Fondazione Audiologica Varese

Pancreatic and periampullary cancers are among the most challenging malignancies. Centralization of care and multidisciplinary management have been associated with improved outcomes. In 2024,the Italian Ministry of Health established a national Steering Committee with the objective of defining a centralized model for the management of pancreatic and periampullary diseases and identifying the minimum requirements for referral centers across Italy. The Steering Committee met every four weeks through plenary and focused working groups. Using data from the National Agency for Regional Health Services and the National Outcome Program, all ICD-9 codes related to pancreatic, periampullary, and distal biliary diseases were analyzed. Criteria were developed according to international recommendations and structured into a Hub-and-Spoke network model. Pancreas Units(Hub centers) were defined as hospitals providing 24/7 multidisciplinary expertise, advanced diagnostic and interventional capabilities, and a minimum surgical volume of ≥ 30 pancreatic resections per year with 90-day mortality < 10% (target < 5% within 3 years). Spoke centers were required to adhere to standardized diagnostic–therapeutic pathways and participate in multidisciplinary team meetings, without performing pancreatic surgery. Based on catchment area analyses, one Hub center per 700,000–1,200,000 inhabitants was recommended. Additional requirements included structured multidisciplinary processes, standardized diagnostic pathways, and integration with national research and training networks. This national model provides a comprehensive framework for centralizing pancreatic and periampullary diseases care. By defining minimum standards, enhancing multidisciplinary coordination, and concentrating complex procedures in high-performance centers, this initiative aims to improve outcomes, reduce regional disparities, and create a sustainable national Pancreas Unit network.

Rationale &amp; objective: For individuals with end-stage kidney disease (ESKD) undergoing hemodialysis (HD), vascular access (VA) is fundamental for extending their lives and enhancing their quality of life (QoL). Placing patients at the heart of dialysis access decisions is crucial, not just addressing immediate access requirements but also looking ahead to their future needs. To facilitate better, it’s essential to understand how various VA methods affect the patient’s overall experience.Study design: Patient experiences with arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs), and central venous catheters (CVCs) were investigated through individual, semi-structured phone interviews, which utilized a validated questionnaire as a framework.Setting &amp; participants: Adult ESKD patients undergoing HD for at least six months, including those with prior kidney transplants, were selected. Participants were over 18, ANED (National Association of Dialyzed and Transplanted) members, and volunteers.Analytical approach: The study’s theoretical framework was built using grounded theory principles. Initial coding was based on themes from a validated questionnaire (Nordyke, et al. 2020), and further codes and subcodes were generated through inductive coding (MAXQDA-2022 software).Results: The study found significant variation in VA types: 30.0% (N = 30) AVF only, 26.7% CVC to AVF, 13.3% AVF to CVC, 10.0% graft, 6.7% stable VA history, and 13.3% complex histories. Appropriate CVC discontinuation was low (10%). VA type significantly impacted social and daily activities/physical functioning, symptoms, and sleep. Younger patients (≤65%) experienced reduced QoL in work, family, and leisure. Reduced QoL stemmed from impaired daily activities, attention deficits, fear, anxiety, and worry. AVF had a greater impact than CVC and AVG in almost all domains. Patients preferred fistulas, regardless of HD years and geographical location.Limitations: The absence of inclusion of patients from surgical hubs may not represent the real-world variety of Italian dialysis center VA protocols.Conclusion: Healthcare providers should discuss VA options and their impact on QoL, considering patients’ life goals and preferences.

Dear Editor, Over the past two decades, the role of the cardiorespiratory physiotherapist has become increasingly prominent within clinical care pathways, significantly contributing to the management of both acute and chronic respiratory diseases...

Background and Objectives: Considering the growing shortage of grafts available for kidney transplantation (KT) due to the increase in the number of end-stage renal disease patients, it is essential to utilize all transplantation options. The Karpinski score is a histological scoring system utilized for the evaluation of pre-implantation kidney biopsies from deceased donors. In contrast with Remuzzi Criteria, there has recently been a tendency to perform single KT using grafts with a Karpinski score of 4 or 5. This strategy allows two score 4 or 5 grafts to be used for two different recipients instead of a double-graft KT on one patient. The aim of this study was to analyze the outcomes of single-graft KT with a score of 4 versus 5, and to investigate possible correlations with the clinical characteristics of donors and recipients. Materials and Methods: Retrospective single-centre analysis of 100 KTs performed with a single Karpinski score 4 or 5 graft between January 2014 and December 2022. Results: Grafts with a Karpinski score of 5 harvested from donors older than 70 years of age had a statistically significant (p = 0.014) worse 5-year survival rate (50.0 +/− 18.6%) compared to younger donors (100% for score 5 grafts from donors aged 31–60, and 100% for score 5 grafts from donors aged 61–70). Conversely, donor’s age did not significantly affect the survival of score 4 grafts. Conclusions: The results suggest that a single-graft KT with a Karpinski score 5 graft may be a viable procedure with favourable outcomes. However, for Karpinski score 5 grafts, the use of an older donor beyond the age of 70 seems to be a significant negative factor for the long-term outcome. In such cases, a double KT would potentially be the optimal approach.

