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Abstract Background Despite their apparent dissimilarity, Anorexia Nervosa (AN) and Autism Spectrum Disorder (ASD) share many features, especially in terms of social and emotional difficulties. In recent years, empathic abilities in AN have been frequently assessed using self-report measures. Otherwise, the director task (DT) has been used to investigate the ability to take the visual perspective of another individual in a communicative context, using eye-tracking technology. The aim of the current study was to test the presence of autism-relevant features in AN, through: (i) comparing self-reported autistic traits and empathic abilities in a group of young inpatients with AN and age/gender matched healthy controls (HC); (ii) comparing performance on the director paradigm. Methods The participants were females in the age-range between 11 and 18 years: 24 with AN and 23 HC. Autistic traits, empathic abilities, and severity of the eating disorder were respectively measured using: the Autism Quotient (AQ), the Interpersonal Reactivity Index (IRI), and the Eating Disorder Inventory-3 (EDI-3). Both groups performed a computerized task in which a director instructed them to move objects placed on a set of shelves using a mouse, while their eye gaze was tracked. A total of 36 shelf configurations, divided into three categories (with dimensional distractor – with spatial distractor – control), were created. Results Subjects with AN showed higher autistic traits than HC. Eye-tracking data revealed that subjects with AN took longer to decide which object to select and where to move it, both in distractor-trials and in control-trials. In the AN group, we found a significant negative correlation between the total score of the AQ and the number of fixations to the irrelevant object in the dimensional control condition -in which the subjects were asked to focus on dimensional aspects of the object (large-small)-. Conclusions Autistic traits were over-represented in a group of young inpatients with AN. Through the use of eye-tracking technology, this exploratory study documented some differences between AN inpatients and HC in their online processes during the perspective taking tasks, which could be considered a target of tailored intervention. A larger sample of patients is needed to confirm these preliminary findings.

Summary: Novelty often influences the retention of nearby weak and transient memory traces, yet its precise role in shaping long-term memory storage remains elusive. Here, we demonstrate that a short-lasting memory is stabilized into a long-lasting one when new information is linked to the weak mnemonic trace in rats, resulting in the formation of long-term memories that are recalled together. An increased overlap between neuronal ensembles and de novo protein synthesis in the dorsal CA1 region of the hippocampus (dCA1) mediates this process. This intricate interconnectedness relies on both temporal and contextual relations between experiences, enhancing the adaptive value of memory consolidation. Finally, this phenomenon is negatively affected by aging, which is associated with reduced ensemble size after novelty exposure and diminished overlap between ensembles in aged dCA1. These findings provide valuable insights into the selectivity and malleability of memory consolidation and its decline during aging.

Abstract Background Post COVID-19 syndrome is characterized by several cardiorespiratory symptoms but the origin of patients’ reported symptomatology is still unclear. Methods Consecutive post COVID-19 patients were included. Patients underwent full clinical evaluation, symptoms dedicated questionnaires, blood tests, echocardiography, thoracic computer tomography (CT), spirometry including alveolar capillary membrane diffusion (DM) and capillary volume (Vcap) assessment by combined carbon dioxide and nitric oxide lung diffusion (DLCO/DLNO) and cardiopulmonary exercise test. We measured surfactant derive protein B (immature form) as blood marker of alveolar cell function. Results We evaluated 204 consecutive post COVID-19 patients (56.5 ± 14.5 years, 89 females) 171 ± 85 days after the end of acute COVID-19 infection. We measured: forced expiratory volume (FEV1) 99 ± 17%pred, FVC 99 ± 17%pred, DLCO 82 ± 19%, DM 47.6 ± 14.8 mL/min/mmHg, Vcap 59 ± 17 mL, residual parenchymal damage at CT 7.2 ± 3.2% of lung tissue, peakVO2 84 ± 18%pred, VE/VCO2 slope 112 [102–123]%pred. Major reported symptoms were: dyspnea 45% of cases, tiredness 60% and fatigability 77%. Low FEV1, Vcap and high VE/VCO2 slope were associated with persistence of dyspnea. Tiredness was associated with high VE/VCO2 slope and low PeakVO2 and FEV1 while fatigability with high VE/VCO2 slope. SPB was fivefold higher in post COVID-19 than in normal subjects, but not associated to any of the referred symptoms. SPB was negatively associated to Vcap. Conclusions In patients with post COVID-19, cardiorespiratory symptoms are linked to VE/VCO2 slope. In these patients the alveolar cells are dysregulated as shown by the very high SPB. The Vcap is low likely due to post COVID-19 pulmonary endothelial/vasculature damage but DLCO is only minimally impaired being DM preserved.

