Search Results (10,887)

Background: Preserving fertility in young women with cancer is crucial for comprehensive care. Based on GBD 2023 estimates, approximately 1000 women aged 15–39 are diagnosed with haematological malignancies annually in Italy. Guidelines recommend timely fertility preservation (FP) counselling for all at-risk patients, yet real-world access data remain limited. Methods: This multicentre, retrospective observational study analysed FP counselling for women aged 15–39 with haematological malignancies from 2015 to 2023. Counselling data were extracted from the Italian Assisted Reproductive Technology Registry (IARTR). This data collection system, known as PreFerIta, was developed within a project supported by the Italian Ministry of Health to collect data on Fertility Preservation (FP) treatments in oncology patients and/or those at risk of iatrogenic infertility, provided in seven specialised ART centres across Italy. The PreFerIta database includes data on both oocyte cryopreservation and ovarian tissue cryopreservation. Annual visits were related to the estimated regional incidence of new haematological malignancies (GBD 2023). Counselling-to-incidence ratios, absolute/relative gaps, and 95% confidence intervals (CIs) were calculated. Results: From 2015 to 2023, an estimated 4473 new haematological malignancies occurred in the catchment regions. Concurrently, 1200 FP counselling visits were recorded. While incidence modestly declined, counselling activity remained high. The counselling-to-incidence ratio increased from 17.33% in 2015 to 31.92% in 2018, stabilising between 26% and 31% thereafter (30.98% in 2023). The relative counselling gap decreased from 82.67% to 69.02%. These ratios represent lower-bound estimates of access to specialised oncofertility consultations. Conclusions: In this Italian network, approximately one in four to one in three incident haematological malignancies in young women were associated with specialised FP counselling. This reflects a substantial integration of oncofertility services into haematology care, highlighting opportunities to further strengthen referral pathways and achieve full guideline concordance. Full article

This article examines Daniel 10 as a key witness to the formation of early Jewish apocalyptic literature. The chapter portrays Daniel as a sage whose encounter with a celestial messenger prepares him to guide his community. Narratively, this scene introduces the final revelation of Daniel 11–12; ideologically, it expresses the authors’ conviction that access to the heavenly realm is achieved through scribal discipline and engagement with inherited traditions. The study advances two related contributions. Drawing on recent reassessments of apocalyptic origins—especially insights from Aramaic texts at Qumran—the study offers a new analysis of intertextuality in Daniel 10, highlighting how apocalyptic writing predates the persecutions of Antiochus IV and is developed through the reinterpretation of authoritative Scriptures in the Persian and Hellenistic periods. Daniel’s profile aligns with elite temple-based scribes who operated across imperial and cultic settings and used apocalyptic discourse in intra-Judean power struggles. In addition, the reference to the Tigris in Dan 10:4 is reinterpreted in light of Seleucia-on-Tigris, whose culturally hybrid environment illuminates the cosmopolitan backdrop of the maśkîlîm traditions. Full article

A dynamic filtering system that can choose in real time between two different noise filters depending on the dynamics of the measured environment is presented. Unlike other adaptive filters approaches, this system does not require prior knowledge of the environment beyond noise characteristics. We implemented this system into a Brillouin optical time-domain analysis (BOTDA) sensing scheme using a closed-circuit control system for dynamic tracking of the Brillouin Frequency Shift (BFS) along the sensing fiber using a Proportional-Integral-Derivative (PID) controller. Through experiments and numerical simulations, we compare this method to the filtering capabilities of P and PI controllers chosen as optimal in a previous work for closed-circuit BOTDA (CC-BOTDA). Results show that the adaptive noise filter provides a dynamic response comparable to the other controllers, while increasing noise suppression by a factor between 30% and beyond 100%, showing how an adaptive system can improve suppression with only knowledge of the measurement noise. Full article

This paper introduces a novel architecture for a navigation system that is designed to estimate the position and velocity of a moving vehicle specifically for remote piloting scenarios where GPS availability is intermittent and can be lost for extended periods of time. The purpose of the navigation system is to keep velocity estimation as reliable as possible to allow the vehicle guidance and control systems to maintain close-to-nominal performance. The cornerstone of this system is a landmark-extraction algorithm, which identifies pertinent features within the environment. These features serve as landmarks, enabling continuous and precise adjustments to the vehicle’s estimated velocity. State estimations are performed by a Sequential Kalman filter, which processes camera data regarding the vehicle’s relative position to the identified landmarks. Tracking the landmarks supports a state-of-the-art LiDAR odometry segment and keeps the velocity error low. During an extensive testing phase, the system’s performance was evaluated across various real word trajectories. These tests were designed to assess the system’s capability in maintaining stable velocity estimation under different conditions. The results from these evaluations indicate that the system effectively estimates velocity, demonstrating the feasibility of its application in scenarios where GPS signals are compromised or entirely absent. Full article

