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Objectives We conducted a cost–benefit analysis of the pediatric National Immunization Program (NIP) in Italy.Methods An economic model evaluated the benefit–cost ratio (BCR) of the Italian pediatric NIP, including 10 pathogens for mandatory vaccines and 4 pathogens for recommended vaccines for children aged 0–10 years from the healthcare-sector and societal perspectives. Separate decision trees were used to model each vaccine-preventable disease (VPD). The 2020 birth cohort (n = 420,084) was followed over their lifetime; the model projected and compared discounted disease cases, life-years, quality-adjusted life-years (QALYs), and costs (2021 euros) with and without immunization (based on current and pre – vaccine era disease incidence estimates, respectively).Results The pediatric NIP was estimated to prevent 1.8 million cases of VPDs and 3,330 deaths, resulting in 45,900 fewer life-years lost and 57,000 fewer QALYs lost. Vaccination costs of €285 million were offset by disease cost savings of €1.6 billion, resulting in a BCR of 5.6 from a societal perspective (BCR = 1.7 from a healthcare-sector perspective). When QALYs gained were valued, the BCR increased to 15.6.Conclusions The benefits of the Italian pediatric NIP, including averted disease-related morbidity, mortality, and associated costs, highlight the value of continued investment in pediatric immunization.

Inroduction: Schwannomas are the most common tumors of the peripheral nervous system. Surgical eradication with excision or enucleation is the treatment for symptomatic and large schwannomas. Aim: Few studies have investigated the clinical outcomes related to the surgical approach to schwannomas. Our study aims to evaluate the clinical and functional results of surgery for the treatment of upper limb schwannomas. Materials and methods: Twenty-two cases of upper limb schwannomas were surgically treated in our institution between January 2016 and December 2023. All cases underwent preoperative and 6-month postoperative MRI. For each case, we recorded the diagnostic interval (symptom-diagnosis), symptoms (stenosis or sensory deficits, pain, and Tinel test), and both pre-and postoperative functional status (with DASH and MSTS scores). We also recorded complications and local recurrences. Results: On average, the diagnosis was made 16.7 months after the onset of the first symptom. The mean preoperative MSTS, DASH, and MRC values were 27.9, 5.7, and 4.8, respectively. We had no intra-operative complications. After a mean follow-up of 43.1 months, MSTS, DASH were 29.7/30 and 0.7, respectively. No case developed local recurrences. No case recorded stenosis deficits at the last follow-up. Only one patient developed local paresthesia (9%), while two reported modest dysesthesias. Conclusions: An adequate surgical approach, possibly preceded by a rapid diagnosis, can significantly improve the symptoms caused by schwannoma, restoring the functionality of the upper limb.

The exchange of knowledge and best practices in adult immunization are essential to improve vaccination strategies across the European region. Italy has made groundbreaking progress in the field, being one of the first countries to propose a life-course vaccination schedule, broadening the traditional focus on childhood immunization to include adults. All vaccines included in Italy’s vaccination schedule are free of charge. Moreover, the country’s National Immunization Plan sets clear coverage targets, immunization priorities, and actions to reduce disparities. However, the fragmentation of its National Health System following the constitutional reform of 2001 has led to an increased complexity and regional inequalities regarding immunization. Other challenges the country faces include growing vaccine hesitancy, data gaps and underserved populations. This review describes Italy’s adult immunization system, from policy to implementation. The successes, challenges and lessons learned were shared during the first Adult Immunization Board country meeting in Italy, where local experts, healthcare providers, public health representatives, and policymakers engaged in collaborative discussions and shared insights through case studies and presentations (December 2023). These insights are reviewed and discussed in this manuscript.

Desert soil hosts many microorganisms, whose activities are essential from an ecological viewpoint. Moreover, they are of great anthropic interest. The knowledge of extreme environments microbiomes may be beneficial for agriculture, technology, and human health. In this study, 11 Arthrobacter strains from topsoil samples collected from the Great Gobi A Strictly Protected Area in the Gobi Desert, were characterized by a combination of different techniques. The phylogenetic analysis, performed using their 16S rDNA sequences and the most similar Arthrobacter sequences found in databases, revealed that most of them were close to A. crystallopoietes, while others joined a sister group to the clade formed by A. humicola, A. pascens, and A. oryzae. The resistance of each strain to different antibiotics, heavy-metals, and NaCl was also tested as well as the inhibitory potential against human pathogens (i.e., Burkholderia ssp., Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus ssp.) via cross-streaking, to check the production of metabolites with antimicrobial activity. Data obtained revealed that all strains were resistant to heavy metals and were able to strongly interfere with the growth of many of the human pathogens tested. The volatile organic compounds (VOCs) profile of the 11 Arthrobacter strains was also analyzed. A total of 16 different metabolites were found, some of which were already known for having an inhibitory action against different Gram-positive and Gram-negative bacteria. Isolate MS-3A13, producing the highest quantity of VOCs, is the most efficient against Burkholderia cepacia complex (Bcc), K. pneumoniae, and coagulase-negative Staphylococci (CoNS) strains. This work highlights the importance of understanding microbial populations' phenotypical characteristics and dynamics in extreme environments to uncover the antimicrobial potential of new species and strains.

