Ospedale Infermi di Rimini

Pluvial flooding on roadways poses a significant threat to drivers. In addition, frequency of such pluvial floods is increasing due to climate change, urbanization, impervious surfaces, and aging stormwater infrastructure. While physics-based hydrodynamic models provide detailed results, their computational demand and reliance on often-uncertain drainage layouts make them impractical for rapid, real-time urban risk assessment.SaferPlaces (saferplaces.co) addresses this with a web-platform that integrates high-resolution geospatial and climate data from sources like GEE, OSM, and Copernicus to automate the construction of digital-twins for flood risk modelling in urban areas. As part of the SaferPlaces platform, Safer_RAIN, a fast-processing DEM based algorithm that combines a pixel-based Green-Ampt infiltration model with a Hierarchical Filling-and-Spilling Algorithm (HFSA) approach to enable building-level risk assessments. By leveraging cloud-based infrastructure, the platform delivers high-resolution, real-time results for urban planning. However, when compared to 2D hydrodynamic models, Safer_RAIN showed some limitations, including the underestimation of flooded extents due to the absence of hydraulic backwater effects and single flow-path constraints. Therefore, this study introduces an enhancement to Safer_RAIN, termed Kinematic Safer_RAIN, by incorporating a kinematic approach to simulate flooding beyond depressions and integrating a flow-path inundation extension feature. This enhancement utilizes the Height Above Nearest Drainage (HAND) approach, coupled with Manning’s equation, to represent flood inundation along flow paths (e.g. essential for assessing risks to urban road networks).Kinematic Safer_RAIN, featuring flow-path flood extension, was benchmarked against HEC-RAS 2D Rain-on-Grid hydrodynamic simulations using 1m-resolution LiDAR DEMs in two case studies. In the Cottonwood Lake Study Area (USA), Kinematic Safer_RAIN produced maximum flooding extents and water depth distributions that closely match HEC-RAS results. The model was further validated in Pamplona (Spain), using the extreme storm event of July 2010. Kinematic Safer_RAIN successfully identified flood-prone depressions and flooding along flow paths (primarily main roads and lanes), yielding high True Positive Rates and aligning with flood evidence from local newspaper images. This research provides a robust, low-cost, and rapid alternative for authorities to accurately predict roadway flooding risks, bridging the gap between topographic simplicity and hydrodynamic complexity to enhance flood mitigation strategies.Keywords: Flow path flood extension, Hierarchical Filling-and-Spilling Algorithm (HFSA), Height Above Nearest Drainage (HAND), Pluvial Flooding, Safer_RAIN, Kinematic_SaferRAIN, SaferPlaces

Background/Objectives: Systemic sclerosis (SSc) patients frequently develop osteoporosis; however, vertebral fracture risk factors remain poorly characterized. This study identifies general and SSc-specific predictors of vertebral fractures in SSc patients undergoing osteoporosis evaluation. Methods: This multicenter cross-sectional study enrolled consecutive SSc patients meeting ACR/EULAR 2013 criteria with suspected osteoporosis. Data included demographics, disease characteristics, bone density (DXA), and vertebral imaging. Stepwise logistic regression analyzed fracture associations (p ≤ 0.05 significant). Results: The majority of 103 enrolled patients were female and all were post-menopausal. The prevalence of osteoporosis was 52.4%, that of vertebral fractures was 38.8%, and that of osteopenia was 28.1%. General risk factor analysis identified family history of fragility fractures (OR 11.8, p = 0.008) and vertebral T-scores (OR 0.6, p = 0.049) as significant predictors. When adding SSc-specific factors, only family history (OR 13.8, p = 0.03) and gastrointestinal (GI) involvement (OR 4.8, p = 0.05) remained significant. Conclusions: Vertebral fractures in SSc patients are strongly linked to a family history of fractures. The suggestive association with GI involvement may imply a significant role for malabsorption-related metabolic impairment. Prioritizing bone density screening in SSc patients with GI symptoms may enable earlier intervention and reduce fracture risk.

Post-translational modifications of human serum albumin (HSA) have been described in patients with liver disease. This prospective cohort study aimed to characterize HSA microheterogeneity in hospitalized patients with alcohol-associated hepatitis (AH) and investigate its clinical relevance. We analyzed HSA isoforms by mass spectrometry in 49 patients with AH (at admission and day 14) and 20 healthy controls. Survival at 30, 90, and 365 days was assessed. Differences in HSA isoform abundance were compared between controls and AH patients, as well as between 90-day survivors and non-survivors. AH patients (69% male, median age 53 years) exhibited a significantly different HSA form profile compared to controls, with a lower amount of native HSA and higher oxidized forms. Native HSA negatively correlated with total HSA concentration (R = -0.47, p < 0.001). The relative amount of native HSA increased non-significantly from admission to day 14, but its estimated concentration increased significantly (8.8 vs. 12.0 g/L, p = 0.005). There were no significant differences in HSA forms between 90-day survivors and non-survivors at admission or day 14. Patients with AH exhibit extensive post-translational modifications of HSA compared to healthy individuals. While HSA forms changed during early hospitalization, they did not significantly correlate with short-term mortality in this cohort.

