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Thanks to the VIR spectrometer onboard NASA’s Dawn spacecraft, which orbited Vesta in 2011–2012, thousands of hyperspectral images of its surface have been collected. The mission confirmed the HED (Howardite–Eucrite–Diogenite) meteorite composition of Vesta. Moreover, the VIR spectrometer detected the 2.8 µm absorption band, due to the presence of the OH molecule. In this work, we took advantage of the newly calibrated data of the VIR spectrometer by characterizing new spectral features thanks to the improved signal-to-noise (S/N) ratio for these spectra. The main goals of this work are as follows: (1) to characterize Vesta’s surface in the visible range and (2) to confirm, reinforce and characterize the OH distribution on Vesta by studying the 2.8 µm band and looking for OH combination bands around 2.2–2.4 µm. A possible relation between the 1.9 µm absorption band due to the presence of pyroxenes and the one at 0.5 µm was analyzed. Finally, the analysis of hydroxyl absorption bands evidenced an anti-correlation between the abundance of hydroxyl-bearing molecules and the surface reflectance. This confirms that the hydroxyl presence is linked to the dark units on Vesta.

ABSTRACTBloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (KP) poses significant challenges, particularly when the infecting isolate carries multiple antimicrobial resistance (AMR) genes/determinants. This study, employing short- and long-read whole-genome sequencing, characterizes six New Delhi metallo-β-lactamase (NDM) 1 and KP carbapenemase (KPC) 3 co-producing KP isolates, the largest cohort investigated in Europe to date. Five [sequence type (ST) 512] and one (ST11) isolates were recovered from patients who developed BSI from February to August 2022 or February 2023 at two different hospitals in Rome, Italy. Phylogenetic analysis revealed two distinct clusters among ST512 isolates and a separate cluster for the ST11 isolate. Beyond blaNDM-1 and blaKPC-3, various AMR genes, indicative of a multidrug resistance phenotype, including colistin resistance, were found. Each cluster-representative ST512 isolate harbored a blaNDM-1 plasmid (IncC) and a blaKPC-3 plasmid [IncFIB(pQil)/IncFII(K)], while the ST11 isolate harbored a blaNDM-1 plasmid [IncFII(pKPX1)] and a blaKPC-3 plasmid [IncFIB(K)/IncFII(K)]. The blaNDM-1 plasmids carried genes conferring resistance to clinically relevant antimicrobial agents, and the aminoglycoside resistance gene aac(6′)-Ib was found on different plasmids. Colistin resistance-associated mgrB/pmrB gene mutations were present in all isolates, and the yersiniabactin-encoding ybt gene was unique to the ST11 isolate. In conclusion, our findings provide insights into the genomic context of blaNDM-1/blaKPC-3 carbapenemase-producing KP isolates.IMPORTANCEThis study underscores the critical role of genomic surveillance as a proactive measure to restrict the spread of carbapenemase-producing KP isolates, especially when key antimicrobial resistance genes, such as blaNDM-1/blaKPC-3, are plasmid borne. In-depth characterization of these isolates may help identify plasmid similarities contributing to their intra-hospital/inter-hospital adaptation and transmission. Despite the lack of data on patient movements, it is possible that carbapenem-resistant isolates were selected to co-produce KP carbapenemase and New Delhi metallo-β-lactamase via plasmid acquisition. Studies employing long-read whole-genome sequencing should be encouraged to address the emergence of KP clones with converging phenotypes of virulence and resistance to last-resort antimicrobial agents.

Lateral trunk flexion (LTF) and its severe form, called Pisa syndrome (PS), are highly invalidating axial postural abnormalities associated with Parkinson’s disease (PD). Management strategies for LTF lack strong scientific evidence. We present a real-life, longitudinal study evaluating long-term efficacy of botulinum toxin (BoNT) injections in axial muscles to reduce LTF and PS in PD. A total of 13 PD patients with LTF > 5° received ultrasound- and electromyography-guided BoNT injections every 4 months. Seven untreated matched PD patients with LTF served as controls and their changes in posture after 18 months were compared with those of seven patients continuing BoNT over 12 months. 53.8% of patients continued the BoNT injections for at least 12 months. Various individual LTF responses were observed. Overall, BoNT-treated patients obtained a not statistically significant improvement of LTF of 17 ± 41% (p = 0.237). In comparison, the seven untreated PD patients suffered a deterioration in LTF over 12 months by 36 ± 45% (p = 0.116), showing a significantly different trajectory of posture change (p = 0.026). In conclusion, repeated BoNT injections in axial muscles showed varying effects in managing PD-associated LTF, suggesting that: (a) a relevant number of patients with LTF can benefit from BoNT; (b) long-term treatment could prevent LTF worsening; (c) an instrumented, personalized approach is important; and (d) there is a need for prospective, long-term studies.

