Search Results (42)

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic, multisystemic disorder characterized by severe, persistent fatigue not alleviated by rest and worsened by minimal exertion, often accompanied by post-exertional malaise (PEM), unrefreshing sleep, cognitive dysfunction, and autonomic disturbances. Despite decades of research, its pathophysiology remains incompletely understood, and skeletal muscle involvement has only recently gained attention. This review aims to provide a historical and pathophysiological synthesis of ME/CFS, emphasizing the pivotal role of skeletal muscle in the onset and persistence of symptoms, and to integrate molecular, cellular, and pathophysiological evidence into a coherent explanatory framework. This is a narrative review of published literature (1990–2025) with critical integration of clinical, biochemical, and experimental data on oxidative stress, mitochondrial dysfunction, Excitation–Contraction (E-C coupling) dysregulation, and muscle secretome alterations in ME/CFS also in relation to post-viral syndromes (e.g., Long COVID). Evidence consistently points to mitochondrial oxidative stress, redox imbalance, impaired Ca²⁺ handling, and altered signaling pathways in skeletal muscle of patients with ME/CFS. Historical milestones show an evolution from psychogenic interpretations toward recognition of ME/CFS as a biological disorder with neuromuscular and metabolic underpinnings. ME/CFS can be interpreted as a skeletal muscle–metabolic disorder characterized by oxidative distress, mitochondrial dysfunction, and impaired energy regulation, leading to the clinical picture of exercise intolerance and post-exertional malaise. Integrating basic and clinical research through a translational approach provides the foundation for new diagnostic tools, targeted therapies, and biomarkers. Full article

The Marnoso-arenacea basin (MaB) of the Northern Apennines represents one of the most significant lower–middle Miocene foredeep turbidite systems in the Mediterranean region. While the northern part of the basin (Emilia-Romagna Region) has been extensively investigated, the Umbrian portion remains less understood, particularly concerning high-resolution stratigraphic and structural frameworks. This study integrates detailed field mapping, physical stratigraphy, biostratigraphic data from calcareous nannofossils, and petrographic analyses of arenites and calcarenites to reconstruct the tectono-stratigraphic evolution of the MaB in the Umbrian portion of the basin. The basin is divided into three main tectono-stratigraphic units: Afra-Mt. Verde, Pietralunga–Gubbio–Valtopina and Mt. Vicino. The middle unit is detailed by means of stratigraphic architecture and sedimentary characteristics, which allow us to identify two distinct sub-units. Several carbonate and hybrid turbidite beds, including the Contessa megabed, serve as regional key markers, enabling robust stratigraphic correlations. Two mass-transport complexes (MTDs) have been identified and dated, revealing close relationships between sedimentation patterns and thrust propagation. Modal petrographic data indicate a mixed provenance, from the Alpine and Apennine regions, changing over time in response to tectonic segmentation. These findings enhance our understanding of the internal organization of the MaB and provide new insights into the foredeep’s paleogeography and tectono-sedimentary evolution during the Langhian–Serravallian stages. Full article

Vulvar viral infections such as condyloma acuminata, genital herpes, molluscum contagiosum, and Lipschütz ulcers span both sexually and non-sexually transmitted diseases and affect patients across all age groups. Lesions may present as papules, verrucous growths, or painful ulcers, often causing functional impairment and significant psychosocial distress. A multidisciplinary strategy that integrates epidemiology, precise diagnostics, individualized therapy, and psychological support is essential to optimize outcomes. We performed a structured literature search in PubMed, Scopus, and Web of Science using terms “vulvar viral infection,” “HPV,” “HSV,” “molluscum contagiosum,” and “Lipschütz ulcers.” International guidelines from the UK, Europe, and Australia were reviewed, alongside reference lists of key articles. Particular attention was given to paradoxical presentations, pediatric considerations, and cost-effectiveness analyses. HPV vaccination programs have markedly reduced anogenital warts, while early PCR/NAAT for HSV accelerates targeted antiviral therapy. First-line treatments like oral acyclovir/famciclovir for HSV and topical imiquimod or podophyllotoxin (±cryotherapy) for HPV are supported by adjunctive measures for self-limiting conditions. Host factors (hormonal cycles, immune status) and local irritants modulate recurrence risk, informing anticipatory suppressive regimens and barrier-reinforcing care. Validated patient-reported outcome measures (VPAQ, DLQI, FSFI) capture pain, sexual function, and quality-of-life impacts. Health–economic evaluations underscore the long-term value of rapid diagnostics and broad vaccination. Personalized, multidisciplinary management that combines prevention, precision diagnostics, tailored therapy, psychosocial support, and economic considerations offers the greatest promise for improving clinical and quality-of-life outcomes in patients with vulvar viral infections. We aim to outline best practices for the diagnosis and management of common vulvar viral infections, providing practical guidance for clinicians to improve recognition and therapeutic decision-making. Full article

