ASST Melegnano e della Martesana

Background/Objectives: Suicide is the second leading cause of death among adolescents and young adults. Those suffering from psychiatric illnesses are at particular risk. Our study, conducted at an outpatient mental health facility in Northern Italy, aimed at delineating demographic and psychopathological features of youths aged 16–29 who attempted suicide and were referred to our community-based outpatient service. Methods: We identified 63 subjects, most of whom suffered from personality disorders, mood disorders, and schizophrenia spectrum disorders. Analysis of variance and post hoc pairwise comparisons were performed. Results: Inferential analysis yielded significant results in terms of age at index suicide attempt across diagnostic groups. Patients with personality disorders attempted suicide at a younger age (M = 18.70) compared to those with schizophrenia spectrum disorders (M = 23.64; η2 = 0.32). Conclusions: Our findings highlighted the period of transition from adolescence to adulthood as a stress on the need of preventive approaches towards suicidality in young people in both clinical and non-clinical settings. Moreover, the difference of age at index suicide attempt across different diagnostic groups stresses the need for tailored clinical interventions based on the specific psychopathological trajectories and natural histories of the diseases.

ABSTRACTGeneral Background: Maternal mortality is associated with obstetric complications, including postpartum hemorrhage caused by birth canal trauma. Specific Background: Perineal rupture occurs in approximately 75% of vaginal deliveries in Indonesia and is associated with parity, maternal age, fetal weight, and perineal elasticity. Perineal massage using virgin coconut oil (VCO) is considered a nonpharmacological approach to maintain tissue flexibility. Knowledge Gap: Empirical evidence examining VCO-based perineal massage for preventing perineal rupture remains limited. Aims: This study evaluated perineal massage with VCO for preventing perineal rupture among pregnant women. Results: A quasi-experimental post-test only non-equivalent control group design involving 56 pregnant women at 34–38 weeks of gestation was conducted. The intervention group received weekly 10-minute massage. The intervention group showed 64.3% without rupture, while 70.4% of the control group experienced rupture, with a significant association (p = 0.021; OR = 0.234). Novelty: This study provides clinical evidence supporting VCO-based perineal massage as an antenatal preventive method. Implications: Integration of this technique into antenatal care may support safer vaginal delivery and reduce birth canal trauma. Highlights: Weekly Intervention Beginning at 34 Weeks Shows Lower Incidence of Birth Canal Tearing. Participants Receiving the Procedure Demonstrated Higher Rates of Intact Tissue During Delivery. Statistical Testing Identified a Significant Association Between Antenatal Manual Therapy and Tissue Integrity Outcomes. Keywords: Perineal Rupture, Virgin Coconut Oil, Antenatal Care, Birth Canal Trauma, Maternal Delivery Outcomes

Stage IV lung cancers are often characterized by widespread systemic metastases, including pleural and cardiac sites. We report the case of a 67-year-old man admitted for suspected advanced lung cancer with bilateral pleural and pericardial effusion. Echocardiography revealed an intracardiac mass with heterogeneous echogenicity (hypo/isoechoic) adherent to the anterior wall of the right ventricle, associated with mild impairment of right ventricular systolic function and a mild-to-moderate pericardial effusion without clinical signs of tamponade. Whole-body positron emission tomography (PET) confirmed hypermetabolic pulmonary nodules and widespread secondary lesions, including myocardial involvement. This case highlights the crucial role of integrated imaging techniques, particularly the combination of echocardiography and PET, in the early detection of cardiac metastases. A multidisciplinary approach, involving oncologists, cardiologists, and radiologists, was fundamental to define an accurate clinical framework and the appropriate therapeutic strategy. Unfortunately, the premature death limited the possibility of targeted therapy. Advanced imaging modalities are confirmed to be essential for the personalized management of complex oncologic patients.

