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Understanding the impact of gravity on daily upper-limb movements is crucial for comprehending upper-limb impairments. This study investigates the relationship between gravitational force and upper-limb mobility by analyzing hand trajectories from 24 healthy subjects performing nine pick-and-place tasks, captured using a motion capture system. The results reveal significant differences in motor behavior in terms of planning, smoothness, efficiency, and accuracy when movements are performed against or with gravity. Analysis showed that upward movements (g-) resembled transversal ones (g0) but differed significantly from downward movements (g+). Corrective movements in g+ began later than in g- and g0, indicating different motor planning models. Velocity profiles highlighted smoother movements in g- and g0 compared to g+. Smoothness was lower in g+, indicating less coordinated movements. Efficiency showed significant variability with no specific trends due to subjective task duration among subjects. This study highlights the importance of considering gravitational effects when evaluating upper-limb movements, especially for individuals with neurological impairments. Planning metrics, including Percent Time to Peak Velocity and Percent Time to Peak Standard Deviation, showed significant differences between g- and g0 compared to g+, supporting Fitts' law on the trade-off between speed and accuracy. Two novel indications were also introduced: the Target Position Error and the Minimum Required Tunnel. These new indicators provided insights into hand-eye coordination and movement variability. The findings suggest that motor planning, smoothness, and efficiency are significantly influenced by gravity, emphasizing the need for differentiated approaches in assessing and rehabilitating upper-limb impairments. Future research should explore these metrics in impaired populations to develop targeted rehabilitation strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bucchieri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background/Objectives: To present the technical aspects of contrast-enhanced 4DCT (ce4DCT) simulation for abdominal SBRT. Methods: Twenty-two patients underwent two sequential 4DCT scans: one baseline and one contrast-enhanced with personalized delay time ( t delay ) calculated to capture the tumor in the desired contrast phase, based on diagnostic triple-phase CT. The internal target volume (ITV) was delineated on ten contrast phases, and a panel of three experts qualitatively evaluated tumor visibility. Aortic HU values were measured to refine the t delay for subsequent patients. The commonly used approach of combining triple-phase CT with unenhanced 4DCT was simulated, and differences in target delineation were evaluated by volume, centroid shift, Dice and Jaccard indices, and mean distance agreement (MDA). The margins required to account for motion were calculated. Results: The ce4DCT acquisitions substantially improved tumor visibility over the entire breathing cycle in 20 patients, according to the experts' unanimous evaluation. The median contrast peak time was 54.5 s, and the washout plateau was observed at 70.3 s, with mean peak and plateau HU values of 292 ± 59 and 169 ± 25. The volumes from the commonly used procedure (ITV2) were significantly smaller than the ce4DCT volumes (ITV1) ( p = 0.045). The median centroid shift was 4.7 mm. The ITV1-ITV2 overlap was 69% (Dice index), 53% (Jaccard index), and 2.89 mm (MDA), with the liver volumes showing significantly lower indices compared to the pancreatic volumes ( p ≤ 0.011). The margins required to better encompass ITV1 were highly variable, with mean values ≥ 4 mm in all directions except for the left-right axis. Conclusions: The ce4DCT simulation was feasible, resulting in optimal tumor enhancement with minimal resource investment, while significantly mitigating uncertainties in SBRT planning by addressing poor visibility and respiratory motion. Triple-phase 3DCT with unenhanced 4DCT led to high variability in target delineation, making the isotropic margins ineffective.

Background: Despite numerous efforts to demonstrate the presence of the SARS-CoV-2 in semen of affected males, no clear evidence exists. We conducted a multicenter prospective study on adult patients with a confirmed diagnosis of SARS-CoV-2 including patients with active infection (Active Group) and with a history of COVID-19 disease at least of 6 months (Recovered Group). An RT-PCR test for SARS-CoV-2 and a semen analysis were performed on the semen of the enrolled patients. Genital/sexual symptoms were investigated in both groups. In the active infection group, urinary and sexual functions were assessed in the active phase and after 6 months. Finally, the literature on the detection of SARS-CoV-2 in semen was reviewed non-systematically., Results: Sixty-five patients were enrolled (Active Group = 15, Recovered Group = 50). RT-PCR testing for SARS-CoV-2 found no trace of the virus in any of the semen samples. Genital/sexual symptoms during the active phase were reported in 8 (12.2%) patients. No statistically significant differences in semen quality were found between the two groups. IPSS and IIEF-5 scores did not change significantly during the different phases of infection about (p > 0.05)., Conclusions: SARS-CoV-2 was not detected in semen of acute or recovered cases. Sperm parameters were not significantly different in the two groups. Urinary and erectile functions appeared stable across the phases of infection., Competing Interests: Declarations. Ethics approval and consent to partecipate: The study has been complied with all the relevant national regulations, institutional policies and in accordance the tenets of the Helsinki Declaration (2013) and has been approved by the Etical Commite of Azienda Ospedaliera of Perugia. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: To compare the aberrometric profile of the Artisan Aphakia lens (Opthec BV) and transscleral plug FIL-SSF lens (Soleko) and to assess the impact of tilt and decentration on their optical performance., Methods: This retrospective observational study was conducted at Azienda Ospedaliera Universitaria Careggi, Florence, Italy, with a consecutive cohort of aphakic eyes undergoing secondary lens implantation with an Artisan or FIL-SSF lens. Wavefront analysis was performed using a pyramidal wavefront-based aberrometer (Osiris-T; CSO). Tilt and decentration were calculated using anterior segment optical coherence tomography (MS-39; CSO)., Results: The study included 47 eyes from 45 patients: 24 eyes in the FIL-SSF group and 23 eyes in the Artisan group. Decentration was 0.39 ± 0.14 mm in the FIL-SSF group and 0.51 ± 0.16 mm in the Artisan group ( P = .02). The mean tilt value was 6.6 ± 2.35 degrees in the FIL-SSF group and 5.9 ± 1.86 degrees in the Artisan group ( P = .13). Internal higher order aberrations (HOAs) were 0.23 ± 0.07 μm in the FIL-SSF group and 0.29 ± 0.13 μm in the Artisan group ( P = .02). The point spread function (PSF) Strehl ratio was 0.12 ± 0.05 in the FIL-SSF group and 0.10 ± 0.04 ( P = .11) in the Artisan group. The PSF Strehl ratio without lower order aberration (PSFw2) was 0.28 ± 0.12 in the FIL-SSF group and 0.23 ± 0.09 in the Artisan group ( P = .01)., Conclusions: The Artisan and FIL-SSF lenses provide comparable optical performance in terms of the PSF Strehl ratio. However, the Artisan lens appears to be more susceptible to decentration, which may result in increased higher order aberrations and a consequently lower PSFw2 Strehl ratio. [ J Refract Surg . 2024;40(12):e926-e933.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Not available.

