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IntroductionEarly and accurate diagnosis of pulmonary tuberculosis (TB) is crucial for timely treatment and prevention of transmission, but diagnostic challenges persist due to complex symptoms and limitations in diagnostic tools. Chest X-ray (CXR) is the standard imaging modality, but its sensitivity and specificity may vary. Recently, some promising alternatives emerged such as chest ultrasonography (CUS) – particularly valuable in resource-limited settings – and computer-aided diagnosis (CAD) systems – helping clinicians in the reading and interpretation of the CXR. However, direct comparisons of CUS, CXR, and CAD score in TB diagnosis are limited.Methods and analysisThis cross-sectional study will assess the diagnostic effectiveness of CUS in diagnosing TB compared to CXR and CAD score among index cases and household contacts. The study will be conducted at Wolisso St. Luke Hospital (Wolisso, Ethiopia). Index cases will be subjects with diagnosis of pulmonary tuberculosis within 7 days. Household contacts will be identified by administering a screening questionnaire to index cases. They will undergo CXR as for standard of care and consequent CAD analysis and CUS. The anticipated sample size is 136 subjects. The common accuracy metrics (sensitivity, specificity, positive and negative predictive values) will be calculated.Ethics and disseminationThe protocol was approved by the Oromia Health Bureau Research Ethics Committee (BFO/MBTFH/1-16/1908). All information obtained will be confidential. Selected investigators will have access to data, while international partners will sign a dedicated Data Protection Agreement. Eligible subjects will receive a brief information about the study before being asked to participate and they will provide a written informed consent. Results will be conveyed to stakeholders and disseminated through conferences and peer-reviewed journals.Clinical trial registrationNCT06409780, https://clinicaltrials.gov.

Background Systemic inflammatory response syndrome (SIRS) following cardiovascular interventions is associated with adverse events during hospitalization and follow‐up. Mitral transcatheter edge‐to‐edge repair is increasingly utilized for treatment of mitral regurgitation (MR). We investigated whether SIRS following mitral transcatheter edge‐to‐edge repair may occur and be associated with adverse clinical outcomes. Methods and Results A total of 158 consecutive patients with severe MR undergoing mitral transcatheter edge‐to‐edge repair were studied. SIRS was defined by leukocytosis (≥12 × 109/L) and fever (≥38 °C) within 48 hours after intervention. Baseline inflammation was measured by absolute neutrophil and lymphocyte counts and neutrophil‐lymphocyte ratio. The primary end point of major cardiovascular events was the composite of nonfatal myocardial infarction, nonfatal stroke, and all‐cause death. Recurrent MR at follow‐up was also recorded. The mean patient age was 80.8±8.8 years. Forty‐four (27.9%) developed SIRS. Neutrophil‐lymphocyte ratio correlated with onset of leukocytosis and fever (P=0.04). During a median follow‐up of 12.5 (5.4–17.4) months, the primary end point occurred in 27 (17.1%) patients (6 myocardial infarction, 5 strokes, and 16 deaths). Patients with SIRS more often had severe MR (79.5% versus 62.7%, P=0.02) at follow‐up. After adjustment for pertinent variables, SIRS (HR 2.73 [95% CI, 1.08–6.86]; P=0.03) was independently associated with major cardiovascular events. Conclusions SIRS after mitral transcatheter edge‐to‐edge repair is a strong independent predictor of major cardiovascular events. Closer follow‐up is warranted because patients with SIRS have more severe MR at follow‐up.

