Search Results (103)

Background: Incomplete eyelid closure and lagophthalmos due to facial nerve palsy are significant functional and aesthetic concerns often requiring surgical correction. The aim of this systematic review is to quantitatively assess the efficacy, safety, and patient satisfaction associated with gold or platinum weight implantation, autologous fat grafting (lipofilling), and müllerectomy. Methods: A systematic review was performed following PRISMA guidelines, searching PubMed, Embase, Cochrane Library, Web of Science, and Scopus up to March 2025. Studies included clinical data on surgical correction for incomplete eyelid closure in facial palsy, reporting functional, anatomical, and satisfaction outcomes. Quality was assessed using the Newcastle–Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: Twenty-six studies including a total of 1205 patients were included. Gold/platinum weight implantation achieved complete or near-complete eyelid closure in 83–92% of cases, with a reduction in lagophthalmos to <1 mm. Complication rates ranged from 5–15% (mainly extrusion/migration), and patient satisfaction averaged 7.9/10. Lipofilling showed persistent benefit in 77% of cases, with 9–20% requiring repeat procedures and 10–12% experiencing minor complications. Müllerectomy yielded symptomatic improvement or resolution in 92% of cases, with a mean lagophthalmos reduction of 1.18 mm. Conclusions: Gold or platinum weight implantation provides the most reliable improvement for severe upper eyelid dysfunction in facial palsy. Lipofilling is a viable autologous alternative, while müllerectomy is effective in selected cases. Further prospective comparative trials are needed to refine surgical selection and optimize outcomes. Full article

Background/Objectives: Autism Spectrum Disorder (ASD) etiology is complex, involving genetics and environmental factors, and associated with impaired energy metabolism. Mitochondrial fatty acid oxidation (mFAO) is instrumental to energy production through the oxidation of acylcarnitines (ACs). We performed a comprehensive investigation of blood AC profiles in a pediatric ASD cohort, aiming to define ASD subgroups based on AC profiles and link these profiles to key clinical features and comorbidities using a phenotype-first approach. Methods: Blood levels of 31 ACs (μmol/L) collected from 102 ASD patients and 117 healthy controls (HCs) were evaluated via tandem mass spectrometry. The percentile distribution of blood AC levels in HC samples was computed to define the normal reference range (RR) and identify values corresponding to the 10th and 90th percentiles. Cognitive levels, emotional–behavioral disturbances and the severity of ASD symptoms (Autism Diagnostic Observation Schedule-Calibrated Severity Score ADOS-CSS) were assessed. Clinical correlates of ASD groups based on AC profiles were evaluated. Results: Three ASD subgroups were identified based on the percentile distribution of AC levels: group A (ACs < 10th percentile), group B (ACs 10th–90th percentile) and group C (ACs > 90th percentile) (abnormal AC number ≥ 3). Out of the thirty-one analyzed ACs in DBSs, fifteen (48.4%) were significantly different when comparing ASD group A to ASD group C. There was a significant difference in the severity of autism symptoms (ADOS CSS) related to the repetitive and restricted behaviors domain (CSS RRB) among the different groups (χ²(2) = 6.26; p = 0.044). The post hoc Dunn’s test with Bonferroni correction showed that ADOS-CSS RRB was significantly higher in ASD group A compared to ASD group B (p = 0.013). AC C14 was more frequently decreased (<10th pc) in patients with more severe symptoms (p = 0.006); C10:1 tended to be more frequently increased (>90th pc) in patients with lower clinical severity (p = 0.052). Conclusions: This study highlights differences across blood AC levels in children with ASD and conveys novel information on clinical severity in ASD patients with abnormal blood AC profiles. Thus, examining metabolic profiles may provide helpful insights to understand the variability of ASD symptoms. Full article

Background/Objectives: Inserting umbilical venous catheters is a common procedure in neonatal intensive care units. However, this maneuver is potentially associated with early and late complications, some of which can be severe. Several strategies have been described in the literature to minimize the risk of such complications. The recently described SIUVeC (Safe Insertion Umbilical Venous Catheter) protocol incorporates all the innovations suggested by the latest literature, with the intention of reducing the risk associated with this procedure. The purpose of this paper is to report the outcomes of the systematic implementation of this protocol. Methods: Infants were enrolled in this prospective study if they were eligible for umbilical venous catheter placement. Results: A total of 449 infants were enrolled in the study. In total, 407 (90.6%) catheters were successfully placed in the proper position, at the inferior cavo–atrial junction. A total of 89.9% of the catheters were removed electively, without any complications. Conclusions: The SIUVeC protocol demonstrates an effective strategy for the safe elective insertion of umbilical venous catheters. Full article