Aims: The most frequent consequence of elevated uric acid (UA) levels is the development of gout and urate kidney disease. Besides these effects, several studies have investigated the association between hyperuricemia and cardiovascular (CV) disease. High serum UA has been identified as an important determinant of all-cause and CV mortality and CV events (acute and chronic coronary syndrome, stroke and peripheral artery disease). Despite the high number of publications on this topic, there are two questions that are still unanswered: do we need a specific CV cut-off of serum UA to better refine the CV risk? Is urate lowering treatment (ULT) able to reduce CV risk in asymptomatic patients? In this review, we will focus on these two points., Data Synthesis: Although no doubt exists that the relationship between CV events starts at lower levels than the actually used cut-off, different papers found dissimilar cut-offs. Furthermore, heterogeneity is present depending on the specific CV events evaluated and none of the found cut-off have been tested in external populations (in order to confirm its discriminatory capacity). Furthermore, only few randomized clinical trials on the role of hypouricemic agents in reducing the CV risk have been published giving heterogeneous results. The last published one (ALL-HEART) has strong limitations, that we will deeply discuss., Conclusions: A definitive answer to the two questions is impossible with the actually published paper but, over identifying current gaps in knowledge we try to individuate how they can be overruled., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Advances in medical and surgical interventions have resulted in a steady increase in the number of patients with congenital heart disease (CHD) reaching adult age. Unfortunately, this ever-growing population faces an added challenge: an increased risk of acquiring coronary artery disease. This review provides insight into the complex interactions between coronary artery disease and CHD in adults. We describe the peculiar features of cardiac anatomy in these patients, the possible role cardiac sequelae may play in an increased risk of myocardial ischemia, and the diagnostic challenges in this patient group. Furthermore, this review outlines the risk factors and potential mechanisms of accelerated atherosclerosis in adults with CHD by pointing out areas where current knowledge is incomplete and highlighting areas for further research. The review concludes by examining potential management strategies for this particular population, emphasizing the necessity for a multidisciplinary approach. Understanding the unique coronary risks that adults with CHD experience can enhance patient care and improve long-term results.

Background: Checkpoint immunotherapy unleashes tumor control by T cells, but it is undermined in non-immunogenic tumors, e.g. with low MHC class I expression and low neoantigen burden, such as neuroblastoma (NB). Endoplasmic reticulum aminopeptidase 1 (ERAP1) is an enzyme that trims peptides before loading on MHC class I molecules. Inhibition of ERAP1 results in the generation of new antigens able of inducing potent anti-tumor immune responses. Here, we identify a novel non-toxic combinatorial strategy based on genetic inhibition of ERAP1 and administration of the HDAC inhibitor (HDACi) entinostat that increase the immunogenicity of NB, making it responsive to PD-1 therapy., Methods: CRISPR/Cas9-mediated gene editing was used to knockout (KO) the ERAP1 gene in 9464D NB cells derived from spontaneous tumors of TH-MYCN transgenic mice. The expression of MHC class I and PD-L1 was evaluated by flow cytometry (FC). The immunopeptidome of these cells was studied by mass spectrometry. Cocultures of splenocytes derived from 9464D bearing mice and tumor cells allowed the assessment of the effect of ERAP1 inhibition on the secretion of inflammatory cytokines and activation and migration of immune cells towards ERAP1 KO cells by FC. Tumor cell killing was evaluated by Caspase 3/7 assay and flow cytometry analysis. The effect of ERAP1 inhibition on the immune content of tumors was analyzed by FC, immunohistochemistry and multiple immunofluorescence., Results: We found that inhibition of ERAP1 makes 9464D cells more susceptible to immune cell-mediated killing by increasing both the recall and activation of CD4 + and CD8 + T cells and NK cells. Treatment with entinostat induces the expression of MHC class I and PD-L1 molecules in 9464D both in vitro and in vivo. This results in pronounced changes in the immunopeptidome induced by ERAP1 inhibition, but also restrains the growth of ERAP1 KO tumors in vivo by remodelling the tumor-infiltrating T-cell compartment. Interestingly, the absence of ERAP1 in combination with entinostat and PD-1 blockade overcomes resistance to PD-1 immunotherapy and increases host survival., Conclusions: These findings demonstrate that ERAP1 inhibition combined with HDACi entinostat treatment and PD-1 blockade remodels the immune landscape of a non-immunogenic tumor such as NB, making it responsive to checkpoint immunotherapy., (© 2024. The Author(s).)

Background: We conducted a systematic review and meta-analysis of comparative studies to analyze intra- and postoperative outcomes of robot-assisted radical prostatectomy (RARP) using either DaVinci (DV-RARP) or Hugo™RAS (H-RARP) platforms., Methods: The study was registered in PROSPERO (CRD42024562326) and followed PRISMA guidelines. Literature search was conducted in June 2024 using academic databases, focusing on articles from 2021 to 2024. Research question focused on men with PCa (P) undergoing H-RARP (I) versus DV-RARP (C) to evaluate surgical, pathology, and functional outcomes (O), across comparative studies. Continuous variables were summarized using mean difference (MD) and categorical variables using odds ratio with 95% confidence intervals (CI). Heterogeneity was assessed using Cochran's Q test and I 2 statistics. Publication bias was evaluated with Egger's and Begg's tests. Statistical analysis was performed with Stata®17.0, with significance set at p < 0.05. Risk of bias was assessed using the ROBINS-I tool. Methodological quality was evaluated with AMSTAR 2., Results: Eight studies (three prospective, five retrospective) with 1114 patients (454 H-RARP vs. 660 DV-RARP) were included. Baseline characteristics were comparable between groups. No significant differences were found in overall operative time, console time, blood loss, nerve-sparing, or lymphadenectomy. Docking time was significantly longer for Hugo™RAS (MD:6 min,95% CI 4.2;7.8). Postoperative outcomes, including complications, length of stay, and catheterization time, were similar. Pathological outcomes showed no significant differences in positive surgical margins or staging, but lower node yield was observed with H-RARP (MD:-2,95% CI -3.3;-0.6). Urinary continence recovery was comparable. Risk of bias was moderate to serious., Conclusion: The meta-analysis suggests H-RARP and DV-RARP perform not statistically different across most of analyzed outcomes, except for docking time and lymph-node yield. The longer docking time associated with the Hugo™RAS suggests demanding setup but does not translate into significantly longer operative time. Although statistically significant, the observed difference in lymph-node yield might be clinically negligible., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Multiple sclerosis (MS) is a prototypical autoimmune disease of the central nervous system (CNS). In addition to CD4 + T cells, memory B cells are now recognized as a critical cell type in the disease. This is underlined by the fact that the best-characterized environmental risk factor for MS is the Epstein-Barr virus (EBV), which can infect and persist in memory B cells throughout life. Several studies have identified changes in anti-EBV immunity in patients with MS. Examples include elevated titers of anti-EBV nuclear antigen 1 (EBNA1) antibodies, interactions of these with the MS-associated HLA-DR15 haplotype, and molecular mimicry with MS autoantigens like myelin basic protein (MBP), anoctamin-2 (ANO2), glial cell adhesion molecule (GlialCAM), and alpha-crystallin B (CRYAB). In this study, we employ a simple in vitro assay to examine the memory B cell antibody repertoire in MS patients and healthy controls. We replicate previous serological data from MS patients demonstrating an increased secretion of anti-EBNA1 380-641 IgG in cell culture supernatants, as well as a positive correlation of these levels with autoantibodies against GlialCAM 262-416 and ANO2 1-275 . For EBNA1 380-641 and ANO2 1-275 , we provide additional evidence suggesting antibody cross-reactivity between the two targets. Further, we show that two efficacious MS treatments - natalizumab (NAT) and autologous hematopoietic stem cell transplantation (aHSCT) - are associated with distinct changes in the EBNA1-directed B cell response and that these alterations can be attributed to the unique mechanisms of action of these therapies. Using an in vitro system, our study confirms MS-associated changes in the anti-EBNA1 memory B cell response, EBNA1 380-641 antibody cross-reactivity with ANO2 1-275, and reveals treatment-associated changes in the immunoglobulin repertoire in MS., Competing Interests: Authors ZM and RM were employed by company Cellerys. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Marti, Ruder, Thomas, Bronge, De La Parra Soto, Grönlund, Olsson and Martin.)