ABSTRACT The use of biostimulants in agriculture provides a sustainable and efficient technology to improve resource‐use efficiency. Biostimulants may boost vegetative growth, enhancing plant tolerance to biotic and abiotic stress. The tomato (Solanum lycopersicum L.) is sensitive to drought stress, particularly during fruit setting and fruit development stages. In Italy, long‐storage tomato genotypes characterised by drought resistance were selected. In this 2‐year study, the foliar application of different biostimulants (betaine, seaweed extracts, vegetal protein hydrolysate and animal protein hydrolysate) was evaluated to determine effects on yield and quality of a local tomato landrace (Pizzutello) cultivated in Sicily without irrigation. The highest dry matter (9.9%) and solid soluble content (6.9° Brix) were observed in plants treated with betaine. Plants treated with A. nodosum or animal protein hydrolysate showed the highest potassium concentrations, whereas those supplied with vegetal protein hydrolysate had the highest calcium concentrations. Tomato treated with betaine were found to have the highest nitrate concentrations. The highest marketable yield (13.8 t ha−1) was recorded in plants treated with vegetal protein hydrolysate, with an increase of 17.4% compared to the control plants. The highest unmarketable yield was observed in control plants and in those treated with betaine (1.1 t ha‐1). In conclusion, we can say that each biostimulant had a different effect on the different parameters analysed. Overall, the application of biostimulants has improved tomato growth, productivity and quality in limited water conditions. Our results highlight the potential of biostimulant applications to optimise both the yield and fruit quality of renowned local varieties. This study demonstrated the improvement in the agronomic performance of the Pizzutello tomato, which is particularly significant not only in response to the growing consumer demand for high‐quality traditional tomatoes, but also for the enhancement of the technological traits valued by the food industry.

BackgroundEchocardiography is essential in cardiovascular medicine for screening, diagnosis, and monitoring. Artificial intelligence (AI) has the potential to improve echocardiography by reducing variability and analysis time. While 3D echocardiography is becoming more accurate, 2D imaging still dominates clinical care. We aimed to evaluate agreement in measures of left ventricular (LV) volumes and function between human readers, a fully automated AI 2D algorithm, and the 3D Heart Model.MethodsA retrospective analysis was conducted on 109 patients who underwent 2D and 3D transthoracic echocardiography. LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and ejection fraction (LVEF) were measured by two operators, a commercially available AI algorithm (US2ai), and the 3D Heart Model. Global longitudinal strain (GLS) was measured by the integrated semi-automated software and the AI algorithm. Outcomes included measures of agreement [bias, limit of agreement and Pearson's correlation (R)]ResultsFor LV volume measurements, the AI algorithm was strongly correlated with the average of the human operators (r = 0.89 for LVEDV and r = 0.92 for LVESV), which was higher than between the operators (r = 0.74 and r = 0.84, respectively, p

BackgroundCardiovascular diseases (CVDs) pose a significant global health challenge, necessitating innovative approaches for primary prevention. Personalized prevention, based on genetic risk scores (PRS) and digital technologies, holds promise in revolutionizing CVD preventive strategies. However, the clinical efficacy of these interventions requires further investigation. This study presents the protocol of the INNOPREV randomized controlled trial, aiming to evaluate the clinical efficacy of PRS and digital technologies in personalized cardiovascular disease prevention.MethodsThe INNOPREV trial is a four-arm RCT conducted in Italy. A total of 1,020 participants, aged 40–69 with high 10-year CVD risk based on SCORE 2 charts, will be randomly assigned to traditional CVD risk assessment, genetic testing (CVD PRS), digital intervention (app and smart band), or a combination of genetic testing and digital intervention. The primary objective is to evaluate the efficacy of providing CVD PRS information, measured at baseline, either alone or in combination with the use of an app and a smart band, on two endpoints: changes in lifestyle patterns, and modification in CVD risk profiles. Participants will undergo a comprehensive assessment and cardiovascular evaluation at baseline, with follow-up visits at one, five, and 12 months. Lifestyle changes and CVD risk profiles will be assessed at different time points beyond the initial assessment, using the Life's Essential 8 and SCORE 2, respectively. Blood samples will be collected at baseline and at study completion to evaluate changes in lipid profiles. The analysis will employ adjusted mixed-effect models for repeated measures to assess significant differences in the data collected over time. Additionally, potential moderators and mediators will be examined to understand the underlying mechanisms of behavior change.DiscussionAs the largest trial in this context, the INNOPREV trial will contribute to the advancement of personalized cardiovascular disease prevention, with the potential to positively impact public health and reduce the burden of CVDs on healthcare systems. By systematically examining the clinical efficacy of PRS and digital interventions, this trial aims to provide valuable evidence to guide future preventive strategies and enhance population health outcomes.

