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Various regional anesthesia techniques have been studied for blunt chest wall trauma over the past decades, but their impact on patient outcomes remains unclear. This systematic review and Bayesian network meta-analysis aimed to identify the most effective regional anesthesia techniques for different outcomes in blunt thoracic trauma patients. We searched Medline, EMBASE, Scopus, and Cochrane databases for randomized controlled trials comparing regional anesthesia techniques (thoracic epidural, erector spinae plane block, serratus anterior plane block, intercostal block, paravertebral block, intrapleural block, retrolaminar block) and standard intravenous analgesia. Eligible studies reported at least one of the following outcomes: pain control, ICU and hospital length of stay, mechanical ventilation duration, pneumonia incidence, and additional analgesic use. Bayesian network meta-analysis models were created for each outcome, and confidence in results was assessed using the CINeMA framework. We included 27 randomized controlled trials with 1586 patients. Thoracic epidural consistently showed efficacy in reducing pain at 24 h, mechanical ventilation duration, and ICU and hospital stays. The erector spinae plane block also reduced pain and hospital stay. Confidence in these results was low to moderate, primarily due to imprecision. Various locoregional techniques are being investigated for managing pain in blunt thoracic trauma, with thoracic epidural showing consistent positive effects on pain and other key outcomes. Fascial blocks are emerging as potential alternatives with similar pain relief, though evidence on other outcomes is limited. Future studies should compare the efficacy of these techniques on more definitive endpoints. [ABSTRACT FROM AUTHOR]

The benefit of combining multiple mechanical circulatory support (MCS) systems in patients with cardiogenic shock (CS) is debated. This review examines patient characteristics across studies to identify differences and assesses if patients with a higher-risk clinical profile receive Impella unloading. A systematic review and meta-analysis was conducted to examine if there were significant differences in baseline clinical parameters among patients receiving MCS in addition to venoarterial extracorporeal membrane oxygenation (VA ECMO). A total of nine retrospective, three prospective, and two randomized controlled trials were included in this analysis. The sample sizes ranged from 34 to 1,678 patients. The outcomes were assessments of differences in baseline clinical characteristics and comorbidities among patients that received VA ECMO alone or VA ECMO with intra-aortic balloon pump (IABP) versus ECPella. ECPella patients showed a higher prevalence of coronary artery disease (65.0% v 34.6%, p < 0.0001), cardiac arrest before MCS implantation (63.1% v 52.7%, p < 0.0001), and ischemic CS (53.1% v 42.6%, p < 0.0001) compared with patients with VA ECMO alone. The comparison between ECPella and VA ECMO + IABP patients showed a higher prevalence of acute myocardial infarction-CS (53.1% v 39.0%, p < 0.0001), preimplantation cardiac arrest (63% v 49.3%, p < 0.0001), and extracorporeal cardiopulmonary resuscitation (25.8% v 20.0%, p = 0.0015). The inclusion of the two randomized controlled trials in the VA ECMO group increased the prevalence of comorbidities compared with the ECPella group. Patients who received a combination of MCS and VA ECMO have a greater prevalence of comorbidities. [Display omitted] [ABSTRACT FROM AUTHOR]

In preclinical experiments, cyclic fasting-mimicking diets (FMDs) showed broad anticancer effects in combination with chemotherapy. Among different tumor types, triple-negative breast cancer (TNBC) is exquisitely sensitive to FMD. However, the antitumor activity and efficacy of cyclic FMD in TNBC patients remain unclear. Here, we show that a severely calorie-restricted, triweekly, 5-day FMD regimen results in excellent pathologic complete response (pCR) rates (primary endpoint) and long-term clinical outcomes (secondary endpoints) when combined with preoperative chemotherapy in 30 patients with early-stage TNBC enrolled in the phase 2 trial BREAKFAST. Bulk and single-cell RNA sequencing analysis revealed that highly glycolytic cancer cells, myeloid cells, and pericytes from tumors achieving pCR undergo a significant, early downmodulation of pathways related to glycolysis and pyruvate metabolism. Our findings pave the wave for conducting larger clinical trials to investigate the efficacy of cyclic FMD in early-stage TNBC patients and to validate early changes of intratumor glycolysis as a predictor of clinical benefit from nutrient restriction. This study was registered at Clinicaltrials.gov (NCT04248998). [Display omitted] • Cyclic FMD plus anthracycline-taxane CT resulted in excellent responses in early TNBC • The experimental treatment was safe, and patient compliance was excellent • Early downmodulation of glucose metabolism in cancer cells predicts pCR to FMD In brief, Vernieri et al. conducted a pilot, randomized phase 2 trial showing that cyclic FMD plus preoperative chemotherapy results in excellent pCR rates in stage I–III TNBC patients. In tumors achieving pCR, bulk and single-cell RNA-seq analysis revealed early downmodulation of glucose metabolism in TNBC cells and in glycolytic intratumor cells. [ABSTRACT FROM AUTHOR]

Industrial production of hollow glass containers constitutes one well-established yet mostly manual manufacturing process, where molten glass—a non-Newtonian fluid—is heated at about 1700 degrees and then sheared into drops (called glass gobs) of variable sizes—from few grams in the pharma sector up to few kilograms for sparkling winery. Gobs are let fall due to gravity into molds lying few meters below, where they are finally blown into containers. Proper forming of gobs to match the size and shape of the mold is generally a manual operation carried out by expert personnel who directly interact with the machinery under extreme conditions in a high-risk environment. Aiding production setup through some form of reliable automation constitutes, therefore, a significant improvement in the safety of people and machinery. In this work, we present an AI-based, physics-informed digital twin of the glass gob production system that we developed for full process automation. Such a digital twin is used in conjunction with a meta-heuristic optimization, enabling the identification of the machine setup that guarantees the optimal gob forming process. This approach was successfully employed in real glass manufacturing facilities, for both machine setup (i.e. production changes) as well as real-time process control, allowing the machinery to keep production stable under changing environmental conditions. The presented digital twin and optimization system represents the first data-driven, fully automated system for hollow glass containers production, resulting in enhanced personnel safety, reduced downtime and improved industrial production. [ABSTRACT FROM AUTHOR]

The techniques employed to enhance the art of teaching are several and must account for various factors, some of which are specific to the subject matter, while others are related to external conditions, such as social characteristics. This study examines the current landscape of innovative teaching methodologies by identifying: (i) the primary fields where these methodologies are applied, (ii) the most active countries in adopting these methods, and (iii) the main types of techniques utilized. Although other reviews exist on this topic, this research primarily focuses on methodologies used in the engineering field and identifies the key countries that are most responsive to these innovative approaches. Through keyword-based analysis and the application of statistical methods, it was found that the leading methodologies in growth are gamification, virtual reality (VR), and project- or problem-based learning. Additionally, their use in doctoral and postgraduate programs remains underexplored, presenting opportunities for future research. [ABSTRACT FROM AUTHOR]

Industry 4.0 (I4.0) offers tremendous potential benefits across various sectors. Manufacturing can derive the greatest value from it. However, the rate of adoption remains low due to barriers such as management commitment, lack of knowledge, and costs. Simple solutions that require minimal investment and carry low risk are the best way to introduce I4.0 into companies. The shared data flow generated by sensors and the Industrial Internet of Things (IIoT) can provide valuable insights thanks to new connectivity between systems. This deeper knowledge enables the creation of highly flexible production systems capable of meeting customer demands and achieving mass customization. However, a key point too little addressed yet is that the intensity of data flow can lead to latency and data loss issues, resulting in a system unable to meet the real requirements as answers are provided too late. To address this challenge, the authors propose a framework based on the integration of Edge, Fog, and Cloud Computing, aimed at extracting maximum value from data by analysing it both locally and centrally. This approach reduces latency in production systems, enhances flexibility, and enables predictive maintenance. The result is an architectural framework that integrates Edge, Fog, and Cloud Computing to improve the flexibility of a multi-product manufacturing system. The implementation of I4.0 in existing Industry 3.0 plants facilitates flexible production capable of meeting mass customization requirements and achieving high resilience. In conclusion, it has been demonstrated that Edge, Fog, and Cloud Computing can be effectively integrated into a Flexible Production framework. [ABSTRACT FROM AUTHOR]

