Azienda Unita' Sanitaria Locale Di Modena

BackgroundTherapeutic hypothermia (TH) is the standard treatment for moderate to severe hypoxic–ischemic encephalopathy (HIE), yet pain assessment during TH remains challenging. This study compares two validated pain scales in asphyxiated newborns undergoing TH and receiving fentanyl analgesia.MethodsTwenty term infants with HIE treated with TH were enrolled. Pain was assessed using EDIN and N-PASS, while sedation was monitored using the N-PASS sedation subscale.ResultsN-PASS pain and sedation scores significantly decreased by day 3, whereas EDIN scores showed no significant temporal change. Effective analgesia significantly increased over time, either when defined based on EDIN (OR 3.12, p = 0.002) and on N-PASS (OR 3.06, p = 0.007), while N-PASS sedation did not show a time-dependent association. No scale showed a significant association with fentanyl dosage. A moderate positive correlation was found between EDIN and N-PASS pain scores (r = 0.409, p < 0.001). Sedation targets were achieved in only 40%–50% of assessments, with early undersedation and later oversedation observed.ConclusionsEDIN and N-PASS pain scores demonstrate moderate concordance, but capture different dimensions of neonatal pain during TH. N-PASS appears more sensitive to temporal changes, likely due to its combined behavioral and physiological components, whereas EDIN may be affected by hypothermia-related behavioral suppression.

Sepsis and septic shock remain major causes of morbidity and mortality worldwide, and management is largely based on source control, antimicrobial therapy, and supportive care. Despite limited high-quality evidence, adjunctive therapies targeting the dysregulated host response involving immune dysfunction, coagulopathy, and endothelial injury, steroids, vasopressors, and adjunctive therapies are frequently used in clinical practice. This survey aimed to describe real-world patterns of sepsis therapy across Europe. We conducted an open, web-based, multinational survey endorsed by the European Society of Intensive Care Medicine (ESICM) and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). The survey was distributed through professional mailing lists, newsletters, and national society networks. A structured 30-item questionnaire collected information on respondent demographics, ICU characteristics, availability of adjunctive therapies, clinical indications, triggers for initiation, and duration of treatment. Participation was voluntary and anonymous. A total of 442 physicians completed the survey. Data were analyzed descriptively and are presented as proportions and frequencies. More than 80% of respondents reported use of at least one adjunctive therapy for septic shock within the previous year. Corticosteroids were used by over 90% of clinicians, predominantly hydrocortisone for septic shock. Considerable variability was observed regarding indications, timing of initiation, and duration of therapy. Extracorporeal blood purification techniques were used by approximately 75% of respondents, most frequently hemoadsorption in patients with refractory shock; high cost and limited availability were the main barriers to broader implementation. Intravenous immunoglobulins were used by approximately one-third of clinicians, often guided by measured immunoglobulin levels or perceived immune dysfunction. Additional vasoactive and inotropic agents, including levosimendan, methylene blue, and beta-blockers, were employed in selected cases. In contrast, specific immunomodulatory therapies such as interleukin (IL)-1receptor antibodies were rarely used. Across all adjunctive strategies, marked heterogeneity in practice patterns was evident. Adjunctive therapies are widely used in European ICUs, particularly in patients with severe or refractory sepsis, despite limited supporting evidence. The substantial variability in practice highlights ongoing clinical uncertainty and underscores the need for well-designed randomized trials to inform evidence-based and individualized treatment strategies.

Understanding patient experiences with opioid substitution treatment (OST) is critical to developing more personalized and responsive care strategies. This study employed latent class analysis (LCA) to: (1) identify subgroups of patients based on their perceptions and satisfaction with OST; (2) examine differences across subgroups in clinical outcomes and interest in novel formulations (methadone tablets, weekly/monthly buprenorphine depot, buprenorphine implant); (3) assess associations with individual and treatment-related factors; and (4) explore class-specific risk and protective factors. A total of 280 individuals (79% male; mean age=46.9years) receiving OST (methadone syrup=78%; sublingual buprenorphine tablets=22%) at six public addiction services in Italy completed an anonymous questionnaire. The survey assessed sociodemographics, current OST type and adherence, treatment perceptions and overall satisfaction, treatment duration, recent substance use and OST misuse, interest in novel formulations, motives for switching, and recovery capital (BARC-10). LCA identified three subgroups: Satisfied yet burdened, Satisfied and engaged, and Not experiencing benefit. The Not experiencing benefit class showed low satisfaction and limited perceived effectiveness with OST, high recent heroin and cocaine use, shorter treatment duration, and lowest recovery capital, with living alone emerging as a key risk factor. The Satisfied yet burdened class reported high satisfaction with OST but significant stigma and burden; recovery capital was positively linked to age and employment; living alone and higher education were associated with cocaine use; heroin use was higher among those receiving methadone syrup. The Satisfied and engaged class showed the highest satisfaction with OST, longer treatment, and appreciation for clinical contact; living alone remained the main risk factor, associated with heroin use. Methadone tablets were preferred by those on methadone syrup across all classes. Interest in monthly buprenorphine depot was highest in the Satisfied yet burdened class, especially among women and those on sublingual buprenorphine. The implant was favored in the Satisfied and engaged class by men with higher education. Individuals living alone in the Not experiencing benefit class showed the lowest interest in long-acting options. Findings highlight the importance of tailoring OST delivery to distinct patient profiles to enhance engagement, reduce unmet needs, and support long-term recovery.

