Ospedale di Mirano

The Castle of Uggiano located in Ferrandina (MT),Italy, is evidently an emblematic example of fragile and inaccessible castle ruins within the landscape of the mediterranean coasts. The information of this architectural heritage appears fragmented and its ruins require early restoration actions due to its abandonment and the associated risk of disappearance. For this reason, a team of three architects, two engineers, a surveyor and an archaeologist were commissioned to carry out an executive restoration project by the Municipality of Ferrandina. This team proposes an integrated multidisciplinary methodology structured in the three main steps of data acquisition, data development and data dissemination, with the aim of identifying specific restoration project interventions and effective dissemination strategies. The systematization process of the data acquired by the archival and literature searches and UAV photogrammetry, allowed tocreate a detailed 3D digital model. This model was used to carry out remote site inspections, to develop studies of its historical building techniques and materials and toanalyse its specific structures, understanding their transformations over time, due to critical events such as landslides, earthquakes and sieges. The proposed methodology provides a dissemination strategy that develops along two parallel paths: the interactive fruition on Virtual Reality,through the use of an existing open-sourceweb platformfor tourism promotion, and the realization of innovative laboratory activities at the Elementary School to sensitize children to respect and care for the local historical heritage.

Excessive daytime sleepiness (EDS) is common in older adults and may contribute to reduced oral intake, potentially increasing the risk of dehydration, which has been linked to adverse health outcomes. We aimed to investigate whether EDS is associated with elevated plasma osmolarity (Posm) in a geriatric population. In this cross-sectional study, 1,335 adults aged ≥ 65 years attending a geriatric outpatient clinic were assessed. Participants were classified as having EDS (Epworth Sleepiness Scale ≥ 11) or non-EDS. Plasma osmolarity was estimated using a validated formula, with thresholds of > 295 mmol/L for dehydration and > 300 mmol/L for overt dehydration. Clinical, laboratory, and demographic data were collected. Associations between EDS and dehydration were analyzed using univariate and multivariate logistic regression, adjusting for age, sex, comorbidities, and medication use. EDS was present in 24% of participants. Plasma osmolarity exceeded 295 mmol/L in 56% and 300 mmol/L in 23% of participants. Patients with EDS were older and had higher prevalence of chronic kidney disease, dementia, and polypharmacy. In multivariate analysis, independent predictors of Posm > 300 mmol/L included diabetes mellitus (OR 4.41), chronic kidney disease (OR 5.32), serum sodium (OR 1.76), and EDS (OR 1.51, p = 0.027). EDS was not independently associated with Posm > 295 mmol/L. In older adults, EDS is independently associated with overt dehydration. Routine assessment of daytime sleepiness may serve as a simple, non-invasive marker to identify individuals potentially at risk, enabling timely hydration interventions and potentially improving health outcomes in aging populations.

Familiak hizkuntza-eragile garrantzizkoak dira, eta, batzuetan oharkabean bada ere, hizkuntza- politikak diseinatu eta garatzen dituzte. Adibidez, etxeko hizkuntza zein izango den, seme- alaben hezkuntza-eredua zein izango den eta aisialdian zein hizkuntzaren alde egingo den hautatzerakoan. Horrelakoak dira euren gain hartzen dituzten erabakiak, hain zuzen, hizkuntza-erabilerari zuzen-zuzenean eragiten diotenak. Familia-mailako nahiak eta helburuak, ordea, hiriko testuinguru soziolinguistikoaren menpe daude, eta horretara egokitu behar dituzte ezinbestean. Hori dela eta, artikulu honetan lekua egiten zaie hizkuntza gutxituari mesede egiten ez dioten hiri-espazioetako hizkuntzen minorizazio- eta biziberritze-prozesuei. Hitz gakoak: familiako hizkuntza-politika, euskararen transmisioa, hizkuntza-praktikak, hizkuntza- ideologiak, hizkuntza-muda, hizkuntza sozializazioa.

