Search Results (9,582)

Background: Most predictive models for assessing the invasiveness of pure ground-glass nodules (pGGOs) have been developed in Asian populations, which may limit their applicability to Western cohorts. As the detection of pGGOs continues to increase, there is a growing need for reliable, population-specific tools to support preoperative decision-making. Methods: This multicenter retrospective study analyzed patients from the GORDON database who underwent surgical resection for pGGOs < 40 mm between January 2013 and June 2024. Radiologic features were assessed using preoperative high-resolution and contrast-enhanced CT scans. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of invasive adenocarcinoma (IAC). A radiologic nomogram was developed and internally validated using a training (80%) and validation (20%) cohort. Results: A total of 490 pGGOs were included, of which 421 (85.9%) were IAC and 69 (14.1%) noninvasive (Adenocarcinoma in Situ or Minimally Invasive Adenocarcinoma). Upon multivariable analysis, maximum radiologic diameter (adjusted odds ratio [aOR] = 1.09, p = 0.001), spiculated margins (aOR = 3.07, p = 0.006), and unenhanced CT attenuation (aOR = 1.01, p < 0.001) were independent predictors of invasiveness. These variables were incorporated into a nomogram demonstrating good discrimination, with an area under the curve (AUC) of 0.86 (95% CI, 0.81–0.90) in the training cohort and 0.80 (95% CI, 0.70–0.90) in the validation cohort. Conclusions: A radiologic nomogram based on routinely available CT features enables accurate estimation of invasive adenocarcinoma risk in pGGOs. By integrating parameters beyond lesion size, this tool supports personalized management and may improve preoperative decision-making. Full article

Background/Objectives: Structured transition care models for adolescents with congenital heart disease (CHD) are increasingly advocated, but methodological evidence to support the design of adequately powered randomized trials remains limited. This pilot randomized study was designed primarily to assess the feasibility of repeated patient-reported outcome (PRO) collection and to generate empirical parameters for planning a future confirmatory trial, rather than to formally evaluate intervention efficacy. Methods: This was a single-center, parallel-group, pilot randomized controlled trial conducted at Meyer Children’s Hospital, Florence, Italy, within the TELEMACO project (NCT05713591). Twenty-three adolescents with CHD were randomized 1:1 to a structured transition care intervention (n = 11) or usual care (n = 12). PROs, including the SF-12 Physical (PCS12) and Mental (MCS12) Component Summaries, health engagement, life satisfaction, and healthcare needs, were collected at baseline and at 3, 6, 9, and 12 months. Pre-specified exploratory analyses addressed retention, missingness, linear mixed-effects models, intraclass correlation coefficients (ICCs), and sample size scenarios. Results: Retention at 12 months was 63.6% (intervention) and 58.3% (control), with substantially lower completion rates at intermediate assessments (T2–T3: 27–50%), directly affecting the reliability of longitudinal estimates at those time points. Mixed-effects models showed no significant time-by-group interaction for PCS12 (p = 0.13) or MCS12 (p = 0.39); unadjusted contrasts suggested nominally higher PCS12 values in the intervention group at selected assessments. ICCs were approximately 0 for PCS12 and 0.56 for MCS12, indicating fundamentally different variance structures. Conclusions: Repeated PRO collection was feasible, though retention across intermediate assessments was inconsistent. The pilot generated empirically grounded estimates for the design of a future confirmatory trial. Sample-size scenarios were highly sensitive to uncertainty in the PCS12 variability estimate, ranging from approximately 25 to 115 analyzable participants per group, depending on the true standard deviation. Within this pilot dataset, PCS12 at 12 months, analyzed cross-sectionally with baseline adjustment, emerged as a provisional endpoint option requiring further evaluation in an adequately powered confirmatory trial. Full article