The production throughputs of the food industry grow continuously due to the ever-increasing customer demand. At the same time, food safety measures become increasingly strict. To this end, efficient quality control is essential to ensure quality and safety for consumers, and to guarantee efficient and valuable production for industrial stakeholders. Computer vision is often applied to this end, usually integrated with other Industry 4.0 technologies and process automation. Computer vision applications in quality control, indeed, can greatly enhance supply chain management in the food industry by maintaining consistent product quality and minimizing waste. In this paper, a keyword-based analysis is carried out to assess the main research trends and topics in the field of computer vision for quality control in the food industry. The bibliometric analysis aims to assess the main applications of the technology in terms of processes and products and the main issues targeted by the analyses. Finally, the results of the bibliometric investigation allow to identify and highlight topics that present potential for future investigations in the field. [ABSTRACT FROM AUTHOR]

In recent years, the market has been increasingly shifting towards more natural products, and nonconventional technologies are gaining increasing attention, as they allow to better preserve the organoleptic and nutritional properties of foods. Ohmic treatment is based on the Joule effect, with the heat produced by generating an electric current passing through the product. It offers several advantages in terms of heating uniformity, reduced fouling of the devices, and increased energy efficiency for products difficult to efficiently heat with traditional treatments. These characteristics make it an optimal choice for protein-rich products, like eggs and dairy products, which are often heterogeneous and particularly sensitive to high temperatures causing protein denaturation. In these applications, it is therefore essential to correctly design and dimension the ohmic heater to prevent the formation of hot spots that would irremediably affect the quality of the product. In this study, CFD simulation was used to evaluate the process performance during the continuous ohmic treatment of liquid whole eggs. The results obtained highlighted a strong relationship between the fluid dynamics inside the reactor and the temperature field. The insights obtained will be of great support to industrial stakeholders in the design phase and in implementing the ohmic treatment. [ABSTRACT FROM AUTHOR]

The machinery industry sector is among the most important due to its production of equipment utilized by other industries in manufacturing processes. Traditionally characterized by transactional sales, this sector is currently shifting towards servitized business models, wherein products such as machines and industrial equipment are bundled with services or offered purely as services. Implementing servitized business models is non-trivial as it necessitates thorough investigation. Additionally, machinery is undergoing a digital transformation that, in combination with servitization, has led to the concept of digital servitization. Since the Italian market is among the most important at European level, it is critical for Italian companies to understand their positioning against competition. This paper delves into the digital servitization evolution of machinery companies, comparing those based in Italy with their foreign counterparts. The findings highlight that, despite facing similar challenges, foreign companies are more advanced in this transition than their Italian counterparts. [ABSTRACT FROM AUTHOR]

[Display omitted] Primary graft dysfunction (PGD) affects survival after lung transplant (LT). The current hypothesis was that prone positioning (PP), proposed as a rescue maneuver to treat refractory hypoxemia due to PGD, may improve LT outcomes, especially when applied early. Bilateral LT recipients developing moderate-to-severe PGD within 24 hours from intensive care unit admission were enrolled. From January 2020 to November 2021, patients developing PGD after LT were turned prone between 24 and 48 hours after diagnosis, only in case of radiological or oxygenation worsening ("late PP" group). After November 2021, patients were routinely turned prone within 24 hours from PGD diagnosis ("early PP"). A propensity score–weighted analysis, adjusted for clinically relevant covariates, was applied. Intensive care unit. Bilateral LT recipients. Early PP, late PP, or supine position. 130 LT patients were screened and 67 were enrolled. A total of 25 (37%) recipients were treated in the supine position, 24 (36%) in early PP, and 18 (27%) in late PP. After propensity score weighting, both supine treatment (estimated effect for 1 ventilator-free day = 8.23, standard error: 2.97, p = 0.007) and early PP treatment (estimated effect = 9.42, standard error: 2.59, p < 0.001) were associated with greater 28-day ventilator-free days than late PP treatment (reference). Compared with late PP, early PP was also associated with better oxygenation, driving pressure, and static respiratory system compliance. Compared with supine recipients, the early PP group showed better oxygenation at 72 hours after PGD diagnosis. Early PP in LT recipients with moderate-to-severe PGD seems to be associated with better 28-day ventilator-free days, oxygenation, and driving pressure than late PP. [ABSTRACT FROM AUTHOR]

Prior studies suggest an association of anemia and blood transfusion with increased morbidity and mortality in patients undergoing cardiac surgery. However, the impact of perioperative anemia and blood transfusion on clinical outcomes in patients undergoing major vascular surgery has been poorly defined yet. The primary objectives of this scoping review were to determine the extent of the evidence base that links anemia and blood transfusions to mortality and cardiovascular outcomes in patients undergoing major vascular surgery, and identify recurring themes or gaps in the literature to guide future research. A scoping review of the literature from PubMed, Cochrane, and EMBASE databases was conducted up to December 2023 to identify articles related to the impact of anemia and blood transfusions on postoperative cardiovascular outcomes on patients undergoing vascular surgery. Methodology followed the PRISMA Protocols Extension for Scoping Reviews. Twenty-two articles met the inclusion criteria, including 15 retrospective and 6 observational prospective studies. Anemia definition varied across studies, mainly based on hemoglobin cut-off levels. An association with older age, coronary artery disease, hypertension, diabetes, and other comorbidities was reported. Particularly in peripheral and endovascular aortic surgery, anemia was linked consistently with higher mortality, major adverse cardiac events, and other postoperative complications, such as respiratory and renal issues, surgical site infections, and longer hospital stays, depending on hemoglobin levels. Anemia itself is an important predictor of transfusions. Transfusions in anemic patients were associated with increased mortality, postoperative complications, and increased need for major amputation. The weight of the evidence suggests that anemia carries a substantial burden of cardiovascular complications, mortality, and multiorgan complications, resulting in increased health care costs. Peripheral and endovascular aortic surgery are affected deeply by the impact of anemia. Anemia itself stands out as a crucial predictor for requiring transfusions. In turn, the effect of transfusion of blood products is associated with worse outcomes and complications. [ABSTRACT FROM AUTHOR]

Gastroenterologists still raise concerns about adopting a non-biopsy strategy for diagnosing celiac disease (CeD) in adults. To assess the performance of the concurrent detection of two autoantibodies targeting two independent antigens, tissue transglutaminase (tTG) and deamidated gliadin peptides (DGP). This prospective, multicenter, binational study collected consecutive patients with a high pre-test probability for CeD. Between 2018 and 2020, adults were enrolled at four Italian and one Argentinian center. Serology was also blindly analyzed by a central laboratory (Werfen, San Diego, USA) for tTG IgA and DGP IgG by Aptiva Particle-based multi-analyte technology (PMAT) assays. CeD diagnosis required histological confirmation of Marsh 3 damage. 181 adult patients with suspected CeD were enrolled (134 with histological diagnosis of CeD and 47 not histologically confirmed as CeD). Patients positive for both tTG IgA and DGP IgG (double positive) were predictive of CeD in 92.5 % of patients at >1x upper limit of normal (ULN). Double positivity for tTG IgA and DGP IgG, both at >10x ULN, had a 100 % positive predictive value for the presence of Marsh 3 histology. Incorporating DGP IgG alongside tTG IgA in a single-step approach can be considered a valid confirmatory strategy for definitive non-biopsy diagnosis of CeD. [ABSTRACT FROM AUTHOR]

