Search Results (67)

Schizophrenia (SCZ) is a debilitating disorder with substantial societal and economic impacts. The clinical high risk of psychosis (CHR-P) state generally precedes the onset of SCZ, offering a window for early intervention. However, treatment guidelines for CHR-P individuals remain contentious, particularly regarding antipsychotic (AP) medications. Although several studies have examined the effects of APs on reducing the risk of conversion to psychosis, the novelty of this narrative review lies in its focus on differentiating APs’ effects on positive and negative symptoms, as well as cognitive functioning, in CHR-P individuals. Evidence suggests that APs may be cautiously recommended for attenuated positive symptoms to stabilize individuals for psychological interventions, but their use in treating negative symptoms is generally discouraged due to limited efficacy and potential side effects. Similarly, the effects of APs on cognitive abilities remain underexplored, with results indicating a lack of significant neurocognitive outcomes. In conclusion, APs’ use in CHR-P patients requires careful consideration due to limited evidence and potential adverse effects. Future research should focus on individual symptom domains and treatment modalities to optimize outcomes in this critical population. Until then, a cautious approach emphasizing non-pharmacological interventions is advisable. Full article

Background: Peritoneal metastases from gastric cancer (GCPM) represent a significant clinical challenge in terms of therapeutic options and prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has demonstrated promising survival benefits within a multimodal approach, particularly in carefully selected patients. Methods: This retrospective single-center study evaluated outcomes in patients with synchronous GCPM treated with CRS + HIPEC following neoadjuvant chemotherapy. The primary endpoints included overall survival (OS), disease-free survival (DFS), and identification of prognostic factors associated with poor outcomes. Additionally, we sought to characterize patients achieving long-term survival (OS ≥ 24 months). Results: The median OS and DFS were 18 and 13 months, respectively. A peritoneal cancer index (PCI) ≥ 7 and major postoperative complications were independently associated with reduced survival. Recurrence was significantly linked to PCI ≥ 7 and signet ring cell histology. Stratification by survival outcome identified PCI ≥ 7 as the only statistically significant variable differentiating average- and long-survival groups. Moreover, elevated PCI was independently associated with a higher incidence of major postoperative complications. Conclusions: CRS + HIPEC may offer a survival advantage over the use of systemic therapy exclusively in appropriately selected patients, particularly those with limited peritoneal disease burden. These results underscore the importance of accurate patient selection to balance surgical risks and maximize oncological benefits in the treatment of GCPM. Full article

Background: RPS are rare tumors requiring complex surgery. The impact of postoperative complications on long-term outcomes is still debated. This study aimed to identify predictors of severe complications and assess their influence on overall survival (OS) and disease-free survival (DFS). Methods: We retrospectively analyzed 61 patients who underwent curative surgery for primary RPS between 2013 and 2023 at a tertiary cancer center. Patients with pelvic or recurrent sarcomas were excluded. Severe complications were defined as Clavien–Dindo (CD) grade ≥ 3A. Cox regression and Fine–Gray competing risk models were used for OS and DFS, respectively. Sarculator and P-POSSUM scores were included in multivariable models. Results: Severe complications occurred in 14.8% of patients; 30-day mortality was 1.6%. Predictive factors for complications included longer operative time, gastric resection, intraoperative complications, and transfusions. In multivariable analysis, Sarculator was significantly associated with both DFS (HR 0.97; p = 0.004) and OS (HR 0.97; p = 0.008). The P-POSSUM mortality score predicted OS (HR 1.12; p = 0.002). Severe complications were not independently associated with DFS or OS. Conclusions: In this cohort, severe complications did not impact long-term oncological outcomes. Prognostic tools such as Sarculator and P-POSSUM may enhance risk stratification in RPS surgery. Prospective validation is warranted. Full article

