Ospedale Cristo Re

BackgroundA prior study demonstrated that the novel radiotranscriptomic signature, C19RS, holds prognostic significance for clinical outcomes (Figure 1a). The automated segmentation of vascular structures, including the internal mammary artery (IMA), the aorta, and their surrounding perivascular areas from contrast-enhanced CT angiography (CCTA), would facilitate the high-throughput extraction of radiomic profiles.PurposeOur goal is to create an innovative deep learning (DL) model for the IMA and aorta that facilitates the automated calculation of C19RS in extensive cohort analyses.MethodsThe model utilises a distinct architecture that combines a CNN (squeeze-and-excitation block) and a transformer (Swin block) to improve segmentation by alternating between these blocks, which helps in capturing discriminative features (Figure 1b). The model was built using the CCTA (n = 227) dataset from the OxHVF study conducted in the UK, applying standardised preprocessing techniques such as resampling, clipping, and intensity normalisation. An iterative refinement process occurred three times (n = 140), resulting in a robust model (see Figure 1c). An external validation cohort (n = 751) from an international site in the United States was utilised, with all segmentations subjected to manual expert review for quality assessment. Lastly, a publicly available dataset (ASOCA) was also validated externally (n = 318).ResultsThe model achieved a mean Dice similarity score (DSC) of 0.7876±0.0176 for IMA/peri-IMA segmentation and 0.9207±0.0057 for aorta/periaortic region segmentation (See figure). After refinement, it achieved a DSC of 0.947 for IMA/peri-IMA segmentation (Figure 1c,d). In the external cohort, 679 out of 751 cases (90.4%) were considered clinically acceptable for both regions; the remaining cases were excluded because the CCTAs' narrow field of view did not capture the IMA/aorta. In the ASOCA cohort, the model consistently performed at 0.961 ± 0.039. These results underscore the model’s generalizability and scalability for large-scale clinical applications.ConclusionThis study presents a powerful and clinically flexible DL model designed for the automatic segmentation of vascular structures, specifically the IMA, aorta, and their surrounding perivascular space. Its use in radiotranscriptomic biomarker analysis presents an exciting opportunity for non-invasive prediction of patient outcomes, making it a significant resource for cardiovascular research and clinical applications.

This study aims to analyze the effect of polyethylene (PE) and rice husk ash (RHA) composition variations on the mechanical properties of recycled composites developed as environmentally friendly ceiling materials. Composite specimens were prepared through a systematic process involving shredding PE plastic waste into 3–5 mm particles, burning rice husks at 600–700 °C followed by sieving through a 200-mesh screen, melting the plastic at 160–170 °C, and mixing with RHA at three composition ratios: 80:20, 70:30, and 60:40 (PE:RHA). The mixtures were molded into 50 × 50 mm specimens and tested in accordance with ASTM D695 for compressive properties and ASTM D792 for density. The results show that composition variation significantly influences compressive strength, elastic modulus, and strain behavior. The 80:20 composition exhibited the highest elasticity, with a compressive strength of 15.59 MPa and an elastic modulus of 463.50 MPa; however, it fractured shortly after exceeding the elastic limit. The 60:40 composition achieved the highest compressive strength of 125 MPa with a strain of 56.6%, but showed brittle behavior due to its very low elastic modulus (7.5 MPa). The 70:30 composition demonstrated the most balanced mechanical performance, with a compressive strength of 61.65 MPa, a strain of 18.20%, and stable ductile behavior. Based on the overall mechanical performance, the 70:30 PE–RHA composition is recommended as the optimal formulation, as it provides the best balance between strength, stiffness, and deformation resistance. This composition is therefore considered the most suitable for non-structural ceiling applications requiring lightweight, mechanically stable, and environmentally sustainable materials.

