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The effect of mM concentrations of K3[Fe(CN)6], Fe(III), Mo(VI), KSCN and KMnO4 on the generation of BiH3 by the reaction of 0.2–10 μg ml−1 Bi(III) with 0.2 M tetrahydroborate(III) at 1 M acidity (HCl or HNO3) was investigated. Chemical vapour generation (CVG) of BiH3 was investigated by atomic absorption spectrometry using a continuous flow reaction system (CF–CVG–AAS) and different mixing sequences and reagent reaction times. Gas chromatography–mass spectrometry (GC–MS) was employed in batch generation experiments with NaBD4. In the absence of additives, the formation of Bi0 at high concentrations of Bi(III) caused rollover of calibration curves and limited the linear range to less than 1 μg ml−1 Bi(III). In the presence of additives, the formation of Bi0 was not observed and the linear range was increased to 5 μg ml−1 of Bi(III) while rollover was completely removed. GC–MS experiments indicated that the presence of additives did not affect the direct transfer of H from boron to bismuth. Experiments with CF–CVG–AAS and different mixing sequences and reagent reaction times suggest that additives act by preventing the formation of Bi0 through the formation of reaction intermediates which evolve towards the formation of BiH3 at elevated Bi(III)/NaBH4 ratios. [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

Background: Although true bifurcation lesions are associated with a high risk of procedural complications, the differential prognostic implications of percutaneous coronary intervention for true bifurcations according to lesion location are unclear. This study aimed to identify whether clinical outcomes of true bifurcation lesions differed between left main coronary artery (LM) and non-LM bifurcations and to determine the optimal treatment strategy for subtypes of bifurcation lesions in the current-generation drug-eluting stent era., Methods: The ULTRA-BIFURCAT (Combined Insights From the Unified COBIS III, RAIN, and ULTRA Registries) was created by merging 3 bifurcation-dedicated registries from Korea and Italy. For this, 6548 patients treated with bifurcation lesions were stratified by lesion location and subtype. The primary end point was major adverse cardiac events (MACEs; composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis) at 800 days., Results: In patients with an LM bifurcation, those with a true bifurcation had a significantly higher risk of a MACE than those with a nontrue bifurcation (20.2% versus 13.4%, adjusted hazard ratio [HR], 1.44 [95% CI, 1.11-1.86]; P =0.006). Conversely, there was no significant difference in the risk of a MACE according to true versus nontrue bifurcation in patients with non-LM bifurcation lesions (9.0% versus 8.8%; adjusted HR, 1.02 [95% CI, 0.82-1.27]; P =0.849). For LM true bifurcations, MACE rates were comparable between 1-stent and 2-stent strategies, whereas for LM nontrue bifurcations, the 2-stent strategy was associated with a significantly higher risk of MACEs than the 1-stent strategy. No significant differences in the risk of MACEs were observed in non-LM bifurcation lesions according to lesion subtype or treatment strategy., Conclusions: Clinical outcomes were worse for LM true bifurcation lesions than non-LM true bifurcation lesions. A provisional 1-stent strategy should be the preferred approach for treating LM nontrue bifurcation lesions., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03068494, NCT03544294, and NCT05205148.

Objective: Learning environments affect the well-being of surgical faculty and trainees. Psychological safety (PS) has been linked with learning behaviors and aspects of well-being within medicine; however, given the unique challenges inherent to the surgical learning environment, there is a need to more closely examine these concepts for surgical faculty and trainees. The objective of this study is to examine the relationships between learning environment and PS, as well as PS and well-being with surgery., Design: Multi-institutional, cross-sectional survey study. The electronic survey included assessments of PS, professional fulfillment, and the learning environment. Exploratory and confirmatory factor analyses were performed to identify learning environment constructs. Index construct scores were generated. Multivariable multivariate regression analyses were used to examine the relationships between constructs in the learning environment and PS as well as PS and well-being., Setting & Participants: The electronic survey was distributed to surgical faculty, fellows, and residents at 8 institutions across the United States., Results: For faculty, higher levels of professional interactions and rapport/climate within the learning environment were significantly associated with higher levels of PS (β = 0.39, p < 0.01; β = 0.34, p < 0.01, respectively). Higher levels of PS were significantly associated with lower levels of interpersonal disengagement (β = -0.16, p = 0.04). For trainees, higher levels of disrespect/retaliation and personal performance worry within the learning environment were significantly associated with lower levels of PS (β = -0.45, p < 0.001; β = -0.11, p = 0.048, respectively). Higher levels of PS were significantly associated with higher levels of professional fulfillment (β = 0.24, p = 0.01) and lower levels of work exhaustion (β = -0.27, p < 0.01) and interpersonal disengagement (β = -0.36, p < 0.001)., Conclusions: This study identified factors within the learning environment that were positively and negatively associated with psychological safety for surgical faculty and trainees. In addition, it identified a direct relationship between psychological safety and elements of well-being and burnout., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Endovascular treatment (EVT) is recommended for acute ischemic stroke due to large-vessel occlusion (LVO) and an ASPECTs ≥ 6. Recent randomized controlled trials (RCTs) have become available on effect of EVT in patients with LVO-related large core infarct stroke (ASPECTS 0-5). We conducted a systematic review and meta-analysis of trials on patients with large core infarct treated with thrombectomy compared to best medical therapy (BMT)., Methods: The study followed PRISMA guidelines. Primary endpoint was functional independence at 90 days (modified Rankin Scale mRS < 3). Secondary endpoints were 3-month moderate disability (mRS < 4), excellent outcome (mRS < 2) and change in mRS (shift analysis). Safety outcomes were: symptomatic intracranial hemorrhage (sICH) and 3-month mortality., Results: Seven RCTs were included with a total of 1964 patients. Functional independence was significantly more frequent in EVT vs BMT group (19.4% vs 8%; OR = 2.72, 95%CI = 2.06-3.61, p heterogeneity  = 0.08; I2: 47%). Moderate outcome was also more prevalent in EVT group (OR = 2.00; 95%CI = 1.61 - 2.48, p heterogeneity  = 0.17; I2: 46%) as well as excellent outcome (OR: 1.54, 95%CI = 1.07 - 2.22, p heterogeneity  = 0.13; I2: 40%). Shift analysis was also significant with OR 1.59 (CI = 1.33-1.82 and p < 0.001). Finally sICH, that occurred in 68 patients, was more frequent in EVT (OR = 1.63, 95%CI = 0.99 - 2.69, p heterogeneity  = 0.68; I2: 0%) while 3 m mortality was reduced in EVT (31% vs 37,1%, OR 0.76 CI = 0.62-0.92)., Conclusions: This updated pooled data show that, in LVO-stroke patients with a large core infarct, EVT plus BMT (as compared to BMT alone) increases significantly the chances of achieving a good functional outcome at 90 days and reduces the 3- month mortality despite a marginal increase in acute sICH., Competing Interests: Declarations. Ethical approval: Since we conducted a pooled analysis of aggregate data (not individual) from published randomized controlled trials, patient informed consent for this study was not collected. Meta-analysis followed PRISMA guideline and study protocol was deposited with OSF ( https://doi.org/10.17605/OSF.IO/CPW97 ). Competing interests: LP received consultancy fees from Amicus and PIAM., (© 2024. Fondazione Società Italiana di Neurologia.)