Renal dysfunction is prevalent in advanced chronic liver disease (aCLD) and is associated to liver-related death (LRD). This makes a reliable evaluation of renal function (RF) a crucial aspect. RF can be estimated by formulas or measured by gold standard method. Estimated RF is not reliable in aCLD. However, there is a lack of information on the reliability of formulas in the prediction of LRD. We analysed a cohort of patients with aCLD in whom RF was measured by the plasma clearance of iohexol (mGFR) and estimated (eGFR) by formulas: MDRD, CKD-EPI, Royal Free Hospital (RFHC), GRAIL and Mindikoglu-eGFR. LRD was defined as death from hepatic causes. Multivariable analysis was used to evaluate association of mGFR or eGFR with LRD. 161 patients were evaluated, with median follow-up of 28 months, 58 died from LRD. In overall group mGFR (OR 0.99; p = 0.022) and formulas: CKD-EPI (OR 0.98; p = 0.044), GRAIL (OR 0.98; p = 0.038) was associated with LRD. In patients with normal creatinine levels (≤ 1.1 mg/dL), mGFR (OR 0.99; p = 0.031) was whereas any formula was not associated with LRD. eGFR appears as an unreliable method for predicting LRDs in aCLD, especially in those with lower creatinine levels. By contrast, mGFR seems to be a superior predictor. [ABSTRACT FROM AUTHOR]

Lifetime treatment of aortic valve disease is a matter of increasing debate. Although the risks of a second aortic valve intervention are recognized, little attention has been given to the challenges of a third. This study delves into the clinical characteristics, indications, and outcomes of patients undergoing 3 aortic valve interventions. The THIRD (THree aortIc Reinterventions for valve Disease) registry is a retrospective multicenter, international study of patients who underwent a third procedure on the aortic valve, either surgically or transcatheter-based. Patients undergoing 2 aortic procedures during the same hospital admission were excluded. Baseline characteristics, timing, and mode of bioprosthetic failure, sequence of the procedures, and clinical outcomes were adjudicated according to the Valve Academic Research Consortium criteria. A total of 51 patients from 11 centers were enrolled in this study. Median follow-up time was 565 (314-1,560) days. Eighteen patients (35%) underwent surgical aortic valve replacement (SAVR), and 33 of 51 patients (65%) underwent transcatheter aortic valve replacement (TAVR) as the third intervention. Mean age was 69 ± 14 years, 20 of 51 patients (39%) were female. STS score was 5.0% (Q1-Q3: 3.3%-7.0%). In all TAVR cases, the indication for the first intervention was severe aortic stenosis, as was the indication in 31 of 45 (69%) of SAVR cases (33% bicuspid). The most prevalent procedure sequence was SAVR-SAVR-TAVR (19/51, 37%), followed by SAVR-SAVR-SAVR (10/51, 20%) and SAVR-TAVR-TAVR (10/51, 20%). TAVR-TAVR-TAVR was performed in 4 of 51 cases (8%). The primary indications for a third intervention included structural valve deterioration (SVD) (39/51, 76%), non-SVD (8/51, 16%), and endocarditis (2/51, 4%). Excluding patients with a mechanical prosthesis, predictors of SAVR as third intervention included a lower STS score (OR: 0.58; 95% CI: 0.34-0.98; P = 0.04) and the presence of moderate or severe prosthesis–patient mismatch (OR: 44.8; 95% CI: 2.41-122.00; P = 0.01). Thirty-day device success was 85% for TAVR and 94% for SAVR. In the THIRD registry, SVD emerged as the predominant indication for a third aortic valve procedure. The most frequent procedure sequence was SAVR-SAVR-TAVR, whereas TAVR-TAVR-TAVR was less common. Although the short-term outcomes in our selected cohort were favorable, further investigation is needed. [Display omitted] [ABSTRACT FROM AUTHOR]

This article discusses a pulmonary artery pseudoaneurysm (PAP) formation following pulmonary artery catheter (PAC) placement for cardiac surgery. The patient, an 82-year-old female with a history of hypertension and chronic heart failure, underwent elective mitral and tricuspid valve surgery. After surgery, bleeding was observed in the endotracheal tube, indicating a potential complication. Fiberoptic bronchoscopy revealed bleeding mainly in the right bronchus. Subsequent computed tomography pulmonary angiogram (CTPA) confirmed the presence of a small pseudoaneurysm in a branch of the pulmonary artery. Prompt collaboration between anesthesiologists, cardiac surgeons, and interventional radiologists led to the successful embolization of the pseudoaneurysm with a minimally invasive approach by using the PAC as a guide catheter to reach the PAP. The article outlines the potential causes of PAP formation, clinical presentation, and management strategies. While conservative, surgical, and interventional approaches are discussed, the preferred treatment is coil embolization due to its effectiveness and minimal invasiveness. The authors emphasize the importance of rapid diagnosis, multidisciplinary collaboration, and the feasibility of using the pulmonary artery route for embolization to rapidly reach the lesion to stabilize. Overall, the case demonstrates the successful resolution of a life-threatening complication through timely intervention and coordinated teamwork. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a strong risk factor for cardiovascular mortality and morbidity. We hypothesized that a senescent phenotype instigated by uremic toxins could account for early vascular aging (EVA) and vascular dysfunctions of microvasculature in end stage kidney disease (ESKD) patients which ultimately lead to increased cardiovascular complication. To test this hypothesis, we utilized both in vivo, and ex vivo approaches to study endothelial and smooth muscle function and structure, and characterized markers related to EVA in 82 ESKD patients (eGFR <15 ml/min) and 70 non-CKD controls. In vivo measurement revealed no major difference in endothelial function between ESKD and control group, aside from higher stiffness detected in the microcirculation of ESKD participants. In contrast, ex vivo measurements revealed a notable change in the contribution of endothelium-derived factors and increased stiffness in ESKD patients vs. controls. In support, we demonstrated that ex vivo exposure of arteries to uremic toxins such as Trimethylamine N-oxide, Phenylacetylglutamine, or extracellular vesicles from CKD patients impaired endothelial function via diminishing the contribution of endothelium-derived relaxing factors such as nitric oxide and endothelium derived hyperpolarizing factor. Uremic arteries displayed elevated expression of senescence markers (p21CIP1, p16INK4a, and SA-β-gal), calcification marker (RUNX2), and reduced expression of Ki67, sirtuin1, Nrf2, and MHY11 markers, indicating the accumulation of senescent cells and EVA phenotype. Correspondingly, treating uremic vessel rings ex vivo with senolytic agents (Dasatinib + Quercetin) effectively reduced the senescence-associated secretory phenotype and changed the origin of extracellular vesicles. Notably, sex differences exist for certain abnormalities suggesting the importance of biological sex in the pathogenesis of vascular complications. In conclusion, the uremic microvasculature is characterized by a "senescence signature", which may contribute to EVA and cardiovascular complications in ESKD patients and could be alleviated by treatment with senolytic agents. [ABSTRACT FROM AUTHOR]

Latin America is a region of great interest for studying the clinical presentation of idiosyncratic drug-induced liver injury (DILI). A comprehensive analysis of patients enrolled into the LATINDILI Network over a decade is presented. Demographics, clinical presentation, histological findings and outcome of prospectively recruited DILI cases in the LATINDILI Network were analyzed. Suspected culprit drugs were classified according to the Anatomical Therapeutic Chemical classification. Causality was assessed using the Roussel Uclaf Causality Assessment Method (RUCAM) scale. Overall, 468 idiosyncratic DILI cases were analyzed (62% women; mean age, 49 years). Hepatocellular injury predominated (62%); jaundice was present in 60% of patients, and 42% were hospitalized. Of the cases, 4.1% had a fatal outcome, and 24 patients (12%) developed chronic DILI. The most common drug classes were systemic anti-infectives (31%), musculoskeletal agents (12%), antineoplastic and immunomodulating agents (11%), and herbal and dietary supplements (9%). Notably, none of the patients with DILI due to antibacterials or immunosuppressants had a fatal outcome. In fact, Hy's law showed to have drug-specific predictive value, with anti-tuberculosis drugs, nimesulide, and herbal and dietary supplements associated with the worst outcome, whereas DILI caused by amoxicillin-clavulanate, nitrofurantoin, and diclofenac, which fulfilled Hy's law, did not have a fatal outcome. Features of DILI in Latin America are comparable to other prospective registries. However, the pattern of drugs responsible for DILI differs. An increasing incidence of herbal and dietary supplements, with high mortality rate, and likewise, nimesulide and nitrofurantoin, was noted. Thus, public health policies should raise awareness of the potential adverse effects of these compounds. [Display omitted] [ABSTRACT FROM AUTHOR]

