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Introduction: Suicidality is a growing problem in the US, and the emergency department (ED) is often the front line for the management and effective treatment of acutely suicidal patients. There is a dearth of interventions that emergency physicians may use to manage and effectively treat acutely suicidal patients. To the extent that recently described interventions are available for ED personnel, no review has been conducted to identify them. This scoping review is intended to fill this gap by systematically reviewing the literature to identify recently described interventions that can be administered in the ED to reduce symptoms and stabilize patients.Methods: We conducted a search of PubMed, SCOPUS, and CINAHL in January 2024 to identify papers published between 2013–2023 for original research trialing recent interventions for the effective treatment of suicidality in the ED. We assessed 16 full-text articles for eligibility, and nine met inclusion criteria. Included studies were evaluated for features and characteristics, the fit of the intervention to the ED environment, and interventional efficacy.Results: Four studies assessed the efficacy of a single dose of the anesthetic/analgesic agent ketamine. Three studies assessed the efficacy of a brief psychosocial intervention delivered in the ED, two of which paired this intervention with the provision of follow-up care (postcard contact and referral assistance/case management, respectively). The remaining two studies trialed a brief, motivational interviewing-based intervention. Included studies had strong experimental designs (randomized controlled trials) but small sample sizes (average 57). Among the interventions represented across these nine studies, a single dose of ketamine and the brief psychosocial intervention Crisis Response Planning (CRP) show promise as ED-appropriate interventions for suicidality. Ketamine and CRP demonstrated the strongest fit to the ED environment and most robust efficacy findings.Conclusion: This review identified one drug (ketamine) and four unique psychological/behavioral interventions that have been used to treat acute suicidality in the ED. There is currently insufficient evidence to suggest that these interventions will prove efficacious and well-suited to be delivered in the ED environment. Future studies should continue to test these interventions in the ED setting to determine their feasibility and efficacy.

Analyses of inequalities related to prevention and cancer therapeutics/care show disparities between countries with different economic standing, and within countries with high Gross Domestic Product. The development of basic technological and biological research provides clinical and prevention opportunities that make their implementation into healthcare systems more complex, mainly due to the growth of Personalized/Precision Cancer Medicine (PCM). Initiatives like the USA-Cancer Moonshot and the EU-Mission on Cancer and Europes Beating Cancer Plan are initiated to boost cancer prevention and therapeutics/care innovation and to mitigate present inequalities. The conference organized by the Pontifical Academy of Sciences in collaboration with the European Academy of Cancer Sciences discussed the inequality problem, dependent on the economic status of a country, the increasing demands for infrastructure supportive of innovative research and its implementation in healthcare and prevention programs. Establishing translational research defined as a coherent cancer research continuum is still a challenge. Research has to cover the entire continuum from basic to outcomes research for clinical and prevention modalities. Comprehensive Cancer Centres (CCCs) are of critical importance for integrating research innovations to preclinical and clinical research, as for ensuring state-of-the-art patient care within healthcare systems. International collaborative networks between CCCs are necessary to reach the critical mass of infrastructures and patients for PCM research, and for introducing prevention modalities and new treatments effectively. Outcomes and health economics research are required to assess the cost-effectiveness of new interventions, currently a missing element in the research portfolio. Data sharing and critical mass are essential for innovative research to develop PCM. Despite advances in cancer research, cancer incidence and prevalence is growing. Making cancer research infrastructures accessible for all patients, considering the increasing inequalities, requires science policy actions incentivizing research aimed at prevention and cancer therapeutics/care with an increased focus on patients needs and cost-effective healthcare.

