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Among gynecological pathologies, cervical cancer has always represented a health problem with great social impact. The giant strides made as a result of both the screening programs perfected and implemented over the years and the use of new and accurate technological equipment have in fact significantly improved our clinical approach in the management and personalized diagnosis of precancerous lesions of the cervix. In this context, the advent of artificial intelligence and digital algorithms could represent new directions available to gynecologists and pathologists for the following: (i) the standardization of screening procedures, (ii) the identification of increasingly early lesions, and (iii) heightening the diagnostic accuracy of targeted biopsies and prognostic analysis of cervical cancer. The purpose of our review was to evaluate to what extent artificial intelligence can be integrated into current protocols, to identify the strengths and/or weaknesses of this method, and, above all, determine what we should expect in the future to develop increasingly safer solutions, as well as increasingly targeted and personalized screening programs for these patients. Furthermore, in an innovative way, and through a multidisciplinary vision (gynecologists, pathologists, and computer scientists), with this manuscript, we highlight a key role that AI could have in the management of HPV-positive patients. In our vision, AI will move from being a simple diagnostic device to being used as a tool for performing risk analyses of HPV-related disease progression. This is thanks to the ability of new software not only to analyze clinical and histopathological images but also to evaluate and integrate clinical elements such as vaccines, the composition of the microbiota, and the immune status of patients. In fact, the single-factor evaluation of high-risk HPV strains represents a limitation that must be overcome. Therefore, AI, through multifactorial analysis, will be able to generate a risk score that will better stratify patients and will support clinicians in choosing highly personalized treatments overall. Our study remains an innovative proposal and idea, as the literature to date presents a limitation in that this topic is considered niche, but we believe that the union of common efforts can overcome this limitation.

Objective: To analyse at our institution the criteria for selecting a first-line therapy for patients with advanced radioiodine-refractory thyroid cancer and their clinical responses, safety and survival outcomes. Patients and methods: We extracted data from 69 consecutive patients referred to Federico II University Hospital from September 2016 to September 2024, among whom 44 patients were treated with TKIs as first-line treatment and outside any clinical trial, and form the basis of this report. Results: Thirty-one (71%) patients were treated with the antiangiogenesis inhibitor lenvatinib and 13 (29%) were treated with selective tyrosine kinase inhibitors (s-TKIs). Among the latter, eight patients were treated with dabrafenib + trametinib (DT), two patients were treated with selpercatinib because of contraindications to lenvatinib, and three patients received DT as redifferentiation therapy. A RECIST partial response was observed in 28% of patients treated with lenvatinib, in 63% of those treated with DT and in one of the two patients treated with selpercatinib. Grade ≥3 adverse events occurred in 13 (42%) patients treated with lenvatinib and only in 1 (9%) patient treated with DT. Progression-free survival (PFS) and overall survival rates at 1 year were 72% and 83% in lenvatinib-treated patients and 69% and 83% in DT-treated patients, respectively. In both selpercatinib-treated patients, the PFS at data cut-off was 10 months. No treatment-related deaths were observed. Conclusion: S-TKIs permitted tailoring systemic treatment based on disease location, tumour volume and patient comorbidities, achieving satisfactory tolerance and outcomes in selected patients with an actionable driver mutation and with contraindications to angiogenesis inhibitors or candidates for redifferentiation therapy.

