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Marco Marenco,1,* Ilaria Macchi,2,* Iacopo Macchi,3 Emilio Galassi,4 Mina Massaro-Giordano,5 Alessandro Lambiase1 1Department of Sense Organs, University of Rome “Sapienza”, 2Department of Ophthalmology, Campus Bio-Medico University of Rome, Rome, 3Department of Ophthalmology, University of Catania, Catania, 4Ophthalmic Clinic, Department of Ophthalmology, University of L’Aquila, L’Aquila, Italy; 5Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA *These authors contributed equally to this work Abstract: Congenital ptosis is a rare condition characterized by lower positioning of the upper eyelid that is present at birth and is a clinical condition that is persistent if not treated. It may be unilateral or bilateral and may be associated with other ocular disorders or systemic conditions, including Marcus Gunn, Horner, and Duane syndromes. It is a benign condition but causes functional, cosmetic, and psychological problems in children. However, not all patients need to undergo surgery, and usually only patients at risk of amblyopia need a prompt surgical correction, while in other cases, surgery can be postponed. The grade of ptosis, the eyelid function, and the amblyopic risk are the parameters that affect the ophthalmologist’s decision on timing of surgery and the surgical technique to be used. In fact, there are several types of surgical techniques to correct a congenital ptosis, although very often more than one is needed to obtain an acceptable result. This paper reviews the causes of congenital ptosis and associated diseases. Particular emphasis is given to surgical management and different procedures available to correct the upper eyelid anomaly and avoid permanent damage to visual function. Keywords: ptosis, extraocular muscle development, neurologic dysfunction, surgical approach

Purpose: Trigonocephaly is the most common craniosynostosis involving orbits. Although some degree of agreement has been reached regarding surgical timing and indications for treatment, there is no consensus regarding the ideal operative technique to guarantee an optimal morphological outcome. The purpose of this study is to describe both strategies and to compare morphological outcomes by means of morphological surface analysis obtained from three-dimensional (3D) stereophotogrammetry, with two different techniques., Methods: We retrospectively investigated 43 patients with metopic synostosis surgically treated between 2004 and 2020. Two different techniques were applied, addressed as technique A and B. Ten patients undergone postoperative 3d stereophotogrammetry were enrolled, and cephalometric measurements were taken and compared to a cohort of unaffected patients matched by age and gender., Results: Comparison of the groups demonstrated a hypercorrection of the metopic angle of the second technique, associated with a slightly lower correction of the interfrontoparietal diameter. The metopic angle showed to be significantly undercorrected with the first method., Conclusions: Alternated barrel staving technique appears to be a quick and satisfactory method in cranial remodelling for metopic synostosis. It guarantees an optimal aesthetic result in the first years after surgery., Competing Interests: Declarations. Ethics approval: This study has been approved by the local Ethical Committee CEAVEC. Conflict of interest: The authors did not receive any financial support for this study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The treatment of osteochondral joint lesions requires the regeneration of both articular cartilage and subchondral bone tissue. Scaffold-based strategies aimed at mimicking the native osteochondral structure have been explored with mixed results. The aim of this study was to evaluate the regenerative potential of a tri-layered osteochondral cell-free scaffold in a large animal model at both 6 and 12 months of follow-up. Bilateral critical-sized osteochondral defects were created in 22 sheep. One defect was filled with the scaffold, whereas the contralateral was left empty. The repair tissue quality was evaluated at 6 and 12 months of follow-up in terms of macroscopic appearance, histology, trabecular bone formation, and inflammation grade. The mean global ICRS II score in the scaffold and control groups was 41 ± 11 vs 30 ± 6 at 6 months (p = 0.004) and 54 ± 13 vs 37 ± 11 at 12 months (p = 0.002), respectively. A higher percentage of bone was found in the treatment group compared to controls both at 6 (BV/TV 48.8 ± 8.6 % vs 37.4 ± 9.5 %, respectively; p < 0.001) and 12 months (BV/TV 51.8 ± 8.8 % vs 42.1 ± 12.6 %, respectively; p = 0.023). No significant levels of inflammation were seen. These results demonstrated the scaffold safety and potential to regenerate both cartilage and subchondral tissues in a large animal model of knee osteochondral lesions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Elisabetta Galassi reports financial support was provided by Fin-Ceramica Faenza S.p.A. Laura Grillini reports financial support was provided by Fin-Ceramica Faenza S.p.A. Alessandro Dotti reports financial support was provided by Fin-Ceramica Faenza S.p.A. Claudio De Luca reports financial support was provided by Fin-Ceramica Faenza S.p.A. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