Background and Objectives: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide and, beyond its oncogenic potential, may impair reproductive health in both sexes. This review examines HPV’s effects on male and female fertility, obstetric outcomes, vertical transmission, and fertility-sparing management in oncology. Materials and Methods: A systematic search of PubMed, Embase, and Scopus was conducted using terms related to HPV and reproduction. Additional search terms included those related to therapeutic vaccines, antivirals, and genotype prevalence. English-language human studies reporting clinical reproductive outcomes were included. Thirty-seven studies met the inclusion criteria. Two reviewers independently screened and assessed study quality using a simplified GRADE framework. Results: In men, seminal HPV infection correlates with reduced progressive motility (SMD ≈ −0.85), abnormal morphology, and increased DNA fragmentation. In women, high-risk HPV doubles the odds of infertility (OR ≈ 2.3) and is associated with endometrial involvement. High first-trimester viral load predicts vertical transmission (aOR 6.4), which is also increased by vaginal delivery (RR 1.8) and is linked to PROM (OR 1.8) and preterm birth (OR 1.8). Modeling suggests that nine-valent vaccination plus 5-year HPV-based screening could reduce CIN2+ by up to 80% and excisional treatments by >75%. Fertility-sparing surgery in early cervical cancer yields a <4% recurrence and up to 68% live birth rates. Conclusions: This review uniquely synthesizes reproductive and oncologic impacts of HPV and emphasizes risk stratification, multidisciplinary prevention, and fertility preservation. Integration of HPV DNA quantification, personalized care, and vaccine-based strategies offers a path toward optimized outcomes in both sexes. Full article

The Gubbio Revisited project, initiated to reinterpret the archaeological evidence collected during the 1980s Gubbio Project, primarily by a conversion from a paper to a digital record, has revealed significant insights into the evolving settlement patterns and religious expression in the Gubbio valley in Central Italy. This reanalysis of the survey evidence underscores the rhythms of settlement and ritual practice from the Neolithic through the Bronze and Iron Ages, into Roman times. Key excavations in the 1980s at Monte Ingino, Monte Ansciano, San Marco Romano, and San Marco Neolitico added details not only of settlement activity but also of embedded ritual, evidenced by material culture including pottery, faunal remains, and votive offerings. The foundation myth of indigenous religious practices, even amidst Roman influence, is documented through the Iguvine Tables alongside the introduction of new cults, showcasing a blend of local and imperial religiosity, a common feature in the Roman world. This research enriches the understanding of Gubbio’s historical and cultural landscape, emphasizing the demographic rhythms of the valley alongside the integral role of ritual in its societal evolution. Full article

Atrial fibrillation (AF) represents the most common sustained arrhythmia necessitating dual focus: acute complication management and sustained longitudinal oversight to modulate disease progression and ensure comprehensive patient care over time. AF is a multifaceted disorder; due to such a great number of potential exacerbating conditions, a multidisciplinary team (MDT) should manage AF patients by cooperating with a cardiologist. Effective management of AF patients necessitates the implementation of a well-coordinated and tailored care pathway aimed at delivering optimized treatment through collaboration among various healthcare professionals. Management of AF should be carefully evaluated and mutually agreed upon in consultation with healthcare providers. It is crucial to recognize that treatment may evolve due to the emergence of new risk factors, symptoms, disease progression, and advancements in treatment modalities. In the context of multidisciplinary AF teams, a coordinated approach involves assembling a diverse team tailored to meet individual patients’ unique needs based on local services’ availability. Full article

Aortic stenosis (AS) represents a notable paradigm for cardiovascular (CV) and geriatric disorders owing to comorbidity. Transcatheter aortic valve replacement (TAVR) was initially considered a therapeutic strategy in elderly individuals deemed unsuitable for or at high risk of surgical valve replacement. The progressive improvement in TAVR technology has led to the need to refine older patients’ stratification, progressively incorporating the concept of frailty and other geriatric vulnerabilities. Recognizing the intricate nature of the aging process, reliance exclusively on chronological age for stratification resulted in an initial but inadequate tool to assess both CV and non-CV risks effectively. A comprehensive geriatric evaluation should be performed before TAVR procedures, taking into account both physical and cognitive capabilities and post-procedural outcomes through a multidisciplinary framework. This review adopts a multidisciplinary perspective to delve into the diagnosis and holistic management of AS in elderly populations in order to facilitate decision-making, thereby optimizing outcomes centered around patient well-being. Full article

