Search Results (93)

Background/Objectives: Congenital ichthyoses (CI) are inherited disorders of keratinization characterized by epidermal barrier dysfunction, abnormal desquamation, and variable degrees of inflammation. Increasing evidence suggests a role for IL-23/Th17-mediated immune dysregulation in some CI subtypes, providing a rationale for targeted biologic therapies. Secukinumab, an anti-IL-17A monoclonal antibody, has emerged as a potential therapeutic option, although real-world evidence remains limited. This study evaluated the effectiveness of secukinumab in adult patients with severe CI. Methods: We performed a retrospective monocentric case series including eight adult patients with severe congenital ichthyosis treated with secukinumab for at least six months and followed for up to 56 months. Clinical outcomes included Investigator Global Assessment (IGA) scores for erythema, scaling, scalp involvement, and palmoplantar hyperkeratosis, together with pruritus assessed by Numeric Rating Scale (NRS). Results: Erythema and scaling showed most of their improvement during the first six months of treatment, after which mean clinical scores remained relatively stable throughout follow-up. At the last available assessment, improvement rates were 100% for erythema, 87.5% for trunk and limb scaling, 100% for scalp scaling, and 75% for palmoplantar hyperkeratosis. Hyperkeratosis showed a less pronounced response than inflammatory manifestations. Pruritus improved within the first 3–4 months of treatment and was sustained over time, with mean NRS scores decreasing from 6.5 at baseline to below 4 within 3–4 months. No discontinuations due to adverse events or lack of efficacy were recorded. Conclusions: Secukinumab was associated with clinically meaningful improvements in inflammatory manifestations of CI, particularly erythema and pruritus, while showing a more limited effect on hyperkeratotic features. These findings support the potential role of IL-17 inhibition in selected CI phenotypes. Full article

Laser technology has recently gained renewed interest in hysteroscopic surgery due to advances in fiber-optic delivery systems, device miniaturization, and the growing adoption of office-based procedures. In this context, laser energy represents a potential alternative to conventional mechanical and electrosurgical techniques, particularly in settings where precision and tissue preservation are clinically relevant. This narrative review provides a comprehensive and clinically oriented overview of the role of laser technology in modern hysteroscopy. A literature search was conducted in PubMed, Scopus, and Web of Science up to December 2025, focusing on studies addressing technical aspects, clinical applications, safety, and outpatient feasibility of laser-assisted hysteroscopy. Different laser systems, including Nd:YAG, diode, CO₂, Ho:YAG, and KTP lasers, are discussed in terms of physical properties and tissue interaction. Current clinical applications include the management of intrauterine adhesions, submucous myomas, endometrial polyps, septate uterus, and selected cases of endometrial ablation. Available evidence suggests that modern diode laser platforms are particularly suited for office-based procedures due to their combined cutting and coagulative effects and compatibility with small-caliber hysteroscopes. However, most of the current literature is based on small, heterogeneous studies, and robust comparative data with standard hysteroscopic techniques remain limited. As a result, laser hysteroscopy cannot yet be considered a standard approach across indications. To move beyond a purely technical appraisal, this review also frames laser hysteroscopy as a potential translational platform in which laser–tissue interaction, biomarker-informed patient selection, endometrial repair biology, fertility outcomes, and adhesion-formation mechanisms may be integrated into future functional precision medicine pathways. In conclusion, laser technology represents a promising and evolving tool in operative hysteroscopy, with potential advantages in selected clinical scenarios. Further prospective and comparative studies are required to better define its role and to support its broader integration into routine clinical practice. Full article

