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The Ross procedure is a preferred treatment for infants and children with aortic valve disease. Progressive neoaortic root dilation and neoaortic insufficiency can occur after the Ross procedure, and because of the young age of these patients, valve-sparing aortic root replacement procedures have advantages compared with the Bentall procedure. The aim of this study is to describe our experience with different techniques of aortic valve-sparing root replacement in this unique cohort of patients. Patients undergoing valve-sparing aortic root replacement with a history of the Ross procedure between January 2001 and March 2021 were identified. A retrospective chart review was performed, and clinical characteristics of these patients were analyzed. The results of different types of valve-sparing aortic root replacement were also compared. Forty-two patients who had previously undergone a Ross procedure in childhood presented for reintervention for neoaortic root or valve pathology. Seventeen of these patients were considered for valve-sparing aortic root replacement but underwent bioprosthetic or mechanical valve replacement, and 25 patients underwent successful valve-sparing aortic root replacement. Patients who underwent valve-sparing aortic root replacement received a traditional aortic root remodeling procedure with or without suture annuloplasty (Yacoub technique, group 1, n = 7), an aortic root reimplantation procedure (David technique, group 2, n = 11), or a modified root remodeling procedure that also used a geometric annuloplasty ring (group 3, n = 7). Patient demographics and comorbidities were similar between groups. Mean follow-up for these 3 cohorts was 14 years, 4 years, and 1 year, respectively. Overall survival was good, with 1 early death due to hemorrhage in group 2 and 1 death due to malignancy in group 1. Eight patients (7 in group 1; 1 in group 2) required subsequent aortic valve replacements due to neoaortic insufficiency, whereas none in group 3 have required any reintervention. Overall, patients requiring valve replacement after valve-sparing aortic root replacement had lower grades of preoperative neoaortic insufficiency and higher grades of postoperative neoaortic insufficiency. Greater than mild postoperative neoaortic insufficiency was associated with the need for subsequent neoaortic valve replacement. Valve-sparing aortic root replacement is safe in patients with a prior Ross procedure. Reimplantation offers superior durability compared with the traditional remodeling procedure. Greater than mild neoaortic insufficiency on postoperative echocardiogram should prompt additional attempts at valve repair. A modified remodeling procedure with geometric ring annuloplasty that is personalized to the patient's individual anatomy is safe with good short-term results, but longer follow-up is needed. [Display omitted] [ABSTRACT FROM AUTHOR]

Detailed accounts of long-term respiratory complications among children with acute flaccid myelitis have not been reported systematically. We describe respiratory complications and outcomes in a single-center cohort of 19 children with acute flaccid myelitis. Significantly, 3 of the 19 children had a prolonged course of nocturnal hypoventilation that required intervention. [ABSTRACT FROM AUTHOR]

Purely hilar lesions and those abutting the main renal artery or vein may be significantly different in terms of surgical complexity, requiring different resection strategies. To describe surgical technique and to assess its safety, oncologic and functional outcomes of a single centre experience of Off-Clamp Robotic Partial Nephrectomy (Off-C RPN) for purely hilar renal masses. The Institutional Review Board renal cancer database was queried for: "robotic", "partial nephrectomy" and "hilar". Baseline imaging was reviewed for all cases to strictly select patients with purely hilar tumors, defined as tumors arising into the renal hilum without any exophytic growth. Off-C RPN with straight access to the hilum was performed in all cases. We reported baseline, perioperative, oncologic and functional outcomes of the institutional series of purely hilar masses treated with Off-C RPN. Between 2011 and 2019, 680 Off-C RPN were performed. Overall, 20 cases were classified as "hilar" renal tumors. Ten lesions abutting the main renal artery or vein were excluded leaving 10 purely hilar cases for analysis. Median operative time was 85 (range 68–115) minutes. No high-grade complications occurred. One patient (10%) required blood transfusion. At a median follow-up of 27 months, one renal recurrence and one newly onset Chronic Kidney Disease stage 3A was observed. RPN for purely hilar tumors has been poorly addressed and distinguishing purely hilar from tumors abutting the hilar vessels may have significant technical implications. In tertiary referral centers, Off-C RPN for purely hilar tumors provides excellent perioperative, oncologic and functional outcomes. • Hilar renal tumors are challenging cases, requiring different resection strategies. • Purely hilar masses best suited off-clamp robotic partial nephrectomy. • It is a feasible and safe approach, providing excellent outcomes. • The technique remains demanding and should be referred to high volume centres. [ABSTRACT FROM AUTHOR]