Pulmonary vein isolation (PVI) with catheter ablation (CA) represents an effective therapy for atrial fibrillation (AF). Unfortunately, it is still not exempt from severe complications. The balance of risks and benefits should be assessed, and a patient-tailored approach is desirable. So far, several clinical and cardiac imaging parameters have been evaluated to investigate pre- and post-procedural features that could help clinicians in the selection of patients at high risk of a poor outcome after CA. This clinical and systematic review analyses the potential role of new LA parameters, such as LA reservoir strain, to predict AF recurrence after CA therapy. Notably, LA reservoir strain gains substantial clinical importance in patients with paroxysmal AF and when a low CHADS2-VASc score is retrieved. LA reservoir strain provides data concerning the risk of AF recurrence after PVI and, thus, in the management of long-term medical therapy in this patient’s group. Full article

A survey was conducted from 2018 to 2023 to assess the presence of Salmonella in 280 hunted wild boar (carcasses after evisceration and skinning, N = 226; liver, N = 258; and fecal samples, N = 174). The overall prevalence was 2.86% (confidence interval 95%, 1.45–5.45%) with five positive samples detected in carcasses, three in the liver, and one in a fecal sample. This prevalence was in line with those found in nearby areas denoting a low number of positive samples. Positive animals were over 24 months of age and weighed, before skinning, 59.00 ± 9.11 Kg and no difference was detected in microbial loads between samples positive and negative for Salmonella (aerobic colony count of 4.59 and 4.66 log CFU/400 cm², and Enterobacteriaceae count of 2.89 and 2.73 log CFU/400 cm² (mean values) in positive and negative subjects, respectively). Salmonella Stanleyville was the most frequently isolated serotype. A semiquantitative risk assessment was conducted for the first time in game meat considering two products, meat cuts intended for cooking and fermented dry sausages. Only proper cooking can reduce the risk of ingestion of Salmonella to the minimum for consumers, whereas ready-to-eat dry sausages constitute risk products in terms of foodborne Salmonellosis (risk score of 64 out of 100). Full article

Digital health, encompassing the use of digital technologies in healthcare, and telemedicine, facilitating healthcare delivery across long distances, have witnessed widespread applications across various healthcare domains. The COVID-19 pandemic accelerated the adoption of digital solutions in healthcare, overcoming barriers to access and fostering transitions to new care models. However, healthcare professionals often lack digital health competencies, necessitating targeted training initiatives. This study presents a project initiated by the Order of Physicians and Dentists of Rome, promoting a comprehensive training program in digital health for healthcare professionals. This investigation aims to describe the project, report demographic characteristics of participants, and analyze survey results on participants’ perceptions of the training program. The Erasmus+ project, titled ‘Training of Physician Trainers in Telemedicine, eHealth, and Digital Medicine,’ facilitated the digital transition of the healthcare sector through international training. The project involved structured courses, job-shadowing, and support activities in Malta and Madrid. A survey, developed using the Delphi methodology, assessed participants’ views on telemedicine. Thirty participants, selected based on merit, engaged in the project. Survey responses highlighted a strong impact on participants’ understanding of digital health concepts and increased confidence in utilizing digital tools. Notably, 85% acknowledged significant skill acquisition in healthcare digitalization. The project addressed a critical training gap among healthcare professionals, emphasizing the need for ongoing education in digital health. Despite existing recommendations, formal digital health education remains limited. The study underscores the importance of educational efforts to foster a digitalized healthcare model. Full article

The present work deals with the acoustic analysis of the Roman theatre of Gubbio, located in Italy, which has already been the subject of architectural studies. Using four specific scenarios, acoustic simulations were carried out to highlight the contributions of different architectural elements to the acoustic response of this open-air theatre. The results were evaluated assuming that unamplified classical music and prose were the main functions of the space, as was the case in the past. The simulated results show that the values of the main acoustic parameters are closer to the optimal ranges borrowed from studies on enclosed theatres, since no criteria are available for Roman theatres. The comparison among different scenarios highlights the poor acoustic response of the existing conditions for a performing arts space. Some suggestions are presented regarding how the outcomes of this research study should be employed. Full article

