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Sleep disorders increase with age and are known risk factors for several mental and physical diseases. They also significantly contribute to a lower quality of life. Nonpharmaceutical approaches, such as cognitive behavioral therapy for insomnia, sleep hygiene advice, relaxation exercises, and physical activity programs, can be delivered directly to patients via mHealth technologies, thereby increasing the accessibility of such interventions and reducing health care-related costs. This scoping review aims to evaluate the effectiveness of mHealth interventions for improving sleep quality among older adults. Published studies in the last 10 years (2013–2023) were identified by searching electronic medical databases (PubMed, PsycINFO, CINAHL, and Scopus) in July 2023 and were independently reviewed by two different authors. The analysis of the data was performed in 2023. The research retrieved 693 records; after duplicates were removed, 524 articles were screened based on their title and abstract, and 28 of them were assessed in full text. A total of 23 studies were excluded because they did not meet the inclusion criteria in terms of population age (60 years or over) or type of intervention (mHealth-based) or because they addressed secondary insomnia. A total of five studies were included in this review, and all of them reported improvements in subjective sleep quality after the application of the mHealth interventions. Two studies also conducted objective assessments of sleep outcomes using actigraphy, reporting improvements only in some of the variables considered. Despite the limited number of available studies, these results are promising and encourage further research.

Primary cardiac angiosarcoma is a rare, aggressive malignancy that commonly metastasizes to various organs. The presenting symptoms are typically nonspecific, so a comprehensive examination is required to confirm the diagnosis promptly. This case report describes the presentation of an older patient with a history of neoplasms. Echocardiography and biopsy were performed, but despite surgical intervention to resect a large right atrial mass, the patient died. A final diagnosis of primary angiosarcoma was made based on the resected specimen.

Background: Fireworks related injuries in children occur in Kosovo particularly during New Year celebrations. Aim: To report the pattern of fireworks- related injuries in children up to 16 years of age treated at the Emergency Center and Plastic Surgery, University Clinical Centre of Kosovo during the 2008 and 2009 New Year celebrations. Methods: Retrospective review of hospital records Results: During the New Year celebrations in 2008, a total of 65 cases were admitted, 32 (49.2%) of who were children injured by fireworks. The ages of the children ranged from 5 to 16 years with a mean of 10.5years. The modal age affected was the 10 – 14 year-old group (53.6%). Boys constituted 93.8% of patients and girls 6.3%. During the 2009 New Year celebration, 17 cases were admitted with fireworks injuries, 12 (70.58%) of who were children ranging in age from 8 to 15 years (mean 11.5 years) with a modal age group of 10 – 14 years (66.7%). Boys accounted for 88.3% and girls for 16.7% of patients. Conclusions: The frequency of fireworks injuries reduced appreciably after introduction of laws restricting sales of fireworks devices and banning their use by children. Recommendations: It is recommended that parents play a greater role in controlling the activities of their children during festivities. The government and police should also ensure compliance with the law on the use of fireworks during the holidays.

This perspective focuses on the role of healthcare simulation in training and implementing processes aimed at improving the quality of care and patient safety. Evidence of the effectiveness of simulation in improving clinical performance, reducing healthcare costs and raising professional education standards is presented. In light of this evidence, we propose to consider simulation-based education as an integrative training modality in the preparation of health professionals in the field of Public Health. A pilot project is presented with the aim of training professionals capable of further contributing to improving the quality and safety of patients through an interdisciplinary and innovative approach.

Abstract Background In industrialized countries, the aging population is steadily rising. The incidence of cutaneous malignant melanoma (CMM) is highest in old people. This study focuses on the clinicopathological profile of CMM and indicators of diagnostic-therapeutic performance in older patients. Methods This retrospective population-based cohort study included 1,368 incident CMM, as recorded in 2017 by the Regional Veneto Cancer Registry (Northeast Italy). Older subjects were defined as ≥ 80, old as 65–79, and adults as