Background: Neuraxial anesthesia (NA) is increasingly utilized across various surgical specialties, particularly for abdominal procedures, making it a potential alternative to general anesthesia (GA). Methods: This narrative review was conducted following the PRISMA guidelines for systematic reviews to report on the application of NA worldwide and across various surgical fields. Results: The findings indicate that while NA is gaining popularity, its adoption varies significantly by procedure type and specialty. Evidence supporting its use in major abdominal surgeries remains limited, with most studies focusing on pelvic and minor procedures. The emerging concept of awake surgery under NA shows promising potential, as preliminary data suggest benefits in reducing perioperative morbidity and enhancing recovery. Despite these advancements, gaps in the literature highlight the need for further high-quality trials to establish NA as a safe and routine alternative to GA. Conclusions: NA is increasingly explored across different surgical specialties as a feasible and effective option for abdominal procedures. However, despite this growing interest, solid evidence supporting its use in major abdominal surgery remains limited.

Hospitalised patients with eating disorders (EDs) often present with severe malnutrition, electrolyte imbalances, and metabolic complications that require specialised nutritional approaches. This consensus aimed to develop evidence-informed, expert-driven recommendations for the nutritional management of hospitalised patients with EDs, addressing risk stratification, caloric progression, refeeding protocols, formulation selection, supplementation and long-term monitoring. An eight-expert panel conducted a modified Delphi process in two online rating rounds. One hundred six statements were formulated across 12 thematic sections and evaluated on a 5-point Likert scale (≥85% accepted, 80%-84.9% revised, <80% rejected). Revised statements were re-evaluated in Round 2 and, if necessary, finalised at an online meeting. Of the 106 original statements, 89 (84.0%) reached immediate consensus, 14 (13.2%) required revision, and three (2.8%) were eliminated. Ten revised statements exceeded the ≥85% threshold in Round 2, one was rejected, and three 'pending' statements were approved in a conclusive online meeting. The final statements span key domains of inpatient care of EDs, including comprehensive nutritional assessment, stepwise refeeding regimens, careful electrolyte and biochemical monitoring, personalised approaches for those at high risk of refeeding syndrome and tailored considerations for paediatric and perinatal populations. The final consensus statements provide a structured framework for the nutritional rehabilitation of hospitalised patients with EDs, emphasising balanced yet flexible refeeding protocols, vigilant metabolic monitoring, ethical considerations in limited-capacity cases, and continuity of care through discharge and relapse prevention. By aligning clinical practice with specialist insight and existing guidelines, these recommendations aim to standardise and enhance inpatient ED management.

Physical Restraint (PR) is a coercive procedure used in emergency psychiatric care to ensure safety in life-threatening situations. Because of its traumatic nature, studies emphasize the importance of considering the patient’s subjective experience. We pursued this aim by overcoming classic qualitative approaches and innovatively applying a multilayered semiautomated language analysis to a corpus of narratives about PR collected from 99 individuals across seven mental health services in Italy. Compared to a reference corpus, PR narratives were characterized by reduced fluency and lexical density, yet a greater use of emotional and cognitive terms, verbs, and first-person singular pronouns. Sadness was the most represented emotion, followed by anger and fear. One-third of the PR narratives contained at least one metaphor, with Animals and War/Prison as the most distinctive source domains. The quality and length of the PR experience impacted both the structure and the sentiment of the narratives. Findings confirm the distressful nature of PR but also point to the use of various linguistic mechanisms which might serve as an early adaptive response toward healing from the traumatic experience. Overall, the study highlights the importance of Natural Language Processing as an unobtrusive window into subjective experience, offering insights for therapeutic choices.

Endopelvic migration of the acetabular prosthetic component is an uncommon but serious complication in hip replacement. When the medial acetabular wall is perforated, intrapelvic injuries may occur. In such cases, the external iliac artery and bladder are the most commonly involved structures. In this case three main sources of potential problems that emerge from preoperative assessment must be taken into account: presence of infection with periprosthetic collection, significant lymphedema in the lower extremities complicated by the presence of ulcerative lesions in both legs, and vascular involvement with the presence of a pseudoaneurysm of the external iliac artery. In order to minimize the surgical risks presented by explanation of the prosthesis, interventional angiography should be conducted, which can reveal the previously undiagnosed pseudoaneurysm and allow positioning of a covered stent to protect the vessel. Placement of a vascular covered stent before explanation of the acetabular component offers a two-fold advantage: i.e. to secure this important blood vessel before surgery and allow a less invasive approach, which is of particular relevance when taking into account the precarious situation of soft tissues.