Background/Objectives: Nutritional patterns influence the gut-brain axis and immune signaling with potential consequences for depression and anxiety. We conducted a review focused on clinically meaningful psychiatric outcomes (symptom severity/diagnosis) to synthesize recent evidence (2020-2025) on Mediterranean-style dietary interventions; ultra-processed food (UPF) exposure; and psychobiotic/prebiotic strategies, integrating mechanistic insights relevant to practice. Methods: Searches in PubMed/MEDLINE, Scopus, and Web of Science (January 2020-October 2025) combined terms for diet, Mediterranean diet (MD), UPF, microbiota, probiotics, psychobiotics, depression, and anxiety. Eligible designs were randomized/controlled trials (RCTs), prospective cohorts, and systematic reviews/meta-analyses reporting clinical psychiatric outcomes in adults. We prioritized high-quality quantitative syntheses and recent RCTs; data were extracted into a prespecified matrix and synthesized narratively. Results: Recent systematic reviews/meta-analyses support that MD interventions reduce depressive symptoms in adults with major or subthreshold depression, although large, long-term, multicenter RCTs remain a gap. Exposure to UPF is consistently associated with higher risk of common mental disorders and depressive outcomes in large prospective cohorts. Psychobiotics (specific probiotic strains and prebiotics) show small-to-moderate benefits on depressive symptoms across clinical and nonclinical samples, with heterogeneity in strains, dosing, and duration. Mechanistic reviews implicate microbiota-derived metabolites (short-chain fatty acids) and immune-inflammatory signaling (including tryptophan-kynurenine pathways) as plausible mediators. Conclusions: Clinically, emphasizing Mediterranean-style dietary patterns, reducing UPF intake, and considering targeted psychobiotics may complement standard psychiatric care for depression. Future work should prioritize adequately powered, longer RCTs with standardized dietary protocols and microbiome-informed stratification to clarify responders and mechanisms.

HighlightsWhat are the main findings?Passive and compulsive social media use in adolescents is associated with increased risks of depression, anxiety, body dissatisfaction, and suicidal ideation.Neurodevelopmental vulnerabilities, gender, emotion regulation difficulties, and problematic usage patterns act as key risk factors in shaping psychiatric outcomes.What are the implications of the main findings?Social media is not inherently harmful; its psychological impact depends on usage patterns, individual traits, and social context.Prevention strategies should go beyond limiting screen time and focus on digital literacy, family engagement, emotion regulation, and platform responsibility.Background: The widespread use of social media among children and adolescents has raised increasing concern about its potential impact on mental health. Given the unique neurodevelopmental vulnerabilities during adolescence, understanding how digital platforms influence psychiatric outcomes is critical. Objectives: This narrative review aims to synthesize current evidence on the relationship between social media exposure and key psychiatric symptoms in youth, including depression, anxiety, body image disturbances, suicidality, and emotional dysregulation. Methods: We conducted a comprehensive narrative review of the literature, drawing from longitudinal, cross-sectional, and neuroimaging studies published in peer-reviewed journals. Specific attention was given to moderators (e.g., age, gender, and personality traits) and mediators (e.g., sleep, emotion regulation, and family context) influencing the relationship between social media use and mental health outcomes. Results: Evidence indicates that certain patterns of social media use, especially passive or compulsive engagement, are associated with increased risk of depression, anxiety, body dissatisfaction, and suicidal ideation. Adolescent girls, younger users, and those with low self-esteem or poor emotional regulation are particularly vulnerable. Neuroimaging studies show that social media activates reward-related brain regions, which may reinforce problematic use. Family support and digital literacy appear to mitigate negative effects. Conclusions: Social media use is not uniformly harmful; its psychological impact depends on how, why, and by whom it is used. Multilevel prevention strategies, including media education, parental involvement, and responsible platform design, are essential to support healthy adolescent development in the digital age.