Close-proximity operations play a crucial role in emerging mission concepts, such as Active Debris Removal or small celestial bodies exploration. When approaching a non-cooperative target, the increased risk of collisions and reduced reliance on ground intervention necessitate autonomous on-board relative pose (position and attitude) estimation. Although navigation strategies relying on monocular cameras which operate in the visible (VIS) spectrum have been extensively studied and tested in flight for navigation applications, their accuracy is heavily related to the target’s illumination conditions, thus limiting their applicability range. The novelty of the paper is the introduction of a thermal-infrared (TIR) camera to complement the VIS one to mitigate the aforementioned issues. The primary goal of this work is to evaluate the enhancement in navigation accuracy and robustness by performing VIS-TIR data fusion within an Extended Kalman Filter (EKF) and to assess the performance of such navigation strategy in challenging illumination scenarios. The proposed navigation architecture is tightly coupled, leveraging correspondences between a known uncooperative target and feature points extracted from multispectral images. Furthermore, handover from one camera to the other is introduced to enable seamlessly operations across both spectra while prioritizing the most significant measurement sources. The pipeline is tested on Tango spacecraft synthetically generated VIS and TIR images. A performance assessment is carried out through numerical simulations considering different illumination conditions. Our results demonstrate that a combined VIS-TIR navigation strategy effectively enhances operational robustness and flexibility compared to traditional VIS-only navigation chains.

Background: The extensor apparatus of the knee can be thought of a chain that transmits the muscular strength developed by the quadriceps muscles to the proximal tibia. This complex is essential to allow the extension of the tibia over the femur, being essential to provide knee mobility and stability. In case of lesions which irreparably damage the patella, such as a locally aggressive bone tumor, it is necessary to restore both the apparatus’ anatomical continuity and its strength.Case report: A 39-years-old Caucasian man with a history of lung carcinoma developed atraumatic swelling and soreness in his left knee. Imaging evidence reported a degeneration of the left patella. We performed an en bloc resection of the patella and the nearby soft tissues of the extensor apparatus. The resulting gap was fulfilled with a massive allograft consisting of a quadriceps tendon, a patella and a patellar ligament. No complication or local recurrences were observed. At the patient’s latest follow-up, he did not have any extension lag and quadriceps strength was completely restored.Conclusion: Massive allografts can represent a reliable alternative for the reconstruction of the patella and the knee extensor apparatus in orthopedic oncology.

Background: The vaccines recommended during pregnancy are the Tdap, the influenza vaccine, and, during the SARS-CoV-2 pandemic, the vaccine against COVID-19. This survey aimed at determining vaccination coverage among pregnant women and adverse events, reasons for vaccine refusal, and factors associated with vaccine uptake. Methods: A single-center cross-sectional study was conducted on women who delivered between March and April 2022 at Careggi University Hospital in Florence, Italy. Information on the vaccinations (Tdap, influenza and COVID-19) received during pregnancy were collected through in-person interviews. Results: Among 307 enrolled women (response rate 99 % on a study population of 310 eligible women), 74 % of patients were vaccinated with Tdap, 82 % against COVID-19, and only 33 % against influenza. Vaccination coverage for Tdap and COVID-19 was significantly higher among Italian than foreign patients (80 % vs 51 %, p