The impact of acute kidney injury (AKI) on long-term outcomes of hospital survivors is controversial. We conducted a systematic review and meta-analysis of all studies reporting such outcomes in patients with AKI and including a control population. We included original studies published in peer-reviewed journals that compared long-term outcomes (survival, need for dialysis, chronic kidney disease [CKD]) among hospitalized patients with vs. without AKI. Pertinent articles enrolled patients who experienced and survived a defined episode of AKI, included a control group without AKI, and reported at least one long-term outcome (mortality, dialysis, or CKD), with a minimum follow-up of 1 year. Two independent investigators extracted data on study characteristics, patient populations, follow-up duration, and long-term outcomes. Discrepancies were resolved by consensus. We identified 14 studies for a total of 1,058,109 overall matched patients with a median duration of follow-up of 3 years. Patients who experienced an episode of AKI and survived hospital discharge had a significant increase in long-term mortality at the longest follow-up available for each study (137,506/519,672 [26.4%] vs. 93,702/530,663 [17.6%]; relative risk [RR], 1.42; 95% CI, 1.13-1.78; p = 0.002), compared with controls. They also had a greater risk of receiving dialysis (1,928/42,529 [4.5%] vs. 854/42,529 [2.0%]; RR, 2.48; 95% CI, 1.79-3.43; p < 0.001), and of developing CKD (2,956/5,739 [51.5%] vs. 2,902/7,781 [37.3%]; RR, 1.71; 95% CI, 1.33-2.19; p < 0.001). Compared with controls, patients who experienced an episode of AKI and survived to hospital discharge have an increased risk of death, dialysis, and CKD.

ABSTRACT Natural Capital Accounting (NCA) is pivotal for advancing the Sustainable Development Goals (SDGs) by quantifying Ecosystem Services (ES) and integrating them into Economic Models. The NCA employs different methodologies to support the three themes that compose SDG layers: biosphere, society, and economy. In the context of the biosphere layer, the NCA provides a comprehensive set of descriptive statistics pertaining to the ES. In the context of the society layer, the adoption of sustainability indicators derived from ES accounts quantifies the extent to which ecosystem contributions impact social well‐being. In the context of economic modeling, ES accounts provide the input data required for the construction of models such as general equilibrium models and multi‐regional input–output analysis. The applications reported in this study demonstrate concretely how accounts can support SDGs both in terms of providing data and of enhancing their analytical capacity. However, challenges persist in the standardization of metrics and the coverage of SDG targets that remain unmeasured.

Background/Objectives: The clinical, histopathological, and dermoscopic features may be associated with melanoma mutational status. The aims of the study were to assess the clinical, histopathological, and dermoscopic features of melanoma to identify their correlation with BRAF, NRAS, and cell cycle genes' mutational status in melanoma. Methods: The clinical, histopathological information, dermoscopic images, and genomic DNA of 55 histopathologically diagnosed primary cutaneous melanomas were retrospectively analyzed. Next-generation sequencing (NGS) assays were conducted on the Ion GeneStudio S5 platform (Thermo Fisher Scientific, Waltham, MA, USA), using the Ion AmpliSeq™ Italian Melanoma Intergroup Somatic Panel. Results: Overall, 55 melanomas, including 30 superficial spreading, 24 nodular, and 1 naevoid, were analyzed. BRAF mutation was more frequently observed in ulcerated melanoma (16/23; 69.6%), with mitotic rate ≥ 5 n/mm2 (8/11; 72.7%), while NRAS mutation was more common in amelanotic/hypomelanotic (8/17; 70.0%) and nodular melanoma (10/24; 41.7%). Dermoscopically, shiny white structures (OR = 3.50; 95% confidence interval: 1.13-10.84) were associated with BRAF-mutated melanomas, whereas a homogeneous disorganized pattern was associated with NRAS-mutated melanomas (OR = 6.96; 1.49-32.53). The risk of diagnosing cell cycle gene-mutated melanomas was significantly increased in presence of vascular patterns (OR = 4.50; 1.33-15.20), linear irregular (OR = 3.75; 1.18-11.92), polymorphous vessels (OR = 4.05; 1.27-12.97), and milky red globules/areas (OR = 3.14; 1.00-9.89). The blue-white veil was significantly associated with P53 mutation (OR = 35.84; 2.01-640.2). Conclusions: Conversely to Wild Type, BRAF, NRAS, and cell cycle gene-mutated melanomas were significantly associated with clinical and dermoscopic features underlying a more aggressive melanoma phenotype. The vascular pattern, linear irregular, polymorphous vessels, and milky-red globules/areas may be considered predictors of cell cycle mutated melanomas.