ABSTRACTObjective.To systematically identify and critically assess indicators used globally and in Brazil to monitor health outcomes related to Sustainable Development Goal (SDG) 3, with an emphasis on identifying those most suitable for the Legal Amazon region.Methods.This rapid review examined global initiatives to achieve SDG 3 and their applicability to the Legal Amazon. Systematic reviews and overviews were included, with no language restrictions, considering studies published from 2015 onwards. Searches were conducted across several databases using both controlled vocabulary and free-text terms. Study selection, data extraction, and quality assessment followed standardized procedures, with independent reviewers ensuring rigor and resolving discrepancies through consensus.Results.The identified indicators covered health coverage, quality of care, environmental health, epidemiology, financial aspects, and governance, although none provided calculation formulas. Studies highlighted positive impacts of health service integration and conditional cash transfer programs, improving treatment adherence, disease detection, and child health outcomes. None of the included articles described specific indicators tailored to the Amazon region.Conclusions.The Legal Amazon faces challenges such as limited healthcare access and threats from deforestation and illegal mining. This review found no systematic reviews addressing these needs, making the findings suggestive rather than definitive. Despite this gap, preliminary efforts made it possible to propose indicators tailored to the region, covering areas such as Indigenous health, environmental risks, and healthcare accessibility. These indicators require validation by regional stakeholders to ensure their relevance and effectiveness in policy development.

Emerging evidence highlights the critical role of the gut microbiota in the development and progression of eating disorders (EDs), particularly in women, who are more frequently affected by these conditions. Women with anorexia nervosa, bulimia nervosa, and binge eating disorder exhibit distinct alterations in gut microbiota composition compared to healthy controls. These alterations, collectively termed dysbiosis, involve reduced microbial diversity and shifts in key bacterial populations responsible for regulating metabolism, inflammation, and gut–brain signaling. The gut microbiota is known to influence appetite regulation, mood, and stress responses—factors closely implicated in the pathogenesis of EDs. In women, hormonal fluctuations related to menstruation, pregnancy, and menopause may further modulate gut microbial profiles, potentially compounding vulnerabilities to disordered eating. Moreover, the restrictive eating patterns, purging behaviors, and altered dietary intake often observed in women with EDs exacerbate microbial imbalances, contributing to intestinal permeability, low-grade inflammation, and disturbances in neurotransmitter production. This evolving understanding suggests that microbiota-targeted therapies, such as probiotics, prebiotics, dietary modulation, and fecal microbiota transplantation (FMT), could complement conventional psychological and pharmacological treatments in women with EDs. Furthermore, precision nutrition and personalized microbiome-based interventions tailored to an individual’s microbial and metabolic profile offer promising avenues for improving treatment efficacy, even though these approaches remain exploratory and their clinical applicability has yet to be fully validated. Future research should focus on sex-specific microbial signatures, causal mechanisms, and microbiota-based interventions to enhance personalized treatment for women struggling with eating disorders.

Rectus Abdominis diastasis (RAD) is a prevalent condition, particularly in post-gravidic women, with functional and esthetic impact. This Delphi consensus, led by general surgeons, aimed to establish evidence-based recommendations for the diagnosis and management of RAD in post-gravidic women. A Delphi process was conducted under the auspices of the Italian Society of Hernia and Abdominal Wall Surgery (ISHAWS), the national chapter of the European Hernia Society (EHS). A steering committee supervised systematic literature reviews to evaluate the quality of evidence and formulate recommendations. Iterative rounds of voting involving 105 expert panellists were conducted, with Consensus defined as ≥ 70% agreement. Non-consensual recommendations were revised and discussed in a plenary session during the Italian Society of Surgery (SIC) Congress, 2024. Consensus was achieved on 12 recommendations covering RAD diagnosis, classification, and treatment. Key findings included the endorsement of radiological methods for accurate RAD assessment, the establishment of surgical thresholds (> 2.5cm inter-recti distance for symptom improvement), and the recommendation of minimally invasive linea alba plication for surgical management. Non-operative treatments, such as targeted exercise programs, were emphasized as first-line approaches. For RAD with concomitant hernias of the linea alba with defects > 1cm, mesh reinforcement was strongly recommended, with extraperitoneal placement preferred. The importance of tailoring approaches based on patient-specific factors and fostering shared decision-making was highlighted. This consensus provides a structured framework for RAD management, emphasizing accurate diagnosis, tailored treatments, and patient-centered care. Future multicenter studies are required to address remaining evidence gaps and refine these recommendations.