Background/Objectives: Peristomal skin complications (PSCs) are common among patients with ostomies, significantly impacting quality of life and increasing healthcare utilization. This study aimed to evaluate the effects of the Dermamecum protocol, a risk-stratified educational intervention, on the prevention of PSCs, self-care improvements, health-related quality of life (HRQoL), and patient satisfaction over a 90-day follow-up period. Methods: This prospective cohort study included 305 patients stratified into three risk-based groups (green, yellow, and red paths) according to the Dermamecum protocol. Primary outcomes included PSC rates at 30, 60, and 90 days. Secondary outcomes included self-care scores, HRQoL, and patient satisfaction. Comparative analyses and trend assessments were performed across groups and time points. Temporal trends in PSCs were analyzed using Poisson regression. Results: Early PSC rates were 8.5% at 30 days, with late complications at 7.9% and 6.2% at 60 and 90 days, respectively. No significant differences in PSC rates were observed between paths. Self-care scores improved over time, with stability across groups and domains. HRQoL remained stable, with minor fluctuations in physical and mental components. Patient satisfaction was high across all paths. Poisson regression identified significant temporal trends in PSC rates, with higher risks at 30, 60, and 90 days compared to baseline. Age, BMI, and path assignment (lower risk for the green path) were significant predictors of PSCs. Conclusions: The Dermamecum protocol effectively maintained low PSC rates, supported self-care, and sustained HRQoL and patient satisfaction. These findings highlight the value of risk-stratified, patient-centered interventions in ostomy care. Further studies are needed to validate these results and explore long-term outcomes. Full article

Background: Recent evidence has shown that insulin resistance (IR), a hallmark of nonalcoholic fatty liver disease, predicts bladder cancer (BC) presence. However, the best surrogate marker of IR in predicting BC is still unclear. This study examined the relationships among ten surrogate markers of IR and the presence of BC. Methods: Data from 209 patients admitted to two urology departments from September 2021 to October 2024 were retrospectively analyzed. Individuals (median age 70 years) were divided into two groups (123 and 86 patients, respectively) based on the presence/absence after cystoscopy/TURB of non-metastatic BC. Univariate logistic regression was used to determine the relationships between groups, and the following IR parameters: Triglyceride–Glucose (TyG) index, TyG-BMI, HOMA-IR HOMAB, MetS-IR, Single Point Insulin Sensitivity Estimator, Disposition Index, non-HDL/HDL, TG/HDL-C ratio and Lipoprotein Combine Index. Stepwise logistic regressions were carried out to evaluate the significant predictions and LASSO regression to confirm any significant variable(s). The predictive value of the index test for coexistent BC was evaluated using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). Results: The univariate analysis revealed that the TyG index and MetS-IR were associated with the BC presence. Specifically, the associations of the TyG index and MetS-IR were more significant in participants =/> 65 years old. In multivariate analysis, the stepwise logistic regression, evaluating the most representative variables at univariate analysis, revealed a prediction of BC by only TyG index (OR 2.51, p = 0.012), confirmed by LASSO regression, with an OR of 3.13, p = 0.004). Assessing the diagnostic reliability of TyG, it showed an interesting predictive value for the existence of BC (AUC = 0.60; 95% CI, 0.51–0.68, cut-off 8.50). Additionally, a restricted cubic spline model to fit the dose–response relationship between the values of the index text (TyG) and the BC evidenced the presence of a non-linear association, with a high predictive value of the first knot, corresponding to its 10th percentile. The decision curve analysis confirmed that the model (TyG) has utility in supporting clinical decisions. Conclusions: Compared to other surrogate markers of IR, the TyG index is effective in identifying individuals at risk for BC. A TyG threshold of 8.5 was highly sensitive for detecting BC subjects and may be suitable as an auxiliary diagnostic criterion for BC in adults, mainly if less than 65 years old. Full article