Background. Treatment-resistant depression (TRD) is a prevalent, high-burden disorder. Esketamine nasal spray (ESK-NS) has been approved for, T.R.D.; and efficacy has been observed in both clinical trials and real-world studies. However, observations integrating patients’ perspective on this treatment are limited. This multicentric Italian study explored experiences with ESK-NS in TRD patients, focusing on perceived therapeutic effects and overall satisfaction. Methods. A self-report survey was administered to 236 outpatients with TRD (55.1% females, 54.1 ± 14.1 years) treated with ESK-NS for at least three consecutive months within standard clinical care. Based on satisfaction levels, participants were classified as “unsatisfied” (10.2%), “partially satisfied” (19.1%), “satisfied” (44.4%), or “very satisfied” (26.3%), and compared for sociodemographic, clinical characteristics, and feedback on perceived benefits. Artificial intelligence (OpenAI) served to categorize responses to an open-ended question. Results. Enhanced quality of life was reported by 88.4% of participants. Significant differences emerged in earliest self-perceived benefits, most relevant effects, and impact on global functioning across groups. Specifically, “very satisfied” patients described the following: early improvements in depressed mood, suicidal thoughts, and restlessness; decreased suicidal thoughts among the most significant effects; and functional gains across all domains. OpenAI identified experiences of personal growth and rediscovery and a desire for tailored settings and approaches as recurring topics. Conclusions. Most patients reported a positive perception of ESK-NS treatment. The most satisfied participants highlighted significant benefits to depressed mood, suicidal thoughts, and overall functioning. Patient-reported experiences offer insights into different psychopathological dimensions, including functional outcomes and quality of life. Integrating these perspectives into clinical practice might assist treatment personalization, improving patients’ adherence and satisfaction. Full article

Background/Objectives: While positive symptoms of schizophrenia are often satisfactorily controlled, negative symptoms are difficult to treat, persisting despite treatment. Different strategies have been devised to deal with this problem. We aimed to review drug treatment for negative symptoms of schizophrenia in controlled trials of marketed drugs. Methods: We searched the PubMed database and the resulting records’ reference lists to identify eligible trials using schizophrenia[ti] AND “negative symptom*”[ti] as a search strategy. We determined eligibility through Delphi rounds among all authors. Results: On 11 February 2025, we identified 1485 records on PubMed and 3 more from reference lists. Eligible were 95 records. Most studies were double-blind, randomized controlled trials, carried-out in add-on in patients stabilized with antipsychotics. Other antipsychotics were the most frequent comparators, followed by antidepressants, and recently, antioxidants are gaining importance in trials. Many trials, especially those conducted in the Western world, found no significant effects compared to placebo, while most Iranian studies were positive, although not with a strong effect size. Conclusions: Current research has contributed little to progress in the treatment of the negative symptoms of schizophrenia. The reason might reside in the absence of knowledge of the mechanisms whereby these symptoms are generated, which prevents us from designing possibly effective treatment strategies, and/or to the chronicity of negative symptoms, as they are the first to be established even when they do not become fully apparent. Full article

Objectives: In addition to traditional ice-cold storage (ICS), other techniques are emerging in the field of donor heart preservation for heart transplantation (HTx). However, in many centers, it could be difficult to justify their use, due to the higher costs and the greater technical complexity compared to ICS. This study aims to analyze the results obtained for HTx at our center employing ICS, controlled hypothermia with Paragonix SherpaPak (PSP), and ex vivo normothermic perfusion with Organ Care System (OCS) as donor graft preservation strategies. Methods: All HTx performed at the University Hospital of Udine, between January 2020 and August 2024, was analyzed and patient outcomes and complications after HTx were assessed. Endomyocardial biopsies were performed in donor hearts immediately after retrieval (T₀), before implantation (T₁), and at reperfusion (T₂) to evaluate signs of myocardial damage. Results: Overall, 100 patients were transplanted with a donor heart preserved with ICS (n = 30), PSP (n = 36), or OCS (n = 34). Compared to ICS, PSP and OCS recipients showed a higher median IMPACT score (5 vs. 8 vs. 7, respectively, p = 0.05) and tended to have a higher rate of bridging to HTx with a long-term ventricular assist device (7% vs. 17% vs. 29%, p = 0.06). OCS was more commonly used in cases of expected ischemic time >4 h compared to ICS and PSP (p < 0.01). Histologically, severe degrees of cellular damage were higher in those hearts preserved with ICS. The 30-day mortality was 3% vs. 6% vs. 9% in ICS, PSP, and OCS groups, respectively (p = 0.65). Moderate-to-severe primary graft dysfunction was 37% vs. 11% vs. 17% (p = 0.03) in the three groups. Conclusions: PSP and OCS seem to be valid alternatives to traditional ICS, and their use could be strongly considered, particularly in the most complex and critical settings, until further data are available on more patient experiences. Full article