Ozone therapy (OT) is used for the treatment of multiple musculoskeletal disorders. In recent years, there has been a growing interest in its use for the treatment of osteoarthritis (OA). The aim of this double-blind randomized controlled trial was to evaluate the efficacy of OT compared with hyaluronic acid (HA) injections for pain relief in patients with knee OA. Patients with knee OA for at least three months were included and randomly assigned to receive three intra-articular injections of ozone or HA (once a week). Patients were assessed at baseline and at 1, 3, and 6 months after the injections for pain, stiffness, and function using the WOMAC LK 3.1, the NRS, and the KOOS questionnaire. Out of 55 patients assessed for eligibility, 52 participants were admitted to the study and randomly assigned into the 2 groups of treatment. During the study, eight patients dropped out. Thus, a total of 44 patients, reached the endpoint of the study at 6 months. Both Group A and B consisted of 22 patients. At 1-month follow-up after injections, both treatment groups improved statistically significantly from baseline in all outcomes measured. At 3 months, improvements remained similarly consistent for Group A and Group B. At 6-month follow-up, the outcomes were comparable between the 2 groups, showing only a worsening trend in pain. No significant differences were found between the two groups in pain scores. Both therapies have proven to be safe, with the few recorded adverse events being mild and self-limiting. OT has demonstrated similar results to HA injections, proving to be a safe approach with significant effects on pain control in patients affected by knee OA. Due to its anti-inflammatory and analgesic effects, ozone might be considered as a potential treatment for OA.

The purpose of the present paper was to review the available evidence on intra-articular botulinum toxin (BTX) injection in the treatment of knee osteoarthritis and to compare it to other conservative treatment options. A systematic review of the literature was performed on the PubMed, Scopus, Cochrane Library, Web of Science, Pedro and Research Gate databases with the following inclusion criteria: (1) randomized controlled trials (RCTs), (2) written in the English language, and (3) published on indexed journals in the last 20 years (2001–2021) dealing with the use of BTX intra-articular injection for the treatment of knee OA. The risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs. Nine studies involving 811 patients in total were included. Patients in the control groups received different treatments: conventional physiotherapy, hyaluronic acid injection or prolotherapy or a combination thereof in 5 studies, steroid infiltrative therapy (triamcinolone) in 1 study, placebo in 2, and local anesthetic treatment in 1 study. Looking at the quality of the available literature, two of the included studies reached “Good quality” standard, three were ranked as “Fair”, and the rest were considered “Poor”. No major complications or serious adverse events were reported following intra-articular BTX, which provided encouraging pain relief, improved motor function, and quality of life. Based on the available data, no clear indication emerged from the comparison of BTX with other established treatments for knee OA. The analysis of the available RCTs on BTX intra-articular injection for the treatment of knee OA revealed modest methodological quality. However, based on the data retrieved, botulinum toxin has been proven to provide good short-term outcomes, especially in patients with pain sensitization, by modulating neurotransmitter release, peripheral nociceptive transduction, and acting on the control of chronic pain from central sensitization.

Abstract Introduction Despite the essential utility of opioids for the clinical management of pain, opioid-induced constipation (OIC) remains an important obstacle in clinical practice. In patients, OIC hinders treatment compliance and has negative effects on quality of life. From a clinician perspective, the diagnosis and management of OIC are hampered by the absence of a clear, universal diagnostic definition across disciplines and a lack of standardization in OIC treatment and assessment. Methods A multidisciplinary panel of physician experts who treat OIC was assembled to identify a list of ten corrective actions—five “things to do” and five “things not to do”—for the diagnosis and management of OIC, utilizing the Choosing Wisely methodology. Results The final list of corrective actions to improve the diagnosis and clinical management of OIC emphasized a need for: (i) better physician and patient education regarding OIC; (ii) systematic use of diagnostically validated approaches to OIC diagnosis and assessment (i.e., Rome IV criteria and Bristol Stool Scale, respectively) across various medical contexts; and (iii) awareness about appropriate, evidence-based treatments for OIC including available peripheral mu-opioid receptor antagonists (PAMORAs). Conclusions Physicians who prescribe long-term opioids should be forthcoming with patients about the possibility of OIC and be adequately versed in the most recent guideline recommendations for its management.

