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Background and Objectives: Metabolic syndrome (MetS) is a condition marked by a complex array of physiological, biochemical, and metabolic abnormalities, including central obesity, insulin resistance, high blood pressure, and dyslipidemia (characterized by elevated triglycerides and reduced levels of high-density lipoproteins). The pathogenesis develops from the accumulation of lipid droplets in the hepatocyte (steatosis). This accumulation, in genetically predisposed subjects and with other external stimuli (intestinal dysbiosis, high caloric diet, physical inactivity, stress), activates the production of pro-inflammatory molecules, alter autophagy, and turn on the activity of hepatic stellate cells (HSCs), provoking the low grade chronic inflammation and the fibrosis. This syndrome is associated with a significantly increased risk of developing type 2 diabetes mellitus (T2D), cardiovascular diseases (CVD), vascular, renal, pneumologic, rheumatological, sexual, cutaneous syndromes and overall mortality, with the risk rising five- to seven-fold for T2DM, three-fold for CVD, and one and a half-fold for all-cause mortality. The purpose of this narrative review is to examine metabolic syndrome as a "systemic disease" and its interaction with major internal medicine conditions such as CVD, diabetes, renal failure, and respiratory failure. It is essential for internal medicine practitioners to approach this widespread condition in a "holistic" rather than a fragmented manner, particularly in Western countries. Additionally, it is important to be aware of the non-invasive tools available for assessing this condition. Materials and Methods: We conducted an exhaustive search on PubMed up to July 2024, focusing on terms related to metabolic syndrome and other pathologies (heart, Lung (COPD, asthma, pulmonary hypertension, OSAS) and kidney failure, vascular, rheumatological (osteoarthritis, rheumatoid arthritis), endocrinological, sexual pathologies and neoplastic risks. The review was managed in accordance with the PRISMA statement. Finally, we selected 300 studies (233 papers for the first search strategy and 67 for the second one). Our review included studies that provided insights into metabolic syndrome and non-invasive techniques for evaluating liver fibrosis and steatosis. Studies that were not conducted on humans, were published in languages other than English, or did not assess changes related to heart failure were excluded. Results: The findings revealed a clear correlation between metabolic syndrome and all the pathologies above described, indicating that non-invasive assessments of hepatic fibrosis and steatosis could potentially serve as markers for the severity and progression of the diseases. Conclusions: Metabolic syndrome is a multisystem disorder that impacts organs beyond the liver and disrupts the functioning of various organs. Notably, it is linked to a higher incidence of cardiovascular diseases, independent of traditional cardiovascular risk factors. Non-invasive assessments of hepatic fibrosis and fibrosis allow clinicians to evaluate cardiovascular risk. Additionally, the ability to assess liver steatosis may open new diagnostic, therapeutic, and prognostic avenues for managing metabolic syndrome and its complications, particularly cardiovascular disease, which is the leading cause of death in these patients.

Robot-assisted extravesical ureteral reimplantation (REVUR) was described for the first time in 2004. Since then, the surgical approach of vesicoureteral reflux (VUR) has changed dramatically. The benefits of this technique are great when compared to the laparoscopic or traditional open approaches. A literature search of PubMed was performed to identify articles covering any aspect of REVUR in the pediatric population. A total of 108 papers published over the period 2004-2024 were collected. Of these, 40 studies were considered valuable in terms of obtaining a complete overview of the REVUR technique. This review aimed to describe the current state of the art of REVUR and define it as the new standard technique for surgical management of selected patients with VUR.

The development of pressure ulcers, associated with increased temperature and moisture in specific areas of the body, and the risk of microbial infections in patients lying in a static position for prolonged periods of time represents a serious issue in medicine. In order to prevent the formation of pressure ulcers, this work aims to present advanced nanostructured coatings developed by three research groups. Nanometric silver, ash and functionalized torrefied biomass were the basis for the treatment of wound dressings to improve thermal conductivity and antimicrobial properties of the conventional cotton gauzes. Each treatment was performed according to its own optimized method. The treated fabrics were characterized in terms of antimicrobial properties, heat transfer, morphology and hydrophobic behavior. The results demonstrated the effectiveness of the deposition treatments also in synergistic actions. In particular, the antibacterial efficacy was improved in all the samples by the addition of silver treatment, and the thermal conductivity was enhanced by around 58% with nanometric ashes. A further step of the study involved the designing of two multilayer systems evaluated using circuit models for determining the total thermal conductivity. In this way, both systems were designed with the aim to guarantee simultaneous efficacy: high antibacterial and hydrophilic properties at the skin level and more hydrophobic and conductive behaviors toward the external environment.