PurposeInclisiran is a long-acting small interfering RNA (siRNA) which prevents the synthesis of PCSK9 in hepatocytes, reducing LDL-C concentration. Only limited data are available in the literature regarding its use in real-world settings.MethodsIn this observational multicenter registry, we included high cardiovascular risk patients from 12 lipid clinics in the Veneto region of Italy who started inclisiran therapy between October 2022 and February 2024. Primary endpoint was changes in LDL-C concentrations at 3 months of follow-up after inclisiran administration. Secondary endpoints were changes in LDL-C concentrations at 9 months of follow-up, safety, percentage of patients reaching LDL-C targets and efficacy of inclisiran according to background therapy and clinical characteristics of the population.ResultsMean LDL-C levels at baseline (n = 240) were 118.7 ± 48.7 mg/dl, then they significantly fell to 56.7 ± 40.4 mg/dl (-52.3 ± 24.3%; p < 0.001) at 3 months (n = 238) and to 60.5 ± 40.1 mg/dl (-50.0 ± 22.7%; p < 0.001) at 9 months (n = 138). Three (1.3%) patients reported mild injection-site side effects. LDL-C target achievement according to ESC/EAS 2019 guidelines was 64.7% at 3 months and 62.3% at 9 months. Patients on statin therapy had a greater LDL-C reduction compared to patients with statin intolerance. At 3 months across we observed greater LDL-C reduction in patients with diabetes (59.9 ± 23.2% vs 49.7 ± 24.1%; p = 0.004). In the multivariable analysis diabetes mellitus (p = 0.006) and background statin therapy (p = 0.034) were independent predictors for greater LDL-C reduction.ConclusionThis real-world multicenter registry supports inclisiran as an effective, well-tolerated option for managing hypercholesterolemia in high cardiovascular risk patients.Graphical Key findings and basal characteristics of the population studied (LDL-C, low-density lipoprotein cholesterol; LLT, lipid-lowering therapy; CV, cardiovascular; ASCVD, atherosclerotic cardiovascular disease; DM, diabetes mellitus; FH, familial hypercholesterolemia).

Meningiomas are common primary central nervous system tumours. They generally behave like slow-growing masses and are often asymptomatic, being incidentally detected. We describe an unusual case of a small frontal meningioma en plaque with extracranial extension, presenting as a painless frontal swelling due to diploic and periosteal infiltration. Multimodal imaging with ultrasound, CT, and contrast-enhanced MRI enabled a precise diagnosis, histopathology confirmed an atypical grade 2 meningioma; a brief literature review is also provided.

Currently available antipsychotics, mainly targeting the dopaminergic pathway, fail to address the complexity of schizophrenic symptoms and can lead to burdening adverse events. The need for innovative pharmacological options remains critical and research is now focusing on the development of non-dopaminergic antipsychotics. This review aims to summarize the current literature on the most promising non-dopaminergic new APs (muscarinic agonists, Trace Amine Associated Receptor 1 agonists, Glycine Transporter Type 1 inhibitors and 5-HT2A antagonists) and provide a clinically oriented overview of their efficacy, safety and potential use in schizophrenia. A preliminary search was conducted through the Clinical Trials Database, in order to identify a representative (at late-stage clinical development) for each pharmacological class. The following drugs were selected: bitopertin (GlyT-1 inhibitor), pimavanserin (5-HT2A antagonist), ulotaront (TAAR1 agonist) and xanomeline-trospium (muscarinic agonist). Then, a literature search was conducted through PubMed, in order to retrieve current literature focusing on the efficacy and safety of these drugs. The clinical development of bitopertin and pimavanserin was halted despite the early promises. Xanomeline-trospium chloride was recently approved by the FDA for the treatment of schizophrenia. Ulotaront showed mixed results, although analysis is ongoing. The findings of our review indicate that research on the treatment of schizophrenia is gaining momentum. However, it is crucial to remain cautious about over-optimism, as many compounds have failed to deliver the expected results. A balanced approach is recommended when dealing with new APs, whether under investigation or approved. In the latter case, clinicians should carefully evaluate the cost-benefit ratio. Since several agents are still being tested, there is hope that additional data may present new therapeutic opportunities.

The optimal treatment for acute minor ischemic stroke is still undefined. and options include dual antiplatelet treatment (DAPT), intravenous thrombolysis (IVT), or their combination. We aimed to investigate benefits and risks of combining IVT and DAPT versus DAPT alone in patients with MIS. This is a prespecified propensity score-matched analysis from a prospective multicentric real-world study (READAPT [Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or Transient Ischemic Attack]). We included patients with MIS (National Institutes of Health Stroke Scale score at admission ≤5), without prestroke disability (modified Rankin scale [mRS] score ≤2). The primary outcomes were 90-day mRS score of 0 to 2 and ordinal mRS distribution. The secondary outcomes included 90-day risk of stroke and other vascular events and 24-hour early neurological improvement or deterioration (≥2-point National Institutes of Health Stroke Scale score decrease or increase from the baseline, respectively). From 1373 patients with MIS, 240 patients treated with IVT plus DAPT were matched with 427 patients treated with DAPT alone. At 90 days, IVT plus DAPT versus DAPT alone showed similar frequency of mRS 0 to 2 (risk difference, 2.3% [95% CI -2.0% to 6.7%]; P=0.295; risk ratio, 1.03 [95% CI 0.98-1.08]; P=0.312) but more favorable ordinal mRS scores distribution (odds ratio, 0.57 [95% CI 0.41-0.79]; P<0.001). Compared with patients treated with DAPT alone, those combining IVT and DAPT had higher 24-hour early neurological improvement (risk difference, 20.9% [95% CI 13.1%-28.6%]; risk ratio, 1.59 [95% CI 1.34-1.89]; both P<0.001) and lower 90-day risk of stroke and other vascular events (hazard ratio, 0.27 [95% CI 0.08-0.90]; P=0.034). There were no differences in safety outcomes. According to findings from this observational study, patients with MIS may benefit in terms of better functional outcome and lower risk of recurrent events from combining IVT and DAPT versus DAPT alone without safety concerns. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05476081.

