Search Results (85)

Background: Psoriasis involving difficult-to-treat anatomical areas, such as the scalp, genitalia, fingernails, and palmoplantar regions, carries a disproportionate disease burden and often requires systemic therapy. In this context, real-life data comparing the long-term effectiveness of tildrakizumab 100 mg versus 200 mg in patients with difficult-to-treat psoriasis remain limited. Methods: This multicenter retrospective observational study included adult patients in three Italian dermatology centers. Global efficacy endpoints included PASI75, PASI90, PASI100, and absolute PASI ≤ 2 at weeks 16, 32, 52, and 104. Site-specific effectiveness was assessed as complete clearance (PGA = 0) in patients with baseline involvement (PGA ≥ 2) of difficult-to-treat areas. Outcomes were described by dose. Results: 183 patients were included (100 mg: n = 89; 200 mg: n = 94). Patients receiving 200 mg had higher baseline BMI and were more frequently biologic-experienced. At week 104, PASI75 was achieved by 94.2% of patients receiving 100 mg and 94.7% receiving 200 mg, while PASI90 and PASI100 were achieved by 82.7% vs. 57.9% and 48.1% vs. 47.4%, respectively. Clearance of difficult-to-treat areas improved progressively across all sites. Scalp and genital psoriasis showed higher and earlier clearance rates, whereas nail and palmoplantar psoriasis showed slower and more heterogeneous responses. No consistent dose-dependent advantage emerged, despite less favorable baseline characteristics in the 200 mg group. Conclusions: Over 104 weeks, tildrakizumab showed sustained long-term effectiveness in both global disease control and difficult-to-treat areas. The 200 mg dose, used in a more difficult-to-treat population, achieved comparable long-term outcomes, supporting dose optimization in clinical practice. Full article

Germline genetic testing plays a critical role in diagnosing inherited predispositions and increasingly guides therapeutic and surveillance choices—but becomes technically challenging after allogeneic hematopoietic stem cell transplantation (HSCT), when donor-derived DNA contaminates host tissues. To address this, we compared donor-derived DNA across three accessible tissues—buccal swab, nail, and eyebrow follicles—in recipients after hematopoietic stem cell transplantation using two orthogonal assays (34-SNP next-generation sequencing and a 27-marker short tandem repeat panel) and modeled clinical covariates that influence chimerism. Eyebrow follicles showed consistently low donor DNA (median 1% by NGS; 3% by STR) whereas buccal swabs and nails carried substantially higher donor fractions (+25 and +22 percentage points versus eyebrow, respectively; both p < 0.01). Across methods, STR yielded on average ≈6 percentage points higher donor fractions than NGS at low-level chimerism. Several transplant covariates correlated with chimerism: matched-related donors and a perfect HLA match (10/10) were each associated with lower donor DNA (≈12–14 and 15–20 percentage points, respectively); longer times since hematopoietic stem cell transplantation correlated with lower levels for nail samples, and donor–recipient sex match correlated with higher donor DNA (~7–8 percentage points). Even low-level chimerism can distort germline variant interpretation. We propose a pragmatic protocol for post-hematopoietic stem cell transplantation germline testing that prioritizes eyebrow follicles as the default tissue. An SNP-based quality control assay is used to flag unsafe donor fractions (≥ 5–10%) before comprehensive germline analysis, reducing the risk that chimeric donor DNA distorts germline variant interpretation. Full article