Introduction: Omphalocele (OM) is a congenital defect of the abdominal wall. The main goal of the surgical management is the survival of the neonate. However, the residual scar following the surgery can be extremely burdensome and negatively impact the quality of life (QoL) of these patients. The aim of this study is to assess the cosmetic results of the surgical treatment, the level of satisfaction of patients and surgeons, and the influence of the scar on the QoL of the patient., Materials and Methods: We conducted an observational retrospective cross-sectional study collecting all data regarding patients born with OM, operated at our Centre between 1998 and 2021. The cosmetic results of the surgical repair were evaluated using the validated Patient and Observer Scar Assessment Scale (POSAS). The assessment of the quality of life determined by the presence of the scar was conducted using PedQL 4.0. At last, the patients were visited by two paediatric surgeons and a medical student, which then scored the cosmetic result of the scar. Statistical analysis was conducted with Spearman linear correlation and Mann-Whitney test. A P-value below 0.05 was considered statistically significant., Results: In our study, we included a total of 19 patients, with a mean of 12 years of age at the time of the evaluation. The parameters with the major influence on the patient's general opinion of the scar were stiffness, thickness, and irregularity. We discovered significant differences in median values of all scores between the giant OM group and the nongiant OM group, in favour of the latter. Finally, we found a low grade of concordance between PedsQL filled by parents and patients., Conclusion: The POSAS scale is a valid, feasible, and reliable tool for the assessment of the aesthetic outcome of surgical procedures. The original size of the defect is the most important factor acting on the result. However, it is crucial that any decision on plastic surgery to improve the looks of the scar must be postponed to the adult age of the patient., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2024. The Author(s).)

Purpose: To determine the 10-year morphological outcomes and identify potential risk factors for exudative AMD in the fellow eyes (FE) in patients with naïve exudative AMD., Methods: Data from 100 patients were retrospectively reviewed. Baseline macular neovascularization (MNV) type in the exudative AMD eye and presence of drusen, intraretinal hyperreflective foci (iHRF), non-foveal incomplete atrophy (iRORA), central retinal thickness and subfoveal choroidal thickness in the FEs were analyzed as biomarkers for progression in the second eye., Results: 54 patients developed exudative AMD in the FE at the end of the follow-up. Subjects with type 2 and 3 MNV in the exudative AMD eye had a higher risk of exudative AMD in the FE (HR=3.365; p=0.039 and HR=3.801; p=0.037). FEs with drusen (large HR=6.938, p=0.001; cuticular HR=6.937, p<0.0001; subretinal drusenoid deposits HR=13.678, p<0.0001) and iHRF (HR=1.853, p=0.041) were also at higher risk. Seven patients were legally blind by the end of the follow-up., Conclusions: The rate of exudative AMD in the FE was 54% 10 years after the diagnosis in the exudative eye. The FE of patients with type 2 and 3 MNV was at high risk for early progression. Drusen and iHRF were also significant risk factors for MNV development., Competing Interests: Conflict of Interest Disclosures: None reported., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

Background: Closing the control loop between users and their prostheses by providing artificial sensory feedback is a fundamental step toward the full restoration of lost sensory-motor functions., Methods: We propose a novel approach to provide artificial proprioceptive feedback about two degrees of freedom using a single array of 8 vibration motors (compact solution). The performance afforded by the novel method during an online closed-loop control task was compared to that achieved using the conventional approach, in which the same information was conveyed using two arrays of 8 and 4 vibromotors (one array per degree of freedom), respectively. The new method employed Gaussian interpolation to modulate the intensity profile across a single array of vibration motors (compact feedback) to convey wrist rotation and hand aperture by adjusting the mean and standard deviation of the Gaussian, respectively. Ten able-bodied participants and four transradial amputees performed a target achievement control test by utilizing pattern recognition with compact and conventional vibrotactile feedback to control the Hannes prosthetic hand (test conditions). A second group of ten able-bodied participants performed the same experiment in control conditions with visual and auditory feedback as well as no-feedback., Results: Conventional and compact approaches resulted in similar positioning accuracy, time and path efficiency, and total trial time. The comparison with control condition revealed that vibrational feedback was intuitive and useful, but also underlined the power of incidental feedback sources. Notably, amputee participants achieved similar performance to that of able-bodied participants., Conclusions: The study therefore shows that the novel feedback strategy conveys useful information about prosthesis movements while reducing the number of motors without compromising performance. This is an important step toward the full integration of such an interface into a prosthesis socket for clinical use., (© 2024. The Author(s).)

Purpose: Limited data is available on treatment satisfaction with the management of wet age-related macular degeneration (wAMD) among patients in Italy. In this cross-sectional real-world study, treatment satisfaction with anti-vascular endothelial growth factor (anti-VEGFs) was assessed in patients with wAMD in Italy., Patients and Methods: This was a non-interventional, cross-sectional survey involving patients with wAMD receiving anti-VEGFs. The survey was administered through a virtual assistant via phone. Patients' treatment satisfaction was assessed using a newly developed Novartis Tailored Treatment Satisfaction Questionnaire (NVS TTSQ) and the validated Macular Disease Treatment Satisfaction Questionnaire (MacTSQ)., Results: Overall, 154 evaluable patients were enrolled in 5 centers across Italy. The mean (SD) age of the patients was 76.8 years (7.01). Overall treatment satisfaction score assessed by NVS TTSQ was 40.50 (7.11), with a mean of 9.97 (1.84) on the information domain and 22.98 (4.57) on the unmet need domain. Patients were satisfied with diagnosis communication (4.99 [1.30]), information provided on treatment administration (4.58 [1.49], range 0-6), the waiting room (4.40 [1.43]), and management of visits and injections at the center (5.14 [1.12]), general management of maculopathy at the center (5.22 [1.01]). Patients were not satisfied with their independence in terms of disease management (2.56 [2.45]); they would like additional information about the disease (5.38 [1.03]) and to discuss the injection procedures (4.02 [1.94]) with already-treated patients. The overall treatment satisfaction score on MacTSQ scale was 55.84 (10.13)., Conclusion: Patients with wAMD are satisfied with the overall management of their disease in Italy. However, patients would like to have more information on prognosis and management of the disease., Competing Interests: Enrico Peiretti is a scientific advisor for Bayer and Novartis. He received travel grants from Alcon, Baush and Lomb, Sifi, and Allergan. Chiara Ascardi, Marta Bartezaghi, and Lorenzo De Santi were full-time employees of Novartis Farma S.p.A., Milano, MI, Italy at the time of the study. Francesco Bandello is a consultant/advisor for Abbvie, Alimera, Bayer, Boehringer-Ingelheim, Fidia Sooft, Hofmann La Roche, Novartis, Ntc Pharma, Oxurion Nv, and Sifi. Francesco Boscia is a consultant/advisor for Alcon, Abbvie, Bayer, Novartis, Roche, and Zeiss. Monica Varano serves as an advisory board member of Abbvie, Astellas, Bayer, Biogen, Novartis, and Roche. Giovanni Staurenghi is a consultant/advisor for Abbvie, Apellis Pharmaceuticals, Inc., Annexon Bioscience, Bayer Healthcare Pharmaceuticals, Boehringer, Centervue, Inc., Genentech, Heidelberg Engineering, Hoffman La Roche, Ltd., Iveric Bio, Medscape, Novartis Pharmaceuticals, Optos, Inc., and RetinAI. He received grant support from Carl Zeiss Meditec, Centervue, Inc., Heidelberg Engineering, Hoffman La Roche, Ltd., Nidek, Inc., Novartis Pharmaceuticals, Optos, Inc., and RetinAI. He received lecture and speaker bureau fees from Carl Zeiss, Heidelberg Engineering, Hoffman La Roche, Ltd., Meditec, Nidek, Inc., and Novartis Pharmaceuticals. He also received patent royalties from Ocular Instruments Inc. The authors report no other conflicts of interest in this work., (© 2024 Peiretti et al.)

