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Background and Aims: We aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. Methods: This was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. Results: Of 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. Conclusions: CHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN.

The red–legged partridge Alectoris rufa lives in a situation of potential conservation risk for its long–term preservation in Italy as its habitat is increasingly threatened by the disappearance of traditional agriculture–related environments. In such a situation, it is important to use effective and appropriate monitoring methods to assess population changes over time and to identify potential conservation threats. The objective of this study was to evaluate the effectiveness of the playback method to estimate the density of calling males. We compared playback method with spontaneous calling of males at dawn and direct observations along transects. The results on raw count data of playback counts revealed a strong underestimation rate compared to the method that gave the best results: count of spontaneous calls at dawn. Our study provides a critical evaluation of a method that is widely used even though data about its effectiveness are scarce. Our data do not evaluate detection probability of the three methods. Our aim was only to evaluate which methods give the best results in term of population size estimation under the same field condition (same population density, same period, same monitoring area). The results raise some doubts about the ability of the playback method to monitor red–legged partridge populations. The implications of our results for red–legged population management are discussed.

A 70-year-old Italian man presented to our emergency department for dyspnea and confusion. He was affected by diabetes mellitus type 2, but he stopped his medication 10 years before. At admission, his vital signs were blood pressure of 60/50 mmHg, heart rate of 130 bpm, peripheral oxygen saturation of 94% in the Venturi Mask FiO2 40%, respiratory rate of 40/min, and body temperature of 36°C. Physical examination revealed hypoperfusion with a high Mottling Score and dark stools with a positive hydrogen peroxide reaction. He denied abdominal pain, nausea, and vomiting. Laboratory findings showed leucocytosis (White Blood Cells, WBC, 31,580/mm3; N 91.6%), Hemoglobin (Hb) 14.5 g/dL, Hematocrit Test (Hct) 49%, hyperglycaemia (>700 mg/L), and normal coagulation time. Arterial blood gas documented a metabolic acidosis with pH 6.95, Partial Pressure of Carbon Dioxide (pCO2) 27.5 mmHg, HCO3 7.1 mmol/L, lactate 8.14 mmol/L (normal value

Historic volcanic activity in Tenerife was concentrated within two of the island’s three dorsals and on the Teide-Pico Viejo complex located inside Las Cañadas caldera. Eruptions on the island are primarily characterised by basaltic and trachybasaltic fissural eruptions. However, the Teide-Pico Viejo complex also hosted explosive and effusive phonolitic eruptions. Our study focused on the analysis of the 2004–2005 unrest in Tenerife, which was characterised by an onset of a ground deformation pattern, heightened on-land seismic activity, changes in the chemical composition of fumaroles of the Teide composite volcano, an increase in diffusive emissions of carbon dioxide along the NW rift, and, significant gravity changes. We used the Envisat-ASAR satellite images from 2003 to 2010 to generate the Line-Of-Sight SBAS-DInSAR deformation time series to investigate the source responsible for ground deformation. We applied the Independent Component Analysis (ICA) to separate distinct ground deformation patterns. Specifically, we selected four components for the Independent Component Analysis decomposition: the first one mainly affects the stratovolcano’s summit region of Teide and shows a circular symmetry; the second and third components are possibly related to the topography and atmospheric artifacts, while the fourth contains only a noisy signal. We employed a non-linear optimisation approach in a Finite Element modelling environment to determine the source geometry responsible for the first identified ICA pattern of ground deformation within Las Cañadas. Our results revealed the existence of an ellipsoidal ground deformation source oriented along the E-W axis, located beneath the Teide and Montaña Blanca volcanoes at 1,600 m a.s.l. This source became active during the seismic crisis of 2004–2005, which was associated with the degassing of a magma batch that intruded into the northwest rift of Tenerife island. We propose that the ground deformation observed at Teide volcano during the 2004–2005 crisis was related to hydrothermal activity within the volcano.

