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Abstract Background For years politics and healthcare, faced with the progressive increase in the prevalence of overweight and obesity in childhood, have wondered how to stem it and reduce its consequences on health without finding a valid, effective and applicable solution. Many studies have been written initially on what to prescribe, then on why not to prescribe and how to approach people in a new and more effective way to improve their behaviors, considered the main cause of excess weight. Over the last twenty years it has been highlighted that no diet or physical exercise is truly effective and not even global changes in lifestyle guarantee the large weight reductions traditionally expected, despite offering significant health advantages. A new approach is necessary and we must begin by working on ourselves. Main body We examined literature on weight stigma and considered expert opinions, as well as feedback from parents/caregivers and patients. Literature on stigma has grown enormously in recent years, and finally considers the opinion of parents and patients. By interviewing patients with obesity, it was discovered that very often healthcare workers do not communicate the diagnosis and, if they do, they have a blaming attitude, holding patients responsible for their weight. Furthermore, when these people become aware of their obesity and seek treatment, they do not find adequate professionals and centers. Failure was mostly due to the enormous burden of obesity stigma and discrimination which, especially in children and young people, encourages internalization of the problem and takes away their self-efficacy, desire and ability to take care of themselves. Conclusions New actions are needed to change all this. We propose “Training, Networking and Contrasting Weight Stigma”. Now that we’ve figured out where to start, we should get going. And yet, nothing is changing!

Objective: Breast Cancer (BC) is the primary oncological diagnosis in women, with the annual incidence expected to exceed 3 million new cases by 2040 due to population growth and ageing. During the COVID-19 pandemic, novel methods were adopted to provide continuous care to patients, including the introduction of telehealth. This technique allows for improved access to care, reduced emissions with environmental impact, better resource utilization, and ultimately improved continuity of care. A current issue is the environmental impact of hospitals, particularly operating rooms, as it has been analyzed that 25-30% of hospital waste comes from these areas. In this regard, there has been a consideration to introduce the ERAS protocol, already active in colorectal surgery, into breast surgery, aiming to optimize resources, reduce hospital waste, and expedite waiting lists. Materials and Methods: With the introduction of the Breast Green Surgery (BuGS) protocol, the focus is not only on creating a more environmentally sustainable operating room by reducing waste, but also on minimizing the anesthetic impact on the patient and the environment. It is known that volatile anesthetics significantly contribute to pollution. Results: Our goal is to reduce their use by favoring awake surgery, using local anesthetics along with sedatives to maintain patient comfort during the procedure. Conclusions: Therefore, our multidisciplinary BuGS protocol aims at evaluating for the synergistic effect of different procedure for the first time on Clinical Outcome, Patients’ Reported Outcome Measure (PROM), and Environment Related Outcome Measure (EROM) in BC surgery.

IntroductionCanine atopic dermatitis (AD) closely mimics human AD and is recognized as a beneficial animal model. House dust mites (HDM) are a common allergen for both species. The effects of chronic exposure to HDM on the skin have not been studied in this animal model, and it is not known how changes in gene expression correlate to the severity of dermatitis.MethodsWe used an established canine model of AD and took biopsies before HDM exposure (D0) and five times during repeated allergen challenges (on Days 1, 2, 8, 15, and 29, hereafter referred to as D1, D2, D8, D15, and D29). The severity of dermatitis was scored on the same days.ResultsTrichohyalin (TCHH) gene expression decreased the most (15-fold decrease on D29 vs. D0) and negatively correlated with the severity of dermatitis. Gap-junction protein gene expression increased over 3-fold on D1, D8, and D29 and positively correlated with the severity of dermatitis. Compared to D0, IL-31 gene expression significantly increased on D8 (p = 0.0098), D15 (p = 0.0068), and D29 (p = 0.0187), but the correlation with the severity of dermatitis did not reach significance.DiscussionThis is the first report on trichohyalin, a protein belonging to the S100 family, and gap-junction protein gene expression in the context of the clinical severity of AD. We propose that these proteins should be further investigated to better understand their role in this complex disease.

