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Alessandro Introna, Eustachio D’Errico, Boris Modugno, Antonio Scarafino, Angela Fraddosio, Eugenio Distaso, Irene Tempesta, Antonella Mastronardi, Isabella Laura Simone Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro,” Bari, Italy Objective: Riluzole is the first drug approved to treat amyotrophic lateral sclerosis (ALS). Recently, an oral suspension (OS) of riluzole was made available. Thus, the aim of our study was to evaluate the adherence to 2 formulations of riluzole in patients with ALS.Patients and methods: We enrolled 45 consecutive patients with ALS. At disease diagnosis, riluzole was prescribed in 2 different formulations depending on the severity of dysphagia (27/45 patients received tablets and 18/45 patients received OS). Side effects (SEs) and treatment adherence were investigated using a clinical questionnaire including the ©Morisky 8-item Medication Adherence Questionnaire.Results: Gastroenteric complaints were the most frequent SEs (58% in the tablet group and 48% in the OS group), followed by those at the nervous system (29% and 40%, respectively). No serious SEs related to treatment were reported. The rate of adherence to riluzole was independent of the formulation of the drug and consistent with other medications assumed for comorbidities (p=0.004). In the tablet group, low adherence was caused by SEs in 55.6% and by dysphagia in 44.4% of patients. In the OS group, SEs caused low adherence in 75% of patients. Independently of the drug formulation, patients with high or medium adherence to riluzole had a higher progression rate (p=0.002 and p=0.009, respectively) and a shorter time to generalization (TTG; p=0.01), compared to those with low adherence.Conclusion: Gastroenteric symptoms were the most frequent SE related to tablet as well as OS. The rate of adherence was independent of the formulation of riluzole and the number of medications assumed for comorbidities, and it was consistent with the severity of the disease. The low adherence was caused by dysphagia and SEs in the tablet group, whereas it was caused prevalently by SEs in the OS group. Keywords: adherence, riluzole, oral suspension, tablet, side effects

Introduction The aim of this study was to analyze the results of microsurgery removal of acoustic neuromas (AN) using new technologies: flexible hand-held laser fiber, Sonopet Ultrasound Aspirator, Facial Nerve “detector” monopolar stimulation (for localize position and course of facial nerve), BAER’s with level specific (LS) CE-Chirp stimulus for hearing preservation, endoscope for IAC final check, and injectable bone substitute for closure. We report a retrospective nonrandomized clinical study on 300 cases consecutively operated on. Material and Methods From July, 2010 to December, 2023, 350 consecutive patients suffering from AN have been operated on with microneurosurgical technique by key-hole retrosigmoid approach. In majority of cases tumor resection was performed with the aid of a handheld flexible laser fiber. In the same period, Sonopet Ultrasound aspirator was used for tumor debulking and/or opening of the internal auditory meatus and canal. From May 2015, hearing preservation by means LS CE-Chirp BAER was attempted in patients with preoperative socially useful hearing (AAO-HNS class A and B). In addition, we check the removal of tumor inside the internal auditory canal (IAC) by using the flexible and/or rigid endoscope, for completing tumor removal near the fundus. Results Overall time from incision to skin suture changed in relation to size of tumor (from 165 to 575 minutes) and was not affected by the use of hand-held laser. Facial nerve function was clinically assessed with the House-Brackmann (HB) scale preoperatively, in the early postoperative period (after 1 week), and at 6-month follow-up. In 3 cases a preoperative facial nerve palsy was observed (HB III and HB IV, respectively). In the remaining cases, 6 months after surgery facial nerve preservation rate (HB I) was 92%, Hearing preservation rate (AAO-HNS A and B, pre- and postoperatively) was 52% in eligible cases. Total and “nearly total” removal of tumor was possible in about 80% of cases. Dura closure was performed with underlaying autologous pericranium. Injectable bone substitute in the gaps after bone flap repositioning minimized postoperative CSF leakage and improved the aesthetic result. Conclusions The use of new technologies (handheld flexible laser fibers, Sonopet Ultrasound Aspirator, fluoreceine, Nimbus facial nerve continuous monitoring, LS CE-Chirp BAER, endoscope for IAC final check) in AN microsurgery seems to be safe and efficacious and facilitates tumor resection, especially in ‘‘difficult’’ conditions (e.g., large size, highly vascularized, or hard tumors). The good functional outcome following conventional microsurgery seems to be further improved and the extent of tumor removal could be increased with the proper use of the new technologies available in the neurosurgical armamentarium.