Introduction: The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score is the most important prognostic score to stratify patients with metastatic renal cell carcinoma (mRCC), helping to guide treatment choice in first line. We hypothesized that IMDC change may also exert a prognostic role in subsequent lines of mRCC therapy., Methods: Meet-URO 15 is a multicenter Italian study of patients with mRCC receiving nivolumab as a second or subsequent line of therapy. This posthoc analysis aimed to evaluate the overall survival (OS) and progression-free survival (PFS) from nivolumab start as primary endpoints, overall response rate (ORR) and disease-control rate (DCR) as secondary endpoints, according to the change in the IMDC category from the first-line setting (baseline) to nivolumab start. Patients with available prognostic IMDC category information at baseline and before nivolumab were included., Results: 492 patients were included in the analysis. At baseline, 165 (33.5%), 287 (58.3%), and 40 patients (8.2%) had favorable, intermediate, and poor IMDC categories, respectively. Before nivolumab, 364 patients (73.9%) remained in the same prognostic category as at baseline, 27 (5.5%) improved, and 101 (20.5%) deteriorated. Significantly longer mPFS (P = .01) and mOS (P < .01) were reached by patients with a stable favorable group compared to those worsening to intermediate/poor. A longer mOS was also achieved from intermediate/poor patients who improved their IMDC category before nivolumab compared to those remaining stable/worsening (P < .01 and P = .04, respectively). Maintaining IMDC category stability from baseline to nivolumab determined a more consistent DCR in favorable patients (P = .03). Overall, patients who improved their IMDC risk score reached better survival outcomes than those who remained stable/deteriorated., Conclusions: In our sub-analysis, the shift in the IMDC risk category appears to be a helpful prognostic tool for assessing the outcomes of patients with mRCC treated with ≥2nd line nivolumab., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Immunotherapy represents an emergent and heterogeneous group of anticancer treatments harnessing the human immune-surveillance system, including immune-checkpoint inhibitor monoclonal antibodies (mAbs), Chimeric Antigen Receptor T Cells (CAR-T) therapy, cancer vaccines and lymphocyte activation gene-3 (LAG-3) therapy. While remarkably effective against several malignancies, these therapies, often in combination with other cancer treatments, have showed unforeseen toxicity, including cardiovascular complications. The occurrence of immuno-mediated adverse (irAEs) events has been progressively reported in the last 10 years. These irAEs present an extended range of severity, from self-limiting to life-threatening conditions. Although recent guidelines in CardioOncology have provided important evidence in managing cancer treatments, they often encompass general approaches. However, a specific focus is required due to the particular etiology, unique risk factors, and associated side effects of immunotherapy. This review aims to deepen the understanding of the prevalence and nature of cardiovascular issues in patients undergoing immunotherapy, offering insights into strategies for risk stratification and management., Competing Interests: Declarations. Conflict of interest: The authors have nothing to declare., (© 2024. The Author(s).)

Objectives: This review, conducted by a panel of experts assembled by the International Society for Infectious Diseases, seeks to consolidate the latest recommendations for preventing catheter-associated urinary tract infections (CAUTIs). It offers insights into CAUTI rates and the associated extended hospital stays, costs, mortality, and risk factors across high- and low- to middle-income countries., Methods: An in-depth review of current recommendations and evidence-based strategies for CAUTI prevention was undertaken. To develop practical preventive measures, the expert panel examined data on CAUTI incidence, related health care impacts, and risk factors across various economic contexts., Results: The review highlights notable differences in CAUTI rates, health care costs, extended hospital stays, and mortality between high- and low- to middle-income countries. It emphasizes evidence-based strategies for CAUTI prevention, demonstrating their effectiveness across diverse health care environments., Conclusions: This position paper offers recommendations and insights intended to assist health care professionals in effectively preventing CAUTIs. Implementing evidence-based preventive strategies has the potential to lower CAUTI rates, reduce related costs, and enhance patient outcomes in high- and low- to middle-income countries., Competing Interests: Declarations of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Voxel-Based Morphometry (VBM) and Source-Based Morphometry (SBM) are widely used techniques for analyzing structural Magnetic Resonance Imaging (MRI) data. VBM compares differences in gray and white matter volume, density, or concentration voxel-wise, while SBM identifies patterns of structural variation using independent component analysis. This study aims to compare the performance of VBM and SBM in detecting differences in brain structure across Parkinson's patients and healthy controls, grouped based on their chronotype., Methods: Thirty-three subjects were divided into three groups: a Parkinson's Group (PG), an Early Chronotype Group (EG), and a Late Chronotype Group (LG). Circadian preference, daytime sleepiness, and sleep quality were assessed, and MRI data were acquired using a 3 T scanner. SBM and VBM were used to test differences and similarities in MRI scans and chronotypes., Results: Results from SBM revealed significant clusters surviving the analysis, with the 1st component for the PG-EG and the 4th component for the PG-LG analysis showing the lowest p-value (< 0.05). Denser gray matter volume (GMV) or white matter volume (WMV) was observed in the Middle Frontal Gyrus and the Lentiform Nucleus through Talairach Coordinates analysis., Conclusions: This study emphasizes the importance of selecting appropriate methods for analyzing structural MRI data. VBM is effective in identifying local differences in brain structure, while SBM provides a more comprehensive view of structural variation, detecting patterns not captured by VBM. Future studies should consider utilizing both VBM and SBM to fully characterize brain structural differences in diverse clinical and cognitive populations. Further studies, with larger sample sizes and more balanced genders, genomic analysis, disease severity and duration, as well as medications' effect, are warranted.