Abstract At the beginning of the COVID-19 pandemic, fears grew that making vaccination a political (instead of public health) issue may impact the efficacy of this life-saving intervention, spurring the spread of vaccine-hesitant content. In this study, we examine whether there is a relationship between the political interest of social media users and their exposure to vaccine-hesitant content on Twitter. We focus on 17 European countries using a multilingual, longitudinal dataset of tweets spanning the period before COVID, up to the vaccine roll-out. We find that, in most countries, users’ endorsement of vaccine-hesitant content is the highest in the early months of the pandemic, around the time of greatest scientific uncertainty. Further, users who follow politicians from right-wing parties, and those associated with authoritarian or anti-EU stances are more likely to endorse vaccine-hesitant content, whereas those following left-wing politicians, more pro-EU or liberal parties, are less likely. Somewhat surprisingly, politicians did not play an outsized role in the vaccine debates of their countries, receiving a similar number of retweets as other similarly popular users. This systematic, multi-country, longitudinal investigation of the connection of politics with vaccine hesitancy has important implications for public health policy and communication.

Abstract On Sept. 19th, 2021, the largest historical eruption on the island of La Palma began, which had a significant scientific, social, and economic impact. The 2021 Tajogaite eruption was characterised by short precursors, lasting only 8 days. The seismicity started on Sept. 11th with a westward and upward migration of hypocenters. Permanent GNSS stations started recording deformation on Sept. 12th on the island's western side, which reached more than 15 cm just before the eruption. After the eruption onset, the ground deformation increased, reaching a maximum on Sept. 22nd and showing a nearly steady deflation trend in the following months. To better understand the dynamics of the eruption, we exploited a joint dataset of GNSS and Sentinel-1 SBAS time series along both ascending and descending orbits. To obtain the geometry of the causative source of the ground deformation, we combined the result of a preliminary non-linear inversion and the precise location of the seismicity. The resulting geometry of the source is that of a twisted dike bending eastward. We performed inverse modelling to obtain the spatiotemporal kinematics of the opening function of the dike. The forward modelling has been realised using a 3D finite-element approach considering the island's topography. Our findings reveal a close correspondence between the magmatic intrusion and pre-eruptive seismicity. The ascent of the magma occurred along two branches, and the rheology of a previously identified ductile layer strongly affected the magma propagation process. Finally, we found evidence of an early shallow deformation, which we interpret as the effect of ascending hydrothermal fluids. Our findings highlight the need for advanced modelling to understand pre-eruptive processes in basaltic volcanoes.

This paper examines the role of the World Organisation for Animal Health (WOAH) in the global surveillance and management of pathogens. Since the creation of WOAH, one of its missions has been to ensure transparency of the global animal health situation. WOAH established a Working Group on Wildlife in 1994 to inform and advise WOAH Members, leadership, and technical teams on issues relating to wildlife health. In 2020 it conducted a consultation with its Members before developing a Wildlife Health Framework to improve global health and wildlife conservation. WOAH Members report diseases in wildlife, but detections are dependent on the surveillance systems in place. As an example of data collected in the most recent years (2019–2023), 154 countries have reported 68,862,973 cases, through alert messages and weekly updates, for 84 diseases. One-hundred and fifty countries have reported 68,672,115 cases in domestic animals and 95 countries have reported 190,858 cases in wild animals. These figures illustrate the performance of the organization in collecting data on wildlife, and provide an indication of the difference in completeness of data collected in domestic animals and wildlife. There are several challenges to wildlife disease surveillance and real figures remain unknown; they depend on the existence, quality and sensitivity of national surveillance. A WOAH-led One Health approach with cross-sectoral collaboration is needed to improve surveillance sensitivity, address the challenges and help safeguard wildlife population health and biodiversity conservation.

In the summer of 2008, the fat dormouse (Glis glis Linnaeus 1766), pest animal in the Langhe agricultural territory (Province of Cuneo, Italy), was studied with the aim of understanding its night invasion and feeding exploitation capacity on hazel orchards, in order to assess the resulting loss of marketable hazelnuts. Using 9 hazel orchards as study samples, dormice density, damage in cultivations and exploitation time were calculated and the results obtained were correlated. Damages happened mainly between July (when fruits start to grow) and late August (when fruits are harvested). Density (estimated by 18 nocturnal survey sessions) reached values between 4.13 and 247 vocalizing animals/hectare in the central hours of the night. The fruits loss, evaluated taking into consideration 33 plots placed inside the cultivations, accounted for 61% of the total of collected hazelnuts. Density and damage values were connected with the physical features of hazel orchards, their position in relation to wooded areas and the study period.