Sperm oxidative stress has been extensively associated to male infertility. However, tests to detect this parameter have not been yet introduced in clinical practice and no definitive data are present on the extent of oxidative stress in male infertility. In this study, we used a novel and reliable flow cytometric method to reveal sperm ROS production in subfertile patients (n = 131) and in healthy donors (n = 31). Oxidative stress was higher in subfertile patients (14.22 [10.21–22.08]%) than in healthy donors (9.75 [8.00–14.90]% (p < 0.01)), but no correlation was found with age, semen quality or sDF. We also failed to detect an increase in sperm ROS production with semen viscosity or leukocytospermia, but a sharp impact of semen bacteria was evident (with bacteria: 31.61 [14.08–46.78]% vs. without bacteria: 14.20 [10.12–22.00]%, p < 0.01). Finally, after establishing a threshold as the 95th percentile in healthy donors, we found that 29% of subfertile patients exceeded this threshold. The percentage decreased to 25.56% when we excluded subjects with bacteriospermia and increased to 60.87% when only these patients were considered. In conclusion, 29% of subfertile patients showed an excessive sperm ROS production. Surprisingly, this parameter appears to be independent from routine semen analysis and even sDF determination, promising to provide additional information on male infertility.

Previous studies suggest that autism spectrum disorders are characterized by alterations in the microbiota-gut-brain axis. Probiotics may modify the composition and the functionality of the gut microbiota of autism spectrum disorder individuals, with possible cascading effects on brain function. In this study, we analyzed possible brain modifications induced by the administration of probiotics in 46 children with autism spectrum disorder using electroencephalography. A randomized 6-month controlled trial was performed. In subjects treated with probiotics, we observed a decrease of power in frontopolar regions in beta and gamma bands, and increased coherence in the same bands together with a shift in frontal asymmetry, which suggests a modification toward a typical brain activity. Electroencephalography measures were significantly correlated with clinical and biochemical measures. These findings support the importance of further investigations on probiotics' benefits in autism spectrum disorder to better elucidate mechanistic links between probiotics supplementation and changes in brain activity.

Dapagliflozin, a sodium-glucose co-transporter-2 inhibitor and semaglutide, a glucagon-like peptide 1 receptor agonist, have both demonstrated efficacy in glycemic control, reducing blood pressure, body weight, risk of renal and heart failure in type 2 diabetes mellitus. In this observational, real-world, study we aimed to investigate the efficacy of the combination therapy with those two agents over glycemic control. We thus obtained the data of 1335 patients with type 2 diabetes followed by 11 Diabetes centers in Lombardia, Italy. A group of 443 patients was treated with dapagliflozin alone, the other group of 892 patients was treated with the combination therapy of dapagliflozin plus oral semaglutide. We analyzed changes in glycated hemoglobin from baseline to 6 months of follow-up, as well as changes in fasting glycemia, body weight, body mass index, systolic and diastolic pressure, heart rate, creatinine, estimated glomerular filtration rate and albuminuria. Both groups of patients showed an improvement of glycometabolic control after 6 months of treatment; indeed, the treatment with dapagliflozin plus oral semaglutide showed a reduction of glycated hemoglobin of 1.2% as compared to the 0.5% reduction observed in the dapagliflozin alone group. Significant changes were observed in body mass index, fasting plasmatic glucose, blood pressure, total cholesterol, LDL and albumin to creatinine ratio, with a high rate (55%) of near-normalization of glycated hemoglobin. Our real world data confirmed the potential of the oral combination therapy dapagliflozin with semaglutide in inducing pharmacological remission of type 2 diabetes mellitus.