Background: Varicella infections follow a benign course in around 90% of cases, with more severe forms occurring in adults. To identify potential pockets of susceptibility and to improve targeted immunization strategies, this study aims to critically assess immunological status by evaluating varicella seroprevalence among adults (18–99 years) in the province of Florence (Italy), nearly a decade after Tuscany introduced the vaccination program. Methods: A convenience sample of 430 subjects aged 18 to 94 years (mean age 51.8 ± 18.8 years), stratified by age and sex (53.7% of subjects were female; N = 231), was collected between 2018 and 2019. Sero-analytical analyses were conducted utilizing EUROIMMUN Anti-VZV ELISA (IgG) kits. Results: Most of them were of Italian nationality (87.4%; N = 376). Among the 430 tested samples, 385 (89.5%) were positive and 39 (9.1%) were negative. The remaining six sera (1.4%), confirmed as equivocal, were excluded from further analysis. No significant differences were found based on sex (p-value = 0.706) or nationality (p-value = 0.112). The application of trend tests (Mantel–Haenszel; Kendall Tau-b) showed a significant trend (p < 0.024 and p < 0.032, respectively), with an increasing probability of finding a positive anti-varicella serological status passing from a lower age group (84.2%) to a higher one (93.0%). By considering the female population aged 18–49 years, the seroprevalence of anti-varicella antibodies was found to be 88.4%, with a susceptibility of 11.6%, highlighting the risk of acquiring infection during pregnancy. Conclusions: The introduction of varicella vaccination has had a significant impact on public health in Tuscany and in Italy more generally. However, further efforts should be made to reduce the number of individuals still susceptible in adulthood, with particular attention given to women of childbearing age and the promotion of vaccination through mass and social media and institutional websites.

The fungi Botryosphaeriaceae are involved in olive declines in both the world hemispheres and in all continents where this species is cultivated. In Salento (Apulia, Italy), the Botryosphaeriaceae Neofusicoccum mediterraneum and N. stellenboschiana have been reported as the agents of a branch and twig dieback that overlaps with olive quick decline syndrome caused by Xylella fastidiosa subsp. pauca. In this study, we report the finding of Diplodia seriata, another Botryosphaeriaceae species, in Salento in Xylella fastidiosa-infected olive trees affected by symptoms of branch and twig dieback. Given that its presence was also reported in olive in the Americas and in Europe (Croatia) with different degrees of virulence, we were prompted to assess its role in the Apulian decline. We identified representative isolates based on morphological features and a multilocus phylogeny. In vitro tests showed that the optimum growth temperature of the isolates is around 25–30 °C, and that they are highly thermo-tolerant. In pathogenicity trials conducted over eleven months, D. seriata expressed a very low virulence. Nonetheless, when we imposed severe water stress before the inoculation, D. seriata significatively necrotized bark and wood in a time frame of 35 days. Moreover, the symptoms which resulted were much more severe in the trial performed in summer compared with that in autumn. In osmolyte-supplemented media with a water potential from −1 to −3 Mpa, the isolates increased or maintained their growth rate compared with non-supplemented media, and they also grew, albeit to a lesser extent, on media with a water potential as low as −7 Mpa. This suggests that olives with a low water potential, namely those subjected to drought, may offer a suitable environment for the fungus’ development. The analysis of the meteorological parameters, temperatures and rainfall, in Salento in the timeframe 1989–2023, showed that this area is subjected to a progressive increase of temperature and drought during the summer. Thus, overall, D. seriata has to be considered a contributor to the manifestation of branch and twig dieback of olive in Salento. Coherently with the spiral decline concept of trees, our results suggest that heat and drought act as predisposing/inciting factors facilitating D. seriata as a contributor. The fact that several adverse factors, biotic and abiotic, are simultaneously burdening olive trees in Salento offers a cue to discuss the possible complex nature of the olive decline in Salento.

Seasonal influenza is an acute respiratory infectious disease due to influenza viruses, causing a relevant number of illnesses and deaths each year worldwide. Influenza is a preventable disease by vaccination. The aim of this study was to assess the epidemiology of seasonal influenza in Italy through the analysis of data from the epidemiological and virological RespiVirNet surveillance system for the season 2010/2011 to 2023/2024 to identify the epidemiological key points to plan the most appropriate vaccination strategies. The cumulative and maximum weekly incidence of influenza-like illness (ILI) and epidemic period (beginning, end, duration in weeks) were assessed in the pre-pandemic period (2010/2011–2019/2020) and they were compared to the pandemic and post-pandemic one. In all seasons, children reported the highest incidence values of ILI and longer epidemic periods in contrast with the older population. The epidemic seasons 2020/2021 and 2021/2022 had abnormal trends while in the last seasons 2022/2023 and 2023/2024 the epidemiological and virological trends of ILI were confirmed as reported in the pre-pandemic period but with high intensity. Influenza virus A was predominant: the H3N2 subtype circulated more than virus H1N1pdm09. In the few seasons when influenza virus B was the most frequent influenza agent, it co-circulated with influenza virus A. The monitoring of cases is the fundamental tool to better understand the epidemiology of influenza and to optimize future preventive strategies.

