Search Results (1,270)

Arrhythmogenic cardiomyopathies (ACMs) are a phenotypically and etiologically heterogeneous group of myocardial disorders characterized by fibrotic or fibro-fatty replacement of ventricular myocardium, electrical instability, and an elevated risk of sudden cardiac death. Initially identified as a right ventricular disease, ACMs are now recognized to include biventricular and left-dominant forms. Genetic causes account for a substantial proportion of cases and include desmosomal variants, non-desmosomal variants, and familial gene-elusive forms with no identifiable pathogenic mutation. Nongenetic etiologies, including post-inflammatory, autoimmune, and infiltrative mechanisms, may mimic the phenotype. In many patients, the disease remains idiopathic despite comprehensive evaluation. Cardiac magnetic resonance imaging has emerged as a key tool for identifying non-ischemic scar patterns and for distinguishing arrhythmogenic phenotypes from other cardiomyopathies. Emerging classifications propose the unifying concept of scarring cardiomyopathies based on shared structural substrates, although global consensus is evolving. Risk stratification remains challenging, particularly in patients without overt systolic dysfunction or identifiable genetic markers. Advances in tissue phenotyping, multi-omics, and artificial intelligence hold promise for improved prognostic assessment and individualized therapy. Full article

With the diversification of space applications, the tracking of maneuvering targets has gradually gained attention. Issues such as their wide range of movement and observation outliers caused by human operation are worthy of in-depth discussion. This paper presents a novel distributed diffusion multi-noise Interacting Multiple Model (IMM) filter for maneuvering target tracking in heavy-tailed noise. The proposed approach leverages parallel Gaussian and Student-t filters to enhance robustness against non-Gaussian process and measurement noise. This hybrid filter is implemented as a node within a distributed network, where the diffusion algorithm leads to the global state asymptotically reaching consensus as the filtering time progresses. Furthermore, a fusion of multiple motion models within the IMM algorithm enables robust tracking of maneuvering targets across the distributed network and process outlier caused by maneuver compared to previous studies. Simulation results demonstrate the effectiveness of the proposed filter in tracking maneuvering targets. Full article

In sustainable development studies, a key question is how the abundance of natural resources influences long-run economic growth. However, there is no consensus on this issue. Some literature suggests a negative impact, while other studies find no effect at all, and other research indicates a positive impact. This study aims to examine the relationship between natural resource rents, renewable energy, and economic growth in the Gulf Cooperation Council (GCC) countries over the period from 1990 to 2023. The study utilizes the Method of Moments Quantile Regression (MMQR) to provide reliable findings across different quantiles. We also incorporate a series of control variables, including capital, labor force participation, non-renewable energy, and trade openness. The findings indicate that natural resources rent enhances economic growth in GCC countries, supporting the Rostow hypothesis. Although renewable energy has a positive impact on economic growth, it does not have an effect on natural resource rents. Additionally, capital, labor force participation, non-renewable energy, and trade openness play a critical role in raising economic growth in these countries. Based on the empirical results, this study provides several valuable recommendations for policymakers to enhance the management of natural resources in GCC countries. Full article

Background/Objectives: Rotator cuff calcific tendinopathy (RCCT) is one of the most common causes of non-traumatic shoulder pain. To date, there is still no consensus regarding the most effective method for its treatment. Ultrasound-guided percutaneous aspiration is suggested during the reabsorption phase of calcific metaplasia. We aimed to evaluate the effectiveness of ultrasound-guided lavage for RCCT from a clinical and radiological perspective. Methods: We involved patients affected by RCCT of the supraspinatus tendon. The approach used for the calcification lavage was the one-needle technique, consisting in inserting a 16–18 G needle on a 20 mL syringe with 0.9% saline solution, in the calcific metaplasia, under ultrasound guidance, using an in-plane approach; the repetitive action of pressing and releasing the plunger was repeated until the contents of the syringe became milky, at which point the syringe was replaced with a new one, always containing saline solution. The physiotherapy treatment began 7 days after the procedure. We assessed the Numeric Rating Scale, the Gartner classification, the Disability of the Arm, Shoulder and Hand scale, the Constant–Murley shoulder score, and the passive range of motion of flexion and abduction. Results: We included 23 subjects. The analysis of the data at baseline and t1 showed a statistically significant improvement in all the functional variables (p < 0.05). This result was mainly evident for pain, with a p-value of 0.001. Conclusions: The findings of the present prospective case series study showed an improvement in the clinical and radiological outcomes after ultrasound-guided percutaneous aspiration for rotator cuff calcific tendinopathy. Full article