Objective The purpose of this study was to apply contemporary consensus criteria developed by the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology to the evaluation of aortic pathology, with the expectation that the additional pathologic information may enhance the understanding and management of aortic diseases. Methods A scoring system was applied to ascending aortic specimens from 42 patients with heritable thoracic aortic disease and known genetic variations and from 86 patients from a single year, including patients with known genetic variations (n = 12) and patients with sporadic disease (n = 74). Results The various types of lesions of medial degeneration and the overall severity of medial degeneration overlapped considerably between those patients with heritable disease and those with sporadic disease; however, patients with heritable thoracic aortic disease had significantly more overall medial degeneration (P = .004) and higher levels of elastic fiber fragmentation (P = .03) and mucoid extracellular matrix accumulation (P = .04) than patients with sporadic thoracic aortic disease. Heritable thoracic aortic disease with known genetic variation was more prevalent in women than in men (27.2% vs 9.8%; P = .04), and women had more severe medial degeneration than men (P = .04). Medial degeneration scores were significantly lower for patients with bicuspid aortic valves than for patients with tricuspid aortic valves (P = .03). Conclusion The study’s findings indicate considerable overlap in the pattern, extent, and severity of medial degeneration between sporadic and hereditary types of thoracic aortic disease. This finding suggests that histopathologic medial degeneration represents the final common outcome of diverse pathogenetic factors and mechanisms.

Regular physical exercise lowers the risk of all-cause mortality and various chronic diseases. New technologies, such as smartphones and social media, have been used successfully as health promotion tools in college populations. The purpose of this study was to conduct a systematic review of studies examining the effectiveness of interventions that used modern technologies, as with social media or text messaging, to promote physical activity or reducing sedentary behavior in college students. The systematic review was conducted on the PubMed and SCOPUS databases, considering studies published from 2012 to 2022. For a total of 19 articles selected, an evidence table was drawn up, and the quality of the studies was assessed using the PRISMA checklist. The interventions differed enormously in design, from the strategies implemented to the types of outcome considered. Fifteen of the 19 studies demonstrated an improvement in participants’ physical activity levels, 3 studies found no such improvement, and 1 reported a worsening of baseline activity levels. Interventions to improve college students’ physical activity levels through the use of social media and/or text messaging tend to be effective. However, many factors can influence the effectiveness of such interventions. For example, a gender-related difference emerged in student participation, and the interventions proved more effective if they were accompanied by the creation of social groups.

This paper addresses the planning problem of parallel DC electric springs (DCESs). DCES, a demand-side management method, realizes automatic matching of power consumption and power generation by adjusting non-critical load (NCL) and internal storage. It can offer higher power quality to critical load (CL), reduce power imbalance and relieve pressure on energy storage systems (RESs). In this paper, a planning method for parallel DCESs is proposed to maximize stability gain, economic benefits, and penetration of RESs. The planning model is a master optimization with sub-optimization to highlight the priority of objectives. Master optimization is used to improve stability of the network, and sub-optimization aims to improve economic benefit and allowable penetration of RESs. This issue is a multivariable nonlinear mixed integer problem, requiring huge calculations by using common solvers. Therefore, particle Swarm optimization (PSO) and Elitist non-dominated sorting genetic algorithm (NSGA-II) were used to solve this model. Considering uncertainty of RESs, this paper verifies effectiveness of the proposed planning method on IEEE 33-bus system based on deterministic scenarios obtained by scenario analysis.

The Balinese trengguli flower (Cassia fistula), found in the northern part of Bali, is known to contain flavonoids and phenols, one of the sources of natural antioxidants that can reduce the effects of free radicals. This study aimed to extract the powder of trengguli flower with ethanol and measure the total flavonoids and phenolics. Furthermore, the antioxidant activity of the ethanol extract of Trengguli flower (EEBTF) was investigated. The filtrate was concentrated with a rotary evaporator after soaking the Trengguli flower powder in ethanol. Total phenolic and flavonoid levels were measured using UV-Vis spectrophotometry. Diphenyl-1-picrylhydrazyl (DPPH) technique was used to determine antioxidant activity. This study shows that Balinese trengguli flower extract has the highest antioxidant activity for a concentration of 100 mg/L with a DPPH radical inhibition percentage value of 87%. In this research, the ethanol extract of the Balinese trengguli flower has secondary metabolites of flavonoids and phenolics. The ethanol extract of Balinese trengguli flower has a flavonoid content of 8.35 mg QE/g and a total phenolic content of 8.12 mg GAE/g.