Petrified ear is a rare clinical entity characterized by the progressive hardening of normal flexible auricular cartilage, leading to partial or complete auricular stiffness. In many cases, it provides a valuable clinical clue that allows the clinician to detect endocrinopathies (particularly Addison's disease) in a patient who has not received a diagnosis. We present the first documented case of petrified ears, which resulted in the diagnosis of both secondary hypoadrenalism and growth hormone deficiency (GHD). Additionally, we review the relevant literature. Petrified ears syndrome is probably an underreported clinical manifestation of other systemic disorders. It may, at times, serve as a useful and simple clinical clue to suspect underlying endocrinopathies even in the absence of typical features.

Purpose: The purpose of this study was to determine how well the active range of motion and the forces required to achieve motions are maintained following cadaveric implantation of the ball-and-socket style total wrist arthroplasty (TWA)., Methods: An active wrist motion simulator was used to produce flexion, extension, radioulnar deviation, dart-thrower's motion, and circumduction in 14 fresh-frozen cadaveric wrists before and after TWA. Identical tendon displacements were applied to five major wrist flexors and extensors to control motion presurgery and postsurgery. Motion trials were recorded using biplanar video fluoroscopy and digitally reconstructed with 6 degrees of freedom using x-ray reconstruction of moving morphology. Wrist angles were subsequently measured with respect to an anatomically based radial coordinate system. Forces applied to the five actuated tendons were recorded by the simulator throughout all motion trials. Maximum wrist angles, dart-thrower's motion plane orientation, circumduction ellipse parameters, and peak tendon forces in pre-TWA and post-TWA conditions were compared., Results: There were no significant differences in maximal flexion, extension, radial, or ulnar deviation angles when comparing preoperative anatomic wrists with the same wrist following implantation of the TWA. Orientation of dart-thrower's motion planes and circumduction ellipses with respect to the sagittal plane increased after cadaveric surgery, whereas the area of the circumduction ellipses remained similar. Tendon forces were similar in anatomic and TWA wrists apart from flexor forces, which decreased in flexion in TWA wrists., Conclusions: In our cadaveric setup, the TWA was able to recreate functional motion patterns without significantly increased tendon forces., Clinical Relevance: The results of this study support the assertion that a ball-and-socket style TWA can provide a postoperative range of motion adequate to perform activities of daily living., Competing Interests: Conflicts of Interest Miss Glanville reports an unrestricted research grant from Swemac Innovations AB, the manufacturers of the Motec prosthesis, to support this project. Mr Brown reports an unrestricted research grant from Swemac Innovations AB, the manufacturers of the Motec prosthesis, to support this project; he is a paid consultant for Swemac for education and product development; he did not receive any payment for any aspects relating to this project, and receives no royalties. No benefits in any form have been received or will be received by the other authors related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Global climate is experiencing exceptional warming, leading to a rise in extreme events worldwide. Coastal regions are particularly vulnerable to climate change (CC), due to dense populations, interconnected economies, and fragile ecosystems. These areas face escalating risks as CC intensifies the severity and frequency of extreme weather phenomena, like heavy precipitation, sea-level rise (SLR), storm surges. Integrated approaches are crucial to assess the combined impacts of atmospheric and marine hazards at the land-sea interface. Machine Learning (ML) offer innovative solutions to analyse multi-risk events, leveraging large and heterogeneous datasets and modelling complex, non-linear interactions. This study introduces a two-tier ML approach to estimate risks associated with extreme weather events for the Veneto coastal municipalities under current and future scenarios. The model, tested and validated with present-day data, showed satisfactory performance (error margin ∼20 %). The model was applied to mid-term (until 2045) and long-term (until 2100) periods under different CC scenarios, represented by various Representative Concentration Pathways (RCP). Mid-term analysis reveals an increasing risk trend, driven by SLR under RCP8.5, underscoring the significance of considering non-linear interactions between multiple marine and atmospheric hazards. Long-term analysis highlights how future risks depend mainly on precipitation and SLR across the analysed CC scenarios (RCP2.6/4.5/8.5). Results indicate a gradual increase in the expected annual risk trend, with RCP8.5 scenario showing the most severe outcomes. By 2100, the risks under RCP8.5 are projected to be ten times higher than those observed during the historical period, highlighting the importance of developing effective strategies to address these challenges., Competing Interests: Declaration of competing interest All of the reported work in the attached manuscript is original and the manuscript has not been previous published in whole or in part. I also have read and abided by the statement of ethical standards for manuscripts submitted to this journal. All authors have seen the manuscript and approved its submission to the Science of the Total Environment Journal. Moreover, all the authors declare that they have no known competing financial interests or personal relationships that could had influenced the work reported in this paper., (Copyright © 2025. Published by Elsevier B.V.)