Background: Lower physical activity, lower alcohol intake, higher protein intake, higher sodium intake, and lower potassium intake related to greater kidney function decline over time, according to previous studies. The present study aimed to analyze the cumulative effects of these factors. Methods: This prospective, observational, population-based cohort study included 3039 adult examinees of the Gubbio study who participated in the baseline exam and 15-year follow-up exam. Kidney function was evaluated as estimated glomerular filtration rate (eGFR). Habitual physical activity in leisure time and habitual alcohol intake were assessed by questionnaires; dietary intakes of protein, sodium, and potassium were assessed by urinary markers. Based on previous reports, each one of the five modifiable factors was scored 0 for the tertile associated with smaller eGFR decline (low risk), 2 for the tertile associated with greater eGFR decline (high risk), and 1 for the intermediate tertile (intermediate risk). A cumulative score was calculated as the sum of the factor-specific scores and used as the main independent variable. Results: The cumulative score ranged from 0 to 10, that is, from low risk for all factors to high risk for all factors (skewness = 0.032, mean ± SD = 5 ± 2). To avoid the bias of low-n analyses, score 0 was re-coded as 1 and score 10 was recoded as 9; after re-coding, the cumulative score ranged from 1 to 9 (skewness = 0.016, mean ± SD = 5 ± 2). The cumulative score related to annualized eGFR change in multi-variable linear regression (slope = −0.027, 95%CI = −0.039/−0.014, p < 0.001); findings were consistent in apparently healthy examinees and other subgroups. De novo incidence of eGFR < 60 mL/min × 1.73 m² was higher along the cumulative score (p < 0.001). Compared to score 1 (n examinees = 35, adjusted incidence = 2.0%), incidence of low kidney function was 4.5 times higher in score 5 (n examinees = 624, adjusted incidence = 8.9%) and 6.5 times higher in score 9 (n examinees = 86, adjusted incidence = 12.9%). The cumulative score related to incidence of low kidney function in multi-variable logistic regression (odds ratio = 1.19, 95%CI = 1.08/1.32, p < 0.001). Conclusions: The combination of five modifiable factors predicted large differences in long-term incidence of low kidney function. Full article

Recent advances in computing performance and simulation tools allow today the development of high-fidelity computational models which accurately reproduce the structural behavor of existing structures. At the same time, advancements in sensing technology and data management enable engineers to remotely observe monitored structures in a continuous and comprehensive way. Merging the two approaches is a challenge recently addressed by the engineering research community, which led to the concept of digital twin (DT)—a simulation model continuously fed by sensor data which, throughout the whole lifespan of the structure, stands as its digital proxy. In the seismic field achieving such a task is still problematic, in particular for large and complex structures such as historical masonry palaces. To this aim, the paper proposes the integrated use of DTs and vibration data to support the seismic structural health monitoring of monumental palaces, discussing a practical application to the historical Consoli Palace in Gubbio, Italy. To overcome the computational limitations of classical approaches, an efficient equivalent frame (EF) model of the palace is built and continuously updated in quasi real-time based on modal information identified from vibration data. The performance and accuracy of the Equivalent Frame model are compared with those of a high-fidelity Finite Element representation, highlighting both their feasibility and limitations. Employing modal data recorded across the 15 May 2021 earthquake, the EF model demonstrates the ability to quickly assess the structural integrity of the palace in the post-earthquake scenario, as well as to forecast the residual capacity with respect to future seismic events. Full article

The Murcielago gold placer is located in the Lepaguare Valley, Olancho Department (Central Honduras). The placer mineralogy includes silicates (quartz, garnets, amphibole, Ca-pyroxene, micas, epidote, and tourmaline); calcite; and in the heavy fraction, zircon, ilmenite–rutile, magnetite, hematite, cassiterite, and cinnabar. Gold grains recovered from the Murcielago placer production plant are mainly flattened grains with a moderately to high elliptical shape. The composition of the gold grains varies continuously in the range Au${}_{46}$Ag${}_{54}$ to Au${}_{88}$Ag${}_{12}$. Few of them are characterized by Au-rich rims of a few microns in size (Ag 3-1 atoms percent (at%)). Gold from the Canan lode deposit, a nearby hydrothermal Au mineralization area, has a composition (from Au${}_{54}$Ag${}_{44}$ to Au${}_{81}$Ag${}_{19}$) overlapping the composition of the Murcielago grains. Inclusions in the alluvial gold particles are arsenopyrite, pyrite, acanthite, sphalerite, and hematite. On the basis of the placer mineralogy and the gold grains analyses, possible gold source(s) include the Canan lode and skarn gold deposits in the area. We obtained new data on the Murcielago gold placer that will be the basis for an exploration of the potential sources of gold in the area. Full article

With the Clean Energy for all Europeans legislative package, the European Union (EU) aimed to put consumers “at the heart” of EU energy policy. The recast of the Renewable Energy Directive (RED II) acknowledged the importance of energy communities for the energy transition and introduced new provisions for renewable energy communities (RECs), empowering them to participate in the energy market. This article analyses the progress of transposing and implementing key provisions of the RED II that apply to RECs in nine European countries and focuses on timeliness and completeness of transposition. It comprises both a qualitative and quantitative assessment covering (1) the definition, rights, and market activities of RECs; (2) key elements of enabling frameworks; and (3) consideration of REC specificities in support schemes for renewable energy. The analysis shows considerable variation in transposition performance between the analysed countries. The authors investigate the reasons for this variation and relate them to findings of European implementation and compliance research. Key factors identified include actor-related and capacity-related factors, institutional fit, and characteristics of the RED II itself. Future research in this field needs multi-faceted avenues and should pay particular attention to the influence of national governments and incumbents, not only in the transposition process, but already in upstream policy formulation at the European level. Full article