Several tricuspid annuloplasty (TA) techniques are used for concomitant repair of functional tricuspid regurgitation (TR). This study compared the midterm clinical and valvular outcome among 3 annuloplasty techniques. TA was performed in 307 patients (aged 75.9 ± 10.4 years) with a rigid ring (RA) in 184, a flexible band (FA) in 80, or a suture annuloplasty (SA) in 43. Study end points were survival and recurrence of TR >grade 2 at 5 years. TA was performed concomitantly to mitral valve surgery in 136 patients (44.3%), aortic valve surgery in 18 (5.9%), coronary artery bypass grafting in 13 (4.2%), or a combined procedure in 140 (45.6%). Most had TR >grade 2 (78.5%), without significant differences between the TA groups (P =.878). Within a median follow-up of 3.4 years (interquartile range, 2.2-5.0 years), the 5-year survival was 80.1% ± 3.4% for RA, 83.5% ± 4.7% for FA, and 85.1% ± 6.5% for SA (P =.471). Independent risk factors for late mortality were renal impairment (hazard ratio [HR], 2.83; 95% CI, 1.16-6.89; P =.022), diabetes (HR, 2.10; 95% CI, 1.07-4.11; P =.030), and severe right ventricular dysfunction by tricuspid annulus plane systolic excursion <10 mm (HR, 11.52; 95% CI, 4.98-26.66; P <.001). Pulmonary hypertension was nearly significant (HR, 1.92; 95% CI, 0.98-3.74; P =.057). The cumulative incidence of TR recurrence at 5 years was 15.9%, 19.4%, and 21.1% for RA, FA, and SA, respectively (P =.342). Severe pulmonary hypertension (HR, 2.64; 95% CI, 1.38-5.07; P =.003), preoperative TR grade (HR, 1.82; 95% CI, 1.01-3.27; P =.046), and residual TR >grade 2 at discharge (HR, 3.38; 95% CI, 1.64-6.96; P =.001) were predictive for later TR recurrence, regardless of the annuloplasty technique. This study demonstrates that advanced pathophysiological right circulatory impairment, such as severe pulmonary hypertension and right ventricular dysfunction, affects the midterm survival and TR recurrence rate more than the annuloplasty technique used for concomitant repair of functional TR. [ABSTRACT FROM AUTHOR]

[Display omitted] • Giffonins E, H, J and carpinontriol B were isolated from Corylus avellana. • The diarylheptanoids showed protection against H 2 O 2 -induced cytotoxic damage. • The compounds were able to decrease ROS production and lipid peroxidation. • Molecular docking experiments and Western blot analysis were performed. • The compounds resulted disruptors of the Nrf2/keap1 complex. Hazelnut "Tonda di Giffoni" (Corylus avellana L.) is a PGI (Protected Geographical Indication) product of the Campania region, Southern Italy, marked for its processing quality which guarantees origin, typical features, high physicochemical quality, and organoleptic properties. Previous investigations on hazelnut and its byproducts revealed the presence of diarylheptanoid derivatives, natural compounds with antioxidant properties. With the aim of exploring the nutraceutical properties of hazelnut diarylheptanoids, the antioxidant properties of giffonins E (1), H (2), and J (3), three cyclic diaryletherheptanoids, and carpinontriol B (4), a cyclic diarylheptanoid, were investigated. Tested compounds showed significant protection against hydrogen peroxide (H 2 O 2)-induced cytotoxic damage in human neuroblastoma and embryonic kidney cell lines. Compounds 1 – 4 were also able to prevent oxidative stress by decreasing reactive oxygen species (ROS) production and levels of lipid peroxidation, and attenuating cell apoptosis (caspase-3 activity). Moreover, considering that the nuclear factor erythroid 2-related factor 2 (Nrf2) is responsible for regulating an extensive panel of antioxidant enzymes, the capability of these natural products to disrupt the interaction between Kelch-like ECH-associated protein 1 (Keap1), thereby activating the Nrf2-mediated pathway, was evaluated by molecular docking experiments and in vitro tests. The Western blot analysis revealed that giffonin H and carpinontriol B had an indirect antioxidant action, as evidenced by a significant rise in the translocated protein following their administration. [ABSTRACT FROM AUTHOR]

