Search Results (2,113)

Background: Cystic artery bleeding (CAB) is a rare but potentially life-threatening condition. Its etiologies span iatrogenic trauma, inflammatory diseases, and trauma, often presenting variably as hemoperitoneum, upper gastrointestinal bleeding, or hemorrhagic shock. The clinical heterogeneity of CAB complicates its diagnosis, necessitating a high index of suspicion and reliance on imaging modalities, particularly computed tomography (CT), for accurate identification of bleeding sources and differentiation from other causes of abdominal pain. Methods: This pictorial essay highlights key imaging findings in CAB and pseudoaneurysms, emphasizing the role of ultrasound, CT, and digital subtraction angiography (DSA) in diagnosis and management planning. Additionally, a systematic review of transcatheter arterial embolization (TAE) is presented, consolidating data from 64 studies encompassing 90 patients. Results: The review evaluates patient demographics, etiologies, clinical presentations, and procedural outcomes, underscoring TAE’s high efficacy and safety as a first-line treatment. Conclusions: The findings reinforce the importance of early diagnosis and tailored intervention strategies to optimize outcomes in CAB management. Full article

The rising burden of fungal infections presents a significant challenge to global healthcare, particularly with increasing antifungal resistance limiting treatment efficacy. Early detection and timely intervention remain critical, yet fungal pathogens employ diverse mechanisms to evade host immunity and develop resistance, undermining existing therapeutic options. Limited antifungal options and rising resistance necessitate novel treatment strategies. This review provides a comprehensive overview of conventional antifungal agents, their mechanisms of action, and emerging resistance pathways. Furthermore, it highlights recently approved and investigational antifungal compounds while evaluating innovative approaches such as nanotechnology, drug repurposing, and immunotherapy. Addressing antifungal resistance requires a multifaceted strategy that integrates novel therapeutics, enhanced diagnostic tools, and future research efforts to develop sustainable and effective treatment solutions. Full article

Background: Seasonal influenza currently remains a major public health concern for the community and, in particular, the health care worker (HCW). According to the World Health Organization, HCWs are among the high-risk categories for which vaccination is recommended, due to the derived absenteeism, productivity loss, and high probability of transmitting the disease to vulnerable individuals or patients. Therefore, an HCW vaccination policy should be adopted by every health care provider. There is growing evidence that a time effect of the vaccination event is probable, which may influence vaccine effectiveness. We designed and conducted an observational study to investigate the time to anti-influenza vaccination event of different categories of HCWs belonging to different occupational settings in a tertiary hospital during three seasons in order to retrieve some insight about HCW prioritization when designing vaccination campaigns. Materials and Methods: We retrospectively analyzed the results of two HCW anti-influenza vaccination campaigns (2022 and 2023) to assess any difference regarding job typology and unit typology (critical care, surgical, medical, service). We first fitted a classic Cox proportional hazard model and then an AI random forest model to assess variable importance. We used R, RStudio, and the survex package. Results: Overall, other HCWs reported a lower vaccination rate compared to nurses (HR 0.77; 95%CI 0.62–0.97), and service unit personnel appeared to more likely be vaccinated (HR 1.42; 95%CI 1.01–1.99) compared to those belonging to the critical care units. As expected, older workers tended to be vaccinated more frequently (HR 1.70 for the (46,65] category compared to the younger one; 95%CI 1.39–2.09). The variable importance analysis showed consistent superiority of the ward typology and age category variables with respect to time. During the entire timeline, the ward typology appeared to be more important than the HCW typology. Conclusions: Our results suggest a prioritization policy based firstly on the unit typology followed by the job typology for HCW anti-influenza campaigns. Full article

