Federico II University Hospital

To compare two sodium hyaluronate formulations (HYMOVIS® ONE and MONOVISC®) for single intra-articular (IA) injection in patients with knee osteoarthritis pain. This randomized, controlled study included 347 subjects allocated to two treatment arms: HYMOVIS® ONE (n = 175) and MONOVISC® (n = 172). The primary endpoint assessed non-inferiority of HYMOVIS® ONE versus MONOVISC® based on change from baseline in the WOMAC LK3.1 A1 Pain subscale. Secondary outcomes evaluated patient response using OMERACT-OARSI criteria, changes in WOMAC stiffness and function scores, health-related quality of life (SF-12), global assessments by patients and clinicians, and rescue medication use. The mean WOMAC LK3.1 A1 walking pain subscale score decreased significantly from baseline at week 12 in both groups, with reductions of 65 % for HYMOVIS® ONE and 66 % for MONOVISC®. At week 26, reductions were 73 % for HYMOVIS® ONE and 69 % for MONOVISC®. The non-inferiority test yielded a p-value of 0.0003. Clinically significant change from baseline was observed for all secondary endpoints. For the WOMAC LK3.1 Function subscale, the comparison between groups at week 26 showed a statistically significant difference (p = 0.0367) favoring HYMOVIS® ONE. Both treatments were well tolerated. A single injection of HYMOVIS® ONE was well tolerated and non-inferior to MONOVISC®, with improvements across all study endpoints maintained through 26 weeks, indicating sustained symptomatic relief of knee OA. NCT06528600 (www.clinicaltrials.gov).

Transmural healing (TH) has emerged as a therapeutic target in Crohn's disease (CD), providing a more comprehensive indicator of deep remission than mucosal healing alone. Intestinal ultrasound (IUS) is a noninvasive method for assessing TH, but its prognostic value remains insufficiently defined. The aim of this prospective study was to evaluate whether early improvement in IUS parameters during biological therapy could predict TH at 12 months. This is a prospective multicenter study enrolling CD patients initiating biological therapies. IUS and Doppler parameters were assessed at baseline, 3 months, and 12 months. Delta (Δ) represented the variation in ultrasound measurements between baseline and 3 months. TH was defined as normalization of bowel wall features and absence of hypervascularization. A total of 142 CD patients were included. At 12 months, the TH rate was 19%, the IUS response rate was 44%. Patients achieving TH showed a significantly greater ΔBWT than nonresponders (P = .0004). On ROC analysis, a ΔBWT reduction of 1.25 mm predicted TH with 73% sensitivity and 61% specificity. IUS responders had a significantly greater ΔBWT than nonresponders (P < .0001), with the same threshold predicting response with 83% sensitivity and 57% specificity. Notably, the combination of ΔBWT and Limberg score improvement was strongly associated with both TH (OR 13.26; P < .0001) and IUS response (OR 20.9; P < .0001) at 12 months. Early reduction in BWT, especially when combined with Limberg score, is a strong predictor of TH and IUS response at 12 months, supporting the use of early IUS monitoring in clinical practice.

ABSTRACT In our target article, we proposed a hub-and-processors model of technological cognition. The twelve commentaries that followed offer a rare opportunity to refine, extend and test that framework against new perspectives. We integrate their contributions into a revised synthesis. The parietal sites now gain sharper anatomical definition: core substrates of technical reasoning can be more clearly distinguished from adjacent regions supporting manipulation knowledge and mental-to-digital goal-directed conceptual transformations. The inferior frontal gyrus, in turn, emerges as a dual-function node – one that routes information across hubs while simultaneously meeting the planning and control demands of tool-related behavior. Beyond cortical organization, the commentaries push the framework toward white-matter connectivity, reward and motivational circuits, as well as affordance-based theoretical accounts spanning the physical, digital and symbolic domains. They also broaden the model’s translational scope to aging, neurodegeneration, digital inclusion, and neurorehabilitation, and open new lines of inquiry into temporal dynamics, expertise, and cognitive extension. The cumulative result is a strengthened case for a cognitive neuroscience of technology: a mechanistic, translational and lifespan-oriented program aimed at understanding how the brain supports technology use, acquires technological skills and is, over time, reshaped by sustained engagement with technological artifacts.

Direct immunofluorescence (DIF) is the gold standard for diagnosing subepidermal blistering diseases (SBDs). However, DIF requires specialized expertise; therefore, alternative immunological methods such as enzyme-linked immunosorbent assays (ELISA) are worth exploring. The aim of this review was to evaluate the diagnostic agreement between DIF and ELISA for the diagnosis of SBD. A systematic literature review of international journals and electronic databases (MEDLINE via OVID, Scopus, and Web of Science) was conducted between their inception and December 2023. The risk of bias and overall quality of evidence were assessed using the Newcastle-Ottawa Scale and the GRADE system. Of the 1691 articles identified, 38 were included in the qualitative synthesis and 37 in the quantitative analysis. Three meta-analyses were developed and revealed the superiority of DIF over ELISA, with the following risk differences: BP180, 0.26 (95% CI: 0.19-0.33, p < 0.00001, I 2 : 96%); BP230, 0.59 (95% CI: 0.47-0.71, p < 0.00001, I 2 : 98%); and Lam332, 0.82 (95% CI: 0.70-0.94, p < 0.00001, I 2 : 89%). DIF remains the gold standard for the diagnosis of autoimmune SBDs. ELISA can serve as a complementary diagnostic tool, especially as a follow-up instrument for patients with SBD, owing to its low invasiveness.

Outpatient parenteral antimicrobial therapy (OPAT) enables effective infection management outside hospital settings, offering clinical and economic benefits. While widely adopted internationally, its implementation in Italy remains fragmented. This study aimed to systematically map the use of OPAT in Italy to identify research and policy priorities. A scoping review was conducted following the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews guidelines. The protocol was registered on the Open Science Framework ( https://doi.org/10.17605/OSF.IO/GX8S6 ) in August 2025. Searches were performed across PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Scopus. Eligible studies included primary research on OPAT in Italy, with no restrictions on publication date or language. Data extraction focused on study characteristics, OPAT indications, antimicrobial agents, delivery models, and outcomes. Twenty-three studies were included, mostly observational and single-center, published between 2000 and 2025. OPAT was primarily delivered at home or in infusion centers. The most frequent indications were infections of bone and joint, skin and soft tissue, and the respiratory tract. Ceftriaxone was the most used antimicrobial. Delivery was mainly intravenous, often via elastomeric pumps and peripheral or central venous access. Reported outcomes were generally favorable, with cure or improvement rates exceeding 90% in several studies. Adverse events were infrequent, mostly associated with drug reactions or catheter-related complications. Patient satisfaction was consistently high. Economic evaluations were limited but suggested cost savings primarily driven by reductions in hospital stays. OPAT is feasible and increasingly used in Italy, but remains inconsistently implemented across regions. Broader adoption would benefit from national guidance, standardized protocols, and integrated stewardship frameworks. Future research should address comparative and cost-effectiveness, as well as equitable access, to support systematic scale-up aligned with national health priorities on antimicrobial resistance and community-based care.