Search Results (162,308)

Gestational Diabetes Mellitus (GDM) is the most common metabolic complication of pregnancy, affecting approximately 14% of pregnancies globally. Despite the frequent normalization of glycemic parameters immediately after delivery, GDM is an important precursor of subsequent chronic disease, increasing the risk of type 2 diabetes (T2DM). Current international guidelines suggest just a strictly observational approach during the immediate puerperium, recommending metabolic screening only between 6 and 12 weeks postpartum. This has contributed to the creation of a therapeutic “orphan window” where women receive no specific metabolic support, leaving their metabolic status unassessed and unmanaged. We postulate that the immediate postpartum period represents a critical window of “metabolic plasticity” where the abrupt cessation of placental hormones offers a unique opportunity to restore insulin sensitivity and promote “beta-cell rest” before the onset of irreversible dysfunction. Consequently, this narrative review and perspective examines the epidemiological urgency of the GDM-to-T2DM transition and provides a biological rationale for early pharmacological or nutraceutical intervention. Specifically, we discuss the limitations of metformin and present the hypothesis of myo-inositol combined with alpha-lactalbumin as a safe, lactation-compatible “bridging therapy” to preserve beta-cell function, improve compliance, and modify the natural history of diabetes in this high-risk population, highlighting that this theoretical proposal requires validation through future clinical trials. Full article

Recent climate changes worldwide have negatively impacted crop yields, highlighting the urgent need to develop new cultivation strategies to counteract this phenomenon. Our study aimed to analyze the effects of saline (0 mM, 100 mM, 200 mM, and 300 mM NaCl) and heat stress (24 °C and 32 °C) on the physiological parameters of Chenopodium quinoa variety “Regalona,” evaluating the efficacy of the microalgal biostimulant Chlorella vulgaris-like extract (0%, 0.025% and 0.05%). Sprouts grown under these different conditions were assessed for antioxidant content, antioxidant activity, reactive oxygen species, and photosynthetic pigments. The analyses did not reveal significant effects of the two microalgal concentrations on germination percentage or sprout length across the various temperature and salinity conditions. However, antioxidant activity was increased in many experimental trials, especially when the microalgae were combined with salt stress, with the higher biostimulant concentration showing more pronounced effects. Conversely, a temperature of 32 °C negatively impacted the parameters measured. These findings provide a basis for further research aimed at enhancing the antioxidant and nutraceutical properties of plants valuable for human nutrition. Full article

Purpose: The purpose of this study was to evaluate the feasibility of magnetic resonance imaging (MRI)-based radiomics derived from routine T2-weighted imaging for initial risk stratification in pediatric neuroblastoma (NB) and to explore its potential role as a noninvasive adjunct to established clinical and molecular classification systems. Methods: In this retrospective, single-center pilot study, 45 children with newly diagnosed NB (2015–2024) were analyzed. Primary tumors were manually segmented on baseline axial T2-weighted MRI. A total of 107 Image Biomarker Standardization Initiative (IBSI)-compliant radiomic features were extracted. Supervised machine learning classifiers (Random Forest, XGBoost) and dimensionality reduction approaches (principal component analysis [PCA], linear discriminant analysis [LDA]) combined with K-means clustering were evaluated. Model performance was assessed using stratified cross-validation and an independent test set. Reporting adhered to the Checklist for Evaluation of Radiomics Research (CLEAR). Results: Fifteen patients (33%) were classified as high-risk (HR) and 30 (67%) as non-high-risk (NHR) according to International Neuroblastoma Risk Group (INRG) criteria. The highest classification performance was achieved using LDA followed by K-means clustering, with a test accuracy of 77.8%, sensitivity of 64.7%, and specificity of 85.7%. Radiomic classification agreed with conventional risk stratification in 77.8% of cases. The analysis relied exclusively on T2-weighted imaging, supporting workflow feasibility without requiring contrast administration or advanced MRI sequences. Conclusions: In this single-center pilot study, T2-weighted MRI radiomics demonstrated feasibility for noninvasive initial risk stratification in pediatric NB. Although limited by sample size and the lack of external validation, these findings support further multicenter investigations of radiomics as an adjunctive imaging biomarker during early diagnostic evaluation. Full article

