Search Results (103)

Background: Graphene oxide (GO) is widely explored as a functional additive in polymer composites; however, its simple physical dispersion in dental resins often leads to poor interfacial stability and limited long-term performance. Covalent functionalization may overcome these limitations by enabling chemical integration into the polymer matrix. This study presents the synthesis and FT-IR/Raman characterization of GRAPHYMERE^®, a novel graphene oxide-based monomer obtained through exfoliation, amine functionalization with 1,6-hexanediamine, and transamidation with methyl methacrylate. Methods: A novel GO-based monomer, GRAPHYMERE^®, was synthesized through a three-step process involving GO exfoliation, amine functionalization with 1,6-hexanediamine, and transamidation with methyl methacrylate to introduce polymerizable acrylic groups. The resulting product was characterized using FT-IR and Raman spectroscopy. Results: Spectroscopic analyses confirmed the presence of aliphatic chains and amine functionalities on the GO surface. Although some expected signals were overlapped, the data suggest successful surface modification and partial insertion of methacrylamide groups. The process is straightforward, uses low-toxicity reagents, and avoids complex reaction steps. Conclusions: GRAPHYMERE^® represents a chemically modified GO monomer potentially suitable for copolymerization within dental resin matrices. While its structural features support compatibility with radical polymerization systems, further studies are required to assess its mechanical performance and functional properties in dental resin applications. Full article

Objectives: In the context of the global rise in antimicrobial resistance (AMR), this study aimed to investigate temporal trends in AMR among pathogens isolated from endometrial cultures of patients diagnosed with chronic endometritis (CE). Methods: This cross-sectional study included 244 women consecutively diagnosed with CE at the Gynecology Unit of the University of Bari, Italy, between January 2020 and June 2024. Exclusion criteria were (i) previous CE diagnosis or treatment; (ii) antimicrobial use in the month prior to hysteroscopy and biopsy; (iii) use of oral or vaginal prebiotics/probiotics or contraceptives in the three months prior; (iv) known immunosuppression; and (v) hypersensitivity to quinolones or macrolides. CE was diagnosed using hysteroscopy combined with endometrial histology and microbial culture. Specifically, in cases with hysteroscopic signs suggestive of CE, endometrial biopsies were obtained using a Novak curette and processed for histological and immunohistochemical analyses, as well as for microbial identification and antimicrobial susceptibility testing in accordance with EUCAST guidelines. The primary outcomes were the prevalence of CE-associated pathogens and their AMR profiles. Results: The median age at CE diagnosis was 33 years (range 26–44). The most frequently isolated pathogens were Enterococcus faecalis (26.2%), Escherichia coli (19.3%), and Ureaplasma urealyticum (16.4%). High AMR rates were observed, with increasing trends over time. Ampicillin resistance reached 98.5% (63/64), penicillin resistance 30.8% (16/52), and extended-spectrum beta-lactamase (ESBL) positivity 34.7% (25/72), all with statistically significant trends (p < 0.001). Resistance to commonly used first-line antimicrobials, such as tetracyclines, quinolones, and nitroimidazoles, was also substantial. Conclusions: This study highlights a significant increase in AMRs among microorganisms responsible for CE between 2020 and 2024. As a result, empirical first-line antimicrobial therapies commonly used to treat patients with CE may be increasingly ineffective in a growing number of cases. This underscores the need for improved and targeted diagnostic and therapeutic strategies to effectively manage CE and prevent treatment failures. Strengthening surveillance systems, implementing antimicrobial stewardship programs, and enhancing patient education may help counter the growing threat of AMR. Full article