Habitualmente, se utilizan diversas metodologías e indicadores para evaluar la capacidad económica de los hogares y determinar su nivel de vulnerabilidad. Los análisis monetarios son ampliamente aceptados debido a su capacidad para abordar fenómenos complejos. Algunos de estos enfoques establecen un valor absoluto de pobreza, sin embargo, en países desarrollados, se prefiere una perspectiva relativa basada en ingresos equivalentes, como es el caso del umbral de riesgo de pobreza de la OCDE. Esto permite comparar la situación económica de los hogares en relación con su entorno. En el ámbito internacional, existen algunas experiencias de acercamiento a la pobreza centradas en el gasto como factor relevante. Estas iniciativas han conceptualizado una canasta básica de bienes y servicios necesarios para una vida digna, asignando un valor económico a cada elemento para establecer presupuestos de referencia adaptados a las condiciones de los hogares. En el caso de España, a través del Presupuesto de Referencia para unas Condiciones de Vida Dignas (PRCVD) se lleva a cabo por primera vez una medición en este sentido. Este presupuesto se divide en ocho partidas de gasto que reflejan dimensiones clave de las condiciones de vida dignas de los hogares y sus miembros, como alimentación, vivienda, educación, salud, transporte, etc. El PRCVD es un marco que cuantifica los gastos necesarios para garantizar condiciones de vida dignas, teniendo en cuenta la composición y las necesidades específicas de cada hogar, proporcionando así una herramienta útil para analizar y evaluar las condiciones socioeconómicas de los hogares en España. Various methodologies and indicators are commonly used to assess the economic capacity of households and determine their level of vulnerability. Monetary analyses are widely accepted due to their ability to address complex phenomena. Some of these approaches establish an absolute poverty threshold; however, in developed countries, a relative perspective based on equivalent income is preferred, as seen in the OECD poverty risk threshold. This allows for a comparison of households' economic situations in relation to their environment. Internationally, there are some approaches to poverty that focus on expenditure as a relevant factor. These initiatives have conceptualized a basic basket of goods and services necessary for a dignified life, assigning an economic value to each element to establish reference budgets adapted to household conditions. In the case of Spain, the Reference Budget for Dignified Living Conditions (PRCVD) represents a measurement in this regard for the first time. This budget is divided into eight expense categories reflecting key dimensions of households' and their members' dignified living conditions, such as food, housing, education, health, transportation, etc. The PRCVD serves as a framework that quantifies the necessary expenses to ensure dignified living conditions, considering the composition and specific needs of each household, thus providing a useful tool for analyzing and assessing the socio-economic conditions of households in Spain.

Introduction: Suicidality is a growing problem in the US, and the emergency department (ED) is often the front line for the management and effective treatment of acutely suicidal patients. There is a dearth of interventions that emergency physicians may use to manage and effectively treat acutely suicidal patients. To the extent that recently described interventions are available for ED personnel, no review has been conducted to identify them. This scoping review is intended to fill this gap by systematically reviewing the literature to identify recently described interventions that can be administered in the ED to reduce symptoms and stabilize patients. Methods: We conducted a search of PubMed, SCOPUS, and CINAHL in January 2024 to identify papers published between 2013–2023 for original research trialing recent interventions for the effective treatment of suicidality in the ED. We assessed 16 full-text articles for eligibility, and nine met inclusion criteria. Included studies were evaluated for features and characteristics, the fit of the intervention to the ED environment, and interventional efficacy. Results: Four studies assessed the efficacy of a single dose of the anesthetic/analgesic agent ketamine. Three studies assessed the efficacy of a brief psychosocial intervention delivered in the ED, two of which paired this intervention with the provision of follow-up care (postcard contact and referral assistance/case management, respectively). The remaining two studies trialed a brief, motivational interviewing-based intervention. Included studies had strong experimental designs (randomized controlled trials) but small sample sizes (average 57). Among the interventions represented across these nine studies, a single dose of ketamine and the brief psychosocial intervention Crisis Response Planning (CRP) show promise as ED-appropriate interventions for suicidality. Ketamine and CRP demonstrated the strongest fit to the ED environment and most robust efficacy findings. Conclusion: This review identified one drug (ketamine) and four unique psychological/behavioral interventions that have been used to treat acute suicidality in the ED. There is currently insufficient evidence to suggest that these interventions will prove efficacious and well-suited to be delivered in the ED environment. Future studies should continue to test these interventions in the ED setting to determine their feasibility and efficacy.