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Intraoperative nerve monitoring (IONM) has been recognized as a useful adjunct into the field of thyroid and parathyroid surgery, aiding in the accurate identification and preservation of the recurrent laryngeal nerve (RLN), consequently reducing the probability of nerve injury and promoting surgical safety. This investigation seeks to amplify the findings of a similar nationwide survey performed in 2014 by offering an updated assessment of IONM practices among Italian surgical institutions, reflecting a decade of advancements and transformations in clinical approaches. A comprehensive nationwide survey was implemented targeting Italian endocrine surgeons to assess the prevalence, utilization patterns, attitudes and perceptions surrounding IONM in the context of thyroid and parathyroid surgical procedures. Structured questionnaires were administered to seventy endocrine surgery centers, and the resulting data were evaluated employing both quantitative and qualitative analysis methods. The survey disclosed that 67.14% of the participants confirmed the routine deployment of IONM across all cervical surgical procedures, particularly in high-risk contexts. Relative to the findings from 2014, a marked rise in the implementation of IONM has been recorded; however, variability persists, especially between continuous and intermittent monitoring strategies. Surgeons recognized improved surgical safety, decreased complication frequencies, and educational advantages as significant key drivers for the incorporation of IONM. Nonetheless, issues, such as false-positive and false-negative results, along with the lack of standardized protocols, remain barriers to its uniform application. During the past ten years, IONM has been thoroughly adopted by Italian endocrine surgeons as a result of its critical contribution to the improvement of surgical outcomes and the provision of educational resources. However, the results highlight the imperative for further standardization of protocols, the advancement of training programs, and the resolution of reimbursement obstacles to ensure equitable and consistent application of IONM across Italian centers, ultimately optimizing patient care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13304-025-02157-6.

Background:Postoperative hypoparathyroidism is the most common complication of total thyroidectomy, often resulting from injury or devascularization of the parathyroid glands.Objective:Indocyanine green fluorescence (ICG) technique has been applied in the last 10 years in different kinds of surgery including colorectal, oncological lymph node and endocrine surgery. Minimally invasive thyroidectomy, introduced more than 25 years ago, is a valid surgical option for selected benign and malignant thyroid disease with advantages in terms of cosmetic results and postoperative pain. Aim of this study is to evaluate the feasibility and safety of ICG during minimally invasive thyroidectomy to assess and predict parathyroid gland perfusion and guide preservation.Methods:We report the initial experience in our center of ICG during minimally invasive video-assisted total thyroidectomy in a case series of 9 patients, using the Striker System® to assess parathyroid perfusion and guide preservation. Demographic and surgical data were registered with special attention to hypoparathyroidism.Results:All patients underwent standard minimally invasive video-assisted total thyroidectomy; a standardized dose of ICG was administered intravenously. Real-time near-infrared imaging allowed for clear visualization of parathyroid vascularization, enabling the preservation of well-perfused glands and the auto transplantation of those removed into the sternothyroid muscle. Postoperative assessments, including serial measurements of serum calcium and parathyroid hormone levels, revealed a transient drop in two patients with overall correspondence to indocyanine green evaluation.Conclusion:These findings suggest that ICG angiographic imaging is a valuable adjunct in thyroid surgery, potentially reducing the risk of hypocalcemia by optimizing parathyroid preservation. Further studies are needed to standardize the technique and the evaluation score to confirm preliminary results on definitive hypoparathyroidism.