It has previously been demonstrated that utilization of ambulatory surgery centers (ASCs) results in cost savings and improved outcomes. Despite these benefits, Medicare reimbursement for professional fees at ASCs are decreasing over time. In this study, we sought to analyze the discrepancy between facility fee and professional fee reimbursements for ASCs by Medicare for common shoulder procedures over time. We hypothesized that professional fees for shoulder procedures would decrease over the study period while facility fees kept pace with inflation. Current Procedural Terminology codes were used to identify shoulder specific procedures approved for ASCs by Centers for Medicare and Medicaid Services. Procedures were grouped into arthroscopic and open categories. Publicly available data from Centers for Medicare and Medicaid Services was accessed via the Medicare Physician Fee Schedule Lookup Tool and used to determine professional fee payments from 2018 to 2024. Additionally, Medicare ASC Payment Rates files were accessed to determine facility fee reimbursements to ASCs from 2018 to 2024. Descriptive statistics were used to calculate means and percent change over time. Compound annual growth rates were calculated and discrepancies in inflation were corrected for using the Consumer Price Index. The Benjamini and Hochberg method was used to correct P values in the setting of multiple comparisons. A total of 33 common shoulder procedures were included for analysis (10 arthroscopic codes and 23 open codes). Reimbursements for facility fees have remained significantly higher than corresponding professional fees for both open and arthroscopic procedures (P <.01). On average, facility fee reimbursements for common shoulder surgeries have risen on an annual basis in a manner consistent with inflation (P =.838). However, professional fees for these procedures have experienced a nearly uniform decline over the study period both nominally and in inflation-adjusted dollars (P =.064 and P =.005, respectively). Facility fee payments for outpatient approved shoulder surgeries have matched or outpaced inflation. Over the same time period, professional fee reimbursements for surgeons are consistently decreasing, both in absolute and inflation-adjusted dollars. Reform to the physician fee schedule is necessary to ensure that Medicare patients retain access to high-quality physician care. [ABSTRACT FROM AUTHOR]

The impact of the COAPT results on clinical practice has not yet been investigated in large real-world cohort study. The aim of the study is to evaluate the potential impact of the COAPT trial by analyzing the temporal trends of baseline characteristics and outcome of secondary mitral regurgitation (SMR) patients undergoing MitraClip (MC) included in the GIOTTO registry. The study population was divided into 2 groups, considering the enrolment before or after the COAPT publication. Temporal trend analyses were performed to evaluate the changes in baseline patients' characteristics and clinical outcome over time, and whether the COAPT publication influenced these changes. The outcome measure was the composite of hospitalization for heart failure (HF) and all-cause death at 1 year. The analysis included 1184 consecutive SMR patients treated with MC at 19 Italian centres between January 2016 and March 2020, 809 (68.3%) in the pre-COAPT group and 375 (31.7%) in the post-COAPT group. Temporal trend analyses showed a decreasing trend for New York Heart Association (NYHA) class (P =.003), hemoglobin (P =.014), and a significant upward trend for left ventricular ejection fraction (P <.001) and peripheral arterial disease (PAD, P =.046). The publication of the COAPT trial impacted only on NYHA trend. Nonsignificant differences in the composite outcome were observed between groups (P =.086). The selection process of SMR patients undergoing MC changed over time, with a significant impact of the COAPT publication mainly on the trend of NYHA class. At 1-year, patients in the post-COAPT group showed a nonsignificant reduction in the incidence of hospitalization for HF and all-cause death. [ABSTRACT FROM AUTHOR]

Cold mix patching materials (CMPMs) present an environmentally friendly and sustainable solution for addressing road potholes, particularly during cold and wet weather conditions. While they offer cost-effectiveness and reduced ecological impact, CMPMs encounter challenges related to their mechanical and functional performance in practical applications. There is an increasing demand for higher-quality CMPMs, yet their durability tends to be relatively short-lived. This study conducted a comprehensive assessment of various CMPM variants available on the European market, such as solvent-containing mixtures (SC) and membrane-containing mixtures (MC). The investigation placed specific emphasis on critical aspects, including stability, workability, raveling, and bonding, employing both conventional and innovative testing methodologies such as Marshall stability, indirect tensile strength, Hubbard-Field stability, indentation stability, Leutner shear bond, locking point, and brush tests conducted across a spectrum of temperatures and compaction pressures. The findings indicated that mixtures with locking points ranging from 40 to 60 exhibited good to excellent workability. MC mixtures generally outperformed SC mixtures, except in terms of bonding properties. Despite achieving air voids of up to 31.7 %, their stabilities exceeded recommended values in the literature. Optimal abrasion resistance was observed with higher compaction pressure (600 kPa) and longer cure time (30 days) working in conjunction. Furthermore, increasing the compaction pressure from 200 kPa to 600 kPa resulted in a two to threefold increase in interlayer shear strength for all products. [ABSTRACT FROM AUTHOR]

Long-term effects of coronavirus disease 2019 (long COVID) develop in a substantial number of people following an acute COVID-19 episode. Red beetroot juice may have positive effects on multiple pathways involved in long COVID. The aim of this pilot study was to explore the impact of beetroot juice supplementation on physical function, gut microbiota, and systemic inflammation in adults with long COVID. A single-center, double-blind, placebo-controlled randomized trial was conducted to test the effects of 14 days of beetroot juice supplementation, rich in nitrates and betalains, on functional and biological outcomes in adults aged between 20 and 60 years with long COVID. Participants were randomized 1:1 to receive either daily oral supplementation with 200 mL beetroot juice (∼600 mg nitrate) or placebo (∼60 mg nitrate) for 14 days. The primary endpoint was the change from baseline to day 14 in a fatigue resistance test. Secondary outcomes included the distance walked on the 6-min walk test, handgrip strength, and flow-mediated dilation. Secondary endpoints also included changes from baseline in circulating inflammatory mediators and metagenomic and fecal water metabolomic profiles. Partial least squares discriminant analysis (PLS−DA) models were built to evaluate the differences in biological variables associated with the interventions. Thirty-one participants were randomized in the study. Twenty-five of them (median (interquartile range) age 40 (10), 14 [56 %] women), received either beetroot juice (15) or placebo (10) and completed the study. At 14 days, fatigue resistance significantly improved from baseline (mean difference [standard error]: +21.8 [3.7] s; p < 0.001) with no significant differences between intervention groups. A significant increase from baseline in the distance walked on the 6-min walk test was observed (mean difference [standard error]: +30.0 [9.4] m; p = 0.03), which was not different between groups. Flow-mediated dilation did not differ between participants who received beetroot juice and those on placebo. PLS–DA models allowed correct classification of participants with 92.2 ± 4.4 % accuracy. Those who ingested red beetroot juice had a greater abundance of bacteria with well-known beneficial effects, including Akkermansia , Oscillospira , Prevotella , Roseburia , Ruminococcaceae , and Turicibacter , compared with placebo. Participants allocated to beetroot juice supplementation were also characterized by significantly higher levels of fecal nicotinate, trimethylamine, and markers of beetroot juice intake (e.g., 5,6-dihydroxyindole). Finally, higher levels of interferon gamma and macrophage inflammatory protein-1β were found in participants who consumed beetroot juice. Beetroot juice supplementation for two weeks did not to induce significant improvements in functional outcomes in adults with long COVID compared with placebo. Beneficial effects were observed in both gut microbiota composition (i.e., increase in probiotic species) and inflammatory mediators. Trial was registered under ClinicalTrials.gov. Identifier no. NCT06535165. [ABSTRACT FROM AUTHOR]

