Search Results (85)

Background: Patients undergoing head and neck surgery with free flap reconstruction are at a high risk for postoperative respiratory complications, including hypoxemia. Conventional oxygen therapy (COT) and non-invasive ventilation (NIV) may be poorly tolerated or contraindicated due to anatomical limitations. High-Flow Nasal Cannula (HFNC) therapy represents a promising alternative, offering better humidification, comfort, and oxygenation. Methods: This retrospective single-center study included 50 adult patients admitted to the ICU after head and neck oncologic surgery with flap reconstruction from January 2022 to November 2024. All patients received HFNC immediately after extubation. Hypoxemia was defined as a PaO₂/FiO₂ (P/F) ratio of < 300 mm Hg. The primary outcome was the incidence of postoperative hypoxemia. Secondary outcomes included reintubation rates and patient compliance. Data were collected at 1, 6, 12, and 24 h following HFNC initiation. Results: Out of 59 patients screened, 9 were excluded per predefined criteria. Among the 50 included, only 2 patients (4%) developed hypoxemia, with P/F ratios remaining above 250. No patients required reintubation. The respiratory rate–oxygenation index (ROX index) improved steadily during the first 24 h. HFNC was well tolerated; only three patients required minor adjustments due to discomfort. Conclusions: HFNC use in the immediate postoperative period after head and neck surgery was associated with a low incidence of hypoxemia and no reintubations. These findings suggest that HFNC is a safe and effective strategy for postoperative respiratory support in this high-risk population. Further prospective studies are warranted to confirm the benefit of HFNC in reducing hypoxemia and preventing reintubation in high-risk surgical populations. Full article

Background: Anorectal malformations (ARMs) are rare congenital anomalies requiring surgical correction and long-term multidisciplinary care. Despite advances in surgical techniques like posterior sagittal anorectoplasty (PSARP), patients often experience ongoing issues with bowel and urinary function and psychosocial well-being. Aim: To evaluate the long-term outcomes of bowel function, urinary function, and quality of life in patients born with anorectal malformation and treated at our center. Methods: A cross-sectional study evaluated 55 ARM patients treated at the University Hospital of Palermo between 2002 and 2020. Data on clinical characteristics, surgical management, bowel and urinary function, and quality of life were collected using the following validated tools: Rintala Bowel Function Score, PedsQL Family Impact Module, Fecal Incontinence Quality of Life Score, and Lower Urinary Tract Symptoms Questionnaire. Statistical analysis was performed using Fisher’s exact test and ANOVA. Results: Excellent bowel function was observed in 44% of patients, particularly those with low-type ARMs. A bowel management program (BMP) was required in 62% of cases, though 44% of these patients, especially adolescents, showed poor adherence. BMP non-adherence significantly correlated with lower quality of life and worse bowel function (p < 0.01). Bladder dysfunction was noted in 24% of patients, mainly younger ones. Conclusions: Tailored BMPs and transition care are important for long-term success in ARM patients. Adherence to BMPs improves continence and quality of life, highlighting the need for continuous, multidisciplinary follow-up from childhood into adulthood. Full article

Introduction: Obstructive sleep apnea syndrome (OSAS) is caused by anatomical and non-anatomical factors which lead to upper airway (UA) obstruction during sleep. Intrinsic UA collapse is the most frequent determinant of OSA. In the era of personalized medicine, adopting a tailored diagnostic approach is essential to rule out secondary causes of UA collapse, particularly those stemming from extrinsic anatomical factors. Although being rarely considered in the differential diagnosis, space-occupying lesions of deep cervical spaces such as the parapharyngeal space (PPS) may be responsible for airway obstruction and lead to OSAS. Objective: This study aimed to present an atypical case of OSAS caused by extrinsic PPS compression, outlining the relevance of modern personalized medicine in the diagnostic and therapeutic protocols, and to enhance understanding through a comprehensive literature review. Methods: A 60-year-old female presented with sleep-disordered complaints and was diagnosed with severe OSAS after polysomnography. At physical examination, a swelling of the right posterior oropharyngeal mucosa was noticed. Imaging confirmed the suspicion of a PPS tumor, and transcervical resection was planned. Case presentation was adherent to the CARE checklist. A comprehensive literature review was conducted using the most reliable scientific databases. Results: Surgery was uneventful, and the patient made a full recovery. The histopathology report was consistent with the diagnosis of pleomorphic adenoma. Postoperative outcomes showed marked improvement in polysomnographic parameters and symptom burden. Conclusions: Parapharyngeal space tumors are a rare, often overlooked cause of OSA. This case highlights the role of a personalized head and neck assessment in OSA patients, particularly in identifying structural causes and offering definitive surgical management when indicated. Full article