The coronavirus disease 2019 (COVID-19) that has plagued the world since 2019 has initiated several issues and challenges in the mental health services field. World Health Organisation (WHO) recommended implementing remote mental health services such as telehealth to reach out to patients. One of telehealth services is text messaging therapy. Despite the challenges in treating depression via text messaging, the text messages for depression therapy that were built with different content renders this situation as a captivating subject for study. Nonetheless, the topics included in depression mobile therapy are scarce, particularly from the short text perspective. Fortunately, a machine learning technique known as topic modelling (TM) can be used to extracts topics from a set of documents without manually reading individual documents. It is very useful in searching for topics contained in short texts. This study aims to determine the topics in the text messages sent by mental health practitioners for depression therapy. In this study, three topic modelling techniques, i.e., Biterm Topic Model (BTM), Word Network Topic Model (WNTM), and Latent Feature Dirichlet Multinomial Mixture (LFDMM), were evaluated on 258 text messages of depression therapy. The performance of the TM techniques was evaluated using classification accuracy, clustering, and coherence scores. The findings indicate that the set of text messages comprises five topics. BTM performed better than the other techniques in classification accuracy and clustering in some cases based on the performance measures. Consequently, not much significant difference was found in the coherence score between the three topic modelling.

Necrotizing fasciitis is one of the most serious and deadly infections in surgery. The tissue defects that result after a severe infection with necrotizing fasciitis are often not easy to resolve surgically. The importance of this article is to show the reconstructive efficacy of the lotus petal flap based on two perforators. We present a 71-year-old female case with necrotizing fasciitis infection and defect of the region of the vulva (labia major) and perineum. We solved the reconstruction of the defect of the lower half of the labia major and the perineum, on the left side, by raising a fascio-cutaneous lotus petal flap along the gluteal fold, based on two perforators. Considering that the necrotizing fasciitis infection is very serious, it is also accompanied by large soft tissue defects. Raising the flap based on two perforators gives it greater vascular security and, at the same time, greater success in survival. We can conclude that the reconstruction of defects of the vulva and perineum with a lotus petal flap is a satisfactory solution and acceptable to the patient.

Abstract Introduction Interleukin-17 plays a pivotal role in both hidradenitis suppurativa (HS) and in maintaining oral homeostasis, but their potential link remains unknown. Thus, we aimed to evaluate and quantify the oral burden of patients with HS. Methods In this real-life, multicenter, cross-sectional study, patients with HS were clinically evaluated by two board-certified dermatologists and two board-certified dentists. Oral comorbidities were carefully collected with medical history and therapeutic information. Results A total of 102 patients (44.0 ± 0.9 years, body mass index 27.0 ± 2.2 kg/m2) were enrolled. Remarkably, 48% and 43% did not undergo at least an oral hygiene or a dental visit each year, respectively. Oral disorders were found in 55.9% of patients with HS, in particular 39.2% had caries and 46.7% reported at least one missing tooth. The main oral manifestations in patients with HS were recurrent aphthous stomatitis (N = 19, 19.2%), amalgam tattoo (N = 14, 14.1%), leukoplakia (N = 11, 11.1%), nicotinic stomatitis (N = 9, 9.1%), papilloma (N = 8, 8.1%), and geographic tongue (N = 8, 8.1%). Whilst the main predictor of oral pathological conditions was Hurley staging (P = 0.0276), multivariate regression analysis indicated that gender and International Hidradenitis Suppurativa Severity Score System (IHS4) were the main predictors for the presence of caries and number of missing teeth. Conclusion As a result of the relevant oral burden in patients with HS, dentists should be part of the multidisciplinary team and oral education should be promoted among patients with HS.