Apraglutide is a novel long-acting GLP-2 analog in development for short bowel syndrome with intestinal failure (SBS-IF). This multicenter, open-label, phase 2 study in SBS-IF and colon-in-continuity (CiC) investigates the safety and efficacy of apraglutide. This was a 52-week phase 2 metabolic balance study (MBS) in 9 adult patients with SBS-IF-CiC receiving once-weekly subcutaneous apraglutide injections. Safety was the primary endpoint. Secondary endpoints included changes in absorption parameters (MBS at baseline, after 4 weeks with stable parenteral support (PS), and 48 weeks), PS needs (48-week PS adjustment period based on monthly 48-h fluid balances) and intestinal morphology and motility (static and cine MRI at baseline and 4, 24 and 48 weeks). PS volume decreased by −4702 mL/week (−52 %; p < 0.001) at week 52. Seven patients (78 %) achieved ≥1 day off PS at week 52. At 4 weeks, fecal output was reduced by 253 g/day (p = 0.013). At 48 weeks, increases in wet weight absorption by 316 g/day (p = 0.039), energy absorption by 1134 kJ/day (p = 0.041) and carbohydrate absorption by 56.1 g/day (p = 0.024) were observed. Moreover, small bowel length increased from 29.7 to 40.7 cm (p = 0.012), duodenal wall thickness increased by 0.8 mm (p = 0.02) and motility in the proximal colon was reduced (p = 0.031). A total of 127 adverse events was reported, which were mostly mild to moderate. Apraglutide had an acceptable safety profile and was associated with significant reductions in PS needs and days off PS, improvements in intestinal absorption, and structural and functional intestinal changes in patients with SBS-IF-CiC. ClinicalTrials.gov, Number NCT04964986. [ABSTRACT FROM AUTHOR]

Tumours of the anterior pituitary account for around 20% of intracranial neoplasms and are the most common tumours of the entire neuroendocrine system, representing a sizeable proportion of the diagnostic workload for specialist pituitary centres. The 5th edition WHO Classification of Endocrine and Neuroendocrine Tumours (ENDO5) introduced changes to the classification of adenohypophyseal cell tumours including the nomenclature of pituitary neuroendocrine tumours (PitNET), the introduction of an ICD-O code for malignancy, and the term 'metastatic PitNET' to replace pituitary carcinoma, and further emphasis in the diagnostic use of lineage restricted transcription factors. ENDO5 did not mention any progress in the molecular profiling of PitNETs or any proposal to identify PitNETs with aggressive potential. This review aims to appraise the changes introduced in ENDO5 and provide practical suggestions to interpret the classification of PitNETs and to their diagnostic approach. [ABSTRACT FROM AUTHOR]

Evaluation of treatment outcomes in patients supported by temporary mechanical circulatory support (tMCS) currently relies mainly on mortality, which may not sufficiently address other patient benefits or harms. Bleeding and thrombosis are major contributors to mortality. Still, current bleeding scores are not designed for critically ill patients undergoing tMCS, only consider selected populations, and do not account for the high heterogeneity among bleeding and thrombotic adverse events. To improve clinical management, a group of European experts has proposed a revised scoring system based on the MOMENTUM 3 Hemocompatibility Score and the Society of Cardiac Angiography and Interventions (SCAI)classification of cardiogenic shock. The new system termed the Scoring Haemostasis Events and Assessment for Risk (SHEAR) score, is divided into a baseline characterization stage and four escalating scoring stages encompassing all aspects of clinical relevance. This report summarizes the literature on hemocompatibility-related adverse events associated with tMCS, including bleeding, stroke, vascular access complications, hemolysis, thrombosis, and device failure. The SHEAR score provides a simple and rapid bedside scoring system aiming to provide a univocal tool to increase physician awareness of hemocompatibility complications at baseline and beyond, improve clinical research, and enable the capture of device-related complications that will inform relevant outcomes beyond mortality. [Display omitted] [ABSTRACT FROM AUTHOR]

Most patients receiving atezolizumab-bevacizumab (AB) for hepatocellular carcinoma will eventually experience disease progression. Randomized clinical trials (RCTs) are undergoing to identify second-line treatments. Where RCTs are unavailable or patients are non-eligible, sorafenib is often prescribed based on approval and reimbursement policies. However, evidence supporting this approach is minimal. To assess the efficacy and safety of sorafenib in patients who permanently discontinued AB. The ARTE database prospectively collects patients treated with AB in a real-life setting. We analysed the outcome of patients who received sorafenib as second-line treatment. Amongst 213 patients, 130 (61.0 %) permanently discontinued AB. Of them, 54 received second- line treatments, and sorafenib was prescribed in 40 patients. The disease control rate (DCR) was 10.0 %. The median progression-free (PFS) and overall survival were 3.3 (95 % confidence interval [CI] 2.7-3.9) and 6.9 months (95 % CI 2.7-11.1), respectively. In patients progressing under AB, the efficacy of sorafenib on different outcomes is limited. [ABSTRACT FROM AUTHOR]

To evaluate the safety and effectiveness of lateral or posterolateral percutaneous vertebroplasty (PVP) of osteolytic C1–C2 lesions performed under computed tomography (CT) guidance and local anesthesia. A retrospective study of 16 consecutive patients (11 females and 5 males; aged from 24 to 86 years; median age, 65.5 years) who underwent 17 lateral or posterolateral PVP was performed. Pain status was assessed using a visual analog scale (VAS). Patients were evaluated preprocedurally as baseline and at 24 hours and 1, 6, and 12 months postprocedurally, until death, or until loss to follow-up. The Oswestry Disability Index was used to evaluate the patients' functional disability preprocedurally. The adverse events were recorded using the Society of Interventional Radiology (SIR) classification. The technical success was 100% (17/17) for a median Spinal Instability Neoplastic Score of 13.5 (interquartile range [IQR], 6.8, 20.3). Mean clinical follow-up was 10.1 months (range, 6–36 months; median, 19.5 months, IQR, 4, 35 months). Mean VAS score decreased significantly from 7.5 (SD ± 2.1) preprocedurally to 1.6 (SD ± 1.5) 24 hours postprocedurally, and 1.0 (SD ± 1.1), 1.5 (SD ± 1.0), and 0.5 (SD ± 1.5) at 1, 6, and 12 months, respectively (all P <.001). No severe adverse events were observed, but 3 cases of asymptomatic cement leakage were noted (SIR Grade 1; 17.6% [3/17]). Lateral and posterolateral PVP performed under CT guidance and local anesthesia is safe and effective to treat symptomatic osteolytic C1–C2 lesions. [Display omitted] [ABSTRACT FROM AUTHOR]

Few data are available on long-term drug therapy and its potential prognostic impact after Takotsubo syndrome (TTS). Aim of the study is to evaluate clinical characteristics and long-term outcome of TTS patients on Renin Angiotensin system inhibitors (RASi). TTS patients were enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry. Median follow-up was 31 (Interquartile range 12-56) months. Comparison of RASi treated vs. untreated patients was performed within the overall population and after 1:1 propensity score matching for age, sex, comorbidities, type of trigger and in-hospital complications. clinicaltrials.gov, NCT04361994, https://clinicaltrials.gov/study/NCT04361994 Of the 2453 TTS patients discharged alive, 1683 (68%) received RASi therapy. Patients with RASi were older (age 71 ± 11 vs 69 ± 13 years, P =.01), with higher prevalence of hypertension (74% vs 53%, P <.01) and diabetes (19% v s15%, P =.01), higher admission left ventricular ejection fraction (LVEF) (41 ± 11% vs 39 ± 12%, P <.01) and lower rates of in-hospital complications (18.9% vs 29.6%, P <.01). At multivariable analysis, RASi therapy at discharge was independently associated with lower mortality (HR 0.63, 95% CI 0.45-0.87, P <.01). Survival analysis showed that at long term, patients treated with RASi had lower mortality rates in the overall cohort (log-rank P =.001). However, this benefit was not found among patients treated with RASi in the matched cohort (log-rank P =.168). Potential survival benefit of RASi were present, both in the overall and matched cohort, in 2 subgroups: patients with admission LVEF ≤ 40% (HR 0.54 95% CI 0.38-0.78, P =.001; HR 0.59, 95% CI 0.37-0.95, P =.030) and diabetes (HR 0.41, 95% CI 0.23-0.73, P =.002; HR 0.41, 95% CI 0.21-0.82, P =.011). Long-term therapy with RASi after a TTS episode was not associated with lower mortality rates at propensity score analysis. However, potential survival benefit can be found among patients with admission LVEF ≤ 40% or diabetes. [Display omitted] [ABSTRACT FROM AUTHOR]