Artificial Intelligence (AI) and Generative AI are transformative yet double-edged technologies with evolving risks. While research emphasises trustworthy, fair, and responsible AI by focusing on its “what” and “why,” it overlooks practical “how.” To bridge this gap in financial services, an industry at the forefront of AI adoption, this study employs a qualitative approach grounded in existing Responsible AI and Corporate Digital Responsibility (CDR) frameworks. Through thematic analysis of 15 semi-structured interviews conducted with professionals working in finance, we illuminate nine non-technical barriers that practitioners face, such as sustainability challenges, trade-off balancing, stakeholder management, and human interaction, noting that GenAI concerns now eclipse general AI issues. CDR practitioners adopt a more human-centric stance, emphasising consensus-building and “no margin for error.” Our findings offer actionable guidance for more responsible AI strategies and enrich academic debates on Responsible AI and AI-CDR symbiosis. Full article

Photobiomodulation (PBM) has been widely studied for its regenerative and anti-inflammatory properties. Its application, combined with biomaterials, is emerging as a promising strategy for promoting tissue regeneration. Considering the diversity of available evidence, this study conducted an integrative literature review, aiming to critically analyze and synthesize the effects of PBM on bone tissue, particularly its potential role as an adjunct in guided bone regeneration (GBR) procedures. To ensure an integrative approach, studies with different methodological designs were included, encompassing both preclinical and clinical research. The article search was performed in the digital databases PubMed/MEDLINE, Scopus, and Web of Science, using the following search terms: “Photobiomodulation therapy” AND “guided bone regeneration”. The search was conducted from November 2024 to January 2025. A total of 85 articles were found using the presented terms; after checking the results, 11 articles were selected for this study. The remaining articles were excluded because they did not fit the proposed inclusion and exclusion criteria. Studies to date have shown preclinical models that demonstrated increased bone-volume fraction and accelerating healing. Although it has exciting potential in bone regeneration, offering a non-invasive and promising approach to promote healing and repair of damaged bone tissue, the clinical application of PBM faces challenges, such as the lack of consensus on the ideal treatment parameters. Calcium phosphate ceramics were one of the most used biomaterials in the studied associations. Further well-designed studies are necessary to clarify the effectiveness, optimal parameters, and clinical relevance of PBM in bone regeneration, in order to strengthen the current evidence base and guide its potential future use in clinical practice. Full article

In recent decades, information technology has grown. Computers have become a daily activity, facilitating access to information, faster communication and faster work. If used responsibly, it has many advantages. Objectives: To explore the potential link between prolonged use of computer input devices—such as keyboards and mice—and the development of compressive neuropathies, including carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS), in individuals whose daily routines are heavily reliant on computer-based activities. Methods: A comprehensive review of the literature was undertaken to assess the correlation between the use of computer input devices and the incidence of compressive neuropathies in the upper limbs, with particular attention to repetitive strain, ergonomic posture deviations, and personal risk factors. Results: Current evidence indicates a potential association between prolonged computer use and the development of upper limb compressive neuropathies; however, a definitive consensus within the scientific literature remains elusive. Repetitive movements and non-neutral postures appear to be significant contributing factors, particularly among individuals with predisposing risk factors. Despite increasing awareness of this issue, standardized, evidence-based clinical guidelines for the evaluation and management of work-related nerve disorders remain lacking. Conclusions: While the relationship between computer use and compressive neuropathies remains debated, healthcare professionals should be aware of the risks, particularly in individuals exposed to repetitive strain and ergonomic stress. Further research and the development of clinical guidelines are needed to better understand and manage these work-related conditions. Full article