Background and Objectives: Celiac disease (CD) is a major global public health problem that can occur at any age. Pediatric CD can be typical, atypical, or even asymptomatic. Early diagnosis and early initiation of treatment are essential for improving patients’ quality of life and preventing serious complications later in life. However, it is impossible to identify asymptomatic children and adolescents without screening. In this systematic review, we attempted to identify different mass screening programs that have been reported for CD in apparently healthy children and adolescents across the world, to highlight the advantages and disadvantages of such strategies, and to collect and synthesize data from these studies reporting the prevalence of CD. In addition, where data were available, we also attempted to evaluate the diagnostic accuracy of the tests used, their cost-effectiveness, the reported clinical benefits, and follow-up data from individuals identified through screening. Materials and Methods: Electronic databases, including PubMed and Scopus, were systematically searched. Initially, a total of 316 studies were retrieved. Finally, 55 studies met all inclusion criteria and were included in this review. The included studies were published between 1996 and 2023. Results: The reported age of participants ranged from 6 months to 23 years. Confirmation of CD by biopsy was reported in all but six studies. According to the studies that provided data, the (tTG IgA) seroprevalence of CD in apparently healthy children and adolescents, detected through different mass screening methods around the world, ranged from 0.20% (Turkey) to 3.11% (Italy). In addition, the prevalence of biopsy-confirmed CD ranged from 0.036% (Vietnam) to 3% (Sweden and Spain). Studies from 17 countries reported mass screening strategies based on finger-prick rapid tests. All rapid tests detected CD antibodies, except two, which detected HLA DQ2/DQ8 haplotypes. Rapid tests appeared to be no less sensitive and specific than other screening tests for CD and were probably less expensive, but further studies are needed for more reliable conclusions. Of the 55 studies in the review, only 10 reported follow-up data. After 3 months of a gluten-free diet, the general condition of the patients improved; after 6 months, tTG IgA and EMA IgA levels decreased and hemoglobin values increased; while after 1 year, tTG IgG levels also decreased, symptoms subsided, the children’s weight and height increased, school performance improved, episodes of upper respiratory tract infections decreased, and thyreoperoxidase antibodies that were positive at screening became negative. Conclusions: Mass screening for CD in asymptomatic children and adolescents is a challenge. Future research should provide more answers regarding the most appropriate target age, the frequency of screening, the optimal screening method, the cost-effectiveness, the clinical utility, and the long-term impact of mass screening on patients’ quality of life. Full article

Antonio Basoli’s one hundred Picturesque views of the city of Bologna (1824–1836) include 95 preparatory drawings, 16 of which were executed on oil-impregnated lightweight paper now showing advanced degradation. This study aims to investigate the materials and techniques used by Basoli’s workshop and to develop an evidence-based conservation approach for these fragile works. An integrated analytical methodology combining non-invasive hyperspectral imaging (HSI), Fiber Optics Reflectance Spectroscopy (FORS) and Ion Beam Analysis (IBA) with micro-invasive SEM-EDX and FTIR-ATR spectroscopy was applied on five drawings on lightweight impregnated paper to characterize both the paper supports and drawing media. Linseed oil containing lead-based drying agents was suggested to be the impregnating substance, while iron oxide (sanguine) over metalpoint (Cu, Sb, Pb) defined the graphic media. The detection of copper–lead residues suggests that Basoli employed a direct pressure transfer technique similar to James Watt’s copying machine. Conservation treatments resulted in significant pH stabilization (from 5.35 ± 0.20 to 6.45 ± 0.33) and reduced yellowing (ΔE* = 4.9 ± 1.8) while maintaining the paper’s translucency. The results elucidate the innovative practices of Basoli’s workshop and establish a reproducible analytical and conservation methodology applicable to the preservation of nineteenth-century graphic heritage. Full article