Background : To investigate anatomical and functional changes of the macula caused by epiretinal membrane (ERM) peeling procedures in patients with or without posterior vitreous detachment (PVD). Methods : This is a multicentric prospective observational study on thirty-seven (37) patients affected by symptomatic ERM who underwent 25-gauge pars plana vitrectomy (PPV), induction of a PVD (as needed) and peeling of both the internal limiting membrane (ILM) and ERM. Optical coherence tomography-angiography (OCT-A) ( RS 3000 , Nidek, Japan) and microperimetry ( MP-3 , Nidek, Japan) were performed; central retinal thickness (CRT), foveal avascular zone (FAZ) area and perimeter, vessel density and perfusion density, retinal sensitivity and fixation stability (as a total mean retinal sensitivity (MRS), and MRS in the ellipse area and bivariate contour ellipse area (BCEA)) were recorded at baseline and up to postoperative month 3. Results : Eyes were classified as having complete PVD (51.4%) or incomplete PVD (48.6%). At baseline, patients with incomplete PVD had worse best-corrected distance visual acuity (BCDVA), total MRS, MRS in the ellipse area and BCEA, and higher CRT than patients with complete PVD. At month 3, the differences in BCDVA between the two groups remained statistically significant, with patients with incomplete PVD having worse results (difference: 0.199 logMAR, p < 0.001). The difference in the MRS in the ellipse area was statistically significant at month 3 (-3.378 Db, p = 0.035), with greater improvement in patients with complete PVD. Conclusions : Our study shows that patients with incomplete PVD have worse conditions at baseline than patients with complete PVD, and the differences in visual acuity and retinal sensitivity were maintained postoperatively.

Background: Respiratory problems are frequent in newborns, and are mainly studied with chest X-rays, whereas CT scans are usually needed for the evaluation of rare malformations and diseases. Lung ultrasound (LUS] has been proposed as an alternative method of diagnosing a variety of respiratory conditions. In recent years, there has been a rapid increase in LUS studies, thanks to the ability of LUS to rapidly exclude complications and significantly reduce radiation exposure in this fragile population. We aimed to summarize the current knowledge about LUS. Methods: A literature search was conducted on the Medline and Cochrane databases using appropriate terms. The inclusion criteria were: English language and human species. Exclusion criteria were: non-English language, animal species, case reports, case series, non-systematic reviews, and editorials. Results: The search returned 360 results. No Cochrane reviews were found. Titles and abstracts were screened, and 37 were finally considered. Studies concerning the use of lung ultrasound for the following conditions were presented: neonatal respiratory distress syndrome, transient tachypnea of the newborn, pneumothorax, pulmonary hemorrhage, pneumonia, bronchopulmonary dysplasia, and prediction of extubation success. Conclusions: We discussed the utility of LUS for the diagnosis and treatment of neonatal diseases according to the most recent literature.

Carbon monoxide poisoning remains a leading cause of accidental poisoning worldwide (both at home and at work), and it is also a cause of suicidal poisoning. Such poisoning can arise following prolonged exposure to low levels of CO or following brief exposure to high concentrations of the gas. In fact, despite exposure limits, high safety standards, and the availability of CO alarms, nearly 50,000 people in the United States visit the emergency department each year due to poisoning. Additionally, CO poisoning in the United States causes up to 500 deaths each year. Despite the widespread nature of this form of poisoning, known about for centuries and whose damage mechanisms have been recognized (or rather hypothesized about) since the 1800s, early recognition, especially of late complications, and treatment remain a medical challenge. A well-designed therapeutic diagnostic process is necessary so that indication for hyperbaric or normobaric therapy is correctly made and so that patients are followed up even after acute exposure to diagnose late complications early. Furthermore, it is necessary to consider that in the setting of emergency medicine, CO poisoning can be part of a differential diagnosis along with other more frequent conditions, making its recognition difficult. The last thirty years have been marked by a significant increase in knowledge regarding the toxicity of CO, as well as its functioning and its importance at physiological concentrations in mammalian systems. This review, taking into account the significant progress made in recent years, aims to reconsider the pathogenicity of CO, which is not trivially just poisonous to tissues. A revision of the paradigm, especially as regards treatment and sequelae, appears necessary, and new studies should focus on this new point of view.

Background: There are wide variations in antibiotic use in neonatal intensive care units (NICUs). Limited data are available on antimicrobial stewardship (AS) programs and long-term maintenance of AS interventions in preterm very-low-birth-weight (VLBW) infants., Methods: We extended a single-centre observational study carried out in an Italian NICU. Three periods were compared: I. "baseline" (2011-2012), II. "intervention" (2016-2017), and III. "maintenance" (2020-2021). Intensive training of medical and nursing staff on AS occurred between periods I and II. AS protocols and algorithms were maintained and implemented between periods II and III., Results: There were 111, 119, and 100 VLBW infants in periods I, II, and III, respectively. In the "intervention period", there was a reduction in antibiotic use, reported as days of antibiotic therapy per 1000 patient days (215 vs. 302, p < 0.01). In the "maintenance period", the number of culture-proven sepsis increased. Nevertheless, antibiotic exposure of uninfected VLBW infants was lower, while no sepsis-related deaths occurred. Our restriction was mostly directed at shortening antibiotic regimens with a policy of 48 h rule-out sepsis (median days of early empiric antibiotics: 6 vs. 3 vs. 2 in periods I, II, and III, respectively, p < 0.001). Moreover, antibiotics administered for so-called culture-negative sepsis were reduced (22% vs. 11% vs. 6%, p = 0.002), especially in infants with a birth weight between 1000 and 1499 g., Conclusions: AS is feasible in preterm VLBW infants, and antibiotic use can be safely reduced. AS interventions, namely, the shortening of antibiotic courses in uninfected infants, can be sustained over time with periodic clinical audits and daily discussion of antimicrobial therapies among staff members.