In the last decades, there has been huge interest in Per- and Polyfluoroalkyl Substances (PFAS) worldwide because of the toxic effects on humans. In 2013, a large-scale contamination of PFASs in the Veneto region was caused by a fluorochemical plant in Vicenza. About 130,000 inhabitants were exposed to PFAS in their drinking water. To date, relatively few studies have investigated the associations between blood serum PFAS concentrations and oxidative stress in semen. This study compared the antioxidant activity, lipoperoxide levels and protection or induction of oxidative DNA damage by sperm nuclear basic proteins (SNBP) in subjects living in Veneto exposed to PFAS (VNT) with those living in a non-PFAS contaminated area (VSL). Although the semen parameters were within the WHO range, the VNT semen samples showed higher levels of lipoperoxides and lower antioxidant activity compared to the VSL samples. These differences were statistically significant. We also examined DNA damage following SNBP addition under pro-oxidative conditions, finding a significantly different distribution of DNA damage types between the two groups, where 0 means no damage and 1 to 3 means increasing damage with 3 indicating maximum damage. SNBP of VNT subjects showed a reduced ability to protect DNA from oxidative damage. In the VSL group, damage 0 was found in 56% of subjects, 35% of the VNT group show damage 1, 36% damage 2 and 18% damage 3, while only 11% of VNT subjects show damage 0. Additionally, VNT with 0-grade DNA oxidative damage also exhibited reduced antioxidant activity and higher levels of lipoperoxides, in contrast to VSL. The results of this study indicate that exposure to PFAS produces oxidative stress in the semen of VNT subjects, who were also found to have blood serum perfluorooctanoic acid (PFOA) levels above the threshold. This suggests the possibility of infertility issues and emphasises the necessity for additional research into the long-term consequences of oxidative stress on male fertility and the health of offspring. Full article

Background: Squamous cell carcinoma (SCC) of the penis accounts for approximately 95% of penile cancers and is associated with substantial morbidity and mortality. SCC typically develops in uncircumcised men, most commonly affecting the foreskin or glans. While slow-growing, early detection is crucial to improve survival outcomes. Risk factors include advanced age, lack of circumcision, poor hygiene, HPV infection (types 16 and 18), chronic inflammation, and smoking. Methods: We conducted a retrospective, single-center study at IRCCS Hospital “G. Pascale” of Naples, Italy, involving 59 patients treated between January 2015 and January 2023. The inclusion criteria were surgically treated primary tumors, confirmed SCC pathology, and pathologically verified inguinal lymph node metastasis (ILNM). We analyzed clinical variables including lymph node involvement, lymphovascular invasion (LVI), spongiosum corpus involvement (SCI), HPV infection, and tumor differentiation. Univariate and multivariate logistic regression analyses were performed to determine independent predictors of ILNM. Results: The mean age of patients was 66.67 ± 13.97 years. ILNM was confirmed in 24 patients (40.6%), while 35 (59.3%) had no lymph node involvement. Univariate analysis identified lymph node involvement at diagnosis (p = 0.005), LVI (p = 0.003), and SCI (p = 0.003) as significant predictors of ILNM. These factors were confirmed in the multivariate analysis, with lymph node involvement (p = 0.004), LVI (p = 0.025), and SCI (p = 0.028) as independent predictors. Conclusions: Lymph node status, LVI, and SCI are significant predictors of ILNM in penile SCC. Identifying these factors can aid in risk stratification, optimizing surgical decisions, and potentially reducing unnecessary morbidity. Further large-scale studies are recommended to validate these findings and refine prognostic models. Full article

Background/Objectives: Adverse in-hospital outcomes at radical prostatectomy have not been specifically addressed in young patients aged 40–49 years (quadragenarians). Additionally, no comparison between robot-assisted (RARP) vs. open radical prostatectomy (ORP) has been reported in this population. Methods: Descriptive analyses, propensity score matching (PSM), and multivariable logistic/Poisson regression models addressed quadragenarians undergoing RARP or ORP within the National Inpatient Sample (2009–2019). Results: Of 5426 quadragenarians, 4083 (75.2%) and 1343 (24.8%) underwent RARP and ORP, respectively. The proportion of RARP increased from 68.1 to 84.5% (2009–2019, EAPC: +2.8%, p < 0.001). Adverse in-hospital outcomes after RARP were invariably lower than those after ORP. Specifically, the rates of overall complications (7.8 vs. 13.4%, Δ −5.6%, multivariable odds ratio (OR): 0.54), blood transfusions (1.2 vs. 6.3%, Δ −5.1%, OR: 0.21), and length of stay (LOS) > 2 days (10.6 vs. 28.7%, Δ −18.1%, OR: 0.32) were lower after RARP than after ORP (all p < 0.001). After additional one-to-one PSM between ORP and RARP patients, virtually the same results were reported (overall complications: 7.0 vs. 13.4%, Δ −6.4%, OR: 0.49; blood transfusion rates: 1.5 vs. 6.3%, Δ −4.8%, OR: 0.23; LOS > 2 days: 10.9 vs. 28.7%, Δ −17.8%, OR: 0.30). Conversely, RARP use resulted in higher total hospital charges (USD 43,690 vs. 36,840, Δ USD +6850, IRR: 1.18; p < 0.001). Conclusions: Quadragenarians exhibited a more favorable adverse in-hospital outcome profile after RARP vs. ORP. These advantages are offset by a small, albeit significant, increase in total hospital charges. Full article