• Informative real-world data on DMT use in pregnancy are needed. • We evaluated DMT use and relapse in patients with MS before, during, and post-pregnancy. • DMT use during pregnancy sharply declined; by trimester 3, few patients used a DMT. • Numbers of patients with MS with relapse declined over pregnancy but increased postpartum. • Reinitiation of DMT postpartum was associated with lower risk of relapses, supporting early DMT initiation postpartum. Pregnancy is a common consideration for people with multiple sclerosis (pwMS); MS onset is typically between 20 and 45 years of age, during potential child-bearing years. Pregnancy and postpartum care are a significant factor influencing disease-modifying therapy (DMT) selection for many pwMS. To date, few DMTs are considered safe to continue during pregnancy and real-world treatment patterns before, during, and after pregnancy remain uncharacterized. Evolving guidance is needed regarding how to optimize management of the pregnancy and postpartum periods considering the changing DMT landscape. This analysis in two large claims databases describes DMT utilization for the treatment of MS before, during, and after pregnancy and relapse patterns during pregnancy and postpartum. In this retrospective, observational study, the US MarketScan Commercial and Medicaid claims database was assessed for female patients aged 18–55 years with ≥1 insurance claim submitted under the diagnosis code of MS from 01 January 2016–30 April 2021 and continuous enrollment eligibility from ≥6 months prior to pregnancy date (preconception) through 6 months of follow-up following delivery (postpartum period). Comorbid conditions were examined preconception and postpartum, including anxiety and depression. Moderate/severe relapse was defined as MS-related hospitalization, or an outpatient visit and one claim within 7 days of the visit with steroids or total plasma exchange. A total of 944 patients (mean [standard deviation] age, 32.4 [5.0] years) were eligible; 688 (73%) were commercially insured and 256 (27%) received Medicaid. Compared with commercially-insured patients, use of DMTs was lower among Medicaid patients at 6 months preconception (25.4% vs 40.4%; p < 0.001), with similar patterns observed both during pregnancy and postpartum. Overall, prevalence of DMT use declined sharply during pregnancy, from 36.3% of patients in the 6 months preconception to 17.9%, 5.3%, and 5.8% in trimesters 1, 2 and 3, respectively. Postpartum DMT utilization increased to 20.9% at 0–3 months and 24.4% at 4–6 months. Of all patients in the preconception period, the most frequently used DMTs were glatiramer acetate (14.3%), dimethyl fumarate (6.0%), interferon (5.2%), and natalizumab (4.9%). Due to small sample size, information was limited for anti-CD20s and alemtuzumab. The proportion of patients with any moderate/severe relapse declined over pregnancy (preconception, n = 82 [8.7%]; pregnancy, n = 25 [2.6%]), but increased postpartum (n = 94 [10.0%]). Of the 889 patients who stopped DMT during pregnancy, the risk of postpartum relapses was lower in the patients who resumed DMT postpartum (10/192) than in patients who did not (76/697) (5.2% vs 10.9%; odds ratio, 0.455 [95% confidence interval 0.216–0.860], p = 0.018). Cases of postpartum depression and anxiety were significantly lower in commercially-insured patients vs Medicaid patients (postpartum depression, 13.7% vs 27.0%, p < 0.01; postpartum anxiety, 16.3% vs 30.5%, p < 0.01). DMT utilization declined sharply during pregnancy; it gradually increased postpartum but remained below pre-pregnancy use. The proportion of pwMS experiencing a moderate/severe relapse and number of relapses declined over pregnancy but increased postpartum. Reinitiation of DMT during the postpartum period was associated with lower risk of relapses, supporting a role for early reinitiation of DMT postpartum. Biogen [ABSTRACT FROM AUTHOR]

Big-data mining approaches based on Artificial Intelligence models can help forecast biodiversity changes before they happen. These approaches can predict macroscopic species distribution patterns and trends that can inform preventive measures to avoid the loss of ecosystem functions and services. They can, therefore, help study and mitigate climate change implications on biodiversity conservation in fragile ecosystems. Wetlands are particularly fragile ecosystems where climate change poses severe risks and has dramatically reduced their size over the past century, with profound consequences on biodiversity and ecosystem services. Through big-data mining approaches, we can predict future wetland biodiversity trends in the context of climate change. This paper proposes such predictive analysis for a specific wetland: The Massaciuccoli Lake basin in Tuscany, Italy. This basin is a critical tourist attraction due to its rich biodiversity, making it an area of interest for citizens, tourists, and scientists. However, the region's suitability for native and non-native species is at risk due to climate and land-use change. Using machine-learning models, we predict the potential effects of climate change on animal spatial distribution in the basin under different greenhouse gas emission scenarios. The results suggest that habitat suitability has generally improved from 1950 to today, presumably owing to the targeted conservation strategies adopted in the area, but climate change will severely reduce bird biodiversity by 2050 while favouring several insect species' proliferation and other species' habitat change, even under a medium-emission scenario. This will lead to significant changes in the basin's biodiversity. Our methodology is adaptable to other wetland basins, being fully based on open data and models. The spatially explicit modelling used in this research provides valuable information for policymakers and spatial planners, complementing traditional biodiversity trend analyses. [Display omitted] • Bayesian Open Science ecological niche models for 180 species in an Italian wetland • Environmental change in the last 70 years has benefited animal biodiversity • Climate change will disadvantage birds even under medium greenhouse gas emission • Climate change will alter other species' richness and habitat distribution [ABSTRACT FROM AUTHOR]