Elderly patients, when they present to the emergency department (ED) or are admitted to the hospital, are at higher risk of adverse outcomes such as higher mortality and longer hospital stays. This is mainly due to their age and their increased fragility. In order to minimize this already increased risk, adequate triage is of foremost importance for fragile geriatric (>75 years old) patients who present to the ED. The admissions of elderly patients from 1 January 2014 to 31 December 2020 were examined, taking into consideration the presence of two different triage systems, a 4-level (4LT) and a 5-level (5LT) triage system. This study analyzes the difference in wait times and under- (UT) and over-triage (OT) in geriatric and general populations with two different triage models. Another outcome of this study was the analysis of the impact of crowding and its variables on the triage system during the COVID-19 pandemic. A total of 423,257 ED presentations were included. An increase in admissions of geriatric, more fragile, and seriously ill individuals was observed, and a progressive increase in crowding was simultaneously detected. Geriatric patients, when presenting to the emergency department, are subject to the problems of UT and OT in both a 4LT system and a 5LT system. Several indicators and variables of crowding increased, with a net increase in throughput and output factors, notably the length of stay (LOS), exit block, boarding, and processing times. This in turn led to an increase in wait times and an increase in UT in the geriatric population. It has indeed been shown that an increase in crowding results in an increased risk of UT, and this is especially true for 4LT compared to 5LT systems. When observing the pandemic period, an increase in admissions of older and more serious patients was observed. However, in the pandemic period, a general reduction in waiting times was observed, as well as an increase in crowding indices and intrahospital mortality. This study demonstrates how introducing a 5LT system enables better flow and patient care in an ED. Avoiding UT of geriatric patients, however, remains a challenge in EDs.

Introduction: There are scarce papers about the use of fluorescence-guided surgery (FGS) in the open surgical field. This study aimed to assess the usefulness of FGS in an open setting in the pediatric population and to report our preliminary experience using the Rubina ® Lens system., Methods: All patients undergoing ICG fluorescence-assisted open surgery over the period September 2022-September 2023 were enrolled. Each surgical procedure was performed using the Rubina ® Lens for ICG fluorescence visualization., Results: A total of 25 patients, 14 boys and 11 girls with a median age at surgery of 5.8 years-old (range 0-15), were enrolled. Surgical indications were dermoid/epidermoid cysts of the head ( n = 7), lymphangiomas of the head/neck ( n = 2), thyroglossal duct cysts ( n = 7), gynecomastia ( n = 3), preauricular fistula ( n = 2), second branchial cleft fistula ( n = 1), fibrolipoma of the shoulder ( n = 1) and myofibroma of the gluteal/perineal region ( n = 2). In all procedures, an intralesional injection of 2.5 mg/mL ICG solution using a 30-gauge needle was administered. No adverse reactions to ICG occurred. Median operative time was 68.6 min (range 35-189). The visualization of ICG-NIRF with the Rubina ® Lens was achieved in all cases. No intraoperative complications were reported. Postoperative complications occurred in 3/25 patients (12%), with gynecomastia ( n = 1), thyroglossal duct cyst ( n = 1) and neck lymphangioma ( n = 1), who developed a fluid collection in the surgical site, requiring needle aspiration in outpatient care (Clavien-Dindo 2). Complete mass excision was confirmed with pathology reports., Conclusions: Based on this initial experience, FGS using the Rubina ® Lens was very helpful in open surgery, providing enhanced visualization of anatomy and identification of margins, real-time reliability and low complication rate. It was easy to use, time saving, feasible and clinically safe. Previous experience in MIS is necessary to adopt this technology. The accuracy of the injection phase is important to avoid diffusion of the ICG into the perilesional tissue.

Hypothermia is a widespread condition all over the world, with a high risk of mortality in pre-hospital and in-hospital settings when it is not promptly and adequately treated. In this review, we aim to describe the main specificities of the diagnosis and treatment of hypothermia through consideration of the physiological changes that occur in hypothermic patients. Hypothermia can occur due to unfavorable environmental conditions as well as internal causes, such as pathological states that result in reduced heat production, increased heat loss or ineffectiveness of the thermal regulation system. The consequences of hypothermia affect several systems in the body-the cardiovascular system, the central and peripheral nervous systems, the respiratory system, the endocrine system and the gastrointestinal system-but also kidney function, electrolyte balance and coagulation. Once hypothermia is recognized, prompt treatment, focused on restoring body temperature and supporting vital functions, is fundamental in order to avert preventable death. It is important to also denote the fact that CPR has specificities related to the unique profile of hypothermic patients.

