Search Results (151)

Background: Dietary advice for Paralympic athletes (PAs) with a spinal cord injury (PAs-SCI) requires particular attention and has been widely studied. However, currently, no particular attention has been addressed to nutritional guidelines for athletes with an amputation (PAs-AMP). This study aimed at filling up this gap, at least partially, and compared veteran PAs-SCI with PAs-AMP. Methods: A sample of 25 male PAs (12 with SCI and 13 with AMP), recruited during two training camps, was submitted to the following questionnaires: allergy questionnaire for athletes (AQUA), Nordic Musculoskeletal Questionnaire (NMQ), Starvation Symptom Inventory (SSI), neurogenic bowel dysfunction (NBD), orthorexia (ORTO-15/ORTO-7), alcohol use disorders identification test (AUDIT), and Mediterranean diet adherence (MDS). The PAs were also submitted to the following measurements: dietary Oxygen Radical Absorbance Capacity (ORAC) and intakes, body composition, handgrip strength (HGS), basal energy expenditure (BEE), peak oxygen uptake (VO_2peak), peak power, peak heart rate (HR), post-exercise ketosis, and antioxidant response after a cardiopulmonary exercise test (CPET) to voluntary fatigue. Results: Compared to PAs-AMP, PAs-SCI had higher NBD and lower VO_2peak (p < 0.05), peak power, peak HR, peak lactate, phase angle (PhA) of the dominant leg (p < 0.05), and ORTO15 (p < 0.05). The latter was related to NBD (r = −0.453), MDS (r = −0.638), and ORAC (r = −0.529), whereas ORTO7 correlated with PhA of the dominant leg (r = 0.485). Significant differences between PAs-AMP and PAs-SCI were not found in the antioxidant response, glucose, and ketone levels after CPET, nor in dietary intake, AUDIT, AQUA, NMQ, SSI, BEE, HGS, and FM%. Conclusions: The present study showed that PAs-SCI and PAs-AMP display similar characteristics in relation to lifestyle, energy intake, basal energy expenditure, and metabolic response to CPET. Based on both the similarities with PAs-SCI and the consequences of the limb deficiency impairment, PAs-AMP and PAs-SCI require personalized nutritional advice. Full article

Four entire male sugar gliders (Petaurus breviceps) belonging to the same colony were presented for elective orchiectomy. After clinical examination, dexmedetomidine (120 μg/kg) in combination with ketamine (5 mg/kg) were administered subcutaneously (SC). Once righting and pedal withdrawal reflexes were lost, ringer lactate solution, enrofloxacin and meloxicam were administered SC and a bilateral intratesticular block with lidocaine 0.25% was performed. Heart, respiratory rates and pulse oximetry values were recorded every minute. Onset of sedation, additional use of isoflurane, duration of anaesthesia, duration of surgery, time of recovery after atipamezole administration, quality of recovery and time of food intake were recorded. Postoperative assessment (posture, level of activity, vocalisation, response to manipulation, attention to the surgical wound) was performed hourly until discharge, five hours after surgery. Dexmedetomidine in combination with ketamine provided adequate short-lasting anaesthesia for castration in 3 out of 4 sugar gliders. One sugar glider needed additional isoflurane administration to perform orchiectomy. No perioperative additional analgesia was needed in any sugar glider. Full article

Background: Foreign bodies (FBs) within the masticatory space are a rare but significant complication of oral and maxillofacial procedures. Despite advancements in orthognathic surgery, instrument breakage and accidental loss can lead to challenging secondary procedures. Clinical experience with retained foreign bodies in the masticatory space following orthognathic surgery and related dental procedures is summarized. Methods: A retrospective search was conducted in the surgical and radiological database of a tertiary referral center for maxillofacial surgery, covering procedures from January 2017 to December 2024. Patients were included if they had undergone orthognathic surgery and presented with a retained FB in the masticatory space confirmed through imaging. Clinical records, operative notes, imaging studies, and follow-up data were reviewed. Results: Out of 2092 procedures, four patients (0.19%) were identified. Two FBs were related to broken surgical instruments during orthognathic surgery (a suture needle and a burr fragment), while two were fractured local anesthesia needles during third molar extraction under local anesthesia. All FBs were located in deep compartments of the masticatory space (paramandibular or pterygopalatine region). Surgical retrieval via transoral approach under general anesthesia was successful in all cases. One patient experienced transient facial nerve dyskinesia; no long-term complications or recurrences were noted. Conclusions: Retained foreign bodies in the masticatory space are infrequent yet warrant prompt recognition and surgical management to mitigate the risk of infection, nerve damage, and repeated procedures. Thorough instrument checks, proper technique, and advanced imaging modalities are crucial for minimizing these complications in orthognathic surgery. Full article