Academically resilient students achieve high performance despite socioeconomic disadvantages. Although this population has received increasing attention, little is known about its motivational heterogeneity, a critical gap given the central role of motivation in persistence and success. Guided by Self-Determination Theory (SDT), this study examined motivational profiles among a population of academically resilient 10th-grade students in Italy (N = 15,751). Using a person-centered approach, Latent Profile Analysis (LPA) identified three profiles: a “multifaceted regulation resilient” profile (72%), marked by low amotivation and high levels across regulations; a “moderately amotivated resilient” profile (21%), with higher amotivation and lower levels of regulation; and a “strongly amotivated resilient” profile (7%), characterized by the highest amotivation and the lowest levels of regulation. Auxiliary analyses indicated that the amotivated profiles, particularly the “strongly amotivated resilient” profile, exhibited higher school dropout intentions than the “multifaceted regulation resilient” profile. Overall, although the majority of academically resilient students displayed multiple coexisting forms of regulation, a non-negligible subgroup showed significant motivational vulnerability, with amotivation emerging as a central risk factor. These findings challenge the assumption that academic resilience is sufficient to protect students from motivational disengagement and dropout risk. High academic achievement, in other words, should not be taken to imply the absence of motivational concerns. This highlights the importance of moving beyond a one-size-fits-all approach, recognizing that even within resilient populations, specific subgroups remain motivationally vulnerable and in need of tailored support. Full article

Background/Objectives. Country-level evidence on the economic footprint of home care nursing is still scarce, particularly in systems where tariffs for community-based nursing are lacking. In Italy, recent laws have expanded home care; yet planning and funding remain constrained by the absence of robust micro-costing evidence. Objectives. To estimate the accounting cost of home care nursing visits in Italy using a bottom-up micro-costing approach and to identify the main cost drivers influencing expenditure. Methods. A multicentre, cross-sectional study was conducted. Data were collected in two phases: (1) a national survey of 3949 home care nurses from 70 Local Health Authorities (April–October 2023), describing workload, travel time, and the most frequently performed activities; and (2) a time-and-motion study of 527 consecutive home visits performed by 83 nurses in three Local Health Authorities (March 2024). Direct costs were estimated from the Italian National Health Service perspective and included nursing time, travel time and transportation, back-office activities, and materials. Personnel costs were derived from national collective labour agreements and inflation-adjusted. A base-case scenario estimated accounting costs directly measured in the study. An extended, illustrative scenario explored the economic value of nursing activities by applying existing outpatient tariffs. Deterministic and probabilistic sensitivity analyses (10,000-iteration Monte Carlo simulation) were performed. Results. The mean accounting cost of home care nursing was €27.78 per patient per day. At the provider level, the corresponding daily cost per nurse was €190.00, assuming a mean caseload of 6.84 patients per nurse per shift. In the extended scenario, the imputed economic value of nursing activities increased the estimated daily cost to €120.81 per patient and €826.32 per nurse. Sensitivity analyses identified organizational factors (particularly the number of patients per shift and the number of activities per visit) as the dominant cost drivers, while material and transportation costs had a comparatively limited impact. Conclusions. Home care nursing in Italy appears to be delivered at a relatively low accounting cost, with organizational factors playing a greater role than unit prices in determining expenditure. The absence of a dedicated reimbursement framework for nursing activities may result in a substantial under-recognition of the economic value of home-based nursing care. These findings provide preliminary evidence to support workforce planning, reimbursement policies, and the sustainable development of territorial care services. Full article