Neuromuscular diseases (NMDs) encompass various hereditary conditions affecting motor neurons, the neuromuscular junction, and skeletal muscles. These disorders are characterized by progressive muscle weakness and can manifest at different stages of life, from birth to adulthood. NMDs, such as Duchenne and Becker muscular dystrophies, myotonic dystrophy, and limb–girdle muscular dystrophies, often involve cardiac complications, including cardiomyopathies and arrhythmias. Underlying genetic mutations contribute to skeletal and cardiac muscle dysfunction, particularly in the DMD, EMD, and LMNA genes. The progressive nature of muscle deterioration significantly reduces life expectancy, mainly due to respiratory and cardiac failure. The early detection of cardiac involvement through electrocardiography (ECG) and cardiac imaging is crucial for timely intervention. Pharmacological treatment focuses on managing cardiomyopathies and arrhythmias, with an emerging interest in gene therapies aimed at correcting underlying genetic defects. Heart transplantation, though historically controversial in patients with muscular dystrophies, is increasingly recognized as a viable option for individuals with advanced heart failure and moderate muscle impairment, leading to improved survival rates. Careful patient selection and management are critical to optimizing outcomes in these complex cases. Full article

European grasslands are vital carbon (C) sinks, contributing to climate change mitigation. Grazing intensity significantly influences soil C and nitrogen (N) cycles through effects on soil conditions and microbial communities. While heavy grazing is linked to soil C loss and altered N processes, existing studies show conflicting outcomes. This study examines the impact of cattle grazing on soil C and N cycles in a historical alpine pasture in the eastern Italian Alps (1868 m a.s.l.). The following three grazing intensities were analyzed: heavy (8.19 LU ha⁻¹), moderate (0.59 LU ha⁻¹), and light (0.06 LU ha⁻¹). Soil was sampled from two depth layers (0–5 cm, 5–10 cm) and analyzed for bulk density, C and N content, C/N ratio, exchangeable N, δ¹⁵N, and microbial genes targeting general abundance (16S), N fixation (nifH), nitrification (amoA), and denitrification (nirK, nosZ) using real-time PCR. The results revealed decreased C and N concentrations with increasing grazing intensity, exclusively in the 0–5 cm soil layer. Higher δ¹⁵N and enhanced nitrification and denitrification suggest a more open N cycle under heavy grazing. These findings highlight the potential of microbial gene markers and δ¹⁵N isotopic ratios to monitor N cycle dynamics in alpine pastures, informing sustainable grazing management. Full article

Background. Attachment between romantic partners has been investigated primarily through self-reports assessing the two dimensions of avoidance and ambivalence/anxiety, typically formulating items according to observable psychological properties. However, this approach produces correlated dimensions, with a limited distinction between their features. In this work, we hypothesize that a definition of avoidance and ambivalence driven by their theorized cognitive–evolutionary functions can lead to a clearer-cut distinction between the two (i.e., lower correlation), still maintaining or even further highlighting the expected avoidant and ambivalent characteristics. Methods. To test our hypothesis, we administered to an adult population a battery of self-reports measuring attachment and related properties—i.e., psychological well-being, couple satisfaction, and emotion regulation. We assessed attachment through two classical attachment self-reports—the Experiences in Close Relationships-Revised (ECR-R) and Revised Adult Attachment Scale (RAAS)—and the novel, theory-informed Attachment–Caregiving Questionnaire (ACQ), building a Partial Least Squares Structural Equation Model (PLS-SEM) connecting attachment with the other constructs. Results. Our results demonstrate that measuring attachment through the ECR-R/RAAS and the ACQ leads to similar properties but a more evident characterization of avoidance and ambivalence supported by the ACQ. Conclusions. These first findings suggest that the cognitive–evolutionary definition of these two dimensions may be advantageous and should be further investigated. Full article