Background: New-onset postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, occurring approximately in one-third of the patients. This study considered all-comer patients who underwent cardiac surgery to build a predictive model for POAF. Methods: A total of 3467 (Center 1) consecutive patients were used as a derivation cohort to build the model. The POLARIS score was then derived proportionally from the odds ratios obtained following multivariable logistic regression (MLR). The Brier Score, the area under the receiver operating characteristic curve, and the Hosmer–Lemeshow goodness-of-fit test were used to validate the model. Then, 2272 (Center 2) consecutive patients were used as an external validation cohort. Results: In the overall population (n = 5739), POAF occurred in 32.7% of patients. MLR performed in the derivation cohort showed that age, obesity, chronic renal failure, pulmonary hypertension, minimally invasive surgery, and aortic and mitral valve surgery were predictors of POAF. The derived POLARIS score was used to further stratify the population into four risk clusters: low (1.5–3), intermediate (3.5–5), high (5.5–7), and very high (7.5–9), each progressively showing an increase in POAF incidence. This was confirmed in a correlation analysis (Spearman’s rho: 0.636). Conclusions: The POLARIS score is a simple-to-use tool to stratify patients at higher risk of POAF. Precise identification of such patients might be used to implement clinical practice with the introduction of preoperative antiarrhythmic prophylaxis, further reducing the incidence of POAF and, potentially, its clinical sequelae, despite further investigations being warranted to test this model in prospective studies. Full article

Background: Advances in cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) have improved outcomes for selected patients with peritoneal surface malignancies (PSMs). Methods: This retrospective study analyzed 743 PSM patients treated at Fondazione Policlinico Universitario Agostino Gemelli from January 2016 to February 2024. The primary aim was to assess median overall survival (mOS), median disease-free survival (mDFS), and median progression-free survival (mPFS) stratified by tumor origin. Secondary outcomes examined the role of diagnostic laparoscopy in the management of PSMs and intra- and postoperative complications’ rates. Results: A total of 1113 procedures were performed: 389 CRS, 370 PIPAC, and 354 diagnostic laparoscopies. Colorectal cancer was the predominant indication for CRS (52.4%), with a mOS of 52 months and mDFS of 22 months. Patients affected by gastric cancer undergoing CRS had a mOS of 18 months and a mDFS of 13 months, while PIPAC yielded a mOS of 9 months and a mPFS of 4 months. Among patients with pseudomyxoma peritonei undergoing CRS, the 5-year DFS rate was 64.1%, and OS rate was 89%. Patients affected by mesothelioma and treated with CRS exhibited a median OS of 43 months and a DFS of 26 months. Pancreatic and hepatobiliary cancers were treated with PIPAC, with a respective mOS of 12 and 8 months. Postoperative complications occurred in 12.6% of CRS, 3.2% of PIPAC, and 1.7% of diagnostic laparoscopies. High peritoneal cancer index (PCI), gastric resection, and blood loss over 500 mL were identified as risk factors for major complications in a multivariate analysis. Conclusions: Developing a highly experienced multidisciplinary team is crucial for delivering tailored treatment strategies which aim to achieve optimal oncological outcomes while preserving patients’ quality of life. Full article