Objectives: Oncocyte-rich indeterminate thyroid nodules (O-ITNs) present diagnostic and management challenges due to overlapping features between benign and malignant lesions and differing cytological classifications. This study aimed primarily to assess the ultrasound (US) characteristics and US-based risk of O-ITNs using the American College of Radiology Thyroid Imaging Reporting And Data Systems (ACR TI-RADS). A secondary objective was to compare the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) and Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) cytological systems regarding classification and clinical management implications for O-ITNs. Methods: A retrospective study was conducted on 177 ITNs (TIR3A and TIR3B) evaluated between June 2023 and December 2024 at CTO-Alesini, Rome (Italy). Nodules were assessed with US, cytology, and histology. Oncocyte predominance was defined as >70% oncocytes on fine-needle aspiration (FNA). US features were analyzed according to ACR TI-RADS. Nodules were reclassified by BSRTC, and potential differences in clinical case management (CCM) were analyzed. Results: O-ITNs comprised 47.5% of the sample. Compared to non-O-ITNs, O-ITNs were larger and more frequently showed low-risk US features, including a higher prevalence of ACR TI-RADS 3 nodules. However, no progressive increase in the risk of malignancy (ROM) was observed across ACR TI-RADS classes within O-ITNs. Histological malignancy was identified in 47.1% of O-ITNs, a lower proportion compared to non-O-ITNs, though the difference was not statistically significant. Classification discordance with potential management impact was lower in O-ITNs (20.2%) than in non-O-ITNs (38.7%). Conclusions: O-ITNs typically exhibit benign-appearing US features and lower classification discordance between BSRTC and ICCRTC, yet US risk stratification fails to differentiate malignancy risk within O-ITNs. A tailored approach integrating cytology and cautious US interpretation is essential for optimal O-ITN management. Full article

Background/Objectives: Discrepancies in diabetic retinopathy (DR) grading are well-documented, with retinal non-perfusion (RNP) quantification posing greater challenges. This study assessed intergrader agreement in DR evaluation, focusing on qualitative severity grading and quantitative RNP measurement. We aimed to improve agreement through structured consensus meetings. Methods: A retrospective analysis of 100 comparisons from 50 eyes (36 patients) was conducted. Two paired medical retina fellows graded ultra-widefield color fundus photographs (CFP) and fundus fluorescein angiography (FFA) images. CFP assessments included DR severity using the International Clinical Diabetic Retinopathy (ICDR) grading system, DR Severity Scale (DRSS), and predominantly peripheral lesions (PPL). FFA-based RNP was defined as capillary loss with grayscale matching the foveal avascular zone. Weekly adjudication by a senior specialist resolved discrepancies. Intergrader agreement was evaluated using Cohen’s kappa (qualitative DRSS) and intraclass correlation coefficients (ICC) (quantitative RNP). Bland–Altman analysis assessed bias and variability. Results: After eight consensus meetings, CFP grading agreement improved to excellent: kappa = 91% (ICDR DR severity), 89% (DRSS), and 89% (PPL). FFA-based PPL agreement reached 100%. For RNP, the non-perfusion index (NPI) showed moderate overall ICC (0.49), with regional ICCs ranging from 0.40 to 0.57 (highest in the nasal region, ICC = 0.57). Bland–Altman analysis revealed a mean NPI difference of 0.12 (limits: −0.11 to 0.35), indicating acceptable variability despite outliers. Conclusions: Structured consensus training achieved excellent intergrader agreement for DR severity and PPL grading, supporting the clinical reliability of ultra-widefield imaging. However, RNP measurement variability underscores the need for standardized protocols and automated tools to enhance reproducibility. This process is critical for developing robust AI-based screening systems. Full article

This paper proposes a Distributed Adaptive Regularization Algorithm (DARN) for solving composite non-convex and non-smooth optimization problems in multi-agent systems. The algorithm employs a three-phase iterative framework to achieve efficient collaborative optimization: (1) a local regularized optimization step, which utilizes proximal mappings to enforce strong convexity of weakly convex objectives and ensure subproblem well-posedness; (2) a consensus update based on doubly stochastic matrices, guaranteeing asymptotic convergence of agent states to a global consensus point; and (3) an innovative adaptive regularization mechanism that dynamically adjusts regularization strength using local function value variations to balance stability and convergence speed. Theoretical analysis demonstrates that the algorithm maintains strict monotonic descent under non-convex and non-smooth conditions by constructing a mixed time-scale Lyapunov function, achieving a sublinear convergence rate. Notably, we prove that the projection-based update rule for regularization parameters preserves lower-bound constraints, while spectral decay properties of consensus errors and perturbations from local updates are globally governed by the Lyapunov function. Numerical experiments validate the algorithm’s superiority in sparse principal component analysis and robust matrix completion tasks, showing a 6.6% improvement in convergence speed and a 51.7% reduction in consensus error compared to fixed-regularization methods. This work provides theoretical guarantees and an efficient framework for distributed non-convex optimization in heterogeneous networks. Full article