Geotechnical problems with total stress changes occurring rapidly relative to the soil consolidation time can be conveniently addressed using an effective stress-based approach. For saturated states, analytical formulations of pore-pressure coefficients adopting coherent effective stress concepts exist. These formulations allow the induced pore water pressure variations and the corresponding effective stress changes to be determined. For unsaturated states, there are no analytical formulations of pore-pressure coefficients that adopt a suitable effective stress concept. This paper presents analytical derivations of pore- pressure coefficients for unsaturated elastic isotropic soils using the generalized effective stress (valid for saturated and unsaturated states) for different total stress changes. The model performance is described, and flowcharts to be adopted in engineering practice are provided. Compared with an existing approach that is not based on the effective stress, the proposed one requires fewer constitutive parameters (one of which, conveniently, is the soil bulk modulus), allows to analytically obtain the existing expressions for saturated states when the degree of saturation is 1 and to readily determine the retention curve under undrained conditions. Existing experimental data were analysed, and satisfactory interpretations and predictions of the experimental results were obtained. The proposed framework is a valuable tool for undrained mechanical analyses of unsaturated soils under different practical applications. Key words: pore pressures, pore-pressure coefficients, partial saturation, suction, effective stress, undrained conditions, Introduction In some geotechnical applications (e.g., excavation on a slope, construction of an earth dam, and rapid drawdown), the soil is loaded (or unloaded) quickly relative to its consolidation time. [...]

Background and Aims: Hypoalbuminemia, as defined by serum albumin (SA) levels ≤35 g/L, is associated to venous and arterial thrombosis in general population and in patients at risk of cardiovascular disease. It is unknown if SA ≤35 g/L is also associated to portal vein thrombosis (PVT) in cirrhosis. Methods: Cirrhotic patients enrolled in the Portal vein thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry (PRO-LIVER) study (n = 753), were followed-up for 2 years to assess the risk of PVT, that was diagnosed by Doppler ultrasonography. Child-Pugh classes, Model for End-Stage Liver Disease score, presence of hepatocellular carcinoma and laboratory variables including SA, D-dimer, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline. Results: SA ≤35 g/L was detected in 52% of patients. A logistic multivariate regression analysis showed that higher Child-Pugh class, hepatocellular carcinoma and thrombocytopenia were significantly associated to SA ≤35 g/L. In a subgroup of patients where data regarding hs-CRP and D-dimer were available, SA ≤35 g/L was inversely associated with hs-CRP and D-dimer. During the follow-up, a total of 61 patients experienced PVT. A Kaplan Meier survival analysis showed SA ≤35 g/L was associated to increased risk of PVT compared to SA >35 g/L (P = .005). A multivariate Cox proportional hazards regression analysis showed that male sex, lower platelet count, and SA ≤35 g/L remained associated to PVT after adjusting for confounding factors. Conclusion: Cirrhotic patients with SA ≤35 g/L are at higher risk of experiencing PVT compared to those with SA >35 g/L and could be considered as potential candidates to anticoagulant prophylaxis for PVT prevention.