Background: Liver resection is a critical surgical procedure for treating various hepatic pathologies. Minimally invasive approaches have gradually gained importance, and, in recent years, the introduction of robotic surgery has transformed the surgical landscape, providing potential advantages such as enhanced precision and stable ergonomic vision. Among robotic techniques, the single-site approach has garnered increasing attention due to its potential to minimize surgical trauma and improve cosmetic outcomes. However, the full extent of its utility and efficacy in liver resection has yet to be thoroughly explored. Methods: We conducted a comprehensive systematic review to evaluate the current role of the single-site robotic approach in liver resection. A detailed search of PubMed was performed to identify relevant studies published up to January 2024. Eligible studies were critically appraised, and data concerning surgical outcomes, perioperative parameters, and post-operative complications were extracted and analyzed. Results: Our review synthesizes evidence from six studies, encompassing a total of seven cases undergoing robotic single-site hepatic resection (SSHR) using various versions of the da Vinci© system. Specifically, the procedures included five left lateral segmentectomy, one right hepatectomy, and one caudate lobe resection. We provide a summary of the surgical techniques, indications, selection criteria, and outcomes associated with this approach. Conclusion: The single-site robotic approach represents an option among the minimally invasive approaches in liver surgery. However, although the feasibility has been demonstrated, further studies are needed to elucidate its optimal utilization, long-term outcomes, and comparative effectiveness against the other techniques. This systematic review provides valuable insights into the current state of single-site robotic liver resection and underscores the need for continued research in this rapidly evolving field.

Human Papilloma Virus (HPV) infection and HPV-related cancers can be prevented through vaccinations and mass cervical screening programmes. The Ministry of Health in Italy provides recommendations on primary and secondary prevention of HPV-related diseases, but the 19 Italian regions and 2 autonomous provinces have organisational and decision-making autonomy, with differences in the strategies for offering prevention. The aim of this study is to describe the HPV vaccination and cervical screening offered in all Italian regions. Regional official documents up until 31 December 2021 were first identified. Subsequently, primary and secondary prevention experts from each region were interviewed to validate the previously collected data. The National Immunisation Plan (NIP) 2017–2019 recommends HPV vaccination from the age of 11 for both sexes, with a coverage target of 95%. HPV vaccination is offered free of charge or co-payment. All regions have screening programmes for cervical cancer, using PAP or HPV-DNA tests every three to five years. All regions have an electronic registry for vaccination and screening status. All regions have developed awareness-raising campaigns. It is important to harmonise regional policies with the implementation of information systems integration. The collected data could enhance both regional and national public health initiatives, bolstering the resilience of vaccination programs.

Background: Bacterial endophytic communities associated with medicinal plants synthesize a plethora of bioactive compounds with biological activities. Their easy isolation and growth procedures make bacterial endophytes an untapped source of novel drugs, which might help to face the problem of antimicrobial resistance. This study investigates the antagonistic potential of endophytic bacteria isolated from different compartments of the medicinal plant O. heracleoticum against human opportunistic pathogens. Methods: A panel of endophytes was employed in cross-streaking tests against multidrug-resistant human pathogens, followed by high-resolution chemical profiling using headspace-gas chromatography/mass spectrometry. Results: Endophytic bacteria exhibited the ability to antagonize the growth of opportunistic pathogens belonging to the Burkholderia cepacia complex (Bcc). The different inhibition patterns observed were related to their taxonomic attribution at the genus level; most active strains belong to the Gram-positive genera Bacillus, Arthrobacter, and Pseudarthrobacter. Bcc strains of clinical origin were more sensitive than environmental strains. Cross-streaking tests against other 36 human multidrug-resistant pathogens revealed the highest antimicrobial activity towards the Coagulase-negative staphylococci and Klebsiella pneumoniae strains. Interestingly, strains of human origin were the most inhibited, in both groups. Concerning the production of volatile organic compounds (VOCs), the strain Arthrobacter sp. OHL24 was the best producer of such compounds, while two Priestia strains were good ketones producers and so could be considered for further biotechnological applications. Conclusions: Overall, this study highlights the diverse antagonistic activities of O. heracleoticum-associated endophytes against both Bcc and multidrug-resistant (MDR) human pathogens. These findings hold important implications for investigating bacterial endophytes of medicinal plants as new sources of antimicrobial compounds.

