Search Results (102)

Background: Appropriateness of diagnostic test prescriptions represents a critical component of quality care in pediatric allergology, directly influencing diagnostic accuracy, therapeutic decisions, healthcare resource utilization, and patient outcomes. A multidisciplinary expert panel was convened to develop evidence-based clinical recommendations addressing the appropriate use of specialist consultations and diagnostic investigations in children with asthma, allergic rhinoconjunctivitis, and vernal keratoconjunctivitis (VKC). Methods: Clinical questions were formulated using the PICO framework and prioritized through structured expert consensus. Systematic literature reviews were conducted across major databases, and the certainty of evidence was assessed using the GRADE methodology. Results: Specialist evaluation emerged as a key determinant of improved diagnostic precision, optimization of treatment strategies, and reduction of inappropriate therapies. In asthma, spirometry, FeNO measurement, and allergy testing contributed to enhanced diagnostic accuracy and better control. In allergic rhinoconjunctivitis, allergological assessment supported diagnosis and the selection of immunotherapy, with demonstrated benefits on symptoms and quality of life. For VKC, multidisciplinary specialist involvement facilitated early diagnosis, personalized management, and prevention of complications. Conclusions: Although the overall certainty of evidence ranged from moderate to low, consistent clinical benefits supported consensus-based recommendations. Implementation of these recommendations may improve care quality, promote equitable access to diagnostic resources, and reduce unnecessary healthcare utilization. Full article

Triangular mesh is one of the most widely used representations for 3D surfaces. However, high-resolution mesh models often contain a large number of triangles, leading to significant burdens in storage, transmission, and real-time rendering. Mesh simplification aims to reduce model complexity while preserving geometric fidelity and structural features. Classical methods, such as quadric error metrics (QEM), rely solely on local geometric errors, making them difficult to distinguish between redundant regions and structurally important features, often resulting in feature loss and topological degradation. To address these limitations, this study proposes a structure-aware triangular mesh simplification framework based on graph neural networks (GNNs)-guided QEM. GNNs are employed as a structural importance estimator to predict geometric saliencies of mesh edges. The predicted importances are incorporated into the classical QEM edge collapse cost through a soft modulation mechanism. Furthermore, a geometry-saliency-driven dynamic cost modulation strategy is designed, enabling the simplification process to prioritize critical features in early stages and gradually transition to global error minimization in later stages, without compromising the geometric optimality of QEM. In terms of model design, hybrid structural representation GNNs are constructed by integrating spectral geometry and a dual-branch architecture. Laplacian positional encoding is introduced to capture global topological information, while 1-hop and 2-hop message passing branches enable multi-scale representation of complex geometric structures. In addition, a staged inference strategy is adopted to dynamically update graph structural features during simplification, effectively mitigating topological drift. Experimental results on the TOSCA dataset demonstrate that the proposed method achieves stable performance across various simplification ratios. It consistently outperforms FQMS and QEM in terms of geometric error ($P_{CD}$) and normal consistency ($P_{NE}$). For structural preservation ($P_{LE}$), the method shows advantages, with win-rates generally exceeding 90%. Moreover, it significantly improves the preservation of local geometric details at low to moderate simplification ratios. In summary, the proposed method effectively enhances local structural preservation while maintaining global geometric topology, providing an interpretable and practical solution for integrating learning-based structural awareness with classical geometric optimization in mesh simplification. Full article