Color centers integrated with nanophotonic devices have emerged as a compelling platform for quantum science and technology. Here, we integrate tin-vacancy centers in a diamond waveguide and investigate the interaction with light at the single-photon level in both reflection and transmission. We observe single-emitter-induced extinction of the transmitted light up to 25% and measure the nonlinear effect on the photon statistics. Furthermore, we demonstrate fully tunable interference between the reflected single-photon field and laser light backscattered at the fiber end and show the corresponding controlled change between bunched and antibunched photon statistics in the reflected field.

In orthopedics, X-rays and computed tomography (CT) scans play pivotal roles in diagnosing and treating bone pathologies. Machine bulkiness and the emission of ionizing radiation remain the main problems associated with these techniques. The accessibility and low risks related to ultrasound handling make it a popular 2D imaging method. Indeed, 3D ultrasound assembles 2D slices into a 3D volume. This study aimed to implement a probe-tracking method for 6 DoF 3D ultrasound. The proposed method involves a dodecahedron with ArUco markers attached, enabling computer vision tracking of the ultrasound probe's position and orientation. The algorithm focuses on the data acquisition phase but covers the basic reconstruction required for data generation and analysis. In the best case, the analysis revealed an average error norm of 2.858 mm with a standard deviation norm of 5.534 mm compared to an infrared optical tracking system used as a reference. This study demonstrates the feasibility of performing volumetric imaging without ionizing radiation or bulky systems. This marker-based approach shows promise for enhancing orthopedic imaging, providing a more accessible imaging modality for helping clinicians to diagnose pathologies regarding complex joints, such as the shoulder, replacing standard infrared tracking systems known to suffer from marker occlusion problems.

Background: Central pancreatectomy (CP) is a parenchymal-sparing technique indicated for the resection of selected lesions of the neck or proximal body of the pancreas. 1,2 The risk of postoperative complications is theoretically doubled because the surgeon has to manage two cut surfaces of the pancreas. The video shows a fully robotic CP to treat a 62-year-old male patient with a mixed-type intraductal papillary mucinous neoplasm (IPMN) of the pancreatic neck, using ultrasound (US) and Wirsung endoscopic evaluation to guide the pancreatic resection and ensure optimal resection margins., Materials and Methods: A US-guided robotic CP was carried out, and an intraoperative endoscopic evaluation of the MPD was performed to determine the distal transection level. A transmesocolic, end-to-side, robot-sewn Wirsung-jejunostomy with internal MPD stenting was then created. The procedure was completed with a side-to-side jejunojejunostomy., Results: The operative time was 290 min, with negligible blood loss. During the postoperative course, the patient experienced bleeding from a branch of the gastroduodenal artery with subsequent fluid collection, which was successfully treated with angioembolization and percutaneous drainage. He was discharged home on postoperative day 22. Final pathology revealed a non-invasive IPMN with low-grade dysplasia and free surgical margins. At 12 months of follow-up, the patient was doing well, with no evidence of local recurrence and endocrine or exocrine pancreatic insufficiency., Conclusions: The combination of robotic surgery with intraoperative US and Wirsungoscopy may offer distinct technical advantages for challenging pancreatectomies that follow the principles of parenchymal-sparing surgery., (© 2024. Society of Surgical Oncology.)

Background: Anesthesiologists frequently use intraoperative transesophageal echocardiography (TEE) to aid in the diagnosis and management of hemodynamic problems during liver transplantation (LT). Although the use of TEE in US centers continues to increase, data regarding international use are lacking., Methods: This prospective, global, survey-based study evaluates international experience with TEE for LT. Responses from 252 LT (105 US and 147 non-US) centers representing 1789 anesthesiologists were analyzed., Results: Routine use of TEE in the United States has increased in the last 5 y (from 37% to 47%), but only 21% of non-US LT anesthesiologists use TEE routinely. Lack of training (44% US versus 70% non-US) and equipment (9% non-US versus 34% US) were cited as obstacles. Most survey participants preferred not to perform a complete cardiac examination but rather use only 6 of 11 basic views. Although non-US LT anesthesiologists more frequently had additional clinical training than their US counterparts, they had less TEE experience (13% versus 44%) and less frequently, TEE certification (22% versus 35%). Most LT anesthesiologists agreed that TEE certification is essential for proficiency. Of all respondents, 89% agreed or strongly agreed that TEE provides valuable information needed for immediate clinical decision-making, and >86% agreed or strongly agreed that that information could not be derived from other sources., Conclusions: The use of TEE for LT surgery in the US LT centers is currently higher compared with non-US LT centers. This may become a standard monitoring modality during LT in the near future., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Artificial atoms in solids are leading candidates for quantum networks, scalable quantum computing, and sensing, as they combine long-lived spins with mobile photonic qubits. Recently, silicon has emerged as a promising host material where artificial atoms with long spin coherence times and emission into the telecommunications band can be controllably fabricated. This field leverages the maturity of silicon photonics to embed artificial atoms into the world's most advanced microelectronics and photonics platform. However, a current bottleneck is the naturally weak emission rate of these atoms, which can be addressed by coupling to an optical cavity. Here, we demonstrate cavity-enhanced single artificial atoms in silicon (G-centers) at telecommunication wavelengths. Our results show enhancement of their zero phonon line intensities along with highly pure single-photon emission, while their lifetime remains statistically unchanged. We suggest the possibility of two different existing types of G-centers, shedding new light on the properties of silicon emitters., (© 2024. The Author(s).)