Background: Prostate cancer (PCa) is the second most common cancer in men, and radiotherapy (RT) is one of the main treatment options. Although effective, RT can cause toxic side effects. The accurate prediction of dosimetric parameters, enhanced by advanced technologies and AI-based predictive models, is crucial to optimize treatments and reduce toxicity risks. This study aims to explore current methodologies for predictive dosimetric parameters associated with RT toxicity in PCa patients, analyzing both traditional techniques and recent innovations. Methods: A systematic review was conducted using the PubMed, Scopus, and Medline databases to identify dosimetric predictive parameters for RT in prostate cancer. Studies published from 1987 to April 2024 were included, focusing on predictive models, dosimetric data, and AI techniques. Data extraction covered study details, methodology, predictive models, and results, with an emphasis on identifying trends and gaps in the research. Results: After removing duplicate manuscripts, 354 articles were identified from three databases, with 49 shortlisted for in-depth analysis. Of these, 27 met the inclusion criteria. Most studies utilized logistic regression models to analyze correlations between dosimetric parameters and toxicity, with the accuracy assessed by the area under the curve (AUC). The dosimetric parameter studies included Vdose, Dmax, and Dmean for the rectum, anal canal, bowel, and bladder. The evaluated toxicities were genitourinary, hematological, and gastrointestinal. Conclusions: Understanding dosimetric parameters, such as DVH, Dmax, and Dmean, is crucial for optimizing RT and predicting toxicity. Enhanced predictive accuracy improves treatment effectiveness and reduces side effects, ultimately improving patients’ quality of life. Emerging artificial intelligence and machine learning technologies offer the potential to further refine RT in PCa by analyzing complex data, and enabling more personalized treatment approaches.

The impact of diabetic foot (DF) on the healthcare system represents a major public health problem, leading to a considerable clinical and economic burden. The factors contributing to DF’s development and progression are strongly interconnected, including metabolic causes, neuropathy, arteriopathy, and inflammatory changes. Sodium–glucose cotransporter 2 inhibitors (SGLT2-i), novel oral hypoglycemic drugs used as an adjunct to standard treatment, have recently changed the pharmacological management of diabetes. Nevertheless, data about the risk of limb amputation, discordant and limited to canagliflozin, which is currently avoided in the case of peripheral artery disease, have potentially discouraged the design of specific studies targeting DF. There is good evidence for the single immunomodulatory, neuroprotective, and beneficial vascular effects of SGLT2-i. Still, there is no clinical evidence about the early use of SGLT2-i in diabetic foot due to the lack of longitudinal and prospective studies proving the effect of these drugs without confounders. This narrative review aims to discuss the main evidence about the impact of SGLT2-i on the three complications of diabetes implicated in the development of DF, the state of the art, and the potential future implications.

Cotton, with a cultivated area of 31.92 × 106 ha−1 across 80 countries and an estimated annual turnover of USD 5.68 billion, is the world’s leading natural textile fiber. However, many cotton-producing countries have neglected to improve production practices, adversely affecting the environment and society. A systematic review of the sustainable cotton cultivation literature was performed for the first time to identify and suggest context-specific agricultural strategies that can be applied within different agroecosystems. The key aspects include (1) inoculation with arbuscular mycorrhizal species such as Gigaspora margarita, Funneliformis mosseae, and Acaulospora scrobiculata to enhance root exploration, biomass, and nutrient uptake; (2) using grass, legume, and brassica cover crops as a valid alternative to monoculture and fallow crop rotations to reduce resource depletion and increase the sustainability of cotton production; (3) adopting drip and mulched drip irrigation systems over traditional furrow and sprinkler systems for water conservation; (4) exploring the feasibility of prematurely terminating irrigation in humid subtropical and Mediterranean climates as an alternative to chemical defoliation without affecting cotton yield. This paper, which describes various farming practices adopted in different climates, provides farmers a guide for eco-friendly cotton agronomic management without sacrificing productivity.