Background/Objectives: Cement augmentation of cephalomedullary head elements can improve the purchase of osteoporotic bone; however, it does not eliminate the need for accurate implant positioning or the preservation of sliding. We report the case of an 87-year-old woman who underwent intramedullary nailing with a cement-augmented helical blade for intertrochanteric fracture. Methods: This is a single-patient case report. Calibrated radiographic measurements—tip–apex distance (TAD), calcar-referenced TAD (CalTAD), neck–shaft angle (NSA), and telescoping—were obtained immediately postoperatively and at 4, 7, 12, and 15 months. CT was performed at postoperative week 1 and at failure, and MRI was performed for clinical deterioration. In addition, a targeted narrative review summarizes the evidence on the head-element position, sliding behavior, reduction alignment, and augmentation. Results: Immediate postoperative indices were within the accepted targets: TAD 22.6 mm, CalTAD 22.8 mm, NSA 134°, with the head element inferior on the anteroposterior view and central on the lateral view. Rehabilitation proceeded with full weight bearing as tolerated. Early telescoping was minimal (3.8–3.9 mm). Between 7 and 15 months, progressive varus with shortening of TAD/CalTAD and little additional telescoping was observed, radiographically consistent with relative proximal migration of the head–cement complex and a cleavage plane along the inferior cement mantle, culminating in a subcapital femoral neck fracture with the implant in situ. Emphasis should be placed on accurate implant positioning and preservation of sliding capacity, because cement augmentation alone may not prevent mechanical failure when the implant position or load transfer is suboptimal. Conclusions: Cement augmentation stiffens the interface and reduces micromotion but does not neutralize malposition-induced stresses. Accurate positioning, preservation of sliding, and timely conversion when sliding fails to progress are advisable; these findings are hypothesis-generating from a single case. We propose a position- and sliding-based decision guide to support clinical decision-making; its usefulness remains to be validated in larger studies. Full article

Background/Objectives: Acral melanoma (AM) is a rare and aggressive melanoma subtype that arises on sun-shielded, non-hair-bearing skin of the palms, soles, and nail beds. Although more common among individuals of non-European descent, AM remains underrecognized and understudied in the Middle East and North Africa (MENA). This study presents the first dedicated AM registry from Lebanon, aiming to characterize clinical, histopathological, and molecular features and evaluate diagnostic, referral, treatment approaches, and clinical outcomes over a 12-year period. Methods: This retrospective cohort study was conducted at the American University of Beirut Medical Center (AUBMC), a major tertiary referral center in the MENA region. All melanoma cases diagnosed between January 2012 and January 2024 were identified through electronic health records. From this cohort, all adult patients (≥18 years) with biopsy-confirmed AM or tumors located on the palms, soles, or under the nails were selected. Results: Our cohort consisted of 26 adult AM patients, identified from a total of 331 melanoma cases during the study period (8%). Median age at diagnosis was 58.5 years; 54% were female; and 96% of Middle Eastern origin. Most tumors were plantar (81%), and over half (53%) were diagnosed at early stages (Stage I–II). Surgery was performed in 92% of patients, yet 55% had positive margins. Sentinel lymph node biopsy was performed in 46%, and 35% received immunotherapy. Only 35% underwent molecular testing, identifying BRAF mutations in 11% of those tested; no patients received circulating tumor DNA analysis. At a median follow-up of 24.5 months, recurrence occurred in 27%, and metastasis developed in 23%. At the last follow-up, 92% were alive. Conclusions: Despite early-stage detection, high rates of positive margins and limited molecular testing reveal care gaps. This first national registry highlights the need to improve surgical management and expand access to precision oncology in the region. Full article

Engineered wood products have become key sustainable alternatives to conventional building materials, offering strong potential for reducing climate impacts in the construction sector. This review systematically assesses recent life cycle assessment studies on engineered wood products to compare their environmental performance and support low-carbon building practices. The peer-reviewed literature published over the past decade was analyzed for publication trends, geographic focus, and methodological approaches, including goal and scope definition, life cycle inventory, and life cycle impact assessment. Comparative analyses examined climate change impact and key parameters influencing environmental outcomes. Results indicate a steady growth of research in this field, led by China, the United States, and Europe. Volume-based functional units (e.g., 1 m³) are predominant in structural wood studies, while mass-based units are more common for composites. Cradle-to-gate boundaries are most frequently used, and data are primarily drawn from Ecoinvent, Environmental Product Declarations, and regional databases such as GaBi and CLCD. Common impact assessment methods include CML-IA, ReCiPe, and TRACI, with climate change identified as the core impact category. Cross-laminated timber and glue-laminated timber consistently show lower and more stable climate change impacts, while fiberboards exhibit higher and more variable results due to adhesive content and energy-intensive manufacturing. Key factors influencing environmental outcomes include service life, wood species, and material sourcing. The review highlights the need for standardized methodologies and further exploration of emerging products, such as nail-laminated and dowel-laminated timber and laminated bamboo, to improve comparability and inform sustainable design practices. Full article