Background: Pleural mesothelioma (PM) is a rare and highly aggressive cancer which arises from mesothelial layer and primarily linked to asbestos exposure, genetic predispositions, and specific mutations. Despite current treatment modalities, including chemotherapy, antiangiogenic therapy and more recently immunotherapy, the prognosis remains dismal, with a median survival time of 6–18 months. Objectives: The urgent need for novel therapeutic strategies has prompted research into molecular targets and precision medicine approaches. At present, many potential targets for therapeutic strategies have been identified, and emerging clinical trials are demonstrating certain clinical efficacy. Methods: This review examines advancements in understanding PM’s genetic and epigenetic landscape, signaling pathways, and promising therapeutic targets. Results: We also discuss the results of recent clinical trials and their potential implications for future treatment paradigms. Full article

In recent years, the global demand for food ice cubes has increased. The aim of the study was to evaluate the hygienic quality of both ice and water used for its production. During January–October 2023, 108 ice and water samples were collected in catering locations in Apulia Region and examined for Escherichia coli, Enterococci, total bacterial count (TBC) and fungi. Median counts of E. coli, Coliforms and Enterococci were 0 CFU/100 mL both for ice and water samples, collected in bars (n = 78) and restaurants (n = 30). The median TBCs in ice and water samples were 175 and 43 CFU/mL (p < 0.0001) at 22 °C, and 80 and 30 CFU/mL (p < 0.0001) at 36 °C. Total fungi counts were 4 and 0 CFU/mL for ice and water (p < 0.0001). In restaurants, differences were found between ice and water only for fungal contamination, whereas for bars, a difference was found between ice and water for Coliforms, Enterococci, TBC at 22 °C and fungi. The only statistically significant difference between bars and restaurants was observed for the TBCs at 22 °C (p = 0.017) and 36 °C (p = 0.036). Ice contamination does not appear to be directly related to the hygienic quality of water, but likely linked to the production, storage and maintenance of ice machines. Full article

Prostate cancer presents a substantial challenge, necessitating a delicate balance between effective treatment and preserving the overall quality of life for men, while robot-assisted radical prostatectomy (RARP) stands as the premier surgical approach, with a negligible rate of patients who remained incontinent. This review explores various technical modifications employed in RARP to improve early continence recovery, offering a summary of their implementation and potential benefits. Techniques like bladder neck preservation, subapical urethral dissection, and nerve-sparing approaches are critically discussed, highlighting their role in minimizing continence issues and ensuring a better post-operative experience for patients with prostate cancer. Full article

Chronic endometritis (CE) is a persistent inflammatory condition of the endometrium characterized by abnormal infiltration of plasma cells into the endometrial stroma. Frequently associated with repeated implantation failure, recurrent pregnancy loss, and infertility, CE significantly impacts women’s health, contributing to conditions such as abnormal uterine bleeding and endometriosis. Treatment typically involves antibiotic therapy; however, the efficacy of these treatments is increasingly compromised by the rise of antimicrobial resistance (AMR). This paper examines the critical links between AMR and CE, proposing strategies to enhance clinical management and optimize treatment outcomes. Full article