The widespread adoption of in vitro fertilization (IVF) has profoundly transformed the management of infertility and established IVF as the most effective assisted reproductive technology for many clinical indications. Nevertheless, intrauterine insemination (IUI) remains widely used because of its lower invasiveness, reduced treatment burden, lower costs, and broader accessibility. The contemporary role of IUI in an IVF-dominated era remains a subject of ongoing debate. This narrative review aims to critically evaluate the current role of IUI in modern reproductive medicine by examining its clinical indications, effectiveness, limitations, cost-effectiveness, and patient-centered implications in comparison with IVF. A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Relevant studies, systematic reviews, meta-analyses, randomized controlled trials, and international guidelines published primarily between 2010 and 2025 were identified and synthesized. Particular attention was given to recommendations from the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM). Current evidence supports the use of IUI, particularly when combined with ovarian stimulation, as an appropriate first-line treatment in selected couples with unexplained infertility, mild male-factor infertility, and minimal-to-mild endometriosis. Although IVF generally provides higher live birth rates per treatment cycle and remains the preferred option for several infertility diagnoses, IUI continues to offer meaningful clinical benefits in appropriately selected patients. Beyond effectiveness, treatment decisions should also consider cost-effectiveness, accessibility, treatment burden, safety, and patient preferences. Recent evidence increasingly supports individualized and prognosis-based approaches to fertility treatment selection. Evidence also highlights the importance of female age, infertility duration, and ovarian reserve in determining the relative benefit of IUI versus IVF. Despite the clinical dominance of IVF, IUI remains an evidence-based and clinically relevant component of contemporary fertility care. Rather than being viewed as competing interventions, IUI and IVF should be considered complementary treatment options within a personalized infertility management strategy. Appropriate patient selection, particularly considering female reproductive prognosis, remains essential to maximize reproductive outcomes while minimizing treatment burden and healthcare costs. Full article

Background: Contraceptive counseling is a critical component of reproductive healthcare, directly influencing method uptake, continuation, and user satisfaction. While global health guidelines increasingly emphasize person-centered, rights-based approaches to counseling, wide variations in practice persist, with significant implications for equity and autonomy. Objective: This narrative review aims to synthesize current evidence on the strengths, limitations, and future opportunities of contraceptive counseling within person-centered care frameworks, with particular attention to adolescents and other populations facing structural or sociocultural barriers to equitable care. Methods: A comprehensive literature search was conducted across six indexed databases (PubMed, Scopus, Embase, Web of Science, CINAHL, and PsycINFO) for peer-reviewed articles published between January 2010 and April 2025. Eligible studies included original quantitative, qualitative, and mixed-methods research examining contraceptive counseling practices, user experiences, provider–client communication, counseling interventions, or implementation strategies in reproductive healthcare settings. Results: Emerging strengths in the field include the increasing adoption of shared decision-making, motivational interviewing, and culturally tailored counseling approaches, all of which contribute to improved client satisfaction and method adherence. Digital tools and mHealth platforms have expanded the reach of counseling and show promise in supplementing in-person care. However, significant gaps remain. Provider bias, limited training, communication barriers, and a lack of socio-cultural tailoring frequently undermine the quality of care, especially for adolescents, migrants, women with disabilities, and socially vulnerable populations. Ethical challenges—such as coercion, inadequate informed consent, and structural inequities—persist in many healthcare settings. Moreover, contraceptive counseling is often treated as a one-time event rather than an ongoing, adaptive process. Conclusions: To maximize its impact, contraceptive counseling must be reframed as a longitudinal, relational, and ethically grounded practice. Future efforts should prioritize the development of structured training programs, integration into broader health services, and qualitative research that centers patient experiences. Embedding counseling within reproductive justice frameworks will be essential for advancing equity and autonomy. High-quality contraceptive counseling, when informed by evidence and empathy, is a strategic tool for reproductive empowerment and public health advancement. Full article