In this paper, we describe the geohazard-related elements of the Eastern Tyrrhenian Sea continental margin, situated between the 40° and 41° North latitude. These features were recognised principally through morphological analysis. The investigation utilized medium – and high-resolution digital models of the submarine landscape, produced within the framework of the Magic project (Marine Geohazard along Italian Coasts), and primarily focusing on the bathymetric range of 50–700 meters. The surveyed area encompasses a recently formed continental margin, which connects the internal segments of the Apennine fold-and-thrust belt, verging NE, to the Tyrrhenian Sea bathyal plain, a 3000-m-deep back-arc basin that has developed since the Middle-Late Miocene. Several classes of hazard-related elements have been identified offshore, primarily associated with high-gradient slopes and a large number of volcanic edifices and banks. These include canyon systems, erosive scarps, landslide complexes, fault – and volcanic-related features, such as the products of the volcanic edifices instability, which claim to varying degrees of geo-hazard. Additionally, bedforms, fluid seepages and creeping phenomena in the prodelta slopes suggest high morpho-tectonic and environmental dynamics.HighlightsThis article reports on the thematic maps developed along the Lazio – Campania offshore (Central-eastern Tyrrhenian Sea, Italy) within the framework of the Magic Project, based on geomorphological analysis of the HR Digital Elevation Model of the seafloor.Several classes of hazard-related elements have been identified offshore, mainly associated with high-gradient slopes, volcanic activity and intense morphodynamic processes.The entire suite of maps created in the context of the Magic Project serves as a valuable base of knowledge, extending to the national scale and benchmarks for future monitoring of critical sites and geo-hazard-related features, as well as for maritime spatial planning actions.

ABSTRACTThis paper accompanies the Maps of Geohazard features of the Cilento and the Calabro-Tyrrhenian continental margin in the southern Tyrrhenian Sea (Italy). The main geohazard-related features were derived from extensive seafloor mapping through the collection of high-resolution multibeam data acquired during several oceanographic cruises. They encompass many fluids seepage features, fault scarps, landslides scars, gullies, channels, and canyons. Hazards related to coastal landslides and shelf-indenting canyons are very high in these sectors (especially in southern Calabria) due to active seismicity coupled with rapid uplift, high sedimentation rates and narrow or totally absent continental shelf, thus promoting a direct connection between steep slopes and coastal areas. In this setting, mass-wasting features can directly impact coastal or submarine infrastructures or indirectly create local tsunami waves, as observed in historical times. Moreover, this physiographic setting of the margin facilitates the transfer of marine litter toward deep-sea areas.

AimThe main challenge during breast-conserving surgery (BCS) is to obtain clear margins, especially in patients with ductal carcinoma in situ (DCIS) due to the absence of well-defined nodules. Many surgical approaches have been used in an attempt to reduce the positive margin rate. The aim of this retrospective study is to compare the cavity shave margin technique with standard surgery and the intraoperative evaluation of surgical margins.MethodsThis is a single-center retrospective study analyzing margin status, need for re-excision, and surgical time in a cohort of 227 patients who underwent surgery from September 2016 to September 2022.ResultsIn patients subjected to cavity shaving, we reported a significant reduction in positive margins of 17.1% versus 28.7% (p-value = 0.042). Also, a difference in terms of surgical re-excision was reported as p-value = 0.039 (12.4% versus 23.8%, respectively, for the cavity shave and control group). In the multivariate analysis, intraoperative evaluation of the margins was a risk factor for margins re-excision (Wald = 4.315, p = 0.038, OR: 2.331 [95% CI: 1.049–5.180]). Surgical time was lower in patients subjected to cavity shaves (p = 0.024), and the relative mean time was 68.4 min ± 37.1 min in the cavity shave group versus 93.9 min ± 40.6 min in the control group.ConclusionThe cavity shave margin technique in conserving breast surgery results in a reduction in positive margin rate, surgical re-excision, and operative time.

Background: Resection of additional tissue circumferentially around the cavity left by lumpectomy (cavity shave) was suggested to reduce rates of positive margins and re-excision. Methods: A single center retrospective study which analyzed margins status, re-excision, and surgical time in patients who underwent breast conserving surgery and cavity shave or intraoperative evaluation of resection margins. Results: Between 2021 and 2023, 594 patients were enrolled in the study. In patients subjected to cavity shave, a significant reduction in positive, focally positive, or closer margins was reported 8.9% vs. 18.5% (p = 0.003). No difference was reported in terms of surgical re-excision (p < 0.846) (5% vs. 5.5%). Surgical time was lower in patients subjected to cavity shave (p = 0.006). Conclusions: Cavity shaving after lumpectomy reduced the rate of positive margins and it was associated with a significant reduction in surgical time compared to intraoperative evaluation of resection margins.