In the Maritime Alps (northwestern Italy), we collected ticks from vegetation and Alpine ibex (Capra ibex). Ixodes ricinus was the most abundant species in the study area, questing up to 1824 m a.s.l. and infesting 28 out of 72 ibexes. Haemaphysalis punctata, H. sulcata and Dermacentor marginatus were also collected. The abundance of questing ticks significantly decreased with altitude, with beechwoods being the preferred habitat. By PCR, we identified Borrelia burgdorferi s.l. in questing I. ricinus (28.3%; 95%CI: 19.4–38.6) but not in specimens collected from animals. Rickettsia spp. infected both questing (20.6%; 95%CI: 12.9–30.3) and on-host (30.2%; 95%CI: 21.2–40.4) I. ricinus. Anaplasma phagocytophilum was detected in 4.3% (95%CI: 1.2–10.8) of questing I. ricinus and in 45.3% (95%CI: 34.6–56.4) of I. ricinus collected from ibex. Female I. ricinus collected on animals were significantly more infected with A. phagocytophilum than females collected from vegetation (OR = 11.7; 95%CI: 3.8–48.1). By amplifying and sequencing a fragment of the groEL gene, we identified 13 groEL haplotypes, clustering with ecotypes I and II; ecotype I, prevalent in our sample, is considered zoonotic. Our study demonstrates the presence of different tick-borne zoonotic agents in the study area, encompassing a wide altitudinal range, as confirmed by the ticks found on ibex, a typical mountain-dwelling mammal. The results also confirm the altitudinal range expansion of ticks and associated pathogens in the Alps and suggest that Alpine ibex may act as a reservoir for A. phagocytophilum, as do other wild ungulate species.

Phytophthora cinnamomi is a devastating soil-borne plant pathogen. The primary source of P. cinnamomi infection is the soil, where the pathogen can persist for long periods. Effective prevention and management of this pathogen in tree crops requires an early and reliable detection method. In this study, we developed a simple, fast, reliable, and sensitive method based on real-time quantitative PCR (qPCR) for P. cinnamomi detection and quantification directly in plant or soil samples. Primers were developed targeting the nuclear single-copy ras-related protein gene Ypt1, suitable for Phytophthora-specific PCR. The specificity of the assay was confirmed by testing it against genomic DNA from 50 isolates across eight different Phytophthora clades, including the very similar P. parvispora. The efficiency and reliability of the qPCR protocol were evaluated in challenging environmental samples, such as plant tissue of different host trees (walnut, chestnut, oak) and naturally infected soils in walnut orchards. The main outcome was the development of a qPCR method for the specific identification and quantification of P. cinnamomi in natural soil samples. Additionally, this study established a systematic and repeatable soil sampling method and developed an efficient soil DNA extraction technique to apply the developed qPCR in naturally infested soils of walnut orchards.

Abstract Background Most countries around the world enforced non-pharmaceutical interventions against COVID-19. Italy was one of the first countries to be affected by the pandemic, imposing a hard lockdown, in the first epidemic wave. During the second wave, the country implemented progressively restrictive tiers at the regional level according to weekly epidemiological risk assessments. This paper quantifies the impact of these restrictions on contacts and on the reproduction number. Methods Representative (with respect to age, sex, and region of residence) longitudinal surveys of the Italian population were undertaken during the second epidemic wave. Epidemiologically relevant contact patterns were measured and compared with pre-pandemic levels and according to the level of interventions experienced by the participants. Contact matrices were used to quantify the reduction in the number of contacts by age group and contact setting. The reproduction number was estimated to evaluate the impact of restrictions on the spread of COVID-19. Results The comparison with the pre-pandemic baseline shows a significant decrease in the number of contacts, independently from the age group or contact settings. This decrease in the number of contacts significantly depends on the strictness of the non-pharmaceutical interventions. For all levels of strictness considered, the reduction in social mixing results in a reproduction number smaller than one. In particular, the impact of the restriction on the number of contacts decreases with the severity of the interventions. Conclusions The progressive restriction tiers implemented in Italy reduced the reproduction number, with stricter interventions associated with higher reductions. Readily collected contact data can inform the implementation of mitigation measures at the national level in epidemic emergencies to come.