Background: Auricular defects resulting from congenital anomalies, trauma, or oncologic resection pose significant functional and psychosocial challenges. When autologous reconstruction is not feasible or not desired, implant-retained auricular prostheses represent a reliable alternative with high patient satisfaction. This study aimed to systematically evaluate the clinical performance of craniofacial implants used for auricular prosthetic rehabilitation, focusing on implant survival, prosthetic outcomes, workflow typologies, and complications. A secondary objective was to illustrate the long-term validity of a minimally invasive navigation technique through a clinical case with 6-year follow-up. Methods: A systematic review was conducted according to PRISMA guidelines. Clinical studies published between 2005 and 2025 reporting outcomes of implant-retained auricular prostheses were searched in PubMed and Scopus databases. Data were extracted on implant type, survival rates, prosthetic performance, workflow, and complications. Risk of bias was assessed using appropriate tools based on each study design. Results: A total of thirty-two studies were included, comprising fifteen case reports, fifteen case series, one cohort study, and one prospective observational study. Implant survival was consistently high across all workflow categories, with failures predominantly associated with irradiated or anatomically compromised bone. Prosthetic outcomes were favorable, showing excellent esthetics, stable retention, and high patient satisfaction irrespective of manufacturing method, although digital and navigation-assisted workflows improved reproducibility, symmetry, and planning precision. Complication rates were low and generally limited to mild peri-abutment inflammation manageable with conservative care. The clinical case confirmed these findings, showing stable osseointegration, healthy soft tissues, and uncompromised prosthetic function at 6-year follow-up. Conclusions: Implant-retained auricular prostheses show predictable long-term success, independent of whether traditional, hybrid, or fully digital workflows are employed. Digital technologies enhance surgical accuracy, minimize morbidity, and streamline prosthetic fabrication, although high-quality comparative studies remain limited. Full article

Background: Conservative treatment of chronic musculoskeletal pain includes exercise, manual therapy, medications, physical agents/modalities, and Therapeutic Patient Education (TPE). Research on TPE has predominantly focused on spinal pain, so we do not know the extent and scope of clinical research in other areas, particularly lower extremities. This review aimed to map current research on this topic. Methods: We searched PubMed, PEDro, CINAHL, PsycINFO, and Cochrane Library up to 1 April 2024. We included RCTs on adults with chronic lower limb musculoskeletal pain, written in English, French, Spanish, or Italian. Results: Fifty-two records concerning knee osteoarthritis (n.33), hip and knee osteoarthritis (n.8), hip osteoarthritis (n.3), chronic knee pain (n.3), patellofemoral pain (n.3), and gluteal tendinopathy (n.2) were included. TPE was delivered through self-management, disease-specific information, pain education, and the management of physical activity, load, diet, stress, and sleep. Interventions were both individual- and group-based; delivery methods included in-person intervention, telephone/video calls, and web tools/apps. TPE combined with exercise seemed to be more effective than exercise alone, information/little education, or usual care. The effects of TPE as a stand-alone intervention appeared uncertain. Conclusions: There is considerable variability in TPE in terms of teaching topics, providers, administration methods, and dosage of interventions. Future studies should investigate the effects of TPE in young adult populations and in ankle conditions. They should also investigate the effects of TPE on pain intensity versus pain interference with activities, by deepening TPE effects on disability and quality of life. Full article

Background/Objectives: Large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) are challenging lesions with a variable, yet non-negligible risk of advanced neoplasia. While correct management is therefore mandatory, a discrepancy often persists between guideline recommendations and daily endoscopic practice. To bridge this gap, we performed a comprehensive and structured review of the available evidence, aiming to synthesize the current knowledge and provide practice-oriented guidance for the optimal management of LNPCPs throughout the diagnostic–therapeutic pathway. Methods: A comprehensive literature review was independently performed. We systematically searched PubMed and Google Scholar up to December 2025. After the literature review, we identified the most clinically relevant and controversial aspects in the endoscopic management of LNPCPs. These key areas were then translated into focused, practice-oriented clinical questions. Results: We formulated 14 practice-oriented questions addressing the key steps of endoscopic management of LNPCPs. These questions cover the entire diagnostic–therapeutic pathway, including lesion detection, morphological characterization, optical diagnosis and risk stratification for submucosal invasion, selection of the optimal resection technique, and post-resection surveillance strategies. For each question, the current evidence was synthesized to provide concise, clinically applicable answers aimed at supporting real-world endoscopic decision-making. Conclusions: The endoscopic management of LNPCPs requires a structured and evidence-based approach that integrates accurate assessment, appropriate technique selection, and tailored post-resection surveillance. By framing current evidence into focused, practice-oriented questions, this review aims to bridge the gap between guideline recommendations and real-world endoscopic practice. The proposed framework may support endoscopists in daily clinical decision-making, promoting the appropriate use of advanced endoscopic techniques and ultimately improving patient outcomes. Full article