Introduction: Onychophagia, commonly known as nail-biting, is a chronic and repetitive behaviour disorder characterised by a compulsive/habitual nature. Obsessive–compulsive disorder (OCD) and onychophagia present a noteworthy intersection in clinical psychiatry. With a paucity of clinical investigations on this topic, we decided to perform a study on onychophagia in OCD. Materials and Methods: In this cross-sectional investigation, the sample comprised patients (aged 18 years and older) having a primary diagnosis of OCD (DSM-5) and a score on the Yale–Brown Obsessive–Compulsive Scale of at least 16 (moderate OCD). Individuals were referred to the Department of Neuroscience at the University of Turin. Analysis of the data was performed using JASP (Version 0.16.3), a freely available statistical programme created by the University of Amsterdam (JASP Team, 2022). Statistical value was set at p < 0.05. Results: Our sample consisted of 603 individuals with OCD, and onychophagia was present in 52 of the cases, with a prevalence of 8.6% (95% CI: 6.5–11.2%). Individuals with OCD and onychophagia had some specific clinical features compared to patients with only OCD. The main difference was detected in terms of the presence of autism spectrum disorder (ASD): in the group of patients having OCD and onychophagia, a prevalence of ASD as high as 96.2% was identified, compared to 18.0% in the OCD-without-onychophagia group. Discussion: Onychophagia is a relatively common problem in patients with OCD, with almost one individual out of ten experiencing this issue. OCD and onychophagia, when both present, might define a peculiar clinical phenotype with specific characteristics. The extremely high frequency of ASD in patients with OCD and onychophagia (96.2%) might be very useful information for clinicians, who should pay particular attention to screening for autism in this cohort of individuals. Full article

Background/Objectives: Liquid nitrogen-treated frozen autograft is a biological reconstruction method developed at Kanazawa University for malignant bone tumors. However, nonunion between the treated autograft and host bone remains a complication. In this study, we aimed to identify factors influencing bone union in patients undergoing this procedure for osteosarcoma of long bones in the lower extremities. Methods: We retrospectively analyzed 35 osteosarcoma patients (mean age: 18.0 years) with lower limb long bone tumors treated with frozen autograft between 1999 and 2023. Factors assessed included sex, age, tumor location, fixation method (plate or intramedullary nail), technique (pedicle or free freezing), chemotherapy, and bone union. Results: Nonunion occurred in 6 cases: 2/25 with plate fixation (8.0%) and 4/10 with intramedullary nails (40%). The mean union time was shorter with plates (5.8 months) than with nails (7.2 months). Intramedullary nail use was significantly associated with nonunion (p < 0.05). Among plate fixations, nonunion occurred in 5.6% of multiple plates versus 14.3% of a single plate. Conclusions: Intramedullary nail fixation is associated with nonunion in biological reconstructions of long bones, consistent with previous reports. Multiple-plate fixation after frozen autograft with liquid nitrogen for osteosarcoma of the lower limb long bone should be considered. Full article