Food security is recognized as an inherent human right, enshrined within the principles of the Agenda 2030. The Global Report of Food Crises 2022 points out 193 million people facing severe food insecurity across 53 countries, posing challenges to decision-makers and institutions. Among the many causes of food crises, violent conflict, economic shocks, and environmental pressures are the most influential. In this work, we focus primarily on the conflict-related domain. Finding a stable relationship between conflict and food insecurity is complex for several reasons: first, the relationship is mutually reinforcing; second, the full impact of conflict on food insecurity may take time to have an effect; and third, conflict itself is a multidimensional phenomenon and can include multiple types of violent events. This research set out to comparatively assess the impact of different types of violence on self-reported food insecurity in three prominent food crisis contexts: Burkina Faso, Syria, and Yemen. A measure of food-related classifying events was developed using a rules-based approach. The analysis showed that this approach can effectively code and classify food-related conflict in diverse contexts. By refining the search string, it becomes possible to capture food-related conflict in various food systems. Our findings point out that the new-build measure of food-related conflict is more strongly correlated to subsequent self-reported insufficient food consumption than other forms of violence. The results demonstrate that this relationship is robust across a range of data collection windows and across discrete time periods of analysis. In summary, the research suggests that focusing on the use of food and food systems as tactics in conflict can be highly valuable for understanding and addressing food insecurity.

The nematode Pearsonema plica is a parasite infecting the urinary bladder of carnivores, with a described prevalence ranging from 1 to 90%. This parasite needs earthworms as intermediate host to complete its life cycle, being the red fox (Vulpes vulpes) a definitive host. The objective of this study was to analyse the prevalence and intensity of P. plica in the red fox population from the Region of Murcia (SE Spain), an area with semi-arid Mediterranean climate. The urinary bladder, kidneys and ureters of 167 red foxes were collected at necropsy, opened and observed to detect adult parasites. The influence of host variables (sex, age and body condition using Kidney Fat Index) and environmental variables (Normalized Difference Vegetation Index, Normalized Difference Moisture Index, Bare Soil Index, temperature, radiation, evapotranspiration, precipitation, Corine Land Cover categories and distance to urban areas) were evaluated using a Generalised Linear Model. Moran index was used to evaluate the parasite spatial aggregation. The prevalence found was very low (2.4%; median abundance 0 nematodes per fox; median intensity 7.5 nematodes per parasitized fox), which contrast with those described in other red fox populations in Europe. Environmental variables had a significant influence on the occurrence of P. plica, being NDMI, mean summer precipitation, percentage of forest and agricultural areas positively associated with P. plica abundance. The south-eastern Iberian Peninsula has a semi-arid climate that hinders the development of the life cycle of this nematode, which justifies its occurrence in specific areas where there are the suitable environmental conditions for the presence of earthworms. However, although semi-arid Mediterranean areas do not seem to be favourable carnivores to be parasitized by P. plica, we cannot underestimate the risk that exists in those areas where, either naturally or by human activity, there are environmental factors that favor the presence of this nematode.

Psyllids, members of the family Triozidae, represent a potential threat to the cultivation of solanaceous and apiaceous crops worldwide, mainly as vectors of the phloem-restricted bacterium ‘Candidatus Liberibacter solanacearum’ (Lso). The Lso haplotypes C, D and E are known to affect apiaceous crops, such as carrot and celery, in several European countries. In Italy, data on the incidence and natural spread of both Lso and psyllids have not been reported so far. In this study, the presence of the vectors was investigated in a main Italian district for carrot production, the “Altopiano del Fucino” area (Central Italy). Both occasional and regular surveys were carried out on a total of five carrot fields and one potato field in 2021 and 2022. Bactericera trigonica (Hodkinson), which is known to efficiently transmit Lso to carrots, was found to be well-established in the area. High levels of population density were recorded in the summer period (more than 100 adult specimens per trap caught every two weeks) and then sharply decreased after the carrot harvest, confirming the strict association of this psyllid species with crop availability. In 2022, 27.5% of the total tested psyllid samples resulted in being positive for Lso haplotypes D and E, the latter being prevalent. This survey revealed, for the first time in Italy, the presence of B. trigonica adults associated with Lso in carrot crops. Although this study was limited to a few fields located in one area, it provided important evidence of the risks for Lso outbreaks and prompted further research to assess the spread and incidence of the disease in apiaceous cultivations in Italy.