Thanks to their intrinsic flexibility, energy efficiency and high portability, soft piezoelectric thin films represent the most effective technological approach for wearable devices to monitor health conditions. In order to improve effectiveness and applicability, more and more innovative and high-performing soft piezoelectric materials are being developed and benchmarked through their piezoelectric d33 coefficient. However, most existing methods to measure the d33 were developed for ceramic or bulk materials and cannot be applied to soft materials because high force/pressure can deform and damage the material structure. This work introduces a simple, effective, and fast method to accurately measure the d33 of soft and thin piezoelectric films by applying weak sinusoidal forces to avoid any damage to the sample, and simultaneously measuring the charges produced by the direct piezoelectric effect. The approach is versatile as it can be used for different types of materials and sizes of the active area. This method represents an effective solution to speed up the process of material optimization, paving the way for the rapid development of novel wearable piezoelectric devices.

Abstract Purpose The main research aim was to inspect whether pre-operative body shape concerns and discomfort as Body Shape Questionnaire (BSQ) scores moderate post-operative weight loss trajectory in bariatric patients. Methods Two studies were conducted. Study 1 analyzed cross-sectional data and verified the structural validity of the 34-item BSQ questionnaire on a sample of 327 candidates for bariatric surgery. Study 2 examined longitudinal data, with objective Body Mass Index (BMI) recorded every 6 months, from surgery intervention on, with 5 measurement occasions, from 111 patients who initially completed BSQ as bariatric surgery candidates and then underwent periodic medical post-operative follow-ups, over 2 years. Results In Study 1, confirmatory factor analysis of a single-dimension model yielded acceptable fit indices and high internal consistency levels. Study 2 showed that post-operative excess BMI reduction trend was not linear and pre-operative BSQ scores moderated it, with a higher risk of weight regain in patients who initially were less concerned with their body shape. Conclusions The present findings support the structural validity of the BSQ questionnaire in bariatric candidates and call attention on the role of pre-operative body shape concerns on post-operative weight loss trajectories over 2 years, in accordance with a pathoplasty model. They suggest the need for systematic attention on perceived body image and psychological paths aimed to help bariatric patients regain positive attitudes towards their own body. Level of evidence III, well-designed cohort

ABSTRACTIndividuals with Inflammatory Bowel Disease (IBD) are more susceptible to experiencing severe complications of COVID-19 if infected. Nevertheless, sub-optimal immunization rates have been reported among these patients. Our study aims to assess COVID-19 VH among a global population of patients with IBD and to investigate the role of healthcare professionals, particularly gastroenterologists, in promoting immunization. Twenty-six studies were systematically selected from scientific articles in the MEDLINE/PubMed, WoK, and Scopus databases from January 1, 2020, to September 15, 2023. The pooled prevalence of COVID-19 VH was 27.2% (95%CI = 20.6–34.2%). A significant relationship was evidenced between COVID-19 vaccine compliance and receiving advice from gastroenterologists or healthcare providers (OR = 2.77; 95%CI = 1.79–4.30). By leveraging their knowledge of IBD, familiarity with patient histories, and trusted patient-doctor relationships, gastroenterologists are pivotal in promoting vaccination. This patient-centered care is crucial in increasing vaccine acceptance among individuals with IBD, contributing to better public health outcomes.

Arterial pulse waves contain a wealth of parameters indicative of cardiovascular disease. As such, monitoring them continuously and unobtrusively can provide health professionals with a steady stream of cardiovascular health indices, allowing for the development of efficient, individualized treatments and early cardiovascular disease diagnosis solutions. Blood pulsations in superficial arteries cause skin surface deformations, typically undetectable to the human eye; therefore, Microelectromechanical systems (MEMS) can be used to measure these deformations and thus create unobtrusive pulse wave monitoring devices. Miniaturized ultrathin and flexible Aluminium Nitride (AlN) piezoelectric MEMS are highly sensitive to minute mechanical deformations, making them suitable for detecting the skin deformations caused by cardiac events and consequently providing multiple biomarkers useful for monitoring cardiovascular health and assessing cardiovascular disease risk. Conventional wearable continuous pulse wave monitoring solutions are typically large and based on technologies limiting their versatility. Therefore, we propose the adoption of $29.5 ~\mu \text{m}$ -thick biocompatible, skin-conforming devices on piezoelectric AlN to create versatile, multipurpose arterial pulse wave monitoring devices. In our initial trials, the devices are placed over arteries along the wrist (radial artery), neck (carotid artery), and suprasternal notch (on the chest wall and close to the ascending aorta). We also leverage the mechano-acoustic properties of the device to detect heart muscle vibrations corresponding to heart sounds S1 and S2 from the suprasternal notch measurement site. Finally, we characterize the piezoelectric device outputs observed with the cardiac cycle events using synchronized electrocardiogram (ECG) reference signals and provide information on heart rate, breathing rate, and heart sounds. The extracted parameters strongly agree with reference values as illustrated by minimum Pearson correlation coefficients (r) of 0.81 for pulse rate and 0.95 for breathing rate.