Luminescent Lanthanide (III) (Ln(III)) bioprobes (LLBs) have been extensively used in the last two decades as intracellular molecular probes in bio-imaging for the efficient revelation of analytes, to signal intracellular events (enzymes/protein activity, antigen-antibody interaction), target specific organelles, and determine parameters of particular biophysical interest, to gain important insights on pathologies or diseases. The choice of using a luminescent Ln(III) coordination compound with respect to a common organic fluorophore is intimately connected to how their photophysical sensitization (antenna effect) can be finely tuned and especially triggered to respond (even quantitatively) to a certain biophysical event, condition or analyte. While there are other reviews focused on how to design chromophoric ligands for an efficient sensitization of Ln(III) ions, both in the visible and NIR region, this review is application-driven: it is a small collection of particularly interesting examples where the LLB's emissive information is acquired by imaging the emission intensity and/or the fluorescence lifetime (fluorescence lifetime imaging microscopy, FLIM)., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The World Health Organization has confirmed that asbestos fibres are carcinogenic, claiming that asbestos-related diseases should be eradicated worldwide. Actinolite, amosite, anthophyllite, chrysotile, crocidolite, and tremolite are regulated asbestiform mineral phases. However, in nature, asbestos minerals occur either in a fibrous and asbestiform (original morphology characterized by high length-to-width ratio and provided of high tensile strength and flexibility) or fibrous but not asbestiform appearance. This study used human epithelial cancer cells (A549) and a mouse fibroblast cell line (Balb/c 3T3) to compare the genotoxic and carcinogenic effects of a sample of amphibole asbestos with samples of fibrous not asbestiform named cleavage fragments (CV) obtained by grinding non-asbestiform amphiboles. The results showed that exposure of alveolar lung cells to asbestos and elongated mineral particles, in the habit of cleavage fragments (CF) derived from the grinding of non-asbestiform amphiboles and serpentines, causes cytotoxic effects, oxidative stress and genotoxic damage. Moreover, CF obtained from an actinolite schist induces a transformation effect in the Balb/c 3T3 model. Together, these findings highlight the importance of considering CF as a potential threat to human health since it can cause genotoxic damage by triggering cellular transformation processes that overlap with the mechanisms involved in the carcinogenesis processes of asbestos., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Perinatal asphyxia (PA) is a leading cause of neonatal morbidity and mortality, often resulting in long-term neurodevelopmental challenges. Despite advancements in perinatal care, predicting long-term outcomes remains difficult. Early diagnosis is essential for timely interventions to reduce brain injury, with tools such as Magnetic Resonance Imaging, brain ultrasound, and emerging biomarkers playing a possible key role. Olfaction, one of the earliest senses to develop, may provide valuable insights into long-term neurodevelopmental outcomes following PA due to its intricate neural connections with regions responsible for memory, emotion, and homeostasis. Newborns demonstrate early olfactory abilities, such as recognizing maternal odors, which are vital for bonding, feeding, and emotional regulation. These responses are processed by a network of brain regions, including the olfactory bulb (OB), piriform cortex, amygdala, and orbitofrontal cortex. Hypoxic injury to these regions, particularly the OB, may disrupt olfactory processing in infants with PA, potentially affecting their cognitive and social development. Investigating the relationship between olfactory system development and perinatal brain injury could lead to innovative diagnostic and therapeutic approaches. Further research, including clinical and animal studies, is necessary to fully explore the potential of olfactory assessments in predicting outcomes after PA. This educational review explores and discusses the potential of olfaction as a predictor of long-term outcomes and a tool for risk stratification following PA, opening new pathways for interventions and improved care., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interests in writing this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Accumulating evidence, as outlined by Self-Determination Theory (SDT), highlights the crucial role of emotion dysregulation and basic psychological needs in shaping various psychological outcomes. Parental psychological control may play a key role in understanding how these processes develop within the family context. This study aims to examine the intergenerational transmission of basic psychological needs and emotion dysregulation from parents to adolescents, focusing on the indirect association of parental psychological control within this relationship. 210 Italian families living in the same household, consisting of biological parents and one adolescent (55% female) aged between 13 and 18 years old ( M  = 15.71, SD = 1.76) participated in the study. The results showed that both mothers' and fathers' higher emotion dysregulation were related to their own higher levels of psychological control, while higher maternal need frustration was related to higher perceptions of parental psychological control in adolescents. In turn, higher perceptions of parental psychological control in adolescents were related to adolescents' higher need frustration and emotion dysregulation. Furthermore, higher maternal emotion dysregulation was linked to higher adolescent emotion dysregulation, and higher paternal need frustration was linked to higher adolescent need frustration. These findings are explored in the context of SDT and highlight the significance of both emotion regulation ability and needs in shaping adolescent adjustment.

Background: The present study aimed to investigate the prognostic and predictive roles of Hb/RDW ratio in patients with mRCC treated with first-line immunotherapy combinations (TKI plus ICI or ICI plus ICI)., Materials and Methods: We performed a sub-analysis of a multicenter retrospective observational study (ARON-1 project) involving patients with mRCC treated with first-line immunotherapy combinations., Results: Three hundred and twenty-nine patients were enrolled, 244 males and 85 females. Median age was 65.5 years. The prognostic impact of the Hb/RDW ratio on PFS and OS was observed in the whole population examined. Hb/RDW ratio had a correlation with neutrophil-to-lymphocyte ratio (NLR), a blood inflammatory parameter., Conclusion: Hb/RDW ratio is a new inflammatory prognostic factor, easy to use in daily clinical practice.

Background: Despite advances in uveal melanoma (UM) diagnosis and treatment, about 50% of patients develop distant metastases, thereby displaying poor overall survival. Molecular profiling has identified several genetic alterations that can stratify patients with UM into different risk categories. However, these genetic alterations are currently dispersed over multiple studies and several methodologies, emphasizing the need for a defined workflow that will allow standardized and reproducible molecular analyses., Methods: Following the findings published by "The Cancer Genome Atlas-UM" (TCGA-UM) study, we developed an NGS-based gene panel (called the UMpanel) that classifies mutation sets in four categories: initiating alterations ( CYSLTR2 , GNA11 , GNAQ and PLCB4 ), prognostic alterations ( BAP1 , EIF1AX , SF3B1 and SRSF2 ), emergent biomarkers ( CDKN2A , CENPE , FOXO1 , HIF1A , RPL5 and TP53 ) and chromosomal abnormalities (imbalances in chromosomes 1, 3 and 8)., Results: Employing commercial gene panels, reference mutated DNAs and Sanger sequencing, we performed a comparative analysis and found that our methodological approach successfully predicted survival with great specificity and sensitivity compared to the TCGA-UM cohort that was used as a validation group., Conclusions: Our results demonstrate that a reproducible NGS-based workflow translates into a reliable tool for the clinical stratification of patients with UM.

Carbon perovskite solar cells (C-PSCs) represent a promising photovoltaic technology that addresses the long-term operating stability needed to compete with commercial Si solar cells. However, the poor interface contacts between the carbon electrode and the perovskite result in a gap between C-PSC's performances and state-of-the-art PSCs based on metallic back electrodes. In this work, Cu (II) phthalocyanine (CuPc) was rediscovered as an effective hole-transporting material (HTM) to be coupled with carbon electrodes. In particular, based on computional studies and VASP calculations, it is found that the tetragonal structure of CuPc could efficiently coordinated to perovskite layer via N and Cu atoms to Pb and I atoms, respectively. By systematically optimizing the concentration of the CuPc HTL solution, and screening the coupling of CuPc HTL with two types of carbon electrodes, based on carbon black:graphite mixture and reduced graphene oxide, respectively, a maximum power conversion efficiency of 21.4% has been achieved. In addition, our cells demonstrate satisfactory stability under thermal ageing at 85°C; 20% PCE loss after more than 200 h and shelf-life ageing 20 days with 1.3% PCE loss in ambient conditions (ISOS-D-1). These findings are interesting in developing commercially competitive C-PSCs, as they combine both high PCE and stability., (© 2025 Wiley‐VCH GmbH.)