Objective: Substance Use Disorders (SUD) are common in adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Although predictors of SUD in this population are relevant for prevention and treatment, they need further clarification. Affective temperaments potentially associated with SUD in adult ADHD patients were explored., Methods: ADHD patients with and without SUD were compared for sociodemographic, clinical, and psychological characteristics through: Adult ADHD Self-Report Scale; Wender Utah Rating Scale; Temperament Evaluation Memphis for Pisa, Paris, and San Diego-Autoquestionnaire. Logistic regression investigated factors associated with SUD., Results: We included one-hundred and thirty-six ADHD patients with (n = 51, 37.5 %) and without SUD (n = 85, 62.5 %). The presence of SUD was associated with irritable temperament (p = 0.009), as well as more frequent school failure (p = 0.038), legal problems (p = 0.039), and lifetime suicide attempts (p = 0.014)., Limitations: The cross-sectional design, the relatively small sample size, and the use of self-administered questionnaires., Conclusions: This study confirms the greater overall severity of adult ADHD-SUD compared with ADHD-only patients and suggests the potential role of irritable temperament as a predictor of substance-related problems., Competing Interests: Declaration of competing interest All authors declare that there are no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Few certainties exist regarding optimal management of Blood Pressure (BP) in the very first hours after an ischemic stroke and many questions remain still unanswered. Our work aimed to evaluate the role of BP and its trend as possible determinants of in-hospital mortality (primary outcome), discharge disabilities and hospitalization length (secondary outcomes) in ischemic stroke patients presented with Hypertensive Emergencies (HE)., Methods: We retrospectively evaluated patients presented to Niguarda Hospital, Emergency Department (ED), from 2015 to 2017 with a neurological ischemic HE. BP at ED presentation (T0), its management in ED (T1) and its values at the stroke unit admission (T2) were evaluated., Results: 267 patients were included (0.13 % of all ED accesses and 17.9 % of all ischemic strokes). In the whole population, BP values were not associated with in-hospital mortality while T0 and T2 SBP result were associated to discharge disability and hospitalization length. In pre-specified subgroup analysis these associations were confirmed only in untreated subjects (not anti-hypertensive nor thrombolysis). In fact, no significant relationship can be found between BP values and any secondary outcome in thrombolysis and anti-hypertensive treated patients., Conclusions: BP values and its management can not be related to in-hospital mortality in stroke patients, presented with HE, while they are associated to discharge disability and hospitalization length. In subgroup analysis, results were confirmed only in untreated (not anti-hypertensive therapies nor thrombolytic)., Competing Interests: Declaration of competing interest The authors declare they have no conflict of interest., (Copyright © 2024 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Pathogenic microorganisms released onto the soil from point or diffuse sources represent a public health concern. They can be transported by rainwater that infiltrates into subsoil and reach the groundwater where they can survive for a long time and contaminate drinking water sources. As part of the SCA.Re.S. (Evaluation of Health Risk Related to the Discharge of Wastewater on the Soil) project, we reviewed a selection of field-scale studies that investigated the factors that influenced the fate of microorganisms that were transported from the ground surface to the groundwater. A total of 24 studies published between 2003 and 2022 were included in the review. These studies were selected from the PubMed and Web of Science databases. Microbial contamination of groundwater depends on complex interactions between human activities responsible for the release of contaminants onto the soil, and a range of environmental and biological factors, including the geological, hydraulic, and moisture characteristics of the media traversed by the water, and the characteristics and the viability of the microorganisms, which in turn depend on the environmental conditions and presence of predatory species. Enterococci appeared to be more resistant in the underground environment than thermotolerant coliforms and were suggested as a better indicator for detecting microbial contamination of groundwater.

Competing Interests: The authors declare no conflict of interest in this study.

Multiple sclerosis (MS) is a chronic autoimmune disorder that affects the central nervous system and can result in various symptoms, including muscle weakness, spasticity, and fatigue, ultimately leading to the deterioration of the musculoskeletal system. However, in recent years, exosuits have emerged as a game-changing solution to assist individuals with MS during their daily activities. These lightweight and affordable wearable robotic devices have gained immense popularity. In our study, we assessed the performance of an elbow exosuit on eight individuals with MS using high-density electromyography to measure biceps muscle activity. The results demonstrated that our prototype significantly reduced muscle effort during both dynamic and isometric tasks while increasing the elbow range of motion. In addition, the exosuit effectively delayed the onset of muscle fatigue, enhancing endurance for people with MS and enabling them to perform heavy duty tasks for a longer period.

Psychiatric symptoms have been frequently reported in patients affected by COVID-19, both as new occurring and recurrences of pre-existing diseases. Depressive symptoms are estimated to affect at least 30% of patients following infection, with specific physical and cognitive features and relevant immune-inflammatory alterations. This study aimed to retrospectively characterize post-COVID-19 first-onset and recurrent major depressive episodes (MDE) and to evaluate the effects of antidepressants on physical and cognitive correlates of depression, in addition to mood, anxiety, and underlying inflammatory status. We evaluated 116 patients (44.8% males, 51.1 ± 17 years) with post-COVID-19 first-onset (38.8%) and recurrent (61.2%) MDE at baseline and after one- and three-month treatment with antidepressants (31% SSRIs, 25.9% SNRIs, 43.1% others). We assessed sociodemographic and clinical features and psychopathological dimensions through: Hamilton Depression and Anxiety Rating Scales; Short Form-36 Health Survey Questionnaire; Perceived Deficits Questionnaire-Depression 5-items. The systemic immune-inflammatory index was calculated to measure inflammation levels. Alongside the reduction of depression and anxiety (p < 0.001), physical and cognitive symptoms improved (p < 0.001) and inflammatory levels decreased (p < 0.001) throughout treatment in both groups. Post-COVID-19 recurrent MDE showed a significantly more severe course of physical and cognitive symptoms and persistently higher levels of inflammation than first-onset episodes. Antidepressants proved to be effective in both post-COVID-19 first-onset and recurrent MDE. However, a sustained inflammatory status might blunt treatment response in patients with recurrent depression in terms of physical correlates and cognition. Therefore, personalized approaches, possibly involving combinations with anti-inflammatory compounds, could promote better outcomes in this clinical population., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Ankyloglossia is an anatomical variation of the lingual frenulum that negatively interferes with the functionality of the tongue. This condition can affect breastfeeding negatively. The aim of this study is to assess the prevalence of ankyloglossia among healthy babies born in Siena Hospital and the correlation between ankyloglossia and breastfeeding difficulties., Methods: We performed an observational prospective study conducted on healthy and breastfed newborns born in Siena Hospital in the period between January and June 2022. The evaluation of lingual frenulum in the first few days of life was performed by Martinelli's Lingual Frenulum Protocol with scores for Infants (MLFPI), while the clinical assessment of breastfeeding initiation was performed by the Breastfeeding Observation and Evaluation Form according to WHO-UNICEF guidelines. We also compared the reliability in predicting breastfeeding of a tool that measured the features of the tongue frenulum: the Bristol Tongue Assessment Tool (BTT). Breastfeeding at one and six months of babies' age was assessed by telephone interview, and information among children's nutrition, weight growth and difficulties found in breastfeeding was also collected. This study was approved by the Pediatric Ethics Committee for Clinical Trials of the Tuscany Region., Results: One hundred and ninety infants were included in the study; 21 (11.05%) had a MLFPI score ≥13. Data at one month of age showed a statistically higher MLFPI score (P value <0.001) in babies with breastfeeding difficulties (median score 13.0, IQR 5.5-14), than in those without (median score 5.0, IQR 2.0-7.5). Data at 6 months of age showed a similar difference in babies with and without breastfeeding difficulties (median 12.0, IQR 4.0-14.0 vs. 5.0, IQR 2.0-8.0 respectively). A MLFPI score ≥13 is positively associated with breastfeeding difficulties at 1 and 6 months. Also, the BTT was positively a risk factor for problems in breastfeeding at 1 and 6 months., Conclusions: A high MLFPI score is a risk factor of breastfeeding difficulties. In these cases, a referral to experienced personnel is advisable: they can provide the emotional and professional support to the mother-child dyad, and/or refer for surgical evaluation and frenotomy. In our cohort, the usefulness of either MLFPI score or BTT was evident in predicting breastfeeding difficulties; the rate of surgical removal of the frenulum was nonetheless low.