Background: Adolescents are at an increased risk for experiencing emotional reactions and interpersonal stressors, which can interfere with their access to gratitude. While gratitude is typically defined as an empathic or other-oriented emotion, personal distress is an aversive or self-oriented empathic reaction to others’ emotions or states, which can interfere with prosocial behavior. The goal of this study was to examine whether guilt proneness and gender moderate the prospective association between personal distress and later gratitude. Methods: The participants consisted of 111 early adolescents (61% females; M age = 12.74). Trait gratitude, personal distress (IRI—Personal Distress), and guilt proneness (TOSCA-A) were used as self-report measures. Using conditional process analysis (PROCESS Model 2), we tested whether Time 1 personal distress is associated with Time 2 gratitude, moderated by guilt and gender. Correlations showed that Time 2 gratitude was positively related to guilt but was not significantly related to personal distress. Results: The results indicated that personal distress was associated with lower Time 2 gratitude when guilt proneness was moderate to high, but not when guilt proneness was low. The association between personal distress and gratitude varied across levels of guilt proneness. Although conditional effects were examined separately for boys and girls, the interaction with gender was not significant and should be interpreted cautiously. The findings suggest that lower gratitude in adolescence may reflect distress–guilt dynamics rather than ingratitude itself. Conclusions: These findings highlight the importance of considering guilt proneness in future research on adolescents’ socioemotional development. Full article

Resveratrol is a polyphenol with numerous beneficial properties, acting as a phytoalexin. Plants produce resveratrol in response to various types of stress, such as infections and external damage. Resveratrol is a natural medicine thanks to its antimicrobial, antioxidant, anti-inflammatory, immunomodulatory, and antiallergic properties. However, resveratrol has poor oral bioavailability. To overcome this drawback, a topical nasal formulation has been developed, characterized by the fixed combination of carboxymethyl-β-glucan (CMBG) with trans-resveratrol. This innovative molecule has been the subject of in-depth preclinical studies to demonstrate its stability and solubility. Subsequently, several controlled clinical studies have shown that this formulation is effective and safe in patients with respiratory infections, allergic rhinitis, and nasal surgery. Therefore, taken together, these findings suggest that intranasal resveratrol–CMBG might be a promising option for the management of upper airway diseases. Full article

Background/Objectives: Zinc is an essential trace element involved in multiple aspects of immune function, including epithelial barrier integrity, innate and adaptive immune responses, regulation of inflammation and oxidative stress. Zinc deficiency has been associated with increased susceptibility to infections, particularly in the pediatric population. This narrative review aims to summarize and discuss current evidence on the role of zinc in the prevention and management of pediatric respiratory infections. Methods: A comprehensive literature review was conducted including randomized controlled trials, real-world studies, and international guidelines published in recent years. Both zinc monotherapy and multicomponent dietary supplements containing zinc were considered. Results: Evidence consistently supports a preventive role of zinc supplementation in reducing the incidence and burden of respiratory infections, particularly in children with recurrent disease and in zinc-deficient populations. Zinc-containing multicomponent supplements demonstrated significant reductions in infection frequency and duration, alongside improved patient and parent-reported outcomes, with a favorable safety profile. In contrast, data on zinc as an adjunctive treatment during acute infections, especially severe pneumonia, are less consistent, with limited impact on major clinical outcomes. The effectiveness of zinc appears to be influenced by treatment duration, baseline nutritional status, and formulation. Conclusions: In conclusion, zinc may represent a valuable component of preventive immune-nutritional strategies for pediatric respiratory infections, especially when administered as part of multicomponent formulations and over prolonged periods. While its role in acute disease management remains uncertain, optimizing zinc status may contribute to reducing infection recurrence and overall disease burden. Further well-designed trials are warranted to clarify optimal dosing, timing, and target populations. Full article