Abstract Introduction Minimal erythema dose (MED) remains a parameter of paramount importance to orient narrow-band (NB)-UVB phototherapy in psoriatic (PsO) patients. Recently, circadian rhythm and diet were recognized as potential MED modulators, but their mutual interaction remains understudied. Thus, we aimed to evaluate the potential diet modulation of MED circadian oscillations. Methods In the first phase, a cohort study was performed comparing potential MED oscillations (morning, afternoon, and evening) among omnivorous psoriatic patients before and after a phototherapy cycle and omnivorous healthy controls. The two groups were age-, gender-, skin-type-, MED-, and diet-matched. Then, in the second phase, another cohort study was carried out comparing MED oscillations 24 h after the last phototherapeutic session only in psoriatic patients cleared with NB-UVB and undergoing different diets (vegan, vegetarian, paleo , ketogenic, intermittent circadian fasting, and omnivore). Patients with different diets were age-, gender-, and skin-type matched. Results In the first phase, we enrolled only omnivores, specifically 54 PsO patients and 54 healthy individuals. Their MED before and after NB-UVB therapy changed significantly among the three different time-points (morning, afternoon, and evening) (p

Abstract Introduction Psoriasis (PsO) is currently regarded as a systemic inflammatory disease with a growing burden of post-diagnosis associated comorbidities. To determine the initial burden of comorbiditis we evaluated the comorbidome at PsO onset. Methods In a matched case–control study, we extracted data on 57,228 patients and 125 morbidities from the Clalit Health Services Israeli insurance database. PsO cases were matched with control individuals by sex and age at enrolment. As pre-existing comorbidities, we considered all conditions already present in controls at the same age as the matched PsO case at the time of their diagnosis. To test for differences in the odds of comorbidities between the case and control groups, logistic regression analyses were run to calculate the odds ratio (OR) for each comorbidity, after which the comorbidome was graphically represented. Results In this study we enrolled 28,614 PsO patients and 28,614 controls with an average age of 45.3 ± 19.6 years. At the time of diagnosis, PsO patients were more likely to be diagnosed with 2–4 comorbidities (28.8% vs 23.8%) and > 5 (19.6% vs 12.9%,). PsO patients’ specific comorbidomes evidenced several pathological cores: autoimmune and inflammatory systemic diseases [i.e., hidradenitis suppurativa (OR 3.55, 95% CI 1.88–7.28) or polymyalgia rheumatica (OR 3.01 95% CI 1.96–4.77)], inflammatory bowel diseases [i.e., Crohn’s disease (OR 2.99 95% CI 2.20–4.13)], pulmonary inflammatory diseases [i.e., chronic obstructive pulmonary disease (OR 1.81 95% CI 1.61–2.04)], hepatological diseases [i.e., cirrhosis (OR 2.00 95% CI 1.36–3.00)], endocrine diseases [dysthyroidisms (OR 1.82 95% CI 1.30–2.59)], mental disorders [i.e., depression (OR 1.72 95% CI 1.57–1.87)], and cardiovascular diseases (i.e., hypertension (OR 1.47 95% CI 1.41–1.53)]. Conclusion The PsO-onset comorbidome may help health professionals plan more comprehensive patient management. By screening for these common PsO-linked conditions, early diagnosis and treatment may become more frequent, thus greatly benefiting patients on their medical journey.