Far-Infrared Radiation (FIR) is emerging as a novel non-invasive tool for mitigating inflammation and oxidative stress, offering potential benefits for certain medical conditions such as cardiovascular disease and chronic inflammatory disorders. We previously demonstrated that the application of patch-based FIR therapy on human umbilical vein endothelial cells (HUVECs) reduced the expression of inflammatory biomarkers and the levels of reactive oxygen species (ROS). Several in vitro studies have shown the inhibitory effects of FIR therapy on cell growth in different cancer cells (including murine melanoma cells), mainly using the wound healing assay, without direct cell motility or tracking analysis. The main objective of the present study was to conduct an in-depth analysis of single-cell motility and tracking during the wound healing assay, using an innovative high-throughput technique in the human melanoma cell line M14/C2. This technique evaluates various motility descriptors, such as average velocity, average curvature, average turning angle, and diffusion coefficient. Our results demonstrated that patch-based FIR therapy did not impact cell proliferation and viability or the activation of mitogen-activated protein kinases (MAPKs) in the human melanoma cell line M14/C2. Moreover, no significant differences in cell motility and tracking were observed between control cells and patch-treated cells. Altogether, these findings confirm the beneficial effects of the in vitro application of patch-based FIR therapy in human melanoma cell lines, although such effects need to be confirmed in future in vivo studies.

Abstract Introduction Clinical remission is the main target in the management of patients with rheumatoid arthritis (RA). However, several authors found synovitis in patients with RA in clinical remission at ultrasonography (US). Upadacitinib is a selective Janus kinase 1 inhibitor that achieved significantly higher remission rates than adalimumab and abatacept in patients with RA. Here we present the 24-week data of the UPAdacitinib Rheumatoid Arthritis REmission UltraSonography (UPARAREMUS) study. Methods This is a longitudinal multicenter observational study, enrolling bio-naïve and bio-inadequate responder patients affected by RA. The primary endpoint was the proportion of patients achieving both clinical and US remission at week 24. The proportion of patients achieving clinical remission with different composite indexes at week 12 and 24 was also evaluated. US of four target joints (wrists and second metacarpophalangeal bilaterally) was performed at baseline and weeks 12/24, and US remission was defined as the absence of power Doppler (PD) signal ≥ 2 in one target joint, or PD ≥ 1 in two target joints. Results After 12 weeks and 24 weeks, 40% and 63.6% of patients achieved US plus clinical remission. The following parameters were associated with US plus clinical remission: being bio-naïve and having a shorter disease duration, although at multivariate analysis significant odds ratio (OR) was found only for being bio-naïve. Conclusions UPARAREMUS is the first study evaluating the efficacy of upadacitinib in reaching both clinical and US remission in patients with RA. At 24 weeks, 63.6% of patients reached the primary endpoint, the only baseline associated parameter was being bio-naïve.

SARS-CoV-2 variants of concern (VOCs) emerged during the COVID-19 pandemic. Here, we used unbiased systems approaches to study the host-selective forces driving VOC evolution. We discovered that VOCs evolved convergent strategies to remodel the host by modulating viral RNA and protein levels, altering viral and host protein phosphorylation, and rewiring virus-host protein-protein interactions. Integrative computational analyses revealed that although Alpha, Beta, Gamma, and Delta ultimately converged to suppress interferon-stimulated genes (ISGs), Omicron BA.1 did not. ISG suppression correlated with the expression of viral innate immune antagonist proteins, including Orf6, N, and Orf9b, which we mapped to specific mutations. Later Omicron subvariants BA.4 and BA.5 more potently suppressed innate immunity than early subvariant BA.1, which correlated with Orf6 levels, although muted in BA.4 by a mutation that disrupts the Orf6-nuclear pore interaction. Our findings suggest that SARS-CoV-2 convergent evolution overcame human adaptive and innate immune barriers, laying the groundwork to tackle future pandemics.