Clear aligner therapy (CAT) increasingly relies on composite-based attachments to improve force transmission and aligner retention, yet the role of flowable composite properties in clinical performance remains poorly understood. In this study, five commercially available flowable composites used for orthodontic attachments—Aligner FLOW LC, SIMPLY SHADE, SOFT ENA Flow, TETRIC EvoFlow, and VENUS Bulk Flow One—were comparatively investigated through physicochemical, morphological, optical, thermal, and rheological characterization. Scanning electron microscopy coupled with energy-dispersive X-ray analysis, thermogravimetric analysis, UV–Vis–NIR and ATR–FTIR spectroscopy, and rheological measurements before and after curing were employed to probe composition, filler content, viscoelastic behavior, and mechanical response. The results revealed marked differences among the investigated materials, with post-curing storage modulus spanning nearly two orders of magnitude, from 0.06 MPa for SOFT ENA Flow to approximately 5 MPa for SIMPLY SHADE. Similarly, the elastic modulus ranged from about 20 MPa to nearly 1000 MPa for the softest and stiffest resins, respectively. Interestingly, SOFT ENA Flow, the softest material after curing, also exhibited the highest pre-curing viscosity, nearly one order of magnitude greater than the least viscous resin, Aligner FLOW LC. These findings highlight an intrinsic trade-off between pre-cure processability and post-cure mechanical stability, providing a rational framework for material selection in orthodontic attachments and supporting more predictable and durable CAT outcomes. Full article

Objective: To evaluate adverse effects associated with biologic therapy (Etanercept, Adalimumab, and Secukinumab) in patients with psoriasis, psoriatic arthritis, and hidradenitis suppurativa. Methods: This retrospective observational study included 58 patients receiving biologic therapy: 40 with generalized plaque psoriasis, 13 with psoriatic arthritis, and 3 with hidradenitis suppurativa. Eligibility was based on national treatment protocols (Psoriasis Area and Severity Index [PASI] > 10; Hurley stage II–III). Demographic data, treatment duration, therapy modifications, discontinuations, and adverse events were collected from medical records. Patients were monitored for both efficacy and safety outcomes. Results: Treatment discontinuation due to severe hepatotoxicity occurred in four patients (three receiving Etanercept and one Adalimumab), corresponding to 6.9% of the cohort. Adalimumab was discontinued in one patient due to cutaneous leishmaniasis after 24 months and in another due to pregnancy after 26 months. Upper limb edema was observed following a switch from Adalimumab to Secukinumab. One patient discontinued Etanercept due to lack of efficacy and subsequently died from a fatal methotrexate overdose. Treatment switches included Etanercept to Adalimumab for granulomatous uveitis (one case) and Adalimumab to Etanercept due to generalized urticaria (two cases). Conclusion: Adverse events were relatively infrequent, with an overall incidence below 10% (6.9% for the most common event and <2% for other events). Most adverse events were mild and reversible following dose adjustment or temporary discontinuation. No unexpected or fatal adverse events were directly attributable to biologic therapy. Full article