Background: Neonatal aortic coarctation (CoA) remains difficult to diagnose before hemodynamic deterioration occurs after ductal closure. Pulse wave velocity (PWV) may reflect functional vascular alterations associated with CoA. Methods: A simplified hemodynamic mathematical model describing pulse wave propagation across aortic coarctation has been developed. The model is based on conservation of energy principles and incorporates simplified assumptions regarding arterial compliance to relate PWV changes to systolic–diastolic pressure. Results: The model suggests a nonlinear relationship between PWV reduction distal to the coarctation and pressure excursion damping. Specifically, a twofold PWV reduction corresponds theoretically to an approximately fourfold reduction in systolic–diastolic pressure variation. The derived relationships were shown to be conceptually consistent with the Moens–Korteweg formulation and Laplace law. Conclusions: This theoretical framework supports the physiological plausibility of combining PWV assessment with pressure-gradient evaluation in neonatal CoA screening. Future studies are required to validate the model in clinical settings and define diagnostic thresholds. Full article

Elderly psoriasis patients (≥65 years) demonstrate mainly preserved but substantially delayed therapeutic responses to IL-17 and IL-23 inhibitors, achieving lower PASI90 rates at early time-points with eventual “catch-up” by week 52, alongside increased adverse-event-driven discontinuation. This review synthesizes clinical efficacy data from real-world studies with emerging mechanistic evidence on immunosenescence and cellular senescence to propose the “Inflammatory Noise Floor” hypothesis. We postulate that senescent keratinocytes and fibroblasts constitutively secrete SASP cytokines (IL-6, IL-8, TNF-α) through pathways partially independent of IL-23/IL-17, potentially establishing a persistent baseline inflammation that IL-23/IL-17 blockade might not suppress. Concurrently, immunosenescence, characterized by CD8⁺CD28⁻ T-cell accumulation, exhaustion marker upregulation, and Treg dysfunction, is hypothesized to impair adaptive immune re-equilibration. This dual mechanism represents one plausible, albeit theoretical, explanatory framework for the temporal lag, PASI plateau effects, and infection risk observed in elderly patients. Optimizing outcomes in the elderly may require a pragmatic approach: accepting stable PASI 75-90 as a successful endpoint and prospectively validating extended assessment timelines. While a direct correlation remains to be proven, this framework identifies cellular and immunosenescence as potential targets for future senotherapeutic interventions. Full article

This study confirmed that cultivation technologies, cultivar, and meteorological conditions significantly influenced the contents of ascorbic acid, total polyphenols, and phenolic acids in sweet potato roots. Ascorbic acid content ranged from 27.22 to 111.9 mg·100 g⁻¹ DW, with the highest values recorded in the traditional cultivation system (TC), reaching 111.9 mg·100 g⁻¹ DW in ‘Carmen Rubin’ and 111.4 mg·100 g⁻¹ DW in ‘Beauregard’. In contrast, in the ‘Satsumo Imo’ cultivar grown under nonwoven fabric (WC), ascorbic acid content decreased to 49–58% of the values obtained in TC. Genetic factors strongly differentiated the contents of bioactive compounds. The ‘Purple’ cultivar showed the highest contents of total polyphenols (up to 963.5 mg·100 g⁻¹ DW) and phenolic acids (17,067.42 mg·100 g⁻¹ DW), whereas the lowest values were recorded in ‘Satsumo Imo’ (858.82–1225.89 mg·100 g⁻¹ DW). Cultivation under polyethylene film (FC) increased and stabilized phenolic compounds. The ‘Carmen Rubin’ cultivar also exhibited high phenolic acid content (5332.04–5447.60 mg·100 g⁻¹ DW), while ‘Beauregard’ was characterized by high stability of this trait (1535.93–1581.46 mg·100 g⁻¹ DW). From a practical perspective, the results highlight the importance of appropriate cultivar selection and cultivation technology for obtaining raw material with high functional value. These findings may serve as a basis for developing agrotechnical recommendations aimed at producing sweet potatoes with enhanced nutritional and health-promoting qualities under the climatic and soil conditions of Poland. Full article