Close-proximity operations play a crucial role in emerging mission concepts, such as Active Debris Removal or small celestial bodies exploration. When approaching a non-cooperative target, the increased risk of collisions and reduced reliance on ground intervention necessitate autonomous on-board relative pose (position and attitude) estimation. Although navigation strategies relying on monocular cameras which operate in the visible (VIS) spectrum have been extensively studied and tested in flight for navigation applications, their accuracy is heavily related to the target's illumination conditions, thus limiting their applicability range. The novelty of the paper is the introduction of a thermal-infrared (TIR) camera to complement the VIS one to mitigate the aforementioned issues. The primary goal of this work is to evaluate the enhancement in navigation accuracy and robustness by performing VIS-TIR data fusion within an Extended Kalman Filter (EKF) and to assess the performance of such navigation strategy in challenging illumination scenarios. The proposed navigation architecture is tightly coupled, leveraging correspondences between a known uncooperative target and feature points extracted from multispectral images. Furthermore, handover from one camera to the other is introduced to enable seamlessly operations across both spectra while prioritizing the most significant measurement sources. The pipeline is tested on Tango spacecraft synthetically generated VIS and TIR images. A performance assessment is carried out through numerical simulations considering different illumination conditions. Our results demonstrate that a combined VIS-TIR navigation strategy effectively enhances operational robustness and flexibility compared to traditional VIS-only navigation chains. [ABSTRACT FROM AUTHOR]

Myxoid liposarcomas are malignant soft-tissue sarcomas whose treatment represents a challenge, even for the most experienced surgeon. In this study, we report on our experience with the treatment of myxoid liposarcomas of the thigh. Our retrospective analysis included myxoid liposarcomas of the thigh treated with surgical resection between 2016 and 2022. Resection margins, complications, local recurrences, and metastases were recorded. The oncological outcome of each case was evaluated at their latest follow-up. Adjuvant therapies were administered according to the ESMO guidelines. Functionality was assessed with the MSTS score before surgery and at the patients' latest follow-up. Thirty cases (ten high-grade and 20 low-grade) were included. The mean diameter was 11.8 cm. Twenty-four cases had wide margins (80%) and six (20%) were marginal. Five cases (60% marginal) had local recurrences (17%). Marginal resection was associated with a higher risk of local recurrence (p = 0.041). Three cases with high-grade tumors (10%) developed metastases. At the patients' latest follow-up, their mean MSTS score had risen from 22.9 to 27.3. While tumor grade influences the risk of metastases, the quality of resection margins can determine the local recurrence rate. An adequate surgery can lead to good post-operative functional outcomes. [ABSTRACT FROM AUTHOR]

Background: Varicella infections follow a benign course in around 90% of cases, with more severe forms occurring in adults. To identify potential pockets of susceptibility and to improve targeted immunization strategies, this study aims to critically assess immunological status by evaluating varicella seroprevalence among adults (18–99 years) in the province of Florence (Italy), nearly a decade after Tuscany introduced the vaccination program. Methods: A convenience sample of 430 subjects aged 18 to 94 years (mean age 51.8 ± 18.8 years), stratified by age and sex (53.7% of subjects were female; N = 231), was collected between 2018 and 2019. Sero-analytical analyses were conducted utilizing EUROIMMUN Anti-VZV ELISA (IgG) kits. Results: Most of them were of Italian nationality (87.4%; N = 376). Among the 430 tested samples, 385 (89.5%) were positive and 39 (9.1%) were negative. The remaining six sera (1.4%), confirmed as equivocal, were excluded from further analysis. No significant differences were found based on sex (p-value = 0.706) or nationality (p-value = 0.112). The application of trend tests (Mantel–Haenszel; Kendall Tau-b) showed a significant trend (p < 0.024 and p < 0.032, respectively), with an increasing probability of finding a positive anti-varicella serological status passing from a lower age group (84.2%) to a higher one (93.0%). By considering the female population aged 18–49 years, the seroprevalence of anti-varicella antibodies was found to be 88.4%, with a susceptibility of 11.6%, highlighting the risk of acquiring infection during pregnancy. Conclusions: The introduction of varicella vaccination has had a significant impact on public health in Tuscany and in Italy more generally. However, further efforts should be made to reduce the number of individuals still susceptible in adulthood, with particular attention given to women of childbearing age and the promotion of vaccination through mass and social media and institutional websites. [ABSTRACT FROM AUTHOR]