Background: Lichen planus (LP) is a chronic immune-mediated inflammatory disorder affecting skin, mucosae, nails, and appendages, often with significant impact on quality of life. While associations between oral LP (OLP) and other localizations have been described, comprehensive analyses of patients presenting with multiple LP localizations remain limited. The aim of the study was describing the association of multisite LP among our patients in order to contribute to knowledge about this rare, but possible, clinical situation and its clinical implications in terms of follow-up. Methods: We conducted a retrospective observational study including 44 adult patients with histologically confirmed OLP and at least two additional LP subtypes. Data were collected at the joint dermatology–oral pathology clinic of Policlinico Sant’Orsola Malpighi, Bologna, between January 2022 and December 2024. Demographic characteristics, clinical manifestations, comorbidities, and therapeutic approaches were analyzed. Results: The cohort comprised 31 women and 13 men (mean age at first LP diagnosis: 56 years). All patients presented OLP, predominantly erosive (73%). During a follow-up, 39 patients developed three LP subtypes, and 5 patients developed four LP subtypes. Cutaneous LP was universal, while mucosal involvement included genital LP (n = 23), esophageal/pharyngeal/laryngeal LP (n = 8), and vulvar lichen sclerosus (n = 6). Nail LP was diagnosed in seven cases and frontal fibrosing alopecia in ten cases. Autoimmune comorbidities were frequent, including thyroiditis, psoriasis, systemic sclerosis, lupus, and Sjögren’s syndrome. First-line therapy consisted of topical and systemic corticosteroids, with adjuvant retinoids, cyclosporine, or immunosuppressants in refractory cases. No malignant transformation or dysplasia was detected during the observation period, and the mean follow-up period was 24 months (range: 12–36 months). Conclusions: Multisite LP is a complex, underrecognized condition requiring multidisciplinary management. OLP frequently represents the initial manifestation, followed by progressive involvement of cutaneous and mucosal sites. Regular full-body, oral, and genital examinations, together with tailored systemic treatments, are essential to prevent scarring sequelae and improve quality of life. Our findings highlight the need for heightened clinical vigilance and integrated care pathways for patients with multi-site LP. Full article

Background: Tibial distal diaphyseal–metaphyseal junction (DDMJ) fractures are rare in children and pose therapeutic challenges due to their morphology and risk of displacement. This study compared the clinical, radiological, and economic outcomes of elastic stable intramedullary nailing (ESIN), plate fixation, and Kirschner wire (K-wire) fixation. Methods: A retrospective review was conducted on 64 patients (6–15 years) treated between 2014 and 2023. Patients were grouped according to fixation method. Demographic, operative, radiographic, functional (AOFAS), complication, and cost data were analyzed. Results: The K-wire group, plate group, and ESIN group consisted of 27, 19, and 18 patients, respectively. The mean follow-up duration was 18.03 ± 6.87 months. Of the patients, 38 were male and 26 were female. Concomitant fibula fractures were present in 43 patients and were not present in 21 patients. AOFAS scores were highest in the plate group at the 4th month, while they were similar in all groups in the subsequent follow-ups. The costliest method was plate (2517.64 ± 104.83 $) (p = 0.001). Conclusions: All three fixation methods provided satisfactory long-term outcomes. Plate fixation offers faster early recovery but at higher cost and risk of soft-tissue complications; ESIN balances stability and invasiveness; K-wire is economical but less stable. Treatment choice should be individualized according to fracture pattern, patient factors, and resource availability. Full article

This work presents the development of a Z-depth system for Confocal Raman Spectroscopy (CRS), which allows for the acquisition of Raman spectra both at the surface and at depth profile in heterogeneous samples. The proposed CRS system consists of the coupling of a commercial 785 nm Raman Probe Bifurcated (RPB) with a 20x/0.40 infinity plan achromatic polarizing microscope objective, a Long Working Distance (LWD) of 1.2 cm, and a 50 μm core-multimode optical fiber used as a pinhole filter. With this implementation, it is possible to achieve both a high spatial resolution of approximately 16.2 μm and a spectral resolution of ∼14 cm⁻¹, which is determined by the FWHM of the thin 1004 cm⁻¹ Raman profile band. The system is configured to operate within 400–1800 cm⁻¹ spectral windows. The implementation of a system of this nature offers a favorable cost–benefit ratio, as commercial CRS is typically found in high-cost environments such as cosmetics, pharmaceutical, and biological laboratories. The proposed system is low-cost and employs a minimal set of optical components to achieve functionality comparable to that of a confocal Raman microscope. High signal-to-noise ratio (SNR) Raman spectra (∼660.05 at 1447 cm⁻¹) can be obtained with short integration times (∼25 s) and low laser power (30–35 mW) when analyzing biological samples such as in vivo human fingernails and fingertips. This power level is significantly lower than the exposure limits established by the American National Standards Institute (ANSI) for human laser experiments. Raman spectra were recorded from the surface of both the nails and fingertips of three volunteers, in order to characterize their biological samples at different depths. The measurements were performed in 50 μm steps to obtain molecular structural information from both surface and subsurface tissue layers. The proposed CRS enables the identification of differences between two closely spaced, centered, and narrow Raman bands. Additionally, broad Raman bands observed at the skin surface can be deconvolved into at least three sub-bands, which can be quantitatively characterized in terms of intensity, peak position, and bandwidth, as the confocal plane advances in depth. Moreover, the CRS system enables the detection of subtle, low-intensity features that appear at the surface but disappear beyond specific depth layers. Full article