Approximately 80% of people with multiple sclerosis (MS) experience bladder dysfunction (BD). BD decreases quality of life, reduces mobility, and increases disease burden. Pelvic floor physical therapy (PFPT) is an evidence-based, non-invasive, and effective treatment for MS-related BD. Here, we provide a descriptive study, leveraging longitudinally collected patient-reported (PRO) BD severity scores against coinciding electronic health record (EHR) reports, to understand barriers to timely evaluation and treatment of BD. The FITriMS study is a prospective cohort of ambulatory participants with progressive or relapsing MS, which included PROs of BD at baseline, 6-months, and 1-year. This analysis compared BD PRO (with Bladder Control Scores ≥ 1) to evaluations performed by a neurologist on the same participants concurrently. Chart review categorized the clinical treatment plan. 74% (65/88) of participants met inclusion criteria. They were mostly female (57%), mean age 53.5 years (11.8), median disease duration 19 years (range 1-54), and moderate disability (median EDSS 5.5, range 0-6.5). At baseline, 88% of participants reported BD on their PRO, but only 30% had some treatment documented in the EHR: 44% referred Urology, 50% prescribed medication, 6% provided behavioral techniques. At 6-months, 90% of participants reported BD on their PRO, 38% EHR documented treatment (43% referred Urology, 29% prescribed medication, 28% behavioral techniques); the distribution was similar at the 1-year. 93% of participants reported BD; 33% had treatment plans in the EHR (36% prescribed medication, 36% referred Urology, and 28% behavioral techniques). 0% had a documented referral for PFPT. A gap was found between participant reports of BD on PROs and those referred for treatment. No direct PFPT referrals were documented, despite it being an evidenced-based, effective treatment. Quality improvement and education efforts for timely PFPT referrals can potentially improve patient care and close this gap. [ABSTRACT FROM AUTHOR]

Gait and balance impairment is common in multiple sclerosis (MS), often leading to walking aids need. Rehabilitation is the most common and effective approach to tackle the burden of these symptoms, but less attention is given to the correct use of an assistive device for ambulation. Here, we aimed to maximise the effect of a rehabilitation program including walking aid training with a sensorized crutch in people with MS (PwMS). 24 PwMS (15 females, age=57.8±9.8 years, all EDSS=6) underwent a 20-session rehabilitation program focusing on gait, balance, and proper assistive device use. The experimental group (FB_group, N=12) used a crutch with real-time feedback based on user support load, whilst the control group (NOFB_group, N=12) used a standard crutch. Assessment included Timed 25 Foot Walk (T25FW), Timed Up and Go (TUG) and Modified Fatigue Impact Scale (MFIS). Moreover, functional Near-Infrared Spectroscopy (fNIRS) was used to investigate cortical activity during linear and curvilinear walking tasks. At baseline, no differences were found between groups concerning either clinical or neural evaluations. Following rehabilitation, we observed a reduction in fatigue perception in both groups (p=0.038). Moreover, FB_group performed better than NOFB_group in T25FW and TUG (p=0.028 and p=0.038, respectively). Further, after treatment, FB_group showed increased neural activity in areas involved in cognitive functions (Brodmann Areas-BA 9,10, p<0.01), multisensory integration and body representation (BA39, p=0.01) during both linear and curvilinear walking. Instead, NOFB_group showed increased activity in motor planning areas (BA 6,8, p<0.05). A significant difference was also found between groups in BA9 after treatment (FB_group>NOFBgroup, p=0.04). A 20-session rehabilitation period effectively reduces fatigue among PwMS. Moreover, a real-time feedback crutch seems to have a positive impact on walking ability. This might be due to a feedback-induced increased attention focusing on the assistive device, as suggested by the fNIRS results. [ABSTRACT FROM AUTHOR]

Ultrasound is a reliable tool for airway assessment and management. We evaluated the accuracy of ultrasound in the preprocedure planning and follow-up evaluation of patients undergoing airway stenting for benign upper airway stenosis. This was a retrospective single center study on patients with benign upper airway stenosis treated with airway stenting. Ultrasound evaluated the characteristics of the stenosis (distance from vocal folds, diameter, and length) before treatment and any complications after treatment; these results were then statistically compared with those obtained by computed tomography, taking the endoscopy as the reference method. Twenty-seven patients were evaluated. Ultrasound was significantly correlated with endoscopy and computed tomography scan measurements as distance of stenosis from vocal folds (r = 0.88; P <.001 and r = 0.87; P <.001, respectively), diameter of the stenosis (r = 0.97; P <.001 and r = 0.97; P <.001, respectively), and length of the stenosis (r = 0.97; P <.001 and r = 0.97; P <.001, respectively). Four out of 27 (15%) patients presented complications after treatment as stent migration (n = 2; 7%); stent obstruction (n = 1; 4%), and granulation of vocal fold (n = 1; 4%). All complications but granulation of vocal fold were correctly depicted by ultrasound and computed tomography without significant difference in comparison to endoscopy (P =.87) Ultrasound is a promising tool in assessment of airway stenosis and follow-up of patients after stenting; it may be routinely used in adjunction to computed tomography and/or endoscopy in this setting, if our results are corroborated by a future larger study. [ABSTRACT FROM AUTHOR]