Background/Objectives: Histological follow-up still lacks consensus in the long-term management of adult patients with celiac disease (CD) adhering to a gluten-free diet (GFD). Despite clinical and serological improvement, a significant proportion of patients continue to have persistent villous atrophy. We aimed to synthesize current evidence regarding histological outcomes after GFD treatment in adult CD, focusing on mucosal healing rates, assessment methods, and remission criteria. Methods: We conducted a literature search with extraction and analysis of published cohort studies that included adult patients with CD on GFD with follow-up biopsy data. Extracted parameters included demographic details, baseline histology, GFD duration and adherence, serologic status, and histologic recovery rates with corresponding remission criteria. Results: Data from 46 studies comprising 15,530 patients were analyzed. The overall mean age was 41 years, and 73.3% were female. Mean histologic remission across cohorts was 58.8%, with considerable interstudy variation. Remission criteria also varied widely, ranging from strict Marsh 0 control histology to more inclusive definitions that considered Marsh 1 or even non-atrophic mucosa (Marsh < 3) as indicative of recovery, while some studies relied on quantitative villous height-to-crypt depth ratio thresholds, substantially influencing reported remission rates. Longer GFD duration and rigorous diet adherence assessment using validated questionnaires and accurate laboratory tools were associated with higher remission rates. Conclusions: Histologic remission in GFD-treated adult patients with CD is highly variable and strongly influenced by remission definitions and adherence assessment methods. Standardized reporting using validated metrics for histologic outcome and dietary compliance is essential for harmonizing follow-up strategies in adult CD. Full article

Background: Gestational diabetes mellitus (GDM) affects 7–9% of pregnancies worldwide and is associated with adverse maternal and neonatal outcomes. Nutritional therapy is a key component of GDM management. However, inconsistencies exist across international and national guidelines regarding macronutrient distribution, glycemic targets, and micronutrient supplementation. This systematic review aims to compare updated nutritional recommendations for GDM across major health organizations and identify areas of consensus, divergence, and evidence gaps. Methods: This systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251026194). A comprehensive literature search was performed in PubMed, Scopus, and Google Scholar (concluding March 2025), along with manual searches of official websites of professional health organizations (e.g., ADA, WHO, NICE, IDF). Guidelines published within the last 10 years (or the most relevant national guideline if slightly older), available in English or with access to translation, and including explicit nutritional recommendations for GDM were included. Data were extracted on macronutrient composition, glycemic targets, and micronutrient supplementation, with evaluation of the supporting evidence and regional context, incorporating findings from recent key guideline updates. Results: In total, 12 guidelines met the inclusion criteria. While all guidelines emphasized carbohydrate moderation and adequate fiber intake, significant discrepancies were found in carbohydrate quality recommendations (e.g., low-glycemic index focus vs. total carbohydrate restriction), postprandial glucose targets (e.g., 1-h vs. 2-h measurements and varying thresholds like <120 vs. <140 mg/dL), and the use of non-routine micronutrients such as chromium, selenium, and omega-3 fatty acids (generally lacking endorsement). Recent updates from key bodies like ADA, Diabetes Canada, and KDA largely maintain these core stances but show increasing emphasis on dietary patterns and acknowledgement of CGM technology, without resolving key discrepancies. Cultural adaptability and behavioral counselling strategies were minimally addressed across most guidelines. Conclusions: Despite general agreement on the principal recommendations of nutritional management in GDM, substantial variation persists in specific recommendations, even considering recent updates. Consistent, evidence-based, and culturally adaptable guidelines incorporating implementation strategies are needed to optimize care and reduce disparities in GDM management across regions. Full article