Summary: Climate change has prompted many communities to set targets for carbon-free power supplies, but they often lack data-driven strategies to achieve them. We present a comprehensive analysis of an entirely renewable electric power system that can maintain operating reliability and resource adequacy using detailed models of the city of Los Angeles power grid. In consultation with the operating utility, the Los Angeles Department of Water and Power (LADWP), and the local community, we develop four supply scenarios across three demand projections to analyze which types of infrastructure and operational changes would achieve reliable electricity at least cost. We find that a reliable, 100%-renewable power system yielding more than $1 billion annually in health and climate co-benefits is achievable. Solar can supply most future energy needs, while combustion turbines that use renewable, storable carbon-neutral fuels are key to maintaining reliability. This study provides a replicable methodology that other jurisdictions globally can follow. Science for society: Communities and businesses nationwide have set ambitious goals to combat climate change by generating 100% of their electricity from carbon-free or renewable energy sources. Until now, there has been no comprehensive analysis of the possible pathways to achieve these goals on the scale needed to power the largest US cities. Here, we present findings from the Los Angeles 100% Renewable Energy Study (LA100), a thorough and wide-reaching assessment of the factors needed to make a fully renewable utility system operate reliably and deliver adequate electricity to more than 4 million residents. Our analysis uses detailed models of the city’s power grid to examine not just renewable resource options and technical solutions related to generation, transmission, and distribution systems but also the balance of supply and demand, variability and reliability, and affordability and viability—all through the lens of changing demographics and climate conditions.

Abstract Objectives Hyperpyrexia has been associated with a greater prevalence of bacterial infections in the pediatric population, which prior to routine childhood vaccinations, has led to invasive testing and empiric antibiotic use for urinary tract infections, bacterial pneumonia, bacteremia, and bacterial meningitis. Since the implementation of routine childhood vaccinations, the prevalence of serious bacterial infections (SBIs) has declined. This study aims to determine if there is an association between hyperpyrexia and serious bacterial infections in well‐appearing febrile pediatric patients presenting to the emergency department (ED). Methods This is a cross‐sectional study conducted between January 1, 2019, and December 31, 2019, at a single urban tertiary care pediatric ED. Patients were included if they were between 61 days and ≤18 years old presenting with a chief complaint of fever. Patients were excluded if they received antibiotics within 3 days of presentation, underwent surgical procedures within 2 weeks of presentation, had an ED visit for febrile illness within 2 weeks of study visit, were transferred from another institution, or were ill appearing. Prevalence of SBI was described and compared by presence of hyperpyrexia, age group, chronic medical condition, gender, and vaccination status. Logistic regression was used to analyze the association between SBIs and hyperpyrexia. Results Of the 3862 charts reviewed, 2565 patients were included. The prevalence of SBI was 5.6%. A total of 413 patients presented with hyperpyrexia. Of the patients with hyperpyrexia, 31 (7.5%) had a serious bacterial infection. Hyperpyrexia was not significantly associated with SBIs in our logistic regression models (adjusted Odds Ratio 1.40, 95% confidence interval 0.92–2.12). Conclusions Serious bacterial infections were uncommon in our population. There is no statistically significant association between hyperpyrexia and SBIs in well‐appearing pediatric patients presenting to the ED with fever. The lack of a statistically significant association between hyperpyrexia and SBIs argues that clinicians should be cautious using hyperpyrexia as an independent risk factor for SBIs. More research is needed to identify independent and grouped SBI risk factors in well‐appearing pediatric patients presenting to the ED.

Summary: Medium- and heavy-duty vehicles are 21% of US transportation greenhouse gas (GHG) emissions and a major source of air pollution. We explore how the total cost of driving (TCD) of zero-emission vehicles (ZEVs), including battery electric vehicles and hydrogen fuel cell electric vehicles (EVs and FCEVs), could evolve under alternative scenarios. With continued improvements in vehicles and fuels, ZEVs can rapidly become viable, potentially reaching TCD parity or better compared to diesel vehicles by 2035 for all market segments. For heavy long-haul trucks, EVs become competitive on a TCD basis at charging costs below $0.18/kWh, while FCEVs become competitive on a TCD basis at hydrogen costs below $5/kg. A full transition to ZEV sales by 2035 results in 65% emissions reductions by 2050 compared to 2019 without supportive policies. Incentives such as the Inflation Reduction Act vehicle purchase credits further accelerate ZEV TCD competitiveness with major adoption opportunities over the next five years.