Cochlear implants (CI) allow deaf patients to improve language perception and improving their emotional valence assessment. Electroencephalographic (EEG) measures were employed so far to improve CI programming reliability and to evaluate listening effort in auditory tasks, which are particularly useful in conditions when subjective evaluations are scarcely appliable or reliable. Unfortunately, the presence of CI on the scalp introduces an electrical artifact coupled to EEG signals that masks physiological features recorded by electrodes close to the site of implant. Currently, methods for CI artifact removal have been developed for very specific EEG montages or protocols, while others require many scalp electrodes. In this study, we propose a method based on the Multi-channel Wiener filter (MWF) to overcome those shortcomings. Nine children with unilateral CI and nine age-matched normal hearing children (control) participated in the study. EEG data were acquired on a relatively low number of electrodes (n = 16) during resting condition and during an auditory task. The obtained results obtained allowed to characterize CI artifact on the affected electrode and to significantly reduce, if not remove it through MWF filtering. Moreover, the results indicate, by comparing the two sample populations, that the EEG data loss is minimal in CI users after filtering, and that data maintain EEG physiological characteristics.

The use of benzodiazepines is strongly associated with an increased risk of traffic accidents due to their side effects of sedation and drowsiness, which can significantly impair driving performance. The main aim of our study was to investigate the trend of benzodiazepine use over nine years (2015–2023) in a population of 15,988 subjects who had their license suspended for driving under the influence (DUI) of alcohol or drugs. Among the 15,988 users accessed to our laboratory, 924 tested positive for at least one benzodiazepine. An increase in the number of positive-testing users was observed in the period 2015–2018, followed by a slight decrease in 2019. Overall, the trend of benzodiazepine use was stable over the next four years (2020–2023), with the highest incidence in 2022. The most common benzodiazepines, and/or metabolites, found in urine samples were α-OH-alprazolam (28.66%; n = 366) and oxazepam (27.25%; n = 348). Several cases of mixed positivity were observed in the study population. The main substances taken with benzodiazepines were cocaine and Δ9-tetrahydrocannabinol. Our findings suggest that people taking benzodiazepines should be monitored, as these have a relevant impact on driving ability in addition to significant interindividual differences in the behavioral effects of benzodiazepines on driving performance.

This research aimed to describe the Adjacency Pairs phenomena in the BBC Learning English, comprising two adjacency pairs aspects: The most frequently types of adjacency pairs used by the participants and the most frequently initiators of the first part in adjacency pairs. This research used quantitative descriptive research. The object of this research was one video contained (5 parts), the topic "all about language" with a video duration of 1 hour taken from the 'Six Minutes English Program on BBC Learning English’. The researcher collected and analyzed the data by applying the theory of Murata (1994). The conversation in the English Conversation video was used for data collection. The data were exported to the data sheet for identifying the types of adjacency pairs contained in the video. The result of the research showed 9 types of adjacency pairs on the Six Minutes English Program in BBC learning English in Youtube Channel. The types of adjacency pairs were Greeting-Greeting, Question-Answer, Request-Acceptance/Refusal, Blam-Admission/Denial, Assesment-Agreement/Disagreement, Command-Compliance/Incompliance, Suggestion-Acceptance/Refusal, Assertion-Agreement/Disagreement, Announcement-Acknowledgement. First, researcher found the most frequently appeared in adjacency pairs question-answer and assessment-agreement/disagreement. Also, researcher found the most frequently initiators of the first part in adjacency pairs namely the first participant. In conclusion, from the research video in 13 adjacency pairs, only 9 adjacency pairs often appear, 3 of which are not in the conversation between two participants. For further researchers, it is recomended to develop more about adjacency pairs and use other video conversations that contain many types of adjacency pairs.

Theory of Mind (ToM) or mentalizing is the ability to infer mental states of oneself and other agents. Theory of mind plays a key role in social interactions as it allows one to predict other agents' likely future actions by inferring what they may intend or know. However, there is a wide range of ToM skills of increasing complexity. While most people are generally capable of performing complex ToM reasoning such as recursive belief inference when explicitly prompted, there is much evidence that humans do not always use ToM to their full capabilities. Instead, people often fall back to heuristics and biases, such as an egocentric bias that projects one's beliefs and perspective onto the observed agent. We explore which (internal or external) factors may influence the mentalizing processes that humans employ unsolicitedly, i.e., employ without being primed or explicitly triggered. In this paper we present an online study investigating unbalanced decision problems where one choice is significantly better than the other. Our results demonstrate that participant's are significantly less likely to exhibit an egocentric bias in such situations.