Purpose: This research conducts an analysis of biodiversity reporting among a sample of companies listed on the stock exchanges of South Africa (SA) and the United Kingdom (UK). The aim is to present empirical evidence on how organisations address and report on biodiversity-related matters to their stakeholders and investors. Design/methodology/approach: A disclosure schematic is developed and applied to the selected companies using content analysis to analyse their biodiversity-related disclosures and draw comparisons between the two jurisdictions. Findings/results: Results indicate that South African organisations demonstrate a higher level of visibility in their biodiversity reporting when compared to their UK counterparts. The primary reason for this is because of a higher biodiversity ranking and hosting more biodiversity hotspots, which impact South African organisations. However, UK companies tend to provide more quantitative and valuation-based disclosures because of their advanced management information systems, professional standards network support and access to financial resources. In general, it is observed that biodiversity reporting is still in its nascent stage in both jurisdictions and offers limited insight into the understanding of biodiversity by organisations and their ability to incorporate direct and indirect impacts into their business models, risk assessment and strategy implementation. Practical implications: The disclosure schematic serves as a valuable tool for evaluating biodiversity reporting in different national contexts and provides a framework for companies developing biodiversity action plans. The findings help stakeholders assess organisations’ progress in achieving biodiversity objectives and integrating biodiversity considerations into business operations. Originality/value: This study makes two unique contributions to the literature. First, it provides one of the first comparative analyses of biodiversity reporting between a developing and developed economy, offering novel insights into how different jurisdictional contexts influence reporting practices. Second, it develops and applies a comprehensive disclosure schematic that enables evaluation of both symbolic and substantive biodiversity reporting approaches, advancing our understanding of how organisations integrate biodiversity considerations into their reporting and operations.

Summary: Background: Perivascular spaces (PVS) on brain MRI are surrogates for small parenchymal blood vessels and their perivascular compartment, and may relate to brain health. However, it is unknown whether PVS can predict dementia risk and brain atrophy trajectories in participants without dementia, as longitudinal studies on PVS are scarce and current methods for PVS assessment lack robustness and inter-scanner reproducibility. Methods: We developed a robust algorithm to automatically assess PVS count and size on clinical MRI, and investigated 1) their relationship with dementia risk and brain atrophy in participants without dementia, 2) their longitudinal evolution, and 3) their potential use as a screening tool in simulated clinical trials. We analysed 46,478 clinical measurements of cognitive functioning and 20,845 brain MRI scans from 10,004 participants (71.1 ± 9.7 years-old, 56.6% women) from three publicly available observational studies on ageing and dementia (the Alzheimer’s Disease Neuroimaging Initiative, the National Alzheimer’s Coordinating Centre database, and the Open Access Series of Imaging Studies). Clinical and MRI data collected between 2004 and 2022 were analysed with consistent methods, controlling for confounding factors, and combined using mixed-effects models. Findings: Our fully-automated method for PVS assessment showed excellent inter-scanner reproducibility (intraclass correlation coefficients >0.8). Fewer PVS and larger PVS diameter at baseline predicted higher dementia risk and accelerated brain atrophy. Longitudinal trajectories of PVS markers differed significantly in participants without dementia who converted to dementia compared with non-converters. In simulated placebo-controlled trials for treatments targeting cognitive decline, screening out participants at low risk of dementia based on our PVS markers enhanced the power of the trial independently of Alzheimer’s disease biomarkers. Interpretation: These robust cerebrovascular markers predict dementia risk and brain atrophy and may improve risk-stratification of patients, potentially reducing cost and increasing throughput of clinical trials to combat dementia. Funding: US National Institutes of Health.

BackgroundImmune-checkpoint inhibitors (ICIs) have significantly improved metastatic renal cell carcinoma (mRCC) prognosis, although their efficacy in patients with bone metastases (BMs) remains poorly understood. We investigated the prognostic role of natremia in pretreated RCC patients with BMs receiving immunotherapy.Materials and methodsThis retrospective multicenter study included RCC patients with BMs receiving nivolumab as second-line therapy or beyond. Inclusion criteria involved baseline sodium levels (pre-ICI) and sodium levels after 4 weeks of nivolumab initiation (post-ICI). The population was divided into two groups based on the median value, and response rates, progression-free survival (PFS), and overall survival (OS) were assessed.ResultsAmong 120 eligible patients, those with pre-treatment sodium levels ≥140 mEq/L showed longer OS (18.7 vs. 12.0 months, p=0.04). Pre-treatment sodium levels ≥140 mEq/L were associated with better OS compared to levels

This study aimed to evaluate our center’s experience in diagnosing and managing placenta accreta spectrum (PAS) in a high-risk population, focusing on prenatal ultrasound features associated with PAS severity and maternal outcomes. We conducted a retrospective analysis of 102 high-risk patients with confirmed placenta previa who delivered at our center between 2018 and 2023. Patients underwent transabdominal and transvaginal ultrasound scans, assessing typical sonographic features. Binary and multivariate logistic regression analyses were performed to identify sonographic markers predictive of PAS and relative complications. Key ultrasound features—retroplacental myometrial thinning (