Background/Objectives: Over the last decade, the role and timing of lymph node dissection (LND) in stage III melanoma has shifted from completion LND after a positive sentinel node to a mainly therapeutic procedure for clinically evident nodal disease, driven by randomized evidence showing no survival benefit for routine completion dissection. In this evolving landscape, real-world data on postoperative morbidity—by nodal basin—and on whether complications may influence melanoma-specific survival (MSS) and disease-free survival (DFS) remain limited. We evaluated 90-day postoperative complications after cervical, axillary, and inguino–iliac–obturator LND and explored their association with survival outcomes and treatment era. Methods: We retrospectively analyzed 185 consecutive stage III melanoma patients undergoing LND at a single tertiary center (January 2004–August 2025). Postoperative morbidity was recorded up to 90 days and graded by Clavien–Dindo; given the very low rate of grade > II events, the primary endpoint was a composite of loco-regional surgical field–related complications (persistent seroma, wound dehiscence, surgical-site infection, limb lymphedema). Risk factors were assessed using logistic regression; Firth’s penalized models were applied when appropriate. MSS and DFS were estimated by Kaplan–Meier and explored with Cox models. Results: Median follow-up was 105 months. Surgical field–related complications occurred in 16.8% (31/185), and postoperative mortality was 1.0% (2/185). In multivariable analyses, inguino–iliac–obturator LND was associated with higher odds of overall complications (OR 4.03) and specifically wound dehiscence (OR 4.79) and infection (OR 7.18) versus axillary LND. MSS (n = 179) was 82% at 1 year, 55% at 5 years, and 49% at 10 years; DFS (n = 171) was 63%, 42%, and 41%, respectively. In era-based comparisons, nodal yield decreased in the post–MSLT-II period without clear separation of MSS/DFS curves; exploratory models did not show a consistent independent signal linking postoperative complications to MSS/DFS. Conclusions: In stage III melanoma, LND was associated with low major morbidity, but clinically meaningful locoregional complications persisted—most notably after inguino–iliac–obturator dissection. These data support careful patient selection and basin-tailored strategies to reduce groin morbidity within modern multidisciplinary management. Full article

Background: Catheter ablation is a validated treatment for ventricular arrhythmias (VA), but conventional radiofrequency (RF) energy may cause collateral injury due to non-selective thermal damage. Pulsed Field Ablation (PFA), a non-thermal modality based on irreversible electroporation, offers myocardial tissue selectivity and enhanced safety. While PFA is widely adopted for atrial arrhythmias’ ablation, its application in the ventricles remains an evolving frontier. Methods: We report a single-center experience using the Centauri PFA system integrated with a focal, contact-force sensing irrigated catheter (Tacticath™ SE, Abbott Laboratories, St. Paul, MN, USA) in four consecutive patients with drug-refractory VA. Two patients presented with frequent premature ventricular complexes (PVC) arising from the right and left ventricular outflow tract, respectively, while two had ischemic cardiomyopathy with recurrent scar-related ventricular tachycardia (VT). All procedures were guided by high-density mapping using the EnSite X system (Abbott Laboratories, St. Paul, MN, USA). Procedural safety, acute efficacy, and early follow-up outcomes were assessed. Results: All ablations achieved acute procedural success without complications. In both PVC cases, PFA led to immediate and complete suppression of ectopy, with a ≥95% reduction in arrhythmic burden at 12- and 9-months follow-up, respectively. In the VT cases, the arrhythmogenic substrate was effectively modified, rendering the clinical VT non-inducible. ICD interrogation during a 9-month follow-up showed complete absence of recurrent sustained VT. No coronary spasm, atrioventricular block, pericardial effusion, or other adverse events occurred. Conclusions: In this initial experience, focal PFA using a contact-force sensing catheter appeared feasible and effective for both focal and scar-related VA. This system provides an intuitive workflow similar to RF ablation. While our data suggest a favourable safety profile, larger studies are required to definitively confirm safety margins near critical structures. Full article