Gold kiwifruits from two different farms, harvested at different times, were analysed using both non-destructive and destructive methods. A computer vision system (CVS) and a portable spectroradiometer were used to perform non-destructive measurements of firmness, titratable acidity, pH, soluble solids content, dry matter, and soluble sugars (glucose and fructose), with the goal of building predictive models for the maturity index. Hyperspectral data from the visible–near-infrared (VIS–NIR) and short-wave infrared (SWIR) ranges, collected via the spectroradiometer, along with colour features extracted by the CVS, were used as predictors. Three different regression methods—Partial Least Squares (PLS), Support Vector Regression (SVR), and Gaussian process regression (GPR)—were tested to assess their predictive accuracy. The results revealed a significant increase in sugar content across the different harvesting times in the season. Regardless of the regression method used, the CVS was not able to distinguish among the different harvests, since no significant skin colour changes were measured. Instead, hyperspectral measurements from the near-infrared (NIR) region and the initial part of the SWIR region proved useful in predicting soluble solids content, glucose, and fructose. The models built using these spectral regions achieved R² average values between 0.55 and 0.60. Among the different regression models, the GPR-based model showed the best performance in predicting kiwifruit soluble solids content, glucose, and fructose. In conclusion, for the first time, the effectiveness of a fully portable spectroradiometer measuring surface reflectance until the full SWIR range for the rapid, contactless, and non-destructive estimation of the maturity index of kiwifruits was reported. The versatility of the portable spectroradiometer may allow for field applications that accurately identify the most suitable moment to carry out the harvesting. Full article

Neuroendoscopy is a minimally invasive surgical technique used to treat brain pathologies such as hydrocephalus, arachnoid cysts, and skull base tumors. While it offers several advantages, including reduced tissue trauma and lower morbidity, it is associated with a high risk of postoperative nausea and vomiting (PONV). This paper provides a narrative review of the literature on the incidence, pathophysiology, and management of PONV in patients undergoing neuroendoscopic procedures. The review includes several studies published between 2001 and 2024, analyzing specific risk factors such as female gender, postoperative opioid use, extended endoscopic approaches, and cavernous sinus dissection. PONV prevention strategies include a multimodal approach combining total intravenous anesthesia (TIVA) with propofol, perioperative hydration, and pharmacological prophylaxis (5-HT3 receptor antagonists, NK1 antagonists, dexamethasone, and droperidol). Despite advances in surgical and anesthetic techniques, further research is needed to develop procedure-specific protocols and optimize PONV management in neuroendoscopy. Full article

Building on the Job Demands–Resources model, this study aims to investigate the interaction between job characteristics and work-related stress indicators in a sample of 211 Italian Armed Forces personnel. Using Latent Profile Analysis (LPA), three distinct profiles emerged based on job demands (workload and perception of performing high-risk work) and resources (relationships with colleagues and supervisors, perceived meaningfulness of work, and feedback received on quality of work). The first profile, characterized by high demands and low resources, was associated with higher levels of work–family conflict and need for recovery (an indicator of perceived fatigue at the end of the workday). The second profile, characterized by high resources and low demands, showed the lowest levels of both need for recovery and work–family conflict, while the third profile showed average scores on demands, resources, and outcome variables. These findings are in line with the chosen theoretical framework and prompt several reflections on work-related well-being in the armed forces and what can promote it. Stemming from the results is the importance of organizational interventions designed to protect employees’ well-being and support their effective functioning. Such interventions are particularly critical within the armed forces context, where operational performance has a direct impact on the safety and well-being of citizens. Full article