Background. Epithelial ovarian cancer (EOC) is the deadliest gynecological malignancy worldwide. Brain metastasis (BM) is quite an uncommon presentation. However, the likelihood of central nervous system (CNS) metastasization should be considered in the context of disseminated disease. The therapeutic management of BMs is an unmet clinical need, to date. Case presentation. We identified across different Cancer Centers six cases of both BRCA wild-type and BRCA-mutated EOC spreading to the CNS. They presented either with a single brain lesion or with multiple lesions and most of them had intracranial-only disease. All cases received Poly-ADP ribose polymerase inhibitor (PARPi) maintenance, as by clinical practice, for a long time within a multimodal treatment approach. We also provide an insight into the available body of work regarding the management of this intriguing disease setting, with a glimpse of future therapeutic challenges. Conclusion. Despite the lack of unanimous guidelines, multimodal care pathways should be encouraged for optimal disease control of this unfortunate patient’s subset. Albeit not being directly investigated in BM patients, the PARPi maintenance is deemed to have a valuable role in this setting. Prospective research, aimed to implement worthwhile strategies in the multimodal patient journey of BMs from EOC, is eagerly awaited.

Randomized controlled trials (RCTs) proved the efficacy of short-term dual antiplatelet therapy (DAPT) in secondary prevention of minor ischemic stroke or high-risk transient ischemic attack (TIA). We aimed at evaluating effectiveness and safety of short-term DAPT in real-world, where treatment use is broader than in RCTs. READAPT (REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack) (NCT05476081) was an observational multicenter real-world study with a 90-day follow-up. We included patients aged 18+ receiving short-term DAPT soon after ischemic stroke or TIA. No stringent NIHSS and ABCD2 score cut-offs were applied but adherence to guidelines was recommended. Primary effectiveness outcome was stroke (ischemic or hemorrhagic) or death due to vascular causes, primary safety outcome was moderate-to-severe bleeding. Secondary outcomes were the type of ischemic and hemorrhagic events, disability, cause of death, and compliance to treatment. We included 1920 patients; 69.9% started DAPT after an ischemic stroke; only 8.9% strictly followed entry criteria or procedures of RCTs. Primary effectiveness outcome occurred in 3.9% and primary safety outcome in 0.6% of cases. In total, 3.3% cerebrovascular ischemic recurrences occurred, 0.2% intracerebral hemorrhages, and 2.7% bleedings; 0.2% of patients died due to vascular causes. Patients with NIHSS score ⩽5 and those without acute lesions at neuroimaging had significantly higher primary effectiveness outcomes than their counterparts. Additionally, DAPT start >24 h after symptom onset was associated with a lower likelihood of bleeding. In real-world, most of the patients who receive DAPT after an ischemic stroke or a TIA do not follow RCTs entry criteria and procedures. Nevertheless, short-term DAPT remains effective and safe in this population. No safety concerns are raised in patients with low-risk TIA, more severe stroke, and delayed treatment start.

Osteoporotic fractures represent a major cause of morbidity and, in older adults, a precursor of disability, loss of independence, poor quality of life and premature death. Despite the detrimental health impact, osteoporosis remains largely underdiagnosed and undertreated worldwide. Subjects at risk for osteoporosis-related fractures are identified either via organised screening or case finding. In the absence of a population-based screening policy, subjects at high risk of fragility fractures are opportunistically identified when a fracture occurs or because of other clinical risk factors (CRFs) for osteoporotic fracture and areal bone mineral density (aBMD) measured by dual-energy X-ray absorptiometry (DXA). This paper describes the development of a novel case-finding strategy, named Osteoporosis Diagnostic and Therapeutic Pathway (ODTP), which enables to identify subjects with osteoporosis or at varying risk of fragility fracture. This strategy is based on a specifically designed software tool, named "Bone Fragility Query" (BFQ), which analyses the electronic health record (EHR) databases of General Practitioners (GPs) to systematically identify individuals who should be prescribed DXA-BMD measurement, vertebral fracture assessment (VFA) and anti-osteoporosis medications (AOM). The ODTP through BFQ tool is a feasible, convenient and time-saving osteoporosis model of care for GPs during routine clinical practice. It enables GPs to shift their focus from what to do (clinical guidelines) to how to do it in the primary health care setting. It also allows a systematic approach to primary and secondary prevention of fragility fractures, thereby overcoming clinical inertia and contributing to closing the gap between evidence and practice for the management of osteoporosis in primary care.