The introduction of Super-High-Density (SHD) olive orchards represents a crucial innovation in modern olive growing, enhancing sustainability. However, the long-term success of these planting systems depends strongly on cultivar selection, combining suitable vegetative and reproductive traits. This three-year field study investigated key floral biology parameters—flowering phenograms, gynosterility, and self-compatibility—of ten olive cultivars grown under irrigated conditions in southern Italy: ‘Arbequina’, ‘Arbosana’, ‘Cima di Bitonto’, ‘Coratina’, ‘Don Carlo’, ‘Frantoio’, ‘Favolosa’ (=‘Fs-17’), ‘I-77’, ‘Koroneiki’, and ‘Urano’ (=‘Tosca’). Flowering phenograms varied significantly across years and cultivars, showing temporal shifts related to chilling accumulation and yield of the previous year. Early blooming cultivars (‘Arbequina’, ‘Arbosana’, and ‘Coratina’) exhibited partial flowering overlap with mid-season ones, enhancing cross-pollination opportunities. Quantitative analysis of flowering overlap revealed that most cultivar combinations exceeded the 70% threshold required for effective pollination, although specific genotypes (‘Coratina’, ‘Fs-17’, and especially ‘I-77’) showed critical mismatches, while ‘Frantoio’ and ‘Arbequina’ emerged as the most reliable pollinizers. Gynosterility exhibited statistical differences among cultivars and canopy positions: ‘I-77’ showed the highest values (71.4%), while ‘Coratina’ and ‘Cima di Bitonto’ showed the lowest ones (7.3 and 8.4%, respectively). The median portions of the canopies generally displayed a greater number of sterile flowers (29.4%), reflecting the combined effect of genetic and environmental factors such as light exposure. In the inflorescence, the majority of gynosterile flowers were concentrated in the lower part, for all canopy portions (modal value). Self-compatibility tests were performed considering a fruit set of 1% as a threshold to discriminate. For open pollination, the fruit set was highly variable among cultivars, ranging from 0.5% in ‘I-77’ to 4.7% in ‘Arbosana’. Apart from ‘I77’, all varieties achieved a fruit set greater than 1%. Instead, for the self-pollination, only ‘Arbequina’, ‘Koroneiki’, ‘Frantoio’, and ‘Cima di Bitonto’ could be identified as pseudo-self-compatible, whereas ‘Coratina’, ‘Fs-17’, and the others were clearly self-incompatible and therefore unsuitable for monovarietal orchards in areas with limited availability of pollen. By integrating self-compatibility and gynosterility data, the cultivars were ranked according to reproductive aptitude, identifying ‘Cima di Bitonto’ and ‘Frantoio’ as the most fertile genotypes, whereas ‘Don Carlo’ and particularly ‘I-77’ showed severe genetic sterility constraints. The findings underline the critical role of floral biology in defining reproductive efficiency and varietal adaptability in SHD systems. This research provides valuable insights for optimizing cultivar selection, orchard design, and management practices, contributing to the development of sustainable, climate-resilient olive production models for Mediterranean environments. Full article

Background/Objectives: Evidence-based recommendations are vital in healthcare to standardize care, reduce variability, and improve patient outcomes. In children, anaphylaxis, allergy to antibiotics, and hymenoptera venom allergy are among the commonest reasons for allergological evaluation. This work was intended to optimize the prescriptions for allergological evaluation and for the related diagnostic tests with the aim of improving the management of children with allergic diseases and promoting resource efficiency. Methods: A systematic literature review of the literature was performed to formulate recommendations on the diagnostic management of children with anaphylaxis, drug allergy, and hymenoptera venom allergy. Results: Effective management of anaphylaxis involves rapid assessment and specialist follow-up to identify triggers, prevent recurrence, and ensure patients and caregivers are educated and equipped with an adrenaline auto-injector. Integrating skin testing, specific serological assays, and oral provocation tests into the diagnostic process for children with suspected beta-lactam allergy enhances diagnostic accuracy and minimizes unnecessary avoidance of first-line antibiotics. Children and adolescents with systemic reactions to hymenopteran stings should be referred to an allergy specialist for diagnosis, risk assessment, management education, and adrenaline prescription. Conclusions: These recommendations may enhance care quality, minimize inappropriate prescriptions, and support standardized methods of diagnosis of allergological diseases in children. Full article