Purpose: To evaluate the role of radiomics in preoperative outcome prediction in cirrhotic patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) using “controlled expansion covered stents”. Materials and Methods: This retrospective institutional review board-approved study included cirrhotic patients undergoing TIPS with controlled expansion covered stent placement. From preoperative CT images, the whole liver was segmented into Volumes of Interest (VOIs) at the unenhanced and portal venous phase. Radiomics features were extracted, collected, and analyzed. Subsequently, receiver operating characteristic (ROC) curves were drawn to assess which features could predict patients’ outcomes. The endpoints studied were 6-month overall survival (OS), development of hepatic encephalopathy (HE), grade II or higher HE according to West Haven Criteria, and clinical response, defined as the absence of rebleeding or ascites. A radiomic model for outcome prediction was then designed. Results: A total of 76 consecutive cirrhotic patients undergoing TIPS creation were enrolled. The highest performances in terms of the area under the receiver operating characteristic curve (AUROC) were observed for the “clinical response” and “survival at 6 months” outcome with 0.755 and 0.767, at the unenhanced and portal venous phase, respectively. Specifically, on basal scans, accuracy, specificity, and sensitivity were 66.42%, 63.93%, and 73.75%, respectively. At the portal venous phase, an accuracy of 65.34%, a specificity of 62.38%, and a sensitivity of 74.00% were demonstrated. Conclusions: A pre-interventional machine learning-based CT radiomics algorithm could be useful in predicting survival and clinical response after TIPS creation in cirrhotic patients.

Rheumatoid arthritis (RA) is a systemic autoimmune disorder caused by inflammation of cartilaginous diarthrodial joints that destroys joints and cartilage, resulting in synovitis and pannus formation. Timely detection and effective management of RA are pivotal for mitigating inflammatory arthritis consequences, potentially influencing disease progression. Nuclear medicine using radiolabeled targeted vectors presents a promising avenue for RA diagnosis and response to treatment assessment. Radiopharmaceutical such as technetium-99m (99mTc), combined with single photon emission computed tomography (SPECT) combined with CT (SPECT/CT), introduces a more refined diagnostic approach, enhancing accuracy through precise anatomical localization, representing a notable advancement in hybrid molecular imaging for RA evaluation. This comprehensive review discusses existing research, encompassing in vitro, in vivo, and clinical studies to explore the application of 99mTc radiolabeled targeting vectors with SPECT imaging for RA diagnosis. The purpose of this review is to highlight the potential of this strategy to enhance patient outcomes by improving the early detection and management of RA.

Abstract Background The autonomic nervous system is linked to hyperdynamic circulation in cirrhosis and several studies have highlighted the crucial role that systemic inflammation elicits in altering sympathovagal equilibrium with the consequent reduction in heart rate variability (HRV). To investigate the correlation between time‐domain HRV parameters, serum cytokines concentrations and portal hypertension, we studied a cohort of patients with cirrhosis, accounting for etiology and treatments. Methods In this cross‐sectional, observational cohort study, 107 outpatients with non‐alcoholic cirrhosis were assessed consecutively by abdominal ultrasound and by upper gastrointestinal endoscopy to search for esophagogastric varices. 24‐h electrocardiogram Holter monitoring with time‐domain HRV measurement (square root of the mean of successive differences of Normal‐to‐Normal [NN] [RMSSD], standard deviation or the square root of variance [SDNN] and standard deviation of the means of the NN intervals calculated over a 5‐min period [SDANN]) was performed and serum concentrations of osteopontin (OPN), interleukin (IL)‐22, IL‐6, IL‐1Ra and IL‐17 were obtained in all patients. Results IL‐6, OPN, IL‐22 and IL‐1Ra concentrations in cirrhotic patients were associated with disease severity expressed by Child‐Pugh and MELD score, to some portal hypertension's indirect signs and some of its complications. A significant increase in systemic concentrations of OPN in patients with hepatocellular carcinoma was encountered. SDANN and SDNN values were indirectly related to serum levels of IL‐6, OPN, IL‐1Ra and IL‐22. Conclusions This study underlines the interaction between the alteration of the ANS and the activation of inflammatory pathways that characterize cirrhosis taking into account clinical characteristics and treatments.