Background: The advantage of a robotic-assisted (RARP) over a laparoscopic (LRP) approach in radical prostatectomy (RP) remains to be demonstrated. Aim: The aim of the study is to use a homogeneous population in real life and single primary surgeon surgery to analyze the oncological and functional results based on the type of surgical approach and pathological features. Methods: This is a prospective trial on non-metastatic prostate cancer (PCa) patients considered after a multidisciplinary decision to conduct a RP, using a RARP or LRP approach. A real-life setting was analyzed at our Urological Departments using homogeneous criteria for the management of PCa cases and a single surgeon experience on 444 cases (284 LRP and 160 RARP). Results: Mean operating time was significantly lower in RARP (153.21 ± 25.1 min) than in LRP (173.33 ± 44.3 min) (p < 0.001). In cases submitted to an extended lymph node dissection (eLND), the mean number of lymph nodes removed was 15.16 ± 7.83 and 19.83 ± 4.78, respectively, in LRP and RARP procedures (p < 0.001), but positive lymph nodes (pN1) were similarly found in 15.8% of LRP patients and 13.6% of RARP patients (p = 0.430). Surgical margins (SM) positivity was not significantly higher in the RARP group (20.0%) when compared to the LRP group (15.9%) (p = 0.145). During the postoperative follow-up, a biochemical recurrence (BCR) was detected in 14.4% and 7.5% of cases in the LRP and RARP group, respectively, (p = 0.014). Better results of PAD tests at 3-month intervals using the RARP approach (mean pad weight 75.57 ± 122 g and 14 ± 42 g, respectively, in LRP and RARP (p < 0.01)) were described. Conclusions: In the comparison between the RARP and LRP approach, a clear advantage of the robotic approach is a significant reduction in operating times, days of hospitalization, and postoperative catheterization compared to laparoscopic surgery. It is not possible to describe any certain oncological advantage both in terms of surgical margins and pathological lymph nodes removed. In RARP cases a reduction to the limit of significance is described in terms of biochemical recurrence. RARP produces a more rapid recovery of urinary continence at 3 months postoperatively without significant advantages in terms of erective potency recovery. Full article

Background: This proof-of-concept study aimed to assess the diagnostic potential of gas chromatography–mass spectrometry (GC-MS) in profiling volatile organic compounds (VOCs) from exhaled breath as a diagnostic tool for the chronic coronary syndrome (CCS). Methods: Exhaled air was collected from patients undergoing invasive coronary angiography (ICA), with all samples obtained prior to ICA. Post hoc, patients were divided into groups based on coronary lesion severity and indications for revascularization. VOCs in the breath samples were analyzed using GC-MS. Results: This study included 23 patients, of whom 11 did not require myocardial revascularization and 12 did. GC-MS analysis successfully classified 10 of the 11 patients without the need for revascularization (sensitivity of 91%), and 7 of the 12 patients required revascularization (specificity 58%). In subgroup analysis, GC-MS demonstrated 100% sensitivity in identifying patients with significant coronary lesions requiring intervention when the cohort was divided into three groups. A total of 36 VOCs, including acetone, ethanol, and phenol, were identified as distinguishing markers between patient groups. Conclusions: Patients with CCS exhibited a unique fingerprint of exhaled breath, which was detectable with GC-MS. These findings suggest that GC-MS analysis could be a reliable and non-invasive diagnostic tool for CCS. Further studies with larger cohorts are necessary to validate these results and explore the potential integration of VOC analysis into clinical practice. Full article

The development of tools to quickly identify the fate of damaged trees after a stress event such as a wildfire is of great importance. In this context, an innovative approach to assess irreversible physiological damage in trees could help to support the planning of management decisions for disturbed sites to restore biodiversity, protect the environment and understand the adaptations of ecosystem functionality. The vitality of trees can be estimated by several physiological indicators, such as cambium activity and the amount of starch and soluble sugars, while the accumulation of ethanol in the cambial cells and phloem is considered an alarm sign of cell death. However, their determination requires time-consuming laboratory protocols, making the approach impractical in the field. Biosensors hold considerable promise for substantially advancing this field. The general objective of this review is to define a system for quantifying the plant vitality in forest areas exposed to fire. This review describes recent electrochemical biosensors that can detect plant molecules, focusing on biosensors for glucose, fructose, and ethanol as indicators of tree vitality. Full article

PIPAC is a new surgical procedure and a viable treatment option for PSM patients, due to promising therapeutic outcomes, minimal invasiveness, limited surgical morbidity, and systemic toxicity side effects. However, its implementation throughout hospitals is hard to obtain due to its fragile economical sustainability. A retrospective health economic analysis was conducted in order to evaluate the cost of hospitalization for patients undergoing PIPAC treatment at Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, in Rome. The average cost of a PIPAC procedure was defined based on the cost of surgery (cost of surgical material, operating room, intraperitoneal chemotherapy), hospital stay, diagnostic examinations, and drugs used during the stay. A total of 493 PIPAC procedures were performed on 222 patients with peritoneal metastases or primary peritoneal cancer from 2017 to 2023. Since the mean remuneration for each PIPAC hospitalization is €5916 and the mean expenditure per hospitalization is €6538, this results in an operating profit per PIPAC hospitalization of −€622. The reimbursement of PIPAC treatment by the Italian National Health System currently only partially covers the hospital’s costs. Development of specific codes and adequate reimbursement for PIPAC by recognizing this procedure as a proper treatment for peritoneal carcinomatosis is essential. Full article