Bedellia somnulentella (Lepidoptera: Bedelliidae) is an invasive, leaf-mining, and defoliating pest of sweet potatoes (Ipomoea batatas L.) that has recently established in Brazil. Its colonization and infestation levels in cultivated fields are influenced by the availability of wild Ipomoea species that sustain populations during off-season periods. The objective was to evaluate the biology and life history of B. somnulentella feeding on wild plants of the genus Ipomoea and on I. batatas cv. Beauregard. Vegetative and reproductive parts of Ipomoea plants were collected and cultivated, and the biology and life history of B. somnulentella were studied using twenty adult pairs of the insect per host plant in a climate-controlled room. The wild species Ipomoea hederifolia L., Ipomoea indica (Burm.f.) Merr., Ipomoea purpurea L., and cultivated I. batatas were used for the assays. The experiment followed a completely randomized design with ten replicates. Hatching, larval stages, prepupa, pupa, and adult phases were observed and recorded daily. Variations in the coloration of B. somnulentella larvae feeding on leaves of I. hederifolia, I. indica, and I. purpurea were observed. The survival and development of B. somnulentella were higher on I. batatas and I. hederifolia than on I. indica and I. purpurea, mainly during the larval and adult stages. The results provide information on infestation in alternative wild hosts and on biological aspects of B. somnulentella. Full article

After approximately 60 years of service, the 2856 MHz LINAC injector, of the Canadian Light Source (CLS), has been retired to make space for a new 3000.24 MHz LINAC injector, the frequency of which is a multiple of the 500.04 MHz CESR-B-type superconductive radio frequency cavity used in the CLS storage ring. The new CLS LINAC injector has been designed and built by RI Research Instruments GmbH. The design is based on their robust S-band RF traveling-wave accelerating structures technology already serving other laboratories in the USA, Australia, Taiwan, Switzerland, and Sweden. In order to reduce cost and optimize space, the CLS has replaced its six accelerating RF structures, each 3.05 m long, delivering a 250 MeV electron beam with three 5.26 m long accelerating structures that will deliver the same beam energy. In order to do so, one RF structure is powered by one klystron modulator, and the last two RF structures receive their RF power from a second klystron modulator that passes through a SLED system. The SLED system multiplies the peak power by a factor of 5 to 6 and is then equally split to power each structure. We are reporting on the issues encountered during the commissioning of this new injector, on how we have tackled them and where the injector, compared to its technical specification, is standing today. Full article

Psoriasis is a chronic immune-mediated skin disease with highly variable responses to systemic therapies. Emerging evidence highlights the microbiome as a potential modulator of drug efficacy and toxicity. Gut bacteria can enzymatically metabolize drugs, such as methotrexate, altering bioavailability and therapeutic outcomes, while microbial metabolites—including short-chain fatty acids, branched-chain amino acids, and tryptophan derivatives—shape host immunity and barrier integrity, influencing drug action. Baseline microbial signatures have been linked to treatment response, potentially predicting anti-TNF or IL-17 inhibitor efficacy. Systemic therapies themselves reshape microbial communities: IL-17 blockade induces broad shifts in gut and skin microbiota, whereas cyclosporine and anti-TNF agents exert subtler effects. Small molecules such as apremilast and fumarates may reduce fungal overgrowth and influence microbial composition, whereas data on JAK/TYK2 inhibitors remain limited. Notably, current evidence exhibits a literature bias toward the gut microbiota, while the roles of the oral and skin axes remain understudied. Adjunctive microbiome-directed interventions, including probiotics and fecal microbiota transplantation, have demonstrated potential to enhance treatment outcomes by promoting anti-inflammatory taxa and restoring barrier function. Despite these promising findings, current evidence is heterogeneous, often limited by small sample sizes, short follow-up, and variable methodology. Integrating pharmacomicrobiomics data with clinical, genetic, and multi-omics profiling could enable precision medicine approaches in psoriasis, allowing therapy selection tailored to individual microbial and metabolic signatures. Future research should focus on longitudinal, multicenter studies to identify actionable microbial biomarkers, clarify mechanistic interactions between drugs, microbes, and host immunity, and evaluate microbiome-targeted adjuncts in randomized trials. Understanding the bidirectional crosstalk between systemic therapies and the microbiome may transform psoriasis management, improving efficacy, reducing adverse events, and enabling durable, personalized responses. Full article