The technological and nutritional traits of food-grade sorghum hybrids, hulled/naked oat varieties and maize genotypes of different colors were studied for novel and healthier gluten-free foods. Oat genotypes showed the highest protein content, followed by maize and sorghum. The total starch and the total dietary fiber content were quite similar among the three species. Great variation was found in the amylose content, and the highest was in sorghum (27.12%), followed by oat 16.71% and maize 10.59%. Regarding the pasting profile, the rank of Peak Viscosity was sorghum (742.8 Brabender Unit, BU), followed by maize (729.3 BU) and oat (685.9 BU). Oat and sorghum genotypes had similar average breakdown (407.7 and 419.9 BU, respectively) and setback (690.7 and 682.1 BU, respectively), whereas maize showed lower values for both parameters (384.1 BU and 616.2 BU, respectively). The total antioxidant capacity, only in maize, significantly correlated with total flavonoid, phenolic and proanthocyanidin contents, indicating that all the measured compounds contributed to antioxidant capacity. The study indicated the importance of sounding out the nutritional and technological characteristics of gluten-free cereals in order to select suitable cultivars to be processed in different gluten-free foods with better and healthier quality.

Mediterranean diet is changing to keep up with the increasingly multiethnic Italian society. With food being considered as a means of integration, innovative foods capable of mixing different raw materials could be of interest. In this work, some of the most consumed African foods such as sorghum, cassava, and durum wheat were used to produce wholegrain spaghetti to valorize their nutritional and sensorial aspects and to combine Italian and foreign tastes. Different pasta formulations (cassava, semolina, cassava:semolina, cassava:sorghum, cassava:durum wheat whole meal, sorghum:semolina) were developed and compared for their content of proteins, total starch, resistant starch, amylose, fiber, total antioxidant capacity, ash, cooking quality and sensorial characteristics. The enrichment of cassava flour with durum wheat and sorghum wholegrain enhanced the total antioxidant capacity, protein, and fiber content with respect to 100% cassava pasta. The presence of cassava or sorghum resulted in a high diameter variability of pasta samples, lower water absorption, and shorter optimal cooking time with respect to semolina pasta. Sensory evaluation of cooked pasta revealed better scores in blends containing semolina. Although the obtained pasta samples were interesting for their nutritional aspects, further adjustments are required in the pasta-making process to improve pasta quality.

The increased demand for healthier foods, the recognition of dry pasta as an ideal carrier of functional ingredients, and the current interest for ancient wheats such as einkorn motivated the present research. Two varieties of Triticum monococcum , namely cv Norberto and the free-threshing cv Hammurabi, were milled by ultra-fine milling process (micronization) to produce wholegrain spaghetti. Einkorn pasta was assessed in terms of technological and biochemical properties and cooking and sensorial quality and compared to durum wheat semolina pasta. Wholewheat einkorn pasta showed a threefold increase in total dietary fibre content as well as in total antioxidant capacity in comparison to the control. The level of resistant starch in cv Norberto resulted significantly higher respect to semolina and einkorn cv Hammurabi pasta. Despite the very weak einkorn gluten network, the sensory and instrumental assessment of pasta quality highlighted that einkorn spaghetti presented good sensorial properties related to their technological quality, in particular, for the overall judgment and firmness. Cultivar Hammurabi emerged as the preeminent compromise on the basis of technological performances together with chemical and sensorial aspects.

Through the centuries, the domestication and modern breeding of wheat led to a significant loss of genetic variation in the cultivated gene pool with a consequent decrease in food diversity. Current trends towards low-input and sustainable agriculture call for the revitalization and exploitation of ancient wheats, which represent a reservoir of biodiversity useful to ensure sustainable wheat production in the context of climate change and low-input farming systems. Ancient Caucasian wheat species, such as the hulled wheats Triticum timopheevii (tetraploid A u A u GG) and Triticum zhukovskyi (hexaploid A u A u A m A m GG), are still grown to a limited extent in the Caucasus for the production of traditional foods. These Caucasian wheats were grown in Italy and were analyzed for physical, nutritional and technological characteristics and compared to durum wheat. Both Caucasian species revealed a high protein content (on average 18.5%) associated with a low gluten index, mainly in T. zhukovskyi , and test weight values comparable to commercial wheats. The total antioxidant capacity was revealed to be the double of that in durum wheat, suggesting the use of ancient Caucasian wheats for the production of healthy foods. Finally, the technological and rheological results indicated that Caucasian wheats could be potential raw material for the formulation of flat breads, biscuits and pasta.

The demand for gluten-free products, including pasta, is increasing and rice pasta accounts for the largest share of this market. Usually, the production of rice pasta requires additives or specific technological processes able to improve its texture, cooking quality, and sensory properties. In this work, two rice cultivars, with different amylose content, were subjected to parboiling, micronization, and flour air fractionation to obtain brown rice pasta, without any supplement but rice itself. In particular, two types of pasta (spaghetti shape) were produced, one from 100% micronized wholemeal, and the other from refined rice flour replaced with 15% of the air-fractionated fine fraction. Regardless of the cultivar, pasta from wholemeal micronized flour showed higher protein and fiber content than refined flour enriched with fine fraction, whereas no differences were revealed in resistant starch and antioxidant capacity. Pasta from the high amylose content genotype showed the highest resistant starch content and the lowest predicted glycemic index along with sensorial characteristics as good as durum semolina pasta in fine fraction enriched pasta. Besides the technological processes, pasta quality was affected the most by the genotype, since pasta obtained from high amylose cv Gladio resulted in the best in terms of technological and sensory quality.