IntroductionPeripheral nerves are frequently affected by lesions caused by traumatic or iatrogenic damages, resulting in loss of motor and sensory function, crucial in orthopedic outcomes and with a significant impact on patients’ quality of life. Many strategies have been proposed over years to repair nerve injuries with substance loss, to achieve musculoskeletal reinnervation and functional recovery. Allograft have been tested as an alternative to the gold standard, the autograft technique, but nerves from donors frequently cause immunogenic response. For this reason, several studies are focusing to find the best way to decellularize nerves preserving either the extracellular matrix, either the basal lamina, as the key elements used by Schwann cells and axons during the regenerative process.MethodsThis study focuses on a novel decellularization protocol for porcine nerves, aimed at reducing immunogenicity while preserving essential elements like the extracellular matrix and basal lamina, vital for nerve regeneration. To investigate the efficacy of the decellularization protocol to remove immunogenic cellular components of the nerve tissue and to preserve the basal lamina and extracellular matrix, morphological analysis was performed through Masson’s Trichrome staining, immunofluorescence, high resolution light microscopy and transmission electron microscopy. Decellularized porcine nerve graft were then employed in vivo to repair a rat median nerve lesion. Morphological analysis was also used to study the ability of the porcine decellularized graft to support the nerve regeneration.Results and DiscussionThe decellularization method was effective in preparing porcine superficial peroneal nerves for grafting as evidenced by the removal of immunogenic components and preservation of the ECM. Morphological analysis demonstrated that four weeks after injury, regenerating fibers colonized the graft suggesting a promising use to repair severe nerve lesions. The idea of using a porcine nerve graft arises from a translational perspective. This approach offers a promising direction in the orthopedic field for nerve repair, especially in severe cases where conventional methods are limited.

Satisfaction with the detection process of autism and its determinants was investigated using data from the Autism Spectrum Disorder in the European Union (2015-2018) network. A total of 1342 family members, including 1278 parents, completed an online survey collecting information about their experience and satisfaction with the early detection of autism in their child. Overall, the level of satisfaction varied considerably from one respondent to another. Difficulty in finding information about detection services, lack of professional guidance and support in response to first concerns, finding a diagnostic service on one's own, and a delay of more than 4 months between the confirmation of concerns and the first appointment with a specialist were all experiences individually associated with greater odds of being less satisfied. Using a dominance analysis approach, we further identified professional guidance and support in response to first concerns as the most important predictor of the level of satisfaction. These findings highlight the aspects of the process that need to be improved to enhance the experience of the detection process and are therefore relevant to guide health administrations toward actions to be implemented to this effect.

Background: People with intellectual disability often receive diagnoses which may complicate their clinical care. Among these, personality disorder diagnoses are still considered contentious. Little is also known on the perspectives of staff caring for people with intellectual disability who have received a personality disorder diagnosis. Methods: Three focus groups were carried out to explore 15 healthcare professionals' subjective experiences of working with people with intellectual disability who also have a recorded additional diagnosis of personality disorder. Data were analysed through thematic analysis. Findings: Four overarching themes were identified: (a) diagnostic issues and the need for person-centred approaches; (b) challenges and adjustments to working with combined intellectual disability and PD diagnoses; (c) the importance of multidisciplinary team training, support, and cohesion; (d) provision issues and barriers to service access. Conclusions: The themes are outlined in depth and a number of implications for clinical management and service improvement are discussed.

Abstract Passenger and freight travel account for 28% of U.S. greenhouse gas (GHG) emissions today. We explore pathways to reduce transportation emissions using NREL’s TEMPO model under bounding assumptions on future travel behavior, technology advancement, and policies. Results show diverse routes to 80% or more well-to-wheel GHG reductions by 2050. Rapid adoption of zero-emission vehicles coupled with a clean electric grid is essential for deep decarbonization; in the median scenario, zero-emission vehicle sales reach 89% for passenger light-duty and 69% for freight trucks by 2030 and 100% sales for both by 2040. Up to 3,000 terawatt-hours of electricity could be needed in 2050 to power plug-in electric vehicles. Increased sustainable biofuel usage is also essential for decarbonizing aviation (10–42 billion gallons needed in 2050) and to support legacy vehicles during the transition. Managing travel demand growth can ease this transition by reducing the need for clean electricity and sustainable fuels.

Objective: The aim of the study is to evaluate early and long-term results of chest wall primary Ewing’s sarcoma patients treated in the time period February 2000–February 2023 by a multidisciplinary approach. Methods: We retrospectively reviewed the medical records of patients who underwent chest wall resection for a primary tumor. Treatment approach, extent of resection, 30-day mortality, overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) were analyzed. Results: Overall, n = 15 consecutive patients were treated for chest wall primary Ewing’s sarcoma. A median of n = 3 ribs was resected with a median of n = 2 ribs adjacent to the lesion. Resections were extended to the adjacent structures in n = 5 patients (33.3%). In all cases, we performed a prosthetic reconstruction, associated with muscle flap (n = 10, 66.6%) or with rigid titanium bars and muscle flap (n = 6, 40%). A radical resection was accomplished in n = 13 patients (84.6%). The median surgical time was 310 ± 120 min; median hospitalization was 7.8 ± 1.9 days. Post-operative mortality was zero. We recorded n = 4 (30.7%) post-operative complication. The median follow-up (FU) was 26 months. Moreover, 5-year overall and event-free survival were 52% and 48%, respectively. Conclusions: This case series confirms the benefit of the multidisciplinary approach for Ewing sarcomas in early and long-term results.