The core focus of this research centered on the intricate relationship between mentalization, the fundamental mental process underlying social interactions, and the narrative approach proposed by Bruner. Mentalization, encompassing both implicit and explicit interpretations of one's and others' actions, plays a pivotal role in shaping the complexity of social interactions. Concurrently, the narrative approach, as elucidated by Bruner, serves as the primary interpretative and cognitive tool through which individuals derive meaning from their experiences. Narrative, in essence, empowers individuals to imbue their experiences with significance, constructing knowledge and enabling a reinterpretation of their lives by reconstructing the meanings attached to events. This intertwining of mentalization and the narrative approach is particularly salient, given their shared reliance on autobiographical narratives and the inference of mental states. In the context of this study, our primary objective was to explore how practical and theoretical activities, rooted in the re-elaboration of personal life information and events, could serve as a catalyst for enhancing mentalization skills. By engaging students in activities specifically designed to encourage the reinterpretation of their life experiences, we aimed to bolster their ability to infer mental states effectively. These enhanced mentalization skills, we hypothesized, form the foundational basis for executing complex educational tasks rooted in constructed teaching methodologies. In summary, this research serves as a pioneering exploration into the synergistic interrelation of mentalization and the narrative approach, offering valuable insights for educators and practitioners aiming to foster enhanced social cognition and enriched educational experiences.

Delirium is a common public health concern that significantly impacts older patients admitted to the Emergency Department (ED). This condition is linked to adverse outcomes such as reduced long-term functionality, higher mortality rates, extended hospital stays, and increased medical costs. The identification of risk factors is crucial for the early recognition and management of delirium in ED patients. Aging, cognitive decline, polypharmacy, and sensory impairment are some of the most common general risk factors described in the literature. Although validated delirium assessment tools already exist, they are not practical for the fast-paced ED environment because of their extended evaluation period or specialized training request. Moreover, clear guidance is needed to select the most suitable tool for detecting delirium, balancing between the accuracy and the swiftness required in an overcrowded, high-stress, and understaffed healthcare setting. This narrative review aims to analyze the updated literature on delirium risk factors in older ED patients and focuses on the methods for better screening, managing, and treating this condition in the ED.

Framed within the evolutionary framework, the Interpersonal Motivational System (IMS) theory suggests that eight distinct motivational impulses drive interpersonal human relationships, namely caregiving, social affiliation, attachment, rank-dominance, rank-submission, social play, cooperation, and sexuality. This theory has been widely applied in clinical practice, where psychopathology is viewed as the result of non-flexible or excessive activation of one system over another. Despite its clinical relevance, empirical studies aimed at measuring IMSs are scarce. This paper contributed to filling this gap by proposing a questionnaire to measure individuals' activation of the eight IMSs. Two studies involving large samples of adults were conducted. The first study (N = 455; 76.5% females) concerned the development of the questionnaire and examination of its content validity through explorative factor analysis. In the second study (N = 635; 54.8% females), confirmatory factor analyses were performed to further refine and confirm the instrument's factor structure. The final version consisted of 50 items. Empirical validity was established by investigating the correlations between the eight IMSs and other related measures (i.e., personality traits, human basic values, and attachment dimensions). The findings suggest that the IMS framework can be used to understand individual differences in motivation and behavior in different social contexts.

Instability is one of the causes of failure in total knee arthroplasty (TKA). The aim of this study was to analyze the correlation between objective ligament laxity and the clinical outcome of mechanically aligned TKA. Fifty-one knees in 47 patients were evaluated at a minimum follow-up of 6 months. The correlation between the angular displacement and functional scores (Knee Society Score and Knee Injury and Osteoarthritis Score) was analyzed. A negative correlation ( p -value < 0.05) was observed between medial laxity ≥5° at 0, 30, 60, and 90° of flexion and the outcome measures. Lateral laxity did not correlate with the clinical outcome. At 30° of knee flexion, a total varus and valgus laxity ≥10° was related to poorer outcomes. The same amount of angular displacement did not influence the outcome in the other flexion angles. There was no difference in single-radius vs multi-radius implants in terms of medial and lateral laxity and clinical outcome. A valgus displacement ≥5° measured at 0, 30, 60, and 90 degrees of flexion correlated with an inferior clinical outcome. In contrast, the same amount of displacement measured on the lateral compartment did not influence the clinical outcome after TKA.

Cystic fibrosis is a genetic disease that results in progressive multi-organ manifestations with predominance in the respiratory and gastrointestinal systems. The significant morbidity and mortality seen in the CF population has been the driving force urging the CF research community to further advance treatments to slow disease progression and, in turn, prolong life expectancy. Enormous strides in medical advancements have translated to improvement in quality of life, symptom burden, and survival; however, there is still no cure. This review discusses the most current mainstay treatments and anticipated therapeutics in the CF drug development pipeline within the mechanisms of mucociliary clearance, anti-inflammatory and anti-infective therapies, restoration of the cystic fibrosis transmembrane conductance regulator (CFTR) protein (also known as highly effective modulator therapy (HEMT)), and genetic therapies. Ribonucleic acid (RNA) therapy, gene transfer, and gene editing are being explored in the hopes of developing a treatment and potential cure for people with CF, particularly for those not responsive to HEMT.