BackgroundAntivaccination views pervade online social media, fueling distrust in scientific expertise and increasing the number of vaccine-hesitant individuals. Although previous studies focused on specific countries, the COVID-19 pandemic has brought the vaccination discourse worldwide, underpinning the need to tackle low-credible information flows on a global scale to design effective countermeasures. ObjectiveThis study aimed to quantify cross-border misinformation flows among users exposed to antivaccination (no-vax) content and the effects of content moderation on vaccine-related misinformation. MethodsWe collected 316 million vaccine-related Twitter (Twitter, Inc) messages in 18 languages from October 2019 to March 2021. We geolocated users in 28 different countries and reconstructed a retweet network and cosharing network for each country. We identified communities of users exposed to no-vax content by detecting communities in the retweet network via hierarchical clustering and manual annotation. We collected a list of low-credibility domains and quantified the interactions and misinformation flows among no-vax communities of different countries. ResultsThe findings showed that during the pandemic, no-vax communities became more central in the country-specific debates and their cross-border connections strengthened, revealing a global Twitter antivaccination network. US users are central in this network, whereas Russian users also became net exporters of misinformation during vaccination rollout. Interestingly, we found that Twitter’s content moderation efforts, in particular the suspension of users following the January 6 US Capitol attack, had a worldwide impact in reducing the spread of misinformation about vaccines. ConclusionsThese findings may help public health institutions and social media platforms mitigate the spread of health-related, low-credibility information by revealing vulnerable web-based communities.

Background and Objectives: Percutaneous left-atrial appendage (LAA) occlusion is an important therapeutic option for preventing cardioembolic stroke in patients with non-valvular atrial fibrillation (AF) at high risk of thromboembolic events and with contraindications for oral anticoagulation (OAC). It is usually performed with transesophageal echocardiography (TOE) guidance under general anesthesia (GA). In this retrospective study, we present a multicenter experience of LAA occlusion performed with conscious sedation (CS) without an anesthesiologist on site. Materials and Methods: All the patients on the waiting list for LAA occlusion procedure at Infermi Hospital, Rivoli, and San Luigi Gonzaga University Hospital, Orbassano, from October 2018 to October 2022 were analyzed. All the procedures were performed with a Watchman/FLX LAA closure device under TOE and fluoroscopic guidance without an anesthesiologist on site. CS was performed with a combination of midazolam and fentanyl as needed. Results: One-hundred fifteen patients were included (age 76.4 ± 7.6 years, median CHA2DS2Vasc 4.4 ± 1.4). CS was performed using midazolam (mean dose 5.9 ± 2.1 mg), adding fentanyl for thirty-nine (33.9%) patients in case of poor tolerance for the procedure despite midazolam. The acute procedural success rate was 99.1%. We observed seven acute severe complications. No patients needed anesthesiological assistance during the procedure, and no cases of respiratory failure necessitating ventilation were reported. In a follow-up after 10 ± 9 months, one case of stroke (0.9%) and one case (0.9%) of transient ischemic attack (TIA) occurred. Conclusions: LAA occlusion performed under CS and without the presence of an anesthesiologist on site appears to be safe and effective. It can be an attractive alternative to general anesthesia (GA), as fewer resources are required.

In Europe and the Mediterranean region, ‘Candidatus Liberibacter solanacearum’ (Lso) is associated with emerging diseases of Apiaceae crops, mainly carrot. Emergency measures for import of carrot seed were set, requiring seed to be heat-treated at 50°C or tested as Lso-negative by PCR. The germination response to heat treatment was assessed for 24 carrot cultivar and hybrid seed lots. Ten parsley, five fennel, and two celery seed lots were also analysed. Of these 41 seed lots, 21 were Lso-infected. Water heat treatment significantly decreased germinability compared to dry heat treatment, indicating that dry heat treatment is a cheaper and less detrimental procedure. However, the dry heat treatment significantly decreased seed germination compared to untreated controls in four of 24 seed lots of carrot, four of ten parsley seed lots, three of five fennel seed lots, and one of two celery seed lots. For parsley, the heat treatment reduced germinability to a lesser extent in Lso-infected than Lso-free seed lots. These data show that heat treatment can affect the germination of Apiaceae seeds to varying degrees, depending on species or variety, the type of heat treatment, and the sanitary status of the seeds.