In recent years, Forensic DNA Phenotyping (FDP) has emerged as an innovative "DNA intelligence approach" aimed at predicting externally visible individual characteristics from biological traces collected at crime scenes or from biological samples of unidentified corpses or skeletal remains. This study aims to analyse the allele frequency distribution of genetic markers involved in the prediction of eye and hair colour in an Italian population sample, to enhance the existing European dataset. A large cohort of Italian individuals with at least three generations of ancestry was recruited, ensuring representation of phenotypic variability. The 24 SNP markers included in the HIrisPlex panel were analysed using SNaPshot sequencing technique, and the genotypic data were uploaded to the FDP web tool validated for forensic use by the international VISAGE Consortium's. This tool provides prediction probabilities for three eye colour categories (blue, brown, and intermediate) and four hair colour categories (black, blonde, brown, and red). The results confirmed a high predictive accuracy for the Italian population as well; however, the complex genetic structure of intermediate phenotypic traits highlights the need for novel prediction models that include genetic markers associated with complex phenotypes. The strong north-south European gradient in eye colour, along with the hypothesis that variation in eye colour is associated with skin pigmentation and UV environmental adaptation, underscores the importance for further research. These should focus on novel genetic markers to refine the European dataset, in which the Italian population may be included to enhance the accuracy of predictive models.

Evidence directly comparing ocrelizumab (OCR) and ofatumumab (OFA) after sphingosine-1-phosphate receptor modulators (S1PRMs) withdrawal is limited, even though this transition period carries an increased risk of disease reactivation and the two anti-CD20 agents differ in molecular properties that may influence post-S1PRM outcomes. We compared effectiveness, safety, and tolerability of OFA versus OCR in relapsing-remitting multiple sclerosis (RRMS) after S1PRM therapy. We retrospectively analyzed adult (> 18 years) patients with RRMS from 23 Italian centers who switched from S1PRMs to OCR or OFA (October 2016 to July 2024). Clinical outcomes included annualized relapse rate (ARR), cumulative relapse incidence, confirmed disability progression (CDP), progression independent of relapse activity (PIRA), confirmed disability improvement (CDI), and variation in the expanded disability status scale score (ΔEDSS) from baseline to last follow-up. Magnetic resonance imaging (MRI) outcomes included time to overall MRI activity, new/enlarging T2 lesions, and new T1 Gd-enhancing lesions. Persistence on anti-CD20 and safety were also assessed. We applied inverse probability of treatment weighting (IPTW) to balance baseline covariates, and used Cox, Andersen-Gill, and regression models, further adjusted for variables with residual imbalance, to compare outcomes. We included 225 subjects (mean age 43.3 ± 10.6 years; OCR = 131, OFA = 94), with a median follow-up of 33 months. After IPTW, groups were well balanced. Compared with OCR, OFA was associated with lower ARR (adjusted relative risk [aRR] 0.22, 95% CI 0.06-0.86, p = 0.030) and relapse hazard (adjusted hazard ratio [aHR] 0.21, 95% CI 0.05-0.83, p = 0.026). When restricting washout to ≤ 10 weeks and applying spline-based Andersen-Gill models, results remained consistent, with OFA showing a lower relapse risk than OCR across short-to-intermediate washout intervals. CDP hazard was lower (aHR 0.38, 95% CI 0.15-0.94, p = 0.038), while PIRA and CDI did not differ. ΔEDSS favored OFA (adjusted mean difference [aMD] -0.26, 95% CI -0.51 to -0.02, p = 0.046). OFA showed a lower hazard of overall MRI activity (aHR 0.41, 95% CI 0.19-0.92, p = 0.030), with similar risk for new T1 Gd+ lesions. A sensitivity analysis restricted to patients who switched to OFA or OCR during the same availability window yielded results consistent with the primary analysis. Treatment persistence was shorter on OFA, but absolute discontinuation rates were low in both groups. Severe AEs were rare and did not differ. In S1PRM-exposed RRMS, OFA was associated with reduced relapse risk, disability accumulation, EDSS worsening, and MRI activity compared with OCR, with overall good tolerability and safety.