Attention Deficit-Hyperactivity Disorder (ADHD) is a psychiatric condition that shows developmentally inappropriate levels of inattention, hyperactivity, or impulsivity. Symptoms begin at a young age and usually include a lack of attention, poor concentration, disorganization, difficulty completing tasks, forgetfulness, and losing things. It is important to diagnose and treat the disorder at a young age so that the symptoms do not persist into adulthood and cause other comorbid conditions. Learning difficulties, motor impairment, anxiety, or depressive disorders may occur with this condition. To improve the academic careers of children with ADHD, we focused on a specific innovative educational approach (Universal Design for Learning) that could improve basic learning skills (reading, writing, and arithmetic skills) to prevent or manage any learning difficulty that could occur with ADHD. The Universal Design for Learning is an individualized approach that combines current neuroscientific knowledge, creating personalized teaching based on the strengths and weaknesses of the student. The goal of this study is to analyze the impact that this approach has on basic learning abilities. We found that both interventions led to improvements in test performance, indicating that interventions were necessary to enhance reading, writing, and arithmetic skills. Furthermore, the group that received an educational intervention based on Universal Design for Learning demonstrated a more significant improvement in these areas. Additionally, we propose that the set of techniques implemented by teachers in the classroom helped children to read, write, and perform math tasks correctly and more fluently.

Adolescents who have to make decisions regarding their future career or academic path can be greatly influenced by parental expectations and other individual and contextual factors. The aim of this study is to explore the impact of adolescent-parent career congruence on adolescents' well-being and future intention to enroll in a university course. The recruitment of participants took place through a combination of convenience sampling and snowball sampling. A sample of 142 high school students who are managing their decisions for the future completed an online questionnaire. Data were analyzed through a path analysis (SEM) with observed variables, and different indices were evaluated to check the model goodness of fit. The data show that congruence with parents' wishes has a significant effect on academic motivation, work hope and mattering, which in turn have a positive and significant effect on both future intentions to undertake university studies and on the participants' occupational well-being. In line with past studies, our results demonstrate correlations between adolescent-parent career congruence in career exploration and decision making, pointing out in particular the influence due to complementary congruence with mothers. Furthermore, our study underscores the important role played by both individual and contextual factors in adolescent well-being and intentions for their future. Finally, implications for the practice of vocational guidance practitioners are discussed.

Background: Both direct and indirect effects of COVID-19 have been found in all age groups. In particular, adult data demonstrated significant changes in patients with chronic and metabolic disease (e.g., obesity, diabetes, chronic kidney disease (CKD), and metabolic associated fatty liver dysfunction (MAFLD)), while similar pediatric evidence is still limited. We aimed at investigating the impact of the COVID-19 pandemic lockdown on the relationship between MAFLD and renal function in children with CKD due to congenital abnormalities of the kidney and urinary tract (CAKUT)., Methods: A total of 21 children with CAKUT and CKD ≥ stage 1 underwent a comprehensive evaluation within 3 months before and 6 months after the first Italian lockdown., Results: At follow-up, CKD patients with MAFLD presented higher BMI-SDS, serum uric acid, triglycerides, and microalbuminuria levels and lower eGFR levels than those without MAFLD (all p < 0.05). Higher ferritin and white blood cell concentrations were also found in patients with CKD diagnosed with MAFLD than peers without MAFLD (both p = 0.01). Compared to children without MAFLD, a higher delta of BMI-SDS, eGFR levels, and microalbuminuria levels was found in patients with MAFLD., Conclusions: Due to the negative influence of the COVID-19 lockdown on cardiometabolic health in childhood, a careful management of children with CKD is warranted.

In this review, we will focus on different non-invasive retinal imaging techniques that can be used to evaluate morphological and functional features in full-thickness macular holes with a prognostic purpose. Technological innovations and developments in recent years have increased the knowledge of vitreoretinal interface pathologies by identifying potential biomarkers useful for surgical outcomes prediction. Despite a successful surgery of full-thickness macular holes, the visual outcomes are often puzzling, so the study and the identification of prognostic factors is a current topic of interest. Our review aims to provide an overview of the current knowledge on prognostic biomarkers identified in full-thickness macular holes by means of different retinal imaging tools, such as optical coherence tomography, optical coherence tomography angiography, microperimetry, fundus autofluorescence, and adaptive optics.

Magnesium hydroxide (MOH) is a widely used inorganic chemical owing to its various properties. Hence, researchers have long studied its synthesis and its unique features. However, the morphological consequences have rarely been studied. Despite having several benefits for synthesizing nanoparticles, the hydrothermal method's main drawbacks are its lengthy processing time and the high cost of raw materials. This research aimed to use more easily obtainable raw materials in a reasonably short time to synthesize MOH in various morphologies. For this purpose, we prepared different samples using the same hydrothermal method to investigate the effects of the precursor and surfactant on the structure, morphology, and size of MOH particles. The results of XRD and FTIR analysis demonstrated that a temperature of 180 °C and a duration of 18 h is not sufficient for MgO as a precursor to obtaining MOH in the hydrothermal method. However, in the presence of different surfactants, MgCl2 resulted in nanoparticles with hexagonal structure and plate, flake, spherical, and disc morphologies.