Background: Hypersensitivity reactions to toothpastes are rare. The objective of this study was to present the authors' clinical cases in the past 10 years and perform a scoping review of gingival hypersensitivity responses to toothpastes., Types of Studies Reviewed: The authors reviewed records of documented gingival hypersensitivity reactions to dentifrices at the Postgraduate Clinic of Oral Medicine, Complutense University, Madrid, Spain, from January 2013 through December 2022. Furthermore, the authors conducted a search in PubMed with no date limit for articles reporting these hypersensitivity responses up through October 18, 2023., Results: Eleven cases were collected from the clinic. Eight gingival hypersensitivity reactions occurred in women, and 6 were associated with cinnamon. The most frequent lesions diagnosed were red gingiva. The discontinuation of the toothpaste led to the disappearance of the lesions. The search yielded 643 references. Thirteen articles were included in the scoping review, all of them case series and case reports, reporting 32 cases. Lesions affected middle-aged women most frequently, the most common hypersensitivity reaction was gingival redness, and the cases implicated toothpastes containing cinnamon and herbal composition., Practical Implications: This study provides clues for diagnosing and treating hypersensitivity reactions to toothpastes, which may improve the identification, management, and reporting of these cases., Competing Interests: Disclosures None of the authors reported any disclosures., (Copyright © 2024 American Dental Association. Published by Elsevier Inc. All rights reserved.)

The robotics discipline is exploring precise and versatile solutions for upper-limb rehabilitation in Multiple Sclerosis (MS). People with MS can greatly benefit from robotic systems to help combat the complexities of this disease, which can impair the ability to perform activities of daily living (ADLs). In order to present the potential and the limitations of smart mechatronic devices in the mentioned clinical domain, this review is structured to propose a concise SWOT (Strengths, Weaknesses, Opportunities, and Threats) Analysis of robotic rehabilitation in MS. Through the SWOT Analysis, a method mostly adopted in business management, this paper addresses both internal and external factors that can promote or hinder the adoption of upper-limb rehabilitation robots in MS. Subsequently, it discusses how the synergy with another category of interaction technologies - the systems underlying virtual and augmented environments - may empower Strengths, overcome Weaknesses, expand Opportunities, and handle Threats in rehabilitation robotics for MS. The impactful adaptability of these digital settings (extensively used in rehabilitation for MS, even to approach ADL-like tasks in safe simulated contexts) is the main reason for presenting this approach to face the critical issues of the aforementioned SWOT Analysis. This methodological proposal aims at paving the way for devising further synergistic strategies based on the integration of medical robotic devices with other promising technologies to help upper-limb functional recovery in MS., Competing Interests: GA and JZ were employed by ReWing s r l. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Albanese, Bucchieri, Podda, Tacchino, Buccelli, De Momi, Laffranchi, Mannella, Holmes, Zenzeri, De Michieli, Brichetto and Barresi.)

Edible flowers are regaining interest among both the scientific community and the general population, not only for their appealing sensorial characteristics but also from the growing evidence about their health benefits. Among edible flowers, those that contain anthocyanins are among the most consumed worldwide. However, little is known regarding the bioaccessibility and absorption of their bioactive compounds upon ingestion. The aim of this work was to explore, for the first time, the behavior of anthocyanin-rich extracts from selected edible flowers under different food processing conditions and after ingestion using simulated digestions, as well as their absorption at the intestinal level. Overall, the results showed that the monoglucoside and rutinoside anthocyanin extracts were less stable under different pH, temperature, and time conditions as well as different digestive processes in the gastrointestinal tract. There was a prominent decrease in the free anthocyanin content after the intestinal phase, which was more pronounced for the rutinoside anthocyanin extract (78.41% decrease from the oral phase). In contrast, diglucoside and rutinoside anthocyanin extracts showed the highest absorption efficiencies at the intestinal level, of approximately 5% after 4 h of experiment. Altogether, the current results emphasize the influence of anthocyanins' structural arrangement on both their chemical stability as well as their intestinal absorption. These results bring the first insights about the bioaccessibility and absorption of anthocyanins from wild pansy, cosmos, and cornflower and the potential outcomes of such alternative food sources.

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder. Diagnosis can take a long time, especially in the presence of confounding factors, and it is, to some extent, a process of exclusion. AOSD has life-threating complications ranging from asymptomatic to severe, such as macrophage activation syndrome (MAS), which is also referred to as hemophagocytic lymphohistocytosis (HLH). This condition is correlated with cytokine storm production and monocyte/macrophage overactivation and typically occurs with rash, pyrexia, pancytopenia, hepatosplenomegaly and systemic involvement. Exitus occurs in approximately 10% of cases. For the treatment of MAS-HLH, the Histiocyte Society currently suggests high-dose corticosteroids, with the possible addition of cyclosporine A, anti-interleukin (IL)-1, or IL-6 biological drugs; the inclusion of etoposide is recommended for the most severe conditions. In all cases, a multidisciplinary collaboration involving the resources and expertise of several specialists (e.g., rheumatologist, infectiologist, critical care medicine specialist) is advised. Herein, we provide a detailed description of the clinical case of a previously healthy young woman in which MAS developed as a dramatic onset manifestation of AOSD and whose diagnosis posed a real clinical challenge; the condition was finally resolved by applying the HLH-94 protocol (i.e., etoposide in combination with dexamethasone).

Emerging treatments for alcohol dependence reveal an intricate interplay of neurobiological, psychological, and circumstantial factors that contribute to Alcohol Use Disorder (AUD). The approved strategies balancing these factors involve extensive manipulations of neurotransmitter systems such as GABA, Glutamate, Dopamine, Serotonin, and Acetylcholine. Innovative developments are engaging mechanisms such as GABA reuptake inhibition and allosteric modulation. Closer scrutiny is placed on the role of Glutamate in chronic alcohol consumption, with treatments like NMDA receptor antagonists and antiglutamatergic medications showing significant promise. Complementing these neurobiological approaches is the progressive shift towards Personalized Medicine. This strategy emphasizes unique genetic, epigenetic and physiological factors, employing pharmacogenomic principles to optimize treatment response. Concurrently, psychological therapies have become an integral part of the treatment landscape, tackling the cognitive-behavioral dimension of addiction. In instances of AUD comorbidity with other psychiatric disorders, Personalized Medicine becomes pivotal, ensuring treatment and prognosis are closely defined by individual characteristics, as exemplified by Lesch Typology models. Given the high global prevalence and wide distribution of AUD, a persistent necessity exists for development and improvement of treatments. Current research efforts are steadily paving paths towards more sophisticated, effective typology-based treatments: a testament to the recognized imperative for enhanced treatment strategies. The potential encapsulated within the ongoing research suggests a promising future where the clinical relevance of current strategies is not just maintained but significantly improved to effectively counter alcohol dependence., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: We have reanalyzed the genomic data of the International Collaboration for the Genomics of HIV (ICGH), centering on HIV-1 Elite Controllers., Methods: We performed a genome-wide Association Study comparing 543 HIV Elite Controllers with 3,272 uninfected controls of European descent. Using the latest database for imputation, we analyzed 35,552 Single Nucleotide Polymorphisms (SNPs) within the Major Histocompatibility Complex ( MHC ) region., Results: Our analysis identified 2,626 SNPs significantly associated (p<5. 10-8) with elite control of HIV-1 infection, including well-established MHC signals such as the rs2395029-G allele which tags HLA-B*57:01 . A thorough investigation of SNPs in linkage disequilibrium with rs2395029 revealed an extensive haploblock spanning 1.9 megabases in the MHC region tagging HLA-B*57:01 , comprising 379 SNP alleles impacting 72 genes. This haploblock contains damaging variations in proteins like NOTCH4 and DXO and is also associated with a strong differential pattern of expression of multiple MHC genes such as HLA-B, MICB , and ZBTB12 . The study was expanded to include two cohorts of seropositive African-American individuals, where a haploblock tagging the HLA-B*57:03 allele was similarly associated with control of viral load. The mRNA expression profile of this haploblock in African Americans closely mirrored that in the European cohort., Discussion: These findings suggest that additional molecular mechanisms beyond the conventional antigen-presenting role of class I HLA molecules may contribute to the observed influence of HLA-B*57:01/B*57:03 alleles on HIV-1 elite control. Overall, this study has uncovered a large haploblock associated with HLA-B*57 alleles, providing novel insights into their massive effect on HIV-1 elite control., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Rahmouni, De Marco, Spadoni, Tison, Medina-Santos, Labib, Noirel, Tamouza, Limou, Delaneau, Fellay, Bensussan, Le Clerc, McLaren and Zagury.)