There are sex differences in HF patients. It is not clear whether such differences mainly reflect cultural behaviours and clinical inertia, and the role of sex on clinical outcomes is still controversial. We aimed to investigate the association of sex with in-hospital management and outcomes in patients with HF. We analyzed data of 4016 adult patients hospitalized for HF in 2020 to 2021 and enrolled in a multicentre national registry. Women (n = 1,818 [45%]) were older than men (83 vs 77 years, P <.0001), with a higher prevalence of arterial hypertension (73% vs 69%, P =.011) and atrial fibrillation. Women presented more frequently with HF and preserved ejection fraction -HFpEF (55% vs 32%, P <.001). They were more often hospitalized in internal medicine departments (71% vs 51%), and men in highly specialized cardiology units (49% vs 29%). When considering HF pharmacological treatments at discharge in the subgroup with reduced ejection fraction -HFrEF (n=1525), there were no significant differences (49% of women treated with GDMT [guideline-directed medical therapy] vs 52% of men, P =.197). Sex was not associated either with hospital readmissions (30-days OR [95% CI] = 0.89 [0.71-1.11], P =.304; 1-year OR [95% CI] = 1.02[0.88-1.19], P =.777) or with mortality (in-hospital OR [95% CI] = 1.14 [0.73-1.78], P =.558; 1-year OR [95% CI] = 1.08 [0.87-1.33], P =.478). Similar results were obtained when considering different HF categories based on left ventricular ejection fraction. Women and men exhibited distinct clinical profiles. Although this may have had an impact on hospital pathways (noncardiology/cardiology units) and pharmacological prescriptions, sex per se did not appear as an independent determinant of clinical choices. Moreover, when considering homogeneous groups, women were not undertreated. Finally, female sex was not associated with worse clinical outcomes. Although women and men with heart failure exhibit different phenotypic profiles which in turn may impact on in-hospital management, sex per is not an independent determinant of either the choice of the admitting ward or the prescription of a guideline-directed medical therapy at discharge. Moreover, sex is not independently associated with poor outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Reducing mitral regurgitation (MR) during mitral transcatheter edge-to-edge repair (M-TEER) may come at the cost of increased mitral valve gradient (MVG). The combined impact of residual MR and MVG on clinical outcomes after M-TEER is unknown. This study sought to evaluate the impact of postprocedure MR and MVG on clinical outcomes after M-TEER. EXPANDed is a pooled, patient-level cohort of the EXPAND (A Contemporary, Prospective Study Evaluating Real-world Experience of Performance and Safety for the Next Generation of MitraClip Devices) and EXPAND G4 studies, which were designed to evaluate real-world safety and effectiveness of the third- and fourth-generation MitraClip TEER Systems. Subjects were categorized by echocardiographic core laboratory (ECL) assessments into 4 groups according to 30-day MR grade and mean MVG: 1) MR ≤1+/MVG <5 mm Hg; 2) MR ≤1+/MVG ≥5 mm Hg; 3) MR ≥2+/MVG <5 mm Hg; and 4) MR ≥2+/MVG ≥5 mm Hg. A total of 1,723 subjects had evaluable echocardiograms at 30 days: 72% had MR ≤1+/MVG <5 mm Hg, 18% had MR ≤1+/MVG ≥5 mm Hg, 7% had MR ≥2+/MVG <5 mm Hg, and 3% had MR ≥2+/MVG ≥5 mm Hg. MR≤1+ was sustained through 1 year in 93% of patients who achieved 30-day MR≤1+. MVG decreased from 30 days to 1 year in subjects with MVG ≥5 mm Hg (6.7 ± 4.0 to 5.5 ± 2.5 mm Hg MR ≤1+/MVG ≥5 mm Hg and 6.5 ± 1.5 to 5.5 ± 1.7 mm Hg MR ≥2+/MVG ≥5 mm Hg). One-year rates of all-cause mortality and heart failure hospitalization were lower for subjects who achieved MR ≤1+ at 30 days, regardless of MVG. Reduction of MR to mild or less after M-TEER with the latest-generation MitraClip systems was associated with clinical benefit regardless of MVG. [Display omitted] [ABSTRACT FROM AUTHOR]

Edema in the subcutaneous soft tissue of the lumbar spine is a frequent incidental finding in spinal magnetic resonance imaging, however, its exact explanation is yet to be determined. The aim of this paper is to provide a systematic literature review on posterior lumbar subcutaneous edema (LSE). The present systematic literature search was carried out in October 2023 using electronic databases: PubMed, Cochrane library, and Scopus. The current evidence suggests that lumbar edema is correlated with clinical data such as weight and age, and potentially female sex. Moreover, LSE is related to several specific conditions, including both systemic and spinal disorders, such as heart or kidney disorders, as well as low back pain and degenerative and/or inflammatory diseases. It is important to be aware that there is an association between LSE and a variety systemic and spinal disorders. [ABSTRACT FROM AUTHOR]

Synovitis is a widely accepted sign of osteoarthritis (OA), characterised by tissue hyperplasia, where increased infiltration of immune cells and proliferation of resident fibroblasts adopt a pro-inflammatory phenotype, and increased the production of pro-inflammatory mediators that are capable of sensitising and activating sensory nociceptors, which innervate the joint tissues. As such, it is important to understand the cellular composition of synovium and their involvement in pain sensitisation to better inform the development of effective analgesics. Studies investigating pain sensitisation in OA with a focus on immune cells and fibroblasts were identified using PubMed, Web of Science and SCOPUS. In this review, we comprehensively assess the evidence that cellular crosstalk between resident immune cells or synovial fibroblasts with joint nociceptors in inflamed OA synovium contributes to peripheral pain sensitisation. Moreover, we explore whether the elucidation of common mechanisms identified in similar joint conditions may inform the development of more effective analgesics specifically targeting OA joint pain. The concept of local environment and cellular crosstalk within the inflammatory synovium as a driver of nociceptive joint pain presents a compelling opportunity for future research and therapeutic advancements. [ABSTRACT FROM AUTHOR]

In order to evaluate the early radiographic characteristics of the lateral talocalcaneal (L-TC) angle in patients with idiopathic clubfoot (ICF) and to investigate its prognostic significance for relapse after initial treatment with the Ponseti method. We retrospectively included 151 patients (96 males and 55 females; 227 feet) with ICF treated at our Institution between January 2005 and December 2014. The age at initial treatment was less than 6 months, and radiographs were obtained within 3 months of the Achilles tenotomy (mean age: 2.3 months; range: 0.77-6.8). All patients were followed up for at least 7 years (range, 7-18). The participants' feet were classified into 3 groups: relapsed (Group A), not relapsed (Group B), and normal foot groups which consisted of healthy feet in patients with unilateral ICF (Group C). All angle measurements were expressed in degrees. Forty-seven ICF feet in 33 patients relapsed, while 180 feet in 118 patients did not, and the age at relapse was 5.92 ± 1.91 years. Seventy-five normal feet were included in Group C. The average L-TC angle in Group A and B patients was 33.57° ± 12.05° and 39.37° ± 12.55°, respectively, while Group C was 49.61° ± 9.11°. A significant difference was found among the 3 groups of patients (F = 31.48, p <.001). The L-TC angle cut-off value below which a recurrence could be predicted was 36.1° (sensitivity, 74.47%). The L-TC angle of ICF patients treated using the Ponseti method were reduced compared to normal feet. An L-TC angle of <36.1° has relative value in predicting ICF relapse. [ABSTRACT FROM AUTHOR]