Antimicrobial resistance (AMR) is a growing global health concern driven by bacterial biofilm formation, which increases tolerance to treatments. Developing surface-based strategies to limit biofilm formation is therefore critical. Layered Double Hydroxides (LDHs) are 2D brucite-like nanomaterials with tuneable physicochemical properties that may reduce bacterial colonisation. Their ease of synthesis, with scalability potential for industrial production, alongside their characteristic and tunable physicochemical properties, makes them a promising nanostructured coating for antimicrobial applications. This study evaluates LDH thin-film coatings as intrinsic antimicrobial surfaces, focusing on the combined effects of chemical composition, nanotopography, and wettability on biofilm formation in Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. Four aluminium-based LDHs (ZnAl-NO₃, ZnAl-Cl₂, MgAl-NO₃, MgAl-Cl₂) were synthesised via coprecipitation or in situ growth on aluminium substrates. Materials were characterised by XRD, SEM, EDS, and contact angle measurements. Antimicrobial performance was assessed by quantifying colony-forming units (CFU mL⁻¹) after bacterial exposure. ZnAl-LDH surfaces showed significant antimicrobial activity against E. coli and S. aureus, while MgAl-LDHs showed no effect and occasionally increased bacterial growth. None of the LDH surfaces tested exhibited significant antimicrobial activity against P. aeruginosa strain. The antimicrobial performance of ZnAl-LDH can be attributed to the concurrent effect of the surface chemistry, wettability, and sharp platelet-like nanotopography. The results obtained demonstrate that ZnAl-LDH-based coatings are promising antimicrobial materials with potential relevance for translational research in clinical antimicrobial surface development. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition where many patients are given antibiotics like amoxicillin and macrolides (clarithromycin, azithromycin, roxithromycin) for bacterial infections. Recent concerns about clarithromycin’s potential link to cardiovascular events have arisen, despite its effectiveness against respiratory pathogens. This study aims to compare the cardiovascular risk of macrolide antibiotics versus amoxicillin in suspected COPD patients. Method: We used the Danish National Health Service Prescription Database (DNHSP) to identify COPD patients and their use of antibiotics. The included COPD patients were divided into four groups: amoxicillin users, roxithromycin users, clarithromycin users and azithromycin users. Data from multiple registries were merged to track hospitalizations, causes of death, and major adverse cardiovascular events (MACEs) as the primary endpoint. Patients were followed for a 3-year period. We applied adjusted Cox regression and sensitivity analyses with IPTW and IPCW to address confounders and censoring. Results: Our study involved 45,869 patients who were prescribed a long-acting muscarinic antagonist, over the age of 40 years old and who received one of the following antibiotics: amoxicillin, azithromycin, clarithromycin, or roxithromycin. No increased risk of MACEs was observed in macrolide-treated patients compared to those treated with amoxicillin (azithromycin: HR 0.97: 95% CI 0.83–1.13 p = 0.69, clarithromycin: HR 1.06 95% CI 0.87–1.28 p = 0.57, roxithromycin: HR 1.04 95% CI 0.91–1.18 p = 0.60), as confirmed by the sensitivity analysis (azithromycin: HR 0.95 95% CI 0.82–1.11 p = 0.52, clarithromycin: HR 1.05 95% CI 0.87–1.27 p = 0.60, roxithromycin: HR 1.05 95% CI 0.92–1.19 p = 0.48). Similarly, hazard ratios for all-cause mortality and cardiovascular death among the antibiotic groups showed no significant statistical differences. Conclusions: These findings suggest that there is no difference in the risk of MACEs, all-cause mortality, or cardiovascular death between the amoxicillin group and the macrolide group in a large and unselected population of COPD patients. Full article

Background: Antiphospholipid antibodies (aPLs) are essential for antiphospholipid syndrome (APS) diagnosis, which is based on clinical and laboratory parameters, including the detection of lupus-anticoagulant (LAC), anti-cardiolipin (aCL) and anti-β2-glycoprotein-I (aβ2-GPI) antibodies. The enzyme-linked immunosorbent assay (ELISA) is the reference methodology for classification criteria, although chemiluminescence immunoassays (CLIA) are more common in clinical practice. Methods: Since LAC reflects the functional activity of a large subset of antiphospholipids, through coagulation assays that enhance a phospholipid-dependent inhibitory effect, it has been used as a reference for assessing ELISA and CLIA reliability. Samples, separated into positive and negative LAC, were selected by CLIA detection in negative and positive IgG/IgM aCL and aβ2-GPI (cut-off > 20 U/mL). Results: The ELISA/CLIA comparison showed a 100% concordance in triple negative groups, highlighting an optimal analytical specificity; a higher concordance in the aβ2-GPI IgM-positive groups compared to positive aCL IgM (100% vs. 76% in LAC-positive groups; 82% vs. 71% in LAC-negative groups), as well as in aβ2-GPI IgM-negative groups compared to negative aCL IgM in LAC-positive groups (100% vs. 87.5%); and a massive concordance reduction in positive IgG aβ2-GPI and aCL groups (44% vs. 50% in LAC-positive groups; 4.8% vs. 4.5% in LAC-negative groups). Concordance increased in all groups with a higher CLIA cut-off (>50 U/mL). Conclusions: Although CLIA performances partly differed from ELISA, this does not preclude their use in APS diagnosis, which aims for higher sensitivity in detecting cases of disease. ELISA is confirmed to be more reliable for classification criteria that aim for high specificity to reduce false positives. Full article