Objective: The bidirectional communication between the user and the prosthesis is an important requirement when developing prosthetic hands. Proprioceptive feedback is fundamental to perceiving prosthesis movement without the need for constant visual attention. We propose a novel solution to encode wrist rotation using a vibromotor array and Gaussian interpolation of vibration intensity. The approach generates tactile sensation that smoothly rotates around the forearm congruently with prosthetic wrist rotation. The performance of this scheme was systematically assessed for a range of parameter values (number of motors and Gaussian standard deviation)., Methods: Fifteen non-disabled subjects and one individual with congenital limb deficiency used vibrational feedback to control a virtual hand in the target-achievement control test. Performance was assessed by end-point error and efficiency as well as subjective impressions., Results: The results showed a preference for smooth feedback and a higher number of motors (8 and 6 versus 4). With 8 and 6 motors, the standard deviation, determining the sensation spread and continuity, could be modulated through a broad range of values (0.1 - 2) without a significant performance loss. The overall average error and efficiency across these feedback configurations were ∼ 10% and ∼ 30%, respectively. For low values of standard deviation (0.1-0.5), the number of motors could be reduced to 4 without a significant performance decrease., Conclusion: The study demonstrated that the developed strategy provided meaningful rotation feedback. Moreover, the results indicate that the Gaussian standard deviation could be used as an independent parameter to encode an additional feedback variable., Significance: The proposed method is a flexible and effective approach to provide proprioceptive feedback while adjusting the trade-off between sensation quality and the number of vibromotors.

In this retrospective international multicenter study, we describe the clinical characteristics and outcomes of patients with chronic lymphocytic leukemia (CLL) and related disorders (small lymphocytic lymphoma and high-count monoclonal B lymphocytosis) infected by SARS-CoV-2, including the development of post-COVID condition. Data from 1540 patients with CLL infected by SARS-CoV-2 from January 2020 to May 2022 were included in the analysis and assigned to four phases based on cases disposition and SARS-CoV-2 variants emergence. Post-COVID condition was defined according to the WHO criteria. Patients infected during the most recent phases of the pandemic, though carrying a higher comorbidity burden, were less often hospitalized, rarely needed intensive care unit admission, or died compared to patients infected during the initial phases. The 4-month overall survival (OS) improved through the phases, from 68% to 83%, p = .0015. Age, comorbidity, CLL-directed treatment, but not vaccination status, emerged as risk factors for mortality. Among survivors, 6.65% patients had a reinfection, usually milder than the initial one, and 16.5% developed post-COVID condition. The latter was characterized by fatigue, dyspnea, lasting cough, and impaired concentration. Infection severity was the only risk factor for developing post-COVID. The median time to resolution of the post-COVID condition was 4.7 months. OS in patients with CLL improved during the different phases of the pandemic, likely due to the improvement of prophylactic and therapeutic measures against SARS-CoV-2 as well as the emergence of milder variants. However, mortality remained relevant and a significant number of patients developed post-COVID conditions, warranting further investigations., (© 2023 The Authors. American Journal of Hematology published by Wiley Periodicals LLC.)

Staphylococci are among the most frequent bacteria known to cause biofilm-related infections. Pathogenic biofilms represent a global healthcare challenge due to their high tolerance to antimicrobials. In this study, water soluble polyethylene glycol (PEG)-coated gold nanospheres (28 ppm) and nanostars (15 ppm) with electrostatically adsorbed photosensitizer (PS) Toluidine Blue O (TBO) ∼4 μM were successfully synthesized and characterized as PEG-GNPs@TBO and PEG-GNSs@TBO. Both nanoconjugates and the TBO 4 μM solution showed remarkable, if similar, antimicrobial photodynamic inactivation (aPDI) effects at 638 nm, inhibiting the formation of biofilms by two Staphylococcal strains: a clinical methicillin-resistant Staphylococcus aureus (MRSA) isolate and Staphylococcus epidermidis ( S. epidermidis ) RP62A. Alternatively in biofilm eradication treatments, the aPDI effects of PEG-GNSs@TBO were more effective and yielded a 75% and 50% reduction in viable count of MRSA and S. epidermidis RP62A preformed biofilms, respectively and when compared with untreated samples. This reduction in viable count was even greater than that obtained through aPDI treatment using a 40 μM TBO solution. Confocal laser microscopy (CLSM) and scanning electron microscope (SEM) images of PEG-GNSs@TBO's aPDI treatments revealed significant changes in the integrity and morphology of biofilms, with fewer colony masses. The generation of reactive oxygen species (ROS) upon PEG-GNSs@TBO's aPDI treatment was detected by CLSM using a specific ROS fluorescent probe, demonstrating bright fluorescence red spots across the surfaces of the treated biofilms. Our findings shine a light on the potential synergism between gold nanoparticles (AuNPs) and photosensitizers in developing novel nanoplatforms to target Staphylococcal biofilm related infections., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Breakthrough infections in SARS-CoV-2 vaccinated individuals are an ideal circumstance for the simultaneous exploration of both the vaccine-induced memory reaction to the spike (S) protein and the primary response to the membrane (M) and nucleocapsid (N) proteins generated by natural infection. We monitored 15 healthcare workers who had been vaccinated with two doses of Pfizer BioNTech BNT162b2 and were then later infected with the SARS-CoV-2 B.1.617.2. (Delta) variant, analysing the antiviral humoral and cellular immune responses. Natural infection determined an immediate and sharp rise in anti-RBD antibody titres and in the frequency of both S-specific antibody secreting cells (ASCs) and memory B lymphocytes. T cells responded promptly to infection by activating and expanding already at 2-5 days. S-specific memory and emerging M- and N-specific T cells both expressed high levels of activation markers and showed effector capacity with similar kinetics but with different magnitude. The results show that natural infection with SARS-CoV-2 in vaccinated individuals induces fully functional and rapidly expanding T and B lymphocytes in concert with the emergence of novel virus-specific T cells. This swift and punctual response also covers viral variants and captures a paradigmatic case of a healthy adaptive immune reaction to infection with a mutating virus.

Background: Both thoracic drainage and video-assisted thoracic surgery (VATS) are available treatment for pleural empyema in pediatric patients., Materials and Methods: This retrospective multicenter study includes pediatric patients affected by pleural empyema treated from 2004 to 2021 at two Italian centers. Patients were divided in G1 (traditional approach) and G2 (VATS). Demographic and recovery data, laboratory tests, imaging, surgical findings, post-operative management and follow-up were analyzed., Results: 70 patients with a mean age of 4.8 years were included; 12 (17.1%) in G1 and 58 (82.9%) in G2. Median surgical time was 45 min in G1, 90 in G2 (p < 0.05). Mean duration of thoracic drainage was 7.3 days in G1, 6.2 in G2 (p > 0.05). Patients became afebrile after a mean of 6.4 days G1, 3.9 in G2 (p < 0.05). Mean duration of antibiotic therapy was 27.8 days in G1, 25 in G2 (p < 0.05). Mean duration of postoperative hospital stay was 16 days in G1, 12.1 in G2 (p < 0.05). There were 4 cases (33.3%) of postoperative complications in G1, 17 (29.3%) in G2 (p > 0.05). 2 (16.7%) patients of G1 needed a redosurgery with VATS, 1 (1.7%) in G2., Conclusions: VATS is an effective and safe procedure in treatment of Pleural Empyema in children: it is associated to reduction of chest tube drainage, duration of fever, hospital stay, time of antibiotic therapy and recurrence rate., (© 2023. The Author(s).)