The fungi Botryosphaeriaceae are involved in olive declines in both the world hemispheres and in all continents where this species is cultivated. In Salento (Apulia, Italy), the Botryosphaeriaceae Neofusicoccum mediterraneum and N. stellenboschiana have been reported as the agents of a branch and twig dieback that overlaps with olive quick decline syndrome caused by Xylella fastidiosa subsp. pauca. In this study, we report the finding of Diplodia seriata, another Botryosphaeriaceae species, in Salento in Xylella fastidiosa-infected olive trees affected by symptoms of branch and twig dieback. Given that its presence was also reported in olive in the Americas and in Europe (Croatia) with different degrees of virulence, we were prompted to assess its role in the Apulian decline. We identified representative isolates based on morphological features and a multilocus phylogeny. In vitro tests showed that the optimum growth temperature of the isolates is around 25–30 °C, and that they are highly thermo-tolerant. In pathogenicity trials conducted over eleven months, D. seriata expressed a very low virulence. Nonetheless, when we imposed severe water stress before the inoculation, D. seriata significatively necrotized bark and wood in a time frame of 35 days. Moreover, the symptoms which resulted were much more severe in the trial performed in summer compared with that in autumn. In osmolyte-supplemented media with a water potential from −1 to −3 Mpa, the isolates increased or maintained their growth rate compared with non-supplemented media, and they also grew, albeit to a lesser extent, on media with a water potential as low as −7 Mpa. This suggests that olives with a low water potential, namely those subjected to drought, may offer a suitable environment for the fungus' development. The analysis of the meteorological parameters, temperatures and rainfall, in Salento in the timeframe 1989–2023, showed that this area is subjected to a progressive increase of temperature and drought during the summer. Thus, overall, D. seriata has to be considered a contributor to the manifestation of branch and twig dieback of olive in Salento. Coherently with the spiral decline concept of trees, our results suggest that heat and drought act as predisposing/inciting factors facilitating D. seriata as a contributor. The fact that several adverse factors, biotic and abiotic, are simultaneously burdening olive trees in Salento offers a cue to discuss the possible complex nature of the olive decline in Salento. [ABSTRACT FROM AUTHOR]

Seasonal influenza is an acute respiratory infectious disease due to influenza viruses, causing a relevant number of illnesses and deaths each year worldwide. Influenza is a preventable disease by vaccination. The aim of this study was to assess the epidemiology of seasonal influenza in Italy through the analysis of data from the epidemiological and virological RespiVirNet surveillance system for the season 2010/2011 to 2023/2024 to identify the epidemiological key points to plan the most appropriate vaccination strategies. The cumulative and maximum weekly incidence of influenza-like illness (ILI) and epidemic period (beginning, end, duration in weeks) were assessed in the pre-pandemic period (2010/2011–2019/2020) and they were compared to the pandemic and post-pandemic one. In all seasons, children reported the highest incidence values of ILI and longer epidemic periods in contrast with the older population. The epidemic seasons 2020/2021 and 2021/2022 had abnormal trends while in the last seasons 2022/2023 and 2023/2024 the epidemiological and virological trends of ILI were confirmed as reported in the pre-pandemic period but with high intensity. Influenza virus A was predominant: the H3N2 subtype circulated more than virus H1N1pdm09. In the few seasons when influenza virus B was the most frequent influenza agent, it co-circulated with influenza virus A. The monitoring of cases is the fundamental tool to better understand the epidemiology of influenza and to optimize future preventive strategies. [ABSTRACT FROM AUTHOR]

In orthopedic oncology, total scapulectomy is necessary to allow a wide resection of extended malignancies of the scapula and scapular girdle. Scapular reconstruction is challenging even for the most experienced surgeon. This paper reports our experience with total scapular resections, followed by humeral suspension or custom-made prostheses. In this retrospective study, we evaluated all the oncologic patients treated in our institution between 2016 and 2023 with total scapulectomy and consequential reconstruction using humeral suspension or a custom-made prosthesis. Only cases suffering from malignant bone tumors were included. The postoperative functionality of the treated limbs was assessed using the Musculoskeletal Tumor Society (MSTS) scoring scale. Complications and local recurrences were also recorded. Nine patients were enrolled. Five had custom-made implants, and four had humeral suspensions. The mean postoperative MSTS score of patients treated with custom-made prostheses was 24.0 (22–26). Globally, our cohort's mean MSTS score was 19.1 (9–26). Patients with custom-made prostheses had significantly better functional outcomes (MSTS 24 vs 13) and similar complication rates (40% vs 50%) than those who received humeral suspensions. Our outcomes suggest that, when feasible, custom-made scapular prostheses can represent a reliable reconstructive option after total scapulectomy for malignant scapular tumors. [ABSTRACT FROM AUTHOR]