Autism Spectrum Disorders (ASD) represent a heterogeneous group of disorders, with onset in developmental age, which present a clinical expressiveness that varies from subject to subject and in the same subject over time. The DSM 5 defines Autism Spectrum Disorders according to two main criteria: persistent deficits in social communication and social interaction in multiple contexts and limited and repetitive patterns of behavior, interests or activities. This disorder can manifest itself across a broad spectrum of severity levels. Indeed, ASD includes clinical conditions from low functioning (LF-Low Functioning) to high functioning (HF-High Functioning), taking cognitive and adaptive functioning as a reference. One of the main characteristics of individuals with ASD is a delay in receptive and expressive communication. These deficits have led to the identification of evidence-based practices, particularly for those with severe communication difficulties. Augmentative Alternative Communication (AAC) has been implemented to compensate for deficits in functional communication and language skills in individuals with complex communication deficits. The AAC comprises communication systems including the Manual Signs, speech and image output devices (Communicators), and Image Exchange Systems (PECS); these systems have been shown to actually improve various abilities in autism such as social skills, modify and improve dysfunctional behaviors and, above all, improve learning. Recent meta-analyses have shown how PECS and Manual Sign can have great effects on the communication skills of young people with autism. The aim of this study is to compare these two types of intervention to improve communication in terms of vocalization in subjects with ASD and try to understand which of the two lead to more significant and rapid improvements.

An increasing body of evidence in the literature is reporting the feasibility of using medical ozone as a possible alternative and adjuvant treatment for COVID-19 patients, significantly reducing hospitalization time, pro-inflammatory indicators, and coagulation markers and improving blood oxygenation parameters. In addition to the well-described ability of medical ozone in counteracting oxidative stress through the upregulation of the main anti-oxidant and scavenging enzymes, oxygen-ozone (O 2 -O 3 ) therapy has also proved effective in reducing chronic inflammation and the occurrence of immune thrombosis, two key players involved in COVID-19 exacerbation and severity. As chronic inflammation and oxidative stress are also reported to be among the main drivers of the long sequelae of SARS-CoV2 infection, a rising number of studies is investigating the potential of O 2 -O 3 therapy to reduce and/or prevent the wide range of post-COVID (or PASC)-related disorders. This narrative review aims to describe the molecular mechanisms through which medical ozone acts, to summarize the clinical evidence on the use of O 2 -O 3 therapy as an alternative and adjuvant COVID-19 treatment, and to discuss the emerging potential of this approach in the context of PASC symptoms, thus offering new insights into effective and safe nonantiviral therapies for the fighting of this devastating pandemic.

School bullying is a serious public health concern in many countries worldwide. Over recent decades, several effective anti-bullying prevention programs have been developed. This study aimed to evaluate the effectiveness of an adapted version of the "Equipping Youth to Help One Another (EQUIP) for Educators" (EfE) program in reducing adolescents' engagement in school bullying perpetration by correcting their use of self-serving cognitive distortions (CDs). Furthermore, guided by the vantage sensitivity framework, we investigated whether the intervention effects varied depending on the adolescents' gender and environmental sensitivity. A quasi-experimental pre-test/post-test with a control group design involved 354 Italian middle and high school adolescents (51.7% males; M age = 14.86, SD = 2.54). Both the control ( n = 187) and experimental group ( n = 167) completed self-report questionnaires, before and after the intervention. Structural equation modeling revealed a significant moderated mediation effect: highly sensitive males participating in the EfE program decreased their engagement in bullying by reducing CDs, compared to females and those with low- and medium- sensitivity. These findings support the effectiveness of the EfE program in equipping youth to think and act more responsible and shed light on "why" and "for whom" the intervention might work better to counteract school bullying during adolescence.

High altitude can be a hostile environment and a paradigm of how environmental factors can determine illness when human biological adaptability is exceeded. This paper aims to provide a comprehensive review of high-altitude sickness, including its epidemiology, pathophysiology, and treatments. The first section of our work defines high altitude and considers the mechanisms of adaptation to it and the associated risk factors for low adaptability. The second section discusses the main high-altitude diseases, highlighting how environmental factors can lead to the loss of homeostasis, compromising important vital functions. Early recognition of clinical symptoms is important for the establishment of the correct therapy. The third section focuses on high-altitude pulmonary edema, which is one of the main high-altitude diseases. With a deeper understanding of the pathogenesis of high-altitude diseases, as well as a reasoned approach to environmental or physical factors, we examine the main high-altitude diseases. Such an approach is critical for the effective treatment of patients in a hostile environment, or treatment in the emergency room after exposure to extreme physical or environmental factors.

It is certain and established that overcrowding represents one of the main problems that has been affecting global health and the functioning of the healthcare system in the last decades, and this is especially true for the emergency department (ED). Since 1980, overcrowding has been identified as one of the main factors limiting correct, timely, and efficient hospital care. The more recent COVID-19 pandemic contributed to the accentuation of this phenomenon, which was already well known and of international interest. Considering what would appear to be a trivial definition of overcrowding, it may seem simple for the reader to hypothesize solutions for what seems to be one of the most avoidable problems affecting the hospital system. However, proposing solutions to overcrowding, as well as their implementation, cannot be separated from a correct and precise definition of the issue, which must consider the main causes and aggravating factors. In light of the need of finding solutions that can put an end to hospital overcrowding, this review aims, through a review of the literature, to summarize the triggering factors, as well as the possible solutions that can be proposed.