BackgroundFrailty, a geriatric syndrome associated with adverse outcomes, lacks a universal definition. No consensus exists on the most effective frailty scale for predicting mortality.MethodsThis prospective observational study followed community-dwelling volunteers for 6 years. Frailty was measured with the Frailty Index (FI) and the Frailty Phenotype (FP). Concordance was assessed using Cohen’s Kappa coefficients. Age-and sex-adjusted Cox regression analyses were conducted to evaluate the association with mortality.ResultsOut of 1,114 participants (median age 72 years, IQR 69–77), 186 were classified as frail by the FI, 13 by the FP and 48 by both definitions. The concordance between the two measures was fair (κ = 0.26). Thirty-nine individuals died during the follow-up period. The FI showed a stronger association with mortality (HR 75.29, 95% CI 8.12–697.68, p

IntroductionIn myotonic dystrophy type 2 (DM2), metabolic dysfunctions are frequent. Therefore, measurement of muscle mass and body composition by non-invasive methods could help in evaluating disease severity and progression. The aim of our study was to investigate, by means of bioelectrical impedance analysis (BIA), whether DM2 patients have an alteration in their body composition and if this finding correlates with strength and motor performances.MethodsWe obtained anthropometric measures, nutritional data, BIA and blood tests in 18 DM2 patients and correlated them with motor function tests.ResultsThe 33% of male and 22% of female patients had BMI values compatible with severe obesity, whereas 44% of males and 33% of females had a metabolic syndrome. Considering BIA parameters, phase angle was under normal values in 56% of males and 89% of females. This may be regarded as a marker of deranged cell membrane function. Motor tests showed a fair to strong direct correlation with several BIA parameters.ConclusionThese data suggest that BIA findings may be faithful markers of the degree of muscle wasting and impairment in DM2. The different degree of BIA alterations between genders indicate that body composition undergoes sex-related modifications in this disease. The potential of this technique to capture changes in a slowly progressive disorder such as DM2 should be tested in longitudinal studies.

IntroductionWith the growing older adult population, the European Union emphasizes the need to promote research in healthy aging trough multidisciplinary and innovative approaches, including the integration of advanced technologies like virtual reality (VR) in cognitive rehabilitation. This reflects the increasing awareness of the importance of addressing challenges related to neurodegenerative diseases in the older adult population. Our study aims to present a protocol that will assess the feasibility and provide a preliminary measure of effectiveness for an intervention using immersive CR technology for cognitive remediation (CR) in individuals with Mild Cognitive Impairment (MCI).MethodsA feasibility randomized controlled clinical study will involve 30 individuals who are over 65 years old, both sex, who meet the diagnostic criteria for MCI from the University Hospital of Cagliari, randomly assigned to either the experimental condition or control group. Both groups will continue to receive standard pharmacological therapy. The experimental group will undergo a 3-months cognitive remediation program using fully immersive VR with two sessions per week. Each session will last a maximum of 60 min and will be supervised by expert health professionals. In contrast, the control group will continue with standard care. The intervention program will be carried out by s psychiatric rehabilitation technicians and speech therapists, emphasizing a comprehensive framework aligned with healthcare needs. Feasibility will be assessed based on tolerability, including dropout rates and acceptability, which considers the proportion of recruited participants among those considered eligible and on side effects and level of satisfaction. The preliminary measures of effectiveness will be evaluated on quality of life, cognitive functions, biological and social rhythms, depressive symptoms and anxiety.ResultsThe trial findings will be submitted for publication in international peer-reviewed journals and shared at international meetings and conferences.DiscussionThis study aiming to assess the feasibility and preliminary effectiveness of a fully immersive VR/CR program for MCI in order to give data for a subsequent confirmatory trial. The results of the pilot RCT are expected to significantly contribute to research on the prevention of neurocognitive degeneration, with a specific emphasis on enhancing the application of technologies. The strengths of this work are the high technological innovation program for mental health treatments for healthy aging and multidisciplinary approach emphasizing a holistic framework aligned with health needs.

