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Abstract. Abdominoscrotal hydrocele (ASH) is a rare clinical finding comprising fluid collection between the layers of the tunica vaginalis, extending from the scrotum to the abdominal cavity. At present, there is no unique or recommended management for ASH, and different surgical treatments have been proposed. Despite an open surgical approach being the most common treatment, the use of laparoscopy has also previously been described. The most common intraoperative complication is devascularization of the testis due to damage to the spermatic cord, with consequent orchiectomy. We present a case of ASH treated with minimally invasive surgery, consisting of a right inguinotomy with puncture of the ASH by positioning a mono-J stent avoiding spermatic cord dissection and the risk of testis devascularization. Sclerotization of the hydrocelic sac with iodopovidone through a mono-J stent was performed with healing from ASH and preservation of testicular vascularization. Two months later, magnetic resonance imaging showed the presence of scar tissue replacing the previous ASH cavity.

IntroductionSARS-CoV-2 pandemic still poses a significant burden on global health and economy, especially for symptoms persisting beyond the acute disease. COVID-19 manifests with various degrees of severity and the identification of early biomarkers capable of stratifying patient based on risk of progression could allow tailored treatments.MethodsWe longitudinally analyzed 67 patients, classified according to a WHO ordinal scale as having Mild, Moderate, or Severe COVID-19. Peripheral blood samples were prospectively collected at hospital admission and during a 6-month follow-up after discharge. Several subsets and markers of the innate and adaptive immunity were monitored as putative factors associated with COVID-19 symptoms.ResultsMore than 50 immunological parameters were associated with disease severity. A decision tree including the main clinical, laboratory, and biological variables at admission identified low NK-cell precursors and CD14+CD91+ monocytes, and high CD8+ Effector Memory T cell frequencies as the most robust immunological correlates of COVID-19 severity and reduced survival. Moreover, low regulatory B-cell frequency at one month was associated with the susceptibility to develop long COVID at six months, likely due to their immunomodulatory ability.DiscussionThese results highlight the profound perturbation of the immune response during COVID-19. The evaluation of specific innate and adaptive immune-cell subsets allows to distinguish between different acute and persistent COVID-19 symptoms.

BackgroundHeterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services.MethodsUsing a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups.ResultsClustering revealed four subgroups. One subgroup-broad symptom worsening only (20%)-included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup.LimitationsNotable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic.ConclusionsConcomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis.

Abstract Preprocessing is an essential task for the correct analysis of digital medical images. In particular, X-ray imaging might contain artifacts, low contrast, diffractions or intensity inhomogeneities. Recently, we have developed a procedure named PACE that is able to improve chest X-ray (CXR) images including the enforcement of clinical evaluation of pneumonia originated by COVID-19. At the clinical benchmark state of this tool, there have been found some peculiar conditions causing a reduction of details over large bright regions (as in ground-glass opacities and in pleural effusions in bedridden patients) and resulting in oversaturated areas. Here, we have significantly improved the overall performance of the original approach including the results in those specific cases by developing PACE2.0. It combines 2D image decomposition, non-local means denoising, gamma correction, and recursive algorithms to improve image quality. The tool has been evaluated using three metrics: contrast improvement index, information entropy, and effective measure of enhancement, resulting in an average increase of 35% in CII, 7.5% in ENT, 95.6% in EME and 13% in BRISQUE against original radiographies. Additionally, the enhanced images were fed to a pre-trained DenseNet-121 model for transfer learning, resulting in an increase in classification accuracy from 80 to 94% and recall from 89 to 97%, respectively. These improvements led to a potential enhancement of the interpretability of lesion detection in CXRs. PACE2.0 has the potential to become a valuable tool for clinical decision support and could help healthcare professionals detect pneumonia more accurately.