Background: Pediatric proximal humerus fractures (PHFs) typically heal well due to their strong remodeling potential, supporting non-operative management even in displaced injuries. However, surgery for Neer–Horowitz grade III–IV fractures has become more frequent despite limited evidence of superior outcomes. Methods: A retrospective analysis of 152 children (<14 years) treated for isolated PHFs at a tertiary pediatric orthopedic center (2004–2023) was performed. Clinical records and telephone follow-up provided demographic data, fracture classification, management, complications, and functional outcomes (QuickDASH, Tegner, return to sport). A direct cost analysis compared conservative and surgical pathways. Results: Of 152 patients, 133 were treated non-operatively and 19 surgically. Conservative management achieved excellent results across all fracture types: nearly all patients reported normal QuickDASH scores and full shoulder function. Among Neer III–IV fractures (n = 37), functional outcomes, activity levels, and sport resumption were similar between treatment strategies. Minor transient issues (pin migration, temporary stiffness, delayed return to sport) occurred only after surgery. No meaningful complications were observed in the conservative cohort. Mean costs differed substantially: €1452.09 for non-operative management versus €7832.12 for surgical treatment. Conclusions: Long-term outcomes of pediatric PHFs were uniformly excellent, regardless of fracture severity or treatment modality. Surgery did not improve recovery, function, or return to sport and was associated with higher costs and minor postoperative issues. Conservative management should remain the standard of care for nearly all pediatric PHFs, with surgery reserved for exceptional circumstances such as open fractures, neurovascular compromise, or failed closed reduction. Full article

Catapult systems enable Unmanned Aerial Vehicles (UAVs) to take off without runways and must therefore meet key requirements such as safety, reliability, portability, efficiency, and durability. These systems contain mechanically complex components that are subjected to substantial dynamic loads during operation. This study examines the topology optimization of a UAV catapult launch bracket using the SIMP and BESO methods to achieve a structurally efficient design compatible with additive manufacturing. The bracket was analyzed under axial compression and bending moments representative of launch conditions. SIMP was implemented through the Abaqus Tosca infrastructure, while the BESO optimization employed an Abaqus (2018)–Matlab (2024B) interface supported by automated Python (3.13.0) scripts. The optimized design achieved a 51% reduction in volume, with a 52% increase in maximum von Mises stress and an 8% increase in displacement, yet all stresses remained below the yield strength of AA7075. Manufacturability was assessed in terms of wall thickness, overhang angles, and support requirements, confirming suitability for SLM-based production. The results show that SIMP produces smoother material distribution, whereas BESO converges more quickly, and both approaches provide manufacturable and structurally reliable solutions for lightweight aerospace components. Full article

Introduction: The neutrophil–lymphocyte ratio (NLR) has proven to be an inexpensive and easily available inflammatory marker for cardiovascular disease. The aim of the present study is to evaluate a possible association between preoperative NLR value and endovascular aneurysm repair (EVAR) outcomes. Methods: A multicentric retrospective study of patients undergoing EVAR in elective setting between 2015 and 2023 was performed. Preoperative NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count, and a cut-off of 5 was used as threshold for the analysis. Primary outcomes (technical success, endograft occlusion, AAA-related reintervention, endoleaks, and mortality rates) were compared between the NLR < 5 and the NLR > 5 group. Kaplan–Meier survival analysis was employed to assess overall survival and the incidence of long-term complications. Results: The study initially considered 1360 patients. Eventually, 823 patients were included in the study, of whom 129 (15.7%) with NLR > 5. The latter group presented a higher AAA diameter (59.1 mm vs. 55, mm; p = 0.004). Technical success was obtained in 98,9% of all enrolled patients. NLR values were significantly associated with ASA class (p = 0.014), involvement of the iliac arteries (p = 0.023), duration of ICU stays (p < 0.001), and overall length of hospitalization (<0.001). At Kaplan–Meier analysis, patient with NLR > 5 showed a significant lower survival rates (p = 0.006), while no significant differences were found in terms of endograft occlusion (p = 0.45), AAA-related reintervention (p = 0.63), and endoleaks (p = 0.49). Conclusions: This study highlights the association between the NLR value and an elevated risk of long-term mortality, highlighting its role as an indicator of the patient’s overall clinical condition rather than immediate surgical outcomes. Focusing on this selected group of patients can improve postoperative care and reduce long-term complications. Full article