Major adverse cardiac events, defined as death or myocardial infarction, are common causes of perioperative mortality and major morbidity in patients undergoing non-cardiac surgery. Reduction of perioperative cardiovascular risk in relation to non-cardiac surgery requires a stepwise patient evaluation that integrates clinical risk factors, functional status and the estimated stress of the planned surgical procedure. Major guidelines on preoperative cardiovascular risk assessment recommend to establish, firstly, the risk of surgery per se (low, moderate, high) and the related timing (elective vs. urgent/emergent), evaluate the presence of unstable cardiac conditions or a recent coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting), assess the functional capacity of the patient (usually expressed in metabolic equivalents), determine the value of non-invasive and/or invasive cardiovascular testing and then combine these data in estimating perioperative risk for major cardiac adverse events using validated scores (Revised Cardiac Risk Index (RCRI) or National Surgical Quality Improvement Program (NSQIP)). This stepwise approach has the potential to guide clinicians in determining which patients could benefit from cardiovascular therapy and/or coronary artery revascularization before non-cardiac surgery towards decreasing the incidence of perioperative morbidity and mortality. Finally, it should be highlighted that there is a need to implement specific strategies in the 2019 Coronavirus disease (COVID-19) pandemic to minimize the risk of transmission of COVID-19 infection during the preoperative risk assessment process.

Thanks to modern surgical techniques and implants, traditional exclusion criteria for unicompartmental knee arthroplasty (UKA) are no longer considered contraindications. The aim of this study is to clarify the impact of obesity on functional outcomes and revision rates of UKA. We performed a comprehensive systematic review using PubMed-Medline, Google Scholar and Cochrane Central. Then, we extracted data related to body mass index (BMI), age and follow-up, functional outcome scores and rate of revisions (all-cause, aseptic and septic). Patients were stratified according to BMI into two groups: non-obese (BMI < 30) and obese (BMI ≥ 30). We identified 22 eligible studies, of which 13 were included in the meta-analysis. Patients with a BMI > 30 had a significantly higher likelihood for revision ( p = 0.02), while the risk of septic revision was similar ( p = 0.79). The clinical outcome measures showed a significant difference in favor of patients with a BMI < 30 ( p < 0.0001). The improvements in Oxford Knee Score and Knee Society Score were significant in both obese and non-obese patients, although the latter showed inferior results. The results of this systematic review and meta-analysis show that BMI is not a contraindication to UKA. However, obese patients have a higher risk for aseptic failure and lower improvement in clinical scores compared to non-obese patients.

In this work, we studied the transport properties (thermal and electrical conductivity) of smart fabric materials treated with graphite nanomaterial stacks-acetone suspensions. An innovative and easy method to produce graphite nanomaterial stacks-acetone-based formulations, starting from a low-cost expandable graphite, is proposed. An original, economical, fast, and easy method to increase the thermal and electrical conductivity of textile materials was also employed for the first time. The proposed method allows the impregnation of smart fabric materials, avoiding pre-coating of the fibers, thus reducing costs and processing time, while obtaining a great increase in the transport properties. Two kinds of textiles, cotton and Lycra ® , were selected as they represent the most used natural and artificial fabrics, respectively. The impact of the dimensions of the produced graphite nanomaterial stacks-acetone-based suspensions on both the uniformity of the treatment and the transport properties of the selected textile materials was accurately evaluated using several experimental techniques. An empirical relationship between the two transport properties was also successfully identified. Finally, several theoretical models were applied to predict the transport properties of the developed smart fabric materials, evidencing a good agreement with the experimental data.

In this study, an original and green procedure to produce water-based solutions containing nanometric recycled carbon particles is proposed. The nanometric particles are obtained starting from carbon waste ashes, produced by the wooden biomass pyro-gasification plant CMD (Costruzioni motori diesel) ECO20. The latter is an integrated system combining a downdraft gasifier, a spark-ignition internal combustion engine, an electric generator and syngas cleaning devices, and it can produce electric and thermal power up to 20 kWe and 40 kWth. The carbon-based ashes (CA) produced by the CMD ECO20 plant were, first, characterized by using differential scanning calorimetry (DSC) and microcomputed tomography (microCT). Afterward, they were reduced in powder by using a milling mortar and analyzed by scanning electron microscopy (SEM), energy-dispersive X-ray (EDX) spectrometry, thermogravimetric analysis (TGA), X-ray diffraction (WAXD) and Fourier-transform infrared (FTIR) spectroscopy. The optimization of an original procedure to reduce the dimensions of the ashes in an aqueous solution was then developed by using ball milling and sonication techniques, and the nanometric dimensions of the particles dispersed in water were estimated by dynamic light scattering (DLS) measurements in the order of 300 nm. Finally, possible industrial applications for the nanomaterials obtained from the waste ashes are suggested, including, for example, inks for Aerosol Jet ® Printing (AJ ® P).