Cognitive abilities are essential to children's overall growth; thus, the implementation of early and effective training interventions is a major challenge for developmental psychologists and teachers. This study explores whether an intervention simultaneously operating on fluid reasoning (FR), visuospatial, narrative, and motor abilities could boost these competencies in a group of Italian preschoolers (N = 108, 54 males 54 females, Age[subscript mean] = 4.04). FR and visuospatial abilities showed training-related increases at the end of the training and 1-year follow-up (moderate effect size). Interestingly, positive correlations with working memory and mathematical abilities were found. Beyond their scientific relevance, the short- and long-term effects provide fundamental indications for designing and implementing educational programs dedicated to preschoolers.

Background and Objectives: The association between endometriosis and breast cancer still remains controversial. The aim of this study was to investigate the different subtypes of breast cancer, immunohistochemical markers, hormone receptors, and ki67 proliferation indexes in patients with and without endometriosis and/or adenomyosis. Materials and Methods: All patients with endometriosis and breast cancer were enrolled. Women with endometriosis and breast cancer (Group BC+EN+) were compared to patients with breast cancer without endometriosis (group BC+EN−) and those with endometriosis without breast cancer (group BC-EN+). General population characteristics and histological and immunohistochemical subtypes of breast cancer were compared between groups. Results: Our study included 41 cases affected by both endometriosis and/or adenomyosis and breast cancer (Group BC+EN+) that were matched (1:2) with 82 patients affected only by breast cancer (group BC+EN−) and 82 patients affected only by endometriosis and/or adenomyosis (group BC-EN+). Group BC+EN+ presented a higher percentage of ER receptor expression (83% vs. 70%, p = 0.02), as well as lower values of Ki 67% (15% vs. 24%, p < 0.0001) and HER2+ (9.8% vs. 28%, p = 0.022). These findings were more evident when comparing patients with premenopausal status, while in postmenopausal patients, this difference was no longer significant. Regarding endometriosis, no statistical differences were observed in type or specific localization of the disease among the groups with and without breast cancer. Conclusions: Patients with endometriosis presented lower aggressive breast cancer rates with higher values of ER% and lower values of Ki 67 and HER2neu+. The type and severity of endometriotic diseases seemed not to influence breast cancer occurrence.

Filaggrin is important for the skin barrier and atopic dermatitis. Another filaggrin-like protein, filaggrin 2, has been described. We evaluated antibodies against both filaggrins in normal and atopic skin biopsies from dogs before and after allergen challenges (D0, D1, D3 and D10). Filaggrins expression was evaluated by immunohistochemistry and Western blot. We used PCR to investigate changes in filaggrin gene expression. Effects of group (p = 0.0134) and time (p = 0.0422) were shown for the intensity of filaggrin staining. Only an effect of group was found for filaggrin 2 (p = 0.0129). Atopic samples had higher intensity of staining than normal dogs [filaggrin on D3 (p = 0.0155) and filaggrin 2 on D3 (p = 0.0038) and D10 (p < 0.0001)]. Atopic samples showed increased epidermal thickness after allergen exposure (D3 vs. D0, p = 0.005), while normal dogs did not. In atopic samples, significant increased gene expression was found for filaggrin overtime but not for filaggrin 2. Western blot showed an increase in filaggrin 2 on D3. A small size band (15 kD) containing a filaggrin sequence was found in Western blots of atopic samples only. We conclude that atopic skin reacts to allergen exposure by proliferating and increasing filaggrin production but that it also has more extensive filaggrin degradation compared to normal skin.

The rainbow trout (Oncorhynchus mykiss) is the most important produced species in freshwater within the European Union, usually reared in intensive farming systems. This species is highly susceptible to viral hemorrhagic septicemia (VHS), a severe systemic disease widespread globally throughout the world. Viral hemorrhagic septicemia virus (VHSV) is the etiological agent and, recently, three classes of VHSV virulence (high, moderate, and low) have been proposed based on the mortality rates, which are strictly dependent on the viral strain. The molecular mechanisms that regulate VHSV virulence and the stimulated gene responses in the host during infection are not completely unveiled. While some preliminary transcriptomic studies have been reported in other fish species, to date there are no publications on rainbow trout. Herein, we report the first time-course RNA sequencing analysis on rainbow trout juveniles experimentally infected with high and low VHSV pathogenic Italian strains. Transcriptome analysis was performed on head kidney samples collected at different time points (1, 2, and 5 days post infection). A large set of notable genes were found to be differentially expressed (DEGs) in all the challenged groups (e.s. trim63a, acod1, cox-2, skia, hipk1, cx35.4, ins, mtnr1a, tlr3, tlr7, mda5, lgp2). Moreover, the number of DEGs progressively increased especially during time with a greater amount found in the group infected with the high VHSV virulent strain. The gene ontology (GO) enrichment analysis highlighted that functions related to inflammation were modulated in rainbow trout during the first days of VHSV infection, regardless of the pathogenicity of the strain. While some functions showed slight differences in enrichments between the two infected groups, others appeared more exclusively modulated in the group challenged with the highly pathogenic strain.