Introduction: Primary Sjögren’s (pSS) is an autoimmune disease that affects several organs, especially the heart, and raises cardiovascular risk. Investigating the associations of hemoglobin-to-red cell distribution width (RDW) ratio (HRR), vitamin D status, and cardiac function could provide valuable insights and biomarkers regarding early cardiovascular risk in patients with pSS. Method: This cross-sectional study involved 61 patients diagnosed with pSS based on ACR/EULAR criteria. Data on demographics, hematological (Hb, RDW), echocardiography, and serum vitamin D levels were collected. Echocardiograms were conducted by trained cardiologists following established guidelines, while vitamin D levels were measured using ELISA. Statistical analyses, including univariate linear regression, were performed with SPSS in order to identify whether HRR tertiles were related to cardiac function and vitamin D status. Results: A study of 61 pSS patients (mean age 59.8 years, 89% female) revealed that patients with a lower hemoglobin-to-RDW ratio (HRR ≤ 0.98) had significantly higher pulmonary artery pressures (PAPs) and lower values for the tricuspid annular plane systolic excursion (TAPSE)/PAPs ratio, contributing to poor right heart function. These associations were particularly strong in patients with insufficient levels of vitamin D (<30 ng/mL), while differences in other echocardiographic parameters remained nonsignificant between HRR groups. Conclusions: These findings underscore the clinical value of HRR as a composite biomarker that reflects the interplay between anemia, inflammation, and cardiovascular health in primary Sjögren’s disease. They also suggest that vitamin D status may be an important therapeutic consideration to mitigate cardiopulmonary risks in this population. Full article

Avobenzone (AVO) and ethylhexyl salicylate (EHS) are widely used organic UV filters with distinct photochemical properties and reported biological effects. Experimental and predictive evidence suggests that some lipophilic UV filters may reach systemic circulation and potentially cross the blood–brain barrier (BBB), raising concerns about possible central nervous system effects, although direct evidence for AVO and EHS remains limited. This study evaluated the effects of subcytotoxic concentrations (0.01–1 µM) of AVO and EHS on differentiated SH-SY5Y human neuroblastoma cells, focusing on early stress-related molecular responses. Cell viability and reactive oxygen species production were not significantly affected at any tested concentration. Integrated analyses of microRNA, gene, and protein expression revealed modest and variable modulation of miR-200a-3p and miR-29b-3p. Western blot analysis showed increased phosphorylation of AKT and ERK, no significant changes in mTOR activation, and an increased Bax/Bcl-2 ratio. Overall, these findings indicate that AVO and EHS trigger an early stress-adaptive response involving PI3K/AKT and MAPK/ERK signaling and modulation of apoptosis-related pathways. Such responses reflect a dynamic balance between cellular adaptation and pro-apoptotic signaling, which may become relevant under prolonged or higher-intensity exposure conditions. Full article

Background: Artificial intelligence (AI) and machine learning (ML) are increasingly used in the diagnosis and management of bone metastases, spanning lesion detection, segmentation, prognostic modeling, fracture risk assessment, and surgical decision support. However, the literature is heterogeneous and rapidly evolving, making it difficult for clinicians to contextualize these developments. Methods: We performed a narrative review of the literature on AI/ML applications in bone metastasis management, focusing on studies that address clinically relevant problems such as detection and segmentation of metastatic lesions, prediction of skeletal-related events and survival, and support for reconstructive decision-making. We prioritized recent, peer-reviewed work that reports model performance and highlights opportunities for clinical translation. Results: Most published studies center on imaging-based diagnosis and lesion segmentation using radiomics and deep learning, with generally high internal performance but limited external validation. Emerging work explores prognostic models and biomechanically informed fracture risk estimation, yet these remain at an early proof-of-concept stage. Very few frameworks are integrated into routine workflows, and explainability, bias mitigation, and health-economic impacts are rarely evaluated. Conclusions: AI and ML tools have substantial potential to standardize imaging assessment, refine risk stratification, and ultimately support personalized management of bone metastases. Future research should focus on externally validated, multimodal models; development of AI-augmented alternatives to the Mirels score; federated multicenter collaboration; and routine incorporation of explainability and cost-effectiveness analyses. Full article

Using 2024 Eurobarometer survey data from 26,415 workers in 27 EU countries, this study examines how digital skills and employer transparency shape workers’ attitudes toward and perception of artificial intelligence (AI). Drawing on information systems and behavioral theories, regression analyses reveal that digital skills strongly predict augmentation-dominant attitude. Workers with higher digital skills view AI as complementary rather than threatening, with an augmentation attitude mediating 56% of the skills–perception relationship. Adjacently, employer transparency attenuates the translation of replacement attitude into a negative perception of AI in the workplace. Organizations and policymakers should prioritize digital upskilling and ensure workplace AI transparency requirements to foster a positive attitude and perception, recognizing that skills development and organizational communication are equally vital for the successful integration of AI in the workplace. Full article