Primary cutaneous lymphomas (PCLs) are a heterogeneous group of extranodal T- and B-cell neoplasms confined to the skin at diagnosis, characterised by distinct biological drivers, clinical behaviour, and therapeutic challenges compared with systemic lymphomas. Over the past decade, advances in genomic profiling, single-cell and spatial transcriptomics, and tumour microenvironment analysis have substantially refined the understanding of PCL pathogenesis, highlighting immune evasion, clonal heterogeneity, and compartment-specific disease dynamics as key determinants of outcome and treatment response. These insights have coincided with a rapidly evolving therapeutic landscape that includes immunomodulatory agents, targeted therapies, and ADCs, while also exposing persistent limitations related to diagnostic delay, response heterogeneity, resistance, and lack of validated predictive biomarkers. In this review, we provide a dermatology-focused synthesis of primary cutaneous lymphomas, integrating contemporary classification and clinicopathologic features with molecular pathogenesis and tumour microenvironmental insights of direct clinical relevance. We discuss current diagnostic and staging approaches, critically appraise established and emerging therapeutic strategies in cutaneous T- and B-cell lymphomas, and highlight unresolved clinical challenges and unmet needs, including biomarker integration, longitudinal disease monitoring, and translation of molecular advances into routine practice. Full article

Background: Evidence guiding secondary repair of persistent full-thickness macular holes (FTMHs) remains limited and heterogeneous. Temporal arcuate relaxing retinotomy has been described as a salvage maneuver intended to increase temporal retinal compliance, yet functional safety data are scarce. We report consecutive real-world outcomes of temporal arcuate relaxing retinotomy for persistent FTMHs after failed standard repair(s). Methods: Retrospective consecutive case series of patients with persistent FTMH after ≥1 pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, treated with repeat PPV and temporal arcuate relaxing retinotomy. Outcomes included OCT (Optical Coherence Tomography)-confirmed closure after gas absorption and best-corrected visual acuity (BCVA, logMAR), ellipsoid zone (EZ) status, retinotomy-site morphology on OCT/fundus autofluorescence (FAF), and safety/functional outcomes (systematic scotoma symptom inquiry; Humphrey visual field testing when feasible). Exact binomial 95% confidence intervals (CI) were calculated for proportions. Results: Nine eyes (median age 70 years; range 55–76) underwent temporal arcuate relaxing retinotomy for persistent FTMH. Minimum linear diameter ranged 412–1037 µm (median 613 µm). OCT-confirmed closure was achieved in 7/9 eyes (77.8%; 95% CI 40.0–97.2) at a mean follow-up of 5.9 months (range 2–12). BCVA improved in 8/9 eyes (88.9%; 95% CI 51.8–99.7); mean BCVA improved from 1.26 ± 0.51 logMAR pre-operatively to 0.61 ± 0.18 logMAR at last follow-up (mean change −0.64 logMAR; Wilcoxon signed-rank test p = 0.011). As a sensitivity analysis, the paired t-test yielded p = 0.008. Humphrey visual fields were obtained in 6/9 eyes; one patient reported a new paracentral nasal scotoma, which was subjectively well tolerated. Conclusions: In this small consecutive series, temporal arcuate relaxing retinotomy was associated with a 78% closure rate and mean BCVA improvement in eyes with persistent FTMH after failed standard repair(s), with limited symptomatic scotoma reporting in those assessed. Given the retrospective design, small cohort, and incomplete standardized functional testing, larger comparative studies with uniform functional endpoints (microperimetry, RNFL/GCL metrics, and systematic perimetry) are needed to define patient selection, reproducibility, and relative performance versus contemporary salvage options. Full article