ABSTRACT Staphylococcus aureus is the leading cause of skin and soft-tissue infections (SSTIs). SSTIs caused by bacteria resistant to antimicrobials, such as methicillin-resistant S. aureus (MRSA), are increasing in incidence and have led to higher rates of hospitalization. In this study, we measured MRSA inactivation by nanosecond pulsed electric fields (nsPEF), a promising new cell ablation technology. Our results show that treatment with 120 pulses of 600 ns duration (28 kV/cm, 1 Hz), caused modest inactivation, indicating cellular damage. We anticipated that the perturbation created by nsPEF could increase antibiotic efficacy if nsPEF were applied as a co-treatment. To test this hypothesis, we used three antibiotics approved to treat SSTI, daptomycin, doxycycline, and vancomycin, and compared the cytotoxic effects of these antibiotics administered either before or after nsPEF. Co-treatment with nsPEF and daptomycin greatly potentiated the effects of each monotherapy regardless of their order. Conversely, the sensitivity of MRSA to both doxycycline and vancomycin was increased only when nsPEF preceded the antibiotic incubation. Finally, MRSA cells grown in biofilms were efficiently killed by co-treatment with nsPEF/vancomycin, suggesting that their mutual enhancement is maintained even when treating sessile communities known for their inherent antimicrobial resistance. Altogether our results show that MRSA perturbation by nsPEF potentiates the effect of multiple antibiotics and that the order of the combined treatment can have a major impact on efficacy. Since SSTIs are accessible for physical interventions such as nsPEF stimulus, combinatorial treatments could be used to increase the efficacy of antibiotics used to treat such infections. IMPORTANCE We have found that treatment with short electric pulses potentiates the effects of multiple antibiotics against methicillin-resistant Staphylococcus aureus. By reducing the dose of antibiotic necessary to be effective, co-treatment with electric pulses could amplify the effects of standard antibiotic dosing to treat S. aureus infections such as skin and soft-tissue infections (SSTIs). SSTIs are accessible to physical intervention and are good candidates for electric pulse co-treatment, which could be adopted as a step-in wound and abscess debridement.

The Coping Power Program is an evidence-based intervention for children identified to be at risk for developing externalizing behavioral problems. The Coping Power Program has been adapted to universally prevent behavioral problems in school-aged children. This study sought to test the efficacy of this adaptation, the Coping Power Universal program, on preschoolers' behavioral difficulties and pre-academic skills. Teachers delivered the intervention in their classes. The study included a sample of Italian children (N = 250, 125 boys) with a mean age of 4.50 years (SD = 0.50) at the beginning of the study. Classrooms of these children were randomly assigned to receive either the intervention or the Italian preschool standard curriculum. Measures included a questionnaire and objective and standardized measures for numerical intelligence and metaphonological skills delivered by a psychologist to the preschoolers. Classes in which teachers applied the Coping Power Universal program showed lower problematic behaviors and higher pre-academic skills than those in which teachers followed the standard curriculum only. Although further studies are still needed, the current findings showed that the Coping Power Universal program can be adapted for preschoolers with good results. Implications for practice, methodological limitations, and directions for future research are reviewed.

Abstract Laser wakefield accelerators (LWFAs) can produce high-energy electron bunches in short distances. Successfully coupling these sources with undulators has the potential to form an LWFA-driven free-electron laser (FEL), providing high-intensity short-wavelength radiation. Electron bunches produced from LWFAs have a correlated distribution in longitudinal phase space: a chirp. However, both LWFAs and FELs have strict parameter requirements. The bunch chirp created using ideal LWFA parameters may not suit the FEL; for example, a chirp can reduce the high peak current required for free-electron lasing. We, therefore, design a flexible beamline that can accept either positively or negatively chirped LWFA bunches and adjust the chirp during transport to an undulator. We have used the accelerator design program MAD8 to design a beamline in stages, and to track particle bunches. The final beamline design can produce ambidirectional values of longitudinal dispersion ( $$R_{56}$$ R 56 ): we demonstrate values of + 0.20 mm, 0.00 mm and − 0.22 mm. Positive or negative values of $$R_{56}$$ R 56 apply a shear forward or backward in the longitudinal phase space of the electron bunch, which provides control of the bunch chirp. This chirp control during the bunch transport gives an additional free parameter and marks a new approach to matching future LWFA-driven FELs.