Brewers' spent grain (BSG), the major by-product of the brewing industry, can be used as a functional ingredient to increase the nutritional value of cereal-based products. In this work, micronized BSG from the einkorn and tritordeum brewing processes were characterized and used to produce four macaroni pasta formulations enriched with BSG at ratios of 5 g and 10 g/100 g of semolina. Einkorn BSG showed the highest values for all the parameters analyzed-proteins, total dietary fiber (TDF) and total antioxidant capacity (TAC)-except for β-glucan. TDF increased up to 42 and 68% in pasta samples enriched with 10% of BSG from tritordeum and einkorn, respectively. The replacement of 10% of semolina with BSG from both cereals significantly increased the β-glucan content and TAC values. Finally, the addition of BSG from einkorn and tritordeum affected to a minimal extent the sensory properties of cooked pasta, which showed higher values of optimal cooking time and cooking loss, but lower total organic matter compared to semolina pasta. Results from the sensorial judgment fell in the good quality ranges for durum wheat pasta; the incorporation of 10% of einkorn BSG resulted in the best compromise in terms of technological, nutritional and sensorial aspects of enriched pasta.

Hemolytic uremic syndrome (HUS), the leading cause of acute renal failure in children (< 3 years), is mainly related to Shiga toxins (Stx)-producing Escherichia coli (STEC) infections. STEC are confined to the gut resulting in hemorrhagic colitis, whereas Stx are delivered in blood to target kidney and brain, with unclear mechanisms, triggering HUS in 5 to 15% of infected children. Stx were found on circulating cells, free in sera (soluble Stx) or in blood cell-derived microvesicles (particulate Stx), whereby the relationship between these forms of circulating toxins is unclear. Here, we have examined 2,846 children with bloody diarrhea and found evidence of STEC infection in 5%. Twenty patients were enrolled to study the natural course of STEC infections before the onset of HUS. In patients, Stx were found to be associated to circulating cells and/or free and functionally active in sera. In most children, Stx were bound to neutrophils when high amounts of toxins were found in feces. Time-course analysis showed that Stx increased transiently in patients' sera while the decrease of toxin amount on leukocytes was observed. Notably, patients who recovered (85%) displayed different settings than those who developed HUS (15%). The distinctive feature of the latter group was the presence in blood of particulate Stx2 (Stx2 sedimented at g -forces corresponding to 1 μm microvesicles) the day before diagnosis of HUS, during the release phase of toxins from circulating cells. This observation strongly suggests the involvement of blood cell-derived particulate Stx2 in the transition from hemorrhagic colitis to HUS., Competing Interests: G.A. reports grants from Progetto Organizzazione non Lucrativa di Utilità Sociale–Alice Associazione per la Lotta alla Sindrome Emolitico Uremica, during the conduct of the study. M.B. reports grants from Progetto Organizzazione non Lucrativa di Utilità Sociale–Alice Associazione per la Lotta alla Sindrome Emolitico Uremica, during the conduct of the study. X.H. reports grants from USDA-ARS National Program NP108, CRIS project 2030–42000–049–00D, during the conduct of the study., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective/background: The natural history and the outlook of patients with hydrocephalus are dramatically affected using cerebrospinal fluid shunts. The several issues related with a long-standing shunt should suffice to justify all the possible attempts to free the patient from it. This study focused on the role of secondary endoscopic third ventriculostomy (ETV) in the achievement of shunt removal in cases of shunt malfunction, and to identify patients who could benefit most from the procedure., Methods: In the period of 2006-2015, ETV was attempted in 47 patients >6 months old with ventriculoperitoneal shunt malfunction who presented with increased ventricle size compared with the previous neuroradiological examinations; simultaneously the shunt was removed or ligated., Results: The overall success rate of secondary ETV was 74% (shunt-free patients with normalized intracranial pressure and absence of symptoms attributable to hydrocephalus) in patients with a long shunt duration (up to 30 years). The number of previous shunt revision procedures (P = 0.026) and lower age (P = 0.017) correlate with the likelihood of secondary ETV failure, a score of 80 as ETV success score (calculated for both pediatric and adult patients, even if the score was meant for the pediatric population) correlates with secondary ETV success (P = 0.014)., Conclusions: Many patients with shunt malfunction can benefit from secondary ETV even after decades of shunting. Age at secondary ETV, the number of previous shunt revisions, and the ETV success score can help to better identify the best candidates for the procedure., (Copyright © 2019 Elsevier Inc. All rights reserved.)