Retrusive profiles show an appearance of aging with an under-projected vermilion and pronounced nasolabial folds due to deficient bone support. A study was made of the association between orthognathic surgery and changes in the nasolabial and vermilion areas in patients with retrusive profiles. A retrospective cohort study evaluated patients subjected to bimaxillary surgery according to the Barcelona Line (BL) protocol during 2021 at Teknon Medical Center (Barcelona, Spain). Subjects with craniofacial syndromes, facial esthetic procedures, and dental rehabilitations involving lip changes, were excluded. The predictor variable was the timing of cephalometric measures, reported as T0 (preoperatively), T1 (1 month after surgery), and T2 (after 1 year of follow-up). The outcome variable corresponded to the soft tissue changes of the nasolabial and vermilion area, reported as the nasolabial fold length and angle, nasolabial angle, upper lip concavity, vermilion length, and upper lip sagittal distance from BL. The covariates comprised patient demographic data, the surgical-orthodontic protocol, and the magnitude and direction of the skeletal movements. Descriptive and inferential analyses were performed based on analysis of variance, the Bonferroni test, Pearson's linear coefficient, the nonparametric Mann-Whitney U-test, Kruskal-Wallis test, and multiple linear regression models. Statistical significance was considered for P <.05. The sample comprised 27 subjects with a mean age of 32.5 ± 11.2 years. A mean decrease in nasolabial angle of 5.5 ± 6° was recorded (P <.001), with a shortening of the nasolabial fold length of 4.4 ± 7.6 mm (P =.019). An increase in upper lip concavity angle of 14.4 ± 12° was recorded (P <.001), along with a vermilion lengthening of 1.6 ± 1.3 mm (P <.001) and an increase in upper lip sagittal distance to BL of 5.7 ± 7.3 mm (P =.001), indicating a more projected and everted upper vermilion. When adequate dentoskeletal support is provided by specific positional changes of the jaws planned through orthognathic surgery, the length of the nasolabial fold decreases, and the upper vermilion lengthens and becomes slightly everted. [ABSTRACT FROM AUTHOR]

Several randomized clinical trials comparing different bowel preparations (BP) have shown similar efficacy; however, there is a lack of real-world studies on this topic. This study aims to identify the most effective BP regimen in a real-world setting and any predictors of inadequate BP. A retrospective single-center study was conducted over 14 months at an academic hospital including outpatient colonoscopies in which adult patients did not teach on how to perform BP before colonoscopy. Colonoscopies with 1L-PEG, 2L-PEG and picosulphate mixtures were considered. A multivariable analysis for factors associated to poor BP was fitted. Overall, 1779 patients (51 %F, 60±14) years were included. The 1L-PEG regimen provided a higher rate of BP adequacy at multivariate analysis (adjusted OR 2.30, 95 %CI 1.67–3.16, p < 0.001) and was associated with higher median Boston Bowel Preparation Scale score (p < 0.001), higher rate of right-colon cleansing (p < 0.001) and exam completion (p = 0.04). Furthermore, we identified male sex, history of constipation, active smoking, previous pelvic surgery, concomitant psychiatric/neurological or chronic kidney diseases as predictors of inadequate BP. This is the largest real-world study comparing 1L-PEG to other BP regimens. Our results suggest 1L-PEG provides better BP in a non-controlled setting, improving clinical practice quality and minimizing the need for repeated colonoscopies and saving healthcare resources. [ABSTRACT FROM AUTHOR]

• One in five cirrhotic patients in a western European cohort developed HCC. • The one, three- and five-year HCC cumulative incidence is 1%, 10% and 17%. • In non-cirrhotic chronic hepatitis patients one in forty two (2%) developed HCC. • Follow up MRI of up to 10 months may suffice for detection of very early HCC. • Advanced stages of HCC are seen with prolonged time intervals (median 21 months). To investigate the utilization of MRI using a MRI liver protocol with extracellular contrast-enhanced series for hepatocellular carcinoma (HCC) surveillance in high-risk patients. Consecutive high-risk patients of a western European cohort who underwent repeated liver MRI for HCC screening were included. Lesions were registered according to the Liver Reporting & Data System (LIRADS) 2018. HCC was staged as very early stage HCC (BCLC stage 0) and more advanced stages of HCC (BCLC stage A-D). Differences in time interval between MRI's for BCLC stage 0 and stage A-D were calculated with the Mann-Whitney U test. The HCC cumulative incidence at one-, three- and five years was calculated with the Kaplan Meier estimator. From 2010 to 2019 a total of 240 patients were included (71% male; median age: 57 years; IQR: 50-64 years) with 1350 MRI's. Most patients (83 %) had cirrhosis with hepatitis C as the most common underlying cause. Patients underwent on average four MRI's (IQR: 3-7). Forty-two patients (17.5%) developed HCC (52 HCC lesions: 43 LIRADS-5, eight LIRADS-4, and one LIRADS-TIV). Eighteen patients (43%) had BCLC stage 0 HCC with a significant shorter screening time interval (10 months; IQR: 6-21) compared to patients with BCLC stage A-D (21 months; IQR: 10-32) (p = 0.03). Thirty seven percent of patients with a LIRADS-3 lesion (n=43) showed HCC development within twelve months (median: 7.4 months). One, three- and five-year HCC cumulative incidence in cirrhotic patients was 1%, 10% and 17%, respectively. High-risk patients who underwent surveillance with contrast-enhanced MRI developed HCC in 17.5 % during a follow up period of over 4 years median. Very early stage HCC was seen in compensated cirrhosis after a median time interval of 10 months. Later stages of HCC were related to prolonged screening time interval (median 21 months). [ABSTRACT FROM AUTHOR]

Adhesive capsulitis, or frozen shoulder, causes pain and reduces glenohumeral joint motion. This study aims to assesses ultrasound-guided hydrodistention with rehabilitation in hospital versus home settings. Forty patients with adhesive capsulitis were split into two groups: one received hydrodistention with hospital-assisted rehabilitation, and the other with home-based rehabilitation, following the same exercise protocol. Clinical assessments included range of motion (ROM), numeric pain rating scale (NPRS), shoulder pain and disability index (SPADI), disability of the arm, shoulder and hand (DASH), and assessment shoulder and elbow scale (ASES) The hospital-based group showed more rapid and substantial improvements in ROM and NPRS scores compared to the home-based group. The hospital-based group had a mean flexion ROM of 104.3 ± 31.6°, which increased to 149.5 ± 20.6° at the final follow-up. The home-based group started with a mean flexion ROM of 103.3 ± 29.2°, improving to 161.3 ± 23.2° by the end of the study. Both groups showed significant improvements, with the home-based group slightly outperforming in flexion ROM by the third follow-up. Initial NPRS scores were 4.7 ± 1.92 for the hospital-based group and 6.6 ± 1.63 for the home-based group. By the six-month mark, the hospital-based group's SPADI score dropped to 17.4 ± 19.5, while the home-based group's score was 10.5 ± 13.03. Both groups demonstrated significant improvements, with the hospital-based group showing slightly better outcomes at various follow-ups. Hydrodistention combined with supervised rehabilitation is optimal for treating frozen shoulder, though home-based therapy is also effective. Both methods significantly benefit from hydrodistention, highlighting its importance in treatment strategies. [ABSTRACT FROM AUTHOR]

Endoscopic Submucosal Dissection (ESD) has been reported as a feasible and effective treatment for Rectal Neuroendocrine Tumours (R-NETs). However, most of the experience on the topic comes from retrospective tertiary centre from Eastern Asia. Data on ESD for R-NETs in Western centres are lacking. This is a retrospective study, including patients who underwent endoscopic resection of R-NETS by ESD between 2015 and 2020 in Western Centres. Important clinical variables such as demographic, size of R-NETs, histological type, presence of lymphovascular invasion or distant metastasis, completeness of the endoscopic resection, recurrence, and procedure related complications were recorded. 40 ESD procedure on R-NETs from 39 patients from 8 centres were included. Mean R-NETs size was 10.3 mm (SD 4.01). Endoscopic en-bloc resection was achieved in 39/40 ESD (97.5 %), R0 margin resection was obtained in 87.5 % (35/40) of the procedures, one patient was referred to surgery for lymphovascular invasion, two procedures (5 %) reported significant episodes of bleeding, whereas a perforation occurred in one case (1/40, 2.5 %) managed endoscopically. Recurrence occurred in 1 patient (2.5 %). ESD is an effective and safe treatment for R-NETs in western centres. [ABSTRACT FROM AUTHOR]