Hyaluronic acid (HA) is widely used in medical, cosmetic, and nutraceutical applications, yet the systemic fate of orally administered HA, particularly non-animal forms, remains poorly characterised. This study investigates the stability, absorption, metabolism, and biological effects of a novel fungal-derived HA extracted from Tremella fuciformis using a sequential in vitro multi-barrier model simulating human physiological compartments, including gastric, intestinal, hepatic, renal, chondrocyte, and keratinocyte environments. Across the gastrointestinal stages, fungal-derived HA demonstrated high structural stability, maintained molecular weight, and exerted superior antioxidant and anti-inflammatory activity compared with sodium hyaluronate. It efficiently crossed the intestinal barrier without increasing hyaluronidase activity, indicating protection from premature enzymatic degradation. In hepatic cells, fungal-derived HA exhibited reduced intracellular uptake and greater extracellular persistence, suggesting lower first-pass metabolism and suggesting improved persistence under in vitro conditions. At peripheral targets, it increased the cluster of differentiation 44 (CD44) expression and HA internalisation in chondrocytes and keratinocytes, supporting anti-inflammatory and pro-regenerative effects. Renal assessments revealed minimal excretion and no cytotoxicity, supporting potential systemic availability. Overall, these results provide the first integrated in vitro evidence describing the absorption, distribution, metabolism, and excretion process of fungal-derived HA. This supports the conclusion that this form of HA is stable, biocompatible, and bioactive with therapeutic potential for joint and skin health, as suggested by the in vitro models. Full article

Parasitic diseases pose significant challenges to the success of mariculture. The health management strategies used in sea-cage aquaculture are not completely effective at preventing parasites from entering through interactions with wild fish. This study monitored the health status of greater amberjack (Seriola dumerili, Risso 1810) over a two-month period following their introduction to the farm in the Middle Eastern Adriatic Sea in July 2019. Zeuxapta seriolae was detected on the gills after 722 degree days (DD), with a 28% prevalence, a mean abundance of 1.00 parasite per fish (four examined arches), and a mean intensity of 3.57 parasites per infected fish. From 985 DD, prevalence was 100%; the parasite burden continued to rise, and by the final sampling at 1535 DD, the mean abundance reached 212.68 parasites per fish (53.17 per gill arch). At that point, fish express a sudden loss of appetite; no external symptoms were observed, except for mortality. This is the first report of Z. seriolae in cultured greater amberjack in the Adriatic Sea, and the study emphasises the difficulties in applying effective biosecurity measures in floating net cages. Full article

Subadult flathead grey mullets (Mugil cephalus) were fed three experimental diets containing increasing percentages of partially defatted black soldier fly (Hermetia illucens, BSF) that proportionally replaced the protein sources in the reference diet. At the end of the feeding trial, fish growth and gut, liver and spleen histology were evaluated. BSF inclusion did not significantly affect growth performances in any dietary groups. However, Fulton’s condition factor was lower in fish who were fed diets with the highest replacement levels (15% and 20%; BSF15 and BSF20) compared to those fed the 10% replacement (BSF10) and the control diet (BSF0). Histological analyses revealed increased villi thickness and mucous cell proliferation in the intestine of fish from BSF10 and BSF15 groups. A significant worsening of intestinal condition was observed in fish from the BSF20 group. Liver histology was not affected, while a dose-dependent effect on spleen was observed in fish fed BSF inclusions. Despite the absence of enteritis signs, an increase in macrophages/like TNF-α+ cells in the intestine mucosa indicated immune stimulation in the BSF10 group. Results indicate, for the first time, a threshold for BSF meal inclusion in diets specifically formulated for flathead grey mullets. The BSF10 diet was optimal, as growth performance was not affected and intestine health improved at both morphological and innate immune system levels. Full article

Ready-to-eat (RTE) fresh salads are widely consumed for their convenience and nutritional value, but they could represent a relevant food safety concern, as they do not undergo a lethal heat treatment before consumption, and furthermore, they may support the growth of Listeria monocytogenes during refrigerated storage. In this study, the growth potential of L. monocytogenes was evaluated by standardised challenge tests in five commercially available RTE salads: crispy lettuce, baby lettuce, a baby lettuce–spicy mustard mix, and two mâche products from different producers. Three different batches for each product were inoculated with a three-strain cocktail of L. monocytogenes at a target level of approximately 2–3 log CFU/g and stored under conditions simulating reasonably foreseeable refrigerated storage (7 °C for approximately two-thirds of their shelf life, followed by 10 °C for the remaining one-third), in accordance with ISO 20976-1 and EURL L. monocytogenes guidelines. The growth potential (Δ) was calculated as the difference between the highest mean L. monocytogenes concentration observed during storage and the mean of the initial concentration at time zero, both in three replicate samples; Δmax was defined as the highest Δ value among the tested batches. Crispy lettuce, baby lettuce, and the mixed salad supported the growth of L. monocytogenes, with Δmax values of 2.33, 2.60, and 3.65 log CFU/g, respectively. In contrast, both mâche products showed Δmax values ≤ 0.5 log CFU/g, indicating an inability to support pathogen growth under the tested conditions. These results demonstrate that the growth potential of L. monocytogenes in RTE salads is strongly product-specific and likely influenced by intrinsic characteristics and background microbiota, as well as by storage temperature. The findings underline the importance of strict temperature control and product-specific risk assessment to ensure compliance with microbiological criteria throughout shelf life and to mitigate the risk of listeriosis associated with RTE salads. Full article