The obstruction of the urinary tract is responsible for obstructive nephropathy (ON), also known as uropathy, which may then evolve in a renal parenchymal disease (hydronephrosis). Regarding the etiology of ON, it has been linked to the perturbation of processes occurring during the urinary tract development such as morphogenesis, maturation, and growth. Despite the research carried out in recent years, there is still a pressing need to elucidate the molecular processes underlying the disease. This may then result in the definition of novel biomarkers that can help in patient stratification and the monitoring of therapeutic choices. Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases with key roles in extracellular matrix remodeling due to their wide cleavage specificity and ability to modulate the bioavailability of growth factors. Despite the known changes in the local tissue microenvironment at the site of the urinary tract obstruction, the role of MMPs in ureteropelvic junction obstruction (UPJO) and, therefore, in the pathogenesis of renal damage in ON is not well-documented. In this review, we underline the possible roles of MMPs both in the pathogenesis of UPJO and in the progression of related hydronephrosis. The potential use of MMPs as biomarkers detectable in bodily fluids (such as the patient’s urine) is also discussed. Full article

Background/Objectives: Endoscopy plays a well know role in managing patients treated for esophageal atresia (EA), allowing the detection and treatment of complications such as anastomotic strictures, gastroesophageal reflux disease, and other structural abnormalities, during the critical first year of life. Nevertheless, we would like to underline the importance of endoscopy early in the follow-up of patients treated for EA, as recommended by guidelines. This study evaluates the role of endoscopy in managing patients treated for esophageal atresia (EA), focusing on the detection and treatment of complications such as anastomotic strictures, gastroesophageal reflux disease, and other structural abnormalities during the critical first year of life. Methods: A retrospective analysis was conducted over 20 years at our institution. Clinical assessments were performed at 3, 6, and 9 months to monitor growth, feeding tolerance, and proton pump inhibitor (PPI) adjustments. Endoscopic evaluations were conducted under general anesthesia around one year of age. Results: Between 2003 and 2023, 84 patients underwent surgical treatment for EA, with complete follow-up data available for 77 patients. Complications occurred in 21 patients (27%), including 4 patients (5.5%) with isolated anastomotic stricture, 8 patients (10%) with reflux esophagitis, 8 patients (10%) affected by both stenosis and reflux, and 1 case (1.5%) of fistula recurrence. Endoscopic dilatations for stenosis were successful, averaging three procedures per patient. Growth parameters were normal in 91% of cases by the first year. Conclusions: Esophagogastroscopy is a safe and effective tool for diagnosing and managing complications after EA repair in infants. The minimally invasive procedure could allow early detection of esophagitis and strictures, offering significant therapeutic benefits. Given these important results, we would like to recommend its use in routine follow-up care. Full article

This study investigates how perceived parental criticism is associated with career confidence in students and workers, considering the mediating role of the fear of an uncertain future. In a rapidly changing labor market, students, as young individuals navigating early career decisions, experience heightened uncertainty about their future, especially regarding their professional paths. This research aims to verify whether perceived parental criticism negatively affects career confidence both directly and indirectly through the mediating role of fear of an uncertain future, and whether occupational status (being a student or already working) influences this relationship. Data were collected from a sample of 310 participants, consisting of 108 students and 202 workers. Multigroup structural equation models were used to test the mediation model simultaneously on students and workers. The results indicate that, in students, the relationship between parental criticism and career confidence is fully mediated by fear of an uncertain future, while in workers these associations are weaker and not significant. These findings suggest that students are more vulnerable to uncertainty, as they are in an early stage of career development, while workers may benefit from greater independence and emotional regulation skills. The study highlights the impact of perceived parental criticism on career confidence and the moderating role of occupational status, suggesting the need for interventions that reduce the fear of an uncertain future and encourage greater adaptability to career-related challenges. Full article