The use of lower-pole sling products has made immediate breast reconstruction a feasible option in women undergoing skin-nipple sparing and skin-reducing mastectomies. To date, available data on the comparative efficacy of biological and synthetic meshes regarding postoperative complications are scattered and limited. A systematic literature search was performed to screen three different databases (PubMed, Web of Sciences, and Embase) using the following keywords: "breast reconstruction" AND "TiLOOP®" OR "Titanium-Coated Polypropylene Mesh" OR "TCPM". The perioperative and demographic characteristics of patients, complications profiles, and patient-reported outcomes were considered. We initially identified 234 articles, of which only 41, including 3923 patients and 5042 reconstructed breasts, fully satisfied the inclusion criteria. TiLOOP® Bra could be considered a safe and aesthetically valid alternative to Acellular Dermal Matrices (ADMs) in non-smokers patients undergoing skin-nipple sparing and skin-reducing mastectomies and immediate reconstruction. In such populations, complications are more likely to develop in patients with extreme body mass index values. The incidence of seroma with TiLOOP® Bra is comparable to that of ADMs as it is the beneficial effect in radiated patients, where TiLOOP® Bra seems superior to implant alone reconstruction. It has a good bio-integration with host tissues and resistance to infections in patients with a weakened immune system as a consequence of oncologic perioperative treatments. [ABSTRACT FROM AUTHOR]

There are limited real-world data on the extended prognosis of patients with drug-induced type 1 Brugada electrocardiogram (ECG). We assessed the clinical outcomes and predictors of life-threatening arrhythmias in patients with drug-induced type 1 Brugada ECG. This multicenter retrospective study, conducted at 21 Italian and Swiss hospitals from July 1997 to May 2021, included consecutive patients with drug-induced type 1 ECG. The primary outcome, a composite of appropriate ICD therapies and sudden cardiac death, was assessed along with the clinical predictors of these events. A total of 606 patients (mean age 49.7 ± 14.7 years; 423 [69.8%] men) were followed for a median of 60.3 months (interquartile range 23.0–122.4 months). Nineteen patients (3.1%) experienced life-threatening arrhythmias, with a median annual event rate of 0.5% over 5 years and 0.25% over 10 years. The SCN5A mutation was the only predictor of the primary outcome (hazard ratio 4.54; P =.002), whereas a trend was observed for unexplained syncope (hazard ratio 3.85; P =.05). In patients who were asymptomatic at presentation, the median annual rate of life-threatening arrhythmias is 0.24% over 5 years and increases to 1.2% if they have inducible ventricular fibrillation during programmed ventricular stimulation. In patients with drug-induced type 1 Brugada ECG, the annual risk of life-threatening arrhythmias is low, with the SCN5A mutation as the only independent predictor. Unexplained syncope correlated with worse clinical outcomes. Ventricular fibrillation inducibility at programmed ventricular stimulation significantly increases the median annual rate of life-threatening arrhythmias from 0.24% to 1.2% over 5 years. [Display omitted] [ABSTRACT FROM AUTHOR]

Radiogenomics of clear cell renal cell carcinoma (ccRCC) has been developed thanks to the availability of genomic data, both gene expressions and gene mutations, obtained through the sequencing of ccRCC genome. These data are collected in the Cancer Genome Atlas (TCGA) Research Network-work. Disintegrin and metalloproteinase domain-containing protein 12 (ADAM12) gene belongs to the family of genes coding for multidomain and multifunctional type I transmembrane proteins ADAMs. These proteins are fundamental for regulating cell adhesion and mediating proteolysis of a series of cell surface receptors and signal molecules extracellular domains. Recently, a correlation was detected between ADAM12 expression in ccRCC and tumor aggressiveness in terms of cell proliferation, migration, invasion, tumor progression, metastases, and poor prognosis, suggesting ADAM12 as a prognostic marker and therapeutic target in ccRCC. The computed tomography (CT) imaging phenotype of ADAM12 expression in ccRCC has never been studied. The aim of this study is to investigate the CT imaging phenotype of ADAM12 expression in ccRCC patients. In this retrospective study, we enrolled 202 ccRCC patients divided into two groups: ccRCC patients with ADAM12 expression (n = 35) and ccRCC patients without ADAM12 expression (n = 167). Different imaging features were evaluated on CT scan at first diagnosis. The statistical significance threshold was set at p < 0.05. A statistically significant correlation was found with larger primary tumor size (p = 0.020), ill-defined tumor margins (p = 0.044), tumor necrosis (p = 0.011), and collecting system invasion (p = 0.014). This study demonstrates CT imaging features associated to ADAM12 expression in ccRCC. These results could help delve into ADAM12 gene status through CT approach and to further investigate towards the development of targeted therapies in ccRCC. [ABSTRACT FROM AUTHOR]

Winter is a critical period for the survival of local bird species in temperate regions. Some wintering birds may rely on transient food, such as that provided at birdfeeders, but bird communities around birdfeeders may also attract predators. However, these effects of birdfeeders on interspecific interactions between birds and their predators remain largely unexplored and have so far not been tested experimentally. We hypothesized that birdfeeders indirectly attract predators in winter because of the attraction of small birds, and tested this hypothesis using experimental feeders at 52 different urban and rural sites across western Poland. We found that the number of small birds increased around birdfeeders, particularly those with provided food. We found that birdfeeders that attracted more small birds (regardless of whether they provided food) attracted also more predators, such as sparrowhawks Accipiter nisus and feral cats Felis domesticus. Moreover, birdfeeders in urban habitats attracted relatively fewer small birds but not fewer predators compared to those in rural areas. Altogether, birdfeeders with food provided attracted small prey birds but they attracted also more predators, whose presence may hinder small birds from fully utilizing available resources, potentially impacting their winter survival through direct (mortality) and indirect (increased monitoring and vigilance) effects. [ABSTRACT FROM AUTHOR]

Excessive ballasted track deformations may occur during the railway operations due to poor load bearing capacity of the embankment (placed soil or natural ground) or the manifest accumulation of subsidence caused by the soil consolidation and the passage of trains. The principles of pressure grouting (or jet-grouting) technologies, used to create reinforcement elements for the rail trackbed stabilization, are presented, with reference to the specific construction condition on an existing and in-service railway track. A single-track railway, including the superstructure and substructure components, was modeled using the finite element method (FEM). Some soil stabilization options, based on the installation of grouted micropiles according to different layout configurations, were considered. The results of the numerical analyses, in the form of stress and strain behavior of the whole track structure, demonstrated that the use of jet-grouted micropiles is a rational and less expensive option, which can be installed on or close to the track, having positive effects on limiting the vertical deformations of the embankment without affecting the expected distribution of stress states in the embankment middle. [ABSTRACT FROM AUTHOR]

Functional mitral regurgitation induces adverse effects on the left ventricle and the left atrium. Left atrial (LA) dilatation and reduced LA strain are associated with poor outcomes in heart failure (HF). Transcatheter edge-to-edge repair (TEER) of the mitral valve reduces heart failure hospitalization (HFH) and all-cause death in selected HF patients. The aim of this study was to evaluate the impact of LA strain improvement 6 months after TEER on the outcomes of patients enrolled in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. The difference in LA strain between baseline and the 6-month follow-up was calculated. Patients with at least a 15% improvement in LA strain were labeled as "LA strain improvers." All-cause death and HFH were assessed between the 6- and 24-month follow-up. Among 347 patients (mean age 71 ± 12 years, 63% male), 106 (30.5%) showed improvement of LA strain at the 6-month follow-up (64 [60.4%] from the TEER + guideline-directed medical therapy [GDMT] group and 42 [39.6%] from the GDMT alone group). An improvement in LA strain was significantly associated with a reduction in the composite of death or HFH between the 6-month and 24-month follow-up, with a similar risk reduction in both treatment arms (P interaction = 0.27). In multivariable analyses, LA strain improvement remained independently associated with a lower risk of the primary composite endpoint both as a continuous variable (adjusted HR: 0.94 [95% CI: 0.89-1.00]; P = 0.03) and as a dichotomous variable (adjusted HR: 0.49 [95% CI: 0.27-0.89]; P = 0.02). The best outcomes were observed in patients treated with TEER in whom LA strain improved. In symptomatic HF patients with severe mitral regurgitation, improved LA strain at the 6-month follow-up is associated with subsequently lower rates of the composite endpoint of all-cause mortality or HFH, both after TEER and GDMT alone. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [COAPT]; NCT01626079) [Display omitted] [ABSTRACT FROM AUTHOR]