The prevalence of allergic diseases has dramatically increased among children in recent decades. These conditions significantly impact the quality of life of allergic children and their families. Lactoferrin, a multifunctional glycoprotein found in various biological fluids, is emerging as a promising immunomodulatory agent that can potentially alleviate allergic diseases in children. Lactoferrin’s multifaceted properties make it a compelling candidate for managing these conditions. Firstly, lactoferrin exhibits potent anti-inflammatory and antioxidant activities, which can mitigate the chronic inflammation characteristic of allergic diseases. Secondly, its iron-binding capabilities may help regulate the iron balance in allergic children, potentially influencing the severity of their symptoms. Lactoferrin also demonstrates antimicrobial properties, making it beneficial in preventing secondary infections often associated with respiratory allergies. Furthermore, its ability to modulate the immune response and regulate inflammatory pathways suggests its potential as an immune-balancing agent. This review of the current literature emphasises the need for further research to elucidate the precise roles of lactoferrin in allergic diseases. Harnessing the immunomodulatory potential of lactoferrin could provide a novel add-on approach to managing allergic diseases in children, offering hope for improved outcomes and an enhanced quality of life for paediatric patients and their families. As lactoferrin continues to capture the attention of researchers, its properties and diverse applications make it an intriguing subject of study with a rich history and a promising future. Full article

In eutocic labor, the autonomic nervous system is dominated by the parasympathetic system, which ensures optimal blood flow to the uterus and placenta. This study is focused on the detection of the quantitative presence of catecholamine (C) neurofibers in the internal uterine orifice (IUO) and in the lower uterine segment (LUS) of the pregnant uterus, which could play a role in labor and delivery. A total of 102 women were enrolled before their submission to a scheduled cesarean section (CS); patients showed a singleton fetus in a cephalic presentation outside labor. During CS, surgeons sampled two serial consecutive full-thickness sections 5 mm in depth (including the myometrial layer) on the LUS and two randomly selected samples of 5 mm depth from the IUO of the cervix. All histological samples were studied to quantify the distribution of A nerve fibers. The authors demonstrated a significant and notably higher concentration of A fibers in the IUO (46 ± 4.8) than in the LUS (21 ± 2.6), showing that the pregnant cervix has a greater concentration of A neurofibers than the at-term LUS. Pregnant women’s mechanosensitive pacemakers can operate normally when the body is in a physiological state, which permits normal uterine contractions and eutocic delivery. The increased frequency of C neurofibers in the cervix may influence the smooth muscle cell bundles’ activation, which could cause an aberrant mechano-sensitive pacemaker activation–deactivation cycle. Stressful circumstances (anxiety, tension, fetal head position) cause the sympathetic nervous system to become more active, working through these nerve fibers in the gravid cervix. They might interfere with the mechano-sensitive pacemakers, slowing down the uterine contractions and cervix ripening, which could result in dystocic labor. Full article

Despite the spread of novel-generation cochlear-implant (CI) magnetic systems, access to magnetic resonance imaging (MRI) for CI recipients is still limited due to safety concerns. The aim of this study is to assess and record the experiences of Hires Ultra 3D (Advanced Bionics) recipients who underwent an MRI examination. A multicentric European survey about this topic was conducted focusing on safety issues, and the results were compared with the current literature. We collected a total of 65 MRI scans performed in 9 otologic referral centers for a total of 47 Hires Ultra 3D recipients, including, for the first time, 2 children and 3 teenagers. Preventive measures were represented by scanning time and sedation for children. Head wrapping was used in eight cases, and six of the eight cases received local anesthesia, even if both measures were not needed. Only three patients complained of pain (3/65 examinations, 4.6%) due to the tight head bandage, and one of the three cases required MRI scan interruption. No other adverse events were reported. We believe that these results should encourage MRI execution in accordance with manufacturer recommendations for Ultra 3D recipients. Full article