The aim was to evaluate the effect of age on health-related quality of life (HRQOL) for patients with head and neck cancer (HNC), treated with curative intent, in the Western healthcare region of Sweden. In this prospective observational study, 311 HNC patients completed quality of life questionnaires for cancer (EORTC QLQ-C30 and EORTC QLQ-H&N35) and for older patients with cancer (EORT QLQ-ELD14) at diagnosis and 3, 6, and 12 months after start of treatment. Mean scores for patients ≥70 years old were compared to younger patients (50 to 69 years old) to assess differences in HRQOL. Of the 311 study participants, 105 patients were ≥70 years old (median age 76.7), of which 32 were ≥80 years of age. Most HRQOL scores were equal or better for older adult patients at 3 months after treatment, but physical function was better for younger adult patients up to 12 months after treatment. At 6 months the HRQOL was similar (older patients had less appetite loss and financial difficulties), while the oldest patients (≥80 years) had worse fatigue, role function, and feeling ill at 12 months. For the EORTC-ELD-14 questionnaire, older patients scored better for worries at diagnosis and reported more difficulties in maintaining purpose at 12 months after treatment. When curative treatment is administered, older adult patients with HNC have similar or even better HRQOL compared to younger adult patients, except for physical function, during the first year. [ABSTRACT FROM AUTHOR]

The Rotterdam Prostate Cancer Risk calculator (RPCRC) has been validated in the past years. Recently a new version including multiparametric magnetic resonance imaging (mpMRI) data has been released. The aim of our study was to analyze the performance of the mpMRI RPCRC app. A series of men undergoing prostate biopsies were enrolled in eleven Italian centers. Indications for prostate biopsy included: abnormal Prostate specific antigen levels (PSA>4 ng/ml), abnormal DRE and abnormal mpMRI. Patients' characteristics were recorded. Prostate cancer (PCa) risk and high-grade PCa risk were assessed using the RPCRC app. The performance of the mpMRI RPCRC in the prediction of cancer and high-grade PCa was evaluated using receiver operator characteristics, calibration plots and decision curve analysis. Overall, 580 patients were enrolled: 404/580 (70%) presented PCa and out of them 224/404 (55%) presented high-grade PCa. In the prediction of cancer, the RC presented good discrimination (AUC = 0.74), poor calibration (p = 0.01) and a clinical net benefit in the range of probabilities between 50 and 90% for the prediction of PCa (Fig. 1). In the prediction of high-grade PCa, the RC presented good discrimination (AUC = 0.79), good calibration (p = 0.48) and a clinical net benefit in the range of probabilities between 20 and 80% (Fig. 1). The Rotterdam prostate cancer risk App accurately predicts the risk of PCa and particularly high-grade cancer. The clinical net benefit is wide for high-grade cancer and therefore its implementation in clinical practice should be encouraged. Further studies should assess its definitive role in clinical practice. [ABSTRACT FROM AUTHOR]

Lung ultrasound (LU) has a multitude of features and capacities that make it a useful medical tool to assist physicians contending with the pandemic spread of novel coronavirus disease-2019 (COVID-19) caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, an LU approach to patients with suspected COVID-19 is being implemented worldwide. In noncritical COVID-19 patients, 2 new LU signs have been described and proposed, the "waterfall" and the "light beam" signs. Both signs have been hypothesized to increase the diagnostic accuracy of LU for COVID-19 interstitial pneumonia. In critically ill patients, a distinct pattern of LU changes seems to follow the disease's progression, and this information can be used to guide decisions about when a patient needs to be ventilated, as occurs in other disease states similar to COVID-19. Furthermore, a new algorithm has been published, which enables the automatic detection of B-lines as well as quantification of the percentage of the pleural line associated with lung disease. In COVID-19 patients, a direct involvement of cardiac function has been demonstrated, and ventilator-induced diaphragm dysfunction might be present due to the prolonged mechanical ventilation often involved, as reported for similar diseases. For this reason, cardiac and diaphragm ultrasound evaluation are highly important. Last but not least, due to the thrombotic tendency of COVID-19 patients, particular attention also should be paid to vascular ultrasound. This review is primarily devoted to the study of LU in COVID-19 patients. The authors explain the significance of its "light and shadows," bearing in mind the context in which LU is being used—the emergency department and the intensive care setting. The use of cardiac, vascular, and diaphragm ultrasound is also discussed, as a comprehensive approach to patient care. [ABSTRACT FROM AUTHOR]