This paper presents a wearable system based on low-cost inertial sensors for the continuous monitoring of driver motion and behavior under controlled urban driving conditions. The system consists of distributed wearable units placed on the head, neck, and torso, each equipped with an inertial measurement unit (IMU) that measures linear acceleration and angular velocity. The acquired data are processed in real time to characterize the driver’s kinematic response during vehicle operation. The main contribution of this work is the definition of a novel Driving Aggressiveness Index (DAI) for quantitative driving style assessment. The proposed index integrates motion-derived features based on acceleration and angular velocity and combines information from multiple body segments through a normalization and weighting strategy, enabling a compact and interpretable representation of driver behavior. Experimental validation was conducted in an urban driving scenario under controlled traffic-free conditions, including typical maneuvers such as straight driving, braking, roundabout navigation, lane changes, and yielding, performed under both normal and aggressive driving styles. The results demonstrate that the monitoring system captures distinct kinematic patterns and that the proposed index provides a clear and consistent separation between driving behaviors. A data-driven threshold is also defined, enabling the quantitative classification of driving styles. Overall, the proposed approach offers an interpretable, scalable, and real-time solution for driver monitoring, with potential applications in road safety and sustainable mobility. Full article

Pelvic xanthogranulomatous inflammation is a rare pathological entity that can closely mimic malignant disease on cross-sectional imaging, often leading to consideration of radical surgical intervention. We report the case of a 59-year-old woman who presented with a large retrovesical pelvic mass initially suspected to be a malignant process. A definitive diagnosis was established only after tissue biopsy and comprehensive histopathological examination, which excluded malignancy and demonstrated xanthogranulomatous histiocytic inflammation. In light of the lesion’s anatomical location and the substantial morbidity associated with surgical resection, a conservative medical strategy was pursued. Treatment with systemic corticosteroids and everolimus led to marked clinical improvement and a substantial radiological response, with reduction in lesion size from 41 × 26 mm to 27 × 17 mm, thereby allowing avoidance of mutilating surgery. This case underscores the critical role of biopsy and expert pathological assessment in guiding clinical decision-making and supports the consideration of non-surgical therapeutic approaches in selected patients with xanthogranulomatous pelvic lesions. Full article

Background: Aberrant glycosylation is closely associated with tumor progression, changes in the tumor microenvironment, and chemoresistance. This study aimed to identify prognostic sialylation-related genes in bladder cancer and define the role of ST3GAL6 in gemcitabine–cisplatin resistance. Methods: Molecular subtype analysis, prognostic analysis, and risk model construction were performed for sialylation-related genes using transcriptomic data and clinical information from the TCGA database. GC-resistant bladder cancer cell models were established for transcriptomic sequencing and untargeted metabolomic analysis. Cell proliferation and drug sensitivity assays were performed to evaluate the function of ST3GAL6. The regulatory relationship between IGF2BP3, ST3GAL6, and the PI3K pathway was further assessed by combining database analysis with molecular experiments. Results: Sialylation-related molecular patterns were associated with patient prognosis and tumor microenvironment features, particularly fibroblast-related characteristics, in bladder cancer. The key model gene ST3GAL6 was upregulated in bladder cancer tissues and was closely associated with prognosis. In GC-resistant bladder cancer cells, ST3GAL6 expression was significantly increased and accompanied by enhanced sialylation activity. ST3GAL6 promoted bladder cancer cell proliferation and reduced sensitivity to cisplatin and gemcitabine, at least in part through the PI3K-AKT-mTOR pathway. IGF2BP3 was also upregulated in resistant cells, is positively correlated with ST3GAL6, and may help maintain ST3GAL6’s expression by stabilizing its mRNA. Conclusions: Our findings suggest that aberrant sialylation is involved in bladder cancer progression and GC resistance. The IGF2BP3-ST3GAL6-PI3K/AKT/mTOR signaling axis may contribute to this process and may serve as a potential biomarker and therapeutic target in bladder cancer. Full article