Background/Objectives: Globally, thyroid and parathyroid diseases are common and often require surgery. This review evaluates the current literature on the use of regional anesthesia in these surgeries, highlighting its advantages, limitations, and areas requiring further research. Methods: MEDLINE (via PubMed) and ResearchGate, the largest academic social networks, were utilized to retrieve literature on the topic. Results: Fifteen studies with few patients and largely uncontrolled on the use of loco-regional anesthesia (LRA) not combined with general anesthesia (GA) were found. Meanwhile, twenty-two better quality studies involving several patients on LRA combined GA were found. Conclusions: LRA, in combination with GA, has been proven to be the most reliable evidence for reducing opioid use and postoperative nausea and vomiting. LRA, not combined with GA, has been used in a few well-conducted studies; it seems to be feasible to use even in patients with severe systemic disease. Future controlled studies will need to validate its effectiveness and safety. Full article

Introduction: Hepatitis D virus (HDV) infection remains a significant global health challenge due to its severity and high risk of progression to cirrhosis and hepatocellular carcinoma (HCC). Bulevirtide, a novel HDV entry inhibitor, has shown promise in managing chronic hepatitis D by blocking viral entry into hepatocytes. This study evaluated the efficacy and safety of bulevirtide in reducing HDV RNA levels and improving liver function in a real-life cohort of Italian patients with HDV infection. Methods: This multicenter prospective trial enrolled 108 consecutive patients with chronic HDV infection, from June 2023 to June 2024, who received 2 mg/day of bulevirtide in combination with a nucleoside/nucleotide analogue for hepatitis B virus (HBV) infection. Patients with any stage of liver fibrosis or compensated cirrhosis were included. Data collected included demographic and clinical characteristics, liver function tests, HDV RNA levels, and adverse events at baseline and 6 months. Results: The virological response was achieved in 54.6% of patients (n = 59), with 36 demonstrating undetectable HDV RNA levels. Among responders, ALT levels decreased significantly from 67.0 U/mL [IQR 44.0–116.3] to 31.5 U/mL [IQR 24.0–36.5, p = 0.001], and AST levels from 66.0 U/mL [IQR 46.5–91.0] to 32.5 U/mL [IQR 28.0–38.0, p = 0.021]. Median HDV RNA dropped from 29,800 IU/mL [IQR 3100–375,000] to 0 IU/mL [IQR 0–291, p < 0.001]. No significant predictors of response emerged. Mild adverse events, including pruritus (5.6%) and injection-site reactions (1.9%) and flu-like syndrome (0.9) were reported, with no treatment discontinuation. Conclusions: Bulevirtide effectively reduces HDV RNA levels and improves liver function with a favorable safety profile, offering a promising therapeutic option for chronic hepatitis D. Further large-scale studies are needed to confirm these findings and explore long-term outcomes. Full article

Encephalitis affects 1.9 to 14.3 people per 100,000 each year, and the mortality rate varies but can be up to 40%. After the identification of a particular microorganism in a patient with encephalitis, appropriate antimicrobial therapy should be initiated. Corticosteroid therapy represents a therapeutic option in the treatment of primary central nervous system diseases due to its ability to reduce the inflammatory commitment of CNS and consequently reduce mortality rates regardless of the causative agent of injury. Corticosteroid therapy represents a therapeutic option in the treatment of primary central nervous system diseases. Their use is also recommended in meningitis with autoimmune etiology. While corticosteroids have repeatedly been used as adjunctive treatment in encephalitis of viral etiology, the scientific evidence supporting their effectiveness remains scarce. The use of standard doses recommended by the guidelines seems reasonable as an initial setting, especially when a definitive diagnosis of the causal agent is still awaited. The subsequent adjustment should be personalized based on the individual clinical response. Full article