Background: Micronutrient deficiencies (MD) are highly prevalent among candidates for bariatric surgery (BS) and are associated with adverse perioperative and postoperative outcomes. Although guidelines recommend systematic preoperative screening and correction, conventional targeted supplementation (CTS) often requires multiple products, potentially limiting adherence and delaying surgical readiness. Bariatric-specific multivitamins (BSM) may simplify nutritional management, but their real-world effectiveness for preoperative correction of multiple MD remains insufficiently investigated. Objective: To compare the effectiveness, efficiency, and adherence of a BSM versus CTS for preoperative correction of multiple MD in BS candidates. Methods: This retrospective multicenter cohort study included 1560 adults with obesity evaluated for BS between 2020 and 2024 across three Italian bariatric centers. The primary efficacy analysis was restricted to patients presenting with ≥3 laboratory-confirmed MD at baseline. Patients treated between 2020 and 2022 received individualized CTS using multiple products, whereas those treated between 2023 and 2024 received a single BSM. Biochemical follow-up was scheduled at 4 and 8 weeks. The primary outcome was the achievement of complete biochemical correction of all baseline deficiencies at the predefined 4-week follow-up assessment (composite endpoint). Secondary outcomes included supplementation burden and self-reported adherence. Early correction rates were compared using absolute risk differences and risk ratios; adjusted associations were evaluated using multivariable regression models including center and baseline deficiency burden. As a supplementary analysis, the patient-level proportion of baseline deficiencies corrected at 4 weeks was also evaluated. Results: Among patients with ≥3 baseline deficiencies (n = 216), complete biochemical correction at 4 weeks was achieved in 55/134 patients (41.0%) in the BSM group and in 13/82 patients (15.9%) in the CTS group, corresponding to an absolute risk difference of 25.2 percentage points (95% CI 7.8–40.0) and a risk ratio of 2.59 (95% CI 1.51–4.44). In adjusted analyses accounting for center and baseline deficiency pattern, BSM use remained independently associated with early complete correction (adjusted absolute risk difference 26.3 percentage points; adjusted risk ratio 2.69). Sensitivity analyses restricting follow-up timing and excluding early calendar periods yielded consistent results. The mean proportion of baseline deficiencies corrected per patient at 4 weeks was higher in the BSM group compared with CTS (0.74 ± 0.25 vs. 0.54 ± 0.30). Compared with CTS, BSM was associated with lower supplementation burden (1 vs. 3.5 supplements on average) and higher adherence (92% vs. 70%). Conclusions: In a real-world multicenter cohort of BS candidates with ≥3 baseline MD, a simplified preoperative supplementation strategy based on a BSM was associated with a significantly higher probability of complete biochemical correction at 4 weeks, lower supplementation burden, and higher reported adherence compared with CTS. Although complete correction was not universal at 4 weeks, BSM significantly increased the likelihood of achieving early multi-deficiency normalization. Given the non-concurrent observational design, these findings should be interpreted as hypothesis-generating and warrant confirmation in prospective studies with concurrent cohorts. Full article

Cochlear implantation (CI) effectively restores hearing across the whole lifespan but may be followed by vestibular complaints, especially in adult recipients. The aim of this narrative review is to provide a comprehensive characterization of vestibular complaints after CI in adults, collecting clinical and instrumental data, as well as discussing the risk factors for their development. From data reported in the literature, we defined five recurring clinical presentations of postoperative vestibular disturbances (phenotypes): acute postoperative vestibular syndrome, benign paroxysmal positional vertigo (BPPV), delayed Ménière-like vertigo attributable to secondary endolymphatic hydrops, chronic postoperative disequilibrium, and stimulation-linked vertigo. According to the different pathogeneses underlying each presentation, the management of postoperative vestibular complaints should be phenotype-guided, including short-course vestibular suppressants and early mobilisation for acute presentations; canalith repositioning for BPPV; empiric therapy for hydropic-like episodes; and vestibular rehabilitation when imbalance is persistent, programming changes for stimulation-linked symptoms. Alongside this phenotype-driven approach, subjective symptoms are common across cohorts but are usually transient and persistent disability is uncommon. Furthermore, instrumental data across the studies indicate that objective abnormalities cluster in otolith and low-frequency canal measures: Cervical, ocular VEMP, and caloric responses are more often impaired than high-frequency canal function on vHIT, confirming histopathological studies showing preferential saccular involvement during the insertion of the electrode array. The risk of postoperative vestibular complaints not only appears to be modulated more by patient-related factors, especially pre-existing vestibular loss, but also by the aetiology of deafness, or age, rather than by device characteristics; atraumatic surgical approaches may further reduce this risk. This review emphasizes that future research on vestibular complaints after CI should adopt standardized phenotypes when evaluating symptoms, objective vestibular function, falls, and quality of life. Additionally, it should correlate these outcomes with hypothetical risk factors and detailed surgical reports. Full article