Background: Rising costs and demands for improved quality of care present complex challenges for existing healthcare systems. The strain on healthcare resources is exacerbated by the increasing complexity of patient conditions. The Diagnosis-Related Group (DRG) system classifies inpatients according to clinical and treatment criteria, controls healthcare expenditures, and ensures the sustainability of procedures. The cost of nursing care is included in the DRG system in the same way as other fixed costs of hospital care, but the amount of nursing care provided for the same DRG can vary widely. This study, which is based on this protocol, will aim to assess the variability of nursing costs within and across DRGs and to measure how much variability in nursing care is explained by DRGs by comparing nursing care delivery in acute care hospitals with the DRG reimbursement system in Italy. It is necessary to develop a specific protocol to ensure systematic and consistent data collection at the national level. Methods: A multicenter retrospective cross-sectional study will be conducted. A random sample of five public Italian hospitals will be enrolled. Patients included in medical or surgical DRGs, hospitalized and discharged in 2022 will be included. Data will be collected retrospectively from two sources: hospital discharge records and nursing records. Inferential statistics will be used to assess the variability of nursing time and costs across hospitals and DRGs. Nursing costs will be determined by several factors, including time spent on nursing activities and the hourly wages of nursing staff. The time needed to complete each activity will be estimated by a convenience sample of nurses from the hospitals included in this study. The annual salary of nurses will be used to calculate the nursing cost per minute, multipled by the amount of time spent per each nursing activity. The cost per patient per day of hospitalization will be calculated. Conclusions: The results of this study will shed light on the variation in nursing care across different DRGs. This understanding will guide recommendations for optimizing healthcare resource allocation and enhancing the efficiency of the DRG system in Italy. Full article

Background/Objectives: HER2-positive breast cancer (HER2⁺BC) is an aggressive subtype, with neoadjuvant treatment (NAT) aiming to achieve a pathological complete response (pCR) to improve long-term outcomes. Trastuzumab emtansine (T-DM1) has been established as the standard of care in the adjuvant setting for HER2⁺BC patients who do not obtain pCR. The ATD study aimed to evaluate the real-world tolerability of T-DM1 in this setting. The secondary objective was to assess the effectiveness. Methods: This was a multicenter, retrospective study across 24 Italian oncology centers, including 410 patients with HER2⁺BC treated with adjuvant T-DM1 following a lack of pCR after NAT. Patient characteristics, NAT regimens, and surgical outcomes were recorded. Tolerability was assessed by documenting adverse events (AEs) according to the CTCAE (v5.0). Preliminary effectiveness was evaluated in terms of relapse-free survival (RFS) and overall survival (OS). Results: Overall, 228 patients (55.6%) experienced at least one AE related to T-DM1, with 4.9% experiencing grade 3 or higher AEs. The most common AEs were hepatotoxicity (18.5%) and thrombocytopenia (17.6%). T-DM1 was discontinued in 10.0% of patients due to toxicity. After a median follow-up of 25 months, 31 relapse events (7.6%) and 22 deaths (5.4%) were reported. The preliminary incidence of RFS and OS events was similar between patients who completed the T-DM1 course and those who discontinued it early. Conclusions: T-DM1 demonstrated a manageable safety profile, and the adverse events were consistent with those reported in randomized trials. The data are not yet sufficient to allow for a formal analysis of RFS and OS, and long-term follow-up is required. Full article

Background/Objectives: The limited and inconsistent adoption and regulation of nurse-led clinics (NLCs) and “See & Treat” (S&T) services in Italy needs to be explored considering their value towards patients’ outcomes acknowledged in the literature. This study aims to explore the phenomenon of hidden nursing activities (HNAs) in these settings, hypothesizing that features and activities performed in these settings are heterogeneous across the country and widely underreported or attributed to other professionals than nurses. HNAs are hypothesized to be associated with a poor work environment climate and nurses’ low job satisfaction. Methods: A multicenter, cross-sectional study will be conducted across exclusively nurse-led NLC and S&T services in public health care facilities in Italy. Data collection will involve inputs from organization or nursing managers, coordinators, head nurses, and employed nurses. Information will be gathered on organizational structure, service provision, access modalities, nurses’ perceptions of their work environment, and the health care activities performed. Surveys will be distributed online to collect retrospective data in 2023 and via paper to collect 1-month prospective data about services’ activities. Expected results: This study is expected to reveal HNAs in NLC and S&T, with implications for policy, resource allocation, reimbursement models, and patient outcomes, ultimately supporting healthcare reforms and enhancing nursing’s visibility and impact in Italy. The findings will be essential for guiding health care resource allocation and shaping educational and regulatory policies that recognize and formalize the role of nurses in advanced practice. Policymakers could leverage the findings of this study to promote the development of standardized taxonomies, making nursing contributions more visible and measurable. Ultimately, this research will highlight the value of nursing care in NLC and S&T settings, providing an evidence base to drive policy changes that improve both health care outcomes and resource efficiency. Conclusions: This study lays the groundwork for health care policy reforms by advocating for the recognition, measurement, and funding of nursing contributions, ultimately enhancing patient outcomes and the sustainability of health systems. Full article