Background: Retained products of conception (RPOC) after term delivery are uncommon but may lead to persistent abnormal uterine bleeding and other complications. Hysteroscopic removal is considered the optimal management strategy, and technological advances have increasingly enabled operative procedures to be performed safely in an office setting. Clinical case: We report the case of a 43-year-old woman who presented with intermittent spotting four months after spontaneous vaginal delivery. Transvaginal ultrasound revealed a small, avascular hyperechoic intrauterine lesion consistent with retained amniochorionic tissue. She underwent office hysteroscopic removal using a 16 Fr bipolar mini-resectoscope under nitrous oxide (N₂O) buccal–nasal analgesia. The procedure was performed using a vaginoscopic, no-touch approach without speculum, tenaculum, or cervical dilation. Complete resection was achieved in a seven-minute procedure, with a postoperative pain score of 2/10 on the VAS and no complications. At 30-day follow-up, the patient was asymptomatic, and an ultrasound confirmed complete resolution. Conclusion: This case demonstrates that retained amniochorionic tissue can be safely and effectively treated in a fully ambulatory setting using mini-resectoscopic technology and N₂O analgesia. The combination of minimally invasive instruments, patient-centered procedural strategies, and well-tolerated analgesia supports the growing role of office operative hysteroscopy for selected complex intrauterine conditions. Full article

Breslow thickness (BT) is the most powerful prognostic indicator in cutaneous melanoma, yet histopathological measurement exhibits some limitations such as interobserver variability and diagnostic delays. Preoperative clinical assessment demonstrates 30% misclassification rates. This narrative review synthesizes evidence on deep learning models for non-invasive BT estimation from dermoscopic images. Convolutional neural networks (ResNet, EfficientNet, Vision Transformers) with transfer learning from ImageNet achieve up to 75–79% accuracy and AUC 0.76–0.85 on single-center datasets. Preprocessing techniques (hair removal, color normalization, data augmentation) and interpretability methods (Grad-CAM, LIME) enhance clinical applicability. However, external validation reveals performance degradation. The clinically critical thickness range (0.4–1.0 mm) demonstrates poor discrimination. Significant dataset bias exists: most training data represents lighter skin phototypes, resulting in an underrepresentation of darker skin types. AI models function as complementary decision-support tools rather than replacements for histopathology. Prospective clinical trials validating clinical utility are lacking, and regulatory approval pathways are undefined. Research priorities include diverse public datasets with balanced skin tone representation, the adoption of threshold-weighted loss functions to prioritize accuracy at the 0.8 mm surgical cut-off, multi-institutional external validation, prospective randomized trials, federated learning frameworks, and regulatory engagement. Only rigorous, equitable research can translate AI from proof-of-concept to clinically reliable tools benefiting all melanoma patients. Full article

The central venous catheter (CVC) is essential in the management of pediatric patients, allowing the administration of medications, parenteral nutrition, and other treatments. However, its use carries a high risk of central-line-associated bloodstream infections (CLABSI) and catheter-related bloodstream infections (CRBSI). Advanced chlorhexidine-impregnated dressings have been developed to reduce bacterial colonization, but their effectiveness in the pediatric population remains uncertain. The aim of this review is to evaluate the effectiveness of chlorhexidine-impregnated dressings compared to standard dressings in reducing CLABSI, CRBSI, and CVC colonization in pediatric patients. Randomized clinical trials published between 2005 and 2021 in PubMed, CINAHL, and Embase, in Italian or English, were selected. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist. Relevant data were extracted and summarized in tables. Four studies, including a total of 733 pediatric patients (367 intervention, 366 control), were included. None reported a statistically significant reduction in CLABSI/CRBSI with the use of chlorhexidine-impregnated dressings. However, two studies showed a significant reduction in catheter colonization in the intervention group. Current evidence does not support a superior effect of chlorhexidine-impregnated dressings in preventing CLABSI/CRBSI in pediatric patients, although they may reduce catheter colonization. Randomized trials with larger samples and specific methodologies are needed to clarify the true clinical impact. Full article