Background/Objectives: Juvenile hallux valgus (JHV) and flexible flatfoot (FFF) often coexist in children, yet their combined surgical management remains poorly explored. This study evaluates clinical and radiographic outcomes following a simultaneous approach using lateral hemiepiphysiodesis of the first metatarsal (LHFM) and calcaneal-stop (C-Stop) procedures in skeletally immature patients. Methods: A retrospective cohort of 24 bilateral patients (48 feet) aged 10–12 underwent LHFM and C-Stop between 2017 and 2023. Radiographic evaluation included Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Meary’s angle (MA), and transverse TaloCalcaneal (Kite’s) Angle (tTCA). The Foot and Ankle Disability Index (FADI) and the Tegner Activity Scale (TAS) were administered at the most recent follow-up and complications were recorded. Results: The mean follow-up was 3.7 years. Postoperative radiographs showed significant improvements in all parameters, with correction inversely correlated to baseline deformity severity. Full normalization of flatfoot parameters was achieved in 68.8% of feet, with mild residual deformity in the remainder. Males showed greater radiographic correction than females. IMA and HVA improved in most cases, reaching full normalization in 53.1% and 50% of feet, respectively. Clinically, all patients showed corrected hindfoot alignment and medial arch restoration; 90% achieved the maximum FADI score and 88% resumed recreational sports. Two cases of screw migration occurred, with one revision; no further complications were reported. Conclusions: Simultaneous correction of FFF and JHV using C-Stop and LHFM proved effective, yielding significant radiographic improvements and excellent functional outcomes in most cases, with minimal complications. However, full hallux alignment was achieved in only half of the cases, suggesting that additional distal metatarsal procedures may be needed for more severe deformities. Full article

Background: Large Language Models (LLMs) have driven significant advances in artificial intelligence (AI), with transformative applications across numerous scientific fields, including biomedical research and drug development. However, despite growing interest in adjacent domains, their adoption in pharmacometrics, a discipline central to model-informed drug development (MIDD), remains limited. This study aims to systematically explore the potential role of LLMs across the pharmacometrics workflow, from data processing to model development and reporting. Methods: We conducted a comprehensive literature review to identify documented applications of LLMs in pharmacometrics. We also analyzed relevant use cases from related scientific domains and structured these insights into a conceptual framework outlining potential pharmacometrics tasks that could benefit from LLMs. Results: Our analysis revealed that studies reporting LLMs in pharmacometrics are few and mainly limited to code generation in general-purpose programming languages. Nonetheless, broader applications are theoretically plausible and technically feasible, including information retrieval and synthesis, data collection and formatting, model coding, PK/PD model development, support to PBPK and QSP modeling, report writing and pharmacometrics education. We also discussed visionary applications such as LLM-enabled predictive modeling and digital twins. However, challenges such as hallucinations, lack of reproducibility, and the underrepresentation of pharmacometrics data in training corpora limit the actual applicability. Conclusions: LLMs are unlikely to replace mechanistic pharmacometrics models but hold great potential as assistive tools. Realizing this potential will require domain-specific fine-tuning, retrieval-augmented strategies, and rigorous validation. A hybrid future, integrating human expertise, traditional modeling, and AI, could define the next frontier for innovation in MIDD. Full article