Background: Multiple myeloma remains an incurable malignancy in which patients ultimately experience relapses and refractory disease despite therapeutic advances. Triple-class exposed relapsed/refractory MM (TCE/RRMM) patients represent both a population with high unmet clinical needs and a substantial economic burden for the Italian National Health Service (NHS). Recently, BCMA-CD3 bispecific antibodies, including elranatamab and teclistamab, have expanded the treatment options for these patients. This study aimed to evaluate the cost-effectiveness of elranatamab versus teclistamab in adults with TCE/RRMM from the Italian NHS perspective. Methods: A partitioned survival model with three health states—progression-free survival, post-progression survival, and death—was developed over a 25-year lifetime horizon, adopting weekly cycles and a 3% annual discount rate. Clinical data for elranatamab were derived from the MagnetisMM-3 trial, while teclistamab outcomes were estimated through matching-adjusted indirect comparisons using MajesTEC-1 data. Direct medical costs included those associated with drug acquisition and administration, disease management, adverse event management, and end-of-life care. Utility values were obtained from EQ-5D-based assessments in MagnetisMM-3. Deterministic and probabilistic sensitivity analyses were performed to test model robustness. Results: Elranatamab yielded 3.31 life-years and 2.33 QALYs per patient, compared with 1.83 life-years and 1.27 QALYs for teclistamab. Total lifetime costs were lower for elranatamab (EUR 153,337) versus teclistamab (EUR 224,610), generating EUR 71,273 in savings. Thus, elranatamab is considered to be dominant, due to its higher efficacy and lower cost. Furthermore, the robustness of these findings was confirmed through sensitivity analyses. Conclusions: From the Italian NHS perspective, elranatamab represents a clinically superior and economically favorable option for patients with TCE/RRMM. The obtained results support its value and sustainability within the national treatment landscape. Full article

The objective of this paper is to propose a sociological and interdisciplinary framework for analyzing the digitization of emotions in adolescence. This contribution aims to promote theoretical reflection and inform educational and political interventions in the digital age, framing adolescents’ digital experiences as emotionally embodied and socially integrated processes. These aspects are of paramount importance due to the rapid proliferation of digital technologies and artificial intelligence, which have precipitated a profound transformation in the emotional, relational, and educational experiences of adolescents. The role of digital and AI-based environments in mediating communication is expanding beyond the scope of simple facilitation. These environments are increasingly implicated in the production, modulation, and regulation of emotions, thereby influencing developmental trajectories and identity formation processes. This phenomenon is theorized as a socio-technical process, wherein emotions are embodied, narrated, and governed within digital environments. The article introduces the concept of digital emotional embodiment, drawing on the sociology of emotions, theories of embodiment, and critical perspectives on artificial intelligence. Specifically, the concept refers to the manner in which adolescents experience and express emotions through avatars, images, emojis, algorithmic feedback, and AI-mediated interactions. Therefore, it is imperative to underscore the evolution of empathy, which is progressively configured as a virtualized and datafied process, diverging from the tradition established by Hume and characterized by sympathy. In contemporary processes, shaped by the logic of platforms, recommendation systems, and emotionally reactive technologies, conventional emotional concepts have undergone deconstruction, and digital constructs are undergoing a gradual restructuring. In this context, AI systems do not merely reflect adolescents’ emotions but rather actively contribute to the construction of emotional narratives, influencing emotional regulation, social connection, and future orientation. Digital environments have been shown to encourage emotional expressiveness, experimentation, and inclusivity. Conversely, they have the capacity to encourage emotional standardization, dependency, and forms of affective vulnerability, particularly during a sensitive developmental stage such as adolescence. Full article