ObjectivesThis study aimed to systematically investigate whether plaque autofluorescence properties assessed with intravascular fluorescence lifetime imaging (FLIm) can provide qualitative and quantitative information about intimal composition and improve the characterization of atherosclerosis lesions.BackgroundDespite advances in cardiovascular diagnostics, the analytic tools and imaging technologies currently available have limited capabilities for evaluating in situ biochemical changes associated with luminal surface features. Earlier studies of small number of samples have shown differences among the autofluorescence lifetime signature of well-defined lesions, but a systematic pixel-level evaluation of fluorescence signatures associated with various histological features is lacking and needed to better understand the origins of fluorescence contrast.MethodsHuman coronary artery segments (n = 32) were analyzed with a bimodal catheter system combining multispectral FLIm with intravascular ultrasonography compatible with in vivo coronary imaging. Various histological components present along the luminal surface (200-μm depth) were systematically tabulated (12 sectors) from each serial histological section (n = 204). Morphological information provided by ultrasonography allowed for the accurate registration of imaging data with histology data. The relationships between histological findings and FLIm parameters obtained from 3 spectral channels at each measurement location (n = 33,980) were characterized.ResultsOur findings indicate that fluorescence lifetime from different spectral bands can be used to quantitatively predict the superficial presence of macrophage foam cells (mFCs) (area under the receiver-operator characteristic curve: 0.94) and extracellular lipid content in advanced lesions (lifetime increase in 540-nm band), detect superficial calcium (lifetime decrease in 450-nm band area under the receiver-operator characteristic curve: 0.90), and possibly detect lesions consistent with active plaque formation such as pathological intimal thickening and healed thrombus regions (lifetime increase in 390-nm band).ConclusionsOur findings indicate that autofluorescence lifetime provides valuable information for characterizing atherosclerotic lesions in coronary arteries. Specifically, FLIm can be used to identify key phenomena linked with plaque progression (e.g., peroxidized-lipid-rich mFC accumulation and recent plaque formation).

This study aims to determine the antioxidant potential of Balinese salak rind extract (Salacca amboinensis (Becc) Mogea) (BSRE) as an antihyperglycemic agent in male white mice with hyperglycemia. The research was conducted in three stages extraction of Balinese salak rind using 96% ethanol, phytochemical screening, and antihyperglycemic activity testing. Mice were hyperglycemia induced by alloxan. Mice were divided into five groups consisting of negative control (Aquadest), positive control (Glibenclamide 13 mg/Kg BW), dose 1 (200 mg BSRE/kg BW), dose 2 (400 mg BSRE/kg BW), dose 3 (600 mg BSRE/kg BW). Phytochemical screening showed that the BSRE was positive for containing alkaloids, flavonoids, tannins, saponins, and steroids. The analysis results on the BSRE showed an IC50 value of 81,76 ppm, including strong antioxidant activity. The activity of blood glucose levels showed that BSRE could decrease blood glucose levels of Mus musculus L. with hyperglycemia.

BackgroundThis observational study considers the sex-specific incidence of the most incident cancers as recorded in the population-based Veneto Regional Cancer Registry over a period of more than 30 years (1987-2019).MethodsThe Veneto Regional Cancer Registry collected data for the time interval 1987–2019. Significant changes in incidence trends calculated on age-standardized incidence rates (Annual Percent Change—APC) were identified by join point regression analysis.ResultsOverall, the incidence trend for all cancers decreased in males and remained stable in females. In nine cancer sites, the incidence trends showed consistent differences by sex (oral cavity, esophagus, colon rectum and anus, liver, larynx, lung, cutaneous malignant melanoma, bladder, and thyroid gland). Other malignancies did not show significant sex-related differences (stomach, pancreas, biliary tract, kidney/urinary tract, central nervous system, multiple myeloma, non-Hodgkin lymphoma, and leukemia).ConclusionIn the period 1987–2019, this study revealed sex-related differences in cancer incidence trends. Over time, cancer incidence remained higher in males, with a decreasing epidemiological impact, plausibly resulting from prevention campaigns against environmental cancer risk factors, as tobacco and alcohol. Conversely, a significant decrease was not observed in the incidence trend in females. These findings contribute essential insights for profiling the epidemiological map of cancer in a large Italian population, allowing comparison with other European cancer epidemiology studies and providing updated data supporting sex-related primary and secondary cancer prevention strategies.

