Clinica Mediterranea

The Turtle Dove is a regular migratory species widely distributed in Italy, though the information on its abundance in each Italian region is modest; thus, action plans have been implemented to improve its conservation. This is a preliminary study meant to provide information on the distribution and abundance of the TD in Apulia. We analyzed data collected during 2019–2023 within the Farmland Bird Index (FBI) project, whose sampling design was intensified to achieve more homogeneous coverage of the region. The survey method was based on unlimited-distance point counts lasting 10 min. Counts were carried out between 15 May and 15 June of every year, beginning from dawn until 12:00 AM, with each station visited once. A total of 211 TD birds were recorded across 147-point counts. The MaxEnt analysis showed that olive orchards, needle-leaved woodlands, and evergreen broad-leaved woodlands had a positive effect on species occurrence, whereas winter precipitation had a negative effect. The total estimate of pairs fell within the range 47.14–66. The estimated density for TD in Apulia was 0.87–1.16 birds/km2, while that of pairs was 0.69–0.97/km2. By relating the estimated densities to the area suitable for the species’ presence, the abundance of TD was estimated at approximately 17,337–24,303 birds.

The Mediterranean Diet (MD) has been associated with reduced inflammation and improved immune regulation, suggesting a potential protective role against autoimmune diseases. This review was conducted in accordance with PRISMA 2020 and MOOSE guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Library was performed up to February 28, 2024. Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated with the NUTRIGRADE approach. Pooled effect sizes were computed using a random-effects model and expressed as risk ratios (RR), hazard ratios (HR), or odds ratios (OR), as appropriate. A total of 9 high-quality studies were included. No significant associations were found between high vs. low MD adherence and the incidence of rheumatoid arthritis (RR = 0.99, 95% CI: 0.97-1.01), lupus (HR = 0.97, 95% CI: 0.91-1.03), Crohn's disease (RR = 0.95, 95% CI: 0.84-1.07), or ulcerative colitis (RR = 1.02, 95% CI: 0.97-1.08). A significant inverse association was observed for multiple sclerosis (RR = 0.91, 95% CI: 0.85-0.98) and for Sjögren's syndrome (OR = 0.81, 95% CI: 0.66-0.99). However, the certainty of evidence for all outcomes was rated as low. Promising associations were observed for multiple sclerosis and Sjögren's syndrome, although current evidence does not support a consistent protective effect of the MD across several other autoimmune diseases. Further longitudinal research is needed to confirm these findings and explore underlying mechanisms. Meanwhile, the promotion of MD adherence remains justified within broader public health strategies for chronic disease prevention.

Failure of vascular closure device (VCD) is the most common cause of access-site vascular complications in transfemoral transcatheter aortic valve implantation (TAVI). The authors sought to determine if the systematic use of arteriotomy-site ballooning with concomitant manual compression following the delivery of a plug-based VCD (MANTA, Teleflex) can optimize toggle-plug assembly apposition to the common femoral artery (CFA) wall and improve the final hemostatic efficacy. In this prospective, observational, single-center study, 323 consecutive patients undergoing transfemoral TAVI from October 2021 to December 2024 underwent access closure with the MANTA VCD. The primary endpoints were VCD failure rate, predictors of VCD failure, and access-site and access-related major and minor vascular complications, according to the Valve Academic Research Consortium-3 definition. VCD failure occurred in 12 (3.7%) patients (Failure group). The independent predictors of failure were minimum CFA diameter and patient risk as assessed by the Society of Thoracic Surgeons Predicted Risk of Mortality score. Receiver operating characteristic analysis showed CFA minimum diameter with an area under the curve of 0.77 (0.69-0.86, P less than .001); the best cutoff was 6.30 mm (sensitivity 83%; specificity 59%; positive predictive value 7%; negative predictive value 99%). Access-site vascular complications occurred in 21 (6.5%) patients. The systematic use of arteriotomy-site ballooning plus concomitant manual compression following MANTA VCD delivery should be considered to improve the final hemostatic efficacy. This device should be avoided when dealing with small (less than 6.3 mm) CFA diameters.

