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Background: Hyaluronic acid (HA) hydrogels are the most widely used injectable fillers for facial rejuvenation. A new generation of HA fillers crosslinked with poly(ethylene glycol) diglycidyl ether (PEGDE) has been developed to enhance cohesiveness, tissue integration, stability, and longevity while minimizing swelling and immunogenicity. Owing to their distinct viscoelastic properties, PEGDE-crosslinked HA fillers may require product-specific selection and adapted injection techniques. Objective: The objective of this study is to provide practical, expert-based recommendations for the safe and effective use of PEGDE-crosslinked HA hydrogels in facial aesthetic treatments. Methods: A multidisciplinary panel of nine Italian experts in aesthetic medicine, each with more than 15 years of experience using HA fillers, developed consensus recommendations based on clinical practice and available evidence. A pre-meeting questionnaire informed structured discussions during a face-to-face meeting held in Paris in January 2024. The nominal group technique was applied, with consensus defined as agreement by at least 80% of panel members. Results: Consensus was reached on product selection, injection planes, delivery devices, techniques, and typical treatment volumes for PEGDE-HA hydrogels across multiple facial regions, including the forehead, temples, midface, nasolabial folds, chin, jawline, and lips. Recommended injection techniques included microbolus, macrobolus, and retrograde linear threading, with placement ranging from superficial subcutaneous to supraperiosteal planes depending on the anatomical area and clinical indication. Typical injection volumes generally ranged from 0.1 to 0.5 mL per side. Optional ultrasound mapping was considered beneficial in selected high-risk or superficial procedures to improve anatomical safety. Conclusions: These expert consensus recommendations provide practical guidance for clinicians using PEGDE-crosslinked HA hydrogels in facial rejuvenation. Tailoring product characteristics to injection depth, technique, and regional anatomy may help optimize clinical outcomes and procedural safety. Future research priorities include prospective comparative studies with other crosslinking technologies, standardized reporting of adverse events, long-term outcome registries, and further evaluation of ultrasound-guided injection strategies.

Eating disorders (EDs) often emerge in adolescence and are influenced by family factors. Parental eating attitudes, including orthorexic tendencies, may be associated with adolescent ED severity. We examined parental orthorexic tendencies, cognitive rigidity, and nutritional knowledge in relation to adolescents' ED symptoms. The sample comprised 59 adolescents (93.2% female; mean age = 18.34 ± 3.78years) and their parents (36 dyads; 23 single parents). Parents completed measures of orthorexia (ORTO-R), cognitive rigidity (D-FLEX), and an ad hoc nutritional knowledge questionnaire; adolescents completed the EDE-Q. Analyses were conducted in the full sample and repeated in anorexia nervosa (AN). In the full sample, higher maternal ORTO-R scores were associated with greater EDE-Q restraint (β = 0.29, p = 0.042) and shape concern (β = 0.31, p = 0.030). In fathers, older age was associated with adolescents' shape (β = 0.32, p = 0.037) and weight concerns (β = 0.36, p = 0.018), whereas paternal ORTO-R was not significant. Mothers showed higher nutritional knowledge than fathers (U = 821.0, p = 0.013). No parent-child concordance emerged for BMI or eating psychopathology. Associations were no longer significant in AN-only analyses. Parental orthorexic tendencies showed small associations with adolescent ED severity in the full sample, with limited robustness in AN. Findings are preliminary and warrant replication in larger diagnostically stratified cohorts. Level III, observational analytic study; cross-sectional design.

BackgroundTracheostomy is a commonly performed procedure in patients requiring prolonged mechanical ventilation (MV) in Intensive Care Units (ICUs), including COVID-19-related ARDS. However, limited data exist on the timing and predictors of decannulation.AimTo compare time to decannulation between COVID-19 and non-COVID-19 ARDS patients and to identify predictive factors.MethodsA retrospective study including 96 COVID-19 ARDS and 32 non-COVID-19 ARDS tracheostomized patients admitted to step-down units after ICU stay from March 2020 to May 2021. Clinical, demographic data and comorbidities were analysed as well as predictors for decannulation delay.ResultsTiming of decannulation was similar between the two groups. Multivariate analysis identified limb weakness assessed by the Medical Research Council (MRC) scale, duration of steroids therapy, clinical complications, PaO2/FiO2 ratio and smoking history as independent predictors of decannulation timing.ConclusionsCOVID-19 did not affect timing of decannulation compared to non-COVID-19 ARDS. ICU-acquired weakness, assessed through the MRC scale, was the strongest predictor of delayed decannulation.

The ORANGE II PLUS randomized controlled trial has provided the first high-quality evidence comparing laparoscopic and open hemihepatectomy. While the laparoscopic approach offers faster recovery and better postoperative quality of life, uncertainty has persisted regarding its economic value. The accompanying health-economic analysis by Olij et al.1 addresses this gap, demonstrating that laparoscopic hemihepatectomy incurs higher intraoperative costs but generates meaningful postoperative savings and greater quality-adjusted life-year gains. With an incremental cost-effectiveness ratio well below accepted thresholds, the procedure emerges as a cost-effective strategy within modern health systems. These findings support broader adoption of laparoscopic hemihepatectomy while highlighting the need to optimize operative efficiency, refine the use of disposable instruments, and continue investing in structured training pathways. Collectively, the ORANGE II PLUS data establish laparoscopic hemihepatectomy as not only a clinical advancement, but also a sound investment in patient recovery and long-term value.

This study examines the incidence of unexpected benign (UB) disease in patients undergoing pancreaticoduodenectomy (PD) for suspected malignancy and investigates preoperative factors that may help differentiate benign from malignant disease. A retrospective analysis was conducted on consecutive patients who underwent PD for suspected periampullary or pancreatic malignancy (2011-2022). Demographic data, imaging findings, tumor markers, and postoperative outcomes were assessed, with comparison between UB and confirmed malignancy (CM) cases. UB disease accounted for 2.5% of PDs (16 patients). The median Ca19.9 level in UB group was 10.1U/mL, with 25% above 37U/mL. None of the six UB patients with a double duct sign had elevated Ca19.9. In contrast, 59.9% of CM patients had Ca19.9 > 37U/mL (p = 0.005), confirming an independent predictor of malignancy (p = 0.001). CM patients required more preoperative biliary stenting than UB (57.3% vs. 31.5%, p = 0.038). UB patients had higher reoperation rates (37.5% vs. 9.3%, p = 0.001) then CM, but shared similar mortality rates (p = 0.106). UB disease after PD was infrequent and lower than prior reports (5-10%). Elevated Ca19.9 levels and the need for preoperative biliary stenting are predictor of malignancy. A multidisciplinary team approach with critical imaging assessment is crucial for improve diagnosis and minimize unnecessary resections.