Application requirements in High-Performance Computing (HPC) are becoming increasingly exacting, and the demand for computational resources is rising. In parallel, new application domains are emerging, as well as additional requirements, such as meeting real-time constraints. This requirement, typical of embedded systems, is difficult to guarantee when dealing with HPC infrastructures, due to the intrinsic complexity of the system. Traditional embedded systems static analyses to estimate the Worst-Case Execution Time (WCET) are not applicable to HPC, because modeling and analyzing all the system's hardware and software components is not practical. Measurement-based probabilistic analyses for the WCET emerged in the last decade to overcome these issues, but it requires the system to satisfy certain conditions to estimate a correct and safe WCET. In this work, we show the emerging application timing requirements, and we propose to exploit the probabilistic real-time theory to achieve the required time predictability. After a brief recap of the fundamentals of this methodology, we focus on its applicability to HPC systems to check their ability to satisfy such conditions. In particular, we studied the advantages of having heterogeneous processors in HPC nodes and how resource management affects the applicability of the proposed technique.

Innovation refers to the introduction of a product, a process, a service or a solution resulting in something new or significantly improved compared to the already available alternatives. In the clinical context, it is strictly related to the identification of a new added value in terms of quality, therapeutic efficacy and safety. Over the years several innovative approaches have been introduced in the clinical practice, revolutionizing the treatment and the management of important rhinologic conditions. Innovative tools, including new drugs, biomaterials, and mobile applications seem to be able to improve the clinical outcomes and the quality of life of many patients affected by (often relapsing) rhinologic diseases. Among the main modern pharmacological innovations, mention must be made of the biological drugs like monoclonal antibodies (mAbs). Recently, new mAbs have been introduced and investigated as useful arms in the treatment of some inflammatory/infectious or oncological diseases affecting the nasal cavities and paranasal sinuses. The already approved or still investigated mAbs work inhibiting different type 2 inflammation pathways, including those mediated by IgE (omalizumab), IL-4/IL-13 (dupilumab), and IL-5 (mepolizumab). Moreover, considering the higher expression of PD-L1 in nasopharyngeal carcinoma, the use of PD-1 inhibitors, such as nivolumab, or a dual CTLA-4/PD-1 blockade (ipilimumab plus nivolumab) appear to be an effective strategy for the treatment of this cancer form. The implants with bio-absorbable biomaterials represent new interesting available technological innovations. Moreover, advanced technologies such as the artificial intelligence, the machine learning as well as the augmented or virtual reality have also proved useful in rhinologic field with main impacts on precision medicine and surgery. Finally, the development and use of mobile-Health tools represent a winning strategy in monitoring of the therapy success, safety and tolerability as well as the progress of chronic disease including chronic rhinosinusitis with nasal polyps. Supporting the research of innovative tools and strategies (including pharmacological, technologic, or digital ones) is essential to improve the management of chronic diseases that significantly affect the patients' quality of life.

The proper assessment and follow-up of obesity and sarcopenia are relevant for the proper management of the complications of cardiometabolic and musculoskeletal frailty. A total body dual-energy X-ray absorptiometry (DXA) scan should be systematically incorporated in the rehabilitative routine management of patients with obesity and sarcopenia. In the former patients, the total body DXA can be used to assess the fat tissue amount and distribution, while in the latter patients, it can be used to quantify the reduction of appendicular lean mass and to investigate the inter-limb lean mass asymmetry. This tutorial article provides an overview of different DXA-derived fat and lean indices and describes a step-by-step procedure on how to produce a complete DXA report. We suggest that the systematic incorporation of these indices into routine examinations of the patients with obesity and sarcopenia can be useful for identifying the patients at risk for cardiometabolic and neuromuscular impairment-related comorbidities and for evaluating the effectiveness of pharmacological and rehabilitative interventions.

Purpose: Neuromuscular electrical stimulation (NMES) has been considered as a promising approach for the early rehabilitation of patients during and/or after intensive care unit (ICU) stay. The overall objective of this study is to evaluate the NMES effectiveness to counteract the post-ICU impairment in physical function of COVID-19 patients. The specific aim of this manuscript is to describe the study design, protocol, content of interventions, primary and secondary outcomes and to discuss the clinical rehabilitation impact of the expected experimental results. Methods: This prospective, randomized, controlled, parallel-group, single-blind trial will include 80 patients who had undergone mechanical or non-invasive ventilation following pneumonia-induced respiratory failure. Patients are randomized to a control group (routine physical therapy for 3 weeks) or a NMES group (routine physical therapy plus NMES of quadriceps and gastrocnemius muscles for 3 weeks). The primary outcome is physical performance assessed through the Short Physical Performance Battery (SPPB). Secondary outcomes include independence level, perceived fatigue, muscle strength, rectus femoris thickness, and walking performance. The SPBB and walking performance are assessed once (after the intervention), while all other outcomes are assessed twice (before and after the intervention). Conclusion: NMES is a simple and non-invasive technique for muscle strengthening that is usually well tolerated, does not produce adverse effects, requires no or little cooperation from patients and is quite inexpensive. Therefore, proving the effectiveness of NMES therapy for physical and muscle function in COVID-19 patients could support its systematic incorporation in post-ICU rehabilitation protocols of patients presenting with post-intensive care syndrome.