In pediatric dentistry, antibiotics are currently prescribed for both therapeutic and prophylactic purposes. Antibiotic therapy can be prescribed for the treatment of diffuse dental or oral cavity infections, always as a complement to the most suitable dental procedure for the specific case. The aim of this study was to investigate the knowledge regarding the use and prescribing practices of antibiotics in pediatric patients in a sample of Italian dentists by using an anonymous and telematic questionnaire. Methods: A specially prepared questionnaire was electronically transmitted to a cohort of Italian dentists. The questionnaire consisted of two parts: demographic information and general knowledge of antibiotic prescription in pediatric dentistry. The statistical analysis of the obtained data was performed. Results: The study sample consisted of 242 Italian dentists. Poor statistically significant differences emerged between specialists in Pediatric Dentistry and dentists without specialization or specialists in other branches, as well as between dentists who, in their clinical activity, mainly treat children/adolescents or adults. For the complementary treatment of dental or oral cavity infections, Amoxicillin was the antibiotic indicated as the first choice for pediatric patients with no allergy to penicillins by most of the sample, while more than 20% of dentists would prescribe Clindamycin in patients with an allergy to penicillin. The knowledge regarding the dosage of administration of the chosen antibiotic appeared not to be sufficient. Conclusions: An improvement in the knowledge of the Guidelines in Pediatric Dentistry appeared necessary regarding the posology of the antibiotic of choice. More information about the adverse effects of Clindamycin is needed. Full article

Background: Sjögren’s disease (SD) is an autoimmune condition causing progressive salivary and lacrimal glands dysfunction following lymphocytic infiltration in the glandular tissue. SD patients are more prone to oral health impairment due to a reduction in salivary flow. This study evaluated the relationship between oral health, functional tests, and patient reported outcomes in a cohort of SD patients. Methods: Patients diagnosed with SD underwent complete dental examination, with the recording of the decayed–missing–filled teeth index (DMFT), probing pocket depth (PPD), full mouth bleeding score (FMBS), and full mouth plaque score (FMPS). Hyposalivation was assessed using the unstimulated whole saliva flow rate (UWS). Patients were administered the European League Against Rheumatism (EULAR) Sjögren’s Syndrome Patient Reported Index, EULAR Sjögren’s syndrome disease activity index, Oral Health Impact Profile-14 (OHIP-14), Patient Acceptable Symptom State questionnaires, and a visual analog scale for xerostomia (VASx). Results: Fifty patients in total were enrolled. Reduced UWS was associated with higher DMFT, FMBS, and FMPS. Significant correlation was observed for UWS with VASx and OHIP-14 (p < 0.05). Conclusions: Quality of life and oral health appear mildly impaired in SD patients as an effect of reduced salivary flow, with higher DMFT and tendency towards gingival inflammation and plaque accumulation. Full article

Background and Objectives: Malnutrition’s prevalence and its relationship with functional ability in patients with end-stage spine pathologies, i.e., any disease of the vertebral bodies, intervertebral discs, and associated joints requiring surgical intervention, are yet to be explored. This retrospective study aimed to investigate the association between malnutrition, disability, and physical health in patients undergoing elective spine surgery in our Italian hospital. Materials and Methods: Data between 2016 and 2019, recorded at pre-admission visits, were extracted from our institutional spine registry (ClinicalTrials.gov number: NCT03644407), excluding minor patients or those undergoing emergency or oncological surgery. The measures were the Oswestry disability index (ODI) and the physical health (PH) summary of the 36-item Short-Form Health Survey. Clinical data were linked to nine laboratory parameters from pre-operative routine blood tests, and equations to ascertain the risk of malnutrition and its diagnosis were attributed. Results: The study sample included 2258 spine patients (58.15% females) who underwent surgery in our Italian hospital. The ODI and PH significantly varied across body weight difference (BWd) strata in younger adults (adjusted-p = 0.046, η² = 0.04; adjusted-p = 0.036, η² = 0.06) and adults (adjusted-p = 0.001, η² = 0.02; adjusted-p = 0.004, η² = 0.02). Protein malnutrition with acute/chronic inflammation (PMAC) in both adults (adjusted-p < 0.001, η² = 0.04; adjusted-p < 0.001, η² = 0.04) and older adults (adjusted-p = 0.010, η² = 0.04; adjusted-p = 0.009, η² = 0.05) had also a discernible impact in determining the ODI and PH. In older adults, the ODI was associated with iron deficit malnutrition (IDM) (adjusted-p = 0.005, η² = 0.06) and both the ODI and PH were associated with vitamin B deficit (VBD) (adjusted-p = 0.037, η² = 0.01; adjusted-p = 0.049, η² = 0.01). Trend monotonicity was diagnosis- and sex-specific, with meaningful ordered patterns being observed mostly in young males and older females. Conclusions: Functional ability showed an association with malnutrition in younger adults and adults when using BWd, in adults and older adults when using PMAC, and in older adults when using IDM and VBD. The authors advocate for the inclusion of nutritional management in the pre-operative evaluation to potentially enhance recovery after spine surgery. Full article