It is difficult to capture the realities of the illicit antiquities market because of the lack of accessible, unsiloed data from underground trade networks. Despite existing literature on social network analyses and machine-learning experiments with antiquities data, there is a gap in simple open-source methodologies accessible to the non-academic public. By using a provenance-based analysis, we present a case study of the Italian antiquities trafficking networks that more fully captures their complexity. This study culls provenance data from repatriated antiquities gathered in the Museum of Looted Antiquities’ dataset to create a network visualization for analysis. Using open-source provenance and repatriation data from 1950 to July 2025, we built a dataset of 233 repatriation events with 15.858 objects to produce a network that reveals central actors, roles, and locations while staying within ethical privacy limits. This study captures large portions of the trafficking network by using accessible data and produces a reproducible, ethically framed workflow. Full article

Background: Epstein-Barr virus-related acute pharyngotonsillitis is common in children and adolescents and is generally managed successfully with positive outcomes by both ENT specialists and pediatricians. However, a variety of acute, life-threatening complications can occur, including upper airway obstruction and infectious or immune-mediated sequelae. Methods: This paper describes our recent experience with four pediatric patients presenting with severe ENT manifestations of infectious mononucleosis (IM) that led to life-threatening complications, all of whom were hospitalized and managed at our tertiary pediatric hospital between January 2022 and April 2025. Results: We report four cases (two boys and two girls) aged 5 to 16 years, hospitalized with complicated EBV-related pharyngotonsillitis. Presentations included respiratory distress (cases 1 and 2), hemophagocytic lymphohistiocytosis resulting in death (case 3), and a retropharyngeal abscess (case 4). Conclusions: The prognosis of IM in the pediatric population is generally favourable. However, acute, life-threatening complications may arise. In such cases, timely and coordinated multidisciplinary management involving ENT specialists, pediatricians, and anesthesiologists is crucial. Full article

Mapping land cover, monitoring its changes, and simulating future alterations are essential tasks for sustainable land management. These processes enable accurate assessment of environmental impacts, support informed policymaking, and assist in the planning needed to mitigate risks related to urban expansion, deforestation, and climate change. This study proposes a GeoAI-based framework leveraging Multilayer Perceptron (MLP), a class of Artificial Neural Networks (ANNs), to predict land cover changes in the Aosta Valley region (NW Italy). The model uses Copernicus Earth Observation data, specifically Sentinel-1 and Sentinel-2 imagery, and is trained and validated on land cover maps derived from different time periods previously validated with ground truth data. The objective is to provide a predictive tool capable of simulating potential future landscape configurations, supporting proactive regional land use planning including regulatory constraints under the current land use plan. Model performance is evaluated using accuracy metrics. The land cover classification methodology follows established approaches in the scientific literature, adapted to the specific geomorphological characteristics of the Aosta Valley. To explore and visualize potential future land cover transitions, Sankey and chord diagrams are used in combination with zonal statistics and thematic plots. These provide detailed insights into the intensity, direction, and magnitude of landscape dynamics. Training data were stratified-sampled across the study area, covering a diverse set of land cover classes to ensure robustness and generalization of the MLP model. This GeoAI approach offers a scalable and replicable methodology for anticipating land cover dynamics, identifying vulnerable areas, and informing adaptive environmental management strategies at the regional scale, while simultaneously considering the latest urban planning regulations. Full article

Background/Objectives: Cardiac rehabilitation (CR) is a cornerstone of secondary prevention, traditionally delivered through supervised center-based models. However, significant logistical barriers and high healthcare costs necessitate a paradigm shift. This review aims to assess the impact of emerging digital frontiers, specifically telerehabilitation (CTR) and artificial intelligence (AI), on overcoming these challenges and improving clinical outcomes. Methods: This study is a narrative, clinically oriented review informed by a structured search of PubMed/MEDLINE and EMBASE for literature published between January 2015 and January 2026. Results: Evidence indicates that CTR is non-inferior to center-based programs in terms of exercise capacity and quality of life (QoL). Digital tools, such as wearable devices and mobile health (mHealth) applications, have significantly increased program participation and improved adherence to lifestyle modifications. Furthermore, the integration of AI facilitates early detection of cardiac events and personalized exercise prescription, while prehabilitation models have been shown to reduce postoperative hospital stays. Conclusions: Digitalization of CR may represent a cost-effective alternative that bridges the gap in global access. While technology serves as an essential diagnostic partner, a robust regulatory and privacy framework is required to protect data sovereignty. Ultimately, multidisciplinary synergy between human expertise and digital innovation is important for providing an equitable and personalized pathway to recovery. Full article