The original article can be found online.

This paper presents the statistical power estimation of goodness-of-fit tests for Extreme Value Theory (EVT) distributions. The presented dataset provides quantitative information on the statistical power, in order to enable the sample size selection in external validation scenario. In particular, high precision estimations of the statistical power of KS, AD, and MAD goodness-of-fit tests have been computed using a Monte Carlo approach. The full raw dataset resulting from this analysis has been published as reference for future studies: https://doi.org/10.17632/hh2byrbbmf.1.

Aims of the study were to evaluate the reliability and validity of the Italian version of the Majeed and Iowa questionnaires and to investigate the long-term surgical outcomes following sacroiliac joint arthrodesis. Twenty one patients who underwent a sacroiliac joint arthrodesis and 21 healthy subjects were evaluated. The experimental procedure consisted of gait analysis and a physical activity assessment (in both groups) and of administration of outcome questionnaires and pain assessment (in the patient group). The Majeed and Iowa questionnaires showed excellent reliability, excellent (for the Majeed questionnaire) and good (for the Iowa questionnaire) construct validity, and poor convergent validity (for both questionnaires) relative to walking speed. Most of the patients reported no pain and minimum pain-related disability and their physical activity profile was comparable to healthy controls. Patients showed an impaired walking performance (i.e., they walked slower and using shorter steps) compared with healthy controls. Long-term walking pattern abnormalities following sacroiliac joint arthrodesis may occur despite excellent clinical results. Given their excellent reliability and construct validity, the Majeed and Iowa questionnaires can be used in combination with the assessment of spatiotemporal gait parameters for the prognostic assessment and/or follow-up of surgical patients.

Musculoskeletal disorders are debilitating conditions that significantly impair the state of health, especially in elderly subjects. A pathological triad of inter-related disorders that are highly prevalent in the elderly consists of the following main “components”: sarcopenia, tendinopathies, and arthritis. The aim of this review is to critically appraise the literature relative to the different disorders of this triad, in order to highlight the pathophysiological common denominator and propose strategies for personalized clinical management of patients presenting with this combination of musculoskeletal disorders. Their pathophysiological common denominator is represented by progressive loss of (focal or generalized) neuromuscular performance with a risk of adverse outcomes such as pain, mobility disorders, increased risk of falls and fractures, and impaired ability or disability to perform activities of daily living. The precise management of these disorders requires not only the use of available tools and recently proposed operational definitions, but also the development of new tools and approaches for prediction, diagnosis, monitoring, and prognosis of the three disorders and their combination.

Congenital permanent dislocation of the patella is a rare disorder of the knee joint in which the patella is permanently displaced, even in extension and is fixed on the lateral aspect of the femoral condyle. The dislocation is irreducible without surgical techniques. This rare condition is usually detected within the first decade of life, because of inability of active extension in the knee and impaired ability during walking. This report presents an unusual case of a 51-year-old man with bilateral congenital permanent dislocation of the patella. The pathology had never been treated because there were few symptoms. The patient presented with right knee pain caused by a fall on the knee during his work. The right knee was painful on the lateral side and the clinical signs were positive for pathology of the lateral meniscus, confirmed by MRI. The clinical and the imaging findings suggested a lesion of the lateral meniscus as the probable cause of the pain. Therefore we performed a knee arthroscopy, whose intra-operative findings confirmed the MRI findings. During the surgery we performed just a selective arthroscopic meniscectomy, without correcting patella dislocation, because the condition was unusually asymptomatic before the trauma.

This paper discusses a sciatic nerve palsy developed after a right total hip revision with a Burch-Schneider metal cage. A sciatalgic nerve pain appeared after surgery, while the palsy developed in about fifteen days. An electromyography showed the delay of the nerve impulse gluteal level. During the surgical exploration of the hip, a compression of the nerve on the metal cage was observed. The nerve was isolated, released from the fibrotic tissue and from the impingement, and was protected with a muscular flap. The recover from the pain was immediate, while the palsy recovered one month later.

Leptotrichia amnionii has had a recent taxonomic definition (2002) and definitely belongs to fastidious Gram negative anaerobes group thanks to difficulties to culture and preserve. Few PubMed reports of microbiological detections are documented to date and this is the first isolation described in Italy. Frequently only DNA analysis in direct samples succeeds in finding it out. Our study describes a case of Leptotrichia amnionii successfully cultivated from aspirated pus, but only 16S rRNA gene amplification and subsequent sequencing technique could afford to identify.The work remarks the added value of DNA techniques in routine analysis of anaerobes.