Italy is one of the main European producers of trout fish, and the most important producing area is the Autonomous Province of Trento (APT) in the North East. The objective of the study was to obtain a snapshot of the trout farms of the APT by identifying biosecurity factors, objectifying them, and classifying the establishments accordingly. Data from 62 salmonid farms were collected using a national checklist in which biosecurity elements were identified and assessed using the method of expert elicitation. The purpose was to evaluate the levels of biosecurity of a trout farm in order to rank the risk of introduction and spread of infectious fish diseases. The main critical factors identified during this study were as following: (i) cleaning and disinfection of the cargo truck; (ii) regular collection, storage, and disposal of dead fish; (iii) presence of anti-bird nets; (iv) use of dedicated equipment for the different sectors of the farm; and (v) presence of external areas dedicated to the loading of dead fish.

Alcohol abuse is still one of the leading causes of death worldwide. Early diagnosis of alcohol abuse enables preventive intervention on the effects and risks associated with its consumption. Carbohydrate-deficient transferrin (CDT) is one of the most reliable biomarkers of chronic alcohol misuse. We retrospectively studied a population of 12,624 subjects who had their driving license suspended for driving under the influence of alcohol or drugs from 2016 to 2022. The analytical determination of CDT was performed following a certified high-performance liquid chromatography (HPLC) method. Data were split by year, age and gender. The majority of subjects with positive %CDT were male, although the trend of positivity was similar between males and females. A steady increase in both the number of tests performed and the number of positives was observed over the years. Patients aged 41–50 years had the highest prevalence, followed by 51–60, 31–40 and 18–30 years. CDT continues to be a steady marker for diagnosis of alcohol abuse in the majority of cases. Data emerging from our study are in line with the increasing national trends on traffic accidents, injuries and deaths related to alcohol and drug DUI (driving under the influence), requiring the implementation of preventive measures to limit this ever-growing phenomenon.

The precise measurement of the spectrum of protons, the most abundant component of the cosmic radiation, is necessary to understand the source and acceleration of cosmic rays in the Milky Way. This work reports the measurement of the cosmic ray proton fluxes with kinetic energies from 40 GeV to 100 TeV, with 2 1/2 years of data recorded by the DArk Matter Particle Explorer (DAMPE). This is the first time that an experiment directly measures the cosmic ray protons up to ~100 TeV with high statistics. The measured spectrum confirms the spectral hardening at ~300 GeV found by previous experiments and reveals a softening at ~13.6 TeV, with the spectral index changing from ~2.60 to ~2.85. Our result suggests the existence of a new spectral feature of cosmic rays at energies lower than the so-called knee and sheds new light on the origin of Galactic cosmic rays.

The precise measurement of the spectrum of protons, the most abundant component of the cosmic radiation, is necessary to understand the source and acceleration of cosmic rays in the Milky Way. This work reports the measurement of the cosmic ray proton fluxes with kinetic energies from 40 GeV to 100 TeV, with 2 1/2 years of data recorded by the DArk Matter Particle Explorer (DAMPE). This is the first time that an experiment directly measures the cosmic ray protons up to ~100 TeV with high statistics. The measured spectrum confirms the spectral hardening at ~300 GeV found by previous experiments and reveals a softening at ~13.6 TeV, with the spectral index changing from ~2.60 to ~2.85. Our result suggests the existence of a new spectral feature of cosmic rays at energies lower than the so-called knee and sheds new light on the origin of Galactic cosmic rays.

The Si Beru Dayang folklore is one of the cultural heritages in North Sumatra, and it belongs to Karonese society. Such folklore is believed to entertain the Karonese who still retell it to young generation according to its function since it contains local wisdom. This research is aimed at discussing women’s images seen from the perspective of cultural aspects. Qualitative descriptive methods and interviews were used in this research. The data collection was obtained from recording and from informants’ oral responses when they were invited during interviews; data was discussed from the domains of sociology of literature and from cultural aspects. The sociology of literature was focused on a number of concepts of women’s images in the folklore. The results show that women are portrayed as anak beru (wife taker/daughter), ndehara (wife), and sirukatnakan (rice dipper) as symbols of origin of rice in Karo land, and as women in the merdang traditional ritual.