• Cognitive-motor interference is associated with cognitive functioning in MS. • Lower cognitive performance is associated with higher dual task cost in MS. • Cognitive-motor interference can be attributed partly to cognitive ability in MS. Both physical and cognitive impairments are common in people with multiple sclerosis (PwMS). Performing a cognitive task while walking (i.e., dual-task walking) can introduce cognitive-motor interference (CMI), resulting in changes in walking performance. The association between the levels of cognitive impairment and of CMI in MS remains unclear. To examine the association between cognitive functioning and differences in walking performance arise between single- and dual-task walking. Ninety-five PwMS performed self-preferred pace walking and dual-task walking. The gait parameters recorded were used to compute dual task costs (DTC) as a metric of CMI. Cognitive functioning was assessed using Match, an unsupervised test developed based on the Symbol Digit Modalities Test. Participants were categorized as higher (HCF) and lower cognitive functioning (LCF) based on a Match z-score < −1.5. LCF group had elevated DTC for stride velocity, relative to the HCF group. Higher DTC for stride velocity was associated with lower cognition, as assessed by Match test. The findings support the hypothesis that CMI is associated with cognitive functioning in PwMS. [ABSTRACT FROM AUTHOR]

Multicenter retrospective analysis of robotic partial nephrectomy for completely endophytic renal tumors (i.e. 3 points for the 'E' domain of the R.E.N.A.L. nephrometry score) was performed. Patients' demographics, tumor characteristics, perioperative, functional, pathological and oncological data were analyzed and compared with those of patients with exophytic and mesophytic masses (i.e. 1 and 2 points for the 'E' domain, respectively). Multivariable logistic regression analysis was used to assess variables for trifecta achievement (negative margin, no postoperative complications, and 90% estimated glomerular filtration rate [eGFR] recovery). Overall, 147 patients were included in the study group. Patients with a completely endophytic mass had bigger tumors (mean 4.2 vs. 4.1 vs. 3.2 cm; p < 0.001) on preoperative imaging and higher overall R.E.N.A.L. score. There was no difference in mean operative time. Estimated blood loss was higher in the endophytic group (mean 177.75 vs. 185.5 vs. 130 ml; p = 0.001). Warm ischemia time was shorter for the exophytic group (median 16 vs. 21 vs. 22 min; p < 0.001). Postoperative complications were more frequent in patients with endophytic tumor (24.8% vs. 19.5% vs. 14.8%; p < 0.001). Six (4.5%) patients had positive surgical margins, there was no difference between groups. Trifecta was achieved in 44 patients in endophytic group (45.4 vs. 68.8 and 50.9%, p < 0.001). Multivariable analysis for trifecta revealed that clinical tumor size (odds ratio: 0.667, 95% confidence interval: 0.56–0.79, p < 0.001) was only significant predictor for trifecta achievement. Our findings confirm that RAPN in case of completely endophytic renal masses can be performed with acceptable outcomes in centers with significant robotic expertise. [ABSTRACT FROM AUTHOR]

It has been theorized that hemispheric dominance and more segregated information processing have evolved to overcome long conduction delays through the corpus callosum (transcallosal conduction delay - TCD) but that this may still impact behavioral performance, mostly in tasks requiring high timing accuracy. Nevertheless, a thorough understanding of the temporal features of interhemispheric communication is lacking. Here, we aimed to assess the relationship between TCD and behavioral performance with a noninvasive directional cortical measure of TCD obtained from transcranial magnetic stimulation (TMS)-evoked potentials (TEPs) in the motor system. Twenty-one healthy right-handed subjects were tested. TEPs were recorded during an ipsilateral silent period (iSP) paradigm and integrated with diffusion tensor imaging (DTI) and an in-phase bimanual thumb-opposition task. Linear mixed models were applied to test relationships between measures. We found TEP indexes of transcallosal communication at ∼15 ms both after primary motor cortex stimulation (M1-P15) and after dorsal premotor cortex stimulation (dPMC-P15). Both M1-and dPMC-P15 were predicted by mean diffusivity in the callosal body. Moreover, M1-P15 was positively related to iSP. Importantly, M1-P15 latency was linked to bimanual coordination with direction-dependent effects, so that asymmetric TCD was the best predictor of bimanual coordination. Our findings support the idea that transcallosal timing in signal transmission is essential for interhemispheric communication and can impact the final behavioral outcome. However, they challenge the view that a short conduction delay is always beneficial. Rather, they suggest that the effect of the conduction delay may depend on the direction of information flow. • Early components of TMS-evoked potentials (TEPs) reflect transcallosal communication. • TEPs from M1 are linked to ipsilateral silent period and corpus callosum diffusivity. • TEPs from dorsal premotor cortex are linked to corpus callosum diffusivity. • Delay in M1-M1 transcallosal communication is linked to inphase bimanual coordination. • Short delay in M1-M1 transfer is beneficial or detrimental based on flow direction. [ABSTRACT FROM AUTHOR]