Abstract Background Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a single tantalum cage normally used for PLIF. Tantalum is a metal that is particularly used in orthopedic surgery. It has a modulus of elasticity similar to marrow and leads to high primary stability of the implant. Materials and methods Our study was a retrospective monocentric observational study evaluating clinical and radiological outcomes of tantalum cages in a modified TLIF technique with posterior instrumentation and autologous and/or homologous posterolateral bone grafting. The aim of the study was to evaluate clinical outcomes and the increase in or redistribution of lumbar lordosis. The intersomatic arthrodesis was always carried out with a single tantalum cage normally used for PLIF to reduce the neurological risk. We retrospectively studied 105 patients who were treated with a modified unilateral TLIF approach by two surgeons between 2013 and 2018. We evaluated the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back pain, global lumbar lordosis, lordosis of L4–sacrum, segmental lordosis of functional motion units that underwent arthrodesis, pelvic tilt, pelvic incidence, and the sacral slope in 77 patients. All patients were suffering from grade III or IV Pfirrmann, instability, or foraminal post-laminectomy stenosis and/or grade I–II degenerative spondylolisthesis or low-grade isthmic spondylolisthesis. They had no significant sagittal imbalance, with a sagittal vertical axis (SVA) of

The role of immunotherapy in the multimodal treatment for pleural mesothelioma (PM) is still under investigation, particularly in the preoperative setting. Pathological complete response (pCR) has been previously described after chemotherapy and immunotherapy; however, there is no prior experience reported with immunotherapy alone before surgery. We report the case of a 58-year-old male with biphasic PM treated with immunotherapy, resulting in a major clinical partial response. Following a multidisciplinary evaluation between thoracic surgeons, medical oncologists, pathologists, radiologists and radiation oncologists, the patient underwent surgery with radical intent through a right extended pleurectomy/decortication (eP/D). Histopathological examination of the specimen confirmed a pathological Complete Response (pCR). This case supports the feasibility and potential efficacy of combining preoperative immunotherapy with surgery in the management of advanced PM.

The transition towards energy efficiency measures and green energy sources is strongly fostered by the European Union. Italy is among the EU countries that have heavily invested in renewable energy sources, more than doubling their share in gross final energy consumption. In particular, biogas has a pivotal role in the generation of electricity and can also be upgraded into biomethane, with a higher and more stable energy content. In this study, the sustainability of the supply chain of electricity from biogas in Italy has been thoroughly analyzed in the broader framework of the ARCADIA (Life Cycle Approach in Public Procurement and Italian LCA Database for Resource Efficiency) project. The environmental assessment, carried out by means of Life Cycle Assessment (LCA), provides a two-fold perspective. Firstly, it allows us to identify the main hotspots of the investigated system, such as the cultivation of dedicated crops, and to provide useful insights for improving environmental performance. Furthermore, a focus on the modeling of the dataset related to the production of electricity from biogas within the Italian electricity mix represents a step ahead in the LCA research, filling the lack of site-specific databases for reliable LCA results.

Pleural mesothelioma (PM) is an aggressive and rare disease, characterized by a very poor prognosis. For almost two decades, the world standard treatment regimen for unresectable PM has consisted of a platinum-based drug plus pemetrexed, leading to an overall survival of approximately 12 months. The dramatic therapeutic scenario of PM has recently changed with the entry into the clinic of immune checkpoint inhibition, which has proven to be an effective approach to improve the survival of PM patients. The aim of the present review is to provide a comprehensive overview of the most promising immunotherapeutic-based strategies currently under investigation for advanced PM.

Abstract Pleural mesothelioma is a rare disease with a dismal prognosis and few therapeutic options. Until recently the median overall survival for a pleural mesothelioma patient was up to 2 years, with few exceptional cases of patients achieving a longer survival. Here, we report the clinical case of a patient whose survival spanned over 10 years. The patient underwent several systemic treatments, including three different chemotherapy lines (cisplatin‐pemetrexed, vinorelbine and platinum rechallenge) and two immunotherapy regimens using immune checkpoint inhibitors (anti CTLA‐4 tremelimumab and anti PD‐1 nivolumab). At the time this report was written, the patient was off‐treatment, asymptomatic and with a stable radiological disease. Our case demonstrates that a prolonged survival with a preserved quality of life may be reached in selected patients through the exploitation of the available treatments in an expertise setting.