ObjectiveThis study aimed to develop a consensus of expert opinion on the quality standards of care and outline management best practices for pulmonary arterial hypertension (PAH) in SSc and other CTDs.MethodsTwenty physicians and four nurse practitioners (NPs) managing patients with CTD-PAH (including SSc-PAH) from six European countries participated in a modified Delphi panel. Consensus was defined as ≥80% agreement among the physicians.ResultsThe importance of a multimodal approach to screening and early detection of PAH through combining echocardiography, biomarker tests and symptom evaluation was emphasised. Consensus agreement was also reached on the usefulness and increased access of echocardiography for optimising screening and early detection processes, noting the importance of cardiology expertise for accurate assessment of right-heart variables. Panellists reached consensus agreement on the importance of a multidisciplinary approach to managing SSc- and other CTD-PAHs through collaboration between rheumatologists and pulmonary hypertension (PH) specialists, NPs and patients. Rheumatologists aligned on the usefulness of the DETECT screening algorithm, whereas cardiologists and pulmonologists remained divided, with consensus not being reached, thus highlighting the lack of agreement regarding the relevance of a stepwise approach. Similarly, no consensus was reached on the impact of the new haemodynamic definition of PH in CTD-PAH management, where greater evidence is required.ConclusionsConsensus was reached on key recommendations for optimising CTD-PAH management, including the standardisation of multimodal screening and promotion of closer collaboration between healthcare specialties and patients.

Core stability is essential for maintaining postural alignment and preventing injuries during athletic activities. A growing body of literature suggests that structured core stability programs can reduce the risk of both upper and lower limb injuries across various sports. However, the evidence remains scattered and inconsistent, particularly regarding specific populations and sports contexts. This scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported according to the PRISMA-ScR guidelines. A comprehensive literature search was carried out across MEDLINE (via PubMed), Cochrane Library, PEDro, Scopus, and grey literature databases. Studies were included if they investigated the impact of core stability training on injury prevention in athletic populations, using the PCC (Population, Concept, Context) framework. Data extraction focused on participant characteristics, interventions, outcomes, and conclusions. Five randomized controlled trials (RCTs) met the inclusion criteria. The studies involved athletes aged 8 to 58 years across six sports disciplines (soccer, Gaelic football, basketball, volleyball, gymnastics, and swimming). All included interventions demonstrated positive outcomes in reducing injury incidence, improving neuromuscular control, and enhancing dynamic stability. However, variability in training protocols and methodological quality limited cross-study comparability. Most interventions were low-cost, equipment-free, and feasible in both team and individual settings. Core stability training shows strong potential as a preventive strategy in sports injury management. Despite the variability among existing studies, the consistent positive effects suggest the need for broader integration into routine athletic training. Future research should aim to standardize protocols and explore long-term efficacy across diverse athletic populations.

Methylphenidate is the primary pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD), yet approximately 30% of patients show a poor clinical response. Currently, no reliable biomarkers exist to predict which patients will benefit from treatment. Emerging evidence suggests that methylphenidate-induced increases in blood pressure are associated with improvements in attention and underlying neurobiological mechanisms. Blood pressure could thus serve as a low-cost, accessible predictor of methylphenidate response. The aim of this study was to explore whether acute changes in vital signs-specifically blood pressure and heart rate-after a single methylphenidate dose can predict clinical response after six months of treatment in children and adolescents with ADHD. The final sample consisted of N = 171 children and adolescents (M:F = 148:23; mean age = 9.83 ± 2.61 years, range = 5.27-16.17) diagnosed with ADHD, and ADHD symptoms were assessed using the SNAP-IV. In this context, data on vital parameters and severity of symptoms made during the first single-dose methylphenidate administration and at 6-month methylphenidate monotherapy were retrieved from patients' medical records. Our findings showed that greater increases in blood pressure during the first methylphenidate administration were associated with greater symptom reduction over time (Inattention: β = 0.202, t = 2.452, p = 0.015; Hyperactivity/Impulsivity: β = 0.225, t = 2.743, p = 0.007; Combined: β = 0.233, t = 2.837, p = 0.005). These results suggest that early cardiovascular response may serve as a low-cost, accessible predictor of treatment efficacy, supporting more individualized approaches to ADHD pharmacotherapy.