Objectives: We evaluated the 3-year effectiveness and safety of XEN45, combined or not with phacoemulsification, in patients from the Italian XEN-Glaucoma Treatment Registry. Methods: Data from glaucoma patients who underwent XEN45 alone or combined with phacoemulsification were analyzed. Changes in intraocular pressure (IOP) and the number of ocular hypotensive medications (OHMs) were tested with repeated measures ANOVA in last observation carried forward (LOCF) and per-protocol (PP) analyses. Complete and qualified success (IOP < 18 mmHg and ≥20% IOP reduction from baseline, without or with OHMs) at 36 months and pre- and intraoperative factors predicting surgery failure were explored using survival analysis and Cox proportional-hazard models. Complications rates were evaluated to assess safety. Results: The analysis included 239 eyes (239 patients): 144 (60.2%) in the XEN alone and 95 (39.8%) in the XEN+Phaco groups. Overall success was achieved in 164 (68.1%) eyes [113 (68.9%) complete and 51 (31.1%) qualified], without significant differences in success (p = 0.07) and survival rates (p = 0.46) between groups. At the 36th month, the baseline IOP decreased from a median (IQR) of 23.0 (20.0–26.0) to 15.0 (12.0–17.5) mmHg (p < 0.01), with an overall 34.1 ± 20.1% IOP reduction. The mean ± SD number of OHMs decreased from the baseline of 2.7 ± 0.9 to 0.9 ± 1.1 at month 36 (p < 0.01). PP and LOCF analyses were comparable. Neither pre- nor intraoperative factors were significantly predictive of surgery failure. In 91 (38.1%) and 57 (23.8%) of the eyes, at least one postoperative complication occurred early (<month 1) and late (≥month 1) during follow-up, respectively, without sequelae. During follow-up, 68 (28.5%) eyes needed at least one needling. Conclusions: At 3 years, XEN45, combined or not with phacoemulsification, effectively and safely reduced IOP and OHMs need. Full article

Opioid-induced constipation (OIC) is a very common and troublesome gastrointestinal side effect following the use of opioids. Despite existing international guidelines, OIC is largely underdiagnosed and undertreated. ECHO OIC is a European project designed to improve the diagnosis and management of OIC at the primary care level. The next phase of the ECHO OIC project is to review and adapt the proposed European pathway at national level, considering the local patient journey and clinical practice. A multidisciplinary group of 12 Italian experts reviewed and discussed the European path and formulated a seven-step guide for the practical management of OIC that is also easily applicable in primary care: 1. When prescribing long-term opioids, the physician should inform the patient of the possibility of the onset of OIC; 2. At opioid prescription, doctors should also prescribe a treatment for constipation, preferably macrogol or stimulant laxatives; 3. The patient should be evaluated for OIC within the second week of initiating opioid treatment, by clinical history and Rome IV criteria; 4. In the presence of constipation despite laxatives, prescription of a PAMORA (Peripherally Acting Mu Opioid Receptor Antagonist) should be considered; 5. When prescribing a PAMORA, prescribing information should be carefully reviewed, and patients should be accurately instructed for appropriate use; 6. Efficacy and tolerability of the PAMORA should be monitored regularly by Bowel Function Index, considering a cut-off of 30 for the possible step-up of OIC treatment; 7. After 4 weeks of treatment, if the efficacy of PAMORA is deemed inadequate, discontinuation of the PAMORA, addition of an anti-constipation drugs, change of opioid type, or referral to a specialist should be considered. Spreading knowledge about the OIC problem as much as possible to the health community is crucial to obtain not only an early treatment of the condition but also to promote its prevention. Full article

Background: Cancer-related cognitive impairment (CRCI) represents one of the most common and debilitating effects in patients surviving after cancer treatments. Neurocognitive deficits are important causes of disability and burden in cancer survivors. The true magnitude of CRCI is difficult to define due to significant heterogeneity of literature data. At present, there is no agreement on the gold standard for detection and grading of CRCI in clinical trials, and there is a lack of clear knowledge of its pathophysiology. Objectives: In this review, we aim to discuss some perspectives for future research to pursue in order to cover the gaps in knowledge in the CRCI field. Methods: We focused our literature research on the following relevant issues: neuroradiological correlates of CRCI; objective neuropsychological evaluation and subjective complaint assessment and their correlation with objective measures; timing of assessment; and possible treatments. Results: The correct methodology for evaluating cognitive deficits induced by anti-tumor treatments still requires a definition based on quality scientific evidence, and literature data are currently scarce. Conclusions: This review highlights the need for further research to understand the causes and consequences of cancer-related cognitive impairment using standardized and sensitive measures of cognitive functions and the long-term effects of chemotherapy on cognitive functions and to develop effective interventions. Full article