Background. Assessment of liver fibrosis is essential to guide treatment in autoimmune hepatitis (AIH), but non-invasive tests (NITs) showed poor accuracy. Our study aims to evaluate the performance of NITs among different AIH presentations. Methods. Monocentric retrospective study among 122 AIH patients. NITs were compared to histological grading of liver fibrosis. We performed an accuracy analysis among acute (jaundice and/or transaminases > 10 times upper limit of normal) and non-acute patients. Results. A significant difference in the distribution of NIT values for each Ishak stage was found for spleen-diameter-to-platelet-count ratio (SD/PC) (p < 0.001), fibrosis-4-score (FIB-4) (p = 0.002), AST-to-ALT ratio (AAR) (p = 0.002), red-blood-cell-width-distribution-to-platelet-count ratio (RDW/PC) (p = 0.008) and AST-to-platelet-count ratio (APRI) (p = 0.029). The AUC for advanced fibrosis of SD/PC, FIB-4, RDW/PC, APRI and AAR were, respectively, 0.814, 0.770, 0.768, 0.708 and 0.694. The AUC of SD/PC, FIB-4 and APRI in non-acute subgroup were 0.902, 0.834 and 0.758, while in acute patients they were 0.754, 0.724 and 0.716. RDW/PC and AAR weren’t different among the two subgroups. Conclusions. For SD/PC, FIB-4 and APRI, diagnostic accuracy is higher in patients with non-acute presentation. In this context, SD/PC and FIB-4 showed an overall performance that could be of interest in clinical practice alongside other non-invasive techniques.

Introduction/objectives: Severe Aplastic Anemia (SAA) is the most frequent indication for Hematopoietic Cell Transplantation (HCT) for nonmalignant diseases in Brazil. Survival after HCT from HLA-Matched Related (MRD), HLA-Matched Unrelated (MUD), and Haploidentical Donors (HID) has improved over the past decades. We aimed to compare the outcomes of a large cohort of patients (pts) submitted to HCT for acquired SAA in Brazil. Methods: A retrospective, non-randomized study included 328 pts with acquired SAA who underwent HCT in 5 Brazilian HCT centers between 01/2012 and 12/2022. All pts received bone marrow as the graft source from MRD (n = 154), MUD (n = 96), or HID (n = 78). MUD was defined as HLA 10/10 or 8/8. Results: Pts and donors’ characteristics are summarized in Table 1. Median follow-up after HCT was 4.7 years. Median age was 18.4 years (1‒69 years), most were CMV positive and heavily transfused. 74% had received previous immunosuppression with (n = 09) or without Rabbit-ATG (n = 134). Median disease duration before transplant was 7 months (0.6‒184), however pts with a MRD were transplanted earlier. There were some statistical differences among groups: HID were performed more recently and ATG was more frequently used in MUD. Conditioning regimen and GVHD prophylaxis were also different among donor groups. One-year cumulative incidence of Graft Failure (GF) in MRD, MUD, and HID cohort was 4.8%, 10.8% and 18.1% (p = 0.0028), respectively. 27 pts were rescued with a 2nd transplant (MRD, n = 7;MUD, n = 8;HID, n = 12) at a median of 40 days after 1st HCT, and 14 are alive. In a Multivariate Analysis (MVA), MUD-HCT (HR = 2.35, p = 0.078) and HID-HCT (HR = 4.30, p = 0.0012) were associated with a higher incidence of GF (Table 2). MRD-HCT had a lower incidence of grade II–IV acute graft versus host disease (aGvHD) compared with MUD and HID (12.4% vs. 30.3% vs. 16.9%, p = 0.00175) and lower incidence of chronic GvHD (cGvHD) (8,7% vs. 26,9% vs. 27.2%, p ≤ 0.001).The estimated non adjusted 5-year Overall Survival (OS) for the MRD, MUD, and HID groups were 86%, 72% and 79% (p = 0.02), respectively; event-free survival (event: rejection or death) rates were 85%, 68% and 56%, respectively (p < 0.001) (Figs. 1 and 2). In MVA, OS was increased for transplantations after 2018 (HR = 0.38, p = 0.002) (Fig. 3). MUD-HCT (HR = 3.13, p≤0.001) and HID-HCT (HR = 2.97, p = 0.0039) were associated with decreased OS in comparison to MRD-HCT. The 100-day CI of CMV reactivation and hemorrhagic cystitis were 56% and 8% respectively, with no significant differences between groups. 64 pts died at a median of 102 days (range 2–2328), and the main causes of death were GF, n = 20; sepsis, n = 11; GvHD, n = 9. Discussion: This retrospective analysis showcases some significant differences between donor groups, including the fact that MRD pts are transplanted earlier and are subjected to a lower risk of GF, acute and chronic GVHD, which translates into better survival. HID-HCT showed improved survival in recent years, becoming a more viable transplant option, specially in comparison to MUD-HCT. Improved OS in HID-HCT comes at the expense of higher rates of graft rejection and higher rates of aGvHD remain an issue after MUD-HCT. Conclusion: These real-world data from a large cohort of SAA pts demonstrate that HCT remains an effective curative treatment with significant improvement in survival in the last 5 years across different donor groups.