The European Union is targeting climate neutrality by 2050, with a focus on enhancing energy efficiency, expanding renewable energy sources, and reducing emissions. Within Italy’s electricity mix, bioenergy sources, namely biogas, solid biomass, and bioliquids, play a crucial territorial role. A comparative analysis was conducted through Life Cycle Assessment (LCA), utilizing national data from the ARCADIA project, to assess the environmental sustainability of the investigated bioenergy chains and identify the most convenient ones. The study revealed that, among the bioenergy sources, solid biomass emerges as the most environmentally friendly option since it does not rely on dedicated crops. Conversely, biogas shows the highest environmental impact, demonstrating less favorable performance across nine out of the sixteen evaluated impact categories. The LCA underscores that the cultivation of dedicated energy crops significantly contributes to environmental burdens associated with electricity generation, affecting both biogas and bioliquids performance. The cultivation process needs water and chemical fertilizers, leading to adverse environmental effects. These findings highlight the importance of prioritizing residual biomass for energy generation over dedicated crops. Utilizing forestry and agro-industrial residues, municipal solid waste, and used cooking oils presents numerous advantages, including environmental preservation, resource conservation and recovery, as well as waste reduction.

Climate change is predicted to have significant impacts on aquatic ecosystems. When combined with other stressors such as environmental contaminants, increasing temperatures will have serious consequences to the physiology and behavior of aquatic organisms. Pharmaceuticals such as antidepressants from wastewater treatment plants have been shown to modify the behavior of non-target aquatic species. We tested over 2000 snails (Physa gyrina) from a creek in Pennsylvania, USA for their righting behavior when exposed to different combinations of temperature (12°, 20°, and 25 °C) and antidepressant (venlafaxine and fluoxetine) concentration for one week or 48 hours. Snails exposed for one week righted significantly faster in warmer temperatures and in almost all concentrations of both antidepressants compared to controls. Snails exposed for 48 hours showed similar responses to warmer temperature as they did when exposed for one week, but only at the highest antidepressant concentrations did they right significantly faster than the controls. Exposure to venlafaxine at low concentration (1.56 µg/L) for 48 hours resulted in significant inhibition of righting, indicative of a non-monotonic dose response. We discuss the possible consequences of increased water temperature combined with antidepressant contamination on snail behavior as well as the possible physiological mechanisms of action explaining non-monotonic dose responses. [ABSTRACT FROM AUTHOR]

Objective: Colorectal cancer (CRC) during pregnancy is a rare occurrence, with a reported incidence of 0.8 cases per 100,000 pregnancies. Managing CRC during pregnancy poses substantial challenges for clinicians: the diagnosis is often complicated and delayed due to symptom overlap with pregnancy-related manifestations, and medical imaging is constrained by safety concerns for the foetus. Methods: This article presents two cases of advanced CRC diagnosed and managed during pregnancy. Additionally, we conducted a systematic review of the literature to assess diagnostic and prognostic factors involved in CRC in pregnant individuals. The systematic review, with pre-registration and approval through Prospero, involved an extensive search of medical databases (Pubmed, Web of Science, Scopus and Scholar) and statistical analysis using t-test for continuous variables and chi square for dichotomous variables. Results: A total of 1058 studies were identified. After applying exclusion criteria, sixty-six studies were included. Women whose initial symptoms were severe abdominal pain not responsive to common medical treatments and constipation (acute abdomen) had a mean gestational age at delivery lower than those who presented with paucisymptomatic onset. In our study groups, women who underwent chemotherapy during pregnancy had a higher mean gestational age at delivery and did not experience worse neonatal outcomes compared to those who did not undergo chemotherapy. Conclusions: CRC during pregnancy poses unique diagnostic and therapeutic challenges. Collaborative efforts among various medical disciplines are essential to manage CRC during pregnancy.