Varroa destructor is an ectoparasitic mite that causes a true syndrome with complex symptoms in honeybees. For mite control, several synthetic active principles are commercially available. However, these formulations are proving less effective due to the acquisition of resistance mechanisms by the parasite. Naturally derived compounds, such as essential oils, are less prone to generating resistance mechanisms in mite populations and have been proven effective in numerous independent laboratory investigations. In this study, semi-field and field tests were conducted to evaluate the acaricidal efficacy of two essential oils (Citrus bergamia and Citrus limon), which, in our previous residual contact toxicity tests, showed efficacy against Varroa mites. For semi-field cage tests, two-level cages were set up. Filter paper soaked with different concentrations of essential oils was placed in the lower compartment of the cage; 20 honeybees and 10 Varroa mites were allocated in the upper level. Mite detachment from the honeybees was evaluated after 24 and 48 h. For field tests, cardboard strips soaked with solutions of essential oils at different concentrations were inserted in the experimental hives. Weekly, the strips were replaced, and the fall of parasites on the diagnostic bottom board was assessed. Semi-field tests showed that the essential oils, at the concentrations used, were not toxic to bees. In the semi-field tests, an average acaricidal efficacy of 33% and 60% was obtained, at the highest concentration used, for bergamot and lemon essential oils, respectively. During the 4 weeks of exposure to 600 mL of BEO, the average mite mortality was 28.5%. In the experimental group treated with the intermediate concentration of 1200 mL, the average mite mortality at the end of four weeks was 30.2%, while with the highest concentration of 1800 mL, it was 40.3%. During the four weeks of exposure to 600 mL of LEO, the average mite mortality was 34.1%. In the experimental group treated with the 1200 mL concentration, the average mite mortality at the end of the four weeks was 46.6%, while with the highest concentration, it was 50.7%. This study shows that the acaricidal efficacy observed in field tests differs from that in laboratory tests. Innovative formulations are needed that allow the time-controlled and gradual release of essential oil in the field. Full article

The integrity of p53 machinery is crucial for platinum activity, while p53 mutation is frequent in high-grade serous ovarian cancer (HGS-OC). This study aimed to evaluate the link between p53 mutations, platinum sensitivity (PS), and the platinum-free interval (PFI) in patients with HGS-OC. We prospectively analyzed 159 consecutive women with ovarian cancer who underwent surgery. The somatic mutational status of BRCA, HRD, and TP53 (according to structural, hotspot, and functional classification) was evaluated. Among enrolled patients, 82.4% of cases were TP53-mutated (MT), and 27.8% were BRCA-MT. The distribution of TP53 mutation categories did not differ significantly between the BRCA-MT and wild-type (WT) cases. In the entire population, the proportion of PS patients was significantly lower in TP53-MT compared to TP53-WT (p = 0.0208), in nonsense/frameshift/splicing compared to missense (p = 0.0319), and in loss-of-function (LOF) compared to GOF (p = 0.0048) MT cases. For the BRCA-MT patients, structural and functional TP53 mutations were not significantly different between the PS and PR patients. Conversely, for the BRCA WT patients, the distribution of structural and functional TP53 mutations significantly differed between PS and PR patients. In a multivariate regression analysis, LOF mutations were found to be independent negative predictors of PS (HR: 0.1717; 95% CI: 0.0661–0.4461; p-value: 0.0003). Kaplan–Meier curves showed a significantly lower PFI in cases with LOF mutations in the overall population (log-rank p = 0.0020) and in BRCA-WT patients (log-rank p = 0.0140). Via multivariate COX testing, it was found that LOF mutations were independently associated with a decreased PFI (p = 0.0036). In conclusion, our data show that HGS-OC harboring p53 LOF mutations is the poorest prognostic subgroup regarding PS and the PFI. Further studies are needed to confirm our findings. Full article

Frequency Response Analysis (FRA) is a proven method for detecting mechanical faults in transformers, such as winding deformations and short circuits. However, traditional FRA interpretation relies heavily on visual and subjective comparison of frequency response curves, which can introduce human bias and lead to inconsistent results. Integrating Machine Learning (ML) with FRA can significantly enhance fault diagnosis by automatically identifying complex patterns within the data that are difficult to detect using through human analysis. This integration can automate diagnostics, enhance accuracy, improve predictive maintenance, reduce reliance on expert interpretation and curtail operational costs. This paper reviews the application of FRA and ML alongside complementary techniques for transformer winding health assessment. Full article

