration trial criteria. These patients have a longer survival than the non-eligible ones. If the selection criteria of atezolizumab-bevacizumab trial are maintained in clinical practice, tyrosine-kinase inhibitors will remain the most used systemic therapy for hepatocellular carcinoma patients.(c) 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Primary lung carcinoma is an exceptionally rare childhood tumour, as per definition of the European Cooperative Study Group on Paediatric Rare Tumours (EXPeRT), with an incidence of 0.1-0.2/1,000,000 per year. Little is known about the clinical characteristics of children with primary lung carcinoma, a gap which this joint analysis of the EXPeRT group aimed to fill.We performed a retrospective case series of children (aged 0-18 years) with primary lung carcinoma, as collected through the EXPeRT databases between 2000 and 2021. We recorded relevant clinical characteristics including treatment and outcome.Thirty-eight patients were identified with a median age of 12.8 years at diagnosis (range: 0-17). Mucoepidermoid carcinoma (MEC) was the most frequent entity (n = 20), followed by adenocarcinoma (n = 12), squamous cell carcinoma (n = 4), adenosquamous carcinoma (n = 1) and small-cell lung cancer (n = 1). Patients with MEC presented rarely with lymph node metastases (2/20 cases). Overall, 19/20 patients achieved long-lasting remission by surgical resection only. Patients with other histologies often presented in advanced stages (14/18 TNM stage IV). With multimodal treatment, 3-year overall survival was 52% ± 13%. While all patients with squamous cell carcinoma died, the 12 patients with adenocarcinoma had a 3-year overall survival of 64% ± 15%.Primary lung carcinomas rarely occur in children. While the outcome of children with MEC is favourable with surgery alone, patients with other histotypes have a poor prognosis, despite aggressive treatment, highlighting the need to develop new strategies for these children, such as mutation-guided treatment.

Differential diagnosis between Parkinson’s disease (PD) and corticobasal syndrome (CBS) could be challenging at the early stage, due to the asymmetric onset of both diseases. Despite the clinical overlap, the anatomical circuits involved in these disorders are different. We evaluated R2 Blink Reflex Recovery Cycle (R2BRRC) and cortical thickness (CTh) in drug-naïve PD and CBS patients for characterizing pathophysiological mechanisms underlying these conditions. Patients with a clinically probable diagnosis of PD and possible CBS were recruited. R2BRRC was evaluated bilaterally at interstimulus intervals (ISIs) of 100–150–200–300–400–500–750 ms. Asymmetry index (AI) of R2BRRC for each ISI was computed. Patients underwent a structural brain MRI and hemisphere CTh and AI of MRI was calculated. Fourteen drug-naïve PD patients and 10 patients with early CBS diagnosis were enrolled. R2BRRC of PD patients showed an increased brainstem excitability for less affected side (LAS) stimulation at ISIs of 100 and 150 ms (p

Long-standing health inequities in the United States persist and, in some cases, are worsening (1). Health inequities are not just disparate health outcomes among certain populations, rather they are avoidable and unjust systemic differences in health outcomes based on the position people and communities occupy in a social hierarchy (2). Social and structural factors significantly contribute to these inequities and include factors such as racism (3), gender oppression (4), housing segregation (4), mass incarceration (4), and a lack of Medicaid expansion (5). As such, there has been a recent shift in healthcare provider education toward structural competency that provides training in both recognizing and addressing structural factors leading to health inequities (6). Metzl and Hansen, who coined the term, define structural competency as, “the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases (e.g., depression, hypertension, obesity, smoking, medication ‘non-compliance,’ trauma, psychosis) also represent the downstream implications of a number of upstream decisions about such matters as healthcare and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions illness and health (pg. 5)” (6). Recent findings suggest that structural competency training assists medical providers and medical students with identifying and analyzing relationships between structural factors and health outcomes (7 -10). To date, most structural competency interventions have been implemented with a single healthcare profession such as medicine or pharmacy and a review of the evidence about this competency-based approach to healthcare education has not been conducted (7-14). To address these key gaps, we propose mapping the current state of the literature on structural competency training in pre-health and health professional learning.

Background: Oral activated factor XI (FXIa) inhibitors may modulate coagulation to prevent thromboembolic events without substantially increasing bleeding. We explored the pharmacodynamics, safety, and efficacy of the oral FXIa inhibitor asundexian for secondary prevention after acute myocardial infarction (MI). Methods: We randomized 1601 patients with recent acute MI to oral asundexian 10, 20, or 50 mg or placebo once daily for 6 to 12 months in a double-blind, placebo-controlled, phase 2, dose-ranging trial. Patients were randomized within 5 days of their qualifying MI and received dual antiplatelet therapy with aspirin plus a P2Y12 inhibitor. The effect of asundexian on FXIa inhibition was assessed at 4 weeks. The prespecified main safety outcome was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding comparing all pooled asundexian doses with placebo. The prespecified efficacy outcome was a composite of cardiovascular death, MI, stroke, or stent thrombosis comparing pooled asundexian 20 and 50 mg doses with placebo. Results: The median age was 68 years, 23% of participants were women, 51% had ST-segment–elevation MI, 80% were treated with aspirin plus ticagrelor or prasugrel, and 99% underwent percutaneous coronary intervention before randomization. Asundexian caused dose-related inhibition of FXIa activity, with 50 mg resulting in >90% inhibition. Over a median follow-up of 368 days, the main safety outcome occurred in 30 (7.6%), 32 (8.1%), 42 (10.5%), and 36 (9.0%) patients receiving asundexian 10 mg, 20 mg, or 50 mg, or placebo, respectively (pooled asundexian versus placebo: hazard ratio, 0.98 [90% CI, 0.71–1.35]). The efficacy outcome occurred in 27 (6.8%), 24 (6.0%), 22 (5.5%), and 22 (5.5%) patients assigned asundexian 10 mg, 20 mg, or 50 mg, or placebo, respectively (pooled asundexian 20 and 50 mg versus placebo: hazard ratio, 1.05 [90% CI, 0.69–1.61]). Conclusions: In patients with recent acute MI, 3 doses of asundexian, when added to aspirin plus a P2Y12 inhibitor, resulted in dose-dependent, near-complete inhibition of FXIa activity without a significant increase in bleeding and a low rate of ischemic events. These data support the investigation of asundexian at a dose of 50 mg daily in an adequately powered clinical trial of patients who experienced acute MI. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04304534; URL: https://www.clinicaltrialsregister.eu/ctr-search/search ; Unique identifier: 2019-003244-79.