Introduction: Total and sub-total lesions of the anterior cruciate ligament (ACL) are one of the most frequent and performance-limiting injuries to the knee joint within the active population. Early surgical management, often regarded as the primary management strategy, has recently been shown to have similar outcomes when compared with an initial rehabilitative approach followed by surgical ACL reconstruction if higher levels of functionality are needed. The primary objective of the study was to investigate the physiotherapists and orthopedic surgeons' "coper/non-coper" screening application in the clinical management of the patient after ACL injury. Second, the authors aimed to investigate the cooperation between physiotherapists and orthopedic surgeons when dealing with patients with ACL injuries., Methods: An online survey consisting of 12 questions on the clinical practice of the surveyed physiotherapists ( n  = 803) and orthopedic surgeons ( n  = 201), and the relation between these healthcare professionals, was distributed. The answers were stratified depending on clinical experience in dealing with ACL injuries., Results: Both physiotherapists and orthopedic surgeons showed a low degree of confidence and application of the "coper/non-coper" screening when managing ACL lesions. The sub-population of ACL experts reported a good level of interprofessional interaction. Nevertheless, an updated level of knowledge regarding the recent evidence on the non-surgical management of ACL lesions is still lacking., Conclusions: The study findings indicate the need to improve the collaboration between Italian physiotherapists and orthopedic surgeons as well as their knowledge of the non-surgical approaches to ACL lesions., 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., (© 2025 Macrelli, Mallia, Thiebat, Rocchi, Herrington and Nutarelli.)

Background: Risk assessment at diagnosis is crucial for neuroblastoma (NB) in order to address patients at high-risk to the most timely and appropriate treatments. 3-O-methyldopa (3-OMD), a direct metabolite of L-Dopa, is a promising biomarker of NB at diagnosis able to stratify high-risk patients., Methods: We show the development and validation of a method for measuring 3-OMD from dried plasma samples (DPS) and plasma using liquid chromatography coupled with high resolution mass spectrometry (LC-HRMS) on a Thermo Fisher Scientific Orbitrap Exploris 120., Results: The method was accurate and reproducible in the range 7.8-4000 ng/mL, from small amounts (50 mL) of plasma and DPS (obtained starting from 30 mL plasma). 3-OMD concentrations measured in plasma and DPS were highly correlated (R = 0.99 95 %CI 0.993-0.996). Differences of 3-OMD levels across stages L1 and M and L1 and L2 (p-value < 0.05) were statistically significant. Receiving Operator Curve (ROC) analysis showed that 3-OMD was able to discriminate patients at high-risk with high sensitivity and specificity both from plasma or DPS (AUC = 0.8295 %CI 0.71-0.94, P < 0.0001)., Conclusions: 3-OMD is confirmed as an interesting biomarker of high-risk NB. The described method is an added value for further prospective studies involving multiple sites. The stability of 3-OMD in DPS allows for easy shipment and storage at room temperature., 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 © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Non-exhaust emissions have gained increasing attention during the last years, with the upcoming EURO 7 regulation defining maximum PM 10 emission factors for tire and brake emissions for the first time. This study, therefore, focusses on broadening the knowledge on chemical composition and physical characteristics of brake dust to define emission factors for heavy metal and organic pollutants. Particles from two pads were analyzed utilizing the Worldwide Harmonised Light Vehicle Test Procedure (WLTP) brake cycle. Geometric mean diameters for both pads were found with a bimodal distribution in the ultrafine range. PM 10 emission factors of 15.1 ± 0.1 mg/km and 16.3 ± 0.4 mg/km were measured, which is 2.15 and 2.32 times higher than upcoming maximum permitted emission factor of 7 mg/km. On average 54.9 % and 58.1 % of PM10 was emitted as iron, with a wide variety of Fe concentrations between 43 - 75 % by mass found in individual particles. Other heavy metals, such as Cu, Cr, Mn and Zn, were also found and a high contribution of wear from the brake disc was noticeable, based on the elemental composition. Fe emission factors calculated from the WLTP brake cycle were 8-9 times higher than previously reported values in literature, while Cu levels were significantly lower based on recent trends in brake pad formulations. Four different PAH were detected even at the relatively low temperatures that are common for the WLTP brake test cycle., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Thomas Adam reports financial support was provided by dtec.bw - NextGenerationEU. Thomas Adam reports financial support was provided by ULTRHAS - H2020. If there are other authors, they 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 © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Clonal myeloproliferation and fibrotic transformation of the bone marrow (BM) are the pathogenetic events most commonly occurring in myelofibrosis (MF). There is great evidence indicating that tumor microenvironment is characterized by high lactate levels, acting not only as an energetic source, but also as a signaling molecule., Methods: To test the involvement of lactate in MF milieu transformation, we measured its levels in MF patients' sera, eventually finding a massive accumulation of this metabolite, which we showed to promote the expansion of immunosuppressive subsets. Therefore, to assess the significance of its trafficking, we inhibited monocarboxylate transporter 1 (MCT1) by its selective antagonist, AZD3965, eventually finding a mitigation of lactate-mediated immunosuppressive subsets expansion. To further dig into the impact of lactate in tumor microenvironment, we evaluated the effect of this metabolite on mesenchymal stromal cells (MSCs) reprogramming., Results: Our results show an activation of a cancer-associated phenotype (CAF) related to mineralized matrix formation and early fibrosis development. Strikingly, MF serum, enriched in lactate, causes a strong deposition of collagen in healthy stromal cells, which was restrained by AZD3965. To corroborate these outcomes, we therefore generated for the first time a TPO high zebrafish model for the establishment of experimental fibrosis. By adopting this model, we were able to unveil a remarkable increase in lactate concentration and monocarboxylate transporter 1 (MCT1) expression in the site of hematopoiesis, associated with a strong downregulation of lactate export channel MCT4. Notably, exploiting MCTs expression in biopsy specimens from patients with myeloproliferative neoplasms, we found a loss of MCT4 expression in PMF, corroborating changes in MCT expression during BM fibrosis establishment., Conclusions: In conclusion, our results unveil lactate as a key regulator of immune escape and BM fibrotic transformation in MF patients, suggesting MCT1 blocking as a novel antifibrotic strategy., Competing Interests: Declarations. Ethics approval and consent to participate: Peripheral blood (PB) samples were collected from MF patients and age-matched controls after written informed consent (Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, n. 54/2022/PO). Consent for publication: Not applicable. Competing interests: The authors declare no conflict of interest., (© 2025. The Author(s).)

Purpose: This study examines the multimodal imaging (MMI) findings in two cases of unilateral Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis (SNIFR), including detailed findings from the unaffected fellow eye., Methods: Macular spectral domain optical coherence tomography (OCT) and 3x3 mm optical coherence tomography angiography (OCTA), microperimetry, full-field electroretinography (ff-ERG) for both the affected and the fellow eye were reviewed., Results: The MMI findings were consistent across the two cases (71-year-old female and 60-year-old female). OCT imaging of the affected eyes revealed cystoid spaces between the outer nuclear layer (ONL) and the outer plexiform layer (OPL), with the vascular network remaining intact, indicating no alterations in vessel flow. Microperimetry showed slightly lower pointwise sensitivity in both eyes compared to a normative database., Conclusion: Although SNIFR typically presents as a unilateral condition, our findings suggest that patients may have an inherent structural predisposition to macular schisis, resulting in subtle functional impairments. We hypothesize that the structural damage may involve the macular Müller cells. These observations highlight the importance of further studies to understand SNIFR's pathophysiology and inform therapeutic approaches., Competing Interests: Conflict of interest: no conflict of interest exists for any author.