Bacterial prostatitis (BP) is a common prostatic infection characterized by pain and urinary symptoms, often with negative bacterial cultures from prostatic secretions. It affects young and older men bimodally and impacts quality of life (QoL) significantly. Background and Objectives: Treatment typically involves antibiotics, but a multimodal approach with additional nutraceuticals may enhance outcomes. This study aimed to assess the efficacy of Butirprost^® in association with fluoroquinolones in patients with chronic bacterial prostatitis (CBP). Materials and Methods: Patients diagnosed with prostatitis (positive Meares–Stamey test and symptom duration > 3 months) at the University of Naples “Federico II”, Italy, from March 2024 to July 2024 were included in this study. All patients underwent bacterial cultures. Patients were randomized into two groups: Group A received antibiotics plus Butirprost^® (sodium hyaluronate plus Plantago major) for one month, while Group B received antibiotics alone. International Prostatic Symptoms Score (IPSS) and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaires were administered at baseline and at 15 and 30 days. Results: Out of 60 patients (Group A: 30, Group B: 30), Group A showed significant improvement in IPSS and NIH-CPSI scores at 15 and 30 days compared to Group B. Notable improvements were observed in pain, urinary symptoms, and QoL. Conclusions: The administration of Butirprost^® along with fluoroquinolones resulted in a significant improvement in pain, urinary symptoms, and quality of life along with improvements in both IPSS and NIH-CPSI scores, in patients affected by chronic bacterial prostatitis compared with fluoroquinolones alone. Full article

Objective: To evaluate neurogenic bladder and bowel dysfunction (NBBD) in children with cerebral palsy (CP) and acquired brain injury (ABI), a condition considered less frequent in those patients than in children with spinal cord injury (SCI), and to study the relationship between NBBD and disability grade in this population. Study Design: We retrospectively reviewed the clinical data of all patients (aged 3–18 years old) admitted during a three-month observation in our neurorehabilitation department. Data collected were as follows: demographic parameters; disability status (Wee-FIM Scale, Gross Motor Function Classification System (GMFCS) and the Communication Function Classification System); and gastrointestinal and urological symptoms (diaries, Bristol scale, Pad Test and International Consultation on Incontinence Modular Questionnaire). Results: Sixty patients were enrolled (31 females, 29 males): 30 CP, 17 ABI, 3 SCI, and 10 others with neurological diseases. All presented urinary incontinence without gender differences. CP and ABI had major incidences of bowel dysfunction (50% and 64.7%, respectively) and SCI of urinary tract infections (66.6%) and enuresis (100%). A major incidence of symptoms was recorded in patients with higher GMFCS levels (level 3-4-5). Conclusions: NBBD has a high frequency in children with CP and ABI, as in SCI. More attention is needed from pediatricians and pediatric urologists for this clinical entity. Further studies are needed to better understand clinical relevance and, therefore, to establish specific management. Full article

Objectives: The aim of the current review was to elucidate the clinical context and presentation of sexual dysfunction (SD) and gynecomastia in rheumatological patients undergoing methotrexate treatment. Moreover, we aimed also to make physicians aware of the occurrence of these side effects, to adequately inform the patient before starting treatment. Methods: Systematic review (PROSPERO id: CRD42022358275) was performed according to preferred reporting items for systematic reviews and meta-analyses. Studies (1 January 1995 to 31 May 2022) were identified by highly sensitive searches of electronic databases (Medline, Embase, Cochrane Library databases). Key terms included: ((“sexual dysfunction” OR “erectile dysfunction” OR “impotence”) AND (“methotrexate” OR “MTX”)) and ((“gynecomastia” OR “male breast”) AND (“methotrexate” OR “MTX”)). Results: A total of seven papers (seven case reports), involving a total of eleven patients (min one, max three), were included in the final analysis. The age of the patients ranged from 19 to 68 years (median: 50.9 years). Rheumatoid arthritis (RA) was the most frequent rheumatic disease reported (n = 8, 72.7%). No patients reported erectile dysfunction (ED) and/or gynecomastia before using MTX. Time to onset of SD and gynecomastia after MTX ranged from 2 to 104 weeks (median: 22.7 weeks). ED (n = 5, 45.4%) and gynecomastia (n = 3, 27.2%) were the most common forms of presentation. Conclusions: Future prospective controlled studies with a large sample size and long follow-up as well as randomized controlled trials are needed to confirm this association, investigate its pathophysiological basis, assess the safest dosages, evaluate the most appropriate management, and provide clear recommendations. Full article