Colorectal cancer (CRC) remains a leading cause of cancer-related mortality, with metastatic disease posing significant therapeutic challenges. While anti-EGFR therapy has improved outcomes for patients with RAS and BRAF wild-type tumors, resistance remains a major hurdle, limiting treatment efficacy. The concept of negative hyperselection has emerged as a refinement of molecular profiling, identifying additional genomic alterations—such as HER2 and MET amplificationsand MAP2K1 mutations—that predict resistance to anti-EGFR agents. Studies incorporating these expanded assessments have demonstrated that nearly half of patients with RAS/BRAF wild-type tumors harbor alternative resistance biomarkers, underscoring the need for expanded selection criteria. Liquid biopsies, particularly circulating tumor DNA (ctDNA) analysis, have revolutionized precision oncology by providing a minimally invasive, real-time assessment of tumor dynamics. ctDNA-based hyperselection enables the detection of resistance-associated alterations, guiding treatment decisions with greater accuracy than conventional tissue biopsies. Recent trials support the predictive value of ctDNA-defined negative hyperselection, revealing superior outcomes for patients stratified through liquid biopsy. This narrative review explores the evolving role of molecular hyperselection in first-line anti-EGFR therapy, emphasizing the integration of ctDNA to refine patient selection, enhance therapeutic efficacy, and pave the way for personalized treatment strategies in metastatic CRC. Full article

Background/Objectives: Cryofibrinogenemia, characterized by plasma cryoprecipitation of fibrinogen and related proteins, is a rare and often under-recognized entity that can present with significant renal involvement. Methods: we describe a 66-year-old woman with progressive renal failure due to membranoproliferative glomerulonephritis driven by cryofibrinogen deposits. Her clinical course was marked by relapsing–remitting disease with limited response to high-dose corticosteroids but significant improvement following plasma exchange. Over seven years, she underwent three kidney biopsies, revealing progressive histopathological changes, including glomerular cryofibrinogen deposits and evolving chronicity. A detailed review of the literature identified 50 cases of cryofibrinogenemia, highlighting its association with monoclonal gammopathies, malignancies, and autoimmune diseases. Results: our case uniquely underscores the pathogenic interplay between cryofibrinogenemia and a monoclonal IgG-kappa paraprotein, which was found to directly stabilize fibrinogen and drive cryoprecipitation. This novel observation aligns cryofibrinogenemia with monoclonal gammopathy of renal significance, expanding the diagnostic and therapeutic landscape for this entity. Conclusions: this report also highlights the pivotal role of kidney biopsy with electron microscopy in diagnosing cryofibrinogen-associated renal disease, particularly when conventional biomarkers are insufficient. Moreover, our findings emphasize the therapeutic utility of plasmapheresis and the potential need for therapies aimed at eliminating the pathogenetic monoclonal antibody in managing refractory cases. Enhanced awareness and further research into this rare entity are essential for advancing patient care and outcomes. Full article

Dyslipidemia is a metabolic disorder characterized by quantitative and/or qualitative abnormalities in serum lipid levels. Elevated serum cholesterol levels can modify the turnover and recruitment of ionic channels in myocytes and cellular homeostasis, including those of inflammatory cells. Experimental and clinical data indicate that inflammation is implicated in the pathophysiology of atrial remodeling, which is the substrate of atrial fibrillation (AF). Data about the association between increased lipid serum levels and AF are few and contrasting. Lipoprotein (a), adiposity, and inflammation seem to be the main drivers of AF; in contrast, low-density lipoproteins, high-density lipoproteins and triglycerides are not directly involved in AF onset. The present review aimed to describe the pathophysiological link between dyslipidemia and AF, the efficacy of lipid-lowering therapies in atherosclerotic cardiovascular disease (ASCVD) patients with and without AF, and the impact of lipid-lowering therapies on AF incidence. Full article

Background: Upper gastrointestinal bleeding severity (BleSev) is commonly defined by evaluating different factors that are frequently interdependent on each other, expressing the same underlying cause. Aim: This study aimed to define the severity of a bleeding event and verify its impact on death risk and the time to endoscopy. Methods: We analyzed 12 factors (demographic, hemodynamic, biochemical, and clinical) that could be associated with BleSev. We identified the independent weight of each factor in predicting a composite endpoint (need for surgery, interventional radiology, and death) and the effect of the interactions between time to endoscopy and BleSev on death risk. Results: Clinical data of 2.525 patients were included. Of the 12 factors, 5 were retained in the final model as follows: altered mental status, systolic blood pressure ≤ 100 mmHg, blood urea nitrogen level ≥ 130 mg/dL, hematemesis, and hemoglobin level ≤ 8 g/dL (AUC performance curve, 0.79). We identified the following three classes of BleSev: low (0–1 points, 2.4%), intermediate (3–4 points, 8.6%), and high (≥5 points, 21.1%). When no factors were present, the death risk was 1%; when all factors were present, the risk was 45.5%. Notably, the death risk increased with BleSev but was generally independent of time to endoscopy. However, in high-risk cases, early endoscopy (within 6–12 h) was associated with a reduced mortality rate. Conclusions: This study defines a risk model for BleSev and highlights the need for targeted endoscopic timing strategies based on BleSev for optimizing survival rates. Patients in the highest risk category may benefit from more urgent endoscopic interventions. Full article

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent difficulties in social interaction, communication, and repetitive behaviors. Neuroimaging studies have revealed structural and functional neural changes in individuals with ASD compared to healthy subjects. Objectives: This study aimed to investigate brain network structural connectivity in ASD using Morphometric Similarity Network (MSN) analysis. Methods: Data from the Autism Brain Imaging Data Exchange (ABIDE) were analyzed, comprising 597 individuals with ASD and 644 healthy controls. Structural connectivity was assessed using cortical morphometric features. Global and regional network indices, including the density index, node degree, node strength, and clustering coefficients, were evaluated. Results: Among the global network indices, when using a threshold value of 0.4, ASD patients compared to HCs showed a lower density (p = 0.041) and higher negative clustering (p = 0.0051) coefficients. For regional network indices, ASD patients showed a lower bilateral superior frontal cortices degree (left hemisphere: p = 0.014; right hemisphere: p = 0.0038) and strength (left: p = 0.017; right: p = 0.018). Additionally, they showed higher negative clustering coefficients in the bilateral superior frontal cortices (left, p = 0.0088; right, p = 0.0056) and bilateral pars orbitalis (left, p = 0.016; right, p = 0.0006), as well as lower positive clustering in the bilateral frontal pole (left, p = 0.03; right, p = 0.044). Conclusions: These findings highlight significant alterations in both global and regional brain network organization in ASD, which may contribute to the disorder’s cognitive and behavioral manifestations. Future studies are needed to investigate the pathophysiological mechanisms underlying these structural connectivity changes, to inform the development of more targeted and individualized therapeutic interventions for individuals with ASD. Full article

The no-kill policy for domestic dogs, adopted in Italy in 1991, reflects a growing interest in animal welfare and increases the chances of dogs being adopted and living with a family. However, unadoptable dogs must spend their entire lives in shelters. This paper reports the adoption numbers from the ‘Muratella’ shelter (Rome) during the periods 2012–2016 (first period) and 2018–2022 (second period), illustrating the outcomes of the no-kill policy in a large metropolitan area. Furthermore, it discusses the ethical implications after 34 years of implementing Italian laws on the management of free-ranging dogs. During the first period, 7888 dogs entered the shelter, of which 4247 (53.84%) were adopted and 307 (3.89%) were not adopted. Similarly, during the second period, 8853 dogs entered the shelter, of which 4251 (49.11%) were adopted and 278 (3.16%) remained in the shelter by the end of 2022. Furthermore, we report the fate of unadopted dogs by the end of 2024. Despite the success in adoptions, the small percentage of dogs condemned to lifelong shelter residence still represents a significant number and warrants ethical reflection. Full article