Cancer patients have not been included in landmark trials of SGLT2is in heart failure, so data on safety and effectiveness are lacking. TOSCA is a multi-center observational trial including patients with active cancer receiving SGLT2is for HF treatment. The primary endpoint was safety, and the secondary endpoint was effectiveness. Exploratory endpoints included drug–drug interactions, treatment of cancer therapy-related cardiac dysfunction (CTRCD), and changes in NT-proBNP. One-hundred and twenty-nine patients (median age 72 [range 44–92] yrs) were enrolled who had been receiving SGLT2i for a median of 3 (range 3–25) months. Prevalent etiology was drug-induced HF with HFrEF as the most frequent clinical presentation. The incidence of urinary tract infections was 1.8%, with no cases of genital infections, hypoglycemia, diabetic ketoacidosis, acute renal injury, thrombosis, or bone fractures. The mean overall EF increased (40.3% vs. 47.4%), and NYHA class improved in 19% of cases. Rates of unplanned cardiology visits (0.9%), use of i.v. diuretics (0.9%), coronary angiography (4.5%), emergency access for HF (1.8%), and new HF episodes (3.6%) were extremely low. In 11 cases (8.5%), the initiation of SGLT2i enabled continuation of anticancer therapy that would have otherwise been delayed or suspended due to HF decompensation. SGLT2is appeared effective in 34 cases of CTRCD. No drug–drug interactions were reported. SGLT2is confirmed their safety and effectiveness in active cancer patients with HF, with a potential cardioprotective effect. No new safety warnings were recorded. Full article

Accurate correspondence of complex neuroanatomical surfaces under non-rigid deformations remains a formidable challenge in computational neuroimaging, owing to inter-subject topological variability, partial occlusions, and non-isometric distortions. Here, we introduce the Dynamic Graph Analyzer (DGA), a unified hybrid framework that integrates simplified structural descriptors with spatial constraints and formulates matching as a global linear assignment. Structurally, the DGA computes node-level metrics, degree weighted by betweenness centrality and local clustering coefficients, to capture essential topological patterns at a low computational cost. Spatially, it employs a two-stage scheme that combines global maximum distances and local rescaling of adjacent node separations to preserve geometric fidelity. By embedding these complementary measures into a single cost matrix solved via the Kuhn–Munkres algorithm followed by a refinement of weak correspondences, the DGA ensures a globally optimal correspondence. In benchmark evaluations on the FAUST dataset, the DGA achieved a significant reduction in the mean geodetic reconstruction error compared to spectral graph convolutional netwworks (GCNs)—which learn optimized spectral descriptors akin to classical approaches like heat/wave kernel signatures (HKS/WKS)—and traditional spectral methods. Additional experiments demonstrate robust performance on partial matches in TOSCA and cross-species alignments in SHREC-20, validating resilience to morphological variation and symmetry ambiguities. These results establish the DGA as a scalable and accurate approach for brain shape correspondence, with promising applications in biomarker mapping, developmental studies, and clinical morphometry. Full article

Pediatric asthma and allergic rhinitis are prevalent chronic inflammatory diseases ruled by complex interactions among genetic, environmental, and nutritional factors. Zinc, an essential trace element, plays a crucial role in immune modulation, oxidative stress regulation, and epithelial barrier maintenance, all of which are significant in the context of allergic airway diseases. This review aimed to explore and synthesize current evidence on the biological mechanisms and clinical implications of zinc in pediatric asthma and allergic rhinitis. A comprehensive literature search was conducted through PubMed and the Cochrane Library for studies published between 2015 and 2025. Eligible studies included observational and interventional research focused on zinc status or supplementation in children with asthma or allergic rhinitis. Numerous observational studies and meta-analyses indicated reduced circulating zinc levels in children with asthma, often correlating with poor symptom control, increased oxidative stress, and lower pulmonary function. In allergic rhinitis, zinc depletion in nasal mucosa was associated with elevated local inflammation, although paradoxical increases in zinc concentrations have been observed in nasal secretions during active disease. Interventional trials in pediatric asthma populations showed that zinc supplementation may improve clinical symptoms, reduce inflammation, and enhance lung function, although the results were inconsistent and limited by methodological variability. In conclusion, zinc plays a multifactorial role in modulating immune responses and maintaining mucosal health in pediatric allergic airway diseases. While zinc supplementation holds promise as a safe and accessible adjunctive therapy, further high-quality randomized controlled trials are needed to define its clinical utility and establish evidence-based guidelines. Full article