This paper reports on a new model for faculty hiring workshops involving three components. The first part (Part 1) of the work is an asynchronous, self-guided course that includes video reflections and commentaries from some of our own colleagues about inclusive excellence, hiring legalities, and departmental culture. The second part (Part 2) is a virtual 90-minute interactive session with breakout room discussions overseen by a facilitator. The last part (Part 3) is a monthly offering of optional one-hour discussion sessions to answer additional questions, support university-wide conversations and allow participants to probe more deeply into diversity hiring opportunities and challenges. To evaluate the workshops, we administered a survey immediately following Part 2 and later conducted interviews with participants at the conclusion of their faculty search. Survey results show that nearly all elements of the workshops were well-received and participants reported feeling confident in their understanding of inclusive excellence, legal issues associated with hiring, and the potential for unintended bias in reviewing candidate files. The paper also provides an analysis of the interview and survey data as well as some conclusions about the impact of these new efforts on inclusive hiring.

We describe our experiences with the first offering of a new program, BMEntored, for supporting first-year doctoral students in Biomedical Engineering (BME) during their first semester. The goal of BMEntored was to enhance the first-semester experience of first-year doctoral students in BME with an emphasis on guiding students in selecting a research supervisor and promoting cross-cohort, cross-lab social connections.

The European Roller Coracias garrulus has suffered greatly from breeding habitat loss due to the renovation of old farmhouses and rural buildings and changing agricultural practices that took place extensively across Europe in the last decades. As a consequence, this species experienced a significant decline, and local extinctions of breeding populations were recorded in several European countries. We investigated nest sites and nesting area selection by the Italian Roller population during the breeding period (May–August) between 2016 and 2018. We collected 711 points from field surveys and used four types of point pattern analysis to detect space-time patterns of nest site and nesting area selection. We found that: (a) the spatial distribution of selected (i.e., occupied) nest sites was significantly nonrandom (p < 0.01) for all years and months; (b) only 2.6% of the selected nest sites was located within parks or reserves; (c) there were significant (p < 0.01) latitudinal, longitudinal, and altitudinal shifts of selected nest sites between May and August; (d) the geographical barycentres of selected nest sites shifted northward by about 80 km per month from May (southernmost barycentre) to August (northernmost barycentre); (e) four main nesting areas (7886 km2 in total) occurred in central and southern Italy, whose utilization by the European Rollers differed between months but not between years; (f) the detected nesting areas corresponded mainly to non-irrigated arable lands (41.22% of their extent) and natural grasslands (12.80%). Our results are useful to support conservation strategies for the breeding sites of this farmland species, which is not a regular visitor to protected areas in Italy.

Background: Vestibular schwannoma (VS), also known as acoustic neuroma, is a benign, well-encapsulated, and slow-growing tumor that originates from Schwann cells, which form the myelin sheath around the vestibulocochlear nerve (VIII cranial nerve). The surgical treatment of this condition presents a challenging task for surgeons, as the tumor’s location and size make it difficult to remove without causing damage to the surrounding structures. In recent years, fluorescein sodium (FS) has been proposed as a tool to enhance surgical outcomes in VS surgery. This essay will provide an analytical comparison of the use of FS in VS surgery, evaluating its benefits and limitations and comparing surgical outcomes with and without FS-assisted surgery. Methods: In a retrospective study conducted at San Filippo Neri Hospital, we examined VS cases that were operated on between January 2017 and December 2023. The patients were divided into two groups: group A, which consisted of patients who underwent surgery without the use of FS until January 2020 (102 cases), and group B, which included patients who underwent surgery with FS after January 2020 (55 cases). All operations were performed using the retrosigmoid approach, and tumor size was classified according to the Koos, et al. classification system. The extent of surgical removal was evaluated using both the intraoperative surgeon’s opinion and postoperative MRI imaging. Preoperatively and postoperatively, facial nerve function and hearing were assessed. In group B, FS was used to assist the surgical procedures, which were performed using a surgical microscope equipped with an integrated fluorescein filter. Postoperative clinical and MRI controls were performed at six months and annually, with no patients lost to follow-up. Results: This study investigated the impact of intraoperative fluorescein exposure on tumor resection and clinical outcomes in patients with VS. The study found a statistically significant difference in the tumor resection rates between patients who received fluorescein intraoperatively (p = 0.037). Further analyses using the Koos classification system revealed a significant effect of fluorescein exposure, particularly in the Koos 3 subgroup (p = 0.001). Notably, no significant differences were observed in hearing loss or facial nerve function between the two groups. A Spearman correlation analysis revealed a positive correlation between tumor size and Koos, age, and size, but no significant correlation was found between facial nerve function tests. Conclusions: FS-assisted surgery for VS may potentially enhance tumor resection, allowing for more comprehensive tumor removal.