The design of interfaces between nanostructured electrodes and advanced electrolytes is critical for realizing advanced electrochemical double-layer capacitors (EDLCs) that combine high charge-storage capacity, high-rate capability, and enhanced safety. Toward this goal, this work presents a novel and sustainable approach for fabricating ionogel-based electrodes using a renewed slurry casting method, in which the solvent is replaced by the ionic liquid (IL), namely 1-ethyl-3-methylimidazolium bis(fluorosulfonyl)imide (EMIFSI). This method avoids time-consuming and costly electrolyte-filling steps by integrating the IL directly into the electrode during slurry preparation, while improving the rate capability of EDLCs based on non-flammable ILs. The resulting ionogel electrodes demonstrate exceptional electrolyte accessibility and enable the production of symmetric EDLCs with high energy density (over 30Wh/kg based on electrode material weight) and high-rate performance. These EDLCs could operate at temperatures up to 180°C, far exceeding the limitations of traditional EDLCs based on organic electrolytes (1M TEABF4 in acetonitrile, up to 65°C). Ionogel-type EDLCs exhibit remarkable stability, retaining 88% specific capacity after 10000 galvanostatic charge/discharge cycles at 10Ag-1 and demonstrating superior retention compared to conventional EDLCs (50%), while also maintaining 92.4% energy density during 100h floating tests at 2.7V. These electrochemical properties highlight their potential for robust performance under demanding conditions., (© 2025 Wiley‐VCH GmbH.)

Objectives: In Italy a recent law was approved for providing patients' wishes regarding end of life issues, commonly referred internationally to as "living wills", (Dichiarazione anticipata di trattamento, DAT). Regardless of this official document, advance care planning (ACP) is often used in a palliative care setting to share the treatments to start, to continue, to withdraw, thus preventing the stress on an acute decision. The aim of this study was to assess DAT and ACP in patients with amyotropic lateral sclerosis admitted to home palliative care. Methods: Patients consecutively admitted to speciliazed home palliative care were prospectively assessed. The presence of DAT or ACP was recorded. Results: Sixty-eight patients were enrolled in the period taken into consideration. No patient had drown up DAT, and only one patient provided his ACP prior to home palliative care admission. Along the course of home palliative care care assistance, 30.9% of patients provided their ACP. Discussion: In Italy DAT resulted scarcely widespread, despite an existing law, as no patient officially provided their indication on end of life issues. In addition, ACP was given only after starting specialized home palliative care in less than 1/3 of patients. Home palliative care seems to be a fundamental resource for improving communication and soliciting expression of patients' wishes regarding end of life issues., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver condition marked by excessive lipid accumulation in hepatic tissue. This disorder can lead to a range of pathological outcomes, including metabolic dysfunction-associated steatohepatitis (MASH) and cirrhosis. Despite extensive research, the molecular mechanisms driving MASLD initiation and progression remain incompletely understood. Oxidative stress and lipid peroxidation are pivotal in the "multiple parallel hit model", contributing to hepatic cell death and tissue damage. Gut microbiota plays a substantial role in modulating hepatic oxidative stress through multiple pathways: impairing the intestinal barrier, which results in bacterial translocation and chronic hepatic inflammation; modifying bile acid structure, which impacts signaling cascades involved in lipidic metabolism; influencing hepatocytes' ferroptosis, a form of programmed cell death; regulating trimethylamine N-oxide (TMAO) metabolism; and activating platelet function, both recently identified as pathogenetic factors in MASH progression. Moreover, various exogenous factors impact gut microbiota and its involvement in MASLD-related oxidative stress, such as air pollution, physical activity, cigarette smoke, alcohol, and dietary patterns. This manuscript aims to provide a state-of-the-art overview focused on the intricate interplay between gut microbiota, lipid peroxidation, and MASLD pathogenesis, offering insights into potential strategies to prevent disease progression and its associated complications.

Introduction: Renal cell carcinoma (RCC) is one of the most common types of urogenital cancer. The introduction of immune-based combinations, including dual immune-checkpoint inhibitors (ICI) or ICI plus tyrosine kinase inhibitors (TKIs), has radically changed the treatment landscape for metastatic RCC, showing varying efficacy across different prognostic groups based on the International Metastatic RCC Database Consortium (IMDC) criteria., Materials and Methods: This retrospective multicenter study, part of the ARON-1 project, aimed to evaluate the outcomes of favorable-risk metastatic RCC patients treated with immune-based combinations or sunitinib. Patients were assessed for overall survival (OS), progression-free survival (PFS) and overall response rate. We carried out a survival analysis by a Cox regression model., Results: A total of 524 favorable-risk patients were included in the analysis. After a median follow-up of 37.2 months, the median OS in the overall population was 56.1 months. There was no significant difference in OS between patients receiving sunitinib and those receiving TKI + ICI combinations (p = 0.761). Patients on TKI + ICI had significantly longer PFS compared to patient treated with sunitinib (30.7 vs 22.9 months, p = 0.007). Analysis of OS and PFS based on metastatic site revealed that patients with bone metastases benefited more from ICI plus TKI (56 patients with bone metastases receiving IO + TKI, 38 received pembrolizumab plus axitinib, 15 cabozantinib plus nivolumab and 3 pembrolizumab plus lenvatinib), while sunitinib was more effective for pancreatic and glandular metastases. Additionally, the number of metastatic sites played a role, with TKI plus ICI showing superiority in patients with a single metastatic site. The time from RCC diagnosis to metastatic disease also impacted outcomes, with TKI plus ICI being more effective in patients with a shorter interval (i.e., < 36 months)., Conclusions: The choice between upfront combination or monotherapy for metastatic favorable prognosis RCC remains a current issue. While combination therapy offers prolonged PFS, it does not necessarily translate to improve OS compared to sunitinib. This real-world study supports the superiority in terms of PFS of TKI plus ICI vs TKI monotherapy but not in OS. Probable, other clinical factors should be taking into account to make clinical treatment decisions in this setting., Competing Interests: Declarations. Conflicts of Interest: Javier Molina-Cerrillo declares consultant, advisory or speaker roles for IPSEN, Roche, Pfizer, Sanofi, Janssen and BMS. JMC has received research grants from Pfizer, IPSEN and Roche Francesco Massari has received research support and/or honoraria from Astellas, BMS, Janssen, Ipsen, MSD and Pfizer outside the submitted work. Linda Cerbone has received honoraria for advisory boards, speaker engagements and scientific consultancy for educational purposes from AstraZeneca, EISAI, MSD, Ipsen, BMS, A.A.A.; past MSD employee in Medical Affairs. Ondrej Fiala received honoraria from Novartis, Janssen, Merck and Pfizer for consultations and lectures unrelated to this project. Fernando Sabino M. Monteiro has received research support from Janssen, Merck Sharp Dome and honoraria from Janssen, Ipsen, Bristol Myers Squibb and Merck Sharp Dome, all unrelated to the present paper. R. Kanesvaran has received fees for speaker bureau and advisory board activities from the following companies; Pfizer, MSD, BMS, Eisai, Ipsen, Johnson and Johnson, Merck, Amgen, Astellas and Bayer. Camillo Porta has received honoraria from Angelini Pharma, AstraZeneca, BMS, Eisai, Ipsen and MSD and acted as a Protocol Steering Committee Member for BMS, Eisai and MSD. Sebastiano Buti has received honoraria for speaking at scientific events and advisory roles from AstraZeneca, Bristol Myers Squibb, Ipsen, Merck, Eisai, MSD, Novartis and Pfizer and research funding from Novartis and Pfizer. Matteo Santoni has received research support and honoraria from Janssen, Bristol Myers Squibb, Ipsen, MSD, Astellas, A.A.A. and Bayer, all unrelated to the present paper. The other authors declare no conflicts of interest., (© 2024. The Author(s).)