Since the beginning of the percutaneous coronary intervention (PCI) era, periprocedural myocardial infarction (PMI) has been recognized as a potential source of impaired outcomes in patients undergoing revascularization. Subsequently, several different definitions of PMI have been provided, coming from trial research groups or international consensus. Despite these efforts, the debate over the prognostic value or PMI in terms of mortality risk, as well as its role in defining composite ischemic endpoints in clinical investigations, has been extremely active. Currently, three international definitions of PMI are available: the Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 definition, and the definition by the Society for Cardiovascular Angiography and Interventions (SCAI). These definitions differ significantly in terms of sensitivity and prognostic relevance, which has led to heterogeneous findings in clinical studies investigating this topic. Thus, this review aims to provide an overview of the main features of these definitions, their association with the risk of mortality, and how different definitions can influence the results of major investigations in the research setting.

Abstract Background Pre-eclampsia (PE) is the leading cause of adverse cardiovascular (CV) outcomes during and after pregnancy. Thromboxane (TX)-dependent platelet activation plays a key role in PE pathogenesis. Urinary 11-dehydro-TXB2, a major TX metabolite (TXM), is reduced by at least 75% by low-dose aspirin (ASA) treatment and predicts the occurrence of CV events and mortality in individuals with and without CV disease on ASA. Low-dose ASA showed to prevent PE, even though an interindividual variability in ASA responsiveness exists. Purpose Our aims were to identify platelet and circulating biomarkers and clinical predictors of PE in patients at high risk for PE. Methods We enrolled 24 women with pregnancy at high risk for PE and 11 women with physiological pregnancy in an ongoing study. At first visit and every trimester, women underwent clinical evaluation, CV imaging, blood and urine sampling for biochemical markers of platelet activation. Based on the slope of sTXB2 between 10 and 24 hours after ASA intake, which indicates the recovery rate of COX-1 activity, women at risk for PE were stratified into tertiles. Results At baseline, the two groups did not differ in parameters except for higher glucose and cholesterol levels, lower PAPP-A and PLGF in pregnancies with high PE risk. TXM and circulating P-selectin were not different between groups at baseline, while, as expected, were significantly reduced during ASA treatment compared to healthy women, consistent with the predominant platelet source of TXM. Higher levels of TXM during the II trimester characterized women at high PE risk with serumTXB2 slope in the third vs. I tertile. Six patients at high PE risk experienced childbirth with PE. Compared to high PE risk women who did not develop events (no PE), women who developed PE were more hypertensive (p=0.01), had higher basal body weight (p=0.056), family history of coronary artery disease (p=0.031), lymphocyte count, C-reactive protein (CRP) [I, p=0.028 and III trimester, p=0.042)], higher percentage of immature platelets, higher urinary TXM (p=0.020) and a higher percentage of platelet P-selectin (p=0.072) in the II trimester. Interestingly, patients who developed PE had a suboptimal, lower than 75% TXM percent inhibition (p=0.058) during II trimester of pregnancy (Fig B). Women with TXM<75% have an odds ratio 2.40 (95% CI: 0.30 to 19.04; P = 0.41) of developing PE. Finally, TXM during II trimester, adjusted for baseline values, predicted the development of PE despite ASA, among at-risk patients (p=0.035) (Fig A). Conclusions Residual, TX-dependent platelet activation is associated with a shorter duration of ASA effect over the 24-hour dosing interval and may predict the occurrence of PE, despite prophylaxis with low dose ASA. Studies with a larger sample size are needed to validate the role of urinary TXM as a circulating biomarker predicting suboptimal response to ASA and PE occurrence in pregnant women at high risk for PE.Figure 1, Panel A and B