Introduction: Intraoperative Neurophysiological Monitoring (IOM) is widely used in neurosurgery but specific guidelines are lacking. Therefore, we can assume differences in IOM application between Neurosurgical centers. Research question: The section of Functional Neurosurgery of the Italian Society of Neurosurgery realized a survey aiming to obtain general data on the current practice of IOM in Italy. Materials and methods: A 22-item questionnaire was designed focusing on: volume procedures, indications, awake surgery, experience, organization and equipe. The questionnaire has been sent to Italian Neurosurgery centers. Results: A total of 54 centers completed the survey. The annual volume of surgeries range from 300 to 2000, and IOM is used in 10–20% of the procedures. In 46% of the cases is a neurologist or a neurophysiologist who performs IOM. For supra-tentorial pathology, almost all perform MEPs (94%) SSEPs (89%), direct cortical stimulation (85%). All centers perform IOM in spinal surgery and 95% in posterior fossa surgery. Among the 50% that perform peripheral nerve surgery, all use IOM. Awake surgery is performed by 70% of centers. The neurosurgeon is the only responsible for IOM in 35% of centers. In 83% of cases IOM implementation is adequate to the request. Discussion and conclusions: The Italian Neurosurgical centers perform IOM with high level of specialization, but differences exist in organization, techniques, and expertise. Our survey provides a snapshot of the state of the art in Italy and it could be a starting point to implement a consensus on the practice of IOM.

Introduction: Surgical strategy for meningioma resection in the elderly is controversial: diverse studies in the literature have pointed at the age as a negative prognostic factor in terms of postoperative results. Research question: The aim of this study is to compare surgical outcomes after resection of posterior fossa meningiomas in

Extraintestinal manifestations occur rather frequently in ulcerative colitis (UC) and Crohn’s disease patients and are usually related to an exacerbation of the underlying intestinal bowel disease but sometimes may run a course independent of the inflammatory bowel diseases (IBD). About one-third of patients with IBD develop extraintestinal manifestations, such as pyoderma gangrenosum (PG). PG is an uncommon inflammatory skin disorder of unknown pathogenesis. There are no specific serological or histological markers, and diagnosis is predominantly clinical. Topical and systemic therapies are both vital aspects of treatment and immune modulators have been used with increasing success in recent years, although immunosuppressive drugs raise some concerns due to an increased risk of serious and opportunistic infections and cancer, particularly in elderly and comorbid patients, underlining the unmet need for safer alternative therapies. Thus, in this case report, we highlighted an adsorptive granulocyte/monocyte apheresis (GMA) as a new therapeutic possibility in IBD patients with extraintestinal manifestations. We report a case of a 60-year woman with a history of UC with a Mayo grade 3 score which was associated with a PG. Given that the patients maintained clinical remission with vedolizumab, we preferred not to perform a combined treatment with other antitumor necrosis factor-alpha or ciclosporin, thus avoiding an increased risk of serious infections in the patient. Therefore, we performed the extracorporeal leukocyte apheresis. The patient progressed favorably, with progressive improvement of skin and bowel disease. Therefore, adsorptive GMA has a very favorable safety profile and has been confirmed in numerous studies. In this study, we underlined that an intensive regimen of GMA paves the way to an ideal option for patients with severe and refractory PG complicated with UC.

Abstract The necessity to continuously and seamlessly monitor human health is calling for compliant, comfortable, and safe wearables. The employment of piezoelectric biopolymers in form of thin film perfectly matches with these needs due to their inherent flexibility, sensitivity, and biocompatibility. Among them, chitosan is a low cost, highly sustainable, and biocompatible material with a great potential for applications in compliant wearables. However, chitosan and biopolymers in general show relatively low piezoelectric coefficients and processing difficulties. Here, it is shown a facile approach to increase more than twice the piezoelectric coefficient of thin chitosan film and to process this promising biomaterial for the fabrication of the first set of thin chitosan film‐based ultrasound transducers. This work leverages the exploitation of environmental‐friendly biopolymers in the development of compliant wearable transducers and thus represents a step forward in the development of completely biodegradable, transparent, thin, and flexible piezoelectric macro‐ and microtransducers.

In this paper we describe how to swap two 2 × 2 blocks in a real Schur form and a generalized real Schur form. We pay special attention to the numerical stability of the method. We also illustrate the stability of our approach by a series of numerical tests.

In this paper we describe how to swap two 2 × 2 blocks in a real Schur form and a generalized real Schur form. We pay special attention to the numerical stability of the method. We also illustrate the stability of our approach by a series of numerical tests.