BackgroundCosts related to the care of melanoma patients have been rising over the past few years due to increased disease incidence as well as the introduction of innovative treatments. The aim of this study is to analyse CMM cost items based on stage at diagnosis, together with other diagnostic and prognostic characteristics of the melanoma.MethodsAnalyses were performed on 2,647 incident cases of invasive CMM that were registered in 2015 and 2017 in the Veneto Cancer Registry (RTV). Direct melanoma-related costs per patient were calculated for each year ranging from 2 years before diagnosis to 4 years after, and were stratified by cost items such as outpatient services, inpatient drug prescriptions, hospital admissions, hospice admissions, and emergency room treatment. Average yearly costs per patient were compared according to available clinical-pathological characteristics. Lastly, log-linear multivariable analysis was performed to investigate potential cost drivers among these clinical-pathological characteristics.FindingsOverall, the average direct costs related to melanoma are highest in the first year after diagnosis (€2,903) and then decrease over time. Hospitalization costs are 8 to 16 times higher in the first year than in subsequent years, while the costs of outpatient services and inpatient drugs decrease gradually over time. When stratified by stage it is observed that the higher expenditure associated with more advanced stages of CMM is mainly due to inpatient drug use.ConclusionThe results of the present study show that grouping patients according to tumour characteristics can improve our understanding of the different cost items associated with cutaneous malignant melanoma. CMM patients experience higher costs in the first year after diagnosis due to higher hospitalization and outpatient services. Policy makers should consider overall and stage-specific annual costs when allocating resources for the management of CMM patients.

Microcephalic osteodysplastic primordial dwarfism type II (MOPDII) is caused by biallelic loss-of-function variants in pericentrin (PCNT), and premature coronary artery disease (CAD) is a complication of the syndrome. Histopathology of coronary arteries from patients with MOPDII who died of CAD in their 20s showed extensive atherosclerosis. Hyperlipidemic mice with smooth muscle cell–specific (SMC-specific) Pcnt deficiency (PcntSMC–/–) exhibited significantly greater atherosclerotic plaque burden compared with similarly treated littermate controls despite similar serum lipid levels. Loss of PCNT in SMCs induced activation of heat shock factor 1 (HSF1) and consequently upregulated the expression and activity of HMG-CoA reductase (HMGCR), the rate-limiting enzyme in cholesterol biosynthesis. The increased cholesterol biosynthesis in PcntSMC–/– SMCs augmented PERK signaling and phenotypic modulation compared with control SMCs. Treatment with the HMGCR inhibitor, pravastatin, blocked the augmented SMC modulation and reduced plaque burden in hyperlipidemic PcntSMC–/– mice to that of control mice. These data support the notion that Pcnt deficiency activates cellular stress to increase SMC modulation and plaque burden, and targeting this pathway with statins in patients with MOPDII has the potential to reduce CAD in these individuals. The molecular mechanism uncovered further emphasizes SMC cytosolic stress and HSF1 activation as a pathway driving atherosclerotic plaque formation independently of cholesterol levels.

Olive quick decline syndrome (OQDS) is a devastating plant disease caused by the bacterium Xylella fastidiosa (Xf). Exploratory missions in the Salento area led to the identification of putatively Xf-resistant olive trees (putatively resistant plants, PRPs) which were pauci-symptomatic or asymptomatic infected plants belonging to different genetic clusters in orchards severely affected by OQDS. To investigate the defense strategies employed by these PRPs to contrast Xf infection, the PRPs were analyzed for the anatomy and histology of xylem vessels, patterns of Xf distribution in host tissues (by the fluorescent in situ hybridization technique—FISH) and the presence of secondary metabolites in stems. The xylem vessels of the PRPs have an average diameter significantly lower than that of susceptible plants for each annual tree ring studied. The histochemical staining of xylem vessels highlighted an increase in the lignin in the parenchyma cells of the medullary rays of the wood. The 3D images obtained from FISH-LSM (laser scanning microscope) revealed that, in the PRPs, Xf cells mostly appeared as individual cells or as small aggregates; in addition, these bacterial cells looked to be incorporated in the autofluorescence signal of gels and phenolic compounds regardless of hosts’ genotypes. In fact, the metabolomic data from asymptomatic PRP stems showed a significant increase in compounds like salicylic acid, known as a signal molecule which mediates host responses upon pathogen infection, and luteolin, a naturally derived flavonoid compound with antibacterial properties and with well-known anti-biofilm effects. Findings indicate that the xylem vessel geometry together with structural and chemical defenses are among the mechanisms operating to control Xf infection and may represent a common resistance trait among different olive genotypes.