Background: Benign bone tumors and tumor-like lesions in the proximal femur increase the risk of pathological fractures, often requiring surgical intervention. However, no consensus exists on the optimal treatment strategy. We developed a structured approach to guide the selection of implant types (compression hip screw [CHS] or intramedullary nail [IMN]) with or without bone grafting. This study aims to validate our treatment strategy through a retrospective analysis and a review of previous surgical outcomes. Methods: We sought to validate this strategy through a retrospective analysis of 16 patients (6 males and 10 females, mean age at surgery 37.4 years [range, 16–64 years]) with primary benign bone tumors or tumor-like conditions of the proximal femur, including the femoral head and neck. Curettage and synthetic or autologous bone graft was performed according to our treatment flowchart, utilizing either CHS or IMN for internal fixation. We compared the blood loss, operative time, time to full weight bearing, and perioperative complications between the CHS and IMN groups. Results: Blood loss did not significantly differ between the CHS and IMN groups (p = 0.11), but the operative time was significantly longer in the CHS group (p < 0.01). Two CHS cases experienced local recurrence, while no postoperative fractures were observed in either group. The median time to full weight bearing was 5 weeks, consistent with previous reports. No perioperative complications were noted. Conclusions: Our strategy achieved favorable clinical outcomes. IMN was selectively used in patients with non-aggressive benign tumors not involving the femoral head and neck, yielding good results with reduced surgical invasiveness, while in those patients with aggressive disease involving the head and neck, CHS was more appropriate. This approach may serve as a practical guide for surgical decision-making in benign proximal femoral bone tumors. Full article

Keratin, a fibrous structural protein, has been employed as a biomaterial for hemostasis and tissue repair due to its structural stability, mechanical strength, biocompatibility, and biodegradability. While extensive research has focused on developing scaffolds using keratin extracted from various sources, no studies to date have explored the use of keratin derived from human nail clippings. In this study, keratin was extracted from human nail clippings using the Shindai method and used to fabricate and compare two types of scaffolds for bone tissue engineering via the freeze-drying method. The first scaffold consisted of keratin combined with gelatin (KG), while the second combined keratin, gelatin, and hydroxyapatite (HAp) (KGH), the latter synthesized from blood cockle clam shells using the wet precipitation method. Physicochemical characterization and surface morphology analysis of keratin and both scaffolds showed promising results. Tensile strength testing revealed a significant difference in Young’s modulus. The KG scaffold exhibited higher porosity, water uptake, and water retention capacity compared to the KGH scaffold. In vitro biocompatibility studies revealed that the KGH scaffold supported higher cell proliferation compared to the KG scaffold. This study demonstrates the potential of using human nail-derived keratin in composite scaffold fabrication and serves as a foundation for future research on this novel biomaterial source. Full article

This paper reports on the failure of cells with lithium iron phosphate (LFP) chemistry tested under a range of conditions to understand their effect on the volume and composition of gas generated. Cells of the following formats, 26,650, pouch, and prismatic, and capacities ranging from 3 to 230 Ah, were subjected to external heat, overcharge, and nail penetration tests. Gas volume was calculated, and the following gases analysed: H₂, CO₂, CO, CH₄, C₂H₄, C₂H₆, C₃H₆, and C₃H₈. Cells that failed via external heating under inert conditions (N₂ or Ar atmosphere) at 100% state of charge (SoC) typically generated 0.7 L/Ah of gas; overcharged cells, 0.11–0.68 L/Ah; and nail penetration between 0.3 and 0.5 L/Ah. In general, for all test configurations, regardless of atmosphere, the total gas volume contained a 40% concentration of H₂, 15% of CO₂, and the remaining gas consisted of varying concentrations of CO and flammable hydrocarbons. This demonstrates that despite differences in gas volume, the failure gas composition of LFP cells remains similar. Full article