Cardiac surgery patients have a high risk of postoperative bleeding. Historically, the platelet count has been one of the main parameters used to establish the need for platelet transfusions, and the recent introduction of point-of-care tests for platelet function has allowed clinicians to rationalize platelet transfusion needs by assessing the platelet (dys-)function of the patient. For the present study, the authors evaluated how the introduction of one of these systems—the adenosine diphosphate (ADP) test, performed using a Multiplate electrode analyzer (Roche Diagnostics, Basel, Switzerland)—into their clinical practice had modified their platelet transfusion practice. The relationship between the platelet count and the functional evaluation of platelet aggregation (via the ADP test) also was examined. This was a retrospective, single-center, observational study. Cardiac surgery department of a tertiary care center in North-east Italy. Cardiac surgery patients requiring cardiac bypass in 2017 and 2019. The primary outcome was to compare platelet transfusion practice before and after the implementation of a platelet function test (the ADP test) into the institution's transfusion algorithm, which replaced the platelet count as the trigger. Secondary outcomes were assessing whether the incorporation of the ADP test into their transfusion algorithm brought about a reduction in the frequency of platelet transfusions compared with previous rates (when only platelets counts were used); assessing patient blood loss in the first 12 postoperative hours; and ascertaining the percentage of patients requiring surgical reexplorations. The study comprised 110 patients undergoing cardiac surgery from the platelet count period (2017) and 110 patients from the ADP test period (2019). Agreement between platelet counts versus ADP tests in determining the need for platelet transfusion was moderate (κ = 0.483; 95% confidence interval [CI] 0.239-0.728), and the general linear regression relationship between platelet counts and the ADP test (Akaike information criterion = 2536; p < 0.001) was determined. Since the introduction of ADP testing, a highly significant reduction in platelet transfusions has occurred: 41.82% (platelet count period) versus 13.64% (ADP test period) (p < 0.001); average blood loss in the 12 hours postsurgery also was less in the ADP test period (p < 0.001) at 300 mL (95% CI 150-730) compared with 440 mL in the platelet count period (95% CI 135-900). Furthermore, a decreasing trend was observed in the number of patients requiring reexploration to optimize hemostasis in the first 12 hours postsurgery (6.36% v 2.73%); however, this trend did not achieve statistical significance (p = 0.195). The application of new Multiplate analyzer technologies, like the ADP test, have the potential to reduce platelet transfusion rates in cardiac surgery patients compared with the use of platelet counts alone; this point-of-care test may constitute an important strategy to help spare the use of allogeneic blood products. Additional studies are needed to confirm this trend and establish the best cutoff values to apply. [ABSTRACT FROM AUTHOR]

Right aberrant hepatic ducts are an anatomic variant with clinical relevance because of the risk of injury during cholecystectomy. Treatment options for aberrant hepatic duct injuries are not standardized. This study aims to analyze the long-term results of endoscopic treatment of aberrant hepatic duct lesions. Patients who underwent ERCP for aberrant hepatic duct lesions were retrospectively identified. Demographic data, type of aberrant duct lesion according to the Strasberg classification, type of treatment (number of plastic stents inserted, treatment duration, and number of ERCPs), and adverse events were recorded. Follow-up was obtained by telephone contact or medical examinations. Between January 1996 and March 2019, 32 patients (78% women, mean age 51.7 years) with aberrant hepatic duct injuries underwent ERCP at our Endoscopy Unit. Six patients had Strasberg type B lesions, 11 patients had type C, and 8 patients had type E5, and 7 patients had a stenosis of the aberrant duct. A mean of 3.7 biliary plastic stents per patient were used; mean treatment duration was 6.3 months. All patients with isolated aberrant duct stenosis and 1 of 6 patients (17%) with type B Strasberg lesions achieved patency. Ten of 11 patients (91%) with type C Strasberg lesions achieved duct recanalization. After a mean follow-up of 109.3 ± 61.2 months, 29 of 32 patients (91%) were asymptomatic; 1 underwent surgery for recurrent cholangitis, 1 received a new endoscopic procedure because of cholangitis, and 1 reported episodic biliary colic without an increase in liver function test values and was successfully managed with a low-fat diet. An endoscopic approach to aberrant hepatic duct lesions after cholecystectomy can be considered an effective first-line therapy. [ABSTRACT FROM AUTHOR]

Despite the increasing concerns surrounding the health and environmental risks of microplastics (MPs), the research focus has primarily been on their prevalence in air and the oceans, consequently neglecting their presence on urban facades, which are integral to our everyday environments. Therefore, there is a crucial knowledge gap in comprehending urban MP pollution. Our pioneering interdisciplinary study not only quantifies but also identifies MPs on historic facades, revealing their pervasive presence in a medium-sized urban area in the UK. In this case study, we estimated a mean density of 975,000 fibres/m^2 (0.10 fibres/mm^2) for fibre lengths between 30 and 1000 μm with a ratio of 1:5 for natural to artificial fibres. Our research identifies three groups of fibre length frequencies across varied exposure scenarios on the investigated urban facade. Sheltered areas (4m height) show a high prevalence of 60–120 μm and 180–240 μm fibres. In contrast, less sheltered areas at 3m exhibit lower fibre frequencies but similar lengths. Notably, the lowest area (2-1.5m) features longer fibres (300–1000 μm), while adjacent area S, near a faulty gutter, shows no fibres, highlighting the impact of exposure, altitude, and environmental variables on fibre distribution on urban facades. Our findings pave one of many necessary paths forward to determine the long-term fate of these fibres and provoke a pertinent question: do historic facades serve as an urban 'sink' that mitigates potentially adverse health impacts or amplifies the effects of mobile microplastics? Addressing MP pollution in urban areas is crucial for public health and sustainable cities. More research is required to understand the multi-scale factors behind MP pollution in large cities and to find mitigation strategies, paving the way for effective interventions and policies against this growing threat. [Display omitted] • First study quantifying microplastics on urban facades, revealing their widespread presence. • Concentrations of microplastics on our study walls are up to 975,000 fibres/m2. • Fibres are more prevalent in more sheltered areas of the surfaces, and not present in areas of regular runoff. • Our research suggests historic facades might act as urban sinks of MPs. [ABSTRACT FROM AUTHOR]