Recent studies have demonstrated the viability of quenching and partitioning (Q&P) treatment for processing martensitic stainless steels showing an improved balance of high strength and sufficient ductility. However, to date, the fatigue behaviour of these materials has not been explored. This study examines the effect of their complex hierarchic microstructure on high cycle fatigue performance. Three steels with different alloying element contents underwent Q&P processing, resulting in multiphase microstructures rich in retained austenite. High cycle fatigue tests and analysis of fatigue fracture surfaces were performed using SEM and EBSD techniques. The results indicate satisfactory high cycle fatigue performance in Q&P treated martensitic stainless steels, surpassing traditional counterparts. Fatigue cracks predominantly form and propagate along martensite packet and block boundaries, while prior austenite grain boundaries and MnS inclusions have minimal influence on fatigue crack formation and growth. Microplastic deformation at the fatigue crack tip enhances local KAM values and triggers localized transformation of retained austenite grains. It is hypothesized that the developed Q&P treated martensitic stainless steels exhibit improved resistance to low cycle fatigue.

Abstract Background Chondroblastoma (CBL) is a rare benign chondroid producing bone tumor that typically occurs in epiphysis or apophysis of growing children and young adults. Intralesional curettage is the treatment of choice, while resection is required in selected cases, even though the use of minimally invasive ablation techniques has been advocated. Authors reviewed a series of 75 CBLs with the aim of assess risk factors for local recurrence, the growth plate related complications after epiphyseal curettage and the risk of arthritis of the adjacent joint after epiphyseal curettage. Methods We retrospectively review 69 CBLs treated with intralesional curettage and 6 treated with resection from March 1995 to February 2020. The median age was 18.8 years (7 to 42, median 16). The site was proximal humerus in 18 cases, proximal tibia in 17, distal femur in 16, talus in 6, femur’s head in 4, calcaneus in 3, acromion in 3, trochanteric region in 2, distal tibia in 2, patella in 2, supracetabular region in 1 and distal humerus in 1 patient. Results Mean follow-up was 124.2 months (24 to 322, median 116). Among patients treated with curettage, 7.3% of local recurrence was observed and 12 (17.4%) patients developed osteoarthritis of the adjacent joint. Five patients (7.3%) presented limb length discrepancy of the operated limb ranging from 0.5 to 2 cm. Recurrence free survival rate was 94.2% at 5 and 91.6% at 10 years. A mean Musculoskeletal Tumor Society (MSTS) of 29.3 points (20 to 30, median 30) was observed. Conclusion More than 90% of CBLs were successfully treated with aggressive curettage but segmental resection is required in selected cases. In a relatively small proportion of cases long term complications can occur due to growth plate damage or osteoarthritis. Trial Registration Retrospectively registered.

The capacity of the Child Behavior Checklist 1½-5 (CBCL 1½-5) to identify children with autism spectrum disorder (ASD) at 18 months was tested on 37 children clinically referred for ASD and 46 children at elevated likelihood of developing ASD due to having an affected brother/sister. At 30 months the clinically referred children all received a confirmatory diagnosis, and 10 out of 46 siblings received a diagnosis of ASD. CBCL 1½-5 profiles were compared with a group of matched children with typical development (effect of cognitive level controlled for). The capacity of the CBCL 1½-5 DSM Oriented-Pervasive Developmental Problems scale to differentiate correctly between children diagnosed with ASD and children with typical development appeared dependent on group ascertainment methodology.