IntroductionSarcopenia is a chronic pathological condition, first defined in 2010 and revised in 2018. The most recent definition of sarcopenia focuses mostly on “low muscle strength.” A secondary form of sarcopenia is represented by uremic sarcopenia (US), a condition that characterizes end-stage kidney disease (ESKD) patients. The intramuscular adipose tissue (IMAT) seems to impact negatively on muscle strength, as it would seem to replace muscle fibers with a non-contractile component. The study aims to compare body composition parameters—both standardized and innovative—related to the diagnosis of US in hemodialysis (HD) patients, stratified by sarcopenia diagnosis. Furthermore, the different indices of sarcopenia are compared in order to evaluate their predictive capacity.MethodsWe analyzed 48 ESKD patients according to the sarcopenia diagnosis, obtained using dual-energy X-ray absorptiometry (DXA). Moreover, we assessed the presence of IMAT and calculated the sarcopenia index (SI).ResultsFor the study, the enrolled population was divided according to the sarcopenia diagnosis: no sarcopenic patients had higher transferrin (p = 0.03), total proteins (p = 0.04), and azotemia pre-dialysis (p = 0.05) values. On the contrary, atherogenic indices were lower in no sarcopenic patients. Moreover, we observed an indirect correlation between the SI and parathyroid hormone (PTH) (p = 0.00138, R2 = 0.54). Finally, we calculated the prevalence of sarcopenia and sarcopenia adjusted for IMAT. We showed a different prevalence between sarcopenia diagnosed with a standard index and an index adjusted for IMAT (p = 0.043). In conclusion, we believe that the most important result obtained is the indirect correlation between SI and PTH. These data corroborate the theories, in which PTH seems to play a central role in the cachexia genesis. Moreover, the SI adjusted for IMAT seems to be a more reliable parameter for the early identification of subjects at risk of developing US, allowing timely implementation of targeted therapeutic strategies.

Background and aimsTo investigate the prognostic value of blood neurofilament light chain protein (NfL) levels in the acute phase of coronavirus disease 2019 (COVID-19).MethodsWe conducted an individual participant data (IPD) meta-analysis after screening on MEDLINE and Scopus to May 23rd 2022. We included studies with hospitalized adult COVID-19 patients without major COVID-19-associated central nervous system (CNS) manifestations and with a measurement of blood NfL in the acute phase as well as data regarding at least one clinical outcome including intensive care unit (ICU) admission, need of mechanical ventilation (MV) and death. We derived the age-adjusted measures NfL Z scores and conducted mixed-effects modelling to test associations between NfL Z scores and other variables, encompassing clinical outcomes. Summary receiver operating characteristic curves (SROCs) were used to calculate the area under the curve (AUC) for blood NfL.ResultsWe identified 382 records, of which 7 studies were included with a total of 669 hospitalized COVID-19 cases (mean age 66.2 ± 15.0 years, 68.1% males). Median NfL Z score at admission was elevated compared to the age-corrected reference population (2.37, IQR: 1.13-3.06, referring to 99th percentile in healthy controls). NfL Z scores were significantly associated with disease duration and severity. Higher NfL Z scores were associated with a higher likelihood of ICU admission, need of MV, and death. SROCs revealed AUCs of 0.74, 0.80 and 0.71 for mortality, need of MV and ICU admission, respectively.ConclusionsBlood NfL levels were elevated in the acute phase of COVID-19 patients without major CNS manifestations and associated with clinical severity and poor outcome. The marker might ameliorate the performance of prognostic multivariable algorithms in COVID-19.