Approved labels advise that women with multiple sclerosis (MS) use contraception during treatment with ocrelizumab (OCR) and for 6–12 months thereafter; however, pregnancies may occur in this interval. Pregnancies from the Roche safety database were analysed. Maternal exposure was defined as receiving ≥1 OCR infusion; in utero fetal exposure was defined as the last infusion occurring within 3 months prior to last menstrual period (LMP) or during pregnancy. Fetal death was termed spontaneous abortion (SA) if it occured <22 complete gestational weeks (GW), or stillbirth (SB) if later. Live births (LB) were preterm if <37 complete GW. Major congenital anomalies (MCA) were classified via European Surveillance of Congenital Anomalies (EUROCAT 1.5). Infant outcomes during the first year of life and exposure via breastfeeding were collected. As of 31 January 2023, 2,742 cumulative MS pregnancies were reported. Of these, 2,065 were collected prospectively, 672 retrospectively, 5 unspecified. Of the 2,065 prospectively reported pregnancies, 678 (32.8%) had in utero exposure (204 [9.9%] in the 1st trimester), 467 (22.6%) no in utero exposure and 920 (44.6%) unknown exposure. Outcomes were known for 899 prospectively reported pregnancies: 738 (82.1%) LB (59.5% full-term, 8.3% preterm, 32.2% unknown GW); 12 (1.3%) ectopic pregnancies (EP); 56 (6.2%) therapeutic/elective abortions (TA/EA); 92 (10.2%) SA; 1 (0.1%) SB. Of 678 prospectively reported pregnancies exposed in utero, 404 had known outcomes: 335 (82.9%) LB; 4 (1.0%) EP; 37 (9.2%) TA/EA; 27 (6.7%) SA; 1 (0.2%) SB. A total of 8 (1.1%) MCAs occurred in prospectively reported LB, of which 5 had in utero exposure. Breastmilk exposure and 1-year outcomes of 62 and 97 infants, respectively, will also be presented. This is the largest dataset of pregnancy outcomes for an anti-CD20 therapy in MS, with a continuous increase in reported pregnancies year over year. Cumulative data do not suggest an elevated risk of preterm birth, MCA or other adverse outcomes with OCR in utero exposure over the general or MS population, and are consistent with epidemiological data. Pregnancy and infant outcomes are important to women with MS and will continue to be assessed through routine pharmacovigilance activities, post-marketing commitments and two ongoing prospective phase IV studies on OCR placental and breastmilk transfer. [ABSTRACT FROM AUTHOR]

Cognitive impairment is a core symptom that profoundly impacts the lives of people with multiple sclerosis (PwMS). Since the existing disease modifying therapies can only stabilize, but not actively treat, cognition in PwMS, there is an unmet need to expand approaches to treat these cognitive symptoms. Transcranial alternating current stimulation (tACS) permits frequency-specific entrainment of neural oscillations intrinsic to cognitive activity. However, the effects of the tACS on cognitive function in PwMS have not yet been assessed. We aimed to evaluate the potential efficacy of applying frontal theta-tACS to improve information processing speed in PwMS. 60 PwMS with cognitive complaints were enrolled in a double-blinded, randomized, controlled trial with three stimulation groups: 2 mA, 1 mA, or sham control. A single session of theta-tACS was applied while participants were engaged in a cognitive program which has shown to improve processing speed in PwMS. tACS effects were examined by the Symbol Digit Modalities Test (SDMT). Tolerability, side effects and acceptability were measured. 1 mA groups had a significantly higher SDMT score after stimulation compared to their pre-stimulation score, 2 mA group showed a marginally significant improvement of their SDMT score, while the SDMT score in the sham group did not change. Overall, 49% of the stimulation group participants showed a clinically meaningful SDMT improvement (4+-point increase). tACS is a well-tolerated, non-pharmacological intervention. Based on the positive effects observed in the current study of a single session of tACS applied during cognitive engagement, the effects of repeated tACS on cognitive function in PwMS merit further research. ClinicalTrials.gov NCT04466228. [ABSTRACT FROM AUTHOR]