Introduction: This manuscript addresses the limitations of traditional orthognathic surgery in achieving both functional and aesthetic correction in patients with Class II malocclusion and severe mandibular retrusion. Current techniques often struggle to simultaneously address mandibular deficiency and inadequate transverse dimension, leading to unsatisfactory outcomes. Methods: Seven male patients underwent bimaxillary osteotomy with mandibular advancement. A novel surgical plate, Implate, was used, which was designed to facilitate precise osteotomy and stabilization. Pre-surgical planning included CBCT scanning, 3D modeling, and surgical simulation. Postoperative assessments included clinical examinations, CT and OPT scans. Results: Implate successfully addressed the challenges of conventional techniques, minimizing the formation of bony steps and achieving a more harmonious facial profile. The minimally invasive procedure, with careful periosteal and muscle management, contributed to stable outcomes, and no complications were reported. At the 6-month follow-up, OPT analysis showed a mean mandibular width increase of 18.1 ± 6.2 mm and vertical ramus height gains of 6.0 ± 3.1 mm (left) and 5.8 ± 1.7 mm (right). Conclusions: According to our preliminary experience, the integration of Implate into surgical practice offers a significant improvement in treating complex Class II malocclusions. By simultaneously correcting mandibular retrusion and width while minimizing complications, Implate provides a superior solution compared to traditional methods. This innovative approach highlights the potential of combining advanced surgical techniques with personalized 3D-printed implants to achieve optimal functional and aesthetic outcomes. Further prospective studies with controls and longer follow-up are needed to validate the efficacy and reproducibility of Implate in wider clinical use. Full article

Background/Objectives: Dyspnea is one of the main causes of visits to the Emergency Department (ED) and hospitalization, with its differential diagnosis representing a challenge for the clinician. Lung ultrasound (LUS) is a widely used tool in ED. The objective of this study was to evaluate the impact of LUS, performed by a non-expert operator, in determining diagnosis and prognosis of patients with dyspnea. Methods: A total of 60 patients presenting with dyspnea at the ED were prospectively enrolled and underwent LUS examination by a medical student, after brief training, within 3 h of triage. LUS findings were classified into four patterns: N.1, absence of notable ultrasound findings, attributable to COPD/ASMA exacerbation; N.2, bilateral interstitial syndrome, suggestive of acute heart failure; N.3, subpleural changes/parenchymal consolidations, suggestive of pneumoniae; and N.4, isolate polygonal triangular consolidation, attributable to infarction in the context of pulmonary thromboembolism. Results: The diagnostic hypothesis formulated after LUS was compared with the final diagnosis after further investigations in the ED, showing agreement in 90% of cases. The mean LUS score value was higher in patterns N.2 (18.4 ± 8.5) and N.3 (17 ± 6.6), compared to patterns N.1 and N.4 (9.8± 6.7 and 11.5 ± 2.1). Given the high prevalence of pattern N.2, the diagnostic accuracy of LUS in this context was further evaluated, showing a sensitivity of 82% and specificity of 100%. In terms of the prognostic value of LUS, hospitalized patients had a higher LUS score compared to those discharged (17.3 ± 8.1 vs. 8.5 ± 6.8, p value 0.004). A similar trend was obtained in the subgroup of patients requiring non-invasive ventilation (NIV), who present a higher LUS score (21.1 ± 6.6 vs. 13.1 ± 8.1, p value 0.002). When considering a combined outcome (death and NIV), patients with worse outcomes more often had a LUS score > 15 (p value < 0.001). Conclusions: In conclusion, this study confirms that LUS is a very useful tool in the ED, assisting the clinical evaluation for diagnosis, treatment decision, and determination of the appropriate care setting for patients with acute dyspnea. Its short learning curve allows even non-expert staff to use it effectively. 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. Postoperative pancreatic fistula (POPF) remains one of the most relevant complications following pancreaticoduodenectomy (PD), significantly impacting short-term outcomes and delaying adjuvant therapies. Current predictive models offer limited accuracy, often failing to incorporate early postoperative data. This retrospective study aimed to develop and validate machine learning (ML) models to predict the absence and severity of POPF using clinical, surgical, and early postoperative variables. Methods. Data from 216 patients undergoing PD were analyzed. A total of twenty-four machine learning (ML) algorithms were systematically evaluated using the Matthews Correlation Coefficient (MCC) and AUC-ROC metrics. Among these, the GradientBoostingClassifier consistently outperformed all other models, demonstrating the best predictive performance, particularly in identifying patients at low risk of postoperative pancreatic fistula (POPF) during the early postoperative period. To enhance transparency and interpretability, a SHAP (SHapley Additive exPlanations) analysis was applied, highlighting the key role of early postoperative biomarkers in the model predictions. Results. The performance of the GradientBoostingClassifier was also directly compared to that of a traditional logistic regression model, confirming the superior predictive performance over conventional approaches. This study demonstrates that ML can effectively stratify POPF risk, potentially supporting early drain removal and optimizing postoperative management. Conclusions. While the model showed promising performance in a single-center cohort, external validation across different surgical settings will be essential to confirm its generalizability and clinical utility. The integration of ML into clinical workflows may represent a step forward in delivering personalized and dynamic care after pancreatic surgery. Full article