We report the case of a 50-year-old woman with severe palmoplantar psoriasis who developed alopecia areata (AA) 2 months after initiating treatment with tildrakizumab (100 mg subcutaneously). The patient had no personal or familial history of autoimmune disorders, and the diagnosis of AA was confirmed by clinical and trichoscopic evaluation. Tildrakizumab was discontinued, and the patient was treated with topical corticosteroids and low-dose oral methylprednisolone, achieving complete hair regrowth within 6 months. Psoriasis subsequently recurred, and treatment was successfully switched to bimekizumab, with sustained remission and no adverse events. To the best of our knowledge, published reports of new-onset alopecia areata during tildrakizumab therapy for psoriasis are lacking. The temporal correlation, lack of confounding risk factors, and resolution upon drug withdrawal suggest a causal relationship. This case expands the spectrum of paradoxical reactions (PRs) to biologic therapies and highlights the need for vigilance regarding autoimmune manifestations during interleukin (IL)-23 inhibition.

Evidence directly comparing ocrelizumab (OCR) and ofatumumab (OFA) after sphingosine-1-phosphate receptor modulators (S1PRMs) withdrawal is limited, even though this transition period carries an increased risk of disease reactivation and the two anti-CD20 agents differ in molecular properties that may influence post-S1PRM outcomes. We compared effectiveness, safety, and tolerability of OFA versus OCR in relapsing-remitting multiple sclerosis (RRMS) after S1PRM therapy. We retrospectively analyzed adult (> 18 years) patients with RRMS from 23 Italian centers who switched from S1PRMs to OCR or OFA (October 2016 to July 2024). Clinical outcomes included annualized relapse rate (ARR), cumulative relapse incidence, confirmed disability progression (CDP), progression independent of relapse activity (PIRA), confirmed disability improvement (CDI), and variation in the expanded disability status scale score (ΔEDSS) from baseline to last follow-up. Magnetic resonance imaging (MRI) outcomes included time to overall MRI activity, new/enlarging T2 lesions, and new T1 Gd-enhancing lesions. Persistence on anti-CD20 and safety were also assessed. We applied inverse probability of treatment weighting (IPTW) to balance baseline covariates, and used Cox, Andersen-Gill, and regression models, further adjusted for variables with residual imbalance, to compare outcomes. We included 225 subjects (mean age 43.3 ± 10.6 years; OCR = 131, OFA = 94), with a median follow-up of 33 months. After IPTW, groups were well balanced. Compared with OCR, OFA was associated with lower ARR (adjusted relative risk [aRR] 0.22, 95% CI 0.06-0.86, p = 0.030) and relapse hazard (adjusted hazard ratio [aHR] 0.21, 95% CI 0.05-0.83, p = 0.026). When restricting washout to ≤ 10 weeks and applying spline-based Andersen-Gill models, results remained consistent, with OFA showing a lower relapse risk than OCR across short-to-intermediate washout intervals. CDP hazard was lower (aHR 0.38, 95% CI 0.15-0.94, p = 0.038), while PIRA and CDI did not differ. ΔEDSS favored OFA (adjusted mean difference [aMD] -0.26, 95% CI -0.51 to -0.02, p = 0.046). OFA showed a lower hazard of overall MRI activity (aHR 0.41, 95% CI 0.19-0.92, p = 0.030), with similar risk for new T1 Gd+ lesions. A sensitivity analysis restricted to patients who switched to OFA or OCR during the same availability window yielded results consistent with the primary analysis. Treatment persistence was shorter on OFA, but absolute discontinuation rates were low in both groups. Severe AEs were rare and did not differ. In S1PRM-exposed RRMS, OFA was associated with reduced relapse risk, disability accumulation, EDSS worsening, and MRI activity compared with OCR, with overall good tolerability and safety.

Allomelanin is a natural class of melanin found mainly in fungi and derived from nitrogen-free precursors such as 1,8-dihydroxynaphthalene (1,8-DHN). Despite its biological relevance, allomelanin remains significantly less explored than other synthetic melanin analogs, particularly compared to polydopamine, a synthetic analog of eumelanin. In this review, we provide a comprehensive overview of current knowledge on allomelanin, summarizing the main methods used to characterize its molecular structure, morphology, and chemical functionalities. We also present its emerging applications, ranging from human health to materials science, highlighting how its optical characteristics, ability to modulate redox processes, and antioxidant properties support its growing technological interest. Finally, we describe the natural presence and biological role of allomelanin, highlighting how knowledge of its biosynthetic processes and functions in nature can guide more effective strategies for the design and optimization of new allomelanin materials.

The third stage of labour occurs between the birth of the foetus and the expulsion of the placenta. A major complication during this stage is postpartum hemorrhage, which poses a significant concern for maternal health. To mitigate this risk, active management strategies have emerged, raising concerns about the safety of physiological management following a physiological birth. Midwives play a vital role in ensuring a safe third stage of labour by minimizing medical intervention and preventing postpartum hemorrhage. This scoping review aims to map the evidence on midwifery practices that support a physiological third stage of labour. We conducted a scoping review using the Joanna Briggs Institute methodology. We retrieved articles from PUBMED, PsycINFO (via EBSCO), CINAHL (via EBSCO), LILACS, SCOPUS, ClinicalTrials.gov, Open Science Framework, ProQuest Dissertations and Theses, Cochrane Library, and JBI. The search yielded 2190 articles, with 1779 remaining after duplicates were removed. Screening identified 80 articles for review; 63 were excluded, resulting in 17 articles defining key findings. Two articles contributed to a theoretical framework for a physiological approach. Ten articles further discussed how midwives provide care during this stage to maintain normalcy. Three articles debated the safety of expectant management for low-risk women, while three studies also suggested new risk factors for postpartum hemorrhage. Midwifery care during the physiological third stage of labour must balance safety and trust in the woman's body. More research is needed to assess expectant management in home births and midwifery-led units, with a focus on individual needs and the long-term impacts of a physiological approach.