The effects of environmental factors [including Socio-Economic Status, Cultural Capital, and Social Capital (Socio-Cultural Level) of both parents] on the Vineland-II adaptive behavior dimensions of toddlers with autism spectrum disorder (ASD), in addition to individual factors, was investigated in 148 Italian toddlers (82% males), aged 18 to 37 months with ASD. Toddlers' age and Griffiths Mental Development Scales general development affected all of the adaptive behavior dimensions, with negative and positive associations, respectively. The Child Behavior Checklist comorbid conditions were negatively associated with some adaptive behavior dimensions while the ADOS-2 Social affect only with the communication dimension. Mothers' and fathers' specific Socio-Cultural Level dimensions were positively associated with toddlers' specific adaptive behavior dimensions with the same magnitude as comorbid conditions.

Abstract Background Hip megaprostheses are a long known reconstructive method in the treatment of proximal femur metastases. The use of cemented or uncemented stems is still matter of debate. The aim of this study to compare cemented and uncemented megaprostheses on functional outcomes and complications, in order to establish the role of cementation. Methods We retrospectively analysed 51 metastatic patients with proximal femur metastases treated with endoprosthetic reconstruction by megaprostheses, 25 with cementless stems and 26 with cemented ones with different megaprosthetic implants. The primary endpoint was MSTS score, and the secondary endpoint was to state the incidence of surgical and clinical complications in the two groups. An un-paired T test was used to compare anthropometric, anamnestic data, and MSTS. Chi-square test was performed for evaluation of complication in the two group. Multiple linear regression was used to match the functional outcomes and complications’ incidence in the population study. Logistic regression was performed to analyse the odds ratio of different parameters and their role in the incidence of complications. Results The mean follow-up was 50.1 months (+ 12.5). In thirty case right side was involved. No statistical differences were noticed between Group A and B regard the age, gender, active fracture/impending fracture. Comparing the MSTS results within the two groups at last follow-up, the score cemented group was higher than cementless one (17.9 + 7.8 vs 24.2 + 5.3; statistical significance p = 0.001). Regarding surgical complications a logistic regression was performed to analyse the odds ratio of age, cementation and length of resection; cementation confirm and odds ratio of 11 times in the incidence of surgical complications. Conclusions Cementation seems to be more liable to complications onset, while improves functional score in metastatic patients compared to uncemented megaprostheses. More studies have to be conducted in order to create a protocol and establish criteria to use cemented or uncemented stems in a frail population like metastatic patients.

This study aimed to produce mechanically separated meat (MSM) from tilapia obtained at the Teresina fish market in the state of Piauí, Brazil. Waste production and disposal and yields were estimated, and physico-chemical and microbiological MSM qualities were determined. A questionnaire was applied to the fish market sellers, followed by tilapia carcass sampling for MSM production and assessments concerning yields, microbiological (Escherichia coli and Staphylococcus coagulase positive counts and the detection of Salmonella spp.) and physicochemical (water activity, pH, reaction to hydrogen sulfide and ammonia) quality and proximate composition (moisture, ash, proteins, lipids, carbohydrates and total energy value). The questionnaire results indicated that tilapia is highly in demand and thats processing leads to significant waste. The yield analysis indicated that tilapia MSM presents adequate residual meat extraction rates from tilapia carcasses. All microbiological analyses were in compliance with Brazilian standards. Physicochemical results were as follows: protein (14.9 to 16.1%), lipids (16.6 to 22.1%), ash (1.3 to 2.8%), moisture (60.6 to 64 .1%), carbohydrates (0.6 to 1.5%) and calories (216.5 to 263.1 kcal 100-1). It is, therefore, clear that MSM constitutes a safe and nutritious foodstudd and comprises a viable alternative for the development of co-products.

Background & Aims: Alcohol abuse and metabolic disorders are leading causes of hepatocellular carcinoma (HCC) worldwide. Alcohol-related aetiology is associated with a worse prognosis compared with viral agents, because of the lower percentage of patients diagnosed with HCC under routine surveillance and a higher burden of comorbidity in alcohol abusers. This study aimed to describe the evolving clinical scenario of alcohol-related HCC over 15 years (2006–2020) in Italy. Methods: Data from the Italian Liver Cancer (ITA.LI.CA) registry were used: 1,391 patients were allocated to three groups based on the year of HCC diagnosis (2006–2010; 2011–2015; 2016–2020). Patient characteristics, HCC treatment, and overall survival were compared among groups. Survival predictors were also investigated. Results: Approximately 80% of alcohol-related HCCs were classified as cases of metabolic dysfunction-associated fatty liver disease. Throughout the quinquennia,