Intravenous immunoglobulin (IVIg) is a medical preparation used as replacement therapy for patients with immunodeficiencies. Over time, IVIg's anti-inflammatory and immunomodulatory effects have been recognized, which have led to the approval of this therapy in the treatment of various pathologies, such as Kawasaki disease, immune thrombocytopenia, and Guillain-Barré syndrome. There are numerous studies in the literature regarding the off-label use of IVIg in the treatment of autoimmune diseases (e.g. myositis and vasculitis), and hematological disorders. Since the role of immunoglobulins in fields other than replacement therapy is now consolidated, in this study we carried out a review of the literature to evaluate the main uses of IVIg therapy. We have focused our attention on the treatment of autoimmune, neurological, hematological, dermatological and pediatric diseases. Furthermore, our analysis of the literature also extended to the potential use of IVIg as an adjuvant treatment of long COVID-19. From our analysis, we found consistent data about IVIg's effectiveness in treating numerous clinical conditions. Treatment with IVIg represents a second-line approach or a valid adjuvant to standard therapies capable of positively influencing the clinical course of many pathologies and reducing or avoiding side effects of standard therapies, with a good safety profile., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Maria Giovanna Danieli and Yehuda Shoenfeld are serving in the Editorial Board of Autoimmunity Reviews. The other 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. The other 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 © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The development of novel, efficient and cost-effective emitters for solid-state lighting devices (SSLDs) is ubiquitous to meet the increasingly demanding needs of advanced lighting technologies. In this context, the emergence of thermally activated delayed fluorescence (TADF) materials has stunned the photonics community. In particular, inorganic TADF material-based compounds can be ad hoc engineered by chemical modification of the coordinated ligands and the type of metal centre, allowing control of their ultimate photo-/electroluminescence properties, while providing a viable emitter platform for enhancing the efficiency of state-of-the-art organic light-emitting diodes (OLEDs) and light-emitting electrochemical cells (LECs). By presenting an overview of the state of the art of all metal complex-based TADF compounds, this review aims to provide a comprehensive, authoritative and critical reference for their design, characterization and device application, highlighting the advantages and drawbacks for the chemical, photonic and optoelectronic communities involved in this interdisciplinary research field.

Intrathecal therapy with implanted devices is often reported in some recommendations.for the management of difficult cancer pain However, data is often biased by optimistic view and poor assessment. We report a case of patient in which a comprehensive and complex palliative care treatment was effective in managing a patient who was implanted a subcutaneous port for intrathecal analgesia This patient had many characteristics of a difficult pain, really defined as refractory due to various negative prognostic pain factors, such as neuropathic pain and psychological distress.. A comprehensive pain management with a balanced approach including both interventional therapy and palliative care simultaneously, allowed to achieve optimal pain control. Terms such as intractable or refractory pain, have been ambiguously used in literature to select patients as candidates for implated pumps. A meaningful evaluation and a comprehensive treatment should be mandatory when using intrathecal anlgesia in patients with very difficult pain conditions., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