Objective: Prostate cancer, the second most diagnosed cancer among men, requires precise diagnostic techniques to ensure effective treatment. This review explores the technological advancements, optimal application conditions, and benefits of targeted prostate biopsies facilitated by multiparametric magnetic resonance imaging (mpMRI). Methods: A systematic literature review was conducted to compare traditional 12-core systematic biopsies guided by transrectal ultrasound with targeted biopsy techniques using mpMRI. We searched electronic databases including PubMed, Scopus, and Web of Science from January 2015 to December 2024 using keywords such as “targeted prostate biopsy”, “fusion prostate biopsy”, “cognitive prostate biopsy”, “MRI-guided biopsy”, and “transrectal ultrasound prostate biopsy”. Studies comparing various biopsy methods were included, and data extraction focused on study characteristics, patient demographics, biopsy techniques, diagnostic outcomes, and complications. Conclusion: mpMRI-guided targeted biopsies enhance the detection of clinically significant prostate cancer while reducing unnecessary biopsies and the detection of insignificant cancers. These targeted approaches preserve or improve diagnostic accuracy and patient outcomes, minimizing the risks associated with overdiagnosis and overtreatment. By utilizing mpMRI, targeted biopsies allow for precise targeting of suspicious regions within the prostate, providing a cost-effective method that reduces the number of biopsies performed. This review highlights the importance of integrating advanced imaging techniques into prostate cancer diagnosis to improve patient outcomes and quality of life.

BackgroundSotos syndrome (SoS) is a rare overgrowth genetic disease caused by intragenic mutations or microdeletions of the NSD1 gene located on chromosome 5q35. SoS population might present cognitive impairment and a spectrum of behavioral characteristics, with a worse profile in patients with microdeletion. Although patients with SoS are known to have impaired sleep habits, very little data are available. The present study aimed to assess the prevalence of sleep disorders (SDs) in a pediatric cohort of patients with SoS and their correlation with neuropsychiatric profiles.MethodsWe included patients with a SoS diagnosis and age

Abstract Introduction The aim of this retrospective study was to investigate the clinicopathological characteristics of AYA sarcomas and their clinical outcomes at a high‐volume single center. Methods Demographic, clinicopathological data on the diagnosis, treatment and follow‐up of all sarcoma patients aged 16–39 years (ys) observed at our Institute between January 2010 and December 2021 were retrospectively collected, including diagnostic (TTD) and treatment delay(TTT), clinical outcomes (OS and PFS), and late‐treatment effects. Results We identified 228 AYA patients, median age 30 years, 29% ≤ 25 years, 57% males, 88% soft tissue sarcomas (STS), and 12% bone sarcomas (BS). Among STSs, 13% were small round cell tumors (SRCT), 52% intermediate–high‐grade, 24% low‐grade STSs. Among BS, 32% were high‐grade. Median TTD and TTT were 120 (0–8255) and 7 days (0–83), respectively. Surgery was performed in 83%, radiotherapy in 29%, and systemic therapy in 27%. Median follow‐up was 72.9 months(1.6–145), 5‐year and 10‐year OS were 78.5% and 62%, respectively. Kaplan–Meyer analysis showed a significantly better 5‐year OS and PFS for patients with >92 days of TTD (OS 85.7% vs. 66.7%, p = 0.001, PFS 50.2% vs. 24.9%, p = 0.009). According to age (≤25 years vs. > 25 years), 5‐year OS was 69.8% versus 82.2%, respectively (p = 0.047). Conclusion Our analysis confirmed previous data on sarcoma AYA patients followed in a referral center. Unexpectedly, diagnostic delay was not associated with poor OS and PFS. Patients

Painting materials used in Spanish American Colonial art comprised pigments and binders from European origin as well as those that were already known in pre-Hispanic times. In recent years, we have identified for the first time the mineral atacamite, a basic copper chloride (Cu2Cl(OH)3), in Andean Colonial art pieces (Viceroyalty of Peru, 16th–18th centuries). This work proposes a methodology based on a multitechnical approach to identify and establish the origin (natural or synthetic) of the atacamite pigment in Andean cultural heritage objects. Optical microscopy (OM), scanning electron microscopy with energy-dispersive spectroscopy (SEM-EDS), portable X-ray fluorescence spectroscopy (pXRF), attenuated total reflection infrared spectroscopy (FTIR-ATR), micro-Raman spectroscopy, and wide-angle X-ray scattering (WAXS) were applied to analyse green pigments from the altarpiece of the Church of Ancoraimes, atacamite mineral samples from Chile, and atacamite obtained as a secondary product from traditional recipes used to produce verdigris, a copper acetate. Viride salsum by Teófilo Presbítero (SXII) and the Spanish translation by Andrés de Laguna (1566) of “De Materia Médica” from Dioscorides are both texts that include recipes involving the use of metallic copper as a starting material. These studies will contribute to the history of Spanish American Colonial art and to the knowledge on technological capacities and skills in the Andean region during this period.