Cryoballoon pulmonary vein isolation has become an established treatment for atrial fibrillation (AF). However, data on long-term outcomes beyond 5 years are scarce. This prospective analysis aimed to evaluate the long-term outcome after cryoballoon pulmonary vein isolation. Data from consecutive patients treated with cryoballoon pulmonary vein isolation for symptomatic AF between 2012 and 2018 in 13 institutions were analyzed. Patients with ≥5-year follow-up after the index procedure were included. Arrhythmia recurrence was defined as AF or atrial tachycardia lasting >30 seconds beyond a 3-month blanking period. A total of 1330 patients were enrolled (28.4% female patients, mean age was 60.1±10.5 years). Patients with paroxysmal AF accounted for 73.1%; the median history of AF was 36.0 (13.0-75.0) months. The rate of AF/atrial tachycardia recurrences progressively increased over time (event rate: 52.5% [49.4%-55.8%] at 8-year follow-up). A low incidence of progression to permanent AF was seen in the entire cohort (7.0%). Importantly, 15.7% of patients underwent a redo ablation for AF during follow-up; in 45.9% of these cases, all PVs were isolated at the redo procedure, with a median number of PVs isolated after the index procedure being 3 (1-4) veins. Independent predictors of arrhythmia recurrences were AF type (persistent AF: hazard ratio, 1.36 [95% CI, 1.14-1.62]; P<0.001) and chronic kidney disease (hazard ratio, 1.77 [95% CI, 1.12-2.81]; P=0.016) in multivariate analysis. Cryoballoon pulmonary vein isolation as the index procedure for AF ablation resulted in a favorable long-term outcome in patients with symptomatic AF, with limited progression towards permanent AF during follow-up. Persistent AF was the strongest predictor of recurrences at long-term follow-up.

The project entitled High Precision Aerial Indoor AI-Based Inspection System - PROBE aims to address the limitations of current drone navigation systems by developing an improved inertial navigation solution for indoor applications. In recent years, inertial odometry has emerged as a promising approach to enhance navigation performance, particularly in GNSS-denied environments such as indoor or obstructed areas. Its ability to model complex sensor dynamics and correct error drift makes it an ideal candidate to support or replace traditional positioning aids. The core innovation of PROBE is located in leveraging inertial odometry to compensate for the drift typically associated with pure inertial sensors. The use of advanced Artificial Intelligence based algorithms to improve traditional navigation configurations is a groundbraking field, even if propoer data collection and data management procedures are needed to guaranteed the generalization of the achieved results. Specifically, the presented paper describes a methodology for system configuration development and data acquisition aimed at the training process of Artificial Intelligence based algorithms acquiring an input-output dataset based on a custom set of Commercial Off The Shelf sensors to improve the inertial navigation estimates.

Background: Squamous cell carcinoma (SCC) of the penis accounts for approximately 95% of penile cancers and is associated with substantial morbidity and mortality. SCC typically develops in uncircumcised men, most commonly affecting the foreskin or glans. While slow-growing, early detection is crucial to improve survival outcomes. Risk factors include advanced age, lack of circumcision, poor hygiene, HPV infection (types 16 and 18), chronic inflammation, and smoking. Methods: We conducted a retrospective, single-center study at IRCCS Hospital "G. Pascale" of Naples, Italy, involving 59 patients treated between January 2015 and January 2023. The inclusion criteria were surgically treated primary tumors, confirmed SCC pathology, and pathologically verified inguinal lymph node metastasis (ILNM). We analyzed clinical variables including lymph node involvement, lymphovascular invasion (LVI), spongiosum corpus involvement (SCI), HPV infection, and tumor differentiation. Univariate and multivariate logistic regression analyses were performed to determine independent predictors of ILNM. Results: The mean age of patients was 66.67 ± 13.97 years. ILNM was confirmed in 24 patients (40.6%), while 35 (59.3%) had no lymph node involvement. Univariate analysis identified lymph node involvement at diagnosis (p = 0.005), LVI (p = 0.003), and SCI (p = 0.003) as significant predictors of ILNM. These factors were confirmed in the multivariate analysis, with lymph node involvement (p = 0.004), LVI (p = 0.025), and SCI (p = 0.028) as independent predictors. Conclusions: Lymph node status, LVI, and SCI are significant predictors of ILNM in penile SCC. Identifying these factors can aid in risk stratification, optimizing surgical decisions, and potentially reducing unnecessary morbidity. Further large-scale studies are recommended to validate these findings and refine prognostic models.