Background/Objectives: Portal hypertension (PH) is a common complication in children with chronic liver diseases. Primary and secondary prophylaxis of variceal bleeding in these patients remains controversial. Our study aims to evaluate the management of gastrointestinal (GI) varices in children with PH in Italy. Methods: A questionnaire was sent to 21 major pediatric hepatology centers. It included 34 questions referring to the medical, endoscopic, radiological, and surgical management of GI varices. Results: Out of 21 centers, 16 returned a completed questionnaire (survey response rate 76%) with a high level of completeness. A total of 1206 children with PH were under follow-up. Splenomegaly associated with hypersplenism was the main indication for endoscopic surveillance in all centers (100%). Primary prophylaxis was performed with endoscopy plus non-selective beta-blockers (NSBBs) in 50%, endoscopy alone in 38%, and NSBBs alone in 12%. All centers managed acute variceal bleeding with endoscopy within 24 h, acid suppression, and octreotide infusion. Secondary prophylaxis of variceal bleeding was conducted using endoscopy (100%) and NSBBs (87%). Transjugular intrahepatic portosystemic shunt (TIPS) was considered a good option when endoscopic treatment failed in 94% of centers. Conclusions: In Italy, there is broad consensus among centers regarding the management of gastrointestinal varices in children with portal hypertension. All participating centers endorsed the use of endoscopic screening for children presenting with clinical signs of portal hypertension. Nonetheless, further research is essential to establish evidence-based guidelines and to improve overall quality of care. Full article

This study aims to validate the Online Sexual Harassment Perpetration among Peers (OSHP-P) instrument for assessing online sexual harassment among adolescents in two different countries, Spain and Italy, considering both new forms of online sexual harassment and gender differences. The instrument was validated by means of a Confirmatory Factor Analysis (CFA) with a sample of 1041 Spanish (M_age = 15.0, SD = 0.88) and 1385 Italian (M_age = 14.8, SD = 0.87) adolescents, demonstrating factorial invariance across both country and gender. The best-fitting model was two-dimensional, with ambiguous and direct Sexual Cyber Perpetration (SCP) and Non-Consensual Sharing Perpetration (NCSP) factors. Co-involvement (i.e., involvement in both types of aggression) rates were 10.3% in Spain and 7.8% in Italy. No significant gender differences were found for involvement in either the overall scale (46.4% for girls, 44.1% for boys) or the NCSP subscale (3.0% girls vs. 2.2% boys), although significantly higher co-involvement was found among boys (7.7% girls vs. 10.1% boys). This study contributes to the existing body of research on online sexual harassment among peers in adolescence by presenting a new assessment tool that has been shown to be invariant between Spanish and Italian adolescents, as well as between boys and girls. Full article

Background: We evaluated the utility of HNSCC LN R2* relaxation times to infer the oxygenation status of LN non-invasively at baseline and when breathing air and 100% oxygen to predict chemoradiotherapeutic locoregional response at 2 years. Hypoxia within LNs has been associated with poorer outcomes following CRT. Deoxyhaemoglobin decreases MRI transverse relaxation time (T2*) (lengthening inverse, R2*). Methods: A total of 54 patients underwent 1.5T-MRI before CRT. Conventional MR sequences were supplemented with T2* sequences breathing both air and 100% oxygen; pathological nodes identified in consensus were volumetrically contoured to T2* parametric maps. Results: Patients followed-up with for >2 years were categorised by multidisciplinary consensus into post-therapy complete local response (CR; n = 32/54) and local nodal disease relapse (RD; n = 22/54). Our data demonstrated, by R2*, that nodes that sustained post-therapy CR are significantly more hypoxic compared with relapsing nodes and paradoxically demonstrate a significant increase in hypoxia on 100% oxygen. Pre-treatment LN short axis diameter, various qualitative descriptors of malignancy, and quantitative DWI were not useful in discriminating successful response to CRT. Conclusions: This study demonstrates that a significant differential response to 100% oxygen and higher baseline R2* LN measurements could be exploited in risk stratification prior to CRT, and future work could be directed towards understanding the contrast mechanisms of R2* imaging, underpinning the observed differences in the context of hypoxia. Full article