Background: Atypical subtrochanteric femoral fractures (ASFs), frequently linked to long-term bisphosphonate use, present significant fixation challenges due to impaired bone healing. While intramedullary (IM) nailing is the standard treatment, delayed union or nonunion remains common. This study aimed to evaluate whether supplementing IM nailing with lateral plate augmentation improves radiographic healing in patients with ASFs. Methods: This retrospective comparative study included 12 elderly female patients with ASFs treated between October 2013 and October 2023. Five patients underwent IM nailing alone (IM group), while seven received IM nailing with additional lateral plate fixation (Plate + IM group). Fracture healing was assessed using the modified Radiographic Union Score for Tibial fractures (mRUST) at 3, 6, and 12 months postoperatively. Intergroup comparisons were performed using the Mann–Whitney U test. Results: The median mRUST scores in the IM group were 4 (IQR 3.5–4), 6 (IQR 4.5–6.5), and 8 (IQR 7–9) at 3, 6, and 12 months, respectively. In the Plate + IM group, the scores were 5 (IQR 4–6), 8 (IQR 8–8), and 10 (IQR 10–11), respectively. The Plate + IM group demonstrated significantly higher mRUST scores at all assessed time points (3 months: p = 0.018; 6 months: p = 0.003; 12 months: p = 0.006). No implant failures or postoperative infections occurred in either group during the 12-month follow-up period. One patient (20%) in the IM group developed fracture nonunion, while no nonunion cases were observed in the Plate + IM group. Conclusions: Lateral plate augmentation as an adjunct to IM nailing may promote faster and more consistent radiographic healing in atypical subtrochanteric femoral fractures. This dual-fixation strategy may offer a biomechanically more robust option for patients at risk of delayed union, potentially contributing to a lower risk of nonunion, though further prospective studies are required to confirm this finding. Full article

Background: Cutaneous squamous cell carcinoma (SCC) is the most common primary malignant tumor of the hand, and its aggressive nature can lead to significant morbidity, particularly when affecting critical structures like the thumb. SCC in this location may arise in the periungual area or the pulp and frequently presents with non-specific symptoms such as swelling, nail deformity, or discharge, features that closely mimic common benign conditions. Methods: A retrospective study analyzed patients with neglected or misdiagnosed SCC of the thumb treated at the Hand and Microsurgery Unit of the Jewish Hospital, Rome, between 2015 and 2025. Patient demographics, duration from symptom onset to diagnosis, initial misdiagnoses, and imaging findings (X-rays, MRI, CT scans, lymph node sonography) were reviewed. Surgical interventions, histopathological grading, and postoperative management were documented, with long-term follow-up focusing on disease progression and patient survival. Results: Sixteen patients were included in the study. The mean age at surgery was 73.6 years (range: 55–93 years), with a mean delay of 8.2 months from symptom onset to diagnosis in 87.5% of cases. Initial misdiagnoses included verruca vulgaris, onychomycosis, paronychia, and osteomyelitis. Imaging consistently revealed soft tissue involvement, bony invasion, and occasional metastasis. Surgical approaches ranged from wide resection to amputation, with thumb reconstruction in selected cases and hand amputation in severe presentations. Long-term follow-up (mean 4.6 years) showed high morbidity, a reduction in hand function and QoL, and a 50% mortality rate, with two cases due to metastatic disease (12.5%). Conclusions: Thumb SCC presents diagnostic and therapeutic challenges, exacerbated by late diagnosis and initial misdiagnoses. Multidisciplinary management involving early recognition, comprehensive imaging, appropriate surgical interventions, and vigilant follow-up is crucial for optimizing outcomes. Full article