Context. Potassium was first detected in spectra of the sungrazer comet C/1965 S1 Ikeya-Seki at the heliocentric distance rh = 0.15 au and, 48 years later, in comets C/2011 L4 PanSTARRS and C/2012 S1 ISON at rh = 0.46 au. The alkali tail photoionization model provides a Na/K ratio close to the solar value in comets C/1965 S1 and C/2011 L4. No lithium was detected in any comet: the lower limit of the Na/Li ratio was almost one order of magnitude greater than the solar ratio. Aims. Here we searched for the emissions of the alkali NaI, KI, and LiI in Comets C/2020 F3 NEOWISE and C/2024 G3 ATLAS. Methods. High-resolution spectra of the comets were taken with the 0.84 m telescope at the Schiaparelli Observatory at rh = 0.36 and rh = 0.15 au, respectively, the observations closest to the Sun since C/1965 S1. To model the data, we assumed that alkali phenoxides are present in the aromatic fraction of organic dust at the nucleus surface where they react with carbon dioxide ejecting alkali atoms. Results. NaI and KI were detected in emission lines of exceptional intensity in both comets, with no evidence of LiI emission. The NaI/KI ratios were determined: 31 ± 5 and 26 ± 8 in comets C/2020 F3 and C/2024 G3, respectively, whereas solar Na/K ≈ 15. This excess and its observed trend with the heliocentric distance are consistent with chemistry between CO2 and alkali phenoxides at the nucleus surface. The Li upper limit for comet C/2020 F3 is very stringent at Na/Li &gt; 3.4 × 104, a factor of 34 greater than the solar value. This Li depletion is consistent with the reaction rate of lithium phenoxides, which is a factor of 104 slower than sodium phenoxides. Conclusions. The widespread chemistry of carbon dioxide with organic dust may provide a significant energy and mass sink of carbon dioxide in all comets also at rh &gt; 1 au, reconciling recent models of cometary activity with Rosetta CO2 measurements. At rh &lt; 0.5 au potassium was observed in all comets, so that we predict the formation of a KI tail spatially resolved from the NaI tail.

Background: "Chemsex" involves the intake of a range of drugs (e.g., synthetic cathinones, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL), ketamine, methamphetamine, "poppers", type V phosphodiesterase (PDE) inhibitors, MDMA/ecstasy, cocaine, cannabis, and occasionally a few other molecules as well, to enhance and prolong sexual experiences. This paper aims to provide an overview of the clinical pharmacology of the vast range of drugs that are being used for chemsex with a focus on both the medical and psychopathological disturbances that they can produce. Methods: A narrative literature review was conducted using Pubmed, Scopus, and Web of Science databases. A total of 273 papers published up to January 2025 were screened; articles were selected based on relevance to chemsex/sexualized used behaviour and related substances. Both human and preclinical studies were considered. Results: The use of stimulants is likely related to the need to increase as much as possible both sexual arousal and performance but also to increase social interactions. Furthermore, the empathogenic/entactogenic activities of some MDMA-like "love drugs" facilitate the occurrence of "feeling closer/more intimate" emotional sensations, and GHB/GBL may provide the user with a subjective sensation of disinhibition, hence facilitating condomless meetings with a higher number of random partners. Conversely, ketamine may be used to both enjoy its psychotropic dissociative characteristics and facilitate the potentially painful receptive anal intercourse and/or fisting experiences. Most typically, these drugs are consumed in combination, with polydrug exposure possibly facilitating the occurrence of serotonergic syndrome, seizures, drug-drug pharmacokinetics' interaction, and sympathomimetic overstimulation. Following these polydrug exposures, a range of psychopathological conditions have at times been reported. These issues may lead to misuse of opiates/opioids, gabapentinoids, and/or antipsychotics. Conclusions: Further actions should aim at reducing the stigma that prevents individuals from accessing necessary healthcare and support services. A multidisciplinary approach that combines medical, psychological, and social support remains key to managing the complex challenges posed by chemsex-related drug use.