Ceratitis capitata, known as the Mediterranean fruit fly (Medfly), is a major dipteran pest significantly impacting fruit and vegetable farming. Currently, its control heavily relies mainly on chemical insecticides, which pose health risks and have effects on pollinators. A more sustainable and species-specific alternative strategy may be based on double-stranded RNA (dsRNA) delivery through feeding to disrupt essential functions in pest insects, which is poorly reported in dipteran species. Previous reports in Orthoptera and Coleoptera species suggested that dsRNA degradation by specific nucleases in the intestinal lumen is among the major obstacles to feeding-mediated RNAi in insects. In our study, we experimented with three-day adult feeding using a combination of dsRNA molecules that target the expression of the ATPase vital gene and two intestinal dsRNA nucleases. These dsRNA molecules were recently tested separately in two Tephritidae species, showing limited effectiveness. In contrast, by simultaneously feeding dsRNA against the CcVha68-1, CcdsRNase1, and CcdsRNase2 genes, we observed 79% mortality over seven days, which was associated with a decrease in mRNA levels of the three targeted genes. As expected, we also observed a reduction in dsRNA degradation following RNAi against nucleases. This research illustrates the potential of utilizing molecules as pesticides to achieve mortality rates in Medfly adults by targeting crucial genes and intestinal nucleases. Furthermore, it underscores the importance of exploring RNAi-based approaches for pest management. Full article

Edible ice is often produced by special machines that can represent a source of significant chemical and microbiological contamination. In this work, the presence of phthalic acid esters (phthalates, PAEs) and heavy metals in ice cubes distributed by 77 vending machines installed in two different zones in southern Italy and fed by water from the public water supply was investigated. Solid-phase microextraction coupled to gas chromatography−mass spectrometry (SPME-GC/MS) was used to evaluate contamination with four PAEs, which were selected because they are commonly used in the production of food-contact plastics, while inductively coupled plasma mass spectrometry (ICP/MS) was used to quantify the heavy metals. It was found that ice samples, especially those from one of the two considered zones (zone 2), exceeded the dibutyl phthalate (DBP) threshold limit value; some ice cubes from the other zone (zone 1) instead showed levels of both lead (Pb) and nickel (Ni) up to one order of magnitude higher than those observed in samples collected in zone 2 and higher than the maximum permitted values (European Directive n. 2184/2020). Since the water source connected to the ice vending machines was found to be free from significant levels of all considered target compounds and metals, the high levels of DBP, Ni, and Pb in ice cubes could be attributed to the components and/or to the state of repair of the ice vending machines themselves. Full article

Background: Limited evidence is available about sleep quality changes associated with the use of Cabotegravir (CAB), a new, long-acting (LA) antiretroviral (ARV) drug belonging to the class of Integrase Strand Transfer Inhibitors (INSTIs). Methods: Pittsburgh Sleep Quality Index (PSQI) was calculated in 53 people living with HIV (PLWH) under the care of the outpatient services of two Italian Infectious Diseases Centers in Apuliabefore (M0) and seven months after (M7) the switch to LA CAB. Global scores and relative subitems were compared using paired sample tests. The same analysis was repeated in subgroups of PLWH switching from INSTIs-, Dolutegravir-(DTG), and Bictegravir (BIC)-based regimens. Results: A significant reduction was reported in global mean (±StandardDeviation, SD) PSQI at M7 compared to M0 (4 (±3) vs. 3 (±2), p = 0.01), particularly in the areas of sleep latency and sleep disturbances. The improvement was also significant in PLWH already on INSTIs- (from median 3 to 2 points, p = 0.02) and DTG-based (from median 4 to 2, p = 0.01) ARV regimens, but not among those who switched from BIC-based regimens. Conclusions: PLWH reported improved sleep quality after switching from ARV treatment to LA CAB. Further studies are needed to give deeper insights into this phenomenon. Full article