A platform for indoor monitoring inside buildings, integrating both conventional and environmentally friendly devices with energy-harvesting sources, is proposed. Biomaterials such as gelatin and chitosan, derived from renewable resources, have been utilized to fabricate hydrogel and active layers for sensors and supercapacitors. These devices enhance the environmental profile of the proposed solution by employing sustainable materials and optimizing energy consumption. The developed electronic board prototype provides a versatile platform for testing various sensor configurations while accommodating different energy-harvesting sources. The article details the design of an energy harvesting system for indoor monitoring, covering various aspects regarding energy sources, power management circuits, and low-power microcontroller units. It examines energy storage devices and sensors, including both eco-friendly and commercial ones, as well as radio transceivers with different communication technologies. Additionally, an energy analysis to evaluate the performance and energy efficiency of the platform is presented. Full article

This study, employing an interim analysis, investigates the effects of the Dermamecum protocol, a structured educational and tailored approach that stratifies ostomy patients into risk paths (green, yellow, red) based on pre-operative and post-operative characteristics. The green path indicates a low risk of peristomal skin complications (PSCs), focusing on sustaining healthy behaviours and basic stoma care. The yellow path represents a moderate risk, emphasizing the need for patients to self-monitor and recognize early signs of complications. The red path corresponds to high risk, requiring stringent monitoring and immediate access to healthcare support. The study aims to reduce PSCs and improve patient outcomes. Methods include the stratification of 226 patients, with significant differences in gender distribution, BMI categories, and stoma types across the paths. Results show an occurrence rate of PSCs of 5.9% in all risk paths (5.7% green path, 4.7% yellow path, and 7.9% red path, p = 0.685), significantly lower than the median rate of 35% reported in the literature. Multiple correspondence analysis validated the stratification, with distinct clusters for each path. Poisson regression models in the exploratory framework of an interim analysis identified male gender as the only significant predictor of PSCs, indicating the need for gender-specific interventions. The findings suggest that the Dermamecum protocol effectively reduces early PSCs, providing a foundation for further research. Full article

Consuming an unbalanced diet and being overweight represent a global health problem in young people and adults of both sexes, and may lead to metabolic syndrome. The diet-induced obesity (DIO) model in the C57BL/6J mouse substrain that mimics the gradual weight gain in humans consuming a “Western-type” (WD) diet is of great interest. This study aims to characterize this animal model, using high-frequency ultrasound imaging (HFUS) as a complementary tool to longitudinally monitor changes in the liver, heart and kidney. Long-term WD feeding increased mice body weight (BW), liver/BW ratio and body condition score (BCS), transaminases, glucose and insulin, and caused dyslipidemia and insulin resistance. Echocardiography revealed subtle cardiac remodeling in WD-fed mice, highlighting a significant age–diet interaction for some left ventricular morphofunctional parameters. Qualitative and parametric HFUS analyses of the liver in WD-fed mice showed a progressive increase in echogenicity and echotexture heterogeneity, and equal or higher brightness of the renal cortex. Furthermore, renal circulation was impaired in WD-fed female mice. The ultrasound and histopathological findings were concordant. Overall, HFUS can improve the translational value of preclinical DIO models through an integrated approach with conventional methods, enabling a comprehensive identification of early stages of diseases in vivo and non-invasively, according to the 3Rs. Full article

Background: Retinitis pigmentosa (RP) is a group of hereditary retinal dystrophies characterized by progressive degeneration of photoreceptor cells, which results in debilitating visual impairment. This systematic review aims to evaluate the efficacy and safety of emerging treatment modalities for RP, including gene therapy, mesenchymal-cell-based approaches, and supplementary interventions. Methods: A comprehensive search of electronic databases was conducted to identify relevant studies published up to February 2024. Studies reporting outcomes of treatment interventions for RP, including randomized controlled trials, non-randomized studies, and case series, were included. Data extraction and synthesis were performed according to predefined criteria, focusing on assessing the quality of evidence and summarizing key findings. Results: The search yielded 13 studies meeting inclusion criteria, encompassing diverse treatment modalities and study designs. Gene therapy emerged as a promising therapeutic approach, with several studies reporting favorable outcomes regarding visual function preservation and disease stabilization. Mesenchymal-cell-based therapies also demonstrated potential benefits, although evidence remains limited and heterogeneous. Supplementary interventions, including nutritional supplements and neuroprotective agents, exhibited variable efficacy, with conflicting findings across studies. Conclusions: Despite the lack of definitive curative treatments, emerging therapeutic modalities promise to slow disease progression and preserve visual function in individuals with RP. However, substantial gaps in evidence and heterogeneity in study methodologies underscore the need for further research to elucidate optimal treatment strategies, refine patient selection criteria, and enhance long-term outcomes. This systematic review provides a comprehensive synthesis of current evidence and highlights directions for future research to advance the care and management of individuals with RP. Full article