Background: Liver resection is a critical surgical procedure for treating various hepatic pathologies. Minimally invasive approaches have gradually gained importance, and, in recent years, the introduction of robotic surgery has transformed the surgical landscape, providing potential advantages such as enhanced precision and stable ergonomic vision. Among robotic techniques, the single-site approach has garnered increasing attention due to its potential to minimize surgical trauma and improve cosmetic outcomes. However, the full extent of its utility and efficacy in liver resection has yet to be thoroughly explored. Methods: We conducted a comprehensive systematic review to evaluate the current role of the single-site robotic approach in liver resection. A detailed search of PubMed was performed to identify relevant studies published up to January 2024. Eligible studies were critically appraised, and data concerning surgical outcomes, perioperative parameters, and post-operative complications were extracted and analyzed. Results: Our review synthesizes evidence from six studies, encompassing a total of seven cases undergoing robotic single-site hepatic resection (SSHR) using various versions of the da Vinci© system. Specifically, the procedures included five left lateral segmentectomy, one right hepatectomy, and one caudate lobe resection. We provide a summary of the surgical techniques, indications, selection criteria, and outcomes associated with this approach. Conclusion: The single-site robotic approach represents an option among the minimally invasive approaches in liver surgery. However, although the feasibility has been demonstrated, further studies are needed to elucidate its optimal utilization, long-term outcomes, and comparative effectiveness against the other techniques. This systematic review provides valuable insights into the current state of single-site robotic liver resection and underscores the need for continued research in this rapidly evolving field. [ABSTRACT FROM AUTHOR]

Background: In Bismuth type III and IV Hilar Cholangiocarcinoma (III–IV HC), surgical resection is the only chance for long-term survival. As the surgical procedure is complex and Robotic-Assisted Surgery (RAS) may be particularly suitable in this setting, the aim of this study is to evaluate the potential benefits of RAS in III–IV HC in terms of post-operative outcomes. Methods: We conducted a systematic review using the PRISMA checklist for article selection. We searched the PubMed database and included only studies with clinical data about the treatment of III–IV HC using RAS. Results: A total of 12 papers involving 50 patients were included. All cases were Bismuth IIIa (n = 18), IIIb (n = 27) or IV type (n = 5) and underwent hepatectomy with biliary confluence resection and reconstruction. The mean operative time was 500 minutes with a conversion rate of 4%. The mean hospital stay was 12.2 days, and the morbidity and 30-day mortality rate were 61.9% and 2%, respectively. Over a mean follow up period of 10.1 months, 9/18 cases experienced recurrence (50%). Conclusions: RAS for III–IV HC is safe and feasible, at least if performed by experienced surgeons on selected cases. The oncological outcomes appear acceptable, given the aggressiveness of this pathology, but further studies are needed to fully elucidate the exact role of robotics in this setting. [ABSTRACT FROM AUTHOR]

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Objectives: We conducted a cost–benefit analysis of the pediatric National Immunization Program (NIP) in Italy. Methods: An economic model evaluated the benefit–cost ratio (BCR) of the Italian pediatric NIP, including 10 pathogens for mandatory vaccines and 4 pathogens for recommended vaccines for children aged 0–10 years from the healthcare-sector and societal perspectives. Separate decision trees were used to model each vaccine-preventable disease (VPD). The 2020 birth cohort (n = 420,084) was followed over their lifetime; the model projected and compared discounted disease cases, life-years, quality-adjusted life-years (QALYs), and costs (2021 euros) with and without immunization (based on current and pre – vaccine era disease incidence estimates, respectively). Results: The pediatric NIP was estimated to prevent 1.8 million cases of VPDs and 3,330 deaths, resulting in 45,900 fewer life-years lost and 57,000 fewer QALYs lost. Vaccination costs of €285 million were offset by disease cost savings of €1.6 billion, resulting in a BCR of 5.6 from a societal perspective (BCR = 1.7 from a healthcare-sector perspective). When QALYs gained were valued, the BCR increased to 15.6. Conclusions: The benefits of the Italian pediatric NIP, including averted disease-related morbidity, mortality, and associated costs, highlight the value of continued investment in pediatric immunization. [ABSTRACT FROM AUTHOR]