Abstract Pre-existing mental disorders are considered a risk factor for severe COVID-19 outcomes, possibly because of higher vascular burden. Moreover, an unconventional platelet activation characterizes COVID-19 and contributes to inflammatory and thrombotic manifestations. In the light of the inflammation theory of mental disorders, we hypothesized that patients with mental disorders could be sensitive to the SARS-CoV-2 elicited platelet activation. We investigated platelet activation in 141 COVID-19 survivors at one month after clearance of the virus, comparing subjects with or without an established pre-existing diagnosis of mental disorder according to the DSM-5. We found that platelets from patients with a positive history of psychiatric disorder underwent unconventional activation more frequently than conventional activation or no activation at all. Such preferential activation was not detected when platelets from patients without a previous psychiatric diagnosis were studied. When testing the effects of age, sex, and psychiatric history on the platelet activation, GLZM multivariate analysis confirmed the significant effect of diagnosis only. These findings suggest a preferential platelet activation during acute COVID-19 in patients with a pre-existing psychiatric disorder, mediated by mechanisms associated with thromboinflammation. This event could have contributed to the higher risk of severe outcome in the psychiatric population.

Abstract Background The ageing process is characterized by a change of body composition with an increase of fat mass and a reduction of muscle mass. Above a certain threshold these alterations configure a condition named sarcopenic obesity (SO). SO is associated with physical frailty in Asian and Brazilian populations. SO impacts on physical frailty in other ethnic groups but its influence on general frailty which is multidimensional and includes cognitive, social and physical factors, remain insufficiently explored in the Italian population. Methods Frailty was measured in community dwelling Italian older adults enrolled in the FRASNET study with the frailty index (FI). The FI quantifies frailty as the ratio of the number of present health deficits to the total number of health deficits considered. Regression analyses were performed to assess the association between body composition categories and frailty. Classification and regression tree models were run to evaluate the frailty predictors. Results One Thousand One Hundred Fourteen participants of the FRASNET study were included in the present analysis. The sample was composed for the 60.5% by females and its median age was 72 years. The median FI score was 0.11 (IQR 0.07–0.20); 234 individuals (21%) were frail (FI ≥ 0.25). SO (B 0.074, 95% C.I. 0.05–0.1, p

Abstract As patient exposure to ionizing radiation from medical imaging and its risks are continuing issues, this study aimed to evaluate DNA damage and repair markers after myocardial perfusion single-photon emission computed tomography (MPS). Thirty-two patients undergoing Tc-99m sestamibi MPS were studied. Peripheral blood was collected before radiotracer injection at rest and 60–90 min after injection. The comet assay (single-cell gel electrophoresis) was performed with peripheral blood cells to detect DNA strand breaks. Three descriptors were evaluated: the percentage of DNA in the comet tail, tail length, and tail moment (the product of DNA tail percentage and tail length). Quantitative PCR (qPCR) was performed to evaluate the expression of five genes related to signaling pathways in response to DNA damage and repair (ATM, ATR, BRCA1, CDKN1A, and XPC). Mann–Whitney’s test was employed for statistical analysis; p

After the spread of the COVID-19 pandemic, several articles have described the fragility of young adults, such as students, highlighting the severity, frequency, and nature of mental distress. However, less research has examined the resources of young people, such as their creative competence and their ability to draw on a social network. Furthermore, the analysis of these resources is not very common in international comparative studies. The main aim of this cross-national study is to investigate whether creativity factors such as creative personality and divergent thinking together with social support predict resilience in college students, controlling for gender and nationality, in a sample of college students from Italy and Spain, European Mediterranean countries particularly affected by the pandemic. The following instruments were used to measure these constructs: The Creative Personality Scale, the Runco Ideational Behavior Scale, the Multidimensional Scale of Perceived Social Support, and the Connor Davidson Resilience Scale. A total of 287 college students participated, 147 from Italy and 140 from Spain, with an average age of 22 years. The results show that there are statistically significant differences between Italian and Spanish students for all variables except resilience. The hierarchical regression shows that divergent thinking and social support are predictors of resilience for the whole sample. In light of these results, it may be important for universities to continue investing in divergent thinking and social support through workshops and activities to promote student resilience.