Foot and mouth disease was the first disease for which, in 1996, the World Organisation for Animal Health (WOAH; founded as OIE) established an official list of disease-free territories, which has helped to facilitate the trade of animals and animal products from those territories. Since that year, there have been a number of suspensions of FMD-free status which have impacted the livestock industry of the territories affected. The objective of this study is to identify factors associated with the time taken to recover FMD-free status after suspension. Historical applications submitted (between 1996 and the first semester of 2020) by WOAH Members for recognition and recovery of FMD-free status were used as the main source of data. Only FMD-free status suspensions caused by outbreaks were considered. Data on the Member's socio-economic characteristics, livestock production systems, FMD outbreak characteristics, and control strategies were targeted for the analysis. The period of time taken to recover FMD-free status was estimated using Kaplan–Meier survival curves. A Cox proportional hazard model was used to identify factors associated with the time taken to recover FMD-free status after suspension. A total of 163 territories were granted official FMD-free status during the study period. The study sample consisted of 45 FMD-free status suspensions. Africa and the Americas accounted for over 50% of FMD-free status suspensions, while over 70% of these occurred in formerly FMD-free territories where vaccination was not practiced. The study noted that implementing a stamping-out or vaccination and remove policy shortened the time to recover FMD-free status, compared with a vaccination and retain policy. Other variables associated with the outcome were the income level of the Member, Veterinary Service capacity, time taken to implement control measures, time taken until the disposal of the last FMD case, whether the territory bordered FMD-infected territories, and time elapsed since FMD freedom. This analysis will contribute toward the understanding of the main determinants affecting the time to recover the FMD free status of WOAH Members and policy processes for FMD control and elimination.

Trichinella is a foodborne parasite whose wildlife reservoirs are represented by carnivores and omnivores with predatory and scavenger behavior. The aim of the present study was to investigate the occurrence of Trichinella infection in grey wolves (Canis lupus) that recolonized the Western Alps from the end of the past century, and discuss the epidemiological role played by this apex predator in the early phases of its return. During the period 2017–2022, diaphragm samples were obtained from 130 individuals collected in the frame of a wolf mortality survey. Trichinella larvae were found in 15 wolves (11.53%) with a parasite intensity of 11.74 larvae per gram. Trichinella britovi was the only species identified. This is the first prevalence survey of Trichinella in wolves recolonizing the Alps. Results suggest that, in this particular biotope, the wolf has rejoined the Trichinella cycle and has the potential to play an increasingly important role as maintenance host. Arguments in favor and against this perspective are discussed and knowledge gaps highlighted. The calculated Trichinella larval biomass in the estimated wolf population roaming in Northwest Italy will serve as baseline value to explore possible shifts in the relative importance of wolves as Trichinella reservoir within the regional carnivore community. Finally, wolves re-colonizing the Alps already appear as sensitive sentinels to monitor the risk of Trichinella zoonotic transmission by infected wild boar meat.

The insertion of peripheral intravenous (PIV) catheters is one of the most performed invasive procedures in acute healthcare settings. However, peripheral difficult vascular access (PDVA) is not uncommon and can lead to delays in administering essential medications. Ultrasound (US) has emerged as a valuable tool for facilitating PIV cannulation. Advancements in technology have introduced a technique known as bi-plane imaging, allowing the simultaneous display of both longitudinal and transverse views of vessels. We aimed to investigate whether the utilization of bi-plane imaging, as opposed to the single-plane approach, would yield superior results for PDVA in the emergency department (ED). This study was a single-center randomized controlled trial. We included adult patients admitted to the ED who required PIV cannulation. Patients were randomly assigned to undergo cannulation using either the mono-plane or bi-plane approach, both performed by skilled providers. The primary outcome of the study was to compare the first attempt success rates between the two techniques. A total of 442 patients were enrolled, with 221 undergoing cannulation attempts using the mono-plane approach. Successful placement of a functioning PIV catheter was achieved in a single attempt for 313 out of 442 patients (70.8%). There was no significant difference in the success rates between the two study groups: 68.3% in the mono-plane group and 73.3% in the bi-plane group (p = 0.395). The median time required for a successful attempt differed between the groups, with 45 s (range 18–600) in the mono-plane group and 35 s (range 20–600) in the bi-plane group (p = 0.03). Our study confirms that US is a highly effective tool for facilitating PIV cannulation in patients with PDVA presenting to the ED. However, our investigation into the use of bi-plane imaging did not reveal a significant improvement when compared to mono-plane imaging. [ABSTRACT FROM AUTHOR]