Myocardial contusion is a rare and potentially fatal complication of chest trauma. There is no unique definition for this entity: some authors define myocardial contusion as a mild increase in cardiac biomarkers in the context of chest trauma, while for others the diagnosis requires evidence of pathologic findings at cardiac imaging. Consequently, the real incidence of myocardial contusion remains unknown, varying in reports between 8% and 71%. We describe a case of cardiac contusion secondary to a low-energy blunt chest trauma, manifesting as persistent ST-elevation associated with elevation of myocardial necrosis markers, with consequent myocardial stunning of the right ventricular free wall. As there is no consensus regarding the diagnostic pathway, it is essential to integrate first-level exams (ECG and laboratory findings) with cardiac magnetic resonance imaging, to define the presence of cardiac contusion and its extent, particularly if the echocardiographic data are unconclusive.

Robotic manipulators provide advantages in working environments regarding efficiency and safety, which is further increased in the case of elastic joint manipulators, whose mechanical compliance reduces the energy involved in collisions with workers. Cable-driven manipulators are elastic joint manipulators particularly suitable for industrial inspection thanks to the relocation of actuators outside hostile environments, increasing the manipulator payload-to-weight ratio. Recently, synthetic fibre cables are substituting steel cables due to their better-performing mechanical properties, but their visco-elastic behaviour must be compensated in the controller design. The key novelty of this work is using the four elements model, which includes the viscous behaviour, to design a non-linear full-state feedback controller for cable-driven manipulators. Furthermore, the mathematical proof of the closed-loop Lyapunov stability is provided., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Robotic rehabilitation has demonstrated slight positive effects compared to traditional care, but there is still a lack of targeted high-level control strategies in the current state-of-the-art for minimizing pathological motor behaviors. In this study, we analyzed upper-limb motion capture data from healthy subjects performing a pick-and-place task to identify task-specific variability in postural patterns. The results revealed consistent behaviors among subjects, presenting an opportunity to develop a novel extraction method for variable volume references based solely on observations from healthy individuals. These human-centered references were tested on a simulated 4 degrees-of-freedom upper-limb exoskeleton, showing its compliant adaptation to the path considering the variance in healthy subjects' motor behavior.

Despite progressive developments over the last decades, current upper limb prostheses still lack a suitable control able to fully restore the functionalities of the lost arm. Traditional control approaches for prostheses fail when simultaneously actuating multiple Degrees of Freedom (DoFs), thus limiting their usability in daily-life scenarios. Machine learning, on the one hand, offers a solution to this issue through a promising approach for decoding user intentions but fails when input signals change. Incremental learning, on the other hand, reduces sources of error by quickly updating the model on new data rather than training the control model from scratch. In this study, we present an initial evaluation of a position and a velocity control strategy for simultaneous and proportional control over 3-DoFs based on incremental learning. The proposed controls are tested using a virtual Hannes prosthesis on two healthy participants. The performances are evaluated over eight sessions by performing the Target Achievement Control test and administering SUS and NASA-TLX questionnaires. Overall, this preliminary study demonstrates that both control strategies are promising approaches for prosthetic control, offering the potential to improve the usability of prostheses for individuals with limb loss. Further research extended to a wider population of both healthy subjects and amputees will be essential to thoroughly assess these control paradigms.

The complexity of the human upper limb makes replicating it in a prosthetic device a significant challenge. With advancements in mechatronic developments involving the addition of a large number of degrees of freedom, novel control strategies are required. To accommodate this need, this study aims at developing an IMU-based control for the HannesARM upper-limb prosthetic device, as a proof-of-concept for new control strategies integrating data-fusion approaches. The natural human control of the upper-limb is based on different inputs that allow adaptive control. To mimic this in prostheses, the implementation of IMUs provides kinematic information of both the stump and the prosthesis to enrich the EMG control. The principle of operation is to decode upper limb movements by using a custom-made system and to replicate them in prosthetic arms improving the control algorithms. To evaluate the system's effectiveness, the custom algorithm's motion extraction was compared to a motion capture system using fifteen able-bodied subjects. The results showed that this system scored 0.16 ± 0.04 and 0.81 ± 0.12 in Root Mean Squared Error and Cross-Correlation compared to the motion capture system. Experimental results demonstrate how this work can extract valuable kinematic information necessary for new and improved control strategies, such as intention detection or pattern recognition, to allow users to perform a broader range of tasks and enhancing in turn their quality of life.

When it comes to robotic-mediated rehabilitation it is mandatory to design a system that guarantees a safe and compliant human-machine interaction. Dealing with rehabilitative upper limb exoskeletons, Series Elastic Actuators offer a potential solution for this purpose. This work proposes four different solutions for SEAs' spring design. After an analysis on the mechanical requirements, four different solutions are explored and presented. The performances of the proposed highly integrated SEAs are compared. An initial static characterization provided insights on the linearity and repeatability of each spring torque-angle performances. The dynamics of the springs and their frequency responses are then analysed to show how it is possible to exploit our system for human-robot interaction applications.

The clinical usage of powered exoskeletons for the rehabilitation of patients affected by lower limb disorders has been constantly growing in the last decade. This paper presents a versatile and reliable gait pattern generator for these devices able to accommodate several gait requirements, i.e., step length, clearance, and time, and to suit a wide range of persons. In the proposed method, the human gait phases have been modeled with a set of trajectories as Bèzier curves, enabling a robotic lower-limb exoskeleton to walk in a continuous way, similarly to the physiological gait cycle. The kinematic, kinetic, and spatial requirements for each gait phase are translated into the control points of the Bèzier curves that define the trajectory for that phase. The outcome of this study has been tested on real scenarios with a group of healthy subjects wearing the TWIN lower-limb exoskeleton. They were asked to walk at different speeds, generally defined as slow, medium, and fast. The results are shown in terms of joint positions, velocities, and body-mass-normalized torques. The maximum hip and knee joint torque was observed in the support phase. While, at higher speeds the maximum hip torque was provided in the swing phase due to the mechanical properties and limits of the device. In terms of speed, all the subjects reached 0.44 m/s, which is the minimum required community ambulation.

Recent human-centred design studies suggest that acoustic noise could affect the physical use and psychological acceptance of a biomedical device. These aspects are especially relevant in the prosthetic field, in which device loudness is often related to rejection. The aim of the study is to inquire on the possibility to reduce the acoustic noise emitted by a robotic leg prosthesis by improving its casing. First, acoustic noise emissions are characterized experimentally using an anechoic chamber, both for the whole prosthesis, and for its actuator (i.e., noise source) in isolation. The characterizations show that the whole prosthesis including its casing amplify the actuator noise, and that noise emissions are concentrated within a certain frequency range. Based on these findings, the prosthesis casing has been redesigned to include a panel of Helmholtz resonator-based acoustic metamaterials as proof of concept, which attenuate respective noise emissions. Experimental validations show that the use of such metamaterials in the prosthesis casing can significantly reduce noise emissions without compromising on prosthesis size and weight.