Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6030014

Authors: Courtney N. Wiesepape Jessica Garrelts Alexis Stokes John Britton Makenzie Dubas Emily Paul Marlee Gieselman

The rapid expansion of generative artificial intelligence (AI) in daily life and mental health contexts has generated both enthusiasm and concern. Within schizophrenia spectrum disorders (SSDs), generative AI use is sometimes framed as inherently destabilizing or unsafe. Such blanket assertions risk reinforcing longstanding stigmatizing assumptions that individuals with SSDs cannot engage responsibly with emerging technologies. Drawing on emerging literature on generative AI in mental health and SSDs, as well as the integrated model of metacognition, we propose a conceptual framework in which baseline metacognitive capacity may influence how individuals engage with generative AI tools. Individuals with relatively intact metacognitive capacity may be better able to approach and utilize generative AI in a reflective manner. In contrast, individuals with more limited metacognitive capacity may be more vulnerable to passively accepting AI-generated content, outsourcing reflection, or experiencing adverse outcomes. We hypothesize that metacognitive capacity may represent one individual-level factor influencing the relationship between generative AI engagement and outcomes, alongside characteristics of the individual, technology, and broader clinical and social context. These proposed relationships remain theoretical and require empirical validation. We conclude with anti-stigma implications, calling for nuanced approaches to generative AI use in SSDs and greater inclusion of individuals with lived experience in conversations about technological innovation.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6030013

Authors: Manuela Montatore Federica Masino Ruggiero Tupputi Eluisa Muscogiuri Giuseppe Guglielmi

Distinguishing infectious collections from underlying malignancies may represent a significant diagnostic challenge, particularly when tumors present with necrotic, cystic, perforated, or abscess-like components. Here, we introduce the descriptive concept of “cancer–abscess” as a practical imaging-oriented framework for recognizing underlying malignancies presenting as presumed infectious collections. The first case involves an appendiceal-region malignancy initially interpreted as a postoperative pericecal collection after appendectomy; the second concerns a locally advanced rectal carcinoma complicated by abscess formation and fistulization into the gluteal region. Ultrasound, computed tomography, and magnetic resonance imaging findings are reviewed to highlight recurrent diagnostic red flags, including persistent mass-like architecture, enhancing solid components, irregular soft-tissue proliferation, necrotic-colliquative areas associated with pathological enhancement, suspicious nodal or implant-like disease, and atypical extension patterns. Recognition of these features may support earlier suspicion of malignancy, guide further diagnostic work-up, and reduce delays in oncologic treatment. The “cancer–abscess” concept should be considered whenever presumed infectious collections show atypical or persistent imaging characteristics.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6030012

Authors: Marcello Persico Francesco Sabbatino Pietro Torre Mario Masarone Luciano Tarantino Gaetano Gargiulo Ferdinando Costabile Davide Ferdinando Precone Antonella Cavalli Giuseppe D’Adamo Angela Anna Iaderosa Raffaele Esposito Mariangela Rubino Prisco Piscitelli

The new therapeutic options now available for patients with hepatocellular carcinoma (HCC) have made their assessment more complex, especially due to the different stages of liver cirrhosis typically associated with this tumor. The management of the disease therefore requires an interdisciplinary approach aimed at identifying the most appropriate treatment based on the risk–benefit profile and residual liver function, as well as in relation to the patient’s age and potential for a full or partial recovery, risk of complications, and cancer recurrence. Another factor to be carefully considered in patients with hepatocellular carcinoma is the frequent comorbidities and the associated socio-health variables (substance abuse, addictions, unfavorable economic or family circumstances), which can impact patient management or the possibilities for long-term monitoring, thus influencing the choice of the most appropriate therapeutic pathway. The healthcare services offered in the Province of Salerno (Campania Region, Southern Italy) to ensure all possible diagnostic and therapeutic options for these patients can be difficult to access due to the territorial extension of the Local Health Authority, characterized by clinics and hospitals located in distant locations, as well as the potential fragmentation of expertise between the University Hospital and ambulatorial facilities or small hospitals. An interdisciplinary consensus conference on the management of patients with HCC has been set with the aim of involving clinicians and surgeons working in healthcare facilities located in Salerno and its Province for the optimal care and effective management of these patients, taking into account all the clinical characteristics of the disease and individual health needs or expectations, from the perspective of personalized medicine.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6020011

Authors: Elbahary Shlomo Kargar Saghar Rubin Daniel Hanna Tujan Zaid Nassam Slutzky Hagay Rosen Eyal Tsesis Igor

Occupational stress in dentistry, particularly during endodontic procedures, impacts practitioners’ health and performance. This study introduces a novel approach using real-time Heart Rate (HR) data from Apple Watch technology to assess physiological responses potentially indicative of occupational stress among endodontists. Materials and Methods: Twelve endodontists participated in this study, treating 119 patients. In a controlled clinical environment, HR was continuously monitored with the Apple Watch, and data were recorded via the Cardiogram app, capturing HR variations across treatment stages. Results: Significant HR fluctuations were observed during procedurally demanding stages such as local anesthesia and rubber dam placement. The endodontist’s HR, as a physiological proxy for stress, was significantly influenced by the treatment difficulty level, stage, and the patient’s age. Conclusions: Using Apple Watch technology, our study revealed significant HR variations during different endodontic treatment stages, suggesting fluctuating physiological responses that may reflect occupational stress. Elevated HR was noted during patient examination and rubber dam placement, particularly in complex cases. These preliminary findings suggest that HR monitoring via wearable technology may serve as a useful, albeit indirect, indicator of occupational stress during endodontic procedures. Future studies with larger samples and additional validated stress biomarkers are needed to confirm these observations.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6020010

Authors: Stylianos Vasileios Kontomaris Maria Pettermeridi Anna Malamou Andreas Stylianou

The development of precise quantitative metrics is essential for characterizing the response of biological systems to external perturbations, enabling a transition from qualitative observation to predictive modeling. In this context, mathematical frameworks can provide insight into the dynamic behavior of cell populations under external stimuli. In this study, a logistic-type growth model was employed to describe wound healing dynamics. A scratch assay protocol was applied to lung cancer cells, and a perturbation-based analytical framework was developed to quantify the influence of external factors. Novel metrics were introduced, including the percentage difference in wound closure at specific time points, the shift in inflection time, and the Average Difference in Wound Closure (ADWC). A pilot experimental study was conducted to evaluate the effect of Low-Level Laser Therapy (LLLT) on cell migration. The proposed model successfully captured the nonlinear dynamics of wound closure and enabled quantitative comparison between control and treated groups. The analysis demonstrated that LLLT enhances cellular activity, leading to a shift in the inflection time by approximately 7.6 h and an increase of 25.4% in wound closure at 24 h compared to the control group. The ADWC metric further confirmed a systematic difference in the overall healing dynamics between conditions. The presented perturbation-based framework provides a rigorous and interpretable tool for quantifying the effects of external stimuli on biological systems. These findings suggest a light-dependent modulation of tumor cell migration in an in vitro model, indicating that light exposure may influence cellular behavior under certain conditions. This observation may be relevant for clinical applications involving light, such as photodynamic therapy, particularly in cases of incomplete drug delivery.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6020009

Authors: Zahra Rahemi Meisam Omidi

Background: In electronic health record (EHR) research, multimorbidity is commonly represented by summary indices that may oversimplify disease co-occurrence or by unsupervised cluster labels that may lack stability across samples. This study evaluated a leakage-safe framework for deterministic, overlapping multimorbidity phenotyping. Methods: Data from the All of Us Research Program were used to study 23,435 adults aged 50 years and older, anchored at their first SARS-CoV-2-positive test. Eleven pre-index Charlson component indicators were used as the binary baseline representation. Stable co-occurrence patterns were explored using association rule mining with bootstrap recurrence criteria. K-modes clustering was used as a discovery aid, while final phenotype membership was defined by deterministic rule functions. Results: The framework produced three overlapping phenotype flags and a transparent 8-state overlap structure. The analytic cohort included 1462 incident cognitive impairment cases. Two phenotype flags were associated with higher odds of incident cognitive impairment. However, adding the phenotype flags to baseline models yielded only marginal improvements in discrimination. Conclusions: The framework’s primary value lies in providing a reproducible, transparent, and overlap-aware representation of multimorbidity rather than in producing substantial predictive gains. This approach may support interpretable baseline phenotyping and leakage-safe modeling in real-world EHR studies.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6020008