DNA damage is one of the primary mechanisms underlying cancer and other chronic degenerative diseases. Early evaluation of this damage in the affected cells and tissues is crucial for understanding pathogenesis and implementing effective prevention strategies. However, isolating target cells from affected organs, such as the lungs, can be challenging. Therefore, an alternative approach is to evaluate genotoxic damage in surrogate cells. Pulmonary alveolar macrophages are ideally suited for this purpose because they are in close contact with the target cells of the bronchial and alveolar epithelium, share the exact mechanisms and levels of exposure, and are easily recoverable in large numbers. This review comprehensively lists all studies using alveolar macrophages as surrogate cells to show genotoxic lung damage in humans or laboratory animals. These investigations provide fundamental information on the mechanisms of DNA damage in the lung and allow for better assessment and management of risk following exposure to inhalable genotoxic agents. Furthermore, they may be a valuable tool in cancer chemoprevention, helping the right choice of agents for clinical trials., Competing Interests: Declarations. Conflict of interest: The authors have no competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Atrial natriuretic peptide (ANP), a cardiac hormone involved in the regulation of water/sodium balance and blood pressure, is also secreted by endothelial cells, where it exerts protective effects in response to stress. Autophagy is an intracellular self-renewal process involved in the degradation of dysfunctional cytoplasmic elements. ANP was recently reported to act as an extracellular regulator of cardiac autophagy. However, its role in the regulation of endothelial autophagy has never been investigated. Here, we tested the effects of ANP in the regulation of autophagy in human umbilical vein endothelial cells (HUVECs). We found that ANP rapidly increases autophagy and autophagic flux at physiological concentrations through its predominant pathway, mediated by natriuretic peptide receptor type A (NPR-A) and protein kinase G (PKG). We further observed that ANP is rapidly secreted by HUVEC under stress conditions, where it mediates stress-induced autophagy through autocrine and paracrine mechanisms. Finally, we found that the protective effects of ANP in response to high-salt loading or tumor necrosis factor (TNF)-α are blunted by concomitant inhibition of autophagy. Overall, our results suggest that ANP acts as an endogenous autophagy activator in endothelial cells. The autophagy mechanism mediates the protective endothelial effects exerted by ANP., Competing Interests: Declaration of competing interest None to disclose., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Acute palliative care units have been developing in the last years and their clinical activity and characteristics have been described, despite large differences in different countries. One controversial topic is whether such units should be mandatory as standard in comprehensive cancer centers or even in tertiary hospitals. In this "Controversies in Palliative Care" article, three expert clinicians independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. Interestingly, all three experts arrived at similar conclusions. They underscored the importance of an acute palliative care unit, which provides a different pattern of activities in comparison with typical inpatient hospices, generally caring for patients who have a limited expected survival., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Mitral regurgitation (MR) is one of the most common valvular heart diseases worldwide. Echocardiography remains the first line and most effective imaging modality for the diagnosis of mitral valve (MV) pathology and quantitative assessment of MR. The advent of three-dimensional echocardiography has significantly enhanced the evaluation of MV anatomy and function. Furthermore, recent advancements in cardiovascular imaging software have emerged as step-forward tools, providing a powerful support for acquisition, analysis, and interpretation of cardiac ultrasound images in the context of MR. This review aims to provide an overview of the contemporary workflow for echocardiographic assessment of MR, encompassing standard echocardiographic techniques and the integration of semiautomated and automated ultrasound solutions. These novel approaches include advancements in segmentation, phenotyping, morphological quantification, functional grading, and chamber quantification., (© 2024 Wiley Periodicals LLC.)

Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men., Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents. We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization., Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups., Conclusions: In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome., Trial Registration: ClinicalTrials.gov Identifier: NCT03068494., Competing Interests: The authors have no financial conflicts of interest., (Copyright © 2025. The Korean Society of Cardiology.)

The first-line therapy of metastatic renal cell carcinoma (mRCC) has revolutionized with the approval of immune checkpoint inhibitors (ICIs) in combination with or without tyrosine kinase inhibitors (TKIs). The choice among the many different immuno-combinations (ICI-ICI or ICI-TKI) is challenging due to the lack of predictive factors. The different shapes of the Kaplan-Meier survival curves (e.g. "banana-shaped curves") have raised many questions on the long-term survival benefit. Here, we analyzed the factors that could have impacted the different long-term survival, including the prognostic factors distribution (IMDC score), histological factors (sarcomatoid features, PD-L1 expression), and treatment characteristics (mechanism of action, duration, discontinuation rate). This overview highlights the factors that should be considered in the first-line setting for the patients' therapeutic choice and prognostic assessment. They are also fundamental parameters to examined for head-to-head studies and real-life, large-scale studies.

Background: Palliative sedation involves the intentional proportional lowering of the level of consciousness in patients with life-limiting disease who are experiencing refractory suffering. The efficacy of palliative sedation needs to be monitored to ensure patient comfort. The aim of this study was to evaluate the efficacy using discomfort levels combined with sedation/agitation levels., Methods: In this prospective observational study, adult patients with advanced malignancies were recruited from hospice units, palliative care units, and hospital wards in five European countries. Health care professionals used proxy observations of discomfort levels (Discomfort Scale-Dementia of Alzheimer Type, range 0-27) and sedation/agitation levels (Richmond Agitation-Sedation Scale modified for palliative care inpatients), range - 5 to + 4) to evaluate the efficacy of palliative sedation., Results: In 78 participants, discomfort levels were monitored during palliative sedation. The mean discomfort score before start was 9.4 points (95% CI 8.3-10.5), which showed a significant decrease of 6.0 points (95% CI 4.8-7.1) after start of sedation for the total sedation period. In the multivariable analysis, no significant factors influencing baseline discomfort levels were identified. The discomfort and depth of sedation scores were found to be positively correlated, with an r of 0.72 (95% CI 0.61-0.82). The internal consistency of the discomfort scale was good (0.83), but the "Noisy breathing" item was less informative of the total discomfort score., Conclusions: The efficacy of palliative sedation can be evaluated by measuring discomfort levels combined with sedation/agitation levels. The measurement of discomfort levels might provide a more specific and detailed evaluation of adequate sedation., Trial Registration: This study is registered at ClinicalTrials.gov since January 22, 2021, registration number: NCT04719702., Competing Interests: Declarations. Ethics approval and consent to participate: This study has been approved by the Research Ethics Committee (REC) of the Radboud University Medical Centre in Nijmegen (ref.nr. 2019/6016, June 2020), the REC of the University Hospital Navarra in Pamplona (ref.nr.2020.044, June 2020), the REC of the Rheinische Friedrich-Wilhelm’s University in Bonn (ref.nr. 300/20, July 2020), the REC of the University Hospital of Palermo (ref.nr. 7/2020, July 2020), and the REC of the University Hospitals in Leuven (ref.nr.S64008, August 2020). Written informed consent was obtained before participation in the study, both in the participants and in the relatives and health care professionals for completing questionnaires. All methods were conducted in accordance with relevant guidelines and applicable regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Exophytic tumors of the calvaria (ETCs) remain a challenging pathology because of their complex management. The authors discuss the case of a woman with a large exophytic mass of the right frontotemporal region and underline their decision-making process on the management of this unique case and possible similar ones., Observations: Neuroradiological findings showed a calvarial tumor with both epicranial and intracranial extension involving the frontotemporal bone with a mixed component (lytic and sclerotic) and dural infiltration with a pseudonodular pattern. A wide en bloc excision from the skin to the dura mater was performed. The compound 5-aminolevulinic acid (5-ALA) was not very useful in identifying the tumor boundaries. One-step cranioplasty and a skin pedicle flap were used to reconstruct the anatomical defect. Acellular dermal matrix was used to repair the uncovered calvaria. Pathological examination confirmed the diagnosis of pleomorphic dermal sarcoma (PDS)., Lessons: In the evaluation of an ETC, PDS should be considered. Wide en bloc excision, if achievable, should be considered the gold standard. The 5-ALA was not helpful, and a pedicle skin flap could be considered as a less invasive alternative to microsurgical reconstruction. The use of an acellular matrix implant on the contralateral exposed galea increases the rate of reconstruction success. https://thejns.org/doi/10.3171/CASE24457.