Objectives: This study aimed to translate and validate the Gothenburg Trismus Questionnaire-2 for Italian-speaking patients (I-GTQ2). Methods: A cross-sectional study was conducted with 200 participants. The translation process adhered to international standards. Patients completed the I-GTQ2 along with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) and the Hospital Anxiety and Depression Scale (HADS) to evaluate construct validity. Reliability was assessed using internal consistency and test–retest reliability (ICC). Known-group validity was also analyzed. Results: The I-GTQ2 showed high reliability, with Cronbach’s alpha ranging from 0.61 to 0.94 and ICC between 0.79 and 0.96. Known-group comparisons confirmed discriminative validity, with significant differences between patients with and without trismus in jaw-related problems (p = 0.005, d = 0.575) and large differences between patients and controls in most domains (p < 0.001, d > 0.65) except for muscular tension. Convergent validity was supported by strong correlations between GTQ-2 domains and EORTC QLQ-C30 (e.g., r = −0.54 for facial pain and global health status; r = 0.64 for jaw-related problems and pain) as well as moderate correlations with HADS anxiety (r = 0.39–0.52) and depression (r = 0.37–0.46). Conclusions: The I-GTQ2 is a reliable and valid tool for assessing the impact of trismus on the quality of life in Italian-speaking patients, and it is recommended for clinical and research use. Future studies should investigate its relationship with objective trismus measurements. 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: According to the ISSVA 2018 classification, arteriovenous malformations (AVMs) are high-flow vascular malformations, distinct from low-flow lesions. About 60% of extracranial AVMs occur in the head and neck, making their management a focus of maxillofacial surgery. Due to their complexity, precise diagnosis and careful treatment planning are crucial for optimal aesthetics and structural preservation. The standard approach combines embolization with surgical resection, though Bleomycin electrosclerotherapy (BEST) has recently gained recognition. Methods: From July 2023 to December 2024, a total of 16 patients with vascular malformations were treated with bleomycin electrosclerotherapy at the Azienda Ospedaliera Universitaria Senese (AOUS). Among them, two patients were affected by arteriovenous malformations. These two patients underwent this treatment to avoid more invasive and demolitive procedures, considering the anatomical region involved. Both patients had previously been treated at other hospitals, experiencing subsequent lesion recurrence. Preoperative evaluation included angiographic and ultrasound studies. The patients underwent electrosclerotherapy sessions and were closely monitored during follow-up. The uniqueness of this innovative approach lies in the use of fractionated doses of bleomycin for each treatment session, compared to the standard protocols described in the literature. Results: BEST has demonstrated efficacy in the treatment of high-flow AVMs by delivering bleomycin into the interstitial tissue and subsequently applying electroporation so the drug’s effects can be precisely localized and amplified. The macroscopically evident results, patient satisfaction, and, most importantly, the objective ultrasound flow data demonstrate the effectiveness of this treatment. Conclusions: Arteriovenous malformations (AVMs) pose treatment challenges due to their variability and lack of standardized guidelines. This study explores electrosclerotherapy with bleomycin in two head and neck AVM cases, using fractionated doses to enhance safety and efficacy. The findings support its potential as a minimally invasive alternative, warranting further research on broader applications. Full article