The metabolite profile of ten traditional apple cultivars grown in the Piedmont region (Italy) was studied by means of nuclear magnetic resonance spectroscopy, identifying an overall number of 36 compounds. A more complete assignment of the proton nuclear magnetic resonance ( 1 H NMR) resonances from hydroalcoholic and organic apple extracts with respect to literature data was reported, identifying fructose tautomeric forms, galacturonic acid, γ-aminobutyric acid (GABA), p -coumaroyl moiety, phosphatidylcholine, and digalactosyldiacylglycerol. The chemical profile of each apple cultivar was defined by thorough quantitative NMR analysis of four sugars (fructose, glucose, sucrose, and xylose), nine organic acids (acetic, citric, formic, citramalic, lactic, malic, quinic, and galacturonic acids), six amino acids (alanine, asparagine, aspartate, GABA, isoleucine, and valine), rhamnitol, p -coumaroyl derivative, phloretin/phloridzin and choline, as well as β-sitosterol, fatty acid chains, phosphatidylcholine, and digalactosyldiacylglycerol. Finally, the application of PCA analysis allowed us to highlight possible differences/similarities. The Magnana cultivar showed the highest content of sugars, GABA, valine, isoleucine, and alanine. The Runsé cultivar was characterized by high amounts of organic acids, whereas the Gamba Fina cultivar showed a high content of chlorogenic acid. A significant amount of quinic acid was detected in the Carla cultivar. The knowledge of apple chemical profiles can be useful for industries interested in specific compounds for obtaining ingredients of food supplements and functional foods and for promoting apple valorization and preservation.

Students from sexual minorities generally describe Higher Education contexts as unwelcoming and chilly environments. Based on the Minority Stress theory, these disparities in climate perceptions may lead sexual minority students to negative health and academic outcomes. To date, research documenting the experience of sexual minority students within European Higher Education Institutions is limited. Framed within campus climate literature, the current study aimed to expand on previous knowledge by investigating the associations between sexual minority status, students' perceptions of campus climate and psychological (i.e., anxiety-depression), and academic outcomes (i.e., intellectual and academic success and considering leaving the university) using a self-selected sample of 868 Italian university students (17.9% sexual minority students). The results showed that sexual minority status was associated with negative perceptions of campus climate, which, in turn, were associated with higher levels of anxiety-depression symptoms, lowered academic success, and a high probability of considering leaving university. Further research is needed to investigate the experience of sexual minority students within European Higher Education contexts and to explore possible actions that could contribute to fostering a greater sense of belonging to the campus community for all students, and particularly for students from sexual minority groups.

The chemical characterization of local Italian potato cultivars is reported to promote their preservation and use as high quality raw material in food industries. Twenty potato ( Solanum tuberosum L.) cultivars from Piedmont and Liguria Italian regions were investigated using NMR (Nuclear Magnetic Resonance) and RP-HPLC-PDA-ESI-MSn (Reversed Phase High-Performance Liquid Chromatography with Photodiode Array Detector and Electrospray Ionization Mass Detector) methodologies. Water soluble and lipophilic metabolites were identified and quantified. With respect to literature data, a more complete 1 H (protonic) spectral assignment of the aqueous potato extracts was reported, whereas the 1 H NMR assignment of potato organic extracts was reported here for the first time. Phenolics resulted to be in high concentrations in the purple-blue colored Rouge des Flandres, Bergerac, Fleur Bleu, and Blue Star cultivars. Servane, Piatlina, and Malou showed the highest amount of galacturonic acid, a marker of pectin presence, whereas Jelly cultivar was characterized by high levels of monosaccharides. Roseval and Rubra Spes contained high levels of citric acid involved in the inhibition of the enzymatic browning in fresh-cut potato. High levels of the amino acids involved in the formation of pleasant-smell volatile compounds during potato cooking were detected in Rouge des Flandres, Blue Star, Bergerac, Roseval, and Ratte cultivars. These results suggest that each local cultivar is characterized by a proper chemical profile related to specific proprieties that can be useful to obtain high quality industrial products.

The performances of organometallic halide perovskite-based solar cells severely depend on the device architecture and the interface between each layer included in the device stack. In particular, the interface between the charge transporting layer and the perovskite film is crucial, since it represents both the substrate where the perovskite polycrystalline film grows, thus directly influencing the active layer morphology, and an important site for electrical charge extraction and/or recombination. Here, we focus on engineering the interface between a perovskite-polymer nanocomposite, recently developed by our group, and different commonly employed polymeric hole transporters, namely PEDOT: PSS [poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate)], PEDOT, PTAA [poly(bis 4-phenyl}{2,4,6-trimethylphenyl}amine)], Poly-TPD [Poly( N , N '-bis(4-butylphenyl)- N , N '-bis(phenyl)-benzidine] Poly-TPD, in inverted planar perovskite solar cell architecture. The results show that when Poly-TPD is used as the hole transfer material, perovskite film morphology improved, suggesting an improvement in the interface between Poly-TPD and perovskite active layer. We additionally investigate the effect of the Molecular Weight (MW) of Poly-TPD on the performance of perovskite solar cells. By increasing the MW, the photovoltaic performances of the cells are enhanced, reaching power conversion efficiency as high as 16.3%.

The high efficiencies (>22%) reached by perovskite-based optoelectronic devices in a very short period, demonstrates the great potential and tunability of this material. The current challenge lies in translating such efficiencies to commercially feasible forms produced through industrial fabrication methods. Herein, a novel first step towards the processability of starch-perovskite inks, developed in our previous work, is investigated, by using inkjet printing technology. The tunability of the viscosity of the starch-perovskite-based inks allows the selection of suitable concentrations to be used as printable inks. After exploration of several printing parameters, thick and opaque starch-perovskite nanocomposite films were obtained, showing interesting morphological and optical properties. The results obtained in this work underline the potential and versatility of our approach, opening the possibility to explore and optimize, in the future, further large-scale deposition methods towards fully printed and stable perovskite devices.