The current energy scenario requires that gas turbines (GTs) operate at their maximum efficiency and highest reliability. Trip is one of the most disrupting events that reduces GT availability and increases maintenance costs. To tackle the challenge of GT trip prediction, this paper presents a methodology that has the goal of monitoring the early warnings raised during GT operation and trigger an alert to avoid trip occurrence. The methodology makes use of an auto-encoder (prediction model) and a three-stage criterion (detection procedure). The auto-encoder is first trained to reconstruct safe operation data and subsequently tested on new data collected before trip occurrence. The trip detection criterion checks whether the individually tested data points should be classified as normal or anomalous (first stage), provides a warning if the anomaly score over a given time frame exceeds a threshold (second stage), and, finally, combines consecutive warnings to trigger a trip alert in advance (third stage). The methodology is applied to a real-world case study composed of a collection of trips, of which the causes may be different, gathered from various GTs in operation during several years. Historical observations of gas path measurements taken during three days of GT operation before trip occurrence are employed for the analysis. Once optimally tuned, the methodology provides a trip alert with a reliability equal to 75% at least 10 h in advance before trip occurrence. [ABSTRACT FROM AUTHOR]

The post–COVID-19 condition (PCC) is a disabling syndrome affecting at least 5%–10% of subjects who survive COVID-19. SARS-CoV-2 mediated vagus nerve dysfunction could explain some PCC symptoms, such as dysphonia, dysphagia, dyspnea, dizziness, tachycardia, orthostatic hypotension, gastrointestinal disturbances, or neurocognitive complaints. We performed a cross-sectional pilot study in subjects with PCC with symptoms suggesting vagus nerve dysfunction (n = 30) and compared them with subjects fully recovered from acute COVID-19 (n = 14) and with individuals never infected (n = 16). We evaluated the structure and function of the vagus nerve and respiratory muscles. Participants were mostly women (24 of 30, 80%), and the median age was 44 years (interquartile range [IQR] 35–51 years). Their most prevalent symptoms were cognitive dysfunction 25 of 30 (83%), dyspnea 24 of 30 (80%), and tachycardia 24 of 30 (80%). Compared with COVID-19-recovered and uninfected controls, respectively, subjects with PCC were more likely to show thickening and hyperechogenic vagus nerve in neck ultrasounds (cross-sectional area [CSA] [mean ± standard deviation]: 2.4 ± 0.97mm2 vs. 2 ± 0.52mm2 vs. 1.9 ± 0.73 mm2; p 0.08), reduced esophageal-gastric-intestinal peristalsis (34% vs. 0% vs. 21%; p 0.02), gastroesophageal reflux (34% vs. 19% vs. 7%; p 0.13), and hiatal hernia (25% vs. 0% vs. 7%; p 0.05). Subjects with PCC showed flattening hemidiaphragms (47% vs. 6% vs. 14%; p 0.007), and reductions in maximum inspiratory pressure (62% vs. 6% vs. 17%; p ≤ 0.001), indicating respiratory muscle weakness. The latter findings suggest additional involvement of the phrenic nerve. Vagus and phrenic nerve dysfunction contribute to the complex and multifactorial pathophysiology of PCC. [ABSTRACT FROM AUTHOR]

The exchange of knowledge and best practices in adult immunization are essential to improve vaccination strategies across the European region. Italy has made groundbreaking progress in the field, being one of the first countries to propose a life-course vaccination schedule, broadening the traditional focus on childhood immunization to include adults. All vaccines included in Italy's vaccination schedule are free of charge. Moreover, the country's National Immunization Plan sets clear coverage targets, immunization priorities, and actions to reduce disparities. However, the fragmentation of its National Health System following the constitutional reform of 2001 has led to an increased complexity and regional inequalities regarding immunization. Other challenges the country faces include growing vaccine hesitancy, data gaps and underserved populations. This review describes Italy's adult immunization system, from policy to implementation. The successes, challenges and lessons learned were shared during the first Adult Immunization Board country meeting in Italy, where local experts, healthcare providers, public health representatives, and policymakers engaged in collaborative discussions and shared insights through case studies and presentations (December 2023). These insights are reviewed and discussed in this manuscript.