The present study investigated the effect of inter-limb asymmetry and bilateral indexes (BLIs) in power performance, assessed by squat jump (SJ) and countermovement jump (CMJ), on sport-specific anaerobic performance. Forty-eight taekwondo athletes (24 males and 24 females; mean ± SD, age: 19.8 ± 2.1 years) performed randomly, in separate sessions, SJ and CMJ tests using the right, left, and both legs to determine the asymmetry and BLI, the 10 s Frequency Speed of Kick Test (FSKT_10s), and its multiple version (FSKT_mult). FSKT_10s was positively correlated with CMJ asymmetry (ρ = 0.299, p = 0.039, low) and SJ BLI (r = 0.596, p < 0.001, large), and negatively correlated with CMJ BLI (r = −0.472, p = 0.001, moderate). Similarly, FSKT_mult was positively correlated with SJ BLI (ρ = 0.632, p < 0.001, large), and negatively correlated with CMJ BLI (ρ = −0.532, p < 0.001, large). CMJ and SJ BLI explained 45.9% of the variance of the FSKT_10s performance, whilst they explained 55.7% of the variance of FSKT_mult performance. These results highlight the importance of managing both interlimb asymmetry and bilateral deficit indexes to achieve better performance by improving the strength of the non-dominant leg and using exercises that are performed bilaterally despite unilateral movements being predominant in taekwondo, which can potentially enhance the effectiveness in sport-specific actions 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

This paper presents the development and analysis of a bridge bearing database consistent with the 2020 Italian Guidelines (LG2020), currently enforced by the Italian law for risk classification and management of existing bridges. The database was developed by putting together the contribution of 24 research teams from 18 Italian universities in the framework of a research project foreseen by the agreement between the High Council of Public Works (CSLP, part of the Italian Ministry of Transportation) and the research consortium ReLUIS (Network of Italian Earthquake and Structural Engineering University Laboratories). This research project aimed to apply LG2020 to a set of about 600 bridges distributed across the Italian country, in order to find possible issues and propose modifications and integrations. The database includes almost 12,000 bearing defect forms related to a portfolio of 255 existing bridges located across the entire country. This paper reports a preliminary analysis of the dataset to provide an overview of the bearings installed in a significant bridge portfolio, referring to major highways and state roads. After a brief state of the art about the main bearing types installed on the bridges, along with inspection procedures, the paper describes the database structure, showing preliminary analyses related to bearing types and defects. The results show the prevalence of elastomeric pads, representing more than 55% of the inspected bearings. The remaining bearings are pot, low-friction with steel–Teflon surfaces and older-type steel devices. Lastly, the study provides information about typical defects for each type of bearing, while also underscoring some issues related to the current version of the LG2020 bearing inspection form. 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

Background: Zygomatico-maxillary complex (ZMC) fractures are prevalent facial injuries with significant functional and aesthetic implications. Computer-assisted surgery (CAS) offers precise surgical planning and outcome evaluation. The study aimed to evaluate the application of CAS in the analysis of ZMC fracture outcomes and to propose a reproducible workflow for surgical outcome assessment using cephalometric landmarks. Methods: A retrospective cohort study was conducted on 16 patients treated for unilateral ZMC fractures at the Maxillofacial Surgery Unit of Siena University Hospital (2017–2024). Inclusion criteria included ZMC fractures classified as Zingg B or C, treated via open reduction and internal fixation (ORIF). Pre- and post-operative CT scans were processed for two- and three-dimensional analyses. Discrepancies between CAS-optimized reduction and achieved surgical outcomes were quantified using cephalometric landmarks and volumetric assessments. Results: Out of the 16 patients (69% male, mean age 48.1 years), fractures were predominantly on the right side (81%). CAS comparison between the post-operative and the contralateral side revealed significant asymmetries along the X and Y axes, particularly in the fronto-zygomatic suture (FZS), zygo-maxillary point (MP), and zygo-temporal point (ZT). Computer-assisted comparison between the post-operative and the CAS-simulated reductions showed statistical differences along all three orthonormal axes, highlighting the challenges in achieving ideal symmetry despite advanced surgical techniques. CAS-optimized reductions demonstrated measurable improvements compared to traditional methods, underscoring their utility in outcome evaluation. Conclusions: CAS technology enhances the precision of ZMC fracture outcome evaluation, allowing for detailed comparison between surgical outcomes and virtual simulations. Its application underscores the potential for improved surgical planning and execution, especially in complex cases. Future studies should focus on expanding sample size, refining workflows, and integrating artificial intelligence to automate processes for broader clinical applicability. Full article