(1) Background: Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide. Aberrant remodeling of the extracellular matrix (ECM) is a hallmark of GC progression; however, the mechanisms by which GC cells sense and exploit ECM cues remain unclear. (2) Methods: ITGA11 was identified through integrative bioinformatic analyses. Its expression, clinical significance, and association with ECM-related signatures were evaluated in GC tissues and public datasets. The function of ITGA11 and its role in regulating the FAK/PI3K/AKT/mTOR pathway were investigated using in vitro and in vivo assays, and the inhibitory effect of Naringenin on ITGA11-associated oncogenic activity was assessed. (3) Results: ITGA11 was upregulated in GC tissues and correlated with an ECM-related gene signature, aggressive clinicopathological features and poor patient survival. ITGA11 promoted malignant phenotypes of GC cells in vitro and in vivo. Importantly, molecular docking and target engagement assays suggested a potential interaction between Naringenin and ITGA11. Functional experiments showed that Naringenin attenuated ITGA11-associated oncogenic activity by reducing ITGA11 levels, suppressing pathway activation, and inhibiting malignant phenotypes. (4) Conclusions: Our findings identify ITGA11 as a potential prognostic biomarker and functional driver of GC progression and suggest that Naringenin may represent a promising bioactive compound for modulating the ITGA11/FAK/PI3K/AKT/mTOR axis in GC. Full article

Desmoplastic small round cell tumor (DSRCT) is a rare and highly malignant tumor that mostly occurs in young males. Due to its extremely strong invasiveness and poor prognosis, the treatment of DSRCT remains a major challenge in current medical research. The comprehensive treatment strategy based on surgery, combined with chemotherapy, targeted therapy, immunotherapy has become a clinical consensus. This review summarizes the main pathogenic mechanisms of DSRCT, as well as the targets involved in treatment and their applications, including targeted therapy targets (PDGF, VEGFR, FGFR4, IGF1R, HER2, c-KIT, mTOR, AR), immunotherapy targets (PD-1, PD-L1, B7H3, GD2), and treatments related to DNA damage response. Studies have shown that treatments targeting specific targets can inhibit tumor progression and prolong patient survival to a certain extent, but the efficacy has individual differences and is still limited. Therefore, future research still needs to further explore the molecular mechanism of DSRCT and discover more accurate and effective therapeutic targets. Full article

Avian metapneumovirus (aMPV) is a major respiratory pathogen of poultry with a significant economic impact; however, its epidemiology at the wildlife–poultry interface remains poorly understood, particularly within Afro–Eurasian migratory systems. This cross-sectional study (December 2024–April 2026) investigated aMPV occurrence in wild birds across eleven Egyptian governorates representing key ecological zones along major migratory flyways. A total of 1280 samples were collected from 800 wild birds representing migratory waterfowl and synanthropic species, including 800 oropharyngeal swabs tested by real-time RT-qPCR for aMPV subtypes A and B and 480 serum samples analyzed using indirect ELISA. aMPV RNA was detected in 28/800 samples (3.5%), with all positives identified as subtype B and confined to the Nile Delta, Middle Egypt, and Canal Region. In contrast, serological analysis revealed a high seroprevalence of 58.3% (280/480), indicating widespread prior exposure with significant spatial and species-level variation (p < 0.05). The marked disparity between low molecular detection and high seroprevalence supports transient infection with cumulative exposure. The exclusive detection of subtype B may reflect epidemiological connectivity between poultry and wild bird populations within shared ecological interfaces; however, the directionality of transmission and the possibility of independent wildlife maintenance could not be determined within the scope of the present cross-sectional study. Future studies incorporating whole-genome sequencing, longitudinal surveillance, and broader flyway-scale sampling are needed to resolve transmission pathways and distinguish field strains from potential vaccine-derived viruses within wildlife–poultry interfaces. Full article