Authors: Dhanushka Wijesinghe Ivan T. Lima

Accurate and efficient seizure detection remains a major challenge for portable EEG-based monitoring systems, where computational and power limitations restrict the use of deep learning approaches. We introduce a compact set of fourteen propagation-based EEG features that quantify spike directionality, propagation velocity, and spatial coherence across channels. These physiologically interpretable features were evaluated using a gradient-boosted XGBoost classifier on the TUH Seizure Corpus under a leave-one-subject-out cross-validation framework. The proposed model achieved 97.8% accuracy, 98.7% specificity, 93.6% sensitivity, and a weighted F1 score of 97.8% using 2 s epochs and eight electrodes. The framework remained robust across generalized, focal, and complex partial seizure types and maintained consistent short-window performance. The compact 14-feature representation enables efficient, accurate, and interpretable seizure detection with strong potential for real-time wearable EEG-based applications. The proposed gradient-boosting approach demonstrates that shallow, interpretable architectures can achieve performance comparable to deep learning methods while offering improved computational efficiency, making them promising for low-power embedded implementations.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6020007

Authors: Mattie Rosi-Schumacher Susan Karki Ayham Al Afif Ryan McSpadden

Ossification of the vascular pedicle following fibula free flap (FFF) reconstruction is an uncommon and typically asymptomatic complication. Symptomatic cases requiring intervention are rare. We report a 29-year-old man with anterior maxillary osteosarcoma who underwent tumor resection followed by reconstruction with an osteocutaneous FFF. Calcification within the surgical site region was noted on imaging at two months after fibular reconstruction. By five months, he developed progressive trismus and pain with mastication. Computed tomography demonstrated a calcified structure extending from the mandible to the reconstructed maxilla along the flap pedicle, raising concern for tumor recurrence. Surgical excision was performed, and histopathology revealed benign woven bone without evidence of malignancy. Postoperatively, trismus improved, and flap viability was preserved. Retained periosteum during FFF harvest maintains osteogenic potential and may result in pedicle ossification. In symptomatic patients, particularly when recurrence is suspected, surgical resection is both diagnostic and therapeutic.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6020006

Authors: Roberta Stanzione Chiara Scognamiglio Lucia Luciana Mosca Simona Verniti Valeria Cioffi Enrica Tortora Enrico Moretto

This paper introduces SNAP (Structure, Narrative, Activation, Process, Next), a multidimensional clinical reflection tool supporting psychotherapists in systematically attending to phenomenological, relational, and process-oriented dimensions. SNAP integrates Gestalt therapy, complex systems theory, and the Research Domain Criteria (RDoC) framework, comprising 73 items across five dimensions. A pilot acceptability and perceived utility study (N = 20 psychotherapists) used a retrospective pre-post design in which participants provided retrospective pre-exposure and post-exposure ratings for each item. Post-exposure ratings were higher overall than retrospective pre-exposure ratings (T2: M = 6.69, SD = 0.54 vs. T1: M = 6.02, SD = 0.70; mean difference +0.67; Hedges’ g = 0.28, Cohen’s d = 0.29; 15/73 items p < 0.05 uncorrected; 2/73 after Benjamini-Hochberg FDR correction). The largest descriptive contrasts were observed in phenomenological dimensions: Next (g = 0.61), Activation (g = 0.49), Narrative (g = 0.43), and Process-Therapist (g = 0.41). Structural bio-psycho-social dimensions showed minimal contrasts (d = −0.02 to 0.15). Absolute post-exposure ratings were high across items (89% rated 6/9 or above), supporting good acceptability and perceived usefulness within this sample. These preliminary findings support SNAP as a promising, positively perceived framework for clinical reflection. Larger-sample psychometric validation is warranted.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6020005

Authors: Nitzan Kenig Aina Muntaner Vives Javier Montón Echeverría

Background: Generative artificial intelligence (AI) can produce realistic human faces that are shared on social media, from where younger generations often derive body image norms. Aesthetic bias in these systems may promote unrealistic standards of beauty. This study examines whether generative AI produces facial images that are perceived by humans as more attractive than real human faces. Thus, we examine AI-generated facial imagery as a contemporary site of consumer culture, where beauty may become biased, unrealistic, and commodified: generating an algorithmically optimized product circulating through social media and digital platforms without proper regulation. Methods: Fifty AI-generated female faces were prospectively compared with 50 photographs of female models from a model agency. Facial attractiveness was rated by plastic surgeons, using a Likert scale and Mann–Whitney U for analysis. Results: AI-generated images received higher mean aesthetic scores than real photographs (7.79 vs. 6.88, p < 0.05), despite prompts requesting unattractive features. Conclusions: The AI model showed a small but consistent bias toward enhanced facial attractiveness. As AI-generated imagery increasingly shapes visual culture, this bias may contribute to unrealistic beauty standards, highlighting the need for AI literacy, responsible use of AI, and ethical oversight, especially when shared on social media.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6010004

Authors: Flavio Cassano Giovanni Leo Tomacelli Costa Maria Carmela Besozzi Gianluca Rizzo Tiziana Paladini Adriana Guglielmo Sticchi

Background: Conventional CT–dacryocystography (CT-DCG) requires canalicular cannulation and forced contrast injection, which may distort anatomy and cause discomfort. This study describes a non-cannulated CT-DCG protocol using dropwise iodixanol 320 instillation designed to simulate physiological tear drainage. Methods: We retrospectively reviewed 80 patients (25 males, 55 females; mean age 64.3 ± 8.9 years) with suspected nasolacrimal duct obstruction. Iodixanol 320 was instilled at 2 drops/min for 10 min without cannulation. Imaging was performed on a low-dose 128-slice CT system with multiplanar reconstructions. Lacrimal patency, obstruction site, and patient discomfort (10-point VAS) were evaluated by a blinded radiologist. Results: Adequate contrast opacification was achieved in all cases. Obstruction was detected in 70/80 (87.5%) patients. Mean patient discomfort was 2.1 ± 1.3 VAS scale, lower than the values reported in the literature for conventional CT-DCG. No adverse reactions occurred. Conclusions: Non-cannulated CT-DCG with dropwise iodixanol instillation is a feasible and well-tolerated imaging technique that provides high diagnostic yield while preserving physiological tear flow. Further prospective, comparative studies are warranted to validate these findings.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6010003

Authors: Hervé Becquet Carole Nagot Guillaume Savard Matthieu Renaud Nathalie Magneron Frédéric Denis

Background: A training program for University Internship Supervisors in Dentistry (UISD) was created from scratch in 2022 at the Faculty of Dentistry in Tours. Designed to prepare practitioners for the role of UISD, it is structured into three distinct modules, each with specific educational objectives. The first module, dedicated to the supervision of students during observation internships, has been delivered for three years. Aim: To assess the experience of UISDs as trainers, to identify their perceptions of their role, and to assess their expectations regarding the future development of this training. The study also aimed to propose a knowledge and competency framework that could serve as a basis for this first module. Methods: A qualitative approach was used, based on semi-structured individual interviews with trained UISDs who had supervised students during observation internships. Interviews were coded and analyzed inductively. Results: A total of 19 UISDs participated in the study. The mean age was 49.4 years, with an average of 23.9 years of private practice experience. Providing high-quality supervision to students in their offices was considered a major priority. Based on these results, the UISD training program was revised to identify four structuring themes for a competency framework: the internship environment, required knowledge, interpersonal skills (soft skills), and practical skills (know-how). Conclusions: The UISD training program in dentistry, designed for observation internships, has been adapted to meet practitioners’ expectations and has evolved into an initial structured framework of competencies and knowledge for supervising students during observation internships. This framework will require ongoing refinement.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6010002

Authors: Carla Aloè

We are delighted to welcome the Journal of Interdisciplinary Research Applied to Medicine (JDReAM) [...]

Journal of Interdisciplinary Research Applied to Medicine doi: 10.3390/jdream6010001

Authors: Prisco Piscitelli Michele Maffia

The current challenge for scientists, regardless of their research field or area of activity, consists in presenting the evidence emerging from studies carried out at the local, national, or even international level to the public and decision makers [...]

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v5i1p49

Authors: Antonino Calabro Roberto Lupo Ilaria Bernardini Ornella Mitri Cosimo Caldararo Marcello Antonazzo Carmen Donadio Maicol Carvello Federica Ilari Maria Carriero Luana Conte

In an advanced scientific and technological context, where it is now tangible the possibility of interfering indefinitely in the process of dying, it becomes necessary to disseminate knowledge about end of life that, for the great variety of areas that it invests, presents many controversial aspects. With the Law no. 219/2017, the right of self-determination and freedom of treatment of the patient is enshrined, aspects that to date still remain too little discussed. An online survey was conducted from December 2019 to February 2020, among the population residing in the provinces of Lecce and Brindisi, spread thanks to the collaboration of local authorities. A large part of the sample (82.4%, N=333) claims the right to self-determination, stating that therapeutic decisions are up to the patient who has signed his advance treatment dispositions, declared absolutely binding for 50% (N=205) of the sample. However, there is still a lack of information about how to draw up advance treatment agreements (AADs). 12.6% (N=51) of those interviewed stated that they knew nothing about it and only 32.9% (N=133) felt ready and adequately informed to make their own declarations. Another peculiar aspect is that topics such as euthanasia and assisted suicide seem to be considered at the margins of acceptability among End-of-Life instances. The results of the study show that knowledge on the subject has definitely improved over the years and that in most of the issues addressed, the population has an adequate degree of preparedness even though there is still some skepticism in dealing with issues such as assisted suicide and euthanasia. Future research could explore the possibility of identifying effective training tools and communication strategies that can be used by the widest possible segment of the population.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v5i1p37

Authors: Cosimo Iaia Barbara Fivela Francesco Sigona Mirko Grimaldi

For the last decades neuroscientists have grown interest in the analysis of the rhythmic activity of the brain syn- chronized at temporal and spatial level. These neural oscillations, grouped by their frequency, have been pro- posed to govern all cognitive processes. In the field of the neurobiology of language, considerable research has linked speech processing and language comprehension to neural oscillations. On one hand, neural rhythmic ac- tivity is thought to synchronize to relevant spectral information of speech on three-time scales – which physically reflect phoneme, syllable and phrase processing. On the other hand, syntactic and semantic processing is sub- served by faster oscillatory patterns not necessarily related to the acoustic properties of speech. For each linguistic process, this article summarizes the neural oscillations involved. Further evidence comes from studies on language-related pathologies.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v5i1p33

Authors: Alessandra Cimino Elisa Rizza Luca Luongo Angelo Mita

Cardiac amyloidosis (CA) is characterized by extracellular deposition of protein-derived fibrils and lead to heart failure. Gold standard for its etiological diagnosis is endomyocardial biopsy and laboratory tests, both high-cost and invasive procedures. Technetium- 99m hydroxymethylene diphosphonate (99mTc-HMDP) scintigraphy is important tool for defining CA, specifically transthyretin subtype (ATTR). From July 2020 to February 2021, we retrospectively analyzed 18 pts [14 males, 4 females; aged 32-86y] with suspected ATTR, underwent to scintigraphy 150 min after iv administration of 740 MBq 99mTc-HMDP.Myocardial uptake was assessed optically based on Perugini Score (0- 3). Biopsy confirmed diagnosis. Intense (Score 3) and moderate (Score 2) myocardial uptake verified in 8 patients by 99mTc-HDMP scintigraphy, was consistent with ATTR suspect. In 10 patient’s cardiac radiotracer uptake was absent (Score 0) avoiding biopsy. Our data indicate a 99mTc-HDMP scintigraphy key role in the early diagnosis but even more in the exclusion of patients with ATTR subtype, optimizing the management of pts who do not require high costs and invasive procedures.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v5i1p27

Authors: Alessandro D’Amuri Federica Floccari Marcello Filotico Ottavia D’Oria Gaetano Panese Andrea Tinelli

Adenoid cystic carcinoma of the Bartholin gland (BG-ACC) is a rare form of vulvar cancer. Literature reported approximately 350 cases of BG-ACC since 1864. Literature data and case reports suggested an aggressive nature with protracted clinical symptoms and a tendency for local recurrence despite adequate surgical excision with or without adjuvant radiotherapy. Survival rates of 71% and 59% are reported, respectively, at five and ten years. A comparative analysis of the immunohistochemical profile was performed with the homologous tumor of the salivary glands, and it was observed that the expression of various antigen in different morphological patterns of this neoplasia allowed some considerations about on its histogenesis that was hitherto never proposed.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v5i1p19

Authors: Caterina Arigliani Michele Arigliani Enrico Ciavolino Luana Conte Domenico Toraldo Silvia Passariello Serena Arima Paola Angelelli Luigi Macchitella Antonio Palumbo Michele Benedetto

This study aims to compare polygraphic data in patients with OSA treated with Barbed Reposition Pharyn-goplasty (BRP) performed with a simplified technique compared to the standard method. Variations of tech-nique were performed and tested with the purpose of promoting tolerability and diffusion of this simplified technique. To evaluate the efficacy of the simplified BRP method, a sample of 99 patients was divided into two groups: Group A was treated with BRP (BRP group) and Group B was treated with simplified BRP (sBRP group). The results obtained on the two groups were compared with the two sample Bootstrap t-tests method, showing a substantial overlap in polygraphic results recorded 6 months after surgery.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v5i1p11

Authors: Luana Conte Alessia Lezzi Roberto Lupo Simone Zacchino Antonino Calabrò Cosimo Petrelli Cosimo Caldararo Antonietta Abate Alessandra Rizzo Fiorella Fabrizio Maicol Carvello Maria Carriero

Successful communication is considered an essential component of the quality of care and safety of the patient with Amyotrophic Lateral Sclerosis (ALS). Recent technology has provided alternative communication systems, including the Eye-tracking technology, which enables interaction with others in the more advanced stages of the disease. The aim of the study is to investigate patients' difficulties in using the eye tracker, their problem in ob-taining the device and the clinical complications resulting from it. A “snowball sampling” method study was conducted from April to September 2020 until sample saturation. The results of the study demonstrate the countless difficulties in obtaining the eye- tracker, with long waiting times, which are not followed by adequate training in its correct use. Among the consequences linked to the use of this device, the most frequent were nys-tagmus (8.8%), onset of eyelid ptosis (16.2%) and the appearance of increased fatigue. 56.1% of the sample used the eye tracker to surf the Internet whereas 9.1% used it to write e-mails. Overall, the use of the eye tracker led to an improvement in overall quality of life (24%). In Conclusions, the Eye-tracking technology is a valuable de-vice for Alternative Augmentative Communication (AAC) in ALS patients and can be used with good perfor-mance, therefore the need for information, training and improvement on this topic is essential.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v5i1p7

Authors: Luana Conte Cosimo Caldararo Roberto Lupo

The term "pharmacogenetics" refers to the study of individual genetic variations that give rise to different re-sponses to the intake of a drug. Recently, however, it has begun to think that an important role in this sense can also be played by our microbiota. The interaction between our gut microbial flora and drugs is actually bidirec-tional: evidence has accumulated that some drugs, in addition to classical antibiotics, have a strong impact on the composition of the microbiota.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i2p45

Authors: Alessandro D’Amuri Federica Floccari Ottavia D’Oria Sarah Gustapane Andrea Tinelli

Uterine fibroids or leiomyomas are the most common benign female genital tumors, although this pathology can also manifest itself outside the uterus, as in the case we present, with a retroperitoneal development. In this article, authors showed a rare case of 81-year-old women, with a right pelvic mass and lower abdominal discomfort. Basing on a preoperative radiological imaging, clinicians oriented to a provisional diagnosis of mesenchymal neoplasm of an uncertain origin. During surgery in the retroperitoneal space, it was detected a huge mass close to the uterus, beneath the right broad ligament. After the opening of the retroperitoneal spaces, surgeons enucleated a well-demarcated tumor, measuring 12 x 7 cm in diameter and histopathological findings demonstrated a rare retroper-itoneal uterine leiomyoma.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i2p7

Authors: Marina Damato Michele Maffia

In addition to biochemical and molecular signals coming from the microenvironment, cells are able to sense and integrate mechanical stresses, additional fundamental regulators of cell behaviour. Emerging demonstrations in-dicate that mechanical cues go far beyond the plasma membrane and the cytoskeleton, since, exerting tension on the outside local microenvironment via adhesions, cells develop an equal cytoskeletal stress on the nucleus inside, leading to 3D nuclear modifications. In this context, dynamic changes in nuclear lamina and the surrounding cy-toskeleton modify mechanical properties of the nucleus affecting its structural arrangement, chromatin anchor-ing, 3D chromosome conformation and gene expression. Here we discuss findings supporting the role of the nucleus in cellular mechanosensing, ranging from how mechanical cues are transduced to the nucleus to how ge-nome organization is influenced by cell mechanics.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i2p15

Authors: Giulia Piraino Marialuisa Toto Sara Invitto

Domestic violence is characterized by coercive actions of various kinds (psychological, physical, sexual and eco-nomic) that persist over time; the chronicity of these same actions implies the development of short, medium and long term consequences that compromise the daily functioning of the woman. The aim of this study was to investigate, through a web Survey based on psychophysiological assessments, the relationship between the stress perceived with intimate partner violence and the dysfunctional coping strategies used during the pandemic phase 1 of the health emergency in Italy. The results highlighted a greater sensitivity to perceived stress, resulting in the use of dysfunctional strategies in the management of emergency situations. The levels of perceived anxiety are decreased. High levels of perceived stress produced effects in the management of the health emergency situation, consequences of behavioral, emotional, perceptual and psychophysiological nature (i.e, pain perception, sensory perception, sleep habits).

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i2p21

Authors: Francesco Sigona

A short review of some recent findings in the field of automatic voice disorders detection and classification is provided in this article. The matter is getting more and more interest due to appealing non-invasiveness of the methods as well as the good achievable performances. An increasing role is played by Artificial Neural Networks (ANN), especially Deep ones, despite the need for large amounts of data for such networks, that are not always available for the task in question. The research in this field is directed in other directions too, including the inves-tigation of new features and the capability to process running speech other than sustained sounds.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i2p31

Authors: Sarah Gustapane Sara Cavalera Ottavia D’Oria Andrea Tinelli

Intrauterine adhesions (IUAs) caused by endometrial injury have a serious impact on women’s fertility and mor-bility and involves a wide range of patients. Although the first case of IUAs was published in 1984 by Heinrich Fritsch, a full description of Asherman syndrome was done by Joseph Asherman. IUAs lead to a lot of complica-tions in women, as the partial or complete closure of the uterine cavity, which may result in symptoms including abnormal menstruation, pelvic pain, recurrent pregnancy loss, secondary infertility, and pregnancy complications. Hysteroscopy, which has relegated blind curettage, is currently considered the gold standard diagnostic and thera-peutic approach also as for outpatients. However, an integrated approach, including preoperative, intraoperative and postoperative procedures is needed to improve the reproductive outcome of the complex syndrome. In the post-operative care, the patient can benefit from some therapeutic and prophylactic methods used alone or in combination with each other. In this review, authors discuss on the efficacy of traditional methods for the preven-tion of complications of IUAs after surgery, such as hormonal therapy, physical barriers, vasodilators and antibi-otics, as well as novel strategies such as stem cell therapy and novel therapeutic agents.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i2p41

Authors: Silvio Stomeo

Amyloidosis is a form of plasma cell dyscrasia of unknown etiology, pathologically characterized by the extracel-lular deposit of fibrils derived from the light chain of monoclonal immunoglobulin. The involvement of the airways is more common in primary amyloidosis and is classified into: tracheobronchial amyloidosis, nodular parenchymal, diffuse parenchymal. The tracheobronchial form is usually the most frequent and is characterized by the presence of multiple submucosal plaques or, more rarely, by pseudotumoral endobronchial masses. Symptoms in the initial phase may be silent, subsequently manifesting themselves with cough, dyspnea, hemoptysis.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i2p49

Authors: Gianpasquale Preite Matteo Zaterini

In the digital era, the rising of new rights that redefine the very integrity of the person and legitimize their protec-tion, especially in the field of health, calls for a reflection on the transition from habeas corpus to habeas data. The ancient habeas corpus, personal freedom understood as physical freedom, is now also a habeas data, in terms of dig-ital freedom and the protection of personal information about the physical body. In this passage, the traditional legal culture clashes with the emergence of an information and knowledge society in which full and objective corre-spondence with constitutional concepts and rules is lacking. This is also happening in the health sector. Information in the medical field is an essential element, indispensable to be able to prepare the right treatment. The physician can collect, organize, and interpret patient data for the most correct diagnosis possible. Medical science, therefore, is in-formation “from” the patient and “about” the patient, which is objectified through the computerised aggregation of the data of everyone undergoing medical treatment. Medical information becomes health data when it is processed, transforming it into a documental element of a digital nature. This article aims to give a theoretical contextualization of the concepts of habeas data, self-determination in the digital field and the issues related to informed consent and access to personal data.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i1p37

Authors: Manuela Pulimeno Prisco Piscitelli Alessandro Miani Annamaria Colao Salvatore Colazzo

In the context of the global changes that affect families and communities, including the current COVID-19 pan-demic, today’s young people face new threats to their health and most of them lack adequate nutrition, healthcare services and education. As children and adolescents spend a significant amount of their time at school (or remotely connected with teachers, as occurred in these last months of health emergency), educators have the great opportuni-ty to positively contribute to their global growth, fostering physical, mental and social wellbeing, which has also a significant impact on students’ academic achievements. Nowadays, training teachers as “health promoters” allows educational system to deal more effectively with health needs of the students, helping them in the prevention of risky behaviours (cigarette smoking, binge drinking, drug use etc). According to the recommendations provided by the World Health Organization and UNESCO, we highlight the need for pre-service and in-service teacher training on the major topics concerning young people health, as well as COVID-19 safety issues. Moreover, teachers should be trained on the most participatory and pro-active methodologies to effectively convey health-related contents in school setting, in order to trigger a personal interiorization of the knowledge acquired by the students, and to engage them in practical actions about healthy lifestyles (i.e. balanced nutrition and physical exercise, no smoking, no alco-hol, no drugs). Teacher training on health topics enables educators to develop a new professional identity based on a health-centered vision, in the perspective of reducing social/health inequalities that still concern most disadvantaged children. Medical professionals and pedagogists could be appointed as available consultants respectively for training teachers on health contents and about the most effective didactic strategies useful for displaying educational inter-ventions in school setting aimed at preventing unhealthy habits among young people. Health education should be included in scholastic curricula within scientific disciplines or treated as separate subject in extracurricular activities under direct responsibility of school staff.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i1p25

Authors: Marina Vinciguerra Radmila Sparic Safak Hartinaz Giuseppe Trojano Andrea Tinelli

Background: Cesarean myomectomy (CM) is, for many gynecologists, a discussed surgical procedure character-ized by fibroid’s removal during cesarean section (CS) followed by possible complications. For a long time, it has been common and shared thinking that myoma should not be surgically treated in pregnant women at the time of birth through CS in order to avoid complications for the patient. Nowadays, many studies reconsidered the feasibility of CM. The aim of this investigation is to summarize the scientific evidences on this procedure, high-lighting when and how it can be performed safely. Methods: This review has realized basing on evidences reported in scientific database, as PubMed, Scopus, Cochrane Library, Medline and EMBASE databases, found using key words of reference to the main topic, the cesarean myomectomy. All the observational studies and meta-analysis published in the current century has been considered and results were critically evaluated by the authors, experts on CM. Results: According to the findings reported, the CM could be a valid and feasible treatment option for patients, especially when there are specific conditions which are associated with a lower risk of complications, as peri-operative blood loss and risk of hysterectomy. Authors’ experience and judgment agree with the evidences about the importance of the surgeons’ skill and experience, both to make safer the surgical procedure and to have intra-operative and post-surgical outcomes. Conclusion: The applied surgical technique and the informative counselling and/or informed consent, still need standardization for a safer CM, both for the patients and for the operator, at the same time.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i1p21

Authors: Silvio Stomeo

Osteoplastic tracheopathy is a rare disease with dark etiology, characterized by the presence of nodular cartilagi-nous or bone nodular growths (masses and spicules) in the lumen of the tracheobronchial tree. According to some authors, these nodular outgrowths represent exostosis or eccondrosis of the cartilaginous trachea which often ossifies. Other authors relate this pathology to tracheobronchial amyloidosis. Clinical symptoms can be characterized by cough, dyspnoea, recurrent trachebronchial infections, occasional hemoptysis. Bronchoscopic examination allows the diagnosis to be made. The clinical cases in which the above described pathology has been diagnosed are three: 51 year old man smoker with chronic bronchitis, 62 year old woman smoker with moderate chronic obstructive pulmonary disease and a 65 year oldman, non-smoker, with severe obstruction entity.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i1p15

Authors: Vito P. Pastore Thomas Zimmerman Sujoy K. Biswas Simone Bianco

In this paper we establish a baseline to use Stentor coeruleus, a freshwater single cell ciliate, as a chemical biosensor. We expose Stentor to an array of chemical species and concentration and monitored morphological and dynamic responses. We developed a computer vision pipeline to predict chemical exposure at sub-lethal doses. We pre-sent analysis for butylparaben, a common antimicrobial preservative used in cosmetics and food flavoring. Our preliminary results show high sensitivity of Stentor to sublethal chemical concentrations, amenable for use as an environmental biosensor when combined with the computer vision pipeline.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v4i1p7

Authors: Maria Carriero Fabiana Stella Roberto Lupo Antonino Calabrò Cosimo Petrelli Ilenia Pareo Marco Rizzo Maicol Carvello Valeria Archetta Luana Conte

Background. Attitudes, knowledge and practices of nurses towards HIV/AIDS patients are of continuous in-terest, especially in developing countries. However, in Italy, this topic is still scarcely debated. Materials and methods. An observational, cross sectional, multicentre study was conducted on a sample of 144 nurses in two Italian Hospitals of the Puglia Region ("Vito Fazzi" Hospital in Lecce and "San Giuseppe da Copertino" Hospital in Copertino (Le)). Results. A large part of the sample (97.2%, n=140) stated that they never refused to take care of a patient with AIDS. Only 22.9%, (n=33), of the sample had attended a training course and almost half (63.2%, n=91) used the gloves regularly when performing blood samples or when administering therapy to patients. With regard to the assessment of HIV knowledge, the percentage of nurses who know the meaning of the terms " seropositive" (83.3%, n=120), "HIV-positive person" (91.7%, n=132) and "window period" (47.9%, n=69) decreased. Conclusions. The results of the study show that a non-negligible percentage of nurses could be considered at risk of infection due to non-routine use of gloves, incorrect handling of the patient's biological samples and not knowing how to decontaminate a surface with potentially infected blood.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v3i2p31

Authors: Mariaconcetta Mangia

The health sector is being studied as an object of individual interest with that of society, in order to pursue equity without sacrificing efficiency, citizens of different Italian regions can access services that are equal in quantity and quality. In health care, the problem from the economic point of view is relevant as the health needs are infinite, while resources are limited and scarce. In the field of health, the objectives have evolved, passing from the elimination of infectious diseases to the ex-tension of life. The World Health Organization defines health as a right to be counted among other fun-damental rights that belong to people. The analysis of the work carried out focuses on the concept of healthcare seen through the eyes of economists, of how to deal with the fundamental economic questions of what, how and for whom to produce dictated by the distance between need and resources that drives the search for greater productivity and fair re source allocation systems; discussing the need and expectations for public health intervention. The Italian Health Service has founded its origins on the recognition of health as an individual right linked to cit-izenship and as a collective asset to be protected. The financing is based on the principle of the welfare state, which connects the payment to the contribution capacity and the use of services to anyone who manifests a need within the Italian territory. Since the beginning of the 1990s, a process of reorganization of the health system was initiated, which was main-ly oriented towards the research and improvement of tools for assessing the quality perceived by the user. The search for tools that can reduce as much as possible the inconvenience that the citizen may encounter in contact with highly bureaucratic systems and structures such as health care tend to be. The socio-demographic evolution of the population and the need to balance the available resources with the quality of the healthcare provided, require the definition of new ways of providing health services. In the field of public health, a growing demand for quality in the provision of care and assistance services has intensified in re-cent years. The increase in interfaces between telematic networks and health and social services is part of the general transformation process of world society due to the progressive increase in the degree of use of ICT ser vices. The improvement of the quality of health services concerns the management of total quality understood as the management process aimed at establishing the organizational activities that allow the improvement of overall performance. The success of the organization lies in the continuous and careful communication of the needs related to health by users caused by bad lifestyles, therefore prevention and socio-health policies should reduce the probability of citizens getting sick. From the analysis carried out, the proposal that is made is that the mission assigned to hospitals on the basis of their classification allows users to be "empowered" to health-related problems without compromising the princi-ples of effectiveness, legal efficiency and health law. If the goal of our communities is to improve the health level of the population, it is important to promote health policies not only in terms of health services, but also aimed at removing or in any case reducing the impact of a series of risk factors. Therefore, it is hoped that future health policies will increasingly target individual and social risk factors, with health interventions also in sectors such as education, working conditions, transport and nutrition.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v3i2p27

Authors: Silvio Stomeo

Mounier Kuhn syndrome or tracheobronchomegaly is characterized by a marked dilatation of the trachea and main bronchi that can extend to the periphery of the lungs. Dilation is due to an alteration of the cartilaginous and membranous structure of the trachea and bronchi. It is a pathology much more frequent in men. The ae-tiology is unclear. The clinical case in question concerns a 67-year-old man who has reported recurrent epi-sodes of bronchopulmonary infections and hemoptysis, after undergoing instrumental investigations (fi-brobroncoscopy and chest CT), the diagnosis of Tracheobroncomegalia or Mounier Kuhn syndrome was formu-lated.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v3i2p17

Authors: Barbara Fivela Mirko Grimaldi Francesco Sigona Sonia d’Apolito

The production of speech requires the interplay of a number of cognitive and motoric activities, which make it an interesting object of study from both a linguistic and a medical point of view. In this paper, we discuss, first, the features and domain of application of the most used technologies in linguistic research on speech produc-tion, focusing on those that have been applied to medicine. Second, we offer an insight into the main results that have been obtained so far in studying dysarthria in Italian Parkinson’s Disease, as an example of the interdiscipli-nary, experimental research at the border between linguistics and medicine.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v3i2p7

Authors: Luana Conte Domenico Toraldo Michele Arigliani Marco Greco Michele Maffia Michele De Benedetto

Obstructive Sleep Apnea (OSA) is the most common respiratory disorder in Western societies: according to a first recent worldwide epidemiological study, it was estimated that 936 million patients aged 30-69 years with mild to moderate OSA and 425 million patients aged 30-69 years with severe OSA requiring CPAP treatment. Recently, the Centre for Research on Health and Social Care Management (CERGAS) at the Bocconi University of Milan has estimated that in Italy, the prevalence of moderate to severe OSA occurs in the 27% of the general population, with an overall prevalence of mild to medium-severe OSA of more than 24 million people aged be-tween 15 and 74 years (54% of the adult population), while from a practical point of view, Italian doctors diag-nosed only 460.000 moderate-severe patients (4 per cent of the estimated prevalence) and 230,000 patients were treated (2 per cent of the estimated prevalence), highlighting a substantial gap between diagnosis and treatment. In addition, OSA patients are often obese and the close correlation between the two conditions suggests that the prevalence of OSA will increase in the short term as obesity increases. At the individual level, OSA leads to a significant decrease in quality of life (HRQoL) and intellectual and mechanical/functional capacities with reduced physical activity, as well as a marked increase in sudden death and risk of cardiovascular and metabolic diseases. Emerging epidemiological data also suggest that the severity of OSA associated with the severity of chronic noc-turnal hypoxemia (CIH) correlates with an increased risk of diabetes mellitus, metabolic syndrome (MS) and can-cer. OSA is also an important risk factor for high blood pressure, acute and chronic atrial fibrillation (FAC), chronic coronary artery disease (CAD) and stroke. It is therefore intuitive that at the social level, OSA also leads to a decline in economic productivity. This article addresses OSA from a new epidemiological perspective, according to the latest prevalence studies, and addresses emerging problems related to the diagnosis.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v3i2p39

Authors: Manuela Pulimeno Prisco Piscitelli Giuseppina Pacella Emanuele Rizzo Biagio Galante Salvatore Colazzo

Overweight and obesity in paediatric population are becoming serious public health problems, reaching epidemic proportions in the world and being recognized as the “new pandemic of the twenty first century”. Food choices and nutritional habits are strictly linked to the cultural dimension of communities and symbolic representations of food. Even in Italy, young generations are moving away from the culture of Mediterranean Diet (MD) – rec-ognized as Intangible Heritage of Humanity by UNESCO – being at risk of losing both their identity and the health benefits associated with MD. In this frame, health pedagogy (i.e. nutritional education) can play a funda-mental role in promoting the adoption of healthy eating behaviours since childhood, addressing at the same time such crucial binomials as food-health and environment-sustainability. In the last decades, a huge variety of school-based obesity prevention programs have been introduced. Among those, according to scientific evidence, narrative-based strategies may be helpful in promoting healthy nutritional habits among schoolchildren. Actually, narration is a useful tool in didactic practice, impacting on the emotional and motivational dimension of learning, thus represent-ing a valuable vehicle of health contents. On these bases, as DREAM Laboratory of Health Peda-gogy, we have proposed to the Department of Prevention of the Local Health Authority ASL Lecce – specifi-cally involving the Food Hygiene and Nutrition Service (SIAN) – to implement a research protocol aimed at as-sessing if narrative-based strategies could be more effective than other educational approaches in promoting the adoption of healthy eating behaviours among schoolchildren.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v3i1p19

Authors: Lucio Tommaso De Paolis

Researching in new technologies for diagnosis, planning and medical treatment have allowed the development of computer tools that provide new ways of representing data obtained from patient’s medical images such as com-puted tomography (CT) and magnetic resonance imaging (MRI). In this sense, augmented reality (AR) technolo-gies provide a new form of data representation by combining the common analysis using images and the ability to superimpose virtual 3D representations of the organs of the human body in the real environment. In this pa-per the development of a generic computer platform based on augmented reality technology for surgical pre-operative planning is presented. In particular, the surgeon can navigate in the 3D models of the patient’s organs in order to have the possibility to perfectly understand the anatomy and plan in the best way the surgical proce-dure. In addition, a touchless interaction with the virtual organs is available thanks to the use of an armband pro-vided of electromiographic muscle sensors. To validate the system, we focused in a navigation through aorta ar-tery for mitral valve repair surgery.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v3i1p7

Authors: Sara Sergio Daniele Vergara Michele Maffia

Autophagy is a cellular catabolic process in which cytoplasmic material is delivered to lysosomes for degradation. The autophagy process is regulated by highly conserved autophagy-related genes (ATGs) via different signalling pathways. Among the various biological functions of autophagy, the link between autophagy and cancer has been extensively studied, demonstrating its dual role, of tumor suppressor or promoter in cancer development. Hepa-tocellular carcinoma (HCC) is one of the most lethal cancers that affects most of the world’s population and it is caused by different etiological factors: HBV and HCV viral infections, heavy alcohol consumption, NAFLD (non-alcoholic fatty liver disease), aflatoxin B1 contaminated food. In recent years, the involvement of autophagy in both prevention and promotion of liver cancer has been increasingly studied. Here, we summarize molecular mechanisms and physiological function of liver autophagy, its dual role and its therapeutic potential in HCC.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v3i1p25

Authors: Antonio Belpiede Antonio Malvasi Michael Stark Andrea Tinelli

The postpartum hemorrhage (PPH) it is one of the worst complications of the pregnant woman and the leading cause of maternal mortality in the world, as it produces potentially catastrophic effects on patients, with high morbidity and morbidity. Likewise, the reduction in maternal mortality, which is particularly high in low income countries, but rising even in developed countries (as in USA), is one of the eight primary global health current goals of the WHO. In the complex pathophysiological phenomenon of PPH, the uterine contractility and con-nective tissue arrangement are poorly investigated. Both topics are scantly little understood and investigated, in terms of pelvic functional anatomy and pathophysiology. The anti-version uterine posture is essential for the op-timal and necessary muscle contraction in the immediate postpartum stage, to avoid PPH onset. In this review, authors analyzed the physiology of uterine contraction related to the childbirth and the PPH, identifying an ana-tomical system involved in the physiological post-partum uterine contraction. This biological system is the inte-grated pelvic myofascial system and it has a prime importance in the physiological reduction of the PPH risk and to maintain uterine contractility during and after childbirth.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v3i1p31

Authors: Matteo Jacopo Zaterini

The goal of this paper is to identify and interpret the relationship between the Symbolic Universes (S.U.) and their specific declination in the health context, more precisely how it is expressed in the focus groups on vaccina-tions. I will introduce to the reader the theoretical background that substantiates and motivates research. Starting from the adoption of the culturalist approach to psychological discipline, I will report the characteristics that dis-tinguish it and the critical issues it tries to face. I will continue by illustrating the results of the first phase of the Re.Cri.Re. through the identification and definition of symbolic universes. I will then illustrate the methods and tools used to carry out research, the results obtained from the analysis and the interpretation of the results.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i2p53

Authors: Ughetta Vergari

At the beginning, it was the French philosopher Michel Foucault who explicitly defined medicine as a matter of biopolitics, making evident the role that, in his opinion, medical knowledge assumed in certain strategies of pow-er. Starting from this assumption, the bioeconomic paradigm has been embodied in a form of governmentality of human behaviors, where the individuals are first and foremost considered biological living units. The biopolitical and bio-economic paradigm must not be considered as a space of absence of power, but a place where power leads to obedience by activating alternative devices, acting on population wishes and needs. These dynamics have slowly modified and even subverted the relationship between doctor and patient, determining the default of the paternalistic relationship and the strengthening of defensive medicine.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i2p43

Authors: Andrea Tinelli Yanyan Ma Sarah Gustapane Antonio Malvasi

Diagnosis and management of prolonged second stage of labor and its complications is difficult and often poses a dilemma to the treating obstetrician regarding timing and type of intervention. Nowadays, the diagnosis of dys-tocic prolonged second stage of labor is largely based on digital evaluation of cervical dilatation and fetal head station and position, resulting inaccurate and subjective. Moreover, the problem of timing of delivery for nullipa-ra during dystocic labor and labor analgesia is clinically unsolved, as well as questioned since many years. Thus, labor management is largely based upon clinical and not instrumental findings. Women in dystocic labor require, often, operative delivery, after many hours of pain during labor. Accurate assessment of fetal head position and station is crucial in clinical decision-making during the second stage of labor and the fetal station was misinter-preted as lower than it really was in 15–22% of cases. Misdiagnosis or failure to correctly identify the fetal head position and station is one of the causes of failed instrumental delivery and subsequently of higher rate of neona-tal morbidity. Intrapartum ultrasound also distinguishes patients destined for spontaneous vaginal delivery from those to submit to operative delivery. The intrapartum US is an adjunctive tool for labor ward obstetricians in the management of prolonged second stage and dystocia. It is a more objective and reliable tool than digital ex-amination, and may give the obstetrician a more accurate perspective before making crucial clinical decisions re-garding the chances of a successful vaginal delivery, and may lower the rate of failed instrumental delivery and its associated morbidity.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i2p35

Authors: Marcello Costantini Massimo Trianni Giuseppina De Benedittis Cristina Tritto Lorenzo Costantini Luana Conte Marco Greco Michele Maffia Michele De Benedetto

A wide spectrum of diseases or conditions (genetically based or acquired), in the presence of triggering elements, can lead to arrhythmic events, having sudden death as a common result. The substrate of fatal arrhythmia de-pends on age: over 35 years old it is mainly represented by the instability of coronary heart disease. Up to 35 years of age, the substrate consists mainly of electrical or structural alterations of the heart of a genetic nature the main of which are i) idiopathic hypertrophic cardiomyopathy ii) arrhythmogenic cardiomyopathy of the right ventricle iii) congenital syndrome of long QT iv) congenital syndrome of short QT; v) Brugada syndrome. Each of these proarrhythmic genetic conditions has the prerogative of being able to be highlighted by an electrocardiogram: a simple and economical gesture that can lead directly to an important diag-nosis, or at least make it suspected, addressing the subsequent evaluations. Formulating a diagnosis of this kind can minimize the risk of sudden death, through careful use of lifestyle advice, drugs, devices, procedures. It has been scientifically proved that identifying genetic conditions at risk of malignant arrhythmias in the athlete leads to a dramatic reduction in the risk of sudden death: on this basis, an electrocardiographic screening has become peremptory in many countries in order to be able to perform competitive sports (in Italy, for some years, also to be able to carry out non-competitive sports). Electrocardiographic screening should be considered for the entire youth population, regardless of participation in an organized sports activity program, as this can potentially mean saving young lives from sudden death.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i2p27

Authors: Emanuela Cianci Rosella Cataldo Eleonora Alfinito

Graph theory has been extensively applied in the study of proteins, although few applications still exist on biomolecules like aptamer-protein complexes, whose structure is in silico obtained. Aptamers represent a challenging field of research, especially for their involvement in therapy, diagnosis and early detection of illness; furthermore, the in vivo procedures to synthetize them are quite expensive and more time-consuming than those in silico. This paper is focused on the question if and how general network parameters are able to anticipate some features of those biomolecules. The rationale resides in the fact that, studying a large set of aptamer-angiopoietin complexes, two different types of conformers are manifest. Both types could be present in a real sample with their relative amount reflecting, in a typical population shift scenario, the affinity of the whole sample.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i2p5

Authors: Luana Conte Marco Greco Domenico Maurizio Toraldo Michele Arigliani Michele Maffia Michele De Benedetto

Obstructive sleep apnea (OSA) syndrome is a condition characterized by the presence of complete or partial collapse of the upper airways during sleep, resulting in fragmentation of sleep associated with rapid episodes of intermittent hypoxia (IH) and activation of the sympathetic nervous system and oxidative stress. (Dempsey et al. 2010, 47–112; Bradley and Floras 2003, 1671–78; Bradley and Floras 2009, 82–93). OSA is associated with a broad spectrum of cardiovascular, metabolic, neurocognitive and comorbidities that appear to be particularly evident in obese patients (Floras 2014, 3–8; Luz Alonso-Álvarez et al. 2011, 0, 2–18; Marcus et al. 2012, e714–55; Sforza and Roche 2016, 99), while affecting both sexes in a different manner and varying in severity according to gender and age (Mokhlesi, Ham and Gozal 2016, 1162–69). In recent years, studies on OSA have increased considerably, but in clinical practice it is still a highly underdiagnosed disease (Costa et al. 2015, 1288–92). To date, the gold standard for the diagnosis of OSA is nocturnal polysomnography (PSG). However, since it is not well suited to a large number of patients, also the Home Sleep Test (HST) is an accepted diagnostic method. Currently, the major aim of the research is to identify non-invasive methods to achieve a highly predictive, noninvasive screening system for this category of subjects. The most recent reports indicate that research in this field has made significant progress in identifying possible biomarkers in OSA, using -OMIC approaches, particularly in the field of proteomics and metabolomics. In this review, we analyze a list of these OMIC biomarkers found in literature.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i1p17

Authors: Francesca Farnetani Luana Conte Gian Luca Cervo Massimo Federico Giovanni Pellacani

Reflectance confocal microscopy (RCM) is a new technique enabling the visualization of the skin at a quasi-histological resolution, allowing the identification of clues for the diagnosis of skin diseases. The aim of this anal-ysis was to provide new insights into the role of RCM in the diagnosis of skin cancers. Data comes from the most recent literature, taking into account previous essential reported information in this field. The study eligibil-ity criteria were: studies providing update information, focusing on RCM findings in melanoma and non-melanoma skin cancers (NMSC), without restrictions for age, sex, ethnicity. Duplicated studies and single case report were excluded from this study. A search concerning the role of RCM in melanoma and NMSC was per-formed on the Medline. RCM clues were analyzed for different skin cancers, in particular melanoma and NMSC, in association with clinical, dermoscopic and histopathologic findings. Diagnostic accuracy, sensibility and speci-ficity of the technique were reviewed. Furthermore, some new findings have been described and recent applica-tions have been discussed. The selection of articles was limited in order to provide an up-todate revision. In con-clusion, several RCM features were implemented for the diagnosis of melanoma and NMSC, leading to a confo-cal-based classification in most cases.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i1p37

Authors: Domenico Maurizio Toraldo Francesco De Nuccio Luana Conte Michele De Benedetto

COPD is often accompanied by other chronic diseases that are also associated with systemic inflammation, such as obesity, diabetes, and arteriosclerosis. Recent data indicate that nocturnal oxygen desaturation and coexisting metabolic syndrome are related to systemic inflammation in patients with COPD. Alveolar hypoxia and conse-quent hypoxemia increase in prevalence as COPD severity increases. Chronic hypoxemia contributes to the de-velopment of adverse sequelae of COPD, such as pulmonary hypertension, atherosclerosis, lung microbiome di-versity and systemic inflammation. COPD is a heterogeneous disease with airway inflammation driven by bacte-rial infections, few studies to date they examined microbiology or infection. The introduction of culture-independent techniques for the microbiological analysis of respiratory samples confirmed that respiratory system hosts a large number of microorganisms, which include a wide range of bacteria. Regular exposure to tobacco smoke, lifestyle and food pattern can change the microbiome in healthy smokers and at-risk COPD patients, in-creasing the presence of a limited number of genres that reach a high relative abundance, a pattern, which can be considered as a dysbiosis. We assume that in patients with COPD and concurrent obesity and lung dysbiosis at least three factors play a role in the systemic inflammatory syndrome. Recent data showed that changes in the lung microbiome are associated with numerous exacerbations of COPD and are involved in mediating inflamma-tory responses of the host in some patients. Further research should elucidate the complex relationship between obstructive lung disease, obesity and lung microbiome diversity systemic inflammation accompanying these dif-ferent conditions, and the causative role of systemic inflammation in obese COPD with nocturnal oxygen desat-uration.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i1p51

Authors: Davide Carati Giuliana Conversano Roberta Stefanizzi Antonio Malvasi Domenico Baldini Sarah Gustapane Andrea Tinelli

Diabetes mellitus is a chronic disease that can affect any organ or system of the body. Diabetes mellitus has long been considered as one of the factors causing Candida vaginitis and has the potential to affect sexual function in women. Infectious diseases are more prevalent in individuals with Diabetes Mellitus. One of the problems of women with diabetes is resistant vulvovaginitis, which is related to some factors such as neuropathy, hypergly-cemia, allergy and atopy. Women’s interest in, satisfaction with, and ability to participate in sexual activity may be influenced globally by the effect of diabetes on their overall health, physical and mental functioning, and inter-personal relationships. Additionally, sexual function may be adversely affected by diabetes medications or other health interventions. This manuscript is a comprehensive review on vulvovaginal infections in diabetic patients.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i1p67

Authors: Chiara V. Marinelli Anna Putzolu Marinella De Salvatore Marika Iaia Paola Angelelli

In the Italian language the phoneme-to-grapheme mapping is fairly regular so that children are able to master very early reading and spelling skills. However, persisting phonological spelling deficits, were recently described in a sub-group of Italian dyslexic children with language delay. The study describes spelling and reading deficits of an Italian child suffering from phonological dyslexia and dys-graphia. As a comparison, a case of surface dyslexia and dysgraphia was reported. Quantitative and error analysis were performed on reading and spelling performance. Additionally the locus of the phonological deficit was ex-amined by means of tasks requiring doubled consonants processing. Results showed a parallelism between the reading and the spelling impairments in both children. Phonological dyslexia and dysgraphia was characterized by worse pseudoword than word processing; lexicalizations in reading and a high rate of minimal distance misspell-ings. Concomitant deficits in phoneme manipulation and representation were disclosed. The surface profile was characterized by impaired performance on tasks with pseudo-homophones and stress errors in reading, and con-comitant phonological plausible misspellings.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i1p83

Authors: Giuseppe Gaballo

Introduction [...]

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i1p93

Authors: Marco Giannotta

A fundamental right of every human being is the right to health, which implies the right to life and as such, it is fundamental, unavailable, non-erodible and practically enforceable [...]

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v2i1p5

Authors: Francesco Sigona

Our medical information is perhaps considered the most personal and valuable of all. On the other hand, the rapid increase in the digitization of the healthcare industry nowadays is giving the patient identification and elec-tronic medical record maintenance a key role to improve patient safety, protect against medical identity theft, en-hance patient satisfaction, not to mention financial performances. Regulatory pressures and compliance guide-lines naturally require health care providers to handle patient information with the highest degree of privacy and care. In this scenario, innovative healthcare organizations are increasingly using biometric technologies to sup-port smoother and safer patient access and information sharing to improve security. Biometric identifiers are measurable unique characteristics of an individual physiological (such as fingerprints, iris, retina, DNA) or behav-ioural (such as typing rhythm, voice, and gait) traits that can be used to positively identify a person. Among them, voice biometrics is actually a convenient and secure method of authenticating a speaker’s identity using just a few words, which has many advantages over other forms of biometric identification especially in the healthcare sector. After briefly discussing the impact of biometric technologies from a general point of view, the present paper focuses on voice biometrics, to give a technical understanding of how it works according to the current state of art and the forthcoming progress, and how it can be successfully integrated in the healthcare sys-tems.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v1i1p81

Authors: Gianpasquale Preite

The study and analysis of the organization in health care depends on some aspects that include the observation of social phenomena, law categories, and political strategies as well as the administrative behaviors. All these aspects have led to the overcoming of the traditional concept of bureaucracy, which finds a solid theoretical foundation in the studies undertaken by Weber. In the Weber's vision, bureaucracy is the organization of people and resources for a collective purpose, public, according to any criteria of rationality, impartiality and impersonality. The assumption is that it is hard to perceive organizations oriented towards an end in a rational way, unless as bureaucracies, even considering that there may be non-bureaucratic organizational forms, not rationally oriented to a purpose (Weber 1922). One of the most original contributions of the late twentieth century comes from Luhmann's theory of social systems that is applied to the concept of organization. It provides an understanding of the object that goes beyond tautological assumptions (e.g. the organization is composed of men) and that permits to talk about organization as autopoietic system, not "closed" but "operationally closed" and therefore independent on the structural and operational plan (Luhmann 2000, 29-30). In the theory of systems - although the organizations may arise freely – what is defined as "complex" organizations, are formed within functions systems distinguished in economic organizations, political organizations, trade union organizations, health care organizations, etc. Main features include the possibility that they have to communicate with other systems in their environment (Luhmann and De Giorgi 1994, 328) and the reduction of uncertainty and risk. The absorption of uncertainty occurs when an organization elaborates some decisions that are a prerequisite for other decisions. In the social systems theory, all the organization activities are classified as decisions, take place at a given time, and are always documented. However, the evolutionary path that is used to trace the organizational profiles of complex apparatus cannot ignore the importance of Kuhn's theory, according to which scientific revolutions are characterized by the transition from one paradigm to another (Kuhn, 1999). The application of this latter model to the public organizations, permits to understand that even these organizations are subjected to the dynamics of cultural paradigms, according to which the transition from one paradigm - that no longer recognizes the organizations themselves - to another one, that rather includes new models, methods and practices, definitely involves a revolution (Limone 2008, 17). In order to properly talk about organization and e-government, especially in the health and medical sector, we first need to verify the most suitable organizational context able to manage innovation solutions and, therefore, analyze the organizational conditions as a prerequisite for the technological conditions. In fact, if the organizational environment does not respond to concrete parameters such as transparency, efficiency and economy, even the same e-government process is likely to fail. That is the only viable way to rationalizing and improving the public organizational system, such as health care systems, that tend to have high level of complexity and risk due to their nature.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v1i1p75

Authors: Carlo Olla Atzeni Ermenegildo Colosimo Denise Casella Erika Delos Maria Piera Mano Anna Melcarne Mariano Tomatis Massimo Torsello Antonio Ponti Enrico D’Ambrosio

The aim is to highlight the progress of earliness and quality of diagnosis and breast cancer cure in the Province of Lecce by surveying a number of indicators obtainable from surgical pathologist’s evaluation. The study, conducted with the software SQTM (www.qtweb.it), is based on breast cancer of women 50-69 years old residing in the Province of Lecce who undergone breast surgery in the years 2003, 2004, 2010, 2011 and 2012 at the "V. Fazzi " Hospital, which is reference center for diagnosis and treatment of breast cancer within the Breast Cancer Screening Program of the ASL of Lecce , active since 2008. Compared to the prescreening period, results of all the indicators showed an almost progressive and significant improvement along the years, highlighting the first beneficial effects, primarily the improvement of early diagnosis, resulting from the impact of screening on the female target population. However, the study has emphasized some important problems arising from persistent and systematic deficiencies in the organizational and multidisciplinary approach, on which we must concentrate efforts to further improve the screening program results.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v1i1p61

Authors: Andrea Tinelli

The uterine rupture is a dramatic obstetrical event, fortunately unusual. Unfortunately, onset is often sudden, very often during pregnancy, in the third trimester, and during labor. The uterine rupture depends on a number of biological and mechanical factors, in which the muscular scarring process is the main responsible factor. The biology of uterine muscle scarring depends on a set of biomolecular processes involving growth factors, neurotransmitters, neoangiogenesis, deposition and reabsorption of collagen fibers, ect. Any interference in this precess creates the conditions for the uterine rupture, which occurs under contract, during the maximum muscular tension. Separation of the fibers almost always involves a traumatic vascular interruption with copious haemorrhage. Here is why uterine rupture is a very rare event, but very dangerous for the life of the woman and the fetus inside it.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v1i1p53

Authors: Domenico Toraldo Michele De Benedetto

The Obstructive Sleep Apnea (OSA) is becoming a significant problem nowadays because it is associated with an increasing cardio-metabolic mortality. This disorder is increasing dramatically in the western world because it related to obesity. The cost-effectiveness ratio of OSA's diagnostic and therapeutic management is a strategic issue for health policy, which faces with recent international discussion involving the Western Health Systems. It has been shown that costs for simplified models used for diagnosis and outpatient care for OSA are minimal due to a more and more reduction of expenditure for both equipment and medical staff. This lack of investments and the utilization of portable and simplified monitoring devices could lead to incorrect diagnosis. This short review aims to offer discussion topics on the proper diagnosis and treatment of OSA in view of epidemiological / economic factors and results in terms of costs and social benefit of the disease.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v1i1p41

Authors: Vittoria Tarantino Luana Conte Martina Manni Alessandra Dondi Monica Bellei Massimo Federico

Follicular Lymphoma (FL) is the second most frequent non-Hodgkin lymphoma accounting for approximately 10-20% of all lymphomas in Western Countries. Histologic transformation (HT) is a frequent event in the clinical course of patients with indolent lymphoma that is often accompanied by a dramatic change in the clinical features of the disease towards a more aggressive course. Although the transformation of Follicular Lymphoma (tFL) was described several decades ago, there is a strong need for a better understanding of both the dynamics of the tumor clonal evolution and the genetic events leading to ()transformation. In addition, the management of patients with tFL is challenged by the heterogeneity of the previous treatments. The present review describes the state of art of tFL, outlining recent advances in the understanding of genetic basis and the evolutionary process governing the initiation and persistence of tumor evolution. It will be also addressed the key questions pending on this incurable disease, such as a lack of a standard therapeutic strategy for tFL patients as well as its outcome in the Rituximab (R) era.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v1i1p33

Authors: Giorgio De Nunzio Benedetta Tafuri Marina Donativi Marta Vannini Lorenzo Mazzoni Giovanni Rubino Antonella Castellano Luigi Pirtoli

During the radiation therapy (RT) process, the treatment is planned and simulated with a treatment planning system (TPS). Contouring identifies the Planning Treatment Volume (PTV), that is the physical RT treatment volume. PTV of Glioblastoma (GB) includes, after expansion, Gross Tumor Volume (GTV, the tumor) and Clinical Target Volume (CTV, tumor plus edema). GlioCAD, a Computer-Assisted Detection software for contouring gliomas in MRI/DTI, was used to delineate GTV. The dataset included the images of 21 patients undergoing RT for GB. For each patient, we co-registered CT-planning images and diagnostic MRI (16 T1-gad, 6 T2 Flair, 13 Flair Fat Sat), which were used for GlioCAD training and validation. CAD outlined the tumor with good accuracy, after ruling out in post-processing some false positives. We identified reliable GTVs, suitable for RT requirements. An evolution of GlioCAD will take into account edema for outlining CTV. The method is promising. Together with a further automatic system for the delineation of organs at risk (OAR) in the brain, the procedure may be helpful for standardization of RT-treatment planning.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v1i1p27

Authors: Sara Invitto Giuseppe Nicolardi

Experimental research in this area focuses, in a section of the laboratory of Neurosciences, on new technologies applied to Cognitive Neuroscience and Psychophysiology. The aim of this paper will be highlighting the link between basic research and innovative multidisciplinary experimentation. According with this perspective the projects developed in the Neuroscience Lab will be briefly described: two devices deposited as European patents, a protocol of olfactory stimulation on EEG and neurodegenerative processing, the research on women with IPV (Intimate Partner Violence disorder), projects on neuroaesthetic (applied in museum learning), a study on the marine soundscape and related brain responses, and an experimental work on an haptic and virtual interfaces and on a comparison of motor imagery training with haptic training of augmented reality, as well as training of handling real objects with grasping affordances. These topics would set out a new view of research, extending beyond the technological interfaces in neurocognitive protocols. Will be described the leitmotif of the research activities carried out over the last five years.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v1i1p21

Authors: Alessandra Ferramosca Vincenzo Zara

Mitochondria of spermatozoa significantly differ, structurally and functionally, from the corresponding organelles of somatic cells. Nevertheless, sperm mitochondria, as well as the somatic ones, are the location of the oxidative phosphorylation (OXPHOS) process, which is necessary for the production of metabolic energy in the form of adenosine triphosphate (ATP). In addition to their basic role in oxidative energy generation, mitochondria are also a source of reactive oxygen species (ROS), which, at low concentrations, play a physiological role in many sperm processes. It is commonly accepted that a proper functionality of mitochondria is necessary for a high quality of sperm cells; this last parameter, in its turn, is a prerequisite for a high sperm fertilizing ability. Evaluation of mitochondrial respiratory efficiency represents therefore a valuable test that could integrate routine semen analysis.

Journal of Interdisciplinary Research Applied to Medicine doi: 10.1285/i25327518v1i1p7

Authors: Michele Maffia Luana Conte Marco Greco Maria Maffia Pasquale Simeone Daniele Vergara

The omics sciences of systems biology including genomics, transcriptomics, lipidomics, metabolomics, and proteomics, aim at understanding the biological mechanisms that give rise to the phenotype of an organism by using high-throughput technologies with the promise of great medical advances. The importance of all these sciences is that all, with the exception of genomics are context dependent. Genome is constant in time and place in each cell of an organism, but the entire complement of messenger RNA molecules, proteins and metabolites in a cell, tissue, organ or organism varies with physiological, pathological or developmental conditions (Keusch 2006). The term “omics” represents the study of biological processes as systems. It deciphers the dynamic interactions between the numerous components of a biological system to analyse networks, pathways, and interactive relations that exist among them, such as genes, transcripts, proteins, metabolites, and cells. This new scientific vision has opened the way to new research strategies and experimental technologies that have transformed the study of virtually all life processes. Expansion of the “–ome” concept was incessant and has created a host of new terms, including bacteriome, cardiome, epigenome, erythrome, immunome, microbiome, neurome, connectome, osteome, physiome, proteinome, transportome, degradome, psychome